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Biomedical subjects

R C Li

Publications and source records attributed to R C Li.

At least 73 records · Page 4Linked to original sources

A phase I evaluation of concomitant rifabutin and didanosine in symptomatic HIV-infected patients.

It has been suggested that didanosine (ddI) may undergo hepatic metabolism. Rifabutin is an inducer of drug metabolism. Fifteen human immunodeficiency virus-infected patients whose conditions were stabilized on twice-daily doses of ddI participated in a Phase I, open-label, pharmacokinetic and safety drug interaction study between rifabutin and ddI. Twelve patients completed the study. All patients received their regular ddI dose (167-375 mg) on day 1. On days 2-13 they received once-daily rifabutin (600 mg, three patients; 300 mg, nine patients) with their regular twice-daily ddI regimen. On days 14-16 they received rifabutin alone. Serial blood and urine samples were collected for 12 h on day 1 and for 24 h on days 13 and 16, and safety evaluations were made throughout the study. Average day 1/day 13 ddI pharmacokinetic ratios and 95% confidence interval values for Cmax, AUC0-infinity, Cls/F, and t 1/2, lambda z were 1.17 (0.96-1.38), 1.13 (0.99-1.27), 0.91 (0.81-1.01), and 0.97 (0.79-1.15), respectively (p > 0.05 for all comparisons; paired t test). A 20% difference in AUC0-infinity could be detected with 90% power. Also, there were no significant changes in laboratory values or electrocardiograms, or in rifabutin pharmacokinetic parameters when the two agents were coadministered. Based on the safety and pharmacokinetic assessments, rifabutin did not appear to interact with ddI.

Adult↗

Pharmacodynamic modeling of bacterial kinetics: beta-lactam antibiotics against Escherichia coli.

A simple pharmacodynamic model has been developed to describe the bacterial kinetics exhibited by beta-lactam antibiotics. In contrast with previous models that only characterized the early killing phase of a time-kill curve, the present model is capable of simultaneously describing both the killing and regrowth phases. The model relied on the use of both first-order bactericidal and resistance formation rate constants to accurately define the time-dependent changes in the bacterial populations of an antibiotic-treated culture. The concentration dependency of the bactericidal rate constant was further delineated using a saturable-receptor model. Furthermore, an exponential decrease in the resistance formation rate with increasing antibiotic concentrations was demonstrated. The evolving pharmacodynamic model was also explored via computer simulations by perturbing the two governing rate constants. The model was subsequently applied to the description of time-kill data for amoxicillin, penicillin G, and cephalexin against Escherichia coli. The description of amdinocillin's action against E. coli was not as comprehensive because of the existence of a second killing phase. However, this model can be applicable to many classes of antibiotics that display the usual killing and regrowth phases in time-kill studies. The pharmacodynamic model can potentially improve the prediction of bacterial killing and regrowth and foster an improved understanding of complex antimicrobial pharmacodynamics.

Amoxicillin↗

Cardiorespiratory fitness and isokinetic muscle strength of elite Asian junior soccer players.

There is a scarcity of descriptive data on the physiological characteristics of elite Asian junior soccer players. The purpose of this study was to evaluate the cardiorespiratory fitness and isokinetic muscle strength of elite junior soccer players in Hong Kong. It was conducted in conjunction with the selection of the Hong Kong team to the 1989 Gothia Cup held in Sweden. Twenty-one top junior soccer players were selected as subjects for the study. The following means (+/- SD) were observed: age 17.3 +/- 1.1 years; height 172.5 +/- 6.2 cm; weight 62.8 +/- 7.0 kg; body fat 5.2 +/- 1.8%; forced vital capacity (FVC) 4.6 +/- 0.6 L; maximum oxygen uptake (VO2max) 58.6 +/- 2.9 ml.kg-1.min-1; anaerobic threshold (AT) 76.7 +/- 10.2% of VO2max; peak isokinetic dominant knee extensor and flexor strengths 3.28 +/- 0.37 Nm.kg-1 and 1.84 +/- 0.24 Nm.kg-1; hamstring to quadriceps peak torque ratio (H/Q) 56 +/- 0.6% measured at 60 degrees s-1. Hong Kong players appeared to have comparable aerobic power, light body weight, poor flexibility and above average isokinetic muscle strength compared to other international junior soccer players. Training programs to improve the contralateral knee muscle imbalance and to increase the fast speed movement capability of the non-dominant knee flexors are recommended.

Adipose Tissue↗

Concentration-dependent protein binding of a novel oral thromboxane synthase inhibitor--FCE 22,178.

The protein binding of FCE 22,178 in humans was determined ex vivo by equilibrium dialysis using plasma samples obtained from a dose-ranging study in normal male volunteers. These data suggested that FCE 22,178 may exhibit concentration-dependent protein binding over an in vivo concentration range of .8 to 64 micrograms/mL. Increase in free fraction at higher plasma drug concentrations corresponded directly to the dose-dependent increase in renal drug clearance. Nonlinear parameter estimation showed that FCE 22,178 binds tightly to plasma proteins with an apparent equilibrium association constant of 1.44 x 10(5) mol/L. Predicted change in the free fraction is consistent with the observed changes in renal clearance.

Blood Proteins↗

A phase I dose-ranging safety and pharmacokinetics study of a novel oral thromboxane synthase inhibitor, FCE 22, 178.

A 100- to 3200-mg dose range of FCE 22,178 was studied in this phase I single-dose escalation safety/kinetics study. After oral administration, a rapid drug absorptive phase and a biexponential disposition profile were observed. Mean estimates of the terminal elimination half-life of FCE 22,178, over the doses studied, ranged from 7.6 to 14.4 hours. A disproportionate increase in both maximum peak plasma concentration (Cmax) and area under the curve (AUC0-infinity) was noticed for doses higher than 400 mg. Mean estimates of systemic clearance (CLs/F) over the 100- to 400-mg doses were 0.053 to 0.064 L/hour/kg, and were significantly higher for the three higher dose levels. This nonlinearity appears to be related to the changes in oral bioavailability. Estimates of distribution volume (Vd, lambda z/F) for FCE 22,178 increased from 0.75 L/kg at the 100-mg dose to 3.00 L/kg at the 3200-mg dose, and renal clearance (CLr) also increased with dose. Both observations may be related to an increase in free fraction of FCE 22,178 at higher doses. Urinary excretion of unchanged drug averaged < 10% for all dose levels. The urinary excretion of the glucuronide metabolite (M1) averaged 41 to 70% for doses up to 400 mg, but diminished to 13% at the 3200-mg dose. The disposition of M1 appeared to be formation-rate limited. In addition, the ratio of the formation to the disposition clearance for M1 was relatively stable and apparently dose independent. No drug-related adverse experiences were observed over the studied dose range after single doses at FCE 22,178.

Administration, Oral↗

New turbidimetric assay for quantitation of viable bacterial densities.

A turbidimetric assay was developed and validated against Escherichia coli for the quantitation of viable bacterial densities. The Abbott MS-2 research system was employed for continuous 5-min measurements of optical density. A linear standard curve was obtained by regressing the initial bacterial density (log CFU per milliliter) against the time required for bacterial growth causing a 5% decrease in optical transmittance. Slope and intercept values obtained from eight standard curves showed excellent assay reproducibility. Results obtained by the turbidimetric assay compared favorably to those obtained by the conventional pour plate assay. Prior to the application of the new assay, possible interferences of postantibiotic effect induced by the test antibiotics were excluded. The turbidimetric assay, which is presumably more efficient and less expensive, was implemented for the time-kill studies of three different beta-lactams against E. coli.

Anti-Bacterial Agents↗

The fractional maximal effect method: a new way to characterize the effect of antibiotic combinations and other nonlinear pharmacodynamic interactions.

The checkerboard technique leading to the fractional inhibitory concentration indexes and the killing curve method are currently the most widely used methods to study antibiotic combinations. For both methods, experimental conditions and interpretation criteria are somewhat arbitrary. The relevance of the fractional inhibitory concentration index computation, in the classic case of additivity [P = d1/(D1)p + d2/(D2)p, where d1 and d2 are the doses of drugs 1 and 2 in combination to produce an effect at a percent level (P) and (D1)p and (D2)p are the doses required for the two respective drugs alone to produce the same effect] relies on the assumption of a linear relationship between the MIC and the concentration of the test antibiotics. In addition, there is no consensus as to the definition of synergy in killing curve interpretation. The fractional maximal effect (FME) method is a new approach which was developed to handle the nonlinear pharmacodynamics exhibited by antibiotics and other drugs. This method relies on the mathematical linearization of the nonlinear concentration-effect scales and eventual construction of an isobologram-type data plot. The FME method was applied to study interactions between several antibiotic combinations: amoxicillin and tetracycline, ciprofloxacin and erythromycin, and ticarcillin and tobramycin. These combinations were selected because the pharmacologic basis for their interactions has been previously described. The FME method correctly identified antagonism for the first two combinations and synergism for the last combination. Conclusions were reproducible across the range of concentrations studied. Besides providing information on the nature of the interaction, the method can rapidly explore the effect of changing concentration ratios of two antimicrobial agents on the degrees of interaction. The FME method may be applied to interactions between drugs or agents with either a linear or nonlinear endpoint measurement. Methods frequently used for drug combination testing are also discussed in the paper.

Amoxicillin↗

Kinetic studies of mobilization of copper(II) from human serum albumin with chelating agents.

The kinetics of the mobilizing reactions of five chelating agents for human serum albumin (HSA)-bound copper(II) [Cu(II)] have been studied spectrophotometrically. The decreasing sequence of reaction rate has been determined to be EDTA greater than DTPA greater than EGTA greater than NTA greater than IDA. A group of mathematical models were established to define the mechanisms of the competitive reactions between low-molecular-weight ligand and macromolecular ligand. All reactions of the five chelating agents follow a process involving the intermediate ternary complexes: (formula; see text) The reactions of DTPA and EDTA were found to be different from those of EGTA, NTA, and IDA. In the former cases, the reactions are likely following an overlapping mechanism in which the rate constant k1 was closed to k2. The reactions involving the other three chelators are different in k1 much greater than k2.

Chelating Agents↗

Effects of route of administration and repetitive dosing on the disposition kinetics of di(2-ethylhexyl) phthalate and its mono-de-esterified metabolite in rats.

The disposition kinetics of the plasticizer di(2-ethylhexyl) phthalate (DEHP) and its biologically active metabolite mono(2-ethylhexyl) phthalate (MEHP) were studied in rats following single or multiple administration of DEHP by various routes. Following a single intraarterial (ia) injection, a large apparent volume of distribution (5390 ml/kg) and a high rate of clearance (21.5 ml/min/kg) were observed for DEHP. The systemic availability of DEHP was low following both single po (13.6%) and ip (5.2%) administration. A marked route-dependency in the formation of MEHP from DEHP was observed. The circulating concentrations of MEHP were substantially higher than those of DEHP (i.e., area under the blood concentration-time curve (AUC) ratio of approximately 7) after po administration, whereas concentrations of the mono-de-esterified metabolite were much lower relative to the parent diester concentration after ia or ip administration (i.e., AUC ratio less than 0.4). Pharmacokinetic calculations revealed that approximately 80% of a po dose of DEHP undergoes mono-de-esterification, as compared to only about 1% of the dose following either ia or ip administration. Hence, the low po systemic availability of DEHP may be largely attributed to presystemic hydrolysis of DEHP to MEHP in the gut, whereas slow and/or incomplete absorption is the likely cause of the poor bioavailability of DEHP after ip administration. No significant accumulation in the circulating concentrations of DEHP or derived MEHP were observed following 7 days of repetitive administration of DEHP. However, multiple ip injections resulted in an apparent decrease in the rate and/or extent of DEHP absorption from the peritoneal cavity, while no significant change in the po absorption of the diester was observed. The striking difference in the MEHP to DEHP AUC ratio between po and ip routes was still evident after multiple dosing. These data suggest that previously reported differences in the biologic effects of DEHP in rodents following different routes of administration may be due to route dependency in the mono-de-esterification of the diester.

Administration, Oral↗

Dose-dependent pharmacokinetics of antipyrine in the rat.

In rats given a single intravenous dose, the disposition of antipyrine was dose-dependent and followed apparent first-order kinetics only at the lowest (20 mg/kg) dose administered. The initial rate of disposition decreased with increasing dose, indicating apparent saturation of antipyrine metabolism. The observed nonlinearity was unusual in that the terminal elimination rate increased significantly with increasing dose, suggesting that autoinduction of metabolism may occur after a single exposure to antipyrine. The potential implications of dose-dependent antipyrine pharmacokinetics for the use of antipyrine as a model substrate in the estimation of hepatic microsomal oxidative enzyme activity are discussed.

Animals↗

Induction of hepatic and presystemic metabolism of antipyrine in the mice: rifampicin versus rifabutin.

The effects of hepatic and presystemic enzyme induction on the bioavailability (F) and disposition of antipyrine after repeated rifampicin (RFM) and rifabutin (RBT) exposure were studied in mice. ICR mice were divided to receive 4 daily oral dosing of either the dosing vehicle or 50 mg/kg of REM or RBT. At the completion of rifamycin dosing, the pharmacokinetics of antipyrine were assessed following either a single 50 mg/kg oral dose or a 20 mg/kg intravenous dose. Blood samples were collected (n=4/timepoint) over a 6 h period. The content of P450 in the liver and small intestine (GI) was also assessed in parallel. Systemic antipyrine clearance (CL) increased from 31.8 ml/min/kg (controls) by 64% and 42% following repeated exposure to RFM and RBT, respectively. Estimate of F for antipyrine decreased from 0.97 in controls to 0.58 and 0.82 in animals treated with RFM and RBT, respectively. The content of P450 (nmol/mg protein) in the liver increased from 0.61 (control) to 1.36 following RFM and 0.82 for RBT, while no significant changes were observed for the GI tract. The i.v. dosing data confirmed the induction of antipyrine metabolism in the liver by both rifamycins yet the induction potential was approximately 1/3 lower for RBT. This difference was consistent with the changes observed in the hepatic P450 protein content, but this alone could not account for the reduction in the F for antipyrine. Therefore, predictions for changes in F of an interacting agent should not be judged solely on the basis of the metabolic status of the liver. The relative contribution of metabolic induction and presystemic drug loss to bioavailability/absorption should also be further delineated for its relevance to poly-pharmacy in patients likely to receive long-term rifamycin based treatment.

Administration, Oral↗

Mathematical evaluation of the influence of adverse effect on therapeutic efficacy in a direct response system: a case of pharmacodynamic variability of adverse effect.

Two major concerns in therapeutics are the efficacy (E) and adverse effects (Ae) exhibited by a pharmacological agent. Although these elements are studied routinely in both animals and humans during the drug development processes, the data are usually considered independently and in different contexts. Since E and Ae are different yet inseparable components in drug therapy, E should not be used as the sole descriptor for drug responses. To accommodate the influence of Ae on E, the present approach requires the observed Ae data to be transformed to the equivalencies of E data (Ae'). Using appropriate pharmacokinetic modeling techniques, this approach permits the prediction of the adjusted therapeutic effect (ATE) (i.e. , E minus Ae') as a function of time. Effects of pharmacodynamic variability of Ae due to variations in Hill's parameters (i.e., Ae (max), AeC (50), and n (Ae) ) on ATE were studied by computer simulations for a hypothetical one-compartment model drug that displays simple first-order absorption and elimination with central sites for E and Ae. An increase in Ae' (max) and a decrease in AeC (50) and n (Ae) cause a downward shift and peak inversion on the ATE versus time curves coupling with a longer duration of influence of Ae on E. Results also showed that the downward shift of these curves was more apparent with decreasing n (Ae) values and that peak inversion became less noticeable for n (Ae) values <1.5. Subsequent analyses established the optimal dose for the hypothetical drug studied. This approach allows a more comprehensive description of the time course of the overall drug responses and is potentially useful for therapeutic drug monitoring and dose selection during the drug development process.

Algorithms↗