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Rational design and synthesis of novel dimeric diketoacid-containing inhibitors of HIV-1 integrase: implication for binding to two metal ions on the active site of integrase.

Discovery of diketoacid-containing compounds as HIV-1 integrase (IN) inhibitors played a major role in validating this enzyme as an important target for the development of therapeutics against HIV infection. In fact, S-1360, the first clinically used IN inhibitor containing a triazole ring as a bioisostere of a carboxylic acid moiety belongs to this class of compounds. To understand the role of divalent metal-chelating in the inhibition of IN (J. Med. Chem. 2002, 45, 5661-5670), we designed and synthesized a series of novel dimeric diketo-containing compounds with the notion that such dimeric compounds may simultaneously bind to two divalent metal ions on the active site of IN. We rationalized that the two diketo subunits separated by uniquely designed linkers can potentially chelate two metal ions that are either provided from one IN active site or two active sites juxtaposed together in a higher order tetramer. Herein, we show that all the new compounds are highly potent against purified IN with varied selectivity for strand transfer, and that some of the analogues exert potent inhibition of the cytopathic effect of HIV-1 in infected CEM cells. This study represents the first attempt to rationally target two divalent metal ions on the active site of IN and may have potential implications for the design of second generation diketoacid-containing class of inhibitors.

Binding Sites↗

Rational syntheses of cyclic hexameric porphyrin arrays for studies of self-assembling light-harvesting systems.

Two new cyclic hexameric arrays of porphyrins have been prepared in a rational, convergent manner. The porphyrins in each cyclic hexamer are joined by diphenylethyne linkers affording a wheel-like array with a diameter of approximately 35 A. One array is comprised of five zinc (Zn) porphyrins and one free base (Fb) porphyrin (cyclo-Zn(5)FbU) while the other is comprised of an alternating sequence of two Zn porphyrins and one Fb porphyrin (cyclo-Zn(2)FbZn(2)FbU). The prior synthesis employed a one-flask template-directed process and afforded alternating Zn and Fb porphyrins or all Zn porphyrins. More diverse metalation patterns are attractive for manipulating the flow of excited-state energy in the arrays. The rational synthesis of each array employed three Pd-mediated coupling reactions with four tetraarylporphyrin building blocks bearing diethynyl, diiodo, bromo/iodo, or iodo/ethynyl groups. The final ring closure yielding the cyclic hexamer was achieved by reaction of a porphyrin pentamer + porphyrin monomer or the joining of two porphyrin trimers. In the presence of a tripyridyl template, the yields of the 5 + 1 and 3 + 3 reactions ranged from 10 to 13%. The 5 + 1 reaction in the absence of the template proceeded in 3.5% yield, thereby establishing the structure-directed contribution to cyclic hexamer formation. The 3 + 3 route relied on successive ethyne + iodo/bromo coupling reactions. One template-directed route to cyclo-Zn(2)FbZn(2)FbU employed a magnesium porphyrin, affording cyclo-Zn(2)FbZn(2)MgU from which magnesium was selectively removed. The arrays exhibit absorption spectra that are nearly the sum of the spectra of the component parts, indicating weak electronic coupling. Fluorescence spectroscopy showed that the quantum yield of energy transfer in toluene at room temperature from the Zn porphyrins to the Fb porphyrin(s) was 60% in cyclo-Zn(5)FbU and 90% in cyclo-Zn(2)FbZn(2)FbU. Two dipyridyl-substituted porphyrins, a Zn tetraarylporphyrin and a Fb oxaporphyrin, have been synthesized for use as guests in the cyclic hexamers, affording self-assembled arrays for light-harvesting studies.

Journal Article↗

Rational pharmacotherapy in The Netherlands: formulary management in Dutch hospitals.

A survey regarding the management of rational pharmacotherapy was conducted among all Dutch general hospitals in 1998. The response was 99% (n = 120). The presence of a drugs and therapeutics committee and antibiotic policies in Dutch general hospitals appears independent of hospital characteristics. However, formulary agreements and treatment guidelines are less likely to be present in hospitals that employ only 1 pharmacist or those served by community pharmacies. More than half of the hospitals claim to have restrictive formulary agreements. Large hospitals, hospitals in the eastern and southern provinces and those served by hospital pharmacies more often tend to have restrictive agreements compared to small hospitals, hospitals in the northern, central, and western provinces, and those served by community pharmacies. Various methods to impose restriction and ensure formulary compliance are mentioned. It must be noted that hospitals tend to operate rather solely regarding the large number of different formularies. Surprisingly just a small majority of pharmacists evaluates formulary agreements positively as a management tool. Many drawbacks appear to be present. The results of this survey indicate that in the future Dutch hospitals will favour disease management (treatment guidelines) over drug management (formulary agreements) in the management of rational pharmacotherapy and that information technology will be used to influence clinicians' prescribing behaviour.

Anti-Bacterial Agents↗

Relationship between physicochemical and osteotropic properties of bisphosphonic derivatives: rational design for osteotropic drug delivery system (ODDS).

PURPOSE: The objective of this investigation is to develop a rational design of Osteotropic Drug Delivery System (ODDS), which we have proposed as a novel method for drug delivery to the skeleton via bisphosphonic prodrug, based on the relationship between physicochemical and pharmacokinetic properties of bisphosphonates. METHODS: The theoretical octanol/water partition coefficients (clog P) of 13 bisphosphonates were calculated by computer software, CLOGP ver. 3.05 (Daylight C.I.S., Inc. Irvine, CA) and related to pharmacokinetic or osteotropic parameters after intravenous injection into rats. On the other hand, to optimize ODDS of diclofenac (DIC-BP), the effects of doses or infusion rates on the in vivo disposition were investigated in relation to solubility product value (Ksp) of DIC-BP-calcium complex. RESULTS: Clog P had good correlations with total plasma clearance, apparent distribution volume and the fraction dose delivered to the whole skeleton after bolus injection into rats (r = -0.868 approximately -0.914). The targetability of bisphosphonates to the skeleton was linearly decreased with an increase in clog P value and the more hydrophilic bisphosphonates were suitable for ODDS in bolus administration. On the other hand, DIC-BP, a relatively lipophilic bisphosphonate, was effectively and selectively delivered to the skeleton only when administered as a slow infusion to keep plasma concentration lower than that calculated from Ksp value where DIC-BP could precipitate with calcium in the plasma circulation. CONCLUSIONS: Our results suggest the possibility of a rational design of ODDS via bisphosphonic prodrugs, after consideration of compound lipophilicity and precipitability of bisphosphonate-calcium complex.

Algorithms↗

Transient lowering of plasma vitamin B12 concentrations in Ouessant sheep fed on a potassium-rich ration.

The hypothesis tested was that a high intake of potassium (K) interferes with cobalt (Co)-vitamin B12 metabolism in ruminants. Ouessant sheep were fed either a low- (8 g K/kg dry matter) or high-K diet (43 g K/kg dry matter) with an adequate amount of Co (124 micrograms Co/kg dry matter). Plasma vitamin B12 concentrations were measured. Sheep fed a low-K diet, but containing only 70 micrograms Co/kg dry matter, served as positive controls. Feeding the low-Co ration produced a significant decrease in plasma vitamin B12 concentrations. The high- versus low-K ration induced a significant decrease in plasma vitamin B12 during the first 6 weeks, but thereafter the values in the high-K group rose to those seen in the low-K group. The mechanism by which dietary K may interact with Co-vitamin B12 metabolism in sheep is unknown.

Animal Feed↗

[Autism and metabolic disorders-a rational approach].

The causes of autism are heterogeneous and predominantly genetically determined. An exact aetiology is found in less than 10% of affected patients. The disappointment about low rates of success in identifying a definite pathology, numerous reports about the association of autism and "metabolic derangements", and rumours of "miraculous cures" after application of various drugs and dietary regimes have resulted in substantial confusion about meaningful diagnostic procedures and rational therapies for subjects with autism. The aim of this report is to give an overview about rare, genetically determined neurometabolic disorders (inborn errors of metabolism) that are evidently (e.g. Smith-Lemli-Opitz Syndrome) or allegedly (e.g. succinate semialdehyde dehydrogenase deficiency) associated with autism-specific symptoms. Affected patients usually display additional neurological symptoms. Procedures required to establish the diagnosis and eventual therapeutic consequences derived from a specific metabolic defect are presented. In addition to these well-defined neurometabolic disorders for which there are rational therapeutic strategies, hypotheses about the association of autism with "metabolic derangements" that could not be confirmed or were clearly falsified are discussed.

Adolescent↗

Rational selective exploitation and distress: employee reactions to performance-based and mobility-based reward allocations.

Prior research has demonstrated that allocators frequently distribute greater rewards to persons with high professional and geographic mobility than to persons with constrained mobility, especially among the very competent. This phenomenon has been termed rational selective exploitation. Do the recipients of such allocations actually experience this distribution rule as unjust and distressing, or is it a misnomer to refer to this phenomenon as exploitation? Two studies were conducted to explore this question. Study 1 was a laboratory experiment in which we manipulated relative performance level, relative mobility level, and allocation standard: performance based versus mobility based. Study 2 was a cross-sectional survey of actual employees in which subjects reported the degree to which performance and mobility were the basis for pay decisions at their places of employment, as well as the degree to which they perceived each standard to be fair. Both studies demonstrated that people regard mobility-based allocations as less fair and more distressing than performance-based allocations. Furthermore, the degree of distress resulting from mobility-based allocations is greater among persons who are disadvantaged by that standard: among people with constrained mobility, especially those who perform at high levels. These findings provide good support for the assertion that so-called rational selective exploitation is indeed distressing to employees. Reactions to this form of distress are also explored, and the implications of these findings for the allocation process are discussed.

Adaptation, Psychological↗

Individual differences in intuitive-experiential and analytical-rational thinking styles.

Two studies provide evidence for the reliability and validity of a new self-report measure of individual differences in intuitive-experiential and analytical-rational thinking based on cognitive-experiential self-theory (CEST). The Rational-Experiential Inventory (REI) was constructed to measure the 2 independent processing modes with a modified Need for Cognition Scale (NFC, J.T. Cacioppo & R.E. Petty, 1982) and a new scale, Faith in Intuition (FI). In Study 1, a factor analysis yielded 2 orthogonal factors corresponding to NFC and FI. Although heuristic processing was determined primarily by FI, NFC also contributed to heuristic responding, in line with CEST. The relation of FI and NFC to coping ability also was examined. In Study 2, the factor structure of the REI was replicated (N = 973). NFC and FI were differentially related to measures of personality, adjustment, achievement, and interpersonal relations.

Cognition↗

Item selection counts: a comparison of empirical key and rational scale validities in theory-based and non-theory-based item pools.

Little explicit attention has been given to the impact of item pools on the validities and cross-validities of different background data scoring approaches. This study tests the idea that pools of items theoretically related to the performance of interest will outperform pools of items with no hypothesized relationship with the criterion. Validities and cross-validities of rational scales and empirical keys created from theory- and non-theory-based item pools were compared for 3 criteria. When size of the item pools was held constant, theory-based empirical keys (correlational and vertical percent) and rational scales showed larger validities and cross-validities than non-theory-based empirical keys (correlational and vertical percent) and showed minimal shrinkage in cross-validities. Even when item pool for the non-theory-based keys was expanded to include all items in the instrument, the theory-based keys showed comparable or slightly better validities and cross-validities for 2 of the 3 criteria, including college GPA, which was separated from the predictors by 4 years.

Cross-Sectional Studies↗

Rational design of a GCN4-derived mimetic of interleukin-4.

In this work we describe the rational design of two helix coiled coil peptide mimetics of interleukin-4 (IL-4) which are able to recognize and bind its high affinity receptor (IL-4R alpha). We have used the leucine-zipper domain of the yeast transcription factor GCN4 as a scaffold into which the putative binding epitope of IL-4 for IL-4R alpha was transferred in a stepwise manner, using computer-aided molecular modeling. The resulting molecules bind IL-4R alpha with affinities ranging from 2 mM to 5 microM, depending on the fraction of the IL-4 binding site incorporated and on their stability. To our knowledge this is the first time a molecule capable of binding a cytokine receptor has been successfully designed in a rational manner.

Amino Acid Sequence↗

Synthesis, structure and activity of artificial, rationally designed catalytic polypeptides.

Biological macromolecules with catalytic activity can be created artificially using two approaches. The first exploits a system that selects a few catalytically active biomolecules from a large pool of randomly generated (and largely inactive) molecules. Catalytic antibodies and many catalytic RNA molecules are obtained in this way. The second involves rational design of a biomolecule that folds in solution to present to the substrate an array of catalytic functional groups. Here we report the synthesis of rationally designed polypeptides that catalyse the decarboxylation of oxaloacetate via an imine intermediate. We determine the secondary structures of the polypeptides by two-dimensional NMR spectroscopy. We are able to trap and identify intermediates in the catalytic cycle, and to explore the kinetics in detail. The formation of the imine by our artificial oxaloacetate decarboxylases is three to four orders of magnitude faster than can be achieved with simple amine catalysts: this performance rivals that of typical catalytic antibodies.

Amines↗

Rational design of aromatic polyketide natural products by recombinant assembly of enzymatic subunits.

Recent advances in understanding of bacterial aromatic polyketide biosynthesis allow the development of a set of design rules for the rational manipulation of chain synthesis, reduction of keto groups and early cyclization steps by genetic engineering. The concept of rational design is illustrated by the preparation of Streptomyces strains that produce two new polyketides by expression of combinations of appropriate enzymatic subunits from naturally occurring polyketide synthases. The potential for generating molecular diversity within this class of molecules by genetic engineering is enormous.

Genetic Engineering↗

Computer-assisted rational design of immunosuppressive compounds.

We describe the rational design of immunosuppressive peptides without relying on information regarding their receptors or mechanisms of action. The design strategy uses a variety of topological and shape descriptors in combination with an analysis of molecular dynamics trajectories for the identification of potential drug candidates. This strategy was applied to the development of immunosuppressive peptides with enhanced potency. The lead compounds were peptides, derived from the heavy chain of HLA class I, that modulate immune responses in vitro and in vivo. In particular, a peptide derived from HLA-B2702, amino acids 75-84 (2702.75-84) prolonged skin and heart allograft survival in mice. The biological activity of the rationally designed peptides was tested in a heterotopic mouse heart allograft model. The molecule predicted to be most potent displayed an immunosuppressive activity approximately 100 times higher than the lead compound.

Animals↗

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs.

The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and cost-effectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A cross-sectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61 +/- 12 years (55% females), with a duration of treatment on a particular drug class or combination of 9 +/- 3 months. The initial blood pressure was 176 +/- 20/108 +/- 11 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), P < 0.0001, and ACE-inhibitors (ACEIs) (24%), P < 0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (P < 0.01) compared to the previous study. The fall in systolic blood pressure on D (r = 0.65, P < 0.001) or CCB (r = 0.48, P < 0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BP < 140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs + D or methyldopa+thiazides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (P < 0.01) equally by all treatments, with 95% confidence intervals ranging from -28 to -1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n = 33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar (dollar) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI + D and 13.6 for methyldopa + thiazides. A combination of ACEI + CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BP < 130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and cost-effective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.

Adrenergic beta-Antagonists↗

Impact of a short postgraduate course in rational pharmacotherapy for general practitioners.

AIMS: The impact of a short postgraduate course on rational pharmacotherapy planning behaviour of general practitioners (GP) was investigated via a face-to-face interview with 25 GPs working at health centres in Istanbul. METHODS: GPs were randomly allocated to control and intervention groups. Intervention group attended a 3-day-training program preceded and followed by a written exam to plan treatment for simulated cases with a selected indication. The participants' therapeutic competence was also tested at the post-test for an unexposed indication to show the transfer effect of the course. In addition, patients treated by these GP's were interviewed and the prescriptions were analysed regarding rational use of drugs (RUD) principles at the baseline, 2 weeks and 4 months after the course. RESULTS: At the baseline there was not any significant difference between the control and intervention groups in terms of irrational prescribing habits. The questionnaires revealed that the GPs were not applying RUD rules in making their treatment plans and they were not educating their patients efficiently. Training produced a significant improvement in prescribing habits of the intervention group, which was preserved for 4 months after the course. However, very low scores of the pretest indicate the urgent necessity for solutions. CONCLUSIONS: Training medical doctors on RUD not only at the under- but also at the postgraduate level deserves attention and should be considered by all sides of the problem including academia, health authorities and medical associations.

Adult↗

Intuition and rational decision-making in professional thinking: a false dichotomy?

A number of researchers have sought to understand what enables the 'expert' professional to achieve a rapid and effortless understanding of presenting situations. Central to many of the explanations offered is the term 'intuition'. It might be thought, therefore, that the word describes a coherent concept embracing certain related features and used with consistency. A study of the literature suggests that this is not so. 'Intuition' is more than a contested concept, it is also used in ways that lack both clarity and coherence. Some of the confusion associated with the concept seems to stem from the belief that intuition is an irrational process. As a consequence, it is assumed that intuition can be neither fully understood nor explained. In this paper we discuss a number of issues relating to the nature of 'intuition'. We argue that intuition may be understood as an irrational process that has a rational basis. Intuitive thinking has certain essential features and involves the use of a sound, rational, relevant knowledge base in situations that, through experience, are so familiar that the person has learned how to recognize and act on appropriate patterns.

Awareness↗

Comparison of a rational and an empirical standard setting procedure for an OSCE. Objective structured clinical examinations.

PURPOSE: Earlier studies of absolute standard setting procedures for objective structured clinical examinations (OSCEs) show inconsistent results. This study compared a rational and an empirical standard setting procedure. Reliability and credibility were examined first. The impact of a reality check was then established. METHODS: The OSCE included 16 stations and was taken by trainees in their final year of postgraduate training in general practice and experienced general practitioners. A modified Angoff (independent judgements, no group discussion) with and without a reality check was used as a rational procedure. A method related to the borderline group procedure, the borderline regression (BR) method, was used as an empirical procedure. Reliability was assessed using generalisability theory. Credibility was assessed by comparing pass rates and by relating the passing scores to test difficulty. RESULTS: The passing scores were 73.4% for the Angoff procedure without reality check (Angoff I), 66.0% for the Angoff procedure with reality check (Angoff II) and 57.6% for the BR method. The reliabilities (expressed as root mean square errors) were 2.1% for Angoffs I and II, and 0.6% for the BR method. The pass rates of the trainees and GPs were 19% and 9% for Angoff I, 66% and 46% for Angoff II, and 95% and 80% for the BR method, respectively. The correlation between test difficulty and passing score was 0.69 for Angoff I, 0.88 for Angoff II and 0.86 for the BR method. CONCLUSION: The BR method provides a more credible and reliable standard for an OSCE than a modified Angoff procedure. A reality check improves the credibility of the Angoff procedure but does not improve its reliability.

Clinical Competence↗

Rational choice(s)? Rethinking decision-making on breast cancer risk and screening mammography.

Women who refrain from undergoing breast cancer screening are believed to be uninformed about risks and usually labeled as irrational. Our purpose in writing this paper is to challenge the traditional notion of rational behaviour, illustrating with qualitative data that people's rationality is influenced by their socio-cultural and political identities. We explore three major themes: (1) cultural explanations regarding intention to use screening mammography (2) (dis)trust in science and expert opinion, and (3) self-responsibility and self-surveillance in caring for one's body. Understanding that women rely on different risk discourses to make decisions about their health should aide researchers, health professionals, and the community in better understanding alternative ways of conceptualizing people's health-related behaviours when they do not coincide with health authorities recommendations.

Adult↗