伊立替康原料药中有关物质的合成

目的合成伊立替康原料药中的两种有关物质。方法 7-乙基-N-氧化喜树碱以喜树碱为起始原料经自由基乙基化反应、N-氧化反应制得;10-(4-哌啶基哌啶)甲酰氧基喜树碱以10-羟基喜树碱为起始原料与4-硝基苯基甲酰氯酯发生酯化反应,再与4-哌啶基哌啶发生胺解反应制得。结果与结论合成了伊立替康原料药质量标准中提及的两种有关物质,其化学结构经1H-NMR、质谱确证,质量分数经HPLC检测在99%以上,可作为伊立替康原料药质量控制的对照品。     

高效液相色谱法测定盐酸伊立替康注射液的含量

目的建立测定盐酸伊立替康注射液中盐酸伊立替康含量的高效液相色谱法。方法采用Agilent HC-C_（18）柱（250 mm×4.6 mm,5μm）,以磷酸盐缓冲液（称取无水磷酸二氢钠2.43 g和辛烷磺酸钠1.66 g,溶于1 000 mL水中）-甲醇-乙腈（57：25：18）为流动相,柱温为40℃,流速为1.5 mL/min,检测波长为255 nm。结果盐酸伊立替康质量浓度在0.1831~1.464 7 g/L范围内与峰面积呈良好线性关系（r=0.9994,n=7）,平均回收率为100.33%,RSD=0.46%（n=9）。结论该法准确、简便、重复性好,可用于盐酸伊立替康注射液的含量测定。     

不同剂量伊立替康二线治疗小细胞肺癌的临床研究

目的比较不同剂量伊立替康联合顺铂（DDP）方案二线治疗小细胞肺癌（SCLC）的近期疗效、无进展生存期及不良反应。方法 80例SCLC患者,随机分为低剂量伊立替康组（40例）和高剂量伊立替康组（40例）,分别接受低剂量伊立替康和高剂量伊立替康方案化疗。要研究终点为无进展生存期（progression-free survival,PFS）,客观反应率（response rate,RR）和不良反应。结果低剂量伊立替康组RR52.5%,中位PFS为6.2个月;高剂量伊立替康组RR 60.0%,中位PFS为5.5个月,两组PFS比较差异无统计学意义（P〉0.05）。两组主要不良反应均为骨髓抑制和腹泻,比较差异有统计学意义（P〈0.05）。结论低剂量伊立替康与高剂量伊立替康二线治疗SCLC客观疗效及PFS相当,但骨髓抑制及腹泻明显低于高剂量组。     

盐酸拓扑替康的合成及其表征

目的改进盐酸拓扑替康的合成方法.方法以天然产物喜树碱为原料,经氢化还原、氧化制得中间体10-羟基喜树碱,再与双(二甲氨基)甲烷反应制备盐酸拓扑替康.结果与结论合成了盐酸拓扑替康,并经元素分析、红外光谱、核磁共振谱、质谱等确证了结构.     

1例伊立替康致迟发性腹泻的病例分析

摘 要 目的： 探讨1例伊立替康导致的迟发性腹泻。方法: 分析导致患者发生迟发性腹泻的原因,机制,遗传因素和治疗。结果: 迟发性腹泻是伊立替康的剂量限制性毒性,与其代谢产物7-乙基-10-羟基喜树碱（SN-38）的细胞毒性有关。基因多态性是伊立替康相关迟发性腹泻的重要因素之一。该患者腹泻的治疗方案安全有效,临床药师在治疗过程中发挥了重要作用。结论:加强伊立替康用药患者的药学监护十分重要。     

HPLC法测定盐酸伊立替康脂质体注射液中的溶血卵磷脂

目的采用HPLC法测定盐酸伊立替康脂质体注射液中的溶血卵磷脂的含量。方法色谱柱采用C8柱;流动相为甲醇-0.1mol·L^-1醋酸铵溶液（85∶15）;柱温30℃,示差折光检测器。结果溶血卵磷脂浓度为0.1216～0.2838mg·mL^-1与峰面积线性关系良好（r=0.9992）。结论方法简便,结果准确,盐酸伊立替康与溶血卵磷脂达到很好分离,适用于对盐酸伊立替康脂质体注射液中的溶血卵磷脂的质量控制。     

高效液相色谱法测定血中伊立替康及活性代谢物SN-38浓度

目的：建立高效液相色谱法同时测定结直肠癌患者血中的伊立替康（CPT-11）及其活性代谢物7-乙基-10-羟基喜树碱（SN-38）的浓度,并对我院基因型指导给药方案进行评价。方法：以2μg·mL-110-羟基喜树碱作为内标,先用100μL 10%高氯酸沉淀蛋白,再用50μL 10%高氯酸酸化血浆。采用Agilent ZORBAX Eclipse C8色谱柱（4.6 mm×150 mm,5μm）对CPT-11和SN-38进行分离;以0.05 mol·L-1的磷酸二氢钠-乙腈-三乙胺（75∶25∶0.1,v∶v,磷酸调pH 3.0）为流动相;荧光检测波长：激发波长380 nm,发射波长550 nm。结果：人血浆中CPT-11和SN-38线性范围均为3~1000 ng·mL-1,定量下限为3 ng·mL-1;准确度分别是98.5%和100.0%;回收率分别是83.8%和84.3%。结论：本方法可靠、简便、快速,可为伊立替康个体化给药提供参考。     

三种喜树碱类衍生物分别联合卡铂治疗晚期非小细胞肺癌近期疗效观察

目的观察卡铂分别联合伊立替康、拓扑替康、羟基喜树碱，治疗经一线方案治疗失败的晚期非小细胞肺癌的近期疗效和毒副反应。方法86例晚期复发性非小细胞肺癌患者随机分为3组，A组（29例）给予卡铂350mg／m^2d1＋伊立替康60mg／m^2d1、8、15，每4周重复1次；B组（29例）给予卡铂350mg／m^2d1＋拓扑替康1mg／m^2d1～5，每3周重复1次；C组（28例）给予卡铂350mg／m^2d1＋羟基喜树碱10mg／m^2d1～5，每3周重复1次。结果伊立替康方案组有效率为28．00％、拓扑替康方案组有效率为26．92％，羟基喜树碱方案有效率为28．57％。三组不良反应主要是骨髓抑制、胃肠道反应等，伊立替康组独有延迟性腹泻。结论卡铂分别联合伊立替康、拓扑替康、羟基喜树碱三种喜树碱类衍生物治疗经一线方案治疗失败的非小细胞肺癌的近期疗效相似，但不良反应有所不同，伊立替康独有延迟性腹泻，有待进一步临床上应用观察。     

盐酸伊立替康联合顺铂在老年宫颈癌患者中治疗效果观察

目的：探讨盐酸伊立替康联合顺铂在老年宫颈癌患者中治疗效果。方法选取2013年4月~2015年11月我院收治老年宫颈癌患者84例为研究对象,采用随机分组表将患者分为研究组和对照组,对照组采用盐酸伊立替康治疗,研究组采用盐酸伊立替康联合顺铂治疗,比较两组患者疗效及药物不良反应发生率。结果研究组患者治疗有效率（95.24%）显著高于对照组（78.57%）,比较有统计学意义（P<0.05）。两组患者白细胞减少、恶性呕吐、贫血、腹泻及乏力药物不良反应发生率比较无统计学意义（ P>0.05）。结果盐酸伊立替康联合铂顺在老年宫颈癌患者中治疗可提高患者治疗效果,并不增加药物不良反应,具有较为显著疗效和较高用药安全性。     

HPLC法测定盐酸伊立替康注射液的含量和有关物质

目的：建立盐酸伊立替康注射液含量及有关物质测定的方法。方法：采用高效液相色谱法,色谱柱为Hypersile Luna（2）C18,流动相为水溶液（含0.02mol/L磷酸二氢钠和0.008mol/L辛烷磺酸钠）-乙腈-甲醇（59∶17∶24,V/V/V）,流速为1.5ml/min,检测波长为255nm,柱温为40℃。结果：盐酸伊立替康检测质量浓度线性范围为98.5～985.0μg/m（lr=0.99997）,检测限为1.2ng;高、中、低3种浓度水平的平均回收率分别为99.4%、99.8%、99.6%（n=3）,RSD分别为0.12%、0.10%、0.15%（n=3）。结论：建立的方法准确,适用于盐酸伊立替康制剂的质量控制。     

Antiplatelet effects of KW-7, a new inhibitor of cyclic nucleotide phosphodiesterases

The antiplatelet effect of a new synthetic compound, 8,9-dimethoxyl-1-(4-methoxy-phenyl)-5,6-dihydro-pyrrolo[2,1-a]isoquinoline-2,3-dione (KW-7), was determined in rabbit platelets. KW-7 concentration-dependently prevented platelet aggregation caused by arachidonic acid, collagen, platelet-activating factor, and thrombin. KW-7 induced a substantial increase in cyclic AMP levels and a smaller increase in cyclic GMP levels in platelets. In platelet homogenates, KW-7 inhibited both cyclic AMP- and cyclic GMP-phosphodiesterase activities. The antiplatelet effect of KW-7 was reversed by SQ22536 (an inhibitor of adenylate cyclase) and H89 (an inhibitor of protein kinase A) but not by ODQ (an inhibitor of soluble guanylate cyclase). These data suggest that the antiplatelet effect of KW-7 is cyclic AMP-dependent, and is through inhibition of platelet phosphodiesterases. In addition, KW-7 inhibited arachidonic acid-stimulated thromboxane production; this effect was associated with an increase in prostaglandin D(2) levels indicating KW-7 is also an inhibitor of thromboxane synthase. The dual inhibition of KW-7 on phosphodiesterase and thromboxane synthase might provide an attractive target in developing antiplatelet drugs.     

Angiotensin (1-7) re-establishes impulse conduction in cardiac muscle during ischaemia-reperfusion. The role of the sodium pump.

INTRODUCTION: The effect of angiotensin (1-7) (Ang 1-7) on membrane potential and excitability of rat heart muscle under ischaemia/reperfusion was investigated. MATERIALS AND METHODS: The hearts of adult rats were removed under deep anaesthesia and perfused using the Langendorff method. After 40 minutes of global no-flow ischaemia, the heart was reperfused for five minutes and the right ventricle was dissected out and transferred to a transparent chamber, through which normal oxygenated Krebs solution flowed continuously (37 degrees C). Measurements of membrane potential were performed using an intracellular microelectrode connected to a high impedance preamplifier. The muscle was stimulated with rectangular current pulses (3 ms duration; 0.6 Hz) generated by an electronic stimulator and isolation unit. To study the influence of Ang (1-7) on sodium pump current, isolated myocytes were voltage-clamped at -40 mV and the current generated by the pump was recorded before and after the administration of Ang (1-7) (10-8 M) to the bath. RESULTS: Ang (1-7) (10-8 M) hyperpolarised the ischaemic heart fibre and re-established impulse propagation. The increment of resting potential was related to the activation of the sodium pump. Indeed, Ang (1-7) (10-8 M) enhanced the transient outward current generated by an electrogenic sodium pump. Both effects of Ang (1-7) on membrane potential and pump current were abolished by ouabain (10-7 M). The cardiac refractoriness was also increased by Ang (1-7) (10-8 M). CONCLUSIONS: Ang (1-7) activates the sodium pump, hyperpolarises the heart cell and re-establishes the impulse conduction during ischaemia/reperfusion. These effects of Ang (1-7), and the increment of cardiac refractoriness, provide an explanation for the reduced incidence of arrhythmias during ischaemia/reperfusion in the presence of Ang (1-7).     

Beneficial versus harmful effects of Angiotensin (1-7) on impulse propagation and cardiac arrhythmias in the failing heart.

INTRODUCTION: The presence of Angiotensin (1-7) (Ang 1-7) and ACE 2 in the ventricle of cardiomyopathic hamsters as well as the influence of Ang (1-7) on membrane potential, impulse propagation and cardiac excitability were investigated. METHODS: Histology and immunochemistry were used to demonstrate the presence of Ang (1-7) and ACE 2 in the ventricle of cardiomyopathic hamsters. Measurements of transmembrane potentials, conduction velocity and refractoriness were made using conventional intracellular microelectrodes. The influence of Ang (1-7) on sodium pump current was investigated in voltageclamped myocytes isolated from the ventricle. RESULTS: The results indicated the presence of Ang (1-7) and ACE 2 in myocytes of cardiomyopathic hamsters. Moreover,Ang (1-7) (10(-8) M) hyperpolarised the heart cell, increased the conduction velocity, and reduced transiently the action potential duration. The cardiac refractoriness was also increased by the heptapeptide, an effect in part reduced by an inhibitor of mas receptor. These findings indicate that Ang (1-7) has important antiarrhythmic properties. However, the beneficial effects of Ang (1-7) are dose-dependent because at higher concentration (10(-7) M) the heptapeptide elicited an appreciable increase of action potential duration and early-after depolarisations. Since losartan (10(-7) M) did not counteract this effect of the high dose of the heptapeptide, it is possible to conclude that activation of AT(1)-receptors is not involved in this effect of Ang (1-7).To investigate the mechanism of the hyperpolarising action of Ang (1-7) the influence of the heptapeptide on the sodium potassium pump current was studied in myocytes isolated from the ventricle of cardiomyopathic hamsters. The peak pump current density was measured under voltage clamp using the whole cell configuration. The results indicated that Ang (1-7) (10(-8) M) enhanced the electrogenic sodium pump, an effect suppressed by ouabain (10(-7) M). CONCLUSIONS: Ang (1-7) has beneficial effects on the failing heart by activating the sodium pump, hyperpolarising the cell membrane and increasing the conduction velocity. These effects as well as the increment of refractoriness indicate that Ang (1-7) has antiarrhythmic properties. At higher concentrations (10(-7) M), however, the heptapeptide induced early-after depolarisations which leads to the conclusion that an optimal generation of Ang (1-7) must be achieved to permit a protective role of Ang (1-7) on cardiac arrhythmias.     

The suitability of iodinated Angiotensin-(1-7) peptides as pharmacological tools

INTRODUCTION: The heptapeptide Angiotensin-(1-7) [(Ang-(1-7)] is a biologically active component of the Renin-Angiotensin System. Pharmacological studies often involve Ang-(1-7) radioactively labelled with (125)I. Given the small size of the original peptide, we investigated whether introduction of a rather bulky iodine label interferes with the biological activity of Ang-(1-7). METHODS: Ang-(1-7) was labelled with nonradioactive iodine with the chloramine-T method. The reaction products were separated on HPLC and analysed with mass spectrometry. The products were tested for biological activity in two ways: The ability of labelled Ang-(1-7) to block Ang II-induced contraction in rat aortic rings was tested in an organ bath setup. The affinity of labelled angiotensin for ACE in rat plasma was examined in vitro. RESULTS: Iodination of Angiotensin-(1-7) resulted in two main products: monoiodinated and diiodinated Ang-(1-7) that could be easily separated on HPLC. In an organ bath experiment, monoiodinated Ang-(1-7) blocked Ang II responses identical to the native compound, whereas diiodinated Ang-(1-7) had lost its ability to block Ang II responses. Likewise, monoiodinated Ang-(1-7) had retained its affinity for ACE, while the affinity of diiodinated Ang-(1-7) was greatly reduced. DISCUSSION: Monoiodinated Ang-(1-7) has a biological activity identical to the native compound, whereas this is lost in diiodinated Ang-(1-7). Therefore, only the monoiodinated radioactive form seems suited for pharmacological studies.     

Inhibition of NMDA-gated ion channels by bis(7)-tacrine: whole-cell and single-channel studies

Bis(7)-tacrine is a novel dimeric acetylcholinesterase inhibitor derived from tacrine, and has been proposed as a promising agent to treat Alzheimer's disease. We have recently reported that bis(7)-tacrine prevents glutamate-induced neuronal apoptosis by antagonizing NMDA receptors. The purpose of this study was to characterize bis(7)-tacrine inhibition of NMDA-activated current by using patch-clamp recording techniques. In cultured rat hippocampal neurons, bis(7)-tacrine inhibited NMDA-activated whole-cell current in a concentration-dependent manner with an IC₅₀ of 0.66 ± 0.07 μM. Bis(7)-tacrine produced a gradual decline of NMDA-activated current to a steady-state, but this was not an indication of use-dependence. Also, the slow onset of inhibition by bis(7)-tacrine was not apparently due to an action at an intracellular site. Bis(7)-tacrine, 0.5 μM, decreased the maximal response to NMDA by 40% without changing its EC₅₀. Bis(7)-tacrine inhibition of NMDA-activated current was not voltage-dependent, and was independent of glycine concentration. Results of single-channel experiments obtained from cells expressing NR1 and NR2A subunits revealed that bis(7)-tacrine decreased the open probability and frequency of channel opening, but did not significantly alter the mean open time or introduce rapid closures. These results suggest that bis(7)-tacrine can inhibit NMDA receptor function in a manner that is slow in onset and offset and noncompetitive with respect to both NMDA and glycine. The noncompetitive inhibition of NMDA receptors by bis(7)-tacrine could contribute to its protective effect against glutamate-induced neurotoxicity.     

Effect of 7-nitroindazole alone and in combination with phenobarbitone and diazepam on picrotoxin-induced convulsions in rats

There are no reports on the effect of 7-nitroindazole (7-NI) on chemically-induced convulsions. Hence, in the present study, its (100 and 200 mg/kg) action was tested alone and in combination with phenobarbitone (20 mg/kg) and diazepam (0.25 mg/kg) on picrotoxin (PCT)-induced convulsions in rats. The changes produced by 7-NI on nitric oxide synthase (NOS) activity and nitric oxide (NO) concentration were determined in the brain. The effect of 7-NI was tested in L-arginine (1000 mg/kg) pretreated (30 min) animals. The smaller dose (100 mg/kg) of 7-NI did not alter NOS activity and NO concentration, but inhibited PCT-induced convulsions indicating that its anticonvulsant action was devoid of an involvement of NO. But, an inhibition of NOS activity, by a larger (200 mg/kg) dose of it, resulted in a promotion of the convulsant action of PCT and in an impairment of the anticonvulsant effect of both phenobarbitone and diazepam. The proconvulsant action of 7-NI was reverted by L-arginine. These results suggest that 100 and 200 mg/kg of 7-NI produce distinguishable action on PCT-induced convulsions because NOS activity is inhibited by 200 mg/kg and not by 100 mg/kg of it. The results further suggest that NO acts as anticonvulsant and that the NOS inhibitors, like 7-NI, cannot be used as an anticonvulsant either alone or in combination with other anticonvulsants.     

Synthesis and antihypertensive activity of 6,7-disubstituted trans-4-amino-3,4-dihydro-2,2-dimethyl-2H-1-benzopyran-3-ols

A series of novel 6,7-disubstituted trans-3,4-dihydro-2, 2-dimethyl-4-pyrrolidino-(or piperidino)-2H-1-benzopyran-3-ols was prepared and tested for antihypertensive activity in the conscious spontaneously hypertensive rat (SHR) and compared with certain of their monosubstituted analogues. The potent blood pressure lowering activity of the 6-monosubstituted compounds was enhanced by incorporation of an acetylamino or amino group at C(7) and that of the 7-nitro-substituted compound by incorporation of an amino (but not an acetylamino group) at C(6). The combination of 6-nitro or 6-cyano with 7-(acetylamino) or 7-amino groups and 6-amino with 7-nitro groups in trans-4-pyrrolidino- or -4-piperidino-2,2-dimethyl-2H-1-benzopyranols conferred superior antihypertensive activity to hydralazine and to the calcium antagonist, nifedipine, in SHR. The synthetic route to these compounds involves the conversion of 2H-1-benzopyrans to bromohydrins that were treated with pyrrolidine or piperidine. Preparation of the 6-cyano-7-amino analogue was accomplished when 6-cyano-7-[(trifluoroacetyl)amino]-2,2-dimethylbenzopyran was used as starting material.     

Pharmacokinetics of coumarin and its 7-hydroxy-metabolites upon intravenous and peroral administration of coumarin in man

Summary The pharmacokinetics of coumarin (C) upon i.v. and p.o. administration and its metabolites 7-hydroxy-coumarin (7-HC) and 7-hydroxy-coumarin glucuronide (7-HCG) have been studied. Six healthy volunteers were involved in this investigation. Four of the volunteers participated in a crossover study. Coumarin was administered i.v. and p.o. in dose sizes of 0.25 mg/kg and 0.857 mg/kg, respectively. Coumarin is rapidly absorbed p.o., however the availability to systemic circulation is less than 4%. The rest of the dose appears quantitatively as 7-HC and 7-HCG in systemic circulation suggesting an extensive firstpass effect. Coumarin and 7-HCG are best fitted to an open two-compartment model, whereas 7-HC is best fitted to an open one-compartment model. The biological half-life of both C (0.80 vs. 1.02 h) and 7-HCG (1.47 vs. 1.15 h) was not significantly different for the two routes of administration. The large total clearance of C again suggests a first-pass effect; while that of 7-HCG, which is nearly exclusively eliminated into urine, indicates active tubular secretion of the glucuronide.     

Enhancement of phosphatidylcholine biosynthesis by angiotensin-(1-7) in the rat renal cortex

In the present paper, we investigated the effect of angiotensin-(1-7) (Ang-(1-7)) on phospholipid biosynthesis in the rat renal cortex. A significant increase in phosphatidylcholine (PC) labeling was observed when cortical slices, prelabeled with [32P]orthophosphate, were incubated for 30 min in the presence of Ang-(1-7) (1 pM to 100 nM). Neither the phospholipase C inhibitors, neomycin or db-cAMP nor the protein kinase C inhibitors, chelerythrine or H7, modified the stimulatory effect induced by 0.1 nM Ang-(1-7). The enhancement of PC biosynthesis caused by 0.1 nM Ang-(1-7) was unmodified by either losartan, an AT(1) receptor antagonist, or (1-[[4-(dimethylamino)-3-methylphenyl]methyl]-5-(diphenylacetyl)-4,5,6,7-tetrahydro-1H-imidazol[4,5-c]pyridine-6-carboxylic acid ditrifluoroacetate) (PD 123319), an AT(2) receptor antagonist, but was partially blocked by [D-Ala(7)]Ang-(1-7), an Ang-(1-7) specific antagonist. However, losartan potentiated the effect of 100 nM Ang-(1-7) on PC biosynthesis. Losartan by itself increased the de novo synthesis of PC. These results suggest that the Ang-(1-7)-mediated increase in PC biosynthesis is independent of AT(1) and AT(2) receptor activation but mediated by a specific Ang-(1-7) receptor. This mechanism is independent of phospholipase C and PKC activation.     

Angiotensin-(1-7) induces peripheral antinociception through mas receptor activation in an opioid-independent pathway

The G protein-coupled receptor Mas was recently described as an angiotensin-(1-7) [Ang-(1-7)] receptor. In the present study, we demonstrate an antinociceptive effect of Ang-(1-7) for the first time. Additionally, we evaluated the anatomical localization of Mas in the dorsal root ganglia using immunofluorescence. This is the first evidence indicating that this receptor is present in sensitive neurons. The antinociceptive effect was demonstrated using the rat paw pressure test. For this test, sensitivity is increased by intraplantar injection of prostaglandin E(2). Ang-(1-7) administered locally into the right hind paw elicited a dose-dependent antinociceptive effect. Because the higher dose of Ang-(1-7) did not produce an effect when injected into the contralateral paw, this effect was considered local. The specific antagonist for the Mas receptor, A-779, inhibited the peripheral antinociception induced by exposure to 4 μg/paw Ang-(1-7) in a dose-dependent manner. The highest dose completely reversed the antinociceptive effect induced by Ang-(1-7), suggesting that the Mas receptor is an obligatory component in this process and that other angiotensin receptors may not be involved. When injected alone, the antagonist was unable to induce hyperalgesia or antinociception. Alternatively, naloxone was unable to inhibit the antinociceptive effect induced by Ang-(1-7), suggesting that endogenous opioid peptides may not be involved in this response. These data provide the first anatomical basis for the physiological role of Ang-(1-7) in the modulation of pain perception via Mas receptor activation in an opioid-independent pathway. Taken together, these results provide new perspectives for the development of a new class of analgesic drugs.