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Transplantation and Immunology 1
Transplantation and Immunology 1 Transplantation and Immunology บรรยายโดย อ.นพ.สมชัย ลิ้มศรีจ าเริญ เรียบเรียง นพ.กิตติ์รวี จิรธานีเรืองกิจ อาจารย์ที่ปรึกษา อ.นพ.ราวิน วงษ์สถาปนาเลิศ Outline 1. Immunology 2. Immunosuppression: drug use in transplantation 3. Clinical transplant: liver pancreas intestine and kidney transplant ในอเมริกา ท า Transplant เยอะมาก และ resident ศัลยกรรมทุกคนต้องผ่าน rotation transplant ดังนั้น ในอนาคต บ้านเรา จะท ากันมากขึ้น และอาจจะบรรจุ เป็น requirement ให้ resident ต้องผ่าน • Immunology ประวัติศาสตร์ เริ่มจาก Jensen reported in 1902 - มีการทดลอง ศึกษาเกี่ยวกับ tumor และ immunology ของ tumor พบว่า สามารถน าเอา tumor จากหนูไป transplant ให้ตัวอื่นได้ ( ท าใน 19 successive generation) - พบว่าหนูบางส่วนจะ reject tumor ไม่ให้เติบโต (50% of mice) - โดยจะ reject ทุกครั้ง ที่น า tumor มา transplant ใหม่ (มี resistant to subsequent challenge) และ หากน า เอา normal tissue ใส่ไปก่อน และเอา tumor มา transplant ก็จะ reject ได้เร็วขึ้น - เกิด Theory อธิบายเหตุการณ์นี้ คือ Athrepsia theory (เกี่ยวกับ nutrition) เพราะ เวลาใส่ tumor เข้าไปแรกๆ จะยังเจริญได้ช่วงหนึ่งจากนั้น จึงตายไป เชื่อว่าเกิดจากการขาด สารอาหาร หลังจาก tumor ใช้สารอาหารหมด มันก็จะตายไป นับเป็นจุดเริ่มต้นที่ใช้ tumor ในการศึกษาหลักการเรื่อง Transplantation Medawar reported in 1943 (Nobel prize) - เมื่อมี rejection เกิดขึ้น หากเราใช้ graft ครั้งที่ 2 จาก donor เดิม จะเกิดการ reject เร็วขึ้น ซึ่งคิดว่าเกิดจาก Actively acquired immune reaction จากนั้นมีการศึกษาอีกหลายอย่างเพื่อศึกษา transplant immunology Owen reported in 1947 - ถ้าน าสัตว์เช่น ลูกวัว ที่เป็น dizygotic -
Classification Decisions Taken by the Harmonized System Committee from the 47Th to 60Th Sessions (2011
CLASSIFICATION DECISIONS TAKEN BY THE HARMONIZED SYSTEM COMMITTEE FROM THE 47TH TO 60TH SESSIONS (2011 - 2018) WORLD CUSTOMS ORGANIZATION Rue du Marché 30 B-1210 Brussels Belgium November 2011 Copyright © 2011 World Customs Organization. All rights reserved. Requests and inquiries concerning translation, reproduction and adaptation rights should be addressed to [email protected]. D/2011/0448/25 The following list contains the classification decisions (other than those subject to a reservation) taken by the Harmonized System Committee ( 47th Session – March 2011) on specific products, together with their related Harmonized System code numbers and, in certain cases, the classification rationale. Advice Parties seeking to import or export merchandise covered by a decision are advised to verify the implementation of the decision by the importing or exporting country, as the case may be. HS codes Classification No Product description Classification considered rationale 1. Preparation, in the form of a powder, consisting of 92 % sugar, 6 % 2106.90 GRIs 1 and 6 black currant powder, anticaking agent, citric acid and black currant flavouring, put up for retail sale in 32-gram sachets, intended to be consumed as a beverage after mixing with hot water. 2. Vanutide cridificar (INN List 100). 3002.20 3. Certain INN products. Chapters 28, 29 (See “INN List 101” at the end of this publication.) and 30 4. Certain INN products. Chapters 13, 29 (See “INN List 102” at the end of this publication.) and 30 5. Certain INN products. Chapters 28, 29, (See “INN List 103” at the end of this publication.) 30, 35 and 39 6. Re-classification of INN products. -
Areas of Future Research in Fibroid Therapy
9/18/18 Cumulative Incidence of Fibroids over Reproductive Lifespan RFTS Areas of Future Research Blacks Blacks UFS Whites in Fibroid Therapy CARDIA Age 33-46 William H. Catherino, MD, PhD Whites Professor and Chair, Research Division Seveso Italy Uniformed Services University Blacks Whites Associate Program Director Sweden/Whites (Age 33-40) Division of REI, PRAE, NICHD, NIH The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government. Laughlin Seminars Reprod Med 2010;28: 214 Fibroids Increase Miscarriage Rate Obstetric Complications of Fibroids Complication Fibroid No Fibroid OR Abnormal labor 49.6% 22.6% 2.2 Cesarean Section 46.2% 23.5% 2.0 Preterm delivery 13.8% 10.7% 1.5 BreecH position 9.3% 4.0% 1.6 pp Hemorrhage 8.3% 2.9% 2.2 PROM 4.2% 2.5% 1.5 Placenta previa 1.7% 0.7% 2.0 Abruption 1.4% 0.7% 2.3 Guben Reprod Biol Odds of miscarriage decreased with no myoma comparedEndocrinol to myoma 2013;11:102 Biderman-Madar ArcH Gynecol Obstet 2005;272:218 Ciavattini J Matern Fetal Neonatal Med 2015;28:484-8 Not Impacting the Cavity Coronado Obstet Gynecol 2000;95:764 Kramer Am J Obstet Gynecol 2013;209:449.e1-7 Navid Ayub Med Coll Abbottabad 2012;24:90 Sheiner J Reprod Med 2004;49:182 OR = 0.737 [0.647, 0.840] Stout Obstet Gynecol 2010;116:1056 Qidwai Obstet Gynecol 2006;107:376 1 9/18/18 Best Studied Therapies Hysterectomy Option over Time Surgical Radiologic Medical >100 years of study Hysterectomy Open myomectomy GnRH agonists 25-34 years of study Endometrial Ablation GnRH agonists 20-24 years of study Laparoscopic myomectomy Uterine artery embolization Retinoic acid 10-19 years of study Uterine artery obstruction SPRMs: Mifepristone, ulipristal Robotic myomectomy GnRH antagonists 5-9 years of study Cryomyolysis MRI-guided high frequency ultrasound SPRMs: Asoprisnil, Telapristone, Laparoscopic ablation Vilaprisan SERMs: Tamoxifen, Raloxifene, Letrozole, Genistein Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB. -
Do We Need New Prokinetics to Reduce Enteral Feeding Intolerance During Critical Illness? Arthur Raymond Hubert Van Zanten
van Zanten Critical Care (2016) 20:294 DOI 10.1186/s13054-016-1466-3 EDITORIAL Open Access Do we need new prokinetics to reduce enteral feeding intolerance during critical illness? Arthur Raymond Hubert van Zanten See related research by Chapman et al., http://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1420-4 Abstract Gastrointestinal feeding intolerance and critical illness-associated gastric motility dysfunction are common. Although recent guidelines recommend not interrupting gastric feeding when gastric residual volume (GRV) is lower than 500 mL or to completely abandon measurement of GRV, it may seem that the relevance of prokinetics is reduced. In patients at risk for aspiration and in multimodal strategies to enhance feeding performance, however, use of prokinetics is still advocated. Metoclopramide and erythromycin are commonly used promotility agents, although with relevant side effects. Potential targets for new agents and early study results are addressed. Keywords: Promotility agents, Prokinetics, Feeding intolerance, Gastric emptying, Gastric residual volume, Metoclopramide, Erythromycin, Ghrelin Commentary daily for tolerance of EN and inappropriate cessation of A clear consensus definition on acute gastrointestinal in- EN should be avoided. Administration should be diverted jury during critical illness is lacking. Gastrointestinal lower in the gastrointestinal tract (post-pyloric feeding) in feeding intolerance (GFI) is usually defined by vomiting, patients at high risk for aspiration or in case of gastric EN abdominal distention, complaints of discomfort, high intolerance [4]. nasogastric tube output, high gastric residual volumes Now here a clinical dilemma may arise: The most (GRVs) measured at intervals, diarrhea, reduced passage likely routine to monitor GFI is to measure GRV. -
A Motilin Agonist, on Gastric Emptying and Glucose Absorption In
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Springer - Publisher Connector Chapman et al. Critical Care (2016) 20:232 DOI 10.1186/s13054-016-1420-4 RESEARCH Open Access The effect of camicinal (GSK962040), a motilin agonist, on gastric emptying and glucose absorption in feed-intolerant critically ill patients: a randomized, blinded, placebo-controlled, clinical trial Marianne J. Chapman1,2*, Adam M. Deane1,2, Stephanie L. O’Connor1,2, Nam Q. Nguyen3,4, Robert J. L. Fraser5, Duncan B. Richards6, Kimberley E. Hacquoil6, Lakshmi S. Vasist Johnson7, Matthew E. Barton7 and George E. Dukes7 Abstract Background: The promotility agents currently available to treat gastroparesis and feed intolerance in the critically ill are limited by adverse effects. The aim of this study was to assess the pharmacodynamic effects and pharmacokinetics of single doses of the novel gastric promotility agent motilin agonist camicinal (GSK962040) in critically ill feed- intolerant patients. Methods: A prospective, randomized, double-blind, parallel-group, placebo-controlled, study was performed in mechanically ventilated feed-intolerant patients [median age 55 (19–84), 73 % male, APACHE II score 18 (5–37) with a gastric residual volume ≥200 mL]. Gastric emptying and glucose absorption were measured both pre- and post- treatment after intragastric administration of 50 mg (n = 15) camicinal and placebo (n = 8) using the 13C-octanoic acid breath test (BTt1/2), acetaminophen concentrations, and 3-O-methyl glucose concentrations respectively. Results: Following 50 mg enteral camicinal, there was a trend to accelerated gastric emptying [adjusted geometric means: pre-treatment BTt1/2 117 minutes vs. -
G Protein-Coupled Receptors
S.P.H. Alexander et al. The Concise Guide to PHARMACOLOGY 2015/16: G protein-coupled receptors. British Journal of Pharmacology (2015) 172, 5744–5869 THE CONCISE GUIDE TO PHARMACOLOGY 2015/16: G protein-coupled receptors Stephen PH Alexander1, Anthony P Davenport2, Eamonn Kelly3, Neil Marrion3, John A Peters4, Helen E Benson5, Elena Faccenda5, Adam J Pawson5, Joanna L Sharman5, Christopher Southan5, Jamie A Davies5 and CGTP Collaborators 1School of Biomedical Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK, 2Clinical Pharmacology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK, 3School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK, 4Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK, 5Centre for Integrative Physiology, University of Edinburgh, Edinburgh, EH8 9XD, UK Abstract The Concise Guide to PHARMACOLOGY 2015/16 provides concise overviews of the key properties of over 1750 human drug targets with their pharmacology, plus links to an open access knowledgebase of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties. The full contents can be found at http://onlinelibrary.wiley.com/doi/ 10.1111/bph.13348/full. G protein-coupled receptors are one of the eight major pharmacological targets into which the Guide is divided, with the others being: ligand-gated ion channels, voltage-gated ion channels, other ion channels, nuclear hormone receptors, catalytic receptors, enzymes and transporters. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. -
G Protein‐Coupled Receptors
S.P.H. Alexander et al. The Concise Guide to PHARMACOLOGY 2019/20: G protein-coupled receptors. British Journal of Pharmacology (2019) 176, S21–S141 THE CONCISE GUIDE TO PHARMACOLOGY 2019/20: G protein-coupled receptors Stephen PH Alexander1 , Arthur Christopoulos2 , Anthony P Davenport3 , Eamonn Kelly4, Alistair Mathie5 , John A Peters6 , Emma L Veale5 ,JaneFArmstrong7 , Elena Faccenda7 ,SimonDHarding7 ,AdamJPawson7 , Joanna L Sharman7 , Christopher Southan7 , Jamie A Davies7 and CGTP Collaborators 1School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK 2Monash Institute of Pharmaceutical Sciences and Department of Pharmacology, Monash University, Parkville, Victoria 3052, Australia 3Clinical Pharmacology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK 4School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK 5Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK 6Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK 7Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK Abstract The Concise Guide to PHARMACOLOGY 2019/20 is the fourth in this series of biennial publications. The Concise Guide provides concise overviews of the key properties of nearly 1800 human drug targets with an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties. Although the Concise Guide represents approximately 400 pages, the material presented is substantially reduced compared to information and links presented on the website. -
GPCR/G Protein
Inhibitors, Agonists, Screening Libraries www.MedChemExpress.com GPCR/G Protein G Protein Coupled Receptors (GPCRs) perceive many extracellular signals and transduce them to heterotrimeric G proteins, which further transduce these signals intracellular to appropriate downstream effectors and thereby play an important role in various signaling pathways. G proteins are specialized proteins with the ability to bind the nucleotides guanosine triphosphate (GTP) and guanosine diphosphate (GDP). In unstimulated cells, the state of G alpha is defined by its interaction with GDP, G beta-gamma, and a GPCR. Upon receptor stimulation by a ligand, G alpha dissociates from the receptor and G beta-gamma, and GTP is exchanged for the bound GDP, which leads to G alpha activation. G alpha then goes on to activate other molecules in the cell. These effects include activating the MAPK and PI3K pathways, as well as inhibition of the Na+/H+ exchanger in the plasma membrane, and the lowering of intracellular Ca2+ levels. Most human GPCRs can be grouped into five main families named; Glutamate, Rhodopsin, Adhesion, Frizzled/Taste2, and Secretin, forming the GRAFS classification system. A series of studies showed that aberrant GPCR Signaling including those for GPCR-PCa, PSGR2, CaSR, GPR30, and GPR39 are associated with tumorigenesis or metastasis, thus interfering with these receptors and their downstream targets might provide an opportunity for the development of new strategies for cancer diagnosis, prevention and treatment. At present, modulators of GPCRs form a key area for the pharmaceutical industry, representing approximately 27% of all FDA-approved drugs. References: [1] Moreira IS. Biochim Biophys Acta. 2014 Jan;1840(1):16-33. -
Merck Announces U.S. FDA Approval of VERQUVO® (Vericiguat)
NEWS RELEASE Merck Announces U.S. FDA Approval of VERQUVO® (vericiguat) 1/20/2021 VERQUVO Approved for Reduction of Risk of Cardiovascular Death and Heart Failure (HF) Hospitalization Following a Hospitalization for HF or Need for Outpatient Intravenous (IV) Diuretics in Adults with Symptomatic Chronic Heart Failure and Ejection Fraction Less than 45% VERQUVO is the First Soluble Guanylate Cyclase Stimulator, Approved to Treat Heart Failure KENILWORTH, N.J.--(BUSINESS WIRE)-- Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced that the U.S. Food and Drug Administration (FDA) has approved VERQUVO, a soluble guanylate cyclase (sGC) stimulator, to reduce the risk of cardiovascular death and heart failure hospitalization following a hospitalization for heart failure or need for outpatient intravenous (IV) diuretics in adults with symptomatic chronic heart failure and ejection fraction less than 45%. The approval of VERQUVO by the FDA, which is the rst treatment for chronic heart failure approved specically for patients following a hospitalization for heart failure or need for outpatient IV diuretics, is based on the results of the pivotal Phase 3 VICTORIA trial and follows a priority regulatory review. VERQUVO (vericiguat) 2.5 mg, 5 mg, and 10 mg tablets is being jointly developed with Bayer AG. The VERQUVO label contains a boxed warning that indicates that VERQUVO should not be administered to pregnant females because it may cause fetal harm. For more information, see “Selected Safety Information” below. “Patients with symptomatic chronic heart failure and reduced ejection fraction have a high risk for hospitalization after experiencing symptoms of heart failure requiring outpatient IV diuretic treatment or hospitalization. -
Treatment of Children with Pulmonary Hypertension. Expert Consensus Statement on the Diagnosis and Treatment of Paediatric Pulmonary Hypertension
Pulmonary vascular disease ORIGINAL ARTICLE Heart: first published as 10.1136/heartjnl-2015-309103 on 6 April 2016. Downloaded from Treatment of children with pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK Georg Hansmann,1 Christian Apitz2 For numbered affiliations see ABSTRACT administration (oral, inhaled, subcutaneous and end of article. Treatment of children and adults with pulmonary intravenous). Additional drugs are expected in the Correspondence to hypertension (PH) with or without cardiac dysfunction near future. Modern drug therapy improves the Prof. Dr. Georg Hansmann, has improved in the last two decades. The so-called symptoms of PAH patients and slows down the FESC, FAHA, Department of pulmonary arterial hypertension (PAH)-specific rates of clinical deterioration. However, emerging Paediatric Cardiology and medications currently approved for therapy of adults with therapeutic strategies for adult PAH, such as Critical Care, Hannover PAH target three major pathways (endothelin, nitric upfront oral combination therapy, have not been Medical School, Carl-Neuberg- fi Str. 1, Hannover 30625, oxide, prostacyclin). Moreover, some PH centres may use suf ciently studied in children. Moreover, the com- Germany; off-label drugs for compassionate use. Pulmonary plexity of pulmonary hypertensive vascular disease [email protected] hypertensive vascular disease (PHVD) in children is (PHVD) in children makes the selection of appro- complex, and selection of appropriate therapies remains priate therapies a great challenge far away from a This paper is a product of the fi writing group of the European dif cult. In addition, paediatric PAH/PHVD therapy is mere prescription of drugs. -
Patent Application Publication ( 10 ) Pub . No . : US 2019 / 0192440 A1
US 20190192440A1 (19 ) United States (12 ) Patent Application Publication ( 10) Pub . No. : US 2019 /0192440 A1 LI (43 ) Pub . Date : Jun . 27 , 2019 ( 54 ) ORAL DRUG DOSAGE FORM COMPRISING Publication Classification DRUG IN THE FORM OF NANOPARTICLES (51 ) Int . CI. A61K 9 / 20 (2006 .01 ) ( 71 ) Applicant: Triastek , Inc. , Nanjing ( CN ) A61K 9 /00 ( 2006 . 01) A61K 31/ 192 ( 2006 .01 ) (72 ) Inventor : Xiaoling LI , Dublin , CA (US ) A61K 9 / 24 ( 2006 .01 ) ( 52 ) U . S . CI. ( 21 ) Appl. No. : 16 /289 ,499 CPC . .. .. A61K 9 /2031 (2013 . 01 ) ; A61K 9 /0065 ( 22 ) Filed : Feb . 28 , 2019 (2013 .01 ) ; A61K 9 / 209 ( 2013 .01 ) ; A61K 9 /2027 ( 2013 .01 ) ; A61K 31/ 192 ( 2013. 01 ) ; Related U . S . Application Data A61K 9 /2072 ( 2013 .01 ) (63 ) Continuation of application No. 16 /028 ,305 , filed on Jul. 5 , 2018 , now Pat . No . 10 , 258 ,575 , which is a (57 ) ABSTRACT continuation of application No . 15 / 173 ,596 , filed on The present disclosure provides a stable solid pharmaceuti Jun . 3 , 2016 . cal dosage form for oral administration . The dosage form (60 ) Provisional application No . 62 /313 ,092 , filed on Mar. includes a substrate that forms at least one compartment and 24 , 2016 , provisional application No . 62 / 296 , 087 , a drug content loaded into the compartment. The dosage filed on Feb . 17 , 2016 , provisional application No . form is so designed that the active pharmaceutical ingredient 62 / 170, 645 , filed on Jun . 3 , 2015 . of the drug content is released in a controlled manner. Patent Application Publication Jun . 27 , 2019 Sheet 1 of 20 US 2019 /0192440 A1 FIG . -
EC313-A Tissue Selective SPRM Reduces the Growth and Proliferation of Uterine Fbroids in a Human Uterine Fbroid Tissue Xenograft Model Hareesh B
www.nature.com/scientificreports OPEN EC313-a tissue selective SPRM reduces the growth and proliferation of uterine fbroids in a human uterine fbroid tissue xenograft model Hareesh B. Nair1*, Bindu Santhamma1, Kalarickal V. Dileep2, Peter Binkley3, Kirk Acosta1, Kam Y. J. Zhang 2, Robert Schenken3 & Klaus Nickisch1 Uterine fbroids (UFs) are associated with irregular or excessive uterine bleeding, pelvic pain or pressure, or infertility. Ovarian steroid hormones support the growth and maintenance of UFs. Ulipristal acetate (UPA) a selective progesterone receptor (PR) modulator (SPRM) reduce the size of UFs, inhibit ovulation and lead to amenorrhea. Recent liver toxicity concerns with UPA, diminished enthusiasm for its use and reinstate the critical need for a safe, efcacious SPRM to treat UFs. In the current study, we evaluated the efcacy of new SPRM, EC313, for the treatment for UFs using a NOD-SCID mouse model. EC313 treatment resulted in a dose-dependent reduction in the fbroid xenograft weight (p < 0.01). Estradiol (E2) induced proliferation was blocked signifcantly in EC313-treated xenograft fbroids (p < 0.0001). Uterine weight was reduced by EC313 treatment compared to UPA treatment. ER and PR were reduced in EC313-treated groups compared to controls (p < 0.001) and UPA treatments (p < 0.01). UF specifc desmin and collagen were markedly reduced with EC313 treatment. The partial PR agonism and no signs of unopposed estrogenicity makes EC313 a candidate for the long-term treatment for UFs. Docking studies have provided a structure based explanation for the SPRM activity of EC313. Te unmet need for medical management of uterine fbroids (UFs) has led to the discovery of various novel agents in recent years.