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Item Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference(Springer, 2024) Wong Vega, Molly; Starr, Michelle C.; Brophy, Patrick D.; Devarajan, Prasad; Soranno, Danielle E.; Akcan‑Arikan, Ayse; Basu, Rajit; Goldstein, Stuart L.; Charlton, Jennifer R.; Barreto, Erin; Pediatrics, School of MedicineBackground: In the past decade, there have been substantial advances in our understanding of pediatric AKI. Despite this progress, large gaps remain in our understanding of pharmacology and nutritional therapy in pediatric AKI. Methods: During the 26th Acute Disease Quality Initiative (ADQI) Consensus Conference, a multidisciplinary group of experts reviewed the evidence and used a modified Delphi process to achieve consensus on recommendations for gaps and advances in care for pharmacologic and nutritional management of pediatric AKI. The current evidence as well as gaps and opportunities were discussed, and recommendations were summarized. Results: Two consensus statements were developed. (1) High-value, kidney-eliminated medications should be selected for a detailed characterization of their pharmacokinetics, pharmacodynamics, and pharmaco-"omics" in sick children across the developmental continuum. This will allow for the optimization of real-time modeling with the goal of improving patient care. Nephrotoxin stewardship will be identified as an organizational priority and supported with necessary resources and infrastructure. (2) Patient-centered outcomes (functional status, quality of life, and optimal growth and development) must drive targeted nutritional interventions to optimize short- and long-term nutrition. Measures of acute and chronic changes of anthropometrics, body composition, physical function, and metabolic control should be incorporated into nutritional assessments. Conclusions: Neonates and children have unique metabolic and growth parameters compared to adult patients. Strategic investments in multidisciplinary translational research efforts are required to fill the knowledge gaps in nutritional requirements and pharmacological best practices for children with or at risk for AKI.Item An Origin Story for “Big Pharma” in the Reign of Louis XIV? An Early Modern History for the Present(Ruth Lilly Medical Library, 2024-04-05) Rivest, JustinPresentation slides for lecture delivered by Justin Rivest, PhD (Assistant Professor of History, Kenyon College) on April 5, 2024. This talk poses a fertile, if playfully anachronistic, historical question: In the final two decades of his seventy-two-year reign, did Louis XIV (r. 1643-1715) subsidize the world’s first “Big Pharma” companies into existence? From the 1680s onward the Sun King granted monopoly rights and government supply contracts, first to the court physician Jean-Baptiste Chomel, and then to the Dutch-born medical entrepreneur Adriaan Engelhard Helvetius (naturalized French as Adrien Helvétius). Both men developed proto-industrial operations that annually shipped tens of thousands of standardized medicine chests all over France and beyond. Building on relationships forged in supplying medicines to the French army, Rivest argues that they took advantage of supply problems in existing Catholic poor relief networks to provide their standardized medicines to the largest possible purchaser—the French absolutist state—and the largest possible consumer base—the peasants of rural France. Although grounded in the seventeenth and eighteenth centuries, this talk raises questions about the connections between charity and capitalism; the role of private entrepreneurs in fulfilling the state objectives; and about how the state shapes markets as a consumer, rather than just as a regulator, that continue to have resonance in the twenty-first century. Presentation recording available online: https://purl.dlib.indiana.edu/iudl/media/q47r66rn7rItem Characterization of Two Distinct Structural Classes of Selective Aldehyde Dehydrogenase 1A1 Inhibitors.(ACS, 2015-02-26) Morgan, Cynthia A.; Hurley, Thomas D.; Department of Biochemistry & Molecular Biology, IU School of MedicineAldehyde dehydrogenases (ALDH) catalyze the irreversible oxidation of aldehydes to their corresponding carboxylic acid. Alterations in ALDH1A1 activity are associated with such diverse diseases as cancer, Parkinson?s disease, obesity, and cataracts. Inhibitors of ALDH1A1 could aid in illuminating the role of this enzyme in disease processes. However, there are no commercially available selective inhibitors for ALDH1A1. Here we characterize two distinct chemical classes of inhibitors that are selective for human ALDH1A1 compared to eight other ALDH isoenzymes. The prototypical members of each structural class, CM026 and CM037, exhibit submicromolar inhibition constants but have different mechanisms of inhibition. The crystal structures of these compounds bound to ALDH1A1 demonstrate that they bind within the aldehyde binding pocket of ALDH1A1 and exploit the presence of a unique glycine residue to achieve their selectivity. These two novel and selective ALDH1A1 inhibitors may serve as chemical tools to better understand the contributions of ALDH1A1 to normal biology and to disease states.Item Clinical and educational impact of pharmacogenomics testing: a case series from the INGENIOUS trial(Future Medicine, 2017-06) Pierson, Rebecca C.; Gufford, Brandon T.; Desta, Zeruesenay; Eadon, Michael T.; Medicine, School of MedicinePharmacogenomic testing has become increasingly widespread. However, there remains a need to bridge the gap between test results and providers lacking the expertise required to interpret these results. The Indiana Genomics Implementation trial is underway at our institution to examine total healthcare cost and patient outcomes after genotyping in a safety-net healthcare system. As part of the study, trial investigators and clinical pharmacology fellows interpret genotype results, review patient histories and medication lists and evaluate potential drug-drug interactions. We present a case series of patients in whom pharmacogenomic consultations aided providers in appropriately applying pharmacogenomic results within the clinical context. Formal consultations not only provide valuable patient care information but educational opportunities for the fellows to cement pharmacogenomic concepts.Item Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD(American Society of Nephrology, 2019-05-07) Sinha, Arjun D.; Agarwal, Rajiv; Medicine, School of MedicineCKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.Item The development and maintenance of paclitaxel-induced neuropathic pain require activation of the sphingosine 1-phosphate receptor subtype 1(ASBMB, 2014-07-25) Janes, Kali; Little, Joshua W.; Li, Chao; Bryant, Leesa; Chen, Collin; Chen, Zhoumou; Kamocki, Krzysztof; Doyle, Timothy; Snider, Ashley; Esposito, Emanuela; Cuzzocrea, Salvatore; Bieberich, Erhard; Obedi, Lina; Petrache, Irina; Nicol, Grant; Neumann, William L.; Salvemini, Daniela; Department of Pharmacology and Toxicology, IU School of MedicineThe ceramide-sphingosine 1-phosphate (S1P) rheostat is important in regulating cell fate. Several chemotherapeutic agents, including paclitaxel (Taxol), involve pro-apoptotic ceramide in their anticancer effects. The ceramide-to-S1P pathway is also implicated in the development of pain, raising the intriguing possibility that these sphingolipids may contribute to chemotherapy- induced painful peripheral neuropathy, which can be a critical dose-limiting side effect of many widely used chemotherapeutic agents.We demonstrate that the development of paclitaxel-induced neuropathic pain was associated with ceramide and S1P formation in the spinal dorsal horn that corresponded with the engagement of S1P receptor subtype 1 (S1PR(1))- dependent neuroinflammatory processes as follows: activation of redox-sensitive transcription factors (NFκB) and MAPKs (ERK and p38) as well as enhanced formation of pro-inflammatory and neuroexcitatory cytokines (TNF-α and IL-1β). Intrathecal delivery of the S1PR1 antagonist W146 reduced these neuroinflammatory processes but increased IL-10 and IL-4, potent anti-inflammatory/ neuroprotective cytokines. Additionally, spinal W146 reversed established neuropathic pain. Noteworthy, systemic administration of the S1PR1 modulator FTY720 (Food and Drug Administration- approved for multiple sclerosis) attenuated the activation of these neuroinflammatory processes and abrogated neuropathic pain without altering anticancer properties of paclitaxel and with beneficial effects extended to oxaliplatin. Similar effects were observed with other structurally and chemically unrelated S1PR1 modulators (ponesimod and CYM-5442) and S1PR1 antagonists (NIBR-14/15) but not S1PR1 agonists (SEW2871). Our findings identify for the first time the S1P/S1PR1 axis as a promising molecular and therapeutic target in chemotherapy-induced painful peripheral neuropathy, establish a mechanistic insight into the biomolecular signaling pathways, and provide the rationale for the clinical evaluation of FTY720 in chronic pain patients.Item Effectiveness of biomedical interventions on the chronic stage of traumatic brain injury: a systematic review of randomized controlled trials(Frontiers Media, 2024-03-18) Kawata, Keisuke; Rettke, Devin J.; Thompson, Christopher; Mannix, Rebekah; Bazarian, Jeffrey J.; Datta, Dibyadyuti; Exercise & Kinesiology, School of Health and Human SciencesTraumatic brain injury (TBI), in any form and severity, can pose risks for developing chronic symptoms that can profoundly hinder patients’ work/academic, social, and personal lives. In the past 3 decades, a multitude of pharmacological, stimulation, and exercise-based interventions have been proposed to ameliorate symptoms, memory impairment, mental fatigue, and/or sleep disturbances. However, most research is preliminary, thus limited influence on clinical practice. This review aims to systematically appraise the evidence derived from randomized controlled trials (RCT) regarding the effectiveness of pharmacological, stimulation, and exercise-based interventions in treating chronic symptoms due to TBI. Our search results indicate that despite the largest volume of literature, pharmacological interventions, especially using neurostimulant medications to treat physical, cognitive, and mental fatigue, as well as daytime sleepiness, have yielded inconsistent results, such that some studies found improvements in fatigue (e.g., Modafinil, Armodafinil) while others failed to yield the improvements after the intervention. Conversely, brain stimulation techniques (e.g., transcranial magnetic stimulation, blue light therapy) and exercise interventions were effective in ameliorating mental health symptoms and cognition. However, given that most RCTs are equipped with small sample sizes, more high-quality, larger-scale RCTs is needed.Item Greater inhibition of female rat binge alcohol intake by adrenergic receptor blockers using a novel Two-Shot rat binge drinking model(Springer Nature, 2024-06-18) De Oliveira Sergio, Thatiane; Smith, Rebecca Jane; Wean, Sarah E.; Engleman, Eric A.; Hopf, Frederic W.; Psychiatry, School of MedicineBinge drinking (BD) contributes strongly to the harms of alcohol use disorder. Most rodent models do not result in binge-level blood alcohol concentrations (BACs), and to better understand individual and sex differences in neurobiological mechanisms related to BD, the use of outbred rat strains would be valuable. Here, we developed a novel BD model where after 3+ months of intermittent access to 20% alcohol Wistar rats drank, twice a week, with two 5-min intake (what we called Two-shot) separated by a 10-min break. Our findings showed during Two-Shot that most animals reached ≥ 80 mg% BAC levels (when briefly food-restricted). However, when increasing alcohol concentrations from 20 to 30%, 40%, or 50%, rats titrated to similar intake levels, suggesting rapid sensing of alcohol effects even when front-loading. Two-Shot drinking was reduced in both sexes by naltrexone (1 mg/kg), validating intake suppression by a clinical therapeutic agent for human problem drinking. Further, both propranolol (β-adrenergic receptor antagonist) and prazosin (α1-adrenergic receptor antagonist) reduced female but not male BD at the lower dose. Thus, our results provide a novel model for BD in outbred rats and suggest that female binging is more sensitive to adrenergic modulation than males, perhaps providing a novel sex-related therapy.Item Guns, not roses – here’s the true story of penicillin’s first patient(The Conversation US, Inc., 2022-03-11) Sullivan, BIllItem Identification and functional characterization of genetic variants in the human indoleamine 2, 3-dioxygenase (INDO) gene(2008-10-13T18:43:27Z) Arefayene, Million; Flockhart, David A.; Vasko, Michael R.; Queener, Sherry F.; Safa, Ahmad R.; Wilkes, David S.Indoleamine 2,3-dioxygenase (IDO) is a rate limiting enzyme in tryptophan catabolism that has been implicated in the pathogenesis of a number of diseases. Large interindividual variability in IDO activity in the absence of stimuli and as the result of therapy induced changes has been reported. This variability has the potential to contribute to susceptibility to disease and to interindividual variability in therapeutic response. To identify genetic variations that might contribute to interindividual variability in IDO activity, we resequenced the exons, intron/exon borders and 1.3 kb of the 5’-flanking region of the INDO gene in 48 African-American (AA) and 48 Caucasian-American (CA) subjects from the Coriell DNA Repository. A total of 24 INDO variants were identified. Seventeen of these were in exons, introns, or exon/intron boundries, while seven were within 1.3 kb upstream of the translation start site. Seventeen are novel and 7 were previously identified. When transiently expressed in COS-7 or HEK293 cells the amino acid sequence change in Arg77His resulted in significant decrease in activity, and it reduced the Vmax of IDO. The Arg77His variant and the 9 bp deletion resulted in nearly complete loss of enzyme activity and a lack of detectable protein expression. The function of the Arg77His variant IDO was restored in a dose dependent manner by the heme analog hemin; but there was no associated increase in IDO protein. Cellular heme concentration was higher in cells transfected with the wild type and Ala4Thr variant constructs, but not in cells transfected with the Arg77His variant. The heme synthesis inhibitor, succinylacetone (SA), blocked IDO activity in cells transfected with Arg77His. We identified 22 putative transcription binding sites within the 1.3 kb upstream of the translation start site. Two of the SNPs were located in GATA3 and FOXC1 sites. A specific 3-SNP haplotype reduced promoter activity when transiently transfected into 2 different cell lines. We conclude that there are naturally occurring genetic variants in the INDO gene which affect both expression and activity. These results make clear that interindividual variability in IDO activity at baseline or in response to therapy may be in part due to inherited genetic variability.