• Title/Summary/Keyword: Drug Interaction

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Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial

  • Yong-Joon Lee;Yongsung Suh;Jung-Sun Kim;Yun-Hyeong Cho;Kyeong Ho Yun;Yong Hoon Kim;Jae Young Cho;Ae-Young Her;Sungsoo Cho;Dong Woon Jeon;Sang-Yong Yoo;Deok-Kyu Cho;Bum-Kee Hong;Hyuckmoon Kwon;Sung-Jin Hong;Chul-Min Ahn;Dong-Ho Shin;Chung-Mo Nam;Byeong-Keuk Kim;Young-Guk Ko;Donghoon Choi;Myeong-Ki Hong;Yangsoo Jang;TICO investigators
    • Korean Circulation Journal
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    • v.52 no.4
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    • pp.324-337
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    • 2022
  • Background and Objectives: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Methods: In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). Results: Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76-4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98; p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Conclusions: In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.

Attitudes of Western Medicine Doctors and Korean Medicine Doctors toward Korean Medicine Education for Cooperative Practices (한양방 협진을 위한 한의학 교육에 대한 의사 한의사의 인식조사)

  • Han, Gyungyeon;Gu, Hyungyung;Yun, Youngju
    • The Journal of Korean Medicine
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    • v.34 no.1
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    • pp.160-169
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    • 2013
  • Objectives: This survey was performed to investigate attitudes of western medicine doctors (WMD) and Korean medicine doctors (KMD) toward Korean medicine education (KME) to provide basic data for developing effective KME programs. Methods: We selected study objects in western medicine (WM) - Korean medicine (KM) collaborative institutions and structured questionnaires were administered to both WMD and KMD for comparison. The data from 167 WMD and 135 KMD were analyzed statistically by frequency, ${\chi}^2$ test and T-test analysis. Results: 61.1% of WMD have never experienced KME and 15% were not interested in cooperative practices and research. Most KME was done in medical schools (45%) and only 5% in residency education. WMD interested or experienced in cooperation have had more KME than the uninterested and inexperienced groups. Intentions of WMD to cooperative practices and research made a difference on the willingness to take KME, while relevant experiences didn't. WMD and KMD differed in ideas about major KME topics; WMD put the greatest emphasis on the herb-drug interaction, while KMD did on KM diagnosis and treatment. They also have different views on the optimal KME course load. Conclusions: For successful collaboration, more continuing KME and motivation for cooperation is required for WMD. Improvements are also needed in the form and contents of KME to meet the demands of learners.

Characterization of Functional Domains in NME1L Regulation of NF-κB Signaling

  • You, Dong-Joo;Park, Cho Rong;Mander, Sunam;Ahn, Curie;Seong, Jae Young;Hwang, Jong-Ik
    • Molecules and Cells
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    • v.39 no.5
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    • pp.403-409
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    • 2016
  • NME1 is a well-known metastasis suppressor which has been reported to be downregulated in some highly aggressive cancer cells. Although most studies have focused on NME1, the NME1 gene also encodes the protein (NME1L) containing N-terminal 25 extra amino acids by alternative splicing. According to previous studies, NME1L has potent anti-metastatic activity, in comparison with NME1, by interacting with $IKK{\beta}$ and regulating its activity. In the present study, we tried to define the role of the N-terminal 25 amino acids of NME1L in $NF-{\kappa}B$ activation signaling. Unfortunately, the sequence itself did not interact with $IKK{\beta}$, suggesting that it may be not enough to constitute the functional structure. Further construction of NME1L fragments and biochemical analysis revealed that N-terminal 84 residues constitute minimal structure for homodimerization, $IKK{\beta}$ interaction and regulation of $NF-{\kappa}B$ signaling. The inhibitory effect of the fragment on cancer cell migration and $NF-{\kappa}B$-stimulated gene expression was equivalent to that of whole NME1L. The data suggest that the N-terminal 84 residues may be a core region for the anti-metastatic activity of NME1L. Based on this result, further structural analysis of the binding between NME1L and $IKK{\beta}$ may help in understanding the anti-metastatic activity of NME1L and provide direction to NME1L and $IKK{\beta}$-related anti-cancer drug design.

Application and Prospects of Molecular Imaging (분자영상의 적용분야 및 전망)

  • Choi, Guyrack;Lee, Sangbock
    • Journal of the Korean Society of Radiology
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    • v.8 no.3
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    • pp.123-136
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    • 2014
  • In this paper, we study to classify molecular imaging and applications to predict future. Molecular imaging in vivo at the cellular level and the molecular level changes taking place to be imaged, that is molecular cell biology and imaging technology combined with the development of the new field. Molecular imaging is used fluorescence, bioluminescence, SPECT, PET, MRI, Ultrasound and other imaging technologies. That is applied to monitoring of gene therapy, cell tracking and monitoring of cell therapy, antibody imaging, drug development, molecular interaction picture, the near-infrared fluorescence imaging of cancer using fluorescence, bacteria using tumor-targeting imaging, therapeutic early assessment, prediction and therapy. The future of molecular imaging would be developed through fused interdisciplinary research and mutual cooperation, which molecular cell biology, genetics, chemistry, physics, computer science, biomedical engineering, nuclear medicine, radiology, clinical medicine, etc. The advent of molecular imaging will be possible to early diagnosis and personalized treatment of disease in the future.

Implementation of Ontology-based Clinical Decision Support System for Management of Interactions Between Antihypertensive Drugs and Diet (항고혈압제-식이 상호작용 관리를 위한 온톨로지 기반의 임상의사결정지원시스템 구현)

  • Park, Jeong-Eun;Kim, Hwa-Sun;Chang, Min-Jung;Hong, Hae-Sook
    • Journal of Korean Academy of Nursing
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    • v.44 no.3
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    • pp.294-304
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    • 2014
  • Purpose: The influence of dietary composition on blood pressure is an important subject in healthcare. Interactions between antihypertensive drugs and diet (IBADD) is the most important factor in the management of hypertension. It is therefore essential to support healthcare providers' decision making role in active and continuous interaction control in hypertension management. The aim of this study was to implement an ontology-based clinical decision support system (CDSS) for IBADD management (IBADDM). We considered the concepts of antihypertensive drugs and foods, and focused on the interchangeability between the database and the CDSS when providing tailored information. Methods: An ontology-based CDSS for IBADDM was implemented in eight phases: (1) determining the domain and scope of ontology, (2) reviewing existing ontology, (3) extracting and defining the concepts, (4) assigning relationships between concepts, (5) creating a conceptual map with CmapTools, (6) selecting upper ontology, (7) formally representing the ontology with Protege (ver.4.3), (8) implementing an ontology-based CDSS as a JAVA prototype application. Results: We extracted 5,926 concepts, 15 properties, and formally represented them using Protege. An ontology-based CDSS for IBADDM was implemented and the evaluation score was 4.60 out of 5. Conclusion: We endeavored to map functions of a CDSS and implement an ontology-based CDSS for IBADDM.

Interaction of Cu(II)-meso-tetrakis(n-N-methylpyridiniumyl)porphyrin (n = 2,3,4) with Native and Synthetic Polynucleotides Probed by Polarized Spectroscopy

  • Lee, Mi-Jin;Lee, Gil-Jun;Lee, Dong-Jin;Kim, Seog-K.;Kim, Jong-Moon
    • Bulletin of the Korean Chemical Society
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    • v.26 no.11
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    • pp.1728-1734
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    • 2005
  • The interactions of Cu(II)-meso-Tetrakis(n-N-methylpyridiniumyl)porphyrin (n = 2,3,4), respectively referred to as o-, m- and p-CuTMPyP, and DNA, poly$[d(A-T)_2]$ and poly$[d(G-C)_2]$ were investigated by circular and linear dichroism (CD and LD). In the o-CuTMPyP case, in which the rotation of the pyridinium ring is prevented, the shape of the CD spectrum when associated to DNA and poly$[d(A-T)_2]$ resembles and is characterized by a positive band at a low drug to DNA concentration ratio (R ratio) and is bisignate at a high R ratio. The former CD spectrum shape has been attributed to porphyrin that is bound monomerically outside of DNA while the latter can be attributed to those that are stacked. When o-CuTMPyP is bound to poly$[d(G-C)_2]$, the excitonic CD appeared at a relatively high R ratio. In contrast, a characteristic negative CD band in the Soret region was apparent for both m- and p-CuTMPyP when bound to DNA and poly$[d(G-C)_2]$ at the low R ratios, indicating that the porphyrin molecule intercalates. However, the DNA is bent near the intercalation site and the plane of the porphyrin molecule tilts relative to the DNA helix axis, as judged by the magnitude of the reduced LD. Various stacking patterns were identified by the shape of the CD spectrum for m- and p-CuTMPyP when bound to poly$[d(A-T)_2]$. Three species for the former complex and two for the latter complex were found which may reflect the extent of the stacking.

Development of recombinant human chorionic gonadotropin (hCG) using high-density culture technique of suspension-adapted chinese hamster ovary (CHO) cells

  • Na, Kyu-Heum;Kim, Seung-Chul;Seo, Kwang-Seok;Lee, Sung-Hee;Kang, Soo-Hyung
    • 한국생물공학회:학술대회논문집
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    • 2005.04a
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    • pp.37-37
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    • 2005
  • Human chorionic gonadotropin (hCG) is a heterodimeric glycoprotein hormone consisting of non-covalently linked two subunits, the ${\alpha}$ and ${\beta}$ subunit. It has been used as a infertility drug for ovulation to mimic luteinizing hormone $(LH).^{1)}$ A stable cell line was established by transfection of Rc/CMV-i-dhfr-hCG, expression vector containing hCG ${\alpha}-$ and ${\beta}-genes$, into dihydrofolate reductase-deficient CHO cells and subesquent methotrexate-mediated gene amplification. Anchorage-dependent CHO cells were adapted into a serum-free and/or animal component-free suspension medium through gradual serum weaning for the hCG production. The established cell line showed typical morphological characteristics and growth profile of CHO cells, and could produce FSH with passage-to-passage consistency. The high density perfusion culture of the CHO cells was carried out in Celligen Plus bioreactor equipped with a spin-filter as a internal cell retention device. The cell density reached up to $>1x10^{7}$ cells/ml in less than 7 days and a perfusion-control strategy based on cellular consumption rates of glucose was $established.^{2)}$ Biologically active recombinant hCG was purified by a series of chromatographic steps including anion exchange chromatography and hydrophobic interaction chromatography to homogeneity. The highly purified recombinant hCG was characterized for physicochemical, immunological and biological properties.

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Effect of Herbal Medicines Including Licorice on Serum Potassium Levels (감초가 포함된 한약 복용 시 혈중 포타슘 수치의 저하에 영향을 미치는 요인)

  • Bae, Jeong-Hwa;Kim, Jung-Tae;Chung, Sung-Hyun
    • Korean Journal of Clinical Pharmacy
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    • v.22 no.2
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    • pp.153-159
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    • 2012
  • Licorice is a very useful herbal medicine frequently prescribed, but glycyrrhizin, one of its components, can cause pseudoaldosteronism presenting hypokalemia, metabolic alkalosis and hypertension as a result of prolonging a biological half-life of systemic steroid by strongly inhibiting the enzyme $11{\beta}$-hydroxysteroid dehydrogenase type 2. The risk factors for this side effect are still unclear. Here, 479 hospitalized patients taking herbal medicines including licorice for more than five days were recruited to analyze their serum potassium levels, under following parameters ; age and gender of patient, dose and period of licorice, disease state such as hypertension and with or without diuretics. They were divided into the non-occurrence group (over 3.5 mEq/L) and the occurrence group (under 3.5 mEq/L) of hypokalemia based on serum potassium levels during hospitalization. The average ages of the non-occurrence group and the occurrence group were $52.6{\pm}17.8$ and $68{\pm}10.5$, respectively (p < 0.001). But there were no noticeable differences in the daily dose of licorice, days of taking, and total dose between groups. Regression analysis showed that odd ratio of age (>60) and taking diuretics inducing hypokalemia was 3.5 (95%CI 1.5-8.1), 4.6 (95%CI 2.0-10.9) that indicates significant correlation with hypokalemia. Based upon this analysis, it is imperative to monitor regularly the risk of pseudoaldosteronism or hypokalemia not only when administered licorice of high dose for long period but also when combined it with diuretics causing hypokalemia to the elderly patients over 60 year old.

Socioeconomic impact of traditional Korean medicine, Pyeongwee-San (KMP6) as an anti-allergic inflammatory drug

  • Song, Young-Hoon;Nam, Sun-Young;Choi, Young-Jin;Kim, Jeong-Hwa;Kim, Young-Sick;Jeong, Hyun-Ja
    • CELLMED
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    • v.2 no.3
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    • pp.29.1-29.9
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    • 2012
  • The prevalence of allergic disease has been increasing over the past few decades in the majority of Western industrialized nations. There are some socioeconomic disparities regarding allergic disease status and management. Pyeongwee-San (KMP6) is Korean medicine for the treatment of gastrointestinal tract disease. It is known that KMP6 has an improving effect on the spleen and stomach functions in traditional Korean medical theory. Here, we hypothesized that KMP6 could be used to regulate the inflammatory reaction. We show the molecular mechanisms of Pyeongwee-San (KMP6) on inflammatory reactions. A molecular docking simulation showed that hesperidin, component of KMP6, regulate the enzymatic activity by interaction in the active site of caspase-1. KMP6 control the activity of caspase-1 in activated human mast cell line (HMC-1 cells). KMP6 reduced the expression of receptor interacting protein (RIP)-2 in HMC-1 cells. Thymic stromal lymphopoietin protein production and mRNA expression were inhibited by KMP6. In the activated HMC-1 cells, KMP6 suppressed the activation of mitogen-ativated protein kinase and nuclear factor-kappaB. In addition, KMP6 significantly inhibited the expression of inflammatory cytokines. Our findings indicate that KMP6 may attenuate allergic reactions via the regulation of caspase-1/RIP-2 signaling pathway. These studies will help advance the social welfare system.

Pharmacokinetic Drug Interaction between Carvedilol and Ticlopidine in Rats

  • Choi, Jun-Shik;Choi, Dong-Hyun
    • Biomolecules & Therapeutics
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    • v.18 no.3
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    • pp.343-349
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    • 2010
  • This study was designed to investigate the effects of ticlopidine on the pharmacokinetics of carvedilol after oral or intravenous administration of carvedilol in rats. Carvedilol was administered orally (3 mg/kg) or intravenously (1 mg/kg) without or with oral administration of ticlopidine (4, 12 mg/kg) to rats. The effects of ticlopidine on P-glycoprotein (P-gp) and cytochrome P450 (CYP) 2C9 activity were also evaluated. Ticlopidine inhibited CYP2C9 activity in a concentration-dependent manner with 50% inhibition concentration ($IC_{50}$) of $25.2\;{\mu}M$. In addition, ticlopidine could not significantly enhance the cellular accumulation of rhodamine 123 in MCF-7/ADR cells overexpressing P-gp. Compared with the control group (given carvedilol alone), the area under the plasma concentration-time curve (AUC) was significantly (12 mg/kg, p<0.05) increased by 14-41%, and the peak concentration ($C_{max}$) was significantly (12 mg/kg, p<0.05) increased by 10.7-73.3% in the presence of ticlopidine after oral administration of carvedilol. Consequently, the relative bioavailability (R.B.) of carvedilol was increased by 1.14- to 1.41-fold and the absolute bioavailability (A.B.) of carvedilol in the presence of ticlopidine was increased by 36.2-38.5%. Compared to the i.v. control, ticlopidine could not significantly change the pharmacokinetic parameters of i.v. administered carvedilol. The enhanced oral bioavailability of carvedilol may result from inhibition of CYP2C9-mediated metabolism rather than P-gpmediated efflux of carvedilol in the intestinal and/or in liver and renal eliminatin of carvedilol by ticlopidine.