Comparative receptor mapping of serotoninergic 5-HT3 and 5-HT4 binding sites

The clinical use of currently available drugs acting at the 5-HT4 receptor has been hampered by their lack of selectivity over 5-HT3 binding sites. For this reason, there is considerable interest in the medicinal chemistry of these serotonin receptor subtypes, and significant effort has been made towards the discovery of potent and selective ligands. Computer-aided conformational analysis was used to characterize serotoninergic 5-HT3 and 5-HT4 receptor recognition. On the basis of the generally accepted model of the 5-HT3 antagonist pharmacophore, we have performed a receptor mapping of this receptor binding site, following the active analog approach (AAA) defined by Marshall. The receptor excluded volume was calculated as the union of the van der Waals density maps of nine active ligands (pKi > or = 8.9), superimposed in pharmacophoric conformations. Six inactive analogs (pKi < 7.0) were subsequently used to define the essential volume, which in its turn can be used to define the regions of steric intolerance of the 5-HT3 receptor. Five active ligands (pKi > or = 9.3) at 5-HT4 receptors were used to construct an antagonist pharmacophore for this receptor, and to determine its excluded volume by superimposition of pharmacophoric conformations. The volume defined by the superimposition of five inactive 5-HT4 receptor analogs that possess the pharmacophoric elements (pKi < or = 6.6) did not exceed the excluded volume calculated for this receptor. In this case, the inactivity may be due to the lack of positive interaction of the amino moiety with a hypothetical hydrophobic pocket, which would interact with the voluminous substituents of the basic nitrogen of active ligands. The difference between the excluded volumes of both receptors has confirmed that the main difference is indeed in the basic moiety. Thus, the 5-HT3 receptor can only accommodate small substituents in the position of the nitrogen atom, whereas the 5-HT4 receptor requires more voluminous groups. Also, the basic nitrogen is located at ca. 8.0 A from the aromatic moiety in the 5-HT4 antagonist pharmacophore, whereas this distance is ca. 7.5 A in the 5-HT3 antagonist model. The comparative mapping of both serotoninergic receptors has allowed us to confirm the three-component pharmacophore accepted for the 5-HT3 receptor, as well as to propose a steric model for the 5-HT4 receptor binding site. This study offers structural insights to aid the design of new selective ligands, and the resulting models have received some support from the synthesis of two new active and selective ligands: 24 (Ki(5-HT3) = 3.7 nM; Ki(5-HT4) > 1000 nM) and 25 (Ki(5-HT4) = 13.7 nM; Ki(5-HT3) > 10,000 nM).     

Suitability of gingival indices for use in therapeutic trials. Is bleeding a sine qua non?

A number of gingival indices have been described which include visual and invasive components, either separately or in combination. In selecting indices for use in gingivitis therapeutic trials, some investigators maintain that only invasive indices should be used, since indices that include a bleeding-on-provocation component are deemed to be the most objective. Other investigators, however, maintain that non-invasive indices are the more appropriate insofar as invasive procedures will not only disrupt the plaque at the gingival margin, but could also mildly traumatize the tissue and present an impediment to assessing examiner standardization and reproducibility. This paper discusses these aspects of gingivitis evaluation. The data indicate that all validated indices, whether invasive or non-invasive, have some degree of both objectivity and subjectivity. Therefore, the selection of an appropriate index will depend upon the ability of a given index to achieve the objectives of the clinical trial in which it is to be utilized.     

Scorpion toxins: tools for studying K+ channels

Over the last period of time, a large number of scorpion toxins have been characterized. These peptidyl inhibitors of K+ channels have been very useful as probes for determining the molecular architecture of these channels, for purifying channels from native tissue and determining their subunit composition, for developing the pharmacology of K+ channels, and for determining the physiologic role that K+ channels play in target tissues. The large knowledge that we have developed regarding K+ channel function would not have been possible without the discovery of these peptidyl inhibitors. It is expected that as more novel peptides are discovered, our understanding of K+ channel structure and function will be further enhanced.     

Lifestyle, gender and occupational status as determinants of dental health behavior

A 23-year-old patient suffered from episodic angioedema of the face and neck, accompanied by diarrhea and abdominal pain. Additionally, the patient had bronchial asthma, recurrent nasal polyps and allergic rhinoconjunctivitis. Blood examination revealed leucocytosis with eosinophilia. Histological studies showed eosinophilic infiltrates in the skin and the gastrointestinal mucosa. Allergic food reactions and parasites were ruled out. With systemic corticosteroid treatment, the clinical symptoms and the eosinophilia disappeared. This case shows some parallels to previously described syndromes (eosinophilic gastroenteritis, Samter's syndrome, episodic angioedema with eosinophilia), but to the best of our knowledge this combination of symptoms has not yet been reported.     

Rationale for banning abortions late in pregnancy

Chronic myelogenous leukemia (CML) is a myelo-proliferative disorder which, after a chronic phase which lasts an average of 3 years, evolves into an acute disease which is resistant to chemotherapy. Nevertheless, a few studies have reported cases in which partial or complete hematologic, cytogenetic and/or molecular remission of the disease were observed either spontaneously or after non intensive chemotherapy, with or without medullar aplasia. Some of these patients later relapsed into a blast crisis. We report a case of CML with clinical and hematologic remission for 19 years after two cycles of busulphan not causing medullar aplasia, negative for the BCR/ABL gene by Southern blot but with the gene's mRNA detectable by hot start nested RT-PCR.     

Polycystic ovary syndrome: evidence for reduced sensitivity of the gonadotropin-releasing hormone pulse generator to inhibition by estradiol and progesterone

Plasma LH is commonly elevated in women with the polycystic ovary syndrome (PCOS), but the underlying mechanisms are uncertain. We tested the hypothesis that the elevated LH in part reflects a reduced sensitivity of the hypothalamic GnRH pulse generator to suppression by estradiol (E2) and progesterone (P). In an initial protocol, normal controls (beginning on cycle days 8-10) and women with PCOS were given E2 transdermally and P by vaginal suppository (three times daily), to achieve plasma concentrations similar to those in the midluteal phase of an ovulatory cycle, for 21 days. Blood was obtained at 10-min intervals for 12 h before and on days 5, 10, 20, and 28 (7 days after E2 and P were discontinued). LH pulse amplitude and LH pulse frequency were suppressed in both PCOS and normal controls, but LH pulse frequency fell more rapidly in controls and was lower by day 10 (P < 0.05). Based on this time course a dose-response study was performed, in which E2 in constant dosage and varying concentrations of P were administered for 7 days. Pulsatile LH release was appraised on days 1 and 7. The frequency of LH pulse secretion was reduced in controls and was lower than that in patients with PCOS on day 7 (P < 0.0001). Plasma P concentrations of 13-15 ng/mL suppressed LH pulse frequency to a similar degree in PCOS and controls. In contrast, lower concentrations (P < 10 ng/mL) were more effective in suppressing GnRH/LH pulse frequency in controls (by > 45% of basal) than in PCOS (< 40%; P < 0.01). The data indicate that E2 and P can inhibit the activity of the hypothalamic GnRH pulse generator in women with PCOS. However, higher plasma concentrations of P were required to reduce GnRH/LH pulse frequency in PCOS compared to controls, suggesting an insensitivity of the GnRH pulse generator to suppression by E2 and P. These results suggest that an abnormality in the regulation of hypothalamic GnRH secretion is present in PCOS and may be a factor in the etiology of the disorder in adolescence.