When athletes consult sports outpatient or orthopedic clinics it is possible to undergo drug treatment with the medical staff having prior knowledge of that patient being an athlete. However, if athletes seek any other diagnosis and treatment as an ordinary patient, the possibility of medical staff realizing the potential for imposing a doping issue on the athlete is extremely low. As a result, if the athlete fails to provide medical staff with information regarding anti-doping regulations when receiving clinical treatment, drug treatment administered as part of medical practices could be viewed as doping, resulting in the athlete being disciplined. In order to avoid this, pharmacist should participate in training in order to be able to provide information for anti-doping purposes. It is my personal opinion that knowledge regarding anti-doping is something that should be shared by all pharmacists, as pharmacists are educated in the fields of pharmacology and pharmacokinetics during the pharmacy education process, and sports pharmacology is a part of this. However, in order for pharmacists to understand sports pharmacology, it is necessary to provide education not only on the benefits and adverse effects of pharmaceutical products, but also on the concept of banned substances. It can be considered one of the pharmacist's duties to protect athletes who purchase drugs at a pharmacy or consult medical institutions as patients. With this, I would like to propose considering the potential for introducing sports pharmacology to pharmaceutical education, and specialist pharmacist training in the sports spectrum.
In our unprecedented ageing society, high quality pharmacy practices are recommended; the activities of pharmacists who have received novel education are therefore expected. Although advanced education before graduation is important, postgraduate education is also required because the knowledge and skill required by pharmacists are increasing and are progressing everyday. The period of pharmacist education has been six years, and the new educational system produces next generation pharmacists. Postgraduate education should be established with the education contents corresponding to the new education system. The career path has an important role in postgraduate education, which consists of fundamental to advanced training through the various stages according to pharmacist experience. Clinical academic societies and some pharmacists' organizations provide accreditation systems for pharmacist specialties. This system will play an important role as a route in the career path. It is necessary to accredit pharmacist specialties to establish postgraduate education and research in cooperation with pharmaceutical institutions. It is thought that the responsibility of universities of pharmaceutical science will become more important to improve pharmacist ability and pharmacy practice. Universities of pharmaceutical science should collaborate with pharmaceutical institutions to establish postgraduate education and research into clinical pharmacy practice.
In Japan, recent initiation of the reimbursement from the government to monitor patients in intensive care unit (ICU) and the foundation of certified emergency medicine and critical care specialist resulted in the increased number of ICU pharmacists. Because most pharmacy schools in Japan have provided few lectures or rotations related to critical care, pharmacy students may think critical care is a difficult field. Pharmacy students in the United States usually have basic didactic courses for critical care such as sepsis or sedation. They can also take critical care rotations as an elective advanced rotation. An organized postgraduate training programs, pharmacy practice residency programs (PGY1; post graduate year 1) and specialized pharmacy practice residency programs (PGY2), develop clinical knowledge and skills as clinical pharmacists. Critical care is one of the most popular areas in PGY2 specialty residency programs. Through three years pharmacy students and residents can develop required knowledge and skills in critical care such as patient monitoring skill. As a part of new pharmacists training, our institution provides a week of critical care rotation. The main objective is the introduction of critical care to be a pharmacy generalist and to develop patient monitoring skills. The critical care rotation is the first step to develop critical care clinical pharmacy specialists in the future.
Anyone may get infectious diseases without depending on normal persons or patients. We have the probability of infection in hospital or in community. Pharmacists need to have knowledge of the infection control from the viewpoint to contribute to sanitary improvement and an increase, and to secure the healthy life of the nation. And it is necessary to participate in prevention of hospital infection and infectious disease treatment. However, Faculty of Pharmaceutical Sciences six years system education or postgraduate education is not enough for the education of infection control to pharmacists. Therefore, in Nagasaki University Hospital, three Board Certified Infection Control Pharmacy Specialists (BCICPS) play a starring role in educating about the infection control for pharmacists. They lecture on the basic idea of nosocomial infection control and antibacterial chemotherapy, and perform the instruction by the practical skill about the hand antisepsis. We enhance the education effect by carrying out courses on lectures and practical skills. In this symposium, I introduce educational activities in the Nagasaki University Hospital.
The concept of drug delivery systems (DDS) promises the treatments for the refractory diseases such as cancer. Many kinds of multifunctional DDS have been developed, demonstrating enhanced drug accumulation and therapeutic efficiency. However, it is quite difficult to evaluate that the DDS really perform as expected under in vivo conditions. We have recently developed the intravital real-time confocal laser scanning microscopy (IVRTCLSM) characterized by rapid scanning and simultaneous multicolor detection, to visualize the behavior of DDS in living mice. IVRTCLSM revealed the dynamic states of DDS, which could not be observed by conventional in vitro/ex vivo methods, in the bloodstream, tumors, and other organs. IVRTCLSM will provide new facets in the DDS study, and will facilitate the development of DDS.
The development of a carrier for the delivery of siRNA is a factor in the realization of RNA interference (RNAi) therapeutics. Modification of siRNA carriers with polyethylene glycol, i.e., PEGylation, is a general strategy for stabilizing a particle in the blood stream and delivering it to tissue or cells. However, it is well-known that, when a carrier is modified by PEGylation, it results in a significant inhibition of both cellular uptake and the endosomal escape process. In a previous study, we reported on the development of a multifunctional envelope-type nano device (MEND) for delivering siRNA and peptide-based functional devices for overcoming the effects conferred by PEGylation and succeeded in the delivery of siRNA to tumor tissue. In this study, we noticed that the pH-sensitive property, changing from neutral to cationic in response to a decrease in pH, could avoid the inhibition caused by PEGylation and succeeded in synthesizing a pH-sensitive cationic lipid, YSK05. The YSK05-MEND had a higher fusogenicity and potency for endosomal escape than other MENDs containing conventional cationic lipids. The PEGylated YSK05-MEND induced efficient gene silencing and avoided the inhibition of endosomal escape caused by PEGylation followed by optimization of the lipid composition. Furthermore, the intratumoral injection of the PEGylated YSK05-MEND resulted in a more efficient gene silencing compared with MENDs containing conventional cationic lipids. Thus, the YSK05-MEND is a promising siRNA carrier for avoiding the inhibition in intracellular trafficking caused by PEGylation both in vitro and in vivo.
Nucleic acids like siRNA and pDNA are remarkable for treatment of ophthalmic diseases in posterior segment of eye such as age-related macular degeneration (AMD). However, hydrophilic and high molecule compounds are restricted in intraocular distribution through anterior segment of the eye. In addition, the ocular tissue has a blood-retinal barrier which restricts drug delivery thorough systemic administration. Therefore the invasive intravitreal injection has been generally applied for treatment of retinal diseases. The objective in this study is to prepare nucleic acid-loaded liposomes for effective gene delivery to posterior segment of eye by non-invasive ophthalmic administration such as eye-drops. The pDNA/PEI-complex loaded liposomes were prepared using detergent removal method. The obtained liposomes were lyophilized with optimal amount of a cryoprotectant to avoid changes in physical properties and, followed by adjustment of an appropriate volume and osmotic pressure as ophthalmic solution. The liposomes show high pDNA encapsulation efficiency and good cellular uptake ability in human retinal pigment epithelial cells (ARPE-19 cells). We further demonstrate that the modification of ligand which binds to specific receptor on the RPE cells to the liposomes may improve gene delivery efficacy to the posterior segment of eye by non-invasive ocular instillation.
In the development of nucleic acid medicines such as small interfering RNA (siRNA) drugs, one problem is how to study the pharmacokinetics and pharmacodynamics, since the precise in vivo behavior of siRNA is hard to detect. In this research, to establish a highly sensitive detection system of siRNA biodistribution in the whole body, the technology of positron imaging was applied. First, a one-step synthetic method in which double-stranded siRNA was directly labeled by a positron emitter, 18F, was developed. By using [18F]-labeled siRNA ([18F]-siRNA), the complex of siRNA and polycation liposomes (PCL) containing dicetylphosphate tetraethylenepentamine (TEPA-PCL) was prepared. Then, the biodistribution of the siRNA after intravenous administration to mice was analyzed by planar positron imaging system (PPIS). As a result, whereas naked [18F]-siRNA was immediately excreted in mouse bladder after administration, the complex with cationic liposome (CL) was trapped in the lungs. Furthermore, [18F]-siRNA carried with PEGylated CL (PL) was distributed throughout the body, suggesting that it circulated in the bloodstream for an extended period of time. Additionally, PET imaging revealed more detailed biodistribution of the siRNA than in vivo imaging system (IVIS) because PET imaging is not affected by the depth variation of target tissues. On the other hand, to induce high accumulation of siRNAs against c-myc, MDM2, and VEGF in tumor tissue, a tumor-targeting probe, RGD peptide, was grafted at the top of PEG chain in PEGylated TEPA-PCL and the effect of the complex on experimental lung metastasis of B16 melanoma was examined. The complex suppressed the progression of tumor. We believe that the positron imaging data would support the development of siRNA agent for clinical use.
Muscular dystrophies are a group of heterogeneous diseases that are characterized by progressive muscle weakness, wasting and degeneration. These muscular deficiencies are often caused by the loss of the protein dystrophin, a crucial element of the dystrophin-glycoprotein complex of muscle fibers. Duchenne muscular dystrophy (DMD) is a fatal, X-linked muscular disease that occurs in 1 out of every 3500 males. Therefore, feasible strategies for replacing or repairing the defective gene are required; however, to date, no effective therapeutic strategies for muscular dystrophies have been established. In this review, we first introduce gene therapies mediated by adeno-associated viruses (AAVs) including a functional dystrophin cDNA or antisense oligonucleotide (AO)-induced exon-skipping therapies, which are designed to exclude the mutated or additional exon(s) in the defective gene and thereby correct the translational reading frame. Recently, we developed “Bubble liposomes” (BLs), which are polyethylene glycol (PEG)-modified liposomes entrapping echo-contrast gas that is known as ultrasound (US) imaging gas. BL application combined with US exposure can function as a novel gene delivery tool, and we demonstrate that the US-mediated eruption of BLs is a feasible and efficient technique to deliver plasmid DNA or AOs for the treatment of muscular dystrophies.
Gene therapy is an attractive strategy, for not only targeting nuclear genome, but the mitochondrial genome as well. Human mitochondrial DNA (mtDNA) encodes 13 subunits of the electron transport chain, 22 tRNAs, and 2 rRNAs and their mutations cause a wide range of mitochondrial diseases. Each cell contains hundreds to thousands of mtDNAs, and in the case of a diseased cell, the mitochondrion possesses both mutant mtDNA and wild-type mtDNA. It is generally accepted that the disease phenotype appears when the proportion of the pathogenic mutant mtDNA exceeds a certain threshold. Therefore, the suppression of mutant mtDNA or supplementing wild-type mtDNA will control the onset of mitochondrial disease. To achieve the transfection of an exogenous therapeutic gene to the mitochondrial matrix where mtDNA is transcribed and translated, it is necessary to transfer cargos through mitochondrial outer and inner membranes. Several methods have been examined for mitochondrial transfection, but a universal, wide-ranging transfection technique has yet not been established. We recently developed a mitochondrial targeting delivery system, namely the MITO-Porter. The MITO-Porter is liposomal nanocarrier with a mitochondrial fusogenic lipid composition. We reported that the MITO-Porter could deliver chemical compounds and proteins to the mitochondrial matrix via membrane fusion. In this review, we report (1) on the pharmacological enhancement of lecithinized superoxide dismutase (PC-SOD) using MITO-Porter, (2) the transcription activation of exogenous DNA by mitochondrial transcription factor A (TFAM), and (3) perspectives on a mitochondrial targeting device.
Type II interferon (IFNγ) is a representative Th1 cytokine and it possesses a variety of functions, including immune regulation, antiviral and antitumor activity. Because of its multifunctional nature, IFNγ is expected to be applied to the treatment of autoimmune diseases, cancer and viral infection. Although IFNγ has therapeutic potential for such diseases, the clinical use of IFNγ has been limited due to its short in vivo half-life and serious adverse effects. In contrast, gene delivery of IFNγ is an alternative approach to increasing the retention time of IFNγ. To extend transgene expression after plasmid DNA (pDNA) gene transfer, we designed and developed pDNA with varying numbers of CpG motifs. CpG-reduced pDNA resulted in more durable transgene expression than its CpG replete counterpart in mice. Comparison of the effect of promoter/enhancer elements on transgene expression showed that ROSA26 promoter-mediated IFNγ expression was safe because of the lack of an initial surge after hydrodynamic gene transfer. We also designed an IFNγ-mouse serum albumin (MSA) fusion protein, IFNγ-MSA. Gene transfer of this fusion protein resulted in a sustained concentration of IFNγ fusion protein in mouse serum, and inhibited tumor metastasis in mice. These results provide experimental evidence that IFNγ gene therapy can be a useful treatment for a variety of diseases.
Replication-incompetent adenovirus (Ad) vectors are widely used in gene therapy studies because they are beneficial as a gene delivery vehicle enabling high-titer production and highly efficient gene transfer into a wide spectrum of dividing and non-dividing cells in vitro and in vivo. Theoretically, Ad genes should not be expressed following transduction with a replication-incompetent Ad vector. However, leaky expression of viral genes is known to occur following transduction with a conventional Ad vector, which leads to a cellular immunity against Ad proteins as well as Ad protein-induced toxicity. Such Ad protein-induced cellular immunity and toxicity frequently cause both an elimination of Ad vector-transduced cells and tissue damage, leading to short-lived transgene expression. To date, no detailed analysis of the leaky expression profile of Ad genes has been performed. First, we systematically examined the expression profiles of Ad genes in cells using real-time RT-PCR following transduction with a conventional Ad vector. The results revealed that significant expression was found for E2A, E4, and pIX genes. Next, in order to suppress the leaky expression of Ad genes, complementary sequences for microRNA (miRNA) were inserted into the 3′-untranslated region of the E2A, E4, or pIX genes. miRNAs are an approximately 22-nt length non-coding RNA, and bind to imperfectly complementary sequences in the 3′-untranslated region of target mRNA, leading to suppression of gene expression via post-transcriptional regulation. Incorporation of the miRNA-targeted sequences significantly suppressed the leaky expression of Ad genes in an miRNA-dependent manner.
This review deals with the synthesis of alkaloids using radical cyclizations. Emphasis has been placed on radical cascades that provide synthesis of (−)-cephalotaxine, (±)-stemonamide, and (±)-isostemonamide.
An artificial transcription factor that can regulate the expression of specific genes at a desired time is very useful for research in chemical biology, cell biology, and future gene therapy. A C2H2 zinc finger motif, one of zinc-containing proteins, is known as the most ubiquitous DNA binding motif. The motif is attractive for designing artificial transcription factors with desired DNA binding specificities because of its characteristic DNA binding properties: (1) recognition of 3 bp per motif, (2) tandemly connected modular structure, and (3) binding to non-palindrome sequences as a monomer. Taking advantage of these properties, artificial DNA binding proteins with new DNA binding characteristics have been designed. By changing the linker region between two 3-zinc finger domains, artificial 6-zinc finger proteins were developed and shown to skip DNA sequences. Zinc-responsive transcription factors were created by altering one of the zinc ligands. An artificial zinc finger transcription factor targeting a core clock gene induced phase shifts of the cellular “circadian rhythm”. Herein, I will summarize creation and function of the above-mentioned artificial zinc finger-type DNA binding proteins and transcription factors.
Endoplasmic reticulum (ER)-associated degradation (ERAD) is a mechanism against ER stress, wherein unfolded proteins accumulated in the ER are transported to the cytosol for degradation by the ubiquitin-proteasome system. We identified the novel ubiquitin ligase HRD1 involved in ERAD. HRD1 is expressed in brain neurons and protects against ER stress-induced apoptosis. In familial Parkinson's disease, accumulation of Parkin-associated endothelin receptor-like receptor (Pael-R), a substrate of ubiquitin ligase Parkin involved in ERAD, leads to ER stress and apoptosis. We have demonstrated that HRD1 promotes ubiquitination and degradation of Pael-R and suppresses ER stress and apoptosis induced by Pael-R. Amyloid precursor protein (APP) is processed into amyloid β (Aβ) in Alzheimer's disease. We showed that HRD1 promotes APP ubiquitination and degradation, resulting in decreased generation of Aβ. Furthermore, suppression of HRD1 expression causes APP accumulation and Aβ generation associated with ER stress and apoptosis. Interestingly, HRD1 levels significantly decreased in the cerebral cortex of Alzheimer's disease patients, possibly because of its insolubilization. 4-phenylbutyrate (4-PBA) has been demonstrated to restore normal trafficking and activity of mutant proteins by acting as a chemical chaperone. We demonstrated that 4-PBA possesses chaperone activity in vitro, and this prevents protein aggregation. Furthermore, we revealed that 4-PBA attenuates the activation of ER stress responses and neuronal cell death, suggesting that HRD1 decreases unfolded protein accumulation in the ER. In addition, 4-PBA restores the normal expression of Pael-R protein and suppresses Pael-R-induced ER stress. Therefore, 4-PBA is a potential candidate for use in the pharmacotherapy of several neurodegenerative diseases linked to ER stress.
The recent vigorous transnational migration of people and materials reflecting the development of transportation facilities, changes in social structure, and war disasters has increased the global spread of emerging and re-emerging infections. Once, as the 2009 pandemic influenza A (H1N1) virus, person-to-person transmission was achieved, the spread of pandemic cannot be contained in reality. Thus enhancement of the crisis-management structure against pandemic is critically important to maintain national function. On the basis of this social background, the development of vaccination, which is the only fundamental prophylaxis, is in attention, and earliest possible establishment of system that supply mass-vaccines in a short time is required. Even if, however, rapid manufacture of vaccine antigen is actualized, there are several problems that vaccine is not easily spread across the developing country and mass vaccination is not performed immediately at the time of the crisis, because conventional vaccination is performed mainly by injection. Our research group developed transcutaneous vaccine devices; a hydrogel patch and a dissolving microneedle array which delivered antigens to antigen-presenting cells in the epidermal layer. Our transcutaneous vaccination system receives a high evaluation as novel, easy-to-use, and less-invasive vaccination method against infections from home and abroad. In this review, we introduce the research progress resulted from our basic, preclinical, and clinical study for practical use.
The Hengduan Mountains area of China is rich in plant resources. The Ligularia species, which belong to Senecioneae and Asteraceae, distributed in this area are highly diversified and contain 6 sections and over 100 species, and are considered to be in on-going evolution and diversification. To understand the inter- and intra-specific diversity of these plants and to elucidate the mechanism of diversification, we analyzed Ligularia plants by chemical, genetic, geographical, ecological, and morphological approaches. We investigated 4 species, and isolated 26 novel compounds. Based on the chemical composition of root extract as well as nucleotide sequence variations in internal transcribed spacers (ITS), we obtained 3 findings. (i) L. virgaurea is classified into two groups, ligularol type and virgaurenone type from the view point of chemical constituents, which are phylogenetically distinguished from each other, (ii) L. subspicata and L. lamarum have an overlapped chemical spectrum, but showed no clear genetic correlation, and (iii) L. cyathiceps showed no significant variations in either chemical constituents or nucleotide sequences.
Elderly patients tend to have troubles with oral conditions such as the impairment of deglutition capability (difficulty in swallowing), in addition to a decline in physical performance. An air extruded jelly formulation (AEJF) has been developed as a new formulation consisting of jelly and clean air under increased pressure. As jelly is discharged smoothly by pushing the air portion, elderly patients are able to easily take jelly from the package. In this study, survey questionnaires after a patient's trial of AEJF were conducted to characterize the intra-oral condition and reveal the applicability of AEJF in elderly patients. The subjects were 108 patients (ranging in age from 50 to 79) with chronic diseases who take some oral medicine regularly. A questionnaire on the oral state and compliance level was conducted before the trial of AEJF. The ratios of subjects with deglutition impairment and dryness of the mouth were 29.7% and 36.1%, respectively. Non-compliance was observed in 31.5% of the subjects. After the trial using AEJF, 94.5% of subjects felt that AEJF was easy to swallow. The ratio of the patients expecting AEJF to be an oral formulation was 89.3%, and those with an intention of daily use was 83.4%. A majority of the subjects, 63.9%, intended to switch their present formulations to AEJF. Especially, a high ratio was found among subjects who presently take a powder formulation or more than 5 kinds of medicines daily. Based on these results, AEJF is expected to improve the adherence of elderly patients to their medicine dosage regimens, and to improve compliance among those with oral troubles or some other hindrance to compliance.
At the initiation of long-term practical training in the 6-year pharmaceutical education, there are many issues to be solved. For example, it is necessary for teaching pharmacists, who are in charge of both staffing and teaching pharmacy students, to manage their workload with other staff pharmacists. To overcome this situation and to improve the motivation of teaching pharmacists towards student practical training, we twice held group work (GW) sessions for teaching pharmacists, and then evaluated whether such training was effective for their understanding of the Model Core Curriculum for Practical Training and for promoting a higher level of motivation. During the two-day GW discussions, teaching pharmacists, who work daily in the dispensing area, were separated into two groups to discuss teaching skills. A questionnaire survey was completed by participants before and after each GW session. According to the survey, more than 90% of the pharmacists had a higher motivation level for practical training after the sessions. Particularly in the second GW training, the response rate of “being actively involved” improved from 40% to 70%. Furthermore, “The Educational Evaluation Testing” was conducted, which confirmed the increased participant comprehension. The median scores of the comprehensive exams significantly (p<0.01) improved in twice GW, respectively. Therefore, we conclude that GW sessions are a useful tool for both improving professional knowledge about the Model Core Curriculum and motivating teaching pharmacists involved in the practical training of students. We hope that this exercise will lead to higher student motivation and satisfaction during their practical training.