Blockade of cholesterol absorption by ezetimibe reveals a complex homeostatic network in enterocytes[S

PubMed Central

Engelking, Luke J.; McFarlane, Matthew R.; Li, Christina K.; Liang, Guosheng

2012-01-01

Enterocyte cholesterol homeostasis reflects aggregated rates of sterol synthesis, efflux, and uptake from plasma and gut lumen. Cholesterol synthesis and LDL uptake are coordinately regulated by sterol regulatory element-binding proteins (SREBP), whereas sterol efflux is regulated by liver X receptors (LXR). How these processes are coordinately regulated in enterocytes, the site of cholesterol absorption, is not well understood. Here, we treat mice with ezetimibe to investigate the effect of blocking cholesterol absorption on intestinal SREBPs, LXRs, and their effectors. Ezetimibe increased nuclear SREBP-2 8-fold. HMG-CoA reductase (HMGR) and LDL receptor (LDLR) mRNA levels increased less than 3-fold, whereas their protein levels increased 30- and 10-fold, respectively. Expression of inducible degrader of LDLR (IDOL), an LXR-regulated gene that degrades LDLRs, was reduced 50% by ezetimibe. Coadministration of ezetimibe with the LXR agonist T0901317 abolished the reduction in IDOL and prevented the increase in LDLR protein. Ezetimibe-stimulated LDLR expression was independent of proprotein convertase subtilisin/kexin type 9 (PSCK9), a protein that degrades LDLRs. To maintain cholesterol homeostasis in the face of ezetimibe, enterocytes boost LDL uptake by increasing LDLR number, and they boost sterol synthesis by increasing HMGR and other cholesterologenic genes. These studies reveal a hitherto undescribed homeostatic network in enterocytes triggered by blockade of cholesterol absorption. PMID:22523394

NPC1L1 is a key regulator of intestinal vitamin K absorption and a modulator of warfarin therapy.

PubMed

Takada, Tappei; Yamanashi, Yoshihide; Konishi, Kentaro; Yamamoto, Takehito; Toyoda, Yu; Masuo, Yusuke; Yamamoto, Hideaki; Suzuki, Hiroshi

2015-02-18

Vitamin K (VK) is a micronutrient that facilitates blood coagulation. VK antagonists, such as warfarin, are used in the clinic to prevent thromboembolism. Because VK is not synthesized in the body, its intestinal absorption is crucial for maintaining whole-body VK levels. However, the molecular mechanism of this absorption is unclear. We demonstrate that Niemann-Pick C1-like 1 (NPC1L1) protein, a cholesterol transporter, plays a central role in intestinal VK uptake and modulates the anticoagulant effect of warfarin. In vitro studies using NPC1L1-overexpressing intestinal cells and in vivo studies with Npc1l1-knockout mice revealed that intestinal VK absorption is NPC1L1-dependent and inhibited by ezetimibe, an NPC1L1-selective inhibitor clinically used for dyslipidemia. In addition, in vivo pharmacological studies demonstrated that the coadministration of ezetimibe and warfarin caused a reduction in hepatic VK levels and enhanced the pharmacological effect of warfarin. Adverse events caused by the coadministration of ezetimibe and warfarin were rescued by oral VK supplementation, suggesting that the drug-drug interaction effects observed were the consequence of ezetimibe-mediated VK malabsorption. This mechanism was supported by a retrospective evaluation of clinical data showing that, in more than 85% of warfarin-treated patients, the anticoagulant activity was enhanced by cotreatment with ezetimibe. Our findings provide insight into the molecular mechanism of VK absorption. This new drug-drug interaction mechanism between ezetimibe (a cholesterol transport inhibitor) and warfarin (a VK antagonist and anticoagulant) could inform clinical care of patients on these medications, such as by altering the kinetics of essential, fat-soluble vitamins. Copyright © 2015, American Association for the Advancement of Science.

Lack of pharmacokinetic interaction of mipomersen sodium (ISIS 301012), a 2'-O-methoxyethyl modified antisense oligonucleotide targeting apolipoprotein B-100 messenger RNA, with simvastatin and ezetimibe.

PubMed

Yu, Rosie Z; Geary, Richard S; Flaim, Joann D; Riley, Gina C; Tribble, Diane L; vanVliet, André A; Wedel, Mark K

2009-01-01

Mipomersen sodium (ISIS 301012) is a 20-mer phosphorothioate antisense oligonucleotide that is complementary to human apolipoprotein B-100 (apoB-100) messenger RNA and subsequently reduces translation of ApoB-100 protein, the major apolipoprotein of very low-density lipoprotein, intermediate-density lipoprotein and low-density lipoprotein (LDL). Mipomersen sodium is currently being studied in phase II/III clinical studies to determine its clinical utility as add-on therapy to HMG-CoA reductase inhibitors or other lipid-lowering agents in subjects with hypercholesterolaemia. The aim of this study was to characterize the pharmacokinetic interactions of mipomersen sodium with simvastatin and ezetimibe. Another aim was to evaluate the ability of mipomersen sodium to inhibit major cytochrome P450 (CYP) isoenzymes in vitro. In a phase I clinical study, ten healthy subjects per cohort received a single oral dose of simvastatin 40 mg or ezetimibe 10 mg followed by four 2-hour intravenous doses of mipomersen sodium 200 mg over an 8-day period, with simvastatin 40 mg or ezetimibe 10 mg being administered again with the last dose of mipomersen sodium. Mipomersen sodium pharmacokinetic profiles were assessed following the first dose (mipomersen sodium alone) and the last dose (mipomersen sodium in combination with simvastatin or ezetimibe). Plasma samples for measurement of simvastatin, simvastatin acid, and free and total ezetimibe concentrations were collected at various timepoints following their first and last oral dosing. A comparative pharmacokinetic analysis was performed to determine if there were any effects resulting from coadministration of mipomersen sodium with these lipid-lowering drugs. In addition to the clinical pharmacokinetic analysis, the ability of mipomersen sodium to inhibit the major CYP isoform enzymes (namely CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4) was evaluated in cryo-preserved human hepatocytes in vitro. The area under the plasma concentration-time curve (AUC) from 0 to 24 hours (AUC(24)), maximum plasma concentration and apparent elimination half-life values of mipomersen sodium were similar when administered alone and in combination with oral simvastatin or oral ezetimibe. The 90% confidence intervals of the geometric least squares means ratios (%Reference) of the mipomersen sodium AUC(24) values were 93.6, 107 when administered together with simvastatin, and 92.4, 111 when administered with ezetimibe. Therefore, there were no large deviations outside the default no-effect boundaries (80-125%) for total exposure (the AUC) of mipomersen sodium in combination with either simvastatin or ezetimibe. Similarly, large deviations outside the default no-effect boundaries were not observed for simvastatin, simvastatin acid, or free and total ezetimibe exposure in combination with mipomersen sodium. In cryo-preserved human hepatocytes, mipomersen sodium exhibited no cytotoxicity. Significant cell uptake was demonstrated by analysing cell-associated concentrations of mipomersen sodium. All evaluated enzyme activities had <10% inhibition at tested concentrations up to 800 microg/mL (approximately 100 micromol/L) of mipomersen sodium, and dose-dependent inhibition was not observed. Therefore, mipomersen sodium is not considered an inhibitor of CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 enzyme activities. These data provide evidence that mipomersen sodium exhibits no clinically relevant pharmacokinetic interactions with the disposition and clearance of simvastatin or ezetimibe, and vice versa. Moreover, mipomersen sodium does not inhibit any of the major CYP enzymes that were evaluated. Taken together, the results from this study support the use of mipomersen sodium in combination with oral lipid-lowering agents.

A Randomized Open-Label Trial to Assess the Effect of Plant Sterols Associated with Ezetimibe in Low-Density Lipoprotein Levels in Patients with Coronary Artery Disease on Statin Therapy.

PubMed

Gomes, Gisane Biacchi; Zazula, Ana Denise; Shigueoka, Leonardo Seidi; Fedato, Rosangela Alquieri; da Costa, Ana Beatriz Brenner Affonso; Guarita-Souza, Luiz Cesar; Baena, Cristina Pellegrino; Olandoski, Marcia; Faria-Neto, José Rocha

2017-01-01

Consumption of food products enriched with plant sterols and the use of ezetimibe reduce cholesterol absorption in the intestine and effectively reduce low-density lipoprotein (LDL) plasma levels. We evaluated the therapeutic effect of the ezetimibe+plant sterol association in patients with coronary artery disease still not reaching recommended lipid levels despite the use of statins. We performed a prospective open-label study with 41 patients with stable coronary disease and LDL >70 mg/dL. Patients were randomized into four groups for a 6-week treatment: the control (CT) group remained on the same statin therapy, the ezetimibe (EZ) group received 10 mg/day of ezetimibe, the plant sterol (PS) group received spread enriched with 2 g of plant sterols, and the ezetimibe+PS (EZ+PS) group received 10 mg/day EZ +2 g PS. Initial mean LDL level was 97.4 ± 31.1 mg/dL in control group, 105.1 ± 23.1 mg/dL in EZ group, 95.4 ± 27.7 mg/dL in PS group, and 97.0 ± 8.3 mg/dL in EZ+PS group (P > .05). After 6 weeks of treatment, LDL of patients slightly increased in the control group (+8.9%; P > .05) and dropped in EZ group (-19.1%; P = .06), PS group (-16.6%; P = .01), and EZ+PS group (-27.3%; P < .01). Mean LDL levels after treatment were 70.5 ± 17.9 mg/dL in EZ+PS group, lower than the other groups (control was 106.1 ± 34.9 mg/dL, EZ group was 85.0 ± 35.6 mg/dL, and PS was 79.6 ± 29.7 mg/dL) (P = .05 variance analysis factor [ANOVA]). Body weight, body-mass index, and glucose plasma levels did not change significantly after intervention. The combination of PS+ezetimibe was associated with lower LDL levels and suggests beneficial therapeutic effect against major cardiovascular events.

Ezetimibe enhances and stabilizes anticoagulant effect of warfarin.

PubMed

Hashikata, Takehiro; Yamaoka-Tojo, Minako; Kakizaki, Ryota; Nemoto, Teruyoshi; Fujiyoshi, Kazuhiro; Namba, Sayaka; Kitasato, Lisa; Hashimoto, Takuya; Ishii, Shunsuke; Kameda, Ryo; Shimohama, Takao; Tojo, Taiki; Ako, Junya

2017-01-01

Ezetimibe reduces plasma levels of low-density lipoprotein cholesterol by inhibiting Niemann-Pick C1-like protein 1 (NPC1L1). A recent study demonstrated that NPC1L1 plays an important role in absorption of fat-soluble vitamins including vitamin K. We evaluated whether the add-on treatment of ezetimibe affects anticoagulation in patients taking warfarin. Between October 2007 and March 2015, the administration of ezetimibe was started to a total of 101 outpatients who were already on oral anticoagulation with warfarin. We retrospectively analyzed blood lipid levels, prothrombin time international normalized ratio (PT-INR) and time in therapeutic INR range (TTR). Seventy-one patients (70 %) showed increase in PT-INR after ezetimibe treatment (1.96 ± 0.45 to 2.20 ± 0.61, p < 0.001). It was necessary to reduce the warfarin dose in 9 of 101 patients for clinical indication. There was a significant positive correlation between change in PT-INR and statin usage at baseline (p = 0.03). The mean value of changes in PT-INR of patients with taking statin was significantly larger than that of patients without taking statin (0.34 ± 0.54 vs. 0.06 ± 0.36, p = 0.03). There was an increase in the TTR (52 ± 26 to 61 ± 23 %, p < 0.0001) and a decrease in the frequency to change the dose of warfarin after the ezetimibe treatment [45 times of 735 examination days (6 %) to 20 times of 695 examination days (3 %), p = 0.02]. Our data suggest possible drug interaction between warfarin and ezetimibe. Ezetimibe may increase and stabilize the anticoagulant effect of warfarin, especially in patients taking statins.

Pharmacokinetics and bioequivalence of a rosuvastatin/ezetimibe fixed-dose combination tablet versus single agents in healthy male subjects
.

PubMed

Kang, Woo Youl; Seong, Sook Jin; Ohk, Boram; Gwon, Mi-Ri; Kim, Bo Kyung; Na, Sookie; Kim, Hyun-Ju; Yoon, Young-Ran; Lee, Hae Won

2018-01-01

The pharmacokinetic profiles and bioequivalence of a new rosuvastatin/ezetimibe fixed-dose combination (FDC; NVP-1205) vs. rosuvastatin and ezetimibe concomitantly administered as single agents were evaluated. In this open-label, single-dose, crossover study (NCT02029625), eligible subjects were randomly assigned in a 1 : 1 ratio to receive a single dose of rosuvastatin (10 mg) with ezetimibe (10 mg) as either a FDC or as single agents concomitantly administered under fasted conditions, followed by a 2-week washout period and administration of the alternate formulation. Serial blood samples were collected predose and up to 96 hours postdose in each period for determination of plasma rosuvastatin and ezetimibe concentrations by liquid-chromatography tandem mass spectroscopy and calculation of pharmacokinetic parameters. The mean C_max and AUC_0-t values of rosuvastatin were 12.5 ng/mL and 115.6 ng×h/mL for the FDC, and 12.2 ng/mL and 115.1 ng×h/mL for the single agents concomitantly administered, respectively. The mean C_max and AUC_0-t values of ezetimibe were 4.7 ng/mL and 67.3 ng×h/mL for the FDC, and 4.5 ng/mL and 68.2 ng×h/mL for the single agents concomitantly administered, respectively. The geometric mean ratio (GMR) and 90% confidence interval (CI) for the rosuvastatin C_max and AUC_0-t were 106.20 (96.62 - 116.74) and 102.88 (96.32 - 109.90), respectively. The GMR and 90% CI for the ezetimibe C_max and AUC_0-t were 108.96 (98.56 - 120.51) and 98.13 (92.01 - 104.66), respectively. All treatments were well tolerated during this study, with no serious adverse events reported. The rosuvastatin/ezetimibe (10/10 mg) FDC was bioequivalent to single agents concomitantly administered. A single dose of rosuvastatin/ezetimibe as the FDC or as single agents was well tolerated.
.

Simultaneous determination of ezetimibe and its glucuronide metabolite in human plasma by solid phase extraction and liquid chromatography-tandem mass spectrometry.

PubMed

Guo, Lin; Wang, Meng-meng; He, Min; Qiu, Fu-rong; Jiang, Jian

2015-04-01

A liquid chromatography-tandem mass spectrometry method (LC-MS/MS) was developed to quantify ezetimibe (EZM) and its major glucuronide (ezetimibe glucuronide, EZM-G) in human plasma simultaneously. The analytes were purified by solid phase extraction (SPE) without hydrolysis. Separation of the analytes was achieved using acetonitrile-water (0.08% formic acid) (70:30, v/v) as the mobile phase at a flow rate of 0.8 mL/min on an Agilent Extend C18 column. The analytes were detected by LC-MS/MS using negative ionization in multiple reaction monitoring (MRM) mode. The mass transition pairs of m/z 408.4→271.0 and m/z 584.5→271.0 were used to detect EZM and EZM-G, respectively. The analytical method was linear over the concentration range of 0.1-20 ng/mL for EZM and 0.5-200 ng/mL for EZM-G. Within- and between-run precision for EZM was no more than 8.6% and 12.8%; and for EZM-G was no more than 9.0% and 8.7%, respectively. This method was reproducible and reliable, and was successfully used to analyze human plasma samples for application in a bioequivalence study. Copyright © 2015 Elsevier B.V. All rights reserved.

Transgenic tomatoes expressing the 6F peptide and ezetimibe prevent diet-induced increases of IFN-β and cholesterol 25-hydroxylase in jejunum

PubMed Central

Mukherjee, Pallavi; Hough, Greg; Chattopadhyay, Arnab; Navab, Mohamad; Fogelman, Hannah R.; Meriwether, David; Williams, Kevin; Bensinger, Steven; Moller, Travis; Faull, Kym F.; Lusis, Aldons J.; Iruela-Arispe, M. Luisa; Bostrom, Kristina I.; Tontonoz, Peter; Reddy, Srinivasa T.; Fogelman, Alan M.

2017-01-01

Feeding LDL receptor (LDLR)-null mice a Western diet (WD) increased the expression of IFN-β in jejunum as determined by quantitative RT-PCR (RT-qPCR), immunohistochemistry (IHC), and ELISA (all P < 0.0001). WD also increased the expression of cholesterol 25-hydroxylase (CH25H) as measured by RT-qPCR (P < 0.0001), IHC (P = 0.0019), and ELISA (P < 0.0001), resulting in increased levels of 25-hydroxycholesterol (25-OHC) in jejunum as determined by LC-MS/MS (P < 0.0001). Adding ezetimibe at 10 mg/kg/day or adding a concentrate of transgenic tomatoes expressing the 6F peptide (Tg6F) at 0.06% by weight of diet substantially ameliorated these changes. Adding either ezetimibe or Tg6F to WD also ameliorated WD-induced changes in plasma lipids, serum amyloid A, and HDL cholesterol. Adding the same doses of ezetimibe and Tg6F together to WD (combined formulation) was generally more efficacious compared with adding either agent alone. Surprisingly, adding ezetimibe during the preparation of Tg6F, but before addition to WD, was more effective than the combined formulation for all parameters measured in jejunum (P = 0.0329 to P < 0.0001). We conclude the following: i) WD induces IFN-β, CH25H, and 25-OHC in jejunum; and ii) Tg6F and ezetimibe partially ameliorate WD-induced inflammation by preventing WD-induced increases in IFN-β, CH25H, and 25-OHC. PMID:28592401

Transgenic tomatoes expressing the 6F peptide and ezetimibe prevent diet-induced increases of IFN-β and cholesterol 25-hydroxylase in jejunum.

PubMed

Mukherjee, Pallavi; Hough, Greg; Chattopadhyay, Arnab; Navab, Mohamad; Fogelman, Hannah R; Meriwether, David; Williams, Kevin; Bensinger, Steven; Moller, Travis; Faull, Kym F; Lusis, Aldons J; Iruela-Arispe, M Luisa; Bostrom, Kristina I; Tontonoz, Peter; Reddy, Srinivasa T; Fogelman, Alan M

2017-08-01

Feeding LDL receptor (LDLR)-null mice a Western diet (WD) increased the expression of IFN-β in jejunum as determined by quantitative RT-PCR (RT-qPCR), immunohistochemistry (IHC), and ELISA (all P < 0.0001). WD also increased the expression of cholesterol 25-hydroxylase (CH25H) as measured by RT-qPCR ( P < 0.0001), IHC ( P = 0.0019), and ELISA ( P < 0.0001), resulting in increased levels of 25-hydroxycholesterol (25-OHC) in jejunum as determined by LC-MS/MS ( P < 0.0001). Adding ezetimibe at 10 mg/kg/day or adding a concentrate of transgenic tomatoes expressing the 6F peptide (Tg6F) at 0.06% by weight of diet substantially ameliorated these changes. Adding either ezetimibe or Tg6F to WD also ameliorated WD-induced changes in plasma lipids, serum amyloid A, and HDL cholesterol. Adding the same doses of ezetimibe and Tg6F together to WD (combined formulation) was generally more efficacious compared with adding either agent alone. Surprisingly, adding ezetimibe during the preparation of Tg6F, but before addition to WD, was more effective than the combined formulation for all parameters measured in jejunum ( P = 0.0329 to P < 0.0001). We conclude the following: i ) WD induces IFN-β, CH25H, and 25-OHC in jejunum; and ii ) Tg6F and ezetimibe partially ameliorate WD-induced inflammation by preventing WD-induced increases in IFN-β, CH25H, and 25-OHC. Copyright © 2017 by the American Society for Biochemistry and Molecular Biology, Inc.

Crystalline phase transition of ezetimibe in final product, after packing, promoted by the humidity of excipients: Monitoring and quantification by Raman spectroscopy.

PubMed

Farias, Marco Antônio Dos Santos; Soares, Frederico Luis Felipe; Carneiro, Renato Lajarim

2016-03-20

Ezetimibe (EZT), in its anhydrous form, is a drug used for cholesterol and lipids reduction in blood plasma. The presence of EZT monohydrate in commercial tablets can change the solubility rate of the API, decreasing its activity. The objective of this work was to verify if the humidity present in the excipients could promote the phase transition from EZT anhydrous to hydrate. Initially the stability of the pure anhydrous form was monitored by Raman, at room temperature (23°C) and relative humidity (75%). The MCR-ALS method showed that almost all EZT changed to hydrated form in 30 min. Then tablets of ezetimibe in the presence of its excipients were prepared and vacuum packed using a polyethylene film. Such tablet was monitored by Raman spectroscopy for 24h in order to quantify the mixture of the crystalline forms. A multivariate calibration model using Raman spectroscopy and Partial Least Square (PLS) regression was built, with validation and cross validation errors around 0.6% (wt/wt), for both crystalline forms, and R(2) higher than 0.96. The PLS model was used to quantify the crystalline mixture of ezetimibe in the monitored tablet, after 24h more than 70% of ezetimibe changed to the hydrated form. Copyright © 2016 Elsevier B.V. All rights reserved.

Modulation of Cholesterol-Related Gene Expression by Dietary Fiber Fractions from Edible Mushrooms.

PubMed

Caz, Víctor; Gil-Ramírez, Alicia; Largo, Carlota; Tabernero, María; Santamaría, Mónica; Martín-Hernández, Roberto; Marín, Francisco R; Reglero, Guillermo; Soler-Rivas, Cristina

2015-08-26

Mushrooms are a source of dietary fiber (DF) with a cholesterol-lowering effect. However, their underlying mechanisms are poorly understood. The effect of DF-enriched fractions from three mushrooms species on cholesterol-related expression was studied in vitro. The Pleurotus ostreatus DF fraction (PDF) was used in mice models to assess its potential palliative or preventive effect against hypercholesterolemia. PDF induced a transcriptional response in Caco-2 cells, suggesting a possible cholesterol-lowering effect. In the palliative setting, PDF reduced hepatic triglyceride likely because Dgat1 was downregulated. However, cholesterol-related biochemical data showed no changes and no relation with the observed transcriptional modulation. In the preventive setting, PDF modulated cholesterol-related genes expression in a manner similar to that of simvastatin and ezetimibe in the liver, although no changes in plasma and liver biochemical data were induced. Therefore, PDF may be useful reducing hepatic triglyceride accumulation. Because it induced a molecular response similar to hypocholesterolemic drugs in liver, further dose-dependent studies should be carried out.

Efficacy and safety of coadministration of fenofibrate and ezetimibe compared with each as monotherapy in patients with type IIb dyslipidemia and features of the metabolic syndrome: a prospective, randomized, double-blind, three-parallel arm, multicenter, comparative study.

PubMed

Ansquer, Jean-Claude; Bekaert, Ivan; Guy, Martine; Hanefeld, Markolf; Simon, Alain

2009-01-01

Patients with type IIb, or mixed, dyslipidemia have high levels of low-density lipoprotein cholesterol (LDL-C) with predominance of small dense LDL particles, high levels of triglycerides (TG), and low levels of high-density lipoprotein cholesterol (HDL-C). Fenofibrate significantly reduces TG and, more moderately, LDL-C, increases HDL-C and produces a shift from small to large LDL particle size; the main effect of ezetimibe is a reduction in LDL-C levels. Combined treatment with fenofibrate and ezetimibe may correct all the abnormalities of type IIb dyslipidemia. To assess the efficacy and safety of coadministration of fenofibrate (NanoCrystal(R)) and ezetimibe in patients with type IIb dyslipidemia and the metabolic syndrome compared with administration of fenofibrate and ezetimibe alone (ClinicalTrials.gov Identifier: NCT00349284; Study ID: CLF178P 04 01). This was a prospective, randomized, double-blind, three-parallel arm, multicenter, comparative study. Sixty ambulatory patients (mean age 56 years; 50% women, 50% men) were treated in each group. For inclusion in the study, patients were required to have LDL-C >or=4.13 mmol/L (>or=160 mg/dL), TG >or=1.71 mmol/L and or=150 mg/dL and

Evaluation of Antiatherogenic Properties of Ezetimibe Using 3H-Labeled Low-Density-Lipoprotein Cholesterol and 99mTc-cAbVCAM1-5 SPECT in ApoE-/- Mice Fed the Paigen Diet.

PubMed

Dumas, Laurent S; Briand, François; Clerc, Romain; Brousseau, Emmanuel; Montemagno, Christopher; Ahmadi, Mitra; Bacot, Sandrine; Soubies, Audrey; Perret, Pascale; Riou, Laurent M; Devoogdt, Nick; Lahoutte, Tony; Barone-Rochette, Gilles; Fagret, Daniel; Ghezzi, Catherine; Sulpice, Thierry; Broisat, Alexis

2017-07-01

The addition of ezetimibe, an intestinal cholesterol absorption inhibitor, to statin therapy has recently shown clinical benefits in the Improved Reduction of Outcomes: Vytorin Efficacy International Trial by reducing low-density-lipoprotein (LDL) cholesterol levels more than statin therapy alone. Here, we investigated the mechanisms by which inhibition of intestinal cholesterol absorption might contribute to the clinically observed reduction in cardiovascular events by evaluating its effect on inflammatory plaque development in apolipoprotein E -/- mice. Methods: Apolipoprotein E -/- mice were fed the Paigen diet (1.25% cholesterol, 0.5% cholic acid, and 15% fat) without or with ezetimibe (7 mg/kg/d) for 6 wk. In a first set of mice ( n = 15), we intravenously injected 3 H-cholesteryl oleate-labeled human LDL to test whether ezetimibe promotes LDL-derived cholesterol fecal excretion. In a second set ( n = 20), we used the imaging agent 99m Tc-cAbVCAM1-5 to evaluate expression of an inflammatory marker, vascular cell adhesion molecule 1 (VCAM-1), in atherosclerotic plaques. In a third set ( n = 21), we compared VCAM-1 expression with 99m Tc-cAbVCAM1-5 uptake in various tissues. Results: Mice treated with ezetimibe showed a 173% higher LDL-cholesteryl ester plasma disappearance rate ( P < 0.001 vs. control) after 3 H-cholesteryl oleate-labeled LDL injection. At 96 h after injection, the hepatic fraction of 3 H-tracer was 61% lower in mice treated with ezetimibe ( P < 0.001). Meanwhile, LDL-derived 3 H-cholesterol excretion in the feces was 107% higher ( P < 0.001). The antiatherogenic effect of ezetimibe monitored by 99m Tc-cAbVCAM1-5 SPECT showed a 49% reduction in aortic tracer uptake (percentage injected dose per cubic centimeter, 0.95 ± 0.04 vs. 1.87 ± 0.11; P < 0.01). In addition to hypercholesterolemia, the proinflammatory Paigen diet significantly increased VCAM-1 expression with respect to the control group in various tissues, including the aorta, and this expression correlated strongly with 99m Tc-cAbVCAM1-5 uptake ( r = 0.75; P < 0.05). Conclusion: Inhibition of intestinal cholesterol absorption with ezetimibe promotes antiatherosclerotic effects through increased LDL cholesterol catabolism and LDL-derived cholesterol fecal excretion and reduces inflamed atherosclerotic plaques. These mechanisms may contribute to the benefits of adding ezetimibe to a statin therapy. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

Lipid lowering efficacy and safety of Ezetimibe combined with rosuvastatin compared with titrating rosuvastatin monotherapy in HIV-positive patients.

PubMed

Saeedi, Ramesh; Johns, Kevin; Frohlich, Jiri; Bennett, Matthew T; Bondy, Gregory

2015-06-19

HIV-infected patients on antiretroviral therapy frequently develop dyslipidemias and, despite therapy with potent lipid-lowering agents, a high percentage does not achieve guideline recommended lipid targets. In this study, we examined the efficacy of combination treatment with a statin and the cholesterol transport blocker, ezetimibe, vs. monotherapy with a statin in HIV-infected patients not achieving lipid goals. This was a 12-week, prospective, randomized, open-label clinical trial. Patients were eligible if they had an apolipoprotein B (apoB) >0.80 g/L despite therapy with rosuvastatin 10 mg daily for a minimum of 12 weeks. Patients were randomized to take ezetimibe 10 mg/rosuvastatin 10 mg or rosuvastatin 20 mg for 12 weeks. Percentage and absolute change in apoB (primary outcome), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, apoliporpotein A1 (apoA1), apoB/apoA1, TC/HDL-C, atherogenic index of plasma (API), and high-sensitivity C-reactive protein (hsCRP) were compared. Changes in safety parameters (such as AST, ALT, CK) and clinical symptoms were also assessed. Forty-three patients (23 on ezetimibe 10 mg/rosuvastatin 10 mg and 20 on rosuvastatin 20 mg) completed the trial. Baseline characteristics did not differ between the groups. Significant improvements in apoB were seen with both ezetimibe plus rosuvastatin (mean of -0.17 g/L, p < 0.001) and rosuvastatin 20 mg (mean of -0.13 g/L, p = 0.03) treatment groups, but did not differ between groups (p = 0.53). Significant between-group differences were observed for mean TC (-1.01 mmol/L vs. -0.50 mmol/L, p = 0.03), TG (-0.62 mmol/L vs -0.17 mmol/L, p = 0.03), and non-HDL-C (-0.97 mmol/L vs. -0.53 mmol/L, p = 0.03) all in favour of the ezetimibe plus rosuvastatin group. Two patients, both in the rosuvastatin 20 mg group, experienced mild myalgias; neither discontinued the study. The addition of ezetimibe to rosuvastatin appears to be safe in patients with HIV. Furthermore, the combination of ezetimibe and rosuvastatin improved TG, AIP and non-HDL cholesterol levels more than a dose increase in rosuvastatin in patients with HIV-associated dyslipidemia.

Effects of ezetimibe added to statin therapy on markers of cholesterol absorption and synthesis and LDL-C lowering in hyperlipidemic patients

PubMed Central

Thongtang, Nuntakorn; Lin, Jianxin; Schaefer, Ernst J.; Lowe, Robert S.; Tomassini, Joanne E.; Shah, Arvind K.; Tershakovec, Andrew M.

2013-01-01

Objective Statins inhibit cholesterol synthesis but can upregulate cholesterol absorption, with higher doses producing larger effects. Ezetimibe inhibits cholesterol absorption but also upregulates synthesis. We tested whether ezetimibe added to ongoing statin therapy would be most effective in lowering LDL-cholesterol (LDL-C) in subjects on high-potency statins and whether these effects would be related to alterations in cholesterol absorption (β-sitosterol) and synthesis (lathosterol) markers. Methods Hypercholesterolemic subjects (n=874) on statins received ezetimibe 10 mg/day. Plasma lipids, lathosterol, and β-sitosterol were measured at baseline and on treatment. Subjects were divided into low- (n=133), medium- (n=582), and high- (n=159) statin potency groups defined by predicted LDL-C–lowering effects of each ongoing statin type and dose (reductions of ~20-30%, ~31-45%, or ~46-55%, respectively). Results The high-potency group had significantly lower baseline lathosterol (1.93 vs. 2.58 vs. 3.17 μmol/l; p <0.001) and higher baseline β-sitosterol values (6.21 vs. 4.58 vs. 4.51 μmol/l, p <0.001) than medium-/low-potency groups. Ezetimibe treatment in the high-potency group produced significantly greater reductions from baseline in LDL-C than medium-/low-potency groups (−29.1% vs. −25.0% vs. −22.7%; p <0.001) when evaluating unadjusted data. These effects and group differences were significantly (p <0.05) related to greater β-sitosterol reductions and smaller lathosterol increases. However, LDL-C reduction differences between groups were no longer significant after controlling for placebo effects, due mainly to modest LDL-C lowering by placebo in the high-potency group. Conclusion Patients on high-potency statins have the lowest levels of cholesterol synthesis markers and the highest levels of cholesterol absorption markers at baseline, and the greatest reduction in absorption markers and the smallest increases in synthesis markers with ezetimibe addition. Therefore, such patients may be good candidates for ezetimibe therapy if additional LDL-C lowering is needed. PMID:23040830

Ezetimibe Promotes Brush Border Membrane-to-Lumen Cholesterol Efflux in the Small Intestine

PubMed Central

Nakano, Takanari; Inoue, Ikuo; Takenaka, Yasuhiro; Ono, Hiraku; Katayama, Shigehiro; Awata, Takuya; Murakoshi, Takayuki

2016-01-01

Ezetimibe inhibits Niemann-Pick C1-like 1 (NPC1L1), an apical membrane cholesterol transporter of enterocytes, thereby reduces intestinal cholesterol absorption. This treatment also increases extrahepatic reverse cholesterol transport via an undefined mechanism. To explore this, we employed a trans-intestinal cholesterol efflux (TICE) assay, which directly detects circulation-to-intestinal lumen 3H-cholesterol transit in a cannulated jejunal segment, and found an increase of TICE by 45%. To examine whether such increase in efflux occurs at the intestinal brush border membrane(BBM)-level, we performed luminal perfusion assays, similar to TICE but the jejunal wall was labelled with orally-given 3H-cholesterol, and determined elevated BBM-to-lumen cholesterol efflux by 3.5-fold with ezetimibe. Such increased efflux probably promotes circulation-to-lumen cholesterol transit eventually; thus increases TICE. Next, we wondered how inhibition of NPC1L1, an influx transporter, resulted in increased efflux. When we traced orally-given 3H-cholesterol in mice, we found that lumen-to-BBM 3H-cholesterol transit was rapid and less sensitive to ezetimibe treatment. Comparison of the efflux and fractional cholesterol absorption revealed an inverse correlation, indicating the efflux as an opposite-regulatory factor for cholesterol absorption efficiency and counteracting to the naturally-occurring rapid cholesterol influx to the BBM. These suggest that the ezetimibe-stimulated increased efflux is crucial in reducing cholesterol absorption. Ezetimibe-induced increase in cholesterol efflux was approximately 2.5-fold greater in mice having endogenous ATP-binding cassette G5/G8 heterodimer, the major sterol efflux transporter of enterocytes, than the knockout counterparts, suggesting that the heterodimer confers additional rapid BBM-to-lumen cholesterol efflux in response to NPC1L1 inhibition. The observed framework for intestinal cholesterol fluxes may provide ways to modulate the flux to dispose of endogenous cholesterol efficiently for therapeutic purposes. PMID:27023132

Ezetimibe Promotes Brush Border Membrane-to-Lumen Cholesterol Efflux in the Small Intestine.

PubMed

Nakano, Takanari; Inoue, Ikuo; Takenaka, Yasuhiro; Ono, Hiraku; Katayama, Shigehiro; Awata, Takuya; Murakoshi, Takayuki

2016-01-01

Ezetimibe inhibits Niemann-Pick C1-like 1 (NPC1L1), an apical membrane cholesterol transporter of enterocytes, thereby reduces intestinal cholesterol absorption. This treatment also increases extrahepatic reverse cholesterol transport via an undefined mechanism. To explore this, we employed a trans-intestinal cholesterol efflux (TICE) assay, which directly detects circulation-to-intestinal lumen 3H-cholesterol transit in a cannulated jejunal segment, and found an increase of TICE by 45%. To examine whether such increase in efflux occurs at the intestinal brush border membrane(BBM)-level, we performed luminal perfusion assays, similar to TICE but the jejunal wall was labelled with orally-given 3H-cholesterol, and determined elevated BBM-to-lumen cholesterol efflux by 3.5-fold with ezetimibe. Such increased efflux probably promotes circulation-to-lumen cholesterol transit eventually; thus increases TICE. Next, we wondered how inhibition of NPC1L1, an influx transporter, resulted in increased efflux. When we traced orally-given 3H-cholesterol in mice, we found that lumen-to-BBM 3H-cholesterol transit was rapid and less sensitive to ezetimibe treatment. Comparison of the efflux and fractional cholesterol absorption revealed an inverse correlation, indicating the efflux as an opposite-regulatory factor for cholesterol absorption efficiency and counteracting to the naturally-occurring rapid cholesterol influx to the BBM. These suggest that the ezetimibe-stimulated increased efflux is crucial in reducing cholesterol absorption. Ezetimibe-induced increase in cholesterol efflux was approximately 2.5-fold greater in mice having endogenous ATP-binding cassette G5/G8 heterodimer, the major sterol efflux transporter of enterocytes, than the knockout counterparts, suggesting that the heterodimer confers additional rapid BBM-to-lumen cholesterol efflux in response to NPC1L1 inhibition. The observed framework for intestinal cholesterol fluxes may provide ways to modulate the flux to dispose of endogenous cholesterol efficiently for therapeutic purposes.

The Effect of Ezetimibe/Statin Combination and High-Dose Statin Therapy on Thyroid Autoimmunity in Women with Hashimoto's Thyroiditis and Cardiovascular Disease: A Pilot Study.

PubMed

Krysiak, R; Szkróbka, W; Okopień, B

2016-10-01

Background: Intensive statin therapy was found to reduce thyroid autoimmunity in women with Hashimoto's thyroiditis. No similar data are available for other hypolipidemic agents. Methods: The participants of the study were 16 women with Hashimoto's thyroiditis and coronary artery disease. On the basis of statin tolerance, they were divided into 2 groups. 8 patients who did not tolerate high-dose statin therapy were treated with a statin, the dose of which was reduced by half, together with ezetimibe. The remaining 8 patients tolerating the treatment continued high-dose statin therapy. Plasma lipids, serum levels of thyrotropin, free thyroxine and free triiodothyronine, as well as titers of thyroid peroxidase and thyroglobulin antibodies were measured at the beginning of the study and 6 months later. Results: Replacing high-dose statin therapy with ezetimibe/statin combination therapy increased serum titers of thyroid peroxidase as well as led to an insignificant increase in serum titers of thyroglobulin antibodies. At the end of the study, thyroid peroxidase and thyroglobulin antibody titers were higher in patients receiving the combination therapy than in those treated only with high-dose statin. Conclusions: Our study shows that high-dose statin therapy produces a stronger effect on thyroid autoimmunity than ezetimibe/statin combination therapy. © Georg Thieme Verlag KG Stuttgart · New York.

TRENDS IN USE OF EZETIMIBE AFTER THE ENHANCE TRIAL, 2007–2010

PubMed Central

Ross, Joseph S.; Frazee, Sharon G.; Garavaglia, Susan B.; Levin, Rebecca; Novshadian, Haik; Jackevicius, Cynthia A.; Stettin, Glen; Krumholz, Harlan M.

2014-01-01

Importance Results from the landmark Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression [ENHANCE] trial were announced in January 2008, demonstrating that ezetimibe lowered cholesterol levels but did not slow the progression of atherosclerosis. Objective Examine the association of this announcement with national patterns of ezetimibe prescribing, including medication initiation and discontinuation, as well as predictors of use. Design, Setting and Patients Retrospective analysis of a national sample of adults aged 18 years or older who were continuously enrolled in a large U.S. pharmacy benefit manager from 2007 to 2010. Main Outcome Measures All lipid-lowering therapy prescription claims were categorized as ezetimibe-containing treatments or any other lipid-lowering agent. Initiation was defined as an ezetimibe claim without another in the prior 180 days; discontinuation as an ezetimibe claim without another in the subsequent 180 days. Results From 2007 to 2010, there were 10 million continuously eligible adults, 29.1% of whom obtained at least one prescription for a lipid-lowering agent. Among these adults, 17.8% were prescribed ezetimibe, 95.3% another lipid-lowering agent, predominantly statins. Ezetimibe use peaked in January 2008, when 2.5% of all adults were ezetimibe users, but declined only to 1.8% by December 2010. Although announcement of the ENHANCE trial was not associated with a significant change in overall ezetimibe use (p=0.11), it was associated with significantly more monthly monotherapy use and significantly less monthly ezetimibe use concomitant with other lipid-lowering agents. The ENHANCE trial was also associated with significantly fewer ezetimibe initiations (p=0.002) and significantly more ezetimibe discontinuations (p<0.0001), particularly of ezetimibe monotherapy for both. Before and after the trial, more than half of adults who initiated ezetimibe did so without first being prescribed another lipid-lowering agent. Middle aged adults (50 and 64 years) and those living in the East South Central United States were both more likely to initiate and less likely to discontinue ezetimibe after the ENHANCE trial. Conclusions After announcement of the results of the ENHANCE trial, nearly 2% of all continuously enrolled adult beneficiaries within a large U.S. pharmacy benefit manager used ezetimibe, although ezetimibe initiations declined and discontinuations increased. PMID:25070672

Effects of simvastatin, ezetimibe and simvastatin/ezetimibe on mitochondrial function and leukocyte/endothelial cell interactions in patients with hypercholesterolemia.

PubMed

Hernandez-Mijares, Antonio; Bañuls, Celia; Rovira-Llopis, Susana; Diaz-Morales, Noelia; Escribano-Lopez, Irene; de Pablo, Carmen; Alvarez, Angeles; Veses, Silvia; Rocha, Milagros; Victor, Victor M

2016-04-01

Cholesterol-lowering therapy has been related with several beneficial effects; however, its influence on oxidative stress and endothelial function is not fully elucidated. To investigate the effect of simvastatin and ezetimibe on mitochondrial function and leukocyte-endothelium interactions in polymorphonuclear cells of hyperlipidemic patients. Thirty-nine hyperlipidemic patients were randomly assigned to one of two groups: one received simvastatin (40 mg/day) and the other received ezetimibe (10 mg/day) for 4 weeks, after which both groups were administered combined therapy for an additional 4-week period. Lipid profile, mitochondrial parameters (oxygen consumption, reactive oxygen species (ROS) and membrane potential), glutathione levels, superoxide dismutase activity, catalase activity and leukocyte/endothelial cell interactions and adhesion molecules -VCAM-1, ICAM-1, E-selectin, were evaluated. An improvement in lipid profile was observed after administration of simvastatin or ezetimibe alone (LDLc: -40.2 vs -19.6%, respectively), though this effect was stronger with the former (p < 0.001), and a further reduction was registered when the two were combined (LDLc: -50.7% vs -56.8%, respectively). In addition to this, simvastatin, ezetimibe and simvastatin + ezetimibe significantly increased oxygen consumption, membrane potential and glutathione content, and decreased levels of ROS, thereby improving mitochondrial function. Furthermore, simvastatin + ezetimibe increased catalase activity. In addition, simvastatin and simvastatin/ezetimibe improved leukocyte/endothelium interactions by decreasing leukocyte rolling and adhesion and increasing leukocyte rolling velocity. Finally, simvastatin, ezetimibe and simvastatin + ezetimibe reduced levels of the adhesion molecule ICAM-1, and ezetimibe + simvastatin significantly decreased levels of E-selectin. Co-administration of simvastatin and ezetimibe has an additive cholesterol-lowering effect and beneficial consequences for mitochondrial function and leukocyte/endothelium interactions in leukocytes of hypercholesterolemic patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sociodemographic and diagnostic characteristics of prescribing a second-line lipid-lowering medication: ezetimibe used as initial medication, switch from statins, or add-on medication.

PubMed

Wallach-Kildemoes, Helle; Hansen, Ebba Holme

2015-10-01

Ezetimibe is used as a second-line lipid-lowering medication (LLM) if statin therapy is not tolerated or cholesterol targets are not reached by statins alone. We aimed to investigate the impact of sociodemographic factors on ezetimibe initiation as (a) incident LLM therapy, (b) add-on therapy, and (c) switch from statins. All individuals aged 30+ who had filled at least one prescription for either statins (N = 581.074) or ezetimibe (N = 7.932) in 2011 were followed in the nationwide Danish registries to explore LLM prescribing patterns from 1 January 2011 to end 2012. Using logistic regression analyses, the odds ratio (OR) with 95% confidence intervals (CIs) was calculated for (a) incident ezetimibe use among LLM initiators (N = 77,472), (b) ezetimibe switching by discontinuing statin users (N = 37,509), and (c) ezetimibe as add-on by non-discontinuing statin users (N = 442,672). Women had higher odds for initiating ezetimibe than men (switch OR = 1.55; 95% CI = 1.32-1.82). While prior use of newer high-potency statins was the strongest predictor (add-on (5.56; 4.95-6.24), income was the strongest socioeconomic predictor for incident LLM use (1.33; 1.14-1.56) and switching (1.64; 1.27-2.13). Both income and education were predictors for add-on therapy, with the educational effect mediated by prior use of high-potency statins. Odds for ezetimibe prescribing were highest in myocardial infarction patients. While higher income is a predictor for switching to ezetimibe, both higher education and income are weak predictors for using ezetimibe as add-on therapy. Women and individuals with myocardial infarction are more likely to be prescribed ezetimibe than others, despite lack of evidence of ezetimibe lowering the risk of cardiovascular events.

Real-world data to assess changes in low-density lipoprotein cholesterol and predicted cardiovascular risk after ezetimibe discontinuation post reporting of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression trial.

PubMed

Bays, Harold E; Patel, Mehul D; Mavros, Panagiotis; Ramey, Dena R; Tomassini, Joanne E; Tershakovec, Andrew M; Baxter, Carl A

The 2008 Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) study demonstrated ezetimibe + simvastatin vs simvastatin alone had a neutral effect on the surrogate endpoint of carotid intima-media thickness. Subsequent media portrayal of the study prompted ezetimibe discontinuation in many patients. The objective of the study was to assess the impact of ENHANCE reporting on ezetimibe discontinuation, low-density lipoprotein cholesterol (LDL-C) changes, and potential cardiovascular disease (CVD) risk. This analysis used claims data in a retrospective, observational study of patients receiving ezetimibe + statin and compared LDL-C for patients who discontinued ezetimibe (n = 970) vs those who continued ezetimibe + statins (n = 3706) after ENHANCE results disclosure. Change in relative CVD risk was estimated from the absolute LDL-C difference between groups per the Cholesterol Treatment Trialists' meta-analysis of statin trials. The rate of ezetimibe discontinuation was 2% in the 6 months before and 21% in the 6 months after reporting of ENHANCE results. Among patients who ultimately discontinued vs continued ezetimibe, respective mean LDL-C levels were 79.8 and 78.3 mg/dL 6 months before reporting of the ENHANCE results and 93.5 and 78.1 mg/dL 6 months after reporting of ENHANCE. Predictive application of the Cholesterol Treatment Trialists' meta-analysis suggested the 13.9 mg/dL increase in mean LDL-C translated to a 9.4% increase in relative CVD risk for those who discontinued ezetimibe. After reporting of the neutral ENHANCE results, ezetimibe discontinuation rate increased, LDL-C levels increased, and predicted CVD risk increased among those who discontinued ezetimibe. Characterization of clinical outcomes regarding lipid-altering agents based on surrogate biomarker studies not designed to assess CVD outcomes may be misleading, potentially placing patients at increased CVD risk. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Physicochemical characterization of ezetimibe and its impurities

NASA Astrophysics Data System (ADS)

Filip, Katarzyna; Bańkowski, Krzysztof; Sidoryk, Katarzyna; Zagrodzka, Joanna; Łaszcz, Marta; Trzcińska, Kinga; Szyprowska, Anna; Cmoch, Piotr; Maruszak, Wioleta

2011-04-01

The physicochemical characterization of major degradation and process-related impurities associated with the synthesis of ezetimibe was performed. The possibility of forming the undesirable ( R, R, S) stereoisomer of ezetimibe has been mentioned in literature (Vinod KK, Suhail A, Bhupendra T, Nitin G US 2010/0010212 A1, Ind-Swift Laboratories Limited WO 2008/096372), but no study of its structure determination has been published yet. This paper discusses the structure elucidation of the ( R, R, S) stereoisomer as well as ezetimibe degradation product on the bases of NMR, IR and MS data. Other potential impurities of ezetimibe are also described. A selective and stability-indicating high-performance liquid chromatography method with dual UV detection was developed for the determination of chemical and stereochemical purity of ezetimibe. The characterization of particle size and shape for ezetimibe and its stereoisomer is also described.

Variability of the LDL-C lowering response to ezetimibe and ezetimibe + statin therapy in hypercholesterolemic patients.

PubMed

Descamps, Olivier; Tomassini, Joanne E; Lin, Jianxin; Polis, Adam B; Shah, Arvind; Brudi, Philippe; Hanson, Mary E; Tershakovec, Andrew M

2015-06-01

We compared the variability of LDL-C-lowering responses to treatment with ezetimibe + statins versus statins in hypercholesterolemic patients. An analysis of patient-level data pooled from 27 double-blind, placebo and/or active-controlled studies in 21,671 patients treated with ezetimibe + statins versus statins on first-line (statin-naïve/wash-out) or second-line (on statin, randomized to ezetimibe versus placebo [add-on] or ezetimibe versus uptitrated statin [uptitrate]) for 6-24 wks. Variances (standard deviation [SD], coefficient of variation [CV], and root mean squared error [RMSE] adjusted for various factors) for % change from baseline in LDL-C were compared. In first-line and second-line add-on studies, the variability (SD, RMSE) of % change from baseline in LDL-C was lower in ezetimibe + statin-treated patients versus statin-treated patients, ±covariates. Differences were small but statistically significant due to the large sample size. In second-line uptitrate studies, ezetimibe + statin treatment resulted in greater unadjusted variability (SD) versus statin therapy, while the adjusted variability (RMSE) was significantly lower. Relative variability (CV=SD/mean) was lower for ezetimibe + statins versus statin therapy for all study types, being more pronounced in second-line add-on and uptitrate studies, attributed to larger mean LDL-C reductions for ezetimibe + statins versus statin groups. When assessed by individual study/type, statin brand, potency or dose, the CVs remained lower for ezetimibe + statins versus statins in second-line studies. The SDs showed no consistent trend for either therapy. In hypercholesterolemic patients, the absolute variability of LDL-C-lowering responses to ezetimibe + statins was not greater versus statins alone and appeared lower when adjusted for other factors. Relative variability was lower in patients treated with statins + ezetimibe. A better understanding of the variability of the LDL-C lowering response may help guide clinicians in making therapeutic decisions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Ezetimibe improves hepatic steatosis in relation to autophagy in obese and diabetic rats.

PubMed

Chang, Eugene; Kim, Lisa; Park, Se Eun; Rhee, Eun-Jung; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Park, Cheol-Young

2015-07-07

To investigate whether ezetimibe ameliorates hepatic steatosis and induces autophagy in a rat model of obesity and type 2 diabetes. Male age-matched lean control LETO and obese and diabetic OLETF rats were administered either PBS or ezetimibe (10 mg/kg per day) via stomach gavage for 20 wk. Changes in weight gain and energy intake were regularly monitored. Blood and liver tissue were harvested after overnight fasting at the end of study. Histological assessment was performed in liver tissue. The concentrations of glucose, insulin, triglycerides (TG), free fatty acids (FFA), and total cholesterol (TC) in blood and TG, FFA, and TG in liver tissue were measured. mRNA and protein abundance involved in autophagy was analyzed in the liver. To investigate the effect of ezetimibe on autophagy and reduction in hepatic fat accumulation, human Huh7 hepatocytes were incubated with ezetimibe (10 μmol/L) together with or without palmitic acid (PA, 0.5 mmol/L, 24 h). Transmission electron microscopy (TEM) was employed to demonstrate effect of ezetimibe on autophagy formation. Autophagic flux was measured with bafilomycin A1, an inhibitor of autophagy and following immunoblotting for autophagy-related protein expression. In the OLETF rats that received ezetimibe (10 mg/kg per day), liver weight were significantly decreased by 20% compared to OLETF control rats without changes in food intake and body weight (P < 0.05). Lipid parameters including TG, FFA, and TC in liver tissue of ezetimibe-administrated OLETF rats were dramatically decreased at least by 30% compared to OLETF controls (P < 0.01). The serum glucose, insulin, HOMA-IR, and lipid profiles were also improved by ezetimibe (P < 0.05). In addition, autophagy-related mRNA expression including ATG5, ATG6, and ATG7 and the protein level of microtubule-associated protein light chain 3 (LC3) were significantly increased in the liver in rats that received ezetimibe (P < 0.05). Likewise, for hepatocytes cultured in vitro, ezetimibe treatment significantly decreased PA-induced fat accumulation and increased PA-reduced mRNA and protein expression involved in autophagy (P < 0.05). Ezetimibe-increased autophagosomes was observed in TEM analysis. Immunoblotting analysis of autophagy formation with an inhibitor of autophagy demonstrated that ezetimibe-increased autophagy resulted from increased autophagic flux. The present study demonstrates that ezetimibe-mediated improvement in hepatic steatosis might involve the induction of autophagy.

Peroxisome proliferator-activated receptor delta activation leads to increased transintestinal cholesterol efflux

PubMed Central

Vrins, Carlos L. J.; van der Velde, Astrid E.; van den Oever, Karin; Levels, Johannes H. M.; Huet, Stephane; Oude Elferink, Ronald P. J.; Kuipers, Folkert; Groen, Albert K.

2009-01-01

Peroxisome proliferator-activated receptor delta (PPARδ) is involved in regulation of energy homeostasis. Activation of PPARδ markedly increases fecal neutral sterol secretion, the last step in reverse cholesterol transport. This phenomenon can neither be explained by increased hepatobiliary cholesterol secretion, nor by reduced cholesterol absorption. To test the hypothesis that PPARδ activation leads to stimulation of transintestinal cholesterol efflux (TICE), we quantified it by intestine perfusions in FVB mice treated with PPARδ agonist GW610742. To exclude the effects on cholesterol absorption, mice were also treated with cholesterol absorption inhibitor ezetimibe or ezetimibe/GW610742. GW601742 treatment had little effect on plasma lipid levels but stimulated both fecal neutral sterol excretion (∼200%) and TICE (∼100%). GW610742 decreased intestinal Npc1l1 expression but had no effect on Abcg5/Abcg8. Interestingly, expression of Rab9 and LIMPII, encoding proteins involved in intracellular cholesterol trafficking, was increased upon PPARδ activation. Although treatment with ezetimibe alone had no effect on TICE, it reduced the effect of GW610742 on TICE. These data show that activation of PPARδ stimulates fecal cholesterol excretion in mice, primarily by the two-fold increase in TICE, indicating that this pathway provides an interesting target for the development of drugs aiming at the prevention of atherosclerosis. PMID:19439761

The Glucotoxicity Protecting Effect of Ezetimibe in Pancreatic Beta Cells via Inhibition of CD36.

PubMed

Yoon, Ji Sung; Moon, Jun Sung; Kim, Yong-Woon; Won, Kyu Chang; Lee, Hyoung Woo

2016-04-01

Inhibition of CD36, a fatty acid transporter, has been reported to prevent glucotoxicity and ameliorate high glucose induced beta cell dysfunction. Ezetimibe is a selective cholesterol absorption inhibitor that blocks Niemann Pick C1-like 1 protein, but may exert its effect through suppression of CD36. We attempted to clarify the beneficial effect of ezetimibe on insulin secreting cells and to determine whether this effect is related to change of CD36 expression. mRNA expression of insulin and CD36, intracellular peroxide level and glucose stimulated insulin secretion (GSIS) under normal (5.6 mM) or high glucose (30 mM) condition in INS-1 cells and primary rat islet cells were compared. Changes of the aforementioned factors with treatment with ezetimibe (20 μM) under normal or high glucose condition were also assessed. mRNA expression of insulin was decreased with high glucose, which was reversed by ezetimibe in both INS-1 cells and primary rat islets. CD36 mRNA expression was increased with high glucose, but decreased by ezetimibe in INS-1 cells and primary rat islets. Three-day treatment with high glucose resulted in an increase in intracellular peroxide level; however, it was decreased by treatment with ezetimibe. Decrease in GSIS by three-day treatment with high glucose was reversed by ezetimibe. Palmitate uptake following exposure to high glucose conditions for three days was significantly elevated, which was reversed by ezetimibe in INS-1 cells. Ezetimibe may prevent glucotoxicity in pancreatic β-cells through a decrease in fatty acid influx via inhibition of CD36.

Antileishmanial Activity of Ezetimibe: Inhibition of Sterol Biosynthesis, In Vitro Synergy with Azoles, and Efficacy in Experimental Cutaneous Leishmaniasis

PubMed Central

Andrade-Neto, Valter Viana; Cunha-Júnior, Edézio Ferreira; do Canto-Cavalheiro, Marilene Marcuzzo; Atella, Geórgia Correa; Fernandes, Talita de Almeida; Costa, Paulo Roberto Ribeiro

2016-01-01

Leishmaniasis affects mainly low-income populations in tropical regions. Radical innovation in drug discovery is time-consuming and expensive, imposing severe restrictions on the ability to launch new chemical entities for the treatment of neglected diseases. Drug repositioning is an attractive strategy for addressing a specific demand more easily. In this project, we have evaluated the antileishmanial activities of 30 drugs currently in clinical use for various morbidities. Ezetimibe, clinically used to reduce intestinal cholesterol absorption in dyslipidemic patients, killed Leishmania amazonensis promastigotes with a 50% inhibitory concentration (IC50) of 30 μM. Morphological analysis revealed that ezetimibe caused the parasites to become rounded, with multiple nuclei and flagella. Analysis by gas chromatography (GC)-mass spectrometry (MS) showed that promastigotes treated with ezetimibe had smaller amounts of C-14-demethylated sterols, and accumulated more cholesterol and lanosterol, than untreated promastigotes. We then evaluated the combination of ezetimibe with well-known antileishmanial azoles. The fractional inhibitory concentration index (FICI) indicated synergy when ezetimibe was combined with ketoconazole or miconazole. The activity of ezetimibe against intracellular amastigotes was confirmed, with an IC50 of 20 μM, and ezetimibe reduced the IC90s of ketoconazole and miconazole from 11.3 and 11.5 μM to 4.14 and 8.25 μM, respectively. Subsequently, we confirmed the activity of ezetimibe in vivo, showing that it decreased lesion development and parasite loads in murine cutaneous leishmaniasis. We concluded that ezetimibe has promising antileishmanial activity and should be considered in combination with azoles in further preclinical and clinical studies. PMID:27600041

The Glucotoxicity Protecting Effect of Ezetimibe in Pancreatic Beta Cells via Inhibition of CD36

PubMed Central

2016-01-01

Inhibition of CD36, a fatty acid transporter, has been reported to prevent glucotoxicity and ameliorate high glucose induced beta cell dysfunction. Ezetimibe is a selective cholesterol absorption inhibitor that blocks Niemann Pick C1-like 1 protein, but may exert its effect through suppression of CD36. We attempted to clarify the beneficial effect of ezetimibe on insulin secreting cells and to determine whether this effect is related to change of CD36 expression. mRNA expression of insulin and CD36, intracellular peroxide level and glucose stimulated insulin secretion (GSIS) under normal (5.6 mM) or high glucose (30 mM) condition in INS-1 cells and primary rat islet cells were compared. Changes of the aforementioned factors with treatment with ezetimibe (20 μM) under normal or high glucose condition were also assessed. mRNA expression of insulin was decreased with high glucose, which was reversed by ezetimibe in both INS-1 cells and primary rat islets. CD36 mRNA expression was increased with high glucose, but decreased by ezetimibe in INS-1 cells and primary rat islets. Three-day treatment with high glucose resulted in an increase in intracellular peroxide level; however, it was decreased by treatment with ezetimibe. Decrease in GSIS by three-day treatment with high glucose was reversed by ezetimibe. Palmitate uptake following exposure to high glucose conditions for three days was significantly elevated, which was reversed by ezetimibe in INS-1 cells. Ezetimibe may prevent glucotoxicity in pancreatic β-cells through a decrease in fatty acid influx via inhibition of CD36. PMID:27051238

Impact of Efavirenz on Intestinal Metabolism and Transport: Insights From an Interaction Study With Ezetimibe in Healthy Volunteers

PubMed Central

Oswald, S; zu Schwabedissen, HE Meyer; Nassif, A; Modess, C; Desta, Z; Ogburn, ET; Mostertz, J; Keiser, M; Jia, J; Hubeny, A; Ulrich, A; Runge, D; Marinova, M; Lütjohann, D; Kroemer, HK; Siegmund, W

2013-01-01

Hypercholesterolemia frequently occurs in patients treated with efavirenz who cannot be treated adequately with statins because of drug interactions. These patients may benefit from cholesterol-lowering therapy with ezetimibe. This study determined the influence of single-dose and multiple-dose efavirenz (400 mg/day for 9 days) on the pharmacokinetics and sterol-lowering of ezetimibe (10 mg) in 12 healthy subjects. In addition, the influence of efavirenz on genome-wide intestinal expression and in vitro function of ABCB1, ABCC2, UGT1A1, and OATP1B1 was studied. Efavirenz (multiple dose) had no influence on the pharmacokinetics and lipid-lowering functions of ezetimibe. Intestinal expression of enzymes and transporters (e.g., ABCB1, ABCC2, and UGT1A1) was not affected by chronic efavirenz. Efavirenz (single dose) slightly increased ezetimibe absorption and markedly decreased exposure to ezetimibe-glucuronide (single dose and multiple dose), which may be explained by inhibition of UGT1A1 and ABCB1 (in vitro data). Ezetimibe had no effect on the disposition of efavirenz. Consequently, ezetimibe may be a safe and efficient therapeutic option in patients with HIV infection. PMID:22297387

Ezetimibe improves hepatic steatosis in relation to autophagy in obese and diabetic rats

PubMed Central

Chang, Eugene; Kim, Lisa; Park, Se Eun; Rhee, Eun-Jung; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Park, Cheol-Young

2015-01-01

AIM: To investigate whether ezetimibe ameliorates hepatic steatosis and induces autophagy in a rat model of obesity and type 2 diabetes. METHODS: Male age-matched lean control LETO and obese and diabetic OLETF rats were administered either PBS or ezetimibe (10 mg/kg per day) via stomach gavage for 20 wk. Changes in weight gain and energy intake were regularly monitored. Blood and liver tissue were harvested after overnight fasting at the end of study. Histological assessment was performed in liver tissue. The concentrations of glucose, insulin, triglycerides (TG), free fatty acids (FFA), and total cholesterol (TC) in blood and TG, FFA, and TG in liver tissue were measured. mRNA and protein abundance involved in autophagy was analyzed in the liver. To investigate the effect of ezetimibe on autophagy and reduction in hepatic fat accumulation, human Huh7 hepatocytes were incubated with ezetimibe (10 μmol/L) together with or without palmitic acid (PA, 0.5 mmol/L, 24 h). Transmission electron microscopy (TEM) was employed to demonstrate effect of ezetimibe on autophagy formation. Autophagic flux was measured with bafilomycin A1, an inhibitor of autophagy and following immunoblotting for autophagy-related protein expression. RESULTS: In the OLETF rats that received ezetimibe (10 mg/kg per day), liver weight were significantly decreased by 20% compared to OLETF control rats without changes in food intake and body weight (P < 0.05). Lipid parameters including TG, FFA, and TC in liver tissue of ezetimibe-administrated OLETF rats were dramatically decreased at least by 30% compared to OLETF controls (P < 0.01). The serum glucose, insulin, HOMA-IR, and lipid profiles were also improved by ezetimibe (P < 0.05). In addition, autophagy-related mRNA expression including ATG5, ATG6, and ATG7 and the protein level of microtubule-associated protein light chain 3 (LC3) were significantly increased in the liver in rats that received ezetimibe (P < 0.05). Likewise, for hepatocytes cultured in vitro, ezetimibe treatment significantly decreased PA-induced fat accumulation and increased PA-reduced mRNA and protein expression involved in autophagy (P < 0.05). Ezetimibe-increased autophagosomes was observed in TEM analysis. Immunoblotting analysis of autophagy formation with an inhibitor of autophagy demonstrated that ezetimibe-increased autophagy resulted from increased autophagic flux. CONCLUSION: The present study demonstrates that ezetimibe-mediated improvement in hepatic steatosis might involve the induction of autophagy. PMID:26167075

Comparison of Pharmacokinetics and Safety of a Fixed-dose Combination of Rosuvastatin and Ezetimibe Versus Separate Tablets in Healthy Subjects.

PubMed

Min, Kyoung Lok; Park, Min Soo; Jung, Jina; Chang, Min Jung; Kim, Choon Ok

2017-09-01

Rosuvastatin and ezetimibe are concomitantly used for dyslipidemia treatment. Compared with separate tablets, fixed-dose combination (FDC) tablets of rosuvastatin/ezetimibe could increase patient compliance. The aim of this study was to compare the pharmacokinetic (PK) profiles of an FDC tablet of rosuvastatin/ezetimibe and co-administration of rosuvastatin and ezetimibe as separate tablets in healthy Korean volunteers. This trial was a randomized, open-label, single-dose, 2-way crossover study. The healthy subjects received an FDC tablet of rosuvastatin 20 mg/ezetimibe 10 mg (test) or co-administration of rosuvastatin 20 mg and ezetimibe 10 mg (reference) in each period (periods 1 and 2), with a 14-day washout period. The blood samples for PK analysis were collected predose and up to 96 hours after administration, and safety was assessed throughout the study. Sixty-four healthy Korean subjects were enrolled, and 57 subjects completed the study. All subjects were men and mean age was 28.52 ± 5.93. The geometric least squares mean ratios (test/reference) and 90% CIs of C max and AUC 0-last were 101.54% (94.03-109.65) and 97.71% (91.86-103.93) for rosuvastatin, 108.93% (98.55-120.40) and 102.90% (96.72-109.47) for free ezetimibe, and 106.74% (98.18-116.05) and 104.24 % (99.53-109.17) for total ezetimibe. Twenty-four adverse events (AEs) were reported in 22 subjects. Three cases were related to the study drugs; 2 cases were mild, and 1 case was severe. However, all AEs were resolved without any sequelae. In addition, there were no serious AEs throughout the study. The FDC tablet of rosuvastatin/ezetimibe was well tolerated and resulted in comparable systemic exposure with co-administration of rosuvastatin and ezetimibe. ClinicalTrials.gov identifier: NCT02941848. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Enhanced spectrophotometric determination of two antihyperlipidemic mixtures containing ezetimibe in pharmaceutical preparations.

PubMed

Maher, Hadir M; Youssef, Rasha M; Hassan, Ekram M; El-Kimary, Eman I; Barary, Magda A

2011-02-01

Two spectrophotometric methods are presented for the simultaneous determination of ezetimibe/simvastatin and ezetimibe/atorvastatin binary mixtures in combined pharmaceutical dosage forms without prior separation. The first is the derivative ratio method where the amplitudes of the first derivative of the ratio spectra ((1) DD) at 299.5 and 242.5 nm were found to be linear with ezetimibe and simvastatin concentrations in the ranges 0.5-20 µgml(-1) and 1-40 µgml(-1) , respectively, whereas the amplitudes of the first derivative of the ratio spectra ((1) DD) at 289.5 and 288 nm were selected to determine ezetimibe and atorvastatin in the concentration ranges 5-50 µgml(-1) and 1-40 µgml(-1) , respectively. The second is the H-point standard additions method; absorbances at the two pairs of wavelengths, 228 and 242 nm or 238 and 248 nm, were monitored while adding standard solutions of ezetimibe or simvastatin, respectively. For the analysis of ezetimibe/atorvastatin mixture, absorbance values at 226 and 248 nm or 212 and 272 nm were monitored while adding standard solutions of ezetimibe or atorvastatin, respectively. Moreover, differential spectrophotometry was applied for the determination of ezetimibe in the two mixtures without any interference from the co-existing drug. This was performed by measurement of the difference absorptivities (ΔA) of ezetimibe in 0.07 M 30% methanolic NaOH relative to that of an equimolar solution in 0.07 M 30% methanolic HCl at 246 nm. The described methods are simple, rapid, precise and accurate for the determination of these combinations in synthetic mixtures and dosage forms. Copyright © 2010 John Wiley & Sons, Ltd.

Ezetimibe Attenuates Atherosclerosis Associated with Lipid Reduction and Inflammation Inhibition.

PubMed

Tie, Chunmiao; Gao, Kanglu; Zhang, Na; Zhang, Songzhao; Shen, Jiali; Xie, Xiaojie; Wang, Jian-An

2015-01-01

Ezetimibe, as a cholesterol absorption inhibitor, has been shown protecting against atherosclerosis when combined with statin. However, side by side comparison has not been made to evaluate the beneficial effects of ezetimibe alone versus statin. Herein, the study aimed to test whether ezetimibe alone would exhibit similar effects as statin and the combination therapy would be necessary in a moderate lesion size. ApoE-/- male mice that were fed a saturated-fat supplemented diet were randomly assigned to different therapeutic regimens: vehicle, ezetimibe alone (10 mg/kg/day), atorvastatin (20 mg/kg/day) or combination of ezetimibe and atorvastatin through the drinking water. On 28 days, mice were sacrificed and aorta and sera were collected to analyze the atherosclerotic lesion and blood lipid and cholesterol levels. As a result, ezetimibe alone exerted similar protective effects on atherosclerotic lesion sizes as atorvastatin, which was mediated by lowering serum cholesterol concentrations, inhibiting macrophage accumulation in the lesions and reducing circulatory inflammatory cytokines, such as monocyte chemoattractant protein (MCP-1) and tumor necrosis factor (TNF-α). In contrast to ezetimibe administration, atorvastatin alone attenuated atherosclerotic lesion which is dependent on its anti-inflammation effects. There were no significance differences in lesion areas and serum concentrations of cholesterol, oxidized LDL and inflammatory cytokines between combination therapy and monotherapy (either ezetimibe or atorvastatin). There were significant correlations between the lesion areas and serum concentrations of cholesterol, MCP-1 and TNF-α, respectively. However, there were no significant correlations between the lesion areas and serum concentrations of TGF-β1 and oxLDL. Ezetimibe alone played the same protection against a moderate atherosclerotic lesion as atorvastatin, which was associated with lowering serum cholesterol, decreasing circulating inflammatory cytokines, and inhibiting macrophage accumulation in the lesions.

Does tablet formulation alone improve adherence and persistence: a comparison of ezetimibe fixed dose combination versus ezetimibe separate pill combination?

PubMed

Bartlett, Louise E; Pratt, Nicole; Roughead, Elizabeth E

2017-01-01

The aim of this study was to compare adherence and persistence in patients who add ezetimibe to statin therapy as a separate pill combination (SPC) or fixed dose combination (FDC). This is a retrospective cohort study of prescription data conducted in an Australian health dataset. Two cohorts were identified: those dispensed statins and subsequently ezetimibe as either SPC or FDC. We compared adherence to combination therapy using the medication possession ratio (MPR), multivariate linear and logistic regression. Persistence to initial combination medicines and any lipid-lowering therapies were analysed using Kaplan Meyer survival and Cox proportional hazards models. A total of 3651 people initiated ezetimibe SPC and 5740 ezetimibe FDC. There was no significant difference in adherence with mean MPRs: ezetimibe SPC = 0.99 (95% confidence interval 0.98-1.01) and FDC = 0.97 (95% CI 0.95-0.99). One year persistence rates to initial combination medicines were ezetimibe SPC 49.1% vs. FDC 62.4%; hazard ratio (HR) = 1.81 (95% CI 1.76-1.90). However, persistence to any lipid-lowering therapy was higher in those initiating ezetimibe SPC = 84.9% vs. FDC = 76%; HR = 0.62 (95% CI 0.55-0.72). One year persistence rates to any two lipid-lowering medicines were similar: ezetimibe SPC 65.2% and FDC 65%. In this study FDCs have little impact on either adherence or persistence to combination lipid-lowering therapy in people who have been taking statins. The benefit of higher persistence to FDCs in first episode of treatment with initial medicines is debatable as persistence to dual therapy was similar in both cohorts. © 2016 The British Pharmacological Society.

Does tablet formulation alone improve adherence and persistence: a comparison of ezetimibe fixed dose combination versus ezetimibe separate pill combination?

PubMed Central

Pratt, Nicole; Roughead, Elizabeth E.

2016-01-01

Aims The aim of this study was to compare adherence and persistence in patients who add ezetimibe to statin therapy as a separate pill combination (SPC) or fixed dose combination (FDC). Method This is a retrospective cohort study of prescription data conducted in an Australian health dataset. Two cohorts were identified: those dispensed statins and subsequently ezetimibe as either SPC or FDC. We compared adherence to combination therapy using the medication possession ratio (MPR), multivariate linear and logistic regression. Persistence to initial combination medicines and any lipid‐lowering therapies were analysed using Kaplan Meyer survival and Cox proportional hazards models. Results A total of 3651 people initiated ezetimibe SPC and 5740 ezetimibe FDC. There was no significant difference in adherence with mean MPRs: ezetimibe SPC = 0.99 (95% confidence interval 0.98–1.01) and FDC = 0.97 (95% CI 0.95–0.99). One year persistence rates to initial combination medicines were ezetimibe SPC 49.1% vs. FDC 62.4%; hazard ratio (HR) = 1.81 (95% CI 1.76–1.90). However, persistence to any lipid‐lowering therapy was higher in those initiating ezetimibe SPC = 84.9% vs. FDC = 76%; HR = 0.62 (95% CI 0.55–0.72). One year persistence rates to any two lipid‐lowering medicines were similar: ezetimibe SPC 65.2% and FDC 65%. Conclusion In this study FDCs have little impact on either adherence or persistence to combination lipid‐lowering therapy in people who have been taking statins. The benefit of higher persistence to FDCs in first episode of treatment with initial medicines is debatable as persistence to dual therapy was similar in both cohorts. PMID:27517705

Antileishmanial Activity of Ezetimibe: Inhibition of Sterol Biosynthesis, In Vitro Synergy with Azoles, and Efficacy in Experimental Cutaneous Leishmaniasis.

PubMed

Andrade-Neto, Valter Viana; Cunha-Júnior, Edézio Ferreira; Canto-Cavalheiro, Marilene Marcuzzo do; Atella, Geórgia Correa; Fernandes, Talita de Almeida; Costa, Paulo Roberto Ribeiro; Torres-Santos, Eduardo Caio

2016-11-01

Leishmaniasis affects mainly low-income populations in tropical regions. Radical innovation in drug discovery is time-consuming and expensive, imposing severe restrictions on the ability to launch new chemical entities for the treatment of neglected diseases. Drug repositioning is an attractive strategy for addressing a specific demand more easily. In this project, we have evaluated the antileishmanial activities of 30 drugs currently in clinical use for various morbidities. Ezetimibe, clinically used to reduce intestinal cholesterol absorption in dyslipidemic patients, killed Leishmania amazonensis promastigotes with a 50% inhibitory concentration (IC 50 ) of 30 μM. Morphological analysis revealed that ezetimibe caused the parasites to become rounded, with multiple nuclei and flagella. Analysis by gas chromatography (GC)-mass spectrometry (MS) showed that promastigotes treated with ezetimibe had smaller amounts of C-14-demethylated sterols, and accumulated more cholesterol and lanosterol, than untreated promastigotes. We then evaluated the combination of ezetimibe with well-known antileishmanial azoles. The fractional inhibitory concentration index (FICI) indicated synergy when ezetimibe was combined with ketoconazole or miconazole. The activity of ezetimibe against intracellular amastigotes was confirmed, with an IC 50 of 20 μM, and ezetimibe reduced the IC 90 s of ketoconazole and miconazole from 11.3 and 11.5 μM to 4.14 and 8.25 μM, respectively. Subsequently, we confirmed the activity of ezetimibe in vivo, showing that it decreased lesion development and parasite loads in murine cutaneous leishmaniasis. We concluded that ezetimibe has promising antileishmanial activity and should be considered in combination with azoles in further preclinical and clinical studies. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Clinical outcome of statin plus ezetimibe versus high-intensity statin therapy in patients with acute myocardial infarction propensity-score matching analysis.

PubMed

Ji, Mi Seon; Jeong, Myung Ho; Ahn, Young Keun; Kim, Sang Hyung; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Rha, Seung-Woon; Bae, Jang Ho; Seung, Ki Bae; Park, Seung Jung

2016-12-15

It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ezetimibe Attenuates Atherosclerosis Associated with Lipid Reduction and Inflammation Inhibition

PubMed Central

Tie, Chunmiao; Gao, Kanglu; Zhang, Na; Zhang, Songzhao; Shen, Jiali; Xie, Xiaojie; Wang, Jian-an

2015-01-01

Background Ezetimibe, as a cholesterol absorption inhibitor, has been shown protecting against atherosclerosis when combined with statin. However, side by side comparison has not been made to evaluate the beneficial effects of ezetimibe alone versus statin. Herein, the study aimed to test whether ezetimibe alone would exhibit similar effects as statin and the combination therapy would be necessary in a moderate lesion size. Methods and Results ApoE-/- male mice that were fed a saturated-fat supplemented diet were randomly assigned to different therapeutic regimens: vehicle, ezetimibe alone (10 mg/kg/day), atorvastatin (20 mg/kg/day) or combination of ezetimibe and atorvastatin through the drinking water. On 28 days, mice were sacrificed and aorta and sera were collected to analyze the atherosclerotic lesion and blood lipid and cholesterol levels. As a result, ezetimibe alone exerted similar protective effects on atherosclerotic lesion sizes as atorvastatin, which was mediated by lowering serum cholesterol concentrations, inhibiting macrophage accumulation in the lesions and reducing circulatory inflammatory cytokines, such as monocyte chemoattractant protein (MCP-1) and tumor necrosis factor (TNF-α). In contrast to ezetimibe administration, atorvastatin alone attenuated atherosclerotic lesion which is dependent on its anti-inflammation effects. There were no significance differences in lesion areas and serum concentrations of cholesterol, oxidized LDL and inflammatory cytokines between combination therapy and monotherapy (either ezetimibe or atorvastatin). There were significant correlations between the lesion areas and serum concentrations of cholesterol, MCP-1 and TNF-α, respectively. However, there were no significant correlations between the lesion areas and serum concentrations of TGF-β1 and oxLDL. Conclusions Ezetimibe alone played the same protection against a moderate atherosclerotic lesion as atorvastatin, which was associated with lowering serum cholesterol, decreasing circulating inflammatory cytokines, and inhibiting macrophage accumulation in the lesions. PMID:26555472

Disparities in Intratumoral Steroidogenesis

DTIC Science & Technology

2014-07-01

shown), but does raise cholesterol levels significantly(18-22) (Fig 5). The diets are used with and without ezetimibe , a cholesterol reducing drug...yielding 4 base diet groups: 1) LFNC; 2) LFNC + ezetimibe (30 mg/kg/day); 3) HFHC; and 4) HFHC + ezetimibe (30 mg/kg/day). Critical comments...Serum Cholesterol Levels. Mice were fed either high fat, high cholesterol (HFHC) or a low fat, no cholesterol (LFNC) diet ± ezetimibe (Z) and bled

Physical stability of the amorphous anticholesterol agent (ezetimibe): the role of molecular mobility.

PubMed

Knapik, J; Wojnarowska, Z; Grzybowska, K; Hawelek, L; Sawicki, W; Wlodarski, K; Markowski, J; Paluch, M

2014-11-03

The purpose of this paper is to examine the role of molecular mobility in the recrystallization process from the amorphous state of the anticholesterol drug ezetimibe. Both the molecular dynamics and crystallization kinetics have been studied using various experimental techniques, such as broadband dielectric spectroscopy (BDS), differential scanning calorimetry (DSC), and X-ray diffraction (XRD). Our investigations have shown that ezetimibe easily recrystallizes from the disordered state, both below and above its glass transition temperature (Tg = 336 K). Moreover, we found that an only slightly elevated pressure (5 MPa) significantly accelerates the recrystallization process at T > Tg. We predict that the structural relaxation time of amorphous ezetimibe at 293 K (storage temperature) and ambient pressure is only 22 days. This result corresponds to the characteristic time, determined from XRD measurements, for amorphous ezetimibe to recrystallize during storage at Troom = 298 K. It leads to the conclusion that the molecular mobility reflected in structural relaxation of ezetimibe is mainly responsible for devitrification of this drug. Finally, we determined a relatively easy way to improve the physical stability of the drug by preparing a binary amorphous ezetimibe-Soluplus mixture. Ezetimibe in an amorphous mixture with 20 wt % Soluplus has a much better (over six times) solubility than the pure crystalline material.

Micelle-enhanced spectrofluorimetric method for determination of cholesterol-reducing drug ezetimibe in dosage forms.

PubMed

Alarfaj, Nawal A; Aly, Fatma A

2012-01-01

A simple and sensitive spectrofluorimetric method was developed for the determination of ezetimibe in its pharmaceutical formulations. The proposed method is based on investigation of the fluorescence spectral behavior of ezetimibe in sodium dodecyl sulfate (SDS) micellar system. In aqueous solution of acetate buffer pH 5.0, the fluorescence intensity of ezetimibe was greatly enhanced, 200% enhancement, in the presence of SDS. The fluorescence intensity of ezetimibe was measured at 380 nm after excitation at 268 nm. The fluorescence-concentration plot was rectilinear over the range of 0.03-3.0 μg/mL with lower detection limit of 3.08 × 10(-3) μg/mL. The method was successfully applied to the analysis of ezetimibe in its commercial tablets; the results were in good agreement with those obtained with the reported method. The application of the proposed method was extended to the stability studies of ezetimibe after exposure to different forced degradation conditions, such as acidic, alkaline, photo and oxidative conditions, according to ICH guidelines.

Ezetimibe inhibits hepatic Niemann-Pick C1-Like 1 to facilitate macrophage reverse cholesterol transport in mice.

PubMed

Xie, Ping; Jia, Lin; Ma, Yinyan; Ou, Juanjuan; Miao, Hongming; Wang, Nanping; Guo, Feng; Yazdanyar, Amirfarbod; Jiang, Xian-Cheng; Yu, Liqing

2013-05-01

Controversies have arisen from recent mouse studies about the essential role of biliary sterol secretion in reverse cholesterol transport (RCT). The objective of this study was to examine the role of biliary cholesterol secretion in modulating macrophage RCT in Niemann-Pick C1-Like 1 (NPC1L1) liver only (L1(LivOnly)) mice, an animal model that is defective in both biliary sterol secretion and intestinal sterol absorption, and determine whether NPC1L1 inhibitor ezetimibe facilitates macrophage RCT by inhibiting hepatic NPC1L1. L1(LivOnly) mice were generated by crossing NPC1L1 knockout (L1-KO) mice with transgenic mice overexpressing human NPC1L1 specifically in liver. Macrophage-to-feces RCT was assayed in L1-KO and L1(LivOnly) mice injected intraperitoneally with [(3)H]-cholesterol-labeled peritoneal macrophages isolated from C57BL/6 mice. Inhibition of biliary sterol secretion by hepatic overexpression of NPC1L1 substantially reduced transport of [(3)H]-cholesterol from primary peritoneal macrophages to the neutral sterol fraction in bile and feces in L1(LivOnly) mice without affecting tracer excretion in the bile acid fraction. Ezetimibe treatment for 2 weeks completely restored both biliary and fecal excretion of [(3)H]-tracer in the neutral sterol fraction in L1(LivOnly) mice. High-density lipoprotein kinetic studies showed that L1(LivOnly) mice compared with L1-KO mice had a significantly reduced fractional catabolic rate without altered hepatic and intestinal uptake of high-density lipoprotein-cholesterol ether. In mice lacking intestinal cholesterol absorption, macrophage-to-feces RCT depends on efficient biliary sterol secretion, and ezetimibe promotes macrophage RCT by inhibiting hepatic NPC1L1 function.

Myopathy induced by statin-ezetimibe combination: Evaluation of potential risk factors.

PubMed

Brahmachari, Ballari; Chatterjee, Suparna

2015-01-01

Although both atorvastatin and ezetimibe may cause myopathy, statin-induced myopathy is less likely at low doses, and ezetimibe is only rarely reported to induce myopathy. Also, ezetimibe is not usually known to potentiate statin-induced myopathy. We report a case of myalgia with elevated serum creatinine phosphokinase in a patient after 2 months of therapy with fixed dose combination of atorvastatin and ezetimibe (10 mg each). At the time of the event, patient was undertaking moderate physical exertion in the form of brisk walking for 30-40 min a day and was detected to have low serum Vitamin D levels. The adverse event resolved after stopping atorvastatin-ezetimibe combination therapy. Potential risk factors, such as physical exertion and Vitamin D deficiency, co-existent in dyslipidemic patients, may exacerbate myopathy potential of these drugs, and precipitate muscular symptoms even at a low-dose.

Clinical efficacy and safety of Ezetimibe on major cardiovascular endpoints: systematic review and meta-analysis of randomized controlled trials.

PubMed

Battaggia, Alessandro; Donzelli, Alberto; Font, Maria; Molteni, Davide; Galvano, Antonio

2015-01-01

Randomized clinical trials (RCTs) about Ezetimibe's efficacy on patient-oriented outcomes have given discordant results. The aim of this study was to determine the net effect of Ezetimibe and of the widely marketed combination, Ezetimibe+simvastatin, on mortality and morbidity outcomes. We searched for RCT on Ezetimibe using MEDLINE, CCTR, EMBASE, ClinicalTrials.gov databases up to December 2013, Merck and Novartis online registers, and personal communications. Two authors independently selected trials fulfilling these criteria: RCTs comparing Ezetimibe±statin or another lipid-lowering drug against placebo, or against the same lipid-lowering drug at the same dosage, with a follow-up at least 24 weeks and one or more of these outcomes: all-cause mortality, cardiovascular (CV) mortality, stroke, myocardial infarction (MI), cancer, serious adverse events (SAEs); we assessed the risk of bias using the Cochrane checklist. We extracted the data for major clinical events as a dichotomous measure, with the patient the unit of analysis. Pooled analysis was done with random and fixed effect based models. Trials comparing Ezetimibe plus a lipid-lowering drug against the same lipidlowering drug representing the net effect of Ezetimibe, showed a nonsignificant tendency toward damage for cancer, MI, stroke and SAEs. Ezetimibe+simvastatin vs. simvastatin alone showed a stronger tendency towards a higher risk for all-cause death (2.52; 0.65-9.74), CV death (3.04; 0.48-19.21), non-CV death (3.03; 0.12-73.50), MI (1.91; 0.42-8.70), stroke (2.38; 0.46-12.35), cancer (RR 11.11; 0.62-198.29), and SAEs (1.45; 0.95-2.23). Limitations include small numbers of events and inadequate power of the pooling. Trials comparing Ezetimibe+simvastatin vs placebo showed non-significant effects: MI (0.81; 0.66-1.00 p = 0.051), all-cause death (1.02; 0.95-1.09), CV death (0.91; 0.80-1.04), non-CV death (108; 0.99-1.18), stroke (0.86; 0.72-1.04), cancer (1.18; 0.80-1.74), SAEs (1.01; 0.96-1.06). Ezetimibe±simvastatin had inconsistent effects on important outcomes. No firm conclusions are possible, but findings indicative of damage suggest much more selective use of Ezetimibe±simvastatin.

Clinical Efficacy and Safety of Ezetimibe on Major Cardiovascular Endpoints: Systematic Review and Meta-Analysis of Randomized Controlled Trials

PubMed Central

Battaggia, Alessandro; Donzelli, Alberto; Font, Maria; Molteni, Davide; Galvano, Antonio

2015-01-01

Background Randomized clinical trials (RCTs) about Ezetimibe's efficacy on patient-oriented outcomes have given discordant results. The aim of this study was to determine the net effect of Ezetimibe and of the widely marketed combination, Ezetimibe+simvastatin, on mortality and morbidity outcomes. Methods and Findings We searched for RCT on Ezetimibe using MEDLINE, CCTR, EMBASE, ClinicalTrials.gov databases up to December 2013, Merck and Novartis online registers, and personal communications. Two authors independently selected trials fulfilling these criteria: RCTs comparing Ezetimibe±statin or another lipid-lowering drug against placebo, or against the same lipid-lowering drug at the same dosage, with a follow-up at least 24 weeks and one or more of these outcomes: all-cause mortality, cardiovascular (CV) mortality, stroke, myocardial infarction (MI), cancer, serious adverse events (SAEs); we assessed the risk of bias using the Cochrane checklist. We extracted the data for major clinical events as a dichotomous measure, with the patient the unit of analysis. Pooled analysis was done with random and fixed effect based models. Trials comparing Ezetimibe plus a lipid-lowering drug against the same lipidlowering drug representing the net effect of Ezetimibe, showed a nonsignificant tendency toward damage for cancer, MI, stroke and SAEs. Ezetimibe+simvastatin vs. simvastatin alone showed a stronger tendency towards a higher risk for all-cause death (2.52; 0.65-9.74), CV death (3.04; 0.48-19.21), non-CV death (3.03; 0.12-73.50), MI (1.91; 0.42-8.70), stroke (2.38; 0.46-12.35), cancer (RR 11.11; 0.62-198.29), and SAEs (1.45; 0.95-2.23). Limitations include small numbers of events and inadequate power of the pooling. Trials comparing Ezetimibe+simvastatin vs placebo showed non-significant effects: MI (0.81; 0.66-1.00 p = 0.051), all-cause death (1.02; 0.95-1.09), CV death (0.91; 0.80-1.04), non-CV death (108; 0.99-1.18), stroke (0.86; 0.72-1.04), cancer (1.18; 0.80-1.74), SAEs (1.01; 0.96-1.06). Conclusions Ezetimibe±simvastatin had inconsistent effects on important outcomes. No firm conclusions are possible, but findings indicative of damage suggest much more selective use of Ezetimibe±simvastatin. PMID:25915909

Improved efficacy for ezetimibe and rosuvastatin by attenuating the induction of PCSK9[S

PubMed Central

Ason, Brandon; Tep, Samnang; Davis, Harry R.; Xu, Yiming; Tetzloff, Glen; Galinski, Beverly; Soriano, Ferdie; Dubinina, Natalya; Zhu, Lei; Stefanni, Alice; Wong, Kenny K.; Tadin-Strapps, Marija; Bartz, Steven R.; Hubbard, Brian; Ranalletta, Mollie; Sachs, Alan B.; Flanagan, W. Michael; Strack, Alison; Kuklin, Nelly A.

2011-01-01

Reducing circulating LDL-cholesterol (LDL-c) reduces the risk of cardiovascular disease in people with hypercholesterolemia. Current approaches to reduce circulating LDL-c include statins, which inhibit cholesterol synthesis, and ezetimibe, which blocks cholesterol absorption. Both elevate serum PCSK9 protein levels in patients, which could attenuate their efficacy by reducing the amount of cholesterol cleared from circulation. To determine whether PCSK9 inhibition could enhance LDL-c lowering of both statins and ezetimibe, we utilized small interfer­ing RNAs (siRNAs) to knock down Pcsk9, together with ezetimibe, rosuvastatin, and an ezetimibe/rosuvastatin combination in a mouse model with a human-like lipid profile. We found that ezetimibe, rosuvastatin, and ezetimibe/rosuvastatin combined lower serum cholesterol but induce the expression of Pcsk9 as well as the Srebp-2 hepatic cholesterol biosynthesis pathway. Pcsk9 knockdown in combination with either treatment led to greater reductions in serum non-HDL with a near-uniform reduction of all LDL-c subfractions. In addition to reducing serum cholesterol, the combined rosuvastatin/ezetimibe/Pcsk9 siRNA treatment exhibited a significant reduction in serum APOB protein and triglyceride levels. Taken together, these data provide evidence that PCSK9 inhibitors, in combination with current therapies, have the potential to achieve greater reductions in both serum cholesterol and triglycerides. PMID:21262787

Short-term ezetimibe is well tolerated and effective in combination with statin therapy to treat elevated LDL cholesterol in HIV-infected patients.

PubMed

Chow, Dominic; Chen, Huichao; Glesby, Marshall J; Busti, Anthony; Souza, Scott; Andersen, Janet; Kohrs, Sharon; Wu, Julia; Koletar, Susan L

2009-10-23

Ezetimibe inhibits intestinal absorption of cholesterol. Multicentered double-blind, randomized, placebo-controlled, crossover study to determine the short-term safety, efficacy, and tolerability of ezetimibe in combination with ongoing statin therapy in HIV-infected adults with elevated low-density lipoprotein cholesterol (LDL-C). Participants on stable HAART with fasting LDL-C at least 130 mg/dl and stable statin were randomized to ezetimibe 10 mg daily or placebo for 12 weeks followed by 4 weeks of washout and then 12 weeks with alternative study assignment. Percentage and absolute change in LDL-C (primary endpoint), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), apolipoprotein B, and high sensitivity C-reactive protein were compared. Changes in clinical symptoms and safety laboratory measurements were assessed. Forty-four participants enrolled: 70% men, median age 49 years, 43% White/Non-Hispanic, median CD4 cell count 547 cells/microl, and 95% HIV RNA less than 50 copies/ml. Median (interquartile range) percentage change in LDL-C was -20.8% (-25.4, -10.7) with ezetimibe and -0.7% (-10.3,18.6) with placebo; the median within-participant effect of ezetimibe was -14.1% (-33.0, -5.0; P < 0.0001). Median difference in absolute LDL-C values between ezetimibe and placebo was -32 mg/dl (-58, -6, P < 0.0001). Significant differences in within-participant effect of ezetimibe were noted for total cholesterol -18.60% (-27.22, -11.67, P < 0.001), non-HDL-C -23.18% (-33.14, -14.36, P < 0.0001), and apolipoprotein B -8.73% (-18.75, 1.99, P = 0.02). No significant changes seen in HDL-C, triglyceride, or high sensitivity C-reactive protein. Ezetimibe was well tolerated. Adverse events were similar between phases. The present short-term study found adding ezetimibe to ongoing statin therapy was well tolerated and effective in reducing LDL-C, total cholesterol, non-HDL-C, and apolipoprotein B. Adding ezetimibe to statin therapy offers reasonable treatment option for HIV-infected patients with elevated LDL-C.

Impact of Ezetimibe on the Rate of Cardiovascular-Related Hospitalizations and Associated Costs Among Patients With a Recent Acute Coronary Syndrome: Results From the IMPROVE-IT Trial (Improved Reduction of Outcomes: Vytorin Efficacy International Trial).

PubMed

Pokharel, Yashashwi; Chinnakondepalli, Khaja; Vilain, Katherine; Wang, Kaijun; Mark, Daniel B; Davies, Glenn; Blazing, Michael A; Giugliano, Robert P; Braunwald, Eugene; Cannon, Christopher P; Cohen, David J; Magnuson, Elizabeth A

2017-05-01

Ezetimibe, when added to simvastatin therapy, reduces cardiovascular events after recent acute coronary syndrome. However, the impact of ezetimibe on cardiovascular-related hospitalizations and associated costs is unknown. We used patient-level data from the IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) to examine the impact of simvastatin-ezetimibe versus simvastatin-placebo on cardiovascular-related hospitalizations and related costs (excluding drug costs) over 7 years follow-up. Medicare Severity-Diagnosis Related Groups were assigned to all cardiovascular hospitalizations. Hospital costs were estimated using Medicare reimbursement rates for 2013. Associated physician costs were estimated as a percentage of hospital costs. The impact of treatment assignment on hospitalization rates and costs was estimated using Poisson and linear regression, respectively. There was a significantly lower cardiovascular hospitalization rate with ezetimibe compared with placebo (risk ratio, 0.95; 95% confidence interval, 0.90-0.99; P =0.031), mainly attributable to fewer hospitalizations for percutaneous coronary intervention, angina, and stroke. Consequently, cardiovascular-related hospitalization costs over 7 years were $453 per patient lower with ezetimibe (95% confidence interval, -$38 to -$869; P =0.030). Although all prespecified subgroups had lower cost with ezetimibe therapy, patients with diabetes mellitus, patients aged ≥75 years, and patients at higher predicted risk for recurrent ischemic events had even greater cost offsets. Addition of ezetimibe to statin therapy in patients with a recent acute coronary syndrome leads to reductions in cardiovascular-related hospitalizations and associated costs, with the greatest cost offsets in high-risk patients. These cost reductions may completely offset the cost of the drug once ezetimibe becomes generic, and may lead to cost savings from the perspective of the healthcare system, if treatment with ezetimibe is targeted to high-risk patients. URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00202878. © 2017 American Heart Association, Inc.

Stabilization of the Amorphous Ezetimibe Drug by Confining Its Dimension.

PubMed

Knapik, J; Wojnarowska, Z; Grzybowska, K; Jurkiewicz, K; Stankiewicz, A; Paluch, M

2016-04-04

The purpose of this paper is to investigate the influence of nanoconfinement on the molecular mobility, as well as on the physical stability, of amorphous ezetimibe drug. Two guest/host systems, ezetimibe-Aeroperl 300 and ezetimibe-Neusilin US2, were prepared and studied using various experimental techniques, such as X-ray diffraction (XRD), differential scanning calorimetry (DSC), and broadband dielectric spectroscopy (BDS). Our investigation has shown that the molecular mobility of the examined anticholesterol agent incorporated into nanopore matrices strongly depends on the pore size of the host system. Moreover, it was found that the amorphous ezetimibe confined in 30 nm pores of Aeroperl 300 has a tendency to recrystallize, while the drug incorporated into the smaller--5 nm--pores of Neusilin US2 is not able to crystallize. It has been shown that this significant stabilization of ezetimibe drug can be achieved by an interplay of three factors: changes in molecular dynamics of the confined amorphous drug, the immobilization effect of pore walls on a part of ezetimibe molecules, and the use of host materials with pores that are smaller than the critical size of the drug crystal nuclei.

Human genetic variation in VAC14 regulates Salmonella invasion and typhoid fever through modulation of cholesterol.

PubMed

Alvarez, Monica I; Glover, Luke C; Luo, Peter; Wang, Liuyang; Theusch, Elizabeth; Oehlers, Stefan H; Walton, Eric M; Tram, Trinh Thi Bich; Kuang, Yu-Lin; Rotter, Jerome I; McClean, Colleen M; Chinh, Nguyen Tran; Medina, Marisa W; Tobin, David M; Dunstan, Sarah J; Ko, Dennis C

2017-09-12

Risk, severity, and outcome of infection depend on the interplay of pathogen virulence and host susceptibility. Systematic identification of genetic susceptibility to infection is being undertaken through genome-wide association studies, but how to expeditiously move from genetic differences to functional mechanisms is unclear. Here, we use genetic association of molecular, cellular, and human disease traits and experimental validation to demonstrate that genetic variation affects expression of VAC14, a phosphoinositide-regulating protein, to influence susceptibility to Salmonella enterica serovar Typhi ( S Typhi) infection. Decreased VAC14 expression increased plasma membrane cholesterol, facilitating Salmonella docking and invasion. This increased susceptibility at the cellular level manifests as increased susceptibility to typhoid fever in a Vietnamese population. Furthermore, treating zebrafish with a cholesterol-lowering agent, ezetimibe, reduced susceptibility to S Typhi. Thus, coupling multiple genetic association studies with mechanistic dissection revealed how VAC14 regulates Salmonella invasion and typhoid fever susceptibility and may open doors to new prophylactic/therapeutic approaches.

Human genetic variation in VAC14 regulates Salmonella invasion and typhoid fever through modulation of cholesterol

PubMed Central

Alvarez, Monica I.; Glover, Luke C.; Luo, Peter; Wang, Liuyang; Theusch, Elizabeth; Oehlers, Stefan H.; Walton, Eric M.; Tram, Trinh Thi Bich; Kuang, Yu-Lin; Rotter, Jerome I.; McClean, Colleen M.; Chinh, Nguyen Tran; Medina, Marisa W.; Dunstan, Sarah J.

2017-01-01

Risk, severity, and outcome of infection depend on the interplay of pathogen virulence and host susceptibility. Systematic identification of genetic susceptibility to infection is being undertaken through genome-wide association studies, but how to expeditiously move from genetic differences to functional mechanisms is unclear. Here, we use genetic association of molecular, cellular, and human disease traits and experimental validation to demonstrate that genetic variation affects expression of VAC14, a phosphoinositide-regulating protein, to influence susceptibility to Salmonella enterica serovar Typhi (S. Typhi) infection. Decreased VAC14 expression increased plasma membrane cholesterol, facilitating Salmonella docking and invasion. This increased susceptibility at the cellular level manifests as increased susceptibility to typhoid fever in a Vietnamese population. Furthermore, treating zebrafish with a cholesterol-lowering agent, ezetimibe, reduced susceptibility to S. Typhi. Thus, coupling multiple genetic association studies with mechanistic dissection revealed how VAC14 regulates Salmonella invasion and typhoid fever susceptibility and may open doors to new prophylactic/therapeutic approaches. PMID:28827342

Impact of the ENHANCE trial on the use of ezetimibe in the United States and Canada.

PubMed

Lu, Lingyun; Krumholz, Harlan M; Tu, Jack V; Ross, Joseph S; Ko, Dennis T; Jackevicius, Cynthia A

2014-05-01

We previously found that the use of ezetimibe increased rapidly with different patterns between the United States (US) and Canada prior to the landmark Ezetimibe and Simvastatin in Hypercholesterolemia Enhance Atherosclerosis Regression (ENHANCE) trial, which was reported in January 2008, and failed to show that the drug slowed the progression of atherosclerosis. What is not known is how practice in the 2 countries changed after the ENHANCE trial. We examined ezetimibe use trends in the US and Canada before and after the reporting of the ENHANCE trial. We conducted a population-based, retrospective, time-series analysis using the data collected by IMS Health in the US and CompuScript in Canada from January 1, 2002, to December 31, 2009. The main outcome measure was monthly number of prescriptions for ezetimibe-containing products. The monthly number of ezetimibe prescriptions/100,000 population rose from 6 to 1,082 in the US from November 2002 to January 2008, then significantly declined to 572/100,000 population by December 2009 after the release of the ENHANCE trial, a decrease of 47.1% (P < .001). In contrast, in Canada, use continuously rose from 2 to 495/100,000 population from June 2003 to December 2009 (P = .2). United States expenditures totaled $2.24 billion in 2009. Ezetimibe remains commonly used in both the US and Canada. Ezetimibe use has decreased in the US post-ENHANCE, whereas use has gradually but steadily increased in Canada. The diverging patterns of ezetimibe use in the US and Canada require further investigation, as they reveal that a common evidence base is eliciting very different utilization patterns in neighboring countries. Copyright © 2014 Mosby, Inc. All rights reserved.

Implications for Ezetimibe Therapy Use Based on IMPROVE-IT Criteria.

PubMed

Virani, Salim S; Akeroyd, Julia M; Nambi, Vijay; Maddox, Thomas M; Gillette, Michael A; Michael Ho, P; Rumsfeld, John; Petersen, Laura A; Ballantyne, Christie M

2015-11-01

In the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), simvastatin/ezetimibe combination was associated with a 6% relative risk reduction in the combined cardiovascular outcome compared with simvastatin alone in patients with acute coronary syndrome. Given strict inclusion criteria (low-density lipoprotein cholesterol 50-125 mg/dL and no use of statins more potent than simvastatin 40 mg), the implications of this important trial in routine acute coronary syndrome care are unknown. We identified patients with acute coronary syndrome from the Veterans Affairs health care system over a 5-year period and determined what proportion would be candidates for ezetimibe on the basis of IMPROVE-IT criteria. We then evaluated what proportion could potentially see an increase in ezetimibe use if IMPROVE-IT criteria are not strictly followed. Of 219,625 patients with acute coronary syndrome, 69,508 (31.6%) would qualify for ezetimibe on the basis of strict criteria. Among those who did not meet IMPROVE-IT criteria (n = 150,117), ezetimibe could potentially be prescribed by clinicians in a further 28% of patients (n = 61,635) using statins more potent than simvastatin 40 mg, 7.1% of patients (15,527) with a documented statin intolerance, and 10.4% of patients (22,758) with low-density lipoprotein cholesterol >125 mg/dL. Our results provide a first look at the implications of this trial in a large health care system. Although 31.6% of patients would qualify for ezetimibe, there is a large potential for an increase in ezetimibe use in acute coronary syndrome outside of the strict trial inclusions. These findings call for a discussion on ezetimibe's role in patients with acute coronary syndrome already taking high-intensity statins or those with statin intolerance. Published by Elsevier Inc.

Ezetimibe: Use, costs, and adverse events in Australia.

PubMed

Hollingworth, Samantha A; Ostino, Remo; David, Michael C; Martin, Jennifer H; Tett, Susan E

2017-02-01

To analyze the subsidized use and reported adverse events of ezetimibe, used to lower cholesterol, in Australia over the 11 years following its inclusion on the Pharmaceutical Benefits Scheme (PBS) in 2004. Pharmacoepidemiological analysis of dispensed prescriptions from Medicare Australia. Adverse event data were obtained from the Therapeutic Goods Administration. Use was measured by the defined daily dose (DDD) per 1000 population per day for each calendar year. Adverse events were counted by organ class system. Total ezetimibe use rose to 8.46 DDD/1000 population/d in the 11 years to 2015. Ezetimibe as a sole active ingredient was the most commonly dispensed formulation followed by the two combination products containing ezetimibe and 40 mg or 80 mg simvastatin. The average yearly increase in utilization was 19% with a 24% annual increase in costs to government (2006-2015) to $169.0 million in 2015. There were substantial differences in ezetimibe use between states, with no relationship to deaths from ischaemic heart disease (IHD) in each jurisdiction. The major reported adverse events were musculoskeletal and connective tissue disorders and gastrointestinal disorders. Ezetimibe use has increased rapidly in Australia since receiving public subsidy. Although the indications for subsidy are very restricted, there appears to have been widespread use, not explained by differential geographical IHD death rates. Latest guidelines still question the value of ezetimibe, so further discussion about whether the public spending on this medication for any potential improvement in population health outcomes is justified. © 2016 John Wiley & Sons Ltd.

Effect of Ezetimibe on Insulin Secretion in db/db Diabetic Mice

PubMed Central

Zhong, Yong; Wang, Jun; Gu, Ping; Shao, Jiaqing; Lu, Bin; Jiang, Shisen

2012-01-01

Objective. To investigate the effect of ezetimibe on the insulin secretion in db/db mice. Methods. The db/db diabetic mice aged 8 weeks were randomly assigned into 2 groups and intragastrically treated with ezetimibe or placebo for 6 weeks. The age matched db/m mice served as controls. At the end of experiment, glucose tolerance test was performed and then the pancreas was collected for immunohistochemistry. In addition, in vitro perfusion of pancreatic islets was employed for the detection of insulin secretion in the first phase. Results. In the ezetimibe group, the fasting blood glucose was markedly reduced, and the total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly lowered when compared with those in the control group (P < 0.05). At 120 min after glucose tolerance test, the area under curve in the ezetimibe group was significantly smaller than that in the control group (P < 0.05), but the AUCINS0−30 was markedly higher. In vitro perfusion of pancreatic islets revealed the first phase insulin secretion was improved. In addition, the insulin expression in the pancreas in the ezetimibe group was significantly increased as compared to the control group. Conclusion. Ezetimibe can improve glucose tolerance, recover the first phase insulin secretion, and protect the function of β cells in mice. PMID:23118741

A pilot study of ezetimibe vs. atorvastatin for improving peripheral microvascular endothelial function in stable patients with type 2 diabetes mellitus.

PubMed

Sugiyama, Seigo; Jinnouchi, Hideaki; Hieshima, Kunio; Kurinami, Noboru; Suzuki, Tomoko; Miyamoto, Fumio; Kajiwara, Keizo; Matsui, Kunihiko; Jinnouchi, Tomio

2015-04-23

Elevated cholesterol in type 2 diabetes mellitus (DM) can cause endothelial dysfunction. An effective clinical therapy to improve endothelial dysfunction remains to be established. Different cardiovascular actions between treatments for the inhibition of cholesterol absorption and the suppression of cholesterol synthesis for achieving improvement in endothelial function are unknown in DM. Stable patients with type 2 DM and mildly elevated low-density lipoprotein cholesterol were enrolled. We evaluated peripheral microvascular endothelial function using reactive hyperemia peripheral arterial tonometry (RH-PAT) examination and calculated a natural logarithmic transformed value for the RH-PAT index (LnRHI). We randomly assigned 33 patients to each monotherapy: cholesterol synthesis suppression using atorvastatin (5 mg/day, n=16) or cholesterol absorption inhibition using ezetimibe (10 mg/day, n=17). Patients were prospectively followed for 6 months. Serum lipids and LnRHI were repeatedly examined before and after each therapy. LDL significantly decreased in both groups, but the percent changes of LDL showed a greater decrease in the atorvastatin group compared with the ezetimibe group (-34.5±7.8% vs. -21.9±9.6%, p<0.01). Serum levels of non-esterified free fatty acids (NEFA) significantly decreased in the ezetimibe group but not in the atorvastatin group (ezetimibe group: 561.1±236.8 to 429.7±195.9, p<0.01; atorvastatin group: 538.8±319.5 to 520.2±227.3, p=0.75). The percent decrease in NEFA was significantly greater in the ezetimibe group compared with the atorvastatin group (-19.9±27.4% vs. 11.3±44.1%, p<0.05). LnRHI showed a significant increase in the ezetimibe group but not in the atorvastatin group (ezetimibe group: 0.471±0.157 to 0.678±0.187, p<0.01; atorvastatin group: 0.552±0.084 to 0.558±0.202, p=0.64). The percent changes in LnRHI were significantly greater in the ezetimibe group compared with the atorvastatin group (63.3±89.2% vs. 7.4±41.2%, p<0.05). In patients with type 2 DM, ezetimibe monotherapy significantly reduced LDL and NEFA, and improved peripheral microvascular endothelial dysfunction. Ezetimibe could potentially exhibit beneficial effects on lipid disorders and microvascular endothelial dysfunction in DM.

Impact of Drug Policy on Regional Trends in Ezetimibe Use

PubMed Central

Lu, Lingyun; Krumholz, Harlan M.; Tu, Jack V.; Ross, Joseph S.; Ko, Dennis T.; Jackevicius, Cynthia A.

2014-01-01

Background Ezetimibe use has steadily increased in Canada during the past decade even in the absence of evidence demonstrating a beneficial effect on clinical outcomes. Among the 4 most populated provinces in Canada, there is a gradient in the restrictiveness of ezetimibe in public-funded formularies (most to least strict: British Columbia, Alberta, Quebec and Ontario). The impact of formulary policy on the utilization of ezetimibe over time is unknown. Methods and Results We conducted a population-level cohort study using IMS Health Canada’s data from June 2003 to December 2012 to examine ezetimibe use in these 4 provinces to better understand the association between use and formulary restrictiveness. We found regional variations in the patterns of ezetimibe use. From June 2003 to December 2012, British Columbia(most restrictive) had the lowest monthly increasing rate from $261 to $21,926 ($190/100,000 population/month), whereas Ontario (least restrictive) had the most rapid monthly increase from $223 to $74,030 ($ 647/100,000 population/month); Quebec from $130 to $59,690 ($522/100,000 population/month) and Alberta from $356 to $ 37604 ($327/100,000 population/month) were intermediate. (P<0.001) Conclusions Ezetimibe use remains common, increasing over the past decade. Use steadily increased in provinces with the most lenient formularies. In contrast, use was lower, plateauing since 2008 in British Columbia and Alberta, which have more restrictive formularies. The gradient in ezetimibe use was related to variability in restrictiveness of the provincial formularies, illustrating the potential of a policy-response gradient that may be used to more effectively manage medication use. PMID:24895451

Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia.

PubMed

Ferreira, António Miguel; Marques da Silva, Pedro

2017-06-01

Statin-ezetimibe combinations are a potentially advantageous therapeutic option for high-risk patients who need additional lowering of low-density lipoprotein cholesterol (LDL-C). These combinations may overcome some of the limitations of statin monotherapy by blocking both sources of cholesterol. Recently, a fixed-dose combination with atorvastatin, one of the most extensively studied statins, was approved and launched in several countries, including the USA. Depending on atorvastatin dose, this combination provides LDL-C reductions of 50-60%, triglyceride reductions of 30-40%, and high-density lipoprotein cholesterol (HDL-C) increases of 5-9%. Studies comparing the lipid-lowering efficacy of the atorvastatin-ezetimibe combination with the alternatives of statin dose titration or switching to a more potent statin consistently showed that combination therapy provided greater LDL-C reduction, translating into a greater proportion of patients achieving lipid goals. Simvastatin-ezetimibe combinations have been shown to reduce the incidence of major atherosclerotic events in several clinical settings to a magnitude that seems similar to that observed with statins for the same degree of absolute LDL-C lowering. The atorvastatin-ezetimibe combination has also been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone. Atorvastatin-ezetimibe combinations are generally well tolerated. Previous concerns of a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods. In this paper, we examine the rationale for an atorvastatin-ezetimibe combination, review the evidence supporting it, and discuss its potential role in the management of dyslipidemia.

Efficacy and Safety of Alirocumab Versus Ezetimibe Over 2 Years (from ODYSSEY COMBO II).

PubMed

El Shahawy, Mahfouz; Cannon, Christopher P; Blom, Dirk J; McKenney, James M; Cariou, Bertrand; Lecorps, Guillaume; Pordy, Robert; Chaudhari, Umesh; Colhoun, Helen M

2017-09-15

The proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab has been shown to substantially reduce low-density lipoprotein cholesterol (LDL-C). Demonstrating whether efficacy and safety are maintained over a long duration of exposure is vital for clinical decision-making. The COMBO II trial compared the efficacy and safety of alirocumab versus ezetimibe over 2 years. A prespecified first analysis was reported at 52 weeks. Here we report the final end-of-study data (on-treatment) and evaluate post hoc the safety profile with longer versus shorter duration of alirocumab exposure. Patients (n = 720) on maximally tolerated statin dose were treated with alirocumab (75/150 mg every 2 weeks) or ezetimibe (10 mg/day). Overall mean adherence for both treatment groups during the first and second year was >97%. At 2 years, LDL-C was reduced by 49% (alirocumab) versus 17% (ezetimibe; p <0.0001), and LDL-C <70 mg/dl was achieved by 73% of alirocumab-treated versus 40% of ezetimibe-treated patients. Overall safety was similar in both treatment groups at 2 years and during the first versus the second year. Local injection-site reactions were reported by 2.5% (alirocumab) versus 0.8% (ezetimibe) during the first year, and 0.2% versus 0.5% during the second year, indicating early occurrence during prolonged alirocumab exposure. Two consecutive calculated LDL-C values <25 mg/dl were observed in 28% of alirocumab-treated patients (vs 0.4% with ezetimibe). Persistent anti-drug antibody responses were observed in 1.3% (6 of 454) of alirocumab-treated versus 0.4% (1 of 231) of ezetimibe-treated patients. Neutralizing antibodies (that inhibit binding in vitro) were observed in 1.5% (7 of 454) of alirocumab-treated patients (0 with ezetimibe), mostly at isolated time points. Alirocumab sustained substantial LDL-C reductions and was well tolerated up to 2 years in the COMBO II trial. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Ezetimibe for the Treatment of Nonalcoholic Steatohepatitis: Assessment by Novel Magnetic Resonance Imaging and Magnetic Resonance Elastography in a Randomized Trial (MOZART Trial)

PubMed Central

Loomba, Rohit; Sirlin, Claude B; Ang, Brandon; Bettencourt, Ricki; Jain, Rashmi; Salotti, Joanie; Soaft, Linda; Hooker, Jonathan; Kono, Yuko; Bhatt, Archana; Hernandez, Laura; Nguyen, Phirum; Noureddin, Mazen; Haufe, William; Hooker, Catherine; Yin, Meng; Ehman, Richard; Lin, Grace Y; Valasek, Mark A; Brenner, David A; Richards, Lisa

2015-01-01

Ezetimibe inhibits intestinal cholesterol absorption and lowers low-density lipoprotein cholesterol. Uncontrolled studies have suggested that it reduces liver fat as estimated by ultrasound in nonalcoholic steatohepatitis (NASH). Therefore, we aimed to examine the efficacy of ezetimibe versus placebo in reducing liver fat by the magnetic resonance imaging-derived proton density-fat fraction (MRI-PDFF) and liver histology in patients with biopsy-proven NASH. In this randomized, double-blind, placebo-controlled trial, 50 patients with biopsy-proven NASH were randomized to either ezetimibe 10 mg orally daily or placebo for 24 weeks. The primary outcome was a change in liver fat as measured by MRI-PDFF in colocalized regions of interest within each of the nine liver segments. Novel assessment by two-dimensional and three-dimensional magnetic resonance elastography was also performed. Ezetimibe was not significantly better than placebo at reducing liver fat as measured by MRI-PDFF (mean difference between the ezetimibe and placebo arms -1.3%, P = 0.4). Compared to baseline, however, end-of-treatment MRI-PDFF was significantly lower in the ezetimibe arm (15%-11.6%, P < 0.016) but not in the placebo arm (18.5%-16.4%, P = 0.15). There were no significant differences in histologic response rates, serum alanine aminotransferase and aspartate aminotransferase levels, or longitudinal changes in two-dimensional and three-dimensional magnetic resonance elastography-derived liver stiffness between the ezetimibe and placebo arms. Compared to histologic nonresponders (25/35), histologic responders (10/35) had a significantly greater reduction in MRI-PDFF (-4.35 ± 4.9% versus -0.30 ± 4.1%, P < 0.019). Conclusions: Ezetimibe did not significantly reduce liver fat in NASH. This trial demonstrates the application of colocalization of MRI-PDFF-derived fat maps and magnetic resonance elastography-derived stiffness maps of the liver before and after treatment to noninvasively assess treatment response in NASH. (Hepatology 2015;61:1239–1250) PMID:25482832

Effects of simvastatin and ezetimibe in lowering low-density lipoprotein cholesterol in subjects with type 1 and type 2 diabetes mellitus.

PubMed

Ciriacks, Kevin; Coly, Gerard; Krishnaswami, Shanthi; Patel, Shailendra B; Kidambi, Srividya

2015-03-01

Statins are used to lower total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels among patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). However, there are no studies of statin efficacy among T1DM patients. T1DM patients have higher gut cholesterol absorption than synthesis; hence cholesterol absorption inhibitors such as ezetimibe may also be effective in T1DM. Here, we compare the effects of simvastatin and ezetimibe among subjects with T1DM and T2DM. Subjects with T1DM (n=20, 45% female) or T2DM (n=27, 56% female) were assigned to alternating therapy with simvastatin (40 mg) or ezetimibe (10 mg) for 6 weeks in a crossover design. Among T2DM subjects, simvastatin lowered TC and LDL-C from the baseline (-25±4% and -40±5%, respectively, P<0.001), whereas ezetimibe was not as effective (-2±4% and -3±5%, respectively). Among T1DM subjects, both statin and ezetimibe showed significant decreases in TC and LDL-C from baseline, although ezetimibe lowered LDL-C much more than simvastatin (-32±12 (P<0.001) and -19±5% (P<0.01), respectively). Effect of simvastatin on LDL-C was much lower among T1DM subjects compared to T2DM subjects (P=0.02). This study shows that the cholesterol synthesis inhibitor simvastatin was less effective in lowering LDL-C in T1DM than T2DM subjects, whereas the cholesterol absorption inhibitor ezetimibe was at least as effective in lowering LDL-C as simvastatin among T1DM subjects.

Effect of fixed-dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS-ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe).

PubMed

Kim, Kyung-Jin; Kim, Sang-Hyun; Yoon, Young Won; Rha, Seung-Woon; Hong, Soon-Jun; Kwak, Choong-Hwan; Kim, Weon; Nam, Chang-Wook; Rhee, Moo-Yong; Park, Tae-Ho; Hong, Taek-Jong; Park, Sungha; Ahn, Youngkeun; Lee, Namho; Jeon, Hui-Kyung; Jeon, Dong-Woon; Han, Kyoo-Rok; Moon, Keon-Woong; Chae, In-Ho; Kim, Hyo-Soo

2016-10-01

We aimed to compare the effects of fixed-dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia, including a subgroup analysis of patients with diabetes mellitus (DM) or metabolic syndrome (MetS). This multicenter eight-week randomized double-blind phase III study evaluated the safety and efficacy of fixed-dose combinations of ezetimibe 10 mg plus rosuvastatin, compared with rosuvastatin alone in patients with primary hypercholesterolemia. Four hundred and seven patients with primary hypercholesterolemia who required lipid-lowering treatment according to the ATP III guideline were randomized to one of the following six treatments for 8 weeks: fixed-dose combinations with ezetimibe 10 mg daily plus rosuvastatin (5, 10, or 20 mg daily) or rosuvastatin alone (5, 10, or 20 mg daily). Fixed-dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol, total cholesterol, and triglyceride levels compared with rosuvastatin alone. Depending on the rosuvastatin dose, these fixed-dose combinations of ezetimibe plus rosuvastatin provided LDL cholesterol, total cholesterol, and triglyceride reductions of 56%-63%, 37%-43%, and 19%-24%, respectively. Moreover, the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non-DM or non-MetS patients, respectively, whereas the effect of rosuvastatin alone did not differ between DM vs non-DM or MetS vs non-MetS patients. Fixed-dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy to rosuvastatin alone in lowering LDL cholesterol, total cholesterol, and triglyceride levels. Moreover, the reduction rate was greater in patients with DM or MetS. © 2016 The Authors Cardiovascular Therapeutics Published by John Wiley & Sons Ltd.

Safety and efficacy of ezetimibe: A meta-analysis.

PubMed

Savarese, Gianluigi; De Ferrari, Gaetano M; Rosano, Giuseppe M C; Perrone-Filardi, Pasquale

2015-12-15

The addition of ezetimibe to statin therapy has been widely demonstrated to significantly reduce low-density lipoprotein cholesterol levels. However, the efficacy of ezetimibe in reducing CV events and its safety has been less investigated. The aim of the current meta-analysis was to report efficacy and safety of ezetimibe from randomized clinical trials. Randomized clinical trials with a follow-up of at least 24 weeks, enrolling more than 200 patients, comparing ezetimibe versus placebo or ezetimibe plus another hypolipidemic agent versus the same hypolipidemic drug alone and reporting at least one event among all-cause and CV mortality, myocardial infarction (MI), stroke and new onset of cancer were included in the analysis. 7 trials enrolling 31,048 patients (median follow-up 34.1 ± 26.3 months; 70% women; mean age 61 ± 8 years) were included in the analysis. Compared to control therapy, ezetimibe significantly reduced the risk of MI by 13.5% (RR: 0.865, 95% CI: 0.801 to 0.934, p<0.001) and the risk of any stroke by 16.0% (RR: 0.840, 95% CI: 0.744 to 0.949, p=0.005), without any effect on all-cause and CV mortality (RR: 1.003, 95% CI: 0.954 to 1.055, p=0.908; RR: 0.958, 95% CI: 0.879 to 1.044, p=0.330; respectively) and risk of new cancer (RR: 1.040, 95% CI: 0.965 to 1.120, p=0.303). Ezetimibe significantly reduces the risk of MI and stroke without any effect on all-cause and CV mortality and risk of cancer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Impact of the ENHANCE Trial on the Use of Ezetimibe in the United States and Canada

PubMed Central

Lu, Lingyun; Krumholz, Harlan M.; Tu, Jack V.; Ross, Joseph S.; Ko, Dennis T.; Jackevicius, Cynthia A.

2014-01-01

Background We previously found the use of ezetimibe increased rapidly with different patterns between the United States (US) and Canada prior to the landmark ENHANCE trial, which was reported in January 2008, and failed to show that the drug slowed the progression of atherosclerosis. What is not known is how practice in the two countries changed after the ENHANCE trial. We examined ezetimibe use trends in the US and Canada before and after the reporting of the ENHANCE trial. Methods We conducted a population-based, retrospective, time-series analysis using the data collected by IMS Health in the US and Compuscript in Canada from January 1, 2002 to December 31, 2009. The main outcome measure was monthly number of prescriptions for ezetimibe-containing products. Results The monthly number of ezetimibe prescriptions/100,000 population rose from 6 to 1082 in the US from November 2002 to January 2008, then significantly declined to 572/100,000 population by December 2009 after the release of the ENHANCE trial, a decrease of 47.1% (P<0.001). In contrast, in Canada, use continuously rose from 2 to 495/100,000 population from June 2003 to December 2009 (P=0.2). US expenditures totaled $2.24 billion in 2009. Conclusions Ezetimibe remains commonly used in both the US and Canada. Ezetimibe use has decreased in the US post-ENHANCE, whereas use has gradually but steadily increased in Canada. The diverging patterns of ezetimibe use in the US and Canada requires further investigation as it reveals that a common evidence base is eliciting very different utilization patterns in neighboring countries. PMID:24766978

Efficacy and Safety of Long-term Coadministration of Fenofibrate and Ezetimibe in Patients with Combined Hyperlipidemia: Results of the EFECTL Study

PubMed Central

Yamashita, Shizuya; Nakaya, Noriaki; Sasaki, Jun; Kono, Suminori

2017-01-01

Aim: We investigated the safety and efficacy of a long-term combination therapy with fenofibrate and ezetimibe in Japanese patients with combined hyperlipidemia, in comparison with fenofibrate or ezetimibe alone. Methods: The study was a three-arm parallel-group, open-label randomized trial. Eligible patients were assigned to a combination therapy with fenofibrate (200 mg/day in capsule form or 160 mg/day in tablet form) and ezetimibe (10 mg/day), the fenofibrate monotherapy, or the ezetimibe monotherapy, which lasted for 52 weeks. The changes in serum low-density lipoprotein (LDL) cholesterol and triglycerides were the primary outcomes. Results: A total of 236 patients were assigned to one of the three treatments, and the number of patients included in the final analysis was 107 in the combination therapy, 52 in the fenofibrate monotherapy, and 51 in the ezetimibe monotherapy. Mean ± SD changes in LDL cholesterol were −24.2% ± 14.7% with combination therapy, −16.0% ± 16.0% with fenofibrate alone, and −17.4% ± 10.1% with ezetimibe alone. The combination therapy resulted in a significantly greater reduction in LDL cholesterol as compared with each monotherapy (p < 0.01 for each). The corresponding values for triglycerides were −40.0% ± 29.5%, −40.1% ± 28.7%, and −3.4% ± 32.6%, respectively. Fenofibrate use was associated with some changes in laboratory measurements, but there was no differential adverse effect between the combination therapy and fenofibrate monotherapy. Conclusion: The combination therapy with fenofibrate and ezetimibe substantially reduces concentrations of LDL cholesterol and triglycerides and is safe in a long-term treatment in Japanese patients with combined hyperlipidemia. PMID:27397061

Ezetimibe inhibits platelet activation and uPAR expression on endothelial cells.

PubMed

Becher, Tobias; Schulze, Torsten J; Schmitt, Melanie; Trinkmann, Frederik; El-Battrawy, Ibrahim; Akin, Ibrahim; Kälsch, Thorsten; Borggrefe, Martin; Stach, Ksenija

2017-01-15

Lipid lowering therapy constitutes the basis of cardiovascular disease therapy. The purpose of this study was to investigate effects of ezetimibe, a selective inhibitor of intestinal cholesterol absorption, on platelets and endothelial cells in an in vitro endothelial cell model. After a 24h incubation period with ezetimibe (concentrations 1, 50, 100 and 1000ng/ml), human umbilical vein endothelial cells (HUVEC) were stimulated for 1h with lipopolysaccharide (LPS) and were then incubated in direct contact with activated platelets. Following this, the expression of CD40L and CD62P on platelets, and the expression of ICAM-1, VCAM-1, uPAR, and MT1-MMP on endothelial cells were measured by flow cytometry. Supernatants were analysed by enzyme linked immunosorbent assay for soluble MCP-1, IL-6 and MMP-1. The increased expression of uPAR on endothelial cells by proinflammatory stimulation with LPS and by direct endothelial contact with activated platelets was significantly reduced through pre-incubation with 100ng/ml and 1000ng/ml ezetimibe (p<0.05). Platelets directly incubated with ezetimibe but without endothelial cell contact showed significantly reduced CD62P and CD40L surface expression (p<0.05). Ezetimibe had no significant effects on HUVEC expression of MT1-MMP, ICAM-1 and VCAM-1 and on CD40L expression on platelets in direct contact with endothelial cells. Levels of soluble IL-6 in HUVEC supernatants were significantly lower after pre-incubation with ezetimibe. In this in vitro analysis, ezetimibe directly attenuates platelet activation and has significant endothelial cell mediated effects on selected markers of atherosclerosis. Copyright © 2016. Published by Elsevier Ireland Ltd.

Efficacy and Safety of Long-term Coadministration of Fenofibrate and Ezetimibe in Patients with Combined Hyperlipidemia: Results of the EFECTL Study.

PubMed

Oikawa, Shinichi; Yamashita, Shizuya; Nakaya, Noriaki; Sasaki, Jun; Kono, Suminori

2017-01-01

We investigated the safety and efficacy of a long-term combination therapy with fenofibrate and ezetimibe in Japanese patients with combined hyperlipidemia, in comparison with fenofibrate or ezetimibe alone. The study was a three-arm parallel-group, open-label randomized trial. Eligible patients were assigned to a combination therapy with fenofibrate (200 mg/day in capsule form or 160 mg/day in tablet form) and ezetimibe (10 mg/day), the fenofibrate monotherapy, or the ezetimibe monotherapy, which lasted for 52 weeks. The changes in serum low-density lipoprotein (LDL) cholesterol and triglycerides were the primary outcomes. A total of 236 patients were assigned to one of the three treatments, and the number of patients included in the final analysis was 107 in the combination therapy, 52 in the fenofibrate monotherapy, and 51 in the ezetimibe monotherapy. Mean±SD changes in LDL cholesterol were -24.2%±14.7% with combination therapy, -16.0%±16.0% with fenofibrate alone, and -17.4%± 10.1% with ezetimibe alone. The combination therapy resulted in a significantly greater reduction in LDL cholesterol as compared with each monotherapy (p＜0.01 for each). The corresponding values for triglycerides were -40.0%±29.5%, -40.1%±28.7%, and -3.4%±32.6%, respectively. Fenofibrate use was associated with some changes in laboratory measurements, but there was no differential adverse effect between the combination therapy and fenofibrate monotherapy. The combination therapy with fenofibrate and ezetimibe substantially reduces concentrations of LDL cholesterol and triglycerides and is safe in a long-term treatment in Japanese patients with combined hyperlipidemia.

COMBINATION THERAPY EFFECTIVENESS OF EZETIMIBE AND ATORVASTATIN IN PATIENTS WITH ACUTE CORONARY SYNDROME.

PubMed

Japaridze, L; Sadunishvili, M; Megreladze, I

2016-03-01

Atorvastatin reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe (EZE) , a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. We conducted a 16-week one-center, prospective, randomized, and open-label clinical trial, involving 323 patients who had been hospitalized for an acute coronary syndrome within the preceding 14 days. They were received atorvastatin 20 mg during 28 days and after that 292 patients, who had LDL cholesterol levels≥1.81 mmol/L, were randomized to ezetimibe 10 mg/day co-administered with atorvastatin therapy (EZE+Statin) or doubling their current atorvastatin dose. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. At 16 weeks, the mean LDL cholesterol level during the study was 1.60 mmol per liter in the atorvastatine-ezetimibe group, as compared with 1.91 mmol per liter in the atorvastatin-monotherapy group (p<0.001). The Kaplan-Meier survival rate at 16 weeks were 88 .1 % in the atorvastatin-ezetimibe group and 77.0 % in the atorvastatin monotherapy group (absolute risk reduction, 11.1 percentage points; hazard ratio, 2.099 ; 95% confidence interval, 1.165 to 3.781; p=0.014). Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 16 weeks compared to patients doubling their statin dose. When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Ezetimibe/statin combination therapy was well tolerated among this patients, without safety concerns.

Influence of ezetimibe in addition to high-dose atorvastatin therapy on plaque composition in patients with ST-segment elevation myocardial infarction assessed by serial: Intravascular ultrasound with iMap: the OCTIVUS trial.

PubMed

Hougaard, Mikkel; Hansen, Henrik Steen; Thayssen, Per; Antonsen, Lisbeth; Junker, Anders; Veien, Karsten; Jensen, Lisette Okkels

2017-03-01

The aim of this study was to examine the influence of ezetimibe in addition to atorvastatin on plaque composition in patients with first-time ST-segment Elevation Myocardial Infarction treated with primary percutaneous intervention. Eighty-seven patients were randomized (1:1) to ezetimibe 10mg or placebo in addition to Atorvastatin 80mg. Intravascular ultrasound with iMap was performed at baseline and after 12months in a non-infarct-related artery. Primary endpoint was change in necrotic core (NC). Secondary endpoints were total atheroma volume (TAV) and percentage atheroma volume (PAV). NC did not change significantly: ezetimibe group 24.9 (11.9, 51.3) mm 3 to 24.9 (15.3, 54.5) mm 3 , p=0.76, placebo group 29.4 (16.3, 78.5) mm 3 to 32.0 (16.0, 88.7) mm 3 , p=0.30, (p=0.35 between groups). TAV was reduced in the ezetimibe group only: ezetimibe (200.0 (135.6, 311.9) mm 3 to 189.3 (126.4, 269.1) mm 3 , p<0.001) compared to placebo group (218.4 (163.5, 307.9) mm 3 to 212.2 (149.9, 394.8) mm 3 , p=0.07) (p=0.56 between groups). PAV was reduced in the ezetimibe group only (40.1±8.6% to 39.2±9.0%, p=0.036) compared to placebo group (43.3±9.4% to 42.2±10.7%, p=0.07), p=0.91 between groups. Ezetimibe in addition to atorvastatin therapy did not influence NC content, but was associated with regression of coronary atherosclerosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Ezetimibe on Major Atherosclerotic Disease Events and All-Cause Mortality

PubMed Central

Hayek, Sami; Escaro, Fabrizio Canepa; Sattar, Assad; Gamalski, Steven; Wells, Karen E.; Divine, George; Ahmedani, Brian K.; Lanfear, David E.; Pladevall, Manel; Williams, L. Keoki

2012-01-01

Despite ezetimibe’s ability to reduce serum cholesterol levels, there are concerns over its vascular effects and whether it prevents or ameliorates atherosclerotic disease (AD). Our objective was to estimate the effect of ezetimibe use on major AD events and all-cause mortality and to compare these associations to those observed for hydroxy-methylglutaryl-CoA reductase inhibitor (i.e., statin) use. We identified 367 new ezetimibe users between November 1, 2002 and December 31, 2009. These individuals were ≥18 years of age and had no prior statin use. One to four statin user matches were identified for each ezetimibe user resulting in a total of 1,238 closely matched statin users. Pharmacy data and drug dosage information were used to estimate a moving window of ezetimibe and statin exposure for each day of study follow-up. The primary outcome was a composite of major AD events (coronary heart disease, cerebrovascular disease, and peripheral vascular disease events) and all-cause death. Both ezetimibe use (odds ratio [OR] 0.33, 95% CI 0.13–0.86) and statin use (OR 0.61, 95% CI 0.36–1.04) were associated with reductions in the likelihood of the composite outcome. These protective associations were most significant for cerebrovascular disease events and all-cause death. Subgroup analyses by sex, race-ethnicity, prior history of AD, diabetes status, and estimated renal function showed consistent estimates across strata with no significant differences between ezetimibe and statin use. In conclusion, ezetimibe appeared to have a protective effect on major AD events and all-cause death which was not significantly different from that observed for statin use. PMID:23219178

The Oncogenic Palmitoyl-Protein Network in Prostate Cancer

DTIC Science & Technology

2011-03-31

network is vulnerable to a diet and drug intervention that will employ a Food and Drug Administration-approved cholesterol-reducing agent ( ezetimibe ...therapeutic value of ezetimibe . 15. SUBJECT TERMS castrate-resistant prostate cancer, palmitoylation, signal transduction, S-acylation 16...that this network might be sensitive to pharmacologic targeting of cholesterol using the cholesterol-lowering drug, ezetimibe . Our hypothesis is that

The Role of Ezetimibe in the Treatment of Cardiovascular Disease.

PubMed

Agarwala, Anandita; Kajani, Zaid; Miedema, Michael D; Virani, Salim S

2016-02-01

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Despite the success of treatment of CVD with statin therapy, a number of patients remain at high risk for CVD. Ezetimibe is a non-statin agent that inhibits intestinal cholesterol absorption, leading to reductions in low-density lipoprotein cholesterol (LDL-C). A number of clinical studies evaluating the use of ezetimibe therapy have resulted in discordant data regarding its safety and efficacy. In this review, we discuss the findings from these studies as well as potential indications for the use of ezetimibe for LDL-C lowering and cardiovascular event reduction.

Ezetimibe-sensitive cholesterol uptake by NPC1L1 protein does not require endocytosis

PubMed Central

Johnson, Tory A.; Pfeffer, Suzanne R.

2016-01-01

Human NPC1L1 protein mediates cholesterol absorption in the intestine and liver and is the target of the drug ezetimibe, which is used to treat hypercholesterolemia. Previous studies concluded that NPC1L1-GFP protein trafficking is regulated by cholesterol binding and that ezetimibe blocks NPC1L1-GFP function by inhibiting its endocytosis. We used cell surface biotinylation to monitor NPC1L1-GFP endocytosis and show that ezetimibe does not alter the rate of NPC1L1-GFP endocytosis in cultured rat hepatocytes grown under normal growth conditions. As expected, NPC1L1-GFP endocytosis depends in part on C-terminal, cytoplasmically oriented sequences, but endocytosis does not require cholesterol binding to NPC1L1’s N-terminal domain. In addition, two small- molecule inhibitors of general (and NPC1L1-GFP) endocytosis failed to inhibit the ezetimibe-sensitive uptake of [3H]cholesterol from taurocholate micelles. These experiments demonstrate that cholesterol uptake by NPC1L1 does not require endocytosis; moreover, ezetimibe interferes with NPC1L1’s cholesterol adsorption activity without blocking NPC1L1 internalization in RH7777 cells. PMID:27075173

Annexin 2-caveolin 1 complex is a target of ezetimibe and regulates intestinal cholesterol transport.

PubMed

Smart, Eric J; De Rose, Robert A; Farber, Steven A

2004-03-09

Modulation of cholesterol absorption in the intestine, the primary site of dietary cholesterol uptake in humans, can have profound clinical implications. We have undertaken a reverse genetic approach by disrupting putative cholesterol processing genes in zebrafish larvae by using morpholino (MO) antisense oligonucleotides. By using targeted MO injections and immunoprecipitation (IP) experiments coupled with mass spectrometry, we determined that annexin (ANX)2 complexes with caveolin (CAV)1 in the zebrafish and mouse intestine. The complex is heat stable and unaffected by SDS or reducing conditions. MO targeting of anx2b or cav1, which are both strongly expressed in the larval and adult zebrafish intestinal epithelium, prevents formation of the protein heterocomplex. Furthermore, anx2b MO injection prevents processing of a fluorescent cholesterol reporter and results in reduced sterol mass. Pharmacological treatment of mice with ezetimibe disrupts the heterocomplex in only hypercholesterolemic animals. These data suggest that ANX2 and CAV1 are components of an intestinal sterol transport complex.

Effect of the Combination of Ezetimibe and Simvastatin on Gluconeogenesis and Oxygen Consumption in the Rat Liver.

PubMed

Bracht, Lívia; Caparroz-Assef, Silvana Martins; Bracht, Adelar; Bersani-Amado, Ciomar Aparecida

2016-06-01

The aim of this work was to investigate the effects of chronic treatment with the combination of ezetimibe and simvastatin on gluconeogenesis in rat liver. Rats were treated daily for 28 days with the combination of ezetimibe and simvastatin (10/40 mg/kg) by oral gavage. To measure gluconeogenesis and the associated pathways, isolated perfused rat liver was used. In addition, subcellular fractions, such as microsomes and mitochondria, were used for complementary measures of enzymatic activities. Treatment with the combination of simvastatin and ezetimibe resulted in a decrease in gluconeogenesis from pyruvate (-62%). Basal oxygen consumption of the treated animals was higher (+22%) than that of the control rats, but the resulting oxygen consumption that occurred after pyruvate infusion was 43% lower in animals treated with the combination of simvastatin and ezetimibe. Oxygen consumption in the livers from treated animals was completely inhibited by cyanide (electron transport chain inhibitor), but not by proadifen (cytochrome P450 inhibitor). Chronic treatment with ezetimibe/simvastatin decreased the activity of the key enzymes glucose-6-phosphatase and fructose-1,6-bisphosphatase by 59% and 45%, respectively, which is probably the major reason for the decreased gluconeogenesis seen in ezetimibe-/simvastatin-treated rats. It is also possible that part of the effect of this combination on gluconeogenesis and on the oxygen consumption is related to the impairment of mitochondrial energy transduction. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Potential effect of ezetimibe against Mycobacterium tuberculosis infection in type II diabetes.

PubMed

Tsai, I-Fang; Kuo, Chiu-Ping; Lin, Andrew B; Chien, Ming-Nan; Ho, Hsin-Tsung; Wei, Tsai-Yin; Wu, Chien-Liang; Lu, Yen-Ta

2017-04-01

Tuberculosis (TB) risk might be increased in patients with diabetes by factors other than hyperglycaemia, such as dyslipidaemia. Host lipids are essential energy sources used by mycobacteria to persist in a latent TB state. A potential therapy targeting cholesterol catabolism of mycobacteria has been proposed, but the potential of cholesterol-lowering drugs as anti-TB therapy is unclear. The purpose of this study was to determine the effects of ezetimibe, a 2-azetidinone cholesterol absorption inhibitor, on intracellular mycobacteria survival and dormancy. Intracellular mycobacteria survival was determined by measurements of ATP activity and colony-formation units (CFUs). Gene expression profiles of hypoxia-induced dormant Mycobacterium tuberculosis (Mtb) were analysed by real-time PCR. Flow cytometry and microscopy analysis were used to measure the lipid loads of human macrophages with or without ezetimibe treatment. QuantiFERON-TB Gold In-Tube (QFT-G-IT) assays were performed to diagnose latent TB infection. The levels of intracellular cholesterol/ triglyceride were measured by an enzymatic fluorometric method. Ezetimibe was capable of effectively lowering intracellular growth of Mtb and hypoxia-induced dormant Mtb. There was a significant decrease in Mtb growth in leucocytes from ezetimibe-treated patients with diabetes in terms of ATP levels of intracellular mycobacteria and CFU formation. Also, patients receiving ezetimibe therapy had a lower prevalence of latent TB and had lower intracellular lipid contents. Ezetimibe, which is a currently marketed drug, could hold promise as an adjunctive, host-directed therapy for TB. © 2016 Asian Pacific Society of Respirology.

Economic evaluation of ezetimibe treatment in combination with statin therapy in the United States.

PubMed

Davies, Glenn M; Vyas, Ami; Baxter, Carl A

2017-07-01

This study assessed the cost-effectiveness of ezetimibe with statin therapy vs statin monotherapy from a US payer perspective, assuming the impending patent expiration of ezetimibe. A Markov-like economic model consisting of 28 distinct health states was used. Model population data were obtained from US linked claims and electronic medical records, with inclusion criteria based on diagnostic guidelines. Inputs came from recent clinical trials, meta-analyses, and cost-effectiveness analyses. The base-case scenario was used to evaluate the cost-effectiveness of adding ezetimibe 10 mg to statin in patients aged 35-74 years with a history of coronary heart disease (CHD) and/or stroke, and with low-density lipoprotein cholesterol (LDL-C) levels ≥70 mg/dL over a lifetime horizon, assuming a 90% price reduction of ezetimibe after 1 year to take into account the impending patent expiration in the second quarter of 2017. Sub-group analyses included patients with LDL-C levels ≥100 mg/dL and patients with diabetes with LDL-C levels ≥70 mg/dL. The lifetime discounted incremental cost-effectiveness ratio (ICER) for ezetimibe added to statin was $9,149 per quality-adjusted life year (QALY) for the base-case scenario. For patients with LDL-C levels ≥100 mg/dL, the ICER was $839/QALY; for those with diabetes and LDL-C levels ≥70 mg/dL, it was $560/QALY. One-way sensitivity analyses showed that the model was sensitive to changes in cost of ezetimibe, rate reduction of non-fatal CHD, and utility weight for non-fatal CHD in the base-case and sub-group analyses. Indirect costs or treatment discontinuation estimation were not included. Compared with statin monotherapy, ezetimibe with statin therapy was cost-effective for secondary prevention of CHD and stroke and for primary prevention of these conditions in patients whose LDL-C levels are ≥100 mg/dL and in patients with diabetes, taking into account a 90% cost reduction for ezetimibe.

Fixed-dose combination ezetimibe+atorvastatin lowers LDL-C equivalent to co-administered components in randomized trials: use of a dose-response model.

PubMed

Bays, Harold E; Chen, Erluo; Tomassini, Joanne E; McPeters, Gail; Polis, Adam B; Triscari, Joseph

2015-04-01

Co-administration of ezetimibe with atorvastatin is a generally well-tolerated treatment option that reduces LDL-C levels and improves other lipids with greater efficacy than doubling the atorvastatin dose. The objective of the study was to demonstrate the equivalent lipid-modifying efficacy of fixed-dose combination (FDC) ezetimibe/atorvastatin compared with the component agents co-administered individually in support of regulatory filing. Two randomized, 6-week, double-blind cross-over trials compared the lipid-modifying efficacy of ezetimibe/atorvastatin 10/20 mg (n = 353) or 10/40 mg (n = 280) vs. separate co-administration of ezetimibe 10 mg plus atorvastatin 20 mg (n = 346) or 40 mg (n = 280), respectively, in hypercholesterolemic patients. Percent changes from baseline in LDL-C (primary endpoint) and other lipids (secondary endpoints) were assessed by analysis of covariance; triglycerides were evaluated by longitudinal-data analysis. Expected differences between FDC and the corresponding co-administered doses were predicted from a dose-response relationship model; sample size was estimated given the expected difference and equivalence margins (±4%). LDL-C-lowering equivalence was based on 97.5% expanded confidence intervals (CI) for the difference contained within the margins; equivalence margins for other lipids were not prespecified. Ezetimibe/atorvastatin FDC 10/20 mg was equivalent to co-administered ezetimibe+atorvastatin 20 mg in reducing LDL-C levels (54.0% vs. 53.8%) as was FDC 10/40 mg and ezetimibe+atorvastatin 40 mg (58.9% vs. 58.7%), as predicted by the model. Changes in other lipids were consistent with equivalence (97.5% expanded CIs <±3%, included 0); triglyceride changes varied more. All treatments were generally well tolerated. Hypercholesterolemic patients administered ezetimibe/atorvastatin 10/20 and 10/40 mg FDC had equivalent LDL-C lowering. This FDC formulation proved to be an efficacious and generally well-tolerated lipid-lowering therapy. © 2014 Société Française de Pharmacologie et de Thérapeutique.

Spectrofluorimetric methods of stability-indicating assay of certain drugs affecting the cardiovascular system

NASA Astrophysics Data System (ADS)

Moussa, B. A.; Mohamed, M. F.; Youssef, N. F.

2011-01-01

Two stability-indicating spectrofluorimetric methods have been developed for the determination of ezetimibe and olmesartan medoxomil, drugs affecting the cardiovascular system, and validated in the presence of their degradation products. The first method, for ezetimibe, is based on an oxidative coupling reaction of ezetimibe with 3-methylbenzothiazolin-2-one hydrazone hydrochloride in the presence of cerium (IV) ammonium sulfate in an acidic medium. The quenching effect of ezetimibe on the fluorescence of excess cerous ions is measured at the emission wavelength, λem, of 345 nm with the excitation wavelength, λex, of 296 nm. Factors affecting the reaction were carefully studied and optimized. The second method, for olmesartan medoxomil, is based on measuring the native fluorescence intensity of olmesartan medoxomil in methanol at λem = 360 nm with λex = 286 nm. Regression plots revealed good linear relationships in the assay limits of 10-120 and 8-112 g/ml for ezetimibe and olmesartan medoxomil, respectively. The validity of the methods was assessed according to the United States Pharmacopeya guidelines. Statistical analysis of the results exposed good Student's t-test and F-ratio values. The introduced methods were successfully applied to the analysis of ezetimibe and olmesartan medoxomil in drug substances and drug products as well as in the presence of their degradation products.

Effect of ezetimibe on lipid and glucose metabolism after a fat and glucose load.

PubMed

Hiramitsu, Shinya; Miyagishima, Kenji; Ishii, Junichi; Matsui, Shigeru; Naruse, Hiroyuki; Shiino, Kenji; Kitagawa, Fumihiko; Ozaki, Yukio

2012-11-01

The clinical benefit of ezetimibe, an intestinal cholesterol transporter inhibitor, for treatment of postprandial hyperlipidemia was assessed in subjects who ingested a high-fat and high-glucose test meal to mimic westernized diet. We enrolled 20 male volunteers who had at least one of the following: waist circumference ≥ 85 cm, body mass index ≥ 25 kg/m(2), or triglycerides (TG) from 150 to 400mg/dL. After 4 weeks of treatment with ezetimibe (10mg/day), the subjects ingested a high-fat and high-glucose meal. Then changes in serum lipid and glucose levels were monitored after 0, 2, 4, and 6h, and the area under the curve (AUC) was calculated for the change in each parameter. At 4 and 6h postprandially, TG levels were decreased (p<0.01) after 4 weeks of ezetimibe treatment, and the AUC for TG was also decreased (p<0.01). Apolipoprotein B48 (apo-B48) levels at 4 and 6h postprandially were significantly decreased after ezetimibe treatment (p<0.01 and p<0.001, respectively), and the AUC for apo-B48 was also significantly decreased (p<0.01). Blood glucose and insulin levels at 2h postprandially were significantly decreased by ezetimibe (p<0.05). The AUCs for blood glucose and insulin were also significantly decreased (p<0.05 and p<0.01, respectively). Since ezetimibe improved postprandial lipid and glucose metabolism, this drug is likely to be beneficial for dyslipidemia in patients with postprandial metabolic abnormalities. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Ezetimibe prevents the formation of estrogen-induced cholesterol gallstones in mice

PubMed Central

de Bari, Ornella; Wang, Helen H.; Portincasa, Piero; Paik, Chang-Nyol; Liu, Min; Wang, David Q.-H.

2014-01-01

Background Estrogen is an important risk factor for cholesterol cholelithiasis not only in women of childbearing age taking oral contraceptives and postmenopausal women undergoing hormone replacement therapy, but also in male patients receiving estrogen therapy for prostatic cancer. In women, hormonal changes occurring during pregnancy markedly increase the risk of developing gallstones. We investigated whether the potent cholesterol absorption inhibitor ezetimibe could prevent the formation of estrogen-induced cholesterol gallstones in mice. Design Following ovariectomy, female AKR mice were implanted subcutaneously with pellets releasing 17β-estradiol at 6 μg/day and fed a lithogenic diet supplemented with ezetimibe in doses of 0 or 8 mg/kg/day for 8 weeks. Cholesterol crystallization and gallstone prevalence, lipid concentrations and composition in bile, and biliary lipid output were analyzed by physical-chemical methods. Intestinal cholesterol absorption efficiency was determined by fecal dual-isotope ratio methods. Results Ezetimibe inhibited intestinal cholesterol absorption, while significantly reducing hepatic secretion of biliary cholesterol. Consequently, bile was desaturated through the formation of numerous unsaturated micelles and gallstones were prevented by ezetimibe in mice exposed to high doses of estrogen and fed the lithogenic diet. Ezetimibe did not influence mRNA levels of the classical estrogen receptors α (ERα) and ERβ, as well as a novel estrogen receptor the G protein-coupled receptor 30 (GPR30) in the liver. Conclusions Ezetimibe protects against the estrogen-mediated lithogenic actions on gallstone formation in mice. Our finding may provide an efficacious novel strategy for the prevention of cholesterol gallstones in high-risk subjects, especially those exposed to high levels of estrogen. PMID:25303682

Ezetimibe, an NPC1L1 inhibitor, is a potent Nrf2 activator that protects mice from diet-induced nonalcoholic steatohepatitis.

PubMed

Lee, Da Hyun; Han, Dai Hoon; Nam, Ki Taek; Park, Jeong Su; Kim, Soo Hyun; Lee, Milim; Kim, Gyuri; Min, Byung Soh; Cha, Bong-Soo; Lee, Yu Seol; Sung, Su Haeng; Jeong, Haengdueng; Ji, Hye Won; Lee, Moon Joo; Lee, Jae Sung; Lee, Hui-Young; Chun, Yoomi; Kim, Joungmok; Komatsu, Masaaki; Lee, Yong-Ho; Bae, Soo Han

2016-10-01

Oxidative stress is important for the pathogenesis of nonalcoholic fatty liver disease (NAFLD), a chronic disease that ranges from hepatic steatosis to nonalcoholic steatohepatitis (NASH). The nuclear factor erythroid 2-related factor 2-Kelch-like ECH associated protein 1 (Nrf2-Keap1) pathway is essential for cytoprotection against oxidative stress. In this study, we found that oxidative stress or inflammatory biomarkers and TUNEL positive cells were markedly increased in NASH patients compared to normal or simple steatosis. In addition, we identified that the hepatic mRNA levels of Nrf2 target genes such as Nqo-1 and GSTA-1 were significantly increased in NASH patients. Ezetimibe, a drug approved by the Food and Drug Administration for the treatment of hypercholesterolemia, improves NAFLD and alleviates oxidative stress. However, the precise mechanism of its antioxidant function remains largely unknown. We now demonstrate that ezetimibe activates Nrf2-Keap1 pathway which was dependent of autophagy adaptor protein p62, without causing cytotoxicity. Ezetimibe activates AMP-activated protein kinase (AMPK), which in turn phosphorylates p62 (p-S351) via their direct interaction. Correspondingly, Ezetimibe protected liver cells from saturated fatty acid-induced apoptotic cell death through p62-dependent Nrf2 activation. Furthermore, its role as an Nrf2 activator was supported by methione- and choline- deficient (MCD) diet-induced NASH mouse model, showing that ezetimibe decreased the susceptibility of the liver to oxidative injury. These data demonstrate that the molecular mechanisms underlying ezetimibe's antioxidant role in the pathogenesis of NASH. Copyright © 2016 Elsevier Inc. All rights reserved.

Efficacy, safety and tolerability of ongoing statin plus ezetimibe versus doubling the ongoing statin dose in hypercholesterolemic Taiwanese patients: an open-label, randomized clinical trial

PubMed Central

2012-01-01

Background Reducing low-density lipoprotein cholesterol (LDL-C) is associated with reduced risk for major coronary events. Despite statin efficacy, a considerable proportion of statin-treated hypercholesterolemic patients fail to reach therapeutic LDL-C targets as defined by guidelines. This study compared the efficacy of ezetimibe added to ongoing statins with doubling the dose of ongoing statin in a population of Taiwanese patients with hypercholesterolemia. Methods This was a randomized, open-label, parallel-group comparison study of ezetimibe 10 mg added to ongoing statin compared with doubling the dose of ongoing statin. Adult Taiwanese hypercholesterolemic patients not at optimal LDL-C levels with previous statin treatment were randomized (N = 83) to ongoing statin + ezetimibe (simvastatin, atorvastatin or pravastatin + ezetimibe at doses of 20/10, 10/10 or 20/10 mg) or doubling the dose of ongoing statin (simvastatin 40 mg, atorvastatin 20 mg or pravastatin 40 mg) for 8 weeks. Percent change in total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglycerides, and specified safety parameters were assessed at 4 and 8 weeks. Results At 8 weeks, patients treated with statin + ezetimibe experienced significantly greater reductions compared with doubling the statin dose in LDL-C (26.2% vs 17.9%, p = 0.0026) and total cholesterol (20.8% vs 12.2%, p = 0.0003). Percentage of patients achieving treatment goal was greater for statin + ezetimibe (58.6%) vs doubling statin (41.2%), but the difference was not statistically significant (p = 0.1675). The safety and tolerability profiles were similar between treatments. Conclusion Ezetimibe added to ongoing statin therapy resulted in significantly greater lipid-lowering compared with doubling the dose of statin in Taiwanese patients with hypercholesterolemia. Studies to assess clinical outcome benefit are ongoing. Trial registration Registered at ClinicalTrials.gov: NCT00652327 PMID:22621316

Ezetimibe-Statin Combination Therapy.

PubMed

Nußbaumer, Barbara; Glechner, Anna; Kaminski-Hartenthaler, Angela; Mahlknecht, Peter; Gartlehner, Gerald

2016-07-01

To date, most clinical comparisons of ezetimibe-statin combination therapy versus statin monotherapy have relied entirely on surrogate variables. In this systematic review, we study the efficacy and safety of ezetimibe-statin combination therapy in comparison to statin monotherapy in terms of the prevention of cardiovascular events in hyperlipidemic patients with atherosclerosis and/or diabetes mellitus. This review is based on a systematic literature search (1995 to July 2015) in PubMed, the Excerpta Medica Database (EMBASE), the Cochrane Library, and the ClinicalTrials.gov registry. Nine randomized, controlled trials with data from a total of 19 461 patients were included. Ezetimibe-statin combination therapy was associated with a lower risk of cardiovascular events than statin monotherapy: 33% of the patients treated with ezetimibe and a statin, and 35% of those treated with a statin alone, had a cardiovascular event within seven years (number needed to treat [NNT]: 50 over 7 years). Combination therapy was also significantly more effective in preventing a composite endpoint consisting of death due to cardiovascular disease, nonfatal myocardial infarction, unstable angina pectoris, coronary revascularization, and nonfatal stroke (hazard ratio [HR] 0.94, 95% confidence interval [0,89; 0,99]; p = 0.016). Diabetic patients benefited from combination therapy rather than monotherapy with respect to cardiovascular morbidity (HR 0.87 [0.78; 0.94]). On the other hand, the addition of ezetimibe to statin therapy did not lessen either cardiovascular or overall mortality. Serious undesired events occurred in 38% of the patients taking ezetimibe and a statin nd in 39% of the patients taking a statin alone (relative risk 1.09 [0.77; 1.55]). In high-risk patients with an acute coronary syndrome, combination therapy with ezetimibe and a statin lowered the risk of cardiovascular events in comparison to statin monotherapy. The risk of dying or suffering an adverse drug effect was similar in the two treatment groups.

Comparative effects of cholesteryl ester transfer protein inhibition, statin or ezetimibe on lipid factors: The ACCENTUATE trial.

PubMed

Nicholls, Stephen J; Ray, Kausik K; Ballantyne, Christie M; Beacham, Lauren A; Miller, Debra L; Ruotolo, Giacomo; Nissen, Steven E; Riesmeyer, Jeffrey S

2017-06-01

The optimal approaches to management of patients treated with moderate statin doses on lipid parameters are unknown. The ACCENTUATE study aimed to compare the effects of adding the cholesteryl ester transfer protein inhibitor (CETP) evacetrapib, ezetimibe or increasing statin dose in atorvastatin-treated high-vascular risk patients on lipid parameters. 366 patients with atherosclerotic cardiovascular disease (ASCVD) and/or diabetes were treated with atorvastatin 40 mg/day for 28 days prior to randomization to atorvastatin 40 mg plus evacetrapib 130 mg, atorvastatin 80 mg, atorvastatin 40 mg plus ezetimibe 10 mg or atorvastatin 40 mg plus placebo, daily for 90 days at 64 centers in the United States. Lipid parameters, safety and tolerability were measured. Addition of evacetrapib significantly reduced LDL-C (-33%) compared with ezetimibe (-27%, p=0.045), increasing statin dose (-6%) and statin alone (0%, p<0.001). Evacetrapib also decreased apoB by 23% compared to 19% with ezetimibe (p=0.06) and 7% with increased statin dose (p<0.001), and reduced Lp(a) by 29% (p<0.001 vs. other groups). Evacetrapib increased HDL-C (+125%), apoA-I (+46%), apoC-III (+50%) and apoE (+28%) (p<0.001 vs. other groups). Non-ABCA1-mediated efflux increased by 53% (p<0.001 vs. other groups) with evacetrapib. ABCA1-mediated efflux also increased by 13% with evacetrapib (p<0.001 vs. ezetimibe, p=0.002 vs. increasing statin dose, and p=0.004 vs. statin alone). Addition of evacetrapib to atorvastatin produced an increase in hsCRP compared with ezetimibe (p=0.02). While evacetrapib improved traditional atherogenic and putative protective lipid measures compared with ezetimibe and increasing statin dose in patients with ASCVD and/or diabetes, it also adversely affected novel atherogenic risk factors. These findings may contribute to the lack of clinical benefit observed in the ACCELERATE trial. Copyright © 2017 Elsevier B.V. All rights reserved.

Optimized self nano-emulsifying systems of ezetimibe with enhanced bioavailability potential using long chain and medium chain triglycerides.

PubMed

Bandyopadhyay, Shantanu; Katare, O P; Singh, Bhupinder

2012-12-01

The objective of the current work is to develop systematically optimized self-nanoemulsifying drug delivery systems (SNEDDS) using long chain triglycerides (LCT's) and medium chain triglycerides (MCT's) of ezetimibe employing Formulation by Design (FbD), and evaluate their in vitro and in vivo performance. Equilibrium solubility studies indicated the choice of Maisine 35-1 and Capryol 90 as lipids, and of Labrasol and Tween 80 as emulgents for formulating the LCT and MCT systems, respectively. Ternary phase diagrams were constructed to select the areas of nanoemulsion, and the amounts of lipid (X(1)) and emulgent (X(2)) as the critical factor variables. The SNEDDS were systematically optimized using 3(2) central composite design and the optimized formulations located using overlay plot. TEM studies on reconstituted SNEDDS demonstrated uniform shape and size of globules. The nanometer size range and high negative values of zeta potential depicted non-coalescent nature of the optimized SNEDDS. Thermodynamic studies, cloud point determination and accelerated stability studies ascertained the stability of optimized formulations. In situ perfusion (SPIP) studies in Sprague Dawley (SD) rats construed remarkable enhancement in the absorptivity and permeability parameters of SNEDDS vis-à-vis the conventional marketed product. In vivo pharmacodynamic studies in SD rats indicated significantly superior modification in plasma lipid levels of optimized SNEDDS vis-à-vis marketed product, inclusion complex and pure drug. The studies, therefore, indicate the successful formulation development of self-nanoemulsifying systems with distinctly improved bioavailability potential of ezetimibe. Copyright © 2012 Elsevier B.V. All rights reserved.

Colesevelam, Ezetimibe, and Patients With Type 2 Diabetes Mellitus: Characteristics and Clinical Outcomes From a Health Care Database.

PubMed

Swindle, Jason P; Ye, Xin; Mallick, Rajiv; Song, Rui; Horstman, Thomas; Bays, Harold E

2014-07-01

Despite the prevalence of therapies available to patients at highest coronary heart disease risk, only a minority of type 2 diabetes mellitus (T2DM) patients reach desired cholesterol treatment levels, with limited data regarding their outcomes. To examine "real-world" effectiveness of initiating treatment with either colesevelam or ezetimibe among individuals with evidence of T2DM and hypercholesterolemia (HCh). Key outcomes included treatment patterns and cardiovascular (CV) events. This retrospective administrative claims-based study utilized medical, pharmacy, and enrollment data linked to laboratory results information from a large United States health plan (January 1, 2006, to March 31, 2011) and included individuals with recorded evidence of T2DM and HCh. The index date was the date of first pharmacy claim for colesevelam or ezetimibe, with cohort assignment based on index medication. Assessments included baseline characteristics, follow-up treatment patterns, and composite CV event, with propensity score matching to correct for sample selection bias. In total, 4231 individuals were identified with evidence of HCh and T2DM (ezetimibe n = 3384; colesevelam n = 847). After matching, the baseline characteristics between cohorts were rendered to be similar. Mean days of persistent medication use was lower with colesevelam compared with ezetimibe (P < 0.001). Compared with ezetimibe, a smaller percentage of individuals in the colesevelam cohort experienced a follow-up composite CV event, and adjusted Cox model results suggested decreased risk (hazard ratio = 0.58; P = 0.004) of a follow-up composite CV event. In this health care database analysis among patients with HCh and T2DM, colesevelam was associated with decreased risk of a composite CV event compared with ezetimibe, despite lower persistence. © The Author(s) 2014.

Effect of ezetimibe on the prevalence of cholelithiasis.

PubMed

Stein, Assaf; Hermoni, Doron; Elis, Avishay; Konikoff, Fred M

2012-10-28

To investigate the prevalence of cholelithiasis among patients treated with ezetimibe. A retrospective, case-control study based on computerized medical records from patients of the Clalit Health Services, Sharon-Shomron region, from 2000 to 2009. Patients 20-85 years of age, who had been treated with ezetimibe and statins or statins only for at least 6 mo, and who had an abdominal ultrasound were included in the study. Collected data included age, gender, ezetimibe treatment duration, presence of hypothyroidism or diabetes, and existence of cholelithiasis as determined by ultrasound. Excluded were subjects after gallbladder resection, with hemolysis, myeloproliferative or inflammatory bowel diseases, and those treated with ursodeoxycholic acid and fibrates. Patients treated with statins and ezetimibe (study group) were compared to patients treated with statins only (control group). The study group included 25 patients and the control group 168. All patients in the study were treated with statins. The study group included 13 males (52%) and 12 females (48%), the control group 76 males (45%) and 92 (55%) females (P = 0.544). The groups did not differ in age (mean age: 68 ± 8 years, range 53-85 years vs mean age: 71 ± 8 years, range 51-85 years; P = 0.153) or in the rate of diabetic and hypothyroid patients [11 (44%) vs 57 (33%), P = 0.347 in the study group and 5 (20%) vs 23 (14%), P = 0.449 in the control group, respectively]. Patients in the study group were treated with ezetimibe for an average of 798 ± 379 d. Cholelithiasis was found in 4 (16%) patients in the study group and in 33 (20%) patients in the control group (P = 0.666). Ezetimibe does not appear to influence the prevalence of gallstones.

Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study.

PubMed

Lin Wu, Fe-Lin; Wang, Jui; Ho, Wei; Chou, Chia-Hung; Wu, Yi-Jung; Choo, Dan-Wei; Wang, Yu-Wen; Chen, Po-Yu; Chien, Kuo-Liong; Lin, Zhen-Fang

2017-04-15

The clinical benefits of a combination of statins and ezetimibe in patients with acute coronary syndrome (ACS) were observed in a clinical trial. However, little is known regarding the effectiveness of using statins with or without ezetimibe in patients with ACS and multiple comorbidities in real-world clinical practice. This is a nationwide population-based cohort study using Taiwan National Health Insurance Research Database. A total of 212,110 patients with ACS who had been discharged after their first ACS events between 2006 and 2010 were enrolled. A propensity score matching approach was used to create matched cohorts for adjusting potential confounders. Cox proportional hazards regressions were performed to estimate the risk of re-hospitalization for ACS and revascularization. Patients in the statins-plus-ezetimibe group had a significantly lower risk of re-hospitalization for ACS (adjusted hazard ratio [HR]=0.64, 95% confidence interval [CI]: 0.60-0.69) and revascularization (HR=0.69, 95% CI: 0.63-0.76) than those in the statins-alone group. In the statins-plus-ezetimibe group, female patients had a lower risk of re-hospitalization for ACS than male patients did, and patients without diabetes mellitus had a lower risk of re-hospitalization for ACS than did patients with diabetes mellitus. Patients with ACS and multiple comorbidities receiving a combination therapy of statins and ezetimibe had a lower risk of re-hospitalization for ACS and revascularization than those receiving statins alone. Significant interaction effects were observed between combination with ezetimibe, sex, and diabetes mellitus. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of Ezetimibe, Simvastatin, and their Combination on Inflammatory Parameters in a Rat Model of Adjuvant-Induced Arthritis.

PubMed

Barbosa, Carmem Patrícia; Bracht, Lívia; Ames, Franciele Queiroz; de Souza Silva-Comar, Francielli Maria; Tronco, Rafael Prizon; Bersani-Amado, Ciomar Aparecida

2017-04-01

Statins are hypocholesterolemic drugs that are prescribed for patients with an increased risk of cardiovascular and cerebrovascular complications. Ezetimibe has an atheroprotective activity through inhibition of the expression of vascular adhesion molecule-I and vascular CD14, a marker of the infiltration of mononuclear leukocytes. Ezetimibe reduces the amount of chemoattractant protein-1 that is available for monocytes and macrophages and alters the activity of nuclear factor κB in leukocytes. The mechanisms of action of statins complement those of ezetimibe. Previous studies have demonstrated that the combination of statins and ezetimibe has beneficial effects, including antiinflammatory activity. The present study evaluated the effects of monotherapy with ezetimibe and simvastatin compared with ezetimibe + simvastatin combined on the evolution of the inflammatory response in a rat model of Complete Freund's Adjuvant-induced arthritis. The animals were treated with 10 mg/kg ezetimibe, 40 mg/kg simvastatin, or 10 mg/kg ezetimibe + 40 mg/kg simvastatin for 1, 7, 14, or 28 days. We analyzed leukocyte rolling behavior, leukocyte adhesion to the endothelium, the number of leukocytes that were recruited to the knee joint cavity, and the concentration of cytokines that are involved in the inflammatory response. The data were analyzed using paired t tests or analysis of variance followed by Bonferroni post hoc test. The treatments reduced leukocyte rolling behavior and leukocyte adhesion. The monotherapies did not change the number of leukocytes that were recruited to the knee joint cavity, whereas the ezetimibe + simvastatin combination significantly reduced this parameter. The treatments reduced the levels of proinflammatory cytokines and increased the levels of the antiinflammatory cytokine IL-10, indicating antiinflammatory properties of these drugs in this experimental model of inflammation.

Ezetimibe-sensitive cholesterol uptake by NPC1L1 protein does not require endocytosis.

PubMed

Johnson, Tory A; Pfeffer, Suzanne R

2016-06-01

Human NPC1L1 protein mediates cholesterol absorption in the intestine and liver and is the target of the drug ezetimibe, which is used to treat hypercholesterolemia. Previous studies concluded that NPC1L1-GFP protein trafficking is regulated by cholesterol binding and that ezetimibe blocks NPC1L1-GFP function by inhibiting its endocytosis. We used cell surface biotinylation to monitor NPC1L1-GFP endocytosis and show that ezetimibe does not alter the rate of NPC1L1-GFP endocytosis in cultured rat hepatocytes grown under normal growth conditions. As expected, NPC1L1-GFP endocytosis depends in part on C-terminal, cytoplasmically oriented sequences, but endocytosis does not require cholesterol binding to NPC1L1's N-terminal domain. In addition, two small- molecule inhibitors of general (and NPC1L1-GFP) endocytosis failed to inhibit the ezetimibe-sensitive uptake of [(3)H]cholesterol from taurocholate micelles. These experiments demonstrate that cholesterol uptake by NPC1L1 does not require endocytosis; moreover, ezetimibe interferes with NPC1L1's cholesterol adsorption activity without blocking NPC1L1 internalization in RH7777 cells. © 2016 Johnson and Pfeffer. This article is distributed by The American Society for Cell Biology under license from the author(s). Two months after publication it is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

[Utility of treatment with atorvastatin 40 mg plus ezetimibe 10 mg versus atorvastatin 80 mg in reducing the levels of LDL cholesterol in patients with ischaemic stroke or transient ischaemic attack].

PubMed

Palacio, Enrique; Viadero-Cervera, Raquel; Revilla, Marián; Larrosa-Campo, Davinia; Acha-Salazar, Olga; Novo-Robledo, Francisco; Oterino, Agustín

2016-03-01

After an ischaemic stroke, to reduce LDL cholesterol (LDLc) levels decreases the risk of recurrence. The risk of recurrence is lower with more intense reductions in LDLc levels. To evaluate the efficacy and security of atorvastatin 40 mg plus ezetimibe 10 mg after ischaemic stroke or transient ischaemic attack (TIA). We retrospectively evaluated stroke or TIA patients admitted to our hospital who received atorvastatin 40 mg plus ezetimibe 10 mg (n = 34) or atorvastatin 80 mg (n = 52) at discharge. We analyzed changes in lipid parameters and established as a primary outcome LDLc <= 70 mg/dL and/or reduction in LDLc >= 50%. Furthermore, safety parameters were assessed. Predictors associated with primary outcome achievement were treatment with atorvastatin 40 mg plus ezetimibe 10 mg (odds ratio: 11.94; 95% CI: 2.82-50.64; p = 0.001) and male (odds ratio: 4.76; 95% CI: 1.35-16.67; p = 0.02). Treatment with atorvastatin 40 mg plus ezetimibe 10 mg achieved significantly greater reductions in LDLc (p < 0.001), total cholesterol (p < 0.001) and non-HDLc (p < 0.001). Both treatments were safe and well tolerated, with a low number of secondary effects. Compared with atorvastatin 80 mg, atorvastatin 40 mg plus ezetimibe 10 mg increases the likelihood of achieving LDLc goals after ischaemic stroke or transient ischaemic attack. Both treatments were safe and well tolerated.

Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP)

PubMed Central

Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; Collins, R.; Baigent, C.; Landray, M.J.; Bray, C.; Chen, Y.; Baxter, A.; Young, A.; Hill, M.; Knott, C.; Cass, A.; Feldt-Rasmussen, B.; Fellström, B.; Grobbee, D.E.; Grönhagen-Riska, C.; Haas, M.; Holdaas, H.; Hooi, L.S.; Jiang, L.; Kasiske, B.; Krairittichai, U.; Levin, A.; Massy, Z.A.; Tesar, V.; Walker, R.; Wanner, C.; Wheeler, D.C.; Wiecek, A.; Dasgupta, T.; Herrington, W.; Lewis, D.; Mafham, M.; Majoni, W.; Reith, C.; Emberson, J.; Parish, S.; Simpson, D.; Strony, J.; Musliner, T.; Agodoa, L.; Armitage, J.; Chen, Z.; Craig, J.; de Zeeuw, D.; Gaziano, J.M.; Grimm, R.; Krane, V.; Neal, B.; Ophascharoensuk, V.; Pedersen, T.; Sleight, P.; Tobert, J.; Tomson, C.

2016-01-01

Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10%; medium, 10%-<20%; or high, ≥20%) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy). Model, Perspective, & Timeline Assessment during SHARP follow-up from the UK perspective; long-term projections. Intervention Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years’ median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations High-intensity statin-alone regimens were not studied in SHARP. Conclusions Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD. PMID:26597925

Low-density lipoprotein cholesterol targeting with pitavastatin + ezetimibe for patients with acute coronary syndrome and dyslipidaemia: the HIJ-PROPER study, a prospective, open-label, randomized trial.

PubMed

Hagiwara, Nobuhisa; Kawada-Watanabe, Erisa; Koyanagi, Ryo; Arashi, Hiroyuki; Yamaguchi, Junichi; Nakao, Koichi; Tobaru, Tetsuya; Tanaka, Hiroyuki; Oka, Toshiaki; Endoh, Yasuhiro; Saito, Katsumi; Uchida, Tatsuro; Matsui, Kunihiko; Ogawa, Hiroshi

2017-08-01

To elucidate the effects of intensive LDL-C lowering treatment with a standard dose of statin and ezetimibe in patients with dyslipidaemia and high risk of coronary events, targeting LDL-C less than 70 mg/dL (1.8 mmol/L), compared with standard LDL-C lowering lipid monotherapy targeting less than 100 mg/dL (2.6 mmol/L). The HIJ-PROPER study is a prospective, randomized, open-label trial to assess whether intensive LDL-C lowering with standard-dose pitavastatin plus ezetimibe reduces cardiovascular events more than standard LDL-C lowering with pitavastatin monotherapy in patients with acute coronary syndrome (ACS) and dyslipidaemia. Patients were randomized to intensive lowering (target LDL-C < 70 mg/dL [1.8 mmol/L]; pitavastatin plus ezetimibe) or standard lowering (target LDL-C 90 mg/dL to 100 mg/dL [2.3-2.6 mmol/L]; pitavastatin monotherapy). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina, and ischaemia-driven revascularization. Between January 2010 and April 2013, 1734 patients were enroled at 19 hospitals in Japan. Patients were followed for at least 36 months. Median follow-up was 3.86 years. Mean follow-up LDL-C was 65.1 mg/dL (1.68 mmol/L) for pitavastatin plus ezetimibe and 84.6 mg/dL (2.19 mmol/L) for pitavastatin monotherapy. LDL-C lowering with statin plus ezetimibe did not reduce primary endpoint occurrence in comparison with standard statin monotherapy (283/864, 32.8% vs. 316/857, 36.9%; HR 0.89, 95% CI 0.76-1.04, P = 0.152). In, ACS patients with higher cholesterol absorption, represented by elevated pre-treatment sitosterol, was associated with significantly lower incidence of the primary endpoint in the statin plus ezetimibe group (HR 0.71, 95% CI 0.56-0.91). Although intensive lowering with standard pitavastatin plus ezetimibe showed no more cardiovascular benefit than standard pitavastatin monotherapy in ACS patients with dyslipidaemia, statin plus ezetimibe may be more effective than statin monotherapy in patients with higher cholesterol absorption; further confirmation is needed. UMIN000002742, registered as an International Standard Randomized Controlled Trial. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology

Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).

PubMed

Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J; Baigent, Colin

2016-04-01

Simvastatin, 20mg, plus ezetimibe, 10mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, <10%; medium, 10%-<20%; or high, ≥20%) and CKD stage (3, 4, 5 not on dialysis, or on dialysis therapy). Assessment during SHARP follow-up from the UK perspective; long-term projections. Simvastatin plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. In SHARP, the proportional reductions per 1mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. High-intensity statin-alone regimens were not studied in SHARP. Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are likely to be more cost-effective for reducing cardiovascular risk in CKD. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Fomiroid A, a Novel Compound from the Mushroom Fomitopsis nigra, Inhibits NPC1L1-Mediated Cholesterol Uptake via a Mode of Action Distinct from That of Ezetimibe

PubMed Central

Chiba, Tomohiro; Sakurada, Tsuyoshi; Watanabe, Rie; Yamaguchi, Kohji; Kimura, Yasuhisa; Kioka, Noriyuki; Kawagishi, Hirokazu; Matsuo, Michinori; Ueda, Kazumitsu

2014-01-01

Hypercholesterolemia is one of the key risk factors for coronary heart disease, a major cause of death in developed countries. Suppression of NPC1L1-mediated dietary and biliary cholesterol absorption is predicted to be one of the most effective ways to reduce the risk of hypercholesterolemia. In a screen for natural products that inhibit ezetimibe glucuronide binding to NPC1L1, we found a novel compound, fomiroid A, in extracts of the mushroom Fomitopsis nigra. Fomiroid A is a lanosterone derivative with molecular formula C30H48O3. Fomiroid A inhibited ezetimibe glucuronide binding to NPC1L1, and dose-dependently prevented NPC1L1-mediated cholesterol uptake and formation of esterified cholesterol in NPC1L1-expressing Caco2 cells. Fomiroid A exhibited a pharmacological chaperone activity that corrected trafficking defects of the L1072T/L1168I mutant of NPC1L1. Because ezetimibe does not have such an activity, the binding site and mode of action of fomiroid A are likely to be distinct from those of ezetimibe. PMID:25551765

Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes.

PubMed

Cannon, Christopher P; Blazing, Michael A; Giugliano, Robert P; McCagg, Amy; White, Jennifer A; Theroux, Pierre; Darius, Harald; Lewis, Basil S; Ophuis, Ton Oude; Jukema, J Wouter; De Ferrari, Gaetano M; Ruzyllo, Witold; De Lucca, Paul; Im, KyungAh; Bohula, Erin A; Reist, Craig; Wiviott, Stephen D; Tershakovec, Andrew M; Musliner, Thomas A; Braunwald, Eugene; Califf, Robert M

2015-06-18

Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. The median follow-up was 6 years. The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P=0.016). Rates of prespecified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit. (Funded by Merck; IMPROVE-IT ClinicalTrials.gov number, NCT00202878.).

Efficacy and safety of alirocumab vs ezetimibe in statin-intolerant patients, with a statin rechallenge arm: The ODYSSEY ALTERNATIVE randomized trial.

PubMed

Moriarty, Patrick M; Thompson, Paul D; Cannon, Christopher P; Guyton, John R; Bergeron, Jean; Zieve, Franklin J; Bruckert, Eric; Jacobson, Terry A; Kopecky, Stephen L; Baccara-Dinet, Marie T; Du, Yunling; Pordy, Robert; Gipe, Daniel A

2015-01-01

Statin intolerance limits many patients from achieving optimal low-density lipoprotein cholesterol (LDL-C) concentrations. Current options for such patients include using a lower but tolerated dose of a statin and adding or switching to ezetimibe or other non-statin therapies. ODYSSEY ALTERNATIVE (NCT01709513) compared alirocumab with ezetimibe in patients at moderate to high cardiovascular risk with statin intolerance (unable to tolerate ≥2 statins, including one at the lowest approved starting dose) due to muscle symptoms. A placebo run-in and statin rechallenge arm were included in an attempt to confirm intolerance. Patients (n = 361) received single-blind subcutaneous (SC) and oral placebo for 4 weeks during placebo run-in. Patients reporting muscle-related symptoms during the run-in were to be withdrawn. Continuing patients were randomized (2:2:1) to double-blind alirocumab 75 mg SC every 2 weeks (Q2W; plus oral placebo), ezetimibe 10 mg/d (plus SC placebo Q2W), or atorvastatin 20 mg/d (rechallenge; plus SC placebo Q2W) for 24 weeks. Alirocumab dose was increased to 150 mg Q2W at week 12 depending on week 8 LDL-C values. Primary end point was percent change in LDL-C from baseline to week 24 (intent-to-treat) for alirocumab vs ezetimibe. Baseline mean (standard deviation) LDL-C was 191.3 (69.3) mg/dL (5.0 [1.8] mmol/L). Alirocumab reduced mean (standard error) LDL-C by 45.0% (2.2%) vs 14.6% (2.2%) with ezetimibe (mean difference 30.4% [3.1%], P < .0001). Skeletal muscle-related events were less frequent with alirocumab vs atorvastatin (hazard ratio 0.61, 95% confidence interval 0.38-0.99, P = .042). Alirocumab produced greater LDL-C reductions than ezetimibe in statin-intolerant patients, with fewer skeletal-muscle adverse events vs atorvastatin. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

The safety of ezetimibe and simvastatin combination for the treatment of hypercholesterolemia.

PubMed

Kei, Anastazia A; Filippatos, Theodosios D; Elisaf, Moses S

2016-01-01

In the light of the most recent and stricter dyslipidemia treatment guidelines, the need for combination hypolipidemic therapy is increasing. Ezetimibe plus simvastatin is available as a fixed dose therapy offering an efficient hypolipidemic treatment choice. Based on the positive results of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial, the use of this drug combination is expected to increase in the next years. This review discusses the current evidence regarding the safety of ezetimibe/simvastatin combination. Current evidence regarding possible associated side effects (musculoskeletal, gastrointestinal, endocrine, hematological, renal, ophthalmologic, allergic, malignancy) and drug interactions of this combination is thoroughly discussed. Ezetimibe and simvastatin treatment, either as a single pill or the combined use of the individual compounds, offers limited additional risk compared with simvastatin monotherapy and comprises a safe and efficient choice for dyslipidemia treatment in high-risk and diabetic patients.

Usefulness of Nutraceuticals (Armolipid Plus) Versus Ezetimibe and Combination in Statin-Intolerant Patients With Dyslipidemia With Coronary Heart Disease.

PubMed

Marazzi, Giuseppe; Pelliccia, Francesco; Campolongo, Giuseppe; Quattrino, Silvia; Cacciotti, Luca; Volterrani, Maurizio; Gaudio, Carlo; Rosano, Giuseppe

2015-12-15

Statins are extensively used to treat dyslipidemia, but, because of their low tolerability profile, they are discontinued in a significant proportion of patients. Ezetimibe and nutraceuticals have been introduced as alternative therapies and have proved to be effective and well tolerated. A single-blind, single-center, randomized, prospective, and parallel group trial comparing a combination of nutraceuticals (red yeast rice, policosanol, berberine, folic acid, coenzyme Q10 and astaxanthin), called Armolipid Plus, and ezetimibe for 3 months in terms of efficacy and tolerability. Patients who did not achieve their therapeutic target (low-density lipoprotein cholesterol <100 mg/dl) could add the alternative treatment on top of randomized treatment for another 12 months: 100 patients who are dyslipidemic with ischemic heart disease treated with percutaneous coronary intervention were enrolled (ezetimibe n = 50, nutraceutical n = 50). Efficacy (lipid profile) and tolerability (adverse events, transaminases, and creatine kinase) were assessed after 3 and 12 months. After 3 months, 14 patients in the nutraceutical group achieved their therapeutic target, whereas none of the patients in the ezetimibe group did. At 1-year follow-up, 58 patients (72.5%) of the combined therapy group (n = 86) and 14 (100%) of the nutraceutical group reached the therapeutic goal. No patients experienced important undesirable effects. In conclusion, nutraceuticals alone or in combination with ezetimibe are well tolerated and improve the lipid profile in statin-intolerant patients with coronary heart disease. Further studies are needed to assess long-term effects of nutraceuticals on mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

Ezetimibe increases intestinal expression of the LDL receptor gene in dyslipidaemic men with insulin resistance.

PubMed

Drouin-Chartier, Jean-Philippe; Tremblay, André J; Lemelin, Valéry; Lépine, Marie-Claude; Lamarche, Benoît; Couture, Patrick

2016-12-01

To gain further insight into intestinal cholesterol homeostasis in dyslipidaemic men with insulin resistance (IR) by examining the impact of treatment with ezetimibe on the expression of key genes involved in cholesterol synthesis and LDL receptor (R)-mediated uptake of lipoproteins. A total of 25 men with dyslipidaemia and IR were recruited to participate in this double-blind, randomized, crossover, placebo-controlled trial. Participants received 10 mg/day ezetimibe or placebo for periods of 12 weeks each. Intestinal gene expression was measured by quantitative PCR in duodenal biopsy samples collected by gastroduodenoscopy at the end of each treatment. A total of 20 participants completed the protocol. Treatment with ezetimibe significantly increased intestinal LDLR (+16.2%; P = .01), 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoAR; +14.0%; P = .04) and acetyl-Coenzyme A acetyltransferase 2 (ACAT-2) mRNA expression (+12.5%; P = .03). Changes in sterol regulatory element-binding transcription factor 2 (SREBP-2) expression were significantly correlated with changes in HMG-CoAR (r = 0.55; P < .05), ACAT-2 (r = 0.69; P < .001) and proprotein convertase substilisin/kexin type 9 (PCSK9) expression (r = 0.45; P < .05). These results show that inhibition of intestinal cholesterol absorption by ezetimibe increases expression of the LDLR gene, supporting the concept that increased LDL clearance with ezetimibe treatment occurs not only in the liver but also in the small intestine. © 2016 John Wiley & Sons Ltd.

Ezetimibe reduced hepatic steatosis induced by dietary oxysterols in nonhuman primates.

PubMed

Deushi, Michiyo; Osaka, Mizuko; Nakano, Kaku; Osada, Kyoichi; Egashira, Kensuke; Yoshida, Masayuki

2016-10-01

Oxidized cholesterol (oxysterols) plays an important and multifaceted role in lipid metabolism. Here we examined whether dietary oxysterols accelerate hepatic lipid accumulation and inflammation in nonhuman primates. We also examined the effect of the Niemann-Pick C1-like1 inhibitor, ezetimibe (Ez). Macaca fascicularis (5-year-old males) were fed either regular cholesterol + high-fat diet (control-HFD) or oxysterols + high-fat diet (ox-HFD; with 0.015% of oxysterols cholesterol) for 24 weeks. Compared with control-HFD, ox-HFD did not affect plasma lipid levels, but it did affect hepatic lipid levels [total cholesterol, 40.9 mg·g -1 (ox-HFD) versus 3.2 (control-HFD) mg·g -1 ; triglycerides, 28.0 (ox-HFD) versus 5.7 (control-HFD) mg·g -1 ]. Ox-HFD increased lipid accumulation as well as recruitment of inflammatory cells when compared to control-HFD. We then examined the effects of Ez, 0.2 mg·kg -1 ·day -1 for 12 weeks. In addition to a significant reduction in dyslipidemia, Ez alleviated biochemical and pathological aspects of steatosis. Dietary oxysterols aggravate steatosis in nonhuman primates. Treatment with Ez may be a novel therapeutic approach to NAFLD by alleviating dyslipidemia.

Comparative effectiveness of lipid-lowering treatments to reduce cardiovascular disease.

PubMed

Suh, Dong-Churl; Griggs, Scott K; Henderson, Emmett R; Lee, Seung-Mi; Park, Taehwan

2018-02-01

The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is a new treatment option for patients with hypercholesterolemia. The objective of this study was to systematically review the cost-effectiveness of lipid-lowering agents. Areas covered: Based on Pubmed, Embase, and Cochrane Database of Systematic Reviews, we identified 29 relevant articles. Studies found statins were cost-effective compared with placebo or no treatment in general. Atorvastatin was reported to be cost-effective against simvastatin. In most cases, rosuvastatin was more cost-effective than atorvastatin or simvastatin. Additionally, ezetimibe was considered to be cost-effective compared with no treatment for statin intolerant patients. For patients not meeting treatment goals with their statins, switching to ezetimibe plus simvastatin was consistently reported cost-effective. The cost-effectiveness of ezetimibe plus a hybrid of a statin varied by the source of clinical data and cost of ezetimibe. Finally, the cost-effectiveness of PCSK9 inhibitor plus a statin against statin monotherapy was uncertain. The PCSK9 inhibitor plus a stain was cost-ineffective compared with ezetimibe plus a statin. Expert commentary: Drug costs and treatment efficacy were the key drivers of the cost-effectiveness results in prior analyses. Future evaluations are warranted to reflect the decreasing drug prices and the long-term treatment effects of PCSK9 inhibitors.

Effects of ezetimibe and anticoagulant combined therapy on progressing stroke: a randomized, placebo-controlled study.

PubMed

Yang, Lan; Zhao, Pingping; Zhao, Jing; Wang, Juan; Shi, Lei; Wang, Xiaopeng

2016-12-01

Despite the high prevalence of progressing stroke in patients with acute stroke, preventative treatments are still the unmet needs for those patients. The aim of this study was to evaluate, prospectively, the efficacy and safety of ezetimibe in the prevention of acute progressing stroke and thereby the improvement of patient outcome. A total of 423 patients (267 men and 156 women with a mean age of 65.2 years) were randomly assigned to receive ezetimibe (10 mg daily oral administration, n = 209) or placebo (n = 214) for 14 consecutive days. Analytical procedures performed at baseline (i.e., day 1) and 14 days after the treatments were completed. These included a real-time three-dimensional ultrasound (RT-3DU) examination for carotid plaque volume, clinical laboratory analyses of serum levels of IL-6 and MMP-9, as well as lipid parameters and liver dysfunction marker ALT and TBIL. Ezetimibe significantly reduced the average NIHSS score after 14 days of treatment and attenuated the stroke progression rate, which was associated with reduction in carotid plaque volume and attenuation of serum levels of IL-6, MMP-9, and LDL, without inducing liver dysfunction. Ezetimibe treatment may be a beneficial and effective strategy for preventing progressing stroke.

The impact of the time of drug administration on the effectiveness of combined treatment of hypercholesterolemia with Rosuvastatin and Ezetimibe (RosEze): study protocol for a randomized controlled trial.

PubMed

Obońska, Karolina; Kasprzak, Michał; Sikora, Joanna; Obońska, Ewa; Racki, Krzysztof; Goździkiewicz, Natalia; Krintus, Magdalena; Kubica, Jacek

2017-07-11

Hypercholesterolemia is one of the main risk factors for cardiovascular disease. The first line treatment for hypercholesterolemia is statin therapy. When the expected low-density lipoprotein cholesterol (LDL-C) concentration is not achieved, the pharmacotherapy may be extended by combining the statin with the cholesterol absorption inhibitor ezetimibe. The study is designed as a randomized, open-label, single-center, crossover study evaluating the effectiveness of combined therapy with rosuvastatin and ezetimibe for hypercholesterolemia. The study is planned to include 200 patients with hypercholesterolemia ineffectively treated with statins for at least 6 weeks. After enrollment participants are randomized into one of two arms receiving rosuvastatin and ezetimibe. In the first arm the study drug is administered in the morning (8:00 am) for 6 weeks and then in the evening for the next 6 weeks; in the second arm the study drug is administered at first in the evening (8:00 pm) for the first 6 weeks and then in the morning for the following 6 weeks. In order to minimize non-adherence to the treatment, all patients will receive the study drug free of charge. The primary outcome of the study is change in LDL-C at 6 and 12 weeks of the treatment, depending on the time of day of study drug administration. The secondary endpoints include change in total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoproteins ApoB and Apo AI, non-HDL cholesterol, small, dense (sd)-LDL cholesterol, lipoprotein(a), glucose, glycated hemoglobin, high-sensitivity C-reactive protein, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, and creatine kinase at 6 and 12 weeks of the study drug treatment, as well as assessment of plasma fluorescence using stationary and time-resolved fluorescence spectroscopy at baseline and at 6 and 12 weeks of the therapy. The RosEze trial is expected to demonstrate whether there is a significant difference in the effectiveness of the lipid-lowering therapy in reducing the concentration of cholesterol when the medications are taken in the morning compared with the evening time of day. ClinicalTrials.gov, NCT02772640 . Registered on 28 March 2016.

Cost-effectiveness of ezetimibe coadministration in statin-treated patients not at cholesterol goal: application to Germany, Spain and Norway.

PubMed

Cook, John R; Yin, Don; Alemao, Evo; Davies, Glenn; Krobot, Karl J; Veltri, Enrico; Lipka, Leslie; Badia, Xavier

2004-01-01

Despite the growing use of statins, many hypercholesterolaemic patients fail to reach their lipid goal and remain at elevated risk of coronary heart disease (CHD). Alternative treatment strategies, such as ezetimibe coadministration and statin titration, can help patients achieve greater lipid control, and thereby lower their CHD risk. But is it cost effective to more aggressively lower cholesterol levels across a broad range of current statin users? Using a decision-analytic model based on epidemiological and clinical trials data, we project the lifetime benefit and cost of alternative lipid-lowering treatment strategies for CHD and non-CHD diabetic patients in Germany, Spain and Norway. It is projected that from 40% to 76% of these patients who have failed to reach their lipid goal with their current statin treatment will be able to reach their goal with ezetimibe coadministration; this represents a gain of up to an additional absolute 14% who will be able to reach their goal compared with a 'titrate to goal' strategy where patients are titrated in order to reach their lipid goal (up to the maximum approved dose). For CHD patients, the estimated incremental cost-effectiveness ratio for ezetimibe coadministration is under Euro 18 000 per life-year gained (Euro/LYG) and 26 000 Euro/LYG compared with strategies based on the observed titration rates and the aggressive 'titrate to goal' strategy, respectively; for non-CHD diabetic patients, these ratios are under 26 000 Euro/LYG and 48 000 Euro/LYG for ezetimibe coadministration compared with the two titration strategies. Compared with statin titration, ezetimibe coadministration is projected to be cost effective in the populations and countries studied.

Effect of Low-Density Lipoprotein Cholesterol Lowering by Ezetimibe/Simvastatin on Outcome Incidence: Overview, Meta-Analyses, and Meta-Regression Analyses of Randomized Trials.

PubMed

Thomopoulos, Costas; Skalis, George; Michalopoulou, Helena; Tsioufis, Costas; Makris, Thomas

2015-12-01

This analysis investigated the extent of different outcome reductions from low-density lipoprotein cholesterol (LDL-C) lowering following ezetimibe/simvastatin treatment and the proportionality of outcome to LDL-C reductions. The authors searched PubMed between 1997 and mid-June 2015 (any language) and the Cochrane Library to identify all randomized controlled trials comparing ezetimibe/simvastatin with placebo or less intensive LDL-C lowering. Risk ratios (RR) and 95% confidence intervals (CIs), standardized to 20 mg/dL LDL-C reduction, were calculated for 5 primary outcomes (fatal and nonfatal) and 4 secondary outcomes (non-cardiovascular [CV] death, cancer, myopathy, and hepatopathy). Five ezetimibe/simvastatin RCTs (30 051 individuals) were eligible, 2 comparing ezetimibe/simvastatin vs placebo and 3 vs less intensive treatment. Outcomes reduced almost to the same extent were stroke (RR: -13%, 95% CI: -21% to -3%), coronary heart disease (CHD; RR: -12%, 95% CI: -19% to -5%), and composite of stroke and CHD (RR: -14%, 95% CI: -20% to -8%). Absolute risk reductions: 5 strokes, 10 CHD events, and 16 stroke and CHD events prevented for every 1000 patients treated for 5 years. Residual risk was almost 7× higher than absolute risk reduction for all the above outcomes. All death outcomes were not reduced, and secondary outcomes did not differ between groups. Logarithmic risk ratios were not associated with LDL-C lowering. Our meta-analysis provides evidence that, in patients with different CV disease burden, major CV events are safely reduced by LDL-C lowering with ezetimibe/simvastatin, while raising the hypothesis that the extent of LDL-C lowering might not be accompanied by incremental clinical-event reduction. © 2015 Wiley Periodicals, Inc.

Effects of Combination of Ezetimibe and Rosuvastatin on Coronary Artery Plaque in Patients with Coronary Heart Disease.

PubMed

Wang, Xiaofang; Zhao, Xiaoyan; Li, Ling; Yao, Haimu; Jiang, Yan; Zhang, Jinying

2016-05-01

In approximately 80% of cardiovascular disease-related deaths, patients suffer from coronary atherosclerotic heart disease. Ezetimibe is the first intestinal cholesterol absorption inhibitor. Its combination with statins for treating coronary atherosclerotic heart disease has attracted attention worldwide. The study group comprised 106 patients with coronary atherosclerotic heart disease and hyperlipidaemia. Each was randomly assigned to one of two groups: (1) Ezetimibe (10mg, once a night) plus rosuvastatin (10mg, once a night) (n=55) or (2) Rosuvastatin alone (10mg, once a night) (n=51). The primary endpoint was new or recurrent myocardial infarction, unstable angina pectoris, cardiac death, and stroke. Blood lipid, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9) levels were measured before treatment and at one, six and 12 months after treatment. Coronary plaque size and compositional changes were determined using intravascular ultrasonography. The combination of ezetimibe plus rosuvastatin decreased total cholesterol, low-density lipoprotein cholesterol, hsCRP, IL-6, and MMP-9 levels at six and 12 months after treatment. Statistical significance was detected between two groups. At 12 months, the plaque burden, plaque cross-sectional area, and percentage of necrotic plaque composition were significantly lower in the combination group than in rosuvastatin alone group (P<0.05). And compared with rosuvastatin alone group, the primary endpoint decreased more effectively in combination group. The combination of ezetimibe and rosuvastatin apparently diminishes lipid levels and plaque burden and improves plaque stability, which may be associated with the potent inhibitory effects of ezetimibe and rosuvastatin on inflammatory cytokines. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Ezetimibe suppresses cholesterol accumulation in lipid-loaded vascular smooth muscle cells in vitro via MAPK signaling

PubMed Central

Qin, Li; Yang, Yun-bo; Yang, Yi-xin; Zhu, Neng; Gong, Yong-zhen; Zhang, Cai-ping; Li, Shun-xiang; Liao, Duan-fang

2014-01-01

Aim: To investigate the mechanisms of anti-atherosclerotic action of ezetimibe in rat vascular smooth muscle cells (VSMCs) in vitro. Methods: VSMCs of SD rats were cultured in the presence of Chol:MβCD (10 μg/mL) for 72 h, and intracellular lipid droplets and cholesterol levels were evaluated using Oil Red O staining, HPLC and Enzymatic Fluorescence Assay, respectively. The expression of caveolin-1, sterol response element-binding protein-1 (SREBP-1) and ERK1/2 were analyzed using Western blot assays. Translocation of SREBP-1 and ERK1/2 was detected with immunofluorescence. Results: Treatment with Chol:MβCD dramatically increased the cellular levels of total cholesterol (TC), cholesterol ester (CE) and free cholesterol (FC) in VSMCs, which led to the formation of foam cells. Furthermore, Chol:MβCD treatment significantly decreased the expression of caveolin-1, and stimulated the expression and nuclear translocation of SREBP-1 in VSMCs. Co-treatment with ezetimibe (3 μmol/L) significantly decreased the cellular levels of TC, CE and FC, which was accompanied by elevation of caveolin-1 expression, and by a reduction of SREBP-1 expression and nuclear translocation. Co-treatment with ezetimibe dose-dependently decreased the expression of phosphor-ERK1/2 (p-ERK1/2) in VSMCs. The ERK1/2 inhibitor PD98059 (50 μmol/L) altered the cholesterol level and the expression of p-ERK1/2, SREBP-1 and caveolin-1 in the same manner as ezetimibe did. Conclusion: Ezetimibe suppresses cholesterol accumulation in rat VSMCs in vitro by regulating SREBP-1 and caveolin-1 expression, possibly via the MAPK signaling pathway. PMID:25087996

Synthesis and evaluation of novel amide amino-β-lactam derivatives as cholesterol absorption inhibitors.

PubMed

Dražić, Tonko; Sachdev, Vinay; Leopold, Christina; Patankar, Jay V; Malnar, Martina; Hećimović, Silva; Levak-Frank, Sanja; Habuš, Ivan; Kratky, Dagmar

2015-05-15

The β-lactam cholesterol absorption inhibitor ezetimibe is so far the only representative of this class of compounds on the market today. The goal of this work was to synthesize new amide ezetimibe analogs from trans-3-amino-(3R,4R)-β-lactam and to test their cytotoxicity and activity as cholesterol absorption inhibitors. We synthesized six new amide ezetimibe analogs. All new compounds exhibited low toxicity in MDCKIIwt, hNPC1L1/MDCKII and HepG2 cell lines and showed significant inhibition of cholesterol uptake in hNPC1L1/MDCKII cells. In addition, we determined the activity of the three compounds to inhibit cholesterol absorption in vivo. Our results demonstrate that these compounds considerably reduce cholesterol concentrations in liver and small intestine of mice. Thus, our newly synthesized amide ezetimibe analogs are cholesterol absorption inhibitors in vitro and in vivo. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Long-term administration of a Niemann-Pick C1-like 1 inhibitor, ezetimibe, does not worsen bile lithogenicity in dyslipidemic patients with hepatobiliary diseases.

PubMed

Kishikawa, Nobusuke; Kanno, Keishi; Sugiyama, Akiko; Yokobayashi, Kenichi; Mizooka, Masafumi; Tazuma, Susumu

2016-02-01

Certain lipid-lowering drugs increase bile lithogenicity. Here we investigated whether long-term administration of ezetimibe, a new class of hypocholesterolemic agents designed to inhibit intestinal cholesterol absorption by inhibiting Niemann-Pick C1-like 1, alters bile lithogenicity in patients with hepatobiliary diseases. Eleven dyslipidemic patients with gallstones and/or fatty liver diseases were treated with ezetimibe (10 mg/day) for 12 months. Bile samples were collected by nasal endoscopy before and after 3 and 12 months of treatment. Serum and bile lipids and serum metabolic parameters were analyzed. Serum levels of campesterol, total cholesterol, and low-density lipoprotein cholesterol were significantly decreased after 3 and 12 months of treatment. In contrast, serum lathosterol levels increased gradually. The lithogenic index of bile was unsaturated and unchanged in patients who were previously and concomitantly receiving ursodeoxycholic acid (UDCA). In patients who were not receiving UDCA, bile was initially supersaturated, but eventually was unsaturated. However, ezetimibe tended to elevate bile lithogenicity in cholecystectomy patients. Long-term treatment with ezetimibe improves lipid metabolism without significantly altering the bile lithogenicity. Therefore, inhibiting intestinal cholesterol absorption in dyslipidemic patients with hepatobiliary diseases is a safe therapeutic strategy without worsening biliary physiology. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance: The GAUSS-3 Randomized Clinical Trial.

PubMed

Nissen, Steven E; Stroes, Erik; Dent-Acosta, Ricardo E; Rosenson, Robert S; Lehman, Sam J; Sattar, Naveed; Preiss, David; Bruckert, Eric; Ceška, Richard; Lepor, Norman; Ballantyne, Christie M; Gouni-Berthold, Ioanna; Elliott, Mary; Brennan, Danielle M; Wasserman, Scott M; Somaratne, Ransi; Scott, Rob; Stein, Evan A

2016-04-19

Muscle-related statin intolerance is reported by 5% to 20% of patients. To identify patients with muscle symptoms confirmed by statin rechallenge and compare lipid-lowering efficacy for 2 nonstatin therapies, ezetimibe and evolocumab. Two-stage randomized clinical trial including 511 adult patients with uncontrolled low-density lipoprotein cholesterol (LDL-C) levels and history of intolerance to 2 or more statins enrolled in 2013 and 2014 globally. Phase A used a 24-week crossover procedure with atorvastatin or placebo to identify patients having symptoms only with atorvastatin but not placebo. In phase B, after a 2-week washout, patients were randomized to ezetimibe or evolocumab for 24 weeks. Phase A: atorvastatin (20 mg) vs placebo. Phase B: randomization 2:1 to subcutaneous evolocumab (420 mg monthly) or oral ezetimibe (10 mg daily). Coprimary end points were the mean percent change in LDL-C level from baseline to the mean of weeks 22 and 24 levels and from baseline to week 24 levels. Of the 491 patients who entered phase A (mean age, 60.7 [SD, 10.2] years; 246 women [50.1%]; 170 with coronary heart disease [34.6%]; entry mean LDL-C level, 212.3 [SD, 67.9] mg/dL), muscle symptoms occurred in 209 of 491 (42.6%) while taking atorvastatin but not while taking placebo. Of these, 199 entered phase B, along with 19 who proceeded directly to phase B for elevated creatine kinase (N = 218, with 73 randomized to ezetimibe and 145 to evolocumab; entry mean LDL-C level, 219.9 [SD, 72] mg/dL). For the mean of weeks 22 and 24, LDL-C level with ezetimibe was 183.0 mg/dL; mean percent LDL-C change, -16.7% (95% CI, -20.5% to -12.9%), absolute change, -31.0 mg/dL and with evolocumab was 103.6 mg/dL; mean percent change, -54.5% (95% CI, -57.2% to -51.8%); absolute change, -106.8 mg/dL (P < .001). LDL-C level at week 24 with ezetimibe was 181.5 mg/dL; mean percent change, -16.7% (95% CI, -20.8% to -12.5%); absolute change, -31.2 mg/dL and with evolocumab was 104.1 mg/dL; mean percent change, -52.8% (95% CI, -55.8% to -49.8%); absolute change, -102.9 mg/dL (P < .001). For the mean of weeks 22 and 24, between-group difference in LDL-C was -37.8%; absolute difference, -75.8 mg/dL. For week 24, between-group difference in LDL-C was -36.1%; absolute difference, -71.7 mg/dL. Muscle symptoms were reported in 28.8% of ezetimibe-treated patients and 20.7% of evolocumab-treated patients (log-rank P = .17). Active study drug was stopped for muscle symptoms in 5 of 73 ezetimibe-treated patients (6.8%) and 1 of 145 evolocumab-treated patients (0.7%). Among patients with statin intolerance related to muscle-related adverse effects, the use of evolocumab compared with ezetimibe resulted in a significantly greater reduction in LDL-C levels after 24 weeks. Further studies are needed to assess long-term efficacy and safety. clinicaltrials.gov Identifier: NCT01984424.

A Hamster Model of Diet-Induced Obesity for Preclinical Evaluation of Anti-Obesity, Anti-Diabetic and Lipid Modulating Agents

PubMed Central

Hansen, Gitte; Fabricius, Katrine; Hansen, Henrik B.; Jelsing, Jacob; Vrang, Niels

2015-01-01

Aim Unlike rats and mice, hamsters develop hypercholesterolemia, and hypertriglyceridemia when fed a cholesterol-rich diet. Because hyperlipidemia is a hallmark of human obesity, we aimed to develop and characterize a novel diet-induced obesity (DIO) and hypercholesterolemia Golden Syrian hamster model. Methods and Results Hamsters fed a highly palatable fat- and sugar-rich diet (HPFS) for 12 weeks showed significant body weight gain, body fat accumulation and impaired glucose tolerance. Cholesterol supplementation to the diet evoked additional hypercholesterolemia. Chronic treatment with the GLP-1 analogue, liraglutide (0.2 mg/kg, SC, BID, 27 days), normalized body weight and glucose tolerance, and lowered blood lipids in the DIO-hamster. The dipeptidyl peptidase-4 (DPP-4) inhibitor, linagliptin (3.0 mg/kg, PO, QD) also improved glucose tolerance. Treatment with peptide YY3-36 (PYY3-36, 1.0 mg/kg/day) or neuromedin U (NMU, 1.5 mg/kg/day), continuously infused via a subcutaneous osmotic minipump for 14 days, reduced body weight and energy intake and changed food preference from HPFS diet towards chow. Co-treatment with liraglutide and PYY3-36 evoked a pronounced synergistic decrease in body weight and food intake with no lower plateau established. Treatment with the cholesterol uptake inhibitor ezetimibe (10 mg/kg, PO, QD) for 14 days lowered plasma total cholesterol with a more marked reduction of LDL levels, as compared to HDL, indicating additional sensitivity to cholesterol modulating drugs in the hyperlipidemic DIO-hamster. In conclusion, the features of combined obesity, impaired glucose tolerance and hypercholesterolemia in the DIO-hamster make this animal model useful for preclinical evaluation of novel anti-obesity, anti-diabetic and lipid modulating agents. PMID:26266945

Lupin protein isolate versus casein modifies cholesterol excretion and mRNA expression of intestinal sterol transporters in a pig model

PubMed Central

2014-01-01

Background Lupin proteins exert hypocholesterolemic effects in man and animals, although the underlying mechanism remains uncertain. Herein we investigated whether lupin proteins compared to casein modulate sterol excretion and mRNA expression of intestinal sterol transporters by use of pigs as an animal model with similar lipid metabolism as humans, and cellular cholesterol-uptake by Caco-2 cells. Methods Two groups of pigs were fed cholesterol-containing diets with either 230 g/kg of lupin protein isolate from L. angustifolius or 230 g/kg casein, for 4 weeks. Faeces were collected quantitatively over a 5 d period for analysis of neutral sterols and bile acids by gas chromatographically methods. The mRNA abundances of intestinal lipid transporters were analysed by real-time RT-PCR. Cholesterol-uptake studies were performed with Caco-2 cells that were incubated with lupin conglutin γ, phytate, ezetimibe or albumin in the presence of labelled [4-14C]-cholesterol. Results Pigs fed the lupin protein isolate revealed lower cholesterol concentrations in total plasma, LDL and HDL than pigs fed casein (P < 0.05). Analysis of faeces revealed a higher output of cholesterol in pigs that were fed lupin protein isolate compared to pigs that received casein (+57.1%; P < 0.05). Relative mRNA concentrations of intestinal sterol transporters involved in cholesterol absorption (Niemann-Pick C1-like 1, scavenger receptor class B, type 1) were lower in pigs fed lupin protein isolate than in those who received casein (P < 0.05). In vitro data showed that phytate was capable of reducing the uptake of labelled [4-14C]-cholesterol into the Caco-2 cells to the same extend as ezetimibe when compared to control (−20.5% vs. −21.1%; P < 0.05). Conclusions Data reveal that the cholesterol-lowering effect of lupin protein isolate is attributable to an increased faecal output of cholesterol and a reduced intestinal uptake of cholesterol. The findings indicate phytate as a possible biofunctional ingredient of lupin protein isolate. PMID:24490902

Simultaneous determination of atorvastatin calcium, ezetimibe, and fenofibrate in a tablet formulation by HPLC.

PubMed

Patel, Archita; Macwana, Chhaya; Parmar, Vishal; Patel, Samir

2012-01-01

An accurate, simple, reproducible, and sensitive HPLC method was developed and validated for the simultaneous determination of atorvastatin calcium, ezetimibe, and fenofibrate in a tablet formulation. The analyses were performed on an RP C18 column, 150 x 4.60 mm id, 5 pm particle size. The mobile phase methanol-acetonitrile-water (76 + 13 + 11, v/v/v), was pumped at a constant flow rate of 1 mL/min. UV detection was performed at 253 nm. Retention times of atorvastatin calcium, ezetimibe, and fenofibrate were found to be 2.25, 3.68, and 6.41 min, respectively. The method was validated in terms of linearity, precision, accuracy, LOD, LOQ, and robustness. The response was linear in the range 2-10 microg/mL (r2 = 0.998) for atorvastatin calcium, 2-10 microg/mL (r2 = 0.998) for ezetimibe, and 40-120 microg/mL (r2 = 0.998) for fenofibrate. The developed method can be used for routine quality analysis of the drugs in the tablet formulation.

Ezetimibe therapy: mechanism of action and clinical update

PubMed Central

Phan, Binh An P; Dayspring, Thomas D; Toth, Peter P

2012-01-01

The lowering of low-density lipoprotein cholesterol (LDL-C) is the primary target of therapy in the primary and secondary prevention of cardiovascular events. Although statin therapy is the mainstay for LDL-C lowering, a significant percentage of patients prescribed these agents either do not achieve targets with statin therapy alone or have partial or complete intolerance to them. For such patients, the use of adjuvant therapy capable of providing incremental LDL-C reduction is advised. One such agent is ezetimibe, a cholesterol absorption inhibitor that targets uptake at the jejunal enterocyte brush border. Its primary target of action is the cholesterol transport protein Nieman Pick C1 like 1 protein. Ezetimibe is an effective LDL-C lowering agent and is safe and well tolerated. In response to significant controversy surrounding the use and therapeutic effectiveness of this drug, we provide an update on the biochemical mechanism of action for ezetimibe, its safety and efficacy, as well as the results of recent randomized studies that support its use in a variety of clinical scenarios. PMID:22910633

Pharmacological cholesterol lowering reverses fibrotic NASH in obese, diabetic mice with metabolic syndrome.

PubMed

Van Rooyen, Derrick M; Gan, Lay T; Yeh, Matthew M; Haigh, W Geoffrey; Larter, Claire Z; Ioannou, George; Teoh, Narci C; Farrell, Geoffrey C

2013-07-01

We have recently showed that hyperinsulinemia promotes hepatic free cholesterol (FC) accumulation in obese, insulin-resistant Alms1 mutant (foz/foz) mice with NASH. Here we tested whether cholesterol-lowering drugs reduce stress-activated c-Jun N-terminal kinase (JNK) activation, hepatocyte injury/apoptosis, inflammation, and fibrosis in this metabolic syndrome NASH model. Female foz/foz and WT mice were fed HF (0.2% cholesterol) 16 weeks, before adding ezetimibe (5 mg/kg), atorvastatin (20 mg/kg), or both to diet, another 8 weeks. Hepatic lipidomic analysis, ALT, liver histology, Sirius Red morphometry, hepatic mRNA and protein expression and immunohistochemistry (IHC) for apoptosis (M30), macrophages (F4/80), and polymorphs (myeloperoxidase) were determined. In mice with NASH, ezetimibe/atorvastatin combination normalized hepatic FC but did not alter saturated free fatty acids (FFA) and had minimal effects on other lipids; ezetimibe and atorvastatin had similar but less profound effects. Pharmacological lowering of FC abolished JNK activation, improved serum ALT, apoptosis, liver inflammation/NAFLD activity score, designation as "NASH", macrophage chemotactic protein-1 expression, reduced macrophage and polymorph populations, and liver fibrosis. Cholesterol lowering with ezetimibe/atorvastatin combination reverses hepatic FC but not saturated FFA accumulation. This dampens JNK activation, ALT release, hepatocyte apoptosis, and inflammatory recruitment, with reversal of steatohepatitis pathology and liver fibrosis. Ezetimibe/statin combination is a potent, mechanism-based treatment that could reverse NASH and liver fibrosis. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Comparative study on solid self-nanoemulsifying drug delivery and solid dispersion system for enhanced solubility and bioavailability of ezetimibe

PubMed Central

Rashid, Rehmana; Kim, Dong Wuk; Yousaf, Abid Mehmood; Mustapha, Omer; Din, Fakhar ud; Park, Jong Hyuck; Yong, Chul Soon; Oh, Yu-Kyoung; Youn, Yu Seok; Kim, Jong Oh; Choi, Han-Gon

2015-01-01

Background The objective of this study was to compare the physicochemical characteristics, solubility, dissolution, and oral bioavailability of an ezetimibe-loaded solid self-nanoemulsifying drug delivery system (SNEDDS), surface modified solid dispersion (SMSD), and solvent evaporated solid dispersion (SESD) to identify the best drug delivery system with the highest oral bioavailability. Methods For the liquid SNEDDS formulation, Capryol 90, Cremophor EL, and Tween 80 were selected as the oil, surfactant, and cosurfactant, respectively. The nanoemulsion-forming region was sketched using a pseudoternary phase diagram on the basis of reduced emulsion size. The optimized liquid SNEDDS was converted to solid SNEDDS by spray drying with silicon dioxide. Furthermore, SMSDs were prepared using the spray drying technique with various amounts of hydroxypropylcellulose and Tween 80, optimized on the basis of their drug solubility. The SESD formulation was prepared with the same composition of optimized SMSD. The aqueous solubility, dissolution, physicochemical properties, and pharmacokinetics of all of the formulations were investigated and compared with the drug powder. Results The drug existed in the crystalline form in SMSD, but was changed into an amorphous form in SNEDDS and SESD, giving particle sizes of approximately 24, 6, and 11 µm, respectively. All of these formulations significantly improved the aqueous solubility and dissolution in the order of solid SNEDDS ≥ SESD > SMSD, and showed a total higher plasma concentration than did the drug powder. Moreover, SESD gave a higher area under the drug concentration time curve from zero to infinity than did SNEDDS and SMSD, even if they were not significantly different, suggesting more improved oral bioavailability. Conclusion Among the various formulations tested in this study, the SESD system would be strongly recommended as a drug delivery system for the oral administration of ezetimibe with poor water solubility. PMID:26491288

Model-observational bridging study on the effectiveness of ezetimibe on cardiovascular morbidity and mortality in France: A population-based study.

PubMed

Ferrières, Jean; Dallongeville, Jean; Rossignol, Michel; Bénichou, Jacques; Caro, J Jaime; Getsios, Denis; Hernandez, Luis; Abenhaim, Lucien; Grimaldi-Bensouda, Lamiae

To evaluate the real-life impact of ezetimibe on cardiovascular (CV) morbidity and mortality in France. To estimate the number of non-fatal and fatal CV events that could be prevented and corresponding number of patients needed to treat (NNT) with ezetimibe to prevent one CV event over 5 years. Non-interventional 48-month follow-up cohort conducted in hypercholesterolemic patients starting on ezetimibe <3 months at study entry, either as monotherapy or combined with statins. Prediction modeling using discrete event simulation with calibrated Framingham CV risk equations was applied to data from pivotal clinical trials on ezetimibe and real-life data derived from the cohort. A total of 3215 patients in the cohort accumulated 9314 person-years of follow-up for an average of 2.9 years. Mean age was 61.5 (standard deviation [SD] = 10.7), 54.6% were males, and 27.0% had a history of CV disease. Baseline LDL-cholesterol averaged 4.1 mmol/L (159 mg/dL; SD = 1.0) and HDL-C 1.6 mmol/L (62 mg/dL; SD = 0.5). LDL-C decreased in the first 12 months in ezetimibe-LLT (lipid-lowering therapy) initiators, switchers (monotherapy), and combination therapy with a statin by respectively 21.3%, 6.4%, and 29.1%. The corresponding predicted rate reductions of CV events (non-fatal and fatal) compared to no treatment or to a statin (combination therapy) were respectively 8, 2, and 12 per 1000 patients treated over 5 years, with a global NNT of 143 patients over 5 years. These results, accounting for observed CV event rates, risk factors evolution over time and adherence to treatment in real life, were consistent with those from clinical trials. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Reduction in Total Cardiovascular Events With Ezetimibe/Simvastatin Post-Acute Coronary Syndrome: The IMPROVE-IT Trial.

PubMed

Murphy, Sabina A; Cannon, Christopher P; Blazing, Michael A; Giugliano, Robert P; White, Jennifer A; Lokhnygina, Yuliya; Reist, Craig; Im, KyungAh; Bohula, Erin A; Isaza, Daniel; Lopez-Sendon, Jose; Dellborg, Mikael; Kher, Uma; Tershakovec, Andrew M; Braunwald, Eugene

2016-02-02

Intensive low-density lipoprotein cholesterol therapy with ezetimibe/simvastatin in IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) significantly reduced the first primary endpoint (PEP) in patients post-acute coronary syndrome (ACS) compared to placebo/simvastatin. This analysis tested the hypothesis that total events, including those beyond the first event, would also be reduced with ezetimibe/simvastatin therapy. All PEP events (cardiovascular [CV] death, myocardial infarction [MI], stroke, unstable angina [UA] leading to hospitalization, coronary revascularization ≥30 days post-randomization) during a median 6-year follow-up were analyzed in patients randomized to receive ezetimibe/simvastatin or placebo/simvastatin in IMPROVE-IT. Negative binomial regression was used for the primary analysis. Among 18,144 patients, there were 9,545 total PEP events (56% were first events and 44% subsequent events). Total PEP events were significantly reduced by 9% with ezetimibe/simvastatin vs placebo/simvastatin (incidence-rate ratio [RR]: 0.91; 95% confidence interval [CI]: 0.85 to 0.97; p = 0.007), as were the 3 pre-specified secondary composite endpoints and the exploratory composite endpoint of CV death, MI, or stroke (RR: 0.88; 95% CI: 0.81 to 0.96; p = 0.002). The reduction in total events was driven by decreases in total nonfatal MI (RR: 0.87; 95% CI: 0.79 to 0.96; p = 0.004) and total NF stroke (RR: 0.77; 95% CI: 0.65 to 0.93; p = 0.005). Lipid-lowering therapy with ezetimibe plus simvastatin improved clinical outcomes. Reductions in total PEP events, driven by reductions in MI and stroke, more than doubled the number of events prevented compared with examining only the first event. These data support continuation of intensive combination lipid-lowering therapy after an initial CV event. (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial [IMPROVE-IT]; NCT00202878). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect of Randomized Lipid Lowering With Simvastatin and Ezetimibe on Cataract Development (from the Simvastatin and Ezetimibe in Aortic Stenosis Study).

PubMed

Bang, Casper N; Greve, Anders M; La Cour, Morten; Boman, Kurt; Gohlke-Bärwolf, Christa; Ray, Simon; Pedersen, Terje; Rossebø, Anne; Okin, Peter M; Devereux, Richard B; Wachtell, Kristian

2015-12-15

Recent American College of Cardiology/American Heart Association guidelines on statin initiation on the basis of total atherosclerotic cardiovascular disease risk argue that the preventive effect of statins on cardiovascular events outweigh the side effects, although this is controversial. Studies indicate a possible effect of statin therapy on reducing risk of lens opacities. However, the results are conflicting. The Simvastatin and Ezetimibe in Aortic Stenosis study (NCT00092677) enrolled 1,873 patients with asymptomatic aortic stenosis and no history of diabetes, coronary heart disease, or other serious co-morbidities were randomized (1:1) to double-blind 40 mg simvastatin plus 10 mg ezetimibe versus placebo. The primary end point in this substudy was incident cataract. Univariate and multivariate Cox models were used to analyze: (1) if the active treatment reduced the risk of the primary end point and (2) if time-varying low-density lipoproteins (LDL) cholesterol lowering (annually assessed) was associated with less incident cataract per se. During an average follow-up of 4.3 years, 65 patients (3.5%) developed cataract. Mean age at baseline was 68 years and 39% were women. In Cox multivariate analysis adjusted for age, gender, prednisolone treatment, smoking, baseline LDL cholesterol and high sensitivity C-reactive protein; simvastatin plus ezetimibe versus placebo was associated with 44% lower risk of cataract development (hazard ratio 0.56, 95% confidence interval 0.33 to 0.96, p = 0.034). In a parallel analysis substituting time-varying LDL-cholesterol with randomized treatment, lower intreatment LDL-cholesterol was in itself associated with lower risk of incident cataract (hazard ratio 0.78 per 1 mmol/ml lower total cholesterol, 95% confidence interval 0.64 to 0.93, p = 0.008). In conclusion, randomized treatment with simvastatin plus ezetimibe was associated with a 44% lower risk of incident cataract development. This effect should perhaps be considered in the risk-benefit ratio of statin treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomised trial of three counselling strategies for lifestyle changes in patients with hypercholesterolemia treated with ezetimibe on top of statin therapy (TWICE).

PubMed

Steg, Philippe Gabriel; Verdier, Jean-Claude; Carré, François; Darne, Bernadette; Ducardonnet, Alain; Jullien, Gérard; Farnier, Michel; Giral, Philippe; Haïat, Robert

2008-01-01

To compare the impact of three patient counselling strategies for lifestyle changes and to assess the safety and efficacy of ezetimibe on top of statin therapy in hypercholesterolemic high risk patients. Open, cluster randomized 3-parallel group trial. Physicians were randomized between patient motivation on: diet or physical exercise or both. Counselling was adapted to the patient's baseline Prochaska stage of change. High cardiovascular risk patients, with LDL-C above or equal to 3 mmol/L despite statin therapy for at least 3 months, were enrolled. Ezetimibe (10mg/day) and patient counselling were started at the same time. Target goal was defined as total cholesterol less than 5 mmol/L and LDL-C above 3 mmol/L. Overall 428 physicians enrolled 1,496 patients. At baseline, LDL-C was 3.9+/-0.9 mmol/L and total cholesterol was 6.1+/-1.1 mmol/L. LDL-C decreased by -30.4+/-19.3% and 869 (62%) patients achieved target goal. No difference was shown between randomisation groups. However, improvements in diet consumption patterns were more easily obtained than improvement in physical activity stage of change in non-active patient at baseline. The marked short-term impact (-30%) on LDL-C, although similar between the three groups, slightly exceeds usual LDL-C reductions achieved by this dose of ezetimibe. Decreasing fat consumption seems easier than increasing physical activity. This study confirms the good efficacy, short-term tolerability and safety of ezetimibe on top of statins.

Simultaneous determination of ezetimibe and simvastatin in pharmaceutical preparations by MEKC.

PubMed

Yardimci, Ceren; Ozaltin, Nuran

2010-02-01

A micellar electrokinetic capillary chromatography method was developed and validated for the simultaneous determination of ezetimibe and simvastatin in pharmaceutical preparations. The influence of buffer concentration, buffer pH, sodium dodecyl sulphate (SDS) concentration, organic modifier, capillary temperature, applied voltage, and injection time was investigated, and the method validation studies were performed. The optimum separation for these analytes was achieved in less than 10 min at 30 degrees C with a fused-silica capillary column (56 cm x 50 microm i.d.) and a 25mM borate buffer at pH 9.0 containing 25mM SDS and 10% (v/v) acetonitrile. The samples were injected hydrodynamically for 3 s at 50 mbar, and the applied voltage was +30.0 kV. Detection wavelength was set at 238 nm. Diflunisal was used as internal standard. The method was suitably validated with respect to stability, specificity, linearity, limits of detection and quantification, accuracy, precision, and robustness. The limits of detection and quantification were 1.0 and 2.0 microg/mL for both ezetimibe and simvastatin, respectively. The method developed was successfully applied to the simultaneous determination of ezetimibe and simvastatin in pharmaceutical preparations.

Prevention of Stroke with the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial).

PubMed

Bohula, Erin A; Wiviott, Stephen D; Giugliano, Robert P; Blazing, Michael A; Park, Jeong-Gun; Murphy, Sabina A; White, Jennifer A; Mach, Francois; Van de Werf, Frans; Dalby, Anthony J; White, Harvey D; Tershakovec, Andrew M; Cannon, Christopher P; Braunwald, Eugene

2017-12-19

Patients who experience an acute coronary syndrome are at heightened risk of recurrent ischemic events, including stroke. Ezetimibe improved cardiovascular outcomes when added to statin therapy in patients stabilized after acute coronary syndrome. We investigated the efficacy of the addition of ezetimibe to simvastatin for the prevention of stroke and other adverse cardiovascular events in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), with a focus on patients with a stroke before randomization. Patients who experienced acute coronary syndrome were randomized to a placebo/simvastatin or ezetimibe/simvastatin regimen and followed for a median of 6 years. Treatment efficacy was assessed for the entire population and by subgroups for the first and total (first and subsequent) events for the end points of stroke of any etiology, stroke subtypes, and the primary trial end point at 7 years. Of 18 144 patients, 641 (3.5%) experienced at least 1 stroke; most were ischemic (527, 82%). Independent predictors of stroke included prior stroke, older age, atrial fibrillation, congestive heart failure, diabetes mellitus, myocardial infarction, and renal dysfunction. There was a nonsignificant reduction in the first event of stroke of any etiology (4.2% versus 4.8%; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.73-1.00; P =0.052) with ezetimibe/simvastatin versus placebo/simvastatin, driven by a significant 21% reduction in ischemic stroke (3.4% versus 4.1%; HR, 0.79; 95% CI, 0.67-0.94; P =0.008) and a nonsignificant increase in hemorrhagic stroke (0.8% versus 0.6%; HR, 1.38; 95% CI, 0.93-2.04; P =0.11). Evaluating total events, including the first and all recurrent strokes, ezetimibe/simvastatin reduced stroke of any etiology (HR, 0.83; 95% CI, 0.70-0.98; P =0.029) and ischemic stroke (HR, 0.76; 95% CI, 0.63-0.91; P =0.003). Patients who had experienced a stroke prior to randomization were at a higher risk of recurrence and demonstrated an absolute risk reduction of 8.6% for stroke of any etiology (10.2% versus 18.8%; number needed to treat=12; HR, 0.60; 95% CI, 0.38-0.95; P =0.030) and 7.6% for ischemic stroke (8.7% versus 16.3%; number needed to treat=13; HR, 0.52; 95% CI, 0.31-0.86; P =0.011) with ezetimibe added to simvastatin therapy. The addition of ezetimibe to simvastatin in patients stabilized after acute coronary syndrome reduces the frequency of ischemic stroke, with a particularly large effect seen in patients with a prior stroke. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00202878. © 2017 American Heart Association, Inc.

Atherothrombotic Risk Stratification and Ezetimibe for Secondary Prevention.

PubMed

Bohula, Erin A; Morrow, David A; Giugliano, Robert P; Blazing, Michael A; He, Ping; Park, Jeong-Gun; Murphy, Sabina A; White, Jennifer A; Kesaniemi, Y Antero; Pedersen, Terje R; Brady, Adrian J; Mitchel, Yale; Cannon, Christopher P; Braunwald, Eugene

2017-02-28

Ezetimibe improves cardiovascular (CV) outcomes in patients stabilized after acute coronary syndrome (ACS) when added to statin therapy. After ACS, patients vary considerably in their risk for recurrent CV events. This study tested the hypothesis that atherothrombotic risk stratification may be useful to identify post-ACS patients who have the greatest potential for benefit from the addition of ezetimibe to statin therapy. The TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Secondary Prevention (TRS 2°P) is a simple 9-point risk stratification tool, previously developed in a large population with atherothrombosis to predict CV death, myocardial infarction (MI), and ischemic stroke (CV death/MI/ischemic cerebrovascular accident [iCVA]). The current study applied this tool prospectively to 17,717 post-ACS patients randomized either to ezetimibe and simvastatin or to placebo and simvastatin in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial). Treatment efficacy was assessed by baseline risk for CV death/MI/iCVA, the IMPROVE-IT composite endpoints (CE), and individual component endpoints at 7 years. All 9 clinical variables in the TRS 2°P were independent risk indicators for CV death/MI/iCVA (p < 0.001). The integer-based scheme showed a strong graded relationship with the rate of CV death/MI/iCVA, the trial CE, and the individual components (p trend <0.0001 for each). High-risk patients (n = 4,393; 25%), defined by ≥3 risk indicators, had a 6.3% (95% confidence interval: 2.9% to 9.7%) absolute risk reduction in CV death/MI/iCVA at 7 years with ezetimibe/simvastatin, thus translating to a number-needed-to-treat of 16. Intermediate-risk patients (2 risk indicators; n = 5,292; 30%) had a 2.2% (95% confidence interval: -0.3% to 4.6%) absolute risk reduction. Low-risk patients (0 to 1 risk indicators; n = 8,032; 45%) did not appear to derive benefit from the addition of ezetimibe (p interaction = 0.010). Similar findings were observed for the IMPROVE-IT primary CE. Atherothrombotic risk stratification using the TRS 2°P identifies high-risk patients who derive greatest benefit from the addition of ezetimibe to statin therapy for secondary prevention after ACS. (Improved Reduction of Outcomes: Vytorin Efficacy International Trial [IMPROVE-IT]; NCT00202878). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Impact of Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention: The Multicenter Randomized Controlled PRECISE-IVUS Trial.

PubMed

Tsujita, Kenichi; Sugiyama, Seigo; Sumida, Hitoshi; Shimomura, Hideki; Yamashita, Takuro; Yamanaga, Kenshi; Komura, Naohiro; Sakamoto, Kenji; Oka, Hideki; Nakao, Koichi; Nakamura, Sunao; Ishihara, Masaharu; Matsui, Kunihiko; Sakaino, Naritsugu; Nakamura, Natsuki; Yamamoto, Nobuyasu; Koide, Shunichi; Matsumura, Toshiyuki; Fujimoto, Kazuteru; Tsunoda, Ryusuke; Morikami, Yasuhiro; Matsuyama, Koushi; Oshima, Shuichi; Kaikita, Koichi; Hokimoto, Seiji; Ogawa, Hisao

2015-08-04

Despite standard statin therapy, a majority of patients retain a high "residual risk" of cardiovascular events. The aim of this study was to evaluate the effects of ezetimibe plus atorvastatin versus atorvastatin monotherapy on the lipid profile and coronary atherosclerosis in Japanese patients who underwent percutaneous coronary intervention (PCI). This trial was a prospective, randomized, controlled, multicenter study. Eligible patients who underwent PCI were randomly assigned to atorvastatin alone or atorvastatin plus ezetimibe (10 mg) daily. Atorvastatin was uptitrated with a treatment goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dl. Serial volumetric intravascular ultrasound was performed at baseline and again at 9 to 12 months to quantify the coronary plaque response in 202 patients. The combination of atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy (63.2 ± 16.3 mg/dl vs. 73.3 ± 20.3 mg/dl; p < 0.001). For the absolute change in percent atheroma volume (PAV), the mean difference between the 2 groups (-1.538%; 95% confidence interval [CI]: -3.079% to 0.003%) did not exceed the pre-defined noninferiority margin of 3%, but the absolute change in PAV did show superiority for the dual lipid-lowering strategy (-1.4%; 95% CI: -3.4% to -0.1% vs. -0.3%; 95% CI: -1.9% to 0.9% with atorvastatin alone; p = 0.001). For PAV, a significantly greater percentage of patients who received atorvastatin/ezetimibe showed coronary plaque regression (78% vs. 58%; p = 0.004). Both strategies had acceptable side effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events. Compared with standard statin monotherapy, the combination of statin plus ezetimibe showed greater coronary plaque regression, which might be attributed to cholesterol absorption inhibition-induced aggressive lipid lowering. (Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound [PRECISE-IVUS]; NCT01043380). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect on Fasting Serum Glucose Levels of Adding Ezetimibe to Statins in Patients With Nondiabetic Hypercholesterolemia.

PubMed

Toth, Peter P; Catapano, Alberico L; Farnier, Michel; Foody, Joanne; Tomassini, Joanne E; Jensen, Erin; Polis, Adam B; Hanson, Mary E; Musliner, Thomas A; Tershakovec, Andrew M

2016-12-15

Statin therapy is associated with a slightly increased risk of developing diabetes mellitus and insulin resistance in patients without diabetes. Ezetimibe combined with statins may be considered for high-risk patients who do not achieve optimal low-density lipoprotein cholesterol lowering on statin monotherapy or who are statin intolerant. Changes in fasting serum glucose (FSG) levels during ezetimibe, ezetimibe/statin, and statin treatments were assessed using data pooled from clinical trials in hypercholesterolemic and heterozygous familial hypercholesterolemic patients, who were or were not receiving statin therapy. Study types included first-line trials in statin-naive/wash-out patients and second-line add-on and uptitration studies in patients on stable statin therapy. Similar analyses of FSG changes were performed separately for each study type in patients who were nondiabetic at baseline. Across all study types and treatments, mean FSG increases from baseline were small (0.5 to 3.7 mg/dl with ezetimibe/statin; 0.2 to 4.6 mg/dl with statins) and decreased over time; between-treatment differences (0.3 to 1.4 mg/dl) were nonsignificant for all comparisons. Proportions of patients with elevated FSG ≥126 mg/dl during therapy were low and similar for all treatments in the overall cohort (1.2% to 4.3%). Elevations were highest (3.3% to 25.7%) among patients with baseline factors characteristic of metabolic syndrome and prediabetes, including higher FSG, body mass index, and triglyceride levels, and numerically lower baseline high-density lipoprotein cholesterol; however, these factors were not related to FSG increases. Changes in low-density lipoprotein cholesterol, body mass index, high-density lipoprotein cholesterol, triglycerides, and apolipoprotein B were not significantly correlated with FSG increases. In conclusion, statin therapy was associated with small FSG increases, and the addition of ezetimibe did not further increase FSG levels beyond those of statins when given to patients who are statin naive or those on statin therapy. Copyright © 2016 The Authors and Merck Sharp & Dohme Corp. Published by Elsevier Inc. All rights reserved.

Efficacy and safety of adding alirocumab to rosuvastatin versus adding ezetimibe or doubling the rosuvastatin dose in high cardiovascular-risk patients: The ODYSSEY OPTIONS II randomized trial.

PubMed

Farnier, Michel; Jones, Peter; Severance, Randall; Averna, Maurizio; Steinhagen-Thiessen, Elisabeth; Colhoun, Helen M; Du, Yunling; Hanotin, Corinne; Donahue, Stephen

2016-01-01

To compare lipid-lowering efficacy of adding alirocumab to rosuvastatin versus other treatment strategies (NCT01730053). Patients receiving baseline rosuvastatin regimens (10 or 20 mg) were randomized to: add-on alirocumab 75 mg every-2-weeks (Q2W) (1-mL subcutaneous injection via pre-filled pen); add-on ezetimibe 10 mg/day; or double-dose rosuvastatin. Patients had cardiovascular disease (CVD) and low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL (1.8 mmol/L) or CVD risk factors and LDL-C ≥100 mg/dL (2.6 mmol/L). In the alirocumab group, dose was blindly increased at Week 12 to 150 mg Q2W (also 1-mL volume) in patients not achieving their LDL-C target. Primary endpoint was percent change in calculated LDL-C from baseline to 24 weeks (intent-to-treat). 305 patients were randomized. In the baseline rosuvastatin 10 mg group, significantly greater LDL-C reductions were observed with add-on alirocumab (-50.6%) versus ezetimibe (-14.4%; p < 0.0001) and double-dose rosuvastatin (-16.3%; p < 0.0001). In the baseline rosuvastatin 20 mg group, LDL-C reduction with add-on alirocumab was -36.3% compared with -11.0% with ezetimibe and -15.9% with double-dose rosuvastatin (p = 0.0136 and 0.0453, respectively; pre-specified threshold for significance p < 0.0125). Overall, ∼80% alirocumab patients were maintained on 75 mg Q2W. Of alirocumab-treated patients, 84.9% and 66.7% in the baseline rosuvastatin 10 and 20 mg groups, respectively, achieved risk-based LDL-C targets. Treatment-emergent adverse events occurred in 56.3% of alirocumab patients versus 53.5% ezetimibe and 67.3% double-dose rosuvastatin (pooled data). The addition of alirocumab to rosuvastatin provided incremental LDL-C lowering versus adding ezetimibe or doubling the rosuvastatin dose. Copyright © 2015 Regeneron Pharmaceuticals, Inc. Published by Elsevier Ireland Ltd.. All rights reserved.

Combination Therapy of Rosuvastatin and Ezetimibe in Patients with High Cardiovascular Risk.

PubMed

Yang, Young-June; Lee, Sang-Hak; Kim, Byung Soo; Cho, Yun-Kyeong; Cho, Hyun-Jai; Cho, Kyoung Im; Kim, Seok-Yeon; Ryu, Jae Kean; Cho, Jin-Man; Park, Joong-Il; Park, Jong-Seon; Park, Chang Gyu; Chun, Woo Jung; Kim, Myung-A; Jin, Dong-Kyu; Lee, Namho; Kim, Byung Jin; Koh, Kwang Kon; Suh, Jon; Lee, Seung-Hwan; Lee, Byoung-Kwon; Oh, Seung-Jin; Jin, Han-Young; Ahn, Youngkeun; Lee, Sang-Gon; Bae, Jang-Ho; Park, Woo Jung; Lee, Sang-Chol; Lee, Han Cheol; Lee, Jaewon; Park, Cheolwon; Lee, Backhwan; Jang, Yangsoo

2017-01-01

The aim of this study was to evaluate the efficacy and tolerability of rosuvastatin/ezetimibe combination therapy in Korean patients with high cardiovascular risk. This was a 12-week, randomized, double-blind, placebo-controlled, multicenter study. A total of 337 patients were screened. After a 4-week run-in period, 245 of these patients with high or moderately high risk as defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines were randomly assigned. Patients received 1 of 6 regimens for 8 weeks as follows: (1) rosuvastatin 5 mg, (2) rosuvastatin 5 mg/ezetimibe 10 mg, (3) rosuvastatin 10 mg, (4) rosuvastatin 10 mg/ezetimibe 10 mg, (5) rosuvastatin 20 mg, or (6) rosuvastatin 20 mg/ezetimibe 10 mg. The primary outcome variable was percentage change in the level of LDL-C at week 8 of drug treatment. Secondary outcome variables included percentage changes of other lipid variables and achievement rates of LDL-C targets. Tolerability analyses were also performed. The percentage change of LDL-C ranged from -45% to -56% (mean, -51%) in the monotherapy groups and from -58% to -63% (mean, -60%) in the combination therapy groups. The percentage change was greater in the pooled combination therapy group than in the counterpart (P < 0.001 for the pooled groups); this difference was more obvious for regimens with a lower statin dose. The percentage reductions of total cholesterol and triglycerides were greater in the combination groups than in the monotherapy groups. The LDL-C target achievement rates were 64% to 87% (mean, 73%) in the monotherapy groups and 87% to 95% (mean, 91%) in the combination groups (P = 0.01 for the pooled groups). The rates were significantly greater in patients receiving the combination therapy than in the monotherapy at lower doses of rosuvastatin. The proportions of patients with various adverse events were not significantly different between the groups. Rosuvastatin/ezetimibe combination therapy has better efficacy and target achievement rates than rosuvastatin monotherapy in patients with high cardiovascular risk. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial.

PubMed

Eisen, Alon; Cannon, Christopher P; Blazing, Michael A; Bohula, Erin A; Park, Jeong-Gun; Murphy, Sabina A; White, Jennifer A; Giugliano, Robert P; Braunwald, Eugene

2016-12-21

To examine the efficacy and safety of ezetimibe added to statin in patients with prior coronary artery bypass graft surgery (CABG) following hospitalization for an acute coronary syndrome (ACS). In the IMPROVE-IT trial, post-ACS patients with mean low density lipoprotein cholesterol (LDL-C) of 93.8 mg/dL at presentation were randomized to simvastatin/ezetimibe or simvastatin/placebo. The primary endpoint was cardiovascular death, major coronary event or stroke, and the median follow-up was 6 years. Efficacy and safety endpoints were examined by prior CABG status. Among 18 134 patients, 1684 (9.3%) had a prior CABG (median age 69 years, 82% male). During the trial, the median time-weighted LDL-C level was 55.0 mg/dL with simvastatin/ezetimibe vs. 69.9 mg/dL with simvastatin/placebo in patients with prior CABG (P < 0.001), and it was 53.6 mg/dL vs. 69.5 mg/dL, respectively, in patients without prior CABG (P < 0.001). The rate of the primary endpoint was higher in patients with vs. without prior CABG [56% vs. 32%, adj. hazard ratio 1.45, 95% confidence interval (CI) 1.33-1.58]. Patients with prior CABG receiving simvastatin/ezetimibe had an 8.8% (95% CI 3.1-14.6%) lower absolute risk over simvastatin/placebo in the primary endpoint, whereas patients without prior CABG had a 1.3% (95% CI 0-2.6%) lower absolute risk (P-interaction = 0.02). There were no between-group significant differences in safety endpoints. The clinical benefit of adding ezetimibe to statin appears to be enhanced in patients with prior CABG, supporting the use of intensive lipid lowering therapy in these high-risk patients following ACS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

Synergistic effect of ezetimibe addition on coronary atheroma regression in patients with prior statin therapy: Subanalysis of PRECISE-IVUS trial.

PubMed

Tsujita, Kenichi; Yamanaga, Kenshi; Komura, Naohiro; Sakamoto, Kenji; Sugiyama, Seigo; Sumida, Hitoshi; Shimomura, Hideki; Yamashita, Takuro; Oka, Hideki; Nakao, Koichi; Nakamura, Sunao; Ishihara, Masaharu; Matsui, Kunihiko; Sakaino, Naritsugu; Nakamura, Natsuki; Yamamoto, Nobuyasu; Koide, Shunichi; Matsumura, Toshiyuki; Fujimoto, Kazuteru; Tsunoda, Ryusuke; Morikami, Yasuhiro; Matsuyama, Koushi; Oshima, Shuichi; Kaikita, Koichi; Hokimoto, Seiji; Ogawa, Hisao

2016-09-01

The IMPROVE-IT trial showed that the clinical benefit of statin/ezetimibe combination appeared to be pronounced in patients with prior statin therapy. We hypothesized that the antiatherosclerotic effect of atorvastatin/ezetimibe combination was pronounced in patients with statin pretreatment. In the prospective, randomized, controlled, multicenter PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound-guided percutaneous coronary intervention were randomized to atorvastatin/ezetimibe combination or atorvastatin alone. The dosage of atorvastatin was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol to below 70 mg/dl in both groups. Serial volumetric intravascular ultrasound was performed at baseline and 9-12 month follow-up to quantify the coronary plaque response in 202 patients. We compared the intravascular ultrasound endpoints in all subjects, stratified by the presence or absence of statin pretreatment. The baseline low-density lipoprotein cholesterol level (100.7 ± 23.1 mg/dl vs. 116.4 ± 25.9 mg/dl, p < 0.001) and lathosterol (55 (38 to 87)) µg/100 mg total cholesterol vs. 97 (57 to 149) µg/100 mg total cholesterol, p < 0.001) was significantly lower, and campesterol/lathosterol ratio (3.9 (2.4 to 7.4) vs. 2.6 (1.5 to 4.1), p < 0.001) was significantly increased in patients with statin pretreatment. Contrary to the patients without statin pretreatment (-1.3 (-3.1 to -0.1)% vs. -0.9 (-2.3 to 0.9)%, p = 0.12), the atorvastatin/ezetimibe combination showed a significantly stronger reduction in delta percent atheroma volume, compared with atorvastatin alone, in patients with statin pretreatment (-1.8 (-3.6 to -0.3)% vs. -0.1 (-1.6 to 0.8)%, p = 0.002). Compensatory increase in cholesterol absorption observed in statin-treated patients might attenuate the inhibitory effects of statins on coronary plaque progression. A low-dose statin/ezetimibe combination might be a promising option in statin-hyporesponder. © The European Society of Cardiology 2016.

The Effect of Combined Ezetimibe/Atorvastatin Therapy vs. Atorvastatin Monotherapy on the Erythrocyte Membrane Structure in Patients with Coronary Artery Disease: A Pilot Study.

PubMed

Jackowska, Paulina; Pytel, Edyta; Koter-Michalak, Maria; Olszewska-Banaszczyk, Małgorzata; Legęza, Aleksandra; Broncel, Marlena

2016-01-01

Erythrocytes play an important role in atherogenesis. An excessive accumulation of cholesterol in erythrocyte membranes leads to disruption of the erythrocytes. The aim of the study was to compare the effect of two different hypolipidemic therapies on the structure of erythrocyte membranes. The study included 18 patients with angiographic confirmed coronary artery disease who, despite at least 6 months of hypolipidemic treatment, had not achieved LDL-C < 70 mg/dL and 18 healthy individuals as the control group. The following parameters were studied: total cholesterol level and erythrocyte membrane fluidity, lipid peroxidation, SH groups in membrane protein and plasma lipids. We observed a decrease in TC (20%), LDL-C (35%), level of lipid peroxidation (25%) and total cholesterol in erythrocytes (23%), and an increase in HDL-C (8%) and erythrocyte membrane fluidity of subsurface layers (14%) after 6 months of 10 mg atorvastatin + 10 mg ezetimibe therapy, in comparison with healthy controls. In the group treated with 40 mg atorvastatin for 6 months, decreased LDL-C (23%), lipid peroxidation (37%) and membrane cholesterol concentration (18%) was noted, as well as an increase in erythrocyte membrane fluidity in the subsurface layers (12%). Both the combination therapy and the monotherapy lead to an improvement of erythrocyte membrane structure, whose parameters reached values close to those in the control healthy group.

Safety of coadministration of ezetimibe and statins in patients with hypercholesterolaemia: a meta-analysis.

PubMed

Luo, L; Yuan, X; Huang, W; Ren, F; Zhu, H; Zheng, Y; Tang, L

2015-05-01

Hypercholesterolaemia is a pivotal risk factor for cardiovascular and cerebrovascular disease and is treated with many effective lipid-lowering agents. Statins are often used alone or in combination with ezetimibe. Combination therapy is more effective because of its complementary approach, which has major benefits for patients with unmanageable lipid levels. Extensive application of combination therapy has resulted in an increased incidence of side-effects, which has raised our concern. To evaluate the evidence associated with the safety of coadministration of ezetimibe with statins. Three electronic databases were searched (PubMed, EMBASE and Cochrane Library) from January 2002 to October 2014. Two independent reviewers critically identify randomised controlled trials (RCT), extracted the data and assessed trial quality. A total ot 20 RCT met inclusion criteria, including 14,856 patients. A fixed-effects model was used for meta-analysis to assess the safety of combination therapy. Coadministration of ezetimibe and statins did not result in significant increases in total adverse events (30% vs 29%, P = 0.34), serious adverse events (2% vs 1.6%, P = 0.81), treatment discontinuations (3.5% vs 2.9%, P = 0.22), gastrointestinal adverse events (5% vs 4%, P = 0.08), allergic reactions or rashes (0.9% vs 1.3%, P = 0.33), creatine kinase > 10 × upper limit of normal (ULN) (0.2% vs 0.2%, P = 0.86), alanine aminotransferase > 3 × ULN (0.5% vs 0.4%, P = 0.96) and aspartate aminotransferase > 3 × ULN (0.4% vs 0.4%, P = 0.58). The incidence of adverse events was similar between ezetimibe-statin combination therapy and statin monotherapy; thus, we recommend combination therapy for patients with hypercholesterolaemia at high risk for cardiovascular and cerebrovascular disease. © 2015 Royal Australasian College of Physicians.

Vascular and metabolic effects of ezetimibe combined with simvastatin in patients with hypercholesterolemia.

PubMed

Koh, Kwang Kon; Oh, Pyung Chun; Sakuma, Ichiro; Kim, Eun Young; Lee, Yonghee; Hayashi, Toshio; Han, Seung Hwan; Park, Yae Min; Shin, Eak Kyun

2015-11-15

Ezetimibe demonstrates decreasing visceral fat and improving insulin sensitivity (IS) in animals and humans. We first reported that simvastatin dose-dependently worsens insulin sensitivity. Whether ezetimibe may compensate untoward effects of simvastatin, depending on dosages of simvastatin has not been investigated in patients with hypercholesterolemia, compared with simvastatin alone. This was a randomized, single-blind, placebo-controlled, parallel study. Fifty-one in each group were given placebo, ezetimibe 10mg combined with simvastatin 10mg (Vyto10), ezetimibe 10mg combined with simvastatin 20mg (Vyto20), or simvastatin 20mg alone (Simva20) daily for 2months. Placebo, Vyto10, Vyto20, and Simva20 improved flow-mediated dilation relative to baseline measurements. Placebo therapy did not significantly change insulin and IS and adiponectin levels and visceral fat area (VFA) and VFA/subcutaneous fat area (SFA) relative to baseline measurements. Vyto10 therapy significantly decreased CRP and insulin levels and increased adiponectin levels and IS, and reduced VFA, VFA/SFA, and blood pressure. Vyto20 therapy did not significantly change insulin levels and IS and adiponectin levels but significantly reduced CRP levels and VFA, VFA/SFA, and blood pressure. Simva20 therapy significantly decreased adiponectin levels and IS but did not significantly change VFA, VFA/SFA, and blood pressure. Of note, these different effects of each therapy were significant by ANOVA. Vyto10, Vyto20, and Simva20 showed significant reduction of LDL cholesterol levels and improvement of flow-mediated dilation in patients with hypercholesterolemia. However, Vyto10, Vyto20, and Simva20 showed significantly differential metabolic effects, depending on dosages of simvastatin. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effect of hydroxypropylcellulose and Tween 80 on physicochemical properties and bioavailability of ezetimibe-loaded solid dispersion.

PubMed

Rashid, Rehmana; Kim, Dong Wuk; Din, Fakhar Ud; Mustapha, Omer; Yousaf, Abid Mehmood; Park, Jong Hyuck; Kim, Jong Oh; Yong, Chul Soon; Choi, Han-Gon

2015-10-05

The purpose of this research was to evaluate the effect of the HPC (hydroxypropylcellulose) and Tween 80 on the physicochemical properties and oral bioavailability of ezetimibe-loaded solid dispersions. The binary solid dispersions were prepared with drug and various amounts of HPC. Likewise, ternary solid dispersions were prepared with different ratios of drug, HPC and Tween 80. Both types of solid dispersions were prepared using the solvent evaporation method. Their aqueous solubility, physicochemical properties, dissolution and oral bioavailability were investigated in comparison with the drug powder. All the solid dispersions significantly improved the drug solubility and dissolution. As the amount of HPC increased in the binary solid dispersions to 10-fold, the drug solubility and dissolution were increased accordingly. However, further increase in HPC did not result in significant differences among them. Similarly, up to 0.1-fold, Tween 80 increased the drug solubility in the ternary solid dispersions followed by no significant change. However, Tween 80 hardly affected the drug dissolution. The physicochemical analysis proved that the drug in binary and ternary solid dispersion was existed in the amorphous form. The particle-size measurements of these formulations were also not significantly different from each other, which showed that Tween 80 had no impact on physicochemical properties. The ezetimibe-loaded binary and ternary solid dispersions gave 1.6- and 1.8-fold increased oral bioavailability in rats, respectively, as compared to the drug powder; however, these values were not significantly different from each other. Thus, HPC greatly affected the solubility, dissolution and oral bioavailability of drug, but Tween 80 hardly did. Furthermore, this ezetimibe-loaded binary solid dispersion prepared only with HPC would be suggested as a potential formulation for oral administration of ezetimibe. Copyright © 2015 Elsevier Ltd. All rights reserved.

Coadministration of ezetimibe with pegylated interferon plus ribavirin could improve early virological response in chronic hepatitis C obese Egyptian patients.

PubMed

Helal, Gouda K; Gad, Magdy A; Abd-Ellah, Mohamed F; Mahgoup, Elsayed M

2016-05-01

Ezetimibe has been reported to inhibit viral entry and to reduce BMI and has been proposed as a novel therapeutic agent for chronic hepatitis C (CHC), potentiating the effects of pegylated interferon and ribavirin (peg-IFN/RBV). The aim of the study was to assess the effects of ezetimibe coadministration with peg-IFN/RBV combination on the early virological response (EVR) rates in nonobese and obese patients with CHC genotype 4 (CHC-4). A total of 144 CHC-4 patients were divided into two groups; group 1 included nonobese patients (n=76) and group 2 included obese patients (n=68). Each group was further subclassified into equal control and treated groups. The control groups received peg-IFN/RBV combination for 24 weeks, and the treated groups received peg-IFN/RBV plus ezetimibe for 12 weeks and then only peg-IFN/RBV for the remaining 12 weeks. The study revealed that EVR significantly improved in the obese patients (85.3 vs. 64.7% in the treated and control groups, respectively, at P<0.05) without any significant improvement in the nonobese patients. Biochemical responses (defined as normalization of alanine aminotransferase at week 12) were markedly improved in the treated groups in both the nonobese and obese groups compared with their respective controls. The addition of ezetimibe to peg-IFN/RBV combination significantly improves EVR rates in obese patients compared with nonobese patients, and remarkably improves the biochemical responses in both obese and nonobese patients with CHC-4. This may shed light on a new strategy for the treatment of CHC, particularly in obese Egyptian patients.

Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy.

PubMed

Robins, Douglas N

2007-09-01

Alopecia areata is an organ specific autoimmune disease in which hair is lost in various patterns. Its most extreme form, alopecia universalis, is the total loss of all scalp and body hair. This form of the condition is very resistant to treatment and spontaneous remission is quite rare. The following is a case of a 54-year-old male with longstanding alopecia universalis who began to grow dense hair on his scalp as well as patchy hair growth on his face, pubic and axillary areas one month after starting a course of simvastatin 40 mg and ezetimibe 10 mg daily prescribed for his hyperlipidemia. For 2 years prior to starting the combination drug, he had taken simvastatin 40 mg alone without evidence of any hair growth. The combination of simvastatin and ezetimibe has previously demonstrated synergistic immunomodulatory effects, which most likely accounts for the clinical response in this case.

Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk factor.

PubMed

Tenenbaum, Alexander; Klempfner, Robert; Fisman, Enrique Z

2014-12-04

The existence of an independent association between elevated triglyceride (TG) levels, cardiovascular (CV) risk and mortality has been largely controversial. The main difficulty in isolating the effect of hypertriglyceridemia on CV risk is the fact that elevated triglyceride levels are commonly associated with concomitant changes in high density lipoprotein (HDL), low density lipoprotein (LDL) and other lipoproteins. As a result of this problem and in disregard of the real biological role of TG, its significance as a plausible therapeutic target was unfoundedly underestimated for many years. However, taking epidemiological data together, both moderate and severe hypertriglyceridaemia are associated with a substantially increased long term total mortality and CV risk. Plasma TG levels partially reflect the concentration of the triglyceride-carrying lipoproteins (TRL): very low density lipoprotein (VLDL), chylomicrons and their remnants. Furthermore, hypertriglyceridemia commonly leads to reduction in HDL and increase in atherogenic small dense LDL levels. TG may also stimulate atherogenesis by mechanisms, such excessive free fatty acids (FFA) release, production of proinflammatory cytokines, fibrinogen, coagulation factors and impairment of fibrinolysis. Genetic studies strongly support hypertriglyceridemia and high concentrations of TRL as causal risk factors for CV disease. The most common forms of hypertriglyceridemia are related to overweight and sedentary life style, which in turn lead to insulin resistance, metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Intensive lifestyle therapy is the main initial treatment of hypertriglyceridemia. Statins are a cornerstone of the modern lipids-modifying therapy. If the primary goal is to lower TG levels, fibrates (bezafibrate and fenofibrate for monotherapy, and in combination with statin; gemfibrozil only for monotherapy) could be the preferable drugs. Also ezetimibe has mild positive effects in lowering TG. Initial experience with en ezetimibe/fibrates combination seems promising. The recently released IMPROVE-IT Trial is the first to prove that adding a non-statin drug (ezetimibe) to a statin lowers the risk of future CV events. In conclusion, the classical clinical paradigm of lipids-modifying treatment should be changed and high TG should be recognized as an important target for therapy in their own right. Hypertriglyceridemia should be treated.

Effect of ezetimibe add-on therapy over 52 weeks extension analysis of prospective randomized trial (RESEARCH study) in type 2 diabetes subjects.

PubMed

Sakamoto, Kentaro; Kawamura, Mitsunobu; Watanabe, Takayuki; Ashidate, Keiko; Kohro, Takahide; Tanaka, Akira; Mori, Yasumichi; Tagami, Motoki; Hirano, Tsutomu; Yamazaki, Tsutomu; Shiba, Teruo

2017-06-24

Lowering cholesterol levels decreases the risk of atherosclerotic diseases. Effective ways to stably reduce LDL-C level are warranted in type 2 diabetic patients, a high-risk population for CVD, with various anti-diabetic therapeutic background. The RESEARCH study focuses on LDL-C reduction in this population along with modifications of the lipid profiles. We evaluated long-term ezetimibe add-on therapy in T2DM patients with hypercholesterolemia. In a randomized, multicenter, open-label, prospective study, a total of 109 T2DM patients not attaining LDL-C target value despite first-line dose statin (10 mg of atorvastatin or 1 mg of pitavastatin) therapy in Japan were recruited. We investigated the difference in cholesterol lowering effect between ezetimibe (10 mg) add-on statin (EAT) group and double-dose statin (DST) group. Changes of parameters related to atherosclerotic event risks were assessed. The reduction of LDL-C was larger in the EAT group (28.3%) than in the DST group (9.2%) at 52 weeks as well as the primary endpoint of 12 weeks. EAT achieved significant lower levels of TC and apo B, respectively. Both treatments attained significant reduction in sd-LDL-C or hsCRP on this long-term basis. Notably, sd-LDL-C in EAT reduced as low as 36.1 ± 14.9 mg/dl to reach near the threshold (35.0 mg/dl) for atherosclerosis with significantly higher achievement rate (55.6%) than DST treatment. Simultaneously, hsCRP reduction by EAT attained as low value as 0.52 ± 0.43 mg/l. In the present 52-week long-term period, ezetimibe add-on therapy showed a robust advantage in lowering LDL-C and in attaining target LDL-C values compared with the doubling of statin dose. Moreover, it's meaningful that sd-LDL, powerfully atherogenic lipoprotein, exhibited prominent decrease consistently prominently by ezetimibe add-on therapy. DM patients with hypercholesterolemia are at high risk for CAD, and adding ezetimibe onto usual-dose statin treatment in Japan has been suggested as the first-line therapy for those DM patients who failed to attain the target LDL-C value (UMIN000002593).

Achievement of dual low-density lipoprotein cholesterol and high-sensitivity C-reactive protein targets more frequent with the addition of ezetimibe to simvastatin and associated with better outcomes in IMPROVE-IT.

PubMed

Bohula, Erin A; Giugliano, Robert P; Cannon, Christopher P; Zhou, Jing; Murphy, Sabina A; White, Jennifer A; Tershakovec, Andrew M; Blazing, Michael A; Braunwald, Eugene

2015-09-29

Statins lower low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP); addition of ezetimibe to statins further reduces LDL-C and hs-CRP. An analysis of the relationship between achieved LDL-C and hs-CRP targets and outcomes for simvastatin and ezetimibe/simvastatin was prespecified in Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). The IMPROVE-IT trial randomly assigned 18 144 patients stabilized after acute coronary syndrome to simvastatin or ezetimibe/simvastatin. LDL-C and hs-CRP were measured at baseline and 1 month after randomization. Outcomes were assessed in those achieving one or both of the prespecified targets of LDL-C<70 mg/dL and hs-CRP<2 mg/L versus achieving neither target, adjusting for differences in baseline characteristics. An exploratory analysis examined targets of LDL-C<50 mg/dL and hs-CRP<1 mg/L. Patients meeting both targets at baseline, with no 1-month values, or with end points before 1 month were excluded. Of 15 179 patients, 39% achieved the dual LDL-C (<70 mg/dL) and hs-CRP (<2 mg/L) targets at 1 month, 14% met neither target, 14% met only the hs-CRP target, and 33% met only the LDL-C target. Those achieving dual targets had lower primary end point rates than those meeting neither target (cardiovascular death, major coronary event, or stroke; 38.9% versus 28.0%; adjusted hazard ratio, 0.73; 0.66-0.81; P<0.001). More patients treated with ezetimibe/simvastatin met dual targets than those treated with simvastatin alone (50% versus 29%, P<0.001). The association of dual-target attainment with improved outcomes was similar irrespective of treatment assignment (P-interaction=0.65). Similar findings were observed using the exploratory targets. Significantly more patients treated with ezetimibe/simvastatin met prespecified and exploratory dual LDL-C and hs-CRP targets than patients treated with simvastatin alone. Reaching both LDL-C and hs-CRP targets was associated with improved outcomes after multivariable adjustment. URL: http://www.clinicaltrials.gov; Unique identifier: NCT00202878. © 2015 American Heart Association, Inc.

The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial.

PubMed

Baigent, Colin; Landray, Martin J; Reith, Christina; Emberson, Jonathan; Wheeler, David C; Tomson, Charles; Wanner, Christoph; Krane, Vera; Cass, Alan; Craig, Jonathan; Neal, Bruce; Jiang, Lixin; Hooi, Lai Seong; Levin, Adeera; Agodoa, Lawrence; Gaziano, Mike; Kasiske, Bertram; Walker, Robert; Massy, Ziad A; Feldt-Rasmussen, Bo; Krairittichai, Udom; Ophascharoensuk, Vuddidhej; Fellström, Bengt; Holdaas, Hallvard; Tesar, Vladimir; Wiecek, Andrzej; Grobbee, Diederick; de Zeeuw, Dick; Grönhagen-Riska, Carola; Dasgupta, Tanaji; Lewis, David; Herrington, William; Mafham, Marion; Majoni, William; Wallendszus, Karl; Grimm, Richard; Pedersen, Terje; Tobert, Jonathan; Armitage, Jane; Baxter, Alex; Bray, Christopher; Chen, Yiping; Chen, Zhengming; Hill, Michael; Knott, Carol; Parish, Sarah; Simpson, David; Sleight, Peter; Young, Alan; Collins, Rory

2011-06-25

Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients. This randomised double-blind trial included 9270 patients with chronic kidney disease (3023 on dialysis and 6247 not) with no known history of myocardial infarction or coronary revascularisation. Patients were randomly assigned to simvastatin 20 mg plus ezetimibe 10 mg daily versus matching placebo. The key prespecified outcome was first major atherosclerotic event (non-fatal myocardial infarction or coronary death, non-haemorrhagic stroke, or any arterial revascularisation procedure). All analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00125593, and ISRCTN54137607. 4650 patients were assigned to receive simvastatin plus ezetimibe and 4620 to placebo. Allocation to simvastatin plus ezetimibe yielded an average LDL cholesterol difference of 0·85 mmol/L (SE 0·02; with about two-thirds compliance) during a median follow-up of 4·9 years and produced a 17% proportional reduction in major atherosclerotic events (526 [11·3%] simvastatin plus ezetimibe vs 619 [13·4%] placebo; rate ratio [RR] 0·83, 95% CI 0·74-0·94; log-rank p=0·0021). Non-significantly fewer patients allocated to simvastatin plus ezetimibe had a non-fatal myocardial infarction or died from coronary heart disease (213 [4·6%] vs 230 [5·0%]; RR 0·92, 95% CI 0·76-1·11; p=0·37) and there were significant reductions in non-haemorrhagic stroke (131 [2·8%] vs 174 [3·8%]; RR 0·75, 95% CI 0·60-0·94; p=0·01) and arterial revascularisation procedures (284 [6·1%] vs 352 [7·6%]; RR 0·79, 95% CI 0·68-0·93; p=0·0036). After weighting for subgroup-specific reductions in LDL cholesterol, there was no good evidence that the proportional effects on major atherosclerotic events differed from the summary rate ratio in any subgroup examined, and, in particular, they were similar in patients on dialysis and those who were not. The excess risk of myopathy was only two per 10,000 patients per year of treatment with this combination (9 [0·2%] vs 5 [0·1%]). There was no evidence of excess risks of hepatitis (21 [0·5%] vs 18 [0·4%]), gallstones (106 [2·3%] vs 106 [2·3%]), or cancer (438 [9·4%] vs 439 [9·5%], p=0·89) and there was no significant excess of death from any non-vascular cause (668 [14·4%] vs 612 [13·2%], p=0·13). Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced chronic kidney disease. Merck/Schering-Plough Pharmaceuticals; Australian National Health and Medical Research Council; British Heart Foundation; UK Medical Research Council. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in Patients With a History of Acute Coronary Syndrome: Analysis of Results of the IMPROVE-IT Trial.

PubMed

Almalki, Ziyad S; Guo, Jeff Jianfei; Alahmari, Abdullah; Alotaibi, Nawaf; Thaibah, Hilal

2018-06-01

Simvastatin plus ezetimibe reduced the risk of cardiovascular events in the IMProved Reduction of Outcomes: Vytorin Efficacy International (IMPROVE-IT) study. The aim of this study is to investigate the cost-effectiveness of adding ezetimibe to simvastatin treatment for patients with ACS based on the recently completed IMPROVE-IT trial. We constructed a Markov state-transition model to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness (ICER) associated with co-therapy compared with simvastatin alone from a health care perspective. We ran separate base-case analyses assuming a trial-length and longer term follow-up. One-way sensitivity analyses were used to explore uncertainty in model parameters. In the trial-length model, the ICERs compared with simvastatin alone were $114,400 per QALY for the combination therapy. In 5- and 10-year time horizons, the ICERs remained above the cost-effectiveness threshold of $50,000 per QALY. In the lifetime horizon model, The ICER was $45,046 per QALY for combination treatment compared with simvastatin alone. The combination therapy is cost-effective at an 80% decrease in the current branded simvastatin and ezetimibe cost. Probabilistic sensitivity analysis suggested simvastatin and ezetimibe co-therapy would be a cost-effective alternative to simvastatin monotherapy 60.7% of the time. In our trial-length, 5-year, and 10-year models, the co-therapy was not a cost-effective alternative; however, as follow-up was extended to lifetime, the co-therapy became a cost-effective treatment compared with the simvastatin monotherapy in patients with histories of ACS. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Baseline serum sitosterol level as predictor of adverse clinical events in acute coronary syndrome patients with dyslipidaemia: A sub-analysis of HIJ-PROPER.

PubMed

Yamaguchi, Junichi; Kawada-Watanabe, Erisa; Koyanagi, Ryo; Arashi, Hiroyuki; Sekiguchi, Haruki; Nakao, Koichi; Tobaru, Tetsuya; Tanaka, Hiroyuki; Oka, Toshiaki; Endo, Yasuhiro; Saito, Katsumi; Uchida, Tatsuro; Matsui, Kunihiko; Ogawa, Hiroshi; Hagiwara, Nobuhisa

2018-05-05

We aimed to examine the effect of serum sitosterol, a cholesterol absorption marker, on clinical outcomes in acute coronary syndrome patients with dyslipidaemia. This is a sub-analysis of the HIJ-PROPER trial that assesses the effect of aggressive low-density lipoprotein cholesterol (LDL-C) lowering treatment with pitavastatin + ezetimibe in 1734 acute coronary syndrome (ACS) patients with dyslipidaemia. Patients were divided into two groups based on sitosterol level at enrolment (cut-off value was 2.2 μg/mL; a median of baseline sitosterol level), and clinical outcomes were examined. The mean LDL-C level after 3 years in the low sitosterol group was 84.8 ± 20.1 mg/dL with pitavastatin-monotherapy and 64.6 ± 20.3 mg/dL with pitavastatin + ezetimibe, while corresponding values in the high sitosterol group were 91.0 ± 22.9 mg/dL and 71.1 ± 23.3 mg/dL, respectively. In the high sitosterol group, the Kaplan-Meier event rate for the primary endpoint at 3 years was 26.0% in the pitavastatin + ezetimibe group, as compared with 34.3% in the pitavastatin-monotherapy group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; p = 0.006, p-value for interaction = 0.010). However, in the low sitosterol group, there was no significant reduction of the primary endpoint by pitavastatin + ezetimibe therapy. Aggressive lipid-lowering treatment with ezetimibe had a positive effect on clinical outcomes in the high sitosterol subset of ACS patients with dyslipidaemia, but not in the low sitosterol subset. This effect was independent of LDL-C reduction and suggests that sitosterol measurement on admission in ACS patients might contribute to a "personalised" lipid-lowering approach. Copyright © 2018 Elsevier B.V. All rights reserved.

A randomized, controlled comparison of different intensive lipid-lowering therapies in Chinese patients with non-ST-elevation acute coronary syndrome (NSTE-ACS): Ezetimibe and rosuvastatin versus high-dose rosuvastatin.

PubMed

Ran, Dan; Nie, Hui-Juan; Gao, Yu-Lin; Deng, Song-Bai; Du, Jian-Lin; Liu, Ya-Jie; Jing, Xiao-Dong; She, Qiang

2017-05-15

Statin combined with ezetimibe demonstrates significant benefit in lowering low density lipid cholesterol (LDL-C) and cardiovascular events abroad, but whether intermediate intensity statins combined with ezetimibe is superior to high-intensity statin monotherapy in Chinese people is unknown. A total of 125 patients were randomly assigned to a intermediate intensity rosuvastatin group (rosuvastatin 10mg/d, n=42), high-dose rosuvastatin group (rosuvastatin 20mg/d, n=41) or combination therapy group (ezetimibe 10mg/d and rosuvastatin 10mg/d, n=42) with a 12-week follow-up. The primary end point was the proportion of patients who achieved the 2011 ESC/EAS LDL-C goal <70mg/dL (1.8mmol/L) at week 12. Secondary end points included changes from baseline in lipids, the occurrence of all cardiovascular events, high-sensitivity C-reactive protein and safety markers. The combination therapy group in the primary end point was significantly higher than rosuvastatin (20mg) and rosuvastatin (10mg) at week 12 (81.0% vs 68.3% vs 33.3%, P<0.001). And the similar change was observed in reducing LDL-C levels at week 12 (67.28% vs 52.80% vs 43.89%, P<0.001). The incidence of drug-related adverse events was much higher in the rosuvastatin 20mg group than the rosuvastatin 10mg group and the combination therapy group (17.0% vs 2.4% vs 4.8%, P<0.05). The combination of rosuvastatin 10mg/ezetimibe 10mg was an effectively alternative therapy superior to rosuvastatin 20mg or 10mg with a greater effect on lowering LDL-C and a lower incidence of drug-related adverse events in Chinese patients. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Statin therapy with or without ezetimibe and the progression to diabetes.

PubMed

Barkas, Fotios; Elisaf, Moses; Liberopoulos, Evangelos; Klouras, Eleftherios; Liamis, George; Rizos, Evangelos C

2016-01-01

To assess the risk of progression from normoglycemia or prediabetes to overt diabetes among individuals treated with statins alone or in combination with ezetimibe. This was a retrospective study conducted in Greece including 877 subjects treated for dyslipidemia. We included individuals without overt diabetes at baseline and divided them in 2 subgroups according to their baseline fasting glucose: <100 (normal glucose) and 100 to 125 mg/dL (prediabetes). High and moderate-intensity statin therapy was defined according to the expected low-density lipoprotein cholesterol reduction (≥50% and 30 to <50%, respectively). We identified the predictors of incident diabetes and assessed the risk of new-onset diabetes among subgroups on various intensity statin or no statin treatment at all. Similar analyses were performed across different potency of statin monotherapy or combination of statin plus ezetimibe treatment. A total of 877 subjects were eligible and followed-up for a median of 7 years. There were no differences between statins regarding diabetes development. However, a higher risk of incident diabetes was observed in prediabetic individuals receiving high-intensity statin therapy compared with those on moderate intensity (adjusted odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.06-4.24, P < .05) and those not taking a statin (adjusted OR = 4.90; 95% CI = 1.16-20.66, P < .05). The addition of ezetimibe to statin treatment did not increase the risk of incident diabetes in prediabetic individuals (adjusted OR = 0.89; 95% CI = 0.36-2.22, P > .05). Baseline fasting glucose, presence of metabolic syndrome, family history of diabetes, and follow-up duration were independent predictors of new-onset diabetes. High-intensity statin treatment is associated with a higher risk of incident diabetes in prediabetic individuals, whereas the addition of ezetimibe to statin therapy has a neutral effect on glucose metabolism. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Using human genetics to predict the effects and side-effects of drugs.

PubMed

Stender, Stefan; Tybjærg-Hansen, Anne

2016-04-01

'Genetic proxies' are increasingly being used to predict the effects of drugs. We present an up-to-date overview of the use of human genetics to predict effects and adverse effects of lipid-targeting drugs. LDL cholesterol lowering variants in HMG-Coenzyme A reductase and Niemann-Pick C1-like protein 1, the targets for statins and ezetimibe, protect against ischemic heart disease (IHD). However, HMG-Coenzyme A reductase and Niemann-Pick C1-Like Protein 1-variants also increase the risk of type 2 diabetes and gallstone disease, respectively. Mutations in proprotein convertase subtilisin kexin 9 (PCSK9), apolipoprotein B, and microsomal triglyceride transfer protein cause low LDL cholesterol and protect against IHD. In addition, mutations in apolipoprotein B and microsomal triglyceride transfer protein cause hepatic steatosis, in concordance with drugs that inhibit these targets. Both mutations in PCSK9 and PCSK9-inhibition seem without adverse effects. Mutations in APOC3 cause low triglycerides and protect against IHD, and recent pharmacological APOC3-inhibition reported major reductions in plasma triglycerides. Human genetics support that low lipoprotein(a) protects against IHD, without adverse effects, and the first trial of lipoprotein(a) inhibition reduced lipoprotein(a) up to 78%. Recent genetic studies have confirmed the efficacy of statins and ezetimibe in protecting against IHD. Results from human genetics support that several lipid-lowering drugs currently under development are likely to prove efficacious in protecting against IHD, without major adverse effects.

[LDL cholesterol lowering therapy: no target value but personalised treatment].

PubMed

Simoons, Maarten L; Deckers, Jaap W

2015-01-01

We previously recommended that LDL cholesterol lowering therapy be based on the risk for (recurrent) coronary events, rather than on arbitrary targets for serum LDL cholesterol concentration. We also recommended refraining from therapy with ezetimibe until its efficacy in preventing cardiovascular events had been documented. At the American Heart Association scientific sessions 2014 the results of the IMPROVE-IT study were reported. In this large, randomised trial, a modest benefit of the combination of simvastatin plus ezetimibe over simvastatin alone was reported after 7 years of treatment. The efficacy of such combination therapy was similar to the efficacy of high-dose statin therapy, while the combination therapy is much more expensive. Comparing the efficacy and costs of different preventive therapies, we recommend first prescribing aspirin and a moderate dose of statin, secondly an ACE inhibitor. A high-dose statin should be considered in high-risk patients. The combination of simvastatin and ezetimibe should be prescribed only in high-risk patients (e.g. diabetics after myocardial infarction) who do not tolerate high-dose statins.

Cholesterol-lowering drugs cause dissolution of cholesterol crystals and disperse Kupffer cell crown-like structures during resolution of NASH

PubMed Central

Ioannou, George N.; Van Rooyen, Derrick M.; Savard, Christopher; Haigh, W. Geoffrey; Yeh, Matthew M.; Teoh, Narci C.; Farrell, Geoffrey C.

2015-01-01

Cholesterol crystals form within hepatocyte lipid droplets in human and experimental nonalcoholic steatohepatitis (NASH) and are the focus of crown-like structures (CLSs) of activated Kupffer cells (KCs). Obese, diabetic Alms1 mutant (foz/foz) mice were a fed high-fat (23%) diet containing 0.2% cholesterol for 16 weeks and then assigned to four intervention groups for 8 weeks: a) vehicle control, b) ezetimibe (5 mg/kg/day), c) atorvastatin (20 mg/kg/day), or d) ezetimibe and atorvastatin. Livers of vehicle-treated mice developed fibrosing NASH with abundant cholesterol crystallization within lipid droplets calculated to extend over 3.3% (SD, 2.2%) of liver surface area. Hepatocyte lipid droplets with prominent cholesterol crystallization were surrounded by TNFα-positive (activated) KCs forming CLSs (≥3 per high-power field). KCs that formed CLSs stained positive for NLRP3, implicating activation of the NLRP3 inflammasome in response to cholesterol crystals. In contrast, foz/foz mice treated with ezetimibe and atorvastatin showed near-complete resolution of cholesterol crystals [0.01% (SD, 0.02%) of surface area] and CLSs (0 per high-power field), with amelioration of fibrotic NASH. Ezetimibe or atorvastatin alone had intermediate effects on cholesterol crystallization, CLSs, and NASH. These findings are consistent with a causative link between exposure of hepatocytes and KCs to cholesterol crystals and with the development of NASH possibly mediated by NLRP3 activation. PMID:25520429

Cholesterol-lowering drugs cause dissolution of cholesterol crystals and disperse Kupffer cell crown-like structures during resolution of NASH.

PubMed

Ioannou, George N; Van Rooyen, Derrick M; Savard, Christopher; Haigh, W Geoffrey; Yeh, Matthew M; Teoh, Narci C; Farrell, Geoffrey C

2015-02-01

Cholesterol crystals form within hepatocyte lipid droplets in human and experimental nonalcoholic steatohepatitis (NASH) and are the focus of crown-like structures (CLSs) of activated Kupffer cells (KCs). Obese, diabetic Alms1 mutant (foz/foz) mice were a fed high-fat (23%) diet containing 0.2% cholesterol for 16 weeks and then assigned to four intervention groups for 8 weeks: a) vehicle control, b) ezetimibe (5 mg/kg/day), c) atorvastatin (20 mg/kg/day), or d) ezetimibe and atorvastatin. Livers of vehicle-treated mice developed fibrosing NASH with abundant cholesterol crystallization within lipid droplets calculated to extend over 3.3% (SD, 2.2%) of liver surface area. Hepatocyte lipid droplets with prominent cholesterol crystallization were surrounded by TNFα-positive (activated) KCs forming CLSs (≥ 3 per high-power field). KCs that formed CLSs stained positive for NLRP3, implicating activation of the NLRP3 inflammasome in response to cholesterol crystals. In contrast, foz/foz mice treated with ezetimibe and atorvastatin showed near-complete resolution of cholesterol crystals [0.01% (SD, 0.02%) of surface area] and CLSs (0 per high-power field), with amelioration of fibrotic NASH. Ezetimibe or atorvastatin alone had intermediate effects on cholesterol crystallization, CLSs, and NASH. These findings are consistent with a causative link between exposure of hepatocytes and KCs to cholesterol crystals and with the development of NASH possibly mediated by NLRP3 activation.

Class B type I scavenger receptor is responsible for the high affinity cholesterol binding activity of intestinal brush border membrane vesicles

PubMed Central

Labonté, Eric D.; Howles, Philip N.; Granholm, Norman A.; Rojas, Juan C.; Davies, Joanna P.; Ioannou, Yiannis A.; Hui, David Y.

2007-01-01

Recent studies have documented the importance of Niemann Pick C1-like 1 protein (NPC1L1), a putative physiological target of the drug ezetimibe, in mediating intestinal cholesterol absorption. However, whether NPC1L1 is the high affinity cholesterol binding protein on intestinal brush border membranes is still controversial. In this study, brush border membrane vesicles (BBMV) from wild type and NPC1L1−/− mice were isolated and assayed for micellar cholesterol binding in the presence or absence of ezetimibe. Results confirmed the loss of the high affinity component of cholesterol binding when wild type BBMV preparations were incubated with antiserum against the class B type 1 scavenger receptor (SR-BI) in the reaction mixture similar to previous studies. Subsequently, second order binding of cholesterol was observed with BBMV from wild type and NPC1L1−/− mice. The inclusion of ezetimibe in these in vitro reaction assays resulted in the loss of the high affinity component of cholesterol interaction. Surprisingly, BBMVs from NPC1L1−/− mice maintained active binding of cholesterol. These results documented that SR-BI, not NPC1L1, is the major protein responsible for the initial high affinity cholesterol ligand binding process in the cholesterol absorption pathway. Additionally, ezetimibe may inhibit BBM cholesterol binding through targets such as SR-BI in addition to its inhibition of NPC1L1. PMID:17442616

Two smart spectrophotometric methods for the simultaneous estimation of Simvastatin and Ezetimibe in combined dosage form

NASA Astrophysics Data System (ADS)

Magdy, Nancy; Ayad, Miriam F.

2015-02-01

Two simple, accurate, precise, sensitive and economic spectrophotometric methods were developed for the simultaneous determination of Simvastatin and Ezetimibe in fixed dose combination products without prior separation. The first method depends on a new chemometrics-assisted ratio spectra derivative method using moving window polynomial least square fitting method (Savitzky-Golay filters). The second method is based on a simple modification for the ratio subtraction method. The suggested methods were validated according to USP guidelines and can be applied for routine quality control testing.

Development and validation of a novel stability-indicating HPLC method for the quantitative determination of eleven related substances in ezetimibe drug substance and drug product.

PubMed

Luo, Zhiqiang; Deng, Zhongqing; Liu, Yang; Wang, Guopeng; Yang, Wenning; Hou, Chengbo; Tang, Minming; Yang, Ruirui; Zhou, Huaming

2015-07-01

Ezetimibe is a novel lipid-lowering agent that inhibits intestinal absorption of dietary and biliary cholesterol. In the present work, a simple, sensitive and reproducible gradient reverse phase high performance liquid chromatographic (RP-HPLC) method for separation and determination of the related substances of ezetimibe was developed and validated. Eleven potential process-related impurities (starting materials, (3S,4S,3'S)-isomer, degradants and byproducts) were identified in the crude samples. Tentative structures for all the impurities were assigned primarily based on comparison of their retention time and mass spectrometric data with that of available standards and references. This method can be applied to routine analysis in quality control of both bulk drugs and commercial tablets. Separation of all these compounds was performed on a Phenomenex Luna Phenyl-Hexyl (100mm×4.6mm, 5μm) analytical column. The mobile phase-A consists of acetonitrile-water (pH adjusted to 4.0 with phosphoric acid)-methanol at 15:75:10 (v/v/v), and mobile phase-B contains acetonitrile. The eluted compounds were monitored at 210nm. Ezetimibe was subjected to hydrolytic, acid, base, oxidative, photolytic and thermal stress conditions as per ICH serves to generate degradation products that can be used as a worst case to assess the analytical method performance. The drug showed extensive degradation in thermal, acid, oxidative, base and hydrolytic stress conditions, while it was stable to photolytic degradation conditions. The main degradation product formed under thermal, acid, oxidative, base and hydrolytic stress conditions corresponding to (2R,3R,6S)-N, 6-bis(4-fluorophenyl)-2-(4-hydroxyphenyl)-oxane-3-carboxamide (Ezetimibe tetrahydropyran impurity) was characterized by LC-MS/MS analysis. The degradation products were well resolved from the main peak and its impurities, thus proved the stability-indicating power of the method. The developed method was validated as per international conference on harmonization (ICH) guidelines with respect to specificity, linearity, limit of detection (LOD), limit of quantification (LOQ), accuracy, precision and robustness. Copyright © 2015 Elsevier B.V. All rights reserved.

Ezetimibe in Combination With Statins Ameliorates Endothelial Dysfunction in Coronary Arteries After Stenting: The CuVIC Trial (Effect of Cholesterol Absorption Inhibitor Usage on Target Vessel Dysfunction After Coronary Stenting), a Multicenter Randomized Controlled Trial.

PubMed

Takase, Susumu; Matoba, Tetsuya; Nakashiro, Soichi; Mukai, Yasushi; Inoue, Shujiro; Oi, Keiji; Higo, Taiki; Katsuki, Shunsuke; Takemoto, Masao; Suematsu, Nobuhiro; Eshima, Kenichi; Miyata, Kenji; Yamamoto, Mitsutaka; Usui, Makoto; Sadamatsu, Kenji; Satoh, Shinji; Kadokami, Toshiaki; Hironaga, Kiyoshi; Ichi, Ikuyo; Todaka, Koji; Kishimoto, Junji; Egashira, Kensuke; Sunagawa, Kenji

2017-02-01

We sought to investigate whether treatment with ezetimibe in combination with statins improves coronary endothelial function in target vessels in coronary artery disease patients after coronary stenting. We conducted a multicenter, prospective, randomized, open-label, blinded-end point trial among 11 cardiovascular treatment centers. From 2011 to 2013, 260 coronary artery disease patients who underwent coronary stenting were randomly allocated to 2 arms (statin monotherapy, S versus ezetimibe [10 mg/d]+statin combinational therapy, E+S). We defined target vessel dysfunction as the primary composite outcome, which comprised target vessel failure during treatment and at the 6- to 8-month follow-up coronary angiography and coronary endothelial dysfunction determined via intracoronary acetylcholine testing performed in cases without target vessel failure at the follow-up coronary angiography. Coadministration of ezetimibe with statins further lowered low-density lipoprotein cholesterol levels (83±23 mg/dL in S versus 67±23 mg/dL in E+S; P<0.0001), with significant decreases in oxidized low-density lipoprotein and oxysterol levels. Among patients without target vessel failure, 46 out of 89 patients (52%) in the S arm and 34 out of 96 patients (35%) in the E+S arm were found to have coronary endothelial dysfunction (P=0.0256), and the incidence of target vessel dysfunction at follow-up was significantly decreased in the E+S arm (69/112 (62%) in S versus 47/109 (43%) in E+S; P=0.0059). A post hoc analysis of post-treatment low-density lipoprotein cholesterol-matched subgroups revealed that the incidence of both target vessel dysfunction and coronary endothelial dysfunction significantly decreased in the E+S arm, with significant reductions in oxysterol levels. The CuVIC trial (Effect of Cholesterol Absorption Inhibitor Usage on Target Vessel Dysfunction after Coronary Stenting) has shown that ezetimibe with statins, compared with statin monotherapy, improves functional prognoses, ameliorating endothelial dysfunction in stented coronary arteries, and was associated with larger decreases in oxysterol levels. © 2016 American Heart Association, Inc.

Rationale, design features, and baseline characteristics: The Heart Institute of Japan-PRoper level of lipid lOwering with Pitavastatin and Ezetimibe in acute coRonary syndrome (HIJ-PROPER).

PubMed

Kawada-Watanabe, Erisa; Ogawa, Hiroshi; Koyanagi, Ryo; Arashi, Hiroyuki; Yamaguchi, Junichi; Matsui, Kunihiko; Hagiwara, Nobuhisa

2017-03-01

In contrast to current guidelines in Western countries, moderate reduction of low-density lipoprotein cholesterol (LDL-C) is recommended for Japanese patients with atherosclerotic cardiovascular disease and dyslipidemia even in secondary prevention. HIJ-PROPER (Heart Institute of Japan-PRoper level of lipid lOwering with Pitavastatin and Ezetimibe in acute coRonary syndrome) is a prospective, randomized, open-label, blinded endpoint multicenter trial designed to assess whether closely controlled LDL-C lowering with a standard statin dose plus ezetimibe, targeting LDL-C of <70mg/dL, would reduce cardiovascular events more than standard statin monotherapy targeting LDL-C of <100mg/dL as per the Japan Atherosclerotic Society guideline in patients with acute coronary syndrome (ACS) and dyslipidemia. We recruited patients with ACS and dyslipidemia who had undergone coronary angiography. Participants are randomly allocated to either intensive LDL-C lowering treatment (target LDL-C of <70mg/dL; pitavastatin plus ezetimibe) or standard LDL-C lowering treatment (target LDL-C of 90-100mg/dL; pitavastatin monotherapy). The primary endpoint is a composite of total death, non-fatal myocardial infarction (MI), non-fatal stroke, unstable angina, and any ischemia-driven revascularization. Patients will be followed for a minimum of 3 years. Between January 2010 and April 2013, 1734 patients were enrolled from 19 hospitals in Japan with a mean age of 65.6 years; 75.5% were men and 83.3% were statin-naïve. The qualifying ACS was an acute MI in 61.5%. This study is expected to report its findings in August 2016. HIJ-PROPER will determine whether targeting LDL-C of <70mg/dL with pitavastatin plus ezetimibe can improve cardiovascular outcomes in Japanese patients with ACS and dyslipidemia in comparison to targeting LDL-C of 90-100mg/dL with standard pitavastatin monotherapy. UMIN000002742. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

A Randomized Trial Assessing the Effectiveness of Ezetimibe in South Asian Canadians with Coronary Artery Disease or Diabetes: The INFINITY Study

PubMed Central

Vira, Tasnim; Rampakakis, Emmanouil; Gupta, Anup; Khithani, Anil; Balleza, Lyn; Vaillancourt, Julie; Boukas, Stella; Sampalis, John; de Carolis, Emidio

2012-01-01

Background. There is a paucity of data regarding the effectiveness and safety of lipid-lowering treatments among South-Asian patients. Methods. Sixty-four South-Asian Canadians with coronary artery disease or diabetes and persistent hypercholesterolemia on statin therapy, were randomized to ezetimibe 10 mg/day co-administered with statin therapy (EZE + Statin) or doubling their current statin dose (STAT2). Primary outcome was the proportion of patients achieving target LDL-C (<2.0 mmol/L) after 6 weeks. Secondary outcomes included the change in lipid profile and the incidence of treatment-emergent adverse events through 12 weeks. Exploratory markers for vascular inflammation were assessed at baseline and 12 weeks. Results. At 6 weeks, the primary outcome was significantly higher among the EZE + Statin patients (68% versus 36%; P = 0.031) with an OR (95% CI) of 3.97 (1.19, 13.18) upon accounting for baseline LDL-C and adjusting for age. At 12 weeks, 76% of EZE + Statin patients achieved target LDL-C compared to 48% (P = 0.047) of the STAT2 patients (adjusted OR (95% CI) = 3.31 (1.01,10.89)). No significant between-group differences in exploratory markers were observed with the exception of CRP. Conclusions. Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 6 and 12 weeks compared to patients doubling their statin dose. Ezetimibe/statin combination therapy was well tolerated among this cohort of South-Asian Canadians, without safety concerns. PMID:23304534

Therapeutic effects of atorvastatin and ezetimibe compared with double-dose atorvastatin in very elderly patients with acute coronary syndrome.

PubMed

Liu, Zhi; Hao, Hengjian; Yin, Chunlin; Chu, Yanyan; Li, Jing; Xu, Dong

2017-06-20

Objective Compared the effect of atorvastatin 10 mg combined ezetimibe 10 mg therapy with atorvastatin 20 mg on the long-term outcomes in very elderly patients with acute coronary syndrome.Methods A total of 230 octogenarian patients with acute coronary syndrome underwent coronary angiography were randomized to combined therapy group (atorvastatin 10 mg/d and ezetimibe 10 mg/d, n=114) or double-dose atorvastatin group (atorvastatin 20mg/d, n=116). The primary end point was one-year incidence of major adverse cardiovascular events (including cardiac death, spontaneous myocardial infarction, unplanned revascularization).Result At the end of one year, the percentage of patients with low-density lipoprotein cholesterol level decreased more than 30% or 50% were comparable between the two groups (93.5% vs. 90.1%, p= 0.36; 54.6% vs. 49.6%, p= 0.45). The rate of major adverse cardiovascular events in combined therapy group was similar with double-dose atorvastatin group (23.2% vs. 19.8%, p=0.55). In COX regression model, the risk of major adverse cardiovascular events in combined group isn't significantly higher than double-dose atorvastatin group (HR [95% CI] 1.12 [0.51 to 2.55], p = 0.74). The patients whose alanine aminotransferase increasing more than upper normal limit in combined group was lower than double-dose atorvastatin group (2.8% vs. 9.0%, p = 0.05).Conclusions For very elderly patients with acute coronary syndrome, atorvastatin combining ezetimibe induced similar long-term outcomes compared with double-dose atorvastatin but with less liver dysfunction.

Preventing cardiovascular heart disease: Promising nutraceutical and non-nutraceutical treatments for cholesterol management.

PubMed

Johnston, T P; Korolenko, T A; Pirro, M; Sahebkar, A

2017-06-01

Hypercholesterolemia is one of the major risk factors for the development of cardiovascular disease. Atherosclerosis resulting from hypercholesterolemia causes many serious cardiovascular diseases. Statins are generally accepted as a treatment of choice for lowering low-density lipoprotein (LDL) cholesterol, which reduces coronary heart disease morbidity and mortality. Since statin use can be associated with muscle problems and other adverse symptoms, non-adherence and discontinuation of statin therapy often leads to inadequate control of plasma cholesterol levels and increased cardiovascular risk. Moreover, there is compelling evidence on the presence of still considerable residual cardiovascular risk in statin-treated patients. Ezetimibe improves cholesterol-lowering efficacy and provides mild additional cardiovascular protection when combined with statin treatment. Despite a favorable safety profile compared to statins, ezetimibe-induced cholesterol-lowering is modest when used alone. Hence, there is a critical need to identity additional effective hypolipidemic agents that can be used either in combination with statins, or alone, if statins are not tolerated. Thus, hypolipidemic agents such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, apolipoprotein B-100 antisense oligonucleotides, cholesteryl ester transfer protein (CETP) inhibitors, and microsomal triglyceride transfer protein (MTTP) inhibitors, as well as yeast polysaccharides (beta-glucans and mannans) and compounds derived from natural sources (nutraceuticals) such as glucomannans, plant sterols, berberine, and red yeast rice are being used. In this review, we will discuss hypercholesterolemia, its impact on the development of cardiovascular disease (CVD), and the use of yeast polysaccharides, various nutraceuticals, and several therapeutic agents not derived from 'natural' sources, to treat hypercholesterolemia. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Dyslipidemias : Diagnostics and management].

PubMed

Sinning, D; Landmesser, U

2017-09-01

For disorders of lipid metabolism the risk-adapted adjustment of low-density lipoprotein (LDL) cholesterol remains the primary treatment target, as a causal role in minimizing the progression of ACVD has been shown. Because of their efficacy in reducing cardiovascular morbidity and mortality, statins are recommended as first-line pharmacological treatment in dyslipidemias. Additionally, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition have been shown to significantly reduce cardiovascular events in high-risk patients. Life style changes can improve the plasma lipid profile, particularly in the setting of hypertriglyceridemia. Evaluation of high-density lipoprotein (HDL) cholesterol and lipoprotein(a) provides further information when assessing the individual cardiovascular risk, but direct evidence that pharmacologically targeting HDL cholesterol or Lp(a) results in a reduction of cardiovascular events has not yet been shown.

Ezetimibe Use and LDL-C Goal Achievement: A Retrospective Database Analysis of Patients with Clinical Atherosclerotic Cardiovascular Disease or Probable Heterozygous Familial Hypercholesterolemia.

PubMed

Menzin, Joseph; Aggarwal, Jyoti; Boatman, Brian; Yu, Jeffrey; Stern, Kevin; Harrison, David J; Patel, Jeetvan G

2017-12-01

Ezetimibe is recommended by clinical practice guidelines as a second-line therapy for lowering low-density lipoprotein cholesterol (LDL-C) levels, but little is known about its use and effectiveness in real-world populations. To understand the real-world impact of adding or switching to ezetimibe on LDL-C goal achievement in patients with clinical atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH). Patients aged ≥ 18 years with an LDL-C measurement available between January 1, 2013, and June 30, 2014, were identified using the Inovalon MORE 2 database; this included commercial, health insurance exchange, Medicare Advantage, and managed Medicaid patients. The index date was the date of the first LDL-C measurement. Patients were required to have evidence of clinical ASCVD or probable HeFH based on ICD-9-CM codes and ≥ 1 outpatient pharmacy claim for a statin in the 1-year pre-index period, as well as continuous medical and pharmacy coverage for 1 year pre- and post-index. Patients who added ezetimibe to existing statin therapy or switched to ezetimibe within 90 days post-index LDL-C measurement were identified in order to replicate the typical time a clinician takes to assess the use of ezetimibe. The primary outcome was the proportion of patients who met the LDL-C goal of < 70 mg/dL within the follow-up period. LDL-C goal achievement was evaluated by baseline LDL-C level groupings: < 70 mg/dL, 70-99 mg/dL, 100-129 mg/dL, or ≥ 130 mg/dL; and across 4 patient diagnosis categories: all patients, ASCVD only, probable HeFH only, and ASCVD and probable HeFH. Descriptive analyses were reported. Categorical variables were summarized as the number of and corresponding percentage of patients. Continuous variables were presented as the mean and SD of the number of observations and median and range where appropriate. Of 125,330 patients who met selection criteria, mean age was 70.1 (SD = 9.9) years and mean LDL-C baseline was 90.7 (SD = 34.0) mg/dL. Over one half of patients (70%) were receiving statin therapy. Within the post-index time frame, 1.05% (n = 1,309) of patients added or switched to ezetimibe. Of these, 26% achieved LDL-C goal during the 90-day follow-up (59.5% did not achieve goal and 14.4% did not have a follow-up lab value). Therapeutic targets were reached by 30% of patients with baseline LDL-C levels of 70-99 mg/dL; 14% of those with baseline LDL-C of 100-129 mg/dL; and 7% of those with baseline LDL-C of ≥ 130 mg/dL. Achievement of LDL-C goals also varied by baseline diagnosis category. The addition of or switch to ezetimibe therapy was associated with a relatively small percentage of LDL-C goal achievement (< 70 mg/dL) in patients with clinical ASCVD and/or HeFH, even among patients with baseline LDL-C between 70 and 99 mg/dL. To provide superior individualized care for patients with hyperlipidemia, there is a potential role for newer therapies in lipid lowering, such as PCSK9 inhibitors, in appropriate high-risk populations. This study was sponsored by Amgen. Menzin, Yu, and Stern are employees of Boston Health Economics, which was contracted by Amgen to perform this study. Aggarwal is a former employee of Boston Health Economics. Boatman, Patel, and Harrison are employees and stockholders of Amgen. Study concept and design were contributed by Menzin, Aggarwal, Harrison, and Patel. Aggarwal, Stern, and Yu collected the data. Data interpretation was performed by Aggarwal, Harrison, Patel, and Boatman. The manuscript was written and revised primarily by Aggarwal, with assistance from the other authors.

Non-cholesterol sterols and cholesterol metabolism in sitosterolemia.

PubMed

Othman, Rgia A; Myrie, Semone B; Jones, Peter J H

2013-12-01

Sitosterolemia (STSL) is a rare autosomal recessive disease, manifested by extremely elevated plant sterols (PS) in plasma and tissue, leading to xanthoma and premature atherosclerotic disease. Therapeutic approaches include limiting PS intake, interrupting enterohepatic circulation of bile acid using bile acid binding resins such as cholestyramine, and/or ileal bypass, and inhibiting intestinal sterol absorption by ezetimibe (EZE). The objective of this review is to evaluate sterol metabolism in STSL and the impact of the currently available treatments on sterol trafficking in this disease. The role of PS in initiation of xanthomas and premature atherosclerosis is also discussed. Blocking sterols absorption with EZE has revolutionized STSL patient treatment as it reduces circulating levels of non-cholesterol sterols in STSL. However, none of the available treatments including EZE have normalized plasma PS concentrations. Future studies are needed to: (i) explore where cholesterol and non-cholesterol sterols accumulate, (ii) assess to what extent these sterols in tissues can be mobilized after blocking their absorption, and (iii) define the factors governing sterol flux. Copyright © 2013. Published by Elsevier Ireland Ltd.

Fenofibrate, but not ezetimibe, prevents fatty liver disease in mice lacking phosphatidylethanolamine N-methyltransferase.

PubMed

van der Veen, Jelske N; Lingrell, Susanne; Gao, Xia; Takawale, Abhijit; Kassiri, Zamaneh; Vance, Dennis E; Jacobs, René L

2017-04-01

Mice lacking phosphatidylethanolamine N -methyltransferase (PEMT) are protected from high-fat diet (HFD)-induced obesity and insulin resistance. However, these mice develop severe nonalcoholic fatty liver disease (NAFLD) when fed the HFD, which is mainly due to inadequate secretion of VLDL particles. Our aim was to prevent NAFLD development in mice lacking PEMT. We treated Pemt -/- mice with either ezetimibe or fenofibrate to see if either could ameliorate liver disease in these mice. Ezetimibe treatment did not reduce fat accumulation in Pemt -/- livers, nor did it reduce markers for hepatic inflammation or fibrosis. Fenofibrate, conversely, completely prevented the development of NAFLD in Pemt -/- mice: hepatic lipid levels, as well as markers of endoplasmic reticulum stress, inflammation, and fibrosis, in fenofibrate-treated Pemt -/- mice were similar to those in Pemt +/+ mice. Importantly, Pemt -/- mice were still protected against HFD-induced obesity and insulin resistance. Moreover, fenofibrate partially reversed hepatic steatosis and fibrosis in Pemt -/- mice when treatment was initiated after NAFLD had already been established. Increasing hepatic fatty acid oxidation can compensate for the lower VLDL-triacylglycerol secretion rate and prevent/reverse fatty liver disease in mice lacking PEMT. Copyright © 2017 by the American Society for Biochemistry and Molecular Biology, Inc.

Ezetimibe decreased nonalcoholic fatty liver disease activity score but not hepatic steatosis.

PubMed

Lee, Hyo Young; Jun, Dae Won; Kim, Hyun Jung; Oh, Hyunwoo; Saeed, Waqar Khalid; Ahn, Hyeongsik; Cheung, Ramsey C; Nguyen, Mindie H

2018-03-20

A number of clinical trials reported varying effects of cholesterol lowering agents in nonalcoholic fatty liver disease (NAFLD) patients. We, therefore, assessed the changes in hepatic steatosis and NAFLD activity score (NAS) after treatment with cholesterol lowering agents in NAFLD patients by metaanalysis. The Cochrane Library, the MEDLINE, and the Embase databases were searched until May 2015, without any language restrictions, for randomized controlled trials (RCTs) and nonrandomized studies (NRSs). Additional references were obtained from review of bibliography of relevant articles. The quality of evidence was assessed using the grading of recommendations assessment, development and evaluation guidelines. Three RCTs (n = 98) and two NRSs (n = 101) met our study inclusion criteria (adult, NAFLD, liver biopsy). Liver biopsy was performed in all five studies, but only the three studies reported NAS. Ezetimibe significantly decreased NAS (standardized mean difference [SMD], -0.30; 95% confidence interval [CI], -0.57 to -0.03) but not hepatic steatosis in RCT (SMD, -0.1; 95% CI, -0.53 to 0.32), while the effect was significant for both NAS and intrahepatic content in NRSs (SMD, -3.0; 95% CI, -6.9 to 0.91). Ezetimibe decreased NAS without improving hepatic steatosis.

Fenofibrate, but not ezetimibe, prevents fatty liver disease in mice lacking phosphatidylethanolamine N-methyltransferase[S

PubMed Central

van der Veen, Jelske N.; Lingrell, Susanne; Gao, Xia; Takawale, Abhijit; Kassiri, Zamaneh; Vance, Dennis E.; Jacobs, René L.

2017-01-01

Mice lacking phosphatidylethanolamine N-methyltransferase (PEMT) are protected from high-fat diet (HFD)-induced obesity and insulin resistance. However, these mice develop severe nonalcoholic fatty liver disease (NAFLD) when fed the HFD, which is mainly due to inadequate secretion of VLDL particles. Our aim was to prevent NAFLD development in mice lacking PEMT. We treated Pemt−/− mice with either ezetimibe or fenofibrate to see if either could ameliorate liver disease in these mice. Ezetimibe treatment did not reduce fat accumulation in Pemt−/− livers, nor did it reduce markers for hepatic inflammation or fibrosis. Fenofibrate, conversely, completely prevented the development of NAFLD in Pemt−/− mice: hepatic lipid levels, as well as markers of endoplasmic reticulum stress, inflammation, and fibrosis, in fenofibrate-treated Pemt−/− mice were similar to those in Pemt+/+ mice. Importantly, Pemt−/− mice were still protected against HFD-induced obesity and insulin resistance. Moreover, fenofibrate partially reversed hepatic steatosis and fibrosis in Pemt−/− mice when treatment was initiated after NAFLD had already been established. Increasing hepatic fatty acid oxidation can compensate for the lower VLDL-triacylglycerol secretion rate and prevent/reverse fatty liver disease in mice lacking PEMT. PMID:28159867

Effect of ezetimibe plus pravastatin on endothelial dysfunction in patients with systemic lupus erythematosus.

PubMed

Vera-Lastra, O; Méndez-Flores, S; Cruz-Dominguez, M P; Medina, G; Calderón-Aranda, E; Jara, L J

2016-06-01

Patients with systemic lupus erythematosus (SLE) have a higher risk for cardiovascular disease (CVD), not fully explained by the conventional risk factors. These patients have endothelial dysfunction (ED) as an early process of atherosclerosis, which can be reversed with therapy. To determine the effect of ezetimibe plus pravastatin on endothelial function in patients with SLE after 12 months of treatment. An open study, before and after, which assessed the effect of ezetimibe plus pravastatin treatment, was performed. Twenty two patients (21 women and one man) with diagnosis of SLE were studied, with a mean age 40 ± 5 years. Endothelial dysfunction was evaluated using vascular ultrasound of the brachial artery in order to measure the flow-mediated vasodilation (FMV) basal and after 12 months of treatment with pravastatin 40 mg/day plus ezetimibe 10 mg/day. In addition, a lipid profile: total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and serum C-reactive protein (CRP), was done. We found a basal FMV of 7.58% and 18.22% after 12 months of treatment, with an improvement of 10.64 points 95% CI (7.58-13.58), p < 0.001. TC decreased from 201.3 ± 58.9 mg/dL to 158.06 ± 50.13 mg/dL (p < 0.01); LDL-C from 125.78 ± 44.4 mg/dL to 78.8 ± 32.9 mg/dL (p < 0.001); HDL-C increased from 49.0 ± 16.8 mg/dL to 52.2 ± 13.8 mg/dL (p = 0.077). The basal and final concentrations of CRP were 4.49 and 2.8, respectively, with a mean decrease of 2.11 mg/dL, 95% CI (0.908-3.32), p < 0.002. Both drugs were well tolerated. Ezetimibe plus pravastatin significantly improved FMV in patients with SLE, decreasing ED and the lipid profile. This treatment ameliorated an early process of atherosclerosis and a risk factor for CVD. © The Author(s) 2016.

Identification of drugs and drug metabolites as substrates of multidrug resistance protein 2 (MRP2) using triple-transfected MDCK-OATP1B1-UGT1A1-MRP2 cells

PubMed Central

Fahrmayr, C; König, J; Auge, D; Mieth, M; Fromm, MF

2012-01-01

BACKGROUND AND PURPOSE The coordinate activity of hepatic uptake transporters [e.g. organic anion transporting polypeptide 1B1 (OATP1B1)], drug-metabolizing enzymes [e.g. UDP-glucuronosyltransferase 1A1 (UGT1A1)] and efflux pumps (e.g. MRP2) is a crucial determinant of drug disposition. However, limited data are available on transport of drugs (e.g. ezetimibe, etoposide) and their glucuronidated metabolites by human MRP2 in intact cell systems. EXPERIMENTAL APPROACH Using monolayers of newly established triple-transfected MDCK-OATP1B1-UGT1A1-MRP2 cells as well as MDCK control cells, single- (OATP1B1) and double-transfected (OATP1B1-UGT1A1, OATP1B1-MRP2) MDCK cells, we therefore studied intracellular concentrations and transcellular transport after administration of ezetimibe or etoposide to the basal compartment. KEY RESULTS Intracellular accumulation of ezetimibe was significantly lower in MDCK-OATP1B1-UGT1A1-MRP2 triple-transfected cells compared with all other cell lines. Considerably higher amounts of ezetimibe glucuronide were found in the apical compartment of MDCK-OATP1B1-UGT1A1-MRP2 monolayers compared with all other cell lines. Using HEK cells, etoposide was identified as a substrate of OATP1B1. Intracellular concentrations of etoposide equivalents (i.e. parent compound plus metabolites) were affected only to a minor extent by the absence or presence of OATP1B1/UGT1A1/MRP2. In contrast, apical accumulation of etoposide equivalents was significantly higher in monolayers of both cell lines expressing MRP2 (MDCK-OATP1B1-MRP2, MDCK-OATP1B1-UGT1A1-MRP2) compared with the single-transfected (OATP1B1) and the control cell line. CONCLUSIONS AND IMPLICATIONS Ezetimibe glucuronide is a substrate of human MRP2. Moreover, etoposide and possibly also its glucuronide are substrates of MRP2. These data demonstrate the functional interplay between transporter-mediated uptake, phase II metabolism and export by hepatic proteins involved in drug disposition. PMID:21923755

Low incidence of paradoxical reductions in HDL-C levels in dyslipidemic patients treated with fenofibrate alone or in combination with ezetimibe or ezetimibe/simvastatin

PubMed Central

2011-01-01

Background Fibrates have been reported to cause paradoxical decreases in HDL-C in certain patients. Design and methods This post-hoc analysis explored the frequency/magnitude of HDL-C reductions in a pooled database of mixed dyslipidemic patients (LDL-C:3.4-5.7 mmol/L;TG:1.7-5.7 mmol/L) receiving placebo (PBO), fenofibrate (FENO), ezetimibe plus FENO (EZE+FENO), or EZE/simvastatin plus FENO (EZE/SIMVA+FENO) for 12 weeks. Results PBO-treated patients had the highest incidence of HDL-C reductions from baseline (45%) compared with patients taking FENO (14%), EZE+FENO (9%), or EZE/SIMVA+FENO (9%). Reductions <30% reflected natural variability since the largest reduction in HDL-C approached 30% in the PBO group. Only 3 patients exhibited HDL-C reductions ≥30% (i.e., 2 patients in the FENO group and 1 in the EZE+FENO group). There were no differences in demographic/biochemical characteristics between patients with and without HDL-C reductions. Conclusions The incidence of paradoxical HDL-C reductions was low in mixed dyslipidemic patients receiving FENO alone or combined with EZE or EZE/SIMVA. Trial registrations Clinicaltrials.gov: NCT00092560 and NCT00092573 PMID:22087637

Bean peptides have higher in silico binding affinities than ezetimibe for the N-terminal domain of cholesterol receptor Niemann-Pick C1 Like-1.

PubMed

Real Hernandez, Luis M; Gonzalez de Mejia, Elvira

2017-04-01

Niemann-Pick C1 like-1 (NPC1L1) mediates cholesterol absorption at the apical membrane of enterocytes through a yet unknown mechanism. Bean, pea, and lentil proteins are naturally hydrolyzed during digestion to produce peptides. The potential for pulse peptides to have high binding affinities for NPC1L1 has not been determined. In this study , in silico binding affinities and interactions were determined between the N-terminal domain of NPC1L1 and 14 pulse peptides (5≥ amino acids) derived through pepsin-pancreatin digestion. Peptides were docked in triplicate to the N-terminal domain using docking program AutoDock Vina, and results were compared to those of ezetimibe, a prescribed NPC1L1 inhibitor. Three black bean peptides (-7.2 to -7.0kcal/mol) and the cowpea bean dipeptide Lys-Asp (-7.0kcal/mol) had higher binding affinities than ezetimibe (-6.6kcal/mol) for the N-terminal domain of NPC1L1. Lentil and pea peptides studied did not have high binding affinities. The common bean peptide Tyr-Ala-Ala-Ala-Thr (-7.2kcal/mol), which can be produced from black or navy bean proteins, had the highest binding affinity. Ezetimibe and peptides with high binding affinities for the N-terminal domain are expected to interact at different locations of the N-terminal domain. All high affinity black bean peptides are expected to have van der Waals interactions with SER130, PHE136, and LEU236 and a conventional hydrogen bond with GLU238 of NPC1L1. Due to their high affinity for the N-terminal domain of NPC1L1, black and cowpea bean peptides produced in the digestive track have the potential to disrupt interactions between NPC1L1 and membrane proteins that lead to cholesterol absorption. Copyright © 2017 Elsevier Inc. All rights reserved.

Evolocumab for Treating Primary Hypercholesterolaemia and Mixed Dyslipidaemia: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Carroll, Christopher; Tappenden, Paul; Rafia, Rachid; Hamilton, Jean; Chambers, Duncan; Clowes, Mark; Durrington, Paul; Qureshi, Nadeem; Wierzbicki, Anthony S

2016-11-16

As part of its Single Technology Appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of evolocumab (Amgen) to submit evidence on the clinical and cost effectiveness of evolocumab. The appraisal assessed evolocumab as monotherapy or in combination with a statin (HMG-CoA reductase inhibitor) with or without ezetimibe, or in combination with ezetimibe (without statin therapy), in adult patients with primary hypercholesterolaemia (which includes mixed dyslipidaemia), for whom statins do not provide optimal control of their low-density lipoprotein cholesterol (LDL-C) levels and/or for whom statins are contraindicated or not tolerated. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology, based on the company's submission to NICE. The evidence was derived mainly from four randomised controlled trials comparing evolocumab either with ezetimibe or placebo in adults with primary familial or non-familial hypercholesterolaemia, who were either able to take statins or who were statin-intolerant. The clinical effectiveness review found that evolocumab is efficacious at lowering LDL-C but that there was uncertainty regarding its impact on cardiovascular disease outcomes. In response to the ERG's critique of the submitted health economic model, the company submitted an amended model, which also included a Patient Access Scheme (PAS). Based on this, the deterministic incremental cost-effectiveness ratios (ICERs) for evolocumab against ezetimibe were above £74,000 and £45,000 per quality-adjusted life-year (QALY) gained within the non-familial primary and secondary prevention population, respectively, whilst the ICERs within the heterozygous familial hypercholesterolaemia population were approximately £23,000 per QALY gained. The final determination was that evolocumab would be a clinically and cost effective use of UK National Health Service resources in certain patient subgroups.

Method & apparatus for monitoring plasma processing operations

DOEpatents

Smith, Jr., Michael Lane; Ward, Pamela Denise; Stevenson, Joel O'Don

2004-10-19

The invention generally relates to various aspects of a plasma process and, more specifically, to the monitoring of such plasma processes. One aspect relates to a plasma monitoring module that may be adjusted in at least some manner so as to re-evaluate a previously monitored plasma process. For instance, optical emissions data on a plasma process that was previously monitored by the plasma monitoring module may be replayed through the plasma monitoring module after making at least one adjustment in relation to the plasma monitoring module.

[Lower is better: ENHANCE affair].

PubMed

Scardi, Sabino; Umari, Paolo; D'Agata, Bianca Maria

2008-06-01

Ezetimibe lowers the intestinal absorption of cholesterol, being complementary to the effects of statin. To check its efficacy in lowering the carotid intima-media thickness, in 2002 a multicenter international trial called ENHANCE was started, in order to assess by ultrasound the regression of atherosclerotic plaques. The protocol tested the use of simvastatin 80 mg + placebo versus simvastatin 80 mg + ezetimibe 10 mg in 720 randomized patients. Both drugs were well tolerated. Combination therapy was associated with a larger reduction in LDL cholesterol, but there were no differences in the intima-media thickness measured at three sites in the carotid arteries, nor differences in cardiovascular events between the two groups in the trial. These results provoked disappointment of sponsors (Merck, Schering Plough) who, although the results of the trial were available since march 2007, delayed official communication of about 18 months. This led to speculations and rumors among media, American Government, cardiologic scientific associations, and consequences in the Ezetimibe market and at Wall Street. In particular, the American College of Cardiology didn't accept the communication of ENHANCE results to the Late Breaking Trial Session of the Chicago congress, diverting it to another secondary forum. In conclusion, the experience of the ENHANCE trial suggests to pharmaceutical companies, researchers, clinicians, scientific companies and media a deep meditation in order to avoid in the future similar problems in the management of results of medical research.

Ezetimibe

MedlinePlus

... if you have questions about the risks and benefits of treating increased amounts of cholesterol in your ... disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, ...

Plasma optical modulators for intense lasers

PubMed Central

Yu, Lu-Le; Zhao, Yao; Qian, Lie-Jia; Chen, Min; Weng, Su-Ming; Sheng, Zheng-Ming; Jaroszynski, D. A.; Mori, W. B.; Zhang, Jie

2016-01-01

Optical modulators can have high modulation speed and broad bandwidth, while being compact. However, these optical modulators usually work for low-intensity light beams. Here we present an ultrafast, plasma-based optical modulator, which can directly modulate high-power lasers with intensity up to 1016 W cm−2 to produce an extremely broad spectrum with a fractional bandwidth over 100%, extending to the mid-infrared regime in the low-frequency side. This concept relies on two co-propagating laser pulses in a sub-millimetre-scale underdense plasma, where a drive laser pulse first excites an electron plasma wave in its wake while a following carrier laser pulse is modulated by the plasma wave. The laser and plasma parameters suitable for the modulator to work are based on numerical simulations. PMID:27283369

Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus: Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial).

PubMed

Giugliano, Robert P; Cannon, Christopher P; Blazing, Michael A; Nicolau, José C; Corbalán, Ramón; Špinar, Jindřich; Park, Jeong-Gun; White, Jennifer A; Bohula, Erin A; Braunwald, Eugene

2018-04-10

Ezetimibe, when added to simvastatin, reduces cardiovascular events after acute coronary syndrome. We explored outcomes stratified by diabetes mellitus (DM). In IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), 18 144 patients after acute coronary syndrome with low-density lipoprotein cholesterol 50 to 125 mg/dL were randomized to 40 mg ezetimibe/simvastatin (E/S) or 40 mg placebo/simvastatin. The primary composite end point was cardiovascular death, major coronary events, and stroke. DM was a prespecified subgroup. The 4933 (27%) patients with DM were more often older and female, had had a prior myocardial infarction and revascularization, and presented more frequently with non-ST segment elevation acute coronary syndrome compared with patients without DM (each P <0.001). The median admission low-density lipoprotein cholesterol was lower among patients with DM (89 versus 97 mg/dL, P <0.001). E/S achieved a significantly lower median time-weighted average low-density lipoprotein cholesterol compared with placebo/simvastatin, irrespective of DM (DM: 49 versus 67 mg/dL; no DM: 55 versus 71 mg/dL; both P <0.001). In patients with DM, E/S reduced the 7-year Kaplan-Meier primary end point event rate by 5.5% absolute (hazard ratio, 0.85; 95% confidence interval, 0.78-0.94); in patients without DM, the absolute difference was 0.7% (hazard ratio, 0.98; 95% confidence interval, 0.91-1.04; P int =0.02). The largest relative reductions in patients with DM were in myocardial infarction (24%) and ischemic stroke (39%). No differences in safety outcomes by treatment were present regardless of DM. When stratified further by age, patients ≥75 years of age had a 20% relative reduction in the primary end point regardless of DM ( P int =0.91), whereas patients <75 years of age with DM had greater benefit than those without ( P int =0.011). When stratified by the TIMI (Thrombolysis in Myocardial Infarction) Risk Score for Secondary Prevention, all patients with DM demonstrated benefit with E/S regardless of risk. In contrast, among patients without DM, those with a high risk score experienced a significant (18%) relative reduction in the composite of cardiovascular death, myocardial infarction, and ischemic stroke with E/S compared with placebo/simvastatin, whereas patients without DM at low or moderate risk demonstrated no benefit with the addition of ezetimibe to simvastatin ( P int =0.034). In IMPROVE-IT, the benefit of adding ezetimibe to statin was enhanced in patients with DM and in high-risk patients without DM. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00202878. © 2017 American Heart Association, Inc.

The nonalcoholic fatty liver disease (NAFLD) fibrosis score, cardiovascular risk stratification and a strategy for secondary prevention with ezetimibe.

PubMed

Simon, Tracey G; Corey, Kathleen E; Cannon, Christopher P; Blazing, Michael; Park, Jeong-Gun; O'Donoghue, Michelle L; Chung, Raymond T; Giugliano, Robert P

2018-05-26

The nonalcoholic fatty liver disease fibrosis score (NFS) is comprised of unique metabolic risk indicators that may accurately predict residual cardiovascular (CV) risk in patients with established coronary disease and metabolic dysfunction. We applied the NFS prospectively to 14,819 post-ACS patients randomized to ezetimibe/simvastatin (E/S) or placebo/simvastatin (P/S), in the IMPROVE-IT trial, using validated NFS cutoffs. The primary endpoint included CV death, myocardial infarction, unstable angina, revascularization or stroke. Outcomes were compared between NFS categories and treatment arms using frequency of events, KM rates and adjusted Cox proportional hazard models. The ability of the NFS to predict recurrent CV events was independently validated in 5395 placebo-treated patients enrolled in the SOLID-TIMI 52 trial. Among 14,819 patients enrolled in IMPROVE-IT, 14.2% (N = 2106) were high-risk (NFS > 0.67). The high-risk group had a 30% increased risk of recurrent major CV events, compared to the low-risk NFS group (HR 1.30 [1.19-1.43]; p < 0.001). Among high-risk patients, ezetimibe/simvastatin conferred a 3.7% absolute reduction in risk of recurrent CV events, compared to placebo/simvastatin (HR 0.85 [0.74-0.98]), translating to a number-needed-to-treat of 27. Similar benefit was not found in the low-risk group (HR ezetimibe/simvastatin vs. placebo/simvastatin, 1.01 [0.91-1.12]; p-interaction = 0.053). The relationship between NFS category and recurrent CV events was independently validated in patients enrolled in SOLID-TIMI 52 (HR for NFS > 0.67 vs. NFS < -1.455 = 1.55 [1.32-1.81]; p < 0.001). Stratification of cardiovascular risk by NFS identifies an independent population of patients who are at highest risk of recurrent events, and most likely to benefit from dual lipid-lowering therapy. Clinical trials.gov: NCT00202878. Copyright © 2017 Elsevier B.V. All rights reserved.

Efficacy of Rosuvastatin in Children With Homozygous Familial Hypercholesterolemia and Association With Underlying Genetic Mutations.

PubMed

Stein, Evan A; Dann, Eldad J; Wiegman, Albert; Skovby, Flemming; Gaudet, Daniel; Sokal, Etienne; Charng, Min-Ji; Mohamed, Mafauzy; Luirink, Ilse; Raichlen, Joel S; Sundén, Mattias; Carlsson, Stefan C; Raal, Frederick J; Kastelein, John J P

2017-08-29

Homozygous familial hypercholesterolemia (HoFH), a rare genetic disorder, is characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerotic cardiovascular disease. Statin treatment starts at diagnosis, but no statin has been formally evaluated in, or approved for, HoFH children. The authors sought to assess the LDL-C efficacy of rosuvastatin versus placebo in HoFH children, and the relationship with underlying genetic mutations. This was a randomized, double-blind, 12-week, crossover study of rosuvastatin 20 mg versus placebo, followed by 12 weeks of open-label rosuvastatin. Patients discontinued all lipid-lowering treatment except ezetimibe and/or apheresis. Clinical and laboratory assessments were performed every 6 weeks. The relationship between LDL-C response and genetic mutations was assessed by adding children and adults from a prior HoFH rosuvastatin trial. Twenty patients were screened, 14 randomized, and 13 completed the study. The mean age was 10.9 years; 8 patients were on ezetimibe and 7 on apheresis. Mean LDL-C was 481 mg/dl (range: 229 to 742 mg/dl) on placebo and 396 mg/dl (range: 130 to 700 mg/dl) on rosuvastatin, producing a mean 85.4 mg/dl (22.3%) difference (p = 0.005). Efficacy was similar regardless of age or use of ezetimibe or apheresis, and was maintained for 12 weeks. Adverse events were few and not serious. Patients with 2 defective versus 2 negative LDL receptor mutations had mean LDL-C reductions of 23.5% (p = 0.0044) and 14% (p = 0.038), respectively. This first-ever pediatric HoFH statin trial demonstrated safe and effective LDL-C reduction with rosuvastatin 20 mg alone or added to ezetimibe and/or apheresis. The LDL-C response in children and adults was related to underlying genetic mutations. (A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia [HYDRA]; NCT02226198). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Additive effects of plant sterols supplementation in addition to different lipid-lowering regimens.

PubMed

Malina, Daniela M T; Fonseca, Francisco A; Barbosa, Sílvio A; Kasmas, Soraia H; Machado, Valéria A; França, Carolina N; Borges, Ney C; Moreno, Ronilson A; Izar, Maria C

2015-01-01

Plant sterol (PS) supplementation has been widely used alone or combined with lipid-lowering therapies (LLTs) to reduce low-density lipoprotein (LDL) cholesterol. The effects of PS added to high-intensity LLT are less reported, especially regarding the effects on cholesterol synthesis and absorption. A prospective, randomized, open-label study, with parallel arms and blinded end points was designed to evaluate the effects of addition of PS to LLT on LDL cholesterol, markers of cholesterol synthesis, and absorption. Eighty-six patients of both genders were submitted to a 4-wk run-in period with atorvastatin 10 mg (baseline). Following, subjects received atorvastatin 40 mg, ezetimibe 10 mg, or combination of both drugs for another 4-wk period (phase I). In phase II, capsules containing 2.0 g of PSs were added to previous assigned treatments for 4 wk. Lipids, apolipoproteins, plasma campesterol, β-sitosterol, and desmosterol levels were assayed at all time points. Within and between-group analyses were performed. Compared with baseline, atorvastatin 40 mg reduced total and LDL cholesterol (3% and 22%, respectively, P < .05), increased β-sitosterol, campesterol/cholesterol, and β-sitosterol/cholesterol ratios (39%, 47%, and 32%, respectively, P < .05); ezetimibe 10 mg reduced campesterol and campesterol/cholesterol ratio (67% and 70%, respectively, P < .05), and the combined therapy decreased total and LDL cholesterol (22% and 38%, respectively, P < .05), campesterol, β-sitosterol, and campesterol/cholesterol ratio (54%, 40%, and 27%, P < .05). Addition of PS further reduced total and LDL cholesterol by ∼ 7.7 and 6.5%, respectively, in the atorvastatin therapy group and 5.0 and 4.0% in the combined therapy group (P < .05, for all), with no further effects in absorption or synthesis markers. PS added to LLT can further improve lipid profile, without additional effects on intestinal sterol absorption or synthesis. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Development of enteric-coated fixed dose combinations of amorphous solid dispersions of ezetimibe and lovastatin: Investigation of formulation and process parameters.

PubMed

Riekes, Manoela K; Dereymaker, Aswin; Berben, Philippe; Augustijns, Patrick; Stulzer, Hellen K; Van den Mooter, Guy

2017-03-30

Enteric-coated fixed-dose combinations of ezetimibe and lovastatin were prepared by fluid bed coating aiming to avoid the acidic conversion of lovastatin to its hydroxyacid derivative. In a two-step process, sucrose beads were layered with a glass solution of ezetimibe, lovastatin and Soluplus ® , top-coated with an enteric layer. The impact of different bead size, enteric polymers (Eudragit L100 ® and Eudragit L100-55 ® ) and coating time was investigated. Samples were evaluated by X-ray diffraction, scanning electron microscopy, laser diffraction and in vitro studies in 0.1M HCl and phosphate buffer pH 6.8. Results showed that smaller beads tend to agglomerate and release was jeopardized in acidic conditions, most likely due to irregular coating layer. Eudragit L100-55 ® required longer processing, but thinner coating layers provided lower drug release. Both polymers showed low drug release in acidic environment and fast release at pH 6.8. The off-line measurement of the coating thickness determined the ideal coating time as 15 and 30min for Eudragit L100-55 ® and Eudragit L100 ® -based samples, respectively. Both compounds were molecularly dispersed in Soluplus ® , and Eudragit L100 ® formulations showed concave pores on the surface, presenting higher drug release in acidic conditions. Stability studies after 6 months showed unaltered physical properties and drug release. Copyright © 2017 Elsevier B.V. All rights reserved.

Statins: Are These Cholesterol-Lowering Drugs Right for You?

MedlinePlus

... for use in the United States. They include: atorvastatin (Lipitor) lovastatin (Altoprev) pitavastatin (Livalo) pravastatin (Pravachol) rosuvastatin ( ... combined with another heart health medication. Examples are atorvastatin/amlodipine (Caduet) and simvastatin/ezetimibe (Vytorin). Increasing evidence ...

PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease.

PubMed

Schmidt, Amand F; Pearce, Lucy S; Wilkins, John T; Overington, John P; Hingorani, Aroon D; Casas, Juan P

2017-04-28

Despite the availability of effective drug therapies that reduce low-density lipoprotein (LDL)-cholesterol (LDL-C), cardiovascular disease (CVD) remains an important cause of mortality and morbidity. Therefore, additional LDL-C reduction may be warranted, especially for patients who are unresponsive to, or unable to take, existing LDL-C-reducing therapies. By inhibiting the proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme, monoclonal antibodies (PCSK9 inhibitors) may further reduce LDL-C, potentially reducing CVD risk as well. Primary To quantify short-term (24 weeks), medium-term (one year), and long-term (five years) effects of PCSK9 inhibitors on lipid parameters and on the incidence of CVD. Secondary To quantify the safety of PCSK9 inhibitors, with specific focus on the incidence of type 2 diabetes, cognitive function, and cancer. Additionally, to determine if specific patient subgroups were more or less likely to benefit from the use of PCSK9 inhibitors. We identified studies by systematically searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science. We also searched Clinicaltrials.gov and the International Clinical Trials Registry Platform and screened the reference lists of included studies. We identified the studies included in this review through electronic literature searches conducted up to May 2016, and added three large trials published in March 2017. All parallel-group and factorial randomised controlled trials (RCTs) with a follow-up time of at least 24 weeks were eligible. Two review authors independently reviewed and extracted data. When data were available, we calculated pooled effect estimates. We included 20 studies with data on 67,237 participants (median age 61 years; range 52 to 64 years). Twelve trials randomised participants to alirocumab, three trials to bococizumab, one to RG7652, and four to evolocumab. Owing to the small number of trials using agents other than alirocumab, we did not differentiate between types of PCSK9 inhibitors used. We compared PCSK9 inhibitors with placebo (thirteen RCTs), ezetimibe (two RCTs) or ezetimibe and statins (five RCTs).Compared with placebo, PCSK9 inhibitors decreased LDL-C by 53.86% (95% confidence interval (CI) 58.64 to 49.08; eight studies; 4782 participants; GRADE: moderate) at 24 weeks; compared with ezetimibe, PCSK9 inhibitors decreased LDL-C by 30.20% (95% CI 34.18 to 26.23; two studies; 823 participants; GRADE: moderate), and compared with ezetimibe and statins, PCSK9 inhibitors decreased LDL-C by 39.20% (95% CI 56.15 to 22.26; five studies; 5376 participants; GRADE: moderate).Compared with placebo, PCSK9 inhibitors decreased the risk of CVD events, with a risk difference (RD) of 0.91% (odds ratio (OR) of 0.86, 95% CI 0.80 to 0.92; eight studies; 59,294 participants; GRADE: moderate). Compared with ezetimibe and statins, PCSK9 inhibitors appeared to have a stronger protective effect on CVD risk, although with considerable uncertainty (RD 1.06%, OR 0.45, 95% CI 0.27 to 0.75; three studies; 4770 participants; GRADE: very low). No data were available for the ezetimibe only comparison. Compared with placebo, PCSK9 probably had little or no effect on mortality (RD 0.03%, OR 1.02, 95% CI 0.91 to 1.14; 12 studies; 60,684 participants; GRADE: moderate). Compared with placebo, PCSK9 inhibitors increased the risk of any adverse events (RD 1.54%, OR 1.08, 95% CI 1.04 to 1.12; 13 studies; 54,204 participants; GRADE: low). Similar effects were observed for the comparison of ezetimibe and statins: RD 3.70%, OR 1.18, 95% CI 1.05 to 1.34; four studies; 5376 participants; GRADE: low. Clinical event data were unavailable for the ezetimibe only comparison. Over short-term to medium-term follow-up, PCSK9 inhibitors reduced LDL-C. Studies with medium-term follow-up time (longest median follow-up recorded was 26 months) reported that PCSK9 inhibitors (compared with placebo) decreased CVD risk but may have increased the risk of any adverse events (driven by SPIRE-1 and -2 trials). Available evidence suggests that PCSK9 inhibitor use probably leads to little or no difference in mortality. Evidence on relative efficacy and safety when PCSK9 inhibitors were compared with active treatments was of low to very low quality (GRADE); follow-up times were short and events were few. Large trials with longer follow-up are needed to evaluate PCSK9 inhibitors versus active treatments as well as placebo. Owing to the predominant inclusion of high-risk patients in these studies, applicability of results to primary prevention is limited. Finally, estimated risk differences indicate that PCSK9 inhibitors only modestly change absolute risks (often to less than 1%).

MHD Electrode and wall constructions

DOEpatents

Way, Stewart; Lempert, Joseph

1984-01-01

Electrode and wall constructions for the walls of a channel transmitting the hot plasma in a magnetohydrodynamic generator. The electrodes and walls are made of a plurality of similar modules which are spaced from one another along the channel. The electrodes can be metallic or ceramic, and each module includes one or more electrodes which are exposed to the plasma and a metallic cooling bar which is spaced from the plasma and which has passages through which a cooling fluid flows to remove heat transmitted from the electrode to the cooling bar. Each electrode module is spaced from and electrically insulated from each adjacent module while interconnected by the cooling fluid which serially flows among selected modules. A wall module includes an electrically insulating ceramic body exposed to the plasma and affixed, preferably by mechanical clips or by brazing, to a metallic cooling bar spaced from the plasma and having cooling fluid passages. Each wall module is, similar to the electrode modules, electrically insulated from the adjacent modules and serially interconnected to other modules by the cooling fluid.

The Experiment of Modulated Toroidal Current on HT-7 and HT-6M Tokamak

NASA Astrophysics Data System (ADS)

Mao, Jian-shan; P, Phillips; Luo, Jia-rong; Xu, Yu-hong; Zhao, Jun-yu; Zhang, Xian-mei; Wan, Bao-nian; Zhang, Shou-yin; Jie, Yin-xian; Wu, Zhen-wei; Hu, Li-qun; Liu, Sheng-xia; Shi, Yue-jiang; Li, Jian-gang; HT-6M; HT-7 Group

2003-02-01

The Experiments of Modulated Toroidal Current were done on the HT-6M tokamak and HT-7 superconducting tokamak. The toroidal current was modulated by programming the Ohmic heating field. Modulation of the plasma current has been used successfully to suppress MHD activity in discharges near the density limit where large MHD m = 2 tearing modes were suppressed by sufficiently large plasma current oscillations. The improved Ohmic confinement phase was observed during modulating toroidal current (MTC) on the Hefei Tokamak-6M (HT-6M) and Hefei superconducting Tokamak-7 (HT-7). A toroidal frequency-modulated current, induced by a modulated loop voltage, was added on the plasma equilibrium current. The ratio of A.C. amplitude of plasma current to the main plasma current ΔIp/Ip is about 12%-30%. The different formats of the frequency-modulated toroidal current were compared.

[Severe familial hypercholesterolemia treatment].

PubMed

Vrablík, Michal; Freiberger, Tomáš; Bláha, Vladimír; Češka, Richard

Familial hypercholesterolemia (FH) represents the most frequent of inborn errors of metabolism. It is a group of disorders with a codominant mode of inheritance characterized by marked elevations of LDL-cholesterol as well as atherosclerotic cardiovascular disease risk. Clinical (phenotypic) picture of FH varies widely depending on genotype and concomitant risk factors. Identification of most seriously affected FH individuals is necessary for proper clinical management. The therapeutic approach must be complex and comprehensive. The corner stone of pharmacotherapy is high-intensity statin therapy usually combined with ezetimibe (possibly complemented with bile acid sequestrant). Even this multi-drug combination do not lead majority of patients to their treatment goals. Thus, combinations with other pharmacological (PCSK9 inhibitors, apoB-100 anti-sense therapy, MTP inhibition) and non-pharmacological (LDL-apheresis, liver transplantation) approaches is being used.Key words: ezetimibe - LDL-apheresis - lomitapide - mipomersen - PCSK9 inhibitors - severe familial hypercholesterolemia - statins.

Combined spectroscopic and quantum chemical studies of ezetimibe

NASA Astrophysics Data System (ADS)

Prajapati, Preeti; Pandey, Jaya; Shimpi, Manishkumar R.; Srivastava, Anubha; Tandon, Poonam; Velaga, Sitaram P.; Sinha, Kirti

2016-12-01

Ezetimibe (EZT) is a hypocholesterolemic agent used for the treatment of elevated blood cholesterol levels as it lowers the blood cholesterol by blocking the absorption of cholesterol in intestine. Study aims to combine experimental and computational methods to provide insights into the structural and vibrational spectroscopic properties of EZT which is important for explaining drug substance physical and biological properties. Computational study on molecular properties of ezetimibe is presented using density functional theory (DFT) with B3LYP functional and 6-311++G(d,p) basis set. A detailed vibrational assignment has been done for the observed IR and Raman spectra of EZT. In addition to the conformational study, hydrogen bonding and molecular docking studies have been also performed. For conformational studies, the double well potential energy curves have been plotted for the rotation around the six flexible bonds of the molecule. UV absorption spectrum was examined in methanol solvent and compared with calculated one in solvent environment (IEF-PCM) using TD-DFT/6-31G basis set. HOMO-LUMO energy gap of both the conformers have also been calculated in order to predict its chemical reactivity and stability. The stability of the molecule was also examined by means of natural bond analysis (NBO) analysis. To account for the chemical reactivity and site selectivity of the molecules, molecular electrostatic potential (MEPS) map has been plotted. The combination of experimental and calculated results provide an insight into the structural and vibrational spectroscopic properties of EZT. In order to give an insight for the biological activity of EZT, molecular docking of EZT with protein NPC1L1 has been done.

Laser frequency modulation with electron plasma

NASA Technical Reports Server (NTRS)

Burgess, T. J.; Latorre, V. R.

1972-01-01

When laser beam passes through electron plasma its frequency shifts by amount proportional to plasma density. This density varies with modulating signal resulting in corresponding modulation of laser beam frequency. Necessary apparatus is relatively inexpensive since crystals are not required.

Modulational instability of an electron plasma wave in a dusty plasma

NASA Astrophysics Data System (ADS)

Amin, M. R.; Ferdous, T.; Salimullah, M.

1997-03-01

The modulational instability of an electron plasma wave in a homogeneous, unmagnetized, hot, and collisionless dusty plasma has been investigated analytically. The Vlasov equation has been solved perturbatively to find the nonlinear response of the plasma particles with random static distribution of massive and charged dust grains having certain correlation. It is noticed that the growth rate of the modulational instability of the electron plasma wave through a new ultra-low-frequency dust mode is more efficient than that through the usual ion-acoustic mode in the dusty plasma.

Plasma based optical guiding of an amplitude-modulated electromagnetic beam

NASA Astrophysics Data System (ADS)

Singh, Mamta; Gupta, D. N.

2015-06-01

We propose the stronger optical guiding of an electromagnetic beam in a plasma by considering the amplitude modulation of the fundamental beam. With the advent of high power source of electromagnetic radiation, the electron velocity in a plasma may become quite large (comparable to the light velocity in free space). Thus, the effect of relativistic mass variation must be taken into account. The relativistic effect of the laser propagation in a plasma leads to self-focusing because of the dielectric constant of a plasma being an increasing function of the intensity. The ponderomotive force of the laser beam pushes the electrons out of the region of high intensity, which reduces the local electron density and increases the plasma dielectric function further, leading to even more selffocusing of the laser. In this work, we consider a short pulse laser of finite spot size as an amplitude modulation in time. Our findings show an efficient optical guiding mechanism based on amplitude modulation signal propagation in plasmas. Medium nonlinearity becomes stronger if an amplitude modulated beam is introduced, which contributes significantly in laser guiding in plasmas. Furthermore, the rate of laser self-focusing is increased with modulation index due the fact of stronger Kerr effect. The study related to amplitude modulated optical signal may be useful for communication technology.

Parasitic modulation of electromagnetic signals caused by time-varying plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Min, E-mail: merovingia1911@126.com; Li, Xiaoping; Xie, Kai

2015-02-15

An experiment on the propagation of electromagnetic (EM) signals in continuous time-varying plasma is described. The time-varying characteristics of plasma are considered to cause a parasitic modulation in both amplitude and phase, and the strength of this modulation, which carries the information of the electron density profile, is closely related to the plasma frequency and the incident wave frequency. Through theoretical analysis, we give an explanation and mechanism of the interaction between the continuous time-varying plasma and EM waves, which is verified by a comparative analysis with experiments performed under the same conditions. The effects of this modulation on themore » EM signals in the plasma sheath cannot be ignored.« less

Observation of the Self-Modulation Instability via Time-Resolved Measurements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gross, M.; Engel, J.; Good, J.

Self-modulation of an electron beam in a plasma has been observed. The propagation of a long (several plasma wavelengths) electron bunch in an overdense plasma resulted in the production of multiple bunches via the self-modulation instability. Using a combination of a radio-frequency deflector and a dipole spectrometer, the time and energy structure of the self-modulated beam was measured. The longitudinal phase space measurement showed the modulation of a long electron bunch into three bunches with an approximatelymore » $$200\\text{ }\\text{ }\\mathrm{keV}/c$$ amplitude momentum modulation. Demonstrating this effect is a breakthrough for proton-driven plasma accelerator schemes aiming to utilize the same physical effect.« less

Observation of the Self-Modulation Instability via Time-Resolved Measurements

DOE PAGES

Gross, M.; Engel, J.; Good, J.; ...

2018-04-06

Self-modulation of an electron beam in a plasma has been observed. The propagation of a long (several plasma wavelengths) electron bunch in an overdense plasma resulted in the production of multiple bunches via the self-modulation instability. Using a combination of a radio-frequency deflector and a dipole spectrometer, the time and energy structure of the self-modulated beam was measured. The longitudinal phase space measurement showed the modulation of a long electron bunch into three bunches with an approximatelymore » $$200\\text{ }\\text{ }\\mathrm{keV}/c$$ amplitude momentum modulation. Demonstrating this effect is a breakthrough for proton-driven plasma accelerator schemes aiming to utilize the same physical effect.« less

Progress of plasma wakefield self-modulation experiments at FACET

NASA Astrophysics Data System (ADS)

Adli, E.; Berglyd Olsen, V. K.; Lindstrøm, C. A.; Muggli, P.; Reimann, O.; Vieira, J. M.; Amorim, L. D.; Clarke, C. I.; Gessner, S. J.; Green, S. Z.; Hogan, M. J.; Litos, M. D.; O`Shea, B. D.; Yakimenko, V.; Clayton, C.; Marsh, K. A.; Mori, W. B.; Joshi, C.; Vafaei-Najafabadi, N.; Williams, O.

2016-09-01

Simulations and theory predict that long electron and positron beams may under favorable conditions self-modulate in plasmas. We report on the progress of experiments studying the self-modulation instability in plasma wakefield experiments at FACET. The experimental results obtained so far, while not being fully conclusive, appear to be consistent with the presence of the self-modulation instability.

Dyslipidaemia in nephrotic syndrome: mechanisms and treatment

PubMed Central

Agrawal, Shipra; Zaritsky, Joshua J.; Fornoni, Alessia; Smoyer, William E.

2018-01-01

Nephrotic syndrome is a highly prevalent disease that is associated with high morbidity despite notable advances in its treatment. Many of the complications of nephrotic syndrome, including the increased risk of atherosclerosis and thromboembolism, can be linked to dysregulated lipid metabolism and dyslipidaemia. These abnormalities include elevated plasma levels of cholesterol, triglycerides and the apolipoprotein B containing lipoproteins VLDL and IDL; decreased lipoprotein lipase activity in the endothelium, muscle and adipose tissues; decreased hepatic lipase activity; and increased levels of the enzyme PCSK9. In addition, there is an increase in the plasma levels of immature HDL particles and reduced cholesterol efflux. Studies from the past few years have markedly improved our understanding of the molecular pathogenesis of nephrotic syndrome associated dyslipidaemia, and also heightened our awareness of the associated exacerbated risks of cardiovascular complications, progressive kidney disease and thromboembolism. Despite the absence of clear guidelines regarding treatment, various strategies are being increasingly utilized, including statins, bile acid sequestrants, fibrates, nicotinic acid and ezetimibe, as well as lipid apheresis, which seem to also induce partial or complete clinical remission of nephrotic syndrome in a substantial percentage of patients. Future potential treatments will likely also include inhibition of PCSK9 using recently developed anti PCSK9 monoclonal antibodies and small inhibitory RNAs, as well as targeting newly identified molecular regulators of lipid metabolism that are dysregulated in nephrotic syndrome. PMID:29176657

Research on radiation characteristics of dipole antenna modulation by sub-wavelength inhomogeneous plasma layer

NASA Astrophysics Data System (ADS)

Kong, Fanrong; Chen, Peiqi; Nie, Qiuyue; Zhang, Xiaoning; Zhang, Zhen; Jiang, Binhao

2018-02-01

The modulation and enhancement effect of sub-wavelength plasma structures on compact antennas exhibits obvious technological advantage and considerable progress. In order to extend the availability of this technology under complex and actual environment with inhomogeneous plasma structure, a numerical simulation analysis based on finite element method has been conducted in this paper. The modulation function of the antenna radiation with sub-wavelength plasma layer located at different positions was investigated, and the inhomogeneous plasma layer with multiple electron density distribution profiles were employed to explore the effect of plasma density distribution on the antenna radiation. It has been revealed that the optical near-field modulated distance and reduced plasma distribution are more beneficial to enhance the radiation. On the basis above, an application-focused research about communication through the plasma sheath surrounding a hypersonic vehicle has been carried out aiming at exploring an effective communication window. The relevant results devote guiding significance in the field of antenna radiation modulation and enhancement, as well as the development of communication technology in hypersonic flight.

How effective are the ESC/EAS and 2013 ACC/AHA guidelines in treating dyslipidemia? Lessons from a lipid clinic.

PubMed

Barkas, Fotios; Milionis, Haralampos; Kostapanos, Michael S; Mikhailidis, Dimitri P; Elisaf, Moses; Liberopoulos, Evangelos

2015-02-01

There is a paucity of data regarding the attainment of lipid-lowering treatment goals according to the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The aim of the present study was to assess how applicable these 2013 recommendations are in the setting of an Outpatient University Hospital Lipid Clinic. This was a retrospective (from 1999 to 2013) observational study including 1000 consecutive adults treated for hyperlipidemia and followed up for ≥3 years. Comparisons for the applicability of current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and recent ACC/AHA guidelines were performed. Achievement rates of low density lipoprotein cholesterol (LDL-C) targets set by ESC/EAS were 21%, 44% and 62% among patients at very high, high and moderate cardiovascular risk, respectively, receiving statin monotherapy. Among individuals on high-intensity statins only 47% achieved the anticipated ≥50% LDL-C reduction, i.e. the ACC/AHA target. The corresponding rate was significantly greater among those on statin + ezetimibe (76%, p < 0.05). Likewise, higher rates of LDL-C target attainment according to ESC/EAS guidelines were observed in patients on statin + ezetimibe compared with statin monotherapy (37, 50 and 71% for the three risk groups, p < 0.05 for the very high risk group). The application of the ACC/AHA guidelines may be associated with undertreatment of high risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA.

Treatment dynamics of newly marketed drugs and implications for comparative effectiveness research.

PubMed

Gagne, Joshua J; Bykov, Katsiaryna; Willke, Richard J; Kahler, Kristijan H; Subedi, Prasun; Schneeweiss, Sebastian

2013-01-01

Clinicians and payers require rapid comparative effectiveness (CE) evidence generation to inform decisions for new drugs. We empirically assessed treatment dynamics of newly marked drugs and their implications for conducting CE research. We used claims data to evaluate five drug-outcome pairs: 1) raloxifene (vs. alendronate) and fracture; 2) risedronate (vs. alendronate) and fracture; 3) simvastatin plus ezetimibe fixed-dose combination (simvastatin + ezetimibe) (vs. simvastatin alone) and cardiovascular events; 4) rofecoxib (vs. nonselective nonsteroidal anti-inflammatory drugs [ns-NSAIDs]) and myocardial infarction; and 5) rofecoxib (vs. ns-NSAIDS) and gastrointestinal bleed. We examined utilization dynamics in the early marketing period, including evolving utilization patterns, outcome risk among those treated with new versus established drugs, and prior treatment patterns that may indicate treatment resistance or intolerance. We addressed these challenges by replicating active CE monitoring with sequential matched cohort analysis. Patients initiating new drugs were more likely to have used other drugs for the same indication in the past, but the majority of patients in all new drug cohorts were treatment naive (82.0% overall). Patients initiating rofecoxib had higher predicted baseline risk of gastrointestinal bleed than did patients initiating ns-NSAIDs. Patients initiating risedronate and alendronate had similar predicted baseline risks of fracture, while those initiating raloxifene and simvastatin + ezetimibe had lower risks of outcomes of interest relative to their comparators. Prospective monitoring yielded results consistent with expectation for each example. Many challenges to assessing the CE of new drugs are borne out in empirical data. Attention to these challenges can yield valid CE results. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Imputation of Baseline LDL Cholesterol Concentration in Patients with Familial Hypercholesterolemia on Statins or Ezetimibe.

PubMed

Ruel, Isabelle; Aljenedil, Sumayah; Sadri, Iman; de Varennes, Émilie; Hegele, Robert A; Couture, Patrick; Bergeron, Jean; Wanneh, Eric; Baass, Alexis; Dufour, Robert; Gaudet, Daniel; Brisson, Diane; Brunham, Liam R; Francis, Gordon A; Cermakova, Lubomira; Brophy, James M; Ryomoto, Arnold; Mancini, G B John; Genest, Jacques

2018-02-01

Familial hypercholesterolemia (FH) is the most frequent genetic disorder seen clinically and is characterized by increased LDL cholesterol (LDL-C) (>95th percentile), family history of increased LDL-C, premature atherosclerotic cardiovascular disease (ASCVD) in the patient or in first-degree relatives, presence of tendinous xanthomas or premature corneal arcus, or presence of a pathogenic mutation in the LDLR , PCSK9 , or APOB genes. A diagnosis of FH has important clinical implications with respect to lifelong risk of ASCVD and requirement for intensive pharmacological therapy. The concentration of baseline LDL-C (untreated) is essential for the diagnosis of FH but is often not available because the individual is already on statin therapy. To validate a new algorithm to impute baseline LDL-C, we examined 1297 patients. The baseline LDL-C was compared with the imputed baseline obtained within 18 months of the initiation of therapy. We compared the percent reduction in LDL-C on treatment from baseline with the published percent reductions. After eliminating individuals with missing data, nonstandard doses of statins, or medications other than statins or ezetimibe, we provide data on 951 patients. The mean ± SE baseline LDL-C was 243.0 (2.2) mg/dL [6.28 (0.06) mmol/L], and the mean ± SE imputed baseline LDL-C was 244.2 (2.6) mg/dL [6.31 (0.07) mmol/L] ( P = 0.48). There was no difference in response according to the patient's sex or in percent reduction between observed and expected for individual doses or types of statin or ezetimibe. We provide a validated estimation of baseline LDL-C for patients with FH that may help clinicians in making a diagnosis. © 2017 American Association for Clinical Chemistry.

Efficacy and safety of alirocumab among individuals with diabetes mellitus and atherosclerotic cardiovascular disease in the ODYSSEY phase 3 trials.

PubMed

Ganda, Om P; Plutzky, Jorge; Sanganalmath, Santosh K; Bujas-Bobanovic, Maja; Koren, Andrew; Mandel, Jonas; Letierce, Alexia; Leiter, Lawrence A

2018-05-26

Individuals with both diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) are at very high risk of cardiovascular events. This post-hoc analysis evaluated efficacy and safety of the PCSK9 inhibitor alirocumab among 984 individuals with DM and ASCVD pooled from 9 ODYSSEY Phase 3 trials. Changes in low-density lipoprotein cholesterol (LDL-C) and other lipids from baseline to Week 24 were analysed (intention-to-treat) in 4 pools by alirocumab dosage (150 mg every 2 weeks [150] or 75 mg with possible increase to 150 mg every 2 weeks [75/150]), control (placebo/ezetimibe) and background statin usage (yes/no). At Week 24, LDL-C changes from baseline in pools with background statins were -61.5% with alirocumab 150 (vs -1.0% with placebo), -46.4% with alirocumab 75/150 (vs +6.3% with placebo), and -48.7% with alirocumab 75/150 (vs -20.6% with ezetimibe), and was -54.9% with alirocumab 75/150 (vs +4.0% with ezetimibe) without background statins. A greater proportion of alirocumab recipients achieved LDL-C <70 mg/dL and <55 mg/dL at Week 24 vs controls. Alirocumab also resulted in significant reductions in non-high-density lipoprotein cholesterol, apolipoprotein B and lipoprotein(a) vs controls. Alirocumab did not appear to affect glycaemia over 78-104 weeks. Overall safety was similar between treatment groups, with a higher injection-site reaction frequency (mostly mild) with alirocumab. Alirocumab significantly reduced LDL-C and other atherogenic lipid parameters, and was generally well tolerated in persons with DM and ASCVD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

New medications which decrease levothyroxine absorption.

PubMed

John-Kalarickal, Jennifer; Pearlman, Gwen; Carlson, Harold E

2007-08-01

Medications may sometimes interfere with the intestinal absorption of levothyroxine, primarily by forming an insoluble complex with the thyroid hormone in the intestinal lumen. The goal of this study was to examine the acute effects of three previously unstudied medications on levothyroxine absorption. We studied the effects of three medications on thyroxine absorption in seven normal volunteers. On each study day, the subjects ingested 1 mg levothyroxine sodium, either taken separately or co-administered with sevelamer hydrochloride (Renagel, a phosphate-binding medication used in the treatment of hyperphosphatemia), chromium picolinate (an over-the-counter nutritional supplement), or ezetimibe (Zetia, a drug used in the treatment of hypercholesterolemia). Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Sevelamer hydrochloride and chromium picolinate each significantly (p < 0.05) decreased the area under the serum thyroxine concentration curve, while ezetimibe had no effect. Hypothyroid patients taking sevelamer hydrochloride or chromium picolinate should be advised to separate the time of ingestion of these drugs from their thyroid hormone preparation by several hours.

Two-dimensional modulated ion-acoustic excitations in electronegative plasmas

NASA Astrophysics Data System (ADS)

Panguetna, Chérif S.; Tabi, Conrad B.; Kofané, Timoléon C.

2017-09-01

Two-dimensional modulated ion-acoustic waves are investigated in an electronegative plasma. Through the reductive perturbation expansion, the governing hydrodynamic equations are reduced to a Davey-Stewartson system with two-space variables. The latter is used to study the modulational instability of ion-acoustic waves along with the effect of plasma parameters, namely, the negative ion concentration ratio (α) and the electron-to-negative ion temperature ratio (σn). A parametric analysis of modulational instability is carried out, where regions of plasma parameters responsible for the emergence of modulated ion-acoustic waves are discussed, with emphasis on the behavior of the instability growth rate. Numerically, using perturbed plane waves as initial conditions, parameters from the instability regions give rise to series of dromion solitons under the activation of modulational instability. The sensitivity of the numerical solutions to plasma parameters is discussed. Some exact solutions in the form one- and two-dromion solutions are derived and their response to the effect of varying α and σn is discussed as well.

Cost-effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease.

PubMed

Kazi, Dhruv S; Moran, Andrew E; Coxson, Pamela G; Penko, Joanne; Ollendorf, Daniel A; Pearson, Steven D; Tice, Jeffrey A; Guzman, David; Bibbins-Domingo, Kirsten

2016-08-16

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were recently approved for lowering low-density lipoprotein cholesterol in heterozygous familial hypercholesterolemia (FH) or atherosclerotic cardiovascular disease (ASCVD) and have potential for broad ASCVD prevention. Their long-term cost-effectiveness and effect on total health care spending are uncertain. To estimate the cost-effectiveness of PCSK9 inhibitors and their potential effect on US health care spending. The Cardiovascular Disease Policy Model, a simulation model of US adults aged 35 to 94 years, was used to evaluate cost-effectiveness of PCSK9 inhibitors or ezetimibe in heterozygous FH or ASCVD. The model incorporated 2015 annual PCSK9 inhibitor costs of $14,350 (based on mean wholesale acquisition costs of evolocumab and alirocumab); adopted a health-system perspective, lifetime horizon; and included probabilistic sensitivity analyses to explore uncertainty. Statin therapy compared with addition of ezetimibe or PCSK9 inhibitors. Lifetime major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, or stroke), incremental cost per quality-adjusted life-year (QALY), and total effect on US health care spending over 5 years. Adding PCSK9 inhibitors to statins in heterozygous FH was estimated to prevent 316,300 MACE at a cost of $503,000 per QALY gained compared with adding ezetimibe to statins (80% uncertainty interval [UI], $493,000-$1,737,000). In ASCVD, adding PCSK9 inhibitors to statins was estimated to prevent 4.3 million MACE compared with adding ezetimibe at $414,000 per QALY (80% UI, $277,000-$1,539,000). Reducing annual drug costs to $4536 per patient or less would be needed for PCSK9 inhibitors to be cost-effective at less than $100,000 per QALY. At 2015 prices, PCSK9 inhibitor use in all eligible patients was estimated to reduce cardiovascular care costs by $29 billion over 5 years, but drug costs increased by an estimated $592 billion (a 38% increase over 2015 prescription drug expenditures). In contrast, initiating statins in these high-risk populations in all statin-tolerant individuals who are not currently using statins was estimated to save $12 billion. Assuming 2015 prices, PCSK9 inhibitor use in patients with heterozygous FH or ASCVD did not meet generally acceptable incremental cost-effectiveness thresholds and was estimated to increase US health care costs substantially. Reducing annual drug prices from more than $14,000 to $4536 would be necessary to meet a $100,000 per QALY threshold.

High dose simvastatin exhibits enhanced lipid lowering effects relative to simvastatin/ezetimibe combination therapy

USDA-ARS?s Scientific Manuscript database

Technical Abstract: Background: Statins are the frontline in cholesterol reduction therapies; however use in combination with agents that possess complimentary mechanisms of action may achieve further reduce in LDL-C. Methods and Results: Thirty-nine patients were treated with either 80mg simvasta...

76 FR 55689 - Endocrinologic and Metabolic Drugs Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

..., Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 31.../Schering-Plough) Singapore Company, LLC. Simvastatin lowers lipids (fats that circulate in the bloodstream... in producing lipids in the body, and ezetimibe lowers lipids by inhibiting the absorption of...

Influence of coil current modulation on polycrystalline diamond film deposition by irradiation of Ar/CH4/H2 inductively coupled thermal plasmas

NASA Astrophysics Data System (ADS)

Betsuin, Toshiki; Tanaka, Yasunori; Arai, T.; Uesugi, Y.; Ishijima, T.

2018-03-01

This paper describes the application of an Ar/CH4/H2 inductively coupled thermal plasma with and without coil current modulation to synthesise diamond films. Induction thermal plasma with coil current modulation is referred to as modulated induction thermal plasma (M-ITP), while that without modulation is referred to as non-modulated ITP (NM-ITP). First, spectroscopic observations of NM-ITP and M-ITP with different modulation waveforms were made to estimate the composition in flux from the thermal plasma by measuring the time evolution in the spectral intensity from the species. Secondly, we studied polycrystalline diamond film deposition tests on a Si substrate, and we studied monocrystalline diamond film growth tests using the irradiation of NM-ITP and M-ITP. From these tests, diamond nucleation effects by M-ITP were found. Finally, following the irradiation results, we attempted to use a time-series irradiation of M-ITP and NM-ITP for polycrystalline diamond film deposition on a Si substrate. The results indicated that numerous larger diamond particles were deposited with a high population density on the Si substrate by time-series irradiation.

Treatment of Dyslipidemias to Prevent Cardiovascular Disease in Patients with Type 2 Diabetes.

PubMed

Khavandi, Maryam; Duarte, Francisco; Ginsberg, Henry N; Reyes-Soffer, Gissette

2017-01-01

Current preventive and treatment guidelines for type 2 diabetes have failed to decrease the incidence of comorbidities, such as dyslipidemia and ultimately heart disease. The goal of this review is to describe the physiological and metabolic lipid alterations that develop in patients with type 2 diabetes mellitus. Questions addressed include the differences in lipid and lipoprotein metabolism that characterize the dyslipidemia of insulin resistance and type 2 diabetes mellitus. We also examine the relevance of the new AHA/ADA treatment guidelines to dyslipidemic individuals. In this review, we provide an update on the pathophysiology of diabetic dyslipidemia, including the role of several apolipoproteins such as apoC-III. We also point to new studies and new agents for the treatment of individuals with type 2 diabetes mellitus who need lipid therapies. Type 2 diabetes mellitus causes cardiovascular disease via several pathways, including dyslipidemia characterized by increased plasma levels of apoB-lipoproteins and triglycerides, and low plasma concentrations of HDL cholesterol. Treatments to normalize the dyslipidemia and reduce the risk for cardiovascular events include the following: lifestyle and medication, particularly statins, and if necessary, ezetimibe, to significantly lower LDL cholesterol. Other treatments, more focused on triglycerides and HDL cholesterol, are less well supported by randomized clinical trials and should be used on an individual basis. Newer agents, particularly the PCSK9 inhibitors, show a great promise for even greater lowering of LDL cholesterol, but we await the results of ongoing clinical trials.

Plasma Cutting and Carbon-Arc Cutting. Welding Module 8. Instructor's Guide.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Instructional Materials Lab.

This guide is intended to assist vocational educators in teaching the two units of a module in operating plasma cutting and carbon-arc cutting equipment. The module is part of a welding curriculum that has been designed to be totally integrated with Missouri's Vocational Instruction Management System. The materials included in the module have been…

Modulation instability and dissipative rogue waves in ion-beam plasma: Roles of ionization, recombination, and electron attachment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guo, Shimin, E-mail: gsm861@126.com; Mei, Liquan, E-mail: lqmei@mail.xjtu.edu.cn

The amplitude modulation of ion-acoustic waves is investigated in an unmagnetized plasma containing positive ions, negative ions, and electrons obeying a kappa-type distribution that is penetrated by a positive ion beam. By considering dissipative mechanisms, including ionization, negative-positive ion recombination, and electron attachment, we introduce a comprehensive model for the plasma with the effects of sources and sinks. Via reductive perturbation theory, the modified nonlinear Schrödinger equation with a dissipative term is derived to govern the dynamics of the modulated waves. The effect of the plasma parameters on the modulation instability criterion for the modified nonlinear Schrödinger equation is numericallymore » investigated in detail. Within the unstable region, first- and second-order dissipative ion-acoustic rogue waves are present. The effect of the plasma parameters on the characteristics of the dissipative rogue waves is also discussed.« less

Effect of insulin-sensitizing agents in combination with ezetimibe, and valsartan in rats with non-alcoholic fatty liver disease

PubMed Central

Assy, Nimer; Grozovski, Masha; Bersudsky, Ilana; Szvalb, Sergio; Hussein, Osamah

2006-01-01

AIM: To assess whether treatment with insulin-sensitizing agents (ISAs) in combination with ezetimibe and valsartan have greater effect on hepatic fat content and lipid peroxidation compared to monotherapy in the methionine choline-deficient diet (MCDD) rat model of non-alcoholic fatty liver disease (NAFLD). METHODS: Rats (n = 6 per group) were treated with different drugs, including MCDD only, MCDD diet with either metformin (200 mg/kg), rosiglitazone (3 mg/kg), metformin plus rosiglitazone (M+R), ezetimibe (2 mg/kg), valsartan (2 mg/kg), or combination of all drugs for a total of 15 wk. Liver histology, lipids, parameters of oxidative stress and TNF-alpha were measured. RESULTS: Fatty liver (FL) rats demonstrated severe hepatic fatty infiltration (> 91% fat), with an increase in hepatic TG (+1263%, P < 0.001), hepatic cholesterol (+245%, P < 0.03), hepatic MDA levels (+225%, P < 0.001), serum TNF-alpha (17.8 ± 10 vs 7.8 ± 0.0, P < 0.001), but a decrease in hepatic alpha tocopherol (-74%, P < 0.001) as compared to the control rats. Combination therapy with all drugs produced a significant decrease in liver steatosis (-54%), hepatic TG (-64%), hepatic cholesterol (-31%) and hepatic MDA (-70%), but increased hepatic alpha tocopherol (+443%) as compared to FL rats. Combination therapy with ISA alone produced a smaller decrease in liver steatosis (-32% vs -54%, P < 0.001) and in hepatic MDA levels (-55% vs -70%, P < 0.01), but a similar decrease in hepatic lipids when compared with the all drugs combination. TNF-alpha levels decreased significantly in all treatment groups except in ISA group. CONCLUSION: Combination therapies have a greater effect on liver fat content as compared to monotherapy. Rosiglitazone appears to improve hepatic steatosis to a greater extent than metformin. PMID:16865780

Discharge conditions for CW and pulse-modulated surface-wave plasmas in low-temperature sterilization

NASA Astrophysics Data System (ADS)

Xu, L.; Terashita, F.; Nonaka, H.; Ogino, A.; Nagata, T.; Koide, Y.; Nanko, S.; Kurawaki, I.; Nagatsu, M.

2006-01-01

The discharge conditions required for low-temperature plasma sterilization were investigated using low-pressure surface-wave plasma (SWP). The discharge conditions for both continuous wave (CW) and pulse-modulated SWPs in low-temperature sterilization of Geobacillus stearothermophilus with a population of 1.5 × 106 and 3.0 × 106 were studied by varying the microwave input power from 500 W to 3 kW, and the effective plasma treatment time from 40 to 300 s. Results showed that sterilization was possible in a shorter treatment time using a higher microwave power for both CW and pulse-modulated SWPs. Pulse-modulated SWPs gave effective sterilization at a temperature roughly 10 to 20 °C below that of CW SWPs under the same average microwave power.

Mode suppression of a two-dimensional potential relaxation instability in a weakly magnetized discharge plasma

NASA Astrophysics Data System (ADS)

Gyergyek, T.; Čerček, M.; Jelić, N.; Stanojević, M.

1993-05-01

A potential relaxation instability (PRI) is modulated by an external signal using an additional grid to modulate the radial plasma potential profile in a magnetized plasma column in a linear magnetized discharge plasma device. It is observed that the electrode current oscillations follow the van der Pol equation with an external forcing term, and the linear growth rate of the instability is measured.

An amplitude modulated radio frequency plasma generator

NASA Astrophysics Data System (ADS)

Lei, Fan; Li, Xiaoping; Liu, Yanming; Liu, Donglin; Yang, Min; Xie, Kai; Yao, Bo

2017-04-01

A glow discharge plasma generator and diagnostic system has been developed to study the effects of rapidly variable plasmas on electromagnetic wave propagation, mimicking the plasma sheath conditions encountered in space vehicle reentry. The plasma chamber is 400 mm in diameter and 240 mm in length, with a 300-mm-diameter unobstructed clear aperture. Electron densities produced are in the mid 1010 electrons/cm3. An 800 W radio frequency (RF) generator is capacitively coupled through an RF matcher to an internally cooled stainless steel electrode to form the plasma. The RF power is amplitude modulated by a waveform generator that operates at different frequencies. The resulting plasma contains electron density modulations caused by the varying power levels. A 10 GHz microwave horn antenna pair situated on opposite sides of the chamber serves as the source and detector of probe radiation. The microwave power feed to the source horn is split and one portion is sent directly to a high-speed recording oscilloscope. On mixing this with the signal from the pickup horn antenna, the plasma-induced phase shift between the two signals gives the path-integrated electron density with its complete time dependent variation. Care is taken to avoid microwave reflections and extensive shielding is in place to minimize electronic pickup. Data clearly show the low frequency modulation of the electron density as well as higher harmonics and plasma fluctuations.

Plasma Heating and Ultrafast Semiconductor Laser Modulation Through a Terahertz Heating Field

NASA Technical Reports Server (NTRS)

Li, Jian-Zhong; Ning, C. Z.

2000-01-01

Electron-hole plasma heating and ultrafast modulation in a semiconductor laser under a terahertz electrical field are investigated using a set of hydrodynamic equations derived from the semiconductor Bloch equations. The self-consistent treatment of lasing and heating processes leads to the prediction of a strong saturation and degradation of modulation depth even at moderate terahertz field intensity. This saturation places a severe limit to bandwidth achievable with such scheme in ultrafast modulation. Strategies for increasing modulation depth are discussed.

Optimizing the electrical excitation of an atmospheric pressure plasma advanced oxidation process.

PubMed

Olszewski, P; Li, J F; Liu, D X; Walsh, J L

2014-08-30

The impact of pulse-modulated generation of atmospheric pressure plasma on the efficiency of organic dye degradation has been investigated. Aqueous samples of methyl orange were exposed to low temperature air plasma and the degradation efficiency was determined by absorbance spectroscopy. The plasma was driven at a constant frequency of 35kHz with a duty cycle of 25%, 50%, 75% and 100%. Relative concentrations of dissolved nitrogen oxides, pH, conductivity and the time evolution of gas phase ozone were measured to identify key parameters responsible for the changes observed in degradation efficiency. The results indicate that pulse modulation significantly improved dye degradation efficiency, with a plasma pulsed at 25% duty showing a two-fold enhancement. Additionally, pulse modulation led to a reduction in the amount of nitrate contamination added to the solution by the plasma. The results clearly demonstrate that optimization of the electrical excitation of the plasma can enhance both degradation efficiency and the final water quality. Copyright © 2014 Elsevier B.V. All rights reserved.

Demonstration of Plasma Arc Environmental Technology Applications for the Demilitrization of DOD Stockpiles

NASA Technical Reports Server (NTRS)

Smith, Ed; Dee, P. E.; Zaghloul, Hany; Filius, Krag; Rivers, Tim

2000-01-01

Since 1989 the US Army Construction Engineering Research Laboratories (USACERL) have been active participants in the research and development towards establishing Plasma Arc Technology (PAT) as an efficient, economical, and safe hazardous waste immobilization tool. A plasma torch capable of generating high temperatures makes this technology a viable and powerful tool for the thermal destruction of various military industrial waste streams into an innocuous ceramic material no longer requiring hazardous waste landfill disposal. The emerging plasma environmental thermal treatment process has been used to safely and efficiently meet the waste disposal needs for various demilitarized components disposal needs, such as: (1) pyrotechnic smoke assemblies, (2) thermal batteries, (3) proximity fuses, (4) cartridge actuated devices (CADs), and (5) propellant actuated devices (PADs). MSE Technology Applications, Inc., (MSE) has proposed and fabricated a Mobile Plasma Treatment System to be a technology demonstrator for pilotscale mobile plasma waste processing. The system is capable of providing small-scale waste remediation services, and conducting waste stream applicability demonstrations. The Mobile Plasma Treatment System's innovative concept provides the flexibility to treat waste streams at numerous sites and sites with only a limited quantity of waste, yet too hazardous to transport to a regional fixed facility. The system was designed to be operated as skid mounted modules; consisting of a furnace module, controls module, offgas module, and ancillary systems module. All system components have been integrated to be operated from a single control station with both semi-continuous feeding and batch slag-pouring capability.

Development of a Suitable Dissolution Method for the Combined Tablet Formulation of Atorvastatin and Ezetimibe by RP-LC Method.

PubMed

Ozkan Cansel, Kose; Ozgur, Esim; Sevinc, Kurbanoglu; Ayhan, Savaser; Ozkan, Sibel A; Yalcin, Ozkan

2016-01-01

Pharmaceutical preparations of ezetimibe and atorvastatin are generally used to regulate the lipid level in blood. It decreases the secondary events for patients with high cholesterol and clinical cardiovascular disease such as non-fatal or fatal heart attack. There is no any pharmacopoeia method available for the dissolution testing recommended by the FDA. Development of dissolution tests method is very critical parameter especially for the pharmaceutical preparations that contain Class II drugs (slightly soluble, good permeable). In the proposed method, the effects of pH and surfactant on the dissolution of poorly water soluble combined drug therapy with a different pKa values in an in vitro environment is investigated. The content of our study was designed to answer these open-ended questions. The optimized test conditions achieved under sink conditions with USP apparatus 2 at a paddle rotation speed of 75 rpm and 900 ml in 0.01 M Acetate buffer (pH= 6.8) containing 0.45% SDS as a dissolution medium. Quantification of dissolution samples were analyzed with a new fully validated RP-LC method with UV detection at 242 nm.

Microemulsion Liquid Chromatographic Method for Simultaneous Determination of Simvastatin and Ezetimibe in Their Combined Dosage Forms

PubMed Central

Hammouda, Mohammed E. A.; Abu El-Enin, Mohamed A.; El-Sherbiny, Dina T.; El-Wasseef, Dalia R.; El-Ashry, Saadia M.

2013-01-01

A rapid HPLC procedure using a microemulsion as an eluent was developed and validated for analytical quality control of antihyperlipidemic mixture containing simvastatin (SIM) and ezetimibe (EZT) in their pharmaceutical preparations. The separation was performed on a column packed with cyano bonded stationary phase adopting UV detection at 238 nm using a flow rate of 1 mL/min. The optimized microemulsion mobile phase consisted of 0.2 M sodium dodecyl sulphate, 1% octanol, 10% n-propanol, and 0.3% triethylamine in 0.02 M phosphoric acid at pH 5.0. The developed method was validated in terms of specificity, linearity, lower limit of quantification (LOQ), lower limit of detection (LOD), precision, and accuracy. The proposed method is rapid (8.5 min), reproducible (RSD < 2.0%) and achieves satisfactory resolution between SIM and EZT (resolution factor = 2.57). The mean recoveries of the analytes in pharmaceutical preparations were in agreement with those obtained from a reference method, as revealed by statistical analysis of the obtained results using Student's t-test and the variance ratio F-test. PMID:24282651

The variable rotation period of the inner region of Saturn's plasma disk.

PubMed

Gurnett, D A; Persoon, A M; Kurth, W S; Groene, J B; Averkamp, T F; Dougherty, M K; Southwood, D J

2007-04-20

We show that the plasma and magnetic fields in the inner region of Saturn's plasma disk rotate in synchronism with the time-variable modulation period of Saturn's kilometric radio emission. This relation suggests that the radio modulation has its origins in the inner region of the plasma disk, most likely from a centrifugally driven convective instability and an associated plasma outflow that slowly slips in phase relative to Saturn's internal rotation. The slippage rate is determined by the electrodynamic coupling of the plasma disk to Saturn and by the drag force exerted by its interaction with the Enceladus neutral gas torus.

Homozygous autosomal dominant hypercholesterolaemia: prevalence, diagnosis, and current and future treatment perspectives.

PubMed

Sjouke, Barbara; Hovingh, G Kees; Kastelein, John J P; Stefanutti, Claudia

2015-06-01

Homozygous autosomal dominant hypercholesterolemia (hoADH) is a rare genetic disorder caused by mutations in LDL receptor, apolipoprotein B, and/or proprotein convertase subtilisin-kexin type 9. Both the genetic mutations and the clinical phenotype vary largely among individual patients, but patients with hoADH are typically characterized by extremely elevated LDL-cholesterol (LDL-C) levels, and a very high-risk for premature cardiovascular disease. Current lipid-lowering therapies include bile acid sequestrants, statins, and ezetimibe. To further decrease LDL-C levels in hoADH, lipoprotein apheresis is recommended, but this therapy is not available in all countries. Recently, the microsomal triglyceride transfer protein inhibitor lomitapide and the RNA antisense inhibitor of apolipoprotein B mipomersen were approved by the Food and Drug Administration/European Medicine Agency and the Food and Drug Administration, respectively. Several other LDL-C-lowering strategies and therapeutics targeting the HDL-C pathway are currently in the clinical stage of development. Novel therapies have been introduced for LDL-C-lowering and innovative drug candidates for HDL-C modulation for the treatment of hoADH. Here, we review the current available literature on the prevalence, diagnosis, and therapeutic strategies for hoADH.

Effect of evolocumab or ezetimibe added to moderate- or high-intensity statin therapy on LDL-C lowering in patients with hypercholesterolemia: the LAPLACE-2 randomized clinical trial.

PubMed

Robinson, Jennifer G; Nedergaard, Bettina S; Rogers, William J; Fialkow, Jonathan; Neutel, Joel M; Ramstad, David; Somaratne, Ransi; Legg, Jason C; Nelson, Patric; Scott, Rob; Wasserman, Scott M; Weiss, Robert

2014-05-14

In phase 2 studies, evolocumab, a fully human monoclonal antibody to PCSK9, reduced LDL-C levels in patients receiving statin therapy. To evaluate the efficacy and tolerability of evolocumab when used in combination with a moderate- vs high-intensity statin. Phase 3, 12-week, randomized, double-blind, placebo- and ezetimibe-controlled study conducted between January and December of 2013 in patients with primary hypercholesterolemia and mixed dyslipidemia at 198 sites in 17 countries. Patients (n = 2067) were randomized to 1 of 24 treatment groups in 2 steps. Patients were initially randomized to a daily, moderate-intensity (atorvastatin [10 mg], simvastatin [40 mg], or rosuvastatin [5 mg]) or high-intensity (atorvastatin [80 mg], rosuvastatin [40 mg]) statin. After a 4-week lipid-stabilization period, patients (n = 1899) were randomized to compare evolocumab (140 mg every 2 weeks or 420 mg monthly) with placebo (every 2 weeks or monthly) or ezetimibe (10 mg or placebo daily; atorvastatin patients only) when added to statin therapies. Percent change from baseline in low-density lipoprotein cholesterol (LDL-C) level at the mean of weeks 10 and 12 and at week 12. Evolocumab reduced LDL-C levels by 66% (95% CI, 58% to 73%) to 75% (95% CI, 65% to 84%) (every 2 weeks) and by 63% (95% CI, 54% to 71%) to 75% (95% CI, 67% to 83%) (monthly) vs placebo at the mean of weeks 10 and 12 in the moderate- and high-intensity statin-treated groups; the LDL-C reductions at week 12 were comparable. For moderate-intensity statin groups, evolocumab every 2 weeks reduced LDL-C from a baseline mean of 115 to 124 mg/dL to an on-treatment mean of 39 to 49 mg/dL; monthly evolocumab reduced LDL-C from a baseline mean of 123 to 126 mg/dL to an on-treatment mean of 43 to 48 mg/dL. For high-intensity statin groups, evolocumab every 2 weeks reduced LDL-C from a baseline mean of 89 to 94 mg/dL to an on-treatment mean of 35 to 38 mg/dL; monthly evolocumab reduced LDL-C from a baseline mean of 89 to 94 mg/dL to an on-treatment mean of 33 to 35 mg/dL. Adverse events were reported in 36%, 40%, and 39% of evolocumab-, ezetimibe-, and placebo-treated patients, respectively. The most common adverse events in evolocumab-treated patients were back pain, arthralgia, headache, muscle spasms, and pain in extremity (all <2%). In this 12-week trial conducted among patients with primary hypercholesterolemia and mixed dyslipidemia, evolocumab added to moderate- or high-intensity statin therapy resulted in additional LDL-C lowering. Further studies are needed to evaluate the longer-term clinical outcomes and safety of this approach for LDL-C lowering. clinicaltrials.gov Identifier: NCT01763866.

Electron emission and plasma generation in a modulator electron gun using ferroelectric cathode

NASA Astrophysics Data System (ADS)

Chen, Shutao; Zheng, Shuxin; Zhu, Ziqiu; Dong, Xianlin; Tang, Chuanxiang

2006-10-01

Strong electron emission and dense plasma generation have been observed in a modulator electron gun with a Ba 0.67Sr 0.33TiO 3 ferroelectric cathode. Parameter of the modulator electron gun and lifetime of the ferroelectric cathode were investigated. It was shown that electron emission from Ba 0.67Sr 0.33TiO 3 cathode with a positive triggering pulse is a sort of plasma emission. Electrons were emitted by the co-effect of surface plasma and non-compensated negative polarization charges at the surface of the ferroelectric. The element analyses of the graphite collector after emission process was performed to show the ingredient of the plasma consist of Ba, Ti and Cu heavy cations of the ceramic compound and electrode. It was demonstrated the validity of the Child-Langmuir law by introducing the decrease of vacuum gap and increase of emission area caused by the expansion of the surface plasma.

Plasma-assisted CO2 conversion: optimizing performance via microwave power modulation

NASA Astrophysics Data System (ADS)

Britun, Nikolay; Silva, Tiago; Chen, Guoxing; Godfroid, Thomas; van der Mullen, Joost; Snyders, Rony

2018-04-01

Significant improvement in the energy efficiency of plasma-assisted CO2 conversion is achieved with applied power modulation in a surfaguide microwave discharge. The obtained values of CO2 conversion and energy efficiency are, respectively, 0.23 and 0.33 for a 0.95 CO2  +  0.05 N2 gas mixture. Analysis of the energy relaxation mechanisms shows that power modulation can potentially affect the vibrational-translational energy exchange in plasma. In our case, however, this mechanism does not play a major role, likely due to the low degree of plasma non-equilibrium in the considered pressure range. Instead, the gas residence time in the discharge active zone together with plasma pulse duration are found to be the main factors affecting the CO2 conversion efficiency at low plasma pulse repetition rates. This effect is confirmed experimentally by the in situ time-resolved two-photon absorption laser-induced fluorescence measurements of CO molecular density produced in the discharge as a result of CO2 decomposition.

Effects of radial envelope modulations on the collisionless trapped-electron mode in tokamak plasmas

NASA Astrophysics Data System (ADS)

Chen, Hao-Tian; Chen, Liu

2018-05-01

Adopting the ballooning-mode representation and including the effects of radial envelope modulations, we have derived the corresponding linear eigenmode equation for the collisionless trapped-electron mode in tokamak plasmas. Numerical solutions of the eigenmode equation indicate that finite radial envelope modulations can affect the linear stability properties both quantitatively and qualitatively via the significant modifications in the corresponding eigenmode structures.

Plasma-anode electron gun

NASA Astrophysics Data System (ADS)

Santoru, Joseph; Schumacher, Robert W.; Gregoire, Daniel J.

1994-11-01

The plasma-anode electron gun (PAG) is an electron source in which the thermionic cathode is replaced with a cold, secondary-electron-emitting electrode. Electron emission is stimulated by bombarding the cathode with high-energy ions. Ions are injected into the high-voltage gap through a gridded structure from a plasma source (gas pressure less than or equal to 50 mTorr) that is embedded in the anode electrode. The gridded structure serves as both a cathode for the plasma discharge and as an anode for the PAG. The beam current is modulated at near ground potential by modulating the plasma source, eliminating the need for a high-voltage modulator system. During laboratory tests, the PAG has demonstrated square-wave, 17-microsecond-long beam pulses at 100 kV and 10 A, and it has operated stably at 70 kV and 2.5 A for 210 microsecond pulse lengths without gap closure.

Creosote Bush (Larrea tridentata) Improves Insulin Sensitivity and Reduces Plasma and Hepatic Lipids in Hamsters Fed a High Fat and Cholesterol Diet

PubMed Central

Del Vecchyo-Tenorio, Georgina; Rodríguez-Cruz, Maricela; Andrade-Cetto, Adolfo; Cárdenas-Vázquez, René

2016-01-01

Creosote bush, Larrea tridentata (Sesse y Moc. Ex DC, Zygophyllaceae) is a shrub found in the deserts of Northern Mexico and Southwestern United States. In traditional medicine, it is used to treat a variety of illnesses including type 2 diabetes. The present study aims to investigate the effects of creosote bush ethanolic extract on plasma and liver parameters associated with the metabolic syndrome in hamsters fed a high fat and cholesterol diet (HFD), comparing them with those induced by ezetimibe (EZ). Seven groups of six hamsters each were formed. Six groups were fed HFD for 2 weeks. The following 2 weeks, the HFD groups received: (1) only HFD, (2) HFD + 3 mg% EZ, (3) HFD + 0.2% creosote bush ethanolic extract, (4) only standard diet (Std Diet), (5) Std Diet + 3 mg% EZ, (6) Std Diet + 0.2% creosote bush ethanolic extract. The beneficial effects of creosote bush ethanolic extract in the HFD hamster model were a reduction of insulin resistance, associated with lower serum insulin and leptin, lower hepatic lipid peroxidation and higher liver antioxidant capacity. Plasma and liver lipids tended or were reduced to values closer to those of animals fed standard diet. A similar effect on lipids was induced by EZ, although with even lower hepatic cholesterol and total lipids concentrations. In general, the change from HFD to standard diet plus ethanolic extract induced the same but deeper changes, including a reduction in plasma glucose and an increase in the percentage of HDL cholesterol. Unlike creosote bush extract, EZ increased food consumption and neutral fecal steroids, with no significant effect on body weight, epididymal fat pads, liver peroxidation or antioxidant capacity. Also EZ did not modify serum insulin and leptin. However, insulin sensitivity improved to values similar to those induced by the extract. This suggests that the mechanism of action of creosote bush ethanolic extract is different to inhibition of cholesterol absorption or increase excretion. The ethanolic extract of L. tridentata could be useful in the treatment of the metabolic syndrome. PMID:27445827

Studies on omnidirectional enhancement of giga-hertz radiation by sub-wavelength plasma modulation

NASA Astrophysics Data System (ADS)

Fanrong, KONG; Qiuyue, NIE; Shu, LIN; Zhibin, WANG; Bowen, LI; Shulei, ZHENG; Binhao, JIANG

2018-01-01

The technology of radio frequency (RF) radiation intensification for radio compact antennas based on modulation and enhancement effects of sub-wavelength plasma structures represents an innovative developing strategy. It exhibits important scientific significance and promising potential of broad applications in various areas of national strategic demands, such as electrical information network and microwave communication, detection and control technology. In this paper, laboratory experiments and corresponding analyses have been carried out to investigate the modulation and enhancement technology of sub-wavelength plasma structure on the RF electromagnetic radiation. An application focused sub-wavelength plasma-added intensification up to ∼7 dB higher than the free-space radiation is observed experimentally in giga-hertz (GHz) RF band. The effective radiation enhancement bandwidth covers from 0.85 to 1.17 GHz, while the enhanced electromagnetic signals transmitted by sub-wavelength plasma structures maintain good communication quality. Particularly, differing from the traditional RF electromagnetic radiation enhancement method characterized by focusing the radiation field of antenna in a specific direction, the sub-wavelength plasma-added intensification of the antenna radiation presents an omnidirectional enhancement, which is reported experimentally for the first time. Corresponding performance characteristics and enhancement mechanism analyses are also conducted in this paper. The results have demonstrated the feasibility and promising potential of sub-wavelength plasma modulation in application focused RF communication, and provided the scientific basis for further research and development of sub-wavelength plasma enhanced compact antennas with wide-range requests and good quality for communication.

Simulations of a beam-driven plasma antenna in the regime of plasma transparency

NASA Astrophysics Data System (ADS)

Timofeev, I. V.; Berendeev, E. A.; Dudnikova, G. I.

2017-09-01

In this paper, the theoretically predicted possibility to increase the efficiency of electromagnetic radiation generated by a thin beam-plasma system in the regime of oblique emission, when a plasma column becomes transparent to radiation near the plasma frequency, is investigated using particle-in-cell simulations. If a finite-size plasma column has a longitudinal density modulation, such a system is able to radiate electromagnetic waves as a dipole antenna. This radiation mechanism is based on the conversion of an electron beam-driven potential plasma wave on the periodic perturbation of plasma density. In this case, the frequency of radiated waves appears to be slightly lower than the plasma frequency. That is why their fields enable the penetration into the plasma only to the skin-depth. This case is realized when the period of density modulation coincides with the wavelength of the most unstable beam-driven mode, and the produced radiation escapes from the plasma in the purely transverse direction. In the recent theoretical paper [I. V. Timofeev et al. Phys. Plasmas 23, 083119 (2016)], however, it has been found that the magnetized plasma can be transparent to this radiation at certain emission angles. It means that the beam-to-radiation power conversion can be highly efficient even in a relatively thick plasma since not only boundary layers but also the whole plasma volume can be involved in the generation of electromagnetic waves. Simulations of steady-state beam injection into a pre-modulated plasma channel confirm the existence of this effect and show limits of validity for the simplified theoretical model.

Utilization Patterns of Lipid-lowering Therapies in Patients With Atherosclerotic Cardiovascular Disease or Diabetes: A Population-based Study in South Korea.

PubMed

Kim, Siin; Kim, Hyungtae; Kim, Eunju; Han, Sola; Rane, Pratik P; Fox, Kathleen M; Zhao, Zhongyun; Qian, Yi; Suh, Hae Sun

2018-06-01

We aimed to study the utilization patterns of lipid-lowering treatment (LLT), including treatment modification, adherence, and possible statin intolerance, in patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes using national claims data in South Korea. A retrospective cohort study was conducted using data from the Korean Health Insurance Review & Assessment Service claims database. Patients aged ≥18 years with >1 outpatient pharmacy claim for a statin and/or ezetimibe dated January 1, 2012, to December 31, 2014, were identified and categorized into the following cohorts: patients with ASCVD, and patients with diabetes mellitus without ASCVD. LLT modification, adherence to index LLT, and possible statin intolerance were explored during the 12 months after the date of first prescription for a statin and/or ezetimibe. Among 1,399,872 patients who met the eligibility criteria, 807,547 (57.7%) were patients with ASCVD and 592,325 (42.3%) were patients with diabetes without ASCVD. About half of the patients had no modification in their index treatment (46.2% in the ASCVD cohort and 48.9% in the diabetes cohort), and the most common modification was permanent discontinuation (19.6% in the ASCVD cohort and 21.4% in the diabetes cohort). The mean medication possession ratios were 0.77 in the ASCVD cohort and 0.73 in the diabetes cohort and showed a decreasing trend during the 12-month follow-up period. Among patients who initiated a statin and/or ezetimibe, possible statin intolerance was observed in 53,921 patients (6.7%) in the ASCVD cohort and 42,172 patients (7.1%) in the diabetes cohort. In South Korea, a high rate of permanent discontinuation of statin therapy in patients with ASCVD or diabetes places these patients at high risk for cardiovascular events in the future. A decreasing trend of adherence to LLT implies that more intensive education and management are required to improve therapeutic effect and reduce the risk for ASCVD. The high rate of possible statin intolerance highlights an unmet need in the prevention and management of ASCVD in South Korea. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

Demonstration of Plasma Arc Environmental Technology Applications for the Demilitarization of DOD Stockpiles

NASA Technical Reports Server (NTRS)

Smith, Ed; Zaghloul, Hany; Filius, Krag; Rivers, Tim

2000-01-01

Since 1989 the U.S. Army Construction Engineering Research Laboratories (USACERL) have been active participants in the research and development toward establishing Plasma Arc Technology (PAT) as an efficient, economical, and safe hazardous waste immobilization tool. A plasma torch capable of generating high temperatures makes this technology a viable and powerful tool for the thermal destruction of various military industrial waste streams into an innocuous ceramic material no longer requiring hazardous waste landfill (Class 1) disposal. The emerging pl asma environmental thermal treatment process, has been used to safely and efficiently meet the waste disposal needs for various demilitarized components disposal needs, such as: pyrotechnic smoke assemblies, thermal batteries, proximity fuses, cartridge actuated devices (CAD's), and propellant actuated devices (PAD's). MSE Technology Applications, Inc., (MSE) has proposed and fabricated a Mobile Plasma Treatment System to be a technology demonstrator for pilot-scale mobile plasma waste processing. The system is capable of providing small-scale waste remediation services, and conducting waste stream applicability demonstrations. The Mobile Plasma Treatment System's innovative concept provides the flexibility to treat waste streams at numerous sites and sites with only a limited quantity of waste, yet too hazardous to transport to a regional fixed facility. The system was designed to be operated as skid mounted modules; consisting of a furnace module, controls module, offgas module, and ancillary systems module. All system components have been integrated to be operated from a single control station with both semi-continuous feeding and batch slag-pouring capability.

Inhibition of vincristine binding to plasma membrane vesicles from daunorubicin-resistant Ehrlich ascites cells by multidrug resistance modulators.

PubMed Central

Sehested, M.; Jensen, P. B.; Skovsgaard, T.; Bindslev, N.; Demant, E. J.; Friche, E.; Vindeløv, L.

1989-01-01

The multidrug resistance (MDR) phenotype is presumed to be mostly dependent on changes in the resistant cell plasma membrane, notably the emergence of a 170 kDa glycoprotein called P-glycoprotein, which facilitate increased drug efflux. We have previously demonstrated that ATP-enhanced binding of vincristine (VCR) to plasma membrane vesicles is much greater in MDR than in wild type cells. The present study has shown that VCR binding to MDR Ehrlich ascites tumour cell plasma membrane vesicles is inhibited 50% most efficiently by quinidine (0.5 microM) followed by verapamil (4.1 microM) and trifluoperazine (23.2 microM). This is the reverse order of the effect on whole cells where a ranking of efficiency in terms of enhancement of VCR accumulation, inhibition of VCR efflux, DNA perturbation and modulation of resistance in a clonogenic assay, was trifluoperazine greater than or equal to verapamil much greater than quinidine. The detergent Tween 80 inhibited VCR binding to plasma membrane vesicles at 0.001% v/v which agreed with the level which modulated resistance and increased VCR accumulation in whole cells. No effect was observed on daunorubicin binding to MDR plasma membrane vesicles after incubation with either Tween 80 (up to 0.1% v/v) or verapamil (up to 25 microM). We conclude that the effect of a modulating drug in reversing resistance to VCR correlates with its ability to raise intracellular VCR levels but not with its capability to inhibit VCR binding to the plasma membrane. Thus, enhancement of VCR accumulation in MDR cells is hardly solely due to competition for a drug binding site on P-glycoprotein. Furthermore, the lack of a demonstrable effect on daunorubicin binding to the plasma membrane by modulators points to transport mechanisms which do not utilise specific drug binding to the plasma membrane. PMID:2605092

Nonlinear Right-Hand Polarized Wave in Plasma in the Electron Cyclotron Resonance Region

NASA Astrophysics Data System (ADS)

Krasovitskiy, V. B.; Turikov, V. A.

2018-05-01

The propagation of a nonlinear right-hand polarized wave along an external magnetic field in subcritical plasma in the electron cyclotron resonance region is studied using numerical simulations. It is shown that a small-amplitude plasma wave excited in low-density plasma is unstable against modulation instability with a modulation period equal to the wavelength of the excited wave. The modulation amplitude in this case increases with decreasing detuning from the resonance frequency. The simulations have shown that, for large-amplitude waves of the laser frequency range propagating in plasma in a superstrong magnetic field, the maximum amplitude of the excited longitudinal electric field increases with the increasing external magnetic field and can reach 30% of the initial amplitude of the electric field in the laser wave. In this case, the energy of plasma electrons begins to substantially increase already at magnetic fields significantly lower than the resonance value. The laser energy transferred to plasma electrons in a strong external magnetic field is found to increase severalfold compared to that in isotropic plasma. It is shown that this mechanism of laser radiation absorption depends only slightly on the electron temperature.

Investigation of torque generated by Test Blanket Module mock-up in DIII-D

NASA Astrophysics Data System (ADS)

Salmi, A.; Tala, T.; Lanctot, M.; Degrassie, J. S.; Paz-Soldan, C.; Logan, N.; Solomon, W. M.; Grierson, B. A.

2015-11-01

Experiments at DIII-D have investigated the scaling of Test Blanket Module (TBM) torque with plasma pressure and collisionality by performing dimensionless parameter scans. In each configuration, neutral beam torque modulation and TBM torque modulation were sequentially applied to allow experimental characterization of the TBM generated torque and the underlying transport. Calculations of the neoclassical toroidal viscosity (NTV) torque with PENT code of these plasmas find that TBM torque is strongly edge localized while the tentative experimental analysis indicates a more radially broad TBM torque profile. Both the experimental and PENT results will be elaborated and experimental TBM torque scaling with pressure and collisionality presented. Experimental validation of existing plasma response and NTV torque models is an important step toward understanding the impact of magnetic field ripple on plasma rotation, and for predicting the required compensation fields. Work supported by the US Department of Energy under DE-AC52-07NA27344, DE-FC02-04ER54698 and DE-AC02-09CH11466.

Amplitude modulation of quantum-ion-acoustic wavepackets in electron-positron-ion plasmas: Modulational instability, envelope modes, extreme wavesa)

NASA Astrophysics Data System (ADS)

Rahman, Ata-ur-; Kerr, Michael Mc; El-Taibany, Wael F.; Kourakis, Ioannis; Qamar, A.

2015-02-01

A semirelativistic fluid model is employed to describe the nonlinear amplitude modulation of low-frequency (ionic scale) electrostatic waves in an unmagnetized electron-positron-ion plasma. Electrons and positrons are assumed to be degenerated and inertialess, whereas ions are warm and classical. A multiscale perturbation method is used to derive a nonlinear Schrödinger equation for the envelope amplitude, based on which the occurrence of modulational instability is investigated in detail. Various types of localized ion acoustic excitations are shown to exist, in the form of either bright type envelope solitons (envelope pulses) or dark-type envelope solitons (voids, holes). The plasma configurational parameters (namely, the relativistic degeneracy parameter, the positron concentration, and the ionic temperature) are shown to affect the conditions for modulational instability significantly, in fact modifying the associated threshold as well as the instability growth rate. In particular, the relativistic degeneracy parameter leads to an enhancement of the modulational instability mechanism. Furthermore, the effect of different relevant plasma parameters on the characteristics (amplitude, width) of these envelope solitary structures is also presented in detail. Finally, the occurrence of extreme amplitude excitation (rogue waves) is also discussed briefly. Our results aim at elucidating the formation and dynamics of nonlinear electrostatic excitations in superdense astrophysical regimes.

Particle transport characteristics of the RT-1 magnetospheric plasma using gas-puffing modulation technique

NASA Astrophysics Data System (ADS)

Kenmochi, Naoki; Nishiura, Masaki; Yoshida, Zensho; Sugata, Tetsuya; Nakamura, Kaori; Katsura, Shotaro

2017-10-01

The Ring Trap 1 (RT-1) device creates a laboratory magnetosphere that is realized by a levitated superconducting ring magnet in vacuum. The RT-1 experiment has demonstrated the self-organization of a plasma clump with a steep density gradient; a peaked density distribution is spontaneously created through `inward diffusion'. In order to evaluate particle transport characteristics in the RT-1 magnetospheric plasmas which cause these inward diffusion, density modulation experiments were performed in the RT-1. Density modulation is a powerful method for estimating a diffusion coefficient D and a convection velocity V by puffing a periodic neutral gas. The gas puff modulation causes the change in the electron density measured by two chords of microwave interferometer (the radial positions r = 60 and 70 cm, vertical chord). In the case of 2 Hz gas puff modulation, the phase delay and the modulation-amplitude decay at the chord r = 60 cm are obtained with 15 degree and 0.8, respectively, with respect to the phase and the amplitude at r = 70 cm. The particle balance equations are solved on the assumption of profile shapes for D to evaluate D, V and particle source rate. The result suggests the inward convection in high beta magnetospheric plasmas.

Dark and grey compressional dispersive Alfven solitons in plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shukla, P. K.; Eliasson, B.; Stenflo, L.

2011-06-15

The amplitude modulation of compressional dispersive Alfven (CDA) waves in a low-{beta} plasma is considered. It is shown that the dynamics of modulated CDA waves is governed by a cubic nonlinear Schroedinger equation, which depicts the formation of a dark/grey envelope CDA soliton.

High Voltage, Fast-Switching Module for Active Control of Magnetic Fields and Edge Plasma Currents

NASA Astrophysics Data System (ADS)

Ziemba, Timothy; Miller, Kenneth; Prager, James; Slobodov, Ilia

2016-10-01

Fast, reliable, real-time control of plasma is critical to the success of magnetic fusion science. High voltage and current supplies are needed to mitigate instabilities in all experiments as well as disruption events in large scale tokamaks for steady-state operation. Silicon carbide (SiC) MOSFETs offer many advantages over IGBTs including lower drive energy requirements, lower conduction and switching losses, and higher switching frequency capabilities; however, these devices are limited to 1.2-1.7 kV devices. As fusion enters the long-pulse and burning plasma eras, efficiency of power switching will be important. Eagle Harbor Technologies (EHT), Inc. developing a high voltage SiC MOSFET module that operates at 10 kV. This switch module utilizes EHT gate drive technology, which has demonstrated the ability to increase SiC MOSFET switching efficiency. The module will allow more rapid development of high voltage switching power supplies at lower cost necessary for the next generation of fast plasma feedback and control. EHT is partnering with the High Beta Tokamak group at Columbia to develop detailed high voltage module specifications, to ensure that the final product meets the needs of the fusion science community.

Self-modulational formation of pulsar microstructures

NASA Technical Reports Server (NTRS)

Kennel, C. F.; Chian, A. C.-L.

1987-01-01

A nonlinear plasma theory for self modulation of pulsar radio pulses is discussed. A nonlinear Schroedinger equation is derived for strong electromagnetic waves propagating in an electron positron plasma. The nonlinearities arising from wave intensity induced particle mass variation may excite the modulational instability of circularly and linearly polarized pulsar radiation. The resulting wave envelopes can take the form of periodic wave trains or solitons. These nonlinear stationary waveforms may account for the formation of pulsar microstructures.

Influence of P-glycoprotein modulation on plasma concentrations and pharmacokinetics of orally administered prednisolone in dogs.

PubMed

Van der Heyden, Sara; Croubels, Siska; Gadeyne, Caroline; Ducatelle, Richard; Daminet, Sylvie; Murua Escobar, Hugo; Sterenczak, Katharina; Polis, Ingeborgh; Schauvliege, Stijn; Hesta, Myriam; Chiers, Koen

2012-06-01

To evaluate the impact of modulation of the membrane-bound efflux pump P-glycoprotein (P-gp) on plasma concentrations of orally administered prednisolone in dogs. 7 healthy adult Beagles. Each dog received 3 treatments (control [no treatment], rifampicin [100 mg/d, PO, for 21 days, as an inducer of P-gp], and ketoconazole [100 mg/d, PO, for 21 days, as an inhibitor of P-gp]). A single dose of prednisolone (1 mg/kg, PO) was administered on day 8 of each treatment period. There was a 7-day washout period between subsequent treatments. Plasma concentrations of prednisolone were determined by use of a validated liquid chromatography-tandem mass spectrometry method. Duodenum and colon biopsy specimens were obtained endoscopically from anesthetized dogs and assessed for P-gp protein labeling via immunohistochemical analysis and mRNA quantification via real-time PCR assay. Total fecal collection was performed for evaluation of effects of P-gp modulation on digestion of nutrients. Rifampicin treatment upregulated duodenal P-gp in dogs and significantly reduced the area under the plasma concentration-time curve of prednisolone. Ketoconazole typically downregulated expression of duodenal P-gp, with a subsequent increase in the area under the plasma concentration-time curve of prednisolone. There was a noticeable interindividual difference in response. Digestion of nutrients was not affected. Modulation of P-gp expression influenced plasma concentrations of prednisolone after oral administration in dogs. Thus, treatment response to prednisolone may be influenced by coadministration of P-gp-modulating medications or feed ingredients.

Physicochemical characterization of atorvastatin calcium/ezetimibe amorphous nano-solid dispersions prepared by electrospraying method.

PubMed

Jahangiri, Azin; Barzegar-Jalali, Mohammad; Javadzadeh, Yousef; Hamishehkar, Hamed; Adibkia, Khosro

2017-09-01

In the present study, electrospraying was applied as a novel method for the fabrication of amorphous nano-solid dispersions (N-SDs) of atorvastatin calcium (ATV), ezetimibe (EZT), and ATV/EZT combination as poorly water-soluble drugs. N-SDs were prepared using polyvinylpyrrolidone K30 as an amorphous carrier in 1:1 and 1:5 drug to polymer ratios and the total solid (including drug and polymer) concentrations of 10 and 20% (w/v). The prepared formulations were further investigated for their morphological, physicochemical, and dissolution properties. Scanning electron microscopy studies indicated that the morphology and diameter of the electrosprayed samples (ESs) were influenced by the solution concentration and drug:polymer ratio, so that an increase in the solution concentration resulted in fiber formation while an increase in the polymer ratio led to enhancement of the particle diameter. Differential scanning calorimetry and X-ray powder diffraction studies together with in vitro dissolution test revealed that the ESs were present in an amorphous form with improved dissolution properties. Infrared spectroscopic studies showed hydrogen-bonding interaction between the drug and polymer in ESs. Since the electrospraying method benefits from the both amorphization and nanosizing effect, this novel approach seems to be an efficient method for the fabrication of N-SDs of poorly water-soluble drugs.

Clinical implications of the IMPROVE-IT trial in the light of current and future lipid-lowering treatment options.

PubMed

Serban, Maria-Corina; Banach, Maciej; Mikhailidis, Dimitri P

2016-01-01

A residual risk of morbidity and mortality from cardiovascular (CV) disease remains despite statin therapy. This situation has generated an interest in finding novel approaches of combining statins with other lipid-lowering agents, or finding new lipid and non-lipid targets, such as triglycerides, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, proprotein convertase subtilisin/kexin type 9 (PCSK9) gene, cholesterol ester transfer protein (CETP), lipoprotein (a), fibrinogen or C-reactive protein. The recent results from the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) demonstrated an incremental clinical benefit when ezetimibe, a non-statin agent, was added to simvastatin therapy. The results from IMPROVE-IT revalidated the concept that low-density lipoprotein cholesterol (LDL-C) levels are a clinically relevant treatment goal. This trial also suggested that further decrease of LDL-C levels (53 vs. 70 mg/dl; 1.4 vs. 1.8 mmol/l) was more beneficial in lowering CV events. This "even lower is even better" evidence for LDL-C levels may influence future guidelines and the use of new drugs. Furthermore, these findings make ezetimibe a more realistic option to treat patients with statin intolerance or those who cannot achieve LDL-C targets with statin monotherapy.

Cholesterol auxotrophy and intolerance to ezetimibe in mice with SREBP-2 deficiency in the intestine.

PubMed

Rong, Shunxing; McDonald, Jeffrey G; Engelking, Luke J

2017-10-01

SREBP-2 activates transcription of all genes needed for cholesterol biosynthesis. To study SREBP-2 function in the intestine, we generated a mouse model ( Vil-BP2 -/- ) in which Cre recombinase ablates SREBP-2 in intestinal epithelia. Intestines of Vil-BP2 -/- mice had reduced expression of genes required for sterol synthesis, in vivo sterol synthesis rates, and epithelial cholesterol contents. On a cholesterol-free diet, the mice displayed chronic enteropathy with histological abnormalities of both villi and crypts, growth restriction, and reduced survival that was prevented by supplementation of cholesterol in the diet. Likewise, SREBP-2-deficient enteroids required exogenous cholesterol for growth. Blockade of luminal cholesterol uptake into enterocytes with ezetimibe precipitated acutely lethal intestinal damage in Vil-BP2 -/- mice, highlighting the critical interplay in the small intestine of sterol absorption via NPC1L1 and sterol synthesis via SREBP-2 in sustaining the intestinal mucosa. These data show that the small intestine requires SREBP-2 to drive cholesterol synthesis that sustains the intestinal epithelia when uptake of cholesterol from the gut lumen is not available, and provide a unique example of cholesterol auxotrophy expressed in an intact, adult mammal. Copyright © 2017 by the American Society for Biochemistry and Molecular Biology, Inc.

Modification of modulated plasma plumes for the quasi-phase-matching of high-order harmonics in different spectral ranges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganeev, R. A., E-mail: rashid-ganeev@mail.ru; Ophthalmology and Advanced Laser Medical Center, Saitama Medical University, Saitama 350-0495; Boltaev, G. S.

We demonstrate the technique allowing the fine tuning of the distance between the laser-produced plasma plumes on the surfaces of different materials, as well as the variation of the sizes of these plumes. The modification of plasma formations is based on the tilting of the multi-slit mask placed between the heating laser beam and target surface, as well as the positioning of this mask in the telescope placed on the path of heating radiation. The modulated plasma plumes with the sizes of single plume ranging between 0.1 and 1 mm were produced on the manganese and silver targets. Modification of themore » geometrical parameters of plasma plumes proved to be useful for the fine tuning of the quasi-phase-matched high-order harmonics generated in such structures during propagation of the ultrashort laser pulses. We show the enhancement of some groups of harmonics along the plateau range and the tuning of maximally enhanced harmonic by variable modulation of the plasma.« less

Origin and therapy for hypertriglyceridaemia in type 2 diabetes

PubMed Central

Pang, Jing; Chan, Dick C; Watts, Gerald F

2014-01-01

Hypertriglyceridaemia (HTG) is a risk factor for cardiovascular disease (CVD) in type 2 diabetes and is caused by the interaction of genes and non-genetic factors, specifically poor glycaemic control and obesity. In spite of statin treatment, residual risk of CVD remains high in type 2 diabetes, and this may relate to HTG and atherogenic dyslipidemia. Treatment of HTG emphasises correcting secondary factors and adverse lifestyles, in particular, diet and exercise. Pharmacotherapy is also required in most type 2 diabetic patients. Statins are the first-line therapy to achieve recommended therapeutic targets of plasma low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Fibrates, ezetimibe and n-3 fatty acids are adjunctive treatment options for residual and persistent HTG. Evidence for the use of niacin has been challenged by non-significant CVD outcomes in two recent large clinical trials. Further investigation is required to clarify the use of incretin-based therapies for HTG in type 2 diabetes. Extreme HTG, with risk of pancreatitis, may require insulin infusion therapy or apheresis. New therapies targeting HTG in diabetes need to be tested in clinical endpoint trials. The purpose of this review is to examine the current evidence and provide practical guidance on the management of HTG in type 2 diabetes. PMID:24748930

Progress on the DPASS project

NASA Astrophysics Data System (ADS)

Galkin, Sergei A.; Bogatu, I. N.; Svidzinski, V. A.

2015-11-01

A novel project to develop Disruption Prediction And Simulation Suite (DPASS) of comprehensive computational tools to predict, model, and analyze disruption events in tokamaks has been recently started at FAR-TECH Inc. DPASS will eventually address the following aspects of the disruption problem: MHD, plasma edge dynamics, plasma-wall interaction, generation and losses of runaway electrons. DPASS uses the 3-D Disruption Simulation Code (DSC-3D) as a core tool and will have a modular structure. DSC is a one fluid non-linear, time-dependent 3D MHD code to simulate dynamics of tokamak plasma surrounded by pure vacuum B-field in the real geometry of a conducting tokamak vessel. DSC utilizes the adaptive meshless technique with adaptation to the moving plasma boundary, with accurate magnetic flux conservation and resolution of the plasma surface current. DSC has also an option to neglect the plasma inertia to eliminate fast magnetosonic scale. This option can be turned on/off as needed. During Phase I of the project, two modules will be developed: the computational module for modeling the massive gas injection and main plasma respond; and the module for nanoparticle plasma jet injection as an innovative disruption mitigation scheme. We will report on this development progress. Work is supported by the US DOE SBIR grant # DE-SC0013727.

Dust ion acoustic freak waves in a plasma with two temperature electrons featuring Tsallis distribution

NASA Astrophysics Data System (ADS)

Chahal, Balwinder Singh; Singh, Manpreet; Shalini; Saini, N. S.

2018-02-01

We present an investigation for the nonlinear dust ion acoustic wave modulation in a plasma composed of charged dust grains, two temperature (cold and hot) nonextensive electrons and ions. For this purpose, the multiscale reductive perturbation technique is used to obtain a nonlinear Schrödinger equation. The critical wave number, which indicates where the modulational instability sets in, has been determined precisely for various regimes. The influence of plasma background nonextensivity on the growth rate of modulational instability is discussed. The modulated wavepackets in the form of either bright or dark type envelope solitons may exist. Formation of rogue waves from bright envelope solitons is also discussed. The investigation indicates that the structural characteristics of these envelope excitations (width, amplitude) are significantly affected by nonextensivity, dust concentration, cold electron-ion density ratio and temperature ratio.

Segmented saddle-shaped passive stabilization conductors for toroidal plasmas

DOEpatents

Leuer, James A.

1990-05-01

A large toroidal vacuum chamber for plasma generation and confinement is lined with a toroidal blanket for shielding using modules segmented in the toroidal direction. To provide passive stabilization in the same manner as a conductive vacuum chamber wall, saddle-shaped conductor loops are provided on blanket modules centered on a midplane of the toroidal chamber with horizontal conductive bars above and below the midplane, and vertical conductive legs on opposite sides of each module to provide return current paths between the upper and lower horizontal conductive bars. The close proximity of the vertical legs provided on adjacent modules without making physical contact cancel the electromagnetic field of adjacent vertical legs. The conductive bars spaced equally above and below the midplane simulate toroidal conductive loops or hoops that are continuous, for vertical stabilization of the plasma even though they are actually segmented.

Bleeding complications in dengue are not associated with significant changes in the modulators of the endothelial barrier.

PubMed

Orsi, Fernanda Andrade; Angerami, Rodrigo Nogueira; Mazetto, Bruna Moraes; Quaino, Susan Kelly Picoli; De Paula, Erich Vinícius; Annichino-Bizzachi, Joyce Maria

2014-06-11

Bleeding complications in dengue may occur irrespective of the presence of plasma leakage. We compared plasma levels of modulators of the endothelial barrier among three dengue groups: bleedings without plasma leakage, dengue hemorrhagic fever, and non-complicated dengue. The aim was to evaluate whether the presence of subtle alterations in microvascular permeability could be detected in bleeding patients. Plasma levels of VEGF-A and its soluble receptors were not associated with the occurrence of bleeding in patients without plasma leakage. These results provide additional rationale for considering bleeding as a complication independent of endothelial barrier breakdown, as proposed by the 2009 WHO classification.

Coherent transition radiation from a self-modulated charged particle beam

NASA Astrophysics Data System (ADS)

Xu, X.; Yu, P.; An, W.; Lu, W.; Mori, W. B.

2012-12-01

Plasma wakefield accelerator utilizing a TeV proton beam is a promising method to generate a TeV electron beam. However the length of the existing proton beam is too long compared with the proper plasma skin depth. As a result selfmodulation instability takes place after such a long pulse enters into the plasma. The transverse spot size of the long beam changes periodically in the longitudinal direction. Therefor measurement of the coherent transition radiation when the selfmodulated beam leaves the plasma is a possible method to demonstrate the self-modulation instability. In this paper, we analyze the angular spectrum of this coherent transition radiation when the beam comes from plasma to vacuum.

EFFECTS OF LASER RADIATION ON MATTER. LASER PLASMA: Microwave generation in an optical breakdown plasma created by modulated laser radiation

NASA Astrophysics Data System (ADS)

Antipov, A. A.; Grasyuk, Arkadii Z.; Losev, Leonid L.; Soskov, V. I.

1990-06-01

It was established that when laser radiation, intensity modulated at a frequency of 2.2 GHz, interacted with an optical breakdown plasma which it had created, a microwave component appeared in the thermal emf of the plasma. The amplitude of the microwave thermal emf reached 0.7 V for a laser radiation intensity of 6 GW/cm2. Laser radiation with λL = 1.06 μm was converted to the microwave range with λmω = 13 cm in the optical breakdown plasma. A microwave signal power of ~ 0.5 W was obtained from a laser power of ~ 5 MW.

Non-linear lumped model circuit of capacitively coupled plasmas at the intermediate radio-frequencies

NASA Astrophysics Data System (ADS)

Shihab, Mohammed

2018-06-01

The discharge dynamics in geometrically asymmetric capacitively coupled plasmas are investigated via a lumped model circuit. A realistic reactor configuration is assumed. A single and two separate RF voltage sources are considered. One of the driven frequencies (the higher frequency) has been adjusted to excite a plasma series resonance, while the second frequency (the lower frequency) is in the range of the ion plasma frequency. Increasing the plasma pressure in the low pressure regime (≤ 100mTorr) is found to diminish the amplitude of the self-excited harmonics of the discharge current, however, the net result is enhancing the plasma heating. The modulation of the ion density with the lower driving frequency affect the plasma heating considerably. The net effect depends on the amplitude and the phase of the ion modulation.

Modulational instability of helicon waves in a magnetoactive semiconductor n-InSb

NASA Astrophysics Data System (ADS)

Salimullah, M.; Ferdous, T.

1984-03-01

In this paper the modulational instabilithy of a beam of high amplitude helicon wave in a magnetoactive piezoelectric semiconductor is studied. The nonlinear response of electrons in the semiconductor plasma has been found by following the fluid model of homogeneous plasmas. The low frequency nonlinearity has been taken through the ponderomotive force on electrons, whereas the nonlinearity in the scattered helicon waves arises through the nonlinear current densities of electrons. For typical plasma parameters in n-type indium antimonide and for a considerable power density (approximately 20 kW/sq cm) of the incident helicon beam, the growth rate of the modulational instability is quite high (approximately 10 to the 7th rad/s).

Spatially modulated phase in the holographic description of quark-gluon plasma.

PubMed

Ooguri, Hirosi; Park, Chang-Soon

2011-02-11

We present a string theory construction of a gravity dual of a spatially modulated phase. Our earlier work shows that the Chern-Simons term in the five-dimensional Maxwell theory destabilizes the Reissner-Nordström black holes in anti-de Sitter space if the Chern-Simons coupling is sufficiently high. In this Letter, we show that a similar instability is realized on the world volume of 8-branes in the Sakai-Sugimoto model in the quark-gluon plasma phase. Our result suggests a new spatially modulated phase in quark-gluon plasma when the baryon density is above 0.8Nf  fm(-3) at temperature 150 MeV.

Modulational instability of beat waves in a transversely magnetized plasma: Ion effects

NASA Astrophysics Data System (ADS)

Ferdous, T.; Amin, M. R.; Salimullah, M.

1996-05-01

The effect of ion dynamics on the modulational instability of the electrostatic beat wave at the difference frequency of two incident laser beams in a hot, collisionless, and transversely magnetized plasma has been studied theoretically. The full Vlasov equation in terms of gyrokinetic variables is employed to obtain the nonlinear response of ions and electrons. It is found that the growth rate of modulational instability is about two orders higher when ion motions are included.

In situ Observations of Magnetosonic Waves Modulated by Background Plasma Density

NASA Astrophysics Data System (ADS)

Yu, X.; Yuan, Z.; Huang, S.; Wang, D.; Funsten, H. O.

2017-12-01

We report in situ observations by the Van Allen Probe mission that magnetosonic (MS) waves are clearly relevant to appear relevant to the background plasma number density. As the satellite moved across dense and tenuous plasma alternatively, MS waves occurred only in lower density region. As the observed protons with 'ring' distributions provide free energy, local linear growth rates are calculated and show that magnetosonic waves can be locally excited in tenuous plasma. With variations of the background plasma density, the temporal variations of local wave growth rates calculated with the observed proton ring distributions, show a remarkable agreement with those of the observed wave amplitude. Therefore, the paper provides a direct proof that background plasma densities can modulate the amplitudes of magnetosonic waves through controlling the wave growth rates.

Process Development for Automated Solar Cell and Module Production. Task 4: Automated Array Assembly

NASA Technical Reports Server (NTRS)

1979-01-01

A baseline sequence for the manufacture of solar cell modules was specified. Starting with silicon wafers, the process goes through damage etching, texture etching, junction formation, plasma edge etch, aluminum back surface field formation, and screen printed metallization to produce finished solar cells. The cells were then series connected on a ribbon and bonded into a finished glass tedlar module. A number of steps required additional developmental effort to verify technical and economic feasibility. These steps include texture etching, plasma edge etch, aluminum back surface field formation, array layup and interconnect, and module edge sealing and framing.

Graphene Oxide: A Perfect Material for Spatial Light Modulation Based on Plasma Channels

PubMed Central

Tan, Chao; Wu, Xinghua; Wang, Qinkai; Tang, Pinghua; Shi, Xiaohui; Zhan, Shiping; Xi, Zaifang; Fu, Xiquan

2017-01-01

The graphene oxide (GO) is successfully prepared from a purified natural graphite through a pressurized oxidation method. We experimentally demonstrate that GO as an optical media can be used for spatial light modulation based on plasma channels induced by femtosecond pulses. The modulated beam exhibits good propagation properties in free space. It is easy to realize the spatial modulation on the probe beam at a high concentration of GO dispersion solutions, high power and smaller pulse width of the pump beam. We also find that the spatial modulation on the probe beam can be conveniently adjusted through the power and pulse width of pump lasers, dispersion solution concentration. PMID:28772712

Device for plasma confinement and heating by high currents and nonclassical plasma transport properties

DOEpatents

Coppi, B.; Montgomery, D.B.

1973-12-11

A toroidal plasma containment device having means for inducing high total plasma currents and current densities and at the same time emhanced plasma heating, strong magnetic confinement, high energy density containment, magnetic modulation, microwaveinduced heating, and diagnostic accessibility is described. (Official Gazette)

Gas mixing enhanced by power modulations in atmospheric pressure microwave plasma jet

NASA Astrophysics Data System (ADS)

Voráč, J.; Potočňáková, L.; Synek, P.; Hnilica, J.; Kudrle, V.

2016-04-01

Microwave plasma jet operating in atmospheric pressure argon was power modulated by audio frequency sine envelope in the 102 W power range. Its effluent was imaged using interference filters and ICCD camera for several different phases of the modulating signal. The combination of this fast imaging with spatially resolved optical emission spectroscopy provides useful insights into the plasmachemical processes involved. Phase-resolved schlieren photography was performed to visualize the gas dynamics. The results show that for higher modulation frequencies the plasma chemistry is strongly influenced by formation of transient flow perturbation resembling a vortex during each period. The perturbation formation and speed are strongly influenced by the frequency and power variations while they depend only weakly on the working gas flow rate. From application point of view, the perturbation presence significantly broadened lateral distribution of active species, effectively increasing cross-sectional area suitable for applications.

Segmented saddle-shaped passive stabilization conductors for toroidal plasmas

DOEpatents

Leuer, J.A.

1990-05-01

A large toroidal vacuum chamber for plasma generation and confinement is lined with a toroidal blanket for shielding using modules segmented in the toroidal direction. To provide passive stabilization in the same manner as a conductive vacuum chamber wall, saddle-shaped conductor loops are provided on blanket modules centered on a midplane of the toroidal chamber with horizontal conductive bars above and below the midplane, and vertical conductive legs on opposite sides of each module to provide return current paths between the upper and lower horizontal conductive bars. The close proximity of the vertical legs provided on adjacent modules without making physical contact cancel the electromagnetic field of adjacent vertical legs. The conductive bars spaced equally above and below the midplane simulate toroidal conductive loops or hoops that are continuous, for vertical stabilization of the plasma even though they are actually segmented. 5 figs.

Two dimensional fluid simulation in capacitively coupled silane discharges

NASA Astrophysics Data System (ADS)

Song, Yuan-Hong; Liu, Xiang-Mei; Wang, Yan; Wang, You-Nian

2011-10-01

A two-dimensional (2D) self-consistent fluid model is developed to describe the formation, subsequent growth, transport and charging mechanisms of nanoparticles in a capacitively coupled silane plasma. In this discharge process, large anions are produced by a series of chemical reactions of anions with silane molecules, while the lower limit of the initial nanoparticles are taken as large anions to directly link the coagulation module with the nucleation module. The influences of source parameters on the electron density, electron temperature, nanoparticle uniformity, and deposition rate, are carefully studied. Moreover, the behavior of silicon plasma mixed with SiH4, N2 and O2 in a pulse modulated capacitively coupled plasma has been also investigated. Results showed a strong dependence of the electron density and electron temperature on the duty cycle and the modulated frequency. Supported by NSFC (No.10775025 and No. 10805008), INSTSP (Grant No: 2011ZX02403-001), and PNCETU (NCET-08-0073).

Indirect self-modulation instability measurement concept for the AWAKE proton beam

NASA Astrophysics Data System (ADS)

Turner, M.; Petrenko, A.; Biskup, B.; Burger, S.; Gschwendtner, E.; Lotov, K. V.; Mazzoni, S.; Vincke, H.

2016-09-01

AWAKE, the Advanced Proton-Driven Plasma Wakefield Acceleration Experiment, is a proof-of-principle R&D experiment at CERN using a 400 GeV / c proton beam from the CERN SPS (longitudinal beam size σz = 12 cm) which will be sent into a 10 m long plasma section with a nominal density of ≈ 7 ×1014 atoms /cm3 (plasma wavelength λp = 1.2 mm). In this paper we show that by measuring the time integrated transverse profile of the proton bunch at two locations downstream of the AWAKE plasma, information about the occurrence of the self-modulation instability (SMI) can be inferred. In particular we show that measuring defocused protons with an angle of 1 mrad corresponds to having electric fields in the order of GV/m and fully developed self-modulation of the proton bunch. Additionally, by measuring the defocused beam edge of the self-modulated bunch, information about the growth rate of the instability can be extracted. If hosing instability occurs, it could be detected by measuring a non-uniform defocused beam shape with changing radius. Using a 1 mm thick Chromox scintillation screen for imaging of the self-modulated proton bunch, an edge resolution of 0.6 mm and hence an SMI saturation point resolution of 1.2 m can be achieved.

Ultrafast Modulation and Switching of Quantum-Well Lasers using Terahertz Fields

NASA Technical Reports Server (NTRS)

Ning, Cun-Zheng; Hughes, S.; Citrin, D.; Saini, Subhash (Technical Monitor)

1998-01-01

Modulation and switching of semiconductor lasers are important for laser-based information technology. Typically the speed of modulation and switching is limited by interband processes such as stimulated and spontaneous recombinations which occur on a nanosecond time scale. This is why the diode laser modulation has been restricted to tens of GHz. Modulation at higher speed is highly desirable as the information technology enters into the so-called tera-era. In this paper, we study the possibility of utilizing THz-field-induced plasma heating to modulate quantum-well lasers. This is a timely study since, with the advancement of THz solid-state sources and free-electron lasers, THz physics and related technology is currently coming out of its infancy. The investigation of interplaying THz and optical fields is also of intruiging fundamental interest. First, we introduce theoretical plasma heating results for the quantum-well optical amplifier in the presense of an intense half-cycle THz pulse. The heated carrier distributions are then utilized to calculate the THz-pulse-induced change in refractive index and gain profile. Since the electron-hole-plasma is heated using intraband transitions, we circumvent the usual complications due to an overall change in density, and the nonlinear recovery is governed solely by the carrier-LO-phonon interactions, typically 5 ps for a complete recovery. This procedure implies THz and sub-THz switching and recovery rates, respectively; using either gain modulation or index modulation. Plasma heating via steady-state THz fields is also studied. Finally, numerical simulation of a coupled set of equations to investigate the THz modulation based on a simplified model for quantum-well lasers is presented. Our results show that a semiconductor laser can be modulated at up to 1 THz with little distortion with a THz field amplitude at the order of a few kV/cm. Laser responses to a change in THz frequency will be shown. Constraints, practicalities, and applications will be discussed.

Response function of modulated grid Faraday cup plasma instruments

NASA Technical Reports Server (NTRS)

Barnett, A.; Olbert, S.

1986-01-01

Modulated grid Faraday cup plasma analyzers are a very useful tool for making in situ measurements of space plasmas. One of their great attributes is that their simplicity permits their angular response function to be calculated theoretically. An expression is derived for this response function by computing the trajectories of the charged particles inside the cup. The Voyager plasma science experiment is used as a specific example. Two approximations to the rigorous response function useful for data analysis are discussed. Multisensor analysis of solar wind data indicates that the formulas represent the true cup response function for all angles of incidence with a maximum error of only a few percent.

Modulation of C-reactive protein and plasma omega-6 fatty acid levels by phospholipase A2 gene polymorphisms following a 6-week supplementation with fish oil.

PubMed

Tremblay, B L; Rudkowska, I; Couture, P; Lemieux, S; Julien, P; Vohl, M C

2015-12-01

This clinical trial investigated the impact of a six-week supplementation with fish oil and single nucleotide polymorphisms (SNPs) in PLA2G4A and PLA2G6 genes on total omega-6 fatty acid (n-6 FA) levels in plasma phospholipids (PL) and plasma C-reactive protein (CRP) levels in 191 subjects. Interaction effects between SNPs and supplementation modulated total n-6 FAs and CRP levels in both men and women. Associations between SNPs and total n-6 FA levels and between SNPs and CRP levels were identified in men, independently of supplementation. Supplementation decreased total n-6 FAs without affecting plasma CRP levels. Changes in CRP levels correlated positively with changes in total n-6 FAs in men (r=0.25 p=0.01), but not in women. In conclusion, total n-6 FA levels in plasma PL and plasma CRP levels are modulated by SNPs within PLA2G4A and PLA2G6 genes alone or in combination with fish oil supplementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Extended capability of the integrated transport analysis suite, TASK3D-a, for LHD experiment

NASA Astrophysics Data System (ADS)

Yokoyama, M.; Seki, R.; Suzuki, C.; Sato, M.; Emoto, M.; Murakami, S.; Osakabe, M.; Tsujimura, T. Ii.; Yoshimura, Y.; Ido, T.; Ogawa, K.; Satake, S.; Suzuki, Y.; Goto, T.; Ida, K.; Pablant, N.; Gates, D.; Warmer, F.; Vincenzi, P.; Simulation Reactor Research Project, Numerical; LHD Experiment Group

2017-12-01

The integrated transport analysis suite, TASK3D-a (Analysis), has been developed to be capable for routine whole-discharge analyses of plasmas confined in three-dimensional (3D) magnetic configurations such as the LHD. The routine dynamic energy balance analysis for NBI-heated plasmas was made possible in the first version released in September 2012. The suite has been further extended through implementing additional modules for neoclassical transport and ECH deposition for 3D configurations. A module has also been added for creating systematic data for the International Stellarator-Heliotron Confinement and Profile Database. Improvement of neutral beam injection modules for multiple-ion species plasmas and loose coupling with a large-simulation code are also highlights of recent developments.

Accurate quantitation of circulating cell-free mitochondrial DNA in plasma by droplet digital PCR.

PubMed

Ye, Wei; Tang, Xiaojun; Liu, Chu; Wen, Chaowei; Li, Wei; Lyu, Jianxin

2017-04-01

To establish a method for accurate quantitation of circulating cell-free mitochondrial DNA (ccf-mtDNA) in plasma by droplet digital PCR (ddPCR), we designed a ddPCR method to determine the copy number of ccf-mtDNA by amplifying mitochondrial ND1 (MT-ND1). To evaluate the sensitivity and specificity of the method, a recombinant pMD18-T plasmid containing MT-ND1 sequences and mtDNA-deleted (ρ 0 ) HeLa cells were used, respectively. Subsequently, different plasma samples were prepared for ddPCR to evaluate the feasibility of detecting plasma ccf-mtDNA. In the results, the ddPCR method showed high sensitivity and specificity. When the DNA was extracted from plasma prior to ddPCR, the ccf-mtDNA copy number was higher than that measured without extraction. This difference was not due to a PCR inhibitor, such as EDTA-Na 2 , an anti-coagulant in plasma, because standard EDTA-Na 2 concentration (5 mM) did not significantly inhibit ddPCR reactions. The difference might be attributable to plasma exosomal mtDNA, which was 4.21 ± 0.38 copies/μL of plasma, accounting for ∼19% of plasma ccf-mtDNA. Therefore, ddPCR can quickly and reliably detect ccf-mtDNA from plasma with a prior DNA extraction step, providing for a more accurate detection of ccf-mtDNA. The direct use of plasma as a template in ddPCR is suitable for the detection of exogenous cell-free nucleic acids within plasma, but not of nucleic acids that have a vesicle-associated form, such as exosomal mtDNA. Graphical Abstract Designs of the present work. *: Module 1, #: Module 2, &: Module 3.

Familial Hypercholesterolemia

PubMed Central

Bouhairie, Victoria Enchia; Goldberg, Anne Carol

2015-01-01

Familial hypercholesterolemia is a common, inherited disorder of cholesterol metabolism that leads to early cardiovascular morbidity and mortality. It is underdiagnosed and undertreated. Statins, ezetimibe, bile acid sequestrants, niacin, lomitapide, mipomersen and LDL apheresis are treatments that can lower LDL cholesterol levels. Early treatment can lead to substantial reduction of cardiovascular events and death in patients with FH. It is important to increase awareness of this disorder in physicians and patients in order to reduce the burden of this disorder. PMID:25939291

Statins in primary biliary cirrhosis: are they safe?

PubMed

Abu Rajab, Murad; Kaplan, Marshall M

2010-07-01

Although cholesterol levels are elevated in patients with primary biliary cirrhosis (PBC), most PBC patients are not at increased risk of dying from atherosclerotic heart disease. There is, however, a subgroup, approximately 10%, who have additional disorders of lipid metabolism. They might benefit from a cholesterol-lowering agent. However, there is concern about using statins in patients with pre-existing liver disease. We therefore reviewed our experience with statins in a large cohort of PBC patients who were seen at Tufts Medical Center during the past decade. From January 1, 1996, until June 30, 2006, 603 patients with PBC were seen by one of us (M.M.K.). Fifty-eight were on statins and five were on ezetimibe. The mean duration of usage was 41 months (range 3-125 months). Alanine aminotransferase (ALT) levels were measured at 3-month intervals. Statins were well tolerated. No patient complained of muscle pain or weakness. There was no increase in ALT levels. ALT levels were slightly elevated at the time that statins were begun (41.7 +/- 25.1 U/l), and were normal at the last time these patients were seen (39.0 +/- 21.0 U/l) (P

Gateways to clinical trials.

PubMed

Tomillero, A; Moral, M A

2010-05-01

O(6)-Benzylguanine; (-)-Gossypol; Abatacept, AC-2592, Adalimumab, AIDSVAX gp120 B/E, Alemtuzumab, Aliskiren fumarate, ALVAC E120TMG, Ambrisentan, Amlodipine, Anakinra, Aripiprazole, Armodafinil, Atomoxetine hydrochloride, Avotermin; Bevacizumab, BIBW-2992, Bortezomib, Bosentan, Botulinum toxin type B; Canakinumab, CAT-354, Ciclesonide, CMV gB vaccine, Corifollitropin alfa, Daptomycin, Darbepoetin alfa, Dasatinib, Denosumab; EndoTAG-1, Eplerenone, Esomeprazole sodium, Eszopiclone, Etoricoxib, Everolimus, Exenatide, Ezetimibe, Ezetimibe/simvastatin; F-50040, Fesoterodine fumavate, Fondaparinux sodium, Fulvestrant; Gabapentin enacarbil, Golimumab; Imatinib mesylate, Inhalable human insulin, Insulin glargine, Ivabradine hydrochloride; Lercanidipine hydrochloride/enalapril maleate, Levosimendan, Liposomal vincristine sulfate, Liraglutide; MDV-3100, Mometasone furoate/formoterol fumavate, Multiepitope CTL peptide vaccine, Mycophenolic acid sodium salt, Nabiximols, Natalizumab, Nesiritide; Obeticholic acid, Olmesartan medoxomil, Omalizumab, Omecamtiv mecarbil; Paclitaxel-eluting stent, Paliperidone, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Peginterferon alfa-2b/ ribavirin, Pemetrexed disodium, Polymyxin B nonapeptide, PORxin-302, Prasugrel, Pregabalin, Pridopidine; Ranelic acid distrontium salt, Rasagiline mesilate, rDEN4delta30-4995, Recombinant human relaxin H2, rhFSH, Rilonacept, Rolofylline, Rosiglitazone maleate/metformin hydrochloride, Rosuvastatin calcium, Rotigotine; Salcaprozic acid sodium salt, Sirolimus-eluting stent, Sitagliptin phosphate monohydrate, Sitaxentan sodium, Sorafenib, Sunitinib malate; Tadalafil, Tapentadol hydrochloride, Temsirolimus, Tenofovir, Tenofovir disoproxil fumarate, Teriparatide, Tiotropium bromide, Tocilizumab, Tolvaptan, Tozasertib, Treprostinil sodium; Ustekinumab; Vardenafil hydrochloride hydrate, Varenicline tartrate, Vatalanib succinate, Voriconazole, Vorinostat; Zotarolimus-eluting stent. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.

The combination of ezetimibe and ursodiol promotes fecal sterol excretion and reveals a G5G8-independent pathway for cholesterol elimination[S

PubMed Central

Wang, Yuhuan; Liu, Xiaoxi; Pijut, Sonja S.; Li, Jianing; Horn, Jamie; Bradford, Emily M.; Leggas, Markos; Barrett, Terrence A.; Graf, Gregory A.

2015-01-01

Previous studies suggest an interdependent relationship between liver and intestine for cholesterol elimination from the body. We hypothesized that a combination of ursodiol (Urso) and ezetimibe (EZ) could increase biliary secretion and reduce cholesterol reabsorption, respectively, to promote cholesterol excretion. Treatment with Urso increased hepatic ABCG5 ABCG8 (G5G8) protein and both biliary and fecal sterols in a dose-dependent manner. To determine whether the drug combination (Urso-EZ) further increased cholesterol excretion, mice were treated with Urso alone or in combination with two doses of EZ. EZ produced an additive and dose-dependent increase in fecal neutral sterol (FNS) elimination in the presence of Urso. Finally, we sequentially treated wide-type and G5G8-deficient mice with Urso and Urso-EZ to determine the extent to which these effects were G5G8 dependent. Although biliary and FNS were invariably lower in G5G8 KO mice, the relative increase in FNS following treatment with Urso alone or the Urso-EZ combination was not affected by genotype. In conclusion, Urso increases G5G8, biliary cholesterol secretion, and FNS and acts additively with EZ to promote fecal sterol excretion. However, the stimulatory effect of these agents was not G5G8 dependent. PMID:25635125

Atmospheric pressure plasma analysis by modulated molecular beam mass spectrometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aranda Gonzalvo, Y.; Whitmore, T.D.; Rees, J.A.

Fractional number density measurements for a rf plasma 'needle' operating at atmospheric pressure have been obtained using a molecular beam mass spectrometer (MBMS) system designed for diagnostics of atmospheric plasmas. The MBMS system comprises three differentially pumped stages and a mass/energy analyzer and includes an automated beam-to-background measurement facility in the form of a software-controlled chopper mechanism. The automation of the beam modulation allows the neutral components in the plasma to be rapidly and accurately measured using the mass spectrometer by threshold ionization techniques. Data are reported for plasma generated by a needle plasma source operated using a helium/air mixture.more » In particular, data for the conversion of atmospheric oxygen and nitrogen into nitric oxide are discussed with reference to its significance for medical applications such as disinfecting wounds and dental cavities and for microsurgery.« less

Electrostatic wave modulation in collisional pair-ion plasmas

NASA Astrophysics Data System (ADS)

Sikdar, Arnab; Adak, Ashish; Ghosh, Samiran; Khan, Manoranjan

2018-05-01

The effects of ion-neutral collision on the electrostatic wave packets in the absence of the magnetic field in a pair-ion plasma have been investigated. Considering a two-fluid plasma model with the help of the standard perturbation technique, two distinct electrostatic modes have been observed, namely, a low-frequency ion acoustic mode and a high-frequency ion plasma mode. The dynamics of the modulated wave is governed by a damped nonlinear Schrödinger equation. Damping of the soliton occurs due to the ion-neutral collision. The analytical and numerical investigation reveals that the ion acoustic mode is both stable and unstable, which propagates in the form of dark solitons and bright solitons, respectively, whereas the ion plasma mode is unstable, propagating in the form of a bright soliton. Results are discussed in the context of the fullerene pair-ion plasma experiments.

Saturated Widths of Magnetic Islands in Tokamak Discharges

NASA Astrophysics Data System (ADS)

Halpern, F.; Pankin, A. Y.

2005-10-01

The new ISLAND module described in reference [1] implements a quasi-linear model to compute the widths of multiple magnetic islands driven by saturated tearing modes in toroidal plasmas of arbitrary aspect ratio and cross sectional shape. The distortion of the island shape caused by the radial variation in the perturbation is computed in the new module. In transport simulations, the enhanced transport caused by the magnetic islands has the effect of flattening the pressure and current density profiles. This self consistent treatment of the magnetic islands alters the development of the plasma profiles. In addition, it is found that islands closer to the magnetic axis influence the evolution of islands further out in the plasma. In order to investigate such phenomena, the ISLAND module is used within the BALDUR predictive modeling code to compute the widths of multiple magnetic islands in tokamak discharges. The interaction between the islands and sawtooth crashes is examined in simulations of DIII-D and JET discharges. The module is used to compute saturated neoclassical tearing mode island widths for multiple modes in ITER. Preliminary results for island widths in ITER are consistent with those presented [2] by Hegna. [1] F.D. Halpern, G. Bateman, A.H. Kritz and A.Y. Pankin, ``The ISLAND Module for Computing Magnetic Island Widths in Tokamaks,'' submitted to J. Plasma Physics (2005). [2] C.C. Hegna, 2002 Fusion Snowmass Meeting.

Comparisons of Measurements and Simulations of Turbulence and Transport for DIII-D Discharges with Off-Axis Modulated ECH

NASA Astrophysics Data System (ADS)

Bravenec, R. V.; Ross, D. W.; Austin, M. E.; Gentle, K. W.; Deboo, J. C.; DIII-D Team; McKee, G. R.; Dorland, W.; Rhodes, T. L.; Zeng, L.

2002-11-01

Experiments to elucidate the nature of electron thermal transport have been conducted in DIII-D plasmas using modulated off-axis electron-cyclotron heating (ECH). Density fluctuations were measured using beam-emission spectroscopy, microwave reflectometry, and far-infrared scattering. Simulations of the experiment are performed with the gyrokinetic and gyrofluid flux-tube codes GS2(F. Jenko, W. Dorland, M. Kotschenreuther, and B.N. Rogers, Phys. Plasmas 7), 1904 (2000) and refs. therein. and GRYFFIN,(W. Dorland and G.W. Hammett, Phys. Fluids B 5), 812 (1993); M.A. Beer and G.W. Hammett, Phys. Plasmas 3, 4046 (1996). respectively. Comparisons of experiment and simulation results for the fluctuations and transport fluxes (ion and electron) will be presented for both time-averaged and modulated quantities.

System design and operation of a 100 kilovolt, 2 kilohertz pulse modulator for plasma source ion implantation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reass, W.A.

1994-07-01

This paper describes the electrical design and operation of a high power modulator system implemented for the Los Alamos Plasma Source Ion Implantation (PSII) facility. To test the viability of the PSII process for various automotive components, the modulator must accept wide variations of load impedance. Components have varying area and composition which must be processed with different plasmas. Additionally, the load impedance may change by large factors during the typical 20 uS pulse, due to plasma displacement currents and sheath growth. As a preliminary design to test the system viability for automotive component implantation, suitable for a manufacturing environment,more » circuit topology must be able to directly scale to high power versions, for increased component through-put. We have chosen an evolutionary design approach with component families of characterized performance, which should Ion result in a reliable modulator system with component lifetimes. The modulator utilizes a pair of Litton L-3408 hollow beam amplifier tubes as switching elements in a ``hot-deck`` configuration. Internal to the main of planar triode hot deck, an additional pair decks, configured in a totem pole circuit, provide input drive to the L-3408 mod-anodes. The modulator can output over 2 amps average current (at 100 kV) with 1 kW of modanode drive. Diagnostic electronics monitor the load and stops pulses for 100 mS when a load arcs occur. This paper, in addition to providing detailed engineering design information, will provide operational characteristics and reliability data that direct the design to the higher power, mass production line capable modulators.« less

Space Station Freedom solar array panels plasma interaction test facility

NASA Technical Reports Server (NTRS)

Martin, Donald F.; Mellott, Kenneth D.

1989-01-01

The Space Station Freedom Power System will make extensive use of photovoltaic (PV) power generation. The phase 1 power system consists of two PV power modules each capable of delivering 37.5 KW of conditioned power to the user. Each PV module consists of two solar arrays. Each solar array is made up of two solar blankets. Each solar blanket contains 82 PV panels. The PV power modules provide a 160 V nominal operating voltage. Previous research has shown that there are electrical interactions between a plasma environment and a photovoltaic power source. The interactions take two forms: parasitic current loss (occurs when the currect produced by the PV panel leaves at a high potential point and travels through the plasma to a lower potential point, effectively shorting that portion of the PV panel); and arcing (occurs when the PV panel electrically discharges into the plasma). The PV solar array panel plasma interaction test was conceived to evaluate the effects of these interactions on the Space Station Freedom type PV panels as well as to conduct further research. The test article consists of two active solar array panels in series. Each panel consists of two hundred 8 cm x 8 cm silicon solar cells. The test requirements dictated specifications in the following areas: plasma environment/plasma sheath; outgassing; thermal requirements; solar simulation; and data collection requirements.

Exciting Alfven Waves using Modulated Electron Heating by High Power Microwaves

NASA Astrophysics Data System (ADS)

Wang, Yuhou; Gekelman, Walter; Pribyl, Patrick; van Compernolle, Bart; Papadopoulos, Konstantinos

2014-10-01

Experiments exploring the physics of ionospheric modification with intense perpendicular propagating waves (k-> ⊥B->0) on the Large Plasma Device (LaPD) at UCLA have been upgraded with the addition of a high power rapidly pulsed microwave source. The plasma is irradiated with ten pulses (250 kW X-band) near the upper-hybrid frequency. The pulses are modulated at a frequency of a fraction (0.1-1.0) of fci (ion cyclotron frequency). Based on a previous single-pulse experiment, the modulated electron heating may drive a large amplitude shear Alfvén wave (f

Equatorial Plasma Bubbles: Effect of Thermospheric Winds Modulated by DE3 Tidal Waves

NASA Astrophysics Data System (ADS)

Sidorova, L. N.; Filippov, S. V.

2018-03-01

A hypothesis about the effect of the tropospheric source on the longitudinal distributions of the equatorial plasma bubbles observed in the topside ionosphere was proposed earlier. It was supposed that this influence is transferred mainly by the thermospheric winds modulated by the DE3 tropospheric tidal waves. This conclusion was based on the discovered high degree correlation ( R ≅ 0.79) between the variations of the longitudinal distribution of the plasma bubbles and the neutral atmospheric density. In this work, the hypothesis of the effect of the thermospheric tidal waves on the plasma bubbles at the stage of their generation is subjected to further verification. With this purpose, the longitudinal distributions of the frequency of the plasma bubble observations at the different ionospheric altitudes ( 600 km, ROCSAT-1; 1100 km, ISS-b) are analyzed; their principal similarity is revealed. Comparative analysis of these distributions with the longitudinal profile of the deviations of the zonal thermospheric wind ( 400 km, CHAMP) modulated by the DE3 tidal wave is carried out; their considerable correlation ( R ≅ 0.69) is revealed. We conclude that the longitudinal variations of the zonal wind associated with DE3 tidal waves can effect the longitudinal variations in the appearance frequency of the initial "seeding" perturbations, which further evolve into the plasma bubbles.

Electronegative nonlinear oscillating modes in plasmas

NASA Astrophysics Data System (ADS)

Panguetna, Chérif Souleman; Tabi, Conrad Bertrand; Kofané, Timoléon Crépin

2018-02-01

The emergence of nonlinear modulated waves is addressed in an unmagnetized electronegative plasma made of Boltzmann electrons, Boltzmann negative ions and cold mobile positive ions. The reductive perturbation method is used to reduce the dynamics of the whole system to a cubic nonlinear Schrödinger equation, whose the nonlinear and dispersion coefficients, P and Q, are function of the negative ion parameters, namely the negative ion concentration ratio (α) and the electron-to-negative ion temperature ratio (σn). It is observed that these parameters importantly affect the formation of modulated ion-acoustic waves, either as exact solutions or via the activation of modulational instability. Especially, the theory of modulational instability is used to show the correlation between the parametric analysis and the formation of modulated solitons, obtained here as bright envelopes and kink-wave solitons.

Efficacy and safety of alirocumab in people with prediabetes vs those with normoglycaemia at baseline: a pooled analysis of 10 phase III ODYSSEY clinical trials.

PubMed

Leiter, L A; Müller-Wieland, D; Baccara-Dinet, M T; Letierce, A; Samuel, R; Cariou, B

2018-01-01

To assess the lipid-lowering efficacy and safety of alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, in people with hypercholesterolaemia and prediabetes at baseline vs people with normoglycaemia at baseline in a pooled analysis of 10 ODYSSEY phase III trials. People classified as having prediabetes had baseline HbA 1c ≥39 mmol/mol (5.7%) and <48 mmol/mol (6.5%), or two baseline fasting plasma glucose values ≥5.6 mmol/l (100 mg/dl) but no more than one fasting plasma glucose value ≥7.0 mmol/l (126 mg/dl), or had specific terms reported in their medical history; people diagnosed with diabetes at baseline were excluded, and the remainder were classified as having normoglycaemia. Participants received alirocumab or control (placebo/ezetimibe) for 24-104 weeks, with maximally tolerated statin in most cases. The primary efficacy endpoint was LDL cholesterol reductions from baseline to week 24 in the intention-to-treat population using the mixed-effect model with a repeated measures approach. Reductions in LDL cholesterol from baseline to week 24 with alirocumab were 44.0-61.8% (prediabetes group) and 45.8-59.5% (normoglycaemia group). In both subgroups, LDL cholesterol reductions were generally similar in those with and without baseline triglycerides ≥1.7 mmol/l (150 mg/dl). Alirocumab was not associated with changes in HbA 1c or fasting plasma glucose over time in either subgroup (up to 24 months' follow-up). Adverse event rates were generally similar in those with and without prediabetes. Over a mean follow-up of 24-104 weeks, alirocumab treatment resulted in significant LDL cholesterol reductions from baseline that were similar in participants with prediabetes and those with normoglycaemia at baseline, with no effect on glycaemia and a safety profile similar to that of the control. © 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Inactivating Mutations in NPC1L1 and Protection from Coronary Heart Disease

PubMed Central

2015-01-01

Background Ezetimibe lowers plasma levels of low-density lipoprotein (LDL) cholesterol by inhibiting the activity of the Niemann–Pick C1-like 1 (NPC1L1) protein. However, whether such inhibition reduces the risk of coronary heart disease is not known. Human mutations that inactivate a gene encoding a drug target can mimic the action of an inhibitory drug and thus can be used to infer potential effects of that drug. Methods We sequenced the exons of NPC1L1 in 7364 patients with coronary heart disease and in 14,728 controls without such disease who were of European, African, or South Asian ancestry. We identified carriers of inactivating mutations (nonsense, splice-site, or frameshift mutations). In addition, we genotyped a specific inactivating mutation (p.Arg406X) in 22,590 patients with coronary heart disease and in 68,412 controls. We tested the association between the presence of an inactivating mutation and both plasma lipid levels and the risk of coronary heart disease. Results With sequencing, we identified 15 distinct NPC1L1 inactivating mutations; approximately 1 in every 650 persons was a heterozygous carrier for 1 of these mutations. Heterozygous carriers of NPC1L1 inactivating mutations had a mean LDL cholesterol level that was 12 mg per deciliter (0.31 mmol per liter) lower than that in noncarriers (P = 0.04). Carrier status was associated with a relative reduction of 53% in the risk of coronary heart disease (odds ratio for carriers, 0.47; 95% confidence interval, 0.25 to 0.87; P = 0.008). In total, only 11 of 29,954 patients with coronary heart disease had an inactivating mutation (carrier frequency, 0.04%) in contrast to 71 of 83,140 controls (carrier frequency, 0.09%). Conclusions Naturally occurring mutations that disrupt NPC1L1 function were found to be associated with reduced plasma LDL cholesterol levels and a reduced risk of coronary heart disease. (Funded by the National Institutes of Health and others.) PMID:25390462

Application of plasma gas modulation technique for improvement of the measurement of Mn emission intensity in ICP-AES.

PubMed

Kubota, K; Wagatsuma, K

2001-01-02

A phase-sensitive detection technique associated with a digital lock-in amplifier was applied for an improvement of the detection in ICP-AES. The lock-in amplifier works as an extremely narrow band pass filter. It can pick up the modulated signal, which has the same frequency as the reference signal, from any noise and thus it can improve the signal-to-noise ratio. Modulation of the ICP can be performed by mixing small amounts of air to argon as the outer gas cyclically, because the emission intensities of ionic lines are enhanced by using the mixed gas. An electromagnetic valve, which is placed in the outer-gas flow path, causes periodic variation in the air gas in the outer-gas flow, and thus switching the valve on/off can modulate the ICP. By choosing the appropriate conditions, the addition of air gas enhances the emission intensity of ionic lines more than that of the background, thus leading to improved signal-to-background ratios. At the same time the lock-in amplifier further enhances the ionic emissions because it picks up only the modulated part of the signal. By applying the plasma gas flow modulation technique the detection and the determination limits of the Mn II 257.610 nm line are improved in comparison with the conventional method. A change in plasma shape corresponding to the modulation frequency is observed when the ICP is modulated.

Preliminary Results from the Flight of the Solar Array Module Plasma Interactions Experiment (SAMPIE)

NASA Technical Reports Server (NTRS)

Ferguson, Dale C.; Hillard, G. Barry

1994-01-01

SAMPIE, the Solar Array Module Plasma Interactions Experiment, flew in the Space Shuttle Columbia payload bay as part of the OAST-2 mission on STS-62, March, 1994. SAMPIE biased samples of solar arrays and space power materials to varying potentials with respect to the surrounding space plasma, and recorded the plasma currents collected and the arcs which occurred, along with a set of plasma diagnostics data. A large set of high quality data was obtained on the behavior of solar arrays and space power materials in the space environment. This paper is the first report on the data SAMPIE telemetered to the ground during the mission. It will be seen that the flight data promise to help determine arcing thresholds, snapover potentials and floating potentials for arrays and spacecraft in LEO.

Temporally resolved ozone distribution of a time modulated RF atmospheric pressure argon plasma jet: flow, chemical reaction, and transient vortex

NASA Astrophysics Data System (ADS)

Zhang, S.; Sobota, A.; van Veldhuizen, E. M.; Bruggeman, P. J.

2015-08-01

The ozone density distribution in the effluent of a time modulated RF atmospheric pressure plasma jet (APPJ) is investigated by time and spatially resolved by UV absorption spectroscopy. The plasma jet is operated with an averaged dissipated power of 6.5 W and gas flow rate 2 slm argon  +2% O2. The modulation frequency of the RF power is 50 Hz with a duty cycle of 50%. To investigate the production and destruction mechanism of ozone in the plasma effluent, the atomic oxygen and gas temperature is also obtained by TALIF and Rayleigh scattering, respectively. A temporal increase in ozone density is observed close to the quartz tube exit when the plasma is switched off due to the decrease in O density and gas temperature. Ozone absorption at different axial positions indicates that the ozone distribution is dominated by the convection induced by the gas flow and allows estimating the on-axis local gas velocity in the jet effluent. Transient vortex structures occurring during the switch on and off of the RF power also significantly affect the ozone density in the far effluent.

Control of Reactive Species Generated by Low-frequency Biased Nanosecond Pulse Discharge in Atmospheric Pressure Plasma Effluent

NASA Astrophysics Data System (ADS)

Takashima, Keisuke; Kaneko, Toshiro

2016-09-01

The control of hydroxyl radical and the other gas phase species generation in the ejected gas through air plasma (air plasma effluent) has been experimentally studied, which is a key to extend the range of plasma treatment. Nanosecond pulse discharge is known to produce high reduced electric field (E/N) discharge that leads to efficient generation of the reactive species than conventional low frequency discharge, while the charge-voltage cycle in the low frequency discharge is known to be well-controlled. In this study, the nanosecond pulse discharge biased with AC low frequency high voltage is used to take advantages of these discharges, which allows us to modulate the reactive species composition in the air plasma effluent. The utilization of the gas-liquid interface and the liquid phase chemical reactions between the modulated long-lived reactive species delivered from the air plasma effluent could realize efficient liquid phase chemical reactions leading to short-lived reactive species production far from the air plasma, which is crucial for some plasma agricultural applications.

FPGA based demodulation of laser induced fluorescence in plasmas

NASA Astrophysics Data System (ADS)

Mattingly, Sean W.; Skiff, Fred

2018-04-01

We present a field programmable gate array (FPGA)-based system that counts photons from laser-induced fluorescence (LIF) on a laboratory plasma. This is accomplished with FPGA-based up/down counters that demodulate the data, giving a background-subtracted LIF signal stream that is updated with a new point as each laser amplitude modulation cycle completes. We demonstrate using the FPGA to modulate a laser at 1 MHz and demodulate the resulting LIF data stream. This data stream is used to calculate an LIF-based measurement sampled at 1 MHz of a plasma ion fluctuation spectrum.

Familial Hypercholesterolemia.

PubMed

Bouhairie, Victoria Enchia; Goldberg, Anne Carol

2016-03-01

Familial hypercholesterolemia is a common, inherited disorder of cholesterol metabolism that leads to early cardiovascular morbidity and mortality. It is underdiagnosed and undertreated. Statins, ezetimibe, bile acid sequestrants, niacin, lomitapide, mipomersen, and low-density lipoprotein (LDL) apheresis are treatments that can lower LDL cholesterol levels. Early treatment can lead to substantial reduction of cardiovascular events and death in patients with familial hypercholesterolemia. It is important to increase awareness of this disorder in physicians and patients to reduce the burden of this disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

Familial hypercholesterolemia.

PubMed

Bouhairie, Victoria Enchia; Goldberg, Anne Carol

2015-05-01

Familial hypercholesterolemia is a common, inherited disorder of cholesterol metabolism that leads to early cardiovascular morbidity and mortality. It is underdiagnosed and undertreated. Statins, ezetimibe, bile acid sequestrants, niacin, lomitapide, mipomersen, and low-density lipoprotein (LDL) apheresis are treatments that can lower LDL cholesterol levels. Early treatment can lead to substantial reduction of cardiovascular events and death in patients with familial hypercholesterolemia. It is important to increase awareness of this disorder in physicians and patients to reduce the burden of this disorder. Copyright © 2015 Elsevier Inc. All rights reserved.

Simultaneous Power Deposition Detection of Two EC Beams with the BIS Analysis in Moving TCV Plasmas

NASA Astrophysics Data System (ADS)

Curchod, L.; Pochelon, A.; Decker, J.; Felici, F.; Goodman, T. P.; Moret, J.-M.; Paley, J. I.

2009-11-01

Modulation of power amplitude is a widespread to determine the radial absorption profile of externally launched power in fusion plasmas. There are many techniques to analyze the plasma response to such a modulation. The break-in-slope (BIS) analysis can draw an estimated power deposition profile for each power step up. In this paper, the BIS analysis is used to monitor the power deposition location of one or two EC power beams simultaneously in a non-stationary plasma being displaced vertically in the TCV tokamak vessel. Except from radial discrepancies, the results have high time resolution and compare well with simulations from the R2D2-C3PO-LUKE ray-tracing and Fokker-Planck code suite.

The response function of modulated grid Faraday cup plasma instruments

NASA Technical Reports Server (NTRS)

Barnett, A.; Olbert, S.

1986-01-01

Modulated grid Faraday cup plasma analyzers are a very useful tool for making in situ measurements of space plasmas. One of their great attributes is that their simplicity permits their angular response function to be calculated theoretically. An expression is derived for this response function by computing the trajectories of the charged particles inside the cup. The Voyager Plasma Science (PLS) experiment is used as a specific example. Two approximations to the rigorous response function useful for data analysis are discussed. The theoretical formulas were tested by multi-sensor analysis of solar wind data. The tests indicate that the formulas represent the true cup response function for all angles of incidence with a maximum error of only a few percent.

PV modules for ground testing

NASA Technical Reports Server (NTRS)

1986-01-01

The main objective was to design and build a minimum of three photovoltaic test panels for plasma interaction experiments. These experiments are intended to provide data on the interactions between high-voltage solar arrays and the space plasma environment. Data gathered will significantly contribute to the development of design criteria for the space station solar arrays. Electrical isolation between the solar cell strings and the module mounting plate is required for high-voltage bias.

Density Structures, Dynamics, and Seasonal and Solar Cycle Modulations of Saturn's Inner Plasma Disk

NASA Astrophysics Data System (ADS)

Holmberg, M. K. G.; Shebanits, O.; Wahlund, J.-E.; Morooka, M. W.; Vigren, E.; André, N.; Garnier, P.; Persoon, A. M.; Génot, V.; Gilbert, L. K.

2017-12-01

We present statistical results from the Cassini Radio and Plasma Wave Science (RPWS) Langmuir probe measurements recorded during the time interval from orbit 3 (1 February 2005) to 237 (29 June 2016). A new and improved data analysis method to obtain ion density from the Cassini LP measurements is used to study the asymmetries and modulations found in the inner plasma disk of Saturn, between 2.5 and 12 Saturn radii (1 RS=60,268 km). The structure of Saturn's plasma disk is mapped, and the plasma density peak, nmax, is shown to be located at ˜4.6 RS and not at the main neutral source region at 3.95 RS. The shift in the location of nmax is due to that the hot electron impact ionization rate peaks at ˜4.6 RS. Cassini RPWS plasma disk measurements show a solar cycle modulation. However, estimates of the change in ion density due to varying EUV flux is not large enough to describe the detected dependency, which implies that an additional mechanism, still unknown, is also affecting the plasma density in the studied region. We also present a dayside/nightside ion density asymmetry, with nightside densities up to a factor of 2 larger than on the dayside. The largest density difference is found in the radial region 4 to 5 RS. The dynamic variation in ion density increases toward Saturn, indicating an internal origin of the large density variability in the plasma disk rather than being caused by an external source origin in the outer magnetosphere.

Laser beam-plasma plume interaction during laser welding

NASA Astrophysics Data System (ADS)

Hoffman, Jacek; Moscicki, Tomasz; Szymanski, Zygmunt

2003-10-01

Laser welding process is unstable because the keyhole wall performs oscillations which results in the oscillations of plasma plume over the keyhole mouth. The characteristic frequencies are equal to 0.5-4 kHz. Since plasma plume absorbs and refracts laser radiation, plasma oscillations modulate the laser beam before it reaches the workpiece. In this work temporary electron densities and temperatures are determined in the peaks of plasma bursts during welding with a continuous wave CO2 laser. It has been found that during strong bursts the plasma plume over the keyhole consists of metal vapour only, being not diluted by the shielding gas. As expected the values of electron density are about two times higher in peaks than their time-averaged values. Since the plasma absorption coefficient scales as ~N2e/T3/2 (for CO2 laser radiation) the results show that the power of the laser beam reaching the metal surface is modulated by the plasma plume oscillations. The attenuation factor equals 4-6% of the laser power but it is expected that it is doubled by the refraction effect. The results, together with the analysis of the colour pictures from streak camera, allow also interpretation of the dynamics of the plasma plume.

The ultrasonic characteristics of high frequency modulated arc and its application in material processing.

PubMed

He, Longbiao; Yang, Ping; Li, Luming; Wu, Minsheng

2014-12-01

To solve the difficulty of introducing traditional ultrasonic transducers to welding molten pool, high frequency current is used to modulate plasma arc and ultrasonic wave is excited successfully. The characteristics of the excited ultrasonic field are studied. The results show that the amplitude-frequency response of the ultrasonic emission is flat. The modulating current is the main factor influencing the ultrasonic power and the sound pressure depends on the variation of arc plasma stream force. Experimental study of the welding structure indicates grain refinement by the ultrasonic emission of the modulated arc and the test results showed there should be an energy region for the arc ultrasonic to get best welding joints. Copyright © 2014 Elsevier B.V. All rights reserved.

Preliminary results from the flight of the Solar Array Module Plasma Interactions Experiment (SAMPIE)

NASA Technical Reports Server (NTRS)

Ferguson, Dale C.; Hillard, G. Barry

1994-01-01

SAMPIE, the Solar Array Module Plasma Interactions Experiment, flew in the Space Shuttle Columbia payload bay as part of the Office of Aeronautics and Space Technology-2 (OAST-2) mission on STS-62, March, 1994. SAMPIE biased samples of solar arrays and space power materials to varying potentials with respect to the surrounding space plasma, and recorded the plasma currents collected and the arcs which occurred, along with a set of plasma diagnostics data. A large set of high quality data was obtained on the behavior of solar arrays and space power materials in the space environment. This paper is the first report on the data SAMPIE telemetered to the ground during the mission. It will be seen that the flight data promise to help determine arcing thresholds, snapover potentials, and floating potentials for arrays and spacecraft in LEO.

Magnetotail energy dissipation during an auroral substorm

PubMed Central

Panov, E.V.; Baumjohann, W.; Wolf, R.A.; Nakamura, R.; Angelopoulos, V.; Weygand, J. M.; Kubyshkina, M.V.

2016-01-01

Violent releases of space plasma energy from the Earth’s magnetotail during substorms produce strong electric currents and bright aurora. But what modulates these currents and aurora and controls dissipation of the energy released in the ionosphere? Using data from the THEMIS fleet of satellites and ground-based imagers and magnetometers, we show that plasma energy dissipation is controlled by field-aligned currents (FACs) produced and modulated during magnetotail topology change and oscillatory braking of fast plasma jets at 10-14 Earth radii in the nightside magnetosphere. FACs appear in regions where plasma sheet pressure and flux tube volume gradients are non-collinear. Faster tailward expansion of magnetotail dipolarization and subsequent slower inner plasma sheet restretching during substorm expansion and recovery phases cause faster poleward then slower equatorward movement of the substorm aurora. Anharmonic radial plasma oscillations build up displaced current filaments and are responsible for discrete longitudinal auroral arcs that move equatorward at a velocity of about 1km/s. This observed auroral activity appears sufficient to dissipate the released energy. PMID:27917231

Laser plasma coupling with moderate Z, long scalelength underdense plasma

NASA Astrophysics Data System (ADS)

Kruer, William; Berger, Richard; Meezan, Nathaniel; Suter, Larry; Moody, John; Glenzer, Siegfried; Stevenson, R. M.; Oades, K.

2004-11-01

Recent experiments1,2 have focussed new attention on the coupling of laser light with moderate Z, long scalelength underdense plasmas. We discuss some intriguing features of these experiments, including a significant reduction of stimulated Raman and Brillouin scattering in higher Z plasmas, such as Krypton and Xenon. Threshold conditions for various instabilities are discussed, and potential consequences of thermal filamentation and self-focussing are explored. The presence of significant temperature modulations in the plasma can lead to a number of interesting effects not usually taken into account, such as ion wave refraction out of hot spots and instability reduction by the long wavelength modulations. We also consider the extrapolation of these results to the higher temperature regimes more relevant to ignition-scale hohlraums. 1. R. M. Stevenson, et. al, Phys. Plasmas 11, 2709 (2004) 2. J. Moody (to be published) Work performed under the auspices of the U.S. DOE by the Lawrence Livermore National Laboratory under Contract W-7405-ENG-48.

Current-driven plasmonic boom instability in three-dimensional gated periodic ballistic nanostructures

NASA Astrophysics Data System (ADS)

Aizin, G. R.; Mikalopas, J.; Shur, M.

2016-05-01

An alternative approach of using a distributed transmission line analogy for solving transport equations for ballistic nanostructures is applied for solving the three-dimensional problem of electron transport in gated ballistic nanostructures with periodically changing width. The structures with varying width allow for modulation of the electron drift velocity while keeping the plasma velocity constant. We predict that in such structures biased by a constant current, a periodic modulation of the electron drift velocity due to the varying width results in the instability of the plasma waves if the electron drift velocity to plasma wave velocity ratio changes from below to above unity. The physics of such instability is similar to that of the sonic boom, but, in the periodically modulated structures, this analog of the sonic boom is repeated many times leading to a larger increment of the instability. The constant plasma velocity in the sections of different width leads to resonant excitation of the unstable plasma modes with varying bias current. This effect (that we refer to as the superplasmonic boom condition) results in a strong enhancement of the instability. The predicted instability involves the oscillating dipole charge carried by the plasma waves. The plasmons can be efficiently coupled to the terahertz electromagnetic radiation due to the periodic geometry of the gated structure. Our estimates show that the analyzed instability should enable powerful tunable terahertz electronic sources.

Environmental exposure to lead induces oxidative stress and modulates the function of the antioxidant defense system and the immune system in the semen of males with normal semen profile

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kasperczyk, Aleksandra; Dobrakowski, Michał; Czuba, Zenon P.

We investigated the associations between environmental exposure to lead and a repertoire of cytokines in seminal plasma of males with normal semen profile according to the WHO criteria. Based on the median lead concentration in seminal plasma, 65 samples were divided into two groups: low (LE) and high exposure to lead (HE). Differences in semen volume and the pH, count, motility and morphology of sperm cells were not observed between the examined groups. The total oxidant status value and the level of protein sulfhydryl groups as well as the activities of manganese superoxide dismutase and catalase were significantly higher inmore » the HE group, whereas the total antioxidant capacity value and the activities of glutathione reductase and glutathione-S-transferase were depressed. IL-7, IL-10, IL-12, and TNF-α levels were significantly higher in the HE group compared with the LE group. Environmental exposure to lead is sufficient to induce oxidative stress in seminal plasma and to modulate antioxidant defense system. - Highlights: • Lead induces oxidative stress in seminal plasma in human. • Lead modulates antioxidant defense system in seminal plasma in human. • Lead does not change a Th1/Th2 imbalance in seminal plasma in human.« less

The National Transport Code Collaboration Module Library

NASA Astrophysics Data System (ADS)

Kritz, A. H.; Bateman, G.; Kinsey, J.; Pankin, A.; Onjun, T.; Redd, A.; McCune, D.; Ludescher, C.; Pletzer, A.; Andre, R.; Zakharov, L.; Lodestro, L.; Pearlstein, L. D.; Jong, R.; Houlberg, W.; Strand, P.; Wiley, J.; Valanju, P.; John, H. St.; Waltz, R.; Mandrekas, J.; Mau, T. K.; Carlsson, J.; Braams, B.

2004-12-01

This paper reports on the progress in developing a library of code modules under the auspices of the National Transport Code Collaboration (NTCC). Code modules are high quality, fully documented software packages with a clearly defined interface. The modules provide a variety of functions, such as implementing numerical physics models; performing ancillary functions such as I/O or graphics; or providing tools for dealing with common issues in scientific programming such as portability of Fortran codes. Researchers in the plasma community submit code modules, and a review procedure is followed to insure adherence to programming and documentation standards. The review process is designed to provide added confidence with regard to the use of the modules and to allow users and independent reviews to validate the claims of the modules' authors. All modules include source code; clear instructions for compilation of binaries on a variety of target architectures; and test cases with well-documented input and output. All the NTCC modules and ancillary information, such as current standards and documentation, are available from the NTCC Module Library Website http://w3.pppl.gov/NTCC. The goal of the project is to develop a resource of value to builders of integrated modeling codes and to plasma physics researchers generally. Currently, there are more than 40 modules in the module library.

Plasma Amyloid Is Associated with White Matter and Subcortical Alterations and Is Modulated by Age and Seasonal Rhythms in Mouse Lemur Primates.

PubMed

Gary, Charlotte; Hérard, Anne-Sophie; Hanss, Zoé; Dhenain, Marc

2018-01-01

Accumulation of amyloid-β (Aβ) peptides in the brain is a critical early event in the pathogenesis of Alzheimer's disease (AD), the most common age-related neurodegenerative disorder. There is increasing interest in measuring levels of plasma Aβ since this could help in diagnosis of brain pathology. However, the value of plasma Aβ in such a diagnosis is still controversial and factors modulating its levels are still poorly understood. The mouse lemur ( Microcebus murinus ) is a primate model of cerebral aging which can also present with amyloid plaques and whose Aβ is highly homologous to humans'. In an attempt to characterize this primate model and to evaluate the potential of plasma Aβ as a biomarker for brain alterations, we measured plasma Aβ 40 concentration in 21 animals aged from 5 to 9.5 years. We observed an age-related increase in plasma Aβ 40 levels. We then evaluated the relationships between plasma Aβ 40 levels and cerebral atrophy in these mouse lemurs. Voxel-based analysis of cerebral MR images (adjusted for the age/sex/brain size of the animals), showed that low Aβ 40 levels are associated with atrophy of several white matter and subcortical brain regions. These results suggest that low Aβ 40 levels in middle-aged/old animals are associated with brain deterioration. One special feature of mouse lemurs is that their metabolic and physiological parameters follow seasonal changes strictly controlled by illumination. We evaluated seasonal-related variations of plasma Aβ 40 levels and found a strong effect, with higher plasma Aβ 40 concentrations in winter conditions compared to summer. This question of seasonal modulation of Aβ plasma levels should be addressed in clinical studies. We also focused on the amplitude of the difference between plasma Aβ 40 levels during the two seasons and found that this amplitude increases with age. Possible mechanisms leading to these seasonal changes are discussed.

Concept of a tunable source of coherent THz radiation driven by a plasma modulated electron beam

NASA Astrophysics Data System (ADS)

Zhang, H.; Konoplev, I. V.; Doucas, G.; Smith, J.

2018-04-01

We have carried out numerical studies which consider the modulation of a picosecond long relativistic electron beam in a plasma channel and the generation of a micro-bunched train. The subsequent propagation of the micro-bunched beam in the vacuum area was also investigated. The same numerical model was then used to simulate the radiation arising from the interaction of the micro-bunched beam with a metallic grating. The dependence of the radiation spectrum on the parameters of the micro-bunched beam has been studied and the tunability of the radiation by the variation of the micro-bunch spacing has been demonstrated. The micro-bunch spacing can be changed easily by altering the plasma density without changing the beam energy or current. Using the results of these studies, we develop a conceptual design of a tunable source of coherent terahertz (THz) radiation driven by a plasma modulated beam. Such a source would be a potential and useful alternative to conventional vacuum THz tubes and THz free-electron laser sources.

A Study on the Transient Behavior of Pulse Modulated Dual-Frequency Capacitive Discharges based on Circuit Analysis

NASA Astrophysics Data System (ADS)

Na, Byungkeun; Bae, Inshik; Park, Gi Jung; Chang, Hong-Young

2016-09-01

Multi-frequency capacitively coupled plasma (CCP) has been studied to independently control the ion energy and the ion flux; pulsing technique is used to reduce the electron temperature and finally the charging effects. The use of these techniques is a key to high aspect ratio contact (HARC) etching in the recent semiconductor processing. In this study, the characteristics of pulsed dual frequency (DF) CCP is investigated. Two separate powers of 3 MHz and 40 MHz are delivered to the powered electrode of an asymmetric CCP, and each frequency is modulated by an external 1 kHz pulse. Due to the complexity of the RF compensation in DF CCP, the characteristics of the plasma and the sheath are analyzed by high speed impedance measurement. The transient behavior of pulse modulated DF CCP is analyzed based on the result of continuous wave (CW) DF CCP. The optimized experimental condition for high ion energy will be presented. The difference between electronegative oxygen plasma and electropositive argon plasma is discussed as well.

The sigma-1 receptor chaperone as an inter-organelle signaling modulator

PubMed Central

Su, Tsung-Ping; Hayashi, Teruo; Maurice, Tangui; Buch, Shilpa; Ruoho, Arnold E.

2010-01-01

Inter-organelle signaling plays important roles in many physiological functions. Endoplasmic reticulum (ER)-mitochondrion signaling affects intra-mitochondrial calcium (Ca2+) homeostasis and cellular bioenergetics. ER-nucleus signaling attenuates ER stress. ER-plasma membrane signaling regulates cytosolic Ca2+ homeostasis, and ER-mitochondrion-plasma membrane signaling regulates hippocampal dendritic spine formation. Here we propose that the sigma-1 receptor (Sig-1R), an ER chaperone protein, acts as an inter-organelle signaling modulator. Sig-1Rs normally reside at the ER-mitochondrion contact called the MAM (mitochondrion-associated ER membrane), where Sig-1Rs regulate ER-mitochondrion signaling and the ER-nucleus cross-talk. When cells are stimulated by ligands or undergo prolonged stress, Sig-1Rs translocate from the MAM to the ER reticular network and plasmalemma/plasma membrane to regulate a variety of functional proteins, including ion channels, receptors, and kinases. Thus, the Sig-1R serves as an inter-organelle signaling modulator locally at the MAM and remotely at the plasmalemma/plasma membrane. Many pharmacological/physiological effects of Sig-1Rs may relate to this unique action of Sig-1Rs. PMID:20869780

Rapid Mars transits with exhaust-modulated plasma propulsion

NASA Technical Reports Server (NTRS)

Chang-Diaz, Franklin R.; Braden, Ellen; Johnson, Ivan; Hsu, Michael M.; Yang, Tien Fang

1995-01-01

The operational characteristics of the Exhaust-Modulated Plasma Rocket are described. Four basic human and robotic mission scenarios to Mars are analyzed using numerical optimization techniques at variable specific impulse and constant power. The device is well suited for 'split-sprint' missions, allowing fast, one-way low-payload human transits of 90 to 104 days, as well as slower, 180-day, high-payload robotic precursor flights. Abort capabilities, essential for human missions, are also explored.

New frontiers in gut nutrient sensor research: nutrient sensors in the gastrointestinal tract: modulation of sweet taste sensitivity by leptin.

PubMed

Horio, Nao; Jyotaki, Masafumi; Yoshida, Ryusuke; Sanematsu, Keisuke; Shigemura, Noriatsu; Ninomiya, Yuzo

2010-01-01

The ability to perceive sweet compounds is important for animals to detect an external carbohydrate source of calories and has a critical role in the nutritional status of animals. In mice, a subset of sweet-sensitive taste cells possesses leptin receptors. Increase of plasma leptin with increasing internal energy storage in the adipose tissue suppresses sweet taste responses via this receptor. The data from recent studies indicate that leptin may also act as a modulator of sweet taste sensation in humans with a diurnal variation in sweet sensitivity. The plasma leptin level and sweet taste sensitivity are proposed to link with post-ingestive plasma glucose level. This leptin modulation of sweet taste sensitivity may influence an individual's preference, ingestive behavior, and absorption of nutrients, thereby playing important roles in regulation of energy homeostasis.

Device and method for electron beam heating of a high density plasma

DOEpatents

Thode, L.E.

A device and method for relativistic electron beam heating of a high density plasma in a small localized region are described. A relativistic electron beam generator produces a high voltage electron beam which propagates along a vacuum drift tube and is modulated to initiate electron bunching within the beam. The beam is then directed through a low density gas chamber which provides isolation between the vacuum modulator and the relativistic electron beam target. The relativistic beam is then applied to a high density target plasma which typically comprises DT, DD, hydrogen boron or similar thermonuclear gas at a density of 10/sup 17/ to 10/sup 20/.

Effect of external plasma flows on the interaction between turbulence and convective cells

NASA Astrophysics Data System (ADS)

Uzawa, Ken; Li, Jiquan

2005-10-01

It is widely recognized that large scale structures, such as zonal flows, streamers and also long wavelength Kelvin-Helmholtz modes are nonlinearly generated from maternal turbulence through modulational instability process and play a crucial role in regulating the transport in tokamaks. In order to control the transport, it is desirable to control such structures and/or modulational process. One of control parameters may be mean flow which intrinsically exists in tokamak plasmas. Besides the direct influence on the transport through vortex decorrelation, the mean flow may indirectly change the zonal flow generation by acting on the modulational process itself. In this work, we theoretically investigate the characteristics of zonal flow generation due to the electron temperature gradient (ETG) turbulence in the presence of long wavelength ITG driven zonal flow. This was done by extending our previous modulational analyses[1]. We have numerically analyzed the influence of mean flow on zonal flow generation. The main result is that the zonal flow generation is suppressed by the presence of the mean flow. [1]J. Li, Y. Kishimoto, Physics of Plasmas, 9, 1241 (2002)

Toward "pain-free" statin prescribing: clinical algorithm for diagnosis and management of myalgia.

PubMed

Jacobson, Terry A

2008-06-01

Myalgia, which often manifests as pain or soreness in skeletal muscles, is among the most salient adverse events associated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). Clinical issues related to statin-associated myotoxicity include (1) incidence in randomized controlled trials and occurrence in postmarketing surveillance databases; (2) potential differences between statins in their associations with such adverse events; and (3) diagnostic and treatment strategies to prevent, recognize, and manage these events. Data from systematic reviews, meta-analyses, clinical and observational trials, and post-marketing surveillance indicate that statin-associated myalgia typically affects approximately 5.0% of patients, as myopathy in 0.1% and as rhabdomyolysis in 0.01%. However, studies also suggest that myalgia is among the leading reasons patients discontinue statins (particularly high-dose statin monotherapy) and that treatment with certain statins (eg, fluvastatin) is unlikely to result in such adverse events. This review presents a clinical algorithm for monitoring and managing statin-associated myotoxicity. The algorithm highlights risk factors for muscle toxicity and provides recommendations for (1) creatine kinase measurements and monitoring; (2) statin dosage reduction, discontinuation, and rechallenge; and (3) treatment alternatives, such as extended-release fluvastatin with or without ezetimibe, low-dose or alternate-day rosuvastatin, or ezetimibe with or without colesevelam. The algorithm should help to inform and enhance patient care and reduce the risk of myalgia and other potentially treatment-limiting muscle effects that might undermine patient adherence and compromise the overall cardioprotective benefits of statins.

Variation in Supersaturation and Phase Behavior of Ezetimibe Amorphous Solid Dispersions upon Dissolution in Different Biorelevant Media.

PubMed

Elkhabaz, Ahmed; Sarkar, Sreya; Dinh, Janny K; Simpson, Garth J; Taylor, Lynne S

2018-01-02

The delivery of poorly water-soluble drugs using amorphous solid dispersions (ASDs) has been widely acknowledged as a promising strategy for enhancing oral bioavailability. Upon dissolution, ASDs have accelerated dissolution rates and yield supersaturated solutions leading to higher apparent solubilities. Understanding the complex phase behavior of ASDs during dissolution is crucial for developing an effective formulation. Since the absorption of a lipophilic, high permeability drug is determined primarily by the intraluminal dissolution process and the final concentration achieved, there is a need for evaluation in biorelevant dissolution media that simulate both fasting and fed gastrointestinal states. In this study, using ezetimibe as a model drug, three different ASDs were prepared using poly(acrylic acid) (PAA), polyvinylpyrrolidone (PVP), and hydroxypropyl methylcellulose acetyl succinate (HPMC-AS). Dissolution of ASDs was carried out in sodium phosphate buffer, fed-state simulated intestinal fluid (FeSSIF), and Ensure Plus to evaluate the impact of different dissolution media on release profile, supersaturation, and phase behavior. The supersaturation level and crystallization kinetics varied among the dispersions and were found to be highly dependent on the medium employed. The presence of solubilizing additives in biorelevant media greatly affected the generation and stabilization of supersaturated solutions. Second harmonic generation microscopy was found to enable the detection of crystals in all media including the highly turbid Ensure Plus system. In conclusion, it is important to evaluate the impact of complex biorelevant media on the dissolution performance of ASDs to better design supersaturating formulations for oral delivery.

Gateways to clinical trials.

PubMed

Tomillero, A; Moral, M A

2009-03-01

ABT-869, Acadesine, Acetylsalicylic acid/omeprazole, Adefovir, Adefovir dipivoxil, AEG-35156, Agatolimod sodium, Albiglutide, Alemtuzumab, Alipogene tiparvovec, Alogliptin benzoate, AMG-386, Amrubicin hydrochloride, Apremilast, Aripiprazole, Asoprisnil, Atorvastatin/fenofibrate, AVN-944, Axitinib; Belinostat, Bevacizumab, BHT-3021, BI-2536, Biapenem, Bilastine, Biphasic insulin aspart, Blinatumomab, Bortezomib, Bosentan; Catumaxomab, CD-NP, Cediranib, Certolizumab pegol, Cetuximab, Choline fenofibrate, Ciclesonide, CK-1827452,Clevudine, Clofarabine, CSL-360, CYT-997; Dapagliflozin, Darinaparsin, Denosumab, Densiron 68, Desloratadine, Dulanermin; Edoxaban tosilate, Emtricitabine, Entecavir, Erlotinib hydrochloride, Everolimus, Exenatide, Ezetimibe, Ezetimibe/simvastatin; Fidaxomicintiacumiv, Fulvestrant; G-207, GCR-8015, Gefitinib, Ghrelin (human), Glufosfamide; HPV16L1E7CVLP; Ibutamoren mesilate, Imatinib mesylate, Insulin detemir, Insulin glargine, Iodine (I131) tositumomab, Istaroxime, ITMN-191, Ixabepilone; JZP-4, Lenalidomide; Levetiracetam, Linaclotide acetate, Liposomal cytarabine/daunorubicin, Liposomal doxorubicin, Liraglutide, LY-518674; Milatuzumab, MMR-V, Motesanib diphosphate, Mycophenolic acid sodium salt; Niacin/simvastatin; Obatoclax mesylate, Odanacatib; Paclitaxel nanoparticles, Paclitaxel-eluting stent, Pazufloxacin, PBT-2, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Peginterferon alfa-2b/ribavirin, Pemetrexed disodium, Perampanel, PfCP2.9, Pitavastatin calcium, Poly I:CLC, Pomalidomide, Pralatrexate, Pramlintide acetate, Prucalopride; rhGAD65, Roflumilast; RTS,S/AS02D; SCH-530348, Semagacestat, Sirolimus-eluting coronary stent, Sirolimus-Eluting Stent, SIR-Spheres, Sivelestat sodium hydrate, Sorafenib, Sunitinib malate; Tadalafil, Tafluprost, Tanespimycin, Teduglutide, Telaprevir, Telbivudine, Tenofovir disoproxil fumarate, Tiotropium bromide, TMC-435350, Tositumomab/iodine (I131) tositumomab, Travoprost/timolol, Triciribine phosphate; Vandetanib, VIA-2291, Vinflunine, Vorinostat; XL-019; Yttrium 90 (90Y) ibritumomab tiuxetan. Copyright 2009 Prous Science, S.A.U. or its licensors. All rights reserved.

Hypercholesterolemia Induces Angiogenesis and Accelerates Growth of Breast Tumors in Vivo

PubMed Central

Pelton, Kristine; Coticchia, Christine M.; Curatolo, Adam S.; Schaffner, Carl P.; Zurakowski, David; Solomon, Keith R.; Moses, Marsha A.

2015-01-01

Obesity and metabolic syndrome are linked to an increased prevalence of breast cancer among postmenopausal women. A common feature of obesity, metabolic syndrome, and a Western diet rich in saturated fat is a high level of circulating cholesterol. Epidemiological reports investigating the relationship between high circulating cholesterol levels, cholesterol-lowering drugs, and breast cancer are conflicting. Here, we modeled this complex condition in a well-controlled, preclinical animal model using innovative isocaloric diets. Female severe combined immunodeficient mice were fed a low-fat/no-cholesterol diet and then randomized to four isocaloric diet groups: low-fat/no-cholesterol diet, with or without ezetimibe (cholesterol-lowering drug), and high-fat/high-cholesterol diet, with or without ezetimibe. Mice were implanted orthotopically with MDA-MB-231 cells. Breast tumors from animals fed the high-fat/high-cholesterol diet exhibited the fastest progression. Significant differences in serum cholesterol level between groups were achieved and maintained throughout the study; however, no differences were observed in intratumoral cholesterol levels. To determine the mechanism of cholesterol-induced tumor progression, we analyzed tumor proliferation, apoptosis, and angiogenesis and found a significantly greater percentage of proliferating cells from mice fed the high-fat/high-cholesterol diet. Tumors from hypercholesterolemic animals displayed significantly less apoptosis compared with the other groups. Tumors from high-fat/high-cholesterol mice had significantly higher microvessel density compared with tumors from the other groups. These results demonstrate that hypercholesterolemia induces angiogenesis and accelerates breast tumor growth in vivo. PMID:24952430

Identification of the Niemann-Pick C1-like 1 cholesterol absorption receptor as a new hepatitis C virus entry factor

PubMed Central

Sainz, Bruno; Barretto, Naina; Martin, Danyelle N.; Hiraga, Nobuhiko; Imamura, Michio; Hussain, Snawar; Marsh, Katherine A.; Yu, Xuemei; Chayama, Kazuaki; Alrefai, Waddah A.; Uprichard, Susan L.

2011-01-01

Hepatitis C virus (HCV) is a leading cause of liver disease worldwide. With ~170 million individuals infected and current interferon-based treatment having toxic side-effects and marginal efficacy, more effective antivirals are critically needed1. Although HCV protease inhibitors were just FDA approved, analogous to HIV therapy, optimal HCV therapy likely will require a combination of antivirals targeting multiple aspects of the viral lifecycle. Viral entry represents a promising multi-faceted target for antiviral intervention; however, to date FDA-approved inhibitors of HCV cell entry are unavailable. Here we show that the cellular Niemann-Pick C1-Like 1 (NPC1L1) cholesterol uptake receptor is an HCV entry factor amendable to therapeutic intervention. Specifically, NPC1L1 expression is necessary for HCV infection as silencing or antibody-mediated blocking of NPC1L1 impairs cell-cultured-derived HCV (HCVcc) infection initiation. In addition, the clinically-available FDA-approved NPC1L1 antagonist ezetimibe2,3 potently blocks HCV uptake in vitro via a virion cholesterol-dependent step prior to virion-cell membrane fusion. Importantly, ezetimibe inhibits infection of all major HCV genotypes in vitro, and in vivo delays the establishment of HCV genotype 1b infection in mice with human liver grafts. Thus, we have not only identified NPC1L1 as an HCV cell entry factor, but also discovered a new antiviral target and potential therapeutic agent. PMID:22231557

Alzheimer risk genes modulate the relationship between plasma apoE and cortical PiB binding

DOE PAGES

Lazaris, Andreas; Hwang, Kristy S.; Goukasian, Naira; ...

2015-10-15

Objective: We investigated the association between apoE protein plasma levels and brain amyloidosis and the effect of the top 10 Alzheimer disease (AD) risk genes on this association. Methods: Our dataset consisted of 18 AD, 52 mild cognitive impairment, and 3 cognitively normal Alzheimer's Disease Neuroimaging Initiative 1 (ADNI1) participants with available [ 11C]-Pittsburgh compound B (PiB) and peripheral blood protein data. We used cortical pattern matching to study associations between plasma apoE and cortical PiB binding and the effect of carrier status for the top 10 AD risk genes. Results: Low plasma apoE was significantly associated with high PiBmore » SUVR, except in the sensorimotor and entorhinal cortex. For BIN1 rs744373, the association was observed only in minor allele carriers. For CD2AP rs9349407 and CR1 rs3818361, the association was preserved only in minor allele noncarriers. We did not find evidence for modulation by CLU, PICALM, ABCA7, BIN1, and MS4A6A. Conclusions: Our data show that BIN1 rs744373, CD2AP rs9349407, and CR1 rs3818361 genotypes modulate the association between apoE protein plasma levels and brain amyloidosis, implying a potential epigenetic/downstream interaction.« less

Hybrid Modeling of SiH4/Ar Discharge in a Pulse Modulated RF Capacitively Coupled Plasma

NASA Astrophysics Data System (ADS)

Xi-Feng, Wang; Yuan-Hong, Song; You-Nian, Wang; PSEG Team

2015-09-01

Pulsed plasmas have offered important advantages in future micro-devices, especially for electronegative gas plasmas. In this work, a one-dimensional fluid and Monte-Carlo (MC) hybrid model is developed to simulate SiH4/Ar discharge in a pulse modulated radio-frequency (RF) capacitively coupled plasma (CCP). Time evolution densities of different species, such as electrons, ions, radicals, are calculated, as well as the electron energy probability function (EEPF) which is obtained by a MC simulation. By pulsing the RF source, the electron energy distributions and plasma properties can be modulated by pulse frequency and duty cycle. High electron energy tails are obtained during power-on period, with the SiHx densities increasing rapidly mainly by SiH4 dissociation. As the RF power is off, the densities in the bulk region decrease rapidly owing to high energy electrons disappear, but increase near electrodes since diffusion without the confinement of high electric field, which can prolong the time of radials deposition on the plate. Especially, in the afterglow, the increase of negative ions near the electrodes results from cool electron attachment, which are good for film deposition. This work was supported by the National Natural Science Foundation of China (Grant No. 11275038).

A non-linear 4-wave resonant model for non-perturbative fast ion interactions with Alfv'enic modes in burning plasmas

NASA Astrophysics Data System (ADS)

Zonca, Fulvio; Chen, Liu

2007-11-01

We adopt the 4-wave modulation interaction model, introduced by Chen et al [1] for analyzing modulational instabilities of the radial envelope of Ion Temperature Gradient driven modes in toroidal geometry, extending it to the modulations on the fast particle distribution function due to nonlinear Alfv'enic mode dynamics, as proposed in Ref. [2]. In the case where the wave-particle interactions are non-perturbative and strongly influence the mode evolution, as in the case of Energetic Particle Modes (EPM) [3], radial distortions (redistributions) of the fast ion source dominate the mode nonlinear dynamics. In this work, we show that the resonant particle motion is secular with a time-scale inversely proportional to the mode amplitude [4] and that the time evolution of the EPM radial envelope can be cast into the form of a nonlinear Schr"odinger equation a la Ginzburg-Landau [5]. [1] L. Chen et al, Phys. Plasmas 7 3129 (2000) [2] F. Zonca et al, Theory of Fusion Plasmas (Bologna: SIF) 17 (2000) [3] L. Chen, Phys. Plasmas 1, 1519 (1994).[4] F. Zonca et al, Nucl. Fusion 45 477 (2005) [5] F. Zonca et al, Plasma Phys. Contr. Fusion 48 B15 (2006)

Plasma Protein Corona Modulates the Vascular Wall Interaction of Drug Carriers in a Material and Donor Specific Manner

PubMed Central

Sobczynski, Daniel J.; Charoenphol, Phapanin; Heslinga, Michael J.; Onyskiw, Peter J.; Namdee, Katawut; Thompson, Alex J.; Eniola-Adefeso, Omolola

2014-01-01

The nanoscale plasma protein interaction with intravenously injected particulate carrier systems is known to modulate their organ distribution and clearance from the bloodstream. However, the role of this plasma protein interaction in prescribing the adhesion of carriers to the vascular wall remains relatively unknown. Here, we show that the adhesion of vascular-targeted poly(lactide-co-glycolic-acid) (PLGA) spheres to endothelial cells is significantly inhibited in human blood flow, with up to 90% reduction in adhesion observed relative to adhesion in simple buffer flow, depending on the particle size and the magnitude and pattern of blood flow. This reduced PLGA adhesion in blood flow is linked to the adsorption of certain high molecular weight plasma proteins on PLGA and is donor specific, where large reductions in particle adhesion in blood flow (>80% relative to buffer) is seen with ∼60% of unique donor bloods while others exhibit moderate to no reductions. The depletion of high molecular weight immunoglobulins from plasma is shown to successfully restore PLGA vascular wall adhesion. The observed plasma protein effect on PLGA is likely due to material characteristics since the effect is not replicated with polystyrene or silica spheres. These particles effectively adhere to the endothelium at a higher level in blood over buffer flow. Overall, understanding how distinct plasma proteins modulate the vascular wall interaction of vascular-targeted carriers of different material characteristics would allow for the design of highly functional delivery vehicles for the treatment of many serious human diseases. PMID:25229244

Optical modulation techniques for analog signal processing and CMOS compatible electro-optic modulation

NASA Astrophysics Data System (ADS)

Gill, Douglas M.; Rasras, Mahmoud; Tu, Kun-Yii; Chen, Young-Kai; White, Alice E.; Patel, Sanjay S.; Carothers, Daniel; Pomerene, Andrew; Kamocsai, Robert; Beattie, James; Kopa, Anthony; Apsel, Alyssa; Beals, Mark; Mitchel, Jurgen; Liu, Jifeng; Kimerling, Lionel C.

2008-02-01

Integrating electronic and photonic functions onto a single silicon-based chip using techniques compatible with mass-production CMOS electronics will enable new design paradigms for existing system architectures and open new opportunities for electro-optic applications with the potential to dramatically change the management, cost, footprint, weight, and power consumption of today's communication systems. While broadband analog system applications represent a smaller volume market than that for digital data transmission, there are significant deployments of analog electro-optic systems for commercial and military applications. Broadband linear modulation is a critical building block in optical analog signal processing and also could have significant applications in digital communication systems. Recently, broadband electro-optic modulators on a silicon platform have been demonstrated based on the plasma dispersion effect. The use of the plasma dispersion effect within a CMOS compatible waveguide creates new challenges and opportunities for analog signal processing since the index and propagation loss change within the waveguide during modulation. We will review the current status of silicon-based electrooptic modulators and also linearization techniques for optical modulation.

Redox Stimulation of Human THP-1 Monocytes in Response to Cold Physical Plasma.

PubMed

Bekeschus, Sander; Schmidt, Anke; Bethge, Lydia; Masur, Kai; von Woedtke, Thomas; Hasse, Sybille; Wende, Kristian

2016-01-01

In plasma medicine, cold physical plasma delivers a delicate mixture of reactive components to cells and tissues. Recent studies suggested a beneficial role of cold plasma in wound healing. Yet, the biological processes related to the redox modulation via plasma are not fully understood. We here used the monocytic cell line THP-1 as a model to test their response to cold plasma in vitro. Intriguingly, short term plasma treatment stimulated cell growth. Longer exposure only modestly compromised cell viability but apparently supported the growth of cells that were enlarged in size and that showed enhanced metabolic activity. A significantly increased mitochondrial content in plasma treated cells supported this notion. On THP-1 cell proteome level, we identified an increase of protein translation with key regulatory proteins being involved in redox regulation (hypoxia inducible factor 2α), differentiation (retinoic acid signaling and interferon inducible factors), and cell growth (Yin Yang 1). Regulation of inflammation is a key element in many chronic diseases, and we found a significantly increased expression of the anti-inflammatory heme oxygenase 1 (HMOX1) and of the neutrophil attractant chemokine interleukin-8 (IL-8). Together, these results foster the view that cold physical plasma modulates the redox balance and inflammatory processes in wound related cells.

Model polymer etching and surface modification by a time modulated RF plasma jet: role of atomic oxygen and water vapor

NASA Astrophysics Data System (ADS)

Luan, P.; Knoll, A. J.; Wang, H.; Kondeti, V. S. S. K.; Bruggeman, P. J.; Oehrlein, G. S.

2017-01-01

The surface interaction of a well-characterized time modulated radio frequency (RF) plasma jet with polystyrene, poly(methyl methacrylate) and poly(vinyl alcohol) as model polymers is investigated. The RF plasma jet shows fast polymer etching but mild chemical modification with a characteristic carbonate ester and NO formation on the etched surface. By varying the plasma treatment conditions including feed gas composition, environment gaseous composition, and treatment distance, we find that short lived species, especially atomic O for Ar/1% O2 and 1% air plasma and OH for Ar/1% H2O plasma, play an essential role for polymer etching. For O2 containing plasma, we find that atomic O initiates polymer etching and the etching depth mirrors the measured decay of O atoms in the gas phase as the nozzle-surface distance increases. The etching reaction probability of an O atom ranging from 10-4 to 10-3 is consistent with low pressure plasma research. We also find that adding O2 and H2O simultaneously into Ar feed gas quenches polymer etching compared to adding them separately which suggests the reduction of O and OH density in Ar/O2/H2O plasma.

Sprayed shielding of plastic-encapsulated electronic modules

NASA Technical Reports Server (NTRS)

Muller, A. N.

1969-01-01

Metallic coating directly sprayed on electronic modules provides simple and reliable lightweight protection against radio frequency interference. A plasma arc may be used. Aluminum and copper are the most effective metals.

Synthetic diagnostics platform for fusion plasmas (invited)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shi, L., E-mail: lshi@pppl.gov; Valeo, E. J.; Tobias, B. J.

A Synthetic Diagnostics Platform (SDP) for fusion plasmas has been developed which provides state of the art synthetic reflectometry, beam emission spectroscopy, and Electron Cyclotron Emission (ECE) diagnostics. Interfaces to the plasma simulation codes GTC, XGC-1, GTS, and M3D-C{sup 1} are provided, enabling detailed validation of these codes. In this paper, we give an overview of SDP’s capabilities, and introduce the synthetic diagnostic modules. A recently developed synthetic ECE Imaging module which self-consistently includes refraction, diffraction, emission, and absorption effects is discussed in detail. Its capabilities are demonstrated on two model plasmas. The importance of synthetic diagnostics in validation ismore » shown by applying the SDP to M3D-C{sup 1} output and comparing it with measurements from an edge harmonic oscillation mode on DIII-D.« less

Synthetic diagnostics platform for fusion plasmas (invited)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shi, L.; Valeo, E. J.; Tobias, B. J.

A Synthetic Diagnostics Platform (SDP) for fusion plasmas has been developed which provides state of the art synthetic reflectometry, beam emission spectroscopy, and Electron Cyclotron Emission (ECE) diagnostics. Interfaces to the plasma simulation codes GTC, XGC-1, GTS, and M3D-C-1 are provided, enabling detailed validation of these codes. In this paper, we give an overview of SDP's capabilities, and introduce the synthetic diagnostic modules. A recently developed synthetic ECE Imaging module which self-consistently includes refraction, diffraction, emission, and absorption effects is discussed in detail. Its capabilities are demonstrated on two model plasmas. Finally, the importance of synthetic diagnostics in validation ismore » shown by applying the SDP to M3D-C 1 output and comparing it with measurements from an edge harmonic oscillation mode on DIII-D.« less

Synthetic diagnostics platform for fusion plasmas (invited)

DOE PAGES

Shi, L.; Valeo, E. J.; Tobias, B. J.; ...

2016-08-26

A Synthetic Diagnostics Platform (SDP) for fusion plasmas has been developed which provides state of the art synthetic reflectometry, beam emission spectroscopy, and Electron Cyclotron Emission (ECE) diagnostics. Interfaces to the plasma simulation codes GTC, XGC-1, GTS, and M3D-C-1 are provided, enabling detailed validation of these codes. In this paper, we give an overview of SDP's capabilities, and introduce the synthetic diagnostic modules. A recently developed synthetic ECE Imaging module which self-consistently includes refraction, diffraction, emission, and absorption effects is discussed in detail. Its capabilities are demonstrated on two model plasmas. Finally, the importance of synthetic diagnostics in validation ismore » shown by applying the SDP to M3D-C 1 output and comparing it with measurements from an edge harmonic oscillation mode on DIII-D.« less

Light trapping and circularly polarization at a Dirac point in 2D plasma photonic crystals

NASA Astrophysics Data System (ADS)

Li, Qian; Hu, Lei; Mao, Qiuping; Jiang, Haiming; Hu, Zhijia; Xie, Kang; Wei, Zhang

2018-03-01

Light trapping at the Dirac point in 2D plasma photonic crystal has been obtained. The new localized mode, Dirac mode, is attributable to neither photonic bandgap nor total internal reflection. It exhibits a unique algebraic profile and possesses a high-Q factor resonator of about 105. The Dirac point could be modulated by tuning the filling factor, plasma frequency and plasma cyclotron frequency, respectively. When a magnetic field parallel to the wave vector is applied, Dirac modes for right circularly polarized and left circularly polarized waves could be obtained at different frequencies, and the Q factor could be tuned. This property will add more controllability and flexibility to the design and modulation of novel photonic devices. It is also valuable for the possibilities of Dirac modes in photonic crystal containing other kinds of metamaterials.

AWAKE readiness for the study of the seeded self-modulation of a 400 GeV proton bunch

NASA Astrophysics Data System (ADS)

Muggli, P.; Adli, E.; Apsimon, R.; Asmus, F.; Baartman, R.; Bachmann, A.-M.; Barros Marin, M.; Batsch, F.; Bauche, J.; Berglyd Olsen, V. K.; Bernardini, M.; Biskup, B.; Blanco Vinuela, E.; Boccardi, A.; Bogey, T.; Bohl, T.; Bracco, C.; Braunmuller, F.; Burger, S.; Burt, G.; Bustamante, S.; Buttenschön, B.; Butterworth, A.; Caldwell, A.; Cascella, M.; Chevallay, E.; Chung, M.; Damerau, H.; Deacon, L.; Dexter, A.; Dirksen, P.; Doebert, S.; Farmer, J.; Fedosseev, V.; Feniet, T.; Fior, G.; Fiorito, R.; Fonseca, R.; Friebel, F.; Gander, P.; Gessner, S.; Gorgisyan, I.; Gorn, A. A.; Grulke, O.; Gschwendtner, E.; Guerrero, A.; Hansen, J.; Hessler, C.; Hofle, W.; Holloway, J.; Hüther, M.; Ibison, M.; Islam, M. R.; Jensen, L.; Jolly, S.; Kasim, M.; Keeble, F.; Kim, S.-Y.; Kraus, F.; Lasheen, A.; Lefevre, T.; LeGodec, G.; Li, Y.; Liu, S.; Lopes, N.; Lotov, K. V.; Martyanov, M.; Mazzoni, S.; Medina Godoy, D.; Mete, O.; Minakov, V. A.; Mompo, R.; Moody, J.; Moreira, M. T.; Mitchell, J.; Mutin, C.; Norreys, P.; Öz, E.; Ozturk, E.; Pauw, W.; Pardons, A.; Pasquino, C.; Pepitone, K.; Petrenko, A.; Pitmann, S.; Plyushchev, G.; Pukhov, A.; Rieger, K.; Ruhl, H.; Schmidt, J.; Shalimova, I. A.; Shaposhnikova, E.; Sherwood, P.; Silva, L.; Sosedkin, A. P.; Speroni, R.; Spitsyn, R. I.; Szczurek, K.; Thomas, J.; Tuev, P. V.; Turner, M.; Verzilov, V.; Vieira, J.; Vincke, H.; Welsch, C. P.; Williamson, B.; Wing, M.; Xia, G.; Zhang, H.; AWAKE Collaboration

2018-01-01

AWAKE is a proton-driven plasma wakefield acceleration experiment. We show that the experimental setup briefly described here is ready for systematic study of the seeded self-modulation of the 400 GeV proton bunch in the 10 m long rubidium plasma with density adjustable from 1 to 10× {10}14 cm-3. We show that the short laser pulse used for ionization of the rubidium vapor propagates all the way along the column, suggesting full ionization of the vapor. We show that ionization occurs along the proton bunch, at the laser time and that the plasma that follows affects the proton bunch.

Proceedings of the International Conference on High-Power Particle Beams (12th) Held in Haifa, Israel on June 7-12, 1998. Volume 1

DTIC Science & Technology

1998-06-12

Bucharest, Romania 257 TO THE THEORY OF A PLASMA FILLED ION DIODE L.I. Rudakov, RRC Kurchatov Institute, Moscow, Russia, A.S. Chuvatin, Ecole...B. Moosman, S.J. Stephanakis, Naval Research Laboratory, Washington DC, USA 306 -XVII- PLASMA EVOLUTION OF A POS: COMPARISON OF THEORY AND...POSs. INTRODUCTION The POS is a critical component of the multi-module DECADE generator.’ At present, maximum bremsstrahlung is produced on DECADE Module

SiO2 Hole Etching Using Perfluorocarbon Alternative Gas with Small Global Greenhouse Effect

NASA Astrophysics Data System (ADS)

Ooka, Masahiro; Yokoyama, Shin

2004-06-01

The etching of contact holes of 0.1 μm size in SiO2 is achieved using, for the first time, cyclic (c-)C5F8 with a small greenhouse effect in the pulse-modulated inductively coupled plasma. The shape of the cross section of the contact hole is as good as that etched using conventional c-C4F8. It is confirmed that Kr mixing instead of Ar in the plasma does not change the etching characteristics, although lowering of the electron temperature is expected which reduces the plasma-induced damage. Pulse modulation of the plasma is found to improve the etching selectivity of SiO2 with respect to Si. Langmuir probe measurement of the plasma suggests that the improvement of the etching selectivity is due to the deposition of fluorocarbon film triggered by lowering of the electron temperature when the off time of the radio frequency (rf) power is extended.

The effects of plasma inhomogeneity on the nanoparticle coating in a low pressure plasma reactor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pourali, N.; Foroutan, G.

2015-10-15

A self-consistent model is used to study the surface coating of a collection of charged nanoparticles trapped in the sheath region of a low pressure plasma reactor. The model consists of multi-fluid plasma sheath module, including nanoparticle dynamics, as well as the surface deposition and particle heating modules. The simulation results show that the mean particle radius increases with time and the nanoparticle size distribution is broadened. The mean radius is a linear function of time, while the variance exhibits a quadratic dependence. The broadening in size distribution is attributed to the spatial inhomogeneity of the deposition rate which inmore » turn depends on the plasma inhomogeneity. The spatial inhomogeneity of the ions has strong impact on the broadening of the size distribution, as the ions contribute both in the nanoparticle charging and in direct film deposition. The distribution width also increases with increasing of the pressure, gas temperature, and the ambient temperature gradient.« less

Relativistic laser-plasma interactions in the quantum regime.

PubMed

Eliasson, Bengt; Shukla, P K

2011-04-01

We consider nonlinear interactions between a relativistically strong laser beam and a plasma in the quantum regime. The collective behavior of electrons is modeled by a Klein-Gordon equation, which is nonlinearly coupled with the electromagnetic wave through the Maxwell and Poisson equations. This allows us to study nonlinear interactions between arbitrarily large-amplitude electromagnetic waves and a quantum plasma. We have used our system of nonlinear equations to study theoretically the parametric instabilities involving stimulated Raman scattering and modulational instabilities. A model for quasi-steady-state propagating electromagnetic wave packets is also derived, and which shows possibility of localized solitary structures in a quantum plasma. Numerical simulations demonstrate collapse and acceleration of electrons in the nonlinear stage of the modulational instability, as well as possibility of the wake-field acceleration of electrons to relativistic speeds by short laser pulses at nanometer length scales. Our study is relevant for understanding the localization of intense electromagnetic pulses in a quantum plasma with extremely high electron densities and relatively low temperature.

The impact of positrons beam on the propagation of super freak waves in electron-positron-ion plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ali Shan, S.; National Centre for Physics; Pakistan Institute of Engineering and Applied Sciences

2016-07-15

In this work, we examine the nonlinear propagation of planar ion-acoustic freak waves in an unmagnetized plasma consisting of cold positive ions and superthermal electrons subjected to cold positrons beam. For this purpose, the reductive perturbation method is used to derive a nonlinear Schrödinger equation (NLSE) for the evolution of electrostatic potential wave. We determine the domain of the plasma parameters where the rogue waves exist. The effect of the positron beam on the modulational instability of the ion-acoustic rogue waves is discussed. It is found that the region of the modulational stability is enhanced with the increase of positronmore » beam speed and positron population. Second as positrons beam increases the nonlinearities of the plasma system, large amplitude ion acoustic rogue waves are pointed out. The present results will be helpful in providing a good fit between the theoretical analysis and real applications in future laboratory plasma experiments.« less

Thermodynamic modeling of the solar wind plasma in the presence of envelope-modulated low-frequency Alfvén waves

NASA Astrophysics Data System (ADS)

Nariyuki, Y.

2018-06-01

Alfvénic fluctuation is a typical state of the solar wind turbulence. Due to its finite amplitude and envelope modulation, the Alfvénic fluctuation becomes compressible. In the present study, an analytical model of the specific heat ratio in the presence of envelope-modulated Alfvén waves is derived. Ion kinetic effects are modeled by using a semi-ideal (perfect) gas model, in which the specific heat ratio depends on temperature. It is shown that the fourth order polynomial approximation is in good agreement with the kinetic theory. The resultant model is also applied to the fast solar wind plasma.

Serotonin modulates substance P-induced plasma extravasation and vasodilatation in rat skin by an action through capsaicin-sensitive primary afferent nerves.

PubMed

Khalil, Z; Helme, R D

1990-09-17

Using a blister model of inflammation in the rat hind footpad, the present study was undertaken to examine the ability of serotonin (5-HT) to modulate an inflammatory reaction manifested as plasma extravasation and vasodilatation induced by the neuropeptide substance P (SP). In addition, the role of primary afferent sensory nerve fibres in these modulatory effects was studied in capsaicin pretreated rats. Using a protocol of simultaneous perfusion of amine and peptide over the blister base, no major modulatory effect was observed. On the other hand, using a protocol of sequential perfusion, 5-HT was found to extend the plasma extravasation and vasodilatation responses to SP. 5-HT maintained the plasma extravasation response to SP after cessation of stimulation (during the post-stimulation period). On the other hand, it extended the vasodilatation response to SP during the actual stimulation period by preventing the occurrence of tachyphylaxis. These modulatory effects were absent in capsacin-pretreated rats. The present study provides evidence for the first time in vivo to suggest that serotonin can modulate an inflammatory response to SP via a mechanism that involves capsaicin-sensitive sensory fibres.

Modulated heavy nucleus-acoustic waves and associated rogue waves in a degenerate relativistic quantum plasma system

NASA Astrophysics Data System (ADS)

Sultana, S.; Islam, S.; Mamun, A. A.; Schlickeiser, R.

2018-01-01

A theoretical and numerical investigation has been carried out on amplitude modulated heavy nucleus-acoustic envelope solitons (HNAESs) in a degenerate relativistic quantum plasma (DRQP) system containing relativistically degenerate electrons and light nuclei, and non-degenerate mobile heavy nuclei. The cubic nonlinear Schrödinger equation, describing the nonlinear dynamics of the heavy nucleus-acoustic waves (HNAWs), is derived by employing a multi-scale perturbation technique. The dispersion relation for the HNAWs is derived, and the criteria for the occurrence of modulational instability of the HNAESs are analyzed. The localized structures (viz., envelope solitons and associated rogue waves) are found to be formed in the DRQP system under consideration. The basic features of the amplitude modulated HNAESs and associated rogue waves formed in realistic DRQP systems are briefly discussed.

Genetic modulation of plasma NPY stress response is suppressed in substance abuse: association with clinical outcomes.

PubMed

Xu, Ke; Hong, Kwangik Adam; Zhou, Zhifeng; Hauger, Richard L; Goldman, David; Sinha, Rajita

2012-04-01

Neuropeptide Y (NPY) is involved in stress regulation. Genetic variations predict plasma NPY and neural correlates of emotion and stress. We examined whether the functional NPY haplotype modulates stress-induced NPY and anxiety responses, and if plasma NPY stress responses are associated with substance dependence outcomes. Thirty-seven treatment-engaged, abstinent substance dependent (SD) patients and 28 healthy controls (HCs) characterized on NPY diplotypes (HH: high expression; HLLL: intermediate/low expression) were exposed to stress, alcohol/drug cues and neutral relaxing cues, using individualized guided imagery, in a 3-session laboratory experiment. Plasma NPY, heart rate and anxiety were assessed. Patients were prospectively followed for 90-days post-treatment to assess relapse outcomes. HH individuals showed significantly lower stress-induced NPY with greater heart rate and anxiety ratings, while the HLLL group showed the reverse pattern of NPY, anxiety and heart rate responses. This differential genetic modulation of NPY stress response was suppressed in the SD group, who showed no stress-related increases in NPY and higher heart rate and greater anxiety, regardless of diplotype. Lower NPY predicted subsequent higher number of days and greater amounts of post-treatment drug use. These preliminary findings are the first to document chronic drug abuse influences on NPY diplotype expression where NPY diplotype modulation of stress-related plasma NPY, heart rate and anxiety responses was absent in the substance abuse sample. The finding that lower stress-related NPY is predictive of greater relapse severity provides support for therapeutic development of neuropeptide Y targets in the treatment of substance use disorders. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ladder Climbing and Autoresonant Acceleration of Plasma Waves

NASA Astrophysics Data System (ADS)

Barth, Ido; Dodin, Ilya; Fisch, Nathaniel

2015-11-01

When the background density in a bounded plasma is modulated in time, discrete modes become coupled. Interestingly, for appropriately chosen modulations, the average plasmon energy might be made to grow in a ladder-like manner, achieving up-conversion or down-conversion of the plasmon energy. This reversible process is identified as a classical analog of the effect known as quantum ladder climbing, so that the efficiency and the rate of this process can be written immediately by analogy to a quantum particle in a box. In the limit of densely spaced spectrum, ladder climbing transforms into continuous autoresonance; plasmons may then be manipulated by chirped background modulations much like electrons are autoresonantly manipulated by chirped fields. By formulating the wave dynamics within a universal Lagrangian framework, similar ladder climbing and autoresonance effects are predicted to be achievable with general linear waves in both plasma and other media. Supported by NNSA grant DE274-FG52-08NA28553, DOE contract DE-AC02-09CH11466, and DTRA grant HDTRA1-11-1-0037.

Are Plasma Oxytocin and Vasopressin Levels Reflective of Amygdala Activation during the Processing of Negative Emotions? A Preliminary Study.

PubMed

Motoki, Kosuke; Sugiura, Motoaki; Takeuchi, Hikaru; Kotozaki, Yuka; Nakagawa, Seishu; Yokoyama, Ryoichi; Kawashima, Ryuta

2016-01-01

Plasma oxytocin (OT) and arginine vasopressin (AVP) are associated with individual differences in emotional responses and behaviors. The amygdala is considered to be an important brain region for regulating emotion-based behavior, with OT and AVP modulating activity in the amygdala during the processing of negative emotions. In particular, increased OT levels may diminish amygdala activation (anxiolytic effects) and enhanced AVP levels may augment amygdala activation (anxiogenic effects) when negative emotions are processed. A growing body of research has shown that the effects of OT and AVP are modulated by sex: the aforementioned anxiolytic effects of OT and the anxiogenic effects of AVP occur in men, but not in women. However, we have little knowledge regarding the biological mechanisms underlying OT and AVP plasma levels or their respective anxiogenic and anxiolytic effects; similarly, little is known about the causes and nature of sex differences related to these neuropeptides and their effects on emotional processing. In the current study, we focused on the neural functions associated with the biological mechanisms underlying such effects. We hypothesized that amygdala activation would correlate with trait plasma OT (anxiolytic effects) and AVP (anxiogenic effects) levels because the amygdala is thought to affect the coordinated release of these neuropeptides following affective experiences. We further hypothesized that the effects would be modulated by sex. We assessed 51 participants (male and female) using a paradigm involving negative emotion in conjunction with functional magnetic resonance imaging and measurements of plasma OT and AVP levels. We determined that increased plasma AVP levels were positively associated with amygdala activation (anxiogenic effects) in men, but not in women. These findings highlight the potential underlying neural mechanisms of plasma AVP levels in men.

Advanced control of neutral beam injected power in DIII-D

DOE PAGES

Pawley, Carl J.; Crowley, Brendan J.; Pace, David C.; ...

2017-03-23

In the DIII-D tokamak, one of the most powerful techniques to control the density, temperature and plasma rotation is by eight independently modulated neutral beam sources with a total power of 20 MW. The rapid modulation requires a high degree of reproducibility and precise control of the ion source plasma and beam acceleration voltage. Recent changes have been made to the controls to provide a new capability to smoothly vary the beam current and beam voltage during a discharge, while maintaining the modulation capability. The ion source plasma inside the arc chamber is controlled through feedback from the Langmuir probesmore » measuring plasma density near the extraction end. To provide the new capability, the plasma control system (PCS) has been enabled to change the Langmuir probe set point and the beam voltage set point in real time. When the PCS varies the Langmuir set point, the plasma density is directly controlled in the arc chamber, thus changing the beam current (perveance) and power going into the tokamak. Alternately, the PCS can sweep the beam voltage set point by 20 kV or more and adjust the Langmuir probe setting to match, keeping the perveance constant and beam divergence at a minimum. This changes the beam power and average neutral particle energy, which changes deposition in the tokamak plasma. The ion separating magnetic field must accurately match the beam voltage to protect the beam line. To do this, the magnet current control accurately tracks the beam voltage set point. In conclusion, these new capabilities allow continuous in-shot variation of neutral beam ion energy to complement« less

New Era of Lipid-Lowering Drugs

PubMed Central

Rye, Kerry-Anne

2016-01-01

There are several established lipid-modifying agents, including statins, fibrates, niacin, and ezetimibe, that have been shown in randomized clinical outcome trials to reduce the risk of having an atherosclerotic cardiovascular event. However, in many people, the risk of having an event remains unacceptably high despite treatment with these established agents. This has stimulated the search for new therapies designed to reduce residual cardiovascular risk. New approaches that target atherogenic lipoproteins include: 1) inhibition of proprotein convertase subtilisin/kexin type 9 to increase removal of atherogenic lipoproteins from plasma; 2) inhibition of the synthesis of apolipoprotein (apo) B, the main protein component of atherogenic lipoproteins; 3) inhibition of microsomal triglyceride transfer protein to block the formation of atherogenic lipoproteins; 4) inhibition of adenosine triphosphate citrate lyase to inhibit the synthesis of cholesterol; 5) inhibition of the synthesis of lipoprotein(a), a factor known to cause atherosclerosis; 6) inhibition of apoC-III to reduce triglyceride-rich lipoproteins and to enhance high-density lipoprotein (HDL) functionality; and 7) inhibition of cholesteryl ester transfer protein, which not only reduces the concentration of atherogenic lipoproteins but also increases the level and function of the potentially antiatherogenic HDL fraction. Other new therapies that specifically target HDLs include infusions of reconstituted HDLs, HDL delipidation, and infusions of apoA-I mimetic peptides that mimic some of the functions of HDLs. This review describes the scientific basis and rationale for developing these new therapies and provides a brief summary of established therapies. PMID:26983688

Kotov works with Plasma Crystal-3+ Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-25

ISS022-E-035436 (25 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, works with the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Kotov works with Plasma Crystal-3+ Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-25

ISS022-E-035434 (25 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, works with the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Towards a complete conceptual model of substorm onsets and expansions

NASA Technical Reports Server (NTRS)

Erickson, Gary M.; Burke, William J.; Heinemann, Michael; Samson, John C.; Maynard, Nelson C.

1996-01-01

Observational results from the CRRES satellite near times of substorm onsets support the theoretical premise that substorms initiate near the inner edge of the plasma sheet. The region is connected latitudinally to the equatorward-most pre-breakup arc. During the growth phase, the inner edge of the plasma sheet moves towards the earth. This motion is modulated by various cavity oscillations of the magnetosphere-ionosphere coupled magnetosphere. This modulation can locally reverse the background convection electric field. The reversed convection taps energy stored in the inner-edge region of the plasma sheet. The near earth plasma sheet moves out of equilibrium with the lobes, and a rarefaction is launched tailward. This allows current driven dissipation to grow and a near-earth X-line to form. A model is presented which explains the observations of the CRRES satellite, and can account for the behavior associated with auroral intensification and substorm onset.

Modulational instability: Conservation laws and bright soliton solution of ion-acoustic waves in electron-positron-ion-dust plasmas

NASA Astrophysics Data System (ADS)

EL-Kalaawy, O. H.

2018-02-01

We consider the nonlinear propagation of non-planar (cylindrical and spherical) ion-acoustic (IA) envelope solitary waves in an unmagnetized plasma consisting of electron-positron-ion-dust plasma with two-electron temperature distributions in the context of the non-extensive statistics. The basic set of fluid equations is reduced to the modified nonlinear Schrödinger (MNLS) equation in cylindrical and spherical geometry by using the reductive perturbation method (RPM). It is found that the nature of the modulational instabilities would be significantly modified due to the effects of the non-extensive and other plasma parameters as well as cylindrical and spherical geometry. Conservation laws of the MNLS equation are obtained by Lie symmetry and multiplier method. A new exact solution (envelope bright soliton) is obtained by the extended homogeneous balance method. Finally, we study the results of this article.

Measurement of free radical kinetics in pulsed plasmas by UV and VUV absorption spectroscopy and by modulated beam mass spectrometry

NASA Astrophysics Data System (ADS)

Cunge, G.; Bodart, P.; Brihoum, M.; Boulard, F.; Chevolleau, T.; Sadeghi, N.

2012-04-01

This paper reviews recent progress in the development of time-resolved diagnostics to probe high-density pulsed plasma sources. We focus on time-resolved measurements of radicals' densities in the afterglow of pulsed discharges to provide useful information on production and loss mechanisms of free radicals. We show that broad-band absorption spectroscopy in the ultraviolet and vacuum ultraviolet spectral domain and threshold ionization modulated beam mass spectrometry are powerful techniques for the determination of the time variation of the radicals' densities in pulsed plasmas. The combination of these complementary techniques allows detection of most of the reactive species present in industrial etching plasmas, giving insights into the physico-chemistry reactions involving these species. As an example, we discuss briefly the radicals' kinetics in the afterglow of a SiCl4/Cl2/Ar discharge.

Modulated electron cyclotron drift instability in a high-power pulsed magnetron discharge.

PubMed

Tsikata, Sedina; Minea, Tiberiu

2015-05-08

The electron cyclotron drift instability, implicated in electron heating and anomalous transport, is detected in the plasma of a planar magnetron. Electron density fluctuations associated with the mode are identified via an adapted coherent Thomson scattering diagnostic, under direct current and high-power pulsed magnetron operation. Time-resolved analysis of the mode amplitude reveals that the instability, found at MHz frequencies and millimeter scales, also exhibits a kHz-scale modulation consistent with the observation of larger-scale plasma density nonuniformities, such as the rotating spoke. Sharply collimated axial fluctuations observed at the magnetron axis are consistent with the presence of escaping electrons in a region where the magnetic and electric fields are antiparallel. These results distinguish aspects of magnetron physics from other plasma sources of similar geometry, such as the Hall thruster, and broaden the scope of instabilities which may be considered to dictate magnetron plasma features.

Gateways to clinical trials.

PubMed

Tomillero, A; Moral, M A

2009-04-01

(+)-Dapoxetine hydrochloride, [(123)I]-BZA, 9-Aminocamptothecin; Abacavir sulfate/lamivudine, Adalimumab, Adefovir dipivoxil, Alemtuzumab, Alvocidib hydrochloride, Ambrisentan, Amsilarotene, Anacetrapib, Anakinra, Apricitabine, Aripiprazole, Arsenic trioxide, Atazanavir sulfate, Atazanavir/ritonavir, Atrasentan, Azacitidine; Banoxantrone, Bazedoxifene acetate, Bevacizumab, Bexarotene, Biphasic insulin aspart, Bortezomib, Bosentan, Bromfenac; Cachectin, Calcipotriol/betamethasone dipropionate, Canakinumab, Carfilzomib, CAT-354, CCX-282, Certolizumab pegol, Cetuximab, Choline fenofibrate, Clevudine, Clofarabine, CNTO-328, Corifollitropin alfa, Crofelemer; Daptomycin, Darbepoetin alfa, Darunavir, Dasatinib, Decitabine, Deferasirox, Denosumab, Duloxetine hydrochloride, Dutasteride; Emtricitabine, Enfuvirtide, Entecavir, Epoetin zeta, Erlotinib hydrochloride, Escitalopram oxalate, Eslicarbazepine acetate, Eszopiclone, Etravirine, Everolimus, Exenatide, Ezetimibe, Ezetimibe/simvastatin; Farglitazar, Febuxostat, Fosamprenavir calcium, FX-06; Gabapentin enacarbil, Gefitinib; HIVIS DNA; Imatinib mesylate, INCB- 18424, Indacaterol, Inotuzumab ozogamicin, Insulin detemir; JNJ-26854165; Lacosamide, Landiolol, Laromustine, Lenalidomide, Liposomal doxorubicin, L-NAME, Lopinavir, Lopinavir/ritonavir, Lumiracoxib; Maraviroc, Mepolizumab, Methoxy polyethylene glycol- epoetin-beta, Miglustat, MK-0493, MVA-CMDR, Mycophenolic acid sodium salt; Natalizumab, Nepafenac, Neratinib, Neridronic acid, Nesiritide, Nilotinib hydrochloride monohydrate; Olmesartan medoxomil, Omacetaxine mepesuccinate, Omalizumab; Paclitaxel poliglumex, Palifermin, Patupilone, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Peginterferon alfa-2b/ ribavirin, Pemetrexed disodium, PHA-848125, Pitavastatin calcium, Posaconazole, Povidone-iodine liposome complex, Prasugrel, Pregabalin, Prucalopride; Raltegravir potassium, Retigabine, Revaprazan hydrochloride, rhFSH, Rilpivirine, Rivaroxaban, Romidepsin, Rosuvastatin calcium, RWJ-676070; SAR-109659, Sitagliptin phosphate monohydrate, Sorafenib, Stavudine/Lamivudine/Nevirapine, Sunitinib malate; Tadalafil, Telaprevir, Telbivudine, Tenofovir disoproxil fumarate, Tenofovir disoproxil fumarate/emtricitabine, Tenofovir disoproxil fumarate/emtricitabine/efavirenz, Teriparatide, Tigecycline, Tiotropium bromide, Tipifarnib, Tipranavir, Tocilizumab, Trifluridine/TPI; UP-780; Vandetanib, Vardenafil hydrochloride hydrate, Vatalanib succinate, Vitespen, Vorinostat; Yttrium 90 (90Y) ibritumomab tiuxetan; Zoledronic acid monohydrate. Copyright 2009 Prous Science, S.A.U. or its licensors. All rights reserved.

Hypercholesterolemia induces angiogenesis and accelerates growth of breast tumors in vivo.

PubMed

Pelton, Kristine; Coticchia, Christine M; Curatolo, Adam S; Schaffner, Carl P; Zurakowski, David; Solomon, Keith R; Moses, Marsha A

2014-07-01

Obesity and metabolic syndrome are linked to an increased prevalence of breast cancer among postmenopausal women. A common feature of obesity, metabolic syndrome, and a Western diet rich in saturated fat is a high level of circulating cholesterol. Epidemiological reports investigating the relationship between high circulating cholesterol levels, cholesterol-lowering drugs, and breast cancer are conflicting. Here, we modeled this complex condition in a well-controlled, preclinical animal model using innovative isocaloric diets. Female severe combined immunodeficient mice were fed a low-fat/no-cholesterol diet and then randomized to four isocaloric diet groups: low-fat/no-cholesterol diet, with or without ezetimibe (cholesterol-lowering drug), and high-fat/high-cholesterol diet, with or without ezetimibe. Mice were implanted orthotopically with MDA-MB-231 cells. Breast tumors from animals fed the high-fat/high-cholesterol diet exhibited the fastest progression. Significant differences in serum cholesterol level between groups were achieved and maintained throughout the study; however, no differences were observed in intratumoral cholesterol levels. To determine the mechanism of cholesterol-induced tumor progression, we analyzed tumor proliferation, apoptosis, and angiogenesis and found a significantly greater percentage of proliferating cells from mice fed the high-fat/high-cholesterol diet. Tumors from hypercholesterolemic animals displayed significantly less apoptosis compared with the other groups. Tumors from high-fat/high-cholesterol mice had significantly higher microvessel density compared with tumors from the other groups. These results demonstrate that hypercholesterolemia induces angiogenesis and accelerates breast tumor growth in vivo. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Evaluation of physicochemical properties and in vivo efficiency of atorvastatin calcium/ezetimibe solid dispersions.

PubMed

Jahangiri, Azin; Barzegar-Jalali, Mohammad; Garjani, Alireza; Javadzadeh, Yousef; Hamishehkar, Hamed; Asadpour-Zeynali, Karim; Adibkia, Khosro

2016-01-20

Fixed-dose combination of atorvastatin calcium (ATV) and ezetimibe (EZT) provides a considerable advantage in the management of hyperlipidemia. However, both ATV and EZT suffer from the poor aqueous solubility, which can limit their oral bioavailability. The aim of the present study was to improve the in vitro performance and evaluate the in vivo efficiency of the improved (ATV/EZT) fixed-dose combination. The formulation was prepared through solid dispersion (SD)technique, using Polyvinylpyrrolidone K30 via solvent method. Solid-state analysis and the in vitro drug release of the prepared formulations were also assessed. In order to estimate the therapeutic efficiency of the prepared SDs, in vivo studies including measurement of serum lipid levels, liver index and histological analysis of the liver tissue in hyperlipidemic rats were conducted. Differential scanning calorimetry (DSC) and powder X-ray diffractometry (PXRD) showed that the drugs crystallinity was notably decreased during the preparation process. All SDs showed enhanced release for both drugs compared to their binary mixture, drugs: polymer physical mixtures (PMs) and marketed product. Administration of ATV/EZT SD led to a remarkable decrease (P<0.05) in the serum levels of total cholesterol (TC) and LDL-C in the high fat diet-induced hyperlipidemic rats compared to the PM. Additionally, the histopathological examination of the liver tissue revealed the improved efficiency of the SDs on the liver steatosis. According to the obtained results, ATV/EZT SD with improved physicochemical characteristics, showed favorable effects on the serum lipid levels and liver steatosis. Copyright © 2015 Elsevier B.V. All rights reserved.

Gateways to clinical trials.

PubMed

Tomillero, A; Moral, M A

2010-01-01

(-)-Epigallocatechin gallate, Abafungin, ACE-031, Adapalene/benzoyl peroxide, AE-37, Aflibercept, AGS-003, Albiglutide, Alemtuzumab, Aliskiren fumarate, ALT-801, AN-2728, Anacetrapib, API, Aprepitant, ARQ-197, Ascorbic acid, Atazanavir sulfate, ATN-224, AVI-4658, Azacitidine, Azelnidipine; Belinostat, Bevacizumab, BI-2536, Biphasic insulin aspart, Bortezomib, Bovine lactoferrin, Bryostatin 1, Budesonide/formoterol fumarate; cAC10, Canfosfamide hydrochloride, Cediranib, Clofarabine, Cocaine conjugate vaccine; Darbepoetin alfa, Dasatinib, Denosumab, Disomotide, Doripenem, Dovitinib Lactate, Dronedarone hydrochloride, Drospirenone/estradiol, Dutasteride; Ecogramostim, Entinostat, Enzastaurin hydrochloride, Erlotinib hydrochloride, Everolimus, Exenatide, Ezetimibe, Ezetimibe/simvastatin; Fampridine, Fenretinide LXS, FFR-factor VIIa, Fingolimod hydrochloride, Frovatriptan; Gefitinib, Gimatecan, GP-2/GM-CSF; Iloperidone, Imatinib mesylate, Indibulin, Ipilimumab, Ivabradine hydrochloride; Lactobacillus rhamnosus, Lapatinib ditosylate, LC-07, Lenalidomide, Linifanib, Liposomal doxorubicin, Liposomal vincristine, Litenimod, Lutein; M-118, MDX-1401, MEDI-528, Midostaurin, Miglustat, MK-0657; Natalizumab, Nesiritide, NGR-TNF, Niacin/simvastatin; Obatoclax mesylate, Olaparib, Omacetaxine mepesuccinate; Paclitaxel nanoparticles, Paclitaxel-eluting stent, Palonosetron hydrochloride, Pazopanib hydrochloride, Pegfilgrastim, Pemetrexed disodium, PER.C-flu, Perifosine, PF-02341066, Pimecrolimus, Pitrakinra, Plerixafor hydrochloride, Posaconazole; Rasburicase, Recombinant human relaxin H2, ReoT3D, Retaspimycin hydrochloride, Riferminogene pecaplasmid, Rindopepimut, Romiplostim, Ronacaleret hydrochloride, Rosuvastatin calcium, Rotigotine; Sagopilone, sALP-FcD10, SAR-245409, SCH-697243, Selumetinib, Sirolimus-eluting stent, SIR-Spheres, Sitagliptin phosphate monohydrate, Sitaxentan sodium, Sorafenib, Sunitinib malate; Tadalafil, Tandutinib, Tasimelteon, Temsirolimus, Teriparatide, Tiotropium bromide, TIV, Trabectedin, Tremelimumab, TRU-016; Vadimezan, Val8-GLP-1(7-37)OH, Vandetanib, Vernakalant hydrochloride, Voreloxin, Voriconazole, Vorinostat, Yttrium 90 (90Y) ibritumomab tiuxetan; Zeaxanthin, Ziprasidone hydrochloride, Zosuquidar trihydrochloride. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.

Gateways to clinical trials. July-August 2008.

PubMed

Tomillero, A; Moral, M A

2008-01-01

(-)-Epigallocatechin gallate, 501516, 89-12; Abatacept, Adalimumab, Adefovir dipivoxil, AG-701, Agatolimod sodium, Alefacept, Aliskiren fumarate, Apixaban, Atazanavir sulfate, Atrasentan, Axitinib; BI-1744-CL, BIBF-1120, BIBW-2992, Bortezomib; Carboxyamidotriazole, Caspofungin acetate, CBP-501, Cediranib, Ceftobiprole, Certolizumab pegol, Cetuximab, Cholesteryl hydrophobized polysaccharide-Her2 protein complex, CHP-NY-ESO-1, Cypher; Dalbavancin, Dalcetrapib, Daptomycin, Darapladib, Deferasirox, Deforolimus, Denosumab, DNA-HIV-C, Dovitinib, DR-5001, Dronedarone hydrochloride, DT388IL3; E75, EC-17/EC-90, Ecogramostim, Efungumab, Entecavir, EP HIV-1090, EP-2101, Everolimus, Ezetimibe, Ezetimibe/simvastatin; Faropenem daloxate, Fluticasone furoate, Fondaparinux sodium, Fospropofol disodium, Fulvestrant; Golimumab, GSK-089, GW-590735; HO/03/03, hTERT572, hTERT572Y; Iloperidone; Immunoglobulin intravenous (human), Ispinesib mesylate, Istradefylline, Ixabepilone; JR-031, JX-594; KLH; Laropiprant, Lecozotan hydrochloride, Lenalidomide, Lestaurtinib, Linezolid; MGCD-0103, MK-0646, MVA-BN Measles; NI-0401, Niacin/laropiprant, NSC-719239, NYVAC-C; Ospemifene; Paliperidone palmitate, PAN-811, PCV7, Pegfilgrastim, Peginterferon alfa-2a, PEGirinotecan, Perifosine, Pertuzumab, PF-00299804, Picoplatin, Pimavanserin tartrate, Pitavastatin calcium, Pomalidomide, Prasterone, Pratosartan, Prucalopride, PSMA27/pDOM, Pyridoxal phosphate; QS-21, Quercetin; Rebimastat, Rimonabant, Rolofylline, Romidepsin, Rosuvastatin calcium, RTS,S/SBAS2; SCH-530348, SN-29244, Soblidotin, Sodium dichloroacetate, Solifenacin succinate, Sorafenib, Spheramine, SU-6668, Succinobucol; Taranabant, Taxus, Telaprevir, Telavancin hydrochloride, Telbivudine, Tenofovir disoproxil fumarate, Tigecycline, Tiotropium bromide, Tocilizumab, Triphendiol; UC-781, Udenafil, UNIL-025; V-5 Immunitor, Valsartan/amlodipine besylate, Varenicline tartrate, Velafermin, Vernakalant hydrochloride, Vinflunine, Vitespen, Vorinostat, VX-001; Xience V, XRP-0038; Yttrium Y90 Epratuzumab; Z-360, Ziconotide, Ziprasidone hydrochloride, Zotarolimus, Zotarolimus-eluting stent. Copyright 2008 Prous Science, S.A.U. or its licensors. All rights reserved.

Improved Aqueous Solubility and Antihypercholesterolemic Activity of Ezetimibe on Formulating with Hydroxypropyl-β-Cyclodextrin and Hydrophilic Auxiliary Substances.

PubMed

Srivalli, Kale Mohana Raghava; Mishra, Brahmeshwar

2016-04-01

The purpose of this study was to improve the aqueous solubility, dissolution, and pharmacodynamic properties of a BCS class II drug, ezetimibe (Eze) by preparing ternary cyclodextrin complex systems. We investigated the potential synergistic effect of two novel hydrophilic auxiliary substances, D-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) and L-ascorbic acid-2-glucoside (AA2G) on hydroxypropyl-β-cyclodextrin (HPBCD) solubilization of poorly water-soluble hypocholesterolemic drug, Eze. In solution state, the binary and ternary systems were analyzed by phase solubility studies and Job's plot. The solid complexes prepared by freeze-drying were characterized by Fourier transform infrared (FTIR), differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), nuclear magnetic resonance (NMR), and scanning electron microscopy (SEM). The log P values, aqueous solubility, dissolution, and antihypercholesterolemic activity of all systems were studied. The analytical techniques confirmed the formation of inclusion complexes in the binary and ternary systems. HPBCD complexation significantly (p < 0.05) reduced the log P and improved the solubility, dissolution, and hypocholesterolemic properties of Eze, and the addition of ternary component produced further significant improvement (p < 0.05) even compared to binary system. The remarkable reduction in log P and enhancement in solubility, dissolution, and antihypercholesterolemic activity due to the addition of TPGS or AA2G may be attributed to enhanced wetting, dispersibility, and complete amorphization. The use of TPGS or AA2G as ternary hydrophilic auxiliary substances improved the HPBCD solubilization and antihypercholesterolemic activity of Eze.

Novel Therapies for Familial Hypercholesterolemia.

PubMed

Parizo, Justin; Sarraju, Ashish; Knowles, Joshua W

2016-11-01

Both HeFH and HoFH require dietary and lifestyle modification. Pharmacotherapy of adult HeFH patients is largely driven by the American Heart Association (AHA) algorithm. A high-potency statin is started initially with a goal low-density lipoprotein cholesterol (LDL-C) reduction of >50 %. The LDL-C target is adjusted to <100 or <70 mg/dL in subjects with coronary artery disease (CAD) with ezetimibe being second line. If necessary, a third adjunctive therapy, such as a PSCK9 inhibitor (not yet approved in children) or bile acid-binding resin, can be added. Finally, LDL-C apheresis can be considered in patients with LDL-C >300 mg/dL (or >200 mg/dL with significant CAD, although now approved for LDL-C as low as 160 mg/dL with CAD). Due to the early, severe LDL-C elevation in HoFH patients, concerning natural history, rarity of the condition, and nuances of treatment, all HoFH patients should be treated at a pediatric or adult center with HoFH experience. LDL-C apheresis should be considered as early as 5 years of age. However, apheresis availability and tolerability is limited and pharmacotherapy is required. Generally, the AHA algorithm with reference to the European Atherosclerosis Society Consensus Panel recommendations is reasonable with all patients initiated on high-dose, high-potency statin, ezetimibe, and bile acid-binding resins. In most, additional LDL-C lowering is required with PCSK9 inhibitors and/or lomitapide or mipomersen. Liver transplantation can also be considered at experienced centers as a last resort.

Intensity modulation of HF heater-induced plasma lines

NASA Technical Reports Server (NTRS)

Kuo, S. P.; Lee, M. C.

1990-01-01

The Arecibo HF heater is normally composed of two separate sets of antenna array, transmitting waves vertically at the same frequency and polarization. However, when these two sets of antenna array radiate at slightly different frequencies, the intensities of HF heater-induced plasma lines (HFPLs) can be drastically modulated. In recent Duncan et al.'s (1989) experiments the 100 percent intensity modulation of HFPLs was seen to persist even when the secondary set of antenna array radiated at a few percent of the power transmitted by the primary set of antenna array. An explanation is offered, and it is shown that there exists a minimum power, Pmin, and if the secondary set of antenna array radiates at a power lower than Pmin, the 100-percent intensity modulation of HFPLs will not be observed. The functional dependence of Pmin on the difference frequency of the two sets of antenna array is also predicted for future experiments to corroborate.

Electron distribution function in a laser plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalal, M.; Stoll, I.

1983-01-01

An accurate analytic solution of the Vlasov equation in the one-dimensional case is given for plasma electrons in the potential electric field of a monochromatic high-frequency wave of arbitrary amplitude and spatial modulation allowing for a self-consistent field. The phase velocity of the plasma waves is assumed to be appreciably higher than the electron thermal velocity (the case of nonresonant diffusion).

Device and method for electron beam heating of a high density plasma

DOEpatents

Thode, Lester E.

1981-01-01

A device and method for relativistic electron beam heating of a high density plasma in a small localized region. A relativistic electron beam generator produces a high voltage electron beam which propagates along a vacuum drift tube and is modulated to initiate electron bunching within the beam. The beam is then directed through a low density gas chamber which provides isolation between the vacuum modulator and the relativistic electron beam target. The relativistic beam is then applied to a high density target plasma which typically comprises DT, DD, hydrogen boron or similar thermonuclear gas at a density of 10.sup.17 to 10.sup.20 electrons per cubic centimeter. The target plasma is ionized prior to application of the electron beam by means of a laser or other preionization source. Utilizing a relativistic electron beam with an individual particle energy exceeding 3 MeV, classical scattering by relativistic electrons passing through isolation foils is negligible. As a result, relativistic streaming instabilities are initiated within the high density target plasma causing the relativistic electron beam to efficiently deposit its energy into a small localized region within the high density plasma target.

Plasma Crystal-3 Plus experiment Chamber Leak Check

NASA Image and Video Library

2010-07-01

ISS024-E-007144 (1 July 2010) --- Russian cosmonaut Alexander Skvortsov, Expedition 24 commander, performs chamber leak checks on the new Plasma Crystal-3 Plus experiment in the Poisk Mini-Research Module 2 (MRM2) of the International Space Station.

Kotov works with Plasma Crystal-3+ Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-28

ISS022-E-040614 (28 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, is pictured while working with the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Kotov works with Plasma Crystal-3 Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-25

ISS022-E-035439 (25 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, is pictured while working with the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Kotov works with Plasma Crystal-3 Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-25

ISS022-E-035438 (25 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, uses a computer while servicing the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Kotov works with Plasma Crystal-3+ Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-28

ISS022-E-040617 (28 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, is pictured while working with the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

Kotov works with Plasma Crystal-3+ Experiment in the SM during Expedition 22

NASA Image and Video Library

2010-01-28

ISS022-E-040615 (28 Jan. 2010) --- Russian cosmonaut Oleg Kotov, Expedition 22 flight engineer, uses a computer while servicing the Plasma Crystal-3 experiment in the Zvezda Service Module of the International Space Station.

The low density lipoprotein receptor modulates the effects of hypogonadism on diet-induced obesity and related metabolic perturbations

PubMed Central

Constantinou, Caterina; Mpatsoulis, Diogenis; Natsos, Anastasios; Petropoulou, Peristera-Ioanna; Zvintzou, Evangelia; Traish, Abdulmaged M.; Voshol, Peter J.; Karagiannides, Iordanes; Kypreos, Kyriakos E.

2014-01-01

Here, we investigated how LDL receptor deficiency (Ldlr−/−) modulates the effects of testosterone on obesity and related metabolic dysfunctions. Though sham-operated Ldlr−/− mice fed Western-type diet for 12 weeks became obese and showed disturbed plasma glucose metabolism and plasma cholesterol and TG profiles, castrated mice were resistant to diet-induced obesity and had improved glucose metabolism and reduced plasma TG levels, despite a further deterioration in their plasma cholesterol profile. The effect of hypogonadism on diet-induced weight gain of Ldlr−/− mice was independent of ApoE and Lrp1. Indirect calorimetry analysis indicated that hypogonadism in Ldlr−/− mice was associated with increased metabolic rate. Indeed, mitochondrial cytochrome c and uncoupling protein 1 expression were elevated, primarily in white adipose tissue, confirming increased mitochondrial metabolic activity due to thermogenesis. Testosterone replacement in castrated Ldlr−/− mice for a period of 8 weeks promoted diet-induced obesity, indicating a direct role of testosterone in the observed phenotype. Treatment of sham-operated Ldlr−/− mice with the aromatase inhibitor exemestane for 8 weeks showed that the obesity of castrated Ldlr−/− mice is independent of estrogens. Overall, our data reveal a novel role of Ldlr as functional modulator of metabolic alterations associated with hypogonadism. PMID:24837748

Overview of diagnostic performance and results for the first operation phase in Wendelstein 7-X (invited).

PubMed

Krychowiak, M; Adnan, A; Alonso, A; Andreeva, T; Baldzuhn, J; Barbui, T; Beurskens, M; Biel, W; Biedermann, C; Blackwell, B D; Bosch, H S; Bozhenkov, S; Brakel, R; Bräuer, T; Brotas de Carvalho, B; Burhenn, R; Buttenschön, B; Cappa, A; Cseh, G; Czarnecka, A; Dinklage, A; Drews, P; Dzikowicka, A; Effenberg, F; Endler, M; Erckmann, V; Estrada, T; Ford, O; Fornal, T; Frerichs, H; Fuchert, G; Geiger, J; Grulke, O; Harris, J H; Hartfuß, H J; Hartmann, D; Hathiramani, D; Hirsch, M; Höfel, U; Jabłoński, S; Jakubowski, M W; Kaczmarczyk, J; Klinger, T; Klose, S; Knauer, J; Kocsis, G; König, R; Kornejew, P; Krämer-Flecken, A; Krawczyk, N; Kremeyer, T; Książek, I; Kubkowska, M; Langenberg, A; Laqua, H P; Laux, M; Lazerson, S; Liang, Y; Liu, S C; Lorenz, A; Marchuk, A O; Marsen, S; Moncada, V; Naujoks, D; Neilson, H; Neubauer, O; Neuner, U; Niemann, H; Oosterbeek, J W; Otte, M; Pablant, N; Pasch, E; Sunn Pedersen, T; Pisano, F; Rahbarnia, K; Ryć, L; Schmitz, O; Schmuck, S; Schneider, W; Schröder, T; Schuhmacher, H; Schweer, B; Standley, B; Stange, T; Stephey, L; Svensson, J; Szabolics, T; Szepesi, T; Thomsen, H; Travere, J-M; Trimino Mora, H; Tsuchiya, H; Weir, G M; Wenzel, U; Werner, A; Wiegel, B; Windisch, T; Wolf, R; Wurden, G A; Zhang, D; Zimbal, A; Zoletnik, S

2016-11-01

Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered a MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. An overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.

Radiation source

DOEpatents

Thode, Lester E.

1981-01-01

A device and method for relativistic electron beam heating of a high-density plasma in a small localized region. A relativistic electron beam generator or accelerator produces a high-voltage electron beam which propagates along a vacuum drift tube and is modulated to initiate electron bunching within the beam. The beam is then directed through a low-density gas chamber which provides isolation between the vacuum modulator and the relativistic electron beam target. The relativistic beam is then applied to a high-density target plasma which typically comprises DT, DD, or similar thermonuclear gas at a density of 10.sup.17 to 10.sup.20 electrons per cubic centimeter. The target gas is ionized prior to application of the relativistic electron beam by means of a laser or other preionization source to form a plasma. Utilizing a relativistic electron beam with an individual particle energy exceeding 3 MeV, classical scattering by relativistic electrons passing through isolation foils is negligible. As a result, relativistic streaming instabilities are initiated within the high-density target plasma causing the relativistic electron beam to efficiently deposit its energy into a small localized region of the high-density plasma target.

Multiphysics Engineering Analysis for an Integrated Design of ITER Diagnostic First Wall and Diagnostic Shield Module Design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhai, Y.; Loesser, G.; Smith, M.

ITER diagnostic first walls (DFWs) and diagnostic shield modules (DSMs) inside the port plugs (PPs) are designed to protect diagnostic instrument and components from a harsh plasma environment and provide structural support while allowing for diagnostic access to the plasma. The design of DFWs and DSMs are driven by 1) plasma radiation and nuclear heating during normal operation 2) electromagnetic loads during plasma events and associate component structural responses. A multi-physics engineering analysis protocol for the design has been established at Princeton Plasma Physics Laboratory and it was used for the design of ITER DFWs and DSMs. The analyses weremore » performed to address challenging design issues based on resultant stresses and deflections of the DFW-DSM-PP assembly for the main load cases. ITER Structural Design Criteria for In-Vessel Components (SDC-IC) required for design by analysis and three major issues driving the mechanical design of ITER DFWs are discussed. The general guidelines for the DSM design have been established as a result of design parametric studies.« less

Nonlinear Burn Control in Tokamaks using Heating, Non-axisymmetric Magnetic Fields, Isotopic fueling and Impurity injection

NASA Astrophysics Data System (ADS)

Pajares, Andres; Schuster, Eugenio

2016-10-01

Plasma density and temperature regulation in future tokamaks such as ITER is arising as one of the main problems in nuclear-fusion control research. The problem, known as burn control, is to regulate the amount of fusion power produced by the burning plasma while avoiding thermal instabilities. Prior work in the area of burn control considered different actuators, such as modulation of the auxiliary power, modulation of the fueling rate, and controlled impurity injection. More recently, the in-vessel coil system was suggested as a feasible actuator since it has the capability of modifying the plasma confinement by generating non-axisymmetric magnetic fields. In this work, a comprehensive, model-based, nonlinear burn control strategy is proposed to integrate all the previously mentioned actuators. A model to take into account the influence of the in-vessel coils on the plasma confinement is proposed based on the plasma collisionality and the density. A simulation study is carried out to show the capability of the controller to drive the system between different operating points while rejecting perturbations. Supported by the US DOE under DE-SC0010661.

Betatron x-ray radiation from laser-plasma accelerators driven by femtosecond and picosecond laser systems

NASA Astrophysics Data System (ADS)

Albert, F.; Lemos, N.; Shaw, J. L.; King, P. M.; Pollock, B. B.; Goyon, C.; Schumaker, W.; Saunders, A. M.; Marsh, K. A.; Pak, A.; Ralph, J. E.; Martins, J. L.; Amorim, L. D.; Falcone, R. W.; Glenzer, S. H.; Moody, J. D.; Joshi, C.

2018-05-01

A comparative experimental study of betatron x-ray radiation from laser wakefield acceleration in the blowout and self-modulated regimes is presented. Our experiments use picosecond duration laser pulses up to 150 J (self-modulated regime) and 60 fs duration laser pulses up to 10 J (blowout regime), for plasmas with electronic densities on the order of 1019 cm-3. In the self-modulated regime, where betatron radiation has been very little studied compared to the blowout regime, electrons accelerated in the wake of the laser pulse are subject to both the longitudinal plasma and transverse laser electrical fields. As a result, their motion within the wake is relatively complex; consequently, the experimental and theoretical properties of the x-ray source based on self-modulation differ from the blowout regime of laser wakefield acceleration. In our experimental configuration, electrons accelerated up to about 250 MeV and betatron x-ray spectra with critical energies of about 10-20 keV and photon fluxes between 108 and 1010 photons/eV Sr are reported. Our experiments open the prospect of using betatron x-ray radiation for applications, and the source is competitive with current x-ray backlighting methods on multi-kilojoule laser systems.

Low-density lipoprotein receptor-negative compound heterozygous familial hypercholesterolemia: Two lifetime journeys of lipid-lowering therapy.

PubMed

Yahya, Reyhana; Mulder, Monique T; Sijbrands, Eric J G; Williams, Monique; Roeters van Lennep, Jeanine E

We present the case history of 2 patients with low-density lipoprotein receptor-negative compound heterozygous familial hypercholesterolemia who did not receive lipoprotein apheresis. We describe the subsequent effect of all lipid-lowering medications during their life course including resins, statins, ezetimibe, nicotinic acid/laropiprant, mipomersen, and lomitapide. These cases tell the story of siblings affected with this rare disease, who are free of symptoms but still are at a very high cardiovascular disease risk, and their treatment from childhood. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

The modulational instability for the TDNLS equations for weakly nonlinear dispersive MHD waves

NASA Technical Reports Server (NTRS)

Webb, G. M.; Brio, M.; Zank, G. P.

1995-01-01

In this paper we study the modulational instability for the TDNLS equations derived by Hada (1993) and Brio, Hunter, and Johnson to describe the propagation of weakly nonlinear dispersive MHD waves in beta approximately 1 plasmas. We employ Whitham's averaged Lagrangian method to study the modulational instability. This complements studies of the modulational instability by Hada (1993) and Hollweg (1994), who did not use the averaged Lagrangian approach.

CDR Malenchenko with Russian/German Plasma Crystal-3 (PK-3) payload

NASA Image and Video Library

2003-07-30

ISS007-E-11507 (31 July 2003) --- Cosmonaut Yuri I. Malenchenko, Expedition 7 mission commander, is pictured with the Plasma Crystal Experiment in the Zvezda Service Module’s transfer compartment on the International Space Station (ISS). Malenchenko represents Rosaviakosmos.

Direct Simulation Monte Carlo Simulations of Low Pressure Semiconductor Plasma Processing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gochberg, L. A.; Ozawa, T.; Deng, H.

2008-12-31

The two widely used plasma deposition tools for semiconductor processing are Ionized Metal Physical Vapor Deposition (IMPVD) of metals using either planar or hollow cathode magnetrons (HCM), and inductively-coupled plasma (ICP) deposition of dielectrics in High Density Plasma Chemical Vapor Deposition (HDP-CVD) reactors. In these systems, the injected neutral gas flows are generally in the transonic to supersonic flow regime. The Hybrid Plasma Equipment Model (HPEM) has been developed and is strategically and beneficially applied to the design of these tools and their processes. For the most part, the model uses continuum-based techniques, and thus, as pressures decrease below 10more » mTorr, the continuum approaches in the model become questionable. Modifications have been previously made to the HPEM to significantly improve its accuracy in this pressure regime. In particular, the Ion Monte Carlo Simulation (IMCS) was added, wherein a Monte Carlo simulation is used to obtain ion and neutral velocity distributions in much the same way as in direct simulation Monte Carlo (DSMC). As a further refinement, this work presents the first steps towards the adaptation of full DSMC calculations to replace part of the flow module within the HPEM. Six species (Ar, Cu, Ar*, Cu*, Ar{sup +}, and Cu{sup +}) are modeled in DSMC. To couple SMILE as a module to the HPEM, source functions for species, momentum and energy from plasma sources will be provided by the HPEM. The DSMC module will then compute a quasi-converged flow field that will provide neutral and ion species densities, momenta and temperatures. In this work, the HPEM results for a hollow cathode magnetron (HCM) IMPVD process using the Boltzmann distribution are compared with DSMC results using portions of those HPEM computations as an initial condition.« less

Extended plasma channels created by UV laser in air and their application to control electric discharges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zvorykin, V. D., E-mail: zvorykin@sci.lebedev.ru; Ionin, A. A.; Levchenko, A. O.

2015-02-15

Results are presented from a series of experimental and theoretical studies on creating weakly ionized extended plasma channels in atmospheric air by 248-nm UV laser radiation and their application to control long high-voltage discharges. The main mechanisms of air ionization by UV laser pulses with durations from 100 fs to 25 ns and intensities in the ranges of 3×10{sup 11}–1.5×10{sup 13} and 3×10{sup 6}–3×10{sup 11} W/cm{sup 2}, respectively, which are below the threshold for optical gas breakdown, as well as the main relaxation processes in plasma with a density of 10{sup 9}–10{sup 17} cm{sup −3}, are considered. It is shownmore » that plasma channels in air can be efficiently created by amplitude-modulated UV pulses consisting of a train of subpicosecond pulses producing primary photoelectrons and a long UV pulse suppressing electron attachment and sustaining the density of free electrons in plasma. Different modes of the generation and amplification of trains of subterawatt subpicosecond pulses and amplitude-modulated UV pulses with an energy of several tens of joules were implemented on the GARPUN-MTW hybrid Ti:sapphire-KrF laser facility. The filamentation of such UV laser beams during their propagation in air over distances of up to 100 m and the parameters of the corresponding plasma channels were studied experimentally and theoretically. Laser initiation of high-voltage electric discharges and control of their trajectories by means of amplitude-modulated UV pulses, as well as the spatiotemporal structure of breakdowns in air gaps with length of up to 80 cm, were studied.« less

Allosteric properties of hemoglobin and the plasma membrane of the erythrocyte: new insights in gas transport and metabolic modulation.

PubMed

De Rosa, Maria Cristina; Carelli Alinovi, Cristiana; Galtieri, Antonio; Russo, Annamaria; Giardina, Bruno

2008-02-01

Within the red blood cell the hemoglobin molecule is subjected to modulation mechanisms, namely homo- and heterotropic interactions, which optimize its functional behavior to the specific physiological requirements. At the cellular level, these modulation mechanisms are utilized to perform a number of other functions that are not minor with respect to the basic function of oxygen transport. Here we report some key examples concerning: (i) the interaction of hemoglobin with band 3 and its influence on glucose metabolism; (ii) the role of the ligand-linked quaternary transition of hemoglobin in the control of "NO bioactivity" and of gas diffusion; (iii) the interaction of plasma membrane with the various oxidative derivatives of the hemoglobin molecule. (c) 2008 IUBMB.

Intravenous lipid infusion and total plasma fatty acids positively modulate plasma acylated ghrelin in vivo.

PubMed

Barazzoni, R; Gortan Cappellari, G; Semolic, A; Ius, M; Dore, F; Giacca, M; Zanetti, M; Vinci, P; Guarnieri, G

2017-06-01

Ghrelin is a gastric orexigenic hormone whose activating acylation plays a relevant role in the regulation of energy balance. Nutritional modulators of ghrelin acylation and plasma acylated ghrelin (AG) concentration remain however largely undefined. We aimed at investigating whether circulating free fatty acids (FFA) contribute to regulate plasma AG and its ratio (AG/TG) to total hormone (TG). Plasma FFA, TG, AG and AG/TG were measured in a primary outpatient care setting in a community-based population cohort of 850 individuals (age 54 ± 10 years, M/F: 408/442) from the North-East Italy MoMa study. 150-min intravenous lipid infusions in rodents (10% lipids, 600 μl/h) were used to investigate the potential causal role of FFA in the regulation of plasma ghrelin profile. Plasma FFA were associated positively with AG and AG/TG while negatively with TG (P < 0.01). Associations between FFA, AG and AG/TG remained statistically significant (P < 0.02) in multiple regression analysis including HOMA insulin resistance and metabolic confounders, and both AG and AG/TG but not TG increased through plasma FFA quartiles (P < 0.01). Consistent with these findings, intravenous lipid infusion with plasma FFA elevation caused elevations of AG and AG/TG (P < 0.05) with no TG modifications. The current findings demonstrate a novel role for circulating FFA availability to up-regulate plasma AG, which could involve FFA-induced stimulation of ghrelin acylation. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Device and method for relativistic electron beam heating of a high-density plasma to drive fast liners

DOEpatents

Thode, Lester E.

1981-01-01

A device and method for relativistic electron beam heating of a high-density plasma in a small localized region. A relativistic electron beam generator or accelerator produces a high-voltage electron beam which propagates along a vacuum drift tube and is modulated to initiate electron bunching within the beam. The beam is then directed through a low-density gas chamber which provides isolation between the vacuum modulator and the relativistic electron beam target. The relativistic beam is then applied to a high-density target plasma which typically comprises DT, DD, hydrogen boron or similar thermonuclear gas at a density of 10.sup.17 to 10.sup.20 electrons per cubic centimeter. The target gas is ionized prior to application of the electron beam by means of a laser or other preionization source to form a plasma. Utilizing a relativistic electron beam with an individual particle energy exceeding 3 MeV, classical scattering by relativistic electrons passing through isolation foils is negligible. As a result, relativistic streaming instabilities are initiated within the high-density target plasma causing the relativistic electron beam to efficiently deposit its energy and momentum into a small localized region of the high-density plasma target. Fast liners disposed in the high-density target plasma are explosively or ablatively driven to implosion by a heated annular plasma surrounding the fast liner which is generated by an annular relativistic electron beam. An azimuthal magnetic field produced by axial current flow in the annular plasma, causes the energy in the heated annular plasma to converge on the fast liner.

Immunosenescence Induced by Plasma from Individuals with Obesity Caused Cell Signaling Dysfunction and Inflammation.

PubMed

Parisi, Mariana Migliorini; Grun, Lucas Kich; Lavandoski, Patrícia; Alves, Letícia Biscaino; Bristot, Ivi Juliana; Mattiello, Rita; Mottin, Cláudio Corá; Klamt, Fábio; Jones, Marcus Herbert; Padoin, Alexandre Vontobel; Guma, Fátima Costa Rodrigues; Barbé-Tuana, Florencia María

2017-09-01

To evaluate the consequences of plasma from individuals with obesity on parameters associated with immunosenescence in unrelated healthy peripheral blood mononuclear cells (PBMC). Freshly isolated PBMC were incubated in media supplemented with 10% of plasma from individuals with obesity or control subjects for the first 4 hours of 24 to 120 hours of culture. Plasma from individuals with obesity modulated the phenotype of healthy PBMC, leading to a higher rate of apoptosis, lower amounts of phospho-γH2AX and -p53, and mitochondrial dysfunction. After 120 hours, there was a higher secretion of inflammatory cytokines IL-1β and IL-8. CD8 + T lymphocytes presented decreased expression of CD28, which is associated with the immunosenescent phenotype. CD14 + macrophages showed increased expression of CD80 and CD206, suggesting a modulation in the activation of macrophages. These results demonstrate that chronic systemic inflammation observed in obesity induces dysfunctional features in PBMC that are consistent with premature immunosenescence. © 2017 The Obesity Society.

Arabidopsis SNAREs SYP61 and SYP121 coordinate the trafficking of plasma membrane aquaporin PIP2;7 to modulate the cell membrane water permeability.

PubMed

Hachez, Charles; Laloux, Timothée; Reinhardt, Hagen; Cavez, Damien; Degand, Hervé; Grefen, Christopher; De Rycke, Riet; Inzé, Dirk; Blatt, Michael R; Russinova, Eugenia; Chaumont, François

2014-07-01

Plant plasma membrane intrinsic proteins (PIPs) are aquaporins that facilitate the passive movement of water and small neutral solutes through biological membranes. Here, we report that post-Golgi trafficking of PIP2;7 in Arabidopsis thaliana involves specific interactions with two syntaxin proteins, namely, the Qc-SNARE SYP61 and the Qa-SNARE SYP121, that the proper delivery of PIP2;7 to the plasma membrane depends on the activity of the two SNAREs, and that the SNAREs colocalize and physically interact. These findings are indicative of an important role for SYP61 and SYP121, possibly forming a SNARE complex. Our data support a model in which direct interactions between specific SNARE proteins and PIP aquaporins modulate their post-Golgi trafficking and thus contribute to the fine-tuning of the water permeability of the plasma membrane. © 2014 American Society of Plant Biologists. All rights reserved.

Design and Development of High Voltage Direct Current (DC) Sources for the Solar Array Module Plasma Interaction Experiment

NASA Technical Reports Server (NTRS)

Bibyk, Irene K.; Wald, Lawrence W.

1995-01-01

Two programmable, high voltage DC power supplies were developed as part of the flight electronics for the Solar Array Module Plasma Interaction Experiment (SAMPIE). SAMPIE's primary objectives were to study and characterize the high voltage arcing and parasitic current losses of various solar cells and metal samples within the space plasma of low earth orbit (LEO). High voltage arcing can cause large discontinuous changes in spacecraft potential which lead to damage of the power system materials and significant Electromagnetic Interference (EMI). Parasitic currents cause a change in floating potential which lead to reduced power efficiency. These primary SAMPIE objectives were accomplished by applying artificial biases across test samples over a voltage range from -600 VDC to +300 VDC. This paper chronicles the design, final development, and test of the two programmable high voltage sources for SAMPIE. The technical challenges to the design for these power supplies included vacuum, space plasma effects, thermal protection, Shuttle vibrations and accelerations.

Diode laser sensor to monitor HCL in a plasma etch reactor

NASA Astrophysics Data System (ADS)

Kim, Suhong; Klimecky, Pete; Chou, Shang-I.; Jeffries, Jay B.; Terry, Fred L., Jr.; Hanson, Ronald K.

2002-09-01

Absorption measurements of HCl during plasma etching of poly-silicon are made using the P(4) transition in the first vibrational overtone band near 1.79 μm. Single path absorption provides a real-time HCl monitor during etching of six-inch wafers in a commercial Lam Research 9400SE reactor at the University of Michigan. Wavelength modulation at 10.7 MHz is used to distinguish the absorption signal from the strong plasma emission. The laser center frequency is ramp-tuned at 500 Hz providing an HCl measurement every 2ms. Direct absorption measurements without the plasma are used to calibrate the wavelength modulation signal. The minimum detectable absorbance was 5x(10)-6 with 50 ms averaging, leading to an HCl detection limit of ~(10)12cm-3. For a given ratio of the feedstock HBr/Cl2, the measured HCl concentration tracks the average etch rate. These measurements demonstrate the feasibility of a real-time diode laser-based etch rate sensor.

Nonlinear mechanism for the generation of electromagnetic fields in a magnetized plasma by the beatings of waves

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aburjania, G. D.; Machabeli, G. Z.; Kharshiladze, O. A.

2006-07-15

The modulational instability in a plasma in a strong constant external magnetic field is considered. The plasmon condensate is modulated not by conventional low-frequency ion sound but by the beatings of two high-frequency transverse electromagnetic waves propagating along the magnetic field. The instability reduces the spatial scales of Langmuir turbulence along the external magnetic field and generates electromagnetic fields. It is shown that, for a pump wave with a sufficiently large amplitude, the effect described in the present paper can be a dominant nonlinear process.

Emission intensity modulation of radio-frequency helium glow-discharge emission source by laser ablation.

PubMed

Matsuta, Hideyuki; Naeem, Tariq M; Wagatsuma, Kazuaki

2003-06-01

A novel emission excitation source comprising a high repetition rate diode-pumped Q-switched Nd:YAG laser and a Grimm-style glow-discharge lamp is described. Laser-ablated atoms are introduced into the He glow discharge plasma, which then give emission signals. By using phase-sensitive detection with a lock-in amplifier, the emission signal modulated by the pulsed laser can be detected selectively. It is possible to estimate only the emission intensity of sample atoms ablated by laser irradiation with little interference from the other species in the plasma.

Location of the first plasma response to resonant magnetic perturbations in DIII-D H-mode plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiao, W. W.; Evans, T. E.; Tynan, G. R.

2016-04-27

The resonant location of the first plasma response to periodic toroidal phase flips of a Resonant Magnetic Perturbation (RMP) field is experimentally identified in the DIII-D tokamak using phase minima of the modulated plasma density and toroidal rotation relative to the RMP field. Furthermore, the plasma response coincides with the q=3 rational surface and electron fluid velocity null, which is consistent with simulations of the plasma response to the RMP field from a resistive Magnetohydrodynamics modeling. We also observe an asymmetric propagation of the particle and the momentum from the resonant location of the plasma response to the RMP intomore » to core and into the plasma edge.« less

Role of Ambient Gas Composition on Cold Physical Plasma-Elicited Cell Signaling in Keratinocytes.

PubMed

Schmidt, Anke; Bekeschus, Sander; Jablonowski, Helena; Barton, Annemarie; Weltmann, Klaus-Dieter; Wende, Kristian

2017-06-06

A particularly promising medical application of cold physical plasma is the support of wound healing. This is presumably achieved by modulating inflammation as well as skin cell signaling and migration. Plasma-derived reactive oxygen and nitrogen species (ROS/RNS) are assumed the central biologically active plasma components. We hypothesized that modulating the environmental plasma conditions from pure nitrogen (N 2 ) to pure oxygen (O 2 ) in an atmospheric pressure argon plasma jet (kINPen) will change type and concentration of ROS/RNS and effectively tune the behavior of human skin cells. To investigate this, HaCaT keratinocytes were studied in vitro with regard to cell metabolism, viability, growth, gene expression signature, and cytokine secretion. Flow cytometry demonstrated only slight effects on cytotoxicity. O 2 shielding provided stronger apoptotic effects trough caspase-3 activation compared to N 2 shielding. Gene array technology revealed induction of signaling and communication proteins such as immunomodulatory interleukin 6 as well as antioxidative and proproliferative molecules (HMOX1, VEGFA, HBEGF, CSF2, and MAPK) in response to different plasma shielding gas compositions. Cell response was correlated to reactive species: oxygen-shielding plasma induces a cell response more efficiently despite an apparent decrease of hydrogen peroxide (H 2 O 2 ), which was previously shown to be a major player in plasma-cell regulation, emphasizing the role of non-H 2 O 2 ROS like singlet oxygen. Our results suggest differential effects of ROS- and RNS-rich plasma, and may have a role in optimizing clinical plasma applications in chronic wounds. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

Regulatory landscape of AGE-RAGE-oxidative stress axis and its modulation by PPARγ activation in high fructose diet-induced metabolic syndrome.

PubMed

Cannizzaro, Luca; Rossoni, Giuseppe; Savi, Federica; Altomare, Alessandra; Marinello, Cristina; Saethang, Thammakorn; Carini, Marina; Payne, D Michael; Pisitkun, Trairak; Aldini, Giancarlo; Leelahavanichkul, Asada

2017-01-01

The AGE-RAGE-oxidative stress (AROS) axis is involved in the onset and progression of metabolic syndrome induced by a high-fructose diet (HFD). PPARγ activation is known to modulate metabolic syndrome; however a systems-level investigation looking at the protective effects of PPARγ activation as related to the AROS axis has not been performed. The aim of this work is to simultaneously characterize multiple molecular parameters within the AROS axis, using samples taken from different body fluids and tissues of a rat model of HFD-induced metabolic syndrome, in the presence or absence of a PPARγ agonist, Rosiglitazone (RGZ). Rats were fed with 60% HFD for the first half of the treatment duration (21 days) then continued with either HFD alone or HFD plus RGZ for the second half. Rats receiving HFD alone showed metabolic syndrome manifestations including hypertension, dyslipidemia, increased glucose levels and insulin resistance, as well as abnormal kidney and inflammatory parameters. Systolic blood pressure, plasma triglyceride and glucose levels, plasma creatinine, and albuminuria were significantly improved in the presence of RGZ. The following molecular parameters of the AROS axis were significantly upregulated in our rat model: carboxymethyl lysine (CML) in urine and liver; carboxyethyl lysine (CEL) in urine; advanced glycation end products (AGEs) in plasma; receptor for advanced glycation end products (RAGE) in liver and kidney; advanced oxidation protein products (AOPP) in plasma; and 4-hydroxynonenal (HNE) in plasma, liver, and kidney. Conversely, with RGZ administration, the upregulation of AOPP and AGEs in plasma, CML and CEL in urine, RAGE in liver as well as HNE in plasma and liver was significantly counteracted/prevented. Our data demonstrate (i) the systems-level regulatory landscape of HFD-induced metabolic syndrome involving multiple molecular parameters, including HNE, AGEs and their receptor RAGE, and (ii) attenuation of metabolic syndrome by PPARγ modulation.

New simple spectrophotometric method for determination of the binary mixtures (atorvastatin calcium and ezetimibe; candesartan cilexetil and hydrochlorothiazide) in tablets.

PubMed

Belal, Tarek S; Daabees, Hoda G; Abdel-Khalek, Magdi M; Mahrous, Mohamed S; Khamis, Mona M

2013-04-01

A new simple spectrophotometric method was developed for the determination of binary mixtures without prior separation. The method is based on the generation of ratio spectra of compound X by using a standard spectrum of compound Y as a divisor. The peak to trough amplitudes between two selected wavelengths in the ratio spectra are proportional to concentration of X without interference from Y . The method was demonstrated by determination of two drug combinations. The first consists of the two antihyperlipidemics: atorvastatin calcium (ATV) and ezetimibe (EZE), and the second comprises the antihypertensives: candesartan cilexetil (CAN) and hydrochlorothiazide (HCT). For mixture 1, ATV was determined using 10 μg/mL EZE as the divisor to generate the ratio spectra, and the peak to trough amplitudes between 231 and 276 nm were plotted against ATV concentration. Similarly, by using 10 μg/mL ATV as divisor, the peak to trough amplitudes between 231 and 276 nm were found proportional to EZE concentration. Calibration curves were linear in the range 2.5-40 μg/mL for both drugs. For mixture 2, divisor concentration was 7.5 μg/mL for both drugs. CAN was determined using its peak to trough amplitudes at 251 and 277 nm, while HCT was estimated using the amplitudes between 251 and 276 nm. The measured amplitudes were linearly correlated to concentration in the ranges 2.5-50 and 1-30 μg/mL for CAN and HCT, respectively. The proposed spectrophotometric method was validated and successfully applied for the assay of both drug combinations in several laboratory-prepared mixtures and commercial tablets.

New simple spectrophotometric method for determination of the binary mixtures (atorvastatin calcium and ezetimibe; candesartan cilexetil and hydrochlorothiazide) in tablets

PubMed Central

Belal, Tarek S.; Daabees, Hoda G.; Abdel-Khalek, Magdi M.; Mahrous, Mohamed S.; Khamis, Mona M.

2012-01-01

A new simple spectrophotometric method was developed for the determination of binary mixtures without prior separation. The method is based on the generation of ratio spectra of compound X by using a standard spectrum of compound Y as a divisor. The peak to trough amplitudes between two selected wavelengths in the ratio spectra are proportional to concentration of X without interference from Y. The method was demonstrated by determination of two drug combinations. The first consists of the two antihyperlipidemics: atorvastatin calcium (ATV) and ezetimibe (EZE), and the second comprises the antihypertensives: candesartan cilexetil (CAN) and hydrochlorothiazide (HCT). For mixture 1, ATV was determined using 10 μg/mL EZE as the divisor to generate the ratio spectra, and the peak to trough amplitudes between 231 and 276 nm were plotted against ATV concentration. Similarly, by using 10 μg/mL ATV as divisor, the peak to trough amplitudes between 231 and 276 nm were found proportional to EZE concentration. Calibration curves were linear in the range 2.5–40 μg/mL for both drugs. For mixture 2, divisor concentration was 7.5 μg/mL for both drugs. CAN was determined using its peak to trough amplitudes at 251 and 277 nm, while HCT was estimated using the amplitudes between 251 and 276 nm. The measured amplitudes were linearly correlated to concentration in the ranges 2.5–50 and 1–30 μg/mL for CAN and HCT, respectively. The proposed spectrophotometric method was validated and successfully applied for the assay of both drug combinations in several laboratory-prepared mixtures and commercial tablets. PMID:29403805

The short-term effect of atorvastatin plus ezetimibe therapy versus atorvastatin monotherapy on clinical outcome in acute coronary syndrome patients by gender.

PubMed

Japaridze, Lasha; Sadunishvili, Maia

2017-01-01

Atorvastatin reduces low-density lipoprotein cholesterol (LDL-C) levels and the risk of cardiovascular events, but whether the addition of ezetimibe (EZE), a non-statin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further, and if there any sex differences, is not known. To evaluate the effects of atorvastatin and EZE combination in acute coronary syndrome (ACS) patients on the incidence of composite endpoint in short-term follow-up and to assess differences according their gender. We conducted a 16-week, single-centre, prospective, randomised, open-label clinical trial involving 323 patients who had been hospitalised for an ACS within the preceding 14 days. They received atorvastatin 20 mg for 28 days, and after that 292 patients who had LDL-C levels ≥ 1.81 mmol/L were randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE + statin) or double their current atorvastatin dose. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalisation, coronary revascularisation (≥ 30 days after randomisation), or nonfatal stroke. The Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE + statin group patients and 77.0% in the atorvastatin monotherapy group (absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95% confidence interval: 1.165-3.781; p = 0.014). The log rank test indicated that there was not a statistically significant difference between male and female survival rates in both treatment groups (p = 0.897). The results of our study demonstrated that when added to statin therapy, EZE resulted in improved cardiovascular outcomes, and the response to atorvastatin and EZE combination was similar for both men and women.

Quantitation of the rates of hepatic and intestinal cholesterol synthesis in lysosomal acid lipase-deficient mice before and during treatment with ezetimibe.

PubMed

Chuang, Jen-Chieh; Lopez, Adam M; Turley, Stephen D

2017-07-01

Esterified cholesterol (EC) and triglycerides, contained within lipoproteins taken up by cells, are hydrolysed by lysosomal acid lipase (LAL) in the late endosomal/lysosomal (E/L) compartment. The resulting unesterified cholesterol (UC) is transported via Niemann-Pick type C2 and C1 into the cytosolic compartment where it enters a putative pool of metabolically active cholesterol that is utilized in accordance with cellular needs. Loss-of-function mutations in LIPA, the gene encoding LAL, result in dramatic increases in tissue concentrations of EC, a hallmark feature of Wolman disease and cholesteryl ester storage disease (CESD). The lysosomal sequestration of EC causes cells to respond to a perceived deficit of sterol by increasing their rate of cholesterol synthesis, particularly in the liver. A similar compensatory response occurs with treatments that disrupt the enterohepatic movement of cholesterol or bile acids. Here we measured rates of cholesterol synthesis in vivo in the liver and small intestine of a mouse model for CESD given the cholesterol absorption inhibitor ezetimibe from weaning until early adulthood. Consistent with previous findings, this treatment significantly reduced the amount of EC sequestered in the liver (from 132.43±7.35 to 70.07±6.04mg/organ) and small intestine (from 2.78±0.21 to 1.34±0.09mg/organ) in the LAL-deficient mice even though their rates of hepatic and intestinal cholesterol synthesis were either comparable to, or exceeded those in matching untreated Lal -/- mice. These data reveal the role of intestinal cholesterol absorption in driving the expansion of tissue EC content and disease progression in LAL deficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical Profile of Statin Intolerance in the Phase 3 GAUSS-2 Study.

PubMed

Cho, Leslie; Rocco, Michael; Colquhoun, David; Sullivan, David; Rosenson, Robert S; Dent, Ricardo; Xue, Allen; Scott, Rob; Wasserman, Scott M; Stroes, Erik

2016-06-01

Recent evidence suggests that statin intolerance may be more common than reported in randomized trials. However, the statin-intolerant population is not well characterized. The goal of this report is to characterize the population enrolled in the phase 3 Goal Achievement after Utilizing an anti-PCSK9 antibody in Statin Intolerant Subjects Study (GAUSS-2; NCT 01763905). GAUSS-2 compared evolocumab, a fully human monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9) to ezetimibe in hypercholesterolemic patients who discontinued statin therapy due to statin-associated muscle symptoms (SAMS). GAUSS-2 was a 12-week, double-blind, placebo-controlled, randomized study that enrolled patients with elevated LDL-C who were either not on a statin or able to tolerate only a low-dose due to SAMS. Patients had received ≥2 statins and were unable to tolerate any statin dose or increase in dose above a specified weekly dose due to SAMS. Three hundred seven patients (mean [SD] age, 62 [10] years; 54 % males) were randomized 2:1 (evolocumab:ezetimibe). Mean (SD) LDL-C was 4.99 (1.51) mmol/L. Patients had used ≥2 (100 %), ≥3 (55 %), or ≥4 (21 %) statins. Coronary artery disease was present in 29 % of patients. Statin-intolerant symptoms were myalgia in 80 % of patients, weakness in 39 %, and more serious complications in 20 %. In 98 % of patients, SAMS interfered with normal daily activity; in 52 %, symptoms precluded moderate exertion. Evaluation of the GAUSS-2 trial population of statin-intolerant patients demonstrates that most patients were high risk with severely elevated LDL-C and many had statin-associated muscle symptoms that interfered with their quality of life.

Non-thermal plasma jet without electrical shock for biomedical applications

NASA Astrophysics Data System (ADS)

Baik, Ku Youn; Kang, Han Lim; Kim, Junseong; Park, Shin Young; Bang, Ji Yun; Uhm, Han S.; Choi, Eun Ha; Cho, Guangsup

2013-10-01

A plasma jet without an electrical shock was generated through a Y-shaped tube in which voltages with opposite phases were applied to a pair of tubes. The plasma plume generated at the intersection had a plasma potential of a 60-90 V and high concentrations of reactive species sufficient to induce a high level of lethality on gram-negative bacteria on a tissue mimic. The selective lethality of bacteria on an epithelial-cell-containing tissue mimic could be modulated using oxidant and antioxidant chemicals, thereby leading to the possibility of a shock-reduced plasma jet for biomedical applications.

Laser-driven plasma photonic crystals for high-power lasers

NASA Astrophysics Data System (ADS)

Lehmann, G.; Spatschek, K. H.

2017-05-01

Laser-driven plasma density gratings in underdense plasma are shown to act as photonic crystals for high power lasers. The gratings are created by counterpropagating laser beams that trap electrons, followed by ballistic ion motion. This leads to strong periodic plasma density modulations with a lifetime on the order of picoseconds. The grating structure is interpreted as a plasma photonic crystal time-dependent property, e.g., the photonic band gap width. In Maxwell-Vlasov and particle-in-cell simulations it is demonstrated that the photonic crystals may act as a frequency filter and mirror for ultra-short high-power laser pulses.

Modulation of plasma N-acylethanolamine levels and physiological parameters by dietary fatty acid composition in humans

PubMed Central

Jones, Peter J. H.; Lin, Lin; Gillingham, Leah G.; Yang, Haifeng; Omar, Jaclyn M.

2014-01-01

N-acylethanolamines (NAEs) are endogenous lipid-signaling molecules involved in satiety and energetics; however, how diet impacts circulating NAE concentrations and their downstream metabolic actions in humans remains unknown. Objectives were to examine effects of diets enriched with high-oleic canola oil (HOCO) or HOCO blended with flaxseed oil (FXCO), compared with a Western diet (WD), on plasma NAE levels and the association with energy expenditure and substrate oxidation. Using a randomized controlled crossover design, 36 hypercholesterolemic participants consumed three isoenergetic diets for 28 days, each containing 36% energy from fat, of which 70% was HOCO, FXCO, or WD. Ultra-performance liquid chromatography-MS/MS was used to measure plasma NAE levels and indirect calorimetry to assess energy expenditure and substrate oxidation. After 28 days, compared with WD, plasma oleoylethanolamide (OEA) and alpha-linolenoyl ethanolamide (ALEA) levels were significantly increased in response to HOCO and FXCO (P = 0.002, P < 0.001), respectively. Correlation analysis demonstrated an inverse association between plasma OEA levels and percent body fat (r = −0.21, P = 0.04), and a positive association was observed between the plasma arachidonoyl ethanolamide (AEA)/OEA ratio and android:gynoid fat (r = 0.23, P = 0.02), respectively. Results suggest that plasma NAE levels are upregulated via their dietary lipid substrates and may modulate regional and total fat mass through lipid-signaling mechanisms. PMID:25262934

Image-guided plasma therapy of cutaneous wound

NASA Astrophysics Data System (ADS)

Zhang, Zhiwu; Ren, Wenqi; Yu, Zelin; Zhang, Shiwu; Yue, Ting; Xu, Ronald

2014-02-01

The wound healing process involves the reparative phases of inflammation, proliferation, and remodeling. Interrupting any of these phases may result in chronically unhealed wounds, amputation, or even patient death. Despite the clinical significance in chronic wound management, no effective methods have been developed for quantitative image-guided treatment. We integrated a multimodal imaging system with a cold atmospheric plasma probe for image-guided treatment of chronic wound. Multimodal imaging system offers a non-invasive, painless, simultaneous and quantitative assessment of cutaneous wound healing. Cold atmospheric plasma accelerates the wound healing process through many mechanisms including decontamination, coagulation and stimulation of the wound healing. The therapeutic effect of cold atmospheric plasma is studied in vivo under the guidance of a multimodal imaging system. Cutaneous wounds are created on the dorsal skin of the nude mice. During the healing process, the sample wound is treated by cold atmospheric plasma at different controlled dosage, while the control wound is healed naturally. The multimodal imaging system integrating a multispectral imaging module and a laser speckle imaging module is used to collect the information of cutaneous tissue oxygenation (i.e. oxygen saturation, StO2) and blood perfusion simultaneously to assess and guide the plasma therapy. Our preliminary tests show that cold atmospheric plasma in combination with multimodal imaging guidance has the potential to facilitate the healing of chronic wounds.

Beyond the redox imbalance: oxidative stress contributes to an impaired GLUT3 modulation in Huntington's disease

PubMed Central

Covarrubias-Pinto, Adriana; Moll, Pablo; Solís-Maldonado, Macarena; Acuña, Aníbal I.; Riveros, Andrea; Miró, María Paz; Papic, Eduardo; Beltrán, Felipe A.; Cepeda, Carlos; Concha, Ilona I.; Brauchi, Sebastián; Castro, Maite A.

2016-01-01

Failure in energy metabolism and oxidative damage are associated with Huntington’s disease (HD). Ascorbic acid released during synaptic activity inhibits use of neuronal glucose, favouring lactate uptake to sustain brain activity. Here, we observe a decreased expression of GLUT3 in STHdhQ111 cells (HD cells) and R6/2 mice (HD mice). Localisation of GLUT3 is decreased at the plasma membrane in HD cells affecting the modulation of glucose uptake by ascorbic acid. An ascorbic acid analogue without antioxidant activity is able to inhibit glucose uptake in HD cells. The impaired modulation of glucose uptake by ascorbic acid is directly related to ROS levels indicating that oxidative stress sequesters the ability of ascorbic acid to modulate glucose utilisation. Therefore, in HD, a decrease in GLUT3 localisation at the plasma membrane would contribute to an altered neuronal glucose uptake during resting periods while redox imbalance should contribute to metabolic failure during synaptic activity. PMID:26456058

Distinct pH regulation of slow and rapid anion channels at the plasma membrane of Arabidopsis thaliana hypocotyl cells.

PubMed

Colcombet, Jean; Lelièvre, Françoise; Thomine, Sébastien; Barbier-Brygoo, Hélène; Frachisse, Jean-Marie

2005-07-01

Variations in both intracellular and extracellular pH are known to be involved in a wealth of physiological responses. Using the patch-clamp technique on Arabidopsis hypocotyl cells, it is shown that rapid-type and slow-type anion channels at the plasma membrane are both regulated by pH via distinct mechanisms. Modifications of pH modulate the voltage-dependent gating of the rapid channel. While intracellular alkalinization facilitates channel activation by shifting the voltage gate towards negative potentials, extracellular alkalinization shifts the activation threshold to more positive potentials, away from physiological resting membrane potentials. By contrast, pH modulates slow anion channel activity in a voltage-independent manner. Intracellular acidification and extracellular alkalinization increase slow anion channel currents. The possible role of these distinct modulations in physiological processes involving anion efflux and modulation of extracellular and/or intracellular pH, such as elicitor and ABA signalling, are discussed.

Construction of a Radiometer for the Measurement of the Microwave Radiation of Stationary Plasmas; CONSTRUCTION D'UN RADIOMETRE POUR LA MESURE DU RAYONNEMENT DE MICRO-ONDES DE PLASMAS STATIONNAIRES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klan, F.

1961-01-01

A radiometer for 3-cm waves with mechanical signal modulation was constructed for measurements on lowtemperature, stationary plasmas. The sensitivity limit of the device was also calculated in good agreement with experiment. The theory used for the calculation is presented, and the radiometer is described. (D.C.W.)

Characterization of >100 T magnetic fields associated with relativistic Weibel instability in laser-produced plasmas

NASA Astrophysics Data System (ADS)

Mishra, Rohini; Ruyer, Charles; Goede, Sebastian; Roedel, Christian; Gauthier, Maxence; Zeil, Karl; Schramm, Ulrich; Glenzer, Siegfried; Fiuza, Frederico

2016-10-01

Weibel-type instabilities can occur in weakly magnetized and anisotropic plasmas of relevance to a wide range of astrophysical and laboratory scenarios. It leads to the conversion of a significant fraction of the kinetic energy of the plasma into magnetic energy. We will present a detailed numerical study, using 2D and 3D PIC simulations of the Weibel instability in relativistic laser-solid interactions. In this case, the instability develops due to the counter-streaming of laser-heated electrons and the background return current. We show that the growth rate of the instability is maximized near the critical density region on the rear side of the expanded plasma, producing up to 400 MG magnetic fields for Hydrogen plasmas. We have found that this strong field can be directly probed by energetic protons accelerated in rear side of the plasma by Target Normal Sheath Acceleration (TNSA). This allows the experimental characterization of the instability from the analysis of the spatial modulation of the detected protons. Our numerical results are compared with recent laser experiments with Hydrogen jets and show good agreement with the proton modulations observed experimentally. This work was supported by the DOE Office of Science, Fusion Energy Science (FWP 100182).

Parallel momentum input by tangential neutral beam injections in stellarator and heliotron plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nishimura, S., E-mail: nishimura.shin@lhd.nifs.ac.jp; Nakamura, Y.; Nishioka, K.

The configuration dependence of parallel momentum inputs to target plasma particle species by tangentially injected neutral beams is investigated in non-axisymmetric stellarator/heliotron model magnetic fields by assuming the existence of magnetic flux-surfaces. In parallel friction integrals of the full Rosenbluth-MacDonald-Judd collision operator in thermal particles' kinetic equations, numerically obtained eigenfunctions are used for excluding trapped fast ions that cannot contribute to the friction integrals. It is found that the momentum inputs to thermal ions strongly depend on magnetic field strength modulations on the flux-surfaces, while the input to electrons is insensitive to the modulation. In future plasma flow studies requiringmore » flow calculations of all particle species in more general non-symmetric toroidal configurations, the eigenfunction method investigated here will be useful.« less

Solar array module plasma interactions experiment (SAMPIE) - Science and technology objectives

NASA Technical Reports Server (NTRS)

Hillard, G. B.; Ferguson, Dale C.

1993-01-01

The solar array module plasma interactions experiment (SAMPIE) is an approved NASA flight experiment manifested for Shuttle deployment in early 1994. The SAMPIE experiment is designed to investigate the interaction of high voltage space power systems with ionospheric plasma. To study the behavior of solar cells, a number of solar cell coupons (representing design technologies of current interest) will be biased to high voltages to measure both arcing and current collection. Various theories of arc suppression will be tested by including several specially modified cell coupons. Finally, SAMPIE will include experiments to study the basic nature of arcing and current collection. This paper describes the rationale for a space flight experiment, the measurements to be made, and the significance of the expected results. A future paper will present a detailed discussion of the engineering design.

Betatron x-ray radiation in the self-modulated wakefield acceleration regime (Conference Presentation)

NASA Astrophysics Data System (ADS)

Albert, Felicie

2017-05-01

Betatron x-ray radiation, driven by electrons from laser-wakefield acceleration, has unique properties to probe high energy density (HED) plasmas and warm dense matter. Betatron radiation is produced when relativistic electrons oscillate in the plasma wake of a laser pulse. Its properties are similar to those of synchrotron radiation, with a 1000 fold shorter pulse. This presentation will focus on the experimental challenges and results related to the development of betatron radiation in the self modulated regime of laser wakefield acceleration. We observed multi keV Betatron x-rays from a self-modulated laser wakefield accelerator. The experiment was performed at the Jupiter Laser Facility, LLNL, by focusing the Titan short pulse beam (4-150 J, 1 ps) onto the edge of a Helium gas jet at electronic densities around 1019 cm-3. For the first time on this laser system, we used a long focal length optic, which produced a laser normalized potential a0 in the range 1-3. Under these conditions, electrons are accelerated by the plasma wave created in the wake of the light pulse. As a result, intense Raman satellites, which measured shifts depend on the electron plasma density, were observed on the laser spectrum transmitted through the target. Electrons with energies up to 200 MeV, as well as Betatron x-rays with critical energies around 20 keV, were measured. OSIRIS 2D PIC simulations confirm that the electrons gain energy both from the plasma wave and from their interaction with the laser field.

Exposure to increased levels of estradiol during development can have long-term effects on the response to undernutrition in female rats.

PubMed

Carrillo, B; Collado, P; Díaz, F; Chowen, J A; Pinos, H

2016-11-01

Undernutrition during development alters the expression of peptides that control energy expenditure and feeding behavior. Estrogens can also modulate these peptides. Here, we analyze whether the early postnatal administration of estradiol modulates the effects of undernutrition on neuroendocrine parameters in adult female Wistar rats. Control rats were fed a control diet. Undernourished pups were submitted to a restricted diet with half of the undernourished rats receiving 0.4 mg/kg s.c. of estradiol benzoate (EB) from postnatal day (P) 6 until P13. Quantitative real-time polymerase chain reaction was performed to determine expression in the hypothalamus of agouti-related peptide (AgRP), proopiomelanocortin (POMC), neuropeptide Y (NPY), and cocaine- and amphetamine-regulated transcript. Plasma estradiol, testosterone, and adiponectin levels were measured by enzyme-linked immunosorbent assay. Total and acylated ghrelin levels were measured in plasma by radioimmunoassay. Insulin and leptin were measured by mulitplex immunoassays. Undernourishment decreased body weight, fat mass, plasma leptin and insulin levels, and hypothalamic POMC mRNA levels. An increase in orexigenic signals AgRP and NPY mRNA levels, and in plasma adiponectin levels were found in undernourished animals. Early postnatal treatment with EB to undernourished female rats reversed the effects of undernutrition on adult hypothalamic POMC mRNA levels. In addition, neonatal EB treatment to undernourished females significantly decreased adult plasma testosterone, estradiol, and acylated ghrelin levels. Our results suggest that increased estradiol during a critical period of development has the capacity to modulate the alterations that undernutrition produces on energy metabolism.

Overview of diagnostic performance and results for the first operation phase in Wendelstein 7-X (invited)

DOE PAGES

Krychowiak, M.

2016-10-27

Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered amore » MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. Finally, an overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.« less

Overview of diagnostic performance and results for the first operation phase in Wendelstein 7-X (invited)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krychowiak, M.

Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered amore » MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. Finally, an overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.« less

Device and method for imploding a microsphere with a fast liner

DOEpatents

Thode, Lester E.

1981-01-01

A device and method for relativistic electron beam heating of a high-density plasma in a small localized region. A relativistic electron beam generator or accelerator produces a high-voltage electron beam which propagates along a vacuum drift tube and is modulated to initiate electron bunching within the beam. The beam is then directed through a low-density gas chamber which provides isolation between the vacuum modulator and the relativistic electron beam target. The relativistic beam is then applied to a high-density target plasma which typically comprises DT, DD, hydrogen boron or similar thermonuclear gas at a density of 10.sup.17 to 10.sup.20 electrons per cubic centimeter. The target gas is ionized prior to application of the electron beam by means of a laser or other preionization source to form a plasma. Utilizing a relativistic electron beam with an individual particle energy exceeding 3 MeV, classical scattering by relativistic electrons passing through isolation foils is negligible. As a result, relativistic streaming instabilities are initiated within the high-density target plasma causing the relativistic electron beam to efficiently deposit its energy and momentum into a small localized region of the high-density plasma target. Fast liners disposed in the high-density target plasma are explosively or ablatively driven to implosion by a heated annular plasma surrounding the fast liner generated by an annular relativistic electron beam. An azimuthal magnetic field produced by axial current flow in the annular plasma, causes the energy in the heated annular plasma to converge on the fast liner to drive the fast liner to implode a microsphere.

Effect of glow DBD modulation on gas and thin film chemical composition: case of Ar/SiH4/NH3 mixture

NASA Astrophysics Data System (ADS)

Vallade, Julien; Bazinette, Remy; Gaudy, Laura; Massines, Françoise

2014-06-01

In recent years, atmospheric pressure plasma-enhanced chemical vapour deposition has been identified as a convenient way to deposit good quality thin films. With this type of process, where the gas mixture is injected on one side of the electrodes, the chemical composition of the gas evolves with the gas residence time in the plasma. The consequence is a possible gradient in the chemical composition over the thickness of in-line coatings. The present work shows that the modulation of the plasma with a square signal significantly reduces this gradient while the drawback of low growth rate is avoided by increasing the discharge power. This study deals with plane/plane glow dielectric barrier discharges (DBDs) in an Ar/NH3/SiH4 gas mixture to make thin films. The 50 kHz discharge power of the glow DBD was varied by increasing voltage and modulating excitation. The impact on (i) the plasma development was observed through emission spectroscopy and (ii) the thin film coating through Fourier transform infrared measurements. It is shown that the modulation significantly decreases the time and the energy needed to achieve stable chemistry, enhances secondary chemistry and limits disturbance induced by impurities because of a slower decrease of SiH4 concentration and thus a higher ratio of SiH4/impurities, all very important points for in-line AP-PECVD development. When the growth rate is limited by diffusion, coating growth continues when the discharge is off, so long as there is a precursor gradient between the surface and the gas bulk. A higher discharge power steepens this gradient, which enhances diffusion from the bulk and thus growth rate.

Translational PK-PD modelling of molecular target modulation for the AMPA receptor positive allosteric modulator Org 26576.

PubMed

Bursi, Roberta; Erdemli, Gul; Campbell, Robert; Hutmacher, Matthew M; Kerbusch, Thomas; Spanswick, David; Jeggo, Ross; Nations, Kari R; Dogterom, Peter; Schipper, Jacques; Shahid, Mohammed

2011-12-01

The α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor potentiator Org 26576 represents an interesting pharmacological tool to evaluate the utility of glutamatergic enhancement towards the treatment of psychiatric disorders. In this study, a rat-human translational pharmacokinetic-pharmacodynamic (PK-PD) model of AMPA receptor modulation was used to predict human target engagement and inform dose selection in efficacy clinical trials. Modelling and simulation was applied to rat plasma and cerebrospinal fluid (CSF) pharmacokinetic and pharmacodynamic measurements to identify a target concentration (EC(80)) for AMPA receptor modulation. Human plasma pharmacokinetics was determined from 33 healthy volunteers and eight major depressive disorder patients. From four out of these eight patients, CSF PK was also determined. Simulations of human CSF levels were performed for several doses of Org 26576. Org 26576 (0.1-10 mg/kg, i.v.) potentiated rat hippocampal AMPA receptor responses in an exposure-dependant manner. The rat plasma and CSF PK data were fitted by one-compartment model each. The rat CSF PK-PD model yielded an EC(80) value of 593 ng/ml (90% confidence interval 406.8, 1,264.1). The human plasma and CSF PK data were simultaneously well described by a two-compartment model. Simulations showed that in humans at 100 mg QD, CSF levels of Org 26576 would exceed the EC(80) target concentration for about 2 h and that 400 mg BID would engage AMPA receptors for 24 h. The modelling approach provided useful insight on the likely human dose-molecular target engagement relationship for Org 26576. Based on the current analysis, 100 and 400 mg BID would be suitable to provide 'phasic' and 'continuous' AMPA receptor engagement, respectively.

Combination of nitric oxide therapy, anti-oxidative therapy, low level laser therapy, plasma rich platelet therapy and stem cell therapy as a novel therapeutic application to manage the pain and treat many clinical conditions

NASA Astrophysics Data System (ADS)

Halasa, Salaheldin; Dickinson, Eva

2014-02-01

From hypertension to diabetes, cancer to HIV, stroke to memory loss and learning disorders to septic shock, male impotence to tuberculosis, there is probably no pathological condition where nitric oxide does not play an important role. Nitric oxide is an analgesic, immune-modulator, vasodilator, anti-apoptotic, growth modulator, angiogenetic, anti-thrombotic, anti-inflammatory and neuro-modulator. Because of the above actions of nitric oxide, many clinical conditions associated with abnormal Nitric oxide (NO) production and bioavailability. Our novel therapeutic approach is to restore the homeostasis of nitric oxide and replace the lost cells by combining nitric oxide therapy, anti-oxidative therapy, low level laser therapy, plasma rich platelet therapy and stem cell therapy.

Instrument Reflections and Scene Amplitude Modulation in a Polychromatic Microwave Quadrature Interferometer

NASA Technical Reports Server (NTRS)

Dobson, Chris C.; Jones, Jonathan E.; Chavers, Greg

2003-01-01

A polychromatic microwave quadrature interferometer has been characterized using several laboratory plasmas. Reflections between the transmitter and the receiver have been observed, and the effects of including reflection terms in the data reduction equation have been examined. An error analysis which includes the reflections, modulation of the scene beam amplitude by the plasma, and simultaneous measurements at two frequencies has been applied to the empirical database, and the results are summarized. For reflection amplitudes around 1096, the reflection terms were found to reduce the calculated error bars for electron density measurements by about a factor of 2. The impact of amplitude modulation is also quantified. In the complete analysis, the mean error bar for high- density measurements is 7.596, and the mean phase shift error for low-density measurements is 1.2". .

Influence of apolipoprotein A-V on the metabolic fate of triacylglycerol.

PubMed

Sharma, Vineeta; Forte, Trudy M; Ryan, Robert O

2013-04-01

Apolipoprotein (apo) A-V functions to modulate intracellular and extracellular triacylglycerol metabolism. The present review addresses molecular mechanisms underlying these effects. The relevance of apoA-V to human disease conditions is illustrated by the strong correlation between single nucleotide polymorphisms in APOA5, elevated plasma triacylglycerol and dyslipidemic disease. Despite undergoing processing for secretion from hepatocytes, a portion of apoA-V escapes this destiny and accumulates as a component of cytosolic lipid droplets. Expression of recombinant apoA-V in hepatocarcinoma cells results in increased lipid droplet size and number at the expense of triacylglycerol secretion.ApoA-V modulates atherosclerosis in hypercholesterolemic apoE null mice. ApoE null/human apoA-V transgenic mice had reduced levels of triacylglycerol and cholesterol in plasma along with decreased aortic lesion size. ApoA-V modulates triacylglycerol metabolic fate. Following its synthesis, apoA-V enters the endoplasmic reticulum and associates with membrane defects created by triacylglycerol accumulation. Association of apoA-V with endoplasmic reticulum membrane defects promotes nascent lipid droplets budding toward the cytosol. Despite its low concentration in plasma (∼150 ng/ml), apoA-V modulates lipoprotein metabolism by binding to glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1. This interaction effectively localizes triacylglycerol-rich lipoproteins in the vicinity of glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein1's other ligand, lipoprotein lipase.

Influence of apolipoprotein A-V on the metabolic fate of triacylglycerol

PubMed Central

Sharma, Vineeta; Forte, Trudy M.; Ryan, Robert O.

2013-01-01

Purpose of review Apolipoprotein (apo) A-V functions to modulate intracellular and extracellular triacylglycerol metabolism. The present review addresses molecular mechanisms underlying these effects. The relevance of apoA-V to human disease conditions is illustrated by the strong correlation between single nucleotide polymorphisms in APOA5, elevated plasma triacylglycerol and dyslipidemic disease. Recent findings Despite undergoing processing for secretion from hepatocytes, a portion of apoA-V escapes this destiny and accumulates as a component of cytosolic lipid droplets. Expression of recombinant apoA-V in hepatocarcinoma cells results in increased lipid droplet size and number at the expense of triacylglycerol secretion. ApoA-V modulates atherosclerosis in hypercholesterolemic apoE null mice. ApoE null/human apoA-V transgenic mice had reduced levels of triacylglycerol and cholesterol in plasma along with decreased aortic lesion size. Summary ApoA-V modulates triacylglycerol metabolic fate. Following its synthesis, apoA-V enters the endoplasmic reticulum and associates with membrane defects created by triacylglycerol accumulation. Association of apoA-V with endoplasmic reticulum membrane defects promotes nascent lipid droplets budding toward the cytosol. Despite its low concentration in plasma (~150 ng/ml), apoA-V modulates lipoprotein metabolism by binding to glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1. This interaction effectively localizes triacylglycerol-rich lipoproteins in the vicinity of glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1’s other ligand, lipoprotein lipase. PMID:23241513

MAT1A variants modulate the effect of dietary fatty acids on plasma homocysteine concentrations and DNA damage

USDA-ARS?s Scientific Manuscript database

Dietary n-3 polyunsaturated fatty acids (PUFA) are associated with decreased plasma homocysteine (Hcy), an important biomarker for cardiovascular disease. Methionine adenosyltransferase (MAT1A) is an enzyme involved in formation of form S-adenosylmethionine during methionine metabolism. The objectiv...

LOW COST, EFFICIENT MICROCHANNEL PLASMA OZONE GENERATOR FOR POINT OF USE WATER TREATMENT - PHASE I

EPA Science Inventory

A team of EP Purification and the University of Illinois engineers and chemists is pursuing the commercialization of low-cost microchannel plasma modules capable of efficiently producing ozone for...

Reaction kinetics of a kHz-driven atmospheric pressure plasma with humid air impurities

NASA Astrophysics Data System (ADS)

Murakami, T.; Algwari, Q. Th.; Niemi, K.; Gans, T.; O'Connell, D.; Graham, W. G.

2013-09-01

Atmospheric-pressure plasma jets (APPJs) have been gaining attention because of their great potential in bio-plasma applications. It is important to know the complex chemical kinetics of the reactive multi-species plasma. This is a study starting to address this by using a 0D time-dependent global simulation (comprising 1050 elementary reactions among 59 specie) of kHz-driven (20 kHz) APPJ with a helium-based oxygen-mixture (0.5%) with ambient humid air impurity. The present model is initiated from time dependent measurements and estimates of the basic plasma properties. The dominant neutral reactive species are reactive oxygen species and atomic hydrogen. The positive and negative oxygen ions and electrons are the most pronounced charged species. While most of the neutral reactive species are only weakly modulated at the driving frequency, the atomic oxygen metastables and atomic nitrogen metastables are strongly modulated. So are also the electrons and most of the positive and negative ions, but some are not, as will be discussed. This work was supported by KAKENHI (MEXT 24110704) and (JSPS 24561054),and UK EPSRC through a Career Acceleration Fellowship (EP/H003797/1) and Science and Innovation Award (EP/D06337X/1).

Recent Progress and Future Plans for Fusion Plasma Synthetic Diagnostics Platform

NASA Astrophysics Data System (ADS)

Shi, Lei; Kramer, Gerrit; Tang, William; Tobias, Benjamin; Valeo, Ernest; Churchill, Randy; Hausammann, Loic

2015-11-01

The Fusion Plasma Synthetic Diagnostics Platform (FPSDP) is a Python package developed at the Princeton Plasma Physics Laboratory. It is dedicated to providing an integrated programmable environment for applying a modern ensemble of synthetic diagnostics to the experimental validation of fusion plasma simulation codes. The FPSDP will allow physicists to directly compare key laboratory measurements to simulation results. This enables deeper understanding of experimental data, more realistic validation of simulation codes, quantitative assessment of existing diagnostics, and new capabilities for the design and optimization of future diagnostics. The Fusion Plasma Synthetic Diagnostics Platform now has data interfaces for the GTS and XGC-1 global particle-in-cell simulation codes with synthetic diagnostic modules including: (i) 2D and 3D Reflectometry; (ii) Beam Emission Spectroscopy; and (iii) 1D Electron Cyclotron Emission. Results will be reported on the delivery of interfaces for the global electromagnetic PIC code GTC, the extended MHD M3D-C1 code, and the electromagnetic hybrid NOVAK eigenmode code. Progress toward development of a more comprehensive 2D Electron Cyclotron Emission module will also be discussed. This work is supported by DOE contract #DEAC02-09CH11466.

Asprosin, a fasting-induced glucogenic protein hormone

USDA-ARS?s Scientific Manuscript database

Hepatic glucose release into the circulation is vital for brain function and survival during periods of fasting and is modulated by an array of hormones that precisely regulate plasma glucose levels. We have identified a fasting-induced protein hormone that modulates hepatic glucose release. It is t...

A path to stable low-torque plasma operation in ITER with test blanket modules

DOE PAGES

Lanctot, Matthew J.; Snipes, J. A.; Reimerdes, H.; ...

2016-12-12

New experiments in the low-torque ITER Q = 10 scenario on DIII-D demonstrate that n = 1 magnetic fields from a single row of ex-vessel control coils enable operation at ITER performance metrics in the presence of applied non-axisymmetric magnetic fields from a test blanket module (TBM) mock-up coil. With n = 1 compensation, operation below the ITER-equivalent injected torque is successful at three times the ITER equivalent toroidal magnetic field ripple for a pair of TBMs in one equatorial port, whereas the uncompensated TBM field leads to rotation collapse, loss of H-mode and plasma current disruption. In companion experimentsmore » at high plasma beta, where the n = 1 plasma response is enhanced, uncorrected TBM fields degrade energy confinement and the plasma angular momentum while increasing fast ion losses; however, disruptions are not routinely encountered owing to increased levels of injected neutral beam torque. In this regime, n = 1 field compensation leads to recovery of a dominant fraction of the TBM-induced plasma pressure and rotation degradation, and an 80% reduction in the heat load to the first wall. These results show that the n = 1 plasma response plays a dominant role in determining plasma stability, and that n = 1 field compensation alone not only recovers most of the impact on plasma performance of the TBM, but also protects the first wall from potentially damaging heat flux. Despite these benefits, plasma rotation braking from the TBM fields cannot be fully recovered using standard error field control. Lastly, given the uncertainty in extrapolation of these results to the ITER configuration, it is prudent to design the TBMs with as low a ferromagnetic mass as possible without jeopardizing the TBM mission.« less

Modulation of innate and adaptive cellular immunity relevant to HIV-1 vaccine design by seminal plasma.

PubMed

Selva, Kevin J; Kent, Stephen J; Parsons, Matthew S

2017-01-28

Mucosal exposure to HIV-1 infection generally occurs in the presence of semen. Immunomodulation by seminal plasma is well described in the reproductive biology literature. Little is known, however, about the impact of seminal plasma on innate and adaptive anti-HIV-1 cellular immunity. The study investigated the effects of seminal plasma on immune responses considered important for prophylactic HIV-1 vaccine development, namely innate and adaptive cellular immunity mediated by natural killer (NK) cells and T cells, respectively. The ability of seminal plasma to modulate direct, antibody-dependent and cytokine-stimulated NK cell activation was assessed utilizing intracellular cytokine staining. Direct and antibody-dependent cellular cytotoxicity was assessed using lactate dehydrogenase release assays. The effects of seminal plasma on T-cell activation upon stimulation with staphylococcus enterotoxin B or HIV-1 Gag peptides were assessed by intracellular cytokine staining. The impact of seminal plasma on redirected cytolysis mediated by T cells was measured using lactate dehydrogenase release assays. Both direct and antibody-dependent NK cell activation were dramatically impaired by the presence of either HIV-1-uninfected or HIV-1-infected seminal plasma in a dose-dependent manner. Additionally, seminal plasma suppressed both direct and antibody-dependent NK cell-mediated cytolysis, including anti-HIV-1 antibody-dependent cytolysis of gp120-pulsed CEM.NKr-CCR5 cells. Finally, seminal plasma attenuated both HIV-1 Gag-specific and staphylococcus enterotoxin B-induced CTL activation. Semen contains potent immunosuppressors of both NK cell and CD8 T-cell-mediated anti-HIV-1 immune responses. This could impede attempts to provide vaccine-induced immunity to HIV-1.

Plasma corticotropin releasing hormone during the feeling of induced emotions.

PubMed

Martin Martins, Joao; Vale, Sónia do; Ferreira, Florbela; Fagundes, Maria Joao; Carmo, Isabel do; Saldanha, Carlota; Martins E Silva, J

2010-01-01

Central neuropeptides modulate behaviour. Plasma levels of neuropeptides may reflect central levels due to specific brain-to-blood transport systems. We purposed to show the modulation of plasma corticotropin releasing hormone (CRH) levels in relation to induced emotions. Three groups were defined. For experimental groups A and B, an emotionally significant movie fragment was projected for 20 min, while no film projection occurred in group C. Peripheral venous blood samples were collected before, 10 and 60 min after the film or at 0 and 30 min for group C. Total CRH was measured in plasma. Personality was evaluated by the Minnesota Multiphasic Personality Inventory (MMPI). Plasma CRH levels did not change in the condition with no movie projection - group C - 346 + or - 198 vs. 327 + or - 143 pg/mL. Plasma CRH levels dramatically increased with the projection of a dramatic movie - group A - 394 + or - 147 vs. 791 + or - 636 vs. 803 + or - 771 pg/mL, p<0.05. Plasma CRH increased less markedly in the condition with the projection of a comic movie - group B - 364 + or - 138 vs. 486 + or - 260 vs. 483 + or - 228 pg/mL, p<0.05 for differences between samples 1 and 3. Baseline plasma CRH was significantly and independently related to the neurotic triad and psychotic dyad - partial r=0.328 and 0.267, respectively, p<0.05. We conclude that plasma CRH levels increase with experimental emotion induction and that baseline levels are significantly related to behavioural traits. Plasma levels of neuropeptides may reflect central levels and may be useful in clinical medicine and in the study of behavioural disorders.

A path to stable low-torque plasma operation in ITER with test blanket modules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lanctot, Matthew J.; Snipes, J. A.; Reimerdes, H.

New experiments in the low-torque ITER Q = 10 scenario on DIII-D demonstrate that n = 1 magnetic fields from a single row of ex-vessel control coils enable operation at ITER performance metrics in the presence of applied non-axisymmetric magnetic fields from a test blanket module (TBM) mock-up coil. With n = 1 compensation, operation below the ITER-equivalent injected torque is successful at three times the ITER equivalent toroidal magnetic field ripple for a pair of TBMs in one equatorial port, whereas the uncompensated TBM field leads to rotation collapse, loss of H-mode and plasma current disruption. In companion experimentsmore » at high plasma beta, where the n = 1 plasma response is enhanced, uncorrected TBM fields degrade energy confinement and the plasma angular momentum while increasing fast ion losses; however, disruptions are not routinely encountered owing to increased levels of injected neutral beam torque. In this regime, n = 1 field compensation leads to recovery of a dominant fraction of the TBM-induced plasma pressure and rotation degradation, and an 80% reduction in the heat load to the first wall. These results show that the n = 1 plasma response plays a dominant role in determining plasma stability, and that n = 1 field compensation alone not only recovers most of the impact on plasma performance of the TBM, but also protects the first wall from potentially damaging heat flux. Despite these benefits, plasma rotation braking from the TBM fields cannot be fully recovered using standard error field control. Lastly, given the uncertainty in extrapolation of these results to the ITER configuration, it is prudent to design the TBMs with as low a ferromagnetic mass as possible without jeopardizing the TBM mission.« less

Self-injection of electrons in a laser-wakefield accelerator by using longitudinal density ripple

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dahiya, Deepak; Sharma, A. K.; Sajal, Vivek

By introducing a longitudinal density ripple (periodic modulation in background plasma density), we demonstrate self-injection of electrons in a laser-wakefield accelerator. The wakefield driven plasma wave, in presence of density ripple excites two side band waves of same frequency but different wave numbers. One of these side bands, having smaller phase velocity compared to wakefield driven plasma wave, preaccelerates the background plasma electrons. Significant number of these preaccelerated electrons get trapped in the laser-wakefield and further accelerated to higher energies.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thiemann, H.; Bogus, K.P.

The behavior of solar cell modules at high voltages in a surrounding simulated LEO plasma has been characterized over an applied voltage range from -700 to +500 V. Measurements were obtained in a large chamber under high vacuum using argon ions from a Kaufman source to generate a high-density plasma of up to 10 to the 6th/cu cm. The results suggest that secondary electrons contribute to the anomalous current increase noted at positive module voltages above 300 V. The surface potential on the coverglasses of the solar cells was shown to increase to high values only in the vicinity ofmore » the interconnectors. 27 references.« less

The missing link: do cortical microtubules define plasma membrane nanodomains that modulate cellulose biosynthesis?

PubMed

Fujita, Miki; Lechner, Bettina; Barton, Deborah A; Overall, Robyn L; Wasteneys, Geoffrey O

2012-02-01

Cellulose production is a crucial aspect of plant growth and development. It is functionally linked to cortical microtubules, which self-organize into highly ordered arrays often situated in close proximity to plasma membrane-bound cellulose synthase complexes (CSCs). Although most models put forward to explain the microtubule-cellulose relationship have considered mechanisms by which cortical microtubule arrays influence the orientation of cellulose microfibrils, little attention has been paid to how microtubules affect the physicochemical properties of cellulose. A recent study using the model system Arabidopsis, however, indicates that microtubules can modulate the crystalline and amorphous content of cellulose microfibrils. Microtubules are required during rapid growth for reducing crystalline content, which is predicted to increase the degree to which cellulose is tethered by hemicellulosic polysaccharides. Such tethering is, in turn, critical for maintaining unidirectional cell expansion. In this article, we hypothesize that cortical microtubules influence the crystalline content of cellulose either by controlling plasma membrane fluidity or by modulating the deposition of noncellulosic wall components in the vicinity of the CSCs. We discuss the current limitations of imaging technology to address these hypotheses and identify the image acquisition and processing strategies that will integrate live imaging with super resolution three-dimensional information.

Enhanced stimulated Raman scattering by femtosecond ultraviolet plasma grating in water

NASA Astrophysics Data System (ADS)

Liu, Fengjiang; Yuan, Shuai; He, Boqu; Nan, Junyi; Khan, Abdul Qayyum; Ding, Liang'en; Zeng, Heping

2018-02-01

Efficient forward stimulated Raman scattering (SRS) was observed along 400-nm femtosecond (fs) laser filaments in water. SRS conversion dominated over self-phase modulation induced continuum generation as the input pulse energy was above 4 μJ (˜30 Pcr), implying that plasma in the aqueous filamentation channel played an important role in compensating for the group velocity walk-off between the pump and Stokes pulses. By overlapping two synchronous fs 400-nm filaments to form plasma grating in water, significant enhancement of SRS conversion was observed. Such a SRS enhancement originated from the ultrahigh plasma density in the intersection region of the preformed plasma grating.

A new (2+1) dimensional integrable evolution equation for an ion acoustic wave in a magnetized plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mukherjee, Abhik, E-mail: abhik.mukherjee@saha.ac.in; Janaki, M. S., E-mail: ms.janaki@saha.ac.in; Kundu, Anjan, E-mail: anjan.kundu@saha.ac.in

2015-07-15

A new, completely integrable, two dimensional evolution equation is derived for an ion acoustic wave propagating in a magnetized, collisionless plasma. The equation is a multidimensional generalization of a modulated wavepacket with weak transverse propagation, which has resemblance to nonlinear Schrödinger (NLS) equation and has a connection to Kadomtsev-Petviashvili equation through a constraint relation. Higher soliton solutions of the equation are derived through Hirota bilinearization procedure, and an exact lump solution is calculated exhibiting 2D structure. Some mathematical properties demonstrating the completely integrable nature of this equation are described. Modulational instability using nonlinear frequency correction is derived, and the correspondingmore » growth rate is calculated, which shows the directional asymmetry of the system. The discovery of this novel (2+1) dimensional integrable NLS type equation for a magnetized plasma should pave a new direction of research in the field.« less

The COMPASS Tokamak Plasma Control Software Performance

NASA Astrophysics Data System (ADS)

Valcarcel, Daniel F.; Neto, André; Carvalho, Ivo S.; Carvalho, Bernardo B.; Fernandes, Horácio; Sousa, Jorge; Janky, Filip; Havlicek, Josef; Beno, Radek; Horacek, Jan; Hron, Martin; Panek, Radomir

2011-08-01

The COMPASS tokamak has began operation at the IPP Prague in December 2008. A new control system has been built using an ATCA-based real-time system developed at IST Lisbon. The control software is implemented on top of the MARTe real-time framework attaining control cycles as short as 50 μs, with a jitter of less than 1 μs. The controlled parameters, important for the plasma performance, are the plasma current, position of the plasma current center, boundary shape and horizontal and vertical velocities. These are divided in two control cycles: slow at 500 μs and fast at 50 μs. The project has two phases. First, the software implements a digital controller, similar to the analog one used during the COMPASS-D operation in Culham. In the slow cycle, the plasma current and position are measured and controlled with PID and feedforward controllers, respectively, the shaping magnetic field is preprogrammed. The vertical instability and horizontal equilibrium are controlled with the faster 50-μs cycle PID controllers. The second phase will implement a plasma-shape reconstruction algorithm and controller, aiming at optimized plasma performance. The system was designed to be as modular as possible by breaking the functional requirements of the control system into several independent and specialized modules. This splitting enabled tuning the execution of each system part and to use the modules in a variety of applications with different time constraints. This paper presents the design and overall performance of the COMPASS control software.

Modulation of plasma N-acylethanolamine levels and physiological parameters by dietary fatty acid composition in humans.

PubMed

Jones, Peter J H; Lin, Lin; Gillingham, Leah G; Yang, Haifeng; Omar, Jaclyn M

2014-12-01

N-Acylethanolamines (NAEs) are endogenous lipid-signaling molecules involved in satiety and energetics; however, how diet impacts circulating NAE concentrations and their downstream metabolic actions in humans remains unknown. Objectives were to examine effects of diets enriched with high-oleic canola oil (HOCO) or HOCO blended with flaxseed oil (FXCO), compared with a Western diet (WD), on plasma NAE levels and the association with energy expenditure and substrate oxidation. Using a randomized controlled crossover design, 36 hypercholesterolemic participants consumed three isoenergetic diets for 28 days, each containing 36% energy from fat, of which 70% was HOCO, FXCO, or WD. Ultra-performance liquid chromatography-MS/MS was used to measure plasma NAE levels and indirect calorimetry to assess energy expenditure and substrate oxidation. After 28 days, compared with WD, plasma oleoylethanolamide (OEA) and alpha-linolenoyl ethanolamide (ALEA) levels were significantly increased in response to HOCO and FXCO (P = 0.002, P < 0.001), respectively. Correlation analysis demonstrated an inverse association between plasma OEA levels and percent body fat (r = -0.21, P = 0.04), and a positive association was observed between the plasma arachidonoyl ethanolamide (AEA)/OEA ratio and android:gynoid fat (r = 0.23, P = 0.02), respectively. Results suggest that plasma NAE levels are upregulated via their dietary lipid substrates and may modulate regional and total fat mass through lipid-signaling mechanisms. Copyright © 2014 by the American Society for Biochemistry and Molecular Biology, Inc.

The single-subunit RING-type E3 ubiquitin ligase RSL1 targets PYL4 and PYR1 ABA receptors in plasma membrane to modulate abscisic acid signaling.

PubMed

Bueso, Eduardo; Rodriguez, Lesia; Lorenzo-Orts, Laura; Gonzalez-Guzman, Miguel; Sayas, Enric; Muñoz-Bertomeu, Jesús; Ibañez, Carla; Serrano, Ramón; Rodriguez, Pedro L

2014-12-01

Membrane-delimited events play a crucial role for ABA signaling and PYR/PYL/RCAR ABA receptors, clade A PP2Cs and SnRK2/CPK kinases modulate the activity of different plasma membrane components involved in ABA action. Therefore, the turnover of PYR/PYL/RCARs in the proximity of plasma membrane might be a step that affects receptor function and downstream signaling. In this study we describe a single-subunit RING-type E3 ubiquitin ligase RSL1 that interacts with the PYL4 and PYR1 ABA receptors at the plasma membrane. Overexpression of RSL1 reduces ABA sensitivity and rsl1 RNAi lines that impair expression of several members of the RSL1/RFA gene family show enhanced sensitivity to ABA. RSL1 bears a C-terminal transmembrane domain that targets the E3 ligase to plasma membrane. Accordingly, bimolecular fluorescent complementation (BiFC) studies showed the RSL1-PYL4 and RSL1-PYR1 interaction is localized to plasma membrane. RSL1 promoted PYL4 and PYR1 degradation in vivo and mediated in vitro ubiquitylation of the receptors. Taken together, these results suggest ubiquitylation of ABA receptors at plasma membrane is a process that might affect their function via effect on their half-life, protein interactions or trafficking. © 2014 The Authors The Plant Journal © 2014 John Wiley & Sons Ltd.

The segmented non-uniform dielectric module design for uniformity control of plasma profile in a capacitively coupled plasma chamber

NASA Astrophysics Data System (ADS)

Xia, Huanxiong; Xiang, Dong; Yang, Wang; Mou, Peng

2014-12-01

Low-temperature plasma technique is one of the critical techniques in IC manufacturing process, such as etching and thin-film deposition, and the uniformity greatly impacts the process quality, so the design for the plasma uniformity control is very important but difficult. It is hard to finely and flexibly regulate the spatial distribution of the plasma in the chamber via controlling the discharge parameters or modifying the structure in zero-dimensional space, and it just can adjust the overall level of the process factors. In the view of this problem, a segmented non-uniform dielectric module design solution is proposed for the regulation of the plasma profile in a CCP chamber. The solution achieves refined and flexible regulation of the plasma profile in the radial direction via configuring the relative permittivity and the width of each segment. In order to solve this design problem, a novel simulation-based auto-design approach is proposed, which can automatically design the positional sequence with multi independent variables to make the output target profile in the parameterized simulation model approximate the one that users preset. This approach employs an idea of quasi-closed-loop control system, and works in an iterative mode. It starts from initial values of the design variable sequences, and predicts better sequences via the feedback of the profile error between the output target profile and the expected one. It never stops until the profile error is narrowed in the preset tolerance.

Cell surface dynamics - how Rho GTPases orchestrate the interplay between the plasma membrane and the cortical cytoskeleton.

PubMed

de Curtis, Ivan; Meldolesi, Jacopo

2012-10-01

Small GTPases are known to regulate hundreds of cell functions. In particular, Rho family GTPases are master regulators of the cytoskeleton. By regulating actin nucleation complexes, Rho GTPases control changes in cell shape, including the extension and/or retraction of surface protrusions and invaginations. Protrusion and invagination of the plasma membrane also involves the interaction between the plasma membrane and the cortical cytoskeleton. This interplay between membranes and the cytoskeleton can lead to an increase or decrease in the plasma membrane surface area and its tension as a result of the fusion (exocytosis) or internalization (endocytosis) of membranous compartments, respectively. For a long time, the cytoskeleton and plasma membrane dynamics were investigated separately. However, studies from many laboratories have now revealed that Rho GTPases, their modulation of the cytoskeleton, and membrane traffic are closely connected during the dynamic remodeling of the cell surface. Arf- and Rab-dependent exocytosis of specific vesicles contributes to the targeting of Rho GTPases and their regulatory factors to discrete sites of the plasma membrane. Rho GTPases regulate the tethering of exocytic vesicles and modulate their subsequent fusion. They also have crucial roles in the different forms of endocytosis, where they participate in the sorting of membrane domains as well as the sculpting and sealing of membrane flasks and cups. Here, we discuss how cell surface dynamics depend on the orchestration of the cytoskeleton and the plasma membrane by Rho GTPases.

Control of ultra-intense single attosecond pulse generation in laser-driven overdense plasmas.

PubMed

Liu, Qingcao; Xu, Yanxia; Qi, Xin; Zhao, Xiaoying; Ji, Liangliang; Yu, Tongpu; Wei, Luo; Yang, Lei; Hu, Bitao

2013-12-30

Ultra-intense single attosecond pulse (AP) can be obtained from circularly polarized (CP) laser interacting with overdense plasma. High harmonics are naturally generated in the reflected laser pulses due to the laser-induced one-time drastic oscillation of the plasma boundary. Using two-dimensional (2D) planar particle-in-cell (PIC) simulations and analytical model, we show that multi-dimensional effects have great influence on the generation of AP. Self-focusing and defocusing phenomena occur in front of the compressed plasma boundary, which lead to the dispersion of the generated AP in the far field. We propose to control the reflected high harmonics by employing a density-modulated foil target (DMFT). When the target density distribution fits the laser intensity profile, the intensity of the attosecond pulse generated from the center part of the plasma has a flatten profile within the center range in the transverse direction. It is shown that a single 300 attosecond (1 as = 10(-18)s) pulse with the intensity of 1.4 × 10(21) W cm(-2) can be naturally generated. Further simulations reveal that the reflected high harmonics properties are highly related to the modulated density distribution and the phase offset between laser field and the carrier envelope. The emission direction of the AP generated from the plasma boundary can be controlled in a very wide range in front of the plasma surface by combining the DMFT and a suitable driving laser.

View of FE Volkov working with KPT-21 PK-3+ Plasma Crystal-3+ Payload

NASA Image and Video Library

2011-06-27

ISS028-E-009754 (27 June 2011) --- Russian cosmonaut Sergei Volkov, Expedition 28 flight engineer, works with the new KPT-21 PK-3+ Plasma Crystal-3+ (Plazmennyi-Kristall-3 plus) Telescience payload in the Poisk Mini-Research Module 2 (MRM2) of the International Space Station.

FE Volkov works with the KPT-21 PK-3+ Plasma Crystal-3+ Telescience Payload

NASA Image and Video Library

2011-06-22

ISS028-E-009187 (22 June 2011) --- Russian cosmonaut Sergei Volkov, Expedition 28 flight engineer, works with the new KPT-21 PK-3+ Plasma Crystal-3+ (Plazmennyi-Kristall-3 plus) Telescience payload in the Poisk Mini-Research Module 2 (MRM2) of the International Space Station.

View of FE Volkov working with KPT-21 PK-3+ Plasma Crystal-3+ Payload

NASA Image and Video Library

2011-06-27

ISS028-E-009756 (27 June 2011) --- Russian cosmonaut Sergei Volkov, Expedition 28 flight engineer, works with the new KPT-21 PK-3+ Plasma Crystal-3+ (Plazmennyi-Kristall-3 plus) Telescience payload in the Poisk Mini-Research Module 2 (MRM2) of the International Space Station.

Label Free Detection of Biomolecules Using Charge-Plasma-Based Gate Underlap Dielectric Modulated Junctionless TFET

NASA Astrophysics Data System (ADS)

Wadhwa, Girish; Raj, Balwinder

2018-05-01

Nanoscale devices are emerging as a platform for detecting biomolecules. Various issues were observed during the fabrication process such as random dopant fluctuation and thermal budget. To reduce these issues charge-plasma-based concept is introduced. This paper proposes the implementation of charge-plasma-based gate underlap dielectric modulated junctionless tunnel field effect transistor (DM-JLTFET) for the revelation of biomolecule immobilized in the open cavity gate channel region. In this p+ source and n+ drain regions are introduced by employing different work function over the intrinsic silicon. Also dual material gate architecture is implemented to reduce short channel effect without abandoning any other device characteristic. The sensitivity of biosensor is studied for both the neutral and charge-neutral biomolecules. The effect of device parameters such as channel thickness, cavity length and cavity thickness on drain current have been analyzed through simulations. This paper investigates the performance of charge-plasma-based gate underlap DM-JLTFET for biomolecule sensing applications while varying dielectric constant, charge density at different biasing conditions.

Kinetic effects on Alfven wave nonlinearity. II - The modified nonlinear wave equation

NASA Technical Reports Server (NTRS)

Spangler, Steven R.

1990-01-01

A previously developed Vlasov theory is used here to study the role of resonant particle and other kinetic effects on Alfven wave nonlinearity. A hybrid fluid-Vlasov equation approach is used to obtain a modified version of the derivative nonlinear Schroedinger equation. The differences between a scalar model for the plasma pressure and a tensor model are discussed. The susceptibilty of the modified nonlinear wave equation to modulational instability is studied. The modulational instability normally associated with the derivative nonlinear Schroedinger equation will, under most circumstances, be restricted to left circularly polarized waves. The nonlocal term in the modified nonlinear wave equation engenders a new modulational instability that is independent of beta and the sense of circular polarization. This new instability may explain the occurrence of wave packet steepening for all values of the plasma beta in the vicinity of the earth's bow shock.

Design and Test of Wendelstein 7-X Water-Cooled Divertor Scraper

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boscary, J.; Greuner, Henri; Ehrke, Gunnar

Heat load calculations have indicated the possible overloading of the ends of the water-cooled divertor facing the pumping gap beyond their technological limit. The intention of the scraper is the interception of some of the plasma fluxes both upstream and downstream before they reach the divertor surface. The scraper is divided into six modules of four plasma facing components (PFCs); each module has four PFCs hydraulically connected in series by two water boxes (inlet and outlet). A full-scale prototype of one module has been manufactured. Development activities have been carried out to connect the water boxes to the cooling pipesmore » of the PFCs by tungsten inert gas internal orbital welding. This prototype was successfully tested in the GLADIS facility with 17 MW/m2 for 500 cycles. The results of these activities have confirmed the possible technological basis for a fabrication of the water-cooled scraper.« less

Simulation study of the sub-terawatt laser wakefield acceleration operated in self-modulated regime

NASA Astrophysics Data System (ADS)

Hsieh, C.-Y.; Lin, M.-W.; Chen, S.-H.

2018-02-01

Laser wakefield acceleration (LWFA) can be accomplished by introducing a sub-terawatt (TW) laser pulse into a thin, high-density gas target. In this way, the self-focusing effect and the self-modulation that happened on the laser pulse produce a greatly enhanced laser peak intensity that can drive a nonlinear plasma wave to accelerate electrons. A particle-in-cell model is developed to study sub-TW LWFA when a 0.6-TW laser pulse interacts with a dense hydrogen plasma. Gas targets having a Gaussian density profile or a flat-top distribution are defined for investigating the properties of sub-TW LWFA when conducting with a gas jet or a gas cell. In addition to using 800-nm laser pulses, simulations are performed with 1030-nm laser pulses, as they represent a viable approach to realize the sub-TW LWFA driven by high-frequency, diode-pumped laser systems. The peak density which allows the laser peak power PL˜2 Pc r of self-focusing critical power is favourable for conducting sub-TW LWFA. Otherwise, an excessively high peak density can induce an undesired filament effect which rapidly disintegrates the laser field envelope and violates the process of plasma wave excitation. The plateau region of a flat-top density distribution allows the self-focusing and the self-modulation of the laser pulse to develop, from which well-established plasma bubbles can be produced to accelerate electrons. The process of electron injection is complicated in such high-density plasma conditions; however, increasing the length of the plateau region represents a straightforward method to realize the injection and acceleration of electrons within the first bubble, such that an improved LWFA performance can be accomplished.

Modular and efficient ozone systems based on massively parallel chemical processing in microchannel plasma arrays: performance and commercialization

NASA Astrophysics Data System (ADS)

Kim, M.-H.; Cho, J. H.; Park, S.-J.; Eden, J. G.

2017-08-01

Plasmachemical systems based on the production of a specific molecule (O3) in literally thousands of microchannel plasmas simultaneously have been demonstrated, developed and engineered over the past seven years, and commercialized. At the heart of this new plasma technology is the plasma chip, a flat aluminum strip fabricated by photolithographic and wet chemical processes and comprising 24-48 channels, micromachined into nanoporous aluminum oxide, with embedded electrodes. By integrating 4-6 chips into a module, the mass output of an ozone microplasma system is scaled linearly with the number of modules operating in parallel. A 115 g/hr (2.7 kg/day) ozone system, for example, is realized by the combined output of 18 modules comprising 72 chips and 1,800 microchannels. The implications of this plasma processing architecture for scaling ozone production capability, and reducing capital and service costs when introducing redundancy into the system, are profound. In contrast to conventional ozone generator technology, microplasma systems operate reliably (albeit with reduced output) in ambient air and humidity levels up to 90%, a characteristic attributable to the water adsorption/desorption properties and electrical breakdown strength of nanoporous alumina. Extensive testing has documented chip and system lifetimes (MTBF) beyond 5,000 hours, and efficiencies >130 g/kWh when oxygen is the feedstock gas. Furthermore, the weight and volume of microplasma systems are a factor of 3-10 lower than those for conventional ozone systems of comparable output. Massively-parallel plasmachemical processing offers functionality, performance, and commercial value beyond that afforded by conventional technology, and is currently in operation in more than 30 countries worldwide.

Plasma chamber testing of advanced photovoltaic solar array coupons

NASA Technical Reports Server (NTRS)

Hillard, G. Barry

1994-01-01

The solar array module plasma interactions experiment is a space shuttle experiment designed to investigate and quantify the high voltage plasma interactions. One of the objectives of the experiment is to test the performance of the Advanced Photovoltaic Solar Array (APSA). The material properties of array blanket are also studied as electric insulators for APSA arrays in high voltage conditions. Three twelve cell prototype coupons of silicon cells were constructed and tested in a space simulation chamber.

Experimental investigation of lift enhancement for flying wing aircraft using nanosecond DBD plasma actuators

NASA Astrophysics Data System (ADS)

Yao, Junkai; Zhou, Danjie; He, Haibo; He, Chengjun; Shi, Zhiwei; Du, Hai

2017-04-01

The effects of the arrangement position and control parameters of nanosecond dielectric barrier discharge (NS-DBD) plasma actuators on lift enhancement for flying wing aircraft were investigated through wind tunnel experiments at a flow speed of 25 m s-1. The aerodynamic forces and moments were obtained by a six-component balance at angles of attack ranging from -4° to 28°. The lift, drag and pitching moment coefficients were compared for the cases with and without plasma control. The results revealed that the maximum control effect was achieved by placing the actuator at the leading edge of the inner and middle wing, for which the maximum lift coefficient increased by 37.8% and the stall angle of attack was postponed by 8° compared with the plasma-off case. The effects of modulation frequency and discharge voltage were also investigated. The results revealed that the lift enhancement effect of the NS-DBD plasma actuators was strongly influenced by the modulation frequency. Significant control effects were obtained at f = 70 Hz, corresponding to F + ≈ 1. The result for the pitching moment coefficient demonstrated that the plasma actuator can induce the reattachment of the separation flows when it is actuated. However, the results indicated that the discharge voltage had a negligible influence on the lift enhancement effect.

Ultrafast Modulation of Semiconductor Lasers Through a Terahertz Field

NASA Technical Reports Server (NTRS)

Ning, Cun-Zheng; Hughes, Steven; Citrin, David

1998-01-01

We demonstrate, by means of numerical simulation, a new mechanism to modulate and switch semiconductor lasers at THz and sub-THz frequency rates. A sinusoidal terahertz field applied to a semiconductor laser heats the electron-hole plasma and consequently modifies the optical susceptibility. This allows an almost linear modulation of the output power of tile semiconductor laser and leads to a faithful reproduction of the terahertz-field waveform in the emitted laser intensity.

The application of pulse modulated plasma to the plasma enhanced chemical vapor deposition of dielectric materials

NASA Astrophysics Data System (ADS)

Qi, Yu

This dissertation work applied the pulse modulated plasma to the plasma enhanced chemical vapor deposition (PECVD) of two types of dielectric materials: SiO2-like coatings and Teflon-like coatings. SiO2-like coatings were firstly implemented with continuous plasma. It was proven that three different precursors: hexamethyldisiloxane (HMDSO), 1, 3, 5, 7-tetramethylcyclotetrasiloxane (TMCTS) and octamethylcyclotetrasiloxane (OMCTS) can be used to generate hard, clear and high density SiO2 deposition with coupled high growth rate and low processing temperature via PECVD. Under similar conditions, HMDSO has the lowest growth rate, lowest hardness and highest carbon content; TMCTS has the highest growth rate and hardness, and lowest carbon content; and OMCTS has moderate rates of these deposition qualities, but the best corrosion resistance. Substrate bias seems to have no effect on any deposition quality. High chamber pressure can significantly lower the carbon content in the thin films but does not affect any other qualities; the O2/precursor ratio is the most influential factor among all variables considered in this experiment. The deposition hardness and O:Si ratio always increase with this ratio while the carbon content always decreases. However, different precursors require different optimal ratios to achieve the highest growth rate. Pulse modulation was introduced into PECVD of SiO2-like coatings and OMCTS was selected as the precursor. It was demonstrated that pulse frequency, duty ratio and peak power have significant effects on deposition qualities. The proper combination of the pulse parameters and other traditional plasma parameters can significantly lower the processing temperature while retaining or even improving other deposition qualities, such as growth rate, corrosion resistance and elemental composition. Hardness is the only sacrifice of the lower time-average power caused by pulsing. Therefore, pulse modulation can effectively expand the possible range of combinations of desired deposition qualities. Finally, the pulsed plasma was used to implement PECVD of teflon-like coatings. An important discovery in this application is that in addition to pulse period, on-time and on-time peak power, the power level during the off-time is an important factor. The density of CF2 is a function of all these pulse parameters. The best result obtained is up to 67.2% CF2 and a 1.87:1 of F:C ratio when the off-time power level is ˜100--130 W the frequency is several Hz, the on-time peak power is ˜1000 W and the duty ratio is ˜7--10%.

Ionization asymmetry effects on the properties modulation of atmospheric pressure dielectric barrier discharge sustained by tailored voltage waveforms

NASA Astrophysics Data System (ADS)

Zhang, Z. L.; Nie, Q. Y.; Zhang, X. N.; Wang, Z. B.; Kong, F. R.; Jiang, B. H.; Lim, J. W. M.

2018-04-01

The dielectric barrier discharge (DBD) is a promising technology to generate high density and uniform cold plasmas in atmospheric pressure gases. The effective independent tuning of key plasma parameters is quite important for both application-focused and fundamental studies. In this paper, based on a one-dimensional fluid model with semi-kinetics treatment, numerical studies of ionization asymmetry effects on the properties modulation of atmospheric DBD sustained by tailored voltage waveforms are reported. The driving voltage waveform is characterized by an asymmetric-slope fundamental sinusoidal radio frequency signal superimposing one or more harmonics, and the effects of the number of harmonics, phase shift, as well as the fluctuation of harmonics on the sheath dynamics, impact ionization of electrons and key plasma parameters are investigated. The results have shown that the electron density can exhibit a substantial increase due to the effective electron heating by a spatially asymmetric sheath structure. The strategic modulation of harmonics number and phase shift is capable of raising the electron density significantly (e.g., nearly three times in this case), but without a significant increase in the gas temperature. Moreover, by tailoring the fluctuation of harmonics with a steeper slope, a more profound efficiency in electron impact ionization can be achieved, and thus enhancing the electron density effectively. This method then enables a novel alternative approach to realize the independent control of the key plasma parameters under atmospheric pressure.

Advanced properties of extended plasmas for efficient high-order harmonic generation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganeev, R. A.; Physics Department, Voronezh State University, Voronezh 394006; Suzuki, M.

We demonstrate the advanced properties of extended plasma plumes (5 mm) for efficient harmonic generation of laser radiation compared with the short lengths of plasmas (∼0.3–0.5 mm) used in previous studies. The harmonic conversion efficiency quadratically increased with the growth of plasma length. The studies of this process along the whole extreme ultraviolet range using the long plasma jets produced on various metal surfaces, particularly including the resonance-enhanced laser frequency conversion and two-color pump, are presented. Such plasmas could be used for the quasi-phase matching experiments by proper modulation of the spatial characteristics of extended ablating area and formation of separated plasmamore » jets.« less

Towards Attosecond High-Energy Electron Bunches: Controlling Self-Injection in Laser-Wakefield Accelerators Through Plasma-Density Modulation

NASA Astrophysics Data System (ADS)

Tooley, M. P.; Ersfeld, B.; Yoffe, S. R.; Noble, A.; Brunetti, E.; Sheng, Z. M.; Islam, M. R.; Jaroszynski, D. A.

2017-07-01

Self-injection in a laser-plasma wakefield accelerator is usually achieved by increasing the laser intensity until the threshold for injection is exceeded. Alternatively, the velocity of the bubble accelerating structure can be controlled using plasma density ramps, reducing the electron velocity required for injection. We present a model describing self-injection in the short-bunch regime for arbitrary changes in the plasma density. We derive the threshold condition for injection due to a plasma density gradient, which is confirmed using particle-in-cell simulations that demonstrate injection of subfemtosecond bunches. It is shown that the bunch charge, bunch length, and separation of bunches in a bunch train can be controlled by tailoring the plasma density profile.

Modulation of a compressional electromagnetic wave in a magnetized electron-positron quantum plasma.

PubMed

Amin, M R

2015-09-01

Amplitude modulation of a compressional electromagnetic wave in a strongly magnetized electron-positron pair plasma is considered in the quantum magnetohydrodynamic regime. The important ingredients of this study are the inclusion of the external strong magnetic field, Fermi quantum degeneracy pressure, particle exchange potential, quantum diffraction effects via the Bohm potential, and dissipative effect due to collision of the charged carriers. A modified-nonlinear Schödinger equation is developed for the compressional magnetic field of the electromagnetic wave by employing the standard reductive perturbation technique. The linear and nonlinear dispersions of the electromagnetic wave are discussed in detail. For some parameter ranges, relevant to dense astrophysical objects such as the outer layers of white dwarfs, neutron stars, and magnetars, etc., it is found that the compressional electromagnetic wave is modulationally unstable and propagates as a dissipated electromagnetic wave. It is also found that the quantum effects due to the particle exchange potential and the Bohm potential are negligibly small in comparison to the effects of the Fermi quantum degeneracy pressure. The numerical results on the growth rate of the modulation instability is also presented.

The Endotoxemia Marker Lipopolysaccharide-Binding Protein is Reduced in Overweight-Obese Subjects Consuming Pomegranate Extract by Modulating the Gut Microbiota: A Randomized Clinical Trial.

PubMed

González-Sarrías, Antonio; Romo-Vaquero, María; García-Villalba, Rocío; Cortés-Martín, Adrián; Selma, María Victoria; Espín, Juan Carlos

2018-06-01

Gut microbiota dysbiosis, intestinal barrier failure, obesity, metabolic endotoxemia, and pro-inflammatory status promote cardiovascular risk. However, the modulation of the gut microbiome to prevent endotoxemia in obesity has been scarcely studied. We investigated the association between gut microbiota modulation and plasma lipopolysaccharide-binding protein (LBP), a surrogate marker of endotoxemia, in overweight-obese individuals. In a randomized trial, 49 overweight-obese subjects (body mass index> 27 kg m -2 ) with mild hypelipidemia daily consumed, in a cross-over fashion, two doses (D1 and D2, lasting 3 weeks each) of pomegranate extract (PE) or placebo alternating with 3 weeks of wash-out periods. A significant decrease (p < 0.05) of plasma LBP and a marginal decrease (p = 0.054) of high-sensitivity C-reactive protein were observed, but only after PE-D2 administration (656 mg phenolics). 16S rDNA sequencing analyses revealed the increase of microorganisms important for maintaining normal balance of gut microbiota and gut barrier function, particularly Bacteroides, Faecalibacterium, Butyricicoccus, Odoribacter, and Butyricimonas. PE-D2 also decreased pro-inflammatory microorganisms including Parvimonas, Methanobrevibacter, and Methanosphaera. Remarkably, plasma LBP reduction was significantly associated (p < 0.05) with both Faecalibacterium and Odoribacter increase and Parvimonas decrease. Consumption of PE decreased endotoxemia in overweight-obese individuals by reshaping the gut microbiota, mainly through the modulation of Faecalibacterium, Odoribacter, and Parvimonas. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy.

PubMed

Woźniak, Paweł; Kontek, Bogdan; Różański, Waldemar; Olas, Beata

2017-01-01

Extracorporeal shock wave lithotripsy (ESWL) is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30-240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers. Twelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups. No difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL. Oxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates hemostasis. By having a better understanding of the influence of ESWL on hemostasis, this could lead to modifying patient care for those patients at increased risk of bleeding.

Langmuir probe measurements aboard the International Space Station

NASA Astrophysics Data System (ADS)

Kirov, B.; Asenovski, S.; Bachvarov, D.; Boneva, A.; Grushin, V.; Georgieva, K.; Klimov, S. I.

2016-12-01

In the current work we describe the Langmuir Probe (LP) and its operation on board the International Space Station. This instrument is a part of the scientific complex "Ostonovka". The main goal of the complex is to establish, on one hand how such big body as the International Space Station affects the ambient plasma and on the other how Space Weather factors influence the Station. The LP was designed and developed at BAS-SRTI. With this instrument we measure the thermal plasma parameters-electron temperature Te, electron and ion concentration, respectively Ne and Ni, and also the potential at the Station's surface. The instrument is positioned at around 1.5 meters from the surface of the Station, at the Russian module "Zvezda", located at the farthermost point of the Space Station, considering the velocity vector. The Multi- Purpose Laboratory (MLM) module is providing additional shielding for our instrument, from the oncoming plasma flow (with respect to the velocity vector). Measurements show that in this area, the plasma concentration is two orders of magnitude lower, in comparison with the unperturbed areas. The surface potential fluctuates between-3 and-25 volts with respect to the ambient plasma. Fast upsurges in the surface potential are detected when passing over the twilight zone and the Equatorial anomaly.

High-frequency modulation of ion-acoustic waves.

NASA Technical Reports Server (NTRS)

Albright, N. W.

1972-01-01

A large amplitude, high-frequency electromagnetic oscillation is impressed on a nonrelativistic, collisionless plasma from an external source. The frequency is chosen to be far from the plasma frequency (in fact, lower). The resulting electron velocity distribution function strongly modifies the propagation of ion-acoustic waves parallel to the oscillating electric field. The complex frequency is calculated numerically.

Kuipers holds the Plasma-03 experiment container as Foale looks on during Expedition 9 / Expedition 8

NASA Image and Video Library

2004-04-29

ISS008-E-22393 (29 April 2004) --- European Space Agency (ESA) astronaut Andre Kuipers of the Netherlands, holds a Complex “Plasma-03” canister in the Zvezda Service Module of the International Space Station (ISS). Astronaut C. Michael Foale, Expedition 8 commander and NASA ISS science officer, is at right.

Modifying the ionosphere with intense radio waves.

PubMed

Utlaut, W F; Cohen, R

1971-10-15

The ionospheric modification experiments provide an opportunity to better understand the aeronomy of the natural ionosphere and also afford the control of a naturally occurring plasma, which will make possible further progress in plasma physics. The ionospheric modification by powerful radio waves is analogous to studies of laser and microwave heating of laboratory plasmas (20). " Anomalous" reflectivity effects similar to the observed ionospheric attenuation have already been noted in plasmas modulated by microwaves, and anomalous heating may have been observed in plasmas irradiated by lasers. Contacts have now been established between the workers in these diverse areas, which span a wide range of the electromagnetic spectrum. Perhaps ionospheric modification will also be a valuable technique in radio communications.

Plasma physics and environmental perturbation laboratory. [magnetospheric experiments from space shuttle

NASA Technical Reports Server (NTRS)

Vogl, J. L.

1973-01-01

Current work aimed at identifying the active magnetospheric experiments that can be performed from the Space Shuttle, and designing a laboratory to carry out these experiments is described. The laboratory, known as the PPEPL (Plasma Physics and Environmental Perturbation Laboratory) consists of 35-ft pallet of instruments connected to a 25-ft pressurized control module. The systems deployed from the pallet are two 50-m booms, two subsatellites, a high-power transmitter, a multipurpose accelerator, a set of deployable canisters, and a gimbaled instrument platform. Missions are planned to last seven days, during which two scientists will carry out experiments from within the pressurized module. The type of experiments to be performed are outlined.

Phase A conceptual design study of the Atmospheric, Magnetospheric and Plasmas in Space (AMPS) payload

NASA Technical Reports Server (NTRS)

1974-01-01

The 12 month Phase A Conceptual Design Study of the Atmospheric, Magnetospheric and Plasmas in Space (AMPS) payload performed within the Program Development Directorate of the Marshall Space Flight Center is presented. The AMPS payload makes use of the Spacelab pressurized module and pallet, is launched by the space shuttle, and will have initial flight durations of 7 days. Scientific instruments including particle accelerators, high power transmitters, optical instruments, and chemical release devices are mounted externally on the Spacelab pallet and are controlled by the experimenters from within the pressurized module. The capability of real-time scientist interaction on-orbit with the experiment is a major characteristic of AMPS.

A Semianalytical Ion Current Model for Radio Frequency Driven Collisionless Sheaths

NASA Technical Reports Server (NTRS)

Bose, Deepak; Govindan, T. R.; Meyyappan, M.; Arnold, Jim (Technical Monitor)

2001-01-01

We propose a semianalytical ion dynamics model for a collisionless radio frequency biased sheath. The model uses bulk plasma conditions and electrode boundary condition to predict ion impact energy distribution and electrical properties of the sheath. The proposed model accounts for ion inertia and ion current modulation at bias frequencies that are of the same order of magnitude as the ion plasma frequency. A relaxation equation for ion current oscillations is derived which is coupled with a damped potential equation in order to model ion inertia effects. We find that inclusion of ion current modulation in the sheath model shows marked improvements in the predictions of sheath electrical properties and ion energy distribution function.

Temporally resolved diagnosis of an atmospheric-pressure pulse-modulated argon surface wave plasma by optical emission spectroscopy

NASA Astrophysics Data System (ADS)

Chen, Chuan-Jie; Li, Shou-Zhe; Zhang, Jialiang; Liu, Dongping

2018-01-01

A pulse-modulated argon surface wave plasma generated at atmospheric pressure is characterized by means of temporally resolved optical emission spectroscopy (OES). The temporal evolution of the gas temperature, the electron temperature and density, the radiative species of atomic Ar, and the molecular band of OH(A) and N2(C) are investigated experimentally by altering the instantaneous power, pulse repetitive frequency, and duty ratio. We focused on the physical phenomena occurring at the onset of the time-on period and after the power interruption at the start of the time-off period. Meanwhile, the results are discussed qualitatively for an in-depth insight of its dynamic evolution.

Plasma observations near Jupiter - Initial results from Voyager 2

NASA Technical Reports Server (NTRS)

Bridge, H. S.; Belcher, J. W.; Lazarus, A. J.; Sullivan, J. D.; Bagenal, F.; Mcnutt, R. L., Jr.; Ogilvie, K. W.; Scudder, J. D.; Sittler, E. D.; Vasyliunas, V. M.

1979-01-01

A preliminary report is presented of the results obtained by the Voyager 2 plasma experiment during the encounter of Voyager 2 with Jupiter from about 100 Jupiter radii before periapsis to about 300 Jupiter radii after periapsis, the instrument being identical to that on Voyager 1. The discussion covers the following: (1) the crossings of the bow shock and magnetopause observed on the inbound and outbound passes; (2) the radial variation of plasma properties in the magnetosphere; (3) variations in plasma properties near Ganymede; (4) corotation and composition of the plasma in the dayside magnetosphere; and (5) plasma sheet crossings observed on the inbound and outbound passes. From the planetary spin modulation of the plasma-electron intensity it is inferred that the plasma sheet is centered at the dipole magnetic equator out to a distance of 40-50 Jupiter radii and deviates from it toward the rotational equator at larger distances.

Localized spiraling plasma ejection contributing the ion-flux broadening in the detached linear plasma

NASA Astrophysics Data System (ADS)

Tanaka, H.; Takeyama, K.; Yoshikawa, M.; Kajita, S.; Ohno, N.; Hayashi, Y.

2018-07-01

We have performed multipoint measurements with segmented electrodes and a microwave interferometer in the linear plasma device NAGDIS-II, in order to reveal cross-field motion and axial localization of the enhanced radial transport in the detached plasma. By changing the neutral pressure successively and applying several statistical analysis techniques, it was clarified that there is axially localized ion flux broadening accompanying an enhanced plasma ejection from the center with radially elongated spiraling structure. The spiraling plasma ejection accompanies the m = 0 mode drop near the center with the similar time scale. Further, such behavior composed of f > 1 kHz fluctuations is modulated by several-hundred-hertz fluctuation with m = 0. This cross-field transport causes non-negligible effect for the reduction of the ion flux peak in the detached plasma.

ITER Simulations Using the PEDESTAL Module in the PTRANSP Code

NASA Astrophysics Data System (ADS)

Halpern, F. D.; Bateman, G.; Kritz, A. H.; Pankin, A. Y.; Budny, R. V.; Kessel, C.; McCune, D.; Onjun, T.

2006-10-01

PTRANSP simulations with a computed pedestal height are carried out for ITER scenarios including a standard ELMy H-mode (15 MA discharge) and a hybrid scenario (12MA discharge). It has been found that fusion power production predicted in simulations of ITER discharges depends sensitively on the height of the H-mode temperature pedestal [1]. In order to study this effect, the NTCC PEDESTAL module [2] has been implemented in PTRANSP code to provide boundary conditions used for the computation of the projected performance of ITER. The PEDESTAL module computes both the temperature and width of the pedestal at the edge of type I ELMy H-mode discharges once the threshold conditions for the H-mode are satisfied. The anomalous transport in the plasma core is predicted using the GLF23 or MMM95 transport models. To facilitate the steering of lengthy PTRANSP computations, the PTRANSP code has been modified to allow changes in the transport model when simulations are restarted. The PTRANSP simulation results are compared with corresponding results obtained using other integrated modeling codes.[1] G. Bateman, T. Onjun and A.H. Kritz, Plasma Physics and Controlled Fusion, 45, 1939 (2003).[2] T. Onjun, G. Bateman, A.H. Kritz, and G. Hammett, Phys. Plasmas 9, 5018 (2002).

Assembly & Metrology of First Wall Components of SST-1

NASA Astrophysics Data System (ADS)

Parekh, Tejas; Santra, Prosenjit; Biswas, Prabal; Patel, Hiteshkumar; Paravastu, Yuvakiran; Jaiswal, Snehal; Chauhan, Pradeep; Babu, Gattu Ramesh; A, Arun Prakash; Bhavsar, Dhaval; Raval, Dilip C.; Khan, Ziauddin; Pradhan, Subrata

2017-04-01

First Wall Components (FWC) of SST-1 tokamak, which are in the immediate vicinity of plasma comprises of limiters, divertors, baffles, passive stabilizers are designed to operate long duration (1000 s) discharges of elongated plasma. All FWC consists of a copper alloy heat sink modules with SS cooling tubes brazed onto it, graphite tiles acting as armour material facing the plasma, and are mounted to the vacuum vessels with suitable Inconel support structures at ring & port locations. The FWC are very recently assembled and commissioned successfully inside the vacuum vessel of SST-1 undergoing a meticulous planning of assembly sequence, quality checks at every stage of the assembly process. This paper will present the metrology aspects & procedure of each FWC, both outside the vacuum vessel, and inside the vessel, assembly tolerances, tools, equipment and jig/fixtures, used at each stage of assembly, starting from location of support bases on vessel rings, fixing of copper modules on support structures, around 3800 graphite tile mounting on 136 copper modules with proper tightening torques, till final toroidal and poloidal geometry of the in-vessel components are obtained within acceptable limits, also ensuring electrical continuity of passive stabilizers to form a closed saddle loop, electrical isolation of passive stabilizers from vacuum vessel.

Nonlinear interactions between electromagnetic waves and electron plasma oscillations in quantum plasmas.

PubMed

Shukla, P K; Eliasson, B

2007-08-31

We consider nonlinear interactions between intense circularly polarized electromagnetic (CPEM) waves and electron plasma oscillations (EPOs) in a dense quantum plasma, taking into account the electron density response in the presence of the relativistic ponderomotive force and mass increase in the CPEM wave fields. The dynamics of the CPEM waves and EPOs is governed by the two coupled nonlinear Schrödinger equations and Poisson's equation. The nonlinear equations admit the modulational instability of an intense CPEM pump wave against EPOs, leading to the formation and trapping of localized CPEM wave pipes in the electron density hole that is associated with a positive potential distribution in our dense plasma. The relevance of our investigation to the next generation intense laser-solid density plasma interaction experiments is discussed.

Parvovirus B19 infection modulates the levels of cytokines in the plasma of rheumatoid arthritis patients.

PubMed

Naciute, Milda; Mieliauskaite, Diana; Rugiene, Rita; Maciunaite, Gabriele; Mauricas, Mykolas; Murovska, Modra; Girkontaite, Irute

2017-08-01

Parvovirus B19 (B19V) infection is associated with various autoimmune diseases. We investigated the levels of pro-inflammatory (IFNᵧ, TNFα, IL-2, IL-12) and anti-inflammatory (IL-4, IL-10) cytokines in the plasma of B19V DNA positive (B19 + ) and negative (B19 - ) rheumatoid arthritis (RA) patients in comparison with the control group (healthy persons). Blood samples were collected from 118 patients with RA and 49 healthy voluntaries. B19V sequence was determined in whole blood and cell-free plasma DNA by nested PCR. The levels of cytokines in the plasma and cell culture medium from Concanavalin A (ConA) or B19V VP1 protein stimulated PBMC were determined by ELISA. The levels of IL-4, IL-10, IL-12, IL-2 and TNFα were higher in plasma of RA patients in comparison with control persons. B19 + controls and RA patients had lower levels of IFNᵧ in comparison with B19 - controls and RA patients. Within RA patients the plasma levels of IFNᵧ were lower in patients with low RA disease activity or remission. Plasma level of IL-4 was increased and IL-10 level was decreased in B19 + RA patients in comparison with B19 - RA patients and did not differ between B19 + and B19 - controls. B19V infection did not affect plasma levels of IL-12, IL-2, and TNFα. ConA and B19 VP1 protein stimulated PBMC from RA patients produced less IFNᵧ than stimulated PBMC from the healthy controls. B19V infection could differently modulate the amount of cytokines in the plasma of healthy persons and RA patients. Decreased production of IFNᵧ and raised level of plasma IL-4 in RA patients could lower antiviral clearance. Copyright © 2017 Elsevier Ltd. All rights reserved.

A path to stable low-torque plasma operation in ITER with test blanket modules

NASA Astrophysics Data System (ADS)

Lanctot, M. J.; Snipes, J. A.; Reimerdes, H.; Paz-Soldan, C.; Logan, N.; Hanson, J. M.; Buttery, R. J.; deGrassie, J. S.; Garofalo, A. M.; Gray, T. K.; Grierson, B. A.; King, J. D.; Kramer, G. J.; La Haye, R. J.; Pace, D. C.; Park, J.-K.; Salmi, A.; Shiraki, D.; Strait, E. J.; Solomon, W. M.; Tala, T.; Van Zeeland, M. A.

2017-03-01

New experiments in the low-torque ITER Q  =  10 scenario on DIII-D demonstrate that n  =  1 magnetic fields from a single row of ex-vessel control coils enable operation at ITER performance metrics in the presence of applied non-axisymmetric magnetic fields from a test blanket module (TBM) mock-up coil. With n  =  1 compensation, operation below the ITER-equivalent injected torque is successful at three times the ITER equivalent toroidal magnetic field ripple for a pair of TBMs in one equatorial port, whereas the uncompensated TBM field leads to rotation collapse, loss of H-mode and plasma current disruption. In companion experiments at high plasma beta, where the n  =  1 plasma response is enhanced, uncorrected TBM fields degrade energy confinement and the plasma angular momentum while increasing fast ion losses; however, disruptions are not routinely encountered owing to increased levels of injected neutral beam torque. In this regime, n  =  1 field compensation leads to recovery of a dominant fraction of the TBM-induced plasma pressure and rotation degradation, and an 80% reduction in the heat load to the first wall. These results show that the n  =  1 plasma response plays a dominant role in determining plasma stability, and that n  =  1 field compensation alone not only recovers most of the impact on plasma performance of the TBM, but also protects the first wall from potentially damaging heat flux. Despite these benefits, plasma rotation braking from the TBM fields cannot be fully recovered using standard error field control. Given the uncertainty in extrapolation of these results to the ITER configuration, it is prudent to design the TBMs with as low a ferromagnetic mass as possible without jeopardizing the TBM mission.

Lipids, inflammation, and chronic kidney disease: a SHARP perspective.

PubMed

Waters, David D; Vogt, Liffert

2018-04-01

Accumulating evidence indicates that inflammation plays a role in the initiation and progression of chronic kidney disease. In the Study of Heart and Renal Protection (SHARP) trial, higher baseline C-reactive protein and higher baseline low-density lipoprotein cholesterol levels were both associated with a higher risk of cardiovascular events, but higher baseline C-reactive protein levels were also associated with a higher risk of nonvascular events. Simvastatin/ezetimibe reduced cardiovascular events independent of baseline C-reactive protein levels. However, this observation does not exclude inflammation as a causal factor for cardiovascular disease development in chronic kidney disease patients. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Observations of the effect of lower hybrid waves on ELM behaviour in EAST

NASA Astrophysics Data System (ADS)

Chen, R.; Xu, G. S.; Liang, Y.; Wang, H. Q.; Zhou, C.; Liu, A. D.; Wang, L.; Qian, J. P.; Gan, K. F.; Yang, J. H.; Duan, Y. M.; Li, Y. L.; Ding, S. Y.; Wu, X. Q.; Yan, N.; Chen, L.; Shao, L. M.; Zhang, W.; Hu, G. H.; Zhao, N.; Liu, S. C.; Kong, D. F.; Gong, X. Z.

2015-03-01

Dedicated experiments focusing on the influence of lower hybrid waves (LHWs) on edge-localized modes (ELMs) were first performed during the 2012 experimental campaign of EAST, via modulating the input power of LHWs in the high-confinement-mode (H-mode) plasma mainly sustained by ion cyclotron resonant heating. Natural ELMs are effectively mitigated (ELM frequency increases, while its intensity decreases dramatically) as the LHW is applied, observed over a fairly wide range of plasma current or edge safety factor. By scanning the modulation frequency (fm) of LHW injected power in a target plasma dominated by the so-called small ELMs, we conclude that large ELMs with markedly larger amplitudes and lower frequencies are reproduced at low modulation frequencies (fm < 100 Hz). Analysis of the evolution of edge extreme ultraviolet radiation signals further indicates that plasma fluctuations at the pedestal region indistinctively respond to rapid modulation (fm ⩾ 100 Hz) of LHW injected power. This is proposed as the mechanism responsible for the observed fm dependence of the mitigation effect induced by LHWs on large ELMs. In addition, a critical threshold of LHW input power PLHW is estimated as PLHWthr≃800 kW , beyond which the impact of applied LHWs on ELM behaviours can be achieved. Finally, Langmuir probe measurements suggest that, rather than the concentration of free energy into a narrowband quasi-coherent precursor commonly observed growing until the ELM crash, the continuous development of broadband turbulence during the ELM-absent phase with the application of LHWs might contribute to the avoidance of ELM crashes. These results present new insights into existing experiments, and also provide some foundations and references for the next-step research about exploring in more depth and improving this new attractive method to effectively control the ELM-induced very large transient heat and particle flux.

Modulating action of low frequency oscillations on high frequency instabilities in Hall thrusters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liqiu, Wei, E-mail: weiliqiu@gmail.com, E-mail: weiliqiu@hit.edu.cn; Liang, Han; Ziyi, Yang

2015-02-07

It is found that the low frequency oscillations have modulating action on high frequency instabilities in Hall thrusters. The physical mechanism of this modulation is discussed and verified by numerical simulations. Theoretical analyses indicate that the wide-range fluctuations of plasma density and electric field associated with the low frequency oscillations affect the electron drift velocity and anomalous electron transport across the magnetic field. The amplitude and frequency of high frequency oscillations are modulated by low frequency oscillations, which show the periodic variation in the time scale of low frequency oscillations.

Interferometer for the measurement of plasma density

DOEpatents

Jacobson, Abram R.

1980-01-01

An interferometer which combines the advantages of a coupled cavity interferometer requiring alignment of only one light beam, and a quadrature interferometer which has the ability to track multi-fringe phase excursions unambiguously. The device utilizes a Bragg cell for generating a signal which is electronically analyzed to unambiguously determine phase modulation which is proportional to the path integral of the plasma density.

Polarization of low-frequency electromagnetic radiation in the lobes of Jupiter's magnetotail

NASA Technical Reports Server (NTRS)

Moses, S. L.; Kennel, C. F.; Coroniti, F. V.; Scarf, F. L.; Kurth, W. S.

1987-01-01

The plasma wave instruments on the Voyager spacecraft have detected intense electromagnetic radiation within the lobes of Jupiter's magnetic tail down to the lowest frequency of the detector (10 Hz). During a yaw maneuver performed by Voyager 1 in the lobe of the Jovian magnetotail, a modulation appeared in the amplitudes of waves detected in the 10-, 17.8- and 31.1-Hz channels of the plasma wave analyzer, well below the local electron cyclotron frequency of 260 Hz. The lowest amplitudes occurred when the antenna axis was most nearly parallel to the magnetic field. Wave amplitudes in the 56.2-Hz and higher frequency channels remained nearly constant during the maneuver. From the cold-plasma theory of electromagnetic waves, it is concluded that the plasma frequency was between the 56.2- and 31.1-Hz channels where the parallel-polarized component of the spectrum cuts off. This implies a tail-lobe density between 0.000032 and 0.000015/cu cm. The left-hand cutoff frequency would then be below 10 Hz, consistent with either the Z-mode (L, X) or whistlers (R-mode) in the modulated channels.

A stochastic differential equation model of diurnal cortisol patterns

NASA Technical Reports Server (NTRS)

Brown, E. N.; Meehan, P. M.; Dempster, A. P.

2001-01-01

Circadian modulation of episodic bursts is recognized as the normal physiological pattern of diurnal variation in plasma cortisol levels. The primary physiological factors underlying these diurnal patterns are the ultradian timing of secretory events, circadian modulation of the amplitude of secretory events, infusion of the hormone from the adrenal gland into the plasma, and clearance of the hormone from the plasma by the liver. Each measured plasma cortisol level has an error arising from the cortisol immunoassay. We demonstrate that all of these three physiological principles can be succinctly summarized in a single stochastic differential equation plus measurement error model and show that physiologically consistent ranges of the model parameters can be determined from published reports. We summarize the model parameters in terms of the multivariate Gaussian probability density and establish the plausibility of the model with a series of simulation studies. Our framework makes possible a sensitivity analysis in which all model parameters are allowed to vary simultaneously. The model offers an approach for simultaneously representing cortisol's ultradian, circadian, and kinetic properties. Our modeling paradigm provides a framework for simulation studies and data analysis that should be readily adaptable to the analysis of other endocrine hormone systems.

Uniformity control of the deposition rate profile of a-Si:H film by gas velocity and temperature distributions in a capacitively coupled plasma reactor

NASA Astrophysics Data System (ADS)

Kim, Ho Jun; Lee, Hae June

2018-03-01

The effect of neutral transport on the deposition rate profiles of thin films formed by plasma-enhanced chemical vapor deposition (PECVD) is investigated to improve the uniformity of amorphous hydrogenated silicon films. The PECVD reactor with a cylindrical showerhead is numerically simulated with a variation of the gas velocity and temperature in the capacitively coupled plasma with an intermediate-pressure SiH4/He gas mixture. The modulation of the gas velocity distribution results in a noticeable change in the density distributions of neutral molecules such as SiH4, SiH3, H, SiH2, and Si2H6, especially in the vicinity of the electrode edge. With the locally accelerated gas flow, the concomitant increase in Si2H6 density near the electrode edge induces increases in both the electron density and the deposition rate profile near the electrode edge. In addition, it is observed that changing the surface temperature distribution by changing the sidewall temperature can also effectively modulate the plasma density distributions. The simulated deposition rate profile matches the experimental data well, even under non-isothermal wall boundary conditions.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lazaris, Andreas; Hwang, Kristy S.; Goukasian, Naira

Objective: We investigated the association between apoE protein plasma levels and brain amyloidosis and the effect of the top 10 Alzheimer disease (AD) risk genes on this association. Methods: Our dataset consisted of 18 AD, 52 mild cognitive impairment, and 3 cognitively normal Alzheimer's Disease Neuroimaging Initiative 1 (ADNI1) participants with available [ 11C]-Pittsburgh compound B (PiB) and peripheral blood protein data. We used cortical pattern matching to study associations between plasma apoE and cortical PiB binding and the effect of carrier status for the top 10 AD risk genes. Results: Low plasma apoE was significantly associated with high PiBmore » SUVR, except in the sensorimotor and entorhinal cortex. For BIN1 rs744373, the association was observed only in minor allele carriers. For CD2AP rs9349407 and CR1 rs3818361, the association was preserved only in minor allele noncarriers. We did not find evidence for modulation by CLU, PICALM, ABCA7, BIN1, and MS4A6A. Conclusions: Our data show that BIN1 rs744373, CD2AP rs9349407, and CR1 rs3818361 genotypes modulate the association between apoE protein plasma levels and brain amyloidosis, implying a potential epigenetic/downstream interaction.« less

Plasma Membrane CRPK1-Mediated Phosphorylation of 14-3-3 Proteins Induces Their Nuclear Import to Fine-Tune CBF Signaling during Cold Response.

PubMed

Liu, Ziyan; Jia, Yuxin; Ding, Yanglin; Shi, Yiting; Li, Zhen; Guo, Yan; Gong, Zhizhong; Yang, Shuhua

2017-04-06

In plant cells, changes in fluidity of the plasma membrane may serve as the primary sensor of cold stress; however, the precise mechanism and how the cell transduces and fine-tunes cold signals remain elusive. Here we show that the cold-activated plasma membrane protein cold-responsive protein kinase 1 (CRPK1) phosphorylates 14-3-3 proteins. The phosphorylated 14-3-3 proteins shuttle from the cytosol to the nucleus, where they interact with and destabilize the key cold-responsive C-repeat-binding factor (CBF) proteins. Consistent with this, the crpk1 and 14-3-3κλ mutants show enhanced freezing tolerance, and transgenic plants overexpressing 14-3-3λ show reduced freezing tolerance. Further study shows that CRPK1 is essential for the nuclear translocation of 14-3-3 proteins and for 14-3-3 function in freezing tolerance. Thus, our study reveals that the CRPK1-14-3-3 module transduces the cold signal from the plasma membrane to the nucleus to modulate CBF stability, which ensures a faithfully adjusted response to cold stress of plants. Copyright © 2017 Elsevier Inc. All rights reserved.

Orexin and leptin are associated with nicotine craving: a link between smoking, appetite and reward.

PubMed

von der Goltz, Christoph; Koopmann, Anne; Dinter, Christina; Richter, Anne; Rockenbach, Christine; Grosshans, Martin; Nakovics, Helmut; Wiedemann, Klaus; Mann, Karl; Winterer, Georg; Kiefer, Falk

2010-05-01

Preclinical data suggest modulating effects of both orexin/hypocretin and leptin on dopaminergic transmission in mesolimbic reward pathways. This indicates a possible role of both peptides in reward function and motivation, and thus in addictive diseases. The aim of this study was to examine the possible association between orexin and leptin, and nicotine craving in smokers in a clinical case-control study under standardized conditions. We compared orexin and leptin, ACTH and cortisol plasma concentrations (RIA) between tobacco smokers (n=60) during early nicotine withdrawal and healthy controls (n=64). Motivational aspects of nicotine craving were additionally assessed in the smoking participants using the Questionnaire of Smoking Urges (QSU). As main results we detected a significant negative correlation between orexin plasma concentration and nicotine craving (r=-0.28; p<.05), and a positive association between craving and leptin plasma concentration (r=0.29; p<.05). Our results show an association between craving for nicotine and plasma concentrations of orexin and leptin suggesting that both peptides interfere with the dopaminergic transmission during nicotine withdrawal in a bidirectional manner and, thus, modulate craving for nicotine. Copyright 2009 Elsevier Ltd. All rights reserved.

High-Speed Particle-in-Cell Simulation Parallelized with Graphic Processing Units for Low Temperature Plasmas for Material Processing

NASA Astrophysics Data System (ADS)

Hur, Min Young; Verboncoeur, John; Lee, Hae June

2014-10-01

Particle-in-cell (PIC) simulations have high fidelity in the plasma device requiring transient kinetic modeling compared with fluid simulations. It uses less approximation on the plasma kinetics but requires many particles and grids to observe the semantic results. It means that the simulation spends lots of simulation time in proportion to the number of particles. Therefore, PIC simulation needs high performance computing. In this research, a graphic processing unit (GPU) is adopted for high performance computing of PIC simulation for low temperature discharge plasmas. GPUs have many-core processors and high memory bandwidth compared with a central processing unit (CPU). NVIDIA GeForce GPUs were used for the test with hundreds of cores which show cost-effective performance. PIC code algorithm is divided into two modules which are a field solver and a particle mover. The particle mover module is divided into four routines which are named move, boundary, Monte Carlo collision (MCC), and deposit. Overall, the GPU code solves particle motions as well as electrostatic potential in two-dimensional geometry almost 30 times faster than a single CPU code. This work was supported by the Korea Institute of Science Technology Information.

Relaunch of the Interactive Plasma Physics Educational Experience (IPPEX)

NASA Astrophysics Data System (ADS)

Dominguez, A.; Rusaitis, L.; Zwicker, A.; Stotler, D. P.

2015-11-01

In the late 1990's PPPL's Science Education Department developed an innovative online site called the Interactive Plasma Physics Educational Experience (IPPEX). It featured (among other modules) two Java based applications which simulated tokamak physics: A steady state tokamak (SST) and a time dependent tokamak (TDT). The physics underlying the SST and the TDT are based on the ASPECT code which is a global power balance code developed to evaluate the performance of fusion reactor designs. We have relaunched the IPPEX site with updated modules and functionalities: The site itself is now dynamic on all platforms. The graphic design of the site has been modified to current standards. The virtual tokamak programming has been redone in Javascript, taking advantage of the speed and compactness of the code. The GUI of the tokamak has been completely redesigned, including more intuitive representations of changes in the plasma, e.g., particles moving along magnetic field lines. The use of GPU accelerated computation provides accurate and smooth visual representations of the plasma. We will present the current version of IPPEX as well near term plans of incorporating real time NSTX-U data into the simulation.

Mathematical model of renal elimination of fluid and small ions during hyper- and hypovolemic conditions.

PubMed

Gyenge, Christina C; Bowen, Bruce D; Reed, Rolf K; Bert, Joel L

2003-02-01

This study is concerned with the formulation of a 'kidney module' linked to the plasma compartment of a larger mathematical model previously developed. Combined, these models can be used to predict, amongst other things, fluid and small ion excretion rates by the kidney; information that should prove useful in evaluating values and trends related to whole-body fluid balance for different clinical conditions to establish fluid administration protocols and for educational purposes. The renal module assumes first-order, negative-feedback responses of the kidney to changes in plasma volume and/or plasma sodium content from their normal physiological set points. Direct hormonal influences are not explicitly formulated in this empiric model. The model also considers that the renal excretion rates of small ions other than sodium are proportional to the excretion rate of sodium. As part of the model development two aspects are emphasized (1): the estimation of parameters related to the renal elimination of fluid and small ions, and (2) model validation via comparisons between the model predictions and selected experimental data. For validation, model predictions of the renal dynamics are compared with new experimental data for two cases: plasma overload resulting from external fluid infusion (e.g. infusions of iso-osmolar solutions and/or hypertonic/hyperoncotic saline solutions), and untreated hypo volemic conditions that result from the external loss of blood. The present study demonstrates that the empiric kidney module presented above can provide good short-term predictions with respect to all renal outputs considered here. Physiological implications of the model are also presented. Copyright Acta Anaesthesiologica Scandinavica 47 (2003)

CUSP-PINCH DEVICE

DOEpatents

Baker, W.R.; Watteau, J.P.H.

1962-06-01

An ion-electron plasma heating device of the pinch tube class is designed with novel means for counteracting the instabilities of an ordinary linear pinch discharge. A plasma-forming discharge is created between two spacedapart coaxial electiodes through a gas such as deuterium. A pair of spaced coaxial magnetic field coils encircle the discharge and carry opposing currents so that a magnetic field having a cuspate configuration is created around the plasma, the field being formed after the plasma has been established but before significant instability arises. Thus, containment time is increased and intensified heating is obtained. In addition to the pinch compression heating additional heating is obtained by high-frequency magnetic field modulation. (AEC)

Regulation of PCSK9 by nutraceuticals.

PubMed

Momtazi, Amir Abbas; Banach, Maciej; Pirro, Matteo; Katsiki, Niki; Sahebkar, Amirhossein

2017-06-01

PCSK9 (proprotein convertase subtilisin kexin type 9) is a liver secretory enzyme that regulates plasma low-density lipoprotein (LDL) cholesterol (LDL-C) levels through modulation of LDL receptor (LDLR) density on the surface of hepatocytes. Inhibition of PCSK9 using monoclonal antibodies can efficiently lower plasma LDL-C, non-high-density lipoprotein cholesterol and lipoprotein (a). PCSK9 inhibition is also an effective adjunct to statin therapy; however, the cost-effectiveness of currently available PCSK9 inhibitors is under question. Nutraceuticals offer a safe and cost-effective option for PCSK9 inhibition. Several nutraceuticals have been reported to modulate PCSK9 levels and exert LDL-lowering activity. Mechanistically, those nutraceuticals that inhibit PCSK9 through a SREBP (sterol-responsive element binding protein)-independent pathway can be more effective in lowering plasma LDL-C levels compared with those inhibiting PCSK9 through the SREBP pathway. The present review aims to collect available data on the nutraceuticals with PCSK9-inhibitory effect and the underlying mechanisms. Copyright © 2017 Elsevier Ltd. All rights reserved.

First density profile measurements using frequency modulation of the continuous wave reflectometry on JETa)

NASA Astrophysics Data System (ADS)

Meneses, L.; Cupido, L.; Sirinelli, A.; Manso, M. E.; Jet-Efds Contributors

2008-10-01

We present the main design options and implementation of an X-mode reflectometer developed and successfully installed at JET using an innovative approach. It aims to prove the viability of measuring density profiles with high spatial and temporal resolution using broadband reflectometry operating in long and complex transmission lines. It probes the plasma with magnetic fields between 2.4 and 3.0 T using the V band [~(0-1.4)×1019 m-3]. The first experimental results show the high sensitivity of the diagnostic when measuring changes in the plasma density profile occurring ITER relevant regimes, such as ELMy H-modes. The successful demonstration of this concept motivated the upgrade of the JET frequency modulation of the continuous wave (FMCW) reflectometry diagnostic, to probe both the edge and core. This new system is essential to prove the viability of using the FMCW reflectometry technique to probe the plasma in next step devices, such as ITER, since they share the same waveguide complexity.

The Solar Flux Dependence of Ionospheric 150 km Radar Echoes and Implications

NASA Astrophysics Data System (ADS)

Patra, A. K.; Pavan Chaitanya, P.; St.-Maurice, J.-P.; Otsuka, Y.; Yokoyama, T.; Yamamoto, M.

2017-11-01

Radar echoes from the daytime equatorial ionospheric F1 region, popularly known as "150 km echoes," have challenged ionospheric plasma physicists for several decades. Recent theoretical simulations showed that enhanced photoelectron fluxes can amplify the amplitude of plasma waves, generating spectra similar to those of the radar echoes, implying that larger solar fluxes should produce more frequent and stronger 150 km echoes. Inspired by this proposal, we studied the occurrence and intensity dependence of the echoes on the EUV flux observed by SOHO over several years. The occurrence and intensity of the echoes were found to have an inverse relationship with this EUV flux measurement. The multiyear trend is independent of the variability often observed over successive days with nearly identical EUV fluxes. These results imply that the relationship between the echoes and EUV flux is more complex. We propose that gravity waves modulate the amplitude of 150 km echoes through changes in the variations in plasma density and photoelectron fluxes associated with the gravity wave-induced neutral density modulations.

Highly linear ring modulator from hybrid silicon and lithium niobate.

PubMed

Chen, Li; Chen, Jiahong; Nagy, Jonathan; Reano, Ronald M

2015-05-18

We present a highly linear ring modulator from the bonding of ion-sliced x-cut lithium niobate onto a silicon ring resonator. The third order intermodulation distortion spurious free dynamic range is measured to be 98.1 dB Hz(2/3) and 87.6 dB Hz(2/3) at 1 GHz and 10 GHz, respectively. The linearity is comparable to a reference lithium niobate Mach-Zehnder interferometer modulator operating at quadrature and over an order of magnitude greater than silicon ring modulators based on plasma dispersion effect. Compact modulators for analog optical links that exploit the second order susceptibility of lithium niobate on the silicon platform are envisioned.

Effects of Phytochemical P-Glycoprotein Modulators on the Pharmacokinetics and Tissue Distribution of Doxorubicin in Mice.

PubMed

Kim, Tae Hwan; Shin, Soyoung; Yoo, Sun Dong; Shin, Beom Soo

2018-02-07

Pungent spice constituents such as piperine, capsaicin and [6]-gingerol consumed via daily diet or traditional Chinese medicine, have been reported to possess various pharmacological activities. These dietary phytochemicals have also been reported to inhibit P-glycoprotein (P-gp) in vitro and act as an alternative to synthetic P-gp modulators. However, the in vivo effects on P-gp inhibition are currently unknown. This study aimed to test the hypothesis that phytochemical P-gp inhibitors, i.e., piperine, capsaicin and [6]-gingerol, modulate the in vivo tissue distribution of doxorubicin, a representative P-gp substrate. Mice were divided into four groups and each group was pretreated with intraperitoneal injections of control vehicle, piperine, capsaicin, or [6]-gingerol and doxorubicin (1 mg/kg) was administered via the penile vein. The concentrations of the phytochemicals and doxorubicin in the plasma and tissues were determined by LC-MS/MS. The overall plasma concentration-time profiles of doxorubicin were not significantly affected by piperine, capsaicin, or [6]-gingerol. In contrast, doxorubicin accumulation was observed in tissues pretreated with piperine or capsaicin. The tissue to plasma partition coefficients, K p , for the liver and kidney were higher in the piperine-pretreated group, while the K p for kidney, brain and liver were higher in the capsaicin-pretreated group. [6]-Gingerol did not affect doxorubicin tissue distribution. The data demonstrated that the phytochemicals modulated doxorubicin tissue distribution, which suggested their potential to induce food-drug interactions and act as a strategy for the delivery of P-gp substrate drugs to target tissues and tumors.