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Background: Local anesthetics can easily pass through the blood-brain barrier and may cause adverse effects in the brain; however, the direct influence of these effects on the central nervous system remains to be clarified. ATPases activated by Ca2+ (Ca-ATPase) or Mg 2+ (Mg-ATPase), which are different from the plasma membrane (PMCA) or the sarco-endoplasmic reticulum (SERCA) Ca, Mg-ATPases, exist in the brain. There are some reports on the effect of local anesthetics on PMCA and SERCA, but few have described the effects on Ca- or Mg-ATPase. The aim of our study was to describe the effect of local anesthetics on these ATPases. Methods: We isolated plasma membrane (PII) and microsomal (PIII) fractions from rat brain homogenates and examined the effects of local anesthetics, procaine, tetracaine, lidocaine, prilocaine, bupivacaine, and dibucaine on Ca- or Mg-ATPase activities at pH 7.4 or 9.5. Results: The Ca- and Mg-ATPase activities of the PII fraction were inhibited in a dose-dependent manner by all local anesthetics at pH 9.5, which is the range of clinical use. Tetracaine and dibucaine, which are clinically strong anesthetics, showed strong inhibitory effects on ATPase activity. The inhibition of activity by lidocaine, tetracaine, and dibucaine was recovered after their concentrations were diluted, suggesting that their inhibitory actions were reversible. Conclusion: These results suggest that local anesthetics at concentrations available for dental use, reversibly inhibit PII Ca- or Mg-ATPase activities in the rat brain.

Aim: To compare and analyze the clinical adequacy of two topical anesthetic gels, Precaine (8% lidocaine + 0.8% dibucaine) and Precaine B (20% benzocaine) in children before intraoral local anesthetic injections. Materials and Methods: This clinical study included thirty children who needed an inferior alveolar nerve block. They were divided into three groups: Group A: Precaine topical gel group, Group B: Precaine B topical gel Group, Group C: no anesthetic topical gel group (control group). These two effective topical gels were applied before giving intraoral local anesthesia, and afterward, the child's pain response was surveyed utilizing the Wong-Baker Faces Pain Rating Scale. The scores obtained were subjected to statistical analysis. Results: Intergroup comparison showed a significant mean difference between the control group and Precaine group (P > 0.05) as well as Precaine B group (P > 0.05). However, there is no significant difference obtained between Group A and Group B (P < 0.05). Conclusion: It is psychologically and clinically beneficial to apply a topical anesthetic agent before injecting any intraoral anesthesia. In this study, both anesthetic gels showed a nonsignificant difference in reducing inferior alveolar injection pain, but Precaine B shows more promising results than Precaine.

The diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

The enterovirus genus encompasses many clinically important human pathogens such as poliovirus, coxsackieviruses, echoviruses, numbered enteroviruses and rhinoviruses. These viruses are the etiological agents of several human diseases, including hand-foot-and-mouth disease, neonatal sepsis, encephalitis, meningitis, paralysis and respiratory infections. There is an unmet need for antivirals to treat these diseases. The non-structural protein 2C is a AAA+ helicase and plays a key role in viral replication. As such, it is an attractive target for antiviral drug development. Several repurposing screens with FDA-approved drugs have identified 2C-targeting compounds such as fluoxetine and dibucaine, but the molecular basis of 2C inhibition has remained enigmatic. Here we present the 1.5 Å resolution crystal structure of the soluble fragment of coxsackievirus B3 2C protein in complex with (S)-fluoxetine (SFX), which reveals a conserved, hydrophobic drug-binding pocket which is distal to the ATP binding site. To decipher the molecular mechanism of inhibition by fluoxetine and other 2C-targeting compounds, we engineered a soluble, hexameric and ATPase competent 2C protein. Using this system, we show that SFX, dibucaine, HBB and guanidine hydrochloride inhibit 2C ATPase activity in a dose-dependent manner. Moreover, using cryo-EM analysis, we demonstrate that SFX and dibucaine lock 2C in a defined hexameric state, rationalizing their mode of inhibition and allowing us to generate the first reconstruction of the oligomeric complex. Taken together, these results provide important structural and mechanistic insights into 2C inhibition and provide a robust engineering strategy which can be used for structural, functional and drug-screening analysis of 2C proteins from current or future enteroviruses.

Background Because ordered membrane domains, called lipid rafts, regulate activation of ion channels related to the nerve pulse, lipids rafts are thought to be a possible target for anesthetic molecules. To understand the mechanism of anesthetic action, we examined influence of representative local anesthetics (LAs); dibucaine, tetracaine, and lidocaine, on raft-like liquid-ordered (Lo)/non-raft-like liquid-disordered (Ld) phase separation. Methods Impact of LAs on the phase separation was observed by fluorescent microscopy. LA-induced perturbation of the Lo and Ld membranes was examined by DPH anisotropy measurements. Incorporation of LAs to the membranes was examined by fluorescent anisotropy of LAs. The biding location of the LAs was indicated by small angle x-ray diffraction (SAXD). Results Fluorescent experiments showed that dibucaine eliminated the phase separation the most effectively, followed by tetracaine and lidocaine. The disruption of the phase separation can be explained by their disordering effects on the Lo membrane. SAXD and other experiments further suggested that dibucaine's most potent perturbation of the Lo membrane is attributable to its deeper immersion and bulky molecular structure. Tetracaine, albeit immersed in the Lo membrane as deeply as dibucaine, less perturbs the Lo membrane probably because of its smaller bulkiness. Lidocaine hardly reaches the hydrophobic region, resulting in the weakest Lo membrane perturbation. Conclusion Dibcaine perturbs the Lo membrane the most effectively, followed by tetracaine and lidocaine. This ranking correlates with their anesthetic potency. General significance This study suggests a possible mechanistic link between anesthetic action and perturbation of lipid rafts.

The objective of the experiment was to assess the antinociceptive effect of dibucaine, bupivacaine, and epinephrine. To assess the mechanism of action of the interaction between dibucaine and epinephrine, phentolamine, a nonselective α-adrenergic antagonist, was added to the mixture.We assessed sensory blockade with these drugs by injecting 0.6 mL of drug-in-saline in the dorsal thoracolumbar area of rats; pinprick of the "wheal" formed by the injectate was the area targeted for stimulation to elicit a cutaneous trunci muscle reflex. The sensory block of dibucaine was compared with that of bupivacaine or epinephrine. Drug-drug interactions were analyzed by isobologram. Phentolamine was added to investigate the antinociceptive effect of dibucaine coinjected with epinephrine.We demonstrated that dibucaine, epinephrine, and bupivacaine produced dose-dependent skin antinociception. On the median effective dose (ED50) basis, the potency was higher for epinephrine (mean, 0.011 [95% confidence interval {CI}, 0.007-0.015] μmol) than for dibucaine (mean, 0.493 [95% CI, 0.435-0.560] μmol) (P.01), while there were no significant differences between dibucaine and bupivacaine (mean, 0.450 [95% CI, 0.400-0.505] μmol). On the equipotent basis (75% effective dose, median effective dose, and 25% effective dose), sensory block duration provoked by epinephrine was greater (P.01) than that provoked by dibucaine or bupivacaine. Coadministration of dibucaine with epinephrine produced a synergistic nociceptive block, whereas phentolamine blocked that synergistic block.The preclinical data indicated that there is no statistically significant difference between the potency and duration of dibucaine and bupivacaine in this model. Epinephrine synergistically enhances the effects of dibucaine, while phentolamine partially blocked those effects. α-Adrenergic receptors play an important role in controlling synergistic analgesic effect of dibucaine combined with epinephrine.

Mitochondrial membranes are pointed out as the site of cardiotoxic action of local anaesthetics. Its three main phospholipids components are phosphatidylcholine, phosphatidylethanolamine and cardiolipin. Cardiolipins, in eukaryotes, are only found in mitochondria and are essential for the maintenance of its integrity and dynamics. Fluorescence and nuclear magnetic resonance spectroscopy were used to study the interactions of a local anaesthetics, Dibucaine (DBC), with different mitochondrial membrane models constituted by combinations of its three main lipid components in which cardiolipin was a natural extract (CLmix). Both CLmix presence/absence and its percentage in the model membranes were evaluated. Fluorescence spectroscopy showed that DBC lowered the transition temperature of all membrane models understudy. DBC partition showed to be dependent of CLmix presence and phosphatidylethanolamine:CL ratio. Furthermore, the maximum emission wavelength (λmax) exhibited a notorious decreased with increasing phospholipid to DBC ratio, in all the membrane models containing CLmix. Nevertheless, it remained approximately the same in the membrane without CLmix. This indicates a differential membrane localization of the anaesthetics, dependent on the membrane models used. NMR results showed that DBC interaction and location in the membrane models is mainly influenced by CLmix presence, and DBC can significant alter lipid systems properties e.g. percentage and type of lipid phase present. Taken all together it was shown that DBC interaction and location are largely dependent on the membrane model system. Furthermore, DBC is able to produce significant changes in the lipidic systems which might help to explain its high toxicity.

Enterovirus D68 (EV-D68) is an atypical non-polio enterovirus that mainly infected the respiratory system of humans, leading to moderate to severe respiratory diseases. In rare cases, EV-D68 can spread to the central nervous system and causes paralysis in infected patients, especially young children and immunocompromised individuals. There is currently no approved vaccine or antiviral available for the prevention and treatment of EV-D68. In this study, we aimed to improve the antiviral potency and selectivity of a previously reported EV-D68 inhibitor, dibucaine, through structure-activity relationship studies. In total, sixty compounds were synthesized and tested against EV-D68 using the viral cytopathic effect (CPE) assay. Three compounds 10a, 12a, and 12c were identified to have significantly improved potency (EC(50) < 1 μM) and a high selectivity index (SI > 180) compared to dibucaine against five different strains of EV-D68 viruses. These compounds also showed potent antiviral activity in neuronal cells such as A172 and SH-SY5Y cells, suggesting they might be further developed for the treatment of both respiratory infection as well as neuronal infection.

Orientadores: Eneida de Paula, Daniele Ribeiro de Araújo Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia Resumo: Nanopartículas lipídicas sólidas (SLN) e carreadores lipídicos nanoestruturados (NLC) têm sido utilizados com sucesso como sistemas de liberação modificada. O anestésico local dibucaína (DBC) foi encapsulado em SLN e NLC objetivando aplicação tópica, para melhora de sua disponibilidade redução de efeitos adversos. As nanopartículas lipídicas foram preparadas pelas técnicas de sonicação (Son) ou homogeinização à alta pressão (HP), sendo utilizados palmitato de cetila (CP) ou miristato de miristila (MM) como matrizes lipídicas sólidas, acrescidos (NLC) ou não (SLN) de uma mistura de triglicerídeos de ácido cáprico e caprílico; poloxamer 188 foi usado como tensoativo. A DBC encapsulada foi quantificada por metodologia validada por cromatografia líquida de alta eficiência. As análises físico-químicas compreenderam diâmetro médio, potencial zeta, distribuição de tamanhos e morfologia das nanopartículas, percentual de encapsulação além de medidas de calorimetria exploratória de varredura (DSC), espectroscopia de infravermelho (FTIR), ressonância paramagnética eletrônica (RPE) e difração de raios X à baixo ângulo (SAXS). Medidas in vitro do perfil de liberação do fármaco, da estimativa de fluxo, deformação e elasticidade das partículas através de membranas artificiais e de toxicidade em cultura de células (fibloblastos 3T3 e queratinócitos HaCat) foram feitas. A estabilidade das amostras foi avaliada em função do tempo e testes de antinocicepção (tail flick, em ratos Wistar) foram usados para avaliar a atividade terapêutica in vivo. O diâmetro médio das partículas de SLN e NLC produzidas foi similar (ca. 200nm). A estabilidade física das nanopartículas foi satisfatória por até 240 dias de armazenamento a 4 ºC, principalmente para NLCMM/HP com e sem DBC, sugerindo que a metodologia de HP produz partículas mais estáveis. Todas as formulações apresentaram eficiência de encapsulação maior que 70%, sendo que NLCMMDBC/HP apresentou a maior encapsulação (90,54 ± 0,95%). Medidas de FTIR e DSC revelaram a DBC molecularmente dispersa na matriz lipídica das nanopartículas. Quanto à organização molecular das SLN e NLC, resultados de SAXS indicaram a existência de arranjos lipídicos lamelares no interior das SLN, não alterados pela adição da DBC; as medidas de RPE com marcadores de spin doxil-estearato revelaram espectros compatíveis com bicamadas, com maior organização molecular dos lipídios das SLN e NLC, após inserção da DBC. Ensaios in vitro confirmaram a liberação modificada da dibucaína associada às partículas, governada por difusão de Fick. Tanto a elasticidade quanto o fluxo das partículas in vitro apresentaram baixos valores evidenciando deposição das mesmas nas membranas com poros de 30 nm. A citotoxicidade intrínsica da DBC sobre ambos os tipos celulares foi reduzida após encapsulação nas SLN e NLC. O efeito analgésico in vivo da DBC a 0,05% aplicada topicamente (dispersa em gel de carbopol) aumentou significativamente após encapsulação nas formulações, em particular para SLNCPDBC liofilizada com o crioprotetor maltose. Assim, formulações de dibucaína em SLN ou NLC, preparadas com MM ou CP mostraram-se promissoras como bases para produtos farmacêuticos de liberação modificada, para anestesia dérmica Abstract: Solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), intended for topical application, were successfully prepared as sustained release systems for the encapsulation of the local anesthetic dibucaine (DBC), aiming to reduce its toxic effects and to improve its availability. The particles were prepared by two differents procedures: sonication (Son) or high pressure homogenization (HP), employing either cetyl palmitate (CP) or myristyl myristate (MM) as the solid lipid matrix, in the presence (NLC) or absence (SLN) of a mixture of capric and caprylic acids; poloxamer 188 was used as surfactant. DBC was quantified through a validated HPLC procedure. Physico-chemical analysis of the nanoparticles included measurements of size distribution, zeta potential, morphology, DBC encapsulation efficiency, as well as exploratory scanning calorimetry (DSC), infrared spectroscopy (FTIR), electron paramagnetic resonance (EPR) and small angle X-ray scattering (SAXS) tests. In vitro analysis of the release profile, flow and elasticity of the particles were performed through artificial membranes while toxicity was tested in 3T3 fibroblasts and HaCaT keratinocytes in culture. Stability of the formulations as a function of time was also measured. The therapeutic activity of the formulations was determined using antinociception tests (tail flick) in Wistar rats. SLN and NLC produced by both methodologies were similar (~200 nm), but HP produced more stable nanoparticles. The physical stability of the nanoparticles was satisfactory during a storage period of 240 days, especially for NLCMM/HP with or without DBC. All formulations showed encapsulation efficiencies higher than 70%, the greatest being assigned for NLCMMDBC/HP (90.54 ± 0.95%). FTIR and DSC revealed that DBC was molecularly dispersed in the lipid matrix of the nanoparticles. As for the SLN and NLC molecular packing, SAXS diffractrograms indicated the existence of lamellar repeats in SLN core region, which were not disturbed by the addition of DBC while EPR data with doxyl stearate probes revealed spectra compatible with bilayers, with higher molecular order in the presence of DBC. In vitro assays confirmed the prolonged release of dibucaine from the nanoparticles, by Fickian diffusion. Nanoparticles's elasticity and flow were low showing deposition on the surface of 30 nm pore membranes. The intrinsic cytotoxicity of DBC against both cell types was decreased, when encapsulated in SLN and NLC. The in vivo analgesic effect of 0.05% DBC topically applied (dispersed in carbopol gel) was significantly prolonged in the nanoparticle formulations, largely for SLNCPDBC lyophilized with maltosis as crioprotector. In conclusion, dibucaine formulations in SLN or NLC prepared with MM or CP are promising for the development of pharmaceutical products intended for prolonged dermal anesthesia Doutorado Bioquímica Doutora em Biologia Funcional e Molecular

For the treatment of internal and external hemorrhoids, policresulen (POL) and cinchocaine hydrochloride (CIN) are used in combination. Using a new, simple, fast, and economical first-derivative synchronous fluorescence spectroscopic process, both drugs were simultaneously determined and validated. At Δλ 60 nm and with a scanning rate of 600 nm/min, methanol was used as the solvent for both products. In the concentration ranges of 5.0–21.0 μg mL−1 and 0.5–6.0 μg mL−1 for POL and CIN, the amplitude-concentration plots were rectilinear. The detection limits were found to be 0.770 μg mL−1 and 0.118 μg mL−1 and the quantitation limits for POL and CIN were 2.541 μg mL−1 and 0.391 μg mL−1. To evaluate all compounds in synthetic mixtures and medicinal dosage types, the proposed method has been successfully applied. These findings were in line with the results obtained using high-performance thin layer chromatography, the comparison process.

Electrochemical characterization and detection of protonated dibucaine (DIC+) at microinterface array across water|1,6-dichlorohexane were performed using cyclic voltammetry (CV) and differential pulse voltammetry (DPV). Some thermodynamic parameters of dibucaine, such as the standard transfer potential, the Gibbs energy of transfer and the partition coefficient, were estimated by CV. In addition to the analytical parameters, the impact of bovine serum albumin (BSA) on dibucaine detection (in artificial serum matrices) was also investigated. DPV was applied to detect a lower concentration of DIC+, resulting in a detection limit of 0.9 &plusmn, 0.06 &micro, M. While the presence of BSA affected CV, demonstrated as reduced current responses, DPV was confirmed to be an efficient method for lowering concentrations of the dibucaine detection in the artificial serum matrix in the presence of BSA, with a limit of detection (LOD) of 1.9 &plusmn, 0.12 &micro, M.

Colloidal lipid emulsions are a promising formulation option for poorly water-soluble drugs. Due to their complex composition, they provide different sites for the localization of drugs. Drug molecules can be situated in the lipid matrix, in the aqueous phase with its structures formed by an excess of emulsifier or at the droplet interface. The interface and the mechanism of stabilization is mainly characterized by the emulsifier. In this study, the main focus was on the influence of drug localization on the stability of emulsions sterically stabilized with poloxamer188. In addition to 5% of this non-ionic emulsifier, the emulsions contained 10% soybean oil. The localization of the drugs fenofibrate, curcumin, betamethasone valerate, cinnarizine, dibucaine and flufenamic acid within the emulsion system at a physiological pH of 7.4 as well as their influence on emulsion stability were examined. The results indicated that the stability of poloxamer 188-stabilized emulsions can be influenced in a positive or negative way by the localization of drug molecules in the interface of emulsion droplets. Applying cinnarizine as model substance at pH 5, 7.4 and 10, no pronounced change in the localization was detected as a result of alterations in the charge of the drug.

We have previously developed ammonium sulphate gradient loaded liposomes to encapsulate dibucaine. Thus, the purpose of this study was to evaluate the pre-clinical safety and effectiveness of this novel ionic liposomal formulation of dibucaine (DBC), as described in previous work. Effectiveness was evaluated

Introduction:This paper presents the development and validation of a novel, fast, sensitive and accurate high performance liquid chromatography (HPLC) method for the simultaneous quantitative determination of dibucaine HCl, fluocortolone pivalate and fluocortolone caproate in pharmaceutical preparations.Experiment:Development of the chromatographic method was based on an experimental design approach. A five-level-three-factor central composite design requiring 20 experiments in this optimization study was performed in order to evaluate the effects of three independent variances including mobile phase ratio, flow rate and amount of acid in the mobile phase.Conclusion:The optimum composition for mobile phase was found as a methanol:water:acetic acid mixture at 71.6 : 26.4 : 2 (v/v/v) ratio and optimum separation was acquired by isocratic elution with a flow rate of 1.3 mL/min. The analytes were detected using a UV detector at 240 nm. The developed method was validated in terms of linearity, precision, accuracy, limit of detection/quantitation and solution stability and successfully applied to the determination of dibucaine HCl, fluocortolone pivalate and fluocortolone caproate in pharmaceutical topical formulations such as suppositories and ointments.

To investigate the relationship between acetyl cholinesterase associated collagen gene (COLQ) mutation in patients with acetyl cholinesterase deficiency and its clinical characteristics. Serum and red blood cell acetyl cholinesterase from patients with acetyl cholinesterase deficiency (n=6) and normal controls (n=20) were measured by butyryl thiocholine substrate. COLQ gene variations were detected by sequencing. And the cholinesterase (ChE) genotypes were measured by dibucaine inhibition in vitro. The distributions of ChE surrounded the blood vessels and nerve fibers in lung or pancreas tissues were detected by immunohistochemical staining and indirect immunofluorescence. Serum lactic acid, ammonia and other clinical data were analyzed. Serum ChE in patients with acetyl cholinesterase deficiency were only 1/50 to 1/1000 fold of normal controls. Comparing to controls, dibucaine inhibition values of patients were significantly lower, while there were no differences in red blood cells acetyl cholinesterase. Serum lactic acid and ammonia in patients were significantly higher than controls. Inser 1281-1282 GC of COLQ gene was found in 2 patients, while IVS 6 + 21 T > A, IVS 6 + 30 G > T, IVS 6 + 34 T > C and IVS66 + 12 inser T mutations were found in the other 4 patients, respectively. In addition, the patients with COLQ gene mutation were resistant to regular doses of anesthetics. COLQ gene mutation may be an important reason for the lack of serum ChE in patients with acetyl cholinesterase deficiency.

Cinchocaine hydrochloride (CIN) and betamethasone valerate (BMV) are co-formulated in pharmaceutical formulations that could be used for local treatment of hemorrhoids. Both drugs are susceptible to hydrolytic degradation. Two sensitive and precise stability-indicating chromatographic methods were developed for the simultaneous determination of both active pharmaceutical ingredients. The developed methods were applied for quantitation of CIN and BMV in their pure forms, in presence of their corresponding degradation products and in their pharmaceutical formulation. The first method was a high performance liquid chromatographic (HPLC) one, separation and quantitation was achieved using a Waters Spheriosorb® 5 μm ODS2 C18 analytical column and an isocratic mobile phase formed of acetonitrile-acetate buffer (pH 6.5 ± 0.1) in a ratio of (55:45, v/v). The mobile phase was pumped at a flow rate of 1.2 mL/min. UV-detection was done at 240 nm using photodiode array detector. The second method was based on thin layer chromatography (TLC) fractionation coupled with densitometric determination. Separation was done on high performance thin layer chromatography (HPTLC) silica gel 60F254 plates using a developing system formed of chloroform-toluene-ethanol-acetic acid in a ratio of (4.5:4.5:1:1, by volume). The separated bands were scanned densitometrically at 240 nm. For the HPLC method, linearity was confirmed over concentration ranges of 4-300 and 4-350 μg/mL for CIN and BMV, respectively. For the HPTLC-densitometric method, the obtained ranges were 0.5-12 and 0.5-10 μg/band for CIN and BMV, respectively. The developed methods were optimized and validated according to the ICH guidelines. CIN acid degradation products were separated and identified by mass spectroscopy. The developed HPLC method was used to study the kinetics of acid and alkali degradation of the both drugs. The results obtained were statistically analyzed and compared with those obtained by applying the official methods for both drugs.

Ketoprofen is one of the non-steroidal anti-inflammatory drugs used for fomentation. It is associated with undesirable photosensitivity caused by UV irradiation. Moreover, it induces photodegradation, including decarboxylation, when exposed to UV irradiation. In this study, we attempted to identify compounds that can inhibit the photodegradation of ketoprofen. UV irradiation of ketoprofen follows first-order reaction kinetics and yields three photoproducts. Aqueous solutions containing ketoprofen generate free radicals when it was irradiated with UV. We considered that these free radicals react with ketoprofen. Antioxidants inhibit the photodegradation of ketoprofen. On the other hand, a local anesthetic, dibucaine hydrochloride, was also effective in inhibiting the photodegradation of ketoprofen. We evaluated the difference in the mechanism of inhibition between the antioxidants and the local anesthetic. In conclusion, both antioxidants and dibucaine hydrochloride are effective inhibitors of the photodegradation of ketoprofen.

Dibucaine, a potent and toxic local anaesthetic, although currently withdrawn by the United States Food and Drug Administration for use as a spinal anaesthetic, continues to remain available in many over-the-counter topical formulations. Systemic toxicity following oral ingestion of local anaesthetics is rare. We report a case of accidental ingestion of dibucaine (ear drops) in a 7-year-old child who developed diplopia, giddiness, ventricular premature contractions and a right bundle branch block. We also present a brief discussion on the pharmacologic and toxicity profile of dibucaine, the Naranjo algorithm for assessing causality in case of adverse drug reactions and a review of current guidelines on the management of local anaesthetic systemic toxicity.

Dibucaine (DBC) is among the more potent long-acting local anesthetics (LA), and it is also one of the most toxic. Over the last decades, solid lipid nanoparticles (SLN) have been developed as promising carriers for drug delivery. In this study, SLN formulations were prepared with the aim of prolonging DBC release and reducing its toxicity. To this end, SLN composed of two different lipid matrices and prepared by two different hot-emulsion techniques (high-pressure procedure and sonication) were compared. The colloidal stability of the SLN formulations was tracked in terms of particle size (nm), polydispersity index (PDI), and zeta potential (mV) for 240 days at 4 &deg, C, the DBC encapsulation efficiency was determined by the ultrafiltration/centrifugation method. The formulations were characterized by differential scanning calorimetry (DSC), electron paramagnetic resonance (EPR), and release kinetic experiments. Finally, the in vitro cytotoxicity against 3T3 fibroblast and HaCaT cells was determined, and the in vivo analgesic action was assessed using the tail flick test in rats. Both of the homogenization procedures were found suitable to produce particles in the 200 nm range, with good shelf stability (240 days) and high DBC encapsulation efficiency (~72&ndash, 89%). DSC results disclosed structural information on the nanoparticles, such as the lower crystallinity of the lipid core vs. the bulk lipid. EPR measurements provided evidence of DBC partitioning in both SLNs. In vitro (cytotoxicity) and in vivo (tail flick) experiments revealed that the encapsulation of DBC into nanoparticles reduces its intrinsic cytotoxicity and prolongs the anesthetic effect, respectively. These results show that the SLNs produced are safe and have great potential to extend the applications of dibucaine by enhancing its bioavailability.

Dibucaine (DBC) is one of the most potent long-acting local anesthetics, but it also has significant toxic side effects and low water solubility. Solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs) have been proposed as drug-delivery systems to increase the bioavailability of local anesthetics. The purpose of the present study was to characterize SLNs and NLCs composed of cetyl palmitate or myristyl myristate, a mixture of capric and caprylic acids (for NLCs only) plus Pluronic F68 prepared for the encapsulation of DBC. We intended to provide a careful structural characterization of the nanoparticles to identify the relevant architectural parameters that lead to the desirable biological response. Initially, SLNs and NLCs were assessed in terms of their size distribution, morphology, surface charge, and drug loading. Spectroscopic techniques (infrared spectroscopy and electron paramagnetic resonance, EPR) plus small-angle X-ray scattering (SAXS) provided information on the interactions between nanoparticle components and their structural organization. The sizes of nanoparticles were in the 180 nm range with low polydispersity and negative zeta values (-25 to -46 mV). The partition coefficient of DBC between nanoparticles and water at pH 8.2 was very high (>104). EPR (with doxyl-stearate spin labels) data revealed the existence of lamellar arrangements inside the lipid nanoparticles, which was also confirmed by SAXS experiments. Moreover, the addition of DBC increased the molecular packing of both SLN and NLC lipids, indicative of DBC insertion between the lipids, in the milieu assessed by spin labels. Such structural information brings insights into understanding the molecular organization of these versatile drug-delivery systems which have already demonstrated their potential for therapeutic applications in pain control.

Paraquat (PQ) as a Parkinsonian mimetic has been demonstrated to impair dopaminergic (DAergic) neurons and is highly correlated with the etiology of Parkinson's disease (PD) where the death of DAergic neurons has been mainly attributed to impaired mitochondrial functioning. In this study, PQ-induced cytotoxicity focusing on mitochondrial membrane permeability (MMP), which has been implicated to play a part in neurodegeneration, was investigated. Primarily, PQ-induced cytotoxicity and reactive oxygen species (ROS) were inhibited by an inhibitor of NADPH oxidase (NOX), indicating the toxic effect of PQ redox cycling. Further, dibucaine and cyclosporin A which respectively inhibit mitochondrial apoptosis-induced channels (MAC) and mitochondrial permeability transition pores (mPTP) were used and found to prevent PQ-induced mitochondrial dysfunction, such as decreased mitochondrial membrane potential and increased MMP, mitochondrial ROS, and pro-apoptotic factor release. Knockdown of bax and/or bak blocked PQ-induced mitochondrial clusterization of Bax and/or Bak and cytotoxicity, demonstrating the significance of MAC which is composed of Bax and/or Bak. This clusterization coincided with the release of mitochondrial apoptotic factors before there was an increase in inner MMP, indicating that MAC may precede mPTP formation. Besides, NOX inhibitor but not dibucaine attenuated the earlier PQ-induced cytosolic ROS formation or Bax and/or Bak clusterization indicating PQ redox cycling may account for MAC formation. In this model, we have resolved for the first that PQ cytotoxicity through redox cycling may sequentially result in increased outer (MAC) and inner (mPTP) MMP and suggested MMP could be implicated as a therapeutic target in treating neurodegenerative diseases like PD.

Interactions of two local anesthetics, dibucaine and tetracaine have been studied with phospholipid vesicles containing cholesterol and/or monosialogangliosides (GM1) using fluorescence spectroscopy. The fluorescence intensity of tetracaine showed a marked increase with the increasing molar ratio of the phospholipid to tetracaine, while that of dibucaine showed opposite effects. Steady state anisotropy and the wavelength of maximum emission (λmax) decreased with the increasing phospholipids to tetracaine ratio. The extent of such changes in anisotropy and λmax in the presence and absence of two important components of neuronal membranes, cholesterol and GM1 indicated differential membrane localization of the two local anesthetics. To understand the intercellular mode of action of local anesthetics, we have also studied the interactions of dibucaine and tetracaine with brain spectrin which indicate differential spectrin interactions with similar binding strength. Thermodynamic parameters associated with such binding reveal that binding is favored by entropy. Tetracaine brings about distinct structural changes in spectrin compared to dibucaine, as reflected in the tryptophan mean lifetime and far-UV CD spectra. Tetracaine also exhibits a detergent-like property inducing concentration dependent decrease in spectrin anisotropy, further indicating structural changes in brain spectrin with probable implications in its anesthetic potential.

In this work, the competitive interaction between dibucaine and three fluorescent probes (i.e., berberine, palmatine, and coptisine) for occupancy of the cucurbit[7]uril (CB[7]) cavity was studied by fluorescence spectra, UV-visible absorption spectra, (1)H NMR spectra, and theoretical calculations in acidic aqueous solution. Based on the fluorescence enhancement of berberine, palmatine, and coptisine upon binding with CB[7], respectively, a series of fluorescence detection methods for dibucaine were proposed. At the optimized conditions, the fluorescence intensity of berberine-CB[7], palmatine-CB[7], and coptisine-CB[7] complexes showed negative correlation to the concentration of dibucaine, which led to a series of simple and sensitive fluorescence methods for the determination of dibucaine for the first time. Linear ranges obtained in the detection of the dibucaine were 0.018-3.34 μmol L(-1), 0.032-4.47 μmol L(-1), and 0.079-4.42 μmol L(-1) with detection limits of 6.0 nmol L(-1), 12.0 nmol L(-1), and 25.0 nmol L(-1), respectively. Moreover, the proposed method was successfully applied for the determination of the drug in biological fluids. The competitive mode based on CB[7] superstructure provided a promising assay strategy for fluorescence detection in various potential applications.

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Amongst other strategies for the formulation of poorly water-soluble drugs, solubilization of these drugs in lipid-based formulations is a promising option. Most screening methods for the identification of a suitable lipid-based formulation fail to elucidate the role interfacial effects play for drug solubility in disperse systems. In a novel screening approach called passive drug loading, different preformed lipid nanocarrier dispersions are incubated with drug powder. Afterwards, undissolved drug is filtered off and the amount of solubilized drug is determined. The aim of this study was to identify parameters for drug solubility in pure lipids as well as for drug loading to the lipid-water interface of lipid nanoparticles. Using passive loading, the solubility of eight poorly water-soluble drugs in seven lipid nanocarriers varying in particle size or lipid matrix was investigated. Drug solubility in the nanocarriers did not follow any apparent trend and different drugs dissolved best in different carriers. Drugs with a melting point below approximately 150°C displayed distinctly better solubility than higher melting drugs. Additionally, relating the specific lipid nanocarrier surface area to the drug solubility allowed drawing conclusions on the drug localization. Fenofibrate, dibucaine and, less distinctly also clotrimazole, which all melt below 150°C, were predominantly located in the lipid droplet core of the nanoparticles. In contrast, the five remaining drugs (betamethasone valerate, flufenamic acid, itraconazole, ketoconazole, mefenamic acid) were also located at the lipid-water interface to different, but substantial degrees. The ability to account for drug loading to the lipid-water interface is thus a major advantage of passive loading.

The efficacy of antimicrobial drugs against Mycobacterium tuberculosis , an intracellular bacterial pathogen, is generally first established by testing compounds against bacteria in axenic culture. However, inside infected macrophages, bacteria encounter an environment which differs substantially from broth culture and are subject to important host-dependent pharmacokinetic phenomena which modulate drug activity. Here, we describe how pH-dependent partitioning drives asymmetric antimicrobial drug distribution in M. tuberculosis- infected macrophages. Specifically, weak bases with moderate activity against M. tuberculosis (fluoxetine, sertraline, and dibucaine) were shown to accumulate intracellularly due to differential permeability and relative abundance of their ionized and nonionized forms. Nonprotonatable analogs of the test compounds did not show this effect. Neutralization of acidic organelles directly with ammonium chloride or indirectly with bafilomycin A1 partially abrogated the growth restriction of these drugs. Using high-performance liquid chromatography, we quantified the degree of accumulation and reversibility upon acidic compartment neutralization in macrophages and observed that accumulation was greater in infected than in uninfected macrophages. We further demonstrate that the efficacy of a clinically used compound, clofazimine, is augmented by pH-based partitioning in a macrophage infection model. Because the parameters which govern this effect are well understood and are amenable to chemical modification, this knowledge may enable the rational development of more effective antibiotics against tuberculosis.

In this research, Ag(I) nanoparticle with 4-nitro phenylcyanamide ligand, [AgL] n , where L = 4-nitro phenylcyanamide (4-NO2pcyd), was synthesized successfully. FT-IR, 1H-NMR, TGA, and UV–Vis studies were done for the structural and thermal characterization of the Ag(I) nanoparticle. The spherical morphology of silver nanoparticles was confirmed from SEM image. The transmission electron microscopy image showed that the particle size dimensions of silver nanoparticles were about 1.5–5 nm. Furthermore, Ag(I) nanoparticle was immobilized on the surface of a glassy carbon electrode (GCE), and the electroactivity behavior was investigated by cyclic voltammetry and differential pulse voltammetry (DPV). The obtained [AgL] n -modified GCE showed high catalytic activity for the oxidation of dibucaine and naphazoline. The peak current of differential pulse voltammograms of dibucaine and naphazoline increased linearly with their concentration in the ranges of 2.17–5.74 µM naphazoline and 18.5–72.2 µM dibucaine. The detection limits for dibucaine and naphazoline were 0.002 and 0.009 µM, respectively. In addition, the obtained [AgL] n -modified GCE was investigated for the simultaneous determination of dopamine (DA) and acetaminophen (AP). In DPV technique, both DA and AP give sensitive oxidation peaks at 130 and 312 mV, respectively. Under the optimized experimental conditions, DA and AP give linear response over the range of 5–200 µmol L−1 (r = 0.996) and 5–300 µmol L−1 (r = 0.994), respectively. The lower detection limits were found to be 0.7 for DA and 0.5 µmol L−1 for AP. The investigated method showed good stability, reproducibility [1.4 % (DA) and 2.5 % (AP)], and repeatability (1.8 %).

Lipid nanoemulsions and -suspensions are being intensively investigated as carriers for poorly water soluble drugs. The question on where model compounds or probes are localized within the dispersions has been the subject of several studies. However, only little data exists for pharmaceutically relevant molecules in dispersions composed of pharmaceutically relevant excipients. In this work, the localization of drugs and drug-like substances was studied in lipid nanoemulsions and -suspensions. Conclusions about the drug localization were drawn from the relations between lipid mass, specific particle surface area and drug load in the dispersions. Additionally, the achievable drug loads of the liquid and the solid lipid particles were compared. Nanoemulsions and -suspensions comprised trimyristin as lipid matrix and poloxamer 188 as emulsifier and were prepared with different well-defined particle sizes. These pre-formed dispersions were passively loaded with either amphotericin B, curcumin, dibucaine, fenofibrate, mefenamic acid, propofol, or a porphyrin derivative. The physico-chemical properties of the particles were characterized; drug load and lipid content were quantified by UV spectroscopy and high performance liquid chromatography, respectively. For all drugs the passive loading procedure was successful in both emulsions and suspensions. Solid particles accommodate drug molecules preferably at the particle surface. Liquid particles can accommodate drugs at the particle surface as well as in the core; the distribution between the two sites is drug specific. It is also drug specific whether solid or liquid particles yield higher drug loads. As a general rule, smaller particles led to higher drug loads than larger ones. Propofol and the porphyrin derivative displayed eutectic interaction with the lipid and crystal growth after loading, respectively.

This study determined the effects of melatonin (MEL) and its receptors on monochromatic light-induced bursal B-lymphocyte proliferation in broiler chickens. In vivo, green light (GL) enhanced the proliferation of B lymphocytes in bursas by 16.49% to 30.83% and the expression of MEL receptor subtypes 1a ( Mel1a ), Mel1b , and Mel1c receptors in bursas by 6.91% to 366.98% than other light colors. However, pinealectomy reduced these parameters and eliminated the differences between GL and other light groups. In vitro, the MEL-induced bursal B-lymphocyte proliferation was most suppressed by prazosin ( P = 0.001, selective Mel1c antagonist), followed by luzindole ( P = 0.022, nonselective Mel1a/Mel1b antagonist), but not by 4-phenyl-2-propionamideotetralin ( P = 0.144, selective Mel1b antagonist). Similarly, dibutyryl-cyclic adenosine monophosphate (cAMP; analog of cAMP; P = 0.017) but not 8-(4-chloro-phenylthio)-2′-O-methyladenosine-3′,5′-cyclic monophosphate ( P = 0.736; activator of exchange protein directly activated by cAMP) significantly inhibited bursal B-lymphocyte proliferation. These results suggest that MEL mediates GL-induced bursal B-lymphocyte proliferation through Mel1c and Mel1a receptors but not Mel1b receptors by activating the cAMP/protein kinase A pathway.

Purpose There is a compelling need for prolonged local anesthetic that would be used for analgesia with a single administration. However, due to the low molecular weight of local anesthetics (LA) (lidocaine, bupivacaine, procaine, dibucaine, etc), they present fast systemic absorption. Methods The aim of the present study was to develop and evaluate bupivacaine lipid-polymer hybrid nanoparticles (BVC LPNs), and compared with BVC loaded PLGA nanoparticles (BVC NPs). Their morphology, particle size, zeta potential and drug loading capacity were evaluated. In vitro release study, stability and cytotoxicity were studied. In vivo evaluation of anesthetic effects was performed on animal models. Results A facile nanoprecipitation and self-assembly method was optimized to obtain BVC LPNs, composed of PLGA, lecithin and DSPE-PEG2000, of ∼175 nm particle size. Compared to BVC NPs, BVC LPNs exhibited prolonged in vitro release in phosphate-buffered saline (pH = 7.4). Further, BVC LPNs displayed enhanced in vitro stability in 10% FBS and lower cytotoxicity (the concentration of BVC ranging from 1.0 μM to 20 μM). In addition, BVC LPNs exhibited significantly prolonged analgesic duration. Conclusion These results demonstrate that the LPNs could function as promising drug delivery system for overcoming the drawbacks of poor stability and rapid drug leakage, and prolonging the anesthetic effect with slight toxicity.

Enteroviruses (EVs) represent many important pathogens of humans. Unfortunately, no antiviral compounds currently exist to treat infections with these viruses. We screened the Prestwick Chemical Library, a library of approved drugs, for inhibitors of coxsackievirus B3, identified pirlindole as a potent novel inhibitor, and confirmed the inhibitory action of dibucaine, zuclopenthixol, fluoxetine, and formoterol. Upon testing of viruses of several EV species, we found that dibucaine and pirlindole inhibited EV-B and EV-D and that dibucaine also inhibited EV-A, but none of them inhibited EV-C or rhinoviruses (RVs). In contrast, formoterol inhibited all enteroviruses and rhinoviruses tested. All compounds acted through the inhibition of genome replication. Mutations in the coding sequence of the coxsackievirus B3 (CV-B3) 2C protein conferred resistance to dibucaine, pirlindole, and zuclopenthixol but not formoterol, suggesting that 2C is the target for this set of compounds. Importantly, dibucaine bound to CV-B3 protein 2C in vitro , whereas binding to a 2C protein carrying the resistance mutations was reduced, providing an explanation for how resistance is acquired.

Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome. The enzyme responsible for the metabolism of succinylcholine, pseudocholinesterase, was determined to be low in quantity in this patient but was functionally normal. This low level, by itself, was unlikely to be solely responsible for the prolonged paralysis. The patient likely had an abnormal pseudocholinesterase enzyme variant that is undetectable by standard laboratory tests.

Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. Aim: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine⁰ (8% Lidocaine + 0.8% Dibucaine) and Precaine⁰ B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. Study Design: This triple blind clinical study included sixty children divided equally under three techniques — palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. Results: Precaine⁰ has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine⁰ for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine⁰ B reported significant lower scores (p

The binding geometries, abilities and thermodynamic parameters for the intermolecular complexation of three water-soluble p-sulfonatocalix[n]arenes (SCnAs), p-sulfonatocalix[4]arene (SC4A), p-sulfonatocalix[5]arene (SC5A), andp-sulfonatothiacalix[4]arene (STC4A), with five local anesthetics (LA), procaine, tetracaine, lidocaine, dibucaine, and procainamide, have been determined by means of 1H NMR spectroscopy, X-ray crystallography, and isothermal titration calorimetry (ITC). The obtained results show that the complexation of SCnAs with LA guests shows unappreciable guest selectivity, but regular host selectivity: SC4A > SC5A > STC4A for each guest. A large difference in the enthalpy term is responsible for the decrease in the stability constants. The intrinsic relationship between binding structures and host selectivities were comprehensively analyzed and discussed from the viewpoint of thermodynamics. Furthermore, the complexation of SC4A towards LA guests were compared with other macrocyclic hosts, β-cyclodextrin and cucurbit[7]uril.

E-mail: Ensafi@cc.iut.ac.irReceived January 26, 2011, Accepted July 4, 2011Plasticized poly(vinyl chloride), PVCs, with different membrane compositions tested for use in theconstruction of an ion-selective sensor for the determination dibucaine. A prepared membrane with dioctylphthalate-PVC and ion-pair of N-(1-naphthyl)ethylenediamine dihydrochloride-tetraphenyl borate had a goodpotential to acts as a potentiometric sensor for the analysis of dibucaine. A linear relationship was obtainedbetween potential and logC varying between 1.0 × 10

Understanding the critical factors governing the crystallization tendency of organic compounds is vital when assessing the feasibility of an amorphous formulation to improve oral bioavailability. The objective of this study was to investigate potential links between viscosity and crystallization tendency for organic compounds from the undercooled melt state. Steady shear rate viscosities of numerous compounds were measured using standard rheometry as a function of temperature through the undercooled melt regime. Data for each compound were fit to the Vogel-Tamman-Fulcher (VTF) equation; kinetic fragility via strength parameter (D) was determined. Compounds with high crystallization tendencies exhibited lower melt viscosities than compounds with low crystallization tendencies. A correlation was observed between rate of change in viscosity with temperature and crystallization tendency, with slowly crystallizing compounds exhibiting larger increases in viscosity as temperature decreased below Tm. Calculated strength parameters indicated all compounds were kinetically fragile liquids; thus, kinetic fragility may not accurately assess glass-forming ability from undercooled melt state. A link was observed between the viscosity of a compound through the undercooled melt regime and its resultant crystallization tendency, indicating viscosity is a critical parameter to fully understand crystallization tendency of organic compounds.

Spectroscopic properties of molecules which undergo acid–base equilibrium are greatly influenced by the local pH. Their acid–base equilibrium constants can be experimentally obtained under different environments by measuring spectroscopic parameters such as absorbance, fluorescence intensity and fluorescence lifetimes as a function of pH. The pKa values are obtained fitting the data with the well known Henderson–Hasselbalch equation. Decay curves obtained with time-resolved pulse fluorometry are usually analyzed in terms of multi-exponential functions characterized by the pre-exponential factors or by the integrated fractional fluorescence intensities associated with each lifetime, this last being analogous to the steady state fluorescence contributions. In this paper we show that under normal conditions for many fluorescent drugs, a two-exponential analysis is adequate. We develop expressions for the pH dependence of pre-exponential factors and fractional fluorescence intensities in time-resolved pulse fluorometry of a fluorophore undergoing acid–base transition. We show that the obtained pKa values are apparently shifted, and give the expressions for the pK-shifts. The expressions were tested using the fluorescence decay properties of two compounds: the well characterized local anesthetic dibucaine and the antibiotic levofloxacin.

Calcium-dependent calpains are a family of cysteine proteases that have been demonstrated to play key roles in both platelet glycoprotein Ibα shedding and platelet activation and altered calpain activity is associated with thrombotic thrombocytopenic purpura. Calpain activators induce apoptosis in several types of nucleated cells. However, it is not clear whether calpain activators induce platelet apoptosis. Here we show that the calpain activator dibucaine induced several platelet apoptotic events including depolarization of the mitochondrial inner transmembrane potential, up-regulation of Bax and Bak, down-regulation of Bcl-2 and Bcl-X(L), caspase-3 activation and phosphatidylserine exposure. Platelet apoptosis elicited by dibucaine was not affected by the broad spectrum metalloproteinase inhibitor GM6001. Furthermore, dibucaine did not induce platelet activation as detected by P-selectin expression and PAC-1 binding. However, platelet aggregation induced by ristocetin or α-thrombin, platelet adhesion and spreading on von Willebrand factor were significantly inhibited in platelets treated with dibucaine. Taken together, these data indicate that dibucaine induces platelet apoptosis and platelet dysfunction.

Butyrylcholinesterase (BChE) metabolizes the paralytic succinylcholine. Extended paralysis occurs in people with inherited BChE variants that may be identified by measuring BChE activity with and without the inhibitor dibucaine to calculate a dibucaine number (DN). Accurate phenotyping requires phenotype-specific BChE and DN reference intervals. We investigated the concordance between the biochemical BChE phenotype and the BCHE genotype to establish interpretive criteria for biochemical results. DNA was extracted from 45 serum specimens for which BChE activity and DN had been determined. The BCHE gene coding region was amplified and sequenced. Phenotype-genotype concordance and discordance occurred in 16 (36%) and 15 (33%) of specimens, respectively. A phenotype could not be assigned for 14 specimens (31%). An incorrectly assigned phenotype did not change the risk of prolonged paralysis or implied a slightly increased risk when there was none. Accurate BChE phenotyping is difficult using only enzyme activity and DN. The combination of biochemistry and BCHE genotype could improve the assessment of patient risk.

A wide range of cationic amphiphilic drugs (CADs) from different therapeutic areas are known to cause phospholipidosis both in vivo and in vitro. Although the relevance of this storage disorder for human health remains uncertain, CADs have been repeatedly associated with clinical side effects, and as a result, phospholipidosis is of major concern for drug development in the pharmaceu- tical industry. An important unresolved question in this field is whether phospholipidosis is really linked to cellular toxicity. This work was focused on studying cellular responses associated with CAD-induced phospholipidosis in cultured mammalian kidney cells. Dibucaine (2-butoxy-N-(2-diethylaminoethyl)quinoline-4-carboxamide), an amide-type anesthetic with poorly defined cytotoxic effects, was used to induce phospholipidosis in Vero cells. The results from several assays that measure cell viability, proliferation, and morphological changes indicated that dibucaine-induced lysosomal phospholipidosis was accompanied by cellular defense responses such as transient growth arrest and autophagy, under mild stress conditions. Conversely, when tolerance limits were exceeded treated Vero cells underwent extensive and irreparable injury, leading ultimately to cell death. Our data provide additional information that may be of considerable interest for drug safety assessment.

Summary We injected 0.1 to 3 mg of morphine and atropine morphine added to 0.3% dibucaine solution into the lumbar subarachnoid space of 101 patients for supplementary intraoperative anesthesia and postoperative analgesia. Pain relief occurred within 20 to 40 minutes after injection and lasted 6 to 59 hours, with a mean duration of 25 hours, in 65 patients; the remaining 36 patients obtained unlimited pain relief for over 72 hours. However, increasing the intrathecal dose of morphine to 3 mg did not increase the duration of the analgesia. Respiratory depression was observed in 5 patients who had recieved 1.5 to 3 mg of morphine and atropine morphine. Four of these patients developed delayed respiratory depression 5 to 8 hours after the injection, and one developed early respiratory depression 1 hour after the injection. All required treatment. Other systemic side effects such as itching, nausea and vomiting occurred in a high proportion of the patients. However, in the majority of cases, these side effects were mild. A good euphoric mood appeared in 6 patients. Our experience, although limited, is that intrathecal morphine can be simultaneously used with local anesthetics effectively, safely and simply. But the optimal dose has yet been determined, and requires further investigation.

SUMMARY Dibucaine, a local anesthetic, is known to induce flagellar excision in Chlamydomonas reinhardtii. Herein, we investigate whether other local anesthetics have similar effects. Tetracaine, bupivacaine, procaine, and lidocaine also caused flagellar excision, although their potencies were lower than that of dibucaine. Bupivacaine, procaine, and lidocaine induced a morphological change in flagella from a rod-like shape to a disk-like shape before flagellar excision. Except for lidocaine, these local anesthetics caused cell-wall shedding in addition to flagellar excision. The anesthetics in order of their median effective concentration (1-h EC50) for flagellar excision are as follows: dibucaine (1.37 × 10−5 M)

Background: Enlarged ventricles and reduced hippocampal volume are consistently found in patients with first-episode schizophrenia. Studies investigating brain structure in antipsychotic-naive patients have generally focused on the striatum. In this study, we examined whether ventricular enlargement and hippocampal and caudate volume reductions are morphological traits of antipsychotic-naive firstepisode schizophrenia. Methods: We obtained high-resolution 3-dimensional T1-weighted magnetic resonance imaging scans for 38 antipsychotic-naive first-episode schizophrenia patients and 43 matched healthy controls by use of a 3-T scanner. We warped the brain images to each other by use of a high-dimensional intersubject registration algorithm. We performed voxel-wise group comparisons with permutation tests. We performed small volume correction for the hippocampus, caudate and ventricles by use of a false discovery rate correction (p < 0.05) to control for multiple comparisons. We derived and analyzed estimates of brain structure volumes. We grouped patients as those with (n = 9) or without (n = 29) any lifetime substance abuse to examine the possible effects of substance abuse. Results: We found that hippocampal and caudate volumes were decreased in patients with first-episode schizophrenia. We found no ventricular enlargement, differences in global volume or significant associations between tissue volume and duration of untreated illness or psycho pathology. The hippocampal volume reductions appeared to be influenced by a history of substance abuse. Exploratory analyses indicated reduced volume of the nucleus accumbens in patients with first-episode schizophrenia. Limitations: This study was not a priori designed to test for differences between schizophrenia patients with or without lifetime substance abuse, and this subgroup was small. Conclusion: Reductions in hippocampal and caudate volume may constitute morphological traits in antipsychotic-naive first-episode schizophrenia patients. However, the clinical implications of these findings are unclear. Moreover, past substance abuse may accentuate hippocampal volume reduction. Magnetic resonance imaging studies addressing the potential effects of substance abuse in antipsychoticnaive first-episode schizophrenia patients are warranted.

Micelles of a new ABC triblock copolymer, poly(ethylene oxide-b-sodium 2-(acrylamido)-2-methyl-1-propanesulfonate-b-styrene) (PEO-b-PAMPS-b-PS), were prepared in aqueous solutions. The physicochemical properties of the micelle were investigated by combining different techniques: dynamic light scattering, fluorescence spectroscopy, scanning electron microscopy, and transmission electron microscopy (TEM). The micelles have a spherical morphology with a hydrophobic PS core, a hydrophilic and anionic PAMPS shell, and a hydrophilic and nonionic PEO corona as revealed by TEM measurements. The interactions of dibucaine (DC) and dodecyl trimethyl ammonium chloride (DTAC) with PEO-b-PAMPS-b-PS were also studied. The binding of cationic DC and DTAC to the anionic PAMPS shell was confirmed by zeta-potential measurements. It is elucidated that hydrophobic interactions contribute to the binding of DTAC and DC to the polymer, although electrostatic interactions play a primarily important role.

Rat sarcolemma preparations were incubated with some membranes stabilizers to study their effects on the (Na+,K+)- and Ca2+-ATPase activity. The drugs inhibited the enzymes with the same order of potency as in the earlier observed muscle contractures: chlorpromazine greater than dibucaine greater than propranolol greater than tetracaine greater than procaine (range 0.1-3.6 mM) (Roed & Brodal 1979). The contracture inducing effect of the stabilizers is suggested to be caused by a membrane depolarization due to the (Na+,K+)-ATPase inhibition. Ouabain inhibited the (Na+,K+)-ATPase activity in purified plasma membrane, but did not inherit the sarcolemma located ATPases or induce any contracture.

Background: Contact sensitization to local anaesthetics is often from topical medicaments. Occupational sensitization to topical anaesthetics may occur in certain occupations. Objectives: The aim of the study was to analyse the occurrence of contact sensitization to topical anaesthetics in general dermatology patients. Patients and Methods: Patch testing with topical anaesthetics was carried out in 620 patients. Possible sources of sensitization and the clinical histories of the patients are analysed. Results: Positive patch test reactions to one or more topical anaesthetics were seen in 25/620 patients. Dibucaine reactions were most common (20/25), and lidocaine sensitization was seen in two patients. Six patients had reactions to ester-type and/or amide-type anaesthetics concurrently. Local preparations for perianal conditions were the most common sensitizers. One patient had developed occupational sensitization to procaine with multiple cross-reactions and with concurrent penicillin sensitization from procaine penicillin. Conclusions: Dibucaine-containing perianal medicaments are the major source of contact sensitization to topical anaesthetics. Although sensitization to multiple anaesthetics can be seen, cross-reactions are possible. Contact sensitization to lidocaine is not common, and possible cross-reactions should be determined when reactions to lidocaine are seen. Occupational procaine sensitization from veterinary medicaments is a risk among animal workers.