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  • Kouri, Riikka (2011)
    The p53-family consists of three transcription factors, p53, p73 and p63. The family members have similar but also individual functions connected to cell cycle regulation, development and tumorigenesis. p53 and p73 act mainly as tumor suppressors. During DNA damage caused by anticancer drugs or irradiation, p53 and p73 levels are upregulated in cancer cells leading to apoptosis and cell cycle arrest. p53 is mutated in almost 50 per cent of the cancers, causing the cancer cells unable to undergo cell death. Instead, p73 is rarely mutated in cancer cells and because of that could be more viable target for anticancer therapy. The network surrounding the regulation of p73 is extensive and has several potential targets for cancer therapy. One of the most studied is Itch ligase, the negative regulator of p73 levels. Gene therapy directed towards knockdown of Itch ligase is a potential approach but in need for more in vivo proof. p73 has two isoforms, transactivating TA-forms and dominant-negative ΔN-forms. The specific regulation of these isoforms could also offer a possible way for more effective cancer treatment. The literature work includes information of structures, isoforms, functions and possible therapeutic targets of p73. Also the main therapeutic approaches to date are introduced. The experimental part is based on transfection and cytotoxicity studies done e.g. in pancreatic cancer cells (Mia PaCa-2, PANC1, BxPc-3 and HPAC). The aim of the experimental work was to optimize the conditions for effective transfection with DAB16 dendrimer nanoparticles and to measure the cytotoxicity of plain dendrimers and DAB16-pDNA complexes. Also the protein levels of p73 and Itch ligase were measured by Western blotting. The work was done as a part of a bigger project, which was aiming to down regulate Itch ligase (negative regulator of p73) by siRNA/shRNA. Tranfection results were promising, showing good transfection efficacy with DAB16 N/P30 in pancreatic cancer cells (except in BxPc-3). Pancreatic cancer cells showed recovery in 3 days after they were exposed to plain dendrimer solution or to DAB16-pDNA. Measurement of protein levels by Western blotting was not optimal and the proposals for the improvement regarding e.g. the gels and the extracted protein amounts have been done.
  • Heiman, Johanna (2012)
    This work evaluated the use of roller compaction as granulation method for hydroxypropyl methylcellulose (HPMC) based hydrophilic extended release matrix tablets. Roller compaction is a dry granulation method where powder material is fed through a hopper between two counter-rotating rolls and pressed into a ribbon like compact. The compact is thereafter milled to obtain granules. Two full factorial experimental designs (DoE) were set up using two model active pharmaceutical ingredients (API). Paracetamol was chosen as a model for a highly soluble API that deforms mainly by fragmenting, whereas ibuprofen was used as a model for poorly soluble and plastically deforming API. The effect of process parameters, the roll pressure and the ratio between feeder screw speed and roll speed as well the effect of particle size of API and HPMC on the manufacturability and release robustness were investigated. Both compositions with medium drug load were successfully compacted into ribbon. Roller compaction increased the particle size and bulk density of the tablet mass. However, the methods used for evaluation of flow properties gave contradictive results on whether the flow properties were enhanced after dry granulation. The loss of compactibility after granulation was observed, as the tensile strength of tablets prepared of granules was in most cases lower than that of directly compacted powder. Exceptionally, two of the ibuprofen granulations showed compactibility similar to that of the initial powder blends. Increased roll pressure resulted in denser ribbon and narrower particle size distribution for granules. However, high roll pressure had a tendency to decrease the tablet tensile strength. This is most probably due to the particle size enlargement and work hardening phenomenon during the double compaction. The use of large particle size HPMC improved the permeability of the powder blend and the flow properties of the granulations. Tablet dissolution testing showed that the large sized HPMC particles were unable to percolate through the tablet and form a consistent network. Roller compaction helped to break down the large HPMC agglomerates and distribute them more evenly within the tablets. No significant difference in release profiles was observed for tablets prepared using granules roller compacted with different parameters.
  • Karhunen, Emilia (2018)
    Functional in vitro cultured human hepatocytes are needed in different applications in biomedical research. Treatment for liver diseases is usually liver transplantation, but due to the lack of healthy donors, cell therapy using hepatocytes is considered as a better option. Drug industry will also need representative liver models to test metabolic profiles of drug molecules. Primary human hepatocytes are studied in cell therapy and disease modelling, but they have also drawbacks. In vitro they do not proliferate efficiently, and they are short-lived. In vitro differentiated human pluripotent stem cells (hPSCs) to hepatic fate are an alternative for the primary human hepatocytes. Especially human induced pluripotent stem cells (hiPSCs) are widely studied because they are easily available, and they even make personalized therapy possible without problems with ethical issues related to the human embryonic stem cells (hESCs). Differentiation to hepatic fate includes several steps before mature functional hepatocyte-like cells are formed. Hepatocytes are derived from the definitive endoderm (DE) which is one of the germ layers formed in the gastrulation process. Efficient induction of hPSCs into DE lineage would be a good starting point for generating mature hepatocyte-like cells in further hepatic differentiation. Different protocols to differentiate hPSCs in vitro into DE have been published. In vitro cell culture systems should well represent the environment of the target tissue because signals from the environment guide the differentiation. Three-dimensional (3D) cell culture systems are widely studied, because they better mimic the in vivo microenvironment of cells than two-dimensional (2D) cell culture. The aim of the thesis was to study the efficacy of the 3D differentiation of hiPSCs into DE. Before starting the 3D differentiation, differentiation protocol was optimized and the effect of ROCK inhibitor Y-27632 was investigated. Differentiation medium was supplemented with Y-27632 during the whole 6 days differentiation, because survival of the cells and formation of the spheroids were improved, and gene expression studies of pluripotency markers and several DE markers did not show evident effect of Y-27632 on the gene expression of hiPSCs. The main objective in the studies was also to investigate possible differences between different 3D culture conditions on hiPSCs differentiation into DE. Also, the effect of the spheroid size on differentiation was examined. Two different hydrogels were used as a matrix material in the experiments: basement membrane extract (BME) and nanofibrillar cellulose (NFC) hydrogels. Suspension culture was used as a biomaterial-free 3D culture system. Experiments were performed with three spheroid sizes: 200 cells/spheroid, 500 cells/spheroid and 1000 cells/spheroid. Efficacy of differentiation to DE lineage was estimated by studying protein and mRNA expression of some of the DE markers (HNF3B, SOX17, CXCR4, CER1), pluripotency marker OCT4, mesendoderm marker Brachyury and hepatoblast marker HNF4A in the cells. Spheroids differentiated in suspension and NFC were analysed by flow cytometry to get the number of DE positive live cells and dead cells using CXCR4 and 7-AAD double staining. Besides flow cytometry, protein expression of some of the key markers were studied by immunofluorescent staining and further confocal imaging. Viability of the spheroids in BME hydrogel culture were investigated using live/dead staining followed by confocal imaging. BME hydrogel culture was left out from the further experiments due to the morphology of the spheroids and results from viability and protein expression studies. Spheroids in suspension started DE differentiation faster compared to NFC culture. Suspension and NFC cultures yielded high number of double positive cells in flow cytometry and bright fluorescence of other DE markers was seen in the confocal images. NFC hydrogel proved to be a promising 3D culture system by supporting the differentiation of hiPSCs. Flow cytometry results and gene expression studies propose that four days long 3D differentiation would be efficient to produce sufficient number of DE cells. Smaller spheroids showed higher number of DE positive cells than bigger spheroids on day 2 but gene expression studies showed difference in DE marker expression between size conditions rather in later days in differentiation and it was the opposite. Experiments showed signs of more efficient differentiation of the smaller sized spheroids in the beginning of differentiation. But further studies are needed to verify the obtained results and both draw conclusions about the possible differences between different 3D culture systems and explore the best size of the spheroid for hepatic differentiation. However, results obtained from the studies are useful for designing further experiments.
  • Ruutiainen, Henna (2022)
    In health care, the most patient safety incidents occur from medication errors, to which pediatric patients in particular are susceptible. According to James Reason's Theory of Human Error, errors inevitably occurs in an individual's actions, causing potential harm. The prescribing phase has been identified as a specific risk point in the pediatric medication-use process, and therefore defences must be established to prevent or stop errors before they reach the patient. Such system-centric barriers are, for example, electronic health record (EHR) systems that can include computerized physician order entry (CPOE) systems where e.g., medication orders and prescriptions can be made. Knowledge-based clinical decision support (CDS) tools such as dose range check or dose calculator can be integrated into the CPOE system to assist in the prescribing process. The objective of this systematic review was examine the effects of CPOE systems with CDS functions on preventing wrong dose errors in pediatric inpatient orders and outpatient prescriptions. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-analysis (SWiM) items as an extension to PRISMA criteria. The Joanna Briggs Institute’s (JBI) recommendations from JBI Manual for Evidence Synthesis on mixed methods was used as a guide to conduct this review. Additionally, Cochrane Handbook for Systematic Reviews of Interventions was utilized to conduct the synthesis examining the wrong dose error effectiveness. The study protocol according to the prior defined eligibility criteria was registered in PROSPERO. The literature search was implemented in four databases (MEDLINE Ovid, Scopus, Web of Science and EMB Reviews), reference lists and grey literature in January 2022. Two independent reviewers conducted the study selection and data extraction of the eligible studies using a Covidence software platform. Vote counting method was used to describe and analyze the quantitative findings of the studies exploring the characteristics of CPOE-CDS systems reducing wrong dose errors and regarding their effectiveness on error prevention. JBI’s critical appraisal tools and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach were used to define the quality of the studies. A total of 18 studies met the inclusion criteria. The studies had been published in 2007–2021 and majority (13/18) considered only inpatient orders. Almost all (n=16) studies had customized or homegrown CPOE-CDS system and the most used CDS tools were dose range check (78%, 14/18), dose calculator (45%, 8/18) and dosing frequency check (45%, 8/18). When implementing new or customizing the used CPOE-CDS system usually alert functions were added (n=9) and in total alerts were present in 15 studies. Statistically significant reduction in wrong dose errors (overall, overdosing or underdosing errors) was reported in eight studies. None of the studies (n=18) found an overall increase of wrong dose errors. CPOE systems with CDS functions have a great potential to reduce wrong dose errors and promote pediatric medication safety. CPOE-CDS system customization for pediatric population, implementing CDS alerts and the use of dose range check tool seem to be most advantageous when aiming to prevent wrong dose errors. However, CPOE-CDS systems cannot prevent all wrong dose errors as human errors continue to occur and the implemented CPOE-CDS systems can pose new risks such as alert fatigue. Therefore, systematic actions are needed to optimize the safe use of CPOE-CDS systems in pediatrics. More studies are needed particularly on the effectiveness on wrong dose error prevention comparing basic and advanced CDS tools and the effects of different individual CDS functions on wrong dose errors.
  • Miinalainen, Annika (2022)
    OATP2B1 is a transmembrane transport protein expressed widely in the human body and transports both endogenous compounds and several drugs from outside the cell into the cytoplasm. The abundant expression of OATP2B1 in pharmacokinetically important tissues such as in the intestine, liver, and kidney suggests an important role in the drug absorption and elimination process, although research data on the clinical significance of OATP2B1 is still limited. Several drugs inhibit the function of OATP2B1, creating a risk for drug-drug interactions. OATP inhibition by some inhibitors is time-dependent, which may lead to more potent in vivo effects than expected. In this study, the time dependence of OATP2B1 inhibition by five different drugs was evaluated using OATP2B1-overexpressing HEK293 cells. IC50 values of inhibitors for OATP2B1-mediated uptake of DBF and E1S were determined with and without preincubation for 20 minutes. In addition, the in vivo interaction potential of the inhibitors in the intestine, liver, and other tissues was evaluated by utilizing the FDA and EMA guidelines. All five drugs showed effective and concentration-dependent OATP2B1 inhibition with IC50 values of 0.12– 8.82 µM. Furthermore, the inhibition of OATP2B1-mediated DBF uptake by ticagrelor and atorvastatin was time-dependent, while the effect of pre-incubation remains below the limit for the other inhibitors. The inhibitory effect of ticagrelor continued even after the inhibitor was removed from the inhibition buffer. All five inhibitors showed the potential to cause in vivo OATP2B1 inhibition in the intestine, which could result in decreased absorption of the co-administered substrate drug. About erlotinib, the risk of interaction also appeared in the liver, which could reduce the transfer of the substrate drug to the liver and thus lower its elimination rate. In this study, pre-incubation did not affect the in vivo interaction potential of the inhibitor drugs. The results indicate that drug-induced inhibition of OATP2B1 may be time-dependent and therefore can lead to interactions at lower concentrations than expected. For this reason, evaluating the time dependence would be appropriate when assessing transport protein-mediated interaction risk. The results of this study can be utilized in designing clinical interaction studies and in understanding the results.
  • Aalto, Hanna (2016)
    Atypical antipsychotics (AAPs) can be used to treat severe behavioural symptoms of dementia when certain conditions are fulfilled. They are not considered as primary treatment for these symptoms due to their possible serious side effects that are found to be more common in elderly dementia patients. Package leaflets (PLs) are one of the most important sources of medicine information for elderly patients. Evidence-based medicines information is the prerequisite for decision-making and success of pharmacotherapy. The aim of this study was to evaluate the usability and informational content of atypical antipsychotic PLs from the perspective of the elderly. Additionally, the content of medicines information for the elderly found in PLs was compared to similar medicines information targeted to health care professionals (HCPs). Medication Information Design Assessment Scale (MIDAS) was used to evaluate the usability of the most commonly used AAPs (olanzapine, quetiapine and risperidone) among the elderly in Finland. To evaluate the informational content of the PLs and summaries of product characteristics (SmPCs) all the references for the elderly were identified using certain keywords. The informational content concerning elderly from the PLs was compared to information targeted to HCPs in Beer's criteria, Current Care Guideline for memory disorders, Database of medication for the elderly, Martindale and SmPCs. The usability of the PLs in this study was found to be insufficient. The mean MIDAS-credit was 6,4 (n=61; range 5,0-8,0), the maximum credit being 13. Sufficient line spacing and limiting the length of line were among the poorly represented features in the PLs in this study. The occurrence of sufficient font-size varied. Good contrast, headings, usage of upper and lower case in text and bullet points were among the well-represented features. All the PLs included in the content-analysis (n=106) contained at least three references to the elderly. The way the information was presented and how well it stood out from the leaflet varied. The SmPCs contained useful information targeted to elderly that was not found in corresponding PLs. Actions need to be taken to improve the usability and content of product specific medicines information from the perspective of the elderly. Medicine authorities and the pharmaceutical industry have the authority to make these improvements possible. Scientific data and concrete tools are needed to facilitate the change.
  • Konttinen, Riikka (2017)
    Hepatitis C virus disease is transmitted through blood. Chronic hepatitis C causes liver damages such as liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. It is estimated that there are approximately 20 000 - 30 000 patients infected with hepatitis C virus in Finland. For many years pegylated interferon and ribavirin has been standard of care. However standard of care causes side effects and an adequate treatment response can't be achieved with it. There have been effective direct-acting antivirals available on market which are directed against structural proteins and enzymes of the virus from 2014 onward. These second generation direct-acting antivirals are effective, safe and well tolerated. The only disadvantage is the high price of these medicines which restricts them for severe liver damage patients. More information about cost-effectiveness of second generation direct-acting antivirals is needed to support the decision making. The aim of this master thesis is to describe current care, guidelines, and costs of hepatitis C in Finland. Thesis also describes the principles of economic evaluation and systematic literature review. The purpose of the thesis is to assess cost-effectiveness of second generation direct-acting antivirals versus standard of care in treating of hepatitis C by means of systematic literature review and evaluate the quality of cost-effectiveness analyses. Previously published studies were used to analyze the cost-effectiveness of second generation direct-acting antivirals. In total of 435 references were found through systematic literature search. In addition, two studies were found from the bibliographies of already included studies. Altogether 26 studies were included in the systematic review of which 25 were original studies and one was previously published systematic literature review. The most relevant data of the studies was gathered and analyzed. The quality of the studies was assessed by using three checklists. It is difficult to make conclusions about cost-effectiveness of second generation direct-acting antivirals based on previously published reviews because only one review was found through systematic literature search. The incremental cost-effectiveness ratio (ICER) of second generation direct-acting antivirals varied between dominance and 1 135 655 € /QALY compared to standard of care. When compared to another second generation direct-acting antiviral, ICER of second generation direct-acting antivirals varied between dominance and 65 281 € /QALY. It was also analyzed how stage of liver damage affects the incremental costeffectiveness of second generation direct-acting antivirals. The ICER of second generation direct-acting antivirals was between 299 € - 85 195 € /QALY when treating patients with cirrhosis. When treating non-cirrhotic patients, the ICER of second generation direct-acting antivirals was between 2182 € - 177 679 € /QALY.The connection between funder of the study and the ICER of second generation direct-acting antivirals was also analyzed. The ICER was 1717 € - 86 056 € /QALY in studies funded by pharmaceutical company. The ICER was 299 € - 1 135 655 € /QALY in studies funded by other party. Based on the results of the thesis second generation direct-acting antivirals might be cost-effective compared to current standard of care in treating hepatitis C. The cost-effectiveness ratio of second generation direct-acting antivirals is lower in cirrhotic patients than in non-cirrhotic patients. The incremental cost-effectiveness ratio is lower when pharmaceutical company funds a study. The quality of the cost-effectiveness analyses included in the thesis varied greatly which makes it difficult to draw conclusions and interpretate the results. This study has several strengths. First, literature search was conducted systematically and transparently. Second, quality of the reviewed studies included was assessed by care. Finally, reporting of the results is transparent and repeatable. The study has also some limitations. Selection of the reviewed studies, data extraction and quality assessment of the studies was conducted by one person which may increase the possibility of human error.
  • Hallila, Susanna (2013)
    There is a strong need for new in vitro methods in early drug development that predict in vivo conditions more reliably. One of the prerequisites for successful drug therapy is sufficient permeability. A drug needs to be transported through a cell membrane before it can have a pharmacological effect. Therefore, the drug-cell interactions are studied in the early stage of the drug development process. The literature review of this work covers the traditional in vitro and in silico methods of predicting the permeability of drugs across the intestinal membrane. The widely applied methods are reviewed briefly and the predictability of the methods is evaluated. Moreover, the surface plasmon resonance (SPR) technique is introduced. The principle of SPR and its applications for predicting intestinal permeability using lipid membranes resembling the intestinal membrane and for studying drug-cell interactions are discussed. The advantage of the SPR technique is that it is an optical method which allows real-time monitoring under a constant flow without labeling agents. The aim of the experimental part of this work was to evaluate the suitability of the SPR technique for cell-based studies to monitor drug-cell interactions in native cellular environments. Previously, the SPR technique has been almost merely used in routine biomolecular interaction analysis. Recently, the SPR technique has also been applied to cellbased assays but in those studies the reason for the SPR signal responses is generally poorly discussed. The objective of the experimental study was to evaluate and optimize different cell culturing approaches for living cell sensing for SPR, i.e. cells immobilized on the roof of the PDMS molded flow channel in the SPR instrument and cells immobilized directly on the SPR sensor surface. ARPE-19 cells were immobilized on the PDMS substrates but the challenge of imaging cell monolayers on PDMS molded SPR flow channels suggested that immobilizing the cells directly on the SPR sensor surface would be a more straightforward procedure. Hence, ARPE-19 and MDCKII cell culturing protocols were optimized for successful immobilization of confluent cell monolayers directly on the SPR sensor surface. However, ARPE-19 cells showed poor resistance against shear stress in the flow channel; whereas MDCKII cells showed much better resistance against shear stress in the flow channel. Therefore, only MDCKII cells immobilized on the SPR sensor surfaces were used for drug-cell interaction studies. After three days of culture MDCKII cells were exposed to test compounds in separate SPR measurements. The used test compounds were propranolol, D-mannitol, D-glucose and HSPC:Chol liposomes. During the SPR measurements, the changes in the SPR peak minimum angular position and SPR peak minimum intensity were recorded in real-time, and these were further used for analysis after the measurements. The results showed that clear differences in both SPR signals between propranolol and D-mannitol were observed when the cells were exposed to the test compounds. Propranolol diffuses effectively by the transcellular pathway into cells whereas D-mannitol uses the paracellular pathway. This indicates that the introduced SPR approach may be a potential in vitro method in order to provide real-time information on the permeability of drugs and possibly on cell uptake mechanisms of nanoparticles for a better mechanistic understanding of drug-cell interactions on a cellular level.
  • Lehtola, Minna (2018)
    Tramadol products for cats are not commercially available. Problems may occur when dividing a tablet registered for humans due to uneven distribution of active ingredient within a tablet and bitter taste of tramadol. Minitablets have multiple benefits, including small size, better uniformity of content, coatability and fast administration, in comparison to a divided conventional tablet. The purpose of this study was to develop minitablets which are possible to coat with a taste masking coating. Physical and chemical properties of tramadol hydrochloride, such as water solubility, temperature behavior and hygroscopicity were studied. Additionally, compatibility of tramadol hydrochloride with excipients was studied by a 3-month stability exam. The pre-tests of granulation were carried out by using lactose or ascorbic acid as an active ingredient to model tramadol hydrochloride. The granulation was performed with high shear granulator and tableting with a rotary tablet press. The only variable factor between the granulation batches was the amount of granulation fluid. The impact of the amount of granulation fluid to the tableting properties was examined by determining particle size distribution, Carr index and Hausner ratio. Uniformity of mass, uniformity of content, hardness, disintegration time and dissolution were examined. The study revealed that tramadol hydrochloride did not have incompatibilities with the examined excipients. Tramadol hydrochloride was not hygroscopic even though it was found out to be freely soluble in water. Tablets with adequate hardness were successfully compressed of both granulated masses and the direct compression mass. However, the direct compression mass had more undesirable properties regarding the processes. Most batches fulfilled the requirements set for uniformity of mass and uniformity of content. Although the purpose of this study was to develop a tablet for veterinary medicine, the results in this study may be utilized in developing a formulation for pediatric medicine.
  • Hannula, Juha (2015)
    Ambient mass spectrometry includes methods where ions are produced outside of the mass spectrometry in atmospheric pressure direct from the surface of the sample without sample preparation. The first and most popular ambient ionization methods are DESI, desorption electrospray ionization and DART, direct analysis in real time. DAPPI, desorption atmospheric pressure photoionization is an ionization method where samples are desorbed with hot vapor from surface and then ionized by photoionization. The aim of this study was to develop desorption atmospheric pressure photoionization method in transmission geometry. In transmission geometry hot vapor for microchip is directed through metal or polymer meshes to mass spectrometer inlet. Liquid samples can be analyzed either by soaking the mesh to liquid sample or apply a sample droplet to the mesh. Hot vapor desorbs analytes from the mesh and analytes are ionized in a gas phase by photoionization using VUV lamp. In this method optimal positioning of the mesh and the microchip was determined. Additionally optimal microchip heating power, dopant flow rate, nebulizer gas flow rate, capillary voltage and drying gas parameters were determined. Optimized method was applied for analyzing standard samples, vitamin juice samples and milk samples. According the analysis with authentic samples, transmission mode DAPPI can be applied for analyzing liquid samples without sample preparation. According the analysis with standard samples, transmission mode DAPPI can be applied for extraction of hydrophobic analytes from water samples. Comparing to conventional DAPPI, in transmission mode DAPPI spectra, intensities of the background ions are lower resulting higher signal-to-noise ratios with transmission mode DAPPI.
  • Räsänen, Pirjo (2011)
    A notable amount of the R&D resources of the proprietary drug firms seems to be directed towards the improvement of existing drugs. Hypothetically, this may lead to interesting formulation development strategies. The purpose of the study was to find out, whether any trends in pharmaceutical product development could be detected from data on granted marketing authorisations. Also the lifecycle management approaches the major pharmaceutical companies use to protect their blockbuster products from generic competition and to ensure their market share were in the interest of this study. The emphasis of the study was on oral solid dosage forms. A combination of qualitative and quantitative methods was employed to obtain a wide view on the subject of the study. Qualitative interviews with the Finnish regulatory authorities were used to collect background information for the quantitative part, which consisted of the marketing authorisation databases covering all MA procedures in Finland, the centralised procedure in the EU, and world's ten major pharmaceutical companies in the US. Based on the study results, there was a remarkable rise in the proportion of generic products of all MAAs authorised in Finland and through the centralised procedure within the European Union during 2000-2010. This change may be at least partly amounted to the legislative changes creating incentives for the use and the manufacture of generic drug products, such as the generic substitution and the reference pricing systems. The US data showed the inclination of the big pharma towards lifecycle management: the majority of the new MAs granted to the world's ten major pharmaceutical companies in 2005-2010 were for this purpose. The ratio of lifecycle management to new molecular entities was almost 4:1. Solid oral dosage form is undeniably the most popular method of drug administration, which was confirmed by the expert interviews and the marketing authorisation data as well. The role of oral solids was even more pronounced within the generic MAs. When innovation was measured by the proportion of non-conventional dosage forms, the US data on solid oral dosage forms indicated strong innovation compared to the Finnish or EU data. This may reflect the innovative product portfolio of the major pharmaceutical companies. The proportion of non-conventional oral solid dosage forms was remarkably smaller in generic than in reference products across all regions. In lifecycle management, the most commonly used strategies were new formulation, new strength or new combination of an existing product. Within the solid oral dosage forms, two-thirds of the new LCM formulations were modified-release preparations. Lifecycle management is an essential part of the major pharmaceutical companies' business strategy, the importance of which was illustrated by the case study of Coreg tablets.
  • Annala, Iina (2021)
    Subanesthetic-dose ketamine, an N-methyl-D-aspartate receptor (NMDAR) blocker, exerts rapid antidepressant effects that sustain long after its elimination from the body. The precise mechanism remains unknown, but regulation of TrkB (tropomyosin receptor kinase B), ERK (extracellular-regulated kinase 1 and 2), GSK3β (glycogen synthase kinase 3β) and mTOR (mammalian target of rapamycin) signaling within the prefrontal cortex (PFC) have been deemed important for its antidepressant-like effects in rodents. In addition, activation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) is thought to be an important step in its mechanism. Nitrous oxide (N2O), another NMDAR antagonist and a putative rapid-acting antidepressant, regulates the same molecular pathways as ketamine in the rodent PFC. The fast pharmacokinetics of N2O have been exploited to show that markers of neuronal excitation, including phosphorylation of ERK, are upregulated in the PFC during its acute pharmacological effects (NMDAR blockade), while regulation of TrkB, GSK3β and P70S6K emerges only upon N2O withdrawal. In the first part of this study, we investigated the N2O-induced biochemical changes associated with neuronal excitation and BDNF-TrkB signaling in the PFC and further, the requirement for AMPAR activation in inducing them. We focused on the effects seen after the acute pharmacological effects of N2O. N2O (65% for 20 min) was administered to adult male C57BL/6 mice with or without pretreatment with AMPAR antagonist (NBQX, 10 mg/kg) and PFC samples were collected 15 minutes after stopping N2O delivery. Within this time N2O is expected to be completely eliminated. The brain samples were analyzed using western blot, enzyme-linked immunosorbent assay and quantitative reverse transcription PCR. We observed that N2O increased levels of phosphorylated TrkB, GSK3β and P70S6K, and these effects were not attenuated by NBQX pretreatment. At the same time, we observed a decrease in the levels of phosphorylated ERK, which was attenuated in mice that received NBQX prior to N2O. Tissue levels of BDNF protein or messenger RNA (exon IV) were not different between control and experimental groups. These results indicate that the mechanism of N2O is associated with TrkB and ERK signaling that are regulated independently of each other. It appears that AMPAR activation is not required for TrkB signaling, although it might play a role in ERK signaling. Further, N2O-induced TrkB phosphorylation in the PFC is not associated with changes in total levels of BDNF. In the second part of the study, we aimed to search for new ketamine-like NMDAR blockers with antidepressant potential. Ketamine was used as a query compound for in silico substructure search to find commercial ketamine analogs. The retrieved ketamine analogs were filtered by their computed ADMET properties and then further screened virtually by docking them to the pore region of NMDAR complex (protein data bank code: 4TLM), around the predicted binding site of ketamine. Finally, we sought to study if selected ketamine analogs could elicit ketamine-like effects on TrkB and ERK signaling in mouse primary cortical neurons. However, we did not proceed to test the analogs since ketamine (positive control) did not show any effects on TrkB or ERK phosphorylation in our culture. Overall, this study advances the understanding of the mechanism of N2O, possibly giving new insight of the antidepressant mechanisms of NMDAR-blocking agents more generally. Additionally, we found promising ketamine analogs that await experimental testing.
  • Halinen, Sara (2023)
    Current pharmacological treatments for major depressive disorder leave many patients unresponsive to treatment or treatment response is delayed by weeks. More effective treatments with quicker effect onset are therefore needed. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonists has demonstrated sustained rapid antidepressant activity after single dose. Precise mechanisms behind this effect are unknown, however some crucial contributors to ketamine-induced behavioural effects in rodents include phosphorylation of Tropomyosin receptor kinase B (TrkB), ribosomal protein s6 kinase (p70s6k), glycogen synthase kinase 3 (GSK3), mitogen activated protein kinases (MAPKs), and activation of α-amino-3-hydroxy-5- methyl-4- isoxazolepropionic acid receptors (AMPAR). Similar TrkB related signaling cascades are also activated with another NMDA receptor antagonist and a putative rapid-acting antidepressant, nitrous oxide (N2O). During acute effects of N2O, cortical excitation increases MAPK phosphorylation and upregulates expression of activity dependent immediate early genes (IEG; c-Fos and Bdnf IV). Phosphorylation of TrkB, GSK3 and p70s6k appearing only after N2O has been eliminated suggest that TrkB signaling is induced as an adaptive response to treatment. The first objective of this study was to corroborate previous results from our group to validate our gas administration set up and protein analysis protocol. To analyze N2O-induced phosphorylation of proteins implicated in ketamine’s behavioral effects in mice, we treated C57BL/6J male mice with either room air (control) or 65% nitrous oxide for 20 minutes. After gas exposure and 15-minute washout period, medial prefrontal cortex samples were dissected to be analyzed with western blotting. In this study nitrous oxide exposure did not induce increased TrkB signaling in nitrous oxide withdrawal. Another aim of this study was to investigate the involvement of AMPARs in inducing cortical excitation with N2O. Pretreatment of AMPAR antagonist (10 mg/kg, NBQX) or saline was given to C57BL/6J male mice 10 minutes prior to 1 hour exposure to 50 % O2 or 50 % N2O, a N2O dose previously shown to induce IEG expression. One hour after gas exposure mice were euthanized and mPFCs were dissected and analyzed with reverse transcriptase quantitative PCR (RT-qPCR). No regulation in IEG expression was induced with nitrous oxide, NBQX pretreatment or combination compared to control. Additional studies factoring in limitations of this study are needed to uncover the involvement of AMPAR in inducing cortical excitation and antidepressant-like behavioral effects of N2O in preclinical models of depression.
  • Rauvala, Oskari (2023)
    Rodent studies indicate that the effects of pharmacological antidepressant treatments depend on the TrkB (tropomyosin-related kinase B) receptor of the neurotrophic factor BDNF (brain-derived neurotrophic factor). However, the mechanism by which TrkB signaling becomes active remains disputed. Our group proposes that the activation of TrkB signaling is a result of an indirect physiological adaptation to the drug treatment, which is supported by observations made with rapid-acting antidepressants ketamine and nitrous oxide. Previous studies indicate that the immediate effects of the drugs are followed by a sedative state resembling deep sleep, during which TrkB signaling becomes active. The sedative state is accompanied with a drop in core body temperature, and preliminary findings indicate that preventing the drug-induced hypothermia blocks TrkB signaling in the cortex.    The purpose of this study was to investigate the effect of ambient temperature on TrkB signaling in the hippocampus following nitrous oxide administration. Nitrous oxide (65 % ad 100 % O2) was administered to adult male mice for 20 minutes. After the drug treatment the animals were kept in different recovery conditions: room temperature or a heightened ambient temperature of approximately 36 °C for 15 minutes. Following the recovery, the animals were euthanised, and hippocampus samples were collected from the animals. Levels of BDNF and TrkB signaling were analysed with ELISA and western blot, respectively.    Nitrous oxide caused a significant drop in core body temperature, but this was not accompanied with increased BDNF levels or TrkB signaling. Evidence suggests that hippocampal atrophy contributes to depression, but the acute effects of antidepressant treatments on TrkB signaling in this brain area appear to be less pronounced than those seen in the prefrontal cortex. The findings indicate that nitrous oxide has a replicable hypothermic effect, but this is not associated with increased TrkB signaling in the hippocampus.
  • Hakala, Elina (2011)
    The aim of this study was to explore the functions of T-type calcium channels, and their possible role in neuronal stem cells migration. The role of T-type calcium channel in mature brain is known to be in producing electroencephalographic oscillations. This action in turn is the key factor in some neuronal physiological and pathophysiological functions, like non-REM sleep, memory, learning and absence epilepsy. In addition, T-type calcium channels have peripheral actions, but this study concerns on its neuronal functions. This low-voltage activated channels functions in neurogenesis is less known than its role in mature brain. It is known to promote neuronal proliferation and differentiation, but what comes to its possible actions in neuronal migration, is poorly studied. This study shows some evidence of T-type calcium channel taking part in neuronal migration in mice embryonic subventricular zones progenitor cells. Selective T-type antagonists, ethosuximide, nickelchloride and a scorpion peptide toxin kurtoxin, decreased the rate of migration in differentiating progenitor cells. This study consists of a literature review and an experimental part. Another aim of this study is to consider an alternative approach to stem cell therapies based on invasive transplantation of the cells. This other attempt is non-invasive manipulating of endogenous stem cells to proliferate and migrate to the injured or depleted area in the brain, differentiate into a desired phenotype and stop their division after they have completed their mission. Non-invasive altering of the stem cells is awaiting pharmacological solutions to resolve the problems being faced in this effort. There are some non-invasive therapies already being used successfully to cure pathological conditions such as spinal cord injury. These methods could be used as well in stem cell based therapies in the treatment of neurodegenerative diseases and brain injuries. These methods are still in the beginning of their way and lacking the full understanding of the key factors that affect neuronal development. These factors include some important endogenous inducing and inhibiting substances. One of the most important inducing substances is calcium ion regulating a variety of events in neurogenesis. T-type calcium channel, as being widely expressed during early brain development, and decaying by neuronal maturation, might have a pivotal role in conducting progenitor cells.
  • Lillsved, Iida (2022)
    For their good clinical value and supply the use of biological medicines has increased in the treatment of inflammatory bowel disease (IBD). However, biological medicines are often more expensive compared to traditional small molecule medicines. More inexpensive biosimilars, shown to be clinically equal to the corresponding biological original products, can be used to reduce medication costs as part of rational pharmacotherapy. Although patients’ perceptions about biosimilars may affect the treatment adherence and outcomes of the use of these medicines, only a few studies have been published on this area. The primary aim of the study was to study IBD patients’ perceptions of the features of biosimilars and biosimilars’ suitability for their own treatment. The secondary aim was to study biological medicine users’ perceptions of the suitability of biosimilar switch by a physician for their own treatment. In addition, sources of medicines information of the users of biological medicines were studied. The data of the study were based on a cross-sectional survey conducted by the University Pharmacy and University of Helsinki in January 2021. Research Newsletter and response link were delivered per an email to University Pharmacy’s loyal customers and electronically communicated via the Association of Rheumatism and the Association of IBD and other intestinal diseases. The study comprised of the responses of adult outpatients with IBD (n=979) who were using original biological medicines (n=120), biosimilars (n=30) or traditional small molecule medicines (n=829) (medicine user groups). The sum variables constructed by factor analysis based on the study aims were used as outcome variables. Differences between medicine user groups and the effects of other background variables were analyzed by bivariate and multivariate analysis using SPSS Statistics software. Most of the patients (70–97 % depending on the medicine user group) trusted biosimilars’ features to be equal to the corresponding original biological medicines. However, more than half of the patients (53–67%) did not know whether they would like to physician to prescribe biosimilar to them rather than the original biological medicine. Of the users of original biological medicines, 71 % did not want to be switched to a biosimilar if the current medication was working well. Biosimilar users had more positive perceptions about biosimilars and switching compared to other medicine user groups. Physician’s perception played an important role in biologic switching. Several factors that may affect perceptions about the features of biosimilars and their use in patient’s own treatment were identified. These included, in particular, previous user experience with biosimilars and having information about them. Overall, patients had positive perceptions about the features of biosimilars but had uncertainties about the use of biosimilars, especially, for the treatment of their own disease and when switching medication. More research is needed on the perceptions among different patient groups, and on the need and optimal form of medication information on biological medicines, biosimilars and their switching.
  • Mäntylä, Juhani (2012)
    Inflammatory bowel diseases are among the fastest growing chronic disease of young people in Europe and they are increasing in Western countries for unknown reasons. Illness often occurs at a young age and the symptoms persist generally throughout life, Crohn's disease and ulcerative colitis are the most common diseases in this category. Inflammatory bowel diseases often cause persistent symptoms and require treatment usually for life, affect the quality of life and the ability to go to work. Conventional treatment usually consists of anti-inflammatory and immunosuppressive drug therapy or surgical intervention. In difficult cases, the biologic drug treatment is used. New biological drug products (TNF-blockers) have improved, in particular in Crohn's disease, a response to treatment. The aim of this study is to provide information about the effectiveness and the costs of the biological treatment in inflammatory bowel diseases. The main results presented are the changes of the quality of life during the observation period measured with the generic and disease-specific HRQoL instruments. The results are also reported on the matter of costs for quality-adjusted life-years gained during the follow-up period. The study consists of FinnIBDQ (inflammatory Bowel Disease Questionnaire) survey (n=2831) and the follow-up survey of the patients who used biologic drug products (n=189). Patients were selected into the follow-up if they reported using the biologic drugs to treat the illness. FinnIBDQ-survey was conducted in 2006/2008 and follow-up questionnaire in 2011. As a generic HRQoL instrument was the 15D-instrument used which is a standardized measure of the health related quality of life. 15D-instrument produces a single index number between 0-1. IBDQ is a disease-specific HRQoL instrument, which consists of 32 questions. The total number of points varies between 32 and 224 from the worst to the best. Patients' medical history, symptoms, medication and health care use were studied in their own partition on the questionnaire. Biological drug therapy group belonged at the baseline (n=148) improved the quality of life (p=0.004) during the follow-up. A disease-specific HRQoL instrument (IBDQ) shows the quality of life has changed in parallel (p=0.003)with the 15D-instrument. Dimensions, where progress was achieved (p<0.05) were the elimination, the usual activities, discomfort and symptoms, as well as vitality and sexual activity. In the research group (n=51), the average cost per patient per QALYs gained during the follow-up period proved to be very high, at over 5 million euro's. During this time, the patient gained an average of 0,01 quality adjusted additional years of life. The evidence of the long-term impact of the biologic drug treatment on the patient's quality of life is still scarce. In most of the research concerned with the benefits of biological treatment, the effectiveness data is derived from the pharmaceutical manufacturers' short-term clinical efficacy studies, or taken from any other quality of life studies.
  • Pernilä, Oona (2022)
    The health and social services reform will enter into force in its entirety from the beginning of 2023. With the reform, the responsibility for organizing social and health care will be transferred from municipalities to the responsibility of 21 wellbeing services counties. At the time of writing this thesis, the changes to the medical legislation brought by the reform have not yet been published. Hospital pharmacies and dispensaries take care of Finland's public pharmaceutical services. The tasks of public pharmaceutical services include pharmaceutical logistics tasks, non-industrial pharmaceutical manufacturing, and the preparing of medicines, as well as pharmaceutical expert tasks and services.The aim of this study is to find out the opinions of current hospital district managers, medical directors, and hospital pharmacists about how future pharmaceutical services should be organized in the upcoming wellbeing service counties. The study was conducted using an electronic structured questionnaire, which was sent in October 2021 by e-mail to the heads of all Finnish hospital districts, medical directors, and hospital pharmacists. The survey also included Åland and the Joint Municipal Authority for Social and Healthcare in Central Uusimaa (Keusote). The questionnaire consisted mainly of Likert-scale questions, but the questionnaire also had open answer fields to which respondents were able to add comments and refine their answers. The questionnaire was evaluated by several experts and piloted by two experts. The questionnaire consisted of seven different sections, which addressed the number and concentration of hospital pharmacies and dispensaries, clinical pharmacy services and medication safety, pharmaceutical purchasing and formulary, automation and information systems, co-operation in wellbeing service counties, and pharmaceutical services in a state of emergency and limited resources. The overall response rate to the survey was 50% (n = 34/68). 79 per cent (n = 19/24) of hospital pharmacists and 35 per cent (n = 15/43) of managers and medical directors responded to the survey. Responses were received from all hospital districts, Åland and Keusote. Based on the responses, it is hoped that the activities of hospital pharmacies will be mainly concentrated in wellbeing service counties so that the services would not move too far. Co-operation in individual pharmaceutical service activities could take place in collaborative areas or nationwide. The current number of hospital pharmacies was thought to be sufficient, but the operation of individual dispensaries could be closed or transferred to the administration and coordination of a hospital pharmacy in the area. It is hoped that clinical pharmacy services will be increased, and medication safety officers are desired for at least all wellbeing service counties. It is hoped that purchasing will be centralized nationwide, especially for expensive and rare pharmaceuticals, but the procurement of pharmaceutical formularies could be done by collaborative area, and the formation of the formularies could be done by wellbeing service county or collaborative area. It is hoped that automation and technology will increase in pharmaceutical services and that information systems will become more integrated. Increasing co-operation both between hospital pharmacies and within wellbeing service counties, for example between community pharmacies, was advocated. In the future, resources should be focused on pharmaceutical services personnel and their training, as well as on automation and technological solutions. It is hoped that the crisis preparedness of the pharmaceutical services will be increased in the future.
  • Lahtinen, Ida (2011)
    Celiac disease is life-long autoimmune disorder of the small intestine, which is caused by a reaction to gliadin found in wheat, rye and barley in genetically predisposed individuals. Proline- and glutamine -rich proteins cause villous atrophy and crypt hyperplasia with extensive inflammation in the epithelium and lamina propria. Symptoms of celiac disease vary considerably and elimination of gluten from diet is the only way to treat disease. In small intestine of celiac disease patient transglutaminase 2 (TG2) modifies gluten peptides, which causes T-cell activation and inflammation in the epithelium of mucosa. T-cell activation induces development of celiac disease specific antibodies. These celiac disease specific antibodies recognise TG2 and interfere in vitro and in vivo in angiogenesis. Abnormal angiogenesis is typical in many disorders, such in cancer, in which TG2 has a crucial role in the development and growth of tumor. Overexpression of TG2 has been shown to correlate with accelerated growth of tumor. TG2-specific antibodies are suggested to inhibit differentation of epithelial cell, increase their proliferation, decrease their barrier-function and increase the permeability of blood vessels. The aims of the pilot study were to establish whether celiac disease TG2 antibodies affect in vivo tumorigenesis and tumorangiogenesis as well as to try to clarify the mechanism behind the phenomenon. Tumor xenograft model was used in severe combined immunodeficient (SCID) mice. Human oesophageal carcinoma (OE-19) cancer cells were incubated with celiacs TG2 miniautoantibody (mini 2.8), non-celiac miniautoantibody (mini 6.2) or PBS before cancer cells were injected to mice subcutaneously. During the experiment mice were weighted and tumor size was measured couple of times per week. To estimate the volumes of tumors the following formula was used: π/6 * L* W* H. Experiment lasted for four weeks after which the mice were euthanized, cardiac blood and tissue samples taken and tumours were excised and weighted. Sections were made from tumors and immunohistochemical stainings were done to compare blood vessel areas and to study general tumors'morphology and other parameters. Western blot -analyse were performed to cancer cells. The masses and volumes were clearly smaller in mini 2.8-group compared to control groups and the necrotic area of tumor in mini 2.8 was smallest as percentage compared to control groups. Blood vessel area were smallest in mini 2.8 group. Results suggest that celiac disease anti-TG2-autoantibodies inhibit tumor growth, but the number of animals is insufficient to give an accurate outcome.
  • Niemelä, Aliisa (2023)
    Annually thousands of Finnish children are placed in foster care as a measure of child welfare. Institutional foster care is provided by child welfare institutions. Social and health care professionals, such as bachelors in social services, youth workers, practical nurses, and registered nurses working in these institutions are responsible for carrying out the children’s medication treatment. Depending on completed basic and additional training and work experience, the personnel have varying competencies in medication treatment. The aim of this study was to provide research-based information on the challenges and development needs related to the safe and rational medication treatment of children in foster care living in child welfare institutions. This was studied from the point of view of institution personnel and social workers responsible for placement decisions. Furthermore, the study investigated the medication use process of children in institutional foster care and, how the child’s health and medication treatment related needs are considered in the placement process and in selecting the foster care place. The study was conducted as a qualitative study using focus group discussions (FGDs) carried out to child welfare social workers (n=1) and child welfare institution personnel (n=10) during November and December 2022. Semi-structured focus group discussions (n=3) were conducted over the video conferencing software Microsoft Teams®. The participants (n=11) were recruited through child welfare services of Central Uusimaa Wellbeing County. Qualitative content analysis was used to analyze the data. According to the focus groups, medication treatment is common among children living in child welfare institutions. In the daily life of child welfare institutions, there were challenges and development needs related to medication treatment and medication use process. The main challenges and development needs were the lack of up-to-date information regarding the children’s health status and medication, challenges in organizing acute medication treatment, the personnel’s up-to-date drug administration permissions and varying competencies in medication treatment. In addition, fragmented overall responsibility of the medication treatments and poor access to healthcare presented challenges for organizing and carrying out medication treatment for the children. Medication use process during foster care appeared to be fragmented and it was seen to be susceptible to errors. According to this study, the possibilities for taking children’s health status and medical needs into account at the point of placement were scarce. These needs often did not guide placement decisions. Considering the medication use process and medication safety, it is essential that child welfare institutions have access to up-to-date health and medication information of the children. To achieve the best interests of the children, organizing acute medical treatment should be facilitated and the overall responsibility health care and medication therapy clarified. In addition, seamless access to the necessary healthcare must be ensured for children in foster care. Considering medication safety, it is important to ensure that the personnel of child welfare institutions have up-to-date competencies in medication treatment that meet the needs of the children.