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Ankylosing spondylitis is an inflammatory rheumatoid disease, that is typically diagnosed in young adults. The symptoms include inflammatory back pain, rigidity in the lumbar and thoracic spines, and peripheral inflammations. The incidence of ankylosing spondylitis among northern European population ranges from 0.2 to 0.5%. The mortality rate of people with ankylosing spondylitis is about 50% higher than in the average population. First-line treatment for ankylosing spondylitis includes physiotherapy and NSAIDs. TNF inhibitors are used for patients whose symptoms cannot be controlled with first-line treatment. In Finland, there are five TNF inhibitors indicated for ankylosing spondylitis on the market: infliximab, etanercept, adalimumab, golimumab, and sertolizumab pegol. In 2015, the average medication cost for a patient entitled to reimbursement for TNF inhibitors in Finland was over 12 000 €. The cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis compared to conventional care has been extensively studied, but there is less data on the differences between TNF inhibitors. In this thesis, previously published literature on the cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis was reviewed, and a patient-specific simulation model based on data from the National Register for Biologic Treatment in Finland was conducted. The aim of the simulation was to compare the cost-effectiveness of TNF inhibitors (infliximab, etanercept, adalimumab and golimumab) in the treatment of ankylosing spondylitis as the patient's first biological treatment compared to other TNF inhibitors. The simulation was conducted on a lifetime time horizon and incorporated direct health care and medication costs in 2015 euros. As conclusions of the model, all other TNF inhibitors were found dominant over etanercept. The greatest effectiveness was achieved with golimumab, while the costs were lowest with infliximab. The incremental cost-effectiveness ratio of golimumab compared to infliximab was 63 840 €/QALY. In sensitivity analyzes, the model was found to be very sensitive to TNF inhitors' prices. In addition, sensitivity was also observed for the discount rate and time horizon used.

Parkinson's disease causes changes in the basal ganglia GABAergic neurotransmission in addition to the well-known dopaminergic changes. These GABAergic modulations may cause somed of the symptoms not responding well to the standard dopaminergic medication. Neurotrophic factors are a group of endogenous proteins showing promise as a future treatment for Parkinson's disease. They are known to have neuroprotective and neurorestorative effects on the dopaminergic cells. Their effects to the GABAergic cells are still mostly unknown. Intrastriatal injection of GDNF to rats caused significantly slower weight gain compared to CDNF, MANF one week after stereotaxic operation (p=0,002 for CDNF vs. GDNF and p<0,001 for MANF vs. GDNF). Difference to the vehicle (phosphate buffered saline) used as a negative control was not statistically significant (p=0,055). Three weeks after the operation the differences between the treatment groups were no longer statistically significant. Because of problems with the separation in analysis, microdialysis samples remain still to be analysed. To help the analysis of GABA in the future we determined the analytical parameters of the analytical apparatus. We also defined differences in probe permeability between 1 mm and 2 mm probes and between old and new batches. GABA analysis was performed with a HPLC-fluorometric detection of o-phtaldialdehyde-derived GABA. Detection limit for old apparatus was 7,2 nM and for new apparatus 6,2 nM in a sample of 15 µl (0,11 pmol and 93 fmol respectively). Quantification limits defined were 22 nM and 19 nM (0,33 pmol and 0,28 pmol) for the old and the new apparatus, respectively. Upper limit of quantification was estimated to be 246 nM (3,7 pmol). Probes had significant differences in permeability between 1 mm and 2 mm probes, as well as between batches. The variance of permeability of 1 mm probes was estimated to be approximately twofold compared to the 2 mm probes. Furthermore the permeability of 1 mm probes varied between batches significantly. An average of permeability of the old batch was 34 % lower than that of a new batch (p<0,001).

In pharmaceutical industry GMP compliance and quality of operations can be ensured with quality management system (QMS). QMS is an operational system, which consist of multiple different elements depending on the size of the company and nature and complexity of its operations. For the QMS to be functional, documented and defined operations need to be managed and monitored systematically. Conducting internal audits has been considered necessary with regard to QMS, though it has not always been perceived as adding value or seen as an opportunity to utilise more fully. Internal audits are mainly utilized to control compliance to requirements. However, there are possibilities to utilise it more in improving and developing operations, preparation to external audits, quality risk assessment, finding out the best practices, basis for decision making, learning experience as well as the assessment of functionality and effectiveness of the QMS. The aim of this study was to examine the utilisation of internal audits in Orion (Espoo) and find solutions to improve the utilisation of internal audits with QMS. The focus was on how internal audits can monitor and guide QMS and what is required from internal audits for monitoring and guidance of QMS. These aims were approached qualitatively by conducting semi-standardized open-ended interviews. Interviewees (n=9) were selected from both auditor and auditee side and they had their background in quality assurance or production. Data compiled from these interviews was analysed mainly by qualitative methods, using also some quantitative analysis. Monitoring of the QMS can be looked at as the starting point to guide QMS. Valuable information can be gathered with internal audits with regard to QMS. By utilising this information, internal audit process and QMS can be improved and the quality of operations can be ensured. Based on this work internal audits can be utilised to monitor and have the potential to guide QMS under certain conditions. Internal audit topics need to be systematically selected, QMS needs to be monitored and guided based on the internal audit findings, flow and distribution of information needs to be efficient and flexible, and internal audits should be better utilised and managed. Further research is needed on the development and deployment of tools to aid better utilisation of internal audits in the control of QMS. Also ways to measure the effects of internal auditing should be further investigated.

Melanoma is the most severe case of skin cancer and there is no curative treatment if it has progressed. Despite the recent advances in drug therapy tens of thousands of patients die of melanoma annually. There is still need for new antimelanoma drugs for which marine compounds are a potential source. Halogens are common elements in drug molecules as they enhance their molecular properties. So far most of the halogenated drugs contain fluorine and/or chlorine but the role of bromine and iodine is probably growing in the future due to halogen bonding. Bromotyrosines are originally isolated from Verongiida-order sponges but whether they are truly of bacterial origin is under controversy. All bromotyrosine compounds consist of brominated tyrosine and/or tyramine residues or their derivatives. Purpurealidin I is one of the newest bromotyrosine derivatives extracted from Pseudoceratina purpurea and it has shown activity against melanoma. In this study eight new purpurealidin I derivatives were synthesized following a successful route previously designed. All synthesized derivatives contained the original N-oxime structure which's stereochemistry was determined to be E by X-ray crystallography. Cytotoxicity against A375 melanoma cells was determined for seven compounds synthesized here and for 15 compounds synthesized previously. All seven compounds and one previously synthesized purpurealidin I analog were active with CC50 values between 4,7 and 22,1 µM. The previously synthesized bromotyrosine derivative intermediates and aerophobin-1 analogs were not active. The selectivity of the active compounds was calculated by determining their CC50 value against Hs27 fibroblast cells. None of the compounds showed remarkable selectivity the most selective 2-pyridin containing derivative having four times better selectivity against melanoma. The tyrosine part and N-oxime seem to be important parts to preserve while the tyramine part can be modified more freely and maintain the activity. Still more derivatives need to be synthesized and tested to confirm these observations. More data is also needed considering the selectivity of the compounds.

Prolyloligopeptidase (PREP) and alphasynuclein are linked to various neurological and psychiatric conditions of which the most relevant considering this study is parkinsonism. PREP cleaves small peptides after a proline residue. It has also protein-protein ineractions with alphatubulin, GAP-43 and alphasynuclein. PREP inhibitors have been shown to have an effect to elimination of alphasyuclein via autophagy. Thiazole is a heteroaromatic compound with two heteroatoms (sulphur and nitrogen). Thiazole can be found as a structural component among various active pharmaceutical ingredients with wide array of indications. Synthetic route for thiazole was published in 1887 and a considerable amount of literature regarding the use of thiazole in medicinal and synthetic chemistry has been published. The aim of the study was to extend the the scope of research done in the research group on small-molecular thiazole-based PREP inhibitors. The goal was to develop a synthetic route to access a series of molecules and gain information of the possible biological activities of the produced compounds by determining their IC50-values in vitro, effect on dimerization of alphasynuclein and removal of alphasynuclein via autophagy in a cell culture. Optimization of the synthetic route and search of alternative reactions were among the aims to some extent. During the course of study yields of some steps of the synthesis were improved and some new molecules had biological activity.

The aim of this work was to investigate the feasibility of titanium dioxide (TiO2) photocatalysis for imitation of phase I metabolism of selected anabolic steroids. The role of the solvent composition and the time of UV exposure in the TiO2 photocatalysis were also investigated. TiO2 photocatalysis has been reported to produce mainly the same phase I reaction types formed in drug metabolism in vitro and in vivo. The selected anabolic steroids were testosterone, methyltestosterone, metandienone, nandrolone and stanozolol. Products from TiO2 photocatalysis were compared to products formed in microsomal incubations (HLM). Comparison was made on the basis of same mass, retention time and similarity of the product ion spectra. The samples were analyzed with ultra performance liquid chromatography (UPLC) and quadrupole time-of-flight mass spectrometry (Q-TOF). Electrospray ionization (ESI) in positive ion mode was used for ionization and product ion scan with two different collision energy was used for collision induced dissociation of the steroids and the reaction products. TiO2 photocatalysis is a simple and fast method. For all the steroids studied, the main reactions observed both in TiO2 photocatalysis and microsomal incubations were dehydrogenation, hydroxylation and combination of these two. Several isomers with same mass and retention time were formed. In addition, dihydroxylation and dihydroxylation+dehydrogenation products of stanozolol were observed both in TiO2 photocatalysis, but these were different isomers in different systems. In most cases the product ion spectra of isomers with same retention time were similar but the weak intensity of some peaks caused uncertainty in the interpretation of spectra. TiO2 photocatalysis might be useful in fast screening of possible drug metabolites. However the feasibility of TiO2 photocatalysis needs to be further studied because the differences in stereochemistry in TiO2 photocatalysis and microsomal incubations. If TiO2 photocatalytic reactions can be scaled up, it might be possible to produce standard compounds for example for doping laboratories.

Oxysterols and vitamin D related compounds are found to be biologically active in brain. They might be involved in different psychiatric and neurodegenerative diseases. These compounds have traditionally been analysed from tissues using somewhat laborious and time-consuming gas chromatograpy and liquid chromatography mass spectrometric methods. To the side of these methods ambient desorption ionization methods have been developed. The advantage of these methods is rapid and easy operation. Usually minimal or no sample pretreatment is required. In addition these methods can be applied to imaging of for example tissues. The aim of this work was to study if it is possible to detect certain oxysterols and vitamin D related compounds from rat brain tissue samples with desorption atmospheric pressure photoionization (DAPPI). The compounds chosen to this study were cholesterol, vitamin D3, 25-hydroxyvitamin D3, 7-dehydrocholesterol, desmosterol and 7-ketocholesterol. DAPPI is especially suitable for efficient ionization of this kind of neutral and non-polar compounds. Detected MS and MSn spectras of the brain tissue samples were compared to those obtained from standard compounds. As a result we could not detect vitamin D3, 25-hydroxyvitamin D3, 7-dehydrocholesterol, desmosterol from rat brain samples with DAPPI. Excluding vitamin D3 it is possible that those other analytes are present at the spectras of brain samples but there is some other compound with same mass which makes the reliable identification of studied compounds impossible. 7-ketocholesterol and cholesterol were the only compunds we detected from brain tissue sections. 7-ketocholesterol can be formed via auto-oxidation in samples containing excess amount of cholesterol. According to this study it is impossible to say if the detected 7-ketocholesterol is formed endogenously or during sample preparation and analysis.

Medicine shortages have been an increasing problem in the pharmaceutical industry for several years. While the causes of these shortages have been widely researched, they have been found to be diverse and the root causes are difficult to identify. The pharmaceutical care system has been formed over a long period of time, which has led to a growing problem of shortages for various reasons. This study aims to investigate he views of different pharmaceutical sectors on what reforms to the mandatory reserve supply law could help to prevent and shorten the medicine shortages. The study was conducted through a thematic interview. Abductive analysis and thematic analysis were selected as the method of analysis. The study found that mandatory reserve supply is successful in acting as a buffer against short-term shortages, but that a comprehensive reform of the law would be necessary. According to the study, the reform of the law is linked to a wide range of issues. More flexible processes in regulatory aspects, the profitability of the Finnish market, and hospital procurements are closely related to the mandatory reserve supply law. The reform of the mandatory supply list could bring flexibility to exemptions to maintain lower stock levels by renewing the list of medicines and categorizing them into different groups. The act on public contracts law and the mandatory supply reserve law should be better coordinated to avoid wastage and thus ensure Finland's adequate competitiveness However, it should be noted that ensuring Finland's competitiveness and reducing shortages is not solely the responsibility of the mandatory reserve supply law. It also requires extensive international cooperation and it is also believed that bringing production back to Europe and even to Finland is crucial to shorten medicines shortages.

Nearly all drugs that are abused release dopamine in the nucleus accumbens, the end point structure of mesolimbic dopamine pathway. This why effect of those drugs is closely attached to dopaminergic system. It seems that function of mesolimbic dopamine pathway is necessary for rewarding effects of drugs as cocaine and amphetamine. However rewarding effects of ethanol seems to mediate routes despite of mesolimbic dopamine pathway. This conclusion is a result of several studies that have showed that destruction of synapses of in nucleus accumbens have no effect on ethanol drinking of rats. So it might be that the possible place were effects of ethanol mediate beside of straight stimulation of nucleus accumbens, are GABA- and opioidergic medium spiny neurons that project from nucleus accumbens to ventral pallidum and also from ventral pallidum back to nucleus accumbens. Ventral pallidum is the structure of brain that is thought to be the last common pathway of brain reward circuitry. Ventral pallidum is also found to mediate reinforcement of pleasure of natural rewarders and also drugs that are abused. Meaning of this study was to find how opioidreceptors in ventral pallidum control the drinking of ethanol. The method of study was observe how opioidergic drugs (µ-, δ-, κ-agonist and -antagonist) that are microinjected in brain of AA-rats mediate voluntary ethanol drinking of these animals. Hypothesis of this study was that activation of opioidreceptors in ventral pallidum leads to lower consumption of ethanol and inactivation of these receptors leads to higher consumption of ethanol. Study was performed in National institute for health and welfare, Department of Alcohol, Drugs an Addiction, in research group of Kalervo Kiianmaa. There were used ethanol prefering AA-rats which were microinjected in ventral pallidum with opioidergic drugs. Study involved 72 male rats form generation F99. There were six groups and each had 12 rats. Before the actual trial rats were taught to drink 10 % ethanol/water-solution voluntary. Surgery and placement of canulaes were done with stereotactic device. Bilateral guide canulaes were placed above the ventral pallidum. Each drug was given in three different size doses and also ringer's solution was given as a control. Volume on injections were in each drug and with the ringer's solution 0,3 µl and rate of injection was 0,3 µl/min. Total trial involved four experiment days (three with the drugs and one with the ringer's solution). Injections were given in mixed order. Immediately after injection rats were moved in their homecages and they were given drinking bottle which was filled with ethanol. The consumption of ethanol was observed in time of 10, 20, 30, 50, 70 and 90 minutes. After all experiment's were done rats were decapitated and the places of injections were checked from brain slices that were stained with thionine. Results were analyzed with repeated measures ANOVA and if difference between groups were found the post hoc test were done with Dunnett's test. If the statistical difference were found with repeated measures ANOVA the result were analyzed also in exact time point with ANOVA and Dunnett's test. The only significant result was found with µ-opioidreceptoragonist (DAMGO). It lowered the ethanol consumption significantly. The drop in ethanol consumption was dose dependent and was seen with two highest doses of DAMGO. Clearest difference was seen at the first 50 minutes after rats had started drinking ethanol. The second highest dose of µ-opioidreceptorantagonist (CTOP) had a little tendency to elevate ethanol consumption and was near to be a significant (p=0.08). There were found no effects with other drugs. The main conclusion of this study was that activation of µ-opioidreceptors in the ventral pallidum lowers consumption of ethanol in AA-rats. Inhibition the µ-opioidreceptors had a mild effect of elevating ethanol consumption but this could not be taken as reliable and more studies are needed to be done. δ- and κ-opioidreceptor activation or inhibition had no effect in ethanol consumption in these rats. Conclusions made by these results give support to the theory of role of ventral pallidum as a part of brain reward circuitry. When these results are compared to studies were GABAergic drugs are injected in ventral pallidum and ethanol consumption is observed and also with the knowledge of how these drugs affect the cell's membrane potential, there can be made conclusion that inhibition the activity of ventral pallidum has effects that block pleasure mechanisms that interface with ethanol.