| Posted at 1:30 PM on Jun 03, 2008 by concernedcitizen, #31069 |
If montelukast is effective for duodenal eosinophilia (meaning it does bind with intestinal cysLT1 receptors), then what happens in normal people if it binds those receptors? Talk about confusing!
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1: J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):343-51. Links
Clinical efficacy and pharmacokinetics of montelukast in dyspeptic children with duodenal eosinophilia.Friesen CA, Kearns GL, Andre L, Neustrom M, Roberts CC, Abdel-Rahman SM.
Section of Gastroenterology, The Children's Mercy Hospital and Clinics, Kansas City, Missouri 64108, USA. cfriesen@cmh.edu
BACKGROUND: Montelukast, a competitive cysteinyl leucotriene-1 receptor antagonist, reduces airway eosinophilia in asthmatics. We evaluated the effect of this drug in children with eosinophilic duodenitis, defined histologically as duodenal mucosa with peak eosinophil count of more than 10 eosinophils/hpf. METHODS: Forty children and adolescents (6-18 yr) with dyspepsia and duodenal eosinophilia were enrolled in a double blind, randomized, placebo-controlled, cross-over study of monteleukast therapy. Subjects were randomized to receive either 10 mg montelukast or an identical placebo once daily and were evaluated on day 14 for symptomatic and biochemical responses. Subjects were also randomized to one of two blood sampling schemes to evaluate montelukast pharmacokinetics. RESULTS: Using a post treatment global pain assessment, a positive clinical response was observed in 62.1% of patients receiving montelukast compared with 32.4% on placebo (p < 0.02). Pain assessment score deteriorated in 45% of montelukast responders (5/11) after cross-over to placebo and improved in 62% (8/13) of placebo non-responders on cross-over to montelukast. In patients with peak duodenal eosinophil counts between 20-29/hpf (n=19), a positive pain assessment response was observed in 84% of patients receiving montelukast compared to 42% receiving placebo (p < 0.01). Response rate did not differ by age, gender or histologic findings at baseline. Pharmacokinetic analysis yielded parameter estimates for absorption rate constant (Ka), apparent volume of distribution (Vd/F) and elimination rate constant (Kel) of 0.42 h, 0.19 L/kg and 0.26 h, respectively. The relative extent of systemic drug exposure was comparable to that observed in previous pediatric investigations with similar weight-adjusted montelukast doses. Neither dose nor calculated drug exposure were associated with the level of post treatment pain assessment or the change in biochemical markers. CONCLUSIONS: These data suggest a beneficial role for montelukast in the treatment of pediatric patients with dyspepsia associated with duodenal eosinophilia.
PMID: 15076638
Very interesting the genetics of intestinal transport proteins vs. the genetics of the leukotriene receptor CysLT1.
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intestinal epithelial cells arnold diaz plasma proteins experimental pathology pathology department transport proteins lund university montelukast endogenous production stomach pain gene type hall of shame malmö sweden juhas science hall blood stream epub laboratory medicine oncogene duodenal mucosa j pediatr gastroenterol nutr kansas city missouri sampling schemes receptor antagonist sm section blood sampling assessment score clinical efficacy biochemical responses duodenitis pain assessment filter selection clinical response hpf m roberts asthmatics dyspepsia pharmacokinetics intestinal transport genetics