Good manufacturing practices (GMP) ensure that products are consistently produced and controlled according to appropriate quality standards. This study aimed to evaluate the GMP compliance of Brazilian medicine manufacturers over the past 3 years. The outcomes, deficiencies, and significance of these were collected from 485 inspections performed between 2015 and 2017. The nonconformities were arranged by sections of the GMP guidelines to demonstrate the main areas of deficiency. During the evaluation period, 61.4 % of inspected companies were classified as GMP ‘satisfactory’; 23.3 % were classified as ‘on hold’; and 15.3 % of inspections concluded that the company did not comply with GMP and resulted in an ‘unsatisfactory’ classification. At least one deficiency was found in 280 inspections (57.7 %). Critical deficiencies were found in 52 (10.7 %) inspections, major deficiencies were observed in 203 (41.9 %) inspections, and minor deficiencies were observed in 251 (51.8 %) inspections. The most common areas of deficiency were qualification and validation, documentation, and premises. The level of GMP compliance increased over the evaluation period. Updates or additional guidelines for the specific issues in which deficiencies are often identified might be useful to improve industry GMP compliance. The public disclosure of inspection outcomes and deficiencies may encourage the industry to comply with GMP and assist regulatory authorities in the maintenance of regulatory transparency. Knowledge of GMP noncompliance patterns and trends may allow the prioritization of inspections on high-risk areas and facilities, with the main goal of protecting the population from substandard medicines.

The circulation of poor quality medicines, especially in the developing countries, is a public health concern. Compliance with good manufacturing practices (GMP) is essential to ensure the quality, efficacy, and safety of medicines. This study evaluated the outcomes of the Brazilian Health Regulatory Agency’s (ANVISA) international inspections of two years (2015 and 2016) and compared these to those of other regulatory authorities. The information from 255 inspection reports was analyzed, and the type and extent of deficiencies were collected. In the period evaluated, 62.75% of ANVISA-inspected companies were classified as GMP “satisfactory,” 24.71% were classified as having “on demand” status, and 12.55% of inspections concluded that the company did not comply with Brazilian GMP regulations (“unsatisfactory”). The most common areas of deficiency were documentation (28.63%) and premises (26.27%). The pattern of deficiencies was similar to the findings of other regulatory agencies. However, ANVISA detected a more significant number of non-compliance results than other authorities, which may be caused by differences in classifications adopted by each Agency. Furthermore, manufacturers inspected by ANVISA may follow different standards and practices for products manufactured for the Brazilian market. Disclosure of main GMP deficiencies found can be useful for encouraging the industry to comply with GMP, and additional guidelines in the specific areas where deficiencies are often identified may be useful to industry to improve GMP compliance. Harmonization of GMP guidelines and inspection procedures are the key steps to avoid duplicate work, but regulatory authorities also need to work together to enforce the proper level of GMP compliance by pharmaceutical manufacturers, assuring high quality and safe medicines supply.

In the present study was evaluated the in vivoeffects of arginine administration on creatine kinase (CK) activity in cerebellum of rats. We also tested the influence of antioxidants, namely α-tocopherol and ascorbic acid and the nitric oxide sinthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME), on the effects elicited by Arg in order to investigate the possible participation of nitric oxide (NO) and/or its derivatives peroxynitrite (ONOO−) and other/or free radicals on the effects of arginine on CK activity. Sixty-day-old rats were treated with a single i.p. injection of saline (control, group I), arginine (0.8 g/Kg) (group II), L-NAME (2.0 mg/Kg or 20.0 mg/Kg) (group III) or Arg (0.8 g/Kg) plus L-NAME (2.0 mg/Kg or 20.0 mg/Kg) (group IV) and were killed 1 h later. In another set of experiments, the animals were pretreated for 1 week with daily i.p. administration of saline (control) or α-tocopherol (40 mg/Kg) and ascorbic acid (100 mg/Kg). Twelve hours after the last injection of the antioxidants, the rats received one i.p. injection of arginine (0.8 g/Kg) or saline and were killed 1 h later. Results showed that total and cytosolic CK activities were significantly inhibited by arginine administration in cerebellum of rats, in contrast to mitochondrial CK activity which was not affected by this amino acid. Furthermore, simultaneous injection of L-NAME (20.0 mg/Kg) and treatment with α-tocopherol and ascorbic acid prevented these effects. The data indicate that the reduction of CK activity in cerebellum of rats caused by arginine was probably mediated by NO and/or its derivatives ONOO−and other free radicals. Considering the importance of CK for the maintenance of energy homeostasis in the brain, if this enzyme inhibition also occurs in hyperargininemic patients, it is possible that CK inhibition may be one of the mechanisms by which arginine is neurotoxic in hyperargininemia.

3-hydroxykynurenine, a tryptophan metabolite, is known to be potential neurotoxic in some neurodegenerative disorders. However, the molecular mechanisms of toxicity are not well understood. Creatine kinase plays a key role in energy metabolism of tissues with intermittently high and fluctuating energy requirements, such as nervous tissue. This study investigated the in vitro effect of 3-hydroxykynurenine on creatine kinase activity in the brain cortex of rats. The results indicated that low micromolar 3-hydroxykynurenine concentrations inhibit uncompetitively mitochondrial and cytosolic creatine kinase activities in a time and dose-dependent way. Inhibition was prevented, but not reversed by incubation with reduced glutathione, dithiothreitol and ascorbic acid plus trolox, suggesting adduct formation. The assay under nitrogen atmosphere suggested that the inhibition was caused by products of 3-hydroxykynurenine autoxidation. Determination of thiol groups suggested that adducts between the enzyme and autoxidation products of 3-hydroxykynurenine were not formed with sulfhydryl groups. The interaction plot between tryptophan and 3-hydroxykynurenine suggested different sites of action on creatine kinase with cross-inhibition. Considering the importance of creatine kinase for the maintenance of energy homeostasis in the brain, it is conceivable that an alteration of this enzyme activity may be one of the mechanisms by which 3-hydroxykynurenine might be neurotoxic.

Considering that pyruvate kinase activity, a crucial enzyme for glucose metabolism and energy liberation in brain, may be regulated by some amino acids, it is possible that diminution of this enzyme activity may contribute to the brain damage caused by amino acids accumulated in metabolic diseases, such as phenylalanine, tryptophan and cystine. Therefore, the present study was undertaken to investigate the effect of these amino acids on pyruvate kinase activity in the brain cortex of rats. We also investigated the effect of serine and alanine on pyruvate kinase activity in the same tissue. The results suggested that phenylalanine, tryptophan, cystine, alanine, and serine act at the same site on the enzyme, phenylalanine, tryptophan, and cystine causing inhibition, and alanine and serine preventing this effect. Cystine also inhibited the enzyme activity through a different mechanism, possibly acting on the enzyme thiol groups. Considering that this enzyme is a target for amino acids accumulated in some metabolic diseases of amino acid metabolism, it is possible that its inhibition may contribute to the brain damage found in these diseases.

Cystinosis is a metabolic disturb associated with excessive lysosomal cystine accumulation secondary to defective cystine efflux. Patients affected by this disease develop a variable degree of symptoms depending of the involved tissues. Accumulation of cystine in the brain may lead to severe neurological symptoms. However, the mechanisms by which cystine is neurotoxic are not fully understood. Considering that pyruvate kinase (PK) is a thiolic enzyme crucial for the glycolytic pathway, and disulfides like cystine may alter thiolic enzymes by thiol/disulfide exchange, the main objective of the present study was to investigate the effect of cystine on PK activity in the brain cortex of developing Wistar rats. We also performed kinetic studies and investigated the effects of GSH, a biologically occurring thiol groups protector, and cysteamine (CysN), the drug used for cystinosis treatment, on the enzyme activity. We observed that cystine inhibited the enzyme activity by two different mechanisms, one through the competition with ADP and phosphoenolpyruvate (PEP), and the other non-competitively, probably through oxidation of the thiol groups of PK. We also observed that GSH and cysteamine fully prevented and reversed the inhibition caused by cystine. Considering that cysteamine is used in patients with cystinosis because it causes parenkimal organ cystine depletion, the present data provides a possible new beneficial effect for the use of this drug.

Hypertryptophanemia is a rare inherited metabolic disorder probably caused by a blockage in the conversion of tryptophan to kynurenine, resulting in the accumulation of tryptophan and some of its metabolites in plasma and tissues of affected patients. The patients present mild-to-moderate mental retardation with exaggerated affective responses, periodic mood swings, and apparent hypersexual behavior. Creatine kinase plays a key role in energy metabolism of tissues with intermittently high and fluctuating energy requirements, such as nervous tissue. The main objective of the present study was to investigate the effect of acute administration of tryptophan on creatine kinase activity in brain cortex of Wistar rats. We also studied the in vitro effect of this amino acid on creatine kinase activity in the brain cortex of non-treated rats. The results indicated that tryptophan inhibits creatine kinase in vitro and in vivo. We also observed that the in vitro inhibition was fully prevented but not reversed by pre-incubation with reduced glutathione, suggesting that the inhibitory effect of tryptophan on CK activity is possibly mediated by oxidation of essential thiol groups of the enzyme and/or long-lasting adduct formation. Considering the importance of creatine kinase for the maintenance of energy homeostasis in the brain, it is conceivable that an inhibition of this enzyme activity in the brain may be one of the mechanisms by which tryptophan might be neurotoxic.

Pyruvate kinase plays a crucial role on the glycolytic pathway, the main route that provides energy for brain functioning. In the present study, we investigated the kinetics of the inhibition of pyruvate kinase provoked by phenylalanine and its main metabolite, phenylpyruvate, in mitochondria-free cerebral cortex homogenate from 22-day-old Wistar rats. We found that phenylalanine and phenylpyruvate inhibit PK activity by competition with the enzyme substrates ADP and phosphoenolpyruvate. We also investigated the interaction between phenylalanine and phenylpyruvate, and the kinetics of alanine prevention of the inhibitory action of phenylalanine and phenylpyruvate on pyruvate kinase activity. We observed that alanine per se had no effect on PK activity but prevented the inhibitory action of phenylalanine and phenylpyruvate by competition. The data suggest that phenylalanine, phenylpyruvate, and alanine act on a common site in the enzyme, probably an allosteric one. It is possible that inhibition of brain PK activity may be related to the reduction of glucose metabolism observed in the brain of phenylketonuric patients and may be one of the mechanisms responsible for the neurological dysfunction found in these patients. Further studies, however, are necessary to evaluate the benefit of carbohydrate and alanine supplementation to the diet of phenylketonuric patients.

Hypertryptophanemia is a rare inherited metabolic disorder probably caused by a blockage in the conversion of tryptophan to kynurenine, accumulating tryptophan and some of its metabolites in plasma and tissues of affected patients. The patients present mild to moderate mental retardation with exaggerated affective responses, periodic mood swings, and apparent hypersexual behavior. Pyruvate kinase catalyses a critical step in the glycolysis pathway, the main route that provides energy to brain functioning. The main objective of the present study was to determine pyruvate kinase activity in brain cortex of rats subjected to acute chemically induced hypertryptophanemia. The effect of alanine administration to the treated rats on the enzyme activity was also investigated. We also studied the in vitro effect of the two amino acids on pyruvate kinase activity in the brain cortex of nontreated rats. The results indicated that tryptophan inhibits pyruvate kinase in vitro and in vivo and that alanine prevents this inhibitory effect on the enzyme activity. Considering the crucial role pyruvate kinase plays in glucose metabolism in brain, it is possible that inhibition of this enzyme activity may contribute to the brain damage characteristic of this disease. Further studies will be necessary to evaluate possible benefits of alanine administration to the patients affected by hypertryptophanemia.

The mechanisms by which phenylalanine is toxic to the brain in phenylketonuria are not fully understood. Considering that brain glucose metabolism is reduced in these patients, our main objective was to determine pyruvate kinase activity in brain cortex of rats subjected to acute and chronic chemically induced hyperphenylalaninemia. The effect of alanine administration on the enzyme activity in the treated rats was also investigated. We also studied the in vitro effect of the two amino acids on pyruvate kinase activity in brain cortex of nontreated rats. The results indicated that phenylalanine inhibits pyruvate kinase in vitro and in vivo and that alanine prevents the inhibitory effect of phenylalanine on the enzyme activity. Considering the crucial role pyruvate kinase plays in glucose metabolism in brain, it is possible that inhibition of this enzyme activity may contribute to the brain damage characteristic of this disease.