Interindividual Differences in Chronopharmacologic Effects of Drugs: A Background for Individualization of Chronotherapy

In order to optimize chronotherapeutic schedules (designs), we examined the interindividual differences in chronopharmacologic effects of drugs with consideration of the following three factors: (a) inherited factors of direct relevance to chronopharmacology (genetic variability, gender-related differences) as well as age-related differences; (b) interindividual difference in chronoeffective-ness related to disease (e.g., various types and stages of cancer, affective disorders, etc.) as well as to drug-dependent alteration (phase shifts, distortion) of biological rhythms; and (c) means to solve problems resulting from the need of individualization in chronotherapy. These involve the use of circadian marker rhythms (MR) whose characteristics (peak or trough time, amplitude, etc.) can be precisely quantified and thus are applicable as a reference system for physiologic, pathologic, pharmacologic, and therapeutic uses. The MR has to be specific and pertinent and must be easily monitored and documented. This approach can be further advanced by the use of a battery of MRs rather than a single MR. Other suggested means relate to the fact that chronobiotics (agents capable of influencing parameters of a set of biological rhythms) should be considered (e.g., corticoids and adrenocorticotropic hormone) and/or to the subject's synchronization should be enforced by “conventional” zeitgebers (e.g., bright light, physical activity).     

Sleep and Circadian Rhythms of Temperature and Urinary Excretion on a 22.8 hr “Day”

Two groups of subjects (total N = 6) were studied in an isolation chamber for a period of 3 weeks whilst living on a 22.8 hr “day”. Regular samples of urine were taken when the subjects were awake, deep body temperature was recorded continuously and polygraphic EEG recordings were made of alternate sleeps. The excretion in the urine of potassium, sodium, phosphate, calcium and a metabolite of melatonin were estimated.

Measurements of the quantity and quality of sleep were made together with assessments of the temperature profiles associated with sleep. In addition, cosinor analysis of circadian rhythmicity in urinary variables and temperature was performed.

The 22.8 hr “days” affected variables and subjects differently. These differences were interpreted as indicating that the endogenous component of half the subjects adjusted to the 22.8 hr “days” but that, for the other three, adjustment did not occur. When the behaviour of different variables was considered then some (including urinary potassium and melatonin, sleep length and REM sleep) appeared to possess a larger endogenous component than others (for example, urinary sodium, phosphate and calcium), with rectal temperature behaving in an intermediate manner. In addition, a comparison between different rhythms in any subject enabled inferences to be drawn regarding any links (or lack of them) that might exist between the rhythms. In this respect also, there was a considerable range in the results and no links between any of the rhythms appeared to exist in the group of subjects as a whole.

Two further groups (total N=8) were treated similarly except that the chamber clock ran at the correct rate. In these subjects, circadian rhythms of urinary excretion and deep body temperature (sleep stages and urinary melatonin were not measured) gave no evidence for deterioration. We conclude, therefore, that the results on the 22.8 hr “day” were directly due to the abnormal “day” length rather than to a prolonged stay in the isolation chamber.     

Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease

Agitation is a common problem in institutionalized patients with Alzheimer's disease (AD). “Sundowning,” or agitation that occurs primarily in the evening, is estimated to occur in 10—25% of nursing home patients. The current study examined circadian patterns of agitation in 85 patients with AD living in nursing homes in the San Diego, California, area. Agitation was assessed using behavioral ratings collected every 15 minutes over 3 days, and activity and light exposure data were collected continuously using Actillume recorders. A five-parameter extension of the traditional cosine function was used to describe the circadian rhythms. The mean acrophase for agitation was 14:38, although there was considerable variability in the agitation rhythms displayed by the patients. Agitation rhythms were more robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were“sundowners.”In general, patients were exposed to very low levels of illumination, with higher illumination during the night being associated with less robust agitation rhythms with higher rhythm minima (i.e., some agitation present throughout the day and night). Seasonality was examined; however, there were no consistent seasonal patterns found. This is the largest study to date to examine agitation rhythms using behavioral observations over multiple 24h periods. The results suggest that, although sundowning is uncommon, agitation appears to have a strong circadian component in most patients that is related to light exposure, sleep, and medication use. Further research into the understanding of agitation rhythms is needed to examine the potential effects of interventions targeting sleep and circadian rhythms. (Chronobiology International, 17(3), 405-418, 2000)     

Lack of evidence that feedback from lifestyle alters the amplitude of the circadian pacemaker in humans

Two groups of healthy subjects were studied indoors, first while living normally for 8 days (control section) and then for 18 × 27h “days” (experimental section). This schedule forces the endogenous (body clock-driven) and exogenous (lifestyle-driven) components of circadian rhythms to run independently. Rectal temperature and wrist movement were measured throughout and used as markers of the amplitude of the circadian rhythm, with the rectal temperature also “purified” by means of the activity record to give information about the endogenous oscillator. Results showed that, during the experimental days, there were changes in the amplitude of the overt temperature rhythm and in the relative amounts of out-of-bed and in-bed activity, both of which indicated an interaction between endogenous and exogenous components of the rhythm. However, the amplitude and the amount of overlap were not significantly different on the control days (when endogenous and exogenous components remained synchronized) and those experimental days when endogenous and exogenous components were only transiently synchronized; also, the amplitudes of purified temperature rhythms did not change significantly during the experimental days in spite of changes in the relationship between the endogenous and exogenous components. Neither result offers support for the view that the exogenous rhythm alters the amplitude of oscillation of the endogenous circadian oscillator in humans.     

Daily activity rhythms,chronotypes, and risk-taking behavior in the signal crayfish

Consistent inter-individual differences in daily activity rhythms (i.e., chronotypes) can have ecological consequences in determining access to food resources and avoidance of predators. The most common measure to characterize chronotypes in animals as well as humans is the onset of activity (i.e., early or late chronotypes). However, daily activity rhythms may also differ in the relative amount of activity displayed at particular time periods. Moreover, chronotypes may also be linked to other consistent inter-individual differences in behavior (i.e., personality), such as the propensity to take risks. Here, we used the signal crayfish Pacifastacus leniusculus to test the presence of chronotypes and risk-taking personality traits and a potential behavioral syndrome between these traits. We first exposed crayfish to 5 days of light–darkness to measure daily activity rhythms and then we applied a visual predator-simulating stimulus in 2 different contexts (neutral and food). Our results showed consistent (i.e., across 5 days) inter-individual differences in the relative nocturnal activity displayed in the early and middle, but not in the late part of darkness hours. Moreover, while crayfish displayed inter-individual differences in risk-taking behavior, these were not found to be consistent across 2 contexts. Therefore, we were not able to formally test a behavioral syndrome between these 2 traits. In conclusion, our study provides the first evidence of chronotypes in the relative amount of activity displayed at particular time periods. This could be a valuable information for applied ecological aspects related to the signal crayfish, which is a major invasive species of freshwater ecosystems.     

Some factors influencing the sensitivity of body temperature to activity in neonates

In adult humans, core temperature is influenced by activity; the sensitivity of core temperature to such effects shows a phase dependence and is also influenced by the environment and whether the individual is asleep or awake. We have investigated if similar effects are evident in neonates, in whom thermoregulation and the circadian rhythm of core temperature are not fully developed. Eleven full-term, healthy babies were studied singly (light 07:00-19:00) at 2 days of age and again 4 weeks after birth; between these times, they were tended routinely on a communal ward. On study days, 10-minute recordings were made of rectal and skin (abdominal) temperature, heart rate (HR), and behavioral state. Sensitivities of the temperatures to activity (“arousal”) were assessed throughout the 24h by measuring the gradient of (temperature/HR). Sensitivities measured at 01:00, 05:00, 09:00, 13:00,17:00, and 21:00 were used as dependent variables in stepwise regression and linear regression analyses, with “subjects” “light versus dark”, “behavioral state”, and “difference between time of measurement and the acrophase of the endogenous component of the temperature rhythm” (ignoring sign) as possible predictors. (Acrophases of the temperature rhythms had been estimated from 24h data purified using the behavioral state record.) Light versus dark acted as a significant predictor of the sensitivity of rectal temperature to arousal on day 2 and week 4, the sensitivity increasing in the light, and there was limited evidence for behavioral state acting as a predictor on day 2. Neither factor was a significant predictor when the sensitivity of the babies' skin temperatures to arousal was investigated. There was also some evidence that the difference between the time of measurement and the temperature acrophase acted as a predictor of sensitivity to arousal in both rectal (day 2) and skin (week 4) temperature, with larger differences decreasing the sensitivity. These results indicate that there are masking effects on body temperature due to arousal in neonates, the size of which depends on both internal and external factors. However, this sensitivity of temperature to arousal shows differences from the sensitivity of temperature to physical activity in both adult humans and adult mice. One possible explanation of this result is that temperature regulation and the circadian system are not fully developed in humans at this age. (Chronobiology International, 17(5), 679-692, 2000)     

Melatonin entrains free-running blind people according to a physiological dose-response curve

The specific circadian role proposed for endogenous melatonin production was based on a study of sighted people who took low pharmacological doses (500 µg) of this chemical signal for the “biological night”: the magnitude and direction of the induced phase shifts were dependent on what time of day exogenous melatonin was administered and were described by a phase-response curve that turned out to be the opposite of that for light. We now report that lower (physiological) doses of up to 300 µg can entrain (synchronize) free-running circadian rhythms of 10 totally blind subjects that would otherwise drift later each day. The resulting log-linear dose-response curve in the physiological range adds support for a circadian function of endogenous melatonin in humans. Efficacy of exogenous doses in the physiological range are of clinical significance for totally blind people who will need to take melatonin daily over their entire lifetimes in order to remain entrained to the 24 h day. Left untreated, their free-running endocrine, metabolic, behavioral, and sleep/wake cycles can be almost as burdensome as not having vision.     

A 2-dimensional geometry for biological time

This paper proposes an abstract mathematical frame for describing some features of biological time. The key point is that usual physical (linear) representation of time is insufficient, in our view, for the understanding key phenomena of life, such as rhythms, both physical (circadian, seasonal …) and properly biological (heart beating, respiration, metabolic …). In particular, the role of biological rhythms do not seem to have any counterpart in mathematical formalization of physical clocks, which are based on frequencies along the usual (possibly thermodynamical, thus oriented) time. We then suggest a functional representation of biological time by a 2-dimensional manifold as a mathematical frame for accommodating autonomous biological rhythms. The “visual” representation of rhythms so obtained, in particular heart beatings, will provide, by a few examples, hints towards possible applications of our approach to the understanding of interspecific differences or intraspecific pathologies. The 3-dimensional embedding space, needed for purely mathematical reasons, allows to introduce a suitable extra-dimension for “representation time”, with a cognitive significance.     

The Rhythmic GABAergic System

GABA is the major inhibitory neurotransmitter in the mammalian brain, and has been implicated in the regulation of a variety of behavioral functions, including biological rhythms. The focus of this minireview is the rhythmic variation of the central GABAergic system, comprising fluctuations of GABA levels and turnover, GABA receptor affinity and postsynaptic activity on the chloride ionophore in rodent's brain. Neurochemical rhythms correlated with diurnal and circadian changes in several behaviors associated with the GABA_A receptor, e.g., anxiolysis-related behavior. GABA is considered to be the principal neurotransmitter of the mammalian circadian system, being present in the suprachiasmatic nuclei and the intergeniculate leaflet. Pharmacological manipulations of GABA_A receptors phase shift circadian rhythms and alter circadian responses to light. Administration of putative modulators of GABA function, like melatonin or neuroactive steroids, affects the timing of biological rhythms. Therefore, not only does the GABAergic system exhibit strong diurnal and circadian variations, but it also serves as one of the key modulators of the circadian apparatus.     

Effects of Nocturnal Shiftwork on Mood States of Student Nurses

Daily mood changes were monitored over successive 24-h periods using the Profile of Mood States (POMS) (3) to assess the effect of nocturnal shiftwork on mood. Twenty-three student nurses, age range 19-24 years, were studied throughout their first experience of nocturnal shiftwork. The POMS was administered over four complete solar days during a 12-week period that included an 8-week block of night work. Five POMS dimensions displayed circadian rhythmicity. vigor-activity; fatigue-inertia; confusion-bewilderment; friendliness; and total-mood-disturbance. These five dimensions were sensitive to changes in living patterns, showing phase shifts in their circadian rhythms when subjects alternated between diurnal and nocturnal living patterns. The dimensions were also observed to be sensitive to adjustment to two different nocturnal shiftwork schedules. The subjects who worked “four on, three off showed similar phase shifts to the subjects who worked “eight on, seven off,” suggesting that mood adjustment takes place by the fourth night of a rotation of nights. The “commitment” of the students to the nocturnal living pattern was thought to have a bearing on the adaptation of the students to the nocturnal shifts, as regards mood.     

Hyphenated liquid chromatographic techniques in forensic toxicology

The prerequisite of applicability of hyphenated methods in forensic analysis is the achievement of a stage of “final maturity”. In the field of liquid chromatography, HPLC coupled with diode array detection (DAD) seems to fulfill this criterion, whilst the combination with atmospheric pressure ionization mass spectrometry (HPLC–API-MS) is still in a development stage. HPLC–DAD is broadly used as identification tool in forensic and in emergency toxicology. Two main approaches were observed; development of retention index scales for intra-laboratory exchange of data and establishing of databases only for intra-laboratory use. Using these approaches, several databases were established for toxicological relevant substances (illicit and therapeutic drugs and their metabolites, environmental poisons etc.) in biological fluids. Also, complete HPLC–DAD identification systems are commercially available. Further possibility of progress depends on the on-line combination (“triple hyphenation”) with other detection methods, preferably API-MS. HPLC–API-MS, both in electrospray (ESI) and atmospheric pressure chemical ionization (APCI) options, underwent dramatic development in the last decade and is reaching its final shape. The method was broadly applied for various groups of toxicologically relevant substances, a lot of them unaccessible for other techniques, including GC–MS. Particularly important was application of HPLC–API-MS for detection and quantitation of active, polar metabolites of various drugs and for analysis of macromolecules. APCI seems to be more useful for analysis of less polar compounds, whereas ESI is particularly valuable for determination of polar, large molecules (e.g., toxic peptides, polar metabolites etc.) Up to now, HPLC–API-MS has been mainly applied for dedicated analyses, but the introduction of APCI or ESI in systematic toxicological screening may be expected in the near future.     

Blunting of circadian rhythms and increased acrophase variability in sleep-time hypertensive subjects

24 h and ultradian rhythms of blood pressure (BP) have been previously shown to be disorganized in nocturnal hypertensive subjects. The present study was undertaken to further analyze the ultradian and circadian BP rhythm structure in sleep-time hypertensive subjects with normal or elevated awake-time BP levels. Fourier analysis was used to fit 24, 12, 8, and 6 h curves to mean BP as well as heart rate (HR) time series data derived from 24 h ambulatory blood pressure monitoring. Awake and sleep periods were defined according to individual sleep diaries. Awake-time hypertension was defined as diurnal systolic (SBP) and/or diastolic BP (DBP) means ≥135/85 mmHg. Sleep-time hypertension was defined as nocturnal SBP and/or DBP means ≥120/70 mmHg. The sample included 240 awake-time normotensive subjects (180 sleep-time normotensives and 60 sleep-time hypertensives) and 138 untreated awake-time hypertensive subjects (31 sleep-time normotensives and 107 sleep-time hypertensives). The amplitude and integrity (i.e., percent rhythm) of the 24 and 12 h BP rhythms were lower in the sleep-time hypertensive subjects and higher in the awake-time hypertensive subjects. However, no differences were detected when the integrity and amplitude of the 6 and 8 h mean BP rhythms were analyzed. The sleep-time hypertensive group showed significantly higher 24 h BP rhythm acrophase variability. No differences could be found in any of the HR rhythm parameters. Altogether, the findings suggest a disorganization of the BP circadian rhythm in sleep-time hypertensives that results in reduced 24 h rhythm amplitude and integrity that could be related to cardiovascular risk.     

Reliability and stability of dream recall frequency.

Although a large number of studies investigating factors affecting dream recall frequency (DRF) have been carried out, research investigating the reliability and stability of DRF is scarce. Dream diaries of 196 participants kept over at least 28 days were analyzed. The results of the present study indicate that a time period of 2 weeks was sufficient to obtain reliable measurements of interindividual differences in DRF. Despite the high day-to-day fluctuations of dream recall, the stability of this variable was very high. Studies that investigate the stability of DRF by means of other methodological approaches (e.g., questionnaire scales, laboratory awakenings) and over longer time periods (e.g., 1 year) should be carried out to complement the present findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Circadian Determinants of the Postlunch Dip in Performance

This study compared rectal temperature rhythms in groups of subjects who either did (n = 5) or did not (n - 7) show a clear postlunch dip in performance at a monotonous (25-30 min) vigilance task. Performance was tested every 2h in a standardized routine with lunch replaced by hourly liquid food supplements. Those showing the postlunch performance dip had a higher amplitude and later peaking 12h component to their rectal temperature rhythm that those who did not, resulting in flat, rather than rising, temperatures over the 10:00-15:00 time interval. The effect could not be explained by intergroup differences in prior sleep, morningness, or gender, although there was a trend (p = 0.09) for the “dip” group to be slightly younger (21.8y vs. 24.2y). The postlunch dip appears to be an endogenous phenomenon individually determined, but related to the strength of the (12h) harmonic of the circadian system.     

An Example of Circular Statistics in Chronobiological Studies: Analysis of Polymorphism in the Emergence Rhythms of Schistosoma Mansoni Cercariae

In the not too distant past, it was common belief that rhythms in the physical environment were the driving force, to which organisms responded passively, for the observed daily rhythms in measurable physiological and behavioral variables. The demonstration that this was not the case, but that both plants and animals possess accurate endogenous time-measuring machinery (i.e., circadian clocks) contributed to heightening interest in the study of circadian biological rhythms. In the last few decades, flourishing studies have demonstrated that most organisms have at least one internal circadian timekeeping device that oscillates with a period close to that of the astronomical day (i.e., 24h). To date, many of the physiological mechanisms underlying the control of circadian rhythmicity have been described, while the improvement of molecular biology techniques has permitted extraordinary advancements in our knowledge of the molecular components involved in the machinery underlying the functioning of circadian clocks in many different organisms, man included. In this review, we attempt to summarize our current understanding of the genetic and molecular biology of circadian clocks in cyanobacteria, fungi, insects, and mammals. (Chronobiology International, 17(4), 433–451, 2000)     

Chronophysiology of the cardiovascular system

The development of ambulatory blood pressure monitoring devices and the beat-by-beat measurement of heart rate have enabled it to be established that there are circadian rhythms in heart rate and blood pressure in subjects living normally. Investigations of these variables have led to quantification of their fall at night, and rapid rise on awakening and becoming active in the morning. These changes are of particular interest insofar as abnormalities in them are associated with cardiovascular problems and morbidity in patients and also act as risk factors in otherwise healthy individuals. It has also been shown that there are many other variables of the cardiovascular system. The causes of the circadian rhythms in heart rate and blood pressure are outlined, with particular stress upon the role of the autonomic nervous system, as assessed from low- and high-frequency components of the variation in heart rate measured beat-by-beat. Activity increases blood pressure, but there is evidence that this “reactivity” varies with time of day, and this also might be related to cardiovascular morbidity. Based upon data from several sources, including night work, resting subjects and bed-ridden patients, it is concluded that the contribution of the “body clock” to producing the circadian rhythm in heart rate and blood pressure is relatively small. A bias towards an exogenous cause applies also to most other circadian rhythms in the cardiovascular system. Knowledge of circadian rhythmicity in cardiovascular system, together with an understanding of its causes, provides a rationale for advice to reduce cardiovascular risk and to assess the efficacy of therapies.     

Ultradian, Circadian and Circannual Rhythms of Blood Glucose and Injected Insulins Documented in Six Self-Controlled Adult Diabetics

The aim of the study was to document during one to two years individual rhythmic patterns in blood glucose and injected insulin in self-controlled insulin dependent (C-peptide negative) diabetics with home blood glucose monitoring. Two females and four males with diurnal activity from 0700 to 2300 self-determined their blood glucose three to six times a day over a period of 12-27 months. Circadian and ultradian rhythms were analysed for each subject on a monthly basis to document annual rhythms. Blood glucose (BG) estimated circadian acrophases were located between 2200 and 0300 for all patients and months with few exceptions. A correlation was found between circadian mesors and amplitudes of BG in four subjects. Annual changes in BG were validated for each subject with large interindividual differences in peak times. The individual mean of injected insulin (II) varied from 40 to 80 iU with annual changes validated for each subject. A group pattern was observed with a peak time either in the autumn (four patients) or in the summer (two patients). A circadian rhythm of II was detected in almost all monthly means and for all patients. Locations of computed peak time φ of II exhibited a great stability for a given individual but large interindividual differences. Thus the rather constant φ location of BG for all subjects contrasted with interindividual differences in φ locations of II. These results suggest that rhythmic changes in BG and II should be recognized when forming a realistic strategy for timing and dosing time(s) of insulin.     

The Dry Aerosol Deposition Device (DADD): An instrument for depositing microbial aerosols onto surfaces

Concerns surrounding the contamination of infrastructure and equipment with biowarfare agents have led to the development of antimicrobial surfaces/coatings that are designed to “self-sterilize.” Surfaces will likely be contaminated via an aerosol exposure and thus antimicrobial efficacy measurements should also be performed using biological aerosols. Standard methods that use microbial agents suspended in aqueous buffers may provide misleading results that overestimate the performance of the surface. A settling chamber is the most common instrument for applying biological aerosols to surfaces. However, settling chambers have some drawbacks (e.g., slow loading times, large footprint, variable loading, etc.) that make them undesirable for many applications. We have developed a Dry Aerosol Deposition Device (DADD) that uses impaction rather than settling to load surfaces with biological aerosols. The use of impaction allows for rapid and highly reproducible loading of microorganisms onto surfaces. We have demonstrated that the DADD can deliver both Bacillus atrophaeus spores and Staphylococcus aureus vegetative cells to glass coupons at concentrations exceeding 1 × 10⁴ CFU/cm². The average coefficient of variation (CV) for sample-to-sample loading within an experiment was 13.6% for spores and 6.1% for S. aureus cells. The DADD is also a relatively simple and inexpensive device that can easily be contained within a 4-foot biological safety cabinet.     

The Role of Ions and Second Messengers in Circadian Clock Function

The fact that single cells can exhibit circadian rhythmicity simultaneously in quite different processes, such as those of photosynthesis, bioluminescence, and cell division, suggests that membrane-bound compartmentalization is important for temporal organization. Since these rhythms, as well as others, are known to be affected by changes in the ionic environment and are probably membrane-bound systems, it is not surprising that transmembrane ion transport or flux has been proposed to be a key feature of the underlying circadian oscillator(s). Likewise, signal transduction along the entrainment pathway leading to the clock, among the elements, or “gears,” of the timing loop itself, and within the output pathway between the oscillator and its “hands” likely is mediated by ions and second messengers. In this overview, we examine the theoretical and experimental evidence supporting the possible roles of intracellular free calcium and cyclic AMP in these capacities, particularly in view of the fact that oscillations in the concentrations of both species have been proposed to form the basis of pacemaker activity and other biological rhythms.