Is sino-nasal outcome test-22 reliable for guiding chronic rhinosinusitis patients for endoscopic sinus surgery?

Chronic rhino-sinusitis (CRS) is a significant health problem whose incidence and prevalence is rising. An emphasis has been placed on diseasespecific quality of life (QoL as the predominant measure for most current outcome studies. Therefore a validated measure of health-related QoL in sinonasal disease is needed. The present prospective and observational study was conducted on 50 patients in the Department of ENT at Govt. Medical College and Rajindra Hospital Patiala, Punjab, India. The primary outcomes were the following: (1) the chance of attaining minimal clinically important difference (MCID) improvements of nine points at the 22-item Sino-Nasal Outcome Test (SNOT-22) after endoscopic sinus surgery (ESS) for different preoperative QoL levels, and (2) the percentage of relative improvement in SNOT-22 after ESS for different preoperative QoL levels.

Methods

Patients with CRS who were elected for ESS were prospectively enrolled into an observational cohort study. They were categorized into 10 preoperative SNOT-22 groups based on 10-point increments beginning with a score of 10 and ending at 110. Standard protocol for all patients presenting for evaluation included completion of the SNOT-22 prior to and following surgical intervention. The scores were calculated and the data collected were compiled and analyzed.

Results

A total of 50 patients were included in this study. Patients with a SNOT-22 score between 10 and 19 had the lowest chance of achieving an MCID. Patients with a SNOT-22 score greater than 30 had a greater than 90% chance of achieving an MCID, and there was a relative improvement of 43.3% on their preoperative SNOT-22 scores. CRS patients with polyp had better outcomes (47.1% improvement) after ESS than those without polyp (33.2% improvement).

Conclusion

There is an increased probability of achieving an MCID at SNOT-22 score >30 and in general the percentage of relative improvement increased with an increase in preoperative SNOT score.

Effect of a Pluronic(®) P123 formulation on the nitric oxide-generating drug JS-K

PURPOSE

O(2)-(2,4-dinitrophenyl)1-[(4-ethoxycarbonyl)piperazin-1-yl]diazen-1-ium-1,2-diolate] or JS-K is a nitric oxide-producing prodrug of the arylated diazeniumdiolate class with promising anti-tumor activity. JS-K has challenging solubility and stability properties. We aimed to characterize and compare Pluronic(®) P123-formulated JS-K (P123/JS-K) with free JS-K.

METHODS

We determined micelle size, shape, and critical micelle concentration of Pluronic(®) P123. Efficacy was evaluated in vitro using HL-60 and U937 cells and in vivo in a xenograft in NOD/SCID IL2Rγ (null) mice using HL-60 cells. We compared JS-K and P123/JS-K stability in different media. We also compared plasma protein binding of JS-K and P123/JS-K. We determined the binding and Stern Volmer constants, and thermodynamic parameters.

RESULTS

Spherical P123/JS-K micelles were smaller than blank P123. P123/JS-K formulation was more stable in buffered saline, whole blood, plasma and RPMI media as compared to free JS-K. P123 affected the protein binding properties of JS-K. In vitro it was as efficacious as JS-K alone when tested in HL-60 and U937 cells and in vivo greater tumor regression was observed for P123/JS-K treated NOD/SCID IL2Rγ (null) mice when compared to free JS-K-treated NOD/SCID IL2Rγ (null) mice.

CONCLUSIONS

Pluronic(®) P123 solubilizes, stabilizes and affects the protein binding characteristics of JS-K. P123/JS-K showed more in vivo anti-tumor activity than free JS-K.

Cellular distribution studies of the nitric oxide-generating antineoplastic prodrug O(2) -(2,4-dinitrophenyl)1-((4-ethoxycarbonyl)piperazin-1-yl)diazen-1-ium-1,2-diolate formulated in Pluronic P123 micelles

OBJECTIVE

Nitric oxide (NO) possesses antitumour activity. It induces differentiation and apoptosis in acute myeloid leukaemia (AML) cells. The NO prodrug O(2) -(2,4-dinitrophenyl)1-((4-ethoxycarbonyl)piperazin-1-yl)diazen-1-ium-1,2-diolate, or JS-K, has potent antileukaemic activity. JS-K is also active in vitro and in vivo against multiple myeloma, prostate cancer, non-small-cell lung cancer, glioma and liver cancer. Using the Pluronic P123 polymer, we have developed a micelle formulation for JS-K to increase its solubility and stability. The goal of the current study was to investigate the cellular distribution of JS-K in AML cells.

METHODS

We investigated the intracellular distribution of JS-K (free drug) and JS-K formulated in P123 micelles (P123/JS-K) using HL-60 AML cells. We also studied the S-glutathionylating effects of JS-K on proteins in the cytoplasmic and nuclear cellular fractions.

KEY FINDINGS

Both free JS-K and P123/JS-K accumulate primarily in the nucleus. Both free JS-K and P123/JS-K induced S-glutathionylation of nuclear proteins, although the effect produced was more pronounced with P123/JS-K. Minimal S-glutathionylation of cytoplasmic proteins was observed.

CONCLUSIONS

We conclude that a micelle formulation of JS-K increases its accumulation in the nucleus. Post-translational protein modification through S-glutathionylation may contribute to JS-K's antileukaemic properties.

Abstract 2109: Activation of multiple cellular stresses by the NO generating antineoplastic agent JS-K

The NO prodrug O2-(2,4-dinitrophenyl) 1-[(4-ethoxycarbonyl)piperazin-1-yl]diazen-1-ium-1,2-diolate or JS-K is active against acute myeloid leukemia (AML), multiple myeloma, hepatocellular carcinoma, prostate cancer, glioma and non-small lung cancer. We have developed a nanoscale micelle formulation for JS-K (P123/JS-K) using Pluronic® P123 polymers to stabilize and solubilize the drug. In the present study, the mechanism of action of JS-K was investigated. We speculated that, being a NO-releasing drug, JS-K causes nitrosative/oxidative stress. We therefore hypothesized that JS-K causes multiple stress responses that ultimately trigger apoptosis in the cell. We also hypothesized that JS-K affects the “intrinsic component” (defined as cell cycle, survival and stress pathways in the cell) of leukemic cells.

In this work, using human myeloid leukemia HL-60 cells, we studied the effect of JS-K on two major cellular stresses, namely ER stress and nitrosative/oxidative stress. On treating HL-60 cells with 5μM JS-K formulated in DMSO (JS-K) or P123/JS-K for 4-8 hours, activation of both GRP-78 and CHOP (markers of ER stress) was observed using western blot analysis. ER stress could also be triggered by phosphorylation of JNK protein. Again, using western blot analysis, JNK phosphorylation was observed when HL60 cells were treated with JS-K or P123/JS-K for 4-6 hours. Oxidative stress was studied by quantifying intracellular levels of reactive oxygen/reactive nitrogen species (ROS/RNS) using the ROS/RNS sensitive fluorophore 5-(and-6)-chloromethyl-2’-7’-dichlorodihydrofluorescein diacetate. Treatment of HL-60 cells with 5μM of JS-K or P123/JS-K for 30, 60 or 120 minutes lead to increased levels of ROS/RNS.

These experiments show that JS-K activates the intrinsic component of cell death by producing ER stress and oxidative stress. JS-K is at an advanced stage of pre-clinical development. Its novel and multiple mechanisms of action make it an attractive therapy for the treatment of AML and other malignancies.

Citation Format: Imit Kaur, Moises Terrazas, Ken M. Kosak, Paul J. Shami. Activation of multiple cellular stresses by the NO generating antineoplastic agent JS-K. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2109. doi:10.1158/1538-7445.AM2013-2109

Loop-mediated isothermal amplification assay for the diagnosis of retinitis caused by herpes simplex virus-1

A loop-mediated isothermal amplification (LAMP) assay was developed for the detection of herpes simplex virus 1 (HSV-1). The specificity of the assay was tested using DNA extracted from HSV-1-infected rabbit corneal epithelium cultures, HSV-2 grown on Vero cell line, cytomegalovirus (CMV) (AD-169), varicella zoster virus (VZV) (Oka-vaccine), adenovirus, Aspergillus flavus and Staphylococcus aureus. The specificity of LAMP was confirmed by bidirectional sequencing of the amplicons. The sensitivity of the LAMP assay was tested using different concentrations of HSV-1 DNA. To evaluate the application of the LAMP assay in clinical diagnosis, we tested vitreous samples from 20 patients with suspected viral retinitis using LAMP and real-time PCR for HSV-1. The LAMP primers amplified only HSV-1 DNA; no LAMP products were detected with the DNAs of HSV-2, CMV, VZV, adenovirus A. flavus and S. aureus. The sequences of the positive HSV-1 LAMP products perfectly (99–100%) matched the HSV-1 sequences deposited in the GenBank database. LAMP is as sensitive as real-time PCR, with the lowest detection limit being 10 copies/μL of HSV-1 DNA. Of the 20 patients with suspected viral retinitis, four tested positive for HSV-1 using real- time PCR and LAMP. A 100% concordance was observed across the two methods. The LAMP assay is a rapid, highly specific and sensitive method for the diagnosis of retinitis caused by HSV-1.

Abstract 4392: Protein Interaction and Binding Studies of the Nitric Oxide-Generating Antineoplastic Agent JS-K

The NO prodrug O2-(2,4-dinitrophenyl) 1-[(4-ethoxycarbonyl)piperazin-1-yl]diazen-1-ium-1,2-diolate or JS-K is active against acute myeloid leukemia, multiple myeloma, hepatocellular carcinoma, prostate cancer and non-small lung cancer. We have developed a nanoscale micelle formulation for JS-K using Pluronic® P123 polymers. We studied the interaction between P123-formulated JS-K and free JS-K formulated in 40% DMSO/PBS with 4% human serum albumin (HSA) and 0.09% alpha1 acid glycoprotein (AGP). Particle size was measured by dynamic light scattering. HSA had a single peak (8.2 ± 0.51 nm), but 2 peaks were observed when HSA was mixed with 2.25% P123 (peak 1: 10.65 ± 0.484 nm; peak 2: 133.15 ± 11.95 nm). AGP had 2 peaks (peak 1: 236.33 ± 10.71 nm; peak 2: 9.73 ± 0.12 nm) but a single peak (23.49 nm ± 0.09) was observed in the presence of 2.25% P123, suggesting interaction with P123. Binding studies of both P123 JS-K and free JS-K with HSA and AGP were carried out by dialysis at concentrations of 20 -700 µM for 2 hours. At that time point, saturation of drug-protein binding was observed with the P123 formulation but not with free JS-K. Both P123 JS-K and free JS-K were nearly 100% bound with HSA at concentrations ≤ 50 µM. Total recovery for P123 JS-K was higher than free JS-K, indicating stabilization of the drug. At concentrations of 100, 200, 300, 400, 500, 600, and 700 µM of P123 JS-K, 73.5% ± 15, 80.5% ± 5, 82.6% ± 5, 76.1% ± 11.5, 76.2% ± 9, 74.7% ± 0.4, and 71.9% ± 9.4 HSA binding was observed, respectively (average and SEM of 3 experiments). For free JS-K at similar concentrations, the percentage drug bound were 77.3% ± 11, 80.3% ± 5.5, 68.6% ± 3.1, 66.5% ± 1.6, 60.6% ± 1.9, 62.0% ± 1.5, and 54.7% ± 5.76, respectively (average and SEM of 3 experiments). Differences between the unbound fraction of P123-formulated JS-K and free JS-K were statistically significant (P < 0.001) for each JS-K concentration. The binding constants for P123 JS-K and free JS-K were 3.023 × 10-3/μM and 4.3 × 10-2/μM, respectively. We evaluated protein binding of JS-K by measuring protein fluorescence quenching of tryptophan. Fluorometric analysis with HSA was carried out for P123 JS-K or free JS-K concentrations ranging of 20 to 700 µM at 30 minutes. A Stern Volmer constant of 3.58 × 10-3/µM and 1.5 × 10-2/µM was obtained for P123 JS-K and free JS-K, respectively (3 different experiments, r2 =0.99 and 0.77, respectively). Fluorescence analysis of the interaction between P123 JS-K or free JS-K with AGP was carried out at similar concentrations after 30 minutes. The Stern Volmer constants for the interaction between P123 JS-K and AGP and free JS-K and AGP were 2 × 10-3/µM and 3 × 10-3/µM, respectively (average of three different experiments, r2 = 0.67 and 0.91 respectively). These experiments show that JS-K interacts with serum proteins. Pluronic® P123 micelles affect this interaction. Such interactions are likely to influence the in vivo pharmacokinetic properties of the drug.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4392. doi:10.1158/1538-7445.AM2011-4392

Abstract 2651: Cellular uptake and stability studies of the nitric oxide-generating pro-drug JS-K

The nitric oxide (NO) prodrug O2-(2,4-dinitrophenyl)1-[(4-ethoxycarbonyl)piperazin-1-yl]diazen-1-ium-1,2-diolate, or JS-K, has potent antineoplastic activity in vitro and in vivo. Potential targets of JS-K include acute myeloid leukemia, multiple myeloma, hepatocellular carcinoma, prostate cancer and non-small cell lung cancer. JS-K is sparingly soluble in aqueous media. Preliminary pharmacokinetic studies have shown that JS-K has a short half-life in vivo. We have developed a nanoscale micelle formulation for JS-K using Pluronic® P123 polymers. Pluronics® are polyethylene oxide / polypropylene oxide copolymers that are non-toxic and non-irritant. This formulation prolongs the half-life of JS-K in biologic media in vitro. The purpose of this study was to determine the effect of the P123 Pluronic® formulation on the cellular distribution of JS-K. We compared micelle-solubilized JS-K to free JS-K using the HL-60 human myeloid leukemia cell line. JS-K was added at a concentration of 50 μM to HL-60 cells incubated at 37°C in phosphate buffered saline (PBS), RPMI-1640 with 10% fetal bovine serum (FBS), or PBS with 10% FBS. JS-K recovery from the nuclei and cytoplasm was measured using High Pressure Liquid Chromatography (HPLC). In all experiments, cellular uptake of P123-formulated JS-K was greater than that of free JS-K. The highest levels of recovery of P123-formulated JS-K were from nuclei. Indeed, recovery of JS-K from the cytoplasm was minimal. When cells were incubated in PBS, the percent recovery of free JS-K from nuclei at 15, 30, 60 and 120 minutes was 5.03+2.41; 5.00+2.77, 10.83+5.32 and 0.58+0.22, respectively. Under the same conditions and at the same time points, the percent recovery of P123-formulated JS-K was 9.05+3.5, 20.00+7.07, 21.15+3.14 and 27.73+4.30, respectively (average of two different experiments; P<0.05). When cells were incubated in PBS/10%FBS, the percent recovery of free JS-K from nuclei at 30, 60, 120 and 240 minutes was 3.55+1.92, 3.15+ 1.37, 2.13+1.08, and 1.83+1.55, respectively. Under the same conditions and at the same time points, the percent recovery of P123-formulated JS-K was 20.74+6.57, 12.70+3.41, 16.03+3.59, and 13.22+1.55, respectively (average of three different experiments; P<0.05). When cells were incubated in RPMI/10%FBS, the percent recovery of free JS-K from nuclei at 15, 30, 60, and 120 minutes was 0.38+0.15, 0.45+0.20, 0.43+0.22, and 0.2+0.09, respectively. Under the same conditions and at the same time points, the percent recovery of P123-formulated JS-K was 2.93+1.43, 4.68+1.40, 9.30+1.37 and 11.90+3.81, respectively (average of two different experiments; P<0.05). We conclude that a Pluronic® P123 formulation increases the stability of JS-K in biologic media and facilitates penetration of the drug into the nucleus. This clinically useful formulation could therefore enhance the cytotoxic effects of JS-K and increase its therapeutic efficacy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2651.

Simple and economical method for speciation and resistotyping of clinically significant coagulase negative staphylococci

An attempt was made to speciate 102 clinically significant isolates of coagulase negative staphylococci (CoNS) by a practical scheme adapted from various references. This scheme utilizes slide and tube coagulase test, urease test ornithine decarboxylase, novobiocin susceptibility and aerobic acid from mannose for assigning species group. Inclusion of one or two additional tests in a species group could identify the isolates to species level. Ninety eight (97%) isolates were conveniently identified as S. epidermidis (41%), S. saprophyticus (16.6%), S. haemolyticus (14.7%), S. hominis (14.7%), S. lugdunensis (4.9%), S. schleiferi (1.9%) and S. capitis (1.9%). Only four isolates were not identified to the species level, two of which were probably S. capitis subspecies ureolyticus / S. warneri / S. simulans . Antibiotic susceptibility testing showed maximum resistance to ampicillin (89%) followed by cefotaxime (59%) with no resistance to vancomycin. The increasing recognition of pathogenic potential of CoNS and emergence of drug resistance amongst them denotes the need to adopt simple laboratory procedures to identify and understand the diversity of staphylococci isolated from clinical material.