Self-cross-linking biopolymers as injectable in situ forming biodegradable scaffolds

The injectable polymer scaffolds which are biocompatible and biodegradable are important biomaterials for tissue engineering and drug delivery. Hydrogels derived from natural proteins and polysaccharides are ideal scaffolds for tissue engineering since they resemble the extracellular matrices of the tissue comprised of various amino acids and sugar-based macromolecules. Here, we report a new class of hydrogels derived from oxidized alginate and gelatin. We show that periodate-oxidized sodium alginate having appropriate molecular weight and degree of oxidation rapidly cross-links proteins such as gelatin in the presence of small concentrations of sodium tetraborate (borax) to give injectable systems for tissue engineering, drug delivery and other medical applications. The rapid gelation in the presence of borax is attributed to the slightly alkaline pH of the medium as well as the ability of borax to complex with hydroxyl groups of polysaccharides. The effect of degree of oxidation and concentration of alginate dialdehyde, gelatin and borax on the speed of gelation was examined. As a general rule, the gelling time decreased with increase in concentration of oxidized alginate, gelatin and borax and increase in the degree of oxidation of alginate. Cross-linking parameters of the gel matrix were studied by swelling measurements and trinitrobenzene sulphonic acid (TNBS) assay. In general, the degree of cross-linking was found to increase with increase in the degree of oxidation of alginate, whereas the swelling ratio and the degree of swelling decreased. The gel was found to be biocompatible and biodegradable. The potential of the system as an injectable drug delivery vehicle and as a tissue-engineering scaffold is demonstrated by using primaquine as a model drug and by encapsulation of hepatocytes inside the gel matrix, respectively.

Functional evaluation and cancer risk assessment of BRCA2 unclassified variants

The influence of germ line BRCA2 unclassified variants (UCV), including missense mutations and in-frame deletions and insertions on BRCA2 function and on cancer risk, has not been defined although these mutations account for 43% of all identified BRCA2 sequence alterations. To investigate the effects of UCVs on BRCA2 function, we compared mutant and wild-type forms of BRCA2 using assays of cellular survival and viability, homologous recombination repair, and genome instability. We confirm that the effects of known deleterious mutations can be distinguished from neutral polymorphisms and wild-type BRCA2 in these assays, and we characterize the influence of a series of UCVs on BRCA2 function. We also describe how the results from the assays can be combined with data from analysis of cosegregation of the UCVs with cancer, co-occurrence of the UCVs with other deleterious mutations, and interspecies sequence variation in a comprehensive framework in an effort to better distinguish between disease predisposing and neutral UCVs. This combined approach represents a useful means of addressing the functional significance and cancer relevance of UCVs in BRCA2.

Elevated levels of DNA-protein crosslinks and micronuclei in peripheral lymphocytes of tannery workers exposed to trivalent chromium

DNA-protein crosslinks (DPC) are a promising biomarker of exposure to hexavalent chromium, a known human carcinogen. Although trivalent chromium is considered to have much lower toxicity, the risk involved in chronic exposure is uncertain. DPC may be a useful tool in clarifying this risk, by signaling an exposure of body tissues to biologically active forms of chromium. DPC quantification was carried out in lymphocytes of a group of tannery workers exposed to trivalent chromium, a small group of manual metal arc stainless steel welders exposed to hexavalent chromium and a control group. This biomarker was compared with the frequency of micronuclei in cytokinesis blocked peripheral lymphocytes as a biomarker of cytogenetic lesions and total plasma and urine chromium levels as an index of exposure. The results indicate a significant increase in the formation of DPC in tannery workers compared with controls (0.88 +/- 0.19 versus 0.57 +/- 0.21%, P < 0.001, Mann-Whitney test) and an even higher level of DPC in welders (2.22 +/- 1.12%, P = 0.03). Tanners showed a significant increase in micronucleated cells compared with controls (6.35 +/- 2.94 versus 3.58 +/- 1.69 per thousand, P < 0.01), whereas in welders this increase was not significant (5.40 +/- 1.67 per thousand ). Urinary chromium was increased in both groups, with a greater increase observed in tanners compared with controls (2.63 +/- 1.62 versus 0.70 +/- 0.38 microg/g creatinine, P < 0.001) than in welders (1.90 +/- 0.37 microg/g creatinine, P < 0.005). Plasma chromium was also increased in both groups (tanners 2.43 +/- 2.11 microg/l, P < 0.001, welders 1.55 +/- 0.67 microg/l, P < 0.005 versus controls 0.41 +/- 0.11 microg/l). In summary, chronic occupational exposure to trivalent chromium can lead to a detectable increase in lymphocyte DNA damage which correlates with a significant exposure of the cells to the metal.

Alternative fixation of bioprostheses

The glutaraldehyde fixation technique for bioprosthetic tissue valves has been used for about 30 years. It is more or less generally recognized, however, that a solution to the ongoing problems of calcification and immunomodulated inflammation can only be achieved with the development of alternative fixation techniques that differ from fixation with glutaraldehyde. This review reports on the chemistry behind newly developed tissue-fixation processes and the preliminary results achieved with these.

Intravenous safety and pharmacokinetics of a novel dimerizer drug, AP1903, in healthy volunteers

AP1903 is a novel gene-targeted drug that is being developed for use in drug-regulated cell therapies. An intravenous, single-blind, placebo- and saline-controlled, ascending-dose study was performed to evaluate the safety, tolerability, and pharmacokinetics of AP1903. Twenty-eight normal healthy male volunteers were randomized into five dosage groups of AP1903 (0.01, 0.05, 0.1, 0.5, and 1 mg/kg). Within each group, 4 volunteers received a single dose of AP1903, 1 volunteer received an equal volume of placebo, and 1 received an equal volume of normal saline. The only exception was in the 0.5 mg/kg group, in which 4 volunteers were dosed: 3 received AP1903 and 1 received normal saline. All dosages were administered as intravenous infusions over 2 hours. Clinical safety parameters were monitored, and serial blood and urine samples were collected for analysis of AP1903. No drug-related adverse events were observed at any of the dose levels with the possible exception of facial flushing in 1 volunteer at the 1.0 mg/kg dose level. AP1903 plasma levels were directly proportional to the administered dose, with mean Cmax values ranging from approximately 10 to 1,275 ng/mL over the 0.01 to 1.0 mg/kg dose range. Following the infusion period, blood concentrations revealed a rapid distribution phase, with plasma levels being reduced to approximately 18%, 7%, and 1% of the maximal concentration at 0.5, 2, and 10 hours postdose, respectively. AP1903 was shown to be safe and well tolerated at all dose levels and demonstrated a favorable pharmacokinetic profile at doses well above the anticipated therapeutic dose.

4-hydroxynonenal induces apoptosis via caspase-3 activation and cytochrome c release

We investigated the mechanism by which 4-hydroxynonenal (HNE), a major aldehydic product of lipid peroxidation, induces apoptosis in tumor cells. Treatment of human colorectal carcinoma (RKO) cells with HNE-induced poly-ADP-ribose-polymerase (PARP) cleavage and DNA fragmentation in a dose- and time-dependent manner. The induction of PARP cleavage and DNA fragmentation paralleled caspase-2, -3, -8, and -9 activation. Pretreatment of cells with an inhibitor of caspase-3, z-DEVD-fmk, or a broad spectrum caspase inhibitor, z-VAD-fmk, abolished caspase activation and subsequent PARP cleavage. Constitutive expression of high levels of Bcl-2 protected cells from HNE-mediated apoptosis. In addition, Bcl-2 overexpression inhibited cytochrome c release from mitochondria and subsequent caspase-2, -3, and -9 activation. These findings demonstrate that HNE triggers apoptotic cell death through a mitochondrion-dependent pathway involving cytochrome c release and caspase activation. Bcl-2 overexpression protected cells from HNE-induced apoptosis through inhibition of cytochrome c release.

Antitumoral activity of a sulphur-containing platinum complex with an acidic pH optimum

Platinum complexes are essential tools for cancer treatment despite their toxic side effects. Here we describe a new platinum complex with sulphurs as complexing atoms (thioplatin).

PURPOSE

To demonstrate that the antitumoral activity of a new sulphur-containing platinum compound (thioplatin) depends on a slightly acidic pH.

METHODS

Platinum uptake by tumour cells and interaction with DNA was determined at slightly acidic or alkaline pH. To demonstrate low in vivo toxicity the effects of thioplatin on body weight, blood urea nitrogen, white blood cell count and the histopathological appearance of small intestines and kidneys were evaluated at doses that displayed antitumoral effects against human small-cell lung cancer and human colorectal cancer xenotransplants in nude mice.

RESULTS

The slightly acidic pH optimum of thioplatin was proven by the altered electrophoretic mobility of plasmid DNA, quantitation of the platinum content in the DNA of tumour cells and cytotoxicity studies. Thioplatin displayed antitumoral activity without severe side effects such as weight loss, renal ischaemia, destruction of villi in the small intestine or leukopenia as observed at comparable doses of cisplatin. Furthermore, probably due to its lipophilic nature, thioplatin was taken up readily even by cisplatin-resistant cells. In vivo studies with human tumour xenografts in nude mice showed a therapeutic index of thioplatin five to ten times higher than that of cisplatin.

Protein oxidation in aging and age-related diseases

Although different theories have been proposed to explain the aging process, it is generally agreed that there is a correlation between aging and the accumulation of oxidatively damaged proteins, lipids, and nucleic acids. Oxidatively modified proteins have been shown to increase as a function of age. Studies reveal an age-related increase in the level of protein carbonyl content, oxidized methionine, protein hydrophobicity, and cross-linked and glycated proteins as well as the accumulation of less active enzymes that are more susceptible to heat inactivation and proteolytic degredation. Factors that decelerate protein oxidation also increase the life span of animals and vice versa. Furthermore, a number of age-related diseases have been shown to be associated with elevated levels of oxidatively modified proteins. The chemistry of reactive oxygen species-mediated protein modification will be discussed. The accumulation of oxidatively modified proteins may reflect deficiencies in one or more parameters of a complex function that maintains a delicate balance between the presence of a multiplicity of prooxidants, antioxidants, and repair, replacement, or elimination of biologically damaged proteins.

Identification of human lung and skin proteins conjugated with hexamethylene diisocyanate in vitro and in vivo

Diisocyanates are asthma-causing chemicals used in the commercial production of polyurethane. We have previously shown that human lung epithelial cell proteins can become conjugated with hexamethylene diisocyanate (HDI) and may be biologically important in diisocyanate-induced asthma. The objective of this study was to identify specific human lung and skin proteins that become conjugated with diisocyanate after in vitro and in vivo exposure. Following in vitro exposure of human airway epithelial cells (A549), keratin 18, the 78-kD glucose-regulated protein, trans-1, 2-dihyrobenzene-1,2-diol dehydrogenase, and actin were identified as prominent diisocyanate-conjugated proteins through use of a combination of immunocytochemical and mass spectrometric techniques. Following in vivo inhalation of an HDI aerosol, keratin 18 was also identified as the predominant diisocyanate-conjugated protein in human endobronchial biopsy samples, whereas albumin was the predominant diisocyanate-conjugated protein in bronchoalveolar lavage fluid. Keratin was also identified as a predominant diisocyanate-conjugated protein in human skin biopsy samples after epicutaneous exposure to liquid-phase HDI, although the major skin diisocyanate-conjugated protein (56-kD) differed from the predominant lung diisocyanate-conjugated keratin (47-kD). The data from this study identify keratin and other proteins as potential "carriers" for diisocyanates in vivo, and suggest that HDI conjugation of these proteins may play a role in the pathogenesis of diisocyanate-induced asthma.

Contact allergy and hand eczema in Swedish dentists

Hand eczema and contact allergy in Swedish dentists were studied in a multidisciplinary project. The aims of the study were to establish diagnoses, to investigate the occurrence of contact allergy, in particular to (meth)acrylates, and to evaluate certain consequences of hand eczema. A postal questionnaire on skin symptoms, atopy and occupational experience was mailed to 3,500 dentists aged <65 years, and licensed 1965-1995. The response rate was 88%. Among dentists living in 3 major cities, 14.9% (n= 191) reported hand eczema during the previous year. They were invited to a clinical examination, including patch testing with a standard and a dental series. 158/191 (83%) dentists attended, and hand eczema diagnosis was confirmed in 149/158 (94%). Irritant contact dermatitis was diagnosed in 67% and allergic contact dermatitis in 28%. On patch testing, 50% presented at least 1 positive reaction. The most frequent allergens were nickel sulfate, fragrance mix, gold sodium thiosulfate and thiuram mix. 7 (5%) had positive reactions to (meth)acrylates, all to 2-hydroxyethyl methacrylate and 6 also to ethyleneglycol dimethacrylate. 38% had consulted a physician, 4% had been on sick-leave and 1% had changed occupational tasks due to hand eczema. No dentist with allergy to acrylates had been on sick-leave or changed occupation. It is concluded that dentistry is a high-risk occupation for hand eczema, and that irritant contact dermatitis is most common. The prevalence of contact allergy to acrylates was below 1% in the population of responding dentists, and in most cases did not have serious medical, social or occupational consequences.

Phase II study of bendamustine in patients with relapsed or cisplatin-refractory germ cell cancer

Despite generally high cure rates in patients with metastatic germ cell cancer, patients with incomplete response to first-line cisplatin-based chemotherapy or with relapsed disease following high-dose salvage therapy exhibit a very poor prognosis. We investigated the efficacy and toxicity of bendamustine, a bifunctional alkylating benzimidol derivative with only partial cross-resistance to other alkylating agents such as ifosfamide or cyclophosphamide. Nineteen patients with cisplatin-refractory germ cell tumors (GCT) or relapse after high-dose chemotherapy plus autologous stem cell support were treated with bendamustine at a dose of 120 mg/m2 on 2 consecutive days at 3 week intervals. Patients had received a median of 9 (range 4-20) platinum-containing treatment cycles prior to bendamustine and 13 patients (68%) had previously received carboplatin/etoposide-based high-dose chemotherapy. One patient achieved a partial remission of only 6 weeks duration. No other responses were seen. Toxicity was low with one patient developing WHO grade 3 thrombocytopenia as the only WHO grade 3/4 toxicity observed. Hematologic toxicity was similar in patients pretreated with and without high-dose chemotherapy plus autologous stem cell support. We conclude that bendamustine has little or no clinically relevant activity in patients with cisplatin-refractory GCT or relapsed disease after high-dose chemotherapy.

Too hot to handle: an unusual exposure of HDI in specialty painters

BACKGROUND

Hexamethylene Diisocyanate (HDI) is a color stable aliphatic isocyanate that is used in specialty paints as a hardener. Due to the lower vapor pressure of its commercial biuret form, it is considered a relatively "safe" isocyanate from an exposure standpoint. This case series reports on an unusual toxic exposure to HDI. Between November 1993 and May 1994, seven specialty painters and one boiler maker who were working at three different power plants were examined at the Institute of Occupational and Environmental Health at West Virginia University. At their respective work sites, HDI was applied to the hot surfaces of boilers that were not shut down, and allowed sufficient time to cool. Consequently, these workers were exposed to volatile HDI and its thermal decomposition products.

METHODS

All of these workers underwent a complete physical examination, spirometry, and methacholine challenge testing.

RESULTS

All 8 workers complained of dyspnea, while 4 of the 8 also complained of rash. On examination 3 workers were methacholine challenge positive and 2 had persistent rash. At follow-up 4 years later, 5 workers still had to use inhalation medication and one had progressive asthma and dermatitis. All 8 workers, by the time of the follow-up, had gone through economic and occupational changes.

CONCLUSIONS

This case series reports on an unusual exposure to HDI. It is unusual in that: 1) There were two simultaneous sentinel cases with two different Material Safety Data Sheets (MSDS) for the same product, 2) Exposure was to volatile HDI and its decomposition products and 3) Hazardous conditions of exposure occurred at three different sites.

Current diagnostic methods for diisocyanate induced occupational asthma

BACKGROUND

Diisocyanates are among the most frequent causes of occupational asthma in industrialized countries. Early diagnosis of diisocyanate asthma followed by prompt termination of chemical exposure can prevent chronic morbidity due to persistent asthma. The accurate diagnosis of diisocyanate asthma requires a systematic approach that combines information obtained from the occupational history, immunologic tests and physiologic studies.

METHODS

The advantages, limitations and validity of various methods and diagnostic guidelines utilized in the evaluation of diisocyanate asthma are reviewed.

RESULTS

Recommended methods for evaluation of diisocyanates asthma are similar to approaches for other causative agents. Serologic assays of specific IgE are specific but insensitive diagnostic markers of diisocyanate asthma. If possible, workers should be evaluated, while at work, in order to demonstrate work-related changes in lung function associated with diisocyanate exposures. Specific bronchoprovocation challenge testing with diisocyanates, is reserved for situations where the diagnosis cannot be confirmed at work. Such tests can be performed safely but should be conducted exclusively at specialized centers by experienced personnel.

CONCLUSIONS

Published diagnostic guidelines for occupational asthma are directly applicable to the evaluation of diisocyanate asthma.

[Bullous phototoxic contact dermatitis caused by Ruta graveolens L. (garden rue), Rutaceae. Case report and review of literature]

A patient developed severe bullous phototoxic contact dermatitis caused by Ruta graveolens L. (garden rue) which belongs to the Rutaceae family. To date only a few cases of phototoxic reactions to the garden rue have been reported. The phototoxic components of Ruta graveolens L. are the fouranocoumarins 5-methoxypsoralen (bergapten) and 8-methoxypsoralen (xanthotoxine), and the furanoquinoline dictamnine whose phototoxic properties were recently discovered. Since the garden rue is frequently cultivated, it should be considered in the differential diagnosis of phototoxic phytodermatitis.

Serotonin-independent model of cisplatin-induced emesis in the ferret

para-Chlorophenylalanine (PCPA, 100-200 mg/kg) was used as a pharmacological tool to characterize the 5-hydroxytryptamine (5-HT) involvement in the emesis occurring 24 hr after the administration of cisplatin (10 mg/kg) in the ferret. PCPA was effective to antagonize the initial 8 hr period of retching and vomiting, but potentiated the emesis that occurred during the remaining 8- to 24-hr observation period. Tissue samples removed from the brainstem at 24 hr post injection of cisplatin alone revealed an elevation of 5-HT, dopamine and homovanillic acid that was antagonized by the injection of PCPA. Cisplatin also induced increases in the urinary levels of 5-hydroxyindoleacetic acid that was similarly antagonized by PCPA. Results are discussed in terms of the relevance of 5-HT to the model of cisplatin (10 mg/kg)-induced emesis in the ferret compared to the problem of acute and delayed emesis in man. The residual or delayed phase of cisplatin-induced emesis may involve a 5-HT-independent mechanism.

Complications of periurethral collagen injection for stress urinary incontinence

PURPOSE

Periurethral collagen injection has been advocated as a safe and effective method of treatment for stress urinary incontinence. This study was conducted to determine the complications associated with transurethral collagen injection for treatment of stress urinary incontinence in women. We report the incidence and management of adverse effects.

MATERIALS AND METHODS

A total of 337 women with at least a 1-year history, physical findings and urodynamic abnormalities consistent with stress urinary incontinence, who required pads or protective clothing, and who had no or only grade 1 cystocele were enrolled in this prospective cohort study. A third party documented adverse effects at each followup.

RESULTS

De novo urinary urgency with incontinence was the most frequent and serious complication, occurring in 12.6% of patients, and in many the symptoms were irreversible. Hematuria (5% of patients) and urinary retention (1.9%) were short-lived and resolved spontaneously. Delayed reaction at the skin test site occurred in 0.9% of the patients (3) and was associated with arthralgias in 2.

CONCLUSIONS

Contrary to previous reports that periurethral collagen injection is complication-free, we found an overall incidence of 20% risk of complications in any given individual.

Urethral prolapse after collagen injection

A woman who was treated for intrinsic urethral sphincteric deficiency with periurethral injection of glutaraldehyde cross-linked collagen had prolapse of the urethral mucosa and recurrence of incontinence. She subsequently required surgical resection and a fascia lata sling. This is the first known occurrence of this postinjection complication.

Misdiagnosis of cancer due to multiple glove powder granulomas

A biologically absorbable powder, the cornstarch lubricant used in the production of gloves, is treated with epichlorohydrin, a cross-linking agent forming one to three diether glycerine groups to create a glove lubricating powder. This agent, together with chemicals used in glove fabrication is able to interfere with important biological diagnostic procedures, such as polymerase chain reaction (PCR) and enzyme immunoassay as well as to induce a granulomatous reaction in traumatised surgical tissue.

Thermal cross-linking for biologically degradable materials. Preliminary report

To diminish undesirable side effects of chemical cross-linking of biodegradable materials, the authors developed a thermal cross-linking method that involved esterification by dehydration under dry conditions. The optimal condition for cross-linking was heating at 130-140 degrees C for 40 hr. Efficacy of the cross-linking was evaluated using enzymatic digestion of 0.01% protease in phosphate buffer at pH 7.4. Collagenous materials without cross-linking were digested completely within 30 min. However, with thermal cross-linking, it required 7 days for digestion. The capacity for holding onto water also was tested. Water content decreased when the cross-link density was increased. As an in vivo experiment, six succinylated collagen sealed vascular grafts treated with thermal cross-linking were implanted in the abdominal aortae of dogs and removed 21 days later. These grafts showed no foreign body reaction, and the collagen layer was almost completely absorbed. A collagen sealed graft cross-linked with formaldehyde used as a control showed a strong foreign body reaction. These results suggest that the physical cross-linking method was suitable for biodegradable biologicals, such as collagenous materials, without the undesirable side effects of chemical cross-linking regents.

Role of lipid aldehydes in cataractogenesis: 4-hydroxynonenal-induced cataract

Free radicals have extremely short half-lives and they readily oxidize lipids and initiate an autocatalytic chain reaction of lipid peroxidation, which leads to the formation of lipid peroxides. The lipid peroxides undergo degradation to form metastable lipid aldehydes such as 4-hydroxynonenal (HNE). We have shown earlier that under hyperglycemia, lipid peroxides increase; and aldose reductase, an enzyme that reduces glucose to sorbitol, efficiently reduces HNE. The purpose of the present studies was thus to investigate the role of HNE in hyperglycemic cataract and understand the mechanism(s) of its prevention by antioxidants and aldose reductase inhibitors. HNE and hyperglycemic cataract were developed by culturing rat lenses in TC-199 medium containing 50 microM HNE and 50 mM glucose, respectively. The effect of an anti-oxidant, trolox, and an aldose reductase inhibitor, sorbinil, on the progression of HNE and hyperglycemic cataract, evaluated by digital image analysis, was followed for 8 and 9 days, respectively. In lenses cultured with HNE, the decrease in transmitted light was 43, 65, and 87% on Days 3, 5, and 8, respectively. Trolox ameliorated the HNE cataract, whereas sorbinil accelerated the progression of HNE cataract and prevented the progression of hyperglycemic cataract. It is concluded that HNE formed under hyperglycemia may play a pivotal role in diabetic cataractogenesis.

Occupational allergic contact dermatitis due to acrylates in Lodz

Among 1619 patients suspected of occupational contact dermatitis examined during the years 1990-1994, sensitivity to acrylates was diagnosed in 9 persons (4 dental technicians, 4 dentists, 1 textile printer). Ethyleneglycol dimethacrylate (5 positive patch tests), methyl methacrylate (4), 2-hydroxyethyl methacrylate (4) and triethyleneglycol dimethacrylate (4) were the most common sensitizers. Comparison of patch test results in dental technicians and dentists indicated that dentists were sensitive to a greater number of (meth)acrylate (acrylate and methacrylate) allergens and also to certain other allergens (metals and rubber additives). Dental technicians were sensitive almost exclusively to methacrylates, while the textile printer only to acrylates.

Persistence of injectable collagen in human urethra: case report

A polypoid lesion was found near the bladder neck during cystoscopy in a woman with urinary incontinence who had undergone periurethral collagen (Contigen) injections 3 years before. She had previously received radiation therapy in addition to a radical vulvectomy for vaginal cancer. On transurethral resection of the lesion, particles of unresorbed collagen material extruded from the capsulated suburothelial space. Histologic evaluation verified the material as the foreign collagen. The persistence of glutaraldehyde cross-linked collagen in our patient was much longer than previously reported and may have been due to effects of previous radiation treatment.