Pegylation of liposomes favours the endosomal degradation of the delivered phosphodiester oligonucleotides

Liposomal vesicles have been widely investigated as carriers for the intracellular delivery of oligonucleotides (ONs). To avoid unspecific uptake by the reticulo endothelial system, 'pegylation' of the liposomes, by incorporating polyethyleneglycol (PEG) at the surface, has been an attractive strategy. While pegylation has a clear benefit on the systemic level, one could wonder if pegylation also benefits the delivery efficacy of liposomes at the intracellular level. We compared the intracellular distribution of non-pegylated and pegylated liposomes, with special attention to the integrity of the oligonucleotides they are carrying. After uptake in the cells, the non-pegylated liposomes efficiently escaped from the endosomes thereby releasing phosphodiester oligonucleotides (PO-ONs) in the cytoplasm of the cells. The PO-ONs were however rapidly degraded in the intracellular environment. In contrast to non-pegylated liposomes, pegylated liposomes failed in protecting the PO-ONs they were carrying, leading to rapid degradation of the PO-ONs in the endosomal compartment. Furthermore, the PEG chains inhibited the endosomal escape of the degraded ONs. These intracellular findings explain why pegylated liposomes failed in establishing an antisense effect.

Delivery of phosphodiester oligonucleotides: can DOTAP/DOPE liposomes do the trick?

Delivering phosphodiester ONs (PO-ONs) remains an attractive but challenging goal in antisense therapy. Both in the literature and in our experiments, most cationic liposomes fail in generating an antisense effect with PO-ONs, while they succeed with chemically modified ONs such as phosphothioate ONs (PS-ONs). This work aims to explain the biological activity of PO- and PS-ONs delivered by DOTAP/DOPE liposomes based on a detailed understanding of their cell biological behavior by means of fluorescence correlation spectroscopy and confocal laser scanning microscopy. We conclude that DOTAP/DOPE liposomes are not suited to deliver PO-ONs due to the release of naked PO-ONs in the cytosol at the time of the endosomal escape of the liposomes and the subsequent rapid degradation of the naked PO-ONs. Carriers that would not release the PO-ONs upon endosomal escape but would continue to carry the PO-ONs until they arrive at the target mRNA could therefore be better suited to delivering PO-ONs. In the case of PS-ONs, the ONs are not degraded upon release at the time of the endosomal escape of the liposomes, creating a pool of intact, biologically active PS-ONs and thus making DOTAP/DOPE liposomes mainly suitable for delivering nuclease resistant ONs. However, the cells seemed to display an export pathway for removing intact PS-ONs from the cells, limiting the presence of naked PS-ONs in the nucleus to approximately 8 h following the delivery.

Pharmacological management of akathisia in combination with psychological interventions by a mental health nurse consultant

The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.

Protection of oligonucleotides against nucleases by pegylated and non-pegylated liposomes as studied by fluorescence correlation spectroscopy

Antisense phosphodiester oligonucleotides (ONs), complexed to carriers such as cationic liposomes, inhibit the production of proteins. The biochemical and biophysical phenomena that govern the extent of this inhibition are still not fully understood. Major biological barriers limiting a pronounced antisense effect are the cellular entry and endosomal escape of the ONs containing liposomes, the release of the ONs from the liposomes and the extra- and intracellular degradation of the ONs. In this paper we focus on the latter barrier and evaluate, by fluorescence correlation spectroscopy (FCS), to what extent phosphodiester ONs complexed to DOTAP/DOPE liposomes, are protected against degradation by nucleases. Liposomes studied were either with or without a polyethyleneglycol (PEG) moiety at the surface. Using non-pegylated liposomes the phosphodiester ONs were initially adequately protected when exposed to DNase I. Indeed, in the mechanism for lipoplex formation as suggested by others, the ONs become trapped between lipid bilayers and are therefore shielded from the environment. However, after a few hours the phosphodiester ONs no longer stayed intact. This was explained by a gradual fusion of the lipoplexes in time thereby spontaneously releasing phosphodiester ONs. Using pegylated liposomes, a substantial fraction of the phosphodiester ONs degraded immediately after exposing the complexes to DNase I. Based on experimental evidence we suggest that the presence of the PEG-chains influences lipoplex formation so that the ONs are not trapped between lipid bilayers and therefore remain accessible by the DNase I enzyme.

Studying the intracellular dissociation of polymer-oligonucleotide complexes by dual color fluorescence fluctuation spectroscopy and confocal imaging

To transfect cells, cationic polymers as well as cationic liposomes are widely investigated as carriers for both oligonucleotides and plasmid DNA. A major step in the successful intracellular delivery of the DNA is the release from its carrier. In this study, dual color fluorescence fluctuation spectroscopy (dual color FFS) was explored in order to characterize the intracellular dissociation of cationic polymer/oligonucleotide complexes. As a model, rhodamine green-labeled oligonucleotides (RhGr-ONs) were complexed with Cy5-labeled polymers of either high molar mass (Cy5-graft-pDMAEMA, 1700 kDa) or low molar mass [Cy5-poly(l-lysine), Cy5-pLL, 30 kDa]. The FFS results were compared with confocal laser scanning microscopy (CLSM) observations. CLSM proved that Cy5-graft-pDMAEMA/RhGr-ON complexes endocytosed by Vero cells dissociate in the cytoplasm: the polymer was only detected in the cytoplasm whereas the (released) RhGr-ONs accumulated in the nucleus. Transfecting Vero cells with Cy5-pLL/RhGr-ON complexes resulted, however, in colocalization of polymer and oligonucleotides in the nucleus. In the latter case, CLSM was not able to prove whether intact Cy5-pLL/RhGr-ON complexes were present in the nucleus or whether both components were located together in the nucleus without being associated. Dual color FFS, which monitors the movement of (dual labeled) fluorescent molecules, was able to answer this question. As a Cy5-pLL/RhGr-ON complex is multimolecular, i.e., it consists of many RhGr-ONs associated with many Cy5-pLL chains, it is both highly green and red fluorescent. Consequently, when Cy5-pLL/RhGr-ON complexes move through the excitation volume, the (green and red) detectors of the FFS instrument detect simultaneously a strong green and red fluorescence peak. Upon transfecting the Vero cells with Cy5-pLL/RhGr-ON complexes, FFS was indeed able to detect simultaneously green and red fluorescence peaks in the cytoplasm but never in the nucleus. From these results we conclude that the Cy5-pLL and RhGr-ONs present in the nucleus after transfection were not associated.

Towards a better understanding of the dissociation behavior of liposome-oligonucleotide complexes in the cytosol of cells

To obtain real breakthroughs in antisense therapy, it is necessary to understand the cellular behavior of antisense delivery systems. Fluorescence fluctuation spectroscopy (FFS), which measures in time fluorescence fluctuations in the excitation volume of a microscope and which can thus be applied on a cellular scale, shows potential for this purpose. In this study dual color FFS was explored to characterize the complexation (association and dissociation) between Cy5-labeled oligonucleotides (Cy5-ONs) and FITC-labeled cationic liposomes (FITC-liposomes) in respectively buffer, cell lysate and the cytosol of Vero cells. In Hepes buffer the association of the Cy5-ONs to the FITC-liposomes could be clearly observed from the high peaks of Cy5- and FITC-fluorescence, which appeared simultaneously in the excitation volume. This was explained by the fact that in the complexed state many Cy5-ONs and FITC-liposomes are bound to each other and thus move together through the excitation volume thereby resulting in high fluorescence 'FITC/Cy5-peaks'. FFS measurements on FITC-liposome/Cy5-ONs complexes in cell lysate revealed that a minor part of the Cy5-ONs was released from the complexes. The major part of the Cy5-ONs remained in the complexes, which also seemed to aggregate in cell lysate. In agreement with the measurements in cell lysate, after microinjection of FITC-liposome/Cy5-ONs complexes in the cytosol of Vero cells a part of the Cy5-ONs was released (as Cy-ONs were detected by FFS in the nuclei) while the other part remained bound (as Cy5-peaks were frequently observed in the cytosol). As will be explained, the Cy5-peaks could be due both to Cy5-ONs clustered with cytosol components and Cy5-ONs still complexed to FITC-liposomes with quenched FITC-fluorescence.

Studying biophysical barriers to DNA delivery by advanced light microscopy

Advanced light microscopy (ALM) has been intensively employed by biophysicists to reveal cellular mechanisms. As described in this review, ALM clearly has potential to enhance our understanding of the mechanisms that affect macromolecular therapeutics or nanoscopic drug vectors in biological environments. However, while in recent years confocal microscopy and related techniques became rather routinely used in drug delivery it remains challenging to extract reliable information on the biophysical behaviour of drug delivery systems from ALM measurements. This review discusses studies in which confocal imaging, fluorescence recovery after photobleaching (FRAP), fluorescence correlation spectroscopy (FCS) and fluorescence energy transfer were employed to reveal biophysical properties of DNA and DNA containing nanoparticles in extra- and intracellular media.

FRET-FCS as a tool to evaluate the stability of oligonucleotide drugs after intracellular delivery

The intracellular degradation of single-stranded, double-labeled oligonucleotides (ONs) was studied by following the disappearance of Fluorescence Resonance Energy Transfer (FRET) between the rhodamine green and Cy5 fluorophores attached to respectively the 3' and 5' end of the ONs. The green and red fluorescence intensities upon rhodamine green excitation were monitored using the ultra-sensitive detectors of a dual-color Fluorescence Correlation Spectroscopy (FCS) instrument. The ratio of the red to green fluorescence (R/G ratio) as obtained from such FRET-FCS measurements showed to give accurate information on the integrity of the ONs, without the need for additional auto- or cross-correlation analysis of the registered fluorescence intensity fluctuations. Intracellular measurements revealed that most of the 40mer phosphodiester ONs were degraded before they entered the nucleus. For the 20mer phosphodiester ONs, this degradation occurred more slowly, and both intact and degraded ONs entered the nucleus. For the 20mer phosphorothioate ONs, no intracellular degradation was observed during the measured time period. The sensitive detection of the intracellular fluorescence by the FCS setup will be particularly useful in situations where the expected fluorescence is too low to be detected by FRET-imaging as may occur after intracellular delivery of ONs by cationic carriers.

Effects of cardiac rehabilitation on exercise capacity in Type 2 diabetic patients with coronary artery disease

AIM

To determine whether Type 2 diabetic patients with coronary disease can obtain, after cardiac rehabilitation, a similar benefit on exercise capacity to non-diabetic coronary individuals.

RESEARCH DESIGN AND METHODS

Fifty-nine Type 2 diabetic patients and 36 age-matched non-diabetic patients were enrolled in a 2-month cardiac rehabilitation programme, after an acute coronary event. At the beginning and at the end of the cardiac rehabilitation programme, each subject underwent a cardiopulmonary exercise test to assess exercise capacity as measured by peak workload, duration of test, maximal heart rate, peak VO2 and anaerobic threshold. The two groups of patients were not different in age, sex ratio, type of coronary event or left ventricular ejection fraction.

RESULTS

The baseline exercise capacity parameters were not different between diabetic and non-diabetic subjects. After cardiac rehabilitation, improvement of exercise capacity was significantly less in patients with diabetes compared with those without diabetes: peak workload (19% vs. 29%, P = 0.022), peak VO2 (13% vs. 30%, P = 0.002), anaerobic threshold (12% vs. 31%, P = 0.017). In the diabetic patients, a significant inverse relation between fasting blood glucose and change in peak VO2 was observed on both univariate (r = -0.40, P = 0.002) and multivariate (P = 0.001) analyses.

CONCLUSIONS

The benefit of cardiac rehabilitation, after an acute ischaemic heart event, in exercise capacity is significantly lower in Type 2 diabetic patients. The response to cardiac rehabilitation in those with diabetes appears to be influenced by blood glucose levels.

[Glioblastomas: clinical study and search for prognostic factors]

Glioblastoma multiform is one of the most devastating primary tumors in neurooncology. We analyzed prognosis factors in patients with grade IV glioblastoma treated between 1993 and 1997. The 22 long-term survival patients (survival over 26 months) were extracted from our 30 years archives and the 2 populations are compared. The incidence was 2.6/100,000h/year, 62% male and 38% female, mean age 59 years, mean survival 12 months, median survival time 9 months. Multivariate analysis showed that younger age, surgical treatment and radiotherapy were all dependent prognosis factors for better survival. Statistically, survival was best for total surgical removal of tumors, followed by tumor gross resection then biopsy. Clinical status and inextirpable tumor location were also prognosis factors. The free interval time between total surgery and tumor reappearance was strongly correlated with survival (r=0.94). This suggests that some grade IV gliomas follow a quicker course, others exhibiting slow growth. Each of the prognosis factors was confirmed in the long-survival patients. Prevalence of all glioblastomes was 4.3%. Their mean age was 42 and mean survival 62 months. A larger proportion of these patients had total surgery and radiotherapy. The time lapse before tumor reappearance was longer. Deep tumor locations were less frequent. The proportion of secondary versus primary glioblastomas was the greatest difference between the long-term and regular survivors. Secondary glioblastomas were found in only 4% of the standard population and in 23 to 41% in the long-term survivors (p<0.01). Primary glioblastomas typically show EGFR over expression and mutation (variant III). The pathway to secondary glioblastoma involves early P53 mutation. Despite the fact that the anatomopathologist regards similar tissues under the microscope, these subtypes of glioblastomas are distinct disease entities which evolve through different genetic pathways and exhibit different outcomes.

Multiple renal arteries do not pose an impediment to the routine use of laparoscopic donor nephrectomy

Since the first description by Ratner and collegues in 1996, laparoscopic live-donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return to work. It is unknown whether multiple renal arteries pose additional problems with laparoscopic donor nephrectomy. In November 1998, our institution initiated laparoscopic donor nephrectomy program. In the ensuing 19 months, we performed 25 living donor renal transplants, 24 of them using laparoscopic donor nephrectomy. The left kidney was procured in all cases. Eight donor candidates (33%) had two or more renal arteries (two arteries in five patients and three patients).

RESULTS

In six cases (25%), findings at surgery differed from the CT angography results (in four cases, CT angiogram reported fewer arteries than were found at surgery and in two cases it reported more). We found no significant differences in both donor outcomes and recipient, based on the presence or absence of multiple renal arteries. Among donor outcomes, we found equivalent results for donor warm ischemia time total donor operating time, and donor length of stay. For recipient outcomes, we found no significant differences between groups for the incidence of acute tubular necrosis (ATN), graft survival and most recent serum creatinine. In one case, we constructed two arteries into a single conduit on the backtable prior to transplantation. However, in most cases with multiple arteries, we implanted the arteries separately into the recipient external iliac artery. Based on this experience, we do not find the presence of multiple renal arteries to be a barrier to the successful use of kidney grafts procured by laparoscopic donor nephrectomy.

Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough

BACKGROUND

Heavy users of psychiatric services, often defined as the population that uses the most beds, consume a large part of the resources used by the whole service, despite being relatively small in number. Any intervention that reduces heavy use is therefore likely to lead to significant savings, and enhancement of standard care using a form of intensive case management akin to assertive community treatment was thought to be a pragmatic strategy for testing in this group.

METHODS

The effectiveness of enhanced community management (ECM) was compared with standard care alone in heavy users, who represented the 10% of patients with the highest number of hospital admissions and occupied bed days over the previous 6.5 years in an outer London borough. One hundred and ninety-three patients were randomly assigned to ECM or standard care and their use of services was determined after 1 and 2 years, with assessments of costs, clinical symptoms, needs, and social function made before entry into the study and after 1 and 2 years.

RESULTS

Despite a 24 fold increase in community contacts in the study group, there were no significant differences between the two groups in any of the main outcome measures. Small savings on in-patient and day-hospital service costs were counterbalanced by the increased costs of outpatient and community care for the subjects assigned to ECM. Clinical outcome data derived from interviews in two-thirds of the subjects were similar in both groups.

CONCLUSIONS

Providing additional intensive community focused care to a group of heavy users of psychiatric in-patient services in an outer London borough does not lead to any important clinical gains or reduced costs of psychiatric care.

Sleep and brain lesions: a critical review of the literature and additional new cases

We present a comprehensive review of sleep studies performed in patients with brain lesions complemented by 16 additional personal selected cases and by discussion of the corresponding animal data. The reader is cautioned about the risk of establishing an erroneous correlation between abnormal sleep and a given disorder due to the important inter and intra variability of sleep parameters among individuals. Salient points are stressed: the high frequency of post-stroke sleep breathing disorders is becoming increasingly recognised and may, in the near future, change the way this condition is managed. Meso-diencephalic bilateral infarcts induce a variable degree of damage to both waking and non-REM sleep networks producing and abnormal waking and sometimes a stage 1 hypersomnia reduced by modafinil or bromocriptine, which can be considered as a syndrome of cathecholaminergic deficiency. Central pontine lesions induce REM and non-REM sleep insomnia with bilateral lateral gaze paralysis. Bulbar stroke leads to frequent sleep breathing disorders. Polysomnography can help define the extent of involvement of various degenerative diseases. Fragmented sleep in Parkinson's disease may be preceded by REM sleep behavioural disorders. Multiple system atrophies are characterised by important sleep disorganization. Sleep waking disorganization and a specific ocular REM pattern are often seen in supra-nuclear ophtalmoplegia. In Alzheimer patients, sleep perturbations parallel the mental deterioration and are possibly related to cholinergic deficiency. Fronto-temporal dementia may be associated with an important decrease in REM sleep. Few narcoleptic syndromes are reported to be associated with a tumour of the third ventricle or a multiple sclerosis or to follow a brain trauma; all these cases raise the question whether this is a simple coincidence, a revelation of a latent narcolepsy or, as in non-DR16/DQ5 patients, a genuine symptomatic narcolepsy. Trypanosomiasis and the abnormal prion protein precociously after sleep patterns. Polysomnography is a precious tool for evaluating brain function provided it is realised under optimal conditions in stable patients and interpreted with caution. Several unpublished cases are presented: one case of pseudohypersomnia due to a bilateral thalamic infarct and corrected by modafinil, four probable late-onset autosomal recessive cerebellar ataxias without sleep pattern anomalies, six cases of fronto-temporal dementia with strong reduction in total sleep time and REMS percentage on the first polysomnographic night, one case of periodic hypersomnia associated with a Rathke's cleft cyst and four cases of suspected symptomatic narcolepsy with a DR16-DQ5 haplotype, three of which were post-traumatic without MRI anomalies, and one associated with multiple sclerosis exhibiting pontine hyper signals on MRI.

Vaccination of mice with live recombinant Salmonella typhimurium aroA against H. pylori: parameters associated with prophylactic and therapeutic vaccine efficacy

Previously we described a recombinant attenuated Salmonella typhimurium aroA strain (SL3261[pYZ97]) with constitutive expression of plasmid encoded Helicobacter pylori urease subunits A and B (UreAB). Single dose oral vaccination effectively induced prophylactic immunity against bacterial challenge in BALB/c mice. Here we successfully extended this approach to several mouse strains with allelic differences in NRAMP-1 and H-2 genes. The respective host determinants are known to influence the immune response against S. typhimurium. A comparative analysis of the vaccine efficacy in C57BL/6 and BALB/c mice showed that the live vaccine confers long lasting immunity in both strains (>18 weeks). In C57BL/6 mice, protection was still observed 54 weeks while not all vaccinated BALB/c were immune when challenged after this time. BALB/c mice also needed higher doses of SL3261[pYZ97] for full protection. We also demonstrate a therapeutic potential of SL3261[pYZ97] in H. pylori infected BALB/c and C57BL/6 mice. Urease- and carrier-specific serum antibody responses as well as the level of colonization by the Salmonella were analyzed in both mouse strains after immunization with low (4 x 10(7)CFU) or high (1 x 10(9)CFU) vaccine doses. The results are discussed in the context of inoculum size and the mode of antigen supply required for effective vaccination with recombinant Salmonella.

Prolactin receptor signal transduction pathways and actions determined in prolactin receptor knockout mice

Prolactin-receptor-deficient mice are a good model in which to study the various actions of prolactin. Female homozygous knockout mice are completely infertile and show a lack of mammary development, while hemizogotes are unable to lactate following their first pregnancy. Male and female homozygotes have markedly elevated serum prolactin levels, and in some instances pituitary hyperplasia is present. Maternal behaviour is severely affected in both hemizygous and homozygous animals. Bone formation is reduced in young animals and in adults (males and females). Finally, older males and females show a slight reduction in body weight, which seems to be due to reduced abdominal fat deposition in the knockout animals.

Two-Color Holographic Recording Scheme Allowing Nonvolatile Reading in Mn:YAlO(3)

We propose and experimentally realize the recording of two-color holographic gratings in Mn:YAlO(3), a potential material for holographic data storage. This type of recording allows for nonvolatile retrieval of recorded information at the recording wavelength. We demonstrate two-color recording and readout of a 256 x 256 pixel page using red and green laser beams with a bit error rate of 6 x 10(-7).