Gender- or age-related binding characteristics of valproic acid to serum proteins in adult patients with epilepsy

The aim of the present study was to determine the gender- or age-related binding characteristics of valproic acid (VPA) to serum proteins in the adult population. Serum samples examined in the study were obtained from 70 adult patients (36 males, 34 females) with epilepsy on VPA monotherapy. Their age ranged from 16 to 68 years (mean age with (SD), 37.7 (15.7) years; <45 years, n=44; >/=45 years, n=26). The in vivo population binding parameters of VPA to serum proteins and theoretical minimal unbound serum VPA fraction (Fu) were determined using an equation derived from the Scatchard equation in: (1), all; (2), male and female subgroups; and (3), younger (<45 years) and older (>/=45 years) subgroups. There was a significant difference in serum concentration of unbound VPA between male and female patients. The mean association constant (K) was 0.010 microM(-1) in all, male, and female patients. The mean total concentration of binding sites (n(Pt)) was 1453 microM for all patients, and 1561 and 1394 microM for male and female patients, respectively. The Fu was 0.064 for all patients, and 0.060 and 0.067 for male and female patients, respectively. There were no significant differences in the binding characteristics of VPA to serum proteins between the male and female groups. On the other hand, there were significant differences in the serum albumin concentration and molar concentration ratio of free fatty acids to albumin in serum between the younger and older patients. The mean value of K was 0.016 microM(-1) for the younger patients and 0.007 microM (-1) for the older patients. The mean n(Pt) was 1157 microM for the younger patients and 1703 microM for the older patients. The Fu was 0.051 for the younger patients and 0.077 for the older patients. Thus, significant differences were observed in the binding characteristics of VPA to serum proteins between the younger and older groups. Our results show that age, but not gender, has significant influences on the binding characteristics of VPA to serum proteins in our patient population.

Effect of temperature on serum protein binding characteristics of phenytoin in monotherapy paediatric patients with epilepsy

OBJECTIVES

To determine the effects of temperature on binding characteristics of phenytoin to serum proteins in paediatric patients with epilepsy.

METHOD

Serum samples examined in the study were obtained from 41 paediatric patients (23 male, 18 female) with epilepsy on phenytoin monotherapy. Their age ranged from 1 to 15 years (mean +/- SD, 10;2 +/- 4;0 years). Protein binding of phenytoin was evaluated by ultrafiltration under current laboratory routine conditions (25 +/- 3 degrees C) or at a temperature of 37 degrees C. The in vivo binding parameters of phenytoin to serum proteins were determined using a binding equation derived from the Scatchard equation for a one-site binding model.

RESULTS

Significant differences were observed in serum concentrations of unbound phenytoin at the two temperatures (P < 0;05). The mean association constant L/micromol (K) of phenytoin to serum proteins is 0.016 L/micromol at 25 +/- 3 degrees C and 0;009 L/micromol at 37 degrees C, while mean total concentration of binding sites (n(Pt)) seems to be similar between the two temperatures (682 micromol/L for 25 +/- 3 degrees C and 746 micromol/L for 37 degrees C). Significant differences were observed in binding characteristics of phenytoin to serum proteins for the different temperature conditions of ultrafiltration (P < 0;05).

CONCLUSION

Our study confirms that binding affinity for phenytoin-serum protein interaction is approximately 44% lower at 37 degrees C than at 25 +/- 3 degrees C and consequently, binding potential (K.n(Pt)) is approximately 38% lower at 37 degrees C than at 25 +/- 3 degrees C.

Intestinal mucosal immune response in chickens following intraocular immunization with liposome-associated Salmonella enterica serovar enteritidis antigen

Induction of intestinal mucosal immune responses against Salmonella enterica serovar enteritidis was studied by immunizing chickens with liposome-associated antigen. An ultrasonicated whole cell extract of the bacteria was used for immunizing antigen. Intraocular immunization induced serum IgA, IgG and IgM responses. Also, significant IgA and IgG antibodies were detected in the intestinal tract. Immunization with antigen alone induced only IgG response in the intestine. Salmonella enteritidis-specific antibody-secreting lymphocytes were detected in the spleen and lamina propria of the intestinal tract of immunized chickens. Immunoglobulin (Ig) fractions extracted from intestines of immunized chickens inhibited the adherence of S. enteritidis to cultured HeLa cells. These results indicate that intraocular immunization with liposome-associated S. enteritidis elicits specific antibody-producing lymphocytes in the intestinal tract, and that Ig secreted in the intestine inhibits adherence of the bacteria to intestinal epithelial cells, suppressing the spread of bacterial infection in the host.

Alcohol consumption and severity of angiographically determined coronary artery disease in Japanese men and women

The relation of alcohol consumption to the severity of coronary atherosclerosis was examined among 323 men and 220 women who underwent coronary arteriography. Severity of coronary atherosclerosis was assessed by the number of vessels obstructed > or =75% in diameter and Gensini's severity score. Alcohol consumption was divided into 5 categories in men (never, past, 1-24, 25-49, and > or =50 ml per day) and 3 categories in women (never, past, and current). Among men, odds ratios of severe stenosis (multiple-vessel disease or Gensini's score >15) decreased substantially and significantly in all current drinking categories but without dose-response effect. There was a weak, inverse association of current alcohol consumption with one-vessel disease, but not with moderate stenosis in terms of Gensini's score (< or =15). Past drinkers showed a fairly large, but statistically nonsignificant, decrease in the odds ratios of not only severe stenosis but also of moderate stenosis. Among women, current drinkers showed a small, statistically nonsignificant decrease in the risk of severe stenosis in terms of Gensini's score. These associations with alcohol use did not change after adjustment for known coronary risk factors. The present findings add to evidence that alcohol drinking confers protection against coronary atherosclerosis.

Expression of Fas and Fas ligand mRNA in rat and human preimplantation embryos

The Fas-Fas ligand (L) system is one of the major signalling pathways to induce apoptosis in various cells and tissues. The aim of this study was to investigate the expression of the Fas-Fas L system in rat and human oocytes and preimplantation embryos. We determined the expression of Fas and Fas L mRNA of rat oocytes and embryos up to the blastocyst stage, and of human embryos at the 2- or 4-cell stage, using reverse transcription polymerase chain reaction (PCR) and nested PCR techniques. Moreover, we investigated the expression of Fas mRNA in human fragmented embryos. In rat embryos, Fas mRNA was expressed at the 2-cell stage only, whereas Fas L mRNA was expressed in oocytes, and at the pronuclear (1-cell) and 2-cell stages. In human embryos, Fas mRNA was expressed at the 4-cell stage only, whereas Fas L mRNA was expressed at both 2- and 4-cell stages. Human fragmented embryos expressed both Fas and Fas L mRNA. Because simultaneous expression of Fas and Fas L mRNA occurred in 2-cell rat embryos and in 4-cell human embryos, the Fas-Fas L system might be involved in the apoptotic pathway in the early embryos of these species.

Effects of peptide dimerization on pore formation: Antiparallel disulfide-dimerized magainin 2 analogue

To elucidate the effects of peptide dimerization on pore formation by magainin 2 (MG2), a covalently linked antiparallel dimer of the MG2 analogue [(F5Y, L6C, F16W, I20C-MG2)(2): II] was synthesized based on the dimer structure revealed by our NMR study. The interactions of the dimer with lipid bilayers were investigated by CD and fluorescence in comparison with a monomer analogue (F5Y, F16W-MG2: I). Similar to I, II was found to form a peptide-lipid supramolecular complex pore accompanied with lipid flip-flop and peptide translocation. The pore formed by II was characterized by a slightly larger pore diameter and a threefold longer lifetime than that of I, although the pore formation rate of the dimer was lower than that of the monomer. The coexistence of the dimer and the monomer exhibited slight but significant synergism in membrane permeabilization, which was maximal at a monomer/dimer ratio of 3. Therefore, we concluded that a pentameric pore composed of one pore-stabilizing dimer and three monomers maximized the overall leakage activity in keeping with our kinetic prediction.

Effect of five flavonoid compounds isolated from Quercus dentata Thunb on superoxide generation in human neutrophils and phosphorylation of neutrophil proteins

Effect of five yellow compounds isolated from Quercus dentata on superoxide generation and protein phosphorylation in human neutrophils was investigated. The five yellow compounds examined were Kaempferol 3-O-beta-D-glucopyranoside (B), quercetin 3-O-beta-D-glucopyranoside (DA), Kaempferol 3-O-(6"-trans-p-coumaroyl)-beta-D-glucopyranoside (D1), Kaempferol 3-O-(2"-6"-di-trans-p-coumaroyl)-beta-D-glucopyranoside (D7) and Kaempferol 3-O-(2",4"-di-acetyl-3"-cis-p-coumaroyl-6"-trans-p-coumaroyl)-beta-D-glucopyranoside (A). D7 suppressed significantly the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP). D1 and DA suppressed significantly the superoxide generation induced by arachidonic acid (AA). However, the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA) was suppressed by all yellow compounds. When the cells were incubated with fMLP and D7, the tyrosyl phosphorylation of 67, 60, 58 and 38 kDa proteins of the cells was markedly decreased in a concentration-dependent manner.

Induction of specific cytotoxic T-cell activity against xenogeneic target cells in carp (Cyprinus carpio)

OBJECTIVE

To investigate the induction of cytotoxic T cells in carp (Cyprinus carpio) after inoculation of fish with 2 xenogeneic line cells and to examine specificity of the cytotoxic activity.

ANIMALS

22 carp.

PROCEDURE

Fish were inoculated with mouse myeloma line cells P3.NS-1/1Ag4.1 (NS-1) or chicken Marek's disease tumor-derived lymphoma line cells (MDCC MSB-1). Cytotoxic activity of immune lymphocytes was evaluated by incubating effector cells with homologous and heterologous target cells. Populations of effector cells were identified by blocking T-lymphocytes from effector cells, using anti-carp T-cell monoclonal antibody and complement.

RESULTS

Lymphocytes in blood, spleen, and head kidney of carp inoculated with NS-1 cells or MDCC MSB-1 cells had dose-dependent cytotoxic effects against homologous target cells but not against heterologous target cells. Lymphocytes from noninoculated carp did not have cytotoxic effects. Depletion of T-lymphocytes in spleen cells from NS-1-inoculated carp resulted in a decrease of cytotoxic activity against NS-1 cells. Cytotoxic activity of spleen lymphocytes from NS-1-inoculated or noninoculated carp was not evident when cytotoxic tests were performed after addition of anti-NS-1 carp serum.

CONCLUSIONS AND CLINICAL RELEVANCE

Inoculation with xenogeneic target cells induces a specific cytotoxic T-cell response in carp. Thus, cell-mediated immunity plays a role in defense against infection of parasitic organisms such as protozoa and helminths.

ATP7A gene mutations in 16 patients with Menkes disease and a patient with occipital horn syndrome

Genomic DNA of 17 unrelated Japanese males with Menkes disease and 2 Japanese males with occipital horn syndrome were studied for mutations in the ATP7A gene. Using SSCP analysis and direct sequencing of the exons and the 5'-upstream region of the gene amplified by PCR, we identified 16 mutations in 16 of 17 males with Menkes disease, including 4 deletions, 2 insertions, 6 nonsense mutations, 2 missense mutations, and 2 splice-site mutations. All these mutations were those that affect the function of the gene. Of the two males with occipital horn syndrome, one had a splice-site mutation in intron 6 that led to normal-size and smaller-size transcripts. The amount of the normal-size transcripts in his cultured skin fibroblasts was 19% of the normal level. His serum copper and ceruloplasmin levels were normal, whereas his cultured skin fibroblasts contained increased levels of copper. These findings indicate that his mild clinical manifestations were due to the presence of normal-size and presumably functional transcripts of the gene. DNA sequencing analysis of the exons and 5'-upstream region of the ATP7A gene in 20 normal individuals and the 19 affected males identified 25 polymorphisms.

Adsorption effect of activated charcoal on enterohemorrhagic Escherichia coli

The adsorption property of activated charcoal on verotoxin (VT)-producing Escherichia coli (VTEC) was examined using E. coli O157:H7. In the present study, E. coli O157:H7 strains were effectively adsorbed by activated charcoal. Adsorption was dose-dependent, and the maximum adsorption occurred within 5 min. At 10 mg of activated charcoal, bacteria tested were completely adsorbed. Activated charcoal also had the capacity to adsorb toxin (verotoxin 2) activity from the bacterial extract. Furthermore, the adsorption efficiency of activated charcoal for the normal bacterial flora in the intestine was assessed using Enterococcus faecium, Bifidobacterium thermophilum, and Lactobacillus acidophilus. Activated charcoal showed lower binding capacity to the normal bacterial flora tested than that to E. coli O157:H7 strains. These results suggest that activated charcoal could be a good adsorbent system for the removal of VTEC and verotoxin.

Molecular analysis of Wilson disease in Taiwan: identification of one novel mutation and evidence of haplotype-mutation association

Wilson disease (WND) is caused by a deficiency of the copper-transporting enzyme, P-type ATPase (ATP7B). Twelve different mutations have previously been identified in Taiwan Chinese with Wilson disease. We, herein, report another 4 missense mutations, 1 of which is novel. We did haplotype analysis of Taiwanese WND chromosomes, using three well characterized short tandem repeat markers (haplotype was assigned in the order of D13S314-D13S301-D13S316). Association correlation was found between the mutations and their respective haplotypes. Haplotype-deduced pedigree analysis was shown to be helpful in the mutation analysis of WND chromosomes and in the molecular assessment of both pre-symptomatic WND patients and carriers. Given the complexity and heterogeneity of the mutation spectrum of ATP7B, we suggest that haplotype analysis should be performed before full-scale mutation analysis.

Inhibition of Vero cell cytotoxic activity in Escherichia coli O157:H7 lysates by globotriaosylceramide, Gb3, from bovine milk

In order to clarify the presence and verotoxin (VT) inhibitory activity of globotriaosylceramide (Gb3) in bovine milk, we analyzed neutral glycosphingolipids (GSLs) from bovine milk and investigated the inhibitory effect of bovine milk Gb3 on the cytotoxicity of VT2. Five species of neutral GSLs, designated as N-1, N-2, N-3, N-4, and N-5, were separated on thin-layer chromatography (TLC). N-1, N-2, and N-3 showed the same mobility as glucosylceramide, lactosylceramide, and Gb3 on the TLC plate, respectively. N-4 and N-5 GSLs migrated below globoside on the TLC plate. N-3 GSL having the same TLC mobility as Gb3 from bovine milk was immunologically identified as Gb3 by monoclonal antibody against Gb3, anti-CD77 monoclonal antibody. Furthermore, the effect of bovine milk Gb3 on VT2-induced cytotoxicity was investigated. We found that treatment of VT2 with bovine milk Gb3 can reduce the cytotoxic effect of VT2.

Obesity, body fat distribution and coronary atherosclerosis among Japanese men and women

OBJECTIVE

To investigate the relation of the obesity and body-fat distribution with angiographically defined coronary atherosclerosis.

DESIGN

Cross-sectional study in a clinical setting.

SUBJECTS

Three hundred and twenty men (median age, 59 y) and 212 women (median age, 67 y) who underwent coronary angiography for suspected or known coronary heart disease at 5 cardiology departments between September 1996 and August 1997. Patients with disease duration >1 y were excluded.

MEASUREMENTS

The body mass index (BMI) and the waist to hip circumference ratio (WHR) were used as main exposure variables, and either the presence of significant coronary stenosis or the Gensini's score (> or =10 vs<10) as an outcome variable, in a sex-specific multiple logistic regression analysis controlling for age, hospital, and other coronary risk factors.

RESULTS

Among male patients, BMI was progressively higher with an increasing number of vessels involved (P trend=0.05); the adjusted odds ratios for the presence of significant stenosis across quartiles of BMI were 1.0 (reference), 1.1, 1.9 and 2.5 (P trend=0.02), and the positive association was more pronounced for younger patients. Among females, however, such associations were not evident. Employing the Gensini's score as an outcome gave similar results. WHR was not significantly associated with either outcome regardless of sex.

CONCLUSION

These results suggested that BMI was predictive of coronary stenosis among male patients, but not among female patients. Unlike most previous studies, this study failed to detect a positive association with WHR.

Effect of six compounds isolated from rhizome of Anemone raddeana on the superoxide generation in human neutrophil

The effect of six compounds isolated from rhizome of Anemone raddeana on the superoxide generation in human neutrophils was investigated. The six compounds examined were 3-acetyloleanolic acid (AOA), oleanolic acid (OA), eleutheroside K (EK), oleanolic acid-3-O-alpha-L-rhamnopyranosyl-(1 --> 2)-[beta-D-glucopyranosyl-(1 --> 4)]-alpha-L-arabinopyranoside (Rd10), raddeanoside 12 (Rd12) and raddeanoside 13 (Rd13). AOA, OA, Rd12 and Rd13 suppressed the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) in a concentration-dependent manner. EK and Rd10 significantly enhanced the fMLP-induced superoxide generation in a specific narrow range of low concentration (0.5-0.75 microM), while these compounds more efficiently suppressed the superoxide generation than the other four compounds in other concentrations. In the case of superoxide generation induced by phorbol 12-myristate 13-acetate (PMA), Rd12, OA, EK and Rd10 dose-dependently suppressed the superoxide generation but AOA and Rd13 gave no effect. Arachidonic acid-induced superoxide generation was suppressed by EK, Rd10, Rd12 and Rd13, but was weakly enhanced by AOA and OA. Rd12 dose-dependently inhibited fMLP-induced tyrosyl phosphorylation of 123.0, 79.4, 60.3, 56.2 and 50.1 kDa proteins in human neutrophil. On the other hand, RD10 and EK enhanced the tyrosyl phosphorylation of these proteins in a low concentration range. These phenomena were parallel to the suppression of the fMLP-induced superoxide generations.

Temperature-dependent translational regulation of the ER omega-3 fatty acid desaturase gene in wheat root tips

The proportion of alpha-linolenic acid (18:3) among the total fatty acids in root tissue increases as the growth temperature decreases. Endoplasmic reticulum omega-3 fatty acid desaturase is responsible for the production of most of the 18:3 in root tissue. In this study, the effect of temperature on expression of the TaFAD3 gene, which encodes endoplasmic reticulum omega-3 desaturase in wheat (Triticum aestivum L. cv. Chihoku), was analysed at the mRNA and protein levels. In wheat root tips grown at 30 and 10 degrees C, the proportions of 18:3 among total fatty acids were 22% and 55%, respectively. The level of TaFAD3 protein in microsomal preparations of the root tips grown at 10 degrees C was approximately 7.5 times higher than that of the root tips grown at 30 degrees C. The increased level of TaFAD3 protein at the lower temperature was accompanied by enhanced association of TaFAD3 mRNA with polyribosomes. In contrast, the level of TaFAD3 mRNA in root tips grown at 10 degrees C was slightly higher than in those grown at 30 degrees C. These results suggest that, in root tips, the increase in the 18:3 level at low temperature is achieved directly by an increase in the amount of TaFAD3 protein, and that temperature-dependent translational regulation of the TaFAD3 gene, rather than its transcriptional regulation, contributes to modulation of the TaFAD3 protein accumulation.

Inhibitory effect of intestinal anti-Gb3 IgA antibody on verotoxin-induced cytotoxicity

The effect of intestinal IgA antibody against the receptor for verotoxin (VT), globotriaosylceramide (Gb3), on VT-mediated cytotoxicity was examined. Intestinal IgA antibodies against Gb3 were prepared by oral immunization of mice with Gb3 and adjuvant monophosphoryl lipid A (MPL)-containing liposomes composed of dipalmitoylphosphatidylcholine, dipalmitoylphosphatidylserine and cholesterol (1 : 1 : 2, molar ratio) (PS-liposome). Oral administration with Gb3 and MPL-containing PS-liposome induced significant IgA responses to Gb3 in the intestinal lavage fluid in all mice tested. Furthermore, anti-Gb3 IgA antibodies in the lavage fluid effectively inhibited the cytotoxicity of VT2 to Vero cells in a dose-dependent manner. These results suggest that anti-Gb3 IgA antibodies produced in the intestinal tract, upon oral immunization with Gb3-containing liposome, function as inhibitors against VT and also indicate the potential usefulness of oral PS-liposome vaccines containing MPL for the induction of a protective mucosal immune response against intestinal diseases.

Temperature-dependent translational regulation of the ER omega-3 fatty acid desaturase gene in wheat root tips

The proportion of alpha-linolenic acid (18:3) among the total fatty acids in root tissue increases as the growth temperature decreases. Endoplasmic reticulum omega-3 fatty acid desaturase is responsible for the production of most of the 18:3 in root tissue. In this study, the effect of temperature on expression of the TaFAD3 gene, which encodes endoplasmic reticulum omega-3 desaturase in wheat (Triticum aestivum L. cv. Chihoku), was analysed at the mRNA and protein levels. In wheat root tips grown at 30 and 10 degrees C, the proportions of 18:3 among total fatty acids were 22% and 55%, respectively. The level of TaFAD3 protein in microsomal preparations of the root tips grown at 10 degrees C was approximately 7.5 times higher than that of the root tips grown at 30 degrees C. The increased level of TaFAD3 protein at the lower temperature was accompanied by enhanced association of TaFAD3 mRNA with polyribosomes. In contrast, the level of TaFAD3 mRNA in root tips grown at 10 degrees C was slightly higher than in those grown at 30 degrees C. These results suggest that, in root tips, the increase in the 18:3 level at low temperature is achieved directly by an increase in the amount of TaFAD3 protein, and that temperature-dependent translational regulation of the TaFAD3 gene, rather than its transcriptional regulation, contributes to modulation of the TaFAD3 protein accumulation.

Regulation of early chicken thymocyte proliferation by transforming growth factor-beta from thymic stromal cells and thymocytes

We examined expression of TGF-betas in chicken thymic stromal cells and thymocytes and roles of TGF-betas in thymocyte development within the thymus. Thymic stromal cells expressed TGF-beta 2 and 3 genes but not TGF-beta 4 gene. Thymocytes showed expressions of TGF-beta 2, 3 and 4 genes and each TGF-beta gene was expressed more strongly in CD3- than CD3+ thymocytes. When anti-TGF-beta antibody was added with supernatants of stromal cells into thymocyte culture, only proliferative activity of CD3- thymocytes was enhanced and the cells in S and G2/M compartments of cell cycle increased. These results suggest that TGF-beta which is expressed in the thymus may regulate the ability of immature thymocytes to progress through the cell cycle and to differentiate to CD3+ thymocytes.

Effects of intrauterine IL-6 and IL-8 on the expression of surfactant apoprotein mRNAs in the fetal rat lung

OBJECTIVE

The purpose of this study was to investigate the effect of interleukin-6 (IL-6) and interleukin-8 (IL-8), whose concentrations are elevated with chorioamnionitis, on the expression of surfactant apoprotein mRNAs in fetal rat lung.

STUDY DESIGN

We employed an animal model in which we were able to administer substances continuously into the cavity between the fetal membranes and endometrium using a miniosmotic pump. Lipopolysaccharide (LPS), IL-6, or IL-8 was administered to timed pregnant rats for 3 days (day 16-19), and fetal lung expression of surfactant apoprotein mRNAs for SP (surfactant apoprotein)-A, SP-B, and SP-C was evaluated by Northern blot hybridization.

RESULTS

Continuous administration of LPS increased the expression of each surfactant apoprotein mRNA, but the expression of mRNAs was not dose-dependent. On the other hand, continuous IL-6 or IL-8 administration increased the expression of each surfactant apoprotein mRNA in a dose-dependent manner.

CONCLUSION

Fetal lung maturation may be promoted by either IL-6 or IL-8 produced in response to chorioamnionitis.

In vivo binding characteristics of phenytoin to serum proteins in monotherapy for adults with epilepsy

The aim of the present study was to determine the binding characteristics of phenytoin (PHT) to serum proteins in the adults. Binding parameters of PHT to serum proteins in our study were compared with in vivo or in vitro binding parameters of PHT to serum proteins reported by other investigators. Serum samples in the study were obtained from 36 adult patients (17 men, 19 women) receiving PHT monotherapy. A total of 43 steady-state concentrations were analyzed in the study. Patients' age ranged from 16 to 73 years (mean [SD], 42.9 [14.7] years). The in vivo population binding parameters of PHT to serum proteins and theoretical minimal unbound serum PHT fraction (fu) were determined using an equation derived from the Scatchard equation. The association constant (K) was 0.014 L x micromol(-1), whereas the total concentration of binding sites (n(Pt)) was 754 micromol x L(-1). The number of binding sites per albumin molecule (n) was 1.16, whereas binding ability (n.K) was 0.016 L x micromol(-1). The fu was 0.087. The n.K is approximately 1.2 times higher in PHT monotherapy patients of Pospísil and Perlík (ie, 0.0191 L x micromol(-1)) than in all our patients. The association constant is approximately 1.3 times higher in the in vitro study of Monks et al (ie, 0.0186 L x micromol(-1)) than in our study, whereas n is similar between the two studies. The fu in our patients is similar to the unbound serum PHT fraction in patients receiving PHT therapy reported by Richens (ie, 0.1). Our results suggest that there may be small differences in the binding affinity of PHT to serum proteins between in vivo and in vitro studies. The unbound serum fraction of PHT in epileptic patients can be assumed to be relatively constant in the therapeutic concentration range of PHT.