Potential savings involved in the purchase of low-cost, high-volume medical commodities as established from a community hospital survey

Health technology refers to the instruments, equipment, drugs and procedures used in health care delivery, as well as the organizations supporting it. Health technology assessment, which is the process of conducting investigations to establish the criteria for efficacious, effective and efficient patient care, is becoming increasingly important in an era of diminishing resources. This survey of 39 community hospitals in southwestern Ontario found that improved purchasing strategies can result in substantial cost savings which can in turn be used to improve patient care. The study shows that optimizing the price of basic hospital commodities could save an average community hospital as much as $625,000 per year.

DNA topoisomerase II alpha expression is associated with alkylating agent resistance

Increased expression of DNA topoisomerase II alpha has been associated with resistance to certain DNA-damaging alkylating agents, but no causal relationship or mechanism has been established. To investigate this observation, we developed a model of topoisomerase II overexpression by transfecting a full-length Chinese hamster ovary topoisomerase II alpha into EMT6 mouse mammary carcinoma. Topoisomerase II alpha-transfected cell lines demonstrated continued topoisomerase II alpha mRNA and protein expression, which were undetectable in vector-only lines, in stationary phase (G0-G1). The topoisomerase II transfectants were approximately 5-10-fold resistant to the alkylating agents cisplatin and mechlorethamine. Upon release from G0-G1, the topoisomerase II transfectants demonstrated more rapid thymidine incorporation and shorter cell-doubling times than control cells. Purified topoisomerase II and nuclear extracts with topoisomerase II-decatenating activity bound to cisplatin-treated DNA with significantly greater affinity than to untreated DNA in a cisplatin concentration-dependent manner. These observations suggest that expression of topoisomerase II alpha may have a role in cellular resistance to antineoplastic alkylating agents. The mechanism for this may involve increased binding of topoisomerase II alpha to alkylating agent-damaged DNA.

Molecular cloning and characterization of the promoter for the Chinese hamster DNA topoisomerase II alpha gene

To investigate the mechanisms governing the expression of DNA topoisomerase II alpha, the Chinese hamster topoisomerase II alpha gene has been cloned and the promoter region analyzed. There are several transcriptional start sites clustered in a region of 30 base pairs, with the major one being 102 nucleotides upstream from the ATG translation initiation site. Sequencing data reveal one GC box and a total of five inverted CCAAT elements (ICEs) within a region of 530 base pairs upstream from the major transcription start site. Sequence comparison between the human and Chinese hamster topoisomerase II alpha gene promoter regions shows a high degree of homology centered at the ICEs and GC box. In vitro DNase I footprinting results indicate protection by binding proteins at and around each ICE on both DNA strands. However, no obvious protection was observed for the GC box. Competition gel mobility shift assays with oligonucleotides containing either the wild-type or mutated ICE sequences suggest that identical or similar proteins specifically bind at each ICE, although with different affinities for individual ICE sequences. Chloramphenicol acetyltransferase assays employing nested 5'-deletions of the 5'-flanking sequence of the gene demonstrate that the sequence between -186 and +102, which contains three proximal ICEs, is sufficient for near wild-type level of promoter activity. When these three ICEs were gradually replaced with sequences which do not interact with the binding proteins, reducing promoter activity of the resulted constructs was observed. In conjunction with results from footprinting and gel mobility shift studies, the transient gene expression finding suggests that the ICEs are functionally important for the transcriptional regulation of the topoisomerase II alpha gene.

Molecular cloning and identification of a point mutation in the topoisomerase II cDNA from an etoposide-resistant Chinese hamster ovary cell line

Topoisomerase II (Top II) is the target enzyme for many antineoplastic drugs such as epipodophyllotoxins, anthracyclines, and acridines. Cell lines with alterations in Top II are resistant to drugs that interact with the enzyme. Studies of the Top II from a Chinese hamster ovary line, VpmR-5, that is resistant to VP-16 and VM-26, demonstrated that it is very similar, qualitatively and quantitatively, to its normal counterpart except that DNA cleavage by the VpmR-5 enzyme is not stimulated by VP-16 or VM-26. To understand the basis for the drug-resistant phenotype, the Top II cDNAs were isolated from both Chinese hamster ovary (CHO) and VpmR-5 cells by cDNA cloning with lambda gt22, and the entire cDNAs were sequenced. A mutation of G-->A at nucleotide 1478 was the only alteration observed in the VpmR-5 Top II cDNA compared with the wild-type gene. The mutation in VpmR-5 was confirmed by sequencing DNA fragments amplified from the genomic DNA by the polymerase chain reaction. Southern blot hybridization analysis of genomic DNA demonstrated loss of a Top II allele in VpmR-5 probably occurred during the development of resistance to etoposide. The mutation in VpmR-5 changes amino acid 493 from arginine to glutamine and is located adjacent to a putative ATP binding site of Top II. Mutations in an analogous region have been identified in two human leukemia cell lines by amplification of segments of Top II cDNA with Taq DNA polymerase. Taken together, these observations suggest that mutations in this region of the gyrase B domain of mammalian topoisomerase II may be capable of conferring resistance to antineoplastic agents that interact with this enzyme.

Molecular characterization of a putative peroxidase gene of Drosophila melanogaster

We have identified genomic clones and corresponding cDNAs that encode a putative peroxidase of Drosophila melanogaster. The gene (DmPO) appears as a single copy gene located on the third chromosome at position 89 D/E. It is interrupted by seven small introns and one unusually large 5' intron (about 11 kb). Sequence analysis of the cDNA showed an open reading frame of 690 amino acids resulting in a protein of 77 kDa. The deduced amino acid sequence reveals an overall homology to myeloeosinophil and thyroid peroxidase, a human superfamily of peroxidases.

The reversal of effects of methotrexate on toxicity and glucose transport reduction by thymidine in Ehrlich ascites tumor bearing mice

Methotrexate (MTX) suppressed the growth of Ehrlich ascites tumor cells in vivo and reduced the cellular uptake of glucose and the density of glucose transporters on the tumor cell surface. MTX inhibition of tumor growth was partially prevented by concurrent administration of thymidine. At the same time, the rate of cellular glucose uptake, the density of glucose transporters on the cell as well as the extent of thymidine, uridine and leucine incorporation were significantly increased.

Prevention by thymidine against toxicity and glucose uptake inhibition of methotrexate on cultured Ehrlich ascites tumour cells

Methotrexate (MTX) arrested cell growth and inhibited 2-deoxy-D-glucose uptake of Ehrlich ascites tumour cells in vitro. The changes of glucose concentrations in the culture media did not affect the degree of suppression of cell growth by MTX. Thymidine (dThd) protected against the toxic effect of MTX on the cells. It also prevented the inhibition effect on glucose uptake of the cells by MTX. MTX significantly suppressed the maximal uptake rate of glucose (Vmax) while addition of dThd alleviated the suppression. The half-saturation constant of the uptake (Km) remained constant.

Suppression of glucose transport of Ehrlich ascites tumour cell by interferon inducers

Polyriboinosinic-polyribocytidylic acid, statolon and tilorone arrested the growth of Ehrlich ascites tumour cells in vivo. They inhibited cellular glucose uptake and the density of glucose carriers on the cell surface of tumour cells. In both drug-treated and untreated cells, no qualitative change in the turnover and affinity for substrate of the glucose carrier of the tumour cells was observed. The role of interferon inducer on the change of glucose transport of tumour cells is discussed.

Effect of tumour necrosis factor on growth of Ehrlich ascites tumour cells in vitro and in vivo

Tumour necrosis factor (TNF) suppressed the growth of Ehrlich ascites tumour (EAT) cells in vitro and in vivo. Exposure of EAT cells to TNF for as little as 4 h totally abolished the transplantability of the tumour. At the same time, the rate of glucose uptake and extent of leucine incorporation were significantly reduced. Prolonged treatment with TNF resulted in extensive cell lysis, as determined by trypan blue exclusion and by release of radioactivity from [3H]thymidine-labelled EAT cells. The significance of these observations are discussed.