Bromo- and glycosyl-substituted BODIPYs for application in photodynamic therapy and imaging

The introduction of heavy atoms into the BODIPY-core structure has proven to be a straightforward strategy for optimizing the design of such dyes towards enhanced generation of singlet oxygen rendering them suitable as photosensitizers for photodynamic therapy (PDT). In this work, BODIPYs are presented by combining the concept of bromination with nucleophilic aromatic substitution (S_NAr) of a pentafluorophenyl or a 4-fluoro-3-nitrophenyl moiety to introduce functional groups, thus improving the phototoxic effect of the BODIPYs as well as their solubility in the biological environment. The nucleophilic substitution enabled functionalization with various amines and alcohols as well as unprotected thiocarbohydrates. The phototoxic activity of these more than 50 BODIPYs has been assessed in cellular assays against four cancer cell lines in order to more broadly evaluate their PDT potential, thus accounting for the known variability between cell lines with respect to PDT activity. In these investigations, dibrominated polar-substituted BODIPYs, particularly dibrominated glyco-substituted compounds, showed promising potential as photomedicine candidates. Furthermore, the cellular uptake of the glycosylated BODIPYs has been confirmed via fluorescence microscopy.

Dipyrrinato-Iridium(III) Complexes for Application in Photodynamic Therapy and Antimicrobial Photodynamic Inactivation

The generation of bio-targetable photosensitizers is of utmost importance to the emerging field of photodynamic therapy and antimicrobial (photo-)therapy. A synthetic strategy is presented in which chelating dipyrrin moieties are used to enhance the known photoactivity of iridium(III) metal complexes. Formed complexes can thus be functionalized in a facile manner with a range of targeting groups at their chemically active reaction sites. Dipyrrins with N- and O-substituents afforded (dipy)iridium(III) complexes via complexation with the respective Cp*-iridium(III) and ppy-iridium(III) precursors (dipy=dipyrrinato, Cp*=pentamethyl-η5 -cyclopentadienyl, ppy=2-phenylpyridyl). Similarly, electron-deficient [IrIII (dipy)(ppy)2 ] complexes could be used for post-functionalization, forming alkenyl, alkynyl and glyco-appended iridium(III) complexes. The phototoxic activity of these complexes has been assessed in cellular and bacterial assays with and without light; the [IrIII (Cl)(Cp*)(dipy)] complexes and the glyco-substituted iridium(III) complexes showing particular promise as photomedicine candidates. Representative crystal structures of the complexes are also presented.

Lipid-DNAs as Solubilizers of mTHPC

Hydrophobic drug candidates require innovative formulation agents. We designed and synthesized lipid-DNA polymers containing varying numbers of hydrophobic alkyl chains. The hydrophobicity of these amphiphiles is easily tunable by introducing a defined number of alkyl chain-modified nucleotides during standard solid-phase synthesis of DNA using an automated DNA synthesizer. We observed that the resulting self-assembled micelles solubilize the poorly water-soluble drug, meta-tetra-hydroxyphenyl-chlorin (mTHPC) used in photodynamic therapy (PDT) with high loading concentrations and loading capacities. A cell viability study showed that mTHPC-loaded micelles exhibit good biocompatibility without irradiation, and high PDT efficacy upon irradiation. Lipid-DNAs provide a novel class of drug-delivery vehicle, and hybridization of DNA offers a potentially facile route for further functionalization of the drug-delivery system with, for instance, targeting or imaging moieties.

Antimicrobial peptide-modified liposomes for bacteria targeted delivery of temoporfin in photodynamic antimicrobial chemotherapy

Photodynamic antimicrobial chemotherapy (PACT) and antimicrobial peptides (AMPs) are two promising strategies to combat the increasing prevalence of antibiotic-resistant bacteria. To take advantage of these two strategies, we integrated a novel antimicrobial peptide (WLBU2) and a potent generation II photosensitizer (temoporfin) into liposomes by preparing WLBU2-modified liposomes, aiming at bacteria targeted delivery of temoporfin for PACT. WLBU2 was successfully coupled to temoporfin-loaded liposomes using a functional phospholipid. The delivery of temoporfin to bacteria was confirmed by fluorescence microscopy and flow cytometry, thus demonstrating that more temoporfin was delivered to bacteria by WLBU2-modified liposomes than by unmodified liposomes. Consequently, the WLBU2-modified liposomes eradicated all methicillin-resistant Staphylococcus aureus (MRSA) and induced a 3.3 log(10) reduction of Pseudomonas aeruginosa in the in vitro photodynamic inactivation test. These findings demonstrate that the use of AMP-modified liposomes is promising for bacteria-targeted delivery of photosensitizers and for improving the PACT efficiency against both gram-positive and gram-negative bacteria in the local infections.

The DNA topoisomerase IIbeta binding protein 1 (TopBP1) interacts with poly (ADP-ribose) polymerase (PARP-1)

We investigated the physical association of the DNA topoisomerase IIbeta binding protein 1 (TopBP1), involved in DNA replication and repair but also in regulation of apoptosis, with poly(ADP-ribose) polymerase-1 (PARP-1). This enzyme plays a crucial role in DNA repair and interacts with many DNA replication/repair factors. It was shown that the sixth BRCA1 C-terminal (BRCT) domain of TopBP1 interacts with a protein fragment of PARP-1 in vitro containing the DNA-binding and the automodification domains. More significantly, the in vivo interaction of endogenous TopBP1 and PARP-1 proteins could be shown in HeLa-S3 cells by co-immunoprecipitation. TopBP1 and PARP-1 are localized within overlapping regions in the nucleus of HeLa-S3 cells as shown by immunofluorescence. Exposure to UVB light slightly enhanced the interaction between both proteins. Furthermore, TopBP1 was detected in nuclear regions where poly(ADP-ribose) (PAR) synthesis takes place and is ADP-ribosylated by PARP-1. Finally, cellular (ADP-ribosyl)ating activity impairs binding of TopBP1 to Myc-interacting zinc finger protein-1 (Miz-1). The results indicate an influence of post-translational modifications of TopBP1 on its function during DNA repair.

A fluorogenic substrate as quantitative in vivo reporter to determine protein expression and folding of tobacco etch virus protease in Escherichia coli

Quantitative and folding reporters are adequate tools to optimize recombinant protein expression in various host organisms, including Escherichia coli. To determine the yield of soluble active protease from the tobacco etch virus (TEV), we developed a single-molecule assay based on the fluorogenic substrate ANA-QS-MCA. This substrate consists of a 10 amino acid peptide (ENLYFQSGTK) containing the proteolytic cleavage sequence of the TEV protease. The peptide works as a linker N-terminally tagged with a fluorescent donor group (7-Methoxycoumarin-4-yl)acetyl (MCA) and C-terminally tagged with the acceptor group 5-Amino-2-nitrobenzoic acid (ANA). Fluorescence can be observed after specific cleavage of the substrate at the Gln-Ser bond by active TEV protease. Purified His-tagged TEV protease was used for in vitro analysis. Through determination of proteolytic activity in living E. coli cells and through application of Confocal Laser-Scanning-Microscopy we demonstrate that the peptide is well suited to in vivo expression analysis. This provides an effective tool to monitor the accumulation of active recombinant TEV protease in crude extracts and intact cells.

Early growth response proteins EGR-4 and EGR-3 interact with immune inflammatory mediators NF-κB p50 and p65

Here, we characterize the basis for the T-cell-specific activity of the human zinc-finger protein early growth response factor 4 (EGR-4). A yeast two-hybrid screen showed interaction of EGR-4 with NF-κB p50. Using recombinant proteins, stable physical complex formation was confirmed for EGR-4 and EGR-3 with p50 and with p65 using glutathione-S-transferase pull-down assays and surface-plasmon-resonance and peptide-spot analyses. In vivo interaction of EGR-4 and EGR-3 with NF-κB p65 was demonstrated by immunoprecipitation experiments and fluorescence-resonance-energy transfer (FRET) analysis showing interaction in the nucleus of transfected Jurkat T cells. In transfection assays, EGR-p50 complexes were transcriptionally inactive and EGR-p65 complexes strongly activated transcription of the promoters of the human genes encoding the cytokines interleukin 2, tissue necrosis factor α and ICAM-1. The EGR-p65 complexes increased reporter-gene activity about 100-fold and thus exceeded the transcriptional activities of the p65 homodimer and the p65/p50 heterodimers. The major interaction domain for p65 was localized within the third zinc finger of EGR-4 using deletion mutants for pull-down assays and peptide-spot assays. By computer modeling, this interaction domain was localized to an α-helical region and shown to have the central amino acids surface exposed and thus accessible for interaction. In summary, in T cells, the two zinc-finger proteins EGR-4 and EGR-3 interact with the specific nuclear mediator NF-κB and control transcription of genes encoding inflammatory cytokines.

Ethnicity and decision-makers in a group of frail older people

OBJECTIVE

To assess the relationship between ethnicity and decision-makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All-inclusive Care for the Elderly (PACE).

DESIGN

A retrospective chart review of 1193 participants in the PACE program.

SETTING

Program of All-inclusive Care for the Elderly, a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.

PARTICIPANTS

A total of 1193 older adults, all of whom met state criteria for nursing home level of care. Three hundred were non-Hispanic whites, 364 were black, 156 were Hispanic, and 288 were Asian.

MEASUREMENTS

Demographic characteristics of the patients and the presence or absence of an alternative decision-maker; the characteristics of alternative decision-makers included the relationship to the participant as recorded in the patient's medical record.

RESULTS

Ninety-one percent of white patients expressed their own healthcare wishes in contrast to only 85% of Hispanic, 83% of Asian, and 67% of black patients. An alternative decision-maker was identified for about 15% of Asians and Hispanics and for one-third of blacks, but only about 8% of whites had an alternative decision-maker. Black and Hispanic patients were most likely to have a daughter as an alternative decision-maker, Asians were most likely to have a son, and whites patients were most likely to have a spouse as an alternative decision-maker. Blacks, particularly black men, were the most likely to have a relative other than a spouse or child as an alternative decision-maker.

CONCLUSIONS

In this population, we found significant ethnic variation in the person identified to be the decision-maker in a group of frail older people. Ethnic variation reflected sociodemographic as well as cultural differences. However, there are important limitations to this study, and caution should be used in extrapolating the results to other populations or in attributing the results to ethnicity alone. An awareness of cross-cultural patterns in identified or de facto decision-makers can be significant for healthcare workers when they approach patients and their families about issues surrounding end of life decisions.

[Preserving of independence: effectiveness of multi-dimensional geriatric assessment]

Comprehensive geriatric assessment (CGA) is defined as the process of determining an elderly person's medical, psychosocial, functional, and environmental resources and problems, linked with an overall plan for treatment and follow-up. The principles of geriatric assessment, including the advantages and disadvantages of using quantitative instruments for multi-dimensional evaluation, are reviewed. The findings of a recently published meta-analysis on comprehensive geriatric assessment are discussed and its policy implications addressed. The meta-analysis includes data of 28 controlled trials comprising 4959 subjects allocated to one of five CGA types, and 4912 control subjects. Original investigators provided additional unpublished data from published reports to supplement the data base of this meta-analysis. The combined odds ratios of outcomes in CGA-assessed patients versus control patients were obtained by pooling data from individual trials with a multivariate logistic regression approach. The combined odds ratio (95% confidence interval) of home survival at 1 to 4-year follow-up was 1.7 (1.2-2.3) for inpatient geriatric evaluation and management units, 1.5 (1.1-2.0) for post-discharge home assessment services, and 1.2 (1.1-1.4) for preventive in-home assessment services. Based on these research findings, the establishment of interdisciplinary units with staff trained in multidimensional geriatric assessment for inpatient evaluation and management of frail elderly patients, is recommended. In addition, research to improve geriatric assessment technology and promote its integration into primary care has a great potential for disability prevention and nursing home use reduction in older persons.

Comprehensive geriatric assessment: a meta-analysis of controlled trials

There is disagreement on the usefulness of comprehensive geriatric assessment (CGA) due to conflicting results from individual trials. We did a meta-analysis on 28 controlled trials comprising 4959 subjects allocated to one of five CGA types and 4912 controls. Published data were supplemented with reanalysed data provided by the original investigators. We calculated combined odds ratios of important outcomes by pooling data from individual trials with multivariate logistic regression. Combined odds ratio (95% confidence interval) of living at home at follow-up was 1.68 (1.17-2.41) for geriatric evaluation and management units, 1.49 (1.12-1.98) for hospital-home assessment services, and 1.20 (1.05-1.37) for home assessment services. Covariate analysis showed that programmes with control over medical recommendations and extended ambulatory follow-up were more likely to be effective. Our analysis suggests that CGA programmes linking geriatric evaluation with strong long-term management are effective for improving survival and function in older persons.

Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status

This article presents results of a prospective multivariate study of hospitalized elderly patients at an acute-care Veterans Administration (VA) hospital to identify factors on hospital admission predictive of several short- and long-term outcomes: in-hospital and 6-month mortality, immediate and delayed nursing home admission, length of hospital stay, and 6-month rehospitalization. All patients aged 70 years and over admitted to acute-care beds on the medical service wards during a 1-year period were included in the study (N = 396). Factors most predictive of 6-month mortality (using logistic regression) were decreased functional status, admitting diagnosis, and decreased mental status. Factors most predictive of nursing home admission were decreased functional status, living location, and decreased mental status. Functional status was a stronger predictor of length of stay, mortality, and nursing home placement than was principal admitting diagnosis--of relevance to the current emphasis on diagnosis-related groups (DRGs). These data may be helpful in improving discharge planning, in resource allocation, and in targeting patients for different specialized geriatric programs.

Improved survival for frail elderly inpatients on a geriatric evaluation unit (GEU): who benefits?

Previously reported data from a randomized controlled trial showed that admission to the geriatric evaluation unit (GEU) and follow-up clinic at the Sepulveda VA Medical Center leads to significantly improved outcomes for frail elderly hospital patients--including a 50% reduction of one-year mortality (p less than 0.005). In the present paper, two-year survival curves for GEU and control groups are reported. In addition, we subdivided the population by potential baseline risk factors (both patient- and treatment-related) and examined one-year survival using 12-month survival curves and odds ratios. There is evidence for GEU-related survival effects in specific subgroups of patients (e.g. patients with heart and pulmonary disease, patients with low baseline scores in functional status and mental status, and patients with high baseline morale scores). Finally, employing stepwise logistic regression, we determined the predictors of one-year survival in the pooled study population. These factors were: assignment to the GEU (adjusted odds ratio = 2.45; p less than 0.001); not having a heart diagnosis (2.24; p less than 0.001); and having primarily "geriatric/rehabilitation" problems (1.95; p less than 0.005). A predictive model derived from the regression defines patient subgroups likely to survive only when assigned to the GEU: cardiac patients with primarily "geriatric" or "rehabilitation" problems, and non-cardiac patients whose problems are primarily "medical". The dramatic effect of the GEU on survival appears to be concentrated on certain identifiable subgroups of patients who might be targeted to maximize program cost-effectiveness.

Geriatric assessment on a subacute hospital ward

The authors collected data on all patients admitted to the Sepulveda Veterans Administration Geriatric Evaluation Unit (GEU) during its first 6 years of operation. Analysis of these data indicate several beneficial effects associated with this type of specialized geriatric care: improved diagnostic accuracy, reduced use of drugs, improved functional status, and improved placement location. The authors also analyzed additional data from a previously published, randomized controlled trial to compare better process of care between patients randomized to the GEU and those receiving usual services. During their initial hospitalizations, GEU patients received significantly more specialty evaluations than controls (4.9 versus 1.7, p less than .001), had longer lengths of stay (85.1 days versus 44.3 days, p less than .001), had more new diagnoses discovered (2.9 versus 0.6, p less than .001), and had more drugs discontinued from their regimens (4.6 versus 2.3 p less than .001). These process differences were probably related to the previously reported outcome differences: GEU patients were more likely than controls to show improvements in functional status, affect, placement location, use of institutional services, and survival.

Differential prognosis and utilization patterns among clinical subgroups of hospitalized geriatric patients

While screening elderly inpatients on acute Veterans Administration (VA) hospital wards for a special geriatric program, we prospectively classified all patients age 65 and over, who had been hospitalized at least a week, into five clinical subgroups using specific diagnostic, prognostic, and functional criteria. These five subgroups were "geriatric evaluation unit (GEU) candidate", "severely demented", "medical", "terminal", and "independent". Medical record data from the initial admission and a full year of follow-up were collected from random samples of each subgroup and of nonscreened patients who had been hospitalized for less than a week. Analysis revealed that each subgroup had a distinctive pattern of survival, living location, and use of institutional services during the follow-up period. For one major subgroup ("GEU candidate"), a specific intervention (the GEU) has proved very effective in reducing mortality, increasing patient functioning, improving placement, and decreasing use of institutional services. Moreover, there are specific treatment and intervention strategies appropriate for each of the other subgroups (e.g., hospital-based home care, hospice, respite, and day treatment programs), although these services are not universally available nor clearly proved effective. The process of identifying patient subgroups illustrated in this study may be useful in needs assessment, in planning new intervention programs for frail elderly patients, and for identifying appropriate patients for these programs.

The development of health and social services for the elderly in Iceland: an overview

In the present paper, we provide a general overview of the changing position of the aged population in Iceland. After a long history of subsistence, Icelandic society has evolved only recently from pre-industrial conditions compared with other Western developed nations. The 1000-year preindustrial record is in large part one of a struggle for survival in which formal and informal measures to support the frail and disabled were often overwhelmed by disease and famine; this history is outlined to provide a baseline for recent changes. Both the speed and propinquity of Iceland's transition from these conditions have left a unique stamp on the present-day society: development has driven a quick elaboration of occupational roles and other social status shifts, vast health status improvements, and great population and urban growth. Public and personal health services have grown in scope and adequacy in comparatively recent decades, contributing to the now unsurpassed health status of the general population. The effect of these trends on the condition of elderly is described. As the birth rate in Iceland has dropped in recent decades, the proportion and number of Icelanders in the older and especially the oldest age-strata has been steadily rising. The current and planned organization of health and social services is reviewed, as Iceland faces new tasks of caring for elderly.

Effectiveness of a geriatric evaluation unit. A randomized clinical trial

We randomly assigned frail elderly inpatients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment, therapy, rehabilitation, and placement. Patients randomly assigned to the experimental (n = 63) and control (n = 60) groups were equivalent at entry. At one year, patients who had been assigned to the geriatric unit had much lower mortality than controls (23.8 vs. 48.3 per cent, P less than 0.005) and were less likely to have initially been discharged to a nursing home (12.7 vs. 30.0 per cent, P less than 0.05) or to have spent any time in nursing home during the follow-up period (26.9 vs. 46.7 per cent, P less than 0.05). The control-group patients had substantially more acute-care hospital days, nursing-home days, and acute-care hospital readmissions. Patients in the geriatric unit were significantly more likely to have improvement in functional status and morale than controls (P less than 0.05). Direct costs for institutional care were lower for the experimental group, especially after adjustment for survival. We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients, over and above the benefits of traditional hospital approaches.

Systematic biases in functional status assessment of elderly adults: effects of different data sources

Measuring functional status using specific instruments is an important part of geriatric assessment. These instruments, however, often rely on data sources different from those with which they were originally validated. To study possible biasing effects of different data sources on functional status scores, we examined scores for two widely used instruments (the Lawton Personal Self-Maintenance Scale, PSMS, and Instrumental Activities of Daily Living, IADL, Scale) on a group of hospitalized elderly (n = 61) using three different data sources (the patients themselves, the patients' nurses, and significant others). Analysis showed that PSMS scores derived from patients were significantly higher than scores derived from significant others (p less than .025) and that patient-derived IADL scores were significantly higher than both nurse-derived scores (p less than .001) and significant-other-derived scores (p less than .001). We also compared scores for a group of nursing home patients (n = 68) on the Katz Activities of Daily Living (ADL) Scale, using data obtained from patients and their nurses. Again, the patient-derived scores were significantly higher than those from nurses (p less than .001). We conclude that data sources for determining patient functional ability are not interchangeable and that patients may overstate their functional abilities, whereas significant others may understate them, relative to judgments of skilled nursing personnel.

Pinosylvin Methyl Ether Deters Snowshoe Hare Feeding on Green Alder

Pinosylvin methyl ether (PME), a toxic phenol, is a potent deterrent to showshoe hare feeding on green alder. Concentrations of PME found in green alder parts can account for the low palatability of winter-dormant foliar buds and staminate catkins but cannot affect internode palatability. The lack of a PME-related defense system in internodes suggests that green alder has at least a two-level defense system: defense of growth stages and defense of parts within growth stages.