How intramyocardial fat can alter the electric field distribution during Pulsed Field Ablation (PFA): Qualitative findings from computer modeling

Even though the preliminary experimental data suggests that cardiac Pulsed Field Ablation (PFA) could be superior to radiofrequency ablation (RFA) in terms of being able to ablate the viable myocardium separated from the catheter by collagen and fat, as yet there is no formal physical-based analysis that describes the process by which fat can affect the electric field distribution. Our objective was thus to determine the electrical impact of intramyocardial fat during PFA by means of computer modeling. Computer models were built considering a PFA 3.5-mm blunt-tip catheter in contact with a 7-mm ventricular wall (with and without a scar) and a 2-mm epicardial fat layer. High voltage was set to obtain delivered currents of 19, 22 and 25 A. An electric field value of 1000 V/cm was considered as the lethal threshold. We found that the presence of fibrotic tissue in the scar seems to have a similar impact on the electric field distribution and lesion size to that of healthy myocardium only. However, intramyocardial fat considerably alters the electrical field distribution and the resulting lesion shape. The electric field tends to peak in zones with fat, even away from the ablation electrode, so that 'cold points' (i.e. low electric fields) appear around the fat at the current entry and exit points, while 'hot points' (high electric fields) occur in the lateral areas of the fat zones. The results show that intramyocardial fat can alter the electric field distribution and lesion size during PFA due to its much lower electrical conductivity than that of myocardium and fibrotic tissue.

How far the zone of heat-induced transient block extends beyond the lesion during RF catheter cardiac ablation

PURPOSE

While radiofrequency catheter ablation (RFCA) creates a lesion consisting of the tissue points subjected to lethal heating, the sublethal heating (SH) undergone by the surrounding tissue can cause transient electrophysiological block. The size of the zone of heat-induced transient block (HiTB) has not been quantified to date. Our objective was to use computer modeling to provide an initial estimate.

METHODS AND MATERIALS

We used previous experimental data together with the Arrhenius damage index (Ω) to fix the Ω values that delineate this zone: a lower limit of 0.1-0.4 and upper limit of 1.0 (lesion boundary). An RFCA computer model was used with different power-duration settings, catheter positions and electrode insertion depths, together with dispersion of the tissue's electrical and thermal characteristics.

RESULTS

The HiTB zone extends in depth to a minimum and maximum distance of 0.5 mm and 2 mm beyond the lesion limit, respectively, while its maximum width varies with the energy delivered, extending to a minimum of 0.6 mm and a maximum of 2.5 mm beyond the lesion, reaching 3.5 mm when high energy settings are used (25 W-20s, 500 J). The dispersion of the tissue's thermal and electrical characteristics affects the size of the HiTB zone by ±0.3 mm in depth and ±0.5 mm in maximum width.

CONCLUSIONS

Our results suggest that the size of the zone of heat-induced transient block during RFCA could extend beyond the lesion limit by a maximum of 2 mm in depth and approximately 2.5 mm in width.

Is occlusion of the main pancreatic duct by thermal ablation really safe? A surgical innovation assessed according to IDEAL recommendations

INTRODUCTION

Pre-clinical studies suggest that thermal ablation of the main pancreatic duct (TAMPD) is more recommendable than glue for reducing postoperative pancreatic fistula (POPF). Our aims were (1) to analyze the changes in the pancreas of patients after TAMPD and (2) to correlate the clinical findings with those obtained from a study on an animal model.

MATERIALS AND METHODS

A retrospective early feasibility study of a marketed device for a novel clinical application was carried out on a small number of subjects (n = 8) in whom TAMPD was conducted to manage the pancreatic stump after a pancreatectoduodenectomy (PD). Morphological changes in the remaining pancreas were assessed by computed tomography for 365 days after TAMPD.

RESULTS

All the patients showed either Grade A or B POPF, which generally resolved within the first 30 days. The duct's maximum diameter significantly increased after TAMPD from 1.5 ± 0.8 mm to 8.6 ± 2.9 mm after 7 days (p = .025) and was then reduced to 2.6 ± 0.8 mm after 365 days PO (p < .0001). The animal model suggests that TAMPD induces dilation of the duct lumen by enzymatic digestion of ablated tissue after a few days and complete exocrine atrophy after a few weeks.

CONCLUSIONS

TAMPD leads to long-term exocrine pancreatic atrophy by completely occluding the duct. However, the ductal dilatation that occurred soon after TAMPD could even favor POPF, which suggests that TAMPD should be conducted several weeks before PD, ideally by digestive endoscopy.

In Silico Modelling to Assess the Electrical and Thermal Disturbance Provoked by a Metal Intracoronary Stent during Epicardial Pulsed Electric Field Ablation

Background: Pulsed Electric Field (PEF) ablation has been recently proposed to ablate cardiac ganglionic plexi (GP) aimed to treat atrial fibrillation. The effect of metal intracoronary stents in the vicinity of the ablation electrode has not been yet assessed. Methods: A 2D numerical model was developed accounting for the different tissues involved in PEF ablation with an irrigated ablation device. A coronary artery (with and without a metal intracoronary stent) was considered near the ablation source (0.25 and 1 mm separation). The 1000 V/cm threshold was used to estimate the ‘PEF-zone’. Results: The presence of the coronary artery (with or without stent) distorts the E-field distribution, creating hot spots (higher E-field values) in the front and rear of the artery, and cold spots (lower E-field values) on the sides of the artery. The value of the E-field inside the coronary artery is very low (~200 V/cm), and almost zero with a metal stent. Despite this distortion, the PEF-zone contour is almost identical with and without artery/stent, remaining almost completely confined within the fat layer in any case. The mentioned hot spots of E-field translate into a moderate temperature increase (<48 °C) in the area between the artery and electrode. These thermal side effects are similar for pulse intervals of 10 and 100 μs. Conclusions: The presence of a metal intracoronary stent near the ablation device during PEF ablation simply ‘amplifies’ the E-field distortion already caused by the presence of the vessel. This distortion may involve moderate heating (<48 °C) in the tissue between the artery and ablation electrode without associated thermal damage.

In-Silico Modeling to Compare Radiofrequency-Induced Thermal Lesions Created on Myocardium and Thigh Muscle

Beating heart (BH) and thigh muscle (TM) are two pre-clinical models aimed at studying the lesion sizes created by radiofrequency (RF) catheters in cardiac ablation. Previous experimental results have shown that thermal lesions created in the TM are slightly bigger than in the BH. Our objective was to use in-silico modeling to elucidate some of the causes of this difference. In-silico RF ablation models were created using the Arrhenius function to estimate lesion size under different energy settings (25 W/20 s, 50 W/6 s and 90 W/4 s) and parallel, 45° and perpendicular catheter positions. The models consisted of homogeneous tissue: myocardium in the BH model and striated muscle in the TM model. The computer results showed that the lesion sizes were generally bigger in the TM model and the differences depended on the energy setting, with hardly any differences at 90 W/4 s but with differences of 1 mm in depth and 1.5 m in width at 25 W/20 s. The higher electrical conductivity of striated muscle (0.446 S/m) than that of the myocardium (0.281 S/m) is possibly one of the causes of the higher percentage of RF energy delivered to the tissue in the TM model, with differences between models of 2–5% at 90 W/4 s, ~9% at 50 W/6 s and ~10% at 25 W/20 s. Proximity to the air–blood interface (just 2 cm from the tissue surface) artificially created in the TM model to emulate the cardiac cavity had little effect on lesion size. In conclusion, the TM-based experimental model creates fairly similar-sized lesions to the BH model, especially in high-power short-duration ablations (50 W/6 s and 90 W/4 s). Our computer results suggest that the higher electrical conductivity of striated muscle could be one of the causes of the slightly larger lesions in the TM model.

Computer modeling of radiofrequency cardiac ablation: 30 years of bioengineering research

This review begins with a rationale of the importance of theoretical, mathematical and computational models for radiofrequency (RF) catheter ablation (RFCA). We then describe the historical context in which each model was developed, its contribution to the knowledge of the physics of RFCA and its implications for clinical practice. Next, we review the computer modeling studies intended to improve our knowledge of the biophysics of RFCA and those intended to explore new technologies. We describe the most important technical details of the implementation of mathematical models, including governing equations, tissue properties, boundary conditions, etc. We discuss the utility of lumped element models, which despite their simplicity are widely used by clinical researchers to provide a physical explanation of how RF power is absorbed in different tissues. Computer model verification and validation are also discussed in the context of RFCA. The article ends with a section on the current limitations, i.e. aspects not yet included in state-of-the-art RFCA computer modeling and on future work aimed at covering the current gaps.

Relationship between luminal esophageal temperature and volume of esophageal injury during RF ablation: In silico study comparing low power-moderate duration vs. high power-short duration

OBJECTIVE

To model the evolution of peak temperature and volume of damaged esophagus during and after radiofrequency (RF) ablation using low power-moderate duration (LPMD) versus high power-short duration (HPSD) or very high power-very short duration (VHPVSD) settings.

METHODS

An in silico simulation model of RF ablation accounting for left atrial wall thickness, nearby organs and tissues, as well as catheter contact force. The model used the Arrhenius equation to derive a thermal damage model and estimate the volume of esophageal damage over time during and after RF application under conditions of LPMD (30 W, 20 s), HPSD (50 W, 6 s), and VHPVSD (90 W, 4 s).

RESULTS

There was a close correlation between maximum peak temperature after RF application and volume of esophageal damage, with highest correlation (R²  = 0.97) and highest volume of esophageal injury in the LPMD group. A greater increase in peak temperature and greater relative increase in esophageal injury volume in the HPSD (240%) and VHPSD (270%) simulations occurred after RF termination. Increased endocardial to esophageal thickness was associated with a longer time to maximum peak temperature (R²  > 0.92), especially in the HPSD/VHPVSD simulations, and no esophageal injury was seen when the distances were >4.5 mm for LPMD or >3.5 mm for HPSD.

CONCLUSION

LPMD is associated with a larger total volume of esophageal damage due to the greater total RF energy delivery. HPSD and VHPVSD shows significant thermal latency (resulting from conductive tissue heating after RF termination), suggesting a requirement for fewer esophageal temperature cutoffs during ablation.

Discovery of Diverse Natural Products as Inhibitors of SARS-CoV-2 Mpro Protease through Virtual Screening

SARS-CoV-2 is a type of coronavirus responsible for the international outbreak of respiratory illness termed COVID-19 that forced the World Health Organization to declare a pandemic infectious disease situation of international concern at the beginning of 2020. The need for a swift response against COVID-19 prompted to consider different sources to identify bioactive compounds that can be used as therapeutic agents, including available drugs and natural products. Accordingly, this work reports the results of a virtual screening process aimed at identifying antiviral natural product inhibitors of the SARS-CoV-2 M^pro viral protease. For this purpose, ca. 2000 compounds of the Selleck database of Natural Compounds were the subject of an ensemble docking process targeting the M^pro protease. Molecules that showed binding to most of the protein conformations were retained for a further step that involved the computation of the binding free energy of the ligand-M^pro complex along a molecular dynamics trajectory. The compounds that showed a smooth binding free energy behavior were selected for in vitro testing. From the resulting set of compounds, five compounds exhibited an antiviral profile, and they are disclosed in the present work.

Thermal impact of replacing constant voltage by low-frequency sine wave voltage in RF ablation computer modeling

BACKGROUND AND OBJECTIVES

A constant voltage (DC voltage) is usually used in radiofrequency ablation (RFA) computer models to mimic the radiofrequency voltage. However, in some cases a low frequency sine wave voltage (AC voltage) may be used instead. Our objective was to assess the thermal impact of replacing DC voltage by low-frequency AC voltage in RFA computer modeling.

METHODS

A 2D model was used consisting of an ablation electrode placed perpendicular to the tissue fragment. The Finite Element method was used to solve a coupled electric-thermal problem. Quasi-static electrical approximation was implemented in two ways (both with equivalent electrical power): (1) by a constant voltage of 25 V in the ablation electrode (DC voltage), and (2) applying a sine waveform with peak amplitude of 25√2 V (AC voltage). The frequency of the sine signal (f_AC) varied from 0.5 Hz to 50 Hz.

RESULTS

Sine wave thermal oscillations (at twice the f_AC frequency) were observed in the case of AC voltage, in addition to the temperature obtained by DC voltage. The amplitude of the oscillations: (1) increased with temperature, remaining more or less constant after 30 s; (2) was of up to ±3 °C for very low f_AC values (0.5 Hz); and (3) was reduced at higher f_AC values and with distance from the electrode (almost negligible for distances > 5 mm). The evolution of maximum lesion depth and width were almost identical with both DC and AC.

CONCLUSIONS

Although reducing f_AC reduces the computation time, thermal oscillations appear at points near the electrode, which suggests that a minimum value of f_AC should be used. Replacing DC voltage by low-frequency AC voltage does not appear to have an impact on the lesion depth.

Should fluid dynamics be included in computer models of RF cardiac ablation by irrigated-tip electrodes?

Background

Although accurate modeling of the thermal performance of irrigated-tip electrodes in radiofrequency cardiac ablation requires the solution of a triple coupled problem involving simultaneous electrical conduction, heat transfer, and fluid dynamics, in certain cases it is difficult to combine the software with the expertise necessary to solve these coupled problems, so that reduced models have to be considered. We here focus on a reduced model which avoids the fluid dynamics problem by setting a constant temperature at the electrode tip. Our aim was to compare the reduced and full models in terms of predicting lesion dimensions and the temperatures reached in tissue and blood.

Results

The results showed that the reduced model overestimates the lesion surface width by up to 5 mm (i.e. 70%) for any electrode insertion depth and blood flow rate. Likewise, it drastically overestimates the maximum blood temperature by more than 15 °C in all cases. However, the reduced model is able to predict lesion depth reasonably well (within 0.1 mm of the full model), and also the maximum tissue temperature (difference always less than 3 °C). These results were valid throughout the entire ablation time (60 s) and regardless of blood flow rate and electrode insertion depth (ranging from 0.5 to 1.5 mm).

Conclusions

The findings suggest that the reduced model is not able to predict either the lesion surface width or the maximum temperature reached in the blood, and so would not be suitable for the study of issues related to blood temperature, such as the incidence of thrombus formation during ablation. However, it could be used to study issues related to maximum tissue temperature, such as the steam pop phenomenon.

RF-energised intracoronary guidewire to enhance bipolar ablation of the interventricular septum: in-silico feasibility study

PURPOSE

Although bipolar radiofrequency (RF) ablation (RFA) is broadly used to eliminate ventricular tachycardias in the interventricular septum wall, it can fail to create transmural lesions in thick ventricular walls. To solve this problem, we explored whether an RF-energised guidewire inserted into the ventricular wall would enhance bipolar RFA in the creation of transmural lesions through the ventricular wall.

METHODS

We built three-dimensional computational models including two irrigated electrodes placed on opposing sides of the interventricular septum and a metal guidewire inserted into the septum. Computer simulations were conducted to compare the temperature distributions obtained with two ablation modes: bipolar mode (RF power delivered between both irrigated electrode) and time-division multiplexing (TDM) technique, which consists of activating the bipolar mode for 90% of the time and applying RF power between the guidewire and both irrigated electrodes during the remaining time.

RESULTS

The TDM technique was the most suitable in terms of creating wider lesions through the entire ventricular wall, avoiding the hour-glass shape of thermal lesions associated with the bipolar mode. This was especially apparent in the case of thick walls (15 mm). Furthermore, the TDM technique was able to create transmural lesions even when the guidewire was displaced from the midplane of the wall.

CONCLUSIONS

An RF-energised guidewire could enhance bipolar RFA by allowing transmural lesions to be made through thick ventricular walls. However, the safety of this new approach must be assessed in future pre-clinical studies, especially in terms of the risk of stenosis and its clinical impact.

Zinc Is Involved in Depression by Modulating G Protein-Coupled Receptor Heterodimerization

5-Hydroxytryptamine 1A receptor and galanin receptor 1 belong to the G protein-coupled receptors superfamily, and they have been described to heterodimerize triggering an anomalous physiological state that would underlie depression. Zinc supplementation has been widely reported to improve treatment against major depressive disorder. Our work has focused on the study and characterization of these receptors and its relationships with zinc both under purified conditions and in cell culture. To this aim, we have designed a strategy to purify the receptors in a conformationally active state. We have used receptors tagged with the monoclonal Rho-1D4 antibody and employed ligand-assisted purification in order to successfully purify both receptors in a properly folded and active state. The interaction between both purified receptors has been analyzed by surface plasmon resonance in order to determine the kinetics of dimerization. Zinc effect on heteromer has also been tested using the same methodology but exposing the 5-hydroxytryptamine 1A receptor to zinc before the binding experiment. These results, combined with Förster resonance energy transfer (FRET) measurements, in the absence and presence of zinc, suggest that this ion is capable of disrupting this interaction. Moreover, molecular modeling suggests that there is a coincidence between zinc-binding sites and heterodimerization interfaces for the serotonin receptor. Our results establish a rational explanation for the role of zinc in the molecular processes associated with receptor-receptor interactions and its relationship with depression, in agreement with previously reported evidence for the positive effects of zinc in depression treatment, and the involvement of our target dimer in the same disease.

Computer modeling of electrical and thermal performance during bipolar pulsed radiofrequency for pain relief

PURPOSE

Pulsed RF (PRF) is a nonablative technique for treating neuropathic pain. Bipolar PRF application is currently aimed at creating a "strip lesion" to connect the electrode tips; however, the electrical and thermal performance during bipolar PRF is currently unknown. The objective of this paper was to study the temperature and electric field distributions during bipolar PRF.

METHODS

The authors developed computer models to study temperature and electric field distributions during bipolar PRF and to assess the possible ablative thermal effect caused by the accumulated temperature spikes, along with any possible electroporation effects caused by the electrical field. The authors also modeled the bipolar ablative mode, known as bipolar Continuous Radiofrequency (CRF), in order to compare both techniques.

RESULTS

There were important differences between CRF and PRF in terms of electrical and thermal performance. In bipolar CRF: (1) the initial temperature of the tissue impacts on temperature progress and hence on the thermal lesion dimension; and (2) at 37 °C, 6-min of bipolar CRF creates a strip thermal lesion between the electrodes when these are separated by a distance of up to 20 mm. In bipolar PRF: (1) an interelectrode distance shorter than 5 mm produces thermal damage (i.e., ablative effect) in the intervening tissue after 6 min of bipolar RF; and (2) the possible electroporation effect (electric fields higher than 150 kV m(-1)) would be exclusively circumscribed to a very small zone of tissue around the electrode tip.

CONCLUSIONS

The results suggest that (1) the clinical parameters considered to be suitable for bipolar CRF should not necessarily be considered valid for bipolar PRF, and vice versa; and (2) the ablative effect of the CRF mode is mainly due to its much greater level of delivered energy than is the case in PRF, and therefore at same applied energy levels, CRF, and PRF are expected to result in same outcomes in terms of thermal damage zone dimension.

EuroFlow standardization of flow cytometer instrument settings and immunophenotyping protocols

The EU-supported EuroFlow Consortium aimed at innovation and standardization of immunophenotyping for diagnosis and classification of hematological malignancies by introducing 8-color flow cytometry with fully standardized laboratory procedures and antibody panels in order to achieve maximally comparable results among different laboratories. This required the selection of optimal combinations of compatible fluorochromes and the design and evaluation of adequate standard operating procedures (SOPs) for instrument setup, fluorescence compensation and sample preparation. Additionally, we developed software tools for the evaluation of individual antibody reagents and antibody panels. Each section describes what has been evaluated experimentally versus adopted based on existing data and experience. Multicentric evaluation demonstrated high levels of reproducibility based on strict implementation of the EuroFlow SOPs and antibody panels. Overall, the 6 years of extensive collaborative experiments and the analysis of hundreds of cell samples of patients and healthy controls in the EuroFlow centers have provided for the first time laboratory protocols and software tools for fully standardized 8-color flow cytometric immunophenotyping of normal and malignant leukocytes in bone marrow and blood; this has yielded highly comparable data sets, which can be integrated in a single database.

Molecular mechanisms of disease for mutations at Gly-90 in rhodopsin

Two different mutations at Gly-90 in the second transmembrane helix of the photoreceptor protein rhodopsin have been proposed to lead to different phenotypes. G90D has been classically associated with congenital night blindness, whereas the newly reported G90V substitution was linked to a retinitis pigmentosa phenotype. Here, we used Val/Asp replacements of the native Gly at position 90 to unravel the structure/function divergences caused by these mutations and the potential molecular mechanisms of inherited retinal disease. The G90V and G90D mutants have a similar conformation around the Schiff base linkage region in the dark state and same regeneration kinetics with 11-cis-retinal, but G90V has dramatically reduced thermal stability when compared with the G90D mutant rhodopsin. The G90V mutant also shows, like G90D, an altered photobleaching pattern and capacity to activate Gt in the opsin state. Furthermore, the regeneration of the G90V mutant with 9-cis-retinal was improved, achieving the same A(280)/A(500) as wild type isorhodopsin. Hydroxylamine resistance was also recovered, indicating a compact structure around the Schiff base linkage, and the thermal stability was substantially improved when compared with the 11-cis-regenerated mutant. These results support the role of thermal instability and/or abnormal photoproduct formation in eliciting a retinitis pigmentosa phenotype. The improved stability and more compact structure of the G90V mutant when it was regenerated with 9-cis-retinal brings about the possibility that this isomer or other modified retinoid analogues might be used in potential treatment strategies for mutants showing the same structural features.

Conformational analysis of a cyclopropane analogue of phenylalanine with two geminal phenyl substituents

Quantum mechanical methods have been used to investigate the intrinsic conformational preferences of 1-amino-2,2-diphenylcyclopropanecarboxylic acid (c(3)Dip), a cyclopropane analogue of phenylalanine bearing two phenyl substituents on the same beta-carbon. Geometries, energies, and frequencies were calculated on the N-acetyl-N'-methylamide derivative at the HF and B3LYP levels using the 6-31G(d), 6-311G(d), and 6-31+G(d,p) basis sets. Four minimum energy conformations were characterized: axial C(7), equatorial C(7), right-handed helix, and polyproline II. Analysis of the whole results, which are fully consistent with available experimental data, indicates that c(3)Dip tends to promote gamma-turn conformations.

Critical role of electrostatic interactions of amino acids at the cytoplasmic region of helices 3 and 6 in rhodopsin conformational properties and activation

The cytoplasmic sides of transmembrane helices 3 and 6 of G-protein-coupled receptors are connected by a network of ionic interactions that play an important role in maintaining its inactive conformation. To investigate the role of such a network in rhodopsin structure and function, we have constructed single mutants at position 134 in helix 3 and at positions 247 and 251 in helix 6, as well as combinations of these to obtain double mutants involving the two helices. These mutants have been expressed in COS-1 cells, immunopurified using the rho-1D4 antibody, and studied by UV-visible spectrophotometry. Most of the single mutations did not affect chromophore formation, but double mutants, especially those involving the T251K mutant, resulted in low yield of protein and impaired 11-cis-retinal binding. Single mutants E134Q, E247Q, and E247A showed the ability to activate transducin in the dark, and E134Q and E247A enhanced activation upon illumination, with regard to wild-type rhodopsin. Mutations E247A and T251A (in E134Q/E247A and E134Q/T251A double mutants) resulted in enhanced activation compared with the single E134Q mutant in the dark. A role for Thr(251) in this network is proposed for the first time in rhodopsin. As a result of these mutations, alterations in the hydrogen bond interactions between the amino acid side chains at the cytoplasmic region of transmembrane helices 3 and 6 have been observed using molecular dynamics simulations. Our combined experimental and modeling results provide new insights into the details of the structural determinants of the conformational change ensuing photoactivation of rhodopsin.

A methyl group at C7 of 11-cis-retinal allows chromophore formation but affects rhodopsin activation

The newly synthesized 11-cis-7-methylretinal can form an artificial visual pigment with kinetic and spectroscopic properties similar to the native pigment in the dark-state. However, its photobleaching behavior is altered, showing a Meta I-like photoproduct. This behavior reflects a steric constraint imposed by the 7-methyl group that affects the conformational change in the binding pocket as a result of retinal photoisomerization. Transducin activation is reduced, when compared to the native pigment with 11-cis-retinal. Molecular dynamics simulations suggest coupling of the C7 methyl group and the beta-ionone ring with Met207 in transmembrane helix 5 in agreement with recent experimental results.

Suppression of the cardiac electric field artifact from the heart action evoked potential

The study of heart action-related brain potentials is strongly disrupted by the presence of an inherent cardiac electric artifact. The hypothesis is presented that most of the electric current coupled to the cardiac field surrounds the skull and flows through the scalp tissue without crossing the cranial cavity. This pseudo two-dimensional conduction model contrasts with the volumetric conduction of the brain electrical activity, and this property is exploited to cancel the cardiac electric artifact. QRS loop vector-cardiographic projections on saggital planes were recorded in 11 healthy subjects in the head and neck areas. Comparative analysis of the projection eccentricities, estimated by the correlation coefficients of the paired data on each area, supported the hypothesis and allowed the handling of the cardiac electric field at the scalp as if enclosed in a two-dimensional wrapped space. This approach permitted the combination of different heart action-related brain potentials recorded at different electrode positions to cancel the cardiac electric artifact. The cancellation method, applied to the subjects' EEG data, yielded a slow cortical potential with a negligible cardiac electric residue and an amplitude of about 1.5-2 microV, with a maximum around 150 ms and a minimum at 400 ms post-R wave.

Spatiotemporal pattern of the extracranial component of the rheoencephalographic signal

The use of rheoencephalography (REG) in the clinical practice to evaluate cerebral blood flow is conditional on the finding of a method for removing the extracranial interference caused by the scalp blood flow. To remove this undesirable influence, digital processing based on statistics could be an effective technique if the appropriate data model were applied. This paper focuses on the analysis of the spatiotemporal features of the extracranial REG component, by comparing its morphology and phase shift at several scalp sites. For this purpose, a numerical model of the scalp was employed to assess tissue impedance changes caused by the inflow of a stepwise blood pulse wave. These results were compared with the experimental impedance waveforms recorded on six pairs of adjacent electrodes. The correlation coefficients between each pair of impedance recordings of each subject were always greater than 0.942, showing a mean value of 0.986. This result suggests that the extracranial REG component can be considered as morphologically invariant. On the other hand, negligible phase shifts were observed when mean electrode distances, measured in the blood flow direction, were relatively small, although temporal corrections in the data model would be advisable for longer distances.

Identification of secret agent as the O-GlcNAc transferase that participates in Plum pox virus infection

Serine and threonine of many nuclear and cytoplasmic proteins are posttranslationally modified with O-linked N-acetylglucosamine (O-GlcNAc). This modification is made by O-linked N-acetylglucosamine transferases (OGTs). Genetic and biochemical data have demonstrated the existence of two OGTs of Arabidopsis thaliana, SECRET AGENT (SEC) and SPINDLY (SPY), with at least partly overlapping functions, but there is little information on their target proteins. The N terminus of the capsid protein (CP) of Plum pox virus (PPV) isolated from Nicotiana clevelandii is O-GlcNAc modified. We show here that O-GlcNAc modification of PPV CP also takes place in other plant hosts, N. benthamiana and Arabidopsis. PPV was able to infect the Arabidopsis OGT mutants sec-1, sec-2, and spy-3, but at early times of the infection, both rate of virus spread and accumulation were reduced in sec-1 and sec-2 relative to spy-3 and wild-type plants. By matrix-assisted laser desorption ionization-time of flight mass spectrometry, we determined that a 39-residue tryptic peptide from the N terminus of CP of PPV purified from the spy-3 mutant, but not sec-1 or sec-2, was O-GlcNAc modified, suggesting that SEC but not SPY modifies the capsid. While our results indicate that O-GlcNAc modification of PPV CP by SEC is not essential for infection, they show that the modification has a role(s) in the process.

Unusually High Pyramidal Geometry of the Bicyclic Amide Nitrogen in a Complex 7-Azabicyclo[2.2.1]heptane Derivative: Theoretical Analysis Using a Bottom-up Strategy

The high pyramidalization of the bicyclic amide nitrogen found in the crystal structure of a dipeptide incorporating (1S,2S,4R)-N-benzoyl-2-phenyl-7-azabicyclo[2.2.1]heptane-1-carboxylic acid has been investigated using quantum mechanical calculations. More specifically, a bottom-up strategy based on the study of model molecules of progressive complexity has been used. First, an appropriate quantum mechanical method has been selected by examining the distortion of the amide bond in three simple model molecules. Next, the amide distortion induced by the norbornane ring has been evaluated by considering three different 7-azabicyclo[2.2.1]heptane amides. After this, the suitability of quantum mechanical calculations to predict the effect of the substituents on the pyramidalization of the bicyclic amide nitrogen has been investigated by comparing experimental and theoretical parameters for a number of compounds. Finally, the factors responsible for amide distortion in the (1S,2S,4R)-N-benzoyl-2-phenyl-7-azabicyclo[2.2.1]heptane-1-carboxylic acid derivative have been elucidated using a hierarchical approach. For this purpose, several derivatives were generated by removing or modifying the substituents attached to the 7-azanorbornane system. Results have been discussed in terms of intramolecular specific interactions.

Influence of the scalp thickness on the intracranial contribution to rheoencephalography

In spite of the great efforts made by the scientific community, up to now there is no agreement about the rheoencephalography (REG) capability to reflect cerebral blood flow (CBF). Moreover, a standard procedure and the optimal electrode arrangement have not been established yet. In a previous study, we found, using a classical four-shell spherical model of the head and solving it by numerical methods that, theoretically, there could exist an electrode arrangement to register an REG II free of extracranial contribution. In this paper, we have studied the influence of scalp thickness on the intracranial contribution to REG II. The study has been performed by solving the head model, using in this case analytical methods, and then estimating the partial contribution of CBF pulsatility to REG for a given set of scalp thicknesses. Although our theoretical results validate the previous finding and suggest that, in some cases, an optimal electrode arrangement to register REG II exists, such an arrangement, and even its existence, is very sensitive to the subject's scalp thickness. According to this, there could not exist a universal electrode arrangement suitable for all individuals to register an REG II free of extracranial contribution, since it depends on the subject's physical constitution. This fact could explain the lack of agreement in the literature about REG interpretation.

N-acetyl-N'-methylamide derivative of (2S,3S)-1-amino-2,3-diphenylcyclopropanecarboxylic acid: theoretical analysis of the conformational impact produced by the incorporation of the second phenyl group to the cyclopropane analogue of phenylalanine

The intrinsic conformational preferences of (2S,3S)-1-amino-2,3-diphenylcyclopropanecarboxylic acid, a phenylalanine cyclopropane analogue bearing two phenyl substituents, have been examined theoretically. For this purpose, its N-acetyl-N'-methylamide derivative, Ac-(2S,3S)c(3)diPhe-NHMe, has been investigated by using ab initio HF and DFT methods. Results have been compared with those previously reported for other cyclopropane analogues of phenylalanine, and with experimental data available for c(3)diPhe-containing peptides.

Structural analysis of the inhibition of Cdk4 and Cdk6 by p16(INK4a) through molecular dynamics simulations

Cyclin-dependent kinases 4, 6 and 2 (Cdk4/6/2), are proteins that lead progression through the G1-S transition, a step strictly regulated in the process of cell proliferation. The p16(INK4a) tumor suppressor, whose expression is inhibited in a high number of cancers, binds to Cdk4/6 and inhibits phosphorylation of the retinoblastoma protein, forcing cells to remain in the G1 phase and therefore, arresting cell division. Accordingly, the design of small compounds mimicking the inhibition of p16(INK4a) appears to be a promising way to treat cancer. In order to get some insight into the key interactions governing recognition between different cyclin-dependent kinases and the p16(INK4a) tumor suppressor, the present work reports the results of molecular dynamics simulations of both, the Cdk6-p16(INK4a) complex and the Cdk4-p16(INK4a) complex, respectively at 300 K. Most of the key interactions observed, were already anticipated in the analysis of the crystal structure of Cdk6-p16(INK4a). However, a few different features found out from the analysis of these calculations provide a better understanding of the role of the T-loop conformation, a fragment of Cdks, and the way the ATP binding-site is distorted upon binding of p16(INK4a).

Calcium-induced decrease of the thermal stability and chaperone activity of alpha-crystallin

Alpha-crystallin, one of the major proteins in the vertebrate eye lens, acts as a molecular chaperone, like the small heat-shock proteins, by protecting other proteins from denaturing under stress or high temperature conditions. alpha-Crystallin aggregation is involved in lens opacification, and high [Ca(2+)] has been associated with cataract formation, suggesting a role for this cation in the pathological process. We have investigated the effect of Ca(2+) on the thermal stability of alpha-crystallin by UV and Fourier-transform infrared (FTIR) spectroscopies. In both cases, a Ca(2+)-induced decrease in the midpoint of the thermal transition is detected. The presence of high [Ca(2+)] results also in a marked decrease of its chaperone activity in an insulin-aggregation assay. Furthermore, high Ca(2+) concentration decreases Cys reactivity towards a sulfhydryl reagent. The results obtained from the spectroscopic analysis, and confirmed by circular dichroism (CD) measurements, indicate that Ca(2+) decreases both secondary and tertiary-quaternary structure stability of alpha-crystallin. This process is accompanied by partial unfolding of the protein and a clear decrease in its chaperone activity. It is concluded that Ca(2+) alters the structural stability of alpha-crystallin, resulting in impaired chaperone function and a lower protective ability towards other lens proteins. Thus, alpha-crystallin aggregation facilitated by Ca(2+) would play a role in the progressive loss of transparency of the eye lens in the cataractogenic process.

Identification of selective inhibitors of acetylcholinesterase from a combinatorial library of 2,5-piperazinediones

The potentiation of central cholinergic activity has been proposed as a therapeutic approach for improving cognitive function in patients with Alzheimer's disease. Increasing the acetylcholine concentration in brain by modulating acetylcholinesterase (AChE) activity is among the most promising strategies. We have used a combinatorial approach to identify different 2,5-piperazinediones (DKP) with AChE inhibitory activity. Our goal was to find inhibitors exhibiting high AChE/BuChE (butyrylcholinesterase) selectivity, in order to reduce the undesirable side effects elicited by most of the inhibitors that have been developed to date. Screening of a DKP library constructed on solid-phase using the multiple parallel synthesis format, resulted in the identification of several compounds with moderate efficacy on AChE. In particular, DKP-80 had an IC50 = 2.2 microM with no significant inhibitory activity on BuChE. Moreover, estimated values of Clog P and log BB for the most active compounds fulfilled the bioavailability requirements for enzyme inhibitors acting on the central nervous system. In order to understand the inhibitory properties of the ligand at the molecular level, molecular dynamics simulations were computed on DKP-80 complexed to AChE, and the most relevant binding interactions of this inhibitor to the active center of the enzyme were characterized. Overall the present results indicate that the DKP-based compounds identified are novel AChE inhibitors which may be considered likely lead compounds for further development of drug candidates against Alzheimer's disease.

Early immunophenotypical evaluation of minimal residual disease in acute myeloid leukemia identifies different patient risk groups and may contribute to postinduction treatment stratification

Early response to therapy is one of the most important prognostic factors in acute leukemia. It is hypothesized that early immunophenotypical evaluation may help identify patients at high risk for relapse from those who may remain in complete remission (CR). Using multiparametric flow cytometry, the level of minimal residual disease (MRD) was evaluated in the first bone marrow (BM) in morphologic CR obtained after induction treatment from 126 patients with acute myeloid leukemia (AML) who displayed aberrant phenotypes at diagnosis. Based on MRD level, 4 different risk categories were identified: 8 patients were at very low risk (fewer than 10(-4) cells), and none have relapsed thus far; 37 were at low risk (10(-4) to 10(-3) cells); and 64 were at intermediate risk (fewer than 10(-3) to 10(-2) cells), with 3-year cumulative relapse rates of 14% and 50%, respectively. The remaining 17 patients were in the high-risk group (more than 10(-2) residual aberrant cells) and had a 3-year relapse rate of 84% (P =.0001). MRD level not only influences relapse-free survival but also overall survival (P =.003). The adverse prognostic impact was also observed when M3 and non-M3 patients with AML were separately analyzed, and was associated with adverse cytogenetic subtypes, 2 or more cycles to achieve CR, and high white blood cell counts. Multivariate analysis showed that MRD level was the most powerful independent prognostic factor, followed by cytogenetics and number of cycles to achieve CR. In conclusion, immunophenotypical investigation of MRD in the first BM in mCR obtained after AML induction therapy provides important information for risk assessment in patients with AML.

Synthesis and biological evaluation of 1,3,4-triaryl-3-pyrrolin-2-ones, a new class of selective cyclooxygenase-2 inhibitors

The synthesis and structure activity relationships (SAR) of a series of novel selective COX-2 inhibitors are reported. The results show that some of the 1,3,4-triaryl-3-pyrrolin-2-ones 1 are more potent as COX-2 inhibitors than celecoxib, and that lactam Id has the same selectivity.

Peptide T does not ameliorate experimental autoimmune encephalomyelitis (EAE) in Lewis rats

Peptide T has been shown to inhibit T cell activation and cytokine production and function. Moreover, it has been reported to be a safe treatment in humans. We have studied the ability of peptide T to prevent or ameliorate EAE in Lewis rats. Peptide T was administered subcutaneously at different doses and phases of the disease according to several treatment protocols, but we could not observe a consistent effect of peptide T ameliorating the disease. Lymph node cell proliferation and IL-4 and interferon-gamma production were also studied. We conclude that peptide T neither prevents nor ameliorates EAE in Lewis rats.

Quantification of intracranial contribution to rheoencephalography by a numerical model of the head

OBJECTIVES

Partial contributions of intracranial and extracranial circulation to rheoencephalography (REG) remain uncertain. The main goal of this work is to determine theoretically the capability of REG techniques to reflect intracranial blood flow.

METHODS

Head and current injection electrodes were computationally modeled to assess REG sensitivity to brain and scalp conductivity changes. Data obtained were related to tissue perfusions to calculate the partial contribution of cerebral blood perfusion to REG I, REG II and monopolar REG and to assess their amplitudes.

RESULTS

When REG I and monopolar REG were used, the theoretical maximum of intracranial contribution was reached with large current injection electrodes, being 8% for REG I and 12% for monopolar REG. However, some specific REG II electrode arrangements showed a nil contribution of the extracranial circulation and a minimum influence of the electrode size.

CONCLUSIONS

These results may explain the disagreement on REG origin and suggest a theoretically optimum electrode arrangement.

Modeling cyclooxygenase inhibition. Implication of active site hydration on the selectivity of ketoprofen analogues

Molecular modeling studies performed on the two cyclooxygenase isozymes (COXs) suggest that active site hydration is crucial for understanding inhibitor selectivity. In this work, models have been constructed considering some implicit water molecules, placed in the position suggested by GRID, that participate in the dynamic hydrogen-bonding network at the polar active site entrance together with protein residues 355, 524, 120, and 513. The selectivity observed for ketoprofen (1) and the structural analogues 2 and 3 may be rationalized in terms of such implicit hydration.

Conformational behavior of the HAV-VP3(110-121) peptidic sequence and synthetic analogs in membrane environments studied by CD and computational methods

The present study was undertaken to examine the structural features that may be important to explain the immunogenicity of the (110-121) peptide sequence (FWRGDLVFDFQV) of VP3 capsid protein of hepatitis A virus. A conformational analysis of the preferred conformations by CD and molecular mechanics was carried out. Present results suggest that the interaction with liposomes as biomembrane model induces and stabilizes the amphipathic beta-structure of the peptide. To study the contribution of amino acid replacements at the RGD tripeptide as well as the influence of the peptide chain length on peptide conformation, solid-phase peptide synthesis of several peptide analogs was carried out and the peptide conformation was studied using CD spectroscopy. The results show that the RGD sequence is necessary to induce the beta-structure in the presence of liposomes.

[Kidney transplant from living donor. Experience at the Jiménez Díaz Foundation]

OBJECTIVES

To discuss the organizational and surgical aspects, results, remarkable events and some ethical considerations of the renal transplantation program with grafts from living donors at our institution over a 25-year period.

METHODS

The renal transplant program of the Jiménez Diaz Foundation began in 1964 and the first kidney graft from a living donor was transplanted in 1968. Since then and until December 1993, 157 renal grafts from living donors have been transplanted. The donors were parents in 94, siblings in 55 and the spouse in 4 occasions. Moreover, two free kidneys and two grafts from nonrelated donors were transplanted. The surgical procedure was also similar; i.e., right nephrectomy through a supracostal lumbotomy to remove the kidney and transplantation in the right iliac fosa with anatomosis to cava and common iliac or hypogastric artery. Changes in the surgical technique warranted by the intraoperative findings were infrequent. The ureter was anastomosed to the bladder using an extra- or transvesical technique depending on the surgeon's experience. Harvesting and transplantation of the kidney graft were performed simultaneously by two surgical teams.

RESULTS

There were no major complications in the donors or technical difficulties or errors during harvesting that might have compromised graft viability, although complications such as hemorrhage, urinary fistula, thrombosis and prolonged anuria were observed early postoperatively. The incidence of grafts lost specifically related with the technique was less than 3%. Nineteen recipients had died early postoperatively from acute rejection and sepsis. Recipient and graft survival were basically related with the degree of histocompatibility and the changing therapeutic strategy over the 25-year period. The best results were found in 33 transplants involving HLA identical siblings, with a five-year actuarial survival rate of 89%, a 10- and 15-year survival of 70% and a 22-year survival of 22%, followed by those who were haploidentical who had donor-specific transfusions and the haploidentical cases treated with cyclosporine. The poorest results were seen in the historical group of 52 transplant procedures performed between 1968 and 1981 who were treated with the classical medication.

CONCLUSIONS

The good results achieved and the minimal risk to donors demonstrated by our experience over a period of 25 years support continuation of the renal transplantation program with grafts from living donors, as well as our approach of having two surgical teams working simultaneously.

Ectoparasites and host energetics: house martin bugs and house martin nestlings

We measured the energy cost of ectoparasitism in an experimental study of the house martin bug Oeciacus hirundinis and its main host, nestlings of the house martin Delichon urbica. Nests were randomly assigned to inoculation with 0 (control) 10, or 100 bugs during egg laying, and this resulted in statistically significant differences in parasite loads following fledging of nestlings. Parasite loads negatively affected house martin nestlings as estimated from their body mass at age 16 days and from mass loss estimated over 1 day late in the nestling period. Daily energy expenditure (KJ/d), average daily metabolic rate (ml CO₂/g h), and mass independent daily energy expenditure (kJ/mass^0.67d) did not differ significantly between experimental treatments. However, average daily metabolic rate increased with increasing intensities of ectoparasitism. Mass independent daily energy expenditure also increased with higher levels of parasite infestation. These results demonstrate that the bug imposes an energy cost on its host by elevating the level of metabolism.

Antigenic heterogeneity of a foot-and-mouth disease virus serotype in the field is mediated by very limited sequence variation at several antigenic sites

Antigenic variation in a major discontinuous site (site D) of foot-and-mouth disease virus (FMDV) of serotype C has been evaluated with neutralizing monoclonal antibodies. Isolates representing the major evolutionary sublines previously defined for serotype C were compared. Extensive variation, comparable to that of continuous epitopes within the hypervariable immunodominant site A (the VP1 G-H loop), was found. The amino acid sequences of the complete capsids of three antigenically highly divergent FMDVs (C1 Haute Loire-Fr/69, C5 Argentina/69, and C3 Argentina/85) have been determined and compared with the corresponding sequences previously determined for seven additional type C viruses. Differences in antigenicity are due to a very limited number of substitutions of surface amino acids accessible to antibodies and located within antigenic sites previously identified on FMDV. A significant number of residues at these positions were also replaced in monoclonal antibody escape mutants. Depending on the variants compared, replacements within site A or at site D, or at both sites, contributed significantly to their antigenic differences. Examples of divergence mediated by a few amino acid replacements were found among FMDVs of Europe and South America. The results suggest that within a serotype of FMDV, antigenically highly divergent viruses can arise in the field by very limited sequence variation at exposed key residues of each of several antigenic sites.

[Lead and child health]

Effects of lead toxicity in children are reviewed. Several epidemiological studies performed in Spain are also depicted, with special attention to the city of Cartagena where a mean of 8.05 +/- 4.2 mcg/dl is obtained. The fact that the small increment observed in children living in polluted area may be due more to socioeconomic level (related to indoor pollution) than to outdoor pollution is stressed.

Unique amino acid substitutions in the capsid proteins of foot-and-mouth disease virus from a persistent infection in cell culture

Maintenance of a persistent foot-and-mouth disease virus (FMDV) infection in BHK-21 cells involves a coevolution of cells and virus (J. C. de la Torre, E. Martínez-Salas, J. Díez, A. Villaverde, F. Gebauer, E. Rocha, M. Dávila, and E. Domingo, J. Virol. 62:2050-2058, 1988). The resident FMDV undergoes a number of phenotypic changes, including a gradual decrease in virion stability. Here we report the nucleotide sequence of the P1 genomic segment of the virus rescued after 100 passages of the carrier cells (R100). Only 5 of 15 mutations in P1 of R100 were silent. Nine amino acid substitutions were fixed on the viral capsid during persistence, and three of the variant amino acids are not represented in the corresponding position of any picornavirus sequenced to date. Cysteine at position 7 of VP3, that provides disulfide bridges at the FMDV fivefold axis, was substituted by valine, as determined by RNA, cDNA, and protein sequencing. The modified virus shows high buoyant density in cesium chloride and depicts the same sensitivity to photoinactivation by intercalating dyes as the parental FMDV C-S8c1. Amino acid substitutions fixed in VP1 resulted in altered antigenicity, as revealed by reactivity with monoclonal antibodies. In addition to defining at the molecular level the alterations the FMDV capsid underwent during persistence, the results show that positions which are highly invariant in an RNA genome may change when viral replication occurs in a modified environment.

Molecular modelling study of changes induced by netropsin binding to nucleosome core particles

It is well known that certain sequence-dependent modulators in structure appear to determine the rotational positioning of DNA on the nucleosome core particle. That preference is rather weak and could be modified by some ligands as netropsin, a minor-groove binding antibiotic. We have undertaken a molecular modelling approach to calculate the relative energy of interaction between a DNA molecule and the protein core particle. The histones particle is considered as a distribution of positive charges on the protein surface that interacts with the DNA molecule. The molecular electrostatic potentials for the DNA, simulated as a discontinuous cylinder, were calculated using the values for all the base pairs. Computing these parameters, we calculated the relative energy of interaction and the more stable rotational setting of DNA. The binding of four molecules of netropsin to this model showed that a new minimum of energy is obtained when the DNA turns toward the protein surface by about 180 degrees, so a new energetically favoured structure appears where netropsin binding sites are located facing toward the histones surface. The effect of netropsin could be explained in terms of an induced change in the phasing of DNA on the core particle. The induced rotation is considered to optimize non-bonded contacts between the netropsin molecules and the DNA backbone.