Antibacterial effect of seven days exposure to ceftolozane-tazobactam as monotherapy and in combination with fosfomycin or tobramycin against Pseudomonas aeruginosa with ceftolozane-tazobactam MICs at or above 4 mg/l in an in vitro pharmacokinetic model

OBJECTIVES

To use a pre-clinical pharmacokinetic infection model to assess the antibacterial effect of ceftolozane/tazobactam alone or in combination with fosfomycin or tobramycin against Pseudomonas aeruginosa strains with MICs at or higher than the clinical breakpoint (MIC ≥ 4 mg/L).

METHODS

An in vitro model was used to assess changes in bacterial load and population profiles after exposure to mean human serum concentrations of ceftolozane/tazobactam associated with doses of 2 g/1 g q8h, fosfomycin concentrations associated with doses of 8 g q8h or tobramycin at doses of 7 mg/kg q24 h over 168 h.

RESULTS

Simulations of ceftolozane/tazobactam at 2 g/1 g q8h alone produced 3.5-4.5 log reductions in count by 6 h post drug exposure for strains with MIC ≤32 mg/L. The antibacterial effect over the first 24 h was related to ceftolozane/tazobactam MIC. There was subsequent regrowth with most strains to bacterial densities of >106 CFU/mL. Addition of either fosfomycin or tobramycin resulted in suppression of regrowth and in the case of tobramycin more rapid initial bacterial killing up to 6 h. These effects could not be related to either fosfomycin or tobramycin MICs. Changes in population profiles were noted with ceftolozane/tazobactam alone often after 96 h exposure but such changes were suppressed by fosfomycin and almost abolished by the addition of tobramycin.

CONCLUSIONS

The addition of either fosfomycin or tobramycin to ceftolozane/tazobactam at simulated human clinically observed concentrations reduced P. aeruginosa bacterial loads and the risk of resistance to ceftolozane/tazobactam when strains had ceftolozane/tazobactam MIC values at or above the clinical breakpoint.

Understanding Online Registry Facilitators and Barriers Experienced by Black Brain Health Registry Participants: The Community Engaged Digital Alzheimer's Research (CEDAR) Study

BACKGROUND

Failure of Alzheimer's disease and related diseases (ADRD) research studies to include and engage Black participants is a major issue, which limits the impact and generalizability of research findings. Little is known about participation of Black adults in online ADRD-related research registries.

OBJECTIVES

As part of the Community Engaged Digital Alzheimer's Research (CEDAR) Study, this study aims to increase our understanding of facilitators and barriers of Black adults to participating in ADRD-related online registries, as well as to understand their preferences for communication channels.

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

We invited all Black participants enrolled in the Brain Health Registry (BHR) to complete a cross-sectional online survey. The survey consisted of rating scales and open-text questions asking about their attitudes towards brain health research, reasons for joining and continuing to participate in BHR, difficulties with participating, and preferences for modes of contact and website usage.

RESULTS

Of all invited Black BHR participants (N=3,636), 198 (5.5%) completed the survey. The mean age was 58.4 (SD=11.3), mean years of education were 16.3 (SD=2.4), and 85.5% identified as female. Reported facilitators for joining and continuing to participate in BHR were personal interest (e.g., learning more about own brain health) and altruism (e.g., helping research). Among additional registry features which could encourage return, receiving feedback or scores about BHR tasks was rated the highest. Of those who found BHR participation difficult (21%), the most frequent reason was time burden. The most preferred way of receiving study information was via email. Participants reported that the websites that they used the most were YouTube and Facebook.

DISCUSSION

The results of our study can inform the development of culturally-responsive registry features and engagement efforts to improve inclusion and participation of Black adults in online ADRD research. Providing participants with feedback about their registry performance and reducing the number of registry tasks are among the recommended strategies.

The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry

BACKGROUND

Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research.

OBJECTIVES

To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR.

DESIGN

All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants.

SETTING

BHR, an Internet-based registry and cohort.

PARTICIPANTS

BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled.

MEASUREMENTS

We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study.

RESULTS

Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%).

CONCLUSIONS

A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.

617. Pharmacodynamics of Ceftolozane-Tazobactam (C/T) as Monotherapy and in Combination with Tobramycin or Fosfomycin Against P.aeruginosa with C/T MICs at or Above 4mg/L

Background

Ceftolozane (C/T) is widely used in clinical practice to treat difficult and/or multidrug resistant Pseudomonas aeruginosa (Pa). However, clinical data is absent on the use of C/T therapy to treat Pa strains with C/T MICs ≥ 4mg/L, that is outside the wild type population. To address this, we simulated 7-day courses of C/T against 8 strains of Pa C/T MICs 4-64mg/L as monotherapy and in combination with tobramycin (T) or fosfomycin (F) using an in vitro pharmacokinetic model.

Methods

A single compartment dilutional in vitro model was used, volume central chamber 360mL, inoculum 106 CFU/mL. Differing drugs t½ were simulated using add back. Pa strain C/T MICs were 4-64mg/L, T 0.25-8mg/L and F 4-1024mg/L. C/T doses of 2-1g, 8h (Cmax 112-32mg/L, t½ 2.5-1h), T doses 7mg/Kg 24h (Cmax 22mg/L, t½ 2.5h) and F doses 4g 8h (Cmax 250mg/L, t½ 2.5h) were simulated for 7 days. Endpoints were changes in bacterial load (log CFU/ml) and population profiles (growth on C/T containing media at MICx4 and MICx8 concentrations).

Results

C/T alone resulted in rapid clearance of all strains after 4-12h exposure, with the antibacterial effect being poorest with strains with the highest C/T MICs. Regrowth occurred with 7/8 strains after 24-48h, counts reaching 6-8 logs by 7 days. Combination of C/T plus T increased the rate of initial clearance and suppressed regrowth with all strains. Combination of C/T plus F did not increase the rate of initial clearance except in the strains with the highest C/T MICs but resulted in suppression of regrowth with final bacterial counts of 3-4 logs at day 7. Changes in C/T population profiles occurred after 7 days exposure with growth on C/T MICx8 containing media in 6/8 strains exposed to C/T alone, but 0/8 strains exposed to C/T plus T and 1/8 strains exposed to C/T plus F.

Conclusion

Combinations of C/T plus T or F resulted in long term suppression of Pa bacterial load and minimised emergence of resistance in Pa strains with C/T MICs on or just above the epidemiological cut off value (MIC 4mg/L-64mg/L).

Disclosures

Alasdair P. MacGowan, MD, GSK: Grant/Research Support|InfectoPharm: Grant/Research Support|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Venatorx: Advisor/Consultant.

Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study

INTRODUCTION

This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.

METHODS

Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.

RESULTS

320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%).

CONCLUSION

After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.

Primary ciliary dyskinesia in two English Cocker Spaniels

BACKGROUND

Primary ciliary dyskinesia (PCD) is an inherited condition characterised by structural and functional defects of ciliated cells. Ciliated cells are present in several different anatomic locations and PCD can thus cause a variety of clinical signs; however, the predominant clinical signs in dogs are respiratory in nature, most commonly chronic nasal discharge and recurrent lower respiratory tract infections commencing in the neonatal period.

CASE REPORT AND CONCLUSION

This report describes two cases of PCD in English Cocker Spaniel puppies presenting with chronic nasal discharge and bronchopneumonia. We describe the use of a minimally invasive technique to collect samples suitable for cilial studies for its diagnosis.

Bespoke latex allergen testing improves assessment of respiratory symptoms in textile-braiding workers

BACKGROUND

Latex allergy is poorly understood in latex-exposed textile workers.

METHODS

A cross-sectional study was carried out to better characterize respiratory symptoms, using personal breathing zone latex allergen measurement and specific IgE to latex allergens.

RESULTS

Forty-four of the 86 (51% participation rate) participated. Ten of 39 workers who gave a blood sample (25.6%) were found to have IgE to at least one workplace allergen (5/39 positive to either latex braiding coated with silica or talc, 4/39 were positive to the dyed cotton extract, and 1/39 to latex braiding coated with silica or talc and dyed cotton extract), whilst only 2 of these 10 had specific IgE to the commercial latex extract.

CONCLUSIONS

The presence of symptoms with evidence of sensitization was strongly dictated by current latex exposure. Bespoke workplace allergen IgE testing identified cases of WR respiratory symptoms with sensitization that otherwise would not have been identified.

The partial replacement of soyabean meal and rapeseed meal with feed grade urea or a slow-release urea and its effect on the performance, metabolism and digestibility in dairy cows

The objectives of the study were to determine the effect of the partial replacement of soyabean meal and rapeseed meal with feed grade urea or a slow-release urea on the performance, metabolism and whole-tract digestibility in mid-lactation dairy cows. Forty-two Holstein-Friesian dairy cows were allocated to one of three dietary treatments in each of three periods of 5 weeks duration in a Latin square design. Control (C) cows were offered a total mixed ration based on grass and maize silages and straight feeds that included 93 g/kg dry matter (DM) soyabean meal and 61 g/kg DM rapeseed meal. Cows that received either of the other two treatments were offered the same basal ration with the replacement of 28 g/kg DM soyabean and 19 g/kg DM rapeseed meal with either 5 g/kg DM feed grade urea (U) or 5.5 g/kg DM of the slow-release urea (S; Optigen®; Alltech Inc., Kentucky, USA), with the content of maize silage increasing. There was no effect (P > 0.05) of dietary treatment on DM intake, which averaged 22.5 kg/day. Similarly, there was no effect (P > 0.05) of treatment on daily milk or milk fat yield but there was a trend (P = 0.09) for cows offered either of the diets containing urea to have a higher milk fat content (average of 40.1 g/kg for U and S v. 38.9 g/kg for C). Milk true protein concentration and yield were not affected by treatment (P > 0.05). Milk yield from forage and N efficiency (g milk N output/g N intake) were highest (P < 0.01) in cows when offered S and lowest in C, with cows receiving U having intermediate values. Cows offered S also tended to have the highest live weight gain (0.38 kg/day) followed by U (0.23 kg/day) and C (0.01 kg/day; P = 0.07). Plasma urea concentrations were higher (P < 0.05) at 2 and 4 h post feeding in cows when offered U and lowest in C, with animals receiving S having intermediate values. There was no effect (P > 0.05) of treatment on whole-tract digestibility. In conclusion, the partial replacement of soyabean meal and rapeseed meal with feed grade urea or a slow-release urea can be achieved without affecting milk performance or diet digestibility, with the efficiency of conversion of dietary N into milk being improved when the slow-release urea was fed.

Line-orientation generalization following signalled-reinforcer training

Three naive and three nonnaive pigeons key pecked for food on a multiple variable-interval 1-minute variable-interval 1-minute schedule with a black zero-degree vertical line on a white surround associated with one component and a black line shifted 30 degrees to the right (+30 degree) associated with the other component. Subsequently, a signalled-reinforcer procedure was introduced in the +30 degree component, i.e., whenever the reinforcer was available for the next response, the key changed to blank white. Following this training, the original unsignalled-reinforcer condition was re-instated. Line orientation generalization tests were given at the end of signalled-reinforcer training and after the second unsignalled-reinforcer condition. The signalled-reinforcer procedure reduced response rate in the +30-degree component in all subjects but facilitated responding during the zero-degree component (behavioral contrast) for two of the naive subjects only. However, average generalization gradients following signalled-reinforcer training indicated peak shift in two subjects and area shift in all five subjects that completed the experiment. There was no apparent relation between contrast and peak shift or degree of area shift. The data were interpreted as supporting the notion that the signalled-reinforcer procedure segments a variable-interval schedule into extinction and fixed ratio 1 segments.

Complementary methods to investigate the development of clogging within a horizontal sub-surface flow tertiary treatment wetland

A combination of experimental methods was applied at a clogged, horizontal subsurface flow (HSSF) municipal wastewater tertiary treatment wetland (TW) in the UK, to quantify the extent of surface and subsurface clogging which had resulted in undesirable surface flow. The three dimensional hydraulic conductivity profile was determined, using a purpose made device which recreates the constant head permeameter test in-situ. The hydrodynamic pathways were investigated by performing dye tracing tests with Rhodamine WT and a novel multi-channel, data-logging, flow through Fluorimeter which allows synchronous measurements to be taken from a matrix of sampling points. Hydraulic conductivity varied in all planes, with the lowest measurement of 0.1md(-1) corresponding to the surface layer at the inlet, and the maximum measurement of 1550md(-1) located at a 0.4m depth at the outlet. According to dye tracing results, the region where the overland flow ceased received five times the average flow, which then vertically short-circuited below the rhizosphere. The tracer break-through curve obtained from the outlet showed that this preferential flow-path accounted for approximately 80% of the flow overall and arrived 8h before a distinctly separate secondary flow-path. The overall volumetric efficiency of the clogged system was 71% and the hydrology was simulated using a dual-path, dead-zone storage model. It is concluded that uneven inlet distribution, continuous surface loading and high rhizosphere resistance is responsible for the clog formation observed in this system. The average inlet hydraulic conductivity was 2md(-1), suggesting that current European design guidelines, which predict that the system will reach an equilibrium hydraulic conductivity of 86md(-1), do not adequately describe the hydrology of mature systems.

Nationwide outbreak of listeriosis due to contaminated meat

We used molecular subtyping to investigate an outbreak of listeriosis involving residents of 24 US states. We defined a case as infection with Listeria monocytogenes serotype 4b yielding one of several closely related patterns when subtyped by pulsed-field gel electrophoresis. Patients infected with strains yielding different patterns were used as controls. A total of 108 cases were identified with 14 associated deaths and four miscarriages or stillbirths. A case-control study implicated meat frankfurters as the likely source of infection (OR 17.3, 95% CI 2.4-160). The outbreak ended abruptly following a manufacturer-issued recall, and the outbreak strain was later detected in low levels in the recalled product. A second strain was recovered at higher levels but was not associated with human illness. Our findings suggest that L. monocytogenes strains vary widely in virulence and confirm that large outbreaks can occur even when only low levels of contamination are detected in sampled food. Standardized molecular subtyping and coordinated, multi-jurisdiction investigations can greatly facilitate detection and control of listeriosis outbreaks.

Evaluation of environmental burdens associated with sewage treatment processes using life cycle assessment techniques

Life cycle assessments of a range of wastewater treatment processes have been undertaken. At lower consent standards rotating biological contactors and biological filters exhibit lower environmental burdens for the required functionality than other process options. However, at tighter consents this distinction becomes less clear. Attempts to reduce environmental burdens should focus on operational energy requirements (which dominate burden profiles and, where appropriate, on synthetic materials used for bio-mass growth). However, differences between dry and operational weight, and the consequent size of necessary foundation structures are likely to limit opportunities for reducing overall burden profiles through material substitution. Comparison of processes across population equivalents suggests economies of scale may favour adopting larger scale plant, although there are additional factors yet to be included in this analysis. Furthermore, adopting different waste disposal routes during the demolition phase is unlikely to have a distinct impact on burden profiles.

Factors affecting the longevity of sub-surface horizontal flow systems operating as tertiary treatment for sewage effluent

Compared with other forms of domestic wastewater treatment, reed beds require very little in the way of operational and maintenance input. This is even more markedly the case with tertiary treatment systems (than with secondary treatment systems) where the necessary maintenance amounts to only a few days/year. Unfortunately, in practice this frequently results in them receiving little or no attention at all. Tertiary treatment reed beds are not a "fit and forget" solution but they are often treated this way because they are very forgiving and abuse-tolerant. After a number of years a few of these tertiary reed beds have deteriorated to an extent whereby they are close to failing to comply with the regulator's requirements. Severn Trent Water Ltd has recognised this situation and has committed a budget for a programme of reed bed maintenance. This work has started with a survey of the condition of their beds and particularly to determine the common problems and hence the maintenance regime required. Five main problems occurred either singly or in combination namely: (a) sludge deposition; (b) above surface flooding (partially caused by (a), (c), and (d)); (c) inlet flow distributor problems/clogging; (d) outlet collector problems/incorrect level; (e) weed infestation.

Impact of operational maintenance on the asset life of storm reed beds

This paper reviews the operation of storm reed beds to determine whether the current system of operational maintenance is contributing to premature process failures and if not, to identify other factors of importance. Twelve storm reed beds of the horizontal subsurface flow type, at seven locations in the South Warwickshire area of the United Kingdom, were surveyed. Each survey consisted of a site visit, an interview with the operators in charge and an assessment of the treatment performance based on routine monitoring data. Although some sites suffered from varying degrees of sludge accumulation, surface blinding and/or weed growth, all effluent concentrations remained far below the consent levels. Thorough operational maintenance on a reed bed is proven to be important for the asset life. However, there are other factors or features of a reed bed that play a more pivotal role in premature process failure such as the lack of pretreatment and a premature operation of the storm overflow.

The fate and removal of triclosan during wastewater treatment

This work examines the variation in removal efficiency of triclosan in wastewater treatment works in the United Kingdom between November 2003 and April 2004. Concentrations of triclosan were measured at set points within three different types of wastewater treatment works: rotating biological contactors, trickling filters, and activated sludge. Overall removal of triclosan through these plants ranged from 58 to 96% (rotating biological contactors), 86 to 97% (trickling filter), and 95 to 98% (activated sludge).

Effect of concurrent zidovudine use on the resistance pathway selected by abacavir-containing regimens

OBJECTIVES

Abacavir (ABC) selects for four mutations (K65R, L74V, Y115F and M184V) in HIV-1 reverse transcriptase (RT), both in vitro and during monotherapy in vivo. The aim of this analysis was to compare the selection of these and other nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations by ABC-containing therapies in the presence and absence of concurrent lamivudine (3TC) and/or zidovudine (ZDV) and to assess the effect of these mutations on phenotypic susceptibility to the NRTIs.

DESIGN

This study was a retrospective analysis of the patterns of NRTI-associated mutations selected following virological failure in six multicentre trials conducted during the development of ABC.

METHODS

Virological failure was defined as confirmed vRNA above 400 HIV-1 RNA copies/mL. RT genotype and phenotype were determined using standard methods.

RESULTS

K65R was selected infrequently by ABC-containing regimens in the absence of ZDV (13 of 127 patients), while L74V/I was selected more frequently (51 of 127 patients). Selection of both K65R and L74V/I was significantly reduced by co-administration of ZDV with ABC (one of 86 and two of 86 patients, respectively). Y115F was uncommon in the absence (seven of 127 patients) or presence (four of 86 patients) of ZDV. M184V was the most frequently selected mutation by ABC alone (24 of 70 patients) and by ABC plus 3TC (48 of 70 patients). Thymidine analogue mutations were associated with ZDV use. The K65R mutation conferred the broadest phenotypic cross-resistance of the mutations studied.

CONCLUSIONS

The resistance pathway selected upon virological failure of ABC-containing regimens is significantly altered by concurrent ZDV use, but not by concurrent 3TC use. These data may have important implications for the efficacy of subsequent lines of NRTI therapies.

Prevalence of sensitisation to cellulase and xylanase in bakery workers

AIMS

To assess the prevalence of sensitisation to a range of exogenous fungal enzymes used in bakeries, and determine the relation between sensitisation and work related symptoms.

METHODS

Serum samples (n = 135) from a previous cross sectional study investigating the prevalence of respiratory symptoms and sensitisation to dust components, were reanalysed for specific IgE to the mixed enzymes cellulase, hemicellulase, and xylanase.

RESULTS

Eight (6%) of sera tested had detectable specific IgE to mixed enzymes (excluding fungal alpha-amylase) and 16 (12%) to fungal alpha-amylase. A significant increase (p = 0.03) in nasal symptoms was found in those workers sensitised to enzymes (including alpha-amylase and the mixed enzymes, but with or without sensitisation to wheat flour) when compared to those sensitised to wheat flour alone. Both groups had significantly greater levels of nasal symptoms in comparison to those with no evidence of sensitisation.

CONCLUSIONS

The association between specific IgE to mixed enzymes, and an increased prevalence of nasal symptoms in individuals sensitised to enzymes, highlights the importance of measuring sensitisation to the full range of exogenous enzymes used in the baking industry, as well as to wheat flour.

Ten years experience of treating all flows from combined sewerage systems using package plant and constructed wetland combinations

Severn Trent Water have been using constructed wetlands since 1991 as part of a flowsheet in which 6 DWF (Dry Weather Flow) is treated by rotating biological contactors (RBCs), and constructed reed beds used to provide both tertiary treatment and stormwater treatment. The company now has over 50 such sites using this flowsheet. Dimensioning and effluent quality achievable is reported and data presented showing the performance of reed beds treating stormwater alone or in admixture with RBC effluent. After 8-10 years of operation the condition of a number of storm reed beds was assessed to determine the remaining asset life. The majority seem likely to achieve at least another five years of operation before further review is needed.

Developing a sustainable energy strategy for a water utility. Part II: A review of potential technologies and approaches

Environmental legislation is increasing the amounts of bought-in electricity required for sewage treatment, and generating larger volumes of sewage sludge to be treated and disposed of. Concurrently, concerns over global warming and food safety from sewage sludge recycling on agricultural land is augmenting the costs of conventional sewage and sludge treatment technologies and practices. This paper reviews some emerging technologies and practices that may assist in mitigating these problems in the future. In addition, a number of potential renewable energy technologies available to water companies are reviewed. Results suggest that through the take-up of new technologies, current and future water quality standards could be delivered in a more sustainable way. However, this series of papers also highlights that institutional and political conflicts may have inadvertently failed to recognise the wider effects of improving water quality and lessened the financial support necessary for their widespread take-up. It is also suggested that through the use of a Strategic Environmental Assessment (SEA) approach, stakeholders could gain a better understanding of the broader environmental effects of achieving certain water quality standards and develop policy and long-term investment strategies accordingly. However, to fulfill the information requirements of an SEA, an appropriate appraisal tool that considers many of these factors in unison is required, and a possible technique is suggested.

Developing a sustainable energy strategy for a water utility. Part I: A review of the UK legislative framework

Increasing political effort to improve water quality across the UK and Europe has led to water and sewerage companies investing heavily in high-tech wastewater treatment plants capable of producing high quality effluents. Consequently, amounts of bought-in electricity used for wastewater treatment has and will continue to increase significantly over coming years, while greater provision of enhanced sewage treatment also produces greater volumes of sewage sludge requiring treatment and disposal. Over the same period, tougher controls on the quality of biosolids applied to agricultural land have also been introduced, while there has been an international attempt to reduce the use of fossil-fuel derived power sources because of concerns over global warming. The latter has brought about the introduction of financial instruments, such as the Climate Change Levy, to curb energy use, promote energy efficiency and encourage the development of renewable energy technologies. These factors are set to drive-up the costs of providing adequate sewage treatment services, while at the same time, a tough regulatory line taken to control profits on regional monopolies held by the UK water companies will significantly reduce their revenues over the period 2000-05. The result is that, financially, UK water and sewerage companies face their most challenging period since privatisation in 1989. This paper briefly outlines the current regulations relating to water quality and energy use that will affect water company operations over coming years.

Mechanisms of isocyanate sensitisation. An in vitro approach

Although there is an abundance of clinical evidence which suggests that the inhalation of isocyanates can induce occupational asthma, the immunological basis for the disease is not understood. We have investigated immune cell responses to isocyanate using the cell line mono-mac-6, by measuring the production of hydrogen peroxide, and the expression of ICAM-1 following challenge with isocyanates and their corresponding amines. We observed an increase in the levels of intracellular peroxide, in addition to an upregulation of ICAM-1 expression (P<0.05), following cell stimulation with isocyanates, which was not apparent following stimulation with amines. From the results of this study we hypothesise that the production of reactive oxygen species (ROS) by monocytic cells at the site of exposure to an isocyanate may have two potential outcomes. The first is that the ROS may contribute to tissue damage at the site of inflammation, and then secondly, it is possible this production of hydrogen peroxide may also induce the upregulation of adhesion markers on monocytic cells, specifically ICAM-1, which may potentiate the infiltration and adhesion of cells at the site of inflammation.

Anaerobic treatment of domestic wastewater in temperate climates: treatment plant modelling with economic considerations

Although research suggests that anaerobic treatment of low-strength domestic wastewater is possible in temperate climates, to date, full-scale applications have only been pioneered in hot regions. However, burgeoning environmental legislation in developed countries is giving the impetus to develop anaerobic wastewater treatment systems due to potential economic and environmental benefits they hold over traditional aerobic techniques. In this paper a design rationale for low-temperature, low-strength (COD < 1,000 mgl(-1)), two-phase anaerobic wastewater treatment is developed through empirical modelling of data from published research, and from assumptions arising from a literature review. Model calculations are applied to typical domestic sewage characteristics at two different flow rates, based on population equivalents. Results indicate that soluble COD production in the model hydrolytic tank are similar to those achieved in pilot scale plants in the Netherlands. Model anaerobic reactor sludge characteristics are similar to those achieved in pilot and full-scale anaerobic reactors treating low-strength wastewaters. Indicative cost figures for a two-phase anaerobic treatment plant are given, but are incomplete without an assessment of the cost of post-treatment processes. Anaerobic treatment is likely to become more attractive in the future as new legislation relating to sludge disposal and renewable energy generation are introduced.

Mass spectrometry screening of combinatorial mixtures, correlation of measured and predicted electrospray ionization spectra

Methodology was developed to afford rapid characterization of multicomponent mixtures of small organic molecules prepared by split-and-mix combinatorial synthesis. This methodology involved the use of liquid chromatography mass spectrometry (LC/MS) combined with correlation analysis of measured versus predicted electrospray ionization mass spectra. Low-resolution mass spectra of complex mixtures revealed predictable patterns that confirm library products, assisted in identifying chemical synthesis errors, and assessed overall library integrity. In general, equal signal intensities were observed for most combinatorial mixture components, indicating that differences in electrospray ionization efficiency was not a major limitation to this approach. High-throughput data processing programs and informatics tools were used to speed data analysis and to simplify the presentation of the library characterization results. This approach has been used to characterize combinatorial libraries that were synthesized for a variety of drug-discovery programs. Examples are shown for library formats of 1, 40, 66, 280, and 400 component(s)/well. The applicability of this approach to large combinatorial mixtures should allow direct characterization of massive combinatorial libraries.

Measurement of personal exposure to aerosols of Nephrops norvegicus (scampi) using a monoclonal-based assay

BACKGROUND

The industrial processing of scampi (Nephrops norvegicus) generates bioaerosols which can cause occupational respiratory disease in exposed individuals. The objective of this study was to develop a monoclonal antibody-based immunoassay to measure scampi proteins collected using standard personal air sampling methods.

METHODS

A monoclonal antibody was generated which predominantly bound to a single 97 Kd scampi protein, which we have shown to be a major allergen. This protein was shown by SDS PAGE immunoblotting to be present in various aqueous extracts from wastes produced during scampi processing. A quantitative immunoslotblot method was developed to quantify scampi from air sample filters.

RESULTS

We demonstrated the utility of this method by showing a significant difference (P = 0.015) in the level of exposure of two groups of 12 workers processing scampi at a traditional open workstation (GM = 607 ng m(-3)) and at an enclosed workstation (GM = 451 ng m(-3)).

CONCLUSION

We conclude that this assay can be used, in conjunction with health surveillance, to monitor exposure and the efficacy of measures to reduce exposure to airborne scampi allergen in an occupational environment.

Development of an animal model to assess the immunogenicity of single-dose tetanus and diphtheria vaccines based on controlled release from biodegradable polymer microspheres

We have determined threshold doses of aluminium phosphate (AlPO4) adsorbed tetanus toxoid (TT) and diphtheria toxoid (DT) in mice and guinea pigs with a view to developing an animal model to assess the immunogenicity of controlled release vaccines. A dose was sought (threshold dose) which produces little antibody after primary injection and a moderate response after a booster injection, thus mimicking the adult human response to TT and DT vaccines adsorbed on to aluminium adjuvants. After the first injection, mice and guinea pigs showed a dose response for both tetanus toxin IgG antibodies and tetanus antitoxin over a wide range of doses of AlPO4-adsorbed TT (0.01 to 0.2 Lf). After the second and third injections, there was no clear dose response for doses between 0.05 and 0.2 Lf However, doses between 0.01 and 0.04 Lf still showed a dose response after the second injection. Dilution of AlPO4-adsorbed TT in saline just before injection did not alter immunogenicity after the first injection, but stronger booster responses were seen in mice to diluted versus undiluted vaccine after the second and third injections. The threshold dose of AlPO4-adsorbed TT for both mice and guinea pigs was 0.01 Lf given in 100 microliters. For AlPO4-adsorbed DT, three strains of mice (inbred, Balb/c and C57/B6, and outbred, CD-1) showed a dose response after the first injection for DT IgG antibodies and diphtheria antitoxin at 0.1 and 0.2 Lf doses. Outbred CD-1 mice showed a dose response after the second and third injections also, whereas inbred mice showed inconsistent dose responses after the second injection and none after the third injection. In contrast to AlPO4-adsorbed TT, mice injected with undiluted AlPO4-adsorbed DT elicited significantly higher antibodies than those injected with diluted formulations, particularly after the first injection. The threshold dose of AlPO4-adsorbed DT for mice was 0.1 Lf in a volume of 250 microliters. Lower doses did not produce consistent antibody responses in mice. We propose that a single dose of controlled release formulations at doses not greater than 1/10 of a single human dose when injected into mice and guinea pigs should produce an antibody response similar or higher than two to three threshold doses of AlPO4-adsorbed TT or DT.

Development and validation of a monoclonal based immunoassay for the measurement of fungal alpha-amylase: focus on peak exposures

The inhalation of flour dust has been implicated in the induction of sensitisation and elicitation of respiratory symptoms, such as asthma in bakers. In addition to the cereal allergens present in wheat flour, enzymes in flour improvers, in particular fungal alpha-amylase, are now known to be a significant cause of respiratory allergy in the baking industry.A monoclonal antibody based enzyme-linked immunoassay (ELISA) was developed using two monoclonal antibodies that recognised two distinct epitopes of the fungal alpha-amylase enzyme. The ELISA had an inter-assay variation of 12.0% at 1360 pg/ml and 12.8% at 564 pg/ml and intra-assay variation of 4.9% at 1340 pg/ml and 6.1% at 504 pg/ml. The assay had a sensitivity of 200 pg/ml. Competitive inhibition assays confirmed that the monoclonal antibodies had no cross reactivity with other enzymes used in the baking industry and could distinguish added fungal alpha-amylase from cereal amylase. We assessed the levels of exposure to dust, total protein and fungal alpha-amylase in four UK bakeries ranging in size and technical capabilities. Within the bakeries we surveyed, workers were exposed to variable levels of inhalable dust (0.8-39.8 mg/m3), total protein (0-5.7 mg/m3) and fungal alpha-amylase (0-29.8 ng/m3). Consecutive 15 min personal samples taken over a 1 h period demonstrated that the ELISA could measure fungal alpha-amylase exposure in such a 15 min period. Short term peak exposures to fungal alpha-amylase could be identified which may contribute to the sensitisation in individuals who appear to have low exposure levels if measured over a full shift period.

The development of an antibody to trimellitic anhydride

Acid anhydrides are a group of highly reactive chemicals used widely in the formulation of paints and plastics. Exposure to acid anhydrides causes several occupational lung diseases such as pneumonititis and asthma. Whilst anhydrides, specifically trimellitic anhydride (TMA), have been shown to bind to lung tissue in an animal model, further investigation has been hampered by the lack of a reagent which would enable the identification of primary target proteins for the binding of TMA. Our objective was to develop an antibody to TMA which would enable in vitro studies of TMA interactions with lung epithelial proteins. We developed a monoclonal antibody which binds solely to TMA. We have demonstrated that the antibody can be used to detect TMA bound to different human proteins with little non-specific binding to unconjugated proteins. We then exposed cells of the A549 lung epithelial cell line to TMA in vitro and have shown by western blotting that binding occurs in the 20-35 Kd weight range. We have developed a specific and sensitive reagent to detect TMA bound to proteins. We have used this to show that when TMA is incubated with a lung epithelial cell line, that the TMA binds to proteins with a restricted molecular weight range. These results suggest that the current paradigm for the detection of IgE to small molecular weight reactive chemicals, which presupposes that the chemical binds to serum albumin, may need further investigation.

Personal protective equipment and dermal exposure

Personal protective equipment (PPE) should only be used as a control measure when other measures are inappropriate or are inadequate by themselves. The person undertaking a risk assessment must exercise his or her judgment to take into account the protection afforded by the PPE. There is, therefore, considerable scope for differences in approach and it would seem sensible to eliminate these differences and ensure consistency, where possible, by reaching agreement on the attenuating effect of PPE. However, there is growing evidence that the levels of protection indicated by laboratory-based tests may not be achieved in real use situations. Studies of workplace protection suggest that the spread of contaminants inside protective clothing, including gloves, is commonplace and significant. Insufficient attention may have been paid to the effect of factors such as temperature differentials on the permeation of chemical agents through protective materials. To investigate this, a test cell was designed and built to measure the breakthrough times and subsequent permeation rate of solvents through glove materials where the temperature inside and outside the glove was representative of those that can occur in the workplace. Two chemical solvents were tested against two different glove materials at three different temperature conditions. The differences between the breakthrough times and permeation rates were measured and compared to manufacturer's test data. The practical implications are considered for risk of health and safety to the wearer.

A specialized crisis response site as a core element of police-based diversion programs

Transporting an individual in psychiatric crisis to an emergency department is often frustrating for both law enforcement and mental health professionals. To facilitate collaboration between police and mental heath professionals in crisis cases, some communities have developed prebooking diversion programs that rely on specialized crisis response sites where police can drop off individuals in psychiatric crisis and return to their regular patrol duties. These programs identify detainees with mental disorders and work with diversion staff, community-based providers, and the courts to produce a mental health disposition in lieu of jail. This paper describes three of the diversion programs participating in the Substance Abuse and Mental Health Services Administration jail diversion knowledge development application initiative that demonstrate the importance of specialized crisis response sites. The three programs are in Memphis, Tennessee; Montgomery County, Pennsylvania; and Multnomah County, Oregon. The authors describe important principles in the operation of these programs: being a highly visible, single point of entry; having a no-refusal policy and streamlined intake for police cases; establishing legal foundations to detain certain individuals; ensuring innovative, intensive cross-training; and linking clients to community services.

Growth hormone secretagogue receptor family members and ligands

We have previously reported the cloning and characterization of a new orphan G-protein-coupled receptor (GPC-R), the growth hormone secretagogue receptor (GHS-R), and shown that this receptor mediates the activity of the growth hormone-releasing peptides (GHRPs) and nonpeptide ligands such as L-692,429 and MK-0677. Because the GHS-R obviously does not belong to any of the known GPC-R subfamilies, we searched for GHS-R family members by screening a human genomic library using low-stringency hybridization and screening a Pufferfish genomic library. The Pufferfish was selected because of its compact genome. From the human genomic library, a homolog, GPR38, with 52% identity to the GHS-R was isolated. From the Pufferfish library, three family members were isolated. The Pufferfish gene having 58% identity to the GHS-R, on expression in HEK293 cells, was activated with GHRP-6 and MK-0677. These results indicate that the GHS-R has been conserved for at least 400 million years and that the Pufferfish genome is appropriate for isolation of GHS-R family members. In our search for endogenous ligands for the orphan receptors GHS-R and GPR38, we showed that adenosine is a partial agonist of the GHS-R and that motilin is the endogenous ligand for GPR38. We also confirmed that the endogenous ligand ghrelin is a full agonist of the GHS-R.

Chemical and physical pretreatment of ATAD biosolids for dewatering

This paper reports on two modifications to the typical practice of polymer conditioning intended to enhance the dewaterability of autothermal thermophilic aerobic digested (ATAD) biosolids. One modification was a chemical pretreatment, using ferric chloride prior to polymer conditioning, and the other was a physical pretreatment using an electrical arc technology before polymer addition. These modifications were evaluated separately and in combination, in laboratory conditioning experiments using ATAD biosolids. Results showed that neither ferric chloride nor the arc treatment is sufficient to produce dewaterable biosolids without the use of polymer. However, use of a ferric chloride dose as low as 100 g per kg of dry solids reduced the polymer requirement by about 50%. The arc treatment provided further enhancement of dewaterability, but the observed benefits might not justify its use without further optimization. For this purpose, additional methods were utilized to assist in understanding the pretreatment mechanisms.

Peroxynitrite reductase activity of bacterial peroxiredoxins

Nitric oxide (NO) is present in soil and air, and is produced by bacteria, animals and plants. Superoxide (O2-) arises in all organisms inhabiting aerobic environments. Thus, many organisms are likely to encounter peroxynitrite (OONO-), a product of NO and O2- that forms at near diffusion-limited rates, and rapidly decomposes upon protonation through isomerization to nitrate (NO3-; ref. 1) while generating hydroxyl radical (*OH) and nitrogen dioxide radical (*NO2) (refs 2, 3), both more reactive than peroxynitrite's precursors. The oxidative, inflammatory, mutagenic and cytotoxic potential (ref. 4) of peroxynitrite contrasts with the antioxidant, anti-inflammatory and tissue-protective properties ascribed to NO itself. Thus, the ability of cells to cope with peroxynitrite is central in determining the biological consequences of NO production. We considered whether cells might be equipped with enzymes to detoxify peroxynitrite. Peroxiredoxins have been identified in most genomes sequenced, but their functions are only partly understood. Here we show that the peroxiredoxin alkylhydroperoxide reductase subunit C (AhpC) from Salmonella typhimurium catalytically detoxifies peroxynitrite to nitrite fast enough to forestall the oxidation of bystander molecules such as DNA. Results are similar with peroxiredoxins from Mycobacterium tuberculosis and Helicobacter pylori. Thus, peroxynitrite reductase activity may be widespread among bacterial genera.

Excessive ethanol drinking following a history of dependence: animal model of allostasis

Alcohol withdrawal symptoms, particularly negative emotional states, can persist for months following the removal of alcohol. These protracted withdrawal symptoms have been implicated as an important trigger of relapse to excessive drinking in alcoholics and may represent a long lasting shift in affective tone as a result of chronic alcohol exposure. It was shown previously that ethanol-dependent rats increased their operant responding for ethanol when tested during the first 12 hr after withdrawal. The purpose of the present experiments was to determine the persistence of this finding by examining operant oral ethanol self-administration in rats with a history of physical dependence upon ethanol, detoxified and then allowed a two week period of protracted abstinence. The results of these experiments indicate that operant responding for ethanol was enhanced during protracted abstinence by 30-100% and remained elevated for 4-8 weeks post acute withdrawal. These results have important implications for understanding the characteristics and mechanisms underlying vulnerability to relapse.

Activation of JNK3 alpha 1 requires both MKK4 and MKK7: kinetic characterization of in vitro phosphorylated JNK3 alpha 1

JNK3 alpha 1 is predominantly a neuronal specific MAP kinase that is believed to require, like all MAP kinases, both threonine and tyrosine phosphorylation for maximal enzyme activity. In this study we investigated the in vitro activation of JNK3 alpha 1 by MAP kinase kinase 4 (MKK4), MAP kinase kinase 7 (MKK7), and the combination of MKK4 + MKK7. Mass spectral analysis showed that MKK7 was capable of monophosphorylating JNK3 alpha 1 in vitro, whereas both MKK4 and MKK7 were required for bisphosphorylation and maximal enzyme activity. Measuring catalysis under Vmax conditions showed MKK4 + MKK7-activated JNK3 alpha 1 had Vmax 715-fold greater than nonactivated JNK3 alpha 1 and MKK7-activated JNK3 alpha 1 had Vmax 250-fold greater than nonactivated JNK3 alpha 1. In contrast, MKK4-activated JNK3 alpha 1 had no increase in Vmax compared to nonactivated levels and had no phosphorylation on the basis of mass spectrometry. These data suggest that MKK7 was largely responsible for JNK3 alpha 1 activation and that a single threonine phosphorylation may be all that is needed for JNK3 alpha 1 to be active. The steady-state rate constants kcat, Km(GST-ATF2++), and Km(ATP) for both monophosphorylated and bisphosphorylated JNK3 alpha 1 were within 2-fold between the two enzyme forms, suggesting the addition of tyrosine phosphorylation does not affect the binding of ATF2, ATP, or maximal turnover. Finally, the MAP kinase inhibitor, SB203580, had an IC50 value approximately 4-fold more potent on the monophosphorylated JNK3 alpha 1 compared to the bisphosphorylated JNK3 alpha 1, suggesting only a modest effect of tyrosine phosphorylation on inhibitor binding.

Activation of JNK3 alpha 1 requires both MKK4 and MKK7: kinetic characterization of in vitro phosphorylated JNK3 alpha 1

JNK3 alpha 1 is predominantly a neuronal specific MAP kinase that is believed to require, like all MAP kinases, both threonine and tyrosine phosphorylation for maximal enzyme activity. In this study we investigated the in vitro activation of JNK3 alpha 1 by MAP kinase kinase 4 (MKK4), MAP kinase kinase 7 (MKK7), and the combination of MKK4 + MKK7. Mass spectral analysis showed that MKK7 was capable of monophosphorylating JNK3 alpha 1 in vitro, whereas both MKK4 and MKK7 were required for bisphosphorylation and maximal enzyme activity. Measuring catalysis under Vmax conditions showed MKK4 + MKK7-activated JNK3 alpha 1 had Vmax 715-fold greater than nonactivated JNK3 alpha 1 and MKK7-activated JNK3 alpha 1 had Vmax 250-fold greater than nonactivated JNK3 alpha 1. In contrast, MKK4-activated JNK3 alpha 1 had no increase in Vmax compared to nonactivated levels and had no phosphorylation on the basis of mass spectrometry. These data suggest that MKK7 was largely responsible for JNK3 alpha 1 activation and that a single threonine phosphorylation may be all that is needed for JNK3 alpha 1 to be active. The steady-state rate constants kcat, Km(GST-ATF2++), and Km(ATP) for both monophosphorylated and bisphosphorylated JNK3 alpha 1 were within 2-fold between the two enzyme forms, suggesting the addition of tyrosine phosphorylation does not affect the binding of ATF2, ATP, or maximal turnover. Finally, the MAP kinase inhibitor, SB203580, had an IC50 value approximately 4-fold more potent on the monophosphorylated JNK3 alpha 1 compared to the bisphosphorylated JNK3 alpha 1, suggesting only a modest effect of tyrosine phosphorylation on inhibitor binding.

Resistance profile of the human immunodeficiency virus type 1 reverse transcriptase inhibitor abacavir (1592U89) after monotherapy and combination therapy. CNA2001 Investigative Group

Abacavir (1592U89) is a nucleoside inhibitor of human immunodeficiency virus (HIV) type 1 reverse transcriptase (RT). Resistance to abacavir was studied with abacavir alone and with abacavir in combination with other nucleoside analogues in cell culture, in virus isolates from zidovudine/lamivudine clinical trials, and in the first dose-escalating 12-week clinical trial (CNA2001) to evaluate abacavir clinical potency. Abacavir alone in vitro selected for mutations at HIV RT codons K65R, L74V, Y115F, and M184V. However, abacavir combined with zidovudine selected against virus with the M184V mutation. Abacavir therapy in vivo resulted in large decreases in HIV load (>1 log), even in 1 subject who had the M184V mutation at baseline. A total of 51% of subjects showed new mutations at any of codons K65R, L74V, and M184V after abacavir monotherapy, compared with 11% who received zidovudine/abacavir. Small changes (2- to 4-fold) in abacavir susceptibility were detected. On stopping therapy, reselection of the pretherapy sequence occurred within 4 weeks.

The in vitro percutaneous penetration of chlorpyrifos

Chlorpyrifos is a widely used organophosphate pesticide. In order to study the pharmacokinetics of the penetration of chlorpyrifos through human skin we measured the percutaneous penetration of chlorpyrifos through human skin using an in vitro flow through apparatus. The chlorpyrifos was applied to the skin as a commercial concentrate or as a reference standard dissolved in ethanol. There was a significant difference (P=0.03) between the rate of penetration from the commercial concentrate (9.0 nmoles cm(-2) h(-1)) and that from the reference standard (4.9 nmoles cm(-2) h(-1)). Each experiment was run for 24 h. The recoveries from experiments where chlorpyrifos was applied to the skin as a commercial concentrate and as a reference standard dissolved in ethanol were, respectively, in total 91 and 87% of the applied dose of which 15 and 10% was recovered from the skin, 56 and 66% was recovered from the surface of the skin and 20 and 11% was recovered from the receptor fluid. There was a significant difference in the recoveries from the skin but there was no significant difference in the recoveries from the surface of the skin. We concluded that the majority of a dermal dose of chlorpyrifos was still present at or in the surface of the skin 24 h after application of a dermal dose. Because chlorpyrifos was recovered from the skin after 24 h, it is possible that the skin could act as a reservoir and release chlorpyrifos over a longer period. We also conclude that the solvent vehicle for chlorpyrifos can affect the rate of penetration of the pesticide.

HIV-1 reverse transcriptase (RT) genotype and susceptibility to RT inhibitors during abacavir monotherapy and combination therapy

OBJECTIVE

To examine changes in HIV-1 susceptibility (genotype and phenotype) during an initial abacavir monotherapy phase followed by the addition of zidovudine and lamivudine.

DESIGN

Sixty HIV-1 infected, antiretroviral therapy-naive subjects were randomized to receive 100, 300 or 600 mg abacavir twice daily. Subjects completing 24 weeks of randomized therapy or meeting a protocol defined switch criterion could switch to open label abacavir/zidovudine/lamivudine.

METHODS

Plasma HIV-1 reverse transcriptase was genotyped at baseline, week 12, and at the last time point on ABC monotherapy. Drug susceptibility was analysed at baseline and on subsequent samples with sufficient HIV-1 RNA levels using the recombinant virus assay. Virological responses (week 24) were correlated to week 24 genotypes.

RESULTS

Mutant viruses were not detected before week 12 with the exception of one subject. At the latest time point on abacavir monotherapy (range, weeks 6-48), 21 out of 43 subjects harboured virus with resistance conferring mutations including single, double and triple combinations of K65R, L74V, Y115F and M184V. The most common mutational pattern was L74V + M184V (11/21 cases). Twenty of the 21 subjects with isolates containing abacavir-associated mutations reached week 48, and upon addition of lamivudine/zidovudiine, 16 out of 20 (80%) had week 48 plasma HIV-1 -RNA below 400 copies/ml. At week 48, 16 out of 46 genotypes were obtained; one of these was wild-type; 15 contained M184V either alone, in combination with K65R and/or L74V and/or Y115F or with thymidine analogue-associated mutations. Week 48 viral load levels for these 15 subjects was low (median 3.43 log10 copies/ml or -1.99 log10 copies reduction from baseline). Genotype correlated well with phenotypic resistance to ABC; four samples with three abacavir-associated mutations had high level abacavir resistance (> 8-fold) and six samples with two or three mutations showed intermediate (4-8-fold) resistance. All samples with single mutations retained full ABC susceptibility.

CONCLUSIONS

Resistance conferring mutations to abacavir were relatively slow to develop during the monotherapy phase, and did not preclude durable efficacy of abacavir/lamivudine/zidovudine up to 48 weeks.

Percutaneous penetration studies for risk assessment

During the last few years the general interest in the percutaneous absorption of chemicals has increased. It is generally accepted that there is very few reliable quantitative and qualitative data on dermal exposure to chemicals in the general population and in occupationally exposed workers. In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual experiences, literature data and guidelines already in existence. During the meetings of Percutaneous Penetration Subgroup they presented a number of short papers of up to date information on the key issues. The objective was to focus the existing knowledge and the gaps in the knowledge in the field of percutaneous penetration. This paper is an outcome of the meetings of the Percutaneous Penetration Subgroup and reports the presentations on the key issues identified throughout the 3-year duration of the Dermal Exposure Network (1997-1999).

Mimicry of erythropoietin by a nonpeptide molecule

Erythropoietin (EPO) controls the proliferation and differentiation of erythroid progenitor cells into red blood cells. EPO induces these effects by dimerization of the EPO receptors (EPOR) present on these cells. To discover nonpeptide molecules capable of mimicking the effects of EPO, we identified a small molecule capable of binding to one chain of EPOR and used it to synthesize molecules capable of inducing dimerization of the EPOR. We first identified compound 1 (N-3-[2-(4-biphenyl)-6-chloro-5-methyl]indolyl-acetyl-L-lysine methyl ester) by screening the in-house chemical collection for inhibitors of EPO binding to human EPOR and then prepared compound 5, which contains eight copies of compound 1 held together by a central core. Although both compounds inhibited EPO binding of EPOR, only compound 5 induced dimerization of soluble EPOR. Binding of EPO to its receptor in cells results in activation of many intracellular signaling molecules, including transcription factors like signal transducer and activator of transcription (STAT) proteins, leading to growth and differentiation of these cells. Consistent with its ability to induce dimerization of EPOR in solution, compound 5 exhibited much of the same biological activities as EPO, such as (i) the activation of a STAT-dependent luciferase reporter gene in BAF3 cells expressing human EPOR, (ii) supporting the proliferation of several tumor cell lines expressing the human or mouse EPOR, and (iii) the in vitro differentiation of human progenitor cells into colonies of erythrocytic lineage. These data demonstrate that a nonpeptide molecule is capable of inducing EPOR dimerization and mimicking the biological activities of EPO.