Artificial intelligence-enabled prediction of chemotherapy-induced cardiotoxicity from baseline electrocardiograms

Anthracyclines can cause cancer therapy-related cardiac dysfunction (CTRCD) that adversely affects prognosis. Despite guideline recommendations, only half of the patients undergo surveillance echocardiograms. An AI model detecting reduced left ventricular ejection fraction from 12-lead electrocardiograms (ECG) (AI-EF model) suggests ECG features reflect left ventricular pathophysiology. We hypothesized that AI could predict CTRCD from baseline ECG, leveraging the AI-EF model's insights, and developed the AI-CTRCD model using transfer learning on the AI-EF model. In 1011 anthracycline-treated patients, 8.7% experienced CTRCD. High AI-CTRCD scores indicated elevated CTRCD risk (hazard ratio (HR), 2.66; 95% CI 1.73-4.10; log-rank p < 0.001). This remained consistent after adjusting for risk factors (adjusted HR, 2.57; 95% CI 1.62-4.10; p < 0.001). AI-CTRCD score enhanced prediction beyond known factors (time-dependent AUC for 2 years: 0.78 with AI-CTRCD score vs. 0.74 without; p = 0.005). In conclusion, the AI model robustly stratified CTRCD risk from baseline ECG.

Deep learning-based model detects atrial septal defects from electrocardiography: a cross-sectional multicenter hospital-based study

Background

Atrial septal defect (ASD) increases the risk of adverse cardiovascular outcomes. Despite the potential for risk mitigation through minimally invasive percutaneous closure, ASD remains underdiagnosed due to subtle symptoms and examination findings. To bridge this diagnostic gap, we propose a novel screening strategy aimed at early detection and enhanced diagnosis through the implementation of a convolutional neural network (CNN) to identify ASD from 12-lead electrocardiography (ECG).

Methods

ECGs were collected from patients with at least one recorded echocardiogram at 3 hospitals from 2 continents (Keio University Hospital from July 2011 to December 2020, Brigham and Women's Hospital from January 2015 to December 2020, and Dokkyo Medical University Saitama Medical Center from January 2010 and December 2021). ECGs from patients with a diagnosis of ASD were labeled as positive cases while the remainder were labeled as negative. ECGs after the closure of ASD were excluded. After randomly splitting the ECGs into 3 datasets (50% derivation, 20% validation, and 30% test) with no patient overlap, a CNN-based model was trained using the derivation datasets from 2 hospitals and was tested on held-out datasets along with an external validation on the 3rd hospital. All eligible ECGs were used for derivation and validation whereas the earliest ECG for each patient was used for the test and external validation. The discrimination of ASD was assessed by the area under the receiver operating characteristic curve (AUROC). Multiple subgroups were examined to identify any heterogeneity.

Findings

A total of 671,201 ECGs from 80,947 patients were collected from the 3 institutions. The AUROC for detecting ASD was 0.85-0.90 across the 3 hospitals. The subgroup analysis showed excellent performance across various characteristics Screening simulation using the model greatly increased sensitivity from 80.6% to 93.7% at specificity 33.6% when compared to using overt ECG abnormalities.

Interpretation

A CNN-based model using 12-lead ECG successfully identified the presence of ASD with excellent generalizability across institutions from 2 separate continents.

Funding

This work was supported by research grants from JST (JPMJPF2101), JSR corporation, Taiju Life Social Welfare Foundation, Kondou Kinen Medical Foundation, Research fund of Mitsukoshi health and welfare foundation, Tokai University School of Medicine Project Research and Internal Medicine Project Research, Secom Science and Technology Foundation, and Grants from AMED (JP23hma922012 and JP23ym0126813). This work was partially supported by One Brave Idea, co-funded by the American Heart Association and Verily with significant support from AstraZeneca and pillar support from Quest Diagnostics.

Pediatric chronic graft-versus-host disease-related dry eye disease and the diagnostic association of potential clinical findings

Pediatric graft-versus-host-disease (GVHD)-related dry eye disease (DED) is often overlooked due to a lack of subjective symptoms and reliable testing, leading to irreversible corneal damage. To study the clinical findings contributing to the accurate detection of pediatric GVHD-related DED, a retrospective study of pediatric patients treated with hematopoietic stem cell transplantation (HSCT) at Keio University Hospital between 2004 and 2017 was conducted. Association and diagnostic values of ophthalmological findings for DED were analyzed. Twenty-six patients who had no ocular complications before HSCT were included in the study. Eleven (42.3%) patients developed new-onset DED. The cotton thread test showed excellent diagnostic accuracy in detecting DED (area under the receiver operating curve, 0.96; sensitivity, 0.95; specificity, 0.85) with a cut-off of 17 mm, which was higher than the conventional threshold of 10 mm. Additionally, the presence of filamentary keratitis (FK) and pseudomembranous conjunctivitis (PC) were significantly associated with the diagnosis of DED (p value, 0.003 and 0.001 for FK and PC, respectively) and displayed good diagnostic performance (sensitivity, 0.46 and 0.54; specificity, 0.97 and 0.97 for FK and PC, respectively). In conclusion, the cotton thread test with a new threshold, the presence of PC and FK, could be helpful for promptly detecting pediatric GVHD-related DED.

Importance of external validation and subgroup analysis of artificial intelligence in the detection of low ejection fraction from electrocardiograms

Aim

Left ventricular systolic dysfunction (LVSD) carries an increased risk for overt heart failure and mortality, yet treatable to mitigate disease progression. An artificial intelligence (AI)-enabled 12-lead electrocardiogram (ECG) model demonstrated promise in LVSD screening, but the performance dropped unexpectedly in external validation. We thus sought to train de novo models for LVSD detection and investigated their performance across multiple institutions and across a broader set of patient strata.

Methods and results

ECGs taken within 14 days of an echocardiogram were obtained from four academic hospitals (three in the United States and one in Japan). Four AI models were trained to detect patients with ejection fraction (EF) <40% using ECGs from each of the four institutions. All the models were then evaluated on the held-out test data set from the same institution and data from the three external institutions. Subgroup analyses stratified by patient characteristics and common ECG abnormalities were performed. A total of 221 846 ECGs were identified from the 4 institutions. While the Brigham and Women's Hospital (BWH)-trained and Keio-trained models yielded similar accuracy on their internal test data [area under the receiver operating curve (AUROC) 0.913 and 0.914, respectively], external validity was worse for the Keio-trained model (AUROC: 0.905-0.915 for BWH trained and 0.849-0.877 for Keio-trained model). Although ECG abnormalities including atrial fibrillation, left bundle branch block, and paced rhythm-reduced detection, the models performed robustly across patient characteristics and other ECG features.

Conclusion

While using the same model architecture, different data sets produced models with different performances for detecting low-EF highlighting the importance of external validation and extensive stratification analysis.

Expanded adaptation of an artificial intelligence model for predicting chemotherapy-induced cardiotoxicity using baseline electrocardiograms

Introduction

While effective as chemotherapeutics, anthracyclines can cause cancer therapy-related cardiac dysfunction (CTRCD), which adversely affects the prognosis of patients with malignancies1–5. Despite guideline recommendations6–9, repeated echocardiograms are rarely performed10 with delayed diagnosis of CTRCD leading to unrecoverable cardiac dysfunction11. Recently, artificial intelligence (AI) was shown to be capable of detecting reduced left ventricular ejection fraction (LVEF) solely from electrocardiogram (ECG)12. Furthermore, this model was predictive of a future decrease in LVEF. Therefore, we hypothesized that an AI model detecting reduced LVEF (AI-EF model) could predict CTRCD from ECGs.

Purpose

To assess whether the AI-EF model could detect patients at a high risk of CTRCD by analyzing ECGs taken immediately prior to the initiation of cardiotoxic chemotherapy.

Methods

Among patients who received chemotherapy with a regimen including anthracyclines in two institutions between June 1st, 2015 and October 1st, 2020, those who underwent both an ECG and echocardiogram ≤90 days prior to initial treatment were selected. The ECGs were analyzed by the AI-EF model and patients were divided into two groups according to the scores from the model. CTRCD was defined as LVEF &lt;53% and ≥10% decrease in LVEF from the baseline at any time after the start of chemotherapy13. The cumulative incidence of CTRCD was compared for the two groups using Kaplan-Meier curves, log-rank test, a univariate Cox proportional hazard model, and a multivariable Cox proportional hazard model adjusting for known risk factors for CTRCD. Finally, a prediction model for CTRCD using readily available clinical variables with the AI-EF score was compared with the model using the same variables without the AI-EF score.

Results

1,158 patients were included in this study. 99 of them developed CTRCD during follow-up. The AI-EF model displayed excellent risk stratification of developing CTRCD: while 7.1% in the low AI-EF score group developed CTRCD, 12.9% of the patients in the high AI-EF score group developed CTRCD (hazard ratio (HR), 2.14; 95% confidence interval (CI), 1.43–3.19; log-rank p&lt;0.001; Figure 1). This finding was robust across subgroups such as cancer types, the initial dose of anthracycline and baseline LVEF, and consistent after adjusting for multiple risk factors (adjusted HR, 2.10; 95% CI, 1.37–3.22; p&lt;0.001; Figure 2). Furthermore, the addition of the AI-EF score significantly improved the accuracy of predicting CTRCD compared to clinical features alone (time-dependent area under the received operating curve (AUROC) for 2 years, 77.1; 95% CI, 71.8–82.3 for the model with AI-EF score and AUROC 73.9; 95% CI, 69.0–80.1 for the model without AI-EF score; p=0.02).

Conclusion

The AI-EF model, by utilizing baseline ECG, could stratify patients according to the risk of CTRCD and robustly augmented CTRCD prediction.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): American Heart AssociationVerily

Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria

PURPOSE

To validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD.

METHODS

Between 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD.

RESULTS

The relation between the ICCGVHD score (0-11) and NIH2014 eye score (0-4) was relatively high (r = 0.708, 95% CI: 0.637-0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%-98.1%) and 71.7% (95% CI: 63.0-79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%-82.1%), and the negative predictive value was 87.0% (95% CI:81.6-92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859-0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673-1.000).

CONCLUSIONS

Good sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.

Multinational Federated Learning Approach to Train ECG and Echocardiogram Models for Hypertrophic Cardiomyopathy Detection

BACKGROUND

Novel targeted treatments increase the need for prompt hypertrophic cardiomyopathy (HCM) detection. However, its low prevalence (0.5%) and resemblance to common diseases present challenges that may benefit from automated machine learning-based approaches. We aimed to develop machine learning models to detect HCM and to differentiate it from other cardiac conditions using ECGs and echocardiograms, with robust generalizability across multiple cohorts.

METHODS

Single-institution HCM ECG models were trained and validated on external data. Multi-institution models for ECG and echocardiogram were trained on data from 3 academic medical centers in the United States and Japan using a federated learning approach, which enables training on distributed data without data sharing. Models were validated on held-out test sets for each institution and from a fourth academic medical center and were further evaluated for discrimination of HCM from aortic stenosis, hypertension, and cardiac amyloidosis. Last, automated detection was compared with manual interpretation by 3 cardiologists on a data set with a realistic HCM prevalence.

RESULTS

We identified 74 376 ECGs for 56 129 patients and 8392 echocardiograms for 6825 patients at the 4 academic medical centers. Although ECG models trained on data from each institution displayed excellent discrimination of HCM on internal test data (C statistics, 0.88-0.93), the generalizability was limited, most notably for a model trained in Japan and tested in the United States (C statistic, 0.79-0.82). When trained in a federated manner, discrimination of HCM was excellent across all institutions (C statistics, 0.90-0.96 and 0.90-0.96 for ECG and echocardiogram model, respectively), including for phenotypic subgroups. The models further discriminated HCM from hypertension, aortic stenosis, and cardiac amyloidosis (C statistics, 0.84, 0.83, and 0.88, respectively, for ECG and 0.93, 0.94, 0.85, respectively, for echocardiogram). Analysis of electrocardiography-echocardiography paired data from 11 823 patients from an external institution indicated a higher sensitivity of automated HCM detection at a given positive predictive value compared with cardiologists (0.98 versus 0.81 at a positive predictive value of 0.01 for ECG and 0.78 versus 0.59 at a positive predictive value of 0.24 for echocardiogram).

CONCLUSIONS

Federated learning improved the generalizability of models that use ECGs and echocardiograms to detect and differentiate HCM from other causes of hypertrophy compared with training within a single institution.

The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis

Background

The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era.

Methods

We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for effect measure modification (EMM) by diabetes for adverse events. We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4356 patients, mean follow-up of 4.9 years) and six observational studies (9360 patients, mean follow-up of 5.2 years).

Results

In RCTs among DM patients, DES-based PCI, compared to CABG, was associated with a 30% increased relative risk (RR) (RR 1.30, 95% CI 1.09–1.56, I² = 0%), while among non-DM patients, there was a 25% increased relative risk (RR 1.25, 95% CI 1.07–1.44, I² = 0%) for the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization (MACCE). There was no evidence of EMM (p-value for interaction = 0.70). The mean weighted SYNTAX score was 25.7. In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (RR 1.13, 95% CI 0.91–1.40, I² = 0%).

Conclusions

CABG was superior to PCI for LMCAD in RCTs in DM patients for MACCE. Heart teams may consider DM as one of the many components in the clinical decision-making process, but may not want to consider DM as a primary deciding factor between DES-based PCI and CABG for LMCAD with low to intermediate anatomical complexity in the other coronary arteries.

Study registration

CRD42021246931 (PROSPERO).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-022-01795-w.

Phenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure

Aims

The impact of worsening renal function (WRF) on the prognosis of patients with acute heart failure (AHF) remains controversial. We aimed to identify phenotypically distinct subgroups among individuals with both AHF and WRF using cluster analysis.

Methods and results

Overall, the data of 483 patients with both AHF and WRF enrolled in the West Tokyo Heart Failure Registry were analysed. Using cluster analysis, we identified three phenotypically distinct subgroups (phenogroups 1, 2, and 3). We assessed the impact of WRF on the prognosis of each phenogroup by comparing the incidence of composite endpoints, including all‐cause death and re‐hospitalization due to heart failure, with those of a propensity score‐matched, non‐WRF control group. Participants in phenogroup 1 (N = 122) were the youngest (69.3 ± 13.7 years), had relatively preserved estimated glomerular filtration rate (eGFR, 70.0 ± 27.7 mL/min/1.73 m²), and reduced left ventricular ejection fraction (LVEF) (41.8 ± 13.7%). Conversely, participants in phenogroup 3 (N = 122) were the oldest (81.7 ± 8.5 years), had the worst eGFR (33.0 ± 20.9 mL/min/1.73 m²), and had preserved LVEF (51.7 ± 14.8%). The characteristics of the participants in phenogroup 2 (N = 239) were between those of phenogroups 1 and 3. The propensity score matching analysis showed that WRF was associated with a higher incidence of composite endpoints in phenogroup 1, whereas this association was not observed in phenogroups 2 and 3.

Conclusions

Using cluster analysis, we revealed three phenotypically distinct subgroups of patients with both AHF and WRF. WRF was associated with worse clinical outcomes in the subgroup of younger patients with reduced LVEF and preserved renal function.

Abstract 278: Phenomapping of Worsening Renal Function During Hospitalization for Acute Heart Failure

Background: Worsening renal function (WRF) during the hospitalization has been recognized as a predictor for worse outcomes in patients with acute heart failure (AHF). However, in recent years, elevation of serum creatinine during the acute phase of the treatment is accepted as a sign of efficient decongestion. Herein, we aimed to evaluate the phenotypic difference in this heterogeneous phenomenon by using clustering analysis.

Methods: A total of 4000 patient data from the West-Tokyo Heart Failure Registry, a multicenter, prospective registry for consecutive AHF hospitalization were analyzed. Within 632 patients identified to have WRF (17%; defined as elevation of eGFR over 20 percent during the hospitalization), we applied two-step clustering analysis of phenotypic data (37 variables) to define and characterize phenotypically distinct population. After identification of phenotypically distinct subgroups, survival analysis with Cox proportional hazard was conducted to elucidate the impact of the classification on composite outcomes of heart failure re-hospitalization and all cause death.

Results: The analysis identified four distinct populations (group 1-4) that distinctly differed in terms of clinical characteristics: Group1 composed of patients with reduced ejection fraction (EF), while group 2 to 4 were composed of patients with mid-range and preserved EF. Group 1 patients also had lowest eGFR and blood pressure at the time of admission. Group 1 and 2 patients were younger, but had higher plasma BNP compared to 3 and 4. Among these subgroups, group 1 had the worst, and group 2 had the most favorable prognosis. The difference in prognosis between these two groups was significant after adjustments with known prognostic factors (hazard ratio, 0.58; 95 percent confidence interval, 0.35-0.97).

Conclusion: WRF represents heterogeneous condition; our clustering analysis revealed four phenotypically distinct population with significant difference in their prognosis. Further investigation is needed to assess its therapeutic implication.

Identification of specifically reduced Th2 cell subsets in allergic rhinitis patients after sublingual immunotherapy

BACKGROUND

Although Th2 cells are well known to play important roles in allergic diseases including allergic rhinitis (AR), the factors that induce and sustain the pathogenesis of AR remain unclear. The recent development of sublingual immunotherapy (SLIT) is expected to allow changes to the underlying pathogenesis of AR. However, which Th2 cell subsets are important in house dust mite-induced AR (HDM-AR), the influence of SLIT on the pathogenic Th2 cells, and the association of Th2 cell subsets with SLIT efficacy have not been clarified.

METHODS

The cytokine production and frequency of HDM-reactive T-cell subsets in peripheral blood mononuclear cells (PBMCs) were evaluated using flow cytometry in 89 HDM-AR patients (placebo [n = 43] and HDM 300 IR [n = 46]) who participated in a placebo-controlled study of SLIT with HDM tablets. All patients provided samples both before treatment as a baseline and at the end of the 52-week study. The PBMCs were stained with CellTrace™ Violet (CTV) before culture with HDM extract, and HDM-reactive T cells were detected as the proliferated cells with diminished CTV.

RESULTS

HDM-reactive IL-5⁺ IL-13⁺ CD27^- CD161⁺ CD4⁺ cells and ST2⁺ CD45RO⁺ CD4⁺ cells were observed in the peripheral blood from each patient with HDM-AR; these cells significantly decreased after SLIT in the group treated with active tablets. HDM-reactive ST2⁺ CD45RO⁺ CD4⁺ cells were significantly lower in active-responders.

CONCLUSION

Allergen-reactive ST2⁺ CD45RO⁺ CD4⁺ cells or those combined with IL-5⁺ IL-13⁺ CD27^- CD161⁺ CD4⁺ cells may be useful as markers indicating the successful treatment of SLIT. These cells may play a crucial role in the pathogenesis of AR as pathogenic memory Th2 cells.

Intraoperative 5-aminolevulinic acid-induced photodynamic diagnosis of metastatic brain tumors with histopathological analysis

BACKGROUND

Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is a promising real-time navigation method in the surgical resection of malignant gliomas. In order to determine whether this method is applicable to metastatic brain tumors, we evaluated the usefulness of intraoperative fluorescence patterns and histopathological features in patients with metastatic brain tumors.

METHODS

We retrospectively reviewed the cases of 16 patients with metastatic brain tumors who underwent intraoperative 5-ALA fluorescence-guided resection. Patients were given 20 mg/kg of 5-ALA orally 2 h prior to the surgery. High-powered excitation illumination and a low-pass filter (420, 450, or 500 nm) were used to visualize the fluorescence of protoporphyrin IX (PpIX), the 5-ALA metabolite. We evaluated the relationships between the fluorescence and histopathological findings in both tumoral and peritumoral brain tissue.

RESULTS

Tumoral PpIX fluorescence was seen in only 5 patients (31%); in the remaining 11 patients (69%), there was no fluorescence in the tumor bulk itself. In 14 patients (86%), vague fluorescence was seen in peritumoral brain tissue, at a thickness of 2-6 mm. The histopathological examination found cancer cell invasion of adjacent brain tissue in 75% of patients (12/16), at a mean ± SD depth of 1.4 ± 1.0 mm (range 0.2-3.4 mm) from the microscopic border of the tumor. There was a moderate correlation between vague fluorescence in adjacent brain tissue and the depth of cancer cell invasion (P = 0.004).

CONCLUSION

Peritumoral fluorescence may be a good intraoperative indicator of tumor extent, preceding more complete microscopic gross total resection.

TRIAL REGISTRATION

Institutional Review Board of Osaka Medical College No. 42, registered February 17, 1998, and No. 300, registered April 1, 2008. They were retrospectively registered.

ARAP3 inhibits peritoneal dissemination of scirrhous gastric carcinoma cells by regulating cell adhesion and invasion

During the analysis of phosphotyrosine-containing proteins in scirrhous gastric carcinoma cell lines, we observed an unusual expression of Arf-GAP with Rho-GAP domain, ankyrin repeat and PH domain 3 (ARAP3), a multimodular signaling protein that is a substrate of Src family kinases. Unlike other phosphotyrosine proteins, such as CUB domain-containing protein 1 (CDCP1) and Homo sapiens chromosome 9 open reading frame 10/oxidative stress-associated Src activator (C9orf10/Ossa), which are overexpressed and hyperphosphorylated in scirrhous gastric carcinoma cell lines, ARAP3 was underexpressed in cancerous human gastric tissues. In this study, we found that overexpression of ARAP3 in the scirrhous gastric carcinoma cell lines significantly reduced peritoneal dissemination. In vitro studies also showed that ARAP3 regulated cell attachment to the extracellular matrix, as well as invasive activities. These effects were suppressed by mutations in the Rho-GTPase-activating protein (GAP) domain or in the C-terminal two tyrosine residues that are phosphorylated by Src. Thus, the expression and phosphorylation state of ARAP3 may affect the invasiveness of cancer by modulating cell adhesion and motility. Our results suggest that ARAP3 is a unique Src substrate that suppresses peritoneal dissemination of scirrhous gastric carcinoma cells.

Overview of studies comparing human normal cartilage with minimal and advanced osteoarthritic cartilage

A major area under study in the osteoarthritis (OA) research field is the characterization of specific molecular and biochemical changes that distinguish advanced diseased cartilage from less involved or normal tissue. This information is important to better define the pathogenic mechanisms that are operating during OA progression and to identify disease-specific markers. This review describes recent studies that have addressed changes in chondrocyte gene expression, proliferation, and apoptosis in "experimental" (more advanced OA cartilage) versus "control" (less involved or non-OA cartilage). Included is a comprehensive listing of recently published studies in this area with general findings. The review also includes a discussion of study design and the strengths and weaknesses of the various approaches. In addition, specific strategies to deal with some of the important issues are discussed. One particular model utilizing minimal and advanced OA cartilage obtained from the same patient is described in more detail.

A novel muscle LIM-only protein is generated from the paxillin gene locus in Drosophila

Paxillin is a protein containing four LIM domains, and functions in integrin signaling. We report here that two transcripts are generated from the paxillin gene locus in Drosophila; one encodes a protein homolog of the vertebrate Paxillin (DPxn37), and the other a protein with only three LIM domains, partly encoded by its own specific exon (PDLP). At the myotendinous junctions of Drosophila embryos where integrins play important roles, both DPxn37 and PDLP are highly expressed with different patterns; DPxn37 is predominantly concentrated at the center of the junctions, whereas PDLP is highly enriched at neighboring sides of the junction centers, primarily expressed in the mesodermal myotubes. Northern blot analysis revealed that DPxn37 is ubiquitously expressed throughout the life cycle, whereas PDLP expression exhibits a biphasic pattern during development, largely concomitant with muscle generation and remodeling. Our results collectively reveal that a unique system exists in Drosophila for the generation of a novel type of LIM-only protein, highly expressed in the embryonic musculature, largely utilizing the Paxillin LIM domains.

An ADP-ribosylation factor GTPase-activating protein Git2-short/KIAA0148 is involved in subcellular localization of paxillin and actin cytoskeletal organization

Paxillin acts as an adaptor protein in integrin signaling. We have shown that paxillin exists in a relatively large cytoplasmic pool, including perinuclear areas, in addition to focal complexes formed at the cell periphery and focal adhesions formed underneath the cell. Several ADP-ribosylation factor (ARF) GTPase-activating proteins (GAPs; ARFGAPs) have been shown to associate with paxillin. We report here that Git2-short/KIAA0148 exhibits properties of a paxillin-associated ARFGAP and appears to be colocalized with paxillin, primarily at perinuclear areas. A fraction of Git2-short was also localized to actin-rich structures at the cell periphery. Unlike paxillin, however, Git2-short did not accumulate at focal adhesions underneath the cell. Git2-short is a short isoform of Git2, which is highly homologous to p95PKL, another paxillin-binding protein, and showed a weaker binding affinity toward paxillin than that of Git2. The ARFGAP activities of Git2 and Git2-short have been previously demonstrated in vitro, and we provided evidence that at least one ARF isoform, ARF1, is an intracellular substrate for the GAP activity of Git2-short. We also showed that Git2-short could antagonize several known ARF1-mediated phenotypes: overexpression of Git2-short, but not its GAP-inactive mutant, caused the redistribution of Golgi protein beta-COP and reduced the amounts of paxillin-containing focal adhesions and actin stress fibers. Perinuclear localization of paxillin, which was sensitive to ARF inactivation, was also affected by Git2-short overexpression. On the other hand, paxillin localization to focal complexes at the cell periphery was unaffected or even augmented by Git2-short overexpression. Therefore, an ARFGAP protein weakly interacting with paxillin, Git2-short, exhibits pleiotropic functions involving the regulation of Golgi organization, actin cytoskeletal organization, and subcellular localization of paxillin, all of which need to be coordinately regulated during integrin-mediated cell adhesion and intracellular signaling.

TAZ: a novel transcriptional co-activator regulated by interactions with 14-3-3 and PDZ domain proteins

The highly conserved and ubiquitously expressed 14-3-3 proteins regulate differentiation, cell cycle progression and apoptosis by binding intracellular phosphoproteins involved in signal transduction. By screening in vitro translated cDNA pools for the ability to bind 14-3-3, we identified a novel transcriptional co-activator, TAZ (transcriptional co-activator with PDZ-binding motif) as a 14-3-3-binding molecule. TAZ shares homology with Yes-associated protein (YAP), contains a WW domain and functions as a transcriptional co-activator by binding to the PPXY motif present on transcription factors. 14-3-3 binding requires TAZ phosphorylation on a single serine residue, resulting in the inhibition of TAZ transcriptional co-activation through 14-3-3-mediated nuclear export. The C-terminus of TAZ contains a highly conserved PDZ-binding motif that localizes TAZ into discrete nuclear foci and is essential for TAZ-stimulated gene transcription. TAZ uses this same motif to bind the PDZ domain-containing protein NHERF-2, a molecule that tethers plasma membrane ion channels and receptors to cytoskeletal actin. TAZ may link events at the plasma membrane and cytoskeleton to nuclear transcription in a manner that can be regulated by 14-3-3.

Superconductor-insulator transition in a two-dimensional array of resistively shunted small josephson junctions

We have fabricated two-dimensional (2D) small-Josephson-junction arrays of which each Al-AlOx-Al junction is shunted by a Cr resistor. The arrays with large junction resistance and large charging energy show a transition from insulating to superconducting behavior when the shunt resistance is lowered below a critical value, which is close to 2R(Q) ( R(Q) identical withh/4e(2) = 6.45 kOmega). The measured phase diagram is consistent with theories of quantum-fluctuation-driven and dissipation-driven phase transitions in the 2D Josephson-junction array with Ohmic shunt resistors.

Poly(allylamine) beads as selective sorbent for preconcentration of formaldehyde and acetaldehyde in high-performance liquid chromatographic analysis

Formaldehyde and acetaldehyde in water were determined by preconcentration with poly(allylamine) beads, derivatization with 2,4-dinitrophenylhydrazine (DPH) and analysis by HPLC. Poly(allylamine) beads (0.5 g) were used to adsorb formaldehyde and acetaldehyde at 1.2-150 microg l(-1) and 3.5-220 microg l(-1) from water (1 l). The concentration factor is 50 fold. The aldehydes were eluted and derivatized with 2 mM DPH in 0.5 M H2SO4 (10 ml). The time of analysis was 1 h. The detection limits (S/N=3) for formaldehyde and acetaldehyde were 0.6 and 2 microg l(-1), respectively.

Relationship between EMG signals and force in human vastus lateralis muscle using multiple bipolar wire electrodes

This paper describes the relationship between knee extension force and EMG signals detected by multiple bipolar wire electrodes inserted into the human vastus lateralis muscle under isometric conditions. Six healthy male volunteers participated in this study. Eight pairs of bipolar wire electrodes were inserted into the right vastus lateralis muscle and the EMG data were simultaneously detected and analyzed. The EMG raw data and individual force-IEMG relations were influenced by the location of the electrode inserted into the muscle. The force and IEMG relationship averaged across subjects detected from the eight electrodes, however, showed almost the same linear correlation in spite of different electrode locations. No linear correlation was observed between MdF and the knee extension force. This result suggests that, if all of the muscle fibers participate in the same action at the same time, the averaged normalized IEMG from any places using wire electrodes could reflect the total activities of that muscle even if the muscle is large.

Thapsigargin induces microglial transformation from amoeboid- to ramified- type in vivo

Yagi R, Tanaka S, Koike T. 1999. Thapsigargin induces microglial transformation from amoeboid- to ramified- type in vivo. Glia 28:49-52. The article referenced above was published as an Original Article instead of a Short Communication. The publisher regrets this error.

Reduction in subluxation and improved muscle function of the hemiplegic shoulder joint after therapeutic electrical stimulation

Seventeen hemiplegic patients with chronic shoulder subluxation secondary to a cerebrovascular accident (CVA) were divided into three groups, two of which were subjected to 6 weeks of therapeutic electrical stimulation (TES) for 15 minutes twice a day, in order to assess the effectiveness of the treatment in reducing subluxation, and in improving shoulder abduction function. The third group was used as a control (C group). After 6 weeks of electrical stimulation of the supraspinatus (S group) and deltoid (D group), a significant (p<0.05) reduction in subluxation was observed in both groups when compared to the C group. The maximal force of shoulder abduction showed a tendency to increase in the S group (p<0.10). A significant increase in maximal force was also observed in the D group. In most of the TES-treated muscles, the interference pattern of EMG at maximum voluntary contraction increased. The amplitude of the EMG activity of the stimulated muscle also increased. Thus, we concluded that electrical stimulation therapy of the supraspinatus and the deltoid muscle is an effective treatment modality for shoulder subluxation and shoulder abduction function in hemiplegic patients.

Thapsigargin induces microglial transformation from amoeboid to ramified type in vitro

Microglia generally display amoeboid morphology under prevalent culture conditions. We found that cultured microglia derived from rat cerebral cortex undergo a morphological transformation from amoeboid to process-bearing microglia upon treatment with thapsigargin (TG), a specific Ca2+-ATPase inhibitor of endoplasmic reticulum. Microglial transformation was further enhanced by exposure of amoeboid microglia to serum-free (N2) medium containing TG (TG/N2 treatment). TG/N2-treated microglia showed a marked reduction in the activity of phagocytosis and showed down-regulated expression of MRF-1 or F4/80, which are markers for activated microglia. Thus, both morphological and physiological criteria suggest that TG promotes the ramification of amoeboid microglia in vitro. This method would be helpful in characterization of ramified microglia in vitro.

Structure-activity relationship of HIV-1 protease inhibitors containing alpha-hydroxy-beta-amino acids. Detailed study of P1 site

The structure-activity relationship of HIV-1 protease (HIV-1 PR) inhibitors containing alpha-hydroxy-beta-amino acids is discussed. We demonstrated that substituent groups on the P1 aromatic rings of the inhibitors exert significant influence on their biological activity. Inhibitors bearing an alkyl or a fluorine atom at the meta and para position on their P1 benzene ring were found to be good inhibitors. We also discovered that the substitution positions of the P2 benzamides were crucial for good antiviral potency. In this study, inhibitor 48 was the most potent [IC90 (CEM/HIV-1 IIIB) 27 nM] and showed good pharmacokinetics in rats.

A WW domain-containing yes-associated protein (YAP) is a novel transcriptional co-activator

A protein module called the WW domain recognizes and binds to a short oligopeptide called the PY motif, PPxY, to mediate protein-protein interactions. The PY motif is present in the transcription activation domains of a wide range of transcription factors including c-Jun, AP-2, NF-E2, C/EBPalpha and PEBP2/CBF, suggesting that it plays an important role in transcriptional activation. We show here that mutation of the PY motif in the subregion of the activation domain of the DNA-binding subunit of PEBP2, PEBP2alpha, abolishes its transactivation function. Using yeast two-hybrid screening, we demonstrate that Yes-associated protein (YAP) binds to the PY motif of PEBP2alpha through its WW domain. The C-terminal region of YAP fused to the DNA-binding domain of GAL4 showed transactivation as strong as that of GAL4-VP16. Exogenously expressed YAP conferred transcription-stimulating activity on the PY motif fused to the GAL4 DNA-binding domain as well as to native PEBP2alpha. The osteocalcin promoter was stimulated by exogenous PEBP2alphaA and a dominant negative form of YAP strongly inhibited this activity, suggesting YAP involvement in this promoter activity in vivo. These results indicate that the PY motif is a novel transcription activation domain that functions by recruiting YAP as a strong transcription activator to target genes.

Application of functional electrical stimulation to the paralyzed extremities

This paper describes restoration of motor function in patients with paralyzed extremities due to upper motor neuron disorders by functional electrical stimulation (FES). Percutaneously indwelling intramuscular electrodes were implanted into the muscles of the paralyzed upper and lower extremities to be controlled by FES. Stimulation patterns for extremity FES were created from electromyography (EMG) during motion in healthy subjects. By using a percutaneous FES system, all of the joint movement in the extremities could be controlled as long as severe lower motor neuron damage did not exist. In the paralyzed upper extremity, motor function of not only the hand but also the wrist, elbow, and shoulder could be restored with well-coordinated manner by EMG-based stimulation data and utilized for vocational tasks in the hemiplegic and quadriplegic patients. Continuous bias stimulation to the paralyzed muscle in combination with volitional contraction of its antagonistic muscles provided the patient with more volitional and natural control of the upper extremity. Restoration of locomotive movement in the paraplegics at around T-8 level was also achieved by FES under the usage of a walker.

Analysis of voluntary finger movements during hand tasks by a motion analyzer

Finger movements have primarily been classified by the final position of the hand and finger during deliberate hand activities, rather than as a description of the movement process. In addition, as of yet there have been no reports based upon objective data from the analysis of the motion of three finger joints during movement, and no reports exist that describe the relationship of the three joints' motion during these movements. This paper describes the relationship of the three finger joints during simple finger movements and hand tasks using measurements and analysis from a two-dimensional motion analyzer. Two prehensile movements were examined in 15 healthy volunteers: pure finger extension from finger flex position in different wrist positions (dorsi-flexion position, neutral position and palmar-flexion position of the wrist joint) and the grasping of discs of different diameter (10, 11, 12 and 13 cm). In the sequence of pure finger extension, where the grasping task was not requested, results showed that the movement was started from the proximal joint and extended to the distal joint of the finger, and full finger extension accomplished from distal to proximal, one after another, in any wrist position in most subjects. With the grasping of a disc, however, joint movement was initiated from distal to proximal and the final motion for grasping was carried to completion from the proximal to distal joints of the finger in most subjects. In addition, it was recognized that the proportion of the angular change in each of the three joints was different, as were the time duration of the joint motion and the pattern of the angular change. From these results, it is suggested that deliberate activities of the finger and sophisticated joint movements provided delicate adjustments to fit the fingers to the size of the object, as compared to the simple finger extension movement.

Rotational action of the supraspinatus muscle on the shoulder joint

The shoulder joint allows three-dimensional movement. In order to analyze the function of the muscles which act on the shoulder joint, three-dimensional movements, including rotation, must be considered. Among muscles participating in the shoulder joint movement, the supraspinatus muscle is known to have abduction and stabilization effects on the shoulder joint. However, the rotational function of the supraspinatus muscle has not been identified, because few studies have been reported on it. This study investigates the rotating function of the supraspinatus muscle using electrical stimulation, magnetic resonance imaging (MRI) and anatomical examination. Electrical stimulation was applied selectively to the supraspinatus muscle of healthy subjects using percutaneous wire electrodes. The electrical stimulation was given at different positions of the shoulder joint. It was found that the electrically induced rotational movements changed their direction depending on the position of the shoulder joint. When the humerus was relatively in internal rotation, internal rotation resulted. When it was in external rotation, external rotation occurred. Regarding the abduction angle of the shoulder joint, external rotation was induced with an increase in the abduction angle, whereas internal rotation occurred when the abduction angle was decreased. By the dissection of cadavers and MRI examination, it was indicated that the relation between the running direction of the supraspinatus muscle and the center of rotation of the humeral head was dependent on the position of the shoulder joint. Those findings supported the results of electrical stimulation of the supraspinatus muscle at various shoulder positions. These results indicate that the bi-directional rotating function of the supraspinatus muscle is characterized by an anatomical relationship between the running direction of the supraspinatus muscle and the center of rotation of the humeral head.

Structure-activity relationship of HIV-1 protease inhibitors containing AHPBA. Part III: Modification of P2 site

The structure-activity relationship of HIV-1 protease (HIV-1 PR) inhibitors containing AHPBA (3-amino-2-hydroxy-4-phenylbutanoic acid) is discussed. In order to solve the problem of poor oral bioavailability, small-sized dipeptide HIV-1 protease inhibitors containing cyclic urethanes or benzamides at the P2 site were designed and prepared. The substitution patterns of the benzamides contributed significantly to their HIV-1 PR inhibitory activities, and it was shown that the choice of P2-residues was very important. Highly potent inhibitors possessing subnanomolar IC50 values and exhibiting good antiviral potency have been identified. In this class, inhibitor 18 was the most potent (IC90 (CEM/HIV-1 IIIB) 0.11 microM) and showed good oral bioavailability in dogs.

Design and anti-HIV-1 activity of hammerhead and hairpin ribozymes containing a stable loop

Three ribozymes, a hairpin ribozyme (HR112) and two hammerhead ribozymes (RZ115 and RZ119) containing a 5'C(UUCG)G3' loop were designed to cleave the U5 region in the long terminal repeat (LTR) of HIV-1 RNA. The t1/2 values of chemically synthesized substrates mediated by three ribozymes were measured. The transformed CEM cells possessing these three ribozyme-encoding genes were challenged with a HIV-1IIIB strain, and two of these three ribozymes, HR112 and RZ119, were shown to possess strong anti-HIV-1 activity.

EMG power spectrum and integrated EMG of ankle plantarflexors during stepwise and ramp contractions

The aim of this study was to investigate whether the median frequencies (MF) of the electromyogram (EMG) and the integrated EMG (IEMG) of histochemically differentiated ankle plantarflexors, the gastrocnemius and soleus, were force dependent. Bipolar intramuscular wire electrodes were used to measure EMG of the soleus (SO), medial head of gastrocnemius (GM), and lateral head of gastrocnemius (GL) during ramp (single ongoing contractions) with the force increasing linearly from 0 to 100% of maximum voluntary contraction (MVC) and stepwise (steady force levels) ankle plantarflexion at 10, 20, 30, 40, 60, and 80% MVC. EMG and force were measured simultaneously. Power spectral analysis of these signals was performed to calculate MF on 1024-point by fast Fourier transform (FFT) technique. IEMG value of each muscle was also obtained at the same levels of force. While IEMG of three heads of triceps surae in both stepwise and ramp contractions increased significantly with increasing force, MF values of GL during stepwise contraction increased significantly (20, 40, 60, 80% MVC). These results suggest that the sensitivity of EMG power spectrum might be influenced by the proportion of fast twitch muscle fibers, which histochemically corresponds to type II fibers.

Development of HIV-1 protease expression methods using the T7 phage promoter system

New and simple human immunodeficiency virus type 1 (HIV-1) protease expression methods in Escherichia coli were developed using the T7 phage promoter system. In order to suppress leaky HIV-1 protease expression under the control of the T7 polymerase, two new methods were tested. One involved the introduction of supplementary T7 promoter regions into host cells [E. coli BL-21 (DE3)] containing the HIV-1 protease gene under the control of the T7 promoter. It was expected that the supplementary T7 promoter regions would compete with the HIV-1 protease expression vector for the T7 polymerase binding. The other involved the infection of late-log-phase cultures of E. coli JM109 harboring the same HIV-1 protease expression vector with the M13 phage expressing T7 polymerase. Both methods were effective, and transformants with the mature HIV-1 protease expression vector showed ten times higher HIV-1 protease activity than activities obtained with the autoprocessing vector. The expression systems described here are convenient and are also easily applicable for the expression of other proteins toxic for E. coli.

Replication bypass and mutagenic effect of alpha-deoxyadenosine site-specifically incorporated into single-stranded vectors

alpha-2'-Deoxyadenosine (alpha) is a major adenine lesion produced by gamma-ray irradiation of DNA under anoxic conditions. In this study, single-stranded recombinant M13 vectors containing alpha were constructed and transfected into Escherichia coli to assess lethal and mutagenic effects of this lesion. The data for alpha were further compared with those obtained with M13 vectors containing normal A or a model abasic site (F) at the same site. The transfection assay revealed that alpha constituted a moderate block to DNA replication. The in vivo replication capacity to pass through alpha was approximately 20% relative to normal A, but 20-fold higher than that of F constituting an almost absolute replication block. Similar data were obtained by in vitro replication of oligonucleotide templates containing alpha or F by E.coli DNA polymerase I. The mutagenic consequence of replicating M13 DNA containing alpha was analyzed by direct DNA sequencing of progeny phage. Mutagenesis was totally targeted at the site of alpha introduced into the vector. Mutation was exclusively a single nucleotide deletion and no base substitutions were detected. The deletion frequency associated alpha was dependent on the 3'-nearest neighbor base: with the 3'-nearest neighbor base T mutation (deletion) frequency was 26%, whereas 1% with the 3'-nearest neighbor base G. A possible mechanism of the single nucleotide deletion associated with alpha is discussed on the basis of the misinsertion-strand slippage model.

In vitro and ex vivo anti-human immunodeficiency virus (HIV) activities of a new water-soluble HIV protease inhibitor, R-87366, containing (2S,3S)-3-amino-2-hydroxy-4-phenylbutanoic acid

In a series of compounds containing (2S,3S)-3-amino-2-hydroxy-4-phenylbutanoic acid (AHPBA), a transitionstate mimetic, R-87366:(2S,3S)-3-[N-(quinoxaline-2-carbonyl)-L-asparaginyl]amino- 2-hydroxy-4-phenylbutanoyl-L-proline tert-butylamide, was found to be a potent human immunodeficiency virus protease inhibitor (Ki value was 11 nM) and anti-HIV agent (IC90 value was 0.5 microM for HIV-1IIIB acutely infected cells) with moderate water-solubility (4.2 mg/ml at 25 degrees C). The compound was also active in chronically infected Molt-4/HIV-1IIIB cells, and inhibited the proteolytic processing of p55 into p17, suggesting that its anti-HIV activity was derived from HIV protease inhibition. The compound showed more potent activity (IC90 value was 0.03-0.25 microM) against clinical isolates of HIV in 5 out of 6 patients examined with varying clinical status in an ex vivo assay. One isolate, however, from the sixth patient, was less sensitive to R-87366 (IC90 value was 0.5 microM). In experiments with this strain, R-87366 showed comparatively low efficacy in acutely infected peripheral blood mononuclear cell (PBMC). This result suggests that the diversity of sensitivity shown in the ex vivo assay could be caused by the viral property itself. As a result of the determination of nucleic acid sequences in the clinical isolates, some amino acids were found to be substituted in the protease region, in contrast to the HIV-1 clade B consensus sequence, and some of them have been reported to contribute to the susceptibility of HIV protease inhibitors.

Inhibition of HIV-1 protease by oxim derivatives

In cell-free proteolytic processing using recombinant HIV-1 protease and Gag precursor polypeptide, certain simple oxim derivatives containing halogenomethylketone and phenyl moieties displayed HIV-1 protease inhibitory activity. Their Ki values ranged from 2.1 microM to 6.3 microM and they did not inhibit significantly other aspartic acid proteases. Both the halogenomethylketone moiety and the oxim structure were essential for the observed inhibition. Molecular modeling analysis suggested that these compounds are recognized by the HIV-1 protease as the P1 and P1' part of the substrate. In addition, one potent derivative showed inhibition of viral maturation in HIV-1IIIB chronically infected Molt-4 cells. These results indicate that it is possible to develop new and specific nonpeptidyl HIV protease inhibitors of low molecular weight.

Structure-activity relationships of HIV-1 PR inhibitors containing AHPBA--II. Modification of pyrrolidine ring at P1' proline

Systematic replacement in the 3- or 4-position of the pyrrolidine ring at P1' proline was carried out. Compound 26, which has a Cl atom in the 4(S)-position was the most active among inhibitors substituted with other halogen atoms or other substituents. Furthermore, the replacement of the Z group in compound 26 with five- or six-membered fused aromatic heterocycle carbonyl groups produced more potent inhibitors. 7-Methoxybenzofuran-2-carbonyl derivative (44) was the best of these and showed Ki = 4.5 nM against HIV PR and IC90S 0.58 microM and 0.06 microM in chronic and acute infections, respectively. These results suggest that the combination of the 4(S)-CI atom and fused bicyclic heterocycles may be effective in improving their cellular penetration.

A clinical trial of therapeutic electrical stimulation for amyotrophic lateral sclerosis

This paper describes the effects of therapeutic electrical stimulation (TES) on the wasting muscles in a patient with amyotrophic lateral sclerosis. The patient is a 47-year-old male, and he has a history of progressive muscle weakness and atrophy, affected more in the right side. Percutaneously indwelling intramuscular electrodes were implanted to the affected muscles in the right upper and lower extremities but no electrode in the corresponding left region. Within a month of TES therapy, a rapid improvement of extremity motion appeared in the TES treated side. Long-term application of TES more than 3 months increased the strength of the muscle which had been evidently weaker than the non-treated side. CT findings of both the upper and lower extremities with TES therapy showed an increase in the density and a reduction in the moth-eaten image. An increase in the thickness of the muscles was also observed in the TES treated side while deterioration was observed in the muscles on the non-treated side.

Design and anti-HIV-1 activity of ribozymes that cleave HIV-1 LTR

A hairpin ribozyme (HR112) and two hammerhead ribozymes (RZ115 and RZ119) containing a 5'C(UUCG)G3' loop were designed to cleave the long terminal repeat (LTR) of HIV-1. When the ribozyme catalyzed RNA cleavage reaction for a chemically synthesized 19 mer (LTR 19) was measured, the t 1/2 value of LTR 19 mediated by RZ115 was smaller than that of the RZ119 case. Moreover, the transformed CEM cells harboring the gene encoding these ribozymes were challenged with a HIV-1IIIB strain, two ribozymes, HR112 and RZ119 possessed strong anti-HIV-1 activity. However, the anti-HIV-1 activity displayed by RZ115 was weak. On the basis of secondary structure predictions of the RNA transcribed with the gene encoding ribozymes, the secondary structure of the transcribed RNA with RZ115 sequences was observed to be different from those with the other ribozymes. It has been demonstrated that the secondary structures of transcribed RNAs can possibly influence the anti-HIV-1 activity.

Structure-activity relationships of HIV-1 PR inhibitors containing AHPBA

A series of Human Immunodeficiency Virus type-1 protease (HIV-1 PR) inhibitors that contain 3-amino-2-hydroxy-4-phenylbutanoic acid (AHPBA) at the scission site of the substrate were prepared and evaluated for their inhibitory activity. Preliminary studies on the chain length of inhibitors and the hydroxyl configuration of AHPBA indicated that small (2S,3S)-derivatives, composed of the regions between the P3 and P2' sites, showed enough inhibitory activity toward HIV-1 PR to become prototypes for further structural modification. Systematic replacement at the sites from P3 to P2' revealed that some bicyclic heteroarylcarbonyl derivatives possessed strong potency and good enzyme selectivity.