Public understandings of potential policy responses to health inequalities: Evidence from a UK national survey and citizens' juries in three UK cities

A substantial body of research describes the distribution, causes and potential reduction of health inequalities, yet little scholarship examines public understandings of these inequalities. Existing work is dominated by small-scale, qualitative studies of the experiences of specific communities. As a result, we know very little about what broader publics think about health inequalities; and even less about public views of potential policy responses. This is an important gap since previous research shows many researchers and policymakers believe proposals for 'upstream' policies are unlikely to attract sufficient public support to be viable. This mixed methods study combined a nationally representative survey with three two-day citizens' juries exploring public views of health inequalities and potential policy responses in three UK cities (Glasgow, Manchester and Liverpool) in July 2016. Comparing public opinion elicited via a survey to public reasoning generated through deliberative processes offers insight into the formation of public views. The results challenge perceptions that there is a lack of public support for upstream, macro-level policy proposals and instead demonstrate support for proposals aiming to tackle health inequalities via improvements to living and working conditions, with more limited support for proposals targeting individual behavioural change. At the same time, some macro-economic proposals, notably those involving tax increases, proved controversial among study participants and results varied markedly by data source. Our analysis suggests that this results from three intersecting factors: a resistance to ideas viewed as disempowering (which include, fundamentally, the idea that health inequalities exist); the prevalence of individualising and fatalistic discourses, which inform resistance to diverse policy proposals (but especially those that are more 'upstream', macro-level proposals); and a lack of trust in (local and national) government. This suggests that efforts to enhance public support for evidence-informed policy responses to health inequalities may struggle unless these broader challenges are also addressed.

Development of a lifestyle intervention using the MRC framework for diabetes prevention in people with impaired glucose regulation

Background

We report development of a group-based lifestyle intervention, Let's Prevent, using the UK Medical Research Council (MRC) framework, and delivered by structured education to prevent type 2 diabetes mellitus (T2DM) in people with impaired glucose regulation (IGR) in a UK multi-ethnic population.

Methods

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is the first national T2DM programme that meets National Institute for Health and Care Excellence criteria and formed the basis for Let's Prevent. An iterative cycle of initial development, piloting, collecting and collating qualitative and quantitative data, and reflection and modification, was used to inform and refine lifestyle intervention until it was fit for evaluation in a definitive randomized controlled trial (RCT). The programme encouraged IGR self-management using simple, non-technical language and visual aids.

Results

Qualitative and quantitative data suggested that intervention resulted in beneficial short-term behaviour change such as healthier eating patterns, improved health beliefs and greater participant motivation and empowerment. We also demonstrated that recruitment strategy and data collection methods were feasible for RCT implementation.

Conclusions

Let's Prevent was developed following successful application of MRC framework criteria and the subsequent RCT will determine whether it is feasible, reliable and transferable from research into a real-world NHS primary healthcare setting.

Trial Registration

ISRCTN80605705.

Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment.

•

Whether alcohol outlet availability influences health in Scotland was unknown

•

We assessed relationships with alcohol-related hospitalisations and mortality

•

More hospitalisations and deaths occurred in areas with greater outlet availability

•

Off-sales outlets were more important for health than on-sales outlets

•

Efforts to reduce alcohol harms should consider the alcohol retail environment

NEGATIVE VARIATIONS IN NITELLA PRODUCED BY CHLOROFORM AND BY POTASSIUM CHLORIDE

The results of applying chloroform and KCl to Nitella indicate that a negative variation may be started whenever it is possible to set up along the protoplasm a gradient of potential difference sufficiently steep to produce the necessary outward flow of current. Successive variations may thus be set up.

MECHANICAL RESTORATION OF IRRITABILITY AND OF THE POTASSIUM EFFECT

Treatment of Nitella with distilled water apparently removes from the cell something which is responsible for the normal irritability and the potassium effect, (i.e. the large P.D. between a spot in contact with 0.01 M KCl and one in contact with 0.01 M NaCl). Presumably this substance (called R) is partially removed from the protoplasm by the distilled water. When this has happened a pinch which forces sap out into the protoplasm can restore its normal behavior. The treatment with distilled water which removes the potassium effect from the outer protoplasmic surface does not seem to affect the inner protoplasmic surface in the same way since the latter retains the outwardly directed potential which is apparently due to the potassium in the sap. But the inner surface appears to be affected in such fashion as to prevent the increase in its permeability which is necessary for the production of an action current. The pinch restores its normal behavior, presumably by forcing R from the sap into the protoplasm.

THE PRODUCTION AND INHIBITION OF ACTION CURRENTS BY ALCOHOL

Suitable concentrations of ethyl alcohol (1 to 1.5 M) applied to a spot on a cell of Nitella lower the P.D. enough to cause action currents. The alcohol then suppresses action currents arriving from other parts of the cell and acts as a block. After the alcohol is removed the normal P.D. and irritability return. Similar experiments on the sciatic nerve and skin of the frog produced only a negative result.

POSITIVE VARIATIONS IN NITELLA

The reversible electrical variations hitherto described for plants and animals consist in a reversible loss of positive potential at a stimulated spot by which it becomes more negative. In this paper we describe changes which consist in a reversible loss of negative potential at a stimulated spot whereby it becomes more positive. We suggest that this be called a positive variation. The stimulation was produced in all cases by pinching or bending the cell. This produced a compression wave which traveled along the cell, producing a negative variation at a spot which was positive and a positive variation at a spot which was negative (due to application of 0.1 M KCl). The response produced by the compression wave differs in several respects from an ordinary propagated negative variation and may be termed a positive mechanical variation.

STIMULATION BY COLD IN NITELLA

Sudden local chilling causes action currents to be set up in Nitella and in Chara, an effect which does not follow gradual local chilling. This may be due to a partial solidification of the non-aqueous protoplasmic surfaces which makes them susceptible to rupture by the protoplasmic streaming. This movement continues usually for several minutes after the chilling, whereas if stimulation occurs at all it occurs immediately on chilling. It is found that a chilled spot is much more sensitive to mechanical stimulation than is a spot at room temperature. Chilling is accompanied by a rise of resistance, a lowered rate of recovery following stimulation, and usually by a falling off in the magnitude of the action curve.

THE VALIDITY OF THE GLASS ELECTRODE IN AMMONIUM CHLORIDE BUFFERS

It is shown that the glass electrode may be used without appreciable error to measure pH of ammonia or ammonium chloride buffers, but that corrections must be applied above pH 8.6 if sodium ions are present in the unknown solution. Corrections are given for values from pH 8.6 to 9.4. A slight further modification of form of glass electrode used by previous workers is described.

THE DEATH WAVE IN NITELLA : III. TRANSMISSION

Cutting a cell of Nitella sets up a series of rapid electrical responses, transmitted at a rate too rapid to be measured by means of our records. These are followed by slower responses whose speed falls off as the distance from the cut increases, as though they were caused by a mechanical disturbance whose intensity falls off as it travels. The faster responses seem to be due to the motion of sap past protoplasmic surfaces which have suffered little or no alteration (they seem to be similar to the electrical changes following a blow on the end of a soft rubber tube containing Ag-AgCl electrodes). The slower responses appear to be due to alterations in the protoplasm and are usually irreversible.

THE PENETRATION OF LUMINOUS BACTERIA BY THE AMMONIUM SALTS OF THE LOWER FATTY ACIDS : PART I. GENERAL OUTLINE OF THE PROBLEM, AND THE EFFECTS OF STRONG ACIDS AND ALKALIES

It is shown that disappearance of the light of luminous bacteria may be used as a criterion of cell penetration; that luminous bacteria are cytolyzed by water, hypotonic solutions, and by freely penetrating solutions; that luminous bacteria are not injured by hydrogen or hydroxyl ions in the external solutions within the range of pH values employed with the ammonium salts and that therefore disappearance of the light in isotonic solutions of these salts must be due to penetration of the solute; and that there is a characteristic difference between the effects of strong and of weak acids and alkalies on luminous bacteria.

NATURE OF THE ACTION CURRENT IN NITELLA : III. SOME ADDITIONAL FEATURES

Several forms of the action curve are described which might be accounted for on the ground that the outer protoplasmic surface shows no rapid electrical change. This may be due to the fact that the longitudinal flow of the outgoing current of action is in the protoplasm instead of in the cellulose wall. Hence the action curve has a short period with a single peak which does not reach zero. On this basis we can estimate the P.D. across the inner and outer protoplasmic surfaces separately. These P.D.'s can vary independently. In many cases there are successive action currents with incomplete recovery (with an increase or decrease or no change of magnitude). Some of the records resemble those obtained with nerve (including bursts of action currents and after-positivity).

CALCULATIONS OF BIOELECTRIC POTENTIALS : II. THE CONCENTRATION POTENTIAL OF KCl IN NITELLA

Cells of Nitella have been studied which behave differently from those described in earlier papers. They show unexpectedly large changes in P.D. with certain concentrations of KCl. This is due to the production of action currents (these are recorded at the spot where KCl is applied). A method is given for the separate evaluation of changes of P.D. due to partition coefficients and those due to mobilities. A new amplifier and an improved flowing contact are described.

NATURE OF THE ACTION CURRENT IN NITELLA : II. SPECIAL CASES

The action curve involves four movements each of which shows considerable variation. These variations can be accounted for on the assumption that the action curve is due to the movement of potassium ions accompanied by an increase in permeability.

SALT BRIDGES AND NEGATIVE VARIATIONS

A negative variation in Nitella is unable to pass a spot killed by chloroform but can set up a negative variation beyond this spot when a salt bridge is put around it. It can likewise set up a negative variation in a cell of another plant if connected to it by two salt bridges.

ELECTRICAL VARIATIONS DUE TO MECHANICAL TRANSMISSION OF STIMULI

Mechanical stimulation of Nitella often produces responses resembling propagated negative variations but traveling faster and going past a killed spot. They appear to result from a mechanical disturbance traveling along the cell and stimulating each spot it touches (i.e. the stimulus itself travels). They are called mechanical variations to distinguish them from propagated negative variations. A mechanical disturbance may cause an irreversible change (death wave), but in traveling along the cell it may lose intensity and then produce only a reversible response (mechanical variation) which may eventually change to a propagated negative variation. The all or none law does not apply to incomplete mechanical variations, for the response varies with the strength of the stimulus.

NATURE OF THE ACTION CURRENT IN NITELLA : IV. PRODUCTION OF QUICK ACTION CURRENTS BY EXPOSURE TO NACl

Treatment of Nitella with NaCl greatly reduces the time required for the action current and produces an action curve with one peak instead of the customary two. The time may be reduced to 0.6 second in place of the usual 15 to 30 seconds. This might be expected if the treatment increased the conductivity of the aqueous part of the protoplasm. The experiments favor this idea although they do not prove its correctness. This effect is prevented by calcium, possibly because calcium inhibits penetration of salts. That penetration is an important factor is indicated by the fact that salts which might be expected to penetrate rapidly have the most effect. Thus NaSCN is more effective than NaCl but Na₂SO₄ has little or no effect. The action of NH₄Cl and LiCl is similar to that of NaCl.

CALCULATIONS OF BIOELECTRIC POTENTIALS : IV. SOME EFFECTS OF CALCIUM ON POTENTIALS IN NITELLA

In Nitella the substitution of KCl for NaCl changes the P.D. in a negative direction. In some cases this change is lessened by adding solid CaCl₂ to the solution of KCl. This may be due to lessening the partition coefficient of KCl or to decreasing the solubility of an organic substance which sensitizes the cell to the action of KCl. Little or no correlation exists between this effect of calcium and its ordinary antagonistic action in producing a balanced solution which preserves the life of the cell indefinitely. CaCl₂ is negative to NaCl but positive to KCl. The effects of mixtures of KCl, NaCl, and CaCl₂ are discussed. The concentration effect of a mixture of KCl + CaCl₂ shows certain peculiarities due to action currents: these resemble those found with pure KCl. These studies and others on Nitella, Valonia, and Halicystis indicate that mobilities and partition coefficients are variable and can be brought under experimental control.

ANESTHESIA PRODUCED BY DISTILLED WATER

Cells of Nitella flexilis Ag. lose their power to respond to ordinary electrical stimulation after 2 or 3 days in distilled water. It returns after a day or so when they are replaced in their normal environment, in a suitable nutrient solution, or in a dilute solution of CaCl(2). Here anesthesia seems to be produced by removing something from the cell and this raises the question whether other cases of anesthesia may be explained in the same way. The antagonistic action of calcium, in some cases at least, appears to depend on its power to prevent substances from leaching out of the cell.

ANESTHESIA IN ACID AND ALKALINE SOLUTIONS

The action of distilled water in producing anesthesia (loss of response to electrical stimulation) in Nitella is hastened by the addition of acid and alkali and retarded by the addition of calcium. The loss of irritability is fully reversible.

DELAYED POTASSIUM EFFECT IN NITELLA

In normal cells of Nitella replacement of NaCl by KCl makes the P.D. much less positive: this is called the potassium effect. Cells which have lost the potassium effect usually show little or no change of P.D. when NaCl is replaced by KCl but an occasional cell responds after a delay. It seems possible that the delay may be largely due to the time required for potassium to combine with an organic substance, thus forming a compound which sensitizes the protoplasmic surface to the action of potassium.

PACEMAKERS IN NITELLA : II. ARRHYTHMIA AND BLOCK

Many forms of irregular rhythm and of partial block occurring in the vertebrate heart can be duplicated in Nitella. In order to observe these phenomena the cells of Nitella are kept for 6 weeks or more in a nutrient solution. They are then exposed for 3 hours or less to 0.01 M NaCl, NaSCN, or guanidine chloride, which reduce the time required for the action current to about 1 second (the normal time is 15 to 30 seconds). A pacemaker is established at one end of the cell by placing it in contact with 0.01 M KCl. This produces action currents at the rate of about 1 a second. Apparently some parts of the cell are unable to follow this rapid pace and hence fall into irregular rhythms (arrhythmia) and fail to register all the impulses (partial block).

REVERSIBLE LOSS OF THE POTASSIUM EFFECT IN DISTILLED WATER

Not only does distilled water take away the irritability of Nitella but it also changes its behavior toward potassium. In normal cells potassium is strongly negative to sodium but after sufficient exposure to distilled water this effect disappears. It can be restored by returning the cells to their normal environment or to a suitable nutrient solution. This change in the protoplasm seems to be chiefly in its outer surface.

Oxygen for treatment of severe pneumonia in The Gambia, West Africa: a situational analysis

SETTING

Health facilities in The Gambia, West Africa.

OBJECTIVES

Oxygen treatment is vital in pneumonia, the leading cause of death in children globally. There are shortages of oxygen in developing countries, but little information is available on the extent of the problem. We assessed national oxygen availability and use in The Gambia, a sub-Saharan African country.

METHODS

A government-led team visited 12 health facilities in The Gambia. A modified World Health Organization assessment tool was used to determine oxygen requirements, current provision and capacity to support effective oxygen use.

RESULTS

Eleven of the 12 facilities managed severe pneumonia. Oxygen was reliable in three facilities. Requirement and supply were often mismatched. Both oxygen concentrators and oxygen cylinders were used. Suboptimal electricity and maintenance made using concentrators difficult, while logistical problems and cost hampered cylinder use. Children were usually triaged by trained nurses who reported lack of training in oxygen use. Oxygen was given typically by nasal prongs; pulse oximetry was available in two facilities.

CONCLUSIONS

National data showed that oxygen availability did not meet needs in most Gambian health facilities. Remedial options must be carefully assessed for real costs, reliability and site-by-site usability. Training is needed to support oxygen use and equipment maintenance.

Could mainstream anti-smoking programs increase inequalities in tobacco use? New Zealand data from 1981-96

OBJECTIVE

To examine changes in the socio-economic and ethnic distribution of smoking in the New Zealand population from 1981 to 1996, and to consider the implication of these data for policies aimed at reducing tobacco consumption.

METHODS

Cross-sectional data were taken from 4.7 million respondents to the 1981 and 1996 New Zealand Censuses and 4,619 participants in a 1989 national survey, aged 15 to 79 years. Smoking prevalence rates were calculated by socio-economic position and ethnicity.

RESULTS

Smoking prevalence fell in the period 1981-96 in every population group. However, socio-economic and ethnic differences in smoking increased in relative terms. Smoking prevalence ratios comparing the least advantaged with the most advantaged groups increased in men from 1.20 to 1.53 by income, 1.54 to 1.85 by education, and 1.49 to 1.67 by ethnicity. In women, prevalence ratios increased from 1.17 to 1.51 by income, 1.55 to 2.02 by education, and 1.85 to 2.20 by ethnicity. The greatest increase in socio-economic differences may have occurred during the 1980s, the period of greatest overall decline in total population smoking.

CONCLUSIONS

Socio-economic and ethnic disparities in New Zealanders' smoking patterns increased during the 1980s and '90s, a period of significant decline in overall smoking prevalence.

IMPLICATIONS

Public health programs aimed at reducing tobacco use should pay particular attention to disadvantaged, Indigenous and ethnic minority groups in order to avoid widening relative inequalities in smoking and smoking-related health outcomes.

Organisation of the external region of the starch granule as determined by infrared spectroscopy

Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) was used to study the external regions of starch granules. Native starches (wheat, potato, maize, waxy maize and amylomaize) were analysed and compared to gelatinised and acid-hydrolysed starches. The IR spectra of potato and amylomaize starches were closer to that of highly ordered acid-hydrolysed starch than the other starches. FTIR was not able to differentiate between A- and B-type crystallinity so the difference observed between starches was not related to this factor. The variation between starch varieties was interpreted in terms of the level of ordered structure present on the edge of starch granules with potato and amylomaize being more ordered on their outer regions. This could explain the high resistance of both these starches to enzyme hydrolysis.

Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients

The biomechanics of the pharyngeal swallow in patients with a tracheotomy tube were investigated with manometry. Upper esophageal sphincter (UES) and pharyngeal pressure recordings were made with and without occlusion of the tracheotomy tube. Criteria for selection were ability to tolerate tracheotomy tube occlusion for both 5 minutes prior to and during the first manometric analysis, absence of surgery to the upper aerodigestive tract other than tracheotomy, and no history of oropharyngeal cancer or stroke. Aspiration was determined objectively by fiberoptic endoscopic evaluation of swallowing (FEES) immediately prior to manometric recording. Eleven adult individuals with tracheotomy participated; 7 swallowed successfully and 4 exhibited aspiration on FEES. The results indicated no significant effect of tracheotomy tube occlusion on UES or pharngeal pressures in either aspirating or nonaspirating patients. It was concluded that the biomechanics of the swallow as determined by UES and pharyngeal manometric pressure measurements were not changed significantly by tracheotomy tube occlusion in aspirating or nonaspirating patients. These results support previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status.

Oxygen therapeutics--current concepts

PURPOSE

In an effort to develop agents that enhance the oxygen-delivery capability of blood without the risks associated with allogeneic blood transfusions, several products are undergoing development and clinical trials. These oxygen transport agents can be divided into two main groups, perfluorocarbon (PFC) emulsions and modified hemoglobin solutions.

SOURCE

Articles from the literature on the development and clinical trials of oxygen therapeutic agents were reviewed.

PRINCIPAL FINDING

PFCs are synthetic fluorinated hydrocarbons that increase dissolved oxygen in the fluid phase of the blood without binding the oxygen molecule. They enhance oxygen delivery significantly and may be used to augment the technique of intraoperative autologous donation. Two PFC products have been tested in Phase III clinical trials. Hemoglobin-based oxygen carriers (HBOCs) are either cross-linked or microencapsulated hemoglobin molecules. Modification of the human hemoglobin molecule with intra- and inter-molecular cross-linking eliminates renal toxicity and improves the oxygen dissociation characteristics of the molecule. These modifications are necessary because stroma-free hemoglobin (Hb) does not release oxygen in the physiologic range and dissociates into dimers which can be rapidly filtered by the kidney, leading to renal toxicity. In addition to human Hb, bovine hemoglobin is another source of raw material for HBOC products. Recombinant human Hb has also been produced, using an E. coli expression system, for HBOC manufacturing. Four cross-linked hemoglobin products have been tested in Phase III clinical trials.

CONCLUSION

While no product has yet been approved for clinical use, preliminary studies with oxygen therapeutics show promising results, with effective oxygen carrying capacity and acceptable side effect profiles. In the future, the formation of a hybrid product which combines the best features from several of the products currently undergoing development may yield the ideal oxygen therapeutic agent.

Maillard reaction causes suppression of virulence gene expression in Listeria monocytogenes

Many environmental signals affect the expression of virulence genes of the food borne pathogen Listeria monocytogenes. In addition media composition has been shown to suppress levels of haemolytic activity. Using a Pr(plcA)::luxAB reporter gene fusion it was observed that the heat processing of media also reduces the level of virulence gene expression in L. monocytogenes without affecting its growth. Physicochemical factors that are considered to enhance the Maillard reaction were also found to increase the levels of suppression. The results indicate that heat treatment of a multicomponent matrix gives rise to specific inhibitors of the Listeria virulence gene operon.

Intraoperative physiologic variables and outcome in cardiac surgery: Part I. In-hospital mortality

BACKGROUND

Risk stratification schemes have been developed to predict outcome of coronary artery bypass grafting (CABG) procedures, which are predominately based upon unalterable preoperative patient characteristics. The purpose of this study was to determine if minimum intraoperative hematocrit, maximum glucose concentration, mean arterial pressure on cardiopulmonary bypass, or duration of bypass influence risk-adjusted in-hospital mortality after CABG.

METHODS

Outcome data from 2,862 CABG patients were merged with intraoperative physiologic data. A preoperative mortality risk index was calculated for each patient. Variables found significant (p<0.05) by univariate logistic regression were tested in a multiple variable model to determine risk-adjusted association with mortality.

RESULTS

Overall mortality rate was 1.85%. The preoperative risk index was significantly associated with mortality (p = 0.0001). No significant association was present between mortality and intraoperative variables. Preexisting hypertension was an independent predictor of mortality after controlling for risk index and bypass duration.

CONCLUSIONS

Preexisting hypertension proved to be an independent predictor of mortality in our patient population. This study found no evidence to support the hypothesis that mean arterial pressure less than 50 mm Hg, lower hematocrit, or elevated glucose while on bypass increases in-hospital mortality.

Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome

BACKGROUND

The impact of alterable physiologic variables on neurologic outcome after coronary artery bypass grafting procedures is unknown. The purpose of this study was to determine whether minimum intraoperative hematocrit, maximum glucose concentration, or mean arterial pressure during cardiopulmonary bypass influences risk-adjusted neurologic outcome after coronary artery bypass grafting.

METHODS

Outcome data from 2,862 patients undergoing coronary artery bypass grafting were merged with intraoperative physiologic data. A preoperative stroke risk index was calculated for each patient. Variables found significant by univariate logistic regression were tested in a multivariable model to determine association with outcome.

RESULTS

The incidence of stroke or coma in the study population was 1.3%. After controlling for stroke risk and bypass time, only an index of low mean arterial pressure during bypass retained a significant inverse association with outcome (p = 0.0304).

CONCLUSIONS

This study found no evidence that glucose concentration or minimum hematocrit are associated with major adverse neurologic outcome. The association between lower pressure during bypass and decreased incidence of stroke or coma persisted in all risk groups. This points to mechanisms other than hypoperfusion as the primary cause of neurologic injury associated with cardiac surgery.

Molecular flexibility profiling using NMR spectroscopy

Molecular flexibility is a factor that is not extensively studied in most pharmaceutical research efforts. When it is, the level of effort is high involving the preparation of detailed models supported by either molecular dynamics simulations and/or Nuclear Magnetic Resonance data. While these studies are both powerful and illuminating, they cannot be routinely applied in a drug discovery setting as they are time and expertise intensive. Yet there seems to be little doubt that at least in some cases, molecular flexibility plays a key role in complex formation. A simple, rapid and generally applicable flexibility profiling protocol was applied to two model systems and data describing the internal mobility of carbon atoms were obtained. The protocol utilizes the Model Free approach and NMR data to characterize the internal molecular dynamics of these compounds. The first model system consisted of fluorene and diphenylmethane where the anticipated flexibility trends were observed in the data providing a link between chemical intuition and the experimental results. Data on a second model system, which consisted of two Paclitaxel analogs, showed predictable patterns including dynamical phenyl and methyl groups and a relatively immobile taxane core. Subtle differences in the internal dynamics within the taxane core suggest that it cannot be considered as a rigid structure. Key advantages of using this approach are that no prior knowledge or supposition of dynamical features is required, the protocol can be carried out in most medicinal chemistry laboratories and the data obtained provide a common, empirically derived reference point to discuss the effects of molecular flexibility on activity.

Cellular uptake profile of paclitaxel using liquid chromatography tandem mass spectrometry

A new method for studying cellular uptake has been developed. This method is based on selected reaction monitoring liquid chromatography tandem mass spectrometry analysis of preparations from cell culture. The limit of detection for paclitaxel was approximately 0.1 microM intracellular concentration. This method has been utilized to study the uptake of paclitaxel and an analog (BMS-190616) in normal and multidrug resistant (MDR) cell lines. Paclitaxel and the analog, that had been noted to overcome MDR in animal models, were incubated with normal cells (HCT116) and MDR cells (HCT116(VM)46) at therapeutic concentrations. Intracellular drug concentrations were assayed at intervals from 0 to 1.0 h. Results show that paclitaxel accumulates to a level 12 times greater and BMS-190616 to a level 5 times greater in the normal cells as compared to MDR cells suggesting that paclitaxel is more sensitive to MDR than the analog. Furthermore, the steady state level of BMS-190616 was 4 fold greater than paclitaxel in the MDR cell line suggesting that at least part of this compound's increased therapeutic effect can be attributed to processes of uptake and efflux at the cellular level. These data show that the method is rapid, sensitive and presents a unique advantage over traditional radioisotopic methods in that it can readily be employed on a range of analogs without any additional synthetic effort.

Profiling degradants of paclitaxel using liquid chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry substructural techniques

A rapid and systematic strategy based on liquid chromatography-mass spectrometry (LC-MS) profiling and liquid chromatography-tandem mass spectrometry (LC-MS-MS) substructural techniques was utilized to elucidate the degradation products of paclitaxel, the active ingredient in Taxol. This strategy integrates, in a single instrumental approach, analytical HPLC, UV detection, full-scan electrospray MS, and MS-MS to rapidly and accurately elucidate structures of impurities and degradants. In these studies, degradants induced by acid, base, peroxide, and light were profiled using LC-MS and LC-MS-MS methodologies resulting in an LC-MS degradant database which includes information on molecular structures, chromatographic behavior, molecular mass, and MS-MS substructural information. The stressing conditions which may cause drug degradation are utilized to validate the analytical monitoring methods and serve as predictive tools for future formulation and packaging studies. Degradation products formed upon exposure to basic conditions included baccatin III, paclitaxel sidechain methyl ester, 10-deacetylpaclitaxel, and 7-epipaclitaxel. Degradation products formed upon exposure to acidic conditions included 10-deacetylpaclitaxel and the oxetane ring opened product. Treatment with hydrogen peroxide produced only 10-deacetylpaclitaxel. Exposure to high intensity ligh produced a number of degradants. The most abundant photodegradant of paclitaxel corresponded to an isomer which contains a C3-C11 bridge. These methodologies are applicable at any stage of the drug product cycle from discovery through development. This library of paclitaxel degradants provides a foundation for future development work regarding product monitoring, as well as use as a diagnostic tool for new degradation products.

Maillard induced complexes of bovine serum albumin--a dilute solution study

Association of bovine serum albumin (BSA) on heating in the presence and absence of 2% xylose has been studied using dynamic light scattering and sedimentation velocity. When 3% solutions of the protein alone are heated at 95 degrees C association products are formed with molar masses of approximately 2 x 10(6) g/mol, a value which is independent of the time of heating. These aggregates can be dissociated in solvents that disrupt non-covalent bonds. When the reducing sugar xylose is present there is a continuous change in the hydrodynamic properties with time. After 80 min a molar mass in excess of 7 x 10(6) g/mol is obtained. This increase in molar mass is attributed to additional non-disulphide linkages resulting from the Maillard reaction. Information about the gross conformation of the Maillard induced association products has been obtained from MHKS (Mark-Houwink-Kuhn-Sakarada) double logarithmic plots of D20,w and S20,w against molar mass. The values of the MHKS coefficients obtained are most consistent with a linear rod: i.e. the association is of an end-to-end type.

Himastatin, a new antitumor antibiotic from Streptomyces hygroscopicus. III. Structural elucidation

The structure of the antitumor antibiotic himastatin was determined using a combination of spectroscopic and chemical degradation techniques. Himastatin is a unique dimeric cyclohexadepsipeptide joined through a biphenyl linkage between two oxidized tryptophan units. The gross structure of the dimer was established through degradative ozonolysis. Himastatin consists of D-valine, D-threonine, L-leucine, L-alpha-hydroxyisovaleric acid, (3R,5R)-5-hydroxypiperazic acid, and (2R,3aR,8aR)-3a-hydroxyhexahydropyrrolo[2,3b]indole 2-carboxylic acid subunits.

Fatal microvascular pulmonary emboli from precipitation of a total nutrient admixture solution

BACKGROUND

Paroxysmal respiratory failure and death occurred in two young adult females with pelvic infections. Autopsy revealed an amorphous material containing calcium obstructing the pulmonary microvasculature of each patient. Both patients received an identical total nutrient admixture (TNA) solution before their deaths.

METHODS

Infusion of TNA into an animal model was undertaken in an effort to reproduce the clinical effect. Laboratory investigation was also performed to isolate a precipitate and identify the factors contributing to precipitation.

RESULTS

A nonvisible precipitate containing calcium, phosphorus, and organic material was isolated from the TNA solution. Infusion of the formulation into healthy pigs resulted in sudden death within 4 hours. Alteration of the amino acid component, mix sequence, agitation technique, and mixing container influenced precipitate formation.

CONCLUSION

Pulmonary embolization of a precipitate containing calcium phosphate resulted in the death of two patients. The pH of the amino acid component, transient elevation of calcium and phosphorus concentrations during mixing, and the lack of agitation during automated preparation of the formulation were identified as the etiologic factors producing the fatal precipitate.

Differential scanning calorimetry of lupin and soy proteins

Differential scanning calorimetry (DSC) was used to study the 7S and 11S globulin fractions extracted from lupin seed (Lupinus luteus) flour. In agreement with previous work on other lupin species, the isolate showed three denaturation peaks compared to the two observed with soy. By comparison with the isolated globulin fractions, the denaturation peaks at the two higher temperatures in the lupin isolate were assigned to the 11S and 7S globulins. The denaturation temperature of the lupin 7S globulin was about 10 K higher than that for the corresponding soy globulin, whereas the values for the 11S globulin were similar. All globulins displayed increasing thermal stability with decreasing moisture contents. Possible reasons for the differences in behaviour of soy and lupin protein isolates are discussed.

Profiling taxanes in Taxus extracts using lc/ms and lc/ms/ms techniques

Analytical methodology developed for the trace analysis of natural products in crude extracts was utilized for the rapid and systematic structure elucidation of taxanes in Taxus extracts and process intermediates. This method integrates analytical hplc, uv detection, uv spectroscopy, full-scan ionspray mass spectrometry and tandem mass spectrometry on-line. The identification of structure of a taxane is based on comparing the mass spectrometric characteristics of the taxane with the paclitaxel substructural "template." Analytical data for taxanes in preparations from Taxus brevifolia and Taxus baccata were observed, including chromatographic characteristics using a standard hplc system, molecular weight, and collision induced dissociation (cid) tandem mass spectrometry (ms/ms) product ion spectra. The data obtained for 18 taxanes from natural sources using this method provided a taxane profile database useful for the rapid identification of taxanes in mixtures and samples of limited quantity.

Signal transduction in murine B16 melanoma cells

The relationship between lung colonization and signal transduction was investigated for six B16 melanoma variants. A range of experimental metastatic potential (as determined by lung colonization), forskolin-stimulated cyclic AMP accumulation and FCS-stimulated protein kinase C activity was found. The major findings were that: (1) cells with the highest agonist-stimulated cyclic AMP production were those with the highest level of membrane-associated protein kinase C activity; (2) clones which differed in protein kinase C levels and distribution did so in the presence but not in the absence of foetal calf serum; and (3) no simple relationship was seen between either signal transduction system and lung colonization for all six variants. Altered ras expression was also excluded as an explanation for the differences in signal transduction and lung colonization potential which were observed. We conclude that differences in signal transduction in vitro between these cells do not relate simply to lung colonization potential in vivo.

Evidence for a calcium/calmodulin involvement in density-dependent melanogenesis in murine B16 melanoma cells

Previous work from our laboratory has shown that both cyclic AMP and calcium/calmodulin appear to be involved in the regulation of melanogenesis in murine B16 melanoma cells. In these cells as in murine Cloudman S91 cells, melanogenic responsiveness to melanocyte-stimulating hormone (MSH) varies with cell density in culture. Our objective in this study was to learn more about the intracellular systems involved in the control of melanogenesis, particularly the role played by calcium. The melanogenic response to alpha MSH was compared to the response to drugs affecting intracellular free calcium and calmodulin over a range of cell densities in B16F1 cells. alpha MSH-stimulated melanin production was extremely density-dependent but alpha MSH-stimulated cyclic AMP production was independent of cell density. The melanogenic response to agents that increased intracellular calcium (A23187) or inhibited intracellular calmodulin varied with cell density. A drug (TMB8) that lowered intracellular free calcium, however, increased melanogenesis independently of cell density. At high cell density it was found that an elevation in calcium decreased melanogenesis, whereas agents that reduced calcium or inhibited calmodulin activity increased melanogenesis. At low cell density, however, the inhibitory response to A23187 was lost and in some experiments even stimulated melanogenesis. These data suggest that the calcium/calmodulin signalling system has an inhibitory influence on melanogenesis, and its expression, which depends upon cell density, may also modulate the response to stimulatory agents such as alpha MSH.

The regulation of cyclic AMP production and the role of cyclic AMP in B16 melanoma cells of differing metastatic potential

The nature of the relationship between agonist-stimulated cyclic AMP production and metastatic potential was examined in detail for four B16 melanoma cell lines of varying metastatic potential. Highly metastatic cells (B16 F10C1) appeared to differ from cells of low metastatic potential (B16 F1C29) in the degree to which cyclic AMP production in intact cells was stimulated by protein kinase C activation. No significant difference was found in the adenylate-cyclase enzyme activities of the broken cells, irrespective of the agonist used, or in the distribution of cyclic AMP between the intracellular and extracellular compartment. Although B16F1, F10 and F10C1 cells all produced equally pigmented tumors in vivo, the cells differed in their melanogenic response to cyclic AMP elevating agents in vitro: the least metastatic cells produced least agonist-induced cyclic AMP but this induced greatest tyrosinase activation and melanin production in vitro; conversely, the more metastatic cells produced more cyclic AMP but less tyrosinase activation and melanin production in response to agonist stimulation. Thus, agonist-stimulated cyclic AMP production does not appear to be coupled to the differentiated function of melanogenesis for highly metastatic B16 melanoma cells.

A positive association between agonist-induced cyclic AMP production in vitro and metastatic potential in murine B16 melanoma and hamster fibrosarcoma

A positive association between agonist-stimulated cyclic AMP production in vitro and both experimentally induced (B16 melanoma) and spontaneous (fibrosarcoma) metastases were found. Five B16 melanoma cell lines producing varying degrees of lung colonization following intravenous injection and three hamster fibrosarcoma cell lines producing a varying number of metastases in lungs and regional lymph nodes after removal of the primary tumour were studied. Agonist-stimulated (forskolin and melanocyte-stimulating hormone), but not basal cyclic AMP accumulation, increased with increasing metastatic potential. This relationship did not extend to other intracellular signalling systems as determined by investigation of basal or foetal-calf stimulated phosphatidylinositol hydrolysis for either tumour type. Intracellular free calcium was also similar in B16 melanoma cell lines of varying metastatic potential.