Activation of a Latent Epitope Causing Differential Binding of Antineutrophil Cytoplasmic Antibodies to Proteinase 3

OBJECTIVE

Proteinase 3 (PR3) is the major antigen for antineutrophil cytoplasmic antibodies (ANCAs) in the systemic autoimmune vasculitis, granulomatosis with polyangiitis (GPA). PR3-targeting ANCAs (PR3-ANCAs) recognize different epitopes on PR3. This study was undertaken to study the effect of mutations on PR3 antigenicity.

METHODS

The recombinant PR3 variants, iPR3 (clinically used to detect PR3-ANCAs) and iHm5 (containing 3 point mutations in epitopes 1 and 5 generated for epitope mapping studies) immunoassays and serum samples from patients enrolled in ANCA-associated vasculitis (AAV) trials were used to screen for differential PR3-ANCA binding. A patient-derived monoclonal ANCA 518 (moANCA518) that selectively binds to iHm5 within the mutation-free epitope 3 and is distant from the point mutations of iHm5 was used as a gauge for remote epitope activation. Selective binding was determined using inhibition experiments.

RESULTS

Rather than reduced binding of PR3-ANCAs to iHm5, we found substantially increased binding of the majority of PR3-ANCAs to iHm5 compared to iPR3. This differential binding of PR3-ANCA to iHm5 is similar to the selective moANCA518 binding to iHm5. Binding of iPR3 to monoclonal antibody MCPR3-2 also induced recognition by moANCA518.

CONCLUSION

The preferential binding of PR3-ANCAs from patients, such as the selective binding of moANCA518 to iHm5, is conferred by increased antigenicity of epitope 3 on iHm5. This can also be induced on iPR3 when captured by monoclonal antibody MCPR2. This previously unrecognized characteristic of PR3-ANCA interactions with its target antigen has implications for studying antibody-mediated autoimmune diseases, understanding variable performance characteristics of immunoassays, and design of potential novel treatment approaches.

Pleuritis and Pericarditis in Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis

BACKGROUND

Pleural and pericardial involvements are well recognized in eosinophilic granulomatosis with polyangiitis (EGPA) but considered rare manifestations of the other forms of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV).

RESEARCH QUESTION

What are the frequency and clinical characteristics of pleuritis and pericarditis in AAV?

STUDY DESIGN

and Methods: Using an institutional database of 1,830 patients with AAV, we analyzed clinical notes and diagnosis codes for key words related to pleuritis and pericarditis. Chart review to confirm these findings was performed.

RESULTS

Eighty-eight of 1,058 patients (8.3%) with granulomatosis with polyangiitis (GPA), 27 of 267 (10.1%) with microscopic polyangiitis (MPA), and 35 of 201 (17.4%) with EGPA had a manifestation of pleuritis and/or pericarditis attributable to vasculitis. There was a higher frequency of pericarditis in EGPA compared with that in the other AAVs (P < .01). There was no difference in the frequency of pleuritis in GPA, MPA, or EGPA. In the 156 patients with AAV with pleuritis and/or pericarditis, this was a presenting feature in 127 (81.4%). Overall, it was a presenting feature in 6.9% of all patients with AAV, including 6.5% with GPA, 8.6% with MPA, and 15.9% with EGPA.

INTERPRETATION

Pleuritis and pericarditis occur across all the AAVs and, when present, are commonly presenting features of these diseases. Patients with EGPA have a higher proportion of pericardial involvement compared with pleural involvement, whereas this distribution is more equal in patients with GPA and MPA. Pleuritis and pericarditis are underrecognized features of AAV. All forms of AAV should be considered in the differential diagnosis when evaluating a patient with pleuritis or pericarditis.

Clinical Utility of Serial Measurements of Antineutrophil Cytoplasmic Antibodies Targeting Proteinase 3 in ANCA-Associated Vasculitis

Background: The utility of ANCA testing as an indicator of disease activity in ANCA-associated vasculitis (AAV) remains controversial. This study aimed to determine the association of ANCA testing by various methods and subsequent remission and examine the utility of a widely used automated addressable laser-bead immunoassay (ALBIA) to predict disease relapses.

Methods: Data from the Rituximab vs. Cyclophosphamide for ANCA-Associated Vasculitis (RAVE) trial were used. ANCA testing was performed by direct ELISA, capture ELISA, and ALBIA. Cox proportional hazards regression models were used to evaluate the association of PR3-ANCA level and subsequent remission or relapse. The ALBIA results are routinely reported as >8 when the value is high. For this study, samples were further titrated. A decrease and increase in PR3-ANCA were defined as a halving or doubling in value, respectively.

Results: A decrease in ANCA by ALBIA at 2 months was associated with shorter time to sustained remission (HR 4.52, p = 0.035). A decrease in ANCA by direct ELISA at 4 months was associated with decreased time to sustained remission (HR 1.77, p = 0.050). There were no other associations between ANCA decreases or negativity and time to remission. An increase in PR3-ANCA by ALBIA was found in 78 of 93 subjects (84%). Eleven (14%) had a PR3-ANCA value which required titration for detection of an increase. An increase of ANCA by ALBIA was associated with severe relapse across various subgroups.

Conclusions: A decrease in ANCA by ALBIA at 2 months and by direct ELISA at 4 months may be predictive of subsequent remission. These results should be confirmed in a separate cohort with similarly protocolized sample and clinical data collection. A routinely used automated ALBIA for PR3-ANCA measurement is comparable to direct ELISA in predicting relapse in PR3-AAV. Without titration, 14% of the increases detected by ALBIA would have been missed. Titration is recommended when this assay is used for disease monitoring. The association of an increase in PR3-ANCA with the risk of subsequent relapse remains complex and is affected by disease phenotype and remission induction agent.

Efficacy of Rituximab and Plasma Exchange in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Kidney Disease

BACKGROUND

Treatment of patients with ANCA-associated vasculitis (AAV) and severe renal involvement is not established. We describe outcomes in response to rituximab (RTX) versus cyclophosphamide (CYC) and plasma exchange (PLEX).

METHODS

A retrospective cohort study of MPO- or PR3-ANCA-positive patients with AAV (MPA and GPA) and severe kidney disease (eGFR <30 ml/min per 1.73 m²). Remission, relapse, ESKD and death after remission-induction with CYC or RTX, with or without the use of PLEX, were compared.

RESULTS

Of 467 patients with active renal involvement, 251 had severe kidney disease. Patients received CYC (n=161) or RTX (n=64) for remission-induction, and 51 were also treated with PLEX. Predictors for ESKD and/or death at 18 months were eGFR <15 ml/min per 1.73 m² at diagnosis (IRR 3.09 [95% CI 1.49 to 6.40], P=0.002), renal recovery (IRR 0.27 [95% CI 0.12 to 0.64], P=0.003) and renal remission at 6 months (IRR 0.40 [95% CI 0.18 to 0.90], P=0.027). RTX was comparable to CYC in remission-induction (BVAS/WG=0) at 6 months (IRR 1.37 [95% CI 0.91 to 2.08], P=0.132). Addition of PLEX showed no benefit on remission-induction at 6 months (IRR 0.73 [95% CI 0.44 to 1.22], P=0.230), the rate of ESKD and/or death at 18 months (IRR 1.05 [95% CI 0.51 to 2.18], P=0.891), progression to ESKD (IRR 1.06 [95% CI 0.50 to 2.25], P=0.887), and survival at 24 months (IRR 0.54 [95% CI 0.16 to 1.85], P=0.330).

CONCLUSIONS

The apparent benefits and risks of using CYC or RTX for the treatment of patients with AAV and severe kidney disease are balanced. The addition of PLEX to standard remission-induction therapy showed no benefit in our cohort. A randomized controlled trial is the only satisfactory means to evaluate efficacy of remission-induction treatments in AAV with severe renal involvement.

Remote Activation of a Latent Epitope in an Autoantigen Decoded With Simulated B-Factors

Mutants of a catalytically inactive variant of Proteinase 3 (PR3)—iPR3-Val¹⁰³ possessing a Ser195Ala mutation relative to wild-type PR3-Val¹⁰³—offer insights into how autoantigen PR3 interacts with antineutrophil cytoplasmic antibodies (ANCAs) in granulomatosis with polyangiitis (GPA) and whether such interactions can be interrupted. Here we report that iHm5-Val¹⁰³, a triple mutant of iPR3-Val¹⁰³, bound a monoclonal antibody (moANCA518) from a GPA patient on an epitope remote from the mutation sites, whereas the corresponding epitope of iPR3-Val¹⁰³ was latent to moANCA518. Simulated B-factor analysis revealed that the binding of moANCA518 to iHm5-Val¹⁰³ was due to increased main-chain flexibility of the latent epitope caused by remote mutations, suggesting rigidification of epitopes with therapeutics to alter pathogenic PR3·ANCA interactions as new GPA treatments.

Two-shell structured PMAA@CeO2 nanocontainers loaded with 2-mercaptobenzothiazole for corrosion protection of damaged epoxy coated AA 2024-T3

In this work, novel two-shell structured inhibitor-loaded poly(methacrylic acid)@cerium oxide (PMAA@CeO₂) nanocontainers were synthesised and characterized. The purpose of the nanocontainers is to increase the corrosion protection provided by an epoxy coating applied to an aerospace alloy (AA 2024-T3). The (PMAA@CeO₂) nanocontainers with diameters of 550 nm were synthesised by a four-step process with the method of distillation precipitation polymerization for the synthesis of the inner PMAA layer, and the sol-gel method for the development of the outer CeO₂ layer. The loaded nanocontainers were characterized by scanning and transmission electron microscopies. The corrosion protection properties of the epoxy coated AA 2024-T3 with 2-mercaptobenzothiazole (2-MBT) loaded PMAA@CeO₂ nanocontainers were evaluated with and without artificial scribes by electrochemical impedance spectroscopy (EIS). The results indicated that the epoxy coating containing the 2-MBT-loaded nanocontainers provided enhanced protection of the AA 2024-T3 substrate.

Antibacterial and non-cytotoxic effect of nanocomposites based in polyethylene and copper nanoparticles

In this study, an antibacterial, but not cytotoxic nanomaterial based on polyethylene and copper nanoparticles was prepared by in situ polymerization. PE-CuNps nanocomposites against Escherichia coli, completely suppressed the number of live bacteria after 12 h incubation compared to neat PE. TEM images showed that nanocomposites damage the plasma membrane of the bacteria, revealing a bacteriolytic effect. Toxic effects of copper nanoparticles on viability of neuroblastoma line cell also was evaluated, revealing a non cytotoxic effect for the doses used, showing that this nanocomposite is a ideal material for medical devices.

Revelation of intertwining organic and inorganic fractal structures in polymer coatings

X-ray microtomography and serial block face scanning electron microscopy are used to reveal independent clusters of inorganic particles embedded within a polymer. These clusters are interpenetrating, of varying size, and have fractal dimensions that strongly influence transport and structure-property relations. This interpretation forms a baseline for designing hybrid materials for applications in self-healing, drug delivery, and membranes.

Release of silver and copper nanoparticles from polyethylene nanocomposites and their penetration into Listeria monocytogenes

Since infection is a major cause of death in a patient whose immune responses have been compromised (immunocompromised patient), considerable attention has been focused on developing materials for the prevention of infections. This has been directed primarily at suppressing or eliminating the host's endogenous microbial burden and decreasing the acquisition of new organisms. In this study, the antibacterial properties of two nanocomposites, polyethylene modified with silver nanoparticles (PE-AgNps) or copper nanoparticles (PE-CuNps), against Listeria monocytogenes have been investigated. In order to elucidate the antibacterial mechanism, specifically whether this mechanism corresponds to bactericidal or bacteriolytic activities, we have determined the extent of release of metal ions (Ag(+) and Cu(2+)) and, also, the morphology of the bacteria. The metal ion release from nanocomposites was followed by inductively coupled plasma spectrometry and the morphology of the bacteria was revealed through examination of ultramicrotomed sections of bacteria in a transmission electron microscope. The study of metal ion release from the nanocomposites shows that for both nanocomposites the amount of ions released varies with time, which initially displays a linear behavior until an asymptotic behavior is reached. Further, TEM images show that silver nanoparticles (AgNps) and copper nanoparticles (CuNps), which are released from the nanocomposites, can penetrate to the cell wall and the plasma membrane of bacteria. Resulting morphological changes involve separation of the cytoplasmic membrane from the cell wall, which is known to be an effect of plasmolysis. It was revealed that the antibacterial abilities of the two nanocomposites against L. monocytogenes are associated with both bactericidal and bacteriolytic effects.

Calcium and titanium release in simulated body fluid from plasma electrolytically oxidized titanium

The release of titanium and calcium species to a simulated body fluid (SBF) at 37 degrees C has been investigated for titanium treated by dc plasma electrolytic oxidation (PEO) in three different electrolytes, namely phosphate, silicate and calcium- and phosphorus-containing. The average rate of release of titanium over a 30 day period in immersion tests, determined by solution analysis, was in the range approximately 1.5-2.0 pg cm(-2) s(-1). Calcium was released at an average rate of approximately 11 pg cm(-2) s(-1). The passive current densities, determined from potentiodynamic polarization measurements, suggested titanium losses of a similar order to those determined from immersion tests. However, the possibility of film formation does not allow for discrimination between the metal releases due to electrochemical oxidation of titanium and chemical dissolution of the coating.

Dye-sensitization of self-assembled titania nanotubes prepared by galvanostatic anodization of Ti sputtered on conductive glass

Self-organized porous TiO(2) nanotubes (NTs) were prepared on conductive glass by galvanostatic anodizing of sputtered titanium in an NH(4)F /glycerol electrolyte. DC magnetron sputtering at an elevated substrate temperature (500 degrees C) was used to deposit 650 nm thick titanium films. After anodizing, NTs, 830 nm long, with an average external diameter of 92 nm, were grown; this gave a high conversion rate of oxide from titanium (1.9), with a 220 nm thick layer of titanium, which was not oxidized, located at the base of the tubes. The NTs revealed a mainly amorphous structure, which transformed mostly to anatase upon thermal treatment in air at 450 degrees C. The tubes were sensitized by the N719 complex and the resultant photoelectrodes were incorporated into liquid dye solar cells (DSCs) and further tested under back-side illumination. High values of V(oc) (714 mV) were obtained under 1 sun (AM 1.5), assigned to low dark current magnitude and large recombination resistance and electron lifetime. In addition, typical values of fill factors (of the order of 0.62) were attained, in agreement with the estimated ohmic resistance of the cells in combination with low electron transfer resistance at the platinum/electrolyte interface. The overall moderate power conversion efficiency (of the order of 0.3%) was mainly due to the low short-circuit photocurrents (J(sc) = 0.68 mA cm(-2)), which was confirmed further by the corresponding IPCE values (5.2% at 510 nm). The magnitude of J(sc) was attributed to absorbed light losses due to back-side illumination of the cells, the low dye loading (due to the limited thickness of anodic titania) and the high charge transfer resistance at the TiO(2)/conductive substrate due to the presence of barrier layer(s) underneath the tubes. These preliminary results encourage the DSC community to explore further the galvanostatic anodizing of titanium in order to produce highly efficient porous TiO(2) NTs directly on conductive glass. Current work is focusing on achieving complete anodizing of the metal substrate and full transparency for the photoelectrode in order to increase and optimize the resultant cell efficiencies.

Conical tungsten stamps for the replication of pore arrays in anodic aluminium oxide films

A tungsten master stamp has been generated by applying a novel procedure that includes two-step anodizing, followed by sequential anodizing and pore widening to develop nominally funnelled pores. These conical-shaped pores were filled with tungsten by sputter coating to manufacture a master stamp. Under a pressure of 65 MPa, the master stamp successfully embossed the surface of annealed and electropolished aluminium. The embossed surface was then used to control the position of pores created by anodizing under the conditions used to produce the original pore array.

Transmission electron microscopy of coatings formed by plasma electrolytic oxidation of titanium

Transmission electron microscopy and supporting film analyses are used to investigate the changes in composition, morphology and structure of coatings formed on titanium during DC plasma electrolytic oxidation in a calcium- and phosphorus-containing electrolyte. The coatings are of potential interest as bioactive surfaces. The initial barrier film, of mixed amorphous and nanocrystalline structure, formed below the sparking voltage of 180 V, incorporates small amounts of phosphorus and calcium species, with phosphorus confined to the outer approximately 63% of the coating thickness. On commencement of sparking, calcium- and phosphorus-rich amorphous material forms at the coating surface, with local heating promoting crystallization in underlying and adjacent anodic titania. The amorphous material thickens with increased treatment time, comprising almost the whole of the approximately 5.7-microm-thick coating formed at 340 V. At this stage, the coating is approximately 4.4 times thicker than the oxidized titanium, with a near-surface composition of about 12 at.% Ti, 58 at.% O, 19 at.% P and 11 at.% Ca. Further, the amount of titanium consumed in forming the coating is similar to that calculated from the anodizing charge, although there may be non-Faradaic contributions to the coating growth.

The efficiency of nanotube formation on titanium anodized under voltage and current control in fluoride/glycerol electrolyte

The formation of nanotubes on titanium is compared for anodizing under controlled voltage and controlled current in a fluoride/glycerol electrolyte. Rutherford backscattering spectroscopy and nuclear reaction analysis are employed to determine the film compositions. Film morphologies are examined by electron microscopy. The findings reveal films of approximate composition TiO(2).0.15TiF(4) that probably also contain derivatives of glycerol. Controlled voltage conditions resulted in more uniform final nanotube dimensions, for a particular charge density, and the highest efficiency of film growth, with the charge of the titanium in the film representing ∼48% of the charge passed during anodizing. Under current control, the efficiency decreased from ∼40% to ∼23% with increase of the current density from 0.1 to 0.5 mA cm(-2). Further, the thickness of the barrier layer was sometimes enhanced under current control, possibly due to a non-uniform current distribution and consequently elevated local temperature.

Mineralogical study of salt crusts formed on historic building stones

A historic building stone, Baumberger sandstone, was exposed to gaseous SO(2) under dry and wet surface conditions in an atmospheric test chamber. The extent of salt formation resulting from the exposure to pollutant gases as well as the variations in mineralogical composition were studied based on petrological thin sections. Results reveal that the salts are formed only over the surface of the sample. The thickness of the formed salt crusts is determined. Calcite dissolution as well as porosity decreases are due to gypsum formation.

A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery

Levobupivacaine, the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. In this prospective, randomized, double-blinded study of epidural anesthesia, the onset, extent, and duration of sensory and motor block produced by 0.75% levobupivacaine (20 mL, 150 mg) was compared with that of 0.75% racemic bupivacaine in 56 patients undergoing elective lower abdominal surgery. The time to onset of adequate sensory block (T10 dermatome) was similar in both treatment groups (13.6 +/- 5.6 min for levobupivacaine and 14.0 +/- 9.9 min for bupivacaine), with an average peak block height of T5 reached at 24.3 +/- 9.4 and 26.5 +/- 13.2 min, respectively. Time to complete regression of sensory block was significantly longer with levobupivacaine (550.6 +/- 87.6 min) than bupivacaine (505.9 +/- 71.1 min) (P = 0.016). Abdominal muscle relaxation was adequate for the scheduled procedure in all patients, and there were no significant differences between the groups in rectus abdominis muscle scores (P = 0.386) and quality of muscle relaxation as determined by the surgeon and anesthesiologist (P = 0. 505 and 0.074, respectively). In conclusion, both 0.75% levobupivacaine and 0.75% bupivacaine produced effective epidural anesthesia and their effects were clinically indistinguishable.

IMPLICATIONS

The results of this study indicate that the sensory and motor block produced by 0.75% levobupivacaine is equivalent to that of 0.75% racemic bupivacaine. Both local anesthetics are well tolerated and effective in producing epidural anesthesia for patients undergoing lower abdominal surgery.

Commentary: neurotoxicity of local anesthetics--an issue or a scapegoat?

BACKGROUND AND OBJECTIVES

To evaluate the etiologies of cauda equina syndrome (CES) and transient radicular irritation (TRI) or transient neurologic symptoms (TNSs) following hyperbaric spinal anesthesia.

METHODS

A review of recent (since 1991) and prior (since 1941) investigations regarding CES and TRI (TNSs) was conducted.

RESULTS

Recent publications fail to recognize significant prior information regarding CES and TRI (TNSs).

CONCLUSIONS

Cauda equina syndrome is, in all probability, explainable. Further investigation to pinpoint the etiology of TRI (TNSs) is needed.

Microsatellite deletion mapping on chromosome 10q and mutation analysis of MMAC1, FAS, and MXI1 in human glioblastoma multiforme

Glioblastoma multiforme (GBM) is an end-stage brain tumor of glial origin. Allelic deletions encompassing all or part of chromosome 10q occur frequently in GBMs, indicating that loss of one or more tumor suppressor genes on 10q plays a role in GBM formation. One of these genes is MMAC1 (PTEN), a gene on 10q23 which encodes a dual-specificity protein phosphatase. We carried out a loss of heterozygosity (LOH) analysis of 66 GBM patients using microsatellite markers for 27 loci on 10q. Overall, LOH was detected in 70% of cases, most showing LOH with every informative marker. Eleven patients showed partial 10q deletions, the smallest spanning a 35 cM region distal to D10S187. Sequence analysis of the MMAC1 gene in 45 of these tumors revealed mutations in eleven cases (24%), all with LOH on 10q. None of these mutations was present in normal DNA from the same patients. In addition, we utilized SSCP analysis to test two other candidate genes on 10q: FAS, a cell surface receptor which transduces an apoptotic, cell death signal and MXI1, a transcriptional repressor. The absence of mutations in these genes suggested that FAS and MXI1 are not likely to be tumor suppressor genes physiologically relevant to GBM. These data do support a significant role for MMAC1 in GBM.

Cortisol, parathyroid hormone-related protein and the onset of calcium secretion by the mammary gland of the goat

During lactogenesis in the goat, the onset of secretion of calcium into milk occurs at parturition (Thompson et al. 1995) at approximately the same time as the onset of secretion of parathyroid hormone-related protein (PTHrP) by the mammary gland (Ratcliffe et al. 1992); these events may be unrelated or PTHrP may be involved in calcium transport from blood to milk.

Parturition in goats is initiated by fetal secretion of cortisol (Flint et al. 1978) and maternal secretion of cortisol also increases (Paterson & Linzell, 1971). Injecting cortisol locally into the sinus of a mammary gland of the late-pregnant goat when the tight junctions between secretory epithelial cells appear to be ‘loose’, and injectate can reach the basolateral surfaces of secretory cells, stimulates an early tightening of these junctions (Thompson, 1996) as occurs naturally at parturition. This tightening can be produced by an increased concentration of ionized calcium in the extracellular fluid of the gland (Neville & Peaker, 1981).

The experiments reported here were undertaken to determine if cortisol injection stimulates the mammary gland to secrete both PTHrP and calcium before parturition.

Multidisciplinary patient management by means of a high social risk screening tool

OBJECTIVE

The long-term goal in this study was for the Memorial Hospital of Salem County, Inc (MHSC), to create a seamless system of continuity of care for patients. This continuity of care begins before patients require acute admission through the hospital course and extends beyond discharge and into the post-hospital setting or alternate care situation.

DESIGN

In a retrospective study in 1993, through the first 6 months of 1994, it was discovered that MHSC patients experienced a longer-than-average Medicare length of stay than was seen in other hospitals. MHSC embarked on a program to reduce discharge planning request time to the social work and home care departments by using a patient screening system that began at the time of admission. The nursing, social work, and home care departments collaboratively designed a system that allowed for immediate transfer of vital discharge planning information to the social work and home care departments at the time of the patient's admission. A tool was jointly developed called the multidisciplinary patient management record.

RESULTS

The benefits of this process far exceeded the cost of implementing the tool. The average skilled nursing facility length of stay decreased below the national average by almost one full day. Patients experienced earlier access to social service intervention: discharge planning needs were identified more accurately; and the social services and home care departments' productivity rose because they could anticipate problems before a crisis arose.

CONCLUSIONS

Critical to the success of this overall effort was not designing the new tool, but integrating the tool into a reengineered multidisciplinary patient management process.

Chronic effects of somatotropin treatment on response of subcutaneous adipose tissue lipolysis to acutely acting factors in vivo and in vitro

The basis of the chronic lipolytic effect of somatotropin on adipose tissue was investigated in sheep. Lipolytic rate was assessed in subcutaneous adipose tissue both in vivo, by microdialysis, and in vitro. Somatotropin treatment resulted in a small increase in basal (unstimulated) lipolysis and also in the maximum lipolytic rate observed in the presence of catecholamines both in vivo and in vitro. There was a small increase in the number of beta-adrenergic receptors but no change in the amount of the two isoforms of the stimulatory GTP-binding protein, Gs. Treatment with somatotropin decreased the response to antilipolytic agents such as the adenosine analog N6-phenylisopropyladenosine and prostaglandin E1. There was, however, no change in the number of adenosine receptors or amounts of the inhibitory GTP-binding proteins (Gi-1 plus Gi-2). Somatotropin also decreased prostaglandin E2 production by subcutaneous adipose tissue in vivo. Somatotropin treatment thus alters lipolytic regulation in sheep and this is characterized by changes in a number of proteins involved in this process.

Pharmacokinetics of ropivacaine and bupivacaine for bilateral intercostal blockade in healthy male volunteers

BACKGROUND

Intercostal blockade produces the highest serum local anesthetic concentrations of all regional anesthetic techniques. The purpose of this study was to determine the pharmacokinetic properties of ropivacaine and bupivacaine after bilateral intercostal blockade.

METHODS

The pharmacokinetics of ropivacaine (n = 7) and bupivacaine (n = 7) were determined in adult human volunteers from venous samples drawn over 24 h after bilateral intercostal blockade of T5-T11 with 140 mg of either drug (0.25% plain solutions, 56 ml). Sensory (pinprick, temperature, and touch) and motor blockade (RAM-test and integrated electromyography) were assessed every 2 h.

RESULTS

There was no significant difference between the maximum plasma concentrations (Cmax) obtained for either drug (ropivacaine 1.1 +/- 0.4 microgram/ml, bupivacaine 0.9 +/- 0.2 microgram/ml, P = 0.39), and there were no toxic signs observed in the obtained plasma concentration ranges. Plasma concentrations tended to peak (tmax) earlier with ropivacaine (21 +/- 9 versus 30 +/- 8 min, P = 0.09). The terminal half-life (t1/2 beta) of ropivacaine (2.3 +/- 0.8 h) was significantly less than that for bupivacaine (4.6 +/- 2.6 h, P = 0.04). Sensory blockade measured by pinprick was of shorter duration with ropivacaine (6.0 +/- 2.5 h versus bupivacaine 10.0 +/- 3.0 h; P < 0.001). Likewise, motor blockade was less intense and of shorter duration for ropivacaine by RAM-test (P = 0.02).

CONCLUSIONS

The results of this pharmacokinetic study indicate that 0.25% ropivacaine and 0.25% bupivacaine (56 ml, 140 mg) produce peak plasma levels less than those considered toxic when used in bilateral intercostal blockade. Studies of ropivacaine for intercostal blockade in surgical patients are necessary before the optimum concentration for efficacy and anesthetic/analgesic duration is identified.

Local control of parathyroid hormone-related protein secretion by the mammary gland of the goat

In late-pregnant goats, daily removal of secretion from one mammary gland stimulated an early secretion of fluid by that gland in five of the six animals studied. This early secretion of fluid was accompanied by an early increase of parathyroid hormone-related protein (PTHrP) 1-86 concentration in the secretion of that gland alone. When lactation was established, glands emptied thrice daily secreted PTHrP (1-86) in greater quantities and concentrations than glands emptied once daily concurrently in the same animals. Toward the end of lactation, abrupt cessation of emptying one gland caused levels of PTHrP (1-86) to decline in the fluid in that gland but not the contralateral, emptied gland. We conclude that, in the goat, PTHrP (1-86) secretion into milk is linked to autocrine factor(s) that stimulate milk secretion when fluid is removed from the gland.

Prolactin and the onset of mammary extraction of plasma triacylglycerols during lactogenesis in the goat

1. In untreated goats, the onset of mammary extraction of circulating triacylglycerols (TG) at parturition occurred shortly after the peak of prolactin concentration in circulating plasma. Suppressing this peak of systemic prolactin, by acutely treating with bromocriptine, delayed the onset of mammary extraction of TG and secretion of long-chain TG fatty acids. 2. Regular unilateral removal of secretion pre-partum, which brought about an early local onset of TG extraction and secretion of long-chain TG fatty acids in this treated half of the udder, was not associated with an increased local concentration of prolactin in secretion in this gland.

Production of parathyroid hormone-related protein by the mammary gland of the goat

Parathyroid hormone-related protein (PTHRP) has been quantified by sensitive specific immunoassays in mammary venous blood and milk from 7 days before to 7 days after parturition in the goat. A significant venous-arterial concentration gradient in plasma PTHRP 1-86 concentrations was demonstrated across the mammary gland, indicating that PTHRP enters the maternal circulation and may have a role in calcium homoeostasis during lactation. Significant and sustained increases in mammary venous and milk PTHRP 1-86 concentrations were found from 1 day before parturition to 7 days afterwards, with peak concentrations of 1.57 +/- 0.58 pmol/l (plasma) and 8.69 +/- 2.95 nmol/l (milk) (mean +/- S.E.M.) occurring on day -1 and the day of parturition respectively. Estimates of the mammary output of PTHRP into plasma in four goats averaged 9% (range 1-25%) of that secreted into milk. Suppression of maternal prolactin concentrations by bromocriptine significantly reduced milk yield and the mammary venous PTHRP concentration, without affecting the concentration of PTHRP in milk. In conclusion, parturition in the goat is associated with a sustained increase in secretion of PTHRP into both plasma and milk; the former may be involved in maternal calcium homoeostasis, whereas the latter may have a role in the neonate.

Prostaglandin E2 in adipose tissue extracellular fluid of sheep

Prostaglandin E2 concentration in perfusate from microdialysis tubing implanted in subcutaneous adipose tissue of sheep did not consistently change during feeding. Noradrenaline infused into this tissue produced a prompt increase of glycerol concentration in the perfusate, but this changed to a slight decrease towards the end of the infusion. At approximately the time of this decrease, levels of prostaglandin E2 in the perfusate increased.

Extraction of plasma triacylglycerols by the mammary gland of the lactating cow

The fatty acid content of triacylglycerols (TG) in arterial and mammary venous blood plasma has been analysed in five cows that were close to peak lactation. The fatty acids in arterial TG were extracted by the mammary gland in amounts 14:0 less than 16:0 less than 18:0 and 18:0 greater than 18:1n - 9 greater than 18:2. The difference of extraction between palmitate and stearate was similar in different TG species. The fatty acid 18:1n - 7, which was largely the trans isomer, was extracted more than 18:1n - 9. Significant amounts of phytanic acid were acylated in plasma TG, but not extracted by the mammary gland.

The onset of mammary extraction of plasma triglycerides and circulating levels of progesterone during lactogenesis in the cow and goat

In untreated cows and goats, the onset of mammary extraction of plasma triglyceride was sometimes detected several hours before parturition, prior to removal of secretion from the mammary glands by offspring and when circulating progesterone concentrations were low. In cows and goats that had secretion regularly removed from the mammary glands late in gestation, the onset of triglyceride extraction occurred up to several days before parturition, when circulating progesterone concentrations were moderately high (up to 3.9 ng/ml in the cow and 6.2 ng/ml in the goat).

Mammary gland blood flow and plasma concentrations of 6-keto-prostaglandin F1 alpha in the goat

1. Mammary blood flow and concentrations of the stable metabolite of prostacyclin, 6-keto-prostaglandin F1 alpha, in mixed venous and mammary venous blood plasma have been measured in five lactating goats at various times during the day. 2. Natural variation in blood flow was not associated with any local release of 6-keto-prostaglandin F1 alpha into the mammary venous circulation.

Local control of the onset of mammary extraction of plasma triglycerides during lactogenesis in the goat

In five untreated goats, mammary extraction of plasma triglycerides increased at parturition. In five goats that had as much secretion as possible regularly removed from one mammary gland beginning on d 143 of gestation, the change of triglyceride extraction occurred several d before parturition in the emptied gland but at parturition in the contralateral control gland. The experimentally induced early increase of extraction of plasma triglycerides preceded the increase of prostaglandin F alpha concentration in mammary secretion at parturition, and occurred despite abnormally high concentrations of progesterone in the secretion.

Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery

Ropivacaine is an amide local anesthetic structurally related to, but appearing less cardiotoxic, than bupivacaine. The authors' investigation was designed in a randomized, double-blind fashion to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. Forty-five patients were randomized to receive 20 ml of 0.5% ropivacaine or bupivacaine. Intermittent sensory (pinprick) and motor (Bromage score) measurements were made while the block was in effect, and changes in heart rate, blood pressure and amounts of additional analgesics, sedatives and other medications were also recorded. Presence of tourniquet pain and the quality of anesthesia were also assessed. One patient was excluded from analysis; thus, 22 patients each received ropivacaine or bupivacaine. No differences were found in patient or perioperative characteristics between the groups. The quality and extent of sensory and motor blockade between groups were comparable, although bupivacaine was slightly longer acting. Cardiovascular changes, incidence of tourniquet pain, and the amounts of supplemental medications necessary were also similar between groups. The authors found 0.5% ropivacaine and bupivacaine to be clinically similar in both sensory- and motor-blocking characteristics, with the exception that bupivacaine produced a blockade of slightly longer duration. Because ropivacaine is reported to be less cardiotoxic than bupivacaine in animal studies, the similarity of clinical epidural anesthesia may make ropivacaine the preferred agent.

Effect of epinephrine on central nervous system and cardiovascular system toxicity of bupivacaine in pigs

To determine what effect the addition of epinephrine has on bupivacaine toxicity, toxic doses of bupivacaine were administered to awake spontaneously breathing pigs. Twenty animals were randomized to one of two groups. One group received an infusion of bupivacaine with epinephrine (5 micrograms/ml) at a rate of 2 mg.kg-1.min-1; the other received an infusion of plain bupivacaine at the same rate. Bupivacaine infusion was continued until cardiovascular collapse. Following cardiovascular collapse we attempted to resuscitate the animals via open chest cardiac massage and a standardized resuscitation protocol. The addition of epinephrine to bupivacaine significantly increased blood pressure and systemic vascular resistance but not heart rate or cardiac output early in the bupivacaine infusion. Epinephrine had no effect on the dose of bupivacaine that caused cardiovascular collapse (P = 0.1), on the plasma concentration of bupivacaine at collapse (P = 0.9), or on the ability to resuscitate animals following cardiovascular collapse. The addition of epinephrine decreased the dose of bupivacaine required to initiate cardiac dysrhythmias (P = 0.003). The first dysrhythmia experienced by the epinephrine group was second degree heart block, which contrasts with the premature ventricular and atrial dysrhythmias experienced by the plain group. The dose of bupivacaine that produced seizures was also reduced by the addition of epinephrine (P = 0.006). The addition of epinephrine to bupivacaine did not alter the dose of bupivacaine that caused cardiovascular collapse in awake spontaneously breathing pigs but did decrease the dose of bupivacaine that caused seizures and dysrhythmias.

Release of cholesteryl esters by the mammary gland of the pre-partum cow

In five cows that were regularly milked before parturition, cholesteryl esters were continuously released into the mammary fluid; their concentration in the fluid was initially high, but decreased a few days before parturition when mammary secretion of fluid and triglyceride was increasing. The composition of fatty acids in the cholesteryl esters of mammary fluid and in blood plasma was different, suggesting mammary synthesis of cholesteryl esters.