A Novel Approach for Non-Invasive Continuous In-Line Control of Perfusion Cell Cultivations by Raman Spectroscopy

Continuous manufacturing is becoming more important in the biopharmaceutical industry. This processing strategy is favorable, as it is more efficient, flexible, and has the potential to produce higher and more consistent product quality. At the same time, it faces some challenges, especially in cell culture. As a steady state has to be maintained over a prolonged time, it is unavoidable to implement advanced process analytical technologies to control the relevant process parameters in a fast and precise manner. One such analytical technology is Raman spectroscopy, which has proven its advantages for process monitoring and control mostly in (fed-) batch cultivations. In this study, an in-line flow cell for Raman spectroscopy is included in the cell-free harvest stream of a perfusion process. Quantitative models for glucose and lactate were generated based on five cultivations originating from varying bioreactor scales. After successfully validating the glucose model (Root Mean Square Error of Prediction (RMSEP) of ∼0.2 g/L), it was employed for control of an external glucose feed in cultivation with a glucose-free perfusion medium. The generated model was successfully applied to perform process control at 4 g/L and 1.5 g/L glucose over several days, respectively, with variability of ±0.4 g/L. The results demonstrate the high potential of Raman spectroscopy for advanced process monitoring and control of a perfusion process with a bioreactor and scale-independent measurement method.

Onto better TRAILs for cancer treatment

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), also known as Apo-2 ligand (Apo2L), is a member of the TNF cytokine superfamily. By cross-linking TRAIL-Receptor (TRAIL-R) 1 or TRAIL-R2, also known as death receptors 4 and 5 (DR4 and DR5), TRAIL has the capability to induce apoptosis in a wide variety of tumor cells while sparing vital normal cells. The discovery of this unique property among TNF superfamily members laid the foundation for testing the clinical potential of TRAIL-R-targeting therapies in the cancer clinic. To date, two of these therapeutic strategies have been tested clinically: (i) recombinant human TRAIL and (ii) antibodies directed against TRAIL-R1 or TRAIL-R2. Unfortunately, however, these TRAIL-R agonists have basically failed as most human tumors are resistant to apoptosis induction by them. It recently emerged that this is largely due to the poor agonistic activity of these agents. Consequently, novel TRAIL-R-targeting agents with increased bioactivity are currently being developed with the aim of rendering TRAIL-based therapies more active. This review summarizes these second-generation novel formulations of TRAIL and other TRAIL-R agonists, which exhibit enhanced cytotoxic capacity toward cancer cells, thereby providing the potential of being more effective when applied clinically than first-generation TRAIL-R agonists.

Getting TRAIL back on track for cancer therapy

Unlike other members of the TNF superfamily, the TNF-related apoptosis-inducing ligand (TRAIL, also known as Apo2L) possesses the unique capacity to induce apoptosis selectively in cancer cells in vitro and in vivo. This exciting discovery provided the basis for the development of TRAIL-receptor agonists (TRAs), which have demonstrated robust anticancer activity in a number of preclinical studies. Subsequently initiated clinical trials testing TRAs demonstrated, on the one hand, broad tolerability but revealed, on the other, that therapeutic benefit was rather limited. Several factors that are likely to account for TRAs' sobering clinical performance have since been identified. First, because of initial concerns over potential hepatotoxicity, TRAs with relatively weak agonistic activity were selected to enter clinical trials. Second, although TRAIL can induce apoptosis in several cancer cell lines, it has now emerged that many others, and importantly, most primary cancer cells are resistant to TRAIL monotherapy. Third, so far patients enrolled in TRA-employing clinical trials were not selected for likelihood of benefitting from a TRA-comprising therapy on the basis of a valid(ated) biomarker. This review summarizes and discusses the results achieved so far in TRA-employing clinical trials in the light of these three shortcomings. By integrating recent insight on apoptotic and non-apoptotic TRAIL signaling in cancer cells, we propose approaches to introduce novel, revised TRAIL-based therapeutic concepts into the cancer clinic. These include (i) the use of recently developed highly active TRAs, (ii) the addition of efficient, but cancer-cell-selective TRAIL-sensitizing agents to overcome TRAIL resistance and (iii) employing proteomic profiling to uncover resistance mechanisms. We envisage that this shall enable the design of effective TRA-comprising therapeutic concepts for individual cancer patients in the future.

Aprotinin-associated risks in off-pump coronary artery bypass grafting

BACKGROUND

Little data is available regarding the safety of using the serine protease inhibitor aprotinin in off-pump cardiac surgery. We retrospectively assessed the risks of administering the drug to adult patients undergoing off-pump coronary artery bypass grafting (OPCABG).

METHODS

Aprotinin was administered as a bolus of 1 or 2 million kallikrein inhibiting units to 391 patients following median sternotomy; 370 control patients underwent surgery during the same time period without receiving aprotinin. No other antifibrinolytic agents were administered.

RESULTS

Preoperative characteristics, length of ICU and hospital stay were similar between the mostly medium-risk aprotinin and the control patients. Postoperative cardiac, renal, neurological, and respiratory complications and hospital mortality occurred with comparable frequencies in both groups. Levels of myocardial enzymes during the first 72 h after surgery also did not differ significantly.

CONCLUSION

Use of aprotinin in OPCABG was not associated with a higher incidence of hospital mortality, cardiovascular, renal, or other complications. Given the good safety profile in this large patient population we suggest that aprotinin could still be a valid antifibrinolytic treatment option in OPCABG.

[First traumatic anterior shoulder dislocation: postoperative results 6 months and 2 years after arthroscopic stabilization in young patients]

BACKGROUND

The purpose of this prospective clinical trial was to report about results of primary or early secondary arthroscopic stabilization after first traumatic anterior dislocation of the shoulder.

PATIENTS AND METHODS

Within 2 weeks or in the 7th to 12th week post trauma, 51 subjects between 16 and 30 years received arthroscopic stabilization and rehabilitation. The patients were followed-up 6 months and 2 years post operation and assessed with the Rowe and the Constant scores.

RESULTS

At a mean follow-up of 27.9+/-4.3 months all patients returned to work in their profession. Of the patients, 79.2% were satisfied with the result of the operation; 91.7% returned to their sports. During the follow-up period five patients (10.4%) suffered redislocation. There was no difference in the result comparing the time of operation. The Rowe and Constant scores showed excellent results.

CONCLUSIONS

Arthroscopic stabilization after first traumatic anterior shoulder dislocation of the young patient is an appropriate approach and regardless of whether it is performed as a primary or early secondary operation it significantly lowers the redislocation rate. The method leads to quick reintegration into professional life and sports activities.

DNA degradation during maturation of erythrocytes - molecular cytogenetic characterization of Howell-Jolly bodies

Howell-Jolly bodies (HJBs) are small DNA-containing inclusions of erythrocytes and are often present after splenectomy. The genetic composition of HJBs is unknown at present. We isolated individual erythrocytes that had inclusion bodies from five splenectomized patients and performed DNA amplification using degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) with subsequent reverse painting on normal male metaphase spreads. We also measured the sizes of HJBs in erythrocytes from a splenectomized patient using an inverted microscope. Two-dimensional positions of HJBs were projected onto a virtual erythrocyte. The average size of HJBs was 0.73 +/- 0.17 microm (range 0.4-1.1 microm). Inside the erythrocyte the HJBs were found to be equally distributed. Small HJBs contained DNA from one or two centromeres and larger HJBs contained DNA from up to eight different centromeres. Centromeric DNA from chromosomes 1/5, 7, 8, and 18 was most frequently observed. Signals from the centromeric regions of chromosomes 3, 4, 9, and 10 were not observed. Signals from euchromatic regions were detected in a few cases. We hypothesize that in addition to enucleation and nucleus fragmentation DNA degradation during maturation of erythrocytes preferentially eliminates euchromatic DNA. Similarities between these processes and those described for embryonic stem cells suggest that most stem cells are able to degrade DNA in a genetically controlled manner.

Improved definition of chromosomal breakpoints using high-resolution multicolour banding

Characterisation of chromosome rearrangements using conventional banding techniques often fails to determine the localisation of breakpoints precisely. In order to improve the definition of chromosomal breakpoints, the high-resolution multicolour banding (MCB) technique was applied to identify human chromosome 5 breakpoints from 40 clinical cases previously assessed by conventional banding techniques. In 30 cases (75%), at least one breakpoint was redefined, indicating that MCB markedly improves chromosomal breakpoint localisation. The MCB pattern is highly reproducible and, in contrast to conventional banding pattern, is consistent in both short and elongated chromosomes. This might be of fundamental interest for the detection of chromosomal abnormalities, especially in tumour cells. Moreover, MCB even allows the detection of abnormalities that remain cryptic in GTG-banding analysis.

A comparative trial of imipenem versus ceftazidime in the release of endotoxin and cytokine generation in patients with gram-negative urosepsis. Urosepsis Study Group

Evidence from in vitro experiments and animal and human studies indicate that antibiotic therapy may induce the release of endotoxin from the outer membrane of Gram-negative bacteria. Antibiotics that bind preferentially to penicillin-binding protein-2 (PBP-2)--such as imipenem--are associated with little release of endotoxin, while antibiotics that preferentially bind to PBP-3--such as ceftazidime--are associated with far greater release of endotoxin. We conducted a randomized, multicenter, double-blind study comparing imipenem to ceftazidime in patients with urinary tract infections caused by Gram-negative bacilli associated with signs and symptoms of systemic inflammation. A total of 33 patients were randomized to receive either imipenem (n = 14) or ceftazidime (n = 19) for initial treatment for urosepsis. No differences in plasma endotoxin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) or urine endotoxin, IL-6 or IL-8 levels were found between the two treatment groups within the first 8 h after antibiotic administration. We conclude that, if differences exist with respect to endotoxin release by these two antimicrobial agents, these differences are not readily demonstrable in this clinical study with carefully defined patients with Gram-negative urinary tract infections.

[Congenital syphilis after reactivation of "healed" maternal primary infection]

The congenital syphilis is an infectious fetopathy which is able to affect the whole organism. In most cases symptoms are not obvious before week fourth to twelve of life. The infection of the mother is the precondition for the child's disease. The placental transfer takes place after the fifth to sixth month of gestation. We report about an eight week old baby with congenital syphilis. The positive maternal laboratory findings in the 4th month of pregnancy have been interpreted as a completely cured earlier infection causing a sero scar. The diagnosis became evident by serological tests detecting reactivation of maternal infection in late pregnancy and the clinical signs of acute infection of the child.

CONCLUSION

There is a high risk of reactivation of maternal syphilis in the third trimenon even if the mother does not show any symptoms. In this case further serological tests in the prenatal care and careful examination of the newborn must be initiated.

Genetic differences in the frequency of the hinge variants of porcine IgA is breed dependent

The distribution of the IgA(a) and IgA(b) alleles of porcine IgA in over 160 randomly-selected animals revealed an abundance of heterozygotes but only two b/b homozygotes. Since the IgA(b) allotype is a splice site mutant lacking two-thirds of the hinge, this study tests the hypothesis that pigs with this genotype may be at a selective disadvantage while heterozygous individuals may be at some advantage. This hypothesis was tested by collecting data on 374 animals of known breed and often parentage. We show here that when breed was not considered, young animals of known parentage had genotypic frequencies identical to that expected for Mendelian alleles but that a/b heterozygotes were overrepresented in adults. However, when analyzed with regard to breed, a very strong association between breed and the frequency of the IgA(a) and IgA(b) alleles was discovered. Meishan and NIH minipigs were homozygous for IgA while heterozygotes predominated in Berkshire, Chester White, Durocs, Hampshire and Landrace. Animals homozygous for IgA(b) were best represented in the White Cross line. We show here that this very strong breed dependency of IgA allotypy in swine can produce a sample bias that can explain why only two b/b homozygotes (1.3%) were found in the 160 randomly-selected samples since the original samples came from primarily Landrace and Yorkshire animals. The expected frequency of b/b homozygotes in these breeds would be <3%. Thus, the data presented here reject the hypothesis that swine homozygous for a trait that results in loss of two-thirds of the IgA hinge, are selected against and that heterozygotes are positively selected. Rather, the study shows that IgA(a) and IgA(b) appear to be simple, breed-dependent allotypic markers.

De novo complete trisomy 5p: clinical report and FISH studies

We describe a de novo trisomy 5p in a 1-year-old severely retarded boy. The complete short arm of chromosome 5 segregated as an additional marker chromosome in all metaphases. The marker was identified as 5p by conventional cytogenetic techniques (GTG, GBG, CBG) and molecular cytogenetic techniques (whole chromosome-painting probe, probes for the cri-du-chat region and the centromere, and additionally high-resolution multicolor banding using a chromosome 5-specific DNA probe cocktail). The clinical findings were similar to the established trisomy 5p phenotype including macrocephaly, facial abnormalities, tracheobronchial defects with subsequent respiratory infections, hypotonia, and psychomotor retardation. To the best of our knowledge this is the first description of an isolated complete 5p trisomy without involvement of the aberrant chromosome in any structural chromosomal rearrangements.

High resolution multicolor-banding: a new technique for refined FISH analysis of human chromosomes

A new multicolor-banding technique has been developed which allows the differentiation of chromosome region specific areas at the band level. This technique is based on the use of differently labeled overlapping microdissection libraries. The changing fluorescence intensity ratios along the chromosomes are used to assign different pseudo-colors to specific chromosome regions. The multicolor banding of human chromosome 5 is presented as an example.

Functional impact of nodules: a case-comparison study

Patients diagnosed with nodules (NO = 40) in a large university hospital clinic and an age-stratum matched nondiseased group (ND = 200) described adverse outcomes of vocal impairment on work and work-related communications. NOs were significantly more likely than NDs to report symptoms of hoarseness (73% vs. 26%), high-note difficulty (70% vs. 20%), difficulty speaking with a lower voice (53% vs. 13%) and a tired voice (50% vs. 10%), and their greatest source of physical discomfort was associated with scratchiness (61% vs. 3%). The average number of symptoms was four in NOs and less than one in NDs. Nodule patients were most concerned about the effects their voice problem would have on their future career (78% vs. 24%) and 49% of NOS reported their voice problem had an adverse work effect in the past compared with 4% of NDs. Having a voice condition limited current job performance in 39% of the NO group but only in 2% of the ND group. The results suggest that a diagnosis of nodules plays a major role in disrupting careers and work activities and that available educational programs and additional research are needed for improving their functional ability and preventing adverse outcomes in the lives of individuals with voice disorders.

Frequency of voice problems among teachers and other occupations

This study describes the frequency of reporting vocal problems among a random sample of elementary and high school teachers (n = 554) compared to individuals working in other occupations (n = 220). Teachers were more likely to define themselves as ever having a voice problem (32% versus. 1%, p < .05); having a tired, weak, or effortful voice (p < .05 each); and having a higher frequency of symptoms of physical discomfort with speaking (p < .05). They also were more likely to perceive that their voice problem negatively affected current job performance (p < .05) and limited options regarding change in work (p < .05). About 20% of teachers but only 4% of nonteachers had missed work due to their voice. These findings suggest that teachers are at high-risk for disability from voice disorders and that this health problem may have significant work-related and economic effects.

Spasmodic dysphonia and vocal fold paralysis: outcomes of voice problems on work-related functioning

Patients at a university voice disorder clinic diagnosed with spasmodic dysphonia (SD, n = 68) or vocal fold paralysis (VFP, n = 57) reported vocal symptoms and adverse work outcomes in contrast to a nondisordered group (ND, n = 68). Patients with SD most frequently cited symptoms of effortfulness (57%) and weakness (54%), VFP cited hoarseness (70%) and weakness (60%), while the nondisordered reported hoarseness (28%). SD and VFP produced greater (p< .05) adverse work outcomes than the nondisordered in the past (SD: 65%, VFP: 41%, ND: 3%), potential future (SD: 78%, VFP: 65%, ND: 19%), and current job performance (SD: 64%, VFP: 46%, ND: 2%). These disorders significantly disrupt socioeconomic outcomes and research is needed to improve functional ability and quality of life.

Populations in the U.S. workforce who rely on voice as a primary tool of trade: a preliminary report

The United States Bureau of Labor Statistics and other sources were consulted about the percentages of the working population that we identified as professional voice users. The largest percentage may be in sales and sales-related occupations (13%), but the exact breakdown of those who approach their clients vocally rather than by mail is still uncertain. The second largest population is teachers, who comprise 4.2% percent of the U.S. workforce (1994 statistic). Teachers have been identified as having the greatest incidence of voice disorders. Population data are also given for professional voice users who could present a significant hazard to public safety if their vocal communication skills were severely impaired.

Age-related hearing loss and bone mass in a population of rural women aged 60 to 85 years

Demineralization of the cochlear capsule in conjunction with age-related bone mass loss may be one biologic factor contributing to hearing loss in the elderly. In other metabolic bone diseases, including Paget's disease of the bone and cochlear otosclerosis, demineralization of the cochlea has been associated with sensorineural hearing loss. In 1988/1989, the relation between hearing loss and bone mass of the radius and femoral neck was studied cross-sectionally in 369 women aged 60 to 85 years from three rural communities. Hearing sensitivity was measured using audiometry, and bone mineral density of the radius and femoral neck was measured using single- and dual-photon densitometry, respectively. Three variables, ascertained by interview, were associated with an increased odds for hearing loss: age, family history of hearing loss before the age of 50 years, and current use of more than two nonestrogen, nonthiazide prescription medications. After consideration of the effect of these three variables, women with femoral neck bone mass values below the mean value of 0.696 g/cm2 for this population had a 1.9 greater odds of having a hearing loss (confidence interval: 1.30, 2.50). This study demonstrated a consistent adjusted association between femoral neck bone mass and age-related hearing loss in a population of rural women aged 60 to 85 years. No consistent association was observed between radial bone mass and hearing loss.

Role of interleukin-1 and the therapeutic potential of interleukin-1 receptor antagonist in sepsis

Clinical trials of anticytokines in sepsis have not been as straightforward as had been anticipated from results in animal models of sepsis and the role of cytokines in sepsis is now in question. Retrospective analysis of the results of a phase III trial of interleukin-1 (IL-1) receptor antagonist suggests that sepsis-induced adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), renal dysfunction, and shock are valuable markers of patients in whom IL-1 is a pathogenic mediator and in whom IL-1ra can reduce mortality. A re-examination of the effects of IL-1ra in animal models of sepsis supports the validity of this analysis. A new phase III clinical trial will confirm or disprove the hypothesis that IL-1 is a mediator of pathology, and IL-1ra is a valuable therapy for sepsis complicated by ARDS, DIC, renal dysfunction, or shock.

Prospective study of radial bone mineral density in a geographically defined population of postmenopausal Caucasian women

The radial bone mineral density (BMD) mass of 324 Caucasian women, aged 55-80 years, from geographically defined areas was evaluated in 1983 using single photon absorptiometry; 271 of these women (86%) were reexamined 5 years later in 1988. More than 65% of women lost radial BMD in excess of 1%/year in the 5-year follow-up. Thirty percent of women lost at least 2%/year. Baseline radial BMD measures taken in 1983 were highly predictive of the 1988 radial BMD values, explaining approximately 82% of the variability. The rate of bone change, expressed as percent change or 5-year difference (g/cm2), was not associated with baseline radial BMD value. Rate of change was not strongly associated with chronologic age or years since menopause, even when data were restricted to those women who reported no previous use of perimenopausal estrogen or thiazide medication. We conclude that BMD loss in a general population may be more substantial than previously believed.

[Expert assessment of "traumatic" lumbar intervertebral disk displacement]

A prolapse of a lumbar intervertebral disc as a consequence of trauma is rather often the subject of medical litigation. This paper shows the different aspects of federal and private insurance companies that insure accident consequences. Items hinting at a causal connection between trauma and prolapse are shown. A prolapse of a lumbar intervertebral disc can only very seldom be certified as being traumatic.

[Magnesium sulfate as adjuvant in beta-2-sympathicomimetic inhalation therapy of bronchial asthma]

The protective effects of inhaled MgS04 on exercise-induced asthma were studied in 13 children aged 6-13 years. The patients performed 6 min. running test on 3 separate days. Spirometry (FEV1, SRAW, VK, PF) was recorded on each test day 10 min. after medicament inhalation directly before and instantly, 2, 5, 10 and 20 min after the running test. t-tests on the mean revealed no significant effects on spirometric measurements (p less than 0.1), but in 6 patients MgS04-inhalation prevented FEV1--decreases greater than 20%. The combination gave better protection compared to salbutamol alone demonstrated from the measurements after exercise testing. Thus, MgS04-inhalation could be useful in the protective treatment of asthma.

[Wiedemann-Beckwith syndrome. Study of an oligosymptomatic form]

An infant with an incomplete expression of Wiedemann-Beckwith syndrome during the neonatal period was suspected to suffer from hypothyroidism. However, after exclusion of this tentative diagnosis the phenotypic characteristics lead to the correct diagnosis. In addition to the macroglossia, the typical facial signs of this syndrome such as capillary haemangioma of the glabella, soft tissue folds under the eyes and linear indentations of the ear lobes are demonstrable. Gigantism and umbilical hernia are absent. A tendency to hypoglycaemia and the increased risk of malignancy are the important aspects of this syndrome, which may be expressed in a variety of clinical forms. So far the aetiology of this syndrome is unknown although familial cases implicate the involvement of genetic factors.

Computerized tomography in vascular malformations of the brain

Computerized tomography scans of 166 patients - 99 cases with 117 aneurysms, and 67 cases with angiomatous malformations - were reviewed and correlated with angiographic and clinical findings. An intracranial hemorrhage was identified by CT scan in 103 patients, in 60 cases with aneurysms (17 only subarachnoid, 43 intracerebral), and in 43 cases with angiomas (6 only subarachnoid, 37 intracerebral). The source of hemorrhage was diagnosed with varying degrees of certainty with CT scan in 12 (12%) cases with aneurysms and in 27 (40%) cases with angiomas. Further CT findings were low density lesions in 18 cases indicating vasogenic edma, and calcifications in 10 angiomas. Intravenous infusion of contrast material was necessary to distinguish smaller aneurysms and angiomas. CT scan demonstrated the presence and location of thrombosed portions of giant aneurysms; these findings were less apparent with angiography. In 29 angiomas of medium or large size (macroangiomas) the malformation was demonstrated with CT scan in 25 (86%) cases and with angiography in 26 cases. 3 angiographically occult angiomas were diagnosed with CT as low density lesions and misinterpreted as gliomas. In all 36 microangiomas only the hemorrhage was precisely diagnosed with CT. The microangioma was identified angiographically in 24 cases and histologically in 21. In Sturge-Weber's disease the calcifications may be seen earlier with CT than with skull x-ray.

THE STEREOCHEMISTRY OF THE TETRAHYDROPIMARIC ACIDS

Evidence is presented that the fully reduced derivatives of pimaric acid (I), sandaracopimaric acid (II), and isopimaric acid (III) have trans–anti–trans fused skeletons. The implications of this observation are discussed.