Selection of reference genes for quantitative studies in acute myeloid leukaemia

INTRODUCTION

Quantitative polymerase chain reaction (qPCR) is commonly used in the investigation of acute myeloid leukaemias (AML). Stable reference genes (RG) are essential for accurate and reliable reporting but no standard method for selection has been endorsed.

MATERIALS AND METHODS

We evaluated simple statistics and published model-based approaches. Multiplex-qPCR was conducted to determine the expression of 24 candidate RG in AMLs (N=9). Singleplex-qPCR was carried out on selected RG (SRP14, B2M and ATP5B) and genes of interest in AML (N=15) and healthy controls, HC (N=12).

RESULTS

RG expression levels in AML samples were highly variable and coefficient of variance (CV) ranged from 0.37% to 10.17%. Analysis using GeNorm and Normfinder listed different orders of most stable genes but the top seven (ACTB, UBE2D2, B2M, NF45, RPL37A, GK, QARS) were the same. In singleplex-qPCR, SRP14 maintained the lowest CV in AML samples. B2M, one of most stable reference genes in AML, was expressed near significantly different in AML and HC. GeNorm selected ATP5B+SRP14 while Normfinder chose SRP14+B2M as the best two RG in combination. The median expressions of combined RG genes in AML compared to HC were less significantly different than individually implying smaller expression variation after combination. Genes of interest normalised with RG in combination or individually, displayed significantly different expression patterns.

CONCLUSIONS

The selection of best reference gene in qPCR must consider all sample sets. Model-based approaches are important in large candidate gene analysis. This study showed combination of RG SRP14+B2M was the most suitable normalisation factor for qPCR analysis of AML and healthy individuals.

Targeting leukemia stem cells in vivo with antagomiR-126 nanoparticles in acute myeloid leukemia

Current treatments for acute myeloid leukemia (AML) are designed to target rapidly dividing blast populations with limited success in eradicating the functionally distinct leukemia stem cell (LSC) population, which is postulated to be responsible for disease resistance and relapse. We have previously reported high miR-126 expression levels to be associated with a LSC-gene expression profile. Therefore, we hypothesized that miR-126 contributes to “stemness” and is a viable target for eliminating the LSC in AML. Here we first validate the clinical relevance of miR-126 expression in AML by showing that higher expression of this microRNA (miR) is associated with worse outcome in a large cohort of older (≥60 years) cytogenetically normal AML patients treated with conventional chemotherapy. We then show that miR-126 overexpression characterizes AML LSC-enriched cell subpopulations and contributes to LSC long-term maintenance and self-renewal. Finally, we demonstrate the feasibility of therapeutic targeting of miR-126 in LSCs with novel targeting nanoparticles (NP) containing antagomiR-126 resulting in in vivo reduction of LSCs likely by depletion of the quiescent cell subpopulation. Our findings suggest that by targeting a single miR, i.e., miR-126, it is possible to interfere with LSC activity, thereby opening potentially novel therapeutic approaches to treat AML patients.

Pharmacological targeting of miR-155 via the NEDD8-activating enzyme inhibitor MLN4924 (Pevonedistat) in FLT3-ITD acute myeloid leukemia

High levels of microRNA-155 (miR-155) are associated with poor outcome in acute myeloid leukemia (AML). In AML, miR-155 is regulated by NF-κB, the activity of which is, in part, controlled by the NEDD8-dependent ubiquitin ligases. We demonstrate that MLN4924, an inhibitor of NEDD8-activating enzyme presently being evaluated in clinical trials, decreases binding of NF-κB to the miR-155 promoter and downregulates miR-155 in AML cells. This results in the upregulation of the miR-155 targets SHIP1, an inhibitor of the PI3K/Akt pathway, and PU.1, a transcription factor important for myeloid differentiation, leading to monocytic differentiation and apoptosis. Consistent with these results, overexpression of miR-155 diminishes MLN4924-induced antileukemic effects. In vivo, MLN4924 reduces miR-155 expression and prolongs the survival of mice engrafted with leukemic cells. Our study demonstrates the potential of miR-155 as a novel therapeutic target in AML via pharmacologic interference with NF-κB-dependent regulatory mechanisms. We show the targeting of this oncogenic microRNA with MLN4924, a compound presently being evaluated in clinical trials in AML. As high miR-155 levels have been consistently associated with aggressive clinical phenotypes, our work opens new avenues for microRNA-targeting therapeutic approaches to leukemia and cancer patients.

Tumor antigen ROR1 targeted drug delivery mediated selective leukemic but not normal B-cell cytotoxicity in chronic lymphocytic leukemia

Selective cytotoxicity to cancer cells without compromising their normal counterparts pose a huge challenge for traditional drug design. Here we developed a tumor antigen targeted delivery of immunonanoparticle carrying a novel non-immunosuppressive FTY720 derivative OSU-2S with potent cytotoxicity against leukemic B cells. OSU-2S induces activation of protein phosphatase 2A, phosphorylation and nuclear translocation of SHP1^S591 and deregulation of multiple cellular processes in chronic lymphocytic leukemia (CLL) resulting in potent cytotoxicity. To preclude OSU-2S mediated effects on these ubiquitous phosphatases in unintended cells and avoid potential adverse effects we developed a OSU-2S targeted delivery immunonanoparticles (2A2-OSU-2S-ILP), that mediated selective cytotoxicity of CLL but not normal B cells through targeting receptor tyrosine kinase ROR1 expressed in leukemic but not normal B cells. Developing a novel spontaneous CLL mouse model expressing human ROR1 (hROR1) in all leukemic B cells, we demonstrate the therapeutic benefit of enhanced survival with 2A2-OSU-2S-ILP in-vivo. The newly developed non-immunosuppressive OSU-2S, its delivery using human CLL directed immunonanoparticles and the novel transgenic mouse model of CLL that expresses hROR1 exclusively in leukemic B cell surface are highly innovative and can be applied to CLL and other ROR1+ malignancies including mantle cell lymphoma and acute lymphoblastic leukemia.

DNA translocation through short nanofluidic channels under asymmetric pulsed electric field

Investigation of single molecule DNA dynamics in confined environments has led to important applications in DNA analysis, separation, and sequencing. Here, we studied the electrophoretic transport of DNA molecules through nanochannels shorter than the DNA contour length and calculated the associated translocation time curves. We found that the longer T4 DNA molecules required a longer time to traverse a fixed length nanochannel than shorter λ DNA molecules and that the translocation time decreased with increasing electric field which agreed with theoretical predictions. We applied this knowledge to design an asymmetric electric pulse and demonstrate the different responses of λ and T4 DNA to the pulses. We used Brownian dynamics simulations to corroborate our experimental results on DNA translocation behaviour. This work contributes to the fundamental understanding of polymer transport through nanochannels and may help in designing better separation techniques in the future.

Simulation of Reactive Liquid Composite Molding

The control-volume finite element method (CVFEM) has been used widely to simulate the mold filling process in polymer processing because it is more user friendly and more robust than the conventional finite element or finite difference methods. However, using lower order interpolation functions in CVFEM may result in significant numerical errors. This is especially true for convection–diffusion problems with a changeable source term as in reactive liquid composite molding (LCM). In this study, an Eulerian–Lagrangian approach is proposed where an Eulerian coordinate system is used to solve the velocity field, while the chemical species balance and the energy balance are based on a Lagrangian coordinate system. This approach is used to simulate the non-isothermal LCM process.

Analysis of Flow and Heat Transfer in Liquid Composite Molding

An analysis of flow and heat transfer in Liquid Composite Molding (LCM) is presented. Analytical solutions for the velocity profiles including the boundary effects and temperature distributions are derived for constant viscosity fluids. The heat transfer during mold filling is also analyzed numerically. It is found that the boundary effect has a significant influence on heat transfer when the Reynolds number, Res, is greater than 1. When the Reynolds number is less than 1, the boundary effect on heat transfer can be negligible and Darcy's law is applicable. The results also show that the inertia effect can be neglected during mold filling in LCM. Experiments on heat transfer with a non-reactive fluid lead to measurements of the dispersion effect and test of the boundary effect on heat transfer. Several non-isothermal mold filling and curing experiments on two rather different reactive systems lead to an assessment of the factors a model must include to capture the curing behavior.

Control Volume Finite Element Method for Mold Filling Simulation

This work presents two methods to improve the spatial accuracy of traditional control volume based finite element method for the mold filling simulation. The first method is based on the flow front mesh refinement which results in a better numerical accuracy near the flow front region without any need of remesh. The second method, flow front tracking, traces the exact location of the flow front. Together with local remesh, the spatial accuracy is improved. Application of both methods to the mold filling process in resin transfer molding (RTM) is presented.

Tool Heat Transfer Analysis in Resin Transfer Molding

This work presents four different numerical approaches to analyze heat transfer in the mold halves. The formulations, numerical methods and simulated results of each method are presented and compared to the experimental results based on a metal (aluminum) and a non-metal (reinforced epoxy) molds. Several examples are also presented to show the importance of tool heat transfer analysis in reactive processing.

Flow Analysis of Sheet Molding Compounds in Compression Molding

A series of experiments and a numerical simulation were carried out to investigate the flow of silly putty and sheet molding compound (SMC) at various processing conditions in compression molding. The flow resistance and the interface friction of both materials were characterized by using a squeeze flow rheometer and the ring compression test, respectively. Molding experiments were carried out on an instrumented mold and the finite element code ALPID (Analysis of Large Plastic Incremental Deformation) was used for numerical simulation. The flow front shape, temperature profile, and pressure change obtained by numerical simulation compared well with experimental results.

Non-isothermal Mold Filling and Curing Simulation in Thin Cavities with Preplaced Fiber Mats

A numerical model for non-isothermal mold filling and curing simulation in thin cavities with preplaced fiber mats was developed based on the control volume method. Both lumped temperature system (i.e. local thermal equilibrium between the resin and the fiber) and unlumped temperature system (i.e. thermal non-equilibrium locally) were considered. A Lagrangian coordinate system was used in the flow front region to improve the energy transfer calculation. Several molding simulation results were presented to show the effect of fiber mat presence (in the mold cavity) on the inlet pressure and temperaturedistribution.

Injection Molding of Water Containing Thermoplastic Polyolefin

In this paper, we present a novel injection molding approach using water containing thermoplastic polyolefin (TPO) to reduce the cycle time and to improve the dimensional stability of parts without any equipment or mold modifications. A small amount of water was pressurized into TPO pellets pre-mixed with water carrier particles such as highly porous activated carbon or tubular-shaped nanoclay. Our results showed that the cycle time could be drastically reduced with substantially reduced surface sink mark and part warpage without any adverse effects on mechanical properties. Water evaporation during molding resulted in internal cooling, which led to a large reduction in cycle time. This phenomenon, however, could not be explained by the average water content in TPO alone. It is believed that the accumulation of water in the thickest section of the mold cavity, i.e., the base of the conical shaped sprue in the molds used in the study, during injection molding played a major role. The lower sink mark and part warpage were due to water induced internal cooling and foaming. Complete filling of thin parts could also be achieved at a lower packing pressure in the presence of water, perhaps due to steam (from water evaporation) induced mold cavity heating during filling. This was supported by the measured temperature rise at the mold surface in the early stage of the molding cycle.

Molecular imaging of slip in entangled DNA solution

This work obtains the first molecular imaging of wall slip in entangled solutions. Using a combination of confocal fluorescence microscopy and rheometry, molecular images were captured in the nonlinear response regime of entangled DNA solutions. Conformations of DNA molecules were imaged during shear to correlate with the magnitude of wall slip. Interfacial chain disentanglement results in wall slip beyond the stress overshoot. Sufficient disentanglement can produce tumbling of individual DNA in the entangled solutions.

Local recurrence after curative resection in patients with colon and rectal cancers

BACKGROUND AND AIMS

There are a range of rates and a number of prognostic factors associated with the local recurrence of colorectal cancer after curative resection. The aim of this study was to identify the potential prognostic factors of local recurrence in patients with colon and rectal cancers.

MATERIALS AND METHODS

A retrospective review of 1,838 patients who underwent curative resection of non-metastatic colorectal cancer was conducted. The patients were treated between 1994 and 2004, and had a minimum follow-up of 3 years.

RESULTS

There were 994 patients with colon cancer and 844 patients with rectal cancer. The median duration of follow-up was 60.9 +/- 24.5 months. With respect to colon cancer, the local recurrence rate was 6.1% (61 patients). With respect to rectal cancer, 95 patients had a local recurrence (11.3%), the rate of which was statistically greater than the local recurrence rate for colon cancer (p < 0.001). The overall recurrence rate was 16.4% (301 patients), and the local recurrence rate, with or without systemic metastases, was 8.5% (156 patients). Local recurrences occurred within 2 and 3 years in 59.9% and 82.4% of the patients, respectively. In patients with colon and rectal cancer, the pathologic T stage (p = 0.044 and p = 0.034, respectively), pathologic N stage (p = 0.001 and p < 0.001, respectively), and lymphovascular invasion (p = 0.013 and p = 0.004, respectively) were adverse risk factors for local recurrence. The level of the anastomosis from the anal verge was an additional prognostic factor (p = 0.007) in patients with rectal cancer.

CONCLUSION

Compulsive follow-up care of patients with colon and rectal cancers is needed for 3 years after curative resection, especially in patients who have adverse risk factors for local recurrence.

Safety and efficacy of glargine compared with NPH insulin for the treatment of Type 2 diabetes: a meta-analysis of randomized controlled trials

AIMS

We systematically analysed evidence from randomized controlled trials (RCTs) examining the safety and efficacy of neutral protamine Hagedorn (NPH) insulin and glargine in the management of adults with Type 2 diabetes.

METHODS

Studies were identified by searching medline (1966-March 2007), embase (1974-2007), American Diabetes Association abstract database and the Cochrane Central Register of Controlled Trials using Medical Subject Headings (MeSH) diabetes mellitus, Type 2, insulin, insulin isophane, hypoglycaemic agents and the keywords glargine and NPH. Data on study design, participants, fasting plasma glucose (FPG), glycated haemoglobin (HbA(1c)), body weight and hypoglycaemia were independently abstracted by two investigators using a standardized protocol.

RESULTS

Data from a total of 4385 participants in 12 RCTs were pooled using a random-effects model. The mean net change (95% confidence interval) for FPG, HbA(1c) and body weight for patients treated with NPH insulin as compared with glargine was 0.21 mmol/l (-0.02 to 0.45), 0.08% (-0.04 to 0.21) and -0.33 kg (-0.61 to -0.06), respectively, with negative values favouring NPH and positive values favouring glargine. More participants experienced symptomatic and nocturnal hypoglycaemia on NPH than glargine, but there was no significant difference in confirmed or severe episodes.

CONCLUSIONS

We identified no difference in glucose-lowering between insulin glargine and NPH insulin, but less patient-reported hypoglycaemia with glargine and slightly less weight gain with NPH in adults with Type 2 diabetes.

Dynamics of single polymers in a stagnation flow induced by electrokinetics

An electrokinetics-induced stagnation flow was created inside a microscale cross-channel. Compared to hydrodynamic-induced microfluidics, this flow system can be readily assembled and the operation is very simple due to a low pressure drop. Through image analysis, a fairly homogeneous, two-dimensional elongational flow was observed. The initial conformation of DNA molecules and residence time inside the flow field play important roles in determining the extent of DNA stretching. A coarse-grain molecular simulation agrees reasonably well with experimental observations.

Drug offenders in Taiwan and the United States: a cross-cultural analysis

Using data collected from nationwide surveys of drug-using offenders in the United States and Taiwan, this article compares offender differences with respect to socio-demographic characteristics, childhood experiences, drug use and treatment patterns, and criminal histories. The results suggest that the experiences of U.S. drug-using offenders are more complex, with multiple routes and consequences of drug use, while the social constructionist view is more appropriate to explain the experience of Taiwanese drug-using offenders. Overall, U.S. drug-using offenders reported earlier drug and criminal involvement, experienced more prior arrests, and committed more non-drug-related crimes. Family problems were more prevalent among U.S. drug-using offenders than Taiwanese drug-using offenders. Drug-using offenders in the U.S. also reported using a variety of different drugs and participating in multiple treatment programs. The major agents supplying illicit drugs were known dealers, and friends or acquaintances of U.S. and Taiwanese drug-using offenders, respectively. The article concludes that to effectively eliminate the problem of drug misuse, the Taiwanese government should focus on treatment instead of imprisonment, while the U.S. should target troubled teens and families.

Mechanism of colchicine-induced steroidogenesis in rat adrenocortical cells

Conflicting data for the effects of colchicine on cholesterol transport and steroidogenesis raise the question of the role of microtubules in cholesterol transport from the lipid droplet to mitochondria in steroidogenic cells. In this study, using corticosterone radioimmunoassay and immunofluorescence microscopy, we re-evaluated the effects of colchicine on hormone production and morphological changes of lipid droplets' and studied the signaling pathway involved in colchicine-induced steroidogenesis. Colchicine stimulated steroid production in a dose- and time-dependent manner. The structural integrity of both the microtubules and the lipid droplet capsule was destroyed by colchicine treatment. Disruption of the lipid droplet capsule occurred later than microtubule depolymerization. After cessation of colchicine treatment and a 3 h recovery in fresh medium, capsular protein relocated to the droplet surface before the cytoplasmic microtubule network was re-established. beta-lumicolchicine, an inactive analogue of colchicine, disrupted the capsule and increased hormone production without affecting microtubular structure. Thus, microtubule depolymerization is not required for the increase in steroid production and capsular disruption. To explore the signaling pathway involved in colchicine-induced steroidogenesis, we measured intracellular cAMP levels. Unlike ACTH, colchicine did not increase cAMP levels, suggesting that the cAMP-PKA system is not involved. Colchicine and ACTH had additive effects on corticosterone production, whereas colchicine and PMA did not, implying that part of the PKC signaling mechanism may be involved in colchicine-induced steroidogenesis. Cycloheximide, a protein synthesis inhibitor, completely inhibited colchicine-induced steroidogenesis and capsular disruption. These results demonstrate that the steroid production and lipid droplet capsule detachment induced by colchicine are both protein neosynthesis-dependent and microtubule-independent.

Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography

BACKGROUND AND PURPOSE

The purpose of the present study was to assess the diagnostic usefulness of early diffusion-weighted MRI (DWI) and MR angiography (MRA) in patients with ischemic stroke. Past approaches to stroke diagnosis required a series of diagnostic tests over several days of hospitalization. New magnetic resonance methodologies that include DWI and MRA may allow more rapid characterization of stroke pathophysiology. However, no previous study has assessed the impact on formal stroke subtype diagnosis of early imaging with DWI/MRA.

METHODS

We analyzed 46 consecutive patients with acute ischemic stroke who underwent DWI/MRA within 24 hours of admission. Initial diagnoses were rendered with use of the 2 most widely used formal stroke subtype classification schemes, the TOAST and the Oxfordshire methods, which were applied to patients after CT/conventional MRI but before DWI/MRA. Modified TOAST and Oxfordshire diagnoses were then rendered based on the results of day 1 DWI, MRA, and DWI plus MRA. Final TOAST/Oxfordshire diagnoses at discharge were taken as the gold standard.

RESULTS

Compared with final diagnoses, pre-MRI TOAST diagnoses matched final diagnoses in 48%, improving to 83% after DWI alone, 56% after MRA alone, and 94% after DWI plus MRA. For the TOAST diagnostic subtypes of large-vessel atherothromboembolism and small-vessel disease, pre-MRI diagnoses matched final diagnoses in 56% and 35% of patients, respectively, improving to 89% and 100% after DWI/MRA. Pre-MRI Oxfordshire diagnoses matched final diagnoses in 67% of patients, improving to 100% after DWI.

CONCLUSIONS

The use of DWI/MRA within 24 hours of hospitalization substantially improves the accuracy of the diagnosis of early ischemic stroke subtype. When initial management and clinical trial eligibility decisions are influenced by stroke subtype, day 1 multimodal MRI is advantageous as a guide to therapy.

Anti-tumor-promoting activities of selected pungent phenolic substances present in ginger

Ginger (Zingiber officinale Roscoe, Zingiberaceae) has been widely used as a dietary spice, as well as in traditional oriental medicine. The rhizome of ginger contains pungent vanillyl ketones, including [6]-gingerol and [6]-paradol, and has been reported to possess a strong anti-inflammatory activity. These pungent substances have a vanilloid structure found in other chemopreventive phytochemicals, including curcumin. In our study, we found anti-tumor-promoting properties of [6]-gingerol and [6]-paradol. Thus, topical application of [6]-gingerol or [6]-paradol 30 min prior to 12-O-tetradecanoyl-phorbol-13-acetate (TPA) attenuated the skin papillomagenesis initiated by 7,12-dimethylbenz[a]anthracene in female ICR mice. These substances also significantly inhibited the tumor-promoter-stimulated inflammation, TNF-alpha production, and activation of epidermal ornithine decarboxylase in mice. In another study, [6]-gingerol and [6]-paradol suppressed the superoxide production stimulated by TPA in differentiated HL-60 cells. Taken together, these findings suggest that pungent vanilloids found in ginger possess potential chemopreventive activities.

Compact and Efficient 3.2-W Diode-Pumped Nd:YVO(4)/KTP Green Laser

We demonstrate a simple way to achieve single-frequency operation by using fiber-coupled diode-pumped Nd:YVO(4)/KTP green lasers in a short standing-wave linear cavity. A single-mode output with 3.2-W green power was generated with a 12.6-W pump power corresponding to a conversion efficiency of 25.4%. The single-mode operation was obtained through the combined action of the anisotropic emission cross section of Nd:YVO(4) and the KTP crystal acting as a birefringent filter.

Effects of a water-soluble extract of Cordyceps sinensis on steroidogenesis and capsular morphology of lipid droplets in cultured rat adrenocortical cells

Cordyceps sinensis contains a factor that stimulates corticosteroid production in the animal model. However, it is not known whether this drug acts directly on the adrenal glands or indirectly via the hypothalamus-pituitary axis. In the present study, we used primary rat adrenal cell cultures to investigate the pharmacological function of a water-soluble extract of Cordyceps sinensis (CS) and the signaling pathway involved. Radioimmunoassay of corticosterone indicated that the amount of corticosterone produced by adrenal cells is increased in a positively dose-dependent manner by CS, reaching a maximum at 25 microg/ml. This stimulating effect was seen 1 h after CS treatment and was maintained for up to 24 h. Concomitantly, the lipid droplets in these cells became small and fewer in number. Immunostaining with a monoclonal antibody, A2, a specific marker for the lipid droplet capsule, demonstrated that detachment of the capsule from the lipid droplet occurs in response to CS application and that the period required for decapsulation is inversely related to the concentration of CS applied. The mechanism of CS-induced steroidogenesis is apparently different from that for ACTH, since intracellular cAMP levels were not increased in CS-treated cells. However, combined application with calphostin C, a PKC inhibitor, completely blocked the effect of CS on steroidogenesis, suggesting that activation of PKC may be responsible for the CS-induced steroidogenesis.

Penetration of levofloxacin into lung tissue after oral administration to subjects undergoing lung biopsy or lobectomy

STUDY OBJECTIVE

To evaluate the pulmonary tissue distribution of levofloxacin, the new once-daily fluoroquinolone, after a single 500-mg oral dose.

DESIGN

Open-label study.

SETTING

One pulmonary clinic and two university-affiliated teaching hospitals.

PATIENTS

Eighteen adults undergoing lung biopsy or lobectomy.

INTERVENTIONS

Levofloxacin plasma and lung tissue concentrations were determined by high-performance liquid chromatography with fluorescence detection. Lung tissue levofloxacin concentrations were corrected for blood contamination by measuring hemoglobin.

MEASUREMENTS AND MAIN RESULTS

After a single 500-mg oral dose, concentrations of levofloxacin in lung tissue consistently exceeded those in plasma at every time point over the 24-hour sampling period, with tissue:plasma penetration ratios of 2.02 (2-3 hrs), 5.02 (4-6 hrs), 5.13 (11-17 hrs), and 4.13 (22-25 hrs). The mean penetration ratio over the 24-hour sampling period was 3.95 (range 1.06-9.98). Lung tissue concentrations of levofloxacin also exceeded minimum inhibitory concentration values for most community-acquired respiratory tract pathogens over the 24 hours.

CONCLUSION

This study supports clinical evaluation of levofloxacin as once-daily oral therapy for community-acquired lower respiratory tract infections.

Effects of food and sucralfate on a single oral dose of 500 milligrams of levofloxacin in healthy subjects

The effects of food and sucralfate on the pharmacokinetics of levofloxacin following the administration of a single 500-mg oral dose were investigated in a randomized, three-way crossover study with young healthy subjects (12 males and 12 females). Levofloxacin was administered under three conditions: fasting, fed (immediately after a standardized high-fat breakfast), and fasting with sucralfate given 2 h following the administration of levofloxacin. The concentrations of levofloxacin in plasma and urine were determined by high-pressure liquid chromatography. By noncompartmental methods, the maximum concentration of drug in serum (Cmax), the time to Cmax (Tmax), the area under the concentration-time curve (AUC), half-life (t1/2), clearance (CL/F), renal clearance (CLR), and cumulative amount of levofloxacin in urine (Ae) were estimated. The individual profiles of the drug concentration in plasma showed little difference among the three treatments. The only consistent effect of the coadministration of levofloxacin with a high-fat meal for most subjects was that levofloxacin absorption was delayed and Cmax was slightly reduced (Tmax, 1.0 and 2.0 h for fasting and fed conditions, respectively [P = 0.002]; Cmax, 5.9 +/- 1.3 and 5.1 +/- 0.9 microg/ml [90% confidence interval = 0.79 to 0.94] for fasting and fed conditions, respectively). Sucralfate, which was administered 2 h after the administration of levofloxacin, appeared to have no effect on levofloxacin's disposition compared with that under the fasting condition. Mean values of Cmax and AUC from time zero to infinity were 6.7 +/- 3.2 microg/ml and 47.9 +/- 8.4 microg x h/ml, respectively, following the administration of sucralfate compared to values of 5.9 +/- 1.3 microg/ml and 50.5 +/- 8.1 microg x h/ml, respectively, under fasting conditions. The mean t1/2, CL/F, CLR, and Ae values were similar among all three treatment groups. In conclusion, the absorption of levofloxacin was slightly delayed by food, although the overall bioavailability of levofloxacin following a high-fat meal was not altered. Finally, sucralfate did not alter the disposition of levofloxacin when sucralfate was given 2 h after the administration of the antibacterial agent, thus preventing a potential drug-drug interaction.

Medical necessity for right heart catheterization

Because there are no definitive guidelines for performing right heart catheterizations or controlled clinical trials demonstrating medical benefit, the value and necessity of performing routine right heart catheterizations for coronary artery disease have been questioned. This Texas Medical Foundation Health Care Quality Improvement Program project was designed to ensure medical necessity and proper documentation of right heart catheterization when performed as part of a bilateral procedure. Medicare claims data were used to identify Texas facilities where rates of bilateral catheterizations suggested that right heart catheterizations were being performed routinely. Five facilities were found to have rates of bilateral procedures exceeding 70%. Suggested guidelines for performing right heart catheterizations were prepared by the Texas Medical Association Committee on Cardiovascular Diseases. These guidelines, together with the facility's data on its rate of right heart catheterizations, were presented by the Texas Medical Foundation to the staff of each facility. They were asked to examine their individual facility's procedures for ensuring medical necessity and to develop and implement process improvement plans. Medicare claims data were analyzed to determine the rates of bilateral catheterizations before and after the plans were instituted. The statewide rate of bilateral procedures decreased from 27.2% to 21.3% (p < 0.005). Rate reductions for 4 facilities implementing improvement plans were statistically significant (p < 0.001): at the 1st facility, the rate decreased from 74.3% to 25.0%; at the 2nd, from 85.0% to 21.0%; at the 3rd, from 76.7% to 17.7%; and at the 4th facility, from 85.4% to 42.9%. The rate for the facility not implementing an improvement plan increased from 86.4% to 89.1%. Reductions in rates of bilateral procedures at the 4 facilities suggest that many procedures previously performed were routine and not medically indicated. Presentation of data and practice guidelines to facilities may have contributed to their ability to improve processes.

A protective anti-peptide antibody against the immunodominant site of the A24 Cruzeiro strain of foot-and-mouth disease virus and its reactivity with other subtype viruses containing the same minimum binding sequence

A synthetic peptide vaccine of the general sequence Cys-Cys-(200-213)-Pro-Pro-Ser-(l41-158)-Pro-Cys-Gly(peptide A40), where the numbered residues refer to the VP1 sequence of foot-and-mouth disease virus (FMDV) strain A24 Cruzeiro, has previously been shown to elicit neutralizing and protective antibodies in guinea-pigs and cattle. To examine this immunogenic tract in more detail monoclonal antibodies (MAbs) were raised to this peptide. One such MAb C1.1, which recognized the homologous peptide, bound to native virus, neutralized infectivity in vitro and passively protected mice from challenge. Using overlapping dodecameric peptides the minimum binding 'footprint' of this MAb incorporated residues 149-154 which were respectively Gly-Ser-Leu-Ala-Ala-Arg. Since this 'footprint' occurs in several other A subtype strains of FMDV, the extent to which MAb C1.1 could cross-react was also examined. Using a liquid-phase competition ELISA, only viruses with a sequence that encompassed the same minimum binding 'footprint', namely A27 Cundinamarca Colombia/76, A Argentina/79, and A Venceslau Brazil/76 reacted with similar affinity against MAb C1.1. However, further serological examination of C1.1 with these viruses by indirect ELISA, in vitro neutralization and passive protection showed clear functional disparity. In contrast to the liquid-phase ELISA, the ability of C1.1 to react with electrostatically bound virus varied significantly depending on the subtype examined. Moreover, the capacity of this MAb to neutralize these subtypes showed wide divergence which was mirrored by the protection data.

The effects of recombinant human insulin-like growth factor (rhIGF)-1 and rhIGF-1/IGF binding protein-3 administration on rat osteopenia induced by ovariectomy with concomitant bilateral sciatic neurectomy

We compared the effect of administration of recombinant human insulin-like growth factor-1 (rhIGF-1) alone or the rhIGF-1/IGF binding protein-3 (IGFBP-3) complex on osteopenia in rats. Female Sprague-Dawley rats (8 months old) underwent combined ovariectomy and bilateral sciatic neurectomy (OVX-NX) or sham operation only. After 2 months, the OVX-NX animals were injected subcutaneously with rhIGF-1 alone or with rhIGF-1A IGFBP-3 equimolar complex for 4 weeks. The IGF-1 contents and dose were 0.3 mg/kg of body weight (BW) three times/week, 3 mg/kg of BW once/week, or 3 mg/kg of BW three times /week. At the end of the experiment, the 4th and 5th lumbar vertebrae (L4, L5) and the proximal tibiae were removed after tetracycline labeling, and histomorphometrical analyses were performed on undecalcified sections using Villanueva's staining. The cancellous bone volume at L5 significantly increased by thickening of the trabecular width in rats treated with the complex. However, the increase in the values at the proximal tibia was not significant. The bone formation rates (BFR/BS) in the lumbar vertebrae of rats treated with the complex three times a week at doses of 0.3 mg/kg of BW and 3 mg/kg of BW were both significantly increased but the parameter increase was less marked with the dose of 3 mg/kg of BW once/week. The BFR/BS did not increase significantly in animals treated with IGF-1 alone. These findings clearly demonstrated that the effect of systemically administered rhIGF-1 on bone formation was markedly potentiated when combined with IGFBP-3 in estrogen deficiency combined with reduced activity. The action of IGF-1 was less potent on the bone in paralyzed limbs. The action of rhIGF-1/IGFBP-3 on trabecular bone appeared to depend not only on the dose but also on the frequency of administration and the parts of the skeleton in rats.

Purification of dopamine neurons by flow cytometry

The heterogeneity and preponderence of other cell types present in cultures has greatly impeded our ability to study dopamine neurons. In this report, we describe methods for isolating nearly pure dopamine neurons for study in culture. To do so, the lipid-soluble dye, 1,1'-dioctadecyl-3,3,3'3'-tetramethylindocarbocyanine perchlorate (diI) was injected into the embryonic rat striata where it was taken up by nerve terminals and transported overnight back to the innervating perikarya in the ventral midbrain. Midbrain cells were then dissected, dissociated and separated on the basis of their (rhodamine) fluorescence by flow cytometry. Nearly all cells recovered as fluorescent positive (> 98%) were also immunoreactive for the dopamine specific enzyme tyrosine hydroxylase (80%-96%). Little contamination by other cells types was observed after labeling for specific neuronal and glial markers. Purified dopamine neurons continued to thrive and elaborate neuronal processes for at least 3 days in culture. Using this new model, it may now be possible to directly study the cellular and molecular processes regulating the survival and functioning of developing, injured and transplanted dopamine neurons.

Effect of organ perfusion on renal drug transport. Application to furosemide in the isolated perfused rat kidney

Angiotensin II was used as a probe to study the effect of changes in perfusate flow rate on the renal clearance parameters of furosemide in the isolated perfused rat kidney. Drug studies were performed in three rats with no angiotensin II present in the perfusate (treatment I) and in three rats with a 2.7 ng/min infusion of angiotensin II into the perfusate (treatment II). Furosemide was introduced into the recirculating perfusate at an initial concentration of 3.5 micrograms/ml and was assayed using HPLC. The protein binding of furosemide in perfusate was determined by equilibrium dialysis. Angiotensin II was found to have a dramatic effect on the renal hemodynamics, resulting in a 42% decrease in perfusate flow, a 27% decrease in GFR, and a 25% increase in filtration fraction. Values for the fractional excretion of glucose were very low and consistent, with or without angiotensin II (3.0-3.5%). Although the fraction unbound of furosemide was unchanged between treatments (0.770 for treatment I vs. 0.695% for treatment II), the renal and secretion clearances of furosemide were reduced by about 30% in the presence of angiotensin II. However, if the renal clearance (CLr) was corrected for free fraction (fu) and glomerular filtration rate (GFR) [ER = CLr/(fu.GFR)], there was no difference between the excretion ratio (ER) values of furosemide after the two treatments (29.0 for treatment I vs. 29.6 for treatment II). These results imply that the altered clearance parameters of furosemide are more likely the consequence of a reduction in functional nephron mass rather than a change in intrinsic secretory transport per unit mass of nephron.

Renal transport kinetics of chlorothiazide in the isolated perfused rat kidney

The effect of protein binding on the renal excretion of chlorothiazide was examined in the isolated perfused rat kidney. Drug studies were performed in three rats at 6.00% bovine serum albumin + 0% dextran and in three rats at 0.25% bovine serum albumin + 3.83% dextran. Chlorothiazide was introduced into the recirculating perfusate at an initial concentration of 100 micrograms/ml, and was assayed using high-performance liquid chromatography. Functional viability of the kidney was assessed by measuring the fractional excretion of sodium and glucose, and the glomerular filtration rate. The protein binding of drug in perfusate was determined by equilibrium dialysis. These experimental conditions resulted in an approximate 14-fold increase of percent free (from 5.3-72.0%), and a 3-fold increase of renal (from 1.03-3.30 ml/min) and secretion (from 1.01-2.83 ml/min) clearances. The data were best fitted by a model in which one Michaelis-Menten term was used to describe active transport, and secretion was dependent upon free concentrations of chlorothiazide in the perfusate. The maximum velocity of secretion (Vm = 85.6 micrograms/min) and Michaelis constant (Km = 2.1 micrograms/ml) of chlorothiazide was estimated using a nonlinear least-squares regression program. These results suggest that for compounds of low renal extraction, free drug concentrations are the driving force for carrier-mediated tubular secretion.

Renal transport kinetics of furosemide in the isolated perfused rat kidney

Direct quantitative data and corresponding theory are provided for the effect of protein binding on the renal transport of furosemide. Drug studies were performed with various combinations of bovine serum albumin and dextran. This resulted in a percent unbound (fu) of furosemide ranging from 0.785 to 85.8%. The corrected renal (CLr/GFR) and secretion (CLs/GFR) clearances of furosemide were observed to increase with percent free, but in a nonproportional manner. Plots of CLr/GFR or CLs/GFR vs. fu appeared to have a prominent y intercept as well as a convex ascending curve. In addition, the excretion ratio [ER = CLr/(fu . GFR)] was reduced from 60.8 to 8.72 as fu increased. Overall, the data were best fitted to a model in which two Michaelis-Menten terms were used to describe renal tubular transport, and secretion was dependent upon free drug concentrations in the perfusate. The results demonstrate that the renal mechanisms of furosemide excretion are more complex than previously reported and that active secretion may involve two different transport systems over the concentration range studied.