Nanostructured Graphene Surfaces Promote Different Stages of Bone Cell Differentiation

Nanostructured graphene films were used as platforms for the differentiation of Saos-2 cells into bone-like cells. The films were grown using the plasma-enhanced chemical vapor deposition method, which allowed the production of both vertically and horizontally aligned carbon nanowalls (CNWs). Modifications of the technique allowed control of the density of the CNWs and their orientation after the transfer process. The influence of two different topographies on cell attachment, proliferation, and differentiation was investigated. First, the transferred graphene surfaces were shown to be noncytotoxic and were able to support cell adhesion and growth for over 7 days. Second, early cell differentiation (identified by cellular alkaline phosphatase release) was found to be enhanced on the horizontally aligned CNW surfaces, whereas mineralization (identified by cellular calcium production), a later stage of bone cell differentiation, was stimulated by the presence of the vertical CNWs on the surfaces. These results show that the graphene coatings, grown using the presented method, are biocompatible. And their topographies have an impact on cell behavior, which can be useful in tissue engineering applications.

Ispinesib (SB-715992) a kinesin spindle protein (KSP) inhibitor has single agent activity and enhances the efficacy of standard-of-care therapies in pre-clinical models of breast cancer

Abstract #2122

Background: Ispinesib is a novel highly specific small molecule inhibitor of kinesin spindle protein (KSP), a motor protein that is essential for formation of a bipolar mitotic spindle and for cell cycle progression through mitosis. KSP is expressed only in proliferating cells and not in post-mitotic neurons. In preclinical models and clinical studies thus far, ispinesib exhibits a favorable safety profile compared with tubulin-targeted therapies. Ispinesib has demonstrated clinical activity in patients with locally advanced or metastatic breast cancer that failed to respond/relapsed after treatment with taxanes and anthracyclines, and is currently being evaluated in a Phase I/II trial as first-line treatment in chemotherapy-naïve patients with locally advanced (Stage IIIB) or metastatic (Stage IV) breast cancer. In the current study, we explored the anti-tumor activity of ispinesib as a single agent and in combination with approved therapies in preclinical models of breast cancer. Methods: We implanted cells representative of hormone receptor positive luminal tumors (MCF-7), tumors overexpressing Her-2 (KPL4, HCC1954, BT474) or triple-negative basal tumors (MDA-MB-468) in immunodeficient female Nude or SCID mice. We started dosing Ispinesib when tumor volume reached 100-150mm3 and monitored xenograft growth for 60 days post treatment. Results: Ispinesib administered i.p. as a single agent on a q4dx3 schedule at its MTD induced tumor regressions in all five models of human breast cancer. In particular, all treated MDA-MB-468 xenografts (7/7) were tumor free survivors at 90 days post dosing. In tumors collected at different times post-dosing, we observed a strong mitotic arrest, inhibition of proliferation, and increased apoptosis by western blotting and IHC analyses of PH3, Ki67 and cleaved PARP respectively. We also determined the efficacy of ispinesib in combination with standard-of-care therapies in breast cancer. In the Her2 overexpressing models, the combination of ispinesib and herceptin markedly improved response rate and efficacy over either single agent. Tumor Growth Inhibition (TGI) was 99% for the combined agents, 67% for herceptin and 78% for ispinesib in KPL4. A similar benefit was found by combining ispinesib with lapatinib in BT474. Finally, ispinesib enhanced the anti-tumor activity of doxorubicin, causing an increase in TGI in 2 separate models (in MCF7, TGI was 86% for the combined agents, 39% for doxorubicin and 67% for ispinesib). Additional combination studies with capecitabine are under investigation.Conclusions: In distinct models of human breast cancer, ispinesib exhibited significant anti-tumor activity as a single agent. When used in combination, ispinesib enhanced the activity of standard-of-care therapies herceptin, lapatinib and doxorubicin. These data suggest that ispinesib may offer clinical benefit in the treatment of breast cancer, and support clinical studies of ispinesib in combination with these therapies.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2122.

Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients

This study examined the utility of the Personality Assessment Inventory (PAI) in screening for comorbid psychopathology in eating disordered males and females undergoing residential treatment. The PAI, a self-administered screening tool containing 344 items to provide information on 11 clinical constructs, was administered at admission and discharge to 181 patients, 154 females and 27 males. Average age was 26.88 years (SD=9.35) and average length of stay was 58.31 days (SD=39.94). The results showed that both male and female patients exhibit several comorbid disorders at admission to residential treatment and the severity of these symptoms was statistically significantly reduced over the course of treatment. When comparing differences among genders, the results show that females present with more psychopathology symptoms at the start of treatment but make better progress than males in reducing these symptoms over time. When comparing patients across eating disorder diagnoses, subjects with bulimia displayed more severe comorbid symptomatology as compared to those with anorexia or other eating disorders. A thorough clinical assessment of eating disordered patients including comorbid psychopathology disorders is relevant for clinical diagnosis, treatment planning, and perhaps ultimately the outcome of treatment.

Protease inhibitor drug levels in the management of human immunodeficiency virus-1 antiretroviral therapy

In order to evaluate the relationship between protease inhibitor (PI) plasma concentrations and viral suppression in individuals receiving highly active antiretroviral therapy (HAART), plasma concentrations and area under the time concentration curve (AUC(0.5-4)) for 35 HIV-infected adults receiving their initial (or first salvage) nelfinavir- (NFV) or indinavir (IDV)-based HAART were studied. Two groups were evaluated: those who had achieved HIV-RNA suppression (HIV-RNA <500 copies/mL, group 1, n=21) and those who had achieved incomplete HIV-RNA suppression (HIV-RNA>500 copies/mL, group 2, n=14) at the time of study entry. NFV one-hour pre-dose concentrations were significantly higher in group 1 compared to group 2 (P=0.023). The NFV AUC(0.5-4) for group 1 approached significance (P=0.068). No significant differences in IDV concentrations or AUC(0.5-4) were found between group 1 and group 2. It is feasible to use PI drug level monitoring in the outpatient setting.

Evolution of symptom severity during residential treatment of females with eating disorders

OBJECTIVES

The overall objective of this study was to measure the evolution of symptom severity in a residential programme based on a multidimensional approach to treatment that includes cognitive-behavioural, interpersonal, experiential and family therapies. The specific aims of the study were: 1) to evaluate changes in symptom severity in bulimic and anorexic patients between admission and discharge; 2) to compare the severity of these symptoms with those of non-patient college females (control group); and 3) to monitor the progression of symptom changes six months after discharge.

METHODS

The evolution of symptom severity was measured by comparing the mean raw scores of the Eating Disorder Inventory (EDI original inventory, 1983 version), which was administered at the beginning and end of the residential treatment. A subgroup of patients was also administered the EDI six months after discharge. The study involved 99 females: 47 with bulimia and 52 with anorexia as diagnosed by means of a clinical interview using DSM-IV criteria. The mean raw EDI scores in the control group (FC1, female college students) were obtained from the EDI manual. The population means were compared using the t-test for paired data (Microsoft Excel, version 2000).

RESULTS

The overall results for the population as a whole show that the eight subscales of the EDI improved significantly with treatment (<0.001). The subscales with the largest numerical improvements were drive for thinness, ineffectiveness and interoceptive awareness. When divided on the basis of diagnosis, the mean feelings of perfectionism score of the bulimic patients was less than that of the control female college sample; the symptoms of bulimia in the anorexic patients were similar to those found in the control group. The fact that the mean follow-up scores for a number of the ED1 subscales remained similar to those recorded at the time of discharge suggests that some of the improvements in symptoms remained for at least six months.

CONCLUSIONS

The results of our study show that multidimensional residential treatment leads to statistically significant changes in the severity of the symptoms manifested by females with eating disorders.

A new century approach for alcohol screen in the insurance industry

Several recent studies point to the value of using combinations of biochemical markers for the identification of alcohol abuse. The Early Detection of Alcohol Consumption (EDAC) test uses a statistical method that combines the results of several routine laboratory tests to form a metabolic fingerprint for each subject. In this study, we evaluated the use of the EDAC test as a screening tool to assess heavy drinking in insurance applicants. The EDAC was calculated by linear discriminate function analysis using the results of 14 routine tests including liver enzymes, lipids, proteins, and blood sugars. We collected and analyzed 1680 random samples at Heritage Laboratories (Olathe, Kan). Alcohol Detection Services (Brookfield, Wis) and Millennium Strategies (Madison, Wis) collaborated in the data analysis and interpretation of laboratory tests results. Ninety-three percent of applicants showed a negative EDAC test. The 7% (n = 134) who screened positive for the EDAC test were then reflexed to carbohydrate deficient transferin (CDT) and whole blood associated acetaldehyde (WBAA). Sixteen percent (22/134) showed a positive confirmatory test. Among these 16% of subjects, 41% (9/22) showed no elevations in liver enzymes or HDL-C results. Four of these subjects were among the top one third with the highest elevations for the CDT test in the entire group and one of them was positive for both the CDT and WBAA tests. These results suggest that the EDAC screen may provide an efficient alternative screening tool for the identification of heavy alcohol consumption not HBA as it identifies applicants with both normal or abnormal liver enzymes and HDL-C.

The combined use of the early detection of alcohol consumption (EDAC) test and carbohydrate-deficient transferrin to identify heavy drinking behaviour in males

The aim of this study was to determine the efficacy of the combined use of carbohydrate-deficient transferrin (CDT) and the Early Detection of Alcohol Consumption (EDAC) test to assess heavy drinking in a population of males (n = 187) drinking an average of 20 drinks per day. Heavy drinkers (n = 138) and light drinkers (n = 49) were analysed in three ways: using the EDAC test alone, using the CDT test alone and using the EDAC and CDT tests combined. The EDAC method uses linear discriminant function to analyse a battery of routine laboratory tests that generate a score for each subject and its associated probability value. This translates into the likelihood of each individual being a heavy or a light drinker. CDT uses ion-exchange chromatography to extract CDT in the serum and quantifies it by radioimmunoassay. The EDAC alone showed 88% (122/138) sensitivity rate when identifying heavy drinking males and 98% (48/49) specificity rate when assessing light drinkers. The CDT test alone showed a sensitivity rate of 58% (80/138) and a corresponding specificity rate of 96% (47/49). When analysed in parallel, 92% (127/138) of heavy drinkers showed abnormal EDAC and/or CDT tests and 94% (46/49) of light drinkers were negative for both tests. When analysed sequentially, the CDT test confirmed 61% (75/122) of the heavy drinkers identified by the EDAC test. Specificity rate for this testing strategy was 100%, because the only false positives for EDAC tested negative for CDT. This preliminary study shows that EDAC and CDT may react independently to alcohol intake and can be combined for maximum diagnostic accuracy.

The early detection of alcohol consumption (EDAC) score in the identification of Heavy and at-risk drinkers from routine blood tests

The objective of this study was to use the EDAC score to detect heavy and at-risk drinking in young adults (mean age = 25 years) and compare the results to self-reports. The EDAC score is a linear discriminant function (LDF) derived from the analysis of a combination of up to 35 blood chemistry and hematology analytes ordered routinely in clinical settings. Subjects (N = 150) were recruited from medical care facilities at the University of Missouri, Columbia. Blood samples, obtained from males (N = 66) and females (N = 84), were sent to LabCorp (Burlington, NC) for analysis. The blood chemistry panels were evaluated using a Linear Discriminant Function method available through SPSS software to predict whether each individual was a Heavy Drinker or an At-Risk Drinker. Heavy Drinkers consumed on average > or = 4 drinks daily for males and > or = 3 drinks daily for females. At-Risk Drinkers consumed at least 14 drinks per week or drank more than 4 drinks on any occasion in the last 14 days if male and consumed at least 7 drinks per week or more than 3 drinks on any occasion if female. Not-Heavy Drinkers and Not-At-Risk Drinkers consumed less than the amounts above. The results showed 8/10 (80%) males and 2/2 women identified as Heavy Drinkers by both the EDAC score (prior probability Not-Heavy vs. Heavy Drinker = 0.5:0.5) and self-report. Fifty of 56 (89%) males and 65/82 (79%) of females were identified as Not-Heavy Drinkers by both EDAC score and self-report. There were 6/54 (11%) males and 15/82 (18%) women with false positive results, of these, 14/21 (67%) met dependence criteria by DSM-IV. The EDAC test showed 30% sensitivity and 96% specificity when identifying At-Risk drinking males and 42% sensitivity and 90% specificity when identifying At-Risk drinking females. In females, the EDAC's sensitivity was higher than any single traditional or new laboratory marker previously reported for diagnosis of alcohol abuse such as GGT, MCV and CDT. As a complement or a substitute to an interview, in subjects who are less candid about their drinking, the EDAC is a useful tool to assess heavy and at-risk alcohol consumption in young adults.

Molecular principles underlying hepatitis C virus diagnosis

Although the rate of new cases of HCV infection has decreased as a result of public health policies related to intravenous drug users, the overall rate of infection in the U.S. is still high. With an estimated 3.9 million people infected nationwide, combined with the observation that, for over 50% of all cases of HCV infection, a route of infection is unknown, HCV will continue to be a major cause of infectious disease related morbidity and mortality for years to come. The benefit of molecular assays resides in providing for more effective treatment of HCV-infected patients, which will certainly justify the expense.

Human endothelial cells grow poorly on vitronectin: role of PAI-1

The cell adhesive protein vitronectin is a common component of interstitial extracellular matrix and circulates in plasma. It competes effectively with other plasma proteins to adsorb to certain biomaterial surfaces, and is likely to represent an important cell adhesion mediator on the luminal surface of vascular grafts. It is also found associated with certain vascular pathologies. We have shown previously that human endothelial cells grow poorly on a vitronectin surface compared with other extracellular matrix molecules. In this paper we show that endothelial cells seeded on vitronectin and fibronectin produced substantially different profiles of extracellular matrix molecules. The most outstanding difference was in the amount of matrix-localised plasminogen activator-inhibitor-1 which was high on vitronectin and negligible on fibronectin. This was correlated with a small but significant inhibition of cell adhesion to vitronectin compared with fibronectin, and very significant interference with dissociation of cell: extracellular matrix contacts, resulting either from direct inhibition of the proteolytic activity of urokinase, or from interference with urokinase-receptor signaling and consequent focal adhesion turnover. Such interference would inhibit cell proliferation by disabling the cells from loosening their matrix contacts in order to proceed through mitosis. This would seriously compromise endothelial recovery in cases of damage to the vascular wall and placement of stents or grafts, where the presence of surface-adsorbed vitronectin is likely to modulate the tissue response.

Point mutation detection technology for the new-century laboratory

The READIT system represents the newest contribution to point mutation detection technology. Specifically, the system involves hybridizing DNA or RNA probes using phosphorylation chemistry and luciferase as the detection method. The two primary features that distinguish the READIT technology from the competition are its versatility and the ability of users to design its own probes. The automated genotype assignment and statistical analysis simplify the use of this system even more. In the year 2002 more than a million tests will be performed in molecular diagnostics with significant contributions from both research and private laboratories.(1) The most important attributes for laboratorians when reviewing a new technology are cost, accuracy, automation, and ease of use. The advent of unique point mutation detection technologies will certainly assist the role of the laboratory in demonstrating the positive impact of testing on future applications of these technologies. Cost savings, accuracy, simplicity, and flexible throughput are the must-have features of successful point mutation detection technologies for the new-century laboratory.

Update on HIV patient management: latest trends in laboratory testing, immune cell reconstitution, and vaccine development

HIV patient management requires the close interaction of clinicians and laboratorians to integrate the results obtained by emerging methodologies. Evaluation of drug susceptibility to screen for specific mutations in the HIV genome can avoid needless treatment with ineffective drugs, maximizing the benefits of costly triple-drug therapy. In addition, providing a scientific basis for the effective use of genotyping and therapeutic drug monitoring is a valuable role that laboratorians can play in optimizing patient care. The clinical utility of HIV genotyping has been defined more clearly during the last year, and pharmacokinetic profiles of the antiretrovirals are beginning to emerge in the clinical laboratory as a tool to periodically assess adherence to and efficacy of the drug regimens. However, much more work is required in this area. Switching to simpler regimens is perceived as a means to improve medication adherence, manage drug toxicity, and reduce the potential for interaction among different drugs. HIV affects the function of both cytotoxic T-cells and neutralizing antibodies. The ability to identify and quantify HIV-specific immunity may allow us to target and expand specific deficient cell clones as a means of correcting immune deficiencies and strengthening the effects of drug therapy. One such example is IL-2, shown to increase CD4 cell counts at various stages of HIV disease. Additional studies of IL-2 therapy and newer immune modulators are ongoing. Combination vaccines are being tested as a worthwhile approach to optimize induction of both CTLs and antibodies. The role of the laboratory to determine the potency of HIV vaccine candidates awaits further developments evaluating the relative importance of neutralizing and mucosal antibodies versus CTL responses and the degree of immunogenicity needed to contain the spread of infection. The Center for Disease Control and Prevention aims to reduce new HIV infections by 50% per year in the next five years, and this goal is to be achieved through selected strategies put together by the plethora of experts in this arena. The aim of this article is to update the reader on the latest trends in HIV patient management and motivate collaborations to assist in the prompt implementation of improved medical care.

Identification of heavy drinkers by using the early detection of alcohol consumption score

BACKGROUND

The objective of this study was to evaluate the use of routine blood chemistry and hematology tests to detect heavy drinkers among ambulatory subjects. Heavy drinkers were defined as subjects who consumed an average of four or more standard drinks per day if male and an average of three or more standard drinks per day if female, for at least 1 month before sample collection (1 standard drink = 15 ml of absolute ethanol).

METHODS

A routine blood chemistry panel and the demographic factors of age, sex, and ethnicity were evaluated by using linear discriminant function (LDF) analysis to classify subjects as heavy drinkers or light drinkers. The classification was validated by comparison with drinking patterns established by standardized questionnaire and interview. Subjects (n = 807) were males and females with known drinking patterns recruited from 25 centers that included detoxification and rehabilitation institutions, churches, and community groups in the Milwaukee and Boston areas.

RESULTS

With LDF, 88% of the heavy drinkers and 92% of the light drinkers were correctly identified by the Early Detection of Alcohol Consumption test. The LDF performed the best when used to identify heavy drinking in ages 40 and above, a group that showed 84% (120 of 143) sensitivity at 97% (152 of 157) specificity. Performance in females showed 73% (76 of 104) sensitivity at 94% (129 of 137) specificity, rates higher than obtained with any single biochemical marker previously examined. Receiver operating characteristic plot analysis showed areas under the curve of 0.94 for females and 0.95 for males (p < 0.0001).

CONCLUSIONS

The Early Detection of Alcohol Consumption score is a practical laboratory screen for detecting heavy drinking based on blood constituents ordered routinely in clinical settings.

Innovative technologies for the diagnosis of alcohol abuse and monitoring abstinence

This article summarizes the proceedings of a workshop presented at the 2000 RSA Meeting in Denver, Colorado. The aim of this workshop was to discuss the basic methodologies, diagnostic performance, and clinical utility of three technologies: carbohydrate-deficient transferrin, the "Early Detection of Alcohol Consumption" score, and whole blood associated acetaldehyde. Each method adopts a different strategy to identify heavy alcohol consumption and offers a unique approach to determine alcohol abstinence and relapses. Appropriate application of these technologies can lead to early intervention for alcohol problems before significant tissue damage occurs. To date these methodologies have yet to be formally contrasted and compared. Sensitivity, specificity, predictive value, availability, ease of use, and interpretation of tests results are important aspects to consider when selecting the most appropriate and cost-effective system. Critical evaluation of these methodologies can enable research and clinical laboratories to choose the system that best meets their particular needs in terms of assay feasibility, budget, and goals.

Specific affinity depletion of cell adhesion molecules and growth factors from serum

Serum is a common component of most in vitro cell culture media, particularly of primary cells. Studies of cellular responses to particular adhesion molecules or growth factors are often confounded by the presence of these molecules in the serum supplement. We describe a combined affinity protocol for removing vitronectin and fibronectin from serum. This protocol can also be used to purify these molecules. We also describe the removal of growth-promoting elements using heparin-Sepharose. As vitronectin and fibronectin each bind to heparin, these molecules are removed first and the heparin-Sepharose depletion occurs last in the sequence. This protocol provides a detailed step-by-step guide to achieve quantitative depletion of serum in an optimised format, with additional information on pitfalls and problems. It should be of use to people who wish to accurately determine the relationship between cells, extracellular matrix molecules and growth factors.

Self-functioning traits affecting meal compliance in eating disorder patients

The objective of this study was to measure the extent to which self-functioning traits relate to meal compliance in eating disorder patients by using multiple regression analysis. Compliance was the dependent variable. It was recorded on a meal flowsheet during breakfast, lunch and dinner and compiled for the 8 days immediately preceding each patient's discharge. The independent variables were gender, self-esteem (Rosenberg Scale) and 7 subscales of the Eating Disorder Inventory (EDI-2): drive for thinness, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness and maturity fears. A random sample of 30 subjects who completed the above instruments before May 1999 were included in the study. The results suggest that close to 50% of their meal compliance can be explained by variations in four explanatory variables: gender, ineffectiveness, interoceptive awareness and distrust. The adjusted r2 was 0.497 and the significance of the equation, measured by the p-value, was p = 0.0002. We conclude that multiple regression analysis is a valuable tool to identify patients' traits with the strongest effect in meal compliance.

A physician's primer to antiretroviral drug resistance testing

Evaluating the genetic composition of HIV has evolved from a traditional epidemiologic research tool into a widely used clinical asset in the management of HIV infection. Genotypic and phenotypic testing is designed to identify drugs less likely to be therapeutically effective. Genotypic assays identify specific "gene mutations" or nucleotide substitutions known to confer drug resistance, whereas phenotypic assays measure the amount of drug necessary to inhibit viral replication in vitro. Prospective studies of antiretroviral drug resistance testing have shown its value as an independent predictor of optimal virologic response to drug therapy. Current guidelines recommend use of these tests following treatment failure and during pregnancy; considerations for testing include primary infection and treatment-naive patients. The identification of drug resistance can help the clinician individualize treatment regimens to attain maximal viral suppression and patient longevity.

Comparative evaluation of three human immunodeficiency virus genotyping systems: the HIV-GenotypR method, the HIV PRT GeneChip assay, and the HIV-1 RT line probe assay

Evaluation of drug resistance by human immunodeficiency virus (HIV) genotyping has proven to be useful for the selection of drug combinations with maximum antiretroviral activity. We compared three genotyping methods for identification of mutations known to confer drug resistance in the reverse transcriptase (RT) and protease genes of HIV type 1 (HIV-1). The HIV-GenotypR method (GenotypR; Specialty Laboratories, Inc., Santa Monica, Calif.) with the ABI 377 DNA sequencer (Applied Biosystems Inc.), the HIV PRT GeneChip assay (GeneChip; Affymetrix, Santa Clara, Calif.), and the HIV-1 RT Line Probe Assay (LiPA; Innogenetics, Alpharetta, Ga.) were used to genotype plasma samples from HIV-infected patients attending the University of Wisconsin Hospitals and Clinics and the Mayo Clinic. At the time of analysis, patients were failing combination therapy (n = 18) or were treatment naive (n = 6). Forty codons of the RT and protease genes were analyzed by GenotypR and GeneChip for resistance-associated mutations. LiPA analyzed seven RT codons for mutations. Each sample was genotyped by all three assays, and each assay was subjected to pairwise comparisons. At least 92% of the codons tested (by the three assays) in paired comparisons were concordant. GenotypR and GeneChip demonstrated 96.6% concordance over the 40 codons tested. GenotypR identified slightly more mutations than GeneChip and LiPA; GeneChip identified all primary mutations that corresponded to failing treatment regimens. Each assay identified at least 84% of the mutations identified by the other assays. Mutations that were discordant between the assays mainly comprised secondary mutations and natural polymorphisms. The assays had better concordance for mutations that corresponded to current failing regimens, present in the more predominant viral quasispecies. In the treatment-naive patients, GenotypR, GeneChip, and LiPA mainly identified wild-type virus. Only the LiPA identified K70R, a possible transmitted zidovudine resistance mutation, in the RT gene of a treatment-naive patient. We conclude that although discrepancies in results exist between assays, each assay showed a similar capacity to identify potentially clinically relevant mutations related to patient treatment regimens.

Therapeutic drug monitoring of antiretroviral agents

HIV+ patients fail antiretroviral therapy due to inadequate drug concentrations reaching the site of viral replication and/or the development of viral resistance to the antiretroviral agents. Adequate drug concentrations may not be reaching the virus due to poor compliance, poor absorption, or other pharmacokinetic factors such as metabolism, elimination, and drug interactions. The most important and most common pharmacokinetic drug interactions involve inhibition of metabolism, induction of metabolism, altered drug absorption, inhibition of renal excretion, and displacement from plasma protein binding sites. If a patient is failing antiretroviral therapy, TDM of antiretroviral agents could help in determining both adequacy of drug concentrations and patients' adherence. Ongoing studies will determine whether total drug concentration or free drug concentration of the protease inhibitors is the best predictor of response. Trough concentrations could prove to be the most important predictor of response, but additional studies are needed to compare trough, peak, and AUC concentrations with response to treatment. Finally, if some patients fail therapy due to inadequate drug concentrations, then increasing the dose could benefit patients' outcome and increase longevity. Clinical trials are needed that compare patients who receive a fixed-dosage regimen with patients who have adjusted dose regimens. Such a study is the best way to determine the true value of TDM of the antiretrovirals.

Drug courts and drug treatment

This paper examines the way in which American Drug Courts operate, and the changes required were they to be introduced into the UK.

Semi-automated carbohydrate-deficient transferrin in primary biliary cirrhosis: a pilot study

Primary biliary cirrhosis (PBC) is one of the few non-alcohol induced liver pathologies which causes false positive results in the evaluation of carbohydrate-deficient transferrin (CDT) for the diagnosis of alcohol misuse. This phenomenon has only been observed when using the CDTect assay (Pharmacia & Upjohn, Uppsala, Sweden). In this study, we evaluated CDT in female PBC patients (n = 14) by a new CDT procedure, the %CDT turbidimetric immunoassay (TIA, Axis Biochemicals, Oslo, Norway) using the isoelectric focusing/immunoblotting/laser densitometry (IEF/IB/LD, Specialty Laboratories, Santa Monica, CA, USA) procedure as the gold standard. One of the PBC patients tested CDT+ by IEF/IB/LD (cut-off >9 densitometry units, DU) and %CDT TIA (cut off >6%); one patient tested at the cut-off point of the IEF/IB/LD and another one tested at the cut-off point of the %CDT TIA. Thus, unlike CDTect, the %CDT TIA is a procedure that produces few false positives in PBC.

Inhibition of endothelial cell adhesion and proliferation by extracellular matrix from vascular smooth muscle cells: role of type V collagen

Endothelial cells recovering from damage due to disease or surgical procedures come into close contact with extracellular matrix (ECM) secreted by intimal vascular smooth muscle cells (VSMCs). We have investigated these relationships using human umbilical artery endothelial cells (HUAECs) and human mammary artery VSMC in vitro. HUAEC adhesion and proliferation were significantly lower on ECM secreted by VSMC compared with HUAEC ECM or surface-coated fibronectin. Characterisation of the ECM of both cell types with monoclonal antibodies showed that the ECM secreted by VSMC contained significantly more elastin, chondroitin sulphate and collagen types I, III and V than that from HUAECs. HUAECs adhered poorly to collagen type V coated on plastic and not at all to elastin. When these proteins were co-coated with fibronectin, elastin did not inhibit migration or proliferation compared to the response on fibronectin but collagen type V significantly inhibited both. Treatment of VSMC ECM with enzymes which selectively depleted the matrix of collagen types I, III and IV, or chondroitin sulphate, had no effect on HUAEC responses to the ECM, suggesting that these molecules did not contribute to the inhibition of HUAECs. Treatment of VSMC ECM with a mixture of collagenases, selectively depleted the matrix of collagen type V, as well as types I, III and IV. Such depleted ECMs supported increased proliferation of HUAECs compared to buffer controls. Overall these results suggest that collagen V secreted into the ECM of VSMC may inhibit the recovery of adjacent endothelium.

The effectiveness of a volunteer appropriate adult scheme

This paper discusses the first evaluation to be undertaken of a volunteer Appropriate Adult scheme for mentally vulnerable adults. Southampton MIND was granted funding by the Mental Health Foundation to implement a volunteer Appropriate Adult scheme which began in April 1994 and lasted for two years. The Mental Health Foundation required an evaluation from an independent organization, the implications of which are examined here against the background of previous research conducted by the authors on the use of Appropriate Adult protection for mentally vulnerable adults in the police station. We show that a basic Appropriate Adult training programme has been devised and that there are people willing to take on this training and the onerous role for which it prepares them.