THE MOLECULAR COMPONENTS OF HUMAN TRANSFERRIN TYPE C

Immunologically pure human transferrin type C (TfC) was isolated from the plasmas of 11 individual healthy donors. After conversion into the 2Fe-form, the preparations were analysed by polyacrylamide gel electrophoresis and chromatography on DEAE-cellulose. In all samples studied by either method the presence of three components, designated A, B and C, was observed. Calculations from eight chromatograms yielded the following relative proportions for the components: A:6%, B:62% and C:32%. The quantity of iron bound played no role in this chromatographic resolution. The components were immunologically identical but their sialic acid content increased in the order of A<B<C. The presence of galactose as an ultimate residue of the oligosaccharide chains in TfC component A was confirmed by a biological test. This observation, together with the results of earlier analyses for hexose, hexosamine and galactose in the subfractions from Behringwerke human transferrin, suggests that sialic acid is probably the only variable among TfC components A, B and C. Loss of sialic acid from component C during the isolation of TfC was excluded as an explanation for the presence of the other two components. The electrophoretic appearance of TfC samples from five patients with liver disease (chronic active hepatitis, cirrhosis or alcoholic liver) did not noticeably differ from that of TfC from healthy persons. Baboon transferrin resembles TfC with respect to sialic acid heterogeneity. This species was therefore studied to decide whether sialic acid is gradually lost from transferrin in the circulation or whether transferrin is not fully sialylated before discharge from the hepatocyte. Using DEAE-cellulose chromatography no difference was found between baboon transferrin molecules which were less than 6h old and those which had a mean age of 8.9 days. By inference it is suggested that the reason for the multiplicity of TfC is also likely to be biosynthetic.     

Cyclosporin A disposition following acute traumatic brain injury

Although the precise mechanism of action remains to be defined, Cyclosporin A (CsA) has demonstrated potential for neuroprotection in animal models. Predictive dosing strategies for CsA in acute traumatic brain injured (TBI) patients must account for the influence of the acute phase response on drug disposition. To characterize CsA pharmacokinetic parameters early following acute TBI, serial blood samples from patients enrolled into a Phase II dose-escalation trial were analyzed. Within eight hours of injury, thirty patients admitted with acute severe TBI were prospectively randomized into three cohorts (n = 8 CsA; n = 2 placebo per cohort) in this dose-escalation trial. Patients received one of three doses (I = 0.625 mg/kg/dose; II = 1.25 mg/kg/dose; III = 2.5 mg/kg/dose) or placebo intravenously every 12 h for 72 h. Serial blood collection began prior to dose 1 and continued for 72 h following the completion of six doses. Whole blood concentrations were determined by high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection. Pharmacokinetic parameters were determined for each patient by fitting the concentration-time profile to a two-compartmental model with first order elimination. Mean area under the curve and predicted maximal blood concentration increased with each dosing cohort (I = 9840 h*microg/L, 398 microg/L; II = 18300 h*microg/L, 645 microg/L; III = 32500 h*microg/L, 1300 microg/L). Whole blood clearance, steady state volume of distribution, and beta half-life were independent of dose and higher than published reports from other populations: 0.420 L/h/kg, 5.91 L/kg, and 17.3 h, respectively. These data show patients with acute severe TBI demonstrate a more rapid clearance and a larger distribution volume of CsA. Pharmacokinetic parameters derived from this study will guide dosing strategies for future prospective clinical trials evaluating CsA therapy following acute TBI.     

Systemic metabolic effects of combined insulin-like growth factor-I and growth hormone therapy in patients who have sustained acute traumatic brain injury

OBJECT: Hypermetabolism, hypercatabolism, refractory nitrogen wasting, hyperglycemia, and immunosuppression accompany traumatic brain injury (TBI). Pituitary dysfunction occurs, affecting growth hormone (GH) and plasma insulin-like growth factor-I (IGF-I) concentrations. The authors evaluated whether combination IGF-I/GH therapy improved metabolic and nutritional parameters after moderate to severe TBI. METHODS: The authors conducted a prospective, randomized, double-blind study comparing combination IGF-I/GH therapy and a placebo treatment. Ninety-seven patients with TBI were enrolled in the study within 72 hours of injury and were assigned to receive either combination IGF-I/GH therapy or placebo. All patients received concomitant nutritional support. Insulin-like growth factor-I was administered by continuous intravenous infusion (0.01 mg/kg/hr), and GH (0.05 mg/kg/day) was administered subcutaneously. Placebo control group patients received normal saline solution in place of both agents. Nutritional and metabolic monitoring continued throughout the 14-day treatment period. The two groups did not differ in energy expenditure, nutrient intake, or use of insulin treatment. The mean daily serum glucose concentration was higher in the treatment group (123 +/- 24 mg/dl) than in the control group (104 +/- 11 mg/dl) (p < 0.03). A positive nitrogen balance was achieved within the first 24 hours in the treatment group and remained positive in that group throughout the treatment period (p < 0.05). This pattern was not observed in the control group. Plasma IGF-I concentrations were above 350 ng/ml in the treatment group throughout the study period. Overall, the mean plasma IGF-I concentrations were 1003 +/- 480.6 ng/ml in the treatment group and 192 +/- 46.2 ng/ml in the control group (p < 0.01). CONCLUSIONS: The combination of IGF-I and GH produced sustained improvement in metabolic and nutritional endpoints after moderate to severe acute TBI.     

A less empirical method of representing megavoltage beams for use in rapid radiotherapy dose calculations.

A large number of initial measurements are needed for accurate computation of radiotherapy dose distributions directly from stored data on the dose distribution of single radiation beams. Because of this, interest has been shown in alternative methods which use empirical formulae to represent the dose distributions of single beams. These can be easier to implement but are less directly related to measured quantities and may be of limited validity. A method of representing radiotherapy beams is proposed which closely approximates their radiation physics, in order to calculate the dose at any point by a simple algorithm directly from a small number of initial dose measurements. The method is of wide validity, probably including all megavoltage radiations for which Compton scattering is the dominant interaction in tissue. The accuracy of the method is demonstrated by application to an 8 MV linear accelerator and a cobalt 60 machine.     

Immunoreactive glial fibrillary acidic protein in pituicytes of the rat neurohypophysis

The glial fibrillary acidic protein (GFAP) has been associated with glial filaments. Electron microscopic examination of rat pituicytes in our laboratory has revealed few of these 8–9 nm filaments that are present in other astrocytes. Since the literature is inconsistent on the existence of filaments in pituicytes, we investigated the content of GFAP in these cells. Immunocytochemical methods revealed a strong positivity for GFAP in pituicytes. Furthermore, the primary antiserum dilution required for optimal staining suggests that there may be more GFAP in pituicytes than in other glial elements. The significance of immunoreactive GFAP in pituicytes is discussed in terms of possible functions and embryonic origins.     

Neuronal/glial plasticity in the supraoptic dendritic zone: Dendritic bundling and double synapse formation at parturition

The magnocellular neurosecretory cells of the supraoptic nucleus increase production and release of oxytocin and/or vasopressin under such conditions as parturition, lactation and dehydration. These stimuli have been shown to result in increased direct apposition of neuronal membranes and the formation of double synapses (one presynaptic terminal contacting two postsynaptic elements) within the supraoptic nucleus at the level of the cell bodies. These morphological changes are due to the retraction of the thin glial processes which are normally interposed between adjacent neurons. The present study was undertaken to ascertain whether, and to what extent, neuronal/glial plasticity occurs in the dendritic zone (i.e. the ventral glial laminar area) of the supraoptic nucleus. The instances of two or more dendrites with membrane in direct apposition (dendritic bundles), the number of dendrites per bundle, the amount of dendritic membrane in direct apposition and the percentage of dendrites contacted by double synapses were quantified at the ultrastructural level in virgin female, prepartum (21 days of gestation), postpartum (day of parturition) and lactating rats. All parameters measured varied significantly with the hormone demand states created by pregnancy and lactation, apparently due to glial retraction. Moreover, in the 2–24 h period between pre- and postpartum there was a significant increase in the number of dendrites per bundle, dendritic membrane in direct apposition and the percentage of dendrites contacted by double synapses. This time course corresponds to the known increased release of oxytocin and vasopressin at parturition.These findings constitute the first demonstration that dendritic bundles and double synapses occur in the ventral glial lamina/dendritic zone of the supraoptic nucleus and vary under the physiological conditions of pregnancy, parturition and lactation.     

Evaluation of drug interaction software to identify alerts for transplant medications

BACKGROUND: The ability of computerized physician order entry (CPOE) systems to identify clinically significant drug interactions is dependent upon the integrity of the drug information populating the software. A CPOE system with incomplete or inaccurate drug information will fail to identify clinically important drug interactions and, therefore, fail to reduce preventable adverse drug events (pADEs). OBJECTIVE: To evaluate, from the prescribers' perspective, the ability of a common drug interaction database to identify clinically important drug interactions involving drugs used in transplantation. METHODS: The clinical significance of drug interactions involving 5 transplant drugs was evaluated by an expert panel to determine whether alerts should be generated for physicians not involved in the transplant at the time of order entry. Drug interactions included in the analysis were generated from the expert panel, a common drug interaction database, and 2 standard drug interaction references. Responses on the clinical significance were used to calculate the sensitivity, specificity, and positive and negative predictive values for each severity setting of a common electronic drug interaction database. RESULTS: Overall, the database failed to identify approximately 70% of interactions considered significant by the expert panel. Of the alerts that were generated, >85% were considered clinically significant. The database was most deficient in identifying interactions resulting from additive toxicity. CONCLUSIONS: To expect a decrease in pADEs caused by drug interactions, the information used to populate CPOE systems must be validated. Establishing consistency and integrity of this information may be a future role for pharmacists.