Biomedical subjects

Chris Gennings

Publications and source records attributed to Chris Gennings.

At least 19 recordsLinked to original sources

PubMed2006

Analysis of the interaction of phytoestrogens and synthetic chemicals: an in vitro/in vivo comparison.

In the evaluation of chemical mixture toxicity, it is desirable to develop an evaluation paradigm which incorporates some critical attributes of real world exposures, particularly low dose levels, larger numbers of chemicals, and chemicals from synthetic and natural sources. This study evaluated the impact of low level exposure to a mixture of six synthetic chemicals (SC) under conditions of co-exposure to various levels of plant-derived phytoestrogen (PE) compounds. Estrogenic activity was evaluated using an in vitro human estrogen receptor (ER) transcriptional activation assay and an in vivo immature rat uterotrophic assay. Initially, dose-response curves were characterized for each of the six SCs (methoxyclor, o,p-DDT, octylphenol, bisphenol A, beta-hexachlorocyclohexane, 2,3-bis(4-hydroxyphenyl)-propionitrile) in each of the assays. The six SCs were then combined at equipotent ratios and tested at 5-6 dose levels spanning from very low, sub-threshold levels, to a dose in which every chemical in the mixture was at its individual estrogenic response threshold. The SC mixtures also were tested in the absence or presence of 5-6 different levels of PEs, for a total of 36 (in vitro) or 25 (in vivo) treatment groups. Both in vitro and in vivo, low concentrations of the SC mixture failed to increase estrogenic responses relative to those induced by PEs alone. However, significant increases in response occurred when each chemical in the SC mixture was near or above its individual response threshold. In vitro, interactions between high-doses of SCs and PEs were greater than additive, whereas mixtures of SCs in the absence of PEs interacted in a less than additive fashion. In vivo, the SC and PE mixture responses were consistent with additivity. These data illustrate a novel approach for incorporating key attributes of real world exposures in chemical mixture toxicity assessments, and suggest that chemical mixture toxicity is likely to be of concern only when the mixture components are near or above their individual response thresholds. However, these data suggest that extrapolation from in vitro assays to in vivo mixture effects should be approached with caution.

Animals↗

PubMed2006

Neurotoxicological interactions of a five-pesticide mixture in preweanling rats.

The estimation of risk following exposure to mixtures is an important feature of pesticide risk assessment. Also of concern is the potential for increased sensitivity of the young to pesticide toxicity. We have conducted interaction studies using a mixture of five organophosphorus (OP) pesticides (chlorpyrifos, diazinon, dimethoate, acephate, and malathion) in both adult (published previously) and preweanling rats using a fixed-ratio ray design. In the present study, cholinesterase inhibition and behavioral changes (motor activity, gait, and tail-pinch response) were measured in 17-day-old Long-Evans male rats following acute exposure to the OPs. The ratio of pesticides in the mixture reflected the relative dietary exposure estimates projected by the U.S. Environmental Protection Agency Dietary Exposure Evaluation Model. Dose-response data were collected for each OP alone, which were used (alone or in conjunction with the mixture data) to build an additivity model to predict the effects of the pesticide mixture along a ray of increasing total doses, using the same fixed ratio of components. The mixture data (full ray) were similarly modeled and statistically compared to the additivity model along the ray. Since malathion has been shown to produce synergistic interactions with certain OPs, it was of interest to evaluate the influence of malathion in this study. A second pesticide mixture, without malathion (reduced ray), was tested using the same dose levels of the remaining four OPs. Analysis of the full ray revealed significant greater-than-additive responses for all endpoints. The magnitude of this shift ranged from two- to threefold for estimates of the ED(20) and ED(50). The deviation from additivity was also detected in the reduced ray for all but two endpoints (motor activity and tail-pinch response); however, for all endpoints, the reduced ray was significantly different from the full ray. Thus, greater-than-additive responses were detected in preweanling rats with this OP mixture, and this effect can only partially be attributed to the malathion in the mixture.

Animals↗

PubMed2006

Testing for additivity at select mixture groups of interest based on statistical equivalence testing methods.

Several assumptions, defined and undefined, are used in the toxicity assessment of chemical mixtures. In scientific practice mixture components in the low-dose region, particularly subthreshold doses, are often assumed to behave additively (i.e., zero interaction) based on heuristic arguments. This assumption has important implications in the practice of risk assessment, but has not been experimentally tested. We have developed methodology to test for additivity in the sense of Berenbaum (Advances in Cancer Research, 1981), based on the statistical equivalence testing literature where the null hypothesis of interaction is rejected for the alternative hypothesis of additivity when data support the claim. The implication of this approach is that conclusions of additivity are made with a false positive rate controlled by the experimenter. The claim of additivity is based on prespecified additivity margins, which are chosen using expert biological judgment such that small deviations from additivity, which are not considered to be biologically important, are not statistically significant. This approach is in contrast to the usual hypothesis-testing framework that assumes additivity in the null hypothesis and rejects when there is significant evidence of interaction. In this scenario, failure to reject may be due to lack of statistical power making the claim of additivity problematic. The proposed method is illustrated in a mixture of five organophosphorus pesticides that were experimentally evaluated alone and at relevant mixing ratios. Motor activity was assessed in adult male rats following acute exposure. Four low-dose mixture groups were evaluated. Evidence of additivity is found in three of the four low-dose mixture groups. The proposed method tests for additivity of the whole mixture and does not take into account subset interactions (e.g., synergistic, antagonistic) that may have occurred and cancelled each other out.

Animals↗

PubMed2005

Synergistic affective analgesic interaction between delta-9-tetrahydrocannabinol and morphine.

Evidence for an analgesic interaction between delta-9-tetrahydrocannabinol (Delta(9)-THC) and morphine was sought using an experimental pain model applied to normal volunteers. The study incorporated a double blinded, four treatment, four period, four sequence, crossover design. Subjects received Delta(9)-THC 5 mg orally or placebo and 90 min later morphine 0.02 mg/kg intravenously or placebo. Fifteen minutes later subjects rated the pain associated with the application of thermal stimuli to skin using two visual analog scales, one for the sensory and one for the affective aspects of pain. Among sensory responses, neither morphine nor Delta(9)-THC had a significant effect at the doses used, and there was no significant interaction between the two. Among affective responses, although neither morphine nor Delta(9)-THC had a significant effect, there was a positive analgesic interaction between the two (p = 0.012), indicating that the combination had a synergistic affective analgesic effect. The surprisingly limited reported experimental experience in humans does not support a role for Delta(9)-THC as an analgesic or as an adjunct to cannabinoid analgesia, except for our finding of synergy limited to the affective component of pain. Comparison of our results with those of others suggests that extrapolation from experimental pain models to the clinic is not likely to be a straight-forward process. Future studies of Delta(9)-THC or other cannabinoids in combination with opiates should focus upon clinical rather than experimental pain.

Adolescent↗

PubMed2005

Thermoregulatory response to an organophosphate and carbamate insecticide mixture: testing the assumption of dose-additivity.

Most toxicity data are based on studies using single compounds. This study assessed if there is an interaction between mixtures of the anticholinesterase insecticides chlorpyrifos (CHP) and carbaryl (CAR) using hypothermia and cholinesterase (ChE) inhibition as toxicological endpoints. Core temperature (T(c)) was continuously monitored by radiotelemetry in adult Long-Evans rats administered CHP at doses ranging from 0 to 50mg/kg and CAR doses of 0-150 mg/kg. The temperature index (TI), an integration of the change in T(c) over a 12h period, was quantified. Effects of mixtures of CHP and CAR in 2:1 and 1:1 ratios on the TI were examined and the data analyzed using a statistical model designed to assess significant departures from additivity for chemical mixtures. CHP and CAR elicited a marked hypothermia and dose-related decrease in the TI. The TI response to a 2:1 ratio of CHP:CAR was significantly less than that predicted by additivity. The TI response to a 1:1 ratio of CHP and CAR was not significantly different from the predicted additivity. Plasma and brain ChE activity were measured 4h after dosing with CHP, CAR, and mixtures in separate groups of rats. There was a dose-additive interaction for the inhibition of brain ChE for the 2:1 ratio, but an antagonistic effect for the 1:1 ratio. The 2:1 and 1:1 mixtures had an antagonistic interaction on plasma ChE. Overall, the departures from additivity for the physiological (i.e., temperature) and biochemical (i.e., ChE inhibition) endpoints for the 2:1 and 1:1 mixtures studies did not coincide as expected. An interaction between CHP and CAR appears to depend on the ratio of compounds in the mixture as well as the biological endpoint.

Administration, Oral↗

PubMed2005

Bloodstream infections due to Candida species in the intensive care unit: identifying especially high-risk patients to determine prevention strategies.

Nosocomial bloodstream infections due to Candida species are associated with a 40% crude (total) mortality rate in the United States. The attributable mortality rate defines the number of deaths due directly to the infection and represents the proportion of the total number of deaths influenced by the use of anti-infectives. We used 4 defined risk factors to create a conditional logistic regression model of individual patients' risk of candidemia and then examined the possibility of using a calculated risk threshold to begin treatment with anti-Candida antibiotics. We subsequently examined the number needed to treat (NNT) to prevent a single death related to bloodstream infection due to Candida species. By use of our model and assuming a 33% threshold for treating with an antibiotic, which is assumed to prevent 65% of candidal bloodstream infections, we show that the NNT would be 7 patients. Use of defined risk factors to select patients who are at high risk for candidemia and treatment with effective antibiotics would be an efficient way to reduce infection-related deaths.

Anti-Infective Agents↗

PubMed2005

D-optimal experimental designs to test for departure from additivity in a fixed-ratio mixture ray.

Traditional factorial designs for evaluating interactions among chemicals in a mixture may be prohibitive when the number of chemicals is large. Using a mixture of chemicals with a fixed ratio (mixture ray) results in an economical design that allows estimation of additivity or nonadditive interaction for a mixture of interest. This methodology is extended easily to a mixture with a large number of chemicals. Optimal experimental conditions can be chosen that result in increased power to detect departures from additivity. Although these designs are used widely for linear models, optimal designs for nonlinear threshold models are less well known. In the present work, the use of D-optimal designs is demonstrated for nonlinear threshold models applied to a fixed-ratio mixture ray. For a fixed sample size, this design criterion selects the experimental doses and number of subjects per dose level that result in minimum variance of the model parameters and thus increased power to detect departures from additivity. An optimal design is illustrated for a 2:1 ratio (chlorpyrifos:carbaryl) mixture experiment. For this example, and in general, the optimal designs for the nonlinear threshold model depend on prior specification of the slope and dose threshold parameters. Use of a D-optimal criterion produces experimental designs with increased power, whereas standard nonoptimal designs with equally spaced dose groups may result in low power if the active range or threshold is missed.

Animals↗

PubMed2005

Analysis of an interaction threshold in a mixture of drugs and/or chemicals.

Increasingly, humans are exposed to drug/chemical mixtures. These exposures can result from therapeutic interventions or environmental sources. Of interest is the interaction that may occur among the components of these mixtures. Since interaction can be dose-dependent, it is important to determine exposure levels to either exploit the benefits of the interaction in a therapeutic application or to avoid the effect of the interaction in the case of an environmental risk assessment. We propose generalized linear models that permit the estimation of interaction threshold boundaries. The methods developed are applied to the combination of ethanol and chloral hydrate.

Animals↗

PubMed2005

Quality of life in refractory ascites: transjugular intrahepatic portal-systemic shunting versus medical therapy.

Uncontrolled studies suggest that transjugular intrahepatic portal-systemic shunting (TIPS) may improve quality of life in patients with refractory ascites. We hypothesized that any improvement of quality of life in patients with TIPS would be matched in controls due to the competing effects of improved ascites and worsened hepatic encephalopathy. Thus, an analysis of quality of life was performed using original data from the North American Study for the Treatment of Refractory Ascites, a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis (LVP) for refractory ascites. Short form 36 (SF-36) surveys were completed at baseline and at 6- and 12-month follow-up. Variables analyzed were: randomization group, number of LVP performed, cumulative volume from LVP, shortness of breath, abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits. Outcomes were changes in physical component scale (PCS) and mental component scale (MCS) of SF-36 results. We constructed multivariable, mixed effects models, including randomization group and baseline MCS and PCS. Changes in PCS and MCS from baseline were similar between the two randomization groups. In multivariate analysis, PCS improvement was associated with lack of confusion, improved ascites, and lack of hospitalizations, but not directly with randomization group. Improvement in MCS was associated with randomization to TIPS and lack of confusion. In conclusion, patients with refractory ascites randomized to TIPS or repeated LVP had similar changes in quality of life. Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups.

Analysis of Variance↗

PubMed2005

The utility of microvascular perfusion assessment in heart failure: a pilot study.

BACKGROUND: The evaluation of heart failure is routinely based on subjective patient symptoms and physician examination. We propose the noninvasive evaluation of microvascular and global perfusion can objectify heart failure severity and provide additional prognostic information. METHODS: A prospective, observational pilot study of patients previously stratified into New York Heart Association (NYHA) heart failure classes and who after a routine cardiology clinic evaluation were felt to be at their stable baseline state. Measurements included: thoracic impedance (Zo), hypothenar tissue hemoglobin oxygen saturation (StO2), and Zo-derived cardiac index (CI). To determine if adverse outcomes (hospitalization or death) occurred, patients or their families were contacted 6 months after enrollment and their charts reviewed. Monitor values between the NYHA classes were compared using analysis of variance. Values of those who later developed adverse outcomes were compared to patients who remained stable using a Student t-test (P < .05 considered significant). A Kaplan-Meier survival curve was used to describe the adverse outcome rate over time, and a Cox's proportional hazards model was used to relate perfusion values to adverse outcomes. RESULTS: There were no differences in CI (P = .08), Zo (P = .38), or StO2 (P = .14) found between NYHA classes (n = 46). After 6 months, 6 patients required hospitalization for heart failure and 1 died. This group had lower StO2 values compared with the stable group (P = .015). The time course of the adverse events was found not to be due to chance alone when evaluated using a Kaplan-Meier curve and the StO2 was significantly associated with time to adverse outcome (P < .05). CONCLUSIONS: Outpatient heart failure patients who later develop adverse outcomes have significantly lower StO2 values than those who remain stable. This suggests cardiac performance in stable heart failure patients may be better reflected at the microvascular level using measures such as StO2 as opposed to a global level using the physical exam or impedance cardiography. StO2 may serve as a predictor for future adverse events and as an adjunct to current evaluation techniques.

Adult↗

PubMed2005

The interaction effects of binary mixtures of benzene and toluene on the developing heart of medaka (Oryzias latipes).

The United States Environmental Protection Agency (USEPA) has pursued the estimation of risk of adverse health effects from exposure to chemical mixtures since the early 1980s. Methods used to calculate risk estimates of mixtures were often based on single chemical information that required assumptions of dose-addition or response-addition and did not consider possible changes in response due to interaction effects among chemicals. Full factorial designs for laboratory studies can produce interactions information, but these are expensive to perform and may not provide the information needed to evaluate specific environmentally relevant mixtures. In this research, groups of Japanese medaka (Oryzias latipes) embryos were exposed to binary mixtures of benzene and toluene as well as to each of these chemicals alone. Endpoint specific dose-response models were built for the hydrocarbon mixture under an assumption of dose-additivity, using the single chemical dose-response information on benzene and toluene. The endpoints included heart rate, heart rate progression, and lethality. Results included a synergistic response for heart rate at 72 h of development, and either additivity or antagonism for all other endpoints at 96 h of development. This work uses an established statistical method to evaluate the toxicity of an environmentally relevant mixture to ascertain whether interaction effects are occurring, thus providing additional information on toxicity.

Animals↗

PubMed2005

Resistance exercise and postprandial lipemia: The dose effect of differing volumes of acute resistance exercise bouts.

INTRODUCTION: Resistance exercise has been shown to reduce postprandial lipemia, but no dose-response effect has been established. PURPOSE: The purpose of this study was to determine whether prior resistance exercise exhibited a dose-response effect on postprandial lipemia, while controlling for energy balance. METHODS: Subjects were healthy resistance-trained men (n = 4) and women (n = 6) aged 23.4 +/- 2.5 years. Subjects participated in 4 different treatment conditions consisting of control (no exercise), 1 set, 3 sets, and 5 sets of 8 resistance exercises in a repeated-measures design. On day 1, each exercise was performed at 75% of the subject's 1-repetition maximum for 10 repetitions. This was followed by consumption of a postexercise meal equal in caloric volume designed to maintain energy balance. On day 2, after a 12-hour overnight fast (approximately 13 hours postexercise) in the General Clinical Research Center, subjects consumed a high-fat meal consisting of 1.7 g fat, 1.65 g carbohydrate, 0.25 g-protein per kilogram of fat-free mass and equal to 95 kJ of energy per kilogram of fat-free mass. Blood collections occurred before meal, and at 0.5, 1, 2, 3, 4, 5, and 6 hours after meal consumption and were analyzed for triacylglycerol (TAG), glucose, and insulin concentrations. The lipemic response was evaluated as the area under curve (AUC) for TAG versus time. Glucose and insulin AUCs were also calculated. RESULTS: No significant differences were observed among treatments for postprandial lipemia (mmol/L per 6 hours) as measured by the TAG AUC (control 2.96 +/- 0.79, 1 set 2.52 +/- 0.60, 3 sets 2.61 +/- 0.59, 5 sets 2.45 +/- 0.58). Similarly, no differences were observed for insulin or glucose AUC or for insulin sensitivity between treatments. There was a sex effect with TAG AUC significantly lower in women for control, 1 set, and 3 sets. Conclusion The results of this investigation suggest no dose-response attenuation of the postprandial lipemic response to a high-fat meal after previous resistance exercise.

Adult↗

PubMed2005

Thyroid-hormone-disrupting chemicals: evidence for dose-dependent additivity or synergism.

Endocrine disruption from environmental contaminants has been linked to a broad spectrum of adverse outcomes. One concern about endocrine-disrupting xenobiotics is the potential for additive or synergistic (i.e., greater-than-additive) effects of mixtures. A short-term dosing model to examine the effects of environmental mixtures on thyroid homeostasis has been developed. Prototypic thyroid-disrupting chemicals (TDCs) such as dioxins, polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers have been shown to alter thyroid hormone homeostasis in this model primarily by up-regulating hepatic catabolism of thyroid hormones via at least two mechanisms. Our present effort tested the hypothesis that a mixture of TDCs will affect serum total thyroxine (T4) concentrations in a dose-additive manner. Young female Long-Evans rats were dosed via gavage with 18 different polyhalogenated aromatic hydrocarbons [2 dioxins, 4 dibenzofurans, and 12 PCBs, including dioxin-like and non-dioxin-like PCBs] for 4 consecutive days. Serum total T4 was measured via radioimmunoassay in samples collected 24 hr after the last dose. Extensive dose-response functions (based on seven to nine doses per chemical) were determined for individual chemicals. A mixture was custom synthesized with the ratio of chemicals based on environmental concentrations. Serial dilutions of this mixture ranged from approximately background levels to 100-fold greater than background human daily intakes. Six serial dilutions of the mixture were tested in the same 4-day assay. Doses of individual chemicals that were associated with a 30% TH decrease from control (ED30), as well as predicted mixture outcomes were calculated using a flexible single-chemical-required method applicable to chemicals with differing dose thresholds and maximum-effect asymptotes. The single-chemical data were modeled without and with the mixture data to determine, respectively, the expected mixture response (the additivity model) and the experimentally observed mixture response (the empirical model). A likelihood-ratio test revealed statistically significant departure from dose additivity. There was no deviation from additivity at the lowest doses of the mixture, but there was a greater-than-additive effect at the three highest mixtures doses. At high doses the additivity model underpredicted the empirical effects by 2- to 3-fold. These are the first results to suggest dose-dependent additivity and synergism in TDCs that may act via different mechanisms in a complex mixture. The results imply that cumulative risk approaches be considered when assessing the risk of exposure to chemical mixtures that contain TDCs.

Animals↗

PubMed2004

Potentiation of cell killing by fractionated radiation and suppression of proliferative recovery in MCF-7 breast tumor cells by the Vitamin D3 analog EB 1089.

A senescence-like growth arrest succeeded by recovery of proliferative capacity was observed in MCF-7 breast tumor cells exposed to fractionated radiation, 5 x 2 Gy. Exposure to EB 1089, an analog of the steroid hormone 1alpha, 25 dihydroxycholecalciferol (1alpha, 25 dihydroxy Vitamin D(3); calcitriol), prior to irradiation promoted cell death and delayed both the development of a senescent phenotype and the recovery of proliferative capacity. EB 1089 also reduced clonogenic survival over and above that produced by fractionated radiation alone and further conferred susceptibility to apoptosis in MCF-7 cells exposed to radiation. In contrast, EB 1089 failed to enhance the response to radiation (or to promote apoptosis) in normal breast epithelial cells or BJ fibroblast cells. EB 1089 treatment and fractionated radiation additively promoted ceramide generation and suppressed expression of polo-like kinase 1. Taken together, these data indicate that EB 1089 (and 1alpha, 25 dihydroxycholecalciferol or its analogs) could selectively enhance breast tumor cell sensitivity to radiation through the promotion of cell death, in part through the generation of ceramide and the suppression of polo-like kinase.

Apoptosis↗

PubMed2004

A novel flexible approach for evaluating fixed ratio mixtures of full and partial agonists.

Assessing for interactions among chemicals in a mixture involves the comparison of actual mixture responses to those predicted under the assumption of zero interaction (additivity), based on individual chemical dose-response data. However, current statistical methods do not adequately account for differences in the shapes of the dose-response curves of the individual mixture components, as occurs with mixtures of full and partial receptor agonists. We present here a novel extension of current methods, which overcomes some of these limitations. Flexible single chemical concentration-effect curves combined with a common background parameter are used to describe an additivity surface along each axis. The predicted mixture response under the assumption of additivity is based on the constraint of Berenbaum's definition of additivity. Iterative algorithms are used to estimate mean responses at observed mixture combinations using only single chemical parameters. A full model allowing for different maximum response levels, different thresholds, and different slope parameters for each mixture component is compared to a reduced model under the assumption of additivity. A likelihood-ratio test is used to test the hypothesis of additivity by utilizing the full and reduced model predictions. This approach is useful for mixtures of chemicals with threshold regions and whose component chemicals exhibit differing response maxima (e.g., mixtures of full and partial agonists). The methods are illustrated with a combination of six chemicals in an estrogen receptor-alpha (ER-alpha) reporter gene assay.

Algorithms↗

PubMed2004

Effects of different macronutrient consumption following a resistance-training session on fat and carbohydrate metabolism.

The effect of consuming meals of different macronutrient content on substrate oxidation following resistance exercise was examined in 9 resistance-trained men (26.2 +/- 2.4 years). Subjects completed 3 resistance exercise bouts of 8 exercises and 1 warm-up set (50% of 10 repetition maximum [RM]), which were followed by 3 sets of 10 repetitions (72.7 +/- 1.9% 10RM), with 60 seconds of rest between sets. Forty-five minutes after exercise, subjects consumed meals of high fat (HF, 37% carbohydrate, 18% protein, and 45% fat), high carbohydrate (HC, 79% carbohydrate, 20% protein, and 1% fat), or water (CON). Fat and carbohydrate oxidation were determined at 15-minute periods after meal consumption for 165 minutes. Blood was collected at preexercise (pre), premeal (0 minutes), and 15, 30, 45, 60, 90, 120, 150, and 180 minutes postmeal and was analyzed for insulin, glucose, triacylglycerols, and glycerol. There were no significant differences among the meal conditions for fat and carbohydrate oxidation. Insulin and glucose concentrations were significantly higher (p < 0.05) following HC at 15, 30, 45, 60, and 90 minutes compared to HF and CON. Triacylglycerol concentrations were significantly higher (p < 0.05) following HF at 90, 120, 150, and 180 minutes compared to HC and CON. Fat and carbohydrate oxidation were not affected by differences in macronutrient meal consumption after an acute bout of resistance training. Different macronutrient consumption does influence insulin, glucose, and triacylglycerol concentrations after resistance exercise.

Adult↗

PubMed2003

Titrating and evaluating multi-drug regimens within subjects.

The dosing of combination therapies is commonly undertaken empirically by practising physicians, and a coherent algorithm to approach the problem of combination dosing is currently lacking. Current methods of evaluating multiple drug combinations in clinical trials fail to provide information regarding the location of more effective doses when the combination is not found to differ from the standard, even though the absence of a difference does not necessarily mean the new combination is ineffective. Moreover, in studies where the new combination is found more effective, often a large proportion of the study participants obtain no benefit from the trial. Even with early stopping rules, the time these subjects spend on inferior treatments can have lasting detrimental effects, leading to problems with patient enrolment and adherence to study protocol. This paper describes an evolutionary operation (EVOP) direct-search procedure to titrate combination doses within individual patients. The Nelder-Mead simplex direct-search algorithm is used to titrate combinations of drugs within individual subjects. Desirability functions are utilized to define the main response of interest and additional responses or constraints. Statistical methodology for determining whether the titrated treatment combination has resulted in an improvement in subject response and for evaluating for therapeutic synergism is developed. Inferences can then be made about the efficacy of the combination or about the individual drugs that comprise the combination. The advantages of this approach include affording every patient the potential to benefit from the combination under study and permitting the consideration of multiple endpoints simultaneously.

Algorithms↗

PubMed2003

Effect of the vitamin D3 analog ILX 23-7553 on apoptosis and sensitivity to fractionated radiation in breast tumor cells and normal human fibroblasts.

PURPOSE: Previous work from this laboratory has demonstrated that the vitamin D(3) analogs EB 1089 and ILX 23-7553 enhance the response of breast tumor cells to ionizing radiation and promote radiation-induced apoptotic cell death. The current studies were designed to more closely simulate clinical radiotherapy in the treatment of breast cancer by examining the utility of ILX 23-7553 as an adjunct to fractionated ionizing radiation. The potential toxicity to normal tissue of the combination of ILX 23-7553 and fractionated radiation was assessed in a model of BJ human fibroblasts in culture. METHODS: MCF-7 cells and human fibroblasts were treated with fractionated radiation alone (5x2 Gy over 3 days), ILX 23-7553 alone (50 n M) or ILX 23-7553 followed by 5x2 Gy. Viable cell numbers were determined by trypan blue exclusion and apoptosis by the TUNEL assay. A statistical model of additivity was utilized to assess the nature of the interaction between ILX 23-7553 and fractionated radiation. RESULTS: Radiation and ILX 23-7553 each alone reduced viable cell numbers by 72+/-3.1% and 62+/-4.8%, respectively. Pretreatment with ILX 23-7553 followed by 5x2 Gy reduced viable cell numbers by 93.2+/-0.7%. The interaction between ILX 23-7553 and fractionated radiation appeared to be additive despite the fact that the combination of ILX 23-7553 and fractionated radiation also promoted a twofold increase in apoptotic cell death. ILX 23-7553 failed to enhance the response to radiation or to promote apoptosis in BJ human foreskin fibroblasts. CONCLUSIONS: ILX 23-7553 enhanced the antiproliferative and apoptotic effects of fractionated ionizing radiation in MCF-7 breast cancer cells. These effects appeared to be selective in that similar responses were not observed in a model of normal human fibroblasts. Vitamin D(3) analogs such as ILX 23-7553 may prove to have utility in combination with conventional radiotherapy of breast cancer as well as other malignancies which are sensitive to vitamin D(3).

Apoptosis↗