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Biomedical subjects

G Alvaro

Publications and source records attributed to G Alvaro.

12 recordsLinked to original sources

Atypical mole syndrome and congenital giant naevus in a patient with celiac disease.

We describe a case of a 28-year-old woman affected by celiac disease (CD) associated with rare multiple disorders of the cutaneous pigmentary system: atypical mole syndrome and congenital giant naevus. Some other rare skin lesions have been reported in association with celiac disease such as cutaneous sarcoidosic granuloma, bullous pemphigoid, ichthyosis, alopecia areata, erythema elevatum diutinum, sclero-atrophic lichen and primary cutaneous amyloidosis. This is the 1(st) report concerning celiac disease and congenital disorders of the pigmentary system.

Adult↗

Vinorelbine and alternating cisplatin and ifosfamide in the treatment of non-small cell lung cancer.

In order to explore the activity of a combination of vinorelbine (VNL) and alternating cisplatin (CDDP) and ifosfamide (IFX) in non-small cell lung cancer (NSCLC), a phase II study was performed. Seventy chemoradiotherapy naive patients with NSCLC, stage IIIA, IIIB and IV disease, PS (ECOG) </=2, were treated with CDDP 40 mg/m(2) on days 1, 2, 3, IFX 1,800 mg/m(2) on days 22, 23, 24 and VNL 30 mg/m(2) on days 1, 8, 22, 29 every 6 weeks up to 6 courses. In the 67 evaluable patients, an objective response rate was observed in 47.8 +/- 12% (95% CI) with complete responses in 6%; responses occurred more frequently in patients with locally advanced disease (stage IIIA/IIIB) and/or performance status 0. The median duration of survival was 12 months: 19.9 months in stage III patients who received an integrated treatment and 10 months in metastatic disease. The median time to treatment failure was 10.5 months. Toxicity was mainly hematological, even though it was not dose-limiting and easily manageable. This combination seems to be active, and the good safety profile is probably the result of the use of an alternating schedule of CDDP and IFX. Median overall survival was also encouraging in stage IV disease. The prolongation of survival obtained when surgery and/or radiotherapy is applicable needs confirmation through a larger study.

Adult↗

Industrial design of enzymic processes catalysed by very active immobilized derivatives: utilization of diffusional limitations (gradients of pH) as a profitable tool in enzyme engineering.

We have developed integrated studies of enzyme reaction engineering for the hydrolysis of penicillin G catalysed by very active penicillin G acylase (PGA) derivatives. We have studied the distinct effect of a key variable (pH) on different industrial parameters (e.g. activity/stability parameters). In this way we have demonstrated, in contrast with that proposed by other authors, that the generation of gradients of pH inside the porous structure of very active enzyme derivatives may be not a problem but a 'very profitable tool' to improve the whole set of industrial parameters. In this way we can establish two distinct 'optimal pH values': (i) the one inside the particle of the biocatalyst and (ii) the one in the bulk solution. The use of an external pH of 8.0 associated with the promotion of a controlled decrease in internal pH (e.g. around a mean value of 5.5) was very useful to simultaneously obtain interesting values of all industrial parameters: (i) very high hydrolytic yields (higher than 97%); (ii) a very important increase on the stability of PGA derivatives (higher than a 50-fold factor); and (iii) a very small decrease in operational activity (approximately 15%) as compared with the one of soluble enzyme at pH 8.0 with no diffusional hindrances.

Biotechnology↗

Additional stabilization of penicillin G acylase-agarose derivatives by controlled chemical modification with formaldehyde.

We have tested the effect of chemical modifications with formaldehyde on the activity/stability of immobilized derivatives of the enzyme penicillin G acylase (PGA). These derivatives were previously stabilized through enzyme-support multipoint covalent attachment. We carried out very different chemical treatments of our derivatives by testing the effect of different variables which control the intensity and the nature of these amine-formaldehyde reactions. The variables tested were: formaldehyde concentration, pH, time, and temperature. We also developed a colorimetric titration of the free amine groups on immobilized PGA in order to evaluate the extension of the reaction between formaldehyde and the amine groups of the enzyme. As a consequence of these studies, we have been able to get additional stabilizations of our previously stabilized-immobilized derivatives: e.g. a factor of 24-fold was achieved in terms of stabilization against irreversible thermal inactivation. The integrated effect of additional chemical modification plus previous multipoint covalent attachment has allowed us to prepare PGA derivatives which are 50,000 more thermostable than native PGA as well as most of the commercial PGA derivatives.

Amines↗

Enzyme reaction engineering: design of peptide synthesis by stabilized trypsin.

By using very active and very stable trypsin agarose derivatives, we have optimized the design of the synthesis of a model dipeptide, benzoylarginine leucinamide, by two different strategies: (i) kinetically controlled synthesis (KCS), by using benzoyl arginine ethyl ester and leucinamide as substrates, and (ii) thermodynamically controlled synthesis (TCS), by using benzoyl arginine and leucinamide as substrates. In each strategy, we have studied the integrated effect of a number of variables that define the reaction medium on different parameters of industrial interest, e.g. time course of peptide synthesis, higher synthetic yields, and stability of the catalyst, as well as aminolysis/hydrolysis ratios and rate of peptide hydrolysis in the case of KCS. Both synthetic approaches were carried out in monophasic water or water-organic cosolvent systems. We have mainly tested a number of variables, e.g. temperature, polarity of the reaction medium (presence of cosolvents, presence of ammonium sulfate), and exact structure of the trypsin derivatives. Optimal experimental conditions for these synthetic approaches were established in order to simultaneously obtain good values for all industrial parameters. The use of previously stabilized trypsin derivatives greatly improves the design of these synthetic approaches (e.g. by using drastic experimental conditions: 1 M ammonium sulfate (KCS) or 90% organic cosolvents (TCS]. In these conditions, our derivatives preserve more than 95% of activity after 2 months and we have been able to reach synthetic productivities of 180 (KCS) and 1 (TCS) tons of dipeptide per year per liter of catalyst.

Dipeptides↗

Stabilizing effect of penicillin G sulfoxide, a competitive inhibitor of penicillin G acylase: its practical applications.

We have found that penicillin G sulfoxide (pen G SO) behaves as a general stabilizing agent of two bacterial penicillin G acylases (PGAs) from E. coli and from K. citrophila), and this role is related to a strong inhibitory effect on the enzymes. The stabilizing effect has been observed during two different inactivation processes: (i) thermal inactivation of soluble enzymes at alkaline pH, and (ii) inactivation of immobilized enzymes as a consequence of covalent multiinteraction with highly activated agarose aldehyde gels. At the same time, pen G SO behaves as a strong competitive inhibitor of these two enzymes. The inhibition constant is more than 10-fold lower than the one corresponding to another smaller competitive inhibitor, phenylacetic acid (PAA), the structure of which is exactly the acyl donor moiety corresponding to pen G SO. In turn, PAA hardly exerts any stabilizing effect on PGAs. The stabilizing effect of pen G SO allowed the preparation of derivatives of these PGAs preserving full catalytic activity in spite of being 1,400- and 650-fold more stable than the corresponding soluble or one-point attached immobilized enzymes.

Enzyme Stability↗

Immobilization-stabilization of proteases as a tool to improve the industrial design of peptide synthesis.

Synthesis of dipeptides benzoyl Arginine leucinamide and kyotorphin catalyzed by highly stabilized derivatives of trypsin and chymotrypsin have been performed. Extreme experimental conditions could be tested and parameters of industrial interest could be improved provided the high activity and stability of the derivatives in these unfavourable environments. Thermodynamically controlled synthesis catalyzed by trypsin could be optimized and 97% conversion was obtained in 90% organic cosolvents. 100% yields were achieved in kinetically controlled synthesis catalyzed by trypsin in aqueous medium in the presence of IM Ammonium Sulphate. Higher starting concentrations of poorly soluble substrates of chymotrypsin could be used in a reaction medium containing 50% DMF and 95% yield were obtained.

Catalysis↗

Immobilization-stabilization of penicillin G acylase from Escherichia coli.

We have developed a strategy for immobilization-stabilization of penicillin G acylase from E. coli, PGA, by multipoint covalent attachment to agarose (aldehyde) gels. We hve studied the role of three main variables that control the intensity of these enzyme-support multiinteraction processes: 1. surface density of aldehyde groups in the activated support; 2. temperature; and 3. contact-time between the immobilized enzyme and the activated support prior to borohydride reduction of the derivatives. Different combinations of these three variables have been tested to prepare a number of PGA-agarose derivatives. All these derivatives preserve 100% of catalytic activity corresponding to the soluble enzyme that has been immobilized but they show very different stability. The less stable derivative has exactly the same thermal stability of soluble penicillin G acylase and the most stable one is approximately 1,400 fold more stable. A similar increase in the stability of the enzyme against the deleterious effect of organic solvents was also observed. On the other hand, the agarose aldehyde gels present a very great capacity to immobilize enzymes through multipoint covalent attachment. In this way, we have been able to prepare very active and very stable PGA derivatives containing up to 200 International Units of catalytic activity per mL. of derivative with 100% yields in the overall immobilization procedure.

Aldehydes↗

Reaction engineering for consecutive enzymatic reactions in peptide synthesis: application to the synthesis of a pentapeptide.

A single-pot enzymatic synthesis of Z-CCK5 (4-8) is presented in this work, employing Z-Gly-Trp-OBzl as acyl donor, under kinetic control. The first goal of the work is the development of a synthetic strategy allowing the use of the same medium for two reactions catalyzed by immobilized alpha-chymotrypsin, discriminating between simultaneous and consecutive addition systems. The second goal is the maximization of the pentapeptide yield as a function of the molar excess of both nucleophiles employed. A maximum yield of 36% was obtained, and the addition strategy as well as the optimal initial concentrations of substrates have been determined.

Acetonitriles↗

Epidemiological aspects of respiratory syncytial virus (RSV) infections in Italy: a national survey.

Respiratory syncytial virus (RSV) is a major cause of respiratory infections such as bronchiolitis and pneumonia in babies and children, producing serious infections and short- to medium-term complications. We conducted a survey, using a questionnaire, to determine the opinions of paediatricians on the geographical and seasonal distribution, and the clinical impact of RSV in Italy. Of the 344 paediatricians who responded, 66% had admitted children affected by RSV into their department, and 38% of these had admitted more than 10 cases during the preceding year. According to those interviewed, newborn babies of lowest gestational age were most often affected. The children considered to be at highest risk of severe infection were those with bronchodysplasia, immunodeficiencies or congenital heart disease; most admissions (87%) were attributed to bronchiolitis. In southern Italy and the islands RSV appeared later and persisted later into the year than in central and northern Italy. Most paediatricians (79%) considered the available treatments for serious RSV ineffective but only half were aware of the possibility of immunoprophylaxis against RSV.

Child↗

[Evaluation of the effect of a new milk formula with added nucleotides on some gastrointestinal functions. Results of a nation-wide study of 5009 infants. Pediatric Study Group].

BACKGROUND: The signs and symptoms of gastrointestinal function represent one of the most frequent reasons for pediatric consultation during the first four months of life. Few studies have evaluated these clinical conditions in relation to infant diet. The aim of this study was to evaluate the effects of a new formula enriched with nucleotides (Similac Formula Plus-Abbott) on fecal consistency, wind and regurgitation. METHODS: The study was carried out using an observational type, prospective design which involved 778 pediatricians throughout Italy. From November 1996 to June 1997, a total of 5009 healthy infants were evaluated: all were born at term, aged between newborn and 4 months old. For 2 weeks after the first examination (day 0), the parents kept a record of the number and consistency of feces, frequency of regurgitation and wind in each infant. This diary was given to the pediatrician during the second and last examination (day 14). Any confusing variables, such as intercurrent pathologies, administration of drugs or diet supplements were reported to the pediatrician and corrected during analysis. RESULTS: During the course of the 2-week observation period, infants fed with Similac FormulaPlus showed a lower incidence of formed and hard feces compared to other milk formulas (34.7% vs 44.8%, p > 0.001), and likewise a lower incidence of severe regurgitation (9.7 vs 18.1%, p > 0.001) and wind (62.7% vs 72.5%, p > 0.001). CONCLUSIONS: The results of this study show that the new milk formula enriched with nucleotides has beneficial effects on the consistency of feces, wind and regurgitation and can therefore be regarded as a step towards the benefits which only breast feeding can offer.

Adult↗