Biomedical subjects

Neil D Evans

Publications and source records attributed to Neil D Evans.

6 recordsLinked to original sources

PubMed2007

Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies.

Of patients with newly diagnosed multiple myeloma, approximately 10% have dialysis-dependent acute renal failure, with cast nephropathy, caused by monoclonal free light chains (FLC). Of these, 80 to 90% require long-term renal replacement therapy. Early treatment by plasma exchange reduces serum FLC concentrations, but randomized, controlled trials have shown no evidence of renal recovery. This outcome can be explained by the low efficiency of the procedure. A model of FLC production, distribution, and metabolism in patients with myeloma indicated that plasma exchange might remove only 25% of the total amount during a 3-wk period. For increasing FLC removal, extended hemodialysis with a protein-leaking dialyzer was used. In vitro studies indicated that the Gambro HCO 1100 dialyzer was the most efficient of seven tested. Model calculations suggested that it might remove 90% of FLC during 3 wk. This dialyzer then was evaluated in eight patients with myeloma and renal failure. Serum FLC reduced by 35 to 70% within 2 hr, but reduction rates slowed as extravascular re-equilibration occurred. FLC concentrations rebounded on successive days unless chemotherapy was effective. Five additional patients with acute renal failure that was caused by cast nephropathy then were treated aggressively, and three became dialysis independent. A total of 1.7 kg of FLC was removed from one patient during 6 wk. Extended hemodialysis with the Gambro HCO 1100 dialyzer allowed continuous, safe removal of FLC in large amounts. Proof of clinical value now will require larger studies.

Acute Kidney Injury↗

PubMed2006

The tumor kinetics of multiple myeloma following autologous stem cell transplantation as assessed by measuring serum-free light chains.

In multiple myeloma, changes in serum-free immunoglobulin light chains (FLC) are a more rapid indicator of treatment response than intact immunoglobulin due to their shorter serum half-life. The present study analysed the changes in serum FLC after autologous peripheral blood stem cell transplantation (PBSCT) in 19 patients. The majority of myeloma patients (18 of 19) undergoing PBSCT had a rapid fall in FLC concentrations. In all 11 of 19 patients with raised tumor FLC, it fell within 48 h following high-dose melphalan. In patients with monoclonal intact immunoglobulin, the tumor FLC fell quicker (median half-life 4.3 days) than the monoclonal intact immunoglobulin (median half-life 14 days). FLC recovery occurred after (13 of 19) or around the time of neutrophil engraftment (6 of 19). With a median follow up of 220 days post-transplant, 16 of 19 patients have a normal FLC ratio and 3 of 19 have an elevated tumor FLC/abnormal ratio. FLC assays provided a sensitive monitor of changes in tumor and non-tumor plasma cells after PBSCT. This assay is potentially valuable as a marker of chemosensitivity, as an indicator of residual tumor and indicated time to lymphocyte engraftment. Further follow-up is required to ascertain whether differences in the kinetics of FLC responses have any prognostic clinical utility.

Adult↗

PubMed2005

The mechanism distinguishability problem in biochemical kinetics: the single-enzyme, single-substrate reaction as a case study.

A theoretical analysis of the distinguishability problem of two rival models of the single enzyme-single substrate reaction, the Michaelis-Menten and Henri mechanisms, is presented. We also outline a general approach for analysing the structural indistinguishability between two mechanisms. The approach involves constructing, if possible, a smooth mapping between the two candidate models. Evans et al. [N.D. Evans, M.J. Chappell, M.J. Chapman, K.R. Godfrey, Structural indistinguishability between uncontrolled (autonomous) nonlinear analytic systems, Automatica 40 (2004) 1947-1953] have shown that if, in addition, either of the mechanisms satisfies a particular criterion then such a transformation always exists when the models are indistinguishable from their experimentally observable outputs. The approach is applied to the single enzyme-single substrate reaction mechanism. In principle, mechanisms can be distinguished using this analysis, but we show that our ability to distinguish mechanistic models depends both on the precise measurements made, and on our knowledge of the system prior to performing the kinetics experiments.

Enzymes↗

PubMed2005

The structural identifiability of the susceptible infected recovered model with seasonal forcing.

In this paper, it is shown that the SIR epidemic model, with the force of infection subject to seasonal variation, and a proportion of either the prevalence or the incidence measured, is unidentifiable unless certain key system parameters are known, or measurable. This means that an uncountable number of different parameter vectors can, theoretically, give rise to the same idealised output data. Any subsequent parameter estimation from real data must be viewed with little confidence as a result. The approach adopted for the structural identifiability analysis utilises the existence of an infinitely differentiable transformation that connects the state trajectories corresponding to parameter vectors that give rise to identical output data. When this approach proves computationally intractable, it is possible to use the converse idea that the existence of a coordinate transformation between states for particular parameter vectors implies indistinguishability between these vectors from the corresponding model outputs.

Algorithms↗

PubMed2004

A mathematical model for the in vitro kinetics of the anti-cancer agent topotecan.

In this paper a compartmental modelling approach is applied to provide a mathematical description of the activity of the anti-cancer agent topotecan, and delivery to its nuclear DNA target following administration. The activity of topotecan in defined buffers is first modelled using a linear two compartment model that then forms the basis of a cell based model for drug activity in live cell experiments. An identifiability analysis is performed before parameter estimation to ensure that the model output (i.e., continuous, perfect and noise-free data) uniquely determines the parameters. Parameter estimation is performed using experimental data which offers concentrations of active and inactive forms of topotecan from high performance liquid chromatography methods.

Antineoplastic Agents↗

PubMed2003

Structural identifiability for a class of non-linear compartmental systems using linear/non-linear splitting and symbolic computation.

Under certain controllability and observability restrictions, two different parameterisations for a non-linear compartmental model can only have the same input-output behaviour if they differ by a locally diffeomorphic change of basis for the state space. With further restrictions, it is possible to gain valuable information with respect to identifiability via a linear analysis. Examples are presented where non-linear identifiability analyses are substantially simplified by means of an initial linear analysis. For complex models, with four or more compartments, this linear analysis can prove lengthy to perform by hand and so symbolic computation has been employed to aid this procedure.

Algorithms↗