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Biomedical subjects

R Gentry

Publications and source records attributed to R Gentry.

At least 19 recordsLinked to original sources
PubMed2003

Profile of cognitive progression in early Huntington's disease.

OBJECTIVE: To examine the pattern of cognitive decline in early Huntington's disease (HD). METHODS: The authors studied 61 patients with mild to moderate HD who had at least three annual neuropsychological assessments using the Core Assessment Program for Intracerebral Transplantation in Huntington's Disease short battery. A subset of 34 patients had additional neuropsychological tests, and another subset of 21 patients was assessed annually on the Cambridge Neuropsychological Test Automated Battery. Neuropsychological measures that changed significantly over time were submitted to a multiple analysis of covariance to explore associations with demographic and neurologic indices. RESULTS: Patients showed a progressive impairment in attention, executive function, and immediate memory, with timed tests of psychomotor skill being particularly sensitive to decline. In contrast, general cognition, semantic memory, and delayed recall memory were relatively unaffected. CONCLUSION: The profile of cognitive performance shows selective and progressive dysfunction of attention and executive function in patients with mild to moderate HD, consistent with frontostriatal pathology at this stage of disease.

Adult↗
PubMed2000

Application of a hybrid CFD-PBPK nasal dosimetry model in an inhalation risk assessment: an example with acrylic acid.

The available inhalation toxicity information for acrylic acid (AA) suggests that lesions to the nasal cavity, specifically olfactory degeneration, are the most sensitive end point for developing a reference concentration (RfC). Advances in physiologically based pharmacokinetic (PBPK) modeling, specifically the incorporation of computational fluid dynamic (CFD) models, now make it possible to estimate the flux of inhaled chemicals within the nasal cavity of experimental species, specifically rats. The focus of this investigation was to apply an existing CFD-PBPK hybrid model in the estimation of an RfC to determine the impact of incorporation of this new modeling technique into the risk assessment process. Information provided in the literature on the toxicity and mode of action for AA was used to determine the risk assessment approach. A comparison of the approach used for the current U.S. Environmental Protection Agency (U.S. EPA) RfC with the approach using the CFD-PBPK hybrid model was also conducted. The application of the CFD-PBPK hybrid model in a risk assessment for AA resulted in an RfC of 79 ppb, assuming a minute ventilation of 13.8 l/min (20 m(3)/day) in humans. This value differs substantially from the RfC of 0.37 ppb estimated for AA by the U.S. EPA before the PBPK modeling advances became available. The difference in these two RfCs arises from many factors, with the main difference being the species selected (mouse vs. rat). The choice to conduct the evaluation using the rat was based on the availability of dosimetry data in this species. Once these data are available in the mouse, an assessment should be conducted using this information. Additional differences included the methods used for estimating the target tissue concentration, the uncertainty factors (UFs) applied, and the application of duration and uncertainty adjustments to the internal target tissue dose rather than the external exposure concentration.

Acrylates↗
PubMed1998

Calculation of benchmark doses for reproductive and developmental toxicity observed after exposure to isopropanol.

Reproductive, including developmental, toxicity risk assessment has typically relied on estimation of toxicity criteria values derived from no-observed-adverse-effect levels (NOAELs). The benchmark dose (BMD) approach has been proposed as an alternative that avoids problems with NOAELs. In this analysis of the reproductive and developmental toxicity observed in a multigeneration study of rats exposed to isopropanol, the BMD approach has been applied to all effects exhibiting significant dose-response relationships. The BMD estimates were very consistent across models and across end points; they were within the range of doses (100 to 500 mg/kg/day) that has been suggested as being the NOAEL. The use of the BMD approach for analysis of isopropanol reproductive toxicity is shown to avoid the experiment-specific argument of whether a particular treatment has induced statistically significant differences, compared to controls, in favor of the estimation of experiment-independent doses corresponding to risk levels of interest. The consistency of the BMD estimates, with values of about 420 mg/kg/day, suggests that, for isopropanol, the available multigeneration study data may provide a suitable basis for considering safe exposure.

2-Propanol↗
PubMed1995

A microscopic model of enzyme kinetics.

Many in vivo enzymatic processes, such as those of the tissue factor pathway of blood coagulation, occur in environments with facilitated substrate delivery or enzymes bound to cellular or lipid surfaces, which are quite different from the ideal fluid environment for which the Michaelis-Menten equation was derived. To describe the kinetics of such reactions, we propose a microscopic model that focuses on the kinetics of a single-enzyme molecule. This model provides the foundation for macroscopic models of the system kinetics of reactions occurring in both ideal and nonideal environments. For ideal reaction systems, the corresponding macroscopic models thus derived are consistent with the Michaelis-Menten equation. It is shown that the apparent Km is in fact a function of the mechanism of substrate delivery and should be interpreted as the substrate level at which the enzyme vacancy time equals the residence time of ES-complexes; it is suggested that our microscopic model parameters characterize more accurately an enzyme and its catalytic efficiency than does the classical Km. This model can also be incorporated into computer simulations of more complex reactions as an alternative to explicit analytical formulation of a macroscopic model.

Animals↗
PubMed1995

Surface-mediated enzymatic reactions: simulations of tissue factor activation of factor X on a lipid surface.

Blood coagulation proceeds via reactions in which zymogen coagulation factors are activated to proteases. An essential step is the activation of factor X by a complex of tissue factor and factor VIIa. This complex usually is studied using phospholipid vesicles into which tissue factor is inserted. Because factor X exists free in solution and bound to the lipid-surface, it is difficult to establish experimentally the kinetic contribution of surfaces. We therefore developed a stochastic model to simulate such reactions and generate initial velocity data from which Michaelis-Menten parameters are estimated. Simulated Km values decrease slightly when substrate binding to lipid is increased and by a factor of four when the rates of surface diffusion are increased to that of fluid phase-diffusion. Simulations with various size planar surfaces established an enzyme capture radius of 32-64 nm. Simulations with different modes of enzyme-substrate complex assembly show that if the true substrate is lipid-bound, under certain conditions, the true Kcat is not measured; rather, the product "leaving rate" from the complex is the rate-limiting step that is measured as substrate is taken to infinity. This model is applicable to any surface-bound enzyme reaction.

Animals↗
PubMed1994

Transport rate limited catalysis on macroscopic surfaces: the activation of factor X in a continuous flow enzyme reactor.

Blood coagulation is initiated on cells which present a macroscopic surface to the flowing blood stream. We have used a continuous flow enzyme reactor to model this system and to investigate the effects of shear rate and mass transport on the activation of factor X by the complex of the transmembrane protein, tissue factor, and the serine protease, factor VIIa. This initial step of blood coagulation was found to be half-maximal at very low enzyme densities (0.03-0.06%) on the wall of the capillaries. In agreement with hydrodynamic theory, the apparent Km in the flow reactor was correlated with the cube root of the wall shear rate. These data indicate that at high tissue factor densities (> 0.6%) the activation of 150 nM factor X is controlled by the flux of X toward the surface, which is controlled by wall shear rate and substrate concentration. The appearance of the product, Xa, in the effluent was delayed to 8-12 min, which was caused by high-affinity binding of Xa to the phospholipid. This delay was considerably shortened by embedding tissue factor into PC or by coating the PS/PC surface with the phospholipid binding protein, annexin V. At low tissue factor densities, annexin V inhibited X activation by 45%, while no inhibition was observed at high densities. We demonstrate that when the reaction is limited by substrate flux, addition of further enzyme does not increase reaction rates. This contrasts with classical three-dimensional catalysis in which the initial velocity is ordinarily linear with the enzyme concentration.

Amino Acid Sequence↗
PubMed1990

Considerations in fractionated proton radiation therapy: clinical potential and results.

Protons have a finite range in tissue and can provide a better concentration of radiation dose in the tumor than conventional X-rays in certain situations. The development of optimized treatment plans for X-rays and protons followed by a comparative evaluation is one method of selecting tumor sites best suited for proton treatment. The preliminary results of comparative treatment planning for base of skull tumors and carcinoma of the prostate are discussed. These comparisons suggest a clinical gain for proton treatment of tumors in these locations. The clinical experience with fractionated proton treatment of several tumor sites is also discussed. The results of high dose proton treatment of chordomas and low grade chondrosarcomas of the base of skull is particularly promising: an actuarial 5-year local control of 78% has been obtained in 50 patients followed for a minimum of 22 months.

Carcinoma↗
PubMed1990

Fractionated proton radiation therapy of cranial and intracranial tumors.

Since 1973 fractionated proton radiation therapy has been used in the treatment of malignant disease. Protons have favorable physical characteristics that yield dose distributions superior to those of photons in certain clinical situations. As of December 31, 1987, 1,678 patients had been treated. Of these, 110 had chordomas or low-grade chondrosarcomas of the base of skull. The first 68 patients have a minimum follow-up of 17 months. The median dose was 69 Cobalt Gray Equivalent (CGE). (CGE is the dose in proton Gray multiplied by 1.1, which is the relative biological effectiveness for protons relative to 60Cobalt.) The actuarial 5-year local control rate is 82%, and the disease-free survival rate is 76%. Thirteen patients with meningiomas have been treated, following subtotal resection. The median dose was 59.4 CGE. With a median follow-up of 26 months, no patient has had tumor progression. In addition, nine patients with gliomas and 12 with craniopharyngiomas have been treated.

Adolescent↗
PubMed1989

Conservative treatment of uveal melanoma: local recurrence after proton beam therapy.

Twenty-three of 1006 (2.3%) uveal melanoma patients treated with proton beam therapy at the Harvard Cyclotron Laboratory between July 1975 and December 31, 1986 received additional treatment for documented (15 patients) or suspected (eight patients) tumor growth in the irradiated eye. Growth within the initially irradiated volume was documented at Massachusetts Eye and Ear Infirmary in 12 patients. Documented growth occurred in nine of 665 (1.4%) patients with small and intermediate size tumors, at times after treatment ranging from 6 to 48 months (median 16 months), and in three of 341 (.9%) patients with large tumors at 7, 11, and 12 months after treatment. Melanoma growing totally outside the treated volume was also documented in three additional patients at 7, 9, and 45 months; two of these were thought to be "ring melanomas". Eight patients had the treated eye removed elsewhere for suspected tumor growth. The additional treatment in these 23 patients was conservative in nine patients (repeat proton irradiation in five and laser photocoagulation in four). Thirteen underwent immediate enucleation and one had orbital exenteration. Ultimately, 17 of the 23 eyes (74%) were removed. Estimated probability of local control of the melanoma within the irradiated eye at 60 months was 96.3 +/- 1.5%. Dose distributions to the 12 patients with documented local failure within the irradiated volume were analyzed. Ten tumors recurred marginally in an area receiving less than the prescribed dose of 70 CGE (CGE = Cobalt Gray Equivalents = proton Gy X RBE 1.1), whereas only two recurred in the volume receiving full dose. Based on these data, it appears that a dose of 70 CGE in five fractions is associated with very high rates of local control in human uveal melanoma. It is reasonable to consider initiating studies using a lower total dose or a more protracted course, to determine if some of the observed complications are dose-related.

Adult↗
PubMed1989

Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull.

Sixty-eight patients with chordoma or low-grade chondrosarcoma at the base of the skull received fractionated high-dose postoperative radiation delivered with a 160-MeV proton beam. Protons have favorable physical characteristics which allow the delivery of high doses of radiation to these critically located tumors. The methods employed for these treatments are described. These patients have been followed for at least 17 months and for a median of 34 months. The median tumor dose was 69 CGE (cobalt Gy equivalent): CGE is the dose in proton Gy multiplied by 1.1, which is the relative biological effectiveness for protons compared to cobalt-60. The daily dose was 1.8 to 2.1 CGE. For this group the 5-year actuarial local control rate is 82% and disease-free survival rate is 76%. The incidence of treatment-related morbidity has been acceptable.

Adolescent↗
PubMed1986

Factor VII binding to tissue factor in reconstituted phospholipid vesicles: induction of cooperativity by phosphatidylserine.

The binding of factor VII and tissue factor produces a membrane-associated proteolytic complex which may be the primary biological initiator of coagulation. Homogeneous tissue factor, a glycoprotein purified from bovine brain, was reconstituted into phospholipid vesicles ranging from neutral (100% phosphatidylcholine) to highly charged (40% phosphatidylserine) with octyl glucoside. The vesicles were characterized with respect to size and tissue factor content and orientation. Employing data from protease digestion, we deduced that tissue factor is randomly oriented; thus, its effective concentration in these vesicles was half its total concentration. In all binding experiments, 1 mol of enzyme was bound per mole of available activator at saturation. This stoichiometry was not affected by the form of the enzyme employed or the phospholipid composition of the vesicles. With tissue factor incorporated into phosphatidylcholine vesicles, the Kd was 13.2 +/- 0.72 nM for factor VII and 4.54 +/- 1.37 nM for factor VIIa. Thus, the one-chain zymogen binds to the activator with only slightly less affinity than the more active two-chain enzyme. Active-site modification of factor VII and factor VIIa with diisopropyl fluorophosphate resulted in tighter binding of the derivatized molecules. Inclusion of phosphatidylserine in the vesicles altered the binding both quantitatively and qualitatively. With increasing acidic phospholipid, the concentration of enzyme required to occupy half the activator sites was decreased. In addition, positive cooperativity was observed, the degree of which depended on the vesicle charge and the form of the enzyme. An explicit two-site cooperative binding model is presented which fits these complex data. In this model, tissue factor is at least a dimer with two interacting enzyme binding sites.

Animals↗
PubMed1986

An ordered addition, essential activation model of the tissue factor pathway of coagulation: evidence for a conformational cage.

One way in which coagulation may be initiated is by the action of factor VIIa (a plasma serine protease) and tissue factor (a membrane-bound lipid-dependent glycoprotein). We show that in the absence of either factor VIIa or tissue factor, the activation of the natural coagulation substrates, factors IX and X, is not detectable; i.e., tissue factor is an essential activator. We propose that the reaction is fully ordered; that is, the enzyme-activator complex picks up substrate to form a ternary product forming species. Our model precludes the formation of enzyme-substrate and activator-substrate complexes. We have derived equations for the two possible variations of this model: one in which product formation is accompanied by the release of the enzyme-activator complex and the other in which product, free enzyme, and free activator are formed with each catalytic cycle. Our data support only the former which is consistent with both steady-state and rapid equilibrium assumptions. The model is supported by experiments using a monoclonal anti-tissue factor antibody, which affects only the Km app, and a modified form of factor VIIa, which, depending on the sequence in which reagents are added to the reaction, either decreases the Vmax or increases the Km app. We present equations describing the initial velocity of these reactions. Utilizing dilution-jump experiments, we show that the system is hysteretic and suggest that this phenomenon is due to a slow release of enzyme from activator. However, the kinetically determined dissociation constant of enzyme and activator, previously found to be 4.5 nM under equilibrium conditions, was estimated to be 0.04-0.09 nM. Accordingly, we examined other essential activation models in which the product-forming species consists of a complex of enzyme, activator, and substrate at a molar ratio of 1:1:1; none could account for the apparent tight binding of enzyme and activator. We therefore postulate an ordered addition, essential activation model in which the enzyme undergoes two conformational transformations: one as a consequence of binding to tissue factor, resulting in a species which binds to and hydrolyzes its natural substrates. The other conformational change in the enzyme is induced by substrate, resulting in a species which binds more tightly to its activator. Thus, we hypothesize a "conformational cage" which precludes the dissociation of enzyme from activator while significant concentrations of substrate are present.

Animals↗
PubMed1985

Proton therapy at Harvard.

Fractionated precision high-dose proton radiotherapy has been carried out at the Harvard Cyclotron Laboratory (HCL) since 1973, in a collaborative effort with the Radiation Medicine Department of Massachusetts General Hospital (MGH) and the Retina Service of the Massachusetts Eye and Ear Infirmary (MEEI). This paper will discuss proton treatment in general, treatment planning procedures, and results to date in major patient categories. 846 patients have been treated with fractionated proton therapy at the Harvard Cyclotron, with normal tissue and tumor responses consistent with an RBE of 1.1 for the proton beam. Proton beam therapy is the treatment of choice for patients with uveal melanomas, and chordomas and chondrosarcomas involving the skull base and cervical spine. Improved dose distribution possible with protons have allowed greater doses than are given conventionally to be delivered to patients with prostatic carcinoma, head and neck malignancies, ano-rectal cancers, and retroperitoneal tumors. Doses employed have been usually 10 to 20% greater than normally would be delivered in our department to such tumors. Generally, local control rates have been good.

Animals↗
PubMed1985

Progress in low-LET heavy particle therapy: intracranial and paracranial tumors and uveal melanomas.

The Harvard Cyclotron Laboratory in collaboration with the Department of Radiation Medicine of the Massachusetts General Hospital and the Retina Service of the Massachusetts Eye and Ear Infirmary provides low-LET heavy particle therapy with 160 MeV protons. The improved dose distribution of protons results from their physical characteristics. A total of 965 patients have been treated as of December 31, 1984. Dose is expressed in units of cobalt gray equivalent (CGE) which is the dose in Gy multiplied by the RBE (1.1) for modulated protons relative to 60Co radiation. Sixty-seven patients with chordomas or low-grade chondrosarcomas of the base of skull or cervical spine have received proton treatment. Forty-three of these patients have been followed for at least 8 months with a median follow-up of 27 months. The median dose is 69 CGE. The 3-year actuarial local control rate is 89%. Seven patients with gliomas, eight with craniopharyngiomas, and six with meningiomas have also received proton radiation treatments. A total of 615 patients with uveal melanomas have received a median dose of 70 CGE in five fractions. Tumor regression has been seen in 94% with 66% having vision of 20/100 or better.

Actuarial Analysis↗
PubMed1983

Energy of proton accelerator necessary for treatment of choroidal melanomas.

We have reviewed 94 patients with choroidal melanoma treated by proton beam therapy at the Harvard Cyclotron Laboratory. A beam penetration of f27 mm would be required to treat 90% of the lesions. We conclude that a machine energy of at least 55 and, preferably, 60 MeV would be necessary for a clinically viable therapy unit for the treatment of choroidal melanomas. An extracted beam current of 10(-9) A would be more than sufficient.

Choroid Neoplasms↗