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Biomedical subjects

Robert James

Publications and source records attributed to Robert James.

8 recordsLinked to original sources

Deconvolution of a complex target using DNA aptamers.

In vitro selection of single-stranded nucleic acid aptamers from large random sequence libraries is now a straightforward process particularly when screening with a single target molecule. These libraries contain considerable shape diversity as evident by the successful isolation of aptamers that bind with high affinity and specificity to chemically diverse targets. We propose that aptamer libraries contain sufficient shape diversity to allow deconvolution of a complex mixture of targets. Using unfractionated human plasma as our experimental model, we aim to develop methods to obtain aptamers against as many proteins as possible. To begin, it is critical that we understand how aptamer populations change with increasing rounds of in vitro selection when using complex mixtures. Our results show that sequence representation in the selected population changes dramatically with increasing rounds of selection. Certain aptamer families were apparent after only three selection rounds. Two additional cycles saw a decline in the relative abundance of these families and the emergence of yet another family that accounted for more than 60% of sequences in the pool. To overcome this population convergence, an aptamer-based target depletion method was developed, and the library screen was repeated. The previous dominant family effectively disappeared from the selected populations but was replaced by other aptamer families. Insights gained from these initial experiments are now being applied in the creation of second generation plasma protein screens and also to the analysis of other complex biological targets.

Aptamers, Nucleotide↗

Phase I evaluation of the safety and pharmacokinetics of murine-derived anticryptococcal antibody 18B7 in subjects with treated cryptococcal meningitis.

A promising approach to improving outcomes in patients with cryptococcal meningitis is to use adjunctive passive immunotherapy with a monoclonal antibody (MAb) directed against the capsular polysaccharide of Cryptococcus neoformans. This is the first application of MAb therapy for the treatment of a fungal disease in humans. We determined the safety and maximum tolerated dose of the murine anticryptococcal MAb 18B7 in a phase I dose-escalation study. The subjects were human immunodeficiency virus-infected patients who had been successfully treated for cryptococcal meningitis. Six dosing cohorts received MAb 18B7 at 0.01 to 2 mg/kg of body weight as a single infusion. Three patients each received 0.01, 0.05, 0.2, and 0.5 mg of MAb 18B7 per kg without significant adverse events. Four of the subjects who received the 1-mg/kg dose had mild study drug-associated toxicity, including transient nausea, vomiting, back pain, and urticarial rash. Two of the subjects who received 2 mg/kg developed drug-associated mild to moderate nausea, vomiting, chills, and myalgias. One of the subjects who received 2 mg/kg developed intracranial hypertension 10 weeks after MAb 18B7 administration. Serum cryptococcal antigen titers in the cohorts receiving doses of 1 and 2 mg/kg declined by a median of twofold at 1 week and a median of threefold at 2 weeks postinfusion, but the titers subsequently returned toward the baseline values by week 12. The half-life of MAb 18B7 in serum was approximately 53 h, while the MAb was undetectable in the cerebrospinal fluid of all patients. These data support the continued investigation of MAb 18B7 at a maximum single dose of 1.0 mg/kg.

Animals↗

Explaining the phase behaviour of the pharmaceutically relevant polymers poly(ethylene glycol) and poly(vinyl pyrrolidone) in semi-fluorinated liquids.

Phase behaviour studies of low molecular weight poly(ethylene glycol) (denoted PEG 600 and PEG 1000, corresponding to molecular weights of 600 and 1000 g mol(-1), respectively) have been carried out in 2H,3H-perfluoropentane (HPFP) with and without added poly(vinyl pyrrolidone). The concentration and temperature dependencies of their phase behaviour and the effect of moisture on these systems have been established. Furthermore, the solubility of PEG 600 in binary mixtures of HPFP and perfluoropentane (PFP), as well as HPFP and perfluorodecalin (PFD) have been considered at high HPFP contents. A phase separation phenomenon in fluorinated non-aqueous media is reported for the first time: PEG 600 and PEG 1000 both show a lower critical solution temperature type phase separation boundary. The size of the PEGs was obtained from small-angle neutron scattering (radius of gyration) and pulsed-gradient spin-echo NMR (hydrodynamic radius) measurements. It is shown that polymer conformation follows a regular trend with solution concentration; the size increases from <10 A at 3 wt% in HPFP to 45 +/- 2 A at 20 wt% PEG. On changing the solvent composition by substitution of HPFP by PFP or PFD, the size decreases, consistent with a decrease in the hydrogen-bonding capacity of the solvent mixture. Computer modelling indicates an interaction between the PEG oxygen and the hydrogen of HPFP, an interaction that is absent for the fully fluorinated solvents. This indicates that hydrogen bonding is the driving force for polymer solubility in these solvents.

Chemistry, Pharmaceutical↗

Effect of preemptive retrobulbar analgesia on perioperative hemodynamics and postoperative pain after enucleation.

PURPOSE: To determine the preemptive pain and hemodynamic effects of preincisional retrobulbar analgesia in enucleation. METHODS: This double-blinded, placebo-controlled study enrolled 69 patients scheduled for enucleation. Patients were stratified into two groups: those who used daily analgesics before surgery and those who did not. Each group was randomly assigned to receive a preincisional retrobulbar injection containing either a mixture of bupivacaine, lidocaine, epinephrine, and hyaluronidase; or saline placebo. All patients received postoperative retrobulbar injection containing the analgesic mixture. The outcome measures were intraoperative and postoperative blood pressure, heart rate, postoperative pain, and pain medication consumption. RESULTS: Groups that received preincisional analgesia had a significantly lower mean intraoperative blood pressure (109/59 versus 127/69 mm Hg; P< 0.05). Visual analog scale pain assessment (VAS) was lower in both treatment groups upon recovery room entry (VAS, 0.3 versus 15.8, P=0.08) and after 30 minutes in the nonanalgesic use group (VAS, 5.6 versus 19.4, P=0.11). Among nonchronic analgesic users, fewer patients in the treatment group had pain requiring analgesic rescue in the recovery room (5% versus 25%, P=0.08). Postoperative pain medicine consumption in the first 24 hours did not differ significantly among the groups. CONCLUSIONS: Preemptive retrobulbar analgesia was associated with improved intraoperative hemodynamics during enucleation and a trend toward reduced pain on entry in the recovery room and fewer pain rescues in the early postoperative period. A trend toward reduced pain severity in the early postoperative period was observed in those patients without daily preoperative analgesic use.

Analgesia↗

Patient-controlled epidural analgesia versus continuous epidural infusion with ropivacaine for postoperative analgesia in children.

UNLABELLED: Epidural ropivacaine infusion has been used in children; however, patient-controlled epidural analgesia (PCEA) has not been evaluated in the pediatric population. In this study, we compared the clinical efficiency of PCEA and of continuous epidural infusion analgesia (CEA) in children. Forty-eight children undergoing orthopedic surgery were randomized to receive PCEA or CEA with ropivacaine 0.2%. All patients underwent a standard general anesthetic. Children also received ketoprofen and propacetamol. Pain scores and side effects were recorded for 48 h. If the visual analog score scale score was >4 of 10, analgesia was considered inadequate, and rescue treatment was administered. Both groups obtained effective pain relief. Children in the PCEA group received significantly less local anesthetic than those in the CEA group (0.20 +/- 0.08 mg x kg(-1) x h(-1) versus 0.40 +/- 0.08 mg x kg(-1) x h(-1); P < 0.001). Motor effects, supplemental analgesic requirements, and side effects did not differ. We concluded that PCEA with ropivacaine 0.2% can provide adequate postoperative analgesia for pediatric orthopedic procedures with smaller dose requirements than CEA. IMPLICATIONS: We studied patient-controlled epidural analgesia (PCEA) and continuous epidural infusion analgesia (CEA) with 0.2% ropivacaine during the postoperative period in children. We found that either PCEA or CEA with plain ropivacaine 0.2% provided adequate pain relief in children during the first 48-h postoperative course. However, adequate analgesia was obtained with 50% less volume infused with PCEA compared with CEA.

Amides↗

Multisensory temporal order judgments: when two locations are better than one.

In Experiment 1, participants were presented with pairs of stimuli (one visual and the other tactile) from the left and/or right of fixation at varying stimulus onset asynchronies and were required to make unspeeded temporal order judgments (TOJs) regarding which modality was presented first. When the participants adopted an uncrossed-hands posture, just noticeable differences (JNDs) were lower (i.e., multisensory TOJs were more precise) when stimuli were presented from different positions, rather than from the same position. This spatial redundancy benefit was reduced when the participants adopted a crossed-hands posture, suggesting a failure to remap visuotactile space appropriately. In Experiment 2, JNDs were also lower when pairs of auditory and visual stimuli were presented from different positions, rather than from the same position. Taken together, these results demonstrate that people can use redundant spatial cues to facilitate their performance on multisensory TOJ tasks and suggest that previous studies may have systematically overestimated the precision with which people can make such judgments. These results highlight the intimate link between spatial and temporal factors in determining our perception of the multimodal objects and events in the world around us.

Adult↗

The pharmacokinetics and cardiovascular effects of a single intravenous dose of protamine in normal volunteers.

UNLABELLED: Despite its long use in clinical medicine, protamine concentrations and pharmacokinetics in humans have not been reported. The occasional reoccurrence of anticoagulation after protamine reversal of heparin led us to hypothesize that protamine plasma concentrations decrease rapidly. We developed a method for the measurement of protamine in plasma. Eighteen fit volunteers gave their consent to receive 0.5 mg/kg protamine sulfate administered IV by an infusion pump over 10 min. Heart rate, mean arterial blood pressure, and cardiac output, all measured noninvasively, were recorded and blood samples obtained during and after protamine infusion. Blood plasma was subjected to solid-phase extraction and high-performance liquid chromatography. The administration of protamine was associated with no significant changes in heart rate, mean arterial blood pressure, or cardiac output. Plasma protamine concentrations decreased rapidly, becoming nondetectable within approximately 20 min. Protamine elimination differed significantly between men and women: men had significantly larger areas under the concentration versus time curve. Model-independent pharmacokinetic analysis revealed median (range) values as follows: volume of distribution at steady state, 12.3 (6.9--63.1) L; clearance, 2.2 (1.1--12.1) L/min; and t1/2, 7.4 (5.9--9.3) min. Concentration versus time plots revealed an atypical pattern inconsistent with usual exponential models. The Schwartz-Bayesian criterion identified a one-compartment Michaelis-Menten model and a two-compartment exponential model with irreversible binding as performing better than conventional one- or two-compartmental exponential models; however, performance errors were large with both Michaelis-Menten and exponential models. All models described rapid decreases in protamine blood concentrations. IMPLICATIONS: We developed a method for measurement of protamine in human blood. In volunteers, protamine concentrations decreased rapidly after administration. The rapid disappearance of protamine from the circulation, as defined by a median half-life of 7.4 min, could contribute to cases of "heparin rebound" after initial adequate reversal of heparin.

Adult↗