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New approaches to drug discovery and development: a mechanism-based approach to pharmaceutical research and its application to BNP7787, a novel chemoprotective agent.

Any approach applied to drug discovery and development by the medical community and pharmaceutical industry has a direct impact on the future availability of improved, novel, and curative therapies for patients with cancer. By definition, drug discovery is a complex learning process whereby research efforts are directed toward uncovering and assimilating new knowledge to create and develop a drug for the purpose of providing benefit to a defined patient population. Accordingly, a highly desirable technology or approach to drug discovery should facilitate both effective learning and the application of newly discovered observations that can be exploited for therapeutic benefit. However, some believe that drug discovery is largely accomplished by serendipity and therefore appropriately addressed by screening a large number of compounds. Clearly, this approach has not generated an abundance of new drugs for cancer patients and suggests that a tangibly different approach in drug discovery is warranted. We employ an alternative approach to drug discovery, which is based on the elucidation and exploitation of biological, pharmacological, and biochemical mechanisms that have not been previously recognized or fully understood. Mechanism-based drug discovery involves the combined application of physics-based computer simulations and laboratory experimentation. There is increasing evidence that agreement between simulations based on the laws of physics and experimental observations results in a higher probability that such observations are more accurate and better understood as compared with either approach used alone. Physics-based computer simulation applied to drug discovery is now considered by experts in the field to be one of the ultimate methodologies for drug discovery. However, the ability to perform truly comprehensive physics-based molecular simulations remains limited by several factors, including the enormous computer-processing power that is required to perform the formidable mathematical operations and data processing (e.g. memory bandwidth, data storage and retrieval). Another major consideration is the development of software that can generate an appropriate and increasingly complex physical representation of the atomic arrangements of biological systems. During the past 17 years, we have made tremendous progress in addressing some of these obstacles by developing and optimizing physics-based computer programs for the purpose of obtaining increasingly accurate and precise information and by improving the speed of computation. To perform physics-based simulations that involve complex systems of biological and pharmaceutical interest, we have developed methods that enable us to exceed Moore's law. This has been accomplished by parallel processing as well as other methods that have enabled us to study more complex and relevant molecular systems of interest. This paper provides an overview of our approach to drug discovery and describes a novel drug, currently in clinical development, which has directly resulted from the application of this approach.

Animals↗

Ambulatory electrocardiography and computer technology--practical advantages.

Ambulatory electrocardiography has employed computer technology for more than two decades. This review pertains to current state-of-the-art interaction between ambulatory electrocardiography and computer technology with regard to data analysis, quantitation and standardization, data formatting, data storage and retrieval, and comparative interpretation of ambulatory ECGs. This report also addresses evolving techniques expected in the near future.

Computers↗

A program for handling data obtained by 'blind' histopathological evaluations.

An interactive data input, storage, retrieval and treatment system (LAMES) is described for use in histopathological studies where pathologists evaluate tissues without any identification (termed evaluations which are 'blind'). The system produces the mean values of individual groups within an experiment, and results of statistical comparisons between the groups. The system was implemented on a Hewlett-Packard (HP) 1000-F minicomputer operating under RTE-6/VM, and was written using FORTRAN IV.

Computers↗

Computer-assisted mapping with the light microscope.

With the system described specific features in a histological section such as neuronal degeneration, specific cell types, or the silver grains of autoradiography can be accurately localized. It is simple to operate, and allows for data storage and retrieval. The system consists of a Zeiss Universal microscope equipped with stepping motor drives on the X and Y axes and interfaced to a PDP-12 computer equipped with a printer/plotter. The user controls the system through a joystick control box and teletype. In spite of magnification changes all points in the field remain constant relative to a point of origin selected at the beginning of the mapping sequence. Therefore, the outline and major features of a section are entered at low magnification while the detail of neuronal degeneration, for example, is added in its precise location at a higher magnification. The plotting of points can be done in either random fashion or in a systemized series of horizontal or vertical scans. A graphic display is available throughout the procedure and all maps are both printed on a Versatec printer/plotter and stored on a disk for future recall and analysis. Use of the system in plotting neuronal degeneration is described.

Animals↗

Temporal reasoning and temporal data maintenance in medicine: issues and challenges.

We present a brief, nonexhaustive overview of research efforts in designing and developing time-oriented systems in medicine. The growing volume of research on time-oriented systems in medicine can be viewed from either an application point of view, focusing on different generic tasks (e.g. diagnosis) and clinical areas (e.g. cardiology), or from a methodological point of view, distinguishing between different theoretical approaches. In this overview, we focus on highlighting methodological and theoretical choices, and conclude with suggestions for new research directions. Two main research directions can be noted: temporal reasoning, which supports various temporal inference tasks (e.g. temporal abstraction, time-oriented decision support, forecasting, data validation), and temporal data maintenance, which deals with storage and retrieval of data that have heterogeneous temporal dimensions. Efforts common to both research areas include the modeling of time, of temporal entities, and of temporal queries. We suggest that tasks such as abstraction of time-oriented data and the handling of different temporal-granularity levels should provide common ground for collaboration between the two research directions and fruitful areas for future research.

Artificial Intelligence↗

Schizophrenia: pathophysiological mechanisms--a synthesis.

A Nobel Symposium, 'Schizophrenia: Pathophysiological Mechanisms' was held in Stockholm, October 1-3, 1998. The topics ranged from etiology, genetics, neuropathology, neurotransmitter, brain imaging, to integrative aspects including cognition and language. The collective amount of information is already enormous and will rapidly increase with advances in molecular pathology, gene transcript profiling and non-invasive imaging techniques. Probably reflecting the complexity is the absence of a disease model that can accommodate the data and explain its roots. In the process of moving from simplistic mechanisms involving single or a few interacting neurotransmitters or circuits and turning to more complex interactive models, there is a need for improved data storage and retrieval. Stochastic search in chemical libraries for potential new drug candidates coupled with rational approaches in their final design may improve therapeutic efficacy.

Animals↗

A computer assisted follow up system for spinal cord injury patients.

The comprehensive care of patients with traumatic spinal cord injuries (SCI) necessitates, among other things, a structured, life-long follow up. The high consumption of medical care in chronic SCI patients, often a result of diseases affecting many different organ systems, soon causes the cumulated medical documentation to be extensive and therefore hard to survey. The possibilities for rational patient management, adequate quality assurance, and clinical research may improve considerably by computerisation of medical records. A computerised medical records system for SCI has recently been developed, using a semistructured medical record format for data input and a medical entity dictionary for facilitated data storage and retrieval. The principles for developing this computer-assisted follow up system are described.

Humans↗

Sulfur dioxide and tracheobronchial clearance in man.

Tracheobronchial clearance was measured in nine healthy, nonsmoking adults. Technetium Tc 99m albumin aerosol (mass median diameter, 3 mu; geometric standard deviation, 1.6) was inhaled as a bolus under controlled conditions to achieve reproducible deposition in large airways. Each subject was studied in three seperate three-hour experiments: twice under control conditions and once exposed to 5 ppm sulfur dioxide (pollutant exposure after aerosol inhalation). Lung retention of activity was measured using a gamma camera interfaced to a data storage and retrieval system. The study showed that (1) Both deposition and clearance were highly reproducible in individuals in repeat control studies. (2) Acute exposure to 5 ppm sulfur dioxide had no significant effect (P greater than .05) on mucocillary clearance in resting healthy subjects, except perhaps for a small transient change (P=.05) after one hour. (3) Pulmonary function tests showed a decrease in maximal midexpiratory flow (P less than .01) but no other significant changes.

Adult↗

Development of a computer workstation for famine early warning and food security.

Beginning in 1990, the University of Arizona, Arizona Remote Sensing Center (ARSC) has been involved in a collaborative effort with the Global Information and Early Warning System (GIEWS) and the Remote Sensing Center of the Food and Agriculture Organization (FAO) of the United Nations in designing and developing an integrated computer workstation for famine early warning. The goal of the project is to provide food security analysts with a set of computer tools to manage a very large and diverse set of data for predicting the onset of food security emergencies for every country on Earth. The initial stage of the project involved the conceptual definition of system elements and the development of overall system architecture. We are now developing an open, flexible, and portable system designed to significantly assist the work of the analysts. System architecture provides a task-specific and user-friendly graphic user interface (GUI) within a Windows environment that will link image processing, geographic information system (GIS), spreadsheet, text, and graphics software packages into a single operational environment. A relational database management system (RDBMS) is serving as the back-end of the workstation to facilitate data storage and retrieval and as a means to preserve analysis methodologies.

Computer Systems↗

The role of data organization in the evaluation of toxicology studies in drug application.

One goal of the FDA's ongoing New Drug Regulations rewrite project is to facilitate and expedite drug application review. We believe that this can be aided by improved and consistent organization of the submissions. Therefore, guidelines are being developed to assist applicants in preparing well-structured summaries and full report sections. The proposed format guideline for toxicology and related studies is not intended to increase the amount of documentation beyond what is already required by the GLP regulations, but rather to provide some principles for orderly and coherent submission to aid comparative review of various types of data within and between studies. Certain of these principles may also be applicable to submission of data during the IND. The computer's role as an important, even essential, adjunct to this process is clearly evident. However, it is particular important that data automation be flexible enough to recognize and reconcile the differing perspectives of data collection and storage, and data retrieval and organization to benefit scientific evaluation of a drug application. Examples of recurring problems in the submission of computerized toxicology data are presented to illustrate their frustrating or confounding effect on the scientific evaluation of drug applications.

Computers↗

An on-line electronic portal imaging system for external beam radiotherapy.

A digital imaging system has been constructed to obtain the treatment portal image of a patient during external beam radiotherapy. A DEC LSI-11/23 microcomputer controls a stepper motor, which moves a linear array of 256 silicon diodes to scan the radiation transmitted through the patient. The computer also processes the collected data to generate an image for displaying on a video monitor. The quality of the digital image is comparable to that of the conventional verification radiographs. Major advantages of the system include the speed and simplicity in data storage and retrieval and in its capability of direct comparison with simulation radiographs.

Humans↗

Accurate and systematic numerical recording system for the identification of various types of lip and maxillary clefts (RPL system).

Inaccuracies exist in identifying and recording various types of oral cleft. One of the major reasons for this problem is that no efficient or universally accepted recording system presently exists. The RPL system introduced in this article provides an accurate and systematic numerical recording for the identification of various types of lip and maxillary clefts. The simplicity of the system allows quick and efficient data storage and retrieval.

Alveolar Process↗

Where does informatics fit in health care organizations?

Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.

Computer Communication Networks↗

Transcriptome analysis and related databases of Lactococcus lactis.

Several complete genome sequences of Lactococcus lactis and their annotations will become available in the near future, next to the already published genome sequence of L. lactis ssp. lactis IL 1403. This will allow intraspecies comparative genomics studies as well as functional genomics studies aimed at a better understanding of physiological processes and regulatory networks operating in lactococci. This paper describes the initial set-up of a DNA-microarray facility in our group, to enable transcriptome analysis of various Gram-positive bacteria, including a ssp. lactis and a ssp. cremoris strain of Lactococcus lactis. Moreover a global description will be given of the hardware and software requirements for such a set-up, highlighting the crucial integration of relevant bioinformatics tools and methods. This includes the development of MolGenIS, an information system for transcriptome data storage and retrieval, and LactococCye, a metabolic pathway/genome database of Lactococcus lactis.

Databases, Nucleic Acid↗

[Computer-assisted drug information].

Experience with a university hospital based drug information service (DIS) is reported. A total of 501 drug related questions were analyzed during two prospective evaluation periods of 13 and 14 months' duration respectively. Information was requested by physicians and pharmacists chiefly on practical aspects of drug treatment in individual patients (77%), such as drug choice, dosage adaptation, side effects and interactions. Inquiries on drug safety in pregnancy and lactation (8.8%), and questions on pharmaceutical properties (14.2%), including pharmacokinetics, were also frequent. Our experience indicates that a problem-oriented, comprehensive DIS necessitates close cooperation between physicians trained in clinical pharmacology and pharmacists within the same team. The use of electronic media greatly facilitates the collection of drug related information, data retrieval and storage. Drug information services can contribute to improved quality and safety of drug therapy.

Computers↗