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Enhancers of the non-peroxidative metal porphyrin chemiluminescence reaction.

Metal porphyrins catalyse luminol chemiluminescence at pH13 without added peroxide. The effects of 22 different surface active compounds on this reaction were studied using six metal porphyrins and one metal porphyrin conjugate. The most active catalyst was Mn-meso-tetra(4-sulphonatophenyl)porphine. Tween-20 enhanced the activity of this catalyst best at a Tween-20 to luminol ratio of 74:1. However, lauryl sulphate enhanced best at an optimum lauryl sulphate to luminol ratio of over 1000:1 and both detergents enhanced the reaction when present below their critical micelle concentrations. Negatively charged aliphatic compounds such as fatty acids enhanced the reaction but positive-charged aliphatic compounds inhibited it. Small differences in enhancer structure resulted in differing enhancement. For example, linoleic acid enhanced Mn-meso-tetraphenyl porphine more than 10-fold, yet linolenic acid inhibited this catalyst. Conjugation of a metal porphyrin to antibody did not influence its enhancement by detergents. The results indicate that the enhancement mechanism does not require formation of pure detergent micelles but that direct association between enhancer and catalyst may be important.

Hydrogen-Ion Concentration↗

Effect of permeation enhancer pretreatment on the iontophoresis of luteinizing hormone releasing hormone (LHRH) through human epidermal membrane (HEM).

A 2 x 2 factorial design was performed to determine the effect of a permeation enhancer (oleic acid/propylene glycol), iontophoresis (2 V), and the combination of the two treatments on the permeation enhancement of a model peptide, LHRH (luteinizing hormone releasing hormone), through human epidermal membrane (HEM). In parallel studies, TEAB (tetraethylammonium bromide, a small ionic solute) and sucrose (an electroosmotic flow marker) were also investigated. Structural changes in the HEM were monitored via conductance measurements, differential scanning calorimetry (DSC), and infrared (IR) spectroscopy experiments. LHRH enhancement due to enhancer in combination with iontophoresis (I + E; 29.5 times passive permeability, P), was greater than during iontophoresis alone (I; 14.3) and enhancer treatment alone (E; 3.5). I + E had an additive effect of I and E, indicating the mechanisms of action of the individual enhancement strategies were likely to be located at different sites in the skin. Also, no synergistic enhancement was observed with I + E for either TEAB or sucrose. For TEAB, permeability enhancement due to I (approximately 1400) was much higher than that due to E (14.9), and no additive effect could be detected. For sucrose, E had no effect on either passive or iontophoretic permeability, eliminating the possibility that electroosmosis could explain increases in LHRH permeability. Evidence of synergy between E and I was found, with conductance measurements indicating that I + E synergistically increased the membrane permeability to conducting ions (Na+ and Cl-). It appears these pathways were not available for transport for the solutes used in the current study. DSC and IR investigations showed significant changes in stratum corneum lipid structure following E treatment but not following I. These findings probably arise from the localized action of iontophoresis compared with the bulk action of enhancer. In summary, increased LHRH delivery through HEM in vitro can be achieved using an enhancer in combination with iontophoresis.

Calorimetry, Differential Scanning↗

Mechanistic study of alkyl azacycloheptanones as skin permeation enhancers by permeation and partition experiments with hairless mouse skin.

In previous studies (Yoneto et al., 1995. J Pharm Sci 84:312-317; Kim et al., 1992. Int J Pharm 80:17-31; and Warner et al., 2001. J Pharm Sci 90:1143-53), the transport enhancing effects of four homologous series of enhancers-the n-alkanols, 1-alkyl-2-pyrrolidones, 1,2-alkanediols, and N,N-dimethylalkanamides - on the transport of steroidal permeants across hairless mouse skin (HMS) were investigated. Isoenhancement concentrations are defined as the aqueous concentrations for which different enhancers induce the same extent of permeant transport enhancement, E, for the lipoidal pathway of the stratum corneum (SC). Our studies have shown that the E = 10 isoenhancement concentrations of these four homologous series were nearly the same when compared at the same n-alkyl group chain length and therefore that the contribution of the polar head group toward the enhancer potency was found to be essentially constant. In the present study, we have determined the isoenhancement concentrations (E = 10) for the 1-alkyl-2-azacycloheptanone series [1-butyl-2-azacycloheptanone (BAZ), 1-hexyl-2-azacycloheptanone (HAZ), and 1-octyl-2-azacycloheptanone (OAZ)] and compared the results with those of the previously studied four homologous series. We have found that the E = 10 isoenhancement concentrations (aqueous phase concentrations) of the 1-alkyl-2-azacycloheptanones (Azs) are around 10 times lower than those for the previously studied four homologous series when compared at the same alkyl group chain length. This indicates an approximately 10 times higher potency of Azs. This finding was a point of interest because the polar group of Azs is similar to that of 1-alkyl-2-pyrrolidones (Aps). To further probe the nature of the mechanism of action of the Azs and Aps and to better understand the lower E = 10 isoenhancement concentrations found with the Azs, it was decided (a) to determine the equilibrium partitioning (uptake) of the Azs and the Aps from the aqueous phase into the HMS SC at E = 10, and (b) to determine the equilibrium partitioning (uptake) of a surrogate permeant, estradiol (E2beta), into the SC in the absence of and in the presence of Azs and Aps at E = 10. The following were the outcomes from the two partitioning studies. Firstly, at the E = 10 isoenhancement concentrations, the extent of partitioning (uptake) of the Azs and Aps into the intercellular lipids of the HMS SC was found to be approximately the same, even though the E = 10 isoenhancement concentrations (aqueous phase concentrations) of the Aps were around 10 times greater than those of the Azs. We interpret this to mean (whereas the potencies of the Azs are around ten times greater than those of the Aps when related to their aqueous concentrations) that the potencies of the two enhancer series are about the same when expressed in terms of their concentrations in the intercellular lipid phase of the SC. Another outcome of the partitioning studies has been the finding that the extent of partitioning into the intercellular lipids of the SC at E = 10 isoenhancement conditions for both the Azs and Aps is essentially independent of the n-alkyl chain length (from butyl to octyl). A third result from these experiments has been that the partitioning of E2beta (the surrogate permeant) into the HMS SC under E = 10 isoenhancement concentration conditions is approximately the same with the Aps and Azs as enhancers. For both the Aps and Azs, the E2beta SC partitioning enhancement was found to be in the range of 5-6 at E = 10. This comparable partitioning enhancement for E2beta in the presence of Aps and Azs at E = 10 suggests that the same mechanism was involved and that these enhancers act, in part but to a significant extent, by inducing a higher partitioning tendency of the permeant into the transport rate-limiting lipoidal domains of the SC. (c) 2003 Wiley-Liss, Inc. and the American Pharmaceutical Association J Pharm Sci 92:297-310, 2003

Algorithms↗

Effects of four penetration enhancers on corneal permeability of drugs in vitro.

The usefulness of penetration enhancers in promoting drug permeation across the cornea was investigated for drugs varying from hydrophilic to lipophilic. Four purported penetration enhancers [Azone (laurocapram), hexamethylenelauramide, hexamethyleneoctanamide, and decylmethylsulfoxide] were employed. Corneal permeability coefficients of drugs that were either hydrophilic (acetazolamide, cimetidine, guanethidine, and sulfacetamide), moderately lipophilic (bunolol and prednisolone), or lipophilic (flurbiprofen and its amide analogue) were measured in the absence or in the presence of various Azone concentrations. The effects of penetration enhancers on the corneal penetration of cimetidine were also compared. The corneal penetration of hydrophilic compounds was enhanced by at least 20-fold at 0.1% Azone. For prednisolone and bunolol, the maximal enhancement was at 0.025-0.1% Azone and was marginal (two- to 5-fold), whereas Azone inhibited rather than enhanced the corneal penetration of the lipophilic flurbiprofen and its amide analogue. All four enhancers behaved similarly in enhancing corneal penetration of cimetidine and corneal hydration after incubation in vitro. Possible mechanisms of penetration enhancers on corneal drug penetration were discussed. Penetration enhancers may have clinical benefits in improving ocular drug delivery of hydrophilic compounds, however, their utility may depend on the toxicological profiles.

Animals↗

Investigation of an enhanced resolution triple quadrupole mass spectrometer for high-throughput liquid chromatography/tandem mass spectrometry assays.

Triple quadrupole mass spectrometers, when operated in multiple reaction monitoring (MRM) mode, offer a unique combination of sensitivity, specificity, and dynamic range. Consequently, the triple quadrupole is the workhorse for high-throughput quantitation within the pharmaceutical industry. However, in the past, the unit mass resolution of quadrupole instruments has been a limitation when interference from matrix or metabolites cannot be eliminated. With recent advances in instrument design, triple quadrupole instruments now afford mass resolution of less than 0.1 Dalton (Da) full width at half maximum (FWHM). This paper describes the evaluation of an enhanced resolution triple quadrupole mass spectrometer for high-throughput bioanalysis with emphasis on comparison of selectivity, sensitivity, dynamic range, precision, accuracy, and stability under both unit mass (1 Da FWHM) and enhanced (<or=0.1 Da FWHM) resolution. The advantage of enhanced resolution was demonstrated in the case of mometasone with polypropylene glycol (PPG) interference. At unit mass resolution, the transmitted precursor ion from the first quadrupole contained not only protonated molecules from mometasone, but also PPG interference. At enhanced resolution only selected mometasone peaks were transmitted, and no interference from PPG was detected. Sensitivity of the instrument was demonstrated with 10 femtograms of descarboethoxyloratadine injected on-column, for which a signal-to-noise (S/N) ratio of 24 was obtained for MRM chromatograms at both unit and enhanced resolution. Absolute signals obtained at enhanced resolution were about one-third those obtained at unit mass resolution. However, S/N was maintained at enhanced resolution due to the proportional decrease in noise level. Finally, the stability of the instrument operating at enhanced resolution was demonstrated during an overnight 17 h period that was used to validate a liquid chromatography/tandem mass spectrometry (LC/MS/MS) assay for the quantitation of loratadine and descarboethoxyloratadine in human plasma. Assay performances (dynamic range, correlation coefficients for standard curves, precision and accuracy for QC samples) under unit and enhanced resolution were both within current pharmaceutical and regulatory guidelines demonstrating the stability of the mass spectrometer operating at enhanced resolution for typical bioanalytical high-throughput applications.

Calibration↗

Modulation of phagocytosis and intracellular bactericidal activity of polymorphonuclear and mononuclear cells by cationic proteins from human granulocytes: alternative pathway of phagocytic enhancement.

Cationic lysosomal proteins from human polymorphonuclears (PMN) were isolated by column chromatography and divided into five fractions. On acrylamide gel electrophoresis, fraction I had four bands slower than lysozyme (LZM) mobility; fraction II had five or six bands slower than LZM; fraction III had at least seven bands slower and two bands faster than LZM; fraction IV contained LZM, two bands faster and a few faint bands slower than LZM; fraction V was composed of almost pure LZM. Partial characterization of the fractions showed presence of neutral protease in fractions I-IV, chymotrypsin in fraction III, lysozyme in fractions IV and V, and phospholipase A2 mainly in fractions II and III. Modulatory activity of fractions I-V were tested at concentrations up to 50 micrograms/ml. Enhancement of phagocytosis of Staphylococcus aureus was observed by fractions I, IV, and V, whereas phagocytic index was enhanced by all but the fraction II. Intracellular bactericidal activity (ICBA) was markedly enhanced by fractions I, II, and V. Addition of DNA or cytochalasine B inhibited or abolished phagocytosis-enhancing activity of cationic fractions. Their influence on ICBA was much less pronounced. Fraction III enhanced phagocytic index and phagocytosis of E. coli, whereas fractions I and II enhanced intracellular bactericidal activity against this bacteria. Enhancement of phagocytic activity of monocytes has also been observed. The data suggest that some cationic lysosomal fractions from human PMNs enhance phagocytosis and phagocytic index by human PMNs and monocytes and intracellular bactericidal activity of human PMNs. This alternative pathway of phagocytic enhancement is unrelated to the previously described enhancers of phagocytosis and may play a role in defense mechanisms against infection.

Blood Proteins↗

The amphiphilic peptide adenoregulin enhances agonist binding to A1-adenosine receptors and [35S]GTP gamma S to brain membranes.

1. Adenoregulin is an amphilic peptide isolated from skin mucus of the tree frog, Phyllomedusa bicolor. Synthetic adenoregulin enhanced the binding of agonists to several G-protein-coupled receptors in rat brain membranes. 2. The maximal enhancement of agonist binding, and in parentheses, the concentration of adenoregulin affording maximal enhancement were as follows: 60% (20 microM) for A1-adenosine receptors, 30% (100 microM) for A2a-adenosine receptors, 20% (2 microM) for alpha 2-adrenergic receptors, and 30% (10 microM) for 5HT1A receptors. High affinity agonist binding for A1-, alpha 2-, and 5HT1A-receptors was virtually abolished by GTP gamma S in the presence of adenoregulin, but was only partially abolished in its absence. Magnesium ions increased the binding of agonists to receptors and reduced the enhancement elicited by adenoregulin. 3. The effect of adenoregulin on binding of N6-cyclohexyladenosine ([3H]CHA) to A1-receptors was relatively slow and was irreversible. Adenoregulin increased the Bmax value for [3H]CHA binding sites, and the proportion of high affinity states, and slowed the rate of [3H]CHA dissociation. Binding of the A1-selective antagonist, [3H]DPCPX, was maximally enhanced by only 13% at 2 microM adenoregulin. Basal and A1-adenosine receptor-stimulated binding of [35S]GTP gamma S were maximally enhanced 45% and 23%, respectively, by 50 microM adenoregulin. In CHAPS-solubilized membranes from rat cortex, the binding of both [3H]CHA and [3H]DPCPX were enhanced by adenoregulin. Binding of [3H]CHA to membranes from DDT1 MF-2 cells was maximally enhanced 17% at 20 microM adenoregulin. In intact DDT1 MF-2 cells, 20 microM adenoregulin did not potentiate the inhibition of cyclic AMP accumulation mediated via the adenosine A1 receptor. 4. It is proposed that adenoregulin enhances agonist binding through a mechanism involving enhancement of guanyl nucleotide exchange at G-proteins, resulting in a conversion of receptors into a high affinity state complexed with guanyl nucleotide-free G-protein.

Adenosine↗

Rheumatoid factor modulation of neutrophil superoxide generation enhancing activity of preformed immune complexes.

Heat aggregated human (HAG) IgG pretreated with total rheumatoid factors isolated from the serum of rheumatoid arthritis patients showed decreased superoxide generation enhancing activity as compared with HAG pretreated with buffer alone. Similarly, monoclonal IgM rheumatoid factor isolated from the serum of a patient with macroglobulinemia complicated by rheumatoid arthritis inhibited superoxide generation enhancing activity of HAG. On the other hand, superoxide generation enhancing activity of BSA-antiBSA immune complexes was not affected by preincubation with rheumatoid factors isolated from the sera of either rheumatoid arthritis patients or the macroglobulinemia patient. Rheumatoid factors isolated from rheumatoid arthritis serum were fractionated by high performance liquid chromatography and IgM-class and IgG-class rheumatoid factors were obtained. IgG-class rheumatoid factor significantly enhanced the superoxide generation enhancing activity of HAG, whereas IgM rheumatoid factor inhibited it. Rheumatoid arthritis sera showed significantly higher superoxide generation enhancing activity than normal sera. HAG preincubated with rheumatoid arthritis sera showed significantly lower superoxide generation enhancing activity than HAG preincubated with normal sera. These results suggest that factors inhibiting superoxide generation enhancing activity of HAG are present in rheumatoid arthritis sera, and that the responsible is IgM rheumatoid factor, whereas IgG rheumatoid factor enhances it. The factors that express superoxide generation enhancing activity in rheumatoid arthritis sera are suggested to be intermediate size immune complexes.

Antigen-Antibody Complex↗

Focal nodular hyperplasia of the liver: detection and characterization with plain and dynamic-enhanced MRI.

BACKGROUND: We compared nonenhanced and dynamic gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) appearances of hepatic focal nodular hyperplasia (FNH) as depicted with breath-hold MR sequences and assessed the detectability of the individual MR sequences used. METHODS: We retrospectively reviewed 48 consecutive patients with FNH. All patients underwent nonenhanced (T1 fast low-angle shot [FLASH] and T2 half-Fourier acquisition [HASTE]) and dynamic Gd-enhanced (T1 FLASH) MRI between December 1997 and March 2000. Individual MR sequences were analyzed separately for number of lesions, signal intensity features, dynamic enhancement pattern, and the presence and enhancement profile of a central scar. Ninety-five percent confidence intervals of absolute discrepancy were calculated to define differences in lesion detection. RESULTS: Seventy-seven lesions were found in 48 patients. Nonenhanced FLASH imaging depicted 59 (76.6%) lesions in 45 patients. HASTE images showed 55 (71.4%) lesions in 44 patients. On T1- and T2-weighted images, lesions appeared predominantly hypointense (69.5%) and hyperintense (72.7%), respectively. Arterial and portal venous dominant phase Gd-enhanced MRI demonstrated all 77 lesions (100%), most of which showed hypervascular (94.8%), homogeneous (97.4%), and incomplete (except the central scar: 58.4%) enhancement in the arterial phase. Portal venous phase images showed lesion isointensity (50.6%) or moderate hyperintensity (46.8%) with complete enhancement (central scar: 94.8%). A central scar was detected on nonenhanced T1-weighted images (hypointense: 100%), T2-weighted images (hyperintense: 100%), arterial phase (hypointense: 59.7%) and portal venous phase (hyperintense: 71.4%) Gd-enhanced images in 78%, 69.1%, 77.9%, and 75.3% of tumors, respectively. CONCLUSION: Arterial and portal venous phase Gd-enhanced T1-weighted sequences are superior to nonenhanced images in the detection of FNH. Typical MRI appearances include hypointensity on T1-weighted and hyperintensity on nonenhanced T2-weighted images. Most commonly, FNH shows a homogeneous (without scar) and strong enhancement during the arterial phase, with lesion isointensity or slight hyperintensity during the portal venous phase.

Adult↗

Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization.

BACKGROUND: To assess unenhanced and gadolinium-enhanced magnetic resonance (MR) imaging patterns of hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). METHODS: Thirty-two patients with 48 HCC lesions underwent MR imaging before and 15 days after TACE. Fifteen lesions were then surgically resected. The remaining 33 lesions were not removed and were followed up with MR imaging at 3, 6, 12, and 18 months after treatment. Spin echo (SE) T1- and T2-weighted and gadolinium-enhanced SE T1-weighted sequences were employed. Qualitative evaluation of signal intensity pattern of the treated lesions was performed in all cases. Histological evaluation and selective hepatic arteriography were considered the gold standard of the study for the 15 resected lesions and the 33 unresected lesions, respectively. RESULTS: On follow-up enhanced T1-weighted images of the 15 resected lesions, seven showed no area of enhancement corresponding to complete necrosis at histologic examination. The remaining eight resected lesions showed areas of enhancement; in six of these cases, viable tumor tissue was found at histology; in the other two lesions, histologic examination revealed the presence of complete tumor necrosis. In the group of resected lesions, T2-weighted images showed no pattern characteristic of necrosis. In 24 of 33 unresected lesions, loss of enhancement on follow-up enhanced T1-weighted images was a characteristic finding, which correlated to devascularization at arteriography. Of these 24 lesions, 17 were completely hypointense on follow-up T2-weighted images; the remaining seven showed small foci of hyperintensity. The other nine unresected lesions showed enhanced portions on follow-up enhanced T1-weighted images, which corresponded to hyperintense areas on T2-weighted images. These findings correlated to persistence of hypervascular areas at arteriography. CONCLUSION: Gadolinium-enhanced T1-weighted MR imaging is a reliable method for evaluating the outcome of TACE treatment and is more accurate than unenhanced T2-weighted MR imaging.

Aged↗

Nonpathological focal enhancements on spiral CT hepatic angiography.

BACKGROUND: To assess the frequency and characteristics of nonpathological focal enhancements seen on spiral computed tomographic (CT) hepatic angiography (CTA). METHODS: Spiral CTA and spiral CT arterial portography (CTAP) were performed in 31 patients with suspected liver malignancy prior to potential liver resection. The CTA images were retrospectively reviewed for focal enhancements by two radiologists. After determining nonpathological focal enhancements on CTA images based on the other radiographic tests, surgical exploration including intraoperative sonography, follow-up imagings, the frequency, size, site, and shape of nonpathological focal enhancements with CTA were assessed. RESULTS: Thirty-six nonpathological focal enhancements with CTA from 4 to 23 (mean = 11. 4) mm were seen in 14 (45.2%) of 31 patients. Thirteen (36.1%) of 36 nonpathological focal enhancements with CTA were not depicted with CTAP. Nonpathological focal enhancements with CTA were frequent in Couinaud segments III (27.8%), V (22.2%), and VI (19.4%). Twenty-three (63.9%) of 36 nonpathological focal enhancements were located in the edge of the liver. Shapes of 36 nonpathological focal enhancements with CTA included circular (n = 16), worm (n = 7), irregular (n = 6), dot (n = 6), and wedge (n = 1). CONCLUSION: In nearly half of patients, spiral CTA shows various shapes of small nonpathological focal enhancements more frequently in the liver edge.

Aged↗

Dynamic contrast-enhanced MR imaging in monitoring response to isolated limb perfusion in high-grade soft tissue sarcoma: initial results.

The objective of this study was to evaluate whether dynamic contrast-enhanced MR imaging can determine tumor response and localize residual viable tumor after isolated limb perfusion (ILP) chemotherapy in soft tissue tumors. Twelve consecutive patients, with histologically proven high-grade soft tissue sarcoma, prospectively underwent non-enhanced MR and dynamic contrast-enhanced MR imaging before and after ILP. Tumor volume was measured on non-enhanced MR images. The temporal change of signal intensity in a region of interest on dynamic contrast-enhanced MR images was plotted against time. Start, pattern, and progression of enhancement were recorded. Histopathologic response was defined as complete response if no residual viable tumor was present, partial remission if <50% viable tumor was present, and no change if > or =50% viable tumor was present in the resection specimen. Resected specimens for correlation with histopathology were available for 10 patients; 5 patients had partial remission and 5 had no change. Volume measurements correctly predicted tumor response in 6 of 10 patients. Dynamic contrast-enhanced MR correctly predicted tumor response in 8 of 10 patients. Early rapidly progressive enhancement correlated histologically with residual viable tumor. Late and gradual, or absence of enhancement, was associated with necrosis, predominantly centrally located, or granulation tissue. These preliminary results show that dynamic contrast-enhanced MR imaging offers potential for non-invasive monitoring of response to isolated limb perfusion in soft tissue sarcomas due to identification of residual areas of viable tumor and subsequently may provide clinically useful information with regards to timing and planning of additional surgery. Further prospective studies in a larger patient population is warranted.

Antineoplastic Agents↗

Effect of natalizumab on conversion of gadolinium enhancing lesions to T1 hypointense lesions in relapsing multiple sclerosis.

BACKGROUND: Natalizumab, a humanized monoclonal anti-adhesion molecule antibody, reduces the frequency of new gadolinium (Gd) enhancing lesions and relapses in multiple sclerosis (MS). Its effect on evolution of new Gd enhancing lesions to T1 hypointense lesions is unknown. METHODS: 213 patients were randomized to receive 3 mg/kg or 6 mg/kg natalizumab or placebo monthly for 6 months and then followed for a further 6 months. A subset of patients who had one or more new gadolinium enhancing lesions from Month 0 to Month 6 and available electronic data were analysed. Each new Gd enhancing lesion that developed during treatment (months 1-6) was investigated for conversion to a new T1 hypointense lesion at month 12. Lesions were classified as large or small if their cross-sectional area was greater or less than 20 mm2. Because of the similarity of both doses of natalizumab on the frequency of new Gd enhancing lesions, the two natalizumab arms were combined in all analyses. RESULTS: Compared with the placebo group, the natalizumab group exhibited significant decreases in: (i) the proportion of patients with new Gd enhancing lesions that evolved to T1-hypointense lesions (10/38 [26 %] versus 27/40 [68 %]; p<0.01); (ii) the proportion of patients who developed large T1 hypointense lesions (2/38 [5 %] versus 16/40 [40 %]; p<0.01); (iii) the proportion of new Gd enhancing lesions that became T1 hypointense (11/75 [15 %] versus 118/466 [25 %]; p=0.045); (iv) the mean proportion per patient of new Gd enhancing lesions that converted to T1-hypointense lesions (0.15 versus 0.28; p=0.005), and (v) the odds ratio (OR) of converting from Gd enhancing to T1-hypointense lesions (OR=0.48; 95% CI=0.24, 0.94, p=0.031). CONCLUSION: Natalizumab significantly suppresses the evolution of new Gd enhancing to T1-hypointense lesions. This may reflect several mechanisms including reduced cell migration across the blood brain barrier, reduced T cell activation within lesions, an inhibitory effect on subsequent axonal damage within the new central nervous system lesion, and a reduced likelihood of recurrent lesion inflammation.

Adult↗

Contrast perfusion echocardiography: distribution and reproducibility of myocardial contrast enhancement in coronary artery disease.

A qualitative assessment was undertaken of the echocardiographic distribution of myocardial contrast enhancement after selective intracoronary injections of 2 ml of hand-agitated Urografin solution. The reproducibility and duration of contrast enhancement has also been examined. Forty-five contrast injections were given, 36 into the left and 6 into the right coronary arteries and 3 into bypass grafts of 28 patients undergoing diagnostic arteriography. Myocardial contrast enhancement occurred in 91% of cases. Although contrast enhancement appeared within the expected area of distribution of the artery infused, in no case was enhancement homogeneous. In 4 patients (1 of whom had undergone coronary bypass surgery), contrast enhancement also appeared in areas remote from the expected perfusion territory, in each case due to well established collateral supply seen angiographically. The contrast effect persisted for 71 +/- 26 seconds. Repeat injection in 5 patients (using identical echocardiographic windows) confirmed the reproducibility of the technique. No patient had symptoms related to the injections, although transient left ventricular wall motion abnormalities were observed in 3 cases. High-grade coronary stenoses did not affect distribution of myocardial contrast enhancement, although coronary occlusions produced well defined deficits. Thus, selective intracoronary injections of hand-agitated echocardiographic contrast medium produce regional myocardial enhancement, which probably reflects the perfusion territory of the artery. The technique is safe and reproducible in human subjects. Nevertheless, because regional enhancement after selective coronary injections is not homogeneous, analysis of enhancement deficits is unlikely to provide a clinically useful means of evaluating the functional significance of coronary stenoses.

Angiography↗

Enhancement of hepatic microsomal esterase activity following soman pretreatment in guinea pigs.

Soman (pinacolyl methylphosphonofluoridate), a highly toxic organophosphate compound, has been found to be a strong inhibitor of hepatic microsomal carboxylesterase in vitro, but an enhancer of carboxylesterase when administered in vivo. In response to this paradoxical observation, the objective of this study was to determine if soman could cause true enhancement of the metabolism of drugs in the guinea pig and, if so, to characterize the enhanced enzyme activity. Following the pretreatment of guinea pigs with 90% LD50 soman, enhancement of microsomal esterase activity was noted 12 and 24 hr after pretreatment. Using Michaelis-Menten enzyme kinetic studies, enhancement was found to occur with liver carboxylesterase and procaine esterase, but not with aniline hydroxylase. Since the soman-enzyme complex was known to undergo aging with the release of pinacolyl alcohol and the subsequent formation of pinacolone, the effects of these metabolites on the activity of liver microsomal enzymes in vitro were explored. Pinacolone and pinacolyl alcohol produced enzyme enhancement in vitro in a manner similar to that produced by soman pretreatment. These effects were compared with those made by acetone in the same incubations, since the enhancing influence of acetone has already been well documented. Similarity was found between the in vitro effects of acetone and the effects of pinacolone and pinacolyl alcohol. Lastly, the in vivo effects of pinacolone on the activities of the same liver microsomal enzymes were studied following pretreatment of the guinea pigs with 90% LDLo (lowest published lethal dose) pinacolone. Pretreating guinea pigs with pinacolone prior to killing them enhanced liver microsomal carboxylesterase and procaine esterase activities, but had no effect on microsomal aniline hydroxylase activity. This pattern of enzyme enhancement was similar to that observed after soman pretreatment. Therefore, soman was found to enhance hepatic microsomal esterase activity in the guinea pig in a manner similar to that seen with its metabolites, as well as acetone. This information may give insight into how the efficacy and toxicity of therapeutic drugs, other xenobiotics, and endogenous materials may be altered in individuals who survive an exposure to soman.

Acetone↗

The mechanism by which NBQX enhances NMDA currents in retinal ganglion cells.

When the quinoxaline NBQX (2,3-dihydroxy-6-nitro-7-sulfamoylbenzo (F) quinoxaline), a KA/AMPA antagonist, is bath applied to the tiger salamander retina, a paradoxical action is evident in the light-evoked synaptic responses of ganglion cells: NBQX enhances excitatory synaptic currents at light onset observed under whole-cell voltage-clamp conditions in a perfused retinal slice preparation. This observation was surprising because synaptic inputs into ganglion cells that are mediated by KA/AMPA receptors are entirely blocked by NBQX. Thus, the NBQX-enhanced current is entirely mediated by NMDA receptors. The purpose of this study was to determine the mechanism(s) by which blocking KA/AMPA receptors appears to enhance NMDA currents. Using hyperosmotic sucrose stimulation to activate neurotransmitter release from the inner retina, we observed that NBQX augmented the sucrose-evoked response, suggesting that at least a component of this enhancement may reside in the inner retina. NBQX does not enhance NMDA currents activated by bath applied NMDA, demonstrating that the NBQX-induced enhancement does not result from modulation of NMDA receptors. Voltage-clamp studies, carried out at the appropriate holding potential, indicate that NBQX enhances glutamatergic transmission and reduces inhibitory inputs onto ganglion cells. In the presence of strychnine and picrotoxin, the NBQX-induced enhancement of NMDA currents is eliminated, suggesting that NBQX facilitates the expression of NMDA currents by a selective and partial reduction of inhibitory mechanisms. Additional studies suggest that part of the NMDA enhancement by NBQX is evident at the postsynaptic level, but a presynaptic component probably also participates, perhaps at the level of bipolar cell terminals. One way to account for this observation is to assume that a subpopulation of inhibitory amacrine cells requires KA/AMPA receptors exclusively for their synaptic activation: previous studies of sustained amacrine cells support this interpretation. Thus the NBQX-induced enhancement phenomenon may reflect a network-selective distribution of NMDA and KA/AMPA receptors among third-order neurons.

Animals↗

Improved paracellular uptake by the combination of different types of permeation enhancers.

This study had the purpose to improve the paracellular uptake of drugs by combining the thiomer/reduced glutathione (GSH) permeation-enhancing system with a proteolytic enzyme. Due to the covalent binding of 2-iminothiolane to chitosan the thiomer chitosan-TBA (chitosan-4-thiobutylamidine) was obtained. Permeation studies were performed with freshly excised intestinal mucosa of guinea pigs mounted in Ussing-type chambers using on the one hand the low-molecular size marker flurescein (Na-Flu) and on the other hand the high-molecular size marker FITC-dextran. Apparent permeability coefficient (P(app)) as well as enhancement ratios (=P(app) permeation-enhancing system/P(app) control) were calculated. Trypsin, papain and bromelain displayed a permeation-enhancing effect for Na-Flu on the small intestinal mucosa. Enhancement ratios of 1.84, 1.63 and 1.78 were identified for 2% trypsin, 0.5% papain and 2% bromelain solutions, respectively. However, only bromelain could guarantee a significant permeation enhancement of FITC-dextran with a P(app) of 4.45+/-0.44 x 10(-6) cm/s representing an enhancement ratio of 1.57. A similar enhancement of FITC-dextran permeation was reached by the use of the chitosan-TBA (0.5%)/GSH (5%) system. Moreover, an additive permeation-enhancing effect of the chitosan-TBA/GSH system in combination with bromelain (2%) was observed, leading to a maximum P(app) of 5.91+/-0.51 x 10(-6) cm/s, which corresponds to an enhancement ratio of 2.1. According to these results, the combination of the thiomer/GSH system with bromelain might represent a new promising strategy in order to raise the in vivo efficacy of non-invasive administered hydrophilic macromolecular drugs.

Animals↗

Skin permeation enhancement potential of Aloe Vera and a proposed mechanism of action based upon size exclusion and pull effect.

The aim of this study was to determine in vitro the potential of Aloe Vera juice as a skin permeation enhancer; a secondary aim was to probe the extent to which Aloe Vera itself permeates the skin. Saturated solutions of caffeine, colchicine, mefenamic acid, oxybutynin, and quinine were prepared at 32 degrees C in Aloe Vera juice and water (control) and used to dose porcine ear skin mounted in Franz diffusion cells with water as receptor phase. Receptor phase samples were taken over a 48 h period and permeants determined by reverse-phase HPLC. For caffeine and mefenamic acid no significant enhancements occurred between Aloe Vera and water as vehicles (p>0.05). However, for colchicine, oxybutynin and quinine the presence of Aloe Vera within the formulation provided enhancements (p < or = 0.05). Enhancement potential was dependent upon the molecular weight of the drug in formulation, with the enhancement effect attributable to as yet unidentified components within the Aloe Vera. Colchicine, with a molecular weight of 399.44, achieved the best enhancement with an enhancement ratio of 10.97. No correlation with lipophilicity was apparent. In a further experiment, where freeze-dried Aloe Vera was reconstituted at 200% residue level, permeation of quinine was 2.8 x that from normal Aloe Vera, providing further evidence for the presence of an enhancing factor within Aloe Vera. Certain, although unidentified, components of Aloe Vera readily permeated skin and the relative amount by which they permeated skin was inversely related to the molecular weight of the drug in solution, thus enhancement ratio. A new mechanistic rationale is proposed whereby larger drug solutes inhibit the permeation of Aloe Vera components, but also are then able to interact more effectively with the enhancing factor and be subject to the pull effect.

Aloe↗