Optical imaging of apoptosis as a biomarker of tumor response to chemotherapy

A rapid and accurate assessment of the antitumor efficacy of new therapeutic drugs could speed up drug discovery and improve clinical decision making. Based on the hypothesis that most effective antitumor agents induce apoptosis, we developed a near-infrared fluorescent (NIRF) annexin V to be used for optical sensing of tumor environments. To demonstrate probe specificity, we developed both an active (i.e., apoptosis-recognizing) and an inactive form of annexin V with very similar properties (to account for nonspecific tumor accumulation), and tested the agents in nude mice each bearing a cyclophosphamide (CPA) chemosensitive (LLC) and a chemoresistant LLC (CR-LLC). After injection with active annexin V, the tumor-annexin V ratio (TAR; tumor NIRF/background NIRF) for untreated mice was 1.22+/-0.34 for LLC and 1.43+/-0.53 for CR-LLC (n=4). The LLC of CPA-treated mice had significant elevations of TAR (2.56+/-0.29, P=.001, n=4), but only a moderate increase was obtained for the CR-LLC (TAR=1.89+/-0.19, P=.183). The in vivo measurements correlated well with terminal deoxyribosyl transferase-mediated dUTP nick end labeling indexes. When inactive Cy-annexin V was used, with or without CPA treatment and in both CCL and CR-CCL tumors, tumor NIRF values ranged from 0.91 to 1.17 (i.e., tumor were equal to background). We conclude that active Cy-annexin V and surface reflectance fluorescence imaging provide a nonradioactive, semiquantitative method of determining chemosensitivity in LLC xenografts. The method maybe used to image pharmacologic responses in other animal models and, potentially, may permit the clinical imaging of apoptosis with noninvasive or minimally invasive instrumentation.     

Permeability of human intestinal mucosa using a continuous flow-through perfusion system

Continued interest in in vitro methods for performing bioavailability/bioequivalence (BA/BE) studies for drug registration purposes, prompted us to investigate the suitability of a continuous flow-through perfusion system to determine diffusion of a wide variety of permeants, through human intestinal mucosa. Permeability of fresh and frozen intestinal mucosa towards water, 17beta-estradiol, sumatriptan, arecoline and vasopressin was compared. Furthermore, diffusion studies of water, sumatriptan, arecoline, arecaidine, estradiol, cyclosporin and vasopressin across frozen/thawed intestinal mucosa specimens (-85 degrees C) were performed. No statistically significant differences between the flux values of the five compounds tested across fresh and frozen intestinal tissue, were found. Furthermore, it was demonstrated that the flux rates of the various compounds across these tissues decreased with increasing molecular size. However, the flux rates across frozen intestinal mucosa for compounds with molecular weights >300 Da, were low. Flux rates for the compounds studied across frozen/thawed human vaginal and buccal mucosa were 36-160% higher than those across frozen intestinal mucosa. We concluded that the continuous flow-through perfusion system used shows promise as an in vitro method for permeability determination through intestinal mucosa. However, other human mucosa e.g. vaginal mucosa, may have to be considered as alternatives to intestinal mucosa if therapeutic agents with molecular weights >500 Da are to be compared for in vitro BA/BE purposes, and further studies in this respect are warranted.     

Learning about interagency collaboration: trialling collaborative projects between hospitals and community health services

Interagency collaboration has increasingly been viewed as an important strategy to encourage the co-ordination of healthcare. It is seen to have a number of positive outcomes, including: improved service delivery for people requiring multiple services; more efficient use of healthcare resources; and a means for managers to share the responsibility of community care and reduce organizational stress caused by pressures of increasing demand for services within a climate of cost containment. However, establishing collaborative interagency relationships can be a challenging, long-term and complex process. The present article describes some of the findings of a research project that evaluated collaborative strategies adopted and trialed by a group of four publicly funded healthcare agencies in the southern metropolitan area of Adelaide, South Australia. Key findings from the literature about the factors supporting and impeding collaboration are discussed in the light of some of the findings from the evaluation project. Some of the themes emerging from the Adelaide study include: the need for resources for change; experience of multidisciplinary work; professional barriers to collaboration; the importance of agreed aims, agendas and project ownership; and the importance of supportive leadership. This article concludes with a discussion of the difficulties and opportunities for collaboration between community-based primary healthcare agencies and acute care hospitals. The development of partnerships which are either based on trust, or on the open negotiation of power differences and professional territories, and the management of mistrust are found to be important foundations for achieving greater genuine collaboration between primary and tertiary level healthcare.     

Vaginal calculus as a late complication of bladder exstrophy

STUDY OBJECTIVE: To document an unusual finding of a vaginal calculus in a patient with bladder exstrophy. DESIGN: Case report. SETTING: Tertiary Centre, Royal Children's Hospital, Melbourne, Australia. PARTICIPANTS: Fourteen year old female. INTERVENTIONS: Cystotomy, introitoplasty. MAIN OUTCOME: Removal of vaginal calculus. MEASURES: None. RESULTS: Documentation and removal of a vaginal calculus. CONCLUSIONS: Vaginal calculi should be included in the differential diagnosis of urolithiasis in patients with bladder exstrophy.     

Comparative in vitro permeability of human vaginal,small intestinal and colonic mucosa

Our previous experience with a continuous flow-through perfusion system has demonstrated its usefulness for studying diffusion kinetics of drugs across small intestinal mucosa for bioavailability/bioequivalence (BA/BE) studies. During the last decade, delivery of drugs to the colon for systemic absorption as well as for local delivery in certain colonic diseases, has been extensively investigated. For this reason, we sought to assess the in vitro comparative permeability of human vaginal, small intestinal and colonic mucosa using a flow-through perfusion method. It was clear from our studies that human colonic epithelium was statistically significantly (P<0.05) more permeable to water, 17beta-estradiol, arecoline and arecaidine than intestinal mucosa. However, both these mucosae were statistically significantly less permeable to the above four permeants than human vaginal mucosa. As previously shown for small intestinal mucosa, the low in vitro permeability of colonic mucosa to drugs with molecular weight >300Da may necessitate using other epithelial membranes, e.g. vaginal mucosa, as alternative barriers for in vitro BA/BE studies. We also concluded that the flow-through mucosal perfusion system used in our laboratory is therefore also potentially useful for determining the permeability of a therapeutic agent from the colon for registration purposes.     

Proteomic analysis of pharmacologically preconditioned cardiomyocytes reveals novel phosphorylation of myosin light chain 1

Proteomic analysis of rabbit ventricular myocytes revealed a novel posttranslational modification to myosin light chain 1 (MLC1), consisting of phosphorylation at two sites. Subproteomic extraction to isolate myofilament-enriched fractions enabled determination of the extent of phosphorylation, which increased from 25.7+/-1.6% to 34.0+/-2.7% (mean+/-SE, n=4; P<0.05) after adenosine treatment at levels sufficient to pharmacologically precondition the myocytes (100 micromol/L). Mass spectrometry of MLC1 tryptic digests identified two peptide fragments modified by phosphorylation. These two phosphopeptides were characterized by peptide mass fingerprinting to determine the phosphorylation sites within rabbit ventricular MLC1, which correspond to Thr69 and Ser200 of rat MLC1, and to Thr64 and Ser194 or 195 of human MLC1. This proteomic analysis of preconditioned myocardium has revealed a previously unsuspected in vivo posttranslational modification to MLC1.