Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera: the "RAMP" Italian multicenter prospective study.

Ruxolitinib is beneficial in patients with myelofibrosis (MF) and polycythemia vera (PV). Information on ruxolitinib adherence is scant. The Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera (RAMP) prospective multicenter study (NCT06078319) included 189 ruxolitinib-treated patients. Patients completed the Adherence to Refills and Medications Scale (ARMS) and Distress Thermometer and Problem List (DTPL) at the earliest convenience, after registration in the study, and at later timepoints. At week-0, low adherence (ARMS > 14) and high distress (DT ≥ 4) were declared by 49.7% and 40.2% of patients, respectively. The main reason for low adherence was difficult ruxolitinib supply (49%), intentional (4.3%) and unintentional (46.7%) non-take. In multivariable regression analysis, low adherence was associated to male sex (p = 0.001), high distress (p < 0.001), and treatment duration ≥ 1 year (p = 0.03). Over time, rates of low adherence and high distress remained stable, but unintentional non-take decreased from 47.9% to 26.0% at week-48. MF patients with stable high adherence/low distress were more likely to obtain/maintain the spleen response at week-24. Low adherence to ruxolitinib represents an unmet clinical need that require a multifaceted approach, based on reason behind it (patients characteristics and treatment duration). Its recognition may help distinguishing patients who are truly refractory and those in need of therapy optimization.

Longitudinal Evaluation of Bone Mineral Density and Bone Metabolism Markers in Patients with Indolent Systemic Mastocytosis Without Osteoporosis.

Systemic Mastocytosis has been long identified as a potential cause of osteoporosis; nevertheless, data regarding longitudinal variation of bone mineral density (BMD) in patients with indolent systemic mastocytosis (ISM) are missing . We studied BMD variation at lumbar spine and proximal hip after 30-month (±6 months) follow-up in a large cohort of patients (83) with ISM without osteoporosis, supplementated with vitamin D and/or calcium when needed. We also analyzed the correlation between variation of BMD, basal serum tryptase levels and bone turnover markers (BTM). Sixty-four percent of our population was male; mean age was 52.1 (±11.5) years. Vitamin D insufficiency (serum levels of 25-OH-vitamin D, 25OHD, lower than 75 nmol/L) was found in more than 70 % of patients. After a follow-up of 30 ± 6 months with only vitamin D (5000-7500 IU weekly of oral cholecalciferol) or calcium (500 mg/die) supplementation when needed, we observed 2.1 % increase in BMD at lumbar spine, with no significant changes at hip. At the end of follow-up, almost 60 % of patients showed 25OHD serum levels still lower than recommended, despite vitamin D supplementation. Reduction in BMD after follow-up significantly correlated with high C-telopeptide of type I collagen serum levels at the time of diagnosis. In patients with ISM without osteoporosis, a routinary BMD evaluation within a time <2 years is not justified, except in the presence of elevated BTM. In these patients, vitamin D supplementation is frequently needed.

Differences among young adults, adults and elderly chronic myeloid leukemia patients.

BACKGROUND: The incidence of chronic myeloid leukemia (CML) increases with age, but it is unclear how the characteristics of the disease vary with age. In children, where CML is very rare, it presents with more aggressive features, including huge splenomegaly, higher cell count and higher blast cell percentage. PATIENTS AND METHODS: To investigate if after childhood the disease maintains or loses these characteristics of aggressiveness, we analyzed 2784 adult patients, at least 18 years old, registered by GIMEMA CML WP over a 40-year period. RESULTS: Young adults (YAs: 18-29 years old) significantly differed from adults (30-59 years old) and elderly patients (at least 60 years old) particularly for the frequency of splenomegaly (71%, 63% and 55%, P < 0.001), and the greater spleen size (median value: 4.5, 3.0 and 1.0 cm, P < 0.001). According to the EUTOS score, that is age-independent, high-risk patients were more frequent among YAs, than among adult and elderly patients (18%, 9% and 6%, P < 0.001). In tyrosine kinase inhibitors-treated patients, the rates of complete cytogenetic and major molecular response were lower in YAs, and the probability of transformation was higher (16%, 5% and 7%, P = 0.011). CONCLUSIONS: The characteristics of CML or the host response to leukemia differ with age. The knowledge of these differences and of their causes may help to refine the treatment and to improve the outcome. CLINICAL TRIAL NUMBERS: NCT00510926, NCT00514488, NCT00769327, NCT00481052.

Recovery of biological active catechol-O-methyltransferase isoforms from Q-sepharose.

The development of new catechol-O-methyltransferase inhibitors has led to an improvement in the treatment of Parkinson's disease. However, despite the fact that the soluble isoform has been extensively investigated, few studies have been published concerning membrane isoform chromatographic recovery and bioactivity levels. In this work, chromatographic profiles of both catechol-O-methyltransferase isoforms were compared using quaternary amine as a ligand to evaluate its activity levels and recovery rates. Results show that both proteins required different conditions for adsorption; the soluble isoform adsorption was performed at low ionic strength, while the membrane isoform required increasing linear salt gradient. However, the application of 0.5% Triton X-100 promoted membrane isoform adsorption even at low ionic strength. Indeed, chromatographic conditions of both isoforms became similar when detergents were applied. The developed methods also appear to be highly effective in bioactivity recovery, presenting rates of 107% for soluble protein and 67 and 91% for membrane isoform without and with detergents, respectively. The chromatographic strategies with and without detergents resulted in a 4.3- and sevenfold purification, respectively, corresponding to specific activity values of 331 and 496 nmol/h/mg. Thus, the use of Q-sepharose as anion exchanger was effective in the recovery of both enzymes, which is a requirement for further kinetic and pharmacological trials.

Treatment discontinuation following low-dose TKIs in 248 chronic myeloid leukemia patients: Updated results from a campus CML real-life study.

TKIs long-term treatment in CML may lead to persistent adverse events (AEs) that can promote relevant morbidity and mortality. Consequently, TKIs dose reduction is often used to prevent AEs. However, data on its impact on successful treatment-free remission (TFR) are quite scarce. We conducted a retrospective study on the outcome of CML subjects who discontinued low-dose TKIs from 54 Italian hematology centers participating in the Campus CML network. Overall, 1.785 of 5.108 (35.0%) regularly followed CML patients were treated with low-dose TKIs, more frequently due to relevant comorbidities or AEs (1.288, 72.2%). TFR was attempted in 248 (13.9%) subjects, all but three while in deep molecular response (DMR). After a median follow-up of 24.9 months, 172 (69.4%) patients were still in TFR. TFR outcome was not influenced by gender, Sokal/ELTS risk scores, prior interferon, number and last type of TKI used prior to treatment cessation, DMR degree, reason for dose reduction or median TKIs duration. Conversely, TFR probability was significantly better in the absence of resistance to any prior TKI. In addition, patients with a longer DMR duration before TKI discontinuation (i.e., >6.8 years) and those with an e14a2 BCR::ABL1 transcript type showed a trend towards prolonged TFR. It should also be emphasized that only 30.6% of our cases suffered from molecular relapse, less than reported during full-dose TKI treatment. The use of low-dose TKIs does not appear to affect the likelihood of achieving a DMR and thus trying a treatment withdrawal, but might even promote the TFR rate.

Carboxymethyl cellulose-based hydrogel film combined with berberine as an innovative tool for chronic wound management.

Polysaccharide-based hydrogels are achieving remarkable performances in chronic wounds treatment. In this work, a carboxymethyl cellulose-based hydrogel film was developed to support skin repair. The hydrogel was loaded with berberine, a polyphenolic molecule endowing antioxidant and cytoprotective features. The film was physico-chemically characterized and in vitro tested on keratinocytes and fibroblasts subjected to oxidative stress. The biocomposite showed high thermal stability (onset decomposition temperature 245 °C) and significant fluid uptake performances, both in free conditions (up to 6510%) and under external pressure (up to 3400%). Moreover, it was able to control oxidative stress and inflammation markers involved in wound chronicity. Keratinocytes hyperproliferation, features that normally hamper injury restoration, was reduced of 25%. Our results showed that the combination of berberine and hydrogel provides a synergic improvement of the material properties. The biocomposite represents a promising candidate for dermatological applications against oxidative stress at the chronic wound site, promoting the healing process.

Effect of red thyme oil (Thymus vulgaris L.) vapours on fungal decay, quality parameters and shelf-life of oranges during cold storage.

This work has been aimed at studying the effect of red thyme oil (RTO, Thymus vulgaris L.) on the shelf-life and Penicillium decay of oranges during cold storage. RTO vapours significantly reduced (P ≤ 0.05) the percentage of infected wounds, the external growth area and the production of spores in inoculated orange fruit stored for 12 days at 7 °C in a polypropylene film selected for its appropriate permeability. Among the RTO compounds, p-cymene and thymol were the most abundant in packed boxes at the end of cold storage. The RTO vapours did not affect the main quality parameters of the oranges, or the taste and odour of the juice. The results have shown that an active packaging, using RTO vapours, could be employed, by the citrus industry, to extend the shelf-life of oranges for fresh market use and juice processing.

Assessment of COMT isolation by HIC using a dual salt system and low temperature.

Sodium citrate (SC) and low temperatures between 7 and 5 degrees C are effective in suppressing aggregation of proteins and may be beneficial to be included during a purification process. In this work, we analyzed the application of dual salt system, ammonium sulfate (AS) and SC on binding and elution conditions of recombinant hSCOMT on typical HIC sorbents. Specifically in butyl and octyl supports, the use of, respectively, 300 mM AS/200 mM SC and 25 mM AS/25 mM SC in the loading buffer resulted in complete binding of COMT. Elution was obtained by decreasing the ionic strength to 0 M of salt. For the delineate goal, it also favorably increased the support chain length while a consequent decrease in the dual ionic strength was observed for hSCOMT retention. In the presence of dual salt systems octyl media exhibited classic HIC behavior, good protein selectivity, an excellent purification factor and reduced denaturation effects of hSCOMT observed with higher salt concentrations. Also the inclusion of temperature control during the elution step appears to be advantageous for greater activity recovery without enzyme aggregation. In fact, these results could allow the prediction of most stabilizing conditions for this termolabile enzyme on the chromatographic stage, regarding salt types and therefore effectiveness to improve HIC selectivity and desirable purity on the target fractions.

[Symptomatic epilepsy with Panayiotopoulos-like onset: the importance of neuroimaging]. / Epilepsia sintomática con inicio que imita el síndrome de Panayiotopoulos: importancia de la neuroimagen.

INTRODUCTION: Panayiotopoulos syndrome (PS) is a common form of epilepsy in childhood that is classified as one of the benign idiopathic focal epilepsies. There is no consensus on the indication of neuroimaging in the presence of an electroclinical picture consistent with this disorder. Two cases are presented that began with an electroclinical pattern compatible with PS and in which alterations in the occipital structure were finally detected. CASE REPORTS: Two girls aged 5 and 6 years who began with episodes consistent with PS. In both cases neuroimaging showed structural lesions (cortical dysplasia and pleomorphic xanthoastrocytoma), and hence the final diagnosis was occipital symptomatic focal epilepsy, with the ensuing change in the prognosis and treatment. CONCLUSIONS: The literature describes abnormalities in cranial magnetic resonance imaging in 10-20% of diagnosed cases of PS in which a scan is performed, although the diagnosis of PS is not always changed (matching lesions). Both cases exemplify the importance of reaching a correct diagnosis through a detailed study that must include neuroimaging, since, in some patients, causal brain injuries will be detected and as a result the diagnosis, treatment and evolution will be significantly different.

TITLE: Epilepsia sintomática con inicio que imita el síndrome de Panayiotopoulos: importancia de la neuroimagen.Introducción. El síndrome de Panayiotopoulos (SP) es una epilepsia frecuente en la infancia que se clasifica dentro de las epilepsias focales idiopáticas benignas. No existe consenso sobre la indicación de neuroimagen ante un cuadro electroclínico compatible con este trastorno. Se presentan dos casos que comenzaron con un patrón electroclínico compatible con SP y en los que finalmente se detectaron alteraciones estructurales occipitales. Casos clínicos. Dos niñas de 5 y 6 años que comenzaron con episodios compatibles electroclínicamente con SP. En ambos casos, la neuroimagen mostró lesiones estructurales (displasia cortical y xantoastrocitoma pleomórfico), por lo que finalmente el diagnóstico fue de epilepsia focal sintomática occipital, con el consiguiente cambio en el pronóstico y el tratamiento. Conclusiones. En la bibliografía se describen anomalías en la resonancia magnética craneal en un 10-20% de los casos diagnosticados de SP en los que se realiza una prueba de imagen, aunque no siempre se modifica el diagnóstico de SP (lesiones coincidentes). Ambos casos ejemplifican la importancia de alcanzar un diagnóstico correcto mediante un estudio detallado que ha de incluir la realización de neuroimagen, ya que, en algunos pacientes, se detectarán lesiones cerebrales causales, por lo que el diagnóstico, el tratamiento y la evolución serán drásticamente distintos.

Application of a fed-batch bioprocess for the heterologous production of hSCOMT in Escherichia coli.

In this paper, a fed-batch cultivation process in recombinant Escherichia coli BL21(DE3) bacteria, for the production of human soluble catechol-O-methyltransferase (hSCOMT), is presented. For the first time, a straightforward model is applied in a recombinant hSCOMT expression system and distinguishes an initial cell growth phase from a protein production phase upon induction. Specifically, the kinetic model predicts biomass, substrate, and product concentrations in the culture over time and was identified from a series of fed-batch experiments designed by testing several feed profiles. The main advantage of this model is that its parameters can be identified more reliably from distinct fed-batch strategies, such as glycerol pulses and exponential followed by constant substrate additions. Interestingly, with the limited amount of data available, the proposed model accomplishes satisfactorily the experimental results obtained for the three state variables, and no exhaustive process knowledge is required. The comparison of the measurement data obtained in a validation experiment with the model predictions showed the great extrapolation capability of the model presented, which could provide new complementary information for the COMT production system.

A new approach on the purification of recombinant human soluble catechol-O-methyltransferase from an Escherichia coli extract using hydrophobic interaction chromatography.

Catechol-O-methyltransferase (COMT) is a significant target in protein engineering due to its role not only in normal brain function but also to its possible involvement in some human disorders. In this work, a new approach was employed for the purification of recombinant human soluble COMT (hSCOMT) using hydrophobic interaction chromatography, as the main isolation method, from an Escherichia coli culture broth. A simplified overall process flow is proposed. Indeed, with an optimized heterologous expression system for recombinant hSCOMT production, such as E. coli, it was possible to produce and recover the active monomeric enzyme directly from the cell crude culture broth either by a freeze/thaw or ultrasonication lysis step. The recombinant enzyme present in the bacterial soluble fraction, exhibited similar affinity for epinephrine (K(m) 276 [215; 337] microM) and the methyl donor (S-adenosyl-L-methionine, SAMe) (K(m) 36 [30; 41]microM) as human SCOMT. After the precipitation step by 55% of ammonium sulphate, a HIC step on the butyl-sepharose resin was found to be highly effective in selectively eluting a range of contaminating key proteins present in the concentrate soluble extract. Consequently, the partially purified eluate from HIC could then be loaded and polished by gel filtration in order to increase the process efficiency. The final product appeared as a single band in sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). The procedure resulted in a global 10.9-fold purification with a specific activity of 5500 nmol/h/mg of protein. The widespread applicability of the process, here described, to different COMT sources could make this protocol highly useful for all studies requiring purified and active COMT proteins.

[Nutritional dynamic monitoring during pregnancy: a personalized intervention of prevention]. / Monitoraggio nutrizionale dinamico in gravidanza: intervento di prevenzione personalizzato.

Obesity is an increasing condition spreading out in all of the world, independently by race, sex and age. Obesity in pregnancy represent a risk condition for both mother and her offspring. All of the studies are observational and show intervention strategies on weight gain improvement during gestational period, a current topic, but still controversial. Our study is based on nutritional dynamic monitoring during pregnancy in order to improve health and wellbeing status of both mother and her offspring, through an early and efficacy prevention.

[Diagnostic and operative fertiloscopy]. / La fertiloscopia diagnostica e operativa.

In the last decade, ''fertiloscopy'', a new mini-invasive diagnostic technique, is becoming more and more popular: it is a good alternative to the diagnostic laparoscopy, a standard procedure but surely not harmless, very often capable to discover pathologies in asymptomatic patients. Fertiloscopy allows the visualization of the posterior pelvis (posterior face of the uterus, ovaries, tubes and intestinal ansae with the rectum), with a technique of introducing an optical device in the pouch of Douglas, through the posterior vaginal fornix, under previous general or local anesthesia. When fertiloscopy is performed under local anesthesia, it can comfortably be carried out in out-patient departments and it is generally well tolerated by patients, who follow the whole procedure on the monitor. Moreover, it is possible to perform small interventions, such as adhesiolysis, ovarian drilling, coagulation of endometriosis spots and to perform chromosalpingoscopy and salpingoscopy, important investigations in the diagnostic iter of unexplained female infertility. With fertiloscopy, the patient, therefore, can avoid a real surgical intervention, such as diagnostic laparoscopy, and also uncomfortable examinations, such as hysterosalpingography.

Data on glycerol/tartaric acid-based copolymer containing ciprofloxacin for wound healing applications.

This data article is related to our recently published research paper "Exploiting a new glycerol-based copolymer as a route to wound healing: synthesis, characterization and biocompatibility assessment", De Giglio et al. (Colloids and Surfaces B: Biointerfaces 136 (2015) 600-611) [1]. The latter described a new copolymer derived from glycerol and tartaric acid (PGT). Herein, an investigation about the PGT-ciprofloxacin (CIP) interactions by means of Fourier Transform Infrared Spectroscopy (FT-IR) acquired in Attenuated Total Reflectance (ATR) mode and Differential Scanning Calorimetry (DSC) was reported. Moreover, CIP release experiments on CIP-PGT patches were performed by High Performance Liquid Chromatography (HPLC) at different pH values.

'In vitro' amyloid fibril formation from transthyretin: the influence of ions and the amyloidogenicity of TTR variants.

The mechanisms of amyloid formation in Familial Amyloidotic Polyneuropathy (FAP) are unknown, as well as the factors determining the development of this pathology. To get some insights into this process, we have first tested a fluorimetric assay with thioflavine T, as a quantitative method for transthyretin (TTR) amyloid estimation, using amyloid isolated from post-mortem tissues of a FAP patient. Then production of amyloid fibrils from soluble TTR was achieved by acidification and optimized for protein concentration and pH. The effect of different ions such as metal and sulphate ions in the process of amyloid formation from wild type TTR was compared using a kinetic assay. Under the conditions tested sulphate diminishes the amount of amyloid formed from wild type TTR and in addition appears to promote aggregation of preexisting amyloid fibrils. The relative amyloidogenicity of three TTR variants, TTR Met30, TTR Pro55 and TTR Met119 respectively, was evaluated using a pH dependent assay. It was shown that the Pro55 variant is highly susceptible to amyloid formation as compared to the wild type protein; on the contrary, the Met119 variant is more resistant than the other TTR proteins towards precipitation into amyloid. These results are in agreement with the pathological conditions associated with these mutations. This type of assay has a wide application for testing the influence of other factors, such as therapeutical agents, on amyloid formation.

Crystallization and preliminary X-ray diffraction studies of a catechol-O-methyltransferase/inhibitor complex.

Inhibitors of the enzyme catechol-O-methyltransferase (COMT) are used as co-adjuvants in the therapy of Parkinson's disease. A recombinant form of the soluble cytosolic COMT from rat has been co-crystallized with a new potent inhibitor, BIA 8-176 [(3,4-dihydroxy-2-nitrophenyl)phenylmethanone], by the vapour-diffusion method using PEG 6K as precipitant. Crystals diffract to 1.6 A resolution on a synchrotron-radiation source and belong to the monoclinic space group P2(1), with unit-cell parameters a = 52.77, b = 79.63, c = 61.54 A, beta = 91.14 degrees.

Evaluation of Mut(S) and Mut⁺ Pichia pastoris strains for membrane-bound catechol-O-methyltransferase biosynthesis.

Catechol-O-methyltransferase (COMT, EC 2.1.1.6) is an enzyme that catalyzes the methylation of catechol substrates, and while structural and functional studies of its membrane-bound isoform (MBCOMT) are still hampered by low recombinant production, Pichia pastoris has been described as an attractive host for the production of correctly folded and inserted membrane proteins. Hence, in this work, MBCOMT biosynthesis was developed using P. pastoris X33 and KM71H cells in shake flasks containing a semidefined medium with different methanol concentrations. Moreover, after P. pastoris glass beads lysis, biologically and immunologically active hMBCOMT was found mainly in the solubilized membrane fraction whose kinetic parameters were identical to its correspondent native enzyme. In addition, mixed feeds of methanol and glycerol or sorbitol were also employed, and its levels quantified using liquid chromatography coupled to refractive index detection. Overall, for the first time, two P. pastoris strains with opposite phenotypes were applied for MBCOMT biosynthesis under the control of the strongly methanol-inducible alcohol oxidase (AOX) promoter. Moreover, this eukaryotic system seems to be a promising approach to deliver MBCOMT in high quantities from fermentor cultures with a lower cost-benefit due to the cheaper cultivation media coupled with the higher titers tipically achieved in biorreactors, when compared with previously reported mammallian cell cultures.

Exploiting a new glycerol-based copolymer as a route to wound healing: Synthesis, characterization and biocompatibility assessment.

The use of biocompatible materials based on naturally derived monomers plays a key role in pharmaceutical and cosmetic industries. In this paper we describe the synthesis of a new low molecular weight copolymer, based on glycerol and l-tartaric acid, useful to develop biocompatible dermal patches with drug delivery properties. The copolymer's chemical composition was assessed by FT-IR (Fourier transform infrared spectroscopy), (1)H NMR ((1)H Nuclear Magnetic Resonance) and XPS (X-ray photoelectron spectroscopy), while its molecular weight distribution was estimated by SEC (size exclusion chromatography). Copolymer thermal properties were studied by TGA (thermogravimetric analysis). Biological evaluations by MTT assay and SEM (scanning electron microscopy) observations performed with murine fibroblasts and human keratinocytes (HaCaT) revealed a good compatibility of the proposed copolymer. Ciprofloxacin was selected as model drug and its release was evaluated by HPLC (high performance liquid chromatography), showing that the new copolymer supplied promising results as drug delivery system for wound healing applications. Furthermore, investigations on Skin-Mesenchymal stem cells (S-MSCs) behaviour and gene expression showed that the copolymer and its combination with ciprofloxacin did not affect their stemness. In this regard, the fabrication of dermal patches with new, low cost materials for local treatment of skin infections represents an attractive strategy in order to bypass the worrying side effects of systemic antibiotic therapy. Overall, the performed physico-chemical characterization, drug release test and biological evaluations showed that this new copolymer could be a promising tool for the in situ delivery of bioactive molecules during skin lesions treatment.

Pharmacological profile of opicapone, a third-generation nitrocatechol catechol-O-methyl transferase inhibitor, in the rat.

BACKGROUND AND PURPOSE: Catechol-O-methyltransferase (COMT) is an important target in the levodopa treatment of Parkinson's disease; however, the inhibitors available have problems, and not all patients benefit from their efficacy. Opicapone was developed to overcome those limitations. In this study, opicapone's pharmacological properties were evaluated as well as its potential cytotoxic effects. EXPERIMENTAL APPROACH: The pharmacodynamic effects of opicapone were explored by evaluating rat COMT activity and levodopa pharmacokinetics, in the periphery through microdialysis and in whole brain. The potential cytotoxicity risk of opicapone was explored in human hepatocytes by assessing cellular ATP content and mitochondrial membrane potential. KEY RESULTS: Opicapone inhibited rat peripheral COMT with ED50 values below 1.4 mg⋅kg(-1) up to 6 h post-administration. The effect was sustained over the first 8 h and by 24 h COMT had not returned to control values. A single administration of opicapone resulted in increased and sustained plasma levodopa levels with a concomitant reduction in 3-O-methyldopa from 2 h up to 24 h post-administration, while tolcapone produced significant effects only at 2 h post-administration. The effects of opicapone on brain catecholamines after levodopa administration were sustained up to 24 h post-administration. Opicapone was also the least potent compound in decreasing both the mitochondrial membrane potential and the ATP content in human primary hepatocytes after a 24 h incubation period. CONCLUSIONS AND IMPLICATIONS: Opicapone has a prolonged inhibitory effect on peripheral COMT, which extends the bioavailability of levodopa, without inducing toxicity. Thus, it exhibits some improved properties compared to the currently available COMT inhibitors.

Pregnancy-associated plasma protein A in human ovarian follicular fluid.

Human ovarian follicular fluid contains pregnancy-associated plasma protein A (PAPP-A) immunoreactivity as detected by RIA. This PAPP-A was found to be stable to repeated freeze-thaw cycles and not removed by dialysis. Further characterization showed that ovarian follicular PAPP-A bound reversibly to heparin-Sepharose. On gel chromatography follicular PAPP-A coeluted with radioiodinated PAPP-A and pregnancy serum PAPP-A which was determined to have an apparent mol wt of 820,000. In the RIA, serial dilutions of high molecular weight heparin-Sepharose binding proteins gave parallel displacement curves to pooled late pregnancy serum and to the International Reference Preparation, WHO 78/610. All the human ovarian follicular fluids tested had PAPP-A concentrations between 0.317-1.595 IU/liter. The relationship between follicular content of PAPP-A and follicular volume was best expressed by the exponential relationship, y = 164.3 e0.117x. Therefore, ovarian follicular fluid PAPP-A has many physico-chemical similarities to and shares immunological identity with pregnancy-derived PAPP-A. As this pregnancy-associated glycoprotein cannot be detected in the circulation of normal non-pregnant adults, its presence within the Graafian follicle is believed to be of intrafollicular origin for the maintenance of proteolytic homeostasis.