High positive predictive value of Gram stain on catheter-drawn blood samples for the diagnosis of catheter-related bloodstream infection in intensive care neonates.

Catheter-related bloodstream infections (CRBSIs) remain a leading cause of healthcare-associated infections in preterm infants. Rapid and accurate methods for the diagnosis of CRBSIs are needed in order to implement timely and appropriate treatment. A retrospective study was conducted during a 7-year period (2005-2012) in the neonatal intensive care unit of the University Hospital Erasme to assess the value of Gram stain on catheter-drawn blood samples (CDBS) to predict CRBSIs. Both peripheral samples and CDBS were obtained from neonates with clinically suspected CRBSI. Gram stain, automated culture and quantitative cultures on blood agar plates were performed for each sample. The paired quantitative blood culture was used as the standard to define CRBSI. Out of 397 episodes of suspected CRBSIs, 35 were confirmed by a positive ratio of quantitative culture (>5) or a colony count of CDBS culture >100 colony-forming units (CFU)/mL. All but two of the 30 patients who had a CDBS with a positive Gram stain were confirmed as having a CRBSI. Seven patients who had a CDBS with a negative Gram stain were diagnosed as CRBSI. The sensitivity, specificity, positive predictive value and negative predictive value of Gram stain on CDBS were 80, 99.4, 93.3 and 98.1 %, respectively. Gram staining on CDBS is a viable method for rapidly (<1 h) detecting CRBSI without catheter withdrawal.

Preparation and in vitro/in vivo evaluation of nano-sized crystals for dissolution rate enhancement of ucb-35440-3, a highly dosed poorly water-soluble weak base.

Ucb-35440-3 is a new drug entity under investigation at UCB S.A. Due to its physicochemical characteristics, the drug, a poorly water-soluble weak base, shows poor solubility and dissolution characteristics. In rat, the low oral bioavailability (F < 10%) is largely due to poor absorption. In order to enhance the solubility and dissolution characteristics, formulation of ucb-35440-3 as nanocrystals has been achieved in this study. Nanoparticles were prepared using high pressure homogenization and were characterized in terms of size and morphology. In vitro dissolution characteristics were investigated and compared to the un-milled drug in order to verify the theoretical hypothesis on the benefit of increased surface area. In vivo pharmacokinetic evaluation of ucb-35440-3 nanoparticles was also carried out on rats. Crystalline state evaluation before and following particle size reduction was conducted through polarized light microscopy and PXRD to denote any possible transformation to an amorphous state during the homogenization process. Drug chemical stability was also assessed following homogenization. The dissolution rate increased significantly at pH 3.0, 5.0 and 6.5 for ucb-35440-3 nanoparticles. However, the pharmacokinetic profile obtained yielded lower systemic exposure than the un-milled compound (in fed state), this although being thought to be the consequence of the drug and formulation characteristics.

Micromolar concentrations of Al3+ induce phase separation, aggregation and dye release in phosphatidylserine-containing lipid vesicles.

The interaction of Al3+, Cd2+ and Mn2+ with phosphatidylserine-containing lipid vesicles was studied. Phase separation of vesicles was investigated by monitoring fluorescence quenching of the phospholipid analogue 1-palmitoyl-2-(6-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)] aminocaproyl)phosphatidylcholine (C6-NBD-PC). Aggregation was determined by turbidimetry and leakage of vesicles content during fusion was monitored by the fluorescence of released 6-carboxyfluorescein. Al3+ demonstrated quenching at less than 30 mumol/l with a maximum effect at 100 mumol/l. Al3+-induced aggregation and dye release from the lipid vesicles were observed in the same concentration range. The effect of Cd2+ and Mn2+ on quenching was much less pronounced and could only be demonstrated in the 0.1-1 mmol/l range. Increasing amounts of phosphatidylcholine or phosphatidylethanolamine in the vesicles decreased both Al3+-induced quenching and aggregation, whereas cholesterol only slightly increased aggregation without affecting quenching.

Neurotoxic cations induce membrane rigidification and membrane fusion at micromolar concentrations.

The effect of the neurotoxic cations aluminum, cadmium and manganese on membranes was examined in sonicated unilamellar vesicles containing phosphatidylserine and compared to the effect of Ca2+. Fusion of membranes was monitored by assessing the resonance energy transfer between N-(7-nitrobenz-2-oxa-1,3-diazol-4-y)phosphatidylethanolamine and N-(lissamine-rhodamine B-sulfonyl)phosphatidylethanolamine. Self-quenching of high concentrations of carboxyfluorescein in liposomes was used to demonstrate the release of molecules entrapped in liposomes to compare the kinetics of leakage and intermixing of lipid. Rigidification of membranes was evaluated by monitoring the fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene embedded in membranes containing phosphatidylserine and dipalmitoylphosphatidylcholine. Cation-induced lipid intermixing of vesicles membranes and release of dye from the vesicles occurred in the same concentration range. With aluminum, these effects were observed with concentrations less than 25 microM. Significant rigidification of vesicle membranes was apparent with less than 25 microM of Al3+. Similar effects could only be observed with concentrations of Cd2+ and Mn2+ at least one order of magnitude higher (200 and 400 microM, respectively).

Conformational analysis of lipoxin A, lipoxin B and their trans-isomers.

Lipoxin A and lipoxin B (LXA and LXB) are formed from the oxygenation of arachidonic acid by interactions between the 5- and 15-lipoxygenases of human leukocytes. Each compound displays highly stereospecific biological actions. Here, we present a computational description of the following compounds: lipoxin A, (5S,6R,15S)-trihydroxy-7,9,13-trans-11-cis-eicosatetraenoic acid; 11-trans-lipoxin A, (5S,6R,15S)-trihydroxy-7,9,11,13-trans-eicosatetraenoic acid; lipoxin B, (5S,14R,15S)-trihydroxy-6,10,12-trans-8-cis-eicosatetraenoic acid; and 8-trans-lipoxin B, (5S,14R,15S)-trihydroxy-6,8,10,12-trans-eicosatetraenoic acid. The analyses considered van der Waals energy, electrostatic interactions, torsional potential, and alterations in electrostatic forces. Additional analyses were carried out with each of the four compounds forming complexes with one calcium ion. Each compound gave very different conformers. Both lipoxin A and lipoxin B can form globular conformations, while their all-trans isomers form rigid extended structures. When complexes with each of these compounds and one calcium ion were examined (i.e., (LXA)2Ca: (11-trans-LXA)2Ca), both LXA and LXB formed several flexible conformations including crumpled, wrapped or extended conformations. In this situation, LXA showed a higher probability than LXB to wrap around one Ca2+. In contrast, the two all-trans isomers always lead to extended conformations. Results from the present study illustrate that changes in the stereochemistry of LXA and LXB lead to unique conformations which may underlie the different biological actions of these compounds. Moreover, they indicate that the conformations of eicosanoids can change while in aqueous or hydrophobic environments (i.e., biomembranes).

Na+-H+ exchange in the process of glucose-induced insulin release from the pancreatic B-cell. Effects of amiloride on 86Rb, 45Ca fluxes and insulin release.

The effect of amiloride, an inhibitor of Na+-H+ exchange, on intracellular pH (pHi), 86Rb outflow, 45Ca outflow and insulin release from pancreatic rat islets was examined. In the 0.1-1 mM range, amiloride transiently reduced pHi of glucose-deprived islets and allowed glucose to induce a sustained decrease in pHi of the islet cells. Amiloride reproduced the effect of glucose to decrease 86Rb and 45Ca outflow. In the presence of glucose (5.6 mM or more), amiloride (100 microM) acted synergistically with the sugar to reduce K+ outflow, and to stimulate 40Ca inflow and insulin release from perifused islets. These results add strong support to the view that the generation of protons through the metabolism of glucose represents an important step in the process of glucose-induced release. The stimulation by glucose of Na+-H+ exchange apparently masks and even overcomes the glucose-induced decrease in pHi otherwise expected from the increase in catabolic fluxes.

The effect of surface charge density on valinomycin-K+ complex formation in model membranes.

The model membrane approach was used to investigate the surface charge effect on the ion-antibiotic complexation process. Mixed monolayers of valinomycin and lipids were spread on subphases containing K+ or Na+. The surface charge density was modified by spreading ionizable valinomycin analogs on aqueous subphases of different pH or by changing the nature of the lipid (neutral, negatively charged) in the mixed film. Surface pressure and surface potential measurements demonstrated that a neutral lipid (phosphatidylcholine) or positively charged valinomycin analogs didn't enhance the anti-biotic complexing capacity. However, a maximal complexation is reached for a critical lipid concentration in the valinomycin-phosphatidylserine mixed film. The role of the surface charge on the valinomycin complexing properties was examined in terms of the Gouy-Chapman theory. As a consequence of the negative charge of the lipid monolayer, the K+ concentration near the surface is larger than the bulk concentration, by a Boltzmann factor. A good agreement was observed between the experimental results and the theoretical predictions. Conductance measurements of asymmetric bilayers containing a neutral lipid (egg lecithin) on one side and a negatively charged lipid (phosphatidyl-serine) on the other, confirm the role of the surface charge. Indeed, addition of K+ to the neutral side of the bilayer containing valinomycin had no effect on the conductance whereas addition of K+ to the charged side of the bilayer caused a 80-fold conductance increase.

Preparation and characterization of nanocrystals for solubility and dissolution rate enhancement of nifedipine.

Poorly water-soluble drugs such as nifedipine (NIF) (approximately 20 microg/ml) offer challenging problems in drug formulation as poor solubility is generally associated to poor dissolution characteristics and thus to poor oral bioavailability. In order to enhance these characteristics, preparation of nifedipine nanoparticles has been achieved using high pressure homogenization. The homogenization procedure has first been optimized in regard to particle size and size distribution. Nanoparticles were characterized in terms of size, morphology and redispersion characteristics following water-removal. Saturation solubility and dissolution characteristics were investigated and compared to the un-milled commercial NIF to verify the theoretical hypothesis on the benefit of increased surface area. Crystalline state evaluation before and following particle size reduction was also conducted through differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD) to denote eventual transformation to amorphous state during the homogenization process. Through this study, it has been shown that initial crystalline state is maintained following particle size reduction and that the dissolution characteristics of nifedipine nanoparticles were significantly increased in regards to the commercial product. The method being simple and easily scaled up, this approach should have a general applicability to many poorly water-soluble drug entities.

Increase in CO3H- influx and cellular pH in glucose-stimulated pancreatic islets.

When rat islets are preincubated with fluorescein diacetate and examined in a spectrofluorometer, the intracellular pH rapidly increases by 0.21 pH units in response to a rise from 1.7-16.8 mM glucose. This coincides with a marked increase in 14CO3H- net uptake by the islets, suggesting that the glucose-induced increase in H+ generation rate is compensated for by stimulation of CO3H-/Cl- exchange.

Localization in diphtheria toxin fragment B of a region that induces pore formation in planar lipid bilayers at low pH.

Like diphtheria toxin and the N-terminal (Mr 23 000) region of fragment B, CB1 (Mr 13 000), the cyanogen bromide peptide located in the middle region of fragment B is able to induce pore formation in lipid bilayer membrane at low pH. These two peptides (Mr 23 000 and 13 000) share a common segment (Mr 6300) containing the predicted amphipathic, alpha-helical, transverse lipid-associating domain (Mr 2750) of fragment B [J. Cell Biol. (1980) 87, 837-840]. Therefore, we postulated this domain to be responsible for the pore formation ability of diphtheria toxin [Proc. Natl. Acad. Sci. USA (1981) 78, 172-176]. A relationship between the pH dependency of pore formation and the presence of a cluster of prolines in the C-terminal region of CB1 is proposed.

Binding of tumor-promoting and biologically inactive phorbol esters to artificial membranes.

Multilamellar liposomes formed of phospholipids bind [20-3H(N)]-phorbol 12,13-dibutyrate, the dissociation constant and maximal binding being comparable to those found in fibroblasts or epidermal cells. The relative capacity of distinct phorbol esters to compete with the labeled ligand was similar to their relative tumor-promoting capacity. It is proposed that the specific binding of phorbol esters to biological material may be accounted for by their insertion in the phospholipid domain of membranes.

Phorbol esters parallel effects on tumor promotion, insulin release and calcium ionophoresis.

The tumor promoters 12-O-tetradecanoylphorbol-13-acetate (TPA) and phorbol 12,13-didecanoate (PDD) both stimulated insulin release from rat pancreatic islets and facilitated ionophore-mediated calcium transport in liposomes, the latter effect not resulting from a change in viscosity of the liposomial matrix. Phorbol and 4 alpha-phorbol 12,13-didecanoate (4 alpha-PDD), which fail to cause tumor promotion, also failed to stimulate insulin release and ionophore-mediated calcium transport. An alteration of calcium transport may represent a fundamental event in both the early (insulin release) and late (tumor promotion) biological responses to phorbol esters.

Physico-chemical properties of prostaglandins and related pharmacological compounds. A theoretical study on conformational related activity.

Thromboxane A2, prostaglandin H2, a series of chemically stable cyclic endoperoxide analogues (U 46619, U 44069, ONO 11113, 9, 11, diazo PGH2 and SQ 26655) and different isomers of SQ 26655 were analysed for their spatial configuration by conformational analysis in a simulated membrane-water interface environment with a "structure tree" procedure already described for prostaglandins, leukotrienes and lipoxins. The conformers derived from the structure tree and with a high probability of existence are presented. A new method allows one to visualize the surface charge density of the calculated molecules. The spatial configuration and the surface charge density of each molecule are compared to their known order of competition binding to the putative TXA2/PGH2 receptor of platelets. The conformational and charge density analysis merely shows that the different stereochemistry of these molecules lead to spatial conformation, that mimics (agonists), or that are far from (antagonists) the TXA2/PGH2 conformation.

Structural considerations for calcium ionophoresis by prostaglandins.

The prostaglandins PGB2, PGE2 and PGF2 alpha were found to translocate calcium in a modified Pressman cell. At pH 7.40, PGB2 was more potent than PGE2 and than PGF2 alpha. When incorporated at a 1% molar ratio in liposomes made of cholesterol and different diacyl phosphatidyl choline, prostaglandins are able to mediate a slow calcium exchange diffusion. A significant prostaglandin-mediated calcium release that depends on the lipid matrix rigidity is observable at 37 degrees but not at 22 degrees. Conformational analysis of the complex formed by two molecules of prostaglandins and one calcium atom, either at a simulated membrane-water interface or in a simulated bulk lipid phase reveals rigid complexes with great distances between hydrophilic and hydrophobic gravity centres that predict low ionophoretic properties.

Conformational analysis of the calcium-antagonist gallopamil.

Conformational analysis of gallopamil was performed in order to gain insight into the molecular determinant of its calcium-antagonistic property. Whereas the neutral form of gallopamil was characterized by a single, largely predominant configuration, the protonated form of the drugs yielded several conformers, some of which were characterized by a readily accessible ionized site. The capacity of gallopamil to inhibit ionophore-mediated calcium translocation in a two-phase bulk system was inversely related to the pH of the aqueous phase. These findings indicate that the capacity of gallopamil to interfere with the transport of cations is critically dependent on the availability of a protonated configuration of the drug.

Piracetam-induced changes to membrane physical properties. A combined approach by 31P nuclear magnetic resonance and conformational analysis.

Piracetam, Nootropil (2-oxo-1-pyrrolidine acetamide), is a drug promoting erythrocyte deformability. To establish the mode of action of this compound, we have investigated its influence on the organization of model phospholipid membranes. 31P NMR data show that the drug induces a structural modification in liposomes made of phosphatidylcholine and phosphatidylethanolamine. Our conformational analysis results have allowed the interpretation of the effect of piracetam on these model membranes: the specific interaction between the drug molecules and the phosphate headgroups induces a new organization of the lipids favouring formation of mobile drug-phospholipid complexes that exhibit an isotropic-type signal in the 31P NMR spectra.

Ultrastructural, physico-chemical and conformational study of the interactions of gentamicin and bis(beta-diethylaminoethylether) hexestrol with negatively-charged phospholipid layers.

Aminoglycoside antibiotics such as gentamicin, which are fully hydrophilic, and cationic amphiphilic drugs such as bis(beta-diethylaminoethylether)hexestrol (DEH), are both known to inhibit lysosomal phospholipases and induce phospholipidosis. This enzymatic inhibition is probably related to the neutralization of the surface negative charges on which the lysosomal phospholipases A1 and A2 are dependent to express fully their activities (Mingeot-Leclerq et al., Biochem Pharmacol 37: 591-599, 1988). Using negatively charged liposomes, we show by 31P NMR spectroscopy that both gentamicin and DEH cause a significant restriction in the phosphate head mobility and, in sonicated vesicles, the appearance of larger bilayer structures. Both DEH and gentamicin increased the apparent size of sonicated negatively charged liposomes (but not of neutral liposomes) as measured by quasi-elastic light scattering spectroscopy. Examination of replicas from freeze-etched samples, however, revealed that gentamicin caused aggregation of liposomes, whereas DEH induced their fusion and the formation of intramembranous roundly shaped structures. Only DEH caused a significant decrease of the fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene, a fluorescent lipid-soluble probe. In addition, DEH, but not gentamicin, interfered with the bilayer to hexagonal phase transition occurring in dioleoyl- and dielaidoylphosphatidylethanolamine liposomes upon warming, and caused the appearance of an isotropic signal suggestive of the formation of inverted micelles. In computer-aided conformational analysis of the molecules at a simulated air-water interface, gentamicin was shown to display a largely-open crescent shape. When surrounded by phosphatidylinositol molecules, it remained as such at the interface which it locally mis-shaped, establishing close contact with the negatively charged phospho groups. In contrast, DEH could be oriented perpendicularly to the interface, with its two cationic groups associated with the phospho groups, and its phenyl- and diethylethandiyl moieties deeply inserted between and interacting with the aliphatic chains. Thus, although both agents cause lysosomal phospholipases inhibition, the differences in their interactions with negatively-charged bilayers is likely to result in a different organization of the phospholipids accumulated in vivo, which could lead to different toxicities.

Conformational analysis of phorbol esters at a simulated membrane/water interface.

The conformation at a simulated membrane/water interface of four distinct phorbol esters, selected for their vastly different tumor-promoting potency, was predicted by a modification of the usual computing approach for the conformational analysis of macromolecules. In the modified procedure, the transfer energy of each part of the molecule in either a hydrophobic or hydrophilic domain was taken into account in order to define the orientation of the molecule at the simulated interface. The results of this study are compatible with known tensioactive properties of these phorbol esters, and may help to explain differences in their biological potency by the relative facility of their insertion in lipid bilayers.

Influence of phorbol esters on ionophore-mediated calcium exchange-diffusion in liposomes.

The interference of phorbol esters upon the process of A23187-mediated calcium exchange diffusion was examined in multilamellar liposomes formed of different types of lipids and incubated at variable temperatures. Phorbol esters facilitated the process of calcium ionophoresis in liposomes formed of dipalmitoylphosphatidylcholine (DPPC) or dimyristoylphosphatidyl-choline (DMPC) and incubated below transition temperature. The magnitude of this facilitating action was negatively correlated with the tumor-promoting capacity of the phorbol esters. The phorbol esters also facilitated calcium ionophoresis in liposomes formed of a mixture of DPPC and cholesterol, provided that the temperature exceeded 34 degrees C. The magnitude of the latter facilitating action was positively correlated with both the temperature and the tumor-promoting potency of the phorbol esters. Thus, the existence of a parallelism between the biological potency of phorbol esters and their biophysical effect in this artificial system tightly depended on such factors as the lipid composition of the liposomal matrix and the ambient temperature.

Influence of membrane viscosity on the lateral and transverse mobility of carboxylic ionophores.

The rate of 45Ca or 22Na exchange-diffusion in multilamellar liposomes formed of dipalmitoyl-phosphatidylcholine (DPPC) and cholesterol and containing the ionophore A23187 or Br-X537A was dramatically increased when the temperature and, hence, fluidity of the lipid bilayer were increased. In the case of 45Ca transport, i.e. when each Ca2+ ion binds to two molecules of ionophore, the relative increment in transport velocity in response to a given increase in temperature or fluidity was much more marked in the high range of temperature (30-40 degrees C) than in the low range of temperature (22-28 degrees C). In the case of 22Na transport, however, i.e. when each Na+ ion binds to only one ionophoretic molecule, the temperature-dependency of the transport process followed a single pattern throughout the entire range of temperature. In the latter case, the slope of the temperature-dependent line was the same as that seen for 45Ca transport by the same ionophore at high temperatures. A decrease in the ionophore content of the liposomes shifted to a higher temperature the transition point between the flat and steep lines characterizing the temperature dependency of 45Ca transport. It is concluded that the membrane viscosity affects both the lateral mobility of the ionophoretic molecules and the transverse mobility of the cation-ionophore complex.