Implementation and adherence to regular asymptomatic testing in a COVID-19 vaccine trial.

BACKGROUND: For pathogens which cause infections that present asymptomatically, evaluating vaccine efficacy (VE) against asymptomatic infection is important for understanding a vaccine's potential epidemiological impact. Regular testing for subclinical infections is a potentially valuable strategy but its success hinges on participant adherence and minimising false positives. This paper describes the implementation and adherence to weekly testing in a COVID-19 vaccine trial. METHODS: COV002 was a phase 2/3 trial assessing the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. Asymptomatic infections were detected using weekly self-administered swabs for RT-PCR testing. We analysed adherence using mixed-effects regression models and estimated the probability of true and false positive asymptomatic infections using estimates of adherence and testing characteristics. FINDINGS: 356,551 tests were self-administered by 10,811 participants during the 13-month follow-up. Median adherence was 75.0% (IQR 42·6-90·9), which translated to a 74·5% (IQR 50·9-78·8) probability of detecting a positive asymptomatic infection during the swabbing period, and between 21 and 96 false positives during VE evaluation. The odds of returning a swab declined by 8% per week and further after testing positive and unblinding. Adherence was higher in older age groups, females and non-healthcare workers. INTERPRETATION: The COV002 trial demonstrated the feasibility of running a long-term regular asymptomatic testing strategy. This information could be valuable for designing future phase III vaccine trials in which infection is an outcome. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, AstraZeneca.

Polymeric surfactants at liquid-liquid interfaces: Dependence of structural and thermodynamic properties on copolymer architecture.

Polymeric surfactants are amphiphilic molecules with two or more different types of monomers. If one type of monomer interacts favorably with a liquid, and another type of monomer interacts favorably with another, immiscible liquid, then polymeric surfactants adsorb at the interface between the two liquids and reduce the interfacial tension. The effects of polymer architecture on the structural and thermodynamic properties of the liquid-liquid interface are studied using molecular simulations. The interface is modeled with a non-additive binary Lennard-Jones fluid in the two-phase region of the phase diagram. Block and gradient copolymer surfactants are represented with coarse-grained, bead-spring models, where each component of the polymer favors one or the other liquid. Gradient copolymers have a greater concentration at the interface than do block copolymers because the gradient copolymers adopt conformations partially aligned with the interface. The interfacial tension is determined as a function of the surface excess of polymeric surfactant. Gradient copolymers are more potent surfactants than block copolymers because the gradient copolymers cross the dividing surface multiple times, effectively acting as multiple individual surfactants. For a given surface excess, the interfacial tension decreases monotonically when changing from a block to a gradient architecture. The coarse-grained simulations are complemented by all-atom simulations of acrylic-acid/styrene copolymers at the chloroform-water interface, which have been studied in experiments. The agreement between the simulations (both coarse-grained and atomistic) and experiments is shown to be excellent, and the molecular-scale structures identified in the simulations help explain the variation of surfactancy with copolymer architecture.

Gradient copolymers versus block copolymers: self-assembly in solution and surface adsorption.

The structures of amphiphilic block and gradient copolymers in solution and adsorbed onto surfaces are surveyed using molecular-dynamics simulations. A bead-spring model is used to identify the general effects of the different architectures: block and gradient copolymers have equal numbers of solvophilic and solvophobic beads, and the gradient copolymer is represented by a linear concentration profile along the chain. Each type of isolated copolymer forms a structure with a globular head of solvophobic beads, and a coil-like tail of solvophilic beads. The radius of gyration of a gradient copolymer is found to be much more sensitive to temperature than that of a block copolymer due to an unravelling mechanism. At finite concentrations, both gradient and block copolymers self-assemble into micelles, with the gradient copolymers again showing a larger temperature dependence. The micelles are characterised using simulated scattering profiles, which compare favourably to existing experimental data. The adsorption of copolymers onto structureless surfaces is modelled with an attractive potential that is selective for the solvophobic beads, and the surface structures are characterised using the average height of the molecules, and the proportion of beads adsorbed. Both types of copolymer form adsorbed films with persistent micelle-like structures, but the gradient copolymers show a stronger dependence on the strength of the surface interactions and the temperature. Coarse-grained, bead-spring models allow a rapid survey and comparison of the block and gradient architectures, and the results set the scene for future work with atomistic simulations. A superficial but favourable comparison is made between the results from the bead-spring models, and atomistic simulations of a butyl prop-2-enoate/prop-2-enoic acid (butyl acrylate/acrylic acid) copolymer in n-dodecane at room temperature.

Correlates of protection against symptomatic and asymptomatic SARS-CoV-2 infection.

The global supply of COVID-19 vaccines remains limited. An understanding of the immune response that is predictive of protection could facilitate rapid licensure of new vaccines. Data from a randomized efficacy trial of the ChAdOx1 nCoV-19 (AZD1222) vaccine in the United Kingdom was analyzed to determine the antibody levels associated with protection against SARS-CoV-2. Binding and neutralizing antibodies at 28 days after the second dose were measured in infected and noninfected vaccine recipients. Higher levels of all immune markers were correlated with a reduced risk of symptomatic infection. A vaccine efficacy of 80% against symptomatic infection with majority Alpha (B.1.1.7) variant of SARS-CoV-2 was achieved with 264 (95% CI: 108, 806) binding antibody units (BAU)/ml: and 506 (95% CI: 135, not computed (beyond data range) (NC)) BAU/ml for anti-spike and anti-RBD antibodies, and 26 (95% CI: NC, NC) international unit (IU)/ml and 247 (95% CI: 101, NC) normalized neutralization titers (NF50) for pseudovirus and live-virus neutralization, respectively. Immune markers were not correlated with asymptomatic infections at the 5% significance level. These data can be used to bridge to new populations using validated assays, and allow extrapolation of efficacy estimates to new COVID-19 vaccines.

Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trial.

BACKGROUND: A new variant of SARS-CoV-2, B.1.1.7, emerged as the dominant cause of COVID-19 disease in the UK from November, 2020. We report a post-hoc analysis of the efficacy of the adenoviral vector vaccine, ChAdOx1 nCoV-19 (AZD1222), against this variant. METHODS: Volunteers (aged ≥18 years) who were enrolled in phase 2/3 vaccine efficacy studies in the UK, and who were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 or a meningococcal conjugate control (MenACWY) vaccine, provided upper airway swabs on a weekly basis and also if they developed symptoms of COVID-19 disease (a cough, a fever of 37·8°C or higher, shortness of breath, anosmia, or ageusia). Swabs were tested by nucleic acid amplification test (NAAT) for SARS-CoV-2 and positive samples were sequenced through the COVID-19 Genomics UK consortium. Neutralising antibody responses were measured using a live-virus microneutralisation assay against the B.1.1.7 lineage and a canonical non-B.1.1.7 lineage (Victoria). The efficacy analysis included symptomatic COVID-19 in seronegative participants with a NAAT positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to vaccine received. Vaccine efficacy was calculated as 1 - relative risk (ChAdOx1 nCoV-19 vs MenACWY groups) derived from a robust Poisson regression model. This study is continuing and is registered with ClinicalTrials.gov, NCT04400838, and ISRCTN, 15281137. FINDINGS: Participants in efficacy cohorts were recruited between May 31 and Nov 13, 2020, and received booster doses between Aug 3 and Dec 30, 2020. Of 8534 participants in the primary efficacy cohort, 6636 (78%) were aged 18-55 years and 5065 (59%) were female. Between Oct 1, 2020, and Jan 14, 2021, 520 participants developed SARS-CoV-2 infection. 1466 NAAT positive nose and throat swabs were collected from these participants during the trial. Of these, 401 swabs from 311 participants were successfully sequenced. Laboratory virus neutralisation activity by vaccine-induced antibodies was lower against the B.1.1.7 variant than against the Victoria lineage (geometric mean ratio 8·9, 95% CI 7·2-11·0). Clinical vaccine efficacy against symptomatic NAAT positive infection was 70·4% (95% CI 43·6-84·5) for B.1.1.7 and 81·5% (67·9-89·4) for non-B.1.1.7 lineages. INTERPRETATION: ChAdOx1 nCoV-19 showed reduced neutralisation activity against the B.1.1.7 variant compared with a non-B.1.1.7 variant in vitro, but the vaccine showed efficacy against the B.1.1.7 variant of SARS-CoV-2. FUNDING: UK Research and Innovation, National Institute for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midlands NIHR Clinical Research Network, and AstraZeneca.

Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions.

BACKGROUND: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. OBJECTIVE: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. METHODS: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. RESULTS: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40-60). CONCLUSION: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

An interdisciplinary examination of attentional focus strategies used during running gait retraining.

The aim was to investigate the biomechanical, physiological, and perceptual responses to different motor learning strategies derived to elicit a flatter foot contact. Twenty-eight rearfoot-striking recreational runners (age 24.9 ± 2.8 years; body mass 78.8 ± 13.6 kg; height 1.79 ± 0.09 m) were matched by age, mass, and height and assigned to one verbal cue group: internal focus of attention (IF), external focus of attention (EF), and a clinically derived condition (CLIN) incorporating an IF followed by an EF statement. Participants completed two treadmill runs at 10 km h-1 for 6 minutes each: normal running (control) followed by the experimental condition (IF, EF, or CLIN). Lower limb kinematics, oxygen consumption ( V ˙ O 2 ), and central and peripheral ratings of perceived exertion (RPE) were recorded for each run. Compared to the control condition, foot angle was reduced in the IF (difference = 5.86°, d = 2.58) and CLIN (difference = 3.00°, d = 1.31) conditions, but unchanged in the EF condition (difference = 0.33°, d = 0.14), while greater knee flexion at initial contact in the EF and CLIN conditions was observed (difference = -5.19°, d = 1.97; difference = -3.66°, d = 1.39, respectively). A higher V ˙ O 2 was observed in the CLIN condition (difference = -4.56 mL kg-1  min-1 , d = 2.29), but unchanged in the IF (difference = -1.87 mL kg-1  min-1 , d = 0.94) and EF conditions (difference = -0.37 mL kg-1  min-1 , d = 0.19). All experimental conditions increased central and peripheral RPE (difference = -1.08, d = 0.54 and difference = -2.39, d = 1.33, respectively). Providing gait retraining instructions using an internally directed focus of attention was the most effective way to target specific changes in running kinematics, with no detrimental effect on physiological responses. Yet, perceptual effort responses increased regardless of the type of cue provided.

Buccal bone thickness adjacent to virtual dental implants following guided bone regeneration.

BACKGROUND: Crestal bone thickness is a critical determinant of peri-implant tissue stability. This retrospective observational study sought to quantify the buccal bone thickness achieved adjacent to virtual dental implants following guided bone regeneration (GBR) surgery and evaluate the influence of patient- and procedure-related variables on buccal bone thickness. METHODS: Cone-beam computed tomography (CBCT) images acquired from patients who had undergone GBR surgery between July 1, 2012, and November 7, 2016, were used for this analysis. In all cases, the GBR procedure involved a dense polytetrafluoroethylene (dPTFE) barrier membrane and a mineralized cortical particulate freeze-dried bone allograft (FDBA). Eighty-four virtual dental implants were placed at planned locations using CBCT images from 84 patients, and the adjacent buccal bone thickness was measured at each site. The effects of sex, age, estimated baseline ridge width, number of missing teeth in site, site type (tooth-bounded versus terminal position in arch), dental arch (mandibular or maxillary), arch location (anterior or posterior), smoking status, titanium reinforcement in the membrane, membrane fixation, and tenting screw use were assessed. RESULTS: The mean post-GBR buccal bone thickness adjacent to virtual dental implants was 2.24 ± 1.01 mm. Fifty-nine of 84 virtual implants (70%) exhibited buccal bone thickness > 1.9 mm. GBR sites using membrane fixation produced significantly greater virtual implant buccal bone thickness than those without membrane fixation (2.31 ± 0.96 versus 1.15 ± 1.25 mm, P = 0.012). Virtual implant buccal bone thickness also exhibited moderate correlation with estimated initial ridge width (r = 0.43, P < 0.0001). The alveolar ridge at 81 virtual implant sites (96%) was classified as good or satisfactory, meaning dental implants were actually placed at these sites, with or without additional grafting at implant placement. CONCLUSIONS: Observations in this study suggest GBR procedures using dPTFE membranes and FDBA result in favorable ridge dimensions for dental implant placement in most cases. However, additional augmentation at implant surgery may be necessary at ≈ 30% of sites, if buccal bone thickness > 1.9 mm is intended.

Evaluation of the Antimicrobial Activity of Cationic Polymers against Mycobacteria: Toward Antitubercular Macromolecules.

Antimicrobial resistance is a global healthcare problem with a dwindling arsenal of usable drugs. Tuberculosis, caused by Mycobacterium tuberculosis, requires long-term combination therapy and multi- and totally drug resistant strains have emerged. This study reports the antibacterial activity of cationic polymers against mycobacteria, which are distinguished from other Gram-positive bacteria by their unique cell wall comprising a covalently linked mycolic acid-arabinogalactan-peptidoglycan complex (mAGP), interspersed with additional complex lipids which helps them persist in their host. The present study finds that poly(dimethylaminoethyl methacrylate) has particularly potent antimycobacterial activity and high selectivity over two Gram-negative strains. Removal of the backbone methyl group (poly(dimethylaminoethyl acrylate)) decreased antimycobacterial activity, and poly(aminoethyl methacrylate) also had no activity against mycobacteria. Hemolysis assays revealed poly(dimethylaminoethyl methacrylate) did not disrupt red blood cell membranes. Interestingly, poly(dimethylaminoethyl methacrylate) was not found to permeabilize mycobacterial membranes, as judged by dye exclusion assays, suggesting the mode of action is not simple membrane disruption, supported by electron microscopy analysis. These results demonstrate that synthetic polycations, with the correctly tuned structure are useful tools against mycobacterial infections, for which new drugs are urgently required.

Identification of the anti-mycobacterial functional properties of piperidinol derivatives.

BACKGROUND AND PURPOSE: Tuberculosis (TB) remains a major global health threat and is now the leading cause of death from a single infectious agent worldwide. The current TB drug regimen is inadequate, and new anti-tubercular agents are urgently required to be able to successfully combat the increasing prevalence of drug-resistant TB. The purpose of this study was to investigate a piperidinol compound derivative that is highly active against the Mycobacterium tuberculosis bacillus. EXPERIMENTAL APPROACH: The antibacterial properties of the piperidinol compound and its corresponding bis-Mannich base analogue were evaluated against M. smegmatis and Gram-negative organisms. Cytotoxicity studies were undertaken in order to determine the selectivity index for these compounds. Spontaneous resistant mutants of M. smegmatis were generated against the piperidinol and corresponding bis-Mannich base lead derivatives and whole genome sequencing employed to determine the genetic modifications that lead to selection pressure in the presence of these compounds. KEY RESULTS: The piperidinol and the bis-Mannich base analogue were found to be selective for mycobacteria and rapidly kill this organism with a cytotoxicity selectivity index for mycobacteria of >30-fold. Whole genome sequencing of M. smegmatis strains resistant to the lead compounds led to the identification of a number of single nucleotide polymorphisms indicating multiple targets. CONCLUSION AND IMPLICATIONS: Our results indicate that the piperidinol moiety represents an attractive compound class in the pursuit of novel anti-tubercular agents. LINKED ARTICLES: This article is part of a themed section on Drug Metabolism and Antibiotic Resistance in Micro-organisms. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.14/issuetoc.

Activation of Ice Recrystallization Inhibition Activity of Poly(vinyl alcohol) using a Supramolecular Trigger.

Antifreeze (glyco)proteins (AF(G)Ps) have potent ice recrystallisation inhibition (IRI) activity - a desirable phenomenon in applications such as cryopreservation, frozen food and more. In Nature AF(G)P activity is regulated by protein expression levels in response to an environmental stimulus; temperature. However, this level of regulation is not possible in synthetic systems. Here, a synthetic macromolecular mimic is introduced, using supramolecular assembly to regulate activity. Catechol-terminated poly(vinyl alcohol) was synthesised by RAFT polymerization. Upon addition of Fe3+, larger supramolecular star polymers form by assembly with two or three catechols. This increase in molecular weight effectively 'switches on' the IRI activity and is the first example of external control over the function of AFP mimetics. This provides a simple but elegant solution to the challenge of external control of AFP-mimetic function.

Co-operative transitions of responsive-polymer coated gold nanoparticles; precision tuning and direct evidence for co-operative aggregation.

Responsive polymers and polymer-coated nanoparticles have many potential bio-applications with the crucial parameter being the exact temperature where the transition occurs. Chemical modification of hydrophobic/hydrophilic or ligand binding sites has been widely explored as a tool for controlling this transition, but requires the synthesis of many different components to achieve precise control. This study reports an extensive investigation into the use of blending (i.e. mixing) as a powerful tool to modulate the transition temperature of poly(N-isopropylacrylamide) (PNIPAM) coated gold nanoparticles. By simply mixing two nanoparticles of different compositions, precise control over the transition temperature can be imposed. This was shown to be flexible to all possible mixing parameters (different polymers on different particles, different polymers on same particles and different sized particles with identical/different polymers). Evidence of the co-operative aggregation of differently sized nanoparticles (with different cloud points) is shown using transmission electron microscopy; particles with higher cloud points aggregate with those with lower cloud points with homo-aggregates not seen, demonstrating the co-operative behaviour. These interactions, and the opportunities for transition tuning will have implications in the rational design of responsive biomaterials.

Enzymatically Triggered, Isothermally Responsive Polymers: Reprogramming Poly(oligoethylene glycols) To Respond to Phosphatase.

Polymers which can respond to externally applied stimuli have found much application in the biomedical field due to their (reversible) coil-globule transitions. Polymers displaying a lower critical solution temperature are the most commonly used, but for blood-borne (i.e., soluble) biomedical applications the application of heat is not always possible, nor practical. Here we report the design and synthesis of poly(oligoethylene glycol methacrylate)-based polymers whose cloud points are easily varied by alkaline phosphatase-mediated dephosphorylation. By fine-tuning the density of phosphate groups on the backbone, it was possible to induce an isothermal transition: A change in solubility triggered by removal of a small number of phosphate esters from the side chains activating the LCST-type response. As there was no temperature change involved, this serves as a model of a cell-instructed polymer response. Finally, it was found that both polymers were non cytotoxic against MCF-7 cells (at 1 mg·mL(-1)), which confirms promise for biomedical applications.

Synthesis and characterisation of glucose-functional glycopolymers and gold nanoparticles: study of their potential interactions with ovine red blood cells.

Carbohydrate-protein interactions can assist with the targeting of polymer- and nano-delivery systems. However, some potential protein targets are not specific to a single cell type, resulting in reductions in their efficacy due to undesirable non-specific cellular interactions. The glucose transporter 1 (GLUT-1) is expressed to different extents on most cells in the vasculature, including human red blood cells and on cancerous tissue. Glycosylated nanomaterials bearing glucose (or related) carbohydrates, therefore, could potentially undergo unwanted interactions with these transporters, which may compromise the nanomaterial function or lead to cell agglutination, for example. Here, RAFT polymerisation is employed to obtain well-defined glucose-functional glycopolymers as well as glycosylated gold nanoparticles. Agglutination and binding assays did not reveal any significant binding to ovine red blood cells, nor any haemolysis. These data suggest that gluco-functional nanomaterials are compatible with blood, and their lack of undesirable interactions highlights their potential for delivery and imaging applications.

Siderophore-inspired nanoparticle-based biosensor for the selective detection of Fe3.

Inspired by nature's exploitation of the 1,2-dihydroxybenzene unit (or catechol) in mammalian and bacterial siderophores, we report the first example of a nanoparticle sensing system that utilises the strong catechol-Fe3+ binding motif to trigger nanoparticle aggregation, promoting a powerful optical response. Gold nanoparticles are functionalised with RAFT polymerisation-prepared water-soluble poly(N-hydroxyethyl acrylamide) containing a catechol moiety at the α-chain-end. A strong red-to-purple colorimetric response occurs in the presence of Fe3+ at serum concentrations (8-25 µM) in saline solution. Sodium chloride is critical in generating a strong optical output, as is the length of polymer used to coat the AuNPs. This behaviour is also demonstrated to be selective for Fe3+ over a host of other biologically relevant ions.

One-step grafting of polymers to graphene oxide.

The direct grafting of poly(N-isopropylacrylamide) to the basal plane of graphene oxide has been achieved in a single step: cleavage of the terminal thiocarbonylthio group on RAFT grown poly(N-isopropylacrylamide) reveals a reactive thiol that attacks the epoxides present across the surface of graphene oxide. The new composite material was characterised by a combination of SSNMR, FTIR, Raman, EDX, XPS, TGA and contact angle measurement; it shows enhanced thermal stability and solubility in water.

Redox-sensitive materials for drug delivery: targeting the correct intracellular environment, tuning release rates, and appropriate predictive systems.

SIGNIFICANCE: The development of responsive drug delivery systems (DDS) holds great promise as a tool for improving the pharmacokinetic properties of drug compounds. Redox-sensitive systems are particularly attractive given the rich variety of redox gradients present in vivo. These gradients, where the circulation is generally considered oxidizing and the cellular environment is substantially more reducing, provide attractive options for targeted, specific cargo delivery. RECENT ADVANCES: Experimental evidence suggests that a "one size fits all" redox gradient does not exist. Rather, there are subtle differences in redox potential within a cell, while the chemical nature of reducing agents in these microenvironments varies. Recent works have demonstrated an ability to modulate the degradation rate of redox-susceptible groups and, hence, provide new tools to engineer precision-targeted DDS. CRITICAL ISSUES: Modern synthetic and macromolecular chemistry provides access to a wide range of redox-susceptible architectures. However, in order to utilize these in real applications, the actual chemical nature of the redox-susceptible group, the sub-cellular location being targeted, and the redox microenvironment being encountered should be considered in detail. This is critical to avoid the over-simplification possible when using non-biological reducing agents, which may provide inaccurate kinetic information, and to ensure these materials can be advanced beyond simple "on/off" systems. Furthermore, a strong case can be made for the use of biorelevant reducing agents such as glutathione when demonstrating a materials redox response. FUTURE DIRECTIONS: A further understanding of the complexities of the extra- and intracellular microenvironments would greatly assist with the design and application of DDS.

Isothermally-Responsive Polymers Triggered by Selective Binding of Fe3+ to Siderophoric Catechol End-Groups.

Thermoresponsive polymers have attracted huge interest as a way of developing smart/adaptable materials for biomedicine, particularly due to changes in their solubility above the LCST. However, temperature is not always an appropriate or desirable stimulus given the variety of other cellular microenvironments that exist, including pH, redox potentials, ionic strength, and metal ion concentration. Here, we achieve a highly specific, isothermal solubility switch for poly(N-isopropylacrylamide) by application of ferric iron (Fe3+), a species implicated in a range of neurodegenerative conditions. This is achieved by the site-specific incorporation of (Fe3+-binding) catechol units onto the polymer chain-end, inspired by the mechanism by which bacterial siderophores sequester iron from mammalian hosts. The ability to manipulate the hydrophilicity of responsive systems without the need for a temperature gradient offers an exciting approach toward preparing increasingly selective, targeted polymeric materials.

"Isothermal" LCST transitions triggered by bioreduction of single polymer end-groups.

The α-termini of RAFT-derived thermoresponsive polymers were functionalised via thiol exchange with pyridyl disulfide. Addition of hydrophilic end-groups dramatically increased the observed cloud point of the polymers, without changing the composition of the main chain. Selective cleavage of the disulfide-linked end-groups was observed under conditions intended to mimic intracellular glutathione concentration. This allowed the thermoresponsive behaviour to be 'switched on' without the need for a temperature stimulus - an 'isothermal' switch.

Overcoming sink limitations in dissolution testing: a review of traditional methods and the potential utility of biphasic systems.

OBJECTIVES: The conventional dissolution test, particularly the USP apparatus I and II, remains an important tool in the armory of the pharmaceutical development scientist. For realistic dissolution characterization, sink conditions, where saturation solubility of a drug in the dissolution medium is at least three times more than the drug concentration, are critical. These conditions can be problematic to maintain with formulations containing poorly-soluble actives. This review summarizes the role of the dissolution test in the pharmaceutical industry, together with some traditional techniques/additives used to enhance solubility and facilitate the achievement of sink conditions. The biphasic dissolution system, an innovative model for the treatment of poorly-soluble species, will also be discussed. KEY FINDINGS: The biphasic dissolution model utilizes media comprising immiscible aqueous and organic layers whereby the drug, following initial aqueous dissolution, partitions into the organic layer. This step, which acts to remove all dissolved species from the aqueous layer, enables further aqueous dissolution to occur and hence the dissolution-partition cycle continues. Crucially, the aqueous layer does not saturate allowing sink conditions to be maintained and hence the experiment will, in theory, yield complete dissolution. SUMMARY: This review highlights important concepts regarding solubility/sink limitation and intends to provoke debate among analytical and formulation scientists as to the potential advantages, long-term development and widespread implementation of a biphasic dissolution system in drug development.