Extended Detection Window for Gamma-Hydroxybutyrate in the Urine of an Elderly Woman.

Gamma-hydroxybutyrate (GHB) is a central nervous system depressant that has gained popularity as an illicit recreational drug. We describe a case of an elderly woman who was found unconscious in her home. The paramedics initially suspected an intracranial incident. A head computed tomography was negative, as was the initial urinary drug screening. The diagnosis of GHB intoxication was made with the detection of GHB in a urine sample obtained 28-29 hours after the assumed time of intake. Our case underscores the importance of considering drug testing in a broad range of patients and shows that elderly patients may have an extended detection window of GHB.

Quantitative Assessment of Population Variability in Hepatic Drug Metabolism Using a Perfused Three-Dimensional Human Liver Microphysiological System.

In this work, we first describe the population variability in hepatic drug metabolism using cryopreserved hepatocytes from five different donors cultured in a perfused three-dimensional human liver microphysiological system, and then show how the resulting data can be integrated with a modeling and simulation framework to accomplish in vitro-in vivo translation. For each donor, metabolic depletion profiles of six compounds (phenacetin, diclofenac, lidocaine, ibuprofen, propranolol, and prednisolone) were measured, along with metabolite formation, mRNA levels of 90 metabolism-related genes, and markers of functional viability [lactate dehydrogenase (LDH) release, albumin, and urea production]. Drug depletion data were analyzed with mixed-effects modeling. Substantial interdonor variability was observed with respect to gene expression levels, drug metabolism, and other measured hepatocyte functions. Specifically, interdonor variability in intrinsic metabolic clearance ranged from 24.1% for phenacetin to 66.8% for propranolol (expressed as coefficient of variation). Albumin, urea, LDH, and cytochrome P450 mRNA levels were identified as significant predictors of in vitro metabolic clearance. Predicted clearance values from the liver microphysiological system were correlated with the observed in vivo values. A population physiologically based pharmacokinetic model was developed for lidocaine to illustrate the translation of the in vitro output to the observed pharmacokinetic variability in vivo. Stochastic simulations with this model successfully predicted the observed clinical concentration-time profiles and the associated population variability. This is the first study of population variability in drug metabolism in the context of a microphysiological system and has important implications for the use of these systems during the drug development process.

Physiome-on-a-Chip: The Challenge of "Scaling" in Design, Operation, and Translation of Microphysiological Systems.

Scaling of a microphysiological system (MPS) or physiome-on-a-chip is arguably two interrelated, modeling-based activities: on-platform scaling and in vitro-in vivo translation. This dual approach reduces the need to perfectly rescale and mimic in vivo physiology, an aspiration that is both extremely challenging and not substantively meaningful because of uncertain relevance of any specific physiological condition. Accordingly, this perspective offers a tractable approach for designing interacting MPSs and relating in vitro results to analogous context in vivo.

Quantitative Systems Pharmacology Approaches Applied to Microphysiological Systems (MPS): Data Interpretation and Multi-MPS Integration.

Our goal in developing Microphysiological Systems (MPS) technology is to provide an improved approach for more predictive preclinical drug discovery via a highly integrated experimental/computational paradigm. Success will require quantitative characterization of MPSs and mechanistic analysis of experimental findings sufficient to translate resulting insights from in vitro to in vivo. We describe herein a systems pharmacology approach to MPS development and utilization that incorporates more mechanistic detail than traditional pharmacokinetic/pharmacodynamic (PK/PD) models. A series of studies illustrates diverse facets of our approach. First, we demonstrate two case studies: a PK data analysis and an inflammation response--focused on a single MPS, the liver/immune MPS. Building on the single MPS modeling, a theoretical investigation of a four-MPS interactome then provides a quantitative way to consider several pharmacological concepts such as absorption, distribution, metabolism, and excretion in the design of multi-MPS interactome operation and experiments.

The pros and cons of drug 'trafficking'.

Internalization of targeted therapeutics is often needed for efficacy, but also alters drug penetration of a tissue. A new model explores the trade-offs of intracellular drug trafficking.

Effects of cellular pharmacology on drug distribution in tissues.

The efficacy of targeted therapeutics such as immunotoxins is directly related to both the extent of distribution achievable and the degree of drug internalization by individual cells in the tissue of interest. The factors that influence the tissue distribution of such drugs include drug transport; receptor/drug binding; and cellular pharmacology, the processing and routing of the drug within cells. To examine the importance of cellular pharmacology, previously treated only superficially, we have developed a mathematical model for drug transport in tissues that includes drug and receptor internalization, recycling, and degradation, as well as drug diffusion in the extracellular space and binding to cell surface receptors. We have applied this "cellular pharmacology model" to a model drug/cell system, specifically, transferrin and the well-defined transferrin cycle in CHO cells. We compare simulation results to models with extracellular diffusion only or diffusion with binding to cell surface receptors and present a parameter sensitivity analysis. The comparison of models illustrates that inclusion of intracellular trafficking significantly increases the total transferrin concentration throughout much of the tissue while decreasing the penetration depth. Increasing receptor affinity or tissue receptor density reduces permeation of extracellular drug while increasing the peak value of the intracellular drug concentration, resulting in "internal trapping" of transferrin near the source; this could account for heterogeneity of drug distributions observed in experimental systems. Other results indicate that the degree of drug internalization is not predicted by the total drug profile. Hence, when intracellular drug is required for a therapeutic effect, the optimal treatment may not result from conditions that produce the maximal total drug distribution. Examination of models that include cellular pharmacology may help guide rational drug design and provide useful information for whole body pharmacokinetic studies.

Single-microelectrode voltage clamp measurements of pancreatic beta-cell membrane ionic currents in situ.

A conventional patch clamp amplifier was used to test the feasibility of measuring whole-cell ionic currents under voltage clamp conditions from beta-cells in intact mouse islets of Langerhans perifused with bicarbonate Krebs buffer at 37 degrees C. Cells impaled with a high resistance microelectrode (ca. 0.150 G omega) were identified as beta-cells by the characteristic burst pattern of electrical activity induced by 11 mM glucose. Voltage-dependent outward K+ currents were enhanced by glucose both in the presence and absence of physiological bicarbonate buffer and also by bicarbonate regardless of the presence or absence of glucose. For comparison with the usual patch clamp protocol, similar measurements were made from single rat beta-cells at room temperature; glucose did not enhance the outward currents in these cells. Voltage-dependent inward currents were recorded in the presence of tetraethylammonium (TEA), an effective blocker of the K+ channels known to be present in the beta-cell membrane. Inward currents exhibited a fast component with activation-inactivation kinetics and a delayed component with a rather slow inactivation; inward currents were dependent on Ca2+ in the extracellular solution. These results suggest the presence of either two types of voltage-gated Ca2+ channels or a single type with fast and slow inactivation. We conclude that it is feasible to use a single intracellular microelectrode to measure voltage-gated membrane currents in the beta-cell within the intact islet at 37 degrees C, under conditions that support normal glucose-induced insulin secretion and that glucose enhances an as yet unidentified voltage-dependent outward K+ current.

Estimating and eliminating junctional current in coupled cell populations by leak subtraction. A computational study.

The quantitative characterization of ion channel properties in pancreatic beta-cells under typical patch clamp conditions can be questioned because of the unreconciled differences in experimental conditions and observed behavior between microelectrode recordings of membrane potential in intact islets of Langerhans and patch recordings of single cells. Complex bursting is reliably observed in islets but not in isolated cells under patch clamp conditions. E. Rojas et al. (J. Membrane Biol. 143:65-77, 1995) have attempted to circumvent these incompatibilities by measuring currents in beta-cells in intact islets by voltage-clamping with intracellular microelectrodes (150-250 M omega tip resistance). The major potential pitfall is that beta-cells within the islet are electrically coupled, and contaminating coupling currents must be subtracted from current measurements, just as linear leak currents are typically subtracted. To characterize the conditions under which such coupling current subtraction is valid, we have conducted a computational study of a model islet. Assuming that the impaled cell is well clamped, we calculate the native and coupling components of the observed current. Our simulations illustrate that coupling can be reliably subtracted when neighbor cells' potentials are constant or vary only slowly (e.g., during their silent phases) but not when they vary rapidly (e.g., during their active phases). We also show how to estimate coupling conductances in the intact islet from measurements of coupling currents.

Diffusion of extracellular K+ can synchronize bursting oscillations in a model islet of Langerhans.

Electrical bursting oscillations of mammalian pancreatic beta-cells are synchronous among cells within an islet. While electrical coupling among cells via gap junctions has been demonstrated, its extent and topology are unclear. The beta-cells also share an extracellular compartment in which oscillations of K+ concentration have been measured (Perez-Armendariz and Atwater, 1985). These oscillations (1-2 mM) are synchronous with the burst pattern, and apparently are caused by the oscillating voltage-dependent membrane currents: Extracellular K+ concentration (Ke) rises during the depolarized active (spiking) phase and falls during the hyperpolarized silent phase. Because raising Ke depolarizes the cell membrane by increasing the potassium reversal potential (VK), any cell in the active phase should recruit nonspiking cells into the active phase. The opposite is predicted for the silent phase. This positive feedback system might couple the cells' electrical activity and synchronize bursting. We have explored this possibility using a theoretical model for bursting of beta-cells (Sherman et al., 1988) and K+ diffusion in the extracellular space of an islet. Computer simulations demonstrate that the bursts synchronize very quickly (within one burst) without gap junctional coupling among the cells. The shape and amplitude of computed Ke oscillations resemble those seen in experiments for certain parameter ranges. The model cells synchronize with exterior cells leading, though incorporating heterogeneous cell properties can allow interior cells to lead. The model islet can also be forced to oscillate at both faster and slower frequencies using periodic pulses of higher K+ in the medium surrounding the islet. Phase plane analysis was used to understand the synchronization mechanism. The results of our model suggest that diffusion of extracellular K+ may contribute to coupling and synchronization of electrical oscillations in beta-cells within an islet.

Endothelial cell migration and chemotaxis in angiogenesis.

Our goal has been to provide a quantitative analysis of the random motility and chemotaxis of microvessel endothelial cells (MEC) in order to understand the role of these functions in the development of new capillaries. A major difference of our work from previous investigations has been our use of mathematical analysis to interpret experimental results, and to relate in vitro migration measurements to in vivo angiogenesis observations. In this paper we present some of our methods and their rationale, with recent results from both experiment and mathematical models.

Analysis of the roles of microvessel endothelial cell random motility and chemotaxis in angiogenesis.

The growth of new capillary blood vessels, or angiogenesis, is a prominent component of numerous physiological and pathological conditions. An understanding of the co-ordination of underlying cellular behaviors would be helpful for therapeutic manipulation of the process. A probabilistic mathematical model of angiogenesis is developed based upon specific microvessel endothelial cell (MEC) functions involved in vessel growth. The model focuses on the roles of MEC random motility and chemotaxis, to test the hypothesis that these MEC behaviors are of critical importance in determining capillary growth rate and network structure. Model predictions are computer simulations of microvessel networks, from which questions of interest are examined both qualitatively and quantitatively. Results indicate that a moderate MEC chemotactic response toward an angiogenic stimulus, similar to that measured in vitro in response to acidic fibroblast growth factor, is necessary to provide directed vascular network growth. Persistent random motility alone, with initial budding biased toward the stimulus, does not adequately provide directed network growth. A significant degree of randomness in cell migration direction, however, is required for vessel anastomosis and capillary loop formation, as simulations with an overly strong chemotactic response produce network structures largely absent of these features. The predicted vessel extension rate and network structure in the simulations are quantitatively consistent with experimental observations of angiogenesis in vivo. This suggests that the rate of vessel outgrowth is primarily determined by MEC migration rate, and consequently that quantitative in vitro migration assays might be useful tools for the prescreening of possible angiogenesis activators and inhibitors. Finally, reduction of MEC speed results in substantial inhibition of simulated angiogenesis. Together, these results predict that both random motility and chemotaxis are MEC functions critically involved in determining the rate and morphology of new microvessel network growth.

Migration of individual microvessel endothelial cells: stochastic model and parameter measurement.

Analysis of cell motility effects in physiological processes can be facilitated by a mathematical model capable of simulating individual cell movement paths. A quantitative description of motility of individual cells would be useful, for example, in the study of the formation of new blood vessel networks in angiogenesis by microvessel endothelial cell (MEC) migration. In this paper we propose a stochastic mathematical model for the random motility and chemotaxis of single cells, and evaluate migration paths of MEC in terms of this model. In our model, cell velocity under random motility conditions is described as a persistent random walk using the Ornstein-Uhlenbeck (O-U) process. Two parameters quantify this process: the magnitude of random movement accelerations, alpha, and a decay rate constant for movement velocity, beta. Two other quantities often used in measurements of individual cell random motility properties--cell speed, S, and persistence time in velocity, Pv--can be defined in terms of the fundamental stochastic parameters alpha and beta by: S =square root (alpha/beta) and Pv = 1/beta. We account for chemotactic cell movement in chemoattractant gradients by adding a directional bias term to the O-U process. The magnitude of the directional bias is characterized by the chemotactic responsiveness, kappa. A critical advantage of the proposed model is that it can generate, using experimentally measured values of alpha, beta and kappa, computer simulations of theoretical individual cell paths for use in evaluating the role of cell migration in specific physiological processes. We have used the model to assess MEC migration in the presence of absence of the angiogenic stimulus acidic fibroblast growth factor (aFGF). Time-lapse video was used to observe and track the paths of cells moving in various media, and the mean square displacement was measured from these paths. To test the validity of the model, we compared the mean square displacement measurements of each cell with model predictions of that displacement. The comparison indicates that the O-U process provides a satisfactory description of the random migration at this level of comparison. Using nonlinear regression in these comparisons, we measured the magnitude of random accelerations, alpha, and the velocity decay rate constant, beta, for each cell path. We consequently obtained values for the derived quantities, speed and persistence time. In control medium, we find that alpha = 250 +/- 100 microns 2h-3 and beta = 0.22 +/- 0.03h-1, while in stimulus medium (control plus unpurified aFGF) alpha = 1900 +/- 720 microns 2h-3 and beta = 0.99 +/- 0.37h-1.(ABSTRACT TRUNCATED AT 400 WORDS)

Chemotaxis of human microvessel endothelial cells in response to acidic fibroblast growth factor.

Migration of microvessel endothelial cells (MEC) in response to angiogenic stimuli is a key aspect of angiogenesis, whether in physiologic or pathologic situations. In this work, we provide a rigorous quantitative assessment of the chemokinetic and chemotactic responses of human MEC to acidic fibroblast growth factor (aFGF). A uniform concentration of 1 micrograms/ml of heparin was included in most experiments to exploit heparin's potentiating effect on aFGF activity. The migration is measured in an under-agarose assay with a linear geometry, and evaluated in terms of the random motility and chemotaxis coefficients, mu and chi, which are defined in a mathematical model. The change in value of mu with changes in aFGF concentration provides a quantitative description of the stimulated random motility response, a process known as chemokinesis. This allows the true directional response in gradients to be quantified by the chemotaxis coefficient, chi, and its variation with attractant concentration. The effect of aFGF on MEC random motility is relatively small, with the random motility coefficient ranging from 4.6 +/- 0.4 x 10(-9) to 9.9 +/- 0.3 x 10(-9) cm2/second (mean +/- SE) over four orders of magnitude of aFGF concentration (10(-11) to 10(-8) M). On the other hand, the magnitude of the chemotaxis coefficient at optimal concentrations is quite large (2600 +/- 750 cm2/second-M around 10(-10) M aFGF), demonstrating a significant degree of MEC directional sensitivity to aFGF gradients. The chemotaxis coefficient shows a biphasic dependence on aFGF concentration, suggestive of a receptor-mediated response in which apparent differences in receptor occupancy govern directional bias. These results provide support for the hypothesis that MEC chemotaxis accounts for the directed microvessel growth observed in angiogenesis.

Quantitative analysis of random motility of human microvessel endothelial cells using a linear under-agarose assay.

Angiogenesis is a multistep process intimately involved in embryonic development and subsequent cardiovascular homeostasis and pathology. A major event in the process of angiogenesis is endothelial cell migration. Common in vitro assays (filter, under-agarose, phagokinetic track) used for the evaluation of migration are interpreted by measurements such as leading front distance, total cells migrated, and total area of migration. However, these quantities depend very heavily upon the physical aspects of the assay such as geometry, chemoattractant concentration and diffusivity, and observation time. Thus, while these common cell motility measurements are convenient, they do not represent solely the intrinsic cell response to an attractant. Alternatively, cell motility responses can be described by parameters which do not depend on the physical aspects of the assay system. Such parameters, termed phenomenologic parameters, have been defined for cell migration in a mathematical model derived by others. This model defines two parameters, the random motility coefficient, mu, and the chemotaxis coefficient, chi, which describe the migration responses to uniform concentrations and to gradients of stimulant, respectively. We have used this approach to evaluate the random motility response of human microvessel endothelial cells isolated from omental fat. Human microvessel endothelial cell random motility was measured in uniform concentrations of heparin (10(-3) to 10(3) micrograms/ml) using an under-agarose assay with linear geometry. The value of mu was found to remain constant at 8.2 x 10(-9) cm2/second for all concentrations tested and without heparin. These data indicate that heparin at these concentrations does not significantly stimulate random migration of human microvessel endothelial cell. These results suggest that the potentiating effect of heparin on angiogenesis may not be mediated through a direct affect on endothelial cell migration. Because the random motility coefficient and chemotaxis coefficient are representative of intrinsic cell motility behavior, their use should provide more specific information on endothelial cell migration than other commonly used measurements.