A phase I trial of beta-all-trans-retinoic acid delivered via a collagen sponge and a cervical cap for mild or moderate intraepithelial cervical neoplasia.

A phase I trial was conducted of the vitamin A derivative beta-all-trans-retinoic acid (vitamin A acid; TRA), delivered via a collagen sponge and cervical cap for mild or moderate intraepithelial cervical neoplasia. On the basis of known skin and mucosal membrane toxicity, a concentration of 0.05% TRA in a cream-based vehicle was selected as the starting dose and was escalated later with the use of a modified Fibonacchi scale. The delivery device and the TRA were changed daily for 4 days, and side effects were assessed on days 1, 2, 3, 4, 8, and 30 by clinical and colposcopic examination. Vaginal, cervical, and systemic toxicity were evaluated in 35 patients. No dose-related systemic effects were found; mild cervical inflammation increased in many patients at higher doses. Unacceptably high vaginal toxicity was reached at a TRA concentration of 0.484%. A concentration of 0.372% TRA is recommended for use in phase II trials in mild and moderate cervical intraepithelial neoplasia.

Stimulation of the activity of prolyl hydroxylase in 3T3 fibroblasts by 1,10-phenanthroline.

In confluent cultures of 3T3 fibroblasts, incubated for 24 h with 1,10-phenanthroline at 10(-5)--10(-9) M, the activity of prolyl hydroxylase was significantly increased. 1,10-Phenanthroline was inhibitory at concentrations greater than 10(-4) M. The stimulatory effect of 1,10-phenanthroline manifests itself after 6 h incubation and increased with time up to 48 h. 2,2'-dipyridyl and 5,6-dimethyl-1,10-phenanthroline were also stimulatory; a nonchelating analog, 1,7-phenanthroline had no effect. Cycloheximide did not modify the 1,10-phenanthroline effect. The stimulatory effect does not seem to depend on the shift of an inactive precursor of prolyl hydroxylase to an active form because 1,10-phenanthroline was shown to be ineffective in logarithmically growing cells. While dialysis of washed and homogenized cells significantly increased prolyl hydroxylase activity in cell extracts, undialyzed 1,10-phenanthroline treated samples exhibited higher prolyl hydroxylase activity than dialyzed controls. These data suggested to us that 1,10-phenanthroline and other chelating agents may be forming complexes with certain metal ions or protein-metal ions which are inhibitory towards prolyl hydroxylase.

Urinary excretion of beta-aminopropionitrile and cyanoacetic acid.

Human serum did not convert beta-aminopropionitrile (BAPN) to the deaminated, nonlathyrogenic metabolite, cyanoacetic acid (CAA). Instead, its enzymic activity for oxidizing benzylamine was inhibited by BAPN (I50 = 2 X 10(-3) M). BAPN was found in the urine within one hour of oral administration. Oral 250 mg BAPN at 6-hr intervals each day for 21 days resulted in urinary BAPN recoveries approximating 16% of the total dose. BAPN was not detected in urine in specimens collected later than 7 hr after cessation of BAPN dosage. Urinary CAA appeared more slowly than BAPN and increased gradually to approximately three times that of urinary BAPN. After BAPN was discontinued, there was prolonged urinary excretion of BAPN-derived CAA. These along with earlier findings in experimental animals suggest that unexcreted BAPN is sequestered in tissues where it is metabolized to CAA before slowly released.

Early changes in the arterial wall of chickens fed a cholesterol diet.

A total of 160 1-2 day old chickens were fed a 2% cholesterol diet for a period of 8 to 42 days and compared with an equal number of controls. Aortas were analyzed for various indexes of reactivity of connective tissue, cholesterol content and scanning electron microscopy (SEM) characteristics of the endothelial lining. Cholesterol feeding for a period up to 6 weeks resulted in doubling the level of serum cholesterol. It was, however, without effect on the activity of prolyl hydroxylase, lysyl oxidase, collagenase and collagen content in the aortic wall. As early as 3 weeks of feeding significant changes occurred in total and esterified cholesterol content. At the same time endothelial cells were characteristically contracted with several long cytoplasmic elongations and protrusions. A significant decrease of activity of the above enzymes was found in aortic tissue with increased age of the chicken. Collagen content in aortas increased with age of chickens. It is concluded that cholesterol as an atherogenic agent induces marked changes in endothelial cells and lipids of chicken aorta at earlier periods, prior to the activation of connective tissue.

Distribution of disulfiram in brain after carotid ligation in gerbils.

Aiming whether intraperitoneal administration of disulfiram (tetraethyl thiuram disulfide, DS) achieves potentially therapeutic drug concentrations in brain tissue, the behaviour of blood-brain barrier (BBB) to 14C-labelled DS in cerebral ischemia with and without simultaneous administration of dimethylsulfoxide (DMSO) was studied in Mongolian gerbils subjected to left common carotid artery (CCA) occlusion. The results indicated that: (a) the permeability of DS through the BBB was significantly enhanced in the ischemic brain during the initial 30 min duration after DS administration; (b) administration of DMSO increased the entry of DS into the ischemic brain five-fold during the first 30 min and it was significantly higher even at the 60 min sampling period; (3) in general, the content of DS in the brain was quickly reduced with time.

Pharmacology of fibrosis and tissue injury.

Methods controlling tissue fibrosis are classified into those specifically inhibiting various metabolic aspects of collagen selectively in the injured tissue (ascorbic acid deficiency, effect of agent chelating Fe(2+), proline analogs, lathyrogens). The most promising method seems to be the blocking of crosslinks formation among collagen molecules by beta-aminopropionitrile, a competitive inhibitor of a crosslinking enzyme, lysyl oxidase. The second group of methods is called nonspecific, as they affect any stage of inflammatory process preceding the activation of fibroblasts. The importance of activated macrophages in the stimulation of fibroblast is discussed. Finally, a new concept is proposed, indicating the function of zinc ions in the control of the integrity of biomembrances, tissue reactivity to noxious agents. It is suggested that zinc may control NADPH dependent lipid peroxidation at the membrane level by inhibiting NADPH oxidase activity. The implication of these ideas to lung fibrosis induced by silica or asbestos is discussed.

Perivascular myofibroblasts and microvascular occlusion in hypertrophic scars and keloids.

Microvessels in normal skin, granulation tissue, hypertrophic scar, keloid, and mature scar from human subjects were studied by transmission electron microscopy. Comparative observations suggested that most microvessels in hypertrophic scar and keloid are occluded or partially occluded, apparently owing to an excess of endothelial cells. Endothelial cell contraction was also supported by the observations, and perivascular satellite cells (pericytes), some of which were identified as myofibroblasts, were observed in hypertrophic scars and keloids. Among findings from statistical analyses were that 1) the patency of microvessels in hypertrophic scar and granulation tissue is similar, as is that of microvessels in keloid and mature scar, but the patency of all these microvessels is significantly less than that of microvessels in normal skin, and 2) endothelial cell density is greater in nonpatent vessels than in patent vessels. The observed extent of microvascular occlusion supports a previously published theory that hypoxia is involved in the generation of hypertrophic scar.

Collagen biosynthesis in healing wounds of the spinal cord and surrounding membranes.

Kinetics of collagen synthesis and deposition were studied in the canine spinal cord, pia mater, and dura mater and in wounds of these tissues over the first 8 weeks. Little collagen is present in unwounded spinal cord compared with surrounding mesenchymal membranes. Collagen synthetic potential was found within the spinal cord, a tissue of neurectodermal origin. Rate of collagen synthesis per collagen content in the unwounded spinal cord was high. This synthetic rate was as high as that of wounds at their maximum collagen synthetic rates. Substantial deposition of collagen followed spinal cord wounding. Wounding the spinal cord, pia mater, and dura mater caused substantial elevations in rates of collagen synthesis in each tissue. These synthetic rates remained at maximum levels throughout the 8-week study, a prolonged period when compared with other wounded tissues previously studied. The role of mesenchymal tissue physiology in central nervous system wound healing is discussed. The potential value of these findings for further studies and for experimental manipulation of the healing process in spinal cord and central nervous system wounds is presented. Implications of these findings on the hypothetical relationship of scar to spinal cord and central nervous system regeneration are noted.

Preliminary testing of the contraceptive collagen sponge.

The results of 3 years of developing the collagen sponge as an intravaginal contraceptive are presented. Postcoital tests were used to evaluate the efficacy of the sponge as a mechanical barrier. Results with the collagen sponge alone were compared to those of the sponge with spermicidal cream or spermicidal solution (acid buffer and zinc) and of spermicidal cream alone. The presence of any motile spermatozoa in the cervical mucus was considered a failure of the barrier method. The collagen sponge alone or with acid and zinc and spermicidal cream alone had failure rates of 22, 20, and 14%, respectively, whereas the collagen sponge with spermicidal cream had a 6% failure rate. The authors conclude that the combination of a mechanical and a chemical barrier is a more effective contraceptive method than a mechanical barrier or chemical agent alone.

Studies on vaginal malodor. I. Study in humans.

Forty-two percent of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of the sponges, odor formed only in 4% of the sponges worn by sexually inactive users. No difference in the rate of odor formation was found when neutral pH (7.0) and acid pH (3.4) collagen sponges were tested, although we believe that a pH 3.4 is too acid and promotes odor formation. The optimal pH of the sponge should be 4.5 to 5.5. Malodor was efficiently extracted from sponges by washing in acid milieu of tap water and vinegar or 0.1 M acetate buffer, pH 4.0. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time of malodor development, the high content of polyamines (putrescine, spermine, spermidine) in the ejaculate decreased to undetectable values. We conclude that the ejaculate is the major source of malodor formation in intravaginally worn collagen sponges. Removal, rinsing optimally in vinegar solution, and reinsertion within 24 hours after intercourse reduces the chance of malodor formation.

PIP: 42% of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of sponges, odor formed only in 4% of sponges worn by sexually inactive persons. No difference in the rate of odor formation was found when neutral pH (7) and acid pH (3.4) collagen sponges were tested, although it is believed that a pH of 3.4 is too acidic and promotes odor formation. The optimal pH should be 4.5-5.5. Malodor was effectively extracted from sponges by washing in acid milieu of tapwater and vinegar or .1 M acetate buffer, pH 4. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time maloder develops, the high concentration of polyamines (putrescine, spermine, and spermidine) in ejaculate decreased to undetectable levels. It is therefore concluded that the ejaculate is the major source of malodor formation in intravaginally worn sponges.

Development of an infection-resistant vascular prosthesis.

To develop an infection-resistant arterial prosthesis, amikacin was bonded to 6-mm, uncrimped, filamentous velour prostheses using a collagen-release system. Infrarenal abdominal aortas were resected in 26 mongrel dogs. Thirteen dogs had their aortas replaced with the antibiotic-bonded grafts and 13 dogs had their aortas replaced with a graft containing collagen without antibiotics. Following closure of the abdominal incision, each dog received an intravenous infusion of 10(8) organisms of Staphylococcus aureus administered over a 30-minute interval. Three weeks after recovery from operation, the grafts were removed under aseptic conditions; all 13 (100%) of the control grafts were infected, but only one of 12 experimental grafts (8%) was infected. There were no adverse healing effects; to the contrary, there appeared to be accelerated development of a cellular neointima and fibroblastic infiltration to the interstices. Antibiotic bonding with a collagen-release system is a promising method for imparting infection resistance to a vascular prosthesis.

Vascular manifestations in patients with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is clinically and genetically a heterogenous disorder of connective tissue synthesis. Seven clinical types of this disease have been identified and the underlying biochemical defects defined in types IV through VII. Unfortunately, most patients with major vascular complications of EDS have few, if any of the commonly recognized musculoskeletal and cutaneous abnormalities. Recognition of the correct diagnosis and the application of accepted vascular surgical techniques may improve the morbidity and mortality for these patients.

Influence of shock waves on fracture healing.

During the last decades the influence of physical factors on fracture healing has been widely described. With the use of shock waves for the treatment of urolithiasis, a new mechanical medium has been introduced into medicine. For the first time the influence of shock waves on fracture healing was studied in rats. With fractioned shock-wave treatment (5 times 100 shock waves at 14 or 18 kV) an enhancement in healing could be achieved.

An intravaginal contraceptive diaphragm made of collagen sponge: new old principle.

This study presents a theoretical background for a new intravaginal contraceptive. A highly resilient and liquid-absorbent collagen sponge in the form of a cup is self-administered in the upper vault of the vagina, where it is retained for several days to form a mechanical barrier against sperm. The high fluid-binding capacity contributes to the trapping and immobilization of sperm within the sponge. Other methods enhancing the retention and spermicidal effect of the sponge are discussed. Clinical testing of the sponge is in progress.

Liver function tests in women using intravaginal spermicide nonoxynol-9.

PIP: The effects of intravaginal application of nonoxynol-9 (N-9) on hematological parameters, routine liver function biochemistry (bilirubin, serum bile acid, SGOT, SGPT, GGT, alkaline phosphatase), and serum lipids (cholesterol and triglyceride) were evaluated in 10 normal women who received 150 mg N-9 daily for 14 consecutive days. Only 6 persons completed the trial (4 were excluded because of irritation and vaginal itching, moniliasis, and urinary tract infection). There was no effect of the N-9 on the tests reflecting liver function and hematologic parameters, confirming the results of B. Malyk. Reduction in serum cholesterol at the end of the trial was the only significant finding; such finding was not seen in the subjects of Malyk, who used a lower dose (115 mg) of the drug. Caution should be observed in interpreting the results of such a short-term clinical toxicity study as it does not reliably exclude the possibility of significant liver damage due to chronic clinical use of N-9 as a contraceptive agent. Common laboratory tests of "liver function" have been known to produce totally normal results inspite of the presence of extensive liver disease. Also, because only normal women have been studied, the hepatotoxic potential of N-9 in women with mild or chronic liver disease is not known. Early hepatic damage in rates given N-9 has been observed and suggests the need for continued surveillance of N-9 and evaluation of its systemic effects.^ieng

The acceptance of the collagen sponge diaphragm as an intravaginal contraceptive in human volunteers.

Two types of highly resilient and liquid-absorbent collagen sponge contraceptives (CSC) in the shape of cylindrical cups (6 cm wide and 2.5 cm thick) were evaluated for acceptance as an intravaginal contraceptive method for a period of 3 months in 27 volunteers. Parameters such as retention, odor, irritation, itching, discharge, and convenience for the user and her sexual partner were tested. Average retention time was 7 to 9 days (range, 2 to 28 days); still, most sexually active volunteers preferred to remove the CSC every 3 to 4 days, rinse them in tap water, and reinsert them. Odor was noticed by users in 4% of the tested sponges and in 30% of all volunteers by medical personnel at the time of removal of the CSC from the vagina. No irritation, itching, or discharge was reported. The CSC alone did not cause any inconvenience to the user or partner, while the CSC with inserted rubber ring was felt by both partners and was found to be dislocated. This study indicates good acceptance of the CSC in intravaginal use. Studies to evaluate the efficacy of collagen sponges as mechanical contraceptive barriers are in progress.

Studies on nonoxynol-9. III. Effect on fibroblasts and spermatozoa.

Seven nonionic detergents of the Igepal CO series differing in molecular size and including nonoxynol-9 and a representative anionic (SDS) and cationic (Cepacol) detergent were tested as to their relative cytotoxicity. The biologic effects of these detergents on human W1--38 fibroblasts (DNA and glycosaminoglycans synthesis) and on the motility of human spermatozoa were studied. The relative order of cytotoxicities for both fibroblasts and spermatozoa was cationic greater than nonionic greater than anionic. The concentration of nonoxynol-9-inhibiting fibroblast activity was approximately 30 times less than the amount needed to immobilize spermatozoa. It is concluded that CO-630, used as a source of nonoxynol-9, is the most effective polymer to inhibit spermatozoa and also fibroblasts.

Studies of nonoxynol-9. I. The effect on the vaginas of rabbits and rats.

A standard rabbit vaginal irritation test was used to evaluate the morphologic reaction to an aqueous solution of a nonionic spermicidal detergent, nonoxynol-9 (N-9). Various amounts of N-9, between 2.5 mg and 50 mg, were incorporated into cylindrical collagen sponges which were retained in the vagina for 10 days. Changes in the continuity of the epithelial lining, edema of the submucosal layer, and the inflammatory cell infiltrate of this layer were proportional to the amount of N-9 tested. An increase in semiquantitative score for the inflammatory changes in the vagina was noted for increasing amounts of N-9. In young adult female rats treated vaginally with 5 mg/100 gm body weight/day of aqueous N-9 for 5 to 20 days, the number of cells (DNA) was significantly increased on day 5. The collagen content in the vaginal wall (hydroxyproline) was significantly increased after 15 and 20 daily injections of the detergent. We conclude that both morphologic and chemical changes in the vagina are compatible with the inflammatory reaction induced by the detergent tested.

The organ distribution of liposome-encapsulated and free cobalt in rats. Liposomes decrease the cardiac uptake of the metal.

Rats were administered intravenously liposome-encapsulated or free cobalt, and the organ distribution of the metal was explored using Co57 tracer. Two hours after administration, the cobalt level in the heart was about 40% of the control when given in sphingomyelin (SM)/cholesterol (CH) (1:1 mole ratio) liposomes. These vesicles also tended to decrease the uptake of cobalt in the kidney and the carcass, and to increase it in the spleen and the bones. Liposomes prepared from soybean phosphatidylcholine (SPC)/CH (1:1) had no effect on the uptake of cobalt in the heart, whereas increased its level in the spleen, liver and lung. The time-course of cobalt deposition in the organs displayed substantial variation with the different preparations. Most importantly, no buildup of cobalt level was observed in the heart when the metal was administered in SM/CH vesicles. While confirming known effects of liposomes on the organ-distribution of entrapped drugs, our findings suggest that administration of cobalt in SM/CH liposome-encapsulated form may result in decreased cardiotoxicity and thus increased safety of cobalt-treatment in some anemias.

Changes in the fatty acid profile of lung, liver and serum of rats intratracheally given silica.

The esterified (E) and nonesterified (NE) fatty acid level and profile in the lung, serum, and liver of rats are significantly altered after intratracheal administration of silica. The changes include a silica-specific increase of the total long chain (C16-C20:4) fatty acid content in the lung, and a decrease in the serum and liver of both groups of rats intratracheally given silica and/or saline. In the silicotic lung, arachidonate and palmitate accumulated at the highest rate. A heat-labile, high-molecular weight component from lung homogenates increases lipogenesis in isolated hepatocytes in vitro. These findings, taken together with evidence indicating increased lipogenesis in the liver of rats treated with silica under identical conditions, suggest a lung-liver communication mechanism which coordinates lipid uptake by the lung and lipid synthesis and release by the liver. The stimulatory factor identified in lung homogenates might play an important regulatory role-for hepatic lipogenesis in rats developing silicotic lungs.