Effects of supercritical carbon dioxide sterilization on polysaccharidic membranes for surgical applications.

Sterilization methods such as ɣ-irradiation, steam sterilization and ethylene oxide gas treatment can have negative effects on molecular structure and properties of polysaccharide-based biomaterials. In this perspective, the use of supercritical carbon dioxide (scCO2) has been proposed as an alternative method for biomaterial sterilization. In this work, chemical, mechanical and biological properties of polysaccharidic membranes for surgical applications were investigated after sterilization by scCO2. Four sets of sterilizing conditions were considered and SEC analyses were performed in order to identify the one with lower impact on the polysaccharidic matrix of membranes (alginate). Mechanical tests showed that the resistance of membranes was slightly affected after sterilization. Biological analyses proved the biocompatibility of the sterilized membranes both in vitro and in a preliminary in vivo test. Overall, this study points out that this sterilization technique can be successfully employed to achieve an effective and safe sterilization of polysaccharidic membranes for surgical use.

Safety and effects on the lipid and C-reactive protein plasma concentration of the association of ezetimibe plus atorvastatin in renal transplant patients treated by cyclosporine-A: a pilot study.

Ezetimibe (E) is a new cholesterol adsorption inhibitor which prevents the adsorption of dietary and biliary cholesterol by binding to a recently described cholesterol transporter. This pilot study was performed to evaluate the safety and the low-density lipoprotein (LDL)-C and C-reactive protein lowering efficacy of atorvastatin (A) and of the association of A plus E in five renal transplant patients with hypercholesterolemia and mild renal functional impairment receiving cyclosporine-A (CsA). Patients received for three periods, each of 3 weeks, A at a dose of 20 mg/day; A at a dose of 10 mg/day and finally, A 10 mg plus E 10 mg daily. The medications were well-tolerated and no important clinical or laboratory (muscle enzyme, creatinine clearance and CsA concentration) abnormalities were observed throughout the study period. A alone lead to target LDL-C values only in two of five patients and did not significantly reduce the mean CRP values. The combination of E plus A produced the lowest lipid levels and significantly reduced CRP mean values and allowed all patients to attain target levels of LDL-C: total cholesterol decreased from 240 +/- 42 (mean +/- S.D.) to 171 +/- 34 mg/dl, LDL-C from 129 +/- 32 to 87 +/- 21 mg/dl, plasma triglycerides from 330 +/- 54 to 194 +/- 71 mg/dl and CRP from 6.2 +/- 1.9 to 3.9 +/- 2.4 mg/l (P < 0.05 for all). This pilot study suggests that the co-administration of E and A at 10 mg/day in renal transplant patients receiving CsA is well-tolerated and effective in reducing important cardiovascular risk factors.

C-reactive protein in patients on chronic hemodialysis with different techniques and different membranes.

In hemodialysis patients, C-reactive protein (CRP), an acute-phase reactant, is a sensitive and independent marker of malnutrition, anemia, and cardiovascular mortality. The aim of the present study was to evaluate CRP levels in plasma samples from long-term hemodialysis patients on different extracorporeal modalities and dialyzed with different membranes, at baseline and after 6 months. Two hundred and forty-seven patients were recruited in eight hospital-based centers. All patients had been on their dialytic modality for at least 3 months and were prospectively followed in their initial dialytic modality for 6 months. Patients were treated with conventional bicarbonate dialysis (N = 127) or hemodiafiltration (N = 120). Patients treated with conventional bicarbonate dialysis were dialyzed with different membranes: Cuprophane (N = 51), low-flux cellulose modified membrane (N = 37) and synthetic membranes (N = 39). Hemodiafiltration was performed in post-dilution mode with polysulfone (N = 66) and polyacrylonitrile (N = 54) membranes. Analysis of baseline CRP values in the clinically stable patients showed that an unexpectedly high proportion (47%) of the patients had CRP values higher than 5 mg/l (upper limit in normal subjects). The mean +/- S.D. CRP values were significantly higher (P < 0.05) in hemodiafiltration with infusion volumes < 10 l per session (14.6+/-3.1 mg/l) than in standard hemodialysis (5.1 +/- 2.1 mg/l) and hemodiafiltration with infusion volumes > 20 l per session (4.9 +/- 2.1 mg/l). These values did not significantly change after 6 months of follow-up. Concerning the membranes, the highest levels of CRP were observed in patients dialyzed with Cuprophane with a significant increase from 15.1 +/- 3.6 to 21.2 +/- 3.1 mg/l after 6 months (P < 0.05); a significant reduction of CRP levels was observed in patients dialyzed with polysulfone in the same follow-up period (from 13.5 +/- 2.9 to 8.1 +/- 2.4 mg/l; P < 0.05). The CRP increase following low volume HDF can be related to back-filtration of bacterial derived contaminants.; moreover, an important effect on CRP of the hemodialysis membrane is observed and new synthetic membranes can be used to decrease these levels.

Enhanced bioadhesivity of dopamine-functionalized polysaccharidic membranes for general surgery applications.

UNLABELLED: An emerging strategy to improve adhesiveness of biomaterials in wet conditions takes inspiration from the adhesive features of marine mussel, which reside in the chemical reactivity of catechols. In this work, a catechol-bearing molecule (dopamine) was chemically grafted onto alginate to develop a polysaccharide-based membrane with improved adhesive properties. The dopamine-modified alginates were characterized by NMR, UV spectroscopy and in vitro biocompatibility. Mechanical tests and in vitro adhesion studies pointed out the effects of the grafted dopamine within the membranes. The release of HA from these resorbable membranes was shown to stimulate fibroblasts activities (in vitro). Finally, a preliminary in vivo test was performed to evaluate the adhesiveness of the membrane on porcine intestine (serosa). Overall, this functionalized membrane was shown to be biocompatible and to possess considerable adhesive properties owing to the presence of dopamine residues grafted on the alginate backbone. STATEMENT OF SIGNIFICANCE: This article describes the development of a mussels-inspired strategy for the development of an adhesive polysaccharide-based membrane for wound healing applications. Bioadhesion was achieved by grafting dopamine moieties on the structural component on the membrane (alginate): this novel biomaterial showed improved adhesiveness to the intestinal tissue, which was demonstrated by both in vitro and in vivo studies. Overall, this study points out how this nature-inspired strategy may be successfully exploited for the development of novel engineered biomaterials with enhanced bioadhesion, thus opening for novel applications in the field of general surgery.

Separation and characterization of three beta-galactosidases from Bacillus circulans.

Crude preparation of Bacillus circulans beta-galactosidase is known to have a good transglycolytic activity. Two isoforms of the enzyme have been described so far in the literature. Aiming at separating these two forms to assess their relative contribution to the regioselectivity of transglycosylation, we observed the presence of a third isoform never described before. This paper deals with the isolation procedures of the three enzymes and a re-consideration of their properties. The estimated molecular weight for the isoforms were 212 kDa (I), 145 kDa (II) and 86 kDa (III), respectively. Kinetic parameters were determined towards the hydrolysis of o-nitrophenyl-beta-d-galactopyranoside (ONPG) and lactose. For ONPG the following values of Km were found: 3.6, 5.0 and 3.3 mM for I, II and III, respectively, whereas for lactose the values were 3.7, 2.94 and 2.71 mM, respectively.

The aggregation of pig articular chondrocyte and synthesis of extracellular matrix by a lactose-modified chitosan.

A reductive amination reaction (N-alkylation) obtained exploiting the aldheyde group of lactose and the amino group of the glucosamine residues of chitosan (d.a. 89%) afforded a highly soluble engineered polysaccharide (chitlac) for a potential application in the repair of the articular cartilage. Chitosan derivatives with 9% and 64% of side chain groups introduced have been prepared and characterized by means of potentiometric titration, (1)H-NMR and intrinsic viscosity. Both polymers, with respect to the unmodified chitosan, induce cell aggregation when in contact with a primary culture of pig chondrocytes, leading to the formation of nodules of considerable dimensions (up to 0.5-1 mm in diameter). The nodules obtained from chondrocytes treated with chitlac with the higher degree of substitution have been studied by means of optical and electron microscopy (SEM, TEM) and the production of glycosaminoglycans (GAGs) and collagen has been measured by means of colorimetric assays. The chondro-specificity of GAG and collagen was determined by RT-PCR. The results show that the lactose-modified chitosan is non-toxic and stimulates the production of aggrecan and type II collagen.

Silver-polysaccharide antimicrobial nanocomposite coating for methacrylic surfaces reduces Streptococcus mutans biofilm formation in vitro.

OBJECTIVES: The aim of this study was to determine the in vitro microbiological performances of a lactose-modified chitosan (Chitlac) coating inside which silver nanoparticles were embedded (Chitlac-nAg) for BisGMA/TEGDMA methacrylic specimens. METHODS: Different concentrations of nAg inside Chitlac coating were tested (1 mM, 2 mM, 5 mM). Specimen surface was analyzed by means of field-emission scanning electron microscopy (FEISEM) and energy-dispersive X-ray spectroscopy (EDS). A 48 h monospecific Streptococcus mutans biofilm was developed over the specimen surfaces using a modified drip-flow bioreactor; adherent viable biomass was assessed by MTT test and biofilm was imaged by confocal laser-scanning microscopy (CLSM). RESULTS: The presence of finely dispersed nanoparticles inside the Chitlac coating was confirmed by FEISEM and EDS analysis. All nanoparticles were embedded in the Chitlac coating layer. Chitlac-nAg coatings were able to significantly decrease biofilm formation depending on the nAg concentration, reaching a -80% viable biomass decrease when the 5 mM nAg-Chitlac group was confronted to non-coated control specimens. CLSM analysis did not provide evidence of a contact-killing activity, however the antibacterial Chitlac-nAg coating was able to alter biofilm morphology preventing the development of mature biofilm structures. CONCLUSIONS: The microbiological model applied in this study helped in assessing the antibacterial properties of a coating designed for methacrylate surfaces. CLINICAL SIGNIFICANCE: A microbiological model based on a bioreactor-grown biofilm is useful for preliminary in vitro tests of dental materials. In translational terms, an antibacterial nanocomposite coating based on Chitlac-nAg and designed to be applied to methacrylic surfaces may be a promising way to obtain dental materials able to actively prevent secondary caries.

Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain.

BACKGROUND: Cancer-related breakthrough pain (BTP) is a common and quite challenging pain syndrome, with significant impact on quality of life. To date, no widely recognized and validated tool for the diagnosis and evaluation of BTP exists. The Alberta Breakthrough Pain Assessment Tool (ABPAT) underwent a validation process during its development, but no experience of its implementation in clinical practice has been reported. METHODS: ABPAT was tested in a cohort of cancer patients suffering from chronic severe cancer-related pain in order to assess its acceptability and efficacy as a tool for the characterization of BTP. RESULTS: A total of consecutive 249 patients from seven different centres were included in a 2-month study period and all completed the questionnaire; 231 out of the 249 (92.8%) stated that questions were easily understandable and 217 out of the 249 (87.1%) stated that the tool allowed to explain extensively the BTP problem. Physician-patient correlation tests about baseline BTP intensity and BTP relief by medication showed statistical significance at the level of p = 0.001 and p = 0.0001, respectively. Evaluation of the efficacy of BPT medication revealed a 78.2% of patients declaring a good relief from BTP, with a significant reduction of mean BTP numeric rating scale score (p = 0.0001), but only 55.9% of patients responded to be satisfied about time for onset of the relief. CONCLUSIONS: In this study, ABPAT resulted to be a well-accepted tool for BTP assessment and characterization in a relatively large cohort of cancer patients. It is effective in discovering the unmet needs of cancer patients and in exploring the outcomes of BTP treatment.

Complete synthesis of 3'-sialyl-N-acetyllactosamine by regioselective transglycosylation.

Transglycolytic synthesis of 3'-sialyl-N-acetyllactosamine by sequential use of beta-galactosidase from Bacillus circulans and trans-sialidase from Trypanosoma cruzi was described. These reactions depicted the first complete synthesis of a biologically important oligosaccharide with high regioselectivity avoiding use of glycosyltransferases and NDP sugars.

Human osteosarcoma cells release matrix degrading enzymes in response to chemokine activation.

Matrix degrading enzymes released upon autocrine and/or paracrine induction exert a key role in modulating tumor cell behavior. Osteosarcoma is a highly metastatic cancer, with a redundancy of autocrine loops. Here we report that human osteosarcoma cells express a wide array of chemokine receptors and respond to chemokine activation with the release of N-acetyl-beta-D-glucosaminidase and gelatinase/collagenase activity. Of the two cell lines studied, the osteoblast-like MG-63 showed a higher responsivity compared to the less differentiated HOS. This suggests that chemokine modulation of matrix degrading enzymes requires the maintaining of the osteoblastic phenotype and of signaling pathways which occur in normal tissue.

NK binding capacity and lytic activity depend on the expression of ICAM-1 on target bone tumours.

Osteosarcoma cell lines are differently lysed by natural killer (NK) lymphocytes. A critical step in the lytic process is the recognition and attachment of effector to target cells. To determine binding capacity and lytic activity of NK cells, we investigated the distribution and role of ICAM-1, 2 and 3 on two osteosarcoma cell lines (HOS and Saos-2) in basal conditions and after TNFalpha treatment. Modulation of ICAM-1 after TNFalpha treatment modified the binding capacity of NK cells to osteosarcoma target cells. This modulation process appears to play a critical role in determining the susceptibility of these cells to NK-mediated lysis.

Polyelectrolytic aspects of the titration curve. The semi-flexible model.

An analysis is given of the theoretical approach to the quantitative description of proton dissociation curves for weak polyacids. The basic model of the counterion condensation theory has been used, with the modification reported in the preceding study (S. Paoletti, A. Cesàro, C. Arce Samper and J.C. Benegas, Biophys. Chem. 34 (1989) 301). In this paper we demonstrate the effect of relaxing the hypothesis of a rigid conformation on the polyelectrolytic properties of weak polyacids. As an application of the present approach, a description is given of the titration curves for two weak polyacids, poly(DL-glutamic acid) (PDLGA) and poly(L-aspartic acid) (PLAA).

Polyelectrolytic aspects of the titration curve. pH-induced conformational transition of poly(L-glutamic acid): the semi-flexible model.

The cooperative conformational transition of poly(L-glutamic acid) induced by pH is monitored by the titration curves from literature. The polyelectrolytic approach described in the preceding article (A. Cesàro, S. Paoletti and J.C. Benegas, Biophys. Chem. 39 (1991) 1) is used to fit the experimental curves under various conditions of ionic strength and temperature, with the sole assumption that each polymeric state is characterized by a proper conformational flexibility. The helix-coil transition of the system becomes molecularly defined by the balance between the non-ionic conformational energy and the repulsive electrostatic energy of the two forms. Implications of the results of the theoretical model on the energetics of the cooperative order-disorder transition are discussed.

Conformational transition of poly(alpha-L-glutamic acid). A polyelectrolytic approach.

The charge-induced conformational transition of poly(alpha-L-glutamic acid) (PLGA) is considered in this paper from the point of view of proton dissociation. Equations for the excess electrostatic Gibbs energy of dissociation (i.e., delta pKa) are derived as a function of the degree of ionization, alpha. These analytical equations are used to describe some experimental dissociation curves at different polymer and salt concentrations. The dependence of the calculated delta pKa with respect to the ionic strength for the two conformational states, alpha-helical and extended coil, respectively, is rather satisfactorily explained. Even more interesting are the predictions which are derived from this approach for the transition point, alpha tr which is found to be ionic-strength dependent, in full agreement with the experimental results.

Limiting-laws of polyelectrolyte solutions. Ionic distribution in mixed-valency counterions systems. I: The model.

An extension of the counterion-condensation (CC) theory of linear polyelectrolytes has been developed for the case of a system containing a mixture of counterions of different valency, i and j. The main assumption in the derivation of the model is that the relative amount of the condensed counterions of the type i and j is strongly correlated and it is determined by the overall physical bounds of the system. The results predicted by the model are consistent, in the limiting cases of single species component, with those of the original CC theory. The most striking results are obtained for the cases of low charge density and excess of counterion species: in particular, an apparent positive "binding" cooperativity of divalent ions is revealed for small, increasing additions of M2+ ions to a solution containing a swamping amount of monovalent salt and a polyelectrolyte of low charge density. Apparent "competitive binding" of mono- and divalent ions derives as a bare consequence of the electrostatic interactions. Theoretical calculations of experimentally accessible quantities, namely single-(counter) ion activity coefficients, confirm the surprising predictions at low charge density, which qualitatively agree with the measured quantities.

Limiting-laws of polyelectrolyte solutions. Ionic distribution in mixed-valency counterions systems. II. A comparison of conductometric data and theoretical predictions.

The competitive binding of monovalent and divalent counterions (M+ and M2+, respectively) has been studied by a conductometric procedure as described by De Jong et al. (Biophysical Chemistry 27 (1987) 173) for aqueous solutions of alkali metal polymethacrylates in the presence of Ca (NO3)2 or Mg(NO3)2. The experimentally obtained fractions of conductometrically free counterions are compared with theoretical values computed according to a new thermodynamic model recently developed by Paoletti et al. (Biophysical Chemistry, 41 (1991) 73). For the systems studied, the fractions of free monovalent and divalent counterions can be fairly well described by the theory. In fact, the results support the assumption that under the present conditions the conductometrically obtained distribution parameters (l) and (2) approximate the equilibrium fractions of free monovalent and divalent counterions. For a degree of neutralization of 0.8 and a molar concentration ratio of divalent counterions and charged groups on the polyion up to 0.25, the mean M+/M2+, exchange ratio nu has been found to be 1.39 +/- 0.03 and 1.33 +/- 0.03 for the alkali metal/Ca/PMA and alkali metal/Mg/PMA systems, respectively. These values agree well with the theoretical value, which for this particular case is 1.38.

Analysis of potentiometric titrations of heterogeneous natural polyelectrolytes in terms of counterion condensation theory: application to humic acid.

A model, developed within the framework of the counterion condensation theory of linear polyelectrolytes, is presented in this paper to describe the acid-base properties of linear polyelectrolytes, consisting of several types of functional ionizable groups. This formalism has been successfully applied to Fluka humic acid under salt-free conditions, as well as in the presence of supporting simple 1:1 salt (KNO3) at three different concentrations. As part of this approach, the charge density of the humic acid is obtained from the activity coefficient measurements of potassium counterions at different humic acid concentrations at a constant degree of dissociation of the polyelectrolyte. The humic acid average charge density was found to be 0.80 +/- 0.05. Using the present model, we are able to satisfactorily describe the experimental data obtained from acid-base potentiometric titrations. Four main functional groups making up the polymer are determined through their fractional abundances (Xi) and intrinsic pK (pK0i) values. The fractional abundances remained constant and independent of the ionic strength, indicating that the humic acid constitution does not depend on the concentration of excess salts. The pK0i values show a small change with ionic strength, which can be explained by the polyelectrolytic behavior of the solution.

Factor VIII complex in progressive systemic sclerosis.

Factor VIII complex and its related activities (Coagulant, Antigen and Ristocetin Cofactor) have been investigated in 23 patients with Progressive Systemic Sclerosis (PSS) divided into two groups: acrosclerosis and diffuse sclerosis. All Factor VIII-related activities were higher in PSS patients than in normal subjects. No difference in F. VIII-related Antigen (F. VIIIR:Ag), F. VIII-related Ristocetin Cofactor (F. VIIIR:Co) and F. VIII Coagulant activity (F. VIII:C) was found comparing the patient groups. F. VIII:C was increased significantly less than F. VIIIR:Ag and F. VIIIR:Co in both patient groups. Some hypotheses about the pathogenesis of this increase are discussed.

Stabilization of the T-state of ferrous human adult and fetal hemoglobin by Ln(III) complexes: a thermodynamic study.

The effect of the lanthanide(III) complexes [Gd(1,4,7,10-tetraazacyclododecane-N,N',N", N"'-tetrakis(methylenephosphonate))]5- (Gd-DOTP) and La-DOTP on the oxygen binding and spectroscopic properties of human adult and fetal hemoglobin (HbA and HbF, respectively) has been investigated. The affinity of Gd-DOTP and La-DOTP for oxygenated HbA (HbAO2; KHbAO2 = 2.6 x 10(-3) M) is closely similar to that observed for Ln(III) complexes association to nitrosylated HbA (HbANO KHbANO = 1.8 x 10(-3) M) and to aquo-met HbA (met-HbA; Kmet-HbA = 1.9 x 10(-3) M), being lower than that determined for Gd-DOTP and La-DOTP binding to the deoxygenated form of the tetramer (HbAd; KHbAd = 3.0 x 10(-4) M). The affinity of Gd-DOTP for deoxygenated HbF (HbFd; KHbFd = 9.5 x 10(-4) M) and oxygenated HbF (HbFO2; KHbFO2 = 3.7 x 10(-3) M) is lower than that observed for Ln(III) complexes association to HbAd and HbAO2, respectively. Gd-DOTP and La-DOTP bind to HbA and HbF with a 1:1 stoichiometry per tetramer. Increasing Gd-DOTP and La-DOTP concentration, oxygen affinity for HbA decreases (i.e. P50 increases), this effect being minor for HbF. Upon binding of Ln(III) complexes to HbANO, the X-band EPR spectrum and the absorption spectrum in the Soret region display the characteristics which have been attributed to the T-state of the ligated tetramer. These results represent a clear cut evidence for the specific binding of Gd-DOTP and La-DOTP to the 2,3-D-glycerate bisphosphate (BPG) pocket (i.e. at the dyad axis, in between the beta-chains) of HbA and HbF. The effect of Ln(III) complexes on the ligand binding and spectroscopic properties of HbA and HbF is reminiscent that of BPG, the physiological modulator of human Hb action.

Azide, cyanide, fluoride, imidazole and pyridine binding to ferric and ferrous native horse heart cytochrome c and to its carboxymethylated derivative: a comparative study.

Azide, cyanide, fluoride, imidazole, and pyridine binding to ferric and ferrous native horse heart cytochrome c and to its carboxymethylated derivative has been investigated, from the thermodynamic viewpoint, at pH 7.5 and 25.0 degrees C. Ligand affinity for ferric and ferrous carboxymethylated cytochrome c is higher by about 30- and 400-fold, respectively, than that observed for the native protein. The results here reported: (i) allow the estimation, for the first time, of the ligand-independent free energy associated with the heme-iron sixth coordination bond in ferric and ferrous native cytochrome c, which turns out to be +8.4 kJ mol-1 and +14.6 kJ mol-1, at 25.0 degrees C, respectively, and (ii) suggest an interplay between redox, structural, ligand binding, and recognition properties of cytochrome c.