Chemokine therapy for anal sphincter injury in a rat model: a pilot study.

INTRODUCTION AND HYPOTHESIS: To determine whether delayed administration of CXCL12 alters anorectal manometric pressures and histology in rats following anal sphincterotomy compared to primary surgical repair alone. METHODS: Adult female rats were divided into three groups: A, a control group that did not undergo surgery; B, anal sphincterotomy with primary surgical repair; C, anal sphincterotomy with primary surgical repair and intra-sphincteric injection of CXCL12 at 6 weeks post-injury. All rats underwent anal manometry measurements at baseline and at 6 and 12 weeks post-injury. Histologic analysis of the anal sphincters was also performed. RESULTS: At baseline and 6 weeks, there were no statistically significant differences among D, Tmax and P∆ of Groups A, B and C. At 12-week manometry, the total duration of contractions on anal manometry was significantly less in Group C compared to Groups A and B (3.65, 5.5, 5.3 p < 0.01) as was time to peak of contraction at 12 weeks (1.6, 2.1, 3.1, p < 0.01); however, group C had a significantly higher P∆ at 12 weeks compared to Groups A and B (2.25, 1.4, 0.34, p < 0.01). There were no statistically significant differences in the ratio of muscle to collagen at the site of injury; however, muscle fibers were significantly smaller in group C and less per bundle than the other groups. CONCLUSIONS: Administration of chemokine therapy at 6 weeks post-repair using CXCL12 enhanced the magnitude of anal sphincter contractions in a rat model of anal sphincter injury but decreased overall duration of contraction. Increased anal sphincter contraction magnitude was not explained by histologic differences in explanted specimens.

Using specific antisera to neutralize ACTH in sturgeon: a method for manipulating the interrenal response during stress.

Interrenal function and the magnitude of the stress response were assessed in green sturgeon (Acipenser medirostris) passively immunized with antisera directed against adrenocorticotropic hormone (ACTH). The nucleotide sequence encoding ACTH was determined using reverse transcriptase polymerase chain reaction (RT-PCR). We identified two isoforms of ACTH that differ at a single site (position 26) in the 39 AA peptide. Both forms of green sturgeon ACTH (gsACTH1-39) display 100% homology with both sequences of white sturgeon ACTH (wsACTH1-39). The N-terminal portion of gsACTH also shares absolute identity with the comparable portion of human ACTH (hACTH). However, we identified considerable sequence divergence in the C-terminal domain between gsACTH and hACTH. Species-specific anti-ACTH sera were generated by vaccinating sheep against the C-terminal portion of gsACTH (gsACTH26-39). The peptide was covalently linked to a carrier protein (keyhole-limpet-hemocyanin [KLH]) to further enhance its immunogenicity. The anti-gsACTH sera recognized gsACTH1-39 and the immunogenic peptide (gsACTH26-39), but did not interact with hACTH1-39. To assess the impact of the antisera, fish were passively immunized with anti-gsACTH26-39 sera or anti-KLH sera and challenged with a hACTH1-39 injection on day 1 followed by a 1-min air emersion stressor on day 2. The magnitude and duration of the secretory response induced by hACTH did not differ (P > .05) between groups. Conversely, the magnitude of cortisol secretion induced by air emersion was significantly attenuated (P < .05) in fish passively immunized against gsACTH26-39. Collectively, these data demonstrate that the targeted antisera used in this study can discriminate between mammalian and green sturgeon ACTH and moderate the in vivo response to a stressor.

The cost of chronic stress: impacts of a nonhabituating stress response on metabolic variables and swimming performance in sturgeon.

Metabolic scope for activity (MSA) and critical swimming velocity (U(crit)) were measured in green sturgeon exposed to two stressors daily for 28 consecutive days. The results were compared with unstressed fish in an effort to measure the "cost" of chronic stress. Chronic stress was simulated by exposing fish to a randomized order of acute stressors: a 5-min chasing stressor, a 10-min water depth reduction stressor, or a 5-min confinement stressor. The acute cortisol response to each stressor was initially determined, and the maintenance of that response was verified in 7-d intervals during the chronic stress regime. Exposure to the chronic stress regime resulted in a 25% reduction of MSA caused by significantly increased maintenance metabolic rate (0.27+/-0.01 vs. 0.19+/-0.02 mg O(2) h(-1) g(-1), chronic and control fish, respectively) but did not affect the U(crit) of sturgeon. In addition, a 50% reduction in liver glycogen levels and a twofold increase of resting plasma glucose levels were measured in chronically stressed fish. We conclude that our chronic stress regime resulted in a significant maintenance cost to green sturgeon, possibly because of their inability to habituate to the stressors, but did not decrease their swimming performance.

Time of day and water temperature modify the physiological stress response in green sturgeon, Acipenser medirostris.

The effects of time of day and water temperature on the acute physiological stress response were investigated in young-of-the-year green sturgeon (Acipenser medirostris). The response to a 1-min air-emersion stressor was assessed during the day (08.00 h) and at night (20.00 h), as well as after acclimation to either 11 degrees C or 19 degrees C. Blood samples were collected prior to stress and at several times after exposure to the stressor, and plasma concentrations of cortisol, lactate, and glucose were determined. The magnitudes of cortisol (19.1 ng ml(-1) vs. 4.9 ng ml(-1)) and lactate (190.6 mg l(-1) vs. 166.7 mg l(-1)) were significantly higher in fish stressed at night when compared with the day. There were no significant differences in glucose levels between time periods. Although, acclimation temperature did not affect peak cortisol concentrations (56.7 and 50.3 ng ml(-1) at 11 degrees C and 19 degrees C, respectively), the duration of the response was significantly extended at 11 degrees C. Post-stressor lactate increases were similar between temperature groups, but at 11 degrees C post-stressor glucose levels were significantly increased through 6 h, suggesting stressor-induced glycogenolysis and gluconeogenesis or decreased glucose utilization. These data demonstrate that the physiological stress response in green sturgeon is modified by both time of day and temperature.

Cloning of canine cytochrome P450 2E1 cDNA: identification and characterization of two variant alleles.

Cytochrome P450 (CYP) 2E1 is a toxicologically important enzyme that inactivates a number of drugs and xenobiotics and also bioactivates many xenobiotic substrates to their hepatotoxic or carcinogenic forms. Although cDNAs for the human, rodent, and rabbit forms of CYP2E1 have been isolated and studied extensively, there is an absence of information about canine CYP2E1, despite the fact that the dog is routinely used in drug safety studies. In this study, we isolated and sequenced a full-length CYP2E1 cDNA from a beagle liver cDNA library. The deduced canine CYP2E1 amino acid sequence exhibited 75 to 76% identity with rat, mouse, and rabbit CYP2E1 sequences, and 77% identity with human CYP2E1. Two populations of clones, differing at a single nucleotide, were isolated from the unamplified library. The T1453C base change results in a Tyr485His amino acid substitution, which is well beyond the heme binding region but is possibly part of a beta-sheet structure. An allele-specific polymerase chain reaction-based restriction enzyme test was developed for genotyping individual dogs from genomic DNA samples. One hundred mixed breed dogs were genotyped, and the frequencies of the Tyr485 and His485 alleles were found to be 0. 85 and 0.15, respectively. The canine Tyr485 and His485 alleles and human CYP2E1 were expressed in Escherichia coli cells, and catalytic activities of the proteins were assessed using the substrate chlorzoxazone. Although the two canine enzymes had similar catalytic activity; significant kinetic differences were seen between canine and human CYP2E1s.

Transrectal ultrasound for staging prostate carcinoma prior to radiation therapy: an evaluation based on disease outcome.

BACKGROUND: Despite its subjectivity and inaccuracy, digital rectal examination (DRE) has a long history of well-documented prognostic significance in patients with prostate carcinoma. To the authors' knowledge, very few studies have evaluated the relative prognostic merits of transrectal ultrasound (TRUS) versus DRE. This question is addressed in this study. METHODS: The outcome for 558 men with T1-T3, N0, M0 adenocarcinoma of the prostate who underwent both DRE and TRUS and received external beam radiation without androgen ablation was evaluated relative to the prognostic information from DRE, TRUS, or both. The outcome endpoints were no evidence of disease (NED) (no relapse or rising prostate specific antigen level) and freedom from metastases. Prognostic factors were evaluated with univariate and multivariate techniques. The median follow-up was 55 months. RESULTS: Both purely DRE-based and purely TRUS-based T categories correlated significantly with NED status. For DRE T categories, 6-year NED rates for T1/T2 and T3 disease were 64% and 36%, respectively (P < 0.001). For TRUS T categories, the rates for T1/T2 and T3 were 63% and 39%, respectively (P < 0.001). There were significant differences in patient composition between DRE and TRUS T categories. Only 40% of patients were in the same DRE and TRUS category, but the majority of the reclassification based on TRUS was within rather than between major T categories (T1/T2 vs. T3). Changes between the prognostically significant T1/T2 versus T3 categories occurred in < or =25%. This accounted for the similarity in NED outcome for DRE and TRUS T categories. However, TRUS categories did not discriminate significantly for metastatic recurrence between T1/T2 and T3 categories, whereas DRE categories did. Upstaging or downstaging by TRUS relative to DRE did not alter the DRE prognostic groupings substantially. CONCLUSIONS: There was no clinically meaningful superiority of TRUS over DRE in the definition of prognostically useful T categories. Moreover, the addition of TRUS to DRE did not enhance the prognostic value of DRE findings in any meaningful way. Despite its subjectivity and inaccuracy, DRE provides prognostic information at least equivalent to TRUS and is preferable because of its low cost.

Relationship of ultrasound staging and bilateral biopsy positivity to outcome in stage T1c prostate cancer treated with radiotherapy.

OBJECTIVES: The strict definition of Stage T1c prostate cancer is that the tumor is not palpable on digital rectal examination (DRE) or seen on imaging studies such as ultrasound. The inclusion of ultrasound imaging was brought about without an understanding of the relationship between ultrasound upstaging and prognosis. We have also noticed that in clinical practice, treatment decisions are made on the basis of the finding of bilateral versus unilateral biopsy positivity. The objectives in this study were to determine the prognostic significance of upstaging by transrectal ultrasound (TRUS) to uT2 or uT3, and unilateral versus bilateral biopsy positivity in patients with Stage T1c cancer as determined by DRE (DRE-Stage T1c patients). METHODS: Between 1987 and 1995 there were 643 patients with DRE-Stage T1-T2 prostate cancer treated with external beam radiotherapy; 24 had T1a, 76 had T1b, 183 had T1c, 133 had T2a, 168 had T2b, and 59 had T2c. Of these, 135 DRE-Stage T1c patients underwent ultrasound staging and 122 underwent bilateral prostate biopsies. All had pretreatment prostate-specific antigen values (PSAs) available and no patient received adjuvant androgen ablation. The median pretreatment PSA was 9.1 ng/mL, median radiotherapy dose was 66.0 Gy, and median follow-up was 41 months. Post-treatment failure was defined as disease recurrence and/or two elevations in PSA on consecutive follow-up visits. RESULTS: The 5-year freedom from failure rate for DRE-Stage T1c patients (71%) was not significantly different from that of DRE-Stage T1b (65%) or DRE-Stage T2a (71%) patients. There was a trend (P = 0.1) toward a worse outcome for DRE-Stage T2b/T2c patients compared with DRE-Stage T1b/T1c/T2a patients. The distribution of DRE-Stage T1c patients by ultrasound staging was 29 with uT1c, 88 with uT2, and 18 with uT3 findings. Twenty percent of patients had bilateral positive biopsy specimens. In univariate and multivariate analyses, the only correlates of patient outcome were pretreatment PSA (P < or = 0.002) and isocenter dose (P = 0.03). TRUS upstaging had no effect on freedom from failure; uT1c patients had about the same risk of relapse or a rising PSA as uT2 or uT3 patients. Patients with bilateral positive prostate biopsy specimens had about the same prognosis as those with unilateral positive biopsy specimens. CONCLUSIONS: For patients with DRE-Stage T1c prostate cancer, the data indicate that ultrasound staging and bilateral biopsy positivity are not predictive of outcome for patients treated with external beam radiotherapy and treatment decisions should not be based on these parameters.

Pharmacokinetic-pharmacodynamic relations of losartan and EXP3174 in a porcine animal model.

The pharmacokinetics of losartan and EXP3174, an active metabolite of losartan, were evaluated in the anesthetized pig after both a single intravenous dose (3 mg/kg) and during constant intravenous infusion. The pharmacodynamic activities of losartan and EXP3174 were determined during constant intravenous infusion as the degree of inhibition of angiotensin II-induced increase in the diastolic pressure. The systemic plasma clearance of losartan was 22.1 +/- 4.4 ml/min/kg (mean +/- SEM) and had an apparent volume of distribution at steady state of 0.56 +/- 0.16 L/kg after a 3-mg/kg intravenous dose. The elimination half-life of losartan was 40 +/- 6 min. Less than 2% of the intravenous losartan doses was estimated to be present as unconjugated EXP3174. The plasma clearance of EXP3174 was approximately 50% that of losartan, 11.8 +/- 1.5 ml/min/kg, and had a smaller steady-state apparent volume of distribution, 0.18 +/- 0.04 L/kg. The elimination half-life for EXP3174 was slightly longer than that of losartan (52 min). The time course of the pharmacodynamic effects of losartan and EXP3174 closely followed their respective plasma concentrations. The apparent dissociation constant of EXP3174 to the angiotensin II receptor was estimated, based on the total plasma concentrations, to be approximately 5 times lower than that for losartan.

Prostate-specific antigen cancer volume: a significant prognostic factor in prostate cancer patients at intermediate risk of failing radiotherapy.

PURPOSE: Although the pretreatment serum prostate-specific antigen level (PSAL) is the single-most significant predictor of local and biochemical control in prostate cancer patients treated with radiotherapy, it is relatively insensitive for patients with a PSAL in the intermediate range (4-20 ng/ml). PSA density (PSAD) has been shown to be slightly more predictive of outcome than PSAL for this intermediate risk group; however, this improvement is small and of little use clinically. PSA cancer volume (PSACV), an estimate of cancer volume based on PSA, has recently been described and has been purported to be more significant than PSAL in predicting early biochemical failure after radiotherapy. We report a detailed comparison between this new prognostic factor, PSAL, and PSAD. METHODS AND MATERIALS: The records of 356 patients treated with definitive external beam radiotherapy for regionally localized (T1-4,Nx,M0) adenocarcinoma of the prostate were reviewed. Each patient had a PSAL, biopsy Gleason score, and pretreatment prostate volume by transrectal ultrasonography. The median PSAL was 9.3 ng/ml and 66% had Gleason scores in the 2-6 range. The median radiation dose was 66.0 Gy and the median follow-up for those living was 27 months. PSACV was calculated using a formula which takes into account PSAL, pretreatment prostate ultrasound volume, and Gleason score. The median PSACV was 1.43 cc. Biochemical failure was defined as increases in two consecutive follow-up PSA levels, one increase by a factor > 1.5, or an absolute increase of > 1 ng/ml. Local failure was defined as a cancer-positive prostate biopsy, obtained for evidence of tumor progression. RESULTS: The distributions of PSACV and PSAL were similar and, when normalized by log transformation, were highly correlated (p < 0.0001, linear regression). There was a statistically significant relationship between PSACV and several potential prognostic factors including PSAL, PSAD, stage, Gleason score, and pretreatment prostatic acid phosphatase (PAP). In univariate analyses, PSACV, PSAL, and PSAD proved to be the most significant predictors of both biochemical and local control. In multivariate analyses using Cox proportional hazards models with PSAL, PSAD, PSACV, and PAP as continuous variables, PSAL, PSACV, and Gleason score were significant in predicting biochemical control. Only PSAL was significantly correlated with local control. However, when these analyses were restricted to patients with intermediate PSALs (4-20 ng/ml), only PSACV was significant for predicting both biochemical and local control. CONCLUSION: PSACV was highly correlated with actuarial local and biochemical control and was superior to both PSAL and PSAD in predicting these outcomes in patients with PSALs between 4 and 20 ng/ml.

Conducting a practice management review.

A practice management review can be used by a physician practice to identify problems within the practice, introduce operational improvements, and ensure that the practice is being run as profitably and efficiently as possible. Such a review involves scrutiny of nearly every aspect of a practice's operations--from reimbursement to personnel issues. Before deciding to have a practice review performed, the practice's management team must establish objectives for the review and must ensure that physicians and practice staff understand the review process. Once the review process is initiated, the steps that must be taken to identify and diagnose problems within a practice include conducting interviews, collecting data, analyzing data, and suggesting remedies.

Prostate specific antigen density as a prognostic factor for patients with prostate carcinoma treated with radiotherapy.

BACKGROUND: The pretreatment serum prostate specific antigen level (PSAL) is the most significant predictor of biochemical and local failure in patients treated with definitive radiotherapy. The role of prostate specific antigen (PSA) density (PSAD) relative to PSAL for such patients is controversial. In this article, we describe a comparative analysis of the prognostic value of PSAL and PSAD. METHODS: The study was comprised of 365 patients who were treated with external beam radiotherapy for regionally localized (T1-T4, Nx, M0) adenocarcinoma of the prostate between 1987-1993 and in whom PSAL and pretreatment prostate volume by transrectal ultrasound were available. The mean and median doses were 66.8 Gy and 66 Gy. Median follow-up for those patients living was 27 months. The mean PSAL was 12.7 ng/mL with a median of 9.1 ng/mL. PSAD was calculated by dividing the PSAL by the pretreatment prostate transectal ultrasound volume (in cc). The mean PSAD was 0.44 and the median was 0.31. Biochemical failure was defined as two consecutive increases in follow-up PSAs, one increase by a factor of greater than 1.5 of an absolute increase of greater than 1 ng/mL. RESULTS: The distributions of PSAD and PSAL were similar and were positively skewed. When log-transformed, the distributions of both parameters were normalized and linear regression revealed a high correlation (P < 0.0001). PSAD was significantly associated with several potential prognostic factors, including stage, Gleason score, PSAL, and pretreatment prostatic acid phosphatase. Univariate analyses of PSAD and PSAL revealed that these were the most significant correlates of local and biochemical control. By contrast, stage and Gleason score were the only factors predictive of freedom from distant metastasis. Multivariate analyses using Cox proportional hazards models were then performed to determine if PSAD provided prognostic information independent of PSAL. The manner in which PSAD and PSAL were categorized (four, three, of two groups) dramatically influenced the significance of these covariates. Optimization of these groups for significance showed grouped PSAD to be the stronger predictor of the local control and grouped PSAL to be the stronger predictor of biochemical control. However, when PSAD and PSAL were used as continuous variables, PSAL was the only independently significant prognostic factor for local or biochemical control. CONCLUSIONS: PSAD was highly correlated with actuarial patient outcome in the univariate analyses and appeared to provide independent information when PSAL was between 4 and 20 ng/mL. However, the differences based on PSAD were relatively small and, therefore, not clinically useful.

Radiotherapy for regionally localized hormone refractory prostate cancer.

PURPOSE: Patients with regionally localized hormone refractory adenocarcinoma of the prostate are often referred for radiotherapy to relieve local symptoms, prevent further local progression, or prevent impending urinary tract obstruction. However, the merits of radiotherapy for this patient population have not been documented. In this retrospective series, the results of 29 such patients treated at our institution between 1987-1992 are reviewed. METHODS AND MATERIALS: Prior to androgen ablation, the majority of these patients (79%) had Stage D0 or D1 disease. After androgen ablation, radiotherapy was given to 16 (55%) for progressive symptoms (mostly urinary obstructive), 11 (38%) for palpable local progression in the absence of symptoms, and 2 for a rising prostate specific antigen (PSA) profile without palpable disease. None of the patients had distant metastasis at the time of radiotherapy. The median dose to the prostate was 66 Gy and the median follow-up after radiotherapy was 43 months. RESULTS: Following local-regional radiotherapy, the actuarial rate of local failure at 4 years was only 39%. However, 80% had disease progression or a rising PSA in this time period. The actuarial survival at 4 years following radiotherapy was 39%. Univariate analyses of potential prognostic factors revealed that preandrogen ablation Gleason score, preradiotherapy PSA, and preradiotherapy prostatic acid phosphatase (PAP) were predictive of patient outcome. Most importantly, doses above 60 Gy to the prostate at standard fractionation were associated with symptom-free local control in 90% of patients at 3 years. The majority of the patients were treated using limited fields (n = 20). CONCLUSIONS: The regionally localized hormone refractory prostate cancer patients described benefited from high dose, continuous course, local radiotherapy in that excellent local control rates were obtained for an extended period. Because the majority of these patients fail with distant metastasis within 4 years, this treatment represents an aggressive approach to palliation that is justified by the maintenance of freedom from local symptoms.

The influence of cimetidine on the pharmacokinetics of the enantiomers of verapamil in the dog during multiple oral dosing.

The disposition of intravenously (0.5 mg/kg) and orally (5 mg/kg) administered verapamil was studied in six dogs after 3 days' pre-treatment with verapamil alone (5 mg/kg, every 8 h) and during concomitant oral administration of cimetidine (16 mg/kg, every 8 h). Racemic verapamil and norverapamil, an active metabolite of verapamil, were measured by fluorescence high performance liquid chromatography using an achiral phenyl column. The isolated racemic verapamil was rechromatographed on an Ultron-OVM chiral column, which separated the two verapamil enantiomers. Cimetidine co-administration significantly reduced the systemic clearance of racemic verapamil as well as that of its enantiomers by 25-29%. The clearance of racemic verapamil administered orally as well as that of its enantiomers was also reduced by 28% during cimetidine coadministration. The decrease in verapamil metabolism by cimetidine appeared to be non-stereoselective. On the other hand, cimetidine co-administration had no significant effect on the apparent volume of distribution of racemic verapamil and its enantiomers or the plasma protein binding or the blood to plasma concentration ratio of racemic verapamil. In addition, the ratio of the area under the plasma concentration-time curve for norverapamil to that of verapamil was unaffected by cimetidine co-administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of the stereochemical composition of the major metabolites of verapamil in dog urine with enantioselective liquid chromatographic techniques.

The stereochemical composition of verapamil and seven of its basic-extractable metabolites, isolated from the urine of dogs administered oral racemic verapamil, was determined by HPLC, using an Ultron OVM (ovomucoid) column. One dog was given oral (R)-verapamil alone in order to discriminate the (R)- and (S)-enantiomers of the metabolites. Structure identification of the isolated verapamil metabolites was accomplished using a combination of HPLC-MS and FAB-MS-MS techniques. Six of the urinary verapamil metabolites, including verapamil, were predominantly of the (R)-configuration, whereas one of the metabolites was predominantly in the (S)-form. The remaining isolated metabolite was comprised of approximately equal amounts of the two forms.

Potential effects of age-specific reference ranges for serum prostate-specific antigen.

Age-specific reference ranges for serum prostate-specific antigen (PSA) may improve this test for detecting prostate cancer. We have analyzed PSA levels from 10,024 men to determine the potential effects of these reference ranges. PSA levels (ng/ml) were grouped by patient age for comparison between standard (all ages: PSA < or = 4.0) and age-specific (< or = 49 years: PSA < or = 2.5; 50-59 years: PSA < or = 3.5; 60-69 years: PSA < or = 4.5; > or = 70 years: PSA < or = 6.5) reference ranges. Serum PSA correlated significantly with age (r = 0.33; p < 0.001). Fewer men > or = 60 years had elevated levels when age-specific reference ranges were applied (1,373 vs. 1,967; p < 0.001). Prostate biopsies and prebiopsy PSA levels from 865 men were reviewed. Sensitivities and specificities were calculated using both reference ranges. A significant increase in specificity with the age-specific reference ranges was seen for men > or = 70 years (58.6 vs. 34.2%; p < 0.001). There was, however, a concomitant decrease in sensitivity (77.6 vs. 91.7%; p < 0.001). We conclude serum PSA increases with age and we support the concept of age-specific reference ranges. However, the specificity of this test remains low, illustrating its limitations for prostate cancer detection.

Effects of diltiazem on the disposition and metabolism of the enantiomers of propranolol in the dog during multiple oral dosing.

The intravenous and oral dose kinetics and metabolism of the enantiomers of propranolol were investigated in five dogs during steady-state oral racemic propranolol dosing (5 mg/kg, every 8 hr for 3 days). These results were compared with those obtained during concomitant administration of oral diltiazem (2.5 mg/kg, every 8 hr for 3 days) in the same animals. The oral and intravenous propranolol test doses consisted of a pseudoracemic mixture of equal amounts of hexadeuterated-(R-(+))- and dideuterated-(S-(-))-propranolol. Propranolol metabolism in the urine was evaluated by coadministering 150 muCi of [4'-3H]racemic propranolol HCl, along with the deuterium-labeled compounds. Plasma concentrations of the deuterated enantiomers were measured by HPLC-thermospray MS, using undecadeuterated racemic propranolol as the internal standard. Diltiazem coadministration had no significant effects on either the systemic clearance, renal clearance, the apparent volume of distribution, or the elimination half-lives of either enantiomer. On the other hand, concomitant diltiazem treatment significantly reduced the oral clearance of S-(-)- and R-(+)-propranolol by 58 and 61%, respectively. These reductions resulted in an increase in their respective apparent steady-state oral availabilities of 129 and 106%. The S/R enantiomeric ratio of the oral availability of propranolol was not significantly changed from control. The urinary propranolol metabolites were isolated and purified by solvent extraction and HPLC and quantitated by radioactivity. Twelve metabolites, including propranolol, were isolated and quantitated in the urine. A significant reduction in the percentage of ring oxidation products and a significant increase in the percentage of naphthoxylactic acid and propranolol glucuronide excreted in the urine occurred in the diltiazem-treated animals. The S/R enantiomeric ratios of urinary excreted propranolol, propranolol glucuronide, 4'-hydroxypropranolol glucuronide, and its sulfate were not altered by diltiazem. These results suggest that the decreased oral clearances of the enantiomers of propranolol by diltiazem is caused by a selective decrease in the formation of ring-oxidized products.

Transmembrane domain length affects charge-mediated retention and degradation of proteins within the endoplasmic reticulum.

Previous studies have shown that the presence of potentially charged amino acid residues within the transmembrane domains of type I integral membrane proteins can result in protein retention and, in some cases, degradation within the endoplasmic reticulum (ER). An apparent exception to this observation is the CD3-epsilon chain of the T-cell antigen receptor complex, which is relatively stable in spite of having a transmembrane aspartic acid residue. A chimeric protein (T epsilon T) made by replacing the transmembrane domain of the Tac antigen with that of CD3-epsilon was normally transported to the cell surface, indicating that the transmembrane domain of CD3-epsilon was essentially unable to confer the phenotype of ER retention and degradation to another protein. Progressive shortening of the T epsilon T transmembrane domain, however, resulted in increasing retention and degradation of the mutant proteins in the ER. Conversely, a mutant Tac protein containing a single aspartic acid residue in its transmembrane domain was found to be retained and degraded in the ER, but when the transmembrane domain was lengthened, ER retention and degradation of the protein were abrogated. The aspartic acid residue in the transmembrane domain of all of these mutant proteins could mediate assembly with another protein having an arginine residue in its transmembrane domain, independent of the length of the transmembrane sequence. These findings demonstrate that the length of the hydrophobic transmembrane sequence has a critical influence on the ability of potentially charged transmembrane residues to cause protein retention and degradation in the ER.

Pharmacokinetics of the enantiomers of verapamil in the dog.

The intravenous (0.5 mg/kg) and oral (5 mg/kg) dose kinetics of verapamil were studied in 6 dogs during steady-state oral verapamil dosing (5 mg/kg every 8 h for 3 days). Racemic verapamil and norverapamil, a metabolite of verapamil, were quantitated in plasma by HPLC-fluorescence detection. The verapamil peaks eluting off the column were collected and rechromatographed on an Ultron-OVM column, which resolved the two verapamil enantiomers. After intravenous administration, the systemic clearance and apparent volume of distribution of (-)-(S)-verapamil were nearly twice that of the (+)-(R)-isomer. There was no difference in the elimination half-lives between the two isomers. After oral administration, the oral clearance of (-)-(S)-verapamil was 20 times that of the (+)-(R)-isomer. The apparent bioavailability of (+)-(R)-verapamil was over 14 times that of (-)-(S)-verapamil. The plasma protein binding of the (+)-(R)-isomer was slightly higher by 5% than (-)-(S)-verapamil; however, this effect was not enough to account for the difference between the apparent volume of distribution of the enantiomers, indicating that the tissue binding of (-)-(S)-verapamil was greater than that of the (+)-(R)-isomer. This data on the disposition of the enantiomers of verapamil in the dog is similar to that reported for man and demonstrates that the dog may be an appropriate animal model for man in future studies on the disposition of the enantiomers of verapamil.

Effects of propranolol on the disposition and negative dromotropic activity of diltiazem in the dog during multiple dosing.

The effects of propranolol coadministration on the disposition and negative dromotropic action of intravenous and oral diltiazem were studied in six dogs after 3 days pretreatment with diltiazem alone (2.5 mg/kg, every 8 hr) and with coadministration of oral propranolol (5 mg/kg, every 8 hr). Diltiazem and two of its metabolites, desacetyldiltiazem and demethyldiltiazem, were measured by HPLC. Propranolol coadministration had no significant effects on either the systemic clearance, the apparent volume of distribution, elimination half-life, or the blood binding of diltiazem. On the other hand, the oral clearance of diltiazem was significantly reduced by 51%, and its oral bioavailability was significantly increased by 48% during propranolol coadministration. The area under the plasma demethyldiltiazem concentration-time curve after oral diltiazem increased significantly during propranolol coadministration. This increase was in proportion to the increase in the plasma diltiazem area under the concentration-time curve, such that the ratio of the areas of demethyldiltiazem to that of diltiazem remained the same between control and propranolol coadministration. Propranolol coadministration increased the area under the negative dromotropic activity-time curve after both intravenous and oral diltiazem by 37 and 48%, respectively. Using a log-linear pharmacodynamic model to analyze the data, there were no significant effects on either the slope, y-intercept, or the estimated diltiazem concentration needed to increase the PR interval by 20% of either intravenous or oral diltiazem with propranolol coadministration. These data suggest that propranolol coadministration can result in an increase in the pharmacological activity of diltiazem due to a kinetic drug interaction by increasing its oral bioavailability.