Development of a nomogram for the estimation of long-term adherence to clozapine therapy using neutrophil fluorescence.

AIMS: Previously, we have reported an association between clozapine use and elevated FL3 neutrophil fluorescence, a flow-cytometric parameter for cell viability. Here, we developed and evaluated a pharmacokinetic-pharmacodynamic model relating FL3-fluorescence to clozapine exposure and derived a nomogram for estimation of long-term adherence. METHODS: Data from 27 patients initiating clozapine were analysed using nonlinear mixed effects modelling. A previously described pharmacokinetic model for clozapine was coupled to a FL3 fluorescence model. For this, an effect compartment with clozapine concentrations as input and a first order decay rate as output was linked with an Emax model to FL3-fluorescence. FL3-fluorescence was simulated for clozapine doses of 50, 150 and 400 mg daily (n = 10 000) to establish the nomogram. Finally, true simulated adherence (% of daily doses taken over 100 days) was compared to nomogram-estimated adherence to evaluate the performance of the nomogram. RESULTS: The half-life of FL3-fluorescence was estimated at 228 h (coefficient of variation 35%). Median absolute prediction errors of the nomogram in case of fully random adherence for 50, 150 and 400 mg ranged from -0.193% to -0.525%. The nomogram performed slightly worse in case of nonrandom adherence (median prediction error up to 5.19%), but was still clinically acceptable. Compliance patterns containing longer drug holidays revealed that the nomogram adequately estimates compliance over approximately the last 3 weeks prior to FL3-measurement. CONCLUSION: Our nomogram could provide information regarding long-term adherence based on prescribed clozapine dose and FL3-fluorescence. Future studies should further explore the clinical value of this biomarker and nomogram.

Impact of nutritional status on the pharmacokinetics of erlotinib in rats.

Malnourishment is a complex condition in which physiopathological changes take place in multiple systems as a result of energy, protein and nutrient deficiency. The purpose of this study was to evaluate, using an experimental animal model, the impact of nutritional status on the pharmacokinetic profile of erlotinib, a reversible, highly selective, human epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor. Two groups of rats -WN (well-nourished) and UN (undernourished) - were fed with different diets for 23-26 days. Rats were assigned randomly to one of three erlotinib treatments (n = 42) consisting of a single dose administered intravenously (i.v.), via oral solution or via oral suspension. Blood samples were assayed for erlotinib concentration. A population pharmacokinetic model was developed and pharmacokinetic parameters obtained in UN rats were compared with those in WN rats. Erlotinib clearance suffered a 5% decrease in the mild-undernutrition status. Moreover, when the drug was administered orally as a suspension, the extent and rate of absorption underwent a 20% increase in UN rats. The results of this study might help to explain, at least in part, the variability of erlotinib treatment and could represent the first step towards establishing new dosage guidelines for the treatment of undernourished cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.

Key mutations in the cylindrical inclusion involved in lettuce mosaic virus adaptation to eIF4E-mediated resistance in lettuce.

We previously showed that allelic genes mol¹ and mo1² used to protect lettuce crops against Lettuce mosaic virus (LMV) correspond to mutant alleles of the gene encoding the eukaryotic translation initiation factor 4E. LMV resistance-breaking determinants map not only to the main potyvirus virulence determinant, a genome-linked viral protein, but also to the C-terminal region of the cylindrical inclusion (CI), with a key role of amino acid at position 621. Here, we show that the propagation of several non-lettuce isolates of LMV in mo1¹ plants is accompanied by a gain of virulence correlated with the presence in the CI C terminus of a serine at position 617 and the accumulation of mutations at positions 602 or 627. Whole-genome sequencing of native and evolved isolates showed that no other mutation could be associated with adaptation to mo1 resistance. Site-directed mutagenesis pinpointed the key role in the virulence of the combination of mutations at positions 602 and 617, in addition to position 621. The impact of these mutations on the fitness of the virus was evaluated, suggesting that the durability of mo1 resistance in the field relies on the fitness cost associated with the resistance-breaking mutations, the nature of the mutations, and their potential antagonistic effects.

Characterization of "oil on copper" paintings by energy dispersive X-ray fluorescence spectrometry.

Energy dispersive X-ray fluorescence is a common analytical tool for layer thickness measurements in quality control processes in the coating industry, but there are scarce microanalytical applications in order to ascertain semi-quantitative or quantitative information of painted layers. "Oil on copper" painting becomes a suitable material to be analysed by means of X-ray fluorescence spectrometry, due to the metallic nature of substrate and the possibility of applying layered models as used in coating industry. The aim of this work is to study the suitability of a quantitative energy dispersive X-ray fluorescence methodology for the assessment of the areal distribution of pigments and the characterization of painting methods on such kind of pictorial artworks. The method was calibrated using standard reference materials: dried droplets of monoelemental standard solutions laid on a metallic plate of copper. As an example of application, we estimated pigment mass distribution of two "oil on copper" paintings from the sixteenth and eighteenth centuries. Pictorial layers have been complementarily analysed by X-ray diffraction. Apart of the supporting media made of copper or brass, we could identify two different superimposed layers: (a) a preparation layer mainly composed by white lead and (b) the pictorial layer of variable composition depending on the pigments used by the artist on small areas of the painting surface. The areal mass distribution of the different elements identified in the painting pigments (Ca, Cr, Mn, Fe, Zn, Cd, Hg and Pb) have been determined by elemental mapping of some parts of the artworks.

Comedones flexurales / Flexural Comedones

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The NcGRA7 gene encodes the immunodominant 17 kDa antigen of Neospora caninum.

A Neospora caninum 17-19 kDa antigenic protein fraction (p17) in one-dimensional polyacrylamide gel electrophoresis (SDS-PAGE) is the immunodominant antigen recognized by sera from bovines naturally infected by N. caninum. To identify the proteins making up the p17 fraction, we screened a new N. caninum tachyzoite cDNA library with an affinity-purified antibody against p17 (APA17). We isolated several cDNA clones with 100% sequence identity to the NcGRA7 gene. This previously described gene encodes a dense granule protein with an apparent molecular mass of 33 kDa. A second line of evidence emerged through a combined proteomic approach associating two-dimensional PAGE (2D-PAGE) to Western blotting and to mass spectrometry to characterize the p17 fraction. Two acidic immunodominant but minority protein spots were recognized by APA17 and by bovine sera. These antigens of 17 and 33 kDa are respectively composed of 4 and 2 isoforms. Furthermore, p17 isolation by 2D-PAGE and peptide sequencing by tandem mass spectrometry yielded a partial sequence of 17 amino acids, which allowed the putative amino terminal region of the NcGRA7 protein to be identified unambiguously. The NcGRA7 protein, without the putative signal peptide at the NH2-terminus, was cloned and expressed in Escherichia coli and when the purified recombinant protein (rNcGRA7) was analysed by SDS-PAGE and mass spectrometry, 2 bands of 24 and 33 kDa were resolved and identified as NcGRA7. These results demonstrate that the immunodominant 17 kDa antigen of N. caninum is encoded by the NcGRA7 gene.

Carritos o mochilas en la edad escolar / Carts or backpacks in the school age

El objetivo del presente trabajo es el de correlacionar los hábitos posturales respecto al manejo de cargas en niños escolarizados y en edades comprendidas entre los 8 y los 10 años y su posible riesgo de lesión. Material y métodos. Para llevar a cabo este estudio se recogió la información relacionada con el tipo de cargas (mochilas o carritos), el modo de transportarlas y la cantidad de carga respecto al peso y a la edad del niño. A continuación se registraron los distintos datos (peso de cada niño, peso medio transportado/viaje/día, entrevistas a especialistas en traumatología y ortopedia, así como encuestas respondidas por los padres, los profesores y los alumnos de los centros seleccionados).Las cargas transportadas por cada niño y el peso de éstos fueron valorados mediante una báscula digital para cuantificar los datos obtenidos con mayor exactitud. El proceso seguido para conseguir los resultados lo hemos basado en el estudio estadístico del porcentaje, con relación al total de respuestas obtenidas en cada caso. La selección de las distintas muestras (niños de tercero de primaria de diferentes colegios públicos) se realizó al azar. A continuación pesamos a los niños y a las cargas transportadas por éstos. Se diseñó además una encuesta dirigida a profesores, padres y alumnos. Una vez seleccionados los distintos centros todos los alumnos de cada grupo fueron incluidos en el estudio. Las conclusiones se han elaborado a partir del registro de datos objetivos (edad, peso, carga transportada, modalidad de transporte, etc.) y de las hipótesis que se desprenden de los resultados de las encuestas y de las entrevistas. La muestra en la que hemos basado nuestro estudio es la siguiente: - Noventa niños/as, pertenecientes a cuatro colegios (seis clases en total), con edades comprendidas entre 8 y 10 años.- Veinte madres de niños con edades de 7 a 13 años.- Dieciséis profesores de los cuatro colegios a los que acudimos.- Diez traumatólogos del Hospital Universitario Sant Joan de Reus. Resultados. El método de obtención de los resultados se ha basado en la aplicación de la media respecto al peso medio de los niños y las cargas que transportan. Posteriormente, el registro de los resultados obtenidos se ha plasmado en una tabla. La población total estudiada fue de 75 niños entre 8 y 10 años de edad, el peso medio obtenido fue de 35,5 kg para los niños y de 29 kg para las niñas. El peso medio transportado por viaje/libros/día de la mañana tanto para los niños como para las niñas fue de 2,6 kg con mochila (caso 1) y de 4,6 kg con carrito (caso 3); el peso medio transportado por viaje/libros de mañana y tarde tanto para niños como para niñas fue de 4 kg con mochila (caso 2) y de 5,6 kg con carrito (caso 4).Así pues, basándonos en los datos recogidos en este estudio podríamos afirmar que: - Por su estructura y diseño, el carrito pesa alrededor de 1,6 a 2 kg más que la mochila.- Los niños/as transportan un peso excesivo, que es difícil de justificar, ya que no existe homogeneidad en la carga transportada.- En la mayoría de casos el peso transportado suele ser superior al 10 per cent del peso del niño/a, hecho que puede llegar a perjudicarle físicamente. Conclusiones. En cuanto a los resultados observados en las encuestas realizadas destacaremos que: - Si el peso a transportar es escaso sería conveniente la utilización de la mochila bien ajustada a la columna.- Si el peso es superior a 3 ó 4 kg se debería transportar con un carrito adaptado a la altura del niño/a, empujado hacia delante y no arrastrado.-- Existe una gran falta de información por parte de los profesores sobre este tema y una gran desorganización de los niños/as con relación al material que necesitan cada día (AU)

Analysis of the serologic response to systemic Candida albicans infection in a murine model.

Two different strains of mice with different susceptibilities to systemic candidiasis (BALB/c and CBA/H) were infected with Candida albicans SC5314. Immune sera were obtained on different days post-infection and assayed against two-dimensional polyacrylamide gel electrophoresis separation of cytoplasmic extracts obtained from protoplasts. More than 31 immunoreactive proteins were detected. Some of them were identified and found to correspond to (i) glycolytic enzymes, such as fructose biphosphate aldolase, triose phosphate isomerase (TPIS), glyceraldehyde-3-phosphate dehydrogenase, 3-phosphoglycerate kinase (PGK), enolase (ENO1) and pyruvate kinase, (ii) other metabolic enzymes, such as methionine synthase (METE), inosine-5'-monophosphate dehydrogenase (IMH3), alcohol dehydrogenase and aconitate hydratase and (iii) heat shock proteins: HS71 (or Ssa1p) and HS75 (or Ssb1p), both from the HSP70 family. This work reports for the first time antigenic properties for IMH3 and TPIS. Different profiles of antibody expression, depending on the mouse strain and the course of infection, were observed. ENO1 was the most immunogenic protein in infected BALB/c mice (the most resistant strain). On the other hand, sera from CBA/H mice (a more susceptible strain) showed a strong increase in reactivity along the infection against METE, HS75 and PGK. Many of these immunoreactive proteins have also been detected using sera from human patients with systemic candidiasis, thus indicating the usefulness of the murine model for studying the antibody response in systemic candidiasis. In this work we demonstrate that the combination of two-dimensional electrophoresis with immunoblotting using murine immune sera can be an important tool for the identification of C. albicans antigens and for monitoring the evolution of the disease.

A comparison of antigenic peptides in muscle larvae of several Trichinella species by two-dimensional western-blot analysis with monoclonal antibodies.

The antigens recognised by mAb US5 specific to 53 kDa glycoprotein (gp 53) in T. spiralis L-1 muscle larvae (TSL1) antigens, mAb US9 specific to gp 53 in TSL1 from all encapsulated species and mAb US4 specific to a tyvelose containing tetrasaccharide present in TSL1, were investigated in crude extracts from muscle larvae of T. spiralis, T. nativa and T. britovi by 2D-electrophoresis and western-blot. At least four proteins of different p1 were recognised by mAb US5 on T. spiralis antigens. Recognition profile of mAb US9 on T. spiralis antigens exhibited some variation with regard to that of the US5. Polymorphism was apparent in gp 53. High reactivity was shown by the mAb US4 with the three species.

Cross-species identification of novel Candida albicans immunogenic proteins by combination of two-dimensional polyacrylamide gel electrophoresis and mass spectrometry.

We have previously reported the usefulness of two-dimensional gel electrophoresis followed by Western blotting with sera from patients with systemic candidiasis in the detection of the major Candida albicans antigens (Pitarch et al., Electrophoresis 1999, 20, 1001-1010). The identification of these antigens would be useful for the characterization of good markers for the disease, and for the development of efficient diagnostic strategies. In this work we have used nanoelectrospray tandem mass spectrometry to obtain amino acid sequence information from the immunogenic proteins previously detected. We report here the cross-species identification of these antigens by matching of tandem mass spectrometry data to Saccharomyces cerevisiae proteins. Using this approach, we unambiguously identified the four C. albicans immunogenic proteins analyzed, namely aconitase, pyruvate kinase, phosphoglycerate mutase and methionine synthase. Furthermore, we report for the first time that aconitase, methionine synthase and phosphoglycerate mutase have antigenic properties in C. albicans.

Novel procedure for the identification of proteins by mass fingerprinting combining two-dimensional electrophoresis with fluorescent SYPRO red staining.

The fluorescent sensitive SYPRO Red dye was successfully employed to stain proteins in two-dimensional gels for protein identification by peptide mass fingerprinting. Proteins which are not chemically modified during the SYPRO Red staining process are well digested enzymatically in the gel and hence the resulting peptides can be efficiently eluted and analysed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). A SYPRO Red two-dimensional gel of a complex protein extract from Candida albicans was analysed by MALDI-TOF MS. The validity of SYPRO Red staining was demonstrated by identifying, via peptide mass fingerprinting, 10 different C. albicans proteins from a total of 31 selected protein spots. The peptide mass signal intensity, the number of matched peptides and the percentage of coverage of protein sequences from SYPRO Red-stained proteins were similar to or greater than those obtained in parallel with the modified silver protein gel staining. This work demonstrates that fluorescent SYPRO Red staining is compatible with the identification of proteins separated on polyacrylamide gel and that it can be used as an alternative to silver staining. As far as we know, this is the first report in which C. albicans proteins separated using 2-D gels have been identified by peptide mass fingerprinting. The improved technique described here should be very useful for carrying out proteomic studies.

Two-dimensional gel electrophoresis as analytical tool for identifying Candida albicans immunogenic proteins.

This paper reports the usefulness of two-dimensional gel electrophoresis followed by Western blotting with sera from patients with systemic candidiasis in the identification of the major Candida albicans antigens. In order to have different patterns of protein expression and subcellular localization, three types of protein preparations were obtained: cytoplasmic extracts, protoplast lysates and proteins secreted by protoplasts regenerating their cell wall. These proteins were separated by high-resolution two-dimensional electrophoresis using an immobilized pH gradient. Western blotting with sera from patients with systemic candidiasis allowed the detection of more than 18 immunoreactive proteins. Some of these proteins had different isoforms. All sera reacted with at least three C. albicans proteins and the most reactive serum detected up to eleven proteins. Some of these antigens, e.g., enolase and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), have been identified on the 2-D map. The most reactive proteins were enolase and a 34 kDa protein in the acidic part of the gel (pI 4-4.4) that was only detected in regenerating protoplast-secreted proteins. The identification of all these antigens would be useful for the development of diagnostic strategies.

Widespread angiokeratomas and tuberous sclerosis.

We report a 29-year-old woman who had prominent cutaneous markers of tuberous sclerosis, with subependymal nodules and renal cysts on computerized tomographic scan, who also showed multiple angiokeratomas widely distributed on the buttocks and posterior thighs. Enzymatic studies ruled out Fabry's disease and other lysosomal storage disorders. This is the first reported association of widespread angiokeratomas and tuberous sclerosis.

Xanthelasmoid mastocytosis.

An 8-year-old girl had small, papular vulval lesions for six years; the lesions were yellowish with numerous surface depressions. Symptoms due to the action of mastocyte mediators were observed. A biopsy specimen showed a dense monomorphous infiltrate of the deep dermis by rounded cells with granular cytoplasm and a round or oval central nucleus. The morphology of the lesions and red-purple metachromatic staining led to the diagnosis of xanthelasmoid mastocytosis. Symptoms were controlled with hydroxyzine. Annual follow-up has shown no evidence of systemic involvement to date. Surgery should be contemplated as a future therapeutic option, in view of the location of the lesions.