Characterization of Opalescence in low Volume Monoclonal Antibody Solutions Enabled by Microscale Nephelometry.

Monoclonal antibody (mAb)-based drugs are often prone to unfavorable solution behaviors including high viscosity, opalescence, phase separation, and aggregation at the high concentrations needed to enable patient-centric subcutaneous dosage forms. Given that these can have a detrimental impact on manufacturability, stability, and delivery, approaches to identifying, monitoring, and controlling these behaviors during drug development are critical. Opalescence presents a significant challenge due to its relationship to liquid-liquid phase separation. Quantitative characterization of opalescence via turbidimetry is often restrictive due to large volume requirements (>2 mL) and alternative microscale approaches based on light transmittance (Eckhardt et al., J Pharm Sci Technol. 1994, 48: 64-70) may pose challenging with respect to accuracy. To address the need for accurate and quantitative microscale opalescence measurements, we have evaluated the use of a 'de-tuned' static light scattering detector which requires <10 µL sample per measurement. We show that tuning of the laser power to a range far below that of traditional light scattering measurements results in a stable detector response that can be accurately calibrated to the nephelometric turbidity unit (NTU) scale using appropriate standards. The calibrated detector signal yields NTU values for mAbs and other protein solutions that are comparable to a commercial turbidimeter. We used this microscale approach to characterize the opalescence of 48 commercial mAb drug products and found that the majority have opalescence below 15 NTU. However, in products with mAb concentrations greater than 75 mg/mL, a broad range of opalescence was observed, in a few cases greater than 20 NTU. These measurements as well as nephelometric characterization of several IgG1 and IgG4 mAbs across a broad pH range highlight subclass-specific tendencies toward opalescence in high concentration solutions.

Desmoplastic Trichoepithelioma With Pseudocarcinomatous Hyperplasia: A Folliculosebaceous Neoplasm in Young Persons.

ABSTRACT: Pseudocarcinomatous desmoplastic trichoepithelioma (PDTE) features verrucous squamous epidermal hyperplasia with a jagged undersurface overlying cords of follicular germinative cells in a fibrotic stroma. To date, only 5 cases have been reported. We identified 7 new PDTEs from 2 institutions and reviewed their clinical manifestations and immunohistochemical profile. The median age was 14 years (range 8-34 years). New findings included vacuolization of the basal layer of the pseudocarcinomatous surface epithelium, and the frequent presence of singly distributed sebocytes within the cords of basaloid cells. The immunohistochemical profile resembles desmoplastic trichoepithelioma, with expression of TDAG51, CK15, and Ber-Ep4. Colonizing CK20+ Merkel cells were present in all cases. PDTE needs to be differentiated from malignant neoplasms such as squamous cell carcinoma, morphoeic basal cell carcinoma, and microcystic adnexal carcinoma. Recognizing the features of this sclerosing folliculosebaceous neoplasm facilitates accurate diagnosis and avoids overtreatment.

Localized juvenile spongiotic gingival hyperplasia: A report of 27 cases.

BACKGROUND: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a poorly understood but distinctive inflammatory hyperplasia occurring in children and young adults. Fewer than 100 cases have been reported since its initial description. METHODS: During the period of 2015 to 2018, cases of LJSGH were identified, retrieved and their clinical and histopathological data reviewed. RESULTS: There were 27 cases, with a median age of 13 years (range 7-72 years). Twenty-four of 27 patients were less than 20 years old, and in three cases the patients were over 60 years of age. The most commonly affected site was the anterior maxillary gingiva presenting as a solitary, red, and papillated lesion. Typical microscopic findings included elevated areas of variably acanthotic, spongiotic nonkeratinized epithelium with elongated rete ridges, accompanied by a neutrophilic-rich infiltrate. An abrupt transition between epithelium affected by LJSGH and normal mucosa was characteristic. LJSGH typically exhibited full-thickness epithelial expression of CK19 without expression of estrogen and progesterone receptors. CONCLUSIONS: The clinical and histopathologic characteristics of LJSGH are unique and consistent. Despite the name, the condition is not limited to juveniles and can occur in adults. LJSGH in adults and juveniles shares the same spectrum of histopathologic and immunohistochemical findings.

Deep Learning for Automating the Organization of Institutional Dermatology Image Stores.

A common challenge faced by researchers associated with healthcare institutions is that data of interest are often contained in electronic medical informatics systems that are centered on optimizing clinician/clinician and patient/clinician communication. While this focus naturally enhances the primary goal of care delivery, it is often suboptimal for secondary research purposes. For example at our institution while it is easy for a clinician to view images associated with a specific patient visit, it remains a challenge for an investigator to assemble a cohort of specific images in order to further research objectives. In order to address this important optimization gap we have developed a system for automated image categorization based on a deep neural network. This image classifier organizes the contents of an electronic health record system in a manner which is more amenable to further research by specifically dividing all available images into a lexicon of subclasses. While the current study is focused on dermatology-related images collected by a combined primary and tertiary care center, we expect similar approaches to aid a variety of institutions and clinical specialties.

Treatment of severe drug reactions by hemodialysis.

BACKGROUND: Extracorporeal treatments such as hemodialysis and plasma exchange are lifesaving measures in the treatment of drug poisoning. This treatment method generally is not used for severe cutaneous and systemic drug reactions. METHODS: Here, we describe three cases wherein hemodialysis therapy was instrumental in reversing the adverse drug reaction. RESULTS: In the cases of severe cutaneous drug reactions reviewed, patients presented with linear immunoglobulin A bullous dermatosis, acute generalized exanthematous pustulosis, and toxic epidermal necrolysis. Salvage treatment with hemodialysis therapy drastically influenced the course of disease, resulting in remission. CONCLUSIONS: This novel and highly effective treatment option is not considered in current algorithms for adverse drug reactions. Hence, in addition to the rarity of these reactions, the main limitation of the study is the small number of patients. Hemodialysis can substantially alter the prognosis and, in some cases, be a lifesaving treatment for patients with severe adverse cutaneous drug reaction associated with systemic toxicity.

Amicrobial pustulosis of the folds: Report of 4 cases.

Amicrobial pustulosis of the folds (APF) is a rare disease characterized by aseptic pustular lesions involving cutaneous folds, typically occurring in the context of an autoimmune disorder. We present 4 patients with APF, focusing on clinical and histopathologic characteristics to improve the recognition of this entity. All 4 patients had intertriginous and extra-intertriginous involvement. Common histopathologic features of skin biopsies in these patients were intracorneal, subcorneal, intraepidermal, perivascular, perifollicular and interstitial neutrophilic inflammation. Pustules overlying adnexal ostium and papillary dermal edema were consistently observed. The pustules were negative for microorganisms on stain testing. In these cases, associated conditions were undifferentiated connective tissue disease, systemic lupus erythematosus, antiphospholipid syndrome, Crohn disease and Hashimoto thyroiditis. The aforementioned clinical and histopathologic characteristics of patients with suspected or diagnosed connective tissue disorders should lead to suspicion for APF.

Correlation between histopathologic features and likelihood of identifying superficial dermatophytosis with periodic acid Schiff-diastase staining: a cohort study.

BACKGROUND: Periodic acid Schiff-diastase (PAS-D) staining is used routinely in dermatopathology. Conventionally, parakeratosis or intracorneal neutrophils justify use of PAS-D stain to identify dermatophytosis. We aimed to investigate the histopathological features of superficial dermatophytosis. METHODS: Skin biopsies with PAS-D stain were retrospectively reviewed by a blinded dermatopathologist. Histopathologic findings in cases with dermatophytosis were compared with those without. RESULTS: We studied 110 cases, of which 63 were PAS-D positive for dermatophytes. Dermatophytes were identified on hematoxylin and eosin (H&E) staining in 49 (77.8%) of the PAS-D-positive cases. Diffuse compact orthokeratosis (79.37%, p < 0.001) and focal parakeratosis (65.08%, p = 0.03) were significantly more frequent in dermatophytosis. Intracorneal neutrophils and spongiosis were not significant findings. Fungal elements were frequently observed within compact orthokeratosis (62.0%) and parakeratosis (31.8%) but rarely within intracorneal pustules (12.7%). In some dermatophyte cases, intracorneal neutrophils (47.6%) or parakeratosis (17.5%) were absent. CONCLUSIONS: Compact orthokeratosis or focal parakeratosis justifies PAS-D staining, whereas the absence of intracorneal neutrophils or parakeratosis is insufficient to exclude dermatophytosis. Results indicate that having a low threshold to perform PAS-D stain is justified. PAS-D stain may be deferred until H&E slides have been evaluated.

Chemotherapy of second stage human African trypanosomiasis: comparison between the parenteral diamidine DB829 and its oral prodrug DB868 in vervet monkeys.

Human African trypanosomiasis (HAT, sleeping sickness) ranks among the most neglected tropical diseases based on limited availability of drugs that are safe and efficacious, particularly against the second stage (central nervous system [CNS]) of infection. In response to this largely unmet need for new treatments, the Consortium for Parasitic Drug Development developed novel parenteral diamidines and corresponding oral prodrugs that have shown cure of a murine model of second stage HAT. As a rationale for selection of one of these compounds for further development, the pharmacokinetics and efficacy of intramuscular (IM) active diamidine 2,5-bis(5-amidino-2-pyridyl)furan (DB829; CPD-0802) and oral prodrug2,5-bis[5-(N-methoxyamidino)-2-pyridyl]furan (DB868) were compared in the vervet monkey model of second stage HAT. Treatment was initiated 28 days post-infection of monkeys with T. b. rhodesiense KETRI 2537. Results showed that IM DB829 at 5 mg/kg/day for 5 consecutive days, 5 mg/kg/day every other day for 5 doses, or 2.5 mg/kg/day for 5 consecutive days cured all monkeys (5/5). Oral DB868 was less successful, with no cures (0/2) at 3 mg/kg/day for 10 days and cure rates of 1/4 at 10 mg/kg/day for 10 days and 20 mg/kg/day for 10 days; in total, only 2/10 monkeys were cured with DB868 dose regimens. The geometric mean plasma Cmax of IM DB829 at 5 mg/kg following the last of 5 doses was 25-fold greater than that after 10 daily oral doses of DB868 at 20 mg/kg. These data suggest that the active diamidine DB829, administered IM, should be considered for further development as a potential new treatment for second stage HAT.

Patch test reactions associated with sunscreen products and the importance of testing to an expanded series: retrospective analysis of North American Contact Dermatitis Group data, 2001 to 2010.

BACKGROUND: Both active and inactive ingredients in sunscreen may cause contact dermatitis. OBJECTIVES: This study aimed to describe allergens associated with a sunscreen source. METHODS: A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 2001 and 2010 was performed. RESULTS: Of 23,908 patients patch tested, 219 (0.9%) had sunscreen coded as an allergen source. Patients who were male, with occupational dermatitis, or older (older than 40 years) had significantly lower rates of allergic reactions to sunscreens; the most commonly affected areas were the face and exposed sites (P < 0.0001). The top 3 most frequent allergens in sunscreens were benzophenone-3 (70.2% for 10% concentration, 64.4% for 3% concentration), DL-alpha-tocopherol (4.8%), and fragrance mix I (4.0%). Less than 40% of positive patch test reactions were detected by the North American Contact Dermatitis Group screening series of 65 to 70 allergens. CONCLUSIONS: A supplemental antigen series is important in detecting allergy to sunscreens.

Temozolomide-mediated DNA methylation in human myeloid precursor cells: differential involvement of intrinsic and extrinsic apoptotic pathways.

PURPOSE: An understanding of how hematopoietic cells respond to therapy that causes myelosuppression will help develop approaches to prevent this potentially life-threatening toxicity. The goal of this study was to determine how human myeloid precursor cells respond to temozolomide (TMZ)-induced DNA damage. EXPERIMENTAL DESIGN: We developed an ex vivo primary human myeloid precursor cells model system to investigate the involvement of cell-death pathways using a known myelosuppressive regimen of O(6)-benzylguanine (6BG) and TMZ. RESULTS: Exposure to 6BG/TMZ led to increases in p53, p21, γ-H2AX, and mitochondrial DNA damage. Increases in mitochondrial membrane depolarization correlated with increased caspase-9 and -3 activities following 6BG/TMZ treatment. These events correlated with decreases in activated AKT, downregulation of the DNA repair protein O(6)-methylguanine-DNA methyltransferase (MGMT), and increased cell death. During myeloid precursor cell expansion, FAS/CD95/APO1(FAS) expression increased over time and was present on approximately 100% of the cells following exposure to 6BG/TMZ. Although c-flipshort, an endogenous inhibitor of FAS-mediated signaling, was decreased in 6BG/TMZ-treated versus control, 6BG-, or TMZ alone-treated cells, there were no changes in caspase-8 activity. In addition, there were no changes in the extent of cell death in myeloid precursor cells exposed to 6BG/TMZ in the presence of neutralizing or agonistic anti-FAS antibodies, indicating that FAS-mediated signaling was not operative. CONCLUSIONS: In human myeloid precursor cells, 6BG/TMZ-initiated apoptosis occurred by intrinsic, mitochondrial-mediated and not extrinsic, FAS-mediated apoptosis. Human myeloid precursor cells represent a clinically relevant model system for gaining insight into how hematopoietic cells respond to chemotherapeutics and offer an approach for selecting effective chemotherapeutic regimens with limited hematopoietic toxicity.

Scalp In-Transit Metastatic Melanoma Treated with Interleukin-2 and Pulsed Dye Laser.

No particular regimen is considered standard therapy for widespread metastatic melanoma, although surgery is the primary choice for regional nodal metastases. Systemic interleukin-2 (IL-2) is an effective immunotherapy for melanoma, but standard doses are associated with severe toxicity. We report a patient who was treated with intralesional low-dose IL-2 and V-beam pulsed dye laser for the treatment of scalp melanoma metastases. This treatment resulted in rapid regression of metastatic tumors with limited adverse effects.

Occupational contact dermatitis in hairdressers/cosmetologists: retrospective analysis of north american contact dermatitis group data, 1994 to 2010.

BACKGROUND: European studies document that occupational contact dermatitis (CD) is common in hairdressers, but studies from North America are lacking. OBJECTIVES: The objectives of this study were to estimate the prevalence of occupational CD among North American hairdressers/cosmetologists (HD/CS) and to characterize responsible allergens and irritants as well as their sources. METHODS: A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 1994 and 2010 was conducted. RESULTS: Of 35,842 patients, 432 (1.2%) were HD/CS. Significantly, most of the HD/CS were female (89.8%) and younger than 40 years (55.6%) as compared with non-hairdressers (P < 0.0001). The rates for allergic and irritant CD in HD/CS were 72.7% and 37.0%, respectively. The most common body site of involvement was the hand, and this was significantly more common than in non-HD/CS (P < 0.0001). The most frequent currently relevant and occupationally related allergens were glyceryl thioglycolate, p-phenylenediamine, nickel sulfate, 2-hydroxyethyl methacrylate, and quaternium-15. Hair dyes, permanent wave solutions, and other hair products were common sources of allergens. The North American Contact Dermatitis Group allergen series missed at least 1 occupationally-related allergen in 26.2% of patients. CONCLUSIONS: Contact dermatitis in North American HD/CS is common, and occupationally related allergens are those found in HD/CS products. Supplemental hairdressing/cosmetology antigen series are important in detecting all occupationally related allergens in this population.

Bloodroot.

BLOODROOT (Sanguinaria canadensis) is a flowering herb that can be used as a drug. Historically, it was widely used by Native Americans in blood tonification and purification, pain and fever relief, and wound healing. Bloodroot plants have been advertised to impart a wide range of medical properties, and many bloodrood-containing products are commercially available. Potential side effects of bloodroot products include significant tissue destruction, escarification, and keloid formation. Therefore, it is critical for clinicians to be aware of potential risks, educate their patients on treatment options, and be able to recognize the cutaneous effects of bloodroot and other escharotic agents.

Pharmacology of DB844, an orally active aza analogue of pafuramidine, in a monkey model of second stage human African trypanosomiasis.

Novel drugs to treat human African trypanosomiasis (HAT) are still urgently needed despite the recent addition of nifurtimox-eflornithine combination therapy (NECT) to WHO Model Lists of Essential Medicines against second stage HAT, where parasites have invaded the central nervous system (CNS). The pharmacology of a potential orally available lead compound, N-methoxy-6-{5-[4-(N-methoxyamidino) phenyl]-furan-2-yl}-nicotinamidine (DB844), was evaluated in a vervet monkey model of second stage HAT, following promising results in mice. DB844 was administered orally to vervet monkeys, beginning 28 days post infection (DPI) with Trypanosoma brucei rhodesiense KETRI 2537. DB844 was absorbed and converted to the active metabolite 6-[5-(4-phenylamidinophenyl)-furanyl-2-yl]-nicotinamide (DB820), exhibiting plasma C(max) values of 430 and 190 nM for DB844 and DB820, respectively, after the 14th dose at 6 mg/kg qd. A 100-fold reduction in blood trypanosome counts was observed within 24 h of the third dose and, at the end of treatment evaluation performed four days post the last drug dose, trypanosomes were not detected in the blood or cerebrospinal fluid of any monkey. However, some animals relapsed during the 300 days of post treatment monitoring, resulting in a cure rate of 3/8 (37.5%) and 3/7 (42.9%) for the 5 mg/kg×10 days and the 6 mg/kg×14 days dose regimens respectively. These DB844 efficacy data were an improvement compared with pentamidine and pafuramidine both of which were previously shown to be non-curative in this model of CNS stage HAT. These data show that synthesis of novel diamidines with improved activity against CNS-stage HAT was possible.

Patch-testing with hairdressing chemicals.

BACKGROUND: Hairdressing chemicals may be associated with allergic contact dermatitis. OBJECTIVE: To review our experience of patch-testing with hairdressing chemicals. METHODS: We reviewed results from patients who underwent patch testing with our standard allergen series (including 15 hairdressing chemicals) and a supplementary "hairdresser series" (18 additional hairdressing chemicals) at Mayo Clinic (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL) from January 1, 2000, through December 31, 2008. RESULTS: Two hundred ten patients (mean age, 53.8 years [SD, 16.9 yr]; female, 94.8%) were patch-tested. The most common sites of dermatitis were the scalp, face, and hands. Patients had widely varying occupations. The most common occupations were cosmetologist (10.5%), housewife (9.5%), and beautician (5.2%); 14.3% were retired. The hairdresser series detected 13 additional patients with allergies (6.4%; 204 patients tested with both series) who would not have been detected with the standard allergen series alone. The highest allergic patch-test rates in the supplemental hairdresser series were with ammonium persulfate (14.4%), 4-aminoazobenzene (13.4%), and pyrogallol (9.1%). CONCLUSIONS: Patch-testing with hairdressing-specific chemicals (standard series plus supplemental hairdresser series) was appropriate for numerous clinical situations and was not limited to patients in hair care occupations. The supplemental hairdresser series helped identify more patients than would have been identified with the standard series alone.

Patch testing with a large series of metal allergens: findings from more than 1,000 patients in one decade at Mayo Clinic.

BACKGROUND: The standard allergen series used in patch testing contains metals that most commonly cause allergic contact dermatitis, but testing with additional metal allergens is warranted for select patients. OBJECTIVE: To report our experience with patch testing of metals. METHODS: We retrospectively analyzed outcomes of 1,112 patients suspected of having metal allergies. Patients were seen from January 1, 2000, through December 31, 2009. Patch testing was performed with 42 metal preparations (6 in the standard series, 36 in the metal series). RESULTS: Patch testing most commonly was performed for patients with oral disease (almost half the patients), hand dermatitis, generalized dermatitis, and dermatitis affecting the lips, legs, arms, trunk, or face. At least one positive reaction was reported for 633 patients (57%). Metals with the highest allergic patch-test reaction rates were nickel, gold, manganese, palladium, cobalt, Ticonium, mercury, beryllium, chromium, and silver. Metals causing no allergic patch-test reactions were titanium, Vitallium, and aluminum powder. Metals with extremely low rates of allergic patch-test reactions included zinc, ferric chloride, and tin. Reaction rates varied depending on metal salt, concentration, and timing of readings. CONCLUSION: Many metals not in the standard series were associated with allergic patch-test reactions. The many questions raised by these findings, concerning patch testing with individual metals, will be the subject of future studies.

A role for Cdc2- and PP2A-mediated regulation of Emi2 in the maintenance of CSF arrest.

BACKGROUND: Vertebrate oocytes are arrested in metaphase II of meiosis prior to fertilization by cytostatic factor (CSF). CSF enforces a cell-cycle arrest by inhibiting the anaphase-promoting complex (APC), an E3 ubiquitin ligase that targets Cyclin B for degradation. Although Cyclin B synthesis is ongoing during CSF arrest, constant Cyclin B levels are maintained. To achieve this, oocytes allow continuous slow Cyclin B degradation, without eliminating the bulk of Cyclin B, which would induce release from CSF arrest. However, the mechanism that controls this continuous degradation is not understood. RESULTS: We report here the molecular details of a negative feedback loop wherein Cyclin B promotes its own destruction through Cdc2/Cyclin B-mediated phosphorylation and inhibition of the APC inhibitor Emi2. Emi2 bound to the core APC, and this binding was disrupted by Cdc2/Cyclin B, without affecting Emi2 protein stability. Cdc2-mediated phosphorylation of Emi2 was antagonized by PP2A, which could bind to Emi2 and promote Emi2-APC interactions. CONCLUSIONS: Constant Cyclin B levels are maintained during a CSF arrest through the regulation of Emi2 activity. A balance between Cdc2 and PP2A controls Emi2 phosphorylation, which in turn controls the ability of Emi2 to bind to and inhibit the APC. This balance allows proper maintenance of Cyclin B levels and Cdc2 kinase activity during CSF arrest.

Translating biomarkers into clinical practice: prognostic implications of cyclophilin A and macrophage migratory inhibitory factor identified from protein expression profiles in non-small cell lung cancer.

Biomarkers have the potential to significantly change diagnostic strategies and influence therapeutic management. We developed a MALDI-TOF protein expression profiling platform for biomarker discovery and a proof-of-principle study identified two proteins, cyclophilin A (CyPA) and macrophage migration inhibitory factor (MIF), that were overexpressed in non-small cell lung cancer (NSCLC). The current study focused on evaluating the potential of CyPA and MIF as prognostic markers in patients with a new diagnosis of lung cancer for rapid translation into clinical practice. Two hundred and thirty-four primary NSCLC specimens reflecting a broad range of histologies and stages were examined for CyPA and MIF reactivity by tissue microarray immunohistochemistry (TMA-IHC). The percent tumor cell reactivity, staining intensity and a composite staining score were compared with overall patient survival by Kaplan-Meier curves, log rank test and Cox model statistics. Although both proteins were overexpressed in most NSCLC tumors, neither CypA nor MIF showed a correlation with outcome. This pilot project approach can expedite integration of newly discovered biomarkers into clinical practice, with the goal of improving stratification of patients into appropriate treatment regimens. While both proteins considered in this study were overexpressed in the vast majority of NSCLCs, they were not found to be of prognostic significance.

Thermodynamic analysis of cyclosporin a binding to cyclophilin a in a lung tumor tissue lysate.

We report on the application of SUPREX (stability of unpurified proteins from rates of H/D exchange) to the analysis of a protein-ligand binding interaction under the ex vivo solution conditions of a human lung tumor tissue lysate. A SUPREX-derived binding free energy (i.e. DeltaDeltaG(f) value) and dissociation constant (i.e., K(d) value) were determined for the binding of cyclosporin A (CsA) to a cyclophilin A (CypA) sample in which the protein was a component of a tissue lysate derived from fresh frozen lung tumor. The DeltaDeltaG(f) and K(d) values determined by SUPREX for CsA binding to CypA in this unpurified protein sample, 4.7 +/- 0.8 kcal/mol and 77 +/- 17 nM, respectively, were comparable to the those obtained when SUPREX was used to analyze the binding of CsA to a highly purified CypA sample, 4.2 +/- 1.0 kcal/mol and 32 +/- 20 nM, respectively. Moreover, the SUPREX-derived K(d) values determined in this work were both in the range of those previously reported for the CypA-CsA complex. The results of this proof-of-principle work validate the extension of SUPREX to the thermodynamic analysis of proteins and protein-ligand binding interactions in the unpurified, ex vivo conditions of human tissue lysates,and they represent the first K(d) measurement on a protein-ligand complex under such conditions

Analysis of human serum proteins by liquid phase isoelectric focusing and matrix-assisted laser desorption/ionization-mass spectrometry.

Direct matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis of human serum yielded ion signals from only a fraction of the total number of peptides and proteins expected to be in the sample. We increased the number of peptide and protein ion signals observed in the MALDI-TOF mass spectra analysis of human serum by using a prefractionation protocol based on liquid phase isoelectric focusing electrophoresis. This pre-fractionation technique facilitated the MALDI-TOF MS detection of as many as 262 different peptide and protein ion signals from human serum. The results obtained from three replicate fractionation experiments on the same serum sample indicated that 148 different peptide and protein ion signals were reproducibly detected using our isoelectric focusing and MALDI-TOF MS protocol.