Levetiracetam for seizures after liver transplantation.

Seizures may occur after orthotopic liver transplantation. Antiepileptic drugs (AEDs) are used to treat these seizures, but the immunosuppressant regimen also may be altered. Levetiracetam is an attractive treatment because of its efficacy, lack of hepatic enzyme induction, and its rapid attainment of serum levels. Treatment with levetiracetam is efficacious, and levetiracetam-treated patients require significantly lower doses of immunosuppressant medications to achieve an equivalent antirejection effect.

Improvement in the polyneuropathy associated with familial amyloid polyneuropathy after liver transplantation.

OBJECTIVE: To study, following liver transplantation, the neurologic progression or regression of the polyneuropathy in a cohort of patients with familial amyloidotic polyneuropathy (FAP). BACKGROUND: FAP is characterized by the relentless progression of neurologic and cardiac impairment, leading to death within 7 to 15 years after disease onset. No effective treatment to slow or halt the progression of this disease has been found to date. DESIGN/METHODS: Over the past 3 years, our FAP patients were offered liver transplantation as treatment. We report on nine patients who were followed longitudinally with serial neurologic examinations since transplantation. RESULTS: Clinically, all patients evaluated for neurologic progression reported significant improvement in general well being. No patient showed any progression in neurologic disease since receiving a liver transplant. Improvements are documented in symptomatic, autonomic, and sensorimotor neurologic disease in all patients. CONCLUSION: Our experience suggests that liver transplantation may offer hope for arrest of progression and neurologic improvement in patients with FAP.

A synthetic dural prosthesis constructed from hydroxyethylmethacrylate hydrogels.

Hydroxyethylmethacrylate (HEMA) hydrogels were investigated for their suitability as a dural prosthesis. Poly-HEMA has many characteristics required for an artificial dural substitute: it is durable, flexible, easily prepared, inexpensive, easily sterilized and handled, easily shaped, and known to be chemically inert and nontoxic. Sheets made of plain HEMA were evaluated as dural substitutes in rats and rabbits after either craniotomy or laminectomy with durectomy. Histological evaluations of the prostheses and the underlying tissues were undertaken at various time points from 2 to 9 weeks postoperatively. There was minimal tissue response to the implanted HEMA gel in contrast to marked thickening of the overlying leptomeninges and cortical herniation in the control animals. It is concluded that HEMA gels fulfill the essential criteria for an effective dural substitute.

Oxidation of peptidyl lysine by copper complexes of pyrroloquinoline quinone and other quinones. A model for oxidative pathochemistry.

Various o- and p-quinones were assessed as oxidants of peptidyl lysine in elastin and collagen substrates in the presence and absence of divalent copper as paradigms of protein-lysine 6-oxidase (lysyl oxidase) which contains both quinone and copper cofactors. Pyrroloquinoline quinone was among the most active in the absence and the most active of the o- and p-quinones tested in the presence of copper. The optimal rate of elastin oxidation occurred at a 2:1 PQQ/Cu(II) ratio while Cu(II) itself oxidized elastin relatively slightly. Elastin oxidation by 2:1 PQQ/Cu(II) required aerobic conditions consistent with oxygen-dependent turnover of this catalytic pair. Dimethylsulfoxide and catalase individually or in combination inhibited elastin oxidation by PQQ/Cu(II) by approx. 50%, suggesting that oxygen free radical species participate in the reaction. Amino-acid analysis of elastin and collagen substrates oxidized by 2:1 PQQ/Cu and then reduced with borohydride revealed that alpha-aminoadipic-delta-semialdehyde and lesser amounts of covalent cross-linkages were generated by this oxidant. In contrast, lysine oxidase produced aldehydes and significantly greater quantities of cross-linkage products, consistent with the known specificity of the enzyme. These data, thus, indicate the potential for free quinones, such as PQQ, particularly when stimulated by appropriate metal ions, to act as adventitious oxidants of lysine side-chains in proteins.

Altered electrophysiologic and pharmacologic response of smooth muscle cells on exposure to electrical fields generated by blood flow.

The flow of the blood past the vascular wall gives rise to an electrical potential. This field is calculated to have a periodic waveform with a transluminal peak-to-peak amplitude of approximately 1.35 V/m-1. Digital imaging fluorescent microscopy was used to measure changes in the membrane potentials of smooth muscle cells by following changes in the fluorescence of the potential sensitive dye, 3,3'-dipropyloxacarbocyanine iodide (di-O-C5[3]). The effect of the low level electrical field on the membrane potentials of cultured smooth muscle vascular cells was shown to cause a steady-state depolarization of approximately 10 mV. The degree of steady-state depolarization was shown to directly vary with the frequency of the applied field and the effect was not dependent on the presence of extracellular Ca+2 or Mg+2. These effects are though to be most consistent with an electroconformational coupling mechanism. The presence of this electrokinetic field was also shown to alter the electrophysiological response of smooth muscle cells treated with 5-hydroxytryptamine. Cells exposed concurrently to both 5-HT and the electrical field showed an increased membrane depolarization thus implying that the electrokinetic field may be important in both normal and pathologic cellular responses.

Nontoxic and durable salt bridges using hydroxyethylmethacrylate hydrogels.

Polyhydroxyethylmethacrylate polymers (poly-HEMA) form hydrogels that provide an excellent alternative to agar in the production of salt bridges for use in bioelectrochemical experiments. A method for the simple production of poly-HEMA salt bridges is described. The poly-HEMA bridges were compared with agar bridges of similar geometry. Whereas poly-HEMA salt bridges have a conductivity that is 20 times lower than that of agar bridges of a similar geometry, poly-HEMA bridges are capable of dissipating twice the power compared with agar bridges. The mechanical properties of the poly-HEMA bridges make them easy to manufacture, store, and sterilize. When agar bridges were compared with poly-HEMA bridges in long-term cell culture experiments, the failure rate of the agar bridges was found to be approximately 10% per week vs. a virtually nonexistent failure rate for the poly-HEMA bridges. Because poly-HEMA salt bridges are reliable, durable, and nontoxic to cells, they are a practical alternative to agar salt bridges in certain experimental designs.

Amperometric electrochemical detection of pyrroloquinoline quinone in high-performance liquid chromatography.

The electrochemistry of pyrroloquinoline quinone (PQQ) enables its reduction and oxidation at a variety of electrode surfaces. Two methods of PQQ quantitation are described using amperometric electrochemical detection after HPLC separation. In one method a single electrode is used to reduce PQQ in the eluant stream and is sensitive to as little as 10 pmol of material. The second method is a dual electrode method that takes advantage of the reversible nature of the PQQ redox cycle and though only half as sensitive as the single electrode method, it is more specific. The advantages of the method lie in its simplicity, sensitivity, and low cost.

Effect of the reducing environment on the accumulation of elastin and collagen in cultured smooth-muscle cells.

We show here that cultured neonatal-rabbit aortic smooth-muscle cells produce and accumulate significant amounts of insoluble elastin. When grown in the presence of ascorbic acid, the amount of insoluble elastin in these cultures decreases, whereas the accumulation of collagen increases. These changes have been attributed to increased hydroxylation of proline in elastin. The function of ascorbic acid in proline hydroxylation is thought to be that of a reductive cofactor that maintains the proper oxidation state of molecular iron in the enzyme complex. This study shows that both ascorbic and isoascorbic acids act similarly to modify the accumulation of elastin and collagen in culture. On the other hand, cultures grown in the presence of dithiothreitol, a reducing agent previously shown to act as a cofactor for prolyl hydroxylase, do not demonstrate altered elastin accumulation. These studies are consistent with the suggestion that there is a specific role for ascorbic acid in this cellular system that cannot be replaced by other reducing cofactors.

Modified hydroxyethylmethacrylate hydrogels as a modelling tool for the study of cell-substratum interactions.

The interactions between cells and their extracellular substratum environment are complex and difficult to study. Defined, synthetic substrata are valuable tools for experimentally determining the role of ionic and receptor-specific interactions between cells and their substrata. Hydrogels have been modified to contain stoichiometrically defined quantities of both positive and negative charge as well as specific proteins. These synthetic surfaces are water-rich matrices that possess hydroxyl groups, positive and negative ionized charges and native proteins, and can be considered as models of extracellular matrices on which an assessment of charge contribution and macromolecular content and specificity can be addressed with respect to cell-matrix interactions. This study shows that simple gels made of polyhydroxyethylmethacrylate do not support the spreading of cells but that the generation of copolymers by the addition of monomers that contain ionizable functional groups, will permit cell spreading. These simple modifications do not lead to cellular proliferation, yet when collagen is entrapped in the hydrogel substratum, proliferation occurs. The proliferative rate of cells grown on collagen-containing surfaces may be modified by altering the stoichiometry of the ionizable polymers used to make the surface. This study describes a synthetic, definable model for the study of cell-substratum interactions and control.