Estimated glomerular filtration rate for drug dose adjustment: Cockcroft and Gault or abbreviated MDRD equation?

OBJECTIVES: Evaluate if Cockcroft and Gault (CG) estimated glomerular filtration rate (eGFR) might be replaced by abbreviated MDRD eGFR for drug dose adjustment. DESIGN AND METHODS: eGFR was determined in 140 hospitalized patients (median: 68 years, 65 kg) treated by nephrotoxic and/or renally cleared drugs. RESULTS: CG eGFR was 61 mL/min vs. 78 mL/min/1.73 m(2) for MDRD (p<0.0001). CG-MDRD difference ranged from -93 to +34 mL/min, influenced by patient age, weight, and gender (p<0.001). CONCLUSIONS: CG eGFR cannot be easily replaced by abbreviated MDRD eGFR for drug dose adjustment.

Bone morphogenetic protein-2 stimulates chondrogenic expression in human nasal chondrocytes expanded in vitro.

Articular cartilage contains an extracellular matrix with characteristic macromolecules such as type II collagen. Because this tissue is avascular and mature chondrocytes do not proliferate, cartilage lesions have a limited capacity for healing after trauma. Autologous chondrocyte implantation (ACI) is widely used for the treatment of patients with focal damage to articular cartilage. However, this method faces a major issue: dedifferentiation of chondrocytes occurs during the long-term culture necessary for mass cell production. The aim of this study was to determine if the step of cell amplification required for ACI could benefit from the use of bone morphogenetic protein (BMP)-2, a potent regulator of chondrogenic expression. Chondrocytes were isolated from human nasal cartilage, a hyaline cartilage like articular cartilage and were serially cultured in monolayers. After one, two or three passages, BMP-2 was used to evaluate the chondrogenic potential of the dedifferentiated chondrocytes, at the gene and protein level. We found that BMP-2 can reactivate the program of chondrogenic expression in dedifferentiated chondrocytes. To gain insight into the molecular mechanisms involved in the responsiveness of chondrocytes to BMP-2, we examined the phosphorylation of Smad proteins and the interaction of the Sry-type high-mobility-group box (Sox) transcription factors with the cartilage-specific enhancer of the type II procollagen gene. Our results show that BMP-2 acts by stimulating Smad phosphorylation and by enhancing DNA-binding of the Sox transcription factors to the specific enhancer of the type II procollagen gene. Thus, this study reveals the potential use of BMP-2 as a stimulatory agent in conventional ACI strategies.