Improving diagnostic performance of coronavirus disease 2019 rapid antigen testing through computer-based feedback training using open-source experimental psychology software.

INTRODUCTION: Rapid antigen testing (RAT) results are visually read as whether colored line is present or absent. The subjective interpretation potentially misses detecting weak lines due to lower analyte concentration in samples tested, requiring training. Although routine test experience has improved the result readout skills, it consumes time and resources. Therefore, we created a computer-based feedback training method using open-source experimental psychology software, wherein participants accumulate RAT result readout experience by repeatedly responding positive/negative to randomly presented pictures showing RAT results; then, they receive feedback on their answers as correct or incorrect and are asked to stare at the pictures again with the knowledge of correct answer. This study aimed to examine the training effects in improving the skills, using coronavirus disease 2019 (COVID-19) RAT. METHODS: Twenty-two medical technologists were randomly divided into two groups: the feedback-training and test-experience groups. Using several pictures showing positive and negative results of COVID-19 RAT, after examination of their initial result readout skills, feedback-training group received the feedback training, whereas test-experience group performed an equal number of tests without feedback to accumulate test experience, and their skills were examined again. The ratio of "positive" answers to the pictures showing positive results (i.e., hit rate) was statistically analyzed. RESULTS: The feedback-training group showed a significantly higher hit rate after their training, whereas the test-experience group did not. The feedback training effects were manifested in weak line detection. CONCLUSIONS: This computer-based feedback training method can be an effective tool for improving RAT result readout skills.

Performance characteristics of 5 numerical indexes in mixing test interpretation under coexistence of lupus anticoagulant and coagulation factor deficiency.

Background: The mixing test is useful to investigate the cause of unexpectedly prolonged activated partial thromboplastin time (APTT). Several indexes are available for distinguishing correction from non-correction (ie, factor deficiency from inhibitors), but their performance characteristics may differ because of their different formulas. Furthermore, it is unclear how each index performs under the coexistence of factor deficiency and inhibitors. Objectives: The objective of this study was to examine the differences in indexes, depending on factor VIII activity (FVIII:C) levels and lupus anticoagulant (LA) titers in test samples. Methods: APTT was measured in spiked samples with various FVIII:C levels and LA titers, normal pooled plasma (NPP), and their 4:1, 1:1, and 1:4 mixtures. The following 5 indexes were calculated: index of circulating anticoagulant, mixing test normalized ratio, 4:1 and 1:1 percent corrections, and an APTT difference between the 1:1 mixture and NPP. The samples with LA, showing correction, were measured for FVIII:C in a one-stage assay to check parallelism. Results: All indexes showed correction under FVIII deficiency and non-correction under higher LA titers. However, under lower LA titers, some indexes showed non-correction but others showed correction because of dilution effects and variations in formulas and/or sample mix ratios. The differences among the indexes were more pronounced under coexistent FVIII deficiency and LA, even though LA titers were equal in the tested samples; samples with lower FVIII:C showed correction, whereas those with normal FVIII:C showed non-correction. The samples tested for FVIII:C showed non-parallelism. Conclusion: Each index had different performance characteristics to LA samples, which were pronounced under low FVIII:C levels in test samples.

Effect of Rapid Centrifugation Using High Centrifugal Force on Procoagulant Activity in Plasma Samples.

BACKGROUND: International guidelines for plasma preparation are not always observed because high-speed centrifugation reduces turnaround times. This study assessed the effect of rapid centrifugation on sample quality and clotting time. METHODS: Blood samples were obtained from five healthy volunteers. Normal blood samples were spiked with unfractionated heparin to produce abnormal samples. The normal and abnormal coagulation ability samples were centrifuged at 1,500 x g for 15 minutes, 2,000 x g for 10 minutes (both according to international guidelines), or 3,500 x g for 7 minutes (rapid centrifugation). Microparticle procoagulant activity (MP activity), prothrombin time (PT), and activated partial thromboplastin time (APTT) were measured in the supernatant plasma. RESULTS: Rapid centrifugation caused a significant increase in MP activity compared to the two recommended conditions and significantly shortened clotting times, particularly APTT in the abnormal samples. CONCLUSIONS: Rapid centrifugation should not be used for routine processing of blood samples for coagulopathy screening and monitoring patients on anticoagulant therapy.

Screening and follow-up of chronic liver diseases with understanding their etiology in clinics and hospitals.

BACKGROUND AND AIM: Considering the increasing prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the development of an effective screening and follow-up system that enables the recognition of etiological changes by primary physicians in clinics and specialists in hospitals is required. METHODS: Chronic hepatitis B (HBV) and C (HCV), NASH, and alcoholic steatohepatitis (ASH) patients who were assayed for Mac-2-binding protein glycosylation isomer (M2BPGi) (n = 272) and underwent magnetic resonance elastography (MRE) (n = 119) were enrolled. Patients who underwent MRE were also tested by ultrasound elastography (USE) (n = 80) and for M2BPGi (n = 97), autotaxin (ATX) (n = 62), and platelet count (n = 119), and their fibrosis-4 (FIB-4) index was calculated (n = 119). RESULTS: FIB-4 index >2, excluding HBV-infected patients, M2BPGi >0.5, ATX >0.5, and platelet count <20 × 104/µL were the benchmark indices, and we took into consideration other risk factors, such as diabetes mellitus and age, to recommend further examinations, such as USE, based on the local situation to avoid overlooking hepatocellular carcinoma (HCC) in the clinic. During specialty care in the hospital, MRE exhibited high diagnostic ability for fibrosis stages >F3 or F4; it could efficiently predict collateral circulation with high sensitivity, which can replace USE. We also identified etiological features and found that collateral circulation in NASH/ASH patients tended to exceed high-risk levels; moreover, these patients exhibited more variation in HCC-associated liver stiffness than the HBV and HCV patients. CONCLUSIONS: Using appropriate markers and tools, we can establish a stepwise, practical, noninvasive, and etiology-based screening and follow-up system in primary and specialty care.

Expert consensus regarding standardization of sample preparation for clotting time assays.

Accurate clotting time assay results are vital, as the test is employed to indicate the amount of oral anticoagulant to be prescribed, while it is also used for screening the hemorrhagic and thrombotic diseases. The procedure chosen for preparation of a patient blood sample including centrifugation can contribute to significant differences in the results obtained. Thus, for the purpose of proposing a standardized method to appropriately prepare blood samples prior to assay, the Japanese Society of Laboratory Hematology organized the Working Group for Standardization of Sample Preparation for Clotting Time Assays (WG). Following reviews of previously announced guidelines and original experimental results, consensus was obtained by the WG, with the main findings as follows. (1) The recommended anticoagulant in the blood collection tube is sodium citrate solution at 0.105-0.109 M (3.13-3.2%). (2) Whole blood samples should be stored at room temperature (18-25 ˚C) within 1 h of collection from the patient. (3) For plasma preparation, centrifugation at 1500 × g should be performed for at least 15 min or at 2000 × g for at least 10 min at room temperature. (4) After the plasma sample is prepared, it should be stored at room temperature and assayed within 4 h.

Auditory T-Complex Reveals Reduced Neural Activities in the Right Auditory Cortex in Musicians With Absolute Pitch.

Absolute pitch (AP) is the ability to identify the pitch names of arbitrary musical tones without being given a reference pitch. The acquisition of AP typically requires early musical training, the critical time window for which is similar to that for the acquisition of a first language. This study investigated the left-right asymmetry of the auditory cortical functions responsible for AP by focusing on the T-complex of auditory evoked potentials (AEPs), which shows morphological changes during the critical period for language acquisition. AEPs evoked by a pure-tone stimulus were recorded in high-AP musicians, low-AP musicians, and non-musicians (n = 19 each). A balanced non-cephalic electrode (BNE) reference was used to examine the left-right asymmetry of the N1a and N1c components of the T-complex. As a result, a left-dominant N1c was observed only in the high-AP musician group, indicating "AP negativity," which has previously been described as an electrophysiological marker of AP. Notably, this hemispheric asymmetry was due to a diminution of the right N1c rather than enhancement of the left N1c. A left-dominant N1a was found in both musician groups, irrespective of AP. N1c and N1a exhibited no left-right asymmetry in non-musicians. Hence, music training and the acquisition of AP are both accompanied by a left-dominant hemispheric specialization of auditory cortical functions, as indexed by N1a and N1c, respectively, but the N1c asymmetry in AP possessors was due to reduced neural activities in the right hemisphere. The use of a BNE is recommended for evaluating these radially oriented components of the T-complex.

Poly(N-vinyl-2-pyrrolidone) elution from polysulfone dialysis membranes by varying solvent and wall shear stress.

Some dialysis patients are treated with post-hemodiafiltration (HDF); the blood viscosity of the patients who undergo post-HDF is higher than that of the patients who undergo conventional hemodialysis. This study aims to evaluate poly(N-vinyl-2-pyrrolidone) (PVP) elution from PSf dialysis membranes by varying solvents and high wall shear stress caused by blood viscosity. We tested three commercial membranes: APS-15SA (Asahi Kasei Kuraray), CX-1.6U (Toray) and FX140 (Fresenius). Dialysate and blood sides of the dialyzers were primed with reverse osmosis (RO) water and saline. RO water, saline and dextran solution (2.9 and 5.8 mPa s) were circulated in the blood side. The amount of eluted PVP was determined by 0.02 N iodometry. The hardness and adsorption force of human serum albumin (HSA) on the membrane surfaces were measured by the atomic force microscope. When wall shear stress was increased using dextran, the amount of PVP eluted by the 2.9 mPa s solution equaled that eluted by the 5.8 mPa s solution with APS-15SA and CX-1.6U sterilized by gamma rays. The amount of PVP eluted by the 5.8 mPa s solution was higher than that eluted by the 2.9 mPa s solution with FX140 sterilized by autoclaving. The wall shear stress increased the PVP elution from the surface, hardness and adsorption force of HSA. Sufficient gamma-ray irradiation is effective in decreasing PVP elution.

Solute removal efficiency and biocompatibility of the high-performance membrane - from engineering points of view.

Two major prerequisites of high-performance dialysis membranes are superior biocompatibility and high removal efficiency of pathogenic substances of large molecular size. In this article, we present a review, in the context of recent research results, of the solute removal efficiency and biocompatibility of the high-performance membrane. The former is discussed in terms of differences in separation properties arising from the constituent materials, the dialysis membrane structures, internal filtration-accelerated dialyzers, optimization of the dialysis fluid flow, and solute removal by adsorption, and the latter in terms of invasion of endotoxins present in dialysis fluid, antioxidant actions, and properties of the internal surface of dialysis membranes. We also discuss the main properties and problems of currently available high-performance dialysis membranes. While the solute removal efficiency of high-performance dialysis membranes is already mostly satisfactory and no further significant improvements are expected, except in relation to the fractioning properties (selectivity), there is much scope for improvement in the biocompatibility of dialysis membranes. It is important that ultrahigh-performance dialysis membranes of superior biocompatibility are developed based on the results of basic studies carried out from the engineering point of view, reports from the manufacturers, and clinical outcomes.

Longer storage of dialyzers increases elution of poly(N-vinyl-2-pyrrolidone) from polysulfone-group dialysis membranes.

The objective of this study was to evaluate the effect of protracted storage of dialyzers on the amount of poly(N-vinyl-2-pyrrolidone) (PVP) eluted from polysulfone-group dialysis membranes. We tested five dialysis membranes: APS-15SA (Asahi Kasei Kuraray, wet), CX-1.6U (Toray, moist), FX140 (Fresenius, dry), PES-15Sα (Nipro, dry), and FDX-150GW (Nikkiso, wet). Each dialyzer was stored for 1, 3, 14, and 18 months after sterilization. The dialysis-fluid side compartment was primed with reverse osmosis (RO) water at 500 mL/min for 5 min at 310 K. The blood side compartment was primed with RO water at 200 mL/min for 5 min at 310 K. Finally, 1 L RO water was circulated through the blood side compartment at 200 mL/min for 4 h at 310 K. Eluted PVP was determined by use of the iodine method, using 0.02 N: iodine solution. PVP was mainly eluted from wet-type dialyzers during priming. Thus, the standard 5 min priming of the wet-type dialyzer according to the maker manual inhibits PVP elution during circulation. PVP was eluted in the dialysis-fluid side of the moist-type dialyzer during priming but no PVP was eluted in the blood side. PVP was mainly eluted from dry-type dialyzers during circulation. We recommend more than the standard 5 min priming, particularly for dry-type dialyzers stored for protracted periods, because 5 min insufficient to inhibit PVP elution during circulation.

Evaluation of dialyzer jacket structure and hollow-fiber dialysis membranes to achieve high dialysis performance.

The objective of this study was to determine the optimum dialyzer jacket structure and hollow-fiber dialysis membrane, both of which are indispensable factors for achieving high dialysis performance, by clarifying the relationship between the dialysis performance and the flow of dialysate and blood in a hollow-fiber dialyzer. We evaluated the clearance, dialysate, and blood flow for four commercially available hollow-fiber dialyzers, namely, the APS-15S, APS-15SA, TS-1.6UL, and CX-1.6U. To evaluate dialysate and blood flow, we measured the residence-time distribution of dialysate and blood flow of these dialyzers by the pulse-response method. We also determined the clearances of urea, creatinine, vitamin B(12), and lysozyme to evaluate the dialysis performance of these dialyzers. While the baffle and taper structures allow effective supply of dialysate into the dialyzer jacket, the hollow-fiber shape, inner diameter, and packing density significantly influence the dialysate flow. In dialyzers with long taper-holding slits, the slit area is a key design parameter for achieving optimum dialysate flow. Similarly, the blood flow is significantly influenced by the structure of the inflowing and outflowing blood ports at the header of a dialyzer, and the shape and inner diameter of the hollow fibers. Hollow fibers with smaller inner diameters cause an increase in blood pressure, which causes blood to enter the hollow fibers more easily. The hollow-fiber shape hardly affects the blood flow. While improved dialysate and blood flow cause higher clearance of low molecular-weight substances, higher membrane area and pure-water permeability accelerate internal filtration, thereby causing an increase in the clearance of large molecular-weight substances.

Development of a device for chemiluminescence determination of superoxide generated inside a dialysis hollow-fiber membrane.

Reactive oxygen species (ROS) generated during hemodialysis treatment cause dialysis complications because of the high reactivity of ROS. To prevent dialysis complications caused by oxidative stress, it is important to evaluate the generation and dismutation of ROS during hemodialysis treatment. In this study, our aim was to develop a device to determine superoxide (O(2)(-)) generated inside a dialysis hollow fiber, and also to examine whether this device could detect O(2)(-) separated from plasma using hollow fibers. Experimental apparatus was set up so that hypoxanthine (HX) solution flowed inside the hollow fibers and 2-methyl-6-p-methoxyphenylethynyl-imidazopyrazinone (MPEC) solution flowed outside the hollow fibers. Then, xanthine oxidase (XOD) solution was added to the HX solution to generate O(2)(-), and chemiluminescence resulting from the reaction of O(2)(-) with MPEC was measured with an optical fiber. Chemiluminescence intensity was measured at different HX concentrations, and the peak area of relative luminescence intensity yielded a first-order correlation with the HX concentration. Based on the relationship between HX and O(2)(-) concentrations determined by the cytochrome c reduction method, the relative luminescence intensity measured by this device was linearly dependent on the O(2)(-) concentration inside the hollow fibers. After modifications were made to the device, XOD solution injection into plasma including HX resulted in an increase in the relative luminescence intensity. We concluded that this novel device based on chemiluminescence is capable of determining aqueous O(2)(-) generated inside a hollow fiber and also of detecting O(2)(-) in plasma.

Genetic reduction of GABA(A) receptor gamma2 subunit expression potentiates the immobilizing action of isoflurane.

Potentiation of inhibitory gamma-aminobutyric acid subtype A (GABA(A)) receptor function is involved in the mechanisms of anesthetic action. The present study examined the immobilizing action of the volatile anesthetic isoflurane in mice with double knockout (DKO) of phospholipase C-related inactive protein (PRIP)-1 and -2. Both of these proteins play important roles in the expression of GABA(A) receptors containing the gamma2 subunit on the neuronal cell surface. Immunohistochemistry for GABA(A) receptor subunits demonstrated reduced expression of gamma2 subunits in the spinal cord of the DKO mice. Immunohistochemistry also revealed up-regulation of the alpha1 and beta3 subunits even though there were no apparent differences in the immunoreactivities for the beta2 subunits between wild-type and DKO mice. The tail-clamp method was used to evaluate the anesthetic/immobilizing effect of isoflurane and the minimum alveolar concentration (MAC) was significantly lower in DKO mice compared with wild-type controls (1.07+/-0.01% versus 1.36+/-0.04% atm), indicating an increased sensitivity to isoflurane in DKO mice. These immunohistochemical and pharmacological findings suggest that reduced expression of the GABA(A) receptor gamma2 subunit affects the composition and function of spinal GABA(A) receptors and potentiates the immobilizing action of isoflurane.

Computational evaluation of dialysis fluid flow in dialyzers with variously designed jackets.

Dialyzer performance strongly depends on the flow of blood and dialysis fluid as well as membrane performance. It is necessary, particularly to optimize dialysis fluid flow, to develop a highly efficient dialyzer. The objective of the present study is to evaluate by computational analysis the effects of dialyzer jacket baffle structure, taper angle, and taper length on dialysis fluid flow. We modeled 10 dialyzers of varying baffle angles (0, 30, 120, 240, and 360 degrees ) with and without tapers. We also modeled 30 dialyzers of varying taper lengths (0, 12.5, 25.0, and 50.0 mm) and angles (0, 2, 4, and 6 degrees ) based on technical data of APS-SA dialyzers having varying surface areas of 0.8, 1.5, and 2.5 m(2) (Rexeed). Dialysis fluid flow velocity was calculated by the finite element method. The taper part was divided into 10 sections of varying fluid resistances. A pressure of 0 Pa was set at the dialysis fluid outlet, and a dialysis fluid flow rate of 500 mL/min at the dialysis fluid inlet. Water was used as the dialysis fluid in the computational analysis. Results for dialysis fluid flow velocity of the modeled dialyzers indicate that taper design and a fully surrounded baffle are important in making the dialysis fluid flow into a hollow-fiber bundle easily and uniformly. However, dialysis fluid flow channeling occurred particularly at the outflowing part with dialyzers having larger taper lengths and angles. Optimum design of dialysis jacket structure is essential to optimizing dialysis fluid flow and to increasing dialyzer performance.

Technical characterization of dialysis fluid flow of newly developed dialyzers using mass transfer correlation equations.

Dialysis fluid flow and mass transfer rate of newly developed dialyzers were evaluated using mass transfer correlation equations of dialysis fluid-side film coefficient. Aqueous creatinine clearance and overall mass transfer coefficient for APS-15S (Asahi Kasei Kuraray) as a conventional dialyzer, and APS-15SA (Asahi Kasei Kuraray), PES-150Salpha (Nipro), FPX140 (Fresenius), and CS-1.6U (Toray) as newly developed dialyzers were obtained at a blood-side flow rate (QB) of 200 ml/min, dialysis fluid-side flow rates (QD) of 200-800 ml/min and a net filtration rate (QF) of 0 ml/min. Mass transfer correlation equations between Sherwood number (Sh) containing dialysis fluid-side mass transfer film coefficient and Reynolds number (Re) were formed for each dialyzer. The exponents of Re were 0.62 for APS-15S whereas approximately 0.5 for the newly developed dialyzers. The dialysis fluid-side mass transfer film coefficients of the newly developed dialyzers were higher than those of the conventional dialyzer. Based on the mass transfer correlation equations, introduction of short taper, full baffle of dialyzer jacket and further wave-shaped hollow fiber improves the dialysis fluid flow of the newly developed dialyzers.

Nanotechnological characterization of human serum albumin adsorption on wet synthetic polymer dialysis membrane surfaces.

The objective of the present study was to evaluate the characteristics of protein adsorption on the inner surface of various dialysis membranes, to develop protein adsorption-resistant biocompatible dialysis membranes. The adsorption force of human serum albumin (HSA) on the inner surface of a dialysis membrane and the smoothness of the membrane were evaluated from a nanoscale perspective by atomic force microscopy. The content ratio of the hydrophilic polymer, polyvinylpyrrolidone (PVP), was determined by attenuated total reflection Fourier transform infrared spectroscopy. Nine synthetic-polymer dialysis membranes on the market made of polysulfone (PSF), polyethersulfone (PES), polyester polymer-alloy (PEPA), and ethylene vinylalcohol (EVAL) were used in the present study. The HSA adsorption force on the surface of the hydrophobic polymer PEPA membrane was higher than that on the hydrophilic polymer EVAL membrane surface. It has been considered beneficial, for decreasing the HSA adsorption force, to cover a hydrophobic polymer membrane surface with PVP. However, there were some areas on PVP-containing membrane surfaces at which much higher HSA adsorption forces were observed. The HSA adsorption force gave a nearly linear correlation with the surface roughness on the PSF membrane surface. However, the HSA adsorption force was uncorrelated with the PVP content ratio for any of the PSF membrane surfaces tested. In conclusion, protein adsorption can be minimized by the use of dialysis membranes made of hydrophobic polymers containing PVP with a smooth surface.

Flow uniformity in oxygenators with different outlet port design.

This study reports on evaluation of the optimum design of a blood outlet port structure for providing uniform flow by visualizing the blood flow in an extracapillary membrane oxygenator. We tested a cylindrical type extracapillary membrane oxygenator, HPO-20. The HPO-20 has a tangential blood outlet port and is thus referred to as "Tangential HPO-20." We engineered "Vertical HPO-20" with a vertical blood outlet port by modifying the Tangential HPO-20. To visualize the blood-side flow, a total of 120 insulated copper-wire electrodes were placed in the "Tangential" and the Vertical HPO-20s. The test solution flow was visualized by the dimensionless fluid arrival time reaching each electrode. The test solution flow in the Tangential HPO-20 was not uniform, particularly at the outside blood channel. The flow was more uniform in the Vertical HPO-20. The blood flow in an extracapillary membrane oxygenator with a vertical blood outlet port is well distributed so that it produces more uniform blood flow than that with a tangential outlet port because of the small stagnation and reduced channeling.

Effects of fluid flow on elution of hydrophilic modifier from dialysis membrane surfaces.

When uremic blood flows through dialyzers during hemodialysis, dialysis membrane surfaces are exposed to shear stress and internal filtration, which may affect the surface characteristics of the dialysis membranes. In the present study, we evaluated changes in the characteristics of membrane surfaces caused by shear stress and internal filtration using blood substitutes: water purified by reverse osmosis and 6.7 wt% dextran70 solution. We focused on the levels of a hydrophilic modifier, polyvinylpyrrolidone (PVP), on the membrane surface measured by attenuated total reflectance Fourier transform infrared spectroscopy. Experiments involving 4 h dialysis, 0-144 h shear-stress loading, and 4 h dead-end filtration were performed using polyester-polymer alloy (PEPA) and polysulfone (PS) membranes. After the dialysis experiments with accompanying internal filtration, average PVP retention on the PEPA membrane surface was 93.7% in all areas, whereas that on the PS membrane surface was 98.9% in all areas. After the shear-stress loading experiments, PVP retention on the PEPA membrane surface decreased as shear-stress loading time and the magnitude of shear stress increased. However, with the PS membrane, PVP retention scarcely changed. After the dead-end filtration experiments, PVP retention decreased in all areas for both PEPA and PS membranes, but PVP retention on the PEPA membrane surface was lower than that on the PS membrane surface. PVP on the PEPA membrane surface was eluted by both shear stress and internal filtration, while that on the PS membrane surface was eluted only by internal filtration.

Dependence of chemotherapy response on p53 mutation status in a panel of human cancer lines maintained in nude mice.

In contrast to findings in vitro, the clinical response to anticancer chemotherapy is not simply associated with the p53 mutation status. To analyze the relationship between the actual response of solid tumors with p53 mutation and other biological characteristics, we used a human cancer-nude mouse panel of 21 lines derived from stomach, colorectal, breast, lung, and liver cancers for experimental chemotherapy. We examined the tumor growth rates of the cancer lines and the effects of nine drugs in clinical use, namely, mitomycin C (MMC), cisplatin (CDDP), nimustine hydrochloride (ACNU), irinotecan (CPT-11), cyclophosphamide (CPA), 1-(2-tetrahydrofuryl)-5-fluorouracil (FT-207), a 4:1 mixture of uracil and FT-207 (UFT), 5'-deoxy-5-fluorouridine (5'-DFUR), and adriamycin (ADM), on these tumors. The chemotherapy response was expressed as the tumor growth inhibition rate (IR). The genomic DNA sequences of the p53 gene in exons 5 through 8 were analyzed in these cancer tissues, and p53 mutations were detected in 10 of the 21 cancer lines (48%). Resistance to MMC was observed in p53 mutant tumors with smaller IRs than those for wild-type tumors (57.7% vs. 79.9%, P < 0.03). No significant differences were noted with the other eight drugs. To explore the role of the p53 function in the chemotherapy response, we calculated the correlation coefficients between chemosensitivity and tumor growth rate separately in p53 mutant and wild-type groups. In the p53 wild-type group, we found a positive correlation for the following drugs: ADM (P < 0.02), ACNU (P < 0.007), CPA (P < 0.011), UFT (P < 0.012), and FT-207 (P < 0.02). In the p53 mutant group, only CPA (P < 0.003) showed a positive correlation. The kinetics suggests that in the wild-type tumors, DNA damage caused by anticancer drugs occurs proportionally to the rate of DNA synthesis, and p53-mediated apoptosis is subsequently induced. The low frequency of positive correlation in the p53 mutant tumors is compatible with the loss of function or malfunction of mutant p53. The present results provide kinetic evidence that p53 function affects the response to anticancer drugs. Preserved p53 function tended to confer good chemosensitivity on rapidly growing tumors. However, the p53 mutation status did not seem to be suitable for use as an exclusive indicator to predict the chemotherapy response of human cancer xenografts.

In vivo antitumor activity of a novel sulfonamide, HMN-214, against human tumor xenografts in mice and the spectrum of cytotoxicity of its active metabolite, HMN-176.

The cytotoxic effects of HMN-176 ((E)-4-[[2-N-[4-methoxybenzenesulfonyl] amino] stilbazole] 1-oxide; a newly synthesized compound, were evaluated and compared with those of the clinically used antitumor agents cis-platinum, adriamycin, etoposide, taxol, and vincristine in 22 human tumor cell lines isolated from various organs. HMN-176 exhibited potent cytotoxicity with IC(50) values in the nM range, and the variance of its cytotoxic efficacy was remarkably small. Drug-resistant cell lines also showed low cross-resistance to HMN-176 corresponding to overall resistance indices of less than 14.3. HMN-214 was synthesized as an oral prodrug because of the poor oral absorption of HMN-176 itself. Pharmacokinetic studies showed that HMN-214 was an acceptable oral prodrug of HMN-176. In the in vivo analysis of the schedule-dependency of HMN-214, the repeated administration for over 5 days elicited potent antitumor activity, as expected from the exposure-dependency of the cytotoxicity of HMN-176 and from the cytometric studies. The antitumor activity of HMN-214 against human tumor xenografts was equal or superior to that of clinically available agents, including cis-platinum, adriamycin, vincristine, and UFT without severe toxicity such as neurotoxicity. Because of its good activity in preclinical trials, HMN-214 has entered Phase I clinical trials in the USA.