Conversion from cyclosporine to tacrolimus in patients at risk for chronic renal allograft failure: 60-month results of the CRAF Study.

BACKGROUND: This study compared the long-term effects of switching from cyclosporine to tacrolimus on the incidence, progression, and severity of chronic renal allograft failure in patients with elevated serum creatinine levels. METHODS: Patients were assigned randomly (2:1) to switch to tacrolimus or remain on cyclosporine. Tacrolimus was initiated at 1/50th of the cyclosporine dose or 0.15 mg/kg/day, whichever dose was lower, to maintain trough concentrations between 5 and 15 ng/mL. Cyclosporine doses were adjusted to achieve trough concentrations between 100 and 300 ng/mL. RESULTS: At 60 months, the median change from baseline in serum creatinine was -0.2 mg/dL in the tacrolimus group and 0.3 mg/dL in the cyclosporine group (P=0.003). Median change in estimated creatinine clearance was 1.2 mL/min in the tacrolimus group and -4.1 mL/min in the cyclosporine group (P=0.019). The incidence of new-onset diabetes, hyperglycemia, hypertension, lymphoma, and malignancies was generally low and comparable between groups. Fewer patients in the tacrolimus group than in the cyclosporine group developed new cardiac conditions (11% vs. 28%, P=0.004), had low-density lipoprotein (LDL) cholesterol values more than 130 mg/dL (29% vs. 57%, P=0.002), or developed hyperlipidemia (24% vs. 67%, P=0.046) during the 60-month follow-up period. Despite these changes, patient and graft survival were similar for both groups. CONCLUSION: Switching from cyclosporine to tacrolimus resulted in improved renal function and a reduction in the occurrence of new-onset cardiac conditions and hyperlipidemia, with no increase in the incidence of new-onset diabetes or new-onset hyperglycemia. However, after 5 years there was no impact on patient or graft survival.

Self-organized perylene diimide nanofibers.

A propeller-shaped perylene diimide trimer was synthesized and a simple evaporation method was used for the self-organization of trimer molecules into fluorescent nanofibers. The sizes of these fibers-from 4 to 150 nm in diameter-were measured by atomic force microscopy and can be controlled by adjusting the concentration of the initial solution. The aspect ratios (length/height) are around 500. The plane of the trimer was determined by polarized scanning confocal microscopy to be perpendicular to the axis of the fibers, in agreement with molecular mechanics calculations. UV/vis and NMR spectroscopies were used to monitor concentration-dependent pi-pi stacking in solution. Single-fiber fluorescence imaging and spectroscopy were performed using a total internal reflection fluorescence microscope equipped with a digital color camera and imaging CCD spectrometer. Strongly red-shifted fluorescence from these fibers indicates a high degree of electronic delocalization, and breaking up this delocalization by photobleaching blue-shifts the emission toward that of an isolated noninteracting molecule. The delocalization along these nanofibers and the ability to study the electronic structure using fluorescence make them potentially useful in nanoscale devices, such as field effect transistors and photoconductors.

Molecular switch based on a biologically important redox reaction.

Building on our earlier report of a single-molecule probe, we show how biologically important redox centers, nicotinamide and quinone, incorporated into a fluorophore-spacer-receptor molecular structure, form redox active molecular switches, with the photoinduced electron-transfer behavior of each depending on the oxidation state of the receptor subunit. The switch based on nicotinamide (3/6) is strongly fluorescent in its oxidized state (Phi(F) approximately 1.0) but nonfluorescent in the reduced state (Phi(F) < 0.001) due to electron transfer from the reduced nicotinamide to the photoexcited fluorophore. The fluorescence can be reversibly switched off and on chemically by successive reduction with NaBH(3)CN and oxidation with tetrachlorobenzoquinone and switched electrochemically over 10 cycles without significant degradation. A similar switch based on quinonimine turned out to be nonfluorescent in both reduced and oxidized states: in addition to a similar quenching mechanism in the reduced state, quenching also occurs in the oxidized state, due to electron transfer from the fluorophore to the receptor. Ab initio quantum chemical calculations of orbital energy levels were used to corroborate these quenching mechanisms. Calculations predicted photoinduced electron transfer to be energetically favorable in all cases where quenching was observed and unfavorable in all cases where it was not. Application of the perylene analogue as a biosensor has also been demonstrated by coupling the switch to the catalytic pathway of yeast alcohol dehydrogenase, a common NADH/NAD(+)-utilizing enzyme.

A fatal case of necrotizing fasciitis caused by Serratia marcescens.

A patient with a history of type II diabetes mellitus (DM), end stage renal disease (ESRD), and congestive heart failure (CHF) developed necrotizing fasciitis caused by Serratia marcescens after scraping his leg on rocks in a river while fishing. Aggressive management with surgical debridement, antibiotics, and pressure support was unsuccessful.

Semiqualitative visual and quantitative morphometric evaluations of reduced scan time and wide-beam reconstruction in rest-gated stress SPECT myocardial perfusion imaging.

UNLABELLED: SPECT myocardial perfusion imaging (MPI) now accounts for well over 90% of all MPI studies performed in the United States. A means of reducing the acquisition time while maintaining diagnostic-quality images would be beneficial for both patients and nuclear cardiology clinics. Wide-beam reconstruction (WBR) is a processing algorithm that attempts to address the challenge of obtaining diagnostic-quality images with shorter counting times. This study was designed to incorporate semiqualitative assessments (physician rankings of image parameters) into quantitative assessments (morphologic measurements), as other researchers have done, in an effort to compare filtered backprojection (FBP)-the gold standard-with WBR. METHODS: Forty-seven MPI studies (from 34 men and 13 women) were masked to 3 physicians who qualitatively rated the images for image quality, myocardial normality, lesion reversibility, and treatment recommendation on a scale of 1-5, with 1 representing "good" and 5 representing "poor." Quantitative values for summed stress scores, summed rest scores, summed difference scores (SDS), end-diastolic volume, end-systolic volume, and the ejection fraction were calculated and reported. RESULTS: The semiqualitative analyses of image interpretation indicated that WBR yielded significant improvements over FBP in image quality and showed very good to moderate agreement with FBP among physicians for myocardial normality, lesion reversibility, and treatment recommendation. The quantitative analyses of the morphometric values representing myocardial perfusion, through SDS comparisons, were equivalent for the 2 reconstruction methods. Regression analysis indicated that WBR seemed to underestimate the gated stress-derived FBP ejection fraction by 9%-10%. CONCLUSION: Overall, the WBR method was equivalent or superior to the FBP reconstruction method for MPI with a rest-gated stress same-day protocol in terms of image quality, interpretation, and SDS. Additionally, the advantage of patient comfort derived from shorter imaging times should help reduce motion artifacts and repeat acquisitions as well as enhance patient care and throughput.

Ultrafast spectroscopy of the solvent dependence of electron transfer in a perylenebisimide dimer.

We investigate the photoinduced intramolecular electron-transfer (IET) behavior of a perylenebisimide dimer in a variety of solvents using femtosecond transient absorption spectroscopy. Overlapping photoinduced absorptions and stimulated emission give rise to complicated traces, but they are well fit with a simple kinetic model. IET rates were found to depend heavily on solvent dielectric constant. Good quantitative agreement with rates derived from fluorescence quantum yield and time-resolved fluorescence measurements was found for forward electron transfer and charge recombination rates.

Using single-molecule fluorescence spectroscopy to study electron transfer.

Techniques in single-molecule fluorescence spectroscopy now allow sophisticated studies of photophysical processes in single molecules. As interest grows in the possibilities of molecular electronics, researchers have begun to turn these techniques to the study of electron transfer. Electron-transfer reactions have now been detected and measured at the single-molecule level in a variety of systems and on a variety of timescales by adapting techniques from previous single-molecule fluorescence studies.

Single-molecule spectroscopy of interfacial electron transfer.

It is widely appreciated that single-molecule spectroscopy (SMS) can be used to measure properties of individual molecules which would normally be obscured in an ensemble-averaged measurement. In this report we show how SMS can be used to measure photoinduced interfacial electron transfer (IET) and back electron transfer rates in a prototypical chromophore-bridge-electrode nonadiabatic electron transfer system. N-(1-hexylheptyl)-N'-(12-carboxylicdodecyl)perylene-3,4,9,10-tetracarboxylbisimide was synthesized and incorporated into mixed self-assembled monolayers (SAMs) on an ITO (tin-doped indium oxide, a p-type semiconductor) electrode. Single-molecule fluorescence time trajectories from this system reveals "blinks", momentary losses in fluorescence (>20 ms to seconds in duration), which are attributed to discrete electron transfer events: electron injection from the perylene chromophore into the conduction band of the ITO leads to the loss of fluorescence, and charge recombination (back electron transfer) leads to the return of fluorescence. Such blinks are not observed when an electrode is not present. The fluorescence trajectories were analyzed to obtain the forward and back electron rates; the measured rates are found to lie in the millisecond to second regime. Different rates are observed for different molecules, but the lifetime distributions for the forward or back electron transfer for any given molecule are well fit by single exponential kinetics. The methodology used is applicable to a wide variety of systems and can be used to study the effects of distance, orientation, linker, environment, etc. on electron transfer rates. The results and methodology have implications for molecular electronics, where understanding and controlling the range of possible behaviors inherent to molecular systems will likely be as important as understanding the individual behavior of any given molecule.

Limited dose monoclonal IL-2R antibody induction protocol after primary kidney transplantation.

This study prospectively compared immunoprophylaxis with a single intraoperative dose (2 mg/kg) of monoclonal interleukin-2 receptor (IL-2R) antibody vs. noninduction in kidney transplant recipients treated with tacrolimus (FK 506), mycophenolate mofetil (MMF) and a prednisone-based immunosuppression regimen. One hundred recipients of first-kidney transplant were enrolled into the study to receive either anti-IL-2R monoclonal antibody, daclizumab (2 mg/kg intraoperatively, limited anti-IL-2R) or no induction (control). Each patient also received oral tacrolimus (dosed to target trough level 10-15 ng/mL), MMF (500 mg bid) and prednisone. The primary efficacy end-point was the incidence of biopsy proven acute rejection during the first 6 months post-transplant. The patients were also followed for 12-month graft function, and graft and patient survival rates. Other than the donor's age being significantly lower in the control group, both groups were comparable with respect to age, weight, gender, race, human leukocyte antigen (HLA)-DR mismatch, panel reactive antibody (%PRA), cold ischemic time, cytomegalovirus (CMV) status, causes of renal failure, and duration and modes of renal replacement therapy (RRT). During the first 6 months, episodes of first biopsy confirmed acute rejection was 3/50 (6%) in the limited anti-IL-2R group and 8/50 (16%) in the controls (p < 0.05). Twelve-month patient 100/98 (%) and graft survival 100/96 (%) were not statistically different. The group receiving limited anti-IL-2R did not have any adverse reactions. Our study demonstrates that a limited (single) 2 mg/kg immunoprophylaxis dose with monoclonal IL-2R antibody (daclizumab) when combined with tacrolimus/MMF/steroid allows significant reduction in early renal allograft rejection to the single digit level. The therapy with anti-IL-2R antibody is simple and is well tolerated.

A single-molecule probe based on intramolecular electron transfer.

Detecting structure, dynamics, and chemical reactions at the single-molecule level represents the ultimate degree of sensitivity for sensing and imaging. There is a tremendous need to develop new molecular systems and methodology for single-molecule-based sensing. This work presents for the first time the single-molecule spectroscopy of a new molecular probe which uses an intramolecular electron transfer mechanism to detect binding, local structure, and interfacial processes. Moreover, we show how information about the interaction of these probes with their environment is obtained from an analysis of the intensity, duration and time-varying behavior of the single-molecule fluorescence.

Studying and switching electron transfer: from the ensemble to the single molecule.

We report here on the systematic investigation of photoinduced intramolecular electron transfer (IET) in a series of donor-bridge-acceptor molecules as a means of understanding electron transport through the bridge. Perylenebisimide chromophores connected by various oligophenylene bridges are studied because their electron-transfer behavior can readily be monitored by following changes in the fluorescence intensity. We find dramatic switching of the IET behavior as the solvent polarity (dielectric constant) is increased. By combining steady-state and time-resolved fluorescence spectroscopy in a variety of solvents at multiple temperatures with standard theories of electron transfer, we determine parameters governing the IET behavior of these dimers, such as the electronic coupling through the bridges. We also deploy available ab initio quantum chemical methods to calculate the through-space component of the electronic coupling matrix element. Single-molecule investigations of the electron-transfer behavior also show that IET can be switched reversibly by a similar mechanism in an isolated individual molecule.