Prediction of the disposition of midazolam in surgical patients by a physiologically based pharmacokinetic model.

The aim of this study was to predict the disposition of midazolam in individual surgical patients by physiologically based pharmacokinetic (PBPK) modeling and explore the causes of interindividual variability. Tissue-plasma partition coefficients (k(p)) were scaled from rat to human values by a physiologically realistic four-compartment model for each tissue, incorporating the measured unbound fraction (f(u)) of midazolam in the plasma of each patient. Body composition (lean body mass versus adipose tissue) was then estimated in each patient, and the volume of distribution at steady state (V(dss)) of midazolam was calculated. Total clearance (CL) was calculated from unbound intrinsic CL, f(u), and estimated hepatic blood flow. Curves of midazolam plasma concentration versus time were finally predicted by means of a perfusion-limited PBPK model and compared with measured data. In a first study on 14 young patients undergoing surgery with modest blood loss, V(dss) was predicted with an only 3.4% mean error (range -24-+39%) and a correlation between predicted and measured values of 0.818 (p < 0.001). Scaling of k(p) values by the four-compartment model gave better predictions of V(dss) than scaling using unbound k(p). In the PBPK modeling, the mean +/- standard deviation (SD) prediction error for all data was 9.7 +/- 33%. In a second study with 10 elderly patients undergoing orthopedic surgery, hemodilution and blood loss led to a higher f(u) of midazolam. The PBPK modeling correctly predicted a marked increase in V(dss), a smaller increase in CL, and a prolonged terminal half-life of midazolam, as compared with findings in the first study. Interindividual variation in the disposition of midazolam could thus in part be related to the physiological characteristics of the patients and the f(u) of the drug in their plasma.

Phosphorylation of microtubule-associated proteins MAP2a,b and MAP2c at Ser136 by proline-directed kinases in vivo and in vitro.

The microtubule-associated protein 2 (MAP2) and its juvenile splicing variant MAP2c contain a phosphorylation site at Ser136 which is part of a Ser-Pro motif. This site lies within the N-terminal region common to MAP2b and MAP2c. It has been mapped by site-directed mutagenesis of recombinant MAP2c and by a monoclonal antibody AP18 whose epitope contains the phosphorylated Ser136. In vitro this site is phosphorylated by proline-directed kinases such as MAP kinase, GSK-3, or members of the cdk family, but not by other kinases such as PKA, PKC, or CaMK-II. MAP2a,b or MAP2c isolated from brain is found to be endogenously phosphorylated at Ser136. After microinjection into several cell lines dephosphorylated MAP2 isoforms or recombinant MAP2c become also phosphorylated at Ser136 in vivo. Injection of MAP2a,b or MAP2c into living cells causes reorganization of microtubules, including bundle formation. This effect is independent of the phosphorylation at Ser136. The specificity of the phosphorylation reaction provides a tool for analyzing the role and posttranslational processing of MAP2 in nerve cell development.

Cloning and sequencing of a cDNA encoding rat brain mitogen-activated protein (MAP) kinase activator.

The complete cDNA sequence for mitogen-activated protein kinase activator from rat brain was cloned. It encodes a protein kinase of 393 amino acids with a calculated M(r) of 43,465.

The switch of tau protein to an Alzheimer-like state includes the phosphorylation of two serine-proline motifs upstream of the microtubule binding region.

The paired helical filaments (PHFs) of Alzheimer's disease consist mainly of the microtubule-associated protein tau. PHF tau differs from normal human brain tau in that it has a higher Mr and a special state of phosphorylation. However, the protein kinase(s) involved, the phosphorylation sites on tau and the resulting conformational changes are only poorly understood. Here we show that a new monoclonal antibody, AT8, records the PHF-like state of tau in vitro, and we describe a kinase activity that turns normal tau into a PHF-like state. The epitope of AT8 is around residue 200, outside the region of internal repeats and requires the phosphorylation of serines 199 and/or 202. Both of these are followed by a proline, suggesting that the kinase activity belongs to the family of proline-directed kinases. The epitope of AT8 is nearly coincident with that of another phosphorylation-dependent antibody, TAU1 [Binder, L.I., Frankfurter, A. and Rebhun, L. (1985) J. Cell Biol., 101, 1371-1378], but the two are complementary since TAU1 requires a dephosphorylated epitope.

Distribution and elimination of intravenously injected urinary trypsin inhibitor.

Elimination of human urinary trypsin inhibitor (UTI) after intravenous injection of 125I-labelled UTI was followed by serial plasma and urine samples in three male volunteers. The plasma half-life of 125IUTI during 0-3 h after injection was 33 min and during the following 4 hours the half-life was 2 hours. Free, biologically active inhibitor was found in the urine during the first four hours after injection. Most of the radioactivity in the urine, however, corresponded to free 125I probably released during the degradation of UTI in the kidney. The distribution of UTI was studied after injection of 125IUTI in rats by measurement of radioactivity in excised organs. Fifteen min after the injection 44% of the radioactivity was found in the kidneys and 9% in the liver, implying that the kidneys are the primary site of UTI metabolism.

Nursing in genetics: current and emerging issues for practice and education.

This article focuses on genetics as a dynamic, rapidly expanding health care arena, offering nurses from all specialty areas new career opportunities. Community issues are examined, and the need for nursing research in genetics is identified. A synopsis of a recent national meeting that explored practice changes and the resulting implications for advanced education for nurses in genetics is discussed. Certification remains a controversial issue. Consensus is reached concerning the need to include genetic knowledge at the baccalaureate level. A panel discussion by students and recent graduates describes existing programs in nursing that offer a genetic specialty.

Cloning of a carcinoembryonic antigen gene family member expressed in leukocytes of chronic myeloid leukemia patients and bone marrow.

The carcinoembryonic antigen (CEA) gene family belongs to the immunoglobulin superfamily and can be subdivided into the CEA and pregnancy-specific glycoprotein subgroups. The basic structure of the encoded proteins consists of, in addition to a leader, one IgV-like and 2, 3, or 6 IgC-like domains. These domains are followed by varying COOH-terminal regions responsible for secretion, transmembrane anchoring, or insertion into the membrane by a glycosyl phosphatidylinositol tail. Here we report on the characterization of CGM6, a new member of the CEA gene subgroup, by complementary DNA cloning. The deduced coding region comprises 349 amino acids and consists of a leader, one IgV-like, two IgC-like domains, and a hydrophobic region, which is replaced by a glycosyl phosphatidylinositol moiety in the mature protein. CGM6 transcripts were only found thus far in leukocytes of chronic myeloid leukemia patients, in normal bone marrow, and in marginal amounts in normal granulocytes. The CGM6 gene product might, therefore, represent a myeloid marker. Analyses of CGM6 protein-expressing HeLa transfectants with monoclonal antibodies strongly indicate that the CGM6 gene codes for the CEA family member NCA-95.

Radioimmunological quantitation of the urinary trypsin inhibitor in normal blood and urine.

A radioimmunoassay for measurement of the urinary trypsin inhibitor in human serum and urine is described. Because of the immunological cross-reactivity between the inter-alpha-trypsin inhibitor and the urinary trypsin inhibitor the plasma and serum were treated with perchloric acid to precipitate the inter-alpha-trypsin inhibitor. Gel filtration of serum before and after acid treatment showed identical peaks corresponding to the urinary trypsin inhibitor. The normal level of the urinary trypsin inhibitor in fresh plasma from 30 blood donors was 6.38 +/- 0.33 mg/l (SEM), and in sera from 24 healthy volunteers 7.14 +/- 0.27 mg/l (SEM). In urine from 23 healthy volunteers the normal excretion was 8.17 +/- 1.18 mg/24 h (SEM).

Analysis of the size of the carcinoembryonic antigen (CEA) gene family: isolation and sequencing of N-terminal domain exons.

Five members of the human CEA gene family [human pregnancy-specific beta 1-glycoprotein (PS beta G); hsCGM1, 2, 3 and 4] have been isolated and identified through sequencing the exons containing their N-terminal domains. Sequence comparisons with published data for CEA and related molecules reveal the existence of highly-conserved gene subgroups within the CEA family. Together with published data eleven CEA family members have so far been determined. Apart from the highly conserved coding sequences, these genes also show strong sequence conservation in their introns, indicating a duplication of whole gene units during the evolution of the CEA gene family.

Increasing community independence for adolescents with spina bifida.

This project sought to determine if a community-based habilitation program focusing on normalization and individual goal setting was effective in enhancing levels of independence in teenagers with spina bifida (myelomeningocele). The results of our formal and informal evaluation suggest that the program was effective. Using the goal-attainment scale for formal evaluation, the program averaged a score of 50.8, which reflects slightly better than expected outcomes. The greatest strength in the program was support and socialization among the teenagers. In addition, recommendations for practitioners in programming for teenagers are provided.