[Osteoarthritis of the wrist]. / Arthrosen des Handgelenks.

The term osteoarthritis (OA) of the wrist can be used as an umbrella term for various, often independent areas of OA, as the wrist is made up of several joints. Radiocarpal OA often occurs after untreated ligament injuries, incorrectly healed bone fractures in the carpus or after radius fractures involving the joint. A typical sequence of propagation is known for radiocarpal OA following scapholunate (SL) insufficiency or scaphoid pseudarthrosis. Other causes include inflammation, crystal deposits or bone necrosis. Ulnocarpal arthrosis occurs posttraumatically or primarily when there are differences in levels between the ulna and radius. When treating wrist arthrosis, after conservative measures have been exhausted a surgical procedure should be chosen that enables the best possible load-bearing and residual mobility, considering the surgical risks and individual requirements. During salvage operations, the defective cartilage areas are either fused directly or eliminated using appropriate diverting partial fusions and resection arthroplasty. An accurate analysis of the affected zones is crucial for selecting an appropriate intervention.

Atypical incarcerated abdominal wall hernia mimicking acute diverticulitis.

An 89-year-old female presented with typical symptoms of acute diverticulitis. Abdominal CT revealed an abdominal wall hernia with signs of acute incarceration in the lateral part of the transverse abdominis muscle and rupture of the transversalis fascia. The findings were confirmed intraoperatively. The present case underlines the diagnostic importance of abdominal CT, especially in patients with acute abdomen, allowing for selection of appropriate therapy options.

Protein binding capacity in vitro changes metabolism of substrates and influences the predictability of metabolic pathways in vivo.

UNLABELLED: Large numbers of lipophilic molecules are attached to fractions of serum protein, e.g. albumin, in vivo. Cell culture medium of most in vitro hepatocyte models for the prediction of metabolism does not contain albumin. Consequently, in vitro availability and metabolism of substrates could differ significantly from the in vivo situation. The influence of albumin on the in vitro metabolism was tested on a new lipophilic compound. METHODS: Primary human and rat hepatocytes were cultured in a collagen sandwich configuration and incubated with (14)C-labeled compound X127 that is known to exhibit a high propensity to bind to plastic surfaces. Groups contained either 1% (w/v) BSA or none. Substrates as well as metabolism products were determined with radio-HPLC and radioactivity levels in the medium were recorded. RESULTS: Quantitative differences were seen in the distribution of the compound in BSA and non BSA containing groups, thus indicating a substantial binding of the compound to polystyrol surfaces of cell culture dishes. Metabolic radio-HPLC profiles showed different patterns after 24 h of incubation between the two species as well as between the BSA- and non-BSA groups within the species. CONCLUSIONS: With addition of albumin the adherance of lipophilic substrates and metabolites to cell culture dish surfaces can be neutralized and in vitro systems can more closely mimic the in vivo situation.

A new bioassay including a small scale hepatocyte bioreactor for hepato-mediated toxicity testing in a target cell line.

New approaches for in vitro testing of hepato-mediated toxicity are undertaken to offer alternatives to in vivo animal testing. The described bioassay for hepato-mediated toxicity testing is based on a small scale hepatocyte-bioreactor with pig hepatocytes connected to a silicon sensor based microphysiometer system for monitoring of the extracellular acidification rate (EAR) of cells and the microphysiometer alone. EAR represents the metabolic activity of tested cells (hepatocytes and ZR 751 cells) under the influence of perfused media, compared to controls, which were set to 100%. Cyclophosphamide (CYCL), whose cytostatic effect is dependent on CYP 450 biotransformation was used as a model substrate. CYCL showed decrease of EAR in hepatocytes, but not in ZR 751 cells. Bioreactor supernatant including CYCL was pumped into the microphysiometer and EARs of the target ZR 751 cell line were recorded. After 7 h of bioreactor supernatant perfusion the ZR 751 cell line showed an EAR decrease of 18.68% +/- 10.18, as compared to controls (bioreactor supernatant from the identical set-up without CYCL). Thus the presented model of hepato-activated toxicity showed an EAR decrease in the ZR 751 cell line that reflected the toxic activation of CYCL by the bioreactor. This new bioassay serves as an example of future applications for hepatocyte bioreactors in automated toxicity testing devices, e.g. in preclinical drug studies or evaluation of hepato-mediated toxicity, not depending on cell destruction or further assays.

Towards in-vitro prediction of an in-vivo cytostatic response of human tumor cells with a fast chemosensitivity assay.

The objective of this study is to evaluate a novel approach to chemosensitivity testing with respect to its predictive value in the selection of clinically effective cytostatic drugs to optimize the therapeutic treatment of cancer. The chemosensitivity assay, which we used in this study, has its roots in pharmaceutical drug screening and the surrounding intellectual property is protected by various patent applications and trademarks. Therefore, we will refer to this test in the following pages as ChemoSelect. ChemoSelect is a sensor-chip based diagnostic test, which permits the functional and continuous real-time measurement of induced tumor cell cytotoxicity following the administration of chemotherapeutic drugs. Chemosensitivity is measured through the reduction of the excretion of lactic and carbonic acids--by-products of the metabolic processes of glycolysis and respiration and a parameter for cell vitality--generated specifically by ATP hydrolysis and lactic acid production. We used this test to study the applicability of this assay for tumor cells based on the analysis of tumor cell lines and tumor specimens. In this preliminary study, this test was studied in predicting chemoresistance and chemosensitivity in cell lines and tumor specimens for which the result was already predetermined by the properties of the cell line or the tumor specimen used in the experiment. The applicability in a clinical setting was studied by confirming the trends on selected drug sensitivity and drug resistance with an interim analysis of an ongoing clinical study in selected patients with breast cancer undergoing neoadjuvant chemotherapy. The minimum detection limit of cells and biologic cell responses, an important variable determining the applicability of the test in routine clinical use, was also assessed. ChemoSelect avoids many of the limitations of existing chemoresistance assays and provides more comprehensive information and output, as it has a 24-h turnaround time, is applicable to the majority of solid tumors and available cytostatic drugs, does not need more than 10(5) cells in total, cultivated tumor cells, provides dynamic monitoring of cellular responses through on-line data read-out during the perfusion with drugs and can be extended to the analysis of novel therapeutic modalities such as biologics.

Genomic organization of the human CYP3A locus: identification of a new, inducible CYP3A gene.

Proteins encoded by the human CYP3A genes metabolize every second drug currently in use. The activity of CYP3A gene products in the general population is highly variable and may affect the efficacy and safety of drugs metabolized by these enzymes. The mechanisms underlying this variability are poorly understood, but they include gene induction, protein inhibition and unknown genetic polymorphisms. To better understand the regulation of CYP3A expression and to provide a basis for a screen of genetic polymorphisms, we determined and analysed the sequence of the human CYP3A locus. The 231 kb locus sequence contains the three CYP3A genes described previously (CYP3A4, CYP3A5 and CYP3A7), three pseudogenes as well as a novel CYP3A gene termed CYP3A43. The gene encodes a putative protein with between 71.5% and 75.8% identity to the other CYP3A proteins. The highest expression level of CYP3A43 mRNA is observed in the prostate, an organ with extensive steroid metabolism. CYP3A43 is also expressed in several other tissues including liver, where it can be induced by rifampicin. CYP3A43 transcripts undergo extensive splicing. The identification of a new member of the CYP3A family and the characterization of the full CYP3A locus will aid efforts to identify the genetic variants underlying its variable expression. This, in turn, will lead to a better optimization of therapies involving the numerous substrates of CYP3A proteins.

In vitro toxicology in hepatocyte bioreactors-extracellular acidification rate (EAR) in a target cell line indicates hepato-activated transformation of substrates.

In this article we introduce an in vitro model for hepato-mediated toxicity testing consisting of a Hepatocyte-Bioreactor connected to a microphysiometer system for monitoring of the extracellular acidification rate (EAR) of cells. The EAR in this system represented the metabolic activity of a tested cell line under the influence of bioreactor supernatant. Cyclophosphamide (CYCL), a well-known hepato-activated cytostatic drug was used as a model substrate because of its widespread clinical use. The predrug CYCL needed CYP 450 dependent activation to its active cytotoxic metabolite 4-OH cyclophosphamide. Primary pig hepatocytes from slaughterhouse organs were cultured in a collagen sandwich configuration in specially designed flasks and after 3 days introduced into a 50 ml recirculating perfusion system including 30 microg/ml CYCL. In a parallel open circuit, this bioreactor was connected to three perfusion chambers of a microphysiometer system housing 1.5 x 10(5) ZR 751 cells (breast tumor cell line). Bioreactor supernatant including CYCL was pumped at 150 microl/min into the microphysiometer. The recorded EARs under CYCL influence were correlated to controls, which were set to be 100%. After 1 and 7 h of bioreactor supernatant perfusion, including activated CYCL, the ZR 751 cell line showed an EAR of 98.99%+/-3.15 (mean+/-SD) and 81. 32%+/-10.18 (P<0.05), respectively, as compared to controls (bioreactor supernatant from the identical set-up without CYCL). The inactivated predrug CYCL showed no effect on the EAR: Perfusion of medium with 30 microg/ml CYCL alone, excluding the bioreactor activation, resulted in an EAR of 100. 11%+/-4.74 (mean+/-SD) after 7 h. Thus the presented model of hepato-activated toxicity showed an EAR decrease in the ZR 751 cell line that reflected the toxic activation of the predrug by the bioreactor.

Cryopreserved porcine hepatocyte cultures.

Cryopreservation of freshly isolated hepatocytes is regarded the standard technique for long term storage of liver cells. Frankly, we were not successful in reproducing viability rates of about 70% of that which have been reported by most authors as results of various freezing protocols for hepatocyte suspensions. In fact, we saw mostly devastating results. We assume that intracellular ice crystal formation as well as osmotic changes during freezing and thawing of liver cells cause hazardous effects, especially on membranes of cells after enzymatic isolation, and, thus, generally result in a severe loss in number and impaired specific hepatocyte functions in subsequent culture. We tried to improve results by freezing cell cultures instead. We allowed hepatocytes to regain a more stable condition prior to storage and placed them in tissue flasks in a uniform configuration, rather than to pack cell suspensions in vials or bags under rather indefinable conditions. Porcine hepatocytes (viability 92+/-2%) were isolated from slaughterhouse organs and cultured in a double gel (sandwich) configuration. At day 3, cultures were rate controlled frozen (RCF) and stored in a cell bank for three hours (Group A) or 14 days at -80 degrees C (Group B), respectively. Non-frozen cells (NF) and cultures subjected to a linear freezing rate of -10 degrees C/min (LFR, Group C) with 3 h of storage served as controls from identical cell batches. Upon thawing, at day 2 of subsequent culture, fluorescence microscopy studies revealed a survival rate of 75+/-10% (mean+/-S.D.) in the RCF groups. Time of storage (3 h, 14 d) did not influence results. Survival in Group C was 10+/-5%. Cell integrity was measured by LDH-release, which indicated a larger damage of cells in the LFR group, and thereby resembled the morphological findings. Functional parameters, such as albumin synthesis and CYT P 450-activity were comparable to non-frozen liver cells at 48 h after thawing in the RCF groups (A + B), and showed significantly higher levels in these groups as compared to the LFR Group (C). We recommend to freeze hepatocytes in culture in a rate controlled fashion rather than cell suspensions. This way a cell bank of cryopreserved hepatocyte cultures for batch controlled investigations can be easily obtained. This could ameliorate the availability of rare (human) cell material and might also improve the quality of data generated from in vitro experiments in hepatology or pharmacology/toxicology with liver cells from identical sources. It remains to be seen whether this technique might also be of value in hybrid bioartificial liver devices to make these systems become readily available upon clinical demand.