Pharmacokinetics and pharmacodynamics of GS-9350: a novel pharmacokinetic enhancer without anti-HIV activity.

GS-9350 is a new chemical entity under development as a potent, mechanism-based inhibitor of human cytochrome P450 3A (CYP3A) isoforms. Its intended use is to increase the systemic exposure of coadministered agents that are metabolized by CYP3A enzymes. Unlike ritonavir, which is in current clinical use for this purpose, GS-9350 is devoid of anti-HIV activity. The pharmacokinetics of GS-9350 and its efficacy in increasing systemic exposure of the probe CYP3A substrate midazolam were examined in a study involving single- and multiple-dose escalations of GS-9350 from 50 to 400 mg. Single-dose escalation from 50 to 400 mg resulted in a 164-fold increase in GS-9350 exposure, whereas multiple-dose escalation in the dosage range of 50-300 mg resulted in a 47-fold increase in exposure. GS-9350 potently inhibited midazolam apparent clearance (95% reduction), similar in effect to ritonavir 100 mg. GS-9350 was generally well tolerated at all doses, and there was no evidence of dose-limiting toxicity. Establishing proof-of-concept, GS-9350 is currently under phase II development as a potential alternative to ritonavir for use with antiretroviral agents (including the HIV integrase inhibitor elvitegravir) that are often prescribed along with a "booster" drug.

Evidence for the neural crest origin of turtle plastron bones.

The migrating cranial neural crest cells of birds, fish, and mammals have been shown to form the membranous bones of the cranium and face. These findings have been extrapolated to suggest that all the dermal bones of the vertebrate exoskeleton are derived from the neural crest ectomesenchyme. However, only one group of extant animals, the Chelonians, has an extensive bony exoskeleton in the trunk. We have previously shown that the autapomorphic carapacial and plastron bones of the turtle shell arise from dermal intramembranous ossification. Here, we show that the bones of the plastron stain positively for HNK-1 and PDGFRalpha and are therefore most likely of neural crest origin. This extends the hypothesis of the neural crest origin of the exoskeleton to include the turtle plastron.

Porcine enteric spirochete infections in the UK: surveillance data and preliminary investigation of atypical isolates.

Investigations into the possible causes of colitis and typhlocolitis were carried out on 98 pig units in the United Kingdom between 1997 and 1999. Brachyspira pilosicoli was identified most commonly, occurring as the suggested primary agent in 18% of the outbreaks but forming part of mixed infections in another 24% of outbreaks. The equivalent figures for other bacterial pathogens were: B. hyodysenteriae, 13% and 16%; Lawsonia intracellularis, 10% and 15%: Salmonella species, 6% and 12%; and Yersinia species, 4% and 10%. Unclassified Brachyspira species of unknown pathogenicity were identified in 12% of outbreaks. The 24 unclassified isolates divided into three groups on the basis of their phenotypic characteristics. In addition, there were 50 atypical Brachyspira species isolates that showed differences between their phenotypic characteristics and genetic identity based on sequence analysis of a section of the 23S rDNA gene. Four representative atypical isolates were found to be pathogenic as a result of an experimental oral challenge study in pigs.

Development of an evolutionarily novel structure: fibroblast growth factor expression in the carapacial ridge of turtle embryos.

The turtle shell, an evolutionarily novel structure, contains a bony exoskeleton that includes a dorsal carapace and a ventral plastron. The development of the carapace is dependent on the carapacial ridge (CR), a bulge in the dorsal flank that contains an ectodermal structure analogous to the apical ectodermal ridge (AER) of the developing limb (Burke. 1989a. J Morphol 199:363-378; Burke. 1989b. Fortschr Zool 35:206-209). Although the CR is thought to mediate the initiation and outgrowth of the carapace, the mechanisms of shell development have not been studied on the molecular level. Here, we present data suggesting that carapace formation is initiated by co-opting genes that had other functions in the ancestral embryo, specifically those of limb outgrowth. However, there is divergence in the signaling repertoire from that involved in limb initiation and outgrowth. In situ hybridizations with antisense riboprobes derived from Trionyx spiniferous fibroblast growth factor-10 (tfgf10) and Trachemys scripta (T. scripta) fibroblast-growth factor 8 (tfgf8) cDNAs were performed on sections of early T. scripta embryos (< 30 days). Expression of tfgf10 was localized to the mesenchyme subjacent to the ectoderm of the CR. In the chick limb bud, FGF10 is known to be expressed in the early limb-forming mesenchyme and is capable of inducing FGF8 in the AER to initiate the outgrowth of the limb bud. Although the expression of tfgf8 was found in the AER of the developing turtle limb, it was not seen in the CR. Thus, the initiation of the carapace is in agreement with FGF10 expression in the CR, but FGF8 does not appear to have a role in mediating early carapace outgrowth.

Ubiquitin-dependent 26S proteasomal pathway: a role in the degradation of native human liver CYP3A4 expressed in Saccharomyces cerevisiae?

Cytochrome P450, CYP3A4, is the dominant human liver endoplasmic reticulum (ER) hemoprotein enzyme, responsible for the metabolism of over 60% of clinically relevant drugs. We have previously shown that mechanism-based suicide inactivation of CYP3A4 and its rat liver ER orthologs, CYPs 3A, via heme-modification of their protein moieties, results in their ubiquitin (Ub)-dependent 26S proteasomal degradation (Korsmeyer et al. (1999) Arch. Biochem. Biophys. 365, 31; Wang et al. (1999) Arch. Biochem. Biophys. 365, 45). This is not surprising given that the heme-modified CYP3A proteins are structurally damaged. To determine whether the turnover of the native enzyme similarly recruited this pathway, we heterologously expressed this protein in wild-type Saccharomyces cerevisiae and mutant strains (hrd1Delta, hrd2-1, and hrd3Delta) previously shown to be deficient in the Ub-dependent 26S proteasomal degradation of the polytopic ER protein 3-hydroxy-3-methylglutaryl-CoA reductase (isoform Hmg2p), the rate-limiting enzyme in sterol biosynthesis, as well as in strains deficient in ER-associated Ub-conjugating enzymes, Ubc6p and/or Ubc7p (Hampton et al. (1996) Mol. Biol. Cell 7, 2029; Hampton and Bhakta (1997) Proc. Natl. Acad. Sci. USA 94, 12,944). Our findings reveal that in common with the degradation of Hmg2p, that of native CYP3A4 also requires Hrd2p (a subunit of the 19S cap complex of the 26S proteasome) and Ubc7p, and to a much lesser extent Hrd3p, a component of the ER-associated Ub-ligase complex. In contrast to Hmg2p-degradation, that of native CYP3A4 does not appear to absolutely require Hrd1p, another component of the ER-associated Ub-ligase complex. Furthermore, studies in a S. cerevisiae pep4Delta strain proven to be deficient in the vacuolar degradation of carboxypeptidase Y indicated that CYP3A4 degradation is also largely independent of vacuolar (lysosomal) proteolytic function. The degradation of two other native ER proteins, Sec61p and Sec63p, normal components of the ER translocon, were also examined in parallel and found to be stabilized to some extent in HRD2- and UBC7-deficient strains. Together these findings attest to the remarkable mechanistic diversity in the normal degradation of ER proteins.

Inhibition of human CYP1A2 activity in vitro by methylxanthines: potent competitive inhibition by 8-phenyltheophylline.

1. Humans are exposed in vivo to methylxanthines by dietary ingestion, as well as from their use as therapeutic agents. The inhibitory effect of a series of these compounds on high-affinity phenacetin O-deethylase activity in the human liver microsomal fraction, a measure of CYP1A2 activity, has been evaluated. 2. Paracetamol, the product of phenacetin O-deethylase activity, was analysed by gas chromatography/negative-ion mass spectrometry using a novel bistrifluoromethylbenzoyl/ trimethylsilyl derivative, and incubation conditions for assessing high-affinity phenacetin O-deethylase activity were examined and optimized. 3. 1-Methylxanthine, caffeine, theophylline, 8-methylxanthine, pentoxyfylline and 3isobutyl-1-methylxanthine caused moderate inhibition with IC50 = 260, 140, 120, 100, 62 and 36 microM respectively. 4. 8-Phenyltheophylline was a potent competitive inhibitor of high-affinity phenacetin O-deethylase activity with an IC50 = 0.7 microM and Ki = 0.11 microM. 5. The specificity of inhibition by 8-phenyltheophylline was assessed by measuring its effect on debrisoquine 4-hydroxylase (CYP2D6), terfenadine hydroxylase (CYP3A4), chlorzoxazone 6-hydroxylase (CYP2E1) and tolbutamide 4-hydroxylase (CYP2C9) activities in human liver microsomal fraction. No inhibition of any of these activities was observed. 6. The potency and specificity of 8-phenyltheophylline as an inhibitor of human hepatic CYP1A2 indicate that the compound may be useful as a chemical inhibitor of this enzyme for further in vitro studies.

Structure--function relationships of rat hepatic tryptophan 2,3-dioxygenase: identification of the putative heme-ligating histidine residues.

The liver cytosolic enzyme tryptophan 2,3-dioxygenase (TDO) catalyzes the oxidation of L-tryptophan to formylkynurenine and controls the physiological flux of tryptophan into both the serotonergic and kynureninic pathways. This hemoprotein enzyme is composed of four noncovalently bound subunits of equivalent mass and contains two heme moieties per molecule. Electron paramagnetic resonance analyses have indicated that a histidyl nitrogen is involved in heme ligation [Henry et al., (1976) J. Biol. Chem. 251, 1578], but the identity of the His residue(s) is unknown. In an attempt to characterize the active site of the enzyme we have substituted each of the 12 His residues in the rat TDO subunit with Ala, to determine their relative importance in heme binding. Sequence alignment of the rat liver protein with that of known or putative TDO sequences from other organisms reveals that four of the His residues are conserved in eukaryotes, two of which are also conserved in prokaryotes. Our findings indicate that replacement of the evolutionarily conserved His 76 and 328 residues resulted in a dramatic reduction of TDO activity, whereas that of the eukaryotically conserved His70 resulted in a significant reduction relative to that of the wild-type enzyme. On the other hand, replacement of the other eukaryotically conserved His273 residue, while affecting the relative expression of the enzyme, had little effect on its specific activity. Size-exclusion analyses revealed that the His76Ala and His328Ala mutants retained little or no heme, suggesting that these may be key residues in ligating the prosthetic heme moieties. Whether these His residues are both provided by the same TDO subunit or a different TDO subunit remains to be determined.

An opportunity for HMOs to use marketing to increase enrollee satisfaction.

PURPOSE: To identify the combination of marketing components (i.e., service, price, access, and promotion) of commercial health maintenance organizations (HMOs) that are related to overall enrollee satisfaction. The researchers focus on factors that commercial HMOs control directly--specifically, health care organization and financing. DESIGN: Descriptive (mail order). METHODOLOGY: This study uses national data provided by a major health benefits consulting firm, which collected data from a 1997 calendar year mail survey of HMO administrators. The administrators responded to an extensive survey, which tapped selected HMO marketing-mix components and the percentage of surveyed members who indicated satisfaction with their HMOs. To test hypotheses, researchers treated marketing-mix components as independent variables and enrollee satisfaction as the dependent variable. PRINCIPAL FINDINGS: This study found statistically significant relationships between overall satisfaction and HMO providers' quality; access, particularly to specialists and out-of-network providers; waiting times for physician services; customer service; and disease prevention/health promotion programs. The researchers did not find significant relationships between overall satisfaction and accreditation by the National Committee for Quality Assurance (NCQA), the presence of physician gatekeepers, numbers of providers, or financial indicators. The relationship between overall satisfaction and utilization was mixed. This study's findings are largely consistent with the literature, consumer- and professional-group position papers, and the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. CONCLUSIONS: HMOs can use marketing as a way to address problems and pursue opportunities identified by enrollees. As these findings demonstrate, certain features of HMO design are more appealing to patients. By focusing on these preferences, HMOs can adopt a responsive market orientation that gives rise to more effective marketing mixes and hence improves enrollee satisfaction. With improved satisfaction, enrollees generate less need for government intervention through regulation or legislation.

Integration of nurse executives into executive level administration in Utah hospitals.

Nurse executives (NEs) in Utah acute care hospitals perceive that they are integrated into executive level administration. This perception is shared by NEs' career supporters and hinderers. To integrate NEs, influential colleagues used active methods, especially involvement. NEs add value to the administrative team by combining clinical and managerial expertise. NE integration is manifest in decision making, participation and interaction. Continued integration depends upon commitment from the chief executive officer (CEO), leadership in organizational change, addressing "glass ceiling" issues, and NEs' continuous demonstration of competence.

Room at the top?

Nurse executives have joined hospital administrative teams, but are they accepted as fully integrated team executives? Learn how nurse executives and their influential colleagues view integration and its influences.

Enrollee satisfaction with HMOs and its relationship with disenrollment.

Relying on 1997 data from a universe of 740 HMOs, this study uniquely documented, from the perspective of health plan administrators, rates of enrollee satisfaction and disenrollments. On the basis of various reporting totals per variable or indicator, the average level of satisfaction was 83.9%; the average number of disenrollments was 20,996 per plan. Among different datasets, an average of 18.9% members disenrolled per plan; an average of 10.2% were voluntary disenrollments; and an average of 18.3% were involuntary disenrollments. Plans with higher satisfaction enrollees had predominantly lower disenrollment rates, more enrollees likely to recommend plans to family or friends, fewer older enrollees, fewer male enrollees, and higher overall plan performance. To enhance the gaining and retaining of enrollees, plan administrators should closely monitor the various dimensions of satisfaction, such as services complement, quality of care, administrative efficiency, care management, enrollees' complaints, plan performance, appointment convenience, and waiting times.

Nurse executives' leadership roles. Perceptions of incumbents and influential colleagues.

The authors present a leadership profile of employed nurse executives (NEs). Interviews and survey data show that the typical NE is a married, middle-aged woman who has a masters degree in clinical nursing and extensive clinical experience. When comparing NEs' and influential colleagues' perceptions of the effectiveness of NEs leadership skills, the former rate themselves higher than the latter, and both groups perceive that NEs' leadership styles are more "task motivated" than "relationship motivated." The authors apply these findings to the career planning of NEs, chief executive officers, and educators in healthcare fields.

Investigations into field cases of porcine colitis with particular reference to infection with Serpulina pilosicoli.

Investigations into the possible causes of colitis and typhlocolitis were carried out on 85 pig units in the United Kingdom between 1992 and 1996. Serpulina pilosicoli was identified most commonly, occurring as the suggested primary agent on 21 (25 per cent) of the units but forming part of mixed infections on another 23 (27 per cent) of the units, the main co-infections being Yersinia pseudotuberculosis (eight units), proliferative enteropathy (six units), Salmonella species (four units) or Serpulina hyodysenteriae (two units). 'Atypical' Serpulina species, S hyodysenteriae, Salmonella typhimurium, Y pseudotuberculosis and Lawsonia intracellularis (proliferative enteropathy) were the suggested primary agents on seven, six, four, four and three units, respectively. Various combinations of mixed infections involving the latter organisms and other possibly incidental agents were recorded on another 10 units. Investigations on a further six units failed to detect any recognised pathogens. On units where S pilosicoli was the suggested primary agent, pigs ranging between 20 to 40 kg (eight to 16 weeks of age), but occasionally up to 50 kg, had diarrhoea and grew poorly over a period of two to three weeks. The prevalence was estimated to be between 5 and 15 per cent in affected batches, with a mortality of approximately 1 per cent. The clinical signs usually developed seven to 14 days after the moving and mixing of pigs. At postmortem examination, affected pigs had liquid contents in their colon, which contained accumulations of mucus in some chronic cases. Gross and histological lesions of colitis were prominent in the mid-spiral region of the colon. In mixed infections with Y pseudotuberculosis, Salmonella typhimurium or S hyodysenteriae, lesions were more extensive and affected the caecum as well as the colon. In the colon, lesions of proliferative enteropathy were usually confined to the proximal half of the ascending spiral but mixed infection with S pilosicoli caused more extensive colitis. Mixed infections were reported to prolong the time taken for pigs to recover naturally and to have a more detrimental effect on growth rates than S pilosicoli infection alone. Despite the successful treatment of batches of pigs with tiamulin or lincomycin, S pilosicoli infection persisted as a chronic problem on many units, with diarrhoea and colitis in successive batches of pigs unless prophylactic medication was used.

Hospital CEOs, CFOs, and nurse executives: opportunities for a new alliance.

This article examines the involvement of Utah acute care hospital nurse executives (NEs) in financial management roles. The authors surveyed NEs and their career supporters and hinderers. Findings suggest that NFs: 1. lack financial management skills, support, involvement, and satisfaction; 2. recognize financial management's importance and desire to improve performance; and 3. consider chief executive officers (CEOs) as their major supporters and chief financial officers (CFOs) their major hinderers in financial management. These "supporters" and "hinderers" of NEs showed consensus regarding the primacy of NEs' leadership and patient advocacy roles. These findings contrast with major professional association policy directives and expert opinions that advocate expanded financial management roles for NEs that will enable them to fully realize their executive potential. CEOs are positioned to establish norms that balance the traditional leadership-patient advocacy roles of NEs with newer financial management roles. CEOs can offer NEs and CFOs opportunities to improve NEs' financial management participation and performance. CEOs can provide empowerment and encourage CFOs to offer NEs "power tools" (for example, information, expertise, resources, and support). The three groups, however, must negotiate reasonable expectations for NEs in financial management and adequate preparation for these consequent responsibilities. Together, CEOs, CFOs, and NEs can successfully take hospitals into the future by leading them in ongoing learning and change.

Academic preparation for healthcare executive-track personnel.

This study focuses on career aspirations of executive-track health care administrative personnel and their perceptions of the competencies required to become hospital chief executive officers (CEOs). This article examines these topics using the results of a 1994 survey of 162 junior- and mid-level healthcare managers who work in hospitals in a western state. Respondents included 34 CEO aspirants and 128 CEO nonaspirants. The majority of both groups reported high satisfaction with several work-related activities. Significantly more CEO nonaspirants than CEO aspirants perceived a need for additional self-development in several work areas. CEO aspirants reported that CEOs five years from now would need improved strategy formulation and negotiation skills. CEO aspirants also perceived that in the future, successful CEOs will have to be more proficient in several areas, such as interpersonal skills and medical staff relations. Three lists of academic subject matter considered important to career preparation were generated from (1) the Association of University Programs in Health Administration (AUPHA) undergraduate standards, combined with curriculum graduate standards of the Accrediting Commission on Education for Health Services Administration (ACEHSA); (2) study participants' responses; and (3) professional literature. When compared for relatedness, the contents of the three lists were not significantly different statistically. The implications of these findings for health administration education are discussed.

Hospital administrators' career paths: which way to the top?

This article examines career paths of aspirants to hospital administrator positions. It focuses on successful career objectives, barriers, and paths. The 1994 survey data from 162 hospital-employed executive track personnel in a western state facilitate comparisons with nonaspirants. Only 34 (21 percent) self-reported a goal to become an administrator. Aspirants require institutional and mentor support, and need to follow more proactive and diverse career paths than they have done previously.

Pathogenicity of three strains of Serpulina pilosicoli in pigs with a naturally acquired intestinal flora.

Serpulina pilosicoli is an anaerobic spirochete which has been isolated from the colons of pigs with enteric disease. The clinical and pathologic features of experimental infections of conventional pigs (born by normal farrowing with a naturally acquired intestinal flora) with three strains of S. pilosicoli were determined in order to confirm the enteropathogenicity of this species. Strains were derived from the colons of British pigs with colitis and passaged 8 to 10 times during expansion and purification in vitro. Eighteen ten-week-old Large White-Landrace cross pigs were each inoculated once orally with 0.7 x 10(9) to 1.6 x 10(9) of one of three strains of S. pilosicoli. Six pigs were challenged with each strain. Control pigs were dosed with uninfected broth medium or with 1.8 x 10(7) cells of the nonpathogenic Serpulina innocens. Eight pigs (two to four per S. pilosicoli challenge group) developed soft or diarrheic feces (fecal dry matter < 24%) between 3 and 8 days after challenge, which persisted for 7 to 8 days or until necropsy at 14 days after challenge. Average weight gains in two of the three groups challenged with S. pilosicoli were significantly less than controls. The feed conversion ratios of all the groups challenged with S. pilosicoli were impaired compared to controls. The mean values for daily liveweight gain (and feed conversion ratio) for the three groups challenged with S. pilosicoli were 0.799 (2.13), 0.783 (2.05), and 0.844 kg (2.10), respectively, while that of the uninoculated controls was 0.944 kg (1.70). Gross lesions with slight mucosal thickening, congestion, and multifocal erosions were evident in seven of eight diarrheic pigs. The relative weights of the large intestines of pigs challenged with S. pilosicoli were significantly less than controls. Histologic lesions with an increase in mucosal height, infiltration of the lamina propria with mononuclear cells, mucosal erosion with mixed inflammatory cell infiltration, and goblet cell hyperplasia in colonic glands were evident in 15 of the 18 challenged pigs. S. pilosicoli was recovered on bacterial culture of the colon from all except one of the pigs with these histologic lesions. Serpulina sp. was clearly visible within the colonic glands of these affected pigs in silver-stained sections of the gut. Clinical and pathologic findings in control pigs were unremarkable, with no diarrhea or colonic lesions evident. The results provide further evidence that S. pilosicoli is a specific enteric pathogen for conventional pigs. It is capable of colonizing the large intestine and causing mucosal damage, which although mild is sufficient to result in significant adverse effects on growth.

Job satisfaction of selected categories of Utah hospital managers.

In a survey of managers in Utah hospitals, 85 percent responded overall satisfaction with their jobs. Surprisingly, women in the survey reported significantly greater satisfaction with their jobs than other respondents.

Heterocyclic amines: evaluation of their role in diet associated human cancer.

1. Heterocyclic amines are formed in parts per billion levels when meat is cooked. 2. The heterocyclic amines MeIQx and PhIP are efficiently absorbed into the systemic circulation after ingestion of cooked food. 3. We have shown that MeIQx and PhIP, both in vitro and in vivo, are substrates for human hepatic CYP1A2, which exclusively and efficiently catalyses their conversion to genotoxic hydroxylamines. 4. MeIQx and PhIP are promutagens. MeIQx is a very powerful bacterial mutagen whereas PhIP is a more potent mammalian cell mutagen. Using a mammalian cell target gene, hprt, we have shown that PhIP induces a characteristic mutational 'fingerprint'. 5. MeIQx and PhIP are carcinogenic in bioassays. The PhIP mutational 'fingerprint' has been detected in the Apc gene of 5/8 colonic tumours induced by PhIP in rats.