Genetics informatics trial (GIFT) of warfarin to prevent deep vein thrombosis (DVT): rationale and study design.

The risk of venous thromboembolism (VTE) is higher after the total hip or knee replacement surgery than after almost any other surgical procedure; warfarin sodium is commonly prescribed to reduce this peri-operative risk. Warfarin has a narrow therapeutic window with high inter-individual dose variability and can cause hemorrhage. The genetics-informatics trial (GIFT) of warfarin to prevent deep vein thrombosis (DVT) is a 2 × 2 factorial-design, randomized controlled trial designed to compare the safety and effectiveness of warfarin-dosing strategies. GIFT will answer two questions: (1) does pharmacogenetic (PGx) dosing reduce the rate of adverse events in orthopedic patients; and (2) is a lower target international normalized ratio (INR) non-inferior to a higher target INR in orthopedic participants? The composite primary endpoint of the trial is symptomatic and asymptomatic VTE (identified on screening ultrasonography), major hemorrhage, INR ≥ 4, and death.

A comparison of approaches for estimating relative impacts of nonnative fishes.

Lack of standard methods for quantifying impact has hindered risk assessments of high-impact invaders. To understand methodological strengths and weaknesses, we compared five approaches (in parentheses) for quantifying impact of nonnative fishes: reviewing documented impacts in a large-scale database (review); surveying fish biologists regarding three categories of impact (socioeconomic, ecological, abundance); and estimating frequency of occurrence from existing collection records (collection). In addition, we compared game and nongame biologists' ratings of game and nongame species. Although mean species ratings were generally correlated among approaches, we documented important discrepancies. The review approach required little effort but often inaccurately estimated impact in our study region (Mid-Atlantic United States). Game fishes received lower ratings from the socioeconomic approach, which yielded the greatest consistency among respondents. The ecological approach exhibited lower respondent bias but was sensitive to pre-existing perceptions of high-impact invaders. The abundance approach provided the least-biased assessment of region-specific impact but did not account for differences in per-capita effects among species. The collection approach required the most effort and did not provide reliable estimates of impact. Multiple approaches to assessing a species' impact are instructive, but impact ratings must be interpreted in the context of methodological strengths and weaknesses and key management issues. A combination of our ecological and abundance approaches may be most appropriate for assessing ecological impact, whereas our socioeconomic approach is more useful for understanding social dimensions. These approaches are readily transferrable to other regions and taxa; if refined, they can help standardize the assessment of impacts of nonnative species.

Integration of genetic, clinical, and INR data to refine warfarin dosing.

Well-characterized genes that affect warfarin metabolism (cytochrome P450 (CYP) 2C9) and sensitivity (vitamin K epoxide reductase complex 1 (VKORC1)) explain one-third of the variability in therapeutic dose before the international normalized ratio (INR) is measured. To determine genotypic relevance after INR becomes available, we derived clinical and pharmacogenetic refinement algorithms on the basis of INR values (on day 4 or 5 of therapy), clinical factors, and genotype. After adjusting for INR, CYP2C9 and VKORC1 genotypes remained significant predictors (P < 0.001) of warfarin dose. The clinical algorithm had an R(2) of 48% (median absolute error (MAE): 7.0 mg/week) and the pharmacogenetic algorithm had an R(2) of 63% (MAE: 5.5 mg/week) in the derivation set (N = 969). In independent validation sets, the R(2) was 26-43% with the clinical algorithm and 42-58% when genotype was added (P = 0.002). After several days of therapy, a pharmacogenetic algorithm estimates the therapeutic warfarin dose more accurately than one using clinical factors and INR response alone.

The relationship between body mass index and per cent body fat in the severely obese.

BACKGROUND: International standards define clinical obesity according to body mass index (BMI) without reference to age and gender. Recent studies among adults in the normal to mildly obese BMI ranges have shown that the relationship between BMI and per cent body fat (% fat) differs by age and gender. The extent to which age and gender affect the relationship between BMI and % fat among more severely obese individuals is less known. AIM: The aim was to examine the age-gender association between measured BMI and % fat from a large cohort of adults, including a large number of severely obese subjects (1862 with a BMI > or = 35 kg/m(2)). METHODS: BMI was computed from measured height and weight, and % fat was estimated from bioelectrical impedance in 3068 adults. Two impedance equations, the Sun equation and the Heath equation (specific to severe obesity), were used to calculate % fat. RESULTS: Average age for 991 men and 2077 women was 46 +/- 15 vs. 44 +/- 14 years respectively (p = 0.0003). The average BMI was 36 +/- 9 kg/m(2) for men and 39 +/- 10 kg/m(2) for women (p < 0.0001), with a combined gender BMI range of 19-74 kg/m(2). Using the Sun equation, average % fat was 31 +/- 8 vs. 46 +/- 8% (p < 0.0001) for all men and women respectively. With the Sun equation, age-adjusted Spearman correlations between all BMI and % fat values were r = 0.80 and r = 0.83 for men and women, respectively, but only 0.60 (n = 479) and 0.61 (n = 1383) in severely obese participants (BMI > or = 35 kg/m(2)). Using the Heath equation, only for participants with BMI > or = 35 kg/m(2), the age-adjusted Spearman correlations improved to r = 0.82 (n = 479) and r = 0.70 (n = 1383) for men and women respectively. Finally, by combining the Sun equation for subjects with BMI < 35 kg/m(2) and the Heath equation for those with BMI > or = 35 kg/m(2), correlations improved to 0.89 for men and 0.87 for women. Using these combined equations, the relationship between BMI and % fat was best fit as a linear function for men and curvilinear function (both p < 0.001) for women across the range of BMI. The % fat was approximately 10% higher for any BMI value among women vs. men even among the severely obese (p < 0.0001). CONCLUSIONS: These data that include a large cohort of severely obese individuals demonstrated a linear association between BMI and % fat for men and a curvilinear association between BMI and % fat for women when Sun and Heath equations were combined. Assuming disease risk is driven by adiposity, this study suggests a need to further explore the appropriateness of gender-specific BMI cutpoints for clinical risk assessment due to the marked difference in the BMI-per cent fat relation observed in men and women across the entire range of BMI.

Gender specialization in heterodichogamous Grayia brandegei (Chenopodiaceae): evidence for an alternative pathway to dioecy.

We examined components of male and female reproductive success in protogynous and protandrous sexual morphs of the heterodichogamous and largely monoecious chenopod shrub Grayia brandegei. Percentage femaleness of flowering stalks ranged from 0 to 37.6% female ( = 15.5%) for protandrous plants and from 14 to 100% female ( = 55.8%) for protogynous plants. Functional gender estimates based on ovule production at two locations ranged from 23.0 to 31.8% female for the protandrous morph, and from 65.3 to 77.0% female for the protogynous morph. Realized gender estimates based on total seed production ranged in value from 3.6 to 16.8% female for the protandrous morph and from 76.5 to 96.4% for the protogynous morph, depending on location and year. Differences in reproductive success of the two morphs were largely due to a reduction in the female function of protandrous plants. Protogynous plants produced more female flowers per stalk and had a higher percentage of seed-filled fruits than did protandrous plants. Differences between sexual morphs were more pronounced in dry areas or years in which overall seed production was minimal. Differential seed production between morphs likely reflects temporal patchiness in environmental conditions, particularly in water availability. The significance of these findings in support of heterodichogamy as an evolutionary pathway to dioecy is discussed.

Reproduction and development in Drosophila are dependent upon catecholamines.

Drosophila melanogaster, maintained on culture media containing alpha-methyl-p-tyrosine (alpha-MT) at millimolar levels for 7 days, fail to produce viable progeny. Lesser concentrations delay development. This effect of alpha-MT, an inhibitor of tyrosine hydroxylase (TH), is partially reversible by co-administration of L-dihydroxyphenylalanine, the product of TH. Potent inhibitors of other steps in the pathway for catecholamine biosynthesis are inactive except for a partial effect with dopamine B-hydroxylase inhibition. the effect of alpha-MT is due to a combination of ovulation suppression coupled with decreases in embryonic and larval viability. Effects similar to those of alpha-MT are found with millimolar levels of reserpine, prazosin and to a lesser extent, rauwolscine. No significant effects are found with propranolol, chlorpromazine, sulpiride and SK&F 83566. Mutant alleles of the gene coding for TH are known to be lethal at the embryonic stage when homozygous in both Drosophila and mice. Taken together, these results indicate that in addition to their established roles in the nervous system catecholamines function in animal development via an action mediated through alpha-adrenoceptors.

Inversion of (R)- to (S)-ketoprofen in eight animal species.

The (R)-enantiomer of the NSAID ketoprofen was administered orally at 20 mg/kg to a series of 8 animal species. In all species, a highly significant degree of inversion occurred after 1 h which varied from 27% (gerbil) to 73% (dog) and persisted or increased in plasma samples obtained 3 h after drug administration. Although the (R)-enantiomer was inactive as an inhibitor of cyclooxygenase, the analgesic effects of that isomer was almost the same as the (S)-isomer in animal analgesic assays, following oral administration of the drugs to mice and rats. Taken together, the present results suggest that (R)-ketoprofen administered alone functioned primarily as a prodrug for (S)-ketoprofen under the experimental conditions of this study.

Interaction between peroxidase and cyclooxygenase activities in prostaglandin-endoperoxide synthase. Interpretation of reaction kinetics.

Prostaglandin-endoperoxide synthases have two distinct enzymatic activities in the biosynthesis of prostanoids: a peroxidase and a fatty acid oxygenase. Hydroperoxides, such as the cyclooxygenase reaction product, prostaglandin G2, act both as substrates for the synthase peroxidase and as obligatory initiators of the cyclooxygenase reaction itself. A mechanistic scheme was devised to describe the interactions between the two activities of the synthase. This mechanism was based on a heme-dependent peroxidase mechanism such as that observed with horseradish peroxidase and initiation of the cyclooxygenase reaction by intramolecular reaction with a peroxidase intermediate. Rate equations derived from the mechanism were numerically integrated by an interactive computer program that consolidated the diverse phenomena to provide quantitative predictions of the reaction kinetics of the synthase. The predictions agreed well with experimental observations of the purified ovine seminal vesicle enzyme under a wide variety of conditions, including inhibition by exogenous hydroperoxide scavenger and by cyanide, stimulation by exogenous hydroperoxide, and inhibition of eicosapentaenoic acid oxygenation under conditions where arachidonic acid reacts rapidly. The detailed analyses of reaction kinetics made possible with the computer simulation provide important insights into the interactions between the two catalytic activities of the synthase in the control of prostaglandin biosynthesis.

A frame-relay approach for a state-wide health information network.

An approach for a frame-relay implementation is described which is intended to establish connectivity between the health care providers in the state of Connecticut with a gateway to the internet. While other health care networking efforts have based the interconnectivity efforts on direct connections to the internet for each institution, our design takes a more cost effective approach by establishing a private health care network with a single entry point to the internet. This will not only provide the advantages of internet connections to all participating providers, but it will also isolate intrastate patient care traffic from the internet, reserving internet traffic for those information needs not available within the statewide network. In addition to the network solution, an extensive user support infrastructure is also presented.

Molecular characterization of maize extensin expression.

This study concerned the developmental regulation of wall-localized, hydroxyproline-containing proteins in maize tissues and organs. Silk and pericarp cell walls contained more peptidyl hydroxyproline than did walls of any vegetative tissue, although all tissues and organs accumulated these proteins as they matured. In many tissues, hydroxyproline-rich proteins are first associated with the wall in a soluble form before being insolubilized through covalent attachment to the matrix. Because hydroxyproline was more soluble earlier than later in development, it appears that insolubilization was occurring in maize tissues and organs as well. Tissue prints reacted with an anti-extensin antibody gave positive results, indicating the presence of a soluble form of this common hydroxyproline-rich glycoprotein (HRGP). Silk and pericarp cells actively synthesized this extensin from abundant transcripts. In vegetative tissues, extensin transcripts were somewhat more abundant in seedlings than in pre-anthesis or mature plants, but levels were much lower than in silk and pericarp. Southern blots of maize genomic DNA indicated that these extensin transcripts are encoded by a small multigene family. Potential roles for extensin in reproductive/protective tissues versus the embryo or vegetative tissues are suggested.

Iodometric measurement of lipid hydroperoxides in human plasma.

Many assay techniques have been used to measure lipid hydroperoxides in plasma, including absorbance of conjugated dienes and reactivity with thiobarbituric acid. Because these measurements are not specific for lipid hydroperoxides, we modified an exisiting iodometric method to correct for interfering phenomena and to provide a more specific measurement of the lipid hydroperoxide content of plasma. To ensure reproducible extraction of hydroperoxides from the many possible forms in plasma, the plasma was treated to hydrolyze enzymatically cholesterol ester, triglycerides, and phospholipids, and the nonesterified fatty acid peroxides were then extracted with ethyl acetate. Extracted lipids were reacted with potassium iodide in acetic acid and methylene chloride, and the resulting triiodide ion (I3-) was measured spectrophotometrically. Correction for nonoxidizing chromophores was made after back-titration of the triiodide ion to iodide with sodium thiosulfate and other non-peroxide oxidants were estimated by their resistance to reduction with glutathione peroxidase. Recovery of added hydroperoxide standards provided routine validations of the procedure's efficiency. The method indicated that insignificant amounts of hydroperoxide may be in the less polar lipids, but the total amount of lipid hydroperoxide esterfied in the plasma lipids of apparently healthy humans may be as much as 4.0 +/- 1.7 microM.

Comparative effects of angiotensin II and angiotensin III in rabbit adrenal and aortic tissues.

The addition of angiotensin II (AII) and angiotensin III (AIII) to isolated tissue baths produced the same maximal contractile response of rabbit aortic strips. AIII was about 10 times less potent, the slope of its concentration-response curve was less steep and its rate of onset slower than that of AII. The responses of both AII and AIII were inhibited with equal potency by the surmountable AII antagonist Phe4, Tyr8-AII and its unsurmountable analog Sar1, Leu8-AII but the kinetic patterns of inhibition by both were less well defined with the agonist AIII than with AII. The addition of AIII to tissues which had exhibited a maximal response to AII did not increase the level of contraction, in contrast to the case when norepinephrine was added to tissues contracted by AII. Both AII and AIII displaced [125I]AII binding from rabbit adrenal membranes; AIII was 6 times less potent than AII but displayed competitive kinetics as an inhibitor of [125I]AII binding. In further studies two binding sites for [125I]AII were identified in adrenal membranes, having KD values of 2.0 +/- 0.2 and 19.6 +/- 2.3 nM, respectively. Each site was inhibited by both AII and AIII and the ratio of the apparent Ki values for the two hormones was not significantly different. The Hill coefficient for the high affinity site was, however, lower for AIII than AII. We interpret our data to suggest that AII and AIII act on the same receptors. AIII apparently binds less efficiently than does AII in both rabbit adrenal membranes and rabbit aortic strips.

RG 12915: a potent 5-hydroxytryptamine-3 antagonist that is an orally effective inhibitor of cytotoxic drug-induced emesis in the ferret and dog.

RG 12915 [4-[N-(1-azabicyclo[2.2.2.]octan-3-(S)-yl)]2-chloro-cis 5a-(S)-9a-(S)-5a,6,7,8,9,9a-hexahydrobenzofurancarboxamide hydrochloride] is a potent and effective agent against cisplatin-induced emesis in the ferret after i.v. or p.o. administration. This agent (p.o.) is also highly protective against cisplatin-induced emesis in the dog, as well as cyclophosphamide/doxorubicin-induced emesis in the ferret. When administered either p.o. or i.v., RG 12915 has a lower ED50 value (0.004 mg/kg) than GR 38032F, BRL 43694 and metoclopramide for attenuating cisplatin-induced emetic episodes in the ferret. It also has a long duration of action against cisplatin-induced emesis in the ferret. In contrast to metoclopramide, RG 12915 lacks significant antidopaminergic activity both in vitro [( 3H]spiroperidol displacement), as well as in vivo (apomorphine-induced emesis). In radioligand binding assays, RG 12915 is a potent and selective displacer of binding of 5-hydroxytryptamine (5-HT)3 binding sites (IC50 value = 0.16 nM), whereas failing to displace binding of ligands for the alpha-1, alpha-2 and beta adrenergic, 5-HT1 or 5-HT2 or cholinergic-muscarinic sites with IC50 values less than 1 microM. At a p.o. dose (1 mg/kg) in which RG 12915 is highly protective against cisplatin-induced emesis in the dog, RG 12915 has no significant gastroprokinetic activity in the same species. In summary, RG 12915 is a potent and p.o. effective agent against cytotoxic drug-induced emesis in animal models. The antiemetic potency of RG 12915 against cisplatin is unrelated to antidopaminergic or gastroprokinetic activity, but may be related to its affinity for 5-HT3 binding sites.

Antiinflammatory effects of various drugs on acetic acid induced colitis in the rat.

The efficacy of various drugs used to treat ulcerative colitis, (sulfasalazine, 5-aminosalicylate, hydrocortisone) was investigated in a model of acetic acid-induced colitis in the rat. Subsequently, we tested the ability of antioxidant/5-lipoxygenase inhibitors (gossypol and nordihydroguiaretic acid [NDGA]) and a cyclooxygenase inhibitor (indomethacin) to attenuate the macroscopic colonic damage and/or neutrophil influx (myeloperoxidase activity [MPO]) associated with this model of colitis. Oral pretreatment with either sulfasalazine, gossypol, or NDGA significantly decreased colonic MPO activity induced by acetic acid. Intrarectal administration of such drugs resulted in an even larger reduction of the colonic inflammation, with gossypol being the most potent compound. Oral or intrarectal administration of corticosteroids (dexamethasone, hydrocortisone) also attenuated the parameters of acetic acid induced colitis. In contrast, pretreatment with indomethacin was ineffective, or when administered daily after colitis induction, indomethacin actually increased colonic neutrophil influx significantly. Our data suggest that both the route of drug administration and dosing regimen employed affect the antiinflammatory potency and/or efficacy of compounds on colitis induced by acetic acid in the rat. Drugs which were effective against this colitis may act by scavenging of oxygen derived free radicals.

2,3-Diphosphoglycerate phosphatase/synthase: a potential target for elevating the diphosphoglycerate level in human red blood cells.

To exploit the well documented effect of 2,3-diphosphoglyceric acid (2,3-DPG) in enhancing oxygen delivery by human erythrocytes, we have investigated whether the DPG synthase/phosphatase enzyme system can be targeted to increase DPG levels in the cell. The hydrolytic activity (phosphatase) of the DPG metabolizing enzyme complex exhibits a marked dependence on a physiological effector, 2-phosphoglycolate. Little phosphatase activity is detected in the absence of this activator irrespective of the concentrations of the substrate. The phosphoglycolate-dependent phosphatase activity is competitively inhibited by a glycolytic intermediate, 3-phosphoglyceric acid (3-PGA). The 3-PGA inhibition persists when the 2,3-DPG concentration is raised to saturation level. In contrast, 3-PGA enhances the DPG synthase activity in a dose-dependent manner. In intact red cells, one-half of the cellular DPG content is depleted after 6 hr at 37 degrees C in glucose-free medium. The rate of 2,3-DPG degradation is accelerated when the cellular level of phosphoglycolate is increased by incubation with exogenous glycolate. Together, these results indicate that 2,3-DPG content in erythrocytes can be directly regulated through modulation of phosphatase/synthase activities. In support of this notion, a pyruvate kinase inhibitor, L-alanine, increases by 2-fold the cellular 3-PGA level. This is accompanied by a significant increase (30%) in 2,3-DPG content in human red blood cells. It is postulated that the DPG-promoting action of 3-PGA is mediated through simultaneous phosphatase inhibition and synthase activation. Furthermore, as a result of increased DPG accumulation, the oxygen-hemoglobin dissociation curve in L-alanine-treated cells is rightward shifted by 2.5 torr.

An LTC4 binding site in gastric mucosa is shared with glutathione.

Recent results from our laboratory and others have suggested a possible physiological functional role(s) for leukotrienes in gastric mucosa. In the present study 3H-LTC4 binds to washed rabbit gastric mucosal membranes at 4 degrees C with a Kd of 5 nM and a Bmax of 31.3 pmol/mg protein. Leukotrienes D4, E4, B4, oxidized glutathione (GSSG), cysteine, and mercaptoethanol were unable to displace 3H-LTC4 at 1 microM concentrations, while GSH inhibited binding with a Ki of 47 nM. Differential centrifugation of the membrane preparation to remove mitochondria resulted in Ki values for LTC4 and GSH of 14 and 23 nM, respectively. The similar binding affinities and competitive receptor binding kinetics for GSH and LTC4, the low affinity for other leukotrienes, and a Ki of 7 microM for hematin, a substrate for glutathione S-transferase, suggest that 3H-LTC4 binds to a GSH site which does not discriminate between LTC4 and GSH. Membranes fractionated to remove mitochondria were assayed for glutathione peroxidase, gamma-glutamyltranspeptidase, and glutathione S-transferase as possible binding sites for LTC4. We were unable to detect enzyme activity for any of the three enzymes. The binding of LTC4 in gastric mucosa differs from other tissues with respect to the high affinity for GSH, and thus becomes an appropriate tissue in which to investigate the relationships between LTC4 and GSH.