The structural basis for the functional comparability of factor VIII and the long-acting variant recombinant factor VIII Fc fusion protein.

Essentials Recombinant factor VIII (rFVIII) Fc fusion protein has a 1.5-fold longer half-life than rFVIII. Five orthogonal methods were used to characterize the structure of rFVIIIFc compared to rFVIII. The C-terminal Fc fusion does not perturb the structure of FVIII in rFVIIIFc. The FVIII and Fc components of rFVIIIFc are flexibly tethered and functionally independent. SUMMARY: Background Fusion of the human IgG1 Fc domain to the C-terminal C2 domain of B-domain-deleted (BDD) factor VIII (FVIII) results in the recombinant FVIII Fc (rFVIIIFc) fusion protein, which has a 1.5-fold longer half-life in humans. Objective To assess the structural properties of rFVIIIFc by comparing its constituent FVIII and Fc elements with their respective isolated components, and evaluating their structural independence within rFVIIIFc. Methods rFVIIIFc and its isolated FVIII and Fc components were compared by the use of hydrogen-deuterium exchange mass spectrometry (HDX-MS). The structure of rFVIIIFc was also evaluated by the use of X-ray crystallography, small-angle X-ray scattering (SAXS), and electron microscopy (EM). The degree of steric interference by the appended Fc domain was assessed by EM and surface plasmon resonance (SPR). Results HDX-MS analysis of rFVIIIFc revealed that fusion caused no structural perturbations in FVIII or Fc. The rFVIIIFc crystal structure showed that the FVIII component is indistinguishable from published BDD FVIII structures. The Fc domain was not observed, indicating high mobility. SAXS analysis was consistent with an ensemble of rigid-body models in which the Fc domain exists in a largely extended orientation relative to FVIII. Binding of Fab fragments of anti-C2 domain antibodies to BDD FVIII was visualized by EM, and the affinities of the corresponding intact antibodies for BDD FVIII and rFVIIIFc were comparable by SPR analysis. Conclusions The FVIII and Fc components of rFVIIIFc are structurally indistinguishable from their isolated constituents, and show a high degree of structural independence, consistent with the functional comparability of rFVIIIFc and unmodified FVIII.

Grade III open ankle fractures--a review of the outcome of treatment.

A retrospective review of fifteen patients with Grade III open ankle fractures, admitted to the Singapore General Hospital from January 1980 to December 1990 was done. Nine of the patients were males with a mean age of 47 years. Road traffic and industrial accidents accounted for 12 of the cases. Eleven of the fractures were associated with ankle dislocation or subluxation. Eleven of the fractures were fixed with plate and screws. Two of the ankles were stabilised with Steinmann pins inserted from the calcaneum to the lower end of the tibia. In ten cases the wounds were closed primarily or by delayed primary closure. One case required a flap to cover the defect and the rest were skin grafted. Eleven were immobilised in a plaster cast ranging from six to twelve weeks. Superficial infection was found in three cases and deep infection involving the bone and joint was present in three. Range of motion at one year was satisfactory in eleven but poor in two. Seven patients developed osteoarthritis of the ankle and three had ankle arthrodesis for pain and instability.

Metabolism of 7,8-dihydrobenzo(a)pyrene by rat liver microsomal enzymes and mutagenicity of metabolites.

7,8-Dihydrobenzo[a]pyrene (7,8-H2BaP) was metabolized by rat liver microsomes to form 7,8,9,10-tetrahydro-BaP trans-9,10-diol, 7,8,9,10-tetrahydro-BaP cis-9,10-diol, 7-hydroxy-7,8-H2BaP, 8-hydroxy-7,8-H2BaP, two phenolic products of 7,8-H2BaP [abbreviated as 7,8-H2BaP phenol 1 and phenol 2 according to their elution order on reversed-phase high-performance liquid chromatography (HPLC)], 4,5,7,8-tetrahydro-BaP trans-4,5-diol, BaP cis-7,8-dihydrodiol, BaP, and the metabolites known to be formed from the metabolism of BaP. Metabolites were isolated by reversed-phase and normal-phase HPLC and identified by ultraviolet-visible absorption and mass spectral analyses and by comparing their retention times with synthetic standards whenever available. The enantiomeric compositions of some mono-ol and diol metabolites were determined by chiral stationary phase HPLC. The optical purities of monool and diol metabolites formed were found to be dependent on the nature of cytochrome P-450 isozymes present in liver microsomes. Metabolites formed by liver microsomes from untreated, phenobarbital-treated, 3-methylcholanthrene-treated, and polychlorinated biphenyls (Aroclor 1254)-treated male Sprague-Dawley rats were quantified by using specifically tritium-labeled [10-3H]-7,8-H2BaP and liquid scintillation counting of fractions collected from reversed-phase HPLC. A portion (2-7% depending on the type of microsomes used) of the BaP found was formed nonenzymatically in microsomal metabolism of 7,8-H2BaP. The formations of other major metabolites were all cytochrome P-450 isozymes dependent since their formations were inhibited by carbon monoxide and were dependent on the presence of reduced nicotinamide adenine dinucleotide phosphate. Furthermore, the formations of tetrahydrodiols, monools, and phenols were not inhibited by the epoxide hydrolase inhibitor, 3,3,3-trichloropropylene 1,2-oxide. The relative mutagenic activities toward Salmonella typhimurium TA98 at 2 nmol of chemical per plate and 10 microliters of liver S9 fraction were: (+/-)BaP trans-7,8-dihydrodiol approximately equal to 7,8-H2BaP approximately equal to 7,8-H2BaP phenol 2 greater than (+/-)Bap cis-7,8-dihydrodiol greater than BaP approximately equal to 8-hydroxy-7,8-H2BaP greater than 7,8-H2BaP phenol 1 greater than 7-hydroxy-7,8-H2BaP. The results suggest that, in addition to the bay region 7,8,9,10-tetrahydro-BaP 9,10-epoxide, metabolic products formed by hydroxylations at the aliphatic and aromatic carbons of 7,8-H2BaP and their subsequent metabolism at the 9,10-double bond may also contribute to the carcinogenic activities of 7,8-H2BaP.

Stereoselectivity of rat liver cytochrome P-450 isozymes: direct determination of enantiomeric composition of K-region epoxides formed in the metabolism of benz[a]anthracene and 7,12-dimethylbenz[a]anthracene.

The K-region 5,6-epoxides of benz[a]anthracene (BA) and 7,12-dimethylbenz[a]anthracene (DMBA) were isolated by normal-phase HPLC from metabolites formed by incubation of the respective parent compound with liver microsomes from untreated (control), phenobarbital (PB)-treated, and 3-methylcholanthrene (MC)-treated rats in the presence of an epoxide hydrolase inhibitor, 3,3,3-trichloropropylene 1,2-oxide. The enantiomeric contents of the metabolically formed K-region 5,6-epoxides of BA and DMBA were directly determined by chiral stationary phase HPLC. The K-region 5,6-epoxides formed in the metabolism of BA have (5R,6S): (5S,6R) enantiomer ratios of 25:75 (control), 21:79 (PB), and 4:96 (MC), respectively. In contrast, the (5R,6S):(5S,6R) enantiomeric ratios of the K-region 5,6-epoxides formed in the metabolism of DMBA are 76:24 (control), 80:20 (PB), and 97:3 (MC), respectively. These and earlier results on the stereoselective K-region metabolism studies of 7-methylbenz[a]anthracene and 12-methylbenz[a]anthracene indicate that cytochrome P-450 isozymes exhibit different stereoselectivities in the K-region epoxidations of BA and DMBA and a methyl substituent at the C12 position of BA alters the stereoheterotopic interactions between cytochrome P-450 isozymes and the BA molecule.

Cytochrome P-450-catalyzed stereoselective epoxidation at the K region of benz[a]anthracene and benzo[a]pyrene.

The enantiomers of K-region benz[a]anthracene (BA) 5,6-epoxide and benzo[a]pyrene (BP) 4,5-epoxide were resolved by chiral stationary-phase high-performance liquid chromatography (CSP-HPLC). The K-region epoxides formed in the metabolism of BA by liver microsomes from untreated (control), phenobarbital (PB)-treated, and 3-methylcholanthrene (MC)-treated male Sprague-Dawley rats were determined by CSP-HPLC to have a 5R,6S/5S,6R enantiomer ratio of 25:75, 21:79, and 4:96, respectively. The K-region 4,5-epoxide formed in the metabolism of BP by the same rat liver microsomal preparations contained a 4R,5S/4S,5R enantiomer ratio of 48:52 (control), 40:60 (PB), and 5:95 (MC), respectively. The results indicate that various cytochrome P-450 isozymes of rat liver exhibit different stereoselective properties in catalyzing the epoxidation reactions at the K region of BA and of BP.

Absolute configuration of trans-7,8-dihydroxy-7,8-dihydro-7-methylbenzo[a]pyrene enantiomer and the unusual quasidiequatorial conformation of the diacetate and dimenthoxyacetate derivatives.

The enantiomers of trans-7,8-dihydroxy-7,8-dihydro-7-methylbenzo[a]pyrene (7-MBaP 7,8-dihydrodiol) and of trans-7,8-dihydroxy-7,8,9,10-tetrahydro-7-methylbenzo[a]pyrene (7-MBaP 7,8-tetrahydrodiol) were directly resolved by high-performance liquid chromatography (HPLC) using a commercially available column packed with an (R)-N-(3,5-dinitrobenzoyl)-phenylglycine derivative of gamma-aminopropylsilanized silica. The absolute configurations of the resolved enantiomers were determined by the exciton chirality method. Circular dichroism (CD) spectral analysis of the quasidiequatorial benzo[a]pyrene 7R,8R-dihydrodiol enantiomer and its diacetate and dimenthoxyacetate derivatives indicated conformational changes were induced upon derivatization. However, the characteristic CD Cotton effects of the quasidiequatorial 7-MBaP 7,8-dihydrodiol and its diacetate and dimenthoxyacetate derivatives were similar indicating that the conformation of 7-MBaP trans-7,8-dihydrodiol was not altered upon derivatization. Proton nuclear magnetic resonance (NMR) spectral analyses confirmed that 7-MBaP 7,8-dihydrodiol, its diacetate and dimenthoxyacetate derivatives all have quasidiequatorial conformations. The results indicate that the methyl substituent of 7-MBaP 7,8-dihydrodiol maintains a quasiaxial position regardless of the size of the acyl derivatives linked to the hydroxyl groups.

Stereoselective hydroxylation at the aliphatic carbons of 7,8- and 9,10-dihydrobenzo[a]pyrenes by rat liver microsomes.

Optically active 7-hydroxy-7,8-dihydrobenzo[a]pyrene and 8-hydroxy-7,8-dihydrobenzo[a]pyrene were identified as two of the major metabolites formed by incubation of 7,8-dihydrobenzo[a]pyrene with rat liver microsomes. Optically active 9-hydroxy-9,10-dihydrobenzo[a]pyrene and 10-hydroxy-9,10-dihydrobenzo[a]pyrene were similarly identified as two of the minor metabolites of 9,10-dihydrobenzo[a]pyrene. The formation of these metabolites was abolished either by prior treatment of liver microsomes with carbon monoxide or the absence of NADPH, but was not inhibited by an epoxide hydrolase inhibitor. The results indicate that the aliphatic carbons of dihydro polycyclic aromatic hydrocarbons may undergo stereoselective hydroxylation reactions catalyzed by the cytochrome P-450 system of rat liver microsomes.

Stereoselectivity of rat liver microsomal enzymes in the metabolism of 7-fluorobenz(a)anthracene and mutagenicity of metabolites.

7-Fluorobenz(a)anthracene (7-FBA) was metabolized by rat liver microsomes predominantly to 4-hydroxy-7-FBA and 7-FBA trans-3,4-, 5,6-, 8,9-, and 10,11-dihydrodiols. Proton nuclear magnetic resonance spectral analyses indicated that the fluoro substituent causes 7-FBA trans-5,6- and 8,9-dihydrodiols to adopt preferentially quasidiaxial conformations (Chiu, P.-L., Fu, P. P., and Yang, S. K. Biochem. Biophys. Res. Commun., 106: 1405-1411, 1982). The major enantiomers of the quasidiaxial trans-5,6- and trans-8,9-dihydrodiols have been determined by the exciton chirality method to have R,R absolute stereochemistries. By comparing with the circular dichroism spectra of BA 3R,4R- and 10R,11R-dihydrodiols, the major enantiomers of the quasidiequatorial 7-FBA trans-3,4- and trans-10,11-dihydrodiols were also found to have R,R absolute configurations. All four 7-FBA trans-dihydrodiol metabolites obtained from incubations of 7-FBA with liver microsomes prepared from untreated and 3-methylcholanthrene-, phenobarbital-, and polychlorinated biphenyl-treated male Sprague-Dawley rats were enriched in R,R enantiomers, differing only in optical purities. Pretreatment of rats with phenobarbital, 3-methylcholanthrene, and polychlorinated biphenyls changed the rate of 7-FBA metabolism by 0.47-, 1.14-, and 1.70-fold, respectively. Pretreatment of rats with enzyme inducers also altered the quantitative distribution of metabolites formed. The relative mutagenic activities of metabolites toward Salmonella typhimurium TA 100 were: 7-FBA trans-3,4-dihydrodiol greater than 7-FBA trans-10,11-dihydrodiol greater than 7-methyl-BA approximately equal to 7-FBA greater than 7-FBA trans-8,9-dihydrodiol approximately equal to 7-methyl-BA trans-10,11-dihydrodiol greater than 7-FBA trans-5,6-dihydrodiol approximately equal to 4-hydroxy-7-FBA. The relatively high mutagenic activities of 7-FBA trans-3,4- and trans-10,11-dihydrodiols suggest that both 7-FBA trans-3,4-dihydrodiol 1,2-epoxide(s) and 7-FBA trans-10,11-dihydrodiol 8,9-epoxide(s) may be the major metabolites which contribute to the carcinogenic properties of 7-FBA.

Superoxide production in neutrophils of patients with rheumatoid arthritis and Felty's syndrome.

The production of superoxide by N-formylmethionyl-leucyl-phenylalanine activated neutrophils was measured prospectively with a ferricytochrome C reduction assay in 33 normals, 33 patients with rheumatoid arthritis and 9 patients with Felty's syndrome. Both the rate and quantity of superoxide production were significantly lower in patients with Felty's syndrome when compared to the other 2 groups. This finding suggests a possible additional factor in the increased propensity of these patients to develop infections.

Stereoselective metabolism of benzo[a]pyrene and 7-methylbenzo[a]pyrene by liver microsomes from sprague-Dawley rats pretreated with polychlorinated biphenyls.

The dihydrodiols formed from the metabolism of benzo[a]pyrene (BaP) and 7-methylbenzo[a]pyrene (7-MBaP) by liver microsomes from male Sprague-Dawley rats treated with polychlorinated biphenyls (PCBs, Aroclor 1254) have been examined by circular dichroism (CD) spectropolarimetry. Comparisons with optically pure enantiomers obtained via high performance liquid chromatography (HPLC) resolution of diastereomeric di-(-)-menthoxyacetates indicated that the trans-4,5-, 7,8- and 9,10-dihydrodiols formed from BaP metabolism are predominantly R,R-enantiomers with optical purities greater than 98%. The major enantiomers of the metabolically formed 7-MBaP-trans-4,5- and 9,10-dihydrodiols and 7-hydroxymethyl-BaP-trans-9,10-dihydrodiol have Cotton effects very similar to those of BaP-4R,5R- and 9R,10R-dihydrodiols, respectively. These 7-MBaP-trans-4,5- and 9,10-dihydrodiol metabolites therefore contain predominantly the R,R-enantiomers. The optical purity of metabolically formed 7-MBaP-trans-4,5-dihydrodiol was determined to be 30.8% enriched in (-)-enantiomer. The optical purity of the 9,10-dihydrodiol was not determined due to the lack of synthetic standards. The major trans-7,8-dihydrodiol enantiomer formed from 7-MBaP metabolism is a (+)-enantiomer (optical purity 60.4%) which has Cotton effects opposite in sign to that of the (-)-7R,8R-dihydrodiol formed from BaP metabolism. The results indicate that a methyl substituent on a polycyclic aromatic hydrocarbon may alter the stereoselective properties of the microsomal drug-metabolizing enzyme systems toward the substrate molecule.

Computed tomography of the craniocervical junction in rheumatoid arthritis.

Thirty-three patients with rheumatoid arthritis had computed tomographic examination of the craniocervical junction. This demonstrated soft tissue features which have not previously been described in published reports. A low attenuation lesion between the odontoid and the transverse ligament shown in 11 patients was considered a premonitory sign of rupture of the transverse ligament or a manifestation of active disease. Computed tomography revealed spinal cord compression in 3 patients and ligamentous changes in the transverse ligament and the alar and spinal ligaments in 26 patients. Erosion of the odontoid was shown in 19 patients and subluxation in 20 patients. No relationship could be found between the clinical signs and symptoms and the radiological abnormalities except in the case of cord compression.

The effect of enzyme induction on the stereoselective metabolism of optically pure (-)1R,2R- and (+)1S,2S-dihydroxy-1,2-dihydrobenz-[a]anthracenes to vicinal 1,2-dihydrodiol 3,4-epoxides by rat liver microsomes.

The optically pure (-) and (+)trans-1,2-dihydroxy-1,2-dihydrobenz[a]anthracenes (BA trans-1,2-dihydrodiol) were obtained through the resolution of their diastereomeric di(-)menthoxyacetates by normal-phase h.p.l.c., followed with base-catalyzed hydrolysis. The (-)-BA trans-1,2-dihydrobiol has been determined to have 1R,2R absolute stereochemistry by exciton chirality method. Each of the enantiomeric and racemic BA trans-1,2-dihydrodiol was incubated with liver microsomes from untreated, phenobarbital (PB)-, and 3-methylcholanthrene (MC)-treated male Sprague-Dawley rats. The racemic and enantiomeric BA trans-1,2-dihydrodiols were each metabolized to two 1,2,3,4-tetrahydroxy-1,2,3,4-tetrahydrobenz[a]anthracenes (BA 1,2,3,4-tetrol) derived from the hydrolysis of BA trans-1,2-dihydrodiol anti-3,4-epoxide (the 3,4-epoxy oxygen is trans to the 1-hydroxyl group) and syn-3,4-epoxide (the 3,4-epoxy oxygen is cis to the 1-hydroxyl group), respectively. All the BA 1,2,3,4-tetrols were identified by comparing the reversed-phase h.p.l.c. retention times of tetrols and their vicinal acetonides with the hydrolysis products of the chemically synthesized BA trans-1,2-dihydrodiol anti-3,4-epoxide, BA trans-1,2-dihydrodiol syn-3,4-epoxide, BA trans-3,4-dihydrobiol anti-1,2-epoxide, and BA trans-3,4-dihydrodiol syn-1,2-epoxide, respectively, by their modes of forming vicinal acetonides, and by ultraviolet absorption and mass spectral analyses. From the metabolism of (-)-BA trans-1,2-dihydrodiol, a BA trans-1,2-dihydrodiol anti-3,4-epoxide was the major product formed by liver microsomes from MC-treated rats whereas a BA trans-1,2-dihydrodiol syn-3,4-epoxide was the major product formed by liver microsomes from either untreated or PB-treated rats. In contrast, BA trans-1,2-dihydrodiol syn-3,4-epoxide was the major product formed from the metabolism of (+)-BA trans-1,2-dihydrodiol by all three rat liver microsomal preparations. Liver microsomes from PB-treated rats were found to catalyze the metabolism of both the racemic and the enantiomeric BA trans-1,2-dihydrodiols at a rate higher than those by liver microsomes from untreated and MC-treated rats. All BA 1,2,3,4-tetrol metabolites were found to be optically active by circular dichroism spectral analysis. The results indicate that the 'bay-region' BA trans-1,2-dihydrodiol is metabolized by rat liver microsomes predominantly at the vicinal 3,4-double bond and that each enantiomeric BA trans-1,2-dihydrodiol is metabolized to a pair of diastereomeric BA trans-1,2-dihydrodiol 3,4-epoxides with varying degrees of stereoselectivity depending on the constitutive forms of cytochrome P-450 in the rat liver microsomal preparations.

Metabolic study of 7-methylbenzo[a]pyrene with rat liver microsomes: separation by reversed-phase and normal-phase high performance liquid chromatography and characterization of metabolites.

The 7-methylbenzo[a]pyrene (7-MBaP) was incubated with liver microsomes of rats pretreated with polychlorinated biphenyls (Aroclor 1254) (PCBs). Metabolites of 7-MBaP were isolated by both reversed-phase and normal-phage high performance liquid chromatography (HPLC) and were characterized by nuclear magnetic resonance, UV-visible and mass spectral analyses. The predominant metabolite of 7-MBaP was found to be 3-hydroxy-7-methylbenzo[a]pyrene (3-hydroxy-7-MBaP). Other identified metabolites include 7-MBaP 4,5-, 7,8-, and 9,10-trans-dihydrodiols, 7-hydroxymethyl-BaP, 7-hydroxymethyl-BaP trans-9,10-dihydrodiol, 9-hydroxy-7-MBaP, 3-hydroxy-7-hydroxymethyl-BaP, 7-MBaP 1,6- and 3,6- quinones, and a hydroquinone which is also formed by further metabolism of the 3-hydroxy-7-MBaP. Comparative metabolic studies of 7-MBaP and BaP indicated that, relative to that of BaP, the methyl substituent of 7-MBaP slightly increases the formation of 3-hydroxy-7-MBaP and decreases the metabolism at other regions of the 7-MBaP molecule. The finding that a 7,8-dihydrodiol is a metabolite indicates that, like BaP, 7-MBaP may also be activated to the potentially reactive 7,8-dihydrodiol 9,10-epoxides although their formations are significantly reduced.