The Organ Donation Breakthrough Collaborative: has it made a difference?

BACKGROUND: The Organ Donation Breakthrough Collaborative (ODBC) was established in 2003 to increase the number of transplantable organs in the United States. However, recent publications have suggested that the ODBC has not impacted donation conversion rates at local organ procurement organizations (OPOs). We sought to determine the impact, if any, of our becoming part of the ODBC on organ donation rates in our OPO or in our institution (Carolinas Medical Center [CMC]), particularly among minority donors. METHODS: This is a retrospective review of data entered concurrently into a patient referral database maintained by our local OPO. Donation approach and consent rates were calculated. They were then analyzed by race and institution, and trends were analyzed over the study period of 2002 to 2010. Statistical differences between the various patient groups were determined by the chi-square test or the Fisher exact test. Statistical differences over time were determined by the Cochran-Armitage trend test. RESULTS: From 2002 to 2010, 10,855 patients were screened by our OPO for potential organ donation. The overall approach rate was 13.4%, and the consent rate was 57.6%. An increase in approach and consent rates was noted beginning in 2004, but this increase was not sustained. Consent rates in general were higher for white patients than for black and Hispanic patients. Consent rates for CMC did increase significantly (P = .02), but they did not increase for the non-CMC hospitals. When analyzed by race, no significant changes were noted in consent rates over time. When analyzed by race and institution, the only statistically significant increase in consent rates occurred for white patients at CMC. CONCLUSIONS: Since joining the ODBC, we have noted an increase in consent rates at a single institution (CMC), but no other significant changes. Greater emphasis should be placed on methods to increase and sustain consent rates for all racial groups in general, with a special emphasis on increasing consent rates in minority patients.

Absorption, metabolism and excretion of flavanones from single portions of orange fruit and juice and effects of anthropometric variables and contraceptive pill use on flavanone excretion.

Oranges are rich sources of flavonoids that are bioactive and may protect against age-related diseases. The absorption of orange flavanones may be affected by factors such as processing and subject anthropometric variables, and the bioactivity of the absorbed phytochemicals depends on how they are metabolised during absorption. In a randomised cross-over study, twenty subjects consumed a single portion of orange fruit (150 g) or juice (300 g) that contained the flavanones narirutin and hesperidin, and an additional 109 subjects across a broad age range (18-80 years) consumed the juice. Flavanone metabolites were measured in regularly collected samples of plasma and urine. After consumption of fruit or juice, flavanone conjugates, but not the aglycones, were detected in plasma and urine. The flavanone conjugates were shown to include the 7- and 4'-O-monoglucuronides of naringenin, the 7- and 3'-O-monoglucuronides of hesperetin, two hesperetin diglucuronides and a hesperetin sulfo-glucuronide, but no aglycones or rutinosides. Analysis of the plasma pharmacokinetic and urinary excretion data on a dose-adjusted basis indicated no difference in absorption or excretion of either flavanone between the fruit and juice matrices. In the extended urinary excretion dataset the individual variation was very large (range 0-59 % urinary yield). There was a small but significant (P < 0.05) decrease in the excretion of hesperetin (but not naringenin) with increasing age (P < 0.05), but the effects of sex, BMI and contraceptive pill use were shown not to be associated with the variation in flavanone excretion.

Absorption, Conjugation and Efflux of the Flavonoids, Kaempferol and Galangin, Using the Intestinal CACO-2/TC7 Cell Model.

Flavonoids are biologically active compounds in food with potential health effects. We have used the Caco-2 cell monolayer model to study the absorption and metabolism of two flavonols, a class of flavonoids, specifically kaempferol and galangin. Metabolism experiments allowed identification of 5 kaempferol conjugates: 3-, 7- and 4'-glucuronide, a sulphate and a glucurono-sulphate; and 4 galangin conjugates: 3-, 5- and 7-glucuronides, and a sulphate, using specific enzyme hydrolysis, HPLC-MS, and HPLC with post column metal complexation/tandem MS. Transport studies showed that the flavonols were conjugated inside the cells then transported across the monolayer or effluxed back to the apical side. Sulphated conjugates were preferentially effluxed back to the apical side, whereas glucuronides were mostly transported to the basolateral side. For kaempferol, a small amount of the unconjugated aglycone permeated in both directions, indicating some passive diffusion. When kaempferol-3-glucuronide and quercetin7-sulphate were applied to either side of the cells, no permeation in either direction was observed, indicating that conjugates cannot re-cross the cell monolayer. Formation of apical kaempferol-7- and 4'-glucuronides was readily saturated, whereas formation of other conjugates at the apical side and all at the basolateral side increased with increasing concentration of kaempferol, implying different transporters are responsible at the apical and basolateral sides. The results highlight the important but complex metabolic changes occurring in flavonoids during absorption.

An investigation of the homolytic saccharide cleavage of deprotonated flavonol 3-O-glycosides in a quadrupole ion trap mass spectrometer.

The trend in the extent of homolytic saccharide cleavage is reported for a series of deprotonated flavonol 3-O-glycosides upon collision-induced dissociation (CID) in a quadrupole ion trap mass spectrometer. The second-generation product ions from the primary [Y(0)](-) and [Y(0)- H](-.) product ions were also identified. It was determined that the structure of both the aglycon and the saccharide portions of the flavonoid glycoside are pivotal in inducing radical cleavage. In contrast to earlier work on this subject reported for a smaller group of flavonols, the correlation between the degree of B-ring hydroxylation and the extent of radical saccharide cleavage showed several notable exceptions in the present work. Homolytic cleavage was also investigated in the context of using tandem mass spectrometry to identify the aglycon portions of flavonoid glycosides.

Regioselectivity of human UDP-glucuronosyl-transferase 1A1 in the synthesis of flavonoid glucuronides determined by metal complexation and tandem mass spectrometry.

A three-part tandem mass spectrometric strategy that entails MSn analysis and a post-column LC-MS cobalt complexation method is developed to identify flavonoid monoglucuronide metabolites synthesized using the 1A1 isozyme of human UDP-glucuronosyltransferase (UGT). Ten flavonoid aglycons were used as substrates, spanning the subclasses of flavones, flavonols, and flavanones. The products were characterized by LC-MS and LC-MSn, with post-column cobalt complexation employed to pinpoint the specific sites of conjugation. The dissociation of complexes of the form [Co(II) (flavonoid glucuronide - H) (4,7-diphenyl-1,10-phenanthroline)(2)]+ allowed identification of the products and differentiation of isomers. The correlation between glycosylation site and elution order is used to provide additional structural confirmation. Flavonoids lacking a 3' hydroxyl group were glucuronidated only at position 7, while those containing this functionality also formed 3'-O-glucuronides and sometimes 4'-O-glucuronides, thus supporting the conclusion that the presence or absence of the 3'-OH group is the major determinant of the regioselectivity of glucuronidation. Moreover, the specific distribution of multiple glucuronide products (7-O, 3'-O, 4'-O) is governed by the subclass of flavonoid.

X-ray crystallographic and mass spectrometric probing of the conformational and ionophoric properties of stereoisomeric hexatetrahydrofuranylhexane segments.

A full account of the synthesis of the 12 hexacyclic tetrahydrofuran isomers represented by the nearby formulas is first provided. The key steps involved in further elaboration of the spiro ethers 12, 15, 28, and 45 include controlled ozonolysis, 1,2-addition of the Normant reagent, and heterocyclization. Eight of the end products proved to be sufficiently crystalline to enable X-ray analysis and determination of their solid-state conformational features. The alkali metal ion selectivities of the 12 hexamers were evaluated by a picrate extraction method and by electrospray ionization mass spectrometry (ESI-MS) which indicated that small, but significant, selectivity differences exist within the groups of diastereomers. These results revealed that each hexamer demonstrated a preference for lithium ion complexation relative to sodium or potassium ion complexation. Stereoisomeric classification of the hexamers was based on the competition between two dissociation routes promoted by collision-induced dissociation. The preference for each of the two dissociation pathways, both of which involved cleavage at the midpoint of the hexamer, correlated with the stereochemical configurations (syn versus anti) of the THF groups near the termini.

Synthesis of, and structural assignments to the stereoisomers of bis (2,2')- and tris (2,2',2")-tetrahydrofurans: conformational features and ionic binding capacities of these gateway polycyclic networks.

Construction of the polytetrahydrofuranyl building blocks 6-10 from the common bissiloxyacetone precursor 11 is detailed. The approach is concise and, for the bis-(THF) pair, capitalizes on the full retention of configuration observed during the rhodium-promoted decarbonylation of aldehydes 18 and 19. The capability of the title compounds to associate with alkali metal ions in solution and the gas phase has demonstrated a preference for Li+ over Na+ and K+ in all cases, with 6 and 7 exhibiting somewhat higher binding selectivities than 8-10. The relative energy orderings of attainable conformations with the bis-THF and tris-THF series were explored computationally. The various envelope arrangements present in the individual THF units are shown to play a significant role alongside prevailing gauche interactions. The "gauche effect" is shown computationally not to be an accurate predictor of the lowest energy conformer.

Identification of isomeric flavonoid glucuronides in urine and plasma by metal complexation and LC-ESI-MS/MS.

Noncovalent complexes were used for structural determination and isomer differentiation of flavonoid glucuronides. Several flavonoid glucuronides including naringenin-7-O-glucuronide, synthesized here for the first time, were used as test compounds. Electrospray ionization quadrupole ion trap mass spectrometry with collision-induced dissociation (CID) was used to analyze complexes of the form [Co(II) (L-H) (Aux)]+ and [Co(II) (L-H) (Aux)2]+, in which L is the flavonoid glucuronide and Aux is a phenanthroline-based ligand. These complexes yielded characteristic fragmentation patterns that facilitated assignment of the substitution position of the glucuronides. The methods were adapted to liquid chromatography/tandem mass spectrometry (LC-MS/MS) with postcolumn cobalt complexation and were tested on extracts from biological fluids. The metabolites naringenin-7-O-glucuronide and naringenin-4'-O-glucuronide were detected in human urine following the consumption of grapefruit juice. Isomeric quercetin glucuronides were identified and differentiated after spiking rat plasma at the 1 microM level, proving that the new methods are effective at biologically relevant concentrations.

LC-MSn methods for saccharide characterization of monoglycosyl flavonoids using postcolumn manganese complexation.

A simple tandem mass spectrometry method for differentiating isomeric monoglycosyl flavonols, flavones, and flavanones using manganese complexation is reported. Dissociation of the [Mn(II) (L) (L - H)]+ and [Mn(II) (L)2 (L - H)]+ species provides unique fragment ions that allow the identification of the saccharide moiety as glucose, galactose, arabinose, or xylose. The glycosylation site of the flavonoid can also be determined by the fragmentation pathways of the Mn complexes. The Mn complexation method was adapted for on-line liquid chromatography-mass spectrometry analysis and tested using flavonoid extracts from Fuji apples (Malus domestica Borkh. cv. Fuji) and red onions (Allium cepa L.). Using fragmentation data obtained from collisional activated dissociation of the deprotonated flavonoid glycosides and their Mn complexes, the major flavonoid species in these extracts were identified.

Determination of the glycosylation site of flavonoid monoglucosides by metal complexation and tandem mass spectrometry.

Metal complexation and tandem mass spectrometry were used to differentiate C- and O-bonded flavonoid monoglucoside isomers. Electrospray ionization of solutions containing a flavonoid glycoside and a metal salt led to the generation of the key [M(II) (L) (L-H)](+) complexes, where M is the metal ion and L is the flavonoid glycoside. Thirteen flavonoid monoglucosides were examined in combination with Ca(II), Mg(II), Co(II), Ni(II), and Cu(II). Collisional activated dissociation (CAD) of the [M(II) (L) (L-H)](+) complexes resulted in diagnostic mass spectra, in contrast to the CAD mass spectra of the protonated, deprotonated, and sodium-cationized flavonoid glucosides. Five common sites of glycosylation could be predicted based on the fragmentation patterns of the flavonoid glucoside/magnesium complexes, while flavonoid glucoside/calcium complexes also were effective for location of the glycosylation site when MS(3) was employed. Cobalt, nickel and copper complexation had only limited success in this application. The metal complexation methods were also applied for characterization of a flavonoid rhamnoside, and the dissociation pathways of the metal complexes indicate that flavonoid rhamnosides have distinctive dissociation features from flavonoid glucosides.