Method and device for bio-impedance measurement with hard-tissue applications.

Bio-impedance measurements can be used to detect and monitor several properties of living hard-tissues, some of which include bone mineral density, bone fracture healing or dental caries detection. In this paper a simple method and hardware architecture for hard tissue bio-impedance measurement is proposed. The key design aspects of such architecture are discussed and a commercial handheld ac impedance device is presented that is fully certified to international medical standards. It includes a 4-channel multiplexer and is capable of measuring impedances from 10 kOmega to 10 MOmega across a frequency range of 100 Hz to 100 kHz with a maximum error of 5%. The device incorporates several user interface methods and a Bluetooth link for bi-directional wireless data transfer. Low-power design techniques have been implemented, ensuring the device exceeds 8 h of continuous use. Finally, bench test results using dummy cells consisting of parallel connected resistors and capacitors, from 10 kOmega to 10 MOmega and from 20 pF to 100 pF, are discussed.

The inactivation of single-chain urokinase-type plasminogen activator by thrombin in a plasma milieu: effect of thrombomodulin.

Thrombin cleaves single-chain urokinase-type plasminogen activator (scu-PA) into a virtually inactive two-chain form (tcu-PA/T), a process which may contribute to the maintenance of a fresh blood clot. We have examined the inactivation of scu-PA by thrombin in a plasma milieu to get more insight in the physiological relevance of this phenomenon. Citrated pooled normal plasma was treated with thrombin in the absence and presence of thrombomodulin. After an incubation period of 30 min the concentrations of scu-PA and tcu-PA/T were measured using specific bioimmunoassays. The inactivation of scu-PA in citrated plasma was found to be stimulated fourfold by thrombomodulin. Kinetic experiments showed that the inactivation of scu-PA by thrombin in the absence and presence of thrombomodulin occurred rapidly and declined within 1 min as a result of rapid inhibition by antithrombin III (ATIII) and other possible inhibitors. Calcium had no direct effect on the inactivation of scu-PA by exogenously added thrombin in the absence and presence of thrombomodulin. However, recalcification of plasma induced significant inactivation of scu-PA in plasma as a result of endogenous thrombin generation through the contact activation system. This calcium-induced inactivation of scu-PA was completely abolished in the presence of thrombomodulin, most likely as a result of activation of protein C by the complex formed between thrombomodulin and endogenously generated thrombin. Thrombomodulin thus appeared to play a dual role both by stimulating the inactivation of scu-PA by thrombin, and by inhibiting calcium-induced inactivation of scu-PA in plasma. In the plasma from a patient heterozygous for protein C deficiency, thrombomodulin could not prevent calcium-induced generation of tcu-PA/T, whereas the stimulating effect of thrombomodulin predominated instead. This result implied that disturbance of the protein C pathway may lead to the inactivation of substantial amounts of scu-PA in plasma under (patho)physiological circumstances and may provide an additional explanation for the association found between thromboembolism and deficiencies in the protein C pathway. This study shows that the amount of scu-PA that is inactivated in plasma depends mainly on the generation of thrombin and on thrombomodulin. We conclude that the inhibition of scu-PA-induced fibrinolysis appears to be regulated by activation of the coagulation system, providing a link between coagulation and fibrinolysis.

Impedance spectroscopy of teeth with and without approximal caries lesions--an in vitro study.

Caries diagnosis by the measurement of electrical resistance is hampered by polarization effects when dc or single-low-frequency ac currents are used. Electrical impedance spectroscopy, measuring impedance over a large range of frequencies, will provide more detailed information about the electrical characteristics of teeth. It was the aim of this study (a) to characterize the complex impedance behavior of whole extracted teeth, measured at the approximal surface, and (b) to identify parameters of the complex impedance behavior of the teeth which would be useful in distinguishing between degrees of carious involvement. Thirty-nine extracted premolar teeth with 59 unrestored and undamaged (excepting caries) approximal surfaces were selected. The tooth surfaces were divided into three groups according to their macroscopic appearance: sound (group S, n = 16), white- or brown-spot lesion present (group L, n = 33), or cavitated (group C, n = 10). The teeth were inserted into a jig which allowed for counter-electrode contact via a conducting gel. The working electrode consisted of a carbonated fiber material. Electrical impedance measurements were performed over a maximum range of about 1 MHz to 0.1 Hz. We analyzed electrical impedance data by fitting equivalent circuits. Fit was evaluated numerically and visually. The complex impedance spectra divided naturally into three groups which corresponded almost perfectly with the classifications of S,L, and C. The groups differed most in the dc resistance (Rdc), as calculated from the impedance parameters. Mean Rdc for groups S, L, and C were 68 M omega, 5.9 M omega, and 321 k omega, respectively. These means were significantly different from each other (log-transformed data, ANOVA, p < 0.001; Tukey multiple comparisons, p < 0.001). It is concluded that the in vitro performance of electrical impedance spectroscopy in differentiating among sound, non-cavitated carious, and cavitated approximal tooth surfaces is excellent.

Detection of dental decay and its extent using a.c. impedance spectroscopy.

Dental caries (decay), the most prevalent of diseases, represents a health problem of immense proportions. It principally affects posterior (back) teeth on occlusal (biting) and approximal (adjacent contacting) surfaces. Caries starts as a subsurface demineralization of enamel, may progress to the underlying dentine and, eventually, to cavitation of the surface. Accurate diagnosis before cavitation would permit targeted preventive treatment, thereby significantly improving dental health and reducing the need for expensive drilling and filling. Inaccessibility of caries initiation sites and recent changes in lesion morphology contribute to the relatively poor accuracy of conventional diagnostic methods. Among alternative techniques, measurements of electrical resistance have shown the most promise. Here we describe a new experimental technique that demonstrates an outstanding 100% correlation between a.c. impedance measurements of whole teeth and the actual extent of approximal caries in vitro. Only relatively minor modifications should be required to transfer the technique to in vivo applications.

Fibrin binding of plasminogen coated liposomes in vitro.

In this study, the fibrin binding properties of liposomes containing a number of plasminogen (Plg) molecules on the outside were compared to those of free (non-liposomal) Plg in an in vitro model system. Fibrin monolayer coated 96-wells plates were used, containing fibrin monomer at a density of around 3.4 to 3.9 x 10(-4) nmol/cm2. These densities are similar to liposomal Plg-densities, thus allowing multivalent interactions to occur. In the panel of experimental conditions that was chosen, binding of free Plg and liposomes with Plg showed three main differences in characteristics. Firstly, in the fibrin binding of Plg-liposomes not all Plg may be involved, but on the average 40% of the total amount of liposomal Plg. This was shown by lysing the liposomes after binding to the fibrin and estimation of truly bound Plg. With Plg-densities on the liposomes below the fibrin binding sites density, the maximal number of bound Plg molecules remains below the amount of available fibrin binding sites. Secondly, a higher binding rate by at least one order of magnitude was observed for liposomes with Plg compared to free Plg. Thirdly, liposomes with Plg exhibit a fibrin binding affinity which increases with Plg-density, because of the multivalent character of interaction. Liposomal Plg can successfully compete for fibrin binding sites with a 100 fold higher concentration of free Plg. These in vitro findings indicate that in view of avid and rapid fibrin binding, liposomes with attached plasminogen may be suitable for in vivo targeting to fibrin based thrombi.

Thrombolytic treatment with tissue-type plasminogen activator (t-PA) containing liposomes in rabbits: a comparison with free t-PA.

In this study, we aimed at improving the therapeutic index of tissue-type Plasminogen Activator (t-PA) as thrombolytic agent in the treatment of myocardial infarction. Liposome-encapsulated t-PA was tested in a rabbit jugular vein thrombosis model: administration of free t-PA (t-PA) as a bolus injection in the ear vein was compared to a similar administration of liposomal t-PA (t-PA-lip), liposomal t-PA in plasminogen-coated liposomes (Plg-t-PA-lip), a mixture of free t-PA and empty liposomes (t-PA+ empty lip) and a saline-blank (blank) in terms of thrombolytic activity and side effects. Liposomal t-PA (t-PA-lip/Plg-t-PA-lip) showed a significantly better thrombolysis efficiency than equimolar doses of free t-PA (t-PA/ t-PA+ empty lip): about 0.24 mg/kg of liposomal t-PA practically equalled the lysis-activity of a dose of free t-PA of 1.0 mg/kg (t-PA1mg/kg). On the other hand, liposome encapsulation did not affect the systemic activation of alpha 2-antiplasmin and plasminogen by t-PA. We conclude that for this model an improvement in thrombolytic efficacy of t-PA is achieved by liposome encapsulation of t-PA. As t-PA-lip and Plg-t-PA-lip -treatment induced similar results, targeting of liposomal t-PA by coupled glu-Plg remains a topic to be optimized in future studies.

Development of a procedure for coupling the homing device glu-plasminogen to liposomes.

The aim of this study was to find a suitable way of coupling the homing-device glu-plasminogen to the outside of liposomes. The described procedure is based on the reaction of thiol-groups introduced in the protein with thiol-reactive groups of the liposome. Details on the thiolation of proteins with the reagent succinimidyl-S-acetylthioacetate (SATA) were studied for a model-protein, amylase. Increasing the incubation-ratio SATA: amylase resulted in a gradually growing number of introduced thiol-groups, until a maximum of about 5 mol SH per mol amylase was reached. The enzymatic activity of the derivatized protein was even higher than that of native amylase. The thiol-introduction was then applied to glu-plasminogen itself. After activation with SATA, the protein was incubated with liposomes containing the thiol-reactive anchor maleimido-4-(p-phenylbutyrate)-phosphatidylethanolamine (MPB-PE). Under the chosen conditions, incubation of 0.5-2.5 mg/ml protein with 6.0-7.5 mumol/ml phospholipid for 30-120 min resulted in coupling-ratios of 20 to 94 micrograms glu-plasminogen per mumol phospholipid. This corresponds with about 140 to 660 protein molecules per liposome. SATA-derivatization of glu-plasminogen brought about a loss of its enzymatic activity induced by streptokinase. This activity of liposomally coupled plasminogen was about 52 to 74% of the activity of native glu-plasminogen (depending on the coupling-ratio). Although this may seem a significant loss of activity, it was shown that the capacity of liposomal glu-plasminogen to bind to its target, fibrin, was not reduced but several fold higher under the used conditions than that of the free protein. Therefore, the described method for thiol-introduction is an effective way to thiolate amylase without loss of activity, and to bind the homing-device glu-plasminogen to liposomes without substantially interfering with its fibrin-binding/homing capacity.

Plasmin inhibitors in the prevention of systemic effects during thrombolytic therapy: specific role of the plasminogen-binding form of alpha 2-antiplasmin.

To delineate the role of plasmin inhibitors, especially the two molecular forms of alpha 2-antiplasmin (that is, the plasminogen-binding and the nonplasminogen-binding forms), in the control of systemic effects during thrombolytic therapy, the consumption of plasmin inhibitors and the degree of fibrinogen breakdown were studied in 35 patients with acute myocardial infarction treated with recombinant tissue-type plasminogen activator (rt-PA) or streptokinase. At a low degree of plasminogen activation (in six patients treated with rt-PA), plasminogen-binding alpha 2-antiplasmin was consumed first. At a higher degree of plasminogen activation (in 20 patients), plasminogen-binding alpha 2-antiplasmin became exhausted (less than 20%) and other plasmin inhibitors (that is, nonplasminogen-binding alpha 2-antiplasmin and alpha 2-macroglobulin) were consumed. After extensive plasminogen activation (in nine patients treated with streptokinase), plasminogen-binding alpha 2-antiplasmin consumption was complete and nonplasminogen-binding alpha 2-antiplasmin and alpha 2-macroglobulin were consumed to about 30% to 50% of the pretreatment level. No significant C1-inactivator consumption occurred, even at extreme degrees of plasminogen activation. Fibrinogen breakdown as a marker for systemic effects correlated strongly with consumption of plasminogen-binding alpha 2-antiplasmin. Fibrinogen breakdown did occur, but only when the amount of plasminogen-binding alpha 2-antiplasmin was decreased to less than 20% of the pretreatment level. The other plasmin inhibitors could not prevent fibrinogen breakdown. These results were confirmed by in vitro studies. It is concluded that plasminogen-binding alpha 2-antiplasmin is the most important inhibitor of plasmin in the circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased urinary excretion of the histamine metabolite N tau-methylhistamine during acetylsalicylic acid provocation in chronic urticaria patients.

Seventeen chronic urticaria patients with a history suggestive of acetylsalicylic acid (ASA, Aspirin)-intolerance were challenged with ASA; only 2 patients showed marked clinical reactions. These clinical reactions were accompanied by a significant increase in the urinary excretion of the most important histamine metabolite, N tau-methylhistamine, in comparison with 15 non-responders (p less than or equal to 0.05) and placebo test. These results suggest an involvement of histamine in the pathogenesis of ASA-intolerance in chronic urticaria patients.

Quantitation of plasma levels of tetranectin--effects of oral contraceptives, pregnancy, treatment with L-asparaginase and liver cirrhosis.

Tetranectin is a tetrameric protein that binds to kringle 4 of plasminogen. Increase of electrophoretic mobility of the otherwise slowly migrating tetranectin in the presence of ethylenediaminetetraacetate was used to develop a reproducible electroimmunoassay to quantify plasma levels. Plasma levels in normals were found within narrow limits of 100 +/- 16 (SD)%, (100% = 0.15 mumol/l). There was no difference between males and females, smokers and non-smokers, and there were no significant changes with age from 20 to 49 years. Patients with severe liver cirrhosis showed a large variation in plasma tetranectin levels but no systematic or average reduction, in contrast to strong reductions in plasma levels of other proteins. Patients treated with L-asparaginase showed a gradual reduction in time in plasma levels of various proteins, though tetranectin showed no significant reduction. It is concluded that tetranectin can be assayed reproducibly in plasma and has a well regulated plasma level. This level is not sensitive to conditions with reductions in synthesis of many proteins, such as during cirrhosis of the liver and during L-asparaginase therapy. The reductions in plasma levels during the use of oral contraceptives and pregnancy indicate involvement of sex steroids in the metabolism of tetranectin.

Calcium-dependent binding of tetranectin to fibrin.

The plasma protein, tetranectin, capable of binding to kringle-4 of plasminogen, is reduced in serum after clotting of plasma. Fibrin binding is confirmed by the presence of tetranectin in clot lysates. The amount of tetranectin bound to the fibrin varies with the plasma level, but constitutes a constant percentage of 13-17% of the plasma tetranectin. The fibrin binding of tetranectin requires the presence of CaCl2, but is independent of factor XIII. Further, it is independent of the presence and fibrin binding of plasminogen. Reduction of tetranectin in serum of fresh blood (9%) is less than reduction in serum made from platelet-poor plasma (13-17%). This difference could be attributed to a releasable platelet pool of tetranectin. Extracts of platelets show around 15% tetranectin (relative to the plasma concentration). It is concluded that tetranectin can, upon coagulation, be released from platelets and become partially bound to fibrin.

Functional analogy between lipoprotein(a) and plasminogen in the binding to the kringle 4 binding protein, tetranectin.

Apolipoprotein(a), apo(a), contains 37 repeats structurally homologous to kringle 4 structures of the fibrinolysis zymogen plasminogen. The aim of the study was to explore the functional analogy between apolipoprotein(a) and plasminogen in the binding to the kringle-4-binding plasma protein, tetranectin. With a modified crossed immunoelectrophoresis technique, reversible binding between lipoprotein(a) and tetranectin could be demonstrated with an apparent Kd of 0.013 muMol/l. Lys- and Glu-plasminogen showed an apparent Kd of 0.5 muMol/l. Binding of lipoprotein(a) to fibrin and to fibrin-bound tetranectin was found to be negligible. The absence of fibrin binding of lipoprotein(a) excludes a potential mechanism of coexistence of fibrin and lipid deposits in arterial diseases and does not provide for a link between lipoprotein and the clotting system. Plasminogen and lipoprotein(a) show functional analogy in their binding to tetranectin, but tetranectin primarily targets at lipoprotein(a).

Modified crossed immunoelectrophoresis to study with whole plasma the reversible complex formation of histidine-rich glycoprotein with plasminogen.

To study the reversible complex formation between the plasma protein histidine-rich glycoprotein (HRG) and plasminogen, crossed immunoelectrophoresis of HRG was modified. In the modification, purified plasminogen was introduced into the gel of the first dimension electrophoresis. Two molecular forms of plasminogen, Glu- and Lys-plasminogen, induced a dose-dependent reduction of the electrophoretic mobility of HRG, with a half maximal retardation for both plasminogens at 0.50-0.55 microM of added plasminogen to the agarose gel. HRG in plasma behaved as a uniform fraction with respect to plasminogen binding. In contrast, with the same modified technique another plasma protein, alpha 2-antiplasmin, separated into a retarded plasminogen-binding form and a non-retarded non-plasminogen-binding form. The method can be used to assess several aspects of reversible complex formation between plasma proteins, as demonstrated for plasminogen binding of HRG and alpha 2-antiplasmin in whole plasma.

Specific fibrinolytic properties of different molecular forms of pro-urokinase from a monkey kidney cell culture.

The specific fibrinolytic properties of both high molecular weight (55 kd) and low molecular weight (30 kd) pro-urokinase from a monkey kidney cell culture were evaluated in a plasma clot lysis system and compared with those of human urokinase. The system was composed of a radiolabelled plasma clot immersed in plasma containing the fibrinolytic agent. On unit base, 55 kd pro-urokinase was approximately 1.5 times more effective in lysing the clot than 30 kd pro-urokinase and equally effective as urokinase. In contrast to urokinase, both pro-urokinase forms induced clot lysis without degrading fibrinogen in the surrounding plasma. However, a considerable activation of the fibrinolytic system in the plasma occurred as a large amount of alpha 2-antiplasmin was consumed, indicating that pro-urokinase was not fully fibrin-specific. Quenching antibodies against tissue-type plasminogen activator (t-PA) added to the plasma clot lysis system retarded but did not prevent pro-urokinase-induced clot lysis. This indicated that not only was t-PA in plasma involved in the activation of pro-urokinase (probably via plasmin), but that an additional mechanism also existed.

The mutual relationship between the two molecular forms of the major fibrinolysis inhibitor alpha-2-antiplasmin in blood.

Alpha-2-antiplasmin, a major inhibitor of fibrinolysis, is synthesized in the liver and occurs in blood in two molecular forms: a very active plasminogen-binding (PB) form and a less active nonplasminogen-binding (NPB) form. This study investigates the origin and mutual relationship of these two forms in vivo and in vitro. Despite wide variation in plasma concentration of the inhibitor (16% to 138%), the ratio between the two forms in vivo was found to be, in the main, constant among healthy volunteers, heterozygotes for a congenital deficiency of alpha-2-antiplasmin, and patients with a stable liver cirrhosis: PB/NPB = 2.41 +/- 0.34 (SD). Resynthesis after depletion or increased synthesis in the acute-phase reaction showed a specific increase of the PB form of the molecule in blood after discontinuation of L-asparaginase or streptokinase therapy and after myocardial infarction. In vitro studies demonstrated that only the PB form was present after one day in the culture medium of the human cell line Hep G2, while the NPB form appeared after 11 days. Clearance after inhibition of synthesis by L-asparaginase therapy revealed a more rapid decrease in the PB form relative to the NPB form in blood, demonstrated by a change in the PB-NPB ratio from 2.86 +/- 0.55 to 1.74 +/- 0.24 (mean of 6, SD). An apparently spontaneous first order conversion from the PB to NPB form, with an apparent half-life of about eight days, was demonstrated at 37 degrees C in plasma and serum in vitro. The conversion was found to be temperature dependent and uninfluenced by the fibrinolytic components fibrinogen, fibrin, and plasminogen. Additions of a variety of enzymes or inhibitors did not interfere with the process. These results demonstrate that the PB form of alpha-2-antiplasmin is produced by the liver and that the NPB form is formed in the circulation.

The molecular form of alpha 2-antiplasmin with affinity for plasminogen is selectively bound to fibrin by factor XIII.

Two molecular forms of alpha 2-antiplasmin (PB = plasminogen-binding; NPB = non-PB) exist. We have studied the extent of binding of these two forms to fibrin by factor XIII. A modified crossed immunoelectrophoresis technique which separately determines both forms showed that, compared with plasma, the PB-form is reduced by 31 +/- 11% (SD) in serum of twelve individuals and the NPB form by only 6%. Laurell assay showed a reduction of 18 +/- 9% (n = 12) in total alpha 2-antiplasmin antigen (PB + NPB) in serum; the immediate plasmin inhibition test (mainly recording the PB-form) revealed 35 +/- 6% (n = 12) reduction in inhibition. Coagulation of blood, platelet-rich and platelet-poor plasma yielded comparable results. No decrease in alpha 2-antiplasmin or change in its composition was observed when factor XIII-deficient plasma was clotted. Fibrin binding was not significantly different from normal in either plasminogen-depleted or plasminogen-enriched plasma. It is concluded that the PB-form of alpha 2-antiplasmin becomes selectively bound to fibrin.