Effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir and combinations thereof in hospitalized patients with COVID-19: a pragmatic, open-label randomized trial.

BACKGROUND: The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. METHODS: This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095. FINDINGS: Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. INTERPRETATION: The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.

Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs.

OBJECTIVES: Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs. MATERIALS AND METHODS: Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia. RESULTS: Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively. CLINICAL SIGNIFICANCE: Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.

Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

Laparoscopia en la contracepción: clips de filshie versus anillos de yoon / Laparoscopy in the contraception: clips of filshie versus ring of yoon

Objetivo: Comparar la aplicación de clips de Filshie contra anillos de Yoon a través de laparoscopia para identificar cual método tiene menos complicaciones. Material y Métodos: De 1999 a 2004 en el Servicio de Endoscopia Ginecológica de la División de Ginecología y Obstetricia del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" se realizó un estudio de tipo analítico, casos y controles, en 260 pacientes que se les aplicó clips de Filshie comparándolos con 260 pacientes con anillos de Yoon, utilizándose como pruebas estadística Chi cuadrado y exacta de Fisher. Resultados: Ambos grupos fueron similares en edad, estado civil, peso y talla, hijos vivos, antecedente de cesárea y modalidad (intervalo o postparto). Se presentaron complicaciones en 7 pacientes del grupo de clips de Filshie, mientras en el grupo de anillos de Yoon hubo complicaciones en 15 pacientes, requiriendo laparatomía en tres casos; diferencias no significativas (X2=2,32; p=0,12). Conclusión: La aplicación de clips de Filshie y los anillos de Yoon presentan similar número de complicaciones en la contracepción quirúrgica laparoscópica. Se recomienda la aplicación de clips de Filshie especialmente en mujeres jóvenes por mayor probabilidad de solicitud de revertir el procedimiento

Cancer risk estimation of genotoxic chemicals based on target dose and a multiplicative model.

A mechanistic model and associated procedures are proposed for cancer risk assessment of genotoxic chemicals. As previously shown for ionizing radiation, a linear multiplicative model was found to be compatible with published experimental data for ethylene oxide, acrylamide, and butadiene. The validity of this model was anticipated in view of the multiplicative interaction of mutation with inherited and acquired growth-promoting conditions. Concurrent analysis led to rejection of an additive model (i.e. the model commonly applied for cancer risk assessment). A reanalysis of data for radiogenic cancer in mouse, dog and man shows that the relative risk coefficient is approximately the same (0.4 to 0.5 percent per rad) for tumours induced in the three species. Doses in vivo, defined as the time-integrated concentrations of ultimate mutagens, expressed in millimol x kg-1 x h (mMh) are, like radiation doses given in Gy or rad, proportional to frequencies of potentially mutagenic events. The radiation dose equivalents of chemical doses are, calculated by multiplying chemical doses (in mMh) with the relative genotoxic potencies (in rad x mMh-1) determined in vitro. In this way the relative cancer incidence increments in rats and mice exposed to ethylene oxide were shown to be about 0.4 percent per rad-equivalent, in agreement with the data for radiogenic cancer. Our analyses suggest that values of the relative risk coefficients for genotoxic chemicals are independent of species and that relative cancer risks determined in animal tests apply also to humans. If reliable animal test data are not available, cancer risks may be estimated by the relative potency. In both cases exposure dose/target dose relationships, the latter via macromolecule adducts, should be determined.

Formation of DNA adducts in human buccal epithelial cells exposed to acetaldehyde and methylglyoxal in vitro.

Acetaldehyde (AA) and methylglyoxal (MG) are reactive, ubiquitous aldehydes, present in the environment and endogenously formed in animals and humans. They have both been shown to readily form DNA adducts under simulated physiological conditions. We report here on the use of cultured normal and SV40T antigen-immortalized human buccal epithelial cells as model systems for aldehyde exposure of the oral epithelium, occurring through the ingestion of alcoholic beverages and brewed coffee, as well as by inhalation of tobacco smoke and automobile exhaust. By the application of recently developed 32P-postlabeling methods, the presence of both endogenous and induced AA and MG DNA adducts was demonstrated in cultured human epithelial cells. Furthermore, these DNA adducts were formed in a dose-dependent manner at aldehyde concentrations that were relatively nontoxic to the cells.

High dietary omega-6 polyunsaturated fatty acids drastically increase the formation of etheno-DNA base adducts in white blood cells of female subjects.

Lipid peroxidation generates reactive aldehydes such as trans-4-hydroxy-2-nonenal and malonaldehyde, which form promutagenic exocyclic DNA adducts in human cells and may contribute to diet-related cancers. Using ultrasensitive detection methods, analysis of WBC DNA from volunteers in a dietary study revealed that high intake of omega-6 polyunsaturated fatty acids increased malonaldehyde-derived adducts in male and female subjects. In contrast, etheno adducts (1,N6-ethenodeoxyadenosine; 3,N4-ethenodeoxycytidine) were not elevated in males but were, on average, 40 times higher in females, displaying a huge intersubject variation in lipid peroxidation-derived DNA damage. Exocyclic DNA adducts are promising biomarkers for examining the hypothesis of possible links between increased intake of dietary omega-6 polyunsaturated fatty acids, DNA damage, and elevated cancer risk for breast, colon, and prostate.

Detection of DNA adducts of acetaldehyde in peripheral white blood cells of alcohol abusers.

The effect of alcohol drinking on the formation of DNA adducts of acetaldehyde, the primary oxidative metabolite of ethanol, was investigated in humans. DNA was isolated from granulocytes and lymphocytes from 24 alcoholic patients and 12 control subjects. DNA adduct levels were measured by 32P-postlabelling using reversed-phase HPLC with on-line detection of radioactivity. A large interindividual variation in adduct levels was observed. The average adduct levels in granulocyte and lymphocyte DNA from alcoholic patients were 3.4 +/- 3.8 and 2.1 +/- 0.8 adducts/10(7) nucleotides (n = 24), respectively. These levels were 13- and 7-fold higher than the corresponding levels in control subjects (P<0.001). The average adduct level in granulocyte DNA from alcoholic patients was 60% higher than in lymphocyte DNA (P<0.01). Our results, in conjunction with the genotoxicity of acetaldehyde, thus suggest the formation of DNA adducts of acetaldehyde as a plausible mechanism explaining the involvement of alcohol drinking in carcinogenesis.

Determination of DNA adducts of malonaldehyde in humans: effects of dietary fatty acid composition.

The effects of dietary fatty acid composition on the endogenous formation of DNA adducts of malonaldehyde (MA), the major product of lipid peroxidation, were investigated in humans. A group of 59 healthy individuals of both sexes and different ages was initially fed a milk fat-based diet rich in saturated fatty acids for 14 days. Following this initial period, after which the group was considered homogeneous with respect to diet, 30 randomly chosen subjects were given a sunflower oil-based (rich in polyunsaturated fatty acids) (SO) diet and the remaining 29 individuals a low erucic acid rapeseed oil-based (rich in monounsaturated fatty acids) (RO) diet for 25 days. The fatty acid composition of plasma lipid fractions and the level of DNA adducts of MA in total white blood cells were then determined at the end of the SO and RO dietary periods. DNA adduct levels were measured by 32p-postlabelling using reversed-phase HPLC with on-line detection of radioactivity. Higher concentrations of polyunsaturated fatty acids in plasma triglycerides and higher levels of DNA adducts of MA were found in the subjects on the SO diet when compared with those in the RO dietary group. A large inter-individual variation in adduct levels was observed. The average adduct level in the SO diet group was 7.4 +/- 8.7 adducts/10(7) nucleotides (n = 23). This level was 3.6-fold higher than that found in individuals in the RO diet group (P < 0.001). Our results, in conjunction with the mutagenic and carcinogenic properties of MA, thus suggest the interaction of lipid peroxidation products such as MA with DNA as one plausible mechanism explaining the involvement of dietary fat in carcinogenesis.

Studies of the reaction of acetaldehyde with deoxynucleosides.

The reaction of acetaldehyde with deoxynucleosides was studied in buffered solutions at room temperature (22-24 degrees C) and neutral pH. Reaction products were obtained with all deoxynucleosides with the exception of thymidine, as shown by reversed-phase HPLC analysis. The order of reactivity was dGuo > dAdo > dCyd, for which three, two and one reaction products, respectively, were obtained. We report here data on the kinetics of the reactions, the stability of the adducts at physiological pH, product yields, UV-spectroscopic data at different pH values, and describe the synthesis, isolation and structural characterization by FAB/MS and NMR of the stable adducts of acetaldehyde with dGuo. Furthermore, the formation of adducts with dGuo by the cooperative reaction of Aa with ethanol was studied.

Development of a 32P-postlabelling method for the analysis of adducts arising through the reaction of acetaldehyde with 2'-deoxyguanosine-3'-monophosphate and DNA.

A 32P-postlabelling assay was developed for the analysis of adducts arising from the reaction of 2'-deoxyguanosine-3'-monophosphate with acetaldehyde, the primary oxidative metabolite of ethanol. The 32P-postlabelling reaction was optimized by testing various parameters such as the kinetics of phosphorylation by T4 polynucleotide kinase, substrate-concentration-dependent labelling efficiency and the concentration of the various ingredients of the phosphorylation reaction. The sensitivity to 3'-monophosphate dephosphorylation activity of nuclease P1 was also studied. Three stable adducts were separated by reversed-phase HPLC. The major stable adduct was structurally characterized and identified as N2-ethyl-2'-deoxyguanosine and could be detected, after reduction with NaBH4 or a mixture of ascorbic acid and GSH, in calf thymus DNA samples that had been reacted in vitro with acetaldehyde. DNA adducts were isolated after enzymatic digestion to mononucleotides followed by nuclease P1 digestion of normal nucleotides. The average levels of acetaldehyde-DNA adducts detected in these samples were 12.1 +/- 2.3 (n = 17) and 4.9 +/- 0.9 (n = 9) adducts/10(7) nucleotides after reduction with NaBH4, or ascorbic acid and GSH respectively. The 32P-postlabelling method was further validated by the detection of acetaldehyde adducts in liver DNA from mice treated with ethanol. The average concentration of the adducts detected in these animals was 1.5 +/- 0.8 (n = 7) adducts/10(8) nucleotides, as analyzed by reversed-phase HPLC with online detection of radioactivity.

32P-postlabelling determination of DNA adducts of malonaldehyde in humans: total white blood cells and breast tissue.

DNA adducts of malonaldehyde (MA) were measured in total white blood cells (TWBC) of healthy individuals from both sexes and different ages, as well as in breast tissue (BT) samples obtained from healthy females undergoing reduction mammaplasty. A large interindividual variation in adduct levels was observed. The average adduct level found in TWBC, considering both sexes and all ages was 2.6 +/- 1.2 adducts/10(7) nucleotides (n = 26). A similar average DNA adduct concentration was found in BT and amounted to 3.0 +/- 1.3 (n = 7) adducts/10(7) nucleotides. Our results show that DNA adducts of MA can be measured in humans using 32P-postlabelling in combination with nuclease P1 and reversed-phase HPLC as adduct enrichment procedures, and further validate these adducts as suitable biomarkers for the measurement of DNA damage inflicted by endogenously induced oxidative processes such as lipid peroxidation.

Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels.

PURPOSE: In patients with septic shock, to (1) determine the incidence of adrenal insufficiency (AI), (2) observe the effects of glucocorticoid therapy on outcome in those with impaired adrenal function, and (3) investigate a possible correlation between adrenal function and peripheral cytokine levels. PATIENTS AND METHODS: Twenty-one patients admitted to the medical and surgical intensive care unit with septic shock and 11 healthy volunteers were studied. Cortisol, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) levels were measured before and after infusion of low (1 microgram) and standard doses (250 micrograms) of adrenocorticotropic hormone (ACTH) within 24 hours of the diagnosis of septic shock. Patients with subnormal adrenal responses to ACTH were treated with stress doses of steroids. Hormone, cytokine, and survival data in patients with normal response were compared to those with subnormal adrenal function. RESULTS: Five patients (23.8%) exhibited AI by ACTH stimulation testing. Three of them received steroid supplementation with rapid improvement in hemodynamic parameters. Autopsies of 2 patients with AI revealed intact adrenal cortices. Sixteen patients had adequate adrenal responses (AAR) to the standard-dose ACTH infusion. TNF-alpha levels were inversely correlated with mean arterial pressure (MAP) (r = -.52, P = 0.038) in AAR but not AI. There was no difference in mean peripheral TNF-alpha levels between AAR and AI. There was no correlation between TNF-alpha levels and mortality or adrenal function in those with septic shock. A trend toward lower IL-6 levels in AI suggests a link between reduced IL-6 levels and understimulation of the pituitary-adrenal axis in this group. Mortality in patients with AI was 80% at 4 weeks as compared with 43.8% in the group with normal adrenal response. CONCLUSIONS: Adrenal hyporesponsiveness is a feature of septic shock in some patients. Its etiology is probably complex. Steroid supplementation appeared to improve short-term survival when AI occurred, although these patients' overall mortality was worse than that of patients with septic shock and AAR. The standard-dose (250 micrograms) rapid ACTH infusion test was adequate for detecting AI. Adrenal insufficiency should be suspected in patients with septic shock who do not respond to conventional treatment. Performing the ACTH infusion test and initiating a trial of stress doses of glucocorticoids pending the results is a reasonable strategy in this situation.

Methylglyoxal induces hprt mutation and DNA adducts in human T-lymphocytes in vitro.

Methylglyoxal (MG) is a mutagen present in several foodstuffs, including coffee. We have used the 32P-postlabelling method to measure MG-deoxyguanosine adduct levels, and the T-cell cloning technique, to study the frequency of hprt (hypoxanthine-guanine phosphoribosyl transferase) mutant cells after treatment of human lymphocytes with MG in vitro. The mutant induction by single (18 hr) high-dose (1.0-1.5 mM) treatment was comparable to that induced by repeated (3 x 48 hr) low-dose (0.1-0.4 mM) treatment. The latter also correlated with the adduct levels measured in the same experiment. The relative cell survival measured by direct cloning after the final treatment agreed well with the growth curves monitored during the expression phase. Our results show that MG is capable of inducing hprt mutations as well as DNA adducts in human lymphocytes at doses with low cytotoxicity. However, significant adduct formation (two- to threefold) could be obtained only after the first exposure in cells subjected to a repeated treatment protocol, and the induced mutant frequency was low (two- to fourfold over background). Thus, MG seems to be a comparatively weak mutagen in this system.

Synthesis of fluorescent derivatives of 7-methylguanine through reaction with 2-aryl-substituted malondialdehydes: analysis by HPLC with fluorescence detection.

Fluorescent derivatives of 7-methylguanine were prepared through reaction with 2-aryl-substituted-malondialdehydes and analysed by reversed-phase HPLC with fluorescence detection. Reaction of carbons 1 and 3 of the malondialdehyde molecule at the N1 and N2 positions of 7-methylguanine yielded fluorescent tricyclic structures. Two novel fluorescent derivatives of 7-MeG were obtained, namely, 7-(3,4-dimethoxyphenyl)-10-oxo-1-methyl-9,10-dihydropyrimido[1,2- alpha]purine (yield 15-34%) and 7-(1-naphthyl)-10-oxo-1-methyl-9,10- dihydropyrimido[1,2-alpha]purine (yield 56-70%) after reaction with 3,4-dimethoxyphenylmalondialdehyde and 1-naphthylmalondialdehyde, respectively which were characterized by IR, NMR, MS and UV and fluorescence spectroscopy. The fluorescence intensity of the derivatives was found to be 10-20-fold higher than the intrinsic fluorescence of 7-methylguanine. Concentration versus fluorescence intensity curves exhibit linearity in the picomole to nanomole range. The 2-aryl-substituted malondialdehydes were used to analyse the concentration of 7-methylguanine in neutral hydrolysates obtained from calf thymus DNA samples alkylated with dimethyl sulfate. The results obtained indicate their potential as reagents for the analysis of alkylated guanines in biological samples. Molecular modeling calculations were carried out to generate lowest energy spatial configurations. The results obtained indicated that the aryl-substituents on the malondialdehyde moiety do not lie in the same plane as the tricyclic moiety of the fluorescent derivatives with implications for their fluorescence properties.

32P-postlabelling analysis of DNA adducts in humans: adduct distribution and method improvement.

32P-Postlabelling was applied to study the distribution of adducts in white blood cells of foundry workers exposed to polycylic aromatic hydrocarbons. The distribution of the adducts among 63 workers followed an apparently trimodal pattern, which could relate to polymorphism in PAH metabolism. A modified postlabelling method is described and some parameters were tested for optimal labelling. The total volume of the polynucleotide kinase reaction is 2 microliters, which decreases exposure to radioactivity and costs of isotopes.

Development of a 32P-postlabelling method for the analysis of 2'-deoxyguanosine-3'-monophosphate and DNA adducts of methylglyoxal.

A 32P-postlabelling assay was developed for the analysis of adducts arising from the reaction of 2'-deoxyguanosine-3'-monophosphate with the 1,2-dicarbonyl compound methylglyoxal, a major mutagen in several foodstuffs, in particular, instant and brewed coffee. The 32P-postlabelling reaction was optimized by testing various parameters such as the kinetics of phosphorylation by T4 polynucleotide kinase, substrate concentration-dependent labelling efficiency and the concentration of the various ingredients of the phosphorylation reaction. The sensitivity to the 3'-monophosphate dephosphorylation activity of nuclease P1 was also studied. Four isomeric reaction products were separated by HPLC, structurally characterized and identified as 3-(2'-deoxy-beta-D-erythro-pentafuranosyl)-6,7-dihydro-6,7-dihydro xy-6- methylimidazo[2,3-b]purine-9(8H)one. The same adducts could be detected from calf thymus DNA that had been reacted in vitro with methylglyoxal. DNA adducts were isolated after enzymatic digestion to mononucleotides followed by nuclease P1 digestion of normal nucleotides. The total level of methylglyoxal-DNA adducts obtained was 5.7 +/- 1.7 (n = 15) adducts/10(6) nucleotides. The 32P-postlabelling method was further validated by the detection of adducts of methylglyoxal in DNA from freshly isolated and stimulated human lymphocytes exposed in vitro. The concentrations of the adducts detected in these samples were 8.2 +/- 0.9 (n = 3) adducts/10(7) nucleotides and 1.5 +/- 0.1 (n = 3) adducts/10(6) nucleotides after treatment with 1.5 and 3.0 mM methylglyoxal respectively.

Studies on the relationship between hemoglobin and DNA adducts of malonaldehyde and their stability in vivo.

The stability of the adducts of malonaldehyde (MA) to N-terminal valine in hemoglobin (Hb) and to guanine at N1,N2 in liver DNA was determined in vivo. Mice were injected with radiolabeled or unlabeled MA and the decay of the levels of Hb and DNA adducts was determined using the N-alkyl Edman method and the 32P-postlabeling assay respectively. The rate of adduct formation was much higher towards valine in Hb than towards guanine in DNA. The highest level of adducts to valine was observed 4 h after the treatment, whereas the corresponding level for guanine was after approximately 120 h. The adduct to guanine in DNA was significantly more stable. The estimated half-lives of the adduct to N-terminal valine in Hb and for the adduct to guanine in DNA were approximately 6 and approximately 12.5 days respectively. The persistence of DNA adducts from MA in liver indicates that this type of adduct is poorly recognized by DNA repair enzymes and thus may accumulate during chronic exposure.