Kilo-Scale GMP Synthesis of Renewable Semisynthetic Vaccine-Grade Squalene

Emulsions of the triterpene squalene ((6E,10E,14E,18E)-2,6,10,15,19,23-hexamethyltetracosa-2,6,10,14,18,22-hexaene, CAS 111-02-4) have been used as adjuvants in influenza vaccines since the 1990s. Traditionally sourced from shark liver oil, the overfishing of sharks and concomitant reduction in the oceanic shark population raises sustainability issues for vaccine adjuvant grade squalene. We report a semisynthetic route to squalene meeting current pharmacopeial specifications for use in vaccines that leverages the ready availability of trans-β-farnesene ((6E)-7,11-dimethyl-3-methylene-1,6,10-dodecatriene, CAS 18794-84-8), manufactured from sustainable sugarcane via a yeast fermentation process. The scalability of the proposed route was verified by a kilo-scale GMP synthesis. We also report data demonstrating the synthesized semi-synthetic squalene's physical stability and biological activity when used in a vaccine adjuvant formulation.

Abdominal aortic aneurysm detection by common femoral artery Doppler ultrasound waveform analysis

The aim of this research was to determine the effects of abdominal aortic aneurysm (AAA) on blood flow patterns in the common femoral artery (CFA) and to determine the feasibility of detecting AAA by analysis of the CFA Doppler waveform. CFA Doppler waveforms were measured from 30 patients with AAA and 30 normal patients without significant atherosclerotic disease. On visual inspection of the CFA waveforms five features were noted, predominantly in the AAA group, as being different from a normal CFA waveform: (1) spectral broadening on the systolic down stroke; (2) transient velocity spikes on the systolic down stroke; (3) an irregular reverse flow pattern; (4) simultaneous forward and reverse flow; and (5) waveform elongation with the reverse flow component extending throughout diastole. Based on visual identification of these five features it was possible to predict AAA with 93% sensitivity and 70% specificity in patients without significant atherosclerotic disease.

Forced degradation of Fas inhibits apoptosis in adenovirus-infected cells

DNA viruses have evolved elaborate mechanisms to overcome host antiviral defences. In adenovirus-infected cells, programmed cell death (apoptosis) induced by the cytokine tumour necrosis factor (TNF) is inhibited by several adenovirus-encoded proteins. Occupation of the cell-surface receptor Fas, a member of the TNF-receptor superfamily that is expressed on most cell types, triggers apoptosis of that cell. Here we show that the adenovirus RID (for receptor internalization and degradation) protein complex, which is an inhibitor of TNF-induced apoptosis, mediates internalization of cell-surface Fas and its destruction inside lysosomes within the cell. Fas has not previously been shown to be internalized and then degraded. RID also mediates internalization of the receptor for epidermal growth factor, but it does not affect the transferrin receptor or class I antigens of the major histocompatibility complex. Removal of Fas from the surface of adenovirus-infected cells expressing RID may allow infected cells to resist Fas-mediated cell death and thus promote their survival.

The gene organisation of the human beta 2 integrin subunit (CD18)

We have studied the gene of the human beta 2 integrin subunit (CD18) and found it to be organised into 16 exons spanning a region of about 40 kb. All exon/intron boundaries conform to the GT/AG splicing consensus. The exons coding for the cysteine-rich region, which has been postulated to consist of 3 or 4 repeating elements, are not organised correspondingly. Transcription of the gene initiates from multiple sites which may be due to the absence of an upstream TATA box. The polyadenylation site is also heterogeneous. Five different sites were identified over a stretch of 10 bases.

The primary structure of the beta-subunit of the cell surface adhesion glycoproteins LFA-1, CR3 and p150,95 and its relationship to the fibronectin receptor

The lymphocyte-function-associated antigen-1 (LFA-1), the complement receptor type 3 (CR3) and the antigen p150,95 are cell-surface glycoproteins. They are heterodimeric complexes, each containing a unique alpha-subunit noncovalently associated with a common beta-subunit. We have purified the beta-subunit from human spleen and obtained limited peptide sequences. What appears to be the complete primary structure for the fully processed beta-subunit was obtained by cDNA sequencing of clones from a phorbol ester (PMA) stimulated U937 cDNA library. There are five possible glycosylation sites and a transmembrane segment. The sequence contains a high level of cysteine (7.6%), with 24 of the 57 cysteine residues being found in three repeating units each with eight residues. The entire primary structure has 47% identity to a subunit of a fibronectin binding protein from chicken fibroblasts. It seems that LFA-1, CR3 and p150,95 antigens may belong to an extended family of cell surface molecules including the fibronectin binding protein.

Language disturbance. An initial symptom of cortical degenerations and dementia

Six patients manifested progressive language disturbance, resembling aphasia secondary to a focal dominant hemisphere lesion, as either an isolated initial symptom or a prominent early feature of a more generalized dementing illness. None had a history of transient ischemic attacks or stroke, and in all cases an extensive clinical and laboratory investigation failed to show either a focal brain lesion or a definable etiology of dementia. This article discusses the relationship of isolated or early aphasia to known dementing syndromes. Patients who consult physicians for language disturbance should be evaluated and followed up both for evidence of progressive language deterioration and for the development of a generalized dementia.

Synthesis, isolation, and characterization of two stereoisomeric ring sulfoxides of thioridazine

A selective oxidation of thioridazine to give exclusively its ring sulfoxides and a separation of the resulting products as diastereoisomeric pairs of enantiomers (DL, LD and DD, LL) are reported. These pairs were characterized by TLC, high-performance liquid chromatographic, IR, UV, 1H-NMR, 13C-NMR, GC-MS, and elemental analyses, and by reduction to thioridazine by lithium aluminum hydride. Structural data for the separated diastereoisomeric pairs or their nitric acid salts were obtained from NMR and IR studies. Gram quantities of each of the two diastereoisomeric pairs of enantiomers were isolated in better than 99% purity.

Simultaneous assay of thioridazine and its major metabolites in plasma at single dosage levels with a novel report of two ring sulfoxides of thioridazine

A highly sensitive and selective method of analysis of plasma for thioridazine and its major metabolites, including two isomers of the ring sulfoxide, is presented. It is suitable for following the metabolism of thioridazine for 24 hr after a single dose. The method involves extraction of the materials from plasma, high-performance liquid chromatographic separation, and postcolumn oxidation and fluorometric detection. The sensitivity of the method to thioridazine and its metabolites is 2 ng/ml. Recoveries ranged from 87.8 to 100.6% at levels between 20 and 400 ng/ml.

Thioridazine and its metabolites in post mortem blood, including two stereoisomeric ring sulfoxides

Thioridazine and metabolites were determined by a selective HPLC technique in blood from five post-mortem cases; two deaths attributed to drug overdose and three deaths due to natural causes or trauma. Additionally, total thioridazine-like compounds were determined in these blood samples and liver specimens by a nonspecific fluorometric technique. Blood concentrations were: thioridazine, 0.78-8.85 mg/L; mesoridazine, 0.52-26.8 mg/L; and sulforidazine, 0.00-0.87 mg/L. Thioridazine-5-sulfoxide stereoisomeric DL,LD, and DD,LL pair concentrations ranged from 0.02-0.56 and 0.03-0.83 mg/L, respectively. Thioridazine metabolite profiles were not helpful in differentiating therapeutic administration from severe overdose. Liver appears to be the specimen of choice in the assessment of thioridazine overdose.

Automated sampling of in vitro dissolution medium: effect of sampling probes on dissolution rate of prednisone tablets

The effect of sampling probe size and location on the in vitro dissolution rate of prednisone tablets was examined. Using USP XX Apparatus 2 with an automated sampling system, dissolution rates were determined using two types of large filter-tipped probes and a small capillary probe. Each probe was tested at three locations within the kettle. The large probes caused hydrodynamic changes which, when compared with results obtained through manual sampling, resulted in significant changes in dissolution rates at each location. These changes were less evident when the capillary probe was used, with an insignificant difference between results of automated and manual sampling when the capillary probe was placed midway between the paddle shaft and the kettle wall.

Systematic error associated with apparatus 2 of the USP dissolution test II: Effects of deviations in vessel curvature from that of a sphere

Dissolution vessels made from glass or plastic are recognized by the USP as being suitable for dissolution testing. Glass vessels with a bottom inside curvature flatter than that of a sphere can cause a high bias in dissolution results; vessels with a steeper curvature can cause a low bias. The inside bottom curvature of plastic vessels adhered closely to the curvature of a sphere. The plastic vessels are preferable for use if the drug is not adsorbed and the vessel is not attacked by the dissolution medium. Bias in results between individual positions of a dissolution apparatus was traced to two shafts which were not vertical.

Case studies in neuropsychiatry: diagnosis and treatment of coexistent dementia and depression

A case of coexisting dementia and depression is described. The diagnostic problem is discussed in detail, with special emphasis on the usefulness of the sodium amytal interview in establishing the existence of depression. The patient was treated with a course of ECT, with significant lifting of her depression and improvement in behavior despite the persistence of dementia.

Huntington's Chorea in South Wales. A genetic and epidemiological study

A study of Huntington's Chorea in South Wales has shown a prevalence of 7.61 per 100,000 in the counties of Gwent and Glamorgan, with a total population of 1.7 million. Heterozygote frequency is close to 1 in 5,000. Total ascertainment within this area has been attempted, and experience since conclusion of the study has shown no patients who have been omitted apart from those originating outside the area and those new cases with no living affected relatives. Analysis of migration patterns suggests that around 20% of cases in each generation arise from outside Glamorgan and Gwent and that around 12% of first-degree relatives of indigenous cases have left the area. The survey has formed the initial phase of a long-term prospective study of the disease involving systematic genetic counselling of all high-risk individuals and regular surveillance to monitor possible trends in future prevalence.

Case studies in neuropsychiatry: post-traumatic psychiatric dysfunction--diagnosis and treatment

A patient is described who had clear-cut personality and behavioral changes due to brain trauma. The organic basis of the psychiatric dysfunction was overlooked in diagnosis and treatment planning for a period of six years during which the patient experienced four psychiatric hospitalizations, had numerous encounters with police, and spent a six-month period in jail. The reasons for this neglect or organic etiologic factors are explored and discussed.

Scope of differential UV and differential fluorescence assays for phenothiazines: comparison with official methods

Operational difficulties have been encountered with many of the official phenothiazine assay procedures in this laboratory. Although some difficulties were corrected, the procedures still lack specificity. Accordingly, the general scope of differential UV and differential fluorescence methods was investigated. These specific methods are facile, reproducible, and applicable to both composite and single-tablet assays.

Case studies in neuropsychiaatry. II: Conversion pseudodementia

A patient is described who experienced pseudodementia as a conversion reaction. The patient was considered to be demented originally because of the evidence for profound cognitive impairment elicited on mental state examination. Careful analysis of the patient's verbal production in unstructured situations and of her behavior inthe hospital permitted a clinical diagnosis of pseudodementia to be made, a diagnosis confirmed by response to treatment and long term follow-up. Evidence is presented to support the interpretation of her pseudodementia as a conversion reaction.

A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus

In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrhage were also found more frequently among vaginally delivered fetuses. The authors conclude that for the low birth weight breech fetus, delivery by cesarean section is preferable.

Pseudodementia

Pseudodementia is the syndrome in which dementia is mimicked or caricatured by functional psychiatric disorders. The author describes 10 patients with pseudodementia and compares its clinical features with those of true dementia. The syndrome occurred in patients with various psychiatric diagnoses, but a striking feature in most patients was marked dependency. The recognition of this clinical syndrome should obviate the need for many neurological diagnostic studies and lead to earlier and more effective psychiatric treatment.

Manic psychosis in a patient with multiple metastatic brain tumors

A 45-year-old man, with neither previous psychiatric dysfunction nor a family history of manic-depressive illness, developed a manic psychosis coincident with the growth of 4 metastatic tumors in the right cerebral hemisphere. The psychosis responded well to treatment with lithium even though the metastatic lesions could not by eradicated with surgery or radiation.

Chronic brain disease: an overview

The author discusses the current state of clinical and pathological knowledge regarding chronic brain disease, focusing particularly on the dementias. His review of clinical studies deals with diagnostic issues and methods, etiology, and treatment. More basic research on brain alterations with aging, their relation to clinical manifestations of dementia, and studies of specific disorders are also reviewed. These disorders have been receiving increasing attention from psychiatrists, who are becoming more aware of the importance of organic cerebral factors in their patients' complaints. The need to understand the chronic brain diseases and their appropriate diagnosis and treatment will continue to grow as the proportion of older individuals in our society increases.

Leuco-erythroblastosis following withdrawal from glucocorticoid therapy

Leuco-erythroblastosis has many known associations (Burkett, Cox and Fields, 1965; Weick, Hagedorn and Linman, 1974; Retief, 1964), but the only ones related to drug therapy are the well established response to haematinics (Burkett et al., 1965) and one possible case following anti-epileptic therapy (Retief, 1964). The case described below is of leuco-erythroblastosis following steroid withdrawal in a young man with primary polymyositis.

Hallucinations as a conversion reaction

This clinical report describes a patient who experienced complex visual and auditory hallucinations as a conversion reaction. The evidence suggests that hallucinations as a conversion reaction are qualitatively different from other types of hallucinations.

A membrane-associated autoantibody in a case of myasthenia gravis with chronic hepatitis

A new antibody reacting with a cell membrane-related antigen is described in a patient with myasthenia gravis and chronic liver disease. The antibody gave a striking peripheral immunofluorescence in all cells tested and did not react with smooth muscle fibres, being distinct from anti-actin and anti-myosin antibodies. The antigen was widely distributed in human and animal tissues. The exact relationship of this antibody to the clinical condition is not obvious but its presence is further evidence of widespread disturbances of humoral immunity in myasthenia gravis.

Transient ictal psychosis

Transient psychotic episodes may result from continuous cerebral epileptiform discharges unaccompanied by clinically observed seizures. Such episodes may mimic depressive, hysterical and schizophrenic psychosis and delirium. I describe two patients here and review eight patient histories from the literature. Diagnosis is established by use of electroencephalography during the psychotic episode. Correct diagnosis is essential because specific treatment is available and additional episodes may be prevented by appropriate long-term anticonvulsant therapy.

Chorea, polycythaemis, and cyanotic heart disease

Two cases of polycythaemic chorea are described, both of which were complicated by severe heart disease. The first was a child with patent ductus arteriosus and coarctation of the aorta causing severe cyanosis and secondary polycythaemia. Chorea began intermittently at an early age, becoming continuous by his fifth birthday. The second was a middle-aged male with tight mitral stenosis and a story of paralytic chorea in his teens. Polycythaemia rubra vera was eventually diagnosed two years after mitral valvotomy, some seven years after the onset of chorea.

Stability study of nitroglycerin sublingual tablets

Nitroglycerin sublingual tablets were studied over a 1-year period to determine tablet stability in terms of loss of strength, uniformity of tablets, and degradation of the drug itself. Tablets from six different firms were analyzed by a semiautomated procedure. The samples included two molded tablets and four compressed tablets, ranging in age at the time of initial assay from 40 days to over 1 year. The results indicated that there is a loss of strength of nitroglycerin tablets and that refrigeration slows down this loss. The study also indicated that these tablets were stable during the year of testing in terms of tablet uniformity and degradation of nitroglycerin.