Biomaterial engineering for cell transplantation

The current paradigm of medicine is mostly designed to block or prevent pathological events. Once the disease-led tissue damage occurs, the limited endogenous regeneration may lead to depletion or loss of function for cells in the tissues. Cell therapy is rapidly evolving and influencing the field of medicine, where in some instances attempts to address cell loss in the body. Due to their biological function, engineerability, and their responsiveness to stimuli, cells are ideal candidates for therapeutic applications in many cases. Such promise is yet to be fully obtained as delivery of cells that functionally integrate with the desired tissues upon transplantation is still a topic of scientific research and development. Main known impediments for cell therapy include mechanical insults, cell viability, host's immune response, and lack of required nutrients for the transplanted cells. These challenges could be divided into three different steps: 1) Prior to, 2) during the and 3) after the transplantation procedure. In this review, we attempt to briefly summarize published approaches employing biomaterials to mitigate the above technical challenges. Biomaterials are offering an engineerable platform that could be tuned for different classes of cell transplantation to potentially enhance and lengthen the pharmacodynamics of cell therapies.

Cell Encapsulation and 3D Bioprinting for Therapeutic Cell Transplantation

The promise of cell therapy has been augmented by introducing biomaterials, where intricate scaffold shapes are fabricated to accommodate the cells within. In this review, we first discuss cell encapsulation and the promising potential of biomaterials to overcome challenges associated with cell therapy, particularly cellular function and longevity. More specifically, cell therapies in the context of autoimmune disorders, neurodegenerative diseases, and cancer are reviewed from the perspectives of preclinical findings as well as available clinical data. Next, techniques to fabricate cell-biomaterials constructs, focusing on emerging 3D bioprinting technologies, will be reviewed. 3D bioprinting is an advancing field that enables fabricating complex, interconnected, and consistent cell-based constructs capable of scaling up highly reproducible cell-biomaterials platforms with high precision. It is expected that 3D bioprinting devices will expand and become more precise, scalable, and appropriate for clinical manufacturing. Rather than one printer fits all, seeing more application-specific printer types, such as a bioprinter for bone tissue fabrication, which would be different from a bioprinter for skin tissue fabrication, is anticipated in the future.

Exosome loaded immunomodulatory biomaterials alleviate local immune response in immunocompetent diabetic mice post islet xenotransplantation

Foreign body response (FBR) to biomaterials compromises the function of implants and leads to medical complications. Here, we report a hybrid alginate microcapsule (AlgXO) that attenuated the immune response after implantation, through releasing exosomes derived from human Umbilical Cord Mesenchymal Stem Cells (XOs). Upon release, XOs suppress the local immune microenvironment, where xenotransplantation of rat islets encapsulated in AlgXO led to >170 days euglycemia in immunocompetent mouse model of Type 1 Diabetes. In vitro analyses revealed that XOs suppressed the proliferation of CD3/CD28 activated splenocytes and CD3+ T cells. Comparing suppressive potency of XOs in purified CD3+ T cells versus splenocytes, we found XOs more profoundly suppressed T cells in the splenocytes co-culture, where a heterogenous cell population is present. XOs also suppressed CD3/CD28 activated human peripheral blood mononuclear cells (PBMCs) and reduced their cytokine secretion including IL-2, IL-6, IL-12p70, IL-22, and TNFα. We further demonstrate that XOs mechanism of action is likely mediated via myeloid cells and XOs suppress both murine and human macrophages partly by interfering with NFκB pathway. We propose that through controlled release of XOs, AlgXO provide a promising new platform that could alleviate the local immune response to implantable biomaterials.

Preferences of Type 1 Diabetic Patients on Devices for Islet Transplantation

Transplantation of pancreatic islets within a biomaterial device is currently under investigation in clinical trials for the treatment of patients with type 1 diabetes (T1D). Patients’ preferences on such implants could guide the designs of next-generation implantable devices; however, such information is not currently available. We surveyed the preferences of 482 patients with T1D on the size, shape, visibility, and transplantation site of islet containing implants. More than 83% of participants were willing to receive autologous stem cells, and there was no significant association between implant fabricated by one’s own stem cell with gender (χ² (1, n = 468) = 0.28; P = 0.6) or with age (χ² (4, n = 468) = 2.92; P = 0.6). Preferred location for islet transplantation within devices was under the skin (52.7%). 48.3% preferred microscopic disks, and 32.3% preferred a thin device (like a credit card). Moreover, 58.4% preferred the implant to be as small as possible, 25.4% did not care about visibility, and 16.2% preferred their implants not to be visible. Among female participants, 81% cared about the implant visibility, whereas this number was 64% for male respondents (χ² test (1, n = 468) = 16.34; P < 0.0001). 22% of those younger than 50 years of age and 30% of those older than 50 did not care about the visibility of implant (χ² test (4, n = 468) = 23.69; P < 0.0001). These results suggest that subcutaneous sites and micron-sized devices are preferred choices among patients with T1D who participated in our survey.

Dendritic Cells as Targets for Biomaterial-Based Immunomodulation

Various subtypes of immunocytes react against implanted biomaterials to eliminate the foreign body object from the host's body. Among these cells, dendritic cells (DCs) play a key role in early immune response, later engaging lymphocytes through antigens presentation. Due to their capability to induce tolerogenic or immunogenic responses, DCs have been considered as key therapeutic targets for immunomodulatory products. For instance, tolerogenic DCs are applied in the treatment of autoimmune diseases, rejection of allograft transplantation, and implanted biomaterial. Due to the emerging importance of DCs in immunomodulatory biomaterials, this Review summarizes DCs' responses-such as adhesion, migration, and maturation-to biomaterials. We also review some examples of key molecules and their applications in DCs' immunoengineering. These evaluations would pave the way for designing advanced biomaterials and nanomaterials to modulate the immune system, applicable in tissue engineering, transplantation, and drug delivery technologies.

Biohybrid Nanoparticles to Negotiate with Biological Barriers

Incapability of effective cross-talk with biological environments has partly impaired the in vivo functionality of nanoparticles (NPs). Homing, biodistribution, and function of NPs could be engineered through regulating their interactions with in vivo niches. Inspired by communications in biological systems, endowing a "biological identity" to synthetic NPs is one approach to control their biodistribution, and immunonegotiation profiles. This synthetic-biological combination is referred to as biohybrid NPs, which comprise both i) engineerable, readily producible, and trackable synthetic NPs as well as ii) biological moieties with the capability to cross-talk with immunological barriers. Here, the latest understanding on the in vivo interactions of NPs, biological barriers they face, and emerging methods for quantitative measurements of NPs' biodistribution are reviewed. Some key biomolecules that have emerged as negotiators with the immune system in the context of cancer and autoimmunity, and their inspirations on biohybrid NPs are introduced. Critical design considerations for efficient cross-talk between NPs and innate and adaptive immunity followed by hybridization methods are also discussed. Finally, clinical translation challenges and future perspectives regarding biohybrid NPs are discussed.

On the assessment of incorporation of CNT-TiO2 core-shell structures into nanoparticle TiO2 photoanodes in dye-sensitized solar cells

Herein, we report dye-sensitized solar cells (DSCs) based on conventional nanocrystalline TiO2 photoanodes decorated with one-dimensional (1D) CNT-TiO2 core-shell structures (CTH). The core-shell nanotubes are synthesized by a simple sol-gel template-assisted method via in situ deposition of TiO2 on the surface of non-covalently functionalized CNTs. The core-shell nanotubes are well characterized by various techniques. Field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) images show that formation of the TiO2 shell on the surface of the CNT core follows a layer or Frank-van der Merwe growth mode, resulting in a highly uniform interface with excellent charge transfer from the TiO2 conduction band into the CNTs. The thickness and crystal structure of the TiO2 shell can be tailored by controlling the processing parameters. X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy verify that CNTs have no surface defects and are well preserved using the employed method and the subsequent heat treatment in air, respectively. UV-vis spectroscopy and photoluminescence spectroscopy reveal an extension to visible regions with an increase in overall intensity and a significant reduction in charge recombination due to a shift of the Fermi level toward positive potentials. We find an increase by up to 37% in the DSC device's power conversion efficiency by incorporating the CNT-TiO2 core-shell nanotubes into the nanoparticle TiO2 photoanode due to the charge recombination reduction and electron injection enhancement.

Stem Cell-Derived Exosomes as Nanotherapeutics for Autoimmune and Neurodegenerative Disorders

To dissect therapeutic mechanisms of transplanted stem cells and develop exosome-based nanotherapeutics in treating autoimmune and neurodegenerative diseases, we assessed the effect of exosomes secreted from human mesenchymal stem cells (MSCs) in treating multiple sclerosis using an experimental autoimmune encephalomyelitis (EAE) mouse model. We found that intravenous administration of exosomes produced by MSCs stimulated by IFNγ (IFNγ-Exo) (i) reduced the mean clinical score of EAE mice compared to PBS control, (ii) reduced demyelination, (iii) decreased neuroinflammation, and (iv) upregulated the number of CD4+CD25+FOXP3+ regulatory T cells (Tregs) within the spinal cords of EAE mice. Co-culture of IFNγ-Exo with activated peripheral blood mononuclear cells (PBMCs) cells in vitro reduced PBMC proliferation and levels of pro-inflammatory Th1 and Th17 cytokines including IL-6, IL-12p70, IL-17AF, and IL-22 yet increased levels of immunosuppressive cytokine indoleamine 2,3-dioxygenase. IFNγ-Exo could also induce Tregs in vitro in a murine splenocyte culture, likely mediated by a third-party accessory cell type. Further, IFNγ-Exo characterization by deep RNA sequencing suggested that IFNγ-Exo contains anti-inflammatory RNAs, where their inactivation partially hindered the exosomes potential to induce Tregs. Furthermore, we found that IFNγ-Exo harbors multiple anti-inflammatory and neuroprotective proteins. These results not only shed light on stem cell therapeutic mechanisms but also provide evidence that MSC-derived exosomes can potentially serve as cell-free therapies in creating a tolerogenic immune response to treat autoimmune and central nervous system disorders.

Solvent engineering based on triethylenetetramine (TETA) for perovskite solar cells processed in ambient-air

Solvent engineering as a crucial factor in determining the photovoltaic performance of perovskite solar cells has attracted much attention in recent years. Herein, we treat PbI2 and perovskite films with isopropyl alcohol, acetone, diethyl ether and dichloromethane, as standard solvents, in a modified two-step method. Meanwhile, triethylenetetramine (TETA) is introduced as a new reagent in solvent engineering for perovskite solar cell devices. Structural, optical and photovoltaic characteristics of the TETA-treated perovskite films are compared with those of the ones treated with different solvents. A shiny, pinhole-free and full-coverage texture with sufficiently large grain sizes is obtained in the presence of TETA, suggesting an efficient solvent engineering for perovskite layers. Moreover, the results reveal that residual PbI2 is completely removed and converted to a crystalline perovskite film. Amongst the PSC devices engineered with various solvents, the TETA-treated film exhibits a 55% increase in photoconversion efficiency compared to the control device with no solvent engineering.

The Characteristics, Reliability and Validity of the Persian Version of Simplified Nutritional Appetite Questionnaire (SNAQ)

BACKGROUND/AIMS

Using a reliable and valid instrument to measure appetite is highly important in clinical practice and research. We aimed to evaluate characteristics, reliability and validity of the Persian version of simplified nutritional appetite questionnaire (SNAQ).

MATERIAL AND METHODS

After face and content validation of the SNAQ by a panel of experts, the reliability and validity of the Persian form of this questionnaire were assessed among 213 weight-reduction seeking women referring to a nutrition clinic. Furthermore, the factor analysis was performed by varimax rotation method.

RESULTS

Confirmatory factor analysis shows that all items of the questionnaire are unified and loaded on one factor of "appetite". Internal consistency of the test was approved by Cronbach's alpha coefficient of 0.7. The test-retest reliability of the questionnaire was performed within a two weeks interval. The Pearson correlation showed a consistency of 0.85 between the two administrations (p<0.0001). Concurrent Validity of SNAQ with other eating questionnaires and visual analogue rating scale for appetite (r=0.7, p<0.001)) shows strong correlation. The SNAQ was positively correlated with total dietary calorie intake (r=0.23, p=0.018) Also convergent validity with body composition measurements shows positive weak correlation with body weight, waist circumference, and total body fat percentage, and negative correlation with muscle mass (divergent validity).

CONCLUSION

The current study provides sufficient supports in favor of the reliability and validity of the Persian version of the SNAQ. This questionnaire is a simple and valid instrument to assess the patient's increased appetite in practice and research.

Approaches in Immunotherapy, Regenerative Medicine, and Bioengineering for Type 1 Diabetes

Recent advances on using immune and stem cells as two-pronged approaches for type 1 diabetes mellitus (T1DM) treatment show promise for advancement into clinical practice. As T1DM is thought to arise from autoimmune attack destroying pancreatic β-cells, increasing treatments that use biologics and cells to manipulate the immune system are achieving better results in pre-clinical and clinical studies. Increasingly, focus has shifted from small molecule drugs that suppress the immune system nonspecifically to more complex biologics that show enhanced efficacy due to their selectivity for specific types of immune cells. Approaches that seek to inhibit only autoreactive effector T cells or enhance the suppressive regulatory T cell subset are showing remarkable promise. These modern immune interventions are also enabling the transplantation of pancreatic islets or β-like cells derived from stem cells. While complete immune tolerance and body acceptance of grafted islets and cells is still challenging, bioengineering approaches that shield the implanted cells are also advancing. Integrating immunotherapy, stem cell-mediated β-cell or islet production and bioengineering to interface with the patient is expected to lead to a durable cure or pave the way for a clinical solution for T1DM.

Strategies for directing cells into building functional hearts and parts

This review presents the current state-of-the-art, emerging directions and future trends to direct cells for building functional heart parts.

Nanomaterials engineering for drug delivery: a hybridization approach

The last twenty years have witnessed great advances in biology, medicine, and materials science, leading to the development of various nanoparticle (NP)-mediated drug delivery systems. Innovation in materials science has led the generation of biodegradable, biocompatible, stimuli-responsive, and targeted delivery systems. However, currently available nanotherapeutic technologies are not efficient, which has culminated in the failure of their clinical trials. Despite huge efforts devoted to drug delivery nanotherapeutics, only a small amount of the injected material could reach the desired target. One promising strategy to enhance the efficiency of NP drug delivery is to hybridize multiple materials, where each component could play a critical role in an efficient multipurpose delivery system. This review aims to comprehensively cover different techniques, materials, advantages, and drawbacks of various systems to develop hybrid nano-vesicles for drug delivery. Attention is finally given to the hybridization benefits in overcoming the biological barriers for drug delivery. It is believed that the advent of modern nano-formulations for multifunctional hybrid carriers paves the way for future advances to achieve more efficient drug delivery systems.

Lifetime and current waterpipe use among adolescents in Tehran, Islamic Republic of Iran

Waterpipe use among Iranian adolescents has become a matter for concern. A descriptive, cross-sectional community-based survey was performed in 2010 to determine the prevalence of waterpipe use and associated factors among Iranian adolescents in Tehran, Islamic Republic of Iran. After multi-stage, random cluster sampling 1201 adolescents aged 15-18 years old responded to a questionnaire based on the Youth Risk Behavior Surveillance. The prevalence of current waterpipe smoking (at least once in the previous 30 days) was 28.0%, significantly higher among males (34.8%) than females (21.4%). A total of 45.1% of adolescents reported lifetime use (ever use) of waterpipes and 34.2% had ever shared a waterpipe. In multivariate logistic regression analysis the significant correlates of current waterpipe use for both males and females were having smokers among friends and family members, while for males, older age and educational failure were also risk factors.

Psychometric properties of the persian version of the youth risk behavior survey questionnaire

BACKGROUND

Adolescents may get involved in high-risk behaviors. Surveys are the primary, and sometimes the sole source of data collection for many high-risk health behaviours. We examined the reliability and validity of the psychometric properties of the self-administered Persian version of the 2009 Youth Risk Behavior Surveillance System (YRBSS) questionnaire.

METHODS

In a methodological study in summer 2010, 100 Iranian adolescents aged 15-18 years were recruited through convenience sampling. The face and content validity were used for the questionnaire validity. In order to evaluate the questionnaire's reliability, the Intraclass Correlation Coefficient (ICC) and Cronbach's α were calculated for domains and 89 items.

RESULTS

Among 89 items, the ICC values were below 0.4 (weak reliability) for 2 items (2.25%), 0.4-0.6 (moderate reliability) for 10 items (11.24%), 0.6-0.8 (good reliability) for 32 items (35.96%) and 0.8-1 (excellent reliability) for 45 items (50.56%). The prevalence of most high-risk behaviors was constant in the first and second survey. The value of Cronbach's α was 0.73 for intentional and unintentional injuries, 0.77 for tobacco use, 0.86 for alcohol and other drug use, and 0.79 for unsafe sexual behaviors. No domain had a mean ICC of below 0.6. Furthermore, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability.

CONCLUSION

Over the 2-week period, sexual behaviors were reported with less consistency compared to other behaviors. In any case, researchers must be aware of the limitation of the data collected through this questionnaire, particularly in comparison to the domain of sexual behaviors. Overall, 97.75% of the items had moderate to excellent reliability. Thus, the Persian YRBSS questionnaire had an acceptable reliability.

An optimized method for extraction and detection of Coconut cadang-cadang viroid(CCCVd) from oil palm

Coconut cadong-cadong viroid (CCCVd) causes the Lethal cadang-cadang disease of coconut palms in the Philippines and it is recently reported to be associated with the orange spotting disease on oil palm in Malaysia. The low concentration of the viroid RNA in oil palm as well as the high content of polyphenols and polysaccharides in this plant which interfere with the purification steps makes it difficult to extract and detect this viroid from oil palm. A previously described method was modified and optimized for extraction and detection of CCCVd from infected oil palms. Briefly, 7 g of leaf material was homogenized in a mortar or a blender using liquid nitrogen. 10 ml of extraction buffer (100 mM Tris-HCl pH 7.5, 100 mM NaCl, 10 mM EDTA) along with 100 mM 2-mercaptoethanol and 10 ml water saturated phenol was added to the frozen powder. After centrifuging at 4 degrees C, 4000 g for 30 min, the aqueous phase was extracted once more with phenol then once with chloroform-isoamyl alcohol (24:1). After adding sodium acetate, pH 5.6 to 200 mM, the mixture was precipitated with 2.5 vol ethanol overnight in -20 freezer and then the pellet was washed with 70% ethanol and air-dried. One milliliter of 8 M LiCl was added to the dried pellet and after shaking overnight at 4 degrees C and another centrifugation step the supernatant was collected and precipitated again with ethanol and then the resulting pellet was washed and air-dried. To carry out northern blotting, samples equivalent to 40 g of plant tissue were mixed with formamide buffer and loaded onto a 12% polyacrylamide gel containing 7 M urea and after separation by electrophoresis, were electroblotted onto membrane and fixed by UV cross-linking. Pre-hybridization and hybridization using hybridization buffer (50% formamide, 25%SSPE, 0.1% Ficol and PVP, 0.1 % SDS, 0.02 % DNA (5mg/ml)) was carried out at 45 degrees C for 90 min and 16 h, respectively followed by two low stringency washes (0.5 X SSC, 0.1% SDS, at room temperature for 5 min) and one high stringency wash (0.1X SSC, 0.1% SDS at 60 degrees C for 1 hour). In vitro synthesized DIG-labeled full-length CCCVd(-) RNA probe was used in hybridization step. DIG Nucleic Acid Detection Kit (Roche) instructions were followed for detection procedure and as a result the blue bands corresponding to the position of the viroid were appeared on the membrane. The result of this study showed the ability of DIG labeled probe in detection of the viroid and also provided a suitable extraction and hybridization method for the detection of CCCVd from oil palm.

Frequency of and barriers to utilization of mental health services in an Iranian population

This study in 2005 compared the need for mental health services, actual use of services and barriers to use by 3 groups in Shiraz city in the Islamic Republic of Iran: a sample of the general population, parents of children with mental illness and primary-school teachers. Among the general population, 76.0% reported that they had wanted help in the previous 6 months and, of these, 50.0% actually sought it. The rates for parents of children with mental problems were 81.3% and 55.4% and for teachers were 60.0% and 35.0% respectively. The most common barriers to service use were logistic, especially the cost of and inconvenient access to services. Barriers related to perceptions of mental health services were also important, such as lack of trust and perceptions of friends/family.

Antifungal activity of Cymbopogon parkeri stapf. essential oil on some important phytopathogenic fungi

The genus Cymbopogon that belongs to the Poaceae (Graminae) has some important aromatic species whit remarkable commercial value. Essential oils from different species of the Cymbopogon are used in the perfumery, cosmetic and soap industries and some of them have antifungal and insecticide activity. In this study, antifungal activity of C. parkeri essential oil on the growth of Rhizoctonia solani, Pyricularia orizea and Fusarium oxysporum, three important phytopathogenic fungi, was investigated. The essential oil was extracted from the air-dried parts in flowering stage by hydrodistillation in a Clevenger type apparatus, and Growth inhibition of Rhizoctonia solani, Pyricularia orizea, Fusarium oxysporum for 15, 30, 75,150, 300 and 600 microl L(-1) dosage of the essential oil in PDA was examined in vitro by media mixed method and was compared with control. Antifungal activity was determined in terms of growth inhibitory concentration for 50% growth inhibitory (EC50 microI L(-1)) and inhibition percentage of some dosages was obtained. The results showed that concentration of 600 microl L(-1) of the essential oil completely inhibits the growth of all tested fungi. EC50 for Rhizoctonia solani, Pyricularia orizea, Fusarium oxysporum were counted 39.82, 72.00 and 43.63 microl L(-1) respectively. The results indicated that the essential oil has strong fungi state activity.

Identification of prevalent potyvirus on maize and johnsongrass in corn fields of Tehran province of Iran and a study on some of its properties

During a growing season in 2004, 231 leaf samples of virus infected and mosaic and dwarf mosaic symptoms showing maize (Zea mays L.) plants and 258 leaf samples of mosaic showing johnsongrass (Sorghum halepens L.) plants from various corn fields in Tehran province were collected. Serological tests of DAS-ELISA and DIBA were performed on samples using antisera of sugarcane mosaic virus (SCMV), maize dwarf mosaic virus (MDMV), sorghum mosaic virus (SrMV) and johnsongrasss mosaic virus (JGMV). In both tests performed on leaf samples extractions, all samples reacted strongly with SCMV antiserum and no reaction was seen with other 3 potyviruses antisera. 0.1 M potassium phosphate buffer (pH = 7) containing 2% polyvinyl pyrrolidon (PVP) was used for mechanical inoculation and all isolates were inoculated and propagated on sweet corn cv. Pars 403 and grain sorghum cv. Kimia. In serological tests on the inoculated plants samples also only SCMV was detected. Purification of virus was done using a modified "minipurification" method and the concentration of purified virus was 11.45 mg/ml and ratio of A260/280 = 1.2 was calculated for it. Electron microscopic study using ISEM and decoration method with SCMV antiserum revealed filamentous flexuous particles of SCMV. In SDS-polyachrylamide gel electrophoresis and Western blot test using SCMV antiserum that were performed on infected samples and purified viruses, the molecular weight of the virus coat protein was approximately 37-38 KDa and a difference among the CP weights of various SCMV isolates was not found. Reverse transcription-polymerase chain reaction (RT-PCR) was done using SCMV F3 and SCMV R3 primers and amplified fragments of approximately 900 bp in size were as in expected. The host range study with selected isolates of SCMV showed that the virus isolates were not transmitted by mechanical inoculation on Avena sativa, Panicum miliaceum, Setaria italica, Pennisetum americanum, Hordeum vulgare and Triticum aestivum. The isolates produced red-brown necrotic streaks on sudangrass (Sorghum sudanense) that lately changed in systemic necrosis. In host reaction studies on sorghum (Sorghum bicolor) cultivars, the virus isolates caused severe necrotic and killer reaction on sorghum cultivars Payam, Sepideh and Speed feed, but caused systemic mosaic and non-killer reaction on sorghum cultivars Kimia, KFS2, KFS3 and Jumbo. The present study showed that SCMV is the prevalent potyvirus and the main causal agent of mosaic and dwarf mosaic on maize plants in province. Since the virus is prevalent on johnsongrass plants in marginal areas of corn fields too, it seems that the origin of the virus on corn is from johnsongrass and the virus is a special strain of sugarcane mosaic virus that infects johnsongrass too.

Cyproheptadine in the treatment of autistic disorder: a double-blind placebo-controlled trial

OBJECTIVE

Autism is a childhood-onset disorder of unknown, possibly of multiple aetiologies. The core symptoms of autism are abnormalities in social interaction, communication and behaviour. The involvement of neurotransmitters such as 5-HT has been suggested in neuropsychiatric disorders and particularly in autistic disorder. Increased platelet 5-HT levels were found in 40% of the autistic population, suggesting that hyperserotonaemia may be a pathologic factor in infantile autism. Therefore, it is of interest to assess the efficacy of cyproheptadine, a 5-HT2 antagonist in the treatment of autistic disorder. In this 8-week double-blind, placebo-controlled trial, we assessed the effects of cyproheptadine plus haloperidol in the treatment of autistic disorder.

METHODS

Children between the ages 3 and 11 years (inclusive) with a DSM IV clinical diagnosis of autism and who were outpatients from a specialty clinic for children at Roozbeh Psychiatric Teaching Hospital were recruited. The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder. Patients were randomly allocated to cyproheptadine + haloperidol (Group A) or haloperidol + placebo (Group B) for an 8-week, double-blind, placebo-controlled study. The dose of haloperidol and cyproheptadine was titrated up to 0.05 and 0.2 mg/kg/day respectively. Patients were assessed by a third-year resident of psychiatry at baseline and after 2, 4, 6 and 8 weeks of starting medication. The primary measure of the outcome was the Aberrant Behaviour Checklist-Community (ABC-C) and the secondary measure of the outcome was the Childhood Autism Rating Scale (relating to people and verbal communication). Side effects and extrapyramidal symptoms were systematically recorded throughout the study and were assessed using a checklist and the Extrapyramidal Symptoms Rating Scale, administered by a resident of psychiatry during weeks 1, 2, 4, 6 and 8.

RESULTS

The ABC-C and the Childhood Autism Rating Scale scores improved with cyproheptadine. The behaviour of the two treatments was not homogeneous across time (groups-by-time interaction, Greenhouse-Geisser correction; F = 7.30, d.f. = 1.68, P = 0.002; F = 8.21, d.f. = 1.19, P = 0.004 respectively). The difference between the two treatments was significant as indicated by the effect of group, and the between-subjects factor (F = 4.17, d.f. = 1, P = 0.048; F = 4.29, d.f. = 1, P = 0.045 respectively). No significant difference was observed between the two groups in terms of extrapyramidal symptoms (P = 0.23). The difference between the two groups in the frequency of side effects was not significant.

CONCLUSION

The results suggest that the combination of cyproheptadine with a conventional antipsychotic may be superior to conventional antipsychotic alone for children with autistic disorder. However the results need confirmation by a larger randomized controlled trial.

Efficacy of theophylline compared to methylphenidate for the treatment of attention-deficit hyperactivity disorder in children and adolescents: a pilot double-blind randomized trial

Attention-deficit hyperactivity disorder (ADHD) is a common disorder of childhood that affects 3-6% of school children. Conventional stimulant medications are recognized as useful symptomatic treatments by both specialists and parents. Nevertheless, approximately 30% of ADHD children treated with them do not respond adequately or cannot tolerate the associated adverse effects. Such difficulties highlight the need for alternative, safe and effective medications in the treatment of this disorder. Theophylline is a psychomotor stimulant most widely used as a broncodilator. Purinergic modulation may be therapeutically beneficial in the treatment of psychiatric disorders. We hypothesized that theophylline would be beneficial for the treatment of ADHD and report results of a trial of theophylline compared with methylphenidate for the treatment of ADHD. A total of 32 children with ADHD as defined by DSM IV were randomized to theophylline and methylphenidate dosed on an age and weight-adjusted basis at 4 mg/kg/day (under 12 years) and 3 mg/kg/day theophylline (over 12 years) (group 1) and 1 mg/kg/day methylphenidate (group 2) for a 6-week double-blind and randomized clinical trial. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist, at baseline and at 14, 28 and 42 days after start of the medication. No significant differences were observed between theophylline and methylphenidate on the Parent and Teacher Rating Scale scores over the trial (t = 0.49, d.f. = 24 P = 0.62 and t = 0.19, d.f. = 24 P = 0.54 respectively). Although the number of dropouts in the methylphenidate group was higher than the theophylline group, there was no significant difference between the two protocols in terms of the dropouts. In addition, headaches were observed more often in the methylphenidate group. The results suggest that theophylline may be a useful for the treatment of ADHD. In addition, a tolerable side-effect profile is one of the advantages of theophylline in the treatment of ADHD. Nevertheless, our study is small and our results would need to be confirmed in a larger study.

Process development for production of recombinant human interferon-? expressed in Escherichia coli

A simple fed-batch process was carried out using constant and variable specific growth rates for high-cell-density cultivation of Escherichia coli BL21 (DE3) expressing human interferon-gamma(hIFN-gamma). The feeding rate was adjusted to achieve an appropriate specific growth rate. The dissolved oxygen level was maintained at 20-30% of air saturation by control of airflow and stirrer speed and, where necessary, by enrichment of inlet air with pure oxygen. Glucose was the sole source of carbon and energy and was provided by following a simple exponential feeding rate. The final cell density in the fed-batch fermentation with constant and variable specific growth rate feeding strategies was ~100 g dry cell wt l(-1) after 36 and 20 h, respectively. The final specific yield and overall productivity of recombinant hIFN-gamma in the variable specific growth rate strategy were 0.35 g rHu-IFN-gamma g(-1) dry cell wt and 0.9 g rHu-IFN-gamma l(-1) h(-1), respectively. A new chromatographic purification procedure involving anion exchange and cation exchange chromatographies was developed for purification of rHu-IFN-gamma from inclusion bodies. The established purification process is reproducible and the total recovery of rHu-IFN-gamma was ~30% (100 mg rHu-IFN-gamma g(-1) dry cell wt). The purity of the rHu-IFN-gamma was determined using HPLC. Sterility, pyrogenicity, and DNA content tests were conducted to assure the absence of toxic materials and other components of E. coli in the final product. The final purified rHu-IFN-gamma has a specific antiviral activity of ~2 x 10(7) IU/mg protein, as determined by viral cytopathic effect assay. These results certify the product for clinical purposes.

Schizophrenia: etiology and pharmacotherapy

Schizophrenia is one of the major psychiatric disorders. Psychosis, in its narrow definition, is restricted to delusions or hallucinations in the absence of insight into their pathological nature. Impairment in psychosocial function is an essential feature of schizophrenia. Research in the last decade has confirmed that schizophrenia is a brain disorder that cannot be attributed solely to psychosocial factors. It is widely accepted from twin and adoption studies that schizophrenia has a significant genetic component. In addition, it is a general belief that schizophrenia is caused by a biological abnormality, even though all attempts to identify that abnormality have been unsuccessful. A major landmark in the history of the understanding and treatment of schizophrenia was the discovery that dopamine D2-blocking agents can control the hallucinations and delusions of schizophrenic patients. However, clinicians have noticed that classical antipsychotics are generally ineffective against the negative symptoms that are prominent in patients with a chronic course. In this article, we will focus on the etiology and pharmacotherapy of schizophrenia.

Cyproheptadine in treatment of chronic schizophrenia: a double-blind, placebo-controlled study

OBJECTIVE

There is growing interest in investigating the role of 5-HT receptors in the physiopathology of schizophrenia in particular the negative symptoms. Indeed, newer atypical antipsychotics which interact with 5-HT receptors are more effective in the treatment of negative symptoms compared to typical neuroleptics. We undertook a trial to investigate whether the combination of haloperidol with cyproheptadine, a relatively safe serotonin-blocking agent was more effective than haloperidol alone.

METHODS

Thirty patients who met the DSM IV criteria for chronic schizophrenia completed the study. Patients were allocated in a random fashion, 15 each to haloperidol 30 mg/day plus cyproheptadine 24 mg/ day and haloperidol 30 mg/day plus placebo.

RESULTS

Although both protocols significantly decreased the positive and negative symptom score over the trial period, the combination of haloperidol and cyproheptadine showed significant superiority over haloperidol alone in the treatment of the negative symptoms.

CONCLUSION

Cyproheptadine is a relatively safe compound and may be of therapeutic benefit in treating negative symptoms of schizophrenia in combination with typical neuroleptics. However, a larger study to confirm our results is warranted.

Combination of clomipramine and nortriptyline in the treatment of obsessive-compulsive disorder: a double-blind, placebo-controlled trial

OBJECTIVE

There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone.

METHOD

Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo.

RESULTS

Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD.

CONCLUSION

As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD.