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Pini Prato A, Perretti C, Erculiani M, Mottadelli G, Taverna M, Giordano F, Caruso AM, Magro P, Guanà R, Carretto E, D'Aleo C, Lisi G, Masnata G, Cheli M, Migliazza L. A Structured Training for Trans Anal Irrigation in Pediatric Patients Improves Outcomes and Reduce Failures: Results of an Interventional Multicenter Prospective Study. J Pediatr Surg 2024:S0022-3468(24)00002-2. [PMID: 38245378 DOI: 10.1016/j.jpedsurg.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/16/2023] [Accepted: 12/25/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Continence issues due to organic causes including previous colorectal surgery or neurological issues might benefit from Transanal irrigation (TAI) that proved to be highly effective but with a number of limitations including a relatively high discontinuation rates. Our study was aimed at evaluating the efficacy of an advanced protocol tailored to each patient to prevent dropout and increase satisfaction, independence, and quality of life. MATERIALS AND METHODS This was a prospective, interventional, multicenter, nonrandomized study involving children aged 4-18 years with bowel dysfunction unresponsive to conventional treatments who required TAI. TAI was performed in accordance to the best standards of care with a total irrigation volume that was determined based on low emission X-Ray barium enemas performed at the very beginning of the study. All patients underwent training and assessments of continence, patients' perspectives and quality of life were performed at different timepoints from enrollment (T0) up to 6 months since TAI was introduced (T3). RESULTS A total of 78 patients were enrolled. Male to female ratio was 1.4:1. Mean age at enrollment was 106.1 ± 42.8 months. Discontinuation was reported by 3 patients (3.8 %). Continence, satisfaction and a number of other outcome measures increased from baseline (T0) to the last visit (T3). In particular, mean Rintala total score increased linearly from 7.8 to 14.8 during the study period (T0 to T3 timepoints). On a multivariate analysis, the only parameter that proved to be inversely associated with continence as well as with other outcome measures was the use of laxatives at enrollment and during the study. CONCLUSIONS This study has demonstrated the high efficacy of this innovative patient-tailored TAI protocol across all assessed scores. Of note, given the negative impact of laxatives, our findings suggest limiting their use in this patient population to further increase the efficacy of the procedure.
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Affiliation(s)
- A Pini Prato
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - C Perretti
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - M Erculiani
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G Mottadelli
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - M Taverna
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - F Giordano
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy; University of Florence, Italy
| | - A M Caruso
- Pediatric Surgery, Azienda Ospedaliera Civico di Cristina Benfratelli, Palermo, Italy
| | - P Magro
- Medium Intensity Surgery, OIRM Ospedale Infantile Regina Margherita AO Città della Salute e della Sienza, Torino, Italy
| | - R Guanà
- Medium Intensity Surgery, OIRM Ospedale Infantile Regina Margherita AO Città della Salute e della Sienza, Torino, Italy
| | - E Carretto
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - C D'Aleo
- Spina Bifida Center, Azienda Sanitaria Provinciale, Caltanissetta, Italy
| | - G Lisi
- Pediatric Surgery at the Civil Hospital, Pescara, Italy
| | - G Masnata
- Pediatric Urodynamics, Azienda Ospedaliera G Brotzu, Cagliari, Italy
| | - M Cheli
- Pediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Migliazza
- Pediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Mantovani A, Bortota G, Cinia C, Landia L, Taverna M, Olivera L, Elia A, Masieri L. Hidden incision endoscopic surgery (HIDES) in pediatric urology: initial experience in a single center. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Rouby G, Tran NT, Leblanc Y, Taverna M, Bihoreau N. Investigation of monoclonal antibody dimers in a final formulated drug by separation techniques coupled to native mass spectrometry. MAbs 2021; 12:e1781743. [PMID: 32633190 PMCID: PMC7531515 DOI: 10.1080/19420862.2020.1781743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Therapeutic monoclonal antibodies (mAbs) are highly complex proteins that must be exhaustively characterized according to the regulatory authorities' recommendations. MAbs display micro-heterogeneity mainly due to their post-translational modifications, but also to their susceptibility to chemical and physical degradations. Among these degradations, aggregation is quite frequent, initiated by protein denaturation and then dimer formation. Here, we investigated the nature and structure of the high molecular weight species (HMW) present at less than 1% in an unstressed formulated roledumab biopharmaceutical, as a model of high purity mAb. HMW species were first purified through preparative size-exclusion chromatography (SEC) and then analyzed by a combination of chromatographic methods (ion-exchange chromatography (IEX), SEC) coupled to native mass spectrometry (MS), as well as sodium dodecyl sulfate–polyacrylamide gel electrophoresis and capillary gel electrophoresis under non-reducing conditions. Both covalently and non-covalently bound dimers were identified at a proportion of 50/50. In-depth characterization of the HMW fraction by SEC and IEX hyphenated to native MS revealed the presence of three mAb dimer forms having the same mass, but differing by their charge and size. They were attributed to different compact and elongated dimers. Finally, high-resolution middle-up approaches using different enzymes (IdeS and IgdE) were performed to determine the mAb domains implicated in the dimerization. Our results revealed that the roledumab dimers were associated mainly by a single Fab-to-Fab arm-bound association.
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Affiliation(s)
- G Rouby
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay , 92296, Châtenay-Malabry, France.,Analytical Department, LFB , Courtaboeuf (Les Ulis), France
| | - N T Tran
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay , 92296, Châtenay-Malabry, France
| | - Y Leblanc
- Analytical Department, LFB , Courtaboeuf (Les Ulis), France
| | - M Taverna
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay , 92296, Châtenay-Malabry, France.,Institut Universitaire de France , Paris, France
| | - N Bihoreau
- Analytical Department, LFB , Courtaboeuf (Les Ulis), France
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4
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Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, De Vita N, Santangelo E, Scotti L, Castello L, Cena T, Taverna M, Grillenzoni L, Moschella MA, Airoldi G, Borrè S, Mojoli F, Della Corte F, Baggiani M, Baino S, Balbo P, Bazzano S, Bonato V, Carbonati S, Crimaldi F, Daffara V, De Col L, Maestrone M, Malerba M, Moroni F, Perucca R, Pirisi M, Rondi V, Rosalba D, Vanni L, Vigone F, Navalesi P, Cammarota G. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Res 2021; 7:00541-2020. [PMID: 33527074 PMCID: PMC7607967 DOI: 10.1183/23120541.00541-2020] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Aim We aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation. Methods In this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality. Results The study included 537 patients with a median (interquartile range (IQR) age of 69 (60-76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1-8) days, while hospital length of stay was 16 (9-27) days. 60-day in-hospital mortality was 34% (95% CI 0.304-0.384%) overall, and 21% (95% CI 0.169-0.249%) and 73% (95% CI 0.648-0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345-0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008-0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010-1.184). Conclusions We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.
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Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,These authors contributed equally
| | - Francesco Barone-Adesi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,These authors contributed equally
| | - Fabrizio Racca
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Claudio Pissaia
- Ospedale degli Infermi, Dipartimento di Anestesia e Terapia Intensiva, Ponderano, Biella, Italy
| | - Carlo Maestrone
- Presidio Ospedaliero Domodossola e Verbania, Anestesia Rianimazione ASL VCO, Direzione dipartimento chirurgico, Largo Caduti Lager Nazisti, Domodossola, Italy
| | - Davide Colombo
- Ospedale Ss. Trinità, Department of Anaesthesia and Critical Care, Borgomanero, Italy
| | - Carlo Olivieri
- Azienda Ospedaliera Sant'Andrea, Department of Anaesthesia and Critical Care, Vercelli, Italy
| | - Nello De Vita
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Erminio Santangelo
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Lorenza Scotti
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Luigi Castello
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliero Universitaria "Maggiore della Carità", Medicina d'Urgenza, Novara, Italy
| | - Tiziana Cena
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Martina Taverna
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Luca Grillenzoni
- Ospedale degli Infermi, Medicina D'Urgenza, Ponderano, Biella, Italy
| | - Maria Adele Moschella
- Presidio Ospedaliero Domodossola, Medicina Interna ASL VCO, Largo Caduti Lager Nazisti, Domodossola, Italy
| | | | - Silvio Borrè
- Azienda Ospedaliera Sant'Andrea, Malattie Infettive, Vercelli, Italy
| | - Francesco Mojoli
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Anaesthesia and Intensive Care, Pavia, Italy
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Marta Baggiani
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Sara Baino
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Piero Balbo
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Pneumologia, Novara, Italy
| | - Simona Bazzano
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Valeria Bonato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anaesthesia and Intensive Care, Alessandria, Italy, EU
| | - Sara Carbonati
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Federico Crimaldi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Veronica Daffara
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Luca De Col
- Ospedale degli Infermi, Dipartimento di Anestesia e Terapia Intensiva, Ponderano, Biella, Italy
| | - Matteo Maestrone
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Mario Malerba
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliera Sant'Andrea, Pneumologia, Vercelli, Italy
| | - Federica Moroni
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Raffaella Perucca
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.,Azienda Ospedaliero Universitaria "Maggiore della Carità", Clinica Medica, Novara, Italy
| | - Valentina Rondi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Daniela Rosalba
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Letizia Vanni
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Francesca Vigone
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy
| | - Paolo Navalesi
- Istituto di Anestesia e Rianimazione, Azienda Ospedale-Università di Padova, Dipartimento di Medicina - DIMED - Università di Padova, Padua, Italy.,These authors contributed equally
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,These authors contributed equally
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Longhitano Y, Racca F, Zanza C, Piccioni A, Audo A, Muncinelli M, Santi R, Kozel D, Geraci C, Taverna M, Bonato V, Cassini F, Franceschi F. Venous thromboembolism in critically ill patients affected by ARDS related to COVID-19 in Northern-West Italy. Eur Rev Med Pharmacol Sci 2020; 24:9154-9160. [PMID: 32965007 DOI: 10.26355/eurrev_202009_22864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described. PATIENTS AND METHODS We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed. RESULTS Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died. CONCLUSIONS In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.
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Affiliation(s)
- Y Longhitano
- Department of Anesthesiology and Critical Care, Azienda Ospedaliera SS. Antonio e Biagio, Alessandria, Italy.
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Costamagna D, Gaggiotti M, Chiericatti CA, Costabel L, Audero GML, Taverna M, Signorini ML. Quantification of aflatoxin M 1 carry-over rate from feed to soft cheese. Toxicol Rep 2019; 6:782-787. [PMID: 31428566 PMCID: PMC6695269 DOI: 10.1016/j.toxrep.2019.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022] Open
Abstract
The levels of AFM1 in milk produced in Argentina are relatively low. Milk production, fiber particle size and AFB1 level affected the carry-over rate. The greatest proportion of AFM1 in milk is detected in whey during cheese. production.
From January to December 2016, samples of milk and feeds of dairy cattle were monthly collected. The concentration of mycotoxins in all matrices was determined using the enzymatic immunoassay technique. The average concentration of aflatoxin B1 (AFB1), deoxynivalenol (DON) and zearalenone (ZEA) in feed was 3.01, 218.5 and 467 ug/kg, respectively. The average AFB1 carry-over rate was 0.84% with a variation between 0.05 to 5.93%. Particle size of the feed (P = 0.030) and individual milk production (P = 0.001) affected this rate. Mini-soft cheeses were produced using milk naturally contaminated with aflatoxin M1 (AFM1) as raw material to study its distribution both in whey and in cheese. The average level of AFM1 in milk was 0.014 μg/l. None of milk samples exceeded the maximum level accepted for AFB1 by the Southern Common Market (MERCOSUR) legislation (0.5 μg/l) and only 5.5% of samples exceeded the European Union (UE) regulations (0.05 μg/l). After the cheese elaboration, the concentration of AFM1 was determined in whey and in cheese. The greatest proportion (60%) was detected in whey while 40% AFM1 remained in the cheese. However, the concentration of AFM1 was higher in the cheese compared to the original milk.
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Affiliation(s)
- D Costamagna
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina
| | - M Gaggiotti
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina
| | - C A Chiericatti
- Microbiology Laboratory, Faculty of Chemical Engineering, National University of Littoral. Santiago Del Estero 2829, C.P. 3000, Provincia de Santa Fe, Argentina
| | - L Costabel
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina
| | - G M L Audero
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina
| | - M Taverna
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina
| | - M L Signorini
- National Institute for Agricultural Technology (INTA), Experimental Station Rafaela (EEA), Route 34, Km 227, 2300, Rafaela, Santa Fe, Argentina.,National Council of Scientific and Technical Research (CONICET), National Institute for Agricultural Technology (INTA) EEA Rafaela, Route 34 Km 227, 2300, Rafaela, Santa Fe, Argentina
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7
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Mistraletti G, Umbrello M, Salini S, Cadringher P, Formenti P, Chiumello D, Villa C, Russo R, Francesconi S, Valdambrini F, Bellani G, Palo A, Riccardi F, Ferretti E, Festa M, Gado AM, Taverna M, Pinna C, Barbiero A, Ferrari PA, Iapichino G. Enteral versus intravenous approach for the sedation of critically ill patients: a randomized and controlled trial. Crit Care 2019; 23:3. [PMID: 30616675 PMCID: PMC6323792 DOI: 10.1186/s13054-018-2280-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/27/2018] [Indexed: 01/17/2023]
Abstract
Background ICU patients must be kept conscious, calm, and cooperative even during the critical phases of illness. Enteral administration of sedative drugs might avoid over sedation, and would be as adequate as intravenous administration in patients who are awake, with fewer side effects and lower costs. This study compares two sedation strategies, for early achievement and maintenance of the target light sedation. Methods This was a multicenter, single-blind, randomized and controlled trial carried out in 12 Italian ICUs, involving patients with expected mechanical ventilation duration > 72 h at ICU admission and predicted mortality > 12% (Simplified Acute Physiology Score II > 32 points) during the first 24 h on ICU. Patients were randomly assigned to receive intravenous (midazolam, propofol) or enteral (hydroxyzine, lorazepam, and melatonin) sedation. The primary outcome was percentage of work shifts with the patient having an observed Richmond Agitation-Sedation Scale (RASS) = target RASS ±1. Secondary outcomes were feasibility, delirium-free and coma-free days, costs of drugs, length of ICU and hospital stay, and ICU, hospital, and one-year mortality. Results There were 348 patients enrolled. There were no differences in the primary outcome: enteral 89.8% (74.1–100), intravenous 94.4% (78–100), p = 0.20. Enteral-treated patients had more protocol violations: n = 81 (46.6%) vs 7 (4.2%), p < 0.01; more self-extubations: n = 14 (8.1%) vs 4 (2.4%), p = 0.03; a lighter sedative target (RASS = 0): 93% (71–100) vs 83% (61–100), p < 0.01; and lower total drug costs: 2.39 (0.75–9.78) vs 4.15 (1.20–20.19) €/day with mechanical ventilation (p = 0.01). Conclusions Although enteral sedation of critically ill patients is cheaper and permits a lighter sedation target, it is not superior to intravenous sedation for reaching the RASS target. Trial registration ClinicalTrials.gov, NCT01360346. Registered on 25 March 2011. Electronic supplementary material The online version of this article (10.1186/s13054-018-2280-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo - Polo Universitario, Via A. Di Rudinì, 8, 20142, Milano, Italy. .,SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Michele Umbrello
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Silvia Salini
- Dipartimento di Economia, Management e Metodi Quantitativi, Università degli Studi di Milano, Milano, Italy
| | - Paolo Cadringher
- Dipartimento Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo Formenti
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Davide Chiumello
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Cristina Villa
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo - Polo Universitario, Via A. Di Rudinì, 8, 20142, Milano, Italy
| | - Riccarda Russo
- Dipartimento Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvia Francesconi
- UOC Anestesia e Rianimazione, ASST Monza, Ospedale di Desio, Monza, Italy
| | - Federico Valdambrini
- UO Anestesia e Rianimazione, ASST Ovest Milanese, Ospedale Nuovo di Legnano (MI), Legnano, Italy
| | - Giacomo Bellani
- Dipartimento di Medicina e Chirurgia, Università degli Studi Milano Bicocca, A.O. San Gerardo, Monza, Italy
| | - Alessandra Palo
- Dipartimento Medicina Intensiva, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Enrica Ferretti
- SC Anestesia Rianimazione B DEA, Ospedale San Giovanni Bosco, Torino, Italy
| | - Maurilio Festa
- SCDU Anestesia e Rianimazione, AOU San Luigi Gonzaga di Orbassano (TO), Torino, Italy
| | - Anna Maria Gado
- UO Anestesia e Rianimazione, AO Cardinal Massaia, Asti, Italy
| | - Martina Taverna
- UO Anestesia e Rianimazione, AO Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Cristina Pinna
- UO Anestesia e Rianimazione, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy
| | - Alessandro Barbiero
- Dipartimento di Economia, Management e Metodi Quantitativi, Università degli Studi di Milano, Milano, Italy
| | - Pier Alda Ferrari
- Dipartimento di Economia, Management e Metodi Quantitativi, Università degli Studi di Milano, Milano, Italy
| | - Gaetano Iapichino
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo - Polo Universitario, Via A. Di Rudinì, 8, 20142, Milano, Italy.,SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
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Coty JB, Varenne F, Benmalek A, Garsaa O, Le Potier I, Taverna M, Smadja C, Vauthier C. Characterization of nanomedicines’ surface coverage using molecular probes and capillary electrophoresis. Eur J Pharm Biopharm 2018; 130:48-58. [DOI: 10.1016/j.ejpb.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022]
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Mistraletti G, Umbrello M, Mariani V, Carloni E, Miori S, Taverna M, Sabbatini G, Formenti P, Terzoni S, Destrebecq AL, Chiumello D, Moja EA, Iapichino G. Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers. Minerva Anestesiol 2018; 84:1150-1159. [PMID: 29589416 DOI: 10.23736/s0375-9393.18.12425-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients' perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of "conscious sedation" on ICU patients memories. Purpose of this prospective, observational study is to analyze the stress perception in consciously-sedated ICU-patients, comparing it to caregivers and staff members. METHODS Twenty-nine high-risk ICU-patients treated with awake/cooperative sedation were enrolled. Before discharge, patients received a validated questionnaire for ICU stressors evaluation, also administered to their main caregiver (N.=29), to caregivers of other ICU patients not enrolled in the study (N.=33) and to staff members (ICU nurses, attending physicians, residents, medical students, N.=56). RESULTS Total stress score was: patients 141±41, patient relatives 210±63, other relatives: 202±73, ICU staff: 232±44, P<0.001. Among patients, older age (P=0.031), longer ICU-stay (P=0.018) and awake-sedation (P=0.022) were associated with lower stress; sex and illness severity had no effect; mechanical ventilation length (P=0.021) and agitation (P=0.029) were associated with higher stress. Nurses tended to overestimate stressors more than attending physicians and trainees. Within staff members, age (P=0.021) and years of experience (P=0.069) were positively associated with overestimation. CONCLUSIONS Conscious sedation is associated with stress perception lower than stress assessed by caregivers: relatives and staff members tend to overestimate ICU patient stress, more so with increasing age or expertise. A number of stressors underestimated by staff and families could be target of specific interventions to ameliorate quality of life during ICU stay.
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Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy - .,Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy -
| | - Michele Umbrello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Vera Mariani
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Sara Miori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Martina Taverna
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Paolo Formenti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Stefano Terzoni
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Egidio A Moja
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gaetano Iapichino
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
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10
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Mistraletti G, Paroni R, Umbrello M, D'Amato L, Sabbatini G, Taverna M, Formenti P, Finati E, Favero G, Bonomini F, Rezzani R, Reiter RJ, Iapichino G. Melatonin Pharmacological Blood Levels Increase Total Antioxidant Capacity in Critically Ill Patients. Int J Mol Sci 2017; 18:ijms18040759. [PMID: 28368352 PMCID: PMC5412344 DOI: 10.3390/ijms18040759] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/22/2017] [Accepted: 03/30/2017] [Indexed: 01/17/2023] Open
Abstract
In this study, the aim was to test the biochemical effects of melatonin supplementation in Intensive Care Unit (ICU) patients, since their blood levels are decreased. Sixty-four patients were enrolled in the study. From the evening of the 3rd ICU day, patients were randomized to receive oral melatonin (3 mg, group M) or placebo (group P) twice daily, at 20:00 and 24:00, until discharged. Blood was taken (at 00:00 and 14:00), on the 3rd ICU day to assess basal nocturnal melatonin values, and then during the treatment period on the 4th and 8th ICU days. Melatonin, total antioxidant capacity, and oxidative stress were evaluated in serum. Melatonin circadian rhythm before treatment was similar in the two groups, with a partial preservation of the cycle. Four hours from the 1st administration (4th ICU day, 00:00), melatonin levels increased to 2514 (982.3; 7148) pg·mL−1 in group M vs. 20.3 (14.7; 62.3) pg·mL−1 in group P (p < 0.001). After five treatment days (8th ICU day), melatonin absorption showed a repetitive trend in group M, while in group P nocturnal secretion (00:00) was impaired: 20 (11.5; 34.5) pg·mL−1 vs. 33.8 (25.0; 62.2) on the 3rd day (p = 0.029). Immediately from the beginning of treatment, the total antioxidant capacity was significantly higher in melatonin treated subjects at 00:00; a significant correlation was found between total antioxidant capacity and blood melatonin values (ρ = 0.328; p < 0.001). The proposed enteral administration protocol was adequate, even in the early phase, to enhance melatonin blood levels and to protect the patients from oxidative stress. The antioxidant effect of melatonin could play a meaningful role in the care and well-being of these patients.
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Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20142 Milano, Italy.
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy.
| | - Rita Paroni
- Department of Health Science, Università degli Studi di Milano, 20142 Milano, Italy.
| | - Michele Umbrello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy.
| | - Lara D'Amato
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20142 Milano, Italy.
| | - Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy.
| | - Martina Taverna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20142 Milano, Italy.
| | - Paolo Formenti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy.
| | - Elena Finati
- Department of Health Science, Università degli Studi di Milano, 20142 Milano, Italy.
| | - Gaia Favero
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy.
| | - Francesca Bonomini
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy.
| | - Rita Rezzani
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy.
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Centre, San Antonio, TX 78229-3900, USA.
| | - Gaetano Iapichino
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20142 Milano, Italy.
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy.
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Karavana V, Smith I, Kanellis G, Sigala I, Kinsella T, Zakynthinos S, Liu L, Chen J, Zhang X, Liu A, Guo F, Liu S, Yang Y, Qiu H, Grimaldi DG, Kaya E, Acicbe O, Kayaalp I, Asar S, Dogan M, Eren G, Hergunsel O, Pavelescu D, Grintescu I, Mirea L, Guanziroli M, Gotti M, Marino A, Cressoni M, Vergani G, Chiurazzi C, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Cressoni M, Chiurazzi C, Marino A, Spano S, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Marino A, Cressoni M, Chiurazzi C, Chiumello D, Gattinoni L, Massaro F, Moustakas A, Johansson S, Larsson A, Perchiazzi G, Zhang XW, Guo FM, Chen JX, Xue M, Yang Y, Qiu HB, Chen JX, Liu L, Yang L, Zhang XW, Guo FM, Yang Y, Qiu HB, Fister M, Knafelj R, Suzer MA, Kavlak ME, Atalan HK, Gucyetmez B, Cakar N, Weller D, Grootendorst AF, Dijkstra A, Kuijper TM, Cleffken BI, Regli A, De Keulenaer B, Van Heerden P, Hadfield D, Hopkins PA, Penhaligon B, Reid F, Hart N, Rafferty GF, Grasselli G, Mauri T, Lazzeri M, Carlesso E, Cambiaghi B, Eronia N, Maffezzini E, Bronco A, Abbruzzese C, Rossi N, Foti G, Bellani G, Pesenti A, Bassi GL, Panigada M, Ranzani O, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Panigada M, Bassi GL, Ranzani OT, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Umbrello M, Taverna M, Formenti P, Mistraletti G, Vetrone F, Marino A, Vergani G, Baisi A, Chiumello D, Garnero AG, Novotni DN, Arnal JA, Urner M, Fan E, Dres M, Vorona S, Brochard L, Ferguson ND, Goligher EC, Leung C, Joynt G, Wong W, Lee A, Gomersall C, Poels S, Casaer M, Schetz M, Van den Berghe G, Meyfroidt G, Holzgraefe B, Von Kobyletzki LB, Larsson A, Cianchi G, Becherucci F, Batacchi S, Cozzolino M, Franchi F, Di Valvasone S, Ferraro MC, Peris A, Phiphitthanaban H, Wacharasint P, Wongsrichanalai V, Lertamornpong A, Pengpinij O, Wattanathum A, Oer-areemitr N, Boddi M, Cianchi G, Cappellini E, Ciapetti M, Batacchi S, Di Lascio G, Bonizzoli M, Cozzolino M, Peris A, Lazzeri C, Cianchi G, Bonizzoli M, Di Lascio G, Cozzolino M, Peris A, Katsin ML, Hurava MY, Dzyadzko AM, Hermann A, Schellongowski P, Bojic A, Riss K, Robak O, Lamm W, Sperr W, Staudinger T, Buoninsegni LT, Bonizzoli M, Cozzolino M, Parodo J, Ottaviano A, Cecci L, Corsi E, Ricca V, Peris A, de Garibay APR, Ende-Schneider B, Schreiber C, Kreymann B, Turani F, Resta M, Niro D, Castaldi P, Boscolo G, Gonsales G, Martini S, Belli A, Zamidei L, Falco M, Lamas T, Mendes J, Galazzi A, Mauri T, Benco B, Binda F, Masciopinto L, Lazzeri M, Carlesso E, Lissoni A, Grasselli G, Adamini I, Pesenti A, Thamjamrassri T, Watcharotayangul J, Numthavaj P, Kongsareepong S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Mohamed A, Sklar M, Munshi L, Mauri T, Lazzeri M, Alban L, Turrini C, Panigada M, Taccone P, Carlesso E, Marenghi C, Spadaro S, Grasselli G, Volta C, Pesenti A, Higuera J, Alonso DC, Blandino A, Narváez G, González LR, Aroca M, Saéz S, De Pablo R, Franci A, Stocchi G, Cappuccini G, Socci F, Cozzolino M, Guetti C, Rastrelli P, Peris A, Nestorowicz A, Glapinski J, Fijalkowska-Nestorowicz A, Wosko J, Fijalkowska-Nestorowicz A, Glapinski J, Wosko J, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Bonus T, Duprez F, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Kuchyn I, Bielka K, Sergienko A, Jones H, Day C, Park SC, Yeom SR, Myatra SN, Gupta S, Rajnala V, Divatia J, Silva JV, Olvera OA, Schulte RC, Bermudez MC, Zorrilla LP, Ferretis HL, García KT, Balciuniene N, Ramsaite J, Kriukelyte O, Krikscionaitiene A, Tamosuitis T, Terragni P, Brazzi L, Falco D, Pistidda L, Magni G, Bartoletti L, Mascia L, Filippini C, Ranieri V, Kyriakoudi A, Rovina N, Koltsida O, Konstantellou E, Kardara M, Kostakou E, Gavriilidis G, Vasileiadis I, Koulouris N, Koutsoukou A, Van Snippenburg W, Kröner A, Flim M, Buise M, Hemler R, Spronk P, Regli A, Noffsinger B, De Keulenaer B, Singh B, Hockings L, Van Heerden P, Spina C, Bronco A, Magni F, Di Giambattista C, Vargiolu A, Bellani G, Foti G, Citerio G, Scaramuzzo G, Spadaro S, Waldmann AD, Böhm SH, Ragazzi R, Volta CA, Heines SJ, Strauch U, Van de Poll MC, Roekaerts PM, Bergmans DC, Sosio S, Gatti S, Maffezzini E, Punzi V, Asta A, Foti G, Bellani G, Glapinski J, Mroczka J, Nestorowicz A, Fijalkowska-Nestorowicz A, Yaroshetskiy AI, Rezepov NA, Mandel IA, Gelfand BR, Ozen E, Karakoc E, Ayyildiz A, Kara S, Ekemen S, Yelken BB, Saasouh W, Freeman J, Turan A, Hajjej Z, Sellami W, Bousselmi M, Samoud W, Gharsallah H, Labbene I, Ferjani M, Vetrugno L, Barbariol F, Forfori F, Regeni I, Della Rocca G, Jansen D, Jonkman A, Doorduin J, Roesthuis L, Van der Hoeven J, Heunks L, Marocco SA, Bottiroli M, Pinciroli R, Galanti V, Calini A, Gagliardone M, Bellani G, Fumagalli R, Gatti S, Abbruzzese C, Ippolito D, Sala VL, Meroni V, Bronco A, Foti G, Bellani G, Elbanna M, Nassar Y, Abdelmohsen A, Yahia M, Mongodi S, Mojoli F, Via G, Tavazzi G, Fava F, Pozzi M, Iotti GA, Bouhemad B, Ruiz-Ferron F, Simón JS, Gordillo-Resina M, Chica-Saez V, Garcia MR, Vela-Colmenero R, Redondo-Orts M, Gontijo-Coutinho C, Ozahata T, Nocera P, Franci D, Santos T, Carvalho-Filho M, Fochi O, Gatti S, Nacoti M, Signori D, Bronco A, Bonacina D, Bellani G, Bonanomi E, Mongodi S, Bonvecchio E, Stella A, Roldi E, Orlando A, Luperto M, Bouhemad B, Iotti GA, Mojoli F, Trunfio D, Licitra G, Martinelli R, Vannini D, Giuliano G, Vetrugno L, Forfori F, Näslund E, Lindberg LG, Lund I, Larsson A, Frithiof R, Nichols A, Freeman J, Pentakota S, Kodali B, Pranskunas A, Kiudulaite I, Simkiene J, Damanskyte D, Pranskuniene Z, Arstikyte J, Vaitkaitis D, Pilvinis V, Brazaitis M, Pool R, Haugaa H, Botero A, Escobar D, Maberry D, Tønnessen T, Zuckerbraun B, Pinsky M, Gomez H, Lyons H, Trimmings A, Domizi R, Scorcella C, Damiani E, Pierantozzi S, Tondi S, Monaldi V, Carletti A, Zuccari S, Adrario E, Pelaia P, Donati A, Kazune S, Grabovskis A, Volceka K, Rubins U, Bol M, Suverein M, Delnoij T, Driessen R, Heines S, Delhaas T, Vd Poll M, Sels J, Jozwiak M, Chambaz M, Sentenac P, Richard C, Monnet X, Teboul JL, Bitar Z, Maadarani O, Al Hamdan R, Huber W, Malbrain M, Chew M, Mallat J, Tagami T, Hundeshagen S, Wolf S, Huber W, Mair S, Schmid R, Aron J, Adlam M, Dua G, Mu L, Chen L, Yoon J, Clermont G, Dubrawski A, Duhailib Z, Al Assas K, Shafquat A, Salahuddin N, Donaghy J, Morgan P, Valeanu L, Stefan M, Provenchere S, Longrois D, Shaw A, Mythen MG, Shook D, Hayashida D, Zhang X, Munson SH, Sawyer A, Mariyaselvam M, Blunt M, Young P, Nakwan N, Khwannimit B, Checharoen P, Berger D, Moller P, Bloechlinger S, Bloch A, Jakob S, Takala J, Van den Brule JM, Stolk R, Vinke E, Van Loon LM, Pickkers P, Van der Hoeven JG, Kox M, Hoedemaekers CW, Werner-Moller P, Jakob S, Takala J, Berger D, Bertini P, Guarracino F, Colosimo D, Gonnella S, Brizzi G, Mancino G, Baldassarri R, Pinsky MR, Bertini P, Gonnella S, Brizzi G, Mancino G, Amitrano D, Guarracino F, Goslar T, Stajer D, Radsel P, De Vos R, Dijk NBV, Stringari G, Cogo G, Devigili A, Graziadei MC, Bresadola E, Lubli P, Amella S, Marani F, Polati E, Gottin L, Colinas L, Hernández G, Vicho R, Serna M, Canabal A, Cuena R, Jozwiak M, Gimenez J, Teboul JL, Mercado P, Depret F, Richard C, Monnet X, Hajjej Z, Sellami W, Sassi K, Gharsallah H, Labbene I, Ferjani M, Herner A, Schmid R, Huber W, Abded N, Nassar Y, Elghonemi M, Monir A, Nikhilesh J, Apurv T, Uber AU, Grossestreuer A, Moskowitz A, Patel P, Holmberg MJ, Donnino MW, Graham CA, Hung K, Lo R, Leung LY, Lee KH, Yeung CY, Chan SY, Trembach N, Zabolotskikh I, Caldas J, Panerai R, Camara L, Ferreira G, Almeida J, de Oliveira GQ, Jardim J, Bor-Seng-Shu E, Lima M, Nogueira R, Jatene F, Zeferino S, Galas F, Robinson T, Hajjar LA, Caldas J, Panerai R, Ferreira G, Camara L, Zeferino S, Jardim J, Bor-Seng-Shu E, Oliveira M, Norgueira R, Groehs R, Ferreira-Santos L, Galas F, Oliveira G, Almeida J, Robinson T, Jatene F, Hajjar L, Ferreira G, Ribeiro J, Galas F, Gaiotto F, Lisboa L, Fukushima J, Rizk S, Almeida J, Jatene F, Osawa E, Franco R, Kalil R, Hajjar L, Chlabicz M, Sobkowicz B, Kaminski K, Kazimierczyk R, Musial W, Tycińska A, Siranovic M, Gopcevic A, Gavranovic ZG, Horvat AH, Krolo H, Rode B, Videc L, Trifi A, Abdellatif S, Ismail KB, Bouattour A, Daly F, Nasri R, Lakhal SB, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Girotto V, Teboul JL, Beurton A, Galarza L, Guedj T, Monnet X, Galarza L, Mercado P, Teboul JL, Girotto V, Beurton A, Richard C, Monnet X, Iliæ MK, Sakic L, NN V, Stojcic L, Jozwiak M, Depret F, Teboul JL, Alphonsine J, Lai C, Richard C, Monnet X, Tapanwong N, Chuntupama P, Wacharasint P, Huber W, Hoellthaler J, Lahmer T, Schmid R, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Skladzien T, Cicio M, Garlicki J, Serednicki W, Wordliczek J, Vargas P, Salazar A, Mercado P, Espinoza M, Graf J, Kongpolprom N, Sanguanwong N, Jonnada S, Gerrard C, Jones N, Morley T, Thorburn PT, Trimmings A, Musaeva T, Zabolotskikh I, Salazar A, Vargas P, Mercado P, Espinoza M, Graf J, Horst S, Lipcsey M, Kawati R, Pikwer A, Rasmusson J, Castegren M, Shilova A, Yafarova A, Gilyarov M, Shilova A, Yafarova A, Gilyarov M, Stojiljkovic DLL, Ulici A, Reidt S, Lam T, Jancik J, Ragab D, Taema K, Farouk W, Saad M, Liu X, Holmberg MJ, Uber A, Montissol S, Donnino M, Andersen LW, Perlikos F, Lagiou M, Papalois A, Kroupis C, Toumpoulis I, Osawa E, Carter D, Sardo S, Almeida J, Galas F, Rizk S, Franco R, Hajjar L, Landoni G, Kongsayreepong S, Sungsiri R, Wongsripunetit P, Marchio P, Guerra-Ojeda S, Gimeno-Raga M, Mauricio MD, Valles SL, Aldasoro C, Jorda A, Aldasoro M, Vila JM, Borg UB, Neitenbach AM, García M, González PG, Romero MG, Orduña PS, Cano AG, Rhodes A, Grounds RM, Cecconi M, Lee C, Hatib F, Jian Z, Rinehart J, De Los Santos J, Canales C, Cannesson M, García MIM, Hatib F, Jian Z, Scheeren T, Jian Z, Hatib F, Pinsky M, Chantziara V, Vassi A, Michaloudis G, Sanidas E, Golemati S, Bateman RM, Mokhtar A, Omar W, Aziz KA, El Azizy H, Nielsen DLL, Holler JG, Lassen A, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Capoletto C, Almeida J, Ferreira G, Fukushima J, Nakamura R, Risk S, Osawa E, Park C, Oliveira G, Galas F, Franco R, Hajjar L, Dias F, D’Arrigo N, Fortuna F, Redaelli S, Zerman L, Becker L, Serrano T, Cotes L, Ramos F, Fadel L, Coelho F, Mendes C, Real J, Pedron B, Kuroki M, Costa E, Azevedo L. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3). Crit Care 2017. [PMCID: PMC5374603 DOI: 10.1186/s13054-017-1628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pellegrino S, Tonali N, Erba E, Kaffy J, Taverna M, Contini A, Taylor M, Allsop D, Gelmi ML, Ongeri S. β-Hairpin mimics containing a piperidine-pyrrolidine scaffold modulate the β-amyloid aggregation process preserving the monomer species. Chem Sci 2016; 8:1295-1302. [PMID: 28451272 PMCID: PMC5359901 DOI: 10.1039/c6sc03176e] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/05/2016] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease is a neurodegenerative disorder linked to oligomerization and fibrillization of amyloid β peptides, with Aβ1-42 being the most aggregative and neurotoxic one. We report herein the synthesis and conformational analysis of Aβ1-42-amyloid related β-hairpin peptidomimetics, built on a piperidine-pyrrolidine semi rigid β-turn inducer and bearing two small recognition peptide sequences, designed on oligomeric and fibril structures of Aβ1-42. According to these peptide sequences, a stable β-hairpin or a dynamic equilibrium between two possible architectures was observed. These original constructs are able to greatly delay the kinetics of Aβ1-42 aggregation process as demonstrated by thioflavin-T fluorescence, and transmission electron microscopy. Capillary electrophoresis indicates their ability to preserve the monomer species, inhibiting the formation of toxic oligomers. Furthermore, compounds protect against toxic effects of Aβ on neuroblastoma cells even at substoichiometric concentrations. This study is the first example of acyclic small β-hairpin mimics possessing such a highly efficient anti-aggregation activity. The protective effect is more pronounced than that observed with molecules which have undergone clinical trials. The structural elements made in this study provide valuable insights in the understanding of the aggregation process and insights to explore the design of novel acyclic β-hairpin targeting other types of amyloid-forming proteins.
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Affiliation(s)
- S Pellegrino
- DISFARM-Sez. Chimica Generale e Organica "A. Marchesini" , Universitá degli Studi di Milano , via Venezian 21 , 20133 Milano , Italy .
| | - N Tonali
- Molécules Fluorées et Chimie Médicinale , BioCIS , Univ. Paris-Sud , CNRS , Université Paris Saclay , 5 rue Jean-Baptiste Clément , 92296 Châtenay-Malabry Cedex , France .
| | - E Erba
- DISFARM-Sez. Chimica Generale e Organica "A. Marchesini" , Universitá degli Studi di Milano , via Venezian 21 , 20133 Milano , Italy .
| | - J Kaffy
- Molécules Fluorées et Chimie Médicinale , BioCIS , Univ. Paris-Sud , CNRS , Université Paris Saclay , 5 rue Jean-Baptiste Clément , 92296 Châtenay-Malabry Cedex , France .
| | - M Taverna
- Protéines et Nanotechnologies en Sciences Séparatives , Institut Galien Paris-Sud , Univ. Paris-Sud , CNRS , Université Paris Saclay , 5 rue Jean-Baptiste Clément , 92296 Châtenay-Malabry Cedex , France
| | - A Contini
- DISFARM-Sez. Chimica Generale e Organica "A. Marchesini" , Universitá degli Studi di Milano , via Venezian 21 , 20133 Milano , Italy .
| | - M Taylor
- Lancaster University , Division of Biomedical and Life Sciences , Faculty of Health and Medicine , Lancaster LA1 4YQ , UK
| | - D Allsop
- Lancaster University , Division of Biomedical and Life Sciences , Faculty of Health and Medicine , Lancaster LA1 4YQ , UK
| | - M L Gelmi
- DISFARM-Sez. Chimica Generale e Organica "A. Marchesini" , Universitá degli Studi di Milano , via Venezian 21 , 20133 Milano , Italy .
| | - S Ongeri
- Molécules Fluorées et Chimie Médicinale , BioCIS , Univ. Paris-Sud , CNRS , Université Paris Saclay , 5 rue Jean-Baptiste Clément , 92296 Châtenay-Malabry Cedex , France .
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Taverna M. Soluble or Insoluble Alternative Blowing Agents? Processing Technologies for Both Alternatives, Presented By the Equipment Manufacturer. J CELL PLAST 2016. [DOI: 10.1177/0021955x9102700122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vogel B, Reuter S, Taverna M, Fischer MR, Schelling J. Vaccination: Developing and implementing a competency-based-curriculum at the Medical Faculty of LMU Munich. GMS J Med Educ 2016; 33:Doc5. [PMID: 26958653 PMCID: PMC4766931 DOI: 10.3205/zma001004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 10/12/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND In Germany medical students should gain proficiency and specific skills in the vaccination field. Especially important is the efficient communication of scientific results about vaccinations to the community, in order to give professional counseling with a complete overview about therapeutic options. AIM OF THE PROJECT: The aim of this project is to set up a vaccination-related curriculum in the Medical Faculty at the Ludwig-Maximilians-University in Munich. The structure of the curriculum is based on the National catalogue for competency-based learning objectives in the field of vaccination (Nationaler Kompetenzbasierter Lernzielekatalog Medizin NKLM). Through this curriculum, the students will not only acquire the classical educational skills concerning vaccination in theory and practice, but they will also learn how to become independent in the decision-making process and counseling. Moreover, the students will become aware of consequences of action related to this specific topic. METHODS According to defined guidelines, an analysis was performed on courses, which are currently offered by the university. A separate analysis of the NKLM was carried out. Both analyses identified the active courses related to the topic of vaccination as well as the NKLM learning objectives. The match between the topics taught in current courses and the NKLM learning objectives identified gaps concerning the teaching of specific content. Courses were modified in order to implement the missing NKLM learning objectives. RESULTS These analyses identified 24 vaccination-related courses, which are currently taught at the University. Meanwhile, 35 learning objectives on vaccination were identified in the NKLM catalogue. Four of which were identified as not yet part of the teaching program. In summary, this interdisciplinary work enabled the development of a new vaccination-related curriculum, including 35 learning objectives, which are now implemented in regular teaching courses by the Medical Faculty. CONCLUSIONS This project successfully describes a method to develop and implement a competency-based teaching program on the topic of vaccination. Importantly, the process presented here can serve as a guide to develop and implement similar teaching programs on other subjects and Universities.
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Affiliation(s)
- B. Vogel
- Klinikum der Universität München, Institut für Allgemeinmedizin, München, Deutschland
| | - S. Reuter
- Klinikum der Universität München, Institut für Allgemeinmedizin, München, Deutschland
| | - M. Taverna
- Klinikum der Universität München, Institut für Allgemeinmedizin, München, Deutschland
| | - M. R. Fischer
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
| | - J. Schelling
- Klinikum der Universität München, Institut für Allgemeinmedizin, München, Deutschland
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Mistraletti G, Umbrello M, Sabbatini G, Miori S, Taverna M, Cerri B, Mantovani ES, Formenti P, Spanu P, D'Agostino A, Salini S, Morabito A, Fraschini F, Reiter RJ, Iapichino G. Melatonin reduces the need for sedation in ICU patients: a randomized controlled trial. Minerva Anestesiol 2015; 81:1298-1310. [PMID: 25969139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Critically ill patients suffer from physiological sleep deprivation and have reduced blood melatonin levels. This study was designed to determine whether nocturnal melatonin supplementation would reduce the need for sedation in patients with critical illness. METHODS A single-center, double-blind randomized placebo-controlled trial was carried out from July 2007 to December 2009, in a mixed medical-surgical Intensive Care Unit of a University hospital, without any form of external funding. Of 1158 patients admitted to ICU and treated with conscious enteral sedation, 82 critically-ill with mechanical ventilation >48 hours and Simplified Acute Physiology Score II>32 points were randomized 1:1 to receive, at eight p.m. and midnight, melatonin (3+3mg) or placebo, from the third ICU day until ICU discharge. Primary outcome was total amount of enteral hydroxyzine administered. RESULTS Melatonin treated patients received lower amount of enteral hydroxyzine. Other neurological indicators (amount of some neuroactive drugs, pain, agitation, anxiety, sleep observed by nurses, need for restraints, need for extra sedation, nurse evaluation of sedation adequacy) seemed improved, with reduced cost for neuroactive drugs. Post-traumatic stress disorder prevalence did not differ between groups, nor did ICU or hospital mortality. Study limitations include the differences between groups before intervention, the small sample size, and the single-center observation. CONCLUSION Long-term enteral melatonin supplementation may result in a decreased need for sedation, with improved neurological indicators and cost reduction. Further multicenter evaluations are required to confirm these results with different sedation protocols.
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Affiliation(s)
- G Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy -
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Fazavana J, Bianchini EP, Saller F, Smadja C, Picard V, Taverna M, Borgel D. A chemically-modified inactive antithrombin as a potent antagonist of fondaparinux and heparin anticoagulant activity. J Thromb Haemost 2013; 11:1128-36. [PMID: 23581397 DOI: 10.1111/jth.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heparin and its analogs, mediating their anticoagulant activity through antithrombin (AT) activation, remain largely used for the preventive and curative treatment of thrombosis. The major adverse reaction of these drugs is the bleeding risk associated with overdose. Unfractionnated heparin (UFH) can be efficiently and rapidly neutralized by protamine sulfate, but this reversal partially neutralizes low-molecular-weight heparin (LMWH) and is inefficient in reversing fondaparinux. To secure administration of AT-mediated anticoagulants and counteract bleeding disorders, we previously designed a recombinant inactive AT as an antidote to heparin derivatives. OBJECTIVES To get around the limited production level of recombinant AT, we propose in this study an alternative strategy to produce a chemically modified inactive AT, exhibiting increased heparin affinity, as an antagonist of heparin analogs. METHODS Plasma-derived AT was chemically modified with 2,3 butanedione, a diketone known to specifically react with the arginine side chain. The chemical reaction was conducted in the presence of heparin to preserve basic residues within the heparin binding site from modifications. RESULTS AT treated by butanedione and selected for its high heparin affinity (AT-BD) was indeed modified on reactive Arg393 and thus exhibited decreased anticoagulant activity and increased heparin affinity. AT-BD was able to neutralize anticoagulant activity of heparin derivatives in vitro and in vivo and was devoid of intrinsic anticoagulant activity, as assessed by activated partial thromboplastin time assay. CONCLUSIONS AT-BD appears to be as efficient as protamine to neutralize UFH in vivo but could be more largely used because it also reverses fondaparinux and LMWH.
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Affiliation(s)
- J Fazavana
- Laboratoire d'Hématologie, University Paris-Sud-XI, Châtenay-Malabry Cedex, France
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Fregin A, Czogalla KJ, Gansler J, Rost S, Taverna M, Watzka M, Bevans CG, Müller CR, Oldenburg J. A new cell culture-based assay quantifies vitamin K 2,3-epoxide reductase complex subunit 1 function and reveals warfarin resistance phenotypes not shown by the dithiothreitol-driven VKOR assay. J Thromb Haemost 2013; 11:872-80. [PMID: 23452238 DOI: 10.1111/jth.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/20/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Warfarin directly inhibits the vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1) enzyme to effect anticoagulation. VKORC1 function has historically been assessed in vitro using a dithiothreitol (DTT)-driven vitamin K 2,3-epoxide reductase (VKOR) assay. Warfarin inhibits wild-type VKORC1 function by the DTT-VKOR assay. However, VKORC1 variants with warfarin resistance-associated missense mutations often show low VKOR activities and warfarin sensitivity instead of resistance. OBJECTIVES A cell culture-based, indirect VKOR assay was developed and characterized that accurately reports warfarin sensitivity or resistance for wild-type and variant VKORC1 proteins. METHODS Human coagulation factor (F)IX and VKORC1 variants were coexpressed in HEK 293T cells under standardized conditions at various warfarin concentrations. Secreted FIX activity served as surrogate marker to report wild-type and variant VKORC1 inhibition by warfarin. RESULTS AND CONCLUSIONS Warfarin dose-response curves fit to the secreted FIX activity data for coexpressed hVKORC1 wild-type, Val29Leu, Val45Ala and Leu128Arg variants. The corresponding calculated IC50 values were 24.7, 136.4, 152.0 and 1226.4 nm, respectively. Basal activities in the absence of warfarin for all VKORC1 variants were similar to that of wild-type VKORC1. Ranked IC50 values from the cell culture-based assay accurately reflect elevated warfarin dosages for patients with VKORC1 missense mutation-associated warfarin resistance.
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Affiliation(s)
- A Fregin
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
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Brambilla D, Verpillot R, De Kimpe L, Taverna M, Le Droumaguet B, Nicolas J, Canovi M, Gobbi M, Salmona M, Nicolas V, Scheper W, Couvreur P, Andrieux K. Nanoparticles against Alzheimer's disease: PEG–PACA nanoparticles are able to link the aβ-peptide and influence its aggregation kinetic. J Control Release 2010; 148:e112-3. [DOI: 10.1016/j.jconrel.2010.07.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mistraletti G, Sabbatini G, Taverna M, Figini MA, Umbrello M, Magni P, Ruscica M, Dozio E, Esposti R, DeMartini G, Fraschini F, Rezzani R, Reiter RJ, Iapichino G. Pharmacokinetics of orally administered melatonin in critically ill patients. J Pineal Res 2010; 48:142-7. [PMID: 20070489 DOI: 10.1111/j.1600-079x.2009.00737.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Critically ill patients exhibit reduced melatonin secretion, both in nocturnal peaks and basal daytime levels. Oral melatonin supplementation may be useful for known sedative and antioxidant properties. Its early enteral absorption and daily pharmacokinetics were determined in two cohorts of six high-risk patients in this prospective trial. During their third and fourth Intensive Care Unit (ICU) day, they underwent two different sets of repeated blood samples to detect serum melatonin levels through radio-immuno-assay. Cohort 1: samples taken at 20:00, 20:45, 21:30, 24:00, 03:00, 06:00, 14:00, 20:00 to describe the daily pharmacokinetics. Cohort 2: 20:00, 20:05, 20:10, 20:20, 20:30, 20:45 to study the early absorption. On ICU day 3, endogenous levels were measured, while the absorption of exogenous melatonin was determined on ICU day 4 after administration, at 20:00, of 3 mg melatonin. All basal levels were below the expected values. Following enteral administration, pharmacological levels were already reached in 5 min, with a serum peak after 16 min (half-absorption time: 3 min 17 s). The maximum serum level observed was 11040 pg/mL and the disappearance rate indicated a half-elimination time of 1 hr 34 min. Serum melatonin levels decreased significantly after midnight; pharmacological levels were maintained up to 10 hr following administration. No excessive sleepiness was reported in this patient group. Critically ill patients exhibited reduced melatonin secretion, as reported in the literature. Despite the critical illness, the oral bioavailability was satisfactory: serum levels after oral administration showed basically unchanged intestinal absorption, while disappearance rate was slower than reported elsewhere in healthy volunteers.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano, Milano, Italy.
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Mistraletti G, Taverna M, Sabbatini G, Carloni E, Bolgiaghi L, Pirrone M, Cigada M, Destrebecq ALL, Carli F, Iapichino G. Actigraphic monitoring in critically ill patients: preliminary results toward an "observation-guided sedation". J Crit Care 2009; 24:563-7. [PMID: 19592212 DOI: 10.1016/j.jcrc.2009.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/15/2009] [Accepted: 05/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study is to evaluate continuous wrist actigraphy (measurement of limb movements) in intensive care unit patients as a neurologic status monitoring. MATERIALS AND METHODS This is a prospective, observational study on motor activity of adult patients using wrist actigraphs. Nurses recorded the number of sleep and agitation hours as well as assessed pain and anxiety level (verbal numeric rating) and the agitation/sedation level (Richmond Agitation-Sedation Scale). RESULTS Thirteen mechanically ventilated patients were studied during their whole intensive care unit stay (total, 165 patients/d). The number of surveyed movements was gathered for each hour, obtaining an estimation of patient motor status. This measure was different between days and nights (33.3 [20.3-49.0] vs 8.5 [4.4-13.8]; P < .001), with a correlation with sleeping hours estimated by nurses (P = .017 during the days [D], P < .001 during the nights [N]), agitation hours (P = .002 D, P = .017 N), Richmond Agitation-Sedation Scale value (P < .001 D and N), pain (P = .012 D), and anxiety (P < .001 D) verbal numeric rating. No differences were found using epochs of 15 or 120 seconds. Compliance with patients and nurses was acceptable. CONCLUSIONS Patients' limb movements were significantly related to all studied neurologic status indexes. Continuous actigraphy measuring may become important as a clinical tool both to guide utilization of sedative drugs and to enhance early recognition and management of agitation.
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Affiliation(s)
- Giovanni Mistraletti
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, Azienda Ospedaliera San Paolo-Polo Universitario, 20142 Milano, Italy.
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Abbood A, Smadja C, Herrenknecht C, Alahmad Y, Tchapla A, Taverna M. Retention mechanism of peptides on a stationary phase embedded with a quaternary ammonium group: A liquid chromatography study. J Chromatogr A 2009; 1216:3244-51. [DOI: 10.1016/j.chroma.2009.02.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/03/2009] [Accepted: 02/12/2009] [Indexed: 10/21/2022]
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Mistraletti G, Carloni E, Cigada M, Zambrelli E, Taverna M, Sabbatini G, Umbrello M, Elia G, Destrebecq ALL, Iapichino G. Sleep and delirium in the intensive care unit. Minerva Anestesiol 2008; 74:329-333. [PMID: 18500209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Intensive Care Unit (ICU) patients almost uniformly suffer from sleep disruption. Even though the role of sleep disturbances is not still adequately understood, they may be related to metabolic, immune, neurological and respiratory dysfunction and could worsen the quality of life after discharge. A harsh ICU environment, underlying disease, mechanical ventilation, pain and drugs are the main reasons that underlie sleep disruption in the critically ill. Polysomnography is the gold standard in evaluating sleep, but it is not feasible in clinical practice; therefore, other objective (bispectral index score [BIS] and actigraphy) and subjective (nurse and patient assessment) methods have been proposed, but their adequacy in ICU patients is not clear. Frequent evaluation of neurological status with validated tools is necessary to avoid excessive or prolonged sedation in order to better titrate patient-focused therapy. Hypnotic agents like benzodiazepines can increase total sleep time, but they alter the physiological progression of sleep phases, and decrease the time spent in the most restorative phases compared to the phases normally mediated by melatonin; melatonin production is decreased in critically ill patients, and as such, exogenous melatonin supplementation may improve sleep quality. Sleep disruption and the development of delirium are frequently related, both because of sleep scarcity and inappropriate dosing with sedatives. Delirium is strongly related to increased ICU morbidity and mortality, thus the resolution of sleep disruption could significantly contribute to improved ICU outcomes. An early evaluation of delirium is strongly recommended because of the potential to resolve the underlying causes or to begin an appropriate therapy. Further studies are needed on the effects of strategies to promote sleep and on the evaluation of better sleep in clinical outcomes, particularly on the development of delirium.
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Affiliation(s)
- G Mistraletti
- Department of Anesthesiology and Reanimation, University of Milan, Milan, Italy
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23
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Helali N, Tran N, Monser L, Taverna M. Capillary zone electrophoresis method for the determination of famotidine and related impurities in pharmaceuticals. Talanta 2008; 74:694-8. [DOI: 10.1016/j.talanta.2007.06.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 06/25/2007] [Accepted: 06/27/2007] [Indexed: 11/16/2022]
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Fregin A, Taverna M, Rost S, Mueller-Reible C, Oldenburg J. IN VIVO-ASSAY FOR WARFARIN-RESISTANCE BY COEXPRESSION OF VKORC1 AND VITAMIN K-DEPENDENT COAGULATION FACTORS. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb00148.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Progent F, Taverna M, Banco A, Tchapla A, Smadja C. Chromatographic behaviour of peptides on a mixed-mode stationary phase with an embedded charged group by capillary electrochromatography and high-performance liquid chromatography. J Chromatogr A 2006; 1136:221-5. [PMID: 17081551 DOI: 10.1016/j.chroma.2006.09.095] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 09/11/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
Retention behaviour of biological peptides was investigated on a stationary phase bearing an embedded quaternary ammonium group in a C21 alkyl chain by both high-performance liquid chromatography (HPLC) and capillary electrochromatography (CEC). In HPLC experiments, variation of acetonitrile (ACN) content in the mobile phase showed that peptides are mainly separated by RP mechanism. The weak or negative retention factors observed as compared to C18 silica stationary phase suggested the involvement of an electrostatic repulsion phenomenon in acidic conditions. Comparison of HPLC and CEC studies indicated that (i) ion-exclusion phenomenon is more pronounced in HPLC and (ii) higher ACN percentage in mobile phase induce for some peptides an increase of retention in CEC, pointing out the existence of mechanisms of retention other than partitioning mainly involved in chromatographic process. This comparative study demonstrated the critical role of electric field on peptide retention in CEC and supports the solvatation model of hydrolytic pillow proposed by Szumski and Buszewski for CEC using mixed mode stationary phase in CEC.
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Affiliation(s)
- F Progent
- Univ Paris-Sud, JE 2495, Protéines et Nanotechnologies en Sciences Séparatives, F-92296 Châtenay-Malabry Cedex, France
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Andrieux K, Olivier JC, Taverna M, Vauthier C, Couvreur P, Ferrier D. Analysis of Serum Proteins by Micellar Electrokinetic Capillary Chromatography. Application to a Drug Carrier Evaluation. J LIQ CHROMATOGR R T 2006. [DOI: 10.1080/10826079608014583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- K. Andrieux
- a Laboratoire de Chimie Analytique , Centre d'études pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
| | - J. C. Olivier
- b Laboratoire de Pharmacotechnie , Centre d'etudes pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
| | - M. Taverna
- a Laboratoire de Chimie Analytique , Centre d'études pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
| | - C. Vauthier
- b Laboratoire de Pharmacotechnie , Centre d'etudes pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
| | - P. Couvreur
- b Laboratoire de Pharmacotechnie , Centre d'etudes pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
| | - D. Ferrier
- a Laboratoire de Chimie Analytique , Centre d'études pharmaceutiques , rue J.-B. Clément, 92290, Chatenay-Malabry, France
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M'bemba J, Cynober L, de Bandt P, Taverna M, Chevalier A, Bardin C, Slama G, Selam JL. Effects of dipeptide administration on hypoglycaemic counterregulation in type 1 diabetes. Diabetes Metab 2003; 29:412-7. [PMID: 14526269 DOI: 10.1016/s1262-3636(07)70052-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate if a dipeptide made of glutamine and alanine is able to contribute to the recovery from insulin-induced hypoglycaemia in type 1 diabetes. RESEARCH DESIGN AND METHODS Fifteen adult type 1 patients were randomly assigned to study group (n=7): intravenous infusion of 20 g Dipeptiven in normal saline (i.e., 8 g alanine and 13 g glutamine), or control group (n=8): same infusion, normal saline only. A 150 min gradual hypoglycaemic hyperinsulinemic clamp was administered after 2 h of infusion. Counterregularory hormones, symptoms, and cognitive function (4 choice reaction test) were regularly measured during the study. RESULTS Blood glucose and glucose infusion rates were similar in the 2 groups. Circulating levels of alanine and glutamine peaked at 90 min and remained elevated throughout the test. This was associated with significant differences in: glucagonemia 107 +/- 20 vs 58 +/- 8 pg/ml, and neuroglycopenic symptoms scores: 7 +/- 3 vs 18 +/- 13, at t 150 min, in study and control group, p<0.05. Dysautonomic symptoms, cognitive tests as well as epinephrine, norepinephrine, cortisol and growth hormone were similar between groups. CONCLUSION Intravenous infusion of a dipeptide made of alanine and glutamine is capable to reactivate glucagon secretion during insulin-induced hypoglycaemia and to reduce hypoglycaemic symptoms.
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Affiliation(s)
- J M'bemba
- Inserm U341, Department of Diabetology, Hospital Assistance Publique, Paris, France
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Duchemin V, Le Potier I, Troubat C, Ferrier D, Taverna M. Analysis of intact heparin by capillary electrophoresis using short end injection configuration. Biomed Chromatogr 2002; 16:127-33. [PMID: 11857645 DOI: 10.1002/bmc.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A capillary electrophoresis method for the analysis of intact heparin was developed using a phosphate buffer and a fused silica capillary. Operational parameters such as pH and concentration of the running buffer were investigated. The short end injection configuration permitted a gain on peak efficiency, on the analysis time and on the repeatability of both migration times and peak areas, through a reduction of the migration distance. Moreover, the beneficial effect of the presence of sodium chloride in the heparin sample on the peak efficiency was demonstrated and the influence of the salts on the conformation of the heparin was discussed. The optimized method (short end injection configuration, 50mM phosphate buffer pH 3, heparin sample prepared in 10 g/L NaCl solution) was validated in terms of linearity, reproducibility and specificity according to ICH requirements.
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Affiliation(s)
- V Duchemin
- ROCHE, Service de développement analytique, 52 rue M. et J. Gaucher, 94120 Fontenay-sous-Bois, France
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Tran NT, Daali Y, Cherkaoui S, Taverna M, Neeser JR, Veuthey JL. Routine o-glycan characterization in nutritional supplements--a comparison of analytical methods for the monitoring of the bovine kappa-casein macropeptide glycosylation. J Chromatogr A 2001; 929:151-63. [PMID: 11594397 DOI: 10.1016/s0021-9673(01)01176-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Analytical procedures, including capillary isoelectric focusing (CIEF), high-performance anion-exchange chromatography coupled to amperometric detection (HPAEC-PAD) and normal-phase chromatography with fluorescence detection are presented for the characterization of a highly O-glycosylated caseinomacropeptide (CGMP) and the detection of subtle glycosylation differences between CGMP Batches obtained with two different preparation procedures. Modified two-step CIEF allowed monitoring of glycopeptide heterogeneity and determination of the isoelectric points of acidic glycoforms. The mixture of wide and narrow pH range ampholytes was optimized to improve glycoform resolution. The pI of the different CGMP glycoforms was evaluated with pI internal standards and found to range between 3.08 and 3.58, which indicates a very acidic glycopeptide. Moreover, the monosaccharide composition was determined with HPAEC-PAD after neutral and amino sugars release by using adequate acidic hydrolysis of CGMP. Results indicated a similar composition for Batches I and II, but the monosaccharide percentages were 3-4 fold higher in Batch I, particularly for galactose and glucose. This likely reflects a higher content in lactose in the case of Batch I. Finally, O-linked oligosaccharides were released with an automated hydrazinolysis and derivatized with a sensitive labelling reagent, 2-aminobenzamide. The derivatives were then analyzed by normal-phase HPLC coupled with fluorescence detection, and separated on the basis of hydrophilic interaction, which allowed oligosaccharide mapping of the two CGMP. It appeared that the two CGMP preparations had an almost identical O-glycan population, but CGMP Batch I was more glycosylated than Batch II. Additionally, the sizes of the separated glycans, expressed as the number of glucose units, were tentatively assigned using calibration with a partial hydrolysate of dextran. In conclusion, a combination of electrophoretic and chromatographic techniques was found powerful in studying glycoprotein heterogeneity and assessing batch-to-batch consistency.
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Affiliation(s)
- N T Tran
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France
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Paglione AM, Ferrari N, Berg G, Frechtel G, Taverna M, Fasulo V, Lopez GI, Gomez RM, Bruno O, Ruiz M, Wikinski RL. [Acquired partial lipodystrophy. Insulin resistance, hepatic lipase activity and small and dense LDL particles]. Medicina (B Aires) 2001; 61:81-4. [PMID: 11265632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Partial lipodystrophy (PLD) is an infrequent condition characterized by symmetric loss of subcutaneous adipose tissue in the upper or lower part of the body, although occasionally it affects only the extremities. In all cases it appears along with acantosis nigricans (AN), insulin resistance and impairment in the metabolism of lipids and carbohydrates. The case depicted pertains to a 49 year old female with no family history involving loss of adipose tissue in face and upper body. No fat in lower part of body was observed. The patient showed facial thinning at age 8, AN at 11 and gestational diabetes during her fourth pregnancy at 33. At present, the patient presents severe hyperglycemia and hyperinsulinemia with a marked insulin resistance. Type IV hyperlipoproteinemia (OMS), declined C-HDL and Apo A1 and low C-LDL but with a high proportion of small and dense LDL particles were present. Non esterified fatty acids were high. Lipoprotein lipase and hepatic lipase activities are in the lower limit and increased respectively. Fraction C3 of the complement was diminished. No mutations were observed either in codons 170, 809 and 972 of the IRS-1 receptor or in codon 276 of the adrenergic beta 2 gene.
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Affiliation(s)
- A M Paglione
- Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, UBA, Junin 956, 1113 Buenos Aires, Argentina.
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Le Potier I, Taverna M, Fattal E, Benzaki J, Chevalier M, Ferrier D. Performance evaluation of capillary surface treatments for peptide mapping by capillary zone electrophoresis. Chromatographia 2001. [DOI: 10.1007/bf02491624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tran NT, Taverna M, Merry AH, Chevalier M, Morgant G, Valentin C, Ferrier D. A sensitive mapping strategy for monitoring the reproducibility of glycan processing in an HIV vaccine, RGP-160, expressed in a mammalian cell line. Glycoconj J 2000; 17:401-6. [PMID: 11294506 DOI: 10.1023/a:1007160115293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The external envelope glycoprotein (gp160) of HIV-1 is a candidate for vaccines against AIDS. Most of the surface of the molecule is shielded by carbohydrate and the structures and locations of these glycans may be important in defining the immunogenicity of the viral coat. Here we report a sensitive mapping strategy for profiling and analysing the N-glycosylation of gp160, based on chemical release of glycans, fluorescent labelling and HPLC analysis. This approach has been validated in terms of establishing the reproducibility of all steps in the analytical procedure and on overall reproducibility on a run-to-run and day-to-day basis. The validated analysis technique was used to monitor the consistency of N-glycosylation of one rgp 160 vaccine candidate produced in baby hamster kidney (BHK) cell culture. It was demonstrated that the variation in the glycan profiles of 6 different lots was not statistically significant.
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Affiliation(s)
- N T Tran
- Department of Biochemistry, University of Oxford, United Kingdom
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Tran NT, Taverna M, Chevalier M, Ferrier D. One-step capillary isoelectric focusing for the separation of the recombinant human immunodeficiency virus envelope glycoprotein glycoforms. J Chromatogr A 2000; 866:121-35. [PMID: 10681015 DOI: 10.1016/s0021-9673(99)01045-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
One-step capillary isoelectric focusing was investigated as a rapid method to resolve the glycoforms of the heterogeneous recombinant human immunodeficiency virus (HIV) envelope glycoprotein (rgp 160sMN/LAI). The separation was performed in a poly(vinyl alcohol) (PVA) coated capillary using a mixture of ampholyte of narrow and wide pH range. A combination of saccaharose and 3-(cyclohexylamino)-1-propanesulfonic acid was shown to be the most efficient additive to avoid protein precipitation which occurs at a pH close to its pI. Although the calibration curve [isoelectric point (pI) vs. migration times] showed a non-linear relationship, an adequate linearity could be yielded for short pI ranges permitting to exhibit the acidic character of the different glycoforms of the rgp 160s MN/LAI (pI from 4.00 to 4.95). Reproducibility evaluated by comparing the performance of a polyacrylamide and a PVA coated capillary showed that low RSD values were obtained for intra-day (0.5 to 1.9%) and inter-day (1.6 to 7.6%) measurements using the PVA capillary. Moreover, the long term stability of the PVA capillary was demonstrated by measuring the variation of migration times of the protein markers for a long period of use. Finally, this method was able to differentiate the glycoform pattern of two close glycoproteins such as the rgp 160 of two sub-populations of the virus HIV-1.
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Affiliation(s)
- N T Tran
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France
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Taverna M, Nguyet TT, Valentin C, Level O, Merry T, Kolbe HV, Ferrier D. A multi-mode chromatographic method for the comparison of the N-glycosylation of a recombinant HIV envelope glycoprotein (gp160s-MN/LAI) purified by two different processes. J Biotechnol 1999; 68:37-48. [PMID: 10036769 DOI: 10.1016/s0168-1656(98)00187-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The glycosylation pattern of a recombinant gp160s-MN/LAI variant of human immunodeficiency virus type 1 (HIV-1) was studied in relation to two alternative purification techniques one of which involves an immunoprecipitation step. For analysis a multi-mode high performance liquid chromatography (HPLC) method which combines gel permeation chromatography on the RAAM 2000 GlycoSequencer, weak anion exchange chromatography and normal phase chromatography was developed and profiles were obtained for the fluorescently-labelled glycans released from the two gp160s-MN/LAI preparations. Charged glycans accounted for 77 and 80% of the total glycans for the IAP- and SP-purified samples, respectively. The acidic character of these glycans was mainly due to the presence of sialic acids. However, following sialidase treatment, residual charged glycans were still found. No differences were found in the glycan distributions of the two gp160s-MN/LAI preparations either in their degree of sialylation or in their relative proportion of each separated structure. Although this did not reach statistical significance, a lower proportion of large glycan structures regardless of their charge status was found on the gp160s-MN/LAI prepared by the procedure which involved an immunoaffinity chromatography step.
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Affiliation(s)
- M Taverna
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France
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Le Potier I, Tamisier-Karolak S, Morin P, Megel F, Taverna M. Comparison of native, alkylated and charged cyclodextrins for the chiral separation of labetalol stereoisomers by capillary electrophoresis. J Chromatogr A 1998. [DOI: 10.1016/s0021-9673(98)00793-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tran NT, Taverna M, Deschamps FS, Morin P, Ferrier D. Investigation of micelles and anionic cyclodextrins as pseudostationary phases for the capillary electrophoresis separation of oligosaccharides derivatized with 2-amino-benzamide. Electrophoresis 1998; 19:2630-8. [PMID: 9848671 DOI: 10.1002/elps.1150191511] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Oligomers of glucose and oligosaccharides released from glycoproteins were derivatized with 2-aminobenzamide. As this fluorophore imparts no charge to the oligosaccharides, several strategies were investigated to achieve capillary electrophoresis (CE) separation of both neutral and charged derivatized glycans. Micellar electrokinetic capillary chromatography (MEKC) with the addition of anionic surfactants was evaluated as a first approach: sodium dodecyl sulfate (SDS) produced the best separation of the oligoglucose fragments, where the migration was inversely related to their degree of polymerization. To demonstrate the applicability of this method for complex carbohydrate analysis, oligosaccharide mixtures derived from ribonuclease B (RNase B) and alpha-acid glycoprotein (alpha-AGP) were analyzed. A satisfactory separation for the high-mannose structures found in RNase B could be obtained, whereas charged oligosaccharides from alpha-AGP were poorly resolved. Cyclodextrin-modified CE was chosen as the second approach: the effect of the addition of sulfobutylether-beta-cyclodextrin (SBE-beta-CD) or sulfobutylether-gamma-cyclodextrin (SBE-gamma-CD) on the electrophoretic mobilities and resolution of neutral and charged oligosaccharides was then studied. Selectivity of sialylated structures could be further improved by using anionic cyclodextrins (CDs) instead of micelles. However, this latter approach failed to baseline-resolve the different high-mannose structures of RNase B. A successful separation of the complex mixture of oligosaccharides from alphaalpha-AGP was obtained with the addition of 4% of SBE-gamma-CD and triethylamine (TEA) in a phosphate buffer, pH 6.7.
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Affiliation(s)
- N T Tran
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France
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Taverna M, Tran NT, Merry T, Horvath E, Ferrier D. Electrophoretic methods for process monitoring and the quality assessment of recombinant glycoproteins. Electrophoresis 1998; 19:2572-94. [PMID: 9848665 DOI: 10.1002/elps.1150191505] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In many ways electrophoretic techniques appear ideal for quality monitoring of proteins and are thus well suited for the analysis of recombinant glycoproteins. The requirements of high throughput, comparative analysis and resolution of many variants are met by several electrophoretic techniques. A wide variety of such techniques are available to biotechnologists in the rapidly developing area of recombinant glycoproteins. It is the aim of this review to specifically cover recent work which has been applied to the analysis of DNA-derived glycoproteins, both from a process control standpoint and final product validation. All major areas of electrophoresis including sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), isoelectric focusing and techniques utilizing capillary electrophoresis are covered, with emphasis on analysis of glycoforms and oligosaccharide profiles of recombinant glycoproteins. As illustration, actual examples rather than standard glycoproteins are given to indicate the potential and limitations which may be encountered. It is anticipated that this review will prove a useful and practical guide to the latest developments by indicating the relevant merits of different methods.
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Affiliation(s)
- M Taverna
- Laboratoire de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France.
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Lemesle-Lamache V, Wouessidjewe D, Taverna M, Ferrier D, Perly B, Duchene D. Physicochemical characterization of different batches of ethylated beta-cyclodextrins. J Pharm Sci 1997; 86:1051-6. [PMID: 9294821 DOI: 10.1021/js960318i] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Different ethylated beta-cyclodextrin (Et-beta-CD) derivatives were obtained by various synthetic routes and their chemical structures and physical properties were elucidated. The aqueous solubility studies were carried out at 25 and 37 degrees C. A gas phase chromatography analysis, with head space extraction, was developed to detect the presence of residual solvents in the dry preparations. Electrospray ionization mass spectrometry allowed the determination of the average degree of substitution and the molecular mass of the Et-beta-CDs. Nuclear magnetic resonance analysis was used to elucidate the relationship between the solubility behavior and substituted positions of ethyl groups on the CD glucopyranose units. Finally, this paper deals with different physico-chemical methods used to fully characterize the different batches of Et-beta-CD to correlate the data obtained with the pharmacotechnical behavior of these cyclodextrins.
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Affiliation(s)
- V Lemesle-Lamache
- Faculté de Pharmacie, Université Paris-Sud, URA CNRS 1218, Chatenay-Malabry, France
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Denuzière A, Taverna M, Ferrier D, Domard A. Capillary electrophoresis of glycosaminoglycan-derived disaccharides: application to stability studies of glycosaminoglycan chitosan complexes. Electrophoresis 1997; 18:745-50. [PMID: 9194600 DOI: 10.1002/elps.1150180514] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Capillary zone electrophoresis (CZE) was used to separate the disaccharides produced by chondroitinase digestion of chondroitin sulfates. The main disaccharides formed upon depolymerization have identical charge and mass. Baseline resolution of these two compounds was achieved by selecting appropriate concentration and pH of a borate buffer. Validation of the method showed a good linearity of the response and a very satisfactory reproducibility of migration times with a relative standard deviation (RSD) of less than 0.4%. The reproducibility of peak areas was improved by using an internal standardization. The addition of cinnamic acid (internal standard) to the incubation medium allowed us to perform kinetic measurements of the depolymerization while keeping a baseline resolution of the two main disaccharides analyzed during the complete digestion course even when their concentration in the incubation medium increased. Application of this method to the comparison of the rate of hydrolysis of chondroitin sulfate and of a complex associating chondroitin sulfate with chitosan showed clearly that, at the physiological pH, chitosan protected the chondroitin sulfate from depolymerization. This phenomenon was more pronounced as the pH of the incubation medium was far from the optimum pH activity of the chondroitinase.
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Affiliation(s)
- A Denuzière
- Faculté de pharmacie, Laboratoire de Chimie Analytique, Châtenay-Malabry, France
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Gómez Treviño M, Taverna M, Boureau H, Bourlioux P, Ferrier D. Contribution of capillary zone electrophoresis to the analysis of cecal mucins. J Capillary Electrophor 1996; 3:287-94. [PMID: 9384722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The ability of capillary electrophoresis to perform the separation of mucin glycoforms has been investigated. Adsorption of mucins to the capillary was observed in most cases, leading to unreproducible results. This was due in part to the characteristic structure of mucin (highly charged, large size) and also to its poor solubility. Various buffers were therefore investigated; it was found that a zwitterionic electrolyte, such as a (3-[cyclohexylamino]-1-propanesulfonic acid) (CAPS) buffer, pH 8.8, greatly improved the separation. Using this buffer, mucin was resolved into five main fractions. The use of several additives, such as cationic molecules (1,4-diaminobutane [DAB]) or hydrophilic polymers (hydroxypropylmethylcellulose [HPMC], polyethylene glycol [PEG]) was also investigated. PEG and HPMC did not affect the separation and the electroosmotic flow (EOF) in the same manner. The favorable effect of the addition of PEG was clearly demonstrated and it was postulated that some interaction of this polymer with the mucins occurred. Finally, the application of the method to the comparison of glycoform patterns of mouse cecal mucins showed a marked difference for mucins derived from two sources: germ-free and gnotobiotic mice. These results indicate that mucins from gnotobiotic mice have been degraded due to the glycosidic activity of the bacterial strains present in these mice.
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Affiliation(s)
- M Gómez Treviño
- Laboratoire de Microbiologie, Faculté de Pharmacie, Châtenay-Malabry, France
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Abstract
BACKGROUND The induction of estrogen and progesterone receptors (ER and PGR) has been reported in breast and endometrial cancer cells exposed to human fibroblast interferon-beta (hIFN-beta). Clinical verification of this finding might provide the rationale for new therapeutic approaches. This study was designed to evaluate whether clinical treatment with high doses of hIFN-beta induced ER and PGR in patients with endometrial adenocarcinoma. METHODS Two biopsies were obtained, 1 before and 1 after hIFN-beta treatment (3 x 10(6) i.m. every other day for 3 weeks) from 36 patients with endometrial adenocarcinoma. ER and PGR were determined with standard procedures using radiolabeled ligands. RESULTS hIFN-beta treatment did not affect the proportion of ER-positive (i.e., >15 fmol/mg protein) or PGR-positive (i.e., >20 fmol/mg protein) cases. However, in patients with detectable ER and PGR at baseline, hIFN-beta raised the levels. Using a 35% difference before and after therapy as a cut-off, 72 and 79% of cases had increases in ER and PGR, respectively. The difference was highly significant for PGR. CONCLUSIONS In patients with endometrial adenocarcinoma with undetectable ER or PGR, hIFN-beta did not induce the expression of these receptors. When the receptors were present they were upregulated by hIFN-beta. Whether this increase in receptor levels, particularly PGR, has therapeutic applications remains to be established.
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Affiliation(s)
- A M Codegoni
- Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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Olivier JC, Vauthier C, Taverna M, Puisieux F, Ferrier D, Couvreur P. Stability of orosomucoid-coated polyisobutylcyanoacrylate nanoparticles in the presence of serum. J Control Release 1996. [DOI: 10.1016/0168-3659(95)00175-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Lemesle-Lamache V, Taverna M, Wouessidjewe D, Duchêne D, Ferrier D. Determination of the binding constant of salbutamol to unmodified and ethylated cyclodextrins by affinity capillary electrophoresis. J Chromatogr A 1996. [DOI: 10.1016/0021-9673(96)84680-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guglielmi A, Aschele C, Mori A, Baldo C, Russo P, Debernardis D, Valenti M, Bruno S, Taverna M, Rosso R. In vitro synergism between 5-fluorouracil and natural beta interferon in human colon carcinoma cells. Clin Cancer Res 1995; 1:1337-44. [PMID: 9815929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The combination of 5-fluorouracil (FUra) plus IFN-beta was studied in vitro using a human colon carcinoma cell line, HCT-8. Continuous exposure to high concentrations of IFN-beta is cytotoxic to these cells (ED50, 600 +/- 50 IU/ml). A strong synergism (P < 0.002) was observed when a short-term (1-h), high-concentration exposure to fluoropyrimidine (300 or 1000 microM) was followed by IFN-beta given continuously. In fact, the mean ratio between the expected (product of the survival of each agent alone) and the observed clonogenic cell survival rates of the combination was 3.4 (range, 2.4-4.9). Longer exposures to the fluoropyrimidine (24 h, 7 days) produced less than additive effects with IFN-beta, indicating strong schedule dependency for this synergism. The mechanism of interaction was studied at four levels. First, thymidylate synthase (TS) activity, inhibition, and recovery were measured by an in situ assay in cells treated with FUra, IFN-beta, and their combination. When the prolonged infusion of IFN-beta followed a 1-h exposure to FUra, the observed TS inhibition and recovery, at each time point, were very similar to the expected values, indicating that the interactions between these drugs at the level of TS are not the determinant of the synergism. Second, cell cycle analysis was done. During the continuous exposure to IFN-beta, a significant accumulation of HCT-8 cells in S-phase was observed at 24, 48, and 72 h compared to untreated controls (P = 0.003); however, under the same experimental conditions producing synergy in the clonogenic assay, no significant cell cycle perturbations were produced by the combination of FUra followed by IFN-beta compared to those caused by each agent alone. Third, using the alkaline elution test, we also demonstrated that the synergism is not due to enhanced FUra-induced DNA single-strand break frequency in high molecular weight DNA. Finally, nucleic acid incorporation experiments, using tritiated FUra, showed that the cytokine, given continuously (300 IU/ml), enhanced the amount of FUra incorporated into nucleic acids 24 h after a 1-h exposure to 300 and 1000 microM of FUra. The median percentage of enhancement values were 31.6 +/- 11.5%,m for the lower drug concentration and 18. 4 +/- 8.1% for the higher drug concentration tested. These results suggest that the mechanism of this synergism may be related to the ability of IFN-beta to promote the incorporation of intracellular FUra metabolites into nucleic acids and/or to inhibit the cleavage of FUra nucleotides from RNA/DNA.
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Affiliation(s)
- A Guglielmi
- Medical Oncology, Istituto Nazionale per la Ricerca sul Cancro, V.le Benedetto XV, 10, 16132 Genova, Italy
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Taverna M, Baillet A, Schlüter M, Baylocq-Ferrier D. N-glycosylation site mapping of recombinant tissue plasminogen activator by micellar electrokinetic capillary chromatography. Biomed Chromatogr 1995; 9:59-67. [PMID: 7795387 DOI: 10.1002/bmc.1130090202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This report describes the N-glycosylation mapping of recombinant tissue plasminogen activator (rt-PA) using micellar electrokinetic capillary chromatography. The carbohydrate structures were tentatively assigned by comparison with the anion-exchange fractionated oligosaccharides and by a comparison with previously reported data. The separation was shown to rely mainly on the degree of sialylation of the oligosaccharides, allowing a quantitative determination of the proportion of neutral and mono- to tetrasialylated structures. Significant differences in the oligosaccharide distribution of the two variants of rt-PA, which differ by the presence (type I) or the absence (type II) of oligosaccharides at the Asn-184 site, were observed. The distribution of the oligosaccharides at each of the rt-PA glycosylation sites was then determined. Glycopeptides were prepared by tryptic digestion of rt-PA and isolated using two consecutive chromatographic procedures. The glycopeptides were finally treated with N-glycanase, and the resulting oligosaccharides were analysed by capillary electrophoresis. Oligosaccharide mapping revealed that the Asn-448 and Asn-184 sites carry the same population of complex-type oligosaccharides but that the relative amounts of each oligosaccharide vary markedly. High-pH anion-exchange chromatography performed on the desialylated oligosaccharides at each glycosylation site showed that the degree of microheterogeneity was related not only to the degree of sialylation but also to structural differences in the oligosaccharide sequences. From the results as a whole, we concluded that the Asn-448 site contains a greater proportion of heavily sialylated structures and has a higher degree of microheterogeneity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Taverna
- Faculté de Pharmacie, Laboratoire de Chimie Analytique III, Chatenay-Malabry, France
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Bonfanti M, Taverna P, Mangioni C, Losa G, Taverna M, D'Incalci M. Interferon-beta does not change the level of O6-alkylguanine-DNA alkyltransferase in cancer patients' lymphocytes. Anticancer Drugs 1994; 5:601-2. [PMID: 7858294 DOI: 10.1097/00001813-199410000-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Olivier JC, Taverna M, Vauthier C, Couvreur P, Baylocq-Ferrier D. Capillary electrophoresis monitoring of the competitive adsorption of albumin onto the orosomucoid-coated polyisobutylcyanoacrylate nanoparticles. Electrophoresis 1994; 15:234-9. [PMID: 8026440 DOI: 10.1002/elps.1150150140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The simultaneous and rapid quantitation of a glycoprotein, human orosomucoid, and a protein, human serum albumin (HSA), by micellar electrokinetic capillary electrophoresis was developed and optimized (pH and sodium dodecyl sulfate concentration) in order to study the competitive adsorption of HSA onto orosomucoid-coated nanoparticles of polyisobutylcyanoacrylate. This method provided satisfactory repeatability and the response was linear for concentrations of orosomucoid and HSA ranging from 0.025 to 0.500 mg/mL (r > 0.994 for both proteins). To study the competitive adsorption of HSA, the amounts of free orosomucoid and free HSA were determined in the supernatant obtained after centrifugation of the orosomucoid-coated nanoparticle suspension incubated with HSA. Furthermore, the quantities of both orosomucoid and HSA absorbed onto nanoparticles were also determined after desorption of these molecules from the nanoparticle surface, using sodium dodecyl sulfate. No analytical interference was observed with this surfactant. The results showed that HSA did not at all absorb onto the orosomucoid-coated nanoparticles and, thus, that this protein did not displace the layer of absorbed orosomucoid from the nanoparticle surface.
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Affiliation(s)
- J C Olivier
- Laboratoire de Physico-Chimie, Pharmacotechnie et Biopharmacie URA CNRS 1218, Université Paris-Sud-5, Châtenay-Malabry, France
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Baillet A, Pianetti GA, Taverna M, Mahuzier G, Baylocq-Ferrier D. Fosfomycin determination in serum by capillary zone electrophoresis with indirect ultraviolet detection. J Chromatogr 1993; 616:311-6. [PMID: 8376512 DOI: 10.1016/0378-4347(93)80400-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Capillary zone electrophoresis with indirect ultraviolet detection was used for the determination of fosfomycin in serum. Running buffer consisted of a mixture of 200 mM sodium borate with 10 mM phenylphosphonic acid used as ultraviolet absorbing background electrolyte. Relationships between the pH of the buffer and the efficiency of the separation (migration times and selectivities) or the sensitivity of detection were investigated. The method was then validated over a 10-100 micrograms ml-1 concentration range to be applied to further therapeutic drug monitoring. The choice of ethylphosphonic acid as internal standard is discussed. The specificity and the linearity of the technique are demonstrated. The inter-day precision was satisfactory with a relative standard deviation of less than 2%. Accuracy was calculated with a standard error near 0.5 and 18% for 100 and 10 micrograms ml-1, respectively.
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Affiliation(s)
- A Baillet
- Laboratoires de Chimie Analytique, Faculté de Pharmacie, Châtenay-Malabry, France
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Taverna M, Baillet A, Biou D, Schlüter M, Werner R, Ferrier D. Analysis of carbohydrate-mediated heterogeneity and characterization of N-linked oligosaccharides of glycoproteins by high performance capillary electrophoresis. Electrophoresis 1992; 13:359-66. [PMID: 1505497 DOI: 10.1002/elps.1150130174] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Capillary zone electrophoresis (CZE) has been investigated as an alternative method to analyze the carbohydrate moieties of glycoproteins. Carbohydrate-mediated microheterogeneity of the recombinant plasminogen activator (rt-PA) was examined. The glycoprotein was resolved in multiple electrophoretic species using CZE but the separation was complicated by adsorption of the molecules to the wall of the capillary. The influence of several parameters, such as pH, molarity of the buffer and addition of a cationic additive, on the separation of glycopeptides was investigated. High resolution and reproducible separations of rt-PA glycopeptides carrying hybrid and complex type chains were obtained using either a 100 mM phosphate buffer, pH 6.6, or a 100 mM Tricine buffer, pH 8.2, containing 1.25 mM of putrescine. N-Oligosaccharides from fetuin, t-PA and alpha 1-acid glycoprotein were separated within 20 min on the basis of both their sialic acid content and their structure. The use of an oligosaccharide fingerprinting technique, such as the present one, could have many applications in biotechnology to assess, for example, the consistency of production of a glycoprotein or for analytical glycoprotein chemistry.
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Affiliation(s)
- M Taverna
- Laboratoire de Chimie Analytique, Centre d'Etudes Pharmaceutiques, Chatenay-Malabry, France
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Taverna M, Baillet A, Werner R, Baylocq-Ferrier D. Liquid chromatographic method for the determination of the carbohydrate moiety of glycoproteins. Application to alpha 1-acid glycoprotein and tissue plasminogen activator. J Chromatogr A 1991; 558:105-14. [PMID: 1744209 DOI: 10.1016/0021-9673(91)80115-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A rapid procedure is described for the qualitative and quantitative analysis of the carbohydrate composition of glycoproteins by liquid chromatography with light-scattering detection. The analysis was carried out in three steps. First, the glycoprotein samples were purified by a two-step purification on a Sephadex G-25 column with a 90% yield. Second, the selectivity of the separation and the sensitivity of detection of monosaccharides, as methyl glycosides obtained by direct methanolysis of glycoproteins, were improved by modified simplex optimization of the methanolysis parameters (temperature, methanolic hydrochloric acid strength and reaction time) determined at 66 degrees C, 1.2 M and 8.1 h for alpha 1-acid glycoprotein (alpha-AGP) and 73 degrees C, 1.5 M and 12.5 h for tissue plasminogen activator (tPA). Finally, the method was applied to the determination of the carbohydrate moiety of the two N-glycosylated glycoproteins alpha-AGP and tPA.
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Affiliation(s)
- M Taverna
- Centre d'Etudes Pharmaceutiques, Laboratoire de Chimie Analytique, Chatenay Malabry, France
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