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Biomedical subjects

J Carlsson

Publications and source records attributed to J Carlsson.

At least 91 records · Page 5Linked to original sources

Conjugate chemistry and cellular processing of EGF-dextran.

Conjugates with specific binding to the epidermal growth factor receptor, EGFR, of interest for radionuclide based imaging and therapy were prepared using mouse epidermal growth factor, mEGF, and dextran. In one type of conjugate, mEGF was coupled to dextran by reductive amination in which the free amino group on the mEGF N-terminal reacted with the aldehyde group on the reductive end of dextran. The end-end coupled conjugate could be further activated by the cyanopyridinium agent CDAP, thereby introducing tyrosines to the dextran part. In the other type of conjugate, the cyanylating procedure using CDAP was applied, first to activate dextran and then allowing for the amino terminus of mEGF to randomly attach to the dextran. In the latter case, radionuclide-labelled tyrosines or glycines could be added in the same conjugation step. All types of mEGF-dextran conjugates had EGFR-specific binding since the binding could be displaced by an excess of non-radioactive mEGF. The conjugates were to a large extent internalized in the test cells and the associated radioactivity was retained intracellularly for different times depending on both the type of cells and conjugate applied. Different intracellular 'traffic routes' for the radionuclides are discussed as well as applications for both imaging and therapy.

Astatine↗

Positron emission tomography and radioimmunotargeting--general aspects.

To optimize radioimmunotherapy, in vivo information on individual patients, such as radionuclide uptake, kinetics, metabolic patterns and optimal administration methods, is important. An overriding problem is to determine accurately the absorbed dose in the target organ as well as critical organs. Positron Emission Tomography (PET) is a superior technique to quantify regional kinetics in vivo with a spatial resolution better than 1 cm3 and a temporal resolution better than 10 s. However, target molecules often have distribution times of several hours to days. Conventional PET nuclides are not applicable and alternative positron-emitting nuclides with matching half-lives and with suitable labelling properties are thus necessary. Over many years we have systematically developed convenient production methods and labelling techniques of suitable positron nuclides, such as 110In(T(1/2) = 1.15 h), 86Y(T(1/2) = 14 h), 76Br(T(1/2) = 16 h) and 124I(T(1/2) = 4 days). 'Dose planning' can be done, for example, with 86Y- or 124I-labelled ligands before therapy, and 90Y- and 131I-labelled analogues and double-labelling, e.g. with a 86Y/90Y-labelled ligand, can be used to determine the true radioactivity integral from a pure beta-emitting nuclide. The usefulness of these techniques was demonstrated in animal and patient studies by halogen-labelled MAbs and EGF-dextran conjugates and peptides chelated with metal ions.

Bromine Radioisotopes↗

Positron emission tomography and radioimmunotargeting--aspects of quantification and dosimetry.

Positron emission tomography (PET) is a medical imaging tool with high resolution and good quantitative properties, which makes it suitable for in vivo quantification of radioimmunotargeting agents. Most radionuclides used in radioimmunotherapy have positron-emitting analogues, which can be used for PET imaging, and this opens the possibility of performing dosimetry with PET. These isotopes, however, often emit gamma radiation and high-energy positrons in their decay, influencing the imaging properties of PET. Spatial resolution, reconstructed background and line source recovery for a number of non-pure positron emitters were investigated and compared with the imaging properties of 18F. PET imaging properties did not degrade severely for these non-pure positron emitters, but caution has to be applied when doing quantitative measurements. To assess the possibility of conducting PET studies during therapy, by combining, for example, a small amount of 124I with 131I, the influence of the presence of large amounts of gamma radiation on PET count rate characteristics was studied. The results of these studies were related to the necessary amounts of radioactivity needed for treatment of post-operative remains of glioma. The results indicate that the count rate capabilities of 2D PET permit PET studies for dose evaluation during radioimmunotherapy.

Dose-Response Relationship, Radiation↗

Comparison of cell survival models for mixed LET radiation.

PURPOSE: Biophysical models for predicting survival for mixed LET radiations have been investigated by comparisons with experimental results from heavy ion irradiations. The aim was to choose a model for further theoretical studies on the effects of a variable RBE for protons. METHODS AND MATERIALS: Predicted survival curves by the Katz track-structure model, the linear quadratic model, LQ model, by Kellerer and Rossi and the lesion additivity model of Lam were compared to experimental survival curves for V79 cells that were irradiated with a mixture of nitrogen ions with an LET of either 78 or 165 keV/microm and 60Co gamma-rays. RESULTS: Results showed that all three models could predict survival within the uncertainty of the measurements for the different mixed radiation schedules used in this study. CONCLUSION: The choice of model could be made on other grounds, such as the type of model parameters and the availability of biological data for these parameters. Also, the possibility of including dose-rate effects and repair functions should be considered. For the purpose of carrying out theoretical studies on the effects of a variable RBE for protons, the LQ model was preferred.

Animals↗

Kinetics of 76Br-labeled anti-CEA antibodies in pigs; aspects of dosimetry and PET imaging properties.

A monoclonal antibody labeled with the positron-emitting radionuclide 76Br (T(1/2) 16.2 h) has previously been shown useful for positron emission tomography (PET) imaging of experimental tumors. Our aim in the present study was to investigate the effects of the complex decay scheme of this radionuclide on normal organ dosimetry and PET image quality. Three mini-pigs were injected intravenously with 46-75 MBq of the 76Br-labeled anti-CEA antibody 38S1, and the whole-body kinetics followed by PET imaging for 19 h. From PET data, absorbed doses in human organs were estimated using the MIRDOSE 3.0 software. The highest 76Br concentrations were found in lungs, after a correction for the air volume in this organ. The lungs received the highest absorbed dose (mGy/MBq, mean+/-maximum error), 0.84+/-0.16, followed by liver, 0.74+/-0.28, and small intestine, 0.55+/-0.05, while the effective dose equivalent was 0.41+/-0.03 mSv/MBq. The PET imaging properties of 76Br in a two-dimensional 2D PET camera, including central area resolution and scattering effects, were investigated in phantoms and compared to those of 18F. In a 0.97 g/cm3 material, approximating soft tissue density, the FMHW ("full width at half-maximum") value of the point spread function was 7.7+/-0.2 mm for 76Br and 6.0+/-0.1 mm for 18F. In conclusion, radioimmuno PET using 76Br-labeled antibodies resulted in a fairly even distribution of the radiation dose, where the highest absorbed organ doses were only about two to three times higher than the mean absorbed body dose. The high energy beta+ spectrum in the 76Br decay had only minor effects on the resolution, but may decrease the quantification accuracy, especially in organs with a lower density such as a lung.

Animals↗

Cost effectiveness of omeprazole and ranitidine in intermittent treatment of symptomatic gastro-oesophageal reflux disease.

OBJECTIVE: This 1-year study compared the cost effectiveness of omeprazole and ranitidine when used as initial therapy in an intermittent treatment strategy for the management of patients with symptomatic gastro-oesophageal reflux disease with or without erosive oesophagitis. DESIGN AND SETTING: A prospective health economic analysis was conducted alongside an international multicentre randomised, double-blind clinical study. The economic analysis was performed from a societal perspective. PATIENTS: A total of 704 patients in the UK, the Republic of Ireland, Germany, France, Italy and Spain were randomised to 1 of the 3 treatment groups. INTERVENTIONS: Patients were randomised to receive either omeprazole 20 mg once daily, omeprazole 10 mg once daily or ranitidine 150 mg twice daily. Initial treatment failure resulted in dose titration and drug switching from ranitidine to omeprazole, and subsequently open maintenance treatment. MAIN OUTCOME MEASURES AND RESULTS: The estimated mean direct medical costs (medication and number of visits and endoscopies) were found to be lower for both dosages of omeprazole than for ranitidine in all countries except Germany. However, none of the differences were statistically significant. The differences between omeprazole 10 mg and omeprazole 20 mg were small and nonsignificant. With regard to numbers of symptom-free days, both omeprazole 20 mg and omeprazole 10 mg were found to be more effective than ranitidine. However, none of the differences were statistically significant. CONCLUSIONS: Following a pragmatic interpretation, incorporating intermediate short term results, the results in this study give no support to the notion that a step-up approach, either as dose titration from omeprazole 10 mg to omeprazole 20 mg or as drug switching from ranitidine to omeprazole, will result in cost savings and thereby be cost effective.

Algorithms↗

Induction and rejoining of large DNA fragments after ion irradiation.

Radiation-induced DNA double-strand breaks (DSBs) were analyzed by separating large DNA fragments by pulsed-field gel electrophoresis. Human U-343MG glioma and K562 erythroleukemia cells were irradiated with 60Co gamma rays or nitrogen ions with high linear energy transfer (125 keV/microm). By comparing the fraction of DNA released into the gel below different size thresholds, corresponding to megabase-pair-sized DNA fragments, the relative effectiveness of the nitrogen ions was found to be dependent on both dose and the threshold size used in the evaluation. This dose dependence was most evident for the smallest threshold (6 Mbp) and was due to a linear dose response for release of the fragments for the ions compared to the curvilinear response for the gamma rays. The two curves intersected, and the relative yield of fragments (nitrogen ions/gamma rays) decreased from more than 3 below 1.5 Gy to 0.8 at 30 Gy. For the larger sizes (6-10.5 Mbp), the relative yield was constant at around 0.7. Thus the ion-induced fragments were shifted to smaller sizes compared to the 60Co gamma rays, and the data for nitrogen ions could not be fitted to random fragment distributions at doses < or =20 Gy. From these results, we conclude that a substantial fraction of the DSBs induced by heavy ions were nonrandomly distributed, correlated with DSBs within a region of < or =2 Mbp. After a dose of 20 Gy, the rejoining curves for ion-induced DSBs were different for each fragment size, resulting in different levels of unrejoined breaks after 6 h.

DNA↗

Clinical and angiographic outcome of NIR stent implantation in small vessels with unfavorable lesion morphology.

BACKGROUND: Coronary artery stents are used for the treatment of acute or threatened vessel occlusion complicating coronary angioplasty or for the prevention of restenosis after angioplasty. Improvements in stent design made the stenting of complex and small vessels feasible. We prospectively evaluated the safety, efficacy and long-term patency of NIR stent (Boston Scientific, Maple Grove, Minnesota) implantation in small vessels with complex lesion morphology. METHODS: The study population consisted of patients with complex (type OCO) lesions under 3 mm vessel diameter who were undergoing coronary angioplasty for symptomatic coronary artery disease followed by high-pressure NIR stent implantation and antiplatelet therapy only. Follow-up angiography was performed six months after the initial procedure. RESULTS: Of 143 patients fulfilling the angiographic criteria and undergoing stent implantation between October 1995 and November 1997, 67 patients (46.9%) received NIR stents. In 58 patients (86.6%), angiographic 6-month follow-up was available. In one patient (1.7%), stent implantation was unsuccessful. Procedural success of the NIR stent implantation was 98.2%. Implantation of other stents failed in 12 cases. NIR stent implantation was successful in all of them. No patient required urgent bypass surgery. No patient died. Restenosis occurred 5.8 +/- 1.3 months after the initial procedure in 21 patients (36.2%). CONCLUSIONS: Coronary high-pressure stenting of small (< 3 mm) type OCO (AHA/ACC) lesions in patients with symptomatic coronary heart disease is a feasible treatment option with a high procedural success rate and low complication rate. The new flexible NIR stent showed an acceptable restenosis rate. The implantation was successful even in vessels in which previous attempts of Palmaz-Schatz stent placement had failed.

Aged↗

TM-AFM Threshold Analysis of Macromolecular Orientation: A Study of the Orientation of IgG and IgE on Mica Surfaces.

Adsorption and orientation properties of two different types of immunoglobulin molecules on derivatized and native mica surfaces were investigated using TM-AFM. The analyses included height measurements at two different pH values and a new technique, presented here as threshold analysis, which displays the outer mantle shape of an adsorbed protein. A major difference in preferential orientation is observed upon comparing the adsorption of the two proteins onto the different surfaces. The characteristics of both the adsorbed immunoglobulin and the surface are important for any preferential orientation of the adsorbed protein. Copyright 1998 Academic Press.

Journal Article↗

Effect of reteplase on hemostasis variables: analysis of fibrin specificity, relation to bleeding complications and coronary patency.

UNLABELLED: The first aim of the present study was to characterize the systemic and fibrin-specific lytic effect of reteplase in the treatment of patients with acute myocardial infarction. The second aim was to investigate the relation of hemostasis variables to risk of bleeding complications and to coronary patency. The present study is a hemostatic substudy of the German Recombinant Activator Study. Forty two patients have been treated with 10 MU of reteplase (Group A) and 100 patients with 15 MU of reteplase (Group B), given as a single bolus. Blood samples for assessment of fibrinogen, plasminogen, alpha-2-antiplasmin, fibrinogen degradation products (FDP) and D-dimers were obtained before and at 2, 4, 8, and 24 h after thrombolytic therapy. The median fibrinogen concentration was decreased from 279 to 169 mg/dl in Group A and from 254 to 92 mg/dl in Group B four hours after administration of reteplase. The decrease in fibrinogen was significantly more pronounced in Group B (P=0.0004). The median plasminogen concentration was decreased to 53% in Group A and to 33% in Group B two hours after administration of reteplase (P=0.0001). Alpha-2-antiplasmin was reduced to 27% and 17,5%, respectively (P=0.0007). D-Dimer levels were increased to 5.2 microg/ml in Group A and 11,6 microg/ml in Group B (P=0.02) and FDP levels to 3.0 microg/ml in Group A and 12,6 microg/ml in Group B (P=0.04). Patients with bleeding complications revealed significant lower nadir levels of fibrinogen than patients without bleeding complications (54 mg/dl versus 125.5 mg/dl, P=0.02). There was no significant difference in any hemostatic parameter between patients with patent and nonpatent infarct related arteries. CONCLUSIONS: Reteplase causes a moderate systemic lytic effect comparable with other relative fibrin specific thrombolytic agents. An increase in the dose from 10 to 15 MU is associated with a marked increase in both fibrin specific and systemic lytic effect. Patients with bleeding complications reveal significant lower nadir levels of fibrinogen than patients without bleeding complications. Determination of any hemostatic parameter seems to be no useful method to predict efficacy of thrombolysis in terms of coronary patency in the individual patient.

Clinical Trials, Phase II as Topic↗

Expression of epidermal growth factor receptor in urinary bladder cancer metastases.

Bladder cancers frequently exhibit an increased number of epidermal growth factor receptors (EGFR) in comparison to normal urothelium. The EGFR could potentially be a target for toxic conjugates. The aim of our study was to compare the expression of EGFR in metastases with concurrent or primary tumour in the urinary bladder using immunohistochemical techniques and a monoclonal antibody. Tumour material from 20 patients was investigated. The majority (13/20) of the metastases were homogeneously stained and showed a moderate to strong membranous staining for EGFR. The expression of EGFR in primary bladder tumours and metastases was similar. There was no indication that tumour tissue exposed to chemotherapy or radiation had a decreased number of EGFR. Targeting of the EGFR thus seems potentially applicable to metastatic disease.

Aged↗

Influence of gradually increased slow balloon inflation on restenosis after coronary angioplasty.

BACKGROUND: Balloon inflation during coronary angioplasty results in shear stress-induced vessel wall injury with development of restenosis. This randomized trial compared the impact of two different balloon inflation strategies (slow versus fast) on restenosis after coronary angioplasty. METHODS: Two hundred seven patients were randomized to undergo either fast or gradually increased slow inflation after successful placement of the balloon catheter inside the target lesion. One hundred six underwent fast, and 101 underwent gradually increased slow balloon inflation. Coronary angiograms were quantitatively analyzed before angioplasty, after angioplasty, and at follow-up 5.9+/-1.6 months after the initial procedure. RESULTS: Both groups had an identical primary success rate (98.1% vs 98%; p = 0.96) and a similar minimal luminal diameter before (0.49+/-0.26 mm vs 0.48+/-0.22 mm; p = 0.8) and after (2.22+/-0.97 mm vs 2.26+/-0.66 mm; p = 0.7) angioplasty. Slow balloon inflation did not reduce late luminal loss (0.58+/-0.77 mm vs 0.74+/-0.87 mm; p = 0.2), net gain (1.33+/-0.84 mm vs 1.19+/-0.81 mm; p = 0.3), or minimal luminal diameter at follow-up (1.80+/-0.97 mm vs 1.72+/-1.0 mm; p = 0.6) significantly. Restenosis, defined as >50% diameter stenosis at follow-up, occurred in 24% in the slow inflation group versus 36% in the fast inflation group (p = 0.09). Clinical events during 6-month follow-up were similar in both groups (repeat angioplasty, fast 5.6%, slow 4.8%, p = 0.8; nonfatal myocardial infarction, fast 2.2%, slow 1.2%, p = 0.6; death, fast 1.1%, slow 0%, p = 0.3). CONCLUSION: The present randomized trial of two different balloon inflation strategies shows no statistically significant difference in net gain, minimal luminal diameter, or restenosis after coronary angioplasty. The difference in net gain, minimal luminal diameter, and restenosis rate were not statistically significant, but may represent a trend toward a reduction of smooth muscle cell proliferation and intimal hyperplasia induced by careful dilation of the stenotic lesion with gradually increased slow balloon inflation and reduction of shear stress-related vessel wall injury.

Angioplasty, Balloon↗

Does endoscopy have a positive impact on quality of life in dyspepsia?

BACKGROUND: It is unclear whether normal endoscopy results in patients investigated for dyspepsia has therapeutic value. Therefore the aim of this study was to evaluate the effect of the endoscopy on quality of life and dyspeptic symptoms. METHODS: One hundred ninety-six symptomatic patients (85 men and 111 women, mean age 42.9 years), who were receiving no treatment, were investigated before and 1 week after endoscopy with the use of a battery of validated questionnaires. RESULTS: Before endoscopy the health-related quality of life was compromised in comparison with a normal population, but 1 week after a negative endoscopy it is increased to a level which was close to the normal range despite no major change in symptoms. Physical activity and sleep scores improved significantly after endoscopy. CONCLUSION: The present results suggest that a negative endoscopy improves quality of life in the short-term in patients with dyspepsia, even though symptoms may persist.

Abdominal Pain↗

A review of dsb induction data for varying quality radiations.

PURPOSE: This short review summarizes the data obtained with various techniques for measuring the yields of double strand breaks (dsb) produced by particle radiations of differing linear energy transfer (LET) in order to obtain relative biological effectiveness (RBE) values. RESULTS AND CONCLUSIONS: Studies aimed at understanding the interactions of different types of radiation with cellular DNA have monitored the yields of DNA dsb versus radiation quality. Several techniques have been used to measure dsb yields in mammalian cells, and these include: neutral sedimentation gradients, filter elution and more recently pulsed field gel electrophoresis techniques (PFGE). Recent developments in PFGE have allowed the measurement of both the yields and the distribution of breaks within the genome, which go part of the way to explaining the RBE values close to 1.0 previously measured using other approaches with various radiation qualities. It is clear that future studies to determine the effectiveness of radiations of differing LET must use techniques that determine both yields and distributions of dsb, and assays need to be developed to allow these measurements at biologically relevant doses.

Alkalies↗

Uptake, toxicity and radiation effects of the boron compounds DAAC-1 and DAC-1 in cultured human glioma cells.

PURPOSE: To study the uptake, toxicity and radiation effects in vitro of a diol-amino acid-carborane (DAAC-1) and make comparisons with the previously studied diol-amine-carborane (DAC-1). MATERIALS AND METHODS: Toxicity and radiation effects were studied with clonogenic survival, uptake by measuring the cellular boron content and the subcellular distribution was investigated after organelle separation with centrifugation. The studied cell line was human glioma U343. RESULTS: DAAC-1 showed an accumulation of 1-1.5 times, compared with the culture medium, and was non-toxic up to 47 microg boron/ml. The accumulation of DAC-1 was about 90 times, but toxic effects were detectable already at the concentration 5 microg boron/ml. None of the compounds was localized in the cell nucleus. Following irradiation with thermal neutrons, DAC-1 was about 2.5 times more effective than DAAC-1 and about 4.9 times more effective than neutrons alone, at the survival level 0.2. The dose modifying factors, when compared with the neutron beam alone, were for both DAAC-1 and DAC-1 about 1.5 and about 5 when compared with 60Co-gamma-radiation. CONCLUSIONS: DAAC-1 was less toxic than DAC-1 but gave less accumulation of boron. Both substances gave significant boron-dependent cell inactivation when the test cells were exposed to thermal neutrons.

Boranes↗

Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients.

BACKGROUND AND PURPOSE: A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. METHODS: One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. RESULTS: There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. CONCLUSIONS: The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services.

Activities of Daily Living↗

Conjugate chemistry, iodination and cellular binding of mEGF-dextran-tyrosine: preclinical tests in preparation for clinical trials.

A conjugate with specific binding to the epidermal growth factor receptor, EGFR, and of interest for clinical tests was prepared using mouse epidermal growth factor, mEGF, and dextran. The mEGF was first coupled to dextran by reductive amination in which the free amino group on the N-terminal of mEGF was reacted with the aldehyde group on the reductive end of the dextran chain. The end-end coupled intermediate was further activated by the cyanopyridinium agent CDAP and tyrosines introduced to the dextran part of the conjugate. The mEGF-dextran-tyrosine conjugate was, with high efficiency, iodinated with the chloramine-T method. Approximately 25-35% of the radioactivity could be removed from the conjugate after exposure to protease K while 65-75% of the radioactivity could be removed after exposure to dextranase. Thus, the largest amount of the iodine was on the dextran part of the conjugate. The iodinated mEGF-dextran-tyrosine had EGFR specific binding since the binding to an EGFR rich human glioma cell line could be displaced by an excess of non-radioactive mEGF. The conjugate was to a large extent internalized in these cells and the administrated radioactivity was thereby retained inside the cells for at least up to 50 h.

Animals↗