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Biomedical subjects

J D Berman

Publications and source records attributed to J D Berman.

At least 91 records · Page 5Linked to original sources
PubMed1983

Metabolism of formycin B by Leishmania amastigotes in vitro. Comparative metabolism in infected and uninfected human macrophages.

Formycin B is metabolized by cutaneous Leishmania amastigotes within cultured human macrophages to give formycin B 5'-monophosphate and formycin A 5'-mono-, di-, and triphosphates. Formycin A is also incorporated into RNA. The activity of formycin B against amastigotes was correlated with the levels of formycin A metabolites formed in the parasites. Uninfected macrophages also convert formycin B into the same products, but the levels are markedly lower than those seen in infected macrophages. The results suggest that a sufficient therapeutic index exists to warrant consideration of formycin B as an anti-leishmanial drug in humans.

Animals↗
PubMed1983

Leishmania donovani: oral efficacy and toxicity of formycin B in the infected hamster.

Formycin B, a structural analog of inosine, was evaluated as an orally administrable antileishmanial agent. Against Leishmania donovani in hamsters, it achieved an 85-92% reduction in numbers of parasites in livers of infected animals after oral administration at 13 mg/kg/day for 4 days. Its efficacy by oral administration was approximately four to eight times that by intramuscular administration and four times that of the positive control drug Glucantime by intramuscular administration. The levels of formycin B in serum after the final oral administration of 26 mg/kg/day were 1.4 micrograms/ml at 1 hr and 0.3 microgram/ml at 2 hr. The concentration in liver was greater (9.0 micrograms/ml at 1 hr) and declined more slowly. With this latter dosage or with 104 mg/kg/day there was no acute toxicity of formycin B to bone marrow or formed elements of the blood. The only statistically significant toxicity to the liver was a doubling of serum total bilirubin levels. Comparison of the in vivo efficacy of formycin B against L. donovani to the mild acute toxicity of the drug suggests that formycin B has potential as an oral agent against visceral leishmaniasis.

Administration, Oral↗
PubMed1983

Diagnosing for administrative purposes: some ethical problems.

The performing of medical evaluations which result in the awarding or denial of substantial material benefits to claimants in the absence of therapeutic intent creates a situation in which traditional values of medicine cannot operate and raises many difficult ethical questions. The certifying physician is not accountable for the psychosocial consequences to the claimant of denial or direct gratification of basic needs even if these consequences can be determined. With the loss of therapeutic intent, the physician is more likely to be influenced by personal rather than professional values. Because of the adversary nature of these proceedings, the physician is placed in a classic 'double agent' dilemma which may reverberate his own internal conflicts. Since certification determinations often have 'life-and-death' economic consequences for disadvantaged claimants, the 'ethics of reality' may ultimately transcend all other ethical concerns. Perhaps a first step in clarifying these ethical issues would be to make a clear-cut distinction between diagnosing for administrative purposes and diagnosing for therapeutic purposes.

Diagnosis↗
PubMed1983

Fine-structural alterations in Leishmania tropica within human macrophages exposed to antileishmanial drugs in vitro.

The mechanism of action of antileishmanial compounds is poorly understood. Ultrastructural changes in Leishmania tropica within human macrophages exposed in vitro to Pentostam, pentamidine, amphotericin B, WR 6026, ketoconazole, and Formycin B were examined in these experiments. In Pentostam-treated cultures, some organisms exhibited diminished definition of mitochondrial and other membranes, while other organisms had completely disintegrated. Pentostam-exposed macrophages demonstrated loss of membrane definition in the absence of further alterations; it is therefore hypothesized that impaired macrophage membrane function may contribute towards the effect of this drug against macrophage-contained organisms. Leishmania parasites in pentamidine-treated cultures initially demonstrated swollen kinetoplasts and fragmentation of the kinetoplast DNA core. The initial observed effect of the other four drugs on the parasites was cytoplasmic condensation. These ultrastructural studies suggest that all five non-antimonial drugs may have different mechanisms of action than antimony (Pentostam) against Leishmania.

Aminoquinolines↗
PubMed1983

Activity of purine analogs against Leishmania tropica within human macrophages in vitro.

The activity of purine analogs against Leishmania tropica in human monocyte-derived macrophages in vitro was determined. Formycin B, formycin A, formycin B and A monophosphate, and formycin A triphosphate all had 50% effective doses of 0.02 to 0.04 microM and eliminated 90% of organisms at less than or equal to 0.5 microM. Allopurinol ribonucleoside was much less active: the 50% effective dose was 76 to 190 microM, and 90% of organisms were not eliminated at the highest dose tested (190 microM). 7-Deazainosine had a low 50% effective dose (0.2 microM), but only 80% of organisms were eliminated at 4 microM. Thio derivatives were as active as or less active than the parent compounds. These data suggest that certain inosine analogs are much more active than others against macrophage-contained Leishmania spp. such as are found in human lesions. However, because toxicity to the human macrophage hosts generally paralleled antileishmanial activity, the more active compounds might also be more toxic to human cells. The activity of 3-deazaguanosine (50% effective dose, 3.6 microM) in this model suggests that guanosine derivatives may have potential as antileishmanial agents.

Allopurinol↗
PubMed1983

Activity of 8-aminoquinolines against Leishmania tropica within human macrophages in vitro.

Antileishmanial activity of 8-aminoquinolines with substitutions on the quinoline ring or on the 8-amino side-chain was assessed in the Leishmania tropica-infected human macrophage in vitro model of leishmaniasis. The 4-methyl-5,6-dimethoxy compounds were more active than 6-methoxy compounds, which were approximately as active as 4-methyl-6-methoxy compounds. Certain 6-hydroxy compounds were the most active drugs tested. The precise composition of substituents on the 8-amino side-chain had little effect on activity. These investigations identify WR 226292 (a 4-methyl-5,6-dimethoxy compound) and WR 6881 and WR 49577 (6-hydroxy compounds) as the most active 8-aminoquinolines in this in vitro model. The 6-hydroxy compounds also can be considered to be the 6-demethyl derivatives of 6-methoxy-8-aminoquinolines. This study therefore indicates that 6-demethyl-8-aminoquinolines may be generally more active in vitro than the parent 6-methoxy structures against macrophage-contained Leishmania.

Aminoquinolines↗
PubMed1983

Activity of oral drugs against Leishmania tropica in human macrophages in vitro.

Because of the need for orally active antileishmanial agents, orally administrable drugs have sometimes been used to treat human leishmaniases without prior demonstration of efficacy in experimental models. The antileishmanial activity of such agents was tested against Leishmania tropica (a cause of cutaneous leishmaniasis) within human macrophages in vitro. Although trimethoprim + sulfamethoxazole and isoniazid + rifampin have been reported as efficacious orally in certain human studies of cutaneous disease, these drugs were ineffective in vitro (less than or equal to 40% parasite elimination) at peak achievable serum levels. The combination of allopurinol and Pentostam is being tested in humans. In vitro, allopurinol (5 micrograms/ml) augmented the antileishmanial effect of a low concentration of Pentostam (5 micrograms/ml) but not of a higher concentration of Pentostam (20 micrograms/ml). Nifurtimox is a nitrofuran which has questionable activity against human cutaneous disease. Nifurtimox was similarly only 50% effective in vitro at peak achievable serum levels (1.0-3.0 micrograms/ml). However, furazolidone, another orally administered nitrofuran, eliminated 92% of parasites at 1.0 micrograms/ml. Chlorpromazine and quinacrine are concentrated in tissues that are susceptible to infection by Leishmania. Chlorpromazine and quinacrine eliminated only 15% and 35% of organisms in vitro at achievable serum levels (less than or equal to 0.3 microgram/ml), but eliminated virtually all organisms in vitro at possible achievable tissue levels. Both the negative and the positive data of this report may aid in selection of effective orally active agents for in vivo trials.

Antiprotozoal Agents↗
PubMed1982

In vitro effects of mycophenolic acid and allopurinol against Leishmania tropica in human macrophages.

The possibility that purine inhibitors or analogs might be effective antileishmanial agents led to the determination of the antileishmanial activity of mycophenolic acid and allopurinol in vitro. The drugs were tested against Leishmania tropica amastigotes (mammalian forms) within human macrophages, a model in which achievable serum concentrations of antileishmanial agents currently in use eliminate approximately 90% of the parasites. Mycophenolic acid, an inhibitor of guanosine nucleotide synthesis from inosinic acid, was shown here to inhibit guanosine nucleotide synthesis in L. tropica promastigotes (insect forms). When tested against L. tropica amastigotes within macrophages, mycophenolic acid eliminated 50% of the parasites at achievable peak human serum levels (20 micrograms/ml) and 40% of the parasites at trough serum levels (1 to 10 micrograms/ml). This demonstrates that an inhibitor of guanosine nucleotide synthesis is partially effective against L. tropica in vitro. The purine analog allopurinol was also tested and was found to eliminate 50% of L. tropica amastigotes in this model. Because mycophenolic acid and allopurinol are partially, but not completely, effective antileishmanial agents in this in vitro model, their in vivo utility remains to be determined by clinical trials.

Adenosine Diphosphate↗
PubMed1982

Susceptibility of clinically sensitive and resistant Leishmania to pentavalent antimony in vitro.

Standard courses of pentavalent antimonials frequently fail to cure cutaneous, mucocutaneous, and visceral leishmaniasis, and characteristically fail to cure diffuse cutaneous disease. We have determined the in vitro sensitivity of clinical isolates of Leishmania to pentavalent antimony to determine if inherent drug resistance of the parasite is responsible for treatment failures in human beings. Intracellular amastigotes resulting from promastigote-initiated infection of human macrophages were exposed to pentavalent antimony for 6 days at 34.5-35 degrees C. Amastigotes from clinically sensitive simple cutaneous lesions exhibited a range of in vitro sensitivity. Four strains were greater than or equal to 90% eliminated and two strains were 70-75% eliminated in vitro by concentrations of antimony (15-20 micrograms Sb/ml), comparable to peak achievable serum levels in humans. Amastigotes from initially clinically resistant simple cutaneous lesions showed a wider range of sensitivities. Five strains were greater than or equal to 90% eliminated, but one strain was only 40% eliminated and another strain was completely insensitive in vitro. The clinically resistant diffuse cutaneous strain was 61% eliminated. The techniques described herein permit determination of the in vitro antimicrobial susceptibility of Leishmania from all major human forms of leishmaniasis. The data from this series indicate that in a minority of initially resistant cases parasite resistance to the drug may be contributing to clinical resistance, and use of non-antimonial drugs might be recommended for future therapy.

Animals↗
PubMed1981

In vivo and in vitro localization of Leishmania within macrophage phagolysosomes: use of colloidal gold as a lysosomal label.

The interaction of Leishmania with lysosomes within macrophages in vivo has been investigated. Lysosomes labeled with colloidal gold in vivo fused with phagocytic vacuoles containing Leishmania amastigotes within the macrophages of infected footpad tissue of BALB/c mice. This localization of Leishmania within macrophage phagolysosomes in vivo is the first confirmation for any obligate intracellulaire protozoon that parasite-lysosome interactions in vitro occur in vivo.

Animals↗
PubMed1981

Effect of temperature on multiplication of Leishmania amastigotes within human monocyte-derived macrophages in vitro.

Leishmania tropica, a cause of cutaneous leishmaniasis, multiplied more rapidly within human macrophages in vitro at 35 degrees C than at 37 degree C, and was almost completely eliminated at 39 degrees C. In contrast, Leishmania donovani, the cause of the visceral leishmaniasis, multiplied equally well at 35 degrees C and at 37 degrees C,, and was only 40% eliminated at 39 degrees C. This in vitro study suggests that the localization of the two strains to cooler and warmer regions of the body, respectively, is at least partially explained by the inherent temperature sensitivity of the parasite-macrophage unit. The striking elimination of this strain of L. tropica within macrophages at 39 degrees C may make this model suitable for predicting the clinical response of cutaneous strains to heat therapy.

Humans↗
PubMed1981

Activity of imidazoles against Leishmania tropica in human macrophage cultures.

The anti-leishmanial activity of four imidazoles has been determined in Leishmania tropica-infected human monocyte-derived macrophage cultures. One of the imidazoles, hydrolyzed ketoconazole [cis-1-[4-[2-(2,4-dichlorophenyl)-2-(1H-imidazol-1-ylmethyl)-1,3-dioxolan-4-yl] methoxyphenyl]piperazine], eliminated 80 and 95% of the parasites at drug concentrations (2.0 and 2.5 microgram/ml) that are achievable in vivo by a structurally similar compound, ketoconazole. These results demonstrate that an imidazole has anti-leishmanial activity in a model system, and suggests that hydrolyzed ketoconazole should be considered for in vivo trials in animal models of the disease.

Clotrimazole↗
PubMed1981

Cysticercus of 60-milliliter volume in human brain.

A cerebral cyst 5 cm in diameter and 60 ml in volume was found to be as large as a racemose cysticercus. Because this cyst bore necrotic remnants of a scolex and its hooks, it was presumed to be a cysticercus of Taenia solium. This case demonstrates that in contrast with the unusual presentation of cerebral cysticercosis, cysts of the Taenia solium type can be very large, and when such cyst is encountered, a special search should be made for evidence of a scolex.

Brain↗
PubMed1981

Expression of Leishmania antigen on the surface membrane of infected human macrophages in vitro.

Resolution of leishmaniasis is associated with host immunological responsiveness to parasite antigens. In clinical disease, leishmania are found as amastigotes contained with macrophages. We investigated the possibility that Leishmania antigens are expressed on the infected macrophage surface by reacting infected macrophages with antibody to Leishmania. In vitro-infected human monocyte-derived macrophages were labelled with antibody to amastigotes when examined with immunofluorescent or immunoelectron microscopic techniques. Infected macrophages were poorly labelled by antibody to promastigotes (insect forms of Leishmania). Certain antisera that reacted with the surface membranes of amastigotes did not label the infected macrophage surface. These results indicate that human macrophages infected in vitro express Leishmania amastigote antigen(s) on their surface membranes, that such antigen(s) may not be present in large quantities in promastigotes, and that certain antigen(s) on the amastigote surface are not expressed on the surface membranes of infected macrophages.

Antibody Specificity↗
PubMed1980

An in vitro model for investigation of chemotherapeutic agents in leishmaniasis.

Clinically achievable concentrations of the three major antileishmanial drugs in use--pentavalent antimony, pentamidine, and amphotericin B--eliminated 90%--100% of the mammalian forms (amastigotes) of Leishmania tropica and Leishmania donovani from in vitro infected human monocyte-derived macrophages. This is apparently the first report of in vitro susceptibility of Leishmania to pentavalent antimony or to pentamidine. The insensitivity of insect forms (promastigotes) multiplying in cell-free media to thee drugs suggests that amastigotes are more sensitive than promastigotes to these antileishmanial agents. Alternatively, macrophages may concentrate or metabolize the drugs to increase their toxicity. In contrast, amphotericin B was toxic to both amastigotes and promastigotes. The sensitivities of Leishmania within human monocyte-derived macrophages in vitro to clinically achievable concentration of antileishmanial agents suggests that this model may be useful for investigation of mechanisms of sensitivity and resistance of antimicrobial agents against Leishmania.

Amidines↗
PubMed1979

Multiplication of Leishmania in human macrophages in vitro.

To facilitate in vitro studies of the immunology of human leishmaniasis, we developed a method of growing pathogenic Leishmania in human monocyte-derived macrophages. After 6 days of incubation, adherent mononuclear cells were infected with Leishmania donovani amastigotes obtained from infected hamster spleen cells or with L. tropica amastigotes obtained from infected BALB/c tissue mouse footpad. Forty-eight percent of the macrophages were initially infected, with a mean of 3.0 amastigotes per infected macrophage. After 6 days of incubation, 59% of macrophages were infected and contained 8.8 amastigotes per infected macrophage, representing 2.9-fold multiplication. Electron microscopy revealed the presence of dividing parasites within phagolysosomes. These observations indicate that Leishmania survive and multiply within human monocyte-derived macrophages despite fusion of secondary lysosomes with the parasitophorous vacuole.

Cell Adhesion↗