Biomedical subjects

J D Connor

Publications and source records attributed to J D Connor.

At least 55 records · Page 3Linked to original sources

PubMed1990

Toxicity of combined ganciclovir and zidovudine for cytomegalovirus disease associated with AIDS. An AIDS Clinical Trials Group Study.

OBJECTIVE: To assess the toxicity, efficacy, and pharmacology of combined zidovudine and ganciclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS) and serious cytomegalovirus (CMV) disease. DESIGN: Prospective, phase I multicenter trial (ACTG 004) with patients grouped by previous study drug history. SETTING: Three university-based AIDS Clinical Trials Units sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). PATIENTS: Forty-one patients with AIDS-related CMV disease. Previous therapy with either zidovudine or ganciclovir was allowed. INTERVENTIONS: Patients were treated with zidovudine, 600 to 1200 mg/d; or, if on ganciclovir maintenance, ganciclovir, 5 mg/kg body weight; blood was sampled for pharmacokinetic studies. The other drug was then administered to the patient with blood sampling and, finally, the two drugs in combination were given. Patients were continued on both drug therapies with dose reduction of zidovudine only for grade 3 or 4 toxicity. MEASUREMENTS AND MAIN RESULTS: Forty patients were eligible. Hematologic toxicity was frequent, with 9 of the 10 patients requiring dose reductions for grade 3 or 4 toxicity at zidovudine doses of 1200 mg/d. With zidovudine doses of 600 mg/d, 82% experienced such hematologic toxicity. Median survival was 6 months; 10 patients developed intercurrent infection and 19, progressive CMV disease. Pharmacokinetic variables (alpha and beta half-lives, volume of distribution, clearance) were not affected in combination therapy. CONCLUSION: The combination of zidovudine and ganciclovir is poorly tolerated in patients with AIDS and serious-CMV disease, with 82% developing severe to life-threatening hematologic toxicity. Such toxicity is not a result of pharmacologic interactions, drug metabolism, or excretion.

Acquired Immunodeficiency Syndrome↗

PubMed1990

The metabolism of ribavirin in erythrocytes and nucleated cells.

1. The metabolism of the broad-spectrum antiviral drug ribavirin was examined in intact human erythrocytes, cultured skin fibroblasts and EBV-transformed lymphoblasts. At an extracellular ribavirin concentration of 35 microM all the cell types produced ribavirin mono-, di- and triphosphate, with the nucleotide concentration reaching half-maximum in 210, 245 and 267 min for fibroblasts, lymphoblasts and erythrocytes, respectively. The ratio of mono-, di- and triphosphates was ca 4:1:40 in fibroblasts, 3:1:8 in lymphoblasts and 1:5:17 in erythrocytes. 2. When ribavirin was removed from the medium, the half-life of ribavirin nucleotides was less than 2 hr in fibroblasts and lymphoblasts, but greater than 24 hr in erythrocytes. 3. In energy-starved erythrocytes, the catabolism of ribavirin nucleotides closely followed the catabolism of adenine nucleotides. 4. None of these cell types excreted appreciable amounts of the ribavirin catabolites triazole carboxamide, triazole carboxylate or triazole carboxylate ribonucleoside. 5. Cells deficient in adenosine kinase produced greater than 4% of the ribavirin nucleotides of normal controls. 6. The nucleated cells quickly hydrolyzed ribavirin 5'monophosphate to ribavirin, whereas this activity was negligible in erythrocytes.

Cell Nucleus↗

PubMed1990

Central nervous system tuberculosis in children: a review of 30 cases.

The medical records of 30 children with central nervous system tuberculosis (CNS tuberculosis) who were treated between March, 1976, and February, 1989, were reviewed. All had cranial computerized tomography scans at presentation. The mean cerebrospinal fluid leukocyte count was 200/mm3, protein 239 mg/dl, glucose 25 mg/dl and CSF/serum glucose ratio 21%. Mantoux skin tests with 5 tuberculin units were greater than or equal to 10 mm induration in 50%, and chest radiographs were positive in 40% of patients. Hydrocephalus was demonstrated by cranial computerized tomography in all 30 patients (100%). Cranial computerized tomography scan demonstrating hydrocephalus is a sensitive radiographic nervous system tuberculosis and should be part of the early evaluation of children with suspected central nervous system tuberculosis.

Brain Diseases↗

PubMed1990

Hemodialysis clearance of intravenously administered ribavirin.

A patient with an implanted artificial heart, acute, anuric renal failure, and disseminated influenza virus type A infection received intravenous ribavirin. Drug elimination by hemodialysis was measured. Plasma dialysis clearance averaged 93.9 +/- 8.6 ml/min. The maximum amount of ribavirin removed from the body during one period of hemodialysis was 79.1 mg. Ribavirin is not removed in important quantities by hemodialysis.

Adult↗

PubMed1990

Exposure of health care workers to ribavirin during therapy for respiratory syncytial virus infections.

Health care workers (HCW) are exposed to ribavirin aerosol during therapy of infants with respiratory syncytial virus infections. To assess the degree of HCW exposure, we analyzed air samples from patient rooms and HCW personal breathing zones during ribavirin aerosol delivery by ventilator (two samples), oxygen hood (two samples), and a new vacuum exhaust hood (four samples). HCW exposure to ribavirin during aerosol delivery by ventilator or vacuum exhaust hood system was substantially lower than HCW exposure during aerosol delivery by oxygen hood in rooms with adequate ventilation.

Aerosols↗

PubMed1990

Rapid detection of respiratory syncytial virus in nasopharyngeal specimens obtained with the rhinoprobe scraper.

We compared the Rhinoprobe scraping technique for collection of superficial nasal mucosa epithelial cells and rapid detection of respiratory syncytial virus by immunofluorescence with paired, swab-collected specimens for virus culture from 1,257 infants and children with acute respiratory infections. Compared with viral culture as the reference test, the sensitivity, specificity, and accuracy of the immunofluorescence test were 83.6, 93.6, and 91.3%, respectively. We found the Rhinoprobe method safe, easy to use, and helpful in obtaining large quantities of epithelial cells for detection of respiratory syncytial virus and other respiratory viruses.

Adolescent↗

PubMed1989

Induction of erythroid differentiation in K562 cells by inhibitors of inosine monophosphate dehydrogenase.

The effects of three inhibitors of inosine monophosphate (IMP) dehydrogenase on a human erythroleukemic cell line, K562, were studied. Following incubation with these inhibitors, K562 cells underwent differentiation and accumulated hemoglobins. The induction of hemoglobin accumulation was dose dependent; maximum induction was observed at 100, 25, and 3 microM, respectively, for ribavirin, tiazofurin, and mycophenolic acid. The induction was associated with reduction of intracellular GTP content and was blocked by adding guanosine within 24 h after adding inducer. The effective dose for half-maximum induction by ribavirin was 3 times less than that for 50% inhibition of K562 proliferation; however, for tiazofurin and mycophenolic acid, it closely approximated the concentrations which suppressed cellular proliferation. Ribavirin was sequestered preferentially inside the K562 cells, and the induction by ribavirin had a greater than 30-fold increase in hemoglobin. Studies with isoelectric focusing, globin chain analyses, and immunochemical assays indicated that both A gamma and G gamma were detected and that the hemoglobin produced in the ribavirin-treated cells consisted of approximately 60% fetal hemoglobin and its acetylated equivalents. The adult-type alpha globin was found, while no beta globin chains were demonstrated. Thus, accumulation of fetal hemoglobin and production of alpha globin chain in ribavirin-treated cells are different from the pattern of hemoglobins induced by hemin.

Cell Compartmentation↗

PubMed1989

Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group.

A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.

Adolescent↗

PubMed1989

Identification of herpes simplex viruses by automated profile analysis of viral proteins.

In this report we describe a computerized virus identification system based upon the fact that viral proteins, separated by one-dimensional (ID) SDS-PAGE have unique banding patterns (protein profiles). Fifty-eight clinical strains of herpes simplex virus (HSV) were correctly identified by comparing their protein profiles with reference profiles of HSV, other viruses and uninfected cell cultures stored in a computer data base.

Electronic Data Processing↗

PubMed1989

Protein fingerprinting: a novel virus identification system.

Viral proteins separated by one-dimensional SDS-PAGE produce protein binding patterns (fingerprints) which are unique for different viruses. We have applied this concept successfully for the development of a practical and objective virus identification system which is applicable to most viruses. The method is simple, specific, and, unlike the currently available methods, free from all virus-specific reagents. Interference by host protein bands in SDS-PAGE preparations of virus-infected cell lysates was eliminated consistently by treating virus infected cell cultures with optimum concentration of NaCl for selective inhibition of host protein synthesis. The method utilizes the comparison of protein fingerprints of 'unknown' viruses with protein fingerprints of reference viruses stored in a computer data base, using pattern recognition software. All 113 'unknown' virus strains were correctly identified to the genus level by the protein fingerprint method, when compared with the conventional virus identification methods.

Animals↗

PubMed1989

The antiviral effect of zidovudine and ribavirin in clinical trials and the use of p24 antigen levels as a virologic marker.

The inhibition of viremia and p24 core antigenemia in patients infected with human immunodeficiency virus (HIV) was evaluated in separate multicenter, double-blind, placebo-controlled trials of zidovudine and ribavirin. Of 29 patients (14 with AIDS and 15 with AIDS-related complex [ARC]) enrolled in the zidovudine study, 16 received 250 mg of zidovudine every 4 h and 13 received placebo. No difference in HIV isolation from peripheral blood was observed at 20 w in treated versus placebo groups (79% vs. 82%). In patients tolerating zidovudine, mean p24 antigen levels dropped to 8.2% +/- 8.1% of their baseline values, whereas in placebo recipients mean p24 antigen levels declined to 61.3% +/- 40.8% of their baseline values (P less than .005). In the ribavirin study, patients with ARC treated with either 800 mg or 600 mg ribavirin daily or with placebo showed no consistent reduction in p24 antigenemia or decrease in HIV isolation. These data indicate that decline in p24 antigenemia can be a useful virologic marker in evaluation of new antiretroviral drugs.

AIDS-Related Complex↗

PubMed1989

Controlled release infusion kinetics of tobramycin.

Ten healthy male volunteers received two doses of tobramycin (2 mg/kg) in a crossover fashion, first by intravenous piggyback (IVPB), then by the CRIS infusion system after a washout period. Serum samples were drawn both during and after the infusions. Twenty-four-hour urine collections were assayed for tobramycin. Residual fluid from the lines of both delivery systems was measured and assayed for tobramycin concentration. All samples were run in duplicate, using an enzyme-multiplied immunoassay technique assay. The results indicate that there was a statistically higher amount of drug delivered via the CRIS system (98.3 +/- 0.3% versus 90.4 +/- 2.3%). No significant difference was found in urinary recovery between the two groups. Peak serum levels were significantly higher with the CRIS system, with 8/10 subjects having at least one serum level greater than 10 micrograms/ml, as compared to 0/10 when given by IVPB. Peak serum levels occurred at 30 min in all subjects given tobramycin through the CRIS system, compared to 50-60 min when delivered by IVPB. This difference in peak serum levels is primarily related to the rate of drug delivery and to the difference in the dose delivered to each subject. The significance of the serum concentration profiles is discussed.

Adult↗

PubMed1989

High-performance liquid chromatography (HPLC) assay for ribavirin and comparison of the HPLC assay with radioimmunoassay.

The use of high-performance liquid chromatography (HPLC) to measure ribavirin in serum and other biological fluids has been limited by endogenous interfering substances. We report an HPLC procedure based on the extraction of ribavirin from serum, plasma, or cerebrospinal fluid with a boronate affinity gel, which uses a 3-methylcytidine internal standard. This assay is sensitive (to 0.4 microM), specific (no interference with 34 commonly prescribed drugs), reproducible (coefficients of variation from 5.4 to 22.4%), and linear (r = 0.999) over the range of clinically relevant concentrations in serum (from 0.5 to 50.0 microM). It also correlates well with the ribavirin radioimmunoassay (r = 0.992). This HPLC assay should be useful for measuring ribavirin in serum and other body fluids during clinical trials.

Chromatography, High Pressure Liquid↗

PubMed1989

Nodulus-uvula depressor response: central GABA-mediated inhibition of alpha-adrenergic outflow.

Electrical stimulation of a lateral region of the cerebellar nodulus-uvula transition zone in anesthetized albino rabbits decreases mean arterial blood pressure in direct proportion to stimulus intensity. The hypotension has an abrupt onset and is phasic; heart rate is unaffected. Neural pathways that might mediate the depressor response were studied using autonomic-blocking agents. Pretreatment with 2 mg/kg iv of either propranolol HCl or atropine methyl nitrate did not alter the onset or duration of the hypotensive response. However, pretreatment with 2 mg/kg iv phentolamine HCl abolished the depressor response, and 7 mg.kg-1.min-1 iv tetraethylammonium infusion decreased the response by more than 50%. Ipsilateral injections of 200 ng bicuculline methiodide into an area immediately dorsal to the superior cerebellar peduncle or the dorsal aspect of the superior vestibular nucleus reversibly attenuated the nodulus-uvula evoked depression. Anterograde horseradish peroxidase-wheat germ agglutinin (HRP-WGA) transport experiments revealed that both these regions receive direct inputs from the nodulus-uvula. These data suggest that hypotensive events elicited by lateral nodulus-uvula stimuli represent a central, alpha-aminobutyric acid-mediated, phasic inhibition of vasomotor drive mediated through autonomic ganglia to alpha-adrenoreceptors in the vasculature.

Animals↗

PubMed1989

Axons of passage may be responsible for fastigial nucleus pressor response.

Bilateral destruction of perikarya in the fastigial nucleus (FN) of the rat with the cytotoxic agent kainic acid (0.5 mg) did not alter the blood pressure (BP) increases observed during monopolar electrical stimulation (100 microA, 50 Hz, 0.5-ms pulse width) of this region. BP increases in control animals were 30 +/- 8 mm Hg, whereas BP increased 30 +/- 7 mmHg in kainic acid-lesioned rats. Furthermore, picrotoxin (100 ng) and muscimol (25 ng) microinjected unilaterally into the FN of conscious, unrestrained rats produced postural asymmetry but no change in BP or heart rate. These data suggest that the FN pressor response may be due, at least in part, to stimulation of axons of passage.

Animals↗

PubMed1988

Therapy of herpes zoster with oral acyclovir.

Oral acyclovir therapy for herpes zoster has been studied in double-blind, placebo-controlled trials of two dosages, 400 mg and 800 mg five times per day for 10 days. Compared with placebo recipients, recipients of the high-dosage acyclovir experienced a significantly shortened period of viral shedding, significantly accelerated time to 50 percent scabbing, significantly accelerated time to 50 percent healing, and after two days of therapy, significantly less frequent formation of new lesions. The duration and severity of acute pain were less in acyclovir recipients, with differences in pain severity achieving statistical significance (p = 0.03) between Days 3 and 10 and correlating with the treatment differences in new lesion formation. In studies of the 400 mg five times per day dose schedule, differences between acyclovir and placebo recipients were not significant. In a six-month follow-up of recipients in the higher dosage study, the acyclovir recipients experienced less post-zoster pain than placebo recipients; differences in the prevalence of pain were most significant for the presence of a persistent pain in the first three months of follow-up. Oral acyclovir at these dosages appears to be free of adverse reactions. In summary, oral acyclovir at a dosage of 800 mg five times per day for 10 days for treatment of acute herpes zoster is superior to 400 mg five times per day and favorably alters the course of the disease.

Acyclovir↗

PubMed1988

Treatment of bacterial meningitis with once daily ceftriaxone therapy.

Ceftriaxone, a cephalosporin with an extended half-life and excellent antibacterial activity was used to treat bacterial meningitis, given as a single daily intravenous dose of 100 mg/kg on day one, followed by 80 mg/kg daily. A total of 22 patients were treated, of whom 14 had Haemophilus influenzae type b, five had Streptococcus pneumoniae and three Neisseria meningitidis isolated from their CSF. The CSF of all patients became sterile within 24-48 h. The CSF ceftriaxone concentrations 24 h after dosing were 10 to 100-fold higher than the MIC of the pathogenic bacteria early in therapy, and five to 50-fold higher at the end of therapy. Side effects encountered included mild diarrhoea (32%), thrombocytosis (77%) and neutropenia (9%), but none caused therapy to be stopped. Ceftriaxone is a safe and effective antibiotic for the treatment of bacterial meningitis when administered once daily.

Adolescent↗

PubMed1987

Ribavirin pharmacodynamics in high-risk patients for acquired immunodeficiency syndrome.

Ribavirin was administered orally in escalating doses for 2 or 4 weeks to 15 symptom-free, human immunodeficiency virus seropositive homosexual men with generalized lymphadenopathy. Reverse transcriptase activity was inhibited during therapy when steady-state plasma concentrations were greater than 6 mumol/L. These concentrations were achieved with 1200 or 2400 mg/day for 2 weeks or a loading dose of 2400 mg/day for 3 days followed by 600 mg/day for 4 weeks. Drug accumulation occurred at all doses. The elimination half-life appeared to be approximately 2 weeks. Reversible adverse reactions, principally resulting in central nervous system symptoms and anemia, correlated with dose and duration of therapy. Immunologic enhancement of T-lymphocyte-mediated mitogen-induced responses was observed in the majority of patients who had reduction in reverse transcriptase activity. However, specific T4+ lymphocyte-mediated antigen-induced responses increased to within the normal range in only three patients. Significant enhancement appeared to correlate with the severity of baseline antigen-induced functional impairment. These data indicate that oral ribavirin can be given for at least 1 month with acceptable toxicity at doses that appear to inhibit human immunodeficiency virus replication.

Acquired Immunodeficiency Syndrome↗