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Biomedical subjects

M J Hope

Publications and source records attributed to M J Hope.

At least 19 recordsLinked to original sources
PubMed2004

Disability can be avoided after open fractures in Africa-results from Malawi.

UNLABELLED: In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg. The treatment regimen contained the following: primary external fixation; scheduled sequential debridement; immediate coverage of any bone devoid of periosteum using local muscle or fasciocutaneous flaps, alternatively limb shortening; no skin closure; controlled secondary healing under moist dressings; dynamisation and/or removal of the external fixator followed by functional treatment (Sarmiento and Latta) as soon as the soft tissues permitted. The first 34 consecutive cases were monitored from the time of treatment; 24 of them attended for clinical review at 36 (+/-16) weeks after injury. Only 72% (13/22) patients had reached the hospital within 24h after sustaining the fracture; 80% (18/22) had developed a septic wound infection, which healed in all cases after 20 weeks. At the time of follow-up, recovery of function was found in 20 (80%) of the injured extremities. Only three patients (12%) remained disabled due to the open fracture, one other patient died during treatment from tuberculosis secondary to AIDS and one patient required knee disarticulation. CONCLUSION: If the biological principles guiding the contemporary treatment of open fractures in the first world are respected, results under third world conditions do not differ as much as the differences in setting might suggest. The application of recent advances of global knowledge in trauma surgery into methods of treatment appropriate to the health care systems of highly resource constraint countries remains a rewarding task for modern trauma surgeons and their scientific community.

Developing Countries↗
PubMed2004

Acute compartment syndrome in the absence of fracture.

OBJECTIVES: To determine if there are differences in demographics, referral patterns, and operative findings between patients with and without a fracture who develop an acute compartment syndrome. DESIGN: Retrospective cohort. SETTING: Orthopaedic trauma unit, university teaching hospital. METHODS: This study examines 164 cases of acute compartment syndrome over an 8-year period. Of these, 13 patients had a diagnosis of crush syndrome and are excluded from this study. The remaining 38 cases with no fracture form the basis for this study. MAIN OUTCOME MEASURES: Patient demographics, referral patterns, and operative findings were compared for the "fracture" and "no fracture" groups. RESULTS: Patients who had acute compartment syndrome in the absence of fracture were older (P < 0.05) and had significantly more comorbidities (P < 0.001) than those with a fracture. Cases without a fracture had a significantly greater mean delay to fasciotomy of 12.4 hours (P < 0.05) compared to those with a fracture. At fasciotomy, 20% of patients without a fracture had muscle necrosis requiring debridement compared to 8% for patients with a fracture (P < 0.05). CONCLUSIONS: This study demonstrates that muscle necrosis is more commonly found in acute compartment syndrome in the absence of a fracture than in those with a fracture. Referral of swollen limbs without fracture for an orthopaedic opinion should not be delayed.

Acute Disease↗
PubMed2002

Characterization of the inhibitory effect of PEG-lipid conjugates on the intracellular delivery of plasmid and antisense DNA mediated by cationic lipid liposomes.

Poly(ethylene glycol)-lipid (PEG-lipid) conjugates are widely used in the field of liposomal drug delivery to provide a polymer coat that can confer favorable pharmacokinetic characteristics on particles in the circulation. More recently these lipids have been employed as an essential component in the self-assembly of cationic and neutral lipids with polynucleic acids to form small, stable lipid/DNA complexes that exhibit long circulation times in vivo and accumulate at sites of disease. However, the presence of a steric barrier lipid might be expected to inhibit the transfection activity of lipid/DNA complexes by reducing particle-membrane contact. In this study we examine what effect varying the size of the hydrophobic anchor and hydrophilic head group of PEG-lipids has on both gene and antisense delivery into cells in culture. Lipid/DNA complexes were made using unilamellar vesicles composed of 5 mole% PEG-lipids in combination with equimolar dioleoylphosphatidylethanolamine and the cationic lipid dioleyldimethylammonium chloride. Using HeLa and HepG2 cells we show that under the conditions employed PEG-lipids had a minimal effect on the binding and subsequent endocytosis of lipid/DNA complexes but they severely inhibited active gene transfer and the endosomal release of antisense oligodeoxynucleotides into the cytoplasm. Decreasing the size of the hydrophobic anchor or the size of the grafted hydrophilic PEG moiety enhanced DNA transfer by the complexes.

Cell Nucleus↗
PubMed2001

Efficient encapsulation of antisense oligonucleotides in lipid vesicles using ionizable aminolipids: formation of novel small multilamellar vesicle structures.

Typical methods used for encapsulating antisense oligodeoxynucleotides (ODN) and plasmid DNA in lipid vesicles result in very low encapsulation efficiencies or employ cationic lipids that exhibit unfavorable pharmacokinetic and toxicity characteristics when administered intravenously. In this study, we describe and characterize a novel formulation process that utilizes an ionizable aminolipid (1,2-dioleoyl-3-dimethylammonium propane, DODAP) and an ethanol-containing buffer system for encapsulating large quantities (0.15--0.25 g ODN/g lipid) of polyanionic ODN in lipid vesicles. This process requires the presence of up to 40% ethanol (v/v) and initial formulation at acidic pH values where the DODAP is positively charged. In addition, the presence of a poly(ethylene glycol)-lipid was required during the formulation process to prevent aggregation. The 'stabilized antisense-lipid particles' (SALP) formed are stable on adjustment of the external pH to neutral pH values and the formulation process allows encapsulation efficiencies of up to 70%. ODN encapsulation was confirmed by nuclease protection assays and (31)P NMR measurements. Cryo-electron microscopy indicated that the final particles consisted of a mixed population of unilamellar and small multilamellar vesicles (80--140 nm diameter), the relative proportion of which was dependent on the initial ODN to lipid ratio. Finally, SALP exhibited significantly enhanced circulation lifetimes in mice relative to free antisense ODN, cationic lipid/ODN complexes and SALP prepared with quaternary aminolipids. Given the small particle sizes and improved encapsulation efficiency, ODN to lipid ratios, and circulation times of this formulation compared to others, we believe SALP represent a viable candidate for systemic applications involving nucleic acid therapeutics.

Animals↗
PubMed2001

Immune stimulation by a CpG-containing oligodeoxynucleotide is enhanced when encapsulated and delivered in lipid particles.

The therapeutic benefit from phosphorothioate oligodeoxynucleotides (PS ODN) containing immune stimulatory sequences (ISS) has been demonstrated in animal models of cancer and infection. In particular, when CpG-containing PS ODN are administered to mice, activation of macrophages and dendritic, NK, T, and B cells occurs, resulting in the release of an array of cytokines, including interleukin-12 (IL-12), interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha (TNF-alpha). We have previously described stabilized antisense-lipid particles (SALP) for the i.v. administration of antisense ODN [Biochim Biophys Acta (2001) 1510:152--166]. Given the propensity for SALP to target macrophages in vivo it was of interest to determine whether they could enhance the potency of CpG ODN to induce an immune response. In this report we show that when CpG-containing SALP are administered intravenously to ICR mice the plasma concentrations of IL-12, IFN-gamma, IL-6, monocyte chemoattractant protein-1, and TNF-alpha are greatly increased compared with the same dose of free ODN. The pattern of cytokine induction indicates that the immune response is T helper cell type 1-biased, similar to that observed for PS CpG ODN ISS in general. Furthermore, when phosphodiester (PO) ODN is substituted for PS ODN in the SALP formulation cytokine induction is even greater at the early time points, in marked contrast to free PO ODN, which is inactive. These results demonstrate that the immunogenicity of ISS is not only enhanced by encapsulation in lipid particles, which more closely mimic the way ISS DNA would normally be presented to antigen presenting cells by pathogens in vivo, but also SALP enable unmodified PO CpG ODN to be used as immune stimulants.

Adjuvants, Immunologic↗
PubMed2000

Membrane perturbation and the mechanism of lipid-mediated transfer of DNA into cells.

Mixtures of cationic lipids and unsaturated phosphatidylethanolamine are used extensively for the intracellular delivery of plasmids and antisense oligodeoxynucleotides (ODN) in vitro. However, the mechanism by which cytoplasmic delivery of these large molecules is achieved remains unclear. The common hypothesis is that phosphatidylethanolamine promotes fusion of lipid/DNA particles with endosomal membranes, but this is inconsistent with several reports that have failed to correlate the fusogenic activity of a wide variety of lipid/DNA particles, measured by lipid mixing techniques, with their transfection activity. To address this issue further we have conducted a detailed analysis of the lipid mixing and DNA transfer activity of two, physically similar but functionally different, lipid/DNA particles composed of equimolar dioleyldimethylammonium chloride (DODAC) and dioleoylphosphatidylethanolamine (DOPE) or dioleoylphosphatidylcholine (DOPC). In combination with DODAC both phospholipids form almost identical lipid/DNA particles, they are endocytosed by cells to the same extent and each undergoes equivalent lipid mixing with cell membranes after uptake. Despite this, DNA transfer is 10- to 100-fold more extensive for lipid/DNA particles containing DOPE. We conclude that lipid mixing between lipid-based delivery systems and endosomal membranes must occur for DNA transfer to occur. However, the potency of different lipid/DNA particles correlates better with the ability of the exogenous lipid to disrupt membrane integrity.

Animals↗
PubMed2000

Intravenous administration of stabilized antisense lipid particles (SALP) leads to activation and expansion of liver natural killer cells.

Stabilized antisense lipid particles (SALP) have been developed for the systemic delivery of oligonucleotides. The impact of intravenous SALP administration was measured with respect to activation of natural killer (NK) and NK1.1+ T (NKT) cells in the livers of immunocompetent mice. Treatment with a SALP containing a highly mitogenic oligonucleotide (INX-6295) generated an increase in NK cytolytic activity and cell number within the liver but did not appear to affect the number of hepatic NKT cells or their cytolytic activity. The same results were observed after intravenous administration of the mitogenic oligonucleotide alone. Interestingly, treatment with a SALP containing a weakly mitogenic oligonucleotide (INX-6300) also activated the liver NK cells, whereas the oligonucleotide alone was unable to elicit these effects. The NK stimulatory activity of a SALP containing INX-6300 required both lipid and oligonucleotide components. These results demonstrate that in addition to modifying the pharmacokinetics and biodistribution of intravenously administered oligonucleotides, SALP possess immunostimulatory activity independent of oligonucleotide mitogenicity, which can serve as an adjuvant to antisense therapies for cancer.

Adjuvants, Immunologic↗
PubMed2000

Enhanced anti-inflammatory activity of a liposomal intercellular adhesion molecule-1 antisense oligodeoxynucleotide in an acute model of contact hypersensitivity.

The anti-inflammatory activity of free and liposome-encapsulated oligonucleotide targeted against intercellular adhesion molecule-1 mRNA was investigated in a delayed type hypersensitivity model of acute inflammation in mice. Contact hypersensitivity reactions to 2, 4-dinitrofluorobenzene were monitored by measuring ear thickness and cellular infiltration, both of which were observed to be maximal 24 h after ear challenge. A murine-specific phosphorothioate oligodeoxynucleotide and various control sequences were each passively encapsulated into 100-nm diameter large unilamellar vesicles composed of egg phosphatidylcholine and cholesterol. All formulations were administered as a single-bolus injection into the tail vein approximately 15 min after initiating ear inflammation. Oligodeoxynucleotide dose was varied from 5 to 50 mg/kg and the extent of inflammation was assessed 24 h later. Mice treated with free oligonucleotide, empty vesicles, or encapsulated control sequences showed no measurable effect on ear swelling or cellular infiltration compared with untreated controls. However, mice that received the active sequence encapsulated in lipid vesicles exhibited near baseline levels of ear thickness and leukocyte infiltration, similar to that observed in mice treated with a topical corticosteroid. These data demonstrate the utility of liposome-encapsulated intercellular adhesion molecule-1 antisense oligonucleotide as a novel anti-inflammatory therapeutic.

Animals↗
PubMed1999

Contact hypersensitivity: a simple model for the characterization of disease-site targeting by liposomes.

A murine model of delayed-type hypersensitivity (DTH) is characterized with respect to liposome accumulation at a site of inflammation. Mice were sensitized by painting the abdominal region with a solution of 2,4-dinitrofluorobenzene (DNFB) and inflammation was induced 5 days later by challenging the ear with a dilute solution of DNFB. The inflammatory response was readily monitored by measuring ear thickness (edema) and radiolabeled leukocyte infiltration. Maximum ear swelling and cellular infiltration occurred 24 h after the epicutaneous challenge with the ear returning to normal size after approximately 72 h. We demonstrate that large unilamellar vesicles (LUV) accumulate at the site of inflammation to a level more than 20-fold higher than that measured in the untreated ear. Vesicle delivery to the ear correlated with increased vascular leakage resulting from endothelium remodeling in response to DNFB challenge, and was not a consequence of increased local tissue blood volume. Extravasation occurred only during the first 24 h after ear challenge; after this time the permeability of the endothelium to vesicles returned to normal. We further showed that LUV with a diameter of 120 nm exhibit maximum levels of accumulation, that a polyethylene glycol surface coating does not increase delivery, and that the process can be inhibited by the application of topical corticosteroids at the time of induction. These data and the inflammation model are discussed with respect to developing lipid-based drug delivery vehicles designed to accumulate at inflammatory disease sites.

Administration, Topical↗
PubMed1999

Stabilized plasmid-lipid particles: construction and characterization.

A detergent dialysis procedure is described which allows encapsulation of plasmid DNA within a lipid envelope, where the resulting particle is stabilized in aqueous media by the presence of a poly(ethyleneglycol) (PEG) coating. These 'stabilized plasmid-lipid particles' (SPLP) exhibit an average size of 70 nm in diameter, contain one plasmid per particle and fully protect the encapsulated plasmid from digestion by serum nucleases and E. coli DNase I. Encapsulation is a sensitive function of cationic lipid content, with maximum entrapment observed at dioleoyldimethylammonium chloride (DODAC) contents of 5 to 10 mol%. The formulation process results in plasmid-trapping efficiencies of up to 70% and permits inclusion of 'fusigenic' lipids such as dioleoylphosphatidylethanolamine (DOPE). The in vitro transfection capabilities of SPLP are demonstrated to be strongly dependent on the length of the acyl chain contained in the ceramide group used to anchor the PEG polymer to the surface of the SPLP. Shorter acyl chain lengths result in a PEG coating which can dissociate from the SPLP surface, transforming the SPLP from a stable particle to a transfection-competent entity. It is suggested that SPLP may have utility as systemic gene delivery systems for gene therapy protocols.

Animals↗
PubMed1998

Anomalous solubility behavior of the antibiotic ciprofloxacin encapsulated in liposomes: a 1H-NMR study.

Many drugs are weak bases and can be accumulated into liposomes in response to a pH gradient to achieve high internal drug concentrations. This study is aimed at gaining an understanding of the relationship between the retention of the fluoroquinolone antibiotic ciprofloxacin in liposomes and the intraliposomal form and location of this drug. 1H-NMR spectroscopy was used to probe the interactions experienced by ciprofloxacin following uptake into large unilamellar liposomes (LUV). It is shown that ciprofloxacin is located in the aqueous interior of the liposomes and is self-associated in the form of small stacks. It does not precipitate out of solution even though the intraliposomal ciprofloxacin concentration can exceed its solubility in aqueous solutions by almost two orders of magnitude. The results also indicate that little entrapped ciprofloxacin partitions into the inner monolayer of the LUV. As a result of the lack of precipitation and rapid exchange properties, ciprofloxacin can respond quickly to changes in electrochemical equilibria such as depletion of the pH gradient. This provides a rationale for the rapid leakage of this drug in response to serum destabilization or depletion of the pH gradient.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1998

Cholesterol mobilization and regression of atheroma in cholesterol-fed rabbits induced by large unilamellar vesicles.

The antiatherogenic properties of repeated injections of egg phosphatidylcholine large unilamellar vesicles (LUVs) of 100 nm diameter were tested in an experimental model for atherosclerosis. Forty eight rabbits were divided into two diet groups fed standard rabbit chow or fed a cholesterol-enriched diet (0.5% by weight) to induce the formation of atherosclerotic lesions. Prior to the initiation of LUV therapy, the cholesterol diet was ceased and all animals were returned to standard rabbit chow. The treatment protocol consisted of a total of 10 bolus injections of vesicles, at a phospholipid dose of 300 mg/kg body weight or the equivalent volume of saline, with one injection given to each animal every 10 days. LUV injections brought about a large movement of cholesterol into the blood pool and resulted in a significant reduction in the cholesterol content as well as the degree of surface plaque involvement of aortic tissue in atherosclerotic animals. Most notably, the thoracic aorta of LUV-treated animals exhibited a 48% reduction in tissue cholesterol content per gram of protein compared to saline-treated controls. Histochemical analyses revealed that aortas from animals receiving the repeated injections of LUVs displayed less cholesterol deposits in lesions, and a moderate reduction in intimal-to-medial thickness. This regression of atheroma, induced by LUV therapy, was observed even though animals possessed persistent elevated plasma cholesterol levels after the cholesterol-enriched diet was ceased. These results suggest that repeated injections of LUVs, working with endogenous HDL, may be a useful therapy in the management of atherosclerosis.

Animals↗
PubMed1998

Antibacterial efficacy against an in vivo Salmonella typhimurium infection model and pharmacokinetics of a liposomal ciprofloxacin formulation.

The fluoroquinolone antibiotic ciprofloxacin has been encapsulated into large unilamellar vesicles (LUV) at efficiencies approaching 100%. Drug accumulation proceeded in response to a transmembrane gradient of methylammonium sulfate and occurred concomitantly with the efflux of methylamine. A mechanism for the encapsulation process is described. LUV composed of dipalmitoylphosphatidylcholine-cholesterol (DPPC/chol), distearoylphosphatidylcholine-cholesterol (DSPC/chol), or sphingomyelin-cholesterol (SM/chol) increased the circulation lifetime of ciprofloxacin after intravenous (i.v.) administration by > 15-fold. The retention of ciprofloxacin in liposomes in the circulation decreased in the sequence SM/chol > DSPC/chol > DPPC/chol. Increased circulation lifetimes were associated with enhanced delivery of the drug to the livers, spleens, kidneys, and lungs of mice. Encapsulation of ciprofloxacin also conferred significant increases in the longevity of the drug in the plasma after intraperitoneal administration and in the lungs after intratracheal administration in comparison to free ciprofloxacin. The efficacy of a single i.v. administration of an SM/chol formulation of ciprofloxacin was measured in a Salmonella typhimurium infection model. At 20 mg of ciprofloxacin per kg of body weight, the encapsulated formulation resulted in 10(3)- to 10(4)-fold fewer viable bacteria in the livers and spleens of infected mice than was observed for animals treated with free ciprofloxacin. These results show the utility of liposomal encapsulation of ciprofloxacin in improving the pharmacokinetics, biodistribution, and antibacterial efficacy of the antibiotic. In addition, these formulations are well suited for i.v., intraperitoneal, and intratracheal or aerosol administration.

Animals↗
PubMed1998

Intracellular delivery and antibacterial activity of gentamicin encapsulated in pH-sensitive liposomes.

Cell membranes are relatively impermeable to the antibiotic gentamicin, a factor that, along with the toxicity of gentamicin, precludes its use against many important intracellular bacterial infections. Liposomal encapsulation of this drug was used in order to achieve intracellular antibiotic delivery and therefore increase the drug's therapeutic activity against intracellular pathogens. Gentamicin encapsulation in several dipalmitoylphosphatidylcholine (DPPC) and pH-sensitive dioleoylphosphatidylethanolamine (DOPE)-based carrier systems was characterized. To systematically test the antibacterial efficacies of these formulations, a tissue culture assay system was developed wherein murine macrophage-like J774A.1 cells were infected with bacteria and were then treated with encapsulated drug. Of these formulations, DOPE-N-succinyl-DOPE and DOPE-N-glutaryl-DOPE (70:30;mol:mol) containing small amounts of polyethyleneglycol-ceramide showed appreciable antibacterial activities, killing greater than 75% of intracellular vacuole-resident wild-type Salmonella typhimurium compared to the level of killing of the control formulations. These formulations also efficiently eliminated intracellular infections caused by a recombinant hemolysin-expressing S. typhimurium strain and a Listeria monocytogenes strain, both of which escape the vacuole and reside in the cytoplasm. Control non-pH-sensitive liposomal formulations of gentamicin had poor antibacterial activities. A fluorescence resonance energy transfer assay indicated that the efficacious formulations undergo a pH-dependent lipid mixing and fusion event. Intracellular delivery of the fluorescent molecules encapsulated in these formulations was confirmed by confocal fluorescence microscopy and was shown to be dependent on endosomal acidification. This work shows that encapsulation of membrane-impermeative antibiotics in appropriately designed lipid-based delivery systems can enable their use in treating intracellular infections and details the development of a general assay for testing the intracellular delivery of encapsulated drug formulations.

Animals↗
PubMed1995

Transbilayer movement and net flux of cholesterol and cholesterol sulfate between liposomal membranes.

The kinetics of cholesterol and cholesterol sulfate (CS) movement between vesicles have been investigated. CS is widely distributed in cell membranes, plasma and skin and is similar in structure to cholesterol, but possesses an ionizable sulfate moiety at the 3 beta-position which imparts a negative charge at physiological pHs. Donor vesicles of various sizes ranging from 40 to 250 nm, composed of egg phosphatidylcholine (EPC)/sterol/N-palmitoyldihydrolactosylcerebroside (75:10:15 mole ratio) containing trace amounts of [3H]sterol, were used to monitor sterol transfer into a 10-fold excess of large unilamellar vesicles (LUV) composed of EPC with a diameter of 100 nm. The two populations of vesicles were separated by centrifugation following the addition of a lectin which caused the aggregation of donor vesicles. Both cholesterol and CS exhibited biphasic kinetics of exchange. The rate constants for efflux and transbilayer diffusion for both sterol molecules were determined after fitting kinetic data, using numerical integration, to a three-compartment model, which includes the inner and outer monolayers of donor vesicles and the acceptor bilayer. The rate of intermembrane exchange for CS was approximately 10-fold faster than for cholesterol in all liposomes tested. Using the kinetic model, a rate of transbilayer movement for cholesterol and CS was estimated. In both cases, it was found to be slower than the rate of efflux from the surface of vesicles. For vesicles containing CS, the surface charge was monitored to demonstrate that the slowly exchanging pool was located in the inner monolayer, and the rapidly exchanging pool in the outer half of the bilayer. For cholesterol, it was not possible to distinguish between this model and one where lateral domains of cholesterol within the plane of the bilayer may influence the kinetics of exchange.

Biological Transport↗
PubMed1993

The influence of size and composition on the cholesterol mobilizing properties of liposomes in vivo.

As part of a study into the antiatherogenic properties of phospholipid liposomes we have investigated the capacity of a variety of preparations to increase plasma cholesterol concentrations in mice. Large unilamellar vesicles, composed of egg phosphatidylcholine, were found to be approximately twice as effective at mobilizing cholesterol than sonicated vesicles of the same composition. For egg phosphatidylcholine liposomes the change in plasma cholesterol profile is proportional to the residence time of vesicles in the circulation. Large unilamellar vesicles with a diameter of approx. 100 nm accumulate the most sterol in the animal model tested here, reaching equimolar concentrations with phospholipid after 24 h. Gel-state vesicles gave rise to a smaller increase in plasma cholesterol compared to liquid-crystalline vesicles. Our data indicate that, in vivo, net transfer of cholesterol into liposomes occurs more extensively from the lipoprotein cholesterol pool than from the erythrocyte cell membrane pool. This is consistent with the hypothesis (Williams, K.J., Werth, V.P. and Wolff, J.A. (1984) Perspect. Biol. Med. 27, 417-431) that liposomes enhance reverse cholesterol transport by generating cholesterol-poor HDL particles that can extravasate and promote more sterol efflux from peripheral tissues.

Animals↗