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Binding of amitriptyline and nortriptyline in plasma determined from their equilibrium distributions between red cells and plasma, and between red cells and buffer solution.

In a new method for the measurement of plasma binding, amitriptyline (AT) and nortriptyline (NT) were allowed to reach equilibrium distribution between the cells and plasma of whole blood. A separate sample of the cells was equilibrated with a buffer solution containing the drugs. From the two distribution ratios for each drug, the fraction free in the plasma was calculated. Equilibria were achieved rapidly, avoiding denaturation of binding proteins. The pH was adequately controlled and the composition of the plasma was not altered by the experimental procedures. Large volumes of buffer solution gave amounts of free drug readily measurable by gas chromatography. Duplicate determinations showed coefficients of variation of 6% and 4.8% respectively for the free fractions of AT and NT in a given plasma sample. In 51 subjects the mean percentage of AT free in plasma was 4.31 +/- 0.59 SD and, of NT, 8.59 +/- 0.86. Binding was independent of drug concentration in the therapeutic range and did not differ between males and females nor between patients and normal subjects. It increased slightly with age. It was not affected by chylomicrons in the blood.

Amitriptyline↗

An accurate method of plasma volume measurement by direct analysis of Evans blue spectra in plasma without dye extraction: origins of albumin-space variations during maximal exercise.

The Evans blue dye (EBD) dilution method, including a dye extraction step, is a standard way of measuring plasma volume. This report describes a new direct spectrophotometric method, which is simple and specific and avoids the dye extraction step. To begin with, all the contaminants which may appear during a plasma volume study were added to plasma samples, prior to the absorbance measurements. In this way we calculated correction factors for the haemolysis and the turbidity of the plasma samples, without dye. The study of the visible spectra showed that the correction factors could be obtained by measuring absorbances at only four visible wavelengths: 780, 720, 619 and 578 nm. The addition of various amounts of contaminants to dye-containing plasma samples allowed us to obtain precise values for the absorbance errors. The previously defined correction factors were then applied, and the residual absorbance errors were found to become nil. This spectrophotometric method can be used to check the efficiency of a dye-extraction procedure, as well as to study other biological fluids containing EBD. When used to analyse a chronological series of blood samples this method appeared to provide an effective way of simultaneously studying the processes of plasma volume concentration and albumin extravasation induced by maximal exercise.

Coloring Agents↗

Development of radioimmunoassays for the measurement of aldosterone in unprocessed plasma and simple plasma extracts.

Inexpensive and rapid radioimmunoassay techniques for the measurement of aldosterone in unprocessed plasma and simple plasma extracts are described. The use of low pH (pH 5.0) and merthiolate to minimise plasma protein binding and the use of aldosterone-free plasma in the standards allows the measurement of aldosterone in 50 microliter of unprocessed plasma, which has been found useful in the diagnostic screening and classification of hyperaldosteronism. Despite quantitative recovery of added (+)-aldosterone and high specificity, the aldosterone content of unprocessed plasma is overestimated, probably by the presence of a water-soluble compound which closely resembles aldosterone. The use of a simple preliminary dichloromethane extraction procedure gives an excellent correlation with values obtained after chromatography. Values are given for chosen normal people and people with benign essential hypertension, using both assay procedures in three different physiological contexts.

Aldosterone↗

Evidence that plasma fibrinogen and platelet membrane GPIIb-IIIa are involved in the adhesion of platelets to an artificial surface exposed to plasma.

We investigated the molecular mechanism(s) by which platelets adhere to an artificial surface exposed to plasma, using polystyrene microtiter plates pretreated with plasma. Washed platelets labelled with 51Cr were incubated with the plates under static conditions. Prostaglandin E1(PGE1) was added to the platelets to prevent platelet-platelet interactions. Adhesion required the presence of a divalent cation such as Mg++ or Ca++. Polyclonal anti-fibrinogen antibody inhibited adhesion by 70%. Polyclonal antibodies against fibronectin, vitronectin, von Willebrand's Factor, and the Fc portion of human IgG, had no effect on adhesion. Platelets adhered normally to a surface pretreated with plasma from a patient with severe von Willebrand's disease. No platelet adhesion occurred when the surface was pretreated with an afibrinogenemic plasma. Monoclonal antibodies against platelet membrane GPIIb-IIIa, potent inhibitors of ADP-induced fibrinogen binding to platelets, completely inhibited adhesion. Monoclonal antibodies against the GPIb alpha subunit and GPIc(VLA alpha 5) showed no inhibitory effects on adhesion. Platelets from a patient with Glanzmann's thrombasthenia (type I) did not adhere to the surface pretreated with normal plasma. These results suggest that plasma fibrinogen adsorbed onto the surface and that platelet membrane glycoprotein(GP)IIb-IIIa were responsible for adhesion in an activation-independent manner.

Adsorption↗

Functional assay of plasma antithrombin using polyethylene glycol (PEG) defibrinated plasma.

Polyethylene glycol(PEG) was used to precipitate fibrinogen to prepare defibrinated plasma in the two stage clotting assay of antithrombin activity. Five percent PEG-8000 precipitated fibrinogen from plasma without loss of antithrombin activity in the defibrinated plasma. Fibrin degradation products(FDP) as high as 640 ug/ml did not interfere the two stage clotting assay using PEG defibrinated plasma possibly because part of FDP was precipitated by PEG in the process of plasma defibrination. The two stage clotting assay was very sensitive to the changes of antithrombin activity in the range of 60%-100% of normal level. The assay was reproducible and correlated with chromogenic assay. The decrease of plasma antithrombin activity in a baboon septic shock model was demonstrated with this assay.

Animals↗

Risks and side effects of therapy with plasma and plasma fractions.

Transfusion of plasma can lead to adverse reactions or events. Immune-mediated reactions are most common--these include allergic and anaphylactic reactions, transfusion-related acute lung injury (TRALI) and haemolysis. They can range in severity from mild to fatal. Fluid overload and citrate toxicity can occur after rapid or massive transfusion. In developed countries, microbial transmission rates are low because of donor selection and testing. Pathogen reduction processes can be applied to either single-unit components (methylene blue) or plasma pools (solvent-detergent). They have the unwanted effect of reducing some coagulation factors but reduce viral transmission risk even further. Reactions associated with plasma products or fractions also include allergic reactions, although TRALI is rare. Viral transmission risk is very low because of the use of two independent viral inactivation steps. Different products have particular specific unwanted effects: intravenous immunoglobulin has been associated with thrombotic events, renal toxicity and aseptic meningitis; coagulation factors are associated with development of inhibitors and thrombotic events. The risk of transmission of variant Creutzfeldt-Jakob disease in both plasma components and pooled plasma products is as yet unknown. If anything, the low titre of prion infectivity in the blood of an infected individual (approximately 10 infectious units/ml) will be massively diluted by the thousands of units of plasma in the pool. Subsequent manufacturing processes also remove prions from the final product.

Blood Coagulation Factors↗

Interaction of cubosomes with plasma components resulting in the destabilization of cubosomes in plasma.

Cubosomes are novel dispersed nanoparticles with bicontinuous cubic phases of monoolein in their interior. We investigated their disintegration process in plasma by in vitro and in vivo studies. Cubosomes were incubated with whole plasma or plasma components such as HDL, LDL, and albumin. The lypolysis study indicated lipolytic activity of whole plasma towards cubosomes. Gel filtration chromatography revealed that HDL, LDL and albumin interacted with cubosomes. HDL affected cubosomes' integrity and gave rise to smaller particles which contained the components of both cubosomes and HDL. Upon incubation with LDL, cubosomes fused with LDL. Albumin was shown to take up monoolein out of the particles. Cubosomes were disintegrated by whole plasma as a result of the interaction with plasma components. It was concluded that in vivo observation of a long circulation time of a hydrophobic substance in cubosomes was due to the sustained behavior of cubosome remnant particles.

Animals↗

The biological significance of non-enzymatic reaction of menadione with plasma thiols: enhancement of menadione-induced cytotoxicity to platelets by the presence of blood plasma.

To test the hypothesis that the non-enzymatic reaction of quinones with thiols in plasma can generate reactive oxygens (ROS), thereby leading to potentiated cellular toxicity, we have studied the effect of a representative quinone compound, menadione, on plasma isolated from rats. The experimental results are as follows: (1) menadione generated ROS via non-enzymatic reaction with protein thiols in plasma; (2) the presence of plasma increased menadione-induced cytotoxicity to platelets; (3) pretreatment of plasma with a thiol-depleting agent significantly suppressed menadione-induced ROS and cytotoxicity. These results suggest that the non-enzymatic reaction of menadione with plasma thiols could be an important process in quinone-induced cellular toxicity.

Animals↗

Blimp-1 is required for the formation of immunoglobulin secreting plasma cells and pre-plasma memory B cells.

Blimp-1 is a transcriptional repressor able to drive the terminal differentiation of B cells into Ig-secreting plasma cells. We have created mice with a B cell-specific deletion of prdm1, the gene encoding Blimp-1. B cell development and the number of B cells responding to antigen appear to be normal in these mice. However, in response to either TD or TI antigen, serum Ig, short-lived plasma cells, post-GC plasma cells, and plasma cells in a memory response are virtually absent, demonstrating that Blimp-1 is required for plasmacytic differentiation and Ig secretion. In the absence of Blimp-1, CD79b(+)B220(-) pre-plasma memory B cell development is also defective, providing evidence that this subset is an intermediate in plasma cell development. B cells lacking Blimp-1 cannot secrete Ig or induce muS mRNA when stimulated ex vivo. Furthermore, although prdm1-/- B cells fail to induce XBP-1, XBP-1 cannot rescue plasmacytic differentiation without Blimp-1.

Animals↗

Detection and characterization of plasma cells in peripheral blood: correlation of IgE+ plasma cell frequency with IgE serum titre.

In atopic patients and patients with hyper-IgE syndrome (HIE) highly elevated IgE serum levels can be detected. Due to their very low frequency little is known about IgE-producing plasma cells (PC) in peripheral blood. We used CD138 MACS microbeads to enrich plasma cells from peripheral blood of normal donors, atopic patients and one HIE patient. CD138+ cells were mainly CD45+, CD44++, CD19dim, CD38++, CD27++, CD86+, HLA-DR+/++, CD71dim, VLA-4+, VLA-5-, CD28-, CD25-, CD69-, CLA-, CD20-, CD21- and CD22-. They show weak expression of surface Ig but high levels of intracellular Ig and they secrete Ig in culture. Thus CD138+ cells from peripheral blood show characteristics of early plasma cells. IgE+ CD138+ plasma cells could be detected in 19 of 24 normal donors with an average frequency of 0.06% IgE+ cells among CD138+ cells. Higher frequencies were detected in atopic patients, atopic patients with markedly elevated serum IgE levels and the hyper-IgE patient with an average of 0.32%, 7.21% and 6.54%, respectively. Additionally, using the recently developed cellular affinity matrix technology, we were able to detect IgE secreting plasma cells and thereby could demonstrate that most of the IgE secreting cells express CD138. The frequency of IgE+ CD138+ cells among PBMC correlated highly significantly with serum IgE titres (r = 0.8532***), indicating that IgE secreting CD138+ cells in peripheral blood are directly related to the plasma cell pool contributing to the IgE titre.

Antibody Affinity↗

Research and development commitments in an integrated plasma collection and plasma fractionation environment.

Plasma fractionation has emerged as one of the most scientifically demanding fields in the biopharmaceutical area. Producing safe plasma derivatives implies the development, use, and proper understanding of sensitive testing technologies to detect infection markers in starting plasma. It also requires the implementation of carefully selected, nondenaturing, efficient plasma protein purification and viral reduction technologies that do not alter the physiological functions and clinical potential of plasma proteins. Success in this field can be achieved only by a strong commitment to sustain constant research and development of projects targeting the production of safer and innovative plasma products.

Blood Coagulation Factors↗

Intravascular circulation and distribution of human 51Cr-DBBF stroma-free hemoglobin, 51Cr-plasma, 51Cr-saline, 59FE-plasma, and 125I-albumin in the mouse.

Male B6C3HF1 mice were infused with human 51Cr-labeled DBBF (bis 3,5-dibromosalicyl fumarate) crosslinked stroma-free hemoglobin (SFH). In the first hour following SFH infusion, 11.2% of the infused radioactivity was found in the skin, 11.4% in muscle, 9.1% in the skeleton, and 5% in the liver. Twenty-four hours after infusion, 15.4% of the radioactivity was found in the skin, 10.3%, in the muscle, 16.6% in the skeleton, and 6.7% in the liver. The circulation and distribution of 51Cr-labeled DBBF-SFH were compared with levels of 51Cr labeled plasma, 51Cr in saline, 59Fe labeled plasma, and 125I albumin. The radioactivity in the blood was similar for 51Cr-DBBF-SFH, 51Cr-plasma, and 59Fe-plasma. During the 24-hour post-infusion period, extravascular distribution of the 51Cr-saline, 51Cr-plasma, and 125I albumin within the organs was similar to that of 51Cr-DBBF-SFH, with the highest levels being in skin, muscle, skeleton and liver, and no increase in the levels in the lung or spleen. The distribution of 59Fe compared to that of 51Cr-DBBF, 51Cr-plasma, 51Cr-saline, and 125I albumin can be explained by the fact that 59Fe is utilized in the production of new red blood cells.

Albumins↗

Studies on a proteolytic enzyme in human plasma; the relationship between the proteolytic activity of plasma and blood coagulation.

A fraction of globulin was prepared from human plasma which was deficient in prothrombin, thrombin, fibrinogen, plasma thromboplastin, and accelerator globulin. The preparation of globulin contained considerable potential proteolytic activity which could be activated by streptococcal fibrinolysin. This fraction of globulin accelerated the clotting of normal platelet-deficient plasma. However, the clot-accelerating effect of the globulin fraction was the same whether or not its proteolytic property had been activated. The addition of streptococcal fibrinolysin to normal platelet-deficient plasma did not accelerate coagulation. Nor did the addition of streptococcal fibrinolysin to hemophilic platelet-deficient plasma promote its coagulation. The data presented suggest that proteolysis by activated plasma proteolytic enzyme is not an essential stage in the coagulation of the blood.

Blood↗

A comparison of lyophilized artificially depleted plasmas and lyophilized plasmas from patients receiving warfarin in correcting for coagulometer effects on international normalized ratios.

The comparative value of lyophilized artificially depleted plasmas and plasmas from warfarin-treated patients in local (thromboplastin/coagulometer) system International Sensitivity Indices (ISI) determination has been studied at 39 centers in an international collaborative study. At each center, both types of plasmas were tested with two common thromboplastins (low ISI RecombiPlasTin and high ISI OBT), and in-house reagents using three brands of coagulometers. In 95 local systems, they was agreement. With both thromboplastins, coagulometers lowered the ISI from the manual or stated ISI with all systems. Differences between the two types of lyophilized plasmas with the two common thromboplastins were not of clinical importance. Artificially depleted plasmas are easier to obtain in sufficient volumes than plasma from warfarin-treated patients, and more easily provide the wide range of INR values required for reliable local ISI calibration. The agreement between the two types of lyophilized calibrant is reassuring.

Blood Coagulation Tests↗

Effect of plasma exchange on phenytoin plasma concentration.

The effect of plasma exchange on the concentrations of total and unbound phenytoin (DPH) was determined in one normal subject and four patients undergoing therapeutic plasma exchange (PE). The average percentage of plasma exchanged ranged from 57 to 70% among the five patients studied. The reduction in DPH concentration was more variable and ranged from 10 to 16%. However, the extent of reduction within each patient for both total DPH and "free" DPH serum concentrations was minimal; in addition, the ratio of free to total DPH remained virtually unchanged by plasma exchange. Thus, the replacement of endogenous albumin with exogenous albumin, which is an integral part of therapeutic plasma exchange, does not appear to alter DPH binding. Our findings indicate that rapid equilibration of DPH occurs between the intra- and extravascular compartments and that for the occasional plasma exchange procedure, dose adjustment does not appear indicated.

Blood Component Removal↗

Plasma volume and plasma volume distribution at rest, during muscular work, cold pressure test and psychological stress in male offspring from families with heavy aggregation of hypertension.

Total and central plasma volume was measured in 51 male offspring of hypertensive individuals belonging to families with a history of essential hypertension for at least two generations. They were compared to 38 age-matched individuals without known hypertension in their families for at least two generations. Central plasma volume was determined at rest and during muscle work, cold pressure test and psychological stress. The offspring had significantly lower total plasma volume than the controls. Central plasma volume was equal in offspring and controls. The quotient central/total plasma volume was thus higher in offspring than in controls, and the difference was statistically significant during psychological stress and dynamic muscle work. Possible reasons for the differences between offspring and controls are an increased transcapillary escape of plasma, an increased quotient intracellular/extracellular fluid and/or increased tone of the capacitance vessels.

Adult↗

Cryoprecipitate-removed plasma 'cryo-removed plasma' as a source of factor IX in the treatment of haemophilia B.

Fresh frozen plasma (FFP) is the main source of factor IX (FIX) in the treatment of bleeding episodes of haemophilia B in the Philippines. Cryoprecipitate-removed plasma otherwise known in the Philippines as cryosupernate, is a by-product of cryoprecipitate preparation. These blood products expire in storage or are just thrown- away because of less demand for clinical use. By theory, this product should have almost the same amount of FIX as in FFP, therefore can be used in the treatment of haemophilia B. There is no local data on the actual FIX content of the cryoprecipitate-removed plasma. Hence, the authors established these data to support the use of this product. Eighty-three bags of cryoprecipitate-removed plasma received from three different blood banks in Manila, Philippines were tested for FIX activity using an activated partial thromboplastin time (APTT)-based one-stage FIX assay. The FIX content in each bag of cryoprecipitate-removed plasma was calculated by multiplying its volume in mL with that of FIX activity per mL of plasma measured in vitro. The total mean FIX content per bag was 212.20 U (+/-88.98) exceeding the contents set by the American Association of Blood Banks (AABB, 70-90 U). The mean FIX activity per bag was 127.62% (+/-38.23) with the mean volume of 164.28 mL (+/-52.23). Statistically significant difference on volume (P = 0.000) was found across the three sources resulting to a significant variation of the actual FIX content (P = 0.000).

Factor IX↗

Monoclonality and polyclonality of plasma cells in Castleman's disease of the plasma cell variant.

Castleman's disease of the plasma cell variant observed in 21 patients was investigated morphologically and by immunohistochemistry. The male to female ratio was 2.5:1. The age ranged from 18 to 71 years (mean age 47.6 years). Histologically, the lesions were characterized by numerous, evenly distributed germinal centres ranging from large hyperplastic to small hyaline-vascular types with moderate to extensive sheets of plasma cells in between. In all cases with generalized lymph node enlargement dilated sinuses could be found. Immunohistochemical studies demonstrated a polyclonal plasma cell population in 11 of 18 lesions. Seven lesions contained a monoclonal plasma cell population, five with IgG/lambda and two with IgA/lambda; clinically, two of these patients had generalized lymphadenopathy; in none could manifestation of a plasmacytoma be found outside the lymph node lesion; only two of the seven patients exhibited a paraproteinaemia (IgG/lambda and IgA/lambda, respectively) corresponding to the Ig type of the proliferated plasma cells. Six patients with polyclonal lesions had constitutional symptoms such as fever, anaemia, polyclonal hypergammaglobulinaemia; one of these six patients manifested symptoms consistent with a diagnosis of Takatsuki syndrome. The monoclonal plasma cell type of Castleman's disease did not progress to a generalized disease. This monoclonal variant may be a lymph nodebased type of benign monoclonal gammopathy.

Adolescent↗