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Identification of substrate-analog trypsin inhibitors through the screening of synthetic peptide combinatorial libraries.

Synthetic peptide combinatorial libraries (SPCLs), which are made up in total of tens to hundreds of millions of peptides, enable the systematic screening for biologically active peptides in virtually all in vitro and even in vivo assay systems. In the current study, the applicability of this method to the identification of peptide enzyme inhibitors was investigated using trypsin as the model enzyme. A specifically designed library of hexapeptide mixtures was synthesized on cotton carriers and screened. The synthetic approach, using cotton as a solid support, was modified so that the deprotected peptides remained attached to the cotton carrier until they were released into solution directly prior to being assayed. Following an iterative process of synthesis and screening, in which all of the positions of the sequence were successively defined, a number of individual hexapeptides with trypsin inhibitory activity were identified. The most active, defined individual peptide sequence was then reincorporated into a new library, now made up of dodecapeptide mixtures. The iterative screening and synthesis of this library led to a dodecapeptide with improved inhibitory activity when compared to the hexapeptide from which it was derived.

Amino Acid Sequence↗

Generation and use of synthetic peptide combinatorial libraries for basic research and drug discovery.

Existing methods for the synthesis and screening of large numbers of peptides are limited by their inability to generate and screen the requisite number (millions) of individual peptides and/or their inability to generate unmodified free peptides in quantities able to interact in solution. We have circumvented these limitations by developing synthetic peptide combinatorial libraries composed of mixtures of free peptides in quantities which can be used directly in virtually all existing assay systems. The screening of these heterogeneous libraries, along with an iterative selection and synthesis process, permits the systematic identification of optimal peptide ligands. Starting with a library composed of more than 34 million hexa-peptides, we present here the precise identification of an antigenic determinant recognized by a monoclonal antibody as well as the straightforward development of new potent antimicrobial peptides.

Antibodies, Monoclonal↗

Evaluation of cancer screening programs: parallels with clinical trials.

The methodologic limitations of available observational evidence for the evaluation of ongoing cancer control programs is reviewed. The specific example of Control Programs for Cervical Cancer is chosen to illustrate these limitations. These limitations pertain to the special features of the natural history of this disease, to the types of data available as well as to problems in the interpretation of these data. Given the unacceptability of conducting a rigorous randomized clinical trial of an ongoing and accepted cancer control procedure, an alternative experimental approach is proposed. This approach consists in the random allocation of census tracts with a high risk population to either of two groups: 1) an experimental group in which active and repeated screening activities will attempt to reach virtually all susceptible women, 2) a comparable control group which will only benefit from regularly available services.

Adult↗

Use of screening and preventive services among women with disabilities.

Roughly 54 million Americans have some disability; at older ages, women are more likely to be disabled than men. Many people with disabilities today live virtually normal life spans, and therefore routine screening and preventive services are essential to their overall quality of care. We used the 1994-1995 National Health Interview Survey (NHIS), with Disability, Family Resources, and Healthy People 2000 supplements, to examine screening and preventive service use for adult women with disabilities living in the community--about 18.4% of women (estimated 18.28 million). Disability was associated with higher age-adjusted rates of: poverty; living alone; low education; inability to work; obesity; and being frequently depressed or anxious. Disabled women generally reported screening and preventive services at rates comparable to all women. Women with major lower extremity mobility difficulties had much lower adjusted odds of Papanicolaou smears (odds ratio, 0.6; 95% confidence interval, 0.4-0.9), mammograms (odds ratio, 0.7; 95% confidence interval, 0.5-0.9), and smoking queries (odds ratio, 0.6; 95% confidence interval, 0.5-0.8). Various approaches exist to improve access for disabled women to health care services.

Adult↗

Three-dimensional virtual dissection at CT colonography: unraveling the colon to search for lesions.

Computed tomographic (CT) colonography is a promising noninvasive examination for colorectal cancer screening; however, the optimal interpretation strategy remains undecided. Virtual dissection is an innovative technique whereby the three-dimensional (3D) model of the colon is virtually unrolled, sliced open, and displayed as a flat 3D rendering of the mucosal surface, similar to a gross pathologic specimen. This technique has the potential to reduce evaluation time by providing a more rapid 3D image assessment than is possible with an antegrade and retrograde 3D endoluminal fly-through. It may also ultimately improve accuracy by reducing blind spots present with 3D endoluminal displays and by reducing reader fatigue. A disadvantage of virtual dissection is the potential for distortion of colonic lesions and normal anatomy. To avoid potential pitfalls in image interpretation, the radiologist must be familiar with the unique appearance of the normal colon anatomy and of various pathologic findings when using virtual dissection with two-dimensional axial and 3D endoluminal CT colonographic image data sets.

Colonic Diseases↗

Target-induced formation of neuraminidase inhibitors from in vitro virtual combinatorial libraries.

Neuraminidase, a key enzyme responsible for influenza virus propagation, has been used as a template for selective synthesis of small subsets of its own inhibitors from theoretically highly diverse dynamic combinatorial libraries. We show that the library building blocks, aldehydes and amines, form significant amounts of the library components resulting from their coupling by reductive amination only in the presence of the enzyme. The target amplifies the best hits at least 120-fold. The dynamic libraries synthesized and screened in such an in vitro virtual mode form the components that possess high inhibitory activity, as confirmed by enzyme assays with independently synthesized individual compounds.

Aldehydes↗

Colon cancer screening strategies.

Screening has been shown to reduce morbidity and mortality related to colorectal cancer. However, the optimal strategy for population screening for colorectal cancer has been a topic of heated debate. Recent studies have challenged the efficacy and cost-effectiveness of current population screening practices. Novel approaches to improve the assessment of an individual's colorectal cancer risk and advances in technology are changing our approach to colorectal screening. This review covers current guidelines for screening for colorectal cancer, recent advances in cancer risk assessment, and the role of endoscopy, virtual colonoscopy, and fecal DNA testing in colorectal cancer screening.

Journal Article↗

Colorectal cancer prevention.

Colorectal cancer is the second leading cause of mortality in the United States. In the United States, the cumulative lifetime risk of developing colorectal cancer for both men and women is 6%. Despite advances in the management of this disease, the 5-year survival rate in the United States in only 62%. Because only 38% of patients are diagnosed when the cancers are localized to the bowel wall, it is likely that widespread implementation of screening could significantly improve the outcome. Colorectal cancer screening is cost effective, irrespective of the methods used. In addition to currently available methods (fecal occult blood, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema), computed tomographic colonography (virtual colonoscopy) and stool-based molecular screening are under development. Four classes of chemopreventive compounds have demonstrated efficacy in reducing recurrent colorectal adenomas and/or cancer in randomized, controlled trials. They are selenium, calcium carbonate, hormone replacement therapy, and nonsteroidal anti-inflammatory drugs. The mechanisms of action of nonsteroidal anti-inflammatory drugs include inhibition of the cyclooxygenase system as well as cyclooxygenase-independent effects. Considerable effort is being expended to define chemopreventive activity, optimal dose, administration schedule, and toxicity for the coxibs in adenoma recurrence prevention trials. The threshold for tolerating toxicities is very low in asymptomatic individuals at minimally increased risk for colorectal neoplasia.

Adenomatous Polyps↗

Virtual colonoscopy: a gastroenterologist's perspective.

Virtual colonoscopy is an exciting new imaging technique with potential to alter current diagnostic approaches to colonic diseases, particularly colonic neoplasms. Although colonoscopy continues to offer the highest sensitivity and specificity for evaluation of the colon, virtual colonoscopy may offer greater safety, less discomfort, and consequently greater patient acceptance. In addition, virtual colonoscopy offers shorter procedure time, more accurate lesion location, and potentially lower cost as a screening test. Limited data are currently available to define virtual colonoscopy's full clinical role. This article describes the technical considerations, current clinical status, limitations, and potential indications of this new and exciting technology which gastroenterologists should not fear but embrace.

Colonoscopy↗

Twenty-year outcome analysis of genetic screening programs for Tay-Sachs and beta-thalassemia disease carriers in high schools.

Programs for education, screening, and counseling of senior-high-school students, in populations at high risk for Tay-Sachs and beta-thalassemia diseases, have existed for >20 years in Montreal. Four process and outcome variables are reported here: (i) voluntary participation rates in the high-school cohort; (ii) uptake rates for the screening test; (iii) origin of carrier couples seeking the prenatal diagnosis option in the programs; and (iv) change in incidence of the two diseases. Between 1972 and 1992, we screened 14,844 Ashkenazi-Jewish students, identified 521 HexA-deficient carriers (frequency 1:28), reached 89% of the demographic cohort in the educational component of the program, and achieved 67% voluntary participation in the subsequent screening phase. The corresponding data for the beta-thalassemia program are 25,274 students (mainly of Mediterranean origin) representing 67% of the cohort with 61% voluntary participation in the screening phase (693 carriers; frequency 1:36). From demographic data, we deduce that virtually all the carriers identified in the high-school screening program remembered their status, had their partner tested if they did not already know they were a carrier couple, and took up the options for reproductive counseling/prenatal diagnosis. In Montreal, the current origin of all couples using prenatal diagnosis for Tay-Sachs and beta-thalassemia diseases is the corresponding genetic screening/testing program, whereas, at the beginning of the programs, it was always because there was a history of an affected person in the family. Incidence of the two diseases has fallen by 90%-95% over 20 years; the rare new cases are born (with two exceptions) outside the target communities or to nonscreened couples.

Adolescent↗

The impact of secondary tasks on multi-tasking in a virtual environment.

One experiment is described that examined the possible involvement of working memory in the Virtual Errands Test (McGeorge et al. (2001). Using virtual environments in the assessment of executive dysfunction. Presence, 10, 375-383), which requires participants to complete errands within a virtual environment, presented on a computer screen. Time was limited, therefore participants had to swap between tasks (multi-task) efficiently to complete the errands. Forty-two undergraduates participated, all attempting the test twice. On one of these occasions they were asked to perform a concurrent task throughout (order of single and dual-task conditions was counterbalanced). The type of secondary task was manipulated between groups. Twenty-one participants were asked to randomly generate months of the year aloud in the dual-task condition, while another 21 were asked to suppress articulation by repeating the word "December". An overall dual-task effect on the Virtual Errands Test was observed, although this was qualified by an interaction with the order of single and dual-task conditions. Analysis of the secondary task data showed a drop in performance (relative to baseline) under dual-task conditions, and that drop was greater for the random generation group than the articulatory suppression group. These data are interpreted as suggesting that the central executive and phonological loop components of working memory are implicated in this test of multi-tasking.

Adolescent↗

A FRET-based assay platform for ultra-high density drug screening of protein kinases and phosphatases.

Protein phosphorylation is one of the major regulatory mechanisms involved in signal-induced cellular events, including cell proliferation, apoptosis, and metabolism. Because many facets of biology are regulated by protein phosphorylation, aberrant kinase and/or phosphatase activity forms the basis for many different types of pathology. The disease relevance of protein kinases and phosphatases has led many pharmaceutical and biotechnology companies to expend significant resources in lead discovery programs for these two target classes. The existence of >500 kinases and phosphatases encoded by the human genome necessitates development of methodologies for the rapid screening for novel and specific compound inhibitors. We describe here a fluorescence-based, molecular assay platform that is compatible with robotic, ultra-high throughput screening systems and can be applied to virtually all tyrosine and serine/threonine protein kinases and phosphatases. The assay has a coupled-enzyme format, utilizing the differential protease sensitivity of phosphorylated versus nonphosphorylated peptide substrates. In addition to screening individual kinases, the assay can be formatted such that kinase pathways are re-created in vitro to identify compounds that specifically interact with inactive kinases. Miniaturization of this assay format to the 1-microl scale allows for the rapid and accurate compound screening of a host of kinase and phosphatase targets, thereby facilitating the hunt for new leads for these target classes.

Adenosine Triphosphate↗

The ultimate biochemical diagnosis of endocrine pancreatic tumours in MEN-1.

Multiple endocrine neoplasia type 1 (MEN-1) is a well characterized hereditary syndrome with the occurrence of primary hyperparathyroidism (HPT) in combination with pancreatic-duodenal endocrine and anterior pituitary tumours. The diagnosis of MEN-1, the possible probands, necessitates the recognition of at least two or three lesions classically associated with the syndrome whilst only one of them is required for individuals belonging to established MEN-1 kindreds. A distinct feature of MEN-1 comprises the multiplicity of organ involvement, the multicentricity of tumours within the affected organs as well as the complex pattern of the clinical signs of these tumours and their sometimes temporarily variable profile of hormone excess. Thorough screening studies have demonstrated that the MEN-1 trait is biochemically detectable virtually two decades prior to clinically overt disease. The primary biochemical screening programme for MEN-1 includes serum prolactin and insulin growth factor 1 (IGF-1) for pituitary lesions, intact PTH and albumin corrected total serum calcium for the parathyroids and for duodenal/pancreatic tumours serum glucose, insulin, proinsulin, pancreatic polypeptide, glucagon, gastrin and plasma chromogranin A. Furthermore a standardized meal stimulatory test analysing serum polypeptides (PP) and gastrin is recommended. Our current primary screening procedure has yielded about 10% false positives when compared with RFLP data. Pancreatic endocrine tumour diagnosis must be biochemically established since radiology fails to show lesions in half of the patients. Pancreatic involvement in young MEN-1 patients is most consistently demonstrated by analysing serum insulin, proinsulin, PP as well as plasma glucagon chromogranin A levels, which have exhibited sensitivities of 56, 67, 37 and 60%, respectively. Serum PP is a non-specific marker of islet cell tumours that should be applied in conjunction with other peptide markers. Elevation of basal serum gastrin generally indicates the presence of advanced pancreatic tumour involvement or duodenal carcinoids. Early diagnosis of pancreatic endocrine tumours in MEN-1 is enhanced by the use of a standardized meal stimulation test with measurements of serum PP and gastrin response. This test was the most sensitive test and substantiated the presence of tumour in 75% of individuals whose mean age was 25 years. False-positive stimulation due to the meal test has been found in about 10% of previous investigated individuals. The diagnosis of MEN-1 pancreatic tumours is based on biochemical screening alone and it has been substantiated that an unequivocal rise in pancreatic tumour markers precedes radiological detection of these lesions by at least five years.

Biomarkers, Tumor↗

Colonoscopy.

Colonoscopy and polypectomy are the most effective tools available to prevent colorectal cancer. The technical performance of colonoscopy can be improved by methods that make polyp detection easier and more reliable, facilitate cecal intubation, and reduce recurrence and complication rates after polypectomy. The state-of-the-art and possible future trends in patient preparation, indications, screening and surveillance intervals, sedation issues, and virtual colonoscopy are reviewed in this article.

Cecum↗

Motion - computerized tomographic colography is a better method for screening for polyps: arguments for the motion.

Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities. Virtual colonoscopy, or computerized tomographic colography, is a minimally invasive technique that safely evaluates the entire colon and does not require sedation. Thorough cleansing as well as immobilization and air insufflation of the colon is crucial to a successful examination. Sensitivity and specificity rates are reasonable, compared with conventional colonoscopy, and it has been shown that the latter technique can be averted in over two-thirds of cases, with few false-negative examinations. Most patients find virtual colonoscopy more acceptable than the conventional technique, and would prefer it if a repeat procedure were warranted. An economic analysis that found that computerized tomographic colography was less cost effective than conventional colonoscopy did not consider the indirect costs of the latter, which is an important limitation. Virtual colonoscopy is a novel radiological technique that may revolutionize screening for colorectal cancer.

Colonic Polyps↗

Ovarian cancer screening: a primary care guide.

Ovarian cancer is a deadly disease, rarely diagnosed in early stages when the possibility for cure exists. A reliable screening technique would reduce the number of late-stage diagnoses and increase the long-term survival of ovarian cancer patients. Unfortunately, the absence of an identified premalignant phase of the disease makes it virtually impossible to develop an effective routine screening technique. This article reviews the risk factors related to the increased incidence of ovarian cancer. Advanced age and factors related to incessant ovulation, such as early menarche, late menopause, nulliparity, or few pregnancies, have been shown to increase a woman's chance of developing ovarian cancer. Also, a family history of endometrial, colon, breast, or ovarian cancers may increase the likelihood of developing the disease. The role of the primary care provider in the identification of high-risk individuals is reviewed, and currently available early detection test such as pelvic examination, CA-125, abdominal or pelvic ultrasound, and color-flow Doppler technique are summarized.

Aged↗

Application of a virtual neurode in a model thyroid diagnostic network.

UNLABELLED: Screening laboratory tests for thyroid disease often include serum levels for thyroxine (T4), thyrotropic hormone (TSH), and triiodothyronine resin binding (T3) as a measure of T4 binding to serum. A neural network using the above values as input was unable to converge during training to identify an output diagnoses of six common thyroid functional states. When binding protein (TBG) data were supplied the network readily converged. Since thyroxine binding can be roughly estimated from a relationship between T4 and T3, a virtual input node reflecting the binding was calculated from each T4/T3 input set and used as additional input. With this addition, the system trained easily and accurately diagnosed from the training set. CONCLUSION: 1) Quantitative laboratory data can be used in input neurodes in a diagnostic network 2) Training and diagnostic accuracy for the network is more efficient using the virtual TBG neurode than by either omitting TBG data or using actual TBG values.

Diagnosis, Computer-Assisted↗

[Dynamic mesh of carpal scaphoid].

Despite the use of cannulated compression screws, it is still difficult to screw non-displaced fractures of the scaphoid percutaneously. That is due in particular to the difficulty in assessing the correct position for the guide pin from the 2D fluoroscopic images. This work is designed to enable 3D visualisation of the scaphoid during surgical operations by using the technique of dynamic meshing and having the image appearing on a computer screen rather than as a mental image. In this context, the MEFP3C software includes applications for converting a generic scaphoid into a virtual scaphoid, based on the fluoroscopic 2D images of a given scaphoid. These applications include a module for acquiring a cloud of points, a modeller, a dynamic meshing system, an animation module, a texture module and a multi-resolution meshing system. The result of this process, the virtual scaphoid, in spite of the imperfections, enables images to be obtained comparable with those from tomodensitometric reconstruction of the same scaphoid specimen. The virtual scaphoid can be moved over the computer screen in the three spatial planes in translation, rotation and scaling. In conclusion, we think that dynamic meshing is a powerful, simple and ergonomic method of viewing a scaphoid in 3D, which could, in future, be routinely integrated into the fluroroscopic monitor.

Computer Simulation↗