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Computational models for predicting interactions with cytochrome p450 enzyme.

Cytochrome p450 (CYP) enzymes are predominantly involved in Phase 1 metabolism of xenobiotics. As only 6 isoenzymes are responsible for approximately 90 % of known oxidative drug metabolism, a number of frequently prescribed drugs share the CYP-mediated metabolic pathways. Competing for a single enzyme by the co-administered therapeutic agents can substantially alter the plasma concentration and clearance of the agents. Furthermore, many drugs are known to inhibit certain p450 enzymes which they are not substrates for. Because some drug-drug interactions could cause serious adverse events leading to a costly failure of drug development, early detection of potential drug-drug interactions is highly desirable. The ultimate goal is to be able to predict the CYP specificity and the interactions for a novel compound from its chemical structure. Current computational modeling approaches, such as two-dimensional and three-dimensional quantitative structure-activity relationship (QSAR), pharmacophore mapping and machine learning methods have resulted in statistically valid predictions. Homology models have been often combined with 3D-QSAR models to impose additional steric restrictions and/or to identify the interaction site on the proteins. This article summarizes the available models, methods, and key findings for CYP1A2, 2A6, 2C9, 2D6 and 3A4 isoenzymes.

Computational Biology↗

A computer model to predict the effects of level of nutrition on composition of empty body gain in beef cattle: I. Theory and development.

A computer model was developed to simulate differences in the composition of empty body gain of beef cattle resulting from differences in postweaning level of nutrition that are not associated with empty BW. Differences in rate of empty body gain of cattle of similar genotype reflect differences in the level of nutrition; hence, empty body gain was used to represent level of nutrition. The model was based on four assumptions: 1) as animals mature, the proportion of fat is greater in gain than in body weight, 2) effects on body composition caused by plane of nutrition that are not associated with empty BW are predictable from rate of empty BW gain, 3) effects resulting from changes in nutrition are not exerted immediately nor are they permanent, and 4) cattle approach an empty body composition equilibrium when empty body gain is zero. Six parameters were used to characterize mature fat-free matter, rate of change to body composition equilibrium, minimum and maximum fractional growth rate relative to fractional growth rate for empty BW, time lag of response to change in nutrition, and influence of stage of maturity and nutrition on rate of change for fat-free matter. Two parameters were specific for genotype and gender. Using results from the model, we were able to explain conflicting results obtained from compensatory gain experiments.

Adipose Tissue↗

Clinical prediction rules for computed tomographic scanning in senile dementia.

The role of computed tomography (CT) of the head in evaluating patients with dementing illnesses remains a controversial issue. Several prediction rules to guide the selective application of CT in the evaluation of dementia have recently been proposed in the medical literature. The present authors examine the value of four such rules through a validation study performed in an outpatient geriatric assessment unit. The rules were assessed in terms of their diagnostic sensitivities, specificities, misclassification rates, and information contents. Prediction rule sensitivities ranged from 12.5% to 87.5%, specificities from 37.2% to 77.9%, and misclassification rates from 23.5% to 60.8%. Of the four prediction rules examined, one emerged as significantly more sensitive than the others, and also served to reduce diagnostic uncertainty a full order of magnitude more than the others, as determined by an information content analysis. Disadvantages to this rule, however, were found in its more complex nature and the assessment of a very high rate of misclassification. Through a critique of existing strategies, this study purports to determine the potential for establishing a useful clinical prediction rule to guide selective CT scanning in the diagnostic evaluation of dementia.

Aged↗

Computer-assisted retention prediction system for oligonucleotides in gradient anion-exchange chromatography.

A technique is presented for the retention prediction of single-stranded homo-oligonucleotides under gradient elution conditions in anion-exchange chromatography. The prediction system is based on the theory proposed by Jandera and Churacek. In the present system, the theory was modified by the extrapolation method, utilizing the linear relationship between the log of the capacity factor and the number of nucleotides. The modified theory allowed the prediction of retention times for high-molecular-weight oligonucleotides, which could not be calculated from the original theory. Oligoadenylate was used as a standard oligonucleotide to demonstrate the accuracy of the prediction system. By use of this system, the retention times of oligoadenylates up to 25-35 bases in chain length were predicted within 8% errors under both binary-linear and binary-convex gradient shapes.

Chromatography, High Pressure Liquid↗

Quantitative bone single-photon emission computed tomography for prediction of pain relief in metastatic bone disease treated with rhenium-186 etidronate.

PURPOSE: To calculate radiation doses of rhenium-186 ((186)Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ((99m)Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of (186)Re etidronate in painful lesions. MATERIALS AND METHODS: Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of (186)Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)-measured concentration of (186)Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of (186)Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of (99m)Tc MDP was compared with radiation doses to painful metastases. RESULTS: The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between (99m)Tc MDP concentration and radiation doses of (186)Re etidronate was 0.92. CONCLUSION: QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Adult↗

Preoperative computed tomography finding predicts for postoperative inguinal hernia: new perspective for radical prostatectomy-related inguinal hernia.

OBJECTIVES: To investigate the incidence of radical prostatectomy-related inguinal hernia (RPRIH) and the predictive factors for RPRIH. METHODS: We reviewed the medical charts of patients who had undergone retropubic radical prostatectomy (RRP) at our institution from January 2002 to December 2004 and had a median follow-up of 17 months (range 3 to 42). All patients were examined for RPRIH every 3 months. We also reviewed the computed tomography results in a blinded manner and investigated the predictive factors for RPRIH with multivariate analysis using the Cox proportional hazards model. RESULTS: Of 98 patients analyzed, 17 were diagnosed with RPRIH after RRP (17.3%) at the median of 7 months (range 3 to 12). Preoperative computed tomography results were available for all patients, and subclinical inguinal hernia was identified in 20 (20.4%) of the 98 patients. Multivariate analysis showed that a subclinical inguinal hernia was the single predictive factor for RPRIH. The estimated rate of RPRIH was 60.6% in the subclinical inguinal hernia group and 9.5% in the normal group at 12 months (log-rank test, P <0.001). CONCLUSIONS: The results of the present study have indicated that a preoperative computed tomography finding of a subclinical inguinal hernia predicts for postoperative inguinal hernia formation after RRP. RRP might only advance the time at which the inguinal hernia would develop with or without surgery. Thus, all patients with a subclinical inguinal hernia finding should be informed about the possibility of the development of RPRIH within 12 months after RRP and recommended to undergo surgical repair at RRP.

Aged↗

Downstream determinants of pulsatility of the mean velocity waveform in the umbilical artery as predicted by a computer model.

An electrical analog model of the umbilicoplacental circulation that was based on hemodynamic measurements in fetal sheep was used to predict the mean blood velocity waveform in the umbilical artery. A 300% increase in placental resistance reduced the normally forward diastolic blood velocity in the umbilical artery nearly to zero. When resistance was normal, variations in umbilical arterial wall thickness (h) and elastic modulus (E) had little effect on the velocity waveform, whereas a 20% increase in radius (a) halved the ratio of the diastolic-to-systolic blood velocity (D/S). When placental resistance was high, abnormal umbilical arterial wall properties (a large, or h or E small) further reduced D/S. We conclude that high placental resistance, low umbilical arterial resistance, or a combination of high placental resistance with abnormal umbilical arterial wall properties are the primary downstream determinants of elevated pulsatility in umbilical arterial blood velocity.

Animals↗

Additive value of low-dose dobutamine to technetium-99m sestamibi-gated single-photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft.

BACKGROUND: The two most useful methods for myocardial viability assessment are perfusion imaging and dobutamine echocardiography. HYPOTHESIS: The present study investigated the additive value of a new method, dobutamine technetium 99m (99mTc)-sestamibi-gated single-photon emission computed tomography (SPECT), which combines these two modalities, to the prediction of wall motion improvement after revascularization. METHODS: Fifty-five consecutive patients with ischemic cardiomyopathy, who were referred for viability evaluation, underwent resting and dobutamine (dose, 5-10 microkg/kg/min) gated SPECT with 99mTc-sestamibi. Of these patients, 36 underwent coronary artery bypass graft (CABG) within 1 month of the study and 32 had repeat resting gated SPECT within 1 year. Global and regional wall motion, wall thickness, and perfusion were simultaneously analyzed at rest and after dobutamine using the 20-segment model; the sestamibi uptake and wall motion response to dobutamine of each segment were rated quantitatively. Based on these findings, the segments were categorized as normal, viable, or nonviable. The predictive values for wall motion improvement were assessed by perfusion, using cutoffs of 50 and 60% of sestamibi uptake, and thereafter by the addition of dobutamine response in the segments that were rated nonviable. RESULTS: Of the 1,080 myocardial segments studied, 906 (84%) had abnormal wall motion and were analyzed for viability. Concordance between perfusion and wall motion response to dobutamine was 60% with the 50% cutoff of sestamibi uptake, and increased to 65% with the 60% sestamibi cutoff (p < 0.04). The respective predictive values of wall motion improvement using the 50 and 60% cutoff points were as follows: sensitivity 93 and 70%, respectively, (p < 0.01); specificity 59 and 86% (p < 0.001), respectively; accuracy 77% for both. The addition of the wall motion response to dobutamine to the assessment of the nonviable segments by perfusion (60% cutoff) increased the sensitivity from 70 to 85% (p = 0.001) and the negative predictive value from 70 to 81% (p = 0.009); the positive predictive value remained high (86 vs. 82%). No additive value of wall motion response to dobutamine was demonstrated for nonviable segments by perfusion with a 50% cutoff. CONCLUSION: Dobutamine sestamibi-gated SPECT is a feasible method for the analysis of myocardial perfusion, function, and contractile reserve of individual myocardial segments in patients with ischemic cardiomyopathy. Viability assessment based on a threshold of 60% uptake of sestamibi, with the addition of the wall motion response to dobutamine in the nonviable segments, seems to yield better predictive values for wall motion improvement after CABG.

Aged↗

Computational approaches for predicting CYP-related metabolism properties in the screening of new drugs.

The site of biotransformation, the extent and rate of metabolism and the number of active metabolic pathways are among the most important characteristics of the pharmacokinetics of a drug. The catalytic activity of drug metabolizing enzymes is likely the most influential determinant of the pharmacokinetic variability. Metabolic stability is the prerequisite for sustaining the therapeutically relevant concentrations. Metabolic inhibition and induction can give rise to clinically important drug-drug interactions. A variety of computational approaches are currently available for predicting different cytochrome P450 (CYP)-related metabolism endpoints. The present review will describe these approaches and their impact on drug development process. Indications on the available software for the implementation will also be given.

Animals↗

Using technetium-99m methoxyisobutylisonitrile lung single-photon-emission computed tomography to predict response to chemotherapy and compare with P-glycoprotein expression in patients with untreated small cell lung cancer.

The purpose of this study was to predict chemotherapy response by technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) lung single-photon-emission computed tomography (SPECT) and compare P-glycoprotein (Pgp) expression in patients with untreated small cell lung cancer (SCLC). Before chemotherapy, 40 patients with untreated SCLC underwent Tc-99m MIBI lung SPECT. Immunohistochemical analyses were performed using multiple nonconsecutive sections of the biopsy specimens to detect Pgp expression. Chemotherapy response was evaluated in the third month after completion of treatment by clinical and radiological methods. Based on quantitative analyses, the tumor uptake ratios (TUR) of the 20 patients with good response (1.89 +/- 0.28) were significantly higher than that of the 20 patients with poor response (1.21 +/- 0.28) (p value < 0.05). Based on visual interpretation, all of the 20 patients (100%) with good response had positive Tc-99m TF lung SPECT findings and negative Pgp expression. Five of the other 20 patients (25%) with poor response had positive Tc-99m MIBI lung SPECT findings, and 12 of the other 20 patients (60%) with poor response had negative Pgp expression (p value < 0.05). Negative Tc-99m MIBI lung SPECT findings could predict poor response. Therefore, we concluded that Tc-99m MIBI lung SPECT can accurately predict the chemotherapy response, and Tc-99m MIBI lung SPECT findings can be partially compatible with Pgp expression in patients with untreated SCLC.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Accuracy of computed tomography in predicting adrenal tumor size.

We undertook a multi-institutional, retrospective study of 51 patients with adrenal tumors (pheochromocytomas, functioning and nonfunctioning cortical adenomas, cysts and carcinomas). All patients had computed tomography (CT) with a maximum of 5 millimeter cuts the week before undergoing complete adrenalectomy. Pathologists were asked to measure the tumor to the nearest 0.1 centimeter. Tumor size obtained from pathologic reports (actual size) and CT reports (estimated size) were compared. Adrenal tumors were divided into two groups on the basis of size--tumors with actual size of 6 centimeters or greater and tumors with actual size of less than 6 centimeters. Statistical analysis was performed with Newman-Keuls analysis of variance. After controlling for tumor type and for the institution at which the measurement was made, we found that CT consistently underestimated adrenal tumor size in both tumor groups. Moreover, the average, underestimated difference for tumors 6 centimeters or greater was 32 percent, but 47 percent for tumors less than 6 centimeters (p = 0.060). CT seemed to underestimate the size of small adrenal tumors more than large tumors. Because the decision to operate on solid, nonfunctioning adrenal tumors is based on tumor size and because CT is currently the standard technique used to estimate size, our findings need to be considered before undertaking surgical treatment.

Adenoma↗

Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: predictive value of computed tomography.

OBJECTIVE: To evaluate the prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome (ARDS) and to asses the value of pulmonary artery trunk diameter (PAT) to predict pulmonary hypertension. DESIGN: Prospective study SETTING: University teaching hospital and ARDS referral center. PATIENTS: 103 patients with ARDS, who received both right heart catheterization and chest computed tomography. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: 95 patients (92.2%) with ARDS had pulmonary artery hypertension, 16 of them (16.8%) mild, 72 (75.8%) moderate, and 7 (7.4%) severe, as assessed by right heart catheterization. Of the patients with moderate and severe pulmonary hypertension, 43 had a pulmonary artery trunk diameter >or=29 mm yielding a sensitivity of 0.54 and a specificity of 0.63. Pulmonary artery trunk diameter correlated significantly but weakly with mean pulmonary artery pressure (r=0.34, p=0.0004). The positive predictive value was 0.83, and the negative predictive value was 0.28. The diagnosis of pulmonary hypertension by PAT diameter measurements was incorrect in 43.7% of patients with ARDS. CONCLUSIONS: Pulmonary artery hypertension has a high prevalence in patients with severe ARDS. Measurement of PAT diameter on admission CT scan is an unreliable tool for identification of ARDS patients with pulmonary hypertension.

Comorbidity↗

The predictive value of quantitative computed tomography for vertebral body compressive strength and ash density.

Whole lumbar vertebral sections (L2 and L3) were obtained from 30 elderly individuals aged 43-95 years, mean 81 years (13 females, 17 males). None of the subjects had had malignant diseases. Quantitative computed tomography (QCT) was performed on an EMI 7070 scanner. One 8 mm slice parallel to the end-plates was obtained from the center of each vertebral body. The trabecular bone mass in each slice was outlined interactively by means of a tracer-ball. A CT-histogram was recorded inside this area, and average CT-values were expressed in Hounsfield Units (HU). The whole vertebral body (L2) was compressed in a materials testing machine. From the central part of L3, vertical cylindrical pure trabecular bone specimens were obtained. The biomechanical competence of these specimens was also assessed by means of a materials testing machine. Finally, all bone specimens were incinerated for determination of apparent ash-density. Highly significant positive correlations were found between average CT-values and (a) stress values of the trabecular bone (r = 0.81, p less than 0.001) and (b) ash-density of the pure trabecular bone (r = 0.81, p less than 0.001). Furthermore, a significant positive correlation was found between CT-values and (a) total vertebral body load (r = 0.72, p less than 0.001), (b) total vertebral body stress (load/cross-sectional area) (r = 0.55, p less than 0.001) and (c) ash-density of the whole vertebral body (r = 0.76, p less than 0.001). It is concluded that quantitative computed tomography gives valid predictions of both vertebral trabecular bone mass and mechanical competence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Computed tomography in predicting gall stone solubility: a prospective trial.

This prospective study was undertaken to evaluate the correlation between densitometric values of gall stones assessed by computed tomography and the success rate of litholytic therapy in 28 patients eligible for oral treatment. A densitometric study of the stones was performed in all patients before treatment. A cut off point of 60 Hounsfield units (HU) was chosen to divide the subjects into two groups--group 1, 14 patients with low density stones (less than 60 HU) and group 2, 14 patients with high density stones (greater than 60 HU). All patients were treated with ursodeoxycholic acid (8-10 mg/kg/day) for 12 months and followed up by ultrasound. In group 1, dissolution was complete in 50% of the patients and partial in a further 20%. In group 2 patients, complete dissolution was not observed but 33% showed partial dissolution. The number of patients with total dissolution at 12 months was significantly higher in group 1 compared with group 2 (p less than 0.02). These results suggest that computed tomography can be used to select patients with a better likelihood of successful stone dissolution after bile acid therapy.

Adult↗

Physiological basis of muscle functional MRI: predictions using a computer model.

Muscle functional MRI (mfMRI) has been proposed as a tool for noninvasively measuring the metabolic and hemodynamic responses to muscle activation, but its theoretical basis remains unclear. One challenge is that it is difficult to isolate individually those variables affecting the magnitude and temporal pattern of the mfMRI response. Therefore, the purpose of this study was to develop a computer model of how physiological factors altered during exercise affect the mfMRI signal intensity time course and then predict the contributions made by individual factors. A model muscle containing 39,204 fibers was defined. The fiber-type composition and neural activation strategies were designed to represent isometric contractions of the human anterior tibialis muscle, for which published mfMRI data exist. Sustained isometric contractions at 25 and 40% maximum voluntary contraction were modeled, as were the vascular (capillary recruitment, blood oxygen extraction) and metabolic (lactate accumulation, phosphocreatine hydrolysis, pH) responses. The effects on the transverse relaxation of MRI signal were estimated, and the mfMRI signal intensity time course was measured from simulated images. The model data agreed well qualitatively with published experimental data, and at long exercise durations the quantitative agreement was also good. The model was then used to predict that NMR relaxation effects secondary to blood volume and oxygenation changes, plus the creatine kinase reaction, dominate the mfMRI time course at short exercise durations (up to approximately 45 s) and that effects secondary to glycolysis are the main contributors at later times.

Animals↗

How accurate is computed tomography in predicting the real size of adrenal tumors? A retrospective study.

BACKGROUND: The ability to accurately assess tumor size is an important consideration during the preoperative evaluation of adrenal tumors, particularly solid nonfunctioning masses (incidentalomas or adrenalomas). Does the histological size of the adrenal tumor correspond to the preoperative computed tomography (CT)-estimated size? OBJECTIVE: To evaluate the accuracy of CT in predicting the real size of adrenal tumors. DESIGN: Retrospective review of all clinical records of patients who underwent adrenalectomy from 1984 through 1995. The mean tumor size reported from CT examinations was compared with the corresponding size obtained from the pathology reports and the statistical difference was evaluated. SETTING: University and private hospitals in Athens, Greece. PATIENTS: Seventy-six patients who underwent adrenalectomy for various adrenal diseases and who met strict entry criteria. RESULTS: For the entire population, the mean diameter of the tumors was estimated (CT reports) at 4.64 cm, but the real value (pathology reports) was 5.96 cm (P < .001). The underestimation held true for all of the studied subgroups that were defined by the different proposed cutoffs for malignancy. Three patients were incidentally found to have adrenal cancer, with the tumors measuring from 2.6 to 2.9 cm on CT. In addition, 4 pheochromocytomas were clinically and laboratory "silent" at the time of their discovery. The regression line (y = 0.85 + 1.09x) relating CT-estimated and histological tumor size was linear (r = 0.90, P < .001). CONCLUSIONS: Computed tomography underestimates the real size of adrenal tumors. The CT-estimated value should be corrected accordingly to obtain the real size. The size of an adrenal tumor, even when corrected, cannot predict the tumor's clinical behavior in many cases. Surgeons should always cautiously interpret the proposed diagnostic cutoffs, especially when considering surgical or conservative management of small nonfunctioning adrenal tumors.

Adolescent↗