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Monoclonal antibodies against tissue-nonspecific alkaline phosphatase. Report of the ISOBM TD9 workshop.

Nineteen monoclonal antibodies (MAbs) against tissue-nonspecific (liver/bone/kidney) alkaline phosphatase (TNALP) were investigated in the ISOBM TD-9 Workshop. These MAbs were generated with antigens obtained from human bone tissue (n = 9), human osteosarcoma cell lines (SaOS-2 and TPX; n = 7) and human liver tissue (n = 3). The evaluation included the following antigen forms: (a) commercially available preparations of human bone ALP (BALP) and liver ALP (LALP); (b) human BALP isoforms, B/I, B1 and B2; and (c) soluble secreted epitope-tagged recombinant human TNALP (setTNALP) expressed in COS-1, osteosarcoma (SaOS-2) and hepatoma (Huh2) cell lines. In addition, 16 TNALP mutant cDNAs corresponding to a wide spectrum of reported hypophosphatasia mutations were used in an attempt to map specific immunoreactive epitopes on the surface of the TNALP molecule. The TD-9 MAbs were evaluated by immunoradiometric (IRMA) assays, cross-inhibition and different enzyme immunoassay designs. No indications of explicit tissue discriminatory immunoreactivities of the investigated MAbs against TNALP were found. However, certain IRMA combinations of MAbs increased the specificity of BALP measurements. All MAbs bound to the three BALP isoforms B/I, B1 and B2, but none of the investigated MAbs were specific for any of the isoforms. Significant differences were, however, found in immunoreactivity between these isoforms, with cross-reactivities ranging from 21 to 109% between the two major BALP isoforms B1 and B2. Desialylation with neuraminidase significantly increased the MAb affinity for the BALP isoforms B/I, B1 and B2, and also decreased the observed differences in cross-reactivity between these isoforms. We suggest, therefore, that the MAb affinity is dependent on the amount/number of terminal sialic acid residues located at the five putative N-glycosylation sites. Based on the overall results, we present a putative three-dimensional model of the TNALP molecule with positioning of the four major antigenic domains (designated A-D) of the investigated MAbs. The TNALP molecule is depicted as a homodimer, hence most, but not necessarily all, epitopes are displayed twice. The antigenic domains were positioned with the following assumptions: domain A was positioned close to the active site since most of these MAbs interfered with the catalytic activity. Interestingly, both MAbs included in the commercial BALP kits were grouped with domain A. Moreover, 4 of the 5 putative N-glycosylation sites (with terminal sialic acid residues) are located within, or with close proximity to, domain A. Domain B was localized at the top flexible loop (crown domain) of the TNALP molecule. Domain C was clearly defined by the IRMA assay combinations and by site-directed mutants of TNALP to be close to residue E281, which is located near the fourth metal binding site, likely to be occupied by a calcium ion. Domain D was positioned close to residues A115, A162 and E174, but this domain was also close to the GPI anchor site. In conclusion, none of the 19 investigated TD-9 MAbs were entirely specific for BALP or LALP, thus indicating that all MAbs bind mainly to epitopes on the common protein core of BALP and LALP and/or common glycosylated epitopes. However, some MAbs (either single or in combination with other MAbs) work sufficiently well to measure BALP when the assayed samples do not contain elevated levels of LALP.

Alkaline Phosphatase↗

Conserved epitopes in human and mouse tissue-nonspecific alkaline phosphatase. Second report of the ISOBM TD-9 workshop.

A panel of 19 monoclonal antibodies (MAbs) against human tissue-nonspecific (liver/bone/kidney) alkaline phosphatase (TNAP) was obtained through the ISOBM TD-9 workshop. In the present study, the reactivity of these MAbs has been characterized against mouse TNAP. A mouse embryonic stem cell line, frozen sections of long bones, alkaline phosphatase extracted from mouse bone, and serum were used as the source of TNAP for individual assays. Each MAb was tested for immunoreactivity to mouse TNAP by Western blot analysis, immunohistochemistry and enzyme immunoassay. Antibodies 314 and 315 reacted strongly with mouse TNAP in Western blots, while all other antibodies were negative. By immunohistochemistry, antibodies 314, 315 and 333 produced strong positive staining using frozen sections, while antibody 334 was moderately positive. Enzyme immunoassays indicated that MAb 333 was also able to bind to serum TNAP. These antibodies represent very useful reagents to study the pathophysiological expression of TNAP in mouse tissues and in mouse serum.

Alkaline Phosphatase↗

Specificity and affinity of 26 monoclonal antibodies against the CA 125 antigen: first report from the ISOBM TD-1 workshop. International Society for Oncodevelopmental Biology and Medicine.

The specificity of 26 monoclonal antibodies against the CA 125 antigen was investigated in two phases of the ISOBM TD-1 workshop. The binding specificity was studied using CA 125 immunoextracted by specific antibodies immobilized on various solid phases, or on the surface of human cell lines. Immunometric assays using all possible antibody combinations were used to study the topography of antibody binding sites on the antigen. We conclude that the CA 125 antigen carries only two major antigenic domains, which classifies the antibodies as OC125-like (group A) or M11-like (group B). One antibody, OV 197, showed binding specificity related to some of the OC125-like antibodies, but was classified into a separate group C. The OC125-like group of antibodies has four subgroups with different binding specificities. These are A1 = OC 125 and K 95, A2 = K 93, A3 = B43.13, and A4 = ZS 33, B27.1 and CCD 247. Binding of nonlabelled OC 125 or K 95 to CA 125 caused a marked increase in binding of labelled OV 197 to the complex. This conformational change was not observed with any other antibody combinations. Antibody B43.13 could form immunometric assay combinations particularly with antibodies of subgroup A4, indicating that the B43.13 epitope is in the periphery of the binding area of OC125-like antibodies. The M11-like group of antibodies is more homogenous with strong cross-inhibition between most antibodies. Only one antibody, ZR 38, would form an immunoassay combination with other M11-like antibodies and thus represents a distinct subgroup. The main group of M11-like antibodies are M 11, ZR 45, MA602-6, K 91, OV 185, K 101, K 90, K 96, K 97, K 102, CCD 242, 145-9, and 130-22. Antibody OV 197 binds to a domain designated C and is unique, as stated above. Antibody pairs from any two of the three groups may be used in immunometric assays. Three antibodies were not studied by complete cross-inhibition due to low affinity (OV 198 and K 100) or lack of material (MA602-1). OV 198 and K 100 are most likely OC125-like and MA602-1 is M11-like. Antibody affinity was estimated with labelled antigen in solution or with antigen absorbed on microtiter wells. Western blot analysis showed staining both in the stacking gel and corresponding to a molecule of 200 kDa. There was a marked difference between the antibodies in their ability to bind to CA 125 immobilized on a membrane. Strongest binding was observed with the M11-like antibodies, particularly M 11, K 96, K 97, MA602-6, 145-9. Antibodies belonging to the subgroup A4 were the only OC 125-like antibodies which reacted well with CA 125 in Western analysis. Digestion of CA 125 with proteolytic enzymes showed it to be particularly sensitive to trypsin cleavage. However, no low molecular weight fragments with preserved immunoreactivity were found.

Animals↗

Proteasome workshop at Colorado State University. Fort Collins, Colo., July 1-3, 1995. Report and abstracts.

An international workshop on the proteasome was held on the campus of Colorado State University, Fort Collins, July 1-3, 1995. The program consisted of five oral sessions and one poster session. The abstracts of the posters and many of the oral presentations appear in this issue of Enzyme and Protein. The oral sessions were organized around four themes: structure and catalytic properties; allosteric regulators and synthetic inhibitors; the 26S proteasome; and physiological functions, developmental expression, and endogenous substrates. Since entire issues of Enzyme and Protein [vol. 47, No. 4-6, 1993] and Molecular Biology Reports [vol. 21, No. 1, 1995] have been devoted to the proteasome, this summary emphasizes recent results and current research of many of the laboratories studying this fascinating complex.

Cysteine Endopeptidases↗

Sudden cardiac death, genes, and arrhythmogenesis : consideration of new population and mechanistic approaches from a national heart, lung, and blood institute workshop, part I.

Malignant ventricular arrhythmias are the leading mechanism of death in patients with acute and chronic cardiac pathologies. The extent to which inherited mutations and polymorphic variation in genes determining arrhythmogenic mechanisms affect these patients remains unknown, but based on recent population studies, this risk appears significant, deserving much greater investigation. This report summarizes a National Heart, Lung, and Blood Institute workshop that considered sources of genetic variation that may contribute to sudden cardiac death in common cardiac diseases. Evidence on arrhythmogenic mechanisms in recent population studies suggests a significant portion of the risk of sudden cardiac death in such broad populations may be unrelated to traditional risk factors for predisposing conditions such as atherosclerosis, hypertension, and diabetes and instead may involve unrecognized genetic and environmental interactions that influence arrhythmic susceptibility more directly. Additional population and genetic studies directed at discovering the sources of inherited molecular risk that are most directly linked to arrhythmia initiation and propagation, in addition to studies on previously well-described risk factors, would appear to have considerable potential for reducing premature cardiovascular mortality.

Arrhythmias, Cardiac↗

Rapid diagnostic tests for tuberculosis: what is the appropriate use? American Thoracic Society Workshop.

Recent technologic developments have introduced a number of improvements in the ability of clinical laboratories to cultivate and identify Mycobacterium tuberculosis complex more quickly than previously. These developments include more rapid detection of growth and tests to identify RNA or DNA of M. tuberculosis complex directly in clinical samples. United States Food and Drug Administration (FDA) panels have recently recommended approval of two direct amplification tests (DAT), the Gen-Probe MTD (San Diego, CA) and the AMPLICOR M. tuberculosis test (Roche Diagnostic Systems, Inc., Branchburg, NJ). The FDA has approved the MTD for identification of M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). In addition, the specimen must be from a patient who has not received antituberculous medication for seven or more days or within the last 12 months. From the data reviewed by the FDA, the specificity (100%) and sensitivity (95%/96% in the two studies) of these two tests in AFB smear-positive specimens were found to be comparable to the Accuprobe (Gen-Probe) for identification of M. tuberculosis complex in culture, with the advantage that the DAT results are available much sooner. The DAT are significantly more sensitive than the AFB smear. However, in AFB smear-negative samples, the specificity, sensitivity, and positive predictive value were 96/99%, 48/53% and 24/58%, respectively, in the two studies. For some results, the Gen-Probe assay had the higher value and for others, the Roche assay was higher. The DAT result, particularly when discordant with the AFB smear, must be used in conjunction with clinical assessment. While both the MTD and the AMPLICOR M. tuberculosis test have undergone extensive testing in clinical laboratories, neither test has been examined for its utility in routine clinical use or public health settings in the United States. An American Thoracic Society Workshop was convened to examine the data and technology available to date, to develop a consensus addressing the appropriate use of the rapid diagnostic tests (in particular, DAT's) for tuberculosis, and to identify future research needs and directions. The consensus among three focus groups, clinical, laboratory, and public health, was that, while these tests are a major improvement over standard techniques, there is currently insufficient information on their clinical and public health utility. When the AFB smear and DAT are both positive, the diagnosis of tuberculosis can be considered to be established. Furthermore, when the AFB smear is negative and the DAT is also negative, it is unlikely that M. tuberculosis will be grown from that sample. When there is discordance between the AFB smear and the DAT, additional consideration must be given to the overall clinical picture and repeat testing should be done. It is recommended that the currently available DAT's always be performed in conjunction with microscopy and culture, and each test result must be interpreted within the overall clinical setting in which it is used.

Bacteriological Techniques↗

Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research.

Economic evaluations are increasingly common in the critical care literature, although approaches to their conduct are not standardized. The American Thoracic Society convened a workshop to address methodologic and reporting issues for economic analyses in critical care and to determine how guidelines from the U.S. Public Health Service Panel on Cost-effectiveness in Health and Medicine (PCEHM) were applicable to critical care. We identified several issues that hamper cost-effectiveness analyses (CEAs) in the critically ill. Data on the effectiveness of intensive care unit (ICU) interventions are often lacking; ICU patients are complex, with multiple concurrent problems and interventions; most ICU therapies are only supportive, and therefore may not individually result in improved outcome; accurate cost data are not commonly available and are difficult to obtain; there is no standardized approach for measuring or valuing costs across countries; typical outcomes in ICU studies (e.g., short-term mortality) are not ideal for CEAs while preferred outcomes for CEAs (e.g., long-term quality-adjusted survival) are rarely collected; valuing the importance of appropriate end-of-life care, an important aspect of ICU care, is difficult, and the burden of critical illness on family members is not easily captured in a CEA. Nevertheless, many of these problems are not unique to critical care, and we believe the PCEHM guidelines can be adapted to the critical care setting. We recommend all CEAs in the critically ill include a PCEHM reference case, where the cost-effectiveness ratio is calculated by adopting a societal perspective, estimating long-term costs and quality of life after ICU care, applying a 3% annual discount rate to costs and effects, and conducting multiway sensitivity analyses. Because elements of the reference case, such as long-term costs and quality of life, may only be estimated using modeling and assumptions, we also recommend inclusion of a "data-rich" case, where the cost-effectiveness ratio is generated as closely as possible from data on actual patient outcomes and costs (e.g., hospital costs per hospital survivor). We recommend that investigators conducting a CEA concurrently with a randomized trial make the proposed model available (e.g., via the Internet) before unblinding of trial data to minimize bias. Adopting a standard approach to CEAs of ICU therapies will provide a valid and more transparent evidence base for health care policy with regard to care of the critically ill.

Cost-Benefit Analysis↗

NHLBI workshop summary. Research needs and opportunities related to respiratory health of women.

To summarize, the overwhelming conclusion of the participants was that relatively little is known about respiratory health and disease in women. Much work will be required to obtain even the most basic information upon which hypotheses for future research can be developed and to determine whether pulmonary biology differs between men and women and between women of various ages. The many recommendations and suggestions generated at the workshop should serve to underscore the unique opportunities for research in the field of respiratory health of women.

Female↗

Workshop on airway smooth muscle. Summary of a conference held September 25-27 1983.

Airway smooth muscle contraction and the extreme sensitivity of the airway smooth muscle responses to various stimuli are accepted as key factors in the pathogenesis of asthma and are recognized to be important in other diseases (e.g., bronchitis and cystic fibrosis). A Workshop on Airway Smooth Muscle sponsored by the National Heart, Lung and Blood Institute (September 25 to 27, 1983) identified various avenues of future research. Smooth muscle anatomists pointed to the paucity of quantitative information on airway smooth muscle structure, especially electron microscopic information and details of the neural arrangement. Investigations of the neural network, similar to those that have led to important discoveries in the gut, are urgently needed. Now that intramural ganglia can be studied electrophysiologically (and in vivo!), new information concerning possible local neural modulation can be examined. A similar lack of information was found in the biochemical study of airway smooth muscle. Among potential causes of abnormalities in asthmatic muscles are alterations in membrane channels and pumps, receptor transduction processes, cGMP-mediated processes, and other metabolic pathways. Inflammation and inflammatory mediators appear to play important roles in disease of airway smooth muscle. Utilization of cell isolation and culture, and immunologic and other cell biologic and biochemical methods will accelerate the study of the various cells in the airways, their interactions, and their roles in disease. Of special potential importance are peptide and lipid mediators produced by various airway cells. Development of synthetic analogues and antagonists, including monoclonal antibodies, will provide more specific tools for dissecting these cell-to-cell interactions. Regardless of the level of study--from examination of the whole organism to molecular mechanisms--the fact is that there is no entirely satisfactory animal "model" of asthma or asthmatic muscle, presumably because we do not fully understand the etiology and pathogenesis of asthma. This makes it all the more important to take appropriate opportunities to obtain tissue from asthmatics for laboratory study. Relatively simple, careful studies of asthmatic smooth muscle may prove important, unique insights into its possible abnormalities.

Asthma↗

Summary and recommendations of a workshop on the investigative use of fiberoptic bronchoscopy and bronchoalveolar lavage in asthmatics.

The participants in the workshop reached unanimous consensus that as an investigative tool, BAL has enormous potential for extending knowledge of the immunopathogenesis of asthma. When utilized according to these guidelines, maximal knowledge may be gained with minimal risks to study subjects. However, we wish to emphasize that the extent to which the safety of the procedure applies to those asthmatics with more symptoms and an FEV1 of less than 60% of predicted remains to be established by carefully controlled clinical investigations.

Adolescent↗

A research development workshop to stimulate outcome research in consultation-liaison psychiatry.

With shrinking federal resources, innovative approaches involving both professional organizations and federal program staff are needed to stimulate research in new or undeveloped clinical areas. National Institute of Mental Health staff and members of the American Psychiatric Association's task force on cost-effectiveness in consultation-liaison psychiatry applied a collaborative model, the research development workshop, to stimulate outcome research in consultation-liaison psychiatry, a field with little previous such research. As a result 12 grant proposals have been submitted to NIMH for review in the last three years, and six are now funded. In contrast, in the previous ten fiscal years none of the nearly 700 services research proposals focused on the consultation-liaison area. The model could be applied to other mental health fields in which research should be stimulated.

Follow-Up Studies↗

Propionic acidemia revisited: a workshop report.

Propionic acidemia (PA) is one of the most frequent organic acidurias, but information on the outcome of individuals with PA is rather limited. We present data of 49 patients with PA, which were gathered from 18 metabolic centers throughout Central Europe on the occasion of an international workshop. All patients were identified by selective metabolic screening, and 86% of them were classified as having early-onset PA owing to their presentation with clinical symptoms within the first 90 days of life. Mortality rate was one third, and details of symptoms and treatment of the surviving patients are discussed. The great variation of phenotypic expression of the disease and different therapeutic strategies (especially in regard to the degree of protein restriction) used at the various institutions involved in this study imply the need for a registry of PA patients and for a multicenter prospective treatment study.

Amino Acid Metabolism, Inborn Errors↗

Neuroimaging consortium workshop: development of novel PET and SPECT ligands for brain imaging.

It was clear from the levels of participation in this panel discussion and from the levels of interest expressed in the upcoming NIMH tracer Consortium Workshop that there is a great deal of potential benefit to public health from the development of new PET and SPECT (and, perhaps, MRI?) tracers. For extramural NIH programs, the tool guidelines for grantees are in fact only that--guidelines--but they could become specific regulations if unacceptable threats to basic research are perceived. This is because the benefits of collaboration among basic scientists are considered essential for the success of research programs. On the other hand, intramural programs at NIH are considered by some to be the "beta test site" for emerging issues and policies, regardless of the specific scientific topic. This may well be true for research tools and presents an opportunity to find new ways of working. As for the industry, threats to intellectual property arise from myriad sources. The magnitude of these threats can only be appreciated from the perspective of long-term investment in research-based industries with significant regulation. In particular, the pharmaceutical industry enjoys only a relatively short period of time during which investments in the last medicament can be recouped to support the development of the next. A great deal of commitment and sophistication will be required if the United States shall succeed in finding new ways of translating basic into applied science for the practical benefit of currently underserved patient populations.

Brain↗

New achievements in human cell toxicology: the 20th annual workshop on in vitro toxicology.

The 20th Annual Workshop on In Vitro Toxicology (Oxford, UK, September 22-24, 2002) was convened as part of a European meeting entitled Human Cell Culture 2002. The meeting was arranged by the Scandinavian Society for Cell Toxicology (SSCT), the European Tissue Culture Society and the British Prostate Group. Two sessions, which are summarised in this report, were devoted to in vitro toxicology: Human Cell Toxicology and The SSCT Free Paper Session. Outstanding experts in the field of toxicology outlined contemporary approaches in toxicity testing in their lectures. Short oral presentations demonstrated a variety of in vitro model systems and methodologies, which can be useful for investigating human toxicity, as well as for studies on mechanisms of toxicity.

Cell Line↗

Opportunities to replace the use of animals in sepsis research. The report and recommendations of a Focus on Alternatives workshop.

Sepsis and multiple organ failure are common causes of death in patients admitted to intensive care units. The incidence of sepsis and associated mortalities has been steadily increasing over the past 20 years. Sepsis is a complex inflammatory condition, the precise causes of which are still poorly understood. Animal models of sepsis have the potential to cause substantial suffering, and many of them have been poorly representative of the human syndrome. However, a number of non-animal approaches, including in vitro, in silico and clinical studies, show promise for addressing this situation. This report is based on discussions held at an expert workshop convened by Focus on Alternatives and held in 2004 at the Wellcome Trust, London. It provides an overview of some non-animal approaches to sepsis research, including their strengths and weaknesses, and argues that they should be prioritised for further development.

Animal Testing Alternatives↗

Evaluation of clinical efficacy of new medical treatments in advanced colorectal cancer. Results of a workshop organized by the EORTC GITCCG. European Organization for Research and Treatment of Cancer. Gastrointestinal Tract Cancer Cooperative Group.

During the last few years several factors have contributed to an increasing change in the medical treatment of advanced colorectal cancer. Among them are the more general acceptance of the impact of chemotherapy on quality of life and survival in first as well as in second-line treatment, the introduction of new drugs and the definition of novel endpoints which can roughly be defined as "patient benefit". For this reason the European Organization for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Cooperative Group (GITCCG) felt it was appropriate to organize a workshop with experts from different countries and national groups to discuss in depth several aspects concerning the treatment of patients with advanced colorectal cancer.

Clinical Trials as Topic↗