Acute aortic syndromes are life threatening. Time is of the essence as mortality rises with increasing time after the acute episode. The keys to successful treatment of acute aortic disease include early diagnosis, transfer to the appropriate care facility, rapid institution of therapy, availability of cardiovascular anesthesia, and dedicated cardiovascular intensive care unit care. To report the outcomes of a pathway, an Acute Aortic Treatment Center (AATC), to expedite the care of acute aortic syndromes in a major metropolitan area with the hypothesis that “door to intervention” time under 90 minutes reduces mortality and morbidity from acute aortic disease. A database of patients admitted with aortic disease during one year prior to initiation (2007) and one year after initiation of AATC in 2008 was developed. Anatomic and functional outcomes were determined and categorized by Society of Vascular Surgery reporting criteria. Multivariate analysis and Cox proportional hazard analyses were performed. A Total of 621 patients reported with aortic disease to the cardiovascular services; 304 patients were admitted of which 73(25%) were considered to have acute disease. When compared to the year before the AATC there was a 10 % increase in total number of admissions and a 25 % increase in acute pathology after setting up the AATC (p=0.02). There was a 2 fold increase in thoracic aortic dissections admitted to the service. Initiation of AATC resulted in significant reduction in time to definitive therapy (61% decrease) (p=0.016). Despite the increase in acuity, mortality and morbidity rates were unchanged and there were trends to lower ICU and total hospital stay (Table).TableVariablePre- AATCAATCp-valueTotal Inpatients - n (%)130161Acute Presentations - n (%)24(18)49(30)0.02Time to Definite Acute Care - mean ± SD (median) min328±363 (107)129±156 (73)0.015Mortality - n (%)1(4)5(10)0.66Morbidity - n (%)19(79)33(67)0.41LOS ICU - mean ± SD days11±149±80.52LOS Hospital - mean ± SD days21±2015±90.17 Open table in a new tab Institution of AATC increased awareness for correct and early diagnosis of the acute aorta, reduced time to definitive treatment, increased referrals and appeared to impact inpatient hospital stays. Widespread adoption of the AATC paradigm is recommended.

The heme-containing enzyme myeloperoxidase (MPO) is both present and active in inflammatory conditions. This enzyme is potentiated by its formation of multiple inflammatory mediators. The two most common mediators are the modified tyrosines: nitrotyrosine and 3-chlorotyrosine. Along with other modified tyrosines, these molecules have been found to be elevated in atherosclerosis, lung disease, sepsis, vasculitis, and other inflammatory diseases. By treating some of these diseases, the levels of modified tyrosines have been shown to decrease. There have been a wide range of animal models designed to study the in vivo effects of these tyrosine molecules. In addition, there are also several reports in the literature of the in vitro actions of modified tyrosine molecules demonstrated by various cell-culture models. The purpose of this review is to evaluate the clinical significance and biological functions of these modified tyrosine molecules in atherosclerosis as well as a variety of other inflammatory conditions. It is timely information because of their association with diseases as well as lack of overview of their molecular actions. This review will focus on the formation, clinical significance, and animal and cell-culture models of these important molecules. (c) 2006 Elsevier Inc. All rights reserved.

In vivo phage display is a screening method in which peptides homing to specific vascular beds are selected after IV administration of a random peptide library. This strategy has revealed a vascular address system that allows tissue-specific targeting of normal blood vessels and angiogenesis-related targeting of tumor blood vessels by selected peptides. Many vascular receptors or "addresses" targeted by homing peptides have been identified. One such vascular receptor of normal lung endothelium is membrane dipeptidase (MDP), which was found by in vivo phage display to bind the tripeptide motif gly-phe-glu (GFE). Our studies with GFE peptide and lung vasculature suggest that MDP mediates cancer cell adhesion to lung vasculature and the development of lung metastases, but that MDP is not present in the vasculature of lung metastases. MDP appears to occupy a vascular distribution that is similar to the pulmonary artery circulation. These results demonstrate the promise of defining critical functional and anatomic characteristics of endothelial cells in lung and other organs by in vivo phage display.

Background. When acted on by beta-glucuronidase (BG), HMR1826 is metabolized to doxorubicin. Use of this prodrug with adenoviral transfer of beta-glucuronidase (AdBG) is limited by the drug's inability to enter cells and intracellular retention of BG after transduction. We evaluated a system combining AdBG, transfer of the proapoptotic gene bax (AdBax) at a low multiplicity of infection, and HMR1826 administration.Materials and methods. Fibrosarcoma cells were treated with AdBG alone, AdBG plus HMR1826, AdBG followed by beta-galactosidase (AdLacZ) plus HMR1826, and AdBG followed by AdBax with no prodrug. In the experimental group, cells were transfected with AdBG, followed by AdBax plus HMR1826. Viability was measured 24 h after transfection and prodrug administration. Western blots for BG were performed on cell lysates and supernatants.Results. Minimal cellular killing was noted in the AdBG alone, AdBG plus HMR 1826, or AdBG:AdLacZ plus RAM 1826 groups, and Western blot did not demonstrate BG in the supernatant even though all AdBG-transfected cell lysates were positive. Cell killing was noted in the AdBG:AdBax group, but less than in the AdBG:AdBax plus HMR 1826 group (without prodrug versus with prodrug: 1:1 to 55.5% versus 75.9%, 5:1 to 10.0% versus 75.9%, 10:1 7.6% versus 49.0%, 20:1 4.6% versus 24.9%, P = 0.037). Western blot demonstrated BG in the supernatant of the AdBG:AdBax groups. Conclusions. We have devised a novel enzyme prodrug method of killing tumor cells and engendering a bystander effect. AdBax leads to BG release from dying cells after AdBG transduction and conversion of HMR1826 to an active anthracycline. (C) 2004 Elsevier Inc. All rights reserved.

We have investigated the effects of an improved liposomal formulation (extruded DOTAP:cholesterol (DOTAP:Chol)-DNA complex) on transgene expression in tumor cells and normal cells of murine and human origin both in vitro and in vivo. In vitro, transgene expression was significantly increased (P = 0.01) in human tumor cells compared to normal human cells. The increased transgene expression was due to increased uptake of the liposome-DNA complex by tumor cell phagocytosis. Furthermore, immunohistochemical analysis demonstrated a greater transgene expression in lung tumors than in surrounding normal tissues. Increased transgene expression due to enhanced uptake of the liposome-DNA complexes by tumor cells in vivo was also demonstrated using fluorescently labeled DOTAP:Chol liposomes. Finally, evaluation of lung tissue explants obtained from patients undergoing pulmonary resection demonstrated significantly higher (P = 0.001) transgene expression in tumor cells than in normal cells. Thus, we demonstrated that intravenous injection of DOTAP:Chol-DNA complex results in increased transgene expression in tumor and is due to increased phagocytosis of the complexes by tumor cells.

BACKGROUND:Abnormal phosphatase and tensin analog (PTEN) gene expression has been noted in neoplasms. The PTEN protein cleaves phosphate groups from cellular growth kinases, inhibiting tumor propagation. A downstream target of PTEN is AKT, a serine-threonine kinase that when activated inhibits apoptosis. We sought to determine whether PTEN overexpression in mesothelioma cells would engender hypophosphorylation of AKT and apoptosis.METHODS:Human malignant mesothelioma cell lines REN and I-45 were transfected with adenoviral vectors AdPTEN and AdBgal (marker gene) at various multiplicities of infection (MOI). Cell viability was measured using a colorimetric assay, and apoptosis was assessed by morphology and subG1 fluorescence-activated cell sorter (FACS) analysis. PTEN protein and AKT phophorylation were evaluated by Western blot, and AKT kinase activity was evaluated by functional assay.RESULTS:Increased cellular killing was noted with AdPTEN gene transfer. The ratio of cell killing with AdPTEN to AdBgal widened with increasing MOI and was statistically significant at all MOI. Cells demonstrated apoptosis by morphologic and subG1 FACS analyses. Cells overexpressing PTEN demonstrated decreased phosphorylated (active) AKT and AKT kinase activity compared with controls.CONCLUSIONS:Overexpression of PTEN engenders apoptosis in mesothelioma by AKT hypophosphorylation. The forced overexpression of PTEN may prove useful clinically in this treatment-resistant neoplasm.

The ratio of pro-apoptotic (PAP) and anti-apoptotic (AAP) bcl-2 proteins is important in apoptosis regulation. We sought to determine if inhibition of the AAP bcl-xl by sodium butyrate (SB) would augment apoptotic cellular death in mesothelioma when combined with adenoviral pro-apoptotic gene therapy (PAGT) by simultaneously increasing PAP and decreasing AAP in these cells. Human mesothelioma cell lines were exposed to AdBax, AdBak, Adp53, and SB alone as well as all vectors combined with SB at varying doses and time points. Cell death was assessed, and apoptosis evaluated by morphology and FACS. Isobologram analysis evaluated additive or synergistic effect. Cellular death and apoptosis were augmented by PAGT/SB combinations compared to monotherapy. Following AdBax/SB and AdBak/SB, a decrease of the AAP bcl-xl was noted in combination with increases in PAP bax and bak. By isobologram analysis, additive or synergistic cell killing was noted with both combinations. SB treatment did not significantly augment cell killing or apoptosis in combination with Adp53. PAGT/SB was more effective than monotherapy in induction of apoptotic cell death. Synergy may be due to the ability of SB to decrease bcl-xl with marked increases in PAP engendered by PAGT. Combination therapy with agents that down-regulate AAP in addition to PAGT may prove useful clinically.