Quality assurance of monoclonal products: Virologic and molecular biologic considerations

Summary The FDA has set limits concerning the viral and molecular contamination of monoclonal antibody products intended for human use. Industry has an obligation to be as familiar with these limits as it has been with federal requirements pertaining to pyrogens and bacteria. The assessment of risk from polynucleotides, based on molecular biologic and existing technical limitations, is discssed, as is the strategy of validating the purification of monoclonal antibodies of viral contaminants in terms of an indicator organism concept.     

Towards microbiological quality assurance in radiation sterilization processing: a limiting case model

A Limiting Case Model has been developed which describes the dependence on radiation dose of the proportion of items, in a population of items subjected to irradiation, which are contaminated by one or more organisms. This model is independent of the initial distribution of numbers of micro-organisms on items and represents a conservative approach to estimation of the proportions of non-sterile items in an irradiated population of items.     

A Bayesian mixture model relating dose to critical organs and functional complication in 3D conformal radiation therapy

A goal of cancer radiation therapy is to deliver maximum dose to the target tumor while minimizing complications due to irradiation of critical organs. Technological advances in 3D conformal radiation therapy has allowed great strides in realizing this goal; however, complications may still arise. Critical organs may be adjacent to tumors or in the path of the radiation beam. Several mathematical models have been proposed that describe the relationship between dose and observed functional complication; however, only a few published studies have successfully fit these models to data using modern statistical methods which make efficient use of the data. One complication following radiation therapy of head and neck cancers is the patient's inability to produce saliva. Xerostomia (dry mouth) leads to high susceptibility to oral infection and dental caries and is, in general, unpleasant and an annoyance. We present a dose-damage-injury model that subsumes any of the various mathematical models relating dose to damage. The model is a nonlinear, longitudinal mixed effects model where the outcome (saliva flow rate) is modeled as a mixture of a Dirac measure at zero and a gamma distribution whose mean is a function of time and dose. Bayesian methods are used to estimate the relationship between dose delivered to the parotid glands and the observational outcome-saliva flow rate. A summary measure of the dose-damage relationship is modeled and assessed by a Bayesian chi(2) test for goodness-of-fit.     

Towards microbiological quality assurance in radiation sterilization processing: the limiting case model applied to a microbial population having a distribution of radiation responses

A limiting case model, developed earlier to provide a conservative estimate of the proportion of non-sterile items ( P ) in an irradiated population of items contaminated with micro-organisms of a single type, has been extended to include items having organisms of different types. Estimates of P are compared with exact values derived on purely theoretical grounds and with values obtained by computer simulation of microbiological inactivation on items.     

Degradation of biochemical activity in soil sterilized by dry heat and gamma radiation.

The activities of three enzymes present in soil, phosphatases, urease, and decarboxylase, were monitered as indicators of the loss of biochemical information occurring when soil was sterilized by dry heat (0.08% relative humidity), gamma radiation, or a combination of both. More enzymatic activity was retained in soil sterilized by a long exposure to dry heat at relatively low temperature (8 weeks at 100.5 degrees C) than by a shorter exposure to a higher temperature (2 weeks at 124.5 degrees C). No enzymatic activity was detectable in soil sterilized by an even higher temperature (4 days at 148.5 degrees C). Soil sterilized with 7.5 Mrads of radiation retained much higher enzymatic activity than with heat sterilization. Combining sublethal doses of heat radiation effectively sterilized the soil and yielded enzymatic activities higher than those of soil sterilized by dry heat alone but lower than those of soil sterilized by radiation.     

Intracranial pressure. II. Experimental verification of a mathematical model]

The authors report the results of experiments (performed on the dog in vitro and in vivo) which were designed to verify hypotheses made concerning vascular elasticity and characteristics of CSF resorption, as well as to test the validity of a mathematical model that was described in a previous paper. The authors concluded that the equations of the model account for most of the phenomena satisfactorily, but fail to predict a rebound phenomena which occurs after sudden injections in the cisterna magna. The elasticity coefficient S appears to be constant over a range of 200 mm Hg. On the other hand, the filtration coefficient K depends upon pressure, probably due to morphological changes in the size and shape of the CSF valves. These discrepancies are taken into account in a more general model that is presented in the following paper.     

Chromosome aberration frequency and radiation dose to lymphocytes by alpha-particles from internal deposit of Thorotrast

Summary Frequencies of chromosome aberrations in peripheral blood lymphocytes from 63 Thorotrast patients were analysed basing on the age distribution of lymphocytes. The frequency and distribution of chromosome aberrations among lymphocytes are best explained if we assume that the lymphocytes are renewed as an exponential function of time and spend most of their lifetime in the distributive pool where, while exchange of lymphocytes is taking place, the lymphocytes are hit by-particles from Thorotrast aggregates resulting in the formation of chromosome aberrations and killing at specific rates per hit. The model predicts that the aberration frequency is rather insensitive to the fluence rate because of modulation by cell killing by hit. Fitting the observed data to the model showed that approximately 0.8 dicentrics and rings were produced by a single path of-particle and average fluence rate to lymphocytes in a group of patients with the highest aberration frequency was estimated to be about 1.5 hits or 87 rad/lymphocyte/year.     

Molecular mechanisms of radiation carcinogenesis and the linear, non-threshold dose response model of radiation risk estimation

Recent research in molecular radiation carcinogenesis is reviewed with the specific aim of exploring the implications this research may have on the dose response relationship of radiation-induced cancer at low doses and low dose rates. It is concluded that the linear non-threshold dose response hypothesis may be used in radiation protection planning as a simple, convenient method to optimize procedures and regulations, but should not be mistaken as a stringent scientific conclusion directly derived from the present state of knowledge of the processes involved in radiation carcinogenesis.     

Quality assurance in cytopathology. Recommendations and ongoing quality assurance activities of the American Society of Clinical Pathologists

The recommendations and activities of the American Society of Clinical Pathologists (ASCP) pertaining to quality assurance in cytopathology are reviewed. To assure the early detection of cervical cancer, the ASCP recommends that all women who are, or have been, sexually active should have an annual Papanicolaou smear examination, the reasons for which are discussed. To assure the optimal quality in the evaluation of these smears, the ASCP recommends that the screening should be performed (1) in an accredited laboratory by certified cytotechnologists, (2) for whom realistic workloads have been established, (3) under the supervision of a pathologist adequately trained in cytology, (4) who will maintain an ongoing quality assurance program. In addition, (5) Papanicolaou smear evaluations should be available to all patients at a reasonable cost and (6) the financial incentives for the performance of low-quality screening should be eliminated. The society's quality assurance activities discussed include the Check Sample program, self-assessment examinations, meetings and publications; planned additions to this arena include a challenge exam and proficiency survey mechanisms.     

A theoretical model of the knee and ACL: theory and experimental verification.

A three-dimensional mathematical model of the human knee joint was developed to examine the role of single ligaments, such as an anterior cruciate ligament (ACL) graft in ACL reconstruction, on joint motion and tissue forces. The model is linear and valid for small motions about an equilibrium position. The knee joint is modeled as two rigid bodies (the femur and the tibia) interconnected by deformable structures, including the ACL or ACL graft, the cartilage layer, and the remainder of the knee tissues (modeled as a single element). The model was demonstrated for the equilibrium condition of the knee in extension with an anterior tibial force, causing anterior drawer and hyperextension. The knee stiffness matrix for this condition was measured for a human right knee in vitro. Predicted model response was compared with experimental observations. Qualitative agreement was found between model and experiment, validating the model and its assumptions. The model was then used to predict the change in graft and cartilage forces and joint motion of the knee due to an increment of load in the normal joint both after ACL removal and with various altered states simulating ACL reconstructions. Results illustrate the interdependence between loads in the ACL graft, other knee structures, and contact force. Stiffer grafts and smaller maximum unloaded length of the ligament lead to higher graft and contact forces. Changes in cartilage stiffness alter load sharing between ACL graft and other joint tissues.     

Multiple assembly states of lumazine synthase: a model relating catalytic function and molecular assembly

Lumazine synthases have been observed in the form of pentamers, dimers of pentamers, icosahedral capsids consisting of 60 subunits and larger capsids with unknown molecular structure. Here we describe the analysis of the assembly of native and mutant forms of lumazine synthases from Bacillus subtilis and Aquifex aeolicus at various pH values and in the presence of different buffers using small angle X-ray scattering and electron microscopy. Both wild-type lumazine synthases are able to form capsids with a diameter of roughly 160 A and larger capsids with diameters of around 300 A. The relative abundance of smaller and larger capsids is strongly dependent on buffer and pH. Both forms can co-exist and are in some cases accompanied by other incomplete or deformed capsids. Several mutants of the B. subtilis lumazine synthase, in which residues in or close to the active site were replaced, as well as an insertion mutant of A. aeolicus lumazine synthase form partially or exclusively larger capsids with a diameter of about 300 A. The mutations also reduce or inhibit enzymatic activity, suggesting that the catalytic function of the enzyme is tightly correlated with its quaternary structure. The data show that multiple assembly forms are a general feature of lumazine synthases.     

Physicochemical, toxicological and hygienic aspects of ethylene oxide application for the sterilization of medical products. III. Setting hygienic norms in sterilized medical products

Some of the drawbacks are discussed associated with hygienic norms for gaseous sterilizing agents in polymeric products for medical applications. A new approach is proposed for regulating ethylene oxide (EO) in such products. To this end, limiting types of biological effect and its pathways have been determined and substantiated as well as the reliability factor for establishing hygienic norms for EO in medical products. Daily threshold EO limit values were calculated for momentary and repeated exposure of humans. The duration of long-term and short-term exposure of the patient to sterilized products was evaluated on the basis of EO extraction kinetics from a variety of materials. Using daily threshold limit values, threshold residual values (TRV) of EO were calculated for different groups of polymeric products for medical applications.     

A systemic model of the reproductive death of mammalian cells. The effect of radiation dose rate and fractionation

On the basis of the previously developed systemic model a study was made of the effect of dose rate on the survival of mammalian cells, RBE of small doses of heavy ions, and fractionation of radiation. There was a good agreement between theoretical and experimental results. The calculations showed that D10 (10% survival dose) is a function of dose rate P even for such ions as helium and boron which, however, exhibited an insignificant dependence of D10 on P (within the range from (10(-1) to 1 cGy/min). The influence of repair and the rate of cell division on RBE of radiation was determined.     

Absolute dose verification of static intensity modulated radiation therapy (IMRT) with ion chambers of various volumes and TLD detectors

Aim

This study aims at examining absolute dose verification of step-and-shoot intensity modulated radiation treatment (IMRT) of prostate and brain patients by use of ion chambers of two different volumes and thermoluminescent detectors (TLD).

Acute biological effects of simulating the whole-body radiation dose distribution from a solar particle event using a porcine model

In a solar particle event (SPE), an unshielded astronaut would receive proton radiation with an energy profile that produces a highly inhomogeneous dose distribution (skin receiving a greater dose than internal organs). The novel concept of using megavoltage electron-beam radiation to more accurately reproduce both the total dose and the dose distribution of SPE protons and make meaningful RBE comparisons between protons and conventional radiation has been described previously. Here, Yucatan minipigs were used to determine the effects of a superficial, SPE-like proton dose distribution using megavoltage electrons. In these experiments, dose-dependent increases in skin pigmentation, ulceration, keratinocyte necrosis and pigment incontinence were observed. Five of 18 animals (one each exposed to 7.5 Gy and 12.5 Gy radiation and three exposed to 25 Gy radiation) developed symptomatic, radiation-associated pneumonopathy approximately 90 days postirradiation. The three animals from the highest dose group showed evidence of mycoplasmal pneumonia along with radiation pneumonitis. Moreover, delayed-type hypersensitivity was found to be altered, suggesting that superficial irradiation of the skin with ionizing radiation might cause immune dysfunction or dysregulation. In conclusion, using total doses, patterns of dose distribution, and dose rates that are compatible with potential astronaut exposure to SPE radiation, animals experienced significant toxicities that were qualitatively different from toxicities previously reported in pigs for homogeneously delivered radiation at similar doses.