Opportunities for improvement of distal autologous reconstructions in patients with chronic critical limb ischemia
ZAPOROZHYE MEDICAL JOURNAL
Authors: Gudz, O., I
Abstract
Study objective: to evaluate the diagnostic capabilities of spiral CT-angiography (CIA) for planning of autovenous distal arterial reconstruction (DAR) and to develop intraoperative techniques aimed at reducing the negative effect of traumatic processes of harvesting and preparation of the great saphenous vein in patients with chronic critical limb ischemia (CCLI). Materials and methods. DARs were performed in 176 patients with manifestations of CCLI. Before the surgery, 48 patients underwent CTAwith an additional venous phase to study the morphological changes and size of the great saphenous vein (GSV) as a bypass material. During DAR procedures, we evaluated the effectiveness of our own approach to the harvesting and subsequent preparation (pharmacological dilation) of GVS as a vein graft. Results. CTA performing using 2-phase mode served to detect morphological changes (hypoplasia, varicose transformation) and determine the diameters of GSV at three levels of the thigh with high accuracy. The obtained data were correlated (the lowest index - r = 0.58) with the results of ultrasound examination of the vein size on the thigh. The diagnostic value of CTA in the planning of autovenous shunting was 89.8 +/- 2.9 %. Taking into account the GSV anatomical location, the Vollmar ring dissector was used for less traumatic GSV harvesting. This allowed reducing the number and size of skin incisions, preventing lymphatic basins and cutaneous nerves damage and making the GSV harvesting less traumatic forthigh soft tissues. The use of a vasodilators solution in the process of GSV preparation for DAR managed to avoid the destructive effect of hydraulic vasodilation on the venous endothelium functional state. Aformula was proposed to predict an increase in lumen of vein graft during pharmacological vasodilation performing. Conclusions. CTA performing using a special mode (arterial and venous phases) in DAR planning for patients with CCLI, allows a high reliability of GSV suitability evaluation for autologous bypass surgery. It is possible to reduce the surgical injury during GSV for DAR harvesting and preparation procedures by using a ring dissector for careful preparation as well as by dilating the vein graft lumen not by the usual mechanical method but by a pharmacological one.
Rapid and Simultaneous Characterization of Drug Conjugation in Heavy and Light Chains of a Monoclonal Antibody Revealed by High-Resolution Ion Mobility Separations in SLIM
ANALYTICAL CHEMISTRY
Authors: Nagy, Gabe; Attah, Isaac K.; Conant, Christopher R.; Liu, Weijing; Garimella, Sandilya V. B.; Gunawardena, Harsha P.; Shaw, Jared B.; Smith, Richard D.; Ibrahim, Yehia M.
Abstract
Antibody-drug conjugates (ADCs) have recently gained traction in the biomedical community due to their promise for human therapeutics and an alternative to chemotherapy for cancer. Crucial metrics for ADC efficacy, safety, and selectivity are their drug-antibody ratios (DARs). However, DAR characterization (i.e., determining the average number of conjugated drugs on the antibody) through analytical methods remains challenging due to the heterogeneity of drug conjugation as well as the numerous post-translational modifications possible in the monoclonal antibody. Herein, we report on the use of high-resolution ion mobility spectrometry separations in structures for lossless ion manipulations coupled to mass spectrometry (SLIM IMS-MS) for the rapid and simultaneous characterization of the drug load profile (i.e., stoichiometric distribution of the number of conjugated drugs present on the mAb), determination of the weighted average DAR in both the heavy and light chains of a model antibody-drug conjugate, and calculation of the overall DAR of the ADC. After chemical reduction of the ADC and a subsequent 31.5 m SLIM IMS separation, the various drug-bound antibody species could be well resolved for both chains. We also show significantly higher resolution separations were possible for these large ions with SLIM IMS as compared to ones performed on a commercially available (1 m) drift tube IMS-MS platform. We expect high-resolution SLIM IMS separations will augment the existing toolbox for ADC characterization, particularly to enable the rapid optimization of DAR for a given ADC and thus better understand its potential toxicity and potency.