In this setting, in which most patients with allergy were switched to another preparation, there was no adverse prognostic impact of clinical or subclinical allergy to asparaginase.

Asparaginase is an effective antileukemic agent and is included in most front-line protocols for pediatric acute lymphoblastic leukemia (ALL) worldwide; however, allergic reactions to asparaginase may be dose-limiting. We evaluated plasma anti-asparaginase antibody concentrations in a cohort of children with newly diagnosed ALL, who did and who did not exhibit clinical hypersensitivity, after Escherichia coli (E. coli) asparaginase therapy. Thirty-five children who received asparaginase 10 000 IU/m 2 i.m. three times weekly for nine doses as part of both multiagent induction and reinduction chemotherapy, and seven monthly doses during the first 7 months of continuation treatment, were studied. Twenty-two patients experienced initial allergic reactions to asparaginase during continuation (n = 20) or reinduction (n = 2) phases and 13 children did not exhibit any reaction. An enzyme-linked immunosorbent assay (ELISA) was used to measure anti-asparaginase antibodies in plasma samples, diluted 1:3200, using E. coli asparaginase as the antigen. The median anti-asparaginase antibody concentration (OD at 1:3200 dilution) increased from 0.039 at induction to 0.506 at reinduction in patients who exhibited clinical hypersensitivity (P = 0.0002). By comparison, median antibody level increased from 0.011 to 0.032 OD at identical time points in patients who did not react to asparaginase (P = 0.02). Both post-induction and post-reinduction anti-asparaginase antibody levels were higher in reacting than in nonreacting patients (P = 0.004 and P = 0.01, respectively). Antibody levels were inversely related to the time elapsed between the reaction and sampling (P = 0.011). Although anti-asparaginase antibody levels increased from the post-induction plasma sample to the post-reinduction sample in 28 of 35 patients regardless of whether they exhibited clinical hypersensitivity, patients with hypersensitivity reactions had higher antibody levels than did identically treated control patients at comparable time points in therapy. Therefore, antibody analysis may be of clinical value in predicting future hypersensitivity.

Substitution of Cd2+ for Zn2+ yields a hexameric insulin species containing 3 mol of metal ion per hexamer. The Cd2+ binding loci consist of the two His(B10) sites and a new site involving the Glu(B13) residues located at the center of the hexamer [Sudmeier, J. L., Bell, S. J., Storm, M. C., & Dunn, M. F. (1981) Science (Washington, D.C.) 212, 560-562]. Substitution of Co2+ or Co3+ for Zn2+ gives hexamers containing 2 mol of metal per hexamer. Insulin solutions to which both Cd2+ and Co2+ have been added in a ratio of 6:2:1 [In]:[Co2+]:[Cd2+] followed by oxidation to the exchange-inert Co3+ state yield stable hybrid species containing both Co3+ and Cd2+ with a composition of (In)6(Co3+)2Cd2+. The kinetics of the reaction of 2,2',2"-terpyridine (terpy) with the exchange-labile (In)6(Cd2+)2 and (In)6(Co2+)2 derivatives are biphasic and involve the rapid formation of an intermediate with coordination of one terpy molecule to each protein-bound metal ion; then, in a rate-limiting step the terpy-coordinated metal ion dissociates from the protein, and a second molecule of terpy binds to the metal ion to form a bis complex. Reaction of the exchange-inert Co3+ ions of (In)6(Co3+)2 with terpy is a slow apparent first-order process (t1/2 = 13.1 h). In contrast to the kinetic behavior of (In)6(Co2+)2 and (In)6(Cd2+)2, the Cd2+ ions bound to the hybrid (In)6(Co3+)2Cd2+ react quite slowly with terpy (t1/2 = 1 h at pH 8.0).(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract