On the role of modeling parameters in IMRT plan optimization

The formulation of optimization problems in intensity-modulated radiotherapy (IMRT) planning comprises the choice of various values such as function-specific parameters or constraint bounds. In current inverse planning programs that yield a single treatment plan for each optimization, it is often unclear how strongly these modeling parameters affect the resulting plan. This work investigates the mathematical concepts of elasticity and sensitivity to deal with this problem. An artificial planning case with a horse-shoe formed target with different opening angles surrounding a circular risk structure is studied. As evaluation functions the generalized equivalent uniform dose (EUD) and the average underdosage below and average overdosage beyond certain dose thresholds are used. A single IMRT plan is calculated for an exemplary parameter configuration. The elasticity and sensitivity of each parameter are then calculated without re-optimization, and the results are numerically verified. The results show the following. (1) elasticity can quantify the influence of a modeling parameter on the optimization result in terms of how strongly the objective function value varies under modifications of the parameter value. It also can describe how strongly the geometry of the involved planning structures affects the optimization result. (2) Based on the current parameter settings and corresponding treatment plan, sensitivity analysis can predict the optimization result for modified parameter values without re-optimization, and it can estimate the value intervals in which such predictions are valid. In conclusion, elasticity and sensitivity can provide helpful tools in inverse IMRT planning to identify the most critical parameters of an individual planning problem and to modify their values in an appropriate way.

Expression profiling reveals specific gene expression signatures in gastric MALT lymphomas

The purpose of this study is to identify genes that are involved in the etiology of Helicobacter pylori induced gastric MALT lymphoma. We compared gene expression profiles of gastric MALT lymphoma with their corresponding gastric MALT (chronic gastritis with formation of follicles and aggregates). cDNA microarrays were used to compare these two tissue types from the same patient (n = 21). Quantitative PCR and immunohistochemical staining were performed to validate the microarray results. Three hundred and fifty eight out of 11,552 genes were differentially expressed between gastric MALT lymphomas and gastric MALT. Thirty eight genes are implicated in immune response, 66 in signal transduction and 36 in cell proliferation. Interestingly, chromosome 6 was the only chromosome which was significantly over-represented with 25 genes (EASE score p = 0.01254). Several surface markers of haematopoietic cells, such as CD1c, CD40, CD44, CD53, CD83, CD86 and members of the HLA-D family were up-regulated in lymphoma tissues, indicating antigen-dependent survival of lymphoma cells. We conclude that gastric MALT lymphoma shows a specific gene expression profile, which allows the differentiation from H. pylori induced lymphoid gastritis.

[Choroidal effusion after uncomplicated cataract surgery]

BACKGROUND

Intake of ACE inhibitors may promote angioedema which can appear months and years after the medication has been stopped. Surgery and local anaesthesia can further aggravate angioedema. A 61-year-old patient with age-related cataract was admitted to our hospital for elective out-patient cataract surgery. A few days after surgery, the patient complained of pain and reduced vision in the operated eye.

RESULTS

Postoperative findings were elevated intraocular pressure (28 mmHg) and a significant reduction of vision. The anterior chamber was shallow. Ophthalmoscopy showed a circumferential choroidal and focal exudative retinal detachment. Local and systemic therapy with antiglaucomatous medications as well as steroids (methylprednisolone) and antibiotics (ciprofloxacin) resulted in control of the eye pressure and an increase of vision. After two weeks, the choroidal detachment disappeared. Important preexisting diseases included a minimal change glomerulonephritis under treatment with low doses of cortisone (4 mg), as well as arterial hypertension. An ACE inhibitor (ramipril) was taken.

CONCLUSIONS

ACE inhibitor intake might be associated with choroidal effusion. A preoperative change to another antihypertensive medication should be considered in patients with a tendency to develop angioedema. A glomerulonephritis might also support edema. Patients with such edema should undergo diagnostic evaluation and receive treatment before cataract surgery.

The embryonic muscle transcriptome of Caenorhabditis elegans

Fluorescence activated cell sorting and microarray profiling were used to identify 1,312 expressed genes that are enriched in myo-3::GFP-positive muscle cells of Caenorhabditis elegans.

Background

The force generating mechanism of muscle is evolutionarily ancient; the fundamental structural and functional components of the sarcomere are common to motile animals throughout phylogeny. Recent evidence suggests that the transcription factors that regulate muscle development are also conserved. Thus, a comprehensive description of muscle gene expression in a simple model organism should define a basic muscle transcriptome that is also found in animals with more complex body plans. To this end, we applied microarray profiling of Caenorhabtidis elegans cells (MAPCeL) to muscle cell populations extracted from developing C. elegans embryos.

Results

We used fluorescence-activated cell sorting to isolate myo-3::green fluorescent protein (GFP) positive muscle cells, and their cultured derivatives, from dissociated early C. elegans embryos. Microarray analysis identified 7,070 expressed genes, 1,312 of which are enriched in the myo-3::GFP positive cell population relative to the average embryonic cell. The muscle enriched gene set was validated by comparisons with known muscle markers, independently derived expression data, and GFP reporters in transgenic strains. These results confirm the utility of MAPCeL for cell type specific expression profiling and reveal that 60% of these transcripts have human homologs.

Conclusion

This study provides a comprehensive description of gene expression in developing C. elegans embryonic muscle cells. The finding that more than half of these muscle enriched transcripts encode proteins with human homologs suggests that mutant analysis of these genes in C. elegans could reveal evolutionarily conserved models of muscle gene function, with ready application to human muscle pathologies.

Discovery of N-[(3R,5R)-1-azabicyclo[3.2.1]oct-3-yl]furo[2,3-c]pyridine-5-carboxamide as an agonist of the alpha7 nicotinic acetylcholine receptor: in vitro and in vivo activity

A novel alpha7 nAChR agonist, N-[(3R,5R)-1-azabicyclo[3.2.1]oct-3-yl]furo[2,3-c]pyridine-5-carboxamide (3a, PHA-709829), has been identified for the potential treatment of cognitive deficits in schizophrenia. The compound shows potent and selective alpha7 in vitro activity, excellent brain penetration, good rat oral bioavailability and robust in vivo efficacy in a rat auditory sensory gating model.

Synaptic commitment: developmentally regulated reciprocal changes in hippocampal granule cell NMDA and AMPA receptors over the lifespan

Synaptic transmission in hippocampal field CA1 is largely N-methyl-d-aspartate receptor (NMDA(R)) dependent during the early postnatal period. It becomes increasingly mediated by alpha-amino-3-hydroxy-5-methylisoxazole-4-proprionate (AMPA) receptors until an adult ratio of AMPA to NMDA receptors is achieved. It is shown here that increases in the AMPA receptor (AMPA(R))-mediated field potential response continue over the life span of the F-344 rat at the perforant path-granule cell synapse in the dentate gyrus. In contrast, the NMDA(R)-dependent component of the response decreases with age between 1 and 27 mo, leading to an increase of AMPA(R)/NMDA(R) ratio with age. One possible explanation of this age difference is that the AMPA(R)/NMDA(R) ratio can be modified by experience. To test the idea that the changed ratio is caused by the old rats' longer lives, an intensive 10-mo period of enrichment treatment was given to a group of animals, beginning at 3 mo of age. Compared with animals housed in standard cages, the enrichment treatment did not alter the glutamatergic response ratio measured with field potential recording methods. These data provide support for the conclusion that the observed change with age is developmentally regulated rather than experience dependent. Given the role of the NMDA(R) in synaptic plasticity, these changes suggest a progressive commitment of perforant path synapses to particular weights over the life span. One possible implication of this effect includes preservation of selected memories, ultimately at the expense of a reduced capacity to store new information.

Altered dendritic integration in hippocampal granule cells of spatial learning-impaired aged rats

Glutamatergic transmission at central synapses undergoes activity-dependent and developmental changes. In the hippocampal dentate gyrus, the non-N-methyl d-aspartate (NMDA) receptor component of field excitatory postsynaptic potentials (fEPSPs) increases with age in Fischer-344 rats. This effect may not depend on the animal's activity or experience but could be part of the developmental process. Age-dependent differences in synaptic transmission at the perforant path-granule cell synapse may be caused by changes in non-NMDA and NMDA receptor-mediated currents. To test this hypothesis, we compared whole cell excitatory postsynaptic currents (EPSCs) in dentate granule cells evoked by perforant path stimulation in young (3-4 mo) and aged (22-27 mo) Fischer-344 rats using a Cs+-based intracellular solution. Aged animals as a group showed spatial learning and memory deficits in the Morris water maze. Using whole cell recordings, slope conductances of both non-NMDA and NMDA EPSCs at holding potentials -10 to +50 mV were significantly reduced in aged animals and the non-NMDA/NMDA ratio in aged animals was found to be significantly smaller than in young animals. In contrast, we detected no differences in basic electrophysiological parameters, or absolute amplitudes of non-NMDA and NMDA EPSCs. Extracellular Cs+ increased the fEPSP in young slices to a greater degree than was found in the aged slices, while it increased population spikes to a greater degree in the aged rats. Our results not only provide evidence for reduced glutamatergic synaptic responses in Fischer-344 rats but also point to differential changes in Cs+-sensitive dendritic conductances, such as Ih or inwardly rectifying potassium currents, during aging.

The protein arginine methyltransferases CARM1 and PRMT1 cooperate in gene regulation

Protein arginine methyltransferases (PRMT) have been implicated in the regulation of transcription. They are recruited to promoters via interaction with transcription factors and exert their coactivator function by methylating arginine residues in histones and other chromatin proteins. Here, we employ an unbiased approach to identify novel target genes, which are under the control of two members of the enzyme family, PRMT1 and CARM1/PRMT4 (coactivator associated arginine methyltransferase 1). By using cDNA microarray analysis, we find that the siRNA-mediated single knockdown of neither CARM1 nor PRMT1 causes significant changes in gene expression. In contrast, double knockdown of both enzymes results in the deregulated expression of a large group of genes, among them the CITED2 gene. Cytokine-stimulated expression analysis indicates that transcriptional activation of CITED2 depends on STAT5 and the coactivation of both PRMTs. ChIP analysis identifies the CITED2 gene as a direct target gene of STAT5, CARM1 and PRMT1. In reporter gene assays, we show that STAT5-mediated transcription is cooperatively enhanced by CARM1 and PRMT1. Interaction assays reveal a cytokine-induced association of STAT5 and the two PRMTs. Our data demonstrate a widespread cooperation of CARM1 and PRMT1 in gene activation as well as repression and that STAT5-dependent transcription of the CITED2 gene is a novel pathway coactivated by the two methyltransferases.

Cholinergic inhibition by botulinum toxin in a rat model of congenital glaucoma raises intraocular pressure

BACKGROUND

Cholinergic receptors are crucially involved in the regulation of intraocular pressure (IOP). Muscarinic agonists in the trabecular meshwork tissue increase aqueous humour outflow facility by a direct stimulation of ciliary muscle contraction. We investigated the contribution of cholinergic state to IOP regulation.

METHODS

Intracameral injections of botulinum toxin A (BTA) were applied in a group with four normotensive rats and a group with four glaucoma rats (genetic glaucoma model). BTA is a potent neurotoxin which inhibits presynaptic cholinergic transmission for 6-8 weeks. The same amount of saline was injected in a third group of four normotensive rats (sham condition). IOP measurements were performed preoperatively, as well as 1, 2 and 4 weeks postoperatively. Afterwards, the rat eyes were removed and subjected to immunhistochemistry and western blotting analysis using antibodies against choline acetyltransferase (CHAT).

RESULTS

Mean IOP in both normotensive groups was unaltered compared with the preoperative status. The glaucoma group showed a significant increase in the mean IOP (Student test, p<0.05) and a signal reduction for CHAT by immunolabelling in the trabecular meshwork compared with the other two groups. Western blotting confirmed the decreased expression of CHAT.

CONCLUSION

Our results suggest that modification of the cholinergic status in the normotensive eye does not significantly affect the IOP; cholinergic regulation of the ciliary trabecular meshwork may have differential levels of control, apart from the ciliary muscle contraction. Moreover, it seems that differential expression of the muscarinic receptors may be responsible for the decreased trabecular cholinergic state occurring in this rat model of glaucoma.

Role of Ena/VASP proteins in homeostasis and disease

The actin cytoskeleton is required for many important processes during embryonic development. In later stages of life, important homeostatic processes depend on the actin cytoskeleton, such as immune response, haemostasis and blood vessel preservation. Therefore, the function of the actin cytoskeleton must be tightly regulated, and aberrant regulation may cause disease. A growing number of proteins have been described to bind and regulate the actin cytoskeleton. Amongst them, Ena/VASP proteins function as anti-capping proteins, thereby directly modulating the actin ultrastructure. Ena/VASP function is regulated by their recruitment into protein complexes downstream of plasma membrane receptors and by phosphorylation. As regulators of the actin ultrastructure, Ena/VASP proteins are involved in crucial cellular functions, such as shape change, adhesion, migration and cell-cell interaction and hence are important targets for therapeutic intervention. In this chapter, we will first describe the structure, function and regulation of Ena/VASP proteins. Then, we will review the involvement of Ena/VASP proteins in the development of human diseases. Growing evidence links Ena/VASP proteins to important human diseases, such as thrombosis, cancer, arteriosclerosis, cardiomyopathy and nephritis. Finally, present and future perspectives for the development of therapeutic molecules interfering with Ena/VASP-mediated protein-protein interactions are presented.

CD14(++)CD16+ monocytes but not total monocyte numbers predict cardiovascular events in dialysis patients

Migration of monocytes into the vessel wall contributes to the onset and progression of atherosclerosis. Because monocytes are a heterogeneous population, we determined potential associations between monocyte subsets and cardiovascular events in a prospective cohort of 94 dialysis patients followed for 35 months. The incidence of cardiovascular events and death measured by Kaplan-Meier plots and flow cytometric analysis of monocyte subsets showed that total leukocyte and monocyte numbers failed to predict event-free survival. Among monocyte subsets, a high CD14(++)CD16(+) monocyte number was associated with higher rates of cardiovascular events and death. In a multivariate proportional hazards model adjusted for classical cardiovascular risk factors, patients with CD14(++)CD16(+) monocyte numbers in the top quartile were at higher risk of cardiovascular events and death compared to patients in the lowest quartile. Our study suggests that the number of CD14(++)CD16(+) monocytes was independently associated with cardiovascular events and death in a high-risk population of dialysis patients.

Time-course-dependent microvascular alterations in a model of myeloid leukemia in vivo

Functional and morphological properties of tumor microcirculation play a pivotal role in tumor progression, metastasis and inefficiency of tumor therapies. Despite enormous insights into tumor angiogenesis in solid tumors, little is known about the time-course-dependent properties of tumor vascularization in hematologic malignancies. The aim of this study was to establish a model of myeloid leukemia, which allows long-term monitoring of tumor progression and associated microcirculation. Red fluorescent protein-transduced human leukemic cell lines (M-07e) were implanted into cranial windows of severe combined immunodeficient mice. Intravital microscopy was performed over 55 days to measure functional (microvascular permeability, tissue perfusion rate and leukocyte-endothelium interactions) and morphological vascular parameters (vessel density, distribution and diameter). Tumor progression was associated with elevated microvascular permeability and an initial angiogenic wave followed by decreased vessel density combined with reduced tissue perfusion due to loss in small vessels and development of heterogenous tumor vascularization. Following altered geometric resistance of microcirculation, leukocyte-endothelium interactions were more frequent without increased leukocyte extravasation. It was concluded that time-dependent alterations of leukemic tumor vascularization exhibit strong similarities to those found in solid tumors. The potential contribution to the development of barriers to drug delivery in leukemic tumors is discussed.