A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women

Background:

Chinese women tend to have small and dense breasts and ultrasound is a common method for breast cancer screening in China. However, its efficacy and cost comparing with mammography has not been evaluated in randomised trials.

Methods:

At 14 breast centres across China during 2008–2010, 13 339 high-risk women aged 30–65 years were randomised to be screened by mammography alone, ultrasound alone, or by both methods at enrolment and 1-year follow-up.

Results:

A total of 12 519 and 8692 women underwent the initial and second screenings, respectively. Among the 30 cancers (of which 15 were stage 0/I) detected, 5 (0.72/1000) were in the mammography group, 11 (1.51/1000) in the ultrasound group, and 14 (2.02/1000) in the combined group (P=0.12). In the combined group, ultrasound detected all the 14 cancers, whereas mammography detected 8, making ultrasound more sensitive (100 vs 57.1%, P=0.04) with a better diagnostic accuracy (0.999 vs 0.766, P=0.01). There was no difference between mammography and ultrasound in specificity (100 vs 99.9%, P=0.51) and positive predictive value (72.7 vs 70.0% P=0.87). To detect one cancer, the costs of ultrasound, mammography, and combined modality were $7876, $45 253, and $21 599, respectively.

Conclusions:

Ultrasound is superior to mammography for breast cancer screening in high-risk Chinese women.

Exploring the Value of Using Color-Coded Quantitative DSA Evaluation on Bilateral Common Carotid Arteries in Predicting the Reliability of Intra-Ascending Aorta Flat Detector CT-CBV Maps

BACKGROUND AND PURPOSE

Cerebral blood volume, acquired with flat panel detector CT by injecting contrast medium into the ascending aorta, enabled real-time acquisition of brain functional information with remarkable reduction of contrast medium usage comparing to an intravenous injection approach. However, individual vasculature and flow variations cause inhomogeneous contrast medium distribution and unexpected asymmetric perfusion for certain patients even without cerebral circulatory disorders. This work aimed at testing the feasibility of using color-coded quantitative DSA to predict the reliability of flat panel detector CT-based CBV maps by injecting contrast medium into the ascending aorta by exploring the correlation between measurements of color-coded quantitative DSA and the symmetry of CBV maps.

MATERIALS AND METHODS

For 12 patients without perfusion-related cerebral abnormities, color-coded quantitative DSA at the aortic arch and flat panel detector CT-based CBV maps by injecting contrast medium into the ascending aorta were acquired. In color-coded quantitative DSA, ROIs were defined on the bilateral common carotid arteries. Time-density curves were extracted, and area under the curve values were calculated. To evaluate brain perfusion symmetry, we defined ROIs on the anterior and middle cerebral artery territories in CBV maps, and quantitative CBV values were extracted.

RESULTS

Eight patients demonstrated good perfusion symmetry with relative CBV of 0.96 ± 0.06, and their relative area under the curve was found to be 0.99 ± 0.02. For the other 4 patients, CBV from the left hemisphere was significantly lower than that from the right with relative CBV of 0.81 ± 0.09. This asymmetric perfusion was confirmed by the color-coded quantitative DSA with relative area under the curve values of 0.79 ± 0.03.

CONCLUSIONS

This preliminary study showed good correlation between relative area under the curve from color-coded quantitative DSA and relative CBV from CBV maps. Color-coded quantitative DSA potentially helped sort out patients whose vascular anatomy could support reliable CBV acquisitions of flat detector CT by injecting contrast medium into the ascending aorta.

Macrophage recruitment in obese adipose tissue

Obesity is characterized as a chronic state of low-grade inflammation with progressive immune cell infiltration into adipose tissues. Adipose tissue macrophages play critical roles in the establishment of the chronic inflammatory state and metabolic dysfunctions. The novel discovery that pro-inflammatory macrophages are recruited to obese adipose tissue prompted an increased interest in the interplay between immune cells and metabolism. Since this discovery, many works have been published investigating the factors that lead to macrophage recruitment, the phenotypic change of adipose tissue macrophages, and metabolic dysfunctions. Adipokines and chemokines are key mediators that play crucial roles in crosstalk between adipocytes and macrophages and in regulating the adipose tissue inflammation. In the present review, we discuss the obesity-mediated adipose tissue remodelling, and particularly, the role of adipokines/chemokines in macrophage recruitment to obese adipose tissue. This review provides new insights into the physiological role of these factors and identifies a potential therapeutic target for obesity and associated disorders.

Impact of the 21-Gene Recurrence Score Assay in adjuvant chemotherapy selection for node-negative, hormone receptor-positive breast cancer in the Chinese population

The 21-Gene Recurrence Score Assay has been intensively studied and recommended by major guidelines for treatment decision in early breast cancer. Its impact in adjuvant chemotherapy selection for Chinese population has not been revealed.The prospective part of this study enrolled consecutive node-negative, hormone receptor-positive patients who underwent 21-gene RS testing at Breast Surgery Department of PUMCH (n=134) between May 2012 and August 2013(21-gene RS group). Risk categories were assigned based on the RS and on standard clinicopathologic criteria according to St. Gallen and Adjuvant! Online. The chemotherapy selection and the oncologists' confidence in decision-making before and after RS testing were recorded. The retrospective part of this study compared the chemotherapy decision in the 21-gene RS group and a control group without RS testing (diagnosed between Jan 2011 and Apr 2012,n=170). A total of 304 patients were included in the analysis (134 21-gene RS group, 170 controls). Based on RS, 97 patients were classified as low risk, 29 patients as intermediate risk, and 8 patients as high risk. Tumor grade (P=0.002), PR expression (P<0.001) and Ki-67 index (P<0.001) were significantly different between the 3 risk cohorts.Comparing the St. Gallen guidelines and RS, there was a 41% concordance between risk groups. By using Adjuvant! Online, the correlation between the predicted BCSM and RS was nominal (r=0.10). A total of 29% 21-gene RS group patients changed their treatment decisions after RS testing (P<0.001, 95% CI, 0.18 to 0.49) with 6% (8/134) patients changing to receive chemotherapy besides endocrine therapy and 23% (31/134) changing to reject chemotherapy. After RS testing, more than one half of the oncologists increased their confidence level in treatment recommendation. In the control group, 67.6% (115/170) patients chose chemotherapy plus endocrine therapy. The chemotherapy percentage was much higher than that of 21-gene RS group (30/134, 22%).This is the first study to demonstrate a reduction in the use of adjuvant chemotherapy in women with node-negative hormone receptor-positive breast cancer, based on use of the RS. The RS had an impact on the physicians' treatment decision-making.

BST-2 expression in human hepatocytes is inducible by all three types of interferons and restricts production of hepatitis C virus

Bone marrow stromal cell antigen 2 (BST-2, also known as tetherin, CD317, or HM1.24) has recently been identified as a host restriction factor against diverse families of enveloped viruses. However, the effects of BST-2 on the life cycle of hepatitis C virus (HCV), an enveloped RNA virus, remain unclear and controversial. Here we demonstrated that human hepatocytes including Huh7.5.1 cells, primary human hepatocytes (PHHs), and HepG2 cells constitutively expressed low to moderate levels of endogenous BST-2 on the cell surface, which could be robustly up-regulated by all three types of interferons (IFNs) such as IFN-α, IFN-γ, and IFN-λ. IFN-α and IFN-γ showed a synergistic effect in induction of BST-2 expression on human hepatocytes. Over-expression of BST-2 by BST-2-expressing vector transfection or up-regulation of BST-2 by IFN stimulation markedly suppressed HCV production, whereas shRNA-mediated depletion of endogenous BST-2 significantly enhanced HCV production in infected Huh7.5.1 cells. IFN-mediated anti-HCV activity was partially but significantly diminished by shRNA-mediated knockdown of BST-2 expression, indicating that BST- 2 upregulation is directly involved in IFN-mediated inhibition of HCV production. We also found that both BST-2 and HCV core co-localized with intracellular lipid droplets (LDs), suggesting that BST-2-HCV interaction may take place around LDs as LDs constitute an important intracellular organelle for HCV assembly and replication. Taken together, our data suggest that BST-2 is a host restriction factor against HCV, and induction of BST-2 in hepatocytes could be one of the mechanisms by which current HCV standard therapy (IFN-α plus ribavirin) achieves a sustained virological response (SVR).

Clinical and laboratory characteristics of systemic sclerosis patients with pulmonary arterial hypertension in China

OBJECTIVES

Pulmonary arterial hypertension (PAH) is associated with significant morbidity and mortality, especially in systemic sclerosis (SSc). Since there was no published study regarding PAH in the Chinese SSc population, we aimed to describe a cohort to provide some data for early diagnosis.

METHODS

We evaluated 236 systemic sclerosis patients prospectively registered in the EUSTAR (European League Against Rheumatism Scleroderma Trial and Research Group) database from the Peking Union Medical College Hospital from 2009 to 2012. Among them, 33 individuals received right heart catheterisations (RHC) while the remaining patients were grouped by echocardiographic data. These patients were classified into two groups, PAH and non-PAH group. Their clinical and laboratory features were statistically analysed to identify possible risk factors for PAH in Chinese SSc population.

RESULTS

The possible prevalence of PAH in SSc patients was approximately 11% in our study. Digital ulcers (52.0% vs. 31.2%), telangiectasias (64.0% vs. 37.6%) and gastroesophageal reflux disease (GERD) (60.0% vs. 36.2%) were more common in SSc patients with PAH. Some laboratory results were also proved to be significantly correlated with it. Logistic regression analysis showed that telangiectasias (OR=2.888, 95% CI=1.176-7.093), presence of GERD (OR=2.592, 95% CI=1.067-6.296), anti-RNP positivity (OR=24.384, 95% CI=1.978-36.651), IgA level elevation (OR=8.745, 95% CI 4.838-122.896) and FVC/TLCO ratio (OR=97.067, 95% CI 12.475-755.271) were associated with an increased odds for PAH in SSc patients.

CONCLUSIONS

This study described possible predictors of PAH in Chinese SSc population, which have been supported by similar studies in other ethnic groups.

Expression of urocortin and corticotrophin-releasing hormone receptor-2 in patients with intrahepatic cholestasis of pregnancy

INTRODUCTION

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse pregnancy outcomes. Fetal distress in ICP is an acute process, and the abnormal expression of placental local vasodilatory factors play an essential role. Urocortin (UCN) exhibits a powerful concentration-dependent vasodilatation effect in the utero-placental-fetal unit. Our study aimed to investigate placental and serum UCN expression in ICP patients.

METHODS

Blood and placenta samples were obtained from the ICP patients and controls. UCN and corticotrophin-releasing hormone receptor-2 (CRH-R2) expression were detected by ELISA, immunohistochemistry, Western Blotting and real-time PCR.

RESULTS

Placental UCN expression of ICP was lower compare to the controls (0.27 ± 0.11 vs. 0.85 ± 0.21) (P < 0.05). Placental CRH-R2 (0.97 ± 0.09 vs. 0.86 ± 0.09) showed no difference between the ICP and controls (P > 0.05). Placental UCN mRNA (1.45 ± 0.31 vs. 0.72 ± 0.29) and CRH-R2 mRNA expression (1.11 ± 0.10 vs. 0.84 ± 0.24) were higher compared to the controls (all P < 0.05). Maternal serum UCN levels demonstrated no difference from 34 (79.47 ± 11.35 pg/ml) to 37 (84.24 ± 13.62 pg/ml) weeks of gestation in controls (P > 0.05). Maternal serum UCN levels of ICP were decreased from 34 (68.53 ± 16.95 pg/ml) to 37 (47.91 ± 15.65 pg/ml) weeks of gestation (P < 0.05) and were lower than controls at 35 (64.19 ± 22.50 pg/ml), 36 (50.06 ± 13.98 pg/ml) and 37 weeks of gestation (all P < 0.05).

DISCUSSION

The down-regulated UCN expression in the placenta and maternal serum during ICP may impair the blood flow regulation of the utero-placental-fetal unit and contribute to fetal distress. Maternal serum UCN levels might represent a potential clinical predictor of adverse fetal outcomes and optimize the clinical management.

Association of serum homocysteine levels with the severity and calcification of coronary atherosclerotic plaques detected by coronary CT angiography

AIM

In this study, we aim to evaluate the association of risk factors including homocysteine (Hcy) with the severity and burden of coronary atherosclerotic plaques detected by computed tomography angiography (CTA).

METHODS

Six hundred fifty-nine subjects who underwent CTA for the assessment of coronary artery disease (CAD) were studied. All the subjects enrolled had no clinical cardiovascular disease symptoms. Logistic regression showed apart from age, hypertension, smoking, triglyceride, low-density lipoprotein (LDL) cholesterol, and total bilirubin, Hcy was an independently risk factor of the severity of coronary disease. And Hcy was also found an independent predictor for the presence of calcified plaque. When the participants were divided into 4 groups according to serum Hcy quartiles (Q1-Q4 groups), both the percentage of patients with >50% stenosis and the percentage of patients with calcified plaque were higher in Q4 compared to other groups. The OR of Hcy (>15 µmol/L) for >50% stenosis was 2.212 (95% CI=1.119 to 4.375, P=0.022) and the OR for Hcy (>15 µmol/L) for calcification was 1.668 (95% CI=1.030 to 2.699, P=0.037) respectively.

CONCLUSION

Our study shows Hcy is independently associated with both the severity and calcified plaque detected by CTA. Hcy may provide additional information about CAD in the subjects without clinical symptoms.

KPT-330 has antitumour activity against non-small cell lung cancer

BACKGROUND

We investigated the biologic and pharmacologic activities of a chromosome region maintenance 1 (CRM1) inhibitor against human non-small cell lung cancer (NSCLC) cells both in vitro and in vivo.

METHODS

The in vitro and in vivo effects of a novel CRM1 inhibitor (KPT-330) for a large number of anticancer parameters were evaluated using a large panel of 11 NSCLC cell lines containing different key driver mutations. Mice bearing human NSCLC xenografts were treated with KPT-330, and tumour growth was assessed.

RESULTS

KPT-330 inhibited proliferation and induced cell cycle arrest and apoptosis-related proteins in 11 NSCLC cells lines. Moreover, the combination of KPT-330 with cisplatin synergistically enhanced the cell kill of the NSCLC cells in vitro. Human NSCLC tumours growing in immunodeficient mice were markedly inhibited by KPT-330. Also, KPT-330 was effective even against NSCLC cells with a transforming mutation of either exon 20 of EGFR, TP53, phosphatase and tensin homologue, RAS or PIK3CA, suggesting the drug might be effective against a variety of lung cancers irrespective of their driver mutation.

CONCLUSIONS

Our results support clinical testing of KPT-330 as a novel therapeutic strategy for NSCLC.

Effects of conservatively treated diseased cementum with or without EMD on in vitro cementoblast differentiation and in vivo cementum-like tissue formation of human periodontal ligament cells

OBJECTIVES

The present study aimed to evaluate the effects of conservatively treated diseased cementum on in vitro cementoblast differentiation and in vivo cementum-like tissue formation of human periodontal ligament cells (hPDLCs), and observe differential effects of enamel matrix derivative (EMD) on in vivo cementum formation by hPDLCs.

MATERIALS AND METHODS

Forty-eight cementum slices and 48 dentin slices were prepared from periodontitis compromised teeth, and hPDLCs were inoculated on to all root slices. Twenty-four co-cultured root slices of each group were used for mRNA expression of cementum attachment protein and CEMP1. With application of EMD, 24 co-cultured root slices (divided into groups C, D, C+E, D+E) were transplanted subcutaneously into nude mice. All root fragments were reviewed by histological analysis and immunohistochemical staining for bone sialoprotein.

RESULTS

mRNA expressions of cementum attachment protein and cementum protein - 1 from hPDLCs on cementum slices were statistically higher than those of dentin slices. Seven specimens of group C and 10 specimens of group C+E revealed a layer of cementum-like tissue (NFC) on surfaces of pre-existing cementum. NFC was thicker in group C+E than in group C. All NFCs were positively stained for bone sialoprotein, however, there was no NFC formation on dentin slices.

CONCLUSION

Conservatively treated diseased cementum promoted in vitro cementoblast differentiation and in vivo cementum-like tissue formation by hPDLCs, and the in vivo effect was enhanced by the presence of EMD.

The association of new inflammatory markers with type 2 diabetes mellitus and macrovascular complications: a preliminary study

AIM

Type 2 diabetes mellitus (T2DM) is not simply a disease of hyperglycemia, but also is an inflammatory disorder. This study aimed to observe the expression of inflammation-related factors in elderly T2DM patients with or without macrovascular disease (MVD).

PATIENTS AND METHODS

A total of 64 T2DM patients participated in this study, including 31 patients with MVD (group A) and 33 patients without MVD (group B); and 30 healthy volunteers were recruited as normal control (group C). The levels of serum irisin, retinol-binding protein 4 (RBP4) and adiponectin expression were all detected and compared between groups.

RESULTS

The demographic and clinical characteristics were comparable between T2DM patients and healthy volunteers. For patients in group A, the serum levels of irisin, RBP4 and adiponectin were 12.05 ± 2.12 pg/mL, 2.13 ± 0.83 µg/mL and 45.65±20.13 ng/mL, respectively. While the corresponding parameters were 26.11 ± 4.09 pg/ml, 1.54 ± 0.54 µg/ml and 57.93 ± 23.47 ng/mL for patients in group B; and were 40.25 ± 2.73 pg/mL, 0.98 ± 0.36 µg/mL and 60.03 ± 20.26 ng/mL for healthy volunteers in group C, respectively. As compared to healthy volunteers, the levels of irisin, RBP4 and adiponectin were all significantly changed in T2DM patients; and the difference in irisin, RBP4 and adiponectin between T2DM patients with and without MVD were all significant (p = 0.000, p = 0.001, and p = 0.029, respectively). Multivariate regression analysis showed that irisin and RBP4 are both independent predictors for MVD in T2DM patients.

CONCLUSIONS

Inflammatory disorder is significantly in T2DM patients with MVD, and serum irisin and RBP4 would be reasonable new markers of MVD.

Urinary concentrations of bisphenol A and phthalate metabolites and weight change: a prospective investigation in US women

OBJECTIVE

Both bisphenol A (BPA) and phthalates are known endocrine-disrupting chemicals for which there is widespread general population exposure. Human exposure occurs through dietary and non-dietary routes. Although animal studies have suggested a potential role of these chemicals in obesity, evidence from human studies is sparse and inconsistent, and prospective evidence is lacking. This study evaluated urinary concentrations of BPA and major phthalate metabolites in relation to prospective weight change.

METHODS

The study population was from the controls in a prospective case-control study of type 2 diabetes in the Nurses' Health Study (NHS) and NHSII. A total of 977 participants provided first-morning-void urine samples in 1996-2002. Urinary concentrations of BPA and nine phthalate metabolites were measured using liquid chromatography-mass spectrometry. Body weights were self-reported at baseline and updated biennially thereafter for 10 years.

RESULTS

On average, the women gained 2.09 kg (95% confidence interval (CI), -2.27 to 6.80 kg) during the 10-year follow-up. In multivariate analysis with adjustment of lifestyle and dietary factors, in comparison with women in the lowest quartile of BPA concentration, those in the highest quartile had 0.23 kg per year (95% CI, 0.07-0.38 kg per year) greater weight gain during the 10-year follow-up (P-trend=0.02). Several phthalate metabolites, including phthalic acid, MBzP and monobutyl phthalate, were also associated with faster prospective weight gain in a dose-response fashion (P-trend<0.01), whereas other phthalates metabolites, including MEP and monoethylhexyl phthalate, were not monotonically associated with body weight change.

CONCLUSIONS

These data suggest urinary concentrations of BPA and certain individual phthalate metabolites that were associated with modestly greater weight gain in a dose-response fashion. These data are consistent with a potential role of BPA and phthalates in obesity, although more prospective data are needed to corroborate these observations.

SCAR marker for sex identification of Pistacia chinensis Bunge (Anacardiaceae)

Pistacia chinensis Bunge is a dioecious plant that originated in China, and its sex cannot be identified at the early stage of cultivation by only its appearance. Recent studies show that the seed of P. chinensis is an ideal feedstock for biofuel production. To guide the cultivation of this energy plant scientifically, a new method is urgently needed to identify the sex of P. chinensis seedlings. In this paper, from 21 random-amplified polymorphic DNA primers and 20 inter-simple sequence repeat primers, 2 sex-specific primers (S1 and S281) were identified that can amplify female-specific fragments of 473 and 1242 bp, respectively. However, only 1 fragment (FS281) was converted successfully into a sequence-characterized amplified region marker using S281-1 and S281-2 primers. When the annealing temperature was 64°C, a 636-bp specific sequence appeared in all female specimens but was absent in all the male samples tested. This study will offer some clues to sex selection in P. chinensis plantations.

Effects of tetra-arsenic tetra-sulfide on BXSB lupus-prone mice: a pilot study

Systemic lupus erythematosus (SLE) is an autoimmune disease of uncertain etiology that affects multiple tissues and organs. Arsenic trioxide (ATO) has been used in lupus-prone mice with a regulatory effect on immune abnormality. Tetra-arsenic tetra-sulfide (As4S4), a traditional Chinese medicine, is effective on acute promyelocytic leukemia with mild side effects than ATO. In this study, a pilot study was performed to investigate the effects and the mechanism of As4S4 on the lupus-prone BXSB mice. Improvement of monocytosis (p<0.05) in spleen and decreased serum interleukin-6 (IL-6) (p=0.0277) were observed with As4S4 treatment. As4S4-treated mice exhibited amelioration of skin, liver and renal disease with mild side effects. Histological analysis revealed that As4S4 suppressed immune complex deposition, mesangial proliferation and inflammatory cell infiltration in kidney and liver. Our study support that As4S4 selectively suppresses cutaneous lupus and nephritis in BXSB mice and might be a potential treatment for SLE.

The cyclic hexapeptide AcF attenuates sepsis-induced acute lung injury and mortality in rats

OBJECTIVE

The purpose of this study was to elucidate the possible beneficial effects of AcF on acute lung injury (ALI) in a rat model of sepsis.

MATERIALS AND METHODS

Male Sprague-Dawley rats were randomly divided into the following four experimental groups (n = 10 per group): animals undergoing a sham cecal ligature puncture (CLP) (Sham group); animals undergoing CLP (control group); or animals undergoing CLP and treated with saline (Saline group) and animals undergoing CLP and treated with AcF (AcF group). At 24 h after CLP, blood, bronchoalveolar lavage fluid (BALF) and lung tissue were collected. The lung wet/dry weight ratio, Protein concentration and the count of inflammatory cells or neutrophils in the BALF were determined. The pathologic changes in lungs were examined with the optical microscopy. Myeloperoxidase (MPO) activity, the expression of inflammatory cytokines were measured in lung tissue and BALF respectively. Survival rates were recorded at 120h in the four groups in another experiment.

RESULTS

Histology findings revealed acute lung injury in rats in the CLP group, whereas those in the AcF-treated group had mild lung injury. Treatment with AcF significantly attenuated the CLP-induced pulmonary edema and inflammation, as it significantly decreased lung wet/dry ration, protein concentration and the infiltration of inflammatory cells and neutrophils in the lung tissues. In addition, the secretion of inflammatory cytokines, such as TNF-α, IL-6, IL-1b and macrophage inflammatory protein-2 (MIP-2) was decreased in AcF treated group compared with the control saline treated group.

CONCLUSIONS

AcF administration ameliorates acute lung injury in a rat model of sepsis induced by CLP. AcF can be developed as a novel treatment for severe sepsis-induced ALI.

The Intrinsic Ferromagnetism in a MnO2 Monolayer

The Mn atom, because of its special electronic configuration of 3d(5)4s(2), has been widely used as a dopant in various two-dimensional (2D) monolayers such as graphene, BN, silicene and transition metal dichalcogenides (TMDs). The distributions of doped Mn atoms in these systems are highly sensitive to the synthesis process and conditions, thus suffering from problems of low solubility and surface clustering. Here we show for the first time that the MnO2 monolayer, synthetized 10 years ago, where Mn ions are individually held at specific sites, exhibits intrinsic ferromagnetism with a Curie temperature of 140 K, comparable to the highest TC value achieved experimentally for Mn-doped GaAs. The well-defined atomic configuration and the intrinsic ferromagnetism of the MnO2 monolayer suggest that it is superior to other magnetic monolayer materials.

Liver-directed adeno-associated virus serotype 8 gene transfer rescues a lethal murine model of citrullinemia type 1

Citrullinemia type 1 (CTLN1) is an autosomal recessive disorder of metabolism caused by a deficiency of argininosuccinate synthetase. Despite optimal management, CTLN1 patients still suffer from lethal metabolic instability and experience life threatening episodes of acute hyperammonemia. A murine model of CTLN1 (fold/fold) that displays lethality within the first 21 days of life was used to determine the efficacy of adeno-associated viral (AAV) gene transfer as a potential therapy. An AAV serotype 8 (AAV8) vector was engineered to express the human ASS1 cDNA under the control of a liver-specific promoter (thyroxine binding globulin, TBG), AAV8-TBG-hASS1, and delivered to 7–10 day old mice via intraperitoneal injection. Greater than 95% of the mice were rescued from lethality and survival was extended beyond 100 days after receiving a single dose of vector. AAV8-TBG-hASS1 treatment resulted in liver specific expression of hASS1, increased ASS1 enzyme activity, reduction in plasma ammonia and citrulline concentrations, and significant phenotypic improvement of the fold/fold growth and skin phenotypes. These experiments highlight a gene transfer approach using AAV8 vector for liver targeted gene therapy that could serve as a treatment for CTLN1.