Solution structure of the cellular factor BAF responsible for protecting retroviral DNA from autointegration

The solution structure of the human barrier-to-autointegration factor, BAF, a 21,000 Mr dimer, has been solved by NMR, including extensive use of dipolar couplings which provide a priori long range structural information. BAF is a highly evolutionarily conserved DNA binding protein that is responsible for inhibiting autointegration of retroviral DNA, thereby promoting integration of retroviral DNA into the host chromosome. BAF is largely helical, and each subunit is composed of five helices. The dimer is elongated in shape and the dimer interface comprises principally hydrophobic contacts supplemented by a single salt bridge. Despite the absence of any sequence similarity to any other known protein family, the topology of helices 3-5 is similar to that of a number of DNA binding proteins, with helices 4 and 5 constituting a helix-turn-helix motif. A model for the interaction of BAF with DNA that is consistent with structural and mutagenesis data is proposed.

Giant hidradenocarcinoma: a report of malignant transformation from nodular hidradenoma

A giant hidradenocarcinoma presented by a 75-year-old female is reported. The patient had a malignant transformation within a nodular hidradenoma involving the right postauricular area, which was treated by mass removal and a right radical neck dissection with a free-flap covering. Malignant hidradenocarcinoma is the least common adnexal tumor of uncertain origin. They are usually malignant from their inception, but some develop from a benign counterpart. To the authors' knowledge, only three cases have been reported previously. Two histologically distinct components were seen in this tumor: (i) typical nodular hidradenoma, which constituted a small part of the tumor; and (ii) carcinoma with areas of transition. The secretory cells of hidradenocarcinoma showed decapitation secretion on light and electron microscopic observations, which is evidence of apocrine differentiation. Histologically, this case was concluded as a hidradenocarcinoma arising from a long-standing nodular hidradenoma. A literature review is presented and the histological, immunohistochemical and ultrastructural features are described.

Skin necrosis due to photodynamic action of benzoporphyrin depends on circulating rather than tissue drug levels: implications for control of photodynamic therapy

In an ideal world, photodynamic therapy (PDT) of abnormal tissue would reliably spare the surrounding normal tissue. Normal tissue responses set the limits for light and drug dosimetry. The threshold fluence for necrosis (TFN) was measured in normal skin following intravenous infusion with a photosensitizer, benzoporphyrin derivative monoacid ring A (BPD-MA) Verteporin as a function of drug dose (0.25-2.0 mg/kg), wavelength of irradiation (458 and 690 nm) and time interval (0-5 h) between drug administration and irradiation. The BPD-MA levels were measured in plasma and skin tissue to elucidate the relationship between TFN, drug kinetics and biodistribution. The PDT response of normal skin was highly reproducible. The TFN for 458 and 690 nm wavelengths was nearly identical and the estimated quantum efficiency for skin response was equal at these two wavelengths. Skin phototoxicity, quantified in terms of 1/TFN, closely correlated with the plasma pharmacokinetics rather than the tissue pharmacokinetics and was quadratically dependent on the plasma drug concentration regardless of the administered drug dose or time interval between drug and light exposure. This study strongly suggests that noninvasive measurements of the circulating drug level at the time of light treatment will be important for setting optimal light dosimetry for PDT with liposomal BPD-MA, a vascular photosensitizer.

The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits

The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Experimental groups included (1) a control group, (2) a surgical delay (4-day and 7-day delay) group, and (3) a combined surgical and chemical (doxazosin mesylate, nitroglycerine patch) delay group. These groups were further divided into subgroups (n = 10) depending on the delay period and the chemical agents. An arterialized venous flap was created on one ear of each rabbit. In the arterialized venous flap, arterial inflow was provided by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. In the control group, the arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. In the surgical delay group, the mean percentage survival of arterialized venous flaps was 36.6 percent in the 4-day delay group and 59.7 percent in the 7-day delay group. In the combined surgical and chemical delay group, a 3-day chemical delay followed by a 4-day simultaneous surgical and chemical delay resulted in mean percentage survival of the arterialized venous flaps of 81.1 percent in the doxazosin mesylate group, 72.8 percent in the nitroglycerine patch group, and 92.9 percent in a combination group of doxazosin mesylate and nitroglycerine patch. A 3-day chemical delay followed by a 7-day simultaneous surgical and chemical delay resulted in mean percentage survival of the arterialized venous flaps of 94 percent in the doxazosin mesylate group, 90.2 percent in the nitroglycerine patch group, and 99 percent in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increased the percentage survival of the arterialized venous flaps in proportion to the delay period. The combination group of surgical and chemical delay procedures had a significantly greater percentage survival than that of the surgical delay group (p < 0.001), and the delay period could be shortened.

Induction of growth inhibition of 293 cells by downregulation of the cyclin E and cyclin-dependent kinase 4 proteins due to overexpression of TIS21

We earlier reported that TIS21 mRNA expression was markedly decreased in A549 and NCIH69 human lung cancer cells and in thymic carcinoma tissues obtained from transgenic mice containing simian virus 40 large T antigen (J Cancer Res Clin Oncol 121:279-284, 1995). To determine how TIS21 inhibits growth, we made 293 cells that constitutively expressed TIS21 protein. The constitutive TIS21 expresser lines C9 and C11 grew to a lower saturation density than did those in the vector-transfected clones (V7 and V10) and antisense-transfected clones (AS1 and AS4), and the size of the C9 and C11 cells increased significantly after transfection with TIS21 cDNA. The serum-stimulated cell cycle was analyzed by fluorescence-activated cell sorting after double thymidine treatment; V10 progressed normally through the cell division cycle, but C9 and C11 cells accumulated continuously in G1 phase until 36 h after treatment. On the other hand, the progression of cells that had already entered to S or G2/M phase was not inhibited. When cell-cycle regulatory proteins were measured, C9 and C11 cells showed significantly reduced synthesis of cyclin E and cyclin-dependent kinase (cdk) 4 as well as a decrease in cyclin E-associated cdk activity. These observations led us to conclude that TIS21 overexpression in G1 phase decreased the amounts of cyclin E and cdk4, thereby decreasing the activity of cdks at the G1-S transition.

Cytokinetic pattern in the thoracic spinal cord of chick embryos (incubation day 5-13) using PCNA staining and TUNEL method

For the cytokinetic studies using spinal cords of chick embryos, chronological patterns of cell proliferation and programmed cell death (apoptosis) should be known. Information in the early stages of chick embryos is available while data on later stages are seldom available. To investigate the chronological patterns of cell proliferation and apoptosis in the thoracic spinal cord of normal chick embryos on incubation day 5, 6, 8, 10 and 13 (Hamburger and Hamilton stage 26-40), proliferating cell nuclear antigen (PCNA) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method were used. Cell proliferation was active at the germinal layer on days 5 and 6. It markedly declined on day 8 and became negligible on day 13. TUNEL-positive cells were mainly found in the germinal layer, the ventrolateral part of the mantle layer and the dorsal root ganglion. Compared to PCNA-positive cells, TUNEL-positive cells were sparse, especially after day 10, when only a few positive cells were scattered. These results will be used as a control data for the studies such as an experimental research for neural tube defects.

The effects of diffusion blur on Snellen and grating acuity and foveal function in amblyopia

In order to verify that the effects of diffusion blur on Snellen and grating acuity in amblyopic eyes resemble those obtained from the peripheral or central retina in normal controls, we conducted the following experiment using a liquid crystal window (Edmund Scientific Co.) to produce diffusion blur on Snellen and grating acuity. Spatial frequencies used for a Snellen chart and Teller acuity card were 3.2, 6.5, 13.0, 26.0 cyc/cm at a working distance of 55 cm. The values of diffusive blur on central and peripheral visual acuity obtained from 20 normal healthy control eyes were compared with those values of central visual acuity in 26 amblyopic eyes. The diffusion blur had a strong negative effect on both Snellen and grating acuity in amblyopic eyes, but it had more potent effects on grating acuity (p < 0.05). The diffusion blur values obtained from the central amblyopic retina were more compatible with those of the central retina than with those of the peripheral retina in the control group (p > 0.05). Snellen acuity obtained from diffusion blur overestimated grating acuity in the normal central acuity group and amblyopic central acuity group. The result of this investigation demonstrated that the liquid crystal diffusion blur had a strong negative effect on both Snellen and grating acuity and suggested that the visual function of an amblyopic retina resembled that of a normal central retina.

Localization of atrial natriuretic peptide receptors in the rat tongue and hard palate

Atrial natriuretic peptide (ANP) receptors were characterized in rat oral mucosa using quantitative in vitro autoradiography and activation of particulate guanylyl cyclase (GC) by natriuretic peptides. Competition-binding analysis performed by quantitative in vitro autoradiography demonstrated specific [125I]rANP(1-28) binding sites in the tongue and hard palate. The precise location of this binding was revealed on the basal and parabasal cells of the epithelia by microautoradiography. The dissociation constant (Kd) and maximal binding capacity (Bmax) of these sites were 3.34+/-1.35 nM and 2.71+/-2.21 fmol/mm2 on the epithelium of the tongue, and 4.09+/-1.52 nM and 3.45+/-3.01 fmol/mm2 on the epithelium of the hard palate, respectively. Receptor subtypes were characterized by competition with des [Gln18, Ser19, Gly20, Leu21, Gly22] ANP(4-23) (C-ANP), a specific ligand for the clearance receptor (NPR-C). These binding sites were displaced by C-ANP with inhibition constant (Ki) of 8.96+/-3.18 nM and Bmax of 2.89+/-2.45 fmol/mm2 on the epithelium of the tongue, and Ki of 9.12+/-2.71 nM and Bmax of 3.08+/-2.94 fmol/mm2 on the epithelium of the hard palate, respectively. Production of cyclic GMP by particulate GC in the epithelial membranes of the tongue and hard palate was stimulated by rANP(1-28), porcine brain natriuretic peptide (BNP)(1-26), and C-type natriuretic peptide (CNP)(1-22) in a dose-dependent manner. These results indicate that ANP-binding sites in the epithelium of the tongue and hard palate are mainly clearance receptors (NPR-C) but biological receptors (NPR-A and/or NPR-B) with GC activity are also present, and suggest that ANP may have a role in the proliferation of the oral epithelial cells, especially in the tongue and hard palate.

Mutations of ret proto-oncogene in 3 Korean families with MEN 2A: clinical use of new restriction sites for genetic diagnosis

Abnormalities in the ret proto-oncogene are found in several disorders such as multiple endocrine neoplasia (MEN) 2, sporadic medullary thyroid cancer, congenital megacolon and papillary thyroid cancer. In MEN 2A or 2B, early genetic diagnosis before the development of clinical tumors is crucial for the cure of the disease. We studied mutations of ret proto-oncogene in 3 Korean families with MEN 2A and searched for new restriction sites that could be used for genetic diagnosis. By direct sequencing of exon 10 and 11 harboring 'hot' spots, heterozygous point mutation was detected at positions translating cysteine codon in all 3 families. In 2 families, mutations at codon 634 in exon 11 were found (from TGC to CGC or TAC), yielding a new CfoI or RsaI restriction site. In one family, a mutation was located at codon 618 in exon 10 (from TGC to CGC), generating a new CfoI restriction site. These new restriction sites were used in detecting 2 undiagnosed family members without clinical symptoms or signs. In one of them, thyroidectomy was performed to disclose a small medullary thyroid cancer. These results indicate that Korean MEN 2A patients have germ-line mutations in the ret protooncogene at the cysteine residues like patients of other races, and the strategy employing direct sequencing to find mutations at 'hot spot' and search for ensuing new restriction sites could be a useful approach for the molecular diagnosis of genetic diseases accompanied by mutations in restricted areas of disease genes such as MEN 2.

Use of affinity capillary electrophoresis for the study of protein and drug interactions

Protein-drug interactions were studied using affinity capillary electrophoresis (ACE). The initial study was performed using a model system, fibronectin-heparin interaction. Two distinct binding constants, 21 and 641 nM, were derived from the Scatchard plots. The results are consistent with reported data obtained using other analytical techniques. The ACE binding assay was applied for studying molecular interactions between kedarcidin chromophore and apoprotein. Conditions with an organic solvent as buffer component were examined to establish a suitable binding assay. It appears that the electrophoretic behavior of the protein shows little distortion in the presence of either dimethyl sulfoxide (up to 10%) or acetonitrile (ACN) (up to 30%). The binding assay was initially conducted in aqueous buffer phase. The saturation concentration of chomophore was found to be around 15 microM. A linear Scatchard plot was derived from binding data with a correlation coefficient of 0.94. The binding constant was determined as Kd = 5.6 microM. The effects of organic solvent content ranging from 0 to 30% ACN on the constant were examined. The binding constants were determined as Kd = 11, 12.5 and 16.2 microM for 5, 10 and 30% ACN, respectively. It appeared that the binding affinity between kedarcidin chromophore and apoprotein is reduced as the organic solvent content in the aqueous phase is increased.

Cloning of the histidine biosynthetic genes of Corynebacterium glutamicum: organization and sequencing analysis of the hisA, impA, and hisF gene cluster

The hisA and hisF genes of Corynebacterium glutamicum were cloned by transforming histidine auxotrophic Escherichia coli with the genomic DNA library. They are two of the eight genes that participate in the histidine biosynthetic pathway. Cloned DNA fragments containing the genes can also complement hisH and hisI auxotrophs of Escherichia coli, suggesting that the four genes are clustered in the genome. We determined the nucleotide sequences of the minimal fragment containing the hisA and hisF genes, which are separated by the impA gene. The coding regions of the hisA and hisF genes are 245 and 257 amino acids in length with a predicted size of about 26 and 27 kDa, respectively. These are in good agreement with the sizes of proteins expressed in E. coli. A high similarity was observed in comparison of nucleotide sequences of each protein between C. glutamicum and other species, as well as those between hisA and hisF genes of C. glutamicum.

Stabilization of the receptor protein tyrosine phosphatase-like protein ICA512 in GH4C1 cells upon treatment with estradiol, insulin, and epidermal growth factor

Treatment with 1 nM estradiol, 300 nM insulin, and 5 nM epidermal growth factor induces secretory granule accumulation and prolactin storage in GH4C1 rat pituitary tumor cells. The same triple treatment induced more than 6-fold accumulation of both the precursor (100 kDa, pro-ICA512) and the mature forms (60-70 kDa, ICA512 transmembrane fragment) of ICA512, a receptor protein tyrosine phosphatase-like protein that is preferentially localized in secretory granule membranes. Accumulation of ICA512 resembles that of prolactin storage, for the combination of all three, estradiol, insulin, and epidermal growth factor, gave the greatest induction, which was maximal at 4 days. This effect was specific, as the levels of the small GTP-binding protein Rab3, which is also associated with secretory granule membranes, were unaffected by the triple hormone/growth factor treatment. Increased transcription and translation of ICA512 could only partially account for its 6-fold accumulation, as ICA512 messenger RNA and ICA512 synthesis levels were 1.8 +/- 0.35- and 1.6 +/- 0.17-fold in triple treated GH4C1 cells compared with those in untreated cells, respectively. Pulse-chase procedures showed that pro-ICA512 was more stable in treated cells. These results indicate that the enlargement of the secretory granule compartment results in the stabilization of ICA512 and raise the possibility that trafficking of secretory granules may affect ICA512's function and vice versa.

Pancreatic IL-10 induces diabetes in NOD.B6 Idd3 Idd10 mice

Transgenic NOD backcross mice expressing pancreatic interleukin 10 (IL-10) were crossed and backcrossed to NOD.B6 Idd3 Idd10 mice, which have diabetes-resistance alleles at Idd3 and Idd10 on chromosome 3 and have a very low frequency diabetes and insulitis. Insulitis and diabetes developed in almost all IL-10 transgenic backcross 1 (BC1) mice of the H2g(7/g7) haplotype regardless of the allelic status at Idd3 and Idd10. Furthermore, diabetes occurred in 23% of IL-10 transgenic H2g(7/d) BC1 mice. These results indicate that pancreatic IL-10 is able to overcome the diabetes protection afforded by C57BL/6 (B6)-derived alleles at Idd3 and Idd10 as well as the absence of NOD MHC homozygosity, if other non-MHC NOD-derived Idd alleles are provided.

TGF-beta1 alters APC preference, polarizing islet antigen responses toward a Th2 phenotype

TGF-beta1, expressed in the pancreatic islets, protects the nonobese diabetic (NOD) mouse from insulin-dependent diabetes mellitus (IDDM). The islet antigen-specific T cell response of ins-TGF-beta1 mice relied on different antigen-presenting cells (APC) from those used by NOD T cells. T cells from NOD mice utilized B cells to present islet antigen, whereas T cells from ins-TGF-beta1 mice utilized macrophages. In addition, the islet antigen-specific T cell repertoire of ins-TGF-beta1 mice was distinct and deviated toward an IL-4-producing Th2 phenotype. When ins-TGF-beta1 mice were treated with anti-iL-4 antibody, islet antigen-specific IFNGamma-producing Th1 cells were unleashed, and the incidence of diabetes increased to the level of NOD mice. This suggests active suppression of a diabetogenic T cell response. This study describes a novel mechanism in which expression of TGF-beta1 in the context of self-antigen shifts APC preference, deviating T cell responses to a Th2 phenotype, preventing IDDM.

Decreased interleukin-2 production in Korean schizophrenic patients

BACKGROUND

It has been postulated that autoimmune process may play a role in the pathogenesis of symptoms in some schizophrenic patients. Findings of altered interleukin (IL) regulation have been regarded as additional proof that schizophrenia has an autoimmunological background.

METHODS

Sixteen patients who fulfilled DSM-IV criteria for schizophrenia and who were drug free for at least six months and the same number of age- and sex-matched controls were recruited. The severity of symptoms in schizophrenia was assessed by BPRS. Phytohemagglutinin (PHA)-stimulated production and serum level of IL-1 beta, IL-2, and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

There was a significant decrease of IL-2 production (p < .01) in schizophrenic patients and a significant increase of IL-2 serum level (p < .01). No significant difference of IL-1 beta and IL-6 was found. Some patients and controls had measurable serum level of IL-1 beta and IL-6. No significant correlation between production and serum level of IL-1 beta, -2, -6 and age, duration of illness, and BPRS score in schizophrenics was found.

CONCLUSIONS

This is the first study to describe a decrease of IL-2 production and increase of IL-2 serum level in non-Caucasian schizophrenic patients. These findings are further evidence that autoimmune process is present, regardless of ethnic origin, in some schizophrenic patients.

Korean status of alcoholics and alcohol-related health problems

Recent changes in the socioeconomic status of Korea have caused big differences in alcohol-related social and health problems. The traditional trait of drinking mild fermented beverages with nutritional side dishes and meals has shifted to drinking strongly distilled liquors without any side dishes. Moreover, the alcohol consumption per adult capita of Korea is now 8.1 liters, which parallels the level of other developed countries; it used to be 1.0 liter in 1960 and 7.0 liters in 1980, respectively. But the alcohol consumption per capita of adult males is now 18.4 liters. Consequently, the national incidence of alcohol-related diseases and accidents has rapidly increased. Korean adult males have the highest risk of the incidence of hepatoma. The rate of car accidents caused by drunken driving is about 10-fold higher than in any other developed country.

Radiation-induced muscle damage in rats after fractionated high-dose irradiation

Muscle damage in the legs of male Wistar rats after exposure to high-dose radiation was evaluated by observations of biopsied tissue made with light and transmission electron microscopy. Both legs of about 40 mature male Wistar rats were exposed to 80 Gy 6 MV X rays from a linear accelerator given in 40 fractions of 2 Gy. At intervals starting from the first day to 12 months after irradiation, serial muscle biopsies were obtained by sacrificing the rats on different days according to the experimental design. The irradiated gastrocnemius muscle displayed a progressive structural change that began immediately after the completion of the exposures. Morphological changes in irradiated muscles were characterized by hemorrhage, lymphocytic infiltration and obvious vascular destruction. Increased amounts of collagen between the muscle fibers were present even at 12 months after irradiation. There were significant changes in the number, size and structure of mitochondria in the muscle cells from the first day until 1 year after irradiation. Even 12 months after the final exposure, no recovery of muscle tissue was seen by light and transmission electron microscopy.

The effect of aqueous humor suppressants on intravitreal gas bubble duration in rabbits

PURPOSE

To evaluate the effect of topical aqueous humor suppressants on the absorption of intravitreal perfluorocarbon gases.

METHODS

Sulfur hexafluoride or perfluoropropane was injected intravitreally in five rabbits. Time to gas disappearance was measured in eyes treated with topical aqueous humor suppressants and in those not treated.

RESULTS

The mean time (+/- SD) to disappearance of 0.4 cc of sulfur hexafluoride was 5.6 +/- 0.9 days, which was prolonged by 43% to 8.0 +/- 0.7 days with topical aqueous humor suppressants (P = .009). The mean time (+/- SD) to disappearance of 0.2 cc of perfluoropropane was 18.4 +/- 1.9 days, which was prolonged by 55% to 28.6 +/- 2.7 days with topical aqueous humor suppressants (P = .009).

CONCLUSION

Aqueous suppressants prolong sulfur hexafluoride and perfluoropropane intravitreal gas bubble duration in rabbits.

Preliminary results of a new covered biliary metal stent for malignant biliary obstruction

BACKGROUND AND STUDY AIMS

The biliary stents in current use have a tendency to be blocked, so we designed a self-expandable metal stent covered with polyurethane to overcome the risk of tumor ingrowth of uncovered self-expandable metal stents. To evaluate the success and the effectiveness of the new membrane-covered self-expandable metal stent (covered modified Gianturco biliary stent), we studied patients with biliary obstruction caused by biliopancreatic carcinoma.

PATIENTS AND METHODS

We retrospectively evaluated 47 patients with malignant biliary obstruction to receive either a newly developed self-expandable metal stent covered with polyurethane (21 cases) or an uncovered metal stent (Strecker stent or Wallstent, 26 cases) by the endoscopic transpapillary route.

RESULTS

The success rate of stent insertion and drainage effect of stent showed no statistical difference in patients with a new membrane-covered self-expandable metal stent compared with those with an uncovered metal stent (90.4% vs. 88.5%, P > 0.05; and 100% vs. 95.6%, P > 0.05, respectively). The median patency of the stent was slightly prolonged in patients with a membrane-covered self-expandable metal stent, but there was no statistical difference between two groups (267 vs. 233 days, P > 0.05). The rate of early complication related to stent insertion showed no significant difference between the two groups. During the follow-up period, stent occlusion due to tumor ingrowth occurred in two patients (10.5%) in the membrane-covered, self-expandable stent group, compared with six patients (26.1%) in the uncovered metal stent group. The membrane-covered metal stent was removed successfully and a polyethylene stent was reinserted in one patient who had developed tumor overgrowth.

CONCLUSIONS

A new, membrane-covered, self-expandable metal stent has a tendency towards better long-term patency than the uncovered metal stent, and it can effectively prevent tumor ingrowth into the stent. Also it is possible to remove an occluded membrane-covered stent. However, a case-controlled study, including a larger patient number, and long-term follow-up are needed.

Thin-layer chromatography and histochemistry analyses of neutral lipids in Helisoma trivolvis infected with four species of larval trematodes

Thin-layer chromatography (TLC) and histochemistry studies were done on the neutral lipid content of the digestive gland gonad (DGG) complex of Helisoma trivolvis infected with four species of larval trematodes. Two of the species, Ribeiroia sp. and Zygocotyle lunata, contained rediae, and the two others, Spirorchis sp. and an armatae xiphidiocercaria, contained sporocysts. The DGG infected by each species had its own distinct neutral lipid profile as determined by TLC. All profiles differed from that of the uninfected DGG. Densitometric TLC studies showed some quantitative differences in free sterols in infected versus uninfected DGGs. Visual observations of the chromatograms showed that all four species caused a marked elevation in the triacylglycerol fraction in the DGG as compared with the uninfected controls. Oil Red O (ORO) histochemistry studies showed that levels of neutral lipids were increased in the DGGs of infected versus uninfected samples. These histochemistry studies showed a variable distribution of neutral fat, ranging from its absence in the cercariae of Z. lunata and the armatae xiphidiocercaria to ORO-positive droplets in the excretory system of Ribeiroia sp. Rediae and sporocysts contained ORO-positive material in the body wall and in the space between cercariae.

The clinical significance of molecular response in indolent follicular lymphomas

Most patients with follicular lymphoma (FL) achieve a complete response (CR) after treatment, but eventually most of them, particularly those with stage IV, relapse due to minimal residual disease (MRD). The t(14;18) gives rise to a rearrangement of the bcl-2 oncogene that constitutes an excellent target for detection of MRD by polymerase chain reaction (PCR). One hundred ninety-four previously untreated patients with indolent FL and detectable bcl-2 rearrangement were studied. The PCR assay was used to detect bcl-2-rearranged cells in blood and marrow before and after treatment. Molecular response rate was 37%, 53%, 56%, and 66% at 3 to 5, 6 to 8, 9 to 14, and 15 to 18 months from the start of therapy, respectively. Although molecular response was higher among clinical CRs, one third of partial responders at 3 to 5 months also achieved a molecular response. Patients who achieved a molecular response during the first year of treatment had a significantly longer failure-free survival (FFS) than those who did not (4-year FFS: 76% v 38%, respectively; P < .001). Similar results were also observed in the subset of patients in clinical CR 1 year after treatment. By multivariate analysis, beta2-microglobulin (beta2-M; P < .01), and molecular response (P < .001) were the most important variables associated with outcome. When we combined beta2-M and molecular response, three prognostic groups emerged: (1) low beta2-M and molecular responders, (2) low beta2-M and nonresponders or high beta2-M and responders, and (3) high beta2-M and nonresponders. The 4-year FFS of these 3 groups were 86%, 65%, and 23%, respectively. Finally, patients who achieved molecular response and sustained it had better FFS than those who either reverted back to PCR-positive or who never achieved molecular response. Serial PCR analysis to determine the molecular response in FL correlates well with outcome especially when combined with pretreatment beta2-M.

Unilateral peripapillary myelinated retinal nerve fibers associated with strabismus, amblyopia, and myopia

PURPOSE

To describe the association of unilateral peripapillary myelinated retinal nerve fibers with myopia, strabismus, and amblyopia and to propose a possible pathologic mechanism.

METHODS

Four patients who have the findings associated with unilateral peripapillary myelinated nerve fibers are described and reviewed.

RESULT

All patients had poor visual outcomes despite treatment with full cycloplegic refraction and appropriate patching.

CONCLUSIONS

Although the origin of this association is unknown, we believe that peripapillary myelinated nerve fibers in a unilateral myopic eye may be secondary to an imbalance between the process of myelination and the formation of the lamina cribrosa. Good results have been reported with amblyopic therapy; however, it is our experience that these patients are somewhat refractory to amblyopia therapy.

Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura: report of seven patients and a meta-analysis

We present the results of a meta-analysis using clinical data obtained from seven of our patients and 24 previously reported patients with idiopathic thrombocytopenic purpura complicated by intracranial hemorrhage. Twenty-four had an intracerebral hemorrhage (ICH) and seven had a subdural hematoma (SDH). Mean age of the patients with ICH was significantly younger than those with SDH. The mortality rate of ICH associated with ITP was similar to that of spontaneous ICH. All seven patients with SDH improved without sequelae.

Association of HLA phenotype and response to interferon-alpha in patients with chronic myelogenous leukemia

Twenty to 25% of patients with chronic myelogenous leukemia (CML) treated with interferon-alpha (IFN-A) achieve a complete cytogenetic response (CCR). However, cells bearing rearrangement of BCR/ABL can still be detected many years after achieving a CCR despite the absence of clinical evidence of active disease. It has been suggested that the disease is kept in a dormant state by immune mechanisms. How this is achieved is not known, but it has been speculated that p210BCR/ABL might be presented by malignant cells through HLA molecules, thus making them the target for specific immune cell killing. Because specific peptides will be expressed in association with certain HLA molecules, different HLA phenotypes could be associated with different response rates to IFN-A. The response to IFN-A-based therapies in 239 patients with chronic phase CML was analyzed according to their HLA phenotype. One hundred and ninety-four (81%) achieved complete hematologic response, 142 (59%) had a cytogenetic response which was major (MCR) in 93 patients (39%): complete (CCR) in 71 (30%) and partial (PCR) in 22 (9%). Patients with an HLA-B27 phenotype had the best response rate to IFN-A: 10 of 14 (71%) had an MCR, including eight (57%) with a CCR (P=0.02). Patients with HLA-B35, -A3, and -A31 also showed a trend towards a higher response rate, whereas patients with HLA-B18 had the lowest response rate (MCR 17%). Patients with HLA-B27 and those with HLA-A31 showed a trend for better survival, whereas patients with HLA-A2, -B7, or -B18 had a trend for shorter survival. We conclude that response to IFN-A in patients with CML may be associated with the HLA phenotype. However, a much larger population would be required to determine if the impact of HLA phenotype on survival is independent of other clinical prognostic features. These findings could be relevant for the understanding of immune mechanisms of control of CML and possibly the design of immune therapy for this disease.

Hepatitis B vaccination and reduced risk of primary liver cancer among male adults: a cohort study in Korea

BACKGROUND

Primary liver cancer is an important health problem in Korea, where hepatitis B virus (HBV) infection is prevalent. The authors conducted a prospective cohort study to evaluate the protective effect of HBV vaccination against liver cancer in adults.

METHODS

A total of 370,285 males aged > or = 30 comprised the study population. They were clinically free of liver diseases, and had not been vaccinated against HBV at enrolment. The results of HBV surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) marker positivity and those of the vaccination programme which took place during 1985 were used for the construction of the cohort. About 5% (n = 18,914) were HBsAg positive, 78,094 were anti-HBs positive, and 273,277 were negative for both. Among the candidates for HBV vaccination (n = 273,277), 35,934 (13.2%) people had been vaccinated against HBV during 1985. Cases of liver cancer were ascertained by record linkage and from medical records covering 1986-1989. A multivariate log-linear model was used to test statistical significance and to estimate relative risks (RR).

RESULTS

The total follow-up period was 1,404,566 person-years, with an average of 3 years and 10 months. A total of 302 incident cases were ascertained. The overall incidence rate of liver cancer was 21.7 per 100,000 person-years. With reference to the incidence level among the unvaccinated and uninfected, the RR of primary liver cancer among the chronically infected and that of the unvaccinated and infected was 18.1 (95% CI: 14.2-22.9) and 0.34 (95% CI: 0.19-0.60), respectively. The RR among the vaccinated group was 0.58 (95% CI: 0.31-1.09).

CONCLUSIONS

This study suggested that artificial immunization through HBV vaccination, even in adulthood, reduces the risk of liver cancer. It might also offer a practicable means of primary prevention, especially in areas with hyperendemicity of HBV infection.