Homozygosity and linkage-disequilibrium mapping of the urofacial (Ochoa) syndrome gene to a 1-cM interval on chromosome 10q23-q24

The urofacial (Ochoa) syndrome (UFS) is a rare autosomal recessive disease characterized by congenital obstructive uropathy and abnormal facial expression. The patients present with enuresis, urinary-tract infection, hydronephrosis, and voiding dysfunctions as a result of neurogenic bladders. To map the UFS gene, a genome screen using a combination of homozygosity-mapping and DNA-pooling strategies was performed in 20 selected patients, one patient pool, and three control pools (unaffected relatives). After analyses of 36 randomly chosen markers, D10S677 was identified as being linked to and associated with UFS, as suggested by a significant excess of homozygosity in patients compared with that in unaffected relatives (P < 10(-6)), as well as by the allelic-frequency differences between the patient pool and control pools. Ten additional markers flanking D10S677 and covering a 22-cM region then were analyzed to fine-map the UFS gene by use of haplotype (linkage disequilibrium) analysis. All 31 patients were found to be homozygous for two closely linked markers (D10S1726 and D10S198) located approximately 5 cM telomeric to D10S677, whereas only 12% of the unaffected relatives were homozygous for both markers (P < 10(-19)). Several patients are heterozygous at two markers immediately flanking D10S1726/D10S198, one on the centromeric side (D10S1433) and the other on the telomeric side (D10S603). These recombinational events place the UFS gene near D10S1726/D10S198 and within a 1-cM interval defined by D10S1433 and D10S603 on chromosome 10q23-q24.

International clinical trials of HIV vaccines: II. phase I trial of an HIV-1 synthetic peptide vaccine evaluating an accelerated immunization schedule in Yunnan, China

A Phase 1, double-blind, placebo controlled trial was conducted in Longchuan County, China, to evaluate the safety and immunogenicity of a prototype HIV-1 synthetic peptide vaccine in a target population at risk for HIV infection, and to establish the infrastructure for future large-scale HIV vaccine efficacy trials. Subjects were randomly assigned to receive 100 microg or 500 microg of vaccine or alum placebo, and were given three injections at an accelerated 0, 1, and 2 month schedule. The vaccine was well tolerated with no significant local or systemic reactions observed in any subjects. Fifty-five percent (100 microg dose) and 64% (500 microg dose) of subjects who received the vaccine produced binding antibody to the immunogen as determined by ELISA. However, HIV-1 (MN) neutralizing antibody was detected in only 23% (3/13) of subjects with detectable HIV-1 specific binding antibody. It was concluded that this prototype HIV-1 synthetic peptide vaccine was well tolerated, safe and immunogenic, and that a 0, 1, 2 month schedule was not as effective in stimulating HIV-1 specific neutralizing antibodies compared with previous trials utilizing a 0, 1, 6 month schedule. Finally, this trial demonstrated that well-designed HIV vaccine trials can be performed at this clinical trials site in Yunnan, China, and that this site should be considered for conducting larger safety, immunogenicity and efficacy trials of candidate HIV vaccines.

Biological growth on a surface

A new biological growth model is introduced. After random selection of possible growth sites, cells are added in an allowable random direction. Unlike the Eden model, the current model is grid independent and can be adapted to any curved surface. Growths of colonies of as many as 10(5) cells are simulated on planar, cylindrical, and spherical surfaces. It is found that the interior density is constant, whereas the boundary is fractal.

Role of acetyltransferases in the metabolism and carcinogenicity of aromatic amines

The genotoxicity of N-substituted aryl compounds is dependent on their conversion to reactive metabolites, frequently through the production of reactive N-acetoxyarylamines. This activation is accomplished by acetyltransferases that are widely distributed. In the rat, the production of N-acetoxyarylamines has been most clearly related to the induction of tumors in the mammary gland, but this pathway also appears to be an important factor in the production of tumors in the liver, Zymbal gland and gastrointestinal tract. Expression of rat acetyltransferases responsible for acetylation of the nitrogen and the oxygen of arylamine derivatives (i.e., acetyltransferases 1 and 2) in bacterial cells has now permitted experiments which demonstrate that these enzymes exhibit good affinities for and N-acetylation of the endogenous arylalkylamines derived from tryptophan, i.e., tryptamine, 5-hydroxytryptamine (serotonin) and 5-methoxytryptamine, the immediate metabolic precursor of melatonin. Evidence that these reactions are likely to reflect real biological potentials is bolstered by histological localization of acetyltransferase mRNAs with synthetic antisense oligodeoxynucleotide probes. The results of these studies in rat indicate that the expression of acetyltransferase in tissues of the central nervous, gastrointestinal, urinary and reproductive systems is highly regulated, as it is in other organs commonly associated with aromatic amine carcinogenicity. Similar experimental approaches have been successful with human liver, mammary gland, kidney and bladder preparations. These observations give evidence that genotoxic N-acetoxyarylamines are produced by acetyltransferases that can metabolize, and possibly modulate, the hormonal and neurotransmitter effects of endogenous arylalkylamines. These relationships may help explain the occasional induction of tumors in organs not usually considered as targets of aromatic amines, as well as raise the possibility that the production of N-oxidized endogenous substrates may represent a mechanism for tumor induction in the absence of exogenous carcinogens.

Immunogenicity and protection in small-animal models with controlled-release tetanus toxoid microparticles as a single-dose vaccine

Tetanus toxoid (TT) was encapsulated in microparticles prepared from polylactide-co-glycolide polymers by a solvent-evaporation technique. Combinations of small- and large-sized microparticles with controlled-release characteristics were used to immunize Sprague-Dawley rats, and the antibody responses were monitored for 1 year. For comparison, control groups of rats were immunized at 0, 1, and 2 months with TT adsorbed to alum. The antibody responses generated by the TT entrapped in microparticles were comparable to those generated by TT adsorbed to alum in control groups from 32 weeks onwards. Microparticles with a single entrapped antigen (TT) induced better antibody responses than microparticles with two antigens (TT and diphtheria toxoid) entrapped simultaneously. A combination vaccine consisting of TT adsorbed to alum and also entrapped in microparticles gave the best antibody responses. In an inhibition assay designed to determine the relative levels of binding of antisera to the antigens, the sera from the microparticle- and the alum-immunized animals showed comparable levels of binding. In addition, in a passive-challenge study with mice, TT adsorbed to alum and TT entrapped in microparticles provided equal levels of protection against a lethal challenge with tetanus toxin. An intradermal-challenge study was also performed with rabbits, which showed similar levels of protection in sera from alum- and microparticle-immunized animals at 4, 12, and 32 weeks after immunization.

Controlled release microparticles as a single dose hepatitis B vaccine: evaluation of immunogenicity in mice

Hepatitis B surface antigen (HBsAg) was encapsulated in microparticles prepared from polylactide-co-glycolide (PLG) and polylactide (PLA) polymers using a solvent evaporation process. The immunoreactivity of the entrapped antigen was investigated by SDS-PAGE and Western blot. The microencapsulation process was modified to obtain both small (< 10 microns) and large microparticles (10-100 < microns). 80% of the antigen was encapsulated. Various combinations of small and large microparticles with controlled release characteristics were investigated in CD1 mice. Groups of animals were immunized with 30 micrograms equivalent of HBsAg in microparticles per animals. The control group received, three injections of 10 micrograms of HBsAg on alum at 0, 1 and 6 months. Results indicated that a single injection of HBsAg in microparticles could maintain the antibody response at a level comparable to the three-injection alum schedule for at least 1 year. An in vitro inhibition assay was developed to demonstrate that antigen-antibody reactivity were comparable for the microparticle immunized mice and the alum immunized mice. A competition assay with a monoclonal antibody specific for the neutralizing epitope of HBsAg demonstrated comparable binding for the sera from the microparticle and alum immunized mice.

Light-induced fluorescence spectroscopy to differentiate benign and malignant uterine cervical lesions

In Taiwan, cervical cancer is the leading malignancy among women. For the early detection of cervical neoplasia, light-induced fluorescence spectroscopy was conducted ex vivo to assess the ability of this technique to differentiate cervical neoplastic tissue (20 samples) from normal or inflammatory cervical tissue (37 samples) at an excitation wavelength of 280 nm. The principal fluorescent peaks occurred within +/- 5 nm of 330 nm and 470 nm emission. At 330 nm emission, the spectrum of the normal or inflammatory tissue was significantly stronger than that of the neoplastic tissue after are normalization. However, at 470 nm emission, the spectrum of the normal or inflammatory tissue was significantly weaker than that of the neoplastic tissue. A diagnostic algorithm based on the ratio of relative intensities of 330 nm to 470 nm emission within the 5 +/- nm peak area of each sample was calculated and paired. The ratios showed that histologically neoplastic lesions could be distinguished from inflammatory samples using a 280-nm-excitation wavelength with a sensitivity, specificity and positive predictive value of 94%, 82% and 73%, respectively. The average ratio of malignant or dysplastic cervical samples was significantly greater than that of the inflammatory samples (p < 0.001). Our ex vivo study indicated that light-induced fluorescence spectroscopy may be useful in differentiating malignant or premalignant from normal or inflammatory cervical tissue.

Bone-resorptive cytokine gene expression in periapical lesions in the rat

Periapical bone destruction is an important pathogenic sequela of pulpal infection. Recent findings from this laboratory have demonstrated that most bone-resorbing activity in extracts of rat periapical lesions can be neutralized by an anti-interleukin (IL)-1 alpha antiserum. To further clarify pathogenic mechanisms, bone-resorptive cytokine messenger RNA (mRNA) expression was analyzed in developing rat periapical lesions. The molar teeth of 20 Sprague-Dawley rats were surgically exposed and left open to permit infection from the oral environment. Total cell RNA was isolated from periapical granuloma tissue obtained on days 3, 7, 15 and 30 after exposure. mRNA for IL-1 alpha, IL-1 beta and tumor necrosis factor alpha (TNF-alpha) was amplified by reverse transcription polymerase chain reaction, and levels were approximated by comparison to the parallel amplification of the housekeeping gene glyceraldehyde phosphate dehydrogenase. IL-1 alpha and TNF-alpha mRNA were both highly expressed beginning on day 7, increased on day 15, and declined somewhat on day 30. In contrast, IL-1 beta mRNA was expressed at much lower levels, but with similar kinetics. The kinetics of steady state IL-1 alpha and TNF-alpha mRNA levels were confirmed using the quantitative RNase protection assay, whereas IL-1 beta mRNA could not be detected by this technique. IL-1 alpha mRNA-expressing cells were identified using in situ hybridization and included infiltrating macrophages, as well as resident fibroblasts, endothelial cells and osteoclasts. These results demonstrate that the IL-1 alpha and TNF-alpha genes are highly expressed in developing periapical lesions in the rat and confirm previous studies at the protein level in this model.

Serial changes in ultrasound-guided fine needle aspiration cytology in subacute thyroiditis

OBJECTIVE

To elucidate the serial cytologic presentations of subacute thyroiditis (SAT) with ultrasound-guided fine needle aspiration (FNA).

STUDY DESIGN

Nine patients with clinically evident SAT were recruited; serial sonography and ultrasound-guided fine needle aspiration cytology were performed.

RESULTS

Sixty-one follow-up examinations were obtained in nine patients. The follow-up ranged from 1 to 5 months (mean, 3.3). Initial sonographic presentations revealed focal hypoechogenicity in three patients and multiple hypoechogenicity in six. Initial cytologic findings showed chiefly enlarged, degenerated follicular cells with prominent nucleoli, lymphocytes, colloid substance, multinucleated giant cells and neutrophils. Regression of sonographic hypoechogenicity paralleled the disappearance of acute inflammatory cells and enlarged, degenerated follicular cells and the appearance of cohesive follicles.

CONCLUSION

Improvement of SAT in sonography is fairly parallel to that in cytology even though there is a lag of improvement in the latter. Smear pattern is also related to the clinical stage of SAT. Ultrasound-guided FNA is a convenient method of obtaining sufficient and representative specimens in patients with SAT.

Specific immobilization of firefly luciferase through a biotin carboxyl carrier protein domain

Firefly luciferase (Photinus pyralis) was fused with a histidine tag and a biotin carboxyl carrier protein (BCCP) domain at its amino terminus. Highly purified recombinant luciferase was obtained by a one-step purification protocol, utilizing immobilized metal affinity chromatography. The novel BCCP-luciferase had properties, stability, and activity similar to those of native luciferase. The biotin molecule on the BCCP domain allowed specific immobilization of BCCP-luciferase on avidin-coated surfaces via the biotin-avidin interaction.

Regression calibration in failure time regression

In this paper we study a regression calibration method for failure time regression analysis when data on some covariates are missing or mismeasured. The method estimates the missing data based on the data structure estimated from a validation data set, a random subsample of the study cohort in which covariates are always observed. Ordinary Cox (1972; Journal of the Royal Statistical Society, Series B 34, 187-220) regression is then applied to estimate the regression coefficients, using the observed covariates in the validation data set and the estimated covariates in the nonvalidation data set. The method can be easily implemented. We present the asymptotic theory of the proposed estimator. Finite sample performance is examined and compared with an estimated partial likelihood estimator and other related methods via simulation studies, where the proposed method performs well even though it is technically inconsistent. Finally, we illustrate the method with a mouse leukemia data set.

International clinical trials of HIV vaccines: I. Phase I trial of an HIV-1 synthetic peptide vaccine in Bangkok, Thailand

A randomized, double blind, placebo controlled Phase I trial of a prototype human immunodeficiency virus type 1 (HIV-1) synthetic peptide vaccine was conducted in Bangkok, Thailand, to evaluate the safety and immunogenicity of the vaccine in a population of healthy adults at low risk for HIV infection, and to establish essential infrastructure for future HIV vaccine trials in Thailand. Thirty volunteers (25 males; 5 females) were recruited and randomized into 3 groups, receiving 3 intramuscular injections of either 100 micrograms vaccine (N = 12) or 500 micrograms vaccine (N = 12) or alum placebo (N = 6) on weeks 0, 4 and 25. The vaccine was well tolerated without any serious adverse effects. HIV-1 specific ELISA responses were detected in 20/24 subjects who received the vaccine, with V3 binding antibody titers ranging from 1:69 to 1:5,041. HIV-1 (MN) specific neutralizing antibody was detected in 19/20 of subjects with detectable HIV-1 specific binding antibody. Neutralization titers ranged from 1:14 to 1:1,294, which were less than titers observed in HIV-infected subjects. The results of this study indicate that the vaccine was well tolerated, and that the vaccine stimulated anti-HIV humoral immune responses in Thai subjects. The successful undertaking of this first HIV vaccine trial conducted in Thailand provided important preparatory information surrounding volunteer recruitment and motivations, and paves the way for future trials of HIV vaccines in Thailand.

Approached to monitoring the results of long-term disease prevention trials: examples from the Women's Health Initiative

We contrast monitoring therapeutic trials with monitoring prevention trails. We argue that in monitoring prevention trials one should place more emphasis on formally defined global measures of health, not simply on a single targeted disease, particularly when an intervention may reduce the incidence of some diseases but increase the incidence of others. We describe one approach, illustrated by the Women's Health Initiative. For each of several sets of hypothetical interim results ("scenarios"), members of the Data and Safety Monitoring Committee (DSMC) were asked whether they would continue or stop the trial. In parallel with this exercise, various statistical methods of monitoring that are based on (1) the primary targeted disease, (2) a combination of various disease outcomes, or (3) a mixture of both were applied to these scenarios. One objective was to find a statistical approach that mirrors the majority view of the DSMC. A second objective was to stimulate discussion among DSMC members in preparation for their task of monitoring the trial as the real data become available. We found that no single method fully matched the majority vote of the DSMC. However, a mixed approach requiring the primary outcome to be significant and the global index to be "supportive," with separate monitoring of adverse effects, corresponded with the majority vote quite well. This approach maintains the emphasis on the primary hypothesis while assuring that broader safety and ethical issues of multiple diseases are incorporated.

Colonoscopic screening for families of patients with colorectal cancer

We conducted a prospective study using primary colonoscopy in the families of patients with surgically treated colorectal cancer (CRC) to evaluate its feasibility as a screening method for CRC. The presumed detection sensitivity of sigmoidoscopy in this group was also evaluated. Over a 3-year period, 142 first-degree relatives (73 men and 69 women) of 117 patients with CRC participated in this colonoscopic screening study. The average age at presentation for examination was 49.1 years (range, 31-79 yr). Forty-nine patients had adenomatous polyps (AP) and four patients had cancer, yielding a frequency of 37% (53/142). Thirty-six family members were under 40 years of age, eight of whom had AP. In total, there were 111 AP and four invasive cancers; 42% (48/111) of AP and 75% (3/4) of cancers were beyond the reach of conventional flexible sigmoidoscope. Of 53 patients with AP or cancer in the large bowel, 36 had AP or cancer in the distal colon (rectosigmoid region and descending colon), 15 (42%) of whom were found to have at least one AP or cancer in the proximal colon (proximal to the descending colon). The remaining 17 patients' lesions were confined to the proximal colon, and would not have been detected with a flexible sigmoidoscope. Sigmoidoscopy in high-risk patients with neoplasm in the large bowel has a sensitivity of 68%. We conclude that a vigorous surveillance program using primary colonoscopy should be set up for those who are first-degree relatives of patients with CRC. Routine examination should start at the age of 40, and the entire colon should be evaluated.

Synthetic peptides entrapped in microparticles can elicit cytotoxic T cell activity

Peptides from Plasmodium berghei circumsporozoite protein (CS) and influenza A virus nucleoprotein (NP) were entrapped in microparticles prepared from poly (lactide-co-glycolide) polymers, and the microparticles were administered parenterally to mice. After immunization with single or multiple doses, splenocytes were tested for a cytotoxic T cell (CTL) response and high levels of CTL activity were detected. The CTL induced were CD8+, MHC class I restricted, and could recognize virus infected cells. Peptide entrapped in microparticles of mean size < 500 nm were better inducers of CTL than larger microparticles (mean > 2 microns and above). Microparticles could also be used to deliver lipid modified peptides (lipopeptides) and elicited higher levels of cytolytic activity than either free peptide in microparticles or lipopeptide alone. Microparticles provide a novel way of inducing a CTL response using synthetic peptides.

TNF- and cancer therapy-induced apoptosis: potentiation by inhibition of NF-kappaB

Many cells are resistant to stimuli that can induce apoptosis, but the mechanisms involved are not fully understood. The activation of the transcription factor nuclear factor-kappa B (NF-kappaB) by tumor necrosis factor (TNF), ionizing radiation, or daunorubicin (a cancer chemotherapeutic compound), was found to protect from cell killing. Inhibition of NF-kappaB nuclear translocation enhanced apoptotic killing by these reagents but not by apoptotic stimuli that do not activate NF-kappaB. These results provide a mechanism of cellular resistance to killing by some apoptotic reagents, offer insight into a new role for NF-kappaB, and have potential for improvement of the efficacy of cancer therapies.

Light-induced fluorescence spectroscopy: a potential diagnostic tool for oral neoplasia

For the early detection of oral neoplasia, light-induced fluorescence spectroscopy was used to measure the fluorescence emission of malignant (squamous cell carcinoma & verrucous carcinoma) and premalignant (epithelial dysplasia, hyperkeratosis & lichen planus) oral tissues as well as normal oral mucosa ex vivo to assess the ability of this technique to distinguish neoplastic from normal oral tissues. The emission spectra of histologically normal and neoplastic oral tissues were obtained under excitation wavelengths varied from 270 nm to 400 nm at 10-nm intervals. At 300-nm excitation, the most intensely fluorescent peak occurred at 330-nm and 470 nm emission. At 330-nm emission, the spectrum of the malignant oral tissue was significantly stronger than that of the normal oral mucosal tissue after area normalization. However, at 470-nm emission, the spectrum of the malignant oral tissue was significantly weaker than that of the normal oral mucosal tissue. A diagnostic algorithm based on the ratio of relative intensities of 330 nm to 470 nm emission within the +/-5 nm peak area of each sample was calculated and paired. The histogram of ratios showed that histologically neoplastic oral tissues could be distinguished from normal oral mucosal tissues using the 300 nm excitation wavelength. The average ratio of malignant or premalignant oral samples was significantly greater than that of the normal oral mucosal samples (p < 0.001). This ex vivo study indicated that fluorescence spectroscopy may be useful in differentiating malignant or premalignant oral tissue from normal oral mucosa.

Self-care of adults with non-insulin-dependent diabetes mellitus: influence of family and friends

This study examined the relationships among the source of support, universal self-care, and health-deviation self-care behaviors in adults who control their blood glucose with oral agents. A descriptive correlational design was used. Respondents completed a total of 51 items on questionnaires. Significant differences were found between the group with family-plus-friend support and the group without support in relation to universal self-care and health-deviation self-care. A significant difference was also found between the group with family-plus-diabetes-group support and the group without support in relation to health-deviation self-care. Subjects who received support from friends in addition to family support reported higher universal and health-deviation self-care behaviors than those without support. Support systems explained 23% of variance in universal self-care and 17% of variance in health-deviation self-care.

Response surface method: a novel strategy to optimize iontophoretic transdermal delivery of thyrotropin-releasing hormone

PURPOSE

To maximize the iontophoretic transdermal delivery rate of thyrotropin-releasing hormone (TRH) facilitated by periodically monophase-pulsed current across excised skin.

METHODS

The pH of the buffer, the ionic strength in the solution, the frequency of the periodically monophase-pulsed current and the current on/off ratio were chosen as the key variables. A response surface method was applied to optimize the transdermal delivery rate of TRH under different operational conditions.

RESULTS

The optimum operating conditions were achieved via experimentation based on the response surface method by systematically adjusting the pH of the buffer, the ionic strength in the solution, the current amplitude, frequency and the active temporal ratio of the pulsed current. The rate of permeation of TRH crossing the skin during iontophoresis varied from two to ten-fold, depending on operating conditions.

CONCLUSIONS

Only a few steps, two in this work, were needed to reach the optimal. The response surface near the region of the maximal point was thoroughly described with a quadratic function. A maximal transdermal rate of permeation of TRH, 103.2 micrograms h-1 cm-2, was obtained when the donor solution was at pH = 7.0, ionic strength = 0.037, and with a periodically monophase-pulsed current iontophoresis with duty cycle = 75%. The effect of pulse frequency was not statistically significant.

Comparison of adjuvant formulations for cytotoxic T cell induction using synthetic peptides

We have investigated the capacity of synthetic peptides delivered in different adjuvant formulations to induce cytotoxic T lymphocyte (CTL) responses to a class I H-2Kd-restricted Plasmodium berghei circumsporozoite epitope, CS 252-260. Using three immunogen formulations: soybean emulsion; Montanide ISA720; and lipopeptide (P3-CS), we first evaluated the effects of immunization routes on CTL induction. No CTL response was induced in mice immunized s.c. or i.p. with CS peptide formulated in soybean emulsion. In contrast, immunization with lipopeptide P3-CS either s.c. or i.p. effectively primed for CTL. Interestingly, CS peptide emulsified in Montanide ISA720 induced a CTL response only when delivered s.c. and not i.p., indicating the critical influence of immunization routes on CTL induction. We then compared the effectiveness of eight adjuvant formulations to induce CTL response following a single s.c. immunization. Notably, lipopeptide P3-CS and CS peptide admixed with P3 or POE lipid molecules stimulated a vigorous CTL response. However, only mice immunized with P3-CS and CS peptide admixed with P3 molecule generated long-lived CTL which persisted in vivo for 5 months. Thus, based on a simultaneous comparison of the different adjuvant formulations, we demonstrated that the conjugated and unconjugated P3 lipopeptides were the most effective immunogens for eliciting primary and memory CTL in mice.

Mass allele detection (MAD) of rare 5-HT1A structural variants with allele-specific amplification and electrochemiluminescent detection

A strategy is described that exploits allele-specific amplification (ASA-PCR) and electrochemiluminescence (ECL) detection technology to rapidly and cheaply screen large numbers of DNAs arranged in pooled matrices in order to identify individual nucleotide sequence variants. To demonstrate this strategy, a large genomic DNA collection was screened for two nucleotide variants in the 5-HT1A serotonin receptor gene and individual heterozygotes were identified. Conversion of two SSCP variants to allele-specific PCR polymorphisms was accomplished, and PCR product capture and ECL detection were enabled by the covalent addition of biotin to allele-specific PCR primers and ruthenium to the nonspecific PCR primer. A two-level DNA pooling strategy was used to reduce the number of individual PCR reactions required. Pooling experiments established that ASA-PCR with ECL detection is sufficiently sensitive to reproducibly detect a single specific allele in the presence of a 40-fold excess of genomic DNA from individuals negative for the specific allele. The detection sensitivity of the ECL device and the design of the pooled DNA arrays reduced the number of PCRs required to detect the rare individuals with the variant sequences by approximately 90%. This strategy is called mass allele detection (MAD).