Inefficient in vivo repair of mismatches at an oncogenic hotspot correlated with lack of binding by mismatch repair proteins and with phase of the cell cycle

Repair rates of mismatched nucleotides located at an activating hotspot of mutation, H-ras codon 12, have been analyzed in vivo in mammalian cells. Repair rates at codon 12 are significantly improved in cells synchronized to the G(1) stage of the mammalian cell cycle as compared with non-synchronous cells, demonstrating that mismatch repair mechanisms are active in G(1). Repair rates in non-synchronous cells for the same mismatches at a nearby non-hotspot of mutation, H-ras codon 10, are also significantly improved over repair rates at codon 12 in non-synchronous cells, demonstrating that DNA mismatch repair rates can differ depending on the sequence context. These results suggest that inefficiencies in mismatch repair are responsible, at least in part, for the well documented hotspot of mutation at codon 12. Further experiments involving gel-shift analysis demonstrate a mismatch-specific binding factor for which the degree of binding correlates with in vivo repair rates for each mismatch tested at the codon 12 location. This binding factor appears to be the hMutSalpha heterodimer as identified by monoclonal antibody assay and inhibition of binding by ATP. Furthermore, a lack of binding is observed only for G:A mismatches at the codon 12 location. This lack of binding correlates with the low rate of repair observed in vivo for G:A mismatches at codon 12 versus the improved repair rates for G:A mismatches at codon 10. This may have biological relevance in that G:C-->T:A tranversions are a common mutation at this location in naturally occurring human tumors. These results suggest that there is lowered efficiency in the kinetics of mismatch repair at codon 12. Mismatches at this location are therefore more likely to be replicated before repair, thus resulting in a mutation.

Association of Blood Clotting Factors I and VII with Phospholipid Monolayers at the Air-Water Interface

Phospholipid monolayers adsorbed at the air-water interface are useful model membranes and have been employed to study the interactions between phospholipids and blood clotting factors I and VII. Factor I is a non-membrane-binding protein and was found to penetrate both distearoylphosphatidylcholine (DSPC) and dipalmitoylphosphatidylcholine (DPPC) monolayers at low lipid pressures. At high lipid pressures, the protein was crowded out of the interface. Factor I penetration of phospholipid monolayers was independent of hydrocarbon chain length, while penetration was maximized with electrolytes in the subphase. Factor VII is a membrane binding protein and was found to penetrate a DPPC monolayer only when electrolytes were added to the subphase. Factor VII penetrated DSPC monolayers regardless of electrolyte addition in the subphase, and its interactions with DSPC films are attributed to protein-lipid hydrophobic interactions. Copyright 1999 Academic Press.

Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: results from the San Antonio Heart Study

BACKGROUND

The prevalence of type 2 diabetes has increased in the early part of the 20th century, particularly in developing countries. There is now evidence that the prevalence also continues to increase in developed countries, including the United States. However, it is unknown whether this increase is due to a rise in the incidence of diabetes or to decreasing diabetic mortality or both.

METHODS

Participants in the San Antonio Heart Study, who were nondiabetic at baseline and who returned for a 7- to 8-year follow-up examination, were examined for secular trends in the incidence of type 2 diabetes. Risk factors for diabetes, such as obesity, were also examined. Patients were enrolled in the San Antonio Heart Study from 1979 to 1988 and 7- to 8-year incidence of diabetes was determined from 1987 to 1996.

RESULTS

A significant secular trend in the 7- to 8-year incidence of type 2 diabetes was observed in Mexican Americans (5.7% for participants enrolled in 1979 to 15.7% for participants enrolled in 1988). In non-Hispanic whites, the incidence increased from 2.6% for participants enrolled in 1980 to 9.4% for participants enrolled in 1988 (P = .07) . After adjusting for age and sex, the secular trend remained significant in Mexican Americans and borderline significant in non-Hispanic whites. This indicates that between 1987 and 1996 the 7- to 8-year incidence of type 2 diabetes approximately tripled in both ethnic groups. The overall secular trend also remained significant after adjusting for additional risk factors for diabetes, such as obesity. A rising secular trend in obesity was also observed.

CONCLUSIONS

There has been a significant increasing secular trend in the incidence of type 2 diabetes in Mexican Americans and a borderline significant trend in non-Hispanic whites participating in the San Antonio Heart Study. Unlike other cardiovascular risk factors such as lipid levels, cigarette smoking, and blood pressure, which are either declining or under progressively better medical management and control, and unlike cardiovascular mortality, which is also declining, obesity and type 2 diabetes are exhibiting increasing trends. Thus, obesity and diabetes could easily become the preeminent US public health problem.

A study of loss of heterozygosity at 70 loci in anaplastic astrocytoma and glioblastoma multiforme with implications for tumor evolution

Cancers that arise from astrocytes in the adult CNS present as either anaplastic astrocytomas (AAs) or as more aggressive glioblastomas multiforme (GBMs). GBMs either form de novo or progress from AAs. We proposed to examine the molecular genetic relationship between these CNS tumors by conducting a genome-wide allelic imbalance analysis that included 70 loci on examples of AA and GBM. We found significant loss of heterozygosity (LOH) at 13 discrete chromosomal loci in both AAs and GBMs. Loss was significant in both AAs and GBMs at 9 of these loci. AAs show the highest rates of LOH at chromosomes 1p, 4q, 6p, 9p, 11p, 11q, 13q, 14q, 15p, 17p, 17q, and 19q. GBMs showed the greatest losses at 1p, 6q, 8p, 9p, 10p, 10q, 11p, 13q, 17p, 17q, 18p, 18q, and 19q. GBMs also demonstrated significant amplification at the epidermal growth factor receptor locus (7p12). These data suggest that there are three classes of loci involved in glioma evolution. First are loci that are likely involved in early events in the evolution of both AAs and GBMs. The second class consists of AA-specific loci, typified by higher LOH frequency than observed in GBMs (4q, 6p, 17p, 17q, 19q). The third class consists of GBM-specific loci (6q, 8p, 10, 18q). Damage at these loci may either lead to de novo GBMs or permit existing AAs to progress to GBMs. Glioma-related LOH profiles may have prognostic implications that could lead to better diagnosis and treatment of brain cancer patients.

Correlation of marker values in Down's syndrome screening: the effect of dating error

Central to any screening algorithm for Down's syndrome are the values used for the parameters in the multivariate Gaussian statistical model that is used to describe the joint distribution of the marker values. There has been much discussion about the values of the means and standard deviations which are appropriate but little interest has been shown in the values of the correlation coefficients between markers. There has been some speculation that the range of parameter values quoted in the literature arises from factors such as storage of samples, between-assay effects and differences in assay methodologies. We show that gestational dating error, among other factors, could be responsible for much of the variation that is present in quoted parameter values, though the factors mentioned above clearly have an effect.

A regulatory domain (R1-R2) in the amino terminus of the N-methyl-D-aspartate receptor: effects of spermine, protons, and ifenprodil, and structural similarity to bacterial leucine/isoleucine/valine binding protein

There are complex interactions between spermine, protons, and ifenprodil at N-methyl-D-aspartate receptors. Spermine stimulation may involve relief of proton inhibition, whereas ifenprodil inhibition may involve an increase in proton inhibition. We studied mutations at acidic residues in the NR1 subunit using voltage-clamp recording of NR1/NR2B receptors expressed in Xenopus oocytes. Mutations at residues near the site of the exon-5 insert, including E181 and E185, reduced spermine stimulation and proton inhibition. Mutation NR1(D130N) reduced sensitivity to ifenprodil by more than 500-fold, but had little effect on sensitivity to spermine and pH. Mutations at six other residues in this region of the NR1 subunit reduced the potency and, in some cases, the maximum effect of ifenprodil. These mutants did not affect sensitivity to pH, glutamate, glycine, or other hallmark properties of N-methyl-D-aspartate channels such as Mg2+ block and Ba2+ permeability. Residues in this region presumably form part of the ifenprodil-binding site. To model this region of NR1 we compared the predicted secondary structure of NR1 (residues 19-400) with the known structures of 1,400 proteins. This region of NR1 is most similar to bacterial leucine/isoleucine/valine binding protein, a globular amino acid binding protein containing two lobes, similar to the downstream S1-S2 region of glutamate receptors. We propose that the tertiary structure of NR1(22-375) is similar to leucine/isoleucine/valine binding protein, containing two "regulatory" domains, which we term R1 and R2. This region, which contains the binding sites for spermine and ifenprodil, may influence the downstream S1 and S2 domains that constitute the glycine binding pocket.

Strand displacement amplification and homogeneous real-time detection incorporated in a second-generation DNA probe system, BDProbeTecET

BACKGROUND

Amplified DNA probes provide powerful tools for the detection of infectious diseases, cancer, and genetic diseases. Commercially available amplification systems suffer from low throughput and require decontamination schemes, significant hands-on time, and specially trained laboratory staff. Our objective was to develop a DNA probe system to overcome these limitations.

METHODS

We developed a DNA probe system, the BDProbeTecTMET, based on simultaneous strand displacement amplification and real-time fluorescence detection. The system uses sealed microwells to minimize the release of amplicons to the environment. To avoid the need for specially trained labor, the system uses a simple workflow with predispensed reagent devices; a programmable, expandable-spacing pipettor; and the 96-microwell format. Amplification and detection time was 1 h, with potential throughput up to 564 patient results per shift. We tested 122 total patient specimens obtained from a family practice clinic with the BD ProbeTecET and the Abbott LCx(R) amplified system for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae.

RESULTS

Based on reportable results, the BDProbeTecET results for both organisms were 100% sensitive and 100% specific relative to the LCx.

CONCLUSIONS

The BDProbeTecET is an easy-to-use, high-throughput, closed amplification system for the detection of nucleic acid from C. trachomatis and N. gonorrhoeae and other organisms.

Genetic pattern of prostate cancer progression

Genetic alterations in primary prostate cancer (CaP) have been extensively studied, yet little is known about the genetic mechanisms underlying progression of primary CaP to metastatic prostate cancer. As a result, it is not possible to distinguish clinically indolent localized disease from potentially life-threatening tumors with high metastatic potential. To address this question, we collected tissue from 34 autopsy-derived metastases, samples rarely analyzed in previous studies. These were compared to a separate set of 17 prostatectomy specimens containing 22 foci of CaP associated with 49 examples of high-grade prostatic intraepithelial neoplasia (PIN), a histological precursor of CaP. We compared the loss of heterozygosity (LOH) profiles of high-grade PIN, primary CaP and metastases by analyzing 33 microsatellite markers previously found to have high frequencies of LOH in primary CaP. These markers were on chromosomes 5q, 6q, 7q, 8p, 9p, 10q, 11p, 13q, 16q, 17, 18q and 21q. In addition, markers on chromosomes 4p, 11q, 14q and 20q with no reported LOH in primary CaP were analyzed to determine the frequency of background LOH. In PIN lesions, the rate of LOH was significant only at D5S806 (20%) and D16S422 (29%). In addition, different PIN lesions within the same prostate gland were genetically diverse, indicating divergent evolution of synchronous neoplastic precursor lesions. LOH frequency was progressively higher in primary CaP and metastatic lesions. In primary CaP, significant losses occurred at the 8p, 10q, 11p, 16q, 17p, 18q and 21q loci (range 17-43%). Distinct patterns of LOH frequencies were observed in primary CaP compared with metastases. Although some loci (D16S422, D17S960, D21S156) showed similar frequencies of LOH in primary CaP and metastatic CaP, most other loci showed up to 7-fold metastasis-related increases. The metastatic samples revealed previously unrecognized prostate cancer LOH at D5S806, D6S262, D9S157, D13S133 and D13S227. These significant stage-specific differences in LOH frequency specify genetic loci that may play key roles in CaP progression and could represent clinically useful biomarkers for CaP aggressiveness.

Rett syndrome: randomized controlled trial of L-carnitine

Rett syndrome is a severe neurodevelopmental disorder of unknown etiology, occurring almost exclusively in female patients. The etiology and functional significance of plasma carnitine deficiency seen in some patients with Rett syndrome is unknown. To investigate whether L-carnitine might be of benefit in Rett syndrome, a randomized, placebo-controlled, double-blind crossover trial of L-carnitine has been completed in 35 subjects. Eight-week treatment phases were completed for both a placebo and L-carnitine. Outcome was measured by parents/caregivers and at medical follow-up using three established tools: the Rett Syndrome Motor Behavioral Assessment, the Hand Apraxia Scale, and the Patient Well-Being Index. Analysis comparing change between baseline and week 8 of treatment for L-carnitine and the placebo showed that both parents/caregivers and medical follow-up detected improvements in the subjects' well-being. In addition, medical review showed an improvement on the Hand Apraxia Scale for a higher proportion of girls on L-carnitine. Identification of predictors of clinical improvement has been limited by the power of the study. These findings suggest that L-carnitine is of benefit in some patients with Rett syndrome. While L-carnitine did not lead to major functional changes in ability, the type of changes reported could still have a substantial impact on the girls and their families. Information is still needed, however, to determine if only subgroups of girls with the disorder are responsive to L-carnitine and the appropriate duration of therapy.

Assessment of therapeutic response of oropharyngeal and esophageal candidiasis in AIDS with use of a new clinical scoring system: studies with D0870

We developed and compared five scoring systems designed to quantitate therapeutic response in cases of oropharyngeal candidiasis. We utilized prospectively collected data on 114 patients treated with several doses of the azole D0870. Patients were infected with fluconazole-susceptible (n = 49) or -resistant organisms (MIC, > or = 16 mg/mL; n = 61). Patients with fluconazole resistance had lower CD4+ cell counts at baseline; more symptoms (P = .0006); a higher frequency of dysgeusia (P = .004), dysphagia (P = .006), and throat pain (P = .0034); and greater oral coverage by plaques of Candida. There was no difference between the two groups in terms of colony-forming units, and any change did not correlate with response to therapy. Resolution of dysphagia (P < .01) and oral pain (P < .01) correlated well with response to therapy, unlike retrosternal pain and throat pain, which were also less frequent. Xerostomia, a "furry" taste, and dysgeusia were frequent nonspecific symptoms. Scoring system C, weighting resolution of a symptom higher than absence of a symptom at baseline, yielded the best correlation with global outcome (r = 0.86) and allows the quantitation of incomplete but clinically beneficial responses to therapy.

Stereoselective disposition of tiaprofenic acid enantiomers in rats

The pharmacokinetics and metabolic chiral inversion of the S(+)- and R(-)-enantiomers of tiaprofenic acid (S-TIA, R-TIA) were assessed in vivo in rats, and in addition the biochemistry of inversion was investigated in vitro in rat liver homogenates. Drug enantiomer concentrations in plasma were investigated following administration of S-TIA and R-TIA (i.p. 3 and 9 mg/kg) over 24 hr. Plasma concentrations of TIA enantiomers were determined by stereospecific HPLC analysis. After administration of R-TIA it was found that 1) there was a time delay of peak S-TIA plasma concentrations, 2) S-TIA concentrations exceeded R-TIA concentrations from approximately 2 hr after dosing, 3) Cmax and AUC(0-infinity) for S-TIA were greater than for R-TIA following administration of S-TIA, and 4) inversion was bidirectional but favored inversion of R-TIA to S-TIA. Bidirectional inversion was also observed when TIA enantiomers were incubated with liver homogenates up to 24 hr. However, the rate of inversion favored transformation of the R-enantiomer to the S-enantiomer. In conclusion, stereoselective pharmacokinetics of R- and S-TIA were observed in rats and bidirectional inversion in rat liver homogenates has been demonstrated for the first time. Chiral inversion of TIA may involve metabolic routes different from those associated with inversion of other 2-arylpropionic acids such as ibuprofen.

Skill levels of educational interpreters working in public schools

The Educational Interpreter Performance Assessment, or EIPA, is an evaluation tool designed specifically for educational interpreters. An evaluation using the EIPA considers the child's grade level, the sign language or sign system that the interpreter is using as well as any other child-specific factors. Fifty-nine educational interpreters were evaluated using the EIPA. They had different backgrounds and training, and used different types of sign language or sign language or sign systems. The results show that not all of the educational interpreters were qualified to provide a child with an adequate interpretation of classroom discourse. Less than half of the educational interpreters assessed in this study performed at a level considered minimally acceptable. These data also show that sign vocabulary skills were significantly better than grammatical skills. Eighteen interpreters were evaluated twice in order to test-retest reliability, which showed that scores were not significantly different between the two evaluations. The picture that emerges from these data is that many deaf children receive an interpretation of classroom discourse that may distort and inadequately represent the information being communicated.

Evaluation of a national surveillance unit

AIM

The Australian Paediatric Surveillance Unit (APSU) facilitates national active surveillance of uncommon childhood conditions. This study assessed whether it fulfilled its objectives and satisfied criteria established by the Centers for Disease Control and Prevention (CDC) for evaluating surveillance systems.

METHODS

Anonymous questionnaires were sent to users of the system, individual studies were reviewed, and data were collected from independent sources.

RESULTS

Seven hundred and sixty six clinicians, 48 investigators, and 15 public health professionals responded to the questionnaires. Clinicians reported that the APSU was useful, 33% saying information provided by the APSU informed or changed their clinical practice. Most (88%) reported that completing monthly report cards was not a burden. Impact on policy development was limited by suboptimal dissemination of information to public health professionals. Flexibility and timeliness were limited by design. Estimated sensitivity of APSU studies ranged from 92% (congenital rubella) to 31% (drowning/near drowning). Positive predictive value of notified cases was over 70% for most studies.

CONCLUSION

The APSU fulfils most of its objectives and meets CDC criteria salient to these. Ways in which the APSU could be improved have been identified, as have methodological challenges and limitations in applying CDC guidelines to this type of unit.

Role of the Australian Paediatric Surveillance Unit in monitoring communicable diseases of childhood

The Australian Paediatric Surveillance Unit (APSU) conducts active national surveillance of conditions affecting children, including communicable diseases and their complications. By mailing over 900 clinicians each month the APSU gathers national information, not available from other sources, about the incidence, demographic and clinical features of these conditions. In some conditions APSU data supplements that available from existing schemes. The APSU has monitored 20 conditions to date. Eight of these are communicable diseases or their complications, two have a possible infectious aetiology and one frequently presents with infection. Since its inception in 1993 the return rate of monthly report cards by the mailing list has increased from 88 per cent to 94 per cent. Return rate of questionnaires for the communicable diseases studied ranged from 74 per cent to 100 per cent. Studies have enabled estimation of disease incidence, identification of risk factors and possible preventive strategies and provision of detailed clinical information. Although the APSU cannot serve a public health role by case identification and contact tracing it provides information that contributes to the communicable disease strategy for Australia.

The role of carbohydrate reserves in the growth, resilience, and persistence of cabbage palm seedlings (Sabal palmetto)

Sabal palmetto (Walt.) Lodd. ex Schultes (cabbage palm) is an arborescent palm common in many plant communities throughout Florida, U.S.A., and the Caribbean. Although its seedlings grow very slowly in forest understories, they survive damage and defoliation well, and the species may increase in dominance following disturbances such as fire, logging, and hurricanes. We investigated the potential importance of total nonstructural carbohydrate (TNC) pools in the ability of cabbage palm seedlings to recover from the loss of aboveground tissue such as that caused by fire, grazing, or shallow burial by storm debris. TNC concentrations in belowground organs of seedlings from a forest understory were high, and TNC pools were sufficient to theoretically replace >50% of a seedling's canopy. The largest fraction of the belowground TNC pool was in stem tissue, where TNC in unclipped plants accounted for 26-54% of stem dry mass. Experimental reduction of TNC pools by repeated defoliation slowed seedling regrowth, and seedlings with inherently smaller pools (smaller seedlings) suffered higher mortality after repeated defoliation than did larger seedlings. Although regrowth and recovery after the loss of aboveground tissue was related to the size of the TNC pool in belowground organs, even the smallest seedlings with the smallest pools had sufficient stores to withstand at least two defoliations at frequent (7-week) intervals. Large belowground TNC pools in S. palmetto seedlings appear to enable them to survive all but the most frequent defoliations (e.g., frequent grazing or mowing). Allocation of resources to these stores, however, may contribute to the slow growth rates of S. palmetto seedlings in natural communities.

The roles of seedling salt tolerance and resprouting in forest zonation on thewest coast of Florida, USA

To determine whether the zonation of seven coastal tree species in north Florida correlated with the relative abilities of their seedlings to tolerate soil salinity, we subjected seedlings of Sabal palmetto, Juniperus virginiana var. silicicola, Quercus virginiana, Celtis laevigata, Ulmus spp., Acer floridanum, and Liquidambar styraciflua to a range of salinities (∼0, 2, 4, 8, 15, and 22 g synthetic sea salt/L; up to 63% full strength seawater salinity) in a 6-mo greenhouse experiment. Pots with shoot-killed plants were flushed with freshwater for ≥5 wk to assess recovery. Salt tolerance was assessed as plant survival under saline conditions and as the ability to retain green leaf tissue under saline conditions. Using either criterion, the rank order of seedling salt tolerance correlated significantly (P ≤ 0.05) with that expected based on species zonation near the coast. Agreement was better, however, using retention of leaf tissue as an index of salt tolerance. Species from forest zones that were frequently exposed to tidal water retained green leaf tissue under saline conditions. Species from zones occasionally subjected to very high tides were shoot killed but resprouted following removal of salt from the root zone. Those restricted to zones exposed only to infrequent storm surges died at salinities ≥4 g/L. Thus, differential seedling salt tolerance was consistent with tree zonation and, although the ability of young seedlings to resprout following salt removal did not appear to allow tree establishment at the extreme seaward margin of the forest, it appeared important in intermediate zones.

Benefits of normalizing plasma phenylalanine: impact on behaviour and health. A case report

An elderly man with mental retardation who had never received dietary treatment for his phenylketonuria was placed on a phenylalanine-restricted diet. Social skills and walking gait improved and a new interest in the objects in his environment developed spontaneously. A 2-year analysis of diet, blood plasma phenylalanine levels and behavioural state indicated that small differences in phenylalanine intake impacted his well-being. Of significant note, leg tremor and spasm that precipitated severe self-injury were only reversible when plasma blood phenylalanine concentrations were titrated to near normal ranges and daily phenylalanine intake was strictly controlled. This case may offer a potential explanation for some of the late treatment failures that have been reported and suggest new avenues to explore in the late treatment of PKU.

Medicare managed care: policy concerns

This paper briefly reviews the extent of current drug coverage for Medicare beneficiaries and describes the most important issues faced by aged beneficiaries who receive or seek drug coverage through a Medicare managed care plan. Changes in payment rates to these plans as a result of the Balanced Budget Act of 1997 may result in plans reducing or eliminating drug coverage. Under current law beneficiaries in these plans will have severely limited options for replacing drug coverage; as a result, many will not be able to obtain this coverage either through Medigap or previous retiree coverage. In the absence of any change in current law, one approach to addressing these issues is to refocus Medicare managed care plans on managing the total cost of caring for patients over time and across settings. Only through such an integrated approach will Medicare managed care plans have the tools to function within the new payment rates and realize the value of the pharmaceutical benefit to the plan and the patients.

Rapid method for fluorescent in situ ribosomal RNA labelling of Cryptosporidium parvum

A method for fluorescence in situ hybridization (FISH) is described that requires less than 1 h duration. Oocysts were resuspended in 50% ethanol and incubated at 80 degrees C for 10 min for simultaneous fixation and permeabilization. Samples were than incubated with the oligonucleotide probe at 48 degrees C for more than 30 min. The rRNA binding specificity of the optimized protocol was confirmed. FISH was found to be valuable as a second label for oocysts presumptively identified immunofluorescently, but required more than an order of magnitude signal amplification for independent use. The number of oligonucleotide probes bound per oocyst was compared with the copy number of 18S rRNA molecules per oocyst to provide a measure of the labelling efficiency of the FISH method. Hybridization kinetics were also analysed. These data indicate that significant further increases in the brightness of FISH-labelled oocysts cannot be achieved by further optimization of the pre-treatment and hybridization conditions.

Role of secondary stressors in the parental death-child distress relation

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death-child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed.