ATP-binding cassette transporters are required for efficient RNA interference in Caenorhabditis elegans

RNA interference (RNAi) is a conserved gene-silencing phenomenon that can be triggered by delivery of double-stranded RNA (dsRNA) to cells and is a widely exploited technology in analyses of gene function. Although a number of proteins that facilitate RNAi have been identified, current descriptions of RNAi and interrelated mechanisms are far from complete. Here, we report that the Caenorhabditis elegans gene haf-6 is required for efficient RNAi. HAF-6 is a member of the ATP-binding cassette (ABC) transporter gene superfamily. ABC transporters use ATP to translocate small molecule substrates across the membranes in which they reside, often against a steep concentration gradient. Collectively, ABC transporters are involved in a variety of activities, including protective or barrier mechanisms that export drugs or toxins from cells, organellar biogenesis, and mechanisms that protect against viral infection. HAF-6 is expressed predominantly in the intestine and germline and is localized to intracellular reticular organelles. We further demonstrate that eight additional ABC genes from diverse subfamilies are each required for efficient RNAi in C. elegans. Thus, the ability to mount a robust RNAi response to dsRNA depends upon the deployment of two ancient systems that respond to environmental assaults: RNAi mechanisms and membrane transport systems that use ABC proteins.

Methods for delivery of double-stranded RNA into Caenorhabditis elegans

The nematode Caenorhabditis elegans is often employed in investigations of diverse aspects of biology, including behavior, development, basic cellular processes, and disease states. The ability to utilize double-stranded RNA (dsRNA) to inhibit specific gene function in this organism has dramatically increased its value for these kinds of studies and has provided more flexibility in experimental design that include procedures. Here, we have collected a set of protocols from the C. elegans community for propagation of C. elegans, techniques for dsRNA preparation, four basic methods for delivery of dsRNA to C. elegans (injection, soaking, feeding, and in vivo delivery), and we suggest schemes that should facilitate detection of specific gene silencing.

Beneficial pharmacokinetic interaction between cyclosporine and itraconazole in renal transplant recipients

BACKGROUND

Itraconazole is often given for fungal prophylaxis to renal transplant recipients, who require concomitant cyclosporine in the immediate posttransplant period. We determined the extent of the pharmacokinetic interaction between cyclosporine and itraconazole oral solution in renal transplant recipients and the effect on daily drug costs.

METHOD

This was a single-center, open-label, nonrandomized study. Posttransplantation, renal transplant recipients received itraconazole solution 200 mg twice daily and cyclosporine, dosed to achieve target concentrations. Once at steady state, blood samples were collected over 12 hours for pharmacokinetic evaluation of cyclosporine, itraconazole, and hydroxy-itraconazole. Itraconazole was discontinued after approximately a 3-month prophylaxis regimen. Cyclosporine doses were titrated to achieve target concentrations and cyclosporine concentrations were once again determined when steady state was achieved. A noncompartmental analysis was used to analyze cyclosporine pharmacokinetic parameters. The pharmacoeconomic impact was measured based on the percent change in dose of cyclosporine when administered with and without itraconazole. Drug costs were calculated using the average wholesale price. The cost per patient, as well as the average cost, was calculated for the cyclosporine/itraconazole combination, as well as the cyclosporine regimen alone.

RESULTS

Eight renal transplant recipients completed the study. All were included for itraconazole analyses and seven for cyclosporine analyses. Mean peak and trough itraconazole levels were 1.64 +/- 0.82 and 1.23 +/- 0.90 microg/mL respectively. Mean peak and trough hydroxy-itraconazole levels were 2.37 +/- 1.55 and 2.20 +/- 1.48 microg/mL, respectively. While on itraconazole, a 48% reduction in the mean total daily dose of cyclosporine was necessary to maintain target concentrations (171 +/- 63.6 versus 329 +/- 103.5 mg, P =.003). This reduction in cyclosporine dose resulted in a discounted itraconazole daily drug cost of approximately 29.5%.

CONCLUSION

Administering itraconazole with cyclosporine allows for a decrease in the cyclosporine dose, thus lowering daily drug costs and providing adequate antifungal coverage with itraconazole and hydroxy-itraconazole trough concentrations above the MIC(90) of Candida and Aspergillus spp.

Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach

PURPOSE

Hand assisted laparoscopy combines aspects of open and laparoscopic surgery. A hand in the abdomen may facilitate laparoscopic live donor nephrectomy, allowing more urologists to participate. We report and compare our initial series of hand assisted laparoscopy donor nephrectomy with nephrectomy performed by standard open methods.

MATERIALS AND METHODS

In the last 18 months 60 patients at 2 institutions underwent hand assisted laparoscopy donor nephrectomy. This cohort was compared to a contemporary group of 31 patients who underwent open donor nephrectomy via a flank incision at our 2 institutions. Demographic and outcome data were compared retrospectively in a nonrandomized fashion in the 2 groups.

RESULTS

Demographic data on patient age, male-to-female ratio and body mass index were similar in the 2 groups. Operative time, transfusion rate, time to oral intake and complications were also similar. However, estimated blood loss, change in hematocrit preoperatively to postoperatively, hospitalization, parenteral and oral narcotic requirement, and donor convalescence were significantly less in the hand assisted laparoscopy versus open groups. In terms of allograft function, nadir creatinine, time to nadir creatinine, creatinine clearance at 6, 12, and 18 months, delayed graft function, episodes of acute rejection and ureteral stricture were similar in the groups.

CONCLUSIONS

Hand assisted laparoscopy is safe, efficacious and reproducible for living related donor nephrectomy. Compared with the open technique hand assisted laparoscopy provides the donor with significantly decreased postoperative morbidity, while enabling excellent allograft function. Further randomized prospective studies are warranted.

Use of cryopreserved cadaveric vein allograft for hemodialysis access precludes kidney transplantation because of allosensitization

BACKGROUND

Dimethyl sulfoxide-cryopreserved cadaveric vein allografts have recently been proposed as an alternative to prosthetic grafts in the problem hemodialysis population. The transfer of mismatched major histocompatibility complex I and II molecules in association with these allografts can potentially lead to allosensitization in nonimmunosuppressed individuals.

METHODS

In a university-affiliated medical center, 20 consecutive patients receiving technically successful upper arm cadaveric vein allograft fistulas (CAVFs) for hemodialysis between April 1999 and April 2000 were studied. A control cohort of 20 patients on a kidney transplantation waiting list was selected by nurses blinded to the study. These patients were matched for age, sex, history of transfusion, pregnancy, cause of kidney failure, and prior transplantation. The panel reactive antibody (PRA) values were recorded in this group over the same time period as the CAVF group.

RESULTS

Patients receiving CAVFs had a mean PRA assay value of 84.1% (median, 96.5%) at an average of 3.1 months after engraftment (median, 1.5 months). The preengraftment PRA values were available for seven patients who were on the transplant waiting list. Six of these patients had nonreactive PRA assays before CAVF creation. All of these patients converted to positive PRA assays after CAVF creation with a mean value of 92.3% (median, 98%) at 2.85 months follow-up (median, 1.3 months). The mean PRA value for the control cohort was 5.5% (median, 2.5%), with no patients converting from a nonreactive to a reactive PRA assay during this same time interval.

CONCLUSION

The use of dimethyl sulfoxide-cryopreserved cadaveric vein allografts for hemodialysis access leads to broad allosensitization as measured by PRA assay. Cryopreserved cadaveric vein allografts should not be used for hemodialysis access in potential kidney transplant recipients.

Fatty acid balance studies in preterm infants fed formula milk containing long-chain polyunsaturated fatty acids (LCP) II

A milk formula (Prematil-LCP) containing long-chain polyunsaturated fatty acids (LCP) and with a fatty acid profile closely resembling breast milk has recently been introduced for preterm infants. A double-blind randomized controlled trial was performed comparing fatty acid absorption from Prematil-LCP (n=10) and standard Prematil (n=10). Formula-fed preterm infants underwent 3 d fat balances (once full enteral feeds were established) along with a parallel human milk fed group (n=11). Plasma samples were taken on the last day. Median total fat excretion (absorption, %) was 2.34g kg(-1) (82.0), 2.64g kg(-1) (82.9) and 1.65g kg(-1) (87.8) with Prematil, Prematil-LCP and human milk feeding, respectively. This reflected differences in the excretion and absorption of long-chain saturated fatty acids. All groups excreted detectable LCP. LCP disappearance was higher in infants fed human milk than in those fed Prematil-LCP, particularly for n-6 LCP (p < 0.01). Nevertheless, excreted LCP equated to < 30% dietary intake, with Prematil-LCP feeding. Plasma lipid fatty acid composition reflected differences in dietary LCP intake.

Fatty acid balance studies in term infants fed formula milk containing long-chain polyunsaturated fatty acids

Long-chain polyunsaturated fatty acids (LCP) are thought to be required for optimal nervous system development in the newborn. A commercial milk formula containing LCP (Aptamil-LCP) with a fatty acid profile closely resembling breast milk, has recently been introduced for term infants. The absorption of fatty acids in term infants was examined in a double-blind randomized controlled trial comparing Aptamil-LCP (n = 20) and standard Aptamil (n = 20). Formula-fed newborn infants were studied from birth for 14 d. Fat balances (3 d) were performed from d 10. A 3-d stool collection was performed from d 10 in a parallel breastfed group (n = 21). Plasma samples were taken on d 6. Median fat excretion (mg kg[-1]) was 897.1, 615.0 and 355.2 with Aptamil, Aptamil-LCP and breastfeeding, respectively. The median total fat absorption coefficient in Aptamil-LCP-fed infants was higher than in those fed standard Aptamil (p < 0.01). These findings were accounted for by differences in the excretion and absorption of long-chain saturated fatty acids (C14:0, C16:0 and C18:0). Higher fat excretion was associated with bulkier and firmer stools. Only trace amounts of LCP were detected in the stools of all groups. This accounted for less than 4% of dietary intake in Aptamil-LCP-fed infants. No differences in the utilization of LCP from Aptamil-LCP and breast milk feeding were apparent. Plasma phospholipid fatty acid composition data reflected differences in dietary LCP intake. Thus, PL LCP levels were highest in the breastfed infants and lowest in the Aptamil-fed infants, with values for the Aptamil-LCP-fed group falling in between.

Superior mesenteric vein occlusion presenting with a massive vascular malformation of the colon

Superior mesenteric vein occlusion is a rare condition which has protean clinical manifestations. It frequently occurs secondary to an underlying coagulation defect. We present the case of a young female who presented uniquely with a massive colonic vascular malformation and who had various predisposing factors, the most serious being a protein C deficiency.

Metabolic rate of sleeping infants

AIM

To measure the sleeping metabolic rate (SMR) of healthy infants in the first year of life.

METHODS

The SMR was measured on 73 infants aged 1 to 12 months in a special nursery using indirect calorimetry. One hundred satisfactory observations were made. The room air and radiative temperatures, humidity, and amount of insulation were measured. Parents chose the clothing and bedding that they judged their infant needed.

RESULTS

The mean (SD) SMR was 2.4 (0.4) watts (W)/kg or 45 (10) W/m2. The mean SMR of infants aged 1-2 months was 38 compared with 44 W/m2 in infants of 8-12 months; the difference was not significant. There were no obvious differences in SMR between boys and girls. But there were wide differences in SMR between apparently similar infants, range 1.4 to 3.5 W/kg. Most parents selected insulation between 1 and 3 togs, and this was weakly negatively correlated with air temperature.

CONCLUSION

These wide variations in SMR mean that it is impossible to give specific guidelines on the amount of clothing and bedding a particular infant will need for thermal comfort in a given room temperature.

Individual variation in sleeping metabolic rates in infants

AIM

To measure the variation in sleeping metabolic rate (SMR) of healthy infants in the first year of life.

METHODS

Attempts were made to measure SMR in the home of one group of infants at monthly intervals over the first year of life and of another group in the 1 to 12 age range, over three consecutive days. Sixty one infants were recruited and 181 measurements made. In 11 infants six or more satisfactory measurements were made a monthly intervals and in another 11 infants, three consecutive daily measurements were obtained. Parents chose the clothing and bedding that they judged their infant needed to fall asleep. The room air and radiative temperatures, humidity, and amount of insulation were recorded.

RESULTS

The mean (SD) SMR was 2.4 (0.4) watts (W)/kg or 45 (10) W/m2. The rate was the same for infants in the age groups 0.25, 0.5, 0.75, and 1 years; individual infants did not show a systematic change with age. There was wide variation. Ninety eight per cent of infants had a SMR between 1.8 and 3.1 W/kg. The mean SMR for the infants measured on three consecutive days varied from 1.7 to 3.1 W/kg, and SMR varied within infants, from 0.06 to 0.86 W/kg. The variation within six to 11 measurements on infants over the first year of life ranged from 0.38 to 1.05 W/kg.

CONCLUSION

Infants in the first year of life exhibit wide variations in SMR from day to day and from month to month. As the range is wide, guidance on clothing and bedding for thermal comfort can be given only in broad terms.

Malignant lymphoma in congenital dyserythropoietic anaemia type III

A 60 year old woman with congenital dyserythropoietic anaemia (CDA) type III developed a malignant T cell lymphoma with cutaneous and widespread nodal involvement. Bone marrow aspirates showed erythroid hyperplasia and dyserythropoiesis with multinucleate erythroblasts and gigantoblasts, in keeping with CDA type III. Electron microscopy showed multinucleate erythroblasts with notably irregular nuclear outlines and intranuclear clefts. The development of malignant lymphoma in this patient, together with a documented high prevalence of monoclonal gammopathy and multiple myeloma and a single case of Hodgkin's disease, may indicate an increased incidence of lymphoproliferative disease in CDA type III.

Organ transplantation at the Hartford Transplant Center

Over 1,243 organ transplants have been performed at the Hartford Transplant Center over the past two decades. Survival in kidney, heart, liver, and pancreas patients is at or above the national average. Hartford was one of the first centers to use triple immunosuppression, which significantly improved survival in kidney transplantation. For recipients of kidneys from living related donors and cadaveric kidneys, two-year actuarial graft survival has been 98% and 83%, respectively, over the last five years. For heart and liver transplants, two-year survival has been 79% and 67%, respectively. Despite high success rates at most transplant centers, donor organs remain scarce. This problem needs to be addressed through increased cooperative efforts in the health-care community and the general public.

Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment

There is growing concern about adverse health effects of fungal bio-aerosols on occupants of water-damaged buildings. Accidental, occupational exposure in a nonagricultural setting has not been investigated using modern immunological laboratory tests. The objective of this study was to evaluate the health status of office workers after exposure to fungal bio-aerosols, especially Stachybotrys chartarum (atra) (S. chartarum) and its toxigenic metabolites (satratoxins), and to study laboratory parameters or biomarkers related to allergic or toxic human health effects. Exposure characterization and quantification were performed using microscopic, culture, and chemical techniques. The study population (n = 53) consisted of 39 female and 14 male employees (mean age 34.8 years) who had worked for a mean of 3.1 years at a problem office site; a control group comprised 21 persons (mean age 37.5 years) without contact with the problem office site. Health complaints were surveyed with a 187-item standardized questionnaire. A comprehensive test battery was used to study the red and white blood cell system, serum chemistry, immunology/antibodies, lymphocyte enumeration and function. Widespread fungal contamination of water-damaged, primarily cellulose material with S. chartarum was found. S. chartarum produced a macrocyclic trichothecene, satratoxin H, and spirocyclic lactones. Strong associations with exposure indicators and significant differences between employees (n = 53) and controls (n = 21) were found for lower respiratory system symptoms, dermatological symptoms, eye symptoms, constitutional symptoms, chronic fatigue symptoms and several enumeration and function laboratory tests, mainly of the white blood cell system. The proportion of mature T-lymphocyte cells (CD3%) was lower in employees than in controls, and regression analyses showed significantly lower CD3% among those reporting a history of upper respiratory infections. Specific S. chartarum antibody tests (IgE and IgG) showed small differences (NS). It is concluded that prolonged and intense exposure to toxigenic S. chartarum and other atypical fungi was associated with reported disorders of the respiratory and central nervous systems, reported disorders of the mucous membranes and a few parameters pertaining to the cellular and humoral immune system, suggesting a possible immune competency dysfunction.

Metabolic rate in febrile infants

An open circuit indirect calorimeter was used to measure resting energy expenditure in febrile infants. Twelve infants admitted to hospital with fever (axillary temperature 37.5 degrees C) were studied on admission and then again at the same time of day and in similar environmental conditions after the fever had resolved. Mean age of the infants was 0.31 years (range 0.12-0.54) and the mean body weight 6.59 kg (range 4.50-8.88 kg). On average the infants' axillary temperatures were +2.1 degrees C higher when they were febrile. Overall the mean difference in oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (REE) between the febrile and afebrile measurements was not statistically significant. Of eight infants with a greater REE when febrile, five were diagnosed as having viral illness and three had bacterial meningitis. Of the four with a lower REE when febrile, two had viral illness and two had bacterial infection (one chest infection and one meningitis). In conclusion, there was no consistent alteration of REE during a fever in infants 1 to 6 months of age. In particular, age and type of infection were not predictors of whether REE would increase or decrease during the illness.