Nature of HLA-associated predisposition to childhood acute lymphoblastic leukemia

A molecular analysis was carried out in 63 sequentially diagnosed childhood acute lymphoblastic leukemia (ALL) patients and 1011 controls to investigate the homozygosity rate for HLA-DR53. HLA-DR53 is associated with acute myeloblastic leukemia at the protein level, and our previous study has shown its association with early-onset chronic myeloid leukemia only in homozygous form at the DNA level. In the present study, the homozygosity rates for DR53 were 17.5 and 13.6% in patients and controls, respectively. Ten of the 11 homozygous patients were boys. In the common ALL group (n = 40), all seven DR53 homozygous patients were boys, and among 19 girls this genotype was not observed (P = 0.006). For males, homozygosity for DR53 revealed a relative risk (RR) of 3.29 (P = 0.008) for common ALL. Five of the 11 relapsed patients were homozygous for DR53. Heterozygous frequencies for HLA-DR53 were not different between patients and controls. Homozygosity for DR53 was associated with a very high relapse rate (45.5 vs 7.7%, P = 0.002, RR = 9.1). These results extended our findings in chronic myeloid leukemia and showed the recessive nature and the male predominance of the interactive HLA influence on the development of childhood leukemia. Molecular mimicry of an HLA-DR53 epitope by oncogenic (retro)viruses or putative susceptibility genes in linkage disequilibrium with HLA-DR53 may be responsible for this association.

A molecular analysis of the telomeric end of the major histocompatibility complex. DNA typing of HLA-A3 subtypes and -B7

A molecular investigation of the HLA-A, -B, -C, I82, D6S128, and D6S265 loci was carried out using RFLP and PCR analyses in 331 healthy individuals, 21 HLA-A3B7 homozygous subjects, and 17 HLA homozygous cell lines. New polymorphic RFLP patterns were noted at the HLA-A and -B loci which were useful for distinguishing subtypes of HLA-A3 and -B44. Strictly specific bands were observed for HLA-A3, -A11, -B7, -B57. and -Cw4. Molecular identification of two HLA-A3 subtypes was possible by HLA-A RFLP and D6S265 PCR analyses. The two alleles of the I82 locus were associated with different HLA-A3 subtypes. It was shown that the serologically HLA-A3 homozygous cell line EHM was heterozygous for the two subtypes. The common subtype formed 91% of HLA-A3 antigens. Some serologically HLA-A3 homozygous healthy individuals were heterozygous for the subtypes. Using these new polymorphisms, a thorough molecular analysis of the haplotype HLA-A3B7DR15 at the three regions of the MHC was performed. The results have implications on HLA matching in transplantation, population genetics of the MHC, and disease association studies.

Homozygous MHC genotypes and longevity

To investigate the relevance of the major histocompatibility complex (MHC) in longevity, we carried out a molecular analysis of the MHC in 432 unrelated healthy individuals. The comparison of individuals < or = 25 years and > 25 years showed that the 5.8-kb DQA1 allele, which corresponds to HLA-DR53, was negatively associated with longevity (p = 0.0035) resulting mainly from decreased homozygosity with age for that allele (p = 0.008), and restricted to males (p = 0.008). The difference was more striking for the 5.8 kb DQA1: 9.0 kb HSP70 haplotype again only in males (26.3 vs. 6.2%; p = 0.017, OR = 5.4, 95% CI = 1.5 - 19.5). The oldest male subject homozygous for this DQA1: HSP70 haplotype was 54 years (p = 0.005). Comparing leukemic patients and healthy individuals with the same ethnic and geographical origin, homozygosity for these genotypes was more frequent in the young leukemic group. The results suggested the existence of recessive deleterious genes in a segment of HLA-DR53 haplotypes.

Occupational exposure to human immunodeficiency virus (HIV)-infected blood in Denver, Colorado, police officers

The authors undertook a study of Denver, Colorado, police department officers to measure their risk of exposure to blood and human immunodeficiency virus (HIV) by type of work assignment and to document how exposures occurred. From December 1989 through March 1991, 137 officers reported an exposure to either blood or saliva, and 42 exposures to blood were independently documented. The overall rate of exposure to HIV-infected blood for medium and high risk assignments was 0.10 per 10,000 person-days. Thirty-two source persons underwent voluntary testing for HIV antibodies, and five (15.6%) were seropositive. Two thirds of the 42 blood exposures occurred in circumstances in which 1) there was little or no time for the officer to put on protective gloves and clothing because the officer was restraining or being assaulted by a suspect or 2) gloves would have not been protective because of penetration by needles. The authors conclude that Denver police officers rarely have percutaneous or mucosal exposures to blood, but when they do, the risk of exposure to HIV-infected blood is quite high. A health department can provide to police officers a number of services: evaluation of an incident involving contact with blood or body fluids to determine whether there was potential for disease transmission; information about modes of transmission and prevention of bloodborne diseases; serologic testing of source persons; HIV counseling for exposed officers and source persons; documentation for worker's compensation claims; and consultation regarding the use of zidovudine for postexposure prophylaxis.

Human major histocompatibility complex contains several leukemia susceptibility genes

In mice, homozygosity for the Mhc haplotype H-2k is associated with increased susceptibility to spontaneous and virus-induced leukemia, lymphoma and other neoplasms in the predisposed host. The influence of the Mhc on malignant development in these models is to shorten the latency after virus inoculation. Here, we present evidence that a similar phenomenon results in early-onset of human leukemia. A molecular analysis of the MHC in 112 CML patients showed that those who developed the disease when aged less than 35 years (early-onset group) had higher homozygosity rates for the DOA1, HSP70 and C4 alleles of the DR53 group of ancestral haplotypes, for a subtype of HLA-A3, and a higher allele frequency of BfFb compared to the late-onset group. The oldest patient (n = 13) homozygous for DR53 was 52-years-old (p = 0.004), and all HLA-A3 homozygous patients (n = 4) were in the early-onset group (p = 0.01). The relative risk for early-onset CML yielded by HLA-A3 homozygosity was 17.6. The well-known serological HLA-Cw4 association was not confirmed at the DNA level and thought to be due to linkage disequilibrium with BfFb. The factor B association was sex-limited. The DR52 group haplotypes appeared to be protective. The HLA-identical sibling frequency was increased only in the early-onset group (p < 0.01). Our findings agree with the concept of an MHC influence on the development of malignancies. The similarity in the location of the susceptibility loci and the serological cross-reaction between H-2Ek and DR53 raise the possibility that the mouse and human MHC share the same leukemia susceptibility genes.

MHC class III polymorphisms in selection of donors for BMT

Current practice for the selection of unrelated donors involves serological typing of HLA-A, -B and -DR antigens, DNA analysis of the class II region and the MLR. However, even after matching for the class II loci at the DNA level, a significant proportion of matched unrelated pairs remain MLR reactive. Ideal matching for BMT would be a match for the whole MHC haplotype rather than individual HLA loci. In the present study, we have evaluated the complementary role of class III typing in determining MHC identity. A group of 86 donor/recipient pairs, of which 14 were unrelated, was investigated using C4, Bf, HSP70 and TNF DNA probes. Phenotypically HLA-matched siblings were always identical at the C4 locus which is the most polymorphic of all the loci examined. Nine of the 14 HLA serologically matched MLR non-reactive (RRI < 20%) unrelated pairs had class III mismatching. Four of these pairs with class III mismatching were matched at the DRB and DQB loci by RFLP analysis. These results demonstrate that serological identity, DRB/DQB RFLP-matching and a negative MLR do not always match the whole haplotype in unrelated pairs. It can be concluded that the linkage of the class III loci to both HLA regions makes this region a reliable marker of the whole MHC haplotype.

Age-related enhancement and suppression of a T-cell-dependent antibody response following stressor exposure

The effects of uncontrollable footshock on the peak splenic plaque-forming cell (PFC) response and serum antibody titers to sheep red blood cells (10(6) cells ip) were assessed in 3-month-old and 9-month-old male CD-1 mice. Exposure to uncontrollable footshock provoked an immunosuppression in mice of both age groups. The critical period for the induction of the suppression (i.e., 72 hr after inoculation) did not differ between the 3-month-old and 9-month-old mice; however, the suppression could be provoked more readily in the older animals. In the 9-month-old mice, the variations of immune activity were dependent on the severity of the stressor and the time of stressor application. Specifically, in contrast to the suppression induced by footshock, a relatively mild stressor such as exposure to a novel environment effectively increased the PFC response. A marked enhancement of the PFC response and antibody titers was evident in older animals that were shocked immediately or 24 hr after inoculation. The possibility exists that stressor application in older mice may influence regulatory processes that are associated with an immune response and that the nature of these regulatory mechanisms may vary with the time after antigenic challenge.

Substitutions at a single amino acid residue in the nitrogen-regulated activator protein NTRC differentially influence its activity in response to phosphorylation

Four substitutions at serine residue 160 which increase the activity of the sigma 54-dependent activator protein NTRC in the absence of NTRB have been analysed in detail. Mutagenesis of the putative phosphoacceptor site of NTRC and analysis of double mutants indicate that the positive control function of the S160W and S160C mutants is phosphorylation-dependent, whereas the activity of the S160Y and S160F mutants is phosphorylation-independent. This was confirmed with two purified mutant proteins in vitro. Occupancy of tandem NTRC-binding sites upstream of the Klebsiella pneumoniae nifL promoter by S160W protein is also phosphorylation-dependent in contrast to occupancy by S160F protein, confirming that both the DNA-binding and activator functions of NTRC are influenced by phosphorylation. The S160W and S160C mutants are apparently more responsive than wild-type protein to 'cross-talk' by other members of the histidine protein kinase family but are less responsive to phosphorylation and dephosphorylation mediated by NTRB.

Nucleolysis of the rabbit intervertebral disc using chondroitinase ABC

The nucleolytic action of chondroitinase ABC was studied by the use of rabbit lumbar intervertebral discs. The injection of one unit of enzyme results in necrosis of the nucleus pulposus. Radiologic, histologic, and biochemical changes were evident in discs studied 2 days after injection, and consistent nucleolysis was seen in those studied after 6 days. These results show that chondroitinase ABC deserves further evaluation as a possible chemonucleolytic enzyme.

Age-related enhancement and suppression of a T-cell-dependent antibody response following stressor exposure

The effects of uncontrollable footshock on the peak splenic plaque-forming cell (PFC) response and serum antibody titers to sheep red blood cells (10(6) cells ip) were assessed in 3-month-old and 9-month-old male CD-1 mice. Exposure to uncontrollable footshock provoked an immunosuppression in mice of both age groups. The critical period for the induction of the suppression (i.e., 72 hr after inoculation) did not differ between the 3-month-old and 9-month-old mice; however, the suppression could be provoked more readily in the older animals. In the 9-month-old mice, the variations of immune activity were dependent on the severity of the stressor and the time of stressor application. Specifically, in contrast to the suppression induced by footshock, a relatively mild stressor such as exposure to a novel environment effectively increased the PFC response. A marked enhancement of the PFC response and antibody titers was evident in older animals that were shocked immediately or 24 hr after inoculation. The possibility exists that stressor application in older mice may influence regulatory processes that are associated with an immune response and that the nature of these regulatory mechanisms may vary with the time after antigenic challenge.

The practical application of DRG and casemix information in planning and funding models

There is concern in some quarters about the practical application of casemix information and Diagnosis Related Groups (DRGs). Hospital executive and financial management staff have generally played an observation role as debate about technical issues continue. Notwithstanding, there are already many practical applications of DRGs in strategic service planning, and more recently, in drawing a closer and quantifiable relationship between casemix and costs. These techniques have been developed and applied in a wide variety of situations, from small rural, to larger tertiary referral hospitals. Ongoing use and refinement of these methods has led to the conceptual development of a financial and service planning tool, which has the potential to have wide practical application in the very short term. A positive approach to such a model will allow philosophical and technical debates to continue in the interim, without impeding the further development and application of useful casemix information, particularly at the hospital management level.

Targeted insertion of exogenous DNA into the eukaryotic genome by the Cre recombinase

Cre is a 38-kD protein from bacteriophage P1 that catalyzes site-specific recombination between 34-bp loxP sequences. Our previous work has shown that Cre can perform site-specific excisive recombination not only in prokaryotes, but also in eukaryotes such as yeast and cultured mammalian cells. In this work we show that intermolecular Cre-mediated recombination can specifically direct the integration of a loxP-containing circular DNA into a chromosomal loxP site, both in yeast and in mammalian cells. The resulting integrants are predominantly simple single-copy insertions. Cre-mediated recombination thus provides a simple way to direct single-copy site-specific integration of exogenous DNA into the eukaryotic genome.

Characterisation of the Klebsiella pneumoniae nitrogen-fixation regulatory proteins NIFA and NIFL in vitro

Transcriptional activation by the Klebsiella pneumoniae nitrogen-fixation-specific positive control protein, NIFA, (nifA gene product) has been demonstrated in vitro in S30 extracts from cells which overproduce this protein. The activity of NIFA was dramatically reduced in vitro in the presence of the negative regulatory protein NIFL (nifL gene product) but was not inhibited by the presence of a mutant NIFL protein, NIFL2404. Transcriptional activation from the nifH promoter by NIFA was dependent on the alternative sigma factor, sigma 54, and also required the presence of an upstream activator sequence. NIFA activity was temperature-sensitive in vitro (as it is in vivo) which is due, at least in part, to the intrinsic lability of the protein itself. The majority of overproduced NIFA and NIFL was insoluble after low-speed centrifugation and was inactive in vitro. A low level of less aggregated NIFA protein present in cell extracts was responsible for in vitro activity and this fraction was partially purified.

Variability of somatosensory cortical evoked potential monitoring during spinal surgery

The intraoperative variability of somatosensory cortical evoked potentials (SCEPs) has been measured for 320 consecutive spinal surgeries and found to be a function of patient diagnosis, neuromuscular status, age, and procedural factors. In many cases, it is likely that this variability severely limits the reliability and usefulness of spinal cord monitoring in detecting early cord compromise. Patients with idiopathic scoliosis, spondylolisthesis, and pseudarthrosis have the smallest spontaneous variability and strongest amplitudes, while those with congenital, paralytic scoliosis, stenosis, or tumor have very variable, weak SCEPs. Patients with neurologic disorders, particularly cerebral palsy, myelomeningocele, Friedreich's ataxia, and peripheral deficits, also have high variability and weak amplitudes. A monitoring quality scoring system is proposed that may be useful during surgery in judging how well the SCEPs can discern surgically related changes in cord function from background variations.

Cre-stimulated recombination at loxP-containing DNA sequences placed into the mammalian genome

The cre gene of coliphage P1 encodes a 38 kDa protein which efficiently promotes both intra- and intermolecular recombination at specific 34 bp sites called loxP. To demonstrate that the Cre protein can promote DNA recombination at loxP sites resident on a mammalian chromosome, a mouse cell line was constructed containing two directly repeated loxP sites flanking a 2.5 kb yeast DNA fragment and inserted between the SV40 promoter and the neo structural gene to disrupt expression of the neo gene. Expression of the cre gene in this cell line results in excision of the intervening yeast DNA and thus permits sufficient expression of the neo gene to allow cell growth in high concentrations of G418. Southern analysis indicated that Cre-mediated excision occurred at the loxP sites. In the absence of the cre gene such excisive events are quite rare. Cre-mediated recombination should thus be quite useful in effecting a variety of genomic rearrangements in eukaryotic cells.

The cyclization of linear DNA in Escherichia coli by site-specific recombination

The efficiency with which linearized plasmid DNA can transform competent Escherichia coli can be significantly increased by use of the Cre-lox site-specific recombination system of phage P1. Linear plasmid molecules containing directly repeated loxP sites (lox2 plasmids) are cyclized in Cre+ E. coli strains after introduction either by transformation or by mini-Mu transduction. Exonuclease V activity of the RecBC enzyme inhibits efficient cyclization of linearized lox2 plasmids after transformation. By use of E. coli mutants which lack exonuclease V activity, Cre-mediated cyclization results in transformation efficiencies for linearized lox2 plasmids identical to those obtained with covalently closed circular plasmid DNA. Moreover, Cre+ E. coli recBC strains allow the efficient recovery of lox2 plasmids integrated within large linear DNA molecules such as the 150-kb genome of pseudorabies virus.

Site-specific DNA recombination in mammalian cells by the Cre recombinase of bacteriophage P1

The Cre protein encoded by the coliphage P1 is a 38-kDa protein that efficiently promotes both intra- and intermolecular synapsis and recombination of DNA both in Escherichia coli and in vitro. Recombination occurs at a specific site, called lox, and does not require any other protein factors. The Cre protein is shown here also to be able to cause synapsis of DNA and site-specific recombination in a mammalian cell line. A stable mouse cell line was established that expresses the Cre protein under the control of the Cd2+-inducible metallothionein I gene promoter. DNA recombination was monitored with DNA substrates containing two directly repeated lox sites. One such substrate is a circular plasmid with two directly repeated lox sites (lox2) flanking a marker gene and was introduced into cells by Ca3(PO4)2 transformation. As a second substrate we used a pseudorabies virus (a herpesvirus) containing a lox2 insertion designed to provide a sensitive detection system for recombination. In both cases, site-specific recombination in vivo is dependent on the presence of the Cre protein and occurs specifically at the 34-base-pair lox sites. These results demonstrate the controlled site-specific synapsis of DNA and recombination by a prokaryotic protein in mammalian cells and suggest that Cre-mediated site-specific recombination may be a useful tool for understanding and modulating genome rearrangements in eukaryotes.

Requirements for transcriptional activation in vitro of the nitrogen-regulated glnA and nifLA promoters from Klebsiella pneumoniae: dependence on activator concentration

Three proteins involved in nitrogen regulation in Klebsiella pneumoniae, NTRA, NTRB and NTRC, have been purified. In a defined in vitro system all three NTR proteins are required for initiation of transcription at the ntr activatable glnA and nifLA promoters. However, in crude S-30 extracts, transcription from the glnA promoter, but not the nifLA promoter, can be activated in the absence of NTRB. A higher concentration of NTRC is required for activation of nifLA transcription than for glnA transcription. Sequences located between -227 and -158 with respect to the nifL transcription start site are required for efficient activation of the nifLA promoter in vitro.

The ability of the serum thyrotrophin receptor antibody (TRAb) index and HLA status to predict long-term remission of thyrotoxicosis following medical therapy for Graves' disease

In agreement with previous authors we found patients with Graves' disease to have an increased incidence of the DR 3 antigen. We could find no association, however, between the presence of the antigen and relapse after carbimazole treatment. A concordant HLA status and thyrotrophin receptor antibody (TRAb) index, obtained at either 6 or 12 months after the start of treatment could only predict cases of relapse and remission in a minority of patients making this of very limited clinical use. The TRAb index obtained at 12 months after the start of medical therapy could accurately predict cases of relapse and remission for the next 3 years in 24/30 patients studied.

Defective splenic reticuloendothelial function in idiopathic membranous nephropathy

We studied splenic macrophage reticuloendothelial function in 18 patients with idiopathic membranous nephropathy and eight patients with mesangio-capillary glomerulonephritis by measuring the clearance from the circulation of technetium labelled, autologous, antibody coated erythrocytes (IgG cells) or heat damaged erythrocytes (HDE). Nine of 15 rhesus-D positive patients with membranous nephropathy had delayed clearance of the IgG cells and the defect did not correlate with disease activity. Circulating immune complexes were not detected in any of the patients with membranous nephropathy. The defect in clearance of the IgG cells in the membranous patients was associated with the presence of HLA-B8 and DR3. In the mesangio-capillary glomerulonephritis patients, the clearance rates of the IgG cells were fast-normal in six and enhanced in two, and correlated with the clearance of HDE. The clearance rates of the cells in this group correlated with the degree of hypocomplementaemia but not with the disease activity nor HLA haplotype.

Hyperacetylation of histone H4 in rat testis spermatids

Acetate was incorporated efficiently into rat testis histones after an intratesticular injection of [3H]acetate. The pattern of in vivo acetylation of the testis histones was quite similar to the pattern of in vitro acetylation seen in a previous study with histones H3 and H4 acetylated to the greatest extent [13]. Acetylation of one or more of the major testis H2A variants was confirmed by analysis of these histones on high resolution polyacrylamide gels (PAGE) containing Triton X-100. Of the four variants, H2A.1 appeared to be labeled to the greatest extent. When testis cells were separated into highly enriched populations of specific cell types by centrifugal elutriation after an intratesticular injection of labeled acetate, histone H4 from all fractions of cells was acetylated, but histone H4 from the fraction of cells most enriched in elongating spermatids was hyperacetylated. Thus, the in vivo hyperacetylation of histone H4 which occurs in elongating spermatids is a physiological event which occurs during the relatively short time period when the entire complement of histones is replaced by more basic, protamine-like proteins, and therefore must be one of the key steps in this dramatic protein transition.

Acetylation of rat testis histones H2B and TH2B

The in vivo acetylation of rat testis histones H3 and H4 has been demonstrated in previous studies. In this study, analysis of purified histone fractions revealed the in vivo acetylation of histone H2B, the testis histone variant designated TH2B, and two or more of the histone H2A variants. These findings are quite significant, because it is possible that all of the core histones are acetylated in elongating spermatids at the time of removal of the entire histone complement for replacement by basic spermatidal transition proteins (S.R. Grimes and N. Henderson, 1983, Arch. Biochem. Biophys. 221, 108-116).

Occurrence of minute ring-shaped nucleoprotein particles in culture media conditioned by mammalian cells

Conditioned media of 21 mammalian cell lines have been examined by electron microscopic and biochemical techniques for the presence of a minute ring-shaped nucleoprotein particle (RSP). Electron microscopy showed the presence of RSP in 20 of the 21 cell lines tested. Comparative analyses of sex cell cultures for radioactive RSP, following 3H-thymidine incorporation, suggested that quantitative differences exist in the amount of RSP detectable in conditioned media of normal and pathologic cells. The cell lines tested included cells of different morphologies, origin and function

The association between HL-A antigens ankylosing spondylitis and sacro-iliitis

The second series antigen W27 has been found to have an increased frequency in ankylosing spondylitis (82 per cent of 17 patients) and juvenile rheumatoid arthritis (Still's disease) (29 per cent of 24 patients). Three family studies are presented, including one in which the antigen W27 occurs both in the absence and the presence of ankylosing spondylitis. It is suggested that this family illustrates that the relationship between W27 and sacro-iliitis is affected by non-HL-A genes. The development of clinical disease depends upon the coincidence of several factors in one individual, some of which are genetically controlled by two or more loci which are not necessarily linked.