Complement factor H gene polymorphisms and Chlamydia pneumoniae infection in age-related macular degeneration

PURPOSE

To investigate the association of the complement factor H gene (CFH)Y402H polymorphism and age-related macular degeneration (AMD) in the Austrian population (Caucasoid descent), and to determine whether there is an association between exposure to Chlamydia pneumoniae-responsible for up to 20% of community-acquired pneumoniae-and the AMD-associated CFHrisk polymorphism.

METHODS

Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism analysis in 75 unrelated AMD patients and compared with 75 healthy, age-matched control subjects. C. pneumoniaeserum IgG was tested by ELISA (R&D) in both groups. The association between the CFHY402H genetic polymorphism and the disease was examined by chi (2)-test and logistic regression.

RESULTS

CFH Y402H genotypefrequencies differed significantly between AMD patients and healthy controls (1277 TT, 22.7%; 1277 TC, 53.3%; and 1277 CC, 22.7% in the AMD group; 1277 TT, 48.0%; 1277 TC, 38.7%; and 1277 CC, 13.3% in the control group) showing a P-value <0.005 (OR:2.920/3.811).No association was found between a positive C. pneumoniae titre and AMD (P=0.192), nor was any association found between C. pneumoniae and the CFH Y402H polymorphism.

CONCLUSIONS

Our data confirm that the CFHY402H polymorphism is a risk factor for AMD in the Austrian population with a higher frequency of the Y402 polymorphism in AMD patients. No association between preceding C. pneumoniaeinfection and diagnosed AMD was found.

The role of age in cost-benefit analysis of thromboprophylaxis

Socioeconomic studies about deep-vein thrombosis prophylaxis with low-molecular-weight heparins have shown that general prophylaxis in patients at risk is economically justified. However, the question arises whether the guidelines for thromboprophylaxis developed hitherto provide a fair balance between the medical as well as the socio-economic standpoint and the need of the individual patient. Thromboprophylaxis has to be performed according to acknowledged professional standards under the restraints of cost-effectiveness, whereas the patient is only interested in receiving the best treatment available. Guidelines for thromboprophylaxis are based on the allocation of risk factors, one of those, a higher age of the patient. Most guidelines mention a threshold of 40 years, only in cases where additional risks prevail, thromboprophylaxis in younger patients is recommended. Because some trials suggest that the thromboembolic risk in young patients has been underestimated so far, a computer model was developed to determine the age-dependent cost-benefit ratio for thromboprophylaxis. The results with different sets of input data show that providing thromboprophylaxis to younger patients is also cost-effective, suggesting to reconsider the existing medical guidelines.

Synthesis of human coagulation factor XIII in yeast

The active form of coagulation factor XIII, factor XIIIa, is a transglutaminase that covalently cross-links fibrin molecules by joining gamma-glutamyl and epsilon-lysyl primary amino groups. In this paper we report the design of a yeast expression vector called pPH3 which includes the GAL1-GAL10 promoter, multiple cloning sites, the URA3 selectable marker, the 2 mu sequences and the ampicillin-resistance gene. We have placed full-length factor XIII cDNA into the PstI site of this vector, transformed the yeast cells and expressed human coagulation factor XIII which was found to be enzymatically active based on observations that this recombinant factor XIII: (a) showed immunological identity with placental factor XIII; (b) was demonstrated to have transglutaminase activity, and (c) cross-linked fibrin in a manner identical to human placental factor XIIIa-catalyzed polymerization (gamma-gamma dimerization and alpha polymerization).

Intraoperative MRI-Guided Resection Is Not Superior to 5-Aminolevulinic Acid Guidance in Newly Diagnosed Glioblastoma: A Prospective Controlled Multicenter Clinical Trial

PURPOSE

Prospective data suggested a superiority of intraoperative MRI (iMRI) over 5-aminolevulinic acid (5-ALA) for achieving complete resections of contrast enhancement in glioblastoma surgery. We investigated this hypothesis in a prospective clinical trial and correlated residual disease volumes with clinical outcome in newly diagnosed glioblastoma.

METHODS

This is a prospective controlled multicenter parallel-group trial with two center-specific treatment arms (5-ALA and iMRI) and blinded evaluation. The primary end point was complete resection of contrast enhancement on early postoperative MRI. We assessed resectability and extent of resection by an independent blinded centralized review of preoperative and postoperative MRI with 1-mm slices. Secondary end points included progression-free survival (PFS) and overall survival (OS), patient-reported quality of life, and clinical parameters.

RESULTS

We recruited 314 patients with newly diagnosed glioblastomas at 11 German centers. A total of 127 patients in the 5-ALA and 150 in the iMRI arm were analyzed in the as-treated analysis. Complete resections, defined as a residual tumor ≤0.175 cm³, were achieved in 90 patients (78%) in the 5-ALA and 115 (81%) in the iMRI arm (P = .79). Incision-suture times (P < .001) were significantly longer in the iMRI arm (316 v 215 [5-ALA] minutes). Median PFS and OS were comparable in both arms. The lack of any residual contrast enhancing tumor (0 cm³) was a significant favorable prognostic factor for PFS (P < .001) and OS (P = .048), especially in methylguanine-DNA-methyltransferase unmethylated tumors (P = .006).

CONCLUSION

We could not confirm superiority of iMRI over 5-ALA for achieving complete resections. Neurosurgical interventions in newly diagnosed glioblastoma shall aim for safe complete resections with 0 cm³ contrast-enhancing residual disease, as any other residual tumor volume is a negative predictor for PFS and OS.

Assessing the impact of a downscaled climate change simulation on the fish fauna in an Inner-Alpine River

This study assesses the impact of a changing climate on fish fauna by comparing the past mean state of fish assemblage to a possible future mean state. It is based on (1) local scale observations along an Inner-Alpine river called Mur, (2) an IPCC emission scenario (IS92a), implemented by atmosphere-ocean global circulation model (AOGCM) ECHAM4/OPYC3, and (3) a model-chain that links climate research to hydrobiology. The Mur River is still in a near-natural condition and water temperature in summer is the most important aquatic ecological constraint for fish distribution. The methodological strategy is (1) to use downscaled air temperature and precipitation scenarios for the first half of the twenty-first century, (2) to establish a model that simulates water temperature by means of air temperature and flow rate in order to generate water temperature scenarios, and (3) to evaluate the impact on fish communities using an ecological model that is driven by water temperature. This methodology links the response of fish fauna to an IPCC emission scenario and is to our knowledge an unprecedented approach. The downscaled IS92a scenarios show increased mean air temperatures during the whole year and increased precipitation totals during summer, but reduced totals for the rest of the annual cycle. These changes result in scenarios of increased water temperatures, an altered annual cycle of flow rate, and, in turn, a 70 m displacement in elevation of fish communities towards the river's head. This would enhance stress on species that rely on low water temperatures and coerce cyprinid species into advancing against retreating salmonids. Hyporhithral river sectors would turn into epipotamal sectors. Grayling (Thymallus thymallus) and Danube salmon (Hucho hucho), presently characteristic for the Mur River, would be superceded by other species. Native brown trout (Salmo trutta), already now under pressure of competition, may be at risk of losing its habitat in favour of invaders like the exotic rainbow trout (Oncorhynchus mykiss), which are better adapted to higher water temperatures. Projected changes in fish communities suggest an adverse influence on salmonid sport fishing and a loss in its high economic value.

Effect of transmembrane helix packing on tryptophan and tyrosine environments in detergent-solubilized bacterio-opsin

Bacterio-opsin (bO) is folded in a nearly native conformation in mixed micelles of dimyristoyl phosphatidyl choline (DMPC) and 3-[(3-cholamidopropyl)-dimehtylamonio]-1-propane sulfonic acid (CHAPS), but bO is partially unfolded in sodium dodecyl sulfate (SDS). UV difference spectroscopy was used to study the changes in environment of bO aromatic amino acid side chains that occur upon partial unfolding. The UV difference spectra of peptides in CHAPS/DMPC minus peptides in SDS were measured for bO and the following subfragments of bO: C1 (residues 72-248), C2 (1-71), V1 (1-166), V2 (167-248), CB7 (119-145), CB9 (164-209), and CB10 (72-118). The spectra show that, in partially unfolded bO in SDS, the Tyr and Trp absorbance is blue-shifted. The difference spectra were compared to solvent perturbation difference spectra of N-acetyl-L-tyrosine ethyl ester and N-acetyl-L-tryptophanamide. The exposure change calculated from the difference spectra was found to correlate with the change in the number of van der Waals contacting atoms upon partial unfolding, and also with the number of transmembrane helical segments. This result suggests a simple experimental method of testing helix packing arrangements derived from hydropathy plots and model building.