A multi-stage multi-design strategy provides strong evidence that the BAI3 locus is associated with early-onset venous thromboembolism

BACKGROUND

Factor VIII (FVIII) and von Willebrand factor (VWF) are two known quantitative risk factors for venous thromboembolism (VTE).

OBJECTIVES

To identify new loci that could contribute to VTE susceptibility and to modulating FVIII and/or VWF levels.

PATIENTS/METHODS

A pedigree linkage analysis was first performed in five extended French-Canadian families, including 253 individuals, to identify genomic regions linked to FVIII or VWF levels. Identified regions were further explored using 'in silico' genome-wide association studies (GWAS) data on VTE (419 patients and 1228 controls), and two independent case-control studies (MARTHA and FARIVE) for VTE, gathering 1166 early-onset patients and 1408 healthy individuals. Single nucleotide polymorphisms (SNPs) associated with VTE risk were further investigated in relation to plasma levels of FVIII and VWF in a cohort of 108 healthy nuclear families.

RESULTS

Four main linkage regions were identified, among which the well-characterized ABO locus, the recently identified STAB 2 gene, and a third one, on chromosome 6q13-14, harbouring four non-redundant SNPs, associated with VTE at P < 10(-4) in the GWAS dataset. The association of one of these SNPs, rs9363864, with VTE was further replicated in the MARTHA and FARIVE studies. The rs9363864-AA genotype was associated with a lower risk for VTE (OR = 0.58 [0.42-0.80], P = 0.0005) but mainly in non-carriers of the FV Leiden mutation. This genotype was further found to be associated with the lowest levels of FVIII (P = 0.006) and VWF (P = 0.001).

CONCLUSIONS

The BAI3 locus where the rs9363864 maps is a new candidate for VTE risk.

Outcome in acute stroke with different intra-arterial infusion rate of urokinase on thrombolysis

Intra-arterial infusion of urokinase (UK) has been widely used. However, the optimal infusion rate of the reagent has never been determined. This was investigated in the acute stage of middle cerebral artery (MCA) embolism in the present study. Sprague Dawley male rats (n=43) were randomly divided into sham-operation and five ischemic groups with urokinase administration at different infusion rates or without urokinase administration. Ischemia was induced with MCA embolism. Two hours after embolism, total urokinase (urokinase, 170,000U/kg) was given in groups A,B,C and D (n=8 each) at different rates: 1,000 U (0.03 ml/min) per minute, 4,000U (0.12 ml/min), 10,000U (0.30 ml/min), and 16,000U (0.48 ml/min), respectively. Group E received normal saline at a rate of 0.48 ml/min. The sham-operation group (no embolism) received urokinase at (170,000U/kg, 1.5 ml, 16,000 U/min). During ischemia and thrombolysis, regional cerebral blood flow (CBF) was monitored by laser Doppler flowmetry. The neurological deficits, infarct volumes and mortalities in each group were determined. The CBF in ischemic hemisphere were significantly (p<0.05) decreased after embolism in groups A∼E at similar levels (27.32±8.20% to 34.71±6.84%). After different treatments, in group B 4,000U/min infusion of UK induced the best reperfusion, the least neurological deficits and infarct volume, as well as the least mortality and lowest incidence of hemorrhage. The effect of intra-artery thrombolysis of urokinase was related to the infusion rate. Our study demonstrated an optimal infusion rate at 4,000U/min, suggesting relatively low levels of infusion are better able to improve brain reperfusion and reduce brain injury after stroke.

Molecular imaging of glioblastoma multiforme using anti-insulin-like growth factor-binding protein-7 single-domain antibodies

Background:

Insulin-like growth factor-binding protein 7 (IGFBP7) is an abundant, selective and accessible biomarker of glioblastoma multiforme (GBM) tumour vessels. In this study, an anti-IGFBP7 single-domain antibody (sdAb) was developed to target GBM vessels for molecular imaging applications.

Methods:

Human GBM was modelled in mice by intracranial implantation of U87MG.EGFRvIII cells. An anti-IGFBP7 sdAb, isolated from an immune llama library by panning, was assessed in vitro for its binding affinity using surface plasmon resonance and by ex vivo immunobinding on mouse and human GBM tissue. Tumour targeting by Cy5.5-labelled anti-IGFBP7 sdAb as well as by anti-IGFBP7 sdAb conjugated to PEGylated Fe₃O₄ nanoparticles (NPs)-Cy5.5 were assessed in U87MG.EGFRvIII tumour-bearing mice in vivo using optical imaging and in brain sections using fluorescent microscopy.

Results:

Surface plasmon resonance analyses revealed a medium affinity (K_D=40–50 nM) binding of the anti-IGFBP7 sdAb to the purified antigen. The anti-IGFBP7 sdAb also selectively bound to both mouse and human GBM vessels, but not normal brain vessels in tissue sections. In vivo, intravenously injected anti-IGFBP7 sdAb-Cy5.5 bound to GBM vessels creating high imaging signal in the intracranial tumour. Similarly, the anti-IGFBP7 sdAb-functionalised PEGylated Fe₃O₄ NP-Cy5.5 demonstrated enhanced tumour signal compared with non-targeted NPs. Fluorescent microscopy confirmed the presence of anti-IGFBP7 sdAb and anti-IGFBP7 sdAb-PEGylated Fe₃O₄ NPs selectively in GBM vessels.

Conclusions:

Anti-IGFBP7 sdAbs are novel GBM vessel-targeting moieties suitable for molecular imaging.

[Application of susceptibility weighted imaging in revealing intratumoral blood products and grading gliomas]

OBJECTIVE

Susceptibility weighted imaging (SWI) is a novel imaging method that utilizes the magnetic susceptibility differences between tissues. The purpose of our study was to evaluate the application of SWI for revealing inratumoral blood products and diagnosing high-grade gliomas.

MATERIALS AND METHODS

Conventional MR sequences and SWI were performed in 32 patients, 10 low-grade gliomas (1 grade I and 9 grade II) and 22 high-grade gliomas (8 grade III and 14 grade IV). The ability of SWI for detecting inratumral blood products was analyzed and compared with conventional MR sequences. Logistic regression and Receiver operating characteristic (ROC) curve analysis were used to evaluate the diagnostic value of SWI for high-grade gliomas.

RESULTS

SWI was sensitive for showing intrtumoral blood products (P=0.00) and depicted much more micro bleeds. No statistical difference was found in detection rate of blood products between low-grade and high-grade group. According to the result of logistic regression, the frequency of blood products and the diameter of maximum blood products were significant determinants of high-grade gliomas. The result of ROC analysis indicated that with an optimal cut-off point (0.67), the sensitivity, specificity, positive predictive value and negative predictive value for diagnosing high-grade gliomas with blood products detected by SWI were 81.8%, 80.0%, 90.0%, and 66.6%, respectively.

CONCLUSION

SWI can accurately detect blood products with superlative contrast. With a high-grade gliomas risk estimation model based on two variables, satisfied sensitivity, specificity, PPV and NPV were obtained. Thus, SWI could be a useful adjunct sequence in glioma grading.

Therapeutic effect of norisoboldine, an alkaloid isolated from Radix Linderae, on collagen-induced arthritis in mice

The alkaloid fraction of Radix Linderae, the main active component of this herb drug, has been proven to exhibit anti-inflammatory, analgesic and antimicrobial activities. The present study was undertaken to investigate the therapeutic potential of norisoboldine, the major isoquinoline alkaloid present in Radix Linderae, in collagen II -induced arthritis (CIA) of mice as well as the possible mechanisms. CIA was induced in mice by immunization with chicken type II collagen (II). After boosted on day 21, mice were treated with norisoboldine (10, 20, 40 mg/kg) for twenty consecutive days. The clinical scores, body weight changes and joint histopathology were evaluated. Norisoboldine treatment significantly alleviated the severity of the disease, based on the reduced clinical scores and elevated the lowered body weights of model mice. Meanwhile, this alkaloid dose-dependently reduced the infiltration of inflammatory cells, synovial hyperplasia and protected joint from destruction. Additionally, the serum level of anti-CII IgG and the CII-stimulated lymphocyte proliferation were remarkably decreased in the groups administered with norisoboldine. An assessment of Th1 function using the delayed-type hypersensitivity model confirmed that norisoboldine also significantly suppressed the enhanced T cell responses in vivo. These findings suggest that norisoboldine might be a potential therapeutic agent for rheumatoid arthritis, and it functions through protecting joint destruction as well as regulating the abnormal immune responses.

A randomized trial on root caries prevention in elders

Root caries is common in institutionalized elders, and effective prevention methods are needed. This clinical trial compared the effectiveness of four methods in preventing new root caries. From 21 residential homes, 306 generally healthy elders having at least 5 teeth with exposed sound root surfaces were randomly allocated into one of four groups: (1) individualized oral hygiene instruction (OHI); (2) OHI and applications of 1% chlorhexidine varnish every 3 months; (3) OHI and applications of 5% sodium fluoride varnish every 3 months; and (4) OHI and annual applications of 38% silver diamine fluoride (SDF) solution. Two-thirds (203/306) of the elders were followed for 3 years. Mean numbers of new root caries surfaces in the four groups were 2.5, 1.1, 0.9, and 0.7, respectively (ANOVA, p < 0.001). SDF solution, sodium fluoride varnish, and chlorhexidine varnish were more effective in preventing new root caries than giving OHI alone.

Dynamic formation of a hot field reversed configuration with improved confinement by supersonic merging of two colliding high-β compact toroids

A hot stable field-reversed configuration (FRC) has been produced in the C-2 experiment by colliding and merging two high-β plasmoids preformed by the dynamic version of field-reversed θ-pinch technology. The merging process exhibits the highest poloidal flux amplification obtained in a magnetic confinement system (over tenfold increase). Most of the kinetic energy is converted into thermal energy with total temperature (T{i}+T{e}) exceeding 0.5 keV. The final FRC state exhibits a record FRC lifetime with flux confinement approaching classical values. These findings should have significant implications for fusion research and the physics of magnetic reconnection.

CD10 enhances metastasis of colorectal cancer by abrogating the anti-tumoural effect of methionine-enkephalin in the liver

OBJECTIVE

To examine the role of CD10, a characteristic marker of liver metastasis of colorectal cancers (CRCs).

DESIGN

The effect of CD10 and Met-enkephalin (MENK) in CD10-positive and -negative human CRC cells was investigated under in vitro and in vivo conditions. Human CRC samples were examined.

MAIN OUTCOME MEASURE

CD10-positive and CD10-knockdown HT29 cells and CD10-negative and CD10-transfected Colo320 cells in nude mice were treated with MENK and/or the CD10 inhibitor (thiorphan). Intracellular signalling of MENK and delta-opioid receptor (DOR) was examined by immunoblotting.

RESULTS

MENK inhibited the growth, invasion and survival of CRC cells following thiorphan-induced CD10 inactivation. Thiorphan suppressed liver metastasis of CD10-positive CRC cells. Inoculation of mice with CRC cells induced MENK expression in the liver. Inhibition of hepatic MENK expression by cholesterol-conjugated antisense S-oligodeoxynucleotide increased liver metastasis of CRC cells even when the cells did not express CD10. DOR activation by MENK decreased the phosphorylation of epidermal growth factor receptor and extracellular signal-regulated kinase and increased p38-dependent apoptosis. Nitric oxide was found to induce DOR expression in CRC cells. Co-treatment with thiorphan and a nitric oxide donor had a marked anti-tumour effect on liver metastasis of HT29 cells. Of 68 CRC patients, 19 (28%) showed CD10 expression, which was dependent on the extent of liver metastasis. MENK concentration in metastasis-positive human liver was higher than that in the normal liver.

CONCLUSION

CD10 expression in CRC cells abrogates the anti-tumour effect of hepatic MENK by degrading it, which enhances liver metastasis of CD10-positive CRC cells.

Interleukin-10 inhibits Mycobacterium bovis bacillus Calmette-Guérin (BCG)-induced macrophage cytotoxicity against bladder cancer cells

The mechanisms underlying bacillus Calmette-Guérin (BCG) immunotherapy of bladder cancer currently remain elusive. Previously, we demonstrated that macrophages were cytotoxic to bladder cancer cells upon BCG stimulation in vitro. However, macrophages from C57BL/6 mice were less potent than those from C3H/HeN mice for the killing of bladder cancer cells. This study was to determine whether interleukin (IL)-10 produced by macrophages in response to BCG is a causative factor for the reduced cytotoxicity in BCG-stimulated C57BL/6 macrophages. Thioglycollate-elicited peritoneal macrophages were prepared and analysed for the BCG induction of cytotoxicity, cytokines and nitric oxide (NO) in vitro. Compared to BCG-stimulated C3H/HeN macrophages, BCG-stimulated C57BL/6 macrophages exhibited reduced killing of bladder cancer MBT-2 cells and MB49 cells. Studies demonstrated further that BCG-stimulated C57BL/6 macrophages produced a high level of IL-10, which correlated with reduced production of tumour necrosis factor (TNF)-alpha, IL-6 and NO. Neutralizing endogenous IL-10 during BCG stimulation increased C57BL/6 macrophage cytotoxicity against MB49 cells by 3.2-fold, along with increased production of TNF-alpha by 6.4-fold and NO by 3.6-fold, respectively. Macrophages from C57BL/6 IL-10(-/-) mice also exhibited increased killing of MB49 cells and production of TNF-alpha and NO upon BCG stimulation. In addition, supplementation of exogenous recombinant IL-10 reduced BCG-induced C3H/HeN macrophage cytotoxicity against both MBT-2 cells and MB49 cells in a dose-dependent manner. These results reveal the inhibitory role of IL-10 in BCG-induced macrophage cytotoxicity, suggesting that blockage of IL-10 may potentially enhance the effect of BCG in the treatment of bladder cancer patients.

Effects of n-3 Polyunsaturated Fatty Acid Therapy on Plasma Inflammatory Markers and N-Terminal Pro-brain Natriuretic Peptide in Elderly Patients with Chronic Heart Failure

Several previous studies have suggested that n-3 polyunsaturated fatty acids ( n-3 PUFA) can exert favourable effects in patients with heart failure, but the mechanisms involved are not fully understood. This study was designed to investigate the effects of n-3 PUFA on circulating inflammatory markers and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with heart failure. Seventy-six patients with heart failure were randomly assigned to receive 2 g/day of n-3 PUFA or placebo for 3 months. Treatment with n-3 PUFA significantly decreased plasma levels of tumour necrosis factor, interleukin-6, intercellular adhesion molecule 1 and NT-proBNP. Left ventricular ejection fraction showed a small, non-significant improvement. High-sensitivity C-reactive protein levels decreased significantly in smokers after n-3 PUFA treatment. Thus, n-3 PUFA can reduce levels of plasma inflammatory markers and NT-proBNP as biomarkers of risk stratification in patients with heart failure. n-3 PUFA may offer a novel therapy for heart failure.

Widespread pain symptoms and psychological distress in southern Chinese with orofacial pain

The study investigated the experience of widespread pain (WP) symptoms and psychological distress in southern Chinese with orofacial pain (OFP). A community-based, cross-sectional case-control study involving people aged 35-70 registered with the Hospital Authority/University of Hong Kong Family Medicine Clinic served as the sampling frame. People with recent OFP symptoms and a group without OFP took part. Standard questions were asked about OFP conditions in the previous month. Psychological status was evaluated through depression, and non-specific physical symptoms (NPS) scores were measured with depression and somatization sub-scales of the Symptom Checklist-90. Widespread pain was determined using body outline drawings to identify painful sites prior to a standard clinical examination. Two hundred people with OFP and 200 without OFP participated. Compared with 5.0% in the comparison group (P = 0.005), 13.5% of participants with OFP had WP (OFP/WP). Multiple OFP symptoms were more common in the OFP/WP sub-group than the OFP sub-group without WP (OFP/No WP) (P < 0.002). Sixty-three percent of the OFP/WP sub-group had moderate/severe depression scores compared with 26.0% in the OFP/No WP sub-group (P < 0.001). When pain items were included and excluded, 92.6% and 88.9% of the OFP/WP sub-group had moderate/severe NPS scores, respectively compared with 68.5% and 65.0% in the OFP/No WP sub-group (P = 0.004). Co-morbid WP occurred relatively often in southern Chinese with OFP. Psychological distress was common in OFP sufferers, particularly those with WP. A multidisciplinary approach to treatment including cognitive/behavioural therapy should be considered in Chinese people with OFP as part of a WP pattern.

Polyurethane as a potential knee hemiarthroplasty biomaterial: An in-vitro simulation of its tribological performance

Hemiarthroplasty is an attractive alternative to total joint replacement for the young active patient, when only one side of the synovial joint is damaged. In the development of a hemiarthroplasty prosthesis, a comprehensive understanding of the tribology of both the natural joint and the hemireplaced joint is necessary. The objectives of this study were to investigate the tribological response of polyurethane (PU) as a potential hemiarthroplasty material. Bovine medial compartmental knees were tested in a Prosim pendulum friction simulator, which applied physiologically relevant loading and motion. The healthy medial compartment was investigated as a negative control; a stainless steel hemiarthroplasty was investigated as a positive control; and three PU hemiarthroplasty plates of different moduli (1.4 MPa, 6.5 MPa, and 22 MPa) were also investigated. Using the lower-modulus PU caused reduced levels of contact stress and friction shear stress, which resulted in reduced levels of opposing cartilage wear. The two PU bearings with the lowest moduli demonstrated a similar tribological performance to the negative control. The higher-modulus PU (22 MPa) did demonstrate higher levels of friction shear stress, and wear resulted on the opposing cartilage, although not as severe as the wear from the stainless steel group. This study supports the use of compliant PU designs in future tribological experiments and hemiarthroplasty design applications.