Chemotherapy for AIDS-related and endemic African Kaposi's sarcoma in southern Africa

BACKGROUND

Kaposi's sarcoma (KS), either in its endemic (African) form or its AIDS-related variant, is a common neoplastic disorder seen in Southern Africa. Chemotherapy has been proven to be very effective in advanced or relapsed African Kaposi's sarcoma, but much less so in AIDS-related, endemic KS.

PATIENTS AND METHODS

The study consists of a retrospective analysis of the results of chemotherapy alone in 17 patients with African KS (AKS) and in 32 patients with epidemic AIDS-related KS (EKS), treated at the Johannesburg General Hospital between 1982 and 1992. Single agents included vinblastine, actinomycin D, bleomycin, and vincristine; combined regimens were largely doxorubicin/vincristine/bleomycin or etoposide/methotrexate. Outcome classifications were: complete remission (CR), partial remission (PR), and treatment failure (TF).

RESULTS

Four of the 17 patients with AKS had CR, 10 a PR, and three were TF and died rapidly from their disease. The combined chemotherapeutic regimens produced marked symptomatic relief and even long-term remission in AKS. In patients with EKS, the response rate to chemotherapy was very low and of brief duration. No patient had a CR and debilitating side effects were common.

CONCLUSIONS

The African type of AKS is a chemo-sensitive tumor, whereas the endemic type EKS, like its Western counterpart, has a dismal prognosis.

Blood transfusion and its benefits in palliative care

The value of blood transfusion as a supportive treatment in haematological disease and oncology is well established and is seen as an essential part of treatment. The place of blood transfusion in the alleviation of symptoms within palliative care units is less well established. There has been no evaluation of its benefits in terms of symptom relief and impact on the quality of life. This study was designed to identify the benefit achieved by transfusion as well as possible indicators for its appropriate use in the future. Ninety-seven patients were recruited over one year, from the beginning of September 1992 to the end of August 1993, from eight centres, all members of the South West Thames Palliative Medicine Collaborative Audit Group. Patients completed visual analogue scales before and on two occasions after transfusion, to assess its impact on dyspnoea, weakness and overall sense of well-being. Results indicated that a significant proportion showed improvement in all three parameters. Those whose main indication for transfusion was weakness showed a particular benefit. The group of patients entered into the study were anaemic in comparison with our normal patient population, but the degree of improvement seen did not correlate with the degree of anaemia prior to transfusion. We conclude that transfusion does offer symptom relief and improvement in well-being in patients with advanced malignant disease. It should be considered as a worthwhile option in palliative treatment of weakness, dyspnoea and impaired overall sense of well-being, when associated with anaemia.

Case report: pulmonary calcification after liver transplantation in children

Pulmonary calcification following liver transplantation is a recognized phenomenon in adults but has not been previously described in children. We describe two children who developed pulmonary calcification after liver transplantation. Pulmonary calcification should be considered after liver transplantation when radiographic changes fail to resolve with appropriate treatment.

Zinc reduces dentate granule cell hyperexcitability in epileptic humans

The hippocampi of epileptic patients with medial temporal lobe epilepsy exhibit a characteristic pattern of anatomical changes including cell loss and sprouting of the granule cell axons, the mossy fibers, into the inner molecular layer of the dentate. In addition to glutamate, mossy fibers release Zn2+. In the present study we investigated the action of Zn2+ on excitatory synaptic potentials in the dentate granule cells of patients with medial temporal lobe epilepsy. We show here that Zn2+ limits the duration of excitatory responses in these cells, probably by blocking the N-methyl-D-aspartate (NMDA) receptors. Zinc may, therefore, play an important role in limiting epileptiform activity in this issue.

Bean [alpha]-Amylase Inhibitor Confers Resistance to the Pea Weevil (Bruchus pisorum) in Transgenic Peas (Pisum sativum L.)

Bruchid larvae cause major losses of grain legume crops through-out the world. Some bruchid species, such as the cowpea weevil and the azuki bean weevil, are pests that damage stored seeds. Others, such as the pea weevil (Bruchus pisorum), attack the crop growing in the field. We transferred the cDNA encoding the [alpha]-amylase inhibitor ([alpha]-AI) found in the seeds of the common bean (Phaseolus vulgaris) into pea (Pisum sativum) using Agrobacterium-mediated transformation. Expression was driven by the promoter of phytohemagglutinin, another bean seed protein. The [alpha]-amylase inhibitor gene was stably expressed in the transgenic pea seeds at least to the T5 seed generation, and [alpha]-AI accumulated in the seeds up to 3% of soluble protein. This level is somewhat higher than that normally found in beans, which contain 1 to 2% [alpha]-AI. In the T5 seed generation the development of pea weevil larvae was blocked at an early stage. Seed damage was minimal and seed yield was not significantly reduced in the transgenic plants. These results confirm the feasibility of protecting other grain legumes such as lentils, mungbean, groundnuts, and chickpeas against a variety of bruchids using the same approach. Although [alpha]-AI also inhibits human [alpha]-amylase, cooked peas should not have a negative impact on human energy metabolism.

Halsey needle holder for micro and mini slit grafting

BACKGROUND

Few suggestions have been made to date concerning how to more reproducibly place scalp slits for micro- and minigrafts.

OBJECTIVE

To improve on the unpredictable consistency of depth and angle of scalp slits for micro- and minigrafting.

METHOD

Seven-inch Halsey needle holders were used to stabilize the cutting instruments (No-Kor microblades, #15c, and #15 blades) for making scalp slits for micro- and minigrafts on approximately 80 patients over 5 months.

CONCLUSION

Using the Halsey needle holder or stabilization of the blades for slit placement of scalp micro- and minigrafting is superior to directly holding the blades by improving on depth, angle control, ease of holding and adjustment, and greater reproducibility.

Accumulation and proteolytic processing of vicilin deletion-mutant proteins in the leaf and seed of transgenic tobacco

Vicilin, a 7S globulin of Pisum sativum L. seed, accumulates in protein-storage vacuoles (protein bodies) of cotyledonary storage-parenchyma cells. The synthesis and proteolytic processing of various genetically engineered proteins within the leaf and seed of a heterologous (tobacco, Nicotiana tabacum L.) host was examined. A modified vicilin gene, in which the DNA sequence corresponding to the signal peptide was removed, resulted in a polypeptide of 50 kDa in the tobacco leaf and seed; none of the normal proteolytic cleavage products characteristic of expression of an unmodified vicilin gene were obtained. Likewise, no vacuolar accumulation of this mutant vicilin occurred in leaf protoplasts, which is also supportive of the predicted cytosolic localization for this protein. In-frame deletions were made within the region of the vicilin gene encoding the mature protein, to eliminate the N-terminal 28 and 121 amino acids and the C-terminal 69 residues, while maintaining an intact signal peptide. All of these "mature" deletion-mutant proteins were accumulated to only low levels in the host, but exhibited the predicted molecular weight and underwent some normal proteolytic processing in the seed. Mutant vicilin proteins having deletions in either the N-terminus (delta NT 121) or C-terminus (delta CT 69) were not found in appreciable amounts within the vacuolar fraction of transgenic tobacco leaf protoplasts, perhaps due to protein degradation in this compartment. Compared with the intact vicilin, oligomer assembly of the C-terminal deletion-mutant protein was disrupted in leaf cells, which may have further affected protein stability.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in plasma TGF beta levels during pulmonary radiotherapy as a predictor of the risk of developing radiation pneumonitis

PURPOSE

To determine whether plasma transforming growth factor-beta (TGF-beta) levels measured before and during radical radiotherapy for lung cancer could be used to predict patients at risk for the development of radiation pneumonitis.

METHODS AND MATERIALS

The first eight patients with lung cancer (nonsmall cell: seven, small cell: one) enrolled in a prospective study designed to evaluate physiological and molecular biologic correlates of radiation induced normal tissue injury are described. The study began in June 1991. All patients were treated with radiotherapy with curative intent. Plasma transforming growth factor-beta levels were obtained before, weekly during, and at each follow-up after treatment. Pretreatment pulmonary function tests and single photon emission computed tomography scans were obtained to assess baseline lung function and were repeated at follow-up visits. Dose-volume histogram analyses were performed to determine the volume of lung which received > or = 30 Gy. Patients were assessed at each follow-up visit for signs and symptoms of pneumonitis.

RESULTS

Five patients developed signs and/or symptoms of pulmonary injury consistent with pneumonitis and three patients did not. In all three patients not developing pneumonitis, plasma TGF-beta levels normalized by the end of radiotherapy. In contrast, four out of five patients who suffered pneumonitis had persistently elevated plasma TGF-beta levels by the end of therapy. This finding appeared to be independent of the volume of irradiated lung.

CONCLUSIONS

These results suggest that plasma TGF-beta levels during treatment may be useful to determine which patients are at high risk of developing symptomatic pneumonitis following thoracic radiotherapy. This finding may have implications when planning additional therapy (either chemotherapy or radiotherapy) which may have potentially adverse consequences on the lung.

Lymphoproliferative disorders in non-AIDS-associated Kaposi's sarcoma. The Johannesburg Hospital experience, 1980-1992

The association of the non-AIDS-related, classic form of Kaposi's sarcoma (KS) with secondary malignancies, especially lymphoproliferative disorders, has frequently been noted. However, in endemic African-type KS, such an association has been reported only rarely. A review of 62 non-AIDS-related cases of KS treated and followed up at Johannesburg General Hospital between 1980 and 1992 revealed 8 patients (13%) in whom KS was associated with malignant lymphoproliferative disorders. The prevalence of secondary lymphoproliferative disorders was not significantly different among patients with classic KS (3/15; 20%) when compared with those who had African KS (4/47; 8%). In both forms of KS subtle disturbances of immunity have been described which may play a role in the pathogenesis of secondary lymphoproliferative disorders, although the factors responsible and the pathogenetic mechanisms involved in malignant lymphoid transformation in these patients have not been fully elucidated.

Lymphoproliferative malignancies in association with endemic African Kaposi's sarcoma

The association of classical Kaposi's sarcoma with lymphoproliferative disorders is well known. However, far less is known about lymphoproliferative malignancies in endemic African Kaposi's sarcoma. A review of 47 patients with the endemic type of Kapos's sarcoma treated at the Johannesburg Teaching Hospital Complex between 1980 and 1992 revealed four patients (8.5 pc) in whom Kaposi's sarcoma was associated with a malignant lymphoma. Possible pathogenetic mechanisms are suggested and the current literature is reviewed.

Epidemic AIDS-related Kaposi's sarcoma in southern Africa: experience at the Johannesburg General Hospital (1980-1990)

Epidemic acquired immune deficiency syndrome-related Kaposi's sarcoma (AKS) in tropical and southern Africa is a highly varied neoplastic disease, characterized by multifocal mucocutaneous, lymphatic and visceral involvement. It follows a clinical course similar to AKS in Europe and the USA. However, lack of adequate medical facilities in many African countries hampers successful palliation of this fatal disease. In this retrospective analysis, we summarize our experience with 52 patients with AKS treated at Johannesburg General Hospital, South Africa, between 1980 and 1990. Radiation therapy can provide good to excellent palliation with only minimal side-effects, producing a lesser impact on the haematological and immunological system than chemotherapy.

Radiation Therapy in Epidemic, Aids-Related Kaposi's Sarcoma in Southern Africa

Aims and background

Acquired Immunodeficiency Syndrome (AIDS) associated Kaposi's Sarcoma (EKS) is widely spread in the Southern African Region. No large studies concerning the role of radiation therapy in the Southern African variant of EKS have been reported to date.

Methods

Over a 10 year period (1982-1992) 25 patients with EKS (disseminated skin involvement) were treated primarily with radiation therapy at the Johannesburg General Hospital. Radiation fields were individually tailored to the extent of the disease. Total administered doses ranged between 8-12 Gy (single fraction) to 24-30 Gy fractionated over 2-3 weeks.

Results

Overall response and symptomatic relief rates were 72% and 80%, respectively. Toxicity was mild and manageable.

Conclusions

Our retrospective analysis supports the use of radiation therapy for the Southern African type of EKS.

Agrobacterium-Mediated Transformation of Subterranean Clover (Trifolium subterraneum L.)

We have developed a rapid and reproducible transformation system for subterranean clover (Trifolium subterraneum L.) using Agrobacterium tumefaciens-mediated gene delivery. Hypocotyl segments from seeds that had been allowed to imbibe were used as explants, and regeneration was achieved via organogenesis. Glucose and acetosyringone were required in the co-cultivation medium for efficient gene transfer. DNA constructs containing four genes encoding the enzymes phosphinothricin acetyl transferase, [beta]-glucuronidase (GUS), neomycin phosphotransferase, and an [alpha]-amylase inhibitor were used to transform subterranean clover. Transgenic shoots were selected on a medium containing 50 mg/L of phosphinothricin. Four commercial cultivars of subterranean clover (representing all three subspecies) have been successfully transformed. Southern analysis revealed the integration of T-DNA into the subterranean clover genome. The expression of the introduced genes has been confirmed by enzyme assays and northern blot analyses. Transformed plants grown in the glasshouse showed resistance to the herbicide Basta at applications equal to or higher than rates recommended for killing subterranean clover in field conditions. In plants grown from the selfed seeds of the primary transformants, the newly acquired gene encoding GUS segregated as a dominant Mendelian trait.

Biology of disease and clinical aspects of AIDS-associated lymphoma: a review

AIDS-related lymphoma was not apparent until 1985, when a statistically significant increase in the frequency of lymphoma had occurred. Over 50% are high-grade lymphoma, either immunoblastic or small, noncleaved cells (Burkitt's-like lymphoma), with involvement of extranodal sites such as the central nervous system (> one-third of patients), gastrointestinal tract, skin and bone marrow. Optimal therapy for AIDS-associated lymphoma has not yet been defined. Using intensive chemotherapy protocols, high response rates, albeit of brief duration, have been demonstrated. The majority of patients succumbed to intercurrent opportunistic infections. Poor prognosis has been particularly noted in debilitated patients, patients with a CD4 cell count of < 200/dl, bone marrow and brain involvement and a history of AIDS before diagnosing the lymphoma. New strategies in the management of patients with AIDS-lymphoma should include cytotoxic therapy, antiretroviral therapy, anti-pneumocystic Carini pneumonia, prophylaxis of CNS spread and marrow protective therapy (haematopoietic growth factors).

Radiation Therapy in an Elderly African Population with Kaposi's Sarcoma

There are no published studies on the efficacy of modern radiation therapy in elderly populations with the endemic African type of Kaposi's sarcoma (AKS). The present retrospective analysis of 20 elderly AKS patients treated by radiotherapy attempts to supply information relevant to the older age group. It demonstrates that excellent symptomatic relief with minimal side effects can be attained and suggests that the role of radiotherapy as the treatment of choice in this particular group should be emphasized.

AIDS-related Kaposi's sarcoma: a review

Infection with the human immunodeficiency virus (HIV) is the primary cause of AIDS and related disorders. Infection with HIV results in diminished cellular immunity, propensity to opportunistic infections, and an increased incidence of certain neoplasms. Kaposi's sarcoma (KS) is the most common neoplasm in persons infected with HIV. This epidemic, or HIV-related KS, usually follows an aggressive course with involvement of skin, lymph nodes, and internal organs. Normally, the disease has a progressive clinical course despite being responsive to radio- or chemotherapy.

Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma

PURPOSE

A retrospective analysis of patients with non-AIDS and AIDS-related Kaposi's sarcoma, who were treated with radiation therapy.

METHODS AND MATERIALS

Between 1978 and 1992, 56 patients with one of the three major types (classical, endemic, epidemic) of Kaposi's sarcoma received radiation therapy as their sole treatment modality. Extent of fields, daily fractionation, and total dose were applied on a clinical basis. These lesions received superficial x-ray therapy, Co-60 teletherapy, or 6-8 MeV electron beams. Field sizes depended on extent of the lesion. Total dose administration ranged from 8-12 Gy in one exposure, or a total of 24-30 Gy fractionated over 2-3 weeks.

RESULTS

The majority of patients responded to radiation therapy. Symptomatic relief was achieved in 80-100% of patients irrespective of the type of Kaposi's sarcoma, treatment modality, or schedule. Side effects were tolerable in all but three patients with epidemic type Kaposi's sarcoma, who developed severe mucositis.

CONCLUSION

Radiotherapy is the most useful mode of palliative treatment for all forms of Kaposi's sarcoma in southern African patients.

Development of a non-selecting, non-perturbing method to study human brain tumor cell invasion in murine brain

The infiltrative nature of glial and some meningeal neoplasms is responsible for the failure of surgical removal and high recurrence rate of these tumors. Modeling of this process in vitro and in vivo will lead to a better understanding of the pathophysiology of this process and identify targets for novel therapy directed towards this phenotype. We present the results of the development and refinement of two model systems of tumor invasion: one in vitro barrier assay using the basement membrane extract Matrigel, and one in vivo where molecular detection of tumor cells allows single cell discrimination by in situ hybridization histochemistry. These techniques have strong correlations which validate their utility as measures of nervous system tumor invasion.

Endemic African Kaposi's sarcoma: clinical and therapeutic implications. 10-year experience in the Johannesburg Hospital (1980-1990)

Endemic African Kaposi's sarcoma is a common neoplastic disorder in the sub-Saharan region of Africa. We present a retrospective analysis of 47 black patients with the endemic African (HIV-negative) variant of Kaposi's sarcoma treated and followed up in the Johannesburg General Hospital between 1980 and 1990. Four patients (8%) presented with simultaneous Kaposi's sarcoma plus malignant lymphoma, indicating a low but significant association with lymphoproliferative disorders. Of 47 patients seen, 29 presented with localized disease and were treated by means of local radiation therapy. Seventeen patients received chemotherapy. The objective response rate was > 80% irrespective of the treatment modality. We conclude that endemic African Kaposi's sarcoma is a chemo- and radiosensitive tumour.

Malignant lymphoma with primary cardiac manifestations: a case report

This case report describes a 29-year-old black patient presenting with right heart failure secondary to massive lymphomatous cardiac involvement. Additional sites of involvement included mesenteric lymph nodes and the small bowel. Malignant lymphoma with primary cardiac manifestations is very rare and follows an aggressive course. The importance of early diagnosis and commencement of immediate therapy is emphasized.

Kaposi's sarcoma in renal transplant recipients. Experience at Johannesburg Hospital, 1966-1989

Between August 1966 and December 1989, 989 renal transplant recipients were followed up at the Renal Transplant Unit of Johannesburg Hospital. Seventy-five (7%) patients developed a total of 95 malignancies of which 5 (6%) were Kaposi's sarcoma. All patients received immunosuppressive agents; steroids, azathioprine and/or cyclosporin A. Clinical presentations included both limited skin involvement (1 patient) and disseminated forms of the disease: necrotic oral lesions (1 patient); disseminated skin involvement and lung metastases (1 patient); and widespread skin lesions with lymphadenopathy (2 patients). Four patients responded with complete tumour regression at all sites upon withdrawal of the immunosuppressive drugs. One patient suffered disease progression, and immunosuppression was continued, albeit at reduced dosages. These cases illustrate a relatively rare complication of immunosuppressive therapy. However, complete withdrawal of immunosuppressive drugs may result in sustained complete regression, despite the presence of advanced KS.

Classical Kaposi's sarcoma in Caucasians in Africa--experience at the Johannesburg Hospital (1978-1992)

The data are scant concerning classical Kaposi's sarcoma (CKS) among the Caucasian population of Africa. A description of the clinical features of 15 such patients, treated and followed up at the Johannesburg General Hospital over a 14-year period (1978-1992) is presented. All patients were negative for the human immunodeficiency virus. After a mean follow-up of 50 months (range: 7-168 months), 2 patients are alive with absent or minimal disease; 1 patient is alive with stable disease and 1 has active disease involving his extremities. Three patients were lost to follow-up but had minimal or no disease when last seen. Five patients died of unrelated causes but also had minimal or no disease at their last visit. One patient died of sepsis related to active KS. Only two patients died of progressive KS. No alterations in humoral or cellular immunity were demonstrated in 2 patients with persistent disease. Four (27%) patients developed lymphoproliferative disorders including non-Hodgkin's lymphoma, Waldenström's macroglobulinemia, Hodgkin's disease and Castleman's disease (angiofollicular lymph node hyperplasia) preceding or following the diagnosis of CKS. These data confirm the indolent nature and good outcome of the classical form of Kaposi's sarcoma among Caucasians in the southern African region. The marked association between CKS and lymphoproliferative disorders warrants a long-term awareness and continued monitoring for these complications.

Radiation therapy in endemic (African) Kaposi's sarcoma

PURPOSE

Evaluating the role of radiation therapy in the treatment of the endemic, African variant of Kaposi's sarcoma. A retrospective analysis.

METHODS AND MATERIALS

Between 1978 and 1990, 28 symptomatic African patients with the African Human Immunodeficiency Virus negative type of Kaposi's sarcoma were referred to the Johannesburg General Hospital. Following staging, all patients were treated with radiation therapy. Doses ranged between 8-10 Gy (single fraction) or 14-24 Gy fractionated over 1-3 weeks.

RESULTS

Complete and partial regression of cutaneous lesions was achieved in 9 (32%) and 15 (54%) patients, retrospectively. A complete/near-complete alleviation of symptoms was achieved in all patients. Response rate and duration of response was not influenced by age, radiation modality or schedule. Side effects were minimal.

CONCLUSION

Our study emphasizes the high radiosensitivity of the endemic, African type of Kaposi's sarcoma, indicating its usefulness as the treatment of choice for this disease.

The role of viral enhancer "core" motif-related sequences in regulating T cell receptor-gamma and -delta gene expression

T cells express clonally distributed alpha beta or gamma delta Ag receptor heterodimers. Transcriptional enhancers for the genes of all four subunits are active in both gamma delta and alpha beta T cells, but are less active or inactive in other cells. Conserved sequence motifs are present in all four enhancers, suggesting that common transcription factors regulate TCR gene expression. One of these motifs in the gamma 3 site of the TCR-gamma enhancer is similar to motifs found in several other lymphoid-specific and viral enhancers. This conserved "core" sequence is present in the enhancers of Moloney and SL3-3 murine leukemia viruses, important for transcription in T cells and in determining disease specificity. Here we characterize the gamma 3 site of the gamma enhancer and a corresponding homologous site, delta E3, of the TCR-delta enhancer. Our results suggest that the core site is critical for activity of the 200-bp gamma enhancer fragment and of the gamma 3 and delta E3 sites. Furthermore, we identify a nuclear factor in human T cell lines that specifically binds the core region in these and several other core-containing enhancers. This factor may be identical to or related to a purified bovine nuclear core binding factor that binds the core region of the Moloney murine leukemia virus enhancer, gamma 3 and delta E3 sites, suggesting that similar proteins regulate the TCR-gamma, delta and Moloney murine leukemia virus enhancers. Other sequences in the gamma 3 site upstream of the core sequence are also critical for activity in T cells, suggesting that at least two different factors are required for functional activity of the gamma 3 site.

The role of viral enhancer "core" motif-related sequences in regulating T cell receptor-gamma and -delta gene expression

T cells express clonally distributed alpha beta or gamma delta Ag receptor heterodimers. Transcriptional enhancers for the genes of all four subunits are active in both gamma delta and alpha beta T cells, but are less active or inactive in other cells. Conserved sequence motifs are present in all four enhancers, suggesting that common transcription factors regulate TCR gene expression. One of these motifs in the gamma 3 site of the TCR-gamma enhancer is similar to motifs found in several other lymphoid-specific and viral enhancers. This conserved "core" sequence is present in the enhancers of Moloney and SL3-3 murine leukemia viruses, important for transcription in T cells and in determining disease specificity. Here we characterize the gamma 3 site of the gamma enhancer and a corresponding homologous site, delta E3, of the TCR-delta enhancer. Our results suggest that the core site is critical for activity of the 200-bp gamma enhancer fragment and of the gamma 3 and delta E3 sites. Furthermore, we identify a nuclear factor in human T cell lines that specifically binds the core region in these and several other core-containing enhancers. This factor may be identical to or related to a purified bovine nuclear core binding factor that binds the core region of the Moloney murine leukemia virus enhancer, gamma 3 and delta E3 sites, suggesting that similar proteins regulate the TCR-gamma, delta and Moloney murine leukemia virus enhancers. Other sequences in the gamma 3 site upstream of the core sequence are also critical for activity in T cells, suggesting that at least two different factors are required for functional activity of the gamma 3 site.

Transformation and Regeneration of Two Cultivars of Pea (Pisum sativum L.)

A reproducible transformation system was developed for pea (Pisum sativum L.) using as explants sections from the embryonic axis of immature seeds. A construct containing two chimeric genes, nopaline synthase-phosphinothricin acetyl transferase (bar) and cauliflower mosaic virus 35S-neomycin phosphotransferase (nptII), was introduced into two pea cultivars using Agrobacterium tumefaciens-mediated transformation procedures. Regeneration was via organogenesis, and transformed plants were selected on medium containing 15 mg/L of phosphinothricin. Transgenic peas were raised in the glasshouse to produce flowers and viable seeds. The bar and nptII genes were expressed in both the primary transgenic pea plants and in the next generation progeny, in which they showed a typical 3:1 Mendelian inheritance pattern. Transformation of regenerated plants was confirmed by assays for neomycin phosphotransferase and phosphinothricin acetyl transferase activity and by northern blot analyses. Transformed plants were resistant to the herbicide Basta when sprayed at rates used in field practice.

Morphological patterns of seizures recorded intracranially

We analyzed the frequency and morphological characteristics of the initial EEG manifestations of spontaneous seizures recorded from depth and subdural electrodes in 26 patients for whom pathological analysis of the area of seizure onset was available after resective surgery. Pathological features considered to be positive findings included well-defined structural lesions (hamartoma, neoplasm) or strictly defined mesial temporal sclerosis. Seizure onset was characterized by the frequency of the rhythmic discharge greater than 2 Hz in the first second and by the presence or absence of periodic low-frequency spikes (less than 2 Hz) preceding this stable change in background frequency. These features were correlated with the presence or absence of pathologic abnormalities in temporal and extratemporal locations. Although all patterns and frequencies of seizure onset were recorded in both medial temporal and extratemporal locations, medial temporal seizure onset was significantly more likely to have high frequency (greater than 13 Hz, p less than 0.00001) and tended to show periodic spikes prior to the seizure when it was associated with medial temporal sclerosis compared to when it was not. Extratemporal seizure onset associated with abnormal pathological substrate was significantly more likely to have a lower frequency (less than 13 Hz, p less than 0.05) and no periodic spikes before seizure onset (p less than 0.00001) than extratemporal seizure onset recorded from areas without pathological findings. Variability of seizure onset frequency was a characteristic of temporal, but not extratemporal, seizures (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Vicilin with carboxy-terminal KDEL is retained in the endoplasmic reticulum and accumulates to high levels in the leaves of transgenic plants

Gene constructs were designed to test the effect of the endoplasmic reticulum (ER)-targeting signal, KDEL, on the level of accumulation of a foreign protein in transgenic plants. The gene for the pea seed protein vicilin was modified by the addition of a sequence coding for this tetrapeptide at its carboxyl terminus. The altered gene was placed under the control of a CaMV 35S promoter and its expression in the leaves of both tobacco and lucerne (alfalfa) was compared with that of an equivalent vicilin construct lacking the KDEL-coding sequence. The presence of the ER-targeting signal led to a greatly enhanced accumulation of the heterologous protein. In lucerne and tobacco leaves, the level of vicilin-KDEL protein was 20 and 100 times greater than that of the unmodified vicilin, respectively. These differences in expression level could not be explained by corresponding differences in the steady-state levels or the translatability of the mRNAs. However, when the stability of vicilin and vicilin-KDEL proteins was compared in their respective transgenic hosts, unmodified vicilin was found to be degraded with a half-life of 4.5 h while vicilin-KDEL was much more stable with a half-life of more than 48 h. Immunogold labelling of leaf tissues from transgenic lucerne and tobacco showed the presence of vicilin associated with large aggregates within the ER lumen of vicilin-KDEL plants. No such aggregates were detected in transgenic plants expressing wild-type vicilin. It is concluded that the carboxy-terminal KDEL caused the retention of the modified vicilin in the ER, and that this retention led to the increased stability and higher level of accumulation of vicilin-KDEL in leaves of transgenic plants.

Spinal arteriovenous malformation

The authors discuss a patient with a large (15 x 10 x 12 cm), bony soft tissue intradural arteriovenous malformation (AVM) who presented with a 20-year history of back pain. Plain radiographs revealed a destructive lesion. Magnetic resonance imaging showed serpentine vascular structures within the thecal sac and lytic bone lesions with multiple level involvement. A Craig needle biopsy by the referring physician, as well as an open biopsy by the authors, caused severe bleeding. There was no evidence of neoplasm. Selective spinal angiography demonstrated a metameric juvenile type AVM whose intradural component was fed by the artery of Adamkiewicz. Because the patient had no neurological deficit on presentation, the options of embolization and then surgery were considered too risky. The patient is being followed conservatively.

Interictal spikes and hippocampal somatostatin levels in temporal lobe epilepsy

We investigated the relationship between somatostatin-like immunoreactivity (SSLI) and interictal spikes (IIS) in human temporal lobe epileptic tissue. IIS counted manually from depth electrode recordings obtained preoperatively were expressed as spike frequency in anterior, middle, and posterior portions of hippocampus. SSLI was determined by radioimmunoassay (RIA). An inverse relationship between SSLI in the entorhinal cortex (EC) and IIS frequency in hippocampus was present (r = -0.55, p = 0.06). No correlation between IIS and SSLI in CA4, CA3, CA1, or the dentate was evident. This finding suggests a role of the EC in generation, regulation, or expression of interictal paroxysmal electrical activity in temporal lobe epilepsy (TLE), for which somatostatin may be a marker.

Renal epithelial amino acid concentrations in mercury-induced and postischemic acute renal failure

The concentration of 18 alpha-amino acids (AAs) in plasma and renal cortical cell water were measured 3 or 24 hr after 1 hr of unilateral renal artery clamping or 24 or 48 hr after 15 mg/kg body weight HgCl2 injection sc as a test of epithelial integrity. Cellular glycine (Gly), hydroxyproline (Hpr), ornithine (Orn), phenylalanine (Phe), serine (Ser), and tryptophan (Trp) concentrations were depressed 24 hr after HgCl2 (p less than 0.05), but the remaining 12 AAs were not distinguishable from control despite the presence of severe renal failure. ARginine (Arg), glutamic acid (Glu), and valine (Val) also were decreased (P less than 0.05) 24 hr later, but concentrations of half of all measured AAs were still normal. Cellular alanine (Ala), Arg, Glu, Gly, Phe, and Ser concentrations were decreased 3 hr after ischemia, p less than 0.05, but 12 AAs were unchanged and only Arg, Phe, Ser, and threonine (Thr) were reduced 24 hr after ischemia was reversed. Concentrations of even the most affected AAs remained notably higher than in plasma in both forms of acute renal failure (ARF). Total loss of AAs from a small proportion of tubular cells would be hidden by essentially normal concentrations in the rest, and such losses may well have occurred. Unless cellular AAs in ARF are almost completely bound, however, the well-maintained cell:plasma AA concentration ratios indicate that cellular energetics were adequate for AA uptake and that epithelial permeability to AAs in the vast majority of cells was not greatly disturbed. Such findings suggest that most of the epithelium, although seriously damaged, had remained viable.

Cryopreservation of human brain tissue

Tissues from products of conception were examined to determine the feasibility of obtaining viable neural tissue after suction abortion at 9-12 weeks of gestation. The ventral mesencephalon, a prototype region whose maturation can be monitored and which is a potential tissue for transplantation, was identified in 32 of 120 cases. The tissue was then screened for the presence of infectious agents, while being held at -196 degrees C in cryopreservative solutions. Three of 32 specimens were found to be contaminated by normal vaginal bacteria; all other viral, fungal, and mycoplasma testing was negative. Thawed brain fragments retained high viability after storage in liquid nitrogen and when grown in vitro exhibited neuronal morphology, tyrosine hydroxylase immunoreactivity, and dopamine production. We have demonstrated that human fetal brain tissue can be cryopreserved in a manner which not only retains viability but allows normal phenotypic differentiation after thawing.

Anterior segment upper lobe tuberculosis in the adult. Occurrence in primary and reactivation disease

Nine patients with pulmonary tuberculosis involving predominantly or exclusively the anterior segment of one or both upper lobes were seen over a five-year period. The incidence of anterior segment upper lobe tuberculosis was 6.3 percent of 142 patients presenting with pulmonary tuberculosis during the same time period. Five of the nine patients with anterior segment upper lobe involvement had reactivation disease. An increased incidence of advanced age, diabetes, associated malignant neoplasms, alcoholism, and steroid use were noted in those patients with anterior segment involvement, although only the occurrence of diabetes was statistically significant. We suggest vigilance with regard to the diagnosis of tuberculosis in patients who are elderly, diabetic, or alcohol abusers, particularly where the roentgenographic appearance of anterior segment upper lobe involvement would tend to favor an alternative diagnosis.