Emergence of resistance to fluoroquinolones and third-generation cephalosporins in Shigella flexneri subserotype 1c isolates from China

We report here on the first identification of Shigella flexneri subserotype 1c in China. We also report the emergence of resistance to ciprofloxacin and third-generation cephalosporins in this subserotype 1c for the first time. Isolates of seven strains circulating in China yielded three new sequence types and seven pulsed-field gel electrophoresis patterns, thus demonstrating the existence of high genetic diversity within the isolates. Overall, the seven isolates showed reduced susceptibility to ciprofloxacin; one isolate was ciprofloxacin resistant, whilst another developed resistance to ciprofloxacin, norfloxacin, cefotaxime and ceftriaxone.

Effect of risedronate on osteocyte viability and bone turnover in paired iliac bone biopsies from early postmenopausal women

It is unclear whether standard clinical doses of risedronate affect osteocyte viability. This study examined osteocyte viability and bone remodeling rate in early postmenopausal women (1-5 years after menopause) who were treated with a standard clinical dose of risedronate (5 mg/day, orally) for 1 year. Paired transiliac bone biopsies were obtained from 19 postmenopausal women at baseline and after 1-year treatment with placebo (n = 8, mean age 52.9 ± 3.4 years) or risedronate 5 mg/day (n = 11, mean age 52.5 ± 3.4 years). In these samples, we measured osteocyte- and bone remodeling-related variables in trabecular bone. In both the placebo and risedronate groups, empty lacunae were significantly decreased after 1-year treatment compared to baseline. There were no significant differences in osteocyte-related variables between placebo and risedronate. Risedronate significantly reduced bone-remodeling indices including mineralizing surface (MS/BS), bone formation rate (BFR/BS), and activation frequency (Ac.f). Risedronate treatment caused significantly lower MS/BS and Ac.f than placebo administration. In conclusion, risedronate 5 mg/day effectively inhibited bone remodeling but did not significantly reduce osteocyte viability in trabecular bone.

Practice and Attitudes towards CYP2D6 Testing for Patients on Tamoxifen among US Oncologists

Background: CYP2D6 genotype has been associated with breast cancer outcomes for patients on Tamoxifen (TAM) and testing is commercially available. In the context of emerging data regarding the clinical relevance of CYP2D6 testing (CYPT) and uncertainty regarding how test results should be used in practice, we evaluated current practice and attitudes with regard to this novel pharmacogenomic test among U.S. oncologists.Methods: A survey was mailed to all breast cancer oncologists identified at National Comprehensive Cancer Network (NCCNO) centers and a random sample of community based oncologists (CBO) identified from the American Society of Clinical Oncology directory. The survey evaluated knowledge of the CYP2D test, use of the test, requests for the test by patients and third parties, and response to hypothetical test results. Associations between practice setting and CYP2D6 knowledge, CYPT, and practice patterns were evaluated. All statistical tests were two-sided.Results: 201 of 459 (44%) oncologists responded, including 97/173 (56%) of NCCNO and 104/286 (36%) of CBO. While 90% of all oncologists were aware of CYPT, only 31% had ever ordered CYPT, and only 14% used CYPT for ≥ 10% of patients on TAM. 22% had received a request for CYPT from a 3rd party. While NCCNO were more likely to be aware of CYPT (98% vs. 82%, p < 0.001), and to receive requests for CYPT (33% vs. 12%, p < 0.001), CBO reported higher frequency of CYPT in routine practice (21% vs. 11%, p = 0.06). Despite rare use, 66% of CBO and 44% of NCCNO reported they would order the test upon patient request (p < 0.001). In hypothetical scenarios involving CYPT for patients on TAM, for premenopausal women with poor metabolism, 33% would make no change, while 38% would switch to ovarian suppression (OS) plus aromatase inhibitor (AI), 9% would switch to OS alone, and 8% would add OS to TAM. CBO were more likely to switch to OS + AI in this setting (47% vs. 31%, p < 0.02), while NCCNO were more likely to recommend no change (50% vs. 18%, p < 0.001). For premenopausal intermediate metabolizers, 33% of CBO would change management, compared to 8% of NCCN (p < 0.001), with addition of OS to TAM being most frequent among both groups. For postmenopausal women with poor metabolism the majority of both CBO and NCCNO would switch to AI (82% vs. 71%, p = 0.08). Among oncologists who indicated they might change management based on CYPT results, 43% had never ordered the test. Respondents cited data from randomized trials, and professional guidelines as most influential for decisions regarding ordering tests.Conclusion: Despite calls for increased CYP2D6 testing at academic meetings and occasional requests by 3rd parties, use of CYPT is currently infrequent in oncology practice. Greater familiarity with breast cancer management correlated with lower use of CYPT and greater reluctance to change management based on test results at this time. Diversity in practice patterns and knowledge suggests a need for greater consensus on CYPT in routine practice, and highlights the need for further clinical research in this area.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1077.

Immunogenicity of Ra1A and its tissue-specific expression in hepatocellular carcinoma

In order to understand the immunogenicity of a tumor-associated antigen (TAA), Ras family small GTP binding protein (Ra1A) in hepatocellular carcinoma (HCC), autoantibody responses to RalA were evaluated by enzyme-linked immunosorbent assay (ELISA), Western blotting and indirect immunofluorescence assay in sera from patients with HCC and sera from normal individuals. Immunohistochemistry (IHC) study with tissue array slides was also performed to analyze protein expression profiles of RalA in HCC and control tissues. This study demonstrated that RalA had a relative higher frequency of autoantibody response in HCC (20.1%) compared to liver cirrhosis (3.3%), chronic hepatitis (0%), and normal individuals sera (0%). RalA also showed a stepwise increased expression from normal liver tissues (26.7%), liver cirrhosis tissues (45.0%) to HCC tissues (63.3%). Sensitivity and specificity of anti-RalA antibody in detection of HCC was 20.1% and 99.3%, respectively. The data suggested that RalA might contribute to liver malignant transformation, and could be used as a potential tumor marker in HCC detection.

Exercise training improved insulin sensitivity and ovarian morphology in rats with polycystic ovary syndrome

Hyperandrogenism and hyperinsulinemia are major clinical features in women with polycystic ovary syndrome (PCOS). We hypothesized that serum insulin levels reduced by exercise could relieve hyperandrogenism and ameliorate polycystic ovarian morphology. Wistar female rats with 21-day-old were randomly divided into three groups: PCOS exercise (P-Ex), PCOS sedentary (P-Sed), and control sedentary (C-Sed). The rats with PCOS were induced by injection with testosterone propionate continuously. The exercise program was to swim with 120 min/d for two weeks. Fasting blood glucose (FBG) and insulin (FINS), estrogen (E (2)), progesterone (P), and testosterone (T) in serum were determined by RIA, and ovarian morphology was evaluated by Image-Pro Plus 6.0. The levels of FINS, E (2), and T in serum were significantly lower in P-Ex than in P-Sed. The ratios of FBG/FINS in P-Ex significantly increased in comparison with P-Sed. The levels of serum sex hormones in P-Ex were similar to C-Sed. There were no differences in blood glucose and serum progesterone among three groups. Ovarian morphology showed that the numbers of preantral follicles and atretic follicles significantly decreased, and the numbers of antral follicles and corpora lutea significantly increased in P-Ex compared with P-Sed. The changes of ovarian morphology in P-Ex were similar to C-Sed. These results demonstrated that short-term exercise training can improve insulin sensibility, decrease serum androgen levels, and recover normal ovarian morphology. The exercise training is the basic therapeutic means for PCOS.

Effect of (-)-gossypol (AT-101) on transcriptional regulation of Noxa and Puma and on Mcl-1-mediated cancer cell resistance to apoptosis

e14611

Background: AT-101 is being evaluated in Phase II clinical trials for the treatment of human cancers and demonstrates anticancer activity as a single agent and in combination with docetaxel. Despite extensive investigations, the mechanism of action for its antitumor activity is not completely understood. In this study, we have performed detailed investigations using a panel of human cancer cell lines on the mechanism of action for AT-101. Methods: A series of human breast and prostate cancer cell lines were utilized to evaluate the antitumor activity of AT-101. Cell growth inhibition, cell viability and apoptosis were determined by WST assay, trypan blue assay and flow cytometry, respectively. Gene specific siRNAs were used to knockdown target gene expression. Quantitative RT- PCR was performed to detect the mRNA levels of Puma and Noxa. Co-immunoprecipitation was carried out to detect the association between Mcl-1 and Noxa or Puma. Results: AT-101 induced apoptosis in both Bax/Bak-dependent and -independent manners in a variety of human cancer cell lines concomitant with increased expression of Noxa and Puma in a p53-independent manner. The up-regulation of Noxa was not observed in normal primary breast epithelial cells or normal-like human breast epithelial MCF-12F cells. Transcription inhibitor actinomycin D blocked AT-101-induced up-regulation of Puma and Noxa. Knockdown of Noxa or Puma attenuated AT-101-induced apoptosis. Furthermore, AT-101 effectively overcame Mcl-1-mediated cancer cell resistance to apoptosis. Co-immunoprecipitation studies demonstrated that Mcl-1 specifically associated with Noxa but not Puma. Conclusions: Our findings suggest that transcriptional up-regulation of pro-apoptotic Noxa and Puma contributes to the antitumor activity of AT-101, which plays a dominant role in antagonizing Mcl-1 and overcoming Mcl-1-mediated resistance to apoptosis of cancer cells. AT-101 functions as an antagonist of Bcl-2, Bcl-xL and Mcl-1 through direct binding to these proteins, as well as through upregulation of Noxa and Puma.

[Table: see text]

High expression levels of putative hepatic stem/progenitor cells biomarkers related to tumor angiogenesis and poor prognosis of hepatocellular carcinoma

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Background: To investigate the prognostic values of putative hepatic stem/progenitor cells (HSCs/HPCs) biomarkers in hepatocellular carcinoma (HCC) patients. Methods: Fourteen biomarkers related with HSCs/HPCs or tumor angiogenesis were assessed by qRT-PCR and then validated by tissue microarrays (TMAs) in three independent cohorts of HCC patients underwent curative resection (n=67, 314 and 73). Results: Most of the biomarkers were found over-expressed in recurrent HCC patients by qRT-PCR. HSCs/HPCs biomarkers cytokeratin 19, ABCG2, CD133, Nestin, CD44 and angiogenesis agents CD34, VEGF and PD-ECGF, were confirmed as significant predictors for overall survival (OS) and/or relapse-free survival (RFS) in TMAs analysis. Compared with the low HSCs/HPCs profile group, patients with high HSCs/HPCs profile had significantly lower OS and RFS (p<0.0001), expressed higher VEGF levels (p = 0.012) and microvessel density (MVD, determined by CD34 immunostaining, p = 0.030). Based on Cox regression, a simplified model including CD133, CD44, Nestin, and MVD was constructed and confirmed as an independent predictor for OS (p<0.0001) and RFS (p<0.0001), regardless of alpha-fetoprotein level, tumor stage and recurrence time (p<0.0001 for all). Conclusions: High expression levels of HSCs/HPCs biomarkers are related to tumor angiogenesis and poor prognosis of HCC. The simplified model based on HSCs/HPCs and tumor angiogenesis profile can be used to classify HCC patients with high risk of tumor recurrence after operation.

No significant financial relationships to disclose.

Expression of CD24 as a predictor of prognosis of hepatocellular carcinoma after operation

e22043

Background: CD24 expression has previously been reported in hepatocellular carcinoma (HCC), although little is known about its prognostic significance. The aim of this study is to evaluate the relation of CD24 expression and its prognostic significance in HCC. Methods: CD24 expression in stepwise metastatic HCC cell lines and tumor tissues from 50 HCC patients was investigated by quantitative real-time reverse transcription-PCR and Western blot analyses. The role of CD24 was investigated by depletion CD24 expression in HCC cells through small-interfering RNA. Tumor tissue microarrays of 314 HCC patients who underwent resection between 1997 and 2000 were used to detect the expressions of CD24, β-catenin and PCNA expression. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. Results: CD24 was overexpressed in the high metastatic HCC cell line and in tumor tissues of recurrent patients. Depletion of CD24 caused a notable decrease in cell proliferation, migration and invasiveness in vitro. CD24 was confirmed as an independent predictor for overall survival (p<0.001) and relapse-free survival (p<0.001), regardless of recurrence time, AFP level, TNM stage and Edmondson stage. High expression of CD24 in HCC tissues was significantly associated cytoplasmic/nuclear accumulation of β-catenin (p=0.023), high tumor proliferate status (p=0.018) and diffused intrahepatic recurrence and distance metastasis (p=0.026). Adjuvant TACE after operation reduced the early recurrence (≤1 year) in CD24+ HCC patients (p=0.024), while there had no significant changes in CD24- patients (p=0.284). Conclusions: High expression levels of CD24 were related with high invasive and metastatic potential, high tumor proliferation status and activation of Wnt/β-catenin pathway. The expression of CD24 provides new prognostic information about HCC prognosis and targeted therapy to CD24+fraction in HCC may comprise a promising anti-recurrence strategy for HCC patients after surgery.

No significant financial relationships to disclose.

Magnetic resonance imaging of primary cerebral gliosarcoma: a report of 15 cases

BACKGROUND

Gliosarcomas are rare tumors with mixed glial and mesenchymal components. Many of their radiologic features resemble those of other primary brain malignancies.

PURPOSE

To investigate the magnetic resonance (MR) imaging features of gliosarcomas.

MATERIAL AND METHODS

We retrospectively reviewed the MR images, pathology reports, and clinical information of 11 male and four female patients aged 15-71 years to evaluate the location, morphology, enhancement, and other features of their pathologically confirmed gliosarcomas.

RESULTS

Apart from one tumor in the right cerebellar hemisphere, all were supratentorial. Two tumors were intraventricular, and four involved the corpus callosum. The tumors were well demarcated, with an inhomogeneous or cystic appearance and moderate-to-extensive surrounding edema. Thick walls with strong rim and ring-like enhancement were observed in 13 (87%). Seven (47%) showed intratumoral paliform enhancement.

CONCLUSION

Gliosarcoma demonstrates certain characteristic MR features, such as supratentorial and peripheral location, well-demarcated, abutting a dural surface, uneven and thick-walled rim-like or ring enhancement, as well as intratumoral strip enhancement. These findings, combined with patient age, can aid the differential diagnosis of gliosarcomas from more common primary brain tumors.

First intercomparison of Tn-Rn discriminative measurements in China

The intercomparison measurements with Tn-Rn discriminative monitor were conducted at the Radon Laboratory of Nanhua University. The intercomparison results indicates that the Tn-Rn discrimination of most monitors (including the solid-state nuclear track detector of participant A and participant B, continuous monitors of RAD7 and RTM2100) keeps well in a wide range of the ratio of Tn to Rn. There are great differences of Tn measurement results among RAD7, RTM2100 and reference instrument. The discussion on the reason of these differences reveals the necessity of improvement on monitor calibration, Tn source make and the necessity of more international intercomparisons.

Calibration of a 220Rn flow-through source

Two reference methods have been established to calibrate the yield of a self-made 220Rn flow-through source. These reference methods include (a) a small scintillation cell flow-through method and (b) a gamma spectrometry method that takes advantage of an activated charcoal. The methods were validated theoretically and experimentally including intercomparison measurements. It is shown that the source is stable with a relative deviation less than 2.5% over 5 years, when the relative humidity ranged from 50 to 90%, and the temperature from 5 to 38 degrees C. The 220Rn monitor used in these reference methods is calibrated without a 220Rn gas source with determinate yield. On the basis of the calibration of the 220Rn source by the methods mentioned above, the accurate calibration of any 220Rn monitor by the self-made 220Rn source with stable yield is feasible.

Relationships between osteocyte density and bone formation rate in human cancellous bone

Iliac cancellous osteocyte density decreases with age in deep bone but not in superficial bone, most likely because of remodeling. It has been suggested that osteocytes can inhibit bone remodeling. Accordingly, we examined the relationship between osteocyte density and bone formation rate in 92 healthy women. In superficial bone (<25 microm from the surface), we found a weak but significant (p < 0.03) inverse correlation between BFR/BS and Ot. N/B.Ar that was unaffected by menopause and independent of age. A weaker positive relationship with empty lacunar density improved significance. The data appear to suggest a negative feedback loop, but osteocytes explain only 10% of the variance in BFR/BS, and 97% of the variance in osteocyte density is explained by total lacunar density. This measure of initial osteocyte density during bone formation has a high coefficient of variation (20%) indicating large individual differences. We conclude that: (1) our data support the proposal that osteocytes can inhibit bone remodeling; (2) osteocyte density in superficial bone depends mainly on initial osteocyte density during bone formation and is maintained but not regulated by bone remodeling; and (3) the inverse relationship between BFR/BS and osteocyte density may reflect the homeostatic need to maintain calcium exchangeability in the lining cell-osteocyte syncytium.

Age and distance from the surface but not menopause reduce osteocyte density in human cancellous bone

Previous studies of osteocyte density in human cancellous bone have relied mainly on autopsy samples and have demonstrated an age-related decline in men, but there are insufficient data in women. Using previously obtained transiliac bone biopsies from 94 healthy white women, aged 20-73 years, 38 premenopausal and 56 postmenopausal, we measured osteocytes and lacunae in ten randomly selected areas using 5-microm-thick sections stained with Goldner trichrome. For each subject, the number of osteocytes (Ot.N/B.Ar), empty lacunae (EL.N/B.Ar), and total lacunae (Tt.L.N/B.Ar) per bone area, and the proportion of occupied lacunae (Ot.N/Tt.L.N), were calculated. In 92 cases the measurements were made separately in superficial bone (<25 microm from the surface) and in deep bone (>45 microm from the surface). Mean values and differences between extreme values (DEV) for each variable were computed from the ten measured areas. In addition, confocal microscopic examination was performed on 100 microm sections. We found that Ot.N/B.Ar, Tt.L.N/B.Ar, and Ot.N/Tt.L.N decreased, but EL.N/B.Ar increased significantly with age (p < 0.001). The rates of decline were most rapid initially, falling exponentially with increasing age; the linear regressions for all four variables were significant in premenopausal, but not postmenopausal, women. At all ages, there were significantly more osteocytes in superficial than in deep bone; there was no significant decline with age in superficial bone, but a steeper exponential decline in deep bone than in whole trabeculae. DEV did not change with age for any variable. Confocal images revealed that the morphology of the osteocyte network was heterogeneous in different regions and trabeculae. The trabeculae with lower osteocyte density contained acellular areas, especially in interstitial bone. We conclude: (1) osteocyte density declines with age in women as it does in men; (2) the decline occurs exclusively in deep bone, not in superficial bone, suggesting that it is the age of the bone rather than the age of the subject that is important; (3) the rate of age-related decline falls exponentially with age and is not significant in postmenopausal women alone; (4) except for the differences between superficial and deep bone, the pattern of osteocyte distribution within and between trabeculae was not affected by age or menopause; and (5) the data raise the possibility that one function of remodeling in iliac cancellous bone is to maintain osteocyte viability.

The crystal structure of the influenza matrix protein M1 at neutral pH: M1-M1 protein interfaces can rotate in the oligomeric structures of M1

The influenza matrix protein (M1) forms a protein layer under the viral membrane and is essential for viral stability and integrity. M1 mediates the encapsidation of the viral RNPs into the viral membrane by its membrane and RNP-binding activities. In order to understand the roles of M1-M1 protein interactions in forming the M1 layer, X-ray crystallographic studies of a M1 fragment (1-162) were carried out at neutral pH and compared with an acidic pH structure. At neutral pH the asymmetric unit was a stacked dimer of M1. A long molecular ribbon of neutral stacked dimers was formed by translation as dictated by the P1 space group. The elongated ribbon had a positively charged stripe on one side of the ribbon. A similar M1-M1 stacking interface was also found in the acidic asymmetric unit. However, within the acidic stacked dimer the molecules were not straight, but rotated in relation to each other by slightly changing the M1-M1 stacking interface. The acidic structure possessed an additional M1-M1 twofold interface. Protein docking confirmed that the M1-M1 stacking and M1-M1 twofold interfaces could be used to form a double ribbon of M1 molecules. By iterative repetition of the rotated relationship among the M1 molecules, a helix of M1 was generated. These studies suggest that M1 has the ability to form straight or bent elongated ribbons and helices. These oligomers are consistent with previous electron microscopic studies of M1, which demonstrated that isolated M1 formed elongated and flexible ribbons when isolated from what appeared to be a helical shell of M1 in the influenza virus.

Preferential production of interferon-gamma by CD4+ T cells expressing the homing receptor integrin alpha4/beta7

Recent studies indicate that T helper type 1 (Th1) and 2 (Th2) lymphocytes differ in their expression of molecules that control T-cell migration, including adhesion molecules and chemokine receptors. We investigated the relationship between cytokine production and expression of the homing receptor integrin alpha4/beta7 on T cells. We began by analysing cytokine production by human CD4+ CD45RA- memory/effector T cells following brief (4 hr) stimulation with phorbol 12-myristate 13-acetate (PMA) and ionomycin. alpha4/ beta7high CD4+ T cells were more likely to produce the Th1 cytokine interferon-gamma (IFN-gamma) than were alpha4/beta7- CD4+ T cells in all six subjects studied. In contrast, production of the Th2 cytokine interleukin-4 (IL-4) was similar on alpha4/ beta7high and alpha4/beta7- CD4+ T cells. In addition, we found that human CD4+ CD45RA- T cells that adhered to the alpha4/beta7 ligand mucosal addressin cell adhesion molecule-1 (MAdCAM-1) had a greater capacity to produce IFN-gamma than did non-adherent cells, suggesting that the association between alpha4/beta7 expression and IFN-gamma production has functional significance. These results suggested that primary activation under Th1-promoting conditions might favour expression of alpha4/beta7. We directly examined this possibility, and found that naïve murine CD4+ T cells activated under Th1-promoting conditions expressed higher levels of alpha4/beta7 compared to cells activated under Th2-promoting conditions. The association between alpha4/beta7 expression and IFN-gamma production by CD4+ T cells may help to determine the cytokine balance when MAdCAM-1 is expressed at sites of inflammation in the intestine or elsewhere.

Mesoporous aluminosilicates with ordered hexagonal structure, strong acidity, and extraordinary hydrothermal stability at high temperatures

Highly ordered hexagonal mesoporous aluminosilicates (MAS-5) with uniform pore sizes have been successfully synthesized from assembly of preformed aluminosilcate precursors with cetyltrimethylammonium bromide (CTAB) surfactant. The aluminosilicate precursors were obtained by heating, at 100--140 degrees C for 2--10 h, aluminasilica gels at the Al(2)O(3)/SiO(2)/TEAOH/H(2)O molar ratios of 1.0/7.0--350/10.0--33.0/500--2000. Mesoporous MAS-5 shows extraordinary stability both in boiling water (over 300 h) and in steam (800 degrees C for 2 h). Temperature-programmed desorption of ammonia shows that the acidic strength of MAS-5 is much higher than that of MCM-41 and is comparable to that of microporous Beta zeolite. In catalytic cracking of 1,3,5-triisopropylbenzene and alkylation of isobutane with butene, MAS-5 exhibits greater catalytic activity and selectivity, as compared with MCM-41 and HZSM-5. The MAS-5 samples were characterized with infrared, UV--Raman, and NMR spectroscopy and numerous other techniques. The results suggest that MAS-5 consists of both mesopores and micropores and that the pore walls of MAS-5 contain primary and secondary structural building units, similar to those of microporous zeolites. Such unique structural features might be responsible for the observed strong acidity and high thermal stability of the mesoporous aluminosilicates with well-ordered hexagonal symmetry.

[A preliminary study on the activation of superoxide dismutase by Tiopronin in patients with chronic hepatitis B]

OBJECTIVE

To observe the clearance effect of Tiopronin on oxygen free radicals in chronic hepatitis B patients.

METHODS

The ranthine oxidase assay was used to detect superoxide dismutase (SOD) in 80 chronic hepatitis B patients, the ALT, TBil, TP and AIG ratio of the patients were also tested. The 80 chronic hepatitis B patients were divided into two groups, the control group was treated with routine liver protective and jaundice regressing drugs while the treated group was additionally administered with Tiopromin besides the routine treatment.

RESULTS

In two groups of patients with similar ages and sexes, there showed no differences in levels of SOD, ALT, TBil, TP and ALB before treatment, as the SOD in treated group and control group were 106.57 (40.68 NU/ml and 105.18(44.59 NU/ml respectively, while the normal value for SOD in 16 normal persons was 165.9(23.36 NU/ml. After treatment, there were significant differences (P< 0.01) in SOD, ALT, TBil and ALB levels which showed SOD 187.93(35.24 NU/ml, ALT 38.41(22.22 U/L, TBil 23.15(12.46 micromol/L, ALB 43.28 (4.21 g/L in the treated group and SOD 157.96(47.29 NU/ml, ALT 68.52(34.19 U/L, TBil 30.38(21.80 micromol/L and ALB 40.36(5.19 g/L in the control group.

CONCLUSIONS

There showed a good therapeutic effect of Tiopronin on the clearance of oxygen free radicals in chronic hepatitis B patients and also it can improve the liver function.

Study of the assembly of vesicular stomatitis virus N protein: role of the P protein

To derive structural information about the vesicular stomatitis virus (VSV) nucleocapsid (N) protein, the N protein and the VSV phosphoprotein (P protein) were expressed together in Escherichia coli. The N and P proteins formed soluble protein complexes of various molar ratios when coexpressed. The major N/P protein complex was composed of 10 molecules of the N protein, 5 molecules of the P protein, and an RNA. A soluble N protein-RNA oligomer free of the P protein was isolated from the N/P protein-RNA complex using conditions of lowered pH. The molecular weight of the N protein-RNA oligomer, 513,879, as determined by analytical ultracentrifugation, showed that it was composed of 10 molecules of the N protein and an RNA of approximately 90 nucleotides. The N protein-RNA oligomer had the appearance of a disk with outer diameter, inner diameter, and thickness of 148 +/- 10 A, 78 +/- 9 A, and 83 +/- 8 A, respectively, as determined by electron microscopy. RNA in the complexes was protected from RNase digestion and was stable at pH 11. This verified that N/P protein complexes expressed in E. coli were competent for encapsidation. In addition to coexpression with the full-length P protein, the N protein was expressed with the C-terminal 72 amino acids of the P protein. This portion of the P protein was sufficient for binding to the N protein, maintaining it in a soluble state, and for assembly of N protein-RNA oligomers. With the results provided in this report, we propose a model for the assembly of an N/P protein-RNA oligomer.

[Treatment of non iatrogenic injury of retrohepatic inferior vena cava]

OBJECTIVE

To study a repair method for injured retrohepatic inferior vena cava (IVC) associated with liver trauma.

METHODS

Laceration of IVC was sutured bloodlessly after the injured retrohepatic IVC was occluded by compression combined with occlusion of the first hepatic hilus.

RESULTS

From April 1996 to January 1999, the injured IVC was successfully repaired in 6 patients. The length of laceration was 2.9 cm (1.5 - 4 cm). The occlusion time was 9.2 min (6 - 15 min) for the IVC and 20.5 min (15 - 29 min) for the first hepatic hilus, respectively. All patients recovered uneventfully, and the IVC was patency without stricture as showed by B-mode ultrasonography and CT.

CONCLUSION

The injured retrohepatic IVC can be repaired by direct compression when the laceration of the IVC is caused by liver trauma.

CT via percutaneous splenoportography: experiment and application

OBJECTIVE

To introduce computed tomography via percutaneous splenoportography (CTSP), a new method for determining hepatic diseases.

METHODS

Ten hybrid dogs and 31 patients with primary hepatic cancer (PHC) were included in the study. Each dog was examined by CT, computed tomography via arterial portography (CTAP), and CTSP to compare the enhanced density of the liver. The 31 patients were examined by CTSP and the appearance of PHC was compared with their pathological results to evaluate the diagnostic significance of CTSP.

RESULTS

The animal experiment showed that both CTAP and CTSP could obviously enhance the density of the liver (P < 0.01), but no significant difference was observed in the enhanced densities between the two methods (P > 0.05). On the CTSP images of the 31 patients, the density of the livers was increased to 168-192 Hu, whereas the density of the cancers was as low as that on the images of CT scans (< 58 Hu). The CTSP findings were consistent with the surgical ones from space occupying lesions. The diagnostic value of CTSP was obviously superior to that of general enhanced CT. However, it was difficult for CTSP to show nodules less than 1 cm in size located on the surface of the liver or the hepatic portal zone.

CONCLUSIONS

Like CTAP, CTSP is also a sensitive method for showing occupant in the liver. But the equipments and the procedures are simpler for CTSP than for CTAP. CTSP is an alternative procedure in clinical practice.

[Use of Hopkins rod-lens coupled with grasping forceps sheaths for extraction of tracheobronchial foreign bodies]

OBJECTIVE

To study the clinical application of Hopkins rod-lens coupled with gasping forceps sheaths in the extraction of tracheobronchial foreign bodies.

METHODS

Sixty-two patients with tracheobronchial foreign bodies were operated on with Hopkins rod-lens coupled with grasping forceps sheaths under direct telescopic view or TV watching. High frequency jet ventilation was used and BPs ECGs SaO2 were monitored in all cases.

RESULTS

Sixty-two patients were all successfully operated on. The extraction was primarily successful in 90% of the cases; and secondarily successful in 7% of the cases. No death and serious complication occurred.

CONCLUSION

Compared with conventional bronchoscopic foreign body extraction, this new instrument and technique make it possible for the operator to clamp and extract foreign body under direct telescopic view or TV watching. It has increased the accuracy and safety of bronchoscopic extraction of tracheobronchial foreign bodies.

Proteolytic processing of the astrovirus capsid

To further characterize the nature of proteolytic processing of the astrovirus capsid, we infected Caco-2 cells with a high multiplicity of astrovirus without trypsin in the presence of 5 to 10% fetal calf serum. These infections were characterized by pulse-chase labeling with [35S]Smethionine, electron microscopy, gel electrophoresis of purified viral particles, and analysis of infectivity of such particles with and without added trypsin. Pulse-chase experiments showed that the astrovirus capsid protein was initially translated as an approximately 87-kDa protein. The 87-kDa capsid protein was rapidly converted intracellularly to a 79-kDa form which was found in smaller amounts in the cell supernatant. Purification by differential centrifugation yielded particles that appeared quite similar to trypsin-grown astrovirus particles by negatively stained electron microscopy. These particles were antigenically distinct from trypsin-treated virions as demonstrated by their various reactions with monoclonal antibodies in a solid-phase immunoassay. The purified trypsin-free particles were mainly composed of the 79-kDa capsid protein which was found to have an amino terminus at residue 71 of the entire open reading frame 2 (ORF2) product. The cleavage site was identified in a highly conserved region of the astrovirus ORF2 product. These trypsin-free particles were minimally infectious in cultured Caco-2 cells but became highly infectious (10(5)-fold increase) after trypsin but not chymotrypsin treatment. This trypsin-enhanced infectivity correlated with conversion of the 79-kDa capsid protein to three smaller peptides of approximately 34, 29, and 26 kDa.

Surgical treatment of hepatocellular carcinoma and related basic research with special reference to recurrence and metastasis

OBJECTIVE

To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute of Shanghai Medical University in the recent years, with special reference to recurrence and metastasis.

METHODS

Published and unpublished update clinical and experimental data in the above-mentioned areas are summarized.

RESULTS

Surgical resection has played an important role in improving prognosis of HCC, the 5-year survival were 63.4% for small HCC resection (n = 806), 39.6% for large HCC resection (n = 1061), 64.7% for cytoreduction (using hepatic artery cannulation and ligation) and sequential resection of initially unresectable HCC (n = 93), 56.0% for cytoreduction using transcatheter arterial chemoembolization (TACE) and followed by resection (n = 65), and 22.4% for hepatic resection with removal of tumor thrombi in portal vein (n = 103). Unfortunately, the 5-year recurrent rate after curative resection of HCC was up to 61.5%, which was mainly a result of intrahepatic "metastasis" and multicentric origin of HCC. Clinically, re-resection of subclinical recurrence yielded 56% of 5-year survival (n = 202); prevention of recurrence by transcatheter arterial chemoembolization (TACE) + Interferon, or LAK/IL-2 therapy have decreased 3-year recurrent rate from 33% to 11%-18%. In experimental aspect, metastatic human HCC model in nude mice (LCI-D20) and HCC cell line with metastatic potential (MHCC97) have been established; studies on HCC invasiveness in the molecular level revealed similar results that reported in other solid cancers, and small HCC showed slightly better biological characteristics as compared with large HCC; microvessel density (MVD) that reflecting angiogenesis adversely correlated with 5-year survival of small HCC; experimental interventions using antisense H-ras, bispecific antibody, BB94, as well as anti-angiogenic agents (TNP470, suramin, CAI, heparin, antisense VEGF, etc.) have been demonstrated to inhibit tumor growth and lung metastasis in nude mice model.

CONCLUSIONS

Recurrence and metastasis are the major obstacle to further improve prognosis of HCC, studies should be conducted both in clinical and experimental aspects, "HCC invasiveness" will be the major target to be studied, particularly in the molecular level, and anti-angiogenesis will be one of the important approach.

Preparation of Cu Nanoparticles from Water-in-Oil Microemulsions

Spherical Cu nanoparticles were synthesized in sodium dodecyl sulfate (SDS)/isopentanol/cyclohexane/water microemulsions with sodium borohydride as a reducing agent. Nanoparticles formed in microemulsions were characterized by transmission electron microscopy (TEM), x-ray diffractometry (XRD), and small-angle X-ray scattering (SAXS). The size and polydisperity of particles were greatly affected by the mole ratio of water to surfactant (w) and the concentration of precursor salt. The ideal size and monodispersity of nanoparticles can be obtained at the smaller w value and lower concentration of Cu(2+) solution. Copyright 1999 Academic Press.

[Pharmacological comparison between volatile oil and water extract]

OBJECTIVE

To compare the pharmacological differences between volatile oil and water extract in eight aromatic drugs for resolving dampness.

METHOD

Volatile oil and water extract of eight commonly used aromatic drugs for resolving dampness were ig administered to rats respectively, and the effects of volatile oil and water extract on the secretion of gastric juice, volume of gastric mucous blood flow and activity of SOD in gastric mucous membrane were studied.

RESULT

It was shown that the effects of aromatic volatile oil in eight drugs on the indexes mentioned above were generally equal or similar to those of water extract, and it was obvious that the volatile oil in some high oil content drugs such as Amonum cardamomum L(Baidoukou), Alpinia katsumadai Hagata (Caodoukou), Amomum villosum Lour (Saren), and Amomum tsao-ko Crevost et Lem (Caogou) had better effects on the secretion of gastric juice and volume of gastric mucous blood flow that those of water extract.

CONCLUSION

It has been pharmacologically proved that in using aromatic drugs for resolving dampness, the loss of aromatic (volatile) components should be avoided.

[Hepatic resection with removal of tumor thrombi for hepatocellular carcinoma with tumor thrombi in portal vein and curative analysis]

OBJECTIVE

To study the therapeutic effects of surgical treatment for hepatocellular carcinoma (HCC) with tumor thrombi in the main trunk or the first branch of the portal vein (PVTT) and factors affecting prognosis.

METHODS

111 HCC patients with PVTT underwent hepatic resection with removal of tumor thrombi in the first left or the right branch of the portal vein or removal of tumor thrombi by direct opening of the main trunk of the portal vein. Hepatic artery infusion and/or portal vein infusion were performed after hepatic resection with removal of tumor thrombi for HCC with PVTT in 22 of the patients. Among 111 patients, 32 received postoperative transhepatic arterial chemoembolization and/or portal vein chemotherapy. Conservative treatment and surgical exploration or hepatic artery ligation (HAL) and infusion (HAI) and/or portal vein infusion (PVI) were performed in other 14 and 20 HCC patients with PVTT, respectively.

RESULTS

The 1-, 2-, 3-, 4- and 5- year survival rates were 61.7%, 36.2%, 32.3%, 24.4% and 22.4% in the resected group, respectively, whereas 14 HCC patients with PVTT treated conservatively died in three months and the 1-, 2- year survival rates were 6.0% and 0 in the 20 patients with surgical exploration or HAL and HAI and/or PVI respectively.

CONCLUSIONS

Hepatic resection with removal of tumor thrombi for HCC with PVTT should be encouraged for the prolongation of life span and quality of life.

A branched stem-loop structure in the M-site of bacteriophage Qbeta RNA is important for template recognition by Qbeta replicase holoenzyme

An internal site on bacteriophage Qbeta RNA, the M-site (map position 2545 to 2867), was recently shown by us to be required for the efficient initiation of minus strand synthesis by Qbeta replicase. In a more detailed mutational analysis, we show here that the essential elements within the M-site consist of two successive stem-loop structures followed by a bulge loop of unpaired purines, located at nucleotides 2696 to 2754 on the tip of a long, imperfectly base-paired stalk. Mutational changes affecting the sequences of paired or unpaired nucleotides in this segment reduced the template efficiency only mildly. The only severe effects were observed when one of the helical stems or the unpaired bulge was completely deleted or substantially shortened. We conclude that the three-dimensional backbone arrangement of these three elements constitutes the feature recognized by replicase. The role of the long stalk remains undetermined, because mutations that either stabilized or disrupted its base-pairing barely affected template activity, and even deletion of a major portion of one of its strands did not cause complete inactivation. Earlier evidence had implicated protein S1 (the alpha subunit of replicase) as the mediator of the M-site interaction. The lack of an active M-site on the Qbeta RNA template has the same quantitative and qualitative effects on template recognition as the absence of the S1 protein from replicase in the presence of wild-type RNA. We therefore believe that the M-site interaction explains most of the role of S1 protein in the replication of Qbeta RNA by replicase.

[Retrograde partial hepatectomy: report of 11 patients]

OBJECTIVE

To study a new approach to hepatectomy for liver tumors resected difficulty by typical method.

METHOD

The operative order is retrograde as compared with typical hepatectomy, namely, transection of the liver is performed first, isolating adhesions between the tumor and the diaphragm or partial invaded phrenectomy is performed second, and then after cutting corresponding ligaments, liver tumor is removed. If the surrounding organs were invaded or adhered by tumor too tightly to be separated. They were resected with the tumor.

RESULT

The approach was used in 11 patients with malignant tumors of liver from June 1994 to January 1996. Operation time was 192 min (150 - 250 min) and estimated blood loss during operation was 1460 ml (800 - 4, 200 ml). No operative mortality was found and all of the patients recovered uneventfully.

CONCLUSION

The retrograde partial hepatectomy is a good method for resection of liver tumors resected difficulty by typical hepatectomy.

Metabolism of lipoproteins containing apolipoprotein B in hepatic lipase-deficient mice

Mice lacking hepatic lipase have been reported to express mild hyperlipidemia characterized by increased concentrations of large high density lipoproteins, but normal concentrations of lipoproteins containing apolipoprotein B. Whereas hepatic lipase has been implicated in the clearance and processing of chylomicron remnants in rats, no such defect was found in these mice. We have further characterized the abnormal lipoprotein phenotype in young hepatic lipase-deficient mice and have found more pronounced elevations of high density lipoproteins associated in particular with a 5-fold increase in plasma concentrations of apolipoprotein E. In addition, there was a reduction in the concentration of low density lipoproteins containing apolipoprotein B-100 and B-48 relative to precursor lipoproteins of lower density and a pronounced deficiency of apolipoprotein B-containing low density lipoproteins with density exceeding 1.029 g/mL. Conversion of radiolabeled rabbit intermediate density lipoproteins to low density lipoproteins was reduced by 6-fold as compared with wild-type mice. Although clearance of cholesteryl ester-labeled chylomicrons from the blood was unimpaired in the deficient mice, that of chylomicron remnants was reduced. Furthermore, endocytosis of chylomicron cholesteryl esters into liver cells occurred more rapidly than in wild-type mice. The unimpaired hepatic clearance of injected chylomicron particles in hepatic lipase-deficient mice may be the result of greater acquisition of apoE from high density lipoproteins during remnant formation. These studies thus demonstrate a critical role for mouse hepatic lipase in the formation of small, dense low density lipoproteins, as well as participation in the normal clearance and processing of chylomicron remnants.

Alkylation of 2'-deoxynucleosides and DNA by the Premarin metabolite 4-hydroxyequilenin semiquinone radical

Premarin (Wyeth-Ayerst) is the estrogen replacement treatment of choice and continues to be one of the most widely dispensed prescriptions in the United States. In addition to endogenous estrogens, Premarin contains unsaturated estrogens including equilenin. We synthesized the catechol metabolite of equilenin, 4-hydroxyequilenin (4-OHEN), and found that the semiquinone radical of 4-OHEN reacted with 2'-deoxynucleosides generating very unusual adducts. 2'-Deoxyguanosine (dG), 2'-deoxyadenosine (dA), or 2'-deoxycytosine (dC) all gave four isomers, but no product was observed for thymidine under similar physiological conditions. The structures of these adducts were determined by electrospray mass spectrometry and NMR experiments including 1H, 13C, DQF-COSY, ROESY, HOHAHA, HMQC, and HMBC. The spectral data show that dG forms a cyclic adduct with the 4-OHEN producing 2-N1,3-N2-deoxyguanosyl-1,3-dihydroxy-5,7,9(10)-estratriene-4,17-d ione. Similarly, reaction with dA produced 1-N6,3-C2-deoxyadenosyl-2,3-dihydroxy-5,7,9(10)-estratriene-4,17-d ione, and incubations with dC resulted in 1-N3,3-N4-deoxycytosyl-2,3-dihydroxy-5,7,9(10)-estratriene-4,17-di one. We found that care needed to be taken during the isolation of the dA adducts in particular, as any exposure to acidic environments caused hydrolysis of the sugar moiety leaving alkylated adenine. In mixtures of the deoxynucleosides treated with 4-OHEN, reaction occurred primarily with dG followed by dC and dA. With DNA significant apurinic sites were produced as 4-OHEN-adenine adducts were detected in the ethanol wash prior to hydrolysis. When the DNA was hydrolyzed to deoxynucleosides and analyzed by electrospray mass spectrometry, only one isomer of 4-OHEN-dG and one isomer of 4-OHEN-dC were observed. Our data suggest that several different types of DNA lesions could be expected from 4-OHEN including apurinic sites and bulky stable adducts, in addition to the published oxidized damage to DNA caused by 4-OHEN. The production of these semiquinone radical-derived DNA adducts could play a role in the carcinogenic effects of Premarin estrogens.

Familial aggregation of oesophageal cancer in a high incidence area in China

BACKGROUND

The high incidence of oesophageal cancer in northern China is attributed predominantly to environmental factors. The role of genetic factors has not been extensively studied.

METHODS

Our aim was to study familial aggregation of oesophageal cancer in pedigrees from a defined population base in a high incidence area in China and to quantify the risk associated with different first degree relatives using different analytical approaches. Detailed data on family members of three successive generations and the occurrence of oesophageal and other cancers in family members were collected from a population-based series of 244 oesophageal cancer cases which occurred between 1987 and mid-1992 in Huixian County, Henan.

RESULTS

Compared to expected rates, the standardized mortality ratio (SMR) of oesophageal cancer among first degree relatives of oesophageal cancer patients was 2.4 (2.2 in male and 2.7 in female relatives). The corresponding SMR for first and second degree relatives were 1.6 and 2.2. The null hypothesis of 'no familial aggregation' was rejected using Tarone's one-sided score test for binomial distributions indicating some evidence for clustering within families. To account for variance due to between-pairs correlation and family and/or individual specific variables, we fitted a series of regression models using a Generalized Estimation Equations (GEE) approach. The pairwise odds ratios were 2.3 for parent-parent, 1.9 for sib-parent and 1.1 for sib-sib, adjusted for sex, age and sex of index case.

DISCUSSION

The existence of familial aggregation of oesophageal cancer in the study population was confirmed using different analyses and a two- to threefold increased risk was found for first degree relatives. The clear association of disease between parent and sib provides some indication of a genetic component. The pairwise association between parents but not between sibs suggests that environmental factors have a stronger action after childhood.

[Minor Bupleurum decoction in the treatment of viral myocarditis models]

A myocarditis model of Balb/c mice established by means of coxsackie virus type B3 was treated with the Minor Bupleurum Decoction. The results indicate that the decoction can regulate T lymphocyte subsets, influence anti-cardiac antibody production, help the organism to get clear of viruses, and thus plays an important role in treating viral myocarditis.

[The determination of olaquindox in feeds by HPLC]

A liquid chromatographic procedure for the determination of olaquindox in feeds is described. Chromatography was performed on a PC8-10/S2504 (4.0 mm i.d. x 250 mm, 10 microm, Shimadzu Co.) column at 30 degrees C by using a mobile phase of methanol:water (20:80, V/V ) with a flow rate of 0.8 mL/min and UV detection at 260 nm. Acetanilide was used as internal standard. Olaquindox was extracted with dimethylformamide (DMF) from the feeds. The average recoveries of olaquindox were 98.58%-101.63% and the relative standard deviations were 2.67%-4.25%. The method is simple, rapid, reliable and inexpensive.

[The expression of mdm2 gene related to the invasiveness of human hepatocellular carcinoma]

OBJECTIVE

mdm2 gene was used as an index to study the molecular mechanism related to the invasiveness of human hepatocellular carcinoma (HCC).

METHODS

The expression of mdm2 gene in 34 HCC samples and 19 paratumor liver tissues and the relationship between the expression of mdm2 gene and invasiveness of HCC were studied using reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

The expression level of mdm2 gene (x +/- Sx) in HCC samples was higher than that in paratumor liver tissues (50.18% +/- 5.24% vs. 27.70% +/- 7.43%, P < 0.05). The expression level of mdm2 gene in HCC samples with invasiveness was higher than that in HCC samples without invasiveness (59.09% +/- 7.28% Vs. 37.87% +/- 6.37%, P < 0.05). However, significant difference in expression of mdm2 gene was not found between small and large HCC as well as between HCC with and without capsule.

CONCLUSION

The expression of mdm2 gene was related to the invasiveness of HCC.

[The structural changes of cortical bone beneath plate after rigid platefixation and removal]

We investigated the structural changes of bone under the plate after plate fixation and removal. Twenty-four New Zealand white rabbits were plated on their intact left tibiae with stainless steel plates and 4 animals served as controls. The plates were removed 2 months after implantation in 20 plated animals, of which, 4 were sacrificed immediately after plate removal and the other were killed in successive groups of 4 each at 1, 2, 3 and 4 months after plate removal respectively. The remaining 4 plated animals were killed at 6 months after implantation. Bone samples were harvested and prepared for scanning microscopic observation. Internal fixation with a rigid plate may lead not only to osteopenia of the cortex under the plate, but also to disorganization of the cortex, in which the mineral column and collagen fibers were oriented in a randomized pattern. The regional osteoporosis could recover gradually after removal of the rigid plate. However, the restoration of normal bone structure occurred later than that of the bone mass. Delayed restoration of bone structure might be one of the potential causes of refracture of the plated bone.

Acceptance, efficacy, and side effects of Norplant implants in four counties in north China

This report attempts to present a comprehensive analysis of the acceptability, side effects, and efficacy of Norplant as used in rural areas, based on a field experiment conducted in four counties in Hebei and Shandong Provinces, China. The initial acceptance of Norplant was relatively high but waned after the first year in three of the four counties. Compared with clinical trials, the current study shows a lower prevalence but similar patterns of side effects. The pregnancy rate during the first two years of use is similar to that found in large-scale clinical trials conducted in China, but discontinuation due to other reasons is lower. A three-level logistic regression analysis shows significant variation in the probability of discontinuation due to side effects across counties. It also indicates an increase in the conditional probability of discontinuation with the duration of use. Whereas introducing Norplant and achieving a very low failure rate and high continuation rate in rural areas is feasible under diverse socioeconomic conditions, the results vary significantly across different areas. Particular attention should be paid to the local factors that may affect results.

[Contrast on therapeutic results of intraocular lens implantation in diabetics and non-diabetics]

PURPOSE

To observe the results of intraocular lens implantation in diabetics who suffered from cataract.

METHODS

30 cases (37 eyes) of diabetics with cataract and 174 cases (197 eyes) of non-diabetics with senile cataract were performed with intraocular lens implantation. The postoperative follow-up was from 2 to 18 months.

RESULTS

The statistics of the visual acuity in two groups had no difference. The primary factor that effected visual acuity was original retinopathy. Postoperative complications of diabetics group, such as anterior chamber fibrinous exudate, pigment diffusion, were much serious than those of non-diabetic group. But if strong effective hormones were locally administrated, inflammation was absorbed.

CONCLUSION

The therapeutic results of the diabetics with no or only minor retinopathy were similar with those of non-diabetics.

Abnormal regulation of the LDL-R and HMG CoA reductase genes in subjects with familial hypercholesterolemia with the "French Canadian mutation"

Familial hypercholesterolemia (FH) is seen with high frequency in the province of Québec, Canada. A large deletion (> 10 kb) of the 5'-end of the low density lipoprotein receptor (LDL-R) gene is the major mutation of the LDL-R in FH subjects in Québec (approximately 60% of FH subjects). No mRNA is produced from the allele bearing the mutation, and cellular cholesterol obtained by receptor-mediated endocytosis is under the control of the non-deletion allele. We have previously reported that some patients with the 10-kb deletion (approximately 9%) fail to respond to the hydroxymethylglutaryl coenzyme A reductase (HMG CoA reductase) inhibitor class of medications. We studied mRNA levels of the LDL-R and HMG CoA reductase genes in response to the HMG CoA reductase inhibitor lovastatin in a time- and dose-dependent fashion in cultured human skin fibroblasts and we devised an in vitro model to study the response to drug therapy in subjects with FH. We determined mRNA levels by RNase protection assay in skin fibroblasts obtained from controls (n = 3) and FH subjects with the > 10-kb deletion (responders, n = 3; non responders, n = 3; to drug therapy). We measured 125I-LDL binding on skin fibroblasts grown in the presence of lipoprotein-deficient serum with or without 1 microM lovastatin, using 10 micrograms/mL of 125I-LDL protein. Control subjects exhibited coordinate regulation of the LDL-R and HMG CoA reductase genes in response to lovastatin, 0.1-25 microM, for 0-24 h. Correlation coefficients between mRNA levels of both genes were > 0.9 in controls and FH subjects. However, by linear regression analysis, the corresponding slopes for the correlation between both genes were 0.98 (controls), 3.36 and 3.63 (FH responders and non-responders), indicating a pattern of dissociated but still coordinate regulation in FH subjects. The magnitude of increase of mRNA levels of the LDL-R gene was approximately five-fold over LPDS in controls, two-fold in FH responders and two-fold in non-responders. Binding studies using 125I-LDL reveal that a control subject and all responders had a 2-2.5-fold increase in binding to cell surface receptors but two out of three FH non-responders showed no increase in binding in response to 1 microM lovastatin. The LDL-R and HMG CoA reductase genes are expressed in coordinate regulation in fibroblasts from subjects with FH due to the > 10-kb deletion, but with a proportionately greater up-regulation of the HMG CoA reductase gene. Some subjects, with FH caused by the > 10-kb deletion of the LDL-R gene, who fail to respond to HMG CoA reductase inhibitors have abnormal LDL receptor binding activity at the cell surface in response to lovastatin in vitro.