Neutralizing human monoclonal antibodies binding multiple serotypes of botulinum neurotoxin

Botulism, a disease of humans characterized by prolonged paralysis, is caused by botulinum neurotoxins (BoNTs), the most poisonous substances known. There are seven serotypes of BoNT (A-G) which differ from each other by 34-64% at the amino acid level. Each serotype is uniquely recognized by polyclonal antibodies, which originally were used to classify serotypes. To determine if there existed monoclonal antibodies (mAbs) capable of binding two or more serotypes, we evaluated the ability of 35 yeast-displayed single-chain variable fragment antibodies generated from vaccinated humans or mice for their ability to bind multiple BoNT serotypes. Two such clonally related human mAbs (1B18 and 4E17) were identified that bound BoNT serotype A (BoNT/A) and B or BoNT/A, B, E and F, respectively, with high affinity. Using molecular evolution techniques, it proved possible to both increase affinity and maintain cross-serotype reactivity for the 4E17 mAb. Both 1B18 and 4E17 bound to a relatively conserved epitope at the tip of the BoNT translocation domain. Immunoglobulin G constructed from affinity matured variants of 1B18 and 4E17 were evaluated for their ability to neutralize BoNT/B and E, respectively, in vivo. Both antibodies potently neutralized BoNT in vivo demonstrating that this epitope is functionally important in the intoxication pathway. Such cross-serotype binding and neutralizing mAbs should simplify the development of antibody-based BoNT diagnostics and therapeutics.

Potential role for bone marrow-derived fibrocytes in the orbital fibroblast heterogeneity associated with thyroid-associated ophthalmopathy

Fibroblast heterogeneity has been recognized for decades, but the basis for multiple phenotypes among these cells has been investigated only recently. More than 15 years ago, Bucalla and his colleagues described for the first time a population of fibroblast-like cells among circulating mononuclear blood cells. Subsequently these mesenchymal cells, termed fibrocytes, have been characterized and found to participate in normal and pathological tissue remodelling. In this review, I have attempted to present the evidence generated thus far suggesting that fibrocytes are participants in autoimmune diseases where tissues are injured and undergo remodelling. Aspects of their phenotype suggest that they are well suited to help orchestrate immune responses through mononuclear cell recruitment and their ability to produce inflammatory mediators and extracellular matrix molecules. These attributes also raise the possibility that they might be useful targets against which therapeutic agents might be aimed.

Enzyme Immunoassay Detection of Nitrosomonas europaea

An exploratory effort to selectively detect the presence of a nitrifying bacterium, Nitrosomonas europaea, successfully demonstrated the fundamental utility of an enzyme-based immunoassay protocol. The applied polyclonal antibody test seemingly offered a marked improvement over the available analytical options, including plating, activity, and fluorescence immunoassay techniques. Following an initial purification step to enhance overall specificity, this procedure had an apparent lower limit of detection of approximately 5 x 10 cells per ml. Tests conducted with activated sludge samples exhibited a distinct difference between nitrifying and nonnitrifying mixed liquors, although the highest Nitrosomonas levels observed (i.e., at 1 to 2% of the overall viable cell density) were relatively close to the latter detection boundary.

Pathogenesis of Graves' orbitopathy: a 2010 update

The most important of the extra-thyroidal manifestations of Graves' disease, Graves' orbitopathy (GO), remains a vexing clinical problem. Treatment of severe active disease has been limited to steroids or radiotherapy. In the relatively rare case where vision is threatened, emergent decompression surgery can be performed. The proptosis, motility, or cosmetic concerns associated with stable GO are commonly remedied with surgical intervention. Substantial obstacles have prevented the development of specific medical therapies for GO, in large part resulting from poor understanding of disease pathogenesis and the absence of preclinical animal models. Fundamental aspects of GO's etiology have been uncovered from studies based in cell culture, extensive analysis of blood constituents, and detailed examination of orbital contents collected at the time of surgical intervention. Many of the published reports resulting from these studies are descriptive and all have failed to yield unifying concepts that integrate the anatomically divergent manifestations of Graves' disease. This brief review covers recent findings of several research groups. While major breakthroughs continue to occur in closely related autoimmune diseases, progress in identifying the pathogenic mechanisms relevant to GO has been limited. As emerging insights into human autoimmunity becomes applied to the study of Graves' disease, we anticipate that improved therapeutic strategies will find their way to our patients with GO.

An Investigation into the Effect of Surface Roughness of Stainless Steel on Human Umbilical Vein Endothelial Cell Gene Expression

The surface properties of vascular devices dictate the initial postimplantation reactions that occur and thus the efficacy of the implantation procedure. Over the last number of years, a number of different stent designs have emerged and stents are generally polished to a mirror finish during the manufacturing procedure. This study sought to investigate the effect of stainless steel surface roughness on endothelial cell gene expression using an appropriate cell culture in vitro assay system. Stainless steel discs were roughened by shot blasting or polished by mechanical polishing. The surface roughness of the treated and untreated discs was determined by atomic force microscopy (AFM). Cells were seeded on collagen type 1 gels and left to attach for 24 h. Stainless steel discs of varying roughness were then placed in contact with the cells and incubated for 24 h. RNA extractions and quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was then performed to determine the expression levels of candidate genes in the treated cells compared to suitable control cells. E-selectin and vascular cellular adhesion molecule (VCAM-1) were found to be significantly up-regulated in cells incubated with polished and roughened samples, indicating endothelial cell activation and inflammation. This study indicates that the surface roughness of stainless steel is an important surface property in the development of vascular stents.

Exploration of hereditary cancer and feasibility of genetic services at the end of life

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Background: For families, optimal hereditary cancer assessment begins with an affected relative. End of life could be the last chance for testing or DNA banking. Many palliative care oncologists do not feel qualified to offer genetic services and are rarely doing so (NSGC, 2008). The genetic burden of cancer in palliative care is unknown. Methods: We investigated prevalence of hereditary cancer among dying cancer patients, previous genetic testing or DNA banking, and awareness and intentions regarding these services. In spring/summer 2008 we recruited and interviewed patients (or surrogate decision makers) from the VCUHS Palliative Care Unit. Genetic risk was characterized as “strong” using classification criteria developed by Scheuner et al. (1997) or other consensus diagnostic criteria. Statistics were assessed using SAS 9.1.3. Results: 43 (47%) patients (including 9 surrogates) agreed to participate. The most common diagnoses were leukemias/lymphomas (n=9), and cancers of the lung (n=8), colon (n=5), and breast (n=4). 8 of 43 (18.6%, 95% CI = 7.0% to 30.2%) patients had “strong” genetic risk. Currently available genetic tests could have addressed risk for several patients, especially for HNPCC and hereditary breast/ovarian cancer. None had previous testing or DNA banking. Of strong-risk patients (or surrogates), 7 (87.5%) had heard/read “almost nothing” or “relatively little” about testing. All had heard/read little or nothing about DNA banking. 83% would “probably get tested” if offered, and 72% would “probably” or “definitely” bank DNA. There were no significant differences by race/ethnicity, nor by genetic risk. Conclusions: The genetic burden of cancer may be at least as high in the palliative care population as in other clinical settings and is not being discovered upstream. Patient interest in genetic services is high, but awareness is low.

No significant financial relationships to disclose.

Willingness of cancer patients to discuss advance directives with admitting doctor or oncologists

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Background: Many seriously ill cancer patients do not discuss prognosis or advance directives (ADs), which may lead to aggressive care at end of life (Harrison & Smith, JAMA 2008). Ten years ago, cancer patients did not want to discuss ADs with their oncologist (ONC), but would discuss them with an admitting doctor (Lamont JPM 2000).We assessed if this still held. Methods: We administered semi-structured interviews to cancer inpatients on the VCUHS Hematology-Oncology service. 55/63 consecutive patients accrued. Information was collected regarding ADs and knowledge of hospice/palliative care. Results: Of those enrolled, 22/55 (40%) reported having ADs. Only 2/55 had discussed ADs with their oncologist. Only 12/55 (22%) would want to discuss ADs with their ONC. But when specifically asked, 22/55 (40%) of patients would prefer to discuss ADs with their oncologist, and 40% with their primary care doctor. 86% would discuss ADs with the admitting doctor. There was no difference in doctor preference based upon prior AD completion. The preference not to discuss ADs with the oncologist was often because they felt their family could make the decisions, or that it was only necessary “If it got serious.” There was a common misconception that ADs mean death is imminent and lead to termination of care. Conclusions: Most patients (86%) are willing to discuss ADs with an admitting doctor, but only a small number (22%) want to discuss with their ONC. However, most patients will discuss ADs and 40% actually prefer their ONC if ADs are discussed. We therefore need to train primary care doctors, house staff, hospitalists, and oncologists to have these difficult discussions.

[Table: see text]

No significant financial relationships to disclose.

Transforming growth factor β1 and laminin-111 cooperate in the induction of interleukin-16 expression in synovial fibroblasts from patients with rheumatoid arthritis

Objectives:

In synovial tissues of patients with rheumatoid arthritis (RA), strong expression of laminins and integrins co-localises with increased expression of inflammatory cytokines. Synovial fibroblasts (SF) contribute to the pathogenesis of RA through increased expression of cytokines and chemoattractant factors, one of which is interleukin-16 (IL16). A study was undertaken to investigate the regulatory pathways of IL16 in SF from patients with RA (RA-SF) and osteoarthritis (OA-SF).

Methods:

SF were seeded in laminin-coated flasks and activated by the addition of cytokines. The expression of IL16 was investigated by quantitative RT-PCR, immunoblotting and ELISA; its biological activity was determined by a cell migration assay. Cell–matrix interactions were investigated by cell binding and attachment assays. Relevant intracellular signalling pathways were studied by immunoblotting and with pharmacological blocking reagents.

Results:

Stimulation of SF with transforming growth factor β1 (TGF-β1) and growth on laminin-111 (LM-111) significantly increased the expression of IL16. Binding to LM-111 induced significantly more IL16 mRNA in RA-SF than in OA-SF (p<0.05). The IL16 cytokine was detected in supernatants of TGF-β1-activated and in LM-111+TGF-β1-activated RA-SF (38 to 62 pg/ml), but not in supernatants of OA-SF. This IL16 regulation involved p38MAPK, ERK1/2 and SMAD2 signalling, but not NFκB.

Conclusions:

Binding of RA-SF to LM-111 in the presence of TGF-β1 triggers a significant IL16 response and thus may contribute to the infiltration of CD4+ lymphocytes into synovial tissues. This mode of IL16 induction represents a novel pathway leading to IL16 production in RA-SF but not in OA-SF, which operates independently of NFκB signalling.

Mode of action and variability in efficacy of plant essential oils showing toxicity against the poultry red mite, Dermanyssus gallinae

This paper describes a series of experiments to examine the mode of action and toxicity of three plant essential oils (thyme, manuka and pennyroyal) to the poultry red mite, Dermanyssus gallinae (De Geer), a serious ectoparasitic pest of laying hens. All three oils were found to be toxic to D. gallinae in laboratory tests with LC(50), LC(90) and LC(99) values below 0.05, 0.20 and 0.30mg/cm(3), respectively, suggesting that these products may make for effective acaricides against this pest. Further experiments demonstrated that when mites were exposed to only the vapour phase of the essential oil without contact with the oil itself, mortality was consistently higher in closed arenas than in arenas open to the surrounding environment, or in control arenas. This suggests that all three essential oils were toxic to D. gallinae by fumigant action. In addition, in an experiment where mites were allowed contact with the essential oil in either open or closed arenas, mortality was always reduced in the open arenas where this was comparable to control mortality for thyme and pennyroyal essential oil treatments. This supports the findings of the previous experiment and also suggests that, with the possible exception of manuka, the selected essential oils were not toxic to D. gallinae on contact. Statistical comparisons were made between the toxicity of the selected essential oils to D. gallinae in the current work and in a previous study conducted in the same laboratory. The results demonstrated considerable variation in LC(50), LC(90) and LC(99) values. Since both the essential oils and the mites were obtained from identical sources in the two studies, it is hypothesized that this variation resulted from the use of different 'batches' of essential oil, which could have varied in chemistry and hence acaricidal activity.

Palliative care in BMT

The field of high-dose therapy and SCT has made many advances in the past several years and the success rates have been steadily increasing as newer therapies emerge and improvements in supportive care continue to improve patient survival and cure rates. There still remains a mortality risk for high-dose therapy and the need for palliative care becomes more apparent as the focus also incorporates quality of life in all facets of cancer treatment and care. This paper reports on the lack of literature available on palliative care into the BMT and explores areas of future research in the integration of these two fields of medicine.

Chronic obstructive pulmonary disease mortality in railroad workers

BACKGROUND

There is little information describing the risk of non-malignant respiratory disease and occupational exposure to diesel exhaust.

METHODS

US railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II. In a retrospective cohort study we examined the association of chronic obstructive pulmonary disease (COPD) mortality with years of work in diesel-exposed jobs. To examine the possible confounding effects of smoking, multiple imputation was used to model smoking history. A Cox proportional hazards model was used to estimate an incidence rate ratio, adjusted for age, calendar year, and length of follow-up after leaving work (to reduce bias due to a healthy worker survivor effect).

RESULTS

Workers in jobs with diesel exhaust exposure had an increased risk of COPD mortality relative to those in unexposed jobs. Workers hired after the introduction of diesel locomotives had a 2.5% increase in COPD mortality risk for each additional year of work in a diesel-exposed job. This risk was only slightly attenuated after adjustment for imputed smoking history.

CONCLUSIONS

These results support an association between occupational exposure to diesel exhaust and COPD mortality.

Urinary naphthalene and phenanthrene as biomarkers of occupational exposure to polycyclic aromatic hydrocarbons

OBJECTIVES

The study investigated the utility of unmetabolised naphthalene (Nap) and phenanthrene (Phe) in urine as surrogates for exposures to mixtures of polycyclic aromatic hydrocarbons (PAHs).

METHODS

The report included workers exposed to diesel exhausts (low PAH exposure level, n = 39) as well as those exposed to emissions from asphalt (medium PAH exposure level, n = 26) and coke ovens (high PAH exposure level, n = 28). Levels of Nap and Phe were measured in urine from each subject using head space-solid phase microextraction and gas chromatography-mass spectrometry. Published levels of airborne Nap, Phe and other PAHs in the coke-producing and aluminium industries were also investigated.

RESULTS

In post-shift urine, the highest estimated geometric mean concentrations of Nap and Phe were observed in coke-oven workers (Nap: 2490 ng/l; Phe: 975 ng/l), followed by asphalt workers (Nap: 71.5 ng/l; Phe: 54.3 ng/l), and by diesel-exposed workers (Nap: 17.7 ng/l; Phe: 3.60 ng/l). After subtracting logged background levels of Nap and Phe from the logged post-shift levels of these PAHs in urine, the resulting values (referred to as ln(adjNap) and ln(adjPhe), respectively) were significantly correlated in each group of workers (0.71 < or = Pearson r < or = 0.89), suggesting a common exposure source in each case. Surprisingly, multiple linear regression analysis of ln(adjNap) on ln(adjPhe) showed no significant effect of the source of exposure (coke ovens, asphalt and diesel exhaust) and further suggested that the ratio of urinary Nap/Phe (in natural scale) decreased with increasing exposure levels. These results were corroborated with published data for airborne Nap and Phe in the coke-producing and aluminium industries. The published air measurements also indicated that Nap and Phe levels were proportional to the levels of all combined PAHs in those industries.

CONCLUSION

Levels of Nap and Phe in urine reflect airborne exposures to these compounds and are promising surrogates for occupational exposures to PAH mixtures.

Polymorphisms inGSTT1andp53and urinary transitional cell carcinoma in south-western Taiwan: A preliminary study

Little is known about the relevance of genetic polymorphisms to arsenic-related bladder cancer. A preliminary case-control study was conducted to explore the association between genetic polymorphisms of GSTT1, p53 codon 72 and bladder cancer in southern Taiwan, a former high arsenic exposure area. Fifty-nine urinary transitional cell carcinoma (TCC) patients from a referral centre in south-western Taiwan and 81 community controls matched on residence were recruited from 1996 to 1999. A questionnaire was administered to obtain arsenic exposure and general health information. Genotypes of p53 codon 72 and GSTT1 were analysed by polymerase chain reaction-restriction fragment length polymerase. The combined variant genotypes (heterozygous or homozygous variant) of p53 codon 72 and GSTT1 null were observed in 29% of cases and in 44% of controls, respectively. In this preliminary study, bladder cancer risk was slightly elevated for subjects carrying the variant genotype of p53 codon 72 or in subjects carrying the GSTT1 null genotype. Variants in p53 codon 72 increased the risk of bladder cancer among smokers. However, the results were not statistically significant and larger confirmatory studies are needed to clarify the role of candidate gene polymorphisms and bladder cancer risk in arsenic exposed populations.

Analysis of the effects of surface treatments on nickel release from nitinol wires and their impact on candidate gene expression in endothelial cells

Nitinol has many applications in the medical device industry, however the large amount of nickel, a known allergen and carcinogen remains a serious concern. Studies have already shown that nickel ions induce the differential expression of a range of genes, including cell adhesion molecules. This study sought to determine the level of nickel ions released from nitinol wires that had been surface treated by etching and mechanically polishing or etching and pickling compared to untreated wires and determine the biological impact of the wires on human umbilical vein endothelial cells (HUVECs) at the transcriptional level by real-time PCR. The four different wire types were incubated in media and the amount of nickel eluted after 24, 48 and 72 h was determined. HUVECs were then cultured and incubated with the four different wire types for 24 h. Cells were harvested, RNA isolated and real-time PCR was carried out to measure the expression levels of ICAM-1, VCAM-1 and E-selectin, three known inflammatory mediators, compared to control cells. E-selectin, a marker of endothelial cell injury and activation was found to be significantly up-regulated in cells incubated with wires that released the highest amount of nickel ions. Nickel ions are released from nitinol wires with certain surface characteristics and these ions have a biological effect on HUVECs in vitro.

Relation of Apple Flower Age to Infection of Hypanthium by Erwinia amylovora

Blossom age as related to hypanthial susceptibility to Erwinia amylovora is not well established, but is relevant to disease risk assessment. To test this, detached crab apple blossoms were maintained for various periods and at different temperatures before applying inoculum to hypanthia. Inoculum potential on hypanthia due to wetting was evaluated by subjecting detached stigma-inoculated blossoms (~10⁶ CFU per flower) to varying amounts and durations of simulated rain (or dew) at 14°C. Blossoms of varying age on mature 'Gala' apple trees were inoculated on hypanthia with 10², 10⁴, or 10⁶ CFU per flower. In the laboratory, susceptibility decreased with flower age at rates that increased with temperature. Wetness periods up to 12 h resulted in populations on hypanthia of <10³ CFU per flower; 24 h of wetness resulted in ~10⁴ or ~10⁵ CFU. A dose response was shown in the orchard, and regression curves indicated steepest decline of susceptibility during initial days after petal expansion. Disease models incorporating a blossom-age component may be effective because they indicate the potential for infection when temperatures favor rapid bacterial growth on stigmas within a window of high hypanthial susceptibility. Further investigation of these relationships could lead to advancements in determining fire blight risk.

Driver exposure to combustion particles in the U.S. Trucking industry

A large study of combustion particle exposures for drivers of diesel-powered trucks was conducted in collaboration with an epidemiologic study of lung cancer outcomes for workers in the trucking industry. Three components of diesel exhaust combustion particles (PM(2.5), elemental carbon, and organic carbon) were measured inside the driver cabs of diesel-powered trucks from 36 different trucking terminals across the United States between 2001 and 2005. In-cab particle exposures for drivers assigned to both short and long distance trips were observed, as well as information on the smoking status of the driver, truck characteristics such as age and model, and weather conditions during the sampling session. This article summarizes these findings and describes the relationship between exhaust particles and various determinants of exposure. The results suggest that in-cab particle exposures are positively related to smoking, ambient particle concentrations, truck age, and open windows, with other significant modifying factors such as weather. This study represents the largest and most comprehensive exposure assessment of drivers in the trucking industry, encompassing a 4-year period of observations on diesel and exhaust particle exposures nationwide. The results are relevant not only to the occupational group of truck drivers being examined but also to the general population that live, commute, or work within proximity to diesel-fueled traffic or trucking terminals.