Renal transplantation between siblings with unrecognized Fabry disease

Fabry disease is an X-linked lysosomal storage disease caused by deficiency of the lysosomal hydrolase, α-galactosidase A (α-Gal A). We report a case of a renal transplant recipient with unrecognized Fabry disease who received the allograft from a sibling donor with unrecognized Fabry disease. The recipient began to show a gradual increase of the serum creatinine with mild proteinuria at 3 years after transplantation. Histopathologic examination revealed finely vacuolated podocytes, demonstrated by ultrastructural examination to contain osmophilic myelin bodies. Furthermore, the recipient showed reduced circulating levels of α-Gal A and elevated urinary levels of globotriaosylceramide. These findings indicated that both the recipient and the donor suffered from Fabry disease of the renal variant phenotype. Enzyme replacement therapy (ERT) was initiated in the recipient, which resulted in a slight decrease of serum creatinine. Although mild proteinuria persisted, initiation of ERT in the recipient led to improvement of the renal function.

Distinct outcome of stage I lung adenocarcinoma with ACTN4 cell motility gene amplification

BACKGROUND

Even if detected at an early stage, a substantial number of lung cancers relapse after curative surgery. However, no method for distinguishing such tumors has yet been established.

PATIENTS AND METHODS

The copy number of the actinin-4 (ACTN4) gene was determined by fluorescence in situ hybridization on tissue microarrays comprising 543 surgically resected adenocarcinomas of the lung.

RESULTS

Amplification (an increase in the copy number by ≥ 2.0 fold) of the ACTN4 gene was detected in two of seven lung adenocarcinoma cell lines and 79 (15%) of 543 cases of pathological stage I-IV lung adenocarcinoma. Multivariate analysis revealed that ACTN4 gene amplification was the most significant independent factor associated with an extremely high risk of death (hazard ratio, 6.78; P = 9.48 × 10(-5), Cox regression analysis) among 290 patients with stage I lung adenocarcinoma. The prognostic significance of ACTN gene amplification was further validated in three independent cohorts totaling 1033 patients.

CONCLUSIONS

Amplification of the ACTN4 gene defines a small but substantial subset of patients with stage I lung adenocarcinoma showing a distinct outcome. Such patients require intensive medical attention and might benefit from postoperative adjuvant chemotherapy.

Mucosal-incision assisted biopsy for suspected gastric gastrointestinal stromal tumors

To evaluate the diagnostic yield of the procedure, mucosal-incision assisted biopsy (MIAB), for the histological diagnosis of gastric gastrointestinal stromal tumor (GIST), we performed a retrospective review of the 27 patients with suspected gastric GIST who underwent MIAB in our hospitals. Tissue samples obtained by MIAB were sufficient to make a histological diagnosis (diagnostic MIAB) in 23 out of the 27 patients, where the lesions had intraluminal growth patterns. Alternatively, the samples were insufficient (non-diagnostic MIAB) in remaining 4 patients, three of whom had gastric submucosal tumor with extraluminal growth patterns. Although endoscopic ultrasound and fine needle aspiration is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.

Interaction of IL-1β and P2X(3) receptor in pathologic masseter muscle pain

The exact mechanism underlying chronic masseter muscle pain, a conspicuous symptom in temporomandibular disorder, remains unclear. We investigated whether expression of P2X3 receptor (P2X3R) is involved in mechanical hyperalgesia after contraction of masseter muscle (CMM). As compared with sham rats, the head-withdrawal threshold (HWT) to mechanical pressure stimulation of masseter muscle (MM) (but not after similar stimulation of facial skin) was significantly lower, and IL-1β level was significantly higher, in CMM rats on day 7 after CMM. The mean percentage of FG-labeled P2X3R-positive neurons was significantly increased in TG following successive IL-1β injections into the MM for 7 days. Successive administration of an IL-1β receptor-antagonist into the MM attenuated the increase of P2X3-IR cells in the TG. ATP release from MM after 300-g pressure stimulation of MM was also significantly enhanced after CMM. Administration into MM of the selective P2X3,2/3 receptor antagonist A-317491 attenuated the decrement of HWT in CMM rats. A significant increase in HWT was also observed at 30 min after A-317491 (60 µg) injection in IL-1β-injected rats. These findings suggest that P2X3R expression associated with enhanced IL-1β expression and ATP release in MM has a possible important role in MM mechanical hyperalgesia after excessive muscular contraction.

297 PRODUCTION OF CHIMERIC PORCINE FETUSES BY AGGREGATION METHOD USING PARTHENOGENETIC EMBRYOS

Porcine induced pluripotent stem (iPS) cells are considered to be an invaluable research tool in translational research with pigs as a large animal model. Pluripotency of the iPS cells needs to be verified by their competence to contribute to chimera formation. The aim of the present study is to establish feasible system to create chimeric pig fetuses using parthenogenetic embryos. In Experiment 1, inner cell mass (ICM) was isolated by immunosurgery from Day 6 blastocysts obtained by parthenogenetic activation of in vitro matured (IVM) oocytes. Isolated ICM were used as the donor cells after staining with fluorescent carbocyanine dye (DiI). Using parthenogenetic morulae or 4- to 8-cell embryos as the host embryos, chimeric embryos were prepared by injection or aggregation method. Injection of ICM was performed by micromanipulation: a single ICM was directly injected into the centre portion of the host morulae. In the aggregation method, a single ICM was aggregated with blastomeres isolated from 2 host embryos at the morula or 4- to 8-cell stage in a micro-well (400 µm diameter, 300 µm deep). The chimeric embryos were cultured in PZM-5 (Yoshioka et al. 2008) for 2 to 3 days to examine development to blastocysts and incorporation of donor ICM cells into the resultant blastocysts ICM (ICM chimerism). In Experiment 2, donor blastomeres isolated from a parthenogenetic morula or 4- to 8-cell embryo were stained by DiI and aggregated with a parthenogenetic host embryo at the morula or 4- to 8-cell stage, and the in vitro development to the blastocyst stage and the ICM chimerism were examined. In Experiment 3, ICM isolated from IVF blastocysts harboring humanized Kusabira-Orange (huKO) gene were used as donor cells. Donor ICM were aggregated with the host embryos at the morula or 4- to 8-cell stage, and the resultant blastocysts were transferred to 4 recipient gilts to collect fetuses on Day 18. Results of Experiments 1 and 2 are summarised in Table 1. Combination of the donor ICM and host morulae yielded high rates of blastocyst formation (~95%) and ICM chimerism (~85%), regardless of the method used (injection or aggregation). Transfer of 73 blastocysts developed from host morulae to 2 recipients (Experiment 3) gave rise to 25 (34.2%) fetuses, of which 6 (24.0%) were confirmed to be chimeric by their clear orange fluorescence and immunostaining by anti-huKO antibody. Of 22 (40.7%) fetuses obtained after transfer of 54 blastocysts derived from 4- to 8-cell host embryos to 2 recipients, 3 (13.6%) were chimeric. Contribution of the donor cells in the tissues of the chimeric fetuses measured by image analysis software (ImageJ, NIH, Bethesda, MD, USA) ranged between 16.1 and 65.2%. These results demonstrate that the aggregation method using parthenogenetic host embryos is an efficient means to produce chimeric pig fetuses, and thereby feasible for verification of pluripotent cells such as iPS cells. Table 1.In vitro development of injected or aggregated porcine embryos

324 PRODUCTION OF GENETICALLY MODIFIED PIGS BY ARTIFICIAL REPRODUCTIVE TECHNOLOGIES USING FROZEN EPIDIDYMAL SPERM

Genetically modified (GM) pigs are useful tools for many types of biomedical research. The objective of this study was to develop a reliable protocol for the reproduction of GM pigs using frozen epididymal sperm. Epididymal sperm were collected from 3 GM boars: (1) humanized Kusabira-Orange (huKO) transgenic, (2) mutant human hepatocyte nuclear factor 1α (HNF-1α) transgenic, and (3) α1,3-galactosyltransferase gene knockout (GalT-KO). Additionally, a wild type (WT) boar was also used for sperm collection. After collection, the sperm were frozen in Niwa and Sasaki freezing medium (Niwa et al. 1989 Manual for Cryopreservation of Pig Spermatozoa 19–23; 1.0 × 109 sperm mL–1) using 0.5-mL straws. The sperm were cooled utilising the 2-step method, from 25 to 15°C at a rate of 0.17°C min–1, and then from 15 to 5°C at 0.08°C min–1. After cooling to 5°C, the straws were frozen in liquid nitrogen with 3% glycerol for storage. After storage for 0.5 to 21 months, the straws were thawed by immersion into a 37°C water bath. The recovered sperm were washed by centrifugation in PBS + 1 mg mL–1 BSA and were resuspended in either Beltsville thawing solution (Pursel and Johnson. 1975 J. Anim. Sci. 40, 99–102) for intra-fallopian AI or in porcine fertilization medium (PFM, Research Institute for the Functional Peptides, Yamagata, Japan) for IVF. Prepubertal gilts (6.5 months), in which oestrus was induced by 1000 IU eCG and 1500 IU hCG given 66 or 72 h apart, were surgically inseminated with 0.9–7.9 × 106 progressive motile sperm 41 to 51 h after receiving an hCG injection. Oocytes, which matured in vitro either in modified porcine oocyte medium (IFP) or modified NCSU23 medium, were inseminated in PFM for 8 h with either 0.5 (huKO, GalT-KO) or 1.6 (HNF-1α) × 106 progressive motile sperm mL–1. The in vitro fertilized oocytes were cultured in porcine zygote medium-5 (Research Institute for the Functional Peptides) for 5 to 6 days until they were transferred. Some of these oocytes were examined for their fertilization rates. Blastocysts were transferred into the uterus of the recipient 150 h after hCG treatment. The fertilization rates for huKO, HNF-1α and GalT-KO sperm were 63.5% (61/96), 62.5% (70/112) and 92.4% (61/66), respectively; 50.8% (31/61), 82.9% (58/70) and 60.7% (37/61) of these were monospermic. The rate at which the IVF embryos developed into blastocysts was 47.8–52.4%. This study demonstrates that IVF using frozen epididymal sperm is more efficient method for reproducing genetically modified pigs than AI (87.5 v. 33.3%). Table 1.Pig production efficiencies of frozen epididymal sperm from genetically modified pigs utilising AI and IVF This study was supported by JST, ERATO, NAKAUCHI Stem Cell and Organ Regeneration Project, Tokyo.

67 A HOLLOW FIBER VITRIFICATION METHOD ENABLES CRYOBANKING OF IN VITRO-MATURATION/IN VITRO-FERTILIZATION-DERIVED TRANSGENIC PIG EMBRYOS

We have recently developed a novel high-performance embryo cryopreservation method: the hollow fiber vitrification (HFV) method (Matsunari et al. 2012 J. Reprod. Dev., in press). In this study, we aimed to demonstrate the utility of the HFV method for the cryopreservation of transgenic pig embryos produced by in vitro oocyte maturation/fertilization (IVM/IVF). In vitro-matured oocytes were inseminated with cryopreserved epididymal sperm (Kikuchi et al. 1998 Theriogenology 50, 615–623) from a transgenic pig carrying the humanized Kusabira-Orange gene (Matsunari et al. 2008 Cloning Stem Cell 10, 313–323) and then cultured for 96 h. Morulae with normal morphology were divided into the vitrification and nonvitrification groups. The vitrification of embryos was performed by the HFV method using 20-mM HEPES-buffered TCM199 containing 20% calf serum as a base medium. Cellulose acetate hollow fibers (25 mm), each containing 10 to 20 embryos, were placed in an equilibration solution containing 7.5% ethylene glycol and 7.5% dimethyl sulfoxide for 5 to 7 min and were then placed for 1 min in the vitrification solution containing 15% ethylene glycol, 15% dimethyl sulfoxide, and 0.5 M sucrose. The embryos were then vitrified by immersion in liquid nitrogen and held there for 5 to 10 min. The embryos were warmed by immersing the hollow fiber in a 1-M sucrose solution at 38.5°C, followed by a stepwise dilution of the cryoprotectants using 0.5-M sucrose solution (3 min) and the base medium (10 min). Vitrified and nonvitrified embryos were cultured for 40 h, and their development into blastocysts was evaluated. The in vitro development of vitrified embryos to the blastocyst stage was compared with that of the nonvitrified controls on Day 6. In the embryo-transfer experiments, blastocysts at either Day 5 or Day 6 from both the vitrification and nonvitrification groups were transferred to 3 recipient gilts per group (25–32 blastocysts/gilt), and their development through farrowing was compared. To test long-term preservation, some of the vitrified morulae were kept in liquid nitrogen for 43 days, and their development to Day 30 fetuses was evaluated after transfer to an additional recipient. The differences in proportional data between the 2 groups were analyzed with the χ2-test. Of the 393 putative zygotes obtained by IVM/IVF, 169 (43.0%) developed into morulae. In vitro development of the vitrified morulae to blastocysts (66/85, 77.6%) was comparable with that of the nonvitrified morulae (67/84, 79.8%, not significant: NS). The embryo-transfer experiments resulted in pregnancy in all 6 of the recipients. The production efficiency of piglets (piglets/embryos transferred) was 17/88 (19.3%) for the vitrification group and 27/88 (27.7%, NS) for the nonvitrification group. Approximately 50% of the offspring in both groups were transgenic. Long-term cryopreservation using the HFV method resulted in similar piglet production efficiency (7 piglets produced out of 32 embryos transferred). This study demonstrated for the first time that the HFV method effectively cryopreserves IVM/IVF-derived transgenic pig embryos. Supported by the JST CREST program.

Reduction in radiation and contrast medium dose via optimization of low-kilovoltage CT protocols using a hybrid iterative reconstruction algorithm at 256-slice body CT: phantom study and clinical correlation

AIM

To optimize low-kilovoltage (kV) computed tomography (CT) protocols using a hybrid iterative reconstruction (HIR) algorithm at 256-detector-row body CT.

MATERIALS AND METHODS

Based on preliminary phantom studies, three different tube voltage protocols with an equal contrast-to-noise ratio (CNR) were developed. They were a conventional 120 kV protocol with filtered back-projection (FBP), an 80 kV protocol with HIR (a 160% increase in the tube current-time product and a 40% reduction in the contrast medium dose), and a 100 kV protocol with HIR (a 20% reduction in the tube current-time product and the contrast medium dose). The clinical study included 70 patients (34 women, 36 men; mean age 70.5 ± 9.1 years, range 44-92 years) who had undergone CT at 120 kV a mean of 148 ± 137 days before undergoing low kV contrast-enhanced body CT (80 kV with HIR, n = 35; 100 kV with HIR, n = 35). The estimated effective radiation dose (ED), image noise, and CNR were calculated and the visual image quality was scored on a four-point scale.

RESULTS

Mean ED was 12.3, 8.4, and 15.4 mSv for the 80, 100, and 120 kV protocol, respectively, and significantly lower using the low kV protocols. There was no significant difference in the image noise and CNR between the low kV protocols with HIR and the 120 kV protocol with FBP, or in the visual scores among the three protocols.

CONCLUSION

Without ensuing image-quality degradation, the radiation and contrast medium dose can be reduced with optimal contrast-enhanced CT protocols using a low kV technique and an HIR algorithm.

Relationship between the thickness of the roof of glenoid fossa, condyle morphology and remaining teeth in asymptomatic European patients based on cone beam CT data sets

OBJECTIVES

The aim of this study was to examine the relationship between the roof of the glenoid fossa (RGF) thickness and condyle morphology and the influence of the number of remaining teeth and age.

METHODS

Cone beam CT data sets from 77 asymptomatic European patients were analysed retrospectively in this study. The thinnest area of RGF was identified among the sagittal and coronal slices on a computer screen; distance measurement software was used to measure the thickness. Moreover, we applied a free digital imaging and communications in medicine viewer for classification of condyle head type. It was also used to analyse any relation between RGF thickness and the number of remaining teeth. We performed a correlation analysis for RGF, age and missing teeth. Finally, we investigated combining sagittal condyle morphological characterization with coronal condyle morphology in relation to the number of joints and RGF thickness.

RESULTS

The Kruskal-Wallis test revealed no significant differences in RGF thickness among any of the coronal condyle head morphology groups (p > 0.05). There were significant differences in the thinnest part of RGF in relation to the sagittal plane for condyle morphological characterization, because we observed increased RGF thickness in joints with osteoarthritis features (p < 0.05). There is a non-significant correlation between the thinnest part of the RGF and the number of remaining teeth (p > 0.05).

CONCLUSIONS

We found that the RGF thickness is unaffected by the coronal condyle head morphology and the number of remaining teeth. Osteoarthritic changes (sagittal condyle morphology) have an effect on RGF.