Detection of rearranged immunoglobulin DNA in plasma

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Background: Tumor DNA is increasingly recognized as a marker in plasma or serum. B cells are characterized by immunoglobulin heavy chain rearrangements (IgH-R)and B cell malignancies by clonal IgH-R. We hypothesized that detection of clonal IgH-R DNA (a DNA spike) might reflect the presence of malignancy. Methods: We used a PCR and capillary electrophoresis. DNA from plasma of 6 healthy donors, 5 patients treated with rituximab, 5 persons with AIDS (PWA) but not lymphoma, 5 patients with AIDS-related lymphoma (ARL) and 5 patients with Hodgkin’s lymphoma (HL) was studied. In some cases matched peripheral blood mononuclear cells (PBMC) and followup specimens were available. Results: In plasma from healthy donors there was a normal (bell-shaped) distribution of IgH-R. In patients treated with rituximab (including a patient with an autoimmune disorder but no malignancy), IgH-R in plasma decreased by at least 100-fold. In PWA, there was a normal distribution of IgH-R. In pretreatment plasma from 2 of 5 patients with ARL, a DNA spike was detected superimposed on the background of IgH-R. The DNA spike was not detected in PBMC. In both ARL patients the spikes disappeared with therapy. However, in 1 it reappeared, and shortly thereafter the patient relapsed. Clinical relapse was associated with an increase in spike amplitude. The spike disappeared again with salvage chemotherapy. Identity of the pretreatment and relapse spikes was confirmed by sequencing. In 1 of 5 patients with HL a pretreatment DNA spike was detected in plasma. It decreased in serial specimens during the first month of combination chemotherapy. Conclusions: A normal distribution of rearranged Ig DNA is readily detected in plasma from healthy donors and patients. This normally distributed rearranged Ig DNA consistently disappears with rituximab therapy. A DNA spike can be detected in the plasma of some patients with B lineage lymphoma even when that spike is not evident in PBMC consistent with the possibility that this DNA is not derived from circulating tumor cells. The reappearance of a DNA spike may presage relapse. Further investigation will be required to determine the sensitivity and specificity of detection of such Ig DNA spikes and to confirm a tumor origin.

No significant financial relationships to disclose.

Construction of phosphorylatable monoclonal antibody CC49 with a casein kinase II recognition site

A phosphorylation site for casein kinase II was introduced into chimeric monoclonal antibody CC49 (MAb-chCC49) by site-specific mutation of the coding sequence. The phosphorylation site for the casein kinase II was positioned at the carboxyl terminus of the heavy chain constant region of the MAb-chCC49. The resultant modified MAb-chCC49CKII was expressed in NS0 cells and purified. The MAb-chCC49CKII protein was phosphorylated by casein kinase II with [gamma-32P]ATP to high radiospecific activity. The 32P-labeled MAb-chCC49CKII binds to cells expressing TAG-72 antigens. The introduction of the phosphorylation sites for casein kinase II into monoclonal antibodies (MAb) provides a new reagent for the diagnosis and treatment of cancers. This demonstrates that the casein kinase II recognition site can also be used to introduce phosphorylation sites into proteins.

Effect of herba artemisiae scopariae on cytogenetic damage induced by aflatoxin B1

It was found that the per mill rate of micronucleus of marrow cells in mice induced by AFB1 decreased with the increasing dosage of Herba Artemisiae Scopariae, and that there were dosage-effect relations in the lowering of percentage of chromosomal aberration induced by AFB1 and in the inhibition effect on some sister chromatid exchanges per cell.

[Quality of semen Hydnocarpi anthelminiticae introduced to various places]

The result shows that the Semen Hydnocarpi Anthelminticae introduced in Guangdong, Hainan and Yunnan Provinces is similar to the control medicinal materials in fatty oil content, index of refraction, effective component content and trace element content. But the saponification value of the introduced products is higher. The quality of the Semen Hydnocarpi Anthelminticae introduced to the above places is up to the level of the control medicinal materials.

A minimal critical region of the 8p22-23 amplicon in esophageal adenocarcinomas defined using sequence tagged site-amplification mapping and quantitative polymerase chain reaction includes the GATA-4 gene

The incidence of esophageal adenocarcinomas has increased greatly over the past 20 years. The genetic alterations associated with this disease, however, remain largely unknown. We identified recently a novel amplicon at 8p22-23 in esophageal adenocarcinomas using the restriction landmark genomic scanning two-dimensional gel technique. Four known genes within or near this amplicon were initially characterized. The cathepsin B (CTSB) gene was found to be amplified in 13% of esophageal tumors. CTSB was shown previously to be overexpressed without amplification in many other human cancers. An approach termed sequence tagged site-amplification mapping has been implemented in the present study, allowing the 8p22-23 amplicon to be narrowed from 12 cM to a <2-cM minimal amplified area located between markers D8S552 and D8S1759. The CTSB gene maps within this region. To identify other cancer-related candidate genes in this region, a positional candidate gene approach was subsequently applied to characterize this minimal critical region. An expressed sequence tag (EST), which was included in the minimal critical region, demonstrated both amplification and overexpression. This EST and the extended sequence from the EST were determined to be a novel sequence in the 3' untranslated region of the human GATA-4 gene. GATA-4, a member of a zinc finger transcription factor family, was confirmed to be amplified and overexpressed in esophageal adenocarcinomas and was localized within <0.5 kb from CTSB. Furthermore, amplification of 8p22-23 was detected in one of eight gastric cardia adenocarcinomas but was not observed in either human lung adenocarcinomas (n = 39) or in esophageal squamous cell carcinomas (n = 24). The relatively high frequency of the 8p22-23 amplification in esophageal (13.6%) and gastric cardia (12.5%) adenocarcinomas may indicate a specificity of this amplicon for tumors of gastroesophageal origin.

[Obesity persistent scleredema: study of 49 cases]

BACKGROUND

Buschke sclerodema is a very rare disease. Our objective was to show that persistent scleredema is frequent in certain group of patients at risk.

PATIENTS AND METHODS

We studied 49 patients, diagnosed between 1995 and 1999 in dermatology, pneumology and endocrinology departments in Martinique. Diagnosis was performed on classical clinical and histopathological aspects of sclerodema. Data studied were age, sex, mode of occurrence, clinical and histopathological aspects and associated diseases.

RESULTS

The 49 patients presented with cutaneous infiltration of the upper part of the trunk, with thick dermis and large collagen bundles on histopathological examination. Forty-two had mucoid substance deposition, stained with Alcian Blue (this criteria was considered as inconstant by most authors in the literature). Sex ratio H/F was 0.06 (93 p. 100 females). Mediam age at onset was 50 years ranging from 20 to 79 years. The occurrence was insidious in 97 p. 100 of cases. All patients had neck and nuchae involvement. The disease involved the back in 93 p. 100, upper limbs in 50 p. 100 and lower limbs and face in 43 p. 100 of patients. Fifty-six percent of patients had limitation of shoulder movements, 16 p. 100 limitation of mouth opening, 20 p. 100 limitation of eyelid opening, 36 p. 100 had myalgia, 73 p. 100 had pruritus and 66 p. 100 had dyspnea. Obesity was present in 95 p. 100, diabetes in 79.5 p. 100, elevated blood pressure in 81.5 p. 100 and monoclonal dysglobulinemia in 46 p. 100 of patients. Twenty-five patients had a polysomnography showing severe obstructive sleep apnea syndrome.

DISCUSSION

The large number of patients in our study can be explained by the search for sclerodema in patients with obesity, diabetes and high blood pressure. The disease is usually unknown by patients and physicians unless a systematic examination is performed. Association with obstructive sleep apnea syndrome was not previously reported and a larger study is ongoing.

[Clinical study on tangweikang capsule in treating diabetic nephropathy]

OBJECTIVE

To observe the effect of Tangweikang capsule (TWKC) in treating diabetic nephropathy (DN).

METHODS

The 119 patients enrolled were divided into 2 groups, 78 patients in the TWKC group treated with TWKC and 41 patients in the control group treated with Captopril. The changes of symptom score, urinary microprotein series (urinary albumin excretion rate, Tamm-horsfall protein and beta 2-microglobulin), blood glucose, kidney function, blood lipid, angiotensin I (A I) and II (A II), atrial natriuretic polypeptide (ANP), thromboxane B2(TXB2), 6-keto-prostaglandin F1 alpha, endothelin 1 (ET-1) and collagen IV in patients after treatment were observed.

RESULTS

The total effective rate in the TWKC group was 84.62%, which was superior to that in the control group (70.73%, P < 0.05). TWKC also showed better effects in improving clinical symptoms, lowering blood glucose, urinary microprotein series, blood lipid, A I, A II, ANP, ET-1 and collagen IV, ameliorating kidney function, and adjusting dynamic equilibrium of thromboxane-prostacyclin system, as compared with the control group (P < 0.05 or P < 0.01).

CONCLUSION

TWKC could lower the levels of blood glucose and lipid, improve the glucose and lipid metabolism, regulate the microcirculation, ameliorate the degree of kidney damage, therefore, it showed a better effect in treating diabetic nephropathy.

[Direct determination of rhizoma cimicifuga by FTIR spectroscopy]

Fifteen samples of original plants of Rhizoma Cimicifuga were determined quickly and directly with the method of FTIR and comparing software. The results showed that the spectra of these samples were characteristic relying on the difference of chemical components and their content of related components. The difference of spectra among samples belonging to different families was distinct, and in different species with same genus too. To the same species, between two samples with different producing areas, or with same producing area but different collection date, the spectra were not obvious. This approach provide a quickly and accurately determination method of crude drug without extraction and separation.

Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity

BACKGROUND AND PURPOSE

The etiology of the neurotoxicity associated with cyclosporin-A (CsA) and FK-506 treatment is not fully understood. At our institution, we noticed a distinct, abrupt change in the imaging characteristics of CsA and FK-506 neurotoxicity, which consisted of a shift in lesion morphology from a white matter abnormality to a mixed cortical and white matter pattern. The purpose of this study was to assess clinical parameters that might explain this change.

METHODS

Twenty-two patients had a neurotoxic reaction and brain imaging changes while receiving CsA or FK-506. Nineteen patients received allogeneic bone marrow transplants, and three had aplastic marrow disorders. Fifty-one imaging studies (CT or MR imaging) were obtained, and lesion characteristics, locations, and time courses were evaluated along with relevant clinical data.

RESULTS

Nine patients who had been conditioned for transplantation with cyclophosphamide and chemotherapy (busulfan or thiotepa) had a mixed pattern of cortical and white matter involvement (57 lesions). Isolated white matter involvement (62 lesions) developed in three nontransplant patients and 10 transplant patients conditioned with cyclophosphamide and total-body irradiation. All lesions occurred at typical brain watershed zones. Lesion enhancement was noted in two patients conditioned with chemotherapy. Initial images demonstrated characteristic lesions in 15 patients (68%). Initial images were normal in four patients (18%) and nonspecific in three patients (14%).

CONCLUSION

Lesion location in CsA and FK-506 neurotoxicity may depend on the presence or type of conditioning used before bone marrow transplantation. Nontransplant patients or those conditioned with total-body irradiation develop white matter lesions, whereas those conditioned with chemotherapy develop mixed cortical and white matter lesions.

[Intraoperative ultrasonographic detection of liver metastasis from tumors of the digestive tract]

OBJECTIVE

To ascertain the value of intraoperative ultrasonography to early detect liver metastasis from tumors of the digestive tract.

METHODS

Intraoperative ultrasonography (US) of the liver was performed in 176 patients with confirmed diagnosis of cancer of the stomach and colon. All the nodules detected were either resected or needle biopsied for histological diagnosis. The results of the liver US were compared with those of pre-operative trans-abdominal US, CT scanning and intraoperative exploration.

RESULTS

Liver metastasis was detected by intraoperative US in 43 of the 176 patients (24.4%), with a total of 81 nodules found. Liver metastasis was confirmed histologically in 42 of the 43 cases (97.7%), the frequency of which was significantly higher than that of preoperative transabdominal US, CT scan and surgical exploration (P < 0.05, P < 0.01). It was particularly superior for the detection of liver metastasis less than 2 cm in diameter.

CONCLUSION

Intraoperative ultrasonography is sensitive enough to early detect tumors of the stomach and colon metastasized to the liver.

[Clinical study on hyperthyroidism of yang hyperactivity type due to yin deficiency treated by jiakang ning capsule]

OBJECTIVE

To investigate the effect of Jiakang Ning (JKN) capsule on hyperthyroidism.

METHODS

Eighty-five cases of hyperthyroidism were divided into JKN group (24 cases), JKN with low dose Tapazol group (35 cases) and Tapazol control group (26 cases) at random. The effects were evaluated by total effective rate, using principal symptoms, body weight, EKG, thyroid hormone and atrial natriuretic peptide (ANP) after 6 months.

RESULTS

The total effective rates of three groups were 83.8%, 97.1%, 88.5% respectively, and there were insignificant difference among them statistically (P > 0.05). The first two groups had better effect in principal symptoms than Tapazol control group (P < 0.05). There were similar results in adjusting thyroid dysfunction and abnormal EKG, decreasing ANP and increasing body weight among those three groups (P > 0.05).

CONCLUSION

The effect on hyperthyroidism treatment by JKN capsule was satisfactory. The combination of Chinese herbs with western medicine could enhance the curative effect of hyperthyroidism without obvious side-effects.

Evaluation of the preterm infant for patent ductus arteriosus

As a first step in a multicenter, collaborative project to study the role of indomethacin in the management of patent ductus arteriosus in premature infants, a diagnostic scheme was developed, on an a priori basis, by a consensus of the participating neonatologists and pediatric cardiologists. The scheme, which utilizes clinical and noninvasive findings, was designed to detect infants with a "hemodynamically significant" patent ductus arteriosus (PDA). Among 1,689 infants with birth weight less than 1,750 g who were monitored during the first year of the study, 342 (20.2%) met the criteria for PDA. Rates were higher for smaller infants (42% with birth weight less than 1,000 g) than for larger infants (7% with birth weight 1,500 to 1,750 g). Although study protocol did not require a direct procedure to confirm the diagnosis of PDA, a marked decrease in the presence of most criteria was noted following surgical ligation of the ductus. Although the echocardiographic criterion (ratio of left atrium to aorta [LA/Ao] greater than or equal to 1.15) proved to have a low specificity for PDA, the data suggest that the overall scheme led to a very low rate of false-positive diagnosis. Following the application of the scheme for 1 year at 13 clinical centers, it has been shown to be a highly acceptable means of detecting infants with PDA.

301. LEUKEMIA INHIBITORY FACTOR IS A CRITICAL REGULATOR OF DECIDUALIZATION OF ENDOMETRIAL STROMAL CELLS IN HUMANS AND MICE

Decidualization is the differentiation of endometrial stromal cells into decidual cells. It is a critical process in embryo implantation, placentation and the establishment of pregnancy. Inadequate decidualization can lead to infertility, abnormal placentation and recurrent miscarriage. Endometrial leukemia inhibitory factor (LIF) is indispensible in blastocyst implantation in mice and dysregulated in infertile women. LIF is produced by 1st trimester decidual cells but its role in decidualization is not known. This study aimed to examine the role of LIF in human and mouse decidualization. Primary human endometrial stomal cells (HESC) were isolated and decidualized (D) by treatment with estradiol (E) +medroxyprogesterone acetate (MPA) for 14 days. HESC were also treated with E+MPA+/–LIF (0.5, 5, 50, 100 and 200 ng/mL) for 14 days. Prolactin secretion was used to assess the extent of decidualization (n = 6). D and non-D HESC were also treated with LIF (0.5, 5, 50, 100 and 200 ng/mL +/– LIF inhibitor) for 15min and the phosphorylation (p) of signal transducer and activator of transcription (STAT)3/STAT3 abundance was detected by Western blot (n = 4). RNA was isolated for analysis of LIF and LIF receptor (R) mRNA expression during decidualization (n = 4). HESC treated with E+MPA+LIF (50, 100 and 200 ng/mL) secreted more prolactin compared to cells treated with E+MPA alone (P < 0.05). LIF increased pSTAT3/STAT3 abundance in D and non-D cells while LIF+LIF inhibitor abolished pSTAT3/STAT3. LIF mRNA was downregulated while LIF-R mRNA increased during decidualization. In vivo, mated mice (n = 5) were injected intraperitoneally with a unique long acting LIF inhibitor post-implantation at day 4.5 of pregnancy and resulted in reduced decidualization compared to control. This is the first study to demonstrate that LIF promoted decidualization of HESC possibly via pSTAT3. It further suggested that LIF regulated decidualization in mice demonstrating a newly identified critical role for LIF in the establishment of pregnancy.