Optimal treatment of systemic bacillus Calmette-Guérin infection: investigations in an animal model

PURPOSE

Hematogenous spread of bacillus Calmette-Guerin (BCG) after intravesical instillation for bladder cancer is rare but it may result in systemic infection and hypersensitivity reaction. We investigated fluoroquinolones and steroids in an animal model to improve the therapeutic options in local and systemic BCG infection. Furthermore, the antitumor effectiveness of intravesical BCG with simultaneous application of fluoroquinolones and/or steroids was tested.

MATERIALS AND METHODS

Oral antimicrobial therapy with and without steroids was started immediately after intraperitoneal injection using fluoroquinolones or trimethoprim-sulfamethoxazole. To evaluate the therapeutic options against a hyperergic reaction after repeat systemic BCG infection re-challenge was performed with intraperitoneal BCG 7 days after primary infection and oral therapy was given with fluoroquinolones or trimethoprim-sulfamethoxazole with and without steroids. The influence of continuous oral fluoroquinolone therapy on the antitumor effect of BCG was also tested in the MB 49 orthotopic murine bladder tumor model.

RESULTS

After primary systemic infection fluoroquinolone therapy alone led to significantly prolonged survival in mice (log rank test p = 0.041), whereas trimethoprim-sulfamethoxazole was ineffective. There was no additional effect of steroid administration. Steroids alone led to premature death (log rank test p = 0.022). After secondary BCG infection only steroid treated animals had prolonged survival (log rank test p = 0.032), whereas antimicrobials alone had no effect. The therapeutic efficacy of BCG in the orthotopic bladder tumor model was not affected by continuous oral fluoroquinolones in terms of survival (log rank test p = 0.001) or bladder weight (Wilcoxon test p = 0.001) compared with untreated controls.

CONCLUSIONS

In a mouse model fluoroquinolones had a beneficial effect for primary systemic BCG infections, whereas the hyperergic reaction after repeat BCG infection was susceptible only to steroids. Administering fluoroquinolones during an intravesical treatment course does not affect the antitumor efficacy of BCG.

Multiple splice isoforms of proteolipid M6B in neurons and oligodendrocytes

Proteolipids are abundant integral membrane proteins, initially described as structural proteins of CNS myelin. More recently, two neuronal proteins related to proteolipid protein (PLP), termed M6A and M6B, were identified, suggesting a common function of proteolipids in oligodendrocytes and neurons. We have analyzed the X-linked M6B gene and discovered an unexpected complexity of protein isoforms. Two promoters and alternative exons yield at least eight M6B proteins and polypeptides, differentially expressed in neurons and oligodendrocytes. Six isoforms are tetraspan membrane proteins that differ by highly conserved amino- and carboxy-terminal domains, termed alpha, beta, psi, and omega. In MDCK cells, the beta-domain of M6B stabilizes tetraspan proteolipids at the cell surface, whereas non-beta isoforms are more abundant in intracellular compartments. Cotransfection experiments suggest a physical interaction of M6B and mutant PLP, when retained in the endoplasmic reticulum, that may also contribute to oligodendrocyte dysfunction in Pelizaeus-Merzbacher disease.

Reactions of the allenylidenes trans-[IrCl[=C=C=C(ph)R](PiPr3)2] with electrophiles: generation of butatriene-, carbene-, and carbyne- iridium complexes

The allenylidenciridium(I) complexes trans-[IrX(=C=C-CPh2)(PiPr3)2] (X = Cl: 1; X = I: 2) react with excess methyl iodide by C-C coupling and elimination of HI to give the eta2-butatriene compounds trans-[IrX-(eta2-CH2=C=C=CPh2)(PiPr3)2] (3, 4), of which 3 (X = Cl) was characterized by X-ray crystallography. Treatment of 1 and 5 (containing C=C=C(Ph)tBu as the allenylidene ligand) with HCI leads to the formation of the six-coordinate hydridoiridium(III) complexes [IrHCl2[= C=C=C(Ph)R](PiPr3)2] (6, 7) by oxidative addition at the metal center. In contrast, the reactions of 1 and 5 with both CF3CO2H and CF3SO3H afford the four-coordinate vinylcarbene compounds trans-[IrCl[=C(X)-CH=C(Ph)R[(PiPr3)2] (8-10). For X= CF3CO2, in nitromethane a dissociation of the C-X bond occurs and the cationic iridium carbynes trans-[IrCl[=C-CH=C(Ph)R](PiPr3)2]+ are generated. Upon addition of NaBPh4, the stable carbyne complexes 11b (R= Ph) and 12b (R = tBu) with BPh4 as the counterion were isolated in almost quantitative yields. The X-ray crystal structure analysis of 6 reveals that the chloro ligands are cis and the phosphane ligands trans disposed.

Transcriptional regulation of IGF-I receptor gene expression by the PAX3-FKHR oncoprotein

Chromosomal translocations that disrupt the molecular organization of transcription factors are typical of a variety of solid and hematopoietic cancers. Alveolar rhabdomyosarcoma (ARMS), a paediatric soft tissue malignant tumour, is characterized by the recurrent translocation t(2;13)(q35;q14) that fuses the 5' DNA binding domain-encoding sequences of the Pax3 gene with the 3' sequences of the FKHR gene. The insulin-like growth factor (IGF) system has an important role in muscle development as well as in the aetiology of paediatric sarcomas, including ARMS. In the present study the potential regulation of the IGF-I receptor (IGF-I-R) gene by PAX3-FKHR at the transcriptional level was investigated. PAX3-FKHR was able to transactivate the IGF-I-R promoter in sarcoma-derived cell lines, whereas PAX3 exhibited a reduced potency in comparison to the fusion protein. Furthermore, transfection of the chimera induced a significant increase in the endogenous levels of IGF-I-R protein, suggesting that the IGF-I-R gene is a physiologically-relevant molecular target for the PAX3-FKHR oncogene.

Circular stationary solutions in two-dimensional neural fields

Stationary solutions are studied in two-dimensional homogeneous neural fields of the lateral-inhibition type. It is shown that in extending the one-dimensional theory to two dimensions, new phenomena arise. We discuss the conditions for the existence of localized solutions analogous to the one-dimensional theory and show that they are no longer sufficient in two dimensions. We give indications for the existence of mono- and bistable dynamics as known from the one-dimensional theory and, additionally, a tri-stable type of dynamic in two-dimensional neural fields, where, depending on the input, excitation dies out, spreads without limit, or causes a stable localized excitation.

Regulation of insulin-like growth factor-I receptor gene expression by tumor necrosis factor-alpha and interferon-gamma

The insulin-like growth factor-I receptor (IGF-l-R) plays a critical role in normal and pathological growth processes. The expression of the IGF-l-R gene is regulated by various stimuli, including hormones and growth factors. We have investigated the molecular mechanisms by which two inhibitory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma), regulate IGF-l-R gene expression. TNF-alpha and IFN-gamma reduced the proliferation rates of the osteogenic sarcoma cell line, Saos-2, and the human salivary gland cell line, HSG, in a dose- and time-dependent fashion. This effect was associated with significant reductions in the levels of IGF-l-R mRNA and protein, and with inhibition of IGF-l-R promoter activity, suggesting that TNF-alpha and IFN-gamma affect IGF-l-R gene expression at the transcriptional level. In addition, TNF-alpha significantly decreased IGF-l-R mRNA stability. Combined cytokine treatment inhibited cellular proliferation and promoter activity in an additive manner. Taken together, these results suggest that a novel potential mechanism by which TNF-alpha and IFN-gamma affect cellular proliferation involves suppression of IGF-l-R promoter activity, as well as destabilization of IGF-l-R transcripts.

An unprecedented type of migratory insertion reactions of unsaturated C3 units into Rh-O and Rh-C bonds

A series of iodo- and hydroxorhodium(I) complexes of the general composition trans-[RhX(=C=C=CRR')(PiPr3)2] (X = I: 5-7; X = OH: 8-11) was prepared from the related chlororhodium(I) precursors. The hydroxo compounds behave as organometallic Brønsted bases and react with acids like MeCO2H, PhCO2H, PhOH, or TsOH by elimination of water to give the substitution products trans-[RhX'(=C=C=CRR')(PiPr3)2] (X' = MeCO2: 12, 13; X' = PhCO2: 14; X' = PhO: 15, 16; X' = TsO: 17, 18) in good to excellent yields. In contrast to the tosylates 17, 18, which react with CO by cleavage of the allenylidene-metal bond to give trans-[Rh(OTs)(CO)(PiPr3)2] (19), treatment of the acetato and phenolato derivatives 12, 13 and 15, 16 with CO affords by migratory insertion of the allenylidene unit into the Rh-O bond the alkynyl complexes trans-[Rh[C(triple bond)CCR(R')X'](CO)(PiPr3)2] (X' = MeCO2: 20, 21; X' = OPh: 22, 23). Similarly, the reactions of the hydroxo compounds 8, 10, and 11 with CH2(CN)2 and either CO or CNMe yield the carbonyl and the isocyanide complexes trans-[Rh[C(triple bond)CCR(R')CH(CN)2](L')(PiPr3)2] (L' = CO: 25-27; L' = CNMe: 28-30), respectively. By protolytic cleavage of the Rh-C sigma bond the gamma-functionalized alkynes HC(triple bond)CCR(R')CH(CN)2 (31, 32) are generated from 25, 26 and HCl in benzene. The molecular structure of 22 was determined by X-ray crystallography.

Carbenerhodium complexes of the half-sandwich-type: synthesis, substitution, and addition reactions

A series of carbenerhodium(I) complexes of the general composition [(eta5-C5H5)Rh(=CRR')(L)] (2a-2i) with R = R'= aryl and L = SbiPr3 or PR3 has been prepared from the square-planar precursors trans-[RhCl(=CRR')(L)2] and NaC5H5 in excellent yields. Reaction of the triisopropylsibane derivative 2a. which contains a rather labile Rh-Sb bond, with CO, PMe3, and CNR (R = Me, CH2Ph, tBu) leads to the displacement of the SbiPr3 ligand and affords the substitution products [(eta5-C5H5)Rh(=CPh2)(L)] (3-7). In contrast, treatment of the triisopropylphosphane compound 2c with CO and CNtBu leads to the cleavage of the Rh=CPh2 bond and gives besides [(eta5-C5H5)Rh(PiPr3)(L)] (10, 12) by metal-assisted C-C coupling diphenylketene Ph2C=C=O (11) or the corresponding imine Ph2C=C=NtBu (13). While the reaction of 2a, c with C2H4 yields [(eta5-C5H5)Rh(C2H4)(L)] (14, 15) and the trisubstituted olefin Ph2C=CHCH3 (16), treatment of 2a, c with RN3 leads to the cleavage of both the Rh-EiPr3 and Rh=CPh2 bonds and gives the chelate complexes [(eta5-C5H5)Rh(kappa2-RNNNNR)] (19, 20). The substitution products 3 (L=CO) and 4 (L= PMe3) react with an equimolar amount of sulfur or selenium by addition of the chalcogen to the Rh=CPh2 bond to generate the complexes [(eta5-C5H5)Rh(kappa2-ECPh2)(L)] (21-24) with thio- or selenobenzophenone as ligand. Similarly, treatment of 3 with CuCl affords the unusual 1:2 adduct [(eta5-C5H5)(CO)Rh(mu-CPh2)(CuCl)2] (25), which reacts with NaC5H5 to form [(eta5-C5H5)(CO)Rh(muCPh2)Cu(eta5-C5H5)] (26). The molecular structures of 3 and 22 have been determined by X-ray crystallography.

The bridging function of an apparently nonbridging ligand: dinuclear rhodium complexes with Rh(mu-SbR3)Rh as a molecular unit

Novel dinuclear rhodium complexes of the general composition [Rh2Cl2(mu-CRR')2(mu-SbiPr3)] (4-6) were prepared by thermolysis of the mononuclear precursors trans-[RhCl(=CRR')(SbiPr3)2] in excellent yield. The X-ray crystal structure analysis of 4 (R = R' = Ph) confirms the symmetrical bridging position of the stibane ligand. Related compounds [Rh2Cl2(mu-CPh2)(mu-CRR')(mu-SbiPr3)] (7, 8) with two different carbene units were obtained either from trans-[RhCl(=CPh2)(SbiPr3)2] (1) and RR'CN2 or by a conproportionation of 4 and 5 (R = R' = p-Tol) or 4 and 6 (R= Ph, R' = p-Tol), respectively. While CO reacts with 4 to give the polymeric product [[RhCl(CPh2)(CO)]n] (9), tert-butyl isocyanide replaces the bridging stibane and yields [Rh2Cl2(mu-CPh2)2(mu-CNtBu)] (10). The reaction of 4 with tertiary phosphanes PR3 leads to complete bridge cleavage and affords the mononuclear compounds trans-[RhCl(=CPh2)(PR3)2] (11-15). In contrast, treatment of 4 with SbMe3 and SbEt3 yields the related triply bridged complexes [Rh2Cl2(mu-CPh2)2(mu-SbR3)] (16, 17) by substitution of SbiPr3 for the smaller stibanes. The displacement of the chloro ligands in 4-6 and 10 by n5-cyclopentadienyl gives the dinuclear complexes [(n5-C5H5)2Rh2(mu-CRR')2] (18-20) and [(n5-C5H5)2Rh2(mu-CPh2)2(mu-CNtBu)] (21), of which 18 (R = R' = Ph) was characterized crystallographically.

[Infection in the elderly--what is different?]

Infectious diseases are a common cause of increased morbidity and mortality in elderly patients and present a frequent problem in the geriatrician's daily practice. Infections in the elderly are quite different from infections in a younger population. These differences are due to Age-related alterations in immunology Different epidemiology and bacteriology Increased morbidity and mortality Altered clinical presentation Concommittant disability and comorbidity in many older patients Different approaches to therapy. This article is an attempt to discuss these various aspects of infectious disease in the elderly. The most important infections in the elderly are caused by bacteria. Incidence and bacterial spectrum depends on the site of infection and whether the patient is hospitalized, living in a nursing home or in the community. Pneumonia, UTI and pressure ulcer infections are more frequent in patients living in nursing homes than in community dwelling older people. Infections are a frequent cause of hospitalization in elderly people and hospitalization on the other hand is a risk factor for life-threatening nosocomial infections, caused by invasive diagnostic procedures and frequent use of urinary and venous catheters. Infections in the elderly are often accompanied by serious complications as bacteriemia (pneumonia), frequent recurrence (UTI), perforation and abscess (abdominal infections) and severe disability (pressure ulcer infections). Because of these serious and frequent complications mortality of infections is higher in older patients than in younger people. Elderly patients with infectious disease often present in the same way as younger patients do. Many elderly however present with non-specific clinical symptoms and non-specific functional decline which makes an accurate diagnosis difficult and may lead to a life-threatening delay of diagnosis and therapy. In older patients with unexplained functional decline, physicians must be aware of the possibility of a serious infection. Moreover, the physician can not rely on typical signs of infections as fever. In the elderly the fever response is often blunted even in the presence of bacteremia. Leokocytosis may be absent and elevation of acute phase protein is a more reliable marker of infection than elevation of erythrocyte sedimentation rate. Clinical suspicion of bacterial infection in elderly patient should prompt Careful anamnesis and clinical investigation Hospitalization if necessary Diagnostic procedures without delay including blood cultures Immediate empiric antibiotic therapy taking into account the site of infection, if the infection is community acquired or nosocomial and the most likely bacterial spectrum and local resistance factors. The use of broad spectrum antibiotic substances with a low side effect profile and pharmacokinetic properties which are suitable for elderly patients.

Regulation of the insulin-like growth factor-I receptor gene by oncogenes and antioncogenes: implications in human cancer

The insulin-like growth factor-I receptor (IGF-I-R) has a central role in normal cellular proliferation as well as in transformation processes. Transcription of the IGF-I receptor gene is controlled by a number of tumor suppressors, including WT1, p53, and BRCA1. It has been demonstrated that, in their wild-type form, these transcription factors can suppress the activity of the IGF-I-R promoter, with ensuing reduction in the levels of cell-surface IGF binding. On the other hand, a number of oncogenes, including mutant p53 and c-myb, and the fusion protein EWS-WT1 significantly stimulate promoter activity. Interactions between stimulatory and inhibitory transcription factors may determine the level of expression of the IGF-I-R gene and, consequently, the proliferative status of the cell.

Seasonal ozone response of mature beech trees (Fagus sylvatica) at high altitude in the Bavarian forest (Germany) in comparison with young beech grown in the field and in phytotrons

Mature beech trees (Fagus sylvatica) grown at two different altitudes in the Bavarian forest were compared with young beech trees grown at nearby field sites or in phytotrons for their macroscopic and physiological responses to different ozone (O(3)) exposures. Cumulative O(3) exposure expressed as the sum of hourly mean concentrations above the canopy ranged between 100 and 150 microl l(-1) h, with the vertical O(3) profiles at the higher altitude site being enhanced by 30%. O(3) profiles at all sites were reduced by up to 20% with increasing depth within and beneath the canopy. The leaf discoloration that developed in the absence of premature leaf loss was similar in the sun foliage of mature and young trees (including plant grown in the phytotron). Injury became apparent at low O(3) exposures, expressed as accumulated hourly means over a threshold of 40 nl l(-1) (AOT40 <3.5 microl l(-1) h) at the lower site in both the mature trees and the young beech at the field site, but only occurred when AOT40 values reached 7 microl l(-1) h at the upper site, and 6 microl l(-1) h in the phytotrons. However, the association between injury and O(3) exposure was improved when cumulative ozone uptake to sun leaves was the ozone index, used with values of about 3 mmol m(-2) resulting in visible injury in both mature and young beech growing in phytotrons. Under high ozone exposure levels of inositol were lowered, whilst concentrations of lignin-like materials were enhanced in mature beech. Similar responses were observed in young beech grown in phytotrons. As the sun foliage was affected by only a small and variable extent each year, the seasonal O(3) impact at high altitude did not appear to pose an acute risk to mature beech trees.

Cationic and neutral diphenyldiazomethanerhodium(I) complexes as catalytically active species in the C-C coupling reaction of olefins and diphenyldiazomethane

Cationic rhodium(I) complexes cis-[Rh(acetone)2(L)(L')]+ (2: L = L'=C8H14; 3: L=C8H14; L'=PiPr3; 4: L=L'=PiPr3), prepared from [RhCl(C8H14)2]2] and isolated as PF6 salts, catalyze the C-C coupling reaction of diphenyldiazomethane with ethene, propene, and styrene. In most cases, a mixture of isomeric olefins and cyclopropanes were obtained which are formally built up by one equivalent of RCH=CH2 (R = H, Me, Ph) and one equivalent of CPh2. The efficiency and selectivity of the catalyst depends significantly on the coordination sphere around the rhodium(I) center. Treatment of 4 with Ph2CN2 in the molar ratio of 1:1 and 1:2 gave the complexes trans-[Rh(PiPr3)2(acetone)(eta1-N2CPh2)]PF6 (8) and trans-[Rh(PiPr3)2(eta1-N2CPh2)2]PF6 (9), of which 8 was characterized by X-ray crystallography. Since 8 and 9 not only react with ethene but also catalyze the reaction of C2H4 and free Ph2CN2, they can be regarded as intermediates (possibly resting states) in the C-C coupling process. The lability of 8 and 9 is illustrated by the reactions with pyridine and NaX (X=Cl, Br, I, N3) which afford the mono(diphenyldiazomethane)rhodium(I) compounds trans-[Rh(PiPr3)2(py)(eta1-N2CPh2)]PF6 (10) and trans-[RhX(eta1-N2CPh2)(PiPr3)2] (11-14), respectively. The catalytic activity of the neutral complexes 11 - 14 is somewhat less than that of the cationic species 8, 9 and decreases in the order Cl > Br> I > N3.