[Expired diagnosis?--the potential of exhaled breath analysis]

Analysis of breath condensate is an innovative approach to biochemical information from the lung. It provides a new tool to estimate and characterize the burden of oxidative and inflammatory processes in the airways/lung. Clinical applications in asthma, COPD and CF can be envisioned as well as determining organ-specific inflammation in mechanically ventilated patients or monitoring patients with transplanted lungs. However, besides inflammation other important areas have begun to be evaluated, such as the demonstration of p53 mutations in NSCLC patients or an increased ratio of EBC nitrite to tidal volume in mechanically stressed lungs. Of course a careful validation of each and every parameter is paramount to the use in clinical applications. The comparison to BAL is oftentimes called for but at the same time is not the comparison to a gold standard because of the well-known problems of BAL. The scope of this review is a summary of facts and theories concerning exhaled breath condensate generation, collection and analysis but at the same time the representation of the many aspects that remain to be resolved.

Endocardial radiofrequency ablation of septal hypertrophy

Transcoronary alcohol ablation of septal hypertrophy (TASH) is a therapeutic catheter based option and an alternative to surgery in the treatment of patients with hypertrophic obstructive cardiomyopathy. However, the anatomic variability of the vascularisation of the obstructing septal bulge may limit the therapeutic efficacy. Thus, we examined an endocardial approach as an alternative. Based on the effects of radiofrequency energy in the treatment of cardiac arrhythmias this is the first report about the use of this modality. It refers to a 45-year-old patient with severe HOCM. The energy was applied by using a cooled-tip ablation catheter at the right side of the ventricular septum. The site corresponded to the obstructing area of the left ventricle. The following changes could be observed: a reduction of the intraventricular pressure gradient during the therapeutic session, a gradient reduction at cycle exercise as assessed by Doppler echocardiography 7 days after intervention, a subaortic septal hypokinesia, an enlargement of the left ventricular outflow tract, a reduction of the septal thickness and an increase in the exercise capacity using the 6-minute walk test. These changes are in accordance with the results after TASH and surgical treatment. The new modality might extend the possibilities in the catheter-based treatment of patients with severe HOCM.

Transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy: feasibility, clinical benefit, and short term results in elderly patients

OBJECTIVE

To evaluate symptomatic and haemodynamic results of transcoronary ablation of septal hypertrophy for hypertrophic obstructive cardiomyopathy in elderly patients.

SETTING

Tertiary referral centre for patients with hypertrophic obstructive cardiomyopathy.

DESIGN

Retrospective study of two groups of consecutive patients divided at a median age (59 years).

PATIENTS

Transcoronary ablation of septal hypertrophy was compared for 80 patients (group 1) < 60 years of age and 77 patients (group 2) > or = 60 years of age. At baseline both groups were similar concerning the proportion of familial hypertrophic cardiomyopathy, concomitant moderate hypertension, prior syncope, left ventricular outflow obstruction, left ventricular end diastolic pressure, and left ventricular ejection fraction. Patients in group 2 had a lower interventricular septal thickness and more severe disease as measured by New York Heart Association (NYHA) functional class, exercise capacity, pulmonary artery mean pressure at workload, and cardiac index at peak exercise.

RESULTS

Median follow up was seven months after transcoronary ablation of septal hypertrophy. Both groups had a significant and similar improvement in basal and provokable obstruction, septal thickness, NYHA functional class, exercise tolerance, peak oxygen consumption, and pulmonary artery mean pressure at workload. Significant differences, compared with the younger group, were a higher proportion of persistent total atrioventricular block (5% v 17%, p = 0.015) and a slight decrease in left ventricular ejection fraction (3 (12) v -6 (11)%, p = 0.001) in the elderly, despite a trend to a lower induced peak creatine kinase activity (596 (339) v 491 (331) U/l, p = 0.051).

CONCLUSIONS

Short term results with transcoronary ablation of septal hypertrophy suggest that independent of a patient's age similar treatment strategies are justified in hypertrophic obstructive cardiomyopathy.

Mechanisch induzierte Apoptose und Nekrose in alveolären Typ-II-Zellen - Beeinflussung durch Captopril und L-Arginin

BACKGROUND

Alveolar type-II(ATII)-cells are exposed to mechanical stretch during breathing and mechanical ventilation. Increased stretch may contribute to lung injury.

METHODS

The influence of three stretching patterns (characterized by frequency [min (-1)] - increase in surface area [%]: S40 - 13, S60 - 13, S40 - 30) on parameters of apoptosis, necrosis and membrane integrity in rat ATII cells was compared with that in static cultures. The S40 - 13 stretching pattern simulated normal breathing. The other patterns were chosen to study increased amplitude and frequency.

RESULTS

There were no significant differences between the S40 - 13 group and static cultures. LDH release and early apoptotic cells were significantly increased in S60 - 13 and S40 - 30 in comparison with static cultures (LDH: 0.089 +/- 0.014 microg/ml and 0.177 +/- 0.050 microg/ml versus 0.050 +/- 0.011 microg/ml; early apoptosis: 17 +/- 3.5 % and 23 +/- 3.1 % versus 9.7 +/- 1.4 %) at 24 h. Necrosis was significantly increased only in the S40-30 group (13 +/- 2.4 % versus 6.1 +/- 0.9 % in static culture at 24 h). Captopril as well as L-Arginine prevented apoptosis and reduced apoptotic cells to static culture levels in the S40 - 30 group but did not influence necrosis and LDH release.

CONCLUSION

Increased mechanical stretch may contribute to lung injury by induction of apoptosis and necrosis in ATII cells. Apoptosis induced by high amplitude mechanical stretch is prevented by captopril and L-Arginine.

Enzymatically modified low-density lipoprotein upregulates CD36 in low-differentiated monocytic cells in a peroxisome proliferator-activated receptor-γ-dependent way

Peroxisome proliferator-activated receptor-gamma (PPARgamma) has been suggested to upregulate CD36. Since free oxidized polyunsaturated fatty acids are PPARgamma ligands, we studied the effects of LDL modified by the simultaneous action of sPLA2 and 15-lipoxygenase (15LO) on CD36 expression and PPARgamma activation in monocytic cells. Exposure of MM6 cells, which do not express CD36 or other scavenger receptors, to such enzymatically modified LDL (enzLDL) resulted in upregulation of CD36 surface protein and mRNA expression. Similar effects were observed with free 13-hydroperoxyoctadecadienoic acid but not its esterified counterpart. Less pronounced effects were observed with LDL modified by 15LO alone. Upregulation of CD36 was inversely correlated to the state of cell differentiation, as showed by lower response to enzLDL of the scavenger receptor-expressing MM6-sr and THP1 cells. Importantly, LDL modified by sPLA2 and 15LO did not efficiently induce upregulation CD36 in PPARgamma-deficient macrophage-differentiated embryonic stem cells confirming a role of PPARgamma in CD36 expression in cells stimulated with enzLDL. Our data show that LDL modified with physiologically relevant enzymes stimulates CD36 expression in non-differentiated monocytes and that this process involves PPARgamma activation. These effects of enzLDL can be considered pro-atherogenic in the context of early atherosclerosis.

Nuclear YB-1 expression as a negative prognostic marker in nonsmall cell lung cancer

The human Y-box binding protein, YB-1, is a multifunctional protein that regulates gene expression. Nuclear expression of YB-1 has been associated with chemoresistance and poor prognosis of tumour patients. Representative samples from autopsied material of primary tumours from 77 patients with NSCLC were investigated by immunohistochemistry for subcellular distribution of YB-1 and p53, in order to evaluate the prognostic role of nuclear expression of YB-1. Cytoplasmic YB-1 expression was found in all tumour samples, whereas nuclear expression was only observed in 48%. There was no correlation with histological classification, clinical parameters or tumour size, stage and metastasis status. However, patients with positive nuclear YB-1 expression in tumours showed reduced survival times when compared with patients without nuclear expression. Including information about the histology and mutational status for p53 increased the prognostic value of nuclear YB-1. Patients with nuclear YB-1 expression and p53 mutations had the worst prognosis (median survival 3 months), while best outcome was found in patients with no nuclear YB-1 and wildtype p53 (median survival 15 months). This suggests that the combined analysis of both markers allows a better identification of subgroups with varying prognosis. Nuclear expression of Y-box binding protien seems to be an independent prognostic marker.

Catheter-based therapy for hypertrophic obstructive cardiomyopathy

BACKGROUND

Registry results of the new catheter-based method in the treatment for HOCM are missing so far. In 1997, the Transcoronary Ablation of Septal Hypertrophy Registry (TASH Registry) was established by the German Cardiac Society (GCS) as a multicenter, national registry of patients with HOCM undergoing the new catheter interventional therapy. This is the report of the in-hospital outcome of patients who underwent the procedure during the first two years of data collection in the registry.

METHODS AND RESULTS

Information was based on three standard forms for each patient, with a total of 86 variables. Information was collected on an "intention to treat" basis. The TASH Registry includes the establishment of a data base in the data collecting center. Ten centers participated. Enrollment forms were received for 264 patients out of 279 patients registered up to January 2000. There was a history of medical treatment of 3.6+/-3.9 years. The vast majority of patients (91%) were treated in three centers. The Vasalva maneuver and the exercise Doppler echocardiography were used for noninvasive stress testing. Exercise Doppler echocardiography induced a significantly higher augmentation of the baseline gradient (70.1% vs 133.4%; p<0.01). The echo-contrast guided technique was used for the intervention in 50.8% and the pressure angiography guided technique in 49.2%. On the average 2.8+/-1.3 ml of alcohol were injected. Before the procedure, the gradient measured by catheterization was 60.4+/-38.6 mmHg at baseline and 142.7+/-46.2 mmHg following the extrasystolic beat. At the end of the session it was reduced significantly by 75% and 67%. The peak phosphocreatine kinase activity was 482.5+/-246.4 U/L. Major complications occurred in 15.6% including a mortality rate of 1.2% and a permanent pacemaker implantation rate because of total heart block in 9.6%. There was an early in-hospital improvement of dyspnoe corresponding to a significant decrease of NYHA functional class from 2.8+/-0.7 to 1.8+/-0.6 (p<0.001). Similar hemodynamic and clinical benefit was found in patients with and without resting gradient at baseline.

CONCLUSION

This analysis for the first time gives a comprehensive overview of clinical characteristics, technique, procedural data, in-hospital outcome and complications in a large number of patients with HOCM who were treated by the new catheter-based method and prospectively enrolled in a registry. The results contribute considerably to critical evaluation and validation of the new technique. This analysis supports the catheter-based method to constitute a new therapeutic option for very symptomatic patients, to be effective both in patients with and without intraventricular pressure gradient at rest and to be an alternative to surgical treatment, as has been stated recently.

Mid-systolic septal deceleration

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by the presence of a dynamic left ventricular outflow tract gradient. We studied septal longitudinal motion by color coded tissue Doppler echocardiography in a 69-year old HOCM patient during and after catheter based treatment by trans coronary alcohol ablation of septal hypertrophy. The presence of dynamic left ventricular outflow tract obstruction was associated with a characteristic abrupt mid-systolic septal deceleration pattern in the tissue Doppler velocity trace. Five weeks after treatment, this pattern was no longer visible at rest.

Fabry disease in patients with hypertrophic cardiomyopathy (HCM)

Fabry disease is an X-linked recessive lysosomal storage disorder with variable phenotype characterized by the accumulation of glycosphingolipid in various tissues. Unlike patients with the classical systemic Fabry disease entity, who present with multiple organ involvement, patients with a cardiac variant of Fabry disease are characterized mainly by myocardial hypertrophy. Therefore, the cardiac variant of Fabry disease may be defined as a cardiomyocytic storage disorder, thus, mimicking the clinical features of hypertrophic obstructive and especially non-obstructive cardiomyopathy. In patients with unexplained left ventricular hypertrophy the diagnosis of a cardiac variant of Fabry disease is performed by light- and electron microscopic evaluation of endomyocardial catheter biopsy specimens and/or serologic investigations (decreased activity of alpha-galactosidase A in plasma or leucocytes). Several studies show that between 4% and 8% of unselected patients with the clinical features of hypertrophic non-obstructive cardiomyopathy have a cardiac variant of Fabry disease. In each patient with unexplained myocardial hypertrophy concealed myocardial storage disease, especially cardiac Fabry disease has to be considered and should be ruled out or confirmed by endomyocardial catheter biopsy. This is important because of the recently reported alpha-galactosidase A enzyme replacement therapy in Fabry disease. Randomized, multicenter studies are mandatory to test the hypothesis that enzyme replacement therapy leads to a beneficial clinical effect in the cardiac variant form of Fabry disease and may prevent the progression of the disease in asymptomatic patients.

The Biostack experiment on Apollo 16

The object of the Biostack experiment is to study the biological effects of high ZE particles of cosmic radiation in order to obtain information on the mechanism of these particles in biological matter. For this purpose individual local evaluation methods have been developed which allow one to identify each biologically effective particle and to correlate the individual hitting particle with the biological effect produced. The Biostack experimental package contains a series of monolayers of selected biological objects (Bacillus subtilis spores, Arabidopsis thaliana seeds, Vicia faba radiculae, Artemia salina eggs) with each layer sandwiched between several different cosmic ion track detectors (nuclear emulsions, cellulose nitrate, polycarbonate). By this arrangement a variety of biological effects due to a single penetrating particle can be analysed. Influence on cellular and tissue development, nuclear damages, and mutation induction are the main investigated effects. These space flight findings will be completed by results of balloon flight and accelerator experiments.

Adenovirus-mediated E2F-1 gene transfer in nonsmall-cell lung cancer induces cell growth arrest and apoptosis

Since overexpression of E2F-1 has been shown to induce apoptosis, the ability of adenovirus-mediated transfer of E2F-1 to inhibit tumour growth in nonsmall-cell lung cancer cell lines was investigated. Three cell lines with various genomic status were infected with AdE2F. Cell proliferation and viability were determined by trypan blue exclusion. Apoptosis induction was assessed by flow cytometry and poly-adenosine diphosphate-ribose-polymerase cleavage assay. In vivo, the effect of E2F-1 on tumour growth was determined in severe combined immunodeficiency (SCID) mice. The current experiments showed that overexpression of E2F-1 suppressed tumour cell growth. The population of apoptotic cells was dramatically increased 96 h after infection with AdE2F. Inhibition of cell growth and induction of apoptosis was not dependent on genomic status. Moreover, treatment of implanted tumours in SCID mice with AdE2F inhibited tumour growth. These data suggest that adenovirus-mediated E2F-1 gene therapy may be effective in the treatment of nonsmall-cell lung cancer.