Association analysis of genetic polymorphisms in the CDC2 gene with late-onset Alzheimer disease

BACKGROUND

Alzheimer disease (AD) is a complex neurodegenerative disorder resulting from multiple genetic and non-genetic factors. Linkage studies indicated that chromosome 10 has at least one locus for this disease. The cell division cycle 2 (CDC2) gene, which is close to one of the linkage regions, has previously been associated with the risk of AD with an odds ratio of 1.78. Biologically, CDC2, which is involved in paired helical filament-tau formation, is thought as a candidate gene in AD.

METHODS

In this study, six single nucleotide polymorphisms spanning the entire gene were selected and examined for association for late-onset AD (LOAD) in two large independent datasets. A family-based dataset including 1,337 Caucasian discordant sib pairs and an independent dataset of 745 Caucasian cases and 998 controls for LOAD were used. Family-based association tests and logistic regression conditional on the apolipoprotein E genotype and sex were applied to association study in family-based and case-control datasets, respectively.

RESULTS

Neither dataset demonstrated any association with LOAD in our samples with all p values >0.16.

CONCLUSION

Our results suggest that if any contribution of common genetic variants in CDC2 to the risk of developing AD exists, it is likely to be very small.

Interaction between the alpha-T catenin gene (VR22) and APOE in Alzheimer's disease

BACKGROUND

APOE is the only gene that has been consistently replicated as a risk factor for late onset Alzheimer's disease. Several recent studies have identified linkage to chromosome 10 for both risk and age of onset, suggesting that this region harbours genes that influence the development of the disease. A recent study reported association between single nucleotide polymorphisms (SNPs) in the VR22 gene (CTNNA3) on chromosome 10 and plasma levels of Abeta42, an endophenotype related to Alzheimer's disease.

OBJECTIVE

To assess whether polymorphisms in the VR22 gene are associated with Alzheimer's disease in a large sample of Alzheimer's disease families and an independent set of unrelated cases and controls.

RESULTS

Several SNPs showed association in either the family based or case-control analyses (p<0.05). The most consistent findings were with SNP6, for which there was significant evidence of association in both the families and the unrelated cases and controls. Furthermore, there was evidence of significant interaction between APOE-4 and two of the VR22 SNPs, with the strongest evidence of association being concentrated in individuals carrying APOE-4.

CONCLUSIONS

This study suggests that VR22 or a nearby gene influences susceptibility to Alzheimer's disease, and the effect is dependent on APOE status.

Covariate analysis of late-onset Alzheimer disease refines the chromosome 12 locus

Alzheimer disease (AD) is a progressive neurodegenerative disorder of later life with a complex etiology and a strong genetic component. Several genomic screens have suggested that a region between chromosome 12p13 and 12q22 contains at least one additional locus underlying the susceptibility of AD. However, localization of this locus has been difficult. We performed a 5 cM microsatellite marker screen across 74 cM on chromosome 12 with 15 markers in 585 multiplex families consisting of 994 affected sibpairs and 213 other affected relative pairs. Analyses across the entire data set did not reveal significant evidence of linkage. However, suggestive linkage was observed in several subsets. In the 91 families where no affected individuals carry an ApoE varepsilon4 allele, an HLOD score of 1.55 was generated at D12S1042. We further examined the linkage data considering the proposed linkages to chromosome 9 (D9S741) and chromosome 10 (alpha-catenin gene). There was a modest (P=0.20) increase in the LOD score for D12S368 (MLOD=1.70) when using the D9S741 LOD scores as a covariate and a highly significant (P<0.001) increase in the MLOD score (4.19) for D12S1701 in autopsy-confirmed families (n=228) when using alpha-catenin LOD scores as a covariate. In both cases, families with no evidence of linkage to D9S741 or alpha-catenin demonstrated most of the evidence of linkage to chromosome 12, suggesting locus heterogeneity. Taken together, our data suggest that the 16 cM region between D12S1042 and D12S368 should be the subject of further detailed genomic efforts for the disease.

Is cochlear outer hair cell function affected by mobile telephone radiation?

Mobile telephones emit high-frequency pulsed electromagnetic fields (PEMF). These are known to have measurable biological effects, and possible effects on the auditory system. Otoacoustic emissions give an indication of the functional state of the auditory system. Otoacoustics are known to be highly specific for the individual when the test pulse is identical. In this way, subtle changes in the ear can be detected. We investigated whether there is a measurable effect on Otoacoustic emissions from PEMF radiation. A total of 12 volunteers were recruited who had normal hearing; confirmed by pure tone audiometry. An Otoacoustic emission trace was obtained. The test subjects were exposed to a mobile telephone that was placed over the test ears mastoid process. The subjects had Otoacoustic emissions measured without the telephone and again on receive and transmit. There was no change in the trace signature during the test. There was no statistically significant change in the trace figures. This would indicate that PEMF from commonly available hand held mobile telephones have no measurable effect on the outer hair cell function during the time of use.

Best Practice No 176: Updated recommendations for HER2 testing in the UK

This paper serves to update previously published guidance on rationale and methodology for HER2 laboratory testing following the recommendation for the use of HER2 targeted treatment in the management of advanced breast cancer in the UK. Emphasis is placed on the standardisation of methodology and assessment and strategies to achieve high quality performance. A two phase testing algorithm based on first line immunocytochemistry evaluation and second line fluorescence in situ hybridisation assessment of borderline cases is recommended. To ensure maintenance of expertise, an annual caseload volume of at least 250 cases is recommended for laboratories providing a testing service.

Correlation between immunohistochemistry (HercepTest) and fluorescence in situ hybridization (FISH) for HER-2 in 426 breast carcinomas from 37 centres

Accurate diagnostic assessment of HER-2 is essential for the appropriate application of the humanized anti-HER-2 monoclonal antibody trastuzumab (Herceptin) to the treatment of patients with metastatic breast cancer. The diagnostic test needs to be applicable to archival, fixed tissue removed at excision, in many cases several years earlier. We compared the assessment of HER-2 by immunohistochemistry (IHC; HercepTest) and fluorescence in situ hybridization (FISH) in 426 breast carcinomas from patients being considered for trastuzumab therapy. The tumours were tested in three reference centres having been sent in from 37 hospitals. Only 2/270 (0.7%) IHC 0/1+ tumours were FISH positive. Six of 102 (5.9%) IHC 3+ tumours were FISH negative. Five of the six had between 1.75 and 2.0 HER-2 gene copies per chromosome 17 and the sixth had multiple copies of chromosome 17. Thirteen per cent of tumours were IHC 2+ and overall 48% of these were FISH positive but this proportion varied markedly between the centres. Sixty IHC-stained slides selected to be enriched with 2+ cases were circulated between the three laboratories and scored. There were 20 cases in which there was some discordance in scoring. Consideration of the FISH score in these cases led to concordance in the designation of positivity/negativity in 19 of these 20 cases. These data support an algorithm in which FISH testing is restricted to IHC 2+ tumours in reference centres. The results may not extrapolate to laboratories with less experience or using different methodologies.

Long-term results of arthroscopic synovectomy for seropositive rheumatoid arthritis: 6-16 year review

We prospectively studied a consecutive series of 25 knees (21 patients) treated with arthroscopic synovectomy for seropositive rheumatoid arthritis. All patients had pain and swelling and were in the early stages of the disease process (Larsen grade 2 or less). Three patients were lost to follow-up. At a mean of 8 years from operation two knees underwent total knee replacement with another two knees required a further arthroscopic synovectomy. One patient continued to experience intermittent mild synovitis. The range of movement was maintained or improved by surgery in 73% of cases but radiological evidence of degenerative change was seen in all knees. We discuss the technical difficulties associated with arthroscopic synovectomy that were associated with a small complication rate. In appropriately selected patients unresponsive to medical therapy, arthroscopic synovectomy can give safe and reliable results.

Death due to bioterrorism-related inhalational anthrax: report of 2 patients

On October 9, 2001, a letter containing anthrax spores was mailed from New Jersey to Washington, DC. The letter was processed at a major postal facility in Washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. Leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.

Mouse model for Chagas disease: immunohistochemical distribution of different stages of Trypanosoma cruzi in tissues throughout infection

Different stages of Trypanosoma cruzi are seen during mammalian infection. Histologic sections of infected hearts have shown amastigotes and, when using immunohistochemistry (IHC), parasite antigens; however, demonstration of trypomastigotes in these tissues has proven elusive. Using a mouse strain that develops chagasic cardiomyopathy (histologically similar to human infection) 70 days after injecting T. cruzi-Brazil strain, we studied the distribution of parasite stages and the extent of inflammation. All organs had varying amounts of mononuclear inflammation by day 10, which peaked between day 20 and day 30, and decreased by day 50. Amastigotes were detected in myocytes, histiocytes, acinar pancreatic cells, astrocytes and ependymal cells by day 10, and the number of amastigotes peaked on day 30. Immunohistochemistry demonstrated trypomastigotes in sinusoids, vessels and interstitial tissues of several organs between day 15 and 50. Abundant parasite antigens (granular staining) were detected in connective tissues throughout the infection. The burden of amastigotes and trypomastigotes during the acute phase seems to correlate with the degree of inflammation and granular staining in the chronic stage.

Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage

We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years.

According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p < 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome.

Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score.

Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage

We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years. According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p < 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome. Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score.

Driving reaction time before and after anterior cruciate ligament reconstruction

Driving reaction time was studied in 73 patients under anterior cruciate ligament (ACL) reconstruction using a computer-linked automobile simulator. Each patient was tested pre-operatively and 2, 4, 6 and 8 weeks after surgery. Stepping and standing tests were studied at each time point. Twenty-five normal subjects were also tested as controls. Pre-operative test results did not differ significantly between groups on any of the tests. Post-operatively it took 6 weeks for driving reaction time of the right ACL group to be equivalent to that of the controls, compared to 2 weeks in the left ACL group. There was a strong correlation between the stepping and standing tests and the driving reaction time; this made them good clinical tests to monitor patients' progress and to suggest the appropriate time to resume driving.

Technology evaluation: SAGE, Genzyme molecular oncology

Genzyme Molecular Oncology (GMO) is using its SAGE (Serial Analysis of Gene Expression) combinatorial chemistry technology to screen compound libraries. SAGE is a high-throughput, high-efficiency method to simultaneously detect and measure the expression levels of genes expressed in a cell at a given time, including rare genes. SAGE can be used in a wide variety of applications to identify disease-related genes, to analyze the effect of drugs on tissues and to provide insights into disease pathways. It works by isolating short fragments of genetic information from the expressed genes that are present in the cell being studied. These short sequences, called SAGE tags, are linked together for efficient sequencing. The sequence data are then analyzed to identify each gene expressed in the cell and the levels at which each gene is expressed. This information forms a library that can be used to analyze the differences in gene expression between cells [293437]. By December 1999, GMO had identified a set of 40 genes from 3.5 million transcripts that were expressed at elevated levels in all cancer tissue but not seen in normal tissue. The company hope these may provide diagnostic markers or therapeutic targets. The studies also provided data furthering the understanding of the way cells use their genome [349968]. GMO has signed a collaborative agreement with the National Cancer Institute (NCI) to search for new drug candidates in the field of cancer chemotherapy. The collaboration combines GMO's SAGE technology with the NCI's extensive array of 60 cell-based cancer screens. Under the agreement, the NCI will evaluate Genzyme's library consisting of one million compounds against selected cancer screens to identify compounds with anticancer properties [255082]. Xenometrix granted a license agreement for gene expression profiling to GMO in February 1999, giving company access to claims covered in issued US and European patents. The license is non-exclusive and covers the collection of gene expression profiles utilizing all methods including high-density microarrays [315329]. Ontogeny (now Curis Inc) and GMO have entered into a collaboration to study genes for the potential discovery of therapeutic products. GMO will use its SAGE technology to produce libraries of RNA supplied by Ontogeny. The libraries will be put through Ontogeny's screening program [279417]. Under an agreement made in August 1998, Bayer will use SAGE technology to identify genes and thus potential therapeutics [317452]. GMO and Hexagen signed an agreement in March 1998 on the use of SAGE technology in Hexagen's disease gene discovery programs. The first phase of the collaboration will focus on the use of SAGE in studies within Hexagen's type II diabetes gene discovery program. Hexagen has designed these studies to discover susceptibility genes for diabetes and to provide gene expression information for genes associated with type II diabetes [280012]. GMO signed a five-year agreement with Johns Hopkins University School of Medicine (JHU) in July 1997 for research leading to the identification of cancer-related genes. Under the terms of the agreement, JHU researchers will use the SAGE technology to identify and analyze gene expression in cancer. The power of SAGE in finding rare genes was confirmed in a study of gastrointestinal cancer by JHU researchers published in the May 27, 1997 issue of Science. The study showed that of almost 50,000 genes expressed in normal gastrointestinal cells and gastrointestinal tumor cells, 86% of the genes were present at five or fewer copies per cell. Only 51% of those low-abundancy genes were recorded in the GenBank database of known genes in the human genome [257128].

The characterisation, treatment and sustainable reuse of biosolids in Ireland

Ireland is an island country on the western boundary of the European Union. A suite of environmental legislation over the last decade has combined to increase the amount of municipal sludge for treatment fourfold, while, simultaneously, eliminating traditional disposal methods. The Irish Government has instituted a comprehensive programme of policy development, infrastructure provision and drafting of "codes of good practice" to meet these environmenta; and legislative challenges. As the programme has developed, it has become clear that the sludge/biosolids issue shares many of the philosophical and logistical elements of other environmental issues that are developing apace in Ireland, including municipal waste management, agricultural waste management and overall integrated development. In many ways, it represents a model of the ultimate "sustainable development" issue. To provide specific data for decision making and policy/infrastructure/technology development, the Irish Government has funded a US$600k programme of research in The Characterisation, Treatment and Sustainable Reuse of Biosolids. The design philosophy of the programme is a "cradle-to-grave" approach, in order to integrate the outcomes of specialised research studies into an overall sustainable development model.

Recommendations for HER2 testing in the UK

Determining the HER2 status of breast carcinomas is a prerequisite for the use of the monoclonal antibody trastuzumab (Herceptin), which has recently been licensed for the treatment of metastatic disease. This necessitates a test based on archival material. The preferred analyses are immunohistochemistry with fluorescent in situ hybridisation (FISH) as a follow up test for ambiguous results. Guidelines have been developed for standardised, well controlled procedures for the provision of reliable results. A group of three reference laboratories has been established to provide advice, quality assurance, and materials, where needed.

Activation and regulation of interferon regulatory factor 4 in HTLV type 1-infected T lymphocytes

The human T cell leukemia virus type 1 (HTLV-1) is the etiologic agent of adult T cell leukemia (ATL), an aggressive and fatal leukemia of CD4(+) T lymphocytes, and is also associated with a neurological demyelinating disease, tropical spastic paraparesis. The oncogenic potential of HTLV-1 resides in the 353-aa, 40-kDa viral Tax oncoprotein, a positive regulator of viral gene transcription. A novel member of the interferon regulatory factor (IRF) family of transcription factors, IRF-4, was shown to be constitutively produced in HTLV-1-infected cells. IRF-4 is transiently expressed in anti-CD3 and PMA/ionomycin-stimulated T lymphocytes but not in continuous non-Tax-expressing T cell lines. In transient coexpression assays, HTLV-1 Tax protein induced the 1. 2-kb IRF-4 promoter, indicating that Tax functions as an indirect trans-activator of the IRF-4 gene. Furthermore, IRF-4 levels in HTLV-1-infected cells appear to be proportional to the level of Tax expression, suggesting a role for IRF-4 in T cell transformation. In an effort to further characterize IRF-4 function, we identified a novel interaction between IRF-4 and FKBP52, a 59-kDa member of the immunophilin family with peptidyl-prolyl isomerase activity (PPIase). IRF-4-FKBP52 association inhibited the interaction between IRF-4 and its DNA-binding partner PU.1, as well as the trans-activation function of IRF-4/PU.1. FKBP52 association resulted in a structural modification of IRF-4, detectable by immunoblot analysis and by IRF-4 partial proteolysis. These results demonstrate a novel posttranslational mechanism of transcriptional control, mediated through the interaction of an immunophilin with a transcriptional regulator.

Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group

BACKGROUND

Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure widespread adoption of these performance measures by health plans, private employers, public payers, and accrediting organizations.

CORE PERFORMANCE MEASURES

Four domains were identified, with specific measures developed for each domain: (1) prevention/education, (2) recognition, (3) treatment (including initiation of alcohol and other plan services, linkage of detoxification and AOD plan services, treatment engagement, and interventions for family members/significant others), and (4) maintenance of treatment effects.

CONTINUING EFFORTS

Four measures that are based on administrative information from health plans and two measures that require a consumer survey of behavioral health care are undergoing extensive pilot testing. The WCG has reached out to a broad range of stakeholders in performance measurement and managed care to acquaint them with the measures and to promote their investigation and adoption. As results of pilot testing become available, these outreach efforts will continue.

CONCLUSIONS

Performance measures for AOD services need to become an integral part of a comprehensive set of behavioral and physical health performance measures for managed care plans.

Treatment of community-acquired pneumonia

Lower respiratory tract infections are the major cause of death due to infectious disease in the developed and developing world. Despite substantial progress in defining pathogens and in therapeutic options, there continues to be major controversies in the clinical management of these infections. This report reviews the guidelines for community-acquired pneumonia from the Infectious Diseases Society of America (IDSA), updated from the initial publication. Diagnosis should include a chest X-ray to differentiate acute bronchitis from pneumonia. The decision for hospitalization should be based on social factors and evaluation of severity of illness. Identification of an etiological agent for inpatients should include two pretreatment cultures, one pretreatment sputum specimen, with seriously ill patients requiring studies for Legionella spp. Recommendations for empiric treatment of outpatients are doxycycline, a macrolide or a fluoroquinolone. Recommendations for empiric treatment of hospitalized patients are a cephalosporin plus a macrolide, or a fluoroquinolone alone. Recommendations for ICU patients are a beta-lactam combined with either a macrolide or a fluoroquinolone. While concern has arisen about increasing resistance to fluoroquinolones, arguments in favor of these agents include the fact that they have good in vitro activity against nearly all treatable pathogens except some anaerobes. Clinical trials have shown equivalence or superiority compared to other standard agents. They are well tolerated, and can be administered intravenously or orally, once daily. A recent retrospective review has shown superior outcome with fluoroquinolone treatment compared to cephalosporins, including a 36% reduction in mortality.

Driving reaction time after right knee arthroscopy

Driving reaction times of 30 right knee arthroscopy patients were measured using a computer-linked car simulator. Each patient was tested pre-operatively and 1 week after and 4 weeks after arthroscopy. As controls, 25 normal subjects were also tested. In the control group the average reaction time was 634 ms; the measurements at 1 week and at 4 weeks were 550 ms and 582 ms, respectively. In the arthroscopy group the average reaction time pre-operatively was 736 ms; the measurements 1 week and 4 weeks post-operatively were 920 ms and 685 ms, respectively. Two clinical tests (the stepping and standing tests) were also performed at each assessment. Statistical analysis showed a good correlation between these and reaction time. We conclude that it is appropriate for patients to delay their return to driving for at least 1 week, and that the actual timing of return to driving may be determined by performance on these two clinical tests.

Collaborative multidisciplinary workshop report: clinical antimicrobial trials for primary and secondary prevention of atherosclerotic cardiovascular disease

The task assigned to the working group on Clinical Antimicrobial Trials for Primary and/or Secondary Prevention of Atherosclerotic Cardiovascular Disease was to evaluate the need for additional clinical antibiotic trials of a primary or secondary nature for the treatment of atherosclerotic heart disease and to suggest possible designs for future trials. In addition, the working group was to define the role of collaboration in answering research questions.