Adverse dermatologic reactions from antiarrhythmic drug therapy

Undesirable cutaneous reactions to drugs may occur early or late in the course of treatment. The ingestion of drugs may also aggravate existing dermatologic conditions. The adverse dermatologic reactions from antiarrhythmic drug therapy are reviewed. The exact incidence of dermatologic side effects from cardiovascular drugs has been difficult to estimate because of sporadic reporting. In this review, the cutaneous side effects are discussed according to drug class and the type of dermatologic reaction.

Picture comprehension in probable Alzheimer's disease

Patients with probable Alzheimer's disease (pAD) are frequently said to be compromised at a semantic level of picture comprehension. In order to test this hypothesis, pAD patients were asked to judge whether pictures are instances of a familiar superordinate category ("vegetable"). The targets (e.g., corn) varied in their representativeness, and the foils were either "coherent" items that were not target exemplars (e.g., apple, chair) or "anomalous" items displaying specific features that disqualified the stimuli as target exemplars (e.g., striped carrot). We also asked patients to judge a comparable set of words to determine whether difficulty appreciating pictures is material-specific. pAD patients were impaired at judging target pictures and a subset of picture foils, according to group-wide analyses, although they also encountered some difficulty judging the category membership of words. Individual patient analyses revealed that some patients were equally impaired at judging pictures and words. In particular, one subgroup experienced significant difficulty distinguishing coherent foils related to the target from true exemplars, and this occurred when the foils were presented as either pictures or words. An item-by-item analysis revealed highly concordant difficulty judging the same concepts expressed as either pictures or words in these patients. A material-specific deficit was evident in other pAD patients that resulted in selectively compromised picture judgments, including essentially all types of picture foils. We discuss these profiles of picture comprehension difficulty and conclude that deficits in understanding pictures in pAD may be due to semantic or perceptual types of impairment.

Gene therapy for cystic fibrosis using E1-deleted adenovirus: a phase I trial in the nasal cavity. The University of North Carolina at Chapel Hill

Cystic fibrosis (CF) is an autosomal recessive disease that reflects mutations in the CFTR gene. Multiple mutations in this gene have been detected that lead to a protein (CFTR) that is abnormally metabolized, dysfunction, or both. The full spectrum of the activities of the gene product have not been defined, but it is clear that CFTR can act as a cAMP-regulated Cl- channel. This type of defect is consistent with the physiologic characterization of CF epithelia, which has revealed abnormalities in salt and water transport. In the lung, abnormalities in epithelial salt and water metabolism lead to abnormal mucociliary clearance. This defect in clerance represents a major failure of lung defense and leads ultimately to infection of the lung with Staphylococcus aureus, Pseudomonas aeruginosa, and other bacterial organisms. The chronic inflammatory response to this persistent intraluminal bacterial infection leads to protease-induced destruction of airway walls and finally, lung failure. More than 95% of CF patients die of lung disease. The clinical therapy of CF lung disease is limited to agents designed to promote clearance of secretions from the lung and antibiotics to treat the chronic bacterial infection. Recent laboratory demonstrations that introduction of the normal CFTR cDNA into CF cells corrects the ion transport defects of these cells has led to the hypothesis that gene therapy in the lung can be an effective, novel mode of therapy for this lung disease. The classic gene transfer vectors, e.g., retroviruses, appear to be not well suited for therapy of lung disease because of the low proliferation rate of airway epithelia in vivo. Recently, adenoviruses, which have a natural tropism for airway epithelia, have been genetically modified (E1-deleted) in an attempt to reduce potential toxicity of this virus and provide space for the CFTR cDNA. A series of in vitro studies have shown that this vector is highly efficient for transferring CFTR into airway epithelial cells in culture and correcting the CF defect. Further, studies in whole animals appear to indicate that this mode of gene transfer is associated with a low degree of toxicity. The present study is a dose-effect study designed to test for the safety and efficacy of E1-deleted recombinant adenovirus containing the CFTR cDNA under a CMV-beta-actin promoter in CF nasal epithelia.(ABSTRACT TRUNCATED AT 400 WORDS)

Photosensitivity as the presenting illness in four patients with human immunodeficiency viral infection

BACKGROUND

A multitude of skin lesions have been reported in individuals with human immunodeficiency virus (HIV) infection. Some of them, eg, severe seborrheic dermatitis and herpes zoster infections, may predate the onset of the diagnostic criteria for the acquired immunodeficiency syndrome and may actually raise the suspicion of HIV infection in healthy-appearing individuals. We have recently evaluated four individuals who presented with a severe idiopathic photosensitivity of eczematous morphologic features who eventuated in a diagnosis of HIV seropositivity. Four individuals who presented with an eczematous eruption of sun-exposed skin were referred to the Environmental Dermatology Unit of Columbia-Presbyterian Medical Center (New York, NY) for evaluation of possible photosensitive disease. They were examined and underwent photobiological testing (minimal erythema dose testing and photopatch testing) to confirm and classify their suspected photosensitivity.

OBSERVATIONS

All four patients fulfilled the criteria for chronic actinic dermatitis, a rare idiopathic photosensitivity characterized by debilitating, unremitting dermatitis with eczematous or lymphomalike histologic features and reproduction of lesions by small quantities of mid-wave UV-B radiation (290 to 320 nm). All four individuals were HIV seropositive and CD4 counts were markedly suppressed in all four. The photosensitivity predated the finding of seropositivity and the diagnosis of acquired immunodeficiency syndrome in all four patients.

CONCLUSION

The presentation of healthy-appearing individuals with photodistributed dermatitis of unknown cause should alert the physician to the possibility of HIV infection.

Successful ex vivo gene therapy directed to liver in a patient with familial hypercholesterolaemia

An ex vivo approach to gene therapy for familial hypercholesterolaemia (FH) has been developed in which the recipient is transplanted with autologous hepatocytes that are genetically corrected with recombinant retroviruses carrying the LDL receptor. We describe the treatment of a 29 year old woman with homozygous FH by ex vivo gene therapy directed to liver. She tolerated the procedures well and in situ hybridization of liver tissue four months after therapy revealed evidence for engraftment of transgene expressing cells. The patient's LDL/HDL ratio declined from 10-13 before gene therapy to 5-8 following gene therapy, improvements which have remained stable for the duration of the treatment (18 months). This represents the first report of human gene therapy in which stable correction of a therapeutic endpoint has been achieved.

Evaluation of lymphadenopathy in children

This chapter provides an approach to the evaluation of lymphadenopathy in children. Malignant etiologies, including HIV-associated malignancies are reviewed. In discussing infectious agents or causes of lymphadenopathy, particular emphasis is placed on chronic regional lymphadenopathy with a focus on new advances in cat-scratch disease and tuberculous and non-tuberculous mycobacterial lymphadenitis. After a suggested preliminary set of laboratory tests, biopsy is often necessary both for histologic and cultural investigation. Therapy must be specific and must follow an accurate diagnosis.

Molecular mechanisms of androgen action

Androgens directly regulate a vast number of physiological events. These direct androgen effects are mediated by a nuclear receptor that exhibits four major functions or activities: steroid binding, DNA binding, transactivation, and nuclear localization. The SBD consists of a hydrophobic pocket of amino acids that exhibits high-affinity, androgen-specific binding. Based on studies of mutant AR, it appears that a number of different amino acids contribute to the steroid binding characteristics of the AR. The DNA binding domain confers sequence-specific binding to structures called androgen-responsive elements. The specificity of steroid binding and DNA binding provides a crucial basis for androgen-specific regulation of target genes. The nuclear localization signal shares homology with known nuclear localization signals and, coupled with the presence of androgens, is responsible for localizing the AR to the nucleus. The transactivation functions reside mostly in the NH2 terminus but the responsible domains are as yet poorly defined. Though the different domains can act as independent moieties, one domain can clearly alter the behavior of another domain. For instance, the SBD appears to inhibit the transactivating functions until steroid is bound and the amino terminus prevents DNA binding activity until steroid is bound. The relative ease of introducing mutations with polymerase chain reaction technology will facilitate further delineation of critical amino acids and domains responsible for the various activities of the AR. The recent cloning and characterization of AR promoters revealed that the AR genes are driven by a TATA-less promoter characteristics of housekeeping genes. Analysis of transcription rates, mRNA levels, and protein levels indicates that androgens and pkA and pkC pathways modulate expression of AR mRNA and protein. This indicates that the same signal pathways that interact to regulate androgen target genes also regulate the levels of AR in the target tissues. Surprisingly few androgen-regulated genes have been well characterized for the mechanisms by which androgen regulates the gene. The C(3), Slp, probasin, PSA, and hKLK2 genes have provided examples where androgens regulate transcription. Posttranscriptional regulation by androgens has been demonstrated for the SVP1, 2, 3, and 4 and AR genes. The mechanisms underlying posttranscriptional regulation are poorly defined but substantial progress has been made in defining the critical elements that mediate transcriptional effects of androgens. Transcriptional effects are mediated through binding of androgen-AR complexes to specific DNA sequences called AREs. Simple AREs such as those found in C(3) and kallikrein genes tend to be permissive in that GR and PR can also act through the same element.(ABSTRACT TRUNCATED AT 400 WORDS)

Sex differences in intensity of emotional experience: a social role interpretation

According to gender role theory, women's greater emotional intensity than men's stems from normative expectations for sex differences that arise as a result of men's and women's social roles. In the 1st experiment, endorsement of normative expectations for sex differences was associated with sex differences in Ss' own emotions: To the extent that they endorsed stereotypical differences between men and women, female Ss reported personally experiencing emotions of greater intensity and male Ss reported experiencing emotions of lesser intensity. The 2nd study manipulated expectations for responsiveness while Ss viewed a series of emotion-inducing slides. When instructions rendered normative expectations comparable for men and women, no sex differences were obtained in emotion self-reports. Furthermore, women evidenced more extreme electromyograph physiological responding than men, suggesting general sex differences in emotion that are not limited to self-report.

Covariance between relatives in multibreed populations: additive model

Covariance between relatives in a multibreed population was derived for an additive model with multiple unlinked loci. An efficient algorithm to compute the inverse of the additive genetic covariance matrix is given. For an additive model, the variance for a crossbred individual is a function of the additive variances for the pure breeds, the covariance between parents, and segregation variances. Provided that the variance of a crossbred individual is computed as presented here, the covariance between crossbred relatives can be computed using formulae for purebred populations. For additive traits the inverse of the genotypic covariance matrix given here can be used both to obtain genetic evaluations by best linear unbiased prediction and to estimate genetic parameters by maximum likelihood in multibreed populations. For nonadditive traits, the procedure currently used to analyze multibreed data can be improved using the theory presented here to compute additive covariances together with a suitable approximation for nonadditive covariances.

Adenovirus-mediated transfer of the CFTR gene to lung of nonhuman primates: biological efficacy study

We have evaluated the biological efficacy of E1-deleted adenoviruses in baboons for lung-directed gene therapy of cystic fibrosis (CF). The experimental design attempted to simulate a phase I clinical trial with animals receiving a single dose of virus to an isolated pulmonary segment. A total of 14 animals divided into four groups, each of which received escalating doses of virus, were used. Individual animals were necropsied 4 and 21 days after gene transfer and tissues were carefully surveyed for gene expression. Expression of the transgene was localized primarily to the area into which it was infused; the efficiency of recombinant gene expression and the abundance of transgene sequences were proportional to dose and both diminished with time. Transgene expression was found predominantly in alveolar cells with patches of expression in the proximal and distal airway. Analysis of adenoviral protein expression within transgene-expressing cells revealed infrequent expression of the E2a gene and no detectable expression of late genes (i.e., fiber protein). These results suggest that recombinant adenovirus can be used to transfer genes efficiently to the lung of nonhuman primates and that therapeutic strategies of cystic fibrosis may require repetitive administration with current vectors.

Determinants of interest rates on tax-exempt hospital bonds

The aim of this paper is to examine the determinants of interest rates on tax-exempt hospital bonds. The results highlight the potential and actual roles of Federal and state policy in the determination of these rates. The shift to a Prospective Payment System under Medicare has subsidized the borrowing costs of some hospitals at the expense of others. The selection of underwriters by negotiation rather than by competitive bidding results in higher interest rates. The Federal tax act of 1986 raised the cost of hospital debt by encouraging bond issues to contain call features.

Adenovirus-mediated transfer of the CFTR gene to lung of nonhuman primates: toxicity study

In preparation for human trials of gene therapy for cystic fibrosis (CF), we performed a preclinical study of gene transfer into the lungs of baboons. Recombinant adenovirus vectors containing expression cassettes for human cystic fibrosis transmembrane conductance regulator (CFTR) and Escherichia coli beta-galactosidase (lacZ) were instilled through a bronchoscope into limited regions of lung in 14 baboons. A detailed accounting of the extent, distribution, and duration of gene expression is contained in a companion article (Engelhardt et al., 1993b). In this article, we report the results of toxicity studies in which clinical laboratory tests, chest radiographs, and necropsy studies were used to detect adverse effects. The only adverse effect noted was a mononuclear cell inflammatory response within the alveolar compartment of animals receiving doses of virus that were required to induce detectable gene expression. Minimal inflammation was seen at 10(7) and 10(8) pfu/ml, but at 10(9) and more prominently at 10(10) pfu/ml, a perivascular lymphocytic and histiocytic infiltrate was seen. The intensity of inflammation increased between 4 and 21 days. At its greatest intensity, there was diffuse alveolar wall damage with intra-alveolar edema. Airways were relatively spared, despite the intensity of alveolar inflammation. Clinical tests did not accurately reflect the presence of lung inflammation, with the exception of chest radiographs which revealed alveolar infiltrates, but only in regions of lung having the greatest intensity inflammation. We conclude that adenovirus-mediated gene transfer into the lungs of baboons is associated with development of alveolar inflammation at high doses of virus.

Sex differences in intensity of emotional experience: a social role interpretation

According to gender role theory, women's greater emotional intensity than men's stems from normative expectations for sex differences that arise as a result of men's and women's social roles. In the 1st experiment, endorsement of normative expectations for sex differences was associated with sex differences in Ss' own emotions: To the extent that they endorsed stereotypical differences between men and women, female Ss reported personally experiencing emotions of greater intensity and male Ss reported experiencing emotions of lesser intensity. The 2nd study manipulated expectations for responsiveness while Ss viewed a series of emotion-inducing slides. When instructions rendered normative expectations comparable for men and women, no sex differences were obtained in emotion self-reports. Furthermore, women evidenced more extreme electromyograph physiological responding than men, suggesting general sex differences in emotion that are not limited to self-report.

Effects of radiation therapy on adult brain behavior: evidence for a rebound phenomenon in a phase 1 trial

Although radiotherapy (XRT) is a necessary course of treatment to prolong life expectancy in patients with many types of brain neoplasms, it has damaging effects that are little understood. We used a comprehensive neuropsychological battery to evaluate five patients with low-grade brain tumors prior to XRT and then at 3-month intervals up to 9 months postcompletion of XRT. We matched patients by age and education with six normal control subjects to assess baseline impairment. In intrasubject comparisons, we examined change over time postcompletion of XRT. In spite of varying locations of tumors, all patients showed deterioration in long-term memory at a mean of 1.5 months postcompletion of XRT. Patients also consistently demonstrated a rebound effect between means of 4.7 and 7.6 months post-XRT. We found no changes over time in working memory, attention, visuospatial processes, or on any other neuropsychological test with the exception of information-processing speed, which quickened over time. Functional measures of fatigue and mood did not correlate significantly with the long-term memory scores. Long-term memory appears sensitive to the proposed white matter changes thought to be the mechanism for the early-delayed effects of XRT. Our findings suggest a neurobehavioral model for studying the effects of XRT on brain functioning.

Therapeutic strategies for familial hypercholesterolemia based on somatic gene transfer

Inherited dyslipidemias are important risk factors for the premature development of coronary artery disease. One example is an inherited deficiency of low density lipoprotein (LDL) receptors that leads to the syndrome familial hypercholesterolemia (FH). We have used FH as a model for developing new approaches for treating this group of disorders by somatic gene therapy. Experiments in animal models that led to the initiation of a clinical trial of homozygous FH will be presented in this review.

Adenovirus-mediated correction of the genetic defect in hepatocytes from patients with familial hypercholesterolemia

Familial hypercholesterolemia (FH) is an inherited deficiency of LDL receptors that has been an important model for liver-directed gene therapy. We are developing approaches for treating FH that are based on direct delivery of recombinant LDL receptor genes to liver in vivo. As a first step towards this goal, replication-defective recombinant adenoviruses were constructed which contained either the lacZ gene or the human LDL receptor cDNA expressed from a beta-actin promoter. Primary cultures of hepatocytes were established from two patients with homozygous FH and one nonFH patient, and subsequently exposed to recombinant adenoviruses at MOIs ranging from 0.1 to 5. Essentially all of the cells expressed high levels of the transgene without demonstrable expression of an early or late adenoviral gene product; the level of recombinant-derived LDL receptor protein in transduced FH hepatocytes exceeded the endogenous levels by at least 20-fold. These studies support the utility of recombinant adenoviruses for efficient transduction of recombinant LDL receptor genes into human FH hepatocytes without expression of viral proteins.

The significance of the relationship between a discipline and its practice

In this paper, it is argued that the absence of conceptual consensus across the university and its sectors is largely responsible for the growing gap between the goals of the discipline and its practice. Both discipline and practice are defined, their symbiotic relationship explored, and specific strategies proposed, to enhance the development of the profession. In particular, the need for a shared conceptual framework which would transcend university and service structures to promote an academic practice is examined in addition to the benefits of instituting theoretically based daily rounds and journal club in the practice setting.

The sum and substance of it: the appreciation of mass and count quantifiers in Parkinson's disease

We performed three experiments in order to determine whether patients with Parkinson's disease (PD) have a sentence comprehension impairment. In the first experiment, we found that nondemented PD patients were impaired at matching a short sentence containing a mass or count quantifier (e.g., "Point to the jar with many") with one of four pictures. Patients erred by pointing to the incorrect mass or count type of substance, but pointed correctly to the large or small amount of a substance in the picture. In the second experiment, we asked the same PD patients to judge short sentences containing mass or count nouns modified by mass or count adjectives (e.g., *"The glass contains many milk"). PD patients were significantly impaired at detecting errors in the agreement between a noun and a quantifying adjective and errors in the appropriate use of the plural associated with a noun. A sentence completion task was performed in order to determine whether patients impaired on both sentence-picture matching and sentence judgment tasks are also compromised in their expression of quantifiers. Some patients impaired on both tasks also had difficulty expressing quantifiers, and it is these patients who may have difficulty performing grammatical computations. Other patients were selectively impaired in their sentence-picture matching or their sentence judgments, suggesting a performance deficit concerned with a particular task. We conclude that sentence comprehension impairments in PD are multifactorial in nature.

A novel approach for introducing hepatocytes into the portal circulation

Many attempts have been made to treat metabolic diseases of the liver. One approach, called ex vivo gene therapy, is based on correcting the genetic defect in the patient's hepatocytes. In this model, the liver is resected and hepatocytes are isolated, plated in culture, and genetically corrected with recombinant retroviruses. The cells are then harvested and infused into the portal circulation, where they seed in the sinusoids of the liver. In this study, a canine model was used to develop an approach to ex vivo gene therapy that requires only one surgical procedure. The basic concept is to place a catheter in the mesenteric circulation at the time of liver resection that can be used subsequently to deliver hepatocytes into the liver. With four 18 to 28 kg mongrel dogs, a laparotomy was performed, the left lateral segment of the liver was resected, and a 9.5 Fr Hickman catheter was introduced into the inferior mesenteric vein. At 10 days, the catheter was studied angiographically and removed. The catheter remained patent and was easily removed without untoward effects. A subsequent necropsy was performed to evaluate the consequences of this procedure. There was no hematoma at the site of the catheter placement or evidence for intraportal clot. This approach has been used in subsequent studies to treat a patient with familial hypercholesterolemia.

Retroviruses: delivery vehicle to the liver

Liver-directed gene therapy holds great promise for the treatment of inherited metabolic disease. Two strategies have emerged. Ex vivo gene therapy involves the transplantation of autologous hepatocytes transduced with recombinant retroviruses while in culture. The feasibility of this approach has been demonstrated in several animal models, and a human trial has been initiated. An alternative strategy uses recombinant viruses to deliver the transgene directly to hepatocytes in vivo.

Multiphasic allometry

A multiphasic linear model is presented that describes the allometric relation between body components and permits a smooth transition from one linear segment to the next. Three applications of a diphasic linear model to allometric growth problems were used to illustrate the model. The data sets were selected because a breakpoint exists in the allometric relation. Relations between growth of the alimentary tract and of empty body weight in rabbits, growth of length and of body weight in larval-carp and growth of protein and of fat in pullets were described by a diphasic allometric model. For rabbits and larval-carp, relations were described significantly better by a diphasic instead of a monophasic (simple) allometric model. For situations where response is expected to consist of more than one linear segment, the multiphasic model is recommended.

Attention and sentence processing deficits in Parkinson's disease: the role of anterior cingulate cortex

Parkinson's disease (PD) is a complex neurodegenerative condition involving a motor disorder that is related to reduced dopaminergic input to the striatum. Intellectual deficits are also seen in PD, but the pathophysiology of these difficulties is poorly understood. Regional cerebral blood flow (rCBF) was studied in neurologically intact subjects during the performance of attention-demanding, sentence processing tasks using positron emission tomography (PET). The results demonstrated significantly increased rCBF in a distributed set of cerebral regions during the detection of an adjective or a particular agent in a sentence, including anterior cingulate cortex, left inferior and middle frontal cortex, left inferior temporo-occipital cortex, posterolateral temporal cortex, left caudate, and left thalamus. We identified defects in this cerebral network by studying PD patients with two PET techniques. Resting PET studies revealed a significant correlation between regional cerebral glucose metabolism in anterior cingulate cortex and deficits in attending to subtle grammatical aspects of sentences. Studies of PD patients with the PET activation technique revealed little change in anterior cingulate and left frontal CBF during performance of the adjective detection or agent detection tasks. These data suggest that a defect in anterior cingulate cortex contributes to the cognitive impairments observed in PD.

Transplantation of genetically modified autologous hepatocytes into nonhuman primates: feasibility and short-term toxicity

Ex vivo gene therapy directed to the liver is being developed for the treatment of inherited metabolic diseases. Transplantation of hepatocytes that have been transduced with a low-density lipoprotein (LDL) receptor gene is a potential form of therapy for familial hypercholesterolemia (FH). We have demonstrated efficacy of ex vivo gene therapy for familial hypercholesterolemia in a rabbit animal model of this disease. In preparation for human trials, we describe in this report experiments in baboons for documentation of the feasibility and safety of autologous hepatocyte transplantation. Three baboons underwent a partial hepatectomy and their hepatocytes were isolated, cultured, and transduced with a retrovirus containing the human LDL receptor gene. The hepatocytes were harvested and infused into an indwelling catheter that had been placed into the inferior mesenteric vein at the time of liver resection. The baboons tolerated the procedures well and are being maintained and clinically evaluated for an indefinite time period. Follow-up evaluations have ranged from 3 to 8 months. Clinical evaluations have been unremarkable and blood chemistry and hematology determinations have stayed within normal limits.

Retroviral-mediated gene transfer in human hepatocytes

BACKGROUND

The ability to modify human hepatocytes genetically is an essential first step in the development of liver-directed ex vivo gene therapy for inherited metabolic disease. The purpose of these studies was to prove that the genome of human hepatocytes can be altered successfully to express foreign genetic material.

METHODS

Human hepatocytes were plated at 2 or 4 x 10(6) cells/10 cm Primaria (Falcon, Oxnard, Calif.) plates. Fresh virus from the amphotropic viral producer cell line BAG, containing the Escherichia coli beta-galactosidase gene lacZ, was placed directly onto hepatocyte cultures and quantitative analysis of cells staining positive for the lacZ gene was undertaken. In a different human liver, a variety of viruses from producer cell lines containing clones of the human low-density lipoprotein (LDL) receptor were plated directly on cultures of human hepatocytes, and gene transfer was demonstrated by increased uptake of fluorescent-labeled LDL.

RESULTS

Beta-galactosidase production in hepatocytes was assayed histochemically with the chromogenic substrate X-gal. The highest percentage of cells staining positive for expression of enzyme was seen at 4 x 10(6) cells/plate (43.66% +/- 1.02% vs 27.99% +/- 2.31%). Gene transfer was also documented by the uptake of fluorescent-labeled LDL with a variety of different vectors containing the human LDL receptor.

CONCLUSIONS

(1) Human hepatocytes can be cultured in vitro and are susceptible to retroviral infection, (2) functional gene transfer is demonstrated by intracellular function of foreign genes, and (3) the level of expression appears dependent on plating density. We conclude that human hepatocytes are suitable targets for genetic manipulation and may play an important role in human gene therapy trials.

Estimation of genetic parameters for somatic cell score in Holsteins

Genetic parameters of somatic cell scores for Holstein cows were estimated using an animal model and REML for two data sets. Set 1, with 13,017 records from 5278 cows, was used to obtain variance components, heritability, and repeatability for two lactation measures: the simple average and the weighted average of test day data. Set 2, with 14,418 records from 4806 cows, was used to obtain genetic correlations for the simple average between lactations 1 and 2, between lactations 1 and 3, and between lactations 2 and 3. Simple and weighted average of test day somatic cell scores had the same heritabilities (.12) and repeatabilities (.35). Phenotypic variances were about 1.2, and herd-sire interaction variances were small (.002). Genetic correlation for somatic cell score was about .55 between lactations 1 and 2 and between lactations 1 and 3 and .65 between lactations 2 and 3. Phenotypic correlation was .20 between lactations 1 and 2, .16 between lactations 1 and 3, and .31 between lactations 2 and 3.

A novel mechanism for achieving transgene persistence in vivo after somatic gene transfer into hepatocytes

Infusion of hepatocyte-specific DNA-protein complexes into rats leads to transient recombinant gene expression in liver. The eventual deterioration of gene expression is due in part to instability of the targeted DNA. In a previous report, we noted retention of transgene sequences in liver and persistent recombinant gene expression when the animals were subjected to partial hepatectomy following in vivo gene transfer. In an attempt to define the mechanism(s) responsible for persistent gene expression following partial hepatectomy, we characterized the molecular state of the retained, liver-associated transgenes. Southern blot analysis of DNA from liver tissues harvested various times after in vivo gene transfer and partial hepatectomy (10 min to 11 weeks) demonstrated high levels of transgene DNA (100-10,000 copies/cell). The predominant form of this DNA appeared to be episomal based on analyses of uncut DNA or DNA restricted by an endonuclease with one site in the plasmid. Livers from several animals contained a small proportion of transgene sequences of unknown structure. The existence of episomal DNA in liver was confirmed in experiments in which intact plasmid was rescued from total hepatocyte DNA by transformation of bacteria. Both strands of DNA in the liver-associated plasmid retained a bacterial pattern of methylation suggesting that the plasmid had not replicated in the eukaryotic cell. These results are consistent with the hypothesis that the majority of transgene sequences are retained as stabilized plasmids. The specific form of DNA which is transcriptionally active was not identified in these studies. This represents a new mechanism for retaining foreign DNA in eukaryotic cells in vivo and has implications both for the development of somatic gene therapies and the pathogenesis of viral diseases.

Somatic gene transfer in the development of an animal model for primary hyperparathyroidism

The overproduction of hormones is associated with a variety of endocrinological disorders. We have used somatic cell gene transfer of human PTH (hPTH) to develop an animal model of hypercalcemia and osteoclastic skeletal resorption. Recombinant retroviruses were used to transduce a functional hPTH gene into cultured rat fibroblasts. The recombinant-derived preproparathyroid hormone peptide was appropriately processed in this ectopic cell, and intact hPTH (1-84) was secreted at a high level (2-5 ng/10(6) cells/24 h). Transplantation of the PTH-secreting cells into syngeneic rat recipients was associated with the development of hypercalcemia mediated by increasing serum concentrations of hPTH. Thyroparathyroidectomy in these hypercalcemic rats producing hPTH did not result in hypocalcemia and tetany, which was observed in control animals undergoing thyroparathyroidectomy. Chronic overproduction of hPTH (60 days) was associated with severe hypercalcemia, metastatic calcification, and histological changes of osteoclastic resorption of bone. This animal model will be useful in studying the pathophysiology of severe hyperparathyroidism in humans and should help in the evaluation of new medical therapies for hypercalcemia.

Ex vivo gene therapy of familial hypercholesterolemia

Familial hypercholesterolemia (FH) is an autosomal dominant disorder caused by a deficiency in the receptor that clears low density lipoprotein (LDL) from the serum (reviewed in Ref. 1 and 2). Patients with one abnormal LDL receptor allele have moderate elevations in plasma LDL and suffer premature coronary artery disease (CAD). Approximately 5% of all patients under 45 who have had a myocardial infarction carry this trait. Patients with two abnormal LDL receptor genes (homozygous deficient patients) have severe hypercholesterolemia and life-threatening coronary artery disease in childhood. Strategies for treating patients with FH are directed at lowering the plasma level of LDL. In heterozygotes, this is accomplished through the administration of drugs that stimulate the expression of LDL receptor from the normal allele (2). This therapeutic approach is not effective in the treatment of homozygous deficient patients, especially those that retain less than 2% of residual LDL receptor activity. Partial amelioration of hyperlipidemia has been achieved in some homozygous deficient patients by diverting the portal circulation through a portacaval anastomosis (3) and by chronic plasmapheresis therapy (4). A more direct approach has been to correct the deficiency of hepatic LDL receptor by transplanting a liver that expresses normal levels of LDL receptor. Three patients that survived this procedure normalized their serum LDL-cholesterol (5-9). We have used an authentic animal model for FH, the Watanabe Heritable Hyperlipidemic rabbit (WHHL), to develop gene therapies for the homozygous form of FH (10-13). The WHHL rabbit has a mutation in its LDL receptor gene which renders the receptor completely dysfunctional (12) leading to severe hypercholesterolemia, diffuse atherosclerosis, and premature death. The potential efficacy of gene therapy for FH is supported by a series of studies we have performed in the WHHL rabbit in which we have achieved metabolic improvement (14-18). Liver tissue was removed from WHHL rabbits and used to isolate hepatocytes and establish primary cultures. A functional rabbit LDL receptor gene was transduced into a high proportion of hepatocytes using recombinant retroviruses, and the genetically corrected cells were transplanted into the animal from which they were derived. Transplantation of the genetically corrected, autologous hepatocytes was associated with a 30-40% decrease in serum cholesterol that persisted for the duration of the experiment (4 months, Ref. 18). Recombinant derived LDL receptor RNA was detected in liver for at least 6 months. There was no apparent immunological response to the recombinant derived LDL receptor.(ABSTRACT TRUNCATED AT 400 WORDS)

Characterization of poultry egg production using a multiphasic approach

Egg production for an individual hen is described by a multiphasic model in which each phase is determined by number of eggs within a clutch, including internally laid eggs, and pause between clutches. Number of eggs in a clutch is determined by circadian rhythm, which consists of a daily rhythm and lag. Internal laying is a result of asynchrony in the development of the oviduct and the ovary. Pause consists of a circadian rhythm and a period called delay. It is expected that lag and internal laying are determined genetically, whereas delay is determined by the environment, especially by photoperiod. A multiphasic model was developed to characterize egg production by lag and delay, expressing cumulative egg number in terms of time. Data need to be adjusted for internal laying prior to the analysis. The inverse function, expressing time in terms of cumulative egg number, was used to estimate average lag and delay for individual hens. Hourly data from four hens over a 16-day period were analyzed to estimate parameters for lag and delay. Data were preadjusted for internal laying and for pause. Lag ranged from -.08 to 2.11 h, and was related positively to number of clutches and, consequently, related negatively to average length of clutch and total number of eggs over the period. Average delay was about 16 h, which may be determined by the light:dark ratio.

Hepatocyte-directed gene transfer in vivo leads to transient improvement of hypercholesterolemia in low density lipoprotein receptor-deficient rabbits

Familial hypercholesterolemia is an inherited disease in humans, caused by a deficiency of low density lipoprotein (LDL) receptors, that we have used as a model for developing liver-directed gene therapies. Our strategy is to reconstitute hepatic LDL receptor expression in vivo by administering a DNA-protein complex that is capable of targeting the delivery of functional LDL receptor genes to hepatocytes. Infusion of this DNA-protein complex into the peripheral circulation of a rabbit animal model for familial hypercholesterolemia resulted in hepatocyte-specific gene transfer and a temporary amelioration of hypercholesterolemia. This noninvasive approach to gene therapy should have applications in the treatment of a wide spectrum of human diseases.

Long-term improvement of hypercholesterolemia after ex vivo gene therapy in LDLR-deficient rabbits

Familial hypercholesterolemia (FH) is an inherited disorder in humans that is caused by a deficiency of low density lipoprotein receptors (LDLRs). An animal model for FH, the Watanabe Heritable Hyperlipidemic rabbit, was used to develop an approach for liver-directed gene therapy based on transplantation of autologous hepatocytes that were genetically corrected ex vivo with recombinant retroviruses. Animals transplanted with LDLR-transduced autologous hepatocytes demonstrated a 30 to 50 percent decrease in total serum cholesterol that persisted for the duration of the experiment (122 days). Recombinant-derived LDLR RNA was harvested from tissues with no diminution for up to 6.5 months after transplantation.

Towards liver-directed gene therapy: retrovirus-mediated gene transfer into human hepatocytes

Liver-directed gene therapy is being considered in the treatment of inherited metabolic diseases. One approach we are considering is the transplantation of autologous hepatocytes that have been genetically modified with recombinant retroviruses ex vivo. We describe, in this report, techniques for isolating human hepatocytes and efficiently transducing recombinant genes into primary cultures. Hepatocytes were isolated from tissue of four different donors, plated in primary culture, and exposed to recombinant retroviruses expressing either the LacZ reporter gene or the cDNA for rabbit LDL receptor. The efficiency of gene transfer under optimal conditions, as determined by Southern blot analysis, varied from a maximum of one proviral copy per cell to a minimum of 0.1 proviral copy per cell. Cytochemical assays were used to detect expression of the recombinant derived proteins, E. coli beta-galactosidase and rabbit LDL receptor. Hepatocytes transduced with the LDL receptor gene expressed levels of receptor protein that exceeded the normal endogenous levels. The ability to isolate and genetically modify human hepatocytes, as described in this report, is an important step towards the development of liver-directed gene therapies in humans.

Sentence comprehension and praxis deficits in Parkinson's disease

We evaluated the ability of nondemented patients with idiopathic Parkinson's disease (PD) to interpret various aspects of sentences and to perform learned limb and oral gestures. The patients were significantly compromised in their ability to answer simple questions about sentences such as "The eagle chased the hawk that was fast. Which bird was chased?" A discriminant analysis revealed that up to 73% of PD patients differ from control subjects in their ability to perform this task. Patients with PD were also significantly compromised in their gestural performance, and a discriminant analysis indicated that a praxis deficit may be evident in up to 64% of patients. We conclude that language and gestural processing impairments are frequent in patients with PD.

Multitrait animal model with genetic groups

Genetic groups of unknown parents are extended to the multitrait animal model. Computationally feasible mixed model equations are obtained. A strategy to include genetic groups for missing data is proposed. Canonical and triangular transformations can be applied to the multitrait animal model with groups if the transformations can be applied to the same model without groups. Formulations for REML estimation with groups are derived, and the results are almost as feasible as REML estimation without groups. A numerical example is given to illustrate computations of REML formulations.

Receptor-mediated gene delivery in vivo. Partial correction of genetic analbuminemia in Nagase rats

A plasmid (palb3) was constructed containing the structural gene for human serum albumin driven by mouse albumin enhancer-rat albumin promoter elements. Using an asialoglycoprotein-polycation conjugate consisting of asialoorosomucoid coupled to poly-L-lysine, a soluble DNA complex was formed that was capable of targeting specifically to hepatocytes via asialoglycoprotein receptors present on these cells. Groups of Nagase analbuminemic rats were injected with complexed DNA or controls, followed by two-thirds partial hepatectomy to stimulate hepatocyte replication. Using a cDNA probe for the human albumin structural gene, hybridizable sequences were detected in analbuminemic rats treated with complex as determined by Southern blot analysis. Two weeks post-injection, the targeted DNA was found to exist primarily in plasmid form with an average copy number of 1000/diploid cell. Human albumin mRNA was detected by dot-blot hybridization with a specific oligonucleotide cDNA probe and confirmed by RNase protection assay using a vector-specific probe. Circulating human albumin was detected in the serum of palb3-treated Nagase analbuminemic rats by Western blots using an antibody specific for human serum albumin. A time course demonstrated that circulating human albumin was not detectable 24 h after injection, but became measurable at a level of 0.05 micrograms/ml within 48 h and increased in concentration to a maximum of 34 micrograms/ml by 2 weeks post-injection. This level of expression remained stable through 4 weeks after injection and partial hepatectomy.

Applications of a multiphasic growth function to body composition in pigs

A multiphasic growth function was used to relate growth of body components to phases of total growth for pigs. Each phase of growth was characterized by asymptotic weight, age at maximum gain, and duration. Age at maximum gain and duration were expressed as a ratio and assumed constant for all phases. One application involved weights of total DM predicted directly with a diphasic function and indirectly with monophasic functions of fat-free DM and fat. Another involved weights of carcass side predicted directly with a diphasic function and indirectly with monophasic functions of offal + muscle + bone and fat + skin. Components were grouped on age at maximum gain. There was good agreement for asymptotic weight between body components and phases, and general agreement for age at maximum gain and for duration, except for carcass weights. A multiphasic growth function may provide a way to examine fat-adjusted weight in living animals because growth of fat appears as a late phase in a multiphasic description of total body growth.

On the principle underlying the tabular method to compute coancestry

The tabular method to compute coancestry between two individuals is based on the principle that coancestry may be computed as the average coancestry between one individual and the parents of the other, on the condition that the former individual is not a direct descendent of the latter. It follows that coancestry also may be computed as the average of the four coancestries between the parents of the two individuals, on the condition that each individual is not a direct descendent of the other. The requirement for these conditions is explained.

The dynamic relationship between low birthweight and induced abortion in New York City. An aggregate time-series analysis

We use a vector autoregression to examine the dynamic relationship between the race-specific percentage of pregnancies terminated by induced abortion and the race-specific percentage of low-birthweight births in New York City. With monthly data beginning in 1972, we find that induced abortion explains low birthweight for blacks, but not for whites. There is no evidence of feedback from low birthweight to induced abortion. The findings suggest that unanticipated decreases in the percentage of pregnancies terminated by induced abortion would worsen birth outcomes among blacks in New York City.