Taking lessons from dendritic cells: multiple xenogeneic ligands for leukocyte integrins have the potential to stimulate anti-tumor immunity

Expression of large numbers of different costimulatory integrin ligands (CILs) attributes dendritic cells with an ability to induce primary anti-tumor immune responses. Here, we show that optimized gene transfer of the xenogeneic (human) CILs VCAM-1, MAdCAM-1 and ICAM-1 causes rapid and complete rejection of established mouse EL-4 tumors, and generates prolonged systemic anti-tumor immunity; whereas human E-cadherin weakly slows tumor growth. In each case the immune response was mediated by CD8+ T cells and NK cells, accompanied by augmented tumor-specific cytolytic T cell (CTL) activity involving both the perforin and Fas-ligand pathways. Adoptive transfer of splenocytes from cured mice rapidly cleared established tumors in recipients. The mechanism for CIL-mediated immunity is unknown, but may involve CTL-facilitated tumor lysis, since CTLs were generally twice as efficient at killing CIL-transfected tumor cells than parental tumor cells. Optimized CIL-based gene therapy may provide an approach to complement or replace conventional DC adoptive cell therapy for suppressing tumor growth.

Serum vitamin A concentration is elevated in idiopathic intracranial hypertension

OBJECTIVE

The primary purpose was to investigate whether serum vitamin A concentration is associated with idiopathic intracranial hypertension (IIH). The secondary aim was to obtain pilot data regarding the amount of vitamin A ingested by patients and controls.

BACKGROUND

Vitamin A is an attractive candidate mediator of IIH as many of the symptoms and signs of hypervitaminosis A mimic those of IIH.

METHODS

We prospectively determined serum retinol and retinyl ester concentration in 16 women with IIH and 70 healthy young women. Using a survey instrument, we also determined the average daily vitamin A ingestion in a convenience sample of patients and controls.

RESULTS

Serum retinol concentration was significantly higher in the patient group (median 752 ug/L) compared with the control group (median 530 ug/L), even after adjusting for age and body mass index (p < 0.001). Retinyl ester concentration, however, was similar in the patient (median 48 ug/L) and control (median 41 ug/L) groups (p = 0.32). There was no significant correlation between serum retinol concentration and body mass index in the patients (r = 0.16) or controls (r = -0.02). Finally, there was no significant difference in the amounts of vitamin A ingested by the patients or controls, although the small number of subjects in both groups reduced the power of this conclusion.

CONCLUSIONS

Elevated serum retinol concentration is associated with IIH. Obesity, by itself, does not explain these higher levels. Patients may ingest an abnormally large amount of vitamin A, metabolize it abnormally, or be unusually sensitive to its effects. Alternatively, elevated level of serum retinol may reflect an epiphenomenon of another variable we did not measure or a nonspecific effect of elevated retinol binding capacity.

Prognostic significance of DNA ploidy in endometrial cancer

OBJECTIVE

The aim of this study was to analyze the prognostic significance of DNA ploidy in patients with endometrial cancer.

METHODS

Between October 1988 and January 1997, DNA ploidy was determined prospectively in 208 women who were staged surgically by a standard protocol that included pelvic and para-aortic lymphadenectomy. Median follow-up was 48 months.

RESULTS

Diploid tumors were identified in 154 (74%) patients and aneuploid tumors in 54 (26%). Patients with aneuploid tumors had a significantly higher prevalence of metastases to the cervix, adnexa, and omentum, malignant pelvic cytology, and advanced surgical stage. Patients with aneuploid tumors had a 4.5 times higher prevalence of pelvic lymph node metastases and a 5.8 times higher prevalence of para-aortic lymph node metastases. A significantly higher proportion of patients with aneuploid tumors was diagnosed with recurrent or progressive endometrial cancer (22.2 versus 6.5%, P = 0.002). Patients with aneuploid tumors had a significantly lower rate of survival from cancer death (P = 0.038) with 83% versus 94% surviving 5 years.

CONCLUSION

Patients with aneuploid tumors are at high risk for lymph node metastases and should be surgically staged, including pelvic and para-aortic lymphadenectomy. Aneuploidy confers a risk for endometrial cancer death and these patients should be candidates for clinical trials evaluating treatment following surgery.

Evaluation of orthodontic treatment success in patients with pronounced Angle Class III

The aim of this study was to assess the success of orthodontic treatment of pronounced Angle Class III malocclusions. The records of 16 patients with pretreatment mesial occlusion and negative overjet were analyzed by evaluating the plaster casts and lateral cephalograms made at the beginning (B1) and end (B2) of active treatment, which was purely orthodontic in all cases. After treatment the patients were divided into 2 groups: group 1 (n = 10) with virtually ideal occlusal relationships, and group 2 (n = 6) where this was not the case. Professional assessment of the results using the Peer Assessment Rating (PAR) Index revealed a reduction of the weighted PAR scores of 90.2% in group 1 and 68.8% in group 2. A questionnaire was specially designed to obtain information on the patient's rating of the treatment and of the treatment outcome. 75% of the patients addressed answered the questionnaire. Following correction of the frontal crossbites, both groups displayed a clear-cut improvement of the sagittal lip relationship; this sometimes had a striking effect on the facial esthetics. The size and heterogeneity of the sample permit only cautious interpretation of the results. However, the study suggests from what degree of Angle Class III malocclusion surgical intervention is more likely to be indicated, although the final decision on elective surgery of this kind must always be left to the patient. The PAR Index offers various advantages in assessing treatment results. However, in view of its lack of esthetic sensitivity, it should be supplemented by other assessment methods.

Orthodontics at the turn of the century. A discussion of some relevant aspects

Some changing paradigms, that might influence orthodontics in the future, are being discussed: economic problems related to our welfare systems; development of the media societies; concepts of normality; future changes as regards the type of treatment records; evaluation of treatment outcome; "exaggerated orthodontics?"; orthodontics and facial aesthetics; Newtonian paradigms and scientific revolution; the growth of knowledge; phenomenology; tacit knowledge; decision making.

Retrospective evaluation of the outcome of orthodontic treatment in adults

The aim of this study was the retrospective evaluation of the outcome of orthodontic treatment in consecutively treated adult patients. Of 147 adult patients, it was possible to evaluate the records of 88 patients (57 female, 31 male) before (T1) and after treatment (T2), and of 20 of these patients 3.3 years on average after completion of the retention phase (T3). During treatment planning, a nearly "ideal" result was considered attainable (ideal group) for 46 patients, and a "compromise" result (compromise group) was seen as realistic for 42. The assessment was made using the PAR (Peer Assessment Rating) index and the Aesthetic Component (AC) and Dental Health Components (DHC) of the IOTN (Index of Orthodontic Treatment Need). Average length of treatment in the ideal group was 2.4 years, i.e. nearly twice as long as in the compromise group. The PAR score was reduced by an average of 56% (T2); the reduction in the ideal group was 73%, and in the compromise group 37%. Among the 20 patients for whom at least 6 months had elapsed since completion of the retention phase, a statistically significant relapse between T2 and T3 was observed. The evaluation of overjet and overbite and, in the ideal group, of the midline and maxillary front teeth were primarily responsible for the worsening of the PAR scores between T2 and T3. According to the AC, 53 patients (60%) had moderate to definite treatment needs at the beginning of treatment. Following completion of active treatment, 69 patients (78%) no longer demonstrated treatment indications for aesthetic or psychosocial reasons. Based on the DHC, 88% of the patients were in definite or moderate need of treatment (T1); in contrast, treatment was no longer indicated in 84% at T2. In general, a marked improvement of the examined morphological parameters was observed.

How mental health providers see managed care

This paper reports findings from two focus groups on managed care conducted in a large U.S. city in 1989. Questions addressed included how managed care had affected mental health practice, specific experiences with managed care, the mechanisms of managed care, and how managed care could be improved. The practitioners complained of multiple problems, but clearly distinguished between "good" and "bad" firms. Firms seen as more positive struck a balance between quality care and cost containment, built ongoing relationships with providers, and negotiated with providers, rather than prescribing a treatment plan. The authors conclude that some of the poor reception by providers of managed care may have been created unnecessarily by firms which have not attended to these factors, and that attention to such factors might lead to a more ready acceptance of managed care.

Analysis of leukocytes recruited to the pancreas by diabetogenic T cell clones

To investigate host leukocytes recruited to the pancreas by diabetogenic T cells, we administered islet-specific CD4(+) T cell clones to 2-week-old nonobese diabetic (NOD) mice and examined the resulting pancreatic infiltrate by flow cytometry. Two different Vbeta4(+)CD4(+) T cell clones, BDC 2.5 and BDC 6.9, were found to recruit a heterogeneous T cell population as determined by staining with a panel of anti-TCR Vbeta monoclonal antibodies. The majority of the diabetes-initiating, Vbeta4(+) T cell clones migrated to the spleen whereas only 5-8% of the T cell population infiltrating the pancreas was Vbeta4(+). Anti-IL-2 receptor staining indicated that fewer than 10% of the total population of infiltrating lymphocytes within the pancreas were in a highly activated state. We have further found that normal splenic T cells from the NOD mouse proliferate poorly to IL-2 in vitro, yet secrete IFN-gamma in response to IL-2 stimulation. These results suggest that the recruited host T cells in our disease transfer system are not directly pathogenic but, rather, are responding to the small numbers of inflammatory T cell clones by providing cytokines that facilitate the disease process.

Knowledge and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use among athletes

The authors assessed high-school athletic coaches' perceptions about oral-facial injuries and mouthguard use in sports that do not mandate mouthguard use. About 72 percent of the coaches said that their athletes sustained oral-facial injuries, 28 percent that some athletes used mouthguards regularly, 48 percent that athletes had sustained injuries and did not use mouthguards regularly, and 31 percent said they would not encourage mouthguard use. Advocacy for mouthguard use should focus on coaches, coaches' associations and rule-making organizations.

Dental caries prevalence and treatment need in Chiriqui Province, Panama

A pathfinder pilot survey was conducted in rural Chiriqui Province, Panama, using standard WHO methodology, in order to estimate dental caries prevalence and treatment need. Examinations for caries and treatment need were performed by six trained, experienced examiners. From a convenience sample of 2,597 subjects, a stratified cluster sample was constructed using index ages 12 and 15 years and age groups 35-44 and 65-74 years. The results showed a mean Decayed, Missing and Filled Teeth index (DMFT) of 4.08 for 12 year olds, 6.40 for 15 year olds, 13.20 for the 35-44 age group, and 18.88 for the 65-74 age group (P < 0.001). No statistically significant differences by gender were found. These findings rank rural Panama with Mexico and Haiti when compared to the results of other Central American community studies. The percentage of caries free 12 year olds was 6.8 per cent. Of the total sample, 74.7 per cent of individuals would require one or multiple surface restorations and 47.9 per cent would require at least one extraction. Restorative need was greatest in the 15 year olds. The severity of dental caries in this sample was moderately severe and the treatment need extraordinarily high.

Identification of multiple forms of 180-kDa ribosome receptor in human cells

Herein, we describe the analysis and mapping of cDNA clones encoding variant forms of the human homolog of the canine 180-kDa ribosome receptor (p180). One form, similar to the chicken ES/130 homolog, possesses a large uninterrupted C-terminal region composed predominantly of heptad repeats predicted to form an alpha-helical double-stranded coiled-coil rod. Other forms contain in addition a 10-amino acid consensus motif, NQGKKAEGAQ, repeated up to 54 times in tandem close to the N-terminus. Such repeats in canine p180 represent a ribosome-binding domain. The cDNA hybridized to a major 6-kb transcript in all tissues examined, where very high expression was observed in tissues that carry out a high level of secretion such as pancreas, liver, and placenta. The ES130/p180 gene was mapped to chromosome 20p12, and a potential pseudogene appears to reside on chromosome 7. In summary, the data suggest that p180 exists in humans in different forms because of complete removal of tandem repeats, or partial intraexonic splicing, creating different repeat lengths with potentially novel ribosome-binding characteristics.

A novel extracellular domain variant of the human integrin alpha 7 subunit generated by alternative intron splicing

The integrin alpha 7 beta 1 laminin receptor, which is expressed on replicating myoblasts, and upregulated during myogenic differentiation, is involved in cell adhesion and communication between muscle cells and the extracellular matrix. It is a major cell-surface substrate in skeletal muscle cells for the cell-surface, argininespecific, ADP-ribosyltransferase. Both the extracellular and cytoplasmic domains of the mouse alpha 7 subunit undergo alternative splicing during development, generating differentially expressed variants with presumably unique ligand-binding and signalling properties. Here human cDNA clones isolated from a fetal heart lambda gt10 cDNA library encoded the complete sequence of the alpha 7 subunit and hybridised to a single major 4.4 kb alpha 7 subunit transcript abundantly expressed in human skeletal muscle, moderately expressed in heart, and weakly expressed in most other tissues. One clone out of four contained a novel 225-nucleotide in-frame deletion corresponding to 75 amino acids in the C-terminal region of the extracellular domain. The variant, whose expression appears to be tissue-specific, is created by alternative splicing at sites flanking an intron in the alpha 7 gene. A related mouse form was identified in P19 embryonal carcinoma cells. Deletion of the spliced region, which either contains or is in very close proximity to the major ADP-ribosylation site of the alpha 7 subunit, may serve to modulate the effects of ADP-ribosylation, or alternatively molecular associations, and receptor-ligand affinity.

Physiologic changes in the elderly

A variety of age-related changes in the oral cavity and throughout the aging body can affect dental care and treatment plans. Some of these changes may be unavoidable features of senescence. Others, previously thought to be part of "normal aging," may be modifiable with lifestyle choices or may represent subclinical pathological processes. The ability to compensate for losses in system capacity varies among individuals and may result in functional changes ranging from substantial to unmeasurable. An appreciation of the intricacy of these relationships, and coordinated treatment with the primary care physician, can enhance the dental care of the aged patient.

xid affects events leading to B cell cycle entry

X-linked agammaglobulinemia patients and X-linked immunodeficient (xid) mice possess mutations in the Bruton's tyrosine kinase (Btk kinase) gene and display defects in B cell development and activation by sIg cross-linking. Btk is an early activation kinase in sIg-cross-linked B cells. xid does not ablate Btk protein kinase activity, and immediate signal transduction events, such as tyrosine phosphorylation, occur in sIg-activated xid B cells. These cells do not subsequently progress into cell division and have a high rate of apoptosis, which has been shown to correlate with an absence of sIg-mediated induction of the bcl-xL protein. To establish the point where Btk activity is critical for progression beyond immediate signaling, we examined early and late events in sIg-cross-linked xid B cells. Induction of proto-oncogenes and nuclear factors occurred normally in xid cells. However, induction of cyclins and increased GAPDH mRNA was not observed in xid cells. Degradation of the cyclin inhibitor p27Kip1 occurred normally in xid cells. After 24 h of culture with anti-mu, the remaining live, nonapoptotic xid cells were enlarged, viable, and primed for subsequent stimulation by LPS. Our data suggest that the Btk kinase is not essential for several G1 events and that the failure of sIg-activated xid B cells to enter cell cycle correlates with a defect of cyclin induction. Moreover, these data suggest that Btk is important not only for immediate events following B cell activation and control of apoptosis but also for subsequent events leading to cyclin activation.

xid affects events leading to B cell cycle entry

X-linked agammaglobulinemia patients and X-linked immunodeficient (xid) mice possess mutations in the Bruton's tyrosine kinase (Btk kinase) gene and display defects in B cell development and activation by sIg cross-linking. Btk is an early activation kinase in sIg-cross-linked B cells. xid does not ablate Btk protein kinase activity, and immediate signal transduction events, such as tyrosine phosphorylation, occur in sIg-activated xid B cells. These cells do not subsequently progress into cell division and have a high rate of apoptosis, which has been shown to correlate with an absence of sIg-mediated induction of the bcl-xL protein. To establish the point where Btk activity is critical for progression beyond immediate signaling, we examined early and late events in sIg-cross-linked xid B cells. Induction of proto-oncogenes and nuclear factors occurred normally in xid cells. However, induction of cyclins and increased GAPDH mRNA was not observed in xid cells. Degradation of the cyclin inhibitor p27Kip1 occurred normally in xid cells. After 24 h of culture with anti-mu, the remaining live, nonapoptotic xid cells were enlarged, viable, and primed for subsequent stimulation by LPS. Our data suggest that the Btk kinase is not essential for several G1 events and that the failure of sIg-activated xid B cells to enter cell cycle correlates with a defect of cyclin induction. Moreover, these data suggest that Btk is important not only for immediate events following B cell activation and control of apoptosis but also for subsequent events leading to cyclin activation.