Pacific ciguatoxin-1 associated with a large common-source outbreak of ciguatera in east Arnhem Land, Australia

We report a retrospective study of the clinical signs and symptoms associated with a point-source outbreak of fish poisoning that occurred with a fish captured from the Arafura Sea, northern Australia. Twenty cases (16 Aboriginal and 4 non-Aboriginal) characteristic of ciguatera, including 4 inpatients and 16 outpatients from the Gove Hospital, were identified based on the pattern of clinical symptoms and signs after ingestion of a large coral cod from a known ciguatera-prone coral reef. In the absence of a serologic test for the victim, laboratory analysis of a 230-g sample of the coral cod (Cephalopolis miniatus), using both mouse bioassay and HPLC/mass spectometry, showed that Pacific ciguatoxin-1 was the principal toxin involved. Intravenous mannitol was administered to one patient without clear benefit. Risk factors for ciguatera poisoning are ingestion of larger portions of reef fish from ciguatera-prone areas. Despite apparent local awareness of the distribution and etiology of the disease, large common-source outbreaks of ciguatera still occur.

Effect of low-dose radiation on mouse dermal tissue using wound strength as an endpoint

PURPOSE

To investigate the existence of enhanced sensitivity of dermal tissue to low radiation doses in the range of 0.1 Gy to 4 Gy/fraction.

MATERIALS AND METHODS

Top-up technique of giving higher radiation doses to skin alone from 150 kVp X-rays followed by fractionated experimental doses to total body from 137Cs were given to C3H mice. Full-depth incisions were made and the tensile strength of skin from 14 day wounds were measured as a response of dermal tissue to radiation.

RESULTS

There was no evidence of enhanced radiosensitivity to doses as low as 0.1 Gy. The data were better fitted by a nonparametric method that predicted the shape of survival curve better than an induced-repair model.

CONCLUSIONS

Dermal tissue like spinal cord has a low sensitive fraction of cells, unlike jejunum, kidney or lung that showed sensitivity at these doses. Tissue kinetics play an important role in the use of low dose fractions to avoid injury to normal tissues.

Two hepatic enhancers, HCR.1 and HCR.2, coordinate the liver expression of the entire human apolipoprotein E/C-I/C-IV/C-II gene cluster

We show that the liver-specific expression of all four genes in the human apolipoprotein (apo) E/C-I/C-IV/C-II gene cluster in transgenic mice is determined by the coordinate action of two distinct hepatic control regions (HCR). These enhancers are positioned 15 kilobases (kb) (HCR.1) and 26 kb (HCR.2) downstream of the apoE gene. To investigate the action of each HCR, transgenic mice were generated with a 70-kb human genomic fragment that contained the complete apoE gene cluster or with this fragment modified by the specific deletion of HCR.1, HCR.2, or both HCR domains. Hepatic expression of all four apolipoprotein genes was observed in transgenic mice in which either HCR.1 or HCR.2 was deleted, but no transgene expression was found in the liver in the absence of both HCR domains. The overall patterns of transgene expression suggested that HCR.2 was the dominant element for apoC-IV and apoC-II expression and that HCR.1 was dominant for the apoE/C-I expression. No liver-specific transcriptional activity was identified for the proximal promoter of any gene in the cluster; all liver-specific activity was associated with HCR.1 and HCR.2. Thus, the HCRs of the apoE gene cluster constitute unique regulatory domains for determining the requirements for apolipoprotein gene expression in the liver.

Non-linear effects in dose-time analyses: application of modern statistical techniques

BACKGROUND AND PURPOSE

The non-linear effect of overall treatment time and total dose on the outcome of fractionated head and neck radiotherapy is of interest. This and other non-linear effects can be investigated using recently developed statistical techniques. This article provides an illustration of the ability of these statistical methods.

MATERIALS AND METHODS

Recently developed statistical methods (Hastie, T.J. and Tibshirani, R.J. Generalised Additive Models. Chapman-Hall, London, 1990), called generalized additive models, are applied to data from the patterns of fractionation study (Withers, H.R., Peters, L.J., Taylor, J.M.G., Owen, J.B., Morrison, W.H., Schultheiss, T.E., Keane, T., O'Sullivan, B., van Dyk, J., Gupta, N., Wang, C.C., Jones, C.U., Doppke, K.P., Myint, S., Thompson, M., Parsons, J.T., Mendenhall, W.M., Dische, S., Aird, E.G.A., Henk, J.M., Bidmead, M.A.M., Svoboda, V., Chon, Y., Hanlon, A.L., Peters, T.L. and Hanks, G.E. Local control of carcinoma of the tonsil by radiation therapy: an analysis of patterns of fractionation in nine institutions. Int. J. Radiat. Oncol. Biol. Phys. 33: 549-562, 1995) of tonsil cancer. These techniques enable one to develop models which more accurately represent the relationship between multivariate predictor variables and the outcome variable in a regression analysis. These data driven methods allow the effect of each predictor variable on the outcome to be non-linear and estimated from the data. This is achieved by replacing the standard linear model combination of predictor variables, such as 'alpha0 + alpha1dose + alpha2time' by 'S1(dose) + S2(time)', where S1 and S2 are smooth non-linear functions of dose and time, respectively, which are estimated from the data.

RESULTS

In the pattern of fractionation study these methods indicate that the effect of total dose on the probability of local recurrence is linear, but there is a suggestion that the effect of overall treatment time is non-linear. There is no effect of dose and time on the latency time to recurrence of those who do recur, but there is a weak suggestion of a non-linear effect of patients age, with younger patients recurring earlier.

CONCLUSIONS

Generalized additive models provide a flexible and powerful means of exploring non-linear effects in experimental data.

A role for the ETS domain transcription factor PEA3 in myogenic differentiation

Activation of adult myoblasts called satellite cells during muscle degeneration is an important aspect of muscle regeneration. Satellite cells are believed to be the only myogenic stem cells in adult skeletal muscle and the source of regenerating muscle fibers. Upon activation, satellite cells proliferate, migrate to the site of degeneration, and become competent to fuse and differentiate. We show here that the transcription factor polyomavirus enhancer activator 3 (PEA3) is expressed in adult myoblasts in vitro when they are proliferative and during the early stages of differentiation. Overexpression of PEA3 accelerates differentiation, whereas blocking of PEA3 function delays myoblast fusion. PEA3 activates gene expression following binding to the ets motif most efficiently in conjunction with the transcription factor myocyte enhancer factor 2 (MEF2). In vivo, PEA3 is expressed in satellite cells only after muscle degeneration. Taken together, these results suggest that PEA3 is an important regulator of activated satellite cell function.

Annexin I in fibrotic rat lung and cultured lung fibroblasts following irradiation

Radiation-induced lung fibrosis is a result of collagen accumulation in the interstitium, partly due to increased collagen synthesis by fibroblasts. One feature of active collagen synthesis is increased membrane trafficking in the fibroblasts. A group of proteins called annexins is believed to play a regulatory role in membrane fusion and exocytosis. Therefore, increased annexin activity might be expected in the fibrotic lung. We tested this hypothesis by measuring annexin I levels, hydroxyproline content and ultrastructural changes in radiation-induced pulmonary fibrosis in rat. Three months after a single exposure to 30 Gy of X-rays to the right hemithorax, the right lung of the rat was atrophied and fibrotic with a concomitant increase in size of the shielded left lung. Electron micrographs revealed that the irradiated lung was ladened with interstitial collagen fibrils, with increased number of fibroblasts amongst them. Hydroxyproline concentration in the irradiated lung was nearly twice that in the sham-irradiated lung. Annexin I in the irradiated lung, on the other hand, was markedly reduced, and barely detectable on immunoblots. Since increased annexin I might precede enhanced collagen production, we also measured annexin I levels in rat lungs 3 days after 30 Gy irradiation and correlated that with hydroxyproline concentration. We found no appreciable difference in annexin I levels and hydroxyproline content between sham-irradiated and irradiated lungs at 3 days. To determine whether annexin I levels in cultured fibroblasts were altered by irradiation, we assayed annexin I in cultured rat lung fibroblasts 3 days after 0.10 Gy exposure, with concomitant measurement of 14C-proline incorporation. The annexin I level in fibroblasts irradiated with 10 Gy X-rays was 55% higher than in sham-irradiated fibroblasts. However, incorporation of 14C-proline into collagenase-sensitive macromolecules in the culture medium and extracellular matrix was not different between these two groups of cells. These data demonstrate a radiation-induced increase in immunoreactive annexin I in cultured lung fibroblasts, but fail to support the hypothesis of a positive correlation between annexin I concentration and fibrosis in irradiated rat lung.

B-cell target DNA quantity is a critical factor in the interpretation of B-cell clonality by PCR

Criteria for the assessment of clonality by Southern blotting are well established but this is not the case for polymerase chain reaction (PCR)-based assays. Our studies, and infrequent reports in the literature, indicate that B-cell clonality may be erroneously inferred if only small numbers of polyclonal B-cells are present in test samples. In order to establish criteria to minimise the false positive assignment of B-cell clonality, DNA was analysed in a semi-nested PCR to detect rearrangement of the immunoglobulin heavy chain gene using a range (1 microgram-0.1 ng) of target DNA amounts from four tonsils and five lymph nodes showing reactive follicular hyperplasia, and from six B-cell lymphomas. A discrete, narrow band of PCR product of constant size was detected throughout the range of target DNA amounts in most lymphomas indicating the presence of a monoclonal B-cell population. In contrast, from the non-malignant tonsils and lymph nodes, larger target amounts generated a broad band of PCR products indicating populations of polyclonal B-cells, but smaller target amounts generated discrete, narrow PCR product bands of inconstant size indicating oligo- or monoclonal B-cell populations. Results of this study demonstrate that a range of DNA target amounts should be tested when the proportion of B-cells in a sample is unknown, thus preventing the analysis of insufficient target DNA which may lead to the false assignment of clonality.

Captopril modulates hormone receptor concentration and inhibits proliferation of human mammary ductal carcinoma cells in culture

The present study evaluated the effect of the angiotensin converting enzyme (ACE) inhibitor captopril on estrogen (ER) and progesterone (PR) receptor concentration and on proliferation in two lines of human mammary ductal carcinoma cells in culture: T-47D (ER+/PR+) and Hs578T (ER-/PR-). The incorporation of [3H]thymidine, validated by cell count, served as an index of proliferation. Compared to control cells, T-47D cells incubated for 48 hrs in 1, 2, or 5 mM captopril (but not in 0.5 mM) exhibited a reduction in ER from 130 +/- 6 to 32 +/- 32 fmol/mg cytosolic protein, and an increase in PR from 1780 +/- 120 to 2740 +/- 400 fmol/ mg protein (p < 0.05). Western analysis confirmed these drug-induced changes in the concentration of immunoreactive receptor proteins. Captopril also induced the appearance of low but detectable PR in the Hs578T cells at concentrations as low as 50 microM. Captopril inhibited the incorporation of [3H]thymidine by both cell types during a 48 hr incubation, although Hs578T cells were 2-3 times more resistant than were T-47D cells. This cytostatic effect of captopril was not due to cytotoxicity as indicated by 51Cr release, and was not accompanied by significant changes in cell cycle distribution as determined by flow cytometry. The incorporation of [3H]uridine (RNA synthesis) and [14C]alanine (protein synthesis) also were inhibited by captopril, suggesting a general antimetabolic effect of the drug in the ductal carcinoma cells. These are novel actions of a common antihypertensive agent. In contrast, the nonthiol ACE inhibitor lisinopril, and penicillamine, a thiol compound with virtually no ACE inhibitory activity, had no effect on any of these endpoints.

Effects of nucleotide changes on the ability of hepatitis delta virus to transcribe, process, and accumulate unit-length, circular RNA

The circular RNA genome of hepatitis delta virus (HDV) can fold into an unbranched rodlike structure. We mutagenized the two ends of this structure and assayed the effects on the ability of the genomes to replicate and accumulate processed RNA transcripts in transfected cells. The top end, defined as that nearest to the 5' end of the putative mRNA for delta antigen, was much more sensitive than the other end, defined as the bottom. Most of the 22 mutants made at the bottom were able to accumulate RNA as well as the wild type. For deletions extending as close as 2 nucleotides (nt) from the predicted domains needed for the two ribozymes, the accumulation levels dropped to <0.1%. In one mutant, 13 nt of HDV was replaced with 57 nt of non-HDV sequences, and accumulation was at 20% of the wild-type level, consistent with the potential of HDV to act as a vector. However, after replacement with a second sequence, accumulation dropped to 1%. For most of the 14 mutants made at the top of the rod, we observed dramatic inhibitory effects. For example, after removal of 3 bp from the stem adjacent to the terminal loop, accumulation dropped to <0.06% of the wild-type genome level. The top region that we considered was adjacent to both the 5' end of the putative mRNA and the domain that has been proposed to contain a promoter for RNA-directed RNA synthesis. The RNA accumulation abilities of certain mutants were tested under additional different experimental conditions. It was found that after longer times, some mutants began to catch up with the wild type. Also, it was found that certain top mutants gave much greater levels of accumulation when transfected into cells containing the small delta antigen. One interpretation of these data is that certain features at the top of the rod are needed for the accumulation of essential delta antigen mRNA species.

Transgenic rabbit models for the study of atherosclerosis

The rabbit rapidly develops severe hypercholesterolemia leading to premature atherosclerosis in response to dietary manipulation. Transgenic rabbit models with altered expression of specific genes will provide new approaches to understanding the underlying mechanisms that contribute to this disease. Recently established lines of transgenic rabbits that overexpress hepatic lipase and apolipoprotein E are yielding fresh insights into the functions of these proteins and their role in lesion development

A stochastic model for the analysis of bivariate longitudinal AIDS data

We present a model for multivariate repeated measures that incorporates random effects, correlated stochastic processes, and measurement errors. The model is a multivariate generalization of the model for univariate longitudinal data given by Taylor, Cumberland, and Sy (1994, Journal of the American Statistical Association 89, 727-736). The stochastic process used in this paper is the multivariate integrated Ornstein-Uhlenbeck (OU) process, which includes Brownian motion and a random effects model as special limiting cases. This process is an underlying continuous-time autoregressive order [AR(1)] process for the derivatives of the multivariate observations. The model allows unequally spaced observations and missing values for some of the variables. We analyze CD4 T-cell and beta-2-microglobulin measurements of the seroconverters at multiple time points from the Los Angeles section of the Multicenter AIDS Cohort Study. The model allows us to investigate the relationship between CD4 and beta-2-microglobulin through the correlations between their random effects and their serial correlation. The data suggest that CD4 and beta-2-microglobulin follow a bivariate Brownian motion process. The fit of the model implies that an increase in beta-2-microglobulin is associated with a decrease in future CD4 but not vice versa, agreeing with immunologic postulates about the relationship between these two variables.

Effects of elevated CO(2) on chloroplast components, gas exchange and growth of oak and cherry

Specific chloroplast proteins, gas exchange and dry matter production in oak (Quercus robur L.) seedlings and clonal cherry (Prunus avium L. x pseudocerasus Lind.) plants were measured during 19 months of growth in climate-controlled greenhouses at ambient (350 vpm) or elevated (700 vpm) CO(2). In both species, the elevated CO(2) treatment increased the PPFD saturated-rate of photosynthesis and dry matter production. After two months at elevated CO(2), Prunus plants showed significant increases in leaf (55%) and stem (61%) dry mass but not in root dry mass. However, this initial stimulation was not sustained: treatment differences in net assimilation rate (A) and plant dry mass were less after 10 months of growth than after 2 months of growth, suggesting acclimation of A to elevated CO(2) in Prunus. In contrast, after 10 months of growth at elevated CO(2), leaf dry mass of Quercus increased (130%) along with shoot (356%) and root (219%) dry mass, and A was also twice that of plants grown and measured at ambient CO(2). The amounts of Rubisco and the thylakoid-bound protein cytochrome f were higher in Quercus plants grown for 19 months in elevated CO(2) than in control plants, whereas in Prunus there was less Rubisco in plants grown for 19 months in elevated CO(2) than in control plants. Exposure to elevated CO(2) for 10 months resulted in increased mean leaf area in both species and increased abaxial stomatal density in Quercus. There was no change in leaf epidermal cell size in either species in response to the elevated CO(2) treatment. The lack of acclimation of photosynthesis in oak grown at elevated CO(2) is discussed in relation to the production and allocation of dry matter. We propose that differences in carbohydrate utilization underlie the differing long-term CO(2) responses of the two species.

Hepatic lipase is abundant on both hepatocyte and endothelial cell surfaces in the liver

The cellular location of hepatic lipase was investigated in transgenic rabbits that expressed human hepatic lipase in the liver. The binding of monoclonal antibodies to human hepatic lipase, as detected by either fluorescence-tagged or gold-conjugated secondary antibodies, showed that hepatic lipase was concentrated at the surfaces of hepatic sinusoids. This distribution was the same as observed in the human liver. At the ultrastructural level, immunogold labeling of the space of Disse showed hepatic lipase on both lumenal and sublumenal surfaces of rabbit liver sinusoidal endothelial cells. An equivalent amount of hepatic lipase also was found on the external surfaces of hepatocyte microvilli in the space of Disse, as well as in the interhepatocyte spaces. The distribution suggests that a majority of the hepatic lipase produced by the liver is associated with hepatocyte surfaces, consistent with the functions of this enzyme in lipoprotein metabolism.

Dependence of the hazard of AIDS on markers

OBJECTIVE

To investigate the dependence of the hazard of symptomatic AIDS on various markers using a non-parametric method. The markers we consider are measures of time (time since infection and calendar date), measures of immune function (numbers and percentage of CD4 T cells) and serological activation markers (neopterin and beta 2-microglobulin).

METHODS

We adapted a non-parametric statistical method to estimate the hazard of AIDS. We considered both univariate analyses, in which each marker was considered separately and bivariate analyses of pairs of markers.

CONCLUSIONS

Using data from 356 seroconverters from the Multicenter AIDS Cohort Study, we found that in the univariate analyses the hazard of AIDS is dependent on all markers, with the strongest dependence for CD4 count and CD4 percentage. In the bivariate analyses we found that the time since infection is of little importance in determining the hazard of AIDS if the CD4 count or percentage are known, and is of minor additional value if one of the serological markers is known. In contrast, we found that both beta 2-microglobulin and neopterin do add some additional information to the hazard of AIDS if CD4 count or CD4 percentage are known.

Annexin I concentration and prostacyclin production in rat lung and alveolar macrophages following irradiation

The purpose of this study was to gather additional evidence in irradiated rat lung on the relationship between annexin I and prostaglandin synthesis. The right hemithorax of the animal was exposed to a single dose of 0 or 30 Gy of X-rays, and the animals were killed 3 months postirradiation. Levels of annexin I and synthesis of prostacyclin (PGI2) were determined in lungs, in cell-free bronchoalveolar lavage (BAL) fluid, and in macrophages lavaged from those lungs. In addition, protein concentration, lactate dehydrogenase (LDH) activity and macrophage count in BAL fluid obtained from irradiated lung were compared with that from sham-irradiated (0 Gy) lung. Levels of annexin I, the putative inhibitor of phospholipase A2, in lung and cell-free BAL fluid were decreased in samples from irradiated animals. By contrast, the level of annexin I in macrophages lavaged from irradiated lung was higher than that in macrophages from sham-irradiated lung. The irradiated lung produced nearly 3.5 times more prostacyclin than did the control lung. However, prostacyclin synthesis by macrophages lavaged from irradiated lung was no different than that of macrophages from sham-irradiated lung. Protein, LDH and macrophage number in BAL fluid from irradiated lungs were significantly higher than in corresponding specimens from sham-irradiated lungs. These data demonstrate that reduced levels of annexin I, as well as increased protein concentration, LDH activity and macrophage numbers in irradiated rat lung are reflected in BAL fluid. Therefore, information obtained from BAL fluid, but not from BAL macrophages, reflects lung status, and may serve as a minimally invasive index of radiation pneumonitis in this model. In irradiated lung, increased PGI2 synthesis coupled with a decreased annexin I level are consistent with the hypothesis of an inhibitory role of annexin I in prostaglandin metabolism. However, this hypothesis is not supported by findings in BAL macrophages, where increased annexin I concentration is not accompanied by a decrease in PGI2 production. In view of the latter findings, and a previous study from our laboratory demonstrating that phospholipase activity in irradiated rat lung is in fact decreased, despite the reduction in annexin I concentration and the hyperproduction of prostanoids, it would seem unlikely that annexin I negatively modulates prostaglandin synthesis via inhibition of phospholipase in this model.

Early levels of CD4, neopterin, and beta 2-microglobulin indicate future disease progression

Reduced CD4 T cell level and increased serum neopterin and beta 2-microglobulin levels, which reflect immunological activation and dysregulation, are three important markers of HIV disease. The aim in this study is to delineate more clearly the relation of activation to future CD4 values and disease progression. By analyzing a cohort of 198 seroconverters from the Multicenter AIDS Cohort Study with 9 years' follow-up, the dynamic changes and levels of these three markers and their interrelationships are explored. We observed that the levels of markers in the first year after seroconversion have a much stronger impact on the progression of the disease than the preseroconversion marker levels. The actual change during the year after seroconversion is not as important as the final level reached during that year. The early levels of markers after seroconversion appear to be good indicators of the subsequent course of disease as defined by CD4 level and slightly better than the quantitative changes following seroconversion or the changes in the period 1 to 2.5 years after seroconversion. To investigate the variation between subjects, the 198 seroconverters were stratified into three approximately equal-sized groups in 12 ways based on their pre- and postseroconversion levels and changes in the three markers. The group with the highest CD4 level within a year after seroconversion maintains the highest CD4 level 8 years after seroconversion. The group with the lowest level of neopterin or beta 2-microglobulin in this period has much higher future CD4 counts than the other two groups. The level of markers during the first year after seroconversion has a high predictive power for AIDS onset. Substantial differences in the hazards of AIDS are found between the groups with the highest and lowest CD4 count, neopterin, and beta 2-microglobulin following seroconversion. The three markers are generally correlated throughout the postseroconversion period but can provide distinct information. High current levels of neopterin or beta 2-microglobulin tend to be associated with low future CD4 count, while current levels of CD4 count have less association with future neopterin and beta 2-microglobulin levels.

Incidence and kinetics of distant metastases in patients with operable breast cancer

The purpose of this paper is to evaluate the incidence and kinetics of distant metastases in operable breast cancer and to relate these estimates to various tumor and patient characteristics. The records of 309 consecutive patients with operable breast cancer in stage T1-4N0-1M0 were reviewed, and the incidence of distant metastases (DM) and death due to DM were evaluated. 195 patients had positive axillary nodes with the following distribution of the number of nodes: 45% had 1-2 node, 16% had 3-4 nodes, 14% and 25% had 5-7 and more nodes, respectively. All patients were treated with radical mastectomy with axillary nodes dissection (the only treatment in 39% of cases). In 198 cases radical mastectomy was combined with radiotherapy and/or chemotherapy given pre- or postoperatively. Hormonal treatment was given in 27% of cases. Minimum follow-up was 10 years. Distant metastases were found in 150 cases (49%) and in 78 cases (25%) they developed early, during the first 18 months follow-up. Average rate of DM in N0 cases was 25%. Number of involved nodes and extracapsular invasion were found significant and independent prognostic factors. High risk (50%) of DM and death due to DM correlate with age < 40 y, premenopausal status, tumor stage > or = T3, more than 2 axillary nodes and/or extracapsular invasion. The linearity of the curves for freedom from DM and for freedom from death due to the DM suggest uniform distribution of progression rates with a median value for halving time for freedom from early DM of about 8 months, and of about 40 months for freedom from the DM occurring later than 18 months, being for whole group an average of 20 months. High incidence of DM is a significant cause of poor long-term survival. Early appearance (< 18 month follow-up) of about half of the DM suggests that they are already present as subclinical micrometastases at the time of initial loco-regional treatment. The time of appearance of distant metastases is consistent with a wide range of metastatic cell burdens among patients. Systemic therapy, at least for selected group of patients, might decrease the incidence of DM and improve long-term results.

Improved models of tumour cure

The standard mechanistic model for the probability of tumour cure (the "Poisson model') is based on the assumption that the number of surviving clonogens at the end of treatment follows a Poisson distribution from tumour to tumour. This assumption is not correct, however, if proliferation of tumour clonogens occurs during treatment, as would be expected in general during a fractionated course of radiotherapy. In the present study, the possible magnitude of the error in the Poisson model was investigated for tumours treated with either conventional fractionation or split-course therapy. An example is presented in which the Poisson model has an absolute error of nearly 100%, predicting a cure rate of 0% when in fact the cure rate was close to 100%. The largest errors in the Poisson model found in this study were for very small tumours (approximately 100 clonogens), but for larger tumours (> or = 10(6) clonogens), the Poisson model may still be highly inaccurate, predicting a cure rate that differs from the actual cure rate by as much as 40%. Three new tumour-cure models are proposed (the GS, PS, and GS+ models), and their accuracy is also investigated. Two of these (the GS and PS models) are better than the Poisson model for the clinically relevant cases tested here. The third model, the GS+ model, consistently produced the most accurate estimate of the tumour cure rate, but has more limited use than the GS and PS models because it is more highly parametrized. It is demonstrated here that no tumour-cure model based on the effective clonogen doubling time will be perfectly accurate in all cases, since the cure rate depends on the details of the cell kinetics contributing to the effective doubling time.

Redistribution of the delta antigens in cells replicating the genome of hepatitis delta virus

When the small form of the delta antigen (deltaAg-S) was expressed from a cDNA expression plasmid and subsequently detected by immunofluorescence, it was found localized to the nucleoli. However, if the cDNA was cotransfected with a cDNA expressing a mutated hepatitis delta virus (HDV) genome that could only replicate by using the deltaAg-S provided by the first plasmid, then most of the deltaAg-S was redistributed to the nucleoplasm, largely to specific discrete nucleoplasmic sites or speckles; this pattern was stable for at least 50 days after transfection. These speckles coincided with those detected with an antibody to SC35, an essential non-small nuclear ribonucleoprotein splicing factor. Others have shown that SC35 speckles correspond to active sites of DNA-directed transcription by RNA polymerase II and also of RNA processing. We also found, in contrast to the cotransfections with the mutant HDV and the deltaAg-S provided in trans, that cells transfected with wild-type HDV showed a variable pattern of staining. The SC35-like speckle pattern of accumulation of delta antigen deltaAg was maintained for only 6 days, after which the pattern began to change. By 18 days posttransfection, a variety of different deltaAg staining patterns were observed. This pattern of change occurs at a time when the large form of the delta antigen deltaAg-L appears and HDV RNA synthesis begins to shut down. Our studies therefore support the interpretation that HDV RNA and deltaAg-S accumulate at SC35 speckle sites in the nucleoplasm. We speculate that these may be the sites at which HDV RNA is transcribed by RNA polymerase II and/or sites of HDV RNA processing. Furthermore, when deltaAg-L, as well as other mutant deltaAg accumulate, the speckle association is disrupted, thereby stopping HDV RNA replication.

Epitopes exposed on hepatitis delta virus ribonucleoproteins

A total of 17 antibodies, raised in several nonhuman species and specific for different regions on the delta antigen (delta Ag), were used to map, via immunoprecipitation, those domains exposed on the surface of the viral ribonucleoprotein (RNP). These studies showed that the domains for the nuclear localization signal and the C-terminal extension, unique to the large form of delta Ag, are exposed. Also exposed is the C-terminal region of the small form of delta Ag. In contrast, reactivity was not found with the coiled-coil domain needed for protein dimerization. When the hepatitis delta virus (HDV) RNA was released by treatment of viral RNP with vanadyl ribonucleoside complexes, no change in the pattern of delta Ag epitope presentation was detected, consistent with the interpretation that a multimeric protein structure persists in the absence of RNA. These RNP studies have implications not only for understanding of the process of HDV assembly but also for evaluation of the immune responses of an infected host to HDV replication.

Influence of selection bias on dose-time analysis: a theoretical investigation

BACKGROUND AND PURPOSE

We investigate the effect of patient selection factors on the interpretation of dose-time analyses of retrospective head and neck data treated with external beam radiation therapy.

MATERIALS AND METHODS

We use a computer simulation model to ascertain the influence of individualizing the fractionation regimen on the estimated steepness of dose-response and time-response estimates, on the probability of local control and on the validity of statistical tests and confidence intervals. We assume that the total dose and overall treatment time for each patient are altered by consideration of three possible factors, the pre treatment size of the tumor, the response of the tumor to therapy or the amount of acute effects.

RESULTS

We find that individualizing treatment leads to very small improvements in the local control rate, but substantial biases in the estimates of the doubling time and the effective D0 value. Patient selection also compromises the validity of confidence intervals and tests. Despite this selection bias our results suggest that if there were no real effect of treatment time then the influence of individualizing treatments would not cause treatment time to be found to be as important as it has been shown to be in many studies.

CONCLUSIONS

Assuming the fundamental radiobiological assumptions in the model are appropriate, individual alterations of the fractionation schedule due to the response to therapy can compromise the interpretation of dose-time analyses of retrospective data, without giving much improvement in the control rate.