Positional cloning of genes involved in the Beckwith-Wiedemann syndrome, hemihypertrophy, and associated childhood tumors

The Beckwith-Wiedemann syndrome (BWS) is an overgrowth malformation syndrome that occurs with an incidence of 1:13,700 births. There is a striking incidence of childhood tumors found in BWS patients. Various lines of investigation have localized "imprinted" genes involved in BWS and associated childhood tumors to 11p15. High resolution mapping of 8 rare balanced chromosomal BWS rearrangements enabled us to identify three distinct regions on chromosome 11p15 that might harbor genes involved in the above-mentioned disorders. These results suggest genetic heterogeneity that correlates with the clinical heterogeneity seen in the patients studied. Expressed candidate gene sequences from these regions have been cloned and partly sequenced. These transcripts are either disrupted by or are at least within a few kb of these BWS chromosome breakpoints. So far, zinc-finger sequences and one Kruppel-associated box (KRAB) domain were found in independent candidate genes which are compatible with a regulating function of growth promoting genes. The abundance of expression of these genes varies from low abundant in all adult and fetal tissues tested to detectable on Northern blots of adult tissues. In addition to our 11p15 studies we have analyzed additional chromosome regions, in particular 1p. Cytogenetic, loss of heterozygosity (LOH) and comparative genomic hybridization (CGH) studies have identified 1p35 as a region of interest. A positional cloning effort to identify a balanced 1p35 translocation found in a Wilms tumor has led to the isolation of a YAC, crossing this breakpoint.

Pharmacokinetics, tissue distribution, and expression efficiency of plasmid [33P]DNA following intravenous administration of DNA/cationic lipid complexes in mice: use of a novel radionuclide approach

The pharmacokinetics, tissue distribution, and efficacy of a systemic gene transfer method were examined in male BALB/c mice (6-8 weeks old) using 33P-labeled plasmid DNA for luciferase. The DNA was delivered via tail vein injection in saline ([33P]DNA) or in a cationic lipid formulation ([33P]DNA/lipid). One group of mice received approximately equal to 1-3 microCi (45 micrograms of DNA) of either formulation, and mice were euthanized at 2 and 20 min, and 1 and 24 h postdose (2 mice/time point). Blood and plasma radioactivity were quantified, and whole body autoradiographic (WBAR) images were obtained from 20-microns whole body sections. A tissue distribution (TD) study was conducted in a second group of mice, which received approximately equal to 4-6 microCi (45-60 micrograms of DNA) of [33P]DNA/lipid. Mice were euthanized at 1.5 h (1 mouse; [33P]DNA/lipid) or 24 h (2 mice/ group), and organ radioactivity and luciferase expression were measured in lung, liver, kidney, spleen thymus, and parotid salivary gland by direct quantitation methods. Microautoradiography (MAR) was performed on a third group of mice (n = 2), which received 3 microCi (45 micrograms of DNA) of [33P]DNA/lipid and were euthanized at 24 h postdose. For WBAR, the [33P]DNA/lipid tissue distribution (% dose equiv/g) at 2 min was lung >> liver > spleen (red pulp) > kidney (cortex); at 24 h the ranking was spleen (red pulp) > liver > lung, kidney (cortex). The [33P]DNA organ distribution observed at 2 min was liver >> spleen (red pulp) > lung, blood > kidney (cortex); at 24 h the ranking was liver, spleen (red pulp) > kidney (cortex) > lung, blood. High levels of radioactivity in bone (cortical, marrow, growth plate) in both groups may represent uptake of the 33P-labeled test articles by the cellular component of the bone marrow, particularly macrophages, as well as deposition of [33P]phosphate in the bone matrix following metabolism of the [33P]DNA. In the luciferase component of the study, no expression was observed in the [33P]DNA group at 24 h. The [33P]- DNA/lip group exhibited expression as early as 1.5 h in the lung; at 24 h, expression was seen in all the organs examined. Microautoradiography of 24-h tissue samples revealed radioactivity in hepatic Kupffer cells, reticuloendothelial system cells in the marginal zone of the spleen, and diffusely along alveolar septae with scattered accumulations in alveolar macrophages. The results of the WBAR, TD, MAR, and luciferase assay show that the use of cationic lipids significantly altered the biodistribution and resulting expression of the DNA plasmid. Further, 33P (0.25 MeV beta, half-life = 25 days) was shown to be an excellent radionuclide for quantitative WBA and MAR, providing sharp images with less personal hazard and greater ease of handling than 32P (1.71 MeV beta, half-life = 14.3 days).

Altered circadian rhythmicity in the Wocko mouse, a hyperactive transgenic mutant

Induced changes in the level of daily activity can alter the period of the mammalian circadian clock. In this report, we examined the period of the circadian rhythm of wheel-running activity in a transgenic neurological mouse mutant, Wocko. Wocko mice display a dominant behavioral phenotype that consists of hyperactivity, circling and head tossing. The period of the circadian rhythm of wheel-running activity in constant dark conditions was significantly shorter in mice expressing the Wocko mutation than in their normal littermates. Total activity, monitored by the interruption of an array of infrared beams, was significantly elevated in Wocko mice. These findings support the view that spontaneous exercise can modulate the circadian timekeeping system.

Physiological regulation of early and late stages of megakaryocytopoiesis by thrombopoietin

Thrombopoietin (TPO) has recently been cloned and shown to regulate megakaryocyte and platelet production by activating the cytokine receptor c-mpl. To determine whether TPO is the only ligand for c-mpl and the major regulator of megakaryocytopoiesis, TPO deficient mice were generated by gene targeting. TPO-/- mice have a >80% decrease in their platelets and megakaryocytes but have normal levels of all the other hematopoietic cell types. A gene dosage effect observed in heterozygous mice suggests that the TPO gene is constitutively expressed and that the circulating TPO level is directly regulated by the platelet mass. Bone marrow from TPO-/- mice have decreased numbers of megakaryocyte-committed progenitors as well as lower ploidy in the megakaryocytes that are present. These results demonstrate that TPO alone is the major physiological regulator of both proliferation and differentiation of hematopoietic progenitor cells into mature megakaryocytes but that TPO is not critical to the final step of platelet production.

Automated interstudy image registration technique for SPECT and PET

We report the extended application of an automated computer technique for three-dimensional spatial registration of SPECT and PET studies.

METHODS

The technique iteratively reslices a misaligned data set until the sum of the absolute differences (SAD) from a reference data set is minimized. The registration accuracy was assessed in Hoffman brain phantom studies collected with known misalignments and transmission studies of a thorax phantom with fiducial markers. The SAD was compared with three other cost functions: stochastic sign change criterion, sum of products and standard deviation (s.d.) of ratios. In clinical neurological and myocardial perfusion studies, registration accuracy was estimated from the relative locations of landmarks in the reference and registered data sets.

RESULTS

Registration accuracy in the Hoffman brain phantom studies was -0.07 +/- 0.46 mm (mean +/- s.d.) for translations and -0.01 +/- 0.20 degrees for rotations, with maximum translation and rotation errors of 1.2 mm and 0.8 degree, respectively. The SAD was the most accurate and reliable cost function. Registration errors in the thorax phantom were 3.1 +/- 1.7 mm. Mean accuracy in the neurological studies, estimated from landmark pairs, was 2.0 +/- 1.1 mm for SPECT to SPECT and 1.8 +/- 1.1 mm for PET to SPECT registrations. Average registration accuracy in 201Tl myocardial perfusion studies was 2.1 +/- 1.2 mm.

CONCLUSION

Our registration method (a) provided accurate registrations for phantom and clinical SPECT and PET studies, (b) is fully automated, (c) simplifies comparison of data sets obtained at different times and with different modalities, and (d) can be applied retrospectively.

Transgenic knockouts reveal a critical requirement for pancreatic beta cell glucokinase in maintaining glucose homeostasis

The secretion of insulin is controlled by the rate of glucose metabolism in the pancreatic beta cells. As phosphorylation by glucokinase (GLK) appears to be the rate-limiting step for glucose catabolism in beta cells, this enzyme may be the glucose sensor. To test this possibility and to resolve the relative roles of liver and beta cell GLK in maintaining glucose levels, we have generated mice completely deficient in GLK and transgenic mice in which GLK is expressed only in beta cells. In mice with only one GLK allele, blood glucose levels are elevated and insulin secretion is reduced. GLK-deficient mice die perinatally with severe hyperglycemia. Expression of GLK in beta cells in the absence of expression in the liver is sufficient for survival. These mice demonstrate the critical need for beta cell GLK in maintaining normal glucose levels and provide a novel model for one form of noninsulin-dependent diabetes.

Ligand-independent repression by the thyroid hormone receptor mediated by a nuclear receptor co-repressor

Thyroid-hormone and retinoic-acid receptors exert their regulatory functions by acting as both activators and repressors of gene expression. A nuclear receptor co-repressor (N-CoR) of relative molecular mass 270K has been identified which mediates ligand-independent inhibition of gene transcription by these receptors, suggesting that the molecular mechanisms of repression by thyroid-hormone and retinoic-acid receptors are analogous to the co-repressor-dependent transcriptional inhibitory mechanisms of yeast and Drosophila.

Inactivation of the mouse Huntington's disease gene homolog Hdh

Huntington's disease (HD) is a dominant neurodegenerative disorder caused by expansion of a CAG repeat in the gene encoding huntingtin, a protein of unknown function. To distinguish between "loss of function" and "gain of function" models of HD, the murine HD homolog Hdh was inactivated by gene targeting. Mice heterozygous for Hdh inactivation were phenotypically normal, whereas homozygosity resulted in embryonic death. Homozygotes displayed abnormal gastrulation at embryonic day 7.5 and were resorbing by day 8.5. Thus, huntingtin is critical early in embryonic development, before the emergence of the nervous system. That Hdh inactivation does not mimic adult HD neuropathology suggests that the human disease involves a gain of function.

An evaluation of changes in composition and contamination of salvaged blood from the cardiopulmonary bypass circuit of pediatric patients

OBJECTIVE

To review changes that occur during an 18-hour period in composition and bacterial contamination of blood salvaged from the cardiopulmonary bypass (CPB) circuit of pediatric patients.

DESIGN

Prospective, blinded study.

SETTING

Pediatric tertiary multidisciplinary intensive care unit.

PATIENTS

One hundred and one children who underwent CPB.

OUTCOME MEASURES

The degree of bacterial contamination and biochemical and hematologic alterations of blood salvaged from the CPB and any increased blood loss associated with reinfusion of this blood.

INTERVENTION

The salvaged blood from the CPB circuit was collected into 1 L blood transfer packs after CPB. This blood was then stored at room temperature for 18 hours. Sampling occurred immediately after CPB and at 6 and 18 hours for biochemic and hematologic assay and for the detection of bacterial organisms. The amount of chest drainage loss was assessed in the first 18 hours after bypass. The type and amount of intravenous fluid infused also was recorded.

RESULTS

Bacterial contamination occurred in three samples (two at 6 hours and in one of the preceding at 18 hours) of the 101 units of salvaged blood. All three positive cultures grew a coagulase-negative staphylococcus. Sodium and potassium remained within normal physiologic values. The glucose values declined from 15.8 to 13.4 mmol/L, and the hemoglobin values increased from 0.4 to 0.5 gm/dl. The reinfusion of the salvaged blood (and any other blood or blood products) to 31 of the 101 patients averaged 14.2 ml/kg/24 hr, with a mean chest drainage loss of 4.9 ml/kg/24 hr. The remaining 70 patients received 12.5 ml/kg/hr of either plasma expanders or blood, with a mean chest drainage loss of 6.0 ml/kg/24 hr.

CONCLUSIONS

The results of this study demonstrate minimal chemical deterioration and limited microbiologic contamination in blood that was salvaged from the CPB circuit and stored at room temperature for an 18-hour period. No increase in postoperative bleeding was noted from the use of this blood. These results suggest it may be safe to reinfuse salvaged blood after CPB in pediatric patients for up to 18 hours; however, a prospective clinical trial is needed to validate these findings.

The changing epidemiology of invasive meningococcal disease in Canada, 1985 through 1992. Emergence of a virulent clone of Neisseria meningitidis

OBJECTIVE

To describe the occurrence of invasive meningococcal disease (IMD) in Canada with respect to demographic variables and characteristics of the isolated strains of Neisseria meningitidis.

DESIGN

National surveillance case series.

SETTING

Canada, 1985 through 1992.

OUTCOME MEASURES

Morbidity and mortality.

MAIN RESULTS

The incidence of IMD averaged 1.38 per 100,000 person-years, with considerable regional variation. In 1988, serogroup C organisms became more common, with one strain of the electrophoretic type 37 (ET-37) complex of N meningitidis, termed ET-15, the predominant group C strain identified. With the increase in group C disease, a greater proportion of cases were older than 5 years. By 1991, ET-15 was the most common strain identified in most parts of the country. Electrophoretic type 15 had a case fatality of 17.8% vs 8.1% for all other IMD (P < .001). Among cases 20 years and older the case fatality for ET-15 was 22.4%.

CONCLUSIONS

The group C, ET-15 strain of N meningitidis, first identified in Canada, was more virulent than other prevalent strains during this period. Active surveillance, rapid identification, and typing of N meningitidis will assist public health decision making in the control of emerging strains.

Epidermal growth factor and basic fibroblast growth factor are induced in guinea-pig tympanic membrane following traumatic perforation

Epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF or FGF-2) have been shown to enhance the healing of traumatic tympanic membrane (TM) perforations. The action of EGF and bFGF in the TM repair process remains unknown. This study was designed to determine the expression of EGF and bFGF in normal and injured TM by immunohistochemistry. EGF was detected in normal TM mainly in the annulus tympani area. After a perforation in the TM posterior/superior quadrant, EGF was detected around the perforated area in polynuclear cells, in pericytes and in basal epithelial cells. EGF was also detected in the antero/superior quadrant in basal epithelial cells and pericytes. The peak of EGF detection was observed 3 days after the perforation. bFGF was not detected in normal TM, but it was expressed 3 days after a traumatic perforation mainly in the perforated area in pericytes and in polynuclear cells. This study suggests that EGF and bFGF are involved in the control of TM acute perforation repair. These findings help to explain the accelerated healing of TM perforations that are seen after application of FGF or EGF, and suggest that antibodies against these growth factors would retard the healing process.

Neutralizing antibodies against basic fibroblast growth factor influence the healing of traumatic tympanic membrane perforations

The beneficial effects of basic fibroblast growth factor (bFGF or FGF-2) in healing of tympanic membrane (TM) perforations have been demonstrated in animal models, and this study was conducted to investigate the effect of neutralizing anti-FGF-2 antibodies on acute tympanic membrane perforation healing. Anti-FGF-2 rabbit polyclonal antibodies were applied to traumatic TM perforations in guinea-pigs on days 0, 1, 2 and 3, whilst the opposite ear was treated with normal rabbit serum. On day 4, the perforation area was assessed, and the histological structure of the scar was studied. The average opening was larger in the neutralizing anti-bFGF-treated group, but the difference was not statistically significant. Histological analysis showed that scars treated with neutralizing anti-bFGF contained significantly less epithelial cells and less mononuclear cells. They also contained less fibroblasts and less vessels, but this difference was not significant. These data suggest that FGF-2 is one of the factors involved in the control of epithelial cells proliferation and mononuclear cell invasion in the initial phase of TM perforation healing. Neutralizing anti-bFGF antibodies could be of use in reducing the inflammation during the healing of TM perforations or to create animal models of chronic tympanic membrane perforations.

Meningococcal infections in the Province of Québec, Canada, during the period 1991 to 1992

A total of 234 strains of Neisseria meningitidis obtained from hospitalized patients living in the province of Québec during the period 1991 to 1992 were characterized according to their serogroup, serotype, subtype, electrophoretic type, and antimicrobial susceptibility. All these strains were recovered from sterile body fluids, except for one strain that was isolated postmortem from a cutaneous lesion. For both years, serogroup C was the most prevalent (69.7%), followed by serogroup B (27.4%). Serotype 2a represented 80.3% of serogroup C isolates, and P1.2 was the most common subtype associated with this serotype. Clone ET 15 accounted for 76.5% of serogroup C isolates and 90.0% of serotype 2a strains. Although meningococcal disease occurred mostly in children under the age of 5 (9.7 cases per 100,000 children), with a peak incidence for children under 1 (20.3 cases per 100,000 children), most fatalities occurred among teenagers (12 to 19 years old). The total fatality rate was 11.5%, and serogroup C strains were responsible for 88.9% of these fatalities. Thirteen strains had a reduced susceptibility to penicillin G, and 28 strains were resistant to sulfadiazine. One strain was resistant to both rifampin and sulfadiazine and showed a reduced susceptibility to penicillin G.

Expression of mRNAs encoding alpha and beta subunit isoforms of Na,K-ATPase in the vestibular labyrinth and endolymphatic sac of the rat

The distribution of mRNAs coding for three different isoforms of the alpha and two of the beta subunit of Na,K-ATPase was studied in the rat vestibular system using in situ mRNA hybridization. The dark cells of the utricular macula and of the ampullae of the semicircular canals expressed high levels of mRNA encoding the alpha 1 and beta 2 isoforms of the Na,K-ATPase, a composition that in the cochlea has been uniquely found in the stria vascularis. However, in the dark cells it was coupled with a weak expression of beta 1. The sensory epithelia of the vestibular system showed alpha 1 and beta 1 expression at much higher levels than in the cochlear sensory epithelium. Weak expression limited to the alpha 1, beta 1, and beta 2 isoforms was observed in the endolymphatic sac, contrasting previous cytochemical results which suggested extensive Na,K-ATPase activity to the sac. The results support the widely held hypothesis that the vestibular dark cells play a role similar to that of the stria vascularis in endolymph production. They indicate that the ion transport requirements of the vestibular sensory epithelia may be different than those in the cochlea. They also suggest that the endolymphatic sac may not be a major site of inner ear ion exchange.

Effect of basic fibroblast growth factor on normal tympanic membrane

PURPOSE

Basic fibroblast growth factor (bFGF) is mitogenic for the cell types that constitute the tympanic membrane and has been shown to potentiate tympanic membrane healing. The purpose of this study is to investigate the direct effect of bFGF application on normal tympanic membrane.

MATERIALS AND METHODS

bFGF was applied to the normal tympanic membrane of 10 guinea pigs via either the external auditory external canal or the middle ear. The drug (400 ng) was delivered on days 0, 1, and 2. The contralateral ear was used as a control. The effects were assessed on day 3.

RESULTS

The cumulative area and the average area of blood vessel in each session of TM was greater after bFGF application than placebo. The number of vessels remained unchanged. A proliferation of keratinocytes was observed.

CONCLUSION

These results suggest that bFGF induces a vasodilatation in the tympanic membrane thereby increasing blood supply. This might explain the acceleration of healing of TM perforations after bFGF application.

Improving discharge planning

In ward 9 of the Nursing Development Unit at Whiteabbey Hospital, Newtonabbey, Northern Ireland, developments and innovations are channelled through the use of working groups which are essentially the pivot on which the unit rotates. This article details the activities of one of these groups, the discharge planning group.