NOD2-expressing bone marrow-derived cells appear to regulate epithelial innate immunity of the transplanted human small intestine

BACKGROUND

Intestinal allograft rejection resembles Crohn's disease clinically and pathologically. An understanding of its mechanism could impact this life-saving procedure, as well as provide insight into the pathophysiology of inflammatory bowel disease. The NOD2 protein has been implicated as a key player in intestinal immune health, as a consequence of the discovery of three polymorphisms linked with Crohn's disease. An investigation was carried out to determine whether epithelial immune function and graft survival were influenced by NOD2 mutations in an intestinal transplant population.

METHODS

The NOD2 genotypes of 34 transplants performed consecutively over the past 3 years were determined. The NOD2 genotypes were related to clinical outcomes and the expression of certain intestinal antimicrobial peptides (AMPs) believed to protect the epithelium.

RESULTS

An unexpectedly high percentage of recipients, 35%, possessed NOD2 polymorphisms, while 8.6% of donors had comparable mutations. The likelihood of allograft failure was about 100-fold higher in recipients with mutant NOD2 alleles compared with recipients with wild-type NOD2 loci. Rejection in NOD2 mutant recipients was characterised by decreased expression of certain Paneth cell and enterocyte AMPs, prior to the onset of epithelial injury and inflammation.

CONCLUSIONS

Crohn's disease-associated polymorphisms in the NOD2 gene in the recipient represent a critical immunological risk factor for intestinal allograft rejection. Compromised epithelial defences precede visible epithelial injury and inflammatory infiltration. The association of impaired epithelial immunity with the recipient's genotype suggests that certain NOD2-expressing cells of haematopoietic origin play a role in the process, perhaps by regulating expression of certain epithelial AMPs within the allograft.

A five-year follow-up study of goiter and thyroid nodules in three regions with different iodine intakes in China

OBJECTIVE

The association between iodine status and the prevalence of goiter and thyroid nodules has been well established but the extent to which different iodine intake levels influence the incidence of goiter and thyroid nodules is unclear. The aim of the study was to determine the incidence of goiter and thyroid nodules in 3 regions with different iodine intake levels: mildly deficient, more than adequate, and excessive.

DESIGN, PATIENTS AND MEASUREMENTS

Of the 3385 unselected subjects enrolled in 1999 in Panshan, Zhangwu, and Huanghua where median urinary iodine excretion (UIE) was 83.5 microg/l, 242.9 microg/l, and 650.9 microg/l, respectively, 2708 (80.0%) participated in the follow-up study in 2004. The examinations of thyroid ultrasonography, thyroid function, thyroid autoantibodies and UIE were performed at baseline and follow-up.

RESULTS

The cumulative incidence of diffuse goiter was 7.1%, 4.4%, and 6.9%, respectively, higher in Panshan and Huanghua than in Zhangwu (p=0.013 and p=0.015) and that of nodular goiter was 5.0%, 2.4%, and 0.8%, respectively, declining with increasing iodine intake levels (p<0.001). Mild iodine deficiency, chronic iodine excess as well as positive thyroid autoantibodies were associated with the occurrence of goiter [Logistic regression: odds ratio (OR)=1.83 (95% confidence interval (CI) 1.26-2.65), OR=1.46 (95% CI 1.01-2.11) and OR=1.68 (95% CI 1.14-2.48), respectively]. The cumulative incidence of single nodule was 4.0%, 5.7%, and 5.6%, respectively and that of multiple nodules was 0.4%, 1.2%, and 1.0%, respectively.

CONCLUSIONS

The relationship between iodine and the risk for the occurrence of diffuse goiter shows a U-shaped curve. Nodular goiters are more prevalent in iodine-deficient areas.

Survival outcome and cost-effectiveness with docetaxel and paclitaxel in patients with metastatic breast cancer: a population-based evaluation

BACKGROUND

A randomized controlled trial showed longer overall survival (OS) with docetaxel compared with paclitaxel in metastatic breast cancer patients with prior exposure to anthracycline. We report a similar comparison using population-based data.

METHODS

Data on patients treated with single-agent paclitaxel or docetaxel were retrospectively reviewed. OS was compared using a two-tailed log-rank test and expressed as Kaplan-Meier plots. A cost-effectiveness analysis was carried out using cost/patient and OS.

RESULTS

Four hundred and thirty-five patients met eligibility criteria. Prognostic factors were balanced between docetaxel and paclitaxel groups. Median OS was significantly longer for docetaxel versus paclitaxel [10.9 versus 8.3 months; hazard ratio 0.76; 95% confidence interval (CI), 0.62-0.92; P = 0.006]. The median number of cycles administered were four (docetaxel) and three (paclitaxel). The incremental cost-effectiveness ratio was $2434/per month of median survival gained. In the sensitivity analysis, the results were robust except that paclitaxel dominated when the low end of the 95% CI of survival for docetaxel was compared with the high end for paclitaxel.

CONCLUSION

This population-based study corroborated the randomized trial's conclusion that for patients with metastatic breast cancer, docetaxel provided superior survival compared with paclitaxel. Each additional month of survival had an incremental cost of $2434.

Immunogenicity of recombinant Bacillus subtilis spores expressing Clonorchis sinensis tegumental protein

Clonorchis sinensis, which causes clonorchiasis, is of major socioeconomic importance in China. In this study, we report the use of CotC, a major component of the Bacillus subtilis spore coat, as a fusion partner for the expression of C. sinensis TP20.8 (Tegumental Protein 20.8 kDa) on the spore coat. Western blotting was used to identify TP20.8 surface expression on spores. Recombinant spores displaying the TP20.8 antigen were used for oral immunization and were shown to generate mucosal response in rats. TP20.8-specific secretory IgA in feces reached significant levels 2 weeks after oral dosing. This report shows that surface display of recombinant C. sinensis TP20.8 on B. subtilis spores was immunogenic and B. subtilis spores can be used as a mucosal immunization vehicle for parasite prevention and control.

The association of epidermal growth factor receptor (EGFR) polymorphisms and clinicopathological factors with skin rash on gefitinib use

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Background: Skin rash is the most common toxicity of EGFR-targeted therapy. Skin rash of EGFR inhibitor is associated with longer survival or tumor response. However, the clinical and genetic factors associated with this skin rash are not well understood. Methods: Fifty-two non-small-cell lung cancer patients enrolled in a prospective clinical trial of first-line gefitinib treatment were genotyped for EGFR intron 1 CA repeat polymorphism (CAn) and single nucleotide polymorphisms at promoters G-216T, C-191A, and R521K. Grade 2 to 3 skin rash within 4 weeks of treatment (early G2/3 rash) was correlated with the genotype and clinicopathological features of the patients by multivariate logistic regression. Results: Seventeen patients (32.7%) developed early G2/3 rash. In multivariate logistic regression analysis, only the CAn genotype was associated with early G2/3 rash and the effect was modified by patient age. Early G2/3 rash developed in 21% of patients with homozygous long allele (19 to 22 repeats, L) genotype (4/19), 31% of heterozygous short allele (15 to 18 repeats, S) / L genotype (8/26), and 71% of S/S genotype (5/7), respectively. The median ages of patients with early G2/3 rash and patients without early G2/3 rash were 57 years (range: 39–77) and 69 years (range: 43–86), respectively. The estimated logarithm of odds ratio (ln OR) for early G2/3 rash, as compared to S/S genotype, for S/L genotype was -0.038 multiplied by patient age (P = 0.011); and the ln OR for L/L genotype was -0.050 multiplied by patient age (P = 0.004). Fifty patients were evaluable for response. In logistic regression analysis, early G2/3 rash correlated with tumor response (P = 0.027). However, the CAn genotype was not significantly correlated with tumor response (P = 0.43). Conclusions: Homozygous short allele of EGFR CAn is more likely to develop skin rashes on gefitinib treatment. Genotyping of EGFR CAn appears to be a useful predictive marker for development of skin rashes on gefitinib use.

[Table: see text]

Molecular cloning and identification of a novel Clonorchis sinensis gene encoding a tegumental protein

The tegumental membrane of platyhelminth parasites is of crucial importance for modulation of the host response and parasite survival. A cDNA encoding a novel tegumental protein 20.8 kDa (TP20.8) was found by large-scale sequencing of a Clonorchis sinensis cDNA library. This new cDNA was 755 bp long containing an open reading frame of 555 bp, which encoded a 20.8-kDa protein with an isoelectric point of 4.33. The deduced amino acid sequence exhibits 40 and 37% identity to Schistosoma japonicum sj20.8 and Schistosoma mansoni Sm 20.8, respectively. TP20.8 transcripts were detected in the adult worm and metacercariae cDNA libraries of C. sinensis but not in the egg. Recombinant C. sinensis TP20.8 protein was produced and purified from Escherichia coli BL21. Using specific anti-recombinant TP20.8 protein sera, the TP20.8 protein was immunohistochemically localized to the outer-surface membrane of C. sinensis. The specificity and sensitivity of the recombinant antigen for serologic diagnosis was assessed by enzyme-linked immunosorbent assay using serum from 100 patients with clonorchiasis, 20 patients with schistosomiasis, and 30 negative controls. The sensitivity was 68%, and the specificity was 84%. The antigen was less useful for the serodiagnosis of clonorchiasis with IgG.

Clonorchis sinensis: expression, characterization, immunolocalization and serological reactivity of one excretory/secretory antigen-LPAP homologue

From a Clonorchis sinensis adult cDNA plasmid library, a cDNA clone encoding a novel lysophosphatidic acid phosphatase (LPAP) homologue was isolated. The predicted molecular weight of putative protein was 48.8 kDa and the deduced amino acid sequence had 45%, 32%, and 29% identity with LPAP of Schistosoma japonicum, Danio rerio, and Homo sapiens, respectively. Prediction of signal peptide and Western blot analysis indicated that the CsLPAP homologue was an excretory-secretory antigen (ES antigen) of C. sinensis. Immunostaining revealed that the CsLPAP was markedly localized in the intestinal cecum, seminal receptacle and eggs of the adult worm. The recombinant CsLPAP showed slightly higher sensitivity (82.14%) and specificity (85.86%) than the crude worm antigen by enzyme-linked immunosorbent assay (ELISA), a result which suggested that the recombinant antigen might be valuable in the serodiagnosis of human clonorchiasis.

Endogenous glucocorticoids protect against TNF-alpha-induced increases in anxiety-like behavior in virally infected mice

Endogenous glucocorticoids restrain proinflammatory cytokine responses to immune challenges such as viral infection. In addition, proinflammatory cytokines induce behavioral alterations including changes in locomotor/exploratory activity. Accordingly, we examined proinflammatory cytokines and open-field behavior in virally infected mice rendered glucocorticoid deficient by adrenalectomy (ADX). Mice were infected with murine cytomegalovirus (MCMV), and open-field behavior (36 h post-infection) and plasma concentrations of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 (42 h post-infection) were assessed. Compared to sham-ADX-MCMV-infected animals, ADX-MCMV-infected mice exhibited significant reductions in total distance moved, number of center entries, and time spent in center. These behavioral alterations were accompanied by significantly higher plasma concentrations of TNF-alpha and IL-6, both of which were correlated with degree of behavioral change. To examine the role of TNF-alpha in these behavioral alterations, open-field behavior was compared in wild-type (WT) and TNF-R1-knockout (KO), ADX-MCMV-infected mice. TNF-R1-KO mice exhibited significantly attenuated decreases in number of rearings, number of center entries and time spent in center, but not distance moved, which correlated with plasma IL-6. Given the potential role of brain cytokines in these findings, mRNA expression of TNF-alpha, IL-1 and IL-6 was assessed in various brain regions. Although MCMV induced increases in proinflammatory cytokine mRNA throughout the brain (especially in ADX animals), no remarkable differences were found between WT and TNF-R1-KO mice. These results demonstrate that endogenous glucocorticoids restrain proinflammatory cytokine responses to viral infection and their impact on locomotor/exploratory activity. Moreover, TNF-alpha appears to mediate cytokine-induced changes in open-field behaviors, especially those believed to reflect anxiety.

Molecular characterization and serodiagnosis analysis of a novel lysophospholipase from Clonorchis sinensis

A cDNA clone encoding a novel lysophospholipase with a predicted molecular weight of 25.2 kDa was isolated from a Clonorchis sinensis adult cDNA library. The enzyme activity of the recombinant protein expressed in Escherichia coli was determined using phosphatidylcholine and lysophosphatidylcholine as substrates. Western blotting analysis indicated that it belonged to excretory/secretory proteins of the adults. The sensitivity and specificity of the recombinant antigen for serodiagnosis were evaluated with immunoglobulin enzyme-linked immunosorbent assay using serum samples from 20 patients with clonorchiasis and 20 patients with schistosomiasis. The sensitivity (75%) and specificity (80%) of the recombinant protein were comparable to those of crude extracts, at 65 and 82.5%, respectively. The sensitivity of the recombinant protein was 77% using 100 serum samples of clonorchiasis patients with various parasite burden. The results suggested that the recombinant lysophospholipase protein was not a satisfactory candidate for diagnosis of clonorchiasis, although it might be an excretory/secretory protein.

A tumor-specific conditionally replicative adenovirus vector expressing TRAIL for gene therapy of hepatocellular carcinoma

We constructed a novel hepatocellular carcinoma-specific conditionally replicative adenovirus (CRAd). This adenovirus, designated Ad.HS4.AFP.E1A/TRAIL, expresses E1A to mediate viral replication and TRAIL to enhance HCC-killing efficacy under the control of a modified AFP promoter. An insulator HS-4 was placed in front of the AFP promoter to enhance the fidelity of the heterologous promoter. This virus was shown to have specific cytolytic activity in AFP-expressing HCC cells in vitro. Furthermore, the replication efficiency of Ad.HS4.AFP.E1A/TRAIL correlated well with AFP expression of the host cells, showing a 100-fold and 1 000 000-fold decrease in the low-and non-AFP-expressing HCC cells, respectively, compared to the high AFP-expressing HCC cells. An increase in mRNA of TRAIL and the elevated Caspase-3 activity were also observed in Ad.HS4.AFP.E1A/TRAIL-infected HCC cells. These results indicated that TRAIL expression from the viral vector activated the Caspase-3 enzymatic capacity and the HCC cells were sensitive to TRAIL. In vivo, Ad.HS4.AFP.E1A/TRAIL effectively prevented the growth of low AFP-expressing BEL-7404 xenografts. These results indicate that Ad.HS4.AFP.E1A/TRAIL could provide a new strategy of gene therapy for HCC.

The factors affecting objective response in patients with advanced malignant tumor treated with H101, an E1B-55kD deleted oncolytic adenovirus

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Background: H101 is E1B-55kD deleted oncolytic adenovirus which can selectively replicate in tumor cells. Previous phase I/II clinical trials have shown that H101 has certain anti-tumor effects and is safe when applied to patients by intratumoral injection. The aim of this study is to identify the factors affecting tumor response in patients with advanced malignant tumor treated with H101. Methods: All patients in H101 phase II clinical trial were retrospectively reviewed. They were treated with either H101 alone (group A) or H101 combined with conventional chemotherapy (group B). H101 was administrated by intratumoral injection at the dosage of 5×1011 viral particles, once a day for 5 consecutive days. The objective response was evaluated according to WHO criteria and the adverse events were recorded. All information required for this study was retrieved from the database of H101 phase II clinical trial. Chi square test and stepwise multivariable regression were used for statistic analysis with a significant level of p<0.05. Results: There were 106 evaluable patients in this study, 54 in group A (36 males and 18 females, age: 36–78 years), 52 in group B (35 males and 17 females, age: 18–76 years). The diagnoses of these patients include head & neck cancer (54), breast cancer (13) and others (39). All were in the advanced stage of the disease, and refractory or resistant to chemo and radio therapy. The objective response rate was higher in group B (23.1%) as compared to group A (16.7%). In patients with response (CR or PR), 62.5% of them experienced fever after the injection of H101, in contrast, only 18.9% of the patients without response did so. The difference was statistically significant (p<0.01). In the stepwise multivariable regression analysis, tumor response was used as dependent variable, and the independent variables included demographic data, clinical and pathologic type of the tumor, and treatment regimen. The result revealed that tumor response was positively correlated with the fever after H101 injection (p<0.01). Conclusions: H101 has certain anti-tumor efficacy in patients with advanced malignancies, which might be enhanced by the fever after H101 injection and/or combining with chemotherapy.

[Table: see text]

Survival and cost-effectiveness of docetaxel (D) and paclitaxel (P) in patients with metastatic breast cancer (MBC): A population-based evaluation

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Background: A randomized comparison between P and D for MBC reported that overall survival (OS) was significantly superior for D (Ravdin, et al). We report a population-based comparison of P (3-hour infusion) to D (1-hour infusion) in MBC patients with prior exposure to anthracycline in terms of OS and cost-effectiveness (CE). Methods: Data on MBC patients treated with single-agent P or D (January 1999 - December 2002) were retrospectively reviewed. OS, defined as time from initiation of taxane to death from any cause, was compared using a 2-tailed log-rank test and expressed as Kaplan-Meier plots. A CE analysis, including cost of drug (list price $CDN), labour and supplies, was performed using median cost/patient and median OS (MOS). Incremental CE ratios (ICERs) were compared in a sensitivity analysis varying MOS to the extremes of the 95% confidence interval (95% CI). Results: 435 patients met eligibility criteria. MBC prognostic factors were balanced between D and P groups ( table ). MOS was significantly longer for D vs. P. (10.9 vs. 8.3 months; HR 0.76; 95% CI, 0.62 to 0.92; P = 0.006). The median number of cycles administered were 4 (D) and 3 (P). The respective cost/month of MOS is $805 (D) and $303 (P). The ICER of D vs. P was $2,434/month MOS gained. The range of ICERs in the sensitivity analysis was $1,121 to 7,361/month MOS gained. These results were robust except that P dominates when the low end of the 95%CI of MOS for D is compared to the high end for P. Conclusion: This population-based study corroborates the randomized trial’s conclusion that for patients with metastatic breast cancer, D provided superior survival compared to P. Each additional month of survival had an incremental cost of $2,434.

[Table: see text]

[Table: see text]

Neuroendocrine properties of intrinsic cardiac adrenergic cells in fetal rat heart

Intrinsic cardiac adrenergic (ICA) cells in developing rat heart constitute a novel adrenergic signaling system involved in cardiac regulation. Regulatory mechanisms of ICA cells remain to be defined. Immunohistochemical study of fetal rat hearts demonstrated ICA cells with catecholamine biosynthetic enzyme tyrosine hydroxylase (TH) and phenylethanolamine N-methyltransferase (PNMT). The mRNA of TH and PNMP was also detected in fetal rat hearts before sympathetic innervation. Immunoreactivity of norepinephrine transporter (NET) was localized to ICA cells in rat heart tissue and primary cell culture. For the functional study, the activity of intracellular Ca2+concentration ([Ca2+]i) transients was quantified by a ratio fluorescent spectrometer in cultured ICA cells and myocytes. ICA cells generated spontaneous [Ca2+]itransients that were eliminated by tetrodotoxin or Ca2+-free solutions and showed greatly reduced amplitude with the addition of L-type Ca2+channel blocker nifedipine. [3H]norepinephrine studies demonstrate release and uptake of norepinephrine. Functional interaction between catecholamines produced by the ICA cells and cocultured myocytes was evident by the effect of the β-adrenergic blocker atenolol eliciting a dose-dependent reduction in the amplitude and frequency of [Ca2+]itransients of beating myocytes. Hypoxia inhibited [Ca2+]itransient activity of ICA cells, which subsequently produced a reoxygenation-mediated rebound augmentation of [Ca2+]itransients. We conclude that ICA cells are capable of catecholamine synthesis, release, and uptake. They generate spontaneous [Ca2+]itransient activity that can be regulated by oxygen tension. ICA cells may provide an alternative adrenergic supply to maintain cardiac contractile and pacemaker function at rest and during stress in the absence of sympathetic innervation.