Evaluation of the NuCLEUS-X™ balloon valvuloplasty catheter for severe pulmonic stenosis in dogs

INTRODUCTION/OBJECTIVES

Balloon instability is commonly encountered during balloon pulmonary valvuloplasty (BPV) and may result in an unsuccessful procedure. The NuCLEUS-X™ catheter is a recently developed BPV catheter with a unique barbell shape and an ordered pattern of inflation that stabilizes the balloon to span the valve annulus before expansion of the balloon center.

ANIMALS

Ten client-owned dogs with severe valvular pulmonic stenosis (PS).

MATERIALS AND METHODS

Prospective observational study. The BPV procedure was performed by standard technique with use of NuCLEUS-X™ catheters targeting a balloon-to-annulus ratio between 1.2 and 1.5. Balloon stability, safety, and procedural success were assessed. Procedural success was defined as either a reduction in the Doppler transpulmonic PG by at least 50% of the pre-procedural PG or <80 mmHg one month post procedure.

RESULTS

Balloon stability centered at the pulmonic valve on the first inflation was achieved in 10/10 cases. The mean PG before BPV was 141 mmHg ±41 mmHg, and the PG after BPV at one month was 83 mmHg ±41 mmHg. Procedural success was achieved in 56% of patients. All dogs survived the BPV, and no major procedural complications were encountered using the NuCLEUS-X™ catheter.

CONCLUSIONS

The use of the NuCLEUS-X™ catheter is feasible for BPV in dogs with severe PS. The unique balloon shape provided catheter stability on the first inflation in all dogs, which may be beneficial when stabilization of a conventional BPV catheter cannot be achieved.

Using RNA Sequencing to Characterize the Tumor Microenvironment

RNA sequencing (RNA-seq) is an integral tool in immunogenomics, allowing for interrogation of the transcriptome of a tumor and its microenvironment. Analytical methods to deconstruct the genomics data can then be applied to infer gene expression patterns associated with the presence of various immunocyte populations. High quality RNA-seq is possible from formalin-fixed, paraffin-embedded (FFPE), fresh-frozen, and fresh tissue, with a wide variety of sequencing library preparation methods, sequencing platforms, and downstream bioinformatics analyses currently available. Selection of an appropriate library preparation method is largely determined by tissue type, quality of RNA, and quantity of RNA. Downstream of sequencing, many analyses can be applied to the data, including differential gene expression analysis, immune gene signature analysis, gene pathway analysis, T/B-cell receptor inference, HLA inference, and viral transcript quantification. In this chapter, we will describe our workflow for RNA-seq from bulk tissue to evaluable data, including extraction of RNA, library preparation methods, sequencing of libraries, alignment and quality assurance of data, and initial downstream analyses of RNA-seq data to extract relevant immunogenomics features. Systems biology methods that draw additional insights by integrating these features are covered further in Chapters 28 - 30 .

Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies

AIM

To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context.

METHODS

PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK.

RESULTS

Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment.

CONCLUSION

Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.

Delayed hematopoietic recovery after auto-SCT in patients receiving arsenic trioxide-based therapy for acute promyelocytic leukemia: a multi-center analysis

A potential link between arsenic (ATO)-based therapy and delayed hematopoietic recovery after autologous hematopoietic SCT (HSCT) for acute promyelocytic leukemia (APL) has previously been reported. We retrospectively reviewed the clinical histories of 58 patients undergoing autologous HSCT for APL at 21 institutions in the United States and Japan. Thirty-three (56%) of the patients received ATO-based therapy prior to stem cell collection. Delayed neutrophil engraftment occurred in 10 patients (17%): 9 of the 10 patients (90%) received prior ATO (representing 27% of all ATO-treated patients), compared with 1 of the 10 patients (10%) not previously treated with ATO (representing 4% of all ATO-naïve patients; P<0.001). Compared with ATO-naïve patients, ATO-treated patients experienced significantly longer times to ANC recovery (median 12 days vs 9 days, P<0.001). In multivariate analysis, the only significant independent predictor of delayed neutrophil engraftment was prior treatment with ATO (hazard ratio 4.87; P<0.001). Of the available stem cell aliquots from APL patients, the median viable post-thaw CD34+ cell recovery was significantly lower than that of cryopreserved autologous stem cell products from patients with non-APL AML. Our findings suggest that ATO exposure prior to CD34+ cell harvest has deleterious effects on hematopoietic recovery after autologous HSCT.

Exenatide dosing in alpacas

In order to investigate whether exenatide could be used to stimulate glucose clearance and insulin secretion in alpacas without causing colic signs, six healthy adult alpacas were injected once a day with increasing subcutaneous doses. A follow-up intravenous glucose injection was given to induce hyperglycemia, and serial blood samples were collected to measure plasma concentrations of glucose, insulin, triglycerides, beta-hydroxybutyrate, and nonesterified fatty acids. The exenatide doses used were saline control (no drug), and 0.02, 0.05, or 0.1 mcg/kg injected subcutaneously. Alpacas had significantly lower plasma glucose concentrations and higher insulin concentrations on all treatment days compared with the control day, but the increase in insulin was significantly greater and lasted significantly longer when the alpacas received the two higher dosages. Two of the alpacas developed mild colic signs at the 0.05 mcg/kg dose and were not evaluated at the highest dose. Based on these findings, the 0.05 mcg/kg dose appears to offer the greatest stimulation of insulin secretion and glucose clearance without excessive risk or severity of complications.

Application of MeV Ion Implantation in the Formation of Nano-Metallic Clusters in Silica

The implantation of metal ions into photorefractive materials followed by thermal annealing leads to an increase in resonance optical absorption as well as an enhancement of the nonlinear optical properties. We have implanted ions of Au (3.6 MeV), Ag (1.5 MeV) and Cu (2.0 MeV) into pure silica followed by careful heat treatment. Using optical absorption spectrophotometry and rutherford backscattering spectrometry we have measured the cluster size for each heat treatment temperature and determined the activation energies for their formation. The third order electric susceptibility for silica with 2 nm gold clusters has been determined by Z-scan to be 65×10−8 esu.

Evolution of sperm quality but not quantity in the internally fertilized fish Xiphophorus nigrensis

Species with alternative reproductive strategies are characterized by discrete differences among males in suites of traits related to competition for fertilizations. Models predict sneaker males should allocate more resources to their ejaculates because they experience sperm competition more frequently and often occupy a disfavoured 'role' owing to subordinance in intramale competition and female preferences for larger males. We examined whether sperm number and quality differed between male strategies in the internally fertilized fish Xiphophorus nigrensis and explored the relationship between sperm morphology and performance. We found sneaker males had similar testes sizes compared to courting males but ejaculates with both more viable and longer lived sperm. Sneaker sperm also had longer midpieces, which was positively correlated with both velocity and longevity. Our study suggests that the evolution of sperm quantity and quality can be decoupled and that the sperm morphology is likely to play an important role in mediating sperm competition through its effects on sperm performance.

The generation of the F2-isoprostane 8-epi-PGF2alpha by human platelets on collagen stimulation

F(2)-isoprostanes are prostaglandin (PG) F(2)-like compounds formed via non-enzymatic peroxidation of arachidonic acid, although some F(2)-isoprostane production may be cyclo-oxygenase (COX)-mediated. Of these substances 8-epi-prostaglandin F(2)alpha (8-epi-PGF(2alpha)) has received the most attention as it induces vasoconstriction and mitogenesis, and influences pathophysiological mechanisms relevant to arterial disease. Using improved methods for F(2)-isoprostane determination we examined collagen-stimulated platelet production of F(2)-isoprostanes in platelet-rich plasma (PRP), distinguishing between the free and esterified forms of these substances. Collagen stimulation caused marked release to the plasma (platelet-poor; PPP) of free 8-epi-PGF(2alpha) (2 +/- 2 pg/mg platelet protein vs 174 +/- 53 pg/mg protein, control (i.e. non-stimulated) vs collagen-stimulated, P < 0.05) and of free 9alpha ,11alpha-PGF (37 +/- 19 pg/mg protein vs 1948 +/- 643 pg/mg protein, control vs stimulated, P < 0.05), a COX derived product. Neither free nor esterified 9alpha, 11beta-PGF and 9beta, 11alpha-PGF(2alpha) were detectable in control or collagen stimulated samples. Sample concentrations of the esters of 8-epi-PGF(2alpha) and 9alpha, 11alpha-PGF(2alpha) were unaltered by collagen stimulation. These data confirm a previous report that activated platelets release the F2-isoprostane 8-epi-PGF(2alpha), accompanying the release of a COX-derived product, 9alpha, 11alpha-PGF(2alpha).

Influence of the alpha-adrenoreceptor naftopidil and doxazosin, on adrenaline-induced serotonin platelets: comparison with the antagonists, collagen and efflux by human effects of nifedipine

Collagen (5 microg/ml) stimulation of washed platelets increased endogenous serotonin (5-HT) release to the medium from 13.88 1.39 to 188.67 26.37 pmol/108 platelets ( P < 0.001). Adrenaline (16 microM) also increased 5-HT release, from 11.0 1.46 to 110.6 29.9 pmol/108 platelets ( P < 0.02). Naftopidil enhanced collagen-induced 5-HT efflux; significant increases occurred with 2 microM (+71.6%, P < 0.01), 10 microM (+89.1%, P < 0.01) and 40 microM (+69.7%, P < 0.01). With 0.4 muM and 2 microM naftopidil, adrenaline-induced 5-HT release was enhanced, albeit non-significantly, whilst with 10 microM and 40 muM naftopidil release was reduced (40 microM,-58.5%, P < 0.05). Doxazosin increased collagen-induced 5-HT release, significant increases being recorded with 7.5 microM (+81.7%, P < 0.05) and 30 microM (+78.4%, P < 0.05). Adrenaline-induced 5-HT release was also increased by doxazosin, but not significantly. Collagen-stimulated 5-HT release was inhibited by nifedipine (7 microM,-38.8%, P < 0.05; 28 microM, -61.2%, P < 0.001). These data suggest that the-antagonists, naftopidil and doxazosin, and the Ca2+ channel blocker, nifedipine, influence agonist-induced platelet 5-HT release through different mechanisms. Thus naftopidil and doxazosin may possess 5-HT transporter-blocking activity. The observation that naftopidil inhibited, adrenaline-induced 5-HT release may indicate that naftopidil also inhibits adrenaline uptake and exchange with dense granular 5-HT, with consequent inhibition of 5-HT release and platelet aggregation. The data obtained with nifedipine are consistent with 5-HT release being reduced as a result of its inhibitory action on platelet Ca2+ mobilisation.

Effects of exenatide on plasma glucose and insulin concentrations in alpacas

BACKGROUND

Exenatide is a degradation-resistant glucagon-like peptide 1 agonist used in the treatment of diabetes mellitus. It enhances the insulin response to hyperglycemia. Because of a poor insulin response, adult camelids are susceptible to hyperglycemia from stress, glucose administration, or energy metabolism disorders. Insulin often is administered to decrease plasma glucose concentration, but this approach has disadvantages such as the risk of hypoglycemia. Noninsulin medications targeting the incretin hormone pathway, such as exenatide, are providing alternate treatment options.

HYPOTHESIS/OBJECTIVES

Exenatide will decrease plasma glucose and increase insulin concentrations in alpacas.

ANIMALS

Six healthy adult alpacas.

METHODS

After food was withheld for 8 hours, alpacas were given, on subsequent days in a randomly determined order, either 0.2 microg/kg of exenatide or similar volume of isotonic saline SC. Blood samples were collected before and 15, 30, 45, 60, 75, 90, 105, and 120 minutes after treatment. A rapid dextrose (0.5 g/kg) injection was given after the time 60 samples. Plasma glucose and insulin concentrations were measured at each time point.

RESULTS

Alpacas had significantly (P=<.001-.015) lower plasma glucose and higher insulin concentrations for the hyperglycemic period after receiving exenatide than after saline injections. Colic signs were observed in 5 of 6 alpacas treated with exenatide.

CONCLUSIONS AND CLINICAL IMPORTANCE

Exenatide appeared to increase insulin release and decrease plasma glucose concentrations in hyperglycemic alpacas. These findings are similar to findings in humans and could support therapeutic usage of exenatide in alpacas. However, induction of colic may limit practical application.

Performance and use of a ribonucleotide reductase herpes simplex virus type-specific serological assay

In response to the increasingly evident need for herpes simplex virus (HSV) serotype-specific serologic assays that rely on proteins other than glycoprotein-G (gG), we developed a rapid serologic assay that is based on type-specific epitopes within the large subunit of HSV ribonucleotide reductase (R1). The assay (Au-2 enzyme-linked immunosorbent assay [ELISA]) uses an HSV type 2 (HSV-2) R1 peptide antigen. It provides a reliable method for detecting serotype-specific antibody to a protein other than gG-2. The Au-2 ELISA has high sensitivity and specificity as determined by direct comparison to Western blotting, a widely accepted "gold standard," and to ELISA with an HSV-1 R1 peptide (Au-1). The use of the Au-2 ELISA in conjunction with the gG-2-based assays will improve the sensitivity and specificity of serologic diagnosis and patient management.

Increasing incidence of acute hepatitis B virus infection referrals to the Aberdeen Infection Unit: a matter for concern

OBJECTIVES

To assess the epidemiology and clinical outcomes of acute hepatitis B virus (HBV) infections presenting to a regional Infection Unit over a ten year period--with reference to the issues of injection drug use and strategies aimed at reducing transmission, notably needle exchange and immunisation programmes.

METHODS

A retrospective casenote review of all patients with acute HBV managed at the Infection Unit in Aberdeen between 1991-2000.

RESULTS

One hundred and nineteen (119) patients with acute HBV infection were managed during the period of review. The annual number of patients increased from a mean of 3.3/year during the years 1991-96 to 46 in 2000. The risk factors associated with HBV infection were being an injection drug user (IDU) in 57 (47.9%), heterosexual sex in 22 (18.5%), sex with an IDU in 4 (3.4%), men who had sex with men in 10 (8.4%), tattooing in 1 (0.8%), a needle stick injury in 1 (0.8%), trauma 1 (0.8%) and unknown in 23 (19.3%). Many of these patients had "dabbled" in drug use. Thirty-one (54.4%) of the IDU patients had previously been hospitalised with drug-related medical problems. Eighteen (31.6%) of the IDUs were receiving methadone at the time of presentation.

CONCLUSIONS

There is an epidemic of HBV infection in the Grampian region of Scotland currently. Forty-six (65.7%) of the 70 infected patients diagnosed during 2000 were seen at the Infection Unit. The remainder had mild or asymptomatic disease and were managed in the community. This epidemic has occurred despite extensive use of local needle exchange facilities and might reflect missed opportunities to immunise IDUs against HBV infection. A co-ordinated approach is now in place to immunise IDUs and other high-risk groups, but the use of universal immunisation demands consideration.

Measures of oxidative stress in heterozygous familial hypercholesterolaemia

Familial hypercholesterolaemia (FH) may be associated with increased oxidative stress which may contribute to atherogenesis. Plasma lipid hydroperoxides (ROOHs), 8-epi PGF(2alpha) and alpha-tocopherol were measured in normal subjects and in newly referred heterozygous FH patients and used as indices of oxidative stress. ROOH levels were higher (+16%), albeit non-significantly, in FH patients than in controls subjects (4.4+/-0.3 vs. 3.8+/-0.3 micromol/l; n=51 and 40, respectively). 8-epi PGF(2alpha) levels were significantly greater (+56%) in the FH patients than in controls (0.43+/-0.06 vs. 0.27+/-0.05 nmol/l; P<0.05; n=14 and 16, respectively). FH patients with vascular disease had significantly higher (+32%) levels of ROOH compared with patients without vascular disease (4.9+/-0.40 vs. 3.7+/-0.33 micromol/l; P<0.05; n=27 and 24, respectively). Similarly, 8-epi PGF(2alpha) concentrations were higher (+100%) in the FH patients with vascular disease than in those without it (0.6+/-0.08 vs. 0.3+/-0.10 nmol/l; P<0.05; n=6 and 8, respectively). Absolute alpha-tocopherol levels in FH patients were similar to those in controls (21.0+/-0.70 vs. 23.8+/-1.30 micromol/l). When alpha-tocopherol levels were expressed relative to cholesterol, however, the concentrations were found to be significantly lower (-43%) in FH patients than in controls (2.9+/-0.10 vs. 5.1+/-0.40 micromol/mmol, P<0.0005). There were no differences in absolute or cholesterol standardised alpha-tocopherol levels in patients with and without vascular disease. These data suggest that oxidative stress is increased in FH-patients and is particularly pronounced in those patients with vascular disease. It is possible that increased oxidative stress may precede the development of vascular disease.

Expression analysis and chromosome location of a novel gene (H11) associated with the growth of human melanoma cells

We have previously described the isolation of a new human gene, H11, that codes for a 25 kDa phosphoprotein with autokinase activity the expression of which is required for cell growth. The data described in this report extend these findings. Using FISH and M-FISH we show that H11 which maps at chromosome site 12q24.1-12q24.31 is not involved in chromosomal translocations. The tissue distribution of H11 mRNA is restricted, with expression being most abundant in skeletal muscle, heart, prostate and placenta. The H11 protein is cytoplasmic and it is associated with the plasma membrane. Cell surface localization in particulate aggregate formations suggests that it may be complexed to proteins involved in the transfer of extracellular growth signals.

Platelet secretion of beta-amyloid is increased in hypercholesterolaemia

Tissue accumulation of the cytotoxic beta-amyloid peptide (Abeta) occurs in Alzheimer's disease (AD), one possible source being the platelet. AD and cardiovascular disease may share some risk factors, including hypercholesterolaemia which is associated with increased platelet activity. We examined platelet Abeta release under resting and collagen-stimulated conditions in normocholesterolaemic and hypercholesterolaemic individuals. Resting platelet Abeta efflux was greater in hypercholesterolaemics than in normocholesterolaemics. Collagen-stimulated Abeta release was concentration-dependent and increased in hypercholesterolaemics. Resting Abeta release correlated positively with plasma total cholesterol and low-density lipoprotein (LDL) cholesterol, and inversely with platelet count. These data indicate that abnormal platelet Abeta release occurs in hypercholesterolaemia.

A growth and latency compromised herpes simplex virus type 2 mutant (ICP10DeltaPK) has prophylactic and therapeutic protective activity in guinea pigs

A growth compromised herpes simplex virus type 2 (HSV-2) mutant which is deleted in the PK domain of the large subunit of ribonucleotide reductase (ICP10DeltaPK) protects from fatal HSV-2 challenge in the mouse model (Aurelian L, Kokuba H, Smith CC. Vaccine potential of a Herpes Simplex Virus type 2 mutant deleted in the PK domain of the large subunit of ribonucleotide reductase (ICP10). Vaccine 1999;17:1951-1963). Here we report the results of our studies with ICP10DeltaPK in the guinea pig model of recurrent HSV-2 disease. ICP10DeltaPK was also compromised for growth and disease causation in this model. It was not isolated from latently infected ganglia by explant co-cultivation. The proportions of latently infected ganglia were significantly lower for ICP10DeltaPK than HSV-2 [3/25 (12%) and 7/10 (70%), respectively]. Similar results were obtained for the levels of viral DNA (8 x 10(3) and 2 x 10(5) molecules/ganglion for ICP10DeltaPK and HSV-2, respectively]. ICP10DeltaPK immunization caused a significant (P< or = 0.001) decrease in the proportion of animals with primary [1/14 (6%) and 16/16 (100%) for ICP10DeltaPK and PBS, respectively) and recurrent [1/14 (6%) and 11/14 (79%) for ICP10DeltaPK and PBS, respectively) HSV-2 skin lesions. It also protected from genital HSV-2 disease [1/10 and 10/10 for ICP10DeltaPK and PBS, respectively] and decreased the severity of the lesions in both models. Quantitative PCR (Q-PCR) with primers that distinguish between HSV-2 and ICP10DeltaPK indicated that immunization reduced the proportion of ganglia positive for HSV-2 DNA [8/25 (32%) and 7/10 (70%) for ICP10DeltaPK and PBS, respectively) and its levels [3 x 10(3) and 2 x 10(5) molecules/ganglion for ICP10DeltaPK and PBS, respectively]. The proportion of HSV-2 infected animals with recurrent disease was also significantly (P < or = 0.001) decreased by immunization with ICP10DeltaPK [1/15 (7%) and 11/14 (79%) with recurrent disease for ICP10DeltaPK and PBS, respectively], suggesting that ICP10DeltaPK has prophylactic and therapeutic activity in the guinea pig.

A novel gene expressed in human keratinocytes with long-term in vitro growth potential is required for cell growth

The herpes simplex virus large subunit of ribonucleotide reductase differs from its counterparts in eukaryotic and prokaryotic cells and in other viruses in that it contains a unique domain that codes for a distinct serine-threonine protein kinase that activates the Ras/MEK/MAPK mitogenic pathway and is required for virus growth. Previous studies suggested that ribonucleotide reductase protein kinase was co-opted from a cellular gene. Cellular genes similar to ribonucleotide reductase protein kinase were not cloned, however, and their function is unknown. Here we report that a novel gene (H11) that codes for a protein similar to herpes simplex virus 2 ribonucleotide reductase protein kinase, is expressed in skin tissues, cultured keratinocytes, and the keratinocyte cell line A431. The protein is phosphorylated and it associates with the plasma membrane. H11 is expressed in keratinocytes with long-term in vitro growth potential and is coexpressed with high levels of adhesion molecules involved in signal transduction, such as beta1 integrin. Antisense oligonucleotides that inhibit H11 expression inhibit DNA synthesis and keratinocyte proliferation, suggesting that H11 expression is required for cell growth.

Ras-GAP binding and phosphorylation by herpes simplex virus type 2 RR1 PK (ICP10) and activation of the Ras/MEK/MAPK mitogenic pathway are required for timely onset of virus growth

We used a herpes simplex virus type 2 (HSV-2) mutant with a deletion in the RR1 (ICP10) PK domain (ICP10DeltaPK) and an MEK inhibitor (PD98059) to examine the role of ICP10 PK in virus growth. In HSV-2-infected cells, ICP10 PK binds and phosphorylates the GTPase activating protein Ras-GAP. In vitro binding and peptide competition assays indicated that Ras-GAP N-SH2 and PH domains, respectively, bind ICP10 at phosphothreonines 117 and 141 and a WD40-like motif at positions 160 to 173. Binding and phosphorylation did not occur in cells infected with ICP10DeltaPK. GTPase activity was significantly lower in HSV-2- than in ICP10DeltaPK-infected cells. Conversely, the levels of activated Ras and mitogen-activated protein kinase (MAPK), and the expression and stabilization of the transcription factor c-Fos were significantly increased in cells infected with HSV-2 or a revertant virus [HSV-2(R)] but not with ICP10DeltaPK. PD98059 inhibited MAPK activation and induction-stabilization of c-Fos. Expression from the ICP10 promoter was increased in cells infected with HSV-2 but not with ICP10DeltaPK, and increased expression was ablated by PD98059. ICP10 DNA formed a complex with nuclear extracts from HSV-2-infected cells which was supershifted by c-Fos antibody and was not seen with extracts from ICP10DeltaPK-infected cells. Complex formation was abrogated by PD98059. Onset of HSV-2 replication was significantly delayed by PD98059 (14 h versus 2 h in untreated cells), a delay similar to that seen for ICP10DeltaPK. The data indicate that Ras-GAP phosphorylation by ICP10 PK is involved in the activation of the Ras/MEK/MAPK mitogenic pathway and c-Fos induction and stabilization. This results in increased ICP10 expression and the timely onset of HSV-2 growth.

Modified adenovirus penton base protein (UTARVE) as a non-replicating vector for delivery of antisense oligonucleotides with antiviral and/or antineoplastic activity

Antisense oligonucleotides that selectively inhibit gene expression are a genetic approach for disease treatment and prevention. However, their use as therapeutic agents is complicated by their low rate of transport across cellular membranes and their sequestration within endocytic-like vesicles. We report that the adenovirus type-2 penton base protein modified to include the fusogenic peptide of the influenza virus hemagglutinin protein is a non-replicating vector (designated UTARVE) that improves delivery of antisense oligonucleotides. Approximately 10-18% of the input vector was internalized by A549 and HeLa cells as determined by immunoblotting. It was cleared by proteolysis within 48 h. The vector had endosome disruptive potential as evidenced by erythrocyte lysis activity at low pH and a primarily diffuse cytoplasmic distribution in treated cells. Despite concentration and time-dependent cell detachment, UTARVE was not cytotoxic in the dye release assay. We used R1T1, an antisense oligonucleotide that inhibits expression of the multifunctional herpes simplex virus type-2 (HSV-2) R1 protein, HSV-2 growth and the proliferation of R1 PK transformed cells to examine vector-mediated delivery. Conjugated FITC-labeled R1T1 was rapidly (15-30 min) internalized by all cells treated at low (80 nM) concentration and the oligomer was intracellularly dissociated from the vector. This compares to 65-83% of cells internalizing the unconjugated R1T1 when treated for 24 h. In antiviral assays, the IC50 and time required to inhibit HSV-2 growth were significantly lower for the conjugated (2 nM; 30 min) as compared to unconjugated (100 nM; 24 h) R1T1. The data indicate that the bioavailability and biological activity of R1T1 were significantly increased by its delivery with UTARVE.

High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics

Injecting drug use, mainly of heroin, currently represents a major public health issue in the North East of Scotland. The recent tendency of the committed injecting drug user to inject into the groin has created novel problems for the Infection Unit. Data are presented on 20 consecutive patients admitted between 1994 and 1999 with iliofemoral venous thromboses, often complicated by severe soft tissue infections and bacteraemia as a result of heroin injection into the femoral vein. Nine had coexistent groin abscesses, four had severe streptococcal soft tissue infection of the right thigh, groin and lower abdomen, and two had coincidental soft tissue infections of the upper limb. Nine were bacteraemic on admission. All of the patients were chronic injecting drug users with a median injection duration of 6.5 years. The 18 patients tested for hepatitis C virus were all seropositive. None of the 14 patients tested was positive for HIV. Seventeen patients were treated with subcutaneous low molecular weight heparin (tinzaparin), three having received intravenous unfractionated heparin initially. The tinzaparin was self administered and given for a median duration of seven weeks. One patient declined to have any treatment. Three months after presentation eight patients were asymptomatic, seven had a persistently swollen leg, and five were lost to follow up. None developed clinically apparent pulmonary embolism after institution of anticoagulant therapy. The management of iliofemoral venous thrombosis in injection drug users is problematic because of poor venous access, non-compliance with prescribed treatment, ongoing injecting behaviour, and coexistent sepsis. It is unlikely that a randomised trial of standard treatment with heparin and warfarin versus low molecular weight heparin alone would be practical in this patient group. These retrospective data indicate that the use of tinzaparin in injecting drug users is feasible and appears to result in satisfactory clinical responses. The possibility of concomitant infection in injecting drug users with venous thrombosis should always be addressed, as it appears to be a common phenomenon. Early drainage of abscesses and antimicrobial chemotherapy, often administered intramuscularly or orally because of lack of peripheral venous access, is central to the appropriate care of these patients.

Presenting clinical features and C-reactive protein in the prediction of a positive stool culture in patients with diarrhoea

OBJECTIVES

To devise a scoring system by which clinical features and C-reactive protein (CRP) can be used to predict a positive stool culture in patients admitted with acute diarrhoea.

METHODS

One hundred and thirty-two patients admitted to the Regional Infection Unit with diarrhoea thought to be due to bacterial gastroenteritis were included. Clinical features, CRP and outcome of stool culture were recorded, together with the final diagnosis.

RESULTS

Forty-one patients had bacterial gastroenteritis characterized by the isolation of a bacterial enteropath (BGE). Sixty-three patients had non-specific gastroenteritis, defined as more than three loose stools per day with no bacterial enteropath isolated (NSGE). In 28 patients another diagnosis was made (Others). More of the patients with BGE (91%) had abdominal pain as compared with those with NSGE (67%) and Others (61%) (P=0.01). The mean duration of symptoms was longer in the Others group (6.14 days) as compared with patients with BGE (3.29) and NSGE (3.25) (P=0.01). The mean CRP was significantly higher in those with BGE (113.9mg/l) and Others (116.9mg/l) as compared to the NSGE patients (38.9mg/l) (P=0.001). A scoring system was devised which incorporated the presence or absence of abdominal pain (+10 or 0), the duration of symptoms (-10, for 5 or more days, 0 for less than 5 days of symptoms) and the CRP (CRP<50=0, CRP>50=5). A score of 15 or more predicted 79% of patients with BGE, while a score of <15 predicted 87% of those with NSGE and 86% of those with another diagnosis.

CONCLUSIONS

This simple scoring system may be useful in predicting the positivity of stool culture, and therefore may be helpful in targeting those small number of patients who require antimicrobial therapy after hospital admission. We would not, however, favour reliance on this scoring system alone to choose whom to treat with antimicrobials.

A novel human gene similar to the protein kinase (PK) coding domain of the large subunit of herpes simplex virus type 2 ribonucleotide reductase (ICP10) codes for a serine-threonine PK and is expressed in melanoma cells

The large subunit of herpes simplex virus type 2 ribonucleotide reductase (ICP10) is a multifunctional protein that contains a serine-threonine protein kinase (PK) activity (Nelson, J. W., Zhu, J. , Smith, C. C., Kulka, M., and Aurelian, L. (1996) J. Biol. Chem. 271, 17021-17027). Phylogenetic analyses indicated that ICP10 PK belongs to a distinct subfamily of growth factor receptor serine-threonine PKs that are characterized by their ability to function with a limited number of conserved catalytic motifs (Hunter, J. C. R., Smith, C. C., and Aurelian, L. (1995) Int. J. Onc. 7, 515-522). Here, we report the isolation and characterization of a novel gene, designated H11, that contains an open reading frame of 588 nucleotides, which encodes a protein similar to ICP10 PK. The H11 protein has Mn(2+)-dependent serine-threonine-specific PK activity as determined with a GST-H11 fusion protein and by immununocomplex PK/immunoblotting assays of 293 cells transfected with a H11 eukaryotic expression vector. PK activity is ablated by mutation of Lys(113) within the presumtive catalytic motif II (invariant Lys). 293 cells stably transfected with H11 acquire anchorage-independent growth. Endogenous H11 RNA and the H11 phosphoprotein are expressed in melanoma cell lines and primary melanoma tissues at levels higher than in normal melanocytes and in benign nevi. Melanoma cell proliferation is inhibited by treatment with antisense oligonucleotides that inhibit H11 translation, suggesting that H11 expression is associated with cell growth.

Impact of the oil industry on malaria diagnosis and management in north-east Scotland (1992-99)

In order to assess the current pattern of malaria presenting to the Aberdeen Infection Unit a retrospective casenote review was undertaken of 110 patients admitted with that diagnosis between 1st January 1992 and 31st August 1999. Oil-related work was the reason for travel in 48 (43.6%) of the UK residents, holiday in 35 (31.8%), backpacking in 8 (7.3%) and other work in 5 (4.5%). Sixty-five patients (59.1%) had PL falciparum malaria (pure or mixed), 25 (22.7%) had PL vivax, 6 (5.4%) PL ovale and 3 (2.7%) PL malariae infection. No prophylaxis had been taken by 66% of the 47 UK-based oil workers and by 36% of the other 48 UK residents who had returned from Africa. There is a need for better education of oil workers and holidaymakers travelling to areas endemic for malaria. We are now setting up a travel advisory service in our Unit to address the problem.

Herpes simplex virus type 2 growth and latency reactivation by cocultivation are inhibited with antisense oligonucleotides complementary to the translation initiation site of the large subunit of ribonucleotide reductase (RR1)

Antisense oligonucleotides complementary to the translation initiation site of the herpes simplex virus type 2 (HSV-2) large subunit of ribonucleotide reductase (RR1) were studied for their ability to inhibit RR1 expression, HSV-2 growth, and its reactivation from latently infected ganglia. The oligomers caused a significant decrease (90%-97% inhibition) in HSV-2 RR1 expression and inhibited HSV-2 growth, with IC50 and IC90 values of 0.11 and 1.0 microM, respectively. The titers of HSV-2 mutants that are respectively deleted in the PK (ICP10deltaPK) or RR (ICP10deltaRR) domains of RR1 were also significantly (500-20,000-fold) decreased, indicating that the antisense oligomers interfere with the independent contributions of the two RR1 functions (PK and RR) toward virus growth. Inhibition was sequence specific, as evidenced by the failure of a two-base mutant (RR1TImu) to inhibit protein expression and HSV-2 growth. Furthermore, the antisense oligomers inhibited HSV-2 reactivation by cocultivation of latently infected ganglia (0/8). Virus was reactivated from ganglia cultured without oligomers, in the presence of unrelated oligomers (6/8), or in the presence of the two-base mutant RR1TImu (5/8) (p < 0.007 by two-tailed Fisher exact test). HSV-2 growth was not inhibited by antisense oligonucleotides complementary to the splice junction of HSV-2 immediate-early (IE) pre-mRNA 4 and 5 (IE4,5SA) or the translation initiation site of IE mRNA 4 (IE4TI), although the respective HSV-1-specific oligomers inhibit HSV-1 growth.

Platelet aggregation may not be a prerequisite for collagen-stimulated platelet generation of nitric oxide

By determining the sum of the supernatant concentrations of nitrite and nitrate the stimulated generation of nitric oxide (NO) by human washed platelets induced by a range of fibrillar collagen concentrations (0.0156-25 microg ml(-1)) was investigated. Platelet serotonin (5-hydroxytryptamine, 5-HT) efflux and platelet aggregation were also measured. Under resting conditions (0 microg ml(-1) collagen) platelet NO release was equivalent to 1.06+/-0.17 nmol per 10(8) platelets. Maximal NO release, equivalent to 2.1+/-0. 37 nmol per 10(8) platelets, was observed with only 0.0625 microg ml(-1) collagen (P<0.02, stimulated vs. resting release), higher collagen concentrations producing no further increases in platelet NO output. By contrast, maximal platelet aggregation and 5-HT efflux did not occur until collagen concentrations of 2.5 microg ml(-1) and 10-25 microg ml-1), respectively, had been achieved. L-NAME (1 mmol l(-1)) and L-NMMA (1 mmol l(-1)) inhibited stimulated platelet NO generation by 78+/-6% and 72%, respectively. Contrasting with fibrillar collagen, fibrillar beta-amyloid protein had no effect on platelet NO generation, or on 5-HT efflux or aggregation. These data perhaps indicate that NO generation by human platelets is stimulated by concentrations of fibrillar collagen insufficient to elicit an aggregatory response. Such a mechanism could operate in vivo to inhibit platelet aggregation which might otherwise be induced by low concentrations of circulating agonists.

Nitric oxide synthesis in patients with infective gastroenteritis

BACKGROUND

There is evidence that endogenous nitrate synthesis is notably increased in patients with infective gastroenteritis.

AIMS

To determine whether this is due to nitric oxide (NO) production via the L-arginine/NO pathway.

METHODS

Seven male patients with community acquired bacterial gastroenteritis and 15 healthy male volunteers participated in this study. All patients had stool culture positive infective gastroenteritis. A bolus of 200 mg L-[(15)N](2)-arginine was administered intravenously after an overnight fast. Urine was collected for the next 36 hours. Urinary [(15)N:(14)N]nitrate ratio was assessed by dry combustion in an isotope ratio mass spectrometer.

RESULTS

Mean 36 hour total urinary nitrate excretion in the gastroenteritis group was 5157 (577) micromol compared with 2594 (234) micromol in the control group (p<0.001). Thirty six hour urinary [(15)N]nitrate excretion was considerably higher in the gastroenteritis group compared with the control group (13782 (1665) versus 1698 (98) etamol; p<0.001). These values represent 1.129 (0.139)% and 0.138 (0.007)% of [(15)N]nitrogen administered (p<0.001), respectively. Corrected 36 hour urinary [(15)N]nitrate excretion for urinary creatinine was also significantly higher in the patient compared with the control group (1934 (221) versus 303 (35) etamol/mmol; p<0.001).

CONCLUSION

Results show notably enhanced nitrate synthesis due to increased activity of the L-arginine/NO pathway in patients with infective gastroenteritis.

Effects of acute prednisone administration on memory, attention and emotion in healthy human adults

We conducted a double-blind study in order to examine the effects of high doses of prednisone on memory, attention and emotion in humans. A total of 24 healthy undergraduate males self-administered either 160 mg of prednisone (n = 12) or a placebo (n = 12) for 4 consecutive days. We examined group differences in mood, regional brain electrical activity (EEG), the startle eyeblink response, memory recall and performance on an attention task after 4 days of treatment. We found significant group differences on measures of mood and frontal EEG alpha activity on 4-day treatment. Subjects treated with prednisone exhibited a significantly greater increase in self-reported negative emotion and greater relative right frontal EEG alpha activity on 4-day treatment compared with adults in the placebo group. We also found that subjects treated with prednisone recalled fewer objects on the memory task following treatment. No significant group differences were found on posterior EEG activity, the startle eyeblink measure, or the attention measure. These findings suggest that administration of high doses of exogenous prednisone may facilitate the experience of negative emotion and shifts in frontal EEG activity, and impair some aspects of cognitive functioning in humans. The multiple roles of glucocorticoids in memory, attention and emotion are discussed.

Vaccine potential of a herpes simplex virus type 2 mutant deleted in the PK domain of the large subunit of ribonucleotide reductase (ICP10)

A herpes simplex virus type 2 (HSV-2) mutant deleted in the PK domain of the large subunit of ribonucleotide reductase (ICP10) was evaluated as a potential vaccine for the prevention of HSV-2 infection and disease. This virus, designated ICP10 deltaPK, expressed a 95 kDa ICP10 protein that lacked PK activity and transforming potential. ICP10 deltaPK was growth compromised in dividing and nondividing cells in culture. In dividing cells, onset of virus growth was delayed, with replication initiating at 10-15 h p.i. depending on the multiplicity of infection. In addition to the delayed growth onset, virus replication was significantly impaired (1000-fold lower titers) in nondividing cells. A revertant virus (HSV-2(R)) expressed ICP10, regained transforming activity and had wild type growth properties. ICP10 deltaPK was growth compromised also in infected animals. It was isolated from the site of infection on day 2, but not day 7 p.i. and its titers at this time (2 x 10(2) pfu/ml) were significantly lower than those of HSV-2 (5 x 10(4) pfu/ml). Mice given high titers of ICP10 deltaPK (5 x 10(7) pfu/footpad) remained free of clinical symptoms and survived infection during a 21-day follow-up period and virus was not isolated from latently infected ganglia at 30 days p.i. ICP10 deltaPK immunized animals developed HSV-specific humoral and T-cell responses and evidenced absolute protection from HSV-2 infection and virus-induced disease.

Risk of latex allergy from medication vial closures

A latex allergy, like all allergies, is a serious matter that requires special precautions on behalf of patients and healthcare workers. The FDA final rule on the labeling of natural rubber-containing medical devices will assist in the creation of a latex-safe environment for latex-sensitive individuals. Currently, this ruling does not apply to medication vial closures that contain latex. Until further action by the FDA, the only way to determine whether a medication vial closure contains latex is by directly contacting the pharmaceutical manufacturer. Moreover, in order to rule whether special labeling should be mandatory for latex-containing medication vials, additional evidence is needed to clarify whether exposure to trace amounts of latex from a medication vial stopper can cause allergic reactions in individuals who are sensitive to latex.

Epidemiology and outcome of HIV infection in North-East Scotland (1985-1997)

OBJECTIVE

to assess the epidemiology of HIV infection in North-East Scotland.

METHODS

retrospective casenote review of all HIV-infected patients who have had contact with the Infection Unit in Aberdeen.

RESULTS

one hundred and forty-two HIV-infected patients were treated between April 1985 and December 1997. The risk behaviour related to the acquisition of the HIV infection was: 56 (39%) homosexually infected, 45 (32%) heterosexually-infected, 34 (24%) injecting drug users (IDUs), and seven (5%) blood products or not known. Sixteen of the 45 (36%) heterosexually-infected patients were native to Africa and 16 of the 34 (31%) IDUs were prisoners in Peterhead prison at the time of referral. Fifty-two (37%) of the cohort continue to attend the Infection Unit, 41 (29%) have relocated, 40 (28%) have died and nine (6%) have been lost to follow-up. The ratio of heterosexual:homosexual men:IDUs changed significantly between the first 7 years (12:21:25) and the second 6 years (33:35:9) of the review, with significantly more patients being infected through heterosexual contact and fewer infected by IDU in the second period-P<0.001. The median AIDS survival was 17 months. Survival was significantly longer in those patients who took anti-retroviral therapy (median = 20 months) than in the patients who opted not to take anti-retroviral therapy (median = 11 months)-P<0.01.

CONCLUSIONS

Although homosexual contact represents the commonest risk group for HIV infection in this region, the number of heterosexually-infected patients has increased significantly in the last 5 years. Temporary residents account for one-third of the HIV-infected population cared for in NE Scotland. Almost half of those lost to follow-up have returned to Africa or been released from prison. The introduction of anti-retroviral therapy has resulted in a dramatic improvement in AIDS survival in our cohort as it has done elsewhere.

Analysis of gene mutations and clastogenicity following short-term treatment with azathioprine in MutaMouse

The mutagenicity and clastogenicity of the immunosuppressive drug azathioprine (AZA), a multitissue rodent carcinogen and IARC-classified human carcinogen, was investigated using transgenic lacZ mice (MutaMouse). Male animals (n = 5 per group) were dosed with AZA (10, 50, 100 mg/kg p.o. daily for 5 days), vehicle (n = 10), or the positive control, chlorambucil (15 mg/kg i.p., n = 3), and killed 24 hr or 25 days after the last treatment. Micronucleus assays were performed with bone marrow (24-hr samples) or peripheral blood (24-hr and 25-day samples) and DNA was extracted from bone marrow and liver for gene mutation analysis at the transgenic lacZ locus. AZA induced 5.3-111.3-fold increases in %MNPCE (P < 0.01) in bone marrow compared with vehicle control, accompanied by 4.4-5. 6-fold increases in %MNRETs (P < 0.01) in peripheral blood. Chlorambucil caused a 14.5-fold increase in %MNRET and there was evidence of significant stem cell toxicity in both positive control and AZA treatment groups. By day 25, however, there was evidence of substantial recovery of the bone marrow as determined by the frequency of RET, and the %MNRET in all treatment groups was the same as the vehicle control. Analysis of lacZ MF showed 1.4-1.6-fold increases in AZA 24-hr bone marrow samples, increasing to approximately 2.0-fold above concurrent controls by day 25 (medium dose P < 0.05, high dose P < 0.01). For liver, there was a 2-fold increase in MF (P < 0.05) in the 24-hr sample at the highest dose only, and increases of 1.3-1.5-fold by day 25 in the medium (P < 0. 05) and high (P = 0.055) dose groups, respectively. The positive control, chlorambucil, induced 2-3-fold increases (P < 0.01) in mean MF in both bone marrow (25-day sample) and liver (24-hr and 25-day samples). These data confirm the clastogenicity of AZA in the mouse, and show that this compound induces gene mutations in bone marrow and liver, in vivo, at the highest dose and supports the view that AZA is a genotoxic carcinogen.

The PK domain of the large subunit of herpes simplex virus type 2 ribonucleotide reductase (ICP10) is required for immediate-early gene expression and virus growth

The large subunit of herpes simplex virus (HSV) ribonucleotide reductase (RR), RR1, contains a unique amino-terminal domain which has serine/threonine protein kinase (PK) activity. To examine the role of the PK activity in virus replication, we studied an HSV type 2 (HSV-2) mutant with a deletion in the RR1 PK domain (ICP10DeltaPK). ICP10DeltaPK expressed a 95-kDa RR1 protein (p95) which was PK negative but retained the ability to complex with the small RR subunit, RR2. Its RR activity was similar to that of HSV-2. In dividing cells, onset of virus growth was delayed, with replication initiating at 10 to 15 h postinfection, depending on the multiplicity of infection. In addition to the delayed growth onset, virus replication was significantly impaired (1,000-fold lower titers) in nondividing cells, and plaque-forming ability was severely compromised. The RR1 protein expressed by a revertant virus [HSV-2(R)] was structurally and functionally similar to the wild-type protein, and the virus had wild-type growth and plaque-forming properties. The growth of the ICP10DeltaPK virus and its plaque-forming potential were restored to wild-type levels in cells that constitutively express ICP10. Immediate-early (IE) genes for ICP4, ICP27, and ICP22 were not expressed in Vero cells infected with ICP10DeltaPK early in infection or in the presence of cycloheximide, and the levels of ICP0 and p95 were significantly (three- to sevenfold) lower than those in HSV-2- or HSV-2(R)-infected cells. IE gene expression was similar to that of the wild-type virus in cells that constitutively express ICP10. The data indicate that ICP10 PK is required for early expression of the viral regulatory IE genes and, consequently, for timely initiation of the protein cascade and HSV-2 growth in cultured cells.

Raw egg ingestion and salmonellosis in body builders

Four patients with Salmonella enteritidis infection are reported. All were body builders who regularly consumed substantial quantities of raw eggs. They presented with a severe febrile illness and diarrhoea--presumably reflecting a large bacterial inoculum. Advice regarding the potential hazards of raw egg ingestion has been repeatedly issued by the Department of Health--but this report highlights the fact that this practice continues in spite of this. The epidemiology of S. enteritidis infection in relation to raw egg ingestion is discussed.

Prevalence of serum antibodies to LA-1 oncoprotein, herpes simplex virus type-2 glycoprotein and human papillomavirus type 16 transactivator (E2) protein among Indian women with cervical neoplasia

Prevalence of serum antibodies to synthetic peptide to oncoprotein of LA-1 known as oncogene of herpes simplex virus type-2, herpes simplex virus type-2 glycoprotein-D as an determinant of viral pathogenicity and human papillomavirus type 16 transactivator E2 protein was studied among 46 Indian women with cervical neoplasia using immunoblot assay for HSV-2 gD glycoprotein and LA-1 antibodies as well as peptide ELISA assay to detect HPV16 E2 antibodies. The seropositivity to LA-1 oncoprotein was found to be high (61%) among patients with invasive cervical carcinoma as compared to 35% in various grades of cervical intraepithelial neoplasia (CIN) and 36% in normal control women. In contrast to this, a uniformly high frequency of antibody to HPV 16 E2 was observed among women with CIN (68%), normal healthy controls (50%) and invasive cervical carcinoma (43%). However, a low frequency of seropositivity (13%) to recombinant vaccinia virus HSV-2 gD protein was found among 15 tested sera each from group of women with various grades of CIN as well as invasive cervical carcinoma as compared to 28% among seven normal healthy control. A negative correlation of LA-1 and HPV16 E2 seropositivity on patient by patient comparison among CIN and invasive cervical carcinoma group was observed which is statistically significant (P = 0.019 for CIN; P = 0.038 for invasive cervical carcinoma). However, a positive correlation (P = 0.144) was found among normal control women. The study has shown a desirable serological marker of cervical neoplasia. This serological marker could be employed as a screening tool in conjunction with cytopathological screening to diagnose women harbouring LA-1 oncogene associated cervical lesions.

Spinal epidural abscess: the importance of early diagnosis and treatment

OBJECTIVES

To remind clinicians of the dangers of delayed diagnosis and the importance of early treatment of spinal epidural abscess.

METHODS

A review of the literature on spinal epidural abscess and a comparison of the published literature with local experience.

RESULTS

Imaging with MRI or CT enables early diagnosis of spinal epidural abcess and optimal therapy is surgical evacuation combined with 6-12 weeks (median 8 weeks) of antimicrobial chemotherapy. Clinical features are fever, pain, and focal neurological signs and may be associated with preceding and pre-existing bone or joint disease. The commonest aetiological organism is S aureus.

CONCLUSION

Early diagnosis and appropriate early antimicrobial chemotherapy with surgery is associated with an excellent prognosis.

Depletion of endogenous dopamine stores and shift in beta-adrenoceptor subtypes in cardiac tissue following five weeks of chronic denervation

Surgical ablation of extrinsic cardiac nerve fibers results in a chronically denervated state of the left ventricle of the heart. The present study was performed to elucidate the effect of a period of 5 weeks of chronic denervation on cardiac catecholamine levels in general and dopamine in particular. Moreover, the possible effect on cardiac beta-adrenoceptor subtypes was investigated. Experiments were performed on adult dogs. In addition to adrenaline and noradrenaline the tissue levels of dopamine were found to be severely depressed. A significant shift from beta1- to beta2-adrenoceptor subtype was observed, while the total beta-adrenoceptor density remained unaffected. The present findings indicate that catecholamine synthesis in chronically denervated hearts is impaired upstream of dopamine and that a shift in beta-adrenoceptor subtype occurs already within a relatively short period of five weeks of denervation, and suggest that the lack of endogenous catecholamines influence the relative expression levels of the two subtypes of beta-adrenoceptors present in cardiac tissue.

Stimulated release of the beta-amyloid protein of Alzheimer's disease by normal human platelets

The circulatory system is a potential source of the beta-amyloid protein (A beta) of ageing and Alzheimer's disease (AD), platelets accounting for the bulk of A beta immunoreactivity detectable in blood. Evidence for the release of A beta by platelets, however, has not been reported. Platelets from normal donors were therefore stimulated with collagen to establish if A beta immunoreactive material is released on activation. For comparison, the release of the platelet monoamines, serotonin (5-HT) adrenaline (Adr) and noradrenaline (NA) was also measured. Like the monoamines, collagen-induced A beta release was concentration-dependent, maximal stimulated release exceeding basal efflux by 184%. Collagen EC50 values for A beta release were similar to those for Adr and NA (3.6 +/- 0.6, 3.4 +/- 0.6 and 3.3 +/- 0.2 microg/ml collagen, respectively) but not 5-HT (9.8 +/- 1.9 microg/ml). These data provide the first evidence that platelets release A beta immunoreactive material on stimulation and may indicate that A beta, Adr and NA reside in the same subcellular compartment.