[Study on construction of c-Met specific CAR-T cells and its killing effect on non-small cell lung carcinoma]

Objective: To produce chimeric antigen receptor T cells (CAR-T) targeting human hepatocyte growth factor/c-Met (HGF/c-Met) protein and detect its cytotoxicity against non-small cell lung cancer (NSCLC) cells H1975 in vitro. Methods: The whole gene sequence of c-Met CAR containing c-Met single-chain fragment variable was synthesized and linked to lentiviral vector plasmid, plasmid electrophoresis was used to detect the correctness of target gene. HEK293 cells were transfected with plasmid and the concentrated solution of the virus particles was collected. c-Met CAR lentivirus was transfected into T cells to obtain second-generation c-Met CAR-T and the expression of CAR sequences was verified by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) and western blot, and the positive rate and cell subtypes of c-Met CAR-T cells were detected by flow cytometry. The positive expression of c-Met protein in NSCLC cell line H1975 was verified by flow cytometry, and the negative expression of c-Met protein in ovarian cancer cell line A2780 was selected as the control. The cytotoxicity of c-Met CAR-T to H1975 was detected by lactate dehydrogenase (LDH) cytotoxicity assay at 1∶1, 5∶1, 10∶1 and 20∶1 of effector: target cell ratio (E∶T). Enzyme-linked immunosorbent assay (ELISA) was used to detect the release of cytokines such as TNF-α, IL-2 and IFN-γ from c-Met CAR-T co-cultured with H1975. Results: The size of band was consistent with that of designed c-Met CAR, suggesting that the c-Met CAR plasmid was successfully constructed. The results of gene sequencing were consistent with the original design sequence and lentivirus was successfully constructed. CAR molecules expression in T cells infected with lentivirus was detected by western blot and RT-qPCR, which showed c-Met CAR-T were successfully constructed. Flow cytometry results showed that the infection efficiency of c-Met CAR in T cells was over 38.4%, and the proportion of CD8(+) T cells was increased after lentivirus infection. The NSCLC cell line H1975 highly expressed c-Met while ovarian cancer cell line A2780 negatively expressed c-Met. LDH cytotoxicity assay indicated that the killing efficiency was positively correlated with the E∶T, and higher than that of control group, and the killing rate reached 51.12% when the E∶T was 20∶1. ELISA results showed that c-Met CAR-T cells released more IL-2, TNF-α and IFN-γ in target cell stimulation, but there was no statistical difference between c-Met CAR-T and T cells in the non-target group. Conclusions: Human NSCLC cell H1975 expresses high level of c-Met which can be used as a target for immunotherapy. CAR-T cells targeting c-Met have been successfully produced and have high killing effect on c-Met positive NSCLC cells in vitro.

Evaluation of the effects of sire and dam calving group on age at first calving in Brahman heifers

This study evaluated the possible effects of sire and dam calving groups on age at first calving in Brahman heifers. A total of 570 heifers born between the years 2004 and 2017 were exposed as yearlings to fertile bulls through time of pregnancy determination. A calving group was determined by calculating the mean (993 d) and standard deviation (187 d) of heifer age at first calving. Heifers considered to calve early (≤899 d; calving group = 1) or late (≥1087 d; calving group = 3) were at least half a standard deviation (94 d) away from the mean. All other heifers were considered to have an intermediate age at first calving (900-1086 d; calving group = 2). Of the 570 heifers, only heifers from a dam (n = 182) with a known age at first calving and from a sire (n = 35) with 5 or more daughters were kept to determine the effect of dam calving group and the effect of sire calving group on age at first calving and calving group in daughters, resulting in a total of 284 heifers available for analysis. Variables included were dam and sire calving groups of the heifer, heifer age at first calving, heifer calving group, heifer season of birth, and heifer year of birth. Data were analyzed using the GLM procedures of SAS and proportions were tested using Chi-square. Sire calving group did affect (P < 0.01) age at first calving and calving group in heifers, but dam calving group did not affect (P > 0.10) daughter age at first calving or calving group. Analysis of dam calving group and sire calving group effects identified a year of birth effect (P < 0.01) on daughter age at first calving and calving group, whereas there was no significant season of birth effect. The proportion of daughters calving early for sire calving groups differed significantly from the expected proportion (P < 0.01), whereas the proportion of daughters calving early for dam calving groups did not differ. An effort to produce a greater proportion of Brahman heifers capable of calving early will not be effective from the dam side but may be effective from the sire side.

Maternal nutrient restriction alters endocrine pancreas development in fetal heifers

Maternal nutrient restriction during pregnancy alters fetal programming, which modifies the growth and health of the offspring in postnatal life. In cattle, nutrient restriction during pregnancy can be a result of environmental or economic factors, but little is known about how it alters the physiology of the fetus and affects future reproductive or growth efficiency. This study used female monozygotic twins, produced through in vitro fertilization and embryo splitting, to determine the effect of moderate maternal nutrient restriction on fetal development. Recipient Angus cross heifers pregnant with one twin were fed a diet meeting 100% National Research Council (NRC) total energy requirements (n = 4; control), whereas recipient heifers pregnant with the second twin were fed at 70% of NRC total energy requirements (n = 4; restricted) from gestational day (GD) 158 to GD 265 in Calan gate feeders. Recipient heifers were killed at GD 265. Change in maternal metabolic body weight was greater from zero in restricted heifers than controls (P < 0.05); restricted heifers lost weight during the nutrient restriction period. There was no difference in last rib back fat or rib eye area between groups (P > 0.10). There was no difference in fetal weight, uterine weight, or total placentome weight between groups (P > 0.10). The pancreas weight was reduced in restricted fetuses compared with control fetuses (P < 0.01), but there were no other differences in fetal organ weights (P > 0.10). Plasma insulin concentrations were reduced in restricted fetuses compared with controls (P < 0.01), but there was no effect of maternal diet on plasma glucose or glucagon concentrations in the fetus (P > 0.10). Histological analyses of the fetal pancreas revealed no differences in endocrine cell number or localization. Results indicate that a modest late gestation nutritional restriction impairs development of the fetal pancreas in the cow. Additional research will be needed to determine if these developmental changes lead to altered glucose and insulin homeostasis in the adult.

The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation

Introduction

Approximately 15% of the US population experiences migraine, with women afflicted three times as often as men. While medications are often used as first-line treatments, up to 50% of people with migraine pursue complementary and integrative medicine. One promising non-pharmacological approach for migraine is chiropractic care, due to the co-occurrence of migraine disease and musculoskeletal tension and pain. To date, no large-scale trials have evaluated the impact of a comprehensive model of chiropractic care on migraine.

Methods

The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) study is a two-arm pilot pragmatic randomized clinical trial evaluating a multimodal chiropractic care intervention plus enhanced usual care (UC) vs. enhanced UC alone for adult women with episodic migraine. A total of 60 women aged 20–55 who meet criteria for episodic migraine will be randomly assigned to an evidence-informed, musculoskeletal focused multimodal chiropractic care (10 sessions over 14 weeks) plus enhanced UC vs. enhanced UC alone. Enhanced UC includes conventional care, migraine education materials, and biweekly check-in phone calls. Study specific aims include: 1) Determine safety and feasibility of the study design; 2) Provide preliminary data on the effectiveness of chiropractic care on migraine frequency, severity, duration and medication use; and 3) Provide preliminary estimates of the effects of chiropractic care on disability, health-related quality of life, and psychosocial well-being.

Discussion

Findings will be used to inform the design of a full-scale trial evaluating chiropractic care for women with episodic migraines.

124 Cell Count of Bovine In Vitro-Produced Blastocysts After In Vitro Maturation in Glass versus Plastic Vials

Optimal bovine in vitro oocyte maturation (IVM) is a prerequisite for subsequent optimal blastocyst rates. Ovum pick-up (OPU), by which cumulus–oocyte complexes (COC) are collected in vivo, is performed outside a laboratory and often requires IVM to take place during transportation from the farm to the IVF laboratory. Hashem et al. (2017 Reprod. Fertil. Dev. 29, 179) demonstrated that blastocyst rates are affected by type of vial (glass v. plastic), number of COC per vial, and volume of medium per vial. This was achieved by maturing more than 2500 COC from slaughterhouse material under contrasting conditions, followed by standardised IVF and in vitro culture (IVC) and observation of blastocyst rates, morphology (1: poor; 2: good; 3: excellent), and kinetics (1: blastocyst; 2: expanded blastocyst ; 3: hatching/hatched blastocyst). Here we examined differential staining of a subset of expanded blastocysts (XB) from the previous study to assess the influence of vial material, medium volume, and number of COC per vial on total cell count, number and ratio of inner cell mass (ICM), and trophectoderm (TE) cells. In experiment 1 (4 groups), oocytes were matured in different vials without lids in an incubator at 5.5% CO2 in humidified atmospheric air at 38.5°C to assess plastic toxicity. In experiment 2 (6 groups) and experiment 3 (6 groups), the 2 best performing vials-polypropylene cryovials (Sigma-Aldrich, St. Louis, MO, USA) and glass vials (VWR International, Radnor, PA, USA)-containing 50% (Exp. 2) or 95% (Exp. 3) medium volume per vial and 5, 20, or 45 COC per vial were tested. In experiments 2 and 3, the vials were closed and incubated in atmospheric air at 38.5°C. All groups were evaluated for blastocyst rates, kinetics, and morphology. Because kinetics (range 2.01–2.25) and morphology (range 2.15–2.50) were similar in all groups, only XB were collected from each group. These were fixed and stained with CDX2 antibody and Hoechst (Wydooghe et al. 2011 Anal. Biochem. 416, 228-230) and their ICM and TE cells were counted. The cells were counted manually in blinded groups using an inverted fluorescence microscope and 16× magnification. Counts of total, ICM, and TE cells were compared between treatments by a two-way ANOVA analysis. A total of 240 XB from the 16 different vial groups were counted in the 3 experiments, with average total cell counts of 139 (110–211) and ICM cell counts of 44 (28–75). Even though the blastocyst rates differed between some of the groups, the cell counts within the XB did not differ statistically significantly between groups. In fact, the highest cell count was found in the glass vial group with the lowest blastocyst rate (45 COC per vial in 50% medium volume; blastocyst rate 28%, total cells 211, ICM cells 75). We have previously demonstrated that the type of vial, number of COC per vial, and the volume of medium per vial influence the subsequent blastocyst rates. It is concluded, however, that the embryos able to proceed to the blastocyst stages seem to be of the same quality in all groups, assessed by kinetics, morphology, and cell counts within XB.

141 BOVINE EMBRYO DEVELOPMENT RATES ARE AFFECTED WHEN OOCYTES ARE MATURED IN DIFFERENT VIALS CONTAINING HEPES/BICARBONATE BUFFERED MEDIUM

Laboratory ware for the in vitro-produced embryos is generally made from embryo-tested plastic instead of glass. The quality of the plastic is crucial for the outcome because plastic is often toxic to gametes (Nijs et al. 2009 Fertil. Steril. 92, 527–535). In addition, gas molecules permeate through the plastic at a rate that depends on a variety of factors, such as diffusion coefficient and thickness of the plastic. In an incubator with appropriate concentration of CO2 and vented culture vessels, the gas permeability of the plastic is not important. When oocytes are transported outside a controlled atmosphere, gas permeability, toxicity, and oocyte cumulus cell CO2 metabolism could perturb the outcome. Medium containing bicarbonate buffer increases pH outside of a controlled atmosphere within minutes, whereas medium buffered with HEPES maintains suitable pH for hours. Previously, we tested that gas permeability differs among plastic vials and glass vials with no cumulus-oocyte complexes (COC) by measuring pH after 2, 5, and 24 h at the same temperature. The objective of this study was to compare pH post-maturation, blastocyst development rates on Day 8 post-IVF (Day 0 = IVF) between 2 different 1.2-mL polypropylene cryovials (A: VWR DK, 479-1219; B: Sigma-Aldrich, St. Louis, MO, USA, CLS430289), glass vial (VWR DK, NSCAC4015-96), and 4-well plate (4WP) as control (Thermo Fisher Scientific, Waltham, MA, USA, 144444). A total of 1135 abattoir-derived COC in Exp. 1 and 133 in Exp. 2 were divided equally between the treatments (20–25 COC per vessel). Vials/4WP contained 0.8/0.5 mL of BO-IVM HEPES, a HEPES/bicarbonate medium (IVF Bioscience; BO-HEPES-IVM, UK). Maturation lasted 22 to 24 h at 38.8°C in an incubator with either a humidified atmosphere of 5.5% CO2 in air (Exp. 1) or with no CO2 contact (Exp. 2). In Exp. 1, oocyte vials were matured without a vial lid while in Exp. 2 vial lids were closed. Statistical analysis was performed with chi-square and mean ± SD. In Exp. 1, Day 8 blastocyst rates were evaluated as percentage of inseminated oocytes, with 4WP and glass vials significantly higher than cryovials A or B (38 ± 8.9%, 35 ± 7.5% v. 26 ± 3.2%, 26 ± 3.5%; respectively; P < 0.05). In Exp. 2, pH was measured for the 3 vials immediately post-maturation. Day 8 blastocyst rates were significantly higher in the glass vials as compared with cryovials A and B (pH 7.26, 31%; pH 7.60, 20% and pH 7.72, 22%, respectively; P < 0.05). In conclusion, blastocyst rates are affected by type of vial, as well as different gas permeability among other factors influencing pH. Further studies are necessary to optimize the maturation of the oocytes in HEPES-buffered media.

94 EFFECTS OF 6- OR 12-HOUR CULTURE IN A Micro Q STRAW INCUBATOR ON DEVELOPMENT OF IN VITRO-PRODUCED BOVINE EMBRYOS

Transporting in vitro-produced (IVP) embryos can be challenging when an embryo transfer destination is more than 6 h away or electricity is not available on site to unload embryos for transfer. The objective of this study was to determine if development rates would be compromised for Day 6.5 IVP embryos when placed in warmed Vigro holding medium (Vetoquinol, Pullman, WA, USA) loaded and plugged into 1/4 cc straws (Professional Embryo Transfer Services, Canton, TX, USA) for a period of either 6 or 12 h in a 38.5°C Micro Q straw block incubator (Micro Q iQ1T 64). Bovine oocytes were shipped and matured in transit from a commercial abattoir (DeSoto Biosciences, Seymour, TN, USA), fertilized (IVF = Day 0) with frozen-thawed semen, and cultured in Bovine Evolve (Zenith Biotech, Guilford, CT, USA) supplemented with 4 mg mL–1 BSA (Probumin, EMD Millipore, Norcross, GA, USA) under oil in a 5% CO2, 5%O2, 90% N2 humidified incubator (Pryor et al. 2011 Theriogenology 75, 24–33). Cleavage rates of 87.7% (664/757) from three replicates produced 273 (36.0%) viable embryos on Day 6.5 post-IVF, which were evenly distributed by IETS stage (4–7) and grade (1 and 2) into three treatment groups (0 = control, 6 or 12 h straw incubation) before in vitro culture for an additional 24 h. For each replicate, the average embryo stage was calculated by multiplying the number of embryos in each treatment by their IETS stage and dividing by total embryos per group. The change in stage for each treatment was calculated by subtracting the initial average stage from the final average stage on Day 8. Grade 1 and 2 embryos at stage 6–8 were counted and used to calculate total viable rates. Day 8 (post-IVF) embryos were fixed in cold methanol, washed in PBS/0.1%Tween 20, mounted in 10 μg mL–1 Hoechst 33342/glycerol and viewed under UV light to count nuclei. Percentage data were transformed using arcsine square root function before analysis, and means were compared using a one-way ANOVA and Tukey’s HSD. Although viability decreased with increasing time in straw incubation, there were no statistical differences between control, 6 and 12 h treatments for total viable rates (90.8, 80.3, and 70.8%, respectively). Average embryo stage on Day 8 for control, 6 and 12 h (7.0 ± 0.66, 6.6 ± 0.24, and 6.2 ± 0.30 s.e.m., respectively) was not different, but tended to be higher in control (P = 0.08). The change in stage, however, was different between control and 12 h (1.46 ± 0.33 and 0.66 ± 0.24, respectively; P < 0.05). Likewise, cell numbers were greater in control and 6 h embryos compared with 12 h straw incubation (149.8 ± 9.14, 138.7 ± 7.94, and 101.8 ± 5.29; n = 47, 50, and 46, respectively P < 0.01). In conclusion, 6.5 day IVP embryos held in warm Vigro holding medium for 12 h in 1/4 cc straws fail to develop at the same rate and incurred lower cell counts than either control or 6 h treatments. Further research to evaluate pregnancy rates following transfer and utilising different incubation or media and/or temperature is warranted to further evaluate the utility of in straw incubation for extended periods of time.

86 IMPROVED BOVINE EMBRYO PRODUCTION USING NOVEL IN VITRO CULTURE SYSTEMS

Development and testing of new embryo production components is important to improve the outcome following in vitro production of bovine embryos. The objective of this study was to compare media used in two bovine embryo production systems (control and EmbryoTrans Biotech: ETB). In Exp. 1, abattoir-derived cumulus-oocyte complexes were randomly assigned and in vitro matured (IVM) in either control [Medium 199 with Earles salts (Invitrogen, Carlsbad, CA, USA), supplemented with 10% fetal bovine serum (Hyclone, Logan, UT, USA), 1% penicillin/streptomycin (Invitrogen), 0.2 mM sodium pyruvate, 2 mM L-glutamine (Sigma Chemical Co., St. Louis, MO, USA), and 5.0 µg mL–1 of Folltropin®-V (Vetoquinol, Pullman, WA, USA)] or ETB BO-IVM medium for 21 to 24 h. IVF was conducted in 500 µL of pre-equilibrated modified Tyrode-lactate medium for control (Pryor et al. 2011 Theriogenology 75, 24–33) or ETB BO-IVF in Nunclon® 4-well multi-dishes (VWR Scientific, Pittsburgh, PA, USA). Seventeen hours post-insemination, presumptive zygotes were cleaned of cumulus cells and cultured in either Bovine Evolve (Zenith Biotech, Guilford, CT, USA) supplemented with 4 mg mL–1 of Probumin BSA (EMD Millipore, Norcross, GA, USA), under oil (Irvine Scientific, Santa Ana, CA, USA) or ETB BO-IVC medium under BO-oil for 7 days (8 days post-IVF). All cultures were performed at 38.5°C in a humidified atmosphere of 5% CO2, 5% O2, and 90% N2 using BT37 incubators (Planer Plc, Sunbury, UK). For Exp. 2, all conditions were maintained except a modified ETB BO-IVCA medium was used. On Day 8 of IVC, grade 1 and 2 blastocysts (BL) through hatching blastocysts (HBL) were counted and used to calculate total viable rates. In Exp. 2, these embryos were fixed in cold methanol, washed in PBS/0.1% Tween 20, mounted in 10 μg mL–1 Hoechst 33342/glycerol, and viewed under UV light to count cells (n = 49 and 107 for control and ETB, respectively). Each experiment was replicated 3 times with a total of 425 oocytes in Exp. 1 and 430 in Exp. 2, divided equally between treatments. Percentage data were transformed using arcsine square root function before analysis and means compared using a paired Student’s t-test. For Exp. 1, there were no differences in rates of cleavage or viable embryos between control and ETB systems (81.3% and 42.9% v. 80.5% and 48.4%, respectively). In Exp. 2, ETB was superior to control for percent viable, HBL, and combined HBL/expanded BL (51.9, 23.9, 45.8% v. 29.2, 5.8, 20.5, respectively; P < 0.05). Differences between mean cell counts for viable embryos were significant (control = 127.0 ± 6.7 s.e.m. and ETB = 162.7 ± 5.7; P < 0.0001). Embryo viability decreased in control media between Exp. 1 and 2 (42.9 v. 29.2%; P < 0.05). Seasonal differences may have contributed via heat stress with temperatures ranging from 23.8°C for Exp. 1 to 33.8°C for Exp. 2. Interestingly, embryo development in the ETB media did not decrease under the same conditions. In conclusion, ETB media produced more high-quality embryos than control under varying conditions experienced by commercial IVF companies.

241 CLUSTERED REGULARLY INTERSPACED SHORT PALINDROMIC REPEATS (CRISPR)/Cas9 ASSOCIATED WITH TRANSIENT DEPLETION OF NON-HOMOLOGOUS END-JOINING PATHWAY INCREASED GENE-TARGETING EFFICIENCY IN GOAT FIBROBLASTS

The transgenic animal platform for the expression of recombinant proteins in the milk offers particularly attractive possibilities. The recent application of clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 to promote precise genome modifications and DNA editing also allows the targeting of specific DNA sequences in embryos or cells in culture. In addition, the transient knockdown of the NHEJ pathway by RNAi has been shown to increase gene‐targeting (GT) rate in cultured cells (Bertolini et al. 2009 Mol. Biotechnol. 41, 106–114). The CRISPR/Cas9 system was used to target a 15-kb transgene construct into the ROSA26 locus in goat fetal fibroblast cells subjected to a transient RNAi‐induced depletion of the NHEJ Ku70 protein. A polycistronic expression vector was constructed by ligating the coding sequences of 3 antigenic proteins against Brucella abortus linked by self-processing 2A peptides under the regulation of the bovine α-lactalbumin promoter. The final vector also contained the neomycin resistance gene and left and right 2-kb arms homologous to the goat ROSA26 locus. A total of 2 × 105 fibroblast cells at passage 3 from a 50-day fetus were transfected using the Neon Transfection System (Invitrogen/ThermoFisher Scientific, Waltham, MA, USA), according to the following groups: mock control (M); vector-only (V); vector + RNAi against Ku70 (VR); vector + ROSA26‐CRISPR/Cas9 (VC); and vector + RNAi against Ku70 + ROSA26-CRISPR/Cas9 (VCR). After antibiotic selection, colonies were characterised for zygosity, transgene copy number, and off-targets. Mortality rates following cell transfection were 68, 78, 75, 83, and 90%, and the number of colonies after selection was 0, 13, 22, 5, and 8 for the M, V, VR, VC, and VCR groups, respectively. Gene targeting was detected only when the ROSA26‐CRISPR/Cas9 was combined to the vector (VC group, 1 in 22 colonies) or to the vector and RNAi against Ku70 (VCR group, 1 in 8 colonies), with a 2.8-fold increase in GT rate when associating the 3 components (VCR group). No CRISPR/Cas9 off-targets were detected in 7 different sequenced hot spots. One colony from the VC group, harboring a biallelic transgene knock-in, was chosen for use in goat cloning by SCNT following our established procedures (Martins et al. 2015 Reprod. Fertil. Dev. 27, 111). Four viable pregnancies (33.3%) were established, based on the ultrasonographic visualisation of the embryo and heartbeat on Day 26, after the transfer of 144 embryos to 12 female recipient does, demonstrating the developmental potential of the transgenic knock-in donor cells. However, pregnancies were lost up to Day 55 of pregnancy. Our preliminary data suggest that the combined cell transfection of gene target-specific CRISPR/Cas9 and RNAi to knockdown the NHEJ pathway is a viable and efficient approach to produce precise genetically modified goat donor cells carrying mono- and biallelic knock-ins of large size transgene constructs for use in cloning by SCNT. Cloning procedures are underway using biallelic knock-in somatic cells to obtain live offspring, which will be the first step to produce and test a recombinant subunit vaccine against B. abortus.

4 SUPPRESSION OF ASH2L ALTERS DNA METHYLATION AND HISTONE PATTERNS DURING BOVINE EMBRYONIC DEVELOPMENT

Epigenetic patterns established during early bovine embryogenesis via DNA methylation and histone modification patterns are essential for proper gene expression and embryonic development. We have previously discovered that suppression of absent, small, or homeotic-like (ASH2L) with small interfering RNA (siRNA) had no significant effect during in vitro embryo development when compared with its respective control (31.3 ± 2.0% standard error of the mean, n = 466 v. 34.8 ± 1.9%, n = 418). Analysing DNA methylation and histone modifications via immunocytochemistry will further explain the role of ASH2L during embryonic development, specifically at the blastocyst stage. In this experiment, we obtained mature bovine oocytes from a commercial supplier (De Soto Biosciences, Seymour, TN) and preformed IVF following standard laboratory protocol. Eighteen hours after IVF, presumptive zygotes were divided into 3 treatments: noninjected controls, nontargeting siRNA injected controls (siNULL), and injection with siRNA targeting ASH2L (siASH2L). Each embryo was injected with ~100 pL of 20 nM siRNA previously verified to suppress expression of ASH2L by ~79%. Embryos were cultured in Bovine Evolve (Zenith Biotech, Guilford, CT) supplemented with 4 mg mL–1 of BSA (Probumin, Millipore) for 7 days. Blastocysts from each treatment (N = 601) were fixed and prepared for immunocytochemistry following standard laboratory protocol. The following primary antibodies were used to target specific DNA and histone methylation marks: 5mc mAb (Epigentek, Farmingdale, NY), 5hmc pAb, H3K4me3 pAb (Active Motif, Carlsbad, CA), H3K4me2 pAb, H3K9me2–3 mAb, and H3K27me3 mAb (Abcam, Cambridge, MA). Embryos were fluorescently labelled with the following secondary antibodies: Alexa Flour 488 Goat Anti-Rabbit, Alexa 488 Donkey Anti-Goat, and Alexa Flour 594 Goat Anti-Mouse (Invitrogen, Carlsbad, CA). The DNA was stained with Hoechst 33342 (Invitrogen). Fluorescent images were captured using the Zeiss Stallion digital imaging work station. Ratio averages (targeting mark/DNA) were calculated and statistical analysis performed using one-way ANOVA and Tukey’s honestly significant difference to assess treatment effects. The ratio of DNA methylation to total DNA increased in siASH2L as compared with control and siNULL embryos (0.35 ± 0.01, 0.26 ± 0.02, and 0.30 ± 0.01, respectively; P < 0.01). The 5hmC was inversely related to 5mC levels and decreased in siASH2L embryos (0.75 ± 0.01, 0.93 ± 0.02, 0.87 ± 0.02, respectively; P < 0.0001). The H3K4me3 and H3K27me3 are also inversely related with decreased H3K4me3 in siASH2L versus control and siNULL embryos (0.48 ± 0.02, 0.57 ± 0.02, 0.58 ± 0.02, respectively; P < 0.001) and increased H3K27me3 (0.62 ± 0.02, 0.053 ± 0.01, 0.54 ± 0.02, respectively; P < 0.001). No differences were observed in H3K9me2–3 or H3K4me2 labelling across treatments. These results indicate that ASH2L may play a role in DNA methylation by decreasing 5mc and 5hmc conversion, which is a key event during early embryonic development. Suppression of ASH2L also alters global levels of H3H4me3 and H3K27me3, which may lead to transcription aberrations. Further analysis of siASH2L embryos via RNA-seq will help define its role during early embryonic development.

Initiation and organization of events during the first cell cycle in mammals: applications in cloning

The technology of cloning involves transplanting a diploid nucleus into a mature oocyte cytoplast. The cytoplast is then activated to initiate the first cell cycle of development as a nuclear transplant embryo. Initiation and regulation of events during the first cell cycle are, therefore, critical for proper reprogramming of the donor nucleus and development as a cloned embryo. Activation is normally induced by the sperm and is mediated by a series of intracellular free calcium ([Ca(2+)](i)) oscillations that last for several hours. Although it is not known precisely how the sperm induces activation, current evidence favors the delivery, by the sperm, of a soluble protein factor that causes the production of IP3. IP3 acts to open a Ca(2+) channel in the endoplasmic reticulum and release Ca(2+) into the cytosol. A variety of methods have been used to duplicate or replace the sperm-induced [Ca(2+)](i) increase to cause activation in nuclear transplant embryos. It has been found that treatments that cause a single transient [Ca(2+)](i) activate some oocytes with the level of activation increasing as the oocyte ages. Attempts have been made to extend the period of time over which [Ca(2+)](i) oscillations occur. This has been successful in increasing activation rates of less mature oocytes but the techniques are still cumbersome. An alternative method, that has been very successful, is the combination of a treatment that elevates [Ca(2+)](i) and a treatment that maintains low levels of maturation promoting factor for several hours after the initial [Ca(2+)](i) elevation. The sperm also contributes the centrosome that organizes microtubules during the first cell cycle. One current hypothesis for regulation of sperm centrosomal activity consists of a dephosphorylation of sperm connecting piece proteins following sperm entry into the oocyte and activation of the oocyte. Dephosphorylation of these proteins results in the disassembly of the connecting piece and assembly of a functional centrosome. In nuclear transfer, centrosomal components are contributed by the donor cell. If the cell is fused to the cytoplast before centriole replication then a single aster forms. If the cell is fused after centriole replication then two asters form. In either case and even in parthenogenetic oocytes, which do not have centrioles, the first cell cycle progresses to metaphase. However, progress is slow and some defects are observed in the assembly of chromosomes into a metaphase plate.

195 SUPPRESSION OF SETDB1 DURING BOVINE EMBRYONIC DEVELOPMENT RESULTS IN PRE-IMPLANTATION MORTALITY AND DECREASED TRANSCRIPTION OF TRANSPOSABLE ELEMENTS

Organization of chromatin structure by the combinatorial patterns of DNA methylation and post-translational histone modification is essential for the establishment and maintenance of proper transcriptional programs that result in the coordination of embryonic development. We previously observed that suppression of transcripts encoding SET domain, bifurcated 1 (SETDB1) using small interfering RNAs (siRNA) is embryonic lethal, with SETDB1-suppressed embryos (n = 361) arresting immediately before the blastocyst stage (blastocyst rate: Control 44.9 ± 4.9% and NULL injected 25.7 ± 6.0%). Studies in rodents indicate SETDB1 is a crucial regulator of transposable elements and that the precise epigenetic regulation of these elements is a key aspect of transcriptional programs controlling pluripotency and placentation. To better characterise the molecular basis of the observed mortality, we analysed expression of the bovine Long Interspersed Nuclear Element 1 family (LINE1) of transposable elements via quantitative real-time reverse-transcription polymerase chain reaction (RT-qPCR). Mature bovine oocytes were obtained from a commercial supplier (De Soto Biosciences, Seymour, TN, USA) and IVF performed by standard laboratory protocol. Eighteen hours after IVF, cumulus cells were removed and presumptive zygotes divided into 3 different treatment groups: non-injected control (CNTL), non-targeting siRNA injected control (siNULL), and zygotes injected with siRNAs targeting SETDB1 (siSETDB1). Each embryo was injected with ~100 pL of siRNAs (10 µM) in fluorescent dextran solution. All zygotes were verified as injected by fluorescent microscopy and then cultured in Bovine Evolve (Zenith Biotech, Guilford, CT, USA) medium supplemented with 4 mg mL of BSA (Probumin, EMD Millipore, Darmstadt, Germany). Groups of embryos (15–20) from each treatment were lysed at the 4-cell, 8-cell, and morula stages, RNA extracted, and analysed by RT-qPCR using GAPDH and YWHAZ as reference genes. A two-way ANOVA and a Student's t-test were used to analyse the results from the RT-qPCR. As expected, siSETDB1-injected morulae displayed dramatic reduction in the level of Setdb1 transcripts as compared to siNULL control (96%; P < 0.05). Preliminary analysis of LINE1 transcripts at the morula stage indicated siSETDB1-injected embryos displayed a 75% reduction compared to the siNULL. Whether alteration in LINE1 regulation contributes to the developmental arrest and embryonic mortality of siSETDB1-injected embryos is under investigation.

122 SUPPRESSION OF EPIGENETIC MODIFIERS ALTERS THE BOVINE EMBRYONIC DEVELOPMENTAL PROGRAM DURING IN VITRO CULTURE

During early bovine embryogenesis, the regular establishment of DNA methylation and histone modification patterns is essential for proper gene expression and continuation of embryonic development. Epigenome patterns established during this period, if improperly maintained, can lead to developmental anomalies and may partially explain the lower pregnancy rates of in vitro-produced embryos. We hypothesised that the suppression of translation of the genes euchromatic histone-lysine N-methyltransferase 2 (EHMT2), DNA methyltransferase 3A (DNMT3A), absent, small, or homeotic-like (ASH2L), and SET domain, bifurcated 1 (SETDB1) would provide insightful information on the importance of these genes during early embryonic development in an in vitro setting. In order to define the roles of these genes, small interfering RNA (siRNA) targeting the gene of interest were synthesised and target verified in bovine cell culture using quantitative real-time RT-PCR (RT-qPCR). We acquired matured bovine oocytes from commercial suppliers, followed by IVF by standard laboratory procedures. Eighteen hours post IVF, cumulus cells were removed and zygotes separated into 3 different treatment groups: non-injected controls (CNTL), non-targeting siRNA injected controls (siNULL), and injection with siRNA targeting the gene of interest (si “gene target”). Each siRNA was mixed with a green fluorescent dextran at a concentration of 20 μM and ~100 pL injected cytoplasmically. The green fluorescent dextran was used to give visual confirmation that zygotes were indeed injected. Post-injection, fluorescent embryos were separated and cultured in Bovine Evolve (Zentih Biotech) medium supplemented with 4 mg mL–1 of BSA (Probumin, Millipore). Cleavage rates were monitored on Day 2, and only cleaved embryos were cultured further. On Day 8 post-IVF, embryos were morphologically examined and numbers of blastocysts recorded. Mean development rates between siNULL and targeting siRNA were compared using a t-test statistic. Over the course of these experiments the mean blastocyst rate for CNTL zygotes was 34.5% ± 2.6 s.e.m. (n = 1647). None of the zygotes injected with siEHMT2 (n = 1184) or siSETDB1 (n = 361) reached the blastocyst stage and these rates differed from the siNULL rate (21.0% ± 2.5 s.e.m., n = 1587; P < 0.05). Morphologically, embryos from both groups developed to the morula stage before they exhibited fragmentation. Injection of siDNMT3A also resulted in significant loss of viability at the 8-cell stage and few zygotes injected (n = 1057) developed to blastocyst (2.1% ± 0.5 s.e.m.; P < 0.001). Inhibiting gene expression of ASH2L showed little variation in blastocyst rate from our siNULL embryos (31.3% ± 2.0 s.e.m., n = 466 v. 34.8% ± 1.9 s.e.m., n = 418, respectively, P > 0.2). It is unknown at this time if inhibition of ASH2L translation will have effects later in development. Ongoing experiments analysing DNA methylation and histone modifications through immunocytochemistry and global gene expression via RT-qPCR will further explore the establishment and maintenance of these genes in the embryonic epigenome.

95 PRODUCTION OF GENE-EDITED PIGS, CATTLE, AND LAMBS BY EMBRYO INJECTION OF TALENS OR ZFNs

Transcription activator-like effector nuclease (TALEN) and zinc finger nuclease (ZFN) DNA editing technology enables site-directed engineering of the genome. To date, all gene-edited large animals have been produced by treatment of somatic cells and cloning to produce gene-edited offspring. Although effective, it does not take advantage of the ‘leave-no-trace' aspect of site-specific nucleases, and the derivation of food animals by cloning is negatively perceived by the public. Thus, we have investigated production of gene-edited pigs, cattle and sheep by direct injection of TALEN or ZFN mRNAs to develop loss-of-function alleles for disease resistance (RELA) or enhanced meat production (GDF8). In vitro studies demonstrated activity of TALENs by cytoplasmic injection of mRNAs from dosages of 2 to 20 ng mL–1 with an apparent increase in both editing frequency and toxicity at high dosage. Our first pregnancies were produced by transfer of pig embryos (in vivo produced) injected with 2 ng mL–1 RELA TALEN mRNA. Pregnancy was confirmed in 5 of 7 recipients 4 of which went full term giving rise to 39 piglets, 8 of which carried editing events (21%). In parallel, we injected ZFN mRNA (2 ng mL–1) targeted to a similar site of the RELA gene and 2 of 2 recipients became pregnant, resulting in the birth of 9 piglets, one of which was edited (11%). For cattle injections, we derived zygotes by ovum pickup from selected Nelore dams followed by in vitro maturation and fertilization with Nelore semen. Low (2 ng mL–1) and medium (5 ng mL–1) dosages of GDF8-targeted TALENs resulted in Day 7 development to morula/blastocyst stage in 40% (n = 18) and 10% (n = 66) of cultured embryos, respectively. A total of 20 morula/blastocysts were chosen for transfer to 11 recipients, resulting in two full-term pregnancies. One pregnancy produced two calves, both of which carried edited GDF8 alleles. Complications with parturition of the second pregnancy resulted in 2 stillborn calves, the genotypes of which are under investigation. Finally, 2 ng mL–1 of TALEN mRNA targeted to ovine GDF8 was injected into in vivo-produced sheep zygotes and transferred into nine recipients, 3 blastocysts each. The pregnancy rate, number of live-born animals, and gene editing frequency is under investigation and will be reported.

337 NONMEIOTIC INTROGRESSION OF QUANTITATIVE TRAIT NUCLEOTIDES AND CORRECTION OF CONGENITAL MUTATIONS IN LIVESTOCK WITH TRANSCRIPTION ACTIVATOR-LIKE EFFECTOR NUCLEASES

Genetic enhancement of livestock productivity and welfare are major goals of breeding and genetics programs. However, the introgression of desirable alleles across breeds is slow and inaccurate. The development of gene editing technologies would provide the opportunity to accelerate the genetic improvement of a diversity of livestock breeds. Transcription activator-like effector nucleases (TALEN) are programmable nucleases that join the modular DNA binding domain of transcription activator-like (TAL) effectors with FokI endonuclease. We found that TALEN could be easily manufactured and that 64% displayed activity in swine and cattle primary fibroblasts, with cleavage of 1.5 to 45% of chromosomes in cell populations, as measured by Surveyor assay. Clonal isolation and sequencing revealed that up to 84% of cells contained at least one modified allele, with up to 24% of cells containing biallelic or homozygous chromosomal modification. Co-transfection of a customized TALEN pair with a template containing a specific allele was effective at the nonmeiotic introgression of quantitative trait into naïve cattle breeds. We will also describe the repair of 2 recently described embryonic lethal mutations that are segregating in important dairy cattle breeds (JH1 and HH1). Injection of TALEN mRNA into the cytoplasm of pig and cattle zygotes was capable of inducing gene knockout (KO) in 27 to 75% of embryos analysed (n = 4–59), nearly half of which (8/19) harbored biallelic modification. We will present data describing efforts towards gene conversion by direct injection of livestock embryos. Finally, we will present alternative strategies for the incorporation of gene editing in livestock production systems by cloning or embryo treatment.

3 OXIDATIVE STRESS INDUCED CHANGES IN EPIGENETIC MODIFYING GENE mRNA IN PRE-IMPLANTATION IN VITRO BOVINE EMBRYOS

In vitro embryo culture systems introduce a myriad of environmental changes to embryos when compared with in vivo development. Accordingly, in vitro culture has been associated with decreased embryo development rates and alterations to the fetal epigenome. We hypothesized that an interaction exists between oxidative stress and the expression of key epigenetic modifying enzymes. To test this hypothesis, we used quantitative PCR to measure transcript levels of several genes known to be associated with oxidative stress and epigenetic modifications during bovine in vitro pre-implantation development. Epigenetic modifiers examined included histone deacetylases (SIRT1, SIRT6), whose actions result in gene repression; a histone demethylase (JMJD1A) associated with gene activation; and DNA hydroxylases (TET1-3), which have been associated with conversion of 5-methylcytosine to 5-hydroxy-methylcytosine. Bovine ova were matured, fertilized, and cultured in vitro according to standard laboratory procedures. At 18 h post-fertilization, cumulus cells were removed and presumptive zygotes were cultured in 5% CO2 and air (high O2), or 5% CO2, 5% O2 and 90% N (low O2). Groups of 16-cell- (n = 20) and blastocyst- (n = 15) stage embryos were collected, RNA was extracted using an RNeasy Mini Kit, and cDNA was generated using qScript reagents. Quantitative PCR was performed using Perfecta SYBR to determine transcript levels of superoxide dismutase 2, mitochondrial (SOD2), lactate dehydrogenase A (LDHA), hypoxia-inducible factor 1 alpha (HIF1A), hypoxia-inducible factor 2 alpha (HIF2A), histone deacetylase 1 (HDAC1), jumonji domain containing 1A (JMJD1A), sirtuin 1 (SIRT1), sirtuin 6 (SIRT6), tet oncogene 1 (TET1), tet oncogene 2 (TET2), and tet oncogene 3 (TET3) in 3 replicates (each measured in triplicate). Data were analyzed using the comparative Ct method normalized to the geometric mean of 2 endogenous control genes [glyceraldehyde-3-phosphate dehydrogenase (GAPDH), succinate dehydrogenase (SDHA)]. Statistical analyses were performed using a paired t-test comparing the relative expression of each gene in high O2 with low O2 within each individual embryo stage. Blastocyst development rates were 35% (n = 710 oocytes) for low O2 and 19% for high O2 (n = 1221 oocytes; P < 0.001). The HIF2A transcript levels were elevated at the 16-cell stage in high-O2 embryos (4.26 ± 0.55 v. 1.22 ± 0.22; P < 0.01), but were not different at the blastocyst stage. Elevated HIF2A was likely in response to oxidative stress and was associated with elevated levels of JMJD1A (1.73 ± 0.18 v. 1.15 ± 0.19), SIRT1 (1.68 ± 0.20 v. 1.09 ± 0.16), SIRT6 (2.30 ± 0.34 v. 1.07 ± 0.13), and TET2 (3.44 ± 0.89 v. 1.23 ± 0.19; P < 0.05) in high-O2 16-cell embryos. The JMJD1A (1.31 ± 0.17 v. 1.05 ± 0.10), SIRT1 (1.45 ± 0.24 v. 1.05 ± 0.11), and TET1 (1.45 ± 0.19 v. 1.02 ± 0.07) transcripts were also elevated in high-O2 blastocysts, whereas TET3 transcript levels were lower (0.69 ± 0.12) than in low O2 (1.07 ± 0.14; P < 0.05). Genes associated with epigenome modification and with oxidative stress were altered in response to the high oxygen tension. The lower blastocyst rate observed in the high-O2 group may be due to the damaging effects of oxidative stress and this stress alters transcript levels associated with the epigenome. These data suggest that embryos surviving oxidative stress may exhibit epigenetic changes that could influence subsequent development.

108 THE EFFECTS OF FORSKOLIN ON BRAHMAN IN VIVO-PRODUCED EMBRYOS AND SUBSEQUENT PREGNANCY RATES POST-THAW

It has been hypothesised that lower survival rates post-thaw of Brahman (BR) embryos is due in part to higher intracellular lipids. The objective of this study was to determine whether pregnancy rates of in vivo–produced BR embryos could be enhanced by exposing them to 10 μM of forskolin (FSK; lipolytic agent) before slow cool freezing, thawing and direct transfer. A previous report (Phase II) indicated that the addition of FSK to culture 24 h before freezing 7 days in vitro–produced, BR-sired embryos can increase survival and blastocyst hatching rates (Pryor et al. 2010 Reprod. Fertil. Dev. 22, 214). For this study (Phase III), 11 BR cows were injected with 25 mg of Lutalyse® (Pfizer Animal Health, New York, NY, USA) to synchronize oestrus. On Day 0 (7 days after synchronized oestrus), all donors were inserted with a CIDR (Controlled Intravaginal Releasing Device; Pharmacia Co., Kalamazoo, MI, USA) and injected with 50 mg of progesterone plus 2.5 mg of oestradiol 17 β (Medshop, Longview, TX, USA). On Day 4, decreasing doses of Folltropin (Bioniche, Pullman, WA, USA) ranging from 160 to 264 mg were given twice daily for 3 days along with 0.625 mg of cloprostenol (Estrumate; Merck/Schering-Plough Animal Health, Whitehouse Station, NJ, USA) given twice on Day 6 (AM and PM) and CIDR removal on Day 7 AM. Donors were artificially inseminated 12 and 24 h post-oestrus (oestrus = Day 8) with frozen/thawed BR semen. On Day 14 (embryo age 6 days), donors were nonsurgically collected, producing a total of 75 grade-one morulae, which were randomly allocated and cultured for 24 h in Evolve (Zenith Biotechnology, Canada) supplemented with 4 mg mL–1 of Probumin BSA (Millipore, Norcross, GA, USA; control) or with FSK (Sigma, St. Louis, MO, USA) at 38.5°C under a 5% CO2, 5% O2 and 90% N2 humidified atmosphere. Immediately following treatment, 7 days compact morula/blastocysts were washed in Vigro Holding Plus medium (Bioniche, Belleville, Ontario, Canada) and submitted to Vigro Ethylene Glycol Freeze Plus medium (Bioniche) for 5 to 7 min before being frozen at 0.5°C min–1 from –6°C to –32°C and plunged in liquid nitrogen. Frozen embryos (n = 35 FSK; n = 35 control) were air thawed for 7 s and then immersed in 30°C H2O for 10 s before being nonsurgically transferred into synchronized recipients. Pregnancy rates were assessed by ultrasonography via rectal palpation 30 to 60 days post-transfer. Contingency analysis was performed using forskolin treatment, technician and embryo stage and location as independent variables (JMP 8.0, SAS Institute Inc., Cary, NC, USA). There were no statistical differences or interactions for any of the analysed variables. Pregnancy rates between control and FSK treatments did not vary (34.3 and 31.4%, respectively; chi-square P = 0.80). In conclusion, treating in vivo–produced BR embryos with 10 μM of forskolin for 24 h did not alter pregnancy rates. The authors acknowledge support from the American Brahman Breeders Association.

Production of transgenic calves expressing an shRNA targeting myostatin

Myostatin (MSTN) is a well-known negative regulator of muscle growth. Animals that possess mutations within this gene display an enhanced muscling phenotype, a desirable agricultural trait. Increased neonatal morbidity is common, however, resulting from complications arising from the birth of offspring with increased fetal muscle mass. The objective of the current research was to generate an attenuated MSTN-null phenotype in a large-animal model using RNA interference to enhance muscle development without the detrimental consequences of an inactivating mutation. To this end, we identified a series of short interfering RNAs that demonstrated effective suppression of MSTN mRNA and protein levels. To produce transgenic offspring capable of stable MSTN suppression in vivo, a recombinant lentiviral vector expressing a short hairpin RNA (shRNA) targeting MSTN for silencing was introduced into bovine fetal fibroblasts. These cells were used as nucleus donors for somatic cell nuclear transfer (SCNT). Twenty blastocysts were transferred into seven recipient cows resulting in five pregnancies. One transgenic calf developed to term, but died following delivery by Caesarean-section. As an alternative strategy, microinjection of recombinant lentiviral particles into the perivitelline space of in vitro-produced bovine zygotes was utilized to produce 40 transgenic blastocysts that were transferred into 14 recipient cows, resulting in 7 pregnancies. Five transgenic calves were produced, of which three expressed the transgene. This is the first report of transgenic livestock produced by direct injection of a recombinant lentivirus, and expressing transgenes encoding shRNAs targeting an endogenous gene (myostatin) for silencing.

201 SUPPRESSION OF Suz12 IN BOVINE PREIMPLANTATION EMBRYOS VIA CYTOPLASMIC SMALL INTERFERING RNA INJECTION

The proper removal of gametic epigenetic marks and coordinated reestablishment of the epigenome are critical to mammalian embryonic development. Suz12 is a member of Polycomb repressive complex 2, known to catalyse trimethylation of lysine 27 on histone 3 (H3K27me3; Pasini et al. 2004); Suz12 has also been shown to interact with Suv39h1 for proper trimethylation of H3K9 (de la Cruz et al. 2007). Our objective in this study was to suppress expression of Suz12 via cytoplasmic injection of small interfering RNA (siRNA) targeted at this gene, and to evaluate the effect on embryo development rates. Bovine zygotes were produced in vitro via standard laboratory procedures. Nineteen hours post-fertilization, presumptive zygotes (n = 3979) were divided into 3 treatment groups: noninjected control (CTL), or injected with a fluorescent dextran marker combined with either a nontargeting siRNA (NULL) or an Suz12-targeting siRNA (SUZ). Embryos were cultured in Bovine Evolve (Zenith Biotech, Canada) with 4 mg mL–1 of BSA (Probumin, Millipore, Billerica, MA) and collected at the 4-cell, 8-cell, morula, and blastocyst stages. Ribonucleic acid was isolated with an RNeasy® Mini Kit (Qiagen, Valencia, CA) from 3 replicates of pooled embryos at each stage (4-cell, n = 15; 8-cell, n = 20; morula, n = 10), except for the blastocyst stage [2 samples (n = 10) collected from the CTL and NULL groups, and 1 sample (n = 3) from the SUZ group]. Each RNA sample was reverse-transcribed into cDNA and diluted for use by quantitative real-time PCR. Relative gene expression levels from each sample were calculated in triplicate using the SYBR Green comparative Ct method (Applied Biosystems, Foster City, CA), adjusted according to individual PCR efficiencies for each primer pair (R2 > 0.95) and normalized to the geometric mean Ct of 3 endogenous controls (GAPDH, YWHAZ, and SDHA), to account for differences in both cell number and amount of total mRNA present in each sample (Goossens et al. 2005). Our data indicate that Suz12 expression was suppressed to undetectable levels in SUZ-treated zygotes at all embryo stages analysed. The blastocyst rate of the SUZ group was extremely low (0.88 ± 0.16% SEM) compared with the CTL (19.87 ± 0.36% SEM) and NULL (5.09 ± 0.36% SEM) groups. Morphologically, SUZ morulae appeared fragmented with fewer larger cells than expected, whereas the NULL and CTL morulae seemed to develop normally. We presume the loss of Suz12 expression during this important developmental time is detrimental to embryo morphology and results in a decreased rate of blastocyst formation. Because of this decrease, we were able to collect only 3 SUZ blastocysts from a total of 227 injected. The microinjection procedure also contributed to significant (P < 0.05) decreases in blastocyst rates of the injected groups as compared with the CTL. Future experiments will explore potential alterations in histone methylation, as well as other epigenetic modifiers in bovine preimplantation embryos, to further elucidate the role of the epigenome in early embryonic development.

133 EVALUATION OF OOCYTE DONOR SOURCE AND CULTURE MEDIUM ON DOMESTIC CAT EMBRYO DEVELOPMENT RATES

The use of assisted reproductive technology (ART), including in vitro maturation (IVM) and embryo culture, is well established in several species, including canine and feline culture systems. Embryo production conditions tend to be specific for each species and prepared in unique formulations by laboratory. However, the increasing numbers of commercially available media allows for new comparisons in companion animal systems. Therefore, a goal of this study was to compare the development rates of feline parthenotes cultured in a commercially available bovine embryo culture medium with those cultured in a published 3-step domestic cat-specific system. In addition, the source of ovaries utilised for oocyte retrieval was evaluated as a factor in development rates. Ovaries from 2 locations (L1 and L2) were collected on the same day, and harvested oocytes were held in meiotic arrest medium containing 25 μM roscovitine for 14 to 18 h. Oocytes were incubated in maturation medium for 24 h before cumulus cell removal with vigorous pipetting in 0.4% hyaluronidase, and a subset of each group was fixed and stained to determine meiotic maturation rates (n = 76 and 55 for L1 and L2, respectively). Following activation (day 0) by a single course of three 50-μs electric pulses at 1.2 kV cm–1 in 0.3 M mannitol, 0.1 mM CaCl2, and 0.1 mM MgSO4, parthenotes from each source were randomly divided to culture medium treatment of Bovine Evolve medium (Zenith Biotech, Guilford, CT, USA) with 4 mg mL–1 BSA (n = 209) or IVC-1 medium n = 269; (Pope et al. 2009 Theriogenology 71, 864–871), each containing 10 μg mL–1 cycloheximide and 7.5 μg mL–1 cytochalasin B. After a 4-h activation treatment, parthenotes were moved to culture media without cycloheximide and cytochalasin B for embryo development. All parthenotes in IVC-1 medium were moved to IVC-1a medium on day 2. On day 5, both sets of parthenotes were moved to culture media containing 10% heat-inactivated FBS instead of BSA. On day 7, all parthenotes were fixed and stained with Hoechst to determine cell number. No differences were seen in maturation rates between L1 and L2 (56.3 ± 9.5 v. 54.7 ± 9.5, respectively). However, cleavage rates tended to differ, and proportion of embryos greater than 64 cells was different (60.7 ± 5.8 v. 78.3 ± 5.8, P = 0.056 and 3.0 ± 3.1 v. 19.7 ± 3.1, P < 0.005; respectively). We hypothesised that the physical condition of the ovary donors may have affected development rates because cats from L1 tended to be feral animals, whereas cats from L2 were mostly privately owned. Bovine Evolve was similar to IVC-1 medium for cleavage, 32-cell, and 64-cell development rates (74.2 ± 6.7 v. 64.8 ± 6.7; 24.0 ± 7.5 v. 31.8 ± 7.5; 10.7 ± 4.8 v. 12.0 ± 4.8, respectively; P > 0.05). These results indicate that commercially available culture medium can support in vitro development, even if the commercial medium is developed for a different species, but that source of cat ovaries should be considered in feline ART.

Clinical and molecular characterization of a re-established line of sheep exhibiting hemophilia A

BACKGROUND

Large animal models that accurately mimic human hemophilia A (HA) are in great demand for developing and testing novel therapies to treat HA.

OBJECTIVES

To re-establish a line of sheep exhibiting a spontaneous bleeding disorder closely mimicking severe human HA, fully characterize their clinical presentation, and define the molecular basis for disease.

PATIENTS/METHODS

Sequential reproductive manipulations were performed with cryopreserved semen from a deceased affected ram. The resultant animals were examined for hematologic parameters, clinical symptoms, and responsiveness to human FVIII (hFVIII). The full coding region of sheep FVIII mRNA was sequenced to identify the genetic lesion.

RESULTS AND CONCLUSIONS

The combined reproductive technologies yielded 36 carriers and 8 affected animals. The latter had almost non-existent levels of FVIII:C and extremely prolonged aPTT, with otherwise normal hematologic parameters. These animals exhibited bleeding from the umbilical cord, prolonged tail and nail cuticle bleeding time, and multiple episodes of severe spontaneous bleeding, including hemarthroses, muscle hematomas and hematuria, all of which responded to hFVIII. Inhibitors of hFVIII were detected in four treated animals, further establishing the preclinical value of this model. Sequencing identified a premature stop codon and frame-shift in exon 14, providing a molecular explanation for HA. Given the decades of experience using sheep to study both normal physiology and a wide array of diseases and the high homology between human and sheep FVIII, this new model will enable a better understanding of HA and facilitate the development and testing of novel treatments that can directly translate to HA patients.

110 THE USE OF FORSKOLIN AND ITS EFFECT ON IN VITRO-PRODUCED BRAHMAN-SIRED EMBRYOS SUBMITTED TO SLOW COOL FREEZING OR VITRIFICATION

The objective of this study was to further test the lipolytic effect of 10 μM forskolin on developmental differences between bovine in vitro produced (IVP) embryos submitted to slow cool (SC) freezing or vitrification (VT). Previously reported (phase I) IVP embryo hatching rates for control embryos (62%) were no different than 10 μM forskolin (67%; Pryoretal et al. 2009 Reprod. Fertil. Dev. 21, 163). For phase II: on Day 6 post-fertilization (IVF = Day 0), 207 Brahman-sired viable embryos were evenly divided and cultured for 24 h in G2.5 medium (Vitrolife, Englewood, CO, USA) with or devoid of 10 μL forskolin (Sigma, St. Louis, MO, USA). On Day 7, compact morula (CM, n = 31), blastocyst (BL, n = 76), and expanded BL (XBL, n = 100) were washed in Vigro Holding Plus medium (Bioniche, Pullman, WA, USA) and randomly allocated to 4 treatment groups; control SC (CSC; no treatment, n = 52), 10 μM forskolin SC (FSC; n = 55), control VT (CVT; n = 49), and 10 μM forskolin VT (FVT; n = 51). All embryos were packaged in sterile 0.25-mL plastic straws. The SC embryos were submitted to Vigro Ethylene Glycol Freeze Plus medium (Bioniche) for 5 min before freezing at 0.5°C/min from -6°C to -32°C and plunging in LN2. Embryos were vitrified using a bovine VT kit (Bioniche): VS1, 3 min; VS2, 45 s in 15 μL; diluent, in straw with VS2 separated by air columns, vitrified in LN2 vapor 1 cm from liquid for 1 to 15 min before plunging. The SC embryos were air thawed 5 s and placed in 30°C H2O bath for 10 s. The VT straws were air warmed 10 s and then in 35°C H2O for 20 s prior to shaking them down to mix columns. All embryos were cultured in G2.5 for 24-h survival and 48-h hatching rates. All percentage data were transformed using arcsin square root function prior to analysis, and means were compared for statistical significance using Student’s t. For mean survival rates, FSC was different than CSC but showed no difference between FVT and CVT (81.7 ± 0.09, 42.6 ± 0.09, 59.4 ± 0.09, 49.0 ± 0.10, respectively (P < 0.01). There were no statistical differences for hatching rates for combined embryo stages (58.2 ± 0.10, 37.8 ± 0.10, 34.4 ± 0.10, 28.1 ± 0.11 for FSC, FVT, CSC, and CVT, respectively; P > 0.07). However, when comparing hatching rates of only the blastocyst stage embryos (n = 176), FSC was superior to CSC and CVT but not different than FVT (74.8 ± 0.11, 29.5 ± 0.11, 29.1 ± 0.11, 48.5 ± 0.11, respectively; P < 0.01). In conclusion, FSC yielded significantly higher survival and blastocyst hatching rates than CSC, but there were no differences between CVT and FVT for survival and FVT for blastocyst hatching rates. These results indicate that the addition of 10 μM forskolin to culture 24 h prior to freezing 7 d IVP Brahman-sired embryos can increase survival and blastocyst hatching rates. The authors acknowledge support from the American Brahman Breeders Association.

246 INDUCTION OF MEIOTIC ARREST IN IMMATURE FELINE OOCYTES WITH ROSCOVITINE AND DIBUTYRYL CYCLIC-AMP

Successful application of some assisted reproduction technologies in feline species requires the use of competent, meiotically mature ova, which can be difficult to obtain in sufficient quantities. Meiotic arrest of immature feline oocytes would allow the accumulation of oocytes over time to maximize laboratory resources. Two meiosis inhibitors commonly used in other species, roscovitine (ROS) and dbcAMP, were evaluated for the ability to maintain a germinal vesicle (GV) in immature feline oocytes after 24 h of in vitro culture. Feline ovaries were obtained from routine ovariohysterectomies and oocytes with homogenous cytoplasm and at least 2 layers of cumulus cells were selected. All oocytes were cultured in a basic medium modified from Gomez et al. (2000 Reprod. Fertil. Dev.) consisting of TCM-199 with Earle’s salts, 0.3% fraction V bovine serum albumin, 2.0 mm L-glutamine, 1.12 mm L-cysteine, 2.2 mm calcium lactate, 0.36 mm sodium pyruvate, 100 μm cysteamine, 10 ng μL–1 epidermal growth factor, 1 μg mL–1 estradiol, and 50 μg mL–1 gentamicin, with or without meiotic inhibitor. After 24 h of culture, cumulus cells were removed; oocytes were fixed, permeabilized, and stained with 5 μg mL–1 of Hoechst 33342; and chromatin configuration was assessed under ultraviolet fluorescence. In 4 replicates of Experiment 1, oocytes were cultured with either 25 nm ROS, 1 mm dbcAMP, both ROS and dbcAMP (Both), or without inhibitor (Control). A greater proportion of oocytes retained the GV when cultured with Both compared with ROS, dbcAMP, or Control (90.6, 67.8, 25.0, and 14.8%, respectively; chi-square P < 0.05), and ROS alone was superior to dbcAMP or Control. Culture of oocytes in the base medium plus 0.5 IU mL–1 eCG and 1.0 IU mL–1 hCG after arrest showed that pretreatment with Both did not decrease their ability to resume meiosis (87.9 v. 87.0%, respectively). Given the low percentage of oocytes with a retained GV in the presence of 1.0 mm dbcAMP, Experiment 2 evaluated the concentration of dbcAMP required to inhibit meiosis. Oocytes were cultured over 4 replicates in the base media containing 0, 0.1, 0.5, 1.0, 2.0, and 10.0 mm dbcAMP. After 24 h of culture, a greater number of oocytes were arrested at the GV stage when cultured in 10 mM dbcAMP (39.8%) than in 0, 0.1, 1.0, and 2.0 mM dbcAMP (22.0, 20.4, 25.8, and 26.3%, respectively; Fisher’s exact test P < 0.05), but there was no difference from those cultured in 0.5 mm dbcAMP (28.1%). For many species, 1.0 mm dbcAMP is commonly used to inhibit meiosis successfully for 24 h. However, dbcAMP alone did not effectively arrest meiosis, but when combined with ROS, it tended to improve meiotic arrest. Experiment 2 indicates that at least 10.0 mm dbcAMP is required to show a significant effect of meiotic inhibition in feline oocytes. Under these culture conditions, dbcAMP at levels up to 10 mm were not effective at inducing meiotic arrest. Interestingly, ROS and dbcAMP may act synergistically to successfully induce a reversible inhibition of meiosis in a high percentage of feline oocytes.

189 TRANSCRIPTIONAL PROFILING OF HISTONE-MODIFYING GENES DURING BOVINE PRE-IMPLANTATION EMBRYO DEVELOPMENT IN VITRO

The proper removal of gametic epigenetic marks and coordinated re-establishment of the epigenome is critical to mammalian embryonic development. This global reprogramming of the embryonic genome includes fluctuations in both DNA methylation and histone modifications that are necessary to control chromatin structure and thus gene expression. In the bovine model, epigenetic changes occur from fertilization through blastocyst stages; in particular, and concurrent with the maternal-embryonic transition, de novo DNA methylation begins at the 8-cell stage. In order to understand which factors might be playing key roles in this epigenetic process, we used quantitative real-time PCR to characterize the temporal expression profiles of several genes involved in DNA and/or histone methylation: G9a, SetB1, Suv39h1, Suv420h1, SmyD3, Suz12, and LSH. Bovine ova and embryos were produced via in vitro maturation, fertilization, and culture from multiple pools of ova. Groups of 12–25 bovine ova or embryos, pooled at the 2-, 4 to 7-, mid 8-, late 8-, 12 to 16-cell, morula, and blastocyst stages, were washed twice through 1X PBS and stored in RNA lysis buffer at –80°C until further use. RNA was isolated from each sample using the RNeasy® Mini kit (Qiagen, Valencia, CA, USA), optimized for isolating RNA from single embryos, and treated to remove any contaminating genomic DNA. cDNA was generated with iScript™ reverse transcriptase (Bio-Rad Laboratories, Hercules, CA, USA) and diluted 1:10 with RNase/DNase-free water for further use in real-time PCR. Relative gene expression from each RNA sample was calculated in triplicate using the SYBR Green comparative Ct method (Applied Biosystems, Foster City, CA, USA) adjusted for individual PCR efficiencies (Bustin 2003) and normalized to the geometric mean Ct of 3 endogenous controls (GAPDH, YWHAZ, and SDHA) in order to account for differences in both cell number and amount of total mRNA present in each sample (Goossens et al. 2005). G9a and SetB1, both lysine-specific methyltransferases, were expressed at their highest levels in the metaphase II (MII) oocyte and 2-cell stage, before expression decreased gradually to basal levels by the morula and blastocyst stages. Suv39h1, Suv420h1, and SmyD3, also lysine-specific methyltransferases, all shared a similar pattern of expression: transcript levels were fairly high in the MII oocyte, increased at the 2-cell stage, then gradually dropped off around the 8–16-cell stage to basal levels by the morula stage. Interestingly, Suz12 and LSH both showed low expression from the MII oocyte until the 4 to 7-cell stage, increased dramatically at the 8-cell stage, then decreased again by the morula stage. Suz12 is a member of several Polycomb group complexes (PRCs); LSH associates with PRC-mediated gene silencing as well as DNMT3a and 3b. These data suggest that Suz12 and LSH may be implicated in bovine embryonic genome activation, while the latter genes are active during earlier cleavage events. Ongoing studies will evaluate the role of each of these epigenetic modifiers in bovine pre-implantation embryos by selective silencing via RNA interference.

126 THE EFFECT OF FORSKOLIN ON IN VITRO PRODUCED BRAHMAN-SIRED BOVINE EMBRYOS

Forskolin (Colforsin) is a lipolytic agent that can be used to reduce intracellular lipids within in vitro produced (IVP) porcine embryos (Men et al. 2006 Theriogenology 66, 2008–2016). Lowering lipids within bovine embryos has shown to decrease sensitivity to cryopreservation. The objective of this preliminary experiment was to determine developmental differences and lipolytic effect on bovine IVP embryos exposed to 10 or 40 μm forskolin. Bovine oocytes (obtained from an abattoir) were fertilized with frozen/thawed Brahman semen (Day 0) and cultured in G1.5/G2.5 medium supplemented with 8 mg mL–1 BSA (Vitrolife, Englewood, CO, USA). On Day 6 post-fertilization, a total of 352 viable embryos were randomly submitted to 3 treatment groups; Control (no treatment, n = 116), 10 μm (n = 122) and 40 μm (n = 114) forskolin (Sigma, St. Louis, MO, USA) in G2.5 medium for 24 h. On Day 7, embryos were washed in holding medium (Vigro Holding Plus, Bioniche, Pullman, WA, USA). From each treatment group, a randomized half was cultured 72 h in G2.5 and assessed for hatched blastocyst rates (development), with the balance stained on Day 7 in Hoechst 33342 (2.5 μg mL–1) under UV light for total cell counts before being fixed/stained in Nile red (1 μg mL–1). Nile red stained embryos were mounted on glass slides with cover slips gently applied over each embryo. Embryos were photographed under UV light using the proper excitation filters. The area measurements of compact morula and blastocysts did not include the zona pellucida. Nile red units (NRU) were measured with computer software Image J (www.rbsweb.nih.gov) from 0 to 255 shades/pixel (0 = no lipids; 255 = highest lipid accrual). Each image was adjusted for variation in embryo size. Student’s t-test was used for statistical analysis. There was no difference (P > 0.05) between development rates for control, 10 μm and 40 μm forskolin (62%, 67% and 65%, respectively). Mean NRU by total cell numbers were calculated per embryo for each treatment group: control, 10 μm and 40 μm with the resulting means being 72.4 ± 5.0, 63.1 ± 5.1 and 66.6 ± 4.8 respectively. With treatment groups combined by embryo stage, compact morula tended to exhibit a higher mean NRU than blastocysts (78.6 ± 6.8 to 64.7 ± 3.1, respectively, P = 0.07). In conclusion, forskolin did not significantly affect embryo development rates or lipid content as measured by Nile Red staining. Compact morula tended to yield a higher NRU mean than blastocysts indicating an elevation in intracellular lipids. Unlike pig IVP embryos exposed to forskolin, forskolin failed to show a significant decrease in intracellular lipids within bovine IVP embryos. However, further research is in progress to test forskolin’s lipolytic effect on cryopreservation of in vitro and in vivo produced bovine embryos. The authors acknowledge support from the American Brahman Breeders Association and Dr. Moisés Barceló Fimbres.

90 THE EFFECT OF LIPID SEGREGATION WITH OR WITHOUT ZONA PELLUCIDA LASER DRILLING ON POST-THAW EMBRYO DEVELOPMENT OF IN VITRO-PRODUCED BOVINE EMBRYOS

High levels of lipid within in vitro-produced embryos during freezing can increase intracellular damage and lower production rates (Seidel 2006 Theriogenology 65, 228). The objective of this study was to determine if lipid segregation with or without laser-assisted hatching (LAH), or zona pellucida drilling of in vitro-fertilized (IVF) embryos would enhance in vitro survivability and development 24 h post-thaw. Three replicates utilizing 1179 bovine oocytes (BOMED, Madison, WI, USA) were fertilized with frozen/thawed Tuli bull semen and cultured in G1.3/G2.3 supplemented with 8 mg mL–1 BSA (Vitrolife, Englewood, CO, USA). On Day 6 of culture, grade 1 & 2 embryos were morphologically divided into 3 developmental stages: 32-cell (n = 78), compact morula (CM, n = 223), and blastocyst (n = 56). Each group was then randomly allocated to the following treatments prior to cryopreservation in 1.5 m ethylene glycol (Vigro Freeze Plus, Bioniche, Pullman, WA, USA): no treatment (control), 7.5 µg mL–1 cytochalasin B for 20 min (CB), or CB with centrifugation (16 000g) for 20 min (CBCF). All CB treatments were extended to include embryo freezing. Embryos were loaded in sterile straws, frozen at 0.5�C min–1 from –6�C to –32�C, and then plunged into LN2. Frozen embryos were air-thawed for 7 s and then thawed in 35�C H2O for 10 s before being assessed for survivability. Immediately post-thaw, one-half of the CBCF and control groups were subjected to LAH, using a single laser pulse at 90% laser power for 600 µs using the XY Clone� system (Hamilton Thorne Biosciences, Beverly, MA, USA), creating groups CBCFLAH and LAH, respectively. All thawed embryos were cultured in G2.3 for 24 h and evaluated morphologically to determine survivability and development. Live/dead staining was performed by using Hoechst 33342 (2.5 µg mL–1) and propidium iodide (5 µg mL–1) under UV light. All percentage data were transformed using arcsin square root function prior to analysis, and means were compared for statistical significance using Student's t-test. Due primarily to low numbers in embryos in stages other than CM, no differences among treatments were detected. For CM, treatment means ranged from 89.6 to 95.0% and from 69.6 to 82.6% for survival and development, respectively, and no treatment differences were observed. Within the CM stage, CBCFLAH was not different from LAH, CBCF, and control (77.0 v. 71.9, 68.8, and 68.3%, respectively; P > 0.05), but showed a significantly greater percentage of live cells than CB (77.0 v. 65.5%; P < 0.05). CBCFLAH and LAH exhibited a significantly greater number of both total and live cells than control (total cells: 69.4, 69.3, and 53.0; live cells: 56.4, 54.7, and 39.3, respectively; P < 0.05). These data indicate that LAH post-thaw alone or in combination with CBCF improves both total cell number and embryo viability following cryopreservation. Financial support was provided by a grant from TAMU-CONACYT (USA-Mexico) and OvaGenix.

177 EXPRESSION PROFILING OF HISTONE-MODIFYING GENES IN BOVINE PREIMPLANTATION EMBRYOS

Global activation of the embryonic genome marks one of the most important aspects of early embryonic development and coincides with both global DNA and histone modifications necessary to control gene expression for further development. In bovine preimplantation embryos, epigenetic reprogramming occurs between fertilization and the blastocyst stage. De novo DNA methylation from the 8-cell stage to the morula represents activation of DNA methyltransferases and histone-modifying genes; however, it is still unclear how these critical events of early development and differentiation are regulated. In this preliminary study, we used quantitative real-time PCR (qRT-PCR) to examine stage-specific expression in bovine gametes (testis and ova) and preimplantation embryos of eight histone-modifying genes: LSH1 (which associates with both DNA and histone methyltransferases), LSD1 (a histone demethylase), SUV39H1, SUV420H1, SETB1, SUZ12, SMYD3, and G9a (all representative histone methyltransferases). Bovine ova and embryos were produced via in vitro maturation, fertilization, and culture from a single pool of ova as per standard laboratory protocol. Testes were harvested from a mature bull and immediately snap frozen in liquid nitrogen. RNA was isolated from testis, and groups of 10–15 in vitro-matured bovine ova or in vitro-produced embryos at the 2-, 8-cell, morula, and blastocyst stages and stored at –80�C until further use. cDNA was generated from each RNA sample using Superscript II" reverse transcriptase (Invitrogen, Carlsbad, CA, USA) under identical PCR conditions. Relative gene expression from each RNA sample was calculated in triplicate using the ΔΔCt method with both SYBR� Green and Taqman� qRT-PCR methods (Applied Biosystems, Foster City, CA, USA) and normalized to endogenous bovine GAPDH expression as per standard protocol. Due to excessive variation in a few of the qRT-PCR reactions, consistent data were collected for only SETB1, SUV39H1, SUV420H1, and G9a. SETB1 and G9a shared a similar expression pattern, with both exhibiting a dramatic relative increase in transcript level near the 8-cell stage and reduction to basal levels thereafter. Also, SUV39H1 and SUV420H1 were similar, showing a gradual increase in relative expression from the oocyte to the 8-cell stage, followed by a drop to low levels by the morula stage. These data indicate that several histone-modifying genes are expressed in distinct patterns during the critical period of zygotic genome activation and establishment of the epigenome in early preimplantation bovine embryos. Continuing studies will determine specific gene function through shRNA-induced silencing of histone-modifying genes and their role in control of gene expression.

New commercial opportunities for advanced reproductive technologies in horses, wildlife, and companion animals

As advanced reproductive technologies become more efficient and repeatable in livestock and laboratory species, new opportunities will evolve to apply these techniques to alternative and non-traditional species. This will result in new markets requiring unique business models that address issues of animal welfare and consumer acceptance on a much different level than the livestock sector. Advanced reproductive technologies and genetic engineering will be applied to each species in innovative ways to provide breeders more alternatives for the preservation and propagation of elite animals in each sector. The commercialization of advanced reproductive techniques in these niche markets should be considered a useful tool for conservation of genetic material from endangered or unique animals as well as production of biomedical models of human disease.

Prevalence of nonmusculoskeletal complaints in chiropractic practice: report from a practice-based research program

OBJECTIVE

To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints.

DESIGN

This was a cross-sectional study conducted through the methods of practice-based research.

SETTING

Data were collected in 1998--1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center.

POPULATION

The subjects were new and established patients of all ages who visited the participating offices during a designated data collection week.

DATA ANALYSIS

Multiple logistic regression was used to examine factors associated with patients' presenting for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to examine associations among practice variables and the proportion of patients with nonmusculoskeletal chief complaints.

RESULTS

A total of 7651 patients of 161 chiropractors in 110 practices in 32 states and 2 Canadian provinces participated; data from 2 Australian practices were included in the totals but not in the analysis. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints. The following characteristics made patients more likely to present with nonmusculoskeletal chief complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9; 95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1 complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0); having received medical care for the chief complaint (AOR, 3.4; CI, 2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7; CI, 1.1--2.4). Practices with the highest proportion of patients with nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance and more likely to be in locations with populations greater than 100,000. They used the most common chiropractic adjustive techniques less frequently and used more nonadjustive procedures, especially diet/nutrition counseling, nutritional supplementation, herbal preparations, naturopathy, and homeopathy.

CONCLUSIONS

Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research.

Cloning to reproduce desired genotypes

Cloned sheep, cattle, goats, pigs and mice have now been produced using somatic cells for nuclear transplantation. Animal cloning is still very inefficient with on average less than 10% of the cloned embryos transferred resulting in a live offspring. However successful cloning of a variety of different species and by a number of different laboratory groups has generated tremendous interest in reproducing desired genotypes. Some of these specific genotypes represent animal cell lines that have been genetically modified. In other cases there is a significant demand for cloning animals characterized by their inherent genetic value, for example prize livestock, household pets and rare or endangered species. A number of different variables may influence the ability to reproduce a specific genotype by cloning. These include species, source of recipient ova, cell type of nuclei donor, treatment of donor cells prior to nuclear transfer, and the techniques employed for nuclear transfer. At present, there is no solid evidence that suggests cloning will be limited to only a few specific animals, and in fact, most data collected to date suggests cloning will be applicable to a wide variety of different animals. The ability to reproduce any desired genotype by cloning will ultimately depend on the amount of time and resources invested in research.

Evidence for placental abnormality as the major cause of mortality in first-trimester somatic cell cloned bovine fetuses

The production of cloned animals is, at present, an inefficient process. This study focused on the fetal losses that occur between Days 30-90 of gestation. Fetal and placental characteristics were studied from Days 30-90 of gestation using transrectal ultrasonography, maternal pregnancy specific protein b (PSPb) levels, and postslaughter collection of fetal tissue. Pregnancy rates at Day 30 were similar for recipient cows carrying nuclear transfer (NT) and control embryos (45% [54/120] vs. 58% [11/19]), although multiple NT embryos were often transferred into recipients. From Days 30-90, 82% of NT fetuses died, whereas all control pregnancies remained viable. Crown-rump (CR) length was less in those fetuses that were destined to die before Day 90, but no significant difference was found between the CR lengths of NT and control fetuses that survived to Day 90. Maternal PSPb levels at Days 30 and 50 of gestation were not predictive of fetal survival to Day 90. The placentas of six cloned and four control (in vivo or in vitro fertilized) bovine pregnancies were compared between Days 35 and 60 of gestation. Two cloned placentas showed rudimentary development, as indicated by flat, cuboidal trophoblastic epithelium and reduced vascularization, whereas two others possessed a reduced number of barely discernable cotyledonary areas. The remaining two cloned placentas were similar to the controls, although one contained hemorrhagic cotyledons. Poor viability of cloned fetuses during Days 35-60 was associated with either rudimentary or marginal chorioallantoic development. Our findings suggest that future research should focus on factors that promote placental and vascular growth and on fetomaternal interactions that promote placental attachment and villous formation.

Chiropractic care for patients aged 55 years and older: report from a practice-based research program

OBJECTIVE

To characterize patients aged 55 years and older and features of chiropractic care provided to them.

DESIGN

Observational, practice-based research study.

SETTING

Chiropractic offices in the United States and Canada, 1997-1998.

PARTICIPANTS

Chiropractors in 96 practices in 32 states and two Canadian provinces collected data on 805 eligible patients aged 55 years and older during a 12-week study period.

MEASUREMENTS

In addition to questionnaires on practice characteristics, patient demographics, chief complaints, and health habits, two standardized instruments were administered: for general health status, the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12); and for disability related to chronic pain, the Pain Disability Index (PDI).

RESULTS

Of 805 study patients, 60.1% were women and' 94.7% were white. Overweight patients comprised 38.6% and obese 20.6% (n = 656) of the total; 9.7% of patients were hypertensive (n = 590). Smoking was reported by 12.7% and 50.2% reported regular exercise. The Physical Component Summary scores of the SF-12 seemed somewhat lower than population norms, whereas the Mental Component Summary scores differed very little from norms. Chief complaints were predominantly pain-related (72.3%), most commonly back pain (32.9%). The PDI mean baseline score for chronic patients was 16.3 (scale, 0-70), and 40.6% of study patients reported using at least one pain medication (prescription or nonprescription) more than three times per week. More than half of complaints (54.9%) had onsets more than 6 weeks before the baseline visit. For 66.6% of subjects, a chiropractor was the only provider for their current complaint. In addition to manipulation, most common features of care were recommendations on exercise (41.0%), heat or cold applications (40.8%), and food supplements (24.5%). At 4 weeks, 19.6% were discharged, 58.8% continued treatment, and 20.1% had discontinued care (self-discharged). For these three groups, those with higher PDI mean baseline scores showed more change at 4 weeks. For patients who were discharged by the doctor, the proportion of reported pain medication use decreased 7.3% from baseline to 4 weeks, increased for patients who discontinued care, and remained about the same for those continuing care.

CONCLUSIONS

Further investigation of the PDI and a decrease in pain medication use as outcome measures seems warranted. The descriptive information in this study may assist providers of care to older adults to better understand their patients' use of chiropractic care.

Development rates of male bovine nuclear transfer embryos derived from adult and fetal cells

This study compared the nuclear transfer (NT) embryo development rates of adult and fetal cells within the same genotype. The adult fibroblast cells were obtained from a 21-yr-old Brahman bull. The fetal cells were derived from a Day 40 NT fetus previously cloned using cells from the Brahman bull. Overall, similar numbers of blastocysts developed from both adult (53 of 190; 28%) and fetal (39 of 140; 28%) donor cells. Improved blastocyst development rates were observed when fetal cells were serum-starved (serum-fed 12% vs. serum-starved 43%; P < 0.01) whereas there was no similar benefit when adult cells were serum-starved (both serum-fed and serum-starved 28%). Day 30 pregnancy rates were similar for blastocysts derived from adult (6 of 26; 23%) or fetal (5 of 32; 16%) cells. Day 90 pregnancy rates were 3 of 26 for adult and 0 of 32 for the fetal cell lines. One viable bull calf derived from a 21-yr-old serum-starved adult skin fibroblast was born in August 1999. In summary, somatic NT embryo development rates were similar whether adult or fetal cells, from the same genotype, were used as donor cells. Serum starvation of these adult donor cells did not improve development rates of NT embryos to blastocyst, but when fetal cells were serum-starved, there was a significant increase in development to blastocyst.

Birth of piglets after transfer of embryos cryopreserved by cytoskeletal stabilization and vitrification

Pig embryos suffer severe sensitivity to hypothermic conditions, which limits their ability to withstand conventional cryopreservation. Research has focused on high lipid content of pig embryos and its role in hypothermic sensitivity, while little research has been conducted on structural damage. Documenting cytoskeletal disruption provides information on embryonic sensitivity and cellular response to cryopreservation. The objectives of this study were to document microfilament (MF) alterations during swine embryo vitrification, to utilize an MF inhibitor during cryopreservation to stabilize MF, and to determine the developmental competence of cytoskeletal-stabilized and vitrified pig embryos. Vitrified morulae/early blastocysts displayed MF disruptions and lacked developmental competence after cryopreservation; hatched blastocysts displayed variable MF disruption and developmental competence. Cytochalasin-b did not improve morula/early blastocyst viability after vitrification; however, it significantly (P < 0.05) improved survival and development of expanded and hatched blastocysts. After embryo transfer, we achieved pregnancy rates of almost 60%, and litter sizes improved from 5 to 7.25 piglets per litter. This study shows that the pig embryo cytoskeleton can be affected by vitrification and that MF depolymerization prior to vitrification improves blastocyst developmental competence after cryopreservation. After transfer, vitrified embryos can produce live, healthy piglets that grow normally and when mature are of excellent fecundity.

In vitro production of sexed embryos for gender preselection: high-speed sorting of X-chromosome-bearing sperm to produce pigs after embryo transfer

The objectives for the present experiments were to apply sperm sexing technology to an in vitro production system with porcine oocytes obtained from slaughterhouse material. On six experimental days, ovaries were obtained from an abattoir, and cumulus-oocyte-complexes were matured in vitro. Semen was collected from mature boars of proven fertility and was sorted for X-chromosome-bearing sperm, using the Beltsville Sperm Sexing Technology incorporating the use of high-speed sorting. A total of 5,378 oocytes were submitted for in vitro fertilization (IVF). Of these, 559 ova were stained for cytogenetic analysis 18 h after IVF. From the remaining 4,819 ova, 1,595 cleaved, and 1,300 of the cleaved embryos were transferred into 26 synchronized recipients (5 control gilts for unsorted sperm, 21 gilts for X-sorted sperm). In a test of two fertilization media (FERT-A vs FERT-B) higher cleavage rates (P<.05) were obtained when FERT-B was used as a fertilization medium for unsorted (43.4+/-5.1%) and sorted sperm (43.1+/-1.1%;), whereas in FERT-A unsorted sperm gave a cleavage rate of 17.9+/-4.4% and sorted sperm gave 30.4+/-1.4%. Additionally, cleavage rates were higher (P<.05) after fertilization with sorted sperm vs unsorted sperm, independent of fertilization medium. Cytogenetic analysis of ova revealed that more oocytes with unsorted than with sorted sperm remained in Metaphase 2 arrest (P<.05). This was also independent of the fertilization medium. Monospermic fertilization rates were the same for IVF with unsorted or sorted sperm, independent of the fertilization system, except FERT-A with unsorted sperm (P<.05). Polyspermic fertilization rates were highest in FERT-B (37.6+/-6.6). A total of 57 pigs were born from nine litters. Six litters from sexed sperm (X-sorted) produced 33 females (97%) and one male. Three litters from control transfers produced 23 pigs, 11 of which were female (48%). The sex ratio of the offspring was predicted based on the sort reanalysis of the sorted sperm for DNA content.

Factors affecting use of chiropractic services in seven midwestern states of the United State

Although chiropractic is used by approximately 10 percent of the U.S. population, predictors of its use have not been definitively described. Previous studies have suggested that chiropractic users differ from nonusers in a number of sociodemographic characteristics, but their findings are inconsistent, perhaps because of differences in populations sampled and dates of data collection, most of which are prior to 1990. Regional studies have been conducted in rural areas based on the premise that rural residents are more likely than non-rural residents to use chiropractice; however, this premise has not been definitively documented. The purpose of this study was to provide clarification of these sociodemographic predictors of chiropractic use in Illinois, Iowa, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin by characterizing chiropractic users and nonusers in terms of sociodemographics, including rural or non-rural residence, and presence of low back pain. Data from 1,511 respondents to a 1994 population-based survey, conducted by the University of Iowa Social Science Institute, were analyzed. Unconditional logistic regression was used to derive odds ratios and 95 percent confidence intervals for univariate and multiple regression models. Overall, 15.1 percent of respondents had used chiropractic within the last year, most often for low back pain (57 percent). Chiropractic use was less likely in African Americans, Hispanics and Asians than whites, less likely by non-rural than rural residents, and less likely in Catholics than Protestants in states other than Iowa and South Dakota. Overall, 42.7 percent of workers with low back pain reported using chiropractic, and use increased with age but remained significantly related to race, rural or non-rural residence, state of residence and religious preference. Race, rural or non-rural residence, state of residence and religious preference, independently of low back pain, affect use of chiropractice in seven Midwestern states.

Preliminary study of the effects of a placebo chiropractic treatment with sham adjustments

OBJECTIVE

To identify aspects of the delivery of placebo chiropractic treatments by using sham adjustments that may cause a treatment effect and that may affect the success of blinding.

DESIGN AND SETTING

Two-period crossover design in a chiropractic college research clinic.

SUBJECTS

Eighteen volunteer staff, students, and faculty of the chiropractic college who reported low-back pain within the last 6 months.

INTERVENTIONS

Flexion-distraction technique was used to perform chiropractic adjustments, and a hand-held instrument (Activator adjusting instrument) with the pressure gauge set on the 0 was used to perform sham adjustments. The treatment period was 2 weeks, with a total of 4 visits.

MAIN OUTCOME MEASURES

The Visual Analog Scale (VAS) for pain and Global Well-Being Scale (GWBS).

RESULTS

Although VAS and GWBS scores improved with both treatments, a somewhat greater improvement occurred in most cases with the active treatment. Eight of 14 patients interviewed believed that the placebo had a treatment effect.

CONCLUSION

This study provided preliminary information that was useful in planning the protocol for a placebo chiropractic treatment in the randomized clinical trial for which it was designed.

The relationship between membrane status and fertility of boar spermatozoa after flow cytometric sorting in the presence or absence of seminal plasma

The motility, viability (percent live), capacitation status and in vitro fertility of boar spermatozoa were examined, after staining with Hoechst 33,342 and flow cytometric sorting in the absence or presence of seminal plasma. Viability was higher in unstained controls and when seminal plasma was present in the medium used to collect spermatozoa from the cell sorter than when seminal plasma was absent or in the staining extender only, but motility was highest when seminal plasma was included in the extender only, compared with the controls and other treatments. The proportions of capacitated spermatozoa were increased by sorting, but were lower when seminal plasma was present, rather than absent, from the staining extender and the collection medium. Compared with unstained controls, extension and staining without sorting only increased the proportion of capacitated spermatozoa after washing in preparation for in vitro fertilization. The percentages of polyspermic, penetrated and cleaved oocytes were lower when inseminated with unsorted (stained) than control (unstained) spermatozoa, regardless of the presence or absence of seminal plasma. These parameters were higher for sorted than for control spermatozoa in the absence of seminal plasma, but in its presence penetration and cleavage were substantially lower. The proportions of capacitated spermatozoa were lower when seminal plasma was present in the collection medium only than in the staining extender or when it was absent altogether, but the former treatment substantially reduced the proportions of polyspermic, penetrated and cleaved oocytes, and the proportion of blastocysts. These findings indicate that sperm capacitation associated with flow cytometric sorting can be reduced by the inclusion of seminal plasma in the collection medium, but this treatment reduces the ability of spermatozoa to fertilize oocytes in vitro under these conditions.

In vitro production of pig embryos: comparisons of culture media and boars

The utilization of in vitro produced pig embryos for commercial production or research is dependent upon the development of improved methodology. Our objective was to establish a consistent in vitro embryo production (IVP) system and subsequently utilize the procedures to evaluate culture system components and boar effects. To summarize the IVP system, 403 inseminated oocytes from a total of 2243 were analyzed across 17 replicates for maturation and fertilization efficiency, while 1838 zygotes were cultured in 26 replicates for developmental data. Penetration, cleavage and blastocyst development rates were determined at 18, 44 and either 144 or 168 h post insemination, respectively. Monospermic penetration averaged 31.8+/-7.3% while polyspermy was 30.8+/-17.2%. Cleavage rate was 44.9+/-16.1%, with 21.8+/-7.5% of fertilized oocytes and 51.9+/-15.9% of cleaved embryos developing to blastocysts. For culture medium comparison, fertilized oocytes were cultured in either BECM-6, BECM-7, NCSU-23 or NCSU-23aa and supplemented on Day 5 post insemination (pi) with 10% FCS. These treatments resulted in 4.0, 4.9, 19.8 and 13.6% (+/-3.2%) blastocysts by Day 7 pi, with an average cell number of 44.4+/-9.0, 65.1+/-8.2, 61.3+/-4.5 and 64.4+/-4.8, respectively. These IVP procedures consistently produced zygotes from semen of several different boars, capable of forming blastocysts in vitro. Comparison of developmental rates among the boars indicated that this system is variable among boars but not strictly boar-dependent. Culture media comparisons suggest that NCSU-23 yielded a higher percentage of blastocysts than the other media in this IVP system.

Spinal manipulative therapy versus a low force mimic maneuver for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial

Non-drug therapies for women with primary dysmenorrhea are primarily based on anecdotal evidence and small-scale clinical studies. This randomized, observer-blinded, clinical trial evaluated the efficacy of spinal manipulative therapy (SMT) in the treatment of women with primary dysmenorrhea. Women were recruited from the Chicago metropolitan area and evaluated for inclusion through four screening levels. One hundred thirty eight women, ages 18-45, with primary dysmenorrhea diagnosed by participating gynecologists, were randomly assigned to either SMT or a low-force mimic (LFM) maneuver. No treatment occurred at menstrual cycle 1. Treatment for both groups took place on day 1 of cycles 2, 3 and 4, and prophylactic treatment of three visits took place during the 7 days before cycles 3 and 4. Main outcome measures were the Visual Analog Scale (VAS) and plasma concentration of the prostaglandin F2alpha metabolite, 15-keto-13,14-dihydro-prostaglandin F2alpha (KDPGF2alpha), measured 15 min before treatment and 60 min after treatment on day 1 of four consecutive menstrual cycles. The Moos' Menstrual Distress Questionnaire (MDQ) was also administered after treatment on day 1 of each cycle. At cycle 2, the post-treatment VAS scores decreased for both groups, with no statistically significant difference in pre- to post-treatment scores between the two groups (P = 0.44). The changes in pre- to post-treatment KDPGF2alpha levels were not statistically different between the SMT and LFM groups (P = 0.15). No treatment effects were detected over the three cycles for VAS, KDPGF2alpha or MDQ (P = 0.65, P = 0.61 and P = 0.78, respectively). However, there were statistically significant linear time effects for VAS (P = 0.008), MDQ (P < 0.001), and borderline significance for KDPGF2alpha (P = 0.054); these decreases were not considered clinically meaningful. The LFM maneuver used in this study was designed to act as a 'placebo-like' control treatment in comparison with SMT. Although it is possible that the trial did not continue long enough for any placebo effect of the LFM to wash out, it seems more likely that this maneuver was indistinguishable from SMT. Therefore, the postulated superior benefit of high-velocity, short-lever, low-amplitude, high-force spinal manipulation to a low-force maneuver is not supported by the results of this study. 1999 International Association for the Study of Pain.

Use of complementary healthcare practices among chiropractors in the United States: a survey

CONTEXT

Although chiropractic is the most commonly used complementary healthcare practice, chiropractors have not been surveyed in depth about their attitudes toward and practice of complementary and alternative therapies apart from spinal manipulation.

OBJECTIVES

To examine attitudes among US chiropractors on the role of their profession in complementary healthcare and to gather data on the types of complementary healthcare practices chiropractors use.

DESIGN

Descriptive, cross-sectional study using a mail-in survey.

SETTING

United States.

PARTICIPANTS

Random sample of US chiropractors stratified by zip code region.

RESULTS

A total of 563 surveys were completed, for a response rate of 30%. Respondents were almost equally divided on their responses to the question "Do you feel that chiropractic should at the present time be termed 'complementary'?" Although many respondents (68%) believed that chiropractic was viewed as a therapeutic modality, more (82%) believed that it should be viewed as a complete system. The therapies most commonly used by respondents in their practice were acupressure (72%), massage (72%), mineral supplements (63%), and herbs (56%).

CONCLUSION

The disparity between the established view of chiropractic as synonymous with spinal manipulation and the profession's view of chiropractic as a complete system indicates a need for better interprofessional communication.

Verification of flow cytometorically-sorted X- and Y-bearing porcine spermatozoa and reanalysis of spermatozoa for DNA content using the fluorescence in situ hybridization (FISH) technique

Flow cytometric sperm sorting based on X and Y sperm DNA difference has been established as the only effective method for sexing the spermatozoa of mammals. The standard method for verifying the purity of sorted X and Y spermatozoa has been to reanalyze sorted sperm aliquots. We verified the purity of flow-sorted porcine X and Y spermatozoa and accuracy of DNA reanalysis by fluorescence in situ hybridization (FISH) using chromosome Y and 1 DNA probe. Eight ejaculates from 4 boars were sorted according to the Beltsville Sperm Sexing method. Porcine chromosome Y- and chromosome 1-specific DNA probes were used on sorted sperm populations in combination with FISH. Aliquots of the sorted sperm samples were reanalyzed for DNA content by flow cytometry. The purity of the sorted X-bearing spermatozoa was 87.4% for FISH and 87.0% for flow cytometric reanalysis; purity for the sorted Y-bearing spermatozoa was 85.9% for FISH and 84.8% for flow cytometric reanalysis. A total of 4,424 X sperm cells and 4,256 Y sperm cells was examined by FISH across the 8 ejaculates. For flow cytometry, 5,000 sorted X spermatozoa and 5,000 Y spermatozoa were reanalyzed for DNA content for each ejaculate. These results confirm the high purity of flow sorted porcine X and Y sperm cells and the validity of reanalysis of DNA in determining the proportions of X- and Y-sorted spermatozoa from viewing thousands of individual sperm chromosomes directly using FISH.

Dual labeling of the cytoskeleton and DNA strand breaks in porcine embryos produced in vivo and in vitro

In vitro-produced embryos exhibit decreased cell numbers, small inner cell masses and reduced pregnancy rates after transfer. Evaluation of intracellular components of in vitro-produced or -manipulated embryos will lead to improved methodology for embryo production. Whole mount techniques were developed to utilize terminal deoxynucleotidyl-transferase 3' nick end labeling (TUNEL) to detect broken DNA. Subsequent labeling of either tubulin or actin filaments provides further evidence of cytological damage. Porcine embryos produced in vitro or in vivo were evaluated throughout the cleavage and preimplantation stages of development. Early cleavage stages up to the 8-cell stage never contained TUNEL-labeled nuclei. However, TUNEL labeling of in vitro-produced morula revealed some blastomeres with broken DNA. Nearly all in vitro-produced blastocysts displayed some TUNEL positive cells, whereas in vivo-collected embryos at a similar stage displayed few, if any, TUNEL-labeled nuclei. The ratio of TUNEL-labeled DNA to total DNA area of in vitro-derived blastocysts was significantly greater than their in vivo counterparts (P < 0.05). Microtubule and microfilament labeling identified blastomeres of unequal size and shape that were losing cellular integrity. These data suggest that the combination of these labeling techniques may be useful in evaluating cellular damage in embryos produced under in vitro conditions.

Living in two worlds: Native American women and prenatal care

The purpose of this qualitative study was to explore traditional beliefs and practices related to pregnancy and childbirth among Native American women and examine the relationship of these beliefs and practices to current use of prenatal care. Focus groups of elders and young women were held and the data analyzed with the Ethnograph software. The central theme was the breakdown in transmission of cultural wisdom among Native American women. The major causes described by women were federal assimilation policies and deaths of elders. Major factors influencing young women's nonutilization of prenatal care were this breakdown, the "Western model" of prenatal care, substance abuse, and domestic violence. Recommendations for improving the use of prenatal care are grounded in the reality that Native American women live in two different worlds. Prenatal care should be reconceptualized as traditional cultural wisdom, with the majority of care provided by natural helpers in the Native American community, including tribal elders, grandmothers, and aunts in collaboration with licensed providers.

Development of a practice-based research program

OBJECTIVE

To establish an infrastructure to collect accurate data from ambulatory settings.

DESIGN

The program was developed through an iterative model governed by a process of formative evaluation. The three iterations were a needs assessment, feasibility study and pilot project. Necessary program components were identified as infrastructure, practitioner-researcher partnership, centralized data management and standardized quality assurance measures.

SETTING AND PARTICIPANTS

Volunteer chiropractors and their staff collected data on patients in their practices in ambulatory settings in the U.S. and Canada.

OUTCOME MEASURES

Evaluative measures were counts of participants, patients and completed forms. Standardized, validated and reliable measures collected by patient self-report were used to assess treatment outcomes. These included the SF-36 or SF-12 Health Survey, the Pain Disability Index, and the Global Well-Being Scale. For characteristics for which appropriate standardized instruments were not available, questionnaires were designed and and pilot-tested before use.

RESULTS

Information was gathered on practice and patient characteristics and treatment outcomes, but for this report, only those data concerning process evaluation are reported. Through the three program iterations, 65 DCs collected data on 1360 patients, 663 of whom were new patients. Follow-up data recorded by doctors were obtained for more than 70% of patients; a maximum of 50% of patient-completed follow-up forms were collected in the three iterations.

CONCLUSIONS

This program is capable of providing data for descriptive epidemiology of ambulatory patients, and, with continued effort to maximize follow-up, may have utility in providing insight into utilization patterns and patient outcomes.