JT002, a small molecule inhibitor of the NLRP3 inflammasome for the treatment of autoinflammatory disorders

The NLRP3 inflammasome is an intracellular, multiprotein complex that promotes the auto-catalytic activation of caspase-1 and the subsequent maturation and secretion of the pro-inflammatory cytokines, IL-1β and IL-18. Persistent activation of the NLRP3 inflammasome has been implicated in the pathophysiology of a number of inflammatory and autoimmune diseases, including neuroinflammation, cardiovascular disease, non-alcoholic steatohepatitis, lupus nephritis and severe asthma. Here we describe the preclinical profile of JT002, a novel small molecule inhibitor of the NLRP3 inflammasome. JT002 potently reduced NLRP3-dependent proinflammatory cytokine production across a number of cellular assays and prevented pyroptosis, an inflammatory form of cell death triggered by active caspase-1. JT002 demonstrated in vivo target engagement at therapeutically relevant concentrations when orally dosed in mice and prevented body weight loss and improved inflammatory and fibrotic endpoints in a model of Muckle-Wells syndrome (MWS). In two distinct models of neutrophilic airway inflammation, JT002 treatment significantly reduced airway hyperresponsiveness and airway neutrophilia. These results provide a rationale for the therapeutic targeting of the NLRP3 inflammasome in severe asthma and point to the use of JT002 in a variety of inflammatory disorders.

Pharmacology of a Potent and Novel Inhibitor of the NOD-Like Receptor Pyrin Domain-Containing Protein 3 (NLRP3) Inflammasome that Attenuates Development of Nonalcoholic Steatohepatitis and Liver Fibrosis

The NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome is a multiprotein complex and component of the innate immune system that is activated by exogenous and endogenous danger signals to promote activation of caspase-1 and the maturation and release of the proinflammatory cytokines interleukin (IL)-1β and IL-18. Inappropriate activation of NLRP3 has been implicated in the pathophysiology of multiple inflammatory and autoimmune diseases, including cardiovascular disease, neurodegenerative diseases, and nonalcoholic steatohepatitis (NASH), thus increasing the clinical interest of this target. We describe in this study the preclinical pharmacologic, pharmacokinetic, and pharmacodynamic properties of a novel and highly specific NLRP3 inhibitor, JT001 (6,7-dihydro-5H-pyrazolo[5,1-b][1,3]oxazine-3-sulfonylurea). In cell-based assays, JT001 potently and selectively inhibited NLRP3 inflammasome assembly, resulting in the inhibition of cytokine release and the prevention of pyroptosis, a form of inflammatory cell death triggered by active caspase-1. Oral administration of JT001 to mice inhibited IL-1β production in peritoneal lavage fluid at plasma concentrations that correlated with mouse in vitro whole blood potency. Orally administered JT001 was effective in reducing hepatic inflammation in three different murine models, including the Nlrp3A350V /+CreT model of Muckle-Wells syndrome (MWS), a diet-induced obesity NASH model, and a choline-deficient diet-induced NASH model. Significant reductions in hepatic fibrosis and cell damage were also observed in the MWS and choline-deficient models. Our findings demonstrate that blockade of NLRP3 attenuates hepatic inflammation and fibrosis and support the use of JT001 to investigate the role of NLRP3 in other inflammatory disease models. SIGNIFICANCE STATEMENT: Persistent inflammasome activation is the consequence of inherited mutations of NLRP3 and results in the development of cryopyrin-associated periodic syndromes associated with severe systemic inflammation. NLRP3 is also upregulated in nonalcoholic steatohepatitis, a metabolic chronic liver disease currently missing a cure. Selective and potent inhibitors of NLRP3 hold great promise and have the potential to overcome an urgent unmet need.

Structure-guided optimization of a novel class of ASK1 inhibitors with increased sp3 character and an exquisite selectivity profile

Apoptosis Signal-Regulating Kinase-1 (ASK1) is a known member of the Mitogen-Activated Protein Kinase Kinase Kinase (MAP3K) family and upon stimulation will activate the p38- and JNK-pathways leading to cardiac apoptosis, fibrosis, and hypertrophy. Using Structure-Based Drug Design (SBDD) in parallel with deconstruction of a published compound, a novel series of ASK1 inhibitors was optimized, which incorporated a saturated heterocycle proximal to the hinge-binding motif. This yielded a unique chemical series with excellent selectivity across the broader kinome, and desirable drug-like properties. The lead compound (10) is highly soluble and permeable, and exhibits a cellular EC₅₀ = 24 nM and K_d < 1 nM. Of the 350 kinases tested, 10 has an IC₅₀ ≤ 500 nM for only eight of them. This paper will describe the design hypotheses behind this series, key data points during the optimization phase, as well as a possible structural rationale for the kinome selectivity. Based on crystallographic data, the presence of an aliphatic cycle adjacent to the hinge-binder in the active site of the protein kinase showed up in <1% of the >5000 structures in the Protein Data Bank, potentially conferring the selectivity seen in this series.

Using Target Engagement Biomarkers to Predict Clinical Efficacy of MetAP2 Inhibitors

Target-engagement pharmacodynamic (PD) biomarkers are valuable tools in the prioritization of drug candidates, especially for novel, first-in-class mechanisms whose robustness to alter disease outcome is unknown. Methionine aminopeptidase 2 (MetAP2) is a cytosolic metalloenzyme that cleaves the N-terminal methionine from nascent proteins. Inhibition of MetAP2 leads to weight loss in obese rodents, dogs and humans. However, there is a need to develop efficacious compounds that specifically inhibit MetAP2 with an improved safety profile. The objective of this study was to identify a PD biomarker for selecting potent, efficacious compounds and for predicting clinical efficacy that would result from inhibition of MetAP2. Here we report the use of NMet14-3-3γ for this purpose. Treatment of primary human cells with MetAP2 inhibitors resulted in an approx. 10-fold increase in NMet14-3-3γ levels. Furthermore, treatment of diet-induced obese mice with these compounds reduced body weight (approx. 20%) and increased NMet14-3-3γ (approx. 15-fold) in adipose tissues. The effects on target engagement and body weight increased over time and were dependent on dose and administration frequency of compound. The relationship between compound concentration in plasma, NMet14-3-3γ in tissue, and reduction of body weight in obese mice was used to generate a pharmacokinetic-pharmacodynamic-efficacy model for predicting efficacy of MetAP2 inhibitors in mice. We also developed a model for predicting weight loss in humans using a target engagement PD assay that measures inhibitor-bound MetAP2 in blood. In summary, MetAP2 target engagement biomarkers can be used to select efficacious compounds and predict weight loss in humans. SIGNIFICANCE STATEMENT: The application of target engagement pharmacodynamic biomarkers during drug development provides a means to determine the dose required to fully engage the intended target and an approach to connect the drug target to physiological effects. This work exemplifies the process of using target engagement biomarkers during preclinical research to select new drug candidates and predict clinical efficacy. We determine concentration of MetAP2 antiobesity compounds needed to produce pharmacological activity in primary human cells and in target tissues from an appropriate animal model and establish key relationships between pharmacokinetics, pharmacodynamics, and efficacy, including the duration of effects after drug administration. The biomarkers described here can aid decision-making in early clinical trials of MetAP2 inhibitors for the treatment of obesity.

Bowel obstruction caused by colonic metastasis of lung adenocarcinoma: a case report and literature review

Introduction

Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma.

Case presentation

A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care.

Conclusions

Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.

Correction to "Structure-Based Design of ASK1 Inhibitors as Potential Agents for Heart Failure"

[This corrects the article DOI: 10.1021/acsmedchemlett.6b00481.].

Structure-based design and SAR development of 5,6-dihydroimidazolo[1,5-f]pteridine derivatives as novel Polo-like kinase-1 inhibitors

Using structure-based drug design, we identified a novel series of 5,6-dihydroimidazolo[1,5-f]pteridine PLK1 inhibitors. Rational improvements to compounds of this class resulted in single-digit nanomolar enzyme and cellular activity against PLK1, and oral bioavailability. Compound 1 exhibits >7 fold induction of phosphorylated Histone H3 and is efficacious in an in vivo HT-29 tumor xenograft model.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Discovery of potent, reversible MetAP2 inhibitors via fragment based drug discovery and structure based drug design-Part 2

Methionine aminopeptidase-2 (MetAP2) is an enzyme that cleaves an N-terminal methionine residue from a number of newly synthesized proteins. This step is required before they will fold or function correctly. Pre-clinical and clinical studies with a MetAP2 inhibitor suggest that they could be used as a novel treatment for obesity. Herein we describe the discovery of a series of pyrazolo[4,3-b]indoles as reversible MetAP2 inhibitors. A fragment-based drug discovery (FBDD) approach was used, beginning with the screening of fragment libraries to generate hits with high ligand-efficiency (LE). An indazole core was selected for further elaboration, guided by structural information. SAR from the indazole series led to the design of a pyrazolo[4,3-b]indole core and accelerated knowledge-based fragment growth resulted in potent and efficient MetAP2 inhibitors, which have shown robust and sustainable body weight loss in DIO mice when dosed orally.

Discovery of potent, reversible MetAP2 inhibitors via fragment based drug discovery and structure based drug design-Part 1

Methionine aminopeptidase 2 (MetAP2) is an enzyme that cleaves an N-terminal methionine residue from a number of newly synthesized proteins. Pre-clinical and clinical studies suggest that MetAP2 inhibitors could be used as a novel treatment for obesity. Herein we describe our use of fragment screening methods and structural biology to quickly identify and elaborate an indazole fragment into a series of reversible MetAP2 inhibitors with <10nM potency, excellent selectivity, and favorable in vitro safety profiles.

Respiratory health outcomes 1 year after admission with severe lower respiratory tract infection

Severe lower respiratory infection (LRI) is believed to be one precursor of protracted bacterial bronchitis, chronic moist cough (CMC), and chronic suppurative lung disease. The aim of this study was to determine and to describe the presence of respiratory morbidity in young children 1 year after being hospitalized with a severe LRI. Children aged less than 2 years admitted from August 1, 2007 to December 23, 2007 already enrolled in a prospective epidemiology study (n = 394) were included in this second study only if they had a diagnosis of severe bronchiolitis or of pneumonia with no co-morbidities (n = 237). Funding allowed 164 to be identified chronologically, 131 were able to be contacted, and 94 agreed to be assessed by a paediatrician 1 year post index admission. Demographic information, medical history and a respiratory questionnaire was recorded, examination, pulse oximetry, and chest X-ray (CXR) were performed. The predetermined primary endpoints were; (i) history of CMC for at least 3 months, (ii) the presence of moist cough and/or crackles on examination in clinic, and (iii) an abnormal CXR when seen at a time of stability. Each CXR was read by two pediatric radiologists blind to the individuals' current health. Results showed 30% had a history of CMC, 32% had a moist cough and/or crackles on examination in clinic, and in 62% of those with a CXR it was abnormal. Of the 81 children with a readable follow-up X-ray, 11% had all three abnormal outcomes, and 74% had one or more abnormal outcomes. Three children had developed bronchiectasis on HRCT. The majority of children with a hospital admission at <2 years of age for severe bronchiolitis or pneumonia continued to have respiratory morbidity 1 year later when seen at a time of stability, with a small number already having sustained significant lung disease.

Discovery of TAK-960: an orally available small molecule inhibitor of polo-like kinase 1 (PLK1)

Using structure-based drug design, we identified and optimized a novel series of pyrimidodiazepinone PLK1 inhibitors resulting in the selection of the development candidate TAK-960. TAK-960 is currently undergoing Phase I evaluation in adult patients with advanced solid malignancies.

3D Pharmacophore Model-Assisted Discovery of Novel CDC7 Inhibitors

A ligand-based 3D pharmacophore model for serine/threonine kinase CDC7 inhibition was created and successfully applied in the discovery of novel 2-(heteroaryl)-6,7-dihydrothieno[3,2-c]pyridin-4(5H)-ones. The pharmacophore model provided a hypothesis for lead generation missed by docking to a homology model. Medicinal chemistry exploration of the series revealed clear structure-activity relationships consistent with the pharmacophore model and pointed to further optimization opportunities.

Heat capacity of water: A signature of nuclear quantum effects

In this note we present results for the heat capacity at constant pressure for the TIP4PQ/2005 model, as obtained from path-integral simulations. The model does a rather good job of describing both the heat capacity of ice I(h) and of liquid water. Classical simulations using the TIP4P/2005, TIP3P, TIP4P, TIP4P-Ew, simple point charge/extended, and TIP5P models are unable to reproduce the heat capacity of water. Given that classical simulations do not satisfy the third law of thermodynamics, one would expect such a failure at low temperatures. However, it seems that for water, nuclear quantum effects influence the heat capacities all the way up to room temperature. The failure of classical simulations to reproduce C(p) points to the necessity of incorporating nuclear quantum effects to describe this property accurately.

Evidence for the cognitive mediational model of cognitive behavioural therapy for depression

BACKGROUND

Although empirical support for the efficacy of cognitive behavioural therapy (CBT) as a treatment for major depressive disorder (MDD) is well established, its mechanism of action is uncertain. In this investigation, we examined evidence for the cognitive mediational model in a randomized control trial involving CBT, interpersonal therapy (IPT) and pharmacotherapy (PHT) in patients with MDD.

METHOD

One hundred and thirty participants diagnosed with MDD were treated with CBT, IPT or PHT. Participants completed the Hamilton Depression Rating Scale, Beck Depression Inventory-II and Dysfunctional Attitudes Scale prior to and following treatment.

RESULTS

The cognitive mediational model, in which dysfunctional attitudes are proposed to mediate depressive symptom reduction in response to treatment, provided a good fit to the data when contrasting CBT v. IPT, with results supporting a mediational role for dysfunctional attitude change in depressive symptom reduction. The complication model, in which dysfunctional attitudes are proposed to be a consequence of depressive symptom reduction, provided a good fit to the data when contrasting CBT v. PHT, with results supporting a mediational role for depressive symptom reduction in dysfunctional attitude change.

CONCLUSIONS

There was no evidence for a mediational role for dysfunctional attitude change in IPT. Changes in dysfunctional attitudes accompanied both CBT and PHT; however, empirical evidence suggests that the role of attitudes in treatment outcome may differ between these two treatments.

Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients?

BACKGROUND

Ventral hernia is a common surgical condition occurring most often as a complication following abdominal surgery. Laparoscopic repair of a ventral hernia has been shown to be safe with low rates of complications, shortened length of stay, and low rates of early recurrence as compared to open surgery. Few studies have documented long-term outcomes of laparoscopic repair in elderly patients. The aim of this study is to report the long-term outcomes of laparoscopic ventral hernia repair with mesh in elderly patients.

METHODS AND MATERIALS

This is a retrospective study in a university setting with IRB approval. Between the years 2000 and 2006, 117 patients underwent laparoscopic repair of ventral hernia with synthetic mesh. Data were collected using patient charts and radiographic reports. Patient variables included age, sex, size and content of hernia, size of mesh used, length of hospital stay (LHS), estimated blood loss (EBL), follow-up duration, and post-operative complications (PC) including infection, deep vein thrombosis, bleeding, and pulmonary embolism. The comparison was done between two different age groups (A <55 years old; B >or= 55 years old).

RESULTS

Current median (range) follow-up periods for group A (<55 years) and B (>or=55 years) were 57.5 and 53 months, respectively. Group A (63 patients) and B (54 patients) had same median LHS (1 day) and size of mesh utilized (285 cm(2)). For groups A and B, the percent female, and the percentages of recurrence, minimal EBL (<50 ml), and PC were 61.9 and 44.4; 1.6 and 3.7; 96.8 and 92.6; 4.8 and 12.9, respectively. Median hernia sizes for groups A and B were 55.1 and 54 cm(2). No significant differences were found for any of the above variables.

CONCLUSION

No significant difference was found in outcomes between younger versus older patients undergoing laparoscopic ventral hernia repair with mesh. Laparoscopic repair provides a durable and effective method of repairing a ventral hernia with low morbidity and mortality in the elderly population.

Phase behavior of attractive and repulsive ramp fluids: Integral equation and computer simulation studies

Using computer simulations and a thermodynamically self-consistent integral equation we investigate the phase behavior and thermodynamic anomalies of a fluid composed of spherical particles interacting via a two-scale ramp potential (a hard core plus a repulsive and an attractive ramp) and the corresponding purely repulsive model. Both simulation and integral equation results predict a liquid-liquid demixing when attractive forces are present, in addition to a gas-liquid transition. Furthermore, a fluid-solid transition emerges in the neighborhood of the liquid-liquid transition region, leading to a phase diagram with a somewhat complicated topology. This solidification at moderate densities is also present in the repulsive ramp fluid, but in this case inhibits the fluid-fluid separation.

Results of FRESH START: A randomized controlled trial to improve diet and exercise behaviors in breast and prostate cancer survivors

8503

Background: Cancer survivors are at increased risk for cardiovascular disease, diabetes, osteoporosis and other cancers. A healthy diet and regular exercise may improve the health and well-being of survivors and ultimately reduce health risks. Methods: 543 individuals within 9-mths of diagnosis with locoregional breast or prostate cancer were referred by 445 providers and recruited from 39 states and 2 provinces within North America. Subjects were randomized to an arm that received a 10-mth program of tailored mailed print materials to promote fruit and vegetable (F&V) consumption, reduce total/saturated fat intake and/or increase exercise or an arm that received a 10-mth program of non-tailored mailed materials on diet and exercise available in the public domain. Telephone surveys conducted at baseline and 1-yr follow-up assessed body mass index (BMI), and responses to the Diet History Questionnaire, the 7-Day Physical Activity Recall and psychosocial/behavioral indices. Anthropometric data were obtained on a 22% subsample to validate self-reports. Results: Complete baseline and follow-up data were obtained on 519 participants (4% attrition). Sample demographics were as follows: mean age = 57 (range: 22–85), 85% white, 56% female, and 64% overweight/obese (none were underweight). Uncontrolled analyses (t-tests) indicate that both arms significantly improved their diet and exercise behaviors (p’s <.05) over the 1-year study period; however significantly greater changes occurred in the experimental arm (see table). Conclusion: The FRESH START intervention was successful in changing the behaviors of individuals with newly diagnosed cancers. Serum assays and collection of 2-yr follow-up data (to determine the durability of longer term behavior change) are currently underway. Further study is needed to determine if the effects of this intervention generalize to other populations of cancer survivors (i.e., other cancers and individuals further-out from diagnosis).

[Table: see text]

No significant financial relationships to disclose.

Scorpion envenomations in young children in central Arizona

INTRODUCTION

Centruroides sculpturatus, also known as Centruroides exilicauda or bark scorpion, is the only scorpion native to the United States whose venom produces a potentially life-threatening illness, particularly in children.

OBJECTIVES

To describe the distribution of the severity grades following scorpion envenomations, the onset of clinical signs and symptoms, the time to deterioration, and side effects of antivenom treatment in children < or = 2 yrs of age.

METHODS

Prospective case-series with the following inclusion criteria of presumed scorpion envenomation, witnessed scorpion or signs and symptoms consistent with envenomation, patient age < or = 2 yrs, and the call was received by the poison center. After data were entered prospectively, a reviewer who was blinded as to the purpose of the study reviewed the charts. A second reviewer examined 10% of the charts for accuracy in coding. Envenomation severity grades were based on a previously described scorpion grading scale and were correlated with admission rates, clinical deterioration, and outcomes. Descriptive statistics (STATA & EXCEL) were used.

RESULTS

Of the 491 charts, 483 (98%) had adequate information available. The mean age was 20.8 [range 2-24] months with 133 patients (27.5%) presenting to an emergency department (ED), 86 patients (17.8%) received antivenom, and 25 patients (5.2%) were admitted. The p-value for kappa and the 95% confidence interval (CI) for interobserver reliability kappa score was 0.69 with CI (0.44-0.95). The grade distributions were Grade I = 343 cases (71%), Grade II = 8 cases (1.7%), Grade III = 49 cases (10.1%), and Grade IV = 83 cases (17.2%). The mean time to advancement of grade was 14 min (95% CI [10.97,17.06], 99% CI [10.04,18.03]) and the median time was < 1 min (range 0-140 min). Twenty-five patients (5.2%) were admitted, of which 13 were Grade III and 12 were Grade IV. Three patients (0.6% of total), all Grade IV envenomations, were intubated (95% CI [0.0021-0.0181] or an upper limit of 8.7 patients). Antivenom was administered to 86 patients (17.8%). The mean time of abatement of symptoms following antivenom was 31 [95% CI 10-82] min vs. 22.2 h [95% CI 12-46]. There was one acute reaction (rash) to antivenom administration and 49 cases (57%) of serum sickness.

CONCLUSIONS

Clinical progression following scorpion envenomation in children < or = 2 yrs old occurred on average within 14 min of envenomation with onset almost immediately. Serum sickness occurred in 57% of toddlers receiving antivenom and typically lasted less than 3 days. Admissions were less common among patients receiving antivenom.

Quantifying levels of transplanted murine and human mesenchymal stem cells in vivo by real-time PCR

BACKGROUND

Previously, we demonstrated that murine mesenchymal stem cells (MSCs) injected intracranially into mice expand throughout the central nervous system (CNS). This paper describes real-time PCR (RT-PCR) assays that enables accurate quantification of transplanted cells in vivo.

METHODS

RT-PCR assays that amplify sequences in the mouse Y chromosome or human Alu repeats were developed and used to quantify the number of male, murine, or human MSCs in the CNS at various times after intracranial injection into neonatal mice, or in various organs of adult mice after i.p. injection of cells into 3 day-old embryos.

RESULTS

In the CNS, levels of male mouse DNA in female transplant recipients increased on average 30-fold between 3 and 60 days post-injection but then was unchanged at 140 days post-transplant (P = 0.107). Male DNA accounted for up to 0.309% of the total DNA content of the brain, representing maximally 600000 donor cells. Human DNA was detected in the CNS up to 300 days post-transplant, but levels never exceeded 7.63 x 10 (-4) % of the total brain content. After in utero transplantation, human DNA levels ranged from 0.36 x 10(-5) % to 2.14 x 10 (-5) % of the total DNA content of liver, kidney and spleen. significantly higher levels were found in heart (P = 0.06), femur and brain (P = 0.0025).

DISCUSSION

RT-PCR assays were developed to quantify levels of male, murine and human cells in vivo following sex-mismatched or xeno-transplants. Due to their accuracy, precision, and sensitivity, these assays provide a versatile alternative to measuring stem-cell engraftment in vivo.

Motivation for smoking cessation among pregnant women

The authors evaluated an expanded measure of intrinsic and extrinsic motivation for smoking cessation in a population-based sample of 897 pregnant smokers (500 current smokers and 397 recent quitters). The measure assessed motivation related to pregnancy and parenthood in addition to general intrinsic and extrinsic dimensions. Current smokers at baseline who quit smoking by 28 weeks of pregnancy (n = 102) had significantly higher baseline levels of pregnancy-related motivation than continuing smokers. Extrinsic and pregnancy motivation dropped between baseline and 28 weeks of pregnancy among continuing smokers. Higher levels of intrinsic relative to extrinsic motivation at baseline were associated with sustained abstinence during the first 2 months postpartum. Results suggest that both general and pregnancy-specific motivation are important for smoking cessation and relapse prevention during pregnancy. Interventions to enhance the salience of health benefits over and above those related to pregnancy and other intrinsic benefits of a greater sense of self-control could protect against postpartum relapse.

The effect of neighborhood-based community organizing: results from the Seattle Minority Youth Health Project

OBJECTIVE

To evaluate the effect of a community mobilization and youth development strategy to prevent drug abuse, violence, and risky sexual activity.

DATA SOURCES/STUDY SETTING

Primary surveys of youth, parents, and key neighborhood leaders were carried out at baseline (1994) and at the end of the intervention period (1997). The study took place in four intervention and six control neighborhoods in Seattle.

STUDY DESIGN

The study was designed as a randomized controlled trial with neighborhood as the unit of randomization. The intervention consisted of a paid community organizer in each neighborhood who recruited a group of residents to serve as a community action board. Key variables included perceptions of neighborhood mobilization by youth, parents, and key neighborhood leaders.

DATA COLLECTION/EXTRACTION METHODS

Youth surveys were self-administered during school hours. Parent and neighborhood leader surveys were conducted over the phone by trained interviewers.

PRINCIPAL FINDINGS

Survey results showed that mobilization increased to the same degree in both intervention and control neighborhoods with no evidence of an overall intervention effect. There did appear to be a relative increase in mobilization in the neighborhood with the highest level of intervention activity.

CONCLUSION

This randomized study failed to demonstrate a measurable effect for a community mobilization intervention. It is uncertain whether the negative finding was because of a lack of strength of the interventions or problems detecting intervention effects using individual-level closed-end surveys.

Excess of rare amino acid polymorphisms in the Toll-like receptor 4 in humans

The Toll-like receptor 4 protein acts as the transducing subunit of the lipopolysaccharide receptor complex and assists in the detection of Gram-negative pathogens within the mammalian host. Several lines of evidence support the view that variation at the TLR4 locus may alter host susceptibility to Gram-negative infection or the outcome of infection. Here, we surveyed TLR4 sequence variation in the complete coding region (2.4 kb) in 348 individuals from several population samples; in addition, a subset of the individuals was surveyed at 1.1 kb of intronic sequence. More than 90% of the chromosomes examined encoded the same structural isoform of TLR4, while the rest harbored 12 rare amino acid variants. Conversely, the variants at silent sites (intronic and synonymous positions) occur at both low and high frequencies and are consistent with a neutral model of mutation and random drift. The spectrum of allele frequencies for amino acid variants shows a significant skew toward lower frequencies relative to both the neutral model and the pattern observed at linked silent sites. This is consistent with the hypothesis that weak purifying selection acted on TLR4 and that most mutations affecting TLR4 protein structure have at least mildly deleterious phenotypic effects. These results may imply that genetic variants contributing to disease susceptibility occur at low frequencies in the population and suggest strategies for optimizing the design of disease-mapping studies.

Isotropic-nematic phase transition: Influence of intramolecular flexibility using a fused hard sphere model

The role of flexibility on the liquid crystal isotropic-nematic phase transition has been studied by means of Monte Carlo simulation. We present equations of state for the isotropic-nematic branches and, in the isotropic phase, numerically calculated values for the virial coefficients B2, B3, and B4. We have studied two models: 11 hard sphere monomers fused in a linear configuration with a reduced bond length of 0.6 and a 15-monomer version of this model in which monomers at one end of the chain become flexible. We have observed spontaneous nematic liquid crystal formation for both of the fully rigid models, and also for models with up to six flexible monomers in the tail. We conclude that molecular flexibility has a strongly destabilizing effect on the nematic phase. This is probably due to the decrease in shape anisotropy that flexible tails allow.

Adolescent HMO enrollees' utilization of out-of-plan services

PURPOSE

To examine use of reproductive health services, correlates of out-of-plan care, and reasons for seeking out-of-plan care among adolescent health maintenance organization (HMO) enrollees.

METHODS

We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget Sound (GHC) who had been enrolled for at least 12 months. The sample was selected from GHC's computerized enrollment database. Questionnaire topics included reproductive history, sexual behavior, and use of health services. Analysis included Chi-square tests to examine differences by gender and out-of-plan status and multivariate analysis using logistic regression.

RESULTS

About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1.84; 95% confidence interval (CI) = 1.35-2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI = 1.29-2.48), living with parents (OR = 0.65; 95% CI =.46-.92), and being female (OR = 1.60; 95% CI = 1.21-2.11). During the prior year, over 80% of sexually active respondents had obtained contraceptives out-of-plan and 45% of those tested for sexually transmitted diseases (STDs) reported out-of-plan testing. The primary reasons reported for using any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active respondents).

CONCLUSIONS

A substantial proportion of GHC-enrolled adolescents used out-of-plan care. Those who did were more likely to have had STDs and other health problems than those who used only in-plan services. Without continuity of care, these at-risk adolescents may not be receiving optimal services.

Motivation for smoking cessation among pregnant women

The authors evaluated an expanded measure of intrinsic and extrinsic motivation for smoking cessation in a population-based sample of 897 pregnant smokers (500 current smokers and 397 recent quitters). The measure assessed motivation related to pregnancy and parenthood in addition to general intrinsic and extrinsic dimensions. Current smokers at baseline who quit smoking by 28 weeks of pregnancy (n = 102) had significantly higher baseline levels of pregnancy-related motivation than continuing smokers. Extrinsic and pregnancy motivation dropped between baseline and 28 weeks of pregnancy among continuing smokers. Higher levels of intrinsic relative to extrinsic motivation at baseline were associated with sustained abstinence during the first 2 months postpartum. Results suggest that both general and pregnancy-specific motivation are important for smoking cessation and relapse prevention during pregnancy. Interventions to enhance the salience of health benefits over and above those related to pregnancy and other intrinsic benefits of a greater sense of self-control could protect against postpartum relapse.

Feasibility of a tailored intervention to improve preventive care use in women

BACKGROUND

Women age 50 years and older are in need of multiple preventive health care services. Despite recent improvements in rates of delivery of preventive care services, especially within managed care organizations, substantial numbers of women are still being underscreened. Efforts to improve delivery of preventive care services have often focused on one outstanding service despite the fact that patients often are in need of many services.

METHODS

A total of 893 women age 50 to 55 years were mailed a self-administered survey to identify outstanding preventive health care service needs. Patients in need of three or more outstanding preventive health care services were identified from survey respondents to participate in a feasibility study evaluating a tailored, customized intervention called Tic Tac Health.

RESULTS

Five-hundred ninety-one women returned the survey (67%). Four-hundred forty-eight (76%) women were in need of one or more preventive health services; 92 (16%) were in need of three or more. Twenty-two patients (24%) completed the Tic Tac Health card. The women who completed the card were similar to those who did not.

CONCLUSIONS

Despite documented physician visits, presence of managed care health insurance, and a designated primary care provider, a significant number of women are still in need of multiple preventive health services. An intervention targeting multiple preventive health services was demonstrated to be both feasible and effective. Further evaluation via a randomized controlled trial should be conducted to determine if an intervention like Tic Tac Health would be an effective modality for improving rates of receipt of multiple preventive health care services.

Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas

BACKGROUND

Cancer survivors are at increased risk for developing secondary tumors, diabetes, osteoporosis, and cardiovascular disease, thus making them an important target population for health-related interventions. However, little is known regarding cancer survivors' behaviors and their interest in pursuing healthier diets, exercise, and smoking cessation.

METHODS

A 65-item survey was mailed to 1667 patients diagnosed with early stage carcinoma of the breast or prostate that requested data regarding demographics, health behaviors, stage of readiness for smoking cessation, exercise, increased fruit and vegetable (F&V) consumption, and decreased fat intake, as well as interest in specific health programs and when, relative to diagnosis, these programs should be offered.

RESULTS

Responses from 978 cancer survivors suggested that the overwhelming majority (85%) reported their health as good to excellent. The majority of respondents (55%) ate fewer than 5 daily servings of F&Vs, with prostate carcinoma patients reporting eating significantly fewer servings than patients with breast carcinoma (P < 0.001). In contrast, 69% of respondents reported adherence to a low fat diet, again with lower practice rates among prostate carcinoma patients than patients with breast carcinoma (P = 0.006). The majority of respondents (58%) reported routine exercise and 8% were current smokers. Significantly more breast carcinoma patients than prostate carcinoma patients were current smokers (P = 0.03). There was strong interest in health promotion programs across behaviors, and a fair amount of concordance between low fat dietary behaviors and exercise, as well as consumption of five daily servings of F&Vs. The majority of patients expressed a preference for programs that could be delivered via mailed brochure, with 57% of respondents indicating that programs should be initiated at the time of diagnosis or soon after (within 6 months).

CONCLUSIONS

The results of the current study suggest that although many cancer survivors already practice healthy life-style behaviors, there is a substantial proportion who do not. Interventions especially are needed to increase daily F&V intake; however, given the fair degree of clustering between dietary and exercise behaviors, multiple risk factor interventions also may be warranted. Among cancer survivors, receptivity is high for health promotion programs, especially those that can be delivered by mail and soon after diagnosis.

The association between cigarette smoking and low-grade cervical abnormalities in reproductive-age women

OBJECTIVE

To evaluate the association between smoking and the occurrence of low-grade cervical cytological abnormalities.

METHODS

We conducted a population-based cross-sectional study of smoking and other exposures in reproductive-age women with normal and abnormal cytology results (Class 1-4 Pap tests). Participants (n = 2,448) were enrollees of the Group Health Cooperative of Puget Sound, a health maintenance organization (HMO) in Washington state, USA. Non-pregnant women were selected monthly from the HMO's cytology database during 1995-6, with over-sampling of women with low-grade abnormalities. All participants completed a structured telephone-administered survey.

RESULTS

Of the 2,448 participants, 19% (n = 465) had Class 2 Pap results, and 5% (n = 117) had Class 3-4 results. Forty percent of the sample (n = 975) reported ever smoking. Women reporting current/recent smoking (n = 514, 21%) had an increased likelihood of cervical abnormalities (adjusted odds ratio (OR) 1.4, 95% confidence interval (CI 1.1-1.8). Women who had never smoked but who reported recent passive smoking exposure also had a greater likelihood of abnormal test results (OR 1.4, 95% CI 1.0-2.0). Prior smoking was not associated with cytology status.

CONCLUSIONS

Our results, examining low-grade cervical abnormalities, are compatible with those from studies of more severe cervical lesions, lending added support to the hypothesis that smoking predisposes to development of a spectrum of cervical abnormalities. Thus, even cytologic screening visits represent an opportunity to counsel women smokers about their health risks, particularly the more proximal risks of cervical abnormalities and cancer.

Measuring community mobilization in the Seattle Minority Youth Health Project

This article assesses the validity and reliability of the approach used to measure community mobilization in the Seattle Minority Youth Health Project (MY Health), a neighborhood-based program to prevent drug use, violence, teen pregnancy, and sexually transmitted diseases (STDs). Two constructs were measured: neighborhood cooperation in solving problems, and sense of pride and identification with the neighborhood. The convergent validity of the measurement approach was assessed by comparing several independent measures of community mobilization generated from surveys of key neighborhood leaders, youth, and parents. For the neighborhood cooperation construct, correlations were uniformly positive across measures from different surveys and statistically significant about a quarter of the time. The correlations for the neighborhood pride construct were weaker and generally not statistically significant. Interrater reliability was low for all of the surveys, possibly reflecting varying ideas about what community mobilization meant among survey respondents.

Same-sex and opposite-sex best friend interactions among high school juniors and seniors

Eighteen adolescents were videotaped during same-sex and opposite-sex interactions in the eleventh and twelfth grades. In both grades, females felt more comfortable during same-sex interactions than during opposite-sex interactions, and they rated their same-sex partners more positively than did males. Females in both grades and males in eleventh grade showed more peer intimacy than did males in twelfth grade. Eleventh-grade females showed the most playful behaviors (the most engaged state). More synchrony (matching of behavior) was found for the animated state in the twelfth grade as compared with the eleventh grade.

Endothelium-dependent relaxation and hyperpolarization in guinea-pig coronary artery: role of epoxyeicosatrienoic acid

1. Acetylcholine (ACh) elicits an endothelium-dependent relaxation and hyperpolarization in the absence of nitric oxide (NO) and prostaglandin synthesis in the guinea-pig coronary artery (GPCA). This response has been attributed to a factor termed endothelial-derived hyperpolarizing factor (EDHF). Recently it has been suggested that EDHF may be a cytochrome P450 product of arachidonic acid (AA) i.e., an epoxyeicosatrienoic acid (EET). The present study investigated whether this pathway could account for the response to ACh observed in the GPCA in the presence of 100 microM N(omega)-nitro-L-arginine and 10 microM indomethacin. 2. ACh, AA and 11,12-EET each produced concentration-dependent relaxations in arteries contracted with the H1-receptor agonist AEP (2,2-aminoethylpyridine). The AA-induced relaxation was significantly enhanced in the presence of the cyclo-oxygenase/lipoxygenase inhibitor, eicosatetranynoic acid (30 microM). 3. The cytochrome P450 inhibitors proadifen (10 microM) and clotrimazole (10 microM) inhibited ACh, lemakalim (LEM) and AA-induced relaxation, whereas 17-octadecynoic acid (100 microM) and 7-ethoxyresorufin (10 microM) were without effect on all three vasodilators. Proadifen and clotrimazole also inhibited ACh (1 microM) and LEM (1 microM)-induced hyperpolarization. 4. The ability of various potassium channel blockers to inhibit relaxation responses elicited with ACh, AA and 11,12-EET was also determined. Iberiotoxin (IBTX; 100 nM) was without effect on responses to ACh but significantly reduced responses to both AA and 11,12-EET. In contrast, 4-aminopyridine (4-AP; 5 mM) significantly reduced response to ACh but not responses to AA and 11,12-EET. Combined IBTX plus (4-AP) inhibited the ACh-induced relaxation to a greater extent than 4-AP alone. Apamin (1 microM), glibenclamide (10 microM) and BaCl2 (50 microM) had no significant effect on responses to ACh, AA and 11,12-EET. 5. IBTX (100 nM) significantly reduced both 11,12-EET (33 microM) and AA (30 microM) hyperpolarization without affecting the ACh (1 microM)-induced hyperpolarization. In contrast, 4-AP significantly reduced the ACh-induced hyperpolarization without affecting either AA or 11,12-EET-induced hyperpolarizations. 6. In summary, our results suggest that the coronary endothelium releases a factor upon application of AA which hyperpolarizes the smooth muscle. The similarity of pharmacology between AA and 11,12-EET suggests that this factor is an EET. However, the disparity of pharmacology between responses to ACh versus responses to 11,12-EET do not support the hypothesis that EETs represent the predominant factor which ACh releases from the endothelium that leads to NO- and prostaglandin-independent hyperpolarization and relaxation in the GPCA.

Reasons for quitting: intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers

An intrinsic-extrinsic model of motivation for smoking cessation is extended to a population-based sample of smokers (N = 1,137), using a previously validated Reasons for Quitting (RFQ) scale. Psychometric evaluation of the RFQ replicated the model that includes health concerns and self-control as intrinsic motivation dimensions and immediate reinforcement and social influence as extrinsic motivation dimensions. Compared to volunteers, the population-based sample of smokers reported equivalent health concerns, lower self-control, and higher social influence motivation for cessation. Within the population-based sample, women compared to men were less motivated to quit by health concerns and more motivated by immediate reinforcement; smokers above age 55 expressed lower health concerns and higher self-control motivation than smokers below age 55. Higher baseline levels of intrinsic relative to extrinsic motivation were associated with more advanced stages of readiness to quit smoking and successful smoking cessation at a 12-month follow-up. Among continuing smokers, improvement in stage of readiness to quit over time was associated with significant increases in health concerns and self-control motivation.

BRCA1 sequence analysis in women at high risk for susceptibility mutations. Risk factor analysis and implications for genetic testing

CONTEXT

A mutation in the BRCA1 gene may confer substantial risk for breast and/or ovarian cancer. However, knowledge regarding all possible mutations and the relationship between risk factors and mutations is incomplete.

OBJECTIVES

To identify BRCA1 mutations and to determine factors that best predict presence of a deleterious BRCA1 mutation in patients with breast and/or ovarian cancer.

DESIGN

A complete sequence analysis of the BRCA1 coding sequence and flanking intronic regions was performed in 798 women in a collaborative effort involving institutions from the United States, Italy, Germany, Finland, and Switzerland.

PARTICIPANTS

Institutions selected 798 persons representing families (1 person for each family) thought to be at elevated a priori risk of BRCA1 mutation due to potential risk factors, such as multiple cases of breast cancer, early age of breast cancer diagnosis, and cases of ovarian cancer. No participant was from a family in which genetic markers showed linkage to the BRCA1 locus.

MAJOR OUTCOME MEASURES

Sequence variants detected in this sample are presented along with analyses designed to determine predictive characteristics of those testing positive for BRCA1 mutations.

RESULTS

In 102 women (12.8%), clearly deleterious mutations were detected. Fifty new genetic alterations were found including 24 deleterious mutations, 24 variants of unknown significance, and 2 rare polymorphisms. In a subset of 71 Ashkenazi Jewish women, only 2 distinct deleterious mutations were found: 185delAG in 17 cases and 5382insC in 7 cases. A bias in prior reports for mutations in exon 11 was revealed. Characteristics of a patient's specific diagnosis (unilateral or bilateral breast cancer, with or without ovarian cancer), early age at diagnosis, Ashkenazi Jewish ethnicity, and family history of cancer were positively associated with the probability of her carrying a deleterious BRCA1 mutation.

CONCLUSIONS

Using logistic regression analysis, we provide a method for evaluating the probability of a woman's carrying a deleterious BRCA1 mutation for a wide range of cases, which can be an important tool for clinicians as they incorporate genetic susceptibility testing into their medical practice.

Child psychiatric patients' interactions with their mothers

This study investigated whether child psychiatric patients' and their mothers interacted differently as a function of whether the children were diagnosed as having internalizing or externalizing disorders. Twenty children and their mothers were rated on eight behavior dimensions as they engaged in a ten-minute play session. Maternal depression was found to interact with their children's diagnoses and behavioral ratings.

A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers

The incremental effects of (a) a self-help booklet alone, (b) self-help booklet with computer-generated personalized feedback, and (c) self-help booklet, personalized feedback, and outreach telephone counseling were evaluated in a population-based, nonvolunteer sample of smokers. Smokers (N = 1,137) were identified through a telephone survey of a random sample of 5,903 enrollees in a health maintenance organization and randomized to a no-treatment control group or 1 of the 3 intervention conditions. Smoking status was ascertained 3, 12, and 21 months postrandomization. Cotinine validation of self-reported cessation was obtained at the 12-month follow-up. Overall, the telephone counseling significantly increased smoking cessation at the 3-month follow-up, but not at 12 or 21 months. Among smokers who were precontemplative at baseline, telephone counseling significantly increased prevalent abstinence at 3 and 12 months and continuous abstinence at 21 months (defined as self-reported abstinence at 3, 12, and 21 months).