Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

[Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy]

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

Efflux pump gene expression study using RNA-seq in multidrug-resistant TB

BACKGROUND: The mechanism underlying kanamycin (KM) resistance in Mycobacterium tuberculosis is not well understood, although efflux pump proteins are thought to play a role. This study used RNA-seq data to investigate changes in the expression levels of efflux pump genes following exposure to KM.METHODS: RNA expression of efflux pump and regulatory genes following exposure to different concentrations of KM (minimum inhibitory concentration MIC 25 and MIC50) in rrs wild-type strain and rrs A1401G mutated strain were compared with the control group.RESULTS: The selected strains had differential RNA expression patterns. Among the 71 putative efflux pump and regulatory genes, 46 had significant fold changes, and 12 genes (Rv0842, Rv1146, Rv1258c, Rv1473, Rv1686c, Rv1687c, Rv1877, Rv2038c, Rv3065, Rv3197a, Rv3728 and Rv3789) that were overexpressed following exposure to KM were thought to contribute to drug resistance. Rv3197A (whiB7) showed a distinct fold change based on the concentration of KM.CONCLUSION: The significant changes in the expression of the efflux pump and regulatory genes following exposure to KM may provide insights into the identification of a new resistance mechanism.

The potential skin lightening candidate, senolytic drug ABT263, for photoageing pigmentation

Senescent cells accumulate in several tissues during ageing, including the skin, and contribute to the functional decline of the skin via the senescence-associated secretory phenotypes (SASPs) ¹ . Due to the potential negative effects of SASPs during the ageing process, drugs that selectively target senescent cells or SASPs represent an important therapeutic strategy to delay skin ageing. The selective induction of cell death specifically to kill senescent cells using drugs, referred to as senolytics, is a main approach to achieve this strategy ² .

[Epidemiological investigation of tinnitus in Sichuan and Chongqing]

Objectives: To investigate the prevalence and associated risk factors of tinnitus in Sichuan and Chongqing. Methods: We designed a tinnitus epidemiological questionnaire. The multi-stage stratified cluster random sampling methods was applied to obtain study subjects in six areas (Nanchong, Jiangjin, Fengdu, Yunyang, Suining and Ya'an), which were selected for epidemiological investigation. Home visit completion of epidemiological questionnaires was conducted. The trained investigators guided the respondents to fill in the tinnitus epidemiological questionnaires, and the epidemiological status of six areas on prevalence and risk factor was investigated. SPSS 22.0 software was used for statistical analysis. Results: Sampling population were 10 289, in which 9 273 were valid questionnaires. There were 4 281 males and 4 992 females, with an average age of 47.3 years, among which 34.83% (3 230/9 273) had tinnitus. 3.99% (370/9 273) were diagnosed with bothersome tinnitus. In a multivariable logistic regression mod, the following factors were associated with onsetting of tinnitus: sleep disorder [Odds Ratio(OR)=3.74] and noise exposure(OR=1.99). The risk of disease was lowest in the age of 30-40 years old, while the risk of disease was higher for people under 30 and over 40. In another multivariable logistic regression mode, the following factors were associated with having bothersome tinnitus: older people were more likely to suffer from tinnitus, sleep disorders (OR=4.68) and noise exposure (OR=1.56). Conclusions: The prevalence of tinnitus in Sichuan and Chongqing is about 34.83%, but most of the tinnitus is short-lived and has low loudness, which will not affect the patients. Only a small number of patients with tinnitus (3.99%) persist and affect their health and need treatment. The occurrence and exacerbation of tinnitus may be related to sleep, age, and noise exposure.

Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel

Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.

[Mutation analysis and prenatal diagnosis of MYO7A gene in a case of Usher syndrome type 1]

Objective: To analyze the clinical characteristics and identify the causative gene of a case with congenital deafness. Methods: Detailed medical history and clinical examination of a 4-year-old male child with congenital deafness were conducted in the First Affiliated Hospital of Army Military Medical University in June 2016. He was diagnosed with sensorineural deafness. The venous blood of the child and his parents was drawn, and genomic DNA was extracted. Proband's DNA was performed with targeted capture of high-throughput sequencing, then Sanger sequencing was used to verify the suspected mutation and segregation in this pedigree. According to the genetic diagnosis of the proband's deafness, ophthalmic examinations were performed. Genetic prenatal diagnosis was performed when the proband's mother was pregnant again. Results: The patient was detected with p.Trp1466Ter/p.Tyr2042Ter compound heterozygous mutations of MYO7A gene with targeted high-throughput sequencing. The mutation of p.Trp1466Ter was a reported mutation, while p.Tyr2042Ter has not been reported. In addition to congenital deafness, retinitis pigmentosa was also found by ophthalmologic examination, and the patient was clinically diagnosed with Usher syndrome type 1. Amniocentesis and fetal DNA sequencing were performed on the repregnancy fetus of this family at 18 weeks of gestation. The heterozygous mutation of MYO7A gene p.Tyr2042Ter was found, and the other allele was the wild type, indicating that the child will not exhibit clinical manifestations of Usher syndrome type 1. Indeed, the second child passed neonatal hearing screening. Conclusions: The clinical features and genetic variants were delineated in this family with Usher syndrome type 1. The results of the current study have enriched the phenotype and genotype data of the disease and provided a basis for genetic counseling.

Second-phase validation study of an alternative developmental toxicity test using mouse embryonic stem cell-derived embryoid bodies

The embryoid body test (EBT) is a developmental toxicity test method that measures the size of embryoid bodies (EBs) and the viability of mouse embryonic stem cells (mESCs) and fibroblasts (3T3 cells). The previous pre-validation study confirmed the high accuracy (above 80%) of EBT using 26 coded test chemicals. This second-phase validation study assessed the inter-laboratory reproducibility (5 chemicals in common) and predictive capacity (10 chemicals in each laboratory) test using the coded test chemicals at three laboratories. For the prediction model, the accuracy is increased when more data is accumulated. Therefore, we updated the prediction model and analyzed the results of the second year with the newly created-prediction model. Statistical analysis of the inter-laboratory reproducibility test results indicated that accuracy, sensitivity, and specificity were 87%, 78%, and 100%, respectively. The results of the statistical analysis of the predictive capacity test showed an accuracy of 80%, sensitivity of 78%, and specificity of 81%. In conclusion, the EBT can accurately classify various embryotoxicants within a short period and with relatively little effort. Therefore, EBT can be used as a good way to test developmental toxicity.

Comparison of the difference between income quintiles with the slope index of inequality

Background

The difference between income quintiles in health is relatively well accepted by the general public as a measure of health inequality. However, the slope index of inequality (SII) in health reflects the patterns of all social groups, including the middle 60%, and it could therefore be considered more academically desirable. If these two measures are closely correlated, the widespread use of the difference between income quintiles in health would be better supported. This study was conducted to compare differences between income quintiles in life expectancy (LE) and healthy life expectancy (HLE) with the SII.

Methods

Data on LE and HLE by income quintile from all 252 subnational districts of Korea were obtained using the National Health Information Database of the National Health Insurance Service and the Korea Community Health Survey. The SII was estimated with linear regression analysis, and Pearson correlation coefficients between differences between income quintiles and the SII were computed.

Results

The correlation coefficients between differences between income quintiles and the SII were generally high: 0.97 (95% CI: 0.96-0.98) for LE in men and women combined and 0.96 (95% CI: 0.94-0.97) for HLE in men and women combined. In most districts, the SII was greater than the difference between income quintiles.

Conclusions

Differences between income quintiles were closely correlated with the SII. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.

Key messages

Differences in life expectancy and health life expectancy between income quintiles were closely correlated with the slope index of inequality in life expectancy and healthy life expectancy. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.

Suicide mortality and its income-based inequalities in Korea, 2005-2017

Backgrounds

The suicide mortality rate in Korea has been the highest in the Organization for Economic Co-operation and Development countries between 2003 and 2016. The trends of suicide mortality and its inequalities according to socioeconomic positions provide important information in establishing suicide prevention policies. This study investigated trends in suicide mortality and its income-based inequalities in Korea between 2005 and 2017.

Methods

Data from 2005-2017 National Health Insurance Database individually linked with cause-of-death data of Statistics Korea were employed. A total of 164,412 suicidal deaths from 574,610,162 subjects aged 10 or over were analyzed. Age-standardized suicide mortality rates were calculated by the calendar year, sex, and income quintiles. The slope index of inequality was calculated as an absolute measure for inequality and relative index of inequality was used as a relative inequality measure.

Results

The suicide mortality in Korea increased from 29.3 per 100,000 in 2005 to 33.3 in 2011, then decreased to 23.1 in 2017. Suicide mortality rates in men were more than twice as high as the rates in women and the gender gap remained throughout the period. The lower income-level, the higher the suicide mortality rate, especially in men. The absolute inequality in suicide measured by the slope index of inequality has changed as the suicide mortality rate fluctuated, but the relative inequality in suicide has increased since 2012.

Conclusions

The suicide mortality in Korea has increased due to the global financial crisis and copycat suicide following celebrity suicides in 2008, but it has decreased since the paraquat ban in 2011-12. Despite the recent decline in suicide mortality, the gap between income quintiles did not change meaningfully during the study period. In particular, the magnitude of relative inequality has increased. Progressive national policies should be implemented to reduce suicide mortality and its income gaps.

Key messages

Despite the recent decline in suicide mortality in Korea, the income-based inequalities in suicide did not change meaningfully. The magnitude of relative inequalities has increased recently.

Assessment of neurotoxicity of pharmacological compounds during early neural development of human embryonic stem cells

Human embryonic stem cells (hESCs), with the potential for differentiation, have been used to evaluate the embryotoxicity of various compounds. The effects of pharmacological compounds (cytosine arabinoside, 5-fluorouracil, hydroxyurea, indomethacin, and dexamethasone) on neurogenesis of hESCs over 28 days were examined based on cytotoxicity (half-maximal inhibitory concentration of viability, IC₅₀) and expression of neural markers. Cytosine arabinoside, 5-fluorouracil, and hydroxyurea showed strong cytotoxicity (IC₅₀ < 10 μM), whereas indomethacin and dexamethasone had weaker cytotoxic effects. Dose-dependent expression profiles of neural markers in the compound-treated groups are presented in triangular charts to allow comparison with the standard expression levels in the control group. Differences in compound-specific reductions in expression patterns of GAD1, OLIG2, FABP, and NES were similar to the differences in cytotoxic strength. Cytosine arabinoside diminished nestin and β3-tubulin in neural differentiated hESCs. The results of this study extend the understanding of how differentiated hESCs may be useful for assessment of cell viability or neurogenesis impairment by chemicals that could have effects during the embryonic stage, particularly during neurogenesis.

[Association between IL-27 gene polymorphisms and susceptibility to allergic rhinitis]

Objective: To evaluate the potential association of IL-27 polymorphisms with allergic rhinitis(AR) in a Chinese Han population. Method:A case-control study was performed in 445 Chinese AR patients and 691 healthy controls. Three SNPs in the IL-27p28 gene, including rs153109, rs17855750 and rs181206, were detected using a polymerase chain reaction-restriction fragment length polymorphism assay(PCR-RFLP). Result:A significantly increased prevalence of the rs153109 TT genotype and the T allele was found in AR patients, while a decreased prevalence of the CT and CC genotypes and the C allele was found. For rs153109, the TT genotype and the T allele were significantly associated with the risk of AR, but the CT and CC genotypes and the C allele decreased the risk of AR; for rs17855750, the TT genotype and T allele were risk factors for AR, and the GT genotype and G allele provided protection. TTT and TTC haplotypes in the IL-27 p28 gene were positively correlated with AR, while CGT, CTC and CTT haplotypes were associated with a significantly decreased risk of AR. Conclusion:This study indicates that IL-27 p28 polymorphisms rs153109 and rs17855750 are likely involved in AR susceptibility, making them potentially useful genetic biomarkers for AR susceptibility in the Chinese Han population.

Posttraumatic myositis ossificans of the hand : A locally aggressive malignancy-mimicking tumor

Posttraumatic myositis ossificans (PTMO) is the most common form of myositis ossificans, but it rarely affects the hand. Due to the aggressive behavior of this unusual tumor, it is commonly misdiagnosed as malignancy or local infection. This report describes a case of PTMO of the hand in a 25-year-old women, and reviews the clinical, radiologic, and histologic characteristics. By understanding the disease characteristics and maturation process, physicians can avoid a misdiagnosis that may lead to functional impairment or improper treatment.

149 THYROID HORMONE MARKER DEIODINASE 1 INDUCED BY 2,4,6-TRIBROMOPHENOL IN GH3 PITUITARY CELLS

Numerous medical materials and products in daily use are made of chemicals that are rarely found in the environment. Some of these chemicals may alter reproductive and thyroid function by interfering with endogenous estrogens, progesterone, and thyroid hormones. They are called endocrine-disrupting chemicals (EDC). To inhibit ignition and to reduce flammability of products, brominated flame retardants (BFR) are added to some products. 2,4,6-Tribromophenol (TBP) is an emerging EDC that is produced in some countries. To compare this emerging chemical to traditional EDC, we investigated this chemical in a rat pituitary cell line, GH3 cells. The GH3 cells were starved without phenol red for 7 days to eliminate any steroidogenic effect. Then, GH3 cells were incubated with 1–850 (thyroid receptor antagonist; 5.0 × 10–6 M) for 1 day before treatment with vehicle, triiodothyronine (T3; 1.0 × 10–9 M) and TBP (1.0 × 10–6 M) for 24 h, respectively. The TBP dose was determined from a previous pilot experiment using high, middle, and low doses. Each group of cells was prepared in triplicate and experiments were performed twice. Type I iodothyronine deiodinase (Dio1; thyromimetic marker), thyroid hormone receptor β, isoform 2 (Thrβ2), and growth hormone (Gh) were quantified by RT-qPCR. All data were analysed with a one-way ANOVA and Tukey’s studentized range test. Statistical analyses were performed with SAS software (SAS Institute Inc., Cary, NC, USA); P-values <0.05 were considered significant. RT-qPCR analysis was performed using the 2–ΔΔCT method employing 18S RNA (18S) as endogenous reference gene. Each gene of interest was normalized to vehicle. The mRNA expression of Dio1 and Gh were up-regulated via TBP treatment, but was lower than that of the T3-treated positive control. In pretreatments of 1–850 with T3 or TBP, mRNA levels of Dio1 were diminished through inhibition of thyroid receptor, but Gh mRNA level was not diminished. The mRNA expression of Thrβ2 was decreased in independent treatment of T3 or TBP, and no change in pretreatments of 1–850 with T3 or TBP. Although interfering effects of TBP on thyroid function have been partly studied, the dangers of TBP have been not yet obviously verified. In this study, we confirmed a thyromimetic effect of TBP mediated by thyroid receptor on GH3 cells.

64 EPITHELIAL MESENCHYMAL TRANSITION AND DIFFERENTIATION OF STEROIDOGENIC FACTOR 1 MOUSE EMBRYONIC STEM CELLS INTO THE STEROIDOGENIC CELLS

Steroidogenic factor 1 (SF-1) is essential for the development and function of steroidogenic tissues. Stable incorporation of SF-1 into embryonic stem cells has been reported to prime the cells for steroidogenesis. In this study, we transfected mouse embryonic stem cells (mESCs) with the mouse SF1 gene (SF1-mESCs) by using the nucleofector (Lonza), and selected SF1-mESCs by G418 250 μg mL–1. The selected cells were differentiated into granulosa-like cells through hanging-drops for 3 days, suspension culture for 1 day, then attachment onto 6-well plates. Expression of steroidogenesis-related genes and gonadal lineage-markers was analysed by real-time PCR. To test the phenotype for granulosa-like cells, transcripts of specific forkhead transcription factor (Foxl2) and follicle stimulating hormone receptor (Fshr) were measured. Also, expression of EMT-related genes, such as E-Cadherin (Cdh1), N-Cadherin (Cdh2), Snai1, Snai2 (Slug), Twist, and Vimentin, was monitored. SF1-mESCs were differentiated into the primitive streak‐mesendoderm and the steroidogenic enzymes such as 3β-hydroxysteroid dehydrogenase (Hsd3b1), cytochrome P450-containing enzyme (Cyp)-11a1, and Cyp19a1 were time-dependently changed. Next, the mRNA levels of Foxl2 and Fshr representing granulosa-like cell were increased during differentiation of SF1-mESCs. Especially, the level of oestradiol and Cdh2 was increased at a specific differentiation time. We induced differentiation of mESCs into the functional granulosa-like cells through transfection of the mouse SF1 gene. These cells will be useful for further study and potential application of these cells in steroidogenesis. This research was supported by a grant (15182MFDS460) from the Ministry of Food and Drug Safety in 2015.

113 EXPRESSION OF BETA-OXIDATION-RELATED GENES IN PREECLAMPSIA-LIKE MODEL UNDER HYPOXIC CONDITION IN VIVO AND IN VITRO

Preeclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and large amounts of protein in the urine. Preeclampsia is thought in many cases to be caused by a shallowly implanted placenta that becomes hypoxic. The hypoxic condition during the pregnancy can result from a failure at any stage in the delivery of oxygen to the cells. In peripheral tissues, oxygen diffuses down a pressure gradient into cells and moves into their mitochondria, where it is used to produce energy. As an expression of beta-oxidation-related genes, ACADVL was detected by gene-fishing technology using the placenta of human. We conducted in vitro and in vivo experiments to confirm preliminary study by inducing hypoxic stress in the BeWo cells and mice placenta. BeWo cells were cultured at 37°C under 1% O2, 5% CO2, and balanced with N2. Pregnant mice were maintained from GD 6.5 to 17.5 under 11% O2, 5% CO2, and balanced with N2. The expression of beta-oxidation related genes (ACADVL, EHHADH, HADH, ACAA1) were observed under hypoxic condition at mRNA and protein levels. The expression of genes known as biomarkers for hypoxia, HIF-1α, was increased in BeWo cells and mouse placenta, which induced PE. The beta-oxidation-related genes ACADVL expression was significantly increased by hypoxic stress both BeWo cells and mouse placenta. The elevated level of HIF-1α indicates that our experimental conditions closely mimicked PE. These results indicate that changes of beta-oxidation-related genes are correlated with PE induced hypoxic condition.

62 EFFECT OF PROGESTERONE ON CALCIUM REGULATION DURING DIFFERENTIATION OF MOUSE EMBRYONIC STEM CELLS INTO CARDIOMYOCYTES

During spontaneous cardiac differentiation of mouse embryonic stem cells (mESCs, cell line E14), the effect of progesterone on calcium regulation was investigated. Calcium (Ca2+) release from sarcoplasmic reticulum (SR) regulates various cellular functions including the smooth or skeletal muscle contraction. The cardiac L-type Ca2+ channel plays a key role in excitation-contraction coupling of cardiomyocytes and contraction-related gene expression. The mESCs formed mouse embryonic bodies (mEBs) by hanging-drop for 4 days, and mEBs were suspended for 2 days in differentiation medium; DMEM/F:12, 15% charcoal-dextran-treated FBS, β-mercaptoethanol, minimal essential medium NEAA, and penicillin/streptomycin. Then, mEBs were attached onto 6-well culture plates and differentiated into cardiomyocytes. We analysed mRNA expressions for the cardiac lineage markers and calcium-regulating genes. Percentage of beating mEBs was time-dependently increased during differentiation. Differentiated mEBs showed the highest beating ratio (92.11 ± 2.98%) after attachment for 12 days. Beating ratio was decreased to 64.86 ± 4.25% in progesterone-treated mEBs. The mRNA levels of cardiac markers such as Tbx20, Isl1, Foxh1, cTn1, and RyR2 were increased, and troponin protein was observed in beating mEBs via immunocytochemistry. Expression of calcium/contraction regulating genes including Trpv2, Ryr2, CaM2, and Mlck3 was down-regulated by progesterone treatment. These results indicate that progesterone has influences on cardiac differentiation and contraction of cardiomyocytes through regulating intercellular calcium ion. This research was supported by a grant (15182MFDS460) from the Ministry of Food and Drug Safety in 2015.

In vivo time-sequential histological study focused on melanocytes: suggestion of golden time for intervention to prevent post-laser pigmentary changes

BACKGROUND

Post-inflammatory pigmentary changes after laser treatments are challenging adverse effect.

OBJECTIVE

To suggest an ideal time period with regard to intervention to prevent post-laser pigmentary changes, an in vivo time-sequential histological study focused on melanocytes was performed.

METHODS

The back skin of four volunteers was irradiated with Q-switched alexandrite laser (QSAL). In one subject (subject 4), topical corticosteroid was applied onto the irradiated skin from the time of irradiation to day 28. In all subjects, time-sequential skin biopsies were performed at baseline, an immediate time after irradiation, day 2, day 7, and day 28. Histological and immunohistochemical analyses were conducted.

RESULTS

Q-switched alexandrite laser led to the successful removal of pigments and most melanocytes from the epidermis in all subjects. At day 28, there was increased epidermal pigmentation in the skin of the subjects 1-3. It was noted that numerous activated melanocytes appeared on day 7, continued to be observed until day 28. However, in the subject 4, the melanocyte activation and post-laser pigmentary changes were not observed.

CONCLUSION

In regard to intervene melanocyte activation, at least 1 week after laser treatment is suggested as a 'golden' time period to prevent pigmentary changes.

358 EXCESS EXPRESSION OF 11β-HSD1 CONTRIBUTES TO LETHALITY THROUGH DYSFUNCTION IN ENERGY BALANCE BETWEEN ANABOLIC PROCESS AND ENERGY RECOVERY PROCESS

11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) effectively amplifies glucocorticoid action in liver, adipose tissue, and brain. This enzyme converts the inactive 11-keto form into a glucocorticoid (e.g. cortisol). Glucocorticoids (GC) are steroid hormones found in the body and produced by the adrenal cortex, the outer layer of the adrenal glands. Glucocorticoids are lipophilic and readily access their intracellular receptors. Glucocorticoids regulate carbohydrate, fat, and protein metabolism. In a previous study, we constructed a vector composed of 2 parts: the 11β-HSD1 expression cassette and the selection cassette containing EGFP and Neo resistant genes. Porcine fibroblasts overexpressing 11β-HSD1 under the control of adipose tissue-specific aP2 promoter were established and used in somatic cell nuclear transfer (SCNT). Somatic cells from the resulting stillborn transgenic piglets were used in a second round of SCNT. Non-obese, transgenic piglets overexpressing 11β-HSD1 were obtained and were identified through PCR-based methods using specific primers for the targeting cassettes from the genomic DNA of piglets. Six live piglets, 1 stillborn piglet, and 3 mummies were born. Integration of target gene into the genomic DNA was confirmed for all of them. However, all 6 live piglets died within 1 month. All of the piglets had displayed hypoglycemia. Increased expression of 11β-HSD1 in metabolic tissues induced up-regulation of gluconeogenesis-related genes (G6PT, G6Pase, PEPCK, HNF4a, FOXO1) in liver and kidney, and showed up-regulation of lipogenesis-related genes (SREBP1c, FASN, DGAT, ACC, SCD) in muscle. The AMPK and SIRT signalling, which controls energy balance and mitochondrial biogenesis, was also stimulated. We propose that overexpression of 11β-HSD1 evokes the excess production and action of glucocorticoid or its receptors, and activates gluconeogenic and lipogenic pathways. For this reason, AMPK and SIRT1 signalling was induced. Also, in compensation of energy loss by anabolic processes, the expression of mitochondrial biogenesis-related genes was increased. Finally, the constitutive expression of 11β-HSD1 might continuously activate complementary energy-gaining processes, and these problems could develop into more fatal diseases that resulted in the piglets' death.

336 DIFFERENTIATION OF MOUSE EMBRYONIC STEM CELLS USING SF1 INTO THE STEROID-PRODUCING CELLS

Steroidogenic factor 1 (SF-1) is essential for the development and function of steroidogenic tissues. Stable incorporation of SF-1 into embryonic stem cells has been reported to prime the cells for steroidogenesis. In this study, we obtained SF1 cDNA from mRNA of murine pituitary glands and constructed the SF1-expressing vector controlled by the CMV promoter. The SF1 transgenic mouse embryonic stem cells (SF1-mES cells) were established through transfection using the nucleofector (Lonza) and selection process using G418 at 250 μg mL–1. The SF1-mES cells were aggregated in hanging drops for 2 days and were transferred to suspension culture for an additional 1 day in mouse basal differentiation medium. Three-day-old SF1-mESC-derived EB were attached onto 6 well culture plates and differentiated into granulosa-like cells. Differentiated SF1-mES cells were analysed by expression of steroidogenesis-related genes and gonadal lineage-markers to the level of mRNA via real-time PCR method. To test the phenotype for granulosa-like cells, we confirmed transcripts of specific forkhead transcription factor FOXL2 and the follicle-stimulating hormone receptor (FSHR). On the other hand, we monitored some specific genes related to differentiation into testicular tissue. We observed the progress to primitive streak-mesendodermby gene expression analyses. In addition, we observed that differentiated SF1-mES cells express steroidogenic enzymes, such as 3β-hydroxysteroid dehydrogenase, cytochrome P450-containing enzyme (CYP)-11A1, and CYP19A1. Using the advanced approach, we explored culture conditions that optimize SF-1-mediated differentiation of ES cells into defined steroidogenic and gonadal lineages. We also induced granulosa-like cells. We established the effective protocol to generate ovarian cells. The derivation of these cells explores new avenues for the further study and potential application of these cells in steroidogenesis.

Effect of Feeding Bacillus subtilis natto on Hindgut Fermentation and Microbiota of Holstein Dairy Cows

The effect of Bacillus subtilis natto on hindgut fermentation and microbiota of early lactation Holstein dairy cows was investigated in this study. Thirty-six Holstein dairy cows in early lactation were randomly allocated to three groups: no B. subtilis natto as the control group, B. subtilis natto with 0.5×10(11) cfu as DMF1 group and B. subtilis natto with 1.0×10(11) cfu as DMF2 group. After 14 days of adaptation period, the formal experiment was started and lasted for 63 days. Fecal samples were collected directly from the rectum of each animal on the morning at the end of eighth week and placed into sterile plastic bags. The pH, NH3-N and VFA concentration were determined and fecal bacteria DNA was extracted and analyzed by DGGE. The results showed that the addition of B. subtilus natto at either treatment level resulted in a decrease in fecal NH3-N concentration but had no effect on fecal pH and VFA. The DGGE profile revealed that B. subtilis natto affected the population of fecal bacteria. The diversity index of Shannon-Wiener in DFM1 decreased significantly compared to the control. Fecal Alistipes sp., Clostridium sp., Roseospira sp., beta proteobacterium were decreased and Bifidobacterium was increased after supplementing with B. subtilis natto. This study demonstrated that B. subtilis natto had a tendency to change fecal microbiota balance.

Effects of xenoestrogens on streptozotocin-induced diabetic mice

In diabetic mellitus, apoptotic or necrotic deaths of pancreatic β-cells lead to insulin deficiency because plasma insulin is synthesized and released from pancreatic β-cells and involved with blood glucose homeostasis. Since estrogen receptors have been related with glucose metabolis, estrogen-like chemicals (xenoestrogens) including bisphenol A (BPA) and octylphenol (OP) alter the endocrine system, and cause adverse health consequences such as obesity and diabetes. In the current study, levels of plasma glucose were evaluated after administration of BPA and OP using biochemical analysis, and were investigated in insulin and insulin synthesis-related genes in the pancreas and liver of streptozotocin (STZ)-induced insulin-deficient mice. Although the STZ-induced insulin-deficient groups showed an increase in blood glucose compared with control groups, the induced blood glucose level dropped to that of baseline after administration of xenoestrogens. When insulin level and mRNA expression of insulin transcriptional regulators (Pdx1, Mafa, and Neurod1) in pancreatic β-cells were decreased in STZ-induced insulin-deficient groups, they were significantly restored by administration of xenoestrogens. The latter observation is also related to NF-κB activation for anti-apoptosis effects in pancreatic β-cells. In addition, we observed a complementary convergence in regulation of gluconeogenesis for determination of blood glucose levels. Therefore, the current study may be particularly important for assessment of xenoestrogens under condition of diabetic mellitus or metabolic disorder.

29 GENERATION OF TRANSGENIC FIBROBLASTS EXPRESSING PANCREAS-SPECIFIC AND DOX-INDUCIBLE ICER Iγ IN A MINIATURE PIG MODEL OF HUMAN DIABETES MELLITUS

Inducible cyclic AMP (cAMP) early repressor (ICER) Iγ, consisting of a DNA binding domain, plays a role as a competitor to the cAMP responsive element-binding protein (CREB), and disrupts the transcriptional regulation of CREB responsive genes. Overexpression of the ICER Iγ gene in a rodent model has been reported to cause impairment of insulin production, reduction of pancreatic β cell number, and induction of glucagon synthesis in the same way in human diabetes mellitus. As mentioned above, overexpression of ICER Iγ causes severe diabetes. Therefore, we focused our attention on an ICER Iγ overexpression vector containing a tissue-specific and an adjustable promoter. In our previous study, ICER Iγ-overexpression controlled by the pancreas-specific human insulin promoter region induced significant decline of glucose-mediated insulin transcription in the mouse pancreatic β cell line, MIN6. Using this promoter region, we established a doxycycline-inducible ICER Iγ expression system via the tet-controlled transactivator (TA) with TA response element (TRE). We developed the unitary tet-on system, which combined an activator cassette under the control of the human insulin promoter with a responder cassette containing ICER Iγ and the green fluorescence protein, which are controlled by the TRE promoter. To determine whether enhanced ICER Iγ by doxycycline influences insulin expression, we first introduced the tet-on ICER Iγ-vector into MIN6 cells, and then treated them with 0.1 to 1 mg mL–1 doxycyline. We observed a robust increase in ICER Iγ expression and a decrease in insulin expression. This in vitro system could be useful for study of human diabetes mellitus and pre-diabetes using tissue-specific promoter and tet-on inducible transgene. In addition, we generated porcine transgenic fibroblasts containing doxycycline-inducible ICER Iγ cDNA.

Beneficial effects of judo training on bone mineral density of high-school boys in Korea

Bone mineralization is strongly stimulated by weight-bearing exercise during growth and development. Judo, an Olympic combat sport, is a well-known form of strenuous and weight-bearing physical activity. Therefore, the primary goal of this study was to determine the effects of Judo practice on the bone health of male high school students in Korea. The secondary goal of this study was to measure and compare the bone mineral density (BMD) of the hands of Judo players and sedentary control subjects. Thirty Judo players (JDP) and 30 sedentary high school boys (CON) voluntarily participated in the present study, and all of the sedentary control subjects were individually matched to the Judo players by body weight. BMD was determined by using dual-energy X-ray absorptiometry (Hologic, Bedford, MA, USA). The lumbar spine, femur and forearm BMD in the JDP group were significantly greater by 22.7%, 24.5%, and 18.3%, respectively, than those in the CON group. In addition, a significant difference in the CON group was observed between the dominant hand (DH) radius (0.710 ± 0.074 g/cm(2)) and the non-dominant hand (NDH) radius (0.683 ± 0.072 g/cm(2)), but this was not observed in the JDP group (DH = 0.819 ± 0.055 g/cm(2); NDH = 810 ± 0.066 g/cm(2)) (P < 0.05). Therefore, the results of this study suggest that Judo practice during the growth period significantly improves bone health in high school male students. In addition, it seems that Judo practice could eliminate the effect of increased BMD in the dominant hand.

Hypopigmented keratosis: is it a hyperkeratotic variant of idiopathic guttate hypomelanosis?

We have occasionally seen patients with acquired well-demarcated, scattered hypopigmented papules. In this study, we investigated the clinical and histopathological characteristics of such lesions. Biopsies were taken from the lesional and perilesional normal skin from 10 of 13 patients, which were compared with 10 idiopathic guttate hypomelanosis (IGH) samples. The lesions were scattered, well-circumscribed, flat-topped, hypopigmented papules. There was no age or gender predilection. Marked hyperkeratosis was present, with clear-cut margins distinguishable from the adjacent normal epidermis. The melanin content was decreased in the lesional epidermis, which was associated with a decrease in expression of melanogenesis-associated markers such as tyrosinase and NKI/beteb (marker of gp100) and reduction in the number of melanocytes. These histological findings were similar to those of IGH except for the additional finding of a thicker stratum corneum in this case seem to represent a 'hyperkeratotic' variant of IGH.

Acquired bilateral melanosis of the neck in perimenopausal women

BACKGROUND

Acquired bilateral patchy or mottled pigmentation of the neck has occasionally been observed.

OBJECTIVE

To investigate the clinical and histopathological characteristics of this pigmentation.

METHODS

Fourteen patients were included in the study. Patch and photopatch tests, and laboratory tests including serum hormonal evaluation were performed. Skin biopsies were performed on lesional skin and perilesional normal skin.

RESULTS

All the patients were women and all were perimenopausal. The lesions were characterized by bilateral, symmetrical, brown-to-grey patchy or mottled pigmentation on the lateral neck. There were positive photopatch results in some cases, but their relevance was doubtful. All laboratory findings were within the normal ranges. The histological findings showed marked accumulation of pigment in the dermis with perivascular lymphocytic infiltration. A significantly higher expression of melanogenesis-associated proteins and an increased number of melanocytes were observed in the epidermis of the lesional skin. The melanin-bearing cells in the dermis were stained with factor XIIIa or CD68, but the majority of these cells were identified as factor XIIIa+ dermal dendrocytes. Some brown pigments were mixed with light brown or golden brown pigment that was positive in iron staining.

CONCLUSIONS

These cases seem to represent a continuum of Riehl melanosis. However, the principal distribution of the pigmentation is a distinguishing feature. Any consistent predisposing factors were not established, but there may be a role for subclinical injury or inflammation as possible causative factors for development of the pigmentation.

Translationally controlled tumour protein is associated with podocyte hypertrophy in a mouse model of type 1 diabetes

AIMS/HYPOTHESIS

Translationally controlled tumour protein (TCTP) is thought to be involved in cell growth by regulating mTOR complex 1 (mTORC1) signalling. As diabetes characteristically induces podocyte hypertrophy and mTORC1 has been implicated in this process, TCTP may have a role in the pathogenesis of diabetes-induced podocyte hypertrophy.

METHODS

We investigated the effects and molecular mechanisms of TCTP in diabetic mice and in high glucose-stimulated cultured podocytes. To characterise the role of TCTP, we conducted lentivirus-mediated gene silencing of TCTP both in vivo and in vitro.

RESULTS

Glomerular production of TCTP was significantly higher in streptozotocin induced-diabetic DBA/2J mice than in control animals. Double-immunofluorescence staining for TCTP and synaptopodin revealed that podocyte was the principal cell responsible for this increase. TCTP knockdown attenuated the activation of mTORC1 downstream effectors and the overproduction of cyclin-dependent kinase inhibitors (CKIs) in diabetic glomeruli, along with a reduction in proteinuria and a decrease in the sizes of podocytes as well as glomeruli. In addition, knockdown of TCTP in db/db mice prevented the development of diabetic nephropathy, as indicated by the amelioration of proteinuria, mesangial expansion, podocytopenia and glomerulosclerosis. In accordance with the in vivo data, TCTP inhibition abrogated high glucose-induced hypertrophy in cultured podocytes, which was accompanied by the downregulation of mTORC1 effectors and CKIs.

CONCLUSIONS/INTERPRETATION

These findings suggest that TCTP might play an important role in the process of podocyte hypertrophy under diabetic conditions via the regulation of mTORC1 activity and the induction of cell-cycle arrest.

Defective barrier function in melasma skin

BACKGROUND

Melasma is characterized by increased pigmentation and photodamaged features, which include solar elastosis. Recently, we detected the downregulation of the genes most associated with lipid metabolism using microarray analysis in melasma. These findings suggested that lesional skin may have different biophysical characteristics, and, in particular, an altered skin barrier function.

OBJECTIVE

To determine the cutaneous biophysical characteristics of melasma.

METHODS

The melanin index, erythema index, stratum corneum hydration, sebum content and transepidermal water loss (TEWL) were measured for lesional and perilesional normal skin of 16 melasma patients and then compared. In addition, a skin biopsy was performed on 11 of the 16 study subjects to measure stratum corneum thickness and to study the protein expressions of PPAR-α and ALOX15B.

RESULTS

Melanin index, erythema index and stratum corneum hydration were significantly higher in lesional skin than in perilesional normal skin. No significant difference was found between lesional and normal skin in terms of basal TEWL level or sebum content. However, the rate of TEWL after barrier perturbation was significantly higher for lesional skin, and the barrier recovery rate was significantly delayed. Furthermore, a trend towards thinned stratum corneum was observed for lesional skin, and this was correlated with barrier recovery rate. The expressions of PPAR-α and ALOX15B were variable in the samples.

CONCLUSIONS

Melasma skin is characterized by impaired stratum corneum integrity and a delayed barrier recovery rate.

Immunohistochemical expression of matrix metalloproteinases in the granulomatous rosacea compared with the non-granulomatous rosacea

BACKGROUND

There is a granulomatous variant which is recognized in the rosacea spectrum. However, the pathogenesis of granuloma formation in rosacea has not been clearly demonstrated. Matrix metalloproteinases (MMPs) are required for recruitment of inflammatory cells and for tissue remodelling, making way for the development of well-organized granuloma.

OBJECTIVE

The aim of this study was to investigate the expression of transforming growth factor (TGF)-β, TGF-β type II receptor (TβRII), Tumour necrosis factor (TNF)-α, MMP-1, 2 and 9 in the granulomatous rosacea (GR) compared with the non-granulomatous rosacea (NGR) and test the hypothesis that the changes of these profiles in GR would be related with chronic ultraviolet radiation (UVR)-exposure.

METHODS

Facial skin samples were obtained from 20 patients with GR and NGR (control group). The sections were stained using haematoxylin and eosin, Verhoeff's elastic stain, and antibodies to TGF-β, TβRII, TNF-α, MMP-1, -2 and -9.

RESULTS

The amount of elastotic material was significantly increased in the dermis of GR lesions. Expression of TGF-β was significantly decreased in the epidermis of GR lesions compared with NGR lesions. In addition, the expression of MMP-9 was significantly increased in the dermis of GR lesions compared with NGR lesions, especially at the centre of the granuloma on a semi-quantitative analysis. MMP-2 expression was also increased in GR lesions, although the difference between the two groups was not statistically significant.

CONCLUSIONS

The results of this study suggest that the increased expression of MMPs in the dermis may participate in granuloma formation of GR in association with UVR.

Acquired bilateral naevus of Ota-like macules: an immunohistological analysis of dermal melanogenic paracrine cytokine networks

BACKGROUND

Acquired bilateral naevus of Ota-like macules (ABNOM) is similar to melasma with regard to their clinical features, including female predominance, acquired onset, and predominant involvement of the malar area. The similar clinical features suggest the possibility of a shared pathogenesis. Dermal factors including vascularity and melanogenic paracrine networks such as the stem cell factor (SCF)/c-kit pathway have recently been suggested to play an important role in the pathogenesis of melasma. However, the role of dermal factors in ABNOM remains unknown.

OBJECTIVES

To provide a novel view on the pathogenesis of ABNOM, we studied the expression of melanogenic paracrine cytokines such as SCF/c-kit, and assessed dermal vascularity.

METHODS

Thirty-seven patients with ABNOM and 20 patients with melasma were enrolled in this study. Skin samples were obtained from lesional and perilesional normal skin. Immunohistochemistry was performed.

RESULTS

Solar elastosis was slightly more intense in the lesional skin of ABNOM. In contrast to dermal pigmentation and melanocytes, the amounts of epidermal pigmentation and melanocytes were not increased in the lesional skin of patients with ABNOM. The expression of dermal SCF and c-kit was increased; however, the expression of epidermal SCF and c-kit and dermal factor VIII-related antigen was not increased in the lesional skin of ABNOM.

CONCLUSIONS

These results suggest that the increased expression of the SCF/c-kit pathway between dermal fibroblasts and dermal melanocytes may play an important role in the pathogenesis of ABNOM.

Time interval to conversion of interferon-gamma release assay after exposure to tuberculosis

The proper interval for repeating an interferon-γ release assay (IGRA) among tuberculosis contacts with initially negative results is unknown. The interval for IGRA conversion after exposure to patients with active pulmonary tuberculosis in an outbreak setting was evaluated. In a platoon of 32 soldiers, four active pulmonary tuberculosis patients, in addition to one index patient, were diagnosed during a contact investigation. For the other 27 contacts, a tuberculin skin test (TST) and QuantiFERON® TB-Gold In-Tube (QFT-GIT) assay were performed. For soldiers with a negative result on the initial QFT-GIT assay, the test was repeated at 2, 4, 8, 14, 18 and 30 weeks until positive conversion occurred. When conversion was identified, the subject was treated for latent tuberculosis infection. Initially, 17 (63.0%) soldiers gave positive QFT-GIT results, whereas 21 (77.8%) showed positive TST results. Among 10 participants with initially negative QFT-GIT results, three showed conversion at 2 weeks, three at 4 weeks and three at 14 weeks. Conversion did not occur during the 30-week observation period in one contact. Based on the tuberculosis exposure time-points among the contacts, IGRA conversion generally occurred 4-7 weeks after exposure, although it could occur as late as 14-22 weeks after exposure.

Bioprocessing papaya processing waste for potential aquaculture feed supplement--economic and nutrient analysis with shrimp feeding trial

Papaya processing waste (PPW), a major fruit processing waste in the Hawaii islands, served as substrate for yeast (Saccharomyces cerevisiae) growth. The fermented PPW products containing nutrients of 45% crude protein and various fat, fiber, lignin, cellulose, and minerals were advantages to nutrients of yeast alone. Three experimental diets controlled at 35% protein formulation containing different levels of inclusion of PPW products and a commercial control diet were fed to shrimps for 8 weeks. The 50% inclusion of PPW diets were comparable to commercial feed in weight, growth, feed conversion ratio (FCR) and survival rate. Such bioprocess treatment system would be economically feasible with the control of annual cost and increase of the amount of PPW treated. The selling price of PPW products and annual operation and maintenance cost were the most influential factors to additional profits. This study presented a promising alternative for environmental-friendly treatment of organic wastes as well as the sustainability of local agriculture and aquaculture industries.