Simultaneous Measurement of Proton and Lepton Kinematics in Quasielasticlike ν_{μ}-Hydrocarbon Interactions from 2 to 20 GeV

Neutrino charged-current quasielastic-like scattering, a reaction category extensively used in neutrino oscillation measurements, probes nuclear effects that govern neutrino-nucleus interactions. This Letter reports the first measurement of the triple-differential cross section for ν_{μ} quasielastic-like reactions using the hydrocarbon medium of the MINERvA detector exposed to a wideband beam spanning 2≤E_{ν}≤20  GeV. The measurement maps the correlations among transverse and longitudinal muon momenta and summed proton kinetic energies, and compares them to predictions from a state-of-art simulation. Discrepancies are observed that likely reflect shortfalls with modeling of pion and nucleon intranuclear scattering and/or spectator nucleon ejection from struck nuclei. The separate determination of leptonic and hadronic variables can inform experimental approaches to neutrino-energy estimation.

Cancer imaging and therapy utilizing a novel NIS-expressing adenovirus: The role of adenovirus death protein deletion

Encoding the sodium iodide symporter (NIS) by an adenovirus (Ad) is a promising strategy to facilitate non-invasive imaging and radiotherapy of pancreatic cancer. However, insufficient levels of NIS expression in tumor cells have limited its clinical translation. To optimize Ad-based radiotherapy and imaging, we investigated the effect of Ad death protein (ADP) deletion on NIS expression. We cloned two sets of oncolytic NIS-expressing Ads that differed only in the presence or absence of ADP. We found that ADP expression negatively affected NIS membrane localization and inhibited radiotracer uptake. ADP deletion significantly improved NIS-based imaging in pancreatic cancer models including patient-derived xenografts, where effective imaging was possible for up to 6 weeks after a single virus injection. This study demonstrates that improved oncolysis may hinder the therapeutic effect of oncolytic viruses designed to express NIS. In vivo studies in combination with ¹³¹I showed potential for effective radiotherapy. This also highlights the need for further investigation into optimal timing of ¹³¹I administration and suggests that repeated doses of ¹³¹I should be considered to improve efficacy in clinical trials. We conclude that ADP deletion is essential for effective NIS-based theranostics in cancer.

Mutant myogenin promoter-controlled oncolytic adenovirus selectively kills PAX3-FOXO1-positive rhabdomyosarcoma cells

The PAX3-FOXO1 fusion gene functions as a transactivator and increases expression of many cancer-related genes. These lead to metastases and other unfavorable outcomes for alveolar rhabdomyosarcoma (ARMS) patients. In order to target ARMS with the PAX3-FOXO1 transactivator, we developed an Oncolytic Adenovirus (OAd) regulated by the myogenin (pMYOG) promoter with a mutation in the Myocyte Enhancer Factor-2 binding site (mMEF2) in this study. The expression of MYOG in the two RMS cell lines (Rh30; PAX3-FOXO1-positive, RD; PAX3-FOXO1-negative) is about 1,000 times higher than normal skeletal muscle cell (SkMC). Ad5/3-pMYOG(S)-mMEF2 (short-length pMYOG-controlled OAd with mMEF2) showed strong replication and cytocidal effect in Rh30, but to a much lesser extent in RD. Ad5/3-pMYOG(S) (pMYOG-controlled OAd with native pMYOG) showed similar effects in RD and Rh30. Neither virus killed SkMC, indicating that Ad5/3-pMYOG(S)-mMEF2 selectively replicates and kills cells with PAX3-FOXO1. Additionally, Ad5/3-pMYOG(S)-mMEF2 showed replication and spread in vitro as well as tumor growth suppression and intratumoral viral spread in vivo, selectively in Rh30 not in RD. Our findings revealed that Ad5/3-pMYOG(S)-mMEF2 shows a promise as a safe and potent therapy to improve treatment in PAX3-FOXO1-positive ARMSs.

B4GALNT1 induces angiogenesis, anchorage independence growth and motility, and promotes tumorigenesis in melanoma by induction of ganglioside GM2/GD2

β-1,4-N-Acetyl-Galactosaminyltransferase 1 (B4GALNT1) encodes the key enzyme B4GALNT1 to generate gangliosides GM2/GD2. GM2/GD2 gangliosides are surface glycolipids mainly found on brain neurons as well as peripheral nerves and skin melanocytes and are reported to exacerbate the malignant potential of melanomas. In order to elucidate the mechanism, we performed functional analyses of B4GALNT1-overexpressing cells. We analyzed ganglioside pattern on four melanoma and two neuroblastoma cell lines by high performance liquid chromatography (HPLC). We overexpressed B4GALNT1 in GM2/GD2-negative human melanoma cell line (SH4) and confirmed production of GM2/GD2 by HPLC. They showed higher anchorage independence growth (AIG) in colony formation assay, and exhibited augmented motility. In vitro, cell proliferation was not affected by GM2/GD2 expression. In vivo, GM2/GD2-positive SH4 clones showed significantly higher tumorigenesis in NOD/Scid/IL2Rγ-null mice, and immunostaining of mouse CD31 revealed that GM2/GD2 induced remarkable angiogenesis. No differences were seen in melanoma stem cell and Epithelial-Mesenchymal Transition markers between GM2/GD2-positive and -negative SH4 cells. We therefore concluded that B4GALNT1, and consequently GM2/GD2, enhanced tumorigenesis via induction of angiogenesis, AIG, and cell motility. RNA-Seq suggested periostin as a potential key factor for angiogenesis and AIG. These findings may lead to development of novel therapy for refractory melanoma.

Abstract 5921: Systemic treatment with mesothelin-targeted oncolytic adenovirus shows efficacy patient-derived xenograft of pancreatic cancer

Pancreatic cancer is an aggressive malignant disease. Despite extensive efforts, systemic therapies have provided only limited efficacy for patients with this disease. Oncolytic Adenovirus (OAd) is a promising therapeutics, and it is also known for its efficient in vivo gene delivery. However, when adenovirus vectors are injected intravenously into mice, most of the virus goes to the liver and can lead to liver toxicity at high dosage. One of the reason for liver tropism is that hepatocytes express high levels of the primary adenovirus receptor, and non-parenchymal liver cells, such as Kupffer cell and epithelial cell, also capture the viral particle. As a consequence of large sequestration of adenovirus by liver, the tumor transduction rate is low and the in vivo efficacy is limited. Therefore, the improvement of cancer selective transduction and vector distribution to avoid liver sequestration would overcome the obstacles for systemic delivery required for efficient systemic treatment of spread and/or metastatic lesions of pancreatic cancer with OAd.

To improve the tumor transduction, we have generated the pancreatic cancer-targeted OAd by high-throughput screening of Ad-fiber library in mesothelin (MSLN) expressing cells. The pancreatic cancer-targeted OAd binds to MSLN protein, which is overexpressed on the surface of pancreatic cancer. MSLN-targeted OAd showed selective and powerful anti-tumor effect against Panc-1 xenograft tumor model in both intratumoral (i.t.) and intravenous (i.v.) injection. Importantly, when we assessed viral distribution after i.v. injection, the liver sequestration of MSLN-targeted OAd was lower than untargeted OAd (Ad5 WT virus) at 48 hrs after injection. By day 7, the viral copy number of MSLN-targeted OAd in the tumor was significantly higher than Ad5 WT virus. These results suggest that systemic injection of the tumor targeted-OAd showed significantly lower liver sequestration and better tumor accumulation. Additionally, we performed multiple time point injection of MSLN-targeted OAd against regrown tumors. Four out of six tumors were controlled with repeated injection. Next, antitumor effect of MSLN-targeted OAd was assessed in patient-derived xenograft (PDX) model. After intravenous administration, only the MSLN-targeted OAd showed significant antitumor effect compared to the untreated group (p<0.05), while the growth of Ad5 WT virus injected group was same as untreated group.

In this study, systemic injection of MSLN-targeted OAd showed remarkable anti-tumor effect in both systemic and intratumoral injections at low dose. Our results indicated that tumor targeted-OAd can embody efficient systemic treatment for pancreatic cancer which are mostly found with spread or metastatic lesions.

Citation Format: Mizuho Sato-Dahlman, Yoshiaki Miura, Praveensingh Hajeri, Hideki Yoshida, Kari Jacobsen, Chikako Yanagiba, Masato Yamamoto. Systemic treatment with mesothelin-targeted oncolytic adenovirus shows efficacy patient-derived xenograft of pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5921.

Abstract 5925: A novel oncolytic adenovirus for radioiodine therapy and imaging

Recently, the use of oncolytic viruses encoding the sodium-iodide symporter (NIS) has become an attractive approach to achieve radionuclide imaging of cancer. However, the potential of virus-induced NIS expression to facilitate therapy with radioactive 131I has not been fully explored. We designed a tumor-selective, infectivity-improved oncolytic adenovirus (Ad5/3-Cox2-NIS-ADP) modified to express high quantities of NIS. This virus induced radioisotope uptake in prostate and lung cancer cells and facilitated SPECT/CT imaging, but more importantly, supported the effective therapy with 131I. In our original vector, enhanced oncolysis was mediated by overexpression of adenoviral death protein (ADP). Although this structure was operative in detection and therapeutic regimens, we were concerned that the cytolytic effect of ADP may affect NIS membrane localization, and diminish its effectiveness as a theranostic tool. We therefore designed an identical Ad5/3-Cox2-NIS-ADP-deleted virus {ADP(-)} and assessed the impact of ADP on NIS expression and radioisotope uptake. Western blot and immunocytochemical analyses of pancreatic cancer cells infected with ADP(-) demonstrated higher NIS levels when compared to the ADP(+) counterpart. This correlated with an improved 125I uptake in vitro. SPECT/CT imaging studies assessing 99mTcO4- accumulation in mice to visualize pancreatic adenocarcinoma (PDAC) using patient-derived xenografts (PDX) showed that a single dose of ADP(-) accumulated far greater levels of 99mTcO4- when compared to ADP(+). Remarkably, ADP(-) produced stronger signal that was maintained up until day 32, and this outlasted ADP(+) and the control vector, replication-deficient AdCMV-NIS, currently employed in a clinical trial. Notably, within the PDAC, ADP(-) showed a distinct NIS cell membrane distribution pattern as it co-localized with cell membrane bound-cytokeratin-4. Unlike ADP(-), ADP(+) produced a punctate NIS staining pattern, with little to no cell membrane localization. These results support our hypothesis that ADP-cytolytic effect reduces NIS membrane localization, subsequently affecting radionuclide uptake. To evaluate the therapeutic potential of NIS-based radiotherapy, we treated mice bearing PDAC tumors with virotherapy alone or in combination with 131I. NIS-expressing OAds in combination with 131I significantly reduced tumor growth when compared to viro- or radiotherapy alone. The therapeutic effect in mice treated with ADP(-) combined with 131I outperformed that with ADP(+) or AdCMV-NIS vectors. Quantitative analyses of 131I uptake in tumor tissues with a gamma counter showed a clear trend where ADP(-) retained higher 131I uptake than ADP(+). These findings support the clinical applicability of the ADP-deleted OAd as the more sensitive tool for NIS-based cancer diagnosis and therapy. We are currently investigating the biodistributon and toxicity of our vectors in a pig model.

Citation Format: Lisa Koodie, Eriko Iguchi Kawakami, Kari Jacobsen, Zuzan Cayci, Andrew Taylor, Edward W. Greeno, Robert J. Schumacher, John C. Morris, Martin E. Fernandez-Zapico, Julia Davydova. A novel oncolytic adenovirus for radioiodine therapy and imaging [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5925.

Abstract 5923: CD133-targeted oncolytic adenovirus exhibits anti-tumor effect in colorectal cancers, and its combination with irradiation inhibits liver metastasis

Colorectal cancer (CRC) is the third most common cancer in the world, and about 50% of patients relapse after treatment. Cancer stem cells (CSCs) have contribution to recurrence, metastasis and chemotherapy resistant of CRC. CD133 (Prominin-1), a member of the transmembrane glycoprotein family, is a marker of CSCs in several cancers including CRC: its expression correlates with recurrence, metastases and chemotherapy resistance, as well as poor prognosis in CRC. It is therefore reasonable to develop a CSC-directed CRC therapeutic strategy by employing CD133as a target molecule. Recently, we have established a method for isolating transductionally-targeted infectivity-selective adenovirus by high-throughput screening. Using this adenovirus library screening system, we isolated the CD133-specific Oncolytic Adenovirus (OAd) and tested the oncolytic activity of CD133-targeted OAd (CD133-OAd) in both in vitro and in vivo, with and without irradiation which induces CD133 expression. The infectivity-selective OAd (ISOAd) with CD133-targeting motif (TYML motif) selectively infected CD133+ CRC cell lines and lysed them efficiently. In the context of modulation of stemness, CD133-OAd inhibited colony formation in vitro. In tumor formation assay in nude mice, treatment with CD133-OAd prior to tumor inoculation inhibited the establishment of tumor of CD133+ CRC cell lines. Intra-tumor (i.t.) administration of CD133-OAd into established subcutaneous tumor exhibited significantly stronger antitumor effect compared to OAd without targeting.

We have reported that the irradiation increases CD133 expression in CRC cells, and the replication of CD133-OAd increased significantly after irradiation. In athymic nude mice, treatment of irradiated cells with CD133-OAd abolished tumor-forming capacity, compared to cells without irradiated and cells treated with radiation alone (5% vs 94% and 5% vs 73% respectively, p<0.0001). When the antitumor effect of CD133-OAd was analyzed on subcutaneously established tumors, treatment with radiation and CD133-OAd significantly reduced tumor growth compared to no treatment and treatment with radiation only (both p<0.0001).

In addition to the effect on the main tumor, CD133-OAd suppressed liver metastasis of CRC. The mice injected with human CRC cells pretreated with CD133-OAd combined with irradiation had significantly lower incidence of liver metastasis compared with the untreated control group or the groups received irradiation or CD133-OAd treatment alone.

Our CD133-targeted ISOAd is effective for cytotoxic killing, reduces tumor formation, and mitigates tumor growth in radiation resistant CRC cells. This targeted OAd therapy may be applicable to address therapeutic resistance and prevent the establishment of recurrent colorectal cancer.

Citation Format: Jing Li Huang, Mizuho Sato-Dahlman, Kari Jacobsen, Masato Yamamoto. CD133-targeted oncolytic adenovirus exhibits anti-tumor effect in colorectal cancers, and its combination with irradiation inhibits liver metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5923.

CD133-targeted oncolytic adenovirus demonstrates anti-tumor effect in colorectal cancer

Oncolytic Adenoviruses (OAds) are one of the most promising anti-cancer agents that can induce cancer specific cell death. Recently, we generated infectivity-selective OAd, and the resultant OAd tumor-specific binding shows strong efficacy and mitigates toxicity. In this study, we applied this strategy based on adenovirus library screening system for generation of CD133-targeted OAd, and examined their oncolytic activity against colorectal cancer (CRC) in vitro and in vivo. CD133 (Prominin-1) is an important cell surface marker of cancer stem (like) cells (CSCs) in various cancers, including CRC. Elimination of CSCs has a high likelihood to improve CRC treatment because CSCs population in the tumor contributes to recurrence, metastases, chemotherapy resistance, and poor survival. The OAd with CD133-targeting motif (AdML-TYML) selectively infected CD133⁺ cultured cells and lysed them efficiently. Treatment with AdML-TYML prior to tumor inoculation inhibited the establishment of tumor of CD133⁺ CRC cell lines in nude mice. AdML-TYML also showed strong antitumor effect after intratumoral injections in already established CD133⁺ CRC subcutaneous xenografts. Our results indicate that CD133-targeted OAd selectively infected CD133⁺ CRC, and exhibited anti-tumorigenicity and therapeutic effect in established tumors. This novel infectivity selective virus could be a potent tool for the prevention of metastases and relapses in CRC.

CD133-targeted oncolytic adenovirus demonstrates anti-tumor effect in colorectal cancer

Oncolytic Adenoviruses (OAds) are one of the most promising anti-cancer agents that can induce cancer specific cell death. Recently, we generated infectivity-selective OAd, and the resultant OAd tumor-specific binding shows strong efficacy and mitigates toxicity. In this study, we applied this strategy based on adenovirus library screening system for generation of CD133-targeted OAd, and examined their oncolytic activity against colorectal cancer (CRC) in vitro and in vivo. CD133 (Prominin-1) is an important cell surface marker of cancer stem (like) cells (CSCs) in various cancers, including CRC. Elimination of CSCs has a high likelihood to improve CRC treatment because CSCs population in the tumor contributes to recurrence, metastases, chemotherapy resistance, and poor survival. The OAd with CD133-targeting motif (AdML-TYML) selectively infected CD133⁺ cultured cells and lysed them efficiently. Treatment with AdML-TYML prior to tumor inoculation inhibited the establishment of tumor of CD133⁺ CRC cell lines in nude mice. AdML-TYML also showed strong antitumor effect after intratumoral injections in already established CD133⁺ CRC subcutaneous xenografts. Our results indicate that CD133-targeted OAd selectively infected CD133⁺ CRC, and exhibited anti-tumorigenicity and therapeutic effect in established tumors. This novel infectivity selective virus could be a potent tool for the prevention of metastases and relapses in CRC.

Debate: adjuvant whole brain radiotherapy or not? More data is the wiser choice

Every year 170,000 patients are diagnosed with brain metastases (BMs) in the United States. Traditionally, adjuvant whole brain radiotherapy (AWBRT) has been offered following local therapy with neurosurgery (NSx) and/or stereotactic radiosurgery (SRS) to BMs. The aim is to increase intracranial control, thereby decreasing symptoms from intracranial progression and a neurological death. There is a rapidly evolving change in the radiation treatment of BMs happening around the world. AWBRT is now being passed over in favour of repeat scanning at regular intervals and more local therapies as more BMs appear radiologically, BMs that may never become symptomatic. This change has happened after the American Society for Radiation Oncology (ASTRO) in Item 5 of its “Choosing Wisely 2014” list recommended: “Don't routinely add adjuvant whole brain radiation therapy to SRS for limited brain metastases”. The guidelines are supposed to be based on the highest evidence to hand at the time. This article debates that the randomised controlled trials (RCTs) published prior to this recommendation consistently showed AWBRT significantly increases intracranial control, and avoids a neurological death, what it is meant to do. It also points out that, despite the enormity of the problem, only 774 patients in total had been randomised over more than three decades. These trials were heterogeneous in many respects. This data can, at best, be regarded as preliminary. In particular, there are no single histology AWBRT trials yet completed. A phase two trial investigating hippocampal avoiding AWBRT (HAWBRT) showed significantly less NCF decline compared to historical controls. We now need more randomised data to confirm the benefit of adjuvant HAWBRT. However, the ASTRO Guideline has particularly impacted accrual to trials investigating this, especially the international ANZMTG 01.07 WBRTMel trial. This is an RCT investigating AWBRT following local treatment in patients with one to three BMs from melanoma. WBRTMel has accrued 196 of a required 220 to date but accrual has slowed. HAWBRT may now never be tested in a randomised setting. Encouraging more data in AWBRT is the wiser choice.

Monitoring a mouse colony for Helicobacter bilis using a Helicobacter-genus-specific nested PCR

Although Helicobacter infections of laboratory mice are usually subclinical, they may interfere with in vivo experiments and thus may lead to misinterpretation of data. As such, it is important to provide a means to unequivocally identify infections with murine Helicobacter spp. In the present study, a nested polymerase chain reaction (PCR) was established and shown to be 10 to 100 times more sensitive than the single-step PCR commonly used for routine diagnosis of Helicobacter spp. Experimental infection of Helicobacter-free mice demonstrated that faeces, caecum, colon and rectum but not liver are equally suitable for the detection of H. bilis. However, use of faecal pellets is advantageous since detection of H. bilis is possible one week after infection and analysis of faeces instead of tissues avoids euthanasia of animals. Furthermore, it generates representative data for all animals housed in the same cage and analysis can be repeatedly performed. Use of samples from breeding pairs but not offspring provides representative information about the Helicobacter status of a mouse colony. Both C3H/HeJ and C57BL/6 mice appear to be susceptible to H. bilis and persistent infection was observed during the 20-week experimental period. Analysis of pooled faecal pellets by nested PCR seems to be the most sensitive approach for H. bilis monitoring of the given breeding colony.

Fractal and Dendritic Growth of Surface Aggregates

The similarity of patterns formed in non-equilibrium growth processes in physics, chemistry and biology is conspicuous and many attempts have been made to discover common mechanisms underlying their growth. The central question in this context is what causes some patterns to be dendritic, as e.g. snowflakes, while others grow fractal (randomly ramified). Here we report a crossover from fractal to dendritic patterns for growth in two dimensions: the diffusion limited aggregation of Ag atoms on a Pt(111) surface as observed by means of variable temperature STM. The microscopic mechanism of dendritic growth can be analyzed for the present system. It originates from the anisotropy of the diffusion of adatoms at corner sites which is linked to the trigonal symmetry of the substrate. This corner diffusion is observed to be active as soon as islands form, therefore, the classical DLA clusters with the hit and stick mechanism do not form. The ideas on the mechanism for dendritic growth have been verified by kinetic Monte-Carlo simulations which are in excellent agreement with experiment.

Quality Assurance of an Organised Screening Programme for Breast Cancer in Denmark 1991-2008

Background: The capital city of Copenhagen, Denmark, has had an organised programme for screening with mammography since 1991. All women resident within the area of uptake and aged 50-69, representing around 45000 women, are invited biennially, unless they actively have asked not to be invited. We have evaluated the programme with regard to the European guidelines for quality assurance in breast cancer screening and diagnosis, to assess performance and impact.Methods: The target population was identified through the national population register, identifying all women meeting the inclusion criteria in terms of age and place of residence, migration and death. The mammography programme supplied data on all invited women, participation and screening test results. Oncological data was retrieved from the National Cancer Register and the Danish Breast Cancer Group. Data was linked using the Danish unique personal identity number.Results: In the first invitation round (1991-1992) the invasive cancer detection rate was 10/1000 and was by the 8th invitation round (2006-2007) 8/1000. The in situ detection rate has been 1/1000 throughout the period. The programme sensitivity is approximately 70%. The detection rate of small tumours (≤ 10mm) was, on average, 39% over the first 4 invitation rounds and 62% by the 8th invitation round. The benign to malign ratio changed from 1:1.6 to 1:11.4, from the first to the 8th invitation round. Recall rates at initial screen dropped from 7% to 4% in the period, and for subsequent screens from 4% to 2%. The false positive rate was 5.5% in the first invitation round and had by the 8th invitation round dropped to 1.3%, with a cumulative risk of 15% over 8 rounds. In the 8th invitation round, there was 82% coverage, a participation rate of 61% and a long term adherence of 50%.Conclusions: The results for the majority of indicators were well within the recommended levels. There had been a significant improvement in the benign to malign ratio, despite that the false positive rate at assessment had decreased. The detection of small tumours had also improved significantly. Participation rates were, however, lower than recommended.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4005.

The Human-Inducible Costimulator Ligand is Polymorphic

Inducible costimulator ligand (ICOSL) is a costimulatory molecule related to B7.1 (CD80) and B7.2 (CD86). B cells, monocytes, dendritic cells and endothelial cells express ICOSL. Inducible costimulator (ICOS) interacts with ICOSL, and this interaction leads to signals involved in isotype switching and the development of immunological memory. Hitherto, no polymorphisms of this gene have been described. The aim of this study was to reveal variation of the ICOSL gene in normal individuals. All eight exons, except exon 1, were sequenced with flanking introns in 10 healthy blood donors. Eight single nucleotide polymorphisms (SNPs) and two length polymorphisms were found. One of the SNPs was found in the coding regions of the gene. The base involved was located in exon 3 and caused a conservative amino acid change from valine (GTT) to isoleucine (ATT). Three individuals were heterozygous G/A for the exon polymorphism, while the remaining seven individuals were homozygous for the wildtype G/G. Exon 3 encodes the immunoglobulin variable (IgV)‐like domain of the molecule which is situated outside the cell. This means that the amino acid could be critical for the stability of the molecule or could constitute part of the binding site for ICOS. The results form the basis for further experiments to find possible associations of the alleles to diseases caused by immune dysregulation. Especially, the exon 3 variant is interesting and could play a role for the development of immunological diseases. Besides, it would be interesting to see whether both exon 3 alleles are expressed or only the wildtype allele is functional.

Normal ICOS, ICOSL and AID Alleles in Danish Patients with Common Variable Immunodeficiency

Common variable immunodeficiency, CVID, is a primary antibody deficiency characterized by decreased levels of serum immunoglobulin G (IgG), decreased IgA and/or IgM and recurrent infections. It is assumed to be heterogeneous group of disorders caused by different genetic defects. Some patients have decreased levels of class switched memory B cells and/or decreased levels of somatic hypermutation which points to defects in the germinal centre (GC) reactions as cause of the disease in these patients. The inducible costimulator, ICOS, and its' ligand, ICOSL, are both involved in and necessary for the GC reaction and so is activation-induced cytidine deaminase, AID. Therefore, we sequenced the ICOS, ICOSL and AID genes in a cohort of 34 Danish CVID patients. We found 13 new single nucleotide polymorphisms (SNP) in the intron regions of the ICOSL gene as well as one SNP in exon 3. However, none of these polymorphisms were associated with CVID. We did not find a previously reported CVID-causing ICOS gene deletion or any other unique mutations in the ICOS or AID genes.

Mouse antibody production test: can we do without it?

Introduction of microbiologically contaminated materials into mice can cause infections of the recipients and jeopardize experimental protocols. As such, the methods used to screen biological materials should be sensitive, reliable and suitable for routine diagnostic work. In this report, the sensitivity of the viral plaque assay, mouse antibody production test and polymerase chain reaction (PCR) for detection of MHV-A59 and MMVp, two of the most prevalent pathogenic viruses in experimental mouse facilities, was compared. Analysis of serial tenfold dilutions of virus stocks revealed that the sensitivity of the mouse antibody production test on day 28 (10(-10) dilution) was at least 10 times higher than that of the viral plaque assay (10(-9) dilution) and 10(4) times more than that of the RT-PCR (10(-6) dilution) for detection of MHV-A59. For detection of MMVp, the PCR (10(-10) dilution) proved to be 10(6) times more sensitive than the viral plaque assay (10(-4) dilution) and the mouse antibody production test on day 28 (10(-4) dilution) which were equally sensitive. Based on the present study, it was shown that the method for diagnosis of viruses in biological materials should be employed only after the sensitivity has been determined for the viruses of interest implying that the most sensitive method needs to be determined independently for each virus.

Receptor heteromerization in adenosine A2A receptor signaling: relevance for striatal function and Parkinson's disease

Recently evidence has been presented that adenosine A2A and dopamine D2 receptors form functional heteromeric receptor complexes as demonstrated in human neuroblastoma cells and mouse fibroblast Ltk- cells. These A2A/D2 heteromeric receptor complexes undergo coaggregation, cointernalization, and codesensitization on D2 or A2A receptor agonist treatments and especially after combined agonist treatment. It is hypothesized that the A2A/D2 receptor heteromer represents the molecular basis for the antagonistic A2A/D2 receptor interactions demonstrated at the biochemical and behavioral levels. Functional heteromeric complexes between A2A and metabotropic glutamate 5 receptors (mGluR5) have also recently been demonstrated in HEK-293 cells and rat striatal membrane preparations. The A2A/mGluR5 receptor heteromer may account for the synergism found after combined agonist treatments demonstrated in different in vitro and in vivo models. D2, A2A, and mGluR5 receptors are found together in the dendritic spines of the striatopallidal GABA neurons. Therefore, possible D2/A2A/mGluR5 multimeric receptor complexes and the receptor interactions within them may have a major role in controlling the dorsal and ventral striatopallidal GABA neurons involved in Parkinson's disease and in schizophrenia and drug addiction, respectively.

Delay of diagnosis in pancreatic cancer due to suspected symptomatic cholelithiasis

BACKGROUND

A single centre study was conducted to examine the frequency of cholecystectomies, both open and laparoscopic, up to 2 years prior to the diagnosis of pancreatic cancer. In particular, it was of interest to investigate whether there is a diagnostic delay in a significant number of pancreatic cancer patients and if these patients already have symptoms or findings at the time of cholecystectomy that might have been indicative of the underlying malignant disease.

METHODS

It is demonstrated that 17 out of 186 pancreatic cancer patients (9%) underwent a cholecystectomy within the 2 years prior to cancer diagnosis.

RESULTS

A significant number of these patients showed a considerable weight loss at the time of the cholecystectomy. It is hypothesized that symptoms which led to cholecystectomies in these patients were most likely related to the pancreatic cancer. Owing to the resulting delay of pancreatic cancer diagnosis the resection rate with curative intent decreases to 35% from 44% in the whole series.

CONCLUSION

Patients suffering from cholecystolithiasis and showing atypical symptoms or other notable findings such as considerable weight loss might be assessed in more detail pre- as well as postoperatively in order to minimize the diagnostic delay in pancreatic cancer and to avoid unnecessary operations.

Assessment of visual acuity in relation to central nervous system activation in children with mental retardation

Assessment of visual acuity was combined with observations of behavioral state indicating CNS activation in 24 individuals with mental retardation. Visual acuity was assessed by presentations of Teller Acuity Cards on two occasions. Behavioral state was classified along a scale with four categories during visual acuity testing. Results showed good test-retest reliability for the Teller Acuity Cards. Six participants had different behavioral state scores on the two test occasions, but displayed similar visual acuity on both tests. No participant rated as "drowsy" displayed responses on the acuity test. Results indicate that forced-choice preferential-looking technique can be used to test visual acuity in this population unless the participant is drowsy.

Rett syndrome and ageing: a case study

PURPOSE

This case study of an elderly women with Rett syndrome is used to consider whether observed changes may be related to physiological processes involved in ageing or environmental adaptations, which is important for delivery of rehabilitation.

METHOD

The life story of a woman with Rett syndrome who lived to the age of 60 is presented. It is based on medical records, older and more recent videotapes, and interviews with her sister and care staff.

RESULTS

After 21 years without walking, following intensive physiotherapy, she regained the ability to walk without support. She also showed improvement in hand use a few years before she died. During the early regression she appeared to lose social interest. The interest improved after some time, but she remained wary of people she did not know.

CONCLUSION

The walking and hand use indicate that these functions may have been present to a greater extent than assumed by people in the environment and that her poor function reflects dyspraxia and lack of opportunity and training rather than lack of ability. Although more studies of elderly women with Rett syndrome is needed to answer whether the observed changes were due to physiological processes involved in ageing or environmental adaptations, the present case story demonstrates that identification of females with Rett syndrome is important at all age levels.

[Chronic Monteggia injury in a child]

The case of a Monteggia fracture neglected from two years of age and seen at the age of fourteen, is described. A shortening of the affected ulna by three cm and a relative elongation of the radius was found. The function of the arm and elbow joint was remarkably unaffected with nearly full extension and flexion, supination and pronation. The carrying angle was ten degrees on both sides. Based on the literature, it is stressed that diagnosis and treatment of Monteggia lesions should be immediate. Complications in non-treated cases and at late treatment are many, and the results of such treatment dubious. It is thus of great importance that, when dealing with ulnar fracture a radiograph is also taken of the elbow joint to secure immediate diagnosis.

Hidden visual capabilities in mentally retarded subjects diagnosed as deaf-blind

The visual acuity of twelve multi-handicapped, mentally retarded subjects, diagnosed as deaf-blind, was measured on two occasions with the Teller Acuity Cards (TAC). Eight subjects scored above the criterion for legally blind and the results of six of these indicated various degrees of poor to approaching-normal eyesight. To evaluate high-level vision four subjects were tested with the Fagan Test, assessing visual recognition memory for faces subsequent to familiarization with the preferential looking technique. The results for three subjects showed evidence for perceptual recognition. It is concluded that TAC combined with the Fagan Test may detect perceptual capacities unnoticed by clinical observation.

Factors influencing the policy responses of host governments to mass refugee influxes

"The policy responses of asylum governments to mass influxes of refugees have varied considerably. Focusing on less developed countries, this article explores why some host governments respond in relatively generous ways, while other governments act more restrictively. The policy alternatives available to receiving governments are classified, and a set of factors influencing refugee policy formation is explored. These factors include: the costs and benefits of accepting international assistance, relations with the sending country, political calculations about the local community's absorption capacity, and national security considerations."

Adhesion receptors on bone marrow stromal cells: in vivo expression of vascular cell adhesion molecule-1 by reticular cells and sinusoidal endothelium in normal and gamma-irradiated mice

Cell adhesion molecules (CAMs) play a key role in interactions between stromal and hematopoietic cells in bone marrow (BM) and in cell traffic through vascular endothelium. To examine the identity of CAMs involved in these processes in mouse BM, we have investigated the in vivo expression of vascular cell adhesion molecule-1 (VCAM-1) and its counter-receptor, very late antigen-4 (VLA-4). Radioiodinated monoclonal antibodies (MoAbs) detecting VLA-4 and VCAM-1 were injected intravenously. Antibody binding was detected in BM by light and electron microscope radioautography. VCAM-1 labeling was restricted to stromal reticular cells and endothelial cells lining BM sinusoids. VCAM-1+ reticular cells formed patchy concentrations, especially in subosteal regions, associated with lymphoid, granulocytic, and erythroid cells. After gamma-irradiation to deplete hematopoietic cells, reticular cells and endothelial cells all showed VCAM-1 labeling in apparently increased intensity. VLA-4 labeling was shown by undifferentiated blast cells and lymphohematopoietic cells both in BM cell suspensions and in vivo, especially at reticular cell contact points. The results demonstrate that VCAM-1 is expressed in vivo by certain BM reticular cells, suggesting that the molecule mediates adhesion to multiple lineages of lymphohematopoietic cells. The finding that VCAM-1 is also expressed constitutively by BM sinusoidal endothelium, unlike its inductive expression by endothelia elsewhere, suggests that VCAM-1 and VLA-4 may be involved in regulating the normal cell traffic between BM and the blood stream.

Federal block grants and state spending: the Alcohol, Drug Abuse, and Mental Health block grant and state agency behavior

With renewed interest in block grants as a way to channel federal funds to states, several questions arise about the effect of block grants on state spending. A central question about the block grant form of intergovernmental aid is whether states spend the funds on the intended services or use budgetary strategies to appear to be in compliance with maintenance-of-effort provisions but then reallocate block grant funds from the targeted program. We studied the effect of the Alcohol, Drug Abuse and Mental Health block grant program on state substance abuse expenditures by analyzing spending data from the fifty states between fiscal years 1987 and 1992. Our findings suggest that this block grant has stimulated state spending, but this effect may be relevant only since 1990, and differs among states.

Preferential looking: a sudden shift in visual fixation pattern at 32 months of age

Observations of eye movements of young children in a modified preferential looking task suggest a change in the visual looking pattern taking place during a very brief time between 32 and 33 months of age. In the younger children, a grating stimulus elicited eye movements towards the target followed by a few seconds of focused attention; in the older children a visual avoidance behavior was observed where subjects looked consistently in the opposite direction of the target. An analysis of video recordings suggests that this avoidance pattern was a composite of a very brief initial target-directed eye movement which was quickly arrested, and followed by eye movements in the opposite direction, initiating a search of the visual scene.

Apoptosis and macrophage-mediated cell deletion in the regulation of B lymphopoiesis in mouse bone marrow

Studies of cell population dynamics and microenvironmental organization of B lymphopoiesis in the bone marrow of normal mice and in various genetically modified states have shown that cell loss, involving processes of apoptosis and macrophage-mediated cell deletion, is a prominent feature of the primary genesis of B lymphocytes. Balanced against the influence of proliferative stimulants, the programmed death of precursor B cells provides a quantitative control, determining the magnitude of the final output of functional B lymphocytes to the peripheral immune system. The cell loss mechanisms can be readily set in motion by external or systemic influences, making the B-cell output particularly vulnerable to suppression by ionizing irradiation, stress or other systemic mediators. In addition, however, cell loss exerts an important quality control in the formation of the primary B-cell repertoire. The combination of apoptosis and macrophage-mediated deletion, acting at successive stages of B-cell differentiation, efficiently eliminates many precursors having non-productive Ig gene rearrangements, cell cycle dysregulations, and certain autoreactive Ig specificities. Outstanding areas of further work abound. Important questions concern the nature of mechanisms which underlie the processes of B-cell apoptosis and macrophage deletion in bone marrow, the microenvironmental signals involved in B-cell life or death decisions and genetic factors which may override these B-cell culling mechanisms. The answers will be relevant to problems of autoimmune disease, humoral immunodeficiency and B-cell neoplasia.

[Pneumonia among patients admitted to intensive care units. An epidemiological multicenter study of APACHE II score, incidence and course]

Pneumonia in patients in intensive care units (ICU) is associated with several diagnostic difficulties and high mortality. This study was conducted to describe the diagnostic procedures and clinical characteristics of the pneumonic and critically ill patient in relation to APACHE II score. The material consisted of 193 patients admitted to seven Danish ICUs and is also included in a European epidemiologic survey (EURO.NIS). Twenty-eight (14.5%) developed pneumonia and 18 (9.3%) of these were nosocomial (> 48h after admission). Patients with pneumonia had a significantly higher APACHE II score, duration of stay and mortality. The techniques used to diagnose pneumonia were mainly conventional and did not or only seldom include protected brush, bronchoalveolar lavage or pulmonary biosy. The predominant pathogens isolated in tracheal aspirate were Gram-negative bacilli (50%). The APACHE II scoring system was found to stratify patients with respect to mortality, duration of stay and pneumonia diagnosed in ICU.