Abstract GS2-02: Direct regulation of estrogen receptor-α (ER) transcriptional activity by NF1

Inactivating germline mutations in the NF1 gene (encoding neurofibromin) cause neurofibromatosis type 1. In addition to peripheral nervous system tumors, NF1 patients are at higher risk for other cancers, including breast cancer. Tumor exome-sequencing studies demonstrate that approximately 20% of all human cancers have somatic NF1 mutations. NF1 has been best known for its ability to inactivate Ras as a GAP (GTPase Activating Protein). However, this function is served by a small GAP domain in a very large protein. Recurrent missense mutations inactivating the GAP activity are infrequent. In contrast, it is common to detect frameshift (FS) and nonsense (NS) NF1 mutations, which can create an NF1-null state deleting not only GAP, but also, potentially, undefined NF1 functions whose loss could also drive tumorigenesis.

As we reported at SABCS previously, in 600+ patients treated by tamoxifen adjuvant monotherapy, we found that FS/NS NF1 mutations independently correlate with relapse risk (HR=2.6, p=0.03). To explore this finding, we silenced NF1 in preclinical models of ER+ breast cancer, which markedly enhanced ER transcriptional activities, causing estradiol (E2) hypersensitivity and converted tamoxifen into an agonist (in vitro and in vivo). Most important, these activities depend on ER, but not on NF1's GAP activity. These findings readily explain the poor patient outcomes associated with NS/FS NF1 mutations, and reveal a previously unrecognized function for NF1 in ER regulation.

In the presence of an agonist, liganded ER repels co-repressors and recruits co-activators, while the reverse is true with an antagonist such as tamoxifen. Many co-regulators contain leucine/isoleucine rich motifs, which bind directly to the ligand-binding domain (LBD) in ER. NF1 has several of these motifs that are much more highly conserved in species with a functional ER pathway, and some of these are mutated in cancers (e.g., in our patient cohort). Furthermore, we found that NF1 canbind directly to ER, and that this binding is mediated between the ER LBD and the NF1 leucine-rich regions. Like a classic co-repressor, wildtype NF1 (but not mutants lacking GAP activity or the Leu-rich motif) binds to ER, and is recruited by ER to the ERE in the presence of tamoxifen, but not E2.

Further preclinical treatment studies indicate that while NF1-deficient ER+ breast cancer should not be treated by tamoxifen or AIs, fulvestrant remains effective. Furthermore, when fulvestrant is combined with dabrafinib and trametinib to inhibit Ras effectors Raf and MEK, apoptosis is induced in vitro, and tumor regression is observed in vivo. In conclusion, we have demonstrated that NF1 is a dual negative regulator at the intersection of two potent oncogenic signaling pathways, Ras and ER, and that NF1-deficient ER+ breast cancer patients may be more effectively treated by co-targeting the Ras and ER signaling. These patients, up to 10% of those with advanced ER+ breast cancer, can be readily identified for treatment by ctDNA analysis. A clinical trial is under development.

Citation Format: Chang EC, Zheng Z, Philip L, Burcu C, Lei J, Singh P, Anurag M, Chan D, Li JD, Du XP, Shafaee MN, Banks K, Sacker S, Song W, Nguyen T, Cao J, Chen X, Haricharan S, Kavuri M, Kim B-J, Zhang B, Gutmann DH, Lanman RB, Foulds C, Ellis M. Direct regulation of estrogen receptor-α (ER) transcriptional activity by NF1 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS2-02.

Abaloparatide-SC improves trabecular microarchitecture as assessed by trabecular bone score (TBS): a 24-week randomized clinical trial

In a phase 2 trial of 222 postmenopausal women with osteoporosis aged 55 to 85 years randomized to one of three different doses of abaloparatide-SC, subcutaneous teriparatide, or placebo for 24 weeks, abaloparatide-SC resulted in improvements in skeletal microarchitecture as measured by the trabecular bone score.

INTRODUCTION

Subcutaneous abaloparatide (abaloparatide-SC) increases total hip and lumbar spine bone mineral density and reduces vertebral and non-vertebral fractures. In this study, we analyzed the extent to which abaloparatide-SC improves skeletal microarchitecture, assessed indirectly by trabecular bone score (TBS).

METHODS

This is a post hoc analysis of a phase 2 trial of 222 postmenopausal women with osteoporosis aged 55 to 85 years randomized to abaloparatide-SC (20, 40, or 80 μg), subcutaneous teriparatide (20 μg), or placebo for 24 weeks. TBS was measured from lumbar spine dual X-ray absorptiometry (DXA) images in 138 women for whom the DXA device was TBS software compatible. Assessments were made at baseline, 12 and 24 weeks. Between-group differences were assessed by generalized estimating equations adjusted for relevant baseline characteristics, and a pre-determined least significant change analysis was performed.

RESULTS

After 24 weeks, TBS increased significantly by 2.27, 3.14, and 4.21% versus baseline in participants on 20, 40, and 80 μg abaloparatide-SC daily, respectively, and by 2.21% in those on teriparatide (p < 0.05 for each). The TBS in the placebo group declined by 1.08%. The TBS increase in each treatment group was significantly higher than placebo at 24 weeks (p < 0.0001 for each) after adjustment for age, BMI, and baseline TBS. A dose-response was observed at 24 weeks across the three doses of abaloparatide-SC and placebo (p = 0.02). The increase in TBS in the abaloparatide-SC 80 μg group was significantly greater than TPTD (p < 0.03).

CONCLUSIONS

These results are consistent with an effect of abaloparatide-SC to improve lumbar spine skeletal microarchitecture, as assessed by TBS.

Castor oil as a natural alternative to labor induction: A retrospective descriptive study

AIM

To describe birthing outcomes among women who consumed castor oil cocktail as part of a freestanding birth center labor induction protocol.

METHODS

De-identified data from birth logs and electronic medical records were entered into SPSS Statistics 22.0 for analysis for all women who received the castor oil cocktail (n=323) to induce labor between January 2008 and May 2015 at a birth center in the United States. Descriptive statistics were analyzed for trends in safety and birthing outcomes.

RESULTS

Of the women who utilized the castor oil cocktail to stimulate labor, 293 (90.7%) birthed vaginally at the birth center or hospital. The incidence of maternal adverse effects (e.g., nausea, vomiting, extreme diarrhea) was less than 7%, and adverse effects of any kind were reported in less than 15% of births. An independent sample t-test revealed that parous women were more likely to birth vaginally at the birth center after using the castor oil cocktail than their nulliparous counterparts (p<.010), while gestational age (p=.26), woman's age (p=.23), and body mass index (p=.28) were not significantly associated.

CONCLUSIONS

Nearly 91% of women in the study who consumed the castor oil cocktail to induce labor were able to give birth vaginally with little to no maternal or fetal complications. Findings indicate further research is needed to compare the safety and effectiveness of natural labor induction methodologies, including castor oil, to commonly used labor induction techniques in a prospective study or clinical trial.

L-arginine promotes gut hormone release and reduces food intake in rodents

AIMS

To investigate the anorectic effect of L-arginine (L-Arg) in rodents.

METHODS

We investigated the effects of L-Arg on food intake, and the role of the anorectic gut hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), the G-protein-coupled receptor family C group 6 member A (GPRC6A) and the vagus nerve in mediating these effects in rodents.

RESULTS

Oral gavage of L-Arg reduced food intake in rodents, and chronically reduced cumulative food intake in diet-induced obese mice. Lack of the GPRC6A in mice and subdiaphragmatic vagal deafferentation in rats did not influence these anorectic effects. L-Arg stimulated GLP-1 and PYY release in vitro and in vivo. Pharmacological blockade of GLP-1 and PYY receptors did not influence the anorectic effect of L-Arg. L-Arg-mediated PYY release modulated net ion transport across the gut mucosa. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) administration of L-Arg suppressed food intake in rats.

CONCLUSIONS

L-Arg reduced food intake and stimulated gut hormone release in rodents. The anorectic effect of L-Arg is unlikely to be mediated by GLP-1 and PYY, does not require GPRC6A signalling and is not mediated via the vagus. I.c.v. and i.p. administration of L-Arg suppressed food intake in rats, suggesting that L-Arg may act on the brain to influence food intake. Further work is required to determine the mechanisms by which L-Arg suppresses food intake and its utility in the treatment of obesity.

Abstract PD7-05: Multi-gene panel testing and the cancers identified in patients at risk for hereditary breast cancer

Background: Next generation sequencing and broadened genetic testing guidelines have made it possible to perform multi-gene testing upfront for patients at risk for hereditary breast cancer. Breast surgeons and oncologists are ideally situated at the forefront of cancer treatment to initiate these tests since results can impact treatment decisions. This study evaluates the utility of multi-gene testing in a multidisciplinary breast practice.

Methods: Data was collected retrospectively from 500 consecutive patients who underwent multi-gene panel testing July 2013 – September 2014. Patients were evaluated at time of visit if they met criteria for genetic testing based on NCCN guidelines.

Results: Most patients had no prior genetic testing; 28.8% of patients had previous negative BRCA1 and BRCA2 (BRCA1/2) tests. All patients had a personal and/or family history of breast or ovarian cancer. All patients were evaluated with a multi-gene panel consisting of a minimum of 5 breast-cancer related genes (BRCA1, BRCA2, PTEN, TP53, and CDH1) and most (68.0%) had extended panel testing of up to 43 cancer-associated genes. Pathogenic mutations were identified in 32 (6.4%) patients. The majority of patients (79.0%) were not found to carry any mutations, while 16.2% had at least one genetic variant of uncertain significance. Of the patients with pathogenic mutations, 37.5% had a mutation in BRCA1/2 while most patients had mutations in non-BRCA1/2 genes.

PatientMutationPersonal History of CancerBreast CancerAge at Breast Cancer DxType of Breast CancerOther Cancer1ATMyes47DCIS 2ATMyes77IDC 3BARD1, CHEK2yes39IDC 4BRCA1yesno Ovarian, age 515BRCA1yes46IDC 6BRCA2yes42IDC 7BRCA2yes76ILCOvarian, age 558BRCA2yes43DCIS 9BRCA2yes46IDC 10BRCA2yes54IDC 11BRCA2yes36ILC 12BRCA2yes38ILC 13BRCA2yes64IDC 14BRCA2yes35IDC 15BRCA2nono  16CHEK2yes35not availableThyroid, age 6017CHEK2yes66IDC 18CHEK2yes65DCIS 19CHEK2yes44IDC 20CHEK2yes43IDC 21CHEK2nono  22MRE11Anono  23MSH2nono  24MUTYHyes41DCIS 25MUTYHyes53DCIS 26MUTYHnono  27NBNyes72IDC 28PALB2yes59IDC 29PALB2yes42IDC 30PALB2yes53IDC 31RAD51Cyesno Ovarian, age 6532TP53yes46DCIS 

The majority of patients with mutations had a personal history of cancer including breast, ovarian, and thyroid cancer. There was no significant difference between age of breast cancer diagnosis and having a BRCA1/2 mutation compared to having a non-BRCA gene mutation. The majority of gene-positive patients with cancer had hormone-positive invasive ductal carcinoma(IDC) while only two patients had triple negative breast cancer. Compared to patients with BRCA1/2 mutations, patients with non-BRCA mutations were more likely to have a family history of non-breast or ovarian cancer(58.3% vs 90%, respectively, p=0.0735).

Conclusions: Multi-gene panel testing will identify more patients with risk of breast and ovarian cancer than routine BRCA1/2 testing alone, and may have an impact on screening for other cancers as well. Obtaining a thorough personal and family cancer history is necessary to provide optimal counseling and screening.

Citation Format: Kapoor NS, Curcio LD, Patrick M, Swisher J, West JD, Banks K. Multi-gene panel testing and the cancers identified in patients at risk for hereditary breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD7-05.

L-cysteine suppresses ghrelin and reduces appetite in rodents and humans

BACKGROUND

High-protein diets promote weight loss and subsequent weight maintenance, but are difficult to adhere to. The mechanisms by which protein exerts these effects remain unclear. However, the amino acids produced by protein digestion may have a role in driving protein-induced satiety.

METHODS

We tested the effects of a range of amino acids on food intake in rodents and identified l-cysteine as the most anorexigenic. Using rodents we further studied the effect of l-cysteine on food intake, behaviour and energy expenditure. We proceeded to investigate its effect on neuronal activation in the hypothalamus and brainstem before investigating its effect on gastric emptying and gut hormone release. The effect of l-cysteine on appetite scores and gut hormone release was then investigated in humans.

RESULTS

l-Cysteine dose-dependently decreased food intake in both rats and mice following oral gavage and intraperitoneal administration. This effect did not appear to be secondary to behavioural or aversive side effects. l-Cysteine increased neuronal activation in the area postrema and delayed gastric emptying. It suppressed plasma acyl ghrelin levels and did not reduce food intake in transgenic ghrelin-overexpressing mice. Repeated l-cysteine administration decreased food intake in rats and obese mice. l-Cysteine reduced hunger and plasma acyl ghrelin levels in humans.

CONCLUSIONS

Further work is required to determine the chronic effect of l-cysteine in rodents and humans on appetite and body weight, and whether l-cysteine contributes towards protein-induced satiety.

Microengineering as a tool to study substratum modulation and cell behaviour

This research is an investigation of the means by which geometrical parameters (e.g. area and shape) and various surface attributes (materials and surface finish) of microengineered structures can modulate cellular response. This is based on biological observations indicating that: (i) the response of tissue cells to injury is determined by the net signal transduction response elicited by soluble regulatory molecules (e.g. cytokines), (ii) common matrix constituents (e.g. collagen) directly affect cell behaviour by the same signal transduction mechanisms mediating cytokine bioactivity, (iii) cellular response to cytokines is modulated by the precise nature of the extracellular matrix to which the target cells are adherent, including its biochemical composition and physical structure.

The effects of water filtration systems on fluoride: Washington, D.C. metropolitan area

According to the U.S. Environmental Protection Agency (EPA), approximately one in eight Americans is exposed to potentially harmful microbes, pesticides, lead, or radioactive radon whenever they drink a glass of tap water or take a shower. One reason for this exposure is that the water plants are aging or ill equipped to process the huge amounts of raw sewage and agricultural pollutants that are still being discharged into our drinking-water sources. Other compounds such as fluoride and chloride have been added to the community water supplies for health benefits. Water filtration systems are becoming more popular as people become concerned with pollutants in the public water supply and questions are being raised as to whether fluoride is affected by these filters. The aim of this pilot study was to assess the efficacy of three types of water filtration systems and to determine their impact on fluoride content of the water in the Washington, D.C. metropolitan area. One sample of water was collected daily for fourteen days, from one location. The sample was divided to use as a control and the test samples which were processed through various filter systems. With the use of a fluoride ion specific electrode, the fluoride concentration level was tested in all samples in order to determine the percentage of fluoride removed. This study was intended to prove that the water filtration systems did not affect the advantage offered by optimum water fluoride levels. The experimental samples were ascertained and compared to the control group, resulting in three of the four carbon filters showing statistically significant amounts of fluoride removed from the water. Both Reverse Osmosis and Distillation, as expected, removed the fluoride at a high rate.

Minor oral injuries in children

Traumatic injuries involving the oral cavity in children often result from falls or collisions with stationary objects. Repair of lacerations involving the soft tissue structures within the oral cavity is described. These injuries often can be managed by emergency department personnel, with referral to an oral and maxillofacial surgeon for follow-up care. Initial management of more extensive injuries such as dentoalveolar fractures, penetrating injuries and burns is also described. Immediate consultation with the appropriate specialist is suggested, because significant deformity and/or morbidity may result from minor oral injuries.

Recombinant follicle-stimulating hormone in a patient hypersensitive to urinary-derived gonadotropins

Hypersensitivity reactions are a documented complication of urinary-derived gonadotropin therapy. In this report, a patient allergic to these older products is successfully treated with recombinant follicle-stimulating hormone.

Pyrithiamine-induced thiamine deficiency impairs object recognition in rats

Pyrithiamine-induced thiamine deficiency (PTD) in rats is used to model the etiology, diencephalic neuropathology, and memory deficits of Korsakoff's amnesia. We assessed the performance of rats exposed to PTD on a test of object recognition--nonrecurring-items delayed nonmatching-to-sample (DNMS). PTD produced thalamic lesions similar to those of Korsakoff's amnesics and similar to those previously observed in PTD rats. PTD rats required more trials to master DNMS at a 4-s retention delay than did controls, and after they had done so, they performed more poorly than controls at delays of 15, 30, 60, and 120 s. DNMS deficits were also observed in PTD rats that received training prior to PTD treatment. These findings support the validity of the PTD rat model of Korsakoff's disease by demonstrating that PTD rats display object-recognition deficits that are similar to those reported in Korsakoff amnesics.

Does the histaminergic system mediate bombesin/GRP-induced suppression of food intake?

Bombesin (BN) and its mammalian homologue, gastrin-releasing peptide (GRP), are potent satiety agents and have been implicated in the physiological regulation of food intake. The mechanism(s) of action of this effect remains unclear. There is a functional and anatomic overlap between histamine and BN in relationship to feeding, which led us to hypothesize that BN may mediate its satiety effects through activation of the histaminergic system. To assess this contention, we examined the effects of R-alpha-methylhistamine (alpha-MH) and Imetit, selective H3-receptor agonists that inhibit the release and synthesis of histamine, on BN- or cholecystokinin (CCK)-induced satiety. In this report we present the first evidence for the role of histamine H3 receptors in the mediation of BN-elicited satiety. During the first hour of the 4-h daily feeding session, BN reduced food intake by > 50% relative to the control condition; this suppression was blocked by prior treatment with the H3-receptor agonist, alpha-MH. This blockade of BN-induced satiety was dose related and selective to BN as alpha-MH failed to attenuate sulfated CCK-8-induced satiety. When alpha-MH was administered alone, it failed to significantly affect food intake. The specificity of this effect was further supported by the demonstration that another H3 agonist, Imetit, was also able to block the feeding-suppressant effects of BN. Furthermore, thioperamide, an H3-receptor antagonist, blocked these effects of Imetit.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated in vivo and in vitro secretion of CD8-alpha molecules in patients with systemic lupus erythematosus

Endogenously activated CD8+ cells contribute to the aberrant immune regulation that characterizes SLE. Because stimulation of CD8+ cells with lectin/Ag triggers release of CD8-alpha molecules (sCD8), we measured, in patients with SLE, serum sCD8 content, its correlation with disease activity, and the in vitro release of sCD8 by SLE PBMCs. sCD8 levels, measured by ELISA in sera of 50 SLE patients, were higher than normal in 16 out of 21 mildly active and 15 out of 15 active SLE patients. sCD8 correlated positively with the clinical index for disease activity (r = 0.57, p = 0.001) and with sIL-2R levels (r = 0.52, p &lt; 0.0001), and negatively with serum C3 levels (r = -0.5, p &lt; 0.04). Freshly isolated SLE PBMCs had higher than normal CD8-alpha mRNA levels and secreted high levels of sCD8 in vitro (p &lt; 0.05 vs control PBMC). sCD8 in vitro release by SLE PBMCs may be modulated by non-CD8+ cells. Thus, anti-CD2 mAb inhibited sCD8 release, whereas anti-HLA mAb increased it in unseparated PBMCs, but not in CD8+ enriched cultures. Moreover, sCD8 release increased significantly in PBMC cultures enriched for CD8+ DR+ cells by negative selection. Added-back monocytes decreased sCD8 to original levels, but not after glutaraldehyde fixation, nor in the presence of anti-HLA mAb. Further, lectin-induced IgG production and proliferation were reduced in the presence of sCD8, suggesting that the soluble CD8 molecules may be immunoregulatory. Because the high sCD8 levels in sera of active SLE likely reflect pathogenic cell activation, serum CD8 content may be an additional serologic activity marker, and its study could provide insights into mechanisms of disease.

Elevated in vivo and in vitro secretion of CD8-alpha molecules in patients with systemic lupus erythematosus

Endogenously activated CD8+ cells contribute to the aberrant immune regulation that characterizes SLE. Because stimulation of CD8+ cells with lectin/Ag triggers release of CD8-alpha molecules (sCD8), we measured, in patients with SLE, serum sCD8 content, its correlation with disease activity, and the in vitro release of sCD8 by SLE PBMCs. sCD8 levels, measured by ELISA in sera of 50 SLE patients, were higher than normal in 16 out of 21 mildly active and 15 out of 15 active SLE patients. sCD8 correlated positively with the clinical index for disease activity (r = 0.57, p = 0.001) and with sIL-2R levels (r = 0.52, p < 0.0001), and negatively with serum C3 levels (r = -0.5, p < 0.04). Freshly isolated SLE PBMCs had higher than normal CD8-alpha mRNA levels and secreted high levels of sCD8 in vitro (p < 0.05 vs control PBMC). sCD8 in vitro release by SLE PBMCs may be modulated by non-CD8+ cells. Thus, anti-CD2 mAb inhibited sCD8 release, whereas anti-HLA mAb increased it in unseparated PBMCs, but not in CD8+ enriched cultures. Moreover, sCD8 release increased significantly in PBMC cultures enriched for CD8+ DR+ cells by negative selection. Added-back monocytes decreased sCD8 to original levels, but not after glutaraldehyde fixation, nor in the presence of anti-HLA mAb. Further, lectin-induced IgG production and proliferation were reduced in the presence of sCD8, suggesting that the soluble CD8 molecules may be immunoregulatory. Because the high sCD8 levels in sera of active SLE likely reflect pathogenic cell activation, serum CD8 content may be an additional serologic activity marker, and its study could provide insights into mechanisms of disease.

A radiographic survey of dental anomalies in Black pediatric patients

During seemingly routine check-ups, the dental practitioner must be ever aware of "quiescent" abnormalities or irregularities. Knowledge of special problems occurring within a certain patient population is of great value to the practitioner when evaluating the individual patient. Numerous studies have been conducted evaluating the pediatric Caucasian population; however, no comparable studies for the Black pediatric population have been done. This study sought to establish prevalence rates for the Black pediatric population with regards to the following anomalies: congenitally missing teeth, supernumerary teeth, dens in dente, odontomas, dentinogenesis imperfecta, gemination, fusion and concrescence. The radiographs (panographs mandatory), history forms and treatment progress records of 2,267 children (1,136 males and 1,131 females) were analyzed. Radiographs of poor quality were eliminated and attempts were made to include only children of Black American heritage. Prevalence rates established for a predominantly Black pediatric population were: 4.4%, congenitally missing teeth; 1.49%, supernumerary teeth; 0.26%, dentinogenesis imperfecta (Brandywine type); 0.44%, odontomas; 0.22%, gemination; and 0.12%, fusion. Evidence of dens in dente was found in only one erupted supernumerary maxillary paralateral, and the detection of only one case of concrescence occurred; both have prevalence rates of 0.04%. No other study has produced such a high rate of dentinogenesis imperfecta (.26%), except that conducted within the tri-racial group itself. In addition, if assumptions are to be made from this investigation for the general population, supernumeraries and odontomas may be present significantly more often in the Black than Caucasian pediatric population.

An effective skin integrity program

Nursing staff development personnel are responsible for increasing the awareness of nursing staff of the problems caused by pressure ulcers and for supplying them with information needed for prevention and treatment. In answer to one hospital's needs, a hospital-wide, nurse-initiated, nurse-managed skin integrity program was developed and instituted. Protocols for treatment were standardized according to the latest concepts in wound healing. Basic components of the program were included in a comprehensive but succinct reference manual available on each nursing unit. Strategies for implementation were carefully planned to include feedback, approval, and support of selected physicians and nurses. Key for an effective, ongoing skin integrity program are the skin integrity clinicians and educated, confident, and enthusiastic staff nurses. Throughout the process of introducing this program, education of various groups of health-care professionals--physicians, staff nurses, skin integrity clinicians--by the Nursing Staff Development Department was pivotal in achieving a relatively smooth implementation of the program. Outcomes have demonstrated the success of this skin integrity program to both patients and staff. Creative planning, diligent research, skillful organization, and credibility of the specialists in the Nursing Staff Development Department were important elements in the development, implementation, and success of this skin integrity program.

Psychosocial adjustment of children with a terminally ill parent

Although a substantial number of children experience serious parental illness and death, the adjustment problems attendant to the stress of having a fatally ill parent have not been examined systematically. This paper compares the psychosocial adjustment of 62 school-aged children with a terminally ill parent (study sample) with that of children in a community sample, using several standard rating scales. Study children had significantly higher levels of self-reported depression (Children's Depression Inventory) and anxiety (State-Trait Anxiety Inventory) and lower self-esteem (Self-Esteem Inventory). Parents also reported study children's significantly higher behavior problems and lower social competence (Child Behavior Checklist). Increased professional attention to this vulnerable population is encouraged.

Epithelium modulates the potency of vasoactive intestinal peptide in the guinea pig

The purpose of the study was to evaluate the importance of the epithelium in determining the potency of exogenous vasoactive intestinal peptide (VIP) in inhibiting responses of isolated guinea pig trachea to vagal stimulation. Isolated innervated tracheal preparations (n = 56) were mounted in glass organ baths in Krebs-Henseleit (K-H) solution at 37 degrees C and gassed with 95% O2-5% CO2. The inside of the trachea was separately perfused with K-H solution at 1 ml/min. The vagal nerve trunks were stimulated (20 V, 1-ms pulses, 10-s trains) at low (0.5 Hz) and high frequency (15 Hz) alternately, and the contractile responses were measured as increases in intratracheal pressures. VIP (10(-8)-10(-7) M) inhibited responses to both high- and low-frequency stimulation. VIP was more potent in inhibiting contractions when administered to the outside than the inside surface of the trachea, and disruptionon of the epithelium abolished this difference. The endopeptidase inhibitors phosphoramidon and thiorphan (5 x 10(-6) M) potentiated the action of VIP. These data indicate that the epithelium reduces the efficacy of VIP. We suggest that the epithelium is a site of degradation of VIP by endopeptidase and may also be a diffusion barrier.

A 5-year safety and efficacy evaluation with fibrel in the correction of cutaneous scars following one or two treatments

In a multicenter clinical trial 300 patients were treated with Fibrel, 4 weeks following a negative skin test, for the correction of cutaneous scars. Fibrel treatment was restricted to one or two implants in a maximum of four scars. The scar corrections were evaluated by the physician, the patient, and also via an objective photogrammetric method. At the end of 1 year the percentage of scars with moderate, marked, or complete correction were 65, 63.3, and 85.8% according to physician, patient, and photogrammetric evaluations, respectively. A cohort of 111 patients were followed for up to 2 years and 87 patients were followed up to 5 years postimplantation. The physician and patient evaluations showed 55.1 and 50.6%, respectively, of the scars in the moderate, marked, or complete correction category at the end of 5 years with only one or two treatments. Safety evaluations included tests for antinuclear antibodies, rheumatoid factor, and presence of antibodies to Fibrel and their crossreactivity to human collagen I and III. These tests did not show any causal relationship to Fibrel treatments and the patients did not have any untoward immunologic symptoms. The data from these patients demonstrate that one or two Fibrel treatments are effective in maintaining greater than 50% correction of depressed cutaneous scars up to 5 years with negligible adverse sequelae and no untoward immunologic symptoms.

NMR distance measurements in DNA duplexes: sugars and bases have the same correlation times

To evaluate whether the sugar moieties of short DNA duplexes exhibit local motion of sufficient amplitude to affect interproton distance measurements, we have carried out a series of time-dependent NOESY experiments at increasingly shorter mixing times on dodecamer DNA duplexes. By use of the cytosine H5-H6 vector as a known distance in the bases and the geminal 2'H-2''H vector as a known distance in the sugars, the corresponding apparent cross-relaxation rates were sampled at various mixing times. While the ratio of the inverse sixth power of these two fixed distances is in the range 6-7, when the system is sampled at 100 ms the apparent initial rate of growth of the 2'H-2''H NOESY crosspeak is only 1.9-2.0 times faster than that of the H5-H6 crosspeak--in agreement with the results of Clore and Gronenborn [Clore, G. M., & Gronenborn, A. M. (1984) FEBS Lett. 172, 219; (1984) FEBS Lett. 175, 117] and of Gronenborn and Clore [Gronenborn, A. M., & Clore, G. M. (1985) Prog. NMR Spectrosc. 17, 1]. This observation was interpreted to indicate the existence of internal mobility with a 3-fold shorter correlation time for the sugar moieties in DNA and led to the use of this shorter correlation time to estimate sugar-sugar proton distances and many sugar-base proton distances in subsequent DNA structure determination. We have examined 2'H-2"H cross-relaxation and H5-H6 cross-relaxation at 100, 90, 60, 30, and 15 ms in dodecamer DNA duplexes.(ABSTRACT TRUNCATED AT 250 WORDS)