[Neurogenetics of schizophrenia: findings from studies based on data sharing and global partnerships]

Schizophrenic psychoses are the result of a multifactorial process in which not only environmental influences but also genetic factors play an important role. These factors are based on a complex mode of inheritance that involves a large number of genetic variants. In the last three decades, biological psychiatric research has focused closely on molecular genetic aspects of the hereditary basis of schizophrenic psychoses. In particular, international consortia are combining cohorts from individual researchers, creating continuously increasing sample sizes and thus increased statistical power. As part of the Psychiatric Genomics Consortium (PGC), genome-wide association studies with tens of thousands of patients and controls have for the first time found robustly replicable markers for schizophrenic psychoses. Through intensive phenotyping, first approaches to a transdiagnostic clinical reclassification of severe mental illnesses have been established in the longitudinal PsyCourse study of the UMG Göttingen and the LMU Munich, allowing new biologically validated disease subgroups with prognostic value to be identified. For the first time environmental factors could even be examined in an African cohort that contribute to the development of the psychosis. In the coming years, the enormous technical progress in the area of genomic high-throughput technologies (next-generation sequencing) is expected to provide new knowledge not only about the influence of frequently occurring single nucleotide polymorphisms but also about rare variants. For the successful use of this technological revolution an exchange of data between research groups is essential.

Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia

Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of bipolar disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case-control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was (i) to detect genes and gene sets involved in BOR and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, major depression (MDD) and schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests and gene-set analyses were performed in 998 BOR patients and 1545 controls. Linkage disequilibrium score regression was used to detect the genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Gene-based analysis yielded two significant genes: DPYD (P=4.42 × 10-7) and PKP4 (P=8.67 × 10-7); and gene-set analysis yielded a significant finding for exocytosis (GO:0006887, PFDR=0.019; FDR, false discovery rate). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [P=2.99 × 10-3]), SCZ (rg=0.34 [P=4.37 × 10-5]) and MDD (rg=0.57 [P=1.04 × 10-3]). We believe our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies.

Pharmacogenomic aspects of bipolar disorder: An update

The hopes for readily implementable precision medicine are high. For many complex disorders, such as bipolar disorder, these hopes critically hinge on tangible successes in pharmacogenetics of treatment response or susceptibility to adverse events. In this article, we review the current state of pharmacogenomics of bipolar disorder including latest results from candidate genes and genome-wide association studies. The majority of studies focus on response to lithium treatment. Although a host of genes has been studied, hardly any replicated findings have emerged so far. Very small samples sizes and heterogeneous phenotype definition may be considered the major impediments to success in this field. Drawing from current experiences and successes in studies on diagnostic psychiatric phenotypes, we suggest several approaches for our way forward.

The effects of milk feeding method and group size on feeding behavior and cross-sucking in group-housed dairy calves

This study investigated the effect of teat feeding and group size on cross-sucking and competition for milk in dairy calves. Ninety-six Holstein-Friesian male and female calves were allocated to either pairs or groups of 6 and fed milk either from a bucket or via a teat. Calves fed via a teat spent more time ingesting the milk. They spent time sucking the empty teat after milk intake and they spent less time cross-sucking compared with calves fed from buckets. The results show that teat feeding reduces cross-sucking in groups of 6 calves. Calves in groups of 6 ingested the milk faster than calves housed in pairs, which suggests that the competition for milk was greater than in pairs. Teat-fed calves changed to another teat more often than bucket-fed calves changed to another bucket during milk intake. Thus, the use of teat feeding did not reduce the competition for milk as compared with bucket feeding and future studies should focus on improving teat-feeding methods so that they reduce competition for milk in group-housed calves.

Prospective registry-based observational cohort study of the long-term risk of malignancies in renal transplant patients treated with mycophenolate mofetil

This large prospectively conducted observational cohort study examined the risk of lymphoma and other malignancies with mycophenolate mofetil (MMF) in de novo renal transplant recipients. A total of 6751 patients receiving MMF, and an equal number of matched controls receiving non-MMF-based immunosuppression, were identified from two large registries (Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) and Collaborative Transplant Study (CTS)) and followed for 3 years. The primary endpoint was development of lymphoma. Secondary endpoints included development of any malignancy. There was no evidence of any increased risk of developing lymphoma or malignancy with MMF. The risk of developing lymphoma with MMF compared with the non-MMF cohort was not higher in either the CTS registry (relative risk (95% confidence interval); 0.4 (0.17-0.94)) or the OPTN/UNOS registry (1.04 (0.61-1.78)). In the MMF group, there was a trend toward a lower risk of malignancy in both registries (OPTN/UNOS 0.86 (0.69-1.07); CTS 0.79 (0.61-1.02)) and a significant increase in time to malignancy in the CTS dataset (p < 0.026). This study has demonstrated that MMF is not associated with an increased risk of lymphoma or other malignancies post-renal transplant, and may even be associated with a lower risk in some populations.

Cloning, expression and characterisation of CYP102A2, a self-sufficient P450 monooxygenase from Bacillus subtilis

The gene encoding CYP102A2, a novel P450 monooxygenase from Bacillus subtilis, was cloned and expressed in Escherichia coli. The recombinant enzyme formed was purified by immobilised metal chelate affinity chromatography (IMAC) and characterised. CYP102A2 is a 119-kDa self-sufficient monooxygenase, consisting of an FMN/FAD-containing reductase domain and a heme domain. The deduced amino acid sequence of CYP102A2 exhibits a high level of identity with the amino acid sequences of CYP102A1 from B. megaterium (59%) and CYP102A3 from B. subtilis (60%). In reduced, CO-bound form, the enzyme shows a typical Soret band at 449 nm. It catalyses the oxidation of even- and odd-chain saturated and unsaturated fatty acids. In all reactions investigated, the products were the respective omega-3, omega-2 and omega-1 hydroxylated fatty acids. Activity was highest towards oleic acid (K(M)=17.36+/-1.4 microM, k(cat)=2,244+/-72 min(-1)) and linoleic acid (K(M)=12.25+/-1.8 microM, k(cat)=1,950+/-84 min(-1)). Comparison of a CYP102A2 homology model with the CYP102A1 crystal structure revealed significant differences in the substrate access channels, which might explain the differences in the catalytic properties of these two enzymes.

Improved quality of life after long-term treatment with the bisphosphonate ibandronate in patients with metastatic bone disease due to breast cancer

Bone metastases occur in most women with advanced breast cancer and can lead to considerable morbidity and a rapid deterioration in the patient's quality of life. It was the aim of the present study to assess changes in quality of life and bone pain due to intravenous (i.v.) ibandronate, a potent third-generation bisphosphonate. In a phase III randomised, double-blind, placebo-controlled trial in patients with bone metastases due to breast cancer, 466 women were randomised to receive placebo, 2 mg ibandronate or 6 mg ibandronate for up to 96 weeks. Treatment was administered i.v. at 3- or 4-weekly intervals. Clinical endpoints included the incidence of adverse events, quality of life (assessed using the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Scale - Core 30 questionnaire (QLQ-C30)), and bone pain (assessed on a 5-point scale from 0=none to 4=intolerable). Ibandronate was generally well tolerated. Compared with baseline measurements, the bone pain score was increased at the last assessment in both the placebo and 2 mg ibandronate groups, but was significantly reduced in the patients receiving 6 mg ibandronate (-0.28+/-1.11, P < 0.001). A significant improvement in quality of life was demonstrated for patients treated with ibandronate (P < 0.05) for all global health status. Overall, at the last assessment, the 6 mg ibandronate group showed significantly better functioning compared with placebo (P = 0.004), and had significantly better scores on the domains of physical, emotional, and social functioning, and in global health status (P < 0.05). Significant improvements in the symptoms of fatigue and pain were also observed in the 6 mg ibandronate group. I.v. ibandronate treatment leads to significant improvements in quality of life, and is an effective and well-tolerated palliative treatment in patients with bone metastases due to breast cancer.

Oral ibandronate for the treatment of metastatic bone disease in breast cancer: efficacy and safety results from a randomized, double-blind, placebo-controlled trial

BACKGROUND

We report the first results of a randomized trial assessing a new oral aminobisphosphonate, ibandronate, in patients with bone metastases from breast cancer.

PATIENTS AND METHODS

Patients (n = 435) received placebo, or oral ibandronate 20 mg or 50 mg once-daily for 96 weeks. The primary efficacy measure was the number of 12-week periods with new bone complications [skeletal morbidity period rate (SMPR)]. Multivariate Poisson regression analysis assessed the relative risk reduction of skeletal-related events. Secondary efficacy analyses included bone pain and analgesic use. Adverse events were monitored.

RESULTS

SMPR was significantly reduced with oral ibandronate [placebo 1.2, 20 mg group 0.97 (P = 0.024), 50 mg group 0.98 (P = 0.037)]. Ibandronate 50 mg significantly reduced the need for radiotherapy (P = 0.005 versus placebo). The relative risk of skeletal events was reduced by 38% (20 mg dose) and 39% (50 mg dose) versus placebo (P = 0.009 and P = 0.005). The tolerability profile of ibandronate was similar to placebo.

CONCLUSIONS

Oral ibandronate is an effective and well-tolerated treatment for metastatic bone disease. The 50 mg dose is being further evaluated in clinical trials, and this dose was recently approved in the European Union for the prevention of skeletal events in patients with breast cancer and bone metastases.

Intravenous ibandronate reduces the incidence of skeletal complications in patients with breast cancer and bone metastases

BACKGROUND

This phase III study compared the efficacy of the new potent bisphosphonate, ibandronate, with placebo as intravenous (i.v.) therapy in metastatic bone disease due to breast cancer.

PATIENTS AND METHODS

A total of 466 patients were randomised to receive placebo (n = 158), or 2 mg (n = 154) or 6 mg (n = 154) ibandronate every 3-4 weeks for up to 2 years. The primary efficacy parameter was the number of 12-week periods with new bone complications, expressed as the skeletal morbidity period rate (SMPR). Bone pain, analgesic use and safety were evaluated monthly. Results SMPR was lower in both ibandronate groups compared with the placebo group; the difference was statistically significant for the ibandronate 6 mg group (P = 0.004 versus placebo). Consistent with the SMPR, ibandronate 6 mg significantly reduced the number of new bone events (by 38%) and increased time to first new bone event. Patients on ibandronate 6 mg also experienced decreased bone pain scores and analgesic use. Treatment with ibandronate was well tolerated.

CONCLUSIONS

These results indicate that 6 mg i.v. ibandronate is effective and safe in the treatment of bone metastases from breast cancer.

Specific enzymatic treatment of bovine and human articular cartilage: implications for integrative cartilage repair

OBJECTIVE

Chondrocyte death in articular cartilage wound edges and the subsequent lack of matrix-producing cells in the interface area are considered to be a major cause of impaired cartilage wound healing and poor integrative cartilage repair. This study was undertaken to investigate whether enzymatic matrix digestion can be used to stimulate integrative cartilage repair via a mechanism of local increase in the amount of vital chondrocytes in cartilage wound edges.

METHODS

Full-thickness bovine articular cartilage samples were cultured in vitro for 14 days in standard medium. Samples were either left untreated or treated for 48 hours with 0.3% hyaluronidase or 30 units/ml highly purified collagenase VII. Nuclear and cytoplasmic changes were analyzed to determine cell viability, and the number of vital chondrocytes in wound edges was determined. Subsequently, we investigated whether increased chondrocyte density in the lesion edges resulted in better wound healing. Finally, full-thickness human tibial plateau cartilage explants were tested with similar enzyme treatment protocols to determine the clinical value of our results.

RESULTS

In bovine explants a rapid onset of chondrocyte death was observed in wound edges in all treatment groups. This led to low chondrocyte density in a band of 0-150 microm from the lesion edges in untreated and hyaluronidase-treated explants. Treatment with 30 units/ml collagenase resulted in a significant increase in chondrocyte density in this area. The integration experiments demonstrated improved integration of the lesion edges after treatment with collagenase. In human articular cartilage an increase in chondrocyte density at the lesion edges could also be achieved, but only when proteoglycans were depleted from the wound edges prior to collagenase treatment.

CONCLUSION

Treatment with highly purified collagenase improves integrative cartilage repair, possibly by increasing the cell density at cartilage wound edges.

Accumulation of advanced glycation endproducts reduces chondrocyte-mediated extracellular matrix turnover in human articular cartilage

OBJECTIVE

The prevalence of osteoarthritis (OAs) increases with age and coincides with the accumulation of advanced glycation endproducts (AGEs) in articular cartilage, suggesting that accumulation of glycation products may be involved in the development of OA. This study was designed to examine the effects of accumulation of AGEs on the turnover of the extracellular matrix of human articular cartilage.

DESIGN

Chondrocyte mediated cartilage degradation (GAG release, colorimetric) was measured in human articular cartilage of donors aged 19-82 years (N=30, 4-day culture). In addition, to mimic the age-related increase in AGE levels in vitro, cartilage was cultured in the absence or presence of glucose, ribose or threose. Cartilage degradation and proteoglycan synthesis ((35)SO(2)(-4) incorporation) were measured and related to the degree of cartilage AGE levels (fluorescence at 360/460 nm).

RESULTS

Chondrocyte-mediated degradation of articular cartilage (i.e. GAG release) decreased with increasing age of the cartilage donor (r=-0.43, P< 0.02). In vitro incubation of cartilage with glucose, ribose or threose resulted in a range of AGE levels that was highly correlated to the chondrocyte-mediated cartilage degradation (r=-0.77, P< 0.001, N=26). In addition, in these in vitro glycated cartilage samples, a decrease in proteoglycan synthesis was observed at increasing AGE levels (r=-0.54, P< 0.005, N=25).

CONCLUSIONS

This study shows that an increase in AGE levels negatively affects the proteoglycan synthesis and degradation of articular cartilage. In combination, these two effects reduce the turnover of the cartilage and thereby the maintenance and repair capacity of the tissue. By this mechanism, the age-related increase in cartilage AGE levels may contribute to the development of OA.

Lifetimes of hydrogen and deuterium related vibrational modes in silicon

Lifetimes of hydrogen and deuterium related stretch modes in Si are measured by high-resolution infrared absorption spectroscopy and transient bleaching spectroscopy. The lifetimes are found to be extremely dependent on the defect structure, ranging from 2 to 295 ps. Against conventional wisdom, we find that lifetimes of Si-D modes typically are longer than for the corresponding Si-H modes. The potential implications of the results on the physics of electronic device degradation are discussed.

Observation of quantum shock waves created with ultra- compressed slow light pulses in a Bose-Einstein condensate

We have used an extension of our slow light technique to provide a method for inducing small density defects in a Bose-Einstein condensate. These sub- resolution, micrometer-sized defects evolve into large-amplitude sound waves. We present an experimental observation and theoretical investigation of the resulting breakdown of superfluidity, and we observe directly the decay of the narrow density defects into solitons, the onset of the "snake" instability, and the subsequent nucleation of vortices.

Accumulation of advanced glycation end products decreases collagen turnover by bovine chondrocytes

The integrity of the collagen network is essential for articular cartilage to fulfill its function in load support and distribution. Damage to the collagen network is one of the first characteristics of osteoarthritis. Since extensive collagen damage is considered irreversible, it is crucial that chondrocytes maintain a functional collagen network. We investigated the effects of advanced glycation end products (AGEs) on the turnover of collagen by articular cartilage chondrocytes. Increased AGE levels (by culturing in the presence of ribose) resulted in decreased collagen synthesis (P < 0.05) and decreased MMP-mediated collagen degradation (P < 0.02). The latter could be attributed to increased resistance of the collagen network to MMPs (P < 0.05) as well as the decreased production of MMPs by chondrocytes (P < 0.02). Turnover of a protein is determined by its synthesis and degradation rates and therefore these data indicate that collagen turnover is decreased at enhanced AGE levels. Since AGE levels in human cartilage increase approximately 50 fold between age 20 and 80, cartilage collagen turnover likely decreases with increasing age. Impaired collagen turnover adversely affects the capacity of chondrocytes to remodel and/or repair its extracellular matrix. Consequently, age-related accumulation of AGE (via decreased collagen turnover) may contribute to the development of cartilage damage in osteoarthritis.

[Conjunctival balloon cell nevi--light- and electronmicroscopic findings in 2 patients]

CASE REPORTS

Two 19-year-old patients presented with small nasal conjunctival tumors. Histologic examination revealed subepithelial tumors consisting of large cells with deeply basophilic, small, centrally-placed nuclei and abundant, slightly eosinophilic cytoplasm with microvesicles. Electron microscopy showed premelanosomes in some of the balloon cells.

CONCLUSION

The balloon cell nevus is a rare variant of the conjunctival nevi. The characteristic intracellular microvesicles are probably degenerative remnants of premelanosomes.

Silicone oil-associated optic nerve degeneration

PURPOSE

To report the frequency and extent of silicone oil migration into the optic nerve during silicone oil endotamponade.

METHODS

Histopathologic analysis of 74 eyes enucleated after silicone oil endotamponade.

RESULTS

In 14 of 74 enucleated eyes (24%), optically empty vacuoles regarded as silicone oil vacuoles were observed in the retrolaminar optic nerve. In three eyes, silicone oil in the optic nerve was surrounded by a granulomatous inflammatory reaction. In serial cross sections, the vacuoles extended up to the line of surgical transsection (up to 9 mm) of the optic nerve and constituted up to 40% of the total cross-sectional area.

CONCLUSIONS

After silicone oil endotamponade, silicone oil may replace a considerable amount of tissue of the retrolaminar optic nerve. A granulomatous inflammatory reaction surrounding silicone oil may add to optic nerve damage.

Local vibrational modes of isolated hydrogen in germanium

Two distinct isolated hydrogen defects are observed in crystalline Ge by in situ infrared absorption spectroscopy. Implantation of protons into Ge at cryogenic temperatures gives rise to two intense absorption lines at 745 and 1794 cm(-1). The lines originate from distinct defects, each of which contains one H atom located on a <111> axis. The 1794-cm(-1) line is assigned to bond center H in the positive charge state, whereas the 745-cm(-1) line is ascribed to negatively charged H located on a <111> axis close to the tetrahedral site.

Vibrational lifetime of bond-center hydrogen in crystalline silicon

The lifetime of the stretch mode of bond-center hydrogen in crystalline silicon is measured to be T1 = 7.8+/-0.2 ps with time-resolved, transient bleaching spectroscopy. The low-temperature spectral width of the absorption line due to the stretch mode converges towards its natural width for decreasing hydrogen concentration C(H), and nearly coincides with the natural width for C(H) approximately 1 ppm. The lifetimes of the Si-H stretch modes of selected hydrogen-related defects are estimated from their spectral widths and shown to range from 1.6 to more than 37 ps.

Long-term outcome of cognition and functional health after cerebral venous sinus thrombosis

The authors examined cognition and functional health of 57 patients with sinus thrombosis 1 year or more after enrollment in a randomized trial of anticoagulant treatment or placebo. Eight patients died and two declined participation. Of the remaining 47 patients, 16 (35%) had cognitive impairments, 3 (6%) were dependent, 19 (40%) had symptoms that led to restrictions in lifestyle, and 19 (40%) could not resume their previous level of economic activity. Outcome after sinus thrombosis may be less favorable than reported previously, and was not significantly influenced by treatment.

[Familial cataract in plasma galactitol increase without known enzyme defect]

BACKGROUND

Several enzyme defects of the galactose pathway may lead to cataract formation. We report on a family with familiar cataract.

PATIENTS

A 2-year-old Turkish girl (daughter of first cousins) presented with dense cortical and subcapsular opacifications and mature cataract respectively. Bilateral phacectomy, planned posterior capsulotomy, transpapillary vitrectomy and implantation of a posterior chamber lens were performed. The child was otherwise healthy and the pregnancy had been unremarkable. The 25-year-old mother showed circumscribed drop-like opacities of the lens cortex bilaterally, the 5-year-old sister a diffuse opacification of the lens cortex in both eyes, the 27-year-old father and the 13-year-old uncle clear lenses.

RESULTS

The girl's level of galactitol was elevated to 2.8 nmol/ml in the plasma (normal values 0.25-1.13 nmol/ml) and to 3.1 nmol/mg protein in the lens (normal values 0.5-1.7 nmol/mg protein). The levels of galactose-1-phosphate in RBC and sorbitol in plasma were in the normal range. The enzyme activities of galactokinase, galactose-1-phosphate uridyl transferase, UDP-galactose epimerase and sorbitol dehydrogenase in RBC, as well as the sorbitol dehydrogenase activity in the lens were in the normal range. The sister and the uncle both had slightly elevated plasma galactitol levels.

CONCLUSIONS

Cataract-formation in this family is most likely due to a defect in the galactitol pathway, e.g. cataract in galactosemia without known enzyme defect (Shin-Jakobs disease). In patients with unexplained congenital or infantile cataracts, disorders of the polyol pathway should be thoroughly checked for to ensure a therapeutic diet if necessary.

The effect of an endothelin-receptor antagonist, bosentan, on blood pressure in patients with essential hypertension. Bosentan Hypertension Investigators

BACKGROUND

Endothelin is a powerful vasoconstrictor peptide derived from the endothelium. We evaluated the contribution of endothelin to blood-pressure regulation in patients with essential hypertension by studying the effect of an endothelin-receptor antagonist, bosentan.

METHODS

We studied 293 patients with mild-to-moderate essential hypertension. After a placebo run-in period of four to six weeks, patients were randomly assigned to receive one of four oral doses of bosentan (100, 500, or 1000 mg once daily or 1000 mg twice daily), placebo, or the angiotensin-converting-enzyme inhibitor enalapril (20 mg once daily) for four weeks. Blood pressure was measured before and after treatment.

RESULTS

As compared with placebo, bosentan resulted in a significant reduction in diastolic pressure with a daily dose of 500 or 2000 mg (an absolute reduction of 5.7 mm Hg at each dose), which was similar to the reduction with enalapril (5.8 mm Hg). There were no significant changes in heart rate. Bosentan did not result in activation of the sympathetic nervous system (as determined by measurement of the plasma norepinephrine level) or the renin-angiotensin system (as determined by measurements of plasma renin activity and angiotensin II levels).

CONCLUSIONS

An endothelin-receptor antagonist, bosentan, significantly lowered blood pressure in patients with essential hypertension, suggesting that endothelin may contribute to elevated blood pressure in such patients. The favorable effect of treatment with bosentan on blood pressure occurred without reflexive neurohormonal activation.

Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Associations with hyperleukocytosis and acute monocytic leukemia

There were 294 children with acute myelogenous leukemia (AML) entered into the German AML Berlin, Frankfurt, and Münster hospitals (BFM) 78 and 83 studies. Thirty (10%) died as a result of hemorrhage and/or leukostasis prior to or in the first 12 days of therapy. The risk of early death due to hemorrhage and/or leukostasis is significantly greater when certain features are initially present: acute monocytic leukemia (French-American-British [FAB] M5), hyperleukocytosis (greater than or equal to 100,000/microliter), and extramedullary organ involvement (P less than 0.001). The risk increases sharply when these factors exist in combination: 72% mortality with FAB M5 and hyperleukocytosis, and 43% with FAB M5 and extramedullary organ involvement. In 11 patients leukostasis alone or in combination with hemorrhage was probably the cause of death during the first 3 days after diagnosis. All 11 children presented with hyperleukocytosis and were classified as monocytic subtype FAB M4 or M5. After induction, a close temporal association between rapid blast reduction and occurrence of fatal hemorrhage was established in five patients. Thrombocytopenic hemorrhages were controllable and, therefore, responsible for death only in exceptional cases. It is difficult to avoid these early fatal complications with current therapeutic measures. Early exchange transfusion together with special supportive care may be useful.

[Detection of aberrations in the karyotype of children with acute leukemia: a comparative analysis of cytogenetics and flow cytophotometry]

In the present study a comparative analysis of DNA flow cytometry and cytogenetics was performed in 257 children with acute leukemias to evaluate the comparability of both techniques for the detection of karyotype aberrations. DNA aneuploidies were detected in 88 (34%) patients while cytogenetic anomalies were revealed in 96 (37%) cases. From 76 patients (30%) with cytogenetically inevaluable metaphases 26 (35%) expressed aneuploid DNA stemlines. 67 (79%) of the 85 patients with normal karyotypes or normal modal chromosome numbers had a DNA index of 1.0 while DNA aneuploidies were identified in 18 cases (21%). 4 of 30 patients (13%) with pseudodiploid karyotypes revealed aneuploid DNA stemlines. While aberrations of the chromosome number by 1-3 chromosomes were combined with DNA aneuploidies in 9 of 35 cases (26%) only, all 31 patients with higher numeric chromosome changes also had aneuploid DNA stemlines. These data indicate that cytogenetics and DNA flow cytometry are complimentary methods for the detection of karyotype aberrations and should therefore be applied simultaneously.

[Current results of cooperative AML therapy studies in children: BFM-78 and 83]

271 children with AML entered the cooperative studies BFM-78 (151 pat.) and BFM-83 (120 pat.) since Dec. 1, 1978. In the second study BFM-83 the 8-10 week intensive induction/consolidation therapy of study BFM-78 was preceded by an 8-day intensive therapy consisting of cytosine arabinoside, daunorubicin and VP-16. 10 children died prior to starting the protocol therapy from hemorrhage and/or leukostasis. 80% of the 261 protocol patients achieved a complete remission. 7% were early deaths by hemorrhage and/or leukostasis 3% died of other complications. 10% were partial or nonresponders. 54 relapses, 11 with CNS involvement have occurred in study BFM-78 after a follow up of 2.10-6.7 years (median 4.10 yrs.). The life table probabilities for event free survival (EFS) and event free interval (EFI) after 6.7 years are 37% (SD 4%) and 47% (SD 5%) respectively. The results of study BFM-83 after a follow up of 0.3-2.8 years (median 1.8 yrs.) are: 23 relapses, EFS 40% (SD 10%) and EFI 48% (SD 12%). So far, the overall results of both studies are nearly identical. The analyses of the prognostic factors show that initial hyperleukocytosis (greater than or equal to 100 X 10(3)/mm3) represents a high risk for early fatal hemorrhage and/or leukostasis, for nonresponse and for the incidence of relapses. Initial deaths caused by hemorrhage and/or leukostasis occur also significantly more often in patients with M5-subtype and extramedullary organ involvement. Additional strategies for achieving a better prognosis in high risk patients are necessary.

Indications for liver transplantation in childhood

Retrospective analysis of 97 children aged 3 months to 15 years presented for liver transplantation in our clinic indicates that children with extrahepatic biliary atresia (BA) show a cumulative survival of only 27% after 2.5 years of observation without transplantation. Children with cirrhosis of the liver of other origin (C) have an even worse cumulative survival rate of only 10% after the same time and treatment. Liver transplantation seems to be very urgent if there is a parallel drop of activity of pseudocholinesterase (CHE) below 1100 U/l, a drop of prothrombin test (PT) below 60% and a concomitant increase of concentration of bilirubin (Bili) and total serum bile acids (TBA) to 380 and 120 mumol/l respectively. In order to improve medical care of children with endstage liver disease it is mandatory to use all potential donor offers and to develop new surgical techniques such as transplantation of liver segments.

[DNA aneuploidy in children with acute leukemia: I. Incidence and clinical significance within the scope of the BFM studies]

Analyses of the cellular DNA content were carried out in 226 patients with acute lymphoblastic leukemia (ALL) and in 61 children with acute myeloid leukemia (AML) to assess the incidence and clinical significance of DNA aneuploidies. All children were treated within the BFM studies ALL 79/81 and 81/83 as well as AML 78 und 83. DNA aneuploidies were identified in ALL in 39,8% and in AML in 36,1% of cases. Within the ALL group a significantly higher rate of aneuploid DNA stemlines was observed for non-T/non-B ALL with 44,1% as compared to T-ALL with 14,3% (p less than 0,01). In AML the morphologic subgroups M 1/2 revealed a lower frequency of 21,7% DNA aneuploidies than M 4/5 leukemias with 44,4%. The rates of complete remissions were not different between patients with and without DNA aneuploidy neither in ALL nor in AML. In the study ALL 79/81, however, a tendency towards longer remissions for patients with DNA aneuploidy was found (p = 0.053) which could not be confirmed at present by the study ALL 81/83. In both ALL trials patients with the lowest pretherapeutic risk-score revealed the highest rate of aneuploid DNA stemlines.