Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study

Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing.

Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study

BACKGROUND

The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign.

METHODS

The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey.

RESULTS

Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa).

CONCLUSION

Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression.

Constitutive expression of immunosuppression-associated cytokine genes in a panel of human T-leukemia-cell lines - high-incidence of transforming growth-factor-Beta gene-expression

The expression of RNA for interleukin (IL) -9, -10 and -12, interferon gamma (IFN-gamma), transforming growth factor beta one (TGF-beta1), macrophage inflammatory protein one alpha (MIP-1alpha) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in a panel of human T leukemia cell lines at various stages of differentiation, and normal thymocytes was examined using reverse transcriptase-polymerase chain reaction (RT-PCR). Fourteen of 16 T cell lines expressed the gene for TGF-beta1 and 12 of the cell lines also expressed the gene for GM-CSF. None of the 5 normal thymocyte samples constitutively expressed RNA for TGF-beta1 or GM-CSF. One cell line established from a patient with adult T cell leukemia (ATL), ED-S-, expressed the genes for TGF-beta1, GM-CSF, IL-10, IL-12, IFN-gamma and MIP-1alpha. IL-9 was not expressed by any cell line, IL-10 was expressed by only three cell lines and IL-12 was expressed by only two cell lines. The production of immunosuppressive factors such as TGF-beta1 by T leukemic cells is a possible mechanism for the clinical progression of this disease.

Ultrasound features of blunt testicular injury

This is a retrospective study of ultrasound examination for patients with blunt scrotal trauma. Fifteen patients were examined over an 18-month period. The purpose of the study was to discover the ultrasonic features of blunt testicular trauma and to distinguish less severe from more severe injury with testicular rupture requiring surgery. Three had ultrasonic findings of acute testicular rupture and this was confirmed by surgery. The ultrasound features of testicular trauma with rupture are irregularity of testicular outline and inhomogeneity of testicular texture. The value of ultrasound in diagnosing patients with testicular rupture and, therefore, requiring urgent surgery is discussed. In our limited study, irregularity of testicular outline was the distinguishing feature of rupture.

The ultrasound investigation of scrotal swelling

The objectives of this study were to: (1) establish the causes of scrotal swelling in the hospital catchment population; (2) define the role of high frequency ultrasound examination in the management of scrotal swelling. A retrospective study of 582 patients who had high frequency ultrasound examination was carried out. Those requiring more information on perfusion had colour doppler examination. Forty-four per cent of examinations were performed for scrotal swelling. The cause of the scrotal swelling was mainly extratesticular (75% of all scrotal swellings), hydrocele being the commonest. Of the intratesticular causes, infection (50.8%) and tumour (20.6%) were the commonest. In conclusion ultrasound examination distinguishes extratesticular (almost always benign) from intratesticular (potentially malignant) causes of scrotal swelling. Infection, trauma and torsion mimic the ultrasound appearance of tumour as do rare benign entities.

Alveolar rhabdomyosarcoma presenting with symmetrical bony and renal metastases in infancy

Alveolar Rhabdomyosarcoma is a small round cell tumour in which may be radiologically and histologically difficult to differentiate from other small round cell tumours such as lymphoma, neuroblastoma and Ewing's tumours. We report a case in infancy of disseminated alveolar rhabdomyosarcoma with symmetrical renal and bony metastases.

Enhancement of experimental pulmonary metastasis and inhibition of subcutaneously transplanted tumor growth following cryosurgery

We have previously reported that inhibition of anti-tumor immune responses and a corresponding enhancement of metastatic tumor growth occurred in rats following cryosurgery of 3-methylcholanthrene-induced WKA rat fibrosarcoma (KMT-17). In this study, to evaluate the enhancement of metastasis arising from the inhibition of anti-tumor immune responses following cryosurgery, we examined how cryosurgery affected experimental pulmonary metastasis and the growth of subcutaneously transplanted tumor. To reveal the effect of cryosurgery on pulmonary metastasis, rats received a subcutaneous inoculation of KMT-17 tumor in the right flank (1 x 10(6)) and i.v. injection (1 x 10(5)) on the same day or 4 days later. The right flank tumors were treated with cryosurgery 5 days after subcutaneous transplantation. The pulmonary metastasis of the rats, which were injected i.v. one day before treatment, was enhanced by cryosurgery as compared with surgical excision, though the pulmonary metastasis of rats, which were injected i.v. 5 days before treatment, was un-affected by cryosurgery. These observations suggest that cryosurgery may enhance the pulmonary metastasis in its early steps but has no effects in its later stages. To reveal the effect of cryosurgery on the growth of distant tumors, rats received subcutaneous inoculations of KMT-17 tumor in the right (1 x 10(6)) and left (1 x 10(4) approximately 10(5)) flanks. Tumors in the right flank were treated with cryosurgery 5 days after inoculation and the growth of untreated left flank tumors was observed. In this double grafted tumor system, however, cryosurgery significantly inhibited the growth of the untreated left flank tumors. Spleen cells obtained from rats which had undergone cryosurgery 4 or 10 days previously (cryo-spleen cells) were used for in vivo neutralizing Winn assay. Antitumor activity of cryo-spleen cells was decreased as compared with that of rats after surgical excision in both spleen cells from 4 and 10 days after treatment. These findings suggest that effector cells in the spleen may not participate in subcutaneous tumor regression and that the evaluation of antitumor effect using the double grafted tumor system needs caution.

Enhancement of tumor associated antigen expression during the regression phase of xenogenized tumor cell growth in vivo

Rat fibrosarcoma cells infected with Friend leukemia virus (FV-KMT-17) grow for a short time and then regress spontaneously in syngeneic hosts. This regression was caused by immunological mechanisms, because the tumor cells were renogenized. In this study, we have tried to find out whether tumor-associated antigen (TAA) expression in these xenogenized tumor cells can be modulated by xenogenization. FV-KMT-17 cells (1 x 10(7)), which were subcutaneously transplanted into ten rats, spontaneously regressed after temporary growth. All rats which rejected FV-KMT-17 cells showed strong resistance to rechallenge with KMT-17 (1 x 10(6)) cells. To reveal the chronological modulation of TAA and virus-associated antigen (VAA), a single-cell suspension was obtained from the subcutaneous tumors and expression of these antigens was chronologically measured. TAA, termed CE7 antigen, was examined by anti-CE7 monoclonal antibody (MoAb) and VAA was examined by anti-FK1 MoAb which recognizes the FV env gene product (gp 70). Expression of VAA was not modulated through either the progression or the regression phase, but expression of TAA was strongly enhanced in the regression phase. These results show that enhancement of TAA expression occurs during the regression phase of FV-KMT-17 growth in vivo and that TAA-expressing cells may stimulate anti-tumor immunity, resulting in acquisition of resistance against parental KMT-17 cells.

Enhancement of tumor antigen expression and inhibition of pulmonary metastasis of rat fibrosarcoma cells by local radiotherapy

Pulmonary metastasis formation after local radiotherapy against a rat fibrosarcoma was investigated. KMT-17 fibrosarcoma cells were transplanted into the hind leg in syngeneic WKA rats and two different doses (30Gy, 60Gy) of irradiation from a 60Co source were applied 5 days after transplantation. Pulmonary metastasis was inhibited by 30Gy irradiation rather than 60Gy irradiation, which was enough to almost completely cure the local tumors. This inhibitory effect of 30Gy irradiation was induced by the continued presence of irradiated tumors. As for pulmonary metastasis, the different effects of irradiation doses were not recognized when the tumor was removed surgically 1 day after irradiation, but when it was removed 4 days after 30Gy irradiation significantly inhibited metastasis. Expression of tumor-associated antigen (TAA), termed CE7 antigen, on the cell surface was enhanced effectively and continuously by 30Gy irradiation rather than by 60Gy. With this increase in CE7-expressing cells, the enhancement of anti-tumor immunity of spleen cells was observed in an in vitro 125I-IudR release assay and an in vivo tumor-neutralizing assay (Winn assay). The above results suggest that an appropriate dose of irradiation such as 30Gy, to a local tumor can efficiently enhance the TAA expression and that TAA-expressing cells may stimulate anti-tumor immunity, resulting in inhibition of pulmonary metastasis. This phenomenon may offer the possibility of resistance to micrometastasis through the induction of antitumor effector cells.

Cloning of the cDNA for human IFN-gamma-inducing factor, expression in Escherichia coli, and studies on the biologic activities of the protein

We have recently reported that a novel molecule, murine IFN-gamma-inducing factor (IGIF) produced by mouse liver cells, possesses potent biologic activities, including the induction of IFN-gamma production by spleen cells and the enhancement of NK cell cytotoxicity. In this paper, we report on the isolation of human IGIF cDNA clones from normal human liver cDNA libraries using murine IGIF cDNA as a probe. The amino acid sequence deduced from the human cDNA clones indicated a 193-amino acid precursor peptide and revealed 65% homology with that of murine IGIF. The amino acid sequence of IGIF also included an IL-1 signature-like sequence. Subsequently, the cloned cDNA was expressed in Escherichia coli, and preliminary studies on the biologic activities of the recombinant protein were performed. The recombinant human IGIF induced IFN-gamma production by mitogen-stimulated PBMC and enhanced NK cell cytotoxicity, in a manner similar to murine IGIF. In addition, recombinant human IGIF also augmented granulocyte-macrophage-CSF production and decreased IL-10 production, but had no effect on IL-4 production by Con A-stimulated PBMC. Based on these pleiotropic effects of IGIF, we propose that this novel cytokine be designated as IL-18.

Cloning of the cDNA for human IFN-gamma-inducing factor, expression in Escherichia coli, and studies on the biologic activities of the protein

We have recently reported that a novel molecule, murine IFN-gamma-inducing factor (IGIF) produced by mouse liver cells, possesses potent biologic activities, including the induction of IFN-gamma production by spleen cells and the enhancement of NK cell cytotoxicity. In this paper, we report on the isolation of human IGIF cDNA clones from normal human liver cDNA libraries using murine IGIF cDNA as a probe. The amino acid sequence deduced from the human cDNA clones indicated a 193-amino acid precursor peptide and revealed 65% homology with that of murine IGIF. The amino acid sequence of IGIF also included an IL-1 signature-like sequence. Subsequently, the cloned cDNA was expressed in Escherichia coli, and preliminary studies on the biologic activities of the recombinant protein were performed. The recombinant human IGIF induced IFN-gamma production by mitogen-stimulated PBMC and enhanced NK cell cytotoxicity, in a manner similar to murine IGIF. In addition, recombinant human IGIF also augmented granulocyte-macrophage-CSF production and decreased IL-10 production, but had no effect on IL-4 production by Con A-stimulated PBMC. Based on these pleiotropic effects of IGIF, we propose that this novel cytokine be designated as IL-18.

Modulation of the rat tumor-associated shedding antigen (CE7) and augmentation of immunogenicity by irradiation

We have previously reported that rat fibrosarcoma KMT-17 cells and their in vitro counterparts, cloned A3 cells, shed a tumor-associated antigen (TAA), termed CE7, from the cell surface on vesicular membranes, under growth-enhancing conditions. This study shows that irradiation (1 approximately Gy) from a 60Co source, inhibited A3 cell growth dose-dependently and correspondingly increased CE7 expression by A3 cells as determined by anti-CE7 monoclonal antibody using flow cytometry. CE7 expression gradually increased with increasing doses of irradiation and reached a peak level at 30Gy. After 30Gy irradiation, CE7 expressing A3 cells were fixed with 1% paraformaldehyde and were used to intradermally immunize syngenic rats. Immunized rats developed transplantation resistance to the parent KMT-17 cells as compared to rats immunized with unirradiated A3 cells. Rat MHC class 1 antigen expression was slightly decreased by irradiation and therefore, resistance to tumor transplantation appeared to arise solely due to the enhancing effects of irradiation on TAA expression which increases the antigenicity of the tumor cells coverting them to an effective stimulator of antitumor effector cells. This phenomenon may offer a possibility of the resistance to the re-emergence and metastasis of the tumor like a KMT-17 through the induction of antitumor memory cells.

Differential platelet-associated factor gene expression by a panel of human cell lines with megakaryoblastic properties after treatment with phorbol myristate acetate

Four human megakaryocytoid cell lines, namely MOLM-1, MOLM-7, MEG-01 and HEL, were treated with phorbol 12-myristate 13-acetate (PMA) and expression of the platelet-derived growth factor (PDGF) A chain, von Willebrand factor (vWF) and endothelial cell growth factor (ECGF) genes was examined by the reverse transcriptase-polymerase chain reaction (RT-PCR) using specific primers. The gene for PDGF A chain is constitutively weakly expressed by MEG-01 cells and strong expression is induced in MEG-01, MOLM-1 and MOLM-7 but not in HEL cells after treatment with PMA for three days. All four cell lines express the vWF gene both constitutively and after exposure to PMA. None of the cell lines constitutively express the gene for ECGF but MEG-01 cells can be induced to do so after treatment with the phorbol diester. Immunohistochemical staining after exposure to PMA showed that the expression of the platelet-associated markers CD41 and CD61 was enhanced in all cell lines indicating possible differentiation along the megakaryocyte lineage. Our results illustrate differential platelet-associated factor gene expression in different megakaryoblastic cell populations in response to treatment with PMA, and suggest that expressions of the PDGF A chain gene and the ECGF gene may be good markers for megakaryocyte maturation.

Tumor-necrosis-factor-alpha induces apoptosis in human leukemia T-cell line molt-16 - its relation to bcl-2 and C-myc expression

Tumor necrosis factor (TNF)-alpha was found to induce apoptotic cell death in the human T cell leukemia line MOLT-16 which constitutively expresses bcl-2 and c-myc Since these proto-oncogenes are known to play an important role in the induction or prevention of apoptosis, we examined the expression of these genes during the TNF-alpha-induced apoptosis of MOLT-16 cells. The expression of c-myc mRNA was found to decrease after exposure to TNF-alpha while the expression of bcl-2 mRNA was found to increase. Western blot analysis showed that the level of protein products of the two genes correlated with their respective mRNA expression. To our knowledge this is the first report on TNF-alpha-induced apoptosis in a human T cell leukemia line and its relationship to bcl-2 and c-myc gene expression.

Modulation of the shedding of a rat tumor-associated antigen by growth regulation and anti-cancer drugs

CE7 antigen is shed from A3 cell surfaces by cells grown in medium containing a sufficient (10%) amount of fetal calf serum (FCS), but shedding of the antigen decreases with a decrease in FCS content in the culture medium. However, the cells contain similar amounts of antigen as evidenced by Western blotting, indicating that low FCS levels interfere with antigen shedding but not antigen synthesis. Antigen expression by A3 cells treated with mitomycin C gradually shifted from negative to a strong positive with time, and on day 2, two peaks corresponding to negative and positive cells within the population can be observed. In contrast, A3 cells treated with bleomycin and cyclophosphamide shifted as a whole from negative to weakly positive. When A3 cells in media containing 10% FCS were incubated at 4 degrees C, although the cells did not proliferate, antigen expression could not be detected by flow cytometry.

Immunoregulatory cytokine production by tumor-bearing rat spleen cells and its modulation by bleomycin

The chemotherapeutic agent bleomycin (BLM) increases cytokine production by mitogen-stimulated healthy rat spleen cells without altering the cellular composition of the spleen. In this study, the chronological production of interleukin (IL)-2, IL-6 and tumor necrosis factor (TNF) by untreated and BLM-treated tumor-bearing rat spleen cells is examined. A significant decrease in the production of both IL-2 and TNF could be observed only 5 days after subcutaneous injection of syngeneic KMT-17 tumor cells. Decrease in cytokine production progressed with time with a slight recovery around day 10 after tumor challenge. Administration of BLM, 5 mg/kg, on day 8, restored IL-2 and IL-6 production and significantly increased TNF production by day 14 of tumor burden as compared with the amounts of cytokine produced by the mitogen-stimulated untreated tumor-bearing rat spleen cells. The response of the tumor-bearing rat spleen cells to concanavalin A (ConA), diminished when compared with that of normal rat spleen cells, could be restored to normal levels by treatment with BLM when examined at low concentrations of mitogen but was unaffected at higher concentrations of ConA. Histological examination of the tumor tissue, following continuous intraperitoneal treatment with BLM, 5 mg/kg, from day 8 to 12, shows disruption of cellular structure with significant infiltration of effector cells as compared with undisrupted organization with no visible infiltration of effector cells in the untreated rat tumors.

Bleomycin but not its derivatives inhibits the in vivo shedding of a rat tumor-associated antigen

Rat fibrosarcoma (KMT-17) cells and their in vitro clone, 10% FCS A3 cells, shed a tumor-associated antigen (TAA), CE7, from the cell surface under growth-promoting conditions. We treated cells with the antitumor agent bleomycin (BLM) and its analogs peplomycin and liblomycin in vitro and in vivo in an attempt to increase expression of this antigen and induce an antitumor response. Although all three agents enhance antigen expression in vitro, proportionate to their direct antiproliferative effects, only BLM enhances antigen expression in vivo. The in vivo regulation of CE7 expression appears not to be related to the direct cytotoxic effects of the antitumor agents but rather to the immuno-augmenting effects of BLM.

Augmented accumulation of transferred lymphokine-activated killer (LAK) cells at murine tumor sites through production of LAK-attractant facilitated by chemotherapy

We observed that effects of adoptive immunotherapy with lymphokine-activated killer (LAK) cells on BMT-11, a fibrosarcoma in C57BL/6 mice were improved by combination with cyclophosphamide (CY)-chemotherapy corresponding to enhanced accumulation at tumor sites of LAK cells. On the other hand, cytotoxic T lymphocytes (CTLs) which were able to accumulate at tumor sites more densely than LAK cells produced significant therapeutic effects by themselves. We have also found observed that LAK-attractant activity was detected in conditioned medium (CM) of CY-treated tumor tissue but not in the CM of untreated tumor tissue. These findings reveal that CY-chemotherapy facilitates LAK-attractant-production and enhances the accumulation in tumor tissue of LAK cells and that therapeutic effects of adoptive transfer of LAK cells are augmented by cancer chemotherapy through the enhanced accumulation of LAK cells.

Rat macrophage activation after treatment with the bleomycin group of antitumour antibiotics in vivo

We have previously reported that bleomycin and its derivative peplomycin enhance the release of cytokines by rat spleen cells during mitogen-stimulated cell culture in vitro, but liblomycin, another derivative of bleomycin, decreases cytokine release to below untreated control levels. Cytokine release correlated well with the inhibition of subcutaneous tumour growth after treatment with equivalent doses of the three analogues. In contrast, ascites tumour growth is completely inhibited by liblomycin and appears to be at least partly macrophage-mediated because the antitumour effect can be significantly inhibited by carageenan. This study shows that bleomycin and its analogues activate rat peritoneal macrophages and increase interleukin-6 release, O2- production, cell spreading, phagocytosis and random migration of macrophages, but only bleomycin enhances peritoneal macrophage invasion into a monolayer of rat lung endothelial cells in vitro. This study also shows that although liblomycin decreases spleen cell cytokine production and is less effective than bleomycin against subcutaneous tumour, as we have previously reported, the antitumour drug activates peritoneal macrophages and, compared to bleomycin, has a remarkable therapeutic effect on rat ascites tumour.

Immunoregulatory cytokine release in rat spleen cell cultures after treatment with bleomycin and its analogues in vivo

We have studied the immunological effects that accompany a change in the chemical structure of a group of antineoplastic antibiotics by comparing the immunoregulatory cytokine release during mitogen-stimulated spleen cell culture after in vivo drug treatment. Whereas bleomycin and peplomycin increased cytokine levels in culture supernatants when compared with supernatants from untreated control rat spleen cell cultures, liblomycin generally reduced cytokine levels under the same culture conditions. We then compared these results with the antitumor effects of equivalent doses of the three drugs against a highly antigenic rat fibrosarcoma, KMT-17, both in vivo and in vitro. The results suggest that the immunoaugmenting effects of these antitumor antibiotics are essential for an optimal antitumor effect in vivo, and that these effects can be drastically altered by modification of the chemical structure of the drugs employed.