Pioglitazone does not enhance exogenous glucose oxidation or metabolic clearance rate during aerobic exercise in men under acute high altitude exposure

Insulin insensitivity decreases exogenous glucose oxidation and metabolic clearance rate (MCR) during aerobic exercise in unacclimatized lowlanders at high altitude (HA). Whether use of an oral insulin sensitizer prior to acute HA exposure enhances exogenous glucose oxidation is unclear. This study investigated the impact of Pioglitazone (PIO) on exogenous glucose oxidation and glucose turnover compared to placebo (PLA) during aerobic exercise at HA. Using a randomized, crossover design, native lowlanders (n=7 males, mean±SD, age: 23±6 yr, body mass: 84±11 kg) consumed 145 g (1.8 g/min) glucose while performing 80-min of steady-state (1.43±0.16 V̇O2 L/min) treadmill exercise at HA (460 mmHg) following short-term (5 days) use of PIO (15 mg oral dose per day) or PLA (microcrystalline cellulose pill). Substrate oxidation and glucose turnover were determined using indirect calorimetry and stable isotopes (13C-glucose and [6,6-2H2]-glucose). Exogenous glucose oxidation was not different between PIO (0.31±0.03 g/min) and PLA (0.32±0.09 g/min). Total carbohydrate oxidation (PIO: 1.65±0.22 g/min, PLA: 1.68±0.32 g/min) or fat oxidation (PIO: 0.10±0.0.08 g/min, PLA: 0.09±0.07 g/min) were not different between treatments. There was no treatment effect on glucose rate of appearance (PIO: 2.46±0.27, PLA: 2.43±0.27 mg/kg/min), disappearance (PIO: 2.19±0.17, PLA: 2.20 ± 0.22 mg/kg/min), or MCR (PIO: 1.63±0.37, PLA: 1.73±0.40 mL/kg/min). Results from this study indicate that PIO is not an effective intervention to enhance exogenous glucose oxidation or MCR during acute HA exposure. Lack of effect with PIO suggests the etiology of glucose metabolism dysregulation during acute HA exposure may not result from insulin resistance in peripheral tissues.

Early time-restricted eating improves markers of cardiometabolic health but has no impact on intestinal nutrient absorption in healthy adults

Early time-restricted eating (eTRE) improves aspects of cardiometabolic health. Although the circadian system appears to regulate nutrient absorption, little is known about the effects of eTRE on intestinal absorption. In this randomized crossover trial, 16 healthy adults follow a controlled, weight maintenance diet for 9 days, consuming all calories between 0800 and 1400 (eTRE schedule) or 0800 and 2000 (control schedule). We measure the energy content of the diet, stool, and urine with bomb calorimetry and calculate intestinal energy absorption. The eTRE schedule is more effective than the control eating schedule for improving markers of cardiometabolic health, including 24-h mean glucose concentrations and glycemic variability, assessed as the mean amplitude of glycemic excursions. However, eTRE has no effect on intestinal energy and macronutrient absorption, gastrointestinal transit time, colonic hydrogen gas production, or stool microbial composition, suggesting eTRE does not impact gastrointestinal function. This trial is registered (ClinicalTrials.gov: NCT04877262).

Replacement of dietary carbohydrate with protein increases fat mass and reduces hepatic triglyceride synthesis and content in female obese Zucker rats

Previous studies have demonstrated both energy restriction (ER) and higher protein (HP), lower carbohydrate (LC) diets downregulate hepatic de novo lipogenesis. Little is known about the independent and combined impact of ER and HP/LC diets on tissue-specific lipid kinetics in leptin receptor-deficient, obese rodents. This study investigated the effects of ER and dietary macronutrient content on body composition; hepatic, subcutaneous adipose tissue (SAT), and visceral AT (VAT) lipid metabolic flux (2 H2 O-labeling); and blood and liver measures of cardiometabolic health in six-week-old female obese Zucker rats (Leprfa+/fa+ ). Animals were randomized to a 10-week feeding intervention: ad libitum (AL)-HC/LP (76% carbohydrate/15% protein), AL-HP/LC (35% protein/56% carbohydrate), ER-HC/LP, or ER-HP/LC. ER groups consumed 60% of the feed consumed by AL. AL gained more fat mass than ER (P-energy = 0.012) and HP/LC gained more fat mass than HC/LP (P-diet = 0.025). Hepatic triglyceride (TG) concentrations (P-interaction = 0.0091) and absolute hepatic TG synthesis (P-interaction = 0.012) were lower in ER-HP/LC versus ER-HC/LP. ER had increased hepatic, SAT, and VAT de novo cholesterol fractional synthesis, absolute hepatic cholesterol synthesis, and serum cholesterol (P-energy≤0.0035). A HP/LC diet, independent of energy intake, led to greater gains in fat mass. A HP/LC diet, in the context of ER, led to reductions in absolute hepatic TG synthesis and TG content. However, ER worsened cholesterol metabolism. Increased adipose tissue TG retention with the HP/LC diet may reflect improved lipid storage capacity and be beneficial in this genetic model of obesity.

Effects of an Overnight, 8-Hour Low Oxygen Exposure on Energy Intake and Resting Energy Expenditure in Healthy, Normal Weight Adults

Objectives

Individuals who travel to high altitude (≥5,000 ft) are exposed to hypobaric hypoxic (HH) conditions (i.e., low pressure, low oxygen). Extended exposure to HH conditions often results in body weight loss. This body weight loss is the result of an increase in resting metabolic rate (RMR) due to alterations in the sympathetic and parasympathetic nervous system (PNS), and a decrease in energy intake due to appetite suppression. However, it is unknown if an acute bout of normobaric hypoxic (NH) exposure (i.e., normal pressure, low oxygen) at sea level induces similar changes in energy expenditure and intake. The objective of the current study was to determine the effects of a single overnight exposure to NH on RMR, heart rate variability (HRV), and energy and macronutrient intake compared to an overnight exposure to normobaric normoxia (NN) in normal-weight adults.

Methods

In this randomized crossover trial, normal-weight adults (n = 20; 22.7 ± 1.7 kg/m², 24.5 ± 3.9 y) slept 8 h in a tent maintained at either 15% oxygen (∼8500 ft) or 20% oxygen (∼1000 ft). The following morning, HRV was measured inside the tent using electrocardiography and RMR was measured outside the tent using indirect calorimetry. Energy and macronutrient intake were assessed in the morning outside the tent with an ad-libitum breakfast buffet and a self-reported dietary record kept for the remainder of the day.

Results

Overnight oxygen saturation was lower in NH (mean ± SD: 88 ± 2%) compared to NN (96 ± 1%; P < 0.0001). Following overnight exposure to NH, RMR was elevated (1537 ± 264 kcal/d) compared to NN (1491 ± 184 kcal/d; P = 0.018. Heart rate was higher in NH (64.2 ± 10.2 bpm) compared to NN (59.7 ± 10.9 bpm; P = 0.003). PNS activity [i.e., the root mean square of successive RR interval differences (RMSSD) and high frequency activity 0.15–0.4 hz (HF)] was lower following NH (47.7 ± 19.5 ms and 524 ± 335 ms², respectively) compared to NN (58.3 ± 22.6 ms, P = 0.034 and 748 ± 476 ms², P = 0.052, respectively). Energy and macronutrient intake did not differ between conditions.

Conclusions

One-night exposure to NH increases RMR and reduces PNS activity without impacting energy or macronutrient intake when compared to one-night NN exposure. Future studies should evaluate whether overnight NH exposure is an effective adjunct to traditional weight loss interventions.

Funding Sources

Internal funds from FSU.

Effects of Early Time-Restricted Eating on Intestinal Energy Absorption in Healthy Adults: The DIGEST Study Protocol

Objectives

Aligning energy intake with circadian rhythms and extending periods of fasting within a 24-h cycle improves whole-body metabolism. However, it is unknown if these improvements are related to changes in intestinal nutrient absorption (i.e., digestibility). The primary objective of the DIGEST study is to determine the impact of early time-restricted eating (eTRE) on energy and macronutrient digestibility, metabolizable energy, intestinal health and microbial composition, energy expenditure, glycemic variability, and circulating metabolites. A secondary objective is to identify factors that predict energy digestibility efficiency.

Methods

Healthy adults (n = 16, 20–45 y) will participate in a randomized, crossover, controlled feeding trial consisting of two 9-d weight maintenance diet periods, separated by at least a 2-wk washout. Participants will be randomized to follow an eTRE schedule (i.e., all calories consumed between 0800 and 1400) and a control eating schedule (i.e., all calories consumed between 0800 and 2000). Following a 3-d acclimation to the study diet and eating schedule, participants will consume a non-absorbable blue dye capsule to mark the beginning of stool collection. This will be repeated on day 7 to mark the end of stool collection. All urinary output will be collected on days 4, 5, and 6. Energy content of the diet, stool, and urine will be measured by bomb calorimetry. Digestible energy will be calculated as the difference between dietary energy intake and stool energy loss, and metabolizable energy as the difference between digestible energy and urinary energy loss. On day 5, participants will consume a capsule that measures intestinal transit time and hydrogen gas production. On day 6, thermic effect of food, circulating metabolites, and circadian gene expression will be measured in response to a mixed meal. A continuous glucose monitor will be worn during each study period to assess glucose concentrations and variability.

Results

To date, 10 participants have been enrolled and randomized and 3 participants have completed the study.

Conclusions

This is the first study, to our knowledge, to investigate the effects of eTRE on energy digestibility, which may provide mechanistic insight regarding the benefits of eTRE on whole-body metabolism.

Funding Sources

2021 Herbalife Nutrition Scholarship, FSU Council on Research & Creativity.

Energy Restriction Decreases Triglyceride Turnover in Subcutaneous and Visceral Adipose Tissue, but Has No Effect on Hepatic De Novo Lipogenesis in Obese Zucker Rats

Objectives

Obesity is associated with increased hepatic de novo lipogenesis (DNL) and altered triglyceride (TG) turnover. A previous trial in male Sprague Dawley rats demonstrated that both energy restriction and higher protein diets downregulate hepatic DNL. It is unknown whether energy restriction and higher protein diets alter kinetic measures of lipid metabolism in obese rodents. The present study examined the effects of energy restriction and dietary protein content on tissue-specific lipid kinetics in obese Zucker rats.

Methods

Six-week-old female obese Zucker rats (Leprfa+/fa+; n = 48) were randomized into one of four groups: ad libitum (AL) standard AIN-93 M diet (14% protein, 9% fat, 3 mg cholesterol/100 g feed), 60% energy-restricted (ER) diet, ad libitum high protein (AL + PRO) modified AIN-93 M diet (35% protein, 9% fat, 7.2 mg cholesterol/100 g feed), or a 60% energy-restricted high protein (ER + PRO) diet. Using 2H2O labeling and mass isotopomer distribution analysis, DNL, TG turnover, and de novo cholesterol synthesis were measured in hepatic, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) after 10 weeks of feeding. Two-way ANOVA and post-hoc Tukey pair-wise comparisons were performed.

Results

Energy restriction, independent of protein content, resulted in less body mass gain (main effect, P &lt; 0.05), although there were no differences in body fat % (ER: 50.8 ± 2.8%, ER + PRO: 50.5 ± 3.7%, AL: 47.3 ± 5.3%, AL + PRO: 50.0 ± 5.3%; P &gt; 0.05). Energy restriction decreased TG turnover in SAT and VAT (main effect, P &lt; 0.05), increased the contribution from DNL versus other sources to newly deposited TG in VAT (P &lt; 0.01), did not change total DNL in VAT or liver (P &gt; 0.05) but reduced DNL in SAT (P &lt; 0.01), and increased hepatic, SAT, and VAT de novo cholesterol synthesis (P &lt; 0.01). Dietary protein had no effect on lipid kinetics.

Conclusions

In obese Zucker rats, hepatic DNL was not altered by energy restriction or higher protein feeding. However, energy restriction did decrease TG turnover in SAT and VAT. In a leptin-deficient rodent model of obesity, energy restriction had differential effects on various measures of lipid metabolism.

Funding Sources

DMRP/USAMRDC. Views expressed are those of the authors and do not reflect the official policy of the Army, DoD, or U.S. Government.

BRD4 bimodal binding at promoters and drug-induced displacement at Pol II pause sites associates with I-BET sensitivity

Background

Deregulated transcription is a major driver of diseases such as cancer. Bromodomain and extra-terminal (BET) proteins (BRD2, BRD3, BRD4 and BRDT) are chromatin readers essential for maintaining proper gene transcription by specifically binding acetylated lysine residues. Targeted displacement of BET proteins from chromatin, using BET inhibitors (I-BETs), is a promising therapy, especially for acute myeloid leukemia (AML), and evaluation of resistance mechanisms is necessary to optimize the clinical efficacy of these drugs.

Results

To uncover mechanisms of intrinsic I-BET resistance, we quantified chromatin binding and displacement for BRD2, BRD3 and BRD4 after dose response treatment with I-BET151, in sensitive and resistant in vitro models of leukemia, and mapped BET proteins/I-BET interactions genome wide using antibody- and compound-affinity capture methods followed by deep sequencing. The genome-wide map of BET proteins sensitivity to I-BET revealed a bimodal pattern of binding flanking transcription start sites (TSSs), in which drug-mediated displacement from chromatin primarily affects BRD4 downstream of the TSS and prolongs the pausing of RNA Pol II. Correlation of BRD4 binding and drug-mediated displacement at RNA Pol II pause sites with gene expression revealed a differential behavior of sensitive and resistant tumor cells to I-BET and identified a BRD4 signature at promoters of sensitive coding and non-coding genes.

Conclusions

We provide evidence that I-BET-induced shift of Pol II pausing at promoters via displacement of BRD4 is a determinant of intrinsic I-BET sensitivity. This finding may guide pharmacological treatment to enhance the clinical utility of such targeted therapies in AML and potentially other BET proteins-driven diseases.

Electronic supplementary material

The online version of this article (10.1186/s13072-019-0286-5) contains supplementary material, which is available to authorized users.

Prediction and monitoring of relapse in stage III melanoma using circulating tumor DNA

BACKGROUND

The advent of effective adjuvant therapies for patients with resected melanoma has highlighted the need to stratify patients based on risk of relapse given the cost and toxicities associated with treatment. Here we assessed circulating tumor DNA (ctDNA) to predict and monitor relapse in resected stage III melanoma.

PATIENTS AND METHODS

Somatic mutations were identified in 99/133 (74%) patients through tumor tissue sequencing. Personalized droplet digital PCR (ddPCR) assays were used to detect known mutations in 315 prospectively collected plasma samples from mutation-positive patients. External validation was performed in a prospective independent cohort (n = 29).

RESULTS

ctDNA was detected in 37 of 99 (37%) individuals. In 81 patients who did not receive adjuvant therapy, 90% of patients with ctDNA detected at baseline and 100% of patients with ctDNA detected at the postoperative timepoint relapsed at a median follow up of 20 months. ctDNA detection predicted patients at high risk of relapse at baseline [relapse-free survival (RFS) hazard ratio (HR) 2.9; 95% confidence interval (CI) 1.5-5.6; P = 0.002] and postoperatively (HR 10; 95% CI 4.3-24; P < 0.001). ctDNA detection at baseline [HR 2.9; 95% CI 1.3-5.7; P = 0.003 and postoperatively (HR 11; 95% CI 4.3-27; P < 0.001] was also associated with inferior distant metastasis-free survival (DMFS). These findings were validated in the independent cohort. ctDNA detection remained an independent predictor of RFS and DMFS in multivariate analyses after adjustment for disease stage and BRAF mutation status.

CONCLUSION

Baseline and postoperative ctDNA detection in two independent prospective cohorts identified stage III melanoma patients at highest risk of relapse and has potential to inform adjuvant therapy decisions.

Recurrent mutations, including NPM1c, activate a BRD4-dependent core transcriptional program in acute myeloid leukemia

Recent evidence suggests that inhibition of bromodomain and extra-terminal (BET) epigenetic readers may have clinical utility against acute myeloid leukemia (AML). Here we validate this hypothesis, demonstrating the efficacy of the BET inhibitor I-BET151 across a variety of AML subtypes driven by disparate mutations. We demonstrate that a common 'core' transcriptional program, which is HOX gene independent, is downregulated in AML and underlies sensitivity to I-BET treatment. This program is enriched for genes that contain 'super-enhancers', recently described regulatory elements postulated to control key oncogenic driver genes. Moreover, our program can independently classify AML patients into distinct cytogenetic and molecular subgroups, suggesting that it contains biomarkers of sensitivity and response. We focus AML with mutations of the Nucleophosmin gene (NPM1) and show evidence to suggest that wild-type NPM1 has an inhibitory influence on BRD4 that is relieved upon NPM1c mutation and cytosplasmic dislocation. This leads to the upregulation of the core transcriptional program facilitating leukemia development. This program is abrogated by I-BET therapy and by nuclear restoration of NPM1. Finally, we demonstrate the efficacy of I-BET151 in a unique murine model and in primary patient samples of NPM1c AML. Taken together, our data support the use of BET inhibitors in clinical trials in AML.

BET protein inhibition shows efficacy against JAK2V617F-driven neoplasms

Small molecule inhibition of the BET family of proteins, which bind acetylated lysines within histones, has been shown to have a marked therapeutic benefit in pre-clinical models of mixed lineage leukemia (MLL) fusion protein-driven leukemias. Here, we report that I-BET151, a highly specific BET family bromodomain inhibitor, leads to growth inhibition in a human erythroleukemic (HEL) cell line as well as in erythroid precursors isolated from polycythemia vera patients. One of the genes most highly downregulated by I-BET151 was LMO2, an important oncogenic regulator of hematopoietic stem cell development and erythropoiesis. We previously reported that LMO2 transcription is dependent upon Janus kinase 2 (JAK2) kinase activity in HEL cells. Here, we show that the transcriptional changes induced by a JAK2 inhibitor (TG101209) and I-BET151 in HEL cells are significantly over-lapping, suggesting a common pathway of action. We generated JAK2 inhibitor resistant HEL cells and showed that these retain sensitivity to I-BET151. These data highlight I-BET151 as a potential alternative treatment against myeloproliferative neoplasms driven by constitutively active JAK2 kinase.

Linezolid-induced dyserythropoiesis: chloramphenicol toxicity revisited

We report here two cases of dyserythropoietic anaemia associated with long-term linezolid use that share striking similarities to chloramphenicol-associated myelotoxicity.

Transjugular liver biopsy is a safe and effective intervention to guide management for patients with a congenital bleeding disorder infected with hepatitis C

The prevalence of hepatitis C virus (HCV) infection in adult patients with a congenital bleeding disorder (CBD) approaches 95% and is a major cause of morbidity and mortality. Histological examination of the liver remains the cornerstone of management decisions in patients without a CBD. The reluctance to perform liver biopsies in patients with a CBD has been a major limitation in the management of these patients. We are currently the only haemophilia centre in Australasia performing liver biopsies in patients with a CBD for the purpose of guiding prognostic and therapeutic decisions. We report here the results of our centre's experience with transjugular liver biopsy (TJLB) in patients with a CBD. An adequate specimen for histological assessment was attained from all of the patients. There were no major complications recorded. Patients were hospitalized for < or = 48 h for haemostasis prophylaxis. The diagnostic specimen obtained from patients was integral in guiding their future management. We suggest that with a coordinated multidisciplinary approach, TJLB can be performed in patients with a CBD.

Successful mobilization of peripheral blood stem cells using recombinant human stem cell factor in heavily pretreated patients who have failed a previous attempt with a granulocyte colony-stimulating factor-based regimen

To assess the efficacy of recombinant human stem cell factor (rHuSCF), 48 patients who had failed to mobilize >2.0 x 10(6) CD34+ cells/kg with granulocyte colony-stimulating factor (G-CSF) (10 microg/kg twice daily) with, or without, concomitant chemotherapy (G-CSF-based regimen), were remobilized with the addition of rHuSCF (20 microg/kg/day). In all, 18/48 (38%) achieved a total of >2.0 x 10(6) CD34+ cells/kg with the second rHuSCF-based mobilisation alone and 29/48 (60%) achieved a cumulative total of >2.0 x 10(6) CD34+ cells/kg following remobilization. Inclusion of chemotherapy in the mobilization regimen resulted in a higher yield of CD34+ cells/kg for both the initial G-CSF-based and subsequent rHuSCF-based regimens (0.90 vs 0.54, P < 0.01 and 2.36 vs 1.34, P < 0.01, respectively). The total peripheral blood stem cells PBSC collected from the G-CSF-based regimen, performance status, baseline platelet count and albumin were significantly associated with successful remobilization. Patients with multiple myeloma were also more likely to successfully remobilize. There was no threshold of total collected from the failed G-CSF-based regimen below which successful remobilization with the rHuSCF-based regimen was not possible. We therefore propose a predictive model [PBSC expected = 0.6+(G-CSF-based total collection)+2 (rHuSCF-based day 1 collection)] to calculate the cumulative total of PBSC expected following a maximum of five leukaphereses. This algorithm may permit the early identification of patients who are unlikely to achieve sufficient PBSC for transplantation and allow physicians to direct the resources involved in PBSC collection in a more appropriate and economical manner.

Efficacy of donor vaccination before hematopoietic cell transplantation and recipient vaccination both before and early after transplantation

Allogeneic hematopoietic cell transplantation is followed by humoral immunodeficiency. We evaluated whether antibody levels can be improved by recipient vaccination on day -1 and 50 and whether the levels can be further improved by donor vaccination on day -20. A total of 85 patients were randomized or assigned to one of the following strategies of immunization with Streptococcus pneumoniae polysaccharides, Haemophilus influenzae polysaccharide-protein conjugate, tetanus toxoid (protein recall antigen) and hepatitis B surface antigen (protein neo-antigen): (1) donor on day -20, recipient on days -1, +50 and +365 (D(-20)R(-1,50,365)); (2) donor nil, recipient on days -1, +50 and +365 (D(N)R(-1,50,365)); or (3) donor nil, recipient on day +365 (D(N)R(365)). For H. influenzae and tetanus, IgG levels after grafting were the highest in the D(-20)R(-1,50,365) patients, intermediate in the D(N)R(-1,50,365) patients and the lowest in the D(N)R(365) patients. For S. pneumoniae and hepatitis B, antibody levels appeared to be similar in all three patient groups. The results suggest that for polysaccharide-protein conjugate antigens or protein recall antigens, recipient immunization on days -1 and 50 improves antibody levels and that donor vaccination on day -20 further improves the levels. In contrast, neither recipient immunization on days -1 and 50 nor donor immunization on day -20 appears to be efficacious for polysaccharide antigens and poorly immunogenic protein neo-antigens.

Immunity of patients surviving 20 to 30 years after allogeneic or syngeneic bone marrow transplantation

The duration of immunodeficiency following marrow transplantation is not known. Questionnaires were used to study the infection rates in 72 patients surviving 20 to 30 years after marrow grafting. Furthermore, in 33 of the 72 patients and in 16 donors (siblings who originally donated the marrow) leukocyte subsets were assessed by flow cytometry. T-cell receptor excision circles (TRECs), markers of T cells generated de novo, were quantitated by real-time polymerase chain reaction. Immunoglobulin G(2) (IgG(2)) and antigen-specific IgG levels were determined by enzyme-linked immunosorbent assay. Infections diagnosed more than [corrected] 15 years after transplantation occurred rarely. The average rate was 0.07 infections per patient-year (one infection every 14 years), excluding respiratory tract infections, gastroenteritis, lip sores, and hepatitis C. The counts of circulating monocytes, natural killer cells, B cells, CD4 T cells, and CD8 T cells in the patients were not lower than in the donors. The counts of TREC(+) CD4 T cells in transplant recipients younger than age 18 years (at the time of transplantation) were not different from the counts in their donors. In contrast, the counts of TREC(+) CD4 T cells were lower in transplant recipients age 18 years or older, even in those with no history of clinical extensive chronic graft-versus-host disease, compared with their donors. The levels of total IgG(2) and specific IgG against Haemophilus influenzae and Streptococcus pneumoniae were similar in patients and donors. Overall, the immunity of patients surviving 20 to 30 years after transplantation is normal or near normal. Patients who received transplants in adulthood have a clinically insignificant deficiency of de novo-generated CD4 T cells, suggesting that in these patients the posttransplantation thymic insufficiency may not be fully reversible.

Factors influencing B lymphopoiesis after allogeneic hematopoietic cell transplantation

In 93 allograft recipients, the numbers of marrow B-cell precursors on days 80 and 365 correlated with the counts of circulating B cells, suggesting that the posttransplantation B-cell deficiency is at least in part due to insufficient B lymphopoiesis. Factors that could affect B lymphopoiesis were evaluated. The number of marrow B-cell precursors on days 30 and 80 was at least 4-fold lower in patients with grade 2 to 4 acute graft-versus-host disease (GVHD) compared with patients with grade 0 to 1 acute GVHD. The number of B-cell precursors on day 365 was 18-fold lower in patients with extensive chronic GVHD compared with patients with no or limited chronic GVHD. The number of B-cell precursors was not related to CD34 cell dose, type of transplant (marrow versus blood stem cells), donor age, or patient age. It was concluded that posttransplantation B-cell deficiency results in part from inhibition of B lymphopoiesis by GVHD and/or its treatment.

Immune reconstitution after allogeneic marrow transplantation compared with blood stem cell transplantation

Allogeneic peripheral blood stem cell grafts contain about 10 times more T and B cells than marrow grafts. Because these cells may survive in transplant recipients for a long time, recipients of blood stem cells may be less immunocompromised than recipients of marrow. Immune reconstitution was studied in 115 patients randomly assigned to receive either allogeneic marrow or filgrastim-mobilized blood stem cell transplantation. Between day 30 and 365 after transplantation, counts of most lymphocyte subsets were higher in the blood stem cell recipients. The difference was most striking for CD4 T cells (about 4-fold higher counts for CD45RA(high) CD4 T cells and about 2-fold higher counts for CD45RA(low/-)CD4 T cells; P <.05). On assessment using phytohemagglutinin and herpesvirus antigen-stimulated proliferation, T cells in the 2 groups of patients appeared equally functional. Median serum IgG levels were similar in the 2 groups. The rate of definite infections after engraftment was 1.7-fold higher in marrow recipients (P =.001). The rate of severe (inpatient treatment required) definite infections after engraftment was 2.4-fold higher in marrow recipients (P =.002). The difference in the rates of definite infections was greatest for fungal infections, intermediate for bacterial infections, and lowest for viral infections. Death associated with a fungal or bacterial infection occurred between day 30 and day 365 after transplantation in 9 marrow recipients and no blood stem cell recipients (P =.008). In conclusion, blood stem cell recipients have higher lymphocyte-subset counts and this appears to result in fewer infections. (Blood. 2001;97:3380-3389)

Low B-cell and monocyte counts on day 80 are associated with high infection rates between days 100 and 365 after allogeneic marrow transplantation

To ascertain which mononuclear cell subset deficiency plays a role in the marrow transplant recipient's susceptibility to infections, mononuclear cell subset counts were prospectively determined in 108 patients on day 80. Infections occurring between day 100 and 365 were recorded by an investigator blinded to the subset counts. In univariate analyses, the counts of the following subsets showed a significant inverse correlation with infection rates: total B cells, IgD(+) B cells, IgD(-) B cells, total CD4 T cells, CD28(+) CD4 T cells, CD28(-) CD4 T cells, CD45RA(low/-) CD4 T cells and monocytes. In multivariate analyses, the counts of the following subsets remained significantly inversely correlated with the infection rates: total B cells (P =.0004) and monocytes (P =.009). CD28(-) CD8 T-cell counts showed no correlation with infection rates. In conclusion, the susceptibility of patients to infections late posttransplant may be due in part to the slow reconstitution of B cells and monocytes.

B-cell-autonomous somatic mutation deficit following bone marrow transplant

Hematopoietic stem cell transplantation is characterized by a prolonged period of humoral immunodeficiency. We have previously shown that the deficiencies are probably not due to the failure to utilize the appropriate V regions in the pre-immune repertoire. However, a striking observation, which correlated with the absence of immunoglobulin IgD(-) cells and was consistent with a defect in antigen-driven responses, was that rearrangements in bone marrow transplant (BMT) recipients exhibited much less somatic mutation than did rearrangements obtained from healthy subjects. In this paper, we present evidence suggesting that naive B cells obtained from BMT recipients lack the capacity to accumulate somatic mutations in a T-cell-dependent manner compared with healthy subjects. This appears to be a B-cell-autonomous deficit because T cells from some patients, which were not able to support the accumulation of mutations in autologous naive B cells, were able to support accumulation of mutations in heterologous healthy-subject naive B cells.

Comparison of two flow cytometric methods enumerating CD4 T cells and CD8 T cells

The enumeration of blood CD4+ (single-positive) T cells by flow cytometry is subject to errors such as counting CD4+ monocytes or CD4+CD8+ (double-positive) T cells as CD4+ T cells. Relatively accurate count can be obtained when CD4+ T cells are defined as CD3+CD4+CD8- mononuclear cells (MNCs), using 3-color flow cytometry. However, using this approach, further classification into CD4+ T cell subsets requires expensive 4-color flow cytometry. In an attempt to enumerate CD4+ T cells using only 2 colors, we have defined CD4+ T cells as MNCs expressing CD4 and not expressing the markers of other MNCs (CD8, CD13, CD14, and CD16) and compared the results to those obtained with the 3-color method in which CD4+ T cells were defined as CD3+CD4+CD8- MNCs. Both methods produced similar results. An analogous approach was undertaken to enumerate CD8+ T cells as MNCs expressing CD8 and not expressing the markers of other MNCs. However, when compared with the percents obtained by the 3-color method in which CD8+ T cells were defmed as CD3+CD4-CD8+ MNCs, the 2-color method overestimated the percent of CD8+ T cells. This was likely due to counting CD8low null cells as CD8+ T cells. When the percentages of CD8high T cells were evaluated, both methods produced similar results. We conclude that the 2-color method is suitable for the enumeration of CD4+ T cells and CD8high T cells and reserves the third color for further enumeration of CD4+ or CD8high T cell subsets.

Interaction of structurally similar pesticides with organic anion transport by primary cultures of winter flounder renal proximal tubule

We assessed the interaction of several pesticides with renal organic anion transport based on inhibition of the active transepithelial transport of p-aminohippuric acid ([3H]PAH) by primary cultures of winter flounder proximal tubules. Four structurally similar chlorophenoxy acid herbicides were tested. 2-Methyl-4-chlorophenoxyacetic acid at 0.1 mM had no effect on PAH transport. 2-(2,4-Dichlorophenoxy)propionic acid, 2-(2-methyl,4-chlorophenoxy)propionic acid and 2,4-dichlorophenoxyacetic acid inhibited PAH secretion with IC50 values (median inhibitory concentrations) of 0.09, 0.2 and 0.2 mM, respectively. At 2-(2-methyl,4-chlorophenoxy)propionic acid concentrations of 10(-7) to 10(-6) M, PAH secretion was stimulated to 132 and 139% of controls, respectively, at 2 hr. 2,2-bis-p-Chlorophenylacetic acid was tested at concentrations of 10(-7) to 10(-3) M and inhibited with an IC50 of 0.02 mM. At 10(-7) M 2,2-bis-p-chlorophenylacetic acid, a delayed increase was again seen in which PAH secretion increased to 154% of control at 2 hr. The anticholinesterase insecticide phosphothioic acid O,O-diethyl-O-(3,5,6-trichloro-2-pyridinyl ester), its more active metabolite O,O-diethyl-O-(3,5,6-trichloro-2-pyridyl)phosphate and its dimethyl analog, phosphothioic acid O,O-dimethyl-O-(3,5,6-trichloro-2-pyridinyl ester) were tested at 0.1 mM. Phosphothioic acid O,O-diethyl-O-(3,5,6-trichloro-2-pyridinyl ester) increased PAH secretion significantly to 115% of control whereas the O,O-diethyl-O-(3,5,6-trichloro-2-pyridyl)phosphate inhibited by 28%.(ABSTRACT TRUNCATED AT 250 WORDS)

Organic anion secretion by winter flounder renal proximal tubule primary monolayer cultures

Recent models of para-aminohippuric acid (PAH) transport by renal proximal tubule have been deduced from isolated membrane vesicles and stopped flow microperfusion. The flounder proximal tubule primary monlayer cultures mounted in Ussing chambers have provided a means to examine the relationship of these models to transepithelial transport. Unidirectional transepithelial 3H-PAH fluxes were determined in 12-day-old monolayers on floating collagen gels under continuously short-circuited conditions. The kinetic values of PAH secretory flux were complex. Over the range of 0.6 microM to 1.5 mM the K1/2 was 0.4 mM and Vmax was 80 nmol/cm2/h. Reabsorptive flux did not saturate. 1 mM probenecid inhibited 95% of the secretory flux (0.07 +/- 0.18 compared with control of 1.38 +/- 0.34 nmol/cm2/h at 10 microM PAH) and had no significant effect on reabsorptive flux (probenecid, 0.07 +/- 0.04; control, 0.05 +/- 0.01 nmol/cm2/h). 0.1 mM 4-acetamido-4'-isothiocyanalostilbene-2,2'-diasulfonic acid and 1 mM benzoylpropionic acid also significantly inhibited secretory flux (95 and 78%, respectively). These inhibitors appeared to be specific in that no effects on transepithelial potential difference, resistance or phlorizin-sensitive current were seen. Removal of Na during flux measurement reduced net PAH secretion to zero, and 1 mM ouabain reduced PAH secretory flux to 10% of control within 90 min with no effect on reabsorptive (leak) flux. Clamping transepithelial voltage to +/- 10 mV had no significant effect on PAH fluxes. Addition of glutarate to flounder saline significantly inhibited PAH secretory flux starting at 0.1 mM and caused 90% inhibition at 1 mM; no stimulation of transport was noted at any glutarate concentration.

Field studies on ozone inactivation of a Gymnodinium breve toxin

Water samples were collected from Boca Ciega Bay (St. Petersburg) during the April, 1974, red tide that occurred on the Florida west coast. The causative agent of this phenomenon was the toxic dinoflagellate, Gymnodinium breve. The toxic red tide samples were treated with ozone gas and rendered nonlethal, as measured by mouse injection.