Deletion of the inhibitory co-receptor CTLA-4 enhances and invigorates chimeric antigen receptor T cells

Chimeric antigen receptor (CAR) T cell therapy targeting CD19 has achieved tremendous success treating B cell malignancies; however, some patients fail to respond due to poor autologous T cell fitness. To improve response rates, we investigated whether disruption of the co-inhibitory receptors CTLA4 or PD-1 could restore CART function. CRISPR-Cas9-mediated deletion of CTLA4 in preclinical models of leukemia and myeloma improved CAR T cell proliferation and anti-tumor efficacy. Importantly, this effect was specific to CTLA4 and not seen upon deletion of CTLA4 and/or PDCD1 in CAR T cells. Mechanistically, CTLA4 deficiency permitted unopposed CD28 signaling and maintenance of CAR expression on the T cell surface under conditions of high antigen load. In clinical studies, deletion of CTLA4 rescued the function of T cells from patients with leukemia that previously failed CAR T cell treatment. Thus, selective deletion of CTLA4 reinvigorates dysfunctional chronic lymphocytic leukemia (CLL) patient T cells, providing a strategy for increasing patient responses to CAR T cell therapy.

Abstract 5571: Disruption of cell-intrinsic checkpoint regulator CTLA-4 in CD19 directed CAR T cells provides clinical efficacy in CLL patients

The field of cancer immunotherapy has led to successful treatments such as monoclonal antibodies (MAb), inhibitory receptor (IR) blockade, and adoptive cell transfer (ACT). ACT modified to express chimeric antigen receptors (CARs) can redirect T cells to tumor antigens and has shown remarkable clinical efficacy in patients with relapse and refractory leukemia and lymphoma. 90% of pediatric patients with acute lymphoblastic leukemia (ALL) respond to CD19 CAR T cell therapy (CAR T19), although only 26-35% of patients with chronic lymphocytic leukemia (CLL) show complete responses (CR). It is unclear why responses are less frequent in CLL compared to ALL. The heavy pre-treatment received by CLL patients likely contributes to lower response rates with CAR T cell therapy, and disease progression is worsened due to profound T cell defects characterized by elevated expression of IRs such as PD-1 and CTLA-4. Fraietta et. al. assessed CLL patient apheresis samples and CART19 products to show that CR was associated with elevated levels of CD27+PD1-CD8+ T memory cells whereas the non-responders (NR) showed an exhausted phenotype with high levels of multiple IRs. We studied 14 patients with advanced, heavily pretreated CLL who received at least one dose of CART19. Patients with CRs exhibited high in vivo expansion and persistence of infused CAR T cells, as opposed to NR’s. Importantly, at peak levels of in vivo CAR expansion, NR’s had elevated levels of CTLA-4 expression which correlated with poor CLL patient responses to CART19 therapy. In summary, these data suggest that eliminating CTLA-4 mediated T cell inhibition can be clinically beneficial. Thus, we tested the hypothesis that disruption of CTLA4 would improve CAR T cell efficacy in CLL based on numerous observations. Our data demonstrate that knockout (KO) of CTLA-4 in T cells from healthy donors using CRISPR Cas9 technology leads to maintenance of surface CAR expression and higher tumor clearance in a chronic re-stimulation model using CART19 cells against NALM6 tumor cells. In xenograft models of ALL, KO of CTLA-4 increases the anti-tumor efficacy of CART19 cells. We then performed CTLA4 disruption in T cells banked from CLL patients that did not respond to CAR T cell therapy to determine whether dysfunctional CAR T infusion products can be invigorated by CTLA-4 KO. In both chronic re-stimulation model and xenograft models of NALM6, CTLA-4 KO CD19 CAR T cells from CLL patients maintained surface CAR expression, exhibited enhanced tumor clearance, and higher survival rates relative to subject-matched unedited CAR T cells. Thus, suggesting that CTLA4 disrupted CAR T cell products may enhance the success rate of CAR T cell therapy for CLL patients. This technology can be feasibly expanded to other tumor indications to increase the overall efficacy of CAR T cells. These IND-enabling studies will support the translation of this therapy to the clinic.

Citation Format: Sangya Agarwal, Angela Aznar Gomez, Tong Da, Shunichiro Kuramitsu, Weimin Kong, Pranali Ravikumar, Mercy Gohil, Megan M. Davis, Joseph A. Fraietta, Gabriela Plesa, David L. Porter, Regina M. Young, Carl H. June. Disruption of cell-intrinsic checkpoint regulator CTLA-4 in CD19 directed CAR T cells provides clinical efficacy in CLL patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5571.

A Fas-4-1BB fusion protein converts a death to a pro-survival signal and enhances T cell therapy

Adoptive T cell therapy (ACT) with genetically modified T cells has shown impressive results against some hematologic cancers, but efficacy in solid tumors can be limited by restrictive tumor microenvironments (TMEs). For example, Fas ligand is commonly overexpressed in TMEs and induces apoptosis in tumor-infiltrating, Fas receptor–positive lymphocytes. We engineered immunomodulatory fusion proteins (IFPs) to enhance ACT efficacy, combining an inhibitory receptor ectodomain with a costimulatory endodomain to convert negative into positive signals. We developed a Fas-4-1BB IFP that replaces the Fas intracellular tail with costimulatory 4-1BB. Fas-4-1BB IFP-engineered murine T cells exhibited increased pro-survival signaling, proliferation, antitumor function, and altered metabolism in vitro. In vivo, Fas-4-1BB ACT eradicated leukemia and significantly improved survival in the aggressive KPC pancreatic cancer model. Fas-4-1BB IFP expression also enhanced primary human T cell function in vitro. Thus, Fas-4-1BB IFP expression is a novel strategy to improve multiple T cell functions and enhance ACT against solid tumors and hematologic malignancies.

Impaired Death Receptor Signaling in Leukemia Causes Antigen-Independent Resistance by Inducing CAR T-cell Dysfunction

Primary resistance to CD19-directed chimeric antigen receptor T-cell therapy (CART19) occurs in 10% to 20% of patients with acute lymphoblastic leukemia (ALL); however, the mechanisms of this resistance remain elusive. Using a genome-wide loss-of-function screen, we identified that impaired death receptor signaling in ALL led to rapidly progressive disease despite CART19 treatment. This was mediated by an inherent resistance to T-cell cytotoxicity that permitted antigen persistence and was subsequently magnified by the induction of CAR T-cell functional impairment. These findings were validated using samples from two CAR T-cell clinical trials in ALL, where we found that reduced expression of death receptor genes was associated with worse overall survival and reduced T-cell fitness. Our findings suggest that inherent dysregulation of death receptor signaling in ALL directly leads to CAR T-cell failure by impairing T-cell cytotoxicity and promoting progressive CAR T-cell dysfunction. SIGNIFICANCE: Resistance to CART19 is a significant barrier to efficacy in the treatment of B-cell malignancies. This work demonstrates that impaired death receptor signaling in tumor cells causes failed CART19 cytotoxicity and drives CART19 dysfunction, identifying a novel mechanism of antigen-independent resistance to CAR therapy.See related commentary by Green and Neelapu, p. 492.

Impaired Death Receptor Signaling in Leukemia Causes Antigen-Independent Resistance by Inducing CAR T-cell Dysfunction

Primary resistance to CD19-directed chimeric antigen receptor T-cell therapy (CART19) occurs in 10% to 20% of patients with acute lymphoblastic leukemia (ALL); however, the mechanisms of this resistance remain elusive. Using a genome-wide loss-of-function screen, we identified that impaired death receptor signaling in ALL led to rapidly progressive disease despite CART19 treatment. This was mediated by an inherent resistance to T-cell cytotoxicity that permitted antigen persistence and was subsequently magnified by the induction of CAR T-cell functional impairment. These findings were validated using samples from two CAR T-cell clinical trials in ALL, where we found that reduced expression of death receptor genes was associated with worse overall survival and reduced T-cell fitness. Our findings suggest that inherent dysregulation of death receptor signaling in ALL directly leads to CAR T-cell failure by impairing T-cell cytotoxicity and promoting progressive CAR T-cell dysfunction. SIGNIFICANCE: Resistance to CART19 is a significant barrier to efficacy in the treatment of B-cell malignancies. This work demonstrates that impaired death receptor signaling in tumor cells causes failed CART19 cytotoxicity and drives CART19 dysfunction, identifying a novel mechanism of antigen-independent resistance to CAR therapy.See related commentary by Green and Neelapu, p. 492.

Ionizable Lipid Nanoparticle-Mediated mRNA Delivery for Human CAR T Cell Engineering

Chimeric antigen receptor (CAR) T cell therapy relies on the ex vivo manipulation of patient T cells to create potent, cancer-targeting therapies, shown to be capable of inducing remission in patients with acute lymphoblastic leukemia and large B cell lymphoma. However, current CAR T cell engineering methods use viral delivery vectors, which induce permanent CAR expression and could lead to severe adverse effects. Messenger RNA (mRNA) has been explored as a promising strategy for inducing transient CAR expression in T cells to mitigate the adverse effects associated with viral vectors, but it most commonly requires electroporation for T cell mRNA delivery, which can be cytotoxic. Here, ionizable lipid nanoparticles (LNPs) were designed for ex vivo mRNA delivery to human T cells. A library of 24 ionizable lipids was synthesized, formulated into LNPs, and screened for luciferase mRNA delivery to Jurkat cells, revealing seven formulations capable of enhanced mRNA delivery over lipofectamine. The top-performing LNP formulation, C14-4, was selected for CAR mRNA delivery to primary human T cells. This platform induced CAR expression at levels equivalent to electroporation, with substantially reduced cytotoxicity. CAR T cells engineered via C14-4 LNP treatment were then compared to electroporated CAR T cells in a coculture assay with Nalm-6 acute lymphoblastic leukemia cells, and both CAR T cell engineering methods elicited potent cancer-killing activity. These results demonstrate the ability of LNPs to deliver mRNA to primary human T cells to induce functional protein expression, and indicate the potential of LNPs to enhance mRNA-based CAR T cell engineering methods.

Cheating death: a Fas-41BB immunomodulatory fusion protein obviates a death signal to enhance T cell function and adoptive therapy targeting leukemia and solid tumors

Fas/FasL signaling plays a significant role in the generation and persistence of tumors. We and others have detected FasL expression in the tumor microenvironment (TME) of human ovarian, pancreatic, and other cancers, where it can function to protect tumor cells from tumor-infiltrating lymphocytes. Adoptive immunotherapy, a promising treatment option, uses genetically modified T cells to eliminate tumors. However, efficacy of T cell immunotherapy is dampened by limited costimulation as well as increased inhibitory and death signals in the TME. We previously showed enhanced therapeutic efficacy by engineering T cells to express an immunomodulatory fusion protein (IFP) to convert the inhibitory CD200R signal to a costimulatory CD28 signal and questioned if IFPs could use a 4-1BB signal to enhance in vivo persistence and memory formation. 4-1BB forms a trimer when binding its ligand, that is requisite for an effective costimulatory signal. We and others engineered T cells to express 4-1BB with an ectodomain that dimerizes, however this IFP did not improve T cell function. We hypothesized a Fas IFP with a 4-1BB signal would effectively replace Fas signaling and provide costimulation, as Fas also trimerizes when engaged by ligand. T cells transduced with the Fas-4-1BB IFP exhibited enhanced accumulation and function in vitro. In a model of leukemia, Fas-4-1BB-transduced T cells eradicated otherwise lethal disease and exhibited increased persistence. Preliminary data in the autochthonous KPC pancreatic and ID8 ovarian cancer models support increased efficacy. We describe for the first time that an IFP can generate an effective 4-1BB signal to overcome obstacles in the TME and enhance T cell immunotherapy of solid and liquid malignancies.

A Comparative Study of Neurological Complications in Chronic Kidney Disease with Special Reference to its Stages and Haemodialysis Status

INTRODUCTION

Globally, Chronic Kidney Disease (CKD) is a critical and rapidly growing health problem and also a major cause of mortality and morbidity. Neurological complications occur in all levels of the nervous system. Central nervous system complications include cerebrovascular accidents, posterior reversible encephalopathy syndrome, osmotic demyelization syndrome, cerebral infection and sinus vein thrombosis. Peripheral nervous system complications include polyneuropathy, mononeuropathy and carpal tunnel syndrome. Haemodialysis (HD) related neurological complications include dialysis disequilibrium syndrome, dementia and cerebrovascular accidents.

AIM

To assess the neurological complications of CKD and to compare the various neurological complications in patients on HD with those not on HD.

MATERIALS AND METHODS

Hundred patients with CKD were included in the study. They were categorized into two groups according to the stage of CKD and those with stage 3 or more were considered as cases and stage 2 or less as controls. The cases and controls were followed up during subsequent visits for neurological complications.

RESULTS

This study comprised of 50 cases and 50 controls. Among 50 cases, males were 62% and females were 38% with male: female ratio was 1.6:1 and in controls, male: female ratio was 1.08:1. The maximum patients were in the age group of 51-60 years. The incidence of neurological complications was significantly higher in cases compared to controls and among people who underwent dialysis compared to those who were not. Headache was the most common complication both among cases and controls and as well as in people who were on HD. Stroke, seizures and altered sensorium were significantly associated with later stage of CKD. Cases underwent HD had significant association with headache, altered sensorium and stroke than those without HD but peripheral neuropathy and seizure did not show such association.

CONCLUSION

The chances of development of neurological complications were significantly higher in late stages of CKD compared to early stages of CKD. Those neurological complications were more among people who underwent dialysis when compared to those not on maintenance HD.

Wheat Seedlings as Food Supplement to Combat Free Radicals: An In Vitro Approach

The present study was designed to evaluate the antioxidant activity of 5 organic solvent extracts (petroleum ether, n-hexane, chloroform, ethyl acetate and methanol) of wheat grains, 3, 5 and 7 days old wheat seedlings. To determine the antioxidant activity of five extracts of four different samples, 1,1-diphenyl-2-picrylhydrazyl and 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging activity, total phenolic content and ferrous reducing power ability were carried out. 1,1-Diphenyl-2-picrylhydrazyl radical scavenging effect of chloroform and ethyl acetate extracts of 3 days old wheat seedlings was higher than wheat grains. Chloroform, ethyl acetate and methanol extracts of 3 days old wheat seedlings exhibited higher 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging effcet than extracts of other samples. The phenolic content was high in chloroform, ethyl acetate and methanol extract of 5 days old wheat seedlings. When compared with wheat grain, reducing power ability was high in chloroform, ethyl acetate and methanol extract of wheat seedlings, especially in 3 and 5 days old wheat seedlings. From the above results, it was concluded that chloroform, ethyl acetate and methanol extract of 3, 5 and 7 days old wheat seedlings showed better antioxidant activity than the wheat grain extracts. Hence, the results of the present study suggest the intake of wheat seedlings as a food supplement to combat the diseases caused by free radicals.

Alveolar-capillary adaptation to chronic hypoxia in the fatty lung

AIM

Obese diabetic (ZDF fa/fa) rats with genetic leptin resistance suffer chronic lipotoxicity associated with age-related lung restriction and abnormal alveolar ultrastructure. We hypothesized that these abnormalities impair adaptation to ambient hypoxia.

METHODS

Male fa/fa and lean (+/+) ZDF rats (4-months old) were exposed to 21 or 13% O2 for 3 weeks. Lung function was measured under anaesthesia. Lung tissue was assayed for DNA damage and ultrastructure measured by morphometry.

RESULTS

In normoxia, lung volume, compliance and diffusing capacity were lower, while blood flow was higher in fa/fa than +/+ rats. In hypoxia, fa/fa animals lost more weight, circulating hematocrit rose higher, and lung volume failed to increase compared to +/+. In fa/fa, the hypoxia-induced increase in post-mortem lung volume was attenuated (19%) vs. +/+ (39%). Alveolar ducts were 35% smaller in normoxia but enlarged twofold more in hypoxia compared to +/+. Hypoxia induced broad increases (90-100%) in the volumes and surface areas of alveolar septal components in +/+ lungs; these increases were moderately attenuated in fa/fa lungs (58-75%), especially that of type II epithelium volume (16 vs. 61% in +/+). In fa/fa compared to +/+ lungs, oxidative DNA damage was greater with increased hypoxia induced efflux of alveolar macrophages. Harmonic mean thickness of the diffusion barrier was higher, indicating higher structural resistance to gas transfer.

CONCLUSION

Chronic lipotoxicity impaired hypoxia-induced lung expansion and compensatory alveolar growth with disproportionate effect on resident alveolar progenitor cells. The moderate structural impairment was offset by physiological adaptation primarily via a higher hematocrit.

Development of a novel malarial vaccine design: a hypothetical approach

P. falciparum is highly virulent in nature because of its ability to modify the infected host red blood cells, adherence to the vascular endothelium and changes in antigenicity at different stages. Also slow migration time in the dermal and endothelial cells leads to decreased immune response. To overcome the problems, there is a need to design a vaccine which increases the migration time of the parasite, enhances the immune response, enables recognition of surface antigens and causes minimal clinical infection as a side-effect. An ITI-based (Infection-Treatment Immunization) vaccine development strategy is to be adopted to develop this novel vaccine. This will include administration of a liquid solution of purified, non-attenuated sporozoites from an infected female Anopheles mosquito, AS02A adjuvant and chlorate (a metabolic inhibitor of sulfation that decreases the extent of GAG sulfation). To control infection, a drug-cover of artemisinin will be administered as a part of the vaccination strategy along with a specific protease inhibitor MRT12113 which prevents RBC rupture and reinvasion by the parasite. This vaccine will intend to increase the overall migration time of the parasite in blood which is otherwise approximately 30 minutes, resulting in an overall enhanced immune response. It also intends to reduce parasite invasion in cells and their consequent rupture thus preventing the clinical condition-malaria.

Geochemistry of groundwater and groundwater prospects evaluation, Anekal Taluk, Bangalore Urban District, Karnataka, India

Anekal Taluk lies in the southern part of the of Bangalore urban district, known for Bannerghatta wildlife sanctuary, Jigani industrial estate, silk industry, and the electronics city, the pride of India and hub of Bangalore's information technology. In the present study, evaluation of geochemistry of 28 representative bore wells samples from Anekal Taluk was undertaken. It was found that most of the samples (92.9%) belong to Ca(2+ )-Mg(2+ )-Cl( - ) -SO²⁻₄water type with Ca-Mg-Cl and Ca-Cl hydrochemical facies. The groundwater sources were further categorized as normal chloride (32.14%) and normal sulfate (100%) water types based on Cl and SO(4) concentrations. Majority of the samples (64.3%) belong to C3-S1 water class, indicating water with high salinity and low sodium. Positive index of base exchange indicates the chloro-alkaline equilibrium in the study area. Groundwater potential zonation map for Anekal Taluk was generated using multiparametric and weighted overlay method using the spatial analyst tool in ArcGIS v9.2. Accordingly, five distinct classes corresponding to good(high), moderate (medium), moderate to poor (low), poor (very low), and poor to nil (very low) groundwater potential zones were identified in the region. Of this, 85.27% of the study area belongs to good/high to moderate/medium groundwater potential and only 14.73% belonging to moderate/poor to nil groundwater potential zones.

Self Replicating Gene Vaccine Carrying P1-2A Gene of FMDV Serotype O and its Effects on the Immune Responses of Cattle

DNA vaccines are considered as alternatives to live attenuated ones for those diseases like foot-and-mouth disease (FMD) where the production and application of live vaccines have been found unsuccessful. However, stability of DNA and the quantity of antigen expressed are the major limitation with naked DNA vaccines. To address these issues self replicating gene vaccine construct was made for foot-and-mouth disease virus (FMDV) type 'O' and studied. The vector for vaccine construct, designated as pSinCMVVac carried CMV promoter and Poly(A) signal sequences at 5' and 3' end of Sindbis replicase gene respectively. Gene for structural protein precursor (P1-2A) of FMDV serotype 'O' was inserted into pSinCMVVac under subgenomic promoter. 5'UTR (untranslated region) of FMDV was introduced upstream of P1-2A to enhance the level of expression of cloned gene. Functionality of the vaccine construct was confirmed in vitro and in vivo. The self-replicating gene vaccine construct was tested in cattle in comparison with naked DNA vaccine carrying P1-2A and 3CD (pUP3CD). Humoral immune response by ELISA and SNT and cellular response by lymphoproliferation assay using MTT were studied. The default approach of using self replicating gene vaccine in high dose and multiple injection in cattle as followed in our studies might result in immunosuppression as this was observed in our subsequent experiments in guinea pigs. Hence based on dose response studies, vaccine strategy needs to be decided. However, the approach of using Sindbis polymerase gene and UTR in FMDV vaccine is the first report and shows future scope of developing such vaccines.

Alterations in HbA(1c) with advancing age in subjects with normal glucose tolerance: Chandigarh Urban Diabetes Study (CUDS)

OBJECTIVE

To study the alterations in HbA(1c) with advancing age in subjects with normal glucose tolerance.

METHODS

Community-based cross-sectional study involving 2368 subjects aged ≥ 20 years from Chandigarh, India. All the subjects underwent an oral glucose tolerance test with 75 g anhydrous glucose and were classified as having normal glucose tolerance, pre-diabetes or diabetes according to World Health Organization 1999 criteria. HbA(1c) was measured on a National Glycohemoglobin Standardization Program-certified Bio-Rad D-10 system and the data were available for 1972 subjects.

RESULTS

Out of 1972 subjects, 1317 (67%) subjects had normal glucose tolerance. There was a significant positive correlation between mean HbA(1c) and age in these subjects (r = 0.308, P(trend) < 0.001). The increase in HbA(1c) with each advancing year was 0.01% above the age of 20 years and corrected HbA(1c) (%) for age was 5.09 + 0.01 (age). The 95th percentile of HbA(1c) exceeded 6.5% (48 mmol/mol) (the American Diabetes Association cut-off for diagnosis of diabetes) in subjects aged ≥ 70 years. A significantly higher number (6.5%, 21/325) of subjects had HbA(1c) of ≥ 6.5% (48 mmol/mol) in those above the age of 50 years compared with those below the age of 50 years (1.7%, 17/992) in the group with normal glucose tolerance (P < 0.001). On multivariate regression analysis, after adjusting for BMI, fasting plasma glucose and 2-h plasma glucose post-glucose load, the correlation of HbA(1c) with age still remained significant (r = 0.241, P < 0.01).

CONCLUSION

HbA(1c) increases with advancing age independent of glycaemia, suggesting caution when seeking to achieve the recommended HbA(1c) targets in the elderly population.

Structural and functional analyses of a saturated acyl ACP thioesterase, type B from immature seed tissue of Jatropha curcas

The distinguishing structural and functional domains of plant acyl-acyl carrier protein (ACP) thioesterases and their complex interaction with the ACP-linked fatty acid substrate complex have remained elusive. E. coli based heterologous expression and characterisation of many plant thioesterases reported so far have not been extended and linked to in silico modelling studies to explain the diversity in plant thioesterase substrate specificities. In this study, a thioesterase cDNA isolated from immature seed tissues of Jatropha curcas was found to be type B and specific to stearoyl acyl ACP when expressed in E. coli K27fadD88, a lipid utilisation mutant. Homology modelling and molecular docking of a selected region of the isolated JcFatB protein predicted that it had high affinity towards both stearate (18:0) and palmitate (16:0). Structural analysis of the sequence confirmed the presence of a transit peptide that is processed in multiple steps. The enzyme is localised in the chloroplasts and has an N-terminal inner chloroplast transmembrane domain characteristic of type B plant thioesterases. Docking of ligands with JcFatB and its comparison with a modelled Jatropha thioesterase type A provided further evidence for native substrate preferences of Jatropha thioesterases. This study provides essential clues to develop future methods for large-scale bacterial production of free fatty acids and for design of strategies to modulate the seed oil composition in this important non-edible, seed oil plant.

Environmental tritium (³H) and hydrochemical investigations to evaluate groundwater in Varahi and Markandeya river basins, Karnataka, India

The present study aimed at assessing the activity of natural radionuclides ((3)H) and hydrochemical parameters (viz., pH, EC, F(-), NO(3)(-), Cl(-), Ca(2+), Mg(2+)) in the groundwater used for domestic and irrigation purposes in the Varahi and Markandeya river basins to understand the levels of hydrochemical parameters in terms of the relative age(s) of the groundwater contained within the study area. The recorded environmental (3)H content in Varahi and Markandeya river basins varied from 1.95 ± 0.25T.U. to 11.35 ± 0.44T.U. and 1.49 ± 0.75T.U. to 9.17 ± 1.13T.U. respectively. Majority of the samples in Varahi (93.34%) and Markandeya (93.75%) river basins being pre-modern water with modern recharge, significantly influenced by precipitation and river inflowing/sea water intrusion. The EC-Tritium and Tritium-Fluoride plots confirmed the existence of higher total dissolved solids (SEC > 500 μS/cm) and high fluoride (MAC > 1.5 mg/L) in groundwater of Markandeya river basin, attributed to relatively longer residence time of groundwater interacting with rock formations and vice versa in case of Varahi river basin. The tritium-EC and tritium-chloride plots indicated shallow and deep circulating groundwater types in Markandeya river basin and only shallow circulating groundwater type in Varahi river basin. Increasing Mg relative to Ca with decreasing tritium indicated the influence of incongruent dissolution of a dolomite phase. The samples with high nitrate (MAC > 45 mg/L) are waters that are actually mixtures of fresh water (containing very high nitrate, possibly from agricultural fertilizers) and older 'unpolluted' waters (containing low nitrate levels), strongly influenced by surface source.

Hydrochemistry and evaluation of groundwater suitability for irrigation and drinking purposes in the Markandeya River basin, Belgaum District, Karnataka State, India

Markandeya River basin stretches geographically from 15°56' to 16°08' N latitude and 74°37' to 74°58' E longitude, positioned in the midst of Belgaum district, in the northern part of Karnataka. Since the quantity and quality of water available for irrigation in India is variable from place to place, groundwater quality in the Markandeya River basin was evaluated for its suitability for drinking and irrigation purposes by collecting 47 open and bore-well samples during the post-monsoon period of 2008. The quality assessment was made by estimating pH, electrical conductivity, total dissolved solids, hardness, and alkalinity besides major cations (Na+, K+, Ca2+, and Mg2+) and anions (HCO3-, Cl-, SO4(2-), PO4(3-), F-, and NO3-). Based on these analyses, irrigation quality parameters like, sodium absorption ratio, %Na, residual sodium carbonate, residual sodium bicarbonate, chlorinity index, soluble sodium percentage, non-carbonate hardness, potential salinity, permeability index, Kelley's ratio, magnesium hazard/ratio, index of base exchange, and exchangeable sodium ratio were calculated. According to Gibbs' ratio, majority of water samples fall in the rock dominance field. The groundwater samples were categorized as normal chloride (95.75%), normal sulfate (95.75%), and normal bicarbonate (61.70%) water types based on Cl, SO4, and HCO3 concentrations. Based on the permeability index, majority of the samples belongs to classes 1 and 2, suggesting the suitability of groundwater for irrigation. The negative index of base exchange indicates the existence of chloro-alkaline disequilibrium (indirect base exchange reaction) existing in majority of the samples (68.08%) from the study area.

Prevalence and risk factors of diabetes in a community-based study in North India: the Chandigarh Urban Diabetes Study (CUDS)

AIMS

As there have been few studies in North India of the prevalence of diabetes within the past decade, this study aimed to assess the prevalence and risk factors associated with diabetes in the North Indian city of Chandigarh.

METHODS

This cross-sectional survey of 2227 subjects (response rate: 94%), aged ≥20 years and representative of the urban Chandigarh population, was conducted from April 2008 to June 2009. Fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) following ingestion of 75 g of an anhydrous glucose equivalent were estimated by glucometer in all subjects except those with known diabetes, in whom only FPG was measured. Diagnosis of diabetes was based on 1999 WHO criteria. The collected prevalence data was age-standardized for the Chandigarh population, and multivariate logistic-regression analysis was used to correlate risk factors with the presence of diabetes.

RESULTS

A total of 349 subjects (15.7%, 95% CI: 13.9-16.9) were diabetic, comprising 210 (9.4%) with known diabetes and 139 (6.2%) with newly diagnosed diabetes, and 344 (15.4%, 95% CI: 14.3-17.1) subjects were prediabetic. The age-standardized prevalence of diabetes and prediabetes were 11.1% (95% CI: 9.7-12.4) and 13.2% (95% CI: 11.8-14.6), respectively. Age ≥50 years, a family history of diabetes, BMI ≥23 kg/m(2), abdominal obesity and hypertension were significantly and positively associated with the presence of diabetes, whereas educational status was negatively associated with diabetes (P<0.001 for all).

CONCLUSION

The age-standardized prevalence of diabetes and prediabetes were 11.1% and 13.2%, respectively. Older age, family history of diabetes, obesity and hypertension were positively related, while educational status was negatively related, to the presence of diabetes.

Prevalence and risk factors of metabolic syndrome among Asian Indians: a community survey

AIM

To determine the prevalence of and risk factors for metabolic syndrome (MS) among urban Asian Indian adults.

METHODS

2225 subjects aged > or =20 years were studied in a population based cross-sectional survey in Chandigarh, a city in north India. Anthropometric measurements, estimation of capillary plasma glucose, HDL cholesterol and triglycerides were done. Metabolic syndrome prevalence was estimated using National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), modified NCEP ATP III and International Diabetes Federation (IDF) criteria. Multiple logistic regression analysis was done to find out risk factors for metabolic syndrome.

RESULTS

The prevalence rates of metabolic syndrome were 35.8% (NCEP ATP III), 45.3% (modified NCEP ATP III) and 39.5% (IDF criteria). As per modified NCEP ATP III criteria, central obesity was the commonest abnormality among females and elevated blood pressure among males. Risk factors for MS were increasing age, female gender, sedentary lifestyle and diabetes in parents.

CONCLUSIONS

Our study showed a high prevalence of metabolic syndrome and its individual components. Independent risk factors for metabolic syndrome included increasing age, female gender, sedentary lifestyle and diabetes mellitus in parents.

Major ion chemistry and hydrochemical studies of groundwater of Bangalore South Taluk, India

Groundwater is almost globally important for human consumption as well as for the support of habitat and for maintaining the quality of base flow to rivers, while its quality assessment is essential to ensure sustainable safe use of the resources for drinking, agricultural, and industrial purposes. In the current study, 28 groundwater samples were collected around Vrishabhavathi valley region of Bangalore South Taluk to assess water quality and investigate hydrochemical nature by analyzing the major cations (Ca(2+), Mg(2+), Na(+), K(+)) and anions,(HCO(3)(-) Cl( - ), F( - ), SO(4)(2-), NO(3)(-), PO(4)(3),CO(3)(2-)) besides some physical and chemical parameters (pH, electrical conductivity, alkalinity, and total hardness). Also, geographic information system-based groundwater quality mapping in the form of visually communicating contour maps was developed to delineate spatial variation in physico-chemical characteristics of groundwater samples. Piper trilinear diagram was constructed to identify groundwater groups (hydrochemical facies) using major anionic and cationic concentration and it was found that majority of the samples belongs to Ca(2+)-Mg(2+)-Cl(-)-SO(4)(2+) and Ca(2+)-Mg(2+)-HCO(3)(-) hydrochemical facies. Wilcox classification and US Salinity Laboratory hazard diagram suggests that 92.86% of the samples were falling under good to permissible category and C3-S1 groups, respectively, indicating high salinity/low sodium.

Precocious puberty and a sellar mass

Precocious puberty in a child less than 3 years of age is usually gonadotropin dependent and is often associated with extrasellar central nervous system disorders. The present report describes the case of a 2½-year-old girl who presented with gonadotropin-independent precocious puberty and had a sellar mass. She was referred for neurosurgical intervention to our institute. On investigation, she was found to have primary hypothyroidism of autoimmune aetiology, which is rarely associated with precocious puberty and sellar mass due to thyrotroph hyperplasia. She was successfully treated with levothyroxine, and with this secondary sexual characteristics progressively regressed and the sellar mass disappeared.

Worsening of bone disease after curative surgery in primary hyperparathyroidism

We describe the case of a 33-year-old woman who underwent surgery successfully 3 years earlier for primary hyperparathyroidism, and subsequently presented with severe bone disease due to secondary hyperparathyroidism associated with chronic kidney disease and vitamin D deficiency.

Restoration on tissue antioxidants by fenugreek seeds (Trigonella Foenum Graecum) in alloxan-diabetic rats

The influence of fenugreek seed powder supplementation in the diet on lipid peroxidation and antioxidant status was studied in normal and alloxan-diabetic rats. The protective effect of the aqueous extract of the seeds on the activity of calcium-dependent adenosinetriphosphatase (Ca2+ ATPase) in liver homogenate in the presence of Fe2+/ascorbate in vitro was also investigated. Normal and diabetic rats were provided with a diet supplemented with fenugreek seed powder for 30 days at a dosage of 2 g/kg body weight. The diabetic rats exhibited enhanced lipid peroxidation and increased susceptibility to oxidative stress associated with depletion of antioxidants in liver, kidney and pancreas. However, treatment with fenugreek seed powder normalised the alterations. In normal rats supplementation resulted in increased antioxidant status with reduction in peroxidation. Ca2+ ATPase activity in liver was protected by the aqueous extract to nearly 80% of the initial activity. The findings suggest that the soluble portion of the seeds could be responsible for the antioxidant property.

Effect of fenugreek seeds on blood lipid peroxidation and antioxidants in diabetic rats

The effect of fenugreek seeds (Trigonella foenum graecum) on blood lipid peroxidation and antioxidant status in alloxan diabetic rats was studied. Increased lipid peroxidation and alterations in circulating antioxidants were observed in the diabetic state. The levels of glutathione, ascorbic acid and beta-carotene in blood were significantly lowered and alpha-tocopherol content was increased. Supplementation of fenugreek seeds in the diet lowered lipid peroxidation. The contents of glutathione and beta-carotene were increased and the alpha-tocopherol content was lowered. The level of ascorbic acid was unaltered. The level of antioxidants were higher in normal rats which were fed with the fenugreek supplemented diet compared with control animals which were fed commercial rat chow. The study shows that disrupted free radical metabolism in diabetic animals may be normalized by fenugreek seed supplementation in the diet.

Physico-Chemical and Bacteriological Investigation on the River Cauvery of Kollegal Stretch in Karnataka

Cauvery River is the major river system of south India was studied for 19 prime physicochemicaland 2 bacteriological parameters at six locations of the Kollegal stretch, for a periodof Two years (2006–2008) at monthly intervals. Over the years of time, river has beensubjected to human interference regularly and water quality was to be getting deterioratedprofoundly. Major anthropogenic activities practiced in and around the stretch: agriculture,abstraction of water for irrigation and drinking, washing cloths and utensils, discharging ofsewage waste, sand dredging, boating, fishing, open defecation and religious ritual activitiesalong the stretch were generating serious threat to the biota of the river by altering thephysicochemical and biological concentration of the river system. The seasonal and yearlytrends were discussed to comprehend anthropogenic interferences on the river stretch.Correlation analysis was also been tried in between physico-chemical parameters. The pH,Conductance, Alkalinity and Hardness levels indicate the moderate quality of water. Thevalues of DO, BOD and COD levels indicate the absence of major organic pollution sources.Seasonal and yearly averages of plant nutrients like phosphate, nitrates, potassium and alsosulphates at drain out falls and mixing zones, were not showing any significant variation intheir concentration indicate no sign of problems like eutrophication, which is generally raisedue to agricultural and sewage wastes. The other possibility is that since there are no majorindustries in the project area, the major source of organic pollutants is only the domesticsource. Population density spread over sparsely located villages like Dasanapura and Harlecertainly contributes towards total and fecal coliforms as excreta of the villagers due to lackof toilets in their houses. Thus present study concludes that river water was not polluted; allresults are within permissible limit when compared with Bureau of Indian Standards (BIS)and National River water quality standards.DOI: 10.3126/kuset.v6i1.3310Kathmandu University Journal of Science, Engineering and Technology Vol.6(1) 2010, pp50-59