Detection of DKK-1 gene methylation in exfoliated cells of cervical squamous cell carcinoma and its relationship with high risk HPV infection

PURPOSE

To detect the methylation of Dickkopf-associated protein 1 (DKK-1) gene promoter in cervical exfoliated cells and to study its clinical significance in cervical squamous cell carcinoma (CSCC) and its relationship with high-risk HPV infection.

METHODS

Methylation-specific PCR (MSP) was utilized to detect the methylation of DKK-1 gene promoter in cervical exfoliated cells from 40 patients with CSCC and 40 patients with chronic cervicitis in the Affiliated Hospital of Inner Mongolia Medical University. The methylation rate of DKK-1 gene promoter in different clinicopathological factors and its relationship with high-risk HPV infection was compared, and different detection methods were compared.

RESULT

The degree of methylation of DKK-1 gene promoter in CSCC group was significantly higher than that in cervicitis group (P < 0.05). In CSCC group, the degree of methylation was significantly different in high-risk HPV infection, histological differentiation, tumor size, lymph node metastasis and the International Federation of Gynecology and Obstetrics (FIGO) staging (all P < 0.05). The degree of methylation is not related to the type of high-risk HPV infection (P > 0.05). The one-year survival rate of CSCC patients with high-risk HPV positive and DKK-1 gene promoter methylation is relatively low, only 74.1%. The sensitivity, specificity and accuracy of DKK-1 gene methylation combined with high-risk HPV detection were 96.7%, 78.0% and 85.0%, respectively.

CONCLUSION

Methylation of DKK-1 gene promoter in cervical exfoliated cells of patients with CSCC is related to high-risk HPV infection and different clinicopathological factors, but the degree of methylation of DKK-1 gene is not related to the type of high-risk HPV infection. It may become an indicator different from HPV typing detection, which may play a shunt role in suggesting whether further invasive cervical examination is needed and reduce cervical invasive examination and overtreatment. It may be related to the survival rate of patients, which can be used to estimate the development and prognosis of CSCC and may play a good role in early warning in follow-up monitoring of CSCC after treatment. DKK1 gene methylation combined with HPV detection can improve the sensitivity, specificity and accuracy of diagnosis, which may improve the detection rate of early CSCC and make up for the deficiency of HPV and TCT detection. That may become a non-invasive screening method for CSCC.

Time-course behavioral features are correlated with Parkinson's disease‑associated pathology in a 6-hydroxydopamine hemiparkinsonian rat model

Parkinson's disease (PD) is one of the most common neurodegenerative diseases. For decades, the unilateral 6‑hydroxydopamine (6‑OHDA) rat model has been employed to investigate the pathogenesis and therapy of PD. However, the behavior and associated pathological features of the model long term have not previously been described dynamically. In the present study, the unilateral model was established by 6‑OHDA injection in the striatum. The PD rat model was determined 2 weeks following surgery, according to the apomorphine (APO)‑induced rotations, cylinder, rotarod and open field tests. TH‑positive neurons and fibers in the substantia nigra pars compacta (SNpc) and striatum, respectively, and glial activation in the SNpc, determined by glial fibrillary acidic protein (GFAP) expression for astrocytes and CD11b (Mac1) expression for microglia, were detected by immunohistological staining. Correlation analysis was performed to understand the association between PD‑associated behavior and pathology. The behavioral impairment progressively deteriorated during the process of experiment. In addition, the decrease in TH‑positive neurons was associated with an increase in GFAP‑ and Mac1‑positive cells in the SNpc. Linear regression analysis indicated the association between behavioral and pathological changes. The results of the present study indicate that the APO‑induced rotation, cylinder and rotarod tests are all sensitive and reliable strategies to predict the loss of TH+ neurons. These results provide a potential intervention time‑point and a comprehensive evaluation index system for assessment of PD therapeutic strategies using the hemiparkinsonian rat.

Differences in mouse and human nonmemory B cell pools

Identifying cross-species similarities and differences in immune development and function is critical for maximizing the translational potential of animal models. Coexpression of CD21 and CD24 distinguishes transitional and mature B cell subsets in mice. In this study, we validate these markers for identifying analogous subsets in humans and use them to compare the nonmemory B cell pools in mice and humans, across tissues, and during fetal/neonatal and adult life. Among human CD19(+)IgM(+) B cells, the CD21/CD24 schema identifies distinct populations that correspond to transitional 1 (T1), transitional 2 (T2), follicular mature, and marginal zone subsets identified in mice. Markers specific to human B cell development validate the identity of marginal zone cells and the maturation status of human CD21/CD24 nonmemory B cell subsets. A comparison of the nonmemory B cell pools in bone marrow, blood, and spleen in mice and humans shows that transitional B cells comprise a much smaller fraction in adult humans than mice. T1 cells are a major contributor to the nonmemory B cell pool in mouse bone marrow, in which their frequency is more than twice that in humans. Conversely, in spleen, the T1:T2 ratio shows that T2 cells are proportionally ∼ 8-fold higher in humans than in mice. Despite the relatively small contribution of transitional B cells to the human nonmemory pool, the number of naive follicular mature cells produced per transitional B cell is 3- to 6-fold higher across tissues than in mice. These data suggest differing dynamics or mechanisms produce the nonmemory B cell compartments in mice and humans.

Efficient generation of integration-free ips cells from human adult peripheral blood using BCL-XL together with Yamanaka factors

The ability to efficiently generate integration-free induced pluripotent stem cells (iPSCs) from the most readily available source-peripheral blood-has the potential to expedite the advances of iPSC-based therapies. We have successfully generated integration-free iPSCs from cord blood (CB) CD34(+) cells with improved oriP/EBNA1-based episomal vectors (EV) using a strong spleen focus forming virus (SFFV) long terminal repeat (LTR) promoter. Here we show that Yamanaka factors (OCT4, SOX2, MYC, and KLF4)-expressing EV can also reprogram adult peripheral blood mononuclear cells (PBMNCs) into pluripotency, yet at a very low efficiency. We found that inclusion of BCL-XL increases the reprogramming efficiency by approximately 10-fold. Furthermore, culture of CD3(-)/CD19(-) cells or T/B cell-depleted MNCs for 4-6 days led to the generation of 20-30 iPSC colonies from 1 ml PB, an efficiency that is substantially higher than previously reported. PB iPSCs express pluripotency markers, form teratomas, and can be induced to differentiate in vitro into mesenchymal stem cells, cardiomyocytes, and hepatocytes. Used together, our optimized factor combination and reprogramming strategy lead to efficient generation of integration-free iPSCs from adult PB. This discovery has potential applications in iPSC banking, disease modeling and regenerative medicine.

Abstract B32: A novel preclinical model to identify therapies for CRLF2 B-ALL and reduce childhood cancer health disparities

Hispanic children with Acute Lymphoblastic Leukemia (ALL) have a 39% higher death rate than white children. A major contributor to this disparity is the lack of therapies that specifically target CRLF2 B cell ALL. This high-risk leukemia occurs five times more frequently among children of Hispanic/Latino ethnicity than others and represents the most significant biological component of childhood cancer health disparities identified to date. CRLF2 B-ALL is caused by genetic alterations that result in B cells that overexpress the cytokine receptor component, CRLF2, leading to malignant transformation and high-risk leukemia with poor prognosis. CRLF2 pairs with the IL-7Rα, to form a receptor complex that is activated by the cytokine, TSLP. Activation of the receptor complex stimulates downstream JAK-STAT5 phosphorylation that has been shown to induce proliferation and survival of B-ALL cells. Activating JAK mutations are found in many cases of CRLF2 B-ALL and have led to speculation that stimulation of the receptor by TSLP is not a factor in this disease. In preliminary studies to address this question we evaluated the effect of TSLP in CRLF2 B-ALL cells with JAK defects. Our data show that TSLP increases STAT5 phosphorylation in these cell lines and also in primary CRLF2 B-ALL cells. These data suggest that TSLP can activate JAK-STAT5 signaling to induce downstream survival and proliferation in CRLF2-B-ALL cells, including those with JAK defects. Bone marrow (BM) provides the tumor microenvironment that can harbor chemoresistant B-ALL cells responsible for relapse in B-ALL. We used RT-PCR and ELISA assays to show that TSLP is expressed in BM cells from pediatric patients and thus could provide an in vivo source of TSLP to stimulate CRLF2 B-ALL cells. Human-mouse xenograft models produced by transplanting human leukemia cells into immune deficient mice mimic the in vivo environment and are the model of choice for identifying therapies that target the mechanisms of chemoresistance that are characteristic of high-risk leukemia. However, mouse TSLP is different from most other cytokines produced in the xenograft in that it is species-specific and does not activate the human TSLP receptor complex that contains CRLF2. Thus, traditional xenograft models do not provide the TSLP-CRLF2 interactions that our data implicate as a contributing factor in CRLF2 B-ALL. To overcome this obstacle we have engineered immune deficient mice to express human TSLP (hTSLP+ mice) as well as control mice that lack the TSLP cytokine (hTSLP– mice). ELISA assays show hTSLP levels in the hTSLP+ mice that approximate the normal range in human plasma. We used this hTSLP+/- xenograft model system to study the in vivo effects of TSLP on mice transplanted with a CRLF2 B-ALL cell line harboring a JAK defect (MUTZ5) and with primary pre-B ALL cells from a Hispanic patient. Mice were euthanized at 5 weeks and BM disease was evaluated. In recipients of MUTZ5 B-ALL cells the percentage of viable leukemia cells in hTSLP+ mice was twice that observed in hTSLP- mice. Similarly, in recipients of primary B-ALL, the percentage of viable leukemia cells was higher in hTSLP+ than hTSLP- mice. These data provide evidence that the TSLP produced in this model is active and that TSLP-CRLF2 interactions contribute in vivo to CRLF2-B-ALL. This model will be particularly important for identifying therapies that can effectively target CRLF2 B-ALL and reduce cancer health disparities in Hispanic childhood B-ALL.

Citation Format: Francis L. Olivia, Shannalee R. Martinez, Terrence Bennett, Ineavely Baez, Terry-Ann Milford, Christopher L. Morris, Ross O. Fisher, Xiao-Bing Zhang, Rui-Jun Su, Sinisa Dovat, Kimberly J. Payne. A novel preclinical model to identify therapies for CRLF2 B-ALL and reduce childhood cancer health disparities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B32.

Abstract 1347: A human-mouse xenograft model to study the role of TSLP in CRLF2d B-ALL

B-cell precursor ALL where genetic defects lead to overexpression of CRLF2 (CRLF2d B-ALL) are high-risk with poor prognosis. CRLFd B-ALL occurs 5 times more frequently among children of Hispanic/Latino ethnicity and is a major contributor to the health disparity in survival of Hispanic children with ALL. CRLF2, together with the IL-7Rα, forms a receptor complex that is activated by the cytokine, TSLP. The JAK-STAT5 pathway is phosphorylated downstream of receptor activation. The activating JAK mutations found in some CRLF2 B-ALL have led to speculation that TSLP stimulation is not a factor in CRLF B-ALL. In preliminary studies to address this question we evaluated the effect of TSLP on two CRLF2d B-ALL cell lines with JAK defects and which have been reported to exhibit constitutive JAK-STAT5 activation. Our data show that TSLP increases STAT5 phosphorylation in both of these cell lines and in primary B-ALL cells that overexpress CRLF2. Our next step was to evaluate the role of TSLP-CRLF2 interaction in vivo in the human-mouse xenograft model. However, mouse TSLP is different from most other cytokines produced in the xenograft in that it is species-specific and does not activate the human TSLP receptor complex that contains CRLF2. Thus, traditional xenograft models do not provide the TSLP-CRLF2 interactions that we believe to be a major factor in CRLF2 B-ALL. To overcome this obstacle we have engineered immune deficient NOD/SCID IL-2Rγ null (NSG) mice to express human TSLP (hTSLP+ mice) as well as control mice that lack the TSLP cytokine (hTSLP- mice). ELISA assays show plasma hTSLP levels in the hTSLP+ mice that approximate the normal range in human plasma. We have used this hTSLP+/− system to expand a sample of primary pre-B ALL cells from a patient that includes clones of CRLF2-HI and CRLF2- B-ALL cells. Preliminary data indicate that the pre-B ALL cells expanded in hTSLP+ mice show higher expression levels of the TSLPR components (CRLF2 and IL-7Rα) than cells expanded in the hTSLP- mice. This data provide evidence that the TSLP produced in this model is active and that it impacts primary pre-B ALL cells. The hTSLP+ mice that we produce will allow for the first time the study of normal and malignant B lymphopoiesis in a model that provides the complex bone marrow architecture of the xenograft while providing the full range of cytokines that are known to act on early B lineage cells (IL-7, FL and TSLP). This model will be particularly important for identifying therapies that can effectively target CRLF2-d B-ALL and reduce cancer health disparities in Hispanic childhood B-ALL.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1347. doi:1538-7445.AM2012-1347

Regulator of myeloid differentiation and function: The secret life of Ikaros

Ikaros (also known as Lyf-1) was initially described as a lymphoid-specific transcription factor. Although Ikaros has been shown to regulate hematopoietic stem cell renewal, as well as the development and function of cells from multiple hematopoietic lineages, including the myeloid lineage, Ikaros has primarily been studied in context of lymphoid development and malignancy. This review focuses on the role of Ikaros in myeloid cells. We address the importance of post-transcriptional regulation of Ikaros function; the emerging role of Ikaros in myeloid malignancy; Ikaros as a regulator of myeloid differentiation and function; and the selective expression of Ikaros isoform-x in cells with myeloid potential. We highlight the challenges of dissecting Ikaros function in lineage commitment decisions among lymphoid-myeloid progenitors that have emerged as a major myeloid differentiation pathway in recent studies, which leads to reconstruction of the traditional map of murine and human hematopoiesis.

Abstract 1094: Role of the CRLF2 ligand TSLP in normal human B-cell development

B cell acute lymphoblastic leukemia (B-ALL) is the most common childhood malignancy. Defects that result in overexpression of CRLF2, a cytokine receptor component, have recently been linked with poor outcome in both high-risk and non-high-risk B-ALL. CRLF2, together with the IL-7R alpha chain, forms the signaling receptor for the cytokine TSLP (Thymic Stromal-derived LymphoPoietin). TSLP-induced CRLF2 signaling results in proliferation of murine B cell progenitors, however, the role of TSLP in murine B cell development remains controversial and little is known of its role in human B lymphopoiesis. Human TSLP and CRLF2, in contrast to other cytokine/receptor pairs that act on B cell progenitors, show low homology to their murine counterparts (&lt;40%), lack species cross reactivity, and activate differing intracellular pathways than in mice. Thus, human model systems are essential for understanding the role of CRLF2 function in normal and malignant B lymphopoiesis. We have developed a novel human-only in vitro culture model that allows the study of human B cell development under highly selective cytokine stimulation. This model is based on co-culturing CD34+ hematopoietic stem cells (HSCs) with primary human bone marrow stroma supplemented with selective exogenous cytokines and/or specific cytokine neutralizing antibodies. We have previously used this model to show that IL-7 increases B cell progenitors by over 60 fold and that IL-7 is essential for normal human B cell production (J. Immunol. 2009 82:4255). Here we use our human-only in vitro model to examine the role of TSLP-induced signals in normal human B cell development. Our data show that TSLP induces an expansion of human B cell progenitor populations generated from HSCs in cord blood that is similar in magnitude to that observed for IL-7. A comparison of TSLP and IL-7 effects shows that TSLP targets early B cell progenitors (CD34+) inducing expansion of this population with limited differentiation. In contrast, IL-7 induces rapid differentiation to the CD34- stage followed by proliferation. RT-PCR and ELISA analysis show that normal human bone marrow stoma express both TSLP and IL-7, thus establishing an endogenous source of these cytokines at the site of normal and malignant hematopoiesis. Our data provide evidence that TSLP and IL-7 exert differential and stage specific effects on proliferation and differentiation of B cell progenitors and suggest that deregulation of the complex interplay between these signals in normal differentiation could set the stage for malignant transformation to B-ALL in the presence of cooperative defects in JAK2 and/or Ikaros.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1094. doi:10.1158/1538-7445.AM2011-1094

Suppression of FVIII inhibitor formation in hemophilic mice by delivery of transgene modified apoptotic fibroblasts

The development of inhibitory antibodies to factor VIII (FVIII) is currently the most significant complication of FVIII replacement therapy in the management of patients with severe hemophilia A. Immune tolerance protocols for the eradication of inhibitors require daily delivery of intravenous FVIII for at least 6 months and are unsuccessful in 20-40% of treated patients. We hypothesize that tolerance can be induced more efficiently and reliably by delivery of FVIII antigen within autologous apoptotic cells (ACs). In this study, we demonstrated suppression of the T cell and inhibitor responses to FVIII by infusion of FVIII expression vector modified apoptotic syngeneic fibroblasts in both naive and preimmunized hemophilia A mice. ACs without FVIII antigen exerted modest generalized immune suppression mediated by anti-inflammatory signals. However, FVIII expressing apoptotic syngeneic fibroblasts produced much stronger antigen-specific immune suppression. Mice treated with these fibroblasts generated CD4+ T cells that suppressed the immune response to FVIII after adoptive transfer into naive recipients and antigen-specific CD4+CD25+ regulatory T cells (Tregs) that inhibited the proliferation of FVIII responsive effector T cells in vitro. These preclinical results demonstrate the potential for using FVIII vector modified autologous ACs to treat high-titer inhibitors in patients with hemophilia A.

Suppression of the Immune Response to Human FVIII with FVIII Transgene Modified Tolerogenic Dendritic Cells in Hemophilia A Mice (89.42)

The development of inhibitory antibodies to factor VIII (FVIII) is the most serious complication in hemophilia A patients. In this study we evaluated the ability of tDCs transduced with a human FVIII transgene foamy virus (FV) vector to modulate the immune response to FVIII in hemophilia A mice. The tDCs were generated by culturing bone marrow cells in RPMI1640/10%FBS supplemented with IL-10 and the neural peptides VIP and PACAP38. Na ?ve hemophilia A mice were treated with 2 weekly infusions of tDC-F8, control tDCs (tDCs-Ctrl), or with no cells (Neg-Ctrl) prior to challenge with four weekly intravenous doses of 0.2 µg rhFVIII. Following immunization the inhibitor titers in tDC-F8 mice were 60-61% lower than the controls. The regulatory T cell related markers such as FOXP3 were up-regulated on splenic CD4+ T cells from tDC-F8 mice and the CD4+ T cell proliferation response to FVIII was suppressed by 80 - 90%. In pre-immunized mice, treatment with 4 weekly infusions of FVIII vector transduced tDCs lowered inhibitor titers by 54%. In contrast, treatment with untransduced tDCs had no significant effect. Adoptive transfer of CD4+ T cells from tDC-F8 mice suppressed the immune response to FVIII in subsequently immunized naïve secondary recipients, but not to OVA, an unrelated antigen. We also observed that infusion of tDCs transduced with FV vectors co-expressing FVIII and IL-10 into naïve mice resulted in a 83 - 85% reduction in inhibitor titers after subsequent immunization. The CD4+ T cell proliferation response to FVIII was suppressed over 90%. In summary, these data indicate that FVIII vector transduced tDCs are useful in suppressing the immune response to FVIII in hemophilia A mice and that co- expression of IL-10 by the vector modified tDCs further enhances their effectiveness.

Suppression of the Immune Responses to Factor VIII in the Hemophilia A Mice by Delivery of Transgene Modified Apoptotic Syngeneic Fibroblasts (89.36)

The development of anti-FVIII inhibitory antibodies is a major obstacle to treatment of hemophilia A patients. Here, we employ the immunosuppressive properties of FVIII gene modified apoptotic syngeneic fibroblasts to reduce immune response to FVIII in hemophilic mice. We generated a fibroblast cell line from the 129Sv-FVIII KO mouse that expresses both FVIII and zeocin resistance gene. A cell line expressing only the zeocin resistance gene was also generated. Both vector modified cell lines were maintained under selective pressure and induced to apoptose just prior to infusion into 129Sv-FVIII KO mice. Mice treated with 2 intravenous infusions of FVIII expressing apoptotic fibroblasts showed up to a 79.5% reduction in Bethesda titers and significantly lower T cell responses after subsequent challenge with 4 doses of rhFVIII. Moreover, hemophilic mice pre-immunized with rhFVIII showed a 65% reduction in Bethesda titers following treatment with 4 infusions of FVIII expressing apoptotic cells. To investigate the antigen specificity of the induced immunosuppression, apoptotic fibroblast treated mice were challenged with an unrelated protein OVA. The immune response to OVA was not affected by the infusion of apoptotic cells. In adoptive transfer studies, a blunted immune response to rhFVIII could be induced in naïve mice by infusion of CD4+ splenocytes from FVIII expressing apoptotic cell treated animals. Moreover, in vitro Treg suppression assays showed that CD4+CD25+ regulatory T cells from FVIII expressing apoptotic cell treated mice were capable of inhibiting the T cell response to rhFVIII, but not to OVA. These data demonstrate that the CD4+CD25+ regulatory T cells in these mice direct antigen specific immune suppression to human FVIII.

Multipotent neural precursors express neural and hematopoietic factors, and enhance ex vivo expansion of cord blood CD34+ cells, colony forming units and NOD/SCID-repopulating cells in contact and noncontact cultures

In view of the possible crosstalks between hematopoiesis and neuropoiesis, we evaluated two microenvironments, murine neonatal neural cell line C17.2 and primary embryonic aorta-gonad-mesonephros (AGM) stromal cells, on the ex vivo expansion of CD34+ cells from human cord blood. In a contact culture system, C17.2 or AGM cells significantly enhanced the expansion of CD34+ cells to a panel of early and committed hematopoietic progenitor cells. In a noncontact transwell system, pre-established C17.2 cells significantly increased the expansion of total nucleated cells, CD34+ cells and multilineage colony forming cells (P<0.01). Expanded cells were infused into nonobese diabetic/severe-combined immunodeficient mice. The engraftment of human (hu)CD45+ cells in the bone marrow of these mice was consistently higher in all the 10 experiments conducted with the support of C17.2 cells when compared with those in respective control groups (11.9 vs 2.43%, P=0.03). Using RT-PCR and Southern blot analysis, we showed that AGM and C17.2 cells expressed a panel of hematopoietic, bone morphogenetic and neurotrophic factors. Our data provided the first evidence on the promoting effects of a neural progenitor cell line on hematopoiesis at a noncontact condition. The mechanism could be mediated by the expression of multilineage regulatory factors.

Platelet-derived growth factor enhances ex vivo expansion of megakaryocytic progenitors from human cord blood

Infusion of ex vivo expanded megakaryocytic (MK) progenitor cells is a strategy for shortening the duration of thrombocytopenia after haematopoietic stem cell transplantation. The cell dose after expansion has emerged as a critical factor for achieving the desired clinical outcomes. This study aimed to establish efficient conditions for the expansion of the MK lineage from enriched CD34(+) cells of umbilical cord blood and to investigate the effect of platelet-derived growth factor (PDGF) in this system. Our results demonstrated that thrombopoietin (TPO) alone produced a high proportion of CD61(+)CD41(+) cells but a low total cell count and high cell death, resulting in an inferior expansion. The addition of interleukin-1 beta (IL-1 beta), Flt-3 ligand (Flt-3L) and to a lesser extent IL-3 improved the expansion outcome. The treatment groups with three to five cytokines produced efficient expansions of CFU-MK up to 400-fold with the highest yield observed in the presence of TPO, IL-1 beta, IL-3, IL-6 and Flt-3L. CD34(+) cells were expanded by five to 22-fold. PDGF improved the expansion of all cell types with CD61(+)CD41(+) cells, CFU-MK and CD34(+) cells increased by 101%, 134% and 70%, respectively. On day 14, the CD61(+) population consisted of diploid (86.5%), tetraploid (11.8%) and polyploid (8N--32N; 1.69%) cells. Their levels were not affected by PDGF. TPO, IL-1 beta, IL-3, IL-6, Flt-3L and PDGF represented an effective cytokine combination for expanding MK progenitors while maintaining a moderate increase of CD34(+) cells. This study showed, for the first time, that PDGF enhanced the ex vivo expansion of the MK lineage, without promoting their in vitro maturation. PDGF might be a suitable growth factor to improve the ex vivo expansion of MK progenitors for clinical applications.

Plasma PTH and PTH-rP levels and clodronate therapy in cancer patients with hypercalcemia

To investigate the roles of parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTH-rP) in hypercalcemic patients with various malignancies, we measured the plasma levels of intact PTH and intact PTH-rP in five hypercalcemic patients with hematologic malignancies and 29 hypercalcemic patients with solid cancers. Ten eucalcemic cancer patients with either hepatocellular carcinoma or squamous cancer of the lung served as controls. The results showed a suppressed PTH level in all of the 34 hypercalcemic cancer patients. The PTH-rP levels were within normal limits (< 2.5 pg/mL) for all of the eucalcemic cancer controls, all of the five hematologic cancer patients with hypercalcemia, and only two out of the 29 hypercalcemic patients with solid cancers. The PTH-rP level was elevated in nearly all (27/29) hypercalcemic patients with or without bony metastasis. There was a good correlation between the corrected total serum calcium level and the natural log of PTH-rP level in 39 patients (10 eucalcemic and 29 hypercalcemic) with solid cancers (r = 0.75, p < 0.001). These results suggest that PTH-rP plays an important role in the hypercalcemia of patients with solid cancers, but this was not the case in our patients with hematologic malignancies. True ectopic secretion of PTH is unlikely in most of these patients. The mean serum total calcium levels of 17 hypercalcemic patients (13 solid cancers, four hematologic malignancies) dropped significantly after the third day of treatment with a new-generation bisphosphonate-clodronate product. This treatment consisted of 300 mg daily intravenous infusion for seven days, followed by oral administration (800 mg, bid) for the following three weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Partial azurophilic granule deficiency. Report of 2 cases with ultrastructural and light-and-electron-microscopic cytochemical observation

The neutrophils in 2 patients with atopic disease were studied. Ultrastructurally, a number of abnormal azurophilic granules (AG) with low electron-density (Case 1) and secondary lysosomes with "myelinoid membranes" figures (Case 2) were found. Myeloperoxidase (MPO) and acid phosphatase activity were detected by light cytochemical techniques, and showed significantly low values. The deficiency of MPO and abnormal distribution of AG were also demonstrated by electron microscopic cytochemical technique. The neutrophils from the parents revealed changes similar to the patients. This study suggests that since genetic partial deficiency of neutrophil AG enzymes existed, the phagocytosed substances were only partially degraded, leading to accumulation of substances with antigenicity, and became trigger event of atopic disease.

Identification of autoantigen recognized by autoimmune ophthalmopathy sera with immunoblotting correlated with orbital computed tomography

We have demonstrated that there is an antibody related to extraocular muscle enlargement in autoimmune ophthalmopathy (Graves' ophthalmopathy, thyroid-associated correlated with orbital computed tomography (CT). This study was designed to identify the autoantigen and to determine whether there are common antigens among the extraocular muscle, the lacrimal gland, and the thyroid. We prepared a 100,000g sediment fraction of porcine extraocular muscle, lacrimal gland, thyroid, and human thyroid, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with sera from patients with Graves' disease, with or without ophthalmopathy, classified by symptoms and signs combined with orbital CT and normal controls. The results showed there was an approximately 55-kDa protein band which was recognized by the sera in 32.1% (9/28) of patients with autoimmune ophthalmopathy and in 47.3% (9/19) of patients with extraocular muscle enlargement demonstrated by orbital CT. It was significantly higher than the positive rates in patients without autoimmune ophthalmopathy and normal controls (15.8 and 11.1%, respectively, P < 0.025). However, there was no common antigen among the extraocular muscles, the lacrimal gland, and the thyroid. To further confirm this eye muscle-specific antigen, the approximately 55-kDa protein band was cut and solubilized from the nitrocellulose paper after SDS-PAGE, and electrophoretically transferred and used as an antigen in enzyme-linked immunosorbent assay. The absorbance was significantly higher in patients with autoimmune ophthalmopathy than patients without ophthalmopathy (P < 0.005), and normal controls (P < 0.01). Our findings suggest that an approximately 55-kDa protein may be a possible antigen in the eye muscle related to autoimmune ophthalmopathy.

Bedtime intermediate-acting insulin in the treatment of secondary failure to oral hypoglycemic agents

Low-dose bedtime insulin therapy in combination with oral hypoglycemic agents (OHAs) has become an alternative treatment for NIDDM subjects with secondary failure to OHA. To assess its clinical efficacy, patient compliance, and its possible side effects, 33 patients with secondary OHA failure were recruited in this study. All of the subjects had experienced poor glycemic control for at least six months on their maximal OHAs before the institution of the bedtime insulin injection. Monotard HM (human insulin zinc suspension) was given at an initial dose of 0.15-0.2 U/kg body weight and was adjusted thereafter. As a whole, low-dose bedtime insulin with OHAs improved glycemic control. According to the clinical response, 10 patients (30.3%) were graded as responders, 12 (36.4%) were partial responders, 10 (30.3%) were non-responders, and one (3%) discontinued insulin therapy. There was no difference in demographic features among these three groups of patients. During this period, eight (25%) cases experienced mild hypoglycemic symptoms. In conclusion, combination of OHAs with a low-dose bedtime insulin injection is an alternative therapy for NIDDM patients with OHA failure.