Predisposal of Interferon Regulatory Factor 1 Deficiency to Accumulate DNA Damage and Promote Osteoarthritis Development in Cartilage

OBJECTIVE

Interferon regulatory factor 1 (IRF1) is a transcriptional regulator conventionally associated with immunomodulation. Recent molecular analyses mapping DNA binding sites of IRF1 have suggested its potential function in DNA repair. However, the physiologic significance of this noncanonical function remains unexplored. Here, we investigated the role of IRF1 in osteoarthritis (OA), a condition marked by senescence and chronic joint inflammation.

METHODS

OA progression was examined in wild-type and Irf1-/- mice using histologic assessments and microcomputed tomography analysis of whole-joint OA manifestations and behavioral assessments of joint pain. An integrated analysis of assay for transposase-accessible chromatin with sequencing and whole transcriptome data was conducted for the functional assessment of IRF1 in chondrocytes. The role of IRF1 in DNA repair and senescence was investigated by assaying γ-H2AX foci and senescence-associated beta-galactosidase activity.

RESULTS

Our genome-wide investigation of IRF1 footprinting in chondrocytes revealed its primary occupancies in the promoters of DNA repair genes without noticeable footprint patterns in those of interferon-responsive genes. Chondrocytes lacking IRF1 accumulated irreversible DNA damage under oxidative stress, facilitating their entry into cellular senescence. IRF1 was down-regulated in the cartilage of human and mouse OA. Although IRF1 overexpression did not elicit an inflammatory response in joints or affect OA development, genetic deletion of Irf1 caused enhanced chondrocyte senescence and exacerbated post-traumatic OA in mice.

CONCLUSION

IRF1 offers DNA damage surveillance in chondrocytes, protecting them from oxidative stress associated with OA risk factors. Our study provides a crucial and cautionary perspective that compromising IRF1 activity renders chondrocytes vulnerable to cellular senescence and promotes OA development.

Outcomes of patients with exomphalos and associated congenital heart diseases

INTRODUCTION

Exomphalos is an anterior abdominal wall defect resulting in herniation of contents into the umbilical cord. Severe associated chromosomal anomalies and congenital heart disease (CHD) are known to influence mortality, but it is not clear which cardiac anomalies have the greatest impact on survival.

METHODS

We performed a retrospective review of the treatment and outcome of patients with exomphalos over a 30-year period (1990-2020), with a focus on those with the combination of exomphalos major and major CHD (EMCHD).

RESULTS

There were 123 patients with exomphalos identified, 59 (48%) had exomphalos major (ExoMaj) (defect > 5 cm or containing liver), and 64 (52%) exomphalos minor (ExoMin). In the ExoMaj group; 17% had major CHD (10/59), M:F 28:31, 29% premature (< 37 weeks, 17/59) and 14% had low birth-weight (< 2.5 kg, 8/59). In the ExoMin group; 9% had major CHD (6/64), M:F 42:22, 18% premature and 10% had low birth-weight. The 5-year survival was 20% in the EMCHD group versus 90% in the ExoMaj with minor or no CHD [p < 0.0001]. Deaths in the EMCHD had mainly right heart anomalies and all of them required mechanical ventilation (MV) for pulmonary hypoplasia prior to cardiac intervention. In contrast, survivors did not require mechanical ventilation prior to cardiac intervention.

CONCLUSION

EMCHD is associated with high mortality. The most significant finding was high mortality in those with right heart anomalies in combination with pulmonary hypoplasia, especially if pre-intervention mechanical ventilation is required.

Tolerogenic nanoparticles induce type II collagen-specific regulatory T cells and ameliorate osteoarthritis

Local inflammation in the joint is considered to contribute to osteoarthritis (OA) progression. Here, we describe an immunomodulating nanoparticle for OA treatment. Intradermal injection of lipid nanoparticles (LNPs) loaded with type II collagen (Col II) and rapamycin (LNP-Col II-R) into OA mice effectively induced Col II-specific anti-inflammatory regulatory T cells, substantially increased anti-inflammatory cytokine expression, and reduced inflammatory immune cells and proinflammatory cytokine expression in the joints. Consequently, LNP-Col II-R injection inhibited chondrocyte apoptosis and cartilage matrix degradation and relieved pain, while injection of LNPs loaded with a control peptide and rapamycin did not induce these events. Adoptive transfer of CD4⁺CD25⁺ T cells isolated from LNP-Col II-R-injected mice suggested that T_regs induced by LNP-Col II-R injection were likely responsible for the therapeutic effects. Collectively, this study suggests nanoparticle-mediated immunomodulation in the joint as a simple and effective treatment for OA.

Challenges in the diagnosis of 2009 H1N1 in a lung transplant patient and the long-term implications for prevention and treatment: a case report

Although respiratory viral infections have been associated with acute rejection and bronchiolitis obliterans syndrome, the long-term impact of the novel pandemic influenza A (2009 H1N1) virus on lung transplant patients has not been defined. We describe the diagnostic challenges and long-term consequences of 2009 H1N1 infection in a lung transplant patient, discuss the potential implications for prevention and treatment, and conclude that even timely antiviral therapy may be insufficient to prevent long-term morbidity.

Ligand-dependent ubiquitination of Smad3 is regulated by casein kinase 1 gamma 2, an inhibitor of TGF-beta signaling

Transforming growth factor-beta (TGF-beta) elicits a variety of cellular activities primarily through a signaling cascade mediated by two key transcription factors, Smad2 and Smad3. Numerous regulatory mechanisms exist to control the activity of Smad3, thereby modulating the strength and specificity of TGF-beta responses. In search for potential regulators of Smad3 through a yeast two-hybrid screen, we identified casein kinase 1 gamma 2 (CKIgamma2) as a novel Smad3-interacting protein. In mammalian cells, CKIgamma2 selectively and constitutively binds Smad3 but not Smad1, -2 or -4. Functionally, CKIgamma2 inhibits Smad3-mediated TGF-beta responses including induction of target genes and cell growth arrest, and this inhibition is dependent on CKIgamma2 kinase activity. Mechanistically, CKIgamma2 does not affect the basal levels of Smad proteins or activity of the receptors. Rather, CKIgamma2 preferentially promotes the ubiquitination and degradation of activated Smad3 through direct phosphorylation of its MH2 domain at Ser418. Importantly, mutation of Ser418 to alanine or aspartic acid causes an increase or decrease of Smad3 activity, respectively, in the presence of TGF-beta. CKIgamma2 is the first kinase known to mark activated Smad3 for destruction. Given its negative function in TGF-beta signaling and its reported overexpression in human cancers, CKIgamma2 may act as an oncoprotein during tumorigenesis.

Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins

BACKGROUND

Despite intent to cure surgery with negative resection margins, locoregional recurrence is common in pancreatic cancer.

AIMS

To determine whether detection of K-ras gene mutation in the histologically negative surgical margins of pancreatic cancer reflects unrecognised disease.

PATIENTS

Seventy patients who underwent curative resection for pancreatic ductal adenocarcinoma were evaluated.

METHODS

All patients had surgical resection margins (pancreatic transection and retroperitoneal) that were histologically free of invasive cancer. DNA was extracted from these paraffin embedded surgical margins and assessed by quantitative real time polymerase chain reaction to detect the K-ras gene mutation at codon 12. Detection of K-ras mutation was correlated with standard clinicopathological factors.

RESULTS

K-ras mutation was detected in histologically negative surgical margins of 37 of 70 (53%) patients. A significant difference in overall survival was demonstrated between patients with margins that were K-ras mutation positive compared with negative (median 15 v 55 months, respectively; p = 0.0008). By univariate and multivariate analyses, detection of K-ras mutation in the margins was a significant prognostic factor for poor survival (hazard ratio (HR) 2.8 (95% confidence interval (CI) 1.5-5.3), p = 0.0009; and HR 2.8 (95% CI 1.4-5.5), p = 0.004, respectively).

CONCLUSIONS

Detection of cells harbouring K-ras mutation in histologically negative surgical margins of pancreatic cancer may represent unrecognised disease and correlates with poor disease outcome. The study demonstrates that molecular-genetic evaluation of surgical resection margins can improve pathological staging and prognostic evaluation of patients with pancreatic ductal adenocarcinoma.

Carotid artery occlusion in association with a retropharyngeal abscess

Deep neck space infections in children are not an uncommon presentation to an otolaryngologist and with appropriate antibiotic therapy, often in conjunction with surgical drainage, complications are rare. We report on a case of a 4-year boy who presented with a retropharyngeal abscess that was complicated by ipsilateral carotid artery and internal jugular vein compression. The patient was treated with intravenous broad-spectrum antibiotics and heparin. There were no subsequent neurological or vascular complications. An overview of the management of deep neck infections and their complications are discussed.

Domestic violence screening and intervention programmes for adults with dental or facial injury

BACKGROUND

Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective.

OBJECTIVES

(1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries.(2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO and Lilacs databases. No language restrictions were applied. Personal contacts were used and international domestic violence organisations were contacted to identify any unpublished trials. Last search was done February 2004.

SELECTION CRITERIA

Randomised controlled trials involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

No eligible randomised controlled trials (RCTs) were identified.

REVIEWERS' CONCLUSIONS

There is no evidence to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.

Preventing gut leakiness by oats supplementation ameliorates alcohol-induced liver damage in rats

Only 30% of alcoholics develop liver disease (ALD) suggesting that additional factors are needed. Endotoxin is one such factor, but its etiology is unclear. Since the gut is the main source of endotoxin, we sought to determine whether an increase in intestinal permeability (leaky gut) is required for alcohol-induced endotoxemia and liver injury and whether the gut leakiness is preventable. For 10 weeks, rats received by gavage increasing alcohol doses (to 8 g/kg/day) and either oats (10 g/kg) or chow b.i.d. Intestinal permeability was then assessed by urinary excretion of lactulose and mannitol. Liver injury was evaluated histologically, biochemically (liver fat content), and by serum aminotransferase. Alcohol caused gut leakiness that was associated with both endotoxemia and liver injury. Oats prevented these changes. We conclude that chronic gavage of alcohol in rats is a simple experimental model that mimics key aspects of ALD, including endotoxemia and liver injury, and can be useful to study possible mechanisms of endotoxemia in ALD. Since preventing the gut leakiness by oats also prevented the endotoxemia and ameliorated liver damage in rat, our results suggest that alcohol-induced gut leakiness 1) may cause alcohol-induced endotoxemia and liver injury and 2) may be the critical cofactor in the 30% of alcoholics who develop ALD. Further studies are needed to determine whether ALD in humans can be prevented by preventing alcohol-induced gut leakiness, studies that should lead to the development of useful therapeutic agents for the prevention of ALD.

Novel antioxidants zolimid and AEOL11201 ameliorate colitis in rats

The mechanism of tissue damage in ulcerative colitis (UC) is unknown. However, recent evidence suggests that reactive oxygen species (ROS) are critical mediators of inflammation, and tissue damage in UC and antioxidants could be beneficial in the treatment of UC. Our aim was to evaluate the effects of two new antioxidants, Zolimid and AEOL11201 on experimental colitis. Antioxidants or vehicle were given to rats for five days after induction of colitis by intrarectal administration of 4% acetic acid. Severity of colitis was assessed on day 5. Zolimid and AEOL11201 significantly improved acetic acid-induced colitis. Both Zolimid and AEOL11201 significantly decreased the severity of diarrhea, and severity of macroscopic and histological changes in the colon. Both agents also significantly decreased colonic MPO levels. In conclusion, Zolimid and AEOL11201 are effective antiinflammatory agents in an animal model of colitis. Further studies are needed to evaluate their beneficial therapeutic effects in patients with UC.

Assessing the effect of fatty acids on prostate carcinogenesis in humans: does self-reported dietary intake rank prostatic exposure correctly?

BACKGROUND

Dietary fatty acids may influence prostate carcinogenesis. Although the standard for assessing dietary effects in humans is the semiquantitative food-frequency questionnaire, the extent to which self-reported intake correctly ranks prostatic exposure is unknown.

OBJECTIVE

The objective was to examine the correlation between reported intakes of different fatty acids and their concentrations in prostate tissue.

DESIGN

This was a cross-sectional study of 52 men undergoing surgical resection of the prostate gland. Usual dietary intake of saturated, total unsaturated, oleic, and linoleic fatty acids over the previous year was estimated with use of a 122-item version of the Health Habits and History Questionnaire. Concentrations in prostate tissue were measured directly by use of gas chromatography in healthy tissue collected at the time of surgery and were expressed as a percentage of total fatty acids. Correlations with 4 measures of dietary intake [g/d, g/d adjusted for total daily energy intake, % of total fat (as g/d), and % of total energy] were evaluated by Spearman's rank-order correlation coefficients.

RESULTS

Linoleic acid concentrations in prostate tissue were significantly correlated with dietary intake expressed as g/d adjusted for total energy [r = 0.29 (95% CI: 0.03, 0.49), P = 0.04], % of total fat [r = 0.36 (0.14, 0.550), P = 0.008], and % of total energy [r = 0.28 (0.04, 0.49), P = 0.042], but not as g/d. Although mean concentrations of saturated, total unsaturated, and oleic fatty acids in prostate tissue resembled mean intakes for the group, prostatic concentrations did not correlate with individual intakes.

CONCLUSION

Self-reported intake of fatty acids is a satisfactory marker of prostatic exposure at the group level, but, with the exception of linoleic acid, does not correctly rank individuals with respect to intensity of exposure.

Leiomyosarcoma of the pancreas

BACKGROUND

This is a single case report of a rare tumour, pancreatic leiomyosarcoma.

CASE OUTLINE

A 44-year-old woman presented with a painless epigastric mass, and CT scan showed a cystic lesion of the head of pancreas. An associated epigastric mass was found to be a lipoma. Pancreatoduodenectomy was successfully performed. Pathology revealed leiomyosarcoma of the pancreas. The patient is well and free of disease four years later.

DISCUSSION

Leiomyosarcomas of the pancreas can present with abdominal pain, weight loss and abdominal mass. However, a certain number of tumours will be discovered incidentally and may be cystic in nature. This patient had no antecedent history of gallstones or alcohol and underwent a curative resection.

Examination of nasopharyngeal epithelium with contact endoscopy

Primarily to evaluate the potential of contact endoscopy, the nasopharyngeal mucosa were examined using contact microscopy. With contact endoscopy it has been possible to visualize (60 x, 150 x ) the superficial cell layers of the nasopharyngeal epithelium, previously stained with methylene blue in vivo and in situ. Normal nasopharyngeal epithelium (20 cases) and cases with pathology (18 cases of chronic nasopharyngitis, 5 cases of nasopharyngeal cyst, and 57 cases of poorly differentiated squamous carcinoma) were assessed with contact endoscopy. The results showed that contact endoscopy can offer clear morphology and arrangement of the epithelial cells of the superficial layers and microvascular networks, such as the size and shapes of the cells or nuclei, nucleus/cytoplasm ratio, karyokinesis, etc. Our study indicated that contact endoscopy can permit the mapping of cellular alteration over mucosa and constitutes a new method of monitoring a high-risk population or precancerous lesions of nasopharyngeal carcinoma.

Prostatic levels of fatty acids and the histopathology of localized prostate cancer

PURPOSE

The consumption of various fatty acids has been associated with advanced stage and fatal prostate cancer. While numerous mechanisms have been postulated, to our knowledge there physiological data linking exposure and prognosis in humans are lacking. We examined prostatic levels of individual fatty acids in relation to the prevalence of histopathological characteristics associated with invasiveness and the risk of progression in 49 men undergoing radical prostatectomy for localized prostate cancer.

MATERIALS AND METHODS

Fatty acids were measured using capillary gas chromatography in fresh nonmalignant prostate tissue collected at surgery. Markers of invasiveness and increased risk of progression (Gleason sum 7 or greater, perineural invasion, anatomical or surgical margin involvement, extracapsular extension, seminal vesical involvement and stage T3 tumor) were evaluated separately. Each marker was dichotomized into a yes (case) and no (control) level with patients grouped accordingly. Mean concentrations were compared using the Wilcoxon rank sum test.

RESULTS

The percent of total prostatic polyunsaturated fat and polyunsaturated-to-saturated fat ratios were significantly lower in the presence of perineural invasion, seminal vesical involvement and stage T3 tumor (p = 0.02 to 0.049). alpha-Linolenic acid was significantly lower when tumor extended to an anatomical or surgical margin (p = 0.008). The omega-3 and omega-3-to-omega-6 fatty acid ratios were 1.5 to 3.3-fold lower in cases than in controls, reaching borderline significance in nearly all comparisons (p = 0.052 to 0.097). Saturated and monounsaturated fatty acids were not associated with the traits examined.

CONCLUSIONS

These data suggest that polyunsaturated fatty acids and perhaps essential fatty acids in particular help to regulate prostate carcinogenesis in humans.

A Phe 486 thyrotropin receptor mutation in an autonomously functioning follicular carcinoma that was causing hyperthyroidism

Hot nodules are rarely found to be carcinomas. We report a case of a nonmetastatic follicular carcinoma that presented as a hot nodule that was causing hyperthyroidism. A base substitution (ATC for TTC) was found in codon 486 of the TSH receptor gene and this resulted in the substitution of an isoleucine for a phenylalanine in the first extracellular loop of the receptor. This was absent in the deoxyribonucleic acid from the surrounding normal thyroid tissue indicating its somatic origin. This mutation, which was previously reported to activate both cyclic adenosine monophosphate and the inositol phosphate-diacylglycerol cascades, may have been responsible for the constitutive activation of the thyrotropin receptor and resulting hyperfunction of this follicular carcinoma.

Intragraft localization of activated nuclear factor kappaB in recurrent hepatitis C virus disease following liver transplantation

Nuclear factor kappaB (NF-kappaB) is activated during viral infection and is central to the regulation of host immune responses. The NF-kappaB activation status and its morphological sources were assessed by immunohistochemistry in allograft biopsy specimens of orthotopic liver transplantation patients with recurrent hepatitis C virus (HCV). Hepatocellular NF-kappaB immunostaining was detected in HCV cases compared with controls (nontransplant: P <.001; transplant: P =.006), which correlated with the number of NF-kappaB positive hepatocytes (P =.007) and contrasted to the absent to weak staining of controls (nontransplant: P =.001; transplant: P =.009). Enhanced NF-kappaB staining of cytokeratin 19-positive bile ducts and proliferating ductules in the HCV group was in contrast to controls. Intense NF-kappaB immunoreactivity was detected in CD68-positive Kupffer cells and macrophages of all HCV specimens compared with a few controls (nontransplant: P <.001; transplant: P =.001) and contrasted to the weak staining of controls (nontransplant: P <.001; transplant: P =.001). NF-kappaB-positive immunoreactivity correlated with the number of T cell receptor (TCR) alpha/beta-positive lymphocytes (P <.001), which was not observed in controls. In those HCV cases showing evidence of necroinflammatory activity (grade) and individual features of portal inflammation, periportal inflammation/piecemeal necrosis, lobular inflammation, and fibrosis (stage), higher NF-kappaB staining intensity scores within bile ducts, proliferating ductules, hepatocytes (piecemeal necrosis: P =.016; stage: P =.030), and lymphocytes (stage: P =.044) and increased number of NF-kappaB-positive cells within bile ducts, proliferating ductules (grade, lobular inflammation, piecemeal necrosis, stage: P =.022), hepatocytes, and lymphocytes were observed. Increased staining intensity and frequency of NF-kappaB-positive cells were similarly observed in HCV-positive allografts obtained from patients under tacrolimus- compared with cyclosporine-based immunosuppression. These data implicate an immunoregulatory role of intragraft NF-kappaB activation in the pathogenesis and progression of posttransplantation HCV disease recurrence.

Pseudomembranous gastritis: a novel complication of Aspergillus infection in a patient with a bone marrow transplant and graft versus host disease

A 36-year-old Hispanic man who had undergone allogeneic bone marrow transplantation, complicated by graft versus host disease, was admitted with acute gastrointestinal symptoms, including severe diarrhea and diffuse abdominal pain. He also had a persistent cough with sputum production. Blood cultures yielded Escherichia coli, and sputum cultures grew Apergillus species. The patient was treated with antifungal agents and broad-spectrum antibiotics. Despite aggressive medical therapy, the patient died 10 days after admission. Postmortem examination disclosed severe, bilateral confluent bronchopneumonia, with numerous septated branching hyphae consistent with Aspergillus species fungal organisms that involved the pulmonary parenchyma and tracheobronchial tree. Although the small and large bowels were only mildly congested, the entire gastric mucosa was covered with a 1.5-cm-thick pseudomembrane that contained numerous Aspergillus organisms. Our report represents the first description, to our knowledge, of a diffuse inflammatory pseudomembrane in the stomach, a complication that to date has only been associated with small and large bowel involvement.

Primary malignant melanoma of the common bile duct: a case report and review of the literature

Primary malignant melanoma of the common bile duct is rare. To our knowledge, only 6 cases have been reported previously. The pathologic diagnosis of primary malignant melanoma in extracutaneous sites often requires the use of confirmatory immunohistochemical stains and electron microscopy studies, as well as tests to rule out other possible remote or concurrent primary sites. The presence of junctional activity adjacent to the tumor is another important requisite for the diagnosis of this entity. Nevertheless, absolute exclusion of a metastatic melanoma from an unknown occult site or regressed site is not entirely possible. We describe our observations in a case of primary malignant melanoma of the common bile duct in a 48-year-old man and discuss the criteria for diagnosis of primary melanoma.

Prostatic levels of tocopherols, carotenoids, and retinol in relation to plasma levels and self-reported usual dietary intake

This study evaluated how prostatic levels of antioxidants relate to plasma levels and self-reported usual dietary intake. Definition of these relations may aid in interpreting studies of antioxidant exposure and prostate cancer risk. Between July 1996 and April 1997, plasma and prostatic tissue levels of tocopherols, carotenoids, and retinol were measured in 47 men undergoing radical prostatectomy or transurethral prostatectomy at Loyola University Medical Center, Maywood, Illinois, and an affiliate hospital. Dietary intake was measured by using a 122-item version of the Block Health Habits and History Questionnaire, and correlations were assessed with Pearson's coefficients. Prostatic levels of tocopherols and carotenoids (but not retinol) were significantly correlated with plasma levels (r= 0.31-0.56, p < 0.05-0.0001); the strongest correlations were associated with lycopene, beta-carotene, and gamma-tocopherol (0.56, 0.54, and 0.52, respectively; p < 0.0001). Relative concentrations of tocopherols and carotenoids in prostate tissue were proportionate to those in plasma. No correlation between prostatic levels and reported dietary intake was observed (r = -0.09 to 0.16, p < not significant). Adjustment for energy intake, body mass index, and serum lipids did not impact these relations. These results suggest that plasma levels of tocopherols and carotenoids better reflect prostatic exposure than self-reported usual dietary intake.

Adenosquamous carcinoma of the pancreas

BACKGROUND

Adenosquamous carcinoma of the pancreas most probably represents squamous metaplasia of an adenocarcinoma. Metastases are typically an admixture of both elements, but more frequently, adenocarcinoma.

METHODS

A review of 102 pancreaticoduodenectomies for masses of the head of the pancreas done between 1994 and 1998 revealed two patients with adenosquamous carcinoma of the pancreas.

RESULTS

Both patients underwent successful pancreaticoduodenctomy, but were found to have nodal metastasis. One patient lived 13 mo and the other lived 14 mo with both dying from metastatic disease.

CONCLUSION

Adenosquamous carcinoma of the pancreas is a rare tumor, and because its presentation, clinical features, and course are identical to adenocarcinoma of the pancreas, it should be considered in the differential diagnosis for any mass of the head of the pancreas. Survival is poor for these patients. In this series, it was 13 and 14 mo, respectively.

Immunohistochemical evaluation of Bcl-2 gene family expression in liver of hepatitis C and cirrhotic patients: a novel mechanism to explain the high incidence of hepatocarcinoma in cirrhotics

OBJECTIVE

The purpose of this study was to determine whether there is an increase in expression of bcl-2 and related bcl-2 gene family members bcl-X and bax in liver biopsy samples obtained from patients with either hepatitis C infection or cirrhosis. Bcl-2, bcl-X, and bax, as well as other bcl-2-related proteins, function coordinately through homo- and heterodimerization to regulate apoptosis. Bcl-2, which is characterized as an antiapoptotic, also functions as an antioxidant. We hypothesized that a mechanism that could account for increased hepatocellular carcinoma in patients with hepatitis C and cirrhosis is selection of bcl-2 expressing cells. This selection would be due to the capacity of individual cells to resist the toxic effects of inflammatory byproducts, specifically reactive oxygen species.

METHODS

Sections cut from archived liver biopsy samples embedded in paraffin were probed with antibody specific for bcl-2, bcl-X, or bax. Liver samples were from normal (N = 5), hepatitis C patients (N = 19), and cirrhotics (N = 10). Percent positive staining and intensity of staining were judged independently for hepatocytes, bile ducts, mononuclear cells, and Kupffer cells.

RESULTS

Bcl-2 expression was evident in bile ducts and mononuclear cells of hepatitis C patients, but was not commonly present in hepatocytes (two of 10). In the cirrhotic liver, bcl-2 expression was also detected in bile ducts and mononuclear cells, but in contrast to hepatitis patients was also expressed in hepatocytes (nine of 10). A similar pattern of expression was evident for bcl-X, but in general the level of expression was limited relative to that of bcl-2. Bax expression was infrequently present in sections from any of the three patient groups.

CONCLUSIONS

The data indicate that bcl-2 expression is elevated in the liver of cirrhotics, but is not evident in the liver of hepatitis C patients. This increase in expression of bcl-2 in cirrhotic patients may correlate with development of hepatocellular carcinoma given the anti-apoptotic/oncogenic potential of bcl-2.

CD40L (CD154) expression in human liver allografts during chronic ductopenic rejection

The CD40-CD40L (CD154) interaction plays a pivotal role in the effector mechanisms of allograft rejection. Blockade of the CD40/CD40L costimulatory pathway prevents the development of chronic allograft rejection in several animal transplant models. The relevance of in situ CD40 and CD40L expression in human liver allografts was assessed by immunohistochemistry during ductopenic chronic rejection (CR). In CR allograft specimens (n = 8), marked CD40L expression was detected on Kupffer cells (KCs) and sinusoidal macrophages with a unique centrilobular distribution (P <.001). The CD40L+ KCs and macrophages were shown to be CD68+ after immunohistochemical analysis of serial sections with anti-CD68 monoclonal antibody. Moderate staining of vascular and sinusoidal endothelial cells and mononuclear infiltrates was observed in some CR cases. These findings were in contrast to the absence of CD40L expression in controls (n = 11) consisting of stable liver allograft and normal liver tissue specimens. Only occasional CD40 expression in some cases of CR and controls was observed. In CR, CD40L (CD154) expression is manifested on KCs and macrophages. The present novel data show another important cellular source of CD40L expression and suggest a potential role of KCs/macrophages and CD40/CD40L costimulatory interactions in the pathogenesis of chronic rejection ductopenic liver allograft.

Cystic glucagonoma: A rare variant of an uncommon neuroendocrine pancreas tumor

Glucagon-producing neuroendocrine tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema, non-insulin-dependent diabetes, weight loss, anemia, glossitis, and an increased thrombotic tendency. Most glucagonomas are solid and arise in the body or tail of the pancreas. We report two cases of cystic glucagonoma, one found incidentally in an asymptomatic patient and one in a patient with weight loss and diabetes but no rash. In the first patient, distal pancreatectomy and splenectomy were curative, whereas the second patient continued to exhibit elevated serum glucagon levels and symptoms of glucose intolerance in the absence of demonstrable metastases. Cystic glucagonoma is a unique variant of classic glucagonoma and should be considered in the differential diagnosis of cystic pancreatic neoplasms.

Mechanism of lymph node metastases: current concepts

Advances in head and neck surgical techniques with aggressive adjuvant treatment have reduced the incidence of locoregional failure in many types of head and neck cancer. Failure to control distant disease, however, remains of the most frustrating aspects in the care of these patients. A strong foundation in the biology of invasion and metastasis is necessary to understand more clearly the reasons for the development of distant and locally recurrent disease. This article focuses on basic mechanisms of invasion and metastasis in head and neck squamous cell carcinoma.

Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis in lung transplant recipients: an immunocytochemical study

Cytomegalovirus (CMV) pneumonitis is a common opportunistic infection in lung transplant recipients. Its diagnosis usually rests on the identification of viral inclusions in lung parenchyma obtained by transbronchial biopsy, or by examination of the cytologic material obtained by bronchioloalveolar lavage (BAL). To determine whether the use of immunocytochemistry (ICC) increases the sensitivity of cytology in the diagnosis of CMV pneumonitis, we retrospectively selected 17 cases in which transbronchial biopsy and BAL were performed simultaneously, and had positive histology with negative cytology. Five negative controls were selected. The 22 slides were decolorized and restained with ICC for CMV. Of the 17 slides, nine (53%) showed cells with positive nuclear staining. All controls were negative. These results were then correlated with the number of infected cells present in the biopsy tissue, and the location of the cells (interstitial vs. intraalveolar). A good correlation was found between positive cytology and intraalveolar location of infected cells, and no correlation was seen between number of infected cells in the biopsy and the positive cytology. In summary, although histologic evaluation of lung parenchyma obtained by transbronchial biopsy is more sensitive for diagnosis of CMV pneumonitis, the sensitivity of the cytologic evaluation of BAL material can be increased by the use of ICC. The likelihood of positive ICC seems to be related to the presence of infected cells in the alveolar space rather than to the number of infected cells.

Antibodies to mycobacterial 65-kDa heat shock protein and other immunodominant antigens in patients with psoriasis

An association of microbial agents and autoimmunity has been suggested for the pathogenesis of psoriasis. Mycobacteria are common environmental microbes and their antigens, especially the highly conserved mycobacterial 65-kDa heat shock protein (hps65), have been implicated in the pathogenesis of autoimmune arthritis and other idiopathic diseases. In this context, we investigated a possible mycobacterium-induced humoral immune response in psoriasis. Sera from 17 patients with chronic plaque-type psoriasis were studied by immunoblotting using the whole sonicate of Mycobacterium tuberculosis and purified recombinant mycobacterial hsp65. Immunoblot analysis demonstrated that 58% of the psoriasis patients compared to patients with acne and DLE, and normal controls showed strong antibody activity to 65-kDa and 48/45 doublet antigens from M. tuberculosis sonicate, whereas 47% of the patients showed antibody activity to mycobacterial hsp65. Only 10-20% of the patients had an antibody response to 16-kDa and 80-kDa antigens. Similar antibody activity to 65 kDa and 48/45 kDa was also found consistently with eight different sonicated mycobacterial species by immunoblotting, indicating that these seroreactive antigens are crossreactive and are present in common environmental mycobacteria. Antibody activities to both mycobacterial 65-kDa and hsp65 showed a positive correlation (r = 0.76) with the psoriasis disease activity, whereas antibodies to 48/45-kDa doublet antigens showed a weak correlation (r = 0.54). By enzyme-linked immunosorbent assay (ELISA), 47% of the psoriasis patients showed significantly elevated antibody titers to hsp65 (p < 0.003) as compared to control groups, and the antibody response by ELISA also showed a significant positive correlation (r = 0.76) with disease activity. Anti-mycobacterial antibody activity may be related to severity of disease and may be useful in monitoring disease activity in psoriasis.

Heterogeneity of monoclonal antibody-reactive epitopes on mycobacterial 30-kilodalton-region proteins and the secreted antigen 85 complex and demonstration of antigen 85B on the Mycobacterium leprae cell wall surface

Proteins of the antigen 85 complex in the 30-kDa region secreted by live mycobacteria are important in the immune response against mycobacterial infections and may play an important biological role in the host-parasite interaction. In the present study, we have characterized epitopes of the 30-kDa-region proteins and the antigen 85 complex by using a panel of 13 monoclonal antibodies (MAbs) reacting with these antigens, 6 of which have not been described before. By using five previously characterized related secreted proteins of Mycobacterium tuberculosis, MPT44 (85A), MPT59 (85B), MPT45 (85C), MPT51 (27 kDa), and MPT64 (26 kDa), we have identified at least 10 different MAb-reactive epitopes on the proteins of the antigen 85 complex. A heterogeneous distribution of epitopes was observed within the components of the antigen 85 complex. Two distinct epitopes specific for antigen 85B and two other epitopes restricted to the 85A and 85B components were recognized. Two of them were shared with a previously unidentified 27-kDa protein present in M. tuberculosis culture fluid from which all MPT proteins were derived. The rest of the MAb-reactive epitopes were found to be present mostly in antigens 85A and 85B and to a lesser extent in antigen 85C. None of these MAbs recognized component 85C alone nor did they bind to the related MPT51 and MPT64 proteins. Interestingly, most of the MAbs reacted with purified native proteins of the antigen 85 complex but not to them in their denatured forms. In contrast, reactivity of the MAbs with the cytosol fraction of M. tuberculosis in immunoblotting revealed that they bound to a closely related cytosolic 30-kDa protein(s) even when they were denatured. Heterogeneity of these MAb-reactive epitopes of the antigen 85 complex was further evident as they were found to be distributed in various patterns among 19 different mycobacterial species. By using fusion proteins of the Mycobacterium leprae 30/31-kDa antigen 85 complex, we have localized at least six different epitopes within amino acid residues 55 to 266 of the M. leprae antigen 85 complex. Finally, by immunohistochemical analysis, we have demonstrated the in situ expression of one of the novel MAb-reactive epitopes specific for antigen 85B on the cell wall surface of M. leprae within macrophages in lepromatous leprosy lesions and thus provide direct evidence for the presence of the B component of the antigen 85 complex on the surface of intact M. leprae.

Sero-diagnosis of tuberculosis with A60 antigen enzyme-linked immunosorbent assay: failure in HIV-infected individuals in Ghana

In order to assess the diagnostic usefulness of the A60 (ANDA Biological, Strassbourg, France) sero-diagnostic enzyme-linked immunosorbent assay (ELISA) kit for tuberculosis in Africa, sera of 53 pulmonary smear-positive tuberculosis (TB) patients, 30 apparently healthy control subjects and 6 AIDS suspects were sampled in Agogo Hospital in the forest area of Ghana. These sera were analyzed for antibodies to HIV-1 and HIV-2, and IgG-antibodies to the A60 BCG-antigen, while the non-HIV individuals were tested for total IgG levels. One healthy control subject, all of 6 AIDS suspects and 7 of the TB patients has HIV infections. In the non-HIV TB group, the sensitivity and specifity of the A60 ELISA was 78% and 86%, respectively, which was much poorer than expected from published reports about the A60 test. The A60 test failed, completely however, to discriminate between TB and non-TB in the HIV-positive group. In the non-HIV groups, total IgG levels were significantly higher in TB patients than in controls. It seems that the usefulness of the A60 ELISA test to diagnose tuberculosis is very limited in this high-incidence area, and that it seems to be of no value in patients infected with HIV.

Cytotoxic effects of hydrogen sulfide on pulmonary alveolar macrophages in rats

Respiratory rates (basal and zymosan-stimulated) and cell viability were monitored in pulmonary alveolar macrophages (PAM) from rats exposed to 0, 70, 280, and 560 mg/m3 (0, 50, 200, and 400 ppm) hydrogen sulfide (H2S) gas for 4 h. Zymosan-stimulated respiratory rates were markedly reduced in PAM collected from rats exposed to 280 and 560 mg/m3 H2S; however, their basal respiratory rates were not affected. Significant decrease in cell viability was also observed in samples from 560 mg/m3 H2S-treated rats, but it remained high and unchanged in other treatments. In vitro incubation of PAM from control rats with sulfide (a precursor of H2S) and its two oxidation products, sulfite and sulfate, showed that sulfide was markedly more inhibitory to both respiratory rates than sulfite or sulfate. These treatments did not affect cell viability.

Identification of a novel B-cell epitope of restricted specificity on the hsp 65-kDa protein of Mycobacterium tuberculosis

A B-cell epitope on the carboxy-terminal region of the mycobacterial 65-kDa heat shock protein that distinguishes Mycobacterium tuberculosis/Mycobacterium bovis BCG from Mycobacterium leprae was identified by two novel monoclonal antibodies (mAbs), Ne5 and Nd4. These mAbs also showed a limited cross reactivity with mycobacterial species belonging to M. tuberculosis complex and Mycobacterium avium complex with the exception of Mycobacterium vaccae. Characterization of the epitope recognized by these mAbs was done with M. bovis BCG 65-kDa fusion proteins expressed in Escherichia coli encoding various segments of the 65-kDa protein. Our results together with those reported in literature indicated that this epitope resides in the highly divergent region of amino acid residues 525 to 540. This B-cell epitope on the 65-kDa protein of M. tuberculosis/M. bovis BCG has not been recognized by previously reported mAbs, although the analogous epitope sequence of M. leprae 65-kDa has been identified by a known mAb (IIIC8) reported in the literature. Therefore Ne5/Nd4 epitope could be considered important in studying the differential immune response of the host against infections with M. tuberculosis complex/M. avium complex and M. leprae.

Effects of hydrogen sulfide exposure on lung mitochondrial respiratory chain enzymes in rats

Fischer-344 rats were exposed for 4 hr to various concentrations of hydrogen sulfide (H2S) gas and killed either immediately or at 1, 24, or 48 hr after exposure. Mitochondrial fractions from lung tissues were assayed for the activities of respiratory chain enzymes. Exposure of rats to a low concentration (10 ppm) of H2S caused no significant changes in the activities of lung mitochondrial enzymes. However, exposure to sublethal concentrations of H2S (50-400 ppm) produced marked and highly significant depressions in the activities of cytochrome c oxidase and succinate oxidase complexes of the respiratory chain. The inhibition of cytochrome c oxidase activity in lungs was most severe (greater than 90%) in rats that died from acute exposure to greater than 500 ppm H2S. In rats exposed to 200 and 400 ppm H2S, a marked recovery in cytochrome c oxidase activity of lungs was observed at 24 and 48 hr postexposure. Studies in vitro with rat lung mitochondria showed that low concentrations of sulfide also caused a similar and selective inhibition of cytochrome c oxidase activity. This effect was reversed upon removal of sulfide either by washing or by oxidation with methemoglobin. The nature of sulfide inhibition of cytochrome c oxidase was noncompetitive with respect to ferrocytochrome c. Because the activities of NADH-cytochrome c reductase and succinate-cytochrome c reductase were not significantly altered by H2S exposure and in vitro treatments with low concentrations of sulfide, it is concluded that under physiological conditions H2S would block the respiratory chain primarily by inhibiting cytochrome c oxidase. Such a biochemical impairment would lead to functional (histotoxic) hypoxia in the lung tissues.

Stimulation by 17 alpha-hydroxyprogesterone of glycoprotein and glycosaminoglycan synthesis in human placenta in vitro

The incorporation of 14C-glucosamine into glycoproteins (GP) and glycosaminoglycans (GAG), of 3H-leucine into protein, and the hexuronic acid (HA) content of polymerized GAG was determined in incubated placental tissue. In placentae of earlier gestational age (GA), incorporation of 14C-glucosamine was 2.6 times greater than other at 38-39 weeks GA. 19 of 26 placentae at 38-39 weeks GA responded by one or more parameters when incubated with 0.5-3 microM 17 alpha-OH-progesterone (17OHP). Those which did not respond were all of earlier GA; the placental content of GAG decreased in these from 31.1 +/- 1.8 nmol HA/mg protein to 16.4 +/- 1.5 nmol in placentae of GA 38-39 weeks. In the latter, 17OHP increased GAG by 42.5% to 24.4 +/- 2.5 nmol HA/mg protein in a 2-hour incubation. Progesterone, oestriol, cortisol and testosterone were without effect. It is concluded that synthesis of placental GAG decreases toward the end of gestation, but can be increased by 17OHP specifically. This indicates that 17OHP is a biologically active steroid and might have a role in maintaining placental function.

Nasal lesions in rats exposed to hydrogen sulfide for four hours

Fischer-344 rats were exposed for 4 hours to 0, 14, 280, or 560 mg of hydrogen sulfide.m-3 and killed 1, 18, or 44 hours later. We evaluated the nasal epithelial cells and determined the anatomic distribution of lesions. Inhalation of 560 mg of hydrogen sulfide.m-3 induced necrosis and exfoliation of respiratory and olfactory mucosal cells, but not squamous epithelial cells. The anatomic distribution of lesions was midway along the nasal passages involving nasal and maxillary conchae, but not ethmoidal conchae. Injured respiratory mucosa repaired rapidly, whereas olfactory mucosa continued to exfoliate at 44 hours after exposure.

Concentration-time interactions in hydrogen sulphide toxicity in rats

Concentration-time interactions were investigated in young male and female Sprague-Dawley, Long Evans and Fischer-344 rats exposed to hydrogen sulphide for two, four or six hours. Higher concentrations caused more deaths, with no significant difference for duration of exposure. A significant sex effect was noted with 30% mortality in males and 20% in females, with no significant difference among strains. Changes in weight were significant: increasing with concentration, higher in males than in females, different among strains (Fischer-344 less than Sprague Dawley less than Long Evans), and affected by duration of exposure. Lethal concentration values (LC50 and LC10) were estimated, for the pooled data set (n = 456); the probit equation was Y = -5.74749 + 3.8259X where X is log10 dose of hydrogen sulphide in parts per million. The LC50/LC10 values were 644/298 parts per million (902/417 mg m-3) respectively. Individual probit analyses were also performed for strain, hours of exposure and sex. The LC50 and LC10 values for male, female and strain were not different. Significant differences were observed among LC50/LC10 values for hours of exposure (2 h = 587/549 parts per million, 822/769 mg m-3; 4 h = 501/422 parts per million, 701/591 mg m-3; 6 h = 335/299 parts per million, 469/491 mg m-3). There was no effect of spatial position in the exposure chamber on the distribution of mortality. All rats of all strains dying had severe pulmonary edema.

Biochemical and cytologic alterations in the respiratory tract of rats exposed for 4 hours to hydrogen sulfide

Fischer-344 rats were killed by exsanguination 1, 20, and 44 hr after a single 4-hr exposure to an atmosphere of 0, 10, 200, and 400 ppm of hydrogen sulfide (H2S). Alterations in the activities of lactate dehydrogenase and alkaline phosphatase, and cytomorphology of epithelial cells in fluids obtained by nasal and bronchoalveolar lavage were used as indicators of cell injury. Changes in the number of leukocytes were used as indicators of inflammatory response, and changes in the concentration of protein were used as indicators of altered vascular permeability. Inhalation of H2S resulted in 139, 483, and 817% increased cellularity in the nasal cavity of rats exposed to 10, 200, and 400 ppm, respectively. This was due to marked exfoliation of degenerated epithelial cells and exudation of neutrophils. The high dose of H2S resulted in a moderate increase in lactate dehydrogenase and protein in nasal passages; values returned to baseline levels 20 hr later. Bronchoalveolar cell counts were decreased in rats exposed to 400 ppm and unchanged in those exposed to 10 and 200 ppm. Enzymatic activities in lung lavage fluid were moderately elevated (up to 90%), yet protein concentrations were increased by more than 3000% and remained significantly elevated up to 44 hr after exposure to 400 ppm. It was concluded that inhalation of H2S has a severe cytotoxic effect on the nasal epithelium and a severe edematogenic effect on lung parenchyma. These results are in agreement with autopsy findings of individuals killed by accidental exposure to H2S-containing sour gas.

Effect of intratracheal inoculation of Pasteurella haemolytica cytotoxin on the integrity of rat lung

This study was conducted to investigate the in vivo effect of a single intratracheal inoculation of Pasteurella haemolytica cytotoxin on the rat lung. Changes in the biochemical and cytological composition of bronchoalveolar lavage fluid were used to estimate the magnitude of pulmonary cell injury, inflammatory response, vascular permeability and functional status of pulmonary alveolar macrophages. Effect of treatment was compared with rats intratracheally inoculated with supernatants of Pasteurella multocida or with sterile physiological saline solution (vehicle). Results indicated that Pasteurella haemolytica supernatants were not significantly toxic for the lungs of rats.

Profiles of type-II pneumocytes in rats inoculated intratracheally with bacterial lipopolysaccharide

Ultrastructural and morphometric profiles of type-II pneumocytes (P-II) were investigated in rats killed 18 or 24 hours after a single intratracheal inoculation of bacterial (Escherichia coli) lipopolysaccharide (LPS). Inoculation with LPS induced pulmonary injury and inflammation, as measured by increased lactate dehydrogenase and alkaline phosphatase activities and increased numbers of polymorphonuclear neutrophils in fluid collected by bronchoalveolar lavage. Marked ultrastructural changes and desquamation of a few P-II developed at the time of high activity of lactate dehydrogenase and alkaline phosphatase in bronchoalveolar lavage fluid. Ultrastructural changes included swollen mitochondria and localized cisternal dilatation of the endoplasmic reticulum in which was contained membrane-bound homogenous material of medium electron density. Twenty-four hours after LPS inoculation, point-count stereologic analysis and digitizing morphometry revealed greater than 50% increase in P-II size. Changes in cell size corresponded with ultrastructural finding of swollen cells. Results obtained by point-count stereologic analysis and digitizing morphometry were highly correlated (r = 0.95). Lamellar bodies (LB) comprised 12 to 15% of P-II volume. Volume density and number of LB remained unaltered in LPS-injured P-II, and evidence of accelerated release of LB was not detected after LPS inoculation. Exudated polymorphonuclear neutrophils and pulmonary alveolar macrophages were involved actively in the phagocytosis of LB originating from necrotic and desquamated P-II. On the basis of measurement of enzyme activity (enzymes released into the bronchoalveolar space), considerable ultrastructural alterations developed in P-II when maximal LPS-induced pulmonary cell injury took place.

Effect of vehicular volume on the early pulmonary injury and inflammatory response in rats inoculated intratracheally with silica

The effect of vehicular saline solution volume on early lesions induced in rats by intratracheal administration of silica was evaluated. Seventy-two male Long-Evans rats were randomly assigned 6 each to 12 factorial groups (3 X 2 X 2): 3 doses of silica (0, 2.5, and 5 mg), 2 volumes of vehicle (saline solution; 0.1 and 0.5 ml), and 2 postinoculation times (1 and 3 days). Lactate dehydrogenase and alkaline phosphatase activities in the bronchoalveolar lavage fluid supernatant and cell viability of bronchoalveolar cells were used as indicators of cell injury. The number of pulmonary alveolar macrophages and polymorphonuclear leukocytes were used as indicators of inflammatory response. Dose of silica and postinoculation time had a significant (P less than 0.05) effect on the biochemical and cellular composition of lavage fluid. The volume of vehicle in which silica was suspended significantly (P less than 0.05) enhanced the pulmonary injury and inflammatory response. However, dose-volume interaction was only significant (P less than 0.05) in 1 of 6 parameters, indicating that the effect was additive, but not synergistic, in nature. Seemingly, vehicle volume had an enhanced effect on the injury and the inflammatory response induced by intratracheal inoculation of silica.