Metabolomic profiling of the Dietary Approaches to Stop Hypertension diet provides novel insights for the nutritional epidemiology of type 2 diabetes mellitus

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is inversely associated with type 2 diabetes mellitus (T2DM) risk. Metabolic changes due to DASH adherence and their potential relationship with incident T2DM have not been described. The objective is to determine metabolite clusters associated with adherence to a DASH-like diet in the Insulin Resistance Atherosclerosis Study cohort and explore if the clusters predicted 5-year incidence of T2DM. The current study included 570 non-diabetic multi-ethnic participants aged 40–69 years. Adherence to a DASH-like diet was determined a priori through an eighty-point scale for absolute intakes of the eight DASH food groups. Quantitative measurements of eighty-seven metabolites (acylcarnitines, amino acids, bile acids, sterols and fatty acids) were obtained at baseline. Metabolite clusters related to DASH adherence were determined through partial least squares (PLS) analysis using R. Multivariable-adjusted logistic regression was used to explore the associations between metabolite clusters and incident T2DM. A group of acylcarnitines and fatty acids loaded strongly on the two components retained under PLS. Among strongly loading metabolites, a select group of acylcarnitines had over 50 % of their individual variance explained by the PLS model. Component 2 was inversely associated with incident T2DM (OR: 0·89; (95 % CI 0·80, 0·99), P-value = 0·043) after adjustment for demographic and metabolic covariates. Component 1 was not associated with T2DM risk (OR: 1·02; (95 % CI 0·88, 1·19), P-value = 0·74). Adherence to a DASH-type diet may contribute to reduced T2DM risk in part through modulations in acylcarnitine and fatty acid physiology.

Branched-Chain Amino Acids and Insulin Metabolism: The Insulin Resistance Atherosclerosis Study (IRAS)

OBJECTIVE

Recent studies using untargeted metabolomics approaches have suggested that plasma branched-chain amino acids (BCAAs) are associated with incident diabetes. However, little is known about the role of plasma BCAAs in metabolic abnormalities underlying diabetes and whether these relationships are consistent across ethnic populations at high risk for diabetes. We investigated the associations of BCAAs with insulin sensitivity (SI), acute insulin response (AIR), and metabolic clearance of insulin (MCRI) in a multiethnic cohort.

RESEARCH DESIGN AND METHODS

In 685 participants without diabetes of the Insulin Resistance Atherosclerosis Study (IRAS) (290 Caucasians, 165 African Americans, and 230 Hispanics), we measured plasma BCAAs (sum of valine, leucine, and isoleucine) by mass spectrometry and SI, AIR, and MCRI by frequently sampled intravenous glucose tolerance tests.

RESULTS

Elevated plasma BCAAs were inversely associated with SI and MCRI and positively associated with fasting insulin in regression models adjusted for potential confounders (β = -0.0012 [95% CI -0.0018, -0.00059], P < 0.001 for SI; β = -0.0013 [95% CI -0.0018, -0.00082], P < 0.001 for MCRI; and β = 0.0015 [95% CI 0.0008, 0.0023], P < 0.001 for fasting insulin). The association of BCAA with SI was significantly modified by ethnicity, with the association only being significant in Caucasians and Hispanics. Elevated plasma BCAAs were associated with incident diabetes in Caucasians and Hispanics (multivariable-adjusted odds ratio per 1-SD increase in plasma BCAAs: 1.67 [95% CI 1.21, 2.29], P = 0.002) but not in African Americans. Plasma BCAAs were not associated with SI-adjusted AIR.

CONCLUSIONS

Plasma BCAAs are associated with incident diabetes and underlying metabolic abnormalities, although the associations were generally stronger in Caucasians and Hispanics.

Nutritional lipidomics: molecular metabolism, analytics, and diagnostics

The field of lipidomics is providing nutritional science a more comprehensive view of lipid intermediates. Lipidomics research takes advantage of the increase in accuracy and sensitivity of mass detection of MS with new bioinformatics toolsets to characterize the structures and abundances of complex lipids. Yet, translating lipidomics to practice via nutritional interventions is still in its infancy. No single instrumentation platform is able to solve the varying analytical challenges of the different molecular lipid species. Biochemical pathways of lipid metabolism remain incomplete and the tools to map lipid compositional data to pathways are still being assembled. Biology itself is dauntingly complex and simply separating biological structures remains a key challenge to lipidomics. Nonetheless, the strategy of combining tandem analytical methods to perform the sensitive, high-throughput, quantitative, and comprehensive analysis of lipid metabolites of very large numbers of molecules is poised to drive the field forward rapidly. Among the next steps for nutrition to understand the changes in structures, compositions, and function of lipid biomolecules in response to diet is to describe their distribution within discrete functional compartments lipoproteins. Additionally, lipidomics must tackle the task of assigning the functions of lipids as signaling molecules, nutrient sensors, and intermediates of metabolic pathways.

Biomarker models as surrogates for the disposition index in the Insulin Resistance Atherosclerosis Study

AIMS

Insulin sensitivity and acute insulin response measure key components of Type 2 diabetes aetiology that contribute independently to risk in the Insulin Resistance Atherosclerosis Study. As insulin sensitivity and acute insulin response are not routinely measured in a clinical setting, we evaluated three fasting biomarker models, homeostasis model assessment of insulin sensitivity (HOMA-%S), β-cell function (HOMA-%B) and a Diabetes Risk Score, as potential surrogates for risk associated with insulin sensitivity, acute insulin response and the interaction of these two measures, the disposition index.

METHODS

Models were calculated from baseline plasma biomarker concentrations for 664 participants who underwent a frequently sampled intravenous glucose tolerance test. To assess relationships among biomarker models and test measures, we calculated improvement in risk estimation gained by combining each fasting measure with each frequently sampled intravenous glucose tolerance test measure using logistic regression.

RESULTS

The strongest correlates of acute insulin response, insulin sensitivity and disposition index were HOMA-%B (r(s)(2) = 0.23), HOMA-%S (r(s)(2) = 0.48) and Diabetes Risk Score (r(s)(2) = 0.34), respectively. Individual areas under the curves for prediction of diabetes were 0.549 (HOMA-%B), 0.694 (HOMA-%S), 0.700 (insulin sensitivity), 0.714 (acute insulin response), 0.756 (Diabetes Risk Score) and 0.817 (disposition index). Models combining acute insulin response with Diabetes Risk Score (area under the curve 0.798) or HOMA-%S (area under the curve 0.805) nearly equalled disposition index, outperforming other individual measures (P < 0.05). Insulin sensitivity plus Diabetes Risk Score (area under the curve 0.760) was better than insulin sensitivity (P = 0.03), but not better than Diabetes Risk Score alone. HOMA-%S plus insulin sensitivity (area under the curve 0.704) was not significantly better than either alone.

CONCLUSIONS

The Diabetes Risk Score and HOMA-%S were excellent surrogates for insulin sensitivity, capturing the predictive power of insulin sensitivity. Diabetes Risk Score captured some of the additional predictive power of acute insulin response, but the HOMA models did not. No fasting model was as predictive as disposition index, but the Diabetes Risk Score was the best surrogate.

Polysome profiling in liver identifies dynamic regulation of endoplasmic reticulum translatome by obesity and fasting

Obesity-associated metabolic complications are generally considered to emerge from abnormalities in carbohydrate and lipid metabolism, whereas the status of protein metabolism is not well studied. Here, we performed comparative polysome and associated transcriptional profiling analyses to study the dynamics and functional implications of endoplasmic reticulum (ER)–associated protein synthesis in the mouse liver under conditions of obesity and nutrient deprivation. We discovered that ER from livers of obese mice exhibits a general reduction in protein synthesis, and comprehensive analysis of polysome-bound transcripts revealed extensive down-regulation of protein synthesis machinery, mitochondrial components, and bile acid metabolism in the obese translatome. Nutrient availability also plays an important but distinct role in remodeling the hepatic ER translatome in lean and obese mice. Fasting in obese mice partially reversed the overall translatomic differences between lean and obese nonfasted controls, whereas fasting of the lean mice mimicked many of the translatomic changes induced by the development of obesity. The strongest examples of such regulations were the reduction in Cyp7b1 and Slco1a1, molecules involved in bile acid metabolism. Exogenous expression of either gene significantly lowered plasma glucose levels, improved hepatic steatosis, but also caused cholestasis, indicating the fine balance bile acids play in regulating metabolism and health. Together, our work defines dynamic regulation of the liver translatome by obesity and nutrient availability, and it identifies a novel role for bile acid metabolism in the pathogenesis of metabolic abnormalities associated with obesity.

Chronic diseases including obesity and associated metabolic abnormalities have become the greatest threat to human health worldwide. How metabolic organs and organelles adapt to nutritional fluctuations, or fail to do so, remains incompletely understood. To explore these issues, we developed a new platform to explore translational responses in the liver, a critical organ for metabolic homeostasis. In this translatomic platform, we integrated polysome profiling and global analysis of polysome-associated mRNAs to systematically quantify protein synthesis on each transcript in obesity and during fasting. Our analysis demonstrated for the first time that protein synthesis is progressively suppressed in the obese liver and that the overall translatome profile of obese liver markedly resembles that of fasting lean mice, particularly in mitochondrial function and bile metabolism. We also examined the physiological impact of some of these alterations and concluded that aberrant bile acid metabolism in the obese liver represents a novel mechanism contributing to hyperglycemia and continuous weight gain. Together, our work reveals abnormal translational regulation as a novel aspect of obesity that could impact future directions in metabolic disease treatment, and we believe translatome profiling represents a new approach to unravel complex mechanisms regulating cellular function and disease pathology.

Biomarkers in Type 2 diabetes: improving risk stratification with the PreDx ® Diabetes Risk Score

Type 2 diabetes is a chronic, debilitating and often deadly disease that has reached epidemic proportions. The onset of diabetes can be delayed or prevented in high-risk individuals by diet and lifestyle changes and medications, and hence a key element for addressing the diabetes epidemic is to identify those most at risk of developing diabetes so that preventative measures can be effectively focused. The PreDx(®) Diabetes Risk Score is a multimarker tool for assessing a patient's risk of developing diabetes within the next 5 years. Requiring a simple blood draw using standard sample collection and handling procedures, the PreDx Diabetes Risk Score is easily implemented in clinical practice and provides an assessment of diabetes risk that is superior to other measures, including fasting plasma glucose, glycated hemoglobin, measures of insulin resistance and other clinical measures. In this article, we provide an overview of the PreDx Diabetes Risk Score.

Specific role for acyl CoA:Diacylglycerol acyltransferase 1 (Dgat1) in hepatic steatosis due to exogenous fatty acids

Nonalcoholic fatty liver disease, characterized by the accumulation of triacylglycerols (TGs) and other lipids in the liver, often accompanies obesity and is a risk factor for nonalcoholic steatohepatitis and fibrosis. To treat or prevent fatty liver, a thorough understanding of hepatic fatty acid and TG metabolism is crucial. To investigate the role of acyl CoA:diacylglycerol acyltransferase 1 (DGAT1), a key enzyme of TG synthesis, in fatty liver development, we studied mice with global and liver-specific knockout of Dgat1. DGAT1 was required for hepatic steatosis induced by a high-fat diet and prolonged fasting, which are both characterized by delivery of exogenous fatty acids to the liver. Studies in primary hepatocytes showed that DGAT1 deficiency protected against hepatic steatosis by reducing synthesis and increasing the oxidation of fatty acids. In contrast, lipodystrophy (aP2-SREBP-1c436) and liver X receptor activation (T0901317), which increase de novo fatty acid synthesis in liver, caused steatosis independently of DGAT1. Pharmacologic inhibition of Dgat1 with antisense oligonucleotides protected against fatty liver induced by a high-fat diet.

CONCLUSION

Our findings identify a specific role for hepatic DGAT1 in esterification of exogenous fatty acids and indicate that DGAT1 contributes to hepatic steatosis induced by this mechanism.

Plasma fatty acid profiles in autism: a case-control study

Increasing evidence is mounting in support of fatty acid metabolism playing a role in neurodevelopmental disorders such as autism. In order to definitely determine whether fatty acid concentrations were associated with autism, we quantitatively measured 30 fatty acids from seven lipid classes in plasma from a large subset of subjects enrolled in the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. The CHARGE study is a large, population-based case-control study on children aged 2-5 born in California. Our subset consisted of 153 children with autism and 97 developmentally normal controls. Results showed that docosahexaenoic acid (DHA, 22:6n-3) was significantly decreased in phosphatidylethanolamine. Dimethyl acetals were significantly decreased in phosphatidylethanolamine and phosphatidylcholine as well. These results are consistent with the only other study to measure dimethyl acetals in children with autism, and suggest that the function of peroxisomes and the enzymes of the peroxisome involved with fatty acid metabolism may be affected in autism.

Functional Annotation of Genomic Data with Metabolic Inference

Metabolomics is an appealing new approach in systems biology aimed at enabling an improved understanding of the dynamic biochemical composition of living systems. Biological systems are remarkably complex. Importantly, metabolites are the end products of cellular regulatory processes, and their concentrations reflect the ultimate response of a biological system to genetic or environmental changes. In this article, we describe the components of lipid metabolomics and then use them to investigate the metabolic basis for increased abdominal adiposity in 2 strains of divergently selected chickens. Lipid metabolomics were chosen due to the availability of well-developed analytical platforms and the pervasive physiological importance of lipids in metabolism. The analysis suggests that metabolic shifts that result in increased abdominal adiposity are not universal and vary with genetic background. Metabolomics can be used to reverse engineer selection programs through superior metabolic descriptions that can then be associated with specific gene networks and transcriptional profiles.

Effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on fatty acid availability and neural tube formation in cynomolgus macaque, Macaca fascicularis

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is known to alter carbohydrate utilization and specific steps in lipid metabolism. TCDD interacts with estradiol in mobilizing specific fatty acids in chickens that may be a cause of cranial/beak malformations in this species. This study was designed to test the hypothesis that TCDD simultaneously alters critical fatty acid mobilization during early pregnancy and determine if those changes correlate to morphological defects of the developing neural tube in the nonhuman primate. Cynomolgus macaques were treated with a single dose of 4 microg/kg body weight (BW) TCDD on gestational day 15 or 20. Pregnancies were terminated by hysterectomy on gestational day 24-26 and embryos were examined to determine morphology of the developing neural tube. Maternal blood samples were used for fatty acid quantification. Embryos exhibited cellular changes, mainly increased cell death, and intercellular spaces in the neural tube, suggestive of an adverse effect on the developing nervous system. Significant decreases on fatty acid composition were found on some of the eight classes of lipids analyzed. Particularly, a decrease was observed in the n-3 (40-60%) and n-6 (47-75%) essential fatty acids in treated pregnancies compared to untreated controls. These data demonstrate the effect of TCDD in decreasing maternal levels of n-3 and n-6 fatty acids that are considered necessary for normal development in mammals. Since neural tube development is dependent, in part, on n-3 and n-6 fatty acids, it is possible that the limitation of these essential fatty acids in plasma resulted in the observed detrimental effects on early brain development.

Individual metabolism should guide agriculture toward foods for improved health and nutrition

Genomics and bioinformatics have the vast potential to identify genes that cause disease by investigating whole-genome databases. Comparison of an individual's geno-type with a genomic database will allow the prescription of drugs to be tailored to an individual's genotype. This same bioinformatic approach, applied to the study of human metabolites, has the potential to identify and validate targets to improve personalized nutritional health and thus serve to define the added value for the next generation of foods and crops. Advances in high-throughput analytic chemistry and computing technologies make the creation of a vast database of metabolites possible for several subsets of metabolites, including lipids and organic acids. In creating integrative databases of metabolites for bioinformatic investigation, the current concept of measuring single biomarkers must be expanded to 3 dimensions to 1) include a highly comprehensive set of metabolite measurements (a profile) by multiparallel analyses, 2) measure the metabolic profile of individuals over time rather than simply in the fasted state, and 3) integrate these metabolic profiles with genomic, expression, and proteomic databases. Application of the knowledge of individual metabolism will revolutionize the ability of nutrition to deliver health benefits through food in the same way that knowledge of genomics will revolutionize individual treatment of dis-ease with pharmaceuticals.

Unique phospholipid metabolism in mouse heart in response to dietary docosahexaenoic or alpha-linolenic acids

Diet and fatty acid metabolism interact in yet unknown ways to modulate membrane fatty acid composition and certain cellular functions. For example, dietary precursors or metabolic products of n-3 fatty acid metabolism differ in their ability to modify specific membrane components. In the present study, the effect of dietary 22:6n-3 or its metabolic precursor, 18:3n-3, on the selective accumulation of 22:6n-3 by heart was investigated. The mass and fatty acid compositions of individual phospholipids (PL) in heart and liver were quantified in mice fed either 22:6n-3 (from crocodile oil) or 18:3n-3 (from soybean oil) for 13 wk. This study was conducted to determine if the selective accumulation of 22:6n-3 in heart was due to the incorporation of 22:6n-3 into cardiolipin (CL), a PL most prevalent in heart and known to accumulate 22:6n-3. Although heart was significantly enriched with 22:6n-3 relative to liver, the accumulation of 22:6n-3 by CL in heart could not quantitatively account for this difference. CL from heart did accumulate 22:6n-3, but only in mice fed preformed 22:6n-3. Diets rich in non-22:6n-3 fatty acids result in a fatty acid composition of phosphatidylcholine (PC) in heart that is unusually enriched with 22:6n-3. In this study, the mass of PC in heart was positively correlated with the enrichment of 22:6n-3 into PC. The increased mass of PC was coincident with a decrease in the mass of phosphatidylethanolamine, suggesting that 22:6n-3 induced PC synthesis by increasing phosphatidylethanolamine-N-methyltransferase activity in the heart.

Comprehensive lipid analysis: a powerful metanomic tool for predictive and diagnostic medicine

The power and accuracy of predictive diagnostics stand to improve dramatically as a result of lipid metanomics. The high definition of data obtained with this approach allows multiple rather than single metabolites to be used in markers for a group. Since as many as 40 fatty acids are quantified from each lipid class, and up to 15 lipid classes can be quantified easily, more than 600 individual lipid metabolites can be measured routinely for each sample. Because these analyses are comprehensive, only the most appropriate and unique metabolites are selected for their predictive value. Thus, comprehensive lipid analysis promises to greatly improve predictive diagnostics for phenotypes that directly or peripherally involve lipids. A broader and possibly more exciting aspect of this technology is the generation of metabolic profiles that are not simply markers for disease, but metabolic maps that can be used to identify specific genes or activities that cause or influence the disease state. Metanomics is, in essence, functional genomics from metabolite analysis. By defining the metabolic basis for phenotype, researchers and clinicians will have an extraordinary opportunity to understand and treat disease. Much in the same way that gene chips allow researchers to observe the complex expression response to a stimulus, metanomics will enable researchers to observe the complex metabolic interplay responsible for defining phenotype. By extending this approach beyond the observation of individual dysregulations, medicine will begin to profile not single diseases, but health. As health is the proper balance of all vital metabolic pathways, comprehensive or metanomic analysis lends itself very well to identifying the metabolite distributions necessary for optimum health. Comprehensive and quantitative analysis of lipids would provide this degree of diagnostic power to researchers and clinicians interested in mining metabolic profiles for biological meaning.

Butyric acid and tributyrin induce apoptosis in human hepatic tumour cells

The anti-colon cancer effect of dietary fibre results in part from its fermentation into the short-chain fatty acid butyric acid (BA) by intestinal microflora. BA has potent anti-colon cancer properties owing to its ability to induce apoptosis in colon cancer cells. The colon is not the only location where BA may reach high concentrations, because dietary BA is rapidly absorbed and transported to the liver. We have investigated whether BA could induce apoptosis in transformed human liver (Hep G2) cells. Hep G2 cells treated with BA displayed acetylated histones, increased DNA fragmentation and morphological features consistent with apoptosis. These biochemical features of BA-treated liver cells are identical to those of BA-treated colon cells. In addition, we investigated whether BA present in tributyrin, a triacylglycerol more compatible for inclusion into colloidal lipid structures than BA, could also induce apoptosis in Hep G2 cells. Tributyrin induced DNA fragmentation and morphological features characteristic of apoptotic cells in Hep G2 cells. These results are a significant advance towards delivering BA via colloidal lipid particles to cancerous sites in vivo. This study showed that BA and tributyrin are potent apoptotic agents, and we suggest that sources of dietary BA, such as milk fat, may provide anti-liver cancer properties.

Docosahexaenoic acid accumulates in cardiolipin and enhances HT-29 cell oxidant production

The objective of this study was to investigate membrane fatty acids for their effects on mitochondrial function in live cells. Mitochondrial potential and oxidant production were measured in human colonic adenocarcinoma (HT-29) cells with membranes enhanced in either oleic acid, linoleic acid, arachidonic acid, eicosapentaenoic acid, or docosahexaenoic acid. Docosahexaenoic acid-enriched cells had increased mitochondrial potential and produced 5-fold more cellular oxidants than did cells enriched with any other fatty acid. Oxidant production in fatty acid-enriched HT-29 cells did not correlate with the degree of unsaturation for total membrane fatty acids. However, there was a strong correlation between the degree of fatty acid unsaturation of cardiolipin, a critical inner-mitochondrial membrane phospholipid, and oxidant production. Cardiolipin acyl composition is known to influence the activity of electron transport complexes, an effect that can increase mitochondrial oxidant production. Docosahexaenoic acid was enriched to 48 mol% of the fatty acids present in HT-29 cell cardiolipin. These results demonstrate the importance of membrane acyl composition to mitochondrial potential and oxidant production in live cells. Additionally, results suggest that docosahexaenoic acid increases cell oxidant production by accumulating in cardiolipin, where its presence alters electron transport efficiency.

The design of arm pressure covers to alleviate pain in high G maneuvers

HYPOTHESIS

Arm pain has been noted especially when increased coverage anti-G suits are worn in combination with PBG (pressure breathing during G) in high G centrifuge test runs. Arm pain has forced the termination of test runs and has the potential to cause a serious decrement in a pilot's ability to function effectively during high-G flight. Based on the theory that arm pain is caused by fluid pooling in the arm, four new pressure cover systems for the arm were designed and tested.

METHODS

Seven test subjects wore each design in a series of runs in a dynamic flight simulator (DFS). Subjects experienced both gradual and rapid onset rate runs with G levels ranging from +3.0 G to +9.0 G. Data were collected on the maximum G's achieved, pain location, and pain intensity. Subjective responses on the comfort and function of each design and overall arm cover design preferences were also obtained via a questionnaire.

RESULTS

Analysis of the DFS data, using a two-factor ANOVA (subjects, designs), revealed that each of the new designs provided significantly better protection from arm pain than the control condition (no protection) and that each of the designs significantly improved the maximum G level attained during rapid onset acceleration in the range of +1 G.

CONCLUSION

No positive correlation was found between subject ranking of the four new design concepts at the conclusion of the study in terms of the pain reduction they provided and the pain levels reported during DFS testing.

Elevated blood lead prevalence in Florida two-year-olds

The prevalence of blood lead values of 10 mcg/dl or higher was estimated in Florida two-year-olds in a population-based random sample survey. Subjects were chosen at random from birth certificates of children born in Florida in mid-1991. Parents were interviewed and children's blood specimens obtained in the summer of 1993. Results are based on 387 subjects. Overall prevalence of elevated blood lead was 3.2% (95% confidence limits 2.2, 4.0), with nine children in the range of 10 to 14 mcg/dl and four of 15 or over. In certain subgroups, prevalence was higher: nonwhite 9.4% (2.9, 15.9); mother not married 8.3% (3.1, 13.5); mother on Medicaid 6.7% (2.5, 10.8); housing built in 1978 or before 7.1% (2.3, 11.8); yard dirt or dirt plus grass 10.8% (4.6, 16.9). In Florida, prevalence is much lower than in the nation as a whole. A screening strategy that concentrates on screening Medicaid-eligible children and those living in homes built before 1978 would appear to be quite efficient and may uncover a prevalence of 7.0% or more.

Phytohaemagglutinin responsiveness of peripheral lymphocytes and survival in patients with primary breast cancer

The response of peripheral blood lymphocytes from 153 breast cancer patients to the T-cell mitogen phytohaemagglutinin (PHA) was measured prior to surgery and patients assigned to either high (Hi/PHA) or low (Lo/PHA) PHA response groups. Patients were followed up for between 8 and 12 years, or until death. Clinical characteristics were similar in Hi/PHA and Lo/PHA groups. In the 96 patients who received no postoperative adjuvant therapy, overall and relapse-free survival was significantly longer in Hi/PHA than in Lo/PHA patients (p less than 0.005, and p less than 0.025 respectively); relative risk of death within 12 years was 0.52 and of relapse was 0.64. In 47 patients who were treated with radiotherapy postoperatively, there was no correlation between the PHA response and overall or relapse-free survival. The implications of these findings for the selection of breast cancer patients for adjuvant treatment following surgery are discussed.

Suppression of in vitro peripheral blood lymphocyte mitogenesis by cytotoxic drugs commonly used in the treatment of breast cancer: a comparative study

Cultures of normal donor peripheral blood mononuclear cells were tested in vitro for suppression by chemotherapeutic agents or their metabolites. The drugs tested were those commonly used in the treatment of breast cancer, namely, 5-fluorouracil, doxorubicin, vincristine, methotrexate and cyclophosphamide (actually testing its active metabolite, 4-hydroxy-cyclophosphamide). The lymphocytes were stimulated by phytohaemagglutinin (PHA), and the inhibitory effect of the drugs on subsequent DNA synthesis was measured by tritiated thymidine uptake. Drug concentrations used were equivalent to expected in vivo plasma and body fluid levels following i.v. injection of a standard therapeutic dose. Results suggest that the drugs may be ranked for suppression of T-cell function as follows: doxorubicin greater than vincristine = cyclophosphamide greater than 5-fluorouracil greater than methotrexate.

Latent period of 9 years in the presentation of a myeloproliferative disorder

A woman developed a leukaemic infiltrate at the site of a smallpox vaccination; the lesion subsequently regressed spontaneously. 9 years later she developed a generalised myeloproliferative disorder.

High incidence of vincristine-induced neuropathy in lymphomas

The incidence of vincristine-induced neuropathy was studied in 60 unselected patients, of whom 23 had lymphoma and 37 had other malignant disease. All were treated with vincristine combined with other cytotoxic agents. Fourteen of the patients with lymphoma (61%) developed neuropathy compared with five patients with leukaemia or non-lymphoid cancer (14%), even though all patients received comparable doses of vincristine. The difference between the two groups in the incidence of neuropathy was highly significant. Of the patients who developed neuropathy, 17 did so within the first three months of treatment and seven in the first month. Patients with lymphoma who are receiving vincristine should be observed carfully for symptoms and signs of neuropathy. Vincristine should be withdrawn if progressive neurotoxicity develops.

Lymphocyte transformation in cancer patients: variation in results according to technique

Lymphocyte transformation to phytohaemagglutinin (PHA) was measured simultaneously by two methods (heparin and methyl cellulose) in 16 patients with non-lymphoid cancer and 21 normal subjects. Twelve cancer patients showed transformation levels below the normal heparin range, but only two patients showed levels below the normal methyl cellulose range. These findings suggest that in interpreting lymphocyte transformation studies close attention should be given to the methods employed.

Cancer prognosis predicted by preoperative lymphocyte responsiveness in vitro

The prognosis in cancer patients was studied in relation to their preoperative cell-mediated immune status. Thirty patients with various types of operable cancer were studied. Transformation of the lymphocytes in response to phytohaemagglutinin (PHA) in vitro was measured preoperatively. All the patients were followed up for 3 years. Those with normal preoperative lymphocyte responsiveness had a far better prognosis than those in whom this test was subnormal.

The effects of surgery on lymphocyte transformation in patients with cancer

Lymphocyte response to phytohaemagglutinin (PHA) in vitro was subnormal in twenty-two out of thirty-six patients with various types of non-lymphoid malignancy. After apparently successful surgery, lymphocyte response improved significantly in most of those in whom it had been previously impaired; it remained markedly subnormal in only two patients, one of whom subsequently died of metastases. This finding indicates that depressed cell-mediated immunity in patients with cancer is the result of the malignant disease. Failure of the PHA response to revert to normal post-operatively may indicate a poor prognosis.

Serum enzyme levels in diagnosis of postoperative myocardial infarction

The levels of creatine kinase, hydroxybutyric dehydrogenase, and aspartate transaminase have been serially measured in the serum of patients undergoing surgery. Serum enzyme levels often rose to a range commonly found after myocardial infarction but fell to normal within 5-10 days. Raised serum enzyme levels have no diagnostic significance in a case of postoperative chest pain until after the fifth postoperative day, but may be significant thereafter.

Polycythaemia masked by megaloblastic anaemia

Images