Dual inhibition of EZH2 and G9A/GLP histone methyltransferases by HKMTI-1-005 promotes differentiation of acute myeloid leukemia cells

All-trans-retinoic acid (ATRA)-based differentiation therapy of acute promyelocytic leukemia (APL) represents one of the most clinically effective examples of precision medicine and the first example of targeted oncoprotein degradation. The success of ATRA in APL, however, remains to be translated to non-APL acute myeloid leukemia (AML). We previously showed that aberrant histone modifications, including histone H3 lysine 4 (H3K4) and lysine 27 (H3K27) methylation, were associated with this lack of response and that epigenetic therapy with small molecule inhibitors of the H3K4 demethylase LSD1/KDM1A could reprogram AML cells to respond to ATRA. Serving as the enzymatic component of Polycomb Repressive Complex 2, EZH2/KMT6A methyltransferase plays a critical role in normal hematopoiesis by affecting the balance between self-renewal and differentiation. The canonical function of EZH2 is methylation of H3K27, although important non-canonical roles have recently been described. EZH2 mutation or deregulated expression has been conclusively demonstrated in the pathogenesis of AML and response to treatment, thus making it an attractive therapeutic target. In this study, we therefore investigated whether inhibition of EZH2 might also improve the response of non-APL AML cells to ATRA-based therapy. We focused on GSK-343, a pyridone-containing S-adenosyl-L-methionine cofactor-competitive EZH2 inhibitor that is representative of its class, and HKMTI-1-005, a substrate-competitive dual inhibitor targeting EZH2 and the closely related G9A/GLP H3K9 methyltransferases. We found that treatment with HKMTI-1-005 phenocopied EZH2 knockdown and was more effective in inducing differentiation than GSK-343, despite the efficacy of GSK-343 in terms of abolishing H3K27 trimethylation. Furthermore, transcriptomic analysis revealed that in contrast to treatment with GSK-343, HKMTI-1-005 upregulated the expression of differentiation pathway genes with and without ATRA, while downregulating genes associated with a hematopoietic stem cell phenotype. These results pointed to a non-canonical role for EZH2, which was supported by the finding that EZH2 associates with the master regulator of myeloid differentiation, RARα, in an ATRA-dependent manner that was enhanced by HKMTI-1-005, possibly playing a role in co-regulator complex exchange during transcriptional activation. In summary, our results strongly suggest that addition of HKMTI-1-005 to ATRA is a new therapeutic approach against AML that warrants further investigation.

Memory technology-a primer for material scientists

From our own experience, we know that there is a gap to bridge between the scientists focused on basic material research and their counterparts in a close-to-application community focused on identifying and solving final technological and engineering challenges. In this review, we try to provide an easy-to-grasp introduction to the field of memory technology for materials scientists. An understanding of the big picture is vital, so we first provide an overview of the development and architecture of memories as part of a computer and call attention to some basic limitations that all memories are subject to. As any new technology has to compete with mature existing solutions on the market, today's mainstream memories are explained, and the need for future solutions is highlighted. The most prominent contenders in the field of emerging memories are introduced and major challenges on their way to commercialization are elucidated. Based on these discussions, we derive some predictions for the memory market to conclude the paper.

Evaluation of disability in multiple sclerosis patients: a comparative study of the Functional Independence Measure, the Extended Barthel Index and the Expanded Disability Status Scale

This study was conducted to compare the Extended Barthel Index (EBI) to the Functional Independence Measure (FIM) and the Expanded Disability Status Scale (EDSS) as a measure used to assess changes in a patient's need for help with activities of daily living. One hundred patients with multiple sclerosis were evaluated by the same person upon arrival in a rehabilitation clinic and four weeks later. EBI and FIM both proved to be far more sensitive in detecting changes than the EDSS (29% of patients changed their EBI score, 32% their FIM score, 5% their EDSS score). EBI and FIM showed a very high correlation (Spearman correlation coefficient rs = 0.9705). Both scales correlated somewhat less with the EDSS ( rs = -0.7624, resp. -0.7611). Considering the high correlation and equal sensitivity of EBI and FIM, the study recommends the use of the EBI, since it has a simpler rating system and the elimination of some redundant FIM items increases user-friendliness and compliance.

From sweet to sweat: Hedonic olfactory range is impaired in Parkinson's disease

INTRODUCTION

Olfactory dysfunction and neuropsychological symptoms like depression and anhedonia are common non-motor symptoms in Parkinson's disease (PD). The assessment of both functional domains includes clinical examination, olfactory testing, and standardized questionnaires. While olfaction is readily assessed by functional tests, the distinction of anhedonia as a separate symptom from other depressive symptoms is challenging. Thus, a test focusing on the assessment of hedonic olfaction may be helpful in the assessment of neuropsychological symptoms in PD.

METHODS

We examined anhedonia by evaluating the perception of pleasantness of odors in PD patients (n = 57) and healthy controls (n = 46). Pleasantness of odors was registered on a visual 9-point scale. For the assessment of anhedonia we used the Snaith-Hamilton-Pleasure-Scale (SHAPS). Depression was evaluated with the Zung Self-Rating Depression Scale and the Beck Depression Inventory II.

RESULTS

PD patients showed a substantial reduction in hedonic olfaction compared to controls (hedonic score: 1.5 vs. 2.2). Hyposmia, one of the most prevalent non-motor symptoms in PD, was a confounding factor. However, even normosmic PD patients showed a reduced hedonic olfaction compared to controls (hedonic score: 1.6 vs. 2.2). Furthermore, we observed a correlation between hedonic olfaction and the SHAPS-score for PD patients even though positive SHAPS-rating was observed in 9% of PD patients only, while no correlation to depression was present.

CONCLUSION

These findings suggest that reduced hedonic olfaction might be an additional neuropsychological feature, probably giving insights into changes in hedonic tone complementary to hyposmia and depression in PD.

Grasping and Pointing in Visual Periphery: Consistent Impairments in Visual form Agnosic Patient DF

In a recent study, we observed that the visuomotor performance of visual form agnosic patient DF is significantly impaired when targets are presented in visual periphery (Hesse, Ball, & Schenk, 2012). Based on the observation that DF's reaching and grasping behaviour is compromised in visual periphery, we argued that her performance cannot be described as being complimentary to that of patients with optic ataxia (as suggested previously). However, there are two possible explanations for our findings. Firstly, DF's visuomotor deficit might indicate that an intact ventral stream is indispensable for the programming and execution of certain visuomotor tasks. Secondly, as DF also shows a small lesion in the left posterior parietal cortex, her failure to perform accurate movements in visual periphery might indicate that she also suffers from an optic ataxia. In a follow-up study, we therefore investigated whether patient DF shows a typical “hand-effect” or “field-effect”, as commonly observed for optic ataxia patients with unilateral lesions. That is, we systematically tested her visuomotor performance when pointing with the left or the right hand into the left or right visual field. Results show that DF's visuomotor deficit occurs independently of the visual field in which the stimuli were presented, as well as the hand with which movements were performed. These findings do not support the hypothesis that unilateral optic ataxia is responsible for the visuomotor deficits in patient DF. Alternatively, we suggest that damage to ventral stream areas can lead to profound visuomotor deficits in specific situations.

Limb activation ameliorates body-related deficits in spatial neglect

Many neglect patients show deficits in the mental representation of their contralesional body side or body parts, termed personal neglect. These deficits include impairments in identifying body parts on schematic drawings of human bodies. Limb activation and alertness cues have been shown to modulate neglect transiently, and are effective treatments for several symptoms of the neglect syndrome. Here, we tested on eight patients with right-hemispheric stroke and left-sided spatial neglect whether these two techniques modulate deficits in the mental representation of hands, assessed with a hand-test in which the subjects had to decide whether a depicted schematic hand belongs to the left or right side of the human body. The results showed that neglect patients made marginally significant (p = 0.065) more errors in left-hand-decisions than right-hand-decisions, indicating a neglect-specific disorder. Moreover, we found that left-sided limb activation but not non-lateralized alertness cueing (a loud noise immediately before patients made their perceptual decision) significantly reduced misidentifications for depicted left hands as compared to baseline. No effect of any intervention was observed on error rates for depicted right hands. We conclude that the amelioration of the performance in the hand task is modulated by the activation of the body schema or other body representations through left-sided limb activation.

Artichoke leave extract for chronic hepatitis C - a pilot study

BACKGROUND

Artichoke leave extracts (ALE) have hepatoprotektive properties and are used by patients with chronic liver disease. Effects in patients with chronic hepatitis C are unclear.

METHODS

17 patients with chronic hepatitis C and persistently elevated aminotransferase levels were treated for 12 weeks with 3200mg standardized ALE per day. Primary outcome parameter was the rate of alanine aminotransferase (ALT) normalisation after 12 weeks. Secondary parameters were the course of ALT, aspartate aminotransferase and gamma glutamyltransferase levels, quantitative HCV RNA, subjective symptoms frequently associated with chronic hepatitis C (fatigue, discomfort upper abdomen, joint problems) and safety.

RESULTS

None of the patients had normalized ALT levels after 12 weeks of treatment. There was no significant change of aminotransferase levels or viral load compared to baseline levels. Fatigue and joint problems significantly improved after 4 weeks of treatment. However, after 12 weeks, there was no significant difference to baseline. Tolerability of ALE was rated as good to excellent. Severe side effects did not occur.

CONCLUSION

ALE seem not to be effective to improve aminotransferase levels in patients with chronic hepatitis C.

Subcutaneous omacetaxine mepesuccinate in imatinib-resistant chronic myeloid leukemia (CML) patients (Pts) with the T315I mutation: Data from an ongoing phase II/III trial

7008

Background: Omacetaxine (OM), a first-in-class cetaxine shows clinical activity against Ph+ CML with a mechanism independent of tyrosine kinase inhibition. Currently available tyrosine kinase inhibitors (TKIs) have no activity against T315I. Methods: Adult Pts with T315I+ CML following TKI failure received OM induction at 1.25 mg/m2 subcutaneous (SC) twice daily (BID) for 14 days every 28 days followed by maintenance at 1.25 mg/m2 SC BID for 7 days every 28 days (maintenance after at least one induction cycle and achievement of hematologic response). Results: 66 pts (39 chronic [CP], 16 accelerated [AP] and 11 blast phase [BP]) have been enrolled. All had failed prior imatinib and 80% failed ≥2 prior TKIs. Median age is 58 yrs. Median disease duration is 58 mos. OM is well tolerated with transient myelosuppression as the primary toxicity. Grade 3/4 non-hematologic events are diarrhea (2%) and fatigue (4%). Efficacy data are available for 44 Pts. In CP Pts, the median number of cycles is 4 (1–22) with 39% having received ≥ 6 cycles of therapy; 64% of Pts have had the T315I clone reduced to below detection limits; the 2-year progression free survival is 70%. Conclusions: Omacetaxine in T315I+ CML Pts results in de-selection of the T315I clone and induces hematologic and cytogenetic responses.

[Table: see text]

[Table: see text]

Subcutaneous omacetaxine mepesuccinate in chronic myeloid leukemia (CML) patients resistant or intolerant to two or more tyrosine kinase inhibitors (TKIs): Data from an ongoing phase II trial

7027

Background: Omacetaxine (OM), a first-in-class cetaxine, shows clinical activity against Ph+ CML with a mechanism of action independent to tyrosine kinase inhibition. Patients (Pts) who have failed multiple TKIs may benefit from an alternative therapy for CML. Methods: Pts include adult CML following resistance or intolerance to at least 2 TKIs. T315I+ Pts are enrolled in a separate trial. Pts receive OM induction at 1.25 mg/m2 subcutaneous (SC) BID for 14 days every 28 days followed by maintenance at 1.25 mg/m2 SC BID for 7 days every 28 days (maintenance after at least one induction cycle and achievement of hematologic response). Results: 60 pts (30 chronic phase [CP], 14 accelerated phase [AP], and 16 blast phase [BP] have been enrolled with 51% having failed at least 3 prior TKIs. Median age: 58 yrs; 50% male. Median disease duration: 74 months. At baseline, 38.5% of pts had Bcr-Abl mutations including 9.6% with compound mutations. The most frequently observed mutations were F317L (11.5%) and V299L (5.8%). OM is well tolerated with transient myelosuppression as the primary toxicity. Grade 3/4 non-hematologic events are rare with pyrexia occurring in 4.3% of patients. Efficacy data are available for 30 Pts: Conclusions: Omacetaxine in multi-TKI resistant or intolerant CML is well tolerated and has achieved hematologic and cytogenetic responses in these heavily pre-treated Pts.

[Table: see text]

[Table: see text]

A new surgical model for hepatectomy in pigs

BACKGROUND

Anhepatic animal models are suitable for simulating acute liver failure. Hepatectomy in pigs includes en bloc resection of the vena cava, and therefore, a temporary extracorporeal bypass and total clamping of the inferior vena cava are needed. These steps cause severe depression of circulation with impaired survival.

METHODS

Previous to en bloc hepatectomy including retrohepatic vena cava in 20 female pigs, a Y-shaped bypass was implanted starting with end-to-side anastomosis between the vena cava and the portal vein, followed by anastomosis to the intrathoracic vena cava.

RESULTS

Blood flow was constant during and after hepatectomy because vessels were only partially clamped. No venous stasis of intestinal organs was observed. Hemodynamic parameters like heart rate, mean arterial pressure, central venous pressure, pulse oximetry and intracranial pressure remained extremely stabile during and after hepatectomy. Postoperative survival time was 100% after 12 h. Maximum survival time was 84.9 h and mean survival time 51.2 +/- 18.7 h. All animals died from multiple organ failure. Intracranial pressure remained stable during the surgical procedure and rose continuously until death. The autopsy showed massive brain edema.

CONCLUSIONS

This new surgical technique is safe and easy to perform and permits total hepatectomy with minimal blood loss under stable circulation without requiring an extracorporeal bypass.

Enhanced probe discrimination at the location of a colour singleton

There is ample evidence to suggest that preparing to saccade to a location is sufficient to produce attentional shifts to this location. However, it is not clear whether engagement of the eye-movement system is also a necessary condition for any spatial shifts in attention. Recent neurophysiological data indicates that neurons in the frontal eye field (FEF) can select visual stimuli (a colour singleton) in the absence of a concurrently activated saccade plan in non-human primates (Juan et al. in Proc Natl Acad Sci USA 101:15541-15544, 2004), suggesting that saccade planning and visual selection are dissociable. However, it is still unclear whether the visual selection is accompanied by an attentional enhancement at the target location. To test this, we used a similar paradigm (i.e. an antisaccade task) with humans to the one employed by Juan and colleagues with monkeys. Our paradigm included a probe-discrimination task, which allowed us to test whether attentional facilitation is indeed observed at the location of the selected visual stimuli. Our results confirm that visual selection is accompanied by attentional facilitation.

Physical activity is independently related to aerobic capacity in cystic fibrosis

It is unclear whether a relationship between physical activity (PA) and maximal oxygen uptake (V'(O2,max)) exists in cystic fibrosis (CF) and, if so, whether the relationship reflects a direct effect or is mediated by the effects of confounding variables, such as pulmonary or muscle function. The objective of the present study was to determine the relationship between PA and V'(O2,max) in CF while adjusting for possible influences of confounding factors. In total, 36 female and 35 male patients with CF from Germany and Switzerland (aged 12-40 yrs, forced expiratory volume in one second (FEV1) 25-107% predicted) were studied. A Wingate test was employed to measure muscle power. PA was monitored for 7 days and expressed in two ways: 1) average daily accelerometer count (ADAC) and 2) time spent in moderate-to-vigorous PA (MVPA). V'(O2,max) was determined during an incremental cycle exercise test to volitional fatigue. PA was positively related to V'(O2,max). In a multiple linear regression analysis, height, sex, FEV1, muscle power and ADAC (additionally explained variance 2.5%) or time spent in MVPA (additionally explained variance 3.7%) were identified as independent predictors of V'(O2,max). In conclusion, high levels of physical activity in addition to good muscular and pulmonary functions are associated with a high aerobic capacity in cystic fibrosis.

In situ and real-time probing of quasicrystal solidification dynamics by synchrotron imaging

Quasicrystal growth remains an unsolved problem in condensed matter. The dynamics of the process is studied by means of synchrotron live imaging all along the solidification of icosahedral AlPdMn quasicrystals. The lateral motion of ledges driving faceted growth at the solid-melt interface is conclusively shown. When the solidification rate is increased, nucleation and free growth of new faceted grains occur in the melt due to the significant interface recoil induced by slow attachment kinetics. The detailed analysis of the evolution of these grains reveals the crucial role of aluminum rejection, both in the poisoning of their growth and driving fluid flow.

Liquid chromatography coupled on-line to flow cytometry for postcolumn homogeneous biochemical detection

The feasibility of flow cytometry as read-out principle for homogeneous cell- or bead-based assays coupled on-line to LC is demonstrated using digoxin-coated beads (Dig-Beads) and fluorescent-labeled anti-digoxin (AD-FITC) as model system. The assay is carried out in a postcolumn continuous-flow reaction detection system where the AD-FITC and Dig-Beads are simultaneously added to the eluate of an LC separation column. Binding of AD-FITC to Dig-Beads results in a constant amount of fluorescence associated with the beads, which is detected by the flow cytometer. The presence of active compounds, such as digoxin and its analogues, in the sample will results in a decrease of the AD-FITC-Dig-Bead complex and, consequently, in the bead-associated fluorescence. Hence, the bead-associated fluorescence detected is inversely related to the digoxin concentration. A data-handling algorithm was developed in-house for adequate analysis of raw data output from the flow cytometer. Various conditions that influence the performance of this novel LC-biochemical detection (LC-BCD) system were investigated to determine the optimal settings of the bead-based biochemical interaction. The optimized flow injection bead-based assay was capable of detecting very low concentrations of digoxigenin (0.5 nmol/L), digoxin (0.1 nmol/L), and gitoxigenin (50 nmol/L). The applicability of LC coupled on-line to flow cytometry was demonstrated by the individual detection of digoxin, digoxigenin, and gitoxigenin in a single LC analysis. The successful coupling of LC on-line to flow cytometry principally enables the use of a wide range of new homogeneous assay formats in LC-BCD, such as membrane-bound receptor assays, cell-binding assays, and functional cell-based assays. Next to the ability to use insoluble targets, and also multiplexing assays, i.e., performing a number of assays simultaneously, using color- or size-coded beads becomes at hand in LC-BCD.

Screening of natural products extracts for the presence of phosphodiesterase inhibitors using liquid chromatography coupled online to parallel biochemical detection and chemical characterization

The ability to rapidly identify active compounds in a complex mixture (e.g., natural products extract) is still one of the major problems in natural products screening programs. An elegant way to overcome this problem is to separate the complex mixture by gradient liquid chromatography followed by online biochemical detection parallel with chemical characterization, referred to as high-resolution screening (HRS). To find and identify phosphodiesterase (PDE) inhibitors in natural products extracts using the HRS technology, the authors developed a continuous-flow PDE enzymatic assay. The suitability of the continuous-flow PDE enzymatic assay for natural products screening was demonstrated. After optimization of the continuous-flow PDE assay, the limit of detection for 3-isobutyl-1-methyl-xanthine (IBMX) was 1 muM, with a dynamic range from 1 to 100 muM IBMX. The applicability of the HRS technology for the detection of PDE inhibitors in natural products extracts was demonstrated by the analysis of a plant extract spiked with 2 naturally occurring PDE inhibitors. The plant extract was analyzed with 2 assay lines in parallel, enabling background fluorescence correction of the sample. The simultaneous quantification of the active compounds using evaporative light-scattering detection allowed the estimation of the IC(50) value of the active compounds directly in the crude extract.

A generic assay for phosphate-consuming or -releasing enzymes coupled on-line to liquid chromatography for lead finding in natural products

A generic continuous-flow assay for phosphate-consuming or -releasing enzymes coupled on-line to liquid chromatography (LC) has been developed. Operating the LC-biochemical assay in combination with mass spectrometry allows the fast detection and identification of inhibitors of these enzymes in complex mixtures. The assay is based on the detection of phosphate, released by the on-line continuous-flow enzymatic reaction, using a fluorescent probe. The probe consists of fluorophore-labeled phosphate-binding protein, which shows a strong fluorescence enhancement upon binding to inorganic phosphate. To detect very small changes of the phosphate concentration in a postcolumn enzymatic reaction medium, the enzymatic removal of phosphate impurities from solvents, reagents, and samples was optimized for application in continuous flow. The potential of the phosphate probe is demonstrated by monitoring the enzymatic activity, i.e., the phosphate release, from alkaline phosphatase. The selectivity of the phosphate readout, necessary to distinguish between phosphate containing substrate or product and free inorganic phosphate released after enzymatic conversion, is shown. The applicability of LC coupled to the enzymatic assay using the phosphate readout was demonstrated by detection of tetramisole in a plant extract as inhibitor of alkaline phosphatase. Parallel mass spectrometry allowed the simultaneous confirmation of the identity of the inhibitor.

Icosahedral short-range order in deeply undercooled metallic melts

Experimental evidence of icosahedral short-range order in stable and deeply undercooled melts of pure metallic elements is obtained using the combination of electromagnetic levitation with neutron scattering. This icosahedral short-range order is shown to occur in the bulk metallic melt independently of the system investigated. It strongly increases with the degree of undercooling.

Potential of on-line micro-LC immunochemical detection in the bioanalysis of cytokines

An on-line liquid chromatography-immunochemical detection (LC-ICD) system for the quantification of cytokines in cell extracts has been developed using a post-column continuous-flow reaction detection system using fluorescence labelled antibodies. Cytokines eluting from the micro-HPLC column react with antibodies to form fluorescent complexes. In a second step the excess of free antibody is trapped on a cytokine bound support prior to fluorescence detection. The concentration detection limit of the flow injection-ICD system was 50 pM (20 microl injection volume) for interleukin 4 (IL-4). An absolute detection limit of 1 fmol was obtained for IL-4. Similar to ICD systems for small non-protein analytes developed earlier, reaction times were in the order of 1 minute. The immobilised cytokine affinity columns can easily be regenerated and used for months. The present ICD system for interleukins 4, 6, 8 and 10 was coupled to ion exchange-, size exclusion- and reversed phase chromatography. Important parameters (reaction times, reaction conditions) were investigated to get a better understanding of post-column ICD systems for macromolecules.

Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness

BACKGROUND

Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder.

METHODS

We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of motion in all three groups before and after the study treatment.

RESULTS

At a mean of twenty months (range, twelve to forty-six months) after the operation, fifty patients were available for assessment of function and range of motion of the involved shoulder. At the time of follow-up, each group had a significant improvement in the scores for pain, patient satisfaction, and functional activity as well as in the overall outcome score (p < 0.01). Comparison of the scores among the different groups revealed that all had a similar degree of improvement in range of motion of the involved shoulder, but patients with postoperative frozen shoulder had significantly (p < 0.05) lower scores for pain (p < 0.03), patient satisfaction (p < 0.004), and functional activity (p < 0.002) than did those with idiopathic or post-fracture frozen shoulder.

CONCLUSIONS

Arthroscopic capsular release was as effective for improving range of motion in patients with postoperative contracture of the shoulder as it was in patients with idiopathic and post-fracture contracture. However, there was less improvement in the subjective scores for pain, function, and patient satisfaction in the postoperative group.

Expression of bcr-abl mRNA in individual chronic myelogenous leukaemia cells as determined by in situ amplification

We present the results of a novel method developed for evaluation of in situ amplification, a molecular genetic method at the cellular level. Reverse transcription polymerase chain reaction (RT-PCR) was used to study bcr-abl transcript levels in individual cells from patients with chronic myelogenous leukaemia (CML). After hybridizing a fluorochrome-labelled probe to the cell-bound RT-PCR product, bcr-abl mRNA-positive cells were determined using image analysis. A dilution series of bcr-abl-positive BV173 into normal cells showed a good correlation between expected and actual values. In 25 CML samples, the percentage of in situ PCR-positive cells showed an excellent correlation with cytogenetic results (r = 0.94, P < 0.0001), interphase fluorescence in situ hybridization (FISH) (r = 0.95, P = 0.001) and hypermetaphase FISH (r = 0.81, P < 0.001). The fluorescence intensity was higher in residual CML cells after interferon (IFN) treatment than in newly diagnosed patients (P = 0.004), and was highest in late-stage CML resistant to IFN therapy and lowest in CML blast crisis (P = 0.001). Mean fluorescence values correlated with bcr-abl protein levels, as determined by Western blot analysis (r = 0.62). Laser scanning cytometry allowing automated analysis of large numbers of cells confirmed the results. Thus, fluorescence in situ PCR provides a novel and quantitative approach for monitoring tumour load and bcr-abl transcript levels in CML.

Kinematic analysis of laryngeal movements in patients with neurogenic dysphagia before and after swallowing rehabilitation

To examine whether kinematic analysis of laryngeal movements (which are closely linked to pharyngeal swallowing) can differentiate between normal and disturbed swallowing, we used a three-dimensional ultrasound movement recording system to measure the movements of the larynx during swallowing in 32 patients with neurogenic dysphagia caused by central nervous system lesions and in 32 age- and sex-matched healthy individuals. At the beginning of an inpatient rehabilitation swallowing program, laryngeal movements in 24 patients were highly disturbed in terms of velocity curve irregularities. After rehabilitation, the majority of patients with hitherto irregular velocity profiles exhibited laryngeal kinematics that were indistinguishable from those of 32 healthy subjects. Kinematic analysis of laryngeal movements, therefore, is suitable for monitoring motor recovery of swallowing disturbances in patients with neurogenic dysphagia while undergoing swallowing rehabilitation.

Is writer's cramp caused by a deficit of sensorimotor integration?

Writer's cramp is a highly specific movement disorder in which handwriting is impaired while most other manual skills are often unaffected. On the basis of abnormal findings in experiments measuring the control of grip forces, it has been suggested that writer's cramp is caused by a deficit of sensorimotor integration. The aim of our study was to determine whether there is a functional link between sensory deficits, abnormalities in the control of grip force, and handwriting disorders. We compared the grip force and handwriting performance of writer's cramp patients with that of control subjects and with that of a stroke patient suffering a purely somatosensory deficit of his dominant hand (patient S1). We found that: (1) writer's cramp patients and patient S1 had elevated grip-force levels; (2) training reduced the grip force to near-normal levels in all writer's cramp patients but not in S1; (3) effortful writing performance also induced increased grip-force levels in healthy subjects; and (4) patient S1 had normal handwriting movements. These findings suggest that the elevated pretraining gripforce levels of writer's cramp patients might be a consequence of their effortful writing style and do not reflect a deficit of sensorimotor integration. Moreover, the good handwriting performance of patient S1 shows that a severe somatosensory deficit is not a sufficient condition for a handwriting disorder. These findings disagree with the sensorimotor explanation of writer's cramp.

Can a motion-blind patient reach for moving objects?

It has been claimed that the visual brain is organized in two separate processing streams for spatial vision: one for perception and one for action. To determine whether motion vision is also divided into vision for action and for perception we examined the interceptive behaviour of the motion-blind patient LM. The task for LM and three age-matched control subjects was to reach-and-grasp for an object that moved away. Three experiments were conducted to examine the effects on perfomance of target speed (Expt 1), observation time (Expt 2) and visual feedback (Expt 3). As LM is only able to reach for objects which move at 0.5 m/s or less, her performance is inferior to that of controls who can reach for objects moving at 1.0 m/s, but it is better than would be expected from her performance in psychophysical experiments on her motion vision. Kinematic analysis of LM's reaching movements showed that she adapted the speed of her moving hand to the speed of the target but only when full vision was available. In contrast to normal subjects, LM required long observation times and vision of her moving hand to produce successful reaching responses. Thus, the impairment of both perception and action in LM suggests that the motion area MT/V5 is located at an early stage of the extrastriate hierarchy and provides input to both the perception and the action processing streams.

A system for the study of visuomotor coordination during reaching for moving targets

Prehensile behavior is a popular task in current research on human motor control. Most studies on reaching used stationary target objects and, therefore, most models do not address the challenges the motor system must respond to when reaching for moving objects. The machines used in earlier studies to produce object motion offered a limited range of trajectories and restricted control over various movement parameters. We have developed a device that allows a great variety of object trajectories along a flat-table surface and gives the experimenter full control over all movement parameters. A linear positioning system is used to move a sled beneath the table surface. Magnetic coupling transfers the sled's movement to the target object on the tabletop. This arrangement allows fast movements of the object (up to 5 m/s) and at the same time protects subjects from any harm due to the moving parts. The system is connected to LC shutter glasses, a 3-D movement registration device, and a switch that detects the onset of hand motion. This allows the selective withdrawal of vision during the reaching task or the introduction of changes in the object motion depending on the subject's reactions.

Cell-surface exposure of phosphatidylserine correlates with the stage of fludarabine-induced apoptosis in chronic lymphocytic leukemia and expression of apoptosis-regulating genes

BACKGROUND

Programmed cell death (PCD) is characterized by a sequence of tightly regulated events that result in the activation of caspases and in internucleosomal DNA cleavage. Late apoptotic events such as DNA-strand breaks can be assayed by in situ end labeling (ISEL) and DNA measurement (sub G1) using flow cytometry. Phosphatidylserine (PS) redistribution from the inner plasma membrane leaflet to the outer leaflet, an early event in PCD, can be detected by annexin V (AxV) binding to PS. AxV-fluorescein isothiocyanate (FITC) fluorescence intensity is variable and characterizes different cell populations, denoted here as AxV-negative (AxV(neg)), AxV-low-positive (AxV(lo)), and AxV-high-positive (AxV(hi)).

METHODS

We investigate the correlation of three methods (ISEL, sub G1 DNA content, and AxV assay) for detecting apoptosis with focus on differences between populations with different levels of PS. We also examined the expression of PCD-regulating Bcl-2 family members in these cell populations by reverse transcription-polymerase chain reaction (RT-PCR). Chronic lymphocytic leukemia (CLL) cells exposed to fludarabine (FAMP) were used as an in vitro model. Cells with different PS/AxV levels were separated using fluorescence-activated cell sorting (FACS).

RESULTS

Only purified AxV(hi) cells had high positivity in the ISEL and sub G1 assays (94 +/- 0.6%, 88.6 +/- 6.6%, and 98.6 +/- 0.6%, respectively), indicating that late apoptotic cells are detected equally by all three methods. In the AxV(lo) population, ISEL was positive in 21% +/- 13% and DNA sub G1 in 20% +/- 6.6% of cells, suggesting that AxV identifies early apoptotic cells better than the other assays. Anti-apoptotic Bcl-2 and Bcl-X(L) were upregulated by FAMP when cells entered apoptosis (AxV(lo)), as was pro-apo- ptotic Bcl-X(S), which was undetectable in nonapoptotic AxV(neg) cells. Pro-apoptotic Bax was only expressed in AxV(neg) and AxV(lo) cells. Late apoptotic AxV(hi) cells did not express Bcl-X(S) or Bax.

RESULTS

(1) AxV staining is more sensitive than sub G1 or ISEL in detecting early apoptotic cells; (2) only late apoptotic cells are equally detected by all assays; (3) AxV is a valuable tool in the detection and isolation of apoptotic cells at different stages of PCD; and (4) pro-apoptotic Bcl-X(S) and Bax are expressed at early, not late, stages of apoptosis.

Closed- and open-loop handwriting performance in patients with multiple sclerosis

Normal subjects use an open-loop motor control strategy in handwriting, but they are able to switch to closed-loop motor control when the demands on accuracy increase. These closed-loop handwriting movements of normal subjects resemble the inefficient movements found in writing-impaired patients. The hypothesis that such movement deficits may in fact reflect the use of a closed-loop strategy was tested in a group of writing-impaired patients with multiple sclerosis (MS). The handwriting movements of 10 MS patients and 20 control subjects were examined with a digitizing tablet. Three conditions were used: a standard writing task (expt 1), a closed-loop condition (expt 2), and an open-loop condition (expt 3). Individual stroke movements were analysed. Stroke duration and segmentation were increased for MS patients in the standard writing task. The same was found for control subjects when they wrote under closed-loop conditions. However, under open-loop conditions, the handwriting movements of the MS patients were as fast and fluent as that of control subjects. The results support the hypothesis that the movement characteristics of the writing-impaired MS patients reflect an inadequate use of a closed-loop motor control strategy.

Dose-dependent effect of angiotensin II on human erythropoietin production

Current evidence suggests that angiotensin II may be involved in the regulation of renal erythropoietin (EPO) production. The present study assessed the role of angiotensin II (A II) in different doses in the control of EPO production in humans. In a parallel, randomized, placebo-controlled open design, 60 healthy male volunteers received a 6-h intravenous infusion of: placebo (placebo, electrolyte solution), a pressor dose of A II (1-3 microg/min; A II press), a combination of a pressor dose of A II and the selective AT1-receptor blocker losartan, 50 mg (A II press + L), a subpressor dose of A II (0.0375-0.15 microg/min; A II subpress) and a combination of a subpressor dose of A II and losartan (A II subpress + L). A II press treatment resulted in a significant increase of the maximum EPO concentration (CmaxEPO, 41% higher versus placebo) and the amount of EPO produced in 24 h (AUCEPO(0-24 h), 61% larger versus placebo), A II subpress treatment increased CmaxEPO (35% higher versus placebo) and AUC(EPO)(0-24 h) (34% larger versus placebo). A II press + L and A II subpress + L treatments did not significantly increase CmaxEPO and AUCEPO(0-24 h) compared to placebo. A II affects EPO production in a dose-dependent manner. The signal seems to be mediated via AT1-receptors. A II appears to be one modulator EPO production in humans.

Time constraints improve reaching movements in an ataxic patient

We report on a patient (AM) with a post-traumatic ataxia who has uncoordinated reaching movements to resting targets, but is able to catch moving objects. AM participated in three experiments to identify factors responsible for the favorable effect of object motion on her performance. In the first experiment, the task was to catch an object that moved away from AM. The speed of the object to be grasped (target object) varied. In experiment 2, the effect of time constraints on reaching performance was examined. AM had to reach for and grasp a stationary object and was allowed either 600 ms or 2000 ms to perform the task. In the third experiment, liquid crystal shutter glasses were used to manipulate the time that the subject was able to view the stationary target object and her reaching movements (vision-on time). While increased speed of the object, tighter time constraints, and short vision-on time hardly affected the performance of AM's unaffected left hand, they greatly improved her right-hand performance. These results are discussed in light of the hypothesis that the brain mechanisms controlling externally triggered movements differ from those controlling internally regulated movements.

Replication of a foamy virus mutant with a constitutively active U3 promoter and deleted accessory genes

Foamy viruses (FVs) are complex retroviruses which require for their replication the activity of a transcriptional trans-activator (Tas) as well as Tas-responsive elements in the viral promoters. A mutant of the chimpanzee FV strain, CFV/hu (previously called human FV), genome in which most of the U3 promoter of the CFV long terminal repeat was substituted by the constitutively active human cytomegalovirus immediate early gene enhancer/promoter was constructed. This plasmid (pTS12) and a derivative (pTS13), which has a deletion in the tas gene, gave rise to replication-competent virus. Compared with parental CFV, both mutants replicated only very poorly, with retarded growth kinetics and maximal cell-free virus titres reduced by approximately three orders of magnitude. Mutation of the DD35E motif of the CFV integrase to DA35E rendered the recombinant TS virus replication-deficient. This indicated that provirus integration is probably still required for this FV derivative, which had been converted from a complex regulated retrovirus into a simple one by incorporation of a constitutively active promoter from another virus which regularly does not integrate into the host cell genome.

Effective depletion of alloreactive lymphocytes from peripheral blood mononuclear cell preparations

BACKGROUND

T cells present in an allogeneic bone marrow transplant may produce graft-versus-host disease but also contribute to immune reconstitution and enhance engraftment. Our aim was to separate alloreactive from nonalloreactive T lymphocytes, by performing a mixed lymphocyte culture (MLC) stimulation of donor cells, followed by selective depletion of activated cells expressing the high-affinity interleukin 2 receptor. We then characterized the resulting depleted cell fraction.

METHODS

Donor peripheral blood mononuclear cells were cocultured with irradiated peripheral blood mononuclear cells from HLA-nonidentical recipient stimulators in an MLC. After 3 days, CD25+ lymphocytes (alloreactive cells expressing the alpha chain of the interleukin 2 receptor) were removed by immunomagnetic separation. The depleted donor fraction and untreated cells were then rechallenged in a secondary MLC with the original irradiated stimulator cells or a third party to assess relative alloreactivity.

RESULTS

Inhibition of the secondary MLC and of host-specific cytotoxic activities was observed as well as a disappearance of interleukin 2 receptor-positive cells. Alloreactivity against unrelated third-party cells was preserved. Limiting dilution analysis of residual alloantigen-reactive T lymphocytes demonstrated a 1.3 log reduction of antihost reactivity. The depletion largely removed host-specific alloreactive CD4+ cells.

CONCLUSIONS

This method reduces alloreactivity while retaining reactivity against third-party targets. This approach may allow therapeutic infusion of T cells after HLA-nonidentical allografts with a reduced capacity to produce graft-versus-host disease.

Arterial hepatic embolization of unresectable hepatocellular carcinoma using a cyanoacrylate/lipiodol mixture

PURPOSE

A survival analysis in 16 patients with unresectable hepatocellular carcinoma (HCC) undergoing transcatheter arterial embolization (TAE) using a combination of lipiodol and N-butyl-2-cyanoacrylate (5:1) was performed in a retrospective study.

METHODS

A combination of lipiodol and N-butyl-2-cyanoacrylate (5:1) was used for TAE. All patients had disease compatible with Okuda stages I and II.

RESULTS

Twenty-four embolizations were done; five patients had more than one embolization. Median alpha-fetoprotein levels declined from 116 to 48.6 ng/ml. A median of 0.3 ml cyanoacrylate was administered per patient. Median survival was 8.5 months (range 2-49 months). After a median follow-up of 4 years, 12 patients have died (75%). Okuda stage I and II patients had a median survival time of 34.4 and 5.5 months respectively. Few side effects (19%) were seen.

CONCLUSION

We conclude that the TAE procedure used [lipiodol and N-butyl-2-cyanoacrylate (5:1)] is safe and produced only few side effects, thus constituting a valuable therapeutic option for patients with Okuda stage I and II HCC.

Visual motion perception after brain damage: I. Deficits in global motion perception

We report on the test results of a group of 32 mostly unilaterally brain-damaged patients examined for global visual motion perception. Three of these patients had severely impaired visual motion perception in their contralateral visual half-field, a deficit remarkably similar to the perceptual defects found in V5-lesioned monkeys. Two of these three patients had a right-hemisphere lesion; the remaining one had a left-hemisphere lesion. We conclude that both hemispheres of the human brain contain an area, functionally equivalent to V5, which subserves visual motion perception in the contralateral visual half-field. Lesion analysis revealed that this area is located in the posterior medial temporal gyrus.

Visual motion perception after brain damage: II. Deficits in form-from-motion perception

We investigated form-from-motion perception (FFM perception) in a sample of 39 patients with acquired brain damage. Pronounced FFM deficits were found in two patients (FM1 and FM2) with biparietal lesions. Both patients were able to identify the relevant figure, when it was not embedded in obstructive texture. Moreover, they could localize the figures in the FFM condition, although they could not reliably identify them. The two patients had normal motion coherence thresholds. Their performance in a static figure-ground task did not differ from that of other patients. These findings imply that the FFM deficits are not caused by impairment of basic visual motion or form perception but are the consequence of damage to a parietal brain structure involved in the combined analysis of visual motion and form information. The nature and functional role of this brain structure as well as the implications of our results for models of FFM perception are discussed.

Detection of chromosomal aneuploidy by interphase fluorescence in situ hybridization in bronchoscopically gained cells from lung cancer patients

BACKGROUND

Development and progression of human malignancies involve multiple genetic changes. New techniques to distinguish neoplastic from benign diseases unequivocally with small amounts of cells as gained by bronchoscopy are needed to come closer to the goal of an early diagnosis in lung cancer.

STUDY OBJECTIVE

The aim of this study was to determine whether interphase fluorescence in situ hybridization (FISH) can be used to visualize chromosomal aberrations in bronchoscopically gained cells from lung cancer patients and could eventually become a complementary technique to conventional cytology.

METHODS

We examined 20 cancerous specimens (10 primary tumors, 10 malignant effusions) of 18 lung cancer patients by FISH with DNA probes specific for chromosomes 3, 8, 11, 12, 17, and 18. From five additional patients, endobronchial brushings and/or forceps biopsy specimens were subjected to interphase FISH analysis.

RESULTS

In all primary tumors and malignant effusions, highly aneuploid cells were detectable by FISH. Chromosomal aberrations always consisted of gains of chromosomal signal numbers, and all chromosomes were found to be aneuploid to a similar extent. Using chromosomal aneuploidy as a marker of malignancy, material obtained by bronchoscopy was then examined for the presence of malignant cells. In all specimens, evidence for malignancy was obtained by FISH, including three specimens in which cells appeared to be normal or reactively changed by cytologic criteria.

CONCLUSION

We conclude that interphase FISH is useful in detecting aneuploidy associated with malignancy in bronchoscopically gained cells that do not clearly meet the criteria of malignancy by conventional cytologic study.

Phase I/II trial of dexverapamil, epirubicin, and granulocyte-macrophage-colony stimulating factor in patients with advanced pancreatic adenocarcinoma

BACKGROUND

The purpose of this study was to determine the maximum tolerated dose (MTD) of a cytotoxic regimen consisting of the second-generation chemosensitizer dexverapamil (DVPM), high dose epirubicin, and recombinant human granulocyte-macrophage-colony stimulating factor (GM-CSF) in pancreatic carcinoma.

PATIENTS AND METHODS

Twenty-eight previously untreated patients with locally advanced or metastatic adenocarcinoma of the pancreas were studied. Treatment consisted of oral DVPM at a dose of 1000-1200 mg/day for 3 days, epirubicin administered as an intravenous bolus injection on Day 2 with an initial dose of 90 mg/m2, and a dose of GM-CSF of 400 micrograms administered subcutaneously from Day 5s through 14. Epirubicin dose escalation levels were 90, 105, 120 and 135 mg/m2. Consecutive cohorts of four to eight patients were planned at each dose level. Treatment cycles were repeated every 3 weeks.

RESULTS

Hematologic toxicity, specifically granulocytopenia, constituted the dose-limiting toxicity with an MTD of 120 mg/m2 for epirubicin. Despite routine supportive therapy with GM-CSF, four, two, and five patients experienced Grade 4 granulocytopenia during their first two treatment courses at levels 105, 120, and 135 mg/m2, respectively. Grade 4 granulocytopenia was observed in two, three, and one additional patients during subsequent courses with these levels. Nonhematologic toxicity was uncommon, generally modest, and did not correlate clearly with the anthracycline dose. Dexverapamil-related cardiovascular symptoms occurred frequently, but they never resulted in serious toxicity requiring active medical intervention or permanent discontinuation of therapy. Nine of 28 patients achieved partial responses to this therapy. Stable disease was observed in nine patients, and tumor progress occurred in 10.

CONCLUSION

The MTD of epirubicin for this regimen with DVPM and GM-CSF was 120 mg/m2 every 3 weeks. Though it remains uncertain whether the encouraging response activity observed in this disease-oriented Phase I study was, in fact, due to successful modulation of multidrug resistance, these results suggest that this regimen is likely to be an effective and tolerable treatment strategy for patients with pancreatic cancer, which should be evaluated further.