A26 BMP-SIGNALING IMPAIRED TELOCYTES CREATE A DISRUPTED NICHE GRADIENT FOSTERING COLITIS-ASSOCIATED CANCER

Background

The colonic stem cell niche is established by a gradient of WNT, R-spondin, BMP factors and their antagonists along the colonic epithelial vertical axis. Telocytes (TC^FoxL1+) are mesenchymal cell forming a 3D hub underneath the epithelium, identified as an important source of niche factors. Specifically, they express non-canonical (nc) WNT factors and are the richest source of BMPs. Disruption of the BMPs gradient has been shown to be related to the development of several gastrointestinal diseases like Inflammatory Bowel Diseases (IBD). Such chronic inflammation drives the onset of Colitis-Associated Cancer (CAC) in about 60% of IBD patients. We previously showed that following a chronic inflammatory stress, 50% of the KO mouse for the BMP receptor 1a in colon telocytes (Bmpr1a^△FoxL1+) presented malignant epithelial transformations. These cancer-like regions showed an aberrant epithelial b-catenin localization and an enlargement of the double positive α-SMA⁺/Vimentin⁺ mesenchymal population.

Purpose:

Loss of BMP signaling in TCFoxL1+ affects the mesenchymal-epithelial crosstalk and makes the colonic epithelium vulnerable to injuries, promoting/perpetuating inflammation fostering CAC onset.

Method

Following a DSS-based chronic inflammatory challenge in mutant and control mice, TCFoxL1+ ultrastructure was analyzed using transmission electron microscopy. Expression levels of members of the WNT-BMP axis (BMPs, WNTs and associated antagonists) were evaluated by qPCR in tumor-like areas and adjacent tissue. YAP cellular localization was evaluated by immunofluorescence in colon after chronic DSS challenge in Bmpr1a△FoxL1+ mice and controls. To differentiate cancer-associated fibroblasts (CAFs) subtypes, myCAF (myofibroblastic) and iCAF (inflammatory), in tumor-like region and adjacent tissue, we used co-staining against gp38, ICAM, Tagln and αSMA.

Result(s)

Following a chronic DSS-challenge, electron microscopy analysis demonstrated that TC^FoxL1+ in the control mice exhibited a shortening and erosion in their telopodes (Tp). TC^FoxL1+ in Bmpr1a^△FoxL1+ mice tumor-like regions presented an expanded endoplasmic reticulum with fragmented and dilated Tp. A significant increase in BMP 4, 5 and 7 and in Wnt5 (nc) was detected in Bmpr1a^△FoxL1+ mice compared to controls. Confocal analysis revealed a strong nuclear accumulation of YAP in cancer-like regions in mutant mice compared to controls. Finally, tumour-like regions presented an heterogeneous distribution of iCAF and myCAF compared to controls.

Conclusion(s)

These results exposed that the disruption of TCFoxL1+ associated BMP signaling disturbs the WNT-BMP gradient essential for the optimal maintenance of the SC niche and thus impacting epithelial regeneration when under stress. Thus, defective TCFoxL1+ assume a key role in the poor regeneration process of the epithelium which in the end promotes the development and progression of CAC.

Please acknowledge all funding agencies by checking the applicable boxes below

CIHR

Disclosure of Interest

None Declared

Reasons for hospitalization and in-hospital mortality for anti-neutrophil cytoplasmic antibody vasculitides: analysis of the National Inpatient Sample

OBJECTIVE

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a heterogeneous group of conditions resulting in frequent hospitalizations and high in-hospital mortality (IHM). Our study aimed to use the National Inpatient Sample (NIS) to determine and categorize the main reasons for hospital admission and IHM in patients with AAV.

METHODS

We performed a retrospective study of adult AAV hospitalizations in 2016, 2017, and 2018 in acute care hospitals across the USA conducted using the NIS database. We classified the main reasons for hospital admission and IHM into 19 different categories using the principal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis.

RESULTS

A total of 41,155 hospitalizations had either a principal or secondary ICD-10 code for AAV (GPA or MPA). Rheumatologic and respiratory diagnoses were the most common reasons for hospitalization, while infectious and respiratory diagnoses were the most common reasons for IHM. Sepsis, unspecified organism A41.9, was the most common specific principal diagnosis for hospitalized and deceased AAV patients.

CONCLUSIONS

Our results show that the leading reasons for hospitalization and mortality for AAV patients were rheumatologic, respiratory, and infectious diagnoses. This data suggests that careful monitoring and management of infectious and pulmonary complications in AAV may improve hospital outcomes. Key points • AAV is a heterogeneous group of conditions resulting in frequent hospitalizations and high IHM. In our study, AAV hospitalizations ended in IHM 4.5% of the time, substantially greater than non-ANCA patients. • The leading reasons for hospital admission for AAV patients were rheumatologic and respiratory diagnoses, but the main reason for IHM were infectious and respiratory diagnoses. • Sepsis was the most common principal diagnosis for hospitalized and deceased AAV patients. • Our results highlight the importance of close monitoring and timely management of infectious and respiratory complications to improve hospitalization outcomes.

The COVID-19 pandemic and maternal mental health in a fragile and conflict-affected setting in Tumaco, Colombia: a cohort study

Background

The effects of the COVID-19 pandemic on mental health have been understudied among vulnerable populations, particularly in fragile and conflict-affected settings. We aimed to analyse how the pandemic is related to early changes in mental health and parenting stress among caregivers, many of whom are internally displaced persons (IDP), in a conflict-affected setting in Colombia.

Methods

For this cohort study, we used longitudinal data from a psychosocial support programme in which 1376 caregivers were randomly assigned across four sequential cohorts. Recruitment of participants took place in March, 2018, for cohort 1; July, 2018, for cohort 2; March, 2019, for cohort 3; and July, 2019, for cohort 4. Participants completed assessments at baseline, 1-month, and 8-month follow-ups. The 8-month assessment occurred before the COVID-19 pandemic for participants in cohorts 1 and 2 (n=573), whereas those in cohorts 3 and 4 (n=803) were assessed during the early stages of the pandemic, 2–5 weeks after the national lockdown began on March 25, 2020. Primary caregiver anxiety and depression were measured with a scale adapted from the Symptoms Checklist-90-Revised and parenting stress was measured with the short form of the Parenting Stress Index. We estimated how mental health changed by comparing prepandemic and postpandemic 8-month outcomes using lagged-dependent variable models.

Findings

Results showed that the likelihood of reporting symptoms above the risk threshold increased by 14 percentage points for anxiety (95% CI 10–17), 5 percentage points for depression (0·5–9), and 10 percentage points for parental stress (5–15). The deterioration in mental health was stronger for IDP, participants with lower education or pre-existing mental health conditions, and for those reporting a higher number of stressors, including food insecurity and job loss.

Interpretation

Maternal mental health significantly worsened during the early stages of the pandemic. Considering the vulnerability and pre-existing mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDP and other vulnerable people will be important to mitigate further mental health and socioeconomic problems.

Funding

Saving Brains–Grand Challenges Canada, Fundación Éxito, Fundación FEMSA, United Way Colombia, Universidad de los Andes.

Translation

For the Spanish translation of the abstract see Supplementary Materials section.

Trait mindfulness and the mental and physical health of caregivers for individuals with cancer

BACKGROUND

Mindfulness plays a role in moderating the negative mental and physical health outcomes associated with caregiving. The aims of this study were to examine the relationship between trait mindfulness and the (1) psychological functioning, (2) health behaviors, (3) and physical health of caregivers for individuals diagnosed with cancer.

METHODS

Caregivers completed a battery of questionnaires and examinations assessing sociodemographic characteristics, trait mindfulness, depression, perceived stress, caregiver stress, sleep, diet, physical activity, tobacco use, alcohol use, blood pressure, and BMI. Demographics and cancer diagnostics were collected for the individuals whom caregivers supported. Linear regression, multivariate analyses, and moderator analyses were performed.

RESULTS

Of the 78 caregivers, the mean age was 63.9 (S.D.=13.1); 59% identified as female; 97% identified as White. Regression analyses indicated that caregivers who reported higher levels of trait mindfulness reported significantly less perceived stress (b= -4.38, SE= 0.88, p <.001), lower levels of depression (b= -3.74, SE= 1.10, p = .001), greater caregiver quality of life (b= -9.05, SE=2.12, p < .001), better sleep quality (b= -0.98, SE=0.44, p = 0.03), and lower rates of tobacco use (b= -10.12, SE= 3.43, p =.003). Trait mindfulness was not significantly related to diet, alcohol use, blood pressure, or BMI.

CONCLUSIONS

Higher levels of trait mindfulness are associated with positive mental and physical health measure for caregivers. Future research would benefit from further examining mindfulness-based interventions and their impacts in mitigating the negative toll of caregiving in the context of cancer.

Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients

PURPOSE

To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost.

METHODS AND MATERIALS

Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011.

RESULTS

Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup.

CONCLUSIONS

Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

Abstract P5-17-08: Study of boost radiotherapy's influence on local control in 646 pure ductal carcinoma in situ breast cancer with long-term follow-up

BACKGROUND: Boost radiotherapy (B-RT) improves outcome in patients (pts) with invasive breast cancer. It's use in patients with pure ductal carcinoma in situ (DCIS) is unclear. There are two ongoing randomize trials, results are expected in ten years. Twelve retrospective observational studies have been published since 2006, the recent meta-analysis, support boost in the presence of positive margins.

PATIENTS and METHODS: We analyse a retrospective women's cohort of 646 pure DCIS patients (pts) treated mainly in two Hospitals (n=518) from 1993 to 2014. The other ten Hospitals included 128 pts all 2005 long. Proportions were compared by boost status, using the chi-square tests. The impact of boost radiation on the development of local recurrence (LR) was determined using survival analyses. In the comparison of Kaplan-Meier (K-M) was used log-rank test.

RESULTS: B-RT subgroup is 394 pts (61%), noB-RT 252 (39%). Median follow-up (FU) is 8.8 years. High risk factors: young age, size, margin status and tamoxifen (TMX) show differences among B-RT (p&lt;0.05). 46% were Estrogen Receptor positive (ER+), 30% B-RT and 16% noB-RT. 22% RE+ in B-RT take TMX vs 9.4 % RE+ noB-RT. Total LR 65 (10%). In situ LR 30 pts (4,6%) and Invasive (Inv) 35 (5,4%). By subgroup, LR in B-RT 47 (12%) vs. 18 (7%) in noB-RT. By subtype, In situ LR in B-RT 20 (5.1%) vs. noB-RT 10 (4%). Inv LR in B-RT 27 (6.9%) vs. noB-RT 8 (3.2%). In uni & multivariate analysis, tumour size, Re-Excision, and TMX, are significant LR risk factors (p&lt;0.05). Boost total doses &gt;16 Gy in the B-RT subgroup is a LR significant risk factor related to 10-16 Gy (p∼0.05). TMX and Dose Boost are related (p&lt;0.001). When Dose is introduced in multivariate analysis model, TMX lost signification. Contralateral local recurrence (CLR) in 29 pts (7%). Second tumours 9 pts (NSD between subgroups). Global disease free survival (DFS) is 80.5%, 77% in B-RT vs. 85% in noB-RT. Four pts have a LR combined with CLR; 2 pts have a LR and a second tumor; 1 pt with CLR and second tumour; 1 pt a Inv regional recurrence; 1 pt mixosarcoma in ipsilateral breast and lung metastases. Deaths: 3 pts (0.5%) after an Inv LR; 3 pts (0.5%) after Inv CR; 20 pts other causes; 10 pts lost their FU. Median FU in B-RT subgroup was 9y vs. 8.3y in noB-RT. The maximum FU according LR in B-RT is 20.6y vs. 17.4y in noB-RT. RL is not significant according to Boost (K-M p=0.398). Median LR in situ or inv depending of B-RT vs. noB-RT shows NSD (p=0.663).

CONCLUSIONS: In this large cohort retrospective study with long-term follow-up B-RT was associated with similar LR as noB-RT despite being used more frequently with higher risk disease. Dose boost &gt;16 Gy has a protective effect. Tamoxifen and boost dose are related variables. Further evidence, based on ongoing randomized trials results is essential.

Citation Format: Cambra MJ, Moreno F, Sanz X, Anglada L, Moià M, Reyes V, Arenas M, Pedro A, Ballester R, García V, Sanjosé S, Cusidó M, Jimenez C, Macià M, Solé JM, Farrus B. Study of boost radiotherapy's influence on local control in 646 pure ductal carcinoma in situ breast cancer with long-term follow-up. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-08.

Optimizing CIGB-300 intralesional delivery in locally advanced cervical cancer

BACKGROUND

We conducted a phase 1 trial in patients with locally advanced cervical cancer by injecting 0.5 ml of the CK2-antagonist CIGB-300 in two different sites on tumours to assess tumour uptake, safety, pharmacodynamic activity and identify the recommended dose.

METHODS

Fourteen patients were treated with intralesional injections containing 35 or 70 mg of CIGB-300 in three alternate cycles of three consecutive days each before standard chemoradiotherapy. Tumour uptake was determined using (99)Tc-radiolabelled peptide. In situ B23/nucleophosmin was determined by immunohistochemistry.

RESULTS

Maximum tumour uptake for CIGB-300 70-mg dose was significantly higher than the one observed for 35 mg: 16.1 ± 8.9 vs 31.3 ± 12.9 mg (P = 0.01). Both, AUC24h and biological half-life were also significantly higher using 70 mg of CIGB-300 (P < 0.001). Unincorporated CIGB-300 diffused rapidly to blood and was mainly distributed towards kidneys, and marginally in liver, lungs, heart and spleen. There was no DLT and moderate allergic-like reactions were the most common systemic side effect with strong correlation between unincorporated CIGB-300 and histamine levels in blood. CIGB-300, 70 mg, downregulated B23/nucleophosmin (P = 0.03) in tumour specimens.

CONCLUSION

Intralesional injections of 70 mg CIGB-300 in two sites (0.5 ml per injection) and this treatment plan are recommended to be evaluated in phase 2 studies.

Dosimetric analysis of prone versus supine concomitant boost IMRT technique for whole breast radiotherapy: prone is better in reducing cardiac dose for left sided breast cancer

Abstract #5129

Introduction: Prone whole breast radiotherapy is feasible and can be delivered with a hypofractionated, concomitant boost IMRT regimen (JCO, vol. 25, 16, 2007). We hypothesized that in occasional patients a supine set-up could better spare heart and lung while optimally treating the target breast. We designed NYU 05-181 protocol to test this hypothesis. Herein we performed a dosimetric analysis by comparing treatment plans in both the prone and supine position for patients with left breast cancer.&#x2028; Methods: Early stage breast cancer patients after segmental mastectomy are eligible for this IRB-approved prospective study. A supine CT simulation with images acquired every 2.5 mm is performed. The patient is then repositioned prone using a dedicated breast mattress and a second CT is obtained. The treatment volume (TV) is the whole index breast, determined according to conventional breast simulation with the patient in the supine position. Each patient is planned in both positions and is treated based on the optimal plan defined as the one that best satisfies each of the following criteria: 1) inclusion of the TV; 2) maximum heart sparing; 3) maximum lung sparing. Dosimetric analysis of the prone and supine treatment plans was performed to compare coverage of the whole breast, PTV coverage of the tumor bed, and the dose to lung and heart.&#x2028; Results: Twenty-five patients with a left breast cancer were analyzed. Five patients were treated supine, and 20 patients were treated prone because this position enabled optimal breast coverage and heart and lung sparing. However, all patients were simulated and planned in both positions. As shown in Table 1, whole breast coverage is better for the prone position although not statistically significant (p=0.38), PTV coverage was superior in the prone position (p&lt;0.001).&#x2028; &#x2028; Importantly, heart dose was not increased in the prone position (p&lt;0.001). Additionally, lung dose was markedly reduced in the prone position (p&lt;0.001).&#x2028; Conclusions: Contrary to many concerns that the prone position leads to anterior displacement of the heart within the treatment field this was only observed in 5 of the 25 patients. This dosimetric analysis demonstrates that in fact prone breast irradiation when compared to supine results in reduced exposure to both heart and lung while enabling complete coverage of the whole breast and tumor bed for the vast majority of patients. There are few left breast patients who are better positioned supine and the NYU protocol 05-181 is currently accruing to fully characterize this infrequent subset.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5129.

Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception

BACKGROUND

Progestin-only methods are among the contraceptive options available for breastfeeding women, however the doses of progestin used in emergency contraception (EC) have not been evaluated in nursing mothers. We therefore investigated the pharmacokinetics of 1.5 mg levonorgestrel (LNG) in lactating women.

METHODS

Twelve healthy exclusively breastfeeding volunteers received 1.5 mg LNG. Women refrained from nursing for 72 h after dosing and fed their infants with milk frozen beforehand. Serial blood and milk samples were collected for 120 h and assayed for LNG and sex hormone binding globulin.

RESULTS

LNG concentrations peaked in plasma and in milk 1-4 h and 2-4 h after dosing, respectively. Concentrations in milk (M) paralleled those in plasma (P) but were consistently lower (mean M:P ratio 0.28). Estimated infant exposure to LNG is 1.6 microg on the day of dosing (1 microg in the first 8 h), 0.3 microg on the second day and 0.2 microg on the third day.

CONCLUSIONS

Nursing mothers may need EC. These results suggest that to limit infant exposure to the period of maximum LNG excretion in milk, mothers should discontinue nursing for at least 8 h, but not more than 24 h, after EC.

[Toxocariasis in an adult manifested as hypereosinophilic syndrome with predominant neurological involvement. Clinical case]

Hypereosinophilic syndrome is characterized by persistent hypereosinophilia and signs or symptoms due to organ involvement, specially nervous system, heart and skin. It can be primary or secondary to allergies, parasites or cancer. Toxocariasis is an uncommon parasitic disease in adults. There is a variant, called visceral larva migrans, that can involve different organs, and among those, the central nervous system. We report a 61 years old male, with a cerebrovascular disease. There were focalizing symptoms, the CAT scan showed multiple ischemic lesions and a peripheral eosinophilia of 12,152 cells/mm3 was present. Anti toxocara IgG antibody titers were 1/1000. The patient was treated with albendazole for 14 days. After a 2 years follow up the patients is in good conditions and, for the first time, his eosinophil count is within normal limits.

Ontogeny of insulin-like growth factor-I and -II gene expression in ovine fetal heart

OBJECTIVE

Insulin-like growth factors (IGF)-I and -II have been implicated in growth and differentiation during embryonic and fetal development. To examine the role of the IGFs in growth of the fetal heart, we determined the gene expression of IGF-I and IGF-II in the four cardiac chambers of the ovine fetus from 58 to 146 days' gestation (term = 147 days).

METHODS

Total RNA was obtained from the cardiac chambers, analyzed by Northern blot, and hybridized to ovine specific cDNA probes for IGF-I and IGF-II. The resulting autoradiograms were subjected to light densitometry, and the intensity of the IGF signals was normalized to the respective 28S ribosomal RNA signals.

RESULTS

In the atria and ventricles, IGF-I mRNA abundance was very low throughout the gestational period studied, whereas IGF-II mRNA levels were higher and readily detectable. In the atria, IGF-I mRNA was very low at 60 days' gestation and appeared to increase gradually toward term. Abundance of IGF-II mRNA was high at 60 days, increased further until 120 days, and decreased slightly toward term. In contrast, in the ventricles, IGF-I mRNA increased from 60 to 100 days and then declined moderately at term. Levels of IGF-II mRNA in the ventricles were high at 60 days and decreased progressively to low levels at term. No difference in IGF-I or IGF-II mRNA levels was noted between the right and left atria or right and left ventricles.

CONCLUSION

These results suggest that developmental patterns for IGF-I and IGF-II gene expression exist in the ovine fetal heart, and the patterns differ between the atria and ventricles. Further, these gestational trends differ from those for atrial natriuretic factor (ANF) found in our previous studies, indicating that expression of the ANF gene in the fetal heart may not be associated with cardiac growth and differentiation.

Bone turnover and density in healthy women during breastfeeding and after weaning

To investigate the changes in maternal bone density and turnover associated with lactation we ran a longitudinal study in fully breastfeeding women (age 26.3 +/- 4.1 years, mean +/- SD) at the first (stage I, n = 30) and sixth (stage II, n = 25) months postpartum and 6 months after weaning (stage III, n = 20), and in a contemporary control group of non-nursing women. At each time point bone density, serum calcium, phosphorus, alkaline phosphatases, parathyroid hormone (PTH), osteocalcin, follicle stimulating hormone (FSH), estradiol (E2), prolactin (PRL) urinary hydroxyproline and creatinine (OH-P/Cr) were measured in both groups. The daily calcium intake of nursing women (1479 +/- 590 mg/day at stage I) was higher than in non-nursing women (536 +/- 231 mg/day at stage I). Biochemical markers of bone turnover were higher (p < 0.05) in nursing than in non-nursing women at stages I and II, while in stage III only OH-P/Cr was elevated. The lumbar spine (L2-4) bone mineral density was similar in the two groups at the beginning of the study (1.148 +/- 0.111 g/cm2 in nursing women vs 1.211 +/- 0.102 g/cm2 in non-nursing women; p = 0.06), but it was lower in nursing women at stage II (1.144 +/- 0.110 g/cm2 vs 1.216 +/- 0.095 g/cm2 respectively; p < 0.05). Right femoral neck bone density decreased by 3% between stages I and II in nursing women but did not differ from values in non-nursing women (0.947 +/- 0.110 vs 0.973 +/- 0.108 in stage I and 0.918 +/- 0.114 vs 0.975 +/- 0.098 in stage II respectively; p < 0.05, ANOVA). After weaning, lumbar spine and femoral neck bone density increased by 6% and 8% respectively (p < 0.05, ANOVA). No correlation was found between changes in bone turnover markers or bone density and parity, frequency and duration of nursing episodes, body weight, body mass index, and plasma PRL, E2 and PTH levels. We conclude that in nursing women with a daily calcium intake at the recommended dietary allowance ( > 1200 mg/day), full breastfeeding extending over 6 months is characterized by increased maternal bone turnover and a transient bone loss which normalizes after weaning.

[Comparison of 2 treatment schemes to eradicate Helicobacter pylori]

INTRODUCTION

Anti secretory drugs, antimicrobials and bismuth salts are used with variable success to eradicate Helicobacter pylori.

AIM

To assess the effectiveness and rates of reinfection of two therapeutic modalities H pylori infection in adult patients with duodenal ulcer or non ulcer dyspepsia.

METHODS

During upper gastrointestinal endoscopy, 5 antral and 2 fundic biopsies were obtained and sent for microbiological and anatomopathological study. Patients infected with Helicobacter pylori were randomly assigned to receive during two weeks omeprazole 20 mg od plus amoxicillin 500 mg tid (group A) or bismuth subsalicylate 260 mg bid, metronidazole 250 mg tid and amoxicillin 500 mg tid (group B). A new endoscopy with antral and fundic biopsies was performed to all patients four weeks after discontinuing treatment and six months later to those in whom H pylori was eradicated.

RESULTS

Eighty patients (40 in each treatment group) completed the treatment and follow up. H pylori was eradicated in 22 patients of group A (55%) and 28 of group B (70%). Minor adverse effects were reported by 5 patients in group A (12%) and 11 in group B (27.5%). Six months later, reinfection was documented in 12 patients of group A and 8 of group B (54% and 30% of those with successful treatment respectively). Ten of twenty five patients with duodenal ulcer had reinfections, but there was only one ulcer relapse.

CONCLUSIONS

These two treatment modalities have similar results.

A specific enzyme immunoassay (EIA) with selective extraction for quantitation of a topical anti-inflammatory agent, SCH 40120, in human plasma

SCH 40120 is a potent anti-inflammatory agent under development for the topical treatment of dermal inflammatory and allergic disorders such as atopic dermatitis, contact dermatitis and psoriasis. We have previously described a sensitive enzyme immunoassay (EIA) for SCH 40120 in unextracted human plasma to support clinical studies. However, severe cross-reaction with unknown metabolites was observed during validation using samples from rats dosed with 14C-SCH 40120. Therefore, a selective extraction procedure was developed to remove the unknown plasma metabolites of SCH 40120 prior to EIA quantitation. The modified EIA using extracted plasma was cross-validated with an LC method using plasma samples from dosed subjects (human and rat), thereby confirming the specificity of the assay. The EIA can reliably quantitate SCH 40120 in plasma samples from 100 pg ml-1 to 10 ng ml-1 with good linearity, accuracy and precision, and is suitable for pharmacokinetic studies in man.

[Non ulcerative dyspepsia: relationship of symptomatology, gastritis and Helicobacter pylori]

BACKGROUND

histological alterations of gastric mucosa and its colonization by Helicobacter pylori are postuled to be implicated in the pathogenesis of non ulcer dyspepsia.

AIM

to study the possible relationships between histological gastritis and Helicobacter pylori in non ulcer dyspepsia symptomatology.

PATIENTS AND METHODS

fifty four patients (39 females) with non ulcer dyspepsia whose ages ranged from 17 to 68 years were subjected to an upper GI endoscopy with gastric mucosa biopsy samples for histological study and microbiological identification of Helicobacter pylori. Gastrointestinal complains were blindly quantified using a scored questionnaire.

RESULTS

thirty one subjects (57.4%) had Helicobacter pylori in their gastric mucosa. There was acute inflammatory activity in 26 of the 31 patients with Helicobacter pylori (81%) and 15 of 23 without Helicobacter (65%). The median score of symptoms was 7 (range 2-13) in patients with Helicobacter and 6 (range 2-10) in patients without Helicobacter.

CONCLUSIONS

there were no significant differences in gastric mucosa acute inflammatory activity and non ulcer dyspepsia symptomatology between patients with or without Helicobacter pylori colonization of gastric mucosa.

A sensitive enzyme immunoassay (EIA) for quantitation of the topical anti-inflammatory agent SCH 40120 in unextracted human plasma

SCH 40120 is a potent acute anti-inflammatory agent under development for topical treatment of dermal inflammatory and allergic disorders such as atopic dermatitis, contact dermatitis and psoriasis. In order to support percutaneous absorption studies, a competitive enzyme immunoassay (EIA) was developed to determine SCH 40120 in unextracted plasma samples. SCH 38280, a carboxylated analogue of SCH 40120, was used as the hapten and conjugated with bovine thyroglobulin (Thy). The hapten-Thy conjugate was used as the immunogen to immunize rabbits for antibody production. The hapten was also coupled to horseradish peroxidase (HRP) to form SCH 38280-HRP, which was used as the tracer. The EIA can detect SCH 40120 concentrations as low as 50 pg ml-1 of plasma, and can reliably quantitate SCH 40120 in plasma samples from 100 pg ml-1 to 10 ng ml-1 with good linearity, accuracy and precision. A variety of structurally related compounds and potential metabolites did not significantly cross-react with the antibodies, except for a few analogues. The availability of this sensitive assay makes it possible to evaluate the pharmacokinetics of SCH 40120 in man.

Effects of substrate and inhibition of oxidative metabolism on contraction and myosin phosphorylation in ASM

Steady-state active stress in smooth muscle is maintained by cross bridges which undergo continuous cycling and myosin phosphorylation, and the two processes both consume ATP. In this study, we investigated whether energy utilization by cross-bridge cycling and myosin phosphorylation is compartmentalized and examined their relative affinities for ATP in airway smooth muscle. We measured active stress, myosin phosphorylation, O2 consumption, and tissue ATP content in bovine tracheal smooth muscle activated by K+ depolarization when glucose was replaced by pyruvate and when oxidative metabolism was inhibited by hypoxia or uncoupled by 2,4-dinitrophenol. The results indicate that ATP produced from both glycolysis and oxidative metabolism is available to both cross-bridge cycling and myosin phosphorylation. However, steady-state myosin phosphorylation was insensitive to the inhibition of oxidative metabolism by hypoxia and mitochondrial uncoupling when steady-state isometric stress and tissue ATP content were significantly reduced. These results suggest that, relative to actomyosin adenosine 5'-triphosphatase, myosin light chain kinase has a higher affinity for ATP in intact airway smooth muscle. However, peak myosin phosphorylation associated with the initial rapid stress development was sensitive to inhibition of oxidative metabolism, probably reflecting a lower content of intracellular calcium store as a result of metabolic inhibition.

[The diagnosis of chronic Chagas disease using recombinant antigens of Trypanosoma cruzi]

A panel of eight recombinant Trypanosoma cruzi antigens was used to study the IgG reactivity of sera proceeding from 151 patients with chronic Chagas disease. These samples were reactive against T Cruzi epimastigotes by immunofluorescence and enzyme linked assays. A dot blot assay was performed to evaluate the reactivity against recombinant clones 1, 2, 13, 26, 30, 36, 54 and SAPA (Shed Acute Phase Antigen). Ninety six percent of samples reacted against one or more of these antigens. The most frequently recognized proteins were clones 1, 2, 13, 36 and 26 with 90, 89, 76, 71 and 66 percent of reactivity respectively. Less than 50% of sera reacted against clones 30, 54 and SAPA. Sera from symptomatic patients had a significantly higher frequency of reactivity against clone SAPA than those from asymptomatic patients. This difference suggests that a high reactivity against clone SAPA may be related to acute infections and symptoms. No significant relationship could be established between specific recombinant clone recognitions and particular clinical forms of the disease (cardiological or digestive). It is concluded that these recombinant proteins may become a good tool for the evaluation of the immune response of patients infected with T. cruzi.

Filipin labeling in Chlamydomonas gametes exposes site-specific lipid specializations

A thin section study of mating Chlamydomonas cell wall-less CW 15 mating type plus (mt+) and mating type minus (mt-) gametes utilized filipin. The results show extensive labeling of mt+ and mt- plasma membranes. No labeling was seen on the mating structure membranes of activated mt+ or mt- gametes. These results indicate that differences exist between the plasma membrane and the mating structure membrane of gametes. If filipin is specific for the 3-beta-OH sterol, ergosterol and/or other Chlamydomonas sterols, then these results imply that the fusing mating structure membranes may be altered or reduced in sterol content. Such lipid specializations may increase local membrane fluidity and thereby facilitate the site-specific cell fusion associated with mating Chlamydomonas gametes.

Immunodetection of antibodies in sera from symptomatic and asymptomatic Chilean Chagas' disease patients with Trypanosoma cruzi recombinant antigens

A panel of eight Trypanosoma cruzi antigens produced by recombinant DNA techniques was used to compare the reactivity of IgG specificities in the sera from 45 chronic Chagas' disease patients with different clinical symptoms (cardiac disease, gastrointestinal lesions, and combined syndrome) with those present in the sera from 55 asymptomatic patients in Chile. All of the serum samples were first characterized for antibody to T. cruzi epimastigotes by immunofluorescence assay. All of the Chagas' disease sera were reactive, but none of five healthy controls whose sera were also tested had antibodies against the fixed parasites. A dot-blot assay was then performed to evaluate the serum reactivity against recombinant DNA clones 1, 2, 13, 26, 30, 36, 54, and SAPA (shed acute phase antigen). These recombinant antigens were recognized by a large proportion of the sera collected from the Chilean patients. Ninety-five percent of the serum samples reacted with one or more of the recombinant clones. Analysis of the reactivity with individual fusion proteins showed that 88% of these sera reacted with clones 1 and 2, and 78% reacted with clone 13. Differences in reactivity to clones number 13, 30, and SAPA were observed when symptomatic and asymptomatic patients were compared. These differences in reactivity were statistically significant (P less than 0.01) according to Fisher's exact test.

[Application of a system of serological surveillance of Chagas disease in a region of high chagasic endemia. I. Prevalence of Trypanosoma cruzi infection in Salamanca]

A serologic study for prevalence of Chagas infection was performed in Salamanca, Northern Chile. Indirect immunofluorescence and indirect hemagglutination reactions were used in samples from 1529 females and 698 males representing 10% of the population. A total of 499 positive results were obtained. The incidence of infection increases at a mean rate of 1% per year up to age 30, declining slowly in older groups to reach a maximum of 39.7% for the population. These data will be used to implement appropriate serologic surveillance programs and sanitary control measures in this and other populations.

[Treatment of gastric ulcer with sucralfate and famotidine]

We conducted a double blind random study on 79 patients with gastric ulcer: 39 received sucralfate, 1 g 4 times a day (Group 1) and 40 received a single evening dose of famotidine, 40 mg (Group 2). At 4 weeks, endoscopy revealed healing of the ulcer in 46% of patients in Group 1 and 40% in Group 2 (NS). At 8 weeks, corresponding figures were 90% and 75% (NS). All patients were able to complete treatment and minor side effects were reported from all patients, 36% with sucralfate and 28% with famotidine. Thus, sucralfate and famotidine are equally effective for therapy of gastric ulcer. The higher percentage of healing with sucralfate observed in this study was not statistically significant.