FRI0054 CHANGES IN DEPRESSIVE SYMPTOMS IN RHEUMATOID ARTHRITIS (RA) PATIENTS DURING TOCILIZUMAB (TCZ) THERAPY: THE GERMAN NONINTERVENTIONAL ARATA STUDY

Background:

Depression is a common comorbidity in patients with RA and influences perception of disease activity and quality of life. We have previously reported that mean depression scores improved during TCZ therapy in conjunction with reductions in disease activity.1

Objectives:

To evaluate individual changes in depressive symptoms over 52 weeks in RA patients initiating treatment with TCZ.

Methods:

We analyzed data from a large German multicenter observational study of patients with active RA who initiated TCZ therapy during routine clinical care (ML29087 ARATA study;NCT02251860). The Beck Depression Inventory-II (BDI-II), a self-report questionnaire for depression screening that has been validated in RA, was used to assess symptoms of depression. Patients were classified by baseline BDI-II scores into depression categories of no (BDI-II<14), mild (BDI-II 14-19), moderate (BDI-II 20-28), and severe depression (BDI-II≥29).2Individual changes in BDI-II scores between baseline and week 52 were assessed. Erythrocyte sedimentation rate was used as the acute phase reactant in Disease Activity Score-28 joints (DAS28) assessments.

Results:

Of 1155 patients enrolled from 108 clinical centers in Germany between May 2014 and July 2018, 474 completed the BDI-II at baseline (BDI-II cohort); baseline characteristics were similar to those of patients who did not complete the BDI-II. Approximately half of patients in the BDI-II cohort had BDI-II scores indicating no depression (248; 52.3%); the remaining patients had mild (87; 18.4%), moderate (84; 17.7%), or severe (55; 11.6%) depression. The mean (SD) baseline characteristics of the BDI-II cohort were 55.5 (12.5) yrs of age, 75.7% female, 10.6 (9.2) yrs RA duration, 4.9 (1.2) DAS28, and 24.3 (10.2) Clinical Disease Activity Index (CDAI). Baseline DAS28 and CDAI scores were similar among different depression subgroups, but patients with severe depression were more likely to be female (87.3% vs 70.6% for no depression) and had higher levels of anxiety, suicidal ideation, fatigue, pain, and sleep disturbance than patients with no or milder depression.

A total of 229 of the 474 patients (48.3%) in the BDI-II cohort completed the BDI-II at both baseline and week 52. At 52 weeks, the depression category of approximately half of patients with depressive symptoms at baseline changed to a lower level or no depression (Figure 1). Moderate to large improvements in BDI-II from baseline (>10 points) were reported by 33.3% to 38.5% of patients with baseline depressive symptoms (Figure 2).

Conclusion:

At 52 weeks after initiating TCZ, the depressive disease burden was reduced. Future analyses with a representative patient cohort will be aimed at exploring whether improvements in depression occur independent of reductions in disease activity.

References:

[1]Behrens F et al.Arthritis Rheumatol2019;71(suppl 10):abstr1414.

[2]Smarr KL, Keefer AL.Arthritis Care Res2011;63(S11):S454-66.

Acknowledgments:

This study was sponsored by Chugai Pharma Germany GmbH and Roche Pharma AG. Sharon L. Cross and Kirsten Dahm provided medical writing services supported by Chugai. Statistical analyses were provided by Roche Pharma AG.

Disclosure of Interests:

Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Martin Feuchtenberger Consultant of: Abbvie, BMS, Chugai, Sanofi, Speakers bureau: Abbvie, BMS, Celgene, Chugai, Jansen-Cilag, Lilly, Pfizer, Roche, Sanofi, UCB, Herbert Kellner: None declared, Cornelia Kühne Grant/research support from: Novartis, Amgen, Roche/Chugai, Pfizer, Celgene, AbbVie, Sanofi, Anke Liebhaber: None declared, Maren Sieburg: None declared, Siegfried Wassenberg: None declared, Christina Luig Employee of: Roche Pharma AG, Michael W. Hofmann Employee of: Chugai Pharma Germany GmbH, Christopher Amberger Grant/research support from: Chugai Pharma Germany GmbH, Consultant of: Chugai Pharma Germany GmbH

OP0020 IMPACT OF BDMARDS WITH DIFFERENT MODES OF ACTION ON FATIGUE IN RA PATIENTS

Background:

Fatigue is an important patient-reported outcome. It has been reported to be potentially targetable by DMARDs with specific modes of action, particularly IL-6 inhibition [1].

Objectives:

To assess to which extent patients on DMARDs with different modes of action reach fatigue levels of 2 or less on a 0 (no fatigue) to 10 (high fatigue) scale after 6 months of treatment.

Methods:

The German register RABBIT is a prospective longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises bionaive patients who were enrolled with start of a b/tsDMARD between 01/2009 and 04/2019, who had at least 1 follow-up, did not switch during the first 3 months and afterwards only within the same substance, and presented fatigue levels of > 2 at baseline.

Poisson regression models with a robust error variance were used to calculate risk ratios (RRs) for reaching fatigue values ≤ 2, for all DMARD modes of action. Propensity score weighting was used to adjust for confounding by indication. Multiple imputation of missing values was performed.

Results:

Baseline fatigue levels were 5.1 overall and 6.1 among patients with a fatigue level of > 2 points on average. They were comparable among different DMARD modes of action. csDMARD patients had lower values than others regarding disease duration, disease activity, or joint erosions (Table 1).

Table 1.

Patient characteristics for different DMARD modes of action

ParametercsDMARDsTNFiRTXABAIL-6JAKiN23762772115166357110Fatigue at baseline5.9 (2)6.1 (2)5.9 (2)5.9 (1.9)6.1 (2)6.3 (1.9)Age [years]58.5 (12.7)56.3 (12.4)62.7 (10.9)59.7 (12.6)57.9 (12.5)61.5 (11.5)Female sex1809 (76.1)2060 (74.3)82 (71.2)118 (71)272 (76.3)79 (70.1)Disease duration [years]6.2 (7.2)8.7 (8.1)10.8 (9.7)9.8 (9.2)7.9 (7.6)8.5 (10)Joint erosions634 (28.4)1358 (50.5)62 (56.8)91 (55.4)158 (46.4)45 (41.3)Prior csDMARD therapies1.3 (0.6)2.3 (1)2.5 (1.1)2.2 (1)2.2 (0.9)1.8 (0.8)DAS28-ESR4.6 (1.2)5 (1.2)5.3 (1.3)5.3 (1.2)5.2 (1.3)4.9 (1.3)% of full physical capacity67.4 (21.6)64.6 (22)57 (23.5)59.5 (21.3)63.8 (20.9)61.6 (23)Glucocorticoid therapy (last 6 months)1161 (48.9)1747 (63)76 (66.4)93 (56)198 (55.5)42 (38.1)Fibromyalgia73 (3.1)111 (4)6 (5.2)7 (4.2)11 (3.1)1 (0.9)Depression180 (7.6)218 (7.9)10 (8.7)14 (8.4)26 (7.3)16 (14.6)Ever smoker1252 (52.7)1497 (54)68 (59)84 (50.7)200 (56)59 (53.5)

Results are presented as mean ± SD or number (percentage). Absolute numbers may be rounded due to multiple imputation.

The RR of IL-6 inhibitors for achieving a fatigue level of ≤ 2 was 1.34 (95% CI: 1.09 – 1.64) compared to csDMARDs. Among other factors, current smoking, prevalent fibromyalgia and depression had a negative impact on achieving a low fatigue level (Table 2).

Table 2.

Risk ratios for achieving fatigue levels ≤2

Parameter (at baseline)RR95% confidence intervalFatigue (1 point higher)0.83(0.80;0.86)TNF inhibitor (vs. csDMARDs)1.11(0.99;1.24)Rituximab (vs. csDMARDs)1.10(0.71;1.68)Abatacept (vs. csDMARDs)1.13(0.82;1.54)IL-6 inhibitor (vs. csDMARDs)1.34(1.09;1.64)JAK inhibitor (vs. csDMARDs)1.19(0.81;1.75)Age (5 years more)0.97(0.95;0.99)Female sex0.83(0.74;0.92)Patient global health (1 point higher)0.97(0.94;0.997)Joint erosions1.19(1.07;1.32)Current smoking0.86(0.76;0.98)Former smoking0.92(0.82;1.04)Fibromyalgia0.56(0.35;0.90)Depression0.75(0.59;0.95)

Conclusion:

Treatment with IL-6 inhibitors significantly increases the chance of reaching low fatigue levels within half a year in RA patients, while current smoking reduces it.

References:

[1]Choy E.H.S. and Calabrese L. H Rheumatology 2018;57:1885-95.

Acknowledgments:

RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Fresenius Kabi, Hexal, Lilly, MSD, Mylan, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, and UCB.

Disclosure of Interests:

Martin Schaefer: None declared, Peter Herzer Speakers bureau: AbbVie, Novartis, Sanofi, Janssen, Cornelia Kühne Grant/research support from: Novartis, Amgen, Roche/Chugai, Pfizer, Celgene, AbbVie, Sanofi, Herbert Kellner Grant/research support from: Biogen, Consultant of: Biogen, Speakers bureau: Biogen, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis

Synthesis, Photophysical, and Biological Evaluation of Sulfated Polyglycerol Dendronized Perylenebisimides (PBIs)--A Promising Platform for Anti-Inflammatory Theranostic Agents?

A set of four water-soluble perylene bisimides (PBI) based on sulfated polyglycerol (PGS) dendrons were developed, their photophysical properties determined via UV/vis and fluorescence spectroscopy, and their performance as possible anti-inflammatory agents evaluated via biological in vitro studies. It could be shown that in contrast to charge neutral PG-PBIs the introduction of the additional electrostatic repulsion forces leads to a decrease in the dendron generation necessary for aggregation suppression, allowing the preparation of PBIs with fluorescence quantum yields of >95% with a considerable decreased synthetic effort. Furthermore, the values determined for L-selectin binding down to the nanomolar range, their limited impact on blood coagulation, and their minor activation of the complement system renders these systems ideal for anti-inflammatory purposes.

[Implantable cardioverter-defibrillator at the end of life]

Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter-defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at the end of life. Family doctors, internists, emergency physicians and paramedics are unable to inactivate shocks. Deactivation of shocks at the end of life is not comparable to euthanasia or assisted suicide, but allow the patient to die at the end of an uncurable endstage disease. Deactivation of shocks should be discussed with the patient before initial implantation of the devices. The precise moment of the inactivation at the end of life should be discussed with patients and relatives. There is no common recommendation for the time schedule of this decision; therefore it should be based on the individual situation of the patient. Emergency health care physicians need magnets and sufficient information to inactivate defibrillators. The wishes of the patient have priority in the decision process and should be written in the patient's advance directive, which must be available in the final situation. However the physician must not necessarily follow every wish of the patient. As long as the laws in the European Union are not uniform, German recommendations are needed.

[Central corneal thickness measurement with online optical coherence pachymetry and ultrasound pachymetry in 513 consecutive eyes]

BACKGROUND

The aim of this study was to assess the reliability of online optical coherence pachymetry (OCP) integrated into the Technolas excimer platform by comparing the intraoperative OCP corneal thickness measurement with the preoperative standard ultrasound pachymetry (USP).

PATIENTS/MATERIALS AND METHODS

The mean central corneal thickness of 513 consecutive eyes was measured using OCP and USP. Immediately before starting the LASIK procedure, three OCP measurements of the central cornea (OCPonline, Heidelberg Engineering GmbH, Germany) were done under the microscope of the Excimer laser (Technolas, Bausch and Lomb, Rochester, NY). The mean value of 10 central USP measurements (Sp-3000, Tomey, Japan) was obtained during the preoperative assessment of the patients. The comparison of the two methods was done using Pearson regression analysis and the Bland- Altman method.

RESULTS

Mean central corneal thickness of the OCP and the USP were 523.1 +/- 30.5 microm and 561.2 +/- 32.7 microm, respectively. The correlation coefficient was r = 0.891 for the two methods. The mean difference between USP and OCP was 37.9 +/- 14.8 microm.

CONCLUSIONS

The intraoperative OCP gives 7% smaller measurements compared with the preoperative USP.

Zyklorotation des Auges bei wellenfrontgeführter LASIK mit statischem Iriserkennungstracker

PURPOSE

Centration of the ablation zone decisively influences the result of wavefront-guided LASIK. Cyclorotation of the eye occurs as the patient changes from the sitting position during aberrometry to the supine position during laser surgery and may lead to induction of lower and higher order aberrations.

METHODS

Twenty patients (40 eyes) underwent wavefront-guided LASIK (B&L 217z 100 excimer laser) with a static eyetracker driven by iris recognition (mean preoperative SE: -4.72+/-1.45 D; range: -1.63 to -7.00 D). The iris patterns of the patients' eyes were memorized during aberrometry and after flap creation.

RESULTS

The mean absolute value of the measured cyclorotation was -1.5+/-4.2 degrees (range: -11.0 to 6.9 degrees ). The mean cyclorotation was 3.5+/-2.7 masculine (range: 0.1 to 11.0 degrees ). In 65% of all eyes cyclorotation was >2 masculine.

CONCLUSIONS

A static eyetracker driven by iris recognition demonstrated that cyclorotation of up to 11 degrees may occur in myopic and myopic astigmatic eyes when changing from a sitting to a supine position. Use of static eyetrackers with iris recognition may provide a more precise positioning of the ablation profile as they detect and compensate cyclorotation.

Wellenfrontanalyse zur Diagnose des subklinischen Keratokonus

BACKGROUND

The entity of subclinical keratoconus (SKC) has not been defined sufficiently yet. The aim of the study was to describe ocular wavefront aberrations of clinically inconspicuous fellow eyes in patients with early keratoconus (KC) as a model of SKC and to assess the feasibility of higher-order wavefront analysis to discriminate eyes with SKC from normal eyes.

METHODS

This prospective study included eight clinically inconspicuous fellow eyes of eight patients with newly detected KC in the contralateral eye and a paracentral inferior-superior difference (PISD) <1.4 D. In total, 15 eyes of 12 patients with newly diagnosed KC and a PISD >1.4 D were included as positive controls and 71 healthy eyes of 40 patients served as negative controls. The wavefront error was measured in all eyes with a Hartmann-Shack sensor. Discriminant analysis was performed with input from ocular HOA data and PISD. Receiver operating characteristic (ROC) curves were plotted for PISD, single Zernike coefficients, and for the output values of the discriminant functions to investigate their usefulness for discrimination between SKC eyes, early KC eyes, and healthy controls.

RESULTS

There were significant differences between inconspicuous fellow eyes (group 2) and controls (group 3) for PISD, for the coefficients Z3(-3), Z3(-1), Z4(0) and Z5(-1), and for the output values of the discriminant functions. The latter discriminated between groups 2 and 3 with maximum sensitivity and specificity (A(z) ROC=1), whereas discriminative ability was considerably lower for single Zernike coefficients.

CONCLUSION

Single Zernike coefficients did not appear to be useful for the detection of SKC. Using discriminant analysis, from PISD and higher-order Zernike coefficients a metric with very high discriminative ability between normal and SKC eyes could be constructed.

Soluble tumour necrosis factor receptor treatment does not affect raised transforming growth factor beta levels in rheumatoid arthritis

OBJECTIVE

To further elucidate the immunomodulating effects of anti-tumour necrosis factor alpha treatment in rheumatoid arthritis (RA) by studying changes in plasma levels of transforming growth factor beta (TGFbeta) in patients with RA undergoing etanercept treatment.

METHODS

Plasma levels of TGFbeta1 and TGFbeta2 were determined in 26 patients with RA during six months of etanercept treatment and compared with disease activity and laboratory parameters, including matrix metalloproteinase-3 (MMP-3) and interleukin 6 (IL6).

RESULTS

Before treatment all patients had raised TGFbeta1, IL6, and MMP-3 levels. In the course of treatment IL6 and MMP-3 levels decreased significantly, accompanied by a drop in serological markers (C reactive protein and erythrocyte sedimentation rate) and clinical disease activity (visual analogue scale and Thompson joint score). By contrast, high levels of latent TGFbeta1 were present in all specimens over the entire six months. TGFbeta2 levels did not change during treatment.

CONCLUSION

Etanercept treatment induces subtle changes in the cytokine network. Although the proinflammatory cytokine IL6 is down regulated, the persistence of high TGFbeta plasma levels indicates the existence of as yet unknown mechanisms for TGFbeta overexpression in RA. This may predispose to severe infections and can cause an altered tumour defence.

The HPV-16 E7 oncoprotein binds Skip and suppresses its transcriptional activity

E7 is the major transforming protein of human papillomavirus (HPV), which is implicated in the development of cervical cancer. The transforming activity of E7 has been attributed in part to its interaction with the retinoblastoma (Rb) tumour suppressor; however, the Rb interaction alone is not sufficient for transformation by E7. In a screen for cellular targets of HPV E7, we identified the Ski interacting protein, Skip, as a new interacting partner of E7. We show that HPV-16 E7 associates with Skip via sequences in its carboxy terminal region, and the evolutionarily conserved proline rich sequences (PRS) of the SNW domain of Skip. E7 functionally targets Skip in vivo and inhibits its transcriptional activation activity. Two transformation defective mutants of E7 were identified that failed both to bind Skip and to inhibit its transcriptional activity. These results suggest that inhibition of Skip function may contribute to cell transformation by HPV-16 E7.

Regulation of the human papillomavirus oncoproteins by differential phosphorylation

Human papillomaviruses (HPVs) are intimately associated with the development of cervical cancer. The virus encodes two oncoproteins, E6 and E7, that are primarily responsible for inducing malignant transformation. The last few years have seen significant progress in elucidating the mechanisms by which these two viral proteins bring about cell transformation. Both proteins interact with a large number of cellular targets, many of which are involved in regulating diverse functions such as cell cycle regulation, transcription, differentiation and apoptosis. However both E6 and E7 are normally present at low levels within the virally infected cell, and how all these interactions are achieved and regulated has, until recently, been unclear. We have found that both E6 and E7 are subject to differential phosphorylation, the net results of which regulate their abilities to interact with some of their respective target proteins. In the case of E6, phosphorylation by Protein Kinase A (PKA) negatively regulates its ability to interact with the Discs Large (Dlg) tumour suppressor. In the case of E7, phosphorylation by Casein Kinase II (CKII) significantly increases its ability to interact with the TATA Box Binding Protein (TBP). Further, CKII regulation of E7 appears to vary during the cell cycle, therefore this provides a means of specifically targeting E7 to a given substrate at a given point within the cell cycle. This differential regulation of E6 and E7 by phosphorylation thus provides specificity to a diverse set of protein-protein interactions.

Ski interacts with the evolutionarily conserved SNW domain of Skip

Ski interacting protein (Skip) has been found to bind to the highly conserved region of Ski, which is required for its transforming activity. Ski is a unique oncoprotein that is involved in inducing both transformation and differentiation. At the molecular level, Ski has been shown to exhibit either co-activator or co-repressor activity depending on the cellular and promoter context. We were interested in further elucidating the biological implications of the Ski-Skip interaction. Here we have identified the SNW domain of Skip as the interaction region for Ski. This domain of Skip is highly conserved in all the Skip homologues identified from different species. Using a series of reporter plasmids, we show that Skip is a potent transcriptional activator of many different promoters, the activity of which was also mapped to the conserved core SNW domain of the protein. Addition of excess Ski further augmented the transcriptional activities of Skip, suggesting that one of the ways in which Ski brings about transformation is by binding and cooperating with the SNW domain of Skip in transcriptional activation.

Differential regulation of human papillomavirus E6 by protein kinase A: conditional degradation of human discs large protein by oncogenic E6

The protein Kinase A (PKA) pathway was found to selectively regulate the function of oncogenic but not non-oncogenic E6 proteins. High risk E6 proteins are phosphorylated at their Dlg/PDZ binding motif at the C-terminus by a PKA like activity. This PKA and PDZ binding module is found only for human PV, is strictly conserved in all the transforming HPVs and is absent in all the low risk HPV types. We present evidence of a conditional regulation of E6 induced degradation of Dlg. HPV18E6 positive but not HPV negative keratinocytes exhibit increased Dlg steady state levels under conditions of high PKA activity, with a concomitant increase in the presence of Dlg at tight junctions. In vitro binding experiments show that E6 phosphorylation by PKA reduces its binding to Dlg and molecular modelling can explain this observation in a structural context. E6 dependent degradation of Dlg in cells with high PKA levels is inhibited and this is dependent on phosphorylation of the PDZ binding site in E6. In contrast, the degradation of p53 induced by E6 is not affected by PKA. We propose a differential regulation of E6 for the ubiquitin mediated degradation of specific E6 target proteins.

Oncogenic human papillomavirus E6 proteins target the discs large tumour suppressor for proteasome-mediated degradation

Previous studies have shown that the oncogenic HPV E6 proteins form a complex with the human homologue of the Drosophila tumour suppressor protein, discs large (Dlg). This is mediated by the carboxy terminus of the E6 proteins and involves recognition of at least one PDZ domain of Dlg. This region of E6 is not conserved amongst E6 proteins from the low risk papillomavirus types and, hence, binding of HPV E6 proteins to Dlg correlates with the oncogenic potential of these viruses. We have performed studies to investigate the consequences of the interaction between E6 and Dlg. Mutational analysis of both the HPV18 E6 and Dlg proteins has further defined the regions of E6 and Dlg necessary for complex formation. Strikingly, co-expression of wild type HPV18 E6 with Dlg in vitro or in vivo results in a dramatic decrease in the amount of Dlg protein, whereas mutants of E6 which fail to complex with Dlg have minimal effect on Dlg protein levels. The oncogenic HPV16 E6 also decreased the Dlg levels, but this was not observed with the low risk HPV11 E6 protein. Moreover, a region within the first 544 amino acids of Dlg containing the three PDZ domains confers susceptibility to E6 mediated degradation. Finally, treatment of cells with a proteasome inhibitor overrides the capacity of E6 to degrade Dlg. These results demonstrate that Dlg is targeted by high risk HPV E6 proteins for proteasome mediated degradation.

Molecular genetic characterisation of intracerebrally transplanted brain tumours

The aim of the present study was the characterisation of genetic alterations in two different experimental gliomas, induced in rats from the inbred strain BDIX by transplacental ethylnitrosourea with subsequent serial transplantation. The genes investigated have been shown previously to be altered during human glial tumour progression and include the gene for the epidermal growth factor receptor (EGFR), the genes for the cell cycle regulators cyclin dependent kinase 4 (CDK4), cyclinD1 (cycD1), the p16 gene (MTS1/INK4) and the retinoblastoma gene (RB). Using a semi-quantitative PCR-based screening method no gross alterations could be detected in these genes, demonstrating that nitrosourea-induced glial tumours of rats do not harbour those genetic changes which typically arise in human malignant gliomas. Thus, the use of this tumour model for gene therapy trials is questionable.

E3-ubiquitin ligase/E6-AP links multicopy maintenance protein 7 to the ubiquitination pathway by a novel motif, the L2G box

Ubiquitin ligases are generally assumed to play a major role in substrate recognition and thus provide specificity to a particular ubiquitin modification system. The multicopy maintenance protein (Mcm) 7 subunit of the replication licensing factor-M was identified as a substrate of the E3-ubiquitin ligase/E6-AP by its interaction with human papillomavirus-18E6. Mcm7 is ubiquitinated in vivo in both an E6-AP-dependent and -independent manner. E6-AP functions in these reactions independently of the viral oncogene E6. We show that recognition of Mcm7 by E6-AP is mediated by a homotypic interaction motif present in both proteins, called the L2G box. These findings served as the basis for the definition of substrate specificity for E6-AP. A small cluster of proteins whose function is intimately associated with the control of cell growth and/or proliferation contains the L2G box and is thereby implicated in an E6-AP and, by default, HPV-E6-dependent ubiquitination pathway.

[Routine hip ultrasonography in inflammatory rheumatoid diseases. Results in 119 consecutive patients of a rheumatism clinic]

METHOD

In 119 consecutive inpatients with rheumatic diseases--mainly rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis--both hips were routinely investigated by sonography.

RESULTS

In 52 of the 119 patients definite or possible pathological findings (in 18 cases bilateral) were observed. The relative frequency of sonographic findings in 223 evaluable hips was 33% and was somewhat higher in patients with rheumatoid arthritis than in those with other diagnoses. Changes were found significantly more often when the patient had joint complaints, limitation of movement, pathological X-ray changes or serological signs of inflammation (elevated ESR, positive C-reactive protein). The relative frequencies were higher than were expected on the basis of data in the literature. Of the pathological sonographic findings, 22% occurred in clinically and radiologically asymptomatic patients.

CONCLUSIONS

In view of the therapeutic consequences and the importance of early treatment, routine sonographic examination of the hip joint is recommended.

Cell cycle regulation of p70 S6 kinase and p42/p44 mitogen-activated protein kinases in Swiss mouse 3T3 fibroblasts

We show here using synchronized Swiss mouse 3T3 fibroblasts that p70 S6 kinase (p70S6k) and mitogen-activated protein kinases (p42mapk/p44mapk) are not only activated at the G0/G1 boundary, but also in cells progressing from M into G1. p70S6k activity increases 20-fold in G1 cells released from G0. Throughout G1, S, and G2 it decreases constantly, so that during M phase low kinase activity is measured. The kinase is reactivated 10-fold when cells released from a nocodazole-induced metaphase block enter G1 of the next cell cycle. p42mapk/p44mapk in G0 cells are activated transiently early in G1 and are reactivated late in mitosis after nocodazole release. p70S6k activity is dependent on permanent signaling from growth factors at all stages of the cell cycle. Immunofluorescence studies showed that p70S6k and its isoform p85S6k become concentrated in localized spots in the nucleus at certain stages in the cell cycle. Cell cycle-dependent changes in p70S6k activity are associated with alterations in the phosphorylation state of the protein. However, examination of the regulation of a p70S6k mutant in which the four carboxyl-terminal phosphorylation sites are changed to acidic amino acids suggests that a mechanism independent of these phosphorylation sites controls the activity of the enzyme during the cell cycle.

Scp160p, a new yeast protein associated with the nuclear membrane and the endoplasmic reticulum, is necessary for maintenance of exact ploidy

We have cloned a new gene, SCP160, from Saccharomyces cerevisiae, the deduced amino acid sequence of which does not exhibit overall similarity to any known yeast protein. A weak resemblance between the C-terminal part of the Scp160 protein and regulatory subunits of cAMP-dependent protein kinases from eukaryotes as well as the pstB protein of Escherichia coli was observed. The SCP160 gene resides on the left arm of chromosome X and codes for a polypeptide of molecular weight around 160 kDa. By immunofluorescence microscopy the Scp160 protein appears to be localized to the nuclear envelope and to the endoplasmic reticulum (ER). However, no signal sequence or membrane-spanning region exists, suggesting that the Scp160 protein is attached to the cytoplasmic surface of the ER-nuclear envelope membranes. Disruption of the SCP160 gene is not lethal but results in cells of decreased viability, abnormal morphology and increased DNA content. This phenotype is not reversible by transformation with a plasmid carrying the wild-type gene. Crosses of SCP160 deletion mutant strains among each other or with unrelated strains lead to irregular segregation of genetic markers. Taken together the data suggest that the Scp160 protein is required during cell division for faithful partitioning of the ER-nuclear envelope membranes which in S. cerevisiae enclose the duplicated chromosomes.

[Clinical relevance of the antiphospholipid syndrome. Antiphospholipid antibodies in a mixed rheumatologic patient sample]

The antiphospholipid syndrome may occur either in association with systemic lupus erythematosus (SLE) or as a primary condition. Diagnostic criteria include the detection of antiphospholipid antibodies using cardiolipin antigen (anticardiolipin antibodies, ACA) or lupus anticoagulant, and at least two clinical manifestations, primarily venous or arterial thrombosis, thrombocytopenia or repeated miscarriage. Among 200 patients with various rheumatic diseases, a pathological ACA test in excess of 44 U/ml was detected with ELISA in 81 cases (41%), and of these 30% had values exceeding 100 U/ml. Both overall positive reactions and the particularly high titers were clearly more common among patients with rheumatoid arthritis (RA) and collagen disease, namely 51% and 33%, respectively, than in patients with sero-negative spondylarthritis and non-inflammatory diseases of the locomotory system (22% pathological, 13% highly pathological, titers. Correlations were also found with miscarriage in women, positive rheumatoid and antinuclear factors, and the number of diagnostic criteria of RA or SLE presenting. A questionnaire survey - evaluating 84 subjects, half with positive and half with negative, ACA reactions - confirmed the correlation between miscarriage and the detection of ACA.

A new pair of B-type cyclins from Saccharomyces cerevisiae that function early in the cell cycle

Two new B-type cyclin genes from Saccharomyces cerevisiae, called CLB5 and CLB6, are located in a tail to tail arrangement adjacent to the G2/M phase promoting cyclins CLB2 and CLB1, respectively. These genomic cyclin arrays are flanked by tRNAs and repeated sequences of Ty elements suggesting an intrachromosomal gene duplication followed by an interchromosomal gene duplication. Based on their deduced protein sequence the CLB5 and CLB6 genes form a new pair of B-type cyclins. They are most related to each other and then to the deduced protein sequence of their adjacent genes CLB1 and CLB2. Both genes are periodically expressed, peaking early in the cell cycle. Loss of function mutants are viable, but clb5- mutants exhibit a delay in S phase whereas clb6- mutants show a delay in late G1 and/or S phase. The clb5 mutant phenotype is somewhat more pronounced in a double null mutant. Both cyclins have the potential to interact with the p34CDC28 kinase in vivo.

Histomorphometry of focal myocardial lesions by means of the automatic image analysis

There is an urgent necessity to objectify focal myocardial lesions (fml) before structural changes in muscle cells can be seen light microscopically. Therefore the succinodehydrogenase (SDH) reaction was chosen because it reliably demonstrates the decrease in aerobic capacity already in structurally unchanged cells and distinguishes the latter from the SDH-negative structures. A combined planimetric and densitometric procedure was developed to measure the area density of fml and their 2 constituents mentioned as well as to evaluate the SDH activity in fml and its decrease in muscle cells using the automatic image analysing system QUANTIMET. The verification tests show that both the area density and extinction can be reliably determined with acceptable measuring errors unless the area density is too low. The results of interobserver and repeatability tests are satisfying.

Structural wall tissue alterations of the microvasculature in the course of spontaneous hypertension of rats

The existence of structural reactions of the microvasculature of spontaneously hypertensive rats (SHR) and the underlying causal mechanisms are generally controversially discussed. Ninety-two male SHR aged 3-52 weeks and 118 normotensive age and sex matched controls were investigated. A new histomorphometric procedure was applied that ascertains structural changes in microvessels with diameters below 9 microns, between 9 microns and 19 microns and above 19 microns in anatomically defined sections of the skeletal muscle, heart and pancreas. Significant rises in the numerical and area densities of microvessel surfaces document a pathological increase in wall tissue of the microvasculature in all 3 organs and stages of spontaneous hypertension, with the exception of the coronary microvessels of 8-16 week old SHR where this progressive structural reaction was antagonized. How far the hypertrophy of the microvascular wall tissue is connected with an increase in wall thickness disproportional to the corresponding lumen wideness remained unknown. A positive correlation between the increase in blood pressure and wall tissue was only substantiated in the pancreas microvasculature. The generalized preferential occurrence of pathological reactions in vessels with diameters below 19 microns in the early established phase indicates that the microvascular control changes in this phase of spontaneous hypertension (SH).

Three ribonucleases H and a reverse transcriptase from the yeast, Saccharomyces cerevisiae

From the yeast, Saccharomyces cerevisiae, three proteins exhibiting ribonuclease H activity were isolated. These proteins differ in molecular weights and enzymatic properties. The two smaller ones, RNAase H(55) and RNAase H(42) are immunologically and structurally related to each other. Neither reacts with antibodies against the largest one, RNAase H(70). Highly purified preparations of RNAase H(70) contain two polypeptides (Mr 70,000 and 160,000) and display reverse transcriptase activity. Deletion of part of the gene for the 160 kDa polypeptide results in mutants possessing about twice the amount of DNA as do wild-type cells. DNA polymerase stimulating activity resides in the 70,000 polypeptide. The processivity of yeast DNA polymerase A(I) does not change in presence of that protein. Possible functions of RNAases H are discussed.

Isolation of a cDNA clone for human NAD+: protein ADP-ribosyltransferase

NAD+:Protein ADP-ribosyltransferase (EC 2.4.2.30) (ADPRT) was purified from human placenta by affinity chromatography. With the purified enzyme specific antibodies were raised and partial amino acid sequences were determined. To one of the amino acid sequences corresponding oligonucleotides were synthesized. A sized HeLa lambda gt11 cDNA library was constructed and screened. Positive clones were characterized to be ADPRT specific by immuno- and hybridization techniques. Clone ADPRT-G8 reacted with affinity chromatographically purified specific antibodies and with two specific oligonucleotides. The DNA of this clone detected an mRNA of about 4 kb, sufficient in size to code for the ADPRT with an Mr of 116,000. Partial sequence analysis of this clone confirmed its identity by revealing sequences which code for peptides which were found in cyanogen bromide (CNBr) fragments of the purified enzyme. The ADPRT-G8 clone was characterized with respect to its restriction pattern. The cloned ADPRT cDNA now opens the possibility to investigate the role of this enzyme in control of cellular functions.

Ribonuclease H(70) from Saccharomyces cerevisiae possesses cryptic reverse transcriptase activity

Yeast cells contain a protein of molecular size 70 kDa that possesses RNase H activity. A polyclonal antibody against it reacts in addition with proteins of molecular sizes 160 kDa from yeast extracts. All these immunologically related proteins exhibit reverse transcriptase activity and in this respect they resemble the products of retroviral pol genes, relatives of which reside in Ty elements and mitochondrial introns of yeast. Experimental evidence, however, indicates that the protein described here that combines RNase H and reverse transcriptase activity is not coded for by a known element of the retrotransposon family. It may originate from a cellular gene distantly related to retrotransposon sequences.

The glycoprotein nature of phospholipase A2, hyaluronidase and acid phosphatase from honey-bee venom

Experiments with immobilized concanavalin A strongly suggest a glycoprotein nature of three honey-bee venom enzymes, phospholipase A2, hyaluronidase and acid phosphatase. The electrophoretically and chromatographically detectable heterogeneity of phospholipase A2 results from absence of carbohydrate in a subfraction. Mannose, fucose and N-acetylglucosamine, but not galactose nor N-acetylgalactosamine, are present in the con A-binding fraction of bee venom. It is therefore concluded that only N-glycosidically linked carbohydrate occurs in bee venom glycoproteins.

[Morphologic reactions and long-term vasal tonus behavior of the coronary microvascular system in different states of spontaneous hypertension in the rat]

The morphological reactions and the long-term vasotonus behaviour of the coronary microvasculature including its smallest ramifications as well as the relationships existing between these reactions and the myocardial activity in the different stages of spontaneous hypertension of rats (SHR) are unknown. Therefore 80 1-12 month-old male SH- and 60 normotensive Wistar control rats were histomorphometrically investigated. Already in the prestage of hypertension (1 month) an increase of wall thickness and phosphatase activity in blood vessels alpha less than 10,5 microns occurred. These appearances of vasotonus increase were regressed in the acute phase (2nd-4th month). When the rise of myocardial activity is lowered in the stabile stage the mentioned signs of vasotonus increase returned (6th month) and showed a strong spreading in the late stage (12th month), which is characterized by enzyme histochemically detected disturbances of heart muscle metabolism. The behaviour of long-term vasotonus of the microvasculature and myocardial metabolism in 6 month-old and older rats provides a hypothesis concerning the cause of the unknown increase of coronary contraction in the stabile phase. It points to the existence of a vicious circle which perhaps plays a role in the genesis of heart insufficiency in hypertension.

[Use of automated image analysis for screening the efficiency of turimycin-producing Streptomyces strains]

The growth of the surface colonies on solid media is studied with the image analyzing system Quantimet 720 M controlled by a PDP 11 computer. For the bacterial strain Streptomyces hygroscopicus JA 6599 a new differential equation describing the kinetic behaviour of the area of the colony is suggested. It is shown that this time dependence of area describes more realistically the experiment than the function resulting from Pirt's model. Two new constants arise from the growing curve, alpha describes the profile of density of the colony and k0 is correlated to the growing constant of the colony. Both parameters can be correlated to the amount of antibiotics produced and, therefore, it is possible to use this information for the selection procedure of the colonies. A uniform criterion for selection was found for each colony of two mutants of the turimycin-producing strain Streptomyces hygroscopicus JA 6599, which reads: (Formula: see text). The quality of the selection criterion of surface colonies with higher productivity is dependent on the mean value of the growing parameters of all colonies under investigation. Limitations of the selection method arise from the need for great uniformity of environmental conditions, growth medium and a homogeneous spore suspension, which have to consist of a large amount of single spores in order to assure a reproducible growing curve of the colonies. For the last condition a special technique is pointed out.

[Spinal epidural lipoma as a cause of paraplegia]

Two cases (a 56-year-old woman and a 57-year-old man) with spinal epidural lipomas are described. In the discussion, the origin, the development and the biological valence of this spinal growth are dealt with. Besides, the age of the manifestation of the neurological symptoms, the localization, the clinical symptoms, diagnosis and differential diagnosis as well as therapy and prognosis of these tumours, which are rarely found in the spinal canal, are discussed. With the exclusion of the lipomatosis combined with lumbosacral malformations of the spinal column, the literature contains reports on about 66 cases of epidural and intradural spinal lipomas described until now.

[Determination of arterial wall thickness variations of vessels in the microcirculation by the ATPase-Quantimet method]

The use of the Quantimet for measurements of structural wall reactions of blood vessels (b.v.), visualized selectively by a modification of the ATPase reaction, requires that changes in wall thickness are not mimicked by differences in deposition of the reaction product, by changes of the b.v. lumen, and/or by b.v. elongations, especially meanderings occurring independently of thickenings of vessel walls and caused solely by increase of the intravascular pressure or by vasoconstriction. The article has substantiated the conclusion that these requirements are fulfilled.

[Functional behavior patterns of the pylorus in duodeno-gastric reflux]

There are relations between function of the pylorus and the appearance of duodeno-gastric reflux. However, much speaks for the fact that the pylorus alone is not able to prevent duodeno-gastric reflux. In the problem of the causes of reflux also the motoric behaviour of the upper duodenum must be taken into consideration.

[Post-cholecystectomy condition: duodeno-gastric reflux and bile acid concentration in the gastric juice]

In cholecystectomized patients highly significantly more frequently a duodenogastric reflux was found than in a group of patients with a healthy abdomen and a group of patients with cholelithiasis. The average concentration of bile acid in the gastric juice was after the removal of the gall-bladder manifoldly higher than in the control groups. The number of patients with concentrated reflux was also highly significantly larger than in patients with cholelithiasis not operated on and in patients with a healthy abdomen. Despite the high reflux rate and the high concentration of the bile acids influencing on the mucous membrane of the stomach the number of patients with ulcera ventriculi was not significantly larger than in a group of not cholecystectomized persons. These observations plead for the fact that the bile acids in the duodenogastric reflux alone are not to be regarded as an ulcerogenic agent, but that perhaps other components of the duodenal juice have to be considered as causes of lesions of the gastric mucous membrane.

Automated image analysis for measurements of morphological reactions of blood vessels of the microvascular system

Using a modification of the Mg-ATPase reaction, the arterial blood vessels of the microcirculatory bed of the rat including the smallest precapillary vessels are visualized in a grey-level difference against their environment which permits to utilize the automatic image analyser QUANTIMET 720 and the programmable desk-top calculator HEWLETT-PACKARD 9100B. The article describes the method for preparing the sections, the measuring procedure, and the statistical verification of the results by means of the computer assisted two-way analysis of variance as well as studies demonstrating the reliability of the method. It is concluded that the procedure at heart, skeletal muscle and pancreas specimens of the rat demonstrates reliably and effectively changes of the number of vessels and the projected whole vessel wall area as well as differences of enzyme activities. Thus it is possible to detect structural wall reactions and enzyme histochemical changes of arterial blood vessels of the microvasculatory bed including its smallest precapillaries which have been practically inaccessible to histomorphometrical investigations in the past.