Provider Perceptions of a Novel Inpatient Co-Rounding Model Integrating Medical Oncology, Neuro-Oncology, and Radiation Oncology for the Care of Patients with Advanced Cancer

PURPOSE/OBJECTIVE(S)

Patients (pts) with advanced cancer require interdisciplinary care. Although tumor boards are well-established in the outpatient setting, few studies have evaluated interventions for improving consultative care coordination for hospitalized pts with cancer. The purpose of this study was to evaluate a novel inpatient co-rounding model of care in which medical-, neuro-, and radiation-oncology consult teams rounded jointly, with the hypothesis that primary referring team perception of the alignment of the recommendations from these consult services would improve post-implementation.

MATERIALS/METHODS

An inpatient co-rounding model was implemented in September 2021 for hospitalized pts with solid malignancies at a tertiary medical center. Attending physicians, nurse practitioners, fellows, and residents from oncologic consulting services met virtually twice weekly to discuss pt care. Providers from the two most common primary services for pts with cancer at this hospital (hospital medicine and neurosurgery) were surveyed via institutional email listservs. The survey included Likert-type questions about the quality of inpatient consultation and the alignment of recommendations across three consulting oncological specialty services. The pre-intervention survey was distributed prior to model implementation, and the post-intervention survey was distributed 9 months later. Wilcoxon rank-sum tests were used to compare responses from the pre-and post-intervention surveys.

RESULTS

At each session, a median of 6 providers attended (range, 4-8 providers), and a median of 6 pts were discussed (range, 4-8 pts). Among 331 providers surveyed, 119 completed the pre-intervention survey (36% response rate), and 34 completed the post-intervention survey (10% response rate). Respondents were 81 (53%) internal medicine attending physicians/hospitalists, 55 (36%) internal medicine resident physicians, 6 (4%) neurosurgery advanced practice providers, 6 (4%) neurosurgery attending physicians, and 5 (3%) neurosurgery resident physicians. When asked to rate agreement with the statement that consultant recommendations from medical-, neuro-, and radiation-oncology were aligned, respondents were significantly more likely to perceive alignment 9 months post-implementation (67% strongly agree) compared to pre-implementation (23% strongly agree, p = 0.0001). There was high satisfaction with the quality of medical-, neuro-, and radiation-oncology consultations at both time points, with no statistical difference pre- vs. post-implementation of the co-rounding model.

CONCLUSION

A novel inpatient co-rounding model of care was successfully launched between medical-, neuro-, and radiation-oncology. Primary teams perceived greater alignment in recommendations between these consulting services after project implementation. Future directions include evaluating the impact of this co-rounding model on patient outcomes.

Topographic connectivity and cellular profiling reveal detailed input pathways and functionally distinct cell types in the subthalamic nucleus

The subthalamic nucleus (STN) controls psychomotor activity and is an efficient therapeutic deep brain stimulation target in individuals with Parkinson's disease. Despite evidence indicating position-dependent therapeutic effects and distinct functions within the STN, the input circuit and cellular profile in the STN remain largely unclear. Using neuroanatomical techniques, we construct a comprehensive connectivity map of the indirect and hyperdirect pathways in the mouse STN. Our circuit- and cellular-level connectivities reveal a topographically graded organization with three types of indirect and hyperdirect pathways (external globus pallidus only, STN only, and collateral). We confirm consistent pathways into the human STN by 7 T MRI-based tractography. We identify two functional types of topographically distinct glutamatergic STN neurons (parvalbumin [PV+/-]) with synaptic connectivity from indirect and hyperdirect pathways. Glutamatergic PV+ STN neurons contribute to burst firing. These data suggest a complex interplay of information integration within the basal ganglia underlying coordinated movement control and therapeutic effects.

In vivo 3D Reconstruction of the Human Pallidothalamic and Nigrothalamic Pathways With Super-Resolution 7T MR Track Density Imaging and Fiber Tractography

The output network of the basal ganglia plays an important role in motor, associative, and limbic processing and is generally characterized by the pallidothalamic and nigrothalamic pathways. However, these connections in the human brain remain difficult to elucidate because of the resolution limit of current neuroimaging techniques. The present study aimed to investigate the mesoscopic nature of these connections between the thalamus, substantia nigra pars reticulata, and globus pallidus internal segment using 7 Tesla (7T) magnetic resonance imaging (MRI). In this study, track-density imaging (TDI) of the whole human brain was employed to overcome the limitations of observing the pallidothalamic and nigrothalamic tracts. Owing to the super-resolution of the TD images, the substructures of the SN, as well as the associated tracts, were identified. This study demonstrates that 7T MRI and MR tractography can be used to visualize anatomical details, as well as 3D reconstruction, of the output projections of the basal ganglia.

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

Air-stable and ultrasensitive solution-cast SWIR photodetectors utilizing modified core/shell colloidal quantum dots

InGaAs-based photodetectors have been generally used for detection in the short-wave infrared (SWIR) region. However, the epitaxial process used to grow these materials is expensive; therefore, InGaAs-based photodetectors are limited to space exploration and military applications. Many researchers have expended considerable efforts to address the problem of SWIR photodetector development using lead sulfide (PbS) quantum dots (QDs). Along with their cost-efficient solution processability and flexible substrate compatibility, PbS QDs are highly interesting for the quantum-size-effect tunability of their bandgaps, spectral sensitivities, and wide absorption ranges. However, the performance of PbS QD-based SWIR photodetectors is limited owing to inefficient carrier transfer and low photo and thermal stabilities. In this study, a simple method is proposed to overcome these problems by incorporating CdS in PbS QD shells to provide efficient carrier transfer and enhance the long-term stability of SWIR photodetectors against oxidation. The SWIR photodetectors fabricated using thick-shell PbS/CdS QDs exhibited a high on/off (light/dark) ratio of 11.25 and a high detectivity of 4.0 × 10¹² Jones, which represents a greater than 10 times improvement in these properties relative to those of PbS QDs. Moreover, the lifetimes of thick-shell PbS/CdS QD-based SWIR photodetectors were significantly improved owing to the self-passivation of QD surfaces.

Development of Positron Emission Tomography With Wobbling and Zooming for High Sensitivity and High-Resolution Molecular Imaging

Demands for in-vivo human molecular imaging with high resolution and high sensitivity in positron emission tomography (PET) require several new design formulae. A classical problem of the PET design, however, was the trade-off between sensitivity and resolution. To satisfy both requirements, the brain-body convertible PET with wobbling and zooming is proposed. The features of this new proposed system are wobble sampling for high-resolution imaging and zooming mode for high sensitivity, especially for the brain dedicated imaging. For the high resolution, wobbling with a linear interpolation and line spread function (LSF) deconvolution reconstruction algorithm was introduced. The result of the proposed system provided resolution up to 1.56 mm full width at half maximum (FWHM) in the brain mode and resulting in the detector-to-resolution ratio (DRR) was 2.47. For both brain phantom and in-vivo rat brain imaging, the proposed system demonstrated superior image quality compared with the commercial PET systems. The newly designed PET with wobbling and zooming also demonstrated the possibility of developing practically usable high-resolution human brain PET-MRI fusion system, especially for the neuroscience research.

Al atomistic surface modulation on colloidal gradient quantum dots for high-brightness and stable light-emitting devices

Quantum-dot (QD) light-emitting devices (QLEDs) have been attracting considerable attention owing to the unique properties of process, which can control the emission wavelength by controlling the particle size, narrow emission bandwidth, and high brightness. Although there have been rapid advances in terms of luminance and efficiency improvements, the long-term device stability is limited by the low chemical stability and photostability of the QDs against moisture and air. In this study, we report a simple method, which can for enhance the long-term stability of QLEDs against oxidation by inserting Al into the shells of CdSe/ZnS QDs. The Al coated on the ZnS shell of QDs act as a protective layer with Al₂O₃ owing to photo-oxidation, which can prevents the photodegradation of QD with prolonged irradiation and stabilize the device during a long-term operation. The QLEDs fabricated using CdSe/ZnS/Al QDs exhibited a maximum luminance of 57,580 cd/m² and current efficiency of 5.8 cd/A, which are significantly more than 1.6 times greater than that of CdSe/ZnS QDs. Moreover, the lifetimes of the CdSe/ZnS/Al-QD-based QLEDs were significantly improved owing to the self-passivation at the QD surfaces.

Characterization of Tetrodes Coated with Au Nanoparticles (AuNPs) and PEDOT and Their Application to Thalamic Neural Signal Detection in vivo

Tetrodes, consisting of four twisted micro-wires can simultaneously record the number of neurons in the brain. To improve the quality of neuronal activity detection, the tetrode tips should be modified to increase the surface area and lower the impedance properties. In this study, tetrode tips were modified by the electrodeposition of Au nanoparticles (AuNPs) and dextran (Dex) doped poly (3,4-ethylenedioxythiophene) (PEDOT). The electrochemical properties were measured using electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). A decrease in the impedance value from 4.3 MΩ to 13 kΩ at 1 kHz was achieved by the modified tetrodes. The cathodic charge storage capacity (CSC_C) of AuNPs-PEDOT deposited tetrodes was 4.5 mC/cm², as determined by CV measurements. The tetrodes that were electroplated with AuNPs and PEDOT exhibited an increased surface area, which reduced the tetrode impedance. In vivo recording in the ventral posterior medial (VPM) nucleus of the thalamus was performed to investigate the single-unit activity in normal rats. To evaluate the recording performance of modified tetrodes, spontaneous spike signals were recorded. The values of the L-ratio, isolation distance and signal-to-noise (SNR) confirmed that electroplating the tetrode surface with AuNPs and PEDOT improved the recording performance, and these parameters could be used to effectively quantify the spikes of each cluster.

Larval species composition and genetic structures of Carposina sasakii, Grapholita dimorpha, and Grapholita molesta from Korea

Rapid determination of the larval species composition and understanding of their genetic structure is important to establish the appropriate management system for multiple species infesting in fruits. We established accurate and rapid diagnostic methods based on multiplex polymerase chain reaction (PCR) diagnostic techniques to discriminate the three major lepidopteran species in orchard, Carposina sasakii, Grapholita dimorpha, and Grapholita molesta. Each species was identified by amplifying species-specific PCR products (375 bp for C. sasakii, 125 and 234 bp for G. dimorpha, and 125 bp for G. molesta). Based on species composition analysis from six types of infested fruits, G. dimorpha constituted the highest proportion (47.8%), followed by 35.2 and 13.5% for G. molesta and C. sasakii, respectively. Interestingly, high prevalence was found in G. dimorpha and G. molesta for plum and peach, respectively. Based on genetic diversity analysis, the three insect species exhibited moderate or high haplotype diversity and low nucleotide diversity, ranging from 0.319 to 0.699 and 0.0006 to 0.0045, respectively. Demographic expansion was not detected according to either a neutrality test or mismatch distribution analysis. Moreover, no significant genetic structure corresponding to province, host plant, fruit type, or collection period was observed. These results suggest that the population of each species would have high dispersal ability following fruit-generating periods via intrinsic host adaptation ability regardless of the spatial and temporal conditions. Determination of larval composition on fruit is valuable for establishing appropriate management systems that take the species into consideration; additionally, population genetic approaches can be utilized to understand the effects of environmental factors (province, host fruit, fruit type, etc.) on population structures.

Easy-to-Fabricate and High-Sensitivity LSPR Type Specific Protein Detection Sensor Using AAO Nano-Pore Size Control

In this study, we developed a pore size/pore area-controlled optical biosensor-based anodic aluminum oxide (AAO) nanostructure. As the pore size of AAO increases, the unit cell of AAO increases, which also increases the non-pore area to which the antibody binds. The increase in the number of antibodies immobilized on the surface of the AAO enables effective detection of trace amounts of antigen, because increased antigen-antibody bonding results in a larger surface refractive index change. High sensitivity was thus achieved through amplification of the interference wave of two vertically-incident reflected waves through the localized surface plasmon resonance phenomenon. The sensitivity of the fabricated sensor was evaluated by measuring the change in wavelength with the change in the refractive index of the device surface, and sensitivity was increased with increasing pore-size and non-pore area. The sensitivity of the fabricated sensor was improved and up to 11.8 ag/mL serum amyloid A1 antigen was detected. In addition, the selectivity of the fabricated sensor was confirmed through a reaction with a heterogeneous substance, C-reactive protein antigen. By using hard anodization during fabrication of the AAO, the fabrication time of the device was reduced and the AAO chip was fabricated quickly and easily.

Low Dark-Current, High Current-Gain of PVK/ZnO Nanoparticles Composite-Based UV Photodetector by PN-Heterojunction Control

We propose a solution-processable ultraviolet (UV) photodetector with a pn-heterojunction hybrid photoactive layer (HPL) that is composed of poly-n-vinylcarbazole (PVK) as a p-type polymer and ZnO nanoparticles (NPs) as an n-type metal oxide. To observe the effective photo-inducing ability of the UV photodetector, we analyzed the optical and electrical properties of HPL which is controlled by the doping concentration of n-type ZnO NPs in PVK matrix. Additionally, we confirmed that the optical properties of HPL dominantly depend on the ZnO NPs from the UV-vis absorption and the photoluminescence (PL) spectral measurements. This HPL can induce efficient charge transfer in the localized narrow pn-heterojunction domain and increases the photocurrent gain. It is essential that proper doping concentration of n-type ZnO NPs in polymer matrix is obtained to improve the performance of the UV photodetector. When the ZnO NPs are doped with the optimized concentration of 3.4 wt.%, the electrical properties of the photocurrent are significantly increased. The ratio of the photocurrent was approximately 10³ higher than that of the dark current.

Au-Polypyrrole Framework Nanostructures for Improved Localized Surface Plasmon Resonance Volatile Organic Compounds Gas Sensing

In this paper, we propose an Au-polypyrrole (Ppy) nanorod gas sensor for the detection of volatile organic compound (VOC) gases. This gas sensor operates on the principle of localized surface plasmon resonance (LSPR). The Au-Ppy nanorods used in this experiment were synthesized using an anodic aluminum oxide template by the electrochemical deposition method. Using field emission scanning electron microscopy, we confirmed that the Au-Ppy nanorod arrays were successfully fabricated with a uniform size. By depositing gold, the Au-Ppy nanorods exhibited both optical and LSPR interference. The gas sensing properties of the fabricated nanorods were tested for VOCs such as acetic acid, benzene, and toluene with a short response time (~1 min). Moreover, the proposed VOC gas sensing system was tested with three types of VOC gases over a wide concentration range from 10 to 100 ppm. Highest sensitivity was observed for acetic acid gas, which had a linear relation with the gas concentration, indicating that the system can be used as a gas sensor.

Enhanced Performance of Light-Emitting Diodes by Surface Ligand Modification on Quantum Dots

The electrical characteristics of quantum dots (QDs) can vary depending on the surface modulation, which can change the luminance and efficiency of electroluminescent devices. Thus, understanding surface ligand is essential in improving the performance of QDs-based light-emitting diodes (LEDs). We analyzed the performance of QDs-based LEDs with respect to the QD surface volume. On the QD surfaces, the 1.1 nm-long tryoctylphosphine oxide (TOPO) ligand with three neck-type structure was replaced with a 1.7 nm-long oleic acid (OA) ligand with a one neck-type structure to evaluate the dependence of the LED properties on the ligand length. With all other conditions being identical, the luminance and efficiency of the QDs-based LEDs with an OA ligand were approximately 1,000 cd/m2 greater and 1.5 times higher, respectively, than those of the QDs-based LEDs with a TOPO ligand. These results show that if the physical length of the surface ligand is relatively long, decreasing the surface area would result in increased injection of electrons and holes into the QDs, increasing the luminance and efficiency.

Solution Processable CdSe/ZnS Quantum Dots Light-Emitting Diodes Using ZnO Nanocrystal as Electron Transport Layer

In this paper, we propose interface engineering between cadmium selenide/zinc sulfide (CdSe/ZnS) quantum dots (QDs) as the emissive layer (EML) and ZnO nanocrystals (NCs) as the electron transport layer (ETL) for reducing the potential barrier in QDs based light-emitting diode (QLED). The n-type ZnO NCs were effective in confining charge to the QDs EML because of their wide band gap. The ZnO NCs were synthesized using a modified sol-gel process and were applied as the ETL in QLED. For comparison, a standard QLED with Tris(8-hydroxyquinolinato)aluminium as the ETL was also fabricated. The standard QLED was shown to have a luminance of 11,240 cd/m2 and current efficiency of 2.3 cd/A. However, QLED with ZnO NCs showed a higher luminance of 28,760 cd/m2 and current efficiency of 4.9 cd/A than the reference structure, and so has more efficient charge transport. Thus, QLED with ZnO NCs not only simplified the process, but also enhanced the luminance and current efficiency by factor of two.

Abstract P1-05-20: Fluorescent Hyaluronan Probes Distinguish Heterogeneous Breast Cancer Cell Subsets and Predict their Invasive Behavior

Background: Tumor heterogeneity is a determining factor in diagnosis and therapy of breast cancer (Bca). We investigated Bca cellular heterogeneity by a functional fluorescent hyaluronan (HA) probe, and monitored its binding characteristics in relation to the degree of Bca aggression. HA is a polysaccharide ligand for CD44 and RHAMM receptors, which are linked to cell plasticity and predict poor clinical outcome in Bca.

Methods: Fluorescent HA probes, multiplexed profiling, and cell sorting strategies were developed and used to detect/capture tumor cell subpopulations with differences in HA binding (HA−/low vs. HAhigh) and HA receptors surface display. Whereas we concentrated on the most metastatic cell line, MDA-MB-231, we also monitored the presence of subpopulations in other Bca lines and showed heterogeneity in all.

Results: The HA probe binding was highly heterogeneous, and the highest binding level was detected in highly invasive triple-negative basal subtypes such as MDA-MB-231. HA probes bound to the cell surface but also accumulated in cytoplasm and nucleus. Binding levels were dramatically reduced upon ‘reversion’ of highly malignant cells to a non-malignant phenotype in three-dimensional cultures, suggesting that the level of cellular binding to fluorescent HA probe provides a measure of malignant behavior. Comparison between HAhigh and HA−/low subpopulations revealed surprising differences in morphology, proliferation and invasion in culture, which were retained in two in vivo models. HAhigh subpopulations exhibited higher levels of invasion but surprisingly lower levels of proliferation compared to either unsorted parental cells or the HA−/low subpopulation.

Conclusions: Querying HA binding in Bca lines reveals an unexpected heterogeneity with respect to tumor phenotype in vivo, morphology in 3D, invasion and proliferation. These results may aid in diagnosis and therapy of invasive Bca subpopulations and early sorting of cancer patients needing intensive chemotherapy.

Keywords: Heterogeneity, 3D cultures, Hyaluronan, CD44, RHAMM/HMMR, Tumor phenotype, Breast cancer, Invasion.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-05-20.

Seven-Tesla magnetic resonance images of the substantia nigra in Parkinson disease

OBJECTIVE

To investigate anatomical changes in the substantia nigra (SN) of Parkinson disease (PD) patients with age-matched controls by using ultra-high field magnetic resonance imaging (MRI).

METHODS

We performed 7T MRI in 10 PD and 10 age-matched control subjects. Magnetic resonance images of the SN were obtained from a 3-dimensional (3D) T(2)*-weighted gradient echo sequence. Region of interest-based 3D shape analysis was performed to quantitatively compare images from the 2 groups.

RESULTS

The boundary between the SN and crus cerebri was not smooth in PD subjects. Undulation in the lateral surface of the SN appeared more intense in the side contralateral to that with the more severe symptoms, and more prominent at the rostral level of the SN than at the intermediate or caudal levels. In addition to the lateral surface, there was a striking difference in the dorsomedial aspects of the SN between PD and control subjects. In control subjects, a brighter signal region was observed along the dorsomedial surface of the lateral portion of SN, whereas in PD subjects, this region was observed as a dark region containing a hypointense signal in T(2)*-weighted images. The measurement of SN volumes, normalized to the intracranial volumes, showed higher values in PD subjects than in control subjects.

INTERPRETATION

This study demonstrates that 3D 7T MRI can definitively visualize anatomical alterations occurring in the SN of PD subjects. Further pathological studies are required to elucidate the nature of these anatomical alterations.

Identification and characterization of three cholinesterases from the common bed bug, Cimex lectularius

We identified and characterized the full-length cDNA sequences encoding two acetylcholinesterases (ClAChE1 and ClAChE2) and a salivary gland-specific cholinesterase-like protein (ClSChE) from the common bed bug, Cimex lectularius. All three cholinesterase genes (Clac1, Clace2 and Clsce) have conserved motifs, including a catalytic triad, a choline-binding site and an acyl pocket. Phylogenetic analysis showed that ClAChE1 belongs to the insect AChE1 clade, whereas ClAChE2 belongs to the insect AChE2 clade. ClSChE was grouped into the clade containing all AChE1s, suggesting a paralogous relationship to ClAChE1. Transcription levels of Clace1 were higher than those of Clace2 in all tissues examined, including the central nervous system (CNS). In contrast, the Clsce transcript was not detected in the CNS but specifically found in the salivary gland at much higher levels (>3000-fold) than those of Clace1 and Clace2. Western blot analysis using anti-ClAChE antibodies, in conjunction with activity staining, revealed that ClAChE1 is more active than ClAChE2, whereas ClSChE has little enzyme activity. Three-dimensional structure modelling suggested that ClAChEs and ClSChE shared structural similarities, but had some differences in the residues forming the acyl pocket and oxyanion hole. The current findings should provide valuable insights into the evolution and functional diversification of insect cholinesterase.

Highly sensitive nano-porous lattice biosensor based on localized surface plasmon resonance and interference

We propose a design for a highly sensitive biosensor based on nanostructured anodized aluminum oxide (AAO) substrates. A gold-deposited AAO substrate exhibits both optical interference and localized surface plasmon resonance (LSPR). In our sensor, application of these disparate optical properties overcomes problems of limited sensitivity, selectivity, and dynamic range seen in similar biosensors. We fabricated uniform periodic nanopore lattice AAO templates by two-step anodizing and assessed their suitability for application in biosensors by characterizing the change in optical response on addition of biomolecules to the AAO template. To determine the suitability of such structures for biosensing applications, we immobilized a layer of C-reactive protein (CRP) antibody on a gold coating atop an AAO template. We then applied a CRP antigen (Ag) atop the immobilized antibody (Ab) layer. The shift in reflectance is interpreted as being caused by the change in refractive index with membrane thickness. Our results confirm that our proposed AAO-based biosensor is highly selective toward detection of CRP antigen, and can measure a change in CRP antigen concentration of 1 fg/ml. This method can provide a simple, fast, and sensitive analysis for protein detection in real-time.

MOSFET-BJT hybrid mode of the gated lateral bipolar junction transistor for C-reactive protein detection

In this study, we propose a novel biosensor based on a gated lateral bipolar junction transistor (BJT) for biomaterial detection. The gated lateral BJT can function as both a BJT and a metal-oxide-semiconductor field-effect transistor (MOSFET) with both the emitter and source, and the collector and drain, coupled. C-reactive protein (CRP), which is an important disease marker in clinical examinations, can be detected using the proposed device. In the MOSFET-BJT hybrid mode, the sensitivity, selectivity, and reproducibility of the gated lateral BJT for biosensors were evaluated in this study. According to the results, in the MOSFET-BJT hybrid mode, the gated lateral BJT shows good selectivity and reproducibility. Changes in the emitter (source) current of the device for CRP antigen detection were approximately 0.65, 0.72, and 0.80 μA/decade at base currents of -50, -30, and -10 μA, respectively. The proposed device has significant application in the detection of certain biomaterials that require a dilution process using a common biosensor, such as a MOSFET-based biosensor.

Direct visualization of Parkinson's disease by in vivo human brain imaging using 7.0T magnetic resonance imaging

Parkinson's disease (PD) is a neurodegenerative disorder resulting from progressive loss of dopaminergic neurons in the substantia nigra (SN) pars compacta. Therefore, imaging of the SN has been regarded to hold greatest potential for use in the diagnosis of PD. At the 7.0T magnetic resonance imaging (MRI), it is now possible to delineate clearly the shapes and boundaries of the SN. We scanned eight early and two advanced PD patients, along with nine age-matched control subjects, using a 7.0T MRI in an attempt to directly visualize the SN and quantify the differences in shape and boundaries of SN between PD subjects in comparison with the normal control subjects. In the normal controls, the boundaries between the SN and crus cerebri appear smooth, and clean "arch" shapes that stretch ventrally from posterior to anterior. In contrast, these smooth and clean arch-like boundaries were lost in PD subjects. The measured correlation analyses show that, in PD patients, there is age-dependent correlation and substantially stronger UPDRS motor score-dependent correlation. These results suggest that, by using 7.0T MRI, it appears possible to use these visible and distinctive changes in morphology as a diagnostic marker of PD.

Highly efficient hybrid light-emitting device using complex of CdSe/ZnS quantum dots embedded in co-polymer as an active layer

We propose a highly efficient hybrid light-emitting device (LED) with a single active layer where CdSe/ZnS quantum dots (QDs) are dispersed as a guest material in a conjugated polymer (co-polymer) matrix used for a host material. In our structure, the QDs act on light-emitting chromophores by trapping the migrating excitons in the co-polymer matrix via Förster energy transfer, and improve the charge balance within the co-polymer by trapping the injected electron carriers. Experimental results show that the electroluminescent properties highly depend on the doping density of the QDs within the co-polymer matrix, where the luminance as well as the external current efficiency are initially enhanced with increasing the concentration of the dispersed QDs in the co-polymer solution, and then such properties are degraded due to aggregation of the QDs. We can get the maximum brightness of 9,088 cd/m(2) and the maximum external current efficiency of 7.5 cd/A in mixing ratio of the QDs by 1.0 wt%. The external current efficiency is enhanced by over 15 times and the turn-on voltage is reduced in comparison with the corresponding values for a reference device that uses only a co-polymer as an active layer.

A point mutation in a glutamate-gated chloride channel confers abamectin resistance in the two-spotted spider mite, Tetranychus urticae Koch

The molecular mechanisms and genetics of abamectin resistance mediated by target site insensitivity in the two-spotted spider mite, Tetranychus urticae, were investigated by comparing two isogenic abamectin-susceptible (AbaS) and abamectin-resistant (AbaR) strains. Cloning and sequencing of full-length cDNA fragments of gamma-amino butyric acid (GABA)-gated chloride channel genes revealed no polymorphisms between the two strains. However, sequence comparison of the full-length cDNA fragment of a T. urticae glutamate-gated chloride channel gene (TuGluCl) identified a G323D point mutation as being tentatively related with abamectin resistance. In individual F(2) progenies obtained by backcrossing, the G323D genotype was confirmed to correlate with abamectin resistance. Bioassays using progeny from reciprocal crossings revealed that the abamectin resistance trait resulting from TuGluCl insensitivity is incompletely recessive.

Extensive gene duplication of acetylcholinesterase associated with organophosphate resistance in the two-spotted spider mite

Monocrotophos-resistant two-spotted spider mites (TSSMs), Tetranychus urticae, are known to possess three mutations on the acetylcholinesterase (AChE) gene (Tuace) that are involved in target site insensitivity. Cross-strain comparison of three strains (highly resistant AD, moderately resistant PyriF and susceptible UD strains) revealed that resistant strains have relatively more Tuace copies than the UD strain and that the levels of transcript were directly proportional to copy numbers. AChEs from the AD and PyriF strains had similar V(max) values to those of AChE from the UD strain but increased K(m) and reduced k(cat) constants, suggesting that the mutated, resistant form of AChE may carry a fitness cost. Relative copy numbers of Tuace in field populations varied from 2.4 to 6.1, correlating well with their levels of resistance (r(2)= 0.895). These results are suggestive of the involvement of Tuace gene duplication in resistance. Thus, monocrotophos resistance in TSSMs appears to have evolved through a combination of mutation accumulation and extensive gene duplication.

Inhibitory effects of orobol 7-O-D-glucoside from banaba (Lagerstroemia speciosa L.) on human rhinoviruses replication

AIMS

The anti-human rhinovirus (HRV) activity of orobol 7-O-d-glucoside (O7G) from Lagerstroemia speciosa L. (Lythraceae) was evaluated in Hela cells.

METHODS AND RESULTS

We tested anti-HRV activity of O7G using a cytopathic effect (CPE) reduction method, which exhibited broad-spectrum anti-HRVs activity with a 50% inhibitory concentration (IC(50)) ranging from 0.58 to 8.80 microg ml(-1). The 50% cytotoxicity concentration (CC(50)) of O7G is more than 100 microg ml(-1), and the derived therapeutic indices are more than 12. Ribavirin didn't possess antiviral activity against HRV15, HRV3 and HRV5, but exhibited weak antiviral activity against HRV2 and HRV3, and showed strong anti-HRV6 and -14 activities.

CONCLUSIONS

These results suggest that O7G is a novel drug class with broad spectrum antiviral activity against HRV species A (HRV1B, HRV2, HRV15 and HRV40) and species B (HRV3, HRV6 and HRV14), as well as pleconaril-resistant virus (HRV5).

SIGNIFICANCE AND IMPACT OF THE STUDY

Therefore, these findings provide important information for the utilization of Q7G promising broad spectrum for human rhinovirus treatment.

Steep left ventricle to aortic root angle and hypertrophic obstructive cardiomyopathy: study of a novel association using three-dimensional multimodality imaging

BACKGROUND

Patients with hypertrophic cardiomyopathy (HCM) exhibit a difference in left ventricular outflow tract (LVOT) obstruction, independently of basal septal thickness (BST). Some patients with HCM have a steeper left ventricle to aortic root angle than controls.

OBJECTIVE

To test the predictors of the LV-aortic root angle and the association between LV-aortic root angle and LVOT obstruction using three-dimensional imaging.

PATIENTS

153 consecutive patients with HCM (mean (SD) age 46 (14) years, 68% men) and 62 patients with hypertensive heart disease of the elderly (all >65 years of age, 73 (6) years, 34% men) who underwent whole-heart three-dimensional cardiac magnetic resonance (CMR) angiography (1.5 T) and Doppler echocardiography. Forty-two controls (age 43 (11) years, 38% men) who underwent contrast-enhanced multidetector computed tomography and were free of cardiovascular pathology were also studied.

MAIN OUTCOMES

LV-aortic root angle, BST and maximal non-exercise LVOT gradient were measured in patients with HCM and in hypertensive-elderly patients. Additionally, LV-aortic root angle and BST were measured in controls.

RESULTS

The mean (SD) LV-aortic root angle was significantly different (p<0.001) in the three groups: HCM (134 (10) degrees ), hypertensive-elderly (128 (10) degrees ), control (140 (7) degrees ). There was an inverse correlation between age and LV-aortic root angle in the three groups (all p<0.001): HCM (r = -0.56), hypertensive-elderly (r = -0.35), control (r = -0.48). On univariate analysis, in the HCM group, LV-aortic root angle (beta = -0.34, p<0.001), age (beta = 0.23, p = 0.01) and end-systolic volume index (beta = -0.20, p = 0.02), but not BST (beta = 0.02, p = 0.8), were associated with LVOT gradient. On multivariate analysis, only LV-aortic root angle was associated with LVOT gradient.

CONCLUSIONS

Patients with HCM have a steeper LV-aortic root angle than controls. In patients with HCM, a steeper LV-aortic root angle predicts dynamic LVOT obstruction, independently of BST.

Endovascular strategies for vertebrobasilar dissecting aneurysms

BACKGROUND AND PURPOSE

Dissecting vertebrobasilar aneurysms are challenging to treat, and standard treatment modalities remain controversial. We retrospectively evaluated our experience using endovascular techniques to treat these aneurysms.

MATERIALS AND METHODS

From February 1997 to December 2007, 42 patients with intradural vertebrobasilar dissecting aneurysms underwent endovascular treatment. Twenty-nine patients had ruptured aneurysms, and 13 patients had unruptured dissecting aneurysms. The endovascular modalities for vertebrobasilar dissecting aneurysms were the following: 1) trapping (n = 30), 2) proximal occlusion (n = 3), 3) stent with coil (n = 6), and 4) stent alone (n = 3).

RESULTS

Seventeen of the 29 patients with ruptured vertebrobasilar dissecting aneurysms had successful outcomes without procedural complications following endovascular treatment. Procedure-related complications were the following: 1) rebleeding (n = 3), 2) posterior inferior cerebellar artery (PICA) territory infarction (n = 6), 3) brain stem infarction (n = 2), and 4) thromboembolism-related multiple infarctions (n = 1). Clinical outcomes were favorable in 32 patients (76.1%). There were 3 (7.1%) procedure-related mortalities due to rebleeding, and 1 (2.4%) non-procedure-related mortality due to pneumonia sepsis. All 13 patients with unruptured vertebrobasilar dissecting aneurysms had favorable clinical and radiologic outcomes without procedure-related complications.

CONCLUSIONS

Endovascular procedures for treatment of unruptured symptomatic dissecting aneurysms resulted in favorable outcomes. Ruptured vertebrobasilar dissecting aneurysms are associated with a high risk of periprocedural complications. Risks can be managed by using appropriate endovascular techniques according to aneurysm location, configuration, and relationship with the PICA.

Antiviral activity of raoulic acid from Raoulia australis against Picornaviruses

RNA viruses are a major source of respiratory diseases worldwide. The lack of effective therapeutical treatment underlines the importance of research for new antiviral compounds. Raoulic acid is a principal ingredient of the plant Raoulia australis Hook. F. Antiviral assay using cytopathic effect (CPE) reduction method showed that raoulic acid possessed strong antiviral activity against human rhinovirus 2 (HRV2) with a 50% inhibition concentration (IC(50)) value of less than 0.1mug/ml, human rhinovirus 3 (HRV3) with a IC(50) value of 0.19 microg/ml, coxsackie B3 (CB3) virus with IC(50) values of 0.33 microg/ml, coxsackie B4 (CB4) virus with IC(50) values of 0.40 microg/ml, and enterovirus 71 (EV71) virus with IC(50) values of less than 0.1 microg/ml. However, the compound did not possess antiviral activity against influenza A (Flu A/PR, Flu A/WS, H1N1) and B viruses at four concentrations ranging from 0.1 to 100 microg/ml.

Development of a simple and rapid immunochromatographic strip test for diarrhea-causative porcine rotavirus in swine stool

A rapid and simple immunochromatography (IC) strip test, for specific detection of porcine rotavirus (PRV) in stool specimen, was developed. Monoclonal antibodies (mAbs) to the OSU strain of PRV have been produced in mice. Among them, two hybridoma clones that generate mAb-1 and mAb-2, respectively, specific for VP6 protein of PRV, have been selected. In the IC configuration, mAb-1, one of the selected mAbs was used to the designed coat microparticles (MP), while another mAb-2 was used to fix it on the nitrocellulose membrane strip to form a result line. The control line was formed on the same membrane strip past the result line by fixing anti-mouse IgG antibody. The IC test was capable of detecting 1000 plaque-forming units of PRV/ml in less than 5min, and the binding capacity was demonstrated by specific recognition of PRV only, but not other porcine diarrhea viruses, transmissible gastroenteritis virus (TGEV) and porcine epidemic diarrhea virus (PEDV). The IC test produced positive results with all the nine PRV-positive stool specimens and negative results with five different non-PRV specimens, which were identified previously by the polymerase chain reaction (PCR) test, respectively. The results indicate an excellent concordance between the two methods, suggesting a potential application of the three combinated IC tests (PRV, TGEV and PEDV) for the on-site, rapid screening of porcine diarrhea cases.

Abnormal papillary muscle morphology is independently associated with increased left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

BACKGROUND

Abnormal papillary muscles (PM) are often found in hypertrophic cardiomyopathy (HCM).

OBJECTIVE

To assess the relationship between morphological alterations of PM in patients with HCM and left ventricular outflow tract (LVOT) obstruction, using magnetic resonance imaging (MRI) and echocardiography.

METHODS

Fifty-six patients with HCM (mean age 42 years (interquartile range 27, 51), 70% male) and 30 controls (mean age (42 (30, 53) years, 80% male) underwent MRI on a 1.5 T scanner (Siemens, Erlangen, Germany). Standard cine images were obtained in short-axis (base to apex), along with two-, three- and four-chamber views. The presence of bifid PM (none, one or both) and anteroapical displacement of anterolateral PM was recorded by MRI and correlated with resting LVOT gradients obtained by echocardiography.

RESULTS

Double bifid PM (70% vs 17%) and anteroapical displacement of anterolateral PM (77% vs 17%) were more prevalent in patients with HCM than in controls (p<0.001). Subjects with anteroapically displaced PM and double bifid PM had higher resting LVOT gradients than controls (45 (6, 81) vs 12 (0, 12) mm Hg (p<0.01) and 42 (6, 64) vs 11 (0, 17) mm Hg (p = 0.02), respectively. In patients with HCM, the odds ratio of having significant (>or=30 mm Hg) peak resting gradient was 7.1 (95% CI 1.4 to 36.7) for anteroapically displaced anterolateral PM and 10.4 (95% CI 1.2 to 91.2) for double bifid PM (both p = 0.005), independent of septal thickness, use of beta-blockers and/or calcium blockers and resting heart rate.

CONCLUSIONS

Patients with HCM with abnormal PM have a higher degree of resting LVOT gradient, which is independent of septal thickness.

Expression of bisecting N-acetylglucosaminyltransferase-III in human hepatocarcinoma tissues, fetal liver tissues, and hepatoma cell lines of Hep3B and HepG2

In this paper, uridine diphosphate (UDP)-N-acetylglucosamine/beta-D-mannoside beta-1,4 N-acetylglucosaminyltransferase III (GlcNAc-transferase-III C 2.4.1.144) activity was determined in human hepatoma cell lines of Hep3B and HepG2, and also compared with those of normal liver tissues and primary hepatocytes. GlcNAc-transferase-III enzymes of Hep3B and HepG2 were mainly detected in the membrane fraction. When GlcN,GlcN-biant-PA and UDP-GlcNAc were used as substrates, the Km values (4.7 mM for UDP-GlcNAc and 1.1 mM for GlcN, GlcN-biant-PA) of Hep3B GlcNAc-transferase-III were distinguishable from those of HepG2 GlcNAc-transferase-III (6.8 mM for UDP-GlcNAc and 3.4 mM for GlcN,GlcN-biant-PA). Furthermore, Hep3B enzyme in membrane fraction showed about 1.5-fold higher specific activity (1423 pmol/hr/mg) than that of HepG2 (1066 pmol/hr/mg). Normal liver cells and primary adult hepatocytes are characterized by a very low level of GlcNAc-transferase-III activity, whereas human hepatoma cells exhibited high activities. These data were supported by reverse transcription-polymerase chain reaction results, showing that expression of the GlcNAc-transferase-III mRNA increased in proportion to the enzymatic activities. Although the mechanism underlying the induction of this enzyme is unknown, lectin blot analysis showed that oligosaccharides in many glycoproteins were observed in hepatoma cells. By treating hepatocarcinoma cultures that express GlcNAc-transferase-III with inhibitors (tunicamycin, deoxymannojirimycin, and swainsonine) of different steps of the glycosylation, we provide evidence that expression of GlcNAc-transferase-III mRNA is dependent on glycosylation of cellular proteins.

DNA sequence analysis of rdxA and frxA from 12 pairs of metronidazole-sensitive and -resistant clinical Helicobacter pylori isolates

We previously reported that inactivation of rdxA and/or frxA converted Helicobacter pylori from metronidazole sensitive to metronidazole resistant. To examine the individual roles of rdxA and frxA in the development of metronidazole resistance in H. pylori, we examined the status of rdxA and frxA from 12 pairs of metronidazole-sensitive and -resistant H. pylori isolates obtained following unsuccessful therapy containing metronidazole. Arbitrary primed fingerprinting analyses revealed that the genotypes of 11 sensitive and resistant pairs of strains were essentially identical. Amino acid sequence identities of RdxA and FrxA from the 14 metronidazole-sensitive isolates ranged from 92 to 98% and 95 to 98%, respectively, compared to that of H. pylori J99 (MIC, 1 microg/ml). All strains with high-level metronidazole resistance (MICs, 128 microg/ml) contained premature truncation of both RdxA and FrxA caused by nonsense and/or frameshift mutations. Strains with intermediate resistance to metronidazole (MICs, 32 to 64 microg/ml) contained a single premature truncation and/or altered RdxA and FrxA caused by nonsense, frameshift, and unique missense mutations. The low-level metronidazole-resistant strains (MICs, 8 microg/ml) contained unique missense mutations in FrxA but no specific changes in RdxA. The results demonstrate that alterations in both the rdxA and frxA genes are required for moderate and high-level metronidazole resistance and that metronidazole resistance that develops during anti-H. pylori therapy containing metronidazole is most likely to involve a single sensitive strain infection rather than a coinfection with a metronidazole-resistant strain.

Assembly, annotation, and integration of UNIGENE clusters into the human genome draft

The recent release of the first draft of the human genome provides an unprecedented opportunity to integrate human genes and their functions in a complete positional context. However, at least three significant technical hurdles remain: first, to assemble a complete and nonredundant human transcript index; second, to accurately place the individual transcript indices on the human genome; and third, to functionally annotate all human genes. Here, we report the extension of the UNIGENE database through the assembly of its sequence clusters into nonredundant sequence contigs. Each resulting consensus was aligned to the human genome draft. A unique location for each transcript within the human genome was determined by the integration of the restriction fingerprint, assembled genomic contig, and radiation hybrid (RH) maps. A total of 59,500 UNIGENE clusters were mapped on the basis of at least three independent criteria as compared with the 30,000 human genes/ESTs currently mapped in Genemap'99. Finally, the extension of the human transcript consensus in this study enabled a greater number of putative functional assignments than the 11,000 annotated entries in UNIGENE. This study reports a draft physical map with annotations for a majority of the human transcripts, called the Human Index of Nonredundant Transcripts (HINT). Such information can be immediately applied to the discovery of new genes and the identification of candidate genes for positional cloning.

Analysis of metronidazole, clarithromycin and tetracycline resistance of Helicobacter pylori isolates from Korea

Antibiotic resistance in Helicobacter pylori varies according to geographical region. We studied the primary resistance rates among 652 H. pylori isolated from Korea in relation to collection date, disease presentation, age and gender. Resistance rates were 40.6% (metronidazole), 5.9% (clarithromycin), 5.3% (tetracycline), 0% (amoxycillin), 1.5% (furazolidone) and 1.5% (nitrofurantoin). Resistance to metronidazole and clarithromycin increased from 1994 to 1999 (from 33.3 to 47.7% and 4.8 to 7.7%, respectively), but the differences only reached significance when rates of metronidazole resistance in women were compared with those in men (48.6 versus 36.9%).

Nitrofurantoin quadruple therapy for Helicobacter pylori infection: effect of metronidazole resistance

BACKGROUND

Antibiotic resistance has increasingly been recognized as the major cause of treatment failure for Helicobacter pylori infection. New therapies for patients with metronidazole- or clarithromycin-resistant H. pylori are needed.

AIM

To investigate the role of nitrofurantoin quadruple therapy for the treatment of H. pylori.

METHODS

Patients with confirmed H. pylori infection received nitrofurantoin (100 mg t.d.s.), omeprazole (20 mg b.d.), Pepto-Bismol (two tablets t.d.s.), and tetracycline (500 mg t.d.s.) for 14 days. Four or more weeks after the end of therapy, outcome was assessed by repeat endoscopy with histology and culture or urea breath testing.

RESULTS

Thirty patients were entered, including 25 men and five women; the mean age was 54.9 years. The most common diagnoses were duodenal ulcer (23%) and GERD (18%). The intention-to-treat cure rate was 70% (95% CI: 50.6-85%). Nitrofurantoin quadruple therapy was more effective with metronidazole-sensitive strains (88%; 15 out of 17) than with metronidazole-resistant strains (33%; three out of nine; P=0.008). Two of the treatment failures had pre-treatment isolates susceptible to metronidazole, which were resistant after therapy.

CONCLUSIONS

Because nitrofurantoin quadruple therapy performed inadequately in the presence of metronidazole resistance, we conclude that nitrofurantoin is unlikely to find clinical utility for the eradication of H. pylori.

Furazolidone- and nitrofurantoin-resistant Helicobacter pylori: prevalence and role of genes involved in metronidazole resistance

The prevalence of furazolidone, nitrofurantoin, and metronidazole resistance among Helicobacter pylori strains was assessed with 431 clinical isolates. Fifty-two percent were metronidazole resistant, compared to 2% (7 of 431) with resistance to furazolidone and nitrofurantoin. All seven furazolidone- and nitrofurantoin-resistant isolates were also metronidazole resistant. rdxA, frxA, and fdxB knockouts did not result in furazolidone or nitrofurantoin resistance. These data suggest that furazolidone and nitrofurantoin may be good alternatives to metronidazole for treating H. pylori infection.

Frameshift mutations in rdxA and metronidazole resistance in North American Helicobacter pylori isolates

In Helicobacter pylori, the oxygen-insensitive nitroreductase RdxA is likely to activate metronidazole (Mtz) by reduction and formation of cytotoxic intermediates. Mutations in rdxA have been associated with Mtz resistance in H. pylori. In vitro Mtz susceptibilities of 17 randomly selected H. pylori isolates were determined by the agar dilution method. DNA sequence analysis of rdxA alleles of eight susceptible isolates (MIC range: 0.25-1.0 mg/L) and nine resistant isolates (MIC range: 16-256 mg/L) showed that six of nine Mtz-resistant H. pylori isolates contained insertion or deletion mutations ('indel' mutations). One isolate contained a substitution mutation at codon position 148 that resulted in the introduction of a premature stop codon. Creation of stop codons within the rdxA coding sequence by either frameshift or substitution mutations resulted in premature translation termination and expression of putatively truncated RdxA polypeptides.

Isolation and characterization of tetracycline-resistant clinical isolates of Helicobacter pylori

Tetracycline is an important component of combination therapies for Helicobacter pylori eradication. Twenty-nine tetracycline-resistant isolates requiring MICs ranging from 4 to 16 microgram/ml were isolated from Korean (22 of 460) and Japanese (7 of 105) patients. Interestingly, all of the 29 tetracycline-resistant isolates exhibited cross-resistance to metronidazole, and the cross-resistance was transferred to tetracycline-sensitive H. pylori strains.

Regional differences in metronidazole resistance and increasing clarithromycin resistance among Helicobacter pylori isolates from Japan

The patterns of antibiotic resistance in Helicobacter pylori were assessed in two different regions in Japan. Overall, prevalences of resistance to metronidazole and clarithromycin were 12.4 and 12.9%, respectively. While there was no difference in clarithromycin resistance, the prevalence of metronidazole resistance was significantly higher in Kyoto (23.8%) than in Sapporo (8.1%). From 1996 to 1999, the prevalence of metronidazole resistance did not change but the prevalence of clarithromycin resistance doubled (from 9.1 to 18.7%).

Analysis of rdxA and involvement of additional genes encoding NAD(P)H flavin oxidoreductase (FrxA) and ferredoxin-like protein (FdxB) in metronidazole resistance of Helicobacter pylori

Metronidazole (Mtz) is a critical ingredient of modern multidrug therapies for Helicobacter pylori infection. Mtz resistance reduces the effectiveness of these combinations. Although null mutations in a rdxA gene that encodes oxygen-insensitive NAD(P)H nitroreductase was reported in Mtz-resistant H. pylori, an intact rdxA gene has also been reported in Mtz-resistant H. pylori, suggesting that additional Mtz resistance mechanisms exist in H. pylori. We explored the nature of Mtz resistance among 544 clinical H. pylori isolates to clarify the role of rdxA inactivation in Mtz resistance and to identify another gene(s) responsible for Mtz resistance in H. pylori. Mtz resistance was present in 33% (181 of 544) of the clinical isolates. There was marked heterogeneity of resistance, with Mtz MICs ranging from 8 to >/=256 microg/ml. rdxA inactivation resulted in Mtz MICs of up to 32 microg/ml for 6 Mtz-sensitive H. pylori strains and 128 microg/ml for one Mtz-sensitive strain. Single or dual (with rdxA) inactivation of genes that encode ferredoxin-like protein (designated fdxB) and NAD(P)H flavin oxidoreductase (frxA) also increased the MICs of Mtz for sensitive and resistant strains with low to moderate levels of Mtz resistance. fdxB inactivation resulted in a lower level of resistance than that from rdxA inactivation, whereas frxA inactivation resulted in MICs similar to those seen with rdxA inactivation. Further evidence for involvement of the frxA gene in Mtz resistance included the finding of a naturally inactivated frxA but an intact rdxA in an Mtz-resistant strain, complementation of Mtz sensitivity from an Mtz-sensitive strain to an Mtz-resistant strain or vice versa by use of naturally inactivated or functional frxA genes, respectively, and transformation of an Mtz-resistant Escherichia coli strain to an Mtz sensitive strain by a naturally functional frxA gene but not an inactivated frxA gene. These results are consistent with the hypothesis that null mutations in fdxB, frxA, or rdxA may be involved in Mtz resistance.

Frame-shift mutations in NAD(P)H flavin oxidoreductase encoding gene (frxA) from metronidazole resistant Helicobacter pylori ATCC43504 and its involvement in metronidazole resistance

Metronidazole is a critical ingredient for combination therapies of Helicobacter pylori infection, the major cause of peptic ulcer and gastric cancer. It has been recently reported that metronidazole resistance from H. pylori ATCC43504 is caused by the insertion of a mini-IS605 sequence and deletion of sequences in an oxygen insensitive NAD(P)H nitroreductase encoding gene (rdxA). We also found that an additional gene (frxA) encoding NAD(P)H flavin oxidoreductase in the same strain was truncated by frame-shift mutations. To assess whether the frxA truncation is also involved in metronidazole resistance, metronidazole sensitive H. pylori strains ATCC43629 and SS1 were transformed by the truncated frxA gene cloned from strain ATCC43504. All transformed cells grew on agar plates containing 16 microg ml(-1) of metronidazole. The involvement of the frxA gene in metronidazole resistance was also confirmed by insertion inactivation of frxA and/or rdxA genes from strain ATCC43629 and one metronidazole sensitive clinical isolate H. pylori 2600. In addition, the frxA gene cloned from the H. pylori 2600 showed metronidazole nitroreductase activity in Escherichia coli and rendered ordinary metronidazole resistant E. coli to metronidazole sensitive cell. These results indicate that the frxA gene may also be involved in metronidazole resistance among clinical H. pylori isolates.

A M(r) 34,000 proinflammatory outer membrane protein (oipA) of Helicobacter pylori

The complete genome sequence revealed a family of 32 outer membrane proteins (OMPs) in Helicobacter pylori. We examined the effect of four OMPs (HP0638, HP0796, HP1501, and babA2) on the production of the proinflammatory cytokine, IL-8. Mutants of the four OMPs, as well as cagE and galE from H. pylori from the U.S. and Japan, were constructed by inserting a chloramphenicol-resistant cassette into the gene. Twenty-two pairs of parental and mutant H. pylori strains, as well as 160 clinical isolates (80 from Japanese and 80 from U.S.), were cocultured with gastric cancer cell lines. IL-8 production in the supernatant and adhesion was assayed by ELISA. HP0796, HP1501, babA2, and galE gene knockouts had no significant effect on IL-8 production. Knockout of the HP0638 gene in 81% of cag-positive strains reduced IL-8 production approximately 50%. The three cag-positive strains in which IL-8 levels were unchanged by HP0638 knockout had five or seven CT dinucleotide repeats in the 5' region, resulting in a frame shift and truncation. Strains with naturally inactive HP0638 gene were all from the U.S.; Japanese strains were always "on" and thus, on average, may be more virulent. Although cag-negative isolates produced a limited IL-8 response, cag-negative strains that contained a functional HP0638 gene produced more than 3-fold greater IL-8 than cag-negative nonfunctional HP0638 strains. We hypothesize that functional HP0638 gene may be an important virulence factor in relation to the risk of clinically significant outcomes of H. pylori infection. We denote HP0638 gene as outer inflammatory protein (oipA).

Metronidazole containing quadruple therapy for infection with metronidazole resistant Helicobacter pylori: a prospective study

BACKGROUND

Metronidazole remains a key component of H. pylori infection therapy. It has been suggested that despite resistance, metronidazole may be effective when given at high dose with bismuth, tetracycline, and a proton pump inhibitor (quadruple therapy).

AIM

To prospectively evaluate metronidazole quadruple therapy for treatment of metronidazole resistant H. pylori infection in the United States.

METHODS

Patients infected with metronidazole resistant H. pylori were prospectively prescribed 14 days of quadruple therapy consisting of metronidazole 500 mg t.d.s., tetracycline 500 mg q.d.s., two bismuth subsalicylate tablets q.d.s., and omeprazole 20 mg o.d.

RESULTS

A total of 26 patients were entered into the study; 22 for their first treatment and four as re-treatment for failed therapy. Of the 26 patients, 24 were cured (cure rate 92%; 95% CI: 78-99%). Both treatment failures reported full compliance to 14 days of therapy. Side-effects were common and resulted in premature discontinuation of therapy in 31%. Premature discontinuation did not reduce the cure rate.

CONCLUSION

Quadruple metronidazole combination therapy is effective despite the presence of metronidazole resistance and should be considered as either first line therapy or for failures of twice-a-day combination therapies.

Quantitative RT-PCR analysis of multiple genes encoding putative metronidazole nitroreductases from Helicobacter pylori

Metronidazole (Mtz), a pro-drug, requires reductive activation by ferredoxin-like electron carrier proteins to kill bacteria and Mtz resistance is associated with a decrease or deficiency of Mtz nitroreductase activities in a target cell. Several genes encoding ferredoxin-like or -linked proteins such as pyruvate oxidoreductase (POR), ferredoxin oxidoreductase (FOR), ferredoxin (FdxA), ferredoxin-like protein (FdxB), flavodoxin (FldA) and oxygen insensitive nitroreductase (RdxA) have been identified from the complete genomic sequence of Helicobacter pylori. To understand the roles of these genes in H. pylori Mtz resistance, the gene expression for the proteins was examined using a method optimized for quantitative reverse transcription polymerase chain reaction (RT-PCR). The RT-PCR products of FOR and RdxA were significantly decreased in the total RNA prepared from H. pylori cultured in the presence of Mtz as compared to the total RNA prepared from H. pylori cultured without Mtz in the media. A slight decrease, however, in band intensity of the RT-PCR products of the POR and, to a lesser extent, FdxB was obtained in the presence of Mtz. In contrast, the RT-PCR products of the FdxA, FldA, and GalE (UDP-galactose 4-epimerase; a control gene) were unchanged in total RNA prepared from H. pylori cultured with or without Mtz in the culture media. These results suggest that Mtz resistance may also be acquired by decreasing the transcription of some genes involved in Mtz reductive activation, in addition to the mutation in some individual genes such as rdxA.