Local production of 17β-oestradiol in the endometrium during the implantation window: a pilot study

Graphical abstract

Abstract

Sex steroids are converted to bioactive metabolites and vice versa by endometrial steroid-metabolising enzymes. Studies indicate that alterations in this metabolism might affect endometrial receptivity. This pilot study determined whether the endometrial formation and inactivation of 17β-oestradiol differed between the supposedly embryo-receptive endometrium and non-receptive endometrium of women undergoing IVF/intracytoplasmic sperm injection (ICSI). Endometrial biopsies were obtained from IVF/ICSI patients 5-8 days after ovulation in a natural cycle, prior to their second IVF/ICSI cycle with fresh embryo transfer (ET). Endometrial biopsies from patients who achieved clinical pregnancy after fresh ET (n = 15) were compared with endometrial biopsies from patients that did not conceive after fresh ET (n = 15). Formation of 17β-oestradiol (oxidative 17β-hydroxysteroid dehydrogenases (HSDs)), oestrone (reductive HSD17Bs) and inhibition of HSD17B1 activity were determined by high-performance liquid chromatography. The endometrial transcriptome was profiled using RNA sequencing followed by principal component analysis and differentially expressed gene analysis. The false discovery rate-adjusted P < 0.05 and log fold change >0.5 were selected as the screening threshold. Formation and inactivation of 17β-oestradiol resulted similar between groups. Inhibition of HSD17B1 activity was significantly higher in the non-pregnant group when only primary infertile women (n = 12) were considered (27.1%, n = 5 vs 16.2%, n = 7, P = 0.04). Gene expression analysis confirmed the presence of HSD17B1 (encoding HSD17B1), HSD17B2 (encoding HSD17B2) and 33 of 46 analysed steroid metabolising enzymes in the endometrium. In the primary infertile subgroup (n = 10) 12 DEGs were found including LINC02349 which has been linked to implantation. However, the exact relationship between steroid-metabolising enzyme activity, expression and implantation outcome requires further investigation in larger, well-defined patient groups.

Lay summary

Sex hormones are produced and broken down by enzymes that can be found in the endometrium (the inner lining of the womb). This enzyme activity might influence the chances of becoming pregnant. We compared (i) enzyme activity in the endometrium of 15 women who did and 15 women who did not become pregnant in their second in vitro fertilisation attempt, (ii) how enzyme activity can be blocked by an inhibitor, and (iii) differences in gene expression (the process by which instructions in our DNA are converted into a product). Enzyme activity was similar between groups. We found that in women who have never been pregnant in the past, inhibition of enzyme activity was higher and found differences in a gene that has been linked to the implantation of the embryo, but future studies should be performed in larger, well-defined patient groups to confirm these findings.

O-144 Endometrial production of 17β-estradiol in relation to pregnancy outcome in women undergoing IVF/ICSI

Study question

Does the endometrial synthesis and inactivation of 17β- estradiol differ between receptive and non-receptive endometrium in women undergoing IVF/ICSI?

Summary answer

The synthesis and inactivation of 17β-estradiol is similar in the endometrium of women who did and did not achieve a clinical pregnancy through IVF/ICSI.

What is known already

Implantation failure of high-quality embryos is a main concern in IVF/ICSI treatment. Blood sex-steroid concentrations do not reflect their corresponding concentrations in endometrial tissue. This is in line with the concept that blood steroids (and precursors) are locally converted to bioactive metabolites and vice versa, by expressing steroid-metabolising enzymes, such as 17β-hydroxy steroid dehydrogenase (17β-HSD). Studies indicate that alterations in intracrinology might modulate endometrial receptivity. We hypothesize that the local 17β-HSD activity during the window of implantation (WOI) differs between pregnant and non-pregnant IVF/ICSI patients.

Study design, size, duration

Case-control study of 40 patients that were recruited in the SCRaTCH study (NL5193/NTR5342), a randomised trial exploring whether ‘endometrial scratching’ in patients with a previous IVF/ICSI cycle failure affects pregnancy outcome in a subsequent IVF/ICSI cycle. For the present investigation, 20 endometrial biopsies from women who achieved clinical pregnancy after fresh embryo transfer (ET) were compared with 20 endometrial biopsies of women that did not conceive after fresh ET.

Participants/materials, setting, methods

Endometrial biopsies and serum were obtained at LH + 5-8 days (urinary test) in a natural cycle, prior to the fresh ET cycle. Cases (negative pregnancy test, n = 20) and controls (clinically pregnant, n = 20) were matched for primary vs. secondary infertility, embryo quality and age. Reduction of estrone to 17β-estradiol (synthesizing 17β-HSDs) and oxidation of 17β-estradiol to estrone (inactivating 17β-HSDs) were determined by high-performance liquid chromatography (HPLC). Results were compared with the Wilcoxon-Mann-Whitney Rank Sum Test.

Main results and the role of chance

Activity of 17β-HSDs responsible for the reduction of estrone to 17β-estradiol (mainly 17β-HSD type 1) was detected in all samples and ranged from 55 to 1864 pmol 17β-estradiol formed/mg protein/24 h. The values obtained from pregnant women (median: 1054) were not significantly different to those obtained from non-pregnant women (median: 997), p = 0.97. The activity of enzymes responsible for the oxidation of 17β-­ estradiol (mainly 17β-HSD type 2) into the less active estrone ranged from 32 to 1731 estrone formed/mg protein/24 h. The values obtained from pregnant women (median: 737) were not significantly different to those obtained from non-pregnant women (median: 624), p = 0.90. The ratio of 17β-HSD type 1:17β-HSD type 2 had a median of 1.63 in the pregnant woman compared to 1.95 in the group of non-pregnant woman (p = 0.57).

Limitations, reasons for caution

The study is pilot in nature and study population is small. Primary and secondary infertility patients were analysed together. A chance phenomenon could have occurred as included women were included after their first IVF/ICSI cycle, hence not every included study person met the criteria for repeated implantation failure (RIF).

Wider implications of the findings

17β-estradiol metabolism takes place during the WOI, controlling the final 17β-estradiol level. Although the present investigation did not show differences between pregnant and non-pregnant women, it remains important to explore if estrogen balance deviations, e.g. in other cycle phases plays a role in clinical conditions such as primary infertility/RIF.

Trial registration number

NL5193/NTR5342

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice

Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.

Inhaled dry powder apomorphine (VR040) for 'off ' periods in Parkinson's disease: an in-clinic double-blind dose ranging study

BACKGROUND

'Off' periods increase as Parkinson's disease (PD) progresses and the benefits of standard therapy wane. Subcutaneous apomorphine rescues 'off' periods, but patient self-injection and adverse cutaneous effects are sometimes problematic.

METHODS

We assessed safety, tolerability and efficacy of inhaled dry powder apomorphine (VR040) in a double-blind clinic-based Phase II study. Of 48 patients recruited at nine sites, 47 were randomized 2:1 inhaled apomorphine/placebo. Respirable doses (drug predicted to reach the lung), ascending through 1.5, 2.3, 3.0 and 4.0 mg until efficacy was achieved, were administered to patients in a practically defined 'off' state. The primary endpoint was the response in unified PD rating scale Part 3 (UPDRS 3), at the highest dose received by the patient. Secondary endpoints included time to 'on', the proportion of patients converting from 'off' to 'on', and duration of 'on'.

RESULTS

In the 47 intent-to-treat patients with PD, mean age 60.6 years, the mean UPDRS 3 improvement was significantly greater for VR040 at 26.8 points (standard deviation 12.0), vs 14.9 (16.3) for placebo (treatment difference 11.6, 95% confidence interval 2.3-20.9, P = 0.016). Rapid apomorphine absorption (2-7 min) translated to rapid (mean 10 min) reversal from the 'off' state. Adverse effects did not differ between VR040 and placebo; no patient discontinued due to an adverse event; one serious adverse event (constipation) in the VR040 group was considered unrelated to trial medication.

CONCLUSIONS

Inhaled apomorphine shows significant promise as a replacement for intermittent subcutaneous injections; further studies are appropriate to optimize efficacy and tolerability.

A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness

BACKGROUND

Large epidemiological studies are needed to better understand the prevalence and profile of offending by people with mental illness. This study used a whole-of-population design to examine the prevalence, type and pattern of offending across all psychiatric diagnoses, including schizophrenia, compared to the general population. Method We used whole-of-population longitudinal record-linked data for a cohort of all Western Australians born 1955-1969 to determine arrest history over the period 1985-1996 and to ascertain recorded history of psychiatric illness. Of the cohort, 116 656 had been arrested and 40 478 were on the psychiatric case register.

RESULTS

The period prevalence of arrest for people with any psychiatric illness was 32.1%. The highest arrest prevalence, by diagnostic category, was for substance use disorders (59.4%); the prevalence for schizophrenia was 38.7%. Co-morbid substance use disorders significantly increased risk of arrest in people with schizophrenia. The prevalence of mental illness among offenders was 11.1%: 6.5% of offenders had substance use disorders and 1.7% had schizophrenia. For the majority of offenders with a psychiatric illness, first arrest preceded first contact with mental health services; for schizophrenia only, this proportion was increasing over time. The mean percentage annual change in the number of arrests during 1985-1996 rose significantly for offenders with a psychiatric illness other than schizophrenia and dropped significantly for those with no mental illness. Compared to non-psychiatric offenders, offenders with schizophrenia were more likely to offend alone, to offend in open places and to target strangers.

CONCLUSIONS

Our findings open the way to an informed approach to the management of offenders with mental illness.

Manipulating polarization of light with ultrathin epsilon-near-zero metamaterials

One of the basic functionalities of photonic devices is the ability to manipulate the polarization state of light. Polarization components are usually implemented using the retardation effect in natural birefringent crystals and, thus, have a bulky design. Here, we have demonstrated the polarization manipulation of light by employing a thin subwavelength slab of metamaterial with an extremely anisotropic effective permittivity tensor. Polarization properties of light incident on the metamaterial in the regime of hyperbolic, epsilon-near-zero, and conventional elliptic dispersions were compared. We have shown that both reflection from and transmission through λ/20 thick slab of the metamaterial may provide nearly complete linear-to-circular polarization conversion or 90° linear polarization rotation, not achievable with natural materials. Using ellipsometric measurements, we experimentally studied the polarization conversion properties of the metamaterial slab made of the plasmonic nanorod arrays in different dispersion regimes. We have also suggested all-optical ultrafast control of reflected or transmitted light polarization by employing metal nonlinearities.

Phase IIa randomized double-blind, placebo-controlled study of inhaled apomorphine as acute challenge for rescuing 'off' periods in patients with established Parkinson's disease

BACKGROUND AND PURPOSE

In this first study of inhaled apomorphine (VR040) in patients with Parkinson's disease, the primary objective was to find the minimum efficacious dose of apomorphine that was useful in rescuing patients during 'off' periods. Safety, tolerability and pharmacokinetics of inhaled apomorphine were assessed during the study.

METHODS

A double-blind, placebo-controlled, randomized trial of three escalating single doses of inhaled apomorphine (0.2, 0.5 and 0.8 mg fine particle dose) versus placebo (3 : 1 active:placebo) was performed. Parkinson's motor severity assessments by a clinician, and disease state assessment by the patient, were performed at baseline during an 'off' state, and at specified times after test drug administration. Safety assessments (including vital signs, electrocardiogram and forced expiratory volume) were performed, and plasma apomorphine levels measured.

RESULTS

All 24 patients completed the study, and considering the three dose levels together, inhaled apomorphine did not significantly increase the proportion of patients switching from 'off' to 'on' (0/6 at 0.2 mg, 3/6 at 0.5 mg and 2/6 at 0.8 mg vs. 1/6 for placebo), or decrease the time from 'off' to 'on' post-treatment (10 min for 0.5 mg, 40 min for 0.8 mg, vs. 20 min for placebo). However, there was a suggestion of benefit at the higher doses (5/12 switched 'on' at the 0.5 or 0.8 mg doses, vs. 1/6 for placebo). There were no serious adverse events and treatment was well tolerated. Peak plasma concentration was 1-3 min post-dose, and plasma level dose proportionality was observed.

CONCLUSIONS

Inhaled apomorphine was safe and well tolerated at the doses tested for an acute challenge to rescue 'off' periods, but efficacy at these doses was limited. A follow-up study at higher doses is appropriate given these initial findings.

Are large perimeter- minimizing two-dimensional clusters of equal-area bubbles hexagonal or circular?

A computer study of clusters of up to N =200 000 equal-area bubbles shows for the first time that partially rounding conjectured optimal hexagonal planar soap bubble clusters reduces perimeter. Different methods of creating optimal clusters are compared, and new candidate minimizers for several N are given.

Energy efficient on-sensor processing in Body Sensor Networks

Body Sensor Networks (BSNs) have tremendous potential in facilitating the real-time monitoring of the health of an individual in their own environment. However to truly exploit this potential, the powerful signal processing and analysis techniques available in the hospital environment must also be deployed in BSNs. In this paper, techniques in algorithm development, communications, hardware architecture and circuit design are described that will achieve the necessary power savings to make intelligent BSNs a reality.

Rehabilitation for children with cerebral palsy in rural Cambodia: parental perceptions of family-centred practices

BACKGROUND

Rehabilitation service providers in Cambodia are increasingly adopting family-centred practices when working with children with cerebral palsy and their families. This study examined the perceptions of parents living in rural Cambodia regarding family-centred rehabilitation practices.

METHODS

This qualitative study used in-depth semi-structured individual and small group interviews with a convenience sample of 24 parents of children with cerebral palsy from three rural provinces. Participants were drawn from Cambodia Trust's client database and had been involved in a rehabilitation planning process which incorporated family-centred practices.

RESULTS

Twenty-four parents and carers of children with cerebral palsy aged 3-12 years were interviewed. Almost all parents valued family-centred practices in rehabilitation, with many of the needs and preferences of parents living in rural Cambodia similar to those of parents in Western contexts.

CONCLUSIONS

Family-centred approaches to paediatric rehabilitation were found to be valued in and appropriate for a rural Cambodian context. Social and cultural mechanisms to be considered when adapting a Western, family-centred model of rehabilitation planning to the rural Cambodian context include the hierarchical nature of Cambodian culture, the emphasis on group relational patterns rather than individual needs and the context of chronic poverty.

127. PUMA MEDIATES GERM CELL DEATH DURING OVARIAN DEVELOPMENT AND DETERMINES INITIAL PRIMORDIAL FOLLICLE NUMBER IN MICE

The proteins that control the number of primordial follicles initially established within the ovary are largely unknown. Here we investigated the hypothesis that PUMA, a pro-apoptotic protein belonging to the Bcl-2 family, regulates germ cell death during ovarian development and thereby determines the number of primordial follicles that make up the ovarian reserve. Ovaries were obtained from embryonic day 17.5 (E17.5) and post-natal day 10 (PN10) wild-type (wt) and puma–/– mice and subjected to morphological, molecular and stereological characterisation (n = 3-6 mice/genotype/age). At E17.5, ovaries were densely populated with germ cells and early meiotic oocytes. Immunostaining for MVH and PCNA confirmed the identity of germ cells and proliferating germ cells, respectively. Pyknotic nuclei and TUNEL positive germ cells were rarely detected, suggesting that cell death was uncommon at this age. At PN10, primordial follicle assembly was complete for both genotypes, as confirmed morphologically and by immunostaining for oocyte markers GCNA and MSY2. The number of germ cells in E17.5 wt and puma–/– ovaries was comparable (p=0.81, See Table 1). However, PN10 puma–/– ovaries contained significantly more primordial follicles than wt ovaries (P < 0.001, See Table 1), revealing an over-endowment of primordial follicles in the absence of PUMA. These data show that PUMA regulates the developmentally programmed death of germ cells between E17.5 and PN10 in the mouse and thereby determines the number of primordial follicles that make up the initial ovarian reserve. This work was supported by the NHMRC (Program Grants #494802 and #257502, Fellowships JKF (#441101), KJH (#494836), CLS (#406675), AS (#461299)); the Leukemia and Lymphoma Society (New York; SCOR grant#7015), the National Cancer Institute (NIH, US; CA80188 and CA43540) and Victorian Government Infrastructure Funds.

Virtual Cell modelling and simulation software environment

The Virtual Cell (VCell; http://vcell.org/) is a problem solving environment, built on a central database, for analysis, modelling and simulation of cell biological processes. VCell integrates a growing range of molecular mechanisms, including reaction kinetics, diffusion, flow, membrane transport, lateral membrane diffusion and electrophysiology, and can associate these with geometries derived from experimental microscope images. It has been developed and deployed as a web-based, distributed, client-server system, with more than a thousand world-wide users. VCell provides a separation of layers (core technologies and abstractions) representing biological models, physical mechanisms, geometry, mathematical models and numerical methods. This separation clarifies the impact of modelling decisions, assumptions and approximations. The result is a physically consistent, mathematically rigorous, spatial modelling and simulation framework. Users create biological models and VCell will automatically (i) generate the appropriate mathematical encoding for running a simulation and (ii) generate and compile the appropriate computer code. Both deterministic and stochastic algorithms are supported for describing and running non-spatial simulations; a full partial differential equation solver using the finite volume numerical algorithm is available for reaction-diffusion-advection simulations in complex cell geometries including 3D geometries derived from microscope images. Using the VCell database, models and model components can be reused and updated, as well as privately shared among collaborating groups, or published. Exchange of models with other tools is possible via import/export of SBML, CellML and MatLab formats. Furthermore, curation of models is facilitated by external database binding mechanisms for unique identification of components and by standardised annotations compliant with the MIRIAM standard. VCell is now open source, with its native model encoding language (VCML) being a public specification, which stands as the basis for a new generation of more customised, experiment-centric modelling tools using a new plug-in based platform.

Instabilities of cylindrical bubble clusters

Small bubbles in an experimental two-dimensional foam between glass plates regularly undergo a three-dimensional instability as the small bubbles shrink under diffusion or equivalently as the plate separation increases, and end up on one of the plates. The most recent experiments of Cox, Weaire, and Vaz are accompanied by Surface Evolver computer simulations and rough theoretical calculations. We show how a recent second variation formula may be used to perform exact theoretical calculations for infinitesimal perturbations for such a system, and verify results with Surface Evolver simulations.

Survival of Listeria monocytogenes during manufacture, ripening and storage of soft lactic cheese made from raw goat milk

Soft lactic cheeses were manufactured with raw goat milk inoculated with Listeria monocytogenes. The physico-chemical and microbiological characteristics of curds and cheeses were determined after each processing step as well as during ripening and refrigerated storage. The fate of Listeria monocytogenes was evaluated by enumeration on PALCAM agar and by a qualitative detection after a double selective enrichment procedure. The results showed that the physico-chemical and microbiological characteristics of lactic cheeses caused a decrease of Listeria monocytogenes counts. However, this decrease did not lead to the complete disappearance of the pathogen and Listeria monocytogenes was able to survive in soft lactic cheeses made with raw goat milk.

Qualitative and quantitative analysis of monocyte transendothelial migration by confocal microscopy and three-dimensional image reconstruction

A novel method for qualitative and quantitative analysis of monocyte transendothelial migration is described. By labeling monocytes and endothelial cells with different fluorophores, and utilizing confocal microscopy and three-dimensional image reconstruction, transmigrating monocytes were resolved and quantified within a subendothelial collagen gel. Comparison of monocyte migration across endothelial monolayers derived from human brain microvessels versus umbilical veins revealed diapedesis across brain endothelium to be significantly delayed. Inclusion of astrocytes within the subendothelial collagen gel resulted in the formation of an array of astrocytic processes that simulated the glia limitans surrounding brain microvessels in situ, thus yielding a more physiologic paradigm of the blood-brain barrier. By virtue of its unique capacity to provide information on the total number of migrating cells, this analytic approach overcomes significant caveats associated with sampling only aspects of the migration process. The potential adaptability of this method to computer-assisted analysis further enhances its prospective use in high-throughput screening.

Modification of bovine beta-lactoglobulin by glycation in a powdered state or in an aqueous solution: immunochemical characterization

Bovine beta-LG was modified by glycation with lactose in a powdered state or in an aqueous solution. An immunological characterization was performed using monoclonal antibodies with defined epitopes. The results showed that the structural changes were confined to the AB loop region of the molecules when glycation was conducted in a restricted water environment and had little consequences on the association state of glycated beta-LG. The protein conformation was much more extensively modified when glycation was performed in an aqueous solution at 60 degrees C, despite a lower glycation extent. These structural changes were located at the dimer interface (AB loop, GH loop, beta-strand I, and alpha-helix). These results allowed us to establish a relationship between the conformational changes and the modification of the association state of the glycated protein (formation of disulfide bridges between the free thiol groups of two monomers), previously described.

Formation of stable covalent dimer explains the high solubility at pH 4.6 of lactose-beta-lactoglobulin conjugates heated near neutral pH

The solubility of lactose-beta-lactoglobulin conjugates at pH 4.6, after heating near neutral pH in phosphate buffer/0.116 M NaCI, was investigated by size exclusion chromatography and compared with unmodified protein. Heated conjugates in the temperature range 65-90 degrees C showed greater solubility at pH 4.6. The proportion of soluble protein increased with the number of bound lactose molecules. Total solubility was obtained for conjugates with nine lactose residues attached per monomer of beta-lactoglobulin. The protective effect of bound sugar toward precipitation was associated with the formation of soluble disulfide cross-linked dimers, highly accessible to trypsin digestion. These results suggested that bound lactose, through steric hindrance and high surface hydrophilicity, prevents the thiol-disulfide exchange reactions of the polymerization-aggregation process of lactose-beta-lactoglobulin conjugates.

Modification of bovine beta-lactoglobulin by glycation in a powdered state or in an aqueous solution: effect on association behavior and protein conformation

The effect of glycation with lactose on the association behavior and conformational state of bovine beta-lactoglobulin (beta-LG) was studied, using size exclusion chromatography, polyacrylamide gel electrophoresis, proteolytic susceptibility, and binding of a fluorescent probe. Two modification treatments were used, i.e., aqueous solution glycation and dry-way glycation. The results showed that the latter treatment did not significantly alter the nativelike behavior of the protein while the former treatment led to important structural changes. These changes resulted in a specific denatured beta-LG monomer, which covalently associated via the free thiol group. The homodimers thus formed and the expanded monomers underwent subsequent aggregation into a high molecular weight species, via noncovalent interactions. The association behavior of glycated beta-LG is discussed with respect to the known multistep denaturation/aggregation process of nonmodified beta-LG.

The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment

There has been little clinical research to examine the effects of patient positioning and pelvic motion on the alignment of the acetabular implant during total hip replacement surgery. Until now, no tools were capable of accurately measuring these variables during the actual procedure. As part of a broader program in medical robotics and computer assisted surgery, a clinical system has been developed that includes several enabling technologies. The hip navigation system (HipNav) continuously and precisely measures pelvic location and tracks relative implant alignment intraoperatively. HipNav technology is used to gauge current clinical practice and provide intraoperative feedback to surgeons with the goal of improving the precision and accuracy of acetabular alignment during total hip replacement. This system provides surgeons with a new class of image guided measurement tools and assist devices. These tools successfully were introduced into the clinical practice of surgery with results showing the following: (1) There exist unpredictable and large variations in the initial position of patients' pelves on the operating room table and significant pelvic movement during surgery and during intraoperative range of motion testing; (2) current mechanical acetabular alignment guides do not account for these variations, and result in variable and in the majority of cases unacceptable acetabular alignment; and (3) press fitting oversized acetabular components influences the final cup orientation.

Intracellular fluorescent probe concentrations by confocal microscopy

A general method is described that takes advantage of the optical sectioning properties of a confocal microscope to enable measurement of both absolute and relative concentrations of fluorescent molecules inside cells. For compartments within cells that are substantially larger than the point spread function, the fluorescence intensity is simply proportional to the concentration of the fluorophore. For small compartments, the fluorescence intensity is diluted by contributions from regions outside the compartment. Corrections for this dilution can be estimated via calibrations that are based on the intensity distribution found in a computationally synthesized model for a cell or organelle that has been blurred by convolution with the microscope point spread function. The method is illustrated with four test cases: estimation of intracellular concentration of a fluorescent calcium indicator; estimation of the relative distribution between the neurite and soma of a neuronal cell of the InsP3 receptor on the endoplasmic reticulum; estimation of the distribution of the bradykinin receptor along the surface of a neuronal cell; and relative distribution of a potentiometric dye between the mitochondria and cytosol as a means of assaying mitochondrial membrane potential.

Intracellular fluorescent probe concentrations by confocal microscopy

A general method is described that takes advantage of the optical sectioning properties of a confocal microscope to enable measurement of both absolute and relative concentrations of fluorescent molecules inside cells. For compartments within cells that are substantially larger than the point spread function, the fluorescence intensity is simply proportional to the concentration of the fluorophore. For small compartments, the fluorescence intensity is diluted by contributions from regions outside the compartment. Corrections for this dilution can be estimated via calibrations that are based on the intensity distribution found in a computationally synthesized model for a cell or organelle that has been blurred by convolution with the microscope point spread function. The method is illustrated with four test cases: estimation of intracellular concentration of a fluorescent calcium indicator; estimation of the relative distribution between the neurite and soma of a neuronal cell of the InsP3 receptor on the endoplasmic reticulum; estimation of the distribution of the bradykinin receptor along the surface of a neuronal cell; and relative distribution of a potentiometric dye between the mitochondria and cytosol as a means of assaying mitochondrial membrane potential.

Augmented reality and its future in orthopaedics

Augmented reality is a display technique that combines supplemental information with the real world environment. Augmented reality systems are on the verge of being used everyday in medical training, preoperative planning, preoperative and intraoperative data visualization, and intraoperative tool guidance. The basic technologies of augmented reality are discussed, augmented reality systems currently being used in the medical domain are examined, and some future uses of these systems in orthopaedic applications are explored.

Selective detection of lactolated peptides in hydrolysates by liquid chromatography/electrospray tandem mass spectrometry

In food processing as well as in human nutrition and physiology, the increasing importance of the Maillard reaction has brought about the need for analytical means to detect and characterize the protein-bound Amadori products. In this paper, we describe a highly selective and sensitive method for detecting peptides glycated with lactose (lactolated peptides) from a complex hydrolysate using electrospray ionization tandem mass spectrometry. Protonated molecular ions of lactolated peptides gave a product-ion spectrum, with the dominant mode of decomposition including cleavage of the O-glycosidic bond followed by dehydration steps giving a characteristic neutral loss of 216 Da. Optimization of the ion marker [M + H]+ - 216, identified as a furylium ion, was investigated. It remained dominant regardless of the nature of the glycated peptides, the collision energy used, or the charge state of the parent ion. An approach for detecting lactolated peptides from protein digest was proposed during reverse-phase high-performance liquid chromatography (HPLC)/electrospray mass spectrometry and reverse-phase HPLC/tandem mass spectrometry using neutral loss scanning. This technique detected picomole amounts of lactolated peptides.

Babe the magnificent organ donor? The perils and promises surrounding xenotransplantation

The number of xenotransplantations may increase despite the many concerns about the likelihood of spreading known and unknown infectious diseases. Regardless of the safety precautions employed in the early trials, the risks remain unknown. Zoonotic and even xenozoonootic diseases are not remote possibilities; they exist in various forms and come from various sources. The nature of transplantation requires the suppression of the immune system to levels where opportunistic infections may take route. Even if procedures to avoid increased levels of immunosuppression to the recipient were successful, risk to third parties, whose immune systems would not be equipped to fight off the infection, would remain. In this context, the PHS Guidelines provide a useful starting point, but they do not go far enough. First, the Guidelines are merely suggestions; this needs to be changed to require institutions undertaking xenotransplantation research and clinical trials to comply with the Guidelines. Second, every possible effort should be made to protect third parties from disease transmission. This requires and justifies placing restrictions on recipients that, in an ordinary context, would be unacceptable. Third, xenotransplantations should occur only after all other medical measures have been exhausted. Until the time when disease transmission risks are scientifically insignificant or cures for the transmitted diseases are found, mandatory guidelines with stringent requirements are the best means of balancing the interests of society against the potential beneficiaries of xenotransplantation.

Nonenzymatic lactosylation of bovine beta-lactoglobulin under mild heat treatment leads to structural heterogeneity of the glycoforms

Lactose reacts nonenzymatically with beta-lactoglobulin (beta-LG), the major whey protein, under mild heat treatment and the formation of the complex may be monitored by mass spectrometry. Using Reverse Phase HPLC coupled with Electrospray Ionization MS (ESI-MS) we have measured the global extent of glycosylation and examined the distribution of lactose among the beta-LG glycoforms. Identification of lactosylated sites by trypsinolysis and Tandem MS indicate that, although the glycosylation reaction was non-specific and potentially involved all the reactive sites (alpha- and epsilon-amino groups), beta-LG appeared to have at least two populations of lysine with the distinct ability to react with lactose. These results underline the structural heterogeneity of beta-LG glycoforms, with respect to the number of lactose linked per molecule and to the binding sites involved, which could affect the biological function of beta-LG.

Protein translation components are colocalized in granules in oligodendrocytes

The intracellular distribution of various components of the protein translational machinery was visualized in mouse oligodendrocytes in culture using high resolution fluorescence in situ hybridization and immunofluorescence in conjunction with dual channel confocal laser scanning microscopy. Arginyl-tRNA synthetase, elongation factor 1a, ribosomal RNA, and myelin basic protein mRNA were all co-localized in granules in the processes, veins and membrane sheets of the cell. Colocalization was evaluated by dual channel cross correlation analysis to determine the correlation index (% colocalization) and correlation distance (granule radius), and by single granule ratiometric analysis to determine the distribution of the different components in individual granules. Most granules contained synthetase, elongation factor, ribosomal RNA and myelin basic protein mRNA. These results indicate that several different components of the protein synthetic machinery, including aminoacyl-tRNA synthetases, elongation factors, ribosomes and mRNAs, are colocalized in granules in oligodendrocytes. We propose that these granules are supramolecular complexes containing all of the necessary macromolecular components for protein translation and that they represent a heretofore undescribed subcellular organization of the protein synthetic machinery. This spatial organization may increase the efficiency of protein synthesis and may also provide a vehicle for transport and localization of specific mRNAs within the cell.

Three-dimensional organization of endoplasmic reticulum in the ventral photoreceptors of Limulus

Living Limulus ventral photoreceptor cells were injected with long chain lipophilic carbocyanine fluorescent dyes to label the endoplasmic reticulum (ER). The purpose of this study was to examine the continuity, dynamic changes, and structure of the ER in the living cell, using laser scanning confocal microscopy and three-dimensional image reconstruction. In this highly polarized neuron, three lines of evidence indicate that the ER is a continuous network extending throughout both lobes of the cell. First, injection of DiO or DiI results in the labeling of ER throughout both lobes of the cell. Second, three-dimensional image reconstruction of the optical sections reveals a dispersed membrane meshwork which may be the structure that serves to interconnect the ER in the two lobes. Third, in cells fixed before dye injection, the pattern of labeling was similar to that in living cells, indicating that vesicle transport was not responsible for the spread of dye throughout the cell. The overall organization of the ER in the photoreceptor cell is relatively stable; however, the fine structure changes over time. This dynamic process appears to represent continual reorganization of the intracellular membranes in the cell. Three morphological types of ER were observed. The ER of the light-sensitive lobe, identified by coinjection of rhodamine-phalloidin to label the microvillar actin, is characterized by a concentration of stratiform membranes interconnected by thin tubular cross-bridges. The perinuclear ER is characterized by a tangle of convoluted tubules sometimes terminating in bulbous structures. Finally, there is a fine tubular reticulum dispersed throughout the cell.

Scanning concentration correlation spectroscopy using the confocal laser microscope

Concentration correlation spectroscopy allows the assessment of molecular motions in complex systems. The technique generally monitors concentration fluctuations by means of some method such as the intensity of fluorescent molecules (fluorescence correlation spectroscopy). We describe here the use of scanning confocal laser microscopy to measure correlation functions in both space and time. This methodology offers two major advantages over conventional methods. First, collecting data from different regions of the sample significantly increases the signal-to-noise ratio. Second, molecular motions of colloidal gold can be analyzed by correlation methods with high temporal and spatial resolution. Using a MRC 600 laser scanning system, we collect data from an ensemble of 768 independent subvolumes and determine the space-time correlation function. We demonstrate the technique using two different types of samples, fluorescently labeled DNA molecules in solution and colloidal gold-tagged lipids in a planar bilayer. This approach, which we term "scanning concentration correlation spectroscopy," provides a straightforward means of performing high resolution correlation analysis of molecular motions with available instrumentation.

Transport and localization of exogenous myelin basic protein mRNA microinjected into oligodendrocytes

We have studied transport and localization of MBP mRNA in oligodendrocytes in culture by microinjecting labeled mRNA into living cells and analyzing the intracellular distribution of the injected RNA by confocal microscopy. Injected mRNA initially appears dispersed in the perikaryon. Within minutes, the RNA forms granules which, in the case of MBP mRNA, are transported down the processes to the periphery of the cell where the distribution again becomes dispersed. In situ hybridization shows that endogenous MBP mRNA in oligodendrocytes also appears as granules in the perikaryon and processes and dispersed in the peripheral membranes. The granules are not released by extraction with non-ionic detergent, indicating that they are associated with the cytoskeletal matrix. Three dimensional visualization indicates that MBP mRNA granules are often aligned in tracks along microtubules traversing the cytoplasm and processes. Several distinct patterns of granule movement are observed. Granules in the processes undergo sustained directional movement with a velocity of approximately 0.2 micron/s. Granules at branch points undergo oscillatory motion with a mean displacement of 0.1 micron/s. Granules in the periphery of the cell circulate randomly with a mean displacement of approximately 1 micron/s. The results are discussed in terms of a multi-step pathway for transport and localization of MBP mRNA in oligodendrocytes. This work represents the first characterization of intracellular movement of mRNA in living cells, and the first description of the role of RNA granules in transport and localization of mRNA in cells.

A prospective comparison of computerized arthrotomography and magnetic resonance imaging of the glenohumeral joint

Twenty-five patients with shoulder instability or shoulder pain of undetermined etiology were prospectively evaluated with magnetic resonance imaging and computerized arthrotomography. Actual lesions were determined by arthroscopy or at the time of open surgical repair. The images obtained were interpreted independently by three radiologists blinded to both surgical results and the results of previous diagnostic tests. Sensitivity, specificity, and accuracy were determined for each imaging technique for a variety of pathologic entities, including anterior and posterior labral abnormalities, capsular redundancy, biceps-labral complex abnormalities, humeral head (Hill-Sachs) impression lesions, and glenohumeral loose bodies. Analysis of imaging techniques also included construction of receiver operator curves for labral abnormalities. Magnetic resonance imaging showed better diagnostic results in the evaluation of glenoid labral and humeral head impression lesions (P < 0.05). Both imaging techniques were equally successful in identifying biceps-labral lesions and intraarticular loose bodies within the glenohumeral joint. Neither imaging technique was consistent in the evaluation of capsular redundancy. Receiver operator curve analysis confirmed that magnetic resonance imaging was the more accurate imaging study in evaluating anterior and posterior glenoid labral abnormalities.

Visualizing cells in three dimensions using confocal microscopy, image reconstruction and isosurface rendering: application to glial cells in mouse central nervous system

This paper describes a general method for visualizing individual cells in intact tissue in three dimensions. The method involves immunostaining intact tissue to label specific cells, "optical sectioning" the stained tissue by laser scanning confocal microscopy, computationally reconstructing a three dimensional image data set from the digitized confocal optical sections, delineating isosurfaces of specific intensity within the reconstructed image by a "marching cubes" algorithm to generate polygon meshes defining boundaries of cells, and displaying individual cells, identified as three dimensional objects enclosed by contiguous polygon meshes, using computer graphics techniques. Each of the components of this method has been described previously in conjunction with other applications. However the combination of these techniques to visualize a variety of different individual cell types in three dimensions in intact tissue represents a new approach. To illustrate the application of this method, we have visualized three different glial cell types in mouse CNS tissue. Oligodendrocytes, specifically stained with antibody to myelin basic protein, were used as an example of cells labelled with an internal membrane antigen. Astrocytes, specifically stained with antibody to glial fibrillary acidic protein, were used as an example of cells labelled with a cytoplasmic antigen. Microglia, specifically stained with Mac.1 antibody, were used as an example of cells labelled with an external membrane antigen. The images that are generated contain remarkably detailed volumetric and textural information that is not obtainable by conventional imaging techniques.

Two rare cases of 6p partial deletion

Two rare cases of 6p partial deletion (6p23----pter) are described. Both patients are at or past the adolescent stage, with severe mental retardation and severe to moderate developmental retardation. Physical dysmorphic features that stand out are: short forehead, borderline microcephaly, low-set malformed ears, hyperplastic nares, dental anomalies and short terminal phalanges. The diversity of the phenotypic features has considerable variations in patients with ring of 6, apparently reflecting the relative loss of p and q arms. A case of a larger terminal deletion and a report of an interstitial deletion is also reviewed.