GM-CSF Promotes Immune Response and Survival in a Mouse Model of COVID-19

COVID-19 results in increased expression of inflammatory cytokines, but inflammation-targeting clinical trials have yielded poor to mixed results. Our studies of other disorders with an inflammatory component, including Alzheimer's disease, chemobrain, Down syndrome, normal aging, and West Nile Virus infection, showed that treatment with the 'pro-inflammatory' cytokine granulocyte-macrophage colony stimulating factor (GM-CSF) in humans or mouse models alleviated clinical, behavioral, and pathological features. We proposed that human recombinant GM-CSF (sargramostim) be repurposed to promote both the innate and adaptive immune responses in COVID-19 to reduce viral load and mortality1. Here, we report the results of a placebo-controlled study of GM-CSF in human ACE2 transgenic mice inoculated intranasally with SARS-CoV2 virus, a model of COVID-19. Infection resulted in high viral titers in lungs and brains and over 85% mortality. GM-CSF treatment beginning one day after infection increased anti-viral antibody titers, lowered mean lung viral titers proportionately (p=0.0020) and increased the odds of long-term survival by up to 5.8-fold (p=0.0358), compared to placebo. These findings suggest that, as an activator of both the innate and adaptive immune systems, GM-CSF/sargramostim may be an effective COVID-19 therapy with the potential to protect from re-infection more effectively than treatment with antiviral drugs or monoclonal antibodies.

Immunolesion of melanopsin neurons causes gonadal regression in Pekin drakes (Anas platyrhynchos domesticus)

Several light sensitive receptors have been described in the avian brain that are thought to regulate the reproductive axis independently from the eyes and pineal gland. Recently, our lab has described the presence of three of these photoneuroendocrine systems in the Pekin duck: opsin, opsin 5, & melanopsin. We set out to test the hypothesis that melanopsin receptive neurons are necessary to maintain seasonal reproductive status along with growth and development in the Pekin drake. To accomplish these goals we first investigated 50-week-old Pekin drakes that were housed in the aviary at Hope College under long day length (18h lights on) conditions in floor pens. To specifically lesion melanopsin-receptive neurons, 3μl of an anti-melanopsin-saporin conjugate (MSAP, 100ng/ul) was injected into the lateral ventricle (n=10). Control drakes were injected with 3μl of equimolar unconjugated anti-melanopsin and saporin (SAP, n=10). Reproductive behaviors were analyzed weekly in a test pen with adult hens and MSAP drakes showed a significant (p<0.01) reduction in reproductive behaviors after week 2. After 5weeks, drakes were euthanized and body weights were measured, and brains, pituitaries, and testes collected and stored for analyses. Mature MSAP-treated drakes had significantly (p<0.001) reduced relative teste weights compared to SAP controls. qRT-PCR analyses of hypothalamus showed a significant reduction (p<0.001) in GnRH and melanopsin mRNA levels, but not opsin 5, vertebrate ancient opsin, or opsin 2 (rhodopsin). Immunocytochemical analyses showed a significant reduction (p<0.01) in tyrosine hydroxylase-immunoreactivity in the PMM. These data suggest that although blue light alone is not able to maintain testicular function, the blue-light sensitive melanopsin activity is critical to maintain gonadal function.

Developing, delivering and evaluating cancer nursing services: Building the evidence base

The rate of evolution of cancer nursing in the UK has been remarkable over the past 20 years. Legislative changes and reform have provided the impetus for a range of developments in practice, research and education, and the push to achieve evidence-based practice has also driven the profession. There is a collective aspiration that all patients with cancer should expect to be supported by a cancer nursing service that is skilled, caring and competent. Demonstrating the value of nursing in terms of its effects on patients has never been so important. This project, commissioned by the Department of Health, was designed as a scoping exercise to assess the current state of the evidence base to support the development, delivery and evaluation of cancer nursing services in the United Kingdom. Three distinct elements were implemented concurrently to achieve this. The first was a review of UK literature centred around aspects of developing, delivering and evaluating cancer nursing and cancer nurses. The second was the development of a research directory profiling recently completed, currently under way and planned UK research concerned with cancer nursing and cancer nurses. The final element was a review of the organisation of cancer nursing services in England. This paper will report on the first two elements. The results of the third element will be published separately.

The organisation of cancer nursing services in the UK: A review of current practices

The reorganization of cancer services in recent years has presented cancer nursing with a range of organisational and developmental challenges. It is therefore encouraging to note that the specialty has evolved to the extent that an efficient and effective cancer nursing workforce is now acknowledged as a prerequisite for the provision of high-quality cancer care (Department of Health, 1995; 2000a; 2000b). However, despite the advances there has been little evaluation of the critical issues faced by specialist cancer nurses.

This project was undertaken as part of a larger scoping exercise designed to assimilate an evidence base to support the development, delivery and evaluation of UK cancer nursing services. This element of the project aimed to provide information to support the development and organisation of cancer nursing services by focusing on specific aspects of care (DoH, 2000a).

The results indicate that lead cancer nurses are striving to ensure that patients are provided with the best quality care through nurses' participation in collaborative endeavours, for example with the primary care and the voluntary sectors. There is still much to be achieved, primarily in the areas of workforce planning, the skill development of non-specialist nurses, and research and development. The evidence demonstrates that cancer nursing will continue to accept the challenges of changing practice, working to ensure that patients receive a high-quality service.

Identifying and managing performance concerns in community pharmacists in the UK

OBJECTIVES

To explore current arrangements for identifying and managing performance concerns in community pharmacists in the UK.

METHODS

Semi-structured qualitative telephone interviews were conducted with 20 senior managers from community pharmacies and locum agencies.

RESULTS

A strong emphasis was placed on business performance alongside other aspects of professional performance in the identification of performance concerns in pharmacists. The majority of concerns were identified reactively, through customer complaints, peer- or self-referral, or following a dispensing error. Community pharmacies sought to manage performance concerns internally where possible, but only the larger organizations had the infrastructure to provide their own training or other remedial support. Several challenges to identifying and managing performance concerns were identified. There were few mechanisms for identifying and supporting locum pharmacists with performance issues.

CONCLUSIONS

Being 'for-profit' organizations, community pharmacies may prioritize business performance over ensuring the professional performance of pharmacists, the responsibility for which would be left to the individual pharmacist. This may be detrimental to the quality of care provided. With the growth of independent sector providers more widely, these findings may have implications for the regulation of other health care professionals' performance.

Pharmacists' and pharmacy technicians' views on a process of revalidation of pharmacy professionals in Great Britain

BACKGROUND

Revalidation will be introduced for pharmacy professionals in Great Britain. However, what pharmacists and technicians understand about it as a process remains unexplored.

OBJECTIVES

This study aimed to explore the views of pharmacists and technicians about the revalidation of fitness to practice. Views were gathered on the sources of evidence that could be used, assessment methods, who should undertake the assessment, and how often it should occur.

METHODS

A multiple methods study was conducted with community and hospital pharmacists and technicians. It included 6 focus groups, 14 one-to-one interviews, and a postal survey sent in March 2009 to a 10% randomly selected sample of 4640 practising pharmacists and 738 technicians working in England, Scotland, and Wales.

RESULTS

Twenty-nine pharmacists and 16 technicians participated in the focus groups and interviews; 1206 (26.4%) pharmacists and 240 (32.8%) technicians returned a completed questionnaire. A large majority of both pharmacists (86%) and technicians (81%) were in favor of continuing professional development (CPD) records being used as evidence to inform revalidation, but only a small proportion of both groups agreed that patient feedback should be used. Evidence from appraisals and peers/colleagues was also well supported. Technicians were significantly more likely than pharmacists to indicate that their assessment for revalidation should be undertaken by their main employer. Although most technicians (49%) believed that revalidation should take place every 2-3 years, most pharmacists (58%) believed that it should occur only every 5 years.

CONCLUSIONS

Pharmacists and technicians do not share the same views on all aspects of revalidation, suggesting that 1 single model may not be desirable or practicable. Both groups identified CPD, appraisal, and feedback from peers as possible components of revalidation, but concerns about impartiality and independence of assessors were raised.

Association of white matter hyperintensity measurements on brain MR imaging with cognitive status, medial temporal atrophy, and cardiovascular risk factors

BACKGROUND AND PURPOSE

White matter hyperintensities (WMHs) are frequently characterized as markers of cerebrovascular disease, whereas medial temporal atrophy (MTA) is a recognized marker of Alzheimer disease (AD). Our purpose was to test the reliability of a visual rating system (VRS) in evaluating WMHs and MTA and in distinguishing healthy from cognitively impaired subjects.

MATERIALS AND METHODS

Subjects (n = 192) enrolled in the Florida Alzheimer's Disease Research Center were diagnosed with no cognitive impairment, nonamnestic mild cognitive impairment (na-MCI), amnestic MCI (a-MCI), or probable AD. The severity of WMHs was assessed on T2-weighted fluid-attenuated inversion recovery axial MR images, and the severity of MTA was evaluated on 1.5-mm-thick coronal MR images by using a computer-based visual rating system. Cardiovascular risk factor scores were calculated as the sum of 10 independent cardiovascular risk factors.

RESULTS

WMH and MTA scores were greater in subjects with probable AD, relative to those with no cognitive impairment and na-MCI. MTA scores differentiated subjects with a-MCI from those with no cognitive impairment and na-MCI. The total WMH score was significantly related to MTA (r = 0.39; P < .001) but not to cardiovascular risk factor scores (r = 0.07; P = not significant). The overall correct classification rate of probable AD versus no cognitive impairment by using MTA scores was 81.8%, improving to 86.5% when combined with WMH scores.

CONCLUSIONS

Both MTA and WMH scores distinguished subjects with no cognitive impairment and probable AD. Combining MTA and WMH scores improved the correct classification rate, whereas WMH scores were significantly related to MTA scores, but not to cardiovascular risk factor scores. This finding suggests that among subjects with a-MCI and probable AD, WMHs on MR images are primarily associated with neurodegenerative disease.

Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease

BACKGROUND

Despite convenience, accessibility, and strong correlation to severity of Alzheimer disease (AD) pathology, medial temporal lobe atrophy (MTA) has not been used as a criterion in the diagnosis of prodromal and probable AD.

METHODS

Using a newly validated visual rating system, mean MTA scores of three bilateral medial temporal lobe structures were compared for subjects with no cognitive impairment (NCI) (n = 117), nonamnestic mild cognitive impairment (MCI) (n = 46), amnestic MCI (n = 45), and probable AD (n = 53). Correlations between MTA scores and neuropsychological test scores at baseline, and predictors of change in diagnosis at 1-year follow-up were evaluated.

RESULTS

With NCI as the reference group, a mean MTA cut score of 1.33 yielded an optimal sensitivity/specificity of 85%/82% for probable AD subjects and 80%/82% for amnestic MCI subjects. MTA and Clinical Dementia Rating Sum of Boxes scores at baseline were independent and additive predictors of diagnosis at baseline, and of transition from NCI to MCI or from MCI to dementia at 1-year follow-up.

CONCLUSION

Medial temporal lobe atrophy (MTA) scores 1) distinguish probable Alzheimer disease (AD) and amnestic mild cognitive impairment (MCI) subjects from nonamnestic MCI and no cognitive impairment (NCI) subjects, 2) help predict diagnosis at baseline, and 3) predict transition from NCI to MCI and from MCI to probable AD. MTA scores should be used as a criterion in the clinical diagnosis of AD.

Transfection by electroporation

Electroporation yields a high frequency of permanent transfectants, has a high efficiency of transient gene expression, and can be easier to carry out than alternative techniques. Electroporation makes use of the fact that the cell membrane acts as an electrical capacitor which is unable (except through ion channels) to pass current. Subjecting membranes to a high-voltage electric field results in their temporary breakdown and the formation of pores that are large enough to allow macromolecules (as well as smaller molecules such as ATP) to enter or leave the cell. The reclosing of the membrane pores is a natural decay process which is delayed at decreased temperatures. This unit presents the procedures which can be used for both transient and stable transfections.

Transfection by electroporation

Electroporation--the use of high-voltage electric shocks to introduce DNA into cells--can be used with most cell types,yields a high frequency of both stable transformation and transient gene expression,and,because it requires fewer steps,can be easier than alternate techniques. In this unit,the basic protocol describes the electroporation of mammalian cells and an alternate protocol outlines modifications for preparation and transfection of plant protoplasts.

A diet high in omega-3 fatty acids does not improve or protect cognitive performance in Alzheimer’s transgenic mice

Although a number of epidemiologic studies reported that higher intake of omega-3 fatty acids (largely associated with fish consumption) is protective against Alzheimer's disease (AD), other human studies reported no such effect. Because retrospective human studies are problematic and controlled longitudinal studies over decades are impractical, the present study utilized Alzheimer's transgenic mice (Tg) in a highly controlled study to determine whether a diet high in omega-3 fatty acid, equivalent to the 13% omega-3 fatty acid diet of Greenland Eskimos, can improve cognitive performance or protect against cognitive impairment. Amyloid precursor protein (APP)-sw+PS1 double transgenic mice, as well as nontransgenic (NT) normal littermates, were given a high omega-3 supplemented diet or a standard diet from 2 through 9 months of age, with a comprehensive behavioral test battery administered during the final 6 weeks. For both Tg and NT mice, long-term n-3 supplementation resulted in cognitive performance that was no better than that of mice fed a standard diet. In NT mice, the high omega-3 diet increased cortical levels of omega-3 fatty acids while decreasing omega-6 levels. However, the high omega-3 diet had no effect on cortical fatty acid levels in Tg mice. Irrespective of diet, no correlations existed between brain omega-3 levels and cognitive performance for individual NT or Tg mice. In contrast, brain levels of omega-6 fatty acids were strongly correlated with cognitive impairment for both genotypes. Thus, elevated brain levels of omega-3 fatty acids were not relevant to cognitive function, whereas high brain levels of omega-6 were associated with impaired cognitive function. In Tg mice, the omega-3 supplemental diet did not induce significant changes in soluble/insoluble Abeta within the hippocampus, although strong correlations were evident between hippocampal Abeta(1-40) levels and cognitive impairment. While these studies involved a genetically manipulated mouse model of AD, our results suggest that diets high in omega-3 fatty acids, or use of fish oil supplements (DHA+EPA), will not protect against AD, at least in high-risk individuals. However, normal individuals conceivably could derive cognitive benefits from high omega-3 intake if it corrects an elevation in the brain level of n-6 fatty acids as a result. Alternatively, dietary fish may contain nutrients, other than DHA and EPA, that could provide some protection against AD.

Environmental enrichment improves cognition in aged Alzheimer's transgenic mice despite stable β-amyloid deposition

Environmental enrichment (EE) has been shown to improve cognitive performance and brain indices of cognition in normal mice and rats. Because the therapeutic potential of intensive, long-term EE to benefit patients with Alzheimer's disease (AD) has yet to be explored, the present study evaluated the effect of long-term EE on cognition in an animal model of AD, the APPsw transgenic mouse. Beginning at 16 months of age, APPsw mice were put into EE or standard housing for 4 months and then tested in four cognitive-based tasks (Morris maze, circular platform, platform recognition, and radial arm water maze) between 20 and 22 months of age. Our results indicate that long-term EE of aged APPsw mice results in global, overall improvement in cognitive function across these tasks without decreasing brain beta-amyloid (A beta) deposition. The results suggest that long-term EE/cognitive stimulation could provide cognitive stabilization or improvement to AD patients through mechanisms independent of A beta deposition and clearance.

Organising UK cancer nursing services: a review

This article describes an NTResearch survey which outlines how UK cancer nursing services have evolved over the past seven years in response to changes in government policy.

Developing, delivering, and evaluating cancer nursing services: searching for a United Kingdom evidence base for practice

The drive toward evidence-based healthcare aims to promote effectiveness and thereby improve quality. The challenge for cancer nursing is to continually evaluate what it does, retaining effective interventions and working to develop new ones and refine those interventions that require improvement, thereby enhancing both practice and patient outcomes. The aim of the project was to assimilate an evidence base to support the development, delivery, and evaluation of cancer nursing services in the United Kingdom. It was believed that determining the extent of the current United Kingdom evidence base through a review of the literature and current and recent research endeavors would allow for comparison with current priorities and facilitate informed strategic planning regarding the process of research commissioning. A rigorous, explicit, and thorough literature review was undertaken of all United Kingdom literature pertaining to cancer nursing and related issues published between 1980 and 2000. Fourteen individual databases were searched using specific keywords, thesaurus terms, and additional search terms. Data were extracted from each individual publication and stored in a purpose-designed database. Current and recent United Kingdom cancer nursing research projects were identified through a mailed survey questionnaire sent to people and organizations involved in cancer-related research. Research projects were categorized according to Royal College of Nursing research priority themes: Care and Caring Practices, Healthcare Environment, Organization and Management of Care, and Healthcare Workforce. Four-hundred forty-six pieces of literature were considered appropriate for inclusion in the review. Two-hundred sixty-four pieces of evidence were included in the Care and Caring Practices theme, which also had the greatest number of current and recent research projects (48%, n = 50). The Healthcare Environment theme included 80 pieces of evidence but only 3% (n = 3) of the current and recent research projects. Thirty-two percent (n = 33) of the current/recent research projects fell into the third theme of Organization and Management of Care, which contained a total of 104 pieces of evidence. The final theme, Healthcare Workforce, included 17% (n = 18) of the current and recent research projects, and the literature review incorporated 49 pieces of evidence in this theme. A number of recommendations have been drawn, which focus on methodological challenges, research considerations, and gaps in the evidence base. The drive toward evidence-based practice is essential for cancer nurses to establish who they are, what they do, and what effect they have on patient outcomes. Currently, although the United Kingdom evidence base for practice is vast, it frequently lacks depth. Although evaluating national evidence for practice is valuable, a more global approach to evidence synthesis is required. Through such endeavors, cancer nurses should realize their potential, support the strategic development of cancer nursing research, and so generate an evidence base that supports their unique contribution to patient outcomes.

A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache

STUDY DESIGN

A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months.

OBJECTIVES

To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group.

SUMMARY OF BACKGROUND DATA

Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache.

METHODS

In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture.

RESULTS

There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant.

CONCLUSION

Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained.

Effect of cytokines, dexamethasone and the A/T-signal peptide polymorphism on the expression of alpha(1)-antichymotrypsin in astrocytes: significance for Alzheimer's disease

Proinflammatory cytokines and acute phase proteins, such as alpha(1)-antichymotrypsin, are over expressed in microglia and astrocytes in brain regions with abundant mature amyloid plaques, suggesting a glial cell-led brain acute phase response in the Alzheimer neuropathology. In this paper, we show that alpha(1)-antichymotrypsin gene expression in human astrocytes is elevated by interleukin-1 and interleukin-6, and further enhanced by glucocorticoid, while the homologous contrapsin gene in rat astrocytes is unaffected by these cytokines. These distinct gene regulation mechanisms might help to explain the differential susceptibility of humans and rodents to amyloid formation of the Alzheimer's type. In addition, we demonstrate that the alpha(1)-antichymotrypsin A-allele that encodes a different signal peptide and is a suggested risk factor for Alzheimer's disease gives rise to a reduced level of immature alpha(1)-antichymotrypsin in transfected cells. The physiological result would be an enhanced ability of the A-encoded alpha(1)-antichymotrypsin protein to become secreted and promote extracellular amyloid formation. We discuss our findings in terms of a model in which cytokine-induced alpha(1)-antichymotrypsin synthesis in astrocytes constitutes a specific inflammatory pathway that accelerates the development of Alzheimer's disease and could at least partly underlie the regional specificity and species restriction of the neuropathology.

The inflammation-induced pathological chaperones ACT and apo-E are necessary catalysts of Alzheimer amyloid formation

Biochemical, genetic, and epidemiological evidence indicates that inflammation is an essential part of the pathogenesis of Alzheimer's disease. Over the last decade, we and others have focused on the mechanism by which specific inflammatory molecules contribute to the Alzheimer pathogenic pathway. In particular, we have learned that several acute phase/inflammatory molecules, specifically alpha(1)-antichymotrypsin (ACT) and apolipoprotein E (apoE) that are overproduced in the AD brain can promote the formation of, and are associated with, the neurotoxic amyloid deposits that are a key pathological hallmark of the disease. Because both of these proteins bind to the Abeta peptide and catalyze its polymerization into amyloid filaments, they have been termed "pathological chaperones".ACT, and, to a lesser extent, apoE are greatly overproduced only in areas of the AD brain that are prone to amyloid formation. This restriction suggests a local inflammatory reaction may underlie the regional specificity of amyloid deposition by inducing the production of pathological chaperones. The data that will be discussed indicate that ACT over-expression is caused by the activation of ACT mRNA synthesis in astrocytes in response to increased production of the inflammatory cytokine IL-1. IL-1 is released from microglia that become activated by pre-amyloid seeds of Abeta. Recently, this inflammatory cascade has been extended to include the amyloid precursor protein (APP), for IL-1 also upregulates the production of APP in astrocytes, but at the translational rather that the transcriptional level. Thus many of the key elements of the Alzheimer's disease pathogenic pathway are products of a local inflammatory reaction in the brain. Further support for a mechanistic role of inflammation in the Alzheimer's disease pathogenic pathway has been provided by genetic studies, which have associated an increased risk of developing AD with specific polymorphisms in the apoE, ACT, and the IL-1 genes. Most recently, transgenic mouse models of AD have demonstrated that ACT and apoE are amyloid promoters/pathological chaperones in vivo whose contribution is necessary for both amyloid formation and for amyloid-associated cognitive decline and memory loss. The importance of these findings is that they help to place inflammation at the center of the pathogenic pathway to Alzheimer's disease and identify specific steps in the pathway that may be amenable to therapeutic intervention.

Lower limb injuries in aerobics participants in Western Australia: An incidence study

To determine the incidence of injury in aerobics classes in Perth, Western Australia, a questionnaire was developed and distributed to 274 aerobics participants and 59 instructors at 20 aerobics centres. Questionnaires were returned from 86 per cent of instructors and 94 per cent of participants. Thirty-five per cent of instructors and 22 per cent of participants reported at least one injury caused or aggravated by aerobics in the previous 12 months. When hours of participation or instruction per year were considered, the injury incidence rate was 0.18 injuries per 100 hours for the instructors and 0.27 injuries per 100 hours for the participants. Instructors reported ankle/foot injuries (43.3 per cent) and shin injuries (23.3 per cent) most commonly while participants, particularly those in step classes, reported that the knee was injured most commonly. Injuries among aquarobics participants were low and were confined to the calf, ankle and foot.

The sensitivity of thermography to temperature changes in breast tissue

This study evaluates the ability of thermography to i) detect temperature changes in a lactating breast in response to the application of therapeutic ultrasound; ii) identify an area of raised temperature in a breast affected by mastitis; and iii) detect temperature changes in the affected area in response to the application of ultrasound. An area of raised temperature (36 degrees C), corresponding with the area of inflammation, was identified in a mastitic breast. Eighty-seven per cent of this area had returned to normal resting breast temperature (33 degrees C) within 30 minutes of application of pulsed ultrasound. The use of thermography to evaluate temperature changes in mastitic breast tissue before and after the application of ultrasound is supported.

Inter-examiner reliability to detect painful upper cervical joint dysfunction

The presence of painful upper cervical joint dysfunction is a diagnostic criterion for cervicogenic headache. This preliminary study investigated whether independent examiners for a planned multicentre study of treatment of cervicogenic headache sufferers would agree on the presence or not of joint dysfunction for inclusion/exclusion of subjects into the trial. Ten subjects with or without neck pain and headache were recruited in each of four centres (total 40 subjects). Examiners manually assessed subjects' upper cervical regions in a single blind manner. There was excellent to complete agreement between each pair of examiners on which subjects should be allowed to enter the study and 70 per cent agreement between examiners on the two most dysfunctional joints in symptomatic subjects. There can be confidence that an homogenous headache group will enter the planned trial.

The anatomy and histology of the rotator interval capsule of the shoulder

Forty-seven rotator interval regions from fetuses and 10 fresh-frozen rotator interval regions from adult cadavers were evaluated by gross dissection and light microscopy. Specimens from adults also were evaluated with ultrasound and magnetic resonance imaging. An analysis of 37 fetal specimens (> 14 weeks gestation) revealed two rotator interval types: Type I (9 of 37) was defined by a contiguous bridge of capsule consisting of poorly organized collagen fibers. A Type II rotator interval (28 of 37) had a complete defect covered by only a thin layer of synovium. Similar to the Type II rotator interval in the fetus, a rotator interval defect was present in six of eight specimens from adults. Histologically, the capsular tissue within the rotator interval consisted of poorly organized collagen fibers in specimens from the fetus and adult. Maximal opening of the rotator interval was seen by ultrasound with internal rotation and downward traction of the hyperextended arm in the coronal, oblique, and sagittal planes. Magnetic resonance imaging of the rotator interval region permitted anatomic evaluation. The complete absence of tissue in 28 of 37 fetuses suggests that the rotator interval defect is congenital. The authors recommend that surgeons carefully evaluate the integrity of the tissue within the rotator interval. When rotator interval closure is desired such as in patients with a persistent sulcus sign after arthroscopic stabilization, suturing the edges of more substantial tissue immediately adjacent to the boundaries of the rotator interval region would seem prudent.

Alpha-1-antichymotrypsin promotes beta-sheet amyloid plaque deposition in a transgenic mouse model of Alzheimer's disease

Alpha(1)-antichymotrypsin (ACT), an acute-phase inflammatory protein, is an integral component of the amyloid deposits in Alzheimer's disease (AD) and has been shown to catalyze amyloid beta-peptide polymerization in vitro. We have investigated the impact of ACT on amyloid deposition in vivo by generating transgenic GFAP-ACT-expressing mice and crossing them with the PDGF-hAPP/V717F mice, which deposit amyloid in an age-dependent manner. The number of amyloid deposits measured by Congo Red birefringence was increased in the double ACT/amyloid precursor protein (APP) transgenic mice compared with transgenic mice that only expressed APP, particularly in the hippocampus where ACT expression was highest, and the increase was preceded by elevated total amyloid beta-peptide levels at an early age. Our data demonstrate that ACT promotes amyloid deposition and provide a specific mechanism by which inflammation and the subsequent upregulation of astrocytic ACT expression in AD brain contributes to AD pathogenesis.

Ultrastructural observations on sperm storage in the ovary of the platyfish, Xiphophorus maculatus (Teleostei: poeciliidae): the role of the duct epithelium

Sperm storage is an important phenomenon occurring in viviparous and oviparous teleosts and contributes to the reproductive life history of these forms. There is a paucity of morphological studies on sperm storage in fishes. The majority of these have been confined to the light level of investigation. In this report, we describe, at the ultrastructural level, sperm storage in the viviparous platyfish, Xiphophorus maculatus. Female platyfish, as is typical of the poeciliids, are capable of storing viable sperm for up to several months within the ovary and gonoduct. We observed that sperm stored within inseminated platyfish became associated with specific epithelial cells (SACs) lining the oviduct. Two forms of association were seen: 1) sperm were found within deep surface pits and pockets, and 2) the spermatozoa were taken up and incorporated within the cytoplasm of the SACs. Junctional complexes in the form of tight junctions (zona occludens) and desmosomes at the apico-lateral surfaces of the SACs were prevalent. The junctions could have contributed to allograft survival of the haploid heterogenetic sperm cells within the female's reproductive tract. Our results shed light on the mechanism of sperm storage in the platyfish and could serve as a model for other poeciliid species and teleosts that are capable of storing sperm.

Immune response to an 18-kilodalton outer membrane antigen identifies lipoprotein 20 as a Helicobacter pylori vaccine candidate

Experiments were performed using the standardized murine model of Helicobacter pylori infection to determine the immunogenicity of H. pylori outer membrane vesicles in immune protection. These vesicles, which are naturally shed from the surface of the bacterium, induce a protective response when administered intragastrically to mice in the presence of cholera holotoxin, despite the absence of the urease enzyme and associated Hsp54 chaperonin. Immunoblotting identified a specific serum immunoglobulin G (IgG) response to an 18-kDa outer membrane protein in a significant number of immunized animals. This commonly expressed, immunodominant protein was subsequently identified as lipoprotein 20 (Lpp20). Hybridoma backpacks secreting an IgG1 subclass monoclonal antibody to Lpp20 were generated in H. pylori-infected mice and were found to significantly reduce bacterial numbers, providing evidence that this surface-exposed antigen is a true vaccine candidate and not merely an antigenic marker for successful, protective immunization.

Chromosome missegregation and trisomy 21 mosaicism in Alzheimer's disease

A connection between Alzheimer's disease (AD) and Down syndrome (trisomy 21) is indicated by the fact that all Down syndrome individuals develop Alzheimer's disease neuropathology by the 4th decade of life. Previous studies have examined the frequency of aneuploidy and other chromosomal defects in cells from familial Alzheimer's disease (FAD) patients, with varying results. To investigate the possibility that a specific type of aneuploidy--trisomy 21 mosaicism--may contribute to Alzheimer's disease, we used quantitative fluorescence in situ hybridization to measure the number of trisomy 21 cells in primary fibroblast cultures from AD and unaffected subjects. The 27 AD cultures, including 15 that were derived from individuals carrying FAD mutations in presenilin 1 or 2, exhibited a significant approximately twofold increase in the number of trisomy 21 cells compared to 13 control cultures. A small double-hybridization experiment suggested that the aneuploidy in AD cells was not limited to chromosome 21 but extended at least to chromosome 18 as well. In a parallel study, the endogenous presenilin proteins in fibroblasts were localized to the centrosomes, the nuclear envelope, and its associated interphase kinetochores. Together these results indicate that the presenilin proteins may be involved in mitosis and that FAD mutations in the presenilin genes may predispose to chromosome missegregation (nondisjunction). The data reported here also suggest that trisomy 21 mosaicism may contribute to other forms of AD that are not caused by a presenilin mutation.

Translation of the alzheimer amyloid precursor protein mRNA is up-regulated by interleukin-1 through 5'-untranslated region sequences

The amyloid precursor protein (APP) has been associated with Alzheimer's disease (AD) because APP is processed into the beta-peptide that accumulates in amyloid plaques, and APP gene mutations can cause early onset AD. Inflammation is also associated with AD as exemplified by increased expression of interleukin-1 (IL-1) in microglia in affected areas of the AD brain. Here we demonstrate that IL-1alpha and IL-1beta increase APP synthesis by up to 6-fold in primary human astrocytes and by 15-fold in human astrocytoma cells without changing the steady-state levels of APP mRNA. A 90-nucleotide sequence in the APP gene 5'-untranslated region (5'-UTR) conferred translational regulation by IL-1alpha and IL-1beta to a chloramphenicol acetyltransferase (CAT) reporter gene. Steady-state levels of transfected APP(5'-UTR)/CAT mRNAs were unchanged, whereas both base-line and IL-1-dependent CAT protein synthesis were increased. This APP mRNA translational enhancer maps from +55 to +144 nucleotides from the 5'-cap site and is homologous to related translational control elements in the 5'-UTR of the light and and heavy ferritin genes. Enhanced translation of APP mRNA provides a mechanism by which IL-1 influences the pathogenesis of AD.

Idiopathic pseudoaneurysm of the dorsalis pedis artery mimicking pigmented villonodular synovitis

Pseudoaneurysm of the dorsalis pedis artery is uncommon and is usually associated with a history of trauma to the vessel. Without such a history, the diagnosis may be challenging, because the mass may be confused with other common soft tissue masses in the foot. This case report describes a 67-year-old man with an idiopathic pseudoaneurysm of the dorsalis pedis artery that mimicked pigmented villonodular synovitis.

A general RNA-binding protein complex that includes the cytoskeleton-associated protein MAP 1A

Association of mRNA with the cytoskeleton represents a fundamental aspect of RNA physiology likely involved in mRNA transport, anchoring, translation, and turnover. We report the initial characterization of a protein complex that binds RNA in a sequence-independent but size-dependent manner in vitro. The complex includes a approximately 160-kDa protein that is bound directly to mRNA and that appears to be either identical or highly related to a approximately 1600-kDa protein that binds directly to mRNA in vivo. In addition, the microtubule-associated protein, MAP 1A, a cytoskeletal associated protein is a component of this complex. We suggest that the general attachment of mRNA to the cytoskeleton may be mediated, in part, through the formation of this ribonucleoprotein complex.

The essential role of inflammation and induced gene expression in the pathogenic pathway of Alzheimer's disease

Alzheimer's disease is among the most common diseases of advanced age affecting almost one out of ten individuals who survive beyond the age of 65 years, and an another 10% for each additional decade of the life-span. The prognosis of the disease is an inexorable decline of mental functions leading to complete dependence on caretakers in the late stages of the disease. Alzheimer's disease will become a steadily increasing financial health-care problem in the industrialized world with the increasing longevity and ageing of the population. To-date there are no effective therapeutics. However, during the last years promising findings suggest that anti-inflammatory treatment strategies might be efficient. Here, we will review the experimental and epidemiological findings which support the idea that inflammatory mechanisms play an important role in Alzheimer's disease pathogenesis. The review of the experimental findings will be focussed on the amyloid-associated proteins, alpha1-antichymotrypsin and apolipoprotein E, as well as the major cytokines. In addition, the epidemiological studies on non-steroidal anti-inflammatory drugs and traumatic head injury will be summarized. We hypothesize a pathogenic model for Alzheimer's disease in which the expression of amyloid-associated proteins/pathological chaperones, induced by inflammatory cytokines, plays an essential role in accelerating the disease progress, and suggest potential targets for drug discovery based on such a model.

Alzheimer presenilins in the nuclear membrane, interphase kinetochores, and centrosomes suggest a role in chromosome segregation

Mutations in two related genes, presenilin 1 and 2, account for most early-onset familial Alzheimer's disease. Although structural features indicate that the presenilins are membrane proteins, their function(s) is unknown. We have localized the presenilins to the nuclear membrane, its associated interphase kinetochores, and the centrosomes-all subcellular structures involved in cell cycle regulation and mitosis. The colocalization of the presenilins with kinetochores on the nucleoplasmic surface of the inner nuclear membrane, together with other results, suggests that they may play a role in chromosome organization and segregation, perhaps as kinetochore binding proteins/receptors. We discuss a pathogenic pathway for familial Alzheimer's disease in which defective presenilin function causes chromosome missegregation during mitosis, resulting in apoptosis and/or trisomy 21 mosaicism.

Cytoskeletal changes in the brains of mice lacking calcineurin A alpha

Hyperphosphorylated tau, the major component of the paired helical filaments of Alzheimer's disease, was found to accumulate in the brains of mice in which the calcineurin A alpha gene was disrupted [calcineurin A alpha knockout (CNA alpha -/-)]. The hyperphosphorylation involved several sites on tau, especially the Ser396 and/or Ser404 recognized by the PHF-1 monoclonal antibody. The increase in phosphorylated tau content occurred primarily in the mossy fibers of the CNA alpha -/- hippocampus, which contained the highest level of calcineurin in brains of wild-type mice. The CNA alpha -/- mossy fibers also contained less neurofilament protein than normal, although the overall level of neurofilament phosphorylation was unchanged. In the electron microscope, the mossy fibers of CNA alpha -/- mice exhibited abnormalities in their cytoskeleton and a lower neurofilament/microtubule ratio than those of wild-type animals. These findings indicate that hyperphosphorylated tau can accumulate in vivo as a result of reduced calcineurin activity and is accompanied by cytoskeletal changes that are likely to have functional consequences on the affected neurons. The CNA alpha -/- mice were found in a separate study to have deficits in learning and memory that may result in part from the cytoskeletal changes in the hippocampus.

Alzheimer A beta neurotoxicity: promotion by antichymotrypsin, ApoE4; inhibition by A beta-related peptides

Two inflammation-associated proteins found in the Alzheimer amyloid deposits-alpha 1-antichymotrypsin (ACT) and apolipoprotein E4 (apoE4)-have been shown to be genetic risk factors for the development of Alzheimer's disease and to promote the polymerization of the A beta peptide into amyloid filaments in vitro. In the present study, we show that ACT and apoE4 increase the neurotoxicity of the A beta peptide in parallel with their promotion of filament formation. Preincubation of ACT or apoE4 with small A beta-related peptides, or of apoE4 with apoE2, abrogated their subsequent ability to promote both the formation and the neurotoxicity of A beta filaments. These results indicate that ACT and apoE4 may play a stimulatory role in the formation of neurotoxic amyloid in Alzheimer's disease, and that their amyloid promoting activity can be blocked by inhibitory peptides.

Structure and alternative splicing of the presenilin-2 gene

Missense mutations in the presenilin-1 (PS-1) and presenilin-2 (PS-2) genes have been shown to be causes of autosomal dominant Alzheimer's disease (the AD3 and AD4 loci, respectively). Alternative splicing has previously been reported in the PS-1 gene. In this study, elucidation of intron/exon boundary sequences revealed that PS-2 is encoded by 10 coding exons. In addition, PS-2 cDNA cloning and RT-PCR using RNA from a variety of normal tissues revealed the presence of alternatively spliced products. These products included species with in frame omissions of exon 8 and simultaneous omissions of exons 3 and 4.