Abstract ND13: The discovery and characterization of CFT7455: A potent and selective degrader of IKZF1/3 for the treatment of relapsed/refractory multiple myeloma

Introduction: Ikaros family zinc finger protein 1 and 3 (IKZF1/3) are essential transcription factors (TF) for terminal differentiation of B and T cells. Depletion of IKZF1/3 inhibits the growth of multiple myeloma (MM) cells, confirming their dependency on IKZF1/3. IMiDs (lenalidomide, pomalidomide) are effective therapies for treatment of MM and promote degradation of IKZF1/3 via their interaction with CRL4-CRBN E3 ligase. However, most patients treated with lenalidomide or pomalidomide eventually develop progressive disease due to acquired resistance, underscoring the unmet medical need. CFT7455 is a novel IKZF1/3 degrader optimized for high binding affinity to cereblon (CRBN), rapid and deep IKZF1/3 degradation, and potent dose-dependent efficacy in vivo.

Results: A series of novel benzoimidazolone-based CRBN ligands with potent binding affinity were discovered and their binding modes were informed by CRBN co-crystal structures. Although the benzoimidazolone-based CRBN binders did not exhibit IKZF1/3 degradation activity, structural insights into their unique binding modes and knowledge of the IKZF1/3 degradation pharmacophore were combined to enable identification of a novel benzoisoindolone-based ligand that exhibited a 10-fold potency increase in biochemical CRBN binding and a 30-fold potency increase in H929 MM cell growth inhibition when compared to lenalidomide. Additional rounds of structure-based drug design, degradation and phenotypic profiling led to the discovery of CFT7455, a highly potent, selective and orally bioavailable degrader of IKZF1/3. CFT7455 demonstrated an 800 and 1600-fold improvement in CRBN binding compared to pomalidomide in biochemical and cellular NanoBRET assays, respectively. In H929 MM cells expressing HiBiT-tagged IKZF1, CFT7455 induced >75% degradation of IKZF1 within 1.5 hrs. The high binding affinity and degradation catalysis shown with CFT7455 enabled potent antiproliferative activity across a panel of MM cell lines, as well as H929 cells made resistant to IMiDs. In vivo, CFT7455 catalyzed deep and durable degradation of IKZF3, translating into potent antitumor activity in multiple myeloma xenograft models. CFT7455 also retained its activity in models resistant or insensitive to clinically approved IMiDs as single agent or in combination with standard of care agent dexamethasone.

Conclusion: Overall, CFT7455 is a next generation IKZF1/3 degrader, with improved potency and anticancer efficacy in preclinical models compared to existing IMiDs. These features make CFT7455 an exciting drug candidate, as a single agent or for use in combination. CFT7455 is currently being studied in a Ph1 clinical trial.

Citation Format: James A. Henderson, Scott J. Eron, Andrew Good, R Jason Kirby, Samantha Perino, Roman V. Agafonov, Prasoon Chaturvedi, Bradley Class, David Cocozziello, Ashley A. Hart, Christina S. Henderson, Marta Isasa, Brendon Ladd, Matt Schnaderbeck, Michelle Mahler, Adam S. Crystal, Roy M. Pollock, Christopher G. Nasveschuk, Andrew J. Phillips, Stewart L. Fisher, David A. Proia. The discovery and characterization of CFT7455: A potent and selective degrader of IKZF1/3 for the treatment of relapsed/refractory multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr ND13.

Generalized neural field theory of cortical plasticity illustrated by an application to the linear phase of ocular dominance column formation in primary visual cortex

Physiologically based neural field theory (NFT) is extended to encompass cortical plasticity dynamics. An illustrative application is provided which treats the evolution of the connectivity of left- and right-eye visual stimuli to neuronal populations in the primary visual cortex (V1), and the initial, linear phase of formation of approximately one-dimensional (1D) ocular dominance columns (ODCs) that sets their transverse spatial scale. This links V1 activity, structure, and physiology within a single theory that already accounts for a range of other brain activity and connectivity phenomena, thereby enabling ODC formation and many other phenomena to be interrelated and cortical parameters to be constrained across multiple domains. The results accord with experimental ODC widths for realistic cortical parameters and are based directly on a unified description of the neuronal populations involved, their connection strengths, and the neuronal activity they support. Other key results include simple analytic approximations for ODC widths and the parameters of maximum growth rate, constraints on cortical excitatory and inhibitory gains, elucidation of the roles of specific poles of the V1 response function, and the fact that ODCs are not formed when input stimuli are fully correlated between eyes. This work provides a basis for further generalization of NFT to model other plasticity phenomena, thereby linking them to the range multiscale phenomena accounted for by NFT.

Determination of Dynamic Brain Connectivity via Spectral Analysis

Spectral analysis based on neural field theory is used to analyze dynamic connectivity via methods based on the physical eigenmodes that are the building blocks of brain dynamics. These approaches integrate over space instead of averaging over time and thereby greatly reduce or remove the temporal averaging effects, windowing artifacts, and noise at fine spatial scales that have bedeviled the analysis of dynamical functional connectivity (FC). The dependences of FC on dynamics at various timescales, and on windowing, are clarified and the results are demonstrated on simple test cases, demonstrating how modes provide directly interpretable insights that can be related to brain structure and function. It is shown that FC is dynamic even when the brain structure and effective connectivity are fixed, and that the observed patterns of FC are dominated by relatively few eigenmodes. Common artifacts introduced by statistical analyses that do not incorporate the physical nature of the brain are discussed and it is shown that these are avoided by spectral analysis using eigenmodes. Unlike most published artificially discretized “resting state networks” and other statistically-derived patterns, eigenmodes overlap, with every mode extending across the whole brain and every region participating in every mode—just like the vibrations that give rise to notes of a musical instrument. Despite this, modes are independent and do not interact in the linear limit. It is argued that for many purposes the intrinsic limitations of covariance-based FC instead favor the alternative of tracking eigenmode coefficients vs. time, which provide a compact representation that is directly related to biophysical brain dynamics.

Dynamical patterns underlying response properties of cortical circuits

Recent experimental studies show cortical circuit responses to external stimuli display varied dynamical properties. These include stimulus strength-dependent population response patterns, a shift from synchronous to asynchronous states and a decline in neural variability. To elucidate the mechanisms underlying these response properties and explore how they are mechanistically related, we develop a neural circuit model that incorporates two essential features widely observed in the cerebral cortex. The first feature is a balance between excitatory and inhibitory inputs to individual neurons; the second feature is distance-dependent connectivity. We show that applying a weak external stimulus to the model evokes a wave pattern propagating along lateral connections, but a strong external stimulus triggers a localized pattern; these stimulus strength-dependent population response patterns are quantitatively comparable with those measured in experimental studies. We identify network mechanisms underlying this population response, and demonstrate that the dynamics of population-level response patterns can explain a range of prominent features in neural responses, including changes to the dynamics of neurons' membrane potentials and synaptic inputs that characterize the shift of cortical states, and the stimulus-evoked decline in neuron response variability. Our study provides a unified population activity pattern-based view of diverse cortical response properties, thus shedding new insights into cortical processing.

Functional mechanisms underlie the emergence of a diverse range of plasticity phenomena

Diverse plasticity mechanisms are orchestrated to shape the spatiotemporal dynamics underlying brain functions. However, why these plasticity rules emerge and how their dynamics interact with neural activity to give rise to complex neural circuit dynamics remains largely unknown. Here we show that both Hebbian and homeostatic plasticity rules emerge from a functional perspective of neuronal dynamics whereby each neuron learns to encode its own activity in the population activity, so that the activity of the presynaptic neuron can be decoded from the activity of its postsynaptic neurons. We explain how a range of experimentally observed plasticity phenomena with widely separated time scales emerge from learning this encoding function, including STDP and its frequency dependence, and metaplasticity. We show that when implemented in neural circuits, these plasticity rules naturally give rise to essential neural response properties, including variable neural dynamics with balanced excitation and inhibition, and approximately log-normal distributions of synaptic strengths, while simultaneously encoding a complex real-world visual stimulus. These findings establish a novel function-based account of diverse plasticity mechanisms, providing a unifying framework relating plasticity, dynamics and neural computation.

Many experiments have documented a variety of ways in which the connectivity strengths between neurons change in response to the activity of neurons. These changes are an important part of learning. However, it is not understood how such a diverse range of observations can be understood as consequences of an underlying algorithm used by brains for learning. In order to understand such a learning algorithm it is also necessary to understand the neural computation that is being learned, that is, how the functions of the brain are encoded in the activity of its neurons and its connectivity. In this work we propose a simple way in which information can be encoded and decoded in a network of neurons for operating on real-world stimuli, and how this can be learned using two fundamental plasticity rules that change the strength of connections between neurons in response to neural activity. Surprisingly, many experimental observations result as consequences of this approach, indicating that studying the learning of function provides a novel framework for unifying plasticity, dynamics, and neural computation.

Design and Synthesis of a Novel Series of Orally Bioavailable, CNS-Penetrant, Isoform Selective Phosphoinositide 3-Kinase γ (PI3Kγ) Inhibitors with Potential for the Treatment of Multiple Sclerosis (MS)

The lipid kinase phosphoinositide 3-kinase γ (PI3Kγ) has attracted attention as a potential target to treat a variety of autoimmune disorders, including multiple sclerosis, due to its role in immune modulation and microglial activation. By minimizing the number of hydrogen bond donors while targeting a previously uncovered selectivity pocket adjacent to the ATP binding site of PI3Kγ, we discovered a series of azaisoindolinones as selective, brain penetrant inhibitors of PI3Kγ. This ultimately led to the discovery of 16, an orally bioavailable compound that showed efficacy in murine experimental autoimmune encephalomyelitis (EAE), a preclinical model of multiple sclerosis.

Inference of direct and multistep effective connectivities from functional connectivity of the brain and of relationships to cortical geometry

BACKGROUND

The problem of inferring effective brain connectivity from functional connectivity is under active investigation, and connectivity via multistep paths is poorly understood.

NEW METHOD

A method is presented to calculate the direct effective connection matrix (deCM), which embodies direct connection strengths between brain regions, from functional CMs (fCMs) by minimizing the difference between an experimental fCM and one calculated via neural field theory from an ansatz deCM based on an experimental anatomical CM.

RESULTS

The best match between fCMs occurs close to a critical point, consistent with independent published stability estimates. Residual mismatch between fCMs is identified to be largely due to interhemispheric connections that are poorly estimated in an initial ansatz deCM due to experimental limitations; improved ansatzes substantially reduce the mismatch and enable interhemispheric connections to be estimated. Various levels of significant multistep connections are then imaged via the neural field theory (NFT) result that these correspond to powers of the deCM; these are shown to be predictable from geometric distances between regions.

COMPARISON WITH EXISTING METHODS

This method gives insight into direct and multistep effective connectivity from fCMs and relating to physiology and brain geometry. This contrasts with other methods, which progressively adjust connections without an overarching physiologically based framework to deal with multistep or poorly estimated connections.

CONCLUSIONS

deCMs can be usefully estimated using this method and the results enable multistep connections to be investigated systematically.

Determination of effective brain connectivity from functional connectivity with application to resting state connectivities

Neural field theory insights are used to derive effective brain connectivity matrices from the functional connectivity matrix defined by activity covariances. The symmetric case is exactly solved for a resting state system driven by white noise, in which strengths of connections, often termed effective connectivities, are inferred from functional data; these include strengths of connections that are underestimated or not detected by anatomical imaging. Proximity to criticality is calculated and found to be consistent with estimates obtainable from other methods. Links between anatomical, effective, and functional connectivity and resting state activity are quantified, with applicability to other complex networks. Proof-of-principle results are illustrated using published experimental data on anatomical connectivity and resting state functional connectivity. In particular, it is shown that functional connection matrices can be used to uncover the existence and strength of connections that are missed from anatomical connection matrices, including interhemispheric connections that are difficult to track with techniques such as diffusion spectrum imaging.

Discovery of Thienoimidazole-Based HCV NS5A Genotype 1a and 1b Inhibitors

The discovery of potent thienoimidazole-based HCV NS5A inhibitors is herein reported. A novel method to access the thienoimidazole [5,5]-bicyclic system is disclosed. This method gave access to a common key intermediate (6) that was engaged in Suzuki or Sonogashira reactions with coupling partners bearing different linkers. A detailed study of the structure-activity relationship (SAR) of the linkers revealed that aromatic linkers with linear topologies are required to achieve high potency for both 1a and 1b HCV genotypes. Compound 20, with a para-phenyl linker, was identified as a potential lead displaying potencies of 17 and 8 pM against genotype 1a and 1b replicons, respectively.

Spectral Characterization of Hierarchical Modularity in Product Architectures

Despite the importance of the architectural modularity of products and systems, existing modularity metrics or algorithms do not account for overlapping and hierarchically embedded modules. This paper presents a graph theoretic spectral approach to characterize the degree of modular hierarchical-overlapping organization in the architecture of products and complex engineered systems. It is shown that the eigenvalues of the adjacency matrix of a product architecture graph can reveal layers of hidden modular or hierarchical modular organization that are not immediately visible in the predefined architectural description. We use the approach to analyze and discuss several design, management, and system resilience implications for complex engineered systems.

Spectral characterization of hierarchical network modularity and limits of modularity detection

Many real world networks are reported to have hierarchically modular organization. However, there exists no algorithm-independent metric to characterize hierarchical modularity in a complex system. The main results of the paper are a set of methods to address this problem. First, classical results from random matrix theory are used to derive the spectrum of a typical stochastic block model hierarchical modular network form. Second, it is shown that hierarchical modularity can be fingerprinted using the spectrum of its largest eigenvalues and gaps between clusters of closely spaced eigenvalues that are well separated from the bulk distribution of eigenvalues around the origin. Third, some well-known results on fingerprinting non-hierarchical modularity in networks automatically follow as special cases, threreby unifying these previously fragmented results. Finally, using these spectral results, it is found that the limits of detection of modularity can be empirically established by studying the mean values of the largest eigenvalues and the limits of the bulk distribution of eigenvalues for an ensemble of networks. It is shown that even when modularity and hierarchical modularity are present in a weak form in the network, they are impossible to detect, because some of the leading eigenvalues fall within the bulk distribution. This provides a threshold for the detection of modularity. Eigenvalue distributions of some technological, social, and biological networks are studied, and the implications of detecting hierarchical modularity in real world networks are discussed.

Synthesis of alcohols from m-fluorophenylsulfones and dialkylboranes: application to the C14-C35 building block of E7389

The reaction of m-fluorophenylsulfone anions with dialkylboranes, followed by alkaline hydroperoxide oxidation, yields alcohols in high yields. Optimization of the process, scope and limitation, and application to the synthesis of one of the C14-C35 building blocks of E7389, a right half analogue of halichondrin B, are reported.

Geometric effects on complex network structure in the cortex

It is shown that homogeneous, short-range, two-dimensional (2D) cortical connectivity, without modularity, hierarchy, or other specialized structure, reproduces key observed properties of cortical networks, including low path length, high clustering and modularity index, and apparent hierarchical block-diagonal structure in connection matrices. Geometry strongly influences connection matrices, implying that simple interpretations of connectivity measures as reflecting specialized structure can be misleading: Such apparent structure is seen in strictly uniform, locally connected architectures in 2D. Geometry is thus a proxy for function, modularity, and hierarchy and must be accounted for when structural inferences are made.

Dramatic improvement in catalyst loadings and molar ratios of coupling partners for Ni/Cr-mediated coupling reactions: heterobimetallic catalysts

Two new ligands 1a,b are reported. Upon treatment with 1 equiv of NiCl(2) x (MeOCH(2))(2), 1a,b give the corresponding Ni complexes. X-ray analysis of 1a x NiCl(2) established that the NiCl(2) is selectively coordinated to the phenanthroline nitrogens. Ni/Cr heterobimetallic catalysts 1a,b x CrCl(2)/NiCl(2), prepared from 1a,b x NiCl(2), have been shown to behave exceptionally well in catalytic asymmetric Ni/Cr-mediated couplings, with highlights including the following: (1) 1-2 mol % catalyst is sufficient to complete the coupling; (2) only negligible amounts of the dimers, byproducts formed through the alkenyl Ni species, are observed; (3) the coupling goes to completion even with a 1:1 molar ratio of the coupling partners; and (4) the asymmetric induction is practically identical with that obtained from the coupling with the Cr catalysts prepared from (S)-sulfonamides 2a,b. The scope of the new Ni/Cr heterobimetallic catalysts was briefly studied using four additional aldehydes. The applicability of the new catalysts to polyfunctional substrates was demonstrated by two C-C bond formations chosen from the halichondrin/E7389 synthesis as examples.

Concurrent differentiation of marrow stromal cells to osteogenic and vasculogenic lineages

When rat bone marrow stromal (BMS) cells were seeded on aligned type I collagen scaffolds and cultured in osteogenic media, they underwent simultaneous maturation and differentiation into osteogenic and vascular cell lineages. In addition, these cells produced mineralized matricellular deposits. BMS cells were seeded in Petri dish or the collagen scaffold, cultured in osteogenic media for 3, 6, and 9 d and subsequently processed for immunohistochemical and cytochemical analysis. Immunolocalization of lineage-specific proteins were visualized using confocal microscopy and mRNA transcript analysis was performed by real-time quantitative polymerase chain reaction (RT-qPCR). The alkaline phosphatase activity and calcium content significantly increased over the observed period of time in an osteogenic medium. Sheets of abundant Pecam (CD31), Flk-1 (VEGFR-2), tomato lectin (TL/LEL), and alpha-smooth muscle actin (alpha-SMA) positive cells were observed in the collagen scaffolds. Nascent capillary-like vessels were also seen amidst the osteoblasts in osteogenic culture, augmenting the maturation and differentiation of BMS cells into osteoblasts. In our in vitro study, concurrent differentiation of BMS cells, a heterogeneous cell population with multilineage differentiation potential, to osteogenic and vascular lineages demonstrated that the substrates (three-dimensional (3-D), collagen type I, aligned fibrils) had a profound effect on guiding the differentiation pathway of BMS cells.

Dynamical reconnection and stability constraints on cortical network architecture

Stability under dynamical changes to network connectivity is invoked alongside previous criteria to constrain brain network architecture. A new hierarchical network is introduced that satisfies all these constraints, unlike more commonly studied regular, random, and small-world networks. It is shown that hierarchical networks can simultaneously have high clustering, short path lengths, and low wiring costs, while being robustly stable under large scale reconnection of substructures.

A total synthesis of norhalichondrin B

Four corners: The syntheses of four key building blocks for the total synthesis of norhalichondrin B (see structure) are described. The assembly of these subunits into the natural product is also reported. Key features of the synthesis are the use of the Achmatowicz oxidation/ionic hydrogenation for the synthesis of pyrans and pyranopyrans, and the application of tandem metathesis for the synthesis of pyranopyrans.

Unique responses of midbrain CART neurons in macaques to ovarian steroids

CART (cocaine and amphetamine regulated transcript) is a neuropeptide involved in the control of several physiological processes, such as response to psychostimulants, food intake, depressive diseases and neuroprotection. It is robustly expressed in the brain, mainly in regions that control emotional and stress responses and it is regulated by estrogen in the hypothalamus. There is a distinct population of CART neurons located in the vicinity of the Edinger-Westphal nucleus of the midbrain that also colocalize urocortin-1. The aims of this study were 1) to determine the distribution of CART immunoreactive neurons in the monkey midbrain, 2) to examine the effects of estrogen (E) and progesterone (P) on midbrain CART mRNA and peptide expression and 3) to determine whether midbrain CART neurons contain steroid receptors. Adult female rhesus monkeys (Macaca mulatta) were spayed and either treated with placebo (OVX), estrogen alone (E), progesterone alone (P) or E+P. Animals were prepared (a) for RNA extraction followed by microarray analysis and quantitative (q) RT-PCR (n=3/group); (b) for immunohistochemical analysis of CART and CART+tryptophan hydroxylase (TPH), CART+estrogen receptors (ER) or CART+progesterone receptors (n=5/group) and (c) for Western blots (n=3/group). Both E- and E+P-administration decreased CART gene expression on the microarray and with qRT-PCR. Stereological analysis of CART immunostaining at five levels of the Edinger-Westphal nucleus indicated little effect of E or E+P administration on the area of CART immunostaining. However, P administration increased CART-immunopositive area in comparison to the OVX control group with Student's t-test, but not with ANOVA. CART 55-102 detection on Western blot was unchanged by hormone administration. ERbeta and PR were detected in CART neurons and CART fibers appeared to innervate TPH-positive serotonin neurons in the dorsal raphe. In summary, E decreased CART mRNA, but this effect did not translate to the protein level. Moreover, P administration alone had a variable effect on CART mRNA, but it caused an increase in CART immunostaining. Together, the data suggest that CART neurons in the midbrain have a unique steroid response, which may be mediated by nuclear receptors, neuroactive steroids or interneurons.

Differential effects of ovarian steroids and raloxifene on serotonin 1A and 2C receptor protein expression in macaques

To further understand the role of ovarian hormones in the function of the serotonin neural system, we investigated the effects of estradiol (E), progesterone (P), and raloxifene on 5HT 1A and 2C receptor protein expression in the dorsal raphe region using Western blot analysis. Adult rhesus macaques (Macaca mulatta) were ovariectomized (Ovx) and implanted with Silastic capsules containing E or P. In the first paradigm, animals that had been Ovx for 6-16 months were treated for 1 month with E (El) or E + P (EP1) and compared to animals that were untreated and Ovx for 5 months (n = 4 per group). In the second paradigm, comparisons were made between animals that were Ovx and untreated for 5 months, or Ovx and immediately implanted with Silastic capsules containing E or E + P for 5 months (E5, EP5), or administered raloxifene in the diet for 5 months (Ral5) (n = 4 per group). The dorsal raphe region was harvested, homogenized and a crude membrane fraction was obtained for examination of receptor proteins. In the first paradigm, 5HT1A receptor protein expression was significantly lower in E1 and EPI treatment groups compared to the Ovx-control group (ANOVA P = 0.01; posthoc P < 0.03), but 5HT2C receptor expression was unaffected by 1 month of E or EP treatment. In the second paradigm, there was no difference in 5HT1A receptor expression between the Ovx-control group and the E5 group, but 5HT1A receptor expression was significantly suppressed in the EP5 group (ANOVA P = 0.04; posthoc P < 0.05). In addition, 5HT2C expression increased in the E5 treatment group relative to the Ovx-control group. Addition of P to the E5 regimen prevented the E5-induced increase in 5HT2C receptor expression and significantly reduced 5HT2C receptor expression to a level below that observed in the Ovx-control group (ANOVA P = 0.001; posthoc P < 0.05). Thus, 5HT1A receptor may lose sensitivity to the suppressive effect of E after 5 months, whereas the 5HT2C receptor increases. However, addition of P in the EP5 regimen maintains the regulatory effects observed with 1 month of treatment. 5HT1A receptor protein levels were higher with raloxifene treatment than in Ovx-control animals (P < 0.01), suggesting that raloxifene may antagonize residual E in Ovx animals.

A synthesis of the C1-C15 domain of the halichondrins

A concise route to the C1-C15 domain of the halichondrins is described. The key reaction is the conversion of a furfuryl alcohol to a pyranone. The stereocenter of this pyranone serves as the starting point for the other 8 stereocenters.

A prospective cohort of American Indian and Alaska Native people: study design, methods, and implementation

In 2001, the National Cancer Institute funded three centers to test the feasibility of establishing a cohort of American Indian and Alaska Native people. Participating tribal organizations named the study EARTH (Education and Research Towards Health). This paper describes the study methods. A computerized data collection and tracking system was developed using audio computer-assisted survey methodology with touch screens. Data were collected on diet, physical activity, lifestyle and cultural practices, medical and reproductive history, and family history of heart disease, diabetes, and cancer. In addition, a small panel of medical measurements was obtained, including height, weight, waist and hip circumferences, blood pressure, and a lipid panel plus glucose. At the completion of the enrollment visit, data were used to provide immediate health feedback to study participants. During the initial funding period, the authors anticipate enrolling 16,000 American Indian and Alaska Native participants. The age distribution of the study population was similar to that reported in the 2000 US Census for the relevant populations. A component critical to the success of the EARTH Study has been the partnerships with tribal members. The study has focused on involvement of American Indian and Alaska Native communities in development and implementation and on provision of feedback to participants and communities.

Multielectrode electroencephalogram power spectra: theory and application to approximate correction of volume conduction effects

Using a physiologically based model of brain activity, electroencephalogram (EEG) power spectra are calculated for signals derived from general linear combinations of voltages from multiple electrodes, with and without filtering by volume conduction. Two simple methods of combining scalp measurements to estimate unfiltered EEG power spectra are then proposed and their accuracy and robustness are explored, using the model predictions as an illustration. It is found that these methods, including a case that uses just three electrodes, enable improved estimation of the underlying spectrum relative to each of several widely used combinations alone.

Requirement of Staphylococcus aureus ATP-binding cassette-ATPase FhuC for iron-restricted growth and evidence that it functions with more than one iron transporter

In Staphylococcus aureus, fhuCBG encodes an ATP-binding cassette (ABC) transporter that is required for the transport of iron(III)-hydroxamates; mutation of either fhuB or fhuG eliminates transport. In this paper, we describe construction and characterization of an S. aureus fhuCBG deletion strain. The delta fhuCBG::ermC mutation not only resulted in a strain that was incapable of growth on iron(III)-hydroxamates as a sole source of iron but also resulted in a strain which had a profound growth defect in iron-restricted laboratory media. The growth defect was not a result of the inability to transport iron(III)-hydroxamates since S. aureus fhuG::Tn917 and S. aureus fhuD1::Km fhuD2::Tet mutants, which are also unable to transport iron(III)-hydroxamates, do not have similar iron-restricted growth defects. Complementation experiments demonstrated that the growth defect of the delta fhuCBG::ermC mutant was the result of the inability to express FhuC and that this was the result of an inability to transport iron complexed to the S. aureus siderophore staphylobactin. Transport of iron(III)-staphylobactin is dependent upon SirA (binding protein), SirB (permease), and SirC (permease). S. aureus expressing FhuC with a Walker A K42N mutation could not utilize iron(III)-hydroxamates or iron(III)-staphylobactin as a sole source of iron, supporting the conclusion that FhuC, as expected, functions with FhuB, FhuG, and FhuD1 or FhuD2 to transport iron(III)-hydroxamates and is the "genetically unlinked" ABC-ATPase that functions with SirA, SirB, and SirC to transport iron(III)-staphylobactin. Finally, we demonstrated that the delta fhuCBG::ermC strain had decreased virulence in a murine kidney abscess model.

Triphasic oral contraceptive treatment alters the behavior and neurobiology of female cynomolgus monkeys

Oral contraceptives (OCs) are the most widely prescribed and effective of the reversible contraceptive methods. In addition to inhibiting ovulation, OCs alter central nervous system function in women; however, methodological problems have prevented clear human studies. Thus, in this experiment we investigated the effects of OC treatment on behavior, hypothalamic- pituitary-adrenal axis function and the central nervous system in 75 adult female cynomolgus monkeys (Macaca fascicularis) housed in social groups of four to five monkeys per pen. Monkey social groups were randomly divided into either a control or an OC treatment group which was administered a clinically prescribed OC (Triphasil(R), levonorgestrel and ethinyl estradiol tablets) for 2 years. OC treatment increased the frequency of contact aggression received, time spent in locomotion, and sitting close to another animal, and decreased time spent fearfully scanning. OC treatment decreased heart rate, increased activity levels, and increased baseline cortisol concentrations and the cortisol response to adrenocorticotropin compared to control animals. OC treatment decreased the prolactin response to fenfluramine suggesting decreased serotonergic activity. These results suggest that this triphasic OC disrupts social behavior, hypothalamic-pituitary-adrenal axis regulation and the underlying central nervous system function.

Soy and social stress affect serotonin neurotransmission in primates

Stress and sex steroidal milieu can each influence mood in women. The purpose of this study was to compare the effect of long-term conjugated equine estrogen (CEE), soy phytoestrogen (SPE), and social subordination stress on dorsal raphe serotonin neurotransmission of ovariectomized cynomolgus monkeys. Tryptophan hydroxylase (TPH) and serotonin reuptake transporter (SERT) protein content were determined, and the in vitro degradation of macaque SERT protein was examined in the presence and absence of protease inhibitors, serotonin (5-HT), and citalopram. Like CEE, SPE increased TPH protein levels. Social subordinates had markedly lower TPH protein levels than dominants regardless of hormone replacement. Therefore, these two variables had independent and additive effects. CEE and SPE increased SERT, and social status had no effect. Thus, the hormone-induced increase in SERT was accompanied by increased 5-HT synthesis and neuronal firing, which appears biologically reasonable as 5-HT prevented SERT degradation in vitro.

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study

OBJECTIVES

To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians.

RESEARCH METHODS AND PROCEDURES

Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins.

RESULTS

Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal.

DISCUSSION

The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.

A re-evaluation of tinnitus reliability testing

The purposes of these investigations were to (1) evaluate tinnitus loudness measures of unskilled normal listeners asked to imagine that they are experiencing a constant monaural tonal tinnitus and (2) compare the performance of these listeners to that of a sample of patients with tinnitus. Subgroups of 24 patients participated in two investigations. Results suggest that (1) normal subjects asked to imagine a high-pitched, tonal tinnitus show significantly greater tinnitus loudness matching levels (a) when they do not have an external reference, (b) after a 1-week interval, and (c) for low-frequency matching tones; (2) patients with high-pitched tinnitus did not demonstrate statistically significant differences in tinnitus loudness judgments within or between sessions or frequencies; (3) tinnitus patients do not differ significantly from normals feigning tinnitus in the variability of tinnitus loudness matching levels within a single session (two measures) or after a 1-week interval (one measure); and (4) normals feigning tinnitus tended to choose significantly greater loudness matching levels than did tinnitus subjects.

Glycemic control in diabetic American Indians. Longitudinal data from the Strong Heart Study

OBJECTIVE

To describe glycemic control and identify correlates of elevated HbA1c levels in diabetic American Indians participating in the Strong Heart Study, which is a longitudinal study of cardiovascular disease in American Indians in Arizona, Oklahoma, South Dakota, and North Dakota.

RESEARCH DESIGN AND METHODS

This analysis is based on data from the baseline (1989-1992) and first follow-up (1994-1995) examinations of the Strong Heart Study. The 1,581 diabetic participants included in this analysis were aged 45-74 years at baseline, were diagnosed with diabetes before and at baseline, and had their HbA1c levels measured at follow-up. HbA1c was used as the index of glycemic control. Characteristics that may affect glycemic control were evaluated for cross-sectional and longitudinal relationships by analysis of covariance and multiple regression.

RESULTS

There was no significant difference between median HbA1c at baseline (8.4%) and at follow-up (8.5%). Sex, age (inversely), and insulin and oral hypoglycemic agent therapy were significantly related to HbA1c levels in both the cross-sectional and longitudinal analyses. Current smoking, prior use of alcohol, and duration of diabetes were significant only for the cross-sectional data. Baseline HbA1c significantly and positively predicted HbA1c levels at follow-up. Comparison of HbA1c by therapy type shows that insulin therapy produced a significant decrease in HbA1c between the baseline and follow-up examinations.

CONCLUSIONS

Glycemic control was poor among diabetic American Indians participating in the Strong Heart Study. Women, patients taking insulin or oral hypoglycemic agents, and younger individuals had the worst control of all the participants. Baseline HbA1c, and weight loss predicted worsening of control, whereas insulin therapy predicted improvement in control. Additional therapies and/or approaches are needed to improve glycemic control in this population.

Surgery centers continue pattern of growth

The number of outpatient surgery centers grew at an 11% clip in 1990, fueled by the continued shift of patients and procedures to the outpatient setting, according to a recent survey by SMG Marketing Group, a Chicago-based healthcare consulting and market research firm. But while figures project continued growth, competition and government regulation could limit future expansion.

Assessment of attitudes toward school-based health promotion programs

Teachers from Orleans Parish public junior and senior high schools completed a survey designed to assess their health-related behaviors and their attitudes toward school-based health promotion programs. Findings suggest that teachers' behaviors and attitudes, as well as school policies toward smoking, are not optimal to creating a pro-health promotion environment. While teachers recognize the value of preventive programs for adolescents and many feel well qualified to implement such programs, few actually do. Resolution of these discrepancies are necessary early steps in increasing primary efforts needed for cancer control in Louisiana.

Emerging contract incentives can add to hospitals' savings

Group purchasing organizations are trying to draw more volume out of their hospital members by offering additional price breaks if purchases meet performance targets, says John Henderson. The purchasing groups see the approach as a way to keep their promise to manufacturers of volume in return for discounts.

Survey. Surgery centers continue making inroads

The number of surgery centers grew more than 25% in 1989, and these outposts now perform one of every six outpatient procedures. Ten years ago, hospital-based surgery suites handled 98% of the market.