Empowering Participatory Research in Urban Health: Wearable Biometric and Environmental Sensors for Activity Recognition

Participatory exposure research, which tracks behaviour and assesses exposure to stressors like air pollution, traditionally relies on time-activity diaries. This study introduces a novel approach, employing machine learning (ML) to empower laypersons in human activity recognition (HAR), aiming to reduce dependence on manual recording by leveraging data from wearable sensors. Recognising complex activities such as smoking and cooking presents unique challenges due to specific environmental conditions. In this research, we combined wearable environment/ambient and wrist-worn activity/biometric sensors for complex activity recognition in an urban stressor exposure study, measuring parameters like particulate matter concentrations, temperature, and humidity. Two groups, Group H (88 individuals) and Group M (18 individuals), wore the devices and manually logged their activities hourly and minutely, respectively. Prioritising accessibility and inclusivity, we selected three classification algorithms: k-nearest neighbours (IBk), decision trees (J48), and random forests (RF), based on: (1) proven efficacy in existing literature, (2) understandability and transparency for laypersons, (3) availability on user-friendly platforms like WEKA, and (4) efficiency on basic devices such as office laptops or smartphones. Accuracy improved with finer temporal resolution and detailed activity categories. However, when compared to other published human activity recognition research, our accuracy rates, particularly for less complex activities, were not as competitive. Misclassifications were higher for vague activities (resting, playing), while well-defined activities (smoking, cooking, running) had few errors. Including environmental sensor data increased accuracy for all activities, especially playing, smoking, and running. Future work should consider exploring other explainable algorithms available on diverse tools and platforms. Our findings underscore ML's potential in exposure studies, emphasising its adaptability and significance for laypersons while also highlighting areas for improvement.

Simulating the impact of particulate matter exposure on health-related behaviour: A comparative study of stochastic modelling and personal monitoring data

Epidemiological and exposure studies concerning particulate matter (PM) often rely on data from sparse governmental stations. While low-cost personal monitors have some drawbacks, recent developments have shown that they can provide fairly accurate and fit-for-purpose data. Comparing a stochastic, i.e., agent-based model (ABM), with environmental, biometric and activity data, collected with personal monitors, could provide insight into how the two approaches assess PM exposure and dose. An ABM was constructed, simulating a PM exposure/dose assessment of 100 agents. Their actions were governed by inherent probabilities of performing an activity, based on population data. Each activity was associated with an intensity level, and a PM pollution level. The ABM results were compared with real-world results. Both approaches had comparable results, showing similar trends and a mean dose. Discrepancies were seen in the activities with the highest mean dose values. A stochastic model, based on population data, does not capture well some specifics of a local population. Combined, personal sensors could provide input for calibration, and an ABM approach can help offset a low number of participants. Implementing a function of agents influencing others transport choice, increased the importance of cycling/walking in the overall dose estimate. Activists, agents with an increased transport influence, did not play an important role at low PM levels. As concentrations rose, higher shares of activists (and their influence) caused the dose to increase. Simulating a person's PM exposure/dose in different scenarios and activities in a virtual environment provides researchers and policymakers with a valuable tool.

Integrated assessment of personal monitor applications for evaluating exposure to urban stressors: A scoping review

Urban stressors pose a health risk, and individual-level assessments provide necessary and fine-grained insight into exposure. An ever-increasing amount of research literature on individual-level exposure to urban stressors using data collected with personal monitors, has called for an integrated assessment approach to identify trends, gaps and needs, and provide recommendations for future research. To this end, a scoping review of the respective literature was performed, as part of the H2020 URBANOME project. Moreover, three specific aims were identified: (i) determine current state of research, (ii) analyse literature according with a waterfall methodological framework and identify gaps and needs, and (iii) provide recommendations for more integrated, inclusive and robust approaches. Knowledge and gaps were extracted based on a systematic approach, e.g., data extraction questionnaires, as well as through the expertise of the researchers performing the review. The findings were assessed through a waterfall methodology of delineating projects into four phases. Studies described in the papers vary in their scope, with most assessing exposure in a single macro domain, though a trend of moving towards multi-domain assessment is evident. Simultaneous measurements of multiple stressors are not common, and papers predominantly assess exposure to air pollution. As urban environments become more diverse, stakeholders from different groups are included in the study designs. Most frequently (per the quadruple helix model), civil society/NGO groups are involved, followed by government and policymakers, while business or private sector stakeholders are less frequently represented. Participants in general function as data collectors and are rarely involved in other phases of the research. While more active involvement is not necessary, more collaborative approaches show higher engagement and motivation of participants to alter their lifestyles based on the research results. The identified trends, gaps and needs can aid future exposure research and provide recommendations on addressing different urban communities and stakeholders.

Assessment of Individual-Level Exposure to Airborne Particulate Matter during Periods of Atmospheric Thermal Inversion

Air pollution exposure is harmful to human health and reducing it at the level of an individual requires measurements and assessments that capture the spatiotemporal variability of different microenvironments and the influence of specific activities. In this paper, activity-specific and general indoor and outdoor exposure during and after a period of high concentrations of particulate matter (PM), e.g., an atmospheric thermal inversion (ATI) in the Ljubljana subalpine basin, Slovenia, was assessed. To this end, personal particulate matter monitors (PPM) were used, worn by participants of the H2020 ICARUS sampling campaigns in spring 2019 who also recorded their hourly activities. ATI period(s) were determined based on data collected from two meteorological stations managed by the Slovenian Environmental Agency (SEA). Results showed that indoor and outdoor exposure to PM was significantly higher during the ATI period, and that the difference between mean indoor and outdoor exposure to PM was much higher during the ATI period (23.0 µg/m3) than after (6.5 µg/m3). Indoor activities generally were associated with smaller differences, with cooking and cleaning even having higher values in the post-ATI period. On the other hand, all outdoor activities had higher PM values during the ATI than after, with larger differences, mostly >30.0 µg/m3. Overall, this work demonstrated that an individual-level approach can provide better spatiotemporal resolution and evaluate the relative importance of specific high-exposure events, and in this way provide an ancillary tool for exposure assessments.

User-Centred Design of a Final Results Report for Participants in Multi-Sensor Personal Air Pollution Exposure Monitoring Campaigns

Using low-cost portable air quality (AQ) monitoring devices is a growing trend in personal exposure studies, enabling a higher spatio-temporal resolution and identifying acute exposure to high concentrations. Comprehension of the results by participants is not guaranteed in exposure studies. However, information on personal exposure is multiplex, which calls for participant involvement in information design to maximise communication output and comprehension. This study describes and proposes a model of a user-centred design (UCD) approach for preparing a final report for participants involved in a multi-sensor personal exposure monitoring study performed in seven cities within the EU Horizon 2020 ICARUS project. Using a combination of human-centred design (HCD), human-information interaction (HII) and design thinking approaches, we iteratively included participants in the framing and design of the final report. User needs were mapped using a survey (n = 82), and feedback on the draft report was obtained from a focus group (n = 5). User requirements were assessed and validated using a post-campaign survey (n = 31). The UCD research was conducted amongst participants in Ljubljana, Slovenia, and the results report was distributed among the participating cities across Europe. The feedback made it clear that the final report was well-received and helped participants better understand the influence of individual behaviours on personal exposure to air pollution.

Harmonization and Visualization of Data from a Transnational Multi-Sensor Personal Exposure Campaign

Use of a multi-sensor approach can provide citizens with holistic insights into the air quality of their immediate surroundings and their personal exposure to urban stressors. Our work, as part of the ICARUS H2020 project, which included over 600 participants from seven European cities, discusses the data fusion and harmonization of a diverse set of multi-sensor data streams to provide a comprehensive and understandable report for participants. Harmonizing the data streams identified issues with the sensor devices and protocols, such as non-uniform timestamps, data gaps, difficult data retrieval from commercial devices, and coarse activity data logging. Our process of data fusion and harmonization allowed us to automate visualizations and reports, and consequently provide each participant with a detailed individualized report. Results showed that a key solution was to streamline the code and speed up the process, which necessitated certain compromises in visualizing the data. A thought-out process of data fusion and harmonization of a diverse set of multi-sensor data streams considerably improved the quality and quantity of distilled data that a research participant received. Though automation considerably accelerated the production of the reports, manual and structured double checks are strongly recommended.

Narrative review of citizen science in environmental epidemiology: Setting the stage for co-created research projects in environmental epidemiology

Several citizen science (CS) initiatives have been adopted in environmental science to monitor air and noise pollution, and water quality related to civic concerns. Nevertheless, CS projects in environmental epidemiology remain scarce. This is because little attention has been paid to evaluate associations of environmental exposures with health effects directly. This narrative review aims to promote the understanding and application of CS in environmental epidemiology. There are many commonalities between CS and other participatory approaches in environmental epidemiology. Yet, CS can foster the democratization of scientific governance and enhance the sustainability of research projects more effectively than other existing participatory approaches. This is especially the case in projects where citizens are invited to participate, engage and become involved throughout all the phases of a research project (co-created projects). This paper identifies various challenges and opportunities specific to the implementation of co-created CS projects in environmental epidemiology. The development of more locally relevant research designs, using local knowledge, obtaining medical ethical clearance, and co-analysing the association between exposure and health, are examples of opportunities and challenges that require epidemiologists to go beyond the traditional research framework and include more outreach activities. Continued efforts, particularly the sharing of information about projects' collaborative processes, are needed to make CS a more concrete and cohesive approach in environmental epidemiology.

Comparing Airborne Particulate Matter Intake Dose Assessment Models Using Low-Cost Portable Sensor Data

Low-cost sensors can be used to improve the temporal and spatial resolution of an individual's particulate matter (PM) intake dose assessment. In this work, personal activity monitors were used to measure heart rate (proxy for minute ventilation), and low-cost PM sensors were used to measure concentrations of PM. Intake dose was assessed as a product of PM concentration and minute ventilation, using four models with increasing complexity. The two models that use heart rate as a variable had the most consistent results and showed a good response to variations in PM concentrations and heart rate. On the other hand, the two models using generalized population data of minute ventilation expectably yielded more coarse information on the intake dose. Aggregated weekly intake doses did not vary significantly between the models (6-22%). Propagation of uncertainty was assessed for each model, however, differences in their underlying assumptions made them incomparable. The most complex minute ventilation model, with heart rate as a variable, has shown slightly lower uncertainty than the model using fewer variables. Similarly, among the non-heart rate models, the one using real-time activity data has less uncertainty. Minute ventilation models contribute the most to the overall intake dose model uncertainty, followed closely by the low-cost personal activity monitors. The lack of a common methodology to assess the intake dose and quantifying related uncertainties is evident and should be a subject of further research.

End-User Feedback on a Low-Cost Portable Air Quality Sensor System-Are We There Yet?

Low-cost sensors are a current trend in citizen science projects that focus on air quality. Until now, devices incorporating such sensors have been tested primarily for their technical capabilities and limitations, whereas their usability and acceptability amongst the public rarely goes beyond proof of concept, leaving user experience (UX) unstudied. The authors argue that UX should be taken into account to make sure that products and services are fit for purpose. Nineteen volunteers tested and evaluated a prototype device and provided feedback through semi-structured interviews and during focus group sessions. Their UX was then coded using mixed coding methods regarding device functionality and recommendations for future product development. The results indicate that UX can identify potentially problematic design aspects while giving deeper insights into user needs. For example, UX recognized that one of the most important aspects of user involvement and motivation was successful data harvesting, which frequently failed. This study recommends that future developers of low-cost portable air quality sensor systems prioritize reliable data transmission to minimize data loss. This will ensure an efficient and positive UX that supports user engagement in citizen science based research where collecting sensor-based data is the primary objective.

In situ degradation studies of two-dimensional WSe₂-graphene heterostructures

Heterostructures of two-dimensional materials can be vulnerable to thermal degradation due to structural and interfacial defects as well as thermal expansion mismatch, yet a systematic study does not exist in the literature. In this study, we investigate the degradation of freestanding WSe2-graphene heterostructures due to heat and charge flow by performing in situ experiments inside a transmission electron microscope. Experimental results show that purely thermal loading requires higher temperatures (>850 °C), about 150 °C higher than that under combined electrical and thermal loading. In both cases, selenium is the first element to decompose and migration of silicon atoms from the test structure to the freestanding specimen initiates rapid degradation through the formation of tungsten disilicide and silicon carbide. The role of the current flow is to enhance the migration of silicon from the sample holder and to knock-out the selenium atoms. The findings of this study provide fundamental insights into the degradation of WSe2-graphene heterostructures and inspire their application in electronics for use in harsh environments.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 μm diameter hot core.

Isolation and Characterization of Neisseria meningitidis Groups A, C, X, and Y Polysaccharide Antigens

To prepare Neisseria meningitidis groups A, C, X, and Y polysaccharide antigens, culture supernatant fluids were subjected to serial processes of salt precipitation, alkaline hydrolysis, ethyl alcohol precipitation, and Sephadex G-200 chromatography. This method resulted in the isolation of large quantities of group antigens. All are acidic polysaccharides, the group C antigen being a polymer of n-acetyl neuraminic acid. Thiobarbituric acid assay failed to reveal sialic acids in the other group antigens. Protein was undetectable by absorption at 280 nm or by Folin analysis. These antigens are of similar molecular size, the majority of which are excluded by Sephadex G-200. They migrate in the upper one-third of sucrose density gradients and are retained by 5% acrylamide gel. All are highly group-specific and react only with homologous hyperimmune antisera in hemagglutination, complement fixation, and immunodiffusion systems. As little as 0.03 mumoles of n-acetyl neuraminic acid in group C antigen inhibits the hemagglutination of group C-sensitized red cells. All antigens are immunogenic in rabbits. These techniques afford a simplified method for the production of relatively large yields of highly specific group antigens which participate in multiple immunologic systems.

Kinetics of hydrogen consumption by rumen fluid, anaerobic digestor sludge, and sediment

Michaelis-Menten kinetic parameters for H(2) consumption by three methanogenic habitats were determined from progress curve and initial velocity experiments. The influences of mass transfer resistance, endogenous H(2) production, and growth on apparent parameter estimates were also investigated. Kinetic parameters could not be determined for undiluted rumen fluid and some digestor sludge from gas-phase measurements of H(2), since mass transfer of H(2) across the gas-liquid interface was rate limiting. However, accurate values were obtained once the samples were diluted. H(2) consumption by digestor sludge with a long retention time and by hypereutrophic lake sediment was not phase transfer limited. The K(m) values for H(2) uptake by these habitats were similar, with means of 5.8, 6.0, and 7.1 muM for rumen fluid, digestor sludge, and sediment, respectively. V(max) estimates suggested a ratio of activity of approximately 100 (rumen fluid):10 (sludge):1 (sediment); their ranges were as follows: rumen fluid, 14 to 28 mM h; Holt sludge, 0.7 to 4.3 mM h; and Wintergreen sediment, 0.13 to 0.49 mM h. The principles of phase transfer limitation, studied here for H(2), are the same for all gaseous substrates and products. The limitations and errors associated with gas phase determination of kinetic parameters were evaluated with a mathematical model that combined mass transport and Michaelis-Menten kinetics. Three criteria are described which can be used to evaluate the possibility that a phase transfer limitation exists. If it does not exist, (i) substrate consumption curves are Michaelis-Menten and not first order, (ii) the K(m) is independent of initial substrate concentration, and (iii) the K(m) is independent of biomass (V(max)) and remains constant with dilution of sample. Errors in the Michaelis-Menten kinetic parameters are caused by endogenously produced H(2), but they were <15% for rumen fluid and 10% for lake sediment and digestor sludge. Increases in V(max) during the course of progress curve experiments were not great enough to produce systematic deviations from Michaelis-Menten kinetics.

Interspecies acetate transfer influences the extent of anaerobic benzoate degradation by syntrophic consortia

Benzoate degradation by an anaerobic, syntrophic bacterium, strain SB, in coculture with Desulfovibrio sp. strain G-11 reached a threshold value which depended on the amount of acetate added and ranged from about 2.5 to 29.9 (mu)M. Increasing acetate concentrations also uncompetitively inhibited benzoate degradation. The apparent V(infmax) and apparent K(infm) for benzoate degradation decreased with increasing acetate concentration, but the benzoate degradation capacities (V(infmax)/K(infm)) of cell suspensions remained comparable. The addition of an acetate-using bacterium to cocultures after the threshold was reached resulted in the degradation of benzoate to below the detection limit. Mathematical simulations showed that the benzoate threshold was not predicted by the inhibitory effect of acetate on benzoate degradation kinetics. With nitrate instead of sulfate as the terminal electron acceptor, no benzoate threshold was observed in the presence of 20 mM acetate even though the kinetics of benzoate degradation were slower with nitrate rather than sulfate as the electron acceptor. When strain SB was grown with Desulfovibrio sp. strain DG2 that had a fourfold-lower V(infmax) for hydrogen use than strain G-11, the V(infmax) for benzoate degradation was 37-fold lower than that of strain SB-G-11 cocultures. The Gibb's free energy for benzoate degradation was less negative in cell suspensions with a threshold than in suspensions without a threshold. These studies showed that the threshold was not a function of the inhibition of benzoate degradation by acetate or the toxicity of the undissociated form of acetate. Rather, a critical or minimal Gibb's free energy may exist where thermodynamic constraints preclude further benzoate degradation.

Kinetics of microbial dehalogenation of haloaromatic substrates in methanogenic environments

The kinetic parameters associated with the microbial dehalogenation of 3-chlorobenzoate, 3,5-dichlorobenzoate, and 4-amino-3,5-dichlorobenzoate were measured in anoxic sediment slurries and in an enriched methanogenic culture grown on 3-chlorobenzoate. The initial dehalogenation of the substrates exhibited Michaelis-Menten kinetics. The apparent K(m) values for the above substrates ranged from 30 to 67 muM. The pattern of degradation, however, was unusual. The enrichment culture accumulated partially dehalogenated intermediates to 72 and 98% of that possible when incubated with either 3,5-dichloro- or 4-amino-3,5-dichlorobenzoate, respectively, but did not accumulate significant amounts of benzoate when 3-chlorobenzoate was the sole carbon and energy source. The accumulated intermediates were rapidly metabolized only after the parent substrate concentrations were nearly depleted (<5 muM). A sequential Michaelis-Menten model was developed to account for the observed pattern of biodegradation. Using this model, we found that relative differences in the K(m) and V(max) parameters for substrate and intermediate dehalogenations alone were insufficient to explain the transitory accumulation of intermediates. However, by inserting a competitive inhibition term, with the primary substrate as the inhibitor, the observed pattern of degradation was simulated. Apparently, the dichlorinated substrates competitively inhibit the dehalogenation of the monochlorinated substrates. Similar kinetic patterns were noted for sediments, although the rates were slower than in the enrichment culture.

Recent progress in the discovery of macrocyclic compounds as potential anti-infective therapeutics

Novel therapeutic strategies are urgently needed for the treatment of serious diseases caused by viral, bacterial and parasitic infections, because currently used drugs are facing the problem of rapidly emerging resistance. There is also an urgent need for agents that act on novel pathogen-specific targets, in order to expand the repertoire of possible therapies. The high throughput screening of diverse small molecule compound libraries has provided only a limited number of new lead series, and the number of compounds acting on novel targets is even smaller. Natural product screening has traditionally been very successful in the anti-infective area. Several successful drugs on the market as well as other compounds in clinical development are derived from natural products. Amongst these, many are macrocyclic compounds in the 1-2 kDa size range. This review will describe recent advances and novel drug discovery approaches in the anti-infective area, focusing on synthetic and natural macrocyclic compounds for which in vivo proof of concept has been established. The review will also highlight the Protein Epitope Mimetics (PEM) technology as a novel tool in the drug discovery process. Here the structures of naturally occurring antimicrobial and antiviral peptides and proteins are used as starting points to generate novel macrocyclic mimetics, which can be produced and optimized efficiently by combinatorial synthetic methods. Several recent examples highlight the great potential of the PEM approach in the discovery of new anti-infective agents.

Chemical vapor detection using single-walled carbon nanotubes

Single-walled carbon nanotubes possess unique properties that make them a potentially ideal material for chemical sensing. However, their extremely small size also presents technical challenges for realizing a practical sensor technology. In this tutorial review we explore the transduction physics by which the presence of molecular adsorbates is converted into a measurable electronic signal, and we identify solutions to the problems such as nanotube device fabrication and large, low-frequency noise that have inhibited commercial sensor development. Finally, we examine strategies to provide the necessary chemical specificity to realize a nanotube-based detection system for trace-level chemical vapor detection.

Otago Diagnostic Laboratories' (ODL) Method for the detection of beta-lactamases in Enterobacteriaceae

AIM

The rapid evolvement of beta-lactamases in Enterobacteriaceae is an important concern and the clinical microbiology laboratory is required to detect them, where possible, using a rapid, reliable, simple and low cost methodology.

MATERIALS AND METHODS

A disc diffusion method using NCCLS breakpoints, Jarlier's principle and cefoxitin test for AmpC was carried out. It incorporated seven antimicrobial discs in one agar plate: cefotaxime, aztreonam, amoxicillin-clavulanate, ceftazidime, cefpodoxime, cefepime and cefoxitin. NCCLS disc confirmation test for extended-spectrum beta-lactamase (ESBL) was carried out simultaneously.

RESULTS

AmpC, ESBL, CTX-M, and K1 were detected using these tests. The prevalence of ESBL was <1% in the hospital.

CONCLUSION

The method is recommended for the phenotypic detection of beta-lactamases in Enterobacteriaceae or for confirmation after the results are obtained by conventional automated systems.

Structure-dependent nonenzymatic deamidation of glutaminyl and asparaginyl pentapeptides

Nonenzymatic deamidation rates for 52 glutaminyl and 52 asparaginyl pentapeptides in pH 7.4, 37.0 degrees C. 0.15 m Tris-HCl buffer have been determined by direct injection mass spectrometry. These and the previously reported 306 asparginyl rates have been combined in a self-consistent model for peptide deamidation. This model depends quantitatively upon peptide structure and involves succinimide, glutarimide and hydrolysis mechanisms. The experimental values and suitable interpolated values have been combined to provide deamidation rate values in pH 7.4, 37.0 degrees C. 0.15 m Tris-HCl buffer for the entire set of 648 single-amide permutations of ordinary amino acid residues in GlyXxxAsnYyyGly and GlyXxxGlnYyyGly. Thus, knowledge about sequence-dependent deamidation in peptides is extended to include very long deamidation half-times in the range of 2-50 years.

Five-year follow-up of hepatitis C-naïve heart transplant recipients who received hepatitis C-positive donor hearts

BACKGROUND

Due to the risk of transmission of hepatitis C virus, the use of hepatitis C seropositive donors in heart transplantation is controversial. The transmission rate of hepatitis C in this patient population is estimated to range from 67% to 80%. Long-term clinical outcomes of heart transplant recipients of hepatitis C-positive donor hearts are not well described. We report the 5-year long-term outcome of seven hepatitis C-naïve heart transplant recipients who received hepatitis C-positive donor hearts.

METHODS

Retrospective analysis of clinical course, liver biochemistry, serology, and hepatitis C virology data.

RESULTS

Seven hearts transplant recipients, six men and one woman were included in our study. After a mean follow-up of 63.3 +/- 20.4 months (range 28.2 to 85.9), four of seven (57.1%) patients are hepatitis C-negative, have normal liver function tests, and no clinical evidence of hepatitis. Three of seven (43%) have been diagnosed with hepatitis C by liver biopsy or the HCV-RNA reverse transcriptase polymerase chain reaction at a mean follow-up of 35.1 months (18.8 months posttransplantation). One had an accelerated course of hepatitis that was ultimately fatal, one was successfully treated with interferon, and the third died from other causes than liver injury. Overall, the 5-year survival was 71.4%.

CONCLUSIONS

The 5-year survival of hepatitis C-naïve recipients of hearts from hepatitis C-positive donors is similar to heart transplant recipients with hepatitis-negative donor hearts. Nevertheless, the transmission rate is high and hepatitis C infection in this population can lead to considerable morbidity and accelerated, fatal hepatitis.

Comparison of analytical methods for the evaluation of antibody responses against epitopes of polymorphic protein antigens

Surface exposed protein antigens of the malaria parasite Plasmodium falciparum frequently harbor multiple dimorphic amino acid positions. These are associated with parasite immune evasion and represent a major obstacle for subunit vaccine design. Here, we have analyzed the flexibility of the humoral immune response against a semiconserved sequence (YX(44)LFX(47)KEKMX(52)L) of the key malaria blood stage vaccine candidate merozoite surface protein-1 (MSP-1). Monoclonal antibodies (mAbs) raised against one of the six described natural sequence variants of MSP-1(43-53) were analyzed for cross-reactivity with the other allelic forms, which differ in one to three positions from the immunizing sequence. Enzyme-linked immunosorbent assay (ELISA) and surface plasmon resonance (SPR) spectroscopy demonstrated marked differences in mAb binding avidity to the variant sequences and isothermal titration calorimetry (ITC) provided evidence for a very low affinity of some of the interactions. In immunofluorescence analysis (IFA) and Western blotting analysis, the mAbs nevertheless stained all analyzed parasite clones expressing MSP-1(43-53) variant sequences. When used for the evaluation of humoral immune responses in clinical malaria vaccine trials, these two commonly used methods may thus not be suitable to distinguish biologically functional high affinity antibody responses from irrelevant low-affinity cross-reactivities.

Ecstasy (MDMA): are the psychological problems associated with its use reversed by prolonged abstinence?

RATIONALE

Chronic, regular recreational use of ecstasy (MDMA) is associated with psychopathology, elevated behavioural impulsivity and persistent impairment of memory performance.

OBJECTIVE

The aim of the present study was to investigate which of these sequelae persist after at least 6 months of abstinence from ecstasy.

METHODS

Four groups of participants were compared: 18 current regular recreational ecstasy users, 15 ex-regular ecstasy users who had abstained from using the drug for an average of 2 years, 16 polydrug users who had never taken ecstasy and 15 drug-naive controls.

RESULTS

There were no significant group differences in age, education level, or pre-morbid intelligence and, generally, the use of illicit drugs other than ecstasy was not significantly different among the three drug-using groups. Both current and ex-ecstasy users exhibited elevated psychopathology and behavioural impulsivity compared with polydrug users and drug-naive controls, but current ecstasy users exhibited a broader range of psychopathology than ex-users. Both groups of ecstasy users also exhibited impaired working memory and verbal recall performance compared with drug-naive controls, but only ex-users exhibited impaired verbal recall relative to polydrug users. Regression analysis indicated that psychopathology was primarily predicted by the extent of previous consumption of cannabis rather than ecstasy, whereas the majority of the cognitive deficits were only predicted by the extent of previous ecstasy use.

CONCLUSIONS

Selective impairments of neuropsychological performance associated with regular ecstasy use are not reversed by prolonged abstinence. This is consistent with evidence that ecstasy has potent and selective neurotoxic effects on brain serotonergic systems in humans.

High grazer toxicity of [D-Asp(3),(E)-Dhb(7)]microcystin-RR of Planktothrix rubescens as compared to different microcystins

Planktothrix rubescens, the dominant cyanobacterium in Lake Zürich, is generally considered to be toxic to zooplankton. The major toxin was determined by NMR spectroscopy and chemical analysis to be [D-Asp(3),(E)-Dhb(7)]microcystin-RR. The compound was isolated in high purity, and its 24-h acute grazer toxicity was compared with microcystin-LR, microcystin-RR, microcystin-YR, and nodularin using a Thamnocephalus platyurus bioassay. Based on LC(50) values [D-Asp(3),(E)-Dhb(7)]microcystin-RR was the most toxic microcystin tested. Nodularin was slightly more toxic under the conditions of the assay. The large number of individuals available for the grazer bioassay allowed the determination of dose-response curves of the different microcystins. These curves showed marked differences in their steepness. Microcystin-RR, which had nearly the same LC(50) as microcystin-LR and microcystin-YR, exhibited a very flat dose-response curve. This flat curve indicates that, for some individuals, lower concentrations of this microcystin are much more toxic than are the other two microcystins. Mortality of 100% requires much higher concentrations of microcystin-RR, indicating the resistance of some animals to the toxin. The purified [D-Asp(3),(E)-Dhb(7)]microcystin-RR exhibited a higher molar absorption coefficient determined by quantitative amino acid analysis than the coefficients generally used for other microcystins. This observation has consequences for the risk assessment for microcystins and makes a structural determination of microcystins an absolute requirement. The presence of the dehydrobutyrine residue may be the reason for the higher specific toxicity of [D-Asp(3),(E)-Dhb(7)]microcystin-RR when compared to the N-methyldehydroalanine-containing microcystins.

Exploiting conformationally constrained peptidomimetics and an efficient human-compatible delivery system in synthetic vaccine design

Peptide and protein mimetics are potentially of great value in synthetic vaccine design. The mimetics should function by stimulating the immune system to produce antibodies that recognize the intact parasite. Also the mimetics should be presented to the immune system in a way that leads to efficient antibody production. Here we investigate the application of cyclic peptidomimetics presented on immunopotentiating reconstituted influenza virosomes (IRIVs), a form of antigen delivery that is licensed already for human clinical use, in synthetic vaccine design. We focus on the central (NPNA)(n) repeat region of the circumsporozoite (CS) protein of the malaria parasite Plasmodium falciparum as a model system. Cyclic peptidomimetics of the NPNA repeats were incorporated into both an IRIV and (for comparison) a multiple-antigen peptide (MAP). Both IRIV and MAP delivery forms induced mimetic-specific humoral immune responses in mice, but only with the mimetic-IRIV preparations did a significant fraction of the elicited antibodies cross-react with sporozoites. The results demonstrate that IRIVs are a delivery system suitable for the efficient induction of antibody responses against conformational epitopes by use of cyclic template-bound peptidomimetics. Combined with combinatorial chemistry, this approach may have great potential for the rapid optimization of molecularly defined synthetic vaccine candidates against a wide variety of infectious agents.

Reproduction studies in the rat with shea oleine and hardened shea oleine

Shea oleine is an oil fraction derived from the nut of the tree Butyrospermum parkii, which grows in central and western Africa. There are several uses of shea oleine including its use as a frying oil and, after hardening, in margarine and toffee fat. This investigation was performed to examine the toxicity of 7 or 15% hardened shea oleine in comparison with 7 or 15% unhardened shea oleine and various commercially available materials, sheanut and palm oils, cocoa butter and toffee powder following dietary administration to rats during pre-mating, mating, pregnancy and offspring weaning in two separate investigations. Reproduction was assessed using number of litters and pups born plus survival and body weights at birth and at weaning on day 21. Skeletal evaluation using X-ray, clinical pathology and a macroscopic examination were also performed for F1 rats. Study measures for parent animals comprised evaluation of body weight, food consumption, clinical pathology, organ weights and macroscopic examination. Fatty acids and hydrocarbon levels were measured and an evaluation for lipogranulomata was made for various tissues. Results showed that shea oleine, whether unhardened or hardened, produced no evidence of reproduction toxicity and gave a similar profile to the other commercially available materials used in this study in the rat. Minor findings with shea oleine were not related to reproduction performance but comprised slightly reduced body weight gain and reduced cholesterol and raised alkaline phosphatase levels. None of the findings in this study were considered to be of toxicological significance. Thus, no evidence of reproduction toxicity was seen for both unhardened and hardened shea oleine in this investigation in the rat at levels equating to greater than 7.5 g/kg/day.

The health behavior selection process of young adolescents

The health behavior selection process of young adolescents was explored using the grounded theory research method. Data were generated from in-depth interviews, field notes from school settings, and memos. A conceptual model was generated identifying 4 major categories: assessing/valuing, confirming, choosing, and safeguarding. The processes identified in the model offer the potential of developing new strategies for school nurses to influence health behavior outcomes among young adolescents.

Extracorporeal photopheresis for the treatment of lung allograft rejection

OBJECTIVES

Acute and chronic rejection continue to limit the survival of lung transplant recipients. Extracorporeal photopheresis has evolved as a possible therapy for patients with acute nd chronic lung allograft rejection.

METHODS

We retrospectively reviewed 14 patients diagnosed with BOS who underwent therapy with extracorporeal photopheresis.

RESULTS

Three patients were classified as BOS 0'b', five as BOS 1, three as BOS 2, and, three as BOS 3 at the time of diagnosis. Of the patients with BOS 0'b' or BOS 1 seven remain alive and one died of lung cancer. Two have progressed to BOS 2. Of the patients with BOS 2 or 3, four have died of BOS, one died of lung cancer, and one was re-transplanted. In three patients with BOS and concurrent acute rejection, therapy with extracorporeal photopheresis led to the resolution of the acute rejection episode. Two of the 14 patients developed line related sepsis.

CONCLUSION

Extracorporeal photopheresis appears to be a promising therapy for patients with early BOS. It may also have a role in the treatment of acute lung allograft rejection.

Fate of ethanol topically applied to skin

Ethanol is a major component of many aerosol sprays and consumer products that are designed to contact the skin. It is theoretically possible that small amounts of ethanol from alcohol-based sprays can be absorbed across the skin or inhaled during spraying. In order to assess the potential systemic dose, three parameters were measured: the evaporation of [14C]ethanol from the skin surface, the in vitro penetration of [14C]ethanol through excised pig skin and the ethanol concentration in the blood of human volunteers following simulated use of an alcohol based deodorant spray. The rate of evaporation from Benchkote and whole pig skin was similar (t(1/2)=13.6 sec and 11.7 sec, respectively) while that from glass was longer (t(1/2)=24.8 sec). Ethanol penetration through pig skin in vitro was greater in occluded cells than in non-occluded cells (2.19 mg/cm(2) and 0.10 mg/cm(2) in 24 hours, respectively). At the maximum flux seen in this experiment under occlusion, the amount of ethanol penetrating from a 1 m(2) area of skin would give a blood alcohol level of about 4 mg% in a 70-kg man. In the human use study, none of the blood samples taken from 16 human volunteers exhibited a detectable level of alcohol. These studies provide evidence that a systemic dose of ethanol is likely to be very low after the use of formulations delivering ethanol to the skin.

Becaplermin and necrobiosis lipoidicum diabeticorum: results of a case control pilot study

Necrobiosis lipoidica diabeticorum (NLD) is a rare skin condition associated with diabetes, which characteristically occurs in the pretibial region of the lower limbs (Boulton et al., 1988). The lesions generally appear as well-circumscribed reddish plaques, which are most often asymptomatic, resulting primarily in cosmetic disability. Currently, there is no reliable form of treatment for NLD, although many regimens have been tried (Shall et al., 1990)

Analysis of antibody A6 binding to the extracellular interferon gamma receptor alpha-chain by alanine-scanning mutagenesis and random mutagenesis with phage display

The monoclonal antibody A6 binds a conformational epitope comprising mainly the CC' surface loop on the N-terminal fibronectin type-III domain of the extracellular interferon gamma receptor (IFNgammaR). The crystal structure of an A6 Fab-IFNgammaR complex revealed an interface rich in the aromatic side chains of Trp, Tyr, and His residues. These aromatic side chains appear to interact with both polar and hydrophobic groups at the interface, a property which, in general, may be advantageous for ligand binding. To analyze these interactions in more detail, the affinities of 19 A6 alanine-scanning mutants for the IFNgammaR have been measured, using engineered A6 single chain variable region fragments, and a surface plasmon resonance biosensor. Energetically important side chains (DeltaG(mutant) - DeltaG(wt) > 2.4 kcal/mol), that form distinct hot spots in the binding interface, have been identified on both proteins. These include V(L)W92 in A6, whose benzenoid ring appears well situated for a pi-cation (or pi-amine) interaction with the side chain of receptor residue K47 and simultaneously for T-stacking onto the indole ring of W82 in the receptor. At another site, energetically important residues V(H)W52 and V(H)W53, as well as V(H)D54 and V(H)D56, surround the aliphatic side chain of the hot receptor residue K52. Taken together, the results show that side chains distributed across the interface, including many aromatic ones, make key energetic contributions to binding. In addition, the receptor CC' loop has been subjected to random mutagenesis, and receptor mutants with high affinity for A6 have been selected by phage display. Residues previously identified as important for receptor binding to A6 were conserved in the clones isolated. Some mutants, however, showed a much improved affinity for A6, due to changes at Glu55, a residue that appeared to be energetically unimportant for binding the antibody by alanine-scanning mutagenesis. An E55P receptor mutant bound A6 with a 600-fold increase in affinity (K(D) approximately 20 pM), which is one of the largest improvements in affinity from a single point mutation reported so far at any protein-protein interface.

Traumatic hyphema: a comprehensive review of the past half century yields 8076 cases for which specific medical treatment reduces rebleeding 62%, from 13% to 5% (P<.0001)

PURPOSE

To eliminate the continuing so-called "controversy" regarding, and opposition to, the specific medical management of traumatic hyphema (TH) with systemic antifibrinolytic agents including aminocaproic acid (ACA) and tranexamic acid (TXA) and steroids (prednisone); to illuminate the role of topical steroids.

METHOD

Review of all (English language) studies since 1950 of these medical treatments of TH, and contemporary no specific medical treatment controls.

RESULTS

The difference between the average rebleeding rate in the specifically medically treated group, 4.89%, and that rate in the untreated group, 13.02%, was statistically a true difference due not to chance but to the difference in therapy with a probability of <0.0001 by Chi Square Test, Yates Corrected Chi Square Test and Fisher's Exact Test. This was also true individually respectively and with identical probabilities of p=<0.0001 for systemic steroids, topical steroids, ACA and TXA. Combined topical steroids and systemic ACA or TXA did not further improve results.

CONCLUSION

Preventing rebleeding episodes remains a major treatment objective in the clinical management of TH. This is best accomplished by the Yasuna systemic steroid No Touch or No Touch PLUS treatment protocol, the only treatment protocols consistently yielding zero rebleed rates in non-Scandinavian populations.

Direct action of naturally occurring estrogen metabolites on human osteoblastic cells

This article describes experiments that were performed to examine the direct action of estrogen metabolites on cultured human osteoblast cells. The human fetal osteoblastic cell line, hFOB/ER9, which expresses high levels of the estrogen receptor (ER) alpha, was used to examine the direct effects of 16alpha-hydroxyestrone (16alpha-OHE1) and 2-hydroxyestrone (2-OHE1) on osteoblast differentiation. The 16alpha-OHE1 caused a decrease in osteocalcin (OC) secretion to a maximum of 40% of control values (vehicle-treated cells) at 10(-7) M. Alkaline phosphatase (AP) activity was significantly induced at 10(-7) M 16alpha-OHE1 with greater than 500% of control at 10(-6) M 16alpha-OHE1. Finally, AP steady-state messenger RNA (mRNA) levels were increased within 24 h of 16alpha-OHE1 treatment. In contrast to 16alpha-OHE1, 2-OHE1 had no effects on the secretion of OC, AP activity, or AP gene expression. The 2-OHE1 also did not display any antiestrogen activity because treatment in combination with 17beta-estradiol (E2) and 16alpha-OHE1 had no significant effect on the reduction in OC secretion or induction of AP activity. Similar to E2, 16alpha-OHE1 stimulated the expression of an early response gene, a TGF-beta inducible early gene, designated TIEG, as early as 60 minutes after treatment, whereas treatment with 2-OHE1 displayed no effect. Support that the 16alpha-OHE1 regulation of these osteoblasts (OB) markers was mediated through the ER is shown by the fact that the estrogen antagonist ICI 182,780 abrogated these effects. These data suggest that is a potent estrogen agonist on human osteoblastic hOB/ER9 cells. In contrast, 2-OHE1 displayed no estrogenic or antiestrogenic activity in this human osteoblast cell model.

Practical low-cost visual communication using binary images for deaf sign language

Deaf sign language transmitted by video requires a temporal resolution of 8 to 10 frames/s for effective communication. Conventional videoconferencing applications, when operated over low bandwidth telephone lines, provide very low temporal resolution of pictures, of the order of less than a frame per second, resulting in jerky movement of objects. This paper presents a practical solution for sign language communication, offering adequate temporal resolution of images using moving binary sketches or cartoons, implemented on standard personal computer hardware with low-cost cameras and communicating over telephone lines. To extract cartoon points an efficient feature extraction algorithm adaptive to the global statistics of the image is proposed. To improve the subjective quality of the binary images, irreversible preprocessing techniques, such as isolated point removal and predictive filtering, are used. A simple, efficient and fast recursive temporal prefiltering scheme, using histograms of successive frames, reduces the additive and multiplicative noise from low-cost cameras. An efficient three-dimensional (3-D) compression scheme codes the binary sketches. Subjective tests performed on the system confirm that it can be used for sign language communication over telephone lines.

Non-extraction treatment of a thirteen-year-old boy with a Class III skeletal discrepancy and severe crowding in both the upper and lower dentitions

A thirteen-year-old boy presented with a Class III skeletal tendency in association with severe crowding in both the upper and lower arches. Whilst there was not a frank posterior crossbite, it was felt that the upper arch was narrow and that the lower arch was similarly constricted. Taking this into account along with the fact that his upper lip was flat and the nasolabial angle obtuse, it was decided to pursue a non-extraction treatment, with the aim of providing by expansion an extra 16 mm of space in the upper arch and 8 mm in the lower arch to accommodate the full dentition, and with a view to extracting third molar teeth later. This proved to be successful, albeit over an extended period of time, with active treatment taking nearly three and a half years. A realistic alternative would have been to remove four bicuspid teeth and pursue an orthodontic/surgical approach to treatment. In retrospect, and with the benefit of reviewing his records without surgical intervention, the treatment plan decided upon has been well justified.

Video compression with binary tree recursive motion estimation and binary tree residue coding

Binary tree predictive coding (BTPC) is an efficient general-purpose still-image compression scheme, competitive with JPEG for natural image coding and with GIF for graphics. We report the extension of BTPC to video compression using motion estimation and compensation techniques which are simple, efficient, nonlinear and predictive. The new methods, binary tree recursive motion estimation coding (BTRMEC), and binary tree residue coding (BTRC) exploit the hierarchical structure of BTPC, in the first case giving progressively refined motion estimates for increasing numbers of pels and in the second case providing efficient residue coding. Compression results for BTRMEC and BTBC are compared against conventional block-based motion compensated coding as provided by MPEG. They show that both BTRMEC and BTRC are efficient methods to code video sequences.

A(3) adenosine receptor activation attenuates neutrophil function and neutrophil-mediated reperfusion injury

This study tested the hypothesis that A(3) adenosine receptors inhibit neutrophil (PMN) function and PMN-mediated reperfusion injury. 2-Chloro-N(6)-(3-iodobenzyl)adenosine-5'-N-methyluronamide (Cl-IB-MECA), an A(3) agonist, did not attenuate superoxide production or myeloperoxidase release from stimulated PMNs. However, Cl-IB-MECA reduced platelet-activating factor-stimulated PMN adherence to coronary endothelium at low concentrations: 52 +/- 27, 45 +/- 10, and 87 +/- 23 PMNs/mm(2) at 0.1, 1.0, and 10 nM vs. 422 +/- 64 PMNs/mm(2) with platelet-activating factor alone. This inhibition was not blocked by A(1) (5 microM KW-3902) or A(2a) (5 microM KF-21326) antagonists: 44 +/- 3 and 43 +/- 2 PMNs/mm(2), respectively. Endothelial pretreatment with 1 nM Cl-IB-MECA reduced PMN adherence, which was reversed by the A(3) antagonist MRS-1220 (100 nM). PMN-mediated reperfusion injury was initiated in isolated rabbit hearts by infusion of 28 x 10(6) PMNs/min for 10 min early in reperfusion. PMNs caused a significant decrease in recovery of left ventricular developed pressure and positive and negative time derivatives of pressure (23 +/- 3, 25 +/- 3, and 23 +/- 3% of baseline, respectively) vs. buffer-perfused hearts (43 +/- 7, 44 +/- 7, and 45 +/- 6%, respectively). Cl-IB-MECA (10 nM) given at reperfusion attenuated the PMN-mediated loss of contractile recovery (40 +/- 3, 46 +/- 5, and 42 +/- 4% of baseline). Cl-IB-MECA reduced myeloperoxidase release activity (5.3 +/- 0.6 absorbance units/min) and CD18-positive cells (54 +/- 9 cells/slide) compared with the untreated PMN group (17.9 +/- 1.7 absorbance units/min and 183 +/- 68 cells/slide). We conclude that Cl-IB-MECA attenuates reperfusion injury by decreasing PMN-endothelial cell interactions. These results suggest that the A(3) adenosine receptor may be a novel therapeutic target for treatment of myocardial ischemia and reperfusion.

Cloning and sequencing of the coenzyme B(12)-binding domain of isobutyryl-CoA mutase from Streptomyces cinnamonensis, reconstitution of mutase activity, and characterization of the recombinant enzyme produced in Escherichia coli

Isobutyryl-CoA mutase (ICM) catalyzes the reversible, coenzyme B(12)-dependent rearrangement of isobutyryl-CoA to n-butyryl-CoA, which is similar to, but distinct from, that catalyzed by methylmalonyl-CoA mutase. ICM has been detected so far in a variety of aerobic and anaerobic bacteria, where it appears to play a key role in valine and fatty acid catabolism. ICM from Streptomyces cinnamonensis is composed of a large subunit (IcmA) of 62.5 kDa and a small subunit (IcmB) of 14.3 kDa. icmB encodes a protein of 136 residues with high sequence similarity to the cobalamin-binding domains of methylmalonyl-CoA mutase, glutamate mutase, methyleneglutarate mutase, and cobalamin-dependent methionine synthase, including a conserved DXHXXG cobalamin-binding motif. Using IcmA and IcmB produced separately in Escherichia coli, we show that IcmB is necessary and sufficient with IcmA and coenzyme B(12) to afford the active ICM holoenzyme. The large subunit (IcmA) forms a tightly associated homodimer, whereas IcmB alone exists as a monomer. In the absence of coenzyme B(12), the association between IcmA and IcmB is weak. The ICM holoenzyme appears to comprise an alpha(2)beta(2)-heterotetramer with up to two molecules of bound coenzyme B(12). The equilibrium constant for the ICM reaction at 30 degrees C is 1.7 in favor of isobutyryl-CoA, and the pH optimum is near 7.4. The K(m) values for isobutyryl-CoA, n-butyryl-CoA, and coenzyme B(12) determined with an equimolar ratio of IcmA and IcmB are 57 +/- 13, 54 +/- 12, and 12 +/- 2 microM, respectively. A V(max) of 38 +/- 3 units/mg IcmA and a k(cat) of 39 +/- 3 s(-1) were determined under saturating molar ratios of IcmB to IcmA.

Vascular damage correlates between heparin-induced thrombocytopenia and the antiphospholipid syndrome

Antibody-mediated disorders of heparin-induced thrombocytopenia and antiphospholipid antibody syndrome have remarkably similar clinical presentations, both of which can progressively result in severe vascular and thrombotic disorders. We hypothesized that the mechanism of platelet activation as occurs in heparin-induced thrombocytopenia may also occur in antiphospholipid antibody syndrome particularly at the vascular wall, that endothelial injury may be similar in heparin-induced thrombocytopenia and antiphospholipid antibody syndrome, and that these alterations may be caused by related antibodies. Antibody titers and vascular endothelial damage in patients with heparin-induced thrombocytopenia and antiphospholipid antibody syndrome were studied in plasma samples collected from normals (n = 17), heparin-induced thrombocytopenia patients (n = 15), antiphospholipid antibody syndrome patients (n = 30), and patients clinically diagnosed with antiphospholipid antibody syndrome and heparin-induced thrombocytopenia (n = 8). Diagnosis of heparin-induced thrombocytopenia was confirmed by 14C-serotonin release assay or positive antiheparin-platelet factor 4 antibody titer, and antiphospholipid antibody syndrome was confirmed by positive anti-beta 2-glycoprotein (GP) 1/cardiolipin (IgG or IgM) antibody titer. The antiheparin-platelet factor 4 antibody was not detected in any patient with antiphospholipid antibody syndrome. Patients with heparin-induced thrombocytopenia did not have elevated IgG anti-beta 2-GP1 titers, but three (20%) patients had low-positive IgM anti-beta 2-GP1 titers. The endothelial damage markers of soluble thrombomodulin, soluble P-selectin (p < 0.05 vs. normal), plasminogen activator inhibitor-1 and tissue factor were elevated in heparin-induced thrombocytopenia and antiphospholipid antibody syndrome patients. The soluble E-selectin was elevated only in the patients with both heparin-induced thrombocytopenia and antiphospholipid antibody syndrome (p < 0.05 vs. normal). Levels of soluble L-selectin and von Willebrand factor were not different from normals. The pathogenesis of heparin-induced thrombocytopenia and antiphospholipid antibody syndrome appears to be due to two distinct antibodies but associated with similar damage to the vascular endothelium in both diseases.

Insertional inactivation of methylmalonyl coenzyme A (CoA) mutase and isobutyryl-CoA mutase genes in Streptomyces cinnamonensis: influence on polyketide antibiotic biosynthesis

The coenzyme B(12)-dependent isobutyryl coenzyme A (CoA) mutase (ICM) and methylmalonyl-CoA mutase (MCM) catalyze the isomerization of n-butyryl-CoA to isobutyryl-CoA and of methylmalonyl-CoA to succinyl-CoA, respectively. The influence that both mutases have on the conversion of n- and isobutyryl-CoA to methylmalonyl-CoA and the use of the latter in polyketide biosynthesis have been investigated with the polyether antibiotic (monensin) producer Streptomyces cinnamonensis. Mutants prepared by inserting a hygromycin resistance gene (hygB) into either icmA or mutB, encoding the large subunits of ICM and MCM, respectively, have been characterized. The icmA::hygB mutant was unable to grow on valine or isobutyrate as the sole carbon source but grew normally on butyrate, indicating a key role for ICM in valine and isobutyrate metabolism in minimal medium. The mutB::hygB mutant was unable to grow on propionate and grew only weakly on butyrate and isobutyrate as sole carbon sources. (13)C-labeling experiments show that in both mutants butyrate and acetoacetate may be incorporated into the propionate units in monensin A without cleavage to acetate units. Hence, n-butyryl-CoA may be converted into methylmalonyl-CoA through a carbon skeleton rearrangement for which neither ICM nor MCM alone is essential.

Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation

BACKGROUND

Patients with a PRA >10% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA >10% at our institution are treated with plasmapheresis and intravenous immunoglobulin G immediately prior to cardiac transplantation.

METHODS

Sixteen (Group 1) of 118 patients awaiting cardiac transplantation were found to be sensitized. These patients underwent plasmapheresis followed by 20 gm of intravenous immunoglobulin G (IVIG) immediately prior to cardiac transplantation. Group 1 was compared to the remaining 102 patients with a PRA <10% (Group 2).

RESULTS

Despite more patients in Group 1 having a positive crossmatch, pulmonary hypertension, and requiring mechanical circulatory support, there was no statistically significant difference in length of stay or mortality at a mean follow-up of 21.6+/-15.0 months. There was no difference in the occurrence of mild, moderate or severe cellular rejection or humoral rejection in these sensitized patients when compared to Group 2.

CONCLUSIONS

Pretransplant plasmapheresis followed by intravenous immunoglobulin G may be an effective therapy that obviates the need for a prospective crossmatch and allows sensitized patients to undergo cardiac transplantation. There is no increase in the post transplant length of stay, occurrence of rejection or short term mortality. Long term follow up is necessary to evaluate whether there is a difference in the development of late rejection, transplant vasculopathy and survival.

Apheresis in thoracic organ transplantation

The beneficial addition of cyclosporine and tacrolimus to the immunosuppressive armamentarium have unfortunately only partially solved the problems of acute and chronic rejection in thoracic organ transplantation. Apheresis techniques offer creative avenues for modifications of allograft rejection. Plasmapheresis can be used for mechanical reduction of alloantibody burdens in highly sensitized patients and permit transplantation in an otherwise almost hopeless situation and can also be used on a short-term basis for the treatment of acute humoral rejection. Extracorporeal photochemotherapy holds promise as a possibly synergistic adjunct to conventional therapy and may even reduce the severity of graft vasculopathy. The increasing availability of highly specific column immunoadsorption techniques may further increase the applicability of apheresis in transplantation.

On the importance of being aromatic at an antibody-protein antigen interface: mutagenesis of the extracellular interferon gamma receptor and recognition by the neutralizing antibody A6

A complex formed between the extracellular human interferon gamma receptor alpha-chain (hIFNgammaR) and the Fab fragment of the neutralizing antibody A6 has been studied by site-directed mutagenesis. Five complementarity determining regions of the A6 antibody interact primarily with the CC' surface loop of the receptor, from Lys47 to Trp56, although contact is also made with residues in the neighbouring F strand, in particular with Trp82. The relative contribution that individual side-chains make to complex stabilization was assessed with 21 receptors mutants, whose affinity for A6 was monitored using a surface plasmon resonance biosensor, as well as by solution-phase competition ELISA. The results reveal two lysine side-chains (Lys47 and Lys52), an asparagine side-chain (Asn53), and two aromatic side-chains (Tyr49 and Trp82) in the receptor that are important for recognition by A6. The role of aromatic side-chains in antibody-antigen recognition is of particular interest, not least in this case because 13 aromatic groups (six Tyr, six Trp and one His) are present at the interface (four in VL, six in VH and three in the receptor), and several are proximal to the charged and polar side-chains of Lys47, Lys52 and Asn53 in the receptor. The results highlight the possibility for aromatic rings to participate in networks of co-operative interactions with not only hydrophobic, but also charged and hydrogen bond donor and acceptor groups, properties that are well suited for creating binding sites for protein epitopes, regardless of the distribution of polar and non-polar surface residues. These findings may contribute, therefore, to an understanding of how surface groups on proteins are captured by the often aromatic-rich hypervariable loops of antibodies, and may be of value for the design of molecules with novel recognition properties.

Plasmapheresis in the management of heparin-induced thrombocytopenia

This study investigated the role of plasmapheresis in the treatment of severe heparin-induced thrombocytopenia (HIT). Patients diagnosed with HIT were divided into three experimental groups. Sixteen patients did not receive plasmapheresis (control). Twenty-one patients received plasmapheresis within 4 days of onset of thrombocytopenia (early group). Seven patients received plasmapheresis 4 days or later after onset (late group). Most patients underwent a second plasmapheresis 24 to 48 hours after the first, when clinically indicated, and platelet aggregation tests became negative in 75% of these patients. Heparin administration was discontinued after 1.4 days in the early group of patients and 4.2 days in the late group, as compared with 2.4 days in the control group. The 30-day mortality rate was 4.8% among patients in the early group and 57% in the late group, as compared with 32% in the control group. Platelet recovery time, incidence of thrombotic events, and length of hospital stay were similar in the early group and controls, but were somewhat higher in the late group. Thus, plasmapheresis within 4 days of the onset of thrombocytopenia reduced mortality in HIT patients, whereas plasmapheresis after 4 days was not beneficial. There were no adverse events related to plasmapheresis. These findings suggest that plasmapheresis may be useful in the treatment of HIT when initiated within 4 days of onset of thrombocytopenia.

Effective oral ganciclovir prophylaxis against cytomegalovirus disease in heart transplant recipients

The presented data show the combined sequential use of i.v. G for 14 days followed by PO G for 90 days is a much more effective prophylaxis for CMVD after heart transplantation than use of i.v. G for 14 days followed by PO A for 90 days. A need for hospitalization due to CMVD is significantly reduced by this new strategy. The follow-up in group II is shorter than in group I but is now at least 6 months in group II, without any new cases in the first 6 months after cardiac transplantation. Some currently unknown adverse effect of prolonged PO G, which may be present, is not identified in this analysis.

Assessment of reductive acetogenesis with indigenous ruminal bacterium populations and Acetitomaculum ruminis

The objective of this study was to evaluate the role of reductive acetogenesis as an alternative H2 disposal mechanism in the rumen. H2/CO2-supported acetogenic ruminal bacteria were enumerated by using a selective inhibitor of methanogenesis, 2-bromoethanesulfonic acid (BES). Acetogenic bacteria ranged in density from 2.5 x 10(5) cells/ml in beef cows fed a high-forage diet to 75 cells/ml in finishing steers fed a high-grain diet. Negligible endogenous acetogenic activity was demonstrated in incubations containing ruminal contents, NaH13CO3, and 100% H2 gas phase since [U-13C]acetate, as measured by mass spectroscopy, did not accumulate. Enhancement of acetogenesis was observed in these incubations when methanogenesis was inhibited by BES and/or by the addition of an axenic culture of the rumen acetogen Acetitomaculum ruminis 190A4 (10(7) CFU/ml). To assess the relative importance of population density and/or H2 concentration for reductive acetogenesis in ruminal contents, incubations as described above were performed under a 100% N2 gas phase. Both selective inhibition of methanogenesis and A. ruminis 190A4 fortification (>10(5) CFU/ml) were necessary for the detection of reductive acetogenesis under H2-limiting conditions. Under these conditions, H2 accumulated to 4, 800 ppm. In contrast, H2 accumulated to 400 ppm in incubations with active methanogenesis (without BES). These H2 concentrations correlated well with the pure culture H2 threshold concentrations determined for A. ruminis 190A4 (3,830 ppm) and the ruminal methanogen 10-16B (126 ppm). The data demonstrate that ruminal methanogenic bacteria limited reductive acetogenesis by lowering the H2 partial pressure below the level necessary for H2 utilization by A. ruminis 190A4.

Cloning, sequencing, expression, and insertional inactivation of the gene for the large subunit of the coenzyme B12-dependent isobutyryl-CoA mutase from Streptomyces cinnamonensis

Purification of the coenzyme B12-dependent isobutyryl-CoA mutase (ICM) from Streptomyces cinnamonensis gave a protein of approximately 65 kDa by SDS-polyacrylamide gel electrophoresis, whose gene icmA was cloned using sequences derived from tryptic peptide fragments. The gene encodes a protein of 566 residues (62, 487 Da), with 43-44% sequence identity to the large subunit of methylmalonyl-CoA mutase (MCM) from S. cinnamonensis and Propionibacterium shermanii. Targeted disruption of the icmA gene yielded an S. cinnamonensis mutant devoid of ICM activity. The IcmA protein is approximately 160 residues shorter than the large subunit of the bacterial MCMs, corresponding to a loss of the entire C-terminal coenzyme B12 binding domain. The sequence of the (beta/alpha)8-barrel comprising residues A1-A400 in P. shermanii MCM is highly conserved in IcmA. The protein was produced in Streptomyces lividans and Escherichia coli with an N-terminal His6 tag (His6-IcmA), but after purification His6-IcmA showed no ICM activity. In the presence of coenzyme B12, protein from S. lividans and S. cinnamonensis of approximately 17 kDa by SDS-polyacrylamide gel electrophoresis could be selectively eluted with His6-IcmA from a Ni2+ affinity column. After purification, this small subunit showed no ICM activity but gave active enzyme when recombined with coenzyme B12 and IcmA or His6-IcmA.