Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.

Schistosome Sulfotransferases: Mode of Action, Expression and Localization

Oxamniquine (OXA) is a prodrug activated by a sulfotransferase (SULT) that was only active against Schistosoma mansoni. We have reengineered OXA to be effective against S. haematobium and S. japonicum. Three derivatives stand out, CIDD-0066790, CIDD-0072229, and CIDD-0149830 as they kill all three major human schistosome species. However, questions remain. Is the OXA mode of action conserved in derivatives? RNA-interference experiments demonstrate that knockdown of the SmSULT, ShSULT, and SjSULT results in resistance to CIDD-0066790. Confirming that the OXA-derivative mode of action is conserved. Next is the level of expression of the schistosome SULTs in each species, as well as changes in SULT expression throughout development in S. mansoni. Using multiple tools, our data show that SmSULT has higher expression compared to ShSULT and SjSULT. Third, is the localization of SULT in the adult, multicellular eucaryotic schistosome species. We utilized fluorescence in situ hybridization and uptake of radiolabeled OXA to determine that multiple cell types throughout the adult schistosome worm express SULT. Thus, we hypothesize the ability of many cells to express the sulfotransferase accounts for the ability of the OXA derivatives to kill adult worms. Our studies demonstrate that the OXA derivatives are able to kill all three human schistosome species and thus will be a useful complement to PZQ.

An iterative process produces oxamniquine derivatives that kill the major species of schistosomes infecting humans

Currently there is only one method of treatment for human schistosomiasis, the drug praziquantel. Strong selective pressure has caused a serious concern for a rise in resistance to praziquantel leading to the necessity for additional pharmaceuticals, with a distinctly different mechanism of action, to be used in combination therapy with praziquantel. Previous treatment of Schistosoma mansoni included the use of oxamniquine (OXA), a prodrug that is enzymatically activated in S. mansoni but is ineffective against S. haematobium and S. japonicum. The oxamniquine activating enzyme was identified as a S. mansoni sulfotransferase (SmSULT-OR). Structural data have allowed for directed drug development in reengineering oxamniquine to be effective against S. haematobium and S. japonicum. Guided by data from X-ray crystallographic studies and Schistosoma worm killing assays on oxamniquine, our structure-based drug design approach produced a robust SAR program that tested over 300 derivatives and identified several new lead compounds with effective worm killing in vitro. Previous studies resulted in the discovery of compound CIDD-0066790, which demonstrated broad-species activity in killing of schistosome species. As these compounds are racemic mixtures, we tested and demonstrate that the R enantiomer CIDD-007229 kills S. mansoni, S. haematobium and S. japonicum better than the parent drug (CIDD-0066790). The search for derivatives that kill better than CIDD-0066790 has resulted in a derivative (CIDD- 149830) that kills 100% of S. mansoni, S. haematobium and S. japonicum adult worms within 7 days. We hypothesize that the difference in activation and thus killing by the derivatives is due to the ability of the derivative to fit in the binding pocket of each sulfotransferase (SmSULT-OR, ShSULT-OR, SjSULT-OR) and to be efficiently sulfated. The purpose of this research is to develop a second drug to be used in conjunction with praziquantel to treat the major human species of Schistosoma. Collectively, our findings show that CIDD-00149830 and CIDD-0072229 are promising novel drugs for the treatment of human schistosomiasis and strongly support further development and in vivo testing.

Why does oxamniquine kill Schistosoma mansoni and not S. haematobium and S. japonicum?

Human schistosomiasis is a disease which globally affects over 229 million people. Three major species affecting humans are Schistosoma mansoni, S. haematobium and S. japonicum. Previous treatment of S. mansoni includes the use of oxamniquine (OXA), a prodrug that is enzymatically activated in S. mansoni but is ineffective against S. haematobium and S. japonicum. The OXA activating enzyme was identified and crystallized, as being a S. mansoni sulfotransferase (SmSULT). S. haematobium and S. japonicum possess homologs of SmSULT (ShSULT and SjSULT) begging the question; why does oxamniquine fail to kill S. haematobium and S. japonicum adult worms? Investigation of the molecular structures of the sulfotransferases indicates that structural differences, specifically in OXA contact residues, do not abrogate OXA binding in the active sites as previously hypothesized. Data presented argue that the ability of SULTs to sulfate and thus activate OXA and its derivatives is linked to the ability of OXA to fit in the binding pocket to allow the transfer of a sulfur group.

Oxamniquine resistance alleles are widespread in Old World Schistosoma mansoni and predate drug deployment

Do mutations required for adaptation occur de novo, or are they segregating within populations as standing genetic variation? This question is key to understanding adaptive change in nature, and has important practical consequences for the evolution of drug resistance. We provide evidence that alleles conferring resistance to oxamniquine (OXA), an antischistosomal drug, are widespread in natural parasite populations under minimal drug pressure and predate OXA deployment. OXA has been used since the 1970s to treat Schistosoma mansoni infections in the New World where S. mansoni established during the slave trade. Recessive loss-of-function mutations within a parasite sulfotransferase (SmSULT-OR) underlie resistance, and several verified resistance mutations, including a deletion (p.E142del), have been identified in the New World. Here we investigate sequence variation in SmSULT-OR in S. mansoni from the Old World, where OXA has seen minimal usage. We sequenced exomes of 204 S. mansoni parasites from West Africa, East Africa and the Middle East, and scored variants in SmSULT-OR and flanking regions. We identified 39 non-synonymous SNPs, 4 deletions, 1 duplication and 1 premature stop codon in the SmSULT-OR coding sequence, including one confirmed resistance deletion (p.E142del). We expressed recombinant proteins and used an in vitro OXA activation assay to functionally validate the OXA-resistance phenotype for four predicted OXA-resistance mutations. Three aspects of the data are of particular interest: (i) segregating OXA-resistance alleles are widespread in Old World populations (4.29–14.91% frequency), despite minimal OXA usage, (ii) two OXA-resistance mutations (p.W120R, p.N171IfsX28) are particularly common (>5%) in East African and Middle-Eastern populations, (iii) the p.E142del allele has identical flanking SNPs in both West Africa and Puerto Rico, suggesting that parasites bearing this allele colonized the New World during the slave trade and therefore predate OXA deployment. We conclude that standing variation for OXA resistance is widespread in S. mansoni.

It has been argued that drug resistance is unlikely to spread rapidly in helminth parasites infecting humans. This is based, at least in part, on the premise that resistance mutations are rare or absent within populations prior to treatment, and take a long time to reach appreciable frequencies because helminth parasite generation time is long. This argument is critically dependent on the starting frequency of resistance alleles–if high levels of “standing variation” for resistance are present prior to deployment of treatment, resistance may spread rapidly. We examined frequencies of oxamniquine resistance alleles present in Schistosoma mansoni from Africa and the Middle East where oxamniquine has seen minimal use. We found that oxamniquine resistance alleles are widespread in the Old World, ranging from 4.29% in the Middle East to 14.91% in East African parasite populations. Furthermore, we show that resistance alleles from West African and the Caribbean schistosomes share a common origin, suggesting that these alleles travelled to the New World with S. mansoni during the transatlantic slave trade. Together, these results demonstrate extensive standing variation for oxamniquine resistance. Our results have important implications for both drug treatment policies and drug development efforts, and demonstrate the power of molecular surveillance approaches for guiding helminth control.

Design, Synthesis, and Characterization of Novel Small Molecules as Broad Range Antischistosomal Agents

Schistosomiasis is a major human parasitic disease afflicting more than 250 million people, historically treated with chemotherapies praziquantel or oxamniquine. Since oxamniquine is species-specific, killing Schistosoma mansoni but not other schistosome species (S. haematobium or S. japonicum) and evidence for drug resistant strains is growing, research efforts have focused on identifying novel approaches. Guided by data from X-ray crystallographic studies and Schistosoma worm killing assays on oxamniquine, our structure-based drug design approach produced a robust structure-activity relationship (SAR) program that identified several new lead compounds with effective worm killing. These studies culminated in the discovery of compound 12a, which demonstrated broad-species activity in killing S. mansoni (75%), S. haematobium (40%), and S. japonicum (83%).

The 1918-1920 influenza pandemic in Peru

BACKGROUND

Increasing our knowledge of past influenza pandemic patterns in different regions of the world is crucial to guide preparedness plans against future influenza pandemics. Here, we undertook extensive archival collection efforts from three representative cities of Peru-Lima in the central coast, Iquitos in the northeastern Amazon region, Ica in the southern coast-to characterize the temporal, age and geographic patterns of the 1918-1920 influenza pandemic in this country.

MATERIALS AND METHODS

We analyzed historical documents describing the 1918-1920 influenza pandemic in Peru and retrieved individual mortality records from local provincial archives for quantitative analysis. We applied seasonal excess mortality models to daily and monthly respiratory mortality rates for 1917-1920 and quantified transmissibility estimates based on the daily growth rate in respiratory deaths.

RESULTS

A total of 52,739 individual mortality records were inspected from local provincial archives. We found evidence for an initial mild pandemic wave during July-September 1918 in Lima, identified a synchronized severe pandemic wave of respiratory mortality in all three locations during November 1918-February 1919, and a severe pandemic wave during January 1920-March 1920 in Lima and July-October 1920 in Ica. There was no recrudescent pandemic wave in 1920 in Iquitos. Remarkably, Lima experienced the brunt of the 1918-1920 excess mortality impact during the 1920 recrudescent wave, with all age groups experiencing an increase in all cause excess mortality from 1918-1919 to 1920. Middle age groups experienced the highest excess mortality impact, relative to baseline levels, in the 1918-1919 and 1920 pandemic waves. Cumulative excess mortality rates for the 1918-1920 pandemic period were higher in Iquitos (2.9%) than Lima (1.6%). The mean reproduction number for Lima was estimated in the range 1.3-1.5.

CONCLUSIONS

We identified synchronized pandemic waves of intense excess respiratory mortality during November 1918-February 1919 in Lima, Iquitos, Ica, followed by asynchronous recrudescent waves in 1920. Cumulative data from quantitative studies of the 1918 influenza pandemic in Latin American settings have confirmed the high mortality impact associated with this pandemic. Further historical studies in lesser studied regions of Latin America, Africa, and Asia are warranted for a full understanding of the global impact of the 1918 pandemic virus.

Frequency of CCR5 gene 32-basepair deletion in Chilean HIV-1 infected and non-infected individuals

A 32-basepair deletion polymorphism in the CCR5 chemokine receptor gene (CCR5Delta32) has been identified and shown to have functional significance in determining susceptibility to infection by human immunodeficiency virus type 1 (HIV-1) and possibly in influencing disease progression in HIV-1 positive individuals. These findings led to an interest in studies of DeltaCCR5 allele geographical distribution in human population, for complete understanding of the role of CCR5 in HIV-1 epidemiology. Inter-population variation in CCR5Delta32 frequency may be a significant factor in the prediction of AIDS endemicity. In this report we assessed the frequency of DeltaCCR5 in a Chilean population (63 HIV-1 infected and 62 non-infected individuals). No homozygous CCR5Delta32 individual was identified, and no significant difference was observed between HIV-1 infected (3/63) and non-infected (3/62) individuals for the heterozygote CCR5Delta32 state. This is the first evidence of the contribution of DeltaCCR5 allele to the genetic background of the Chilean population, which is characterized by intense ethnic admixture and by gene flow from the European Spanish gene pool.

Atherosclerosis and omega-3 fatty acids in the populations of a fishing village and a farming village in Japan

The effect of different dietary habits on atherosclerosis was investigated by examining the content of ordinary diets and relevant risk factors through a mass health survey on two village populations in Japan. In total, 261 inhabitants in the fishing village and 209 in the farming village were examined for body build, blood pressure, and blood chemistry. Information on smoking habits and food consumption was obtained using a semi-quantitative item-frequency questionnaire. Pulse wave velocity of the aorta, intima-media thickness of the carotid artery, and atherosclerotic plaques as obtained by ultrasonography were used as measures of atherosclerosis. All measures of atherosclerosis are lower in the fishing village than in the farming village in both men and women. There is a striking 5-8-fold difference in the number of atherosclerotic plaques (P < 0.0001) between the populations. The observed differences in atherosclerosis parallels differences in dietary habits and differences in the serum essential fatty acids. Evaluation of the omega-3 fatty acids over the combined populations reveals a negative association with the number of plaques in the common carotid while the omega-6 fatty acids shows a weak positive association with plaques.

Comparison of atherosclerosis in alaska Natives and nonnatives

OBJECTIVE

To test the hypothesis that Alaska Natives have fewer atherosclerotic lesions in the coronary arteries and aorta than nonnative Alaska residents.

DESIGN

Systematic standardized collection and evaluation of coronary arteries and aortas collected at autopsy.

SETTING

Forensic autopsy service in Alaska.

SUBJECTS

One hundred thirty Alaska Natives and 115 Alaska nonnatives who underwent forensic autopsy between February 1989 and December 1993.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Prevalence and extent of atherosclerotic lesions in the aortas and coronary arteries in both populations studied.

RESULTS

Alaska Natives had significantly lower prevalence and extent of raised atherosclerotic lesions in the abdominal aorta and coronary arteries than nonnative Alaska residents.

CONCLUSIONS

Differences in coronary heart disease mortality between Alaska Natives and nonnatives are, at least in part, the result of fewer atherosclerotic lesions in Alaska Natives.

Renovasculopathies of nephrosclerosis in relation to atherosclerosis at ages 25 to 54 years

Renovasculopathies of hypertension include arteriolar hyalinization and arterial intimal fibroplasia. Atherosclerotic features of coronary arteries and aorta include fatty streaks and raised lesions. Data were obtained from a series of 573 autopsies of black and Caucasian males and females aged 25 to 54 years, who died of violent and natural causes unrelated to atherosclerosis. Analysis showed positive correlations of coronary and aortic raised lesions with arteriolar hyalinization. Arterial intimal fibroplasia correlated positively with raised lesions in the aorta but only weakly and inconsistently in the coronary arteries. The extent of fatty streaks in the coronaries, as in the aorta, did not correlate with either form of renovasculopathy. These results provide evidence that hyalinization of renal arterioles may be a marker for young people who have the most advanced coronary atherosclerosis, and who therefore have an early start upon a course toward coronary heart disease later in life.

Nephrosclerosis, glycohemoglobin, cholesterol, and smoking in subjects dying of coronary heart disease

Subjects dying of coronary heart disease (CHD) were compared with subjects in a control (basal) group in two series of forensic autopsies. Serum cholesterol assessed in postmortem heart blood was significantly greater in the CHD than in the basal group. CHD subjects were smokers more often than basal subjects, as determined from postmortem serum thiocyanate levels, but the statistical significance is ambiguous (P < 0.06). After exclusion of overt diabetics, a stepwise increase in the percentage of subjects with CHD was observed throughout the normal range for glycohemoglobin. Fibroplasia of small renal arteries, the most reliable postmortem proxy for hypertension, did not differ between CHD and basal groups. These results suggest that young (mean age 49.2 yr) black and white men and women classified from autopsy findings as having CHD as cause of death are often not hypertensive, but instead tend to be hyperlipidemic and glucose intolerant. A surprising result was that arteriolar hyalinization and arterial fibroplasia of the renal cortex often failed to parallel each other between groups of subjects. This was true in comparisons between black and white, male and female, blood cholesterol and glycohemoglobin groupings, and between CHD and basal subjects. This outcome suggests that hyalinization of renal arterioles is an especially reliable marker for CHD and that this association may not be mediated entirely through high blood pressure.

Low calorie unrestricted protein diet attenuates renal injury in hypertensive rats

In the present investigation we researched the effects of low calorie diet without protein restriction on the renal function and glomerular injury of uninephrectomized spontaneously hypertensive rats. We compared the findings with those that occurred in two different groups of uninephrectomized spontaneously hypertensive rats: one treated with oral hydralazine (10 mg/kg per day) and a second fed regular food. The low calorie diet and hydralazine treatment significantly reduced intra-arterial blood pressure in each group (p < 0.05 and p < 0.001, respectively). The control group showed at the end of the experiment a slight but not significantly different increase in the intra-arterial blood pressure. Low calorie diet was more effective in protecting the kidney function. Creatinine clearance after treatment was significantly higher in uninephrectomized spontaneously hypertensive rats on a low calorie diet than in either the hydralazine-treated or control groups (p < 0.01). The 24-hour urinary protein excretion in the low calorie diet group was significantly lower than in the control group (p < 0.05) and lower but not statistically different from the hydralazine-treated group. The mean glomerular injury index of the remaining kidney in the low calorie diet group was lower than in either the hydralazine-treated or control groups (p < 0.05), and the mean mesangial expansion index in the low calorie diet group was significantly lower than in the control group (p < 0.05). The favorable effect of low calorie diet on renal function was independent of protein restriction or sodium and potassium content.(ABSTRACT TRUNCATED AT 250 WORDS)

Nephrosclerosis in three cohorts of black and white men born 1925 to 1944, 1934 to 1953, and 1943 to 1962

The prevailing levels of blood pressure among black and white men of ages 25 to 54 years were examined by two independent approaches in this study. Data on blood pressure obtained in national health surveys (National Health and Nutrition Examination Surveys, NHANES) do not show any appreciable upward or downward trend between 1960 and 1980 in men of these ages. The histologic examination of kidney samples obtained from coroner's autopsies offers an indirect way of estimating the levels of blood pressure that prevail in populations because of statistical relationships between nephrosclerosis and blood pressure. Samples of kidney tissues archived in New Orleans from 1968 to 1986 were evaluated by quantitative morphometry for the severity of the renovasculopathies that accompany high blood pressure. The outcome showed no significant secular trend among black and white men, confirming blood pressure survey findings that show no change in the hypertensive status of the population. The black-white difference in incipient signs of hypertension was seen to be well-established by ages 25 to 34 years in all cohorts of New Orleans subjects, as well as in the NHANES survey data. These result suggest that the adolescent and young adult ages are especially important in establishing the black-white difference in hypertension.

Blood pressure and nephrosclerosis in black and white men and women aged 25 to 54

Kidney samples obtained at autopsy were evaluated for nephrosclerosis by quantitatively measuring the severity of intimal fibroplasia in the interlobular arteries and counting the number of hyalinized arterioles. Most cases were obtained from the coroner and had violent causes of death; subjects with cardiovascular diseases were excluded. Blood pressures in Health Survey data were obtained from published sources. Measures of nephrosclerosis in 365 black and white men and women in age groups 25 to 34, 35 to 44, and 45 to 54 yr were examined by three-way Analysis of Variance (ANOVA). Blacks exceeded whites in fibroplasia at all ages and in both sexes; this excess was paralleled by mean blood pressure in all comparisons. White women were not different from white men in fibroplasia; black women significantly exceeded black men at all ages. Women had lower blood pressures than men when matched for age, race, and fibroplasia; the average magnitude of this difference was 5.5 mm Hg. Since women are known to have as much hypertensive disease as men after age 50 yr, it seems possible that the arterial fibroplasia seen in young women may represent progression toward the hypertensive state, even through blood pressure does not reveal the equality of the sexes in this respect until after menopause. Hence, in women arterial fibroplasia is seen to precede a later rise in blood pressure. Arteriolar hyalinization was greater in men than in women but did not differ significantly between races. Hyalinization did not consistently follow blood pressure in comparisons between subgroups of subjects.

Use of serum lipid and apolipoprotein concentrations to predict extent of diet-induced atherosclerotic lesions in aortas and coronary arteries and to demonstrate regression of lesions in individual rhesus monkeys

In most studies, the assessment of lesion "regression" is based on comparisons of group means between the "progression" and regression groups. This comparison depends on the assumption that the extent and distribution of lesions produced by the end of the lesion-induction period in the regression animals are equal to those observed in the progression group. To determine whether significant regression of lesions occurs in an individual regression animal, it is necessary to obtain a measure of the lesions produced in these animals at the end of the lesion-induction period. We achieved this goal by developing models using multiple stepwise regression analysis that related steady-state serum cholesterol and apolipoprotein B and A-I concentrations measured during a lesion-induction period in 27 rhesus monkeys fed an atherogenic high-saturated-fat/high-cholesterol diet for 2 years. The models were developed to estimate the percent of intimal surface with lesions, the esterified cholesterol content (micrograms/cm2) for the artery segments, and three histomorphometric measures (mean intimal thickness, mean maximal intimal thickness, and mean percent stenosis) for the coronary arteries. In these models, multiple R2 ranged from 0.42 to 0.74 for the aortas and peripheral arteries, indicating that approximately one half to three fourths of the variance in lesions was accounted for. For the three histomorphometric measures in coronary arteries, however, the multiple R2 was 0.27 or 0.28, indicating that only approximately one fourth of the variance in lesions was accounted for.(ABSTRACT TRUNCATED AT 250 WORDS)

Variations with age and serum cholesterol level in the topographic distribution of macroscopic aortic atherosclerotic lesions as assessed by image analysis methods

The topographic distribution of macroscopic atherosclerotic lesions in the aorta was studied by image analysis of aortas taken at autopsy from 155 males aged 10 to 54 yr. In both the thoracic and abdominal aorta, fatty streaks (FS) appear before raised lesions (RL) affecting preferential areas located longitudinally along the intercostal ostia, at the aorta bifurcation, and surrounding the points of origin of branches of the abdominal aorta. Later RL appear in the same areas of the aortic intima affected by FS at younger ages. As for the effect of serum total cholesterol (TC) in the progression of atherosclerosis, the prevalent involvement areas by FS and RL were similarly distributed as indicated by our analyses. However, areas showing frequent occurrence of FS and RL in each aortic segment were distributed more extensively at identical areas in the higher serum TC groups than in the lower TC level group. Thus, it can be concluded that FS are the precursor lesions of RL in the aorta and that the serum TC promotes the progression of atherosclerosis.

Fatty acid composition of adipose tissue in humans: differences between subcutaneous sites

We compared the fatty acid composition of adipose tissue from three different sites, one deep-seated site (perirenal) and two subcutaneous sites (abdominal and buttock), in 143 autopsied adult humans aged 24-61 y. The proportion of saturated fatty acids was highest in the perirenal adipose tissue and lowest in buttock adipose tissue. The proportions of monounsaturated fatty acids in the three sites were in the reverse order. Linoleic and linolenic acids were similar in the three adipose-tissue sites, an important finding for those concerned about the essential fatty acids, which are solely derived from the diet. The results clearly show that the fatty acid composition of the two subcutaneous fat depots differ significantly. We conclude that abdominal fat is more saturated than buttock fat.

Is atherosclerosis increasing in Mexico City?

This report compares quantitative measures of atherosclerosis in aortas and coronaries from autopsies of deceased men from Mexico City collected during 1960 to 1964 and 1986 to 1987. The comparison of lesions in two different time periods provides an opportunity for determining whether the extent of atherosclerosis has changed over time in Mexico City. Three pathologists independently evaluated the extent of fatty streaks (FS), fibrous plaques (FP), calcified plaques (CA), and complicated lesions (CO) in 165 aortas and 120 sets of coronary arteries collected during 1986 to 1987 for comparison with similar gradings of 128 aortas and coronary arteries from the International Atherosclerosis Project in 1960 to 1964. Neither FS nor more advanced lesions differed significantly in either the descending thoracic or abdominal aorta between the two collection periods. In contrast, there were more extensive FP and raised atherosclerotic lesions (RL = FP + CA + CO) in the coronary artery segments evaluated in the younger age groups in 1986 to 1987 versus 1960 to 1964. Additional analyses, based on 75 pairs of aortas and 32 pairs of coronary arteries from age-matched cases, all regraded by the team of pathologists after blind coding, showed more FS in both aortic segments and more extensive involvement with RL in the three main branches of the coronary arteries in the more recent study. An overview of our findings suggests that atherosclerosis, particularly in the coronary arteries, is increasing in Mexico City. This hypothesis merits careful testing in parallel with consideration of possible changes in the risk factors that could be responsible for changes in extent of lesions.

Comparison of two measures of atherosclerosis in a prospective epidemiology study

Two different methods of measuring atherosclerosis, the American Heart Association panel method and the International Atherosclerosis Project unaided visual estimation, were used to estimate the extent of atherosclerosis in the coronary arteries and aortas from 225 men who participated in a prospective study of cardiovascular disease. The two methods produced quite different results of frequency distribution of levels of atherosclerosis. The correlations of the two measures of atherosclerosis were also relatively low for both the coronary arteries (0.63) and the aortas (0.74). The correlation of atherosclerosis with major risk factors was generally higher with the unaided visual estimation method than with the panel method, except for cigarette smoking. However, the associations of coronary atherosclerosis with autopsy-documented myocardial infarction and with clinical coronary disease were similar for the two measures. Thus, it is clear that the estimate of extent of atherosclerosis and its associations with major risk factors depends upon the method used to measure atherosclerosis. Epidemiologic studies that use only one method may miss some types of risk factor associations.

Natural history of aortic and coronary atherosclerosis in Tokyo

The natural history of atherosclerosis in Tokyo was explored in 1,206 unselected consecutive hospital and forensic medicine autopsies performed on deceased persons of both sexes aged 0 to 89 yr. The extent of intimal atherosclerotic lesions in the aorta and coronary arteries was estimated visually after staining with Sudan IV and recorded as the percentage of intima with fatty streaks (FS) and raised lesions (RL). The extent of atherosclerosis by sex and age was compared in two sources of subjects and various broad disease categories associated with the terminal event causing death. Comparisons of hospital cases with forensic medicine cases, by sex, over five arterial segments and nine 10-yr age groups, did not show significant differences in the extent of atherosclerosis between the two sources of cases. However, RL at all age groups over 40 yr in general showed a tendency to be slightly more extensive in the hospital cases. As is commonly reported for certain other population groups, our results showed more extensive atherosclerosis in Japanese men than in Japanese women. The comparisons of the extent of atherosclerosis among five broad disease categories causing death--coronary heart disease (CHD), cerebrovascular disease (CVD), cases with evidence of both CHD and CVD (OVL), cases with CHD-related diseases such as diabetes and hypertension (CHD-rel), and all other diseases, accidents, homicides, and suicides (Basal)--showed more extensive atherosclerosis among CHD and OVL cases when compared with the basal group as control reference.(ABSTRACT TRUNCATED AT 250 WORDS)

Secular trends in atherosclerotic lesions: comparison of two studies of autopsied men conducted in different time periods

The extent and prevalence of atherosclerotic lesions in the coronary arteries and aortas of deceased 25 to 44-yr-old men, autopsied in New Orleans during two different time periods (1960-64 and 1969-78), were evaluated to determine if changes in lesions had occurred in parallel with reported decreases in coronary heart disease death rates. Results of these evaluations showed that both the extent and prevalence of raised atherosclerotic lesions were significantly less in the coronary arteries of white men in the second time period. No significant difference was detected in black men. In the aorta there were no significant differences between studies in whites, but in blacks, there were significantly more extensive raised lesions in the second time period. These findings strongly suggest that the extent of involvement with atherosclerotic lesions in a given population may change over time. The underlying mechanisms responsible for these secular trends in atherosclerosis merit additional study.

Differences in adipose tissue fatty acid composition between black and white men in New Orleans

We report fatty acid composition in perirenal and buttock adipose tissue in 714 deceased black and white men aged 25-44 yr in New Orleans. Percent saturated fatty acids were higher (p less than 0.001) whereas percent monounsaturated fatty acids were lower (p less than 0.001) in perirenal than in buttock fat. Percent linoleic acid was similar in both races. We conclude that dietary intake of linoleic acid is similar in both races. The trend of decreasing linoleic acid with advancing age suggests that either intake of linoleic acid progressively decreases or its mobilization rate increasingly exceeds deposition rate or both. Percent palmitoleic acid (16:1) is lower (p less than 0.001) and that of stearic acid (18:0) is higher (p less than 0.001) in blacks than in whites. We believe no explanation can rest solely on differences in habitual dietary fat intake.

Comparison of coronary atherosclerosis in middle-aged Norwegian and Japanese men. An autopsy study

We compared the extent of lesions in the coronary arteries of autopsied middle-aged men from Oslo, Norway, with lesions in autopsied men of similar ages in Tokyo, Japan. Certain risk factors for coronary heart disease as serum cholesterol, triglycerides, and blood pressure were also available from these men in the two locations. Our comparisons reveal large differences in the extent of atherosclerosis between Oslo and Tokyo, which are reflected in the levels of the risk factors, particularly serum cholesterol levels. Our findings suggest that preventive strategies could retard the development of atherosclerosis and coronary heart disease without the economic and nutritional problems that affect technically underdeveloped societies where atherosclerosis and coronary heart disease are not prevalent.

Coronary and aortic atherosclerosis in young men from Tokyo and New Orleans

Comparisons of atherosclerotic lesions in 25- to 44-year-old men from Tokyo, Japan and New Orleans, Louisiana, by age and cause of death, show significantly more extensive involvement with raised lesions in the coronary arteries and abdominal aorta of black and white men from New Orleans than in men from Tokyo. New Orleans white men have approximately 3-fold the raised lesion intimal surface involvement of their Japanese counterparts in both the aorta and coronary arteries. These findings suggest the need for more extensive and detailed comparisons of atherosclerotic lesions to provide the background information necessary for effective preventive efforts in these two industrialized, technically advanced societies.

Cerebral atherosclerosis in New Orleans. Comparisons of lesions by age, sex, and race

We compared mean extent of atherosclerotic lesions in carotid and intracranial arteries at autopsy among age, sex, and race subgroups in New Orleans. Most comparisons were made within similar broad cause-to-death categories after excluding deaths due to diseases associated with increased amount of atherosclerosis. Use of this basal group of cases reduces the effect of selection bias due to cause of death in this autopsy population. Fatty streaks were present in the carotid arteries of almost all cases even in the youngest age group (10 to 14 years) and were more extensive in blacks than in whites. Raised atherosclerotic lesions increased with age in the carotid arteries of blacks from age group 15 to 24 years and in whites from age group 25 to 34 years; black men and white men had about the same amount of raised lesions, whereas black women consistently had more than white women. In the intracranial arteries, fatty streaks and fibrous plaques began from age 15 to 24 years; blacks had more raised lesions than whites, particularly in the oldest age group, 65 to 69 years. These findings and mortality data suggest that in the 1960s and early 1970s black men and women were more susceptible to cerebral atherosclerosis and cerebrovascular diseases than white men and women.

Coronary heart disease in young black and white males in New Orleans: Community Pathology Study

The biracial population of New Orleans has a high overall mortality rate, high coronary heart disease (CHD) mortality rate, and high autopsy rate. In the New Orleans Community Pathology Study we investigated atherosclerosis and CHD in all deceased males aged 25 to 44 years, with major focus on the 52% of subjects from whom heart and arterial specimens were collected and evaluated according to standardized procedures. Morphologic correlates of CHD are the same in young black and white males. CHD mortality and mortality from cerebral hemorrhage, hypertensive heart disease, chronic renal disease, and diabetes are greater in young black males than young white males. Age, serum cholesterol, and hypertension were identified as important associated factors in the atherosclerotic process, as well as in CHD. The extent of coronary lesions seems to have decreased between 1960-1964 and 1969-1978 in young white males but not in blacks. Racial differences in coronary lesion involvement in non-CHD deaths are smaller than in our earlier studies.

Self-selection and the obese Zucker rat: the effect of dietary fat dilution

Adult female lean and obese Zucker rats were allowed to compose their own diets by giving them access to three macronutrient sources. After a baseline period, the fat source was serially diluted. In all, eight concentrations of fat were used. Dilution of the fat source promoted significant increases in the intake of fat by both lean and obese rats. The increased intake of fat was not simply compensatory in nature, but rather represented significant increases in fat consumption. These results suggest that the reported increased appetite for fat of the obese rat is not a unique trait of that genotype. Further, results from this experiment demonstrate that caloric and protein regulation mechanisms may not be controlling the intake of obese and lean rats as precisely as once believed.

Dietary-atherosclerosis study on deceased persons

Relation of certain market foods to raised coronary lesions. By M. C. Moore, M. A. Guzmán, P. E. Schilling, and J. P. Strong, J. Am. Dietet. A. 79:668, 1981. Dietary patterns of 253 deceased men, as reported by their spouses, were related significantly to atherosclerotic lesions when assessed by the food sources in their diets. Using the macronutrients--protein, fat and carbohydrate--to identify and quantify the food sources in their diets, researchers found lesser lesions to be related to intakes of legumes, grains, and vegetables, while higher lesions were related, but to a lesser degree, to intakes of beef, milk, and fruit. It is concluded that dietary mixing of foods could have either enhanced or obscured the degree of these relationships.

Dissemination of an antibiotic resistance plasmid in hospital patient flora

The 2'' aminoglycoside nucleotidyltransferase, AAD (2''), which adenylates gentamicin, tobramycin, and kanamycin, became prevalent over several months in multiple strains and species of Enterobacteriaceae isolated at one hospital. Eight plasmids with the gene for this enzyme purified from different strains and species isolated at different times had similar EcoRI digestion fragments, indicating that the gene had disseminated on one plasmid without transposition. This 56.5-megadalton plasmid of incompatibility group M, which also carried three other resistance genes, spread, at first, largely in one strain of Klebsiella pneumoniae, which later disappeared. It transferred to some strains which tended not to colonize other patients and later circulated predominantly in Serratia marcescens. Computer surveillance of routine hospital laboratory results was able to detect and trace the gene and the plasmid and measure their effect on resistance prevalence.

Dietary-atherosclerosis study on deceased persons. Relation of eating pattern to raised coronary lesions

Eating patterns of 456 New Orleans males, ages twenty to sixty years, indicate that clock-time and frequency of ingesting foods may help define life styles related to raised coronary lesions. Age, race, and occupation were also related to raised coronary lesions. The multiplicity of variables and strong interrelationships make evaluation difficult, but results from correlation studies, analyses of variance, and discriminant function analyses suggest that the number of meals plus heavy snacks, frequency of intake of caffeine and alcoholic beverages, and cigarette smoking rate for the last ten years of life may be valid factors in relation to development of atherosclerotic lesions. In other words, not only what we eat, as is now generally accepted, but how and when we eat it, merit consideration in studying the etiology of atherosclerosis.