Strain-specific metabarcoding reveals rapid evolution of copper tolerance in populations of the coastal diatom Skeletonema marinoi

Phytoplankton have short generation times, flexible reproduction strategies, large population sizes and high standing genetic diversity, traits that should facilitate rapid evolution under directional selection. We quantified local adaptation of copper tolerance in a population of the diatom Skeletonema marinoi from a mining-exposed inlet in the Baltic Sea and in a non-exposed population 100 km away. We hypothesized that mining pollution has driven evolution of elevated copper tolerance in the impacted population of S. marinoi. Assays of 58 strains originating from sediment resting stages revealed no difference in the average tolerance to copper between the two populations. However, variation within populations was greater at the mining site, with three strains displaying hyper-tolerant phenotypes. In an artificial evolution experiment, we used a novel intraspecific metabarcoding locus to track selection and quantify fitness of all 58 strains during co-cultivation in one control and one toxic copper treatment. As expected, the hyper-tolerant strains enabled rapid evolution of copper tolerance in the mining-exposed population through selection on available strain diversity. Within 42 days, in each experimental replicate a single strain dominated (30%-99% abundance) but different strains dominated the different treatments. The reference population developed tolerance beyond expectations primarily due to slowly developing plastic response in one strain, suggesting that different modes of copper tolerance are present in the two populations. Our findings provide novel empirical evidence that standing genetic diversity of phytoplankton resting stage allows populations to evolve rapidly (20-50 generations) and flexibly on timescales relevant for seasonal bloom progressions.

Transcriptional Responses as Biomarkers of General Toxicity: A Systematic Review and Meta-analysis on Metal-Exposed Bivalves

Through a systematic review and a series of meta-analyses, we evaluated the general responsiveness of putative transcriptional biomarkers of general toxicity and chemical stress. We targeted metal exposures performed on bivalves under controlled laboratory conditions and selected six transcripts associated with general toxicity for evaluation: catalase, glutathione-S-transferase, heat shock proteins 70 and 90, metallothionein, and superoxide dismutase. Transcriptional responses (n = 396) were extracted from published scientific articles (k = 22) and converted to log response ratios (lnRRs). By estimating toxic units, we normalized different metal exposures to a common scale, as a proxy of concentration. Using Bayesian hierarchical random effect models, we then tested the effects of metal exposure on lnRR, both for metal exposure in general and in meta-regressions using toxic unit and exposure time as independent variables. Corresponding analyses were also repeated with transcript and tissue as additional moderators. Observed patterns were similar for general and for transcript- and tissue-specific responses. The expected overall response to arbitrary metal exposure was an lnRR of 0.50, corresponding to a 65% increase relative to a nonexposed control. However, when accounting for publication bias, the estimated "true" response showed no such effect. Furthermore, expected response magnitude increased slightly with exposure time, but there was little support for general monotonic concentration dependence with regard to toxic unit. Altogether, the present study reveals potential limitations that need consideration prior to applying the selected transcripts as biomarkers in environmental risk assessment. Environ Toxicol Chem 2023;42:628-641. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Evaluation of transcriptional biomarkers using a high-resolution regression approach: Concentration-dependence of selected transcripts in copper-exposed freshwater mussels (Anodonta anatina)

We tested concentration-dependence of selected gene transcripts (cat, gst, hsp70, hsp90, mt and sod) for evaluation as biomarkers of chemical stress. Contrary to the common approach of factorial designs and few exposure concentrations, we used regression across a high-resolution concentration series. Specifically, freshwater mussels (Anodonta anatina) were acutely (96 h) exposed to Cu (13 nominal concentrations, measuring 0.13-1 600 µg/L), and transcripts were measured by RT-qPCR. In digestive glands, cat, hsp90 and mt decreased with water Cu (p < 0.05), but response magnitudes saturated at < 2-fold decreases. In gills, gst, hsp70, hsp90 and mt increased with water Cu (p < 0.05). While hsp70, hsp90 and mt exceeded 2-fold increases within the exposure range, high Cu concentrations were required (38-160 µg/L). Although gill responses were generally more robust compared to digestive glands, overall small response magnitudes and moderate sensitivity may set limit for potential application as general biomarkers of chemical stress.

Intraspecific variation in metal tolerance modulate competition between two marine diatoms

Despite widespread metal pollution of coastal ecosystems, little is known of its effect on marine phytoplankton. We designed a co-cultivation experiment to test if toxic dose-response relationships can be used to predict the competitive outcome of two species under metal stress. Specifically, we took into account intraspecific strain variation and selection. We used 72 h dose-response relationships to model how silver (Ag), cadmium (Cd), and copper (Cu) affect both intraspecific strain selection and competition between taxa in two marine diatoms (Skeletonema marinoi and Thalassiosira baltica). The models were validated against 10-day co-culture experiments, using four strains per species. In the control treatment, we could predict the outcome using strain-specific growth rates, suggesting low levels of competitive interactions between the species. Our models correctly predicted which species would gain a competitive advantage under toxic stress. However, the absolute inhibition levels were confounded by the development of chronic toxic stress, resulting in a higher long-term inhibition by Cd and Cu. We failed to detect species differences in average Cu tolerance, but the model accounting for strain selection accurately predicted a competitive advantage for T. baltica. Our findings demonstrate the importance of incorporating multiple strains when determining traits and when performing microbial competition experiments.

Molecular biomarker responses in the freshwater mussel Anodonta anatina exposed to an industrial wastewater effluent

Using a selection of molecular biomarkers, we evaluated responses in freshwater mussels (Anodonta anatina) exposed to effluent from an industrial wastewater treatment facility. The aims of this work were to (1) assess biomarkers of general toxicity under sublethal exposure to an anthropogenic mixture of chemicals, represented by an arbitrary effluent, and (2) evaluate the potential of A. anatina as a bioindicator of pollution. Adult mussels (n = in total 32; 24 males and 8 females) were exposed (96 h) in the laboratory to a fixed dilution of effluent or to a control treatment of standardized freshwater. Metal concentrations were in general higher in the effluent, by an order of magnitude or more, compared to the control. Toxic unit estimates were used as proxies of chemical stress, and Cu, Ni, and Zn were identified as potential major contributors (Cu> Ni > Zn). Six transcriptional (cat, gst, hsp70, hsp90, mt, sod) and two biochemical (AChE, GST) biomarkers were analyzed in two tissues, gills, and digestive glands. Out of the 16 responses (eight biomarkers × two tissues), 14 effect sizes were small (within ± 28 % of control) and differences non-significant (p > 0.05). Results did however show that (1) AChE activity increased by 40% in gills of exposed mussels compared to control, (2) hsp90 expression was 100% higher in exposed female gills compared to control, and (3) three marker signals (AChE in both tissues, and hsp70 in gills) differed between sexes, independent of treatment. Results highlight a need for further investigation of molecular biomarker variability and robustness in A. anatina.

Antipredator phenotype in crucian carp altered by a psychoactive drug

Predator-inducible defenses constitute a widespread form of adaptive phenotypic plasticity, and such defenses have recently been suggested linked with the neuroendocrine system. The neuroendocrine system is a target of endocrine disruptors, such as psychoactive pharmaceuticals, which are common aquatic contaminants. We hypothesized that exposure to an antidepressant pollutant, fluoxetine, influences the physiological stress response in our model species, crucian carp, affecting its behavioral and morphological responses to predation threat. We examined short- and long-term effects of fluoxetine and predator exposure on behavior and morphology in crucian carp. Seventeen days of exposure to a high dose of fluoxetine (100 µg/L) resulted in a shyer phenotype, regardless of the presence/absence of a pike predator, but this effect disappeared after long-term exposure. Fluoxetine effects on morphological plasticity were context-dependent as a low dose (1 µg/L) only influenced crucian carp body shape in pike presence. A high dose of fluoxetine strongly influenced body shape regardless of predator treatment. Our results highlight that environmental pollution by pharmaceuticals could disrupt physiological regulation of ecologically important inducible defenses.

Differences in metal tolerance among strains, populations, and species of marine diatoms - Importance of exponential growth for quantification

Strains of microalgae vary in traits between species and populations due to adaptation or stochastic processes. Traits of individual strains may also vary depending on the acclimatization state and external forces, such as abiotic stress. In this study we tested how metal tolerance differs among marine diatoms at three organizational levels: species, populations, and strains. At the species level we compared two pelagic Baltic Sea diatoms (Skeletonema marinoi and Thalassiosira baltica). We found that the between-species differences in tolerance (EC50) to the biologically active metals (Cu, Co, Ni, and Zn) was similar to that within-species. In contrast, the two species differed significantly in tolerance towards the non-essential metals, Ag (three-fold higher in T. baltica), Pb and Cd (two and three-fold higher in S. marinoi). At the population level, we found evidence that increased tolerance against Cu and Co (17 and 41 % higher EC50 on average, respectively) had evolved in a S. marinoi population subjected to historical mining activity. On a strain level we demonstrate how the growth phase of cultures (i.e., cellular densities above exponential growth) modulated dose-response relationships to Ag, Cd, Co, Cu, and Zn. Specifically, the EC50's were reduced by 10-60 % in non-exponentially growing S. marinoi (strain RO5AC), depending on metal. For the essential metals these differences were often larger than the average differences between the two species and populations. Consequently, without careful experimental design, interactions between nutrient limitation and metal stress may interfere with detection of small, but evolutionary and ecologically important, differences in tolerance between microalgae. To avoid such artifacts, we outline a semi-continuous cultivation approach that maintains, and empirically tests, that exponential growth is achieved. We argue that such an approach is essential to enable comparison of population or strain differences in tolerance using dose-response tests on cultures of microalgae.

Transcriptional and biochemical biomarker responses in a freshwater mussel (Anodonta anatina) under environmentally relevant Cu exposure

Molecular biomarkers, like gene transcripts or enzyme activities, are potentially powerful tools for early warning assessment of pollution. However, a thorough understanding of response and baseline variation is required to distinguish actual effects from pollution. Here, we assess the freshwater mussel Anodonta anatina as a biomarker model species for freshwater ecosystems, by testing responses of six transcriptional (cat, gst, hsp70, hsp90, mt, and sod) and two biochemical (AChE and GST) biomarkers to environmentally relevant Cu water concentrations. Mussels (n = 20), collected from a stream free from point source pollution, were exposed in the laboratory, for 96 h, to Cu treatments (< 0.2 μg/L, 0.77 ± 0.87 μg/L, and 6.3 ± 5.4 μg/L). Gills and digestive glands were extracted and analyzed for transcriptional and biochemical responses. Biological and statistical effect sizes from Cu treatments were in general small (mean log₂ fold-change ≤ 0.80 and Cohen's f ≤ 0.69, respectively), and no significant treatment effects were observed. In contrast, four out of eight biomarkers (cat, gst, hsp70, and GST) showed a significant sex:tissue interaction, and additionally one (sod) showed significant overall effects from sex. Specifically, three markers in gills (cat, mt, GST) and one in digestive gland (AChE) displayed significant sex differences, independent of treatment. Results suggest that sex or tissue effects might obscure low-magnitude biomarker responses and potential early warnings. Thus, variation in biomarker baselines and response patterns needs to be further addressed for the future use of A. anatina as a biomarker model species.

Behaviour of freshwater snails (Radix balthica) exposed to the pharmaceutical sertraline under simulated predation risk

Due to their potential for affecting the modulation of behaviour, effects of selective serotonin reuptake inhibitors (SSRIs) in the environment are particularly interesting regarding interspecies interactions and non-consumptive effects (NCEs) induced by predator cues in prey organisms. We evaluated the effects of sertraline (0.4, 40 ng/L, 40 µg/L) over 8 days on activity and habitat choice in the freshwater snail Radix balthica, on snails' boldness in response to mechanical stimulation (simulating predator attack), and their activity/habitat choice in response to chemical cues from predatory fish. We hypothesised that sertraline exposure would detrimentally impact NCEs elicited by predator cues, increasing predation risk. Although there were no effects of sertraline on NCEs, there were observed effects of chemical cue from predatory fish on snail behaviour independent of sertraline exposure. Snails reduced their activity in which the percentage of active snails decreased by almost 50% after exposure to fish cue. Additionally, snails changed their habitat use by moving away from open (exposed) areas. The general lack of effects of sertraline on snails' activity and other behaviours in this study is interesting considering that other SSRIs have been shown to induce changes in gastropod behaviour. This raises questions on the modes of action of various SSRIs in gastropods, as well as the potential for a trophic "mismatch" of effects between fish predators and snail prey in aquatic systems.

Bioaccumulation and trophodynamics of the antidepressants sertraline and fluoxetine in laboratory-constructed, 3-level aquatic food chains

Although reports of pharmaceutical bioconcentration in aquatic organisms are increasing, less is known about trophic transfer in aquatic food webs. The bioaccumulation and trophodynamics of sertraline and fluoxetine, 2 selective serotonin reuptake inhibitors (SSRIs) frequently detected in aquatic environments, were tested by exposing constructed aquatic food chains to SSRIs under controlled laboratory conditions. Both of these ionizable, weak base pharmaceuticals showed lower bioaccumulation factors (BAFs) with increasing trophic level (i.e., no biomagnifications) in 2 3-level food chains (Acer platanoides, fed to Asellus aquaticus, in turn fed to Notonecta glauca or Pungitius pungitius). Mean sertraline BAFs in A. platanoides, A. aquaticus, N. glauca, and P. pungitus were 2200 L/kg, 360 L/kg, 26 L/kg, and 49 L/kg, respectively, and mean fluoxetine BAFs 1300 L/kg, 110 L/kg, 11 L/kg, and 41 L/kg, respectively. The weak influence of diet was further demonstrated by measured BAFs being equal to or lower than measured bioconcentration factors (BCFs). Organism lipid content was not positively correlated with BAFs, suggesting that other processes are driving interspecific differences in SSRI bioaccumulation. The empirically derived parameter values were introduced into a proposed bioaccumulation model, and a poor correlation was found between modeled and empirical BAFs (predicted r²  = -0.63). In conclusion, the apparent lack of biomagnification of these ionizable pharmaceuticals suggests that environmental concern should not necessarily focus only on higher trophic levels, but also on species showing high BCFs at any trophic level. Environ Toxicol Chem 2017;36:1029-1037. © 2016 SETAC.

Influence of pH-dependent aquatic toxicity of ionizable pharmaceuticals on risk assessments over environmental pH ranges

Due to variation in pH, ionizable pharmaceuticals entering aquatic environments experience different degrees of ionization, which may affect toxicity. Using data from toxicity testing at only neutral pH may potentially under- or overestimate actual toxicity at pH ranges found in natural aquatic environments. Here we show relative pH-dependent acute toxicity to Daphnia magna for the pharmaceutical weak bases fluoxetine and sertraline, as well as the weak acids naproxen, diclofenac, ibuprofen and ketoprofen. A probabilistic modelling approach using the pH-dependent toxicity data for D. magna and an environmental pH distribution based on over 4000 European running waters from 21 countries predicted that environmental toxicity for the weak bases may be underestimated if pH 7 was assumed. The model predicted median underestimation by a factor of 3, with 90% of the model results ranging from 1 to 6. Consequently, due to the slightly basic nature of the European running waters, weak acid toxicity may be overestimated by a factor of 2. Predicted median toxicity was 0.5 of that assuming pH 7 with 90% of the results ranging from 0.03 to 5. Because aquatic pH exhibits large variation both within and between countries, we advise the use of site-specific risk assessments for ionizable pharmaceuticals in making informed water management decisions.

Ecological implications of altered fish foraging after exposure to an antidepressant pharmaceutical

Pharmaceutical residues are increasingly detected in environmental and biological samples, some at levels known to adversely affect non-target organisms; however, less is known of how these organism-level effects relate to the ecology of aquatic systems. Foraging processes may be used as behavioral endpoints that link effects on individuals to the population and community levels, enabling risk assessment of environmental contaminants at larger ecological scales. In this study, we performed feeding trials using juvenile Eurasian perch (Perca fluviatilis) exposed to the selective serotonin reuptake inhibitor (SSRI) sertraline to test the hypothesis that sertraline alters foraging ecology of the fish in terms of their functional response. We found an exposure-dependent decrease in feeding with increasing sertraline concentrations. Further experiments revealed that feeding rates decrease at both low and high prey densities, indicating effects on both attack rate and handling time, respectively. Because the functional response can shape consumer-resource dynamics, such effects may alter the stability of predator-prey systems and consequently, community structure.

Effects of 17α-ethinylestradiol on individual life-history parameters and estimated population growth rates of the freshwater gastropods Radix balthica and Bithynia tentaculata

Studies of aquatic environments exposed to 17α-ethinylestradiol (EE2) have demonstrated detrimental effects on fish communities. However, much less is known about effects on macro-invertebrates and especially how long-term exposure may affect critical life stages and ultimately population dynamics. We studied the effects of EE2 on relevant endpoints for population growth in two common freshwater gastropods, Radix balthica and Bithynia tentaculata, that differ in reproductive, foraging and anti-predator strategies and endocrine systems. We quantified critical life-history parameters (mortality, somatic growth rate, days to and size at first reproduction, egg production and hatching success) in a concentration-response, life cycle experiment. The two species responded to EE2 exposure in different ways, B. tentaculata showing a significantly lower somatic growth rate and R. balthica a higher somatic growth rate. However, the magnitudes of the effects were small and EE2 exposure did not have any significant effect on estimated population growth rates for the two snail species. The significant effects of EE2 on individual endpoints, but not on population growth rate for both species, emphasise the importance of evaluating higher level effects from long-term exposure studies.

Trophic magnification factors: considerations of ecology, ecosystems, and study design

Recent reviews by researchers from academia, industry, and government have revealed that the criteria used by the Stockholm Convention on persistent organic pollutants under the United Nations Environment Programme are not always able to identify the actual bioaccumulative capacity of some substances, by use of chemical properties such as the octanol-water partitioning coefficient. Trophic magnification factors (TMFs) were suggested as a more reliable tool for bioaccumulation assessment of chemicals that have been in commerce long enough to be quantitatively measured in environmental samples. TMFs are increasingly used to quantify biomagnification and represent the average diet-to-consumer transfer of a chemical through food webs. They differ from biomagnification factors, which apply to individual species and can be highly variable between predator-prey combinations. The TMF is calculated from the slope of a regression between the chemical concentration and trophic level of organisms in the food web. The trophic level can be determined from stable N isotope ratios (δ(15) N). In this article, we give the background for the development of TMFs, identify and discuss impacts of ecosystem and ecological variables on their values, and discuss challenges and uncertainties associated with contaminant measurements and the use of δ(15) N for trophic level estimations. Recommendations are provided for experimental design, data treatment, and statistical analyses, including advice for users on reporting and interpreting TMF data. Interspecies intrinsic ecological and organismal properties such as thermoregulation, reproductive status, migration, and age, particularly among species at higher trophic levels with high contaminant concentrations, can influence the TMF (i.e., regression slope). Following recommendations herein for study design, empirical TMFs are likely to be useful for understanding the food web biomagnification potential of chemicals, where the target is to definitively identify if chemicals biomagnify (i.e., TMF > or < 1). TMFs may be less useful in species- and site-specific risk assessments, where the goal is to predict absolute contaminant concentrations in organisms in relation to threshold levels.

Temperature and resource availability may interactively affect over-wintering success of juvenile fish in a changing climate

The predicted global warming may affect freshwater systems at several organizational levels, from organism to ecosystem. Specifically, in temperate regions, the projected increase of winter temperatures may have important effects on the over-winter biology of a range of organisms and especially for fish and other ectothermic animals. However, temperature effects on organisms may be directed strongly by resource availability. Here, we investigated whether over-winter loss of biomass and lipid content of juvenile roach (Rutilus rutilus) was affected by the physiologically relatively small (2-5°C) changes of winter temperatures predicted by the Intergovernmental Panel on Climate Change (IPCC), under both natural and experimental conditions. This was investigated in combination with the effects of food availability. Finally, we explored the potential for a correlation between lake temperature and resource levels for planktivorous fish, i.e., zooplankton biomass, during five consecutive winters in a south Swedish lake. We show that small increases in temperature (+2°C) affected fish biomass loss in both presence and absence of food, but negatively and positively respectively. Temperature alone explained only a minor part of the variation when food availability was not taken into account. In contrast to other studies, lipid analyses of experimental fish suggest that critical somatic condition rather than critical lipid content determined starvation induced mortality. Our results illustrate the importance of considering not only changes in temperature when predicting organism response to climate change but also food-web interactions, such as resource availability and predation. However, as exemplified by our finding that zooplankton over-winter biomass in the lake was not related to over-winter temperature, this may not be a straightforward task.

Toxicity of fungicides to natural bacterial communities in wetland water and sediment measured using leucine incorporation and potential denitrification

We assessed potential toxicity of fungicides to natural bacterial communities from a constructed wetland, located in southern Sweden, and compared the sensitivity of two endpoints indicating bacterial activity, leucine incorporation, and potential denitrification, in detecting toxicity. The effects of eight fungicides (benomyl, carbendazim, carboxin, captan, cycloheximide, fenpropimorph, propiconazole, and thiram), two bactericides (bronopol and chlortetracycline) as controls, and one reference compound (3,5-dichlorophenol), were tested in a water-sediment microcosm set-up. Leucine incorporation was measured in both the water and sediment column, while potential denitrification was measured for the entire microcosm. The bactericides and the reference compound gave sigmoid concentration-response curves for both endpoints in all but one case. The fungicides thiram, captan, and benomyl, and to a lesser extent fenpropimorph and propiconazole had quantifiable toxic effects on leucine incorporation, with EC(50) values ranging from 3 to 70 mg l(-1), while carbendazim, carboxin, and cycloheximide had little effect at the investigated concentrations. Only thiram and captan inhibited potential denitrification; the other fungicides showed no quantifiable effect. A greater toxic effect on leucine incorporation was recorded for bacterial communities associated with the water column, compared to the sediment column, for all tested compounds. Leucine incorporation was the more sensitive method for toxicity assessment of bacterial communities, and also allowed for a rapid and simple way of comparing exposure in the sediment and water column, making it an attractive standard method for community based toxicological assays in aquatic environments.

Heavy metals and stable isotopes in a benthic omnivore in a trophic gradient of lakes

Heavy metals (Cd, Hg, and Pb) and stable isotopes (15N, 13C) in crayfish (Pacifastacus leniusculus) were studied in a trophic gradient of lakes (N=19) in southern Sweden. Trophic indicators of the lakes as total phosphorus (tot-P) varied from 5 to 93 microg/L. The examined lakes had no known point sources of heavy metals, but the catchment areas varied from mainly forested to agricultural land. Cd and Hg in crayfish were affected by the trophic status of the lakes, showing significant negative relationship with tot-P, total nitrogen, and chlorophyll A content and a positive relationship with lake transparency (Secchi depth). The concentration of these two heavy metals was thus higher in crayfish in the oligotrophic lakes and decreased linearly to the eutrophic ones. Pb was not related to any lake variable. Stable isotopes of carbon (delta(13)C) and nitrogen (delta(15)N) in crayfish were a reflection of that found in the sediment as shown by positive linear relationships for the lakes. In the sediment of the lakes, delta(13)C signature showed significant negative relationships with the trophic indicators but positive results were shown for lake transparency. The trophic gradient of the lakes was reflected by delta(13)C in the sediment and in the crayfish. delta(15)N in crayfish was a reflection of delta(15)N in the sediment, but the relationship was not coupled to the trophic status of the lakes. The results from the study show that Cd and Hg in benthic omnivores as crayfish are affected by ecological processes in lakes, such as eutrophication. Stable isotopes, such as 13C and 15N, can be used to study these ecological processes.

Persistent organic pollutants (POP) in a benthic omnivore--a comparison between lake and stream crayfish populations

We investigated the accumulation of PCB and DDT in crayfish populations in 10 streams in southern Sweden. The results were compared with an earlier study on crayfish in lakes from the same area. We found that the concentration of pollutants in crayfish did not differ between the two types of systems. Variation in body burden was higher in stream living crayfish probably because of the higher influence from pollutants deposited in the catchment area and the more dynamic transport in streams. In streams, p,p'-DDE concentrations were positively correlated to trophic status (total phosphorous) while PCB did not show any correlation with the nutrient regime. Further, mean SigmaPCB and p,p'-DDE concentrations in crayfish did not correlate in streams. We suggest that the sources of the two pollutants differ for stream living crayfish. The results indicate that crayfish in streams are affected to a higher degree to pollutants in the catchment area and the precipitation regime. In lakes, internal processes govern uptake of pollutants in crayfish.

The effect of tadalafil on psychosocial outcomes in Swedish men with erectile distress: a multicentre, non-randomised, open-label clinical study

A multicentre, non-randomised, open-label study assessed whether personal distress caused by erectile dysfunction (ED) affected psychosocial outcomes of tadalafil treatment. Eligible Swedish men at least 18 years old reporting > or =3-month history of ED were stratified into two groups (manifest or mild/no distress) based upon a distress question administered at enrollment. Tadalafil 20 mg was taken as needed for 8 weeks. The primary outcome was the difference between the two distress groups in change from baseline in the Psychological and Interpersonal Relationship Scales (PAIRS) spontaneity domain. Secondary outcome measures were PAIRS sexual self-confidence and time concerns domains, Life Satisfaction (LiSat-11) checklist and a Global Assessment of Treatment Response. The study also assessed tolerability. Of 662 men enrolled, 88% had manifest distress and 12% had mild/no distress. Baseline-to-endpoint changes for PAIRS domains were not significantly different between groups. Baseline-to-endpoint changes in LiSat-11 items were not significantly different between groups except for satisfaction with sexual life. Compared with men without ED, below normal baseline satisfaction with partner relationship and family life were normalised at endpoint. Over 90% of men reported improved erection and ability to engage in sexual activity. The most common treatment-emergent adverse events were headache, myalgia, dyspepsia, flushing and back pain. One man discontinued because of myalgia; 630 (95%) completed the study. In conclusion, erectile distress levels vary among patients with ED and distress can affect intra-familiar aspects of life, which may have implications for clinical practise. However, distress does not appear to hinder improvement in both mechanical and psychosocial outcomes of tadalafil treatment.

Low levels of persistent organic pollutants (POPs) in New Zealand eels reflect isolation from atmospheric sources

Polychlorinated biphenyls (PCBs) and organic pesticides (i.e., DDTs) were measured in long finned eels (Anguilla dieffenbachii) in 17 streams on the west coast of South Island, New Zealand. Very low levels of PCBs and low levels of ppDDE were found. The concentrations of PCBs and ppDDE were not correlated within sites indicating that different processes determined the levels of the two pollutants in New Zealand eels. The PCBs probably originate from atmospheric transport, ppDDE levels are determined by land use and are higher in agriculture areas. The low contamination level of these aquatic systems seems to be a function of a low input from both long and short-range transport as well as few local point sources. No correlation could be found between lipid content and persistent organic pollutants (POPs) concentration (as shown in previous studies) in the eels which could be explained by low and irregular intake of the pollutants.

Organochlorine accumulation and stable isotope ratios in an Atlantic salmon (Salmo salar) population from the Baltic Sea

We investigated the organochlorine accumulation (p,p'-DDE and sigmaPCB) and stable isotope ratios (N and C) in a migrating salmon (Salmo salar) population in the Baltic Sea. delta15N in the entire population ranged from 11.7 to 13.7 per thousand and delta13C ranged from -22.0 to - 19.6 per thousand. In the entire population, delta15N were weakly related to p,p'-DDE and sigmaPCB concentrations (r2 = 0.20 and 0.14, respectively). However, lipid content was a better predictor of organochlorine (OC) concentrations (r2 = 0.48 and 0.50, respectively). Lipid adjusted sigmaPCB concentrations were not related to delta15N, and lipid adjusted p,p'-DDE concentrations were only weakly related (r2 = 0.12). We divided the salmon population into three groups representing reproductive strategies: small males < 5 kg (SM); large males > 5 kg (LM); and females (F). delta15N varied between the three reproductive strategies. The mean delta15N for SM was 12.7+/-0.3 per thousand, for F was 12.9+/-0.3 per thousand, and for LM equalled 13.2+/-0.3 per thousand. Lipid adjusted OC concentrations differed between the three reproductive strategies, with the females having the highest concentrations. We conclude that the delta15N varied between reproductive strategies indicating differences in prey choice, but the lipid content was better able to predict OC concentrations than the trophic position of the salmon.

[The first case of rabies in Sweden in 26 years. Inform travellers abroad about risks and treatment following suspected infection]

In June 2000, a case of rabies was diagnosed in Stockholm. The patient, a 19-year-old woman, had been bitten by a dog in Thailand three months earlier. She was admitted with a 2-day history of pain and paresthesia at the exposure site (right arm), along with anxiety. Her neurological symptoms progressed, and during the following week she developed the typical signs of furious rabies. Despite intensive care, her condition deteriorated continuously, and she died 18 days after onset of symptoms. The diagnosis was not considered until five days after admission to the hospital. A saliva sample was obtained and the diagnosis confirmed by virus isolation in mouse neuroblastoma cells. Although Sweden is free of rabies, the diagnosis should be considered in patients with encephalitis after having visited a rabies endemic area. Tourists must be informed of the vital importance of post-exposure prophylaxis after suspected infection.

Influence of trophic status on PCB distribution in lake sediments and biota

We investigated the relationship between trophic status and polychlorinated biphenyl (PCB) distribution in 19 Swedish lakes. We analyzed PCB in water, phytoplankton, zooplankton, fish and sediment during two sampling periods, in spring and summer. The mass of sigma PCB in the lake sediments was positively related to lake trophy, i.e. more PCBs were accumulated and buried in the sediment of eutrophic lakes than in oligotrophic lakes. In the oligotrophic lakes a greater fraction of the total PCB load was dissolved in water. We conclude that this is a result of higher sedimentation rates in eutrophic lakes and relatively lower turnover of organic carbon in the water column of the shallow, eutrophic lakes. In the stratified lakes, the amount of PCB per cubic meter in the epilimnion decreased from spring to summer. We suggest that sedimentation of plankton beneath the thermocline during stratification act as a sink process of PCBs from the epilimnion.

Effect of oligochaete bioturbation on sediment accumulation of 2,2',4,4'-tetrachlorobiphenyl

The influence of clay content, organic carbon, and bioturbation on sediment accumulation of 2,2',4,4'-tetrachlorobiphenyl (TCB) was investigated in microcosms. Four types of sediments differing in porosity, density, organic carbon, and clay content were used in the study. The sediments, with or without oligochaete bioturbation, were exposed for 100 days to water with a constant concentration of 14C-labeled TCB, in a continuous-flow system. The hypothesis for the experiment was that bioturbation would enhance the accumulation rate of TCB by redistributing the sediment particles and/or by changing the physical properties, e.g., porosity of the sediment, in a way that would increase the diffusion rate. The highest accumulation was found in sediments of low organic carbon content. No effect of clay content was found. Contrary to the hypothesis, bioturbation did not increase sediment accumulation of TCB. Instead, the sediment accumulation could be explained by retarded diffusion, a combined effect of the processes of adsorption and diffusion.

Alternating treatment with didanosine and zidovudine versus either drug alone for the treatment of advanced HIV infection. The Alter Study. Nordic HIV Therapy Group

The efficacy and safety of an alternating regime with zidovudine and didanosine versus treatment with either drug alone were investigated in a randomized, open, controlled trial, 552 patients with advanced HIV infection, 47% of whom had received prior treatment with zidovudine, were enrolled. The patients were randomly assigned to zidovudine 600 mg/day, didanosine 400 mg/day or 4-week alternations with the 2 drugs in the same dose. The study had a median length of follow-up of 88 weeks. In the overall analyses, time to death (p = 0.48) and time to death or new AIDA event (0.80) were equally distributed between the 3 treatment groups. In the subgroup of patients with a CD4 count < 100 x 10(6)/l the survival was longer in the alternating arm (p < 0.005) primarily because of differences among zidovudine naive patients. The alternating regime was better tolerated than the 2 monotherapies, with a longer time to dose reduction or withdrawal owing to side effects (p < 0.001).

Aerosolized pentamidine as primary prophylaxis for Pneumocystis carinii pneumonia: efficacy, mortality and morbidity

OBJECTIVE

Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) for patients with HIV infection has been recommended by the Centers for Disease Control and Prevention. We evaluated alternatives to routine primary PCP prophylaxis with aerosolized pentamidine.

METHODS

A total of 121 HIV-infected patients with CD4+ cell counts < or = 200 x 10(6)/l or an AIDS diagnosis were enrolled in a controlled study of aerosolized pentamidine as primary PCP prophylaxis. Patients were randomly assigned to treatment (n = 61) with aerosolized pentamidine once every month or to no treatment (n = 60). Patients were evaluated for PCP, mortality, morbidity and progression of HIV disease. Morbidity was estimated from the number of days patients were unable to work due to illness, number of days hospitalized and AIDS events.

RESULTS

Baseline characteristics were similar in the treatment and control groups and mean CD4+ cell counts were 116 and 107 x 10(6)/l, respectively. Eight incidents of PCP and 19 deaths were observed in the treatment group during a median follow-up of 16.4 months (range, 2.3-32.4 months). Nineteen incidents of PCP and 13 deaths, of which one was related to an acute episode of PCP, were noted in the control group. Median follow-up of controls was 18.5 months (range, 3.1-32.9 months). Patients in the treatment group were unable to work 19% of the observation time and were hospitalized for 4.3% of that time. Corresponding figures were 20 and 3.0%, respectively, in the control group.

CONCLUSIONS

Aerosolized pentamidine had significant prophylactic efficacy, but we could not detect any major effect on mortality and morbidity. The overall mortality and morbidity were not markedly influenced by PCP. Clinical check-ups and treatment of acute PCP could be a justifiable alternative to drug prophylaxis with aerosolized pentamidine in selected patients.

Aerosolized pentamidine versus i.v. pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia

The efficacy and toxicity of aerosolized pentamidine was evaluated in 78 AIDS patients given 60 mg biweekly as secondary prophylaxis against Pneumocystis carinii pneumonia (PCP). Patients were monitored for clinical progression and mortality and were compared to 42 historical controls given 200-300 mg i.v. pentamidine biweekly. The relapse rates did not differ markedly between the two groups, and the PCP-free rates in survivors were at 12 months 0.83 and 0.77, respectively. Seventy-one new AIDS-defining events and 25 deaths were recorded in patients on aerosolized pentamidine compared to 29 AIDS events and two deaths in patients on intravenous pentamidine. Recurrent PCP contributed to death in only one case of the aerosolized pentamidine group. PCP is not a serious clinical problem in immunodeficient patients taking pentamidine prophylaxis by either route compared to the progression of clinical HIV disease and death.

CD4+ cells and CD4+ percent as risk markers for Pneumocystis carinii pneumonia (PCP): implications for primary PCP prophylaxis

The incidence of Pneumocystis carinii pneumonia (PCP) during 2 years in HIV-infected patients with less than or equal to 100 x 10(6)/l CD4+ cells, less than or equal to 200 x 10(6)/l CD4+ cells and less than 20% CD4+ cells of total T lymphocytes were compared. The relative PCP risk in 57 patients with less than or equal to 100 CD4+ cells was more than twice higher than in 120 patients with less than or equal to 200 CD4+ cells. The latter had almost twice higher relative PCP risk than 271 patients with less than or equal to 20% CD4+ cells. Only 3/56 patients who acquired PCP had greater than 200 CD4+ cells and 15/56 patients had greater than 100 CD4+ cells. Centers for Disease Control (CDC) recommends primary PCP prophylaxis in HIV-infected patients when the number of CD4+ cells is less than 200 x 10(6)/l or when the CD4+ is less than 20. On the basis of the presented data we suggest that primary prophylaxis is considered only when CD4+ cells fall below 200 x 10(6)/l.

Microcirculatory disturbances in AIDS patients--a first report

The aim of this study is to explore the vascular perturbations associated with AIDS infections as a means of developing strategies to help in the treatment of these patients. Closed-circuit television microscopic observation of the microcirculation in the nail fold was carried out on 11 AIDS patients and 11 healthy European adults. A striking pattern of severe microvascular disturbances was demonstrated in these patients: (i) a suppression of the spontaneous, rhythmic adjustments of capillary blood perfusion, and (ii) damage to the endothelium of the capillary wall. These findings suggest a substantial involvement of the microcirculation in the pathogenetic development of the AIDS syndrome, as well as a close relationship between microvascular perfusion and the immune condition of the organism. The data indicate that the treatment of the AIDS patient should be directed not only toward the inhibition or killing of the virus, but also toward the improvement of microcirculatory perfusion.

Combined treatment of symptomatic human immunodeficiency virus type 1 infection with native interferon-alpha and zidovudine

Patients with advanced human immunodeficiency virus type 1 (HIV-1) infection who had p24 antigen despite treatment with zidovudine (AZT) for 4-28 months received 3 x 10(6) IU of native interferon-alpha (IFN-alpha) daily for 3 months. Infectious HIV was detected in the plasma of all patients, in most cases at high titers, before IFN-alpha treatment. There was no correlation between HIV titers and p24 antigen levels. Antiviral activity, as measured by significantly decreased levels of infectious virus or p24 antigen, was observed in six of eight completely treated but in only one of nine incompletely treated patients. After termination of IFN-alpha treatment, there was a significant rise of p24 antigen levels. During IFN treatment, absolute CD4 cell counts showed a tendency toward an increased rate of decline. The side effects were unexpectedly severe. Despite its anti-HIV effect in vivo, IFN-alpha in the dosages used does not seem to be a viable additional treatment for severely immunodeficient patients in ongoing AZT therapy.

[Microcirculatory disturbances in patients with advanced AIDS]

CCTV-microscopic observation of nail-fold microcirculation was made on 11 AIDS patients and 11 healthy European adults. Unique severe microcirculatory disturbances were observed in these patients: (1) severe dysfunction of automatic alternative capillary blood flow perfusion. All the capillary loops in the same microscopic field emptied at the same moment and remained empty for a long time (3-100 seconds). Subsequent filling up of the capillary loops was very slow (1-2.5 min/loop). (2) remarkable damage of endothelial cells in the capillary wall. Some parts of the capillary wall were penetrated by some heterogeneous, visible and sludgy mass, making the wall swelled and the lumen narrowed. The wall tension in all the capillaries was markedly decreased. After the capillary loops had emptied, these damaged parts of the wall still remained in the field. These findings demonstrated the deep involvement of microcirculation in the pathogenesis of AIDS, and also showed the close relationship between microcirculation and the immune condition of the organism.

Diabetes is not associated with a change in the elemental composition of the pancreatic B cell in diabetic C57BL KsJ-db/db mice

Freeze-dried pancreas sections from 7-, 17- and 27-week-old genetically diabetic (db/db) and normal (+/-/+/-) mice were subjected to proton bombardment and the concentrations of 15 elements in B cells and exocrine pancreas were calculated from the characteristic X-rays emitted. In the 7-week-old diabetic animals, B cells contained significantly above-normal levels of Na and S, while exocrine pancreas contained subnormal levels of Ca, and excess Mn. The B cells from the 17-week-old diabetic animals contained subnormal levels of Cu and the exocrine pancreas of the 27-week-old diabetic animals was deficient in Cd. The 7-, 17- and 27-week-old, genetically diabetic (db/db) mice were hyperglycemic, hyperinsulinemic and heavier than age-matched normal (+/-/+/-) mice. Although significant changes were found in elemental composition when comparing both B cells and exocrine pancreas at different ages, the changes were not consistent. Therefore, it appears as if the measured elemental changes were random and not related to the onset of diabetes.

Incidence of symptoms and AIDS in 146 Swedish haemophiliacs and blood transfusion recipients infected with human immunodeficiency virus

The times from infection with the human immuno-deficiency virus (HIV) to the onset of the first clinical symptom and the development of AIDS were studied prospectively in 98 haemophiliacs and 48 blood transfusion recipients infected with the virus. Patients were followed up for a median of 61 months after infection, the dates of infection being either known exactly or estimated from the interval between the last negative and first positive HIV antibody test result. The rate of progression to AIDS was significantly higher for the transfusion recipients than for the haemophiliacs. The difference in time to the occurrence of the first clinical symptom was less pronounced between the two groups, though pointing in the same direction. The results suggest that on average roughly half of all patients positive for HIV will develop some clinical sign or symptom within five to six years after infection.

HIV isolation and antigen detection in infected individuals and their seronegative sexual partners

We have examined 39 couples, each consisting of one HIV-seropositive index case and one seronegative sexual partner. HIV isolations, HIV antigen (HIV-Ag) tests and HIV antibody tests were performed on samples from these 78 individuals. Results were compared with those of 68 unselected individuals. Neither HIV, nor HIV-Ag was detected in any of the seronegative individuals. HIV-Ag tests, but not HIV isolations showed positive results with a significantly lower frequency in symptomatic index cases than in unselected patients with symptoms. This indicates that the absence of HIV-Ag in the serum may be correlated with a low level of contagiousness.

HIV transmission by blood transfusions in Stockholm 1979-1985: nearly uniform transmission from infected donors

Thirty-five out of approximately 800 known HIV-seropositive people in Stockholm by mid-1986 were blood donors during the period 1979-1986. Almost all, i.e. 349 recipients of their blood components (red blood cells, platelets, plasma) could be traced. One hundred and eighty were still alive and 112 of these on further analysis, were suspected of being infected. They were contacted and all but one agreed to be tested for HIV antibodies. Fifty recipients were found to be seropositive. They had been transfused with blood components from 14 of the 35 donors. The earliest observed transmission occurred in June 1982. The patterns of HIV transmission showed, with only one exception, that each donor who had transmitted HIV to one recipient had also transmitted it to all later recipients. Appropriate preserved sera and clinical records from five of the donors who had not transmitted the virus were found and analysed. The result indicated that these donors had acquired their HIV infection after their last blood donation. In conclusion, our study indicates that every antibody-positive donor transmits HIV to almost every recipient.

No effect of superoxide dismutase on spontaneous development of diabetes in db/db mice

B-cells have previously been shown to be very susceptible to damage induced by superoxide radicals, and protection against such damage has been achieved both in vitro and in vivo with superoxide dismutase. During maturation, db/db mice develop diabetes and accumulation of potentially superoxide radical-producing leucocytes can be demonstrated in the islets during the process. To test for the possibility that superoxide radical-induced damage contributes to the development of diabetes, db/db mice were given daily ip injections of 200 mg/kg polyethylene glycol-substituted CuZn superoxide dismutase. No effect of the treatment could be demonstrated.

Lack of glucose-induced priming of insulin release in the perfused mouse pancreas

Perfusion of the mouse or rat pancreas with 20 mmol D-glucose/l caused a biphasic release of insulin. The second phase was nearly constant in the mouse but rose in the rat. Repeated pulses of 8, 20 or 30 mmol D-glucose/l did not potentiate subsequent insulin responses in the mouse, whereas repeated pulses of 20 mmol/l did in the rat. When 20 mmol D-glucose/l was introduced through the mesenteric artery or aorta of the mouse, the pattern of insulin release was the same as when it was introduced through the coeliac artery. Thus, insulin secretion in mice differs from that in rats both in not showing an increasing second phase in response to continuous stimulation with glucose and also in not showing successive enhancement in the insulin response to repeated pulses of glucose.

Phosphate flush and glucose metabolism in pancreatic islets of young and old diabetic mice (C57BL/KsJ-db/db)

Pancreatic islets from normal C57BL/KsJ-+/+-mice and diabetic C57BL/KsJ-db/db-mice were collagenase-isolated and incubated with 33P-labelled inorganic phosphate. No significant difference was observed in phosphate uptake between normal and diabetic mouse islets whether the animals were young (6-8 weeks) or old (27 +/- 9 weeks). When 33P-labelled islets were perifused with non-radioactive medium, all types of islets exhibited a brisk and transient peak of phosphate release in response to a change of glucose concentration from 2.8 to 16.7 mmol/l. Expressed in absolute terms, both the basal and peak efflux of phosphate appeared to be diminished in the diabetic mice. In relative terms (peak over basal), the glucose-stimulated phosphate efflux was not lower in diabetic than in normal mice. At both a low (3 mmol/l) and a high (20 mmol/l) glucose concentration, the production of 3H2O from D-[5-3H]glucose was reduced in old but not in young diabetic mouse islets. The percentage increase in glucose metabolism in response to a rise in glucose concentration from 3 to 20 mmol/l was about the same in all types of islets. The results add to previous observations of disturbed ionic fluxes in the pancreatic islets of diabetic KsJ-db/db-mice. These effects are probably not due to gross alterations in glycolytic metabolism but more probably reflect alterations in the function of the beta-cell plasma membrane.