A59 GLOBAL PROTEOMIC PROFILING OF HUMAN COLONOID MONOLAYERS UNDERGOING IN VITRO CHRONIC DAMAGE

Background

An in vitro damage model has been established in our lab using human colonoids grown as 2D monolayers. Upon being subjected to repeated rounds of air-liquid interface (ALI) growth and injury by submergence, these colonoid monolayers lost their barrier integrity and regrowth potential. Changes in mRNA expression and DNA methylation in genes from this human model of injury were similar to those that occur in Inflammatory Bowel Disease (IBD) and colon cancer. Significant morphological changes were observed in these monolayers after they were subjected to subsequent rounds of submergence injury, compared to when they were differentiated in ALI.

Purpose

Submergence injury is predicted to be involved in unfolded protein response (UPR) activation which can specifically alter translation. Hence proteomics studies will help undertand these changes.

Method

To determine if these changes are mirrored in the proteomes of damaged colonoids, we employed a Single-Plot, Solid-Phase-enhanced Sample Preparation (SP3) technology for Mass Spectrometry (MS) based proteomics analysis to characterize these monolayers at baseline, once they were differentiated in ALI, after one and five rounds of injury after differentiation in ALI, and after stimulation with the Toll-like receptor 5 (TLR5) agonist FliC. Hierarchical clustering, enrichment analysis, volcano plot analysis after pre-processing and normalization of the proteomics data set revealed differentially expressed proteins across various groups of monolayers.

Result(s)

Preliminary proteomic data analysis revealed changes in the profile of proteins involved in cellular differentiation, mitochondrial proteins, hypoxia upregulated proteins, those responsible for the maintenance and reorganization of the cytoskeletal structure and Golgi structure. These changes in protein profile may account for the significant morphological changes observed in these monolayers when subjected to submergence injury. Some outliers in monolayers subjected to microbial stimulation included proteins involved in regulation of extracellular matrix dependent motility and components of Adaptor Protein Complexes. Further studies are needed to ascertain if these account for the protective effect of FliC on these monolayers.

Conclusion(s)

This study suggests that the submergence injury to these healthy human derived colonoid monolayers leads to changes in their protein profile which mirror those seen in case of acute and chronic inflammation like IBD and colon cancer. It corroborates with the findings of gene expression and epigenetic analyses using the in vitro model established in our lab.

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Disclosure of Interest

None Declared

P2442Myocardial performance index predicts mortality in people with obstructive lung function from the general population

Background

Forced expiratory volume in one second (FEV1) is a significant predictor of mortality in patients with obstructive lung function (OL). Whether echocardiography can be used to identify patients at high risk, and whether it provides incremental prognostic information on mortality in patients with OL, remains unknown.

Methods

In a large, low-risk general population study, 1873 participants underwent a health examination with spirometry and echocardiography, including tissue Doppler imaging (TDI). The myocardial performance index (MPI) was calculated as the sum of the isovolumic contraction time (IVCT) and the isovolumic relaxation time (IVRT) divided by the left ventricle ejection time (LVET). Spirometry included measurements of (FEV1) and the forced vital capacity (FVC). OL was defined as FEV1/FVC <0.70. The primary endpoint was all-cause mortality.

Results

The mean age was 59±16 years, 57% were women, 43% had hypertension, 11% had diabetes, and 6% had ischemic heart disease. Of the 1873 included participants, 288 (15%) were classified as having OL at baseline. During follow up (median 13.7 years (IQR 13.2–16.2)), 584 (31%) persons died, hereof 178 (62%) in the subgroup of participants with OL and 406 (26%) in the subgroup of participants with normal lung function.

OL was associated with presence of left ventricular hypertrophy (higher left ventricular mass index), impaired diastolic function (lower E, higher A, lower E/A ratio, longer deceleration time, lower e' and higher E/e'), lower global longitudinal strain, and higher MPI.

In unadjusted analysis, higher MPI was associated with all-cause mortality for participants with OL (HR=1.18 (1.11–1.26), p<0.001, per 0.1 increase) and for participants with normal lung function (HR=1.42 (1.34–1.50), p<0.001, per 0.1 increase). The predictive value of MPI was significantly modified by the presence of obstructive lung function (p<0.001).

After multivariable adjustment for age, sex, FEV1/FVC, heart rate, systolic blood pressure, smoking status, body mass index (BMI), hypertension, diabetes, ischemic heart disease, ischemic stroke and heart failure at baseline, MPI remained an independent predictor of all-cause mortality (HR=1.19 (1.06–1.34), p=0.004, per 0.1 increase) for participants with OL but not for participants with normal lung function (HR=1.02 (0.94–1.11), p=0.598, per 0.1 increase).

When adding the MPI to the updated Age, Dyspnea and Obstruction (ADO) index, MPI provided incremental prognostic information beyond the updated ADO index, as determined from a significant increase in the Harrell's C-statistics (0.785 to 0.792, p=0.003).

Conclusion

Presence of OL is associated with subtle impairment of left ventricular systolic function, impaired left ventricular diastolic function, and higher MPI. MPI is an independent predictor of mortality in people with OL and provides incremental prognostic information regarding all-cause mortality in this population.

Acknowledgement/Funding

Herlev & Gentofte University Hospital PhD fund

Muscle α-adrenergic responsiveness during exercise and ATP-induced vasodilation in chronic obstructive pulmonary disease patients

Sympathetic vasoconstriction is blunted in exercising muscle (functional sympatholysis) but becomes attenuated with age. We tested the hypothesis that functional sympatholysis is further impaired in chronic obstructive pulmonary disease (COPD) patients. We determined leg blood flow and calculated leg vascular conductance (LVC) during 1) femoral-arterial Tyramine infusion (evokes endogenous norepinephrine release, 1 µmol·min^-1·kg leg mass^-1), 2) one-legged knee extensor exercise with and without Tyramine infusion [10 W and 20% of maximal workload (WL_max)], 3) ATP (0.05 µmol·min^-1·kg leg mass^-1) and Tyramine infusion, and 4) incremental ATP infusions (0.05, 0.3, and 3.0 µmol·min^-1·kg leg mass^-1). We included 10 patients with moderate to severe COPD and 8 age-matched healthy control subjects. Overall, leg blood flow and LVC were lower in COPD patients during exercise ( P < 0.05). Tyramine reduced LVC in both groups at 10-W exercise (COPD: -3 ± 1 ml·min^-1·mmHg^-1 and controls: -3 ± 1 ml·min^-1·mmHg^-1, P < 0.05) and 20% WL_max (COPD: -4 ± 1 ml·min^-1·mmHg^-1 and controls: -3 ± 1 ml·min^-1·mmHg^-1, P < 0.05) with no difference between groups. Incremental ATP infusions induced dose-dependent vasodilation with no difference between groups, and, in addition, the vasoconstrictor response to Tyramine infused together with ATP was not different between groups (COPD: -0.03 ± 0.01 l·min^-1·kg leg mass^-1 vs.

CONTROLS

-0.04 ± 0.01 l·min^-1·kg leg mass^-1, P > 0.05). Compared with age-matched healthy control subjects, the vasodilatory response to ATP is intact in COPD patients and their ability to blunt sympathetic vasoconstriction (functional sympatholysis) as evaluated by intra-arterial Tyramine during exercise or ATP infusion is maintained. NEW & NOTEWORTHY The ability to blunt sympathetic vasoconstriction in exercising muscle and ATP-induced dilation in chronic obstructive pulmonary disease patients remains unexplored. Chronic obstructive pulmonary disease patients demonstrated similar sympathetic vasoconstriction in response to intra-arterial Tyramine during exercise and ATP-induced vasodilation compared with age-matched healthy control subjects.

Leg blood flow is impaired during small muscle mass exercise in patients with COPD

Skeletal muscle blood flow is regulated to match the oxygen demand and dysregulation could contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). We measured leg hemodynamics and metabolites from vasoactive compounds in muscle interstitial fluid and plasma at rest, during one-legged knee-extensor exercise, and during arterial infusions of sodium nitroprusside (SNP) and acetylcholine (ACh), respectively. Ten patients with moderate to severe COPD and eight age- and sex-matched healthy controls were studied. During knee-extensor exercise (10 W), leg blood flow was lower in the patients compared with the controls (1.82 ± 0.11 vs. 2.36 ± 0.14 l/min, respectively; P < 0.05), which compromised leg oxygen delivery (372 ± 26 vs. 453 ± 32 ml O2/min, respectively; P < 0.05). At rest, plasma endothelin-1 (vasoconstrictor) was higher in the patients with COPD ( P < 0.05) and also tended to be higher during exercise ( P = 0.07), whereas the formation of interstitial prostacyclin (vasodilator) was only increased in the controls. There was no difference between groups in the nitrite/nitrate levels (vasodilator) in plasma or interstitial fluid during exercise. Moreover, patients and controls showed similar vasodilatory capacity in response to both endothelium-independent (SNP) and endothelium-dependent (ACh) stimulation. The results suggest that leg muscle blood flow is impaired during small muscle mass exercise in patients with COPD possibly due to impaired formation of prostacyclin and increased levels of endothelin-1.

NEW & NOTEWORTHY This study demonstrates that chronic obstructive pulmonary disease (COPD) is associated with a reduced blood flow to skeletal muscle during small muscle mass exercise. In contrast to healthy individuals, interstitial prostacyclin levels did not increase during exercise and plasma endothelin-1 levels were higher in the patients with COPD.

[Strategies for cerebrospinal fluid analysis - Integrated results report]

Cerebrospinal fluid (CSF) analysis requires a combined assessment of all individual test findings in an integrated total report in order to achieve a reliable and specific diagnostic conclusion. Such a standard assessment strategy allows the identification of disease-typical result patterns and plausibility checks to avoid analytical errors. The integrated total report consists of 1) a basic CSF program with cytological and protein chemical parameters, 2) an expanded CSF program with special parameters for detection of pathogens and markers of neurodegeneration and 3) a final contextual interpretation considering methodological and clinical aspects.

The effect of home oxygen therapy on hospitalization in moderate hypoxaemic COPD

Background: The aim of the study was to determine whether home oxygen therapy (HOT) reduces hospitalization in moderate hypoxaemic COPD patients. Methods: We studied 170 consecutive moderate hypoxaemic COPD patients (PaO2 on room air and rest: 7.3-9.5 kPa), who were treated with HOT for at least one month. The patients were acting as their own control. Admission rates,days spent in hospital and number of patients with at least one hospitalization were compared in twoperiods of 10 months before and after initiation of HOT. Results: The admission rates, number of days spent in hospital and number of patients with at least one hospitalization was not reduced(preoxygen period versus postoxygen period): 1.55 (2.00) versus 1.67 (2.26), 14.3 (19.9) versus 14.8(23.7), and 60.6% versus 61.2%-P-level > 0.05 for all three parameters. Conclusions: Our resultsdo not support the hypothesis that home oxygen therapy reduces hospitalization in patients with COPD without severe hypoxaemia. However, as this is not a randomized study, we cannot exclude that oxygen therapy has prevented progression of the disease, and that without this therapy, the hospitalization could have been even higher.

Characterization of a biologically derived rabbit tracheal scaffold

There is a clinical need to provide replacement tracheal tissue for the pediatric population affected by congenital defects, as current surgical solutions are not universally applicable. A potential solution is to use tissue engineered scaffold as the framework for regenerating autologous tissue. Rabbit trachea were used and different detergents (Triton x-100 and sodium deoxycholate) and enzymes (DNAse/RNAse) investigated to create a decellularization protocol. Each reagent was initially tested individually and the outcome used to design a combined protocol. At each stage the resultant scaffold was assessed histologically, molecularly for acellularity and matrix preservation. Immunogenicity of the final scaffold was assessed by implantation into a rat model for 4 weeks. Both enzymes and detergents were required to produce a completely acellular (DNA content 42.78 ng/mg) scaffold with preserved collagen and elastin however, GAG content were reduced (8.78 ± 1.35 vs. 5.5 ± 4.8). Following in vivo implantation the scaffold elicited minimal immune response and showed significant cellular infiltration and vasculogenesis. The luminal aspect of the implanted scaffold showed infiltration of host derived cells, which were positive for pan cytokeratin. It is possible to create biologically derived biocompatible scaffolds to address specific pediatric clinical problems. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2126-2135, 2017.

Pilot study of a novel vacuum-assisted method for decellularization of tracheae for clinical tissue engineering applications

Tissue engineered tracheae have been successfully implanted to treat a small number of patients on compassionate grounds. The treatment has not become mainstream due to the time taken to produce the scaffold and the resultant financial costs. We have developed a method for decellularization (DC) based on vacuum technology, which when combined with an enzyme/detergent protocol significantly reduces the time required to create clinically suitable scaffolds. We have applied this technology to prepare porcine tracheal scaffolds and compared the results to scaffolds produced under normal atmospheric pressures. The principal outcome measures were the reduction in time (9 days to prepare the scaffold) followed by a reduction in residual DNA levels (DC no-vac: 137.8±48.82 ng/mg vs. DC vac 36.83±18.45 ng/mg, p<0.05.). Our approach did not impact on the collagen or glycosaminoglycan content or on the biomechanical properties of the scaffolds. We applied the vacuum technology to human tracheae, which, when implanted in vivo showed no significant adverse immunological response. The addition of a vacuum to a conventional decellularization protocol significantly reduces production time, whilst providing a suitable scaffold. This increases clinical utility and lowers production costs. To our knowledge this is the first time that vacuum assisted decellularization has been explored. Copyright © 2015 John Wiley & Sons, Ltd.

Nanophase separation in monomolecularly thin water-ethanol films controlled by graphene

Control over nanoscale patterning of ultrathin molecular films plays an important role both in natural as well as artificial nanosystems. Here we report on nanophase separated patterns of water and ethanol within monomolecularly thin films confined between the cleavage plane of mica and single or a few layers of graphene. Employing scanning force microscopy of the graphene layers conforming to the molecular films we quantify the patterns using the ethanol-water cross correlation and the autocorrelation of domain wall directions. They reveal that lateral pattern dimensions grow and the domain walls stiffen upon increasing the thickness of the graphene multilayers. We attribute the control of the patterns through the graphene layers to the competition between the mechanical deformation energy of the graphene sheets and the electrostatic repulsion of dipoles normal to the interface. The latter results from charge transfer between graphene and the molecules confined between mica and graphene.

Contrast-induced acute kidney injury after computed tomography prior to transcatheter aortic valve implantation

AIM

To identify independent predictors of contrast medium-induced acute kidney injury (CI-AKI) after enhanced multidetector-row computed tomography (MDCT) prior to transcatheter aortic valve implantation (TAVI) in high-risk patients.

MATERIALS AND METHODS

The present single-centre study analysed retrospectively 361 patients who were assessed using MDCT prior to TAVI. CI-AKI was defined as an increase in serum creatinine (SCr) of ≥ 25% or ≥ 0.5 mg/dl in at least one sample over baseline (24 h before MDCT) and at 24, 48, and 72 h after MDCT.

RESULTS

A total of 38 patients (10.5%) experienced CI-AKI. As compared to patients without CI-AKI, they presented more frequently with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), (81.6% versus 64.4%, p = 0.045) and tended to receive higher volumes of iodinated contrast media (ICM; 55.3% versus 39%, p = 0.057). There was a significant interaction between baseline eGFR and the amount of intravenous ICM administered (pfor interaction = <0.001) identifying the amount of ICM >90 ml as independent predictive factor of CI-AKI only in patients with baseline eGFR <60 ml/min/1.73m(2) (OR 2.615; 95% CI: 1.21-5.64).

CONCLUSION

One in ten elderly patients with aortic stenosis undergoing MDCT to plan a TAVI procedure experienced CI-AKI after intravenous ICM injection. Intravenous administration of <90 ml of ICM reduces this risk in patients with or without pre-existing impaired renal function. However, in the majority of patients renal function recovers before the TAVI procedure.

Cerebrospinal fluid findings in geriatric patients from 2008 to 2011

BACKGROUND

The chemical composition of the cerebrospinal fluid (CSF) is age-dependent.

METHODS

Routine CSF parameters, the indications for lumbar puncture (LP), and the most frequent complications were retrospectively studied in patients older (n = 167) and younger (n = 36) than 65 years.

RESULTS

In the absence of meningeal inflammation, the mean CSF lactate level of patients older than 65 years was slightly but significantly higher than the mean CSF lactate level of younger patients. The lactate level of patients with otherwise normal CSF findings correlated significantly with the age of the patients. In the absence of meningeal inflammation, the CSF-to-serum albumin ratio (QAlbumin) was significantly higher in older patients than in younger ones. The most frequent indication for LP, suspected infection of the central nervous system (CNS) (n = 110), was confirmed in 12.7% of patients. The only LP complication documented was headache in two patients.

CONCLUSIONS

Elevations of QAlbumin and CSF lactate levels appear to be nonspecific findings in elderly patients. Suspected infections, the most frequent indication for LP, were confirmed by CSF analysis in more than 10% of patients. The very low complication rate of LP makes it a very valuable tool in the diagnostic routine for older patients with CNS diseases.

Perceived stress and risk of adult-onset asthma and other atopic disorders: a longitudinal cohort study

BACKGROUND

Psychological stress can affect airway inflammatory response to irritants and allergens, but the importance of stress in the etiology of adult-onset respiratory and dermatologic allergic disorders remains unclear. We aim to address the relationship between perceived stress and the risk of adult-onset asthma, allergic rhinitis, atopic dermatitis, and asthma/bronchitis medication.

METHODS

Participants (n = 9785) from the Copenhagen City Heart Study, Denmark, free of atopic disorders at baseline in 1981-1983 were asked questions on stress intensity and frequency. They were followed for first-time asthma hospitalization in nationwide registers until 2010, with < 0.1% loss to follow-up. Objective measures of lung function allowed for thorough adjustment for confounding and prevented ambiguity between diagnosis of asthma and chronic obstructive lung disease. Daily intake of asthma/bronchitis medication and incidence of asthma, allergic rhinitis, and atopic dermatitis were assessed by self-report after 10 years of follow-up in 5648 persons.

RESULTS

Perceived stress was associated with atopic disorders in a dose-dependent manner (P(trend)  < 0.001). High vs low stress was associated with higher risk of self-reported asthma incidence (OR = 2.32; 95% CI: 1.47-3.65), daily intake of asthma/bronchitis medication (OR = 2.26; 95% CI: 1.42-3.58), first-time asthma hospitalization (HR = 2.01; 95% CI: 1.41-2.86), allergic rhinitis (OR = 1.64; 95% CI: 0.99-2.72), and atopic dermatitis (OR = 1.75; 95% CI: 1.11-2.77). The associations were similar for smokers and nonsmokers.

CONCLUSIONS

Stress is strongly associated with asthma incidence and hospitalization, use of asthma medication as well as with allergic rhinitis and atopic dermatitis in adults.

Carcinoembryonic antigen in the CSF of cancer patients--the value of intrathecal synthesis and correlation with IgA-diffusion dynamics

OBJECTIVE

The diagnostic impact of carcinoembryonic antigen (CEA) was evaluated in serum and CSF of cancer and control patients.

METHODS

97 analyses of CEA in CSF and serum from 83 cancer patients were compared with 41 cases without malignancy. CEA diffusion dynamics were evaluated with IgA CSF/serum quotients (Q IgA). Intrathecal synthesis of CEA was analysed both by calculating an index Q CEA/Q IgA and within the IgA-diagram.

RESULTS

In 73 samples without synthesis of IgA or CEA, both quotients correlated well with a mean Q CEA/Q IgA of 1.1 (95% CI 0.97-1.2). The Q CEA/Q IgA was significantly higher in metastasizing adenocarcinomas than in controls or other malignancies. In leptomeningeal disease from adenocarcinoma, Q CEA/Q IgA was significantly higher than in controls, while patients with CNS and/or bone metastases had intermediate values. The sensitivity to detect leptomeningeal disease was 91% and 69% for brain metastases. Q CEA/Q IgA and CEA synthesis assessed with the IgA diagram were equally sensitive.

CONCLUSIONS

Evaluation of CEA in the IgA diagram is feasible and of clinical value. The consideration of intrathecal CEA synthesis correlates better with the clinical status than absolute CSF-CEA or the correlation with albumin.

Prevalence and severity of self-reported asthma in young adults, 1976-2004

The aim of the present study was to describe the prevalence and severity of asthma in young Danish adults over three decades. Males and females aged 20-35 yrs were sampled from the population of Copenhagen for the three surveys (1976-1978, 1991-1993 and 2001-2004). A total of 3,285 (46% male) subjects answered a questionnaire, and had their height, weight, forced expiratory volume in 1 s (FEV1) and forced vital capacity measured. The prevalence of self-reported asthma was 1.5, 4.7 and 6.9%, respectively, in the three surveys (p<0.001). An increasing prevalence of asthma was observed in both males and females, although it was highest among females. The difference in FEV1 between asthmatic and nonasthmatic subjects gradually increased, being 2.3 (p = 0.56) and 14.2% of the predicted value (p<0.001), respectively, in 1976-1978 and 2001-2004. From the 1991-1994 survey, increasing body mass index, especially >30 kg.m(-2), was associated with a lower percentage predicted FEV1 (p< or =0.005), and further analyses suggested an additive effect of asthma and obesity on FEV1. The proportion of smokers declined from 60 to 38% (p<0.001). The prevalence and severity of asthma have continued to increase over the last three decades among young Danish adults, and the observed increase in severity seems, at least partly, to be related to the increase in prevalence of obesity.

Tuberculosis in a developed country

All 515 patients notified for tuberculosis for the first time in 1972, 1977 and 1982 in Copenhagen have been studied. Changes during the period and differences between Danes and immigrants were looked for. The percentage of immigrants increased during the period. The immigrants had a different age distribution, higher frequency of extrapulmonary tuberculosis with a distribution different from that of Danes, fewer complicating diseases and they drank less alcohol. No significant changes in the patient population took place in the decade studied, except for a decreasing number of Danes with tuberculosis, a decreasing number of abacillary patients and an increase in the percentage of extrapulmonary tuberculosis. At follow-up in 1983, none of the immigrants, but 147 of 407 Danes had died, mainly from complicating diseases. Life expectancy for the Danes, who survived the initial phase, was not significantly different from that for the population at large. None of the patients were bacillary at the time of the follow-up.

Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program

Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) improves exercise tolerance and health status, however, these effects have been shown to decline after termination of the rehabilitation program. This study has examined the long-term effect of a 7-week supervised rehabilitation program combined with daily self-monitored training at home on exercise tolerance and health status. Two hundred and nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation program were assessed with endurance shuttle walk test (ESWT) and the St George's Respiratory Questionnaire (SGRQ) at baseline, 0, 3, and 12 months after the program. Sixty-eight (32.5%) patients did not attend the 1-year follow-up. Among the 141 patients who competed the 1-year evaluation, the initial improvement after the 7-week program in the ESWT time was 180 s or 101% ( p = 0.001) and in SGRQ 3.4 units ( p = 0.001). These effects were maintained at the 1-year evaluation (ESWT 59% above baseline; p < 0.001 and improved SGRQ 3.0 units compared with baseline; p = 0.011). The 31 patients who attended the 6-month, but not the 12-month evaluation, improved ESWT time by 96 s ( p = 0.02) without any change in SGRQ +2.0 ( p = 0.40). A relative simple and inexpensive 7-week supervised rehabilitation program combined with daily self-monitored training at home was able to maintain significant improvement in exercise tolerance and health status throughout 1 year. Death and hospital admissions due to acute exacerbations were the main reasons for non-attendance in the follow-up period.

Long-term tolerability of inhaled human insulin (Exubera) in patients with poorly controlled type 2 diabetes

OBJECTIVE

Inhaled human insulin (Exubera; EXU) has shown encouraging tolerability in short-term trials. We evaluated the safety profile of EXU after long-term exposure.

DESIGN

In two, open-label, 2-year studies patients poorly controlled on a sulphonylurea were randomised to adjunctive EXU or metformin (study 1) and patients poorly controlled on metformin were randomised to adjunctive EXU or the sulphonylurea, glibenclamide (study 2).

PATIENTS

The studies included 446 (study 1) and 476 (study 2) patients with type 2 diabetes, no clinically significant respiratory disease and glycosylated haemoglobin (HbA(1c)) levels of 8-12%.

MEASUREMENTS

Main outcome measures were pulmonary function tests and insulin antibody assays.

RESULTS

A total of 109 patients (study 1) and 195 patients (study 2) completed 104 weeks treatment. In both studies, small treatment group differences in change from baseline forced expiratory volume in 1 s were greatest at 6 months (first time-point measured) and less at later visits, and reversed on treatment discontinuation. At 2 years, differences in mean changes were -0.10 and -0.01 l in studies 1 and 2, respectively, and -0.04 l for the pooled studies. There was no discernable effect of long-term EXU therapy on pulmonary gas exchange. Insulin antibody binding reached a plateau at 6 months and did not correlate with HbA(1c) or lung function changes. Glycaemic control was maintained over 2 years.

CONCLUSIONS

Exubera was well tolerated during long-term use. Pulmonary function changes compared with comparator groups were small, non-progressive and reversed upon treatment discontinuation. Importantly, rates of lung function change were indistinguishable between EXU and comparator after 6 months of therapy.

Quantitation of intrathecal antibodies in cerebrospinal fluid of subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis: discrimination between microorganism-driven and polyspecific immune response

The detection of intrathecal antibody synthesis by qualitative methods or the Antibody-Index (AI) is a relevant tool for diagnosis of inflammatory neurological diseases. An increased AI can be observed for a causative antigen as well as part of a polyspecific immune response. The quantitation of the intrathecal antibody fraction in cerebrospinal fluid (CSF), F(S), helps to discriminate both cases. In contrast to AI, F(S) needs an absolute antibody concentration detected in the ELISA in mg/L. The intrathecally synthesized, "local" antibody concentration in CSF (AB(Loc)) is expressed as the specific fraction of the intrathecally synthesized total IgG (IgG(Loc)) in CSF with F(S)=AB(Loc)/IgG(Loc) x 100 in %. F(S) for HSV or measles has about 20- to 60-fold higher values in virus-caused antibody synthesis in acute herpes simplex encephalitis (mean HSV-F(S)=8.9%) or subacute sclerosing panencephalitis (mean measles-F(S)=18.8%) compared to the polyspecific immune response against these antigens e.g., in multiple sclerosis (0.14% or 0.52%, correspondingly). F(S) helps also to avoid misinterpretations of an increasing AI in cases of therapy control, and allows direct comparison of relative antibody concentrations (R(S)) in blood and intrathecally synthesized fractions in CSF (F(S)): In multiple sclerosis patients F(S):R(S) has a mean ratio of about 3 for the measles, rubella and VZV antibodies. Together with the large variability we find by ranking that about two third of MS patients have no direct correlation of the relative concentrations in serum and intrathecal synthesis. So this concept gains increasingly relevance for analysis of the polyspecific immune response in brain.

Elevated levels of IL-18 in plasma and skeletal muscle in chronic obstructive pulmonary disease

The aim of this study was to test the hypothesis that systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) is accompanied by enhanced interleukin 18 (IL-18) expression in skeletal muscle, which may precede muscle weight loss. Twenty patients with moderate to severe COPD [12 women, 66 +/- 9.4 years of age and forced expiratory volume in 1 second (FEV(1)) of 32% +/- 12 % of predicted value] and 20 healthy age-, gender-, and body mass index (BMI)-matched controls (10 nonsymptomatic smokers and 10 nonsmokers) were included in the study. Plasma levels of IL-18 were elevated in COPD patients (n = 20) versus healthy controls (n = 20) (221.2 pg/ml [196.0-294.2 pg/pl] vs. 164.8 pg/ml [144.4-193.3 pg/pl], p = 0.05) [corrected] and IL-18 was expressed in skeletal muscle, with IL-18 mRNA levels being elevated in biopsies from COPD patients (n = 19) versus healthy controls (n = 18) (4.3 [2.6-5.9] vs. 2.4 [1.6-3.1], p = 0.05) [corrected]. Immunohistochemical evaluation revealed a strong expression of IL-18 in Type II muscle fibers from COPD patients. Plasma levels and skeletal muscle mRNA levels of tumor necrosis factor alpha (TNF-alpha) and IL-6 did not differ between the groups. Elevated skeletal muscle expression of IL-18 was found in COPD patients with normal body weight, indicating that IL-18 potentially may be involved in the pathogenesis of COPD-associated muscle wasting.

Developing COPD: a 25 year follow up study of the general population

BACKGROUND

Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general population.

METHODS

As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed.

RESULTS

The percentage of men with normal lung function ranged from 96% of never smokers to 59% of continuous smokers; for women the proportions were 91% and 69%, respectively. The 25 year incidence of moderate and severe COPD was 20.7% and 3.6%, respectively, with no apparent difference between men and women. Smoking cessation, especially early in the follow up period, decreased the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning of the follow up period.

CONCLUSION

The absolute risk of developing COPD among continuous smokers is at least 25%, which is larger than was previously estimated.

Pulmonary regurgitation is a powerful factor influencing QRS duration in patients after surgical repair of tetralogy of Fallot

AIMS

QRS prolongation is a negative prognostic factor for the development of ventricular arrhythmia after repair of tetralogy of Fallot (TOF). In this MRI study, we performed a multivariate analysis to determine the influence of volumetric and functional parameters as well as time factors on QRS duration.

METHODS AND RESULTS

Sixty-seven patients after surgical repair of TOF were studied using a 1.5T MRI. Measurement of the ventricles was performed with a multislice-multiphase sequence. Left and right ventricular volumes, ejection fractions (EF) and myocardial masses were determined. Pulmonary regurgitant fraction (PRF) was quantified by velocity encoded flow measurement in the main pulmonary artery. Maximum QRS duration was taken from a 12-channel ECG. Mean maximum QRS duration was 132 ms (+/- 29 ms). Mean PRF was 29.2% (+/- 13.4%). QRS duration correlated significantly with PRF (r = 0.49; p < 0.01; n = 54) and with right ventricular enddiastolic volume index (RVEDVI) (r = 0.29; p < 0.05; n = 67). Multivariate analysis revealed that the combination of PRF, postoperative period, age at surgical repair, and left ventricular (LV) enddiastolic volume are correlated with QRS prolongation.

CONCLUSION

In patients after repair of TOF, pulmonary regurgitation is related to QRS prolongation. Furthermore, even LV size plays a role in the enlargement of the QRS complex.

Potential misclassification of causes of death from COPD

Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory volume in one second /forced vital capacity ratio at baseline. In COPD patients, having COPD on the death certificate was associated with chronic mucus hypersecretion (CMH) at baseline, an odds ratio (OR) of 3.6 (95% confidence interval 1.7-7.7), and being female (OR 2.7 (1.3-5.6)). In subjects without COPD, CMH and smoking were predictors of COPD as underlying cause of death, ORs 2.3 (1.5-3.7) and 2.2 (1.4-3.6), respectively. It was concluded that chronic obstructive pulmonary disease is underreported on death certificates, that biases in the use of chronic obstructive pulmonary disease as cause of death can be assessed, and that possible "over-diagnosis" of chronic obstructive pulmonary disease on death certificates in subjects unlikely to have significant disease should initiate caution when using causes of mortality in chronic obstructive pulmonary disease epidemiology.

Evoked cavernous activity: measuring penile autonomic innervation following pelvic surgery

To assess cavernous nerve integrity, we measured evoked cavernous activity (ECA) in 16 men who underwent nerve sparing radical prostatectomy (NS group) and 11 men who underwent non-nerve-sparing surgery (non-NS group). The right median nerve was electrically stimulated and ECA was recorded with two concentric electromyography needles placed into the right and left cavernous bodies. We simultaneously recorded hand and foot sympathetic skin responses (SSRs) as controls. All subjects had recordable SSR, and all subjects following nerve-sparing radical prostatectomy had reproducible ECA. Of the 11 non-NS subjects, eight had no response, indicating interrupted corporal innervation. Three subjects had reproducible ECA, one of whom had a very late latency, suggesting residual innervation was present. The mean latencies of ECA were similar to foot SSR mean latencies (P>0.05), but not to hand SSR latencies. The non-NS group was significantly different from the NS group for the presence of ECA (P<0.001). ECA is a viable method of evaluating the autonomic innervation of the penis.