Prognostic Factors and Treatment Outcome of Relapsing and Refractory Pediatric Mature B-cell Non-Hodgkin Lymphoma, Children's Cancer Hospital Egypt Experience

BACKGROUND

Relapsed non-Hodgkin lymphoma treated by chemotherapy and hematopoietic stem cell transplantation (HSCT) has a dismal prognosis.

PATIENTS

It is a retrospective study, including pediatric patients diagnosed as mature B-cell non-Hodgkin lymphoma who were primarily refractory or relapsed over 8 years at CCHE. The aim of the study was to analyze the prognostic factors and outcomes of this group of patients. Our result is, 53 of 750 (7%) patients were included. Thirty-four (64.2%) patients had Burkitt lymphoma. Forty-eight (90.6%) patients received LMB 96 protocol initially. The median delay of duration between chemotherapy cycles in first-line treatment was 37 days. Thirty-five (66%) patients relapsed, 23 (65.7%) of them relapsed early, whereas 18 (34%) had tumor progression. Thirty-one (58.5%) patients presented with stage IV at the time of relapse. rituximab, ifosfamide, carboplatin, etoposide was the second line of treatment in 42 (79.24%) patients, and complete second remission was achieved only in 13 (24.3%) patients. Allogeneic HSCT was done for 4 (7.5%) patients, and auto HSCT was done for 3 (5.7%) patients. Three years of overall survival for relapsed and progressed patients were 35.3% and 11.1%, respectively, with a P-value of 0.009. Three years overall survival for patients who underwent HSCT was 85.7% compared with 18.1% for no HSCT with a P-value of 0.007.

CONCLUSIONS

The relapse rate is higher than literatures because of the delay of duration between chemotherapy cycles in first-line treatment and more advanced stage at time of relapse. Progression of the disease had a worse outcome than relapse. HSCT in patients with the second remission markedly improved the outcome.

Hematopoietic stem cell transplantation from HLA-matched sibling donors in children with acute lymphoblastic leukemia: A report from the Children’s Cancer Hospital Egypt

Introduction

Allogeneic hematopoietic stem cell transplantation (HSCT) is widely used for high-risk acute lymphoblastic leukemia (ALL) patients in their first complete remission (CR1), and for relapsed patients in second complete remission (CR2).

Patients and methods

We retrospectively analyzed data for 67 children with ALL, from a cancer center in a low/middle income country, who had undergone HSCT from human leukocyte antigen (HLA)-matched sibling donors (MSDs) using myeloablative conditioning (MAC) regimens, between 2007 and 2020, describing the survival outcome and relapse probability after achieving CR1 and CR2 and determining outcome differences in relation to indications for HSCT in patients transplanted in CR1. All patients had achieved a negative minimal residual disease prior to transplant (<0.01%).

Results

Forty-six patients (68.7%) were in CR1; 25 had adverse cytogenetics, including 18 patients with Philadelphia chromosome-positive ALL (Ph-positive ALL), and 21 had poor induction response. The 5-year overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse (CIR) for the whole cohort were 56.1% (95% CI, 42.8%-69.4%), 49% (95% CI, 35.7%-62.3%) and 33.5% (95% CI, 21.7%-45.8%), respectively with better EFS and CIR for CR1 transplants compared to CR2 transplants (P=0.02 and P=0.03, respectively). Patients with Ph-positive ALL had better 5-year OS, EFS and non-relapse mortality (NRM) compared with other CR1 transplants (P=0.015, P=0.009 and P=0.028, respectively).

Conclusion

Hematopoietic stem cell transplantation from MSD for ALL in CR1 group had superior outcomes compared to CR2 group and was apparently a curable option for Ph-positive ALL without an increased risk of non-relapse mortality. Poorer survival rates and higher relapse probabilities were associated with HSCT conducted to patients who had a poor response to induction therapy or suffered a relapse.

Incidence cumulée de l'infection au SARS-CoV-2 à l'Institut Pasteur de Tunis, mars 2021

Contexte

L'Institut Pasteur de Tunis (IPT) a été impliqué dans les activités de diagnostic biologique de l'infection par le SARS-CoV-2. De nombreux cas d'infection par le SRAS-CoV-2 ont été détectés parmi le personnel de l'IPT, mais la véritable propagation de l'infection au sein de cette institution était inconnue. Notre étude visait à mesurer l'étendue de l'infection par le SRAS-CoV-2 parmi les agents de l'IPT et de déterminer la proportion d'infections asymptomatiques.

Méthodes

Une enquête transversale exhaustive auprès des agents de l'IPT non encore vaccinés contre la COVID-19 a été menée au cours des deux dernières semaines de mars 2021 qui coïncidaient avec la fin de la deuxième vague de COVID-19 en Tunisie. Les échantillons de sérum collectés auprès des participants ont été testés à l'aide de deux tests ELISA développés à l'IPT pour détecter les immunoglobulines G dirigés contre le domaine de liaison au récepteur (RBD) de la protéine de pointe S (IgG anti-S-RBD) et contre la protéine de nucléocapside N (IgG anti-N) du virus SARS-CoV-2.

Résultats

Au total, 428 personnes ont été incluses dans l'étude. La prévalence des anticorps anti-SARS-CoV-2 (IgG anti-N et/ou IgG anti-SRBD) était de 32,7 % (intervalle de confiance 95 % : [28,0-36,9]) (22,2 % [18,2-25,9] avaient des IgG anti-N et 31,3 % [26,9-35,7] avaient des IgG anti-S-RBD). L'incidence cumulée de l'infection par le SRAS-CoV-2 (sérologie positive et/ou test RT-PCR antérieur positif) était de 39,7 % [35,0-44,2]. La proportion de formes asymptomatiques était de 32,9 %.

Discussion/Conclusion

s Nos résultats ont révélé une incidence relativement élevée d'infection par le SARS-COV-2 parmi les agents de l'IPT. Les échantillons recueillis avant la vaccination seraient très utiles pour les enquêtes séro-épidémiologiques de suivi post-vaccinal. La proportion considérable d'infections asymptomatiques souligne l'importance de l'intensification de la pratique des tests de dépistage pour rompre la chaine de transmission de l'infection.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Characteristics, Treatment Complexity, and Outcome of Mixed-Phenotype Acute Leukemia in Children in a Low–Middle-Income Country

Background

Mixed-phenotype acute leukemia (MPAL) in children is an uncommon subtype of acute leukemia that cannot be definitively assigned to a specific lineage. There is no consensus on the best approach to therapy. Management is more complex in low–middle-income countries (LMICs).

Aim

To evaluate the clinicopathological characteristics and outcomes of patients with MPAL in a developing country.

Patients and Methods

A retrospective descriptive study of 42 pediatric patients newly diagnosed with MPAL from July 2007 until December 2017.

Results

The immunophenotyping was T/Myeloid in 24 patients (57.1%) and B/Myeloid in 16 (38.1%). Three subjects had MLL gene rearrangement, two had Philadelphia-positive chromosomes, and eight had FMS-like tyrosine kinase 3 (FLT3-ITD) internal tandem duplication (FLT3-ITD) with a ratio >0.4. Two subjects died before starting chemotherapy. Ten patients (25%) received acute lymphoblastic leukemia (ALL) induction, and all achieved complete remission (CR) with no induction deaths and no shift of therapy. Thirty patients (75%) started therapy with acute myeloid leukemia (AML) induction: five (16.6%) died during induction, 17 (56.7%) achieved CR, and 10 patients received maintenance ALL therapy after ending AML treatment. Four of the eight patients with induction failure were switched to ALL therapy. The 5-year event-free survival (EFS) and overall survival (OS) rates were 56.7% [standard error (SE): 8.1%] and 61% (SE: 8%), while the cumulative incidence of relapse was 21.7% (SE: 6.7%), with a median follow-up duration of 5.8 years. Patients treated with ALL-directed therapy had a 5-year EFS rate of 111 70% (SE: 14%) and OS rate of 78.8% (SE: 13%). Patients treated with ALL-directed therapy had a 5-year EFS rate of 70% (SE: 14.5%) and OS rate of 78.8% (SE: 13%). FLT3-ITD mutation showed a significantly lower 5-year EFS rate of 28.6% (SE: 17%) vs. 75% (SE: 9%) for the wild type, p = 0.032. Undernourished patients with a body mass index (BMI) z-score ≤-2 at presentation had a significantly lower 5-year EFS rate of 20% (SE: 17%) compared to 61.8% (SE: 8%) for patients with BMI z-score >-2, p = 0.015.

Conclusion

This study supports ALL-directed therapy for pediatric MPAL in a setting of LMIC. Given the poor outcome of FLT3-ITD, the role of FLT3 inhibitor needs to be explored in this subset of cases.

Cardiac remodeling in severe hypertension, does it respond to tight blood pressure control?

Funding Acknowledgements

Type of funding sources: None.

Background

Severe hypertension (HTN) may cause target organ damage (TOD). Kidney can tolerate severe HTN to very high levels. Cardiac remodeling as TOD could be detected by elevation of biomarker Troponin.

Aim

We aim to detect the response of organs (heart & kidney) to tight control of severe HTN.

Patients & Methods

Patients admitted due to severe hypertension (BP> 180/120) associated with any symptoms were enrolled. All patients were managed according to the European guidelines to the target BP. Cardiac biomarker Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured for all patients on admission and 24 hours later.

Results

Ninty five patients with hypertensive crisis were treated to target BP. Forty six patients had initially high hs-TNT (Group A) and 49 patients had initially normal hs-TNT (Group B). There was a highly significant difference between both groups regarding initial and follow-up s.creat with higher values in Group B (P= 0.03 and 0.004 respectively).There was high significant difference between initial and follow up s.creat values in Group B with higher values in the follow up measurements after BP control to the target (P= 0.03), while this difference is insignificant in Group A (P=0.26).  Five patients in Group B developed renal failure after tight BP control. There was a significant positive correlation between hs-TNT and the follow-up s.creat (P=0.018) with more deterioration of s.creat in those having initial high hs-TNT.

Conclusion

In severe HTN, hs-TNT may be elevated due to marked afterload. Renal affection and TOD occurs before cardiac remodeling and damage due to severe HTN. Renal autoregulation occurs in chronic elevation of BP. Acute control of severe HTN leads to disrruption of renal autoregulation and renal shut down. European guidelines regarding severe HTN control should be revised. In hypertensive patients with high hs-TNT, BP should not be well controlled on the short term not to disrupt renal autoregulation.

Outcomes of allogenic hematopoietic cell transplantation for childhood chronic myeloid leukemia: Single-center experience

BACKGROUND/OBJECTIVES

Despite the apparent efficacy and favorable toxicity profile of TKIs, allogeneic SCT remains the only curative treatment for CML especially in younger patients, but TRM should be considered. We evaluated the clinical outcomes of pediatric CML patients who had SCT in our center.

METHODS

This retrospective study included children with CML, who received an allogeneic SCT at Children Cancer Hospital Egypt, 57357, from 2007 to 2017. All patients received myeloablative conditioning chemotherapy containing busulfan/cyclophosphamide followed by stem cell infusion from MRD.

RESULTS

From 121 patients diagnosed with CML, 43 had available MRD and subjected to HSCT while 78 patients continued TKI therapy. The median time to transplant from diagnosis was 13 months. At initial diagnosis, there were 39 patients in CP and 4 had blastic crises. Bone marrow harvest was the stem cell source in 32 patients, while 11 cases received mobilized peripheral blood stem cells with average stem cell dose of 4.45 × 10⁶ /kg. The probabilities of overall survival and event-free survival at 5 years were 97.4% and 79.8%, respectively. TRM at 100 days and TRM at 1-year post-transplant were 0%. The incidence of chronic GVHD was significantly higher in peripheral blood than bone marrow stem cell source (P = .004).

CONCLUSION

Considering the excellent survival rates and very low TRM, HSCT is still a valid option for pediatric patients with newly diagnosed CML with best using marrow stem cell source to avoid a significant risk of cGVHD and its related complications.

RAS Pathway Mutation Patterns in Patients With Juvenile Myelomonocytic Leukemia: A Developing Country Single-center Experience

INTRODUCTION

Juvenile myelomonocytic leukemia (JMML) is a rare clonal myelodysplastic/myeloproliferative neoplasm of early childhood. Historically, it was difficult to diagnose clinically, as patients present with manifestations shared with other hematologic malignancies or viral infections. It is now clear that JMML is a disease of hyperactive RAS signaling.

PATIENTS AND METHODS

We examined the bone marrow of 41 Egyptian children with JMML by direct sequencing for mutations in the RAS pathway genes.

RESULTS

Mutations were detected in 33 (80%) of 41 patients. We identified 12 (29%) of 41 patients with PTPN11 mutation; 18 (44%) of 41 with RAS mutation; 9 (22%) of 41 with NRAS mutation; 9 (22%) of 41 with KRAS mutation; and 3 (7%) of 41 with CBL mutation. Eleven (92%) of the PTPN11 mutations were detected in exon 3 and 1 (8%) in exon 13. Seven of the NRAS mutations were in exon 2, and 2 were in exon 3. All KRAS mutations were in exon 2. The 3 cases with CBL mutation were homozygous mutations in exon 8. All the mutations detected in PTPN11, NRAS/KRAS, and the CBL genes were previously reported missense mutations in JMML.

CONCLUSION

Our results demonstrate that Egyptian children diagnosed with JMML have high frequency of NRAS/KRAS mutations and lower frequency of PTPN11 mutations as compared with previous studies. The concept of mutually exclusive RAS pathway mutations was clearly observed in our patients. All cancer centers in our region should start implementing molecular diagnostic methods before confirming the diagnosis of JMML and before offering hematopoietic stem cell transplantation.

Osteonecrosis in children with acute lymphoblastic leukemia: A report from Children's Cancer Hospital Egypt (CCHE)

BACKGROUND

As survival rates for children with acute lymphoblastic leukemia (ALL) improve, awareness of treatment complications becomes important. Osteonecrosis (ON) is a serious disabling complication in treated ALL patients. The aim of the study was to define the frequency of ON identified by magnetic resonance imaging (MRI) and to study the risk factors for ON.

PATIENTS AND METHODS

The frequency of ON was evaluated retrospectively in 858 patients with ALL who were diagnosed at Children's Cancer Hospital of Egypt from January 2009 to December 2012. Patients were treated with St Jude Total Therapy Study XV.

RESULTS

Of 858 patients evaluated, 665 were eligible for the study and 65 (9.7%) developed ON. The cumulative 5-year incidence of ON was 11.96% (SE, 0.131%). Of 154 patients aged 10 years and older, 40 (26%) developed ON. The mean age of patients with ON was 10.7 years. The prognostic factors with a significant relationship with ON were age 10 years and older (P = 0.0001) and intermediate-/high-risk group (P = 0.0001). However, gender did not have a significant relationship. At the onset of ON, the mean cumulative dexamethasone dose was 796 mg/m² , and the mean total corticosteroid dose, calculated as prednisolone equivalence, was 6,431 mg/m² . Out of 43 patients who developed ON while on corticosteroid therapy, 36 (84%) required dexamethasone dose modification and/or discontinuation.

CONCLUSION

The frequency of ON among the studied patients was 9.7%. Risk factors with a significant association with ON were older age and more intensive corticosteroid therapy.

The role of information in science and technology transfer in Arab countries

This paper discusses the position of science and technol ogy in Arab countries and identifies the problems and obstacles in the transfer of science and technology from the developed countries to the Arab countries. It discusses the reasons for these obstacles and proposes solutions, distin guishing the information role in science and technology trans fer and the role of a national plan for information services.

Abstract B07: Prevalence of the most common fusion gene transcripts in 1080 Egyptian pediatric acute lymphoblastic leukemia patients: Children Cancer Hospital Egypt (CCHE) experience

Introduction: Childhood acute lymphoblastic leukemia (ALL) is a highly heterogeneous disease with distinct biological subgroups.

Objective: To detect the incidence of the most common fusion gene transcripts in a large cohort of de novo Egyptian pediatric precursor B-ALL as well as relapsed cases for the first time in Egypt. To compare our results with other Western and Eastern countries to see if there is ethnic variation.

Procedure: The study included 1080 consecutive patients with de novo precursor B-ALL and 58 relapsed cases with age ≤ 18 years that were admitted and treated at Children Cancer Hospital Egypt (CCHE) from July 2007 till December 2013. Diagnosis was established by morphological examination and immunophenotyping. All cases were subjected to cytogenetic and molecular analysis. RT-PCR was carried out to test for the most common fusion gene transcripts t(12;21) ETV6/RUNX1, t(1;19) TCF3/PBX1, t(9; 22) BCR/ABL and t(4; 11) MLL/AF4.

Results: Out of 1080 newly diagnosed cases, ETV6-RUNX1 was found in 165 (15.3%), E2A-PBX1 in 74 (6.9 %), BCR-ABL in 41 (3.9%) and MLL-AF4 in 20 (1.9 %). The incidence in relapsed cases was 6.7%, 6.7%, 1.7% and 5.1% respectively. As regards immunophenotyping, ETV6-RUNX1 was highly correlated with CALL, E2A-PBX to Pre-B and MLL-AF4 to Pro-B (p 0.0001, 0.0001, 0.0001) while BCR-ABL was not related to any phenotype. As regarding age, all fusion genes were highly correlated to the age group 1-10 years (p 0.0001, 0.007, 0.0001) except MLL-AF4 was correlated to 0-1 age group (p 0.0001). As regards total leucocytic count (TLC), E2A-PBX1 and BCR-ABL were correlated to < 50x103/µl and MLL-AF4 to > 100x103/µl while ETV6-RUNX1 showed no correlation.

ETV6-RUNX1 (15.3%) was much lower than that reported by United States and Western Europe that have range 19-26% with a median of 23% while it is nearly comparable with Far East range of 13.4-17.5%. BCR-ABL (3.9%) is a little bit higher than western 2% while lower than Far East 6.65%. E2A-PBX1 (6.9%) was little higher than Western 3-5% and Far East 4.9%. MLL-AF4 1.9% was comparable with both Western and Far East (2-3%). Comparison with Middle East which is of limited number of studies; ETV6-RUNX1 was higher than Iraq, Kuwait, and Jordan 12.1%, 11.7%, 12% but much lower than Saudi Arabia 21%. E2A-PBX1 was much higher than Kuwait, Iraq and Saudi Arabia (1.8%, 4.2%, and 4.2%). BCR-ABL was comparable.MLL-AF4 was comparable with Saudi Arabia (2.5%) but lower than Kuwait and Iraq (3.6%, 4.2%). About relapsed cases, ETV6-RUNX1, BCR-ABL and MLL-AF4 were much lower than Western Europe and Far East.

Conclusion: These frequency differences of molecular markers in childhood ALL confirm the Ethnic and geographic variation. Other factors may play a role such as exposure to environmental oncogenic factors and of course differences among laboratories may play part in this difference. So we should put into consideration that this frequency difference may have important implication for prognosis, drug selection and treatment outcome.

Citation Format: Dina Yassin, Sonya Soliman, Khaled Shaaban, Sherine Salem, Nayera Hamdy, Hala Reda, Iman Sidhom, Abeer Mokhles, Nesreen Aly, Amr EL Nashar, Wafaa Rashed, Mai Mahmoud, Sarah Hesham, Alaa ELHaddad. Prevalence of the most common fusion gene transcripts in 1080 Egyptian pediatric acute lymphoblastic leukemia patients: Children Cancer Hospital Egypt (CCHE) experience. [abstract]. In: Proceedings of the AACR Special Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(17 Suppl):Abstract nr B07.

Fournier’s gangrene: outcome analysis of 62 consecutive cases

Objectives:

The objective of this article is to study the outcome of management of 62 consecutive cases of Fournier’s gangrene (FG).

Patients and methods:

We conducted an observational study of all cases of FG admitted to the Urology and General Surgery departments of Farwaniya Hospital, Kuwait, between 2004 and 2013. We recorded the laboratory and clinical findings on admission. Operative and postoperative data were also recorded.

Results:

Our study included 62 cases of FG. Patients were divided into two groups: Group A (survival) consisted of 55 cases and Group B (mortality) of seven cases. The mean duration of symptoms before admission was significantly longer in the mortality group (3.86 days versus 1.96 days in survival group) ( p < 0.05). The mean duration of symptoms until time of first debridement was also significantly longer in the mortality group (4.39 days versus 2.35 days in survival group) ( p < 0.05). There was also a statistically significant difference between the two groups regarding the percentage of the affected area in relation to total body surface area (4.6% in Group A versus 8% in Group B) ( p < 0.05). The Fournier Gangrene Severity Index score (FGSI) was significantly higher in Group B (10.26) in comparison to Group A (6) ( p < 0.01). The mean duration of hospital stay was significantly higher in the survival group (22.24 days versus 14.28 days) ( p < 0.01). Diabetes and renal failure were significantly higher in the mortality group (100% and 57.1% in Group B versus 54.5% and 9.1% in Group A, respectively) ( p < 0.05). The number of patients presenting with severe sepsis was higher in the mortality group (71.4% in Group B versus 12.7% in Group A) ( p < 0.05).

Conclusion:

We concluded that FG is a serious, potentially fatal disease. Higher mortality is related to severe sepsis on admission, renal failure, diabetes, extensive disease involving extra-genital areas and late presentation. A multidisciplinary approach in diagnosis and management of the disease can achieve good outcome with low mortality rate.

Outcome of risk-adapted therapy for pediatric acute lymphoblastic leukemia in Egypt

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Background: With modern risk directed therapy, >80% of children with acute lymphoblastic leukemia (ALL) in western countries are cured. The 5-year event free survival (EFS) and relapse free survival (RFS) of pediatric ALL patients in Egypt were 65% and 75% respectively in a previous study using an intensive treatment protocol for all patients. Aim: To improve cure rates of Egyptian children with ALL using risk adapted therapy. Methods: From July 2007 to December 2010, 706 patients aged 1-18 years with newly diagnosed ALL were treated at Children Cancer Hospital Egypt with a risk directed ALL protocol adopted from St Jude Total Study XV. Results: B-precursor phenotype was encountered in 75.8% and T-cell in 24.2%. Based on initial presentation and response to therapy measured by minimal residual disease (MRD), 42.6%, 45.8% and 11.6% of the patients were classified as low, intermediate and high risk respectively. The 5-year RFS and EFS were 88.2 ± 1.5% and 76.5 ± 1.7% respectively. Adverse events included 4.4% induction deaths, 2.5% failure to achieve induction remission (1.4% remained refractory), 6.8% deaths in remission, 9.2% relapses (3.1% hematological, 1.8% combined hematological and CNS, 4% isolated CNS, 0.3% isolated testicular), 0.9% abandonment of therapy and one patient had secondary myeloid leukemia. The median follow up for patients alive in CR was 43months (range 24–65). The 5-year RFS of the low, intermediate and high risk groups were 92.2 ± 2.4%, 85.3 ± 2.2% and 82.7 ± 4.8% respectively (p=0.001), while the 5-year EFS were 87.6 ± 2.5%, 78.2 ± 2.5% and 57.9 ± 5.7% respectively (p<0.001). Prognostic factors that had statistically significant unfavorable impact on both EFS and RFS by univariate analysis were age ≥10 years, TLC ≥100x109/L, T-cell phenotype, risk groups, MRD d42 ≥1% and MRD W7 ≥0.1%, while MRD d15 ≥1% had statistically significant unfavorable outcome on EFS only. By multivariate analysis, TLC and MRD W7 had prognostic significance on EFS and RFS, MRD d42 on EFS, while MRD d15 had marginal significance on EFS (p=0.055). Conclusions: Risk adapted therapy was effective in improving ALL survival among patients at our institution compared with previous trials, although the outcome remains lower than that in high income countries.

Transforming growth factor-β impairs glucocorticoid activity in the A549 lung adenocarcinoma cell line

BACKGROUND AND PURPOSE

The lung adenocarcinoma cell line, A549, undergoes epithelial-mesenchymal cell transition (EMT) in response to TGF-β. Glucocorticoids do not prevent the EMT response, but TGF-β induced resistance to the cytokine-regulatory action of glucocorticoids. We sought to characterize the impairment of glucocorticoid response in A549 cells.

EXPERIMENTAL APPROACH

A549 cells were exposed to TGF-β for up to 96 h before glucocorticoid treatment and challenge with IL-1α to assess glucocorticoid regulation of IL-6 and CXCL8 production. Nuclear localization of the glucocorticoid receptor α (GRα) was ascertained by immunofluorescence and Western blotting. Transactivation of the glucocorticoid response element (GRE) was measured with a transfected GRE-secreted human placental alkaline phosphatase reporter.

KEY RESULTS

TGF-β (40-400 pM) reduced the maximum inhibitory effect of dexamethasone on IL-1α-induced IL-6 and CXCL8 production. The impaired glucocorticoid response was detected with 4 h of TGF-β (40 pM) exposure (and 4 h IL-1α to induce CXCL8 expression) and therefore was not secondary to EMT, a process that requires longer incubation periods and higher concentrations of TGF-β. TGF-β also impaired dexamethasone regulation of granulocyte-macrophage colony-stimulating factor in thrombin-stimulated BEAS-2B epithelial cells. Impaired regulation of CXCL8 was associated with markedly reduced GRE transactivation and reduced induction of mRNA for IκBα, the glucocorticoid-inducible leucine zipper and the epithelial sodium channel (SCNN1A). The expression, cellular levels and nuclear localization of GRα were reduced by TGF-β.

CONCLUSIONS AND IMPLICATIONS

We have identified mechanisms underlying the impairment of responses to glucocorticoids by TGF-β in the A549 and BEAS-2B cell lines.

Contribution of VANGL2 mutations to isolated neural tube defects

Vangl2 was identified as the gene defective in the Looptail (Lp) mouse model for neural tube defects (NTDs). This gene forms part of the planar cell polarity (PCP) pathway, also called the non-canonical Frizzled/Dishevelled pathway, which mediates the morphogenetic process of convergent extension essential for proper gastrulation and neural tube formation in vertebrates. Genetic defects in PCP signaling have strongly been associated with NTDs in mouse models. To assess the role of VANGL2 in the complex etiology of NTDs in humans, we resequenced this gene in a large multi-ethnic cohort of 673 familial and sporadic NTD patients, including 453 open spina bifida and 202 closed spinal NTD cases. Six novel rare missense mutations were identified in seven patients, five of which were affected with closed spinal NTDs. This suggests that VANGL2 mutations may predispose to NTDs in approximately 2.5% of closed spinal NTDs (5 in 202), at a frequency that is significantly different from that of 0.4% (2 in 453) detected in open spina bifida patients (p = 0.027). Our findings strongly implicate VANGL2 in the genetic causation of spinal NTDs in a subset of patients and provide additional evidence for a pathogenic role of PCP signaling in these malformations.

Phenotypic Diversity among Strains of Bradyrhizobium japonicum Belonging to Serogroup 110

Thirty-four strains of Bradyrhizobium japonicum within serogroup 110 were examined for phenotypic diversity. The strains differed in their abilities to nodulate and fix dinitrogen with Glycine max (L.) Merr. cv. Williams. Thirteen strains expressed uptake hydrogenase activity when induced as free-living cultures in the presence of 2% hydrogen and oxygen. Six bacteriophage susceptibility reactions were observed. Each of the strains produced either a large, mucoid or a small, dry colony morphology, but colony type was not related to effectiveness for nitrogen fixation.

Genotypic Diversity among Strains of Bradyrhizobium japonicum Belonging to Serogroup 110

Thirty-three strains of Bradyrhizobium japonicum within serogroup 110 were examined for genotypic diversity by using DNA-DNA hybridization analyses. The analysis of the DNA from 15 hydrogen-uptake-negative strains with the bradyrhizobial uptake hydrogenase probe pHU52 showed variation in degree of homology and restriction fragment length polymorphism of EcoRI-restricted DNA. Clustering analysis of the 33 strains on the basis of DNA-DNA hybridization analysis with four restriction enzymes and with the bradyrhizobial nodulation locus, pRJUT10, as probe indicated the existence of four groups of strains, which were less than 70% similar. Restriction digestion of genomic DNA with BamHI and DNA-DNA hybridization with pRJUT10 permitted classification of each of the strains according to a specific fingerprint pattern.

Replacement of acetonitrile by ethanol as solvent in reversed phase chromatography of biomolecules

Acetonitrile, which is a by-product of acrylonitrile synthesis, is the commonly used solvent in ion-pair reversed phase chromatography. In consequence of the decreasing demand for acrylonitrile due to the financial crisis, a worldwide shortage of acetonitrile is observed. Therefore, the aim of this study was to establish ion-pair reversed phase chromatographic assays using alternative eluents for acetonitrile and to decrease costs incurred hereby. We compared the performance of ion-pair reversed phase chromatography using acetonitrile with the alternative eluents methanol, ethanol and n-propanol, using monolithic reversed phase C5 as well as C18 chromatography columns. We used triethylammonium acetate (TEAA) and tetrabutylammonium sulfate (TBA) as representative cationic ion-pair reagents and trifluoroacetic acid (TFA) as representative anionic ion-pair reagent. For covering a large field of applications, we fractionated representative low, middle and high-molecular weight biomolecules, in particular dinucleoside polyphosphates, peptides, proteins and tryptic digested human serum albumin. Whereas the chromatographic characteristics of both methanol and n-propanol were partly insufficient, ethanol was characterised equally or partly even better in the matter of elution strength and separation quality compared to the eluent water-acetonitrile. In conclusion, ethanol is an appropriate alternative for acetonitrile in ion-pair reversed phase chromatography of biomolecules.

Spectral shape of the two-photon decay of the 2 1S0 state in he-like tin

The spectral distribution of the 1s2s {1}S{0}-->1s{2} 1S0 two-photon decay of He-like tin was measured using a novel approach at the gas-jet target of the ESR storage ring. Relativistic collisions of Li-like projectiles with low-density gaseous matter have been exploited to selectively populate the desired 1s2s state. Compared to conventional techniques, this approach results in a substantial gain in statistical and systematic accuracy, which allowed us to achieve for the first time a sensitivity to relativistic effects on the two-photon decay spectral shape as well as to discriminate the measured spectrum for Sn from theoretical shapes for different elements along the He-isoelectronic sequence.

The protective effect of diabetes mellitus against prostate cancer: role of sex hormones

BACKGROUND

Diabetes mellitus (DM) has been associated with decreased risk of prostate cancer (PC) in several reports. Hormonal environment of diabetic patients is believed to be an important contributing factor in this regard.

METHODS

Using data from a multi-center case-control study in Iran, base line testosterone, sex hormone binding globulin (SHBG), estradiol, and albumin levels as well as thorough demographic and medical characteristics of 194 newly diagnosed prostate cancer patients were determined. There were 317 ethnicity-matched men with no cancer as controls as well. Data was analyzed for hormones of interest in DM patients regarding their cancer status.

RESULTS

Of 511 enrolled patients, twenty-one cases and 63 controls were diagnosed as DM. Patients with DM were significantly less likely to have PC (OR: 0.44, P = 0.003). Time since DM diagnosis was also inversely correlated with the risk of cancer (P trend < 0.0001). Control patients had significantly higher testosterone, estradiol, and testosterone/SHBG ratio (P < 0.05). As time since DM diagnosis increased by quartiles, testosterone significantly increased (P trend < 0.05). The risk of PC also significantly declined (P trend < 0.0001) following an initial remarkable increase early after DM diagnosis. After including the hormones in the logistic regression model, there was a weak, yet significant inverse association of testosterone/SHBG and DM duration with the risk of PC.

CONCLUSIONS

Based on our results DM duration is inversely correlated with the risk of prostate cancer. Our results do not support the hypothesis that sex hormones, including testosterone, play a major role in the protective effect of DM against PC.

Could prophylactic monoclonal antibody improve kidney graft survival?

OBJECTIVES

This study was designed to evaluate the impact of daclizumab monoclonal antibody on early and late kidney graft survival.

MATERIALS AND METHODS

From 2007 to 2008, 57 kidney transplant recipients were followed for a mean of 9.3 months. Twenty-three patients received 1 mg/kg daclizumab 24 hours before and 14 days after transplantation. In contrast, 34 patients (controls) did not receive daclizumab. The same immunosuppressive protocol was administered to all participants: oral prednisolone, mycophenolate mofetil, and cyclosporine. Delayed graft function (DGF), acute rejection, prednisolone pulses and/or antithymoglobulin (ATG), cytomegalovirus (CMV) infection, urinary tract infection (UTI), as well as early and late graft function were compared between the two groups.

RESULTS

The mean age in cases and controls was 39.7 and 37.1 years, respectively. The occurrence of DGF was 4% versus 3%; reversible acute rejection, 16% versus 14.5%, and irreversible acute rejection 0% versus 9% (P < .05) for treated versus control groups, respectively. ATG was used in 21% versus 23%, and pulse prednisolone 26% versus 20%, respectively. In case and control groups, the mean creatinine levels were 1.4 mg/dL versus 1.35 mg/dL at discharge. At last follow-up, it was 1.35 mg/dL versus 1.2 mg/dL, respectively. CMV infection occurred in 30% versus 35%, and UTI in 17% versus 19% of treated versus controls, respectively.

CONCLUSION

The prophylactic administration of daclizumab improved early graft survival and prevented irreversible acute rejection.