It's time to regulate - The importance of accurate surgical-grade tourniquet autoregulation in blood flow restriction exercise applications

OBJECTIVE

Evaluate the efficacy of five common blood flow restriction (BFR) systems to accurately maintain and autoregulate BFR pressure in the tourniquet cuff near target pressure throughout exercise.

DESIGN

Randomised crossover design.

SETTING

Laboratory.

PARTICIPANTS

15 healthy individuals.

OUTCOME MEASURES

1) Percentage of total BFR time that surgical-grade tourniquet autoregulation, defined as automatic and rapid self-regulation of cuff pressure to within ±15 mmHg of initial target pressure within 1 s in the presence of transient pressure changes associated with exercise, was provided; 2) pressure change in the BFR cuff throughout exercise, by comparing the initial target pressure to the measured pressure at completion of BFR exercise.

RESULTS

One BFR system could provide surgical-grade tourniquet autoregulation for the whole duration (100 ± 0%) of the BFR exercise in all subjects. In two of the five BFR systems evaluated, measured cuff pressure at the end of exercise was not different (p < 0.05) to the initial target pressure.

CONCLUSIONS

Surgical-grade tourniquet autoregulation is important to consistently and reliably apply a targeted BFR pressure stimulus. This may allow BFR methodology and protocols to be accurately implemented and controlled so that the results can be more meaningfully compared, leading to the potential optimization of applications.

A novel prognostic biomarker: GINS3 is correlated with methylation and immune escape in liver hepatocellular carcinoma

Background

Liver cancer remains one of the tricky malignancies nowadays. GINS complex subunit 3 (GINS3), part of the GINS tetrameric complex, is significantly upregulated in many cancers, including liver hepatocellular carcinoma (LIHC). With the development of liver cancer treatment, immune and molecular targeted therapy gradually becomes a promising treatment. However, the key target for liver cancer is still indistinct. Herein, the underneath mechanism of GINS3 was investigated to verify its role as a biomarker in LIHC.

Methods

Genomic expression, genetic alteration, and methylation analyses were obtained from The Cancer Genome Atlas (TCGA), Clinical Proteomic Tumor Analysis Consortium (CPTAC), The University of Alabama at Birmingham CANcer (UALCN), and Human Protein Atlas (HPA), cBioPortal, and MethSurv databases. Subsequently, the diagnostic and prognostic role of GINS3 in LIHC were analyzed based on data from receiver operating characteristic (ROC), Kaplan-Meier plotter (KM-plotter), and univariate and multivariate cox regression analyses. The functional analyses were conducted with GeneMANIA and STRING databases, gene-gene, and protein-protein interaction (PPI) networks, Gene Ontology (GO) term, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Tumor Immune Estimation Resource (TIMER), Tumor-Immune System Interaction Database (TISIDB), and Gene Expression Profiling Interactive Analysis (GEPIA) were utilized to explore the internal connection with the immune escape.

Results

Through the analyses of genomic expression, GINS3 was significantly upregulated in LIHC and positively correlated with higher T classification. ROC analysis indicated GINS3 as a potential biomarker in the diagnosis of LIHC. KM-plotter, univariate and multivariate cox regression analyses both associated GINS3 with poor prognosis in LIHC patients. GINS3 genetic alteration, gene-gene interaction, PPI networks, and enrichment analysis further revealed that GINS3 played a pivotal role in the progression of LIHC. Furthermore, hypermethylation of GINS3 at different cytosine-guanine (CpG) sites was correlated with better or worse overall survival (OS) in LIHC and GINS3 was also closely correlated with m6A modification. Moreover, results supported that GINS3 could influence the tumor microenvironment and relate to the immune checkpoints.

Conclusions

Taken together, comprehensive analyses from this study supported GINS3 as a novel targeted biomarker in LIHC.

Early-stage structure-based drug discovery for small GTPases by NMR spectroscopy

Small GTPase or Ras superfamily, including Ras, Rho, Rab, Ran and Arf, are fundamental in regulating a wide range of cellular processes such as growth, differentiation, migration and apoptosis. They share structural and functional similarities for binding guanine nucleotides and hydrolyzing GTP. Dysregulations of Ras proteins are involved in the pathophysiology of multiple human diseases, however there is still a stringent need for effective treatments targeting these proteins. For decades, small GTPases were recognized as 'undruggable' targets due to their complex regulatory mechanisms and lack of deep pockets for ligand binding. NMR has been critical in deciphering the structural and dynamic properties of the switch regions that are underpinning molecular switch functions of small GTPases, which pave the way for developing new effective inhibitors. The recent progress of drug or lead molecule development made for small GTPases profoundly delineated how modern NMR techniques reshape the field of drug discovery. In this review, we will summarize the progress of structural and dynamic studies of small GTPases, the NMR techniques developed for structure-based drug screening and their applications in early-stage drug discovery for small GTPases.

Testing the framework in real life – application for country HSPA process

The ability to use the existing health system assessment tools, HSPA processes and widely available indicators is an important, although not exhaustive, part of the practical application of the framework. With this in mind, we created an annotated template that can be used along with HSPA framework for UHC to facilitate information collection and harmonisation.

This annotated template was tested for Estonia and Azerbaijan with the aim to help with evaluating the transferability of HSPA information between existing approaches and in different settings. More specifically, we tested the extent to which information on assessment areas of the framework can be extracted from the existing sources; the ease of use and clarity of the annotated template; and how the information collected through the annotated template can be combined into a meaningful health system performance assessment, in line with health system goals.

The test showed that the information for Estonia and Azerbaijan could be obtained to complete much of the template. This can be done through a country-led performance assessment process that ensures that the indicative measures in the annotated template are relevant to the country context. The information collected also needs to be assessed in the context of policy priorities of the national health systems. Thus, more detailed guidance on the use of the framework can help to streamline such national processes and clarify the linkages between performance of specific functions and overall health system performance.

The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

[An epidemiologic study of pelvic organ prolapse in urban Chinese women: a population-based sample in China]

Objective: This study aimed to assess the prevalence and factors associated with pelvic organ prolapse (POP) in a representative sample of Chinese urban women. Methods: A total of 29613 Chinese urban women were recruited to this cross-sectional study between February 2014 and March 2016. The prevalence of POP, defined as any stage Ⅱ or higher POP resulting in symptoms, was assessed using questionnaires and physical examinations. Multivariable logistic regression was used to assess factors associated with POP. Results: 2 864 of 29 613 women (9.67%) had POP. The prevalence of POP increased with age ranging from 1.23% (82/6 646) of women aged between 20 and 29 years to 26.11% (727/2 784) for those aged 70 years or older (P<0.000 1). Overweight and obese women were more likely to have POP than normal weight women [AOR=1.56, 95%CI 1.42-1.72 vs AOR=1.74, 95%CI 1.48-2.03]. In the multivariate analysis, the independent risk factors were cough (AOR=1.70, 95%CI 1.44-2.02), constipation (AOR=2.05, 95%CI 1.82-2.32), physical disease (AOR=1.27, 95%CI 1.15-1.41), and gynecological diseases (AOR=2.08, 95%CI 1.89-2.29). Nulliparous (AOR=0.12, 95%CI 0.06-0.22) and caesarean section (CS) (AOR=0.55, 95%CI 0.47-0.64) were protective factors for POP. Conclusions: POP affects nearly 10% of women in Chinese urban region. The prevalence of POP increases significantly with age. The independent risk factors for POP are body mass index, cough, constipation, physical disease and gynecological diseases. Nulliparous and CS are protective factors for POP.

Dimeric Porphyrin Small Molecules for Efficient Organic Solar Cells with High Photoelectron Response in the Near-Infrared Region

Small molecules (SMs) with elongated backbones are promising for achieving a higher photovoltaic performance. Herein, a dimeric porphyrin small molecule, ZnP2-DPP, consisting of two porphyrin units linked with an ethynylene as the core and two diketopyrrolopyrrole (DPP) units as the arms is designed and synthesized as an electron donor for solution-processed bulk-heterojunction (BHJ) organic solar cells (OSCs). A significantly enhanced power conversion efficiency of 8.45% with an impressive short-circuit current density (J_sc) up to 19.65 mA cm^-2 is achieved for the BHJ OSCs based on ZnP2-DPP under AM 1.5G irradiation (100 mW cm^-2) compared to that for the OSCs based on the dimeric porphyrin linked with bis-ethynylenes reported previously. Furthermore, the devices show broad photoelectron responses up to 1000 nm with high near-infrared external quantum efficiency up to 66% at 780 nm. This is the first study reporting SM OSCs displaying such a large J_sc of about 20 mA cm^-2 simultaneously with a considerably high and deep photoelectron response of up to 1000 nm.

Ternary Solar Cells Based on Two Small Molecule Donors with Same Conjugated Backbone: The Role of Good Miscibility and Hole Relay Process

Ternary organic solar cells (OSCs) are very attractive for further enhancing the power conversion efficiencies (PCEs) of binary ones but still with a single active layer. However, improving the PCEs is still challenging because a ternary cell with one more component is more complicated on phase separation behavior. If the two donors or two acceptors have similar chemical structures, good miscibility can be expected to reduce the try-and-error work. Herein, we report ternary devices based on two small molecule donors with the same backbone but different substituents. Whereas both binary devices show PCEs about 9%, the PCE of the ternary cells is enhanced to 10.17% with improved fill factor and short-circuit current values and external quantum efficiencies almost in the whole absorption wavelength region from 440 to 850 nm. The same backbone enables the donors miscible at molecular level, and the donor with a higher HOMO level plays hole relay process to facilitate the charge transportation in the ternary devices. Since side-chain engineering has been well performed to tune the active materials' energy levels in OSCs, our results suggest that their ternary systems are promising for further improving the binary cells' performance although their absorptions are not complementary.

Conjugated D–A porphyrin dimers for solution-processed bulk-heterojunction organic solar cells

Three porphyrin dimers with different linkages are synthesized as donors for organic photovoltaics with an optimized PCE of 6.42%.

Facile preparation of small molecules for bulk heterojunction solar cells

Facile preparation of solution-processable small molecules with only two step reactions for bulk heterojunction solar cells, exhibiting a power conversion efficiency as high as 4.64%.

Automotive shredder residue (ASR) management: An overview

On the basis of statistical data, approximately 6.5 million tons of ELVs were produced in Europe in 2011. ELVs are processed according to a treatment scheme comprising three main phases: depollution, dismantling and shredding. The ferrous fraction represents about 70-75% of the total shredded output, while nonferrous metals represent about 5%. The remaining 20-25% is referred to as automotive shredder residue (ASR). ASR is largely landfilled due to its heterogeneous and complex matrix. With a start date of January 1st 2015, the European Directive 2000/53/EC establishes the reuse and recovery of a minimum of 95% ELV total weight. To reach these targets various post-shredder technologies have been developed with the aim of improving recovery of materials and energy from ASR. In order to evaluate the environmental impacts of different management options of ELVs, the life cycle assessment (LCA) methodology has been applied taking into account the potential implication of sustainable design of vehicles and treatment of residues after shredding of ELVs. Findings obtained reveal that a combination of recycling and energy recovery is required to achieve European targets, with landfilling being viewed as the least preferred option. The aim of this work is to provide a general overview of the recent development of management of ELVs and treatment of ASR with a view to minimizing the amount of residues disposed of in landfill.

Review of Italian experience on automotive shredder residue characterization and management

Automotive Shredder Residue (ASR) is a special waste that can be classified as either hazardous or non hazardous depending on the amount of hazardous substances and on the features of leachate gathered from EN12457/2 test. However both the strict regulation concerning landfills and the EU targets related to End-of-Life Vehicles (ELVs) recovery and recycling rate to achieve by 2015 (Directive 2000/53/EC), will limit current landfilling practice and will impose an increased efficiency of ELVs valorization. The present paper considers ELVs context in Italy, taking into account ASRs physical-chemical features and current processing practice, focusing on the enhancement of secondary materials recovery. The application in waste-to-energy plants, cement kilns or metallurgical processes is also analyzed, with a particular attention to the possible connected environmental impacts. Pyrolysis and gasification are considered as emerging technologies although the only use of ASR is debatable; its mixing with other waste streams is gradually being applied in commercial processes. The environmental impacts of the processes are acceptable, but more supporting data are needed and the advantage over (co-)incineration remains to be proven.

Avoidable mortality in Estonia: exploring the differences in life expectancy between Estonians and non-Estonians in 2005-2007

OBJECTIVES

A considerable increase in social inequalities in mortality was observed in Eastern Europe during the post-communist transition. This study evaluated the contribution of avoidable causes of death to the difference in life expectancy between Estonians and non-Estonians in Estonia.

STUDY DESIGN

Descriptive study.

METHODS

Temporary life expectancy (TLE) was calculated for Estonian and non-Estonian men and women aged 0-74 years in 2005-2007. The ethnic TLE gap was decomposed by age and cause of death (classified as preventable or treatable).

RESULTS

The TLE of non-Estonian men was 3.53 years less than that of Estonian men, and the TLE of non-Estonian women was 1.36 years less than that of Estonian women. Preventable causes of death contributed 2.19 years to the gap for men and 0.78 years to the gap for women, while treatable causes contributed 0.67 and 0.33 years, respectively. Cardiorespiratory conditions were the major treatable causes of death, with ischaemic heart disease alone contributing 0.29 and 0.08 years to the gap for men and women, respectively. Conditions related to alcohol and substance use represented the largest proportion of preventable causes of death.

CONCLUSIONS

Inequalities in health behaviours underlie the ethnic TLE gap in Estonia, rather than inequalities in access to health care or the quality of health care. Public health interventions should prioritize primary prevention aimed at alcohol and substance use, and should be implemented in conjunction with wider social policy measures.

Short Communication: Changes in Micromineral, Magnesium, Cytokine, and Cortisol Concentrations in Blood of Dairy Goats Following Intramammary Inoculation with Staphylococcus aureus

The aim of this study was to investigate mineral metabolism and immune response in dairy goats following intramammary inoculation with varying doses of Staphylococcus aureus. Blood samples were collected at 0, 2, 4, 8, 12, 24, 48, and 72 h after intramammary inoculation. Lowered plasma Fe concentrations were observed from 12 to 24 h postinoculation in groups SAA (Staph. aureus at 10(4) cfu, n = 5) and SAB (Staph. aureus at 10(8) cfu, n = 5). Plasma Cu concentrations increased in group SAB 2 h after inoculation and maintained greater concentrations until the end of the experiment compared with the control group (phosphate-buffered saline, n = 5). Increased plasma Zn concentrations in group SAB were observed 48 h after inoculation, and the concentration was still greater 72 h after inoculation compared with the control group. Greater plasma Mg concentrations were detected in groups SAA and SAB compared with the control group at all timepoints after inoculation. Plasma Mg concentrations were generally greater in group SAA than in group SAB through 72 h (except at 2 h). Plasma tumor necrosis factor-alpha concentrations were unchanged following intramammary inoculation with Staph. aureus throughout the study. Plasma IL-6 concentrations in groups SAA and SAB increased gradually compared with the control group and peaked at 48 h after inoculation. In group SAB, serum cortisol concentrations started to increase from 8 h postinoculation and peaked at 12 h postinoculation. In conclusion, increasing the inoculum dose does not induce more rapid proinflammatory cytokine responses, whereas the data indicate that mineral metabolic alterations occur during the course of Staph. aureus mastitis in the goat.

Characterization of the insulin-like growth factor axis and Wilms' tumour suppressor gene in hyperparathyroidism

Background

Genetic mutations and upregulation of growth factors are implicated in the pathogenesis of hyperparathyroidism. The aim of this study was to evaluate the role of Wilms' tumour suppressor gene (WT-1) and the insulin-like growth factor (IGF) axis in hyperparathyroidism.

Methods

The expression of WT-1 and IGF components was examined by immunohistochemistry, reverse transcriptase–polymerase chain reaction and western immunoblotting in a panel of parathyroid specimens from both primary and secondary hyperparathyroidism. A human parathyroid cell culture model was established to examine the parathyroid response to IGF stimulation.

Results

There was a significantly lower level of WT-1 expression in parathyroid tumours than in normal parathyroid glands. Most tumours expressed IGF-I and IGF-II receptors and responded to IGF stimulation. Only IGF-I was present in normal parathyroid glands, whereas IGF-II was expressed exclusively in parathyroid tumours.

Conclusion

Abnormal expression of WT-1 and the IGF axis may play a role in the pathogenesis of hyperparathyroidism.

The effect of angle on wall shear stresses in a LIMA to LAD anastomosis: numerical modelling of pulsatile flow

The purpose of this study was to examine the effect of anastomotic angle on the flow patterns and wall shear distributions at the distal anastomosis of a left interior mammary artery (LIMA) graft to the left anterior descending artery (LDA). It is now well recognized that abnormal wall shear stress distributions along the anastomotic bed, around the toe, and around the heel can contribute to the focal development of intimal hyperplasia. However, the exact nature of the interaction between the dominant pulsing flow and the anastomotic angle on wall shear stresses has not been fully investigated numerically. In this study a commercial CFD package was used for three-dimensional flow analysis where the pulsatile waveforms and flowrates used as the boundary conditions are representative of an anastomosed left internal mammary artery and a stenosed left anterior descending coronary artery (intermediate, <70 per cent diameter narrowing). The flow patterns and distributions of time-averaged wall shear stress (TAWSS) and the oscillatory shear index (OSI) for three anastomotic angles of 20, 40, and 60 degrees were evaluated and compared with other published data. The findings indicated that transient, highly disturbed flow patterns occurred in localized regions of the proximal and distal native segments and in the anastomotic domain including recirculation zones, moving points of stagnation, and oscillating wall shear stresses mainly on the bed, at the toe, and at the heel. Moreover, higher anastomotic angles resulted in more extreme variations in TAWSS and OSI values, particularly around the toe and along the bed. In addition, the effect of anastomotic angle on OSI values at the heel followed the same pattern whereas the TAWSS values along the graft at the heel showed a significant increase at the lowest anastomotic angle of 20 degrees.

Insulin-like growth factors (IGF) I and II utilize different calcium signaling pathways in a primary human parathyroid cell culture model

BACKGROUND

In most cell types, influx of calcium (Ca2+) induces a growth or secretory response. The opposite occurs in parathyroid (PTH), cells where there is an inverse relationship between intracellular Ca2+ concentration and PTH secretion. We have examined the effects of calcium channel and metabolism modulators on insulin-like growth factors (IGFs) in a parathyroid cell culture model.

METHODS

Cell cultures were prepared from 9 patients undergoing operation for hyperparathyroidism. Following adhesion, the cells were transferred to serum-free medium and dosed with IGF I, II +/- ethyleneglycol-bis(beta-aminoethyl)-N,N,N',N'-tetraacetic acid (EGTA), nifedipine, nickel, 2-aminoethoxy-diphenylborate (2-APB), or dantrolene. Proliferation (96 hours) was assessed by measuring tritiated thymidine incorporation and PTH release (1 and 3 hours) assayed by IRMA.

RESULTS

Both IGF I and II increased DNA synthesis to 162.8% +/- 10.6% (SEM) and 131.1% +/- 7.7%, respectively (P < 0.05). EGTA at 0.2 mmol (ionized Ca2+ 0.2 mmol) did not affect the response to both IGFs. EGTA at 2 mmol (ionized Ca2+ 0 mmol) reduced the DNA synthesis of IGF I and II to 29% and 26%, respectively (P < 0.05). Nifedipine and nickel (nonspecific Ca2+ channel blocker) were equally potent in negating the mitogenic effects of both IGFs. 2-APB (IP3R blocker) reduced the basal DNA synthesis to 51.3% +/- 8.4% but had no effect on either IGF. Dantrolene (ryanodine receptor blocker) negated IGF II induced mitogenisis (74.2% +/- 6.7%) and partially inhibited IGF I mitogenesis (123% +/- 6%) (P < 0.05). The rate of PTH secretion was greater after IGF II stimulation than after IGF I stimulation.

CONCLUSIONS

IGFs I and II induce mitogenesis by different calcium signaling pathways. These data suggest that parathyroid cells may utilize different calcium signaling pathways to distinguish growth factors and serum calcium changes.

Serotonergic polymorphisms and psychotic disorders in populations from North Spain

There is strong biological evidence relating alterations in the serotonergic system with mental disorders. These alterations may be originated at the DNA level by sequence mutations that alter the functioning of serotonin receptors and transporter. To test this hypothesis we investigated three genetic variants of the 5-HT2A receptor (-1438G/A, 102T/C and His452Tyr) and two variants of the serotonin transporter (a VNTR in the second intron and a 44 bp insertion/delition in the promoter region of the gene) in a clinical sample recruited in a human isolate and in surrounding areas in Northern Spain (N = 257) and in ethnically matched controls (N = 334). No clear association was found between 5-HT2A variants and psychosis. However, marginal associations were observed between the 5-HTT LPR and VNTR variants and psychosis (P < or = 0.05) indicating a minor contribution to psychosis of genetic alterations in this gene.

Penetrating keratoplasty in children: visual and graft outcome

AIMS

To review factors affecting graft survival and determinants of visual acuity after penetrating keratoplasty in children.

METHODS

All cases of penetrating keratoplasty performed in an ophthalmic unit, in children aged less than 15 years at the time of operation, for the period 1984 to 2002 were included.

RESULTS

19 penetrating keratoplasties were done in 18 eyes of 16 children, age range 2 weeks to 14 years 8 months (mean 9.24 years), with mean follow up 6.6 years. 73.7% of grafts have remained clear for up to 14 years. Postoperative visual acuity among congenital indications for graft was better than 6/60 in only 14.2% of cases, but was better than or equal to 6/12 in all cases of keratoconus.

CONCLUSION

This series shows that prolonged corneal graft survival can be achieved in children, but successful restoration of visual acuity depends upon a period of normal visual development before the onset of corneal opacification.

Evidence implicating a mid-region sequence of IGFBP-3 in its specific IGF-independent actions

Insulin-like growth factor binding protein-3 (IGFBP-3) is one of six high affinity-binding proteins that share a common function in regulating the bioavailability of the insulin-like growth factors. The six binding proteins have highly conserved C- and N-terminals that are essential to this function. Additionally, they all have specific functions on cellular homeostasis independent to the regulation of the insulin-like growth factors. It has previously been shown that insulin-like growth factor binding protein-3 can accentuate UV-induced apoptosis in a human carcinoma cell line. Using the KYSE 190 oesophageal carcinoma cell line we have demonstrated that a 15 amino acid (aa) peptide that lies within the mid-region of the protein can mimic the effect of the intact protein. This region contains the serine residues Ser(111) and Ser(113). Using two protocols, we modified these serine residues and have shown that both phosphorylation and derivatization of IGFBP-3 can negate the accentuation of UV-induced cell death. These three independent pieces of evidence support the hypothesis that the variable mid-region is responsible for the specific pro-apoptotic functions of IGFBP-3, and suggest that phosphorylation may provide a mechanism for regulation of this action.

Differential interactions between IGFBP-3 and transforming growth factor-beta (TGF-beta) in normal vs cancerous breast epithelial cells

In addition to modulating insulin-like growth factors action, it is now clear that insulin-like growth factor-binding protein-3 also has intrinsic effects on cell growth and survival. We have compared the effects of insulin-like growth factor-binding protein-3 and transforming growth factor-beta on cell proliferation and death of Hs578T cells and the normal breast epithelial cell line, MCF-10A. The growth of MCF-10A cells was inhibited at low concentrations of insulin-like growth factor-binding protein-3 but stimulated at high concentrations. These differential effects were unaffected in the presence of an insulin-like growth factor-I receptor antagonist. A synthetic peptide corresponding to the serine phosphorylation domain of insulin-like growth factor-binding protein-3 (that does not bind to insulin-like growth factors) also mimicked these differential actions. The growth of both cell lines was significantly inhibited by transforming growth factor-beta, this was associated with a 14-fold increase of insulin-like growth factor-binding protein-3 secreted by the Hs578T cells but a five-fold decrease of insulin-like growth factor-binding protein-3 secreted by MCF-10A cells. Replacement doses of exogenous insulin-like growth factor-binding protein-3 overcame the transforming growth factor-beta-induced growth inhibition in the MCF-10A cells. Cell death induced by ceramide was significantly reduced by insulin-like growth factor-binding protein-3 in the MCF-10A cells and depleting insulin-like growth factor-binding protein-3 with transforming growth factor-beta in these cells consequently increased their susceptibility to ceramide. In contrast, insulin-like growth factor-binding protein-3 enhanced apoptosis induced by ceramide in the Hs578T cells but transforming growth factor-beta treated Hs578T cells were resistant to apoptosis. The addition of anti-sense mRNA to insulin-like growth factor-binding protein-3 significantly abrogated this effect of transforming growth factor-beta. These data indicate that insulin-like growth factor-binding protein-3 has intrinsic activity capable of inhibiting or enhancing the growth and survival of breast epithelial cells depending on the cell line and exposure to other cytokines.