Simulation of non-inherited maternal antigens acceptable HLA mismatches to increase the chance of matched cord blood units: Hong Kong's experience

In Cord blood transplantation (CBT), the non-inherited maternal antigen (NIMA) virtual six HLA matched CB is found to have similar outcomes to six HLA inherited matched CB. Such virtual HLA matched CB units can be generated by substituting the inherited alleles with one to three NIMAs. In Hong Kong Cord Blood Bank, CB units have no NIMA defined. 100 CB samples were collected with NIMA defined. Retrospective searches of Hong Kong patients (n = 520) were matched against the inherited and virtual HLA phenotypes of NIMA CB file. One to three NIMA matches was analyzed, virtual six HLA matches were identified for 31.7% patients, 29.4% from CB units with 5/6 HLA match with 1 NIMA match and 1.7% CB units with a 4/6 HLA match and 2 NIMA matches. However, searches in the 167,201 Bone Marrow Donors Worldwide CB units with defined NIMA did not yield similar increases, possibly due to the ethnicity differences between populations. The match performance rises from 26% to 60% after including the NIMA match. Comparing the match performance of 32% in a previous Dutch study, we calculated with 60% matching in this smaller size study. This provides a solid ground to considering NIMA in stem cell donor selection which was adopted in some centers, to be extended to Asian and local CB registries to increase the chance for matches and also to improve patient outcomes, increase the utilization of CB units, enhance clinical flexibility and signify economic intelligence.

Prevalence of hepatitis C infection and its associated factors in healthy adults without identifiable route of transmission

While hepatitis C virus (HCV) infection is long known to be associated with parenteral exposure, the specific route of transmission is not identified in a proportion of infected patients. Taking blood donors as the surrogate of healthy adults in the community in Hong Kong, we identified 91 HCV-infected donors (≤0.02% positive rate) in 2014-2016, of whom 46 were recruited in a mixed-method study to examine their transmission routes. A majority (75%) of the recruited donors were HCV RNA positive, with the predominant subtypes being 1b and 6a. From the results of the structured self-administered questionnaire and in-depth interviews, only 14 (30%) recruited donors could be traced to past history of contaminated blood transfusion (n = 9) or injection drug use (n = 5). Case-control analyses with 3 different control groups were performed to examine factors associated with HCV infection in multivariable analyses. High-risk sexual behaviour, body piercing, intramuscular injection and vaccine inoculation abroad, having lived abroad for >3 months were significantly associated with HCV in donors with otherwise nonidentifiable source of infection. While the specific route of transmission cannot be established for each person, associations with multiple parenteral exposures outside Hong Kong were observed. The World Health Organization has advocated for the global elimination of HCV by 2030. With a high proportion of HCV-infected persons who are unaware of their infections, HCV elimination could be hard to achieve.

A study of human neutrophil antigen genotype frequencies in Hong Kong

BACKGROUND

Alloantibodies against human neutrophil antigens (HNA) are associated with a variety of clinical conditions. Over the past decade, the allelic and genotypic frequencies of the five HNA systems have been evaluated. Although the HNA system is less polymorphic than human leukocyte antigens (HLA), significant differences in the genotypic and allele frequencies still exist in different populations, even those living in close proximity.

OBJECTIVES

To delineate HNA genotypic and allele frequencies to provide vital information on estimating the risk of HNA-associated diseases for our local population.

METHODS

Using a validated, in-house-developed assay, genotyping for HNA-1, HNA-3, HLA-4 and HNA-5 was performed on 300 samples from Chinese blood donors from Hong Kong. In addition, the frequency of the HNA-2 c.843A > T allele was also determined.

RESULTS

The allele frequencies of HNA-1a, -1b and -1c alleles were 67·8, 31·5 and 0%, respectively, whereas the frequencies of HNA-3a and HNA-3b were 71·0 and 29·0%, respectively. The frequencies of HNA-4a and -4b alleles were 99·5 and 0·5%, respectively, and for HNA-5a and -5b, alleles were 85·2 and 14·8%, respectively. Homozygotes for the HNA-2 c.843 TT variant were absent in our population, whereas only <4% of the population were c.843AT heterozygote carriers.

CONCLUSIONS

This is the first study to define HNA genotype and allele frequencies using a validated modified in-house PCR-SSP method in the Hong Kong Chinese blood donor population. Our approach provides a cost-effective assay for conducting routine HNA typing and facilitates the incorporation of these assays into routine clinical service. Our results are comparable with those reported in the Guangzhou Chinese population, but the allele frequencies in our Hong Kong Chinese population are significantly different from the reported European frequencies, confirming that a geographical difference exists for HNA allele frequencies.

Application of APACHE II in the Assessment, Classification of Severity and Predictive Ability of Chinese Patients Presenting to an Emergency Department Resuscitation Room

Objectives

To evaluate the use of APACHE II (Acute Physiology and Chronic Health Status Evaluation) in Chinese patients managed in the resuscitation room of an Accident & Emergency Department of one of the teaching hospitals in Hong Kong.

Design

Prospective study on Chinese patients.

Setting

Resuscitation Room in an Accident & Emergency Department of a university hospital in Hong Kong.

Patients and measurements

Consecutive patients managed in the resuscitation room between 14th August, 2000 and 20th August 2000 (excluding patients younger than 18 years old and patients who were not admitted to hospital after initial assessment and treatment). For each patient, demographic data, diagnosis, the chronic health points, and the worst physiological parameters in the A&E resuscitation room were recorded. The total APACHE II scores and the probability of death were calculated. The accuracy of APACHE II for predicting group mortality was assessed by receiver operating characteristic curve analysis and linear regression analysis.

Results

Of the 88 patients included in the study, 13 (15%) died and 75 (85%) survived. Significant factors associated with mortality included age, mean arterial pressure, heart rate, respiratory rate, arterial pH, serum sodium, Glasgow coma score, and chronic health points. For the three scoring subdivisions of APACHE II – total APS score, age points and chronic health points – higher mean values were found in those patients who died compared with patients who survived. Using logistic regression analysis, the APACHE II score determined in the emergency resuscitation room is a strong predictor of mortality (r2=0.712). At a cut off score of >28 the sensitivity is 100.0% (95% CI 100.0–100.0), specificity is 68.0% (95% CI 56.2–78.3), positive likelihood ratio is 3.13, positive predictive value is 35.1 and negative likelihood ratio is 100.0. Analysis of the ROC curve reveals an area under the curve of 0.910 (95% CI 0.829–0.960). In patients not admitted to ICU, there was a positive correlation between APACHE score and length of hospital stay in patient who survived (r=0.320, P=0.0075) and a negative correlation between APACHE score and length of hospital stay in patients who died (r=-0.760, P=0.0225).

Conclusions

The APACHE II scoring system may be usefully applied in emergency departments for predicting mortality, for classifying and assessing severity of disease, for evaluating performance and for planning departmental resource allocation.

A Prospective Epidemiological Study of Acute Poisoning in Hong Kong

Objective

To update our epidemiological knowledge of acute poisoning in Hong Kong.

Methods

A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients.

Results

A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study.

Conclusions

Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.

Clinical and genetic predictors of paclitaxel neurotoxicity based on patient- versus clinician-reported incidence and severity of neurotoxicity in the ICON7 trial

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of paclitaxel, with no reliable method to identify at-risk patients. We investigated the incidence and risk factors including genetic polymorphisms associated with the development of CIPN based on clinician and patient reporting of neuropathic symptoms.

PATIENTS AND METHODS

Risk factors for the development of CIPN were examined in 454 patients treated with paclitaxel/carboplatin from the International Collaboration on Ovarian Neoplasms 7 (ICON7) trial. Neuropathy was graded by clinicians by standard adverse event reporting and by patients utilising OV28 questionnaire. Genetic risk factors were examined by selecting six single nucleotide polymorphisms in genes associated with microtubule function. Risk factors were assessed via dose-to-event cox regression models.

RESULTS

Grade >2 neuropathy was reported by clinicians in 28% of patients, while 67% of patients reported 'quite a bit' or 'very much' tingling or numbness. Agreement between clinicians and patients was poor (κ = 0.236, 95% confidence interval, 0.177-0.296, P < 0.001). Older age, bevacizumab treatment and bowel resection were associated with clinician reported CIPN, while older age and volume of residual disease were associated with patient-reported neuropathy. There were no significant associations between clinician-reported neuropathy or patient-reported neuropathy and TUBB2, CEP72 or individual MAPT or GSK3B SNPs, however MAPT additive polymorphisms were associated with patient-reported neuropathy and GSK3B additive polymorphisms were associated with clinician reported CIPN.

CONCLUSIONS

There was significant discordance between patient- and clinician-reported neurotoxicity. The lack of consensus regarding optimal outcome measures and whose opinion with regard to CIPN takes precedence is a limitation in the investigation of risk factors for CIPN. Care must be taken to select and include patient-reported outcome measures in CIPN assessment to enable accurate identification of genetic and other risk factors for neuropathy.

The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia

Introduction

There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis.

Materials and Methods

A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated.

Results

Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°.

Conclusions

This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

Non-compliance to infectious disease deferral criteria among Hong Kong's blood donors

BACKGROUND AND OBJECTIVES

Donor screening alone cannot eliminate the risk of transfusion-transmitted HIV infection. Donor deferral according to established criteria is a supplemental strategy, which has focused largely on men who have sex with men (MSM). A study was conducted to determine the compliance of non-MSM donors with such criteria and examine its implications on blood safety.

MATERIALS AND METHODS

Chinese donors who have just donated blood at blood donor centres in Hong Kong were recruited. Based on the contents of the routinely administered predonation Health Screening Questionnaires, participants were requested to complete a survey to assess their practice of deferrable risk behaviours and lifestyle encounters, using tablet computers.

RESULTS

Over an 8-week period in mid-2016, 1614 donors (male-to-female ratio 1·23) had enrolled in the survey, accounting for 40% of donors giving blood on the survey days. The proportion of respondents who gave blood despite having deferrable HIV risk was 5%: MSM 1·2% (of the male donors); non-MSM risk behaviours 2·6%; risky lifestyle encounters 2·1%. If inconsistent declaration and suspected risk behaviours were included, the total non-compliance rate became 10·8%. Male donors had a higher prevalence of deferrable behavioural risk, even after excluding MSM. Unawareness and non-acceptability were main reasons for non-compliance.

CONCLUSION

The non-compliance rate of donors to deferral was high, although the ultimate infection risk might be small in the presence of universal screening. Simplification of questionnaires, focus on time-limited deferral and a reduction of deferral items may improve the deferral mechanism without compromising blood safety.

Randomised clinical trial: the efficacy and safety of oltipraz, a liver X receptor alpha-inhibitory dithiolethione in patients with non-alcoholic fatty liver disease

BACKGROUND

Oltipraz is a synthetic dithiolethione with an antisteatotic effect by inhibiting the activity of liver X receptor alpha (LXR-α). Recent studies demonstrated the disruptive role of oltipraz on LXR-α-dependent lipogenesis in hepatocytes and a high-fat diet mouse model.

AIM

To evaluate the efficacy and safety of oltipraz for reducing liver fat in subjects with non-alcoholic fatty liver disease (NAFLD).

METHODS

We performed a multicentre, double-blind, placebo-controlled, phase II study. Subjects with a liver fat >20% and hypertransaminasemia were randomised to the three groups: placebo (n = 22), 30 mg of oltipraz (n = 22) or 60 mg of oltipraz (n = 24) twice daily for 24 weeks. Changes in the liver fat from baseline to 24 weeks quantified using magnetic resonance spectroscopy were the primary outcome.

RESULTS

Compared with the placebo group (-3.2 ± 11.1%), absolute changes in the liver fat content increased in a dose-dependent manner: -7.7 ± 7.0% and -13.9 ± 10.7% for the low-dose and high-dose groups (P = 0.13 and P < 0.01). Per cent reduction in the liver fat content was also significantly greater in the high-dose group than in the placebo group (-34.6 ± 29.4% vs. -0.6 ± 62.9%, P = 0.046). Body mass indices (-1.0 ± 0.9% vs. -0.5 ± 1.4%, P = 0.04) significantly decreased in the high-dose group compared to the placebo group. However, absolute changes in insulin resistance, liver enzymes, lipids and cytokines were not significantly different among groups. The incidence of adverse events was comparable among groups.

CONCLUSIONS

Twenty-four-week oltipraz treatment significantly reduced the liver fat content in patients with NAFLD. Clinicaltrials.gov (NCT01373554).

Identification of a novel HLA-B allele, HLA-B*55:81

The new allele, B*55:81, differs from B*55:02:01:02 by 2 nucleotide substitutions in codon 116 (TTA → TAC).

Classification of 31 Korean Wheat (Triticum aestivum L.) Cultivars Based on the Chemical Compositions

Whole grain wheat flour (WGWF) is the entire grain (bran, endosperm, and germ) milled to make flour. The WGWF of 31 Korean wheat (Triticum aestivum L.) cultivars were analyzed for the chemical compositions, and classified into groups by hierarchical cluster analysis (HCL). The average composition values showed a substantial variation among wheat varieties due to different wheat varieties. Wheat cv. Shinmichal1 (waxy wheat) had the highest ash, lipid, and total dietary fiber contents of 1.76, 3.14, and 15.49 g/100 g, respectively. Using HCL efficiently classified wheat cultivars into 7 clusters. Namhae, Sukang, Gobun, and Joeun contained higher protein values (12.88%) and dietary fiber (13.74 %). Regarding multi-trait crop breeding, the variation in chemical compositions found between the clusters might be attributed to wheat genotypes, which was an important factor in accumulating those chemicals in wheat grains. Thus, once wheat cultivars with agronomic characteristics were identified, those properties might be included in the breeding process to develop a new variety of wheat with the trait.

Is C1 lateral mass screw placement safe for the Chinese, Indians, and Malays? An analysis of 180 computed tomography scans

INTRODUCTION

C1 lateral mass (C1LM) screw is a common procedure in spine surgery. However, related studies are lacking in Asia. We aim to determine the safety of C1LM screw for the Chinese, Indians, and Malays.

METHODS

Three-dimensional computed tomographies of 180 subjects (60 from each ethnic) were analyzed. The length and angulations of C1LM screw and the location of internal carotid artery (ICA) in relation to C1LM were assessed and classified according to the classification by Murakami et al. The incidence of ponticulus posticus (PP) was determined and the differences among the population of these three ethnics were recorded.

RESULTS

The average base length was 8.5 ± 1.4 mm. The lengths within the lateral mass were between 14.7 ± 1.6 mm and 21.7 ± 2.3 mm. The prevalence of PP was 8.3%. 55.3% (199) of ICA were located in zone 0, 38.3% (138) in zone 1-1, 6.4% (23) in zone 1-2, and none in zone 1-3 and zone 2. The average angulation from the entry point to the ICA was 8.5° ± 6.4° laterally. The mean distance of ICA from C1 anterior cortex was 3.7 ± 1.7 mm (range: 0.6∼11.3). There was no difference in distribution of ICA in zone 1 among the three population (Chinese-47%, Indians-61%, and Malays-53%; p > 0.05).

CONCLUSIONS

No ICA is located medial to the entry point of C1LM screw. If bicortical purchase of C1LM screw is needed, screw protrusion of less than 3 mm or medially angulated is safe for ICA. The incidence of PP is 8.3% with higher prevalence among the Indian population.

HLA-A, -B, -C, and -DRB1 genotyping and haplotype frequencies for a Hong Kong Chinese population of 7595 individuals

HLA-A, -B, -C and -DRB1 gene and haplotype frequencies have been calculated from 7595 southern Chinese unrelated donors in a Hong Kong Bone Marrow Donor Registry. This is the first large-scale paper to report the distribution of A-C-B-DRB1 alleles in Hong Kong Chinese. This information is important for phylogenetic, comparative studies and estimating the optimal and cost-effective donor size and likelihood of obtaining appropriately matched donors for Chinese patients awaiting haematopoietic stem cell transplantation. The allele and haplotype data are available in the Allele Frequencies Net Database under the population name ''Hong Kong Chinese BMDR'' and the identifier (AFND003357).

HLA-A, -B and -DRB1 genotyping and haplotype frequencies of 3892 cord blood units in the Hong Kong Chinese Cord Blood Registry

HLA-A, -B and -DRB1 gene and haplotype frequencies have been calculated from 3892 southern Chinese unrelated cord blood units in a Hong Kong Cord Blood Registry. This is the first large-scale paper to report the distribution of A-B-DRB1 alleles in Hong Kong Chinese Cord Blood Units. This information is important for estimating the optimal and economically cost-effective donor size and likelihood of obtaining appropriately matched cord blood units for Chinese patients awaiting haematopoietic stem cell transplantation. The data are available in the Allele Frequencies Net Database under the population name ''Hong Kong Chinese Cord Blood Registry'' and the identifier (AFND003358).

Donation frequency and its association with demographic characteristics--a 1-year observational study

OBJECTIVE

The aim of this study is to enhance the understanding of frequent blood donors' characteristics and devise strategies to achieve an optimal blood inventory.

BACKGROUND

Apart from donor recruitment and retention, an effective way to increase blood supply is to increase the donation frequency among donors. Understanding the characteristics of frequent donors will be helpful to impact their future donation pattern, which would in turn achieve a stable and adequate blood inventory to meet the changing demands of the society.

METHODS AND MATERIALS

Demographic information of blood donors for each donation in Hong Kong (HK) was routinely collected and stored in the database of Hong Kong Red Cross Blood Transfusion Service. Logistic regression models (by gender group) with interaction effects were constructed to analyse the differences in the likelihood of being frequent donors and the associations with their demographic characteristics.

RESULTS

A total of 158,666 blood donors in 2010 gave 227,634 donations during the study. In general, male donors were more likely to be frequent donors. Logistic regression models further identified the characteristics of frequent donors in HK: older, blood type Rh D-ve and repeat donors, although their extent of impact was different for different gender group.

CONCLUSION

To achieve an optimal blood inventory to meet the challenge of ageing in the society, donors who donate less often should be targeted to increase their donation frequency. More efforts in promotion should be made to recruit those non-donors to join the blood donation pool and motivate 'targeted' existing donors in the population to participate blood donation more regularly.

Metastatic breast cancer in young women: a population-based cohort study to describe risk and prognosis

BACKGROUND

There is limited information on the risk of metastatic breast cancer (MBC) to inform younger women, particularly those under 40 years.

AIMS

We conducted a retrospective analysis of a population-based cohort study to describe the risk, site and prognosis of MBC in young women under 40 years with an initial diagnosis of non-metastatic breast cancer and compared with older women.

METHODS

Data were extracted from the New South Wales Central Cancer Registry and the Admitted Patient Data Collection database between 2001-2007. Main outcome measures were 5-year cumulative incidence of MBC, prognostic factors for MBC and overall survival (OS) from the date of MBC diagnosis.

RESULTS

Three hundred and ninety-five (6%) of 6640 women with non-metastatic BC were <40 years. The 5-year cumulative incidence of MBC was 24% (95% CI 20-29%) for women <40 years with non-metastatic BC, compared with 9% (95% CI 9-10%) for women ≥40 years. Significant independent risk factors for MBC ≤ 5 years were age <40, regional disease at diagnosis, low socioeconomic status and the presence of other non-breast primary. At first record of MBC, visceral sites were more common for women <40 years than ≥40 (54% vs 43%; P = 0.03). Median survival for women with MBC within 5 years was not significantly different between young and older women (<40 years 18 months vs ≥40 years 14 months; log-rank P = 0.21).

CONCLUSIONS

Women with non-metastatic BC before age 40 have a higher 5-year risk of developing MBC than older women. There were no significant differences in median survival following MBC between young and older women.

Nanoscale transport of charge-transfer states in organic donor-acceptor blends

Charge-transfer (CT) states, bound combinations of an electron and a hole on separate molecules, play a crucial role in organic optoelectronic devices. We report direct nanoscale imaging of the transport of long-lived CT states in molecular organic donor-acceptor blends, which demonstrates that the bound electron-hole pairs that form the CT states move geminately over distances of 5-10 nm, driven by energetic disorder and diffusion to lower energy sites. Magnetic field dependence reveals a fluctuating exchange splitting, indicative of a variation in electron-hole spacing during diffusion. The results suggest that the electron-hole pair of the CT state undergoes a stretching transport mechanism analogous to an 'inchworm' motion, in contrast to conventional transport of Frenkel excitons. Given the short exciton lifetimes characteristic of bulk heterojunction organic solar cells, this work confirms the potential importance of CT state transport, suggesting that CT states are likely to diffuse farther than Frenkel excitons in many donor-acceptor blends.

Clonality of neutrophilia associated with plasma cell neoplasms: report of a SETBP1 mutation and analysis of a single institution series

A rare but well-known association between plasma cell neoplasms and neutrophilia is known to exist. Whether the neutrophilia is secondary to the plasma cell neoplasm or this convergence represents two independent clonal disorders is unclear. We reviewed five consecutive cases from a single institution over a 3-year period, applying molecular, cytogenetic and cytokine-profiling approaches to determine whether neutrophilia associated with plasma cell neoplasms represents a reactive or clonal process. We report, for the first time, the occurrence of a SETBP1 mutation in two cases, as well as changes in G-CSF and IL-6 in SETBP1 wild type vs. mutated patients that are supportive of a hypothesis that neutrophilia associated with plasma cell neoplasms may sometimes be reactive and may sometimes represent a second clonal entity. Finally, using an ex vivo drug screening platform we report the potential efficacy of the multi-kinase inhibitor dasatinib in select patients.

First Report of Postharvest Rot of Chestnuts Caused by Mucor racemosus f. sphaerosporus in Korea

The Republic of Korea (South Korea) is the second largest chestnut producer in the world. Major cultivars planted in Korea, including cv. Daebo, Hyogo57, and Okkwang, are hybrids of Japanese chestnut (Castanea crenata) and Chinese chestnut (C. mollissima). Because of high perishability, most chestnuts harvested in September and October are preserved in cold rooms (0°C) for marketing. During a survey of postharvest diseases in April to August 2013, chestnut rots were continuously observed in cold rooms located in Buyeo County, Korea. Preliminary studies revealed that the most common agent of rot appeared to be a species of Mucor. When cut open, infected chestnuts showed partial interior discoloration varying from chalky white to dark brown. About 3 to 10% of chestnuts showed symptoms. Hyogo57 seemed to be the most susceptible variety with higher infection rates, up to 30% in some piles. Isolation was done by placing infected tissues on potato dextrose agar. A representative isolate was deposited in the Korean Agricultural Culture Collection (Accession No. KACC47727). Sporangiophores were mostly erect, branched sympodially, and hyaline. Sporangia were globose, pale yellow at first, then grayish brown at maturity. Columellae were obovoid to globose, subhyaline to pale brown, and usually with truncate base and collars. Sporangiospores were globose to irregular, and 4 to 10 μm in diameter. Chlamydospores were cylindrical to globose with oil drops. The fungus was identified as Mucor racemosus f. sphaerosporus (Hagem) Schipper based on the morphological characteristics and growth at low temperature (3). To conduct molecular analyses, genomic DNA was extracted with DNeasy Plant Mini Kits (Qiagen Inc., Valencia, CA). The primers ITS1/ITS4 and NL1/LR3 were used to amplify the internal transcribed spacer (ITS) region of rDNA and the D1/D2 region of the large subunit (4). The resulting 595-bp ITS sequences and 678 bp D1/D2 sequences were deposited in GenBank (Accession Nos. KJ769665 and KF769666). BLAST searches revealed that both the ITS sequences and D1/D2 sequences showed more than 99% similarity with those of M. racemosus f. sphaerosporus, respectively (JN939201 and AJ878775). To perform a pathogenicity test, a suspension of sporangiospores (1 × 10⁵ spores/ml) was sprayed over 10 chestnuts cv. Hyogo57 wounded with a sewing needle and kept in plastic containers (0°C, 100% RH). Another 10 chestnuts wounded with a sewing needle and treated with sterile water served as controls. After 5 days, typical rots appeared on the inoculated chestnuts, whereas no symptoms were observed on controls. Koch's postulates were fulfilled with the re-isolation of M. racemosus from inoculated chestnuts. The pathogenicity test was carried out twice with similar results. M. hiemalis and M. mucedo have been recorded on chestnuts as postharvest pathogens in Switzerland (2) and Chile (1). To our knowledge, this is first report of postharvest rot of chestnut caused by M. racemosus f. sphaerosporus worldwide as well as in Korea. Further studies are necessary for control measures during cold storage of fresh chestnuts. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., online publication, ARS, USDA, Retrieved May 23, 2014. (2) M. Jermini et al. J. Sci. Food Agric. 86:877, 2006. (3) M. A. A. Schipper. Stud. Mycol. 12:1, 1976. (4) G. Walther et al. Persoonia 30:11, 2013.

First Report of Leaf Spot Caused by Phoma dictamnicola on Dictamnus dasycarpus in Korea

Dictamnus dasycarpus Turcz, known as densefruit pittany, is a perennial herbal plant belonging to the Rutaceae. In Oriental medicine, this plant is used for treatment of various ailments (4). Since the white and purple striped flowers and glossy leaves are of aesthetic value, the plant is popular in gardens throughout Korea. In July 2012, a leaf spot was observed on hundreds of D. dasycarpus with nearly 100% incidence in a garden in Gapyeong County, Korea. Lesions on leaves reaching up to 20 mm in diameter were circular to irregular, brown to dark brown, then becoming zonate with age, and finally fading to grayish brown in the center with a reddish brown margin. The disease caused premature defoliation and reduced plant vigor as well as aesthetic value. In June 2014, the same symptoms were found on D. dasycarpus in a nursery in Jinju City, Korea. Representative samples were deposited in the Korea University Herbarium (KUS). Pycnidia on lesions were epiphyllous, immersed or semi-immersed in host tissue, light brown to olive brown, and 90 to 210 μm in diameter. Ostioles were 15 to 30 μm wide and surrounded by a ring of darker cells. Conidia were hyaline, smooth, ellipsoidal to nearly reniform, straight to mildly curved, aseptate or rarely medianly 1-septate with age, 5.5 to 9.6 × 1.8 to 3.6 μm, and contained small oil drops. These characteristics were consistent with the previous descriptions of Phoma dictamnicola Boerema, Gruyter & Noordel. (1,2). A monoconidial isolate was cultured on potato dextrose agar plates and deposited in the Korea Agricultural Culture Collection (Accession No. KACC46948). Morphological identification of the fungus was confirmed by molecular data. Genomic DNA was extracted using a DNeasy Plant Mini Kit (Qiagen Inc., Valencia, CA). The internal transcribed spacer (ITS) region of rDNA was amplified using the ITS1/ITS4 primers and sequenced. The resulting sequence of 505 bp was deposited in GenBank (Accession No. KM047023). A BLAST search showed that the ITS sequence shared >99% similarity with that of P. dictamnicola (GU237877). For the pathogenicity tests, inoculum was prepared by harvesting conidia from 30-day-old cultures of KACC46948 and a conidial suspension (2 × 10⁶ conidia/ml) was sprayed onto leaves of five healthy seedlings. Five seedlings were sprayed with sterile distilled water, serving as controls. The plants were covered with transparent plastic bags for 48 h in a 25°C glasshouse with a 12-h photoperiod. After 10 days, typical leaf spot symptoms started to develop on the leaves of the inoculated plants. The fungus, P. dictamnicola, was re-isolated from those lesions, confirming Koch's postulates. No symptoms were observed on control plants. Previously, Phoma leaf spot on Dictamnus spp. has been reported in the Netherlands and North America (3) and recently in China (1). To our knowledge, this is the first report of leaf spot on D. dasycarpus caused by P. dictamnicola in Korea. Our observations suggest that low humidity with good ventilation as well as removal of infected leaves and plant debris might be main strategies for preventing this disease. References: (1) Q. Bai et al. Plant Dis. 95:771, 2011. (2) G. H. Boerema et al. Phoma Identification Manual: Differentiation of Specific and Infra-Specific Taxa in Culture. CABI Publishing. Wallingford, UK, 2004. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, USDA ARS, Retrieved June 19, 2014. (4) J. L. Yang et al. Planta Med. 77:271, 2011.

First Report of Powdery Mildew Caused by Phyllactinia actinidiae on Hardy Kiwi in Korea

Actinidia arguta (Siebold & Zucc.) Planch. ex Miq., known as hardy kiwi, is a perennial vine native to Japan, Korea, northern China, and Russian Siberia. It produces a small fruit resembling the kiwifruit. The fruits, referred to as hardy kiwifruit, are edible and often sweeter than kiwifruit. Picking of wild hardy kiwifruits in autumn is a popular ecotourism activity in Korea. In 2000, a powdery mildew disease on the abaxial surface of hardy kiwi leaves was found in Korea. Additional findings of the powdery mildew between 2000 and 2013 showed that the disease of hardy kiwi commonly occurs in Korea. The infected leaves were frequently distorted when young, then becoming prematurely chlorotic and defoliated. Chasmothecia were abundantly formed by September. Voucher specimens (n = 21) were deposited in the Korea University Herbarium (KUS). Mycelia were hypophyllous, thinly effuse, initially forming patches, finally covering the whole abaxial leaf surface. Hyphal appressoria were hook-shaped or often branched, and single or opposite in pairs. Conidiophores were erect, cylindrical, 160 to 300 × 5 to 7.5 μm with straight foot-cells (65 to 115 μm long), basal septum elevated up to 15 μm, and produced conidia singly. Conidia were obpyriform to clavate, papillate at the apex, 55 to 75 × 20 to 32 μm, and devoid of fibrosin bodies. Germ tubes were produced at the terminal and lateral positions of conidia. Chasmothecia were blackish brown, depressed globose, and 190 to 250 μm in diameter. Appendages arising around the equatorial zone of chasmothecia were 9 to 15 in number, acicular with a bulbose base, 1 to 1.3 times as long as the chasmothecial diameter, hyaline throughout, and aseptate. Penicillate cells crowded on the upper part of the chasmothecia were ampulliform, numerous, 50 to 87.8 μm long, and 12.5 to 17.5 μm wide. Asci were 13 to 20 in a chasmothecium, olivaceous brown, 60 to 90 × 22.5 to 40 μm, and short stalked. Ascospores were 2 in an ascus, ellipsoid-ovoid, pale olivaceous, and 32.5 to 40 × 16.5 to 20 μm. On the basis of the morphological characteristics, this fungus was identified as Phyllactinia actinidiae (Jacz.) Bunkina (1). To confirm the identification, the complete internal transcribed spacer (ITS) regions of rDNA of three specimens (KUS-F23673, F26240, and F26308) were amplified using primers ITS5/P3 and sequenced (4). The resulting sequences were deposited in GenBank (Accession Nos. KJ703014, KJ703015, and KJ703016). GenBank BLAST search with the three isolates showed >99% similarity with the results for P. actinidiae on hardy kiwi from Japan (AB080489, AB080500, and AB080508). Actinidia-Phyllactinia associations were recorded in China, Japan, Taiwan, Korea, Russia, and Turkey (2,3). However, P. actinidiae on A. arguta was known only from Japan (3). To our knowledge, this is the first record of P. actinidiae on hardy kiwi in Korea. There has been no finding of powdery mildews on commercial varieties of golden kiwi (A. chinensis) and fuzzy kiwi (A. deliciosa) in Korea. Common occurrence of Phyllactinia powdery mildew on hardy kiwi in Korea can be a potential threat to the commercial kiwi industry. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) I. Erper et al. Scand. J. Forest Res. 27:432, 2012. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication. ARS, USDA, March 10, 2014. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Therapeutic targeting of erbB3 with MM-121/SAR256212 enhances antitumor activity of paclitaxel against erbB2-overexpressing breast cancer

INTRODUCTION

Elevated expression of erbB3 rendered erbB2-overexpressing breast cancer cells resistant to paclitaxel via PI-3 K/Akt-dependent upregulation of Survivin. It is unclear whether an erbB3-targeted therapy may abrogate erbB2-mediated paclitaxel resistance in breast cancer. Here, we study the antitumor activity of an anti-erbB3 antibody MM-121/SAR256212 in combination with paclitaxel against erbB2-overexpressing breast cancer.

METHODS

Cell growth assays were used to determine cell viability. Cells undergoing apoptosis were quantified by a specific apoptotic ELISA. Western blot analyses were performed to assess the protein expression and activation. Lentiviral vector containing shRNA was used to specifically knockdown Survivin. Tumor xenografts were established by inoculation of BT474-HR20 cells into nude mice. The tumor-bearing mice were treated with paclitaxel and/or MM-121/SAR256212 to determine whether the antibody (Ab) enhances paclitaxel’s antitumor activity. Immunohistochemistry was carried out to study the combinatorial effects on tumor cell proliferation and induction of apoptosis in vivo.

RESULTS

MM-121 significantly facilitated paclitaxel-mediated anti-proliferative/anti-survival effects on SKBR3 cells transfected with a control vector or erbB3 cDNA. It specifically downregulated Survivin associated with inactivation of erbB2, erbB3, and Akt. MM-121 enhances paclitaxel-induced poly(ADP-ribose) polymerase (PARP) cleavage, activation of caspase-8 and −3, and apoptosis in both paclitaxel-sensitive and -resistant cells. Specific knockdown of Survivin in the trastuzumab-resistant BT474-HR20 cells dramatically enhanced paclitaxel-induced apoptosis, suggesting that increased Survivin caused a cross-resistance to paclitaxel. Furthermore, the studies using a tumor xenograft model-established from BT474-HR20 cells revealed that either MM-121 (10 mg/kg) or low-dose (7.5 mg/kg) paclitaxel had no effect on tumor growth, their combinations significantly inhibited tumor growth in vivo. Immunohistochemical analysis showed that the combinations of MM-121 and paclitaxel significantly reduced the cells with positive staining for Ki-67 and Survivin, and increased the cells with cleaved caspase-3.

CONCLUSIONS

The combinations of MM-121 and paclitaxel not only inhibit tumor cell proliferation, but also promote erbB2-overexpressing breast cancer cells to undergo apoptosis via downregulation of Survivin in vitro and in vivo, suggesting that inactivation of erbB3 with MM-121 enhances paclitaxel-mediated antitumor activity against erbB2-overexpressing breast cancers. Our data supports further exploration of the combinatorial regimens consisting of MM-121 and paclitaxel in breast cancer patients with erbB2-overexpressing tumors, particularly those resistant to paclitaxel.

First Report of Powdery Mildew Caused by Erysiphe elevata on Catalpa bignonioides in Korea

Catalpa bignonioides Walter, known as southern catalpa or Indian bean tree, is native to the southeastern United States and are planted as shade trees throughout the world. In August 2009, typical powdery mildew symptoms on several leaves of the plants below 5% disease incidence were observed in a public garden of Hongcheon County of Korea. In 2011 to 2013, hundreds of southern catalpa trees were found heavily damaged by a powdery mildew with 90 to 100% disease incidence in a park of Incheon City of Korea, about 140 km apart from Hongcheon County. Symptoms appeared as circular to irregular white patches, which subsequently showed abundant mycelial growth on both sides of leaves and herbaceous stems. Severe infections caused poor growth and premature loss of leaves, resulting in reduced aesthetic value. Voucher specimens (n = 6) were deposited in the Korea University Herbarium (KUS). Appressoria on the mycelium were well-developed, lobed, and solitary or in opposite pairs. Conidiophores composed of 3 to 4 cells were 70 to 100 × 7.5 to 10 μm, and produced conidia singly. Foot-cells of conidiophores were flexuous or nearly straight, and 20 to 40 μm long. Conidia were oblong to oblong-elliptical, measured 30 to 42 × 13 to 20 μm (n = 30) with a length/width ratio of 1.6 to 2.5, devoid of distinct fibrosin bodies, and showed angular/rectangular wrinkling of outer walls. Primary conidia were apically rounded, basally subtruncate, and generally smaller than the secondary conidia. Germ tubes were produced on the end of conidia. Chasmothecia were not observed. These structures are typical of the Pseudoidium anamorph of the genus Erysiphe. The specific measurements and characteristics were compatible with those of E. elevata (Burrill) U. Braun & S. Takam. (1,2). To confirm the identification, the complete internal transcribed spacer (ITS) region of rDNA from KUS-F27676 was amplified with primers ITS5 and P3 (4) and sequenced directly. The resulting 675-bp sequence was deposited in GenBank (Accession No. KF840721). A GenBank BLAST search of the ITS sequence showed >99% similarity with isolates of E. elevata on C. bignonioides (Accession Nos. AY587012 to AY587014). Pathogenicity was confirmed through inoculation by gently dusting conidia onto leaves of five healthy southern catalpa seedlings. Five non-inoculated plants served as controls. Inoculated and non-inoculated plants were maintained in a greenhouse at 24 to 28°C in isolation. Inoculated plants developed symptoms after 6 days, whereas the control plants remained symptomless. The fungus present on the inoculated plants was identical morphologically to that originally observed on diseased plants. E.elevata is a North American powdery mildew on Catalpa species which was recently introduced into Europe (1,2,3). To our knowledge, this is the first report of powdery mildew caused by E. elevata on C. bignonioides in Asia as well as in Korea. The disease would be a serious threat to the widespread ornamental plantings of C. bignonioides in Korea. References: (1) N. Ale-Agha et al. Mycol. Prog. 3:291, 2004. (2) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (3) D. F. Farr and A. Y. Rossman. Fungal Databases, Syst. Mycol. Microbiol. Lab., Online publication. ARS, USDA. Retrieved November 4, 2013. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.