Allogeneic bone marrow transplantation with co-stimulatory blockade induces macrochimerism and tolerance without cytoreductive host treatment

Allogeneic bone marrow transplantation (in immunocompetent adults) has always required cytoreductive treatment of recipients with irradiation or cytotoxic drugs to achieve lasting engraftment at levels detectable by non-PCR-based techniques ('macrochimerism' or 'mixed chimerism'). Only syngeneic marrow engraftment at such levels has been achieved in unconditioned hosts. This requirement for potentially toxic myelosuppressive host pre-conditioning has precluded the clinical use of allogeneic bone marrow transplantation for many indications other than malignancies, including tolerance induction. We demonstrate here that treatment of naive mice with a high dose of fully major histocompatibility complex-mismatched allogeneic bone marrow, followed by one injection each of monoclonal antibody against CD154 and cytotoxic T-lymphocyte antigen 4 immunoglobulin, resulted in multi-lineage hematopoietic macrochimerism (of about 15%) that persisted for up to 34 weeks. Long-term chimeras developed donor-specific tolerance (donor skin graft survival of more than 145 days) and demonstrated ongoing intrathymic deletion of donor-reactive T cells. A protocol of high-dose bone marrow transplantation and co-stimulatory blockade can thus achieve allogeneic bone marrow engraftment without cytoreduction or T-cell depletion of the host, and eliminates a principal barrier to the more widespread use of allogeneic bone marrow transplantation. Although efforts have been made to minimize host pre-treatment for allogeneic bone marrow transplantation for tolerance induction, so far none have succeeded in eliminating pre-treatment completely. Our demonstration that this can be achieved provides the rationale for a safe approach for inducing robust transplantation tolerance in large animals and humans.

Genetic variability in the diapause response of the burnet moth Zygaena trifolii (Lepidoptera: Zygaenidae)

A high degree of phenotypic variability was observed in the diapause response of the burnet moth Zygaena trifolii. In this study, we show that the observed variability is partly based on genetic differences between individuals. In a selection experiment, the larval instar at which diapause occurs was changed within six generations. Diapause instars were dependent on the time of pre-diapause development of larvae, which varied considerably between larvae. A heritability analysis indicates that a part of the variability in development time is based on additive genetic variance. The maintenance of genetic variability in the development time and the diapause response of Z. trifolii is discussed in the context of spatially and temporally changing selection pressures.

Gender differences and individual variation in the immune system of the scorpionfly Panorpa vulgaris (Insecta: Mecoptera)

From investigations of the vertebrate immune system gender specific differences in individual immunocompetence are well known. In general, females seem to possess more powerful immune systems than males. In invertebrates, the situation is much less clear. Therefore, we investigated the immune system of an invertebrate species, the scorpionfly Panorpa vulgaris. We found a high degree of individual variation in both traits studied, the lysozyme-like antibacterial activity of hemolymph and the capacity for in vitro phagocytosis of artificial particles. These two immune traits were positively correlated. As expected, hemolymph derived from females had higher lysozyme-like activity and hemocytes from females phagocytosed more particles. The difference in phagocytosis was mainly based on higher total hemocyte counts and higher proportions of phagocytically active cells in females, while the average number of ingested particles per active phagocyte was not significantly different. The observed gender differences are discussed in the context of reproductive strategies and parasite-mediated sexual selection.

The immunocompetence handicap hypothesis: testing the genetic predictions

The immunocompetence handicap hypothesis suggests that the immune system competes for resources with sexually selected ornaments; variation in ornaments might reflect genetic variation for immunocompetence. We tested this genetic prediction by mating scorpionfly females to males differing in the expression of a condition-dependent ornament trait, saliva secretion, and then comparing offspring immunocompetence. We found several indications of an immunocompetence handicap in our study: females had superior immunocompetence compared with males, the different immune traits were positively correlated, and there were indications of genetic variation in immune traits. However, we found no significant difference in the immunocompetence of offspring derived from males differing in ornament expression, only a tendency for sons of ornamented males to possess slightly better immunocompetence. The estimated effect of fathers on offspring immunocompetence was rather small, but it might be a sufficient benefit of female choice, provided that the costs of choice are small. We conclude that the genetic benefit of female choice is small concerning offspring immunocompetence, but the immunocompetence handicap principle might nevertheless work in scorpionflies.

Meiotic drive and evolution of female choice

As a special version of the good-genes hypothesis, it was recently proposed that females could benefit from choosing drive-resistant males in a meiotic drive system. Here, we examine with a three-locus, six-allele population genetic model whether female choice for drive resistance can evolve. An allele leading to female preference for drive-resistant males was introduced at low frequency into a population polymorphic for meiotic drive and drive resistance. Our simulations show that female choice of drive-resistant males is disadvantageous when resistance is Y-linked. This disadvantage occurs because, at equilibrium, drive-resistant males have lower reproductive success than drive-susceptible males. Thus, female choice of drive-susceptible males can evolve when resistance is Y-linked. When resistance is autosomal, selection on female choice for drive resistance is less strong and depends on the frequency of choice: female preference of resistant males is favoured when choice is rare and disadvantageous when choice is frequent, leading to a stable equilibrium at a low frequency of the choice allele. Independent of the location of drive resistance alleles, males with the non-driving allele always have above average reproductive success. Female choice is therefore beneficial when choosy females prefer males with the non-driving allele.

DNA preparation and efficient microsatellite analysis from insect hemolymph

A simple and time-saving method for DNA preparation for efficient microsatellite analysis is described. The method is based on thermal treatment of only 1-5 microL of insect hemolymph in a Chelex 100-suspension. Since hemolymph withdrawal does not harm the insects, analysis of mating systems, population structure and phylogenetic reconstruction can be conducted with minimal experimental influence.

Multicenter evaluation of the Amplicor Enterovirus PCR test with cerebrospinal fluid from patients with aseptic meningitis. The European Union Concerted Action on Viral Meningitis and Encephalitis

The Amplicor Enterovirus PCR test was compared with viral culture for the detection of enteroviruses in cerebrospinal fluid (CSF) specimens. In a multicenter study in which nine laboratories participated, a total of 476 CSF specimens were collected from patients with suspected aseptic meningitis. Sixty-eight samples were positive by PCR (14.4%), whereas 49 samples were positive by culture (10.4%), demonstrating that the Amplicor Enterovirus PCR test was significantly more sensitive than culture (P < 0.001). After discrepancy analysis the sensitivity and specificity of the Amplicor Enterovirus PCR test obtained by using viral culture as the "gold standard" were 85.7 and 93.9%, respectively. Our results with the CSF specimens collected in different countries demonstrate that the Amplicor test is capable of detecting a large variety of enterovirus serotypes and epidemiologically unrelated isolates in CSF specimens from patients with aseptic meningitis. The Amplicor Enterovirus PCR test is a rapid assay which can be routinely performed with CSF samples and is an important improvement for the rapid diagnosis of enteroviral meningitis.

A life review interview guide: a structured systems approach to information gathering

This clinical project introduces a guide to provide the interviewer with a methodological systems approach for information gathering in the life review process. The guide is structured in such a way as to elicit positive life events for the purpose of enhancing a sense of well-being as well as to elicit negative life events to encourage the client to address unresolved loss-grief issues. In effect, the Life Review Interview Guide serves to promote high self-esteem and to assist the interviewee through the grieving process. In addition, the Guide assisted the student-interviewer in formulating and selecting a wide range of questions.

Influence of transurethral resection on sexual dysfunction in patients with prostate cancer

OBJECTIVE

To evaluate retrospectively the potential influence of disease-related factors and transurethral resection of the prostate (TURP) on the sexual function of patients who had undergone curative radiotherapy for prostate cancer.

PATIENTS AND METHODS

The study comprised 104 patients (median age 69.5 years, range 49-81) who had been treated with curative radiotherapy and no first-line hormones: 16, 52, 33 and three patients had T1, T2, T3 and T4 tumours, respectively. TURP was performed in 73 patients before RT, and needle biopsy alone in 31 patients. They were interviewed about their past and present sexual lives using a questionnaire designed to evaluate the potency of the patients at age 45 years, at 1 year before the diagnosis of the disease, before radiotherapy (after TURP or needle biopsy) and at the last follow-up. Information concerning associated diseases, routine medication and the weight of the resected material was also collected.

RESULTS

Before diagnosis, 20 patients had no erections while 84 were potent. Of the 60 potent patients undergoing a TURP, 31 (51%) indicated complete impotence immediately thereafter. There was no statistical difference between impotent and potent patients after TURP in age, associated diseases, medical treatment and the weight of the resected material.

CONCLUSION

TURP may lead to impotence in a significant proportion of patients. As TURP is an important component of "conservative' treatment approaches, its potential sexual morbidity should be taken into consideration in the comparative risk-benefit analysis of different therapeutic strategies.

Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast

PURPOSE

To determine the 15-year outcome for women with ductal carcinoma in situ (DCIS, intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation.

PATIENTS AND METHODS

An analysis was performed of 270 intraductal breast carcinomas in 268 women from 10 institutions in Europe and the United States. In all patients, breast-conserving surgery included complete gross excision of the primary tumor followed by definitive breast irradiation. When performed, pathologic axillary lymph node staging was node-negative (n=86). The median follow-up time was 10.3 years (range, 0.9 to 26.8).

RESULTS

The 15-year actuarial overall survival rate was 87%, and the 15-year actuarial cause-specific survival rate was 96%. The 15-year actuarial rate of freedom from distant metastases was 96%. There were 45 local recurrences in the treated breast, and the 15-year actuarial rate of local failure was 19%. The median time to local failure was 5.2 years (range, 1.4 to 16.8). A number of clinical and pathologic parameters were evaluated for correlation with local failure, and none were predictive for local failure (all P > or = .15).

CONCLUSION

The results from the present study demonstrate high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of DCIS of the breast using breast-conserving surgery and definitive breast irradiation. These results support the use of breast-conserving surgery and definitive breast irradiation for the treatment of DCIS of the breast.

Conditioning the leukemic patient before allogeneic BMT: value of intensifying immunosuppression in the context of different levels of T lymphocyte depletion of the graft

We have studied the value of additional immune suppression in BMT conditioning regimens in 45 patients with leukemia and 4 with myelodysplastic syndrome allografted between 1984 and 1991. A dose of 6 Gy total lymphoid irradiation (TLI) was delivered to 12 of 24 and 15 of 25 patients conditioned with 10 Gy and 12 Gy total body irradiation (TBI), respectively. Thirteen patients also received methylprednisolone (MP) before BMT to enhance immunosuppression. Differences in immunosuppression between the TBI with or without TLI or MP regimens and the influence of different levels of graft T cell depletion were measured in terms of transplant rejection, and complete versus mixed chimerism. The treatment-related complications were evaluated in terms of GVHD and incidence of pneumonitis. The overall transplant rejection rate was 6% (3 of 49). Complete chimerism was not significantly modified by increasing the TBI dose or by additional TLI (p > 0.10) but was more often seen in patients receiving MP given as pre-transplant immunosuppressor booster (p = 0.01). The incidence of GVHD was only influenced by the level of T cell depletion (p = 0.003). All 49 patients received a TBI lung dose in the range 9.5-10 Gy. A crude pneumonitis range of 19% (9 of 47 evaluable patients) was found. Neither the addition of TLI, MP nor the T cell depletion influenced the lung toxicity rate (p > 0.10) but pneumonitis was more frequent in patients with GVHD (p = 0.005).

Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation. Correlation of pathologic parameters with outcome of treatment

BACKGROUND

To evaluate the pathologic characteristics of the primary tumor relative to local control, survival, and freedom from distant metastases, an analysis was performed of 172 patients with ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive breast irradiation.

METHODS

The clinical records and pathology slides were reviewed from 172 women with ductal carcinoma in situ treated with breast-conserving surgery and definitive breast irradiation at multiple institutions in Europe and the United States. Central pathology review was performed by one pathologist without knowledge of the clinical outcome. The clinical outcome was measured in terms of local control, overall survival, cause-specific survival, and freedom from distant metastases. The median follow-up time was 84 months (range, 17-177 months).

RESULTS

The pathologic parameters evaluated were histologic subtype, nuclear grade, amount of necrosis, and final pathology margin. The only pathologic parameter that correlated with the rate of local recurrence was the presence versus the absence of the combination of the histologic subtype of comedo carcinoma plus nuclear grade 3 (8-year actuarial rate of local recurrence of 20% versus 5%, respectively; P = 0.009 on univariate analysis; P = 0.017 on multivariate analysis). None of the pathologic parameters evaluated correlated with overall survival (all P > or = 0.16), cause-specific survival (all P > or = 0.13), or freedom from distant metastases (all P > or = 0.13).

CONCLUSIONS

These results have demonstrated that there are important differences in the rate of local recurrence based on the pathologic characteristics of the primary tumor for women with ductal carcinoma in situ treated with breast-conserving surgery and definitive irradiation. However, the differences in local recurrence have not been associated with differences in survival or freedom from distant metastases. Careful follow-up for patients at increased risk for local recurrence is warranted because of the potential ability to salvage patients with local recurrence.

Thyroid function before and after four-week light treatment in winter depressives and controls

Thyroid function in patients in a current major depressive episode during the course of recurrent major mood disorder with seasonal pattern according to DSM-IIIR was compared to that of controls before and after 4 weeks' light treatment, and to that of controls at baseline and after 4 weeks' of arising early without exposure to bright light. No consistent abnormalities in thyroxine, free thyroxine index, triiodothyronine, reverse triiodothyronine, thyrotropin, thyrotropin response to TRH infusion, or thyroid autoantibodies were seen in depressives at baseline. No differences in these parameters were seen at baseline between depressives and controls. No intergroup differences were seen with treatment, although reverse T3 decreased significantly during the protocol in all groups. These data do not support the hypothesis that the thyroid axis plays a role in the pathogenesis of winter depressive symptoms or their response to light treatment.