Endosulfatases SULF1 and SULF2 limit Chlamydia muridarum infection

The first step in attachment of Chlamydia to host cells is thought to involve reversible binding to host heparan sulfate proteoglycans (HSPGs), polymers of variably sulfated repeating disaccharide units coupled to diverse protein backbones. However, the key determinants of HSPG structure that are involved in Chlamydia binding are incompletely defined. A previous genome-wide Drosophila RNAi screen suggested that the level of HSPG 6-O sulfation rather than the identity of the proteoglycan backbone maybe a critical determinant for binding. Here, we tested in mammalian cells whether SULF1 or SULF2, human endosulfatases, which remove 6-O sulfates from HSPGs, modulate Chlamydia infection. Ectopic expression of SULF1 or SULF2 in HeLa cells, which decreases cell surface HSPG sulfation, diminished C. muridarum binding and decreased vacuole formation. ShRNA depletion of endogenous SULF2 in a cell line that primarily expresses SULF2 augmented binding and increased vacuole formation. C. muridarum infection of diverse cell lines resulted indownregulation of SULF2 mRNA. In a murine model of acute pneumonia, mice genetically deficient in both endosulfatases or in SULF2 alone demonstrated increased susceptibility to C. muridarum lung infection. Collectively, these studies demonstrate that the level of HSPG 6-O sulfation is a critical determinant of C. muridarum infection in vivo and that 6-O endosulfatases are previously unappreciated modulators of microbial pathogenesis.

Large scale production of recombinant mouse and rat growth hormone by fed-batch GS-NSO cell cultures

Investigations of biological effects of prolonged elevation of growth hormone in animals such as mice and rats require large amounts of mouse and rat growth hormone (GH) materials. As an alternative to scarce and expensive pituitary derived materials, both mouse and rat GH were expressed in NSO murine myeloma cells transfected with a vector containing the glutamine synthetase (GS) gene and two copies of mouse or rat GH cDNA. For optimal expression, the mouse GH vector also contained sequences for targeting integration by homologous recombination. Fed-batch culture processes for such clones were developed using a serum-free, glutamine-free medium and scaled up to 250 L production scale reactors. Concentrated solutions of proteins, amino acids and glucose were fed periodically to extend cell growth and culture lifetime, which led to an increase in the maximum viable cell concentration to 3.5×10(9) cells/L and an up to 10 fold increase in final mouse and rat rGH titers in comparison with batch cultures. For successful scale up, similar culture environmental conditions were maintained at different scales, and specific issues in large scale reactors such as balancing oxygen supply and carbon dioxide removal, were addressed. Very similar cell growth and protein productivity were obtained in the fed-batch cultures at different scales and in different production runs. The final mouse and rat rGH titers were approximately 580 and 240 mg/L, respectively. During fed-batch cultures, the cell growth stage transition was accompanied by a change in cellular metabolism. The specific glucose consumption rate decreased significantly after the transition from the growth to stationary stage, while lactate was produced in the exponential growth stage and became consumed in the stationary stage. This was roughly coincident with the beginning of ammonia and glutamate accumulation at the entry of cells into the stationary stage as the result of a reduced glutamine consumption and periodic nutrient additions.

Host-related carcinoembryonic antigen cell adhesion molecule 1 promotes metastasis of colorectal cancer

Liver metastasis is the predominant cause of colorectal cancer (CRC)-related mortality in developed countries. Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a cell adhesion molecule with reduced expression in early phases of CRC development and thus functions as a tumor growth inhibitor. However, CEACAM1 is upregulated in metastatic colon cancer, suggesting a bimodal role in CRC progression. To investigate the role of this protein in the host metastatic environment, Ceacam1(-/-) mice were injected intrasplenically with metastatic MC38 mouse CRC cells. A significant reduction in metastatic burden was observed in Ceacam1(-/-) compared with wild-type (WT) livers. Intravital microscopy showed decreased early survival of MC38 cells in Ceacam1(-/-) endothelial environment. Metastatic cell proliferation within the Ceacam1(-/-) livers was also diminished. Bone marrow-derived cell recruitment, attenuation of immune infiltrates and diminished CCL2, CCL3 and CCL5 chemokine production participated in the reduced Ceacam1(-/-) metastatic phenotype. Transplantations of WT bone marrow (BM) into Ceacam1(-/-) mice fully rescued metastatic development, whereas Ceacam1(-/-) BM transfer into WT mice showed reduced metastatic burden. Chimeric immune cell profiling revealed diminished recruitment of CD11b(+)Gr1(+) myeloid-derived suppressor cells (MDSCs) to Ceacam1(-/-) metastatic livers and adoptive transfer of MDSCs confirmed the involvement of these immune cells in reduction of liver metastasis. CEACAM1 may represent a novel metastatic CRC target for treatment.

P5-16-01: Are We Going To Be Able To Train Future Surgeons How To Perform Axillary Lymph Node Dissection?

Background: Axillary lymph node dissection (ALND) has been performed regularly by surgeons for several decades. The sentinel lymph node era has led to a reduction in ALND procedures as node negative women are now spared further surgery and morbidity. Following the publication of the ACOSOG Z0011 trial, it is conceivable that completion ALND (cALND) may be rendered unnecessary for many women who have breast conserving surgery and have 1 to 2 positive sentinel lymph node disease. If there is a substantial drop in ALND procedures, this may impact on our ability to train surgeons in the future.

Material and Methods: We retrospectively reviewed the breast cancer practice for 2 consultant surgeons in a busy UK centre. In this centre all patients with a positive diagnosis of invasive breast cancer had preoperative axillary ultrasound scanning (USS) and needle biopsy (fine needle aspiration or core biopsy) if enlarged or suspicious axillary lymph nodes were seen. Hence sentinel lymph node biopsy (SLNB) was only performed on patients with both clinically and radiologically negative axillary lymph nodes.

Results: In 2009 and 2010 the 2 consultants treated a total of 255 patients with invasive breast cancer. Thirty one patients (12.2%) had positive axillary lymph disease identified by USS and axillary needle biopsy; these women were treated with ALND. The remaining 224 patients had clinically and radiologically negative axillary lymph nodes and proceeded to SLNB. Of these, 58 patients had at least one positive sentinel lymph node (25.9%) and proceeded to cALND; 39 women had breast conserving surgery and 19 women had mastectomy. If our centre were to adopt a policy of observation only in those women having breast conserving surgery and whom had no more than 2 positive sentinel lymph nodes (as per ACOSOG Z0011 trial), then 33 fewer ALND would have been performed. This would leave a new total of 56 ALND procedures being performed over a 2 year period in women with pre-operatively identified positive axillary lymph nodes, those undergoing mastectomy and those women with 3 or greater positive sentinel lymph nodes on SLNB. On our service we have 2 residents which would result in a maximum number of 14 ALND procedures per year that each resident may be trained to perform. It is likely that the actual number will be less due to commitments away from the elective operating room, such as emergency duties and annual leave etc. Is this an adequate number of ALND procedures for a resident to gain competence in the technique?

Discussion: The training of surgical residents is competence based and if our centre is representative of most centres treating breast cancers in the UK, will the teaching of ALND procedures be limited to specialist, ultra-high volume centres if the ACOSOG Z0011 trial findings are to be adopted?

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-16-01.

[Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]

These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.

[Pancreatic cancer: the surgeon's point of view]

INTRODUCTION

Pancreatic adenocarcinoma (PA) is not only one of the most common gastrointestinal tumors, but also the most lethal.

OBJECTIVE

Give a comprehensive and up-to-date panorama on pancreatic cancer with a surgical focus.

METHODS

A critical search was performed in Medline focusing on recent relevant publications, renowned authors, high impact publications and a preference for surgical literature in English.

RESULTS

In this article we review PA epidemiology, some aspects of molecular biology, clinical presentation, work-up, staging and current treatment options.

CONCLUSIONS

Patients affected must be studied appropriately and referred to specialized centers for surgical treatment, when indicated, in order to offer them the best chance for cure. Breakthroughs in management will probably include prevention, early diagnosis and molecular therapy.

Evaluation of chronic disease self-management programme (CDSMP) for older adults in Hong Kong

OBJECTIVES

To evaluate the locally-adapted CDSMP for older adults with chronic diseases in Hong Kong in the primary care setting.

DESIGN

A longitudinal, quasi-experimental study.

SETTING

Community-based and primary care setting.

PARTICIPANTS

Seven hundred and seventy-two participants aged 55 or above with at least one chronic disease and were living in the community.

INTERVENTION

The 6-weeks programme consisted of 6 group sessions, with each session lasting for 2.5 hours. Trained professional and elder lay leaders facilitated participants to gain essential self-management knowledge and skills for the effective management of chronic diseases.

MEASUREMENTS

At baseline and 6 months, four categories of outcome measures were documented, covering self-management behaviours, self-efficacy, health status, and health care utilization.

RESULTS

302 and 298 participants in the intervention and control groups completed 6 months follow-up respectively. Participants in the intervention group reported significant improvements in all self-management behaviours and self-efficacy measures, and 5 health status measures (social role limitation, depressive symptoms, health distress, symptoms of pain and discomfort, and self-rated health) when compared with those in the control group.

CONCLUSIONS

The locally-adapted CDSMP may improve self-management behaviours, self-efficacy and health status among older adults with chronic diseases in Hong Kong. CDSMP may be integrated into primary care services for older adults.

Polyfunctional cytomegalovirus-specific immunity in lung transplant recipients receiving valganciclovir prophylaxis

Cytomegalovirus (CMV) is a common opportunistic infection after lung transplant. Despite effective antiviral medications to treat CMV, invasive CMV disease contributes to lung allograft dysfunction and worse survival. Efforts to prevent CMV have led to the use of valganciclovir prophylaxis for increasingly longer periods after transplant. A pivotal concern with long-term antiviral prophylaxis is that it may prevent or delay the development of CMV-specific immunity and increase the subsequent risk of late onset disease. To address this issue, we conducted a pilot study to determine if CMV-specific immunity was detectable in lung transplant recipients at risk for CMV while on antiviral prophylaxis. Utilizing polychromatic flow cytometry panels, CMV-specific immunity was determined by peripheral blood CD4 and CD8 T cell expression of cytokines in response to the HLA restricted CMV peptides pp65 and IE-1. We determined CMV seropositive lung transplant recipients on valganciclovir for a median of 6 months from transplant have a detectable polyfunctional CMV-specific T cell response which is comparable to seropositive recipients not on antiviral medications and to healthy seropositive nontransplant controls. Thus, valganciclovir prophylaxis does not appear to impair the development of CMV-specific immunity in lung transplantation.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 μm diameter hot core.

Relationship of body mass index in young adulthood and health-related quality of life two decades later: the Coronary Artery Risk Development in Young Adults study

OBJECTIVE

The expanding overweight and obesity epidemic notwithstanding, little is known about their long-term effect on health-related quality of life (HRQoL). The main objective of this study was to investigate whether overweight (body mass index (BMI) 25 to <30 kg m(-2)) and obese (BMI ≥ 30 kg m(-2)) young adults have poorer HRQoL 20 years later.

METHODS

We studied 3014 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal, community-dwelling, biracial cohort from four cities. BMI was measured at baseline and 20 years later. HRQoL was assessed by the Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores of the Medical Outcomes Study 12-Item Short-Form Health Survey at year 20. Higher PCS or MCS scores indicate better HRQoL.

RESULTS

Mean year 20 PCS score was 52.2 for normal weight participants at baseline, 50.3 for overweight and 46.4 for obese (P-trend <0.001). This relation persisted after adjustment for baseline demographics, general health, and physical and behavioral risk factors and after further adjustment for 20-year changes in risk factors. No association was observed for MCS scores (P-trend 0.43).

CONCLUSION

Overweight and obesity in early adulthood are adversely associated with self-reported physical HRQoL, but not mental HRQoL 20 years later.

Development, validation and application of ELISAs for pharmacokinetic and HACA assessment of a chimeric anti-CD40 monoclonal antibody in human serum

As part of a Phase I chimeric anti-CD40 monoclonal antibody clinical trial, two enzyme-linked immunosorbent assays (ELISAs) were developed for secondary endpoints: 1) for the pharmacokinetic (PK) monitoring of serum antibody levels and 2) for immunogenic screening of human anti-chimeric antibody (HACA) responses. The ELISA is a well established immunoassay, with clear guidelines for validation when used as a quantitative assay. However, these parameters may not always be relevant for a semi-quantitative assay used to assess whether a sample is positive or negative for a novel marker such as an antibody developed against a therapeutic antibody. We report here the development of a quantitative PK ELISA and a semi-quantitative HACA ELISA, and the different approaches of validation to prove each assay are 'fit for purpose.' The parameters of linearity (R²>0.99), accuracy (±30%), lowest level of detection (4 μg/ml), intra-assay (coefficient of variation (CV) <20%) and inter-assay (CV<20%) variability were assessed for the quantitative PK assay. For the semi-quantitative HACA assay, parameters of linearity (R²>0.99), lowest level of detection, intra (CV<10%) and inter-assay (CV<30%) variability were assessed using a surrogate positive control. The validation outcome showed that each assay was robust, reliable and accurate to meet the requirements of the intended analytical application, that being to 1) quantitatively determine the concentration of antibody in the serum and 2) determine whether a sample is positive or negative for human anti-chimeric antibodies. Each assay has been successfully translated for use in a clinical trial with adequate quality controls and acceptance criteria set for monitoring consistency and performance.

The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research

Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic ('meta-study') review. Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A 'spirit to spirit' framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.

Longitudinal assessment of fibrinogen in relation to subclinical cardiovascular disease: the CARDIA study

OBJECTIVE

To examine the strength of the associations of fibrinogen with subclinical atherosclerosis in healthy persons.

METHODS

A population-based, prospective, observational study of black and white men and women (Coronary Artery Risk Development in Young Adults [CARDIA]). Fibrinogen levels were measured at year 7 (ages 25-37, n = 2969), and again at year 20 (ages 38-50, n = 2832). Measures of subclinical atherosclerosis (coronary artery calcification [CAC] and carotid intimal-medial thickness [CIMT]) were recorded at year 20.

RESULTS

Over the 13-year study interval (1992-1993 to 2005-2006), fibrinogen rose from a mean of 3.32 to 4.05 g L(-1). After adjusting for age, gender and race, fibrinogen was positively associated with greater incidence of CAC and increased CIMT cross-sectionally as well as after 13 years of follow-up (all P-trend < 0.001). After further adjustment for field center, BMI, smoking, education, systolic blood pressure, diabetes, antihypertensive medication use, total and HDL cholesterol, and CRP, significant positive relationships between fibrinogen and incidence of CAC remained for the total cohort longitudinally (P-trend = 0.037), but not cross-sectionally (P-trend = 0.147).

CONCLUSION

This 13-year study demonstrates that higher levels of fibrinogen during young adulthood are positively associated with incidence of CAC and increased CIMT in middle-age, but the strength of the association declines with increasing age.