Differential effect of erythropoietin and GM-CSF on megakaryocytopoiesis from primitive bone marrow cells in serum-free conditions

In this study we have explored the effect of recombinant human erythropoietin (EPO) and recombinant murine GM-CSF on megakaryocyte progenitors (colony forming units-megakaryocyte [CFU-Mk]) using a serum-free fibrin clot assay and enriched primitive hematopoietic progenitors of marrow cells from day 4 post-5-fluorouracil-treated mice. We have monitored the production of high proliferative potential-colony forming cells ([HPP-CFC]; compact colonies, > 0.5 mm) and studied their relationship to CFU-Mk formation. EPO induced the formation of small numbers of megakaryocyte colonies, but acted together with the megakaryocyte-stimulating factors, stem cell factor (SCF) and interleukin (IL-3), to augment the size of CFU-Mk (colonies with > 50 megakaryocytes/colony). A strong correlation between the number of CFU-Mk and HPP-CFC formation from 5-fluorouracil bone marrow cells was observed when these cells were stimulated with EPO in the presence of SCF and IL-3. On the other hand, GM-CSF alone had no effect on megakaryocyte colony formation. Moreover, GM-CSF in the presence of SCF and IL-3 potentiates the HPP-CFC formation (i.e., an increase of 3.1-fold compared to the effect induced by SCF+IL-3) with strong inhibitory effects on the number and size of megakaryocyte colonies. Although several studies suggest that EPO and GM-CSF can stimulate megakaryocytopoiesis, our results indicate that neither EPO nor GM-CSF alone are sufficient to stimulate primitive progenitors committed to the megakaryocyte lineage. The fact that EPO can exert a strong effect on the size of CFU-Mk induced by SCF/IL-3 suggests that only those megakaryocyte progenitors previously stimulated by other megakaryocyte stimulating factors are able to respond to EPO. These findings may explain the physiological and clinical observations in which high levels of EPO are often associated with thrombocytosis.

The Cyberknife: a frameless robotic system for radiosurgery

The Cyberknife is a unique instrument for performing frameless stereotactic radiosurgery. Rather than using rigid immobilization, the Cyberknife relies on an image-to-image correlation algorithm for target localization. Furthermore, the system utilizes a novel, light-weight, high-energy radiation source. The authors describe the technical specifications of the Cyberknife and summarize the initial clinical experience.

IL-6 interferes with stimulation of HPP-CFC and large CFU-Mk in conjunction with cytokine combinations from primitive murine marrow cells

The growth-promoting activities of interleukin 6 (IL-6) in combination with early-acting hematopoietic factors, i.e., stem cell factor (SCF) and interleukin-1 alpha (IL-1 alpha), on primitive hematopoietic and megakaryocyte progenitors (high proliferative potential colony-forming cells [HPP-CFC] and colony-forming units-megakaryocyte [CFU-Mk], respectively) from 5-fluorouracil (5-FU)-treated murine bone marrow cells (BMC) were evaluated in serum-free fibrin clot cultures. IL-6 in combination with SCF and IL-1 induced an irregular and abortive hematopoiesis characterized by a reduction in colony size of at least 50% over those stimulated by SCF + IL-1 + IL-3 and an inability to continue growth to day 12. Moreover, IL-6 in combination with the early-acting factors, SCF and IL-1, had no effect on the formation of HPP-CFC. IL-6 is synergistic with SCF + IL-1 on day 7 CFU-Mk but did not stimulate large day 12 CFU-Mk. Our results suggest that, in the absence of serum, IL-6 prevents the continued proliferation of early hematopoietic and megakaryocytic progenitors initiated by SCF + IL-1 + IL-3. Optimization of cytokine combinations for use in ex vivo expansion of marrow progenitors, either for stem cell transplants or gene therapy, must consider not only the number of colonies but their size, as well as the contributions of serum components.

Thrombopoietin, a direct stimulator of viability and multilineage growth of primitive bone marrow progenitor cells

Thrombopoietin (TPO), the ligand for c-mpl, has recently been demonstrated to be the primary regulator of megakaryocytopoiesis and platelet production. In addition, several studies have demonstrated that c-mpl is expressed on hematopoietic cell populations highly enriched in primitive progenitor cells. Here we summarize and discuss recent studies from our laboratory, as well as others, demonstrating that TPO has effects on primitive hematopoietic progenitor cells. When acting alone, TPO stimulates little or no growth, but promotes viability and suppresses apoptosis of murine multipotent (Lin- Sca-1+) bone marrow progenitor cells in vitro. In addition, TPO directly and potently synergizes with other early acting cytokines (kit ligand, flt3 ligand and interleukin 3) to promote multilineage growth of the same progenitor cell population. Although it remains to be established whether TPO also acts on the long-term reconstituting pluripotent stem cells, these studies combined with progenitor cell studies in c-mpl-deficient mice, suggest that TPO, in addition to its key role in platelet production, might also have an important impact on early hematopoiesis.

Image-guided radiosurgery for the spine and pancreas

A robotic image-guided radiosurgical system has been modified to treat extra-cranial sites using implanted fiducials and skeletal landmarks to locate the treatment targets. The system has been used to treat an artero-venous malformation in the cervical spine, a recurrent schwannoma of the thoracic spine, a metastatic adenocarcinoma of the lumbar spine, and three pancreatic cancers. During each treatment, the image guidance system monitored the position of the target site and relayed the target coordinates to the beam-pointing system at discrete intervals. The pointing system then dynamically aligned the therapy beam with the lesion, automatically compensating for shifts in target position. Breathing-related motion of the pancreas lesions was managed by coordinating beam gating with breath-holding by the patient. The system maintained alignment with the spine lesions to within +/- 0.2 mm on average, and to within +/- 1 mm for the pancreatic tumors. This experience has demonstrated the feasibility of using image-guided robotic radiosurgery outside the cranium.

Robotic motion compensation for respiratory movement during radiosurgery

Tumors in the chest and abdomen move during respiration. The ability of conventional radiation therapy systems to compensate for respiratory motion by moving the radiation source is inherently limited. Since safety margins currently used in radiation therapy increase the radiation dose by a very large amount, an accurate tracking method for following the motion of the tumor is of the utmost clinical relevance. We investigate methods to compensate for respiratory motion using robotic radiosurgery. Thus, the therapeutic beam is moved by a robotic arm, and follows the moving target tumor. To determine the precise position of the moving target, we combine infrared tracking with synchronized X-ray imaging. Infrared emitters are used to record the motion of the patient's skin surface. A stereo X-ray imaging system provides information about the location of internal markers. During an initialization phase (prior to treatment), the correlation between the motions observed by the two sensors (X-ray imaging and infrared tracking) is computed. This model is also continuously updated during treatment to compensate for other, non-respiratory motion. Experiments and clinical trials suggest that robot-based methods can substantially reduce the safety margins currently needed in radiation therapy.

Megakaryocytopoiesis in vitro: from the stem cells' perspective

Megakaryocytopoiesis is a complex network regulated by different megakaryocyte (MK)-stimulating factors (i.e., thrombopoietin [TPO], stem cell factor [SCF], interleukin 3 [IL-3], IL-6, IL-11 and GM-CSF). Although all of these factors can affect human and murine megakaryocytopoiesis at different levels of MK development, the effect on very primitive hematopoietic stem cells (HSC) is not well understood. We have further characterized the in vitro biological activity of recombinant murine TPO, SCF and IL-3 on the maturation and proliferation of MK progenitors from different murine primitive hematopoietic cells in a fibrin clot system under serum-free conditions. Neither TPO nor SCF alone induced MK colony formation (CFU-MK) from Lin- Sca+ cells. However, isolated large and mature MKs were observed in the presence of TPO. In contrast, IL-3 exerted a potent effect on CFU-MK formation from Lin- Sca+ cells. On this population of HSC, a significant increase of large MK colonies with mature MK were obtained under those conditions in which TPO was combined with IL-3 or SCF plus IL-3. Similar results were obtained with murine bone marrow cells enriched by primitive progenitors from day 3 post-5-fluorouracil treated mice (5-FUBMC). In contrast, TPO-sensitive precursors were detected in fetal liver cells (FLC). These cells differentiate and proliferate to MK progenitors in the presence of TPO. A significant increase in the number of CFU-MK was induced when TPO was combined with either IL-3 or SCF. On these populations of primitive hematopoietic progenitors, IL-3 induced both the proliferation and differentiation of MK progenitors. Because erythropoietin and TPO share similarities between their molecules and their receptors, we studied whether these growth factors may modulate megakaryocytopoiesis from FLC. Flow cytometry analysis of FLC expressing erythroid markers demonstrated that these cells expressed c-Mpl receptor. In our in vitro studies, although EPO by itself did not induce MK colonies from FLC, it enhanced the proliferative activity of TPO. High ploidy and proplatelet-shedding MK were observed in Lin- Sca+ cells, 5-FUBMC and FLC stimulated with TPO alone or in combination with other MK-stimulating factors. Based on these observations, we propose that TPO, IL-3 and SCF constitute early MK-acting factors with differential proliferative and differentiative activities on murine stem cells. TPO by itself does not appear to be involved in the proliferation of MK progenitors from bone marrow HSC. TPO appears to induce in these cells the commitment toward MK differentiation. However, this growth factor may enhance the proliferative activity of IL-3. IL-3 is an early MK-stimulating factor able to induce in vitro the proliferation and differentiation of MK progenitors from HSC.

Effects of dexamethasone on development of immunoglobulin G subclass responses following vaccination of horses

OBJECTIVE

To determine the effects of dexamethasone on development of IgG subclass responses following vaccination of healthy horses.

ANIMALS

11 mature Thoroughbreds.

PROCEDURE

Horses received 2 IM injections at 2-week intervals of a vaccine containing inactivated infectious bovine rhinotracheitis, bovine viral diarrhea, and parainfluenza-3 viral antigens and were then randomly assigned to 2 groups. Six horses received dexamethasone (0.2 mg/kg of body weight, IM) twice weekly for 8 weeks starting the day of the first vaccination. Five control horses received an equivalent volume of saline (0.9% NaCl) solution. Antigen-specific serum IgG subclass titers were determined weekly after vaccination by use of an ELISA.

RESULTS

Vaccination resulted in similar antigen-specific serum IgG(T) titers in dexamethasone-treated and control horses. In contrast, although control horses developed IgGa and IgGb responses after vaccination, corticosteroid administration completely inhibited these responses in treated horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Cortico steroids can have profound effects on primary immune responses in horses and can significantly affect IgG responses to inactivated vaccines. Corticosteroid treatment regimens commonly used to treat diseases in horses may result induction of a nonprotective IgG subclass response, leaving treated horses susceptible to disease. Additionally, mechanisms regulating IgGa and IgGb responses appear to differ from those regulating IgG(T) responses. Further defining these mechanisms is a critical step in designing effective vaccines, and corticosteroid-induced immunomodulation may be a valuable tool for studying immune responses in horses.

Postprandial response to a fat tolerance test in young adults with a paternal history of premature coronary heart disease - the EARS II study (European Atherosclerosis Research Study)

BACKGROUND

The European Atherosclerosis Research Study (EARS) I had shown that fasting plasma concentrations of apolipoprotein B (apo B) and triglycerides were the most discriminant variables between offspring with a paternal history of coronary heart disease (CHD) and controls. The EARS II study was undertaken to investigate whether a paternal history of CHD was associated with differences in postprandial lipemia.

DESIGN

Male subjects with a paternal history of CHD (cases, n = 407) and age-matched male controls (n = 415) were recruited from 14 European universities. All subjects had an oral fat tolerance test.

RESULTS

In the sample as a whole, the postprandial triglyceride responses did not significantly differ between the two groups. However, in the upper tertile of fasting triglycerides, cases displayed a higher area under the curve (5.71 vs. 4.49 mmol.h L-1, P < 0.001), a higher peak (1.76 vs. 1.43 mmol L-1, P < 0.001) and a more delayed time to peak (3.15 vs. 2.91 h, P < 0.05) than controls. In the upper tertile, fasting apo B levels (P < 0.05) and triglyceride area under the curve (P = 0.002) significantly discriminated cases from controls in a multivariate analysis. Cases had also higher Lp C-III:B levels at 4 h than controls (11.2 vs. 9.9 mg dL-1, P < 0.01) and this difference remained significant after adjustment for apo B and triglyceride levels.

CONCLUSIONS

These results indicate that in subjects with a moderate elevation of fasting triglycerides, an impaired postprandial response to a fat load constitutes an early biological expression of a paternal history of premature CHD.

Aneurysmal bone cyst of the spine with familial incidence

STUDY DESIGN

A report of two cases of aneurysmal bone cysts of the spine occurring in a father and daughter.

OBJECTIVE

To present an unusual finding of familial incidence of aneurysmal bone cyst and review the literature.

SUMMARY OF BACKGROUND DATA

Aneurysmal bone cysts are benign, expanding, locally aggressive lesions. Up to 20% of cases involve the spine. The cause of primary aneurysmal bone cysts remains unclear. There have been three previous reports of a familial incidence supporting the importance of a hereditary component in the cause of aneurysmal bone cysts.

METHODS

A 36-year-old man and a 7-year-old girl were diagnosed with aneurysmal bone cyst involving the spine by clinical manifestations, radiographic features, and histologic evaluation.

RESULTS

The father remains recurrence- and symptom-free 6 years after primary resection. Five months after surgery, the daughter was found to have recurrent disease by magnetic resonance imaging and underwent a second procedure within 1 year of the primary resection.

CONCLUSION

The occurrence of a primary aneurysmal bone cyst in two family members, occurring at adjacent vertebral levels, is suggestive of a hereditary component to the formation of primary aneurysmal bone cyst.

Midfacial tumours: a review of 72 cases

We review 72 midfacial tumours managed during the 10-year period between 1985 and 1995. We describe presenting features, sites of lesions and histology, treatment regimens and outcomes, as well as the various surgical approaches for the resection of midfacial tumours, and their indications and contraindications. The choice of approach should be based on type of tumour, its site, and extent.

Health and environmental implications of using composted household and yard waste bedding in a cattle feedlot

A study was conducted to determine the safety and feasibility of using municipal solid waste compost (MSWC) as a bedding material for cattle feedlots. Two pens in an open-front pole barn were bedded with either corn stalks or MSWC in each of two feeding periods (blocks) with two pens (23 x 34 m) per block. Block 1 used 336 heifers (initial BW, 398 kg) during a 104-d period (summer), and Block 2 used 276 steers (initial BW, 412 kg) during a 92-d period (winter). Blood concentrations of regulated elements (Cd, Cu, Mo, Pb, Ni, and Zn), electrolytes, glucose, or liver and kidney enzymes were unaffected (P > .05) by use of either bedding material. Polychlorinated biphenyls in perirenal fat were not detectable (< .5 ppm) in cattle bedded with either material. At slaughter, kidney Cu and kidney and liver Pb concentrations were greater (P < .05) for cattle bedded with MSWC. Despite this, tissue concentrations of these elements were well within those considered normal for healthy cattle. Regulated element concentrations of feed did not differ (P > .05) between diets within period, and neither did DMI or DM digestibility; therefore, cattle bedded with MSWC were likely inhaling additional amounts of these elements and excreting them through feces. More MSWC than corn stalks was required to supply a dry bed per animal daily (P < .05). Soiled bedding (manure as-is) output was similar (P > .05) for both bedding materials. On a DM basis, more manure (P < .05) was removed from the pen bedded with MSWC in Block 2. Total manure N and P removed was similar for both bedding materials. Nitrogen and P concentrations in manure were lower (P < .05) during Block 2, but total manure N removed was greater (P < .05) during Block 2. Total manure P removed from the pens was not affected by season. Under the conditions of this study, MSWC seemed to be a safe and effective bedding material for cattle feedlots.

Efficacy of statin therapy: possible effect of phenytoin

Statins are currently the most widely prescribed lipid-lowering drugs. Individual statins are known to be metabolised by the CYP3A4 isoform of the cytochrome P450 system. The effect of CYP3A4 inducers such as phenytoin on the metabolism and efficacy of these agents is unknown. We report a patient with familial hypercholesterolaemia and epilepsy in whom the introduction and subsequent discontinuation of phenytoin were associated with marked changes in the lipid response to treatment with simvastatin and atorvastatin. The serum activity of gamma-glutamyl transpeptidase may have acted as a marker of microsomal induction by phenytoin, since it rose markedly when phenytoin was introduced and returned to normal after it was discontinued.

Use of measurements of myoglobin and cardiac troponins in the diagnosis of acute myocardial infarction

Research indicates that no tests of a single cardiac marker are 100% specific and sensitive for diagnosis of AMI in all patients. Each biomarker has advantages and disadvantages (see Table). Over-reliance on a single diagnostic test is risky. Specific tests should be ordered on the basis of the individual patient's assessment and medical history. Nurses are an important link in the collection of patients' medical history and in assessment as well as in the interpretation of patients' laboratory results. A knowledge of diagnostic tests commonly used in the care of patients with ischemic heart disease is imperative if patients are to receive appropriate, timely, cost-effective care.

The importance of computed tomography slice thickness in radiographic patient positioning for radiosurgery

A new radiographic patient positioning technique developed for radiosurgery has been analyzed to show the effect of computed tomography (CT) slice thickness on the precision of target localization during treatment. The positioning technique establishes the pose of the patient's anatomy during treatment by comparing treatment room radiographs with digitally reconstructed radiographs derived from a CT study. The measured pose is then used to align the x-ray therapy beam with the treatment site, without resorting to mechanical fixation. The technique has been found to be sensitive to submillimeter changes in skull position, which is the level of precision desired for radiosurgery. In this report it is shown that the precision of head localization improves by a factor of 2 when the CT slice thickness is reduced from 3.0 to 1.5 mm. This indicates that, in radiosurgical applications, image-guided beam alignment can be significantly influenced by the spatial resolution of the reference CT study. This result is relevant to all high-precision radiographic positioning techniques that utilize CT images.