Identification of unique genomic signatures in patients with fibromyalgia and chronic pain

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain. The pathophysiology of fibromyalgia is not clearly understood and there are no specific biomarkers available for accurate diagnosis. Here we define genomic signatures using high throughput RNA sequencing on 96 fibromyalgia and 93 control cases. Our findings revealed three major fibromyalgia-associated expression signatures. The first group included 43 patients with a signature enriched for gene expression associated with extracellular matrix and downregulation of RhoGDI signaling pathway. The second group included 30 patients and showed a profound reduction in the expression of inflammatory mediators with an increased expression of genes involved in the CLEAR signaling pathway. These results suggest defective tissue homeostasis associated with the extra-cellular matrix and cellular program that regulates lysosomal biogenesis and participates in macromolecule clearance in fibromyalgia. The third group of 17 FM patients showed overexpression of pathways that control acute inflammation and dysfunction of the global transcriptional process. The result of this study indicates that FM is a heterogeneous and complex disease. Further elucidation of these pathways will lead to the development of accurate diagnostic markers, and effective therapeutic options for fibromyalgia.

Rationale, design and methods of the HEALTHY study nutrition intervention component

The HEALTHY study was a randomized, controlled, multicenter and middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Here we describe the design of the HEALTHY nutrition intervention component that was developed to modify the total school food environment, defined to include the following: federal breakfast, lunch, after school snack and supper programs; a la carte venues, including snack bars and school stores; vending machines; fundraisers; and classroom parties and celebrations. Study staff implemented the intervention using core and toolbox strategies to achieve and maintain the following five intervention goals: (1) lower the average fat content of foods, (2) increase the availability and variety of fruits and vegetables, (3) limit the portion sizes and energy content of dessert and snack foods, (4) eliminate whole and 2% milk and all added sugar beverages, with the exception of low fat or nonfat flavored milk, and limit 100% fruit juice to breakfast in small portions and (5) increase the availability of higher fiber grain-based foods and legumes. Other nutrition intervention component elements were taste tests, cafeteria enhancements, cafeteria line messages and other messages about healthy eating, cafeteria learning laboratory (CLL) activities, twice-yearly training of food service staff, weekly meetings with food service managers, incentives for food service departments, and twice yearly local meetings and three national summits with district food service directors. Strengths of the intervention design were the integration of nutrition with the other HEALTHY intervention components (physical education, behavior change and communications), and the collaboration and rapport between the nutrition intervention study staff members and food service personnel at both school and district levels.

Identification of human cell responses to hexavalent chromium

Hexavalent chromium [Cr(VI)] is a recognized environmental toxin with ubiquitous distribution in industrialized societies. Its concentration in ambient air derives from several sources including but not limited to chemical processes, the burning of fossil fuels and the production of cement. It is a food contaminant because of its deposition into bodies of water. The majority of published studies on the effects of Cr(VI) concern animal models and these studies have shown that it can induce a variety of cytotoxic and genotoxic reactions that affect the immune system. In order to identify the specific cellular impact of Cr(VI) on humans, we studied its effect on protein production and gene expression in human peripheral blood mononuclear cells (PBMC) obtained from both men and women of each major ethnic group including Caucasians, Hispanics, Asians and African-Americans. High-throughput protein profiling using bead-based protein arrays showed a concentration-dependent biphasic effect of Cr(VI) on the expression of many cytokines and chemokines by activated PBMC. High-density oligonucleotide microarray analysis identified several functional families of genes including those involved in immune response, intracellular signaling, cell cycle, apoptosis, RNA transport and binding, organelle organization and biogenesis that were strongly affected by Cr(VI). Cr(VI) suppressed many cellular receptor genes involved in immune response and activated many cell cycle-related and proapoptotic genes. These results defined responses that were unique to Cr(VI). This methodology defined an effective manner for identifying injurious/toxic human exposures to Cr(VI) at the cellular level that may facilitate the identification and monitoring of efficacious treatments for Cr(VI)-related maladies.

Identification of human cell responses to benzene and benzene metabolites

Benzene is a common air pollutant and confirmed carcinogen, especially in reference to the hematopoietic system. In the present study we analyzed cytokine/chemokine production by, and gene expression induction in, human peripheral blood mononuclear cells upon their exposure to the benzene metabolites catechol, hydroquinone, 1,2,4-benzenetriol, and p-benzoquinone. Protein profiling showed that benzene metabolites can stimulate the production of chemokines, the proinflammatory cytokines TNF-alpha and IL-6, and the Th2 cytokines IL-4 and IL-5. Activated cells showed concurrent suppression of anti-inflammatory cytokine IL-10 expression. We also identified changes in global gene expression patterns in response to benzene metabolite challenges by using high-density oligonucleotide microarrays. Treatment with 1,2,4-benzenetriol resulted in the suppression of genes related to the regulation of protein expression and a concomitant activation of genes that encode heat shock proteins and cytochrome P450 family members. Protein and gene expression profiling identified unique human cellular responses upon exposure to benzene and benzene metabolites.

Risk and protective factors affecting the adjustment of siblings of children with chronic disabilities

OBJECTIVE

To examine the adjustment of nondisabled siblings of handicapped children.

METHOD

In a 3-year longitudinal study, 46 siblings of children with pervasive developmental disorder (PDD), 45 siblings of children with Down syndrome, and 46 siblings of developmentally normal children (serving as controls) were examined at time 1 using the sibling, primary caretaker, and teacher as informants. Both direct and indirect variables related to sibling adjustment were considered.

RESULTS

Significantly more difficulties were found in the siblings of children with PDD compared with the other two groups. Different correlates of adjustment were present in the siblings of the disabled compared with nondisabled children, and mediating factors differed in parent and teacher reports of internalizing difficulties in siblings of children with PDD. Marital satisfaction, lack of parental depression, a cohesive family, and a warm, nonconflictual sibling relationship were protective for normal control and Down syndrome siblings but not for PDD siblings.

CONCLUSION

Findings underline the risks for the siblings of children with PDD and suggest the importance of a transactional mechanism rather than identification of single risk or protective factors in predicting sibling adjustment. Subsequent data analysis in this longitudinal study will assist in defining these mechanisms and allow for improved intervention strategies.

Raf-1 is required for T cell IL2 production

Engagement of the T cell receptor/CD3 complex activates the serine/threonine kinase, Raf-1, but the physiologic consequences of its activation have not been determined. The effects of Raf-1 on interleukin 2 (IL2) production in T cells were examined using activated and inhibitory forms of Raf-1. A truncated active form of Raf-1 was expressed constitutively from the metallothionein promoter in a malignant T cell line, Jurkat. Treatment of the cells with zinc and cadmium greatly increased active Raf-1 expression. This increase in Raf-1 expression allowed antibodies to CD3 and to CD28 to stimulate IL2 production in the absence of phorbol myristate acetate (PMA) and enhanced IL2 production stimulated by these antibodies in the presence of PMA. The action of active Raf-1 was to increase IL2 gene transcription as it enhanced transcription of a reporter gene linked to IL2 promoter. Finally, the dominant negative form of Raf-1 inhibited transcription directed by the IL2 promoter that was induced by the mitogen phytohemagglutinin (PHA) and PMA. We conclude that Raf-1 activity is necessary for IL2 gene transcription and secretion. These data indicate a role for Raf-1 in the immune response.

Infusion of autologous platelet rich plasma does not reduce blood loss and product use after coronary artery bypass. A prospective, randomized, blinded study

Prior nonblinded studies have suggested dramatic hemostatic effects and decreased plasma after cardiopulmonary bypass. Platelet rich plasma (8 to 10 ml/kg total body weight) was obtained (Haemonetics Plasma Saver; Haemonetics Corp., Natick, Mass.) from 51 patients undergoing primary coronary artery bypass grafting before heparinization. After double-blinded randomization, the platelet rich plasma was reinfused immediately in the control group or after heparin reversal in the treatment group. Homologous blood product usage, blood loss, and the surgeon's intraoperative subjective assessment of coagulation were evaluated. Additionally, thromboelastography, prothrombin time, partial thromboplastin time, activated clotting time, fibrinogen, platelet counts, and hematocrit values were evaluated before the operation, after heparin reversal, after infusion of platelet rich plasma or control solution, and 2 hours after infusion. The surgeon's subjective assessment of coagulation was not different between control and treatment groups (p = 0.78). According to specific predetermined transfusion guidelines, no statistically significant differences were found in the use of whole blood (p = 0.07), packed red blood cells (p = 0.62), platelets (p = 0.11), total units of blood products (p = 0.45), or in the percentage of patients receiving transfusions (control group 70%, treatment group 71%, p = 0.97). Cumulative amount of blood shed through the chest tube was not significantly different between the groups at any interval but tended toward significance at 4, 6, and 12 hours (p = 0.09, 0.07, and 0.09). The prothrombin time immediately after reinfusion of platelet rich plasma was significantly lower in the treatment group (p = 0.03), but all other laboratory studies were similar at each time interval. Infusion of platelet rich plasma after cardiopulmonary bypass in patients having uncomplicated primary coronary artery bypass grafting has minimal effects on the surgeon's assessment of coagulation, total transfusion requirements, mediastinal drainage, and laboratory studies of coagulation.