Tumor Adjacent IL2 Cytokine Factories Eradicates Ovarian Cancer in Mice Through Cytotoxic T-cell Activation with Safe and Predictable Dosing in Non-human Primates

Recombinant IL-2 has been approved for the treatment of melanoma and renal cancer. However, IL-2 therapy is limited by its short half-life in circulation and the associated toxicities that emerge as a result of high systemic exposure. To overcome these limitations, we developed a localized cytokine LOCOcyteTM platform composed of allogeneic and engineered cells which produce potent immune effector molecules for local delivery with temporal regulation of activity. Administration of AVB-001 in mice and non-human primates demonstrated that IL2 local concentration (IP space) was 100x higher than the systemic concentration. Additional studies in mice demonstrated dose-dependent levels of IL2 in the intraperitoneal cavity in mice. Treatment of peritoneal tumors in mice using a single administration of AVB-001 provided sustained eradication of peritoneal tumors in an ovarian cancer mouse model. Our data in mice confirmed local increases in activation (CD25+CD8+) (8.6 fold) and proliferation (Ki67+CD8+)(3.4 fold) of cytotoxic T cells within the IP space in comparison to sham mice. Finally, a single administration of AVB-001 led to therapeutic levels of IL2 in the IP space in NHP and produced local and systemic T cell biomarker profiles that predict efficacy, AVB-001 was well tolerated by all animals with no abnormal clinical observations during the study. Our findings demonstrate that the LOCOcyteTM platform has a dose-dependent PK/PD effect, is safe and efficacious in animal models and enables itself to deliver a diverse set of cytokines alone or in combination which is presently explored. Combined, our pre-clinical results provide a rationale for testing AVB-001 in ovarian cancer patients.

Trends and risk factors of hepatitis A in Catalonia after the introduction of a hepatitis A+B vaccination programme

At the end of 1998, universal hepatitis A+B vaccination of 12 year olds was introduced in Catalonia. The aim was to examine trends in hepatitis A during 2005-2015 and assess risk factors by age group. We carried out an observational epidemiological study of the incidence and risk factors of hepatitis A reported to the surveillance system. Information on exposure was recorded for each case for the 2-6 weeks before symptom onset. Spearman's coefficient was used to evaluate the trends of rates. The chi-square test was used to compare categorical. We studied 2621 hepatitis A cases; the age mean was 26.6 years (SD=18.2), and >50% of cases were in the 20-49 years age group. The incidence decreased from 3.28/100 000 in 2005 to 1.50/100 000 in 2015. The rate for women decreased over time (P = .008), but the reduction was not significant in men (P = .234). Men consistently had higher rates than women with the biggest difference being in the 20-34 years age group (rate 8.8 vs 2.8). The greatest risk factor was travel to an endemic country (42.1%) in the 0-19 years age group and male-to-male sexual contact (18.6%) in the 20-49 years age group. The case fatality rate in adults aged >49 years was 0.4%. In conclusion, the vaccination programme of preadolescents resulted in a reduction in hepatitis A cases. However, a significant amount of cases still appear in immigrants and men who have sex with men. Hepatitis A in adults is an emerging health problem that will require new strategies.

The alternatively-included 11a sequence modifies the effects of Mena on actin cytoskeletal organization and cell behavior

During tumor progression, alternative splicing gives rise to different Mena protein isoforms. We analyzed how Mena11a, an isoform enriched in epithelia and epithelial-like cells, affects Mena-dependent regulation of actin dynamics and cell behavior. While other Mena isoforms promote actin polymerization and drive membrane protrusion, we find that Mena11a decreases actin polymerization and growth factor-stimulated membrane protrusion at lamellipodia. Ectopic Mena11a expression slows mesenchymal-like cell motility, while isoform-specific depletion of endogenous Mena11a in epithelial-like tumor cells perturbs cell:cell junctions and increases membrane protrusion and overall cell motility. Mena11a can dampen membrane protrusion and reduce actin polymerization in the absence of other Mena isoforms, indicating that it is not simply an inactive Mena isoform. We identify a phosphorylation site within 11a that is required for some Mena11a-specific functions. RNA-seq data analysis from patient cohorts demonstrates that the difference between mRNAs encoding constitutive Mena sequences and those containing the 11a exon correlates with metastasis in colorectal cancer, suggesting that 11a exon exclusion contributes to invasive phenotypes and leads to poor clinical outcomes.

Lamellipodin promotes invasive 3D cancer cell migration via regulated interactions with Ena/VASP and SCAR/WAVE

Cancer invasion is a hallmark of metastasis. The mesenchymal mode of cancer cell invasion is mediated by elongated membrane protrusions driven by the assembly of branched F-actin networks. How deregulation of actin regulators promotes cancer cell invasion is still enigmatic. We report that increased expression and membrane localization of the actin regulator Lamellipodin correlate with reduced metastasis-free survival and poor prognosis in breast cancer patients. In agreement, we find that Lamellipodin depletion reduced lung metastasis in an orthotopic mouse breast cancer model. Invasive 3D cancer cell migration as well as invadopodia formation and matrix degradation was impaired upon Lamellipodin depletion. Mechanistically, we show that Lamellipodin promotes invasive 3D cancer cell migration via both actin-elongating Ena/VASP proteins and the Scar/WAVE complex, which stimulates actin branching. In contrast, Lamellipodin interaction with Scar/WAVE but not with Ena/VASP is required for random 2D cell migration. We identified a phosphorylation-dependent mechanism that regulates selective recruitment of these effectors to Lamellipodin: Abl-mediated Lamellipodin phosphorylation promotes its association with both Scar/WAVE and Ena/VASP, whereas Src-dependent phosphorylation enhances binding to Scar/WAVE but not to Ena/VASP. Through these selective, regulated interactions Lamellipodin mediates directional sensing of epidermal growth factor (EGF) gradients and invasive 3D migration of breast cancer cells. Our findings imply that increased Lamellipodin levels enhance Ena/VASP and Scar/WAVE activities at the plasma membrane to promote 3D invasion and metastasis.

Actin foci facilitate activation of the phospholipase C-γ in primary T lymphocytes via the WASP pathway

Wiscott Aldrich Syndrome protein (WASP) deficiency results in defects in calcium ion signaling, cytoskeletal regulation, gene transcription and overall T cell activation. The activation of WASP constitutes a key pathway for actin filament nucleation. Yet, when WASP function is eliminated there is negligible effect on actin polymerization at the immunological synapse, leading to gaps in our understanding of the events connecting WASP and calcium ion signaling. Here, we identify a fraction of total synaptic F-actin selectively generated by WASP in the form of distinct F-actin ‘foci’. These foci are polymerized de novo as a result of the T cell receptor (TCR) proximal tyrosine kinase cascade, and facilitate distal signaling events including PLCγ1 activation and subsequent cytoplasmic calcium ion elevation. We conclude that WASP generates a dynamic F-actin architecture in the context of the immunological synapse, which then amplifies the downstream signals required for an optimal immune response.

DOI:http://dx.doi.org/10.7554/eLife.04953.001

The immune system is made up of several types of cells that protect the body against infection and disease. Immune cells such as T cells survey the body and when receptors on their surface encounter infected cells, the receptors activate the T cell by triggering a signaling pathway.

The early stages of T cell receptor signaling lead to the formation of a cell–cell contact zone called the immunological synapse. Filaments of a protein called F-actin—which are continuously assembled and taken apart—make versatile networks and help the immunological synapse to form. F-actin filaments have crucial roles in the later stages of T cell receptor signaling as well, but how they contribute to this is not clear. Whether it is the same F-actin network that participates both in synapse formation and the late stages of T cell receptor signaling, and if so, then by what mechanism, remains unknown.

The answers came from examining the function of a protein named Wiscott-Aldrich Syndrome Protein (WASP), which forms an F-actin network at the synapse. Loss of WASP is known to result in the X-linked Wiscott-Aldrich Syndrome immunodeficiency and bleeding disorder in humans. Although T cells missing WASP can construct immunological synapses, and these synapses do have normal levels of F-actin and early T cell receptor signaling, they still fail to respond to infected cells properly.

Kumari et al. analyzed the detailed structure and dynamics of actin filament networks at immunological synapses of normal and WASP-deficient T cells. Normally, cells had visible foci of newly polymerized F-actin directly above T cell receptor clusters in the immunological synapses, but these foci were not seen in the cells lacking WASP. Kumari et al. found that the F-actin foci facilitate the later stages of the signaling that activates the T cells; this signaling was lacking in WASP-deficient cells.

Altogether, Kumari et al. show that WASP-generated F-actin foci at immunological synapses bridge the early and later stages of T cell receptor signaling, effectively generating an optimal immune response against infected cells. Further work will now be needed to understand whether there are other F-actin substructures that play specialized roles in T cell signaling, and if foci play a related role in other cell types known to be affected in Wiscott-Aldrich Syndrome immunodeficiency.

DOI:http://dx.doi.org/10.7554/eLife.04953.002

Muscle enzyme and fiber type-specific sarcomere protein increases in serum after inertial concentric-eccentric exercise

Muscle damage induced by inertial exercise performed on a flywheel device was assessed through the serum evolution of muscle enzymes, interleukin 6, and fiber type-specific sarcomere proteins such as fast myosin (FM) and slow myosin (SM). We hypothesized that a model of muscle damage could be constructed by measuring the evolution of serum concentration of muscle proteins following inertial exercise, according to their molecular weight and the fiber compartment in which they are located. Moreover, by measuring FM and SM, the type of fibers that are affected could be assessed. Serum profiles were registered before and 24, 48, and 144 h after exercise in 10 healthy and recreationally active young men. Creatine kinase (CK) and CK-myocardial band isoenzyme increased in serum early (24 h) and returned to baseline values after 48 h. FM increased in serum late (48 h) and remained elevated 144 h post-exercise. The increase in serum muscle enzymes suggests increased membrane permeability of both fast and slow fibers, and the increase in FM reveals sarcomere disruption as well as increased membrane permeability of fast fibers. Consequently, FM could be adopted as a fiber type-specific biomarker of muscle damage.

Improved protease stability of the antimicrobial peptide Pin2 substituted with D-amino acids

Cationic antimicrobial peptides (AMPs) have attracted a great interest as novel class of antibiotics that might help in the treatment of infectious diseases caused by pathogenic bacteria. However, some AMPs with high antimicrobial activities are also highly hemolytic and subject to proteolytic degradation from human and bacterial proteases that limit their pharmaceutical uses. In this work a D-diastereomer of Pandinin 2, D-Pin2, was constructed to observe if it maintained antimicrobial activity in the same range as the parental one, but with the purpose of reducing its hemolytic activity to human erythrocytes and improving its ability to resist proteolytic cleavage. Although, the hydrophobic and secondary structure characteristics of L- and D-Pin2 were to some extent similar, an important reduction in D-Pin2 hemolytic activity (30-40 %) was achieved compared to that of L-Pin2 over human erythrocytes. Furthermore, D-Pin2 had an antimicrobial activity with a MIC value of 12.5 μM towards Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae and two strains of Pseudomonas aeruginosa in agar diffusion assays, but it was half less potent than that of L-Pin2. Nevertheless, the antimicrobial activity of D-Pin2 was equally effective as that of L-Pin2 in microdilution assays. Yet, when D- and L-Pin2 were incubated with trypsin, elastase and whole human serum, only D-Pin2 kept its antimicrobial activity towards all bacteria, but in diluted human serum, L- and D-Pin2 maintained similar peptide stability. Finally, when L- and D-Pin2 were incubated with proteases from P. aeruginosa DFU3 culture, a clinical isolated strain, D-Pin2 kept its antibiotic activity while L-Pin2 was not effective.

Smoking in tuberculosis patients increases the risk of infection in their contacts

OBJECTIVE

To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB).

METHODS

A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (≥5 mm). The risk of LTBI associated with smoking was determined by multi-variate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI).

RESULTS

The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95%CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections.

CONCLUSIONS

Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.

MicroRNA-34a regulates cardiac ageing and function

Ageing is the predominant risk factor for cardiovascular diseases and contributes to a significantly worse outcome in patients with acute myocardial infarction. MicroRNAs (miRNAs) have emerged as crucial regulators of cardiovascular function and some miRNAs have key roles in ageing. We propose that altered expression of miRNAs in the heart during ageing contributes to the age-dependent decline in cardiac function. Here we show that miR-34a is induced in the ageing heart and that in vivo silencing or genetic deletion of miR-34a reduces age-associated cardiomyocyte cell death. Moreover, miR-34a inhibition reduces cell death and fibrosis following acute myocardial infarction and improves recovery of myocardial function. Mechanistically, we identified PNUTS (also known as PPP1R10) as a novel direct miR-34a target, which reduces telomere shortening, DNA damage responses and cardiomyocyte apoptosis, and improves functional recovery after acute myocardial infarction. Together, these results identify age-induced expression of miR-34a and inhibition of its target PNUTS as a key mechanism that regulates cardiac contractile function during ageing and after acute myocardial infarction, by inducing DNA damage responses and telomere attrition.

Protocadherin-12 cleavage is a regulated process mediated by ADAM10 protein: evidence of shedding up-regulation in pre-eclampsia

Protocadherins are a group of transmembrane proteins with homophilic binding activity, members of the cadherin superfamily. Apart from their role in adhesion, the cellular functions of protocadherins are essentially unknown. Protocadherin (PCDH)12 was previously identified in invasive trophoblasts and endothelial and mesangial cells in the mouse. Invalidation studies revealed that the protein was required for optimal placental development. In this article, we show that its human homolog is abundantly expressed in various trophoblast subtypes of the human placenta and at lower levels in endothelial cells. We demonstrate that PCDH12 is shed at high rates in vitro. The shedding mechanism depends on ADAM10 and results in reduced cellular adhesion in a cell migration assay. PCDH12 is subsequently cleaved by the γ-secretase complex, and its cytoplasmic domain is rapidly degraded by the proteasome. PCDH12 shedding is regulated by interlinked intracellular pathways, including those involving protein kinase C, PI3K, and cAMP, that either increase or inhibit cleavage. In endothelial cells, VEGF, prostaglandin E(2), or histamine regulates PCDH12 shedding. The extracellular domain of PCDH12 was also detected in human serum and urine, thus providing evidence of PCDH12 shedding in vivo. Importantly, we observed an increase in circulating PCDH12 in pregnant women who later developed a pre-eclampsia, a frequent pregnancy syndrome and a major cause of maternal and fetal morbidity and mortality. In conclusion, we speculate that, like in mice, PCDH12 may play an important role in human placental development and that proteolytic cleavage in response to external factors, such as cytokines and pathological settings, regulates its activity.

MicroRNA-92a controls angiogenesis and functional recovery of ischemic tissues in mice

MicroRNAs (miRs) are small noncoding RNAs that regulate gene expression by binding to target messenger RNAs (mRNAs), leading to translational repression or degradation. Here, we show that the miR-17approximately92 cluster is highly expressed in human endothelial cells and that miR-92a, a component of this cluster, controls the growth of new blood vessels (angiogenesis). Forced overexpression of miR-92a in endothelial cells blocked angiogenesis in vitro and in vivo. In mouse models of limb ischemia and myocardial infarction, systemic administration of an antagomir designed to inhibit miR-92a led to enhanced blood vessel growth and functional recovery of damaged tissue. MiR-92a appears to target mRNAs corresponding to several proangiogenic proteins, including the integrin subunit alpha5. Thus, miR-92a may serve as a valuable therapeutic target in the setting of ischemic disease.

Factors influencing the case-fatality rate of Legionnaires' disease

SETTING

The extent of the public health problem posed by Legionnaires' disease (LD) is not always well- appreciated.

OBJECTIVE

To determine the characteristics and factors associated with the case fatality rate (CFR) of LD in Catalonia, Spain.

DESIGN

Confirmed cases of LD reported during 1993-2004 were studied. Age, sex, hospitalisation, the type of diagnostic confirmation test and the personal risk factors for LD of cases were collected. Comparative bivariate and multivariate analyses according to origin (community-acquired or nosocomial) and nature (sporadic or outbreaks) were performed.

RESULTS

Of 1938 cases reported, 164 died (case-fatality rate [CFR] 8.5%). The CFR fell from 35% in 1993 to 5.6% in 2004, and was higher in sporadic than in outbreak-associated cases (10% vs. 4.7%) and in nosocomial than community-acquired cases (31.7% vs. 6.8%). In community-acquired cases, the CFR was associated with age >70 years (OR 3.42, 95%CI 2.02-5.79), cancer (OR 4.58, 95%CI 2.36-8.90) and diagnostic confirmation methods other than Legionella urinary antigen test. The CFR of nosocomial cases was not associated with any of these factors.

CONCLUSIONS

The CFR of LD fell during the study period due to the incorporation of new diagnostic techniques and improved detection of outbreaks.

Caspase-8 is involved in neovascularization-promoting progenitor cell functions

OBJECTIVE

Endothelial progenitor cells (EPCs) comprise a heterogeneous population of cells, which improve therapeutic neovascularization after ischemia. The neovascularization-promoting potential of progenitor cells depends on survival and retention of the infused cells to the tissue. Caspases mediate apoptosis but are also involved in other critical biological processes. Therefore, we aimed to address the role of caspases in proangiogenic cells.

METHODS AND RESULTS

The caspase-8 inhibitor zIETD abrogated the ex vivo formation of EPCs, inhibited EPC adhesion and migration, and reduced their capacity to improve neovascularization in vivo. Consistently, cells isolated from caspase-8-deficient mice exhibited a reduced capacity for enhancing neovascularization when transplanted into mice after hindlimb ischemia. Because inhibition of Caspase-8 reduced the adhesion and homing functions of EPCs, we further determined the surface expression of integrins and receptors involved in cell recruitment to ischemic tissues. Pharmacological inhibition of caspase-8 and genetic depletion of caspase-8 reduced the expression of the fibronectin receptor subunits alpha5 and beta1 and the SDF-1 receptor CXCR4. Moreover, we identified the E3 ubiquitin ligase Cbl-b, which negatively regulates integrin and receptor-mediated signaling, as a potential Caspase-8 substrate.

CONCLUSIONS

In summary, our data demonstrate a novel apoptosis-unrelated role of caspase-8 in proangiogenic cells.

Sustained persistence of transplanted proangiogenic cells contributes to neovascularization and cardiac function after ischemia

Circulating blood-derived vasculogenic cells improve neovascularization of ischemic tissue by a broad repertoire of potential therapeutic actions. Whereas initial studies documented that the cells incorporate and differentiate to cardiovascular cells, other studies suggested that short-time paracrine mechanisms mediate the beneficial effects. The question remains to what extent a physical incorporation is contributing to the beneficial effects of cell therapy. By using the inducible suicide gene thymidine kinase to deplete transplanted cells, we determined the contribution of physical incorporation in 3 animal models. After acute myocardial infarction, depletion of cells 14 days after infusion resulted in a reduction of capillary density and a substantial deterioration of heart function. Likewise, neovascularization of Matrigel plugs and ischemic limbs was significantly suppressed when infused cells were depleted 7 days after infusion. Induction of cell death in the previously transplanted cells reduced perfusion and led to vascular leakage as evidenced by Evans blue extravasation. These results indicate that physical incorporation and persistence of cells contribute to cell-mediated improvement of neovascularization and cardiac function. Long-term paracrine activities and/or cell intrinsic mechanisms may have contributed to the maintenance of functional improvement.

Epidemiology of hepatitis A before and after the introduction of a universal vaccination programme in Catalonia, Spain

A universal vaccination program for preadolescents, aged 12 years, with the hepatitis A + B vaccine was introduced in 1998 in Catalonia (Spain) with the aim of protecting the whole population against hepatitis A. The hepatitis A + B vaccine program replaced the hepatitis B vaccination program for preadolescent started in 1991. The impact of the hepatitis A + B vaccination program was studied by assessment of the trend of reported cases of hepatitis A. All cases of viral hepatitis reported from 1992 to 2006 were included in the study. To evaluate changes in the epidemiology of hepatitis A, two periods were considered: a prevaccination period (1992-1998) and a post-vaccination period (2001-2006). The ratios of the rates were calculated according to age and sex. The comparison of rates and proportions was made by calculation of the normal z statistic. A total of 7536 cases of viral hepatitis were reported, of which 4109 (54.52%) were hepatitis A. The incidence rate of hepatitis A fell from 5.44 per 100 000 person-years in the prevaccination period to 3.02 in the post-vaccination period. In males, the rate fell from 6.85 to 3.89 and in females from 4.10 to 2.18. The male-female ratio of incidence rates was lower in the post-vaccination period. In males the global decline of incidence rate was 43.26% and in females 46.96%. The greatest decline occurred in the 15 to 19 years age group in both sexes (79.1% in men and 78.34% in women) but declines in the 10-14 years age group were also very important (69.21% and 67.88%, respectively). In conclusion, hepatitis A incidence fell in Catalonia in the post-vaccination period in vaccinated adolescents and also in other unvaccinated groups who have benefited from the indirect effects of the vaccination program.

Phosphatidylinositol-3-kinase-gamma is integral to homing functions of progenitor cells

Endothelial progenitor cells (EPCs) and hematopoietic progenitor cells are recruited to ischemic regions, improving neovascularization. beta1 and beta2 integrins play a crucial role for progenitor cell homing to ischemic tissues. Integrin activity is regulated by chemokines and their respective G protein-coupled receptors. The phosphatidylinositol-3-kinase catalytic subunit gamma (PI3Kgamma) is the PI3K isoform that selectively transduces signals from G protein-coupled receptors. Here, we investigated the role of PI3Kgamma as a signaling intermediate in the chemokine-induced integrin-dependent homing functions of progenitor cells. A pharmacological PI3Kgamma inhibitor significantly reduced chemokine-induced chemotaxis and stromal cell-derived factor (SDF)1alpha-induced transmigration of human EPCs. Moreover, the PI3Kgamma inhibitor significantly reduced SDF1alpha-induced adhesion of EPCs to intercellular adhesion molecule-1 and human umbilical vein endothelial cell monolayers. These findings were corroborated with Lin(-) bone marrow-derived progenitor cells from PI3Kgamma-deficient mice that displayed reduced SDF1alpha-induced migration and intercellular adhesion molecule-1 adhesion as compared with wild-type cells. Pharmacological inhibition or genetic ablation of PI3Kgamma reduced SDF1alpha-induced integrin activation in human EPCs and in murine Lin(-) BM-derived progenitor cells, respectively. In vivo, the homing of PI3Kgamma-deficient Lin(-) progenitor cells to ischemic muscles after intravenous infusion in the model of hindlimb ischemia and their neovascularization-promoting capacity was reduced as compared with wild-type cells. In conclusion, PI3Kgamma is integral to the integrin-dependent homing of progenitor cells.

High-mobility group box 1 activates integrin-dependent homing of endothelial progenitor cells

Endothelial progenitor cells (EPCs) are recruited to ischemic regions and improve neovascularization. Integrins contribute to EPC homing. High-mobility group box 1 (HMGB1) is a nuclear protein that is released extracellularly on cell necrosis and tissue damage, eliciting a proinflammatory response and stimulating tissue repair. In the present study, we investigated the effects of HMGB1 on EPC homing. EPCs express the HMGB1 receptors RAGE (receptor for advanced glycation end products) and TLR2 (Toll-like receptor 2). EPC migration was stimulated by HMGB1 in a RAGE-dependent manner. In addition, the HMGB1-induced migration of EPCs on fibronectin and fibrinogen was significantly inhibited by antibodies against beta1 and beta2 integrins, respectively. Short-term prestimulation of EPCs with HMGB1 also increased EPC adhesion to endothelial cell monolayers, and this effect was blocked by antibodies to beta2 integrins or RAGE. HMGB1 increased EPC adhesion to the immobilized integrin ligands intercellular adhesion molecule-1 and fibronectin in a RAGE-dependent manner. Strikingly, HMGB1 rapidly increased integrin affinity and induced integrin polarization. Using intravital microscopy in a tumor model of neovascularization, prestimulation of EPCs with HMGB1 enhanced the initial in vivo adhesion of EPCs to microvessels and the recruitment of EPCs in the tumor tissue. In addition, prestimulation of EPCs with HMGB1 increased the homing of EPCs to ischemic muscles. In conclusion, these data represent a link between HMGB1 and integrin functions of EPCs and demonstrate that HMGB1 stimulates EPC homing to ischemic tissues. These results may provide a platform for the development of novel therapeutic approaches to improve EPC homing.

[Postprandial hypotension: an unclear clinical entity]

Postprandial hypotension (PPH) is a clinical entity considered to affect above all elderly people with hypertension. It is equally common in diastolic heart failure, Parkinson's disease, diabetes mellitus and autonomic dysfunction. Diagnosis is based on a minimum of 20 mmHg drop of the systolic blood pressure oron a symptomatic systolic blood pressure decrease within 2 hours of the meal. Post-prandial dizziness, fatigue, syncope and falls must raise suspicion for this entity. Although more frequent than orthostatic hypotension, PPH is less searched for. Socio-economical repercussions associated to falls require a better screening of PPH in hospital and ambulatory conditions.

Sexually acquired HIV infections on the rise in Catalonia, Spain

Reporting of AIDS cases has been mandatory in Spain since 1987, but only eight out of the seventeen

Dramatic decline in acute hepatitis B infection and disease incidence rates among adolescents and young people after 12 years of a mass hepatitis B vaccination programme of pre-adolescents in the schools of Catalonia (Spain)

The aim of the study was to describe the impact of hepatitis B vaccination and disease incidence in adolescents and young people 12 years after the launching of a mass hepatitis B vaccination of pre-adolescents in schools. Vaccination coverage was assessed using administrative and serological data. Infection trends were evaluated by means of seroepidemiological surveys. High levels of vaccination coverage and vaccine-induced immunity were achieved. The resulting low proportions of susceptible adolescents and young people have undoubtedly contributed to the substantial reduction in the prevalence of hepatitis B infection in the 15-24 years age group (0.9 per 100 in 2001 versus 9.3 per 100 in 1986) and in the reported incidence of hepatitis B cases (80% reduction). Over the last 3 years, the declining trend seems to have been halted, although 35% of cases reported during this period corresponded to immigrants.

Preliminary study on the efficacy and tolerability of newer anticonvulsants in a population of epileptic patients

OBJECTIVE

To study the efficacy and safety of newer antiepileptic drugs.

SUBJECTS AND METHODS

Clinical records of 461 epileptic patients attending the Consorcio General Hospital, Valencia, Spain, were reviewed. Demographic data, adverse reactions and clinical outcome were recorded.

RESULTS

One hundred and five patients experienced a total of 151 adverse drug reactions to antiepileptic medications. Adverse drug reactions occurred in the central nervous system (54.9%), skin (17.0%), gastrointestinal tract (13.2%), liver (4.9%), mouth (4.4%) and others (5.6%). The newer anticonvulsants were withdrawn in 19.1% of patients because of side effects, while older drugs were withdrawn in 9.3% of patients. Of the 461 patients, 78 (17.4%) experienced a > or = 50% reduction in seizure frequency when one of the newer anticonvulsants was added to their therapy. Older anticonvulsants were better tolerated than newer drugs. Tiagabine was the worst tolerated of all the drugs.

CONCLUSION

Our findings show that patients with simple partial secondary generalized epilepsy had a greater benefit when a newer anticonvulsant was added to the treatment regimen.

Cadmium availability from granulated and bulk-blended phosphate-potassium fertilizers

Recent field experiments have shown that high chloride (Cl) in irrigation waters can increase soil cadmium (Cd) uptake by crops because of the formation of soluble ion-pair complexes of Cd with Cl in soil solution. The present study was aimed at testing a hypothesis that KCl in granulated PK fertilizers may enhance Cd uptake by crops from Cd-containing P fertilizers because of close contact between Cd and Cl in the same granules. Less effect would be expected if the same granular PK fertilizers were bulk-blended because of separation of Cd and Cl in different granules. A single superphosphate (SSP) containing 32 mg Cd kg(-1) was granulated by the compaction process with KCl at a P to K ratio = 1:1. Granular KCl was also bulk-blended with granular SSP or Cd-free monocalcium phosphate (MCP) at the same P to K ratio. An acid Ultisol (pH 5.2) was treated with PK fertilizers at 400 mg kg(-1) each for P and K. Upland rice (Oryza sativa L.) and soybean [Glycine max (L.) Merr.] were grown to maturity, and signalgrass (Brachiaria decumbens Stapf.) was cut four times during the study. The results showed that the agronomic effectiveness in increasing crop yield was the same with SSP and MCP whether granulated or bulk-blended with KCl. Concentrations of Cd in plant tissue samples of all crops were much lower for MCP than for SSP. In all the plant tissue samples, except grain samples of upland rice, Cd concentrations obtained with granulated (SSP + KCl) were significantly higher than that with bulk-blended (SSP) + (KCl).

The epidemiology of invasive Streptococcus pneumoniae disease in Catalonia (Spain). A hospital-based study

The aim of this study was to investigate the incidence of invasive pneumococcal disease (IPD) in Catalonia. A hospital-based incidence study of the period 1997-1999 was carried out by reviewing the isolations of Streptococcus pneumoniae obtained from normally sterile sites reported by the hospitals that voluntarily participate in the Microbiological Reporting System of Catalonia (MRSC), and those obtained by active retrospective surveillance of cases recorded by microbiology laboratories of the remaining hospitals. Cases of pneumonia were included only if the blood culture was positive. The age, sex and clinical presentation of each patient were recorded. The global incidence of hospital-based IPD was 10.5 per 100,000 persons-year, and was much higher in subjects <2 years of age (59.6) and in those aged > or = 65 years (27.9). In subjects > or = 65 years, bacteremic pneumococcal pneumonias were more frequent in the months from December to March than they were in children <2 years of age (P<0.0001). The global incidence of IPD (10.5 per 100,000 persons-year) is high in Catalonia, greater than that of meningococcal or Haemophilus influenzae invasive disease. In children <2 years, the incidence is nearly six times higher (59.6 per 100,000 persons-year) with pneumonias (rate of 26.2 per 100,000 persons-year) and non-focal bacteremias (rate of 22.1 per 100,000 persons-year) being especially frequent.

[Professionals and managers in face of training]

OBJECTIVES

To analyse ongoing education within primary care teams from managers' perspective.

DESIGN

Cross-sectional descriptive study.

SETTING

The Mother-Infant Health Programme of Andalusia in primary care.

INTERVENTION

The views of health centre professionals were obtained through 8 groups. The type of health district and the number of years in operation were used as criteria for division. The views of the area managers were collected through a self-filled questionnaire from all the managers in the autonomous community.

MEASUREMENTS AND MAIN RESULTS

Professionals believed it necessary to keep up to date and train in new technology. They thought that training activities should focus on questions such as evaluation of programmes, focus of risk, counselling and communication, and certain techniques such as IUD insertion. Both managers and professionals coincided in recognising the effect of training on the development of mother-child services. There was consensus among professionals in affirming that training increases the quality of care delivered. Access to training was the main incentive element used by most area managers and one of those most highly valued by professionals. The professionals affirmed that in recent years there had been obstacles to their education by attending scientific events outside their areas. Many professionals stated that the economic assistance of the pharmaceutical industry for courses caused inequalities between doctors and nurses in access to training. Professionals were very critical of training combined with specialist training.

CONCLUSIONS

Professionals think they have sufficient training for mother-child health care. It is generally recognised that family doctors are better trained for working on health programmes than other professionals at the centres. Ongoing training was rated very highly by both professionals and directors, as it was seen as a motivating element and thought to be an activity almost solely carried out at health centres.

Measles immunity and vaccination policy in Catalonia

The prevalence of antibodies against measles in a representative sample of the school population in Catalonia was established and the results compared with previous studies. The study was carried out in 1996 using blood samples obtained from schoolchildren aged 6-7 years, 10-11 years, 13 14 years and 15-16 years. 1231 schoolchildren were studied. The global prevalence of antibodies was 96.3%, and a considerable increase was observed with respect to the prevalence in 1986 (89.4%). The level of antibodies was 94% at 6-7 years and 10-11 years, 99.7% at 13-14 years and 98.3% at 15 16 years. These data would suggest the advancement of the administration of the second dose of measles-mumps rubella vaccine to 4 6 years instead of at 11 years.

[Motivation and incentives: different perceptions of administrators and professionals. Evaluation Team of the Materno-Infantile Health Program]

OBJECTIVE

To find the views of Primary Care District managers and Health Centre (HC) professionals in Andalusia on systems of motivation and incentive in use in this autonomous community.

DESIGN

A descriptive study which uses qualitative and quantitative methodology.

SETTING

Primary Care districts and Health Centres in Andalusia.

PARTICIPANTS

Primary Care district managers (51) and HC professionals (91).

MATERIAL AND METHODS

Information-gathering: self-administered questionnaire (managers) and focus groups (professionals).

ANALYTICAL TECHNIQUES

Non-parametric tests to compare means and analysis of contents of discourse. Field-work. July 1994 and February 1995.

RESULTS

55% of the district managers thought that the incentive systems in use were inadequate and insufficient. Enabling professionals to be trained is the main motivating and incentive mechanism in place. Variable productivity was the next most common mechanism. However, variable productivity, in the view of the professionals, was the main demotivating factor of recent years. Professionals thought that the economic rewards of the incentives system were slight, the target variables were unsuitable, there were no objective evaluation mechanisms and the economic differences between the incentives earned by managers and professionals were too great.

CONCLUSIONS

The District managers indicated that improvements in the incentives systems used are needed. The HC professionals affirmed that the Andalusian incentives system has demotivated Primary Care teams and has had little effect on orienting professional practice.

Effects of food FR and food deprivation on disruptions in food-maintained performance of monkeys during phencyclidine withdrawal

Six rhesus monkeys self-administered orally-delivered phencyclidine (PCP) and water under concurrent fixed-ratio (FR) 8 schedules. Liquids were available during three 6.5-h periods daily preceded by 1-h components when food was available under an FR 64 (lever press) schedule. After 10 days of stable behavior, water was substituted for PCP for 8 days. PCP was subsequently reinstated, and this PCP withdrawal sequence was repeated using different food FR values (64, 128, 256, 512 and 1024). Each time the food FR was changed behavior was allowed to stabilize for at least 10 days. Under all FR values food-maintained responding decreased markedly during PCP withdrawal, with a gradual recovery over the next 8 days. As the FR value increased from 64 to 1024 there was a parallel shift downward in food-maintained performance. When PCP was reinstated, food-reinforced responding generally returned to baseline rates during the first few days. In a second experiment monkeys were tested for PCP withdrawal effects under relatively food deprived or food satiated conditions under both an FR 512 and 1024 schedule of food delivery. The results showed that the decrease in food-maintained responding during withdrawal was inversely related to the total amount of food consumed during the control period. The results of these experiments indicate that manipulation of both the response requirements for food (FR) and the total amount of food available (food deprivation/satiation) alters the magnitude of response disruptions during PCP withdrawal.