Validating saliva as a biological sample for cost-effective, rapid and routine screening for SARS-CoV-2

PURPOSE

Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR based SARS-CoV-2 detection.

METHODS

We collected paired nasopharyngeal/oropharyngeal swabs and saliva samples from suspected positive SARS-CoV-2 patients and tested using RT-PCR. We used generalized linear models to investigate factors that explain result agreement. Further, we used simulations to evaluate the effectiveness of saliva-based screening in restricting the spread of infection in a large campus such as an educational institution.

RESULTS

We observed a 75.4% agreement between saliva and N/OPS-VTM, that increased drastically to 83% in samples stored for less than three days. Such samples processed within two days of collection showed 74.5% test sensitivity. Our simulations suggest that a test with 75% sensitivity, but high daily capacity can be very effective in limiting the size of infection clusters in a workspace. Guided by these results, we successfully implemented a saliva-based screening in the Bangalore Life Sciences Cluster (BLiSC) campus.

CONCLUSION

These results suggest that saliva may be a viable alternate source for SARS-CoV-2 surveillance if samples are processed immediately. Although saliva shows slightly lower sensitivity levels when compared to N/OPS-VTM, saliva collection is logistically advantageous. We strongly recommend the implementation of saliva-based screening strategies for large workplaces and in schools, as well as for population-level screening and routine surveillance as we learn to live with the SARS-CoV-2 virus.

Innovator Versus Biosimilar Ranibizumab in Polypoidal Choroidal Vasculopathy: Real-World Evidence

Introduction

To analyze the efficacy and safety profile of the intravitreal ranibizumab biosimilar molecule, Razumab^® (Intas Pharmaceuticals, Ahmedabad, India; BRm; Razumab^®) and the innovator ranibizumab drug (IRm; LUCENTIS^®) in Indian patients with polypoidal choroidal vasculopathy (PCV) under real-world conditions.

Methods

This was a retrospective study of treatment-naïve and previously treated PCV eyes undergoing intravitreal therapy with either BRm or IRm from January 2019 to September 2020 as three loading doses followed by a pro-re-nata (PRN) regimen. Changes in the best-corrected visual acuity (BCVA), subretinal fluid (SRF), intraretinal fluid (IRF), SRF height, and subfoveal choroidal thickness (SFCT) and the safety profiles were assessed at weeks 12, 24, and 52, respectively.

Results

A total of 22 eyes received IRm and 19 eyes underwent BRm therapy, respectively. Both the groups were comparable in age (P = 0.41) and gender distribution, although the BRm arm had significantly more eyes that were previously treated (P < 0.00001) with a greater median number of injections (P < 0.0001). At week 52, both groups had similar gains in visual acuity (P = 0.19), SRF resolution (P = 0.8), IRF resolution (P = 0.47), and SRF height (P = 0.71). The IRm eyes exhibited a significant improvement in BCVA (P = 0.001) at all visits with a greater mean number of injections (IRm: 5.41 ± 0.94; BRm: 4 ± 1.45; P = 0.0004), while the BRm eyes showed a similar increase in BCVA but did not reach statistical significance until week 52. The SFCT decreased significantly in the BRm arm at week 52 (P = 0.045). One eye (5.26%) in the BRm arm experienced mild anterior uveitis, which was treated with topical corticosteroids. In either arm, no other ocular or systemic adverse effects were observed.

Conclusions

Our real-world data demonstrated the ranibizumab biosimilar Razumab to have comparable visual acuity outcomes to the innovator ranibizumab molecule with an adequate safety profile in the management of PCV. Although these encouraging results support its use as a viable alternative to the innovator molecule, further prospective studies in a diverse patient population are needed to validate our findings.

Role of fibroblast growth factor-23 (FGF-23) in the prediction of postoperative atrial fibrillation after coronary artery bypass surgery

Introduction

Fibroblast growth factor-23 (FGF-23) is a bone-derived hormone which had shown a significant association with the occurrence of atrial fibrillation (AF) in patients with chronic kidney disease. We hypothesized that FGF-23 could be a very useful predictive biomarker for atrial remodeling and in turn for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). We also looked at the correlation of cardiac remodeling in right atrial biopsy and its correlation with POAF and with the FGF-23 level.

Methods

This study was a single-center cross-sectional observational study. All the patients who were planned for CABG with no prior history of AF were included in the study. All the patients were tested for preoperative serum FGF-23 level. During CABG, biopsy specimen of the right atrial appendage was sent for histopathology evaluation. All patients were monitored for POAF until discharge from the hospital.

Results

This study involved 60 patients who underwent elective CABG. Multivariate analysis revealed a significant association between preoperative FGF-23 levels with the occurrence of POAF (p < 0.001). The area under the curve of FGF-23 was 0.894 with a sensitivity of 92.3% and specificity of 87.23%. The cut-off value for serum FGF-23 levels was found to be 6.50 ng/ml. Analysis of biopsy specimens revealed that the presence of hypertrophic myocytes had a significant association with the occurrence of POAF/POAE and with FGF-23.

Conclusion

Preoperative FGF-23 levels can predict the incidence of POAF in post-CABG patients. Histopathologically, the presence of hypertrophic myocytes correlated well with the occurrence of POAF.

ImmunoPET, [64Cu]Cu-DOTA-Anti-CD33 PET-CT, Imaging of an AML Xenograft Model

PURPOSE

Acute myeloid leukemia (AML) is a highly aggressive form of leukemia, which results in poor survival outcomes. Currently, diagnosis and prognosis are based on invasive single-point bone marrow biopsies (iliac crest). There is currently no AML-specific noninvasive imaging method to detect disease, including in extramedullary organs, representing an unmet clinical need. About 85% to 90% of human myeloid leukemia cells express CD33 cell surface receptors, highlighting CD33 as an ideal candidate for AML immunoPET.

EXPERIMENTAL DESIGN

We evaluated whether [⁶⁴Cu]Cu-DOTA-anti-CD33 murine mAb can be used for immunoPET imaging of AML in a preclinical model. MicroCT was adjusted to detect spatial/anatomical details of PET activity. For translational purposes, a humanized anti-CD33 antibody was produced; we confirmed its ability to detect disease and its distribution. We reconfirmed/validated CD33 antibody-specific targeting with an antibody-drug conjugate (ADC) and radioimmunotherapy (RIT).

RESULTS

[⁶⁴Cu]Cu-DOTA-anti-CD33-based PET-CT imaging detected CD33⁺ AML in mice with high sensitivity (95.65%) and specificity (100%). The CD33⁺ PET activity was significantly higher in specific skeletal niches [femur (P < 0.00001), tibia (P = 0.0001), humerus (P = 0.0014), and lumber spine (P < 0.00001)] in AML-bearing mice (over nonleukemic control mice). Interestingly, the hybrid PET-CT imaging showed high disease activity in the epiphysis/metaphysis of the femur, indicating regional spatial heterogeneity. Anti-CD33 therapy using newly developed humanized anti-CD33 mAb as an ADC (P = 0.02) and [²²⁵Ac]Ac-anti-CD33-RIT (P < 0.00001) significantly reduced disease burden over that of respective controls.

CONCLUSIONS

We have successfully developed a novel anti-CD33 immunoPET-CT-based noninvasive modality for AML and its spatial distribution, indicating a preferential skeletal niche.

Sodium levels of human pancreatic donors are a critical factor for determination of islet efficacy and survival

Organs from hypernatremia (elevated Na+) donors when used for transplantation have had dismal outcomes. However, islet isolation from hypernatremic donors for both transplantation and research applications has not yet been investigated. A retrospective analysis of in vivo and in vitro islet function studies was performed on islets isolated from hypernatremic (serum sodium levels≥160 meq/l) and normal control (serum sodium levels≤155 meq/l) donors. Twelve isolations from 32 hypernatremic and 53 isolations from 222 normal donors were randomly transplanted into diabetic NOD Scid mice. Sodium levels upon pancreas procurement were significantly elevated in the hypernatremia group (163.5±0.6 meq/l) compared with the normal control group (145.9±0.4 meq/l) (P<0.001). The postculture islet recovery rate was significantly lower in the hypernatremia (59.1±3.8%) group compared with the normal (73.6±1.8%) group (P=0.005). The duration of hypernatremia was inversely correlated with the recovery rate (r2=0.370, P<0.001). Furthermore, the percentage of successful graft function when transplanted into diabetic NOD Scid mice was significantly lower in the hypernatremia (42%) group compared with the normal control (85%) group (P<0.001). The ability to predict islet graft function posttransplantation using donor sodium levels and duration of hypernatremia was significant (ROC analysis, P=0.022 and 0.042, respectively). In conclusion, duration of donor hypernatremia is associated with reduced islet recovery postculture. The efficacy of islets from hypernatremia donors diminished when transplanted into diabetic recipients.

Human Pancreatic Islets Isolated From Donors With Elevated HbA1c Levels: Islet Yield and Graft Efficacy

The aim of this study was to investigate the effects of elevated donor HbA1c levels (type 2 diabetes, T2D) on the islet yield and functionality postisolation. In this retrospective analysis, donors for islet isolations were classified into two groups: T2D group (HbA1c ≥ 6.5%, n = 18) and normal group (HbA1c < 6.5%, n = 308). Optimum pancreas digestion time (switch time) was significantly higher in the T2D group compared to the normal group (13.7 ± 1.2 vs. 11.7 ± 0.1 min, respectively, p = 0.005). Islet yields were significantly lower in the T2D group compared to the control (T2D vs. control): islet equivalent (IEQ)/g (prepurification 2,318 ± 195 vs. 3,713 ± 114, p = 0.003; postpurification 1,735 ± 175 vs. 2,663 ± 89, p = 0.013) and islet particle number (IPN)/g (prepurification, 2,519 ± 336 vs. 4,433 ± 143, p = 0.001; postpurification, 1,760 ± 229 vs. 2,715 ± 85, p = 0.007). Islets from T2D pancreata had significantly lower viability (T2D vs.

CONTROL

91.9 ± 1.6 vs. 94.4 ± 0.3%, p = 0.004) and decreased oxygen consumption rate (ΔOCR) (T2D vs.

CONTROL

0.09 ± 0.01 and 0.21 ± 0.03 nmol O2 100 islets(-1) min(-1), p = 0.049). The islets isolated from T2D donor pancreata reversed diabetes in NOD-SCID mice in 9% (2/22) compared to islets from control donor pancreata, which reversed diabetes in 67% (175/260, p < 0.001). In conclusion, this study demonstrates that elevated HbA1c (≥ 6.5%) is associated with impairment of islet function and lower islet yield; however, these islets could not be suitable for clinical applications.

(64)Cu labeled sarcophagine exendin-4 for microPET imaging of glucagon like peptide-1 receptor expression

The Glucagon-like peptide 1 receptor (GLP-1R) has become an important target for imaging due to its elevated expression profile in pancreatic islets, insulinoma, and the cardiovascular system. Because native GLP-1 is degraded rapidly by dipeptidyl peptidase-IV (DPP-IV), several studies have conjugated different chelators to a more stable analog of GLP-1 (such as exendin-4) as PET or SPECT imaging agents with various advantages and disadvantages. Based on the recently developed Sarcophagin chelator, here, we describe the construction of GLP-1R targeted PET probes containing monomeric and dimeric exendin-4 subunit. The in vitro binding affinity of BarMalSar-exendin-4 and Mal2Sar-(exendin-4)2 was evaluated in INS-1 cells, which over-express GLP-1R. Mal2Sar-(exendin-4)2 demonstrated around 3 times higher binding affinity compared with BaMalSar-exendin-4. After (64)Cu labeling, microPET imaging of (64)Cu-BaMalSar-exendin-4 and (64)Cu-Mal2Sar-(exendin-4)2 were performed on subcutaneous INS-1 tumors, which were clearly visualized with both probes. The tumor uptake of (64)Cu-Mal2Sar-(exendin-4)2 was significantly higher than that of (64)Cu-BaMaSarl-exendin-4, which could be caused by polyvalency effect. The receptor specificity of these probes was confirmed by effective blocking of the uptake in both tumor and normal positive organs with 20-fold excess of unlabeled exendin-4. In conclusion, sarcophagine cage conjugated exendin-4 demonstrated persistent and specific uptake in INS-1 insulinoma model. Dimerization of exendin-4 could successfully lead to increased tumor uptake in vivo. Both (64)Cu-BaMalSar-exendin-4 and (64)Cu-Mal2Sar-(exendin-4)2 hold a great potential for GLP-1R targeted imaging.

An oral vaccine for type 1 diabetes based on live attenuated Salmonella

Type 1 diabetes (T1D) is a metabolic disease that is initiated by the autoimmune destruction of pancreatic insulin-producing beta cells that is accompanied by the development of antigen-specific antibodies and cytotoxic T lymphocytes (CTLs). Several studies have shown that vaccination with diabetic autoantigens provides some protection against this process. In this report we describe a new oral vaccine that utilizes live attenuated Salmonella for simultaneous delivery of autoantigens in conjunction with immunomodulatory cytokine genes to immune cells in the gut mucosa. Recent data showed that live attenuated Salmonella is a safe, simple and effective vector for expression of antigens and cytokines by antigen-presenting cells (APCs) of gut-associated lymphatic tissue (GALT). This novel strategy was tested by fusion of the diabetic autoantigen preproinsulin with Salmonella secretory effector protein (SseF) of pathogenicity island-2 (SPI2). In this way the autoantigen is only expressed inside the host immune cells and translocated to the host cell cytosol. In addition Salmonella was used to deliver the gene for the immunomodulatory cytokine transforming growth factor beta (TGFβ) for host cell expression. Oral co-vaccination of 8 week-old non-obese diabetic (NOD) mice with three weekly doses of both the autoantigen and cytokine significantly reduced the development of diabetes, improved the response to glucose challenge, preserved beta cell mass, and reduced the severity of insulitis compared with controls and autoantigen alone. Combination therapy also resulted in increased circulating levels of IL10 four weeks post-vaccination and IL2 for 12 weeks post-vaccination, but without effect on proinflammatory cytokines IL6, IL12(p70), IL17 and IFNγ. However, in non-responders there was a significant rise in IL12 compared with responders. Future studies will examine the mechanism of this vaccination strategy in more detail. In conclusion, Salmonella-based oral vaccines expressing autoantigens combined with imunomodulatory cytokines appears to be a promising therapy for prevention of T1D.

Development and evaluation of 18F-TTCO-Cys40-Exendin-4: a PET probe for imaging transplanted islets

Because islet transplantation has become a promising treatment option for patients with type 1 diabetes, a noninvasive imaging method is greatly needed to monitor these islets over time. Here, we developed an (18)F-labeled exendin-4 in high specific activity for islet imaging by targeting the glucagonlike peptide-1 receptor (GLP-1R).

METHODS

Tetrazine ligation was used to radiolabel exendin-4 with (18)F. The receptor binding of (19/18)F-tetrazine trans-cyclooctene (TTCO)-Cys(40)-exendin-4 was evaluated in vitro with INS-1 cell and in vivo on INS-1 tumor (GLP-1R positive) and islet transplantation models.

RESULTS

(18)F-TTCO-Cys(40)-exendin-4 was obtained in high specific activity and could specifically bind to GLP-1R in vitro and in vivo. Unlike the radiometal-labeled exendin-4, (18)F-TTCO-Cys(40)-exendin-4 has much lower kidney uptake. (18)F-TTCO-Cys(40)-exendin-4 demonstrated its great potential for transplanted islet imaging: the liver uptake value derived from small-animal PET images correlated well with the transplanted β-cell mass determined by immunostaining. Autoradiography showed that the localizations of radioactive signal indeed corresponded to the distribution of islet grafts in the liver of islet-transplanted mice.

CONCLUSION

(18)F-TTCO-Cys(40)-exendin-4 demonstrated specific binding to GLP-1R. This PET probe provides a method to noninvasively image intraportally transplanted islets.

Are ICT/Web 2.0 Tools Influencing Civic Engagement in Modern Democracies?

Web 2.0 tools, while mobilising citizens to make informed choices, may also manipulated public opinion. This hypothesis forms the central theme of this research investigation through the historiography lens. Based on concurrent research from decade, the authors take a closer look at citizen-to-citizen engagement, so as to trace the role of web 2.0 tools, in perhaps manipulating public opinion or enabling democratic governance through reversal of some existing defects in the Indian context. Specifically, they raise these questions: Has ICT enabled civic engagement manipulated public opinion in this developing democracy? Has it succeeded in reversing apparent defects in the electoral system, which is regarded pivotal in democracies? Focusing on the elections, the authors present a synopsis of the use of web 2.0 tools which were seemingly efficiently and prolifically used during the elections albeit to reach out to the large population base in this country.

Mixed chimerism and growth factors augment β cell regeneration and reverse late-stage type 1 diabetes

Type 1 diabetes (T1D) results from an autoimmune destruction of insulin-producing β cells. Currently, islet transplantation is the only curative therapy for late-stage T1D, but the beneficial effect is limited in its duration, even under chronic immunosuppression, because of the chronic graft rejection mediated by both auto- and alloimmunity. Clinical islet transplantation is also restricted by a severe shortage of donor islets. Induction of mixed chimerism reverses autoimmunity, eliminates insulitis, and reverses new-onset but not late-stage disease in the nonobese diabetic (NOD) mouse model of T1D. Administration of gastrin and epidermal growth factor (EGF) also reverses new-onset but not late-stage T1D in this animal model. Here, we showed that combination therapy of induced mixed chimerism under a radiation-free nontoxic anti-CD3/CD8 conditioning regimen and administration of gastrin/EGF augments both β cell neogenesis and replication, resulting in reversal of late-stage T1D in NOD mice. If successfully translated into humans, this combination therapy could replace islet transplantation as a long-term curative therapy for T1D.

Mesenchymal stem cells facilitate mixed hematopoietic chimerism induction and prevent onset of diabetes in nonobese diabetic mice

OBJECTIVES

Allogeneic mesenchymal stem cells (MSCs) and bone marrow cells (BMCs) were cotransplanted in nonobese diabetic mice after none myeloablative preconditioning and the development of chimerism, insulitis, diabetes, and graft-versus-host disease (GVHD) were monitored.

METHODS

Eight-week-old female nonobese diabetic mice were injected intravenously with 2 × 10 BMCs and 5 × 10 MSCs from C57BL/6 mice after treatment with 2 intraperitoneal injections of anti-CD3 antibody (days -7 and -4) and 3-Gy total body irradiation (day -1). Thereafter, blood glucose and chimerism were monitored on peripheral blood samples.

RESULTS

Stable mixed chimerism (3->90% of donor phenotype) was induced in 63.2% of BMCs-MSCs recipients (n = 19) and 45.0% of BMCs-alone recipients (n = 20, P = 0.256). Insulitis was prevented, and euglycemia persisted for more than 18 weeks in 89.5% of BMCs-MSCs recipients including those with less than 3% chimerism and 55% of BM-alone recipients (P < 0.05). In controls, 9.1% of mice receiving preconditioning treatment alone (n = 11) and 16.7% of preconditioned mice receiving only MSCs (n = 12) were nondiabetic. Graft-versus-host disease was not detected in all mice.

CONCLUSIONS

Coinjection of MSCs and BMCs increased the success rate in inducing chimerism and preventing insulitis and overt diabetes with no incidence of GVHD. Results also indicated that even microchimerism with less than 3% donor cells is sufficient for blocking autoimmunity.

mRNA of the pro-apoptotic gene BBC3 serves as a molecular marker for TNF-α-induced islet damage in humans

AIMS/HYPOTHESIS

TNF-α plays important roles in the pathogenesis of type 1 and type 2 diabetes mellitus. In light of this, we examined the involvement of a pro-apoptotic gene, BBC3 (also known as PUMA), in TNF-α-mediated beta cell dysfunction and destruction in human islets.

METHODS

Human islets were exposed in vitro to TNF-α alone or in combination with IFN-γ. Gene expression was assessed by RT-PCR using a set of single islets. Protein abundance and cellular localisation of BBC3 were assessed by immunoblot and immunohistochemistry. A marginal number of islets were transplanted into diabetic NODscid mice to correlate in vivo islet function with BBC3 expression.

RESULTS

BBC3 and IL8 mRNA were upregulated in TNF-α-stimulated islets in a dose-dependent manner and enhanced through addition of IFN-γ, but not upregulated by IFN-γ alone. Immunohistochemistry revealed that TNF-α in combination with IFN-γ upregulated basal BBC3 abundance in the cytoplasm of beta cells along with the perinuclear clustering of mitochondria partially co-localised with BBC3. TNF-α alone did not induce beta cell death, but did abrogate preproinsulin precursor mRNA synthesis in response to high glucose stimulation, which was inversely associated with upregulation of BBC3 mRNA expression by TNF-α. Higher BBC3 mRNA expression in islets correlated with decreased graft function in vivo.

CONCLUSIONS/INTERPRETATION

These results suggest that BBC3 mRNA can serve as a molecular marker to detect early TNF-α-induced beta cell stress and may help identify islet-protective compounds for the treatment of diabetes.

In vivo imaging of transplanted islets with 64Cu-DO3A-VS-Cys40-Exendin-4 by targeting GLP-1 receptor

Glucagon-like peptide 1 receptor (GLP-1R) is highly expressed in pancreatic islets, especially on β-cells. Therefore, a properly labeled ligand that binds to GLP-1R could be used for in vivo pancreatic islet imaging. Because native GLP-1 is degraded rapidly by dipeptidyl peptidase-IV (DPP-IV), a more stable agonist of GLP-1 such as Exendin-4 is a preferred imaging agent. In this study, DO3A-VS-Cys(40)-Exendin-4 was prepared through the conjugation of DO3A-VS with Cys(40)-Exendin-4. The in vitro binding affinity of DO3A-VS-Cys(40)-Exendin-4 was evaluated in INS-1 cells, which overexpress GLP-1R. After (64)Cu labeling, biodistribution studies and microPET imaging of (64)Cu-DO3A-VS-Cys(40)-Exendin-4 were performed on both subcutaneous INS-1 tumors and islet transplantation models. The subcutaneous INS-1 tumor was clearly visualized with microPET imaging after the injection of (64)Cu-DO3A-VS-Cys(40)-Exendin-4. GLP-1R positive organs, such as pancreas and lung, showed high uptake. Tumor uptake was saturable, reduced dramatically by a 20-fold excess of unlabeled Exendin-4. In the intraportal islet transplantation models, (64)Cu-DO3A-VS-Cys(40)-Exendin-4 demonstrated almost two times higher uptake compared with normal mice. (64)Cu-DO3A-VS-Cys(40)-Exendin-4 demonstrated persistent and specific uptake in the mouse pancreas, the subcutaneous insulinoma mouse model, and the intraportal human islet transplantation mouse model. This novel PET probe may be suitable for in vivo pancreatic islets imaging in the human.

Neuroendocrine tumor of vulva: a case report and review of literature

Neuroendocrine tumor (Merkel cell carcinoma-MCC) of the vulva is a very rare entity with less than 15 cases reported in the English literature. It is known for its aggressive behaviour and propensity for early dissemination. The actual cell of origin and etiology of this disease is controversial. In absence of any definite guidelines for management (due to its rarity), extrapolation of data from extra-vulvar MCC seems logical. We present a case of vulvar neuroendocrine tumor who presented at a locally advanced stage.

Induction of chimerism permits low-dose islet grafts in the liver or pancreas to reverse refractory autoimmune diabetes

OBJECTIVE

To test whether induction of chimerism lowers the amount of donor islets required for reversal of diabetes and renders the pancreas a suitable site for islet grafts in autoimmune diabetic mice.

RESEARCH DESIGN AND METHODS

The required donor islet dose for reversal of diabetes in late-stage diabetic NOD mice after transplantation into the liver or pancreas was compared under immunosuppression or after induction of chimerism. Recipient mice were monitored for blood glucose levels and measured for insulin-secretion capacity. Islet grafts were evaluated for beta-cell proliferation, beta-cell functional gene expression, and revascularization.

RESULTS

With immunosuppression, transplantation of 1,000, but not 600, donor islets was able to reverse diabetes when transplanted into the liver, but transplantation of 1,000 islets was not able to reverse diabetes when transplanted into the pancreas. In contrast, after induction of chimerism, transplantation of as few as 100 donor islets was able to reverse diabetes when transplanted into either the liver or pancreas. Interestingly, when lower doses (50 or 25) of islets were transplanted, donor islets in the pancreas were much more effective in reversal of diabetes than in the liver, which was associated with higher beta-cell replication rate, better beta-cell functional gene expression, and higher vascular density of graft islets in the pancreas.

CONCLUSIONS

Induction of chimerism not only provides immune tolerance to donor islets, but also markedly reduces the required amount of donor islets for reversal of diabetes. In addition, this process renders the pancreas a more superior site than the liver for donor islets in autoimmune mice.

Glucose-stimulated increment in oxygen consumption rate as a standardized test of human islet quality

Standardized assessment of islet quality is imperative for clinical islet transplantation. We have previously shown that the increment in oxygen consumption rate stimulated by glucose (DeltaOCR(glc)) can predict in vivo efficacy of islet transplantation in mice. To further evaluate the approach, we studied three factors: islet specificity, islet composition and agreement between results obtained by different groups. Equivalent perifusion systems were set up at the City of Hope and the University of Washington and the values of DeltaOCR(glc) obtained at both institutions were compared. Islet specificity was determined by comparing DeltaOCR(glc) in islet and nonislet tissue. The DeltaOCR(glc) ranged from 0.01 to 0.19 nmol/min/100 islets (n = 14), a wide range in islet quality, but the values obtained by the two centers were similar. The contribution from nonislet impurities was negligible (DeltaOCR(glc) was 0.12 nmol/min/100 islets vs. 0.007 nmol/min/100 nonislet clusters). The DeltaOCR(glc) was statistically independent of percent beta cells, demonstrating that DeltaOCR(glc) is governed more by islet quality than by islet composition. The DeltaOCR(glc), but not the absolute level of OCR, was predictive of reversal of hyperglycemia in diabetic mice. These demonstrations lay the foundation for testing DeltaOCR(glc) as a measurement of islet quality for human islet transplantation.

Multipotent progenitor cells isolated from adult human pancreatic tissue

The supply of islet cells is a limiting factor for the widespread application of islet transplantation of type-1 diabetes. Islets constitute 1% to 2% of pancreatic tissue, leaving approximately 98% as discard after islet isolation and purification. In this report we present our data on the isolation of multipotent progenitor cells from discarded adult human pancreatic tissue. The collected cells from discarded nonislet fractions, after enzymatic digestion and gradient purification of islets, were dissociated for suspension culture in a serum-free medium. The cell clusters grown to a size of 100 to 150 mum contained cells staining for stage-specific embryonic antigens, but not insulin or C-peptide. To direct cell differentiation toward islets, clusters were recultured in a pancreatic differentiation medium. Insulin and C-peptide-positive cells by immunocytochemistry appeared within a week, reaching over 10% of the cell population. Glucagon and somatostatin-positive cells were also detected. The cell clusters were found to secrete insulin in response to glucose stimulation. Cells from the same clusters also had the capacity for differentiation into neural cells, as documented by staining for neural and glial cell markers when cultured as monolayers in media containing neurotrophic factors. These data suggest that multipotent pancreatic progenitor cells exist within the human pancreatic tissue that is typically discarded during islet isolation procedures. These adult progenitor cells can be successfully differentiated into insulin-producing cells, and thus they have the potential for treatment of type-1 diabetes mellitus.

Generation of human islets through expansion and differentiation of non-islet pancreatic cells discarded (pancreatic discard) after islet isolation

OBJECTIVES

Islet transplantation is hampered by the shortage of donor tissues. Our objective was to generate islet-like cell clusters (ICCs) from cultures of non-islet pancreatic cells.

METHODS

The starting cultured cells came from the non-islet fractions of human pancreases after enzymatic digestion and purification for the purpose of islet isolation. Initially, these cells expanded in monolayer cultures and became confluent on collagen-coated flasks. After trypsination and suspension of these cells in a defined islet differentiation medium, the cells aggregated to form ICCs.

RESULTS

The initial cell population consisted of less than 1% of insulin-positive cells, 44% amylase-positive cells, and 41% cytokeratin (CK) 7-positive, or CK19 cells, but PDX-1 cells were absent. Cells from later stages of the monolayer cultures showed signs of dedifferentiation/transdifferentiation. At the time of harvesting, more than 90% of the cells were positive for CK 7/19 and PDX-1, but less than 1% of the cells were insulin-positive. After aggregation, the ICCs appeared redifferentiated, and contained glucose-responsive, insulin-secreting cells with an insulin content measuring 20% of that found in freshly isolated islets isolated from the same pancreas. ICCs transplanted into athymic mice and removed after 4 months did acquire the morphology of mature islets, indicating further maturation of the ICCs in vivo after transplantation. Human C-peptide was detected in recipient animal sera.

CONCLUSION

Using the specified culture methods, non-islet pancreas cells can generate cell clusters resembling islets. These ICCs, obtained from fractions of the pancreas that are otherwise discarded, continue to differentiate after transplantation to become mature islets.

Increased expression of cyclooxygenase-2 in human pancreatic islets treated with high glucose or ligands of the advanced glycation endproduct-specific receptor (AGER), and in islets from diabetic mice

AIMS/HYPOTHESIS

The cyclooxygenase-2 (PTGS2, previously known as COX2) enzyme and its products, such as prostaglandin E(2) (PGE(2)), have been implicated in the pathogenesis of several inflammatory diseases including islet dysfunction under diabetic conditions. In this study we evaluated whether diabetic conditions in vitro, such as high-glucose (HG) culture or AGE, or in vivo in animal models of diabetes can induce PTGS2 expression and activity in pancreatic islets.

MATERIALS AND METHODS

Isolated human pancreatic islets were treated for 24 h with HG (25 mmol/l) or with S100b (5 mg/l), a specific ligand for the AGE-specific receptor. PTGS2 and cyclooxygenase-1 (PTGS1, previously known as COX1) mRNA, protein expression and product PGE(2) were analysed by RT-PCR, Western blots and specific enzyme immunoassay respectively. Islet PTGS2 production in animal models was assessed by immunofluorescence.

RESULTS

Treatment of human pancreatic islets with HG and S100b led to a three-five-fold induction of PTGS2 mRNA (p<0.001). PTGS2 protein and its product PGE(2) (351.4+/-13.05 fg/ml vs control 39.4+/-0.11 fg/ml) were also increased (p<0.001). Pretreatment with specific inhibitors demonstrated the involvement of protein kinase C and oxidant stress in S100b- and HG-induced PTGS2 expression. However, insulin secretion was not significantly altered by S100b. Double immunofluorescent staining showed increased PTGS2 production in pancreatic islets from diabetic mice relative to corresponding controls.

CONCLUSION/INTERPRETATION

These results show for the first time that diabetes as well as diabetic conditions such as AGE and HG in vitro can directly upregulate the expression of the inflammatory PTGS2 gene in pancreatic islets. This might contribute to the pathogenesis of islet dysfunction in diabetes.

Effects function analysis of ELF magnetic field exposure in the electric utility work environment

The incomplete understanding of the relation between power-frequency fields and biological responses raises problems in defining an appropriate metric for exposure assessment and epidemiological studies. Based on evidence from biological experiments, one can define alternative metrics or effects functions that embody the relationship between field exposure patterns and hypothetical health effects. In this paper, we explore the application of the "effects function" approach to occupational exposure data. Our analysis provides examples of exposure assessments based on a range of plausible effects functions. An EMDEX time series data set of ELF frequency (40-800 Hz) magnetic field exposure measurements for electric utility workers was analyzed with several statistical measures and effects functions: average field strength, combination of threshold and exposure duration, and field strength changes. Results were compared for eight job categories: electrician, substation operator, machinist, welder, plant operator, lineman/splicer, meter reader, and clerical. Average field strength yields a different ranking for these job categories than the ranks obtained using other biologically plausible effects functions. Whereas the group of electricians has the highest exposure by average field strength, the group of substation operators has the highest ranking for most of the other effects functions. Plant operators rank highest in the total number of field strength changes greater than 1 microT per hour. The clerical group remains at the lowest end for all of these effects functions. Our analysis suggests that, although average field strength could be used as a surrogate of field exposure for simply classifying exposure into "low" and "high," this summary measure may be misleading in the relative ranking of job categories in which workers are in "high" fields. These results indicate the relevance of metrics other than average field strength in occupational exposure assessment and in the design and analysis of epidemiological studies.

Effects function simulation of residential appliance field exposures

This paper demonstrates the application of effects function analysis to residential magnetic field exposure, focusing on appliance sources and mitigation choices. Residential field exposure time series were synthesized by using a sample of background household field measurements, a model of average daily appliance use, and a small sample of EMDEX data of field exposure from 12 household strength window, sudden field changes) were simulated by using the synthesized time series data for different exposure situations, such as high and low levels of appliance use, simple avoidance, and use of a set of hypothetical "low field" appliances (50% lower fields). In particular, field exposure from the use of bedside clocks and electric blankets was examined. Results demonstrate that the choice of effects function is critical for the ranks of field sources and exposure reduction choices. For the effects function of average field strength with or without a threshold, exposure from background fields dominated exposure from all appliances except for bedside clocks and electric blankets. In the case of the field strength window effects function, the dominant field sources changed with the width of the window. For the effects function based on rapid field changes, appliance use was the major source of exposure. Because of the small sample of our data set and other simplifications, specific results should be viewed as illustrative.

Biologic effects of low-level electromagnetic fields: current issues and controversies

There is uncertainty and controversy about the extent to which low level electromagnetic fields may cause deleterious effects, but even experts who are skeptical about many supposed hazards are willing to agree that electromagnetic fields even weaker than those in the MR environment can have effects under certain conditions. In order that readers can familiarize themselves enough with the subject to make an informed independent assessment, discuss it knowledgeably in public, and have the means with which to evaluate new developments and avoid experimental pitfalls if planning their own research in the area, they are provided with some of the most recent finding of in vitro and in vivo research from outside the MR literature as well as some of the results and controversies coming from recent epidemiological studies.

Review of uses of the laryngeal mask in ENT anaesthesia

A review of the various uses of the laryngeal mask in otorhinolaryngological surgery is presented. Its primary use is in airway management, especially during recovery from anaesthesia.

Distinguishability of the video display terminal (VDT) as a source of magnetic field exposure

Magnetic field strength or its surrogate has been used as the measurement of exposure in all studies involving field exposure. Video display terminals (VDTs) are considered a minor source on this scale because its field strengths lie in the low range of magnetic fields. Several experiments show, however, that field strength may not be the only relevant variable in determining exposure. This paper explores the use of a method based on "effects functions" to determine the extent to which the VDT can be distinguished from other sources. It is shown that VDT exposure may be of consequence if exposure depends on certain types of time variation of the field. Because of the incompleteness of science in this area, this is a demonstration of a method rather than an actual demonstration of VDT as a significant source of exposure.

A method for evaluating transmission line magnetic field mitigation strategies that incorporates biological uncertainty

A method to determine how much reduction in public exposure to power frequency magnetic fields can be obtained for different levels of investment is presented. Which if any "effects function" best describes the relationship between field exposure and biological effect is uncertain at this time. Also, in a particular context such as construction of new transmission lines there are a variety of different technologies which might be used to reduce exposure. We describe and demonstrate a method by which exposure reduction supply curves (i.e., the cost of purchasing different amounts of exposure reduction given various mitigation options) can be estimated parametrically for different exposure conditions and effects functions, and we display illustrative results.

A method for assessing alternative effects functions that uses simulation with EMDEX data

A method for evaluating a variety of alternative biologically plausible effects functions through the use of simulation studies conducted on personal-monitor exposure data is described. Using magnetic field time series collected with EMDEX instruments, we demonstrate how the method can be used to explore 1) how the outputs from various effects functions simulations compare to the results obtained by assuming that effects are proportional to time average field strength; 2) how the results of epidemiological studies might be used to assess the relative likelihood that each of the alternative effects functions describes biological reality; and 3) how the results might be used to assess possible health risks. Although the available data are sufficient to demonstrate the general method, they are not yet sufficient to support actual discrimination among possible alternatives. The arguments on the use of the method are for illustrative purposes only.

Alternative functional relationships between ELF field exposure and possible health effects: report on an expert workshop

If exposure to 60 Hz fields poses risks to public health, the relationship between exposure and risk may involve something other than the product of field strength and time. Such alternative possible relations, or "effects functions," are of great interest to epidemiologists, engineers, risk analysts, and regulators. A structured survey and workshop were used to explore whether leading researchers in bioelectromagnetics share similar views about alternative possible effects functions. Substantial agreement was found about several effects functions in a few specific contexts such as calcium-ion efflux and cell signalling, and biosynthesis pathways. No significant agreement emerged in many other contexts. No effects function possibilities were ruled out. Further effort of this sort was judged unlikely to yield greater consensus until more complete scientific understanding becomes available. However, a series of structured workshops on research planning and priority setting were judged to hold great potential for useful results.

Antigenic protein from Mycobacterium leprae released in macrophages in vitro as indicator of viability of bacteria

Peritoneal macrophages from randombred, Swiss white mice, when cultured and infected with Mycobacterium leprae for 24 hours, are able to show the presence of antigen(s) with binding affinity to antibodies present in the sera of bacteriologically positive, lepromatous leprosy patients. Such antibodies are not seen in sera from normal and healthy persons, tuberculoid leprosy patients, or long-term-treated, bacteriologically negative, lepromatous leprosy patients. The production of the antigen(s) is blocked by the anti-M leprae drug rifampin. Other mycobacteria when incubated with macrophages from mice show very little antigens in the lysate but the antigens have an equal affinity for antibodies in sera from both normal individuals and lepromatous patients. Only the lysates from macrophages exposed to live M. leprae could discriminate and could exhibit differential binding to sera from leprosy patients compared to sera from normal individuals. This antigen(s) does not have any binding ability to the monoclonal antibodies available to the antigens of M. leprae identified at present and shown to be specific to M. leprae. This indicates a separate identity of this product which has potential for further exploitation in exploring host-pathogen interactions related specifically to the leprosy infection and the tolerance of M. leprae inside cells.

Viability of Mycobacterium leprae inside macrophages from different strains of mice and possible genetic control

Peritoneal macrophages from Swiss white mice in vitro tolerated Mycobacterium leprae and allowed metabolism of the bacteria leading to release of bacteria-specific antigenic protein. This was associated with the maintenance of viability of the bacilli inside the cells. Macrophages from C57BL mice reduced viability of M. leprae after phagocytosis, and this was associated with the production of superoxide. Blockage of superoxide production resulted in maintaining viability of the cells of these mouse strains. Associated with loss of viability of the bacilli is the absence of the production of antigenic protein in the lysate. Interestingly, the maintenance of viability or loss of viability and the factors controlling such viability in the macrophages of Swiss white and C57BL mice, respectively, appeared to be genetically controlled.

Lay understanding of low-frequency electric and magnetic fields

People do not start with a blank slate when they hear risk-communication messages. All such messages are processed through existing knowledge structures and understanding. Hence, to design effective and reliable risk-communication materials one must understand the state of people's knowledge--correct and incorrect--about an issue. We developed a simple "mental model" of what people minimally need to know to make informed decisions about field-related issues. Then we performed studies to explore how and to what extent respondents of various groups understood physical properties of 60-Hz electric and magnetic fields. Actual knowledge of respondents was then compared with the predicates of the model. Electrical engineering juniors and semi-technical employees of utilities displayed a good command of most of the concepts in the simple model, but little awareness of the limits to their knowledge. Lay respondents correctly knew only a few of the simplest elements of the model, but they displayed a much greater awareness of the limits to their knowledge. Both lay and semi-technical respondents were found to share several misconceptions. On average, they correctly rank-ordered some common field-exposure conditions by field strength, but they could not differentiate between electric and magnetic fields and could not differentiate among field strengths associated with different appliances. Most respondents dramatically underestimated the range of actual field strengths. Many respondents understood that field strength decreases with distance from a source, but they underestimated the rate of decrease. In contrast to X-rays and microwaves, which respondents appeared to think about in rather similar terms, 60-Hz fields were not thought of as being highly similar to any other agent, although the closest parallels were found with ultrasound. Changes in mood, thought, and behavior, and the existence of an "electrical aura," were all seen as plausible results of exposure to a 60-Hz field. Although lay respondents displayed a variety of incomplete and confusing ideas, most of these ideas probably do not pose significant obstacles to the learning of a correct, simple, mental model.