Impaired vision in children prenatally exposed to methadone: an observational cohort study

BACKGROUND/OBJECTIVES

To examine prevalence of failed visual assessment at 8-10 years in children born to methadone-maintained opioid dependent (MMOD) mothers and relate this to known in utero substance exposure.

SUBJECTS/METHODS

Follow up of observational cohort study of methadone-exposed and comparison children matched for birthweight, gestation and postcode of residence at birth. Participants were 144 children (98 exposed, 46 comparison). Prenatal drug exposure was previously established via comprehensive maternal and neonatal toxicology. Children were invited to attend for visual assessment and casenotes were reviewed. Presence of acuity poorer than 0.2 logMAR, strabismus, nystagmus and/or impaired stereovision constituted a 'fail'. Fail rates were compared between methadone-exposed and comparison children after adjusting for known confounding variables.

RESULTS

33 children attended in person: data were also derived from casenote review for all children. After controlling for maternal reported tobacco use, methadone-exposed children were more likely to have a visual 'fail' outcome, adjusted odds ratio 2.6, 95% CI 1.1-6.2; adjusted relative risk 1.8 (95% CI 1.1-3.4). Visual 'fail' outcome rates did not differ between methadone-exposed children who had (n = 47) or had not (n = 51) received pharmacological treatment for neonatal abstinence/opioid withdrawal syndrome (NAS/NOWS); fail rate 62% vs 53% (95% CI of difference-11-27%).

CONCLUSIONS

Children born to MMOD mothers are almost twice as likely as unexposed peers to have significant visual abnormalities at primary school age. Prenatal methadone exposure should be considered in the differential diagnosis of nystagmus. Findings support visual assessment prior to school entry for children with any history of prenatal opioid exposure.

TRIAL REGISTRATION

The study was prospectively registered on ClinicalTrials.gov (NCT03603301), https://clinicaltrials.gov/ct2/show/NCT03603301 .

Safety of image guided research biopsies in patients with thoracic malignancies

OBJECTIVE

A common opportunity to collect research samples is during image-guided percutaneous core needle biopsies (CNBs) performed when clinically indicated or for assessing clinical trial eligibility. The relative safety of extra CNBs collected for research is undefined.

MATERIALS AND METHODS

Patients who underwent CNB for research purposes only [RO], as clinically indicated [CI], or as part of a clinical trial [CT] were identified. 30-day post-procedure adverse events (AEs) among the cohorts were examined and compared to the 2020 Society of Interventional Radiology QI guidelines.

RESULTS

236 patients with thoracic cancers (90 % NSCLC, 5 % SCLC, 4 % mesothelioma, and 1 % thymic) had 292 CNBs (63 RO, 229 CI + CT). AEs occurred in 13 % of both the RO and CI + CT groups. Compared to the CI + CT group, the RO group did not have a higher pneumothorax incidence (RO: 5/29 [17 %], CI + CT: 18/114 [16 %], p = 0.79); both were below the suggested QI threshold of 45 % for pneumothorax. There was a negative association between number of cores obtained and risk of AE (AE vs no AE mean cores = 3.5 vs 4.8). After adjusting for the number of cores and smoking history, RO vs CI + CT lung biopsies had a higher risk of AEs (adjusted relative risk [aRR] = 2.44, 1.08-5.55, p = 0.03 vs non-lung aRR = 0.86, 0.10-7.09, p = 0.89).

CONCLUSION

CNBs performed for research purposes do not have a significantly increased risk of AEs when compared to those performed for clinical trials and/or when clinically indicated. However, AEs were most frequent in lung biopsies. When performing research biopsies, a target other than lung may be preferred when clinically appropriate.

Axillary Lymphadenopathy After Coronavirus Disease 2019 Vaccinations in Patients With Thoracic Malignancy: Incidence, Predisposing Factors, and Imaging Characteristics

OBJECTIVES

Axillary lymphadenopathy from coronavirus disease 2019 (COVID-19) vaccine is an emerging phenomenon during unprecedented mass vaccinations, which can be incidentally found on computed tomography (CT) scans. This study investigated the incidence, predisposing factors, and imaging characteristics of vaccine-related axillary lymphadenopathy in patients with thoracic malignancy who underwent CT scans before and after COVID-19 vaccinations.

METHODS

The study included patients with thoracic malignancies who received two doses of mRNA-based COVID-19 vaccinations and had prevaccine and postvaccine chest CT scans. Postvaccine chest CT scan results were reviewed for increase in size of lymph nodes in the axilla and subpectoral areas, comparing with the prevaccine scan results. The cases with lymphadenopathy were further reviewed independently by two radiologists referring to clinical information to find whether lymphadenopathy was attributed to the vaccinations.

RESULTS

Vaccine-related axillary lymphadenopathy was noted in 21 of 232 patients (9.0%). The median short-axis diameter of the largest node was 7 mm (range: 5-14 mm). The median number of increased nodes was 4 (range: 1-10). The median time to the postvaccine scan revealing lymphadenopathy was 1.7 weeks (range: -2.9 to 6.6) from the second dose. Vaccine-related lymphadenopathy was noted more often in women than in men (18 of 144, 12.5% versus 3 of 88, 3.4%, respectively; p = 0.019) and with mRNA-1273 vaccines than BNT162b2 vaccines (6 of 28, 21% versus 15 of 204, 7.4%, respectively; p = 0.026).

CONCLUSIONS

The incidence of lymphadenopathy was 9%, with a median onset time of 1.7 weeks after the second vaccine dose. Female sex and vaccine type (mRNA-1273 vaccine) were associated with higher frequency of lymphadenopathy, providing initial observations to inform further investigations in larger cohorts.

30 Blood-based glycoprotein signatures in advanced non-small-cell lung carcinoma (NSCLC) receiving first-line immune checkpoint blockade

Background

Immune checkpoint blockade is an integral component of first-line therapy for most patients with ad-vanced non-small cell lung cancer (NSCLC), however individual patient outcomes are highly variable and improved biomarkers are needed. Protein glycosylation is an emerging mechanism of immune evasion in cancer. We examined blood-based glycopeptide signatures in a cohort of advanced NSCLC patients treated with first-line immune checkpoint blockade.

Methods

Pretreatment blood samples were obtained from 46 advanced NSCLC patients treated with first line pembrolizumab or pembrolizumab + carboplatin + pemetrexed. All patients provided written in-formed consent to the institutional review board–approved protocols (#02–180 and 13–367) at the Da-na-Farber/Harvard Cancer Center (Boston, MA), and the study was conducted in accordance with the Declaration of Helsinki. Samples were analyzed using an advanced glycoproteomics platform (Inter-Venn Biosciences) that combines ultra-high-performance liquid chromatography coupled to triple quadrupole mass spectrometry with a proprietary neural-network-based data processing engine. 409 individual glycopeptide (GP) signatures derived from 67 abundant serum proteins were analyzed and correlated with overall survival (OS) and other clinical outcomes.

Results

We identified 30 GPs with abundance differences using a False Discovery Rate (FDR) threshold of 0.05. Using the 5 most predictive GP markers, we created a multivariable model for OS by generating leave-one-out cross-validation (LOOCV) scores and determining an optimized cutoff value of -0.83 (range: -2.2 - 3.4) for these scores using Harrell’s concordance index. The median overall survival was 2.8 years for patients (n=14) whose GP classifier value was above the cutoff and 0.8 years for patients (n=32) whose GP classifier value was below the cutoff (HR 7.4, 95% CI 1.7–32.1, p=0.007) The model’s perfor-mance was not affected by sex, age, or treatment regimen.

Conclusions

Blood-based glycopeptide signatures may represent novel, non-invasive biomarkers of clinical out-come to first-line immune checkpoint blockade in advanced NSCLC. Additional research is needed to validate these findings in larger cohorts and to explore potential applications relevant to clinical decision-making.

Ethics Approval

The study obtained ethics approval from the institutional review board (approved protocol #02–180 and 13–367) at the Dana-Farber/Harvard Cancer Center (Boston, MA), and the study was conducted in accordance with the Declaration of Helsinki.

Consent

All patients provided written informed consent to the institutional review board–approved protocols (#02–180 and 13–367) at the Dana-Farber/Harvard Cancer Center (Boston, MA), and the study was conducted in accordance with the Declaration of Helsinki.

248 Empiric profiling of peripheral T cell recall responses to tumor mutanomes versus in silico predictions in NSCLC patients undergoing pembrolizumab treatment ± chemotherapy

Background

Effective immune checkpoint blockade (ICB) treatment is dependent on T-cell recognition of patient-specific mutations (neoantigens). Empirical identification of neoantigens ex vivo has revealed shortcomings of in silico predictions.1 To better understand the impact of ICB treatment on T cell responses and differences between in silico and in vitro methods, neoantigen-specific T cell responses were evaluated in patients with non-small cell lung cancer undergoing first-line therapy with pembrolizumab ± chemotherapy.

Methods

Tumor and whole blood samples were collected from 14 patients prior to and after immunotherapy; seven each in monotherapy and combination therapy cohorts. The ex vivo ATLAS™ platform was used to profile neoantigen-specific T-cell responses. Patient-specific tumor mutations identified by next-generation sequencing (NGS) were expressed individually as ATLAS clones, processed patient-specific autologous antigen presenting cells, and presented to their T cells in vitro. ATLAS-verified antigens were compared with epitope predictions made using algorithms.

Results

On average, 150 (range 37–339) non-synonymous mutations were identified. Pre-treatment, ATLAS identified T cell responses to a median of 15% (9–25%) of mutations, with nearly equal proportions of neoantigens (8%, 5–15%) and Inhibigens™, targets of suppressive T cell responses (8%, 3–13%). The combination therapy cohort had more confirmed neoantigens (46, 20–103) than the monotherapy cohort (7, 6–79). After treatment, the median ratio of CD4:CD8 T cells doubled in the monotherapy but not combination cohort (1.2 to 2.4 v. 1.6 to 1.3). Upon non-specific stimulation, T cells from patients on combination therapy expanded poorly relative to monotherapy (24 v. 65-fold, p = 0.014); no significant differences were observed pre-treatment (22 v. 18-fold, p = 0.1578). Post-treatment, the median number of CD8 neoantigens increased in the combination therapy cohort (11 to 15) but in monotherapy were mostly unchanged (6 to 7). Across timepoints, 36% of ATLAS-identified responses overlapped. In silico analysis resulted in 1,895 predicted epitopes among 961 total mutations; among those, 30% were confirmed with ATLAS, although nearly half were Inhibigens, which could not be predicted. Moreover, 50% of confirmed neoantigens were missed by in silico prediction.

Conclusions

Monotherapy and combination therapy had differential effects on CD4:CD8 T cell ratios and their non-specific expansion. A greater proportion of neoantigens was identified than previously reported in studies employing in silico predictions prior to empirical verification.2 Overlap between confirmed antigens and in silico prediction was observed, but in silico prediction continued to have a large false negative rate and could not characterize Inhibigens.

Acknowledgements

We would like to acknowledge and thank the patients and their families for participating in this study.

References

Lam H, McNeil LK, Starobinets H, DeVault VL, Cohen RB, Twardowski P, Johnson ML, Gillison ML, Stein MN, Vaishampayan UN, DeCillis AP, Foti JJ, Vemulapalli V, Tjon E, Ferber K, DeOliveira DB, Broom W, Agnihotri P, Jaffee EM, Wong KK, Drake CG, Carroll PM, Davis TA, Flechtner JB. An empirical antigen selection method identifies neoantigens that either elicit broad antitumor T-cell responses or drive tumor growth. Cancer Discov 2021;11(3):696–713. doi: 10.1158/2159- 8290.CD-20-0377. Epub 2021 January 27. PMID: 33504579.

Rosenberg SA. Immersion in the search for effective cancer immunotherapies. Mol Med 27,63(2021). https://doi.org/10.1186/s10020-021-00321-3

758 Online Surgical Journal Clubs: Are They Effective?

Aim

Much of medical education has been abruptly forced online during the COVID-19 pandemic. Traditional journal clubs thrive on group interaction and debate. The aim of this project is to assess whether an online surgical journal club could replicate this experience and learning.

Method

A fortnightly, chat-based online surgical journal club with national reach was re-launched under SCALPEL (Manchester Medical School’s surgical society) with defined learning objectives, inclusion of studies from different surgical sub-specialities and a proforma to aid critical appraisal. Anonymous feedback forms were sent to participants to assess confidence in critically appraising the literature before and after attendance, and differences in means were analysed using paired t-test.

Results

32 feedback forms from participants, the majority of whom were final year medical students (34.4%) were analysed. 28.1% had previously attended a journal club. 65.6% of attendees had prior involvement in a research project which led to a publication for 18.8%, while 59.4% were interested in applying for the Academic Foundation Programme (AFP). The self-reported confidence of participants to identify the study design, interpret the results and statistical analyses; and scrutinise the strengths and weaknesses of a study increased by 12.2%, 14.7% and 15.9% respectively (p = <0.001). Furthermore, 96.9% of attendees stated they would attend another online journal club in the future, with 59.4% favouring an online format.

Conclusions

Online surgical journal clubs are effective and are here to stay following the conclusion of social distancing. They have the advantage of further outreach and may encourage greater participation than traditional journal clubs.

757 An Audit of Post-Vasectomy Semen Analysis Adherence

Aim

Following vasectomy, patients undergo post-vasectomy semen analysis (PVSA) to determine whether they can be “cleared” to safely discontinue contraception. The adherence rates to PVSA are notoriously poor in the literature. The aim of this project is to assess our patient’s adherence to PVSA and identify areas for improvement.

Method

All vasectomies undertaken at a large urology centre between 01/01/2019 and 31/12/2019 were included. PVSAs were scrutinised one year later to determine clearance or special clearance according to the 2016 Laboratory Guidelines for Post-vasectomy Semen Analysis endorsed by the British Andrology Society.

Results

256 patients underwent bilateral vasectomy, with 132 (51.6%) undergoing PVSA, at a median of 16.4 weeks (range 7.3 – 71.6). At time of review, 71 (54.5%) of these have been cleared; 45 (63.4%) after a single PVSA and 19 (26.8%) after the second. Seven patients (9.9%) received special clearance, two patients (1.5%) were not cleared despite meeting the special clearance criteria and one patient suffered early failure (0.8%). Clearance letters were issued at a median of 2.7 weeks (range 0.1 – 28.8) following satisfactory PVSA results. Moreover, 33 patients (25%) had at least one PVSA sample rejected by the lab, mainly due to timing issues or incomplete information on the request form.

Conclusions

The adherence rate to PVSA in our cohort is in keeping with the literature, and the majority of patients who are cleared achieve this with just one PVSA. Interventions aimed at counselling patients about the importance of PVSA, reducing unnecessary repeats and reducing rejected samples are necessary.

SPACEWALK: A Remote Participation Study of ALK Resistance Leveraging Plasma Cell-Free DNA Genotyping

Introduction

Remote consent and enrollment offer a unique opportunity to provide rare cancer populations with access to clinical research. The genomic analysis of plasma cell-free DNA (cfDNA) permits remote characterization of the cancer genome. We hypothesized we could leverage these approaches to remotely study drug resistance in patients with metastatic ALK-positive NSCLC.

Methods

The SPACEWALK study (Study of Plasma Next-Generation Sequencing for Remote Assessment, Characterization, Evaluation of Patients With ALK Drug Resistance) enrolled patients with ALK-positive NSCLC and progression on a next-generation ALK inhibitor who could participate remotely. Plasma was collected for next-generation sequencing (NGS) of cfDNA before initiating subsequent therapy, with results returned and subsequent therapy studied.

Results

Of the 62 patients enrolled, an ALK fusion was detected in 27 (44%) with a median allelic fraction of 2.6%. Among these 27 patients, a potential resistance mechanism was identified in 17 patients (63%): eight cases (30%) had secondary ALK kinase domain resistance mutations, three cases (11%) had bypass track resistance, and six cases (22%) had both ALK resistance mutations and bypass resistance. The most frequently detected mechanism of bypass resistance was MET amplification. Repeat plasma NGS was performed in 14 patients after subsequent treatment was initiated, with seven (50%) patients exhibiting greater than 50% reductions in ALK fusion allelic fraction.

Conclusions

Through the leveraging of remote participation, plasma NGS offers an optimal mechanism for characterizing resistance to emerging targeted therapies in rare cancer populations, though sensitivity depends on adequate tumor DNA samples. Repeat cfDNA analysis on therapy may offer an objective monitoring approach to remotely study treatment response.

Oncogenic switch and single-agent MET inhibitor sensitivity in a subset of EGFR-mutant lung cancer

[Figure: see text].

Framework for the assessment of interaction between CO2 geological storage and other sedimentary basin resources

Sedimentary basins around the world considered suitable for carbon storage usually contain other natural resources such as petroleum, coal, geothermal energy and groundwater. Storing carbon dioxide in geological formations in the basins adds to the competition for access to the subsurface and the use of pore space where other resource-based industries also operate. Managing potential impacts that industrial-scale injection of carbon dioxide may have on other resource development must be focused to prevent potential conflicts and enhance synergies where possible. Such a sustainable coexistence of various resource developments can be accomplished by implementing a Framework for Basin Resource Management strategy (FBRM). The FBRM strategy utilizes the concept of an Area of Review (AOR) for guiding development and regulation of CO2 geological storage projects and for assessing their potential impact on other resources. The AOR is determined by the expected physical distribution of the CO2 plume in the subsurface and the modelled extent of reservoir pressure increase resulting from the injection of the CO2. This information is used to define the region to be characterised and monitored for a CO2 injection project. The geological characterisation and risk- and performance-based monitoring will be most comprehensive within the region of the reservoir containing the carbon dioxide plume and should consider geological features and wells continuously above the plume through to its surface projection; this region defines where increases in reservoir pressure will be greatest and where potential for unplanned migration of carbon dioxide is highest. Beyond the expanse of the carbon dioxide plume, geological characterisation and monitoring should focus only on identified features that could be a potential migration conduit for either formation water or carbon dioxide.

Ocean warming and acidification modulate energy budget and gill ion regulatory mechanisms in Atlantic cod (Gadus morhua)

Ocean warming and acidification are threatening marine ecosystems. In marine animals, acidification is thought to enhance ion regulatory costs and thereby baseline energy demand, while elevated temperature also increases baseline metabolic rate. Here we investigated standard metabolic rates (SMR) and plasma parameters of Atlantic cod (Gadus morhua) after 3–4 weeks of exposure to ambient and future PCO₂ levels (550, 1200 and 2200 µatm) and at two temperatures (10, 18 °C). In vivo branchial ion regulatory costs were studied in isolated, perfused gill preparations. Animals reared at 18 °C responded to increasing CO₂ by elevating SMR, in contrast to specimens at 10 °C. Isolated gills at 10 °C and elevated PCO₂ (≥1200 µatm) displayed increased soft tissue mass, in parallel to increased gill oxygen demand, indicating an increased fraction of gill in whole animal energy budget. Altered gill size was not found at 18 °C, where a shift in the use of ion regulation mechanisms occurred towards enhanced Na⁺/H⁺-exchange and HCO₃⁻ transport at high PCO₂ (2200 µatm), paralleled by higher Na⁺/K⁺-ATPase activities. This shift did not affect total gill energy consumption leaving whole animal energy budget unaffected. Higher Na⁺/K⁺-ATPase activities in the warmth might have compensated for enhanced branchial permeability and led to reduced plasma Na⁺ and/or Cl⁻ concentrations and slightly lowered osmolalities seen at 18 °C and 550 or 2200 µatm PCO₂ in vivo. Overall, the gill as a key ion regulation organ seems to be highly effective in supporting the resilience of cod to effects of ocean warming and acidification.

Luminescence of Be-doped GaN layers grown by molecular beam epitaxy on Si (111)

Low temperature photoluminescence spectra of Be-doped layers grown on Si (111) by molecular beam epitaxy have been analyzed. Emissions at 3.466 eV and 3.384 eV, and a broad band centered at 2.4-2.5 eV are observed. Their evolution with temperature and excitation power, and time resolved PL measurements ascribe an excitonic character for the luminescence at 3.466 eV, whereas the emission at 3.384 eV is associated with a donor-acceptor pair transition. This recombination involves residual donors and Be-related acceptors, which are located around 90meV above the valence band, confirming Be as the shallowest acceptor reported in GaN. The intensity of the band at 2.4-2.5 eV increases with the Be content. This emission involves a band of deep acceptors generated by Be complex defects, as suggested by the parameter g = 2.008 ± 0.003 obtained by photoluminescence-detected electron paramagnetic resonance.

E6/E7 expression of human papillomavirus types in cutaneous squamous cell dysplasia and carcinoma in immunosuppressed organ transplant recipients

BACKGROUND

DNA of cutaneous human papillomavirus (HPV) types is frequently found in nonmelanoma skin cancer, and their E6 and E7 proteins can have transforming properties.

OBJECTIVES

To assess the biological activity of HPV types found in tumour tissues we examined HPV E6/E7 RNA expression and the antibody response to E6, E7 and L1 proteins.

METHODS

Thirty-one snap-frozen biopsies from six immunosuppressed organ transplant recipients representing seven squamous cell carcinomas (SCCs), one basal cell carcinoma, four actinic keratoses (AKs), seven normal skin and 12 verrucae vulgaris (Vv) were analysed for 24 cutaneous HPV types by an L1 DNA polymerase chain reaction (PCR)-based method. The presence of E6/E7 transcripts of HPV 5, 8, 9, 15 and 20 was investigated by real-time reverse transcription-PCR. HPV DNA load was determined for HPV 8, 9 and 15 in 11 biopsies. Antibody response was measured by enzyme-linked immunosorbent assay using affinity-purified, bacterially expressed complete viral proteins fused to glutathione S-transferase as antigens.

RESULTS

HPV DNA was detected in 25 of 31 tissue samples, indicating eight single and 17 multiple HPV infections. E6/E7 transcripts of HPV 8, 9 and 15 were found in low copy numbers in one SCC and three AKs, but not in normal skin or Vv. All four patients examined showed antibodies to cutaneous HPV antigens, but the antibody response did not correlate with E6/E7 expression detected in the tumour.

CONCLUSIONS

Transcriptional activity of the E6/E7 oncogenes in AK and SCC suggests an active role of HPV in the lesion.

Relationship of skeletal muscle atrophy to functional status: a systematic research review

In the realm of muscle atrophy research, many studies address minute details of molecular function but few examine the effects of atrophy in terms of mobility, strength, endurance, and performance of activities of daily living. The relationship between impairment and functional limitation is the focus of this research review. A wide array of studies constitute this area of inquiry, including investigations as diverse and widely disparate as molecular chemistry and space travel and populations as different as rats, healthy young men, and elderly women. Thirty-four studies were selected based on their fit with the Enabling-Disabling Model. Three paradigms of atrophy and function emerged. Adaptation reflects the plastic nature of muscle when placed under certain conditions, ranging from disuse to high-resistance exercise. Injury/loss describes damage to muscle tissue from ischemia, medications, or reloading or reperfusion trauma. Also in this category is the loss of muscle that is seen with aging. Integrity relates to the muscle's tendency to protect itself and maintain structural adjacencies and cellular proportions. Based on the 3 muscle research paradigms, the relationship of muscle atrophy to function is portrayed as a bidirectional interaction wherein form and function have an influence on each other by way of physical changes, including those of adaptation, injury/loss, or integrity. A conceptual model is constructed to reflect this relationship.

Which nerve fibers mediate the axon reflex flare in human skin?

Axon reflex vasodilatation due to transcutaneous electrical stimulation in human skin was measured by laser Doppler imaging. Constant current pulses of 10 mA, 0.2 ms, delivered at 1 or 10 Hz for 2 min through a probe of 30 mm2 surface area did not induce a significant flare response, though this stimulus previously has been found supra-maximal for cutaneous polymodal (mechano-heat responsive) C-nociceptors in microneurography experiments. Pulses of the same strength from a pointed probe yielding a higher current density induced an extended and persistent flare. This type of stimulus previously has been proven to recruit mechano-insensitive C-units in microneurography experiments, in contrast to stimuli from the 30 mm2 probe. It is concluded that mechano-insensitive C-nociceptors and not polymodal C-units mediate the axon reflex flare in human skin.

Enhanced RNA binding of dimerized aminoglycosides

Aminoglycoside antibiotics have recently emerged as an intriguing family of RNA binding molecules and they became leading structures for the design of novel RNA ligands. The demystification of the aminoglycoside-RNA recognition phenomenon is required for the development of superior binders. To explore the existence of multiple binding sites in a large RNA molecule, we have synthesized covalently linked symmetrical and nonsymmetrical dimeric aminoglycosides. These unnatural derivatives were compared to their natural "monomeric" counterparts in their ability to inhibit the Tetrahymena ribozyme. The dimeric aminoglycosides inhibit ribozyme function 20 to 1.2 x 10(3) fold more effectively than their natural parent compounds. The inhibition curves of dimeric aminoglycosides have characteristic shapes suggesting the presence of at least two high affinity-binding sites within the ribozyme's three-dimensional fold. The interaction of a dimeric aminoglycoside with two complementary sites of the RNA molecule is proposed. This binding motif may have implications on the development of new drugs targeting pivotal RNA molecules of bacterial and viral pathogens.

Fibrillin-1 (FBN1) mutations in patients with thoracic aortic aneurysms

BACKGROUND

Mutations in the FBN1 gene are the cause of the Marfan syndrome, an autosomal dominant disorder with skeletal, ocular, and cardiovascular complications. Aneurysms or dissections of the ascending thoracic aorta are the major cardiovascular complications of the disorder. We tested the hypothesis that FBN1 mutations cause thoracic aortic aneurysms or dissections in patients who do not have the Marfan syndrome.

METHODS AND RESULTS

The FBN1 gene was screened for mutations by use of genomic DNA from two patients with thoracic aortic aneurysms who did not have the Marfan syndrome. Individual FBN1 exons were amplified with intron-based exon-specific primers; the DNA fragments were screened for mutations using single-stranded conformational polymorphism analysis; and aberrantly migrating bands were sequenced directly. We identified a missense mutation in one patient, D1155N in exon 27. Dermal fibroblasts from the affected individual were used to study the effect of the missense mutation D1155N on fibrillin-1 cellular processing. The mutation decreased the amount of fibrillin-1 deposited into the pericellular matrix. A second putative FBN1 mutation was identified in the second patient, P1837S in exon 44. Although this alteration was not observed in 234 chromosomes from unrelated individuals, the alteration may represent a rare polymorphism.

CONCLUSIONS

Results of these studies support the hypothesis that FBN1 mutations cause thoracic aortic aneurysms in patients who do not have the Marfan syndrome. This information is important for understanding the pathogenesis of aortic aneurysms and identification of individuals at risk for developing thoracic aortic aneurysms or dissections.

S- and C-glycopeptide derivatives of an LH-RH agonist

The S- and C-glycosylated nonapeptides 1 and 2 were synthesized as analogs of the non-glycosylated LH-RH agonist buserelin (pGlu-His-Trp-Ser-Tyr-D-Ser(tBu)-Leu-Arg-Pro-NHEt) by segment condensation in solution. 1 and 2 differ from this peptide in the amino acid in position 6. In the first case (1), D-serine (tBu) is substituted by D-cysteine carrying a rhamnosyl residue, in the second case (2) D-alanine carrying a galactosyl moiety bound as C-glycoside is incorporated. The bioactivity of both glycopeptides as fertility drugs was determined from the dose dependent LH release in male rats. Additionally, in female rats the ovulation rate was assessed. As a result the analog 1 exhibits a similar biological activity as buserelin while analog 2 shows about 25% of this potency. Compared to buserelin the solubility of the analogs 1 and 2 in aqueous buffer is improved by more than two orders of magnitude due to the carbohydrate moieties.

In vitro permeability of the pig placenta in the last third of gestation

The pig placenta is membranous throughout gestation and is suitable for investigation as a membrane system. The site of maternal-fetal exchange in vivo is used for permeability measurements in vitro and its surface area can be measured morphometrically. Fetal weight, placental weight, placental DNA content, placental macroscopic surface area, epithelio-chorial membrane area and thickness, and permeability in vitro to urea, tritiated water and sodium were measured in eight conceptuses aged between 79 and 111 days. These solutes were selected in order to facilitate comparison with data for sheep. Urea permeability per unit DNA increased throughout the last third of gestation although placental weight and DNA content ceased to increase before term.

Gestational changes in pig placental weight, area and DNA content in the second half of pregnancy

Weight and macroscopic surface area of the pig placenta reached a maximum at day 101 and decreased thereafter. However, between day 101 and day 111 (full term 113/115) the epitheliochorial tissue layer increased in area due to the continuing formation of folds. Although lightweight placentae had small macroscopic surface areas, they possessed larger areas per unit weight throughout the second half of gestation. From day 70 to day 92 the lightest placentae, when compared with their heaviest litter mates, had from 15 to 150 per cent more macroscopic surface area per unit weight. In the middle third of gestation there was a phase of rapid cell division, in consequence of which mean cell size was reduced. By the beginning of the last third of gestation mean cell size had reached a steady value, with no demonstrable change thereafter. Cell multiplication continued until day 101 when growth in weight had ceased.

Relationship of fetal to placental size: the pig model

Placental weight and macroscopic surface area are closely correlated with fetal weight throughout the second half of gestation in the pig. The limiting effect of placental size on fetal weight becomes more obvious as gestation advances. Fetal weight/placental weight ratio increases as placental weight decreases. Within individual litters, lightweight placentas have up to 150% more macroscopic surface area per unit placental weight.