Treatment Patterns and Survival Outcomes Before and After Access to Immune Checkpoint Inhibitors for Patients With Metastatic Urothelial Carcinoma: A Single-Center Retrospective Study From 2004 to 2021

INTRODUCTION

Metastatic urothelial carcinoma (mUC) is a lethal disease with limited treatment options. We aimed to compare the treatment patterns and outcomes of patients with mUC who were treated before and after the introduction of immune checkpoint inhibitors (ICIs) at a tertiary hospital in Barcelona.

METHODS

Single-center retrospective study from 2004 to 2021. Access to ICIs began in December 2014. We analyzed differences in clinical characteristics and survival outcomes, such as overall survival (OS), progression-free survival (PFS), and restricted mean survival time (RMST).

RESULTS

A total of 206 patients were included. The median follow-up was 48.6 months. Ninety and 116 patients were treated during the pre-ICIs and the post-ICIs eras, respectively. We found high treatment attrition rates, with no differences in the number of patients who received second-line (48%) and third-line (26%) therapies between the two eras. In the second-line, ICIs became the predominant therapy (58%), leading to a 30% reduction in the utilisation of platinum-based ChT and non-platinum ChT. Innovative approaches including ICIs in the first-line treatment (18%) and targeted therapies in the third-line setting (34%) were observed. We found no differences in the median OS, 2-year OS, or 24-month RMST between the two periods.

CONCLUSION

ICIs have emerged as a transformative treatment option, reshaping the treatment landscape. Nevertheless, substantial attrition rates from first-line to subsequent lines of systemic therapies might impede the potential impact of ICIs on long-term survival outcomes across the entire population.

Changes in perceived health status in older men and women during the COVID-19 pandemic

Background

The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender.

Methods

Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged≥50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Two-way ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and ≥80) in changes in perceived health.

Results

Differences in perceived health were observed by age, as well as by gender in participants aged ≥70 years (F = 91.94; p < 0.001). These differences were significant both by gender (F = 19.39; p < 0.001) and age (F = 191.79; p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%).

Conclusions

The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in perceived health in old age, which in turn can have a potential impact in the quality of life of older people.

Funding

Projects Ref. H2019/HUM-5698 and Ref. 202010E158.

Key messages

Potentiation of the humoral immune response elicited by a commercial vaccine against bovine respiratory disease by Enterococcus faecalis CECT7121

Vaccination against pathogens involved in bovine respiratory disease (BRD) is a useful tool to reduce the risk of this disease however, it has been observed that the commercially available vaccines only partially prevent the infections caused by Pasteurella multocida and Mannheimia haemolytica. Therefore, it is recommended to search for new adjuvant strategies to minimise the economic impact of this respiratory syndrome. A possibility to improve the conventional vaccine response is to modulate the immune system with probiotics, since there is accumulating evidence that certain immunomodulatory strains administered around the time of vaccination can potentiate the immune response. Considering veterinary vaccines are frequently tested in murine models, we have developed an immunisation schedule in BALB/c mice that allows us to study the immune response elicited by BRD vaccine. In order to evaluate a potential strategy to enhance vaccine efficacy, the adjuvant effect of Enterococcus faecalis CECT7121 on the murine specific humoral immune response elicited by a commercial vaccine against BRD was studied. Results indicate that the intragastric administration of E. faecalis CECT7121 was able to induce an increase in the specific antibody titres against the bacterial components of the BRD vaccines (P. multocida and M. haemolytica). The quality of the humoral immune response, in terms of antibody avidity, was also improved. Regarding the cellular immune response, although the BRD vaccination induced a low specific secretion of cytokines in the spleen cell culture supernatants, E. faecalis CECT7121-treated mice showed higher interferon-γ production than immunised control mice. Our results allowed us to conclude that the administration of E. faecalis CECT7121 could be employed as an adjuvant strategy to potentiate humoral immune responses.

Probiotic activity of Enterococcus faecalis CECT7121: effects on mucosal immunity and intestinal epithelial cells

AIMS

To analyse the effect of Enterococcus faecalis CECT7121 on intestinal epithelial cells (IECs) and its effects on the mucosal immune response.

METHODS AND RESULTS

Enterococcus faecalis CECT7121 showed a high adhesion capacity to completely and heterogeneously differentiated human intestinal epithelial cell line (Caco-2 cells). In addition, the contact of this bacterium with Caco-2 cells did not induce inflammatory chemokines (IL-8 and CCL-20). The presence of IgA(+) and IL-6(+) cells in the small intestine, as well as the production of inflammatory cytokines (TNFα, IL-6 and IL-12) in the gut, was determined after intragastric inoculation of Ent. faecalis CECT7121 in BALB/c mice. The administration of Ent. faecalis CECT7121 increased the number of IgA(+) cells in the intestinal lamina propria without modifying the percentage of IL-6(+) cells. No differences were observed in the cytokines measured in the intestinal extracts between probiotic-treated and control mice.

CONCLUSIONS

Enterococcus faecalis CECT7121 stimulates local mucosal immunity and adheres to IECs without inducing inflammatory signals.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results indicate that, apart from its already reported systemic immune activity, Ent. faecalis CECT7121 has a modulatory effect at a local level.

Nanocomposite synthesis by absorption of nanoparticles into macroporous hydrogels. Building a chemomechanical actuator driven by electromagnetic radiation

Macroporous hydrogels irreversibly absorb solid nanoparticles from aqueous dispersions. A nanocomposite is made using a macroporous thermosensitive hydrogel (poly(N-isopropylacrylamide-co-(2-acrylamido-2-methyl propane sulfonic acid)) (poly(NIPAm-co-AMPS)) and conductive polymer (polyaniline, PANI) nanoparticles (PANI NPs). Macroporous gels of poly(NIPAm-co-AMPS) were made by a cryogelation technique. NPs of PANI were produced by precipitation polymerization. It is found that PANI NPs are easily absorbed into the macroporous hydrogels while conventional non-porous hydrogels do not incorporate NPs. It is shown that PANI NPs, dispersed in water, absorb NIR laser light or microwave radiation, increasing their temperature. Upon irradiation of the nanocomposite with microwaves or NIR laser light, the PANI NPs heat up and induce the phase transition of the thermosensitive hydrogel matrix and the internal solution is released. Other nano-objects, such as gold nanorods and PANI nanofibers, are also easily incorporated into the macroporous gel. The resulting nanocomposites also suffer a phase transition upon irradiation with electromagnetic waves. The results suggest that, using a thermosensitive matrix and conducting nanoparticles, mechanical/chemical actuators driven at a distance by electromagnetic radiation can be built. The sensitivity of the nanocomposite to electromagnetic radiation can be modulated by the pH, depending on the nature of the incorporated nanoparticles. Additionally, it is possible to make systems which absorb either NIR or microwaves or both.

DOTS strategy and community participation: an experience in the Ecuadorian Andes

SETTING

The Chine community in Angamarca parish, Cotopaxi Province, in the Ecuadorian Andes.

OBJECTIVE

To relate the DOTS strategy to the world view of the indigenous community in the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) patients.

DESIGN

Cross-sectional study involving all inhabitants of Chine.

RESULTS

Aspects of the community's world view were considered in the community-based application of DOTS. A cure rate of 100% was attained, with 0% defaulting from treatment.

CONCLUSION

The results obtained indicate that involving the world view of the community in the management of tuberculosis has several advantages.

Intra-operative use of PET probe for localization of FDG avid lesions

Localizing positron emission tomography (PET)/computed tomography (CT) findings in heavily scarred surgical fields can be challenging. A high energy gamma probe (PET probe) can be used to guide surgery in those difficult areas. We describe our experience localizing and removing fluorodeoxyglucose (FDG) avid lesions in different body areas. Between 2004 and 2007, we used the PET probe to localize and remove 12 lesions from 9 patients. The lesions were removed confirming ex vivo and tumor bed FDG activity. Five patients had lesions in previously operated and sometimes radiated fields. One patient had FDG avid spots in the retroperitoneum. Two lymphoma patients had been previously treated and had new FDG avid spots in a background of scarred nodes. The last patient had a core biopsy suspicious for lymphoma but a repeat CT was non-specific. One patient with gastric cancer patient, two patients with melanoma patients and two patients with breast cancer had 10 metastatic lesions easily identified and removed. After a median follow-up of 14 months all five patients are alive. The two patients with lymphoma had their FDG avid lymph nodes easily identified and biopsied. In one patient with melanoma and one patient with suspected lymphoma, the preoperative scan revealed no FDG avid lesions. The PET probe confirmed this finding in the operating room. Clinical applications of PET probe guided surgery include restaging for previously treated lymphoma patients, localization and resection of metastatic FDG avid nodules especially in previously operated or radiated fields and biopsy of PET findings difficult to localize.

[Systemic mastocytosis: systematic review]

Mastocytosis is a hematologic malignance characterized by an abnormal proliferation of mastocytes. In a consensus classification in 2001, it was distinguished between matters limited to skin and systemic matters (70% of osseous involvement and 50% of hepatomegaly). The most typical symptoms are skin lesions and systemic manifestations due to mediators secreted by tumoral cells. They are useful chemotherapy to reduce the tumoral burden and antihistaminic to control systemic manifestations. Interferon is useful in most of systemic and local manifestations, and it is recommended to use prednisona before the use of this medication.

Deposition-associated diseases related with a monoclonal compound

Up to 3% of adults over 50 years of age show a monoclonal peak values in blood or urine. Findings and prognosis will be distinct in view of the nature of this factor. In B-cell neoplasias (multiple myeloma, Waldeström macroglobulinaemia, chronic myeloid leukaemia and non-Hodgkin lymphoma) the clinical pattern is dominated by the systemic effects produced by the expansion of the malign clone; the monoclonal protein may result in hyperviscosity syndrome or renal damage. On the other hand, there are other less frequent processes called diseases associated to monoclonal components, where the main clinical manifestations and prognosis depend of the biological effects of the monoclonal protein. With reference to this last group, which is the objective of this revision, no bone lesions, anaemia or a greater tendency to infections usually occur when compared with the first group. Even so, there are some cases of interposition between both groups: for instance, type IgM immunoglobulin present in Waldeström macroglobulinaemia may have cold agglutinin activity, and in the case of multiple myeloma, the clone may secrete amyloidogenic light chains.

Autosomal dominant hereditary hemochromatosis associated with two novel Ferroportin 1 mutations in Spain

Hereditary hemochromatosis is a common disorder of iron metabolism most frequently associated with mutations in the HFE gene. Hereditary hemochromatosis may be caused by other genetic mutations including those in the SLC40A1 gene. This report describes the clinical and laboratory findings of two Spanish families with autosomal dominant iron overload associated with previously unrecognized Ferroportin 1 mutations (p.R88T and p.I180T). The phenotype of iron overload in the patients carrying these mutations could correspond to the group of clinical mutations that lose their iron export function.

Mechanism of action of trastuzumab and scientific update

The humanized anti-p185(HER2) monoclonal antibody trastuzumab has been shown to effectively inhibit the growth of HER2-overexpressing breast cancer cells in vivo and in vitro. The treatment of cancer cells with trastuzumab results in downregulation of the HER2 receptor. Further downstream cellular events include the accumulation of the cyclin-dependent kinase inhibitor p27 and cell cycle arrest. In vivo, trastuzumab induces antibody-dependent cellular cytotoxicity. Trastuzumab also inhibits constitutive HER2 cleavage/shedding mediated by metalloproteases. The ability of trastuzumab to inhibit HER2 cleavage may correlate with the clinical anticancer activity of the multifunctional HER2-targeting antibody.

Trastuzumab (herceptin), a humanized anti-Her2 receptor monoclonal antibody, inhibits basal and activated Her2 ectodomain cleavage in breast cancer cells

HER2 is a ligand-less tyrosine kinase receptor of the ErbB family that is frequently overexpressed in breast cancer. It undergoes proteolytic cleavage that results in the release of the extracellular domain and the production of a truncated membrane-bound fragment, p95. We show that HER2 shedding is activated by 4-aminophenylmercuric acetate (APMA), a well-known matrix metalloprotease activator, in HER2-overexpressing breast cancer cells. The HER2 p95 fragment, which appears after APMA-induced cleavage, is phosphorylated. We analyzed 24 human breast cancer specimens, and a phosphorylated M(r) 95,000 HER2 band could be detected in some of them, which indicated that the truncated receptor is also present in vivo. The activation of HER2 shedding by APMA in cells was blocked with batimastat, a broad-spectrum metalloprotease inhibitor. Trastuzumab (Herceptin; Genentech, San Francisco, CA), a humanized monoclonal antibody directed at the HER2 ectodomain, which has been shown to be active in patients with HER2-overexpressing breast cancer, inhibited basal and induced HER2 cleavage and, as a consequence, the generation of phosphorylated p95. This inhibitory effect of trastuzumab was not shared by 2C4, an antibody against a different epitope of the HER2 ectodomain. The inhibition of basal and APMA-induced cleavage of HER2 by trastuzumab preceded antibody-induced receptor down-modulation, which indicated that the effect of trastuzumab on cleavage was not attributable to a decrease in cell-surface HER2 induced by trastuzumab. We propose that the inhibition of HER2 cleavage and prevention of the production of an active truncated HER2 fragment represent a novel mechanism of action of trastuzumab.

Contribution of C-tail residues of potato carboxypeptidase inhibitor to the binding to carboxypeptidase A A mutagenesis analysis

The role of each residue of the potato carboxypeptidase inhibitor (PCI) C-terminal tail, in the interaction with carboxypeptidase A (CPA), has been studied by the analysis of two main kinds of site-directed mutants: the point substitution of each C-terminal residue by glycine and the sequential deletions of the C-terminal residues. The mutant PCI-CPA interactions have been characterized by the measurement of their inhibition constant, Ki, in several cases, by their kinetic association and dissociation constants determined by presteady-state analysis, and by computational approaches. The role of Pro36 appears to be mainly the restriction of the mobility of the PCI C-tail. In addition, and unexpectedly, both Gly35 and Pro36 have been found to be important for folding of the protein core. Val38 has the greatest enthalpic contribution to the PCI-CPA interaction. Although Tyr37 has a minor contribution to the binding energy of the whole inhibitor, it has been found to be essential for the interaction with the enzyme following the cleavage of the C-terminal Gly39 by CPA. The energetic contribution of the PCI secondary binding site has been evaluated to be about half of the total free energy of dissociation of the PCI-CPA complex.

Increased cyclooxygenase-2 expression in human pancreatic carcinomas and cell lines: growth inhibition by nonsteroidal anti-inflammatory drugs

Cyclooxygenase (COX)-2 mRNA and protein expression were found to be frequently elevated in human pancreatic adenocarcinomas and cell lines derived from such tumors. Immunohistochemistry demonstrated cytoplasmic COX-2 expression in 14 of 21 (67%) pancreatic carcinomas. The level of COX-2 mRNA was found to be elevated in carcinomas, relative to histologically normal pancreas from a healthy individual, as assessed by reverse transcription-PCR. COX-2 protein expression was detected by the Western blot assay in three of five pancreatic carcinoma cell lines (BxPC-3, Capan-1, and MDAPanc-3), whereas COX-1 protein was detected in two of the five cell lines (BxPC-3 and Capan-1). Increased levels of COX-2 mRNA were found in four of five cell lines, and only in PANC-1 cells was the low level of transcript comparable to that in the normal pancreas. The level of COX-2 mRNA was positively correlated with the differentiation status of the tumor of origin for each cell line, COX-2 protein expression was up-regulated by epidermal growth factor when the cells were grown in absence of serum. Finally, two nonsteroidal anti-inflammatory drugs, sulindac sulfide and NS398, produced a dose-dependent inhibition of cell proliferation in all pancreatic cell lines tested. No correlation was found between the level of COX-2 or COX-1 expression and the extent of growth inhibition. Treatment of BxPC-3 cells with sulindac sulfide and NS398 resulted in an induction of COX-2 expression. Our findings indicate that COX-2 up-regulation is a frequent event in pancreatic cancers and suggest that nonsteroidal anti-inflammatory drugs may be useful in the chemoprevention and therapy of pancreatic carcinoma.

Protein similarities beyond disulphide bridge topology

Structural superimposition is an important procedure to analyse the relationships between proteins. A new approach and program, KNOT-MATCH, has been developed for automated structural superimposition of proteins by means of their disulphide bridge topology. As a result of the superimposition, regular secondary structures, loops and clusters of residues become correctly aligned. This fact allows us to find out important structural overlaps of residues, sometimes with functional significance, not only among proteins belonging to the same family but also between apparently non-related proteins. Different disulphide-rich protein families, such as EGF-like, defensin-like and plant protease inhibitors, have been self or cross analysed with this approach. Some amino acids that have been experimentally determined to be structural and/or functional key residues for these proteins are conserved in the three-dimensional space after superimposition by KNOT-MATCH. The program can be very useful for finding relationships among proteins that would be hidden to the current alignment methods based on sequence and on main-chain topology.

Potato carboxypeptidase inhibitor, a T-knot protein, is an epidermal growth factor antagonist that inhibits tumor cell growth

Epidermal growth factor (EGF) and its receptor (EGFR) are involved in many aspects of the development of carcinomas, including tumor cell growth, vascularization, invasiveness, and metastasis. Because EGFR has been found to be overexpressed in many tumors of epithelial origin, it is a potential target for antitumor therapy. Here we report that potato carboxypeptidase inhibitor (PCI), a 39-amino acid protease inhibitor with three disulfide bridges, is an antagonist of human EGF. It competed with EGF for binding to EGFR and inhibited EGFR activation and cell proliferation induced by this growth factor. PCI suppressed the growth of several human pancreatic adenocarcinoma cell lines, both in vitro and in nude mice. PCI has a special disulfide scaffold called a T-knot that is also present in several growth factors including EGF and transforming growth factor alpha. PCI shows structural similarities with these factors, a fact that can explain the antagonistic effect of the former. This is the first reported example of an antagonistic analogue of human EGF.

[Histo-morphometry of bone mass and cellularity using image analysis: characterization of infiltration patterns in CLL]

PURPOSE

The aim of this study was to investigate a possible influence of lymphocytic infiltration in Chronic Lymphocytic Leukemia (CLL) on bone mass, according to the infiltration patterns.

MATERIAL AND METHODS

We have studied histological preparations from decalcified and paraffin included bone biopsies and used a histomorphometric study through a mixed (interactive-automatic) image analysis, in order to quantify bone trabecular (BT/TV) and cellular volume (CV). Preparations were visualized via a 2.5 objective; a video camera was adapted and connected to a computer with analogical-digital converter incorporated. After the image was captured, a binarization was made by trabecular and medullary spaces segmentation; automatically, we calculated trabecular area (TA) and cellular area (CA). Expressions indicated above were used to calculate BV/TV and CV, expressed in percentage: BV/TV (%) = [TA/(TA + CA)] x 100, and CV (%) = [CA/(TA + CA)] x 100.

RESULTS

92 normal biopsies and 79 CLL biopsies were studied (Nodular 12, Diffuse 22, Interstitial 23, Mixed 22). BT/TV in normal subjects age over 45, was 18.40%; it was lower in CLL subjects, 17.25%. CV was 33.62% in normal cases and significantly higher in CLL with 42.95%. According to the infiltration patterns, Nodular pattern showed similar value to normal biopsies, versus Diffuse pattern with BT/TV of 16.19% and CV of 51.49%. Significantly, a high CV value was accompanied of a low B/TV value, in normal and CLL subjects.

CONCLUSIONS

We analyzed histomorphometrically trabecular volume as expression of bone mass in undecalcified biopsies. CLL infiltration tended to show a lower trabecular volume. Diffuse pattern presented the higher cellular infiltration and bone mass destruction.

C-tail valine is a key residue for stabilization of complex between potato inhibitor and carboxypeptidase A

Although the carboxypeptidase A-potato carboxypeptidase inhibitor (CPA-PCI) complex is a well known example of protein-protein interaction, little was known about the basis of its thermodynamic stability. Site-directed mutagenesis has been used to identify key residues in the PCI tail and estimate the contribution of their chemical groups to the binding to CPA. Two deletion mutants were created, one lacking the C-terminal residue of the tail (Gly39) and another one lacking the two C-terminal residues (Val38, Gly39). The last mutant had an inhibition constant for CPA 10(4)-fold higher than that of wild-type PCI, indicating that Val38 is a key residue. The interactions of Val38 with CPA residues contribute 5.4-5.7 kcal mol-1 to the overall stability of the CPA-PCI complex (11.9-12.1 kcal mol-1). A series of PCI point mutants at valine 38 were created, and their inhibition constant for CPA was measured. Two of these mutants with smaller side chains, V38G and V38A, allowed us to estimate that the contribution of the three side chain aliphatic groups of valine 38 to the overall stability of the complex is 3.4-4 kcal mol-1. Another two mutants with larger side chains, V38L and V38I, were constructed, the first being a significantly worse inhibitor than the wild type. These results suggest that only aliphatic groups in positions beta and gamma of residue 38 in PCI (but not those in delta) can establish van der Waals interactions with atoms of the active center of CPA and participate in binding. The energetic contribution of each methyl/methylene group in those positions can be estimated as 1-1.5 kcal mol-1. Our hypothesis is supported by computer simulation analysis.

[Frequency of molecular alterations in heterozygous beta-thalassemia in southern Spain and their relation to the hematologic phenotype]

INTRODUCTION

Heterozygous beta-thalassemia manifests hematologically with microcytosis, reduced red blood cell hemoglobin concentration and high hemoglobin A2 levels. Almost all molecular alterations are due to point mutations. We attempt to determinate the frequency of that mutations in the Oriental Andalusia Area, and its relationship with the hematological phenotype.

PATIENTS AND METHODS

We have studied 45 heterozygous patients. DNA samples were amplified by PCR, using the printers CD7 and HI1. A 16 Kb fragment corresponding to beta globin gene was obtained and analyzed by Dot Blot assay and hybridized with allelic specific oligonucleotide (ASO) probes to detect the 6 more frequent mutations found in the South of Spain.

RESULTS

Codon 39 nonsense mutation (31.1%) was the most frequent finding followed by IVS-1 NT 110 (26.7%). The relationship between hematological parameters and molecular mutations concluded that IVS-I NT 6 mutation developed a minimal anemia.

DISCUSSION

From the practical point of view, this study indicates that we were able to detect more than 90% of heterozygous beta-tal. with 5 out of 6 ASO probes used in this work. Thus, our data also provides a further implication in prenatal diagnosis.

[Thyroid lymphoma in a 51-year-old woman]

Thyroid gland is an uncommon site for involvement by lymphoma. Because of the lack of specific histopathologic criteria for diagnosis, thyroid lymphomas are not usually diagnosed until a thyroidectomy is done, even when a fine-needle aspiration biopsy is performed before surgery. We report the case of a woman with a non-Hodgkin lymphoma presenting as thyroid enlargement with systemic manifestations of the disease. The preoperative histologic diagnosis was poorly differentiated thyroid carcinoma. If the lymphoma was primarily thyroid or the involvement of thyroid was a part of the generalized dissemination of a nodal non-Hodgkin lymphoma is difficult to establish. She was treated with a combination of surgery and chemotherapy with excellent outcome. We comment the problems in the diagnosis of this disease.

Expression of a synthetic gene encoding potato carboxypeptidase inhibitor using a bacterial secretion vector

A synthetic gene encoding the 39-amino-acid (aa) potato carboxypeptidase inhibitor IIa (PCI-IIa) has been constructed and expressed using the secretion vector, pIN-III-ompA-3, fused in frame to the OmpA signal peptide-encoding sequence. Recombinant Escherichia coli secreted a PCI with 10 additional aa at the N terminus (rePCI + 10). These extra aa were removed by site-directed mutagenesis giving a PCI with no additional aa (rePCI), as shown by fast atom bombardment mass spectrometry (M(r) 4295). The two forms of rePCI were found almost exclusively in the culture medium, not in the periplasmic space, as would be expected from OmpA signal peptide fusions. Both rePCI + 10 and rePCI are biologically active and react strongly with serum raised against PCI from potato. A method for the purification of rePCI to homogeneity has been developed. The purified rePCI shows a Ki for carboxypeptidase A within the range of the natural PCI-IIa (1.5-2.7 nM). These results indicate that both rePCI + 10 and rePCI are properly folded and that their three disulfide bridges are correctly formed. Together with previous reports, our results show that fusion to a secretion signal peptide is an effective way of producing small proteins containing disulfide bridges in a biologically active form.

[Neonatal listeriosis: third Spanish series on 45 observations (author's transl)]

During the period January'69-June'81, 45 cases of listeriosis in neonatal period were observed. 37 of them had an early onset (82%) while other eight had late infection disease (18%). Incidence was 1/6,346 newborns with most frequent presentation in spring. No epidemic forms or asymptomatic carriers were discovered. Perinatal, clinical, analytical, radiological, bacteriologic and pathological data are shown, emphasizing differences between the two clinical forms. Overall mortality of 43%, although brought to zero in the last six years, together with the same percentage of neurological sequela in the late form, urges for better knowledge of epidemiology and preventive measures, as well as a closer obstetric-neonatal relationship.

Pharmacodynamic data on fosfomycin in underweight infants during the neonatal period

A study was made of the blood levels, half-life and elimination of fosfomycin in two groups of underweight infants during the 1st to 3rd days of life and after 3-4 weeks. The test dose was 50 mg/kg i.v., administered in a single dose. The times at which the blood was controlled were 5 min, 1, 3, 6, 9 and 24 h; and 0-24 h for the urine. All samples were evaluated by the microbiological method of diffusion in plate. The results obtained indicate that the elimination of fosfomycin after 24 h is slower and occurs in smaller quantities in the group of infants 1-3 days old than in the group of 3- to 4-week-old infants, the half-life of the antibiotic being 7 and 4.9 h, respectively.