Smoking as a Risk Factor for Very Late Recurrence in Surgically Resected Early-Stage Primary Hepatocellular Carcinoma

Background

The risk of first recurrence of hepatocellular carcinoma (HCC) within years 5 to 10 after curative hepatectomy remains unknown. We aimed to assess the incidence and prognostic factors for very late recurrence among patients who achieved 5 years' recurrence-free survival (RFS) after primary resection.

Methods

We retrospectively analyzed 337 patients with early-stage HCC underwent primary tumor resection and achieved more than 5 years' RFS.

Results

A total of 77 patients (22.8%) developed very late recurrence. The cumulative very late recurrence rate increased from 6.9% and 11.7% to 16.6% at 6, 7, and 8 years, respectively. Patients stopped smoking had a higher rate of very late RFS.

Conclusions

The high rates of very late recurrence in HCC indicate that patients warrant continued surveillance, even after 5 recurrence-free years. Moreover, smoking is a risk factor for very late HCC recurrence, and quitting smoking may reduce the risk of very late recurrence.

Effects of direct anti-viral agents on the gut microbiota in patients with chronic hepatitis C

BACKGROUND/PURPOSE

Gut microbiology is associated with liver disease due to gut-liver circulation via the gut microbial-liver axis. There is a paucity of data regarding the effects of treatment to cure hepatitis C virus (HCV) infection on the gut microbiota. The aim of this study was to evaluate the fecal microbiota before and after treatment with direct antiviral agents (DAA) in patients with HCV infection.

METHODS

This prospective study was conducted at Kaohsiung Chung-Gung Memorial Hospital, Taiwan, between December 2019 and November 2020. We recruited patients with chronic hepatitis C (CHC) receiving DAA treatment. Fecal samples were collected twice: at baseline (before DAA treatment; CHC group) and 24 weeks after the end of treatment (EOT; SVR24 group), and once from healthy controls at baseline (control group). The taxonomic composition of the gut microbiota was determined using 16 S ribosomal RNA gene sequencing of stool samples.

RESULTS

A total of 60 patients with CHC and 60 healthy controls matched by age and gender were enrolled. All patients achieved a sustained virologic response (SVR). Alpha diversity was not significantly difference between any groups. Analysis of similarities (ANOSIM) revealed minor differences in the microbial community structure between the control group and CHC group (R = 0.0146, P = 0.098) and less significant differences between the CHC group and SVR24 group (R = -0.0139; P = 0.94). Three phyla and eight genera were differentially abundant between the control group and CHC group.

CONCLUSION

Individuals with CHC do not exhibit significant gut microbiota alterations and eradication of HCV by DAA is not associated with significant modification of the gut microbiota.

The COUP-TFs compose a family of functionally related transcription factors

The chicken ovalbumin upstream promoter transcription factors (COUP-TFs) are members of the steroid/thyroid hormone receptor superfamily and function in transcriptional regulation of a wide variety of genes. The COUP-TFs purified from HeLa nuclear extract by COUP-affinity chromatography are composed of multiple M(r) forms. The Low M(r) COUP-TFs (43,000, 44,000, 46,000, and 47,000 M(r)) produce a relatively fast migrating complex (C1) with DNA in electrophoresis mobility shift assays, while the high M(r) forms (66,000, 68,000, 72,000, and 74,000 M(r)) produce a slower migrating (C2) complex. The high M(r) COUP-TFs were purified by gel filtration chromatography and independently formed the C2 DNA complex, probably acting as dimers. The high M(r) forms are indistinguishable from the low M(r) COUP-TFs in DNA binding and in enhancement of in vitro transcription from the ovalbumin promoter. The finding of multiple COUP-TF forms led us to clone a second low M(r) COUP-TF, "COUP-TF2." The COUP-TF2 sequence has very strong homology with COUP-TF1. The N-termini of COUP-TF1 and COUP-TF2 are least similar, but both contain glutamine-rich and proline-rich motifs, putative activation domains.

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

OBJECTIVES

To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation.

METHODS

This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients.

RESULTS

A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broad-spectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection.

CONCLUSIONS

Patients with Naja atra envenomation who present with skin ecchymosis or the need for a high dose of antivenin may require early surgical assessment. Combined broad-spectrum antibiotics are mandatory.

SLA-constrained service selection for minimizing costs of providing composite cloud services under stochastic runtime performance

Composite cloud services based on the methodologies of Software as a Service and Service-Oriented Architecture are transforming how people develop and use software. Cloud service providers are confronting the service selection problem when composing composite cloud services. This paper deals with an important type of service selection problem, minimizing the total cost of providing a composite cloud service with respect to the constraints of service level agreement (SLA). Two types of SLA are considered in the study: per-request-based SLA and ratio-based SLA. We present three service selection approaches for dynamic cloud environments where services’ performance might vary with time. The first two are iterative compound approaches for per-request-based SLA and the third approach is a one-step method for ratio-based SLA based on the Chebyshev’s theorem and nonlinear programming. Experimental results show that our approaches outperform the previous method significantly in terms of total cost reduction.

Acidic FGF promotes neurite outgrowth of cortical neurons and improves neuroprotective effect in a cerebral ischemic rat model

Acidic fibroblast growth factor (aFGF) is a neurotrophic factor which is a powerful neuroprotective and neuroregenerative factor of the nervous system. Prior study had shown that levels of FGFs significantly increase following ischemic injury, reflecting a physiological protection mechanism. However, few reports demonstrated the efficacy of applying aFGF in cerebral ischemia. A recent report showed that the intranasal aFGF treatment improved neurological functional recovery; however, it did not significantly reduce the lesion size in ischemic rats. The present study examines the neuroprotective effect of aFGF on cortical neuron-glial cultures under oxygen glucose deprivation (OGD)-induced cell damage and investigates whether epidural application of slow-released aFGF could improve benefit on ischemic stroke injury in conscious rats. We used a topical application of aFGF mixed in fibrin glue, a slow-release carrier, over the peri-ischemic cortex and examined such treatment on cerebral infarction and behavioral impairments of rats subjected to focal cerebral ischemia (FCI). Results demonstrate that aFGF effectively protected cortical neuron-glial cultures from OGD-induced neuronal damage. Neurite extension from cortical neurons was significantly enhanced by aFGF, mediated through activation of AKT and ERK. In addition, topical application of fibrin glue-mixed aFGF dose-dependently reduced ischemia-induced brain infarction and improved functional restoration in ischemic stroke rats. Slow-released aFGF not only protected hippocampal and cortical cell loss but reduced microglial infiltration in FCI rats. Our results suggest that aFGF mixed in fibrin glue could prolong the protective/regenerative efficacy of aFGF to the damaged brain tissue and thus improve the functional restorative effect of aFGF.

Higher-Order Structural Determinants for Expression of the Ovalbumin Gene Family

The ovalbumin gene and the ovalbumin-related X and Y genes are expressed in the chicken oviduct in response to steroid hormones. These three genes are linked within a 100 kb domain of DNA which is preferentially sensitive to DNase I digestion in oviduct cell nuclei. No such preferential sensitivity to DNase is observed in nuclei isolated from other chicken tissues in which these genes are not transcribed. Thus, the DNase I sensitivity observed is correlated with the capacity for these genes to be expressed in oviduct. We have asked the question: are there specific signals in the DNA which are responsible for defining this domain or for conferring upon it the active, DNase I-sensitive, conformation? We have located DNA sequences belonging to a single repetitive DNA family, termed CR1, which are preferentially located in or near the boundary regions of the 100 kb domain. Therefore, these CR1 sequences are possible candidates for such a function. We have also searched for, but have not observed, any tissue-specific rearrangements of the DNA in the boundary regions of the domain. It is therefore unlikely that DNA rearrangements are involved in establishing the DNase I-sensitive domain in oviduct cells. However, we do note that a region at the far 3' end of the domain exhibits a cytidine methylation pattern which is highly variable among different chicken tissues. In particular, this region, which is approximately 30 kb downstream from the ovalbumin gene, is undermethylated in oviduct as compared to other hen tissues, and thus could be a control region involved in domain activation.

Arsenite-induced cytotoxicity in dorsal root ganglion explants

Peripheral neuropathy is common in people chronically overexposed to arsenic. We studied sodium arsenite (arsenite)-induced cytotoxicity in dorsal root ganglion (DRG) explants. Incubation with arsenite concentration- and time-dependently increased the expression of stress proteins, heat shock protein 70, and heme oxygenase-1 in DRG explants. Furthermore, apoptosis was involved in the arsenite-induced cytotoxicity in the treated DRG. Elevation in cytosolic cytochrome c levels and reduction in procaspase 3 levels suggested an involvement of the mitochondrial pathway in arsenite-induced apoptosis in this preparation. At the same time, increases in the activating transcription factor-4 and C/EBP homologous protein and reduction in procaspase 12 levels indicated activation of the endoplasmic reticulum (ER) pathway in the arsenite-induced cytotoxicity in DRG explants. Salubrinal (30 microM), an ER inhibitor, was found to attenuate arsenite-induced DNA fragmentation and reduction in procaspase 12 in DRG explants. Cytotoxic effects by arsenite, sodium arsenate (arsenate), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were compared, and the potency was as follows: arsenite >>> arsenate>MMA and DMA. Recombinant adenovirus vectors encoding glial-cell-derived neurotrophic factor (AdGDNF) genes allowed a stable delivery of GDNF genes to the infected cells in DRG explants. Applied in this manner, AdGDNF was found to inhibit arsenite-induced DNA fragmentation in DRG explants. Moreover, AdGDNF attenuated the arsenite-induced reduction in procaspases 3 and 12 levels. Taken together, our study demonstrates that arsenite is capable of inducing cytotoxicity in DRG explants. Both ER and mitochondria pathways are involved in the arsenite-induced apoptosis in DRG explants. Glial-cell-derived neurotrophic factor appears to be protective against arsenite-induced peripheral neuropathy.

Sequential recruitment of steroid receptor coactivator-1 (SRC-1) and p300 enhances progesterone receptor-dependent initiation and reinitiation of transcription from chromatin

Employing a cell-free chromatin transcription system that recapitulates progesterone receptor (PR)-mediated transcription in vivo, we have investigated further the coactivator functions of steroid receptor coactivator-1 (SRC-1) in terms of its functional domains as well as cooperation with other coactivators in PR transactivation. By analyzing wild-type and mutant SRC-1 with liganded PR in the chromatin transcription system in vitro, the basic helix-loop-helix/Per-Arnt-Sim domain, the p300-binding domain, and the carboxyl-terminal region (containing the PR-binding site) of SRC-1 were shown to be important for PR transactivation. Although in context of a synthetic promoter its histone acetyltransferase activity was nonessential for PR-mediated transcription, SRC-1 was observed to act synergistically with p300 to enhance PR transactivation from chromatin. Moreover, SRC-1 and p300 were found to function cooperatively to increase the efficiency of productive transcription initiation and reinitiation. Further analysis of synergism between SRC-1 and p300 revealed an obligatory "sequential" recruitment of SRC-1 and p300 to liganded PR. Efficient recruitment of p300 required the presence of SRC-1. In addition, functional analysis of SRC-2 and SRC-3 coactivators indicated that the SRC family modulated PR transactivation from chromatin by a similar mechanism.

A double-blind, placebo-controlled, and randomized study of loratadine (Clarityne) syrup for the treatment of allergic rhinitis in children aged 3 to 12 years

Allergic rhinitis is a common disease in children, and antihistamines are the key medication. However, traditional tablets are not convenient and lead to low compliance in young children. The aim of this double-blind, placebo-controlled, parallel, randomized study was to evaluate the effectiveness and safety of loratadine syrup for the treatment of children aged 3 to 12 years with allergic rhinitis. Sixty children with allergic rhinitis due to dust mites were enrolled. They were randomized into 2 parallel groups: one group received loratadine syrup 5 mg or 10 mg daily for 3 weeks, and the other group received placebo. The patients returned to special clinics for symptoms evaluation at day 7 and day 21, and the parents were requested to record disease severity daily. Both evaluations, physician's and parents', were recorded with a 4-point scale for 5 symptoms: sneezing, rhinorrhea, nasal congestion, nasal itching and ocular symptoms. Forty-six patients completed the study, 22 in the loratadine group and 24 in the placebo group. At the initial visit, the total symptom score (TSS) in both groups was not significantly different (p = 0.39). The TSS of the loratadine syrup group at day 7 and day 21 was lower than those of the placebo group (p = 0.003, p = 0.06). The daily card scores in the experimental group were also significantly lower than those of the placebo group (week 1, p = 0.014; week 2, p = 0.029; week 3, p = 0.014). No adverse reactions were recorded in both groups. This study revealed that loratadine syrup 5 mg or 10 mg once a day improved symptom scores of children with allergic rhinitis effectively and safely.

COUP-TFI: an intrinsic factor for early regionalization of the neocortex

Regionalization of the cerebral cortex is thought to involve two phases: an early regionalization phase and a later refinement phase. It has been shown that early regionalization of the neocortex does not require thalamic inputs and is regulated by intrinsic factors. Recently, two such intrinsic factors, Pax6 and Emx2, have been identified. In this study, we identified COUP-TFI as a regulatory factor for early neocortical regionalization. The spatial and temporal expression pattern of COUP-TFI suggested a role in specification of the neocortex and in maintaining cortical identity. Altered region-specific expression of marker genes in the cortex as well as miswired area-specific connections between the cortex and the thalamus in COUP-TFI null mice indicate COUP-TFI plays a critical role in regulating early regionalization. Our results substantiate that COUP-TFI, an intrinsic factor, may work in concert with Pax6 and Emx2 to specify neocortical identity.

Physiological function of the orphans GCNF and COUP-TF

Orphan nuclear receptors are members of the nuclear receptor superfamily of ligand-activated transcription factors for which ligands and functions have not been identified. Since the cloning of the original orphans, ligands have been identified for several orphan receptors that heterodimerize with the retinoid X receptor and are no longer classified as orphan receptors. Considering the central role that nuclear receptors play in differentiation, development, metabolic regulation, homeostasis and disease, it is crucial that we understand the roles of the remaining orphans. However, the identification of ligands for those orphans that form homodimers has proven more difficult. Thus, to gain greater insight into the functions of orphan receptors, gene targeting has been used to knock out these factors and study mouse development in their absence. Here we will review the progress made in understanding the roles of the orphans GCNF and the COUP-TFs with the use of gene knockouts.

Tbx19, a tissue-selective regulator of POMC gene expression

Pituitary cell types arise in a temporally and spatially specific fashion, in response to combinatorial actions of transcription factors induced by transient signaling gradients. The critical transcriptional determinants of the two pituitary cell types that express the pro-opiomelanocortin (POMC) gene, the anterior lobe corticotropes, producing adrenocorticotropin, and the intermediate lobe melanotropes, producing melanocyte-stimulating hormone (MSH alpha), have remained unknown. Here, we report that a member of the T-box gene family, Tbx19, which is expressed only in the rostral ventral diencephalon and pituitary gland, commencing on e11.5, marks pituitary cells that will subsequently express the POMC gene and is capable of altering progression of ventral cell types and inducing adrenocorticotropin in rostral tip cells. It is suggested that Tbx19, depending on the presence of synergizing transcription factors, can activate POMC gene expression and repress the alpha glycoprotein subunit and thyroid-stimulating hormone beta promoters.

BETA2 and pancreatic islet development

The pancreas is essential for digestion and glucose homeostasis. Diseases associated with the pancreas (e.g., pancreatitis, pancreatic cancer, diabetes) are generally debilitating for the patient. Diabetes is particularly prominent in the United States, affecting nearly 6 percent of the population, with associated annual health costs in the billions of dollars. Pancreas development is a complex process that requires the timely expression of numerous factors. Among them, a basic Helix-Loop-Helix factor, BETA2, was shown to be important for terminal differentiation of islet cells including insulin- and glucagon-producing cells. Expression studies demonstrated the presence of BETA2 in islet cells and specific neurons. Targeted deletion of the BETA2 gene in mice revealed its significance in pancreas development. In addition, BETA2 is important in granule cell development of the hippocampus and cerebellum. This chapter will focus on the role of BETA2 in pancreas physiology, neuronal development, and its molecular biology.

Selective augmentation of prostacyclin production by combined prostacyclin synthase and cyclooxygenase-1 gene transfer

BACKGROUND

We tested the hypothesis that combined cyclooxygenase-1 (COX-1) and prostacyclin synthase (PGIS) gene transfer selectively augments prostacyclin production without a concurrent overproduction of other prostanoids.

METHODS AND RESULTS

ECV304 cells were transfected with bicistronic pCOX-1/PGIS versus pCOX-1 or pPGIS, and prostanoids were analyzed. Contrary to the high prostaglandin E2 synthesis in pCOX-1 transfected cells, selective prostacyclin formation was noted with bicistronic plasmid transfection. Next, we determined the optimal ratio of Ad-COX-1 to Ad-PGIS by transfecting human umbilical vein endothelial cells with various titers of these 2 adenoviral constructs and determined the level of protein expression and prostanoid synthesis. Our results show that optimal ratios of adenoviral titers to achieve a large prostacyclin augmentation without overproduction of prostaglandin E2 or F2alpha were 50 to 100 plaque forming units (pfu) of Ad-COX-1 to 50 pfu of Ad-PGIS per cell. A higher Ad-PGIS to Ad-COX-1 ratio caused a paradoxical decline in prostacyclin synthesis.

CONCLUSIONS

Prostacyclin synthesis can be selectively augmented by cotransfecting endothelial cells with an optimal ratio of COX-1 to PGIS. Combined COX-1 and PGIS gene transfer has the potential for therapeutic augmentation of prostacyclin.

Overexpression of BETA2/NeuroD induces neurite outgrowth in F11 neuroblastoma cells

BETA2/NeuroD, a basic helix-loop-helix (bHLH) transcription factor, has been shown to play important roles in the development of the nervous system and the maintenance and formation of pancreatic and enteroendocrine cells. The gain of function of BETA2/NeuroD in neurogenesis has been shown in Xenopus embryos. In this study, we investigated the neurogenic potential of BETA2/NeuroD using neuroblastoma cell line, F11, which could be induced to differentiate into neurons in the presence of cAMP. To induce or block the expression of BETA2/NeuroD, expression vectors for the full-length and a C-terminal deletion mutant of BETA2 were constructed and their transactivation potential was verified using reporter genes containing the insulin promoter sequences. Overexpression of BETA2 with full-length construct induced neurite outgrowth in F11 cells in the absence of cAMP. In contrast, the C-terminal deletion mutant, BETA2(1--233), which has dominant negative activity, inhibited neurite outgrowth induced by cAMP in F11 cells. These results indicate that BETA2/NeuroD plays an important role in terminal differentiation of neuroblastoma cells. They also imply that BETA2/NeuroD or related bHLH factors plays an essential role for differentiation of F11 neuroblastoma cells.

Beta2-agonist exerts differential effects on the development of cord blood T cells but not on peripheral blood T cells

Asthma is a chronic inflammatory disease characterized by reversible airway obstruction caused by edematous airway lining, thickened mucosal secretions, and smooth muscle constriction. Beta2-adrenoceptor agonists are widely used in the treatment of bronchial asthma because of their ability to induce relaxation of airway smooth muscle. Evidence indicates that desensitization and down-regulation of beta-adrenoceptors occurs in long-term beta2-agonist therapy, and these medications were thought to cause increased severity of, and mortality in, asthma. The purpose of this study was to delineate further the potential adverse effects of beta2-agonists on the development of T lymphocytes. T cells isolated from umbilical cord blood and adult peripheral blood were cultured in the presence of salbutamol. Intracellular staining with fluorescence-labeled antibodies was used to differentiate the frequency of type 1 T-helper (Th1) and type 2 T-helper (Th2) cells. The results showed a statistically significant inverse relationship between the concentration of salbutamol and the ratio of Th1 over Th2 on cord blood T cells. However, this trend was not observed in adult peripheral blood T cells. The data revealed another potential adverse effect in which chronic beta2-agonist exposure predisposed differentiation of T lymphocytes towards Th2 while that of Th1 was relatively suppressed, especially in cord blood T cells. Hence, beta2-agonists, despite their effect in symptomatic rescue in asthma, should not be used indiscriminately as long-term therapeutic agents.

Childhood Churg-Strauss syndrome: report of a case

Churg-Strauss syndrome (CSS) (allergic granulomatosis and angitis) is an uncommon form of systemic vasculitis, which is rare in children. It is characterized by peripheral blood hypereosinophilia, systemic necrotizing vasculitis, and a preceding history of bronchial asthma. We described a boy with initial presentation of poorly controlled bronchial asthma, allergic rhinitis, recurrent sinusitis and several episodes of hemoptysis since the age of 9. He then developed purpuric skin lesions, generalized soreness, and symptoms of mononeuritis multiplex at age 11. On admission to our hospital at the age of 12, he developed marked pericardial effusion. After a series of studies including chest computed tomography (CT), skin biopsy, nerve conduction study, and serological tests for autoantibodies, CSS was diagnosed. Thereafter, he received regular corticosteroid therapy, and his symptoms were generally well-controlled with occasional acute exacerbation. The clinical characteristics, diagnosis and management of CSS in children are also reviewed.

Essential role of BETA2/NeuroD1 in development of the vestibular and auditory systems

BETA2/NeuroD1 is a bHLH transcription factor that is expressed during development in the mammalian pancreas and in many locations in the central and peripheral nervous systems. During inner ear ontogenesis, it is present in both sensory ganglion neurons and sensory epithelia. Although studies have shown that BETA2/NeuroD1 is important in the development of the hippocampal dentate gyrus and the cerebellum, its functions in the peripheral nervous system and in particular in the inner ear are unclear. Mice carrying a BETA2/NeuroD1 null mutation exhibit behavioral abnormalities suggestive of an inner ear defect, including lack of responsiveness to sound, hyperactivity, head tilting, and circling. Here we show that these defects can be explained by a severe reduction of sensory neurons in the cochlear-vestibular ganglion (CVG). A developmental study of CVG formation in the null demonstrates that BETA2/NeuroD1 does not play a primary role in the proliferation of neuroblast precursors or in their decision to become neuroblasts. Instead, the reduction in CVG neuron number is caused by a combination both of delayed or defective delamination of CVG neuroblast precursors from the otic vesicle epithelium and of enhanced apoptosis both in the otic epithelium and among those neurons that do delaminate to form the CVG. There are also defects in differentiation and patterning of the cochlear duct and sensory epithelium and loss of the dorsal cochlear nucleus. BETA2/NeuroD1 is, thus, the first gene to be shown to regulate neuronal and sensory cell development in both the cochlear and vestibular systems.

Increased transforming growth factor-beta (TGF-beta)-secreting T cells and IgA anti-cardiolipin antibody levels during acute stage of childhood Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis characterized by increased serum IgA and IgA-dominant immune complex deposition in lesions. The involvement of IgA implies a probable role for TGF-beta, a major factor in IgA production, in the pathogenesis of HSP. Among IgA antibodies, serum IgA anti-cardiolipin antibodies (aCL) have been found in many diseases, including vasculitis. In addition to the clinical presentations and laboratory parameters, we further investigated the roles of IgA aCL and TGF-beta in childhood HSP. Twenty-six Chinese children with the diagnosis of HSP were enrolled. Blood samples from these patients were collected at both acute and convalescent stages. Intracellular staining of lymphocytes was performed to enumerate type 1 (interferon-gamma-secreting), type 2 (IL-4-secreting), and type 3 (TGF-beta-secreting) helper T cells. Serum levels of TGF-beta were detected by ELISA. Serum IgA aCL of 21 of 26 patients at the acute stage, 11 of them at the convalescent stage, were measured by ELISA. The data showed that IgA aCL serum levels were significantly elevated in patients compared with healthy controls (P < 0.001), and those patients at the convalescent stage (P < 0.001). In addition, TGF-beta-secreting T cells were significantly elevated during the acute stage, and decreased at the convalescent stage. Although more studies are needed, the high prevalence of IgA aCL and increased TGF-beta-secreting T cells in children with acute HSP revealed some points which should permit a better understanding of the pathogenesis of HSP.

Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction

Eosinophilic gastroenteritis (EG) is a rare allergy-related disease, especially in early childhood. We present the case of a 1 year 4 month old boy with congenital duodenal obstruction who developed EG. That diagnosis of EG was made by a series of imaging studies and was confirmed by upper gastrointestinal (UGI) endoscopic biopsy studies which showed significant tissue eosinophilia in both mucosal and submucosal layers. No evidence of parasite segment or ova was found in the stool and biopsy specimen. Specific IgE antibodies to milk were estimated to be 2 + (CAP system). Cow's milk allergy was highly suspected but not confirmed by consecutive elimination and challenge tests since the child was too much suffered to be tested. There was partial response to the 2-week treatment with Alfare (semi-elemental formula) and oral prednisolone 1 mg/kg/day. One month after initial examination, perforation of the stomach occurred and exploratory laparotomy disclosed stenosis of the duodenum. Congenital duodenal obstruction was diagnosed based on operative findings and previous sonographic findings. There has been only one report of EG in an infant with congenital duodenal obstruction. The nature of the relationships among cow's milk allergy as a possible etiologic factor, congenital duodenal obstruction as an predisposing factor and EG involvement at both mucosal and submucosal layers remains unclear.

Penicillamine induced lupus-like syndrome: a case report

Several drugs have been suggested to cause lupus-like syndrome. However, penicillamine-induced lupus-like syndrome has only rarely been reported in patients with Wilson's disease. We describe a 6- year-old Taiwanese girl, with a diagnosis of Wilson's disease in November, 1997, who developed lupus-like syndrome 17 months after penicillamine treatment. After treatment with prednisolone and decrease in the dose of penicillamine, her symptoms subsided gradually. This is the first such case reported in a Taiwanese patient. Because the symptoms of drug-induced lupus (DIL) are nonspecific, subjective and variable, the diagnosis of DIL requires awareness of DIL-inducing potential of chronic medication.

COUP-TF orphan nuclear receptors in development and differentiation

Chicken ovalbumin upstream promoter transcription factors (COUP-TFs) are orphan members of the steroid/thyroid hormone receptor superfamily. They have been shown to negatively regulate the activation function of vitamin D, thyroid hormone, retinoic acid, the retinoid X and the peroxisome proliferator-activated receptors. COUP-TF genes have been cloned from many species and their sequences are exceptionally conserved through evolution. This suggests a critical role for the COUP-TFs in these organisms. Indeed, the Drosophila COUP-TF, seven-up and mouse COUP-TFII are essential for development and differentiation during embryogenesis. Our current understanding of COUP-TF function suggests that they serve vital physiological roles during development despite extensive overlaps of expression. This defines the COUP-TFs as important factors in regulation of development and differentiation in multiple organisms.

Costimulatory molecules expression and cytokine profiles of cord blood mononuclear cells in newborns with low and high risk of developing atopic diseases

This study sought to determine predictors of atopic diseases in newborns. We evaluated the levels of expression of costimulatory molecules (CD80 and CD86) and the production of cytokines [interleukin (IL)-12, interferon (IFN)-gamma, IL-4, IL-10] in the cord blood of mononuclear cells in high risk newborns (n = 17), and compared them with those in low risk newborns (n = 25). Fluorescence-activated cell sorter (FACScan) analysis was performed to determine the expressions of CD80 and CD86 on activated B cells and monocytes of both groups. The levels of IL-10, IL-12p40 and IL-12p70 in the supernatant were assayed by enzyme-linked immunosorbent assay (ELISA), and also the mRNA levels by reverse transcription-polymerase chain reaction (RT-PCR). Intracellular staining of IL-4 and IFN-gamma in stimulated mononuclear cells was also performed as well. The expressions of CD80 and CD86 on B cells showed no significant difference between the high and low risk group. There was greater expression of CD86 on the monocytes of low risk newborns as compared to high risk newborns (p < 0.05). When B cells and monocytes isolated from the cord blood of both groups were stimulated with mitogens, the production of IL-10, IL-12p40, and IL-12p70 in the supernatants was not significantly different. The expressions of mRNA of IL-10, IL-12p35, and IL-12p40, and the intracellular staining of IL-4 and IFN-gamma in stimulated mononuclear cells were not significantly different between the two groups. These findings suggested that cytokine profiles in the cord blood cannot predict the development of atopic diseases. Determination of whether preferential expression of costimulatory molecules is of predictive value or not will require further study.

Propylthiouracil-induced antineutrophil cytoplasm antibody-positive anaphylactoid purpura-like vasculitis--a case report

Propylthiouracil (PTU), a drug commonly used for treatment of hyperthyroidism, is associated with various rare side effects. Antineutrophil cytoplasm antibody (ANCA)-positive vasculitis is a relatively unusual complication among them. The pathogenesis of ANCA-positive vasculitis during PTU therapy is still obscure. We present the case of a 12-year-old boy who developed ANCA-positive vasculitis during PTU therapy for Graves' disease. His symptoms and signs were indistinguishable from anaphylactoid purpura, a common small-vessel vasculitis in children. The clinical manifestations improved after discontinuation of PTU and immunosuppressant treatment. He remained symptom-free at 11-months follow-up.

Efficacy and safety of methotrexate therapy for juvenile rheumatoid arthritis

BACKGROUND AND PURPOSE

Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study investigated the efficacy and adverse effects of oral methotrexate (MTX) therapy in Taiwanese children with JRA.

METHODS

The medical records of 52 Taiwanese children with JRA treated with oral MTX were retrospectively analyzed. The disease onset was polyarticular in 22 children, oligoarticular in 13, and systemic in 17. The indication for MTX therapy was lack of efficacy of previous drugs, including two or more nonsteroidal anti-inflammatory drugs, in all patients. In addition, three patients had received hydroxychloroquine and one had received sulfasalazine, without improvement. Corticosteroid dependency had developed in 27 patients prior to MTX therapy. The mean initial dose of MTX was 9.1 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1), and the mean maximal dose was 10.2 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1). The mean duration of treatment was 23 months (range, 6-96 mo), and the mean duration of follow-up was 52 months (range, 10-123 mo) from the start of MTX therapy.

RESULTS

Thirty-six children (69%) showed clinical improvement and 25 children (48%) achieved clinical remission. The administration of MTX resulted in more than a 50% reduction in required corticosteroid dosage in six children, and complete discontinuation of corticosteroid in 10 children. MTX was discontinued in 18 patients following a mean of 8 months (range, 2-34 mo) of clinical remission. Relapse occurred in nine (50%) of these patients. Thirteen patients (25%) suffered from adverse effects associated with MTX treatment. All of these adverse effects resolved spontaneously, or subsided within 4 weeks following dosage reduction or discontinuation of MTX.

CONCLUSIONS

Oral MTX therapy is effective and well-tolerated in Taiwanese children with JRA. It can serve as the first choice of second-line therapy in JRA.

Comparison of serum specific IgE antibodies to staphylococcal enterotoxins between atopic children with and without atopic dermatitis

BACKGROUND

The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization and infection by Staphylococcus aureus. The exotoxins secreted by S. aureus can act as superantigens and classic allergens, inducing the production of functionally relevant specific IgE antibodies. The aim of this study was to compare the levels and positive rates of serum staphylococcal enterotoxin A (SEA)- and staphylococcal enterotoxin B (SEB)-specific IgE between atopic children with and without AD.

METHODS

Sixty children with AD, 55 children with respiratory allergy without AD, and 24 nonatopic healthy children were studied. The levels and positive rates of serum SEA- and SEB-specific IgE were compared among three groups. The correlation between the levels or positive rates of serum SEA/SEB-specific IgE and the severity of AD or the presence of previous skin infections was studied.

RESULTS

The children with AD had significantly higher levels and positive rates of serum SEA- and SEB-specific IgE than the atopic children without AD (P < 0.001) and the nonatopic children (P < 0.001). There was no significant difference in the levels and positive rates of serum SEA- and SEB-specific IgE between the atopic children without AD and the nonatopic children. With or without adjustment for the potential confounding effect of total serum IgE levels, the levels and positive rates of serum SEA- and SEB-specific IgE were significantly correlated with severity of AD (P <0.005), but they were not significantly different between AD children with and without previous skin infections.

CONCLUSIONS

SEA and SEB may contribute to chronic inflammation and exacerbation of AD through the IgE-mediated immune response.

Bone marrow transplantation from an HLA-matched unrelated donor for treatment of Chediak-Higashi syndrome

Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disease characterized by partial albinism and large granules in all granule-containing cells. It is also associated with recurrent pyogenic infections secondary to impaired leukocyte function. Most patients with CHS enter an accelerated phase that leads to repeated infections and bleeding complications, often resulting in death. The first accelerated phase may occur shortly after birth or several years later. There are no curative treatments, and bone marrow transplantation (BMT) is the treatment of choice. Here, we report the case of a boy with CHS. The diagnosis was made at the age of 1 month, on the basis of the characteristic clinical findings and family history. He received BMT from an HLA-matched unrelated donor. After BMT, fluorescent cytometric analysis of polymorphonuclear leukocytes showed normalized cellular granularity and a normal increase in CD11b expression on N-formylmethionyl-leucyl-phenylalanine stimulation. The accelerated phase did not develop during 27 months of follow-up. Without BMT, CHS is usually fatal before the age of 10 years. BMT from an unrelated donor may be an effective treatment option for those who lack sibling donors. In addition to the characteristic leukocytic dysfunctions, fluorescent cytometric analysis of cellular granularity and surface molecules offer useful diagnostic information.

Colocalization of prostacyclin synthase with prostaglandin H synthase-1 (PGHS-1) but not phorbol ester-induced PGHS-2 in cultured endothelial cells

The subcellular colocalization of prostacyclin synthase (PGIS) with prostaglandin H synthase (PGHS) has not been delineated. To test the hypothesis that its colocalization with PGHS is crucial for prostacyclin synthesis, we determined subcellular locations of PGIS, PGHS-1, and PGHS-2 in bovine aortic endothelial cells by immunofluorescent confocal microscopy. PGIS and PGHS-1 were colocalized to nuclear envelope (NE) and endoplasmic reticulum (ER) in resting and adenovirus-infected bovine aortic endothelial cells. PGIS and PGHS-2 were also colocalized to ER in serum-treated or adenovirus-cyclooxygenase-2-infected cells. By contrast, PGIS was not colocalized with PGHS-2 in cells induced with phorbol 12-myristate 13-acetate where PGHS-2 was visualized primarily in vesicle-like structures. The lack of colocalization was accompanied by failed prostacyclin production. Resting ECV304 cells did not produce prostacyclin and had no detectable PGHS-1 and PGIS proteins. Confocal analysis showed abnormal colocalization of PGIS and PGHS-1 to a filamentous structure. Interestingly, the abundant PGIS and PGHS-1 expressed in adenovirus-infected ECV304 cells were colocalized to NE and ER, which synthesized a large quantity of prostacyclin. These findings underscore the importance of colocalization of PGHS and PGIS to ER and NE in prostacyclin synthesis.

Neuronal basic helix-loop-helix proteins (NEX and BETA2/Neuro D) regulate terminal granule cell differentiation in the hippocampus

The transcription factors neuronal helix-loop-helix protein (NEX)/mammalian atonal homolog 2 (Math-2), BETA2/neuronal determination factor (NeuroD), and NeuroD-related factor (NDRF)/NeuroD2 comprise a family of Drosophila atonal-related basic helix-loop-helix (bHLH) proteins with highly overlapping expression in the developing forebrain. The ability of BETA2/NeuroD and NDRF to convert ectodermal cells into neurons after mRNA injection into Xenopus oocytes suggested a role in specifying neuronal cell fate. However, neuronal bHLH genes are largely transcribed in CNS neurons, which are fully committed. Here we analyze a defect in mice lacking BETA2/NeuroD, and in NEX*BETA2/NeuroD double mutants, demonstrating that bHLH proteins are required in vivo for terminal neuronal differentiation. Most strikingly, presumptive granule cells of the dentate gyrus are generated but fail to mature, lack normal sodium currents, and show little dendritic arborization. Long-term hippocampal slice cultures demonstrate secondary alterations of entorhinal and commissural/associational projections. The primary developmental arrest appears to be restricted to granule cells in which an autoregulatory system involving all three neuronal bHLH genes has failed.

Regulation of the pancreatic islet-specific gene BETA2 (neuroD) by neurogenin 3

The BETA2 (neuroD) gene is expressed in endocrine cells during pancreas development and is essential for proper islet morphogenesis. The objective of this study is to identify potential upstream regulators of the BETA2 gene during pancreas development. We demonstrated that the expression of neurogenin 3 (ngn3), an islet- and neuron-specific basic-helix-loop-helix transcription factor, partially overlaps that of BETA2 during early mouse development. More importantly, overexpression of ngn3 can induce the ectopic expression of BETA2 in Xenopus embryos and stimulate the endogenous RNA of BETA2 in endocrine cell lines. Furthermore, overexpression of ngn3 could cause a dose-dependent activation on the 1.0-kb BETA2 promoter in islet-derived cell lines. Deletion and mutation analyses revealed that two proximal E box sequences, E1 and E3, could bind to ngn3-E47 heterodimer and mediate ngn3 activation. Based on these results, we hypothesize that ngn3 is involved in activating the expression of BETA2 at an early stage of islet cell differentiation through the E boxes in the BETA2 promoter.

Long-term effects of azathioprine therapy for juvenile rheumatoid arthritis

BACKGROUND AND PURPOSE

Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study investigated the efficacy and adverse effects of azathioprine (AZA) therapy in children with JRA.

METHODS

Data from the medical records of 24 children with JRA treated with oral AZA during the period from 1988 to 1998 were retrospectively analyzed. All 24 patients had received two or more nonsteroidal anti-inflammatory drugs (NSAIDs) and 12 had received disease-modifying antirheumatic drugs (DMARDs) prior to the start of AZA. Of the 24 patients, 21 were corticosteroid-dependent prior to the onset of AZA therapy. The indication for AZA therapy was lack of efficacy of the current treatment regimen. The initial and maximal doses of AZA averaged 1.7 mg.kg-1.d-1 (range, 1-3 mg. kg-1.d-1) and 1.9 mg.kg-1.d-1 (range, 1-6 mg.kg-1.d-1), respectively. The mean duration of treatment was 13 months (range, 4-37 mo). The mean duration of follow-up was 45 months (range, 7-137 mo) from the start of AZA therapy.

RESULTS

Fifteen children (62.5%) showed clinical improvement, while the other nine (37.5%) achieved clinical remission. AZA treatment resulted in a more than 50% reduction in the required corticosteroid dose in seven children and complete discontinuation of corticosteroid administration in eight children. None of the patients treated with AZA doses of 1 to 3 mg.kg-1.d-1 developed AZA-related side-effects. Two patients suffered from AZA-related adverse effects due to AZA overdose (6 mg.kg-1.d-1). Both experienced pancytopenia and disseminated infection, which resolved following reduction of the AZA dose to 3 mg.kg-1.d-1.

CONCLUSIONS

AZA is an effective and well-tolerated steroid-sparing agent for JRA refractory to NSAIDs or DMARDs.

Lichen sclerosus et atrophicus, bullous morphea, and systemic lupus erythematosus: a case report

Lichen sclerosus et atrophicus (LSA) rarely coexists with morphea, especially when bullae occur in lesions of morphea. Here we report the case of a 15-year-old girl with this condition, who also fulfilled four out of 11 diagnostic criteria for systemic lupus erythematosus (SLE). Tissue biopsy of different skin lesions showed LSA in the regions of bullous morphea, that has rarely been reported in the literature.

Age-dependent increase in C7-1 gene expression in rat frontal cortex

We have previously reported that a fragment of mRNA, denoted as C7-1, which expression was significantly increased in the frontal cortex of aged rats. In the present study, we have cloned and sequenced the full length cDNA of the C7-1 gene. We have found that the open reading frame of this gene encoded a 463-amino-acid protein, which shared 84% identity in amino acid sequence with a subunit of vacuolar H(+)-ATPase (V-ATPase). Further Northern blot analysis revealed that there was an age-dependent increase in C7-1 gene expression in rat frontal cortex, but not in other brain areas. Moreover, application of C7-1 antisense oligonucleotide to cortical neuronal cultures markedly inhibited cell survival. These results together suggest that C7-1 is a marker for the aging process and that upregulation of C7-1 may be important in maintaining the normal function of V-ATPase during aging.

Childhood mixed connective tissue disease

Two girls with mixed connective tissue disease (MCTD) were treated in our hospital in the past 5 years. Patient 1, a 10-year-old girl presenting with migratory arthralgia, had an initial diagnosis of juvenile rheumatoid arthritis. Muscle weakness with elevated levels of creatine kinase and liver enzymes, sclerodactyly, Raynaud's phenomenon and heliotrope sign developed subsequently in the following 3 years. Patient 2, a 13-year-old girl, had been treated for suspected systemic lupus erythematosus since 9 years of age. She presented with lymphadenopathy, arthralgia, pericardial effusion, and paralytic ileus. The symptoms waxed and waned. Sclerodactyly, Raynaud's phenomenon, proteinuria, and hypertension were also noted. Both patients had high serum titers of antinuclear antibody (speckled pattern, 1:5120) and were seropositive for antiribonuclear protein antibody. Intravenous immunoglobulin, prednisolone, cyclosporine A, and nonsteroidal anti-inflammatory drugs (NSAIDs) were given to patient 1. Patient 2 received cyclosporine A, prednisolone, and methylprednisolone pulse therapy. The disease has been well controlled for 2 years by low-dose immunosuppressants and NSAIDs. MCTD is a rare juvenile rheumatic disease: early identification and appropriate treatment can improve the disease outcome.

Loss of BETA2/NeuroD leads to malformation of the dentate gyrus and epilepsy

BETA2/NeuroD is a homologue of the Drosophila atonal gene that is widely expressed during development in the mammalian brain and pancreas. Although studies in Xenopus suggest that BETA2/NeuroD is involved in cellular differentiation, its function in the mammalian nervous system is unclear. Here we show that mutant mice homozygous for a deletion at the BETA2/NeuroD locus fail to develop a granule cell layer within the dentate gyrus, one of the principal structures of the hippocampal formation. To understand the basis of this abnormality, we analyzed dentate gyrus development by using immunocytochemical markers in BETA2/NeuroD-deficient mice. The early cell populations in the dentate gyrus, including Cajal-Retzius cells and radial glia, are present and appear normally organized. The migration of dentate precursor cells and newly born granule cells from the neuroepithelium to the dentate gyrus remains intact. However, there is a dramatic defect in the proliferation of precursor cells once they reach the dentate and a significant delay in the differentiation of granule cells. This leads to malformation of the dentate granule cell layer and excess cell death. BETA2/NeuroD null mice also exhibit spontaneous limbic seizures associated with electrophysiological evidence of seizure activity in the hippocampus and cortex. These findings thus establish a critical role of BETA2/NeuroD in the development of a specific class of neurons. Furthermore, failure to express BETA2/NeuroD leads to a stereotyped pattern of pathological excitability of the adult central nervous system.

Transcription factors involved in pancreatic islet development

The endocrine pancreas is an organ of enormous importance, since its dysfunction causes diabetes, one of the most common human diseases in the world. Regulation of pancreatic endocrine cell determination and differentiation requires a unique set of transcription factors, including basic helix-loop-helix and homeodomain-containing proteins. The physiological role of individual transcription factor has been characterized by gene disruption in the mouse. The results indicate that these genes are not only involved in tissue-specific activation of downstream target genes for islet-specific hormones, but also critical for the proper islet morphogenesis. Future elucidation of the genetic relationship of these genes will lead to a better understanding of the molecular mechanisms controlling endocrine pancreas formation and will contribute to the development of new therapeutic approaches to diabetes.

The nuclear orphan receptor COUP-TFI is required for differentiation of subplate neurons and guidance of thalamocortical axons

Chicken ovalbumin upstream promotor-transcription factor I (COUP-TFI), an orphan member of the nuclear receptor superfamily, is highly expressed in the developing nervous systems. In the cerebral cortex of Coup-tfl mutants, cortical layer IV was absent due to excessive cell death, a consequence of the failure of thalamocortical projections. Moreover, subplate neurons underwent improper differentiation and premature cell death during corticogenesis. Our results indicate that the subplate neuron defects lead to the failure of guidance and innervation of thalamocortical projections. Thus, our findings demonstrate a critical role of the subplate in early corticothalamic connectivity and confirm the importance of afferent innervation for the survival of layer IV neurons. These results also substantiate COUP-TFI as an important regulator of neuronal development and differentiation.

Molecular mechanisms of androgen-independent growth of human prostate cancer LNCaP-AI cells

The goal of this study is to investigate the molecular mechanisms of androgen-independent growth in prostate cancer. We have established an androgen-independent prostatic carcinoma LNCaP-AI (defined as a LNCaP cell line that is capable of growing in charcoal-stripped serum) from the androgen-dependent LNCaP-FGC cells. In contrast to the androgen-independent PC-3 human prostate cancer cells, LNCaP-AI cells still express a similar level of androgen receptor as their parental cells and are sensitive to androgen stimulation. Compared with the parental LNCaP-FGC cells, LNCaP-AI cells are more resistant to apoptosis induced by 12-O-tetradecanoylphorbol-13-acetate and express a much higher level of antiapoptotic gene bcl-2 and cyclin-dependent kinase inhibitor p21, which may confer an enhanced antiapoptosis phenotype. On the other hand, expression of cyclin-dependent kinase inhibitor p16 is significantly reduced in the LNCaP-AI cells, implying the release of an inhibitory effect of p16 on cell cycle progression. Taken together, our results suggest that multiple factors contribute to the development of androgen-independent growth of prostatic carcinoma cells, including enhancement of cell antiapoptosis function, release of cell cycle inhibition, and stimulation of cell proliferation by alternative signaling pathways.

Sex differences in pediatric systemic lupus erythematosus: a retrospective analysis of 135 cases

A retrospective review of 135 patients with systemic lupus erythematosus (SLE) (24 boys and 111 girls) under age 18 at the National Taiwan University Hospital (NTUH) from 1989 to 1998 was done. The aim of this retrospective study was to compare the differences in the age at diagnosis, clinical, laboratory features and survival among both sexes. The female to male ratio was 4.6:1. The mean age at the time of diagnosis was 13.7 years (range, 8y5m-18y) for male patients and 13.7 years (range, 6y1m-18y) for female patients. There was no significant differences in the mean age of diagnosis between the sexes. It was found that there were no significant differences in the clinical and laboratory features between male and female patients except for the prevalence of oral ulcers, alopecia and anti-SSA antibodies which were more frequent in the female group. The cumulative 5- and 10-year survival rates were 80.2% and 65%, respectively; male patients appeared to have a better survival, yet it did not reach any statistical significance. Univariate analysis showed that gender is not a significant factor on prognosis in pediatric SLE. Although abnormal creatinine was associated with poor mortality, it was not statistically significant on multivariate analysis.

Steroid receptor coactivator-1 (SRC-1) enhances ligand-dependent and receptor-dependent cell-free transcription of chromatin

Progesterone receptor (PR) functions as a transcription factor that modulates the transcription of target genes in response to progesterone and other signals. The transcriptional activity of PR requires the involvement of coactivators such as steroid receptor coactivator-1 (SRC-1). To dissect the role of SRC-1 in PR transactivation, we established an in vitro transcription system with chromatin templates, in which PR induced transcription in a ligand-dependent and PRE-dependent manner. In the presence of ligand, purified PR bound to chromatin templates, resulting in chromatin remodeling. With this system, the ability of purified SRC-1 to act as a coactivator of PR was examined. SRC-1 potentiated transcription by ligand-activated PR, whereas it had no effect on transcription in the absence of ligands. As SRC-1 possesses intrinsic histone acetyltransferase activity, we tested the role of acetylation in PR-mediated transcription by using a histone deacetylase inhibitor, trichostatin A (TSA). We found that addition of TSA strongly enhanced PR-dependent transcription on chromatin but not on naked DNA template, and the effects of SRC-1 and TSA on PR transactivation were partially redundant. In addition, SRC-1 was able to potentiate PR transactivation with nonchromatin templates. Thus, our results substantiate a two-step mechanism whereby recruitment of coactivator SRC-1 by the ligand-activated PR in vivo leads to (i) chromatin remodeling through histone acetylation and (ii) recruitment/stabilization of the preinitiation complex.

Autoimmune manifestations in patients with primary immunodeficiency

Primary immunodeficiency comprises a heterogeneous group of disorders. Autoimmune and/or rheumatic manifestations are not uncommon in these patients. It may be the first and/or sole sign before the underlying disease is established. This study focuses on the children of primary immunodeficiency with autoimmune disease to survey the clinical and laboratory finding retrospectively. From January 1985 to June 1998, ten patients (M:F = 9:1) of primary immunodeficiency with at least one well defined autoimmune disease were identified. The underlying immunodeficiency included three with Bruton's disease, three with common variable immunodeficiency, one with hyper-IgM, one with primary CD4 T-cell deficiency and two with Wiskott-Aldrich syndrome. The autoimmune manifestations include arthritis in six, ulcerative colitis in one, and autoimmune hemolytic anemia in three children. The major treatment was steroid and non-steroid anti-inflammatory drug. Infection could be controlled with antibiotics and intravenous immunoglobulin in all save one. The morbidity among these patients included bronchiectasis with pulmonary hypertension in three, joint stiffness, short stature, and delayed puberty in two. In conclusion, autoimmune diseases are frequently seen in patients with primary immunodeficiency. It could be the first and/or sole sign of disease. The possibility of immunodeficiency should be kept in mind when evaluating patients with autoimmune diseases.

The orphan nuclear receptor COUP-TFII is required for angiogenesis and heart development

The embryonic expression of COUP-TFII, an orphan nuclear receptor, suggests that it may participate in mesenchymal-epithelial interactions required for organogenesis. Targeted deletion of the COUP-TFII gene results in embryonic lethality with defects in angiogenesis and heart development. COUP-TFII mutants are defective in remodeling the primitive capillary plexus into large and small microcapillaries. In the COUP-TFII mutant heart, the atria and sinus venosus fail to develop past the primitive tube stage. Reciprocal interactions between the endothelium and the mesenchyme in the vascular system and heart are essential for normal development of these systems. In fact, the expression of Angiopoietin-1, a proangiogenic soluble factor thought to mediate the mesenchymal-endothelial interactions during heart development and vascular remodeling, is down-regulated in COUP-TFII mutants. This down-regulation suggests that COUP-TFII may be required for bidirectional signaling between the endothelial and mesenchymal compartments essential for proper angiogenesis and heart development.

A steroid receptor coactivator, SRA, functions as an RNA and is present in an SRC-1 complex

Nuclear receptors play critical roles in the regulation of eukaryotic gene expression. We report the isolation and functional characterization of a novel transcriptional coactivator, termed steroid receptor RNA activator (SRA). SRA is selective for steroid hormone receptors and mediates transactivation via their amino-terminal activation function. We provide functional and mechanistic evidence that SRA acts as an RNA transcript; transfected SRA, unlike other steroid receptor coregulators, functions in the presence of cycloheximide, and SRA mutants containing multiple translational stop signals retain their ability to activate steroid receptor-dependent gene expression. Biochemical fractionation shows that SRA exists in distinct ribonucleoprotein complexes, one of which contains the nuclear receptor coactivator steroid receptor coactivator 1. We suggest that SRA may act to confer functional specificity upon multiprotein complexes recruited by liganded receptors during transcriptional activation.