Muscle-specific, liver-detargeted adeno-associated virus gene therapy rescues Pompe phenotype in adult and neonate Gaa-/- mice

Pompe disease (PD) is a neuromuscular disorder caused by acid α-glucosidase (GAA) deficiency. Reduced GAA activity leads to pathological glycogen accumulation in cardiac and skeletal muscles responsible for severe heart impairment, respiratory defects, and muscle weakness. Enzyme replacement therapy with recombinant human GAA (rhGAA) is the standard-of-care treatment for PD, however, its efficacy is limited due to poor uptake in muscle and the development of an immune response. Multiple clinical trials are ongoing in PD with adeno-associated virus (AAV) vectors based on liver- and muscle-targeting. Current gene therapy approaches are limited by liver proliferation, poor muscle targeting, and the potential immune response to the hGAA transgene. To generate a treatment tailored to infantile-onset PD, we took advantage of a novel AAV capsid able to increase skeletal muscle targeting compared to AAV9 while reducing liver overload. When combined with a liver-muscle tandem promoter (LiMP), and despite the extensive liver-detargeting, this vector had a limited immune response to the hGAA transgene. This combination of capsid and promoter with improved muscle expression and specificity allowed for glycogen clearance in cardiac and skeletal muscles of Gaa-/- adult mice. In neonate Gaa-/- , complete rescue of glycogen content and muscle strength was observed 6 months after AAV vector injection. Our work highlights the importance of residual liver expression to control the immune response toward a potentially immunogenic transgene expressed in muscle. In conclusion, the demonstration of the efficacy of a muscle-specific AAV capsid-promoter combination for the full rescue of PD manifestation in both neonate and adult Gaa-/- provides a potential therapeutic avenue for the infantile-onset form of this devastating disease.

Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

Does region of origin influence the timing and outcome of first-line antiretroviral therapy in France?

OBJECTIVES

The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment.

METHODS

Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses.

RESULTS

Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL.

CONCLUSIONS

Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.

Disrupted trabecular bone micro-architecture in middle-aged male HIV-infected treated patients

OBJECTIVES

HIV-infected individuals are at increased risk of incident fractures. Evaluation of trabecular bone micro-architecture is an important tool to assess bone strength, but its use has not yet been reported in middle-aged HIV-infected male individuals. The aim of the study was to compare bone micro-architecture between HIV-infected and HIV-uninfected men.

METHODS

In this cross-sectional study, 53 HIV-infected male individuals with a mean (± standard deviation) age of 49 ± 9 years who had been receiving antiretroviral therapy including tenofovir disoproxil fumarate (DF) for at least 60 months were compared with 50 HIV-uninfected male controls, matched for age and ethnic origin. We studied the volumetric bone density and micro-architecture of the radius and tibia using high-resolution peripheral quantitative computed tomography (HR-p QCT).

RESULTS

Volumetric trabecular bone density was 17% lower in the tibia (P < 10(-4) ) and 16% lower in the radius (P < 10(-3) ) in HIV-infected patients compared with controls. By contrast, the cortical bone density was normal at both sites. The tibial trabecular micro-architecture differed markedly between patients and controls: bone volume/total volume (BV/TV) and trabecular number were each 13% lower (P < 10(-4) for both). Trabecular separation and inhomogeneity of the network were 18% and 24% higher in HIV-infected patients than in controls, respectively. The radial BV/TV and trabecular thickness were each 13% lower (P < 10(-3) and 10(-2) , respectively). Cortical thickness was not different between the two groups.

CONCLUSIONS

The findings of lower volumetric trabecular bone density and disrupted trabecular micro-architectural parameters in middle-aged male HIV-infected treated patients help to explain bone frailty in these patients.

C1 inhibitor function using contact-phase proteases as target: evaluation of an innovative assay

BACKGROUND

Controlling prekallikrein activation by C1 inhibitor (C1Inh) represents the most essential mechanism for angioedema patient protection. C1Inh function in the plasma is usually measured based on the residual activity of the C1s protease not involved in the pathological process. We have hereby proposed an alternative enzymatic measurement of C1Inh function based on contact-phase activation and correlation with angioedema diagnostic requirements.

METHODS

The contact phase was reconstituted using the purified components, with C1Inh standard or plasma sample. The kinetics of the amidase activity were monitored using Pro-Phe-Arg-pNA, independently of alpha2-macroglobulin. We prevented any interference from a possible high plasma kininogenase activity by preincubating the samples with protease inhibitor. Receiver operating characteristics (ROC) were used to calculate the assay's diagnostic performance.

RESULTS

The calibration curve was built using C1Inh standard (threshold limit 0.10 × 10(-3) U, i.e., 0.2 pmol), and C1Inh function was quantified in the sample, with a reference interval established based on healthy individuals (n = 281; men: 0.61-1.10 U/ml, median: 0.85 U/ml; women: 0.42-1.08 U/ml, median: 0.74 U/ml). The median values of female donors were lower than those of the others due to estrogen, yet C1Inh function remained within the reference interval. The ROC curve calculation provided the following optimum diagnostic cutoff values: women 0.36 U/ml (area under curve [AUC]: 0.99; sensitivity: 93.48%; specificity: 99.37%); and men 0.61 U/ml (AUC: 1; sensitivity: 100.0%; specificity: 100.0%).

CONCLUSION

The performance outcome provided features suitable for angioedema diagnostic or follow-up. Established by means of the kinin formation process, this assay should be preferred over the method based on a C1s protease target.

[Prevalence of granulomatous lesions in minor salivary gland biopsy in a case series of 65 patients with tuberculosis]

PURPOSE

The distinction between tuberculosis (TB), a worldwide infectious granulomatosis requiring specific antibiotic therapy, and sarcoidosis, a rare granulomatous disease that may require corticosteroids is not straightforward and may result in diagnostic and therapeutic delay.

METHODS

We prospectively and consecutively evaluated the presence of epithelioid granulomas in minor salivary gland biopsy of 65 consecutive patients with TB.

RESULTS

In our study, 10.8 % of our TB patients had epithelioid granulomas without caseous necrosis identified in their minor salivary gland biopsy, regardless of the location of TB, HIV status and whether or not the sputum examination was positive for tuberculous bacilli.

CONCLUSION

The presence of epithelioid granulomas in minor salivary gland biopsy may not be helpful to the clinician to rule out TB in a patient with suspected sarcoidosis.

Genetics of residual feed intake in growing pigs: Relationships with production traits, and nitrogen and phosphorus excretion traits

Residual feed intake (RFI) is defined as the difference between the observed ADFI and the ADFI predicted from production and maintenance requirements. The objectives of this study were to evaluate RFI as a selection criterion to improve feed efficiency and its potential to reduce N and P excretion in 4 pig breeds. Data were collected between 2000 and 2009 in French central test stations for 2 dam breeds [French Landrace (LR) and Large White (LWD)], and 2 sire breeds [Large White (LWS) and Piétrain (PP)]. Numbers of recorded pigs were 6407, 10,694, 2342, and 2448 for the LR, LWD, LWS, and PP breeds, respectively. All PP animals were genotyped for the halothane mutation. This data set was used to calculate RFI equations for each of the 4 breeds, and to estimate genetic parameters for RFI together with growth, carcass, and meat quality traits, and N and P excretion during the test period (35 to 110 kg BW). The RFI explained 20.1% in PP, 26.5% in LWS, 27.6% in LWD, and 29.5% in LR of the phenotypic variability of ADFI. The PP breed differed from the others in this respect, probably due to a lower impact of the variation of body composition on ADFI. Heritability estimates of RFI ranged from 0.21 ± 0.03 (LWD) to 0.33 ± 0.06 (PP) depending on the breed. Heritabilities of N and P excretion traits ranged from 0.29 ± 0.06 to 0.40 ± 0.06. The RFI showed positive genetic correlations with feed conversion ratio (FCR) and excretion traits, these correlations being greater in the sire breeds (from 0.57 to 0.86) than in the dam breeds (from 0.38 to 0.53). Compared with FCR, RFI had weaker genetic correlations with carcass composition, growth rate, and excretion traits. Estimates of genetic correlations between FCR and excretion traits were very close to 1 for all breeds. Finally, excretion traits were, at the genetic level, correlated positively with ADFI, negatively with growth rate and carcass leanness, whereas the halothane n mutation in PP was shown to reduce N and P excretion levels. To conclude, new selection indexes including RFI can be envisaged to efficiently disentangle the responses to selection on growth rate and body composition from those on feed efficiency, with favorable impacts on N and P excretions, particularly in sire pig breeds. However, the switch from FCR to RFI in selection indexes should not resolve the genetic antagonism between feed efficiency and meat quality.

Influence of breed and muscle metabolic type on muscle glycolytic potential and meat pH in pigs

Glycolytic potential and activities of myofibrillar ATPase, lactate dehydrogenase, citrate synthase, glycogen synthetases and glycogen phosphorylases were measured in five muscles from five Large White, eight Pietrain, seven Belgian Landrace and eight Penshire pigs (Penshire is a composite line including 50% Hampshire, 35% Duroc and 15% Large White blood). Additionally, ultimate pH was measured on the loin and four ham muscles. Muscles could be classified as follows on the basis of enzyme activities: Longissimus dorsi and Semimembranosus as 'fast white', Rectus abdominis as 'intermediate'. Trapezius and Masseter as 'slow red'. Small breed differences were observed in enzyme activities except for citrate synthase activity and degree of activation of glycogen phosphorylase in the 'fast white' muscles. Large Whites, Pietrains and Belgian Landraces did not differ in glycolytic potential whatever the muscle involved. Compared with these three breeds, Penshires had much higher glycolytic potential values in the 'fast white' muscles (+51 to 75%) and in the 'intermediate' muscle (+29 to 56%). However, in the 'slow red' muscles, there was almost no difference in this trait between the four breeds. The Penshire pigs showed lower ultimate pH than the pigs from the other breeds in three of the four ham muscles studied. It is concluded that muscle metabolic type must be considered when assessing breed variation in glycolytic potential, and that the high muscle glycolytic potential characterizing the Hampshire could be inherited as a dominant trait in Hampshire crosses.

Correlated responses in sow appetite, residual feed intake, body composition, and reproduction after divergent selection for residual feed intake in the growing pig

Residual feed intake (RFI) has been explored as an alternative selection criterion to feed conversion ratio to capture the fraction of feed intake not explained by expected production and maintenance requirements. Selection experiments have found that low RFI in the growing pig is genetically correlated with reduced fatness and feed intake. Selection for feed conversion ratio also reduces sow appetite and fatness, which, together with increased prolificacy, has been seen as a hindrance for sow lifetime performance. The aims of our study were to derive equations for sow RFI during lactation (SRFI) and to evaluate the effect of selection for RFI during growth on sow traits during lactation. Data were obtained on 2 divergent lines selected for 7 generations for low and high RFI during growth in purebred Large Whites. The RFI was measured on candidates for selection (1,065 pigs), and sow performance data were available for 480 sows having from 1 to 3 parities (1,071 parities). Traits measured were sow daily feed intake (SDFI); sow BW and body composition before farrowing and at weaning (28.4 ± 1.7d); number of piglets born total, born alive, and surviving at weaning; and litter weight, average piglet BW, and within-litter SD of piglet BW at birth, 21 d of age (when creep feeding was available), and weaning. Sow RFI was defined as the difference between observed SDFI and SDFI predicted for sow maintenance and production. Daily production requirements were quantified by litter size and daily litter BW gain as well as daily changes in sow body reserves. The SRFI represented 24% of the phenotypic variability of SDFI. Heritability estimates for RFI and SRFI were both 0.14. The genetic correlation between RFI and SRFI was 0.29 ± 0.23. Genetic correlations of RFI with sow traits were low to moderate, consistent with responses to selection; selection for low RFI during growth reduced SDFI and increased number of piglets and litter growth, but also increased mobilization of body reserves. No effect on rebreeding performance was found. Metabolic changes previously observed during growth in response to selection might explain part of the better efficiency of the low-RFI sows, decreasing basal metabolism and favoring rapid allocation of resources to lactation. We propose to consider SRFI as an alternative to SDFI to select for efficient sows with reduced input demands during lactation.

Muscle characteristics and meat quality traits are affected by divergent selection on residual feed intake in pigs

Residual feed intake (RFI) is defined as the difference between the observed feed intake and that expected based on requirements for maintenance and production. A divergent selection was conducted during 4 generations in Large White male pigs to produce low and high RFI lines. The present study aims at determining the influence of this selection on biochemical and histological traits of skeletal muscle, and relating these changes to correlated effects on growth, carcass composition, and meat quality traits. At 8 d preslaughter, biopsies from the LM were taken in the fed state on 14 females from each RFI line fed ad libitum. Animals were slaughtered at 107.8 ± 8.0 kg of BW without any previous fasting. Samples of LM, semimembranosus (SM), biceps femoris (BFM), and rhomboideus muscles were taken at both 30 min and 24 h postmortem. Myofiber typing was only assessed in LM. Low RFI pigs ("efficient") had leaner carcasses with greater muscle content (P < 0.001), less backfat thickness (P < 0.001), and less intramuscular fat content in all 4 muscles (P < 0.01 to P = 0.04). Their greater muscle content was associated with hypertrophy of all fast-twitch fibers. Glycogen content in all glycolytic muscles (i.e., LM, SM and BFM), was greater in low than high RFI pigs. The greater accumulation of glycogen in LM of low RFI pigs was specifically located in the fast-twitch glycolytic IIBW fibers, which correspond to fibers containing IIb, IIb + IIx, or IIx myosin heavy chains. The difference in muscle glycogen content between RFI line pigs was more significant in the living animals (P = 0.0003) than at 30 min postmortem (P = 0.08). This was associated with a decreased ultimate pH (P = 0.001), and greater lightness of color (P = 0.002) and drip loss (P = 0.04) in LM of low than high RFI line pigs, suggesting that selection for reduced RFI may impair some meat quality traits, such as water-holding capacity. Pigs from the low RFI line exhibited a greater (P = 0.02) percentage of IIBW fibers in LM and tended (P < 0.10) to have less lipid β-oxidative capacity in LM, SM, and BFM. In contrast, no difference (P > 0.10) between lines was found for citrate synthase and lactate dehydrogenase activities, mitochondrial activity, and expression of genes coding for uncoupling proteins 2 and 3. Differences between RFI pigs in plasma leptin, cortisol, and thyroid hormone concentrations are presented and discussed. In conclusion, selection for low RFI influenced muscle properties in a way favoring muscle mass, but likely impairing meat quality.

Energy utilization in pigs selected for high and low residual feed intake

Genetic selection on residual feed intake (RFI) can be used as an alternative method to G:F to improve feed efficiency in pigs. The objective of this study was to determine the effects of selection for RFI on digestive and metabolic utilization of energy in 2 lines of purebred French Large White castrated male pigs obtained from a divergent selection experiment over 6 generations. The RFI(+) (high RFI) line consumed more feed than predicted from performance compared with the RFI(-) (low RFI) line. Digestibility of energy and nutrients, total heat production (HP), HP related to physical activity, and energy and N balance were measured in respiration chambers for a 6-d period in pigs offered feed ad libitum. Pigs remained in the chamber for an additional day and did not receive any feed to estimate the fasting HP and calculate the thermic effect of feeding. Five pairs of 2 littermates from the same farrowing batch were used in each line. Because 2 respiration chambers were available for the trial, pigs were measured regularly during the 25- to 95-kg growing period. Two pigs per chamber were used until pigs reached 45 kg of BW, and 1 pig per chamber was used thereafter. Individual feed intake and BW gain were measured continuously from weaning to the end of the trial. Pigs were fed 3 diets with decreasing CP contents during the 25 to 45 (period 1), 45 to 65 (period 2), and 65 to 95 (period 3) kg of BW periods. Average daily feed intake was greater in RFI(+) pigs than in RFI(-) pigs between 25 and 65 kg of BW (2,128 vs. 1,891 g/d; P < 0.01) and G:F was 8% greater in RFI(-) pigs compared with RFI(+) pigs (P < 0.01). There was no line effect on digestibility coefficients or N retention, irrespective of the experimental period studied. Nitrogen retention was 31.2, 28.7, and 20.8 g/d at periods 1, 2, and 3, respectively (P < 0.001). The HP was greater in RFI(+) pigs than in RFI(-) pigs (1,497 vs. 1,383 kJ.kg of BW(-0.60).d(-1); P < 0.01), with no subsequent line effect on energy retention. The activity-related HP tended to be greater in RFI(+) pigs than in RFI(-) pigs (250 vs. 218 kJ.kg of BW(-0.60).d(-1); P = 0.09), and the fasting HP was 10% greater (P = 0.04) in RFI(+) pigs than in RFI(-) pigs (846 vs. 771 kJ.kg of BW(-0.60).d(-1)). The thermic effect of feeding, expressed as a percentage of ME intake, was the same for both lines of pigs (average, 14.7%). In conclusion, the RFI(+) pigs are energetically less efficient because of their greater HP related to physical activity and basal metabolic rate.

Genetic parameters for residual feed intake in growing pigs, with emphasis on genetic relationships with carcass and meat quality traits

Data were collected over the first 4 generations of a divergent selection experiment for residual feed intake of Large White pigs having ad libitum access to feed. This data set was used to obtain estimates of heritability for residual feed intake and genetic correlations (r(a)) between this trait and growth, carcass, and meat quality traits. Individual feed intake of group-housed animals was measured by single-space electronic feeders. Upward and downward selection lines were maintained contemporarily, with 6 boars and 35 to 40 sows per line and generation. Numbers of records were 793 for residual feed intake (RFI1) of boar candidates for selection issued from first-parity (P1) litters and tested over a fixed BW range (35 to 95 kg) and 657 for residual feed intake (RFI2) and growth, carcass, and meat quality traits of castrated males and females issued from second-parity (P2) litters and tested from 28 to 107 kg of BW. Variance and covariance components were estimated using REML methodology applied to a series of multitrait animal models, which always included the criterion for selection as 1 of the traits. Estimates of heritability for RFI1 and RFI2 were 0.14 +/- 0.03 and 0.24 +/- 0.03, respectively, whereas the estimate of r(a) between the 2 traits was 0.91 +/- 0.08. Estimates of r(a) indicated that selection for low residual feed intake has the potential to improve feed conversion ratio and reduce daily feed intake, with minimal correlated effect for ADG of P2 animals. Estimates of r(a) between RFI2 and body composition traits of P2 animals were positive for traits related to the amount of fat depots (r(a) = 0.44 +/- 0.16 for carcass backfat thickness) and negative for carcass lean meat content (r(a) = -0.55 +/- 0.14). There was a tendency for a negative genetic correlation between RFI2 and carcass dressing percent (r(a) = -0.36 +/- 0.21). Moreover, selection for low residual feed intake is expected, through lower ultimate pH and lighter color, to decrease pork quality (r(a) = 0.77 +/- 0.14 between RFI2 and a meat quality index intended to predict the ratio of the weight of ham after curing and cooking to the weight of defatted and boneless fresh ham).

Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals

Objective

To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs).

Design

Cohort study. Setting: French Hospital Database on HIV.

Patients

Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml.

Main outcome measures

Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline.

Results

The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk.

Conclusions

The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.

Comparison between the three porcine RN genotypes for growth, carcass composition and meat quality traits

A three-step experimental design has been carried out to add evidence about the existence of the RN gene, with two segregating alleles RN- and rn+, having major effects on meat quality in pigs, to estimate its effects on production traits and to map the RN locus. In the present article, the experimental population and sampling procedures are described and discussed, and effects of the three RN genotypes on growth and carcass traits are presented. The RN genotype had no major effect on growth performance and killing out percentage. Variables pertaining to carcass tissue composition showed that the RN- allele is associated with leaner carcasses (about 1 s.d. effect without dominance for back fat thickness, 0.5 s.d. effect with dominance for weights of joints). Muscle glycolytic potential (GP) was considerably higher in RN- carriers, with a maximum of a 6.85 s.d. effect for the live longissimus muscle GP. Physico-chemical characteristics of meat were also influenced by the RN genotype in a dominant way, ultimate pH differing by about 2 s.d. between homozygous genotypes and meat colour by about 1 s.d. Technological quality was also affected, with a 1 s.d. decrease in technological yield for RN- carriers. The RN genotype had a more limited effect on eating quality. On the whole, the identity between the acid meat condition and the RN- allele effect is clearly demonstrated (higher muscle GP, lower ultimate pH, paler meat and lower protein content), and the unfavourable relationship between GP and carcass lean to fat ratio is confirmed.

Protein nutrition for ruminants in European countries, in the light of animal feeding regulations linked to bovine spongiform encephalopathy

The outbreak of bovine spongiform encephalopathy (BSE) and the discovery of the central role played by meat-and-bone meal (MBM) as the vehicle of infection resulted, from the late 1980s onwards, in the implementation of new regulations on the incorporation of animal proteins, and then of most fats of animal origin, into diets fed to ruminants and other farmed animals. The BSE-related feed ban, which has gradually been reinforced over time, has led to the investigation of cost-effective routes for adequately replacing MBM and tallow by new sources of dietary proteins, minerals and lipids in the formulation of manufactured concentrates. As far as the technical fulfilment of the nutritive requirements of growing and lactating ruminants is concerned, efficient alternative solutions, based principally on recourse to food materials from vegetals already exist or hopefully will soon be available in most of the situations prevailing in Europe. However, related aspects, such as animal feed-processing, availability and traceability of certain food materials, quality of animal products, environmental constraints or disposal of animal waste from the meat industry give cause for concern. The expected consequences of the BSE-related feeding regulations on the organisational and economic framework of animal and crop production sectors throughout Europe and at world level must also be evaluated.

[Cardiac rehabilitation in the Ile-de-France region. Current organization and suggestions for reorganization]

The Ile-de-France Regional Hospital Agency wished to complete the Regional Health Organisation Plan for Cardiology from 1999-2004 with a specific report on cardiac rehabilitation. A working group was set up and, after 8 meetings, its conclusions were submitted. They were adopted after presentation to the regional technical committee for cardiology. The requirements for cardiac rehabilitation were defined according to acknowledged indications in the medical literature: about 18,000 patients per year are candidates for cardiac rehabilitation in the Ile de France region. The existing equipment (1999-2000) was reviewed: 435 hospital beds allowing treatment of 5,780 patients per year; 45 day hospital places (only 20 of which were operational in 2000), in addition to a large fee for act activity allowing a total ambulatory management of a further 1,265 patients per year. The following proposals were made: more uniform distribution of hospital beds in the region; develop ambulatory rehabilitation especially on a day hospital basis; create a third possibility of rehabilitation associating home exercise rehabilitation and a program of education, prevention, reinsertion, psychotherapy within a network of extra-hospital care.

Transient decrease of water diffusion in Wernicke's encephalopathy

We report water diffusion abnormalities in periventricular areas in a patient with Wernicke's encephalopathy. The reduction in diffusion disappeared after 2 weeks of treatment with intravenous thiamine. We suggest that the restricted mobility of cerebral water is related to inflammatory lesions.

A randomized double-blind trial of intravenous trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction

BACKGROUND

Despite high patency rates, primary angioplasty for myocardial infarction does not necessarily result in optimal myocardial reperfusion and limitation of infarct size. Experimentally, trimetazidine limits infarct size, decreases platelet aggregation, and reduces leukocyte influx into the infarct zone. To assess trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction a prospective, double-blind, placebo-controlled pilot trial was performed.

METHODS

94 patients with acute myocardial infarction were randomized to receive trimetazidine (40 mg bolus followed by 60 mg/day intravenously for 48 h) (n=44) or placebo (n=50), starting before recanalization of the infarct vessel by primary angioplasty. Patients underwent continuous ST-segment monitoring to assess return of ST-segment deviation to baseline and presence of ST-segment exacerbation at the time of vessel recanalization. Infarct size was measured enzymatically from serial myoglobin measurements. Left ventricular angiography was performed before treatment and repeated at day 14.

RESULTS

Blinded ST segment analysis showed that despite higher initial ST deviation from baseline in the trimetazidine group (355 (32) vs. 278 (29) microV, P=0.07), there was an earlier and more marked return towards baseline within the first 6 h than in the placebo group (P=0.014) (change: 245 (30) vs. 156 (31) microV respectively, P=0.044). There was a trend towards less frequent exacerbation of ST deviation at the time of recanalization in the trimetazidine group (23.3 vs. 42.2%, P=0.11). There was no difference in left ventricular wall motion at day 14, or in enzymatic infarct size. There was no side effect from treatment. Clinical outcomes were similar between groups.

CONCLUSION

Trimetazidine was safe and led to earlier resolution of ST-segment elevation in patients treated by primary angioplasty for acute myocardial infarction.

[Prognosis and risk evaluation of postoperative coronary patients (PERISCOP). Methodology and study population characteristics]

The aim of the PERISCOP study was to evaluate the predictive value of cardiological investigations performed after recent coronary bypass surgery with regards to cardiac event and mortality at one year. The treatment of lipid abnormalities was also analysed. This first article describes the methodology and patient characteristics at inclusion. This prospective national multicenter trial included 2065 patients (86% men) with an average age of 63.1 +/- 9.9 years. The number of diseased vessels was 2.6 +/- 0.6. Preoperative left ventricular function was normal (ejection fraction 60 +/- 13%). Revascularisation was complete in 73% of cases (22% of arterial grafts). The cardiological investigations were performed at Day 20 +/- 10 after surgery. The duration of exercise on stress testing was 429 +/- 170 seconds. It was positive or doubtful in 9% of cases. Ventricular arrhythmias were observed in 6.5% of cases. The blood pressure response was abnormal in 6% of cases. Holter monitoring showed a median number of ventricular extrasystoles over 24 hours of 44. Three per cent of patients had one episode of ventricular tachycardia and 7% had ischaemic episodes. The echocardiographic index of segmental contractility was on average 1.75 (ejection fraction: 52.6%). The lipid analysis performed at one month, under lipid therapy in 34% of cases, showed a total cholesterol level at 1.91 +/- 0.10 g/l, an LDL-cholesterol of 1.27 +/- 0.08 g/l. The therapeutic target (LDL-cholesterol < 1 g/l) was attained in 46% of cases with treatment and in 18% of cases without treatment.

Genetically caused retarded growth in animals

Growth process of animals is regulated by a multitude of physiological pathways among which components of the somatotropic axis play a key role. A number of severe, simply inherited growth disturbances have been identified in humans, laboratory and farm animals. These disorders are controlled by defective alleles at major loci referring to hormones or hormone receptors, e.g. growth hormone receptor for the recessive sex-linked dwarfism (dw) in chickens and the recessive autosomal Laron-type dwarfism in man, and growth hormone releasing hormone receptor for the recessive "little" mutation (lit) in mice. Apart from these particular cases, growth rate is a quantitative polygenic trait which has a moderate heritability (close to 0.30) and is influenced by prenatal and postnatal maternal effects. Increase in the average coefficient of inbreeding in a population is also known to result in lower growth rate. Divergent selection experiments have shown that upward or downward selection on growth is effective, sometimes with asymmetrical responses, but patterns of changes in underlying physiological traits appear to differ among experiments.

Recurrent subcutaneous infection due to Scopulariopsis brevicaulis in a liver transplant recipient

We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.