Discovery of GLPG2737, a Potent Type 2 Corrector of CFTR for the Treatment of Cystic Fibrosis in Combination with a Potentiator and a Type 1 Co-corrector

Cystic fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR) protein. This epithelial anion channel regulates the active transport of chloride and bicarbonate ions across membranes. Mutations result in reduced surface expression of CFTR channels with impaired functionality. Correctors are small molecules that support the trafficking of CFTR to increase its membrane expression. Such correctors can have different mechanisms of action. Combinations may result in a further improved therapeutic benefit. We describe the identification and optimization of a new pyrazolol3,4-bl pyridine-6-carboxylic acid series with high potency and efficacy in rescuing CFTR from the cell surface. Investigations showed that carboxylic acid group replacement with acylsulfonamides and acylsulfonylureas improved ADMET and PK properties, leading to the discovery of the structurally novel co-corrector GLPG2737. The addition of GLPG2737 to the combination of the potentiator GLPG1837 and C1 corrector 4 led to an 8-fold increase in the F508del CFTR activity.

Wear patterns in knee OA correlate with native limb geometry

Background: To date, the amount of cartilage loss is graded by means of discrete scoring systems on artificially divided regions of interest (ROI). However, optimal statistical comparison between and within populations requires anatomically standardized cartilage thickness assessment. Providing anatomical standardization relying on non-rigid registration, we aim to compare morphotypes of a healthy control cohort and virtual reconstructed twins of end-stage knee OA subjects to assess the shape-related knee OA risk and to evaluate possible correlations between phenotype and location of cartilage loss.

Methods: Out of an anonymized dataset provided by the Medacta company (Medacta International SA, Castel S. Pietro, CH), 798 end-stage knee OA cases were extracted. Cartilage wear patterns were observed by computing joint space width. The three-dimensional joint space width data was translated into a two-dimensional pixel image, which served as the input for a principal polynomial autoencoder developed for non-linear encoding of wear patterns. Virtual healthy twin reconstruction enabled the investigation of the morphology-related risk for OA requiring joint arthroplasty.

Results: The polynomial autoencoder revealed 4 dominant, orthogonal components, accounting for 94% of variance in the latent feature space. This could be interpreted as medial (54.8%), bicompartmental (25.2%) and lateral (9.1%) wear. Medial wear was subdivided into anteromedial (11.3%) and posteromedial (10.4%) wear. Pre-diseased limb geometry had a positive predictive value of 0.80 in the prediction of OA incidence (r 0.58, p < 0.001).

Conclusion: An innovative methodological workflow is presented to correlate cartilage wear patterns with knee joint phenotype and to assess the distinct knee OA risk based on pre-diseased lower limb morphology. Confirming previous research, both alignment and joint geometry are of importance in knee OA disease onset and progression.

Modulation of sleep behavior in zebrafish larvae by pharmacological targeting of the orexin receptor

New pharmacological approaches that target orexin receptors (OXRs) are being developed to treat sleep disorders such as insomnia and narcolepsy, with fewer side effects than existing treatments. Orexins are neuropeptides that exert excitatory effects on postsynaptic neurons via the OXRs, and are important in regulating sleep/wake states. To date, there are three FDA-approved dual orexin receptor antagonists for the treatment of insomnia, and several small molecule oral OX2R (OXR type 2) agonists are in the pipeline for addressing the orexin deficiency in narcolepsy. To find new hypnotics and psychostimulants, rodents have been the model of choice, but they are costly and have substantially different sleep patterns to humans. As an alternative model, zebrafish larvae that like humans are diurnal and show peak daytime activity and rest at night offer several potential advantages including the ability for high throughput screening. To pharmacologically validate the use of a zebrafish model in the discovery of new compounds, we aimed in this study to evaluate the functionality of a set of known small molecule OX2R agonists and antagonists on human and zebrafish OXRs and to probe their effects on the behavior of zebrafish larvae. To this end, we developed an in vitro IP-One Homogeneous Time Resolved Fluorescence (HTRF) immunoassay, and in vivo locomotor assays that record the locomotor activity of zebrafish larvae under physiological light conditions as well as under dark-light triggers. We demonstrate that the functional IP-One test is a good predictor of biological activity in vivo. Moreover, the behavioral data show that a high-throughput assay that records the locomotor activity of zebrafish throughout the evening, night and morning is able to distinguish between OXR agonists and antagonists active on the zebrafish OXR. Conversely, a locomotor assay with alternating 30 min dark-light transitions throughout the day is not able to distinguish between the two sets of compounds, indicating the importance of circadian rhythm to their pharmacological activity. Overall, the results show that a functional IP-one test in combination with a behavioral assay using zebrafish is well-suited as a discovery platform to find novel compounds that target OXRs for the treatment of sleep disorders.

Principal polynomial shape analysis: A non-linear tool for statistical shape modeling

BACKGROUND AND OBJECTIVES

The most widespread statistical modeling technique is based on Principal Component Analysis (PCA). Although this approach has several appealing features, it remains hampered by its linearity. Principal Polynomial Analysis (PPA) can capture non-linearity in a sequential algorithm, while maintaining the interesting properties of PCA. PPA is, however, computationally expensive in handling shape surface data. To this end, we propose Principal Polynomial Shape Analysis (PPSA) as an adjusted approach for non-linear shape analyzes. The aim of this study was to assess PPSA's features, its model boundaries and its general applicability.

METHODS

PCA and PPSA-based shape models were investigated on one verification and three model evaluation experiments. In the verification experiment, the estimated mean of the PCA and PPSA model on a data set of synthetic lower limbs of different lengths in different poses were compared to the real mean. Further, the PCA-based and PPSA shape models were tested for three challenging cases namely for shape model creation of gait marker data, for regression analysis on aging faces and for modeling pose variation in full body scans. For the latter, additionally a Fundamental Coordinate Model (FCM) and a PPSA model on Fundamental Coordinate(FC) space was created. The performances were evaluated based on model-based accuracy, generalization, compactness and specificity.

RESULTS

In the verification experiment, the scaling error reduced from 75% to below 1% when employing PPSA instead of PCA for a training set with 180° angular variation. For the model evaluation experiments, the PPSA models described the data as accurate and generalized as the PCA-based shape models. The PPSA models were slightly more compact and specific (up to 30%) than the PCA-based models. In regression, PCA and PPSA-based parameterizations explained a similar amount of variation. Lastly, for the full body scans, applying PPSA to parameterizations improved the compactness and accuracy.

CONCLUSIONS

PPSA describes the non-linear relationships between principal variations in a parameterized space. Compared to standard PCA-based shape models, capturing the non-linearity reduced the nonsense information in the shape components and improved the description of the data mean.

Accelerating GPCR Drug Discovery With Conformation-Stabilizing VHHs

The human genome encodes 850 G protein-coupled receptors (GPCRs), half of which are considered potential drug targets. GPCRs transduce extracellular stimuli into a plethora of vital physiological processes. Consequently, GPCRs are an attractive drug target class. This is underlined by the fact that approximately 40% of marketed drugs modulate GPCRs. Intriguingly 60% of non-olfactory GPCRs have no drugs or candidates in clinical development, highlighting the continued potential of GPCRs as drug targets. The discovery of small molecules targeting these GPCRs by conventional high throughput screening (HTS) campaigns is challenging. Although the definition of success varies per company, the success rate of HTS for GPCRs is low compared to other target families (Fujioka and Omori, 2012; Dragovich et al., 2022). Beyond this, GPCR structure determination can be difficult, which often precludes the application of structure-based drug design approaches to arising HTS hits. GPCR structural studies entail the resource-demanding purification of native receptors, which can be challenging as they are inherently unstable when extracted from the lipid matrix. Moreover, GPCRs are flexible molecules that adopt distinct conformations, some of which need to be stabilized if they are to be structurally resolved. The complexity of targeting distinct therapeutically relevant GPCR conformations during the early discovery stages contributes to the high attrition rates for GPCR drug discovery programs. Multiple strategies have been explored in an attempt to stabilize GPCRs in distinct conformations to better understand their pharmacology. This review will focus on the use of camelid-derived immunoglobulin single variable domains (VHHs) that stabilize disease-relevant pharmacological states (termed ConfoBodies by the authors) of GPCRs, as well as GPCR:signal transducer complexes, to accelerate drug discovery. These VHHs are powerful tools for supporting in vitro screening, deconvolution of complex GPCR pharmacology, and structural biology purposes. In order to demonstrate the potential impact of ConfoBodies on translational research, examples are presented of their role in active state screening campaigns and structure-informed rational design to identify de novo chemical space and, subsequently, how such matter can be elaborated into more potent and selective drug candidates with intended pharmacology.

Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation

The risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions. A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large (n = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant (P < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study.

Automatic 3D dense phenotyping provides reliable and accurate shape quantification of the human mandible

Automatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC’s for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

An exploration of adolescent facial shape changes with age via multilevel partial least squares regression

BACKGROUND AND OBJECTIVES

Multilevel statistical models represent the existence of hierarchies or clustering within populations of subjects (or shapes in this work). This is a distinct advantage over single-level methods that do not. Multilevel partial-least squares regression (mPLSR) is used here to study facial shape changes with age during adolescence in Welsh and Finnish samples comprising males and females.

METHODS

3D facial images were obtained for Welsh and Finnish male and female subjects at multiple ages from 12 to 17 years old. 1000 3D points were defined regularly for each shape by using "meshmonk" software. A three-level model was used here, including level 1 (sex/ethnicity); level 2, all "subject" variations excluding sex, ethnicity, and age; and level 3, age. The mathematical formalism of mPLSR is given in an Appendix.

RESULTS

Differences in facial shape between the ages of 12 and 17 predicted by mPLSR agree well with previous results of multilevel principal components analysis (mPCA); buccal fat is reduced with increasing age and features such as the nose, brow, and chin become larger and more distinct. Differences due to ethnicity and sex are also observed. Plausible simulated faces are predicted from the model for different ages, sexes and ethnicities. Our models provide good representations of the shape data by consideration of appropriate measures of model fit (RMSE and R2).

CONCLUSIONS

Repeat measures in our dataset for the same subject at different ages can only be modelled indirectly at the lowest level of the model at discrete ages via mPCA. By contrast, mPLSR models age explicitly as a continuous covariate, which is a strong advantage of mPLSR over mPCA. These investigations demonstrate that multivariate multilevel methods such as mPLSR can be used to describe such age-related changes for dense 3D point data. mPLSR might be of much use in future for the prediction of facial shapes for missing persons at specific ages or for simulating shapes for syndromes that affect facial shape in new subject populations.

Separating positional noise from neutral alignment in multicomponent statistical shape models

Given sufficient training samples, statistical shape models can provide detailed population representations for use in anthropological and computational genetic studies, injury biomechanics, musculoskeletal disease models or implant design optimization. While the technique has become extremely popular for the description of isolated anatomical structures, it suffers from positional interference when applied to coupled or articulated input data. In the present manuscript we describe and validate a novel approach to extract positional noise from such coupled data. The technique was first validated and then implemented in a multicomponent model of the lower limb. The impact of noise on the model itself as well as on the description of sexual dimorphism was evaluated. The novelty of our methodology lies in the fact that no rigid transformations are calculated or imposed on the data by means of idealized joint definitions and by extension the models obtained from them.

Multilevel principal components analysis of three-dimensional facial growth in adolescents

BACKGROUND AND OBJECTIVES

The study of age-related facial shape changes across different populations and sexes requires new multivariate tools to disentangle different sources of variations present in 3D facial images. Here we wish to use a multivariate technique called multilevel principal components analysis (mPCA) to study three-dimensional facial growth in adolescents.

METHODS

These facial shapes were captured for Welsh and Finnish subjects (both male and female) at multiple ages from 12 to 17 years old (i.e., repeated-measures data). 1000 "dense" 3D points were defined regularly for each shape by using a deformable template via "meshmonk" software. A three-level model was used here, namely: level 1 (sex/ethnicity); level 2, all "subject" variations excluding sex, ethnicity, and age; and level 3, age. The technicalities underpinning the mPCA method are presented in Appendices.

RESULTS

Eigenvalues via mPCA predicted that: level 1 (ethnicity/sex) contained 7.9% of variation; level 2 contained 71.5%; and level 3 (age) contained 20.6%. The results for the eigenvalues via mPCA followed a similar pattern to those results of single-level PCA. Results for modes of variation made sense, where effects due to ethnicity, sex, and age were reflected in modes at appropriate levels of the model. Standardised scores at level 1 via mPCA showed much stronger differentiation between sex and ethnicity groups than results of single-level PCA. Results for standardised scores from both single-level PCA and mPCA at level 3 indicated that females had different average "trajectories" with respect to these scores than males, which suggests that facial shape matures in different ways for males and females. No strong evidence of differences in growth patterns between Finnish and Welsh subjects was observed.

CONCLUSIONS

mPCA results agree with existing research relating to the general process of facial changes in adolescents with respect to age quoted in the literature. They support previous evidence that suggests that males demonstrate larger changes and for a longer period of time compared to females, especially in the lower third of the face. These calculations are therefore an excellent initial test that multivariate multilevel methods such as mPCA can be used to describe such age-related changes for "dense" 3D point data.

Statistical Shape Modeling of Skeletal Anatomy for Sex Discrimination: Their Training Size, Sexual Dimorphism, and Asymmetry

Purpose: Statistical shape modeling provides a powerful tool for describing and analyzing human anatomy. By linearly combining the variance of the shape of a population of a given anatomical entity, statistical shape models (SSMs) identify its main modes of variation and may approximate the total variance of that population to a selected threshold, while reducing its dimensionality. Even though SSMs have been used for over two decades, they lack in characterization of their goodness of prediction, in particular when defining whether these models are actually representative for a given population.

Methods: The current paper presents, to the authors' knowledge, the most extent lower limb anatomy shape model considering the pelvis, femur, patella, tibia, fibula, talus, and calcaneum to date. The present study includes the segmented training shapes (n = 542) obtained from 271 lower limb CT scans. The different models were evaluated in terms of accuracy, compactness, generalizability as well as specificity.

Results: The size of training samples needed in each model so that it can be considered population covering was estimated to approximate around 200 samples, based on the generalizability properties of the different models. Simultaneously differences in gender and patterns in left-right asymmetry were identified and characterized. Size was found to be the most pronounced sexual discriminator whereas intra-individual variations in asymmetry were most pronounced at the insertion site of muscles.

Conclusion: For models aimed at population covering descriptive studies, the number of training samples required should amount a sizeable 200 samples. The geometric morphometric method for sex discrimination scored excellent, however, it did not largely outperformed traditional methods based on discrete measures.

Facial soft tissue thicknesses in craniofacial identification: Data collection protocols and associated measurement errors

Facial soft tissue thicknesses (FSTT) form a key component of craniofacial identification methods, but as for any data, embedded measurement errors are highly pertinent. These in part dictate the effective resolution of the measurements. As herein reviewed, measurement methods are highly varied in FSTT studies and associated measurement errors have generally not been paid much attention. Less than half (44%) of 95 FSTT studies comment on measurement error and not all of these provide specific quantification. Where informative error measurement protocols are employed (5% of studies), the mean error magnitudes range from 3% to 45% rTEM and are typically in the order of 10-20%. These values demonstrate that FSTT measurement errors are similar in size to (and likely larger than) the magnitudes of many biological effects being chased. As a result, the attribution of small millimeter or submillimeter differences in FSTT to biological variables must be undertaken with caution, especially where they have not been repeated across different studies/samples. To improve the integrity of FSTT studies and the reporting of FSTT measurement errors, we propose the following standard: (1) calculate the technical error of measurement (TEM or rTEM) in any FSTT research work; (2) assess the error embedded in the full data collection procedure; and (3) conduct validation testing of FSTT means proposed for point estimation prior to publication to ensure newly calculated FSTT means provide improvements. In order to facilitate the latter, a freely available R tool TDValidator that uses the C-Table data for validation testing is provided.

Facial morphology and growth following surgery for congenital midline cervical cleft patients

Congenital midline cervical cleft (CMCC) is a rare condition that consists of a cutaneous midline neck lesion with a sinus extending inferiorly towards the sternum. A fibrous band that extends superiorly to the mandible is a consistent feature of the condition. Restriction of growth of the mandible, possibly due to incomplete removal of the band, is the most significant long-term problem. It remains unclear whether early removal of the fibrous band might allow catch-up growth of the mandible. This study utilized non-invasive three-dimensional photographs to objectively evaluate the facial growth of six CMCC patients. The growth of these CMCC patients was compared to the average growth of age- and sex-matched controls from a database of three-dimensional facial photographs of clinically normal subjects. After surgical removal of the fibrous cord, CMCC patients experience growth in the chin at the same rate as in the normal population; no evidence was found for catch-up growth. As a result, individuals with CMCC are likely to require further surgical intervention to correct the residual retrognathia on completion of facial growth. Early excision of the lesion including aggressive resection of the fibrous band is still recommended, as this should optimize the early growth of the mandible in infancy.

A Comprehensive Craniofacial Study of 22q11.2 Deletion Syndrome

The 22q11.2 deletion syndrome (22q11.2DS) is one of the most frequent microdeletion syndromes and presents with a highly variable phenotype. In most affected individuals, specific but subtle facial features can be seen. In this observational study, we aim to investigate the craniofacial and dental features of 20 children with a confirmed diagnosis of 22q11.2DS by analyzing 3-dimensional (3D) facial surface scans, 2-dimensional (2D) clinical photographs, panoramic and cephalometric radiographs, and dental casts. The 3D facial scans were compared to scans of a healthy control group and analyzed using a spatially dense geometric morphometric approach. Cephalometric radiographs were digitally traced, and measurements were compared to existing standards. Occlusal and dental features were studied on dental casts and panoramic radiographs. Interestingly, a general trend of facial hypoplasia in the lower part of the face could be evidenced with the 3D facial analysis in children with 22q11.2DS compared to controls. Cephalometric analysis confirmed a dorsal position of the mandible to the maxilla in 2D and showed an enlarged cranial base angle. Measurements for occlusion did not differ significantly from standards. Despite individual variability, we observed a retruded lower part of the face as a common feature, and we also found a significantly higher prevalence of tooth agenesis in our cohort of 20 children with 22q11.2DS (20%). Furthermore, 3D facial surface scanning proved to be an important noninvasive, diagnostic tool to investigate external features and the underlying skeletal pattern.

New Polyacetal Polysulphate Active against Human Immunodeficiency Virus and other Enveloped Viruses

A new polyacetal polysulphate, termed PAPS, was synthesized starting from dextran through oxidation, reduction, and subsequent sulphation. PAPS inhibited HIV-1- and HIV-2-induced cytopathicity in MT-4 cells at concentrations comparable to those required for dextran sulphate (MW5000) to inhibit the cytopathicity of these viruses (50% inhibitory concentration: 0.4–0.04 μg ml−1). At these concentrations PAPS had no anticoagulant activity. PAPS suppressed syncytium formation between MOLT-4 cells and persistently HIV-1- or HIV-2-infected HUT-78 cells at a concentration of 1 μg ml−1, that is 25- to 30-fold lower than that required for dextran sulphate to inhibit syncytium formation. Like dextran sulphate, PAPS inhibited HIV-1 binding to the cells and anti-gp120 mAb binding to HIV-1 gp120. Also, PAPS proved equally active as dextran sulphate against herpes simplex virus, cytomegalovirus and the arenaviruses Junin and Tacaribe, and 10-fold more active than dextran sulphate against vaccinia, Sindbis, influenza A, and vesicular stomatitis virus. Neither PAPS nor dextran sulphate proved inhibitory to the non-enveloped viruses polio, Coxsackie and reovirus. Pharmacokinetic studies in rabbits revealed that after intravenous bolus injection the serum concentrations of PAPS decayed biphasically, with an initial half-life of approximately 45–60 min. Twenty-four hours following their intraperitoneal administration to mice, PAPS as well as dextran sulphate generated low titres of an antiviral principle that was at least partially interferon-like.

Sulphated Cyclodextrins are Potent anti-HIV Agents Acting Synergistically with 2′,3′-dideoxynucleoside Analogues

Sulphated cyclodextrins proved to be potent inhibitors of human immunodeficiency virus (HIV), cytomegalovirus (CMV) and herpes simplex virus (HSV) but not other enveloped viruses (i.e. Sindbis virus, respiratory syncytial virus, Tacaribe virus, vesicular stomatitis virus or vaccinia virus). Their mechanism of action against HIV can be attributed to an inhibition of the binding of HIV-1 virions to the cells, as demonstrated by flow cytometric analysis. The sulphated cyclodextrins enhanced the anti-HIV-1 activity of pyrimidine 2′,3′-dideoxyribosides (i.e. azidothymidine, dideoxycytidine, didehydro-dideoxythymidine, fluorodide-oxychlorouridine), in a subsynergistic manner, and the anti-HIV-1 activity of purine 2′,3′-dideoxyribosides (dideoxyadenosine, dideoxyinosine, 2,6-diaminopurine dideoxyriboside) and 9-(2-phosphonylmethoxyethyl)adenine in a synergistic manner. Following intravenous administration of the sulphated cyclodextrins to rabbits, drug serum concentrations were obtained that were 100- to 1000-fold above the minimum inhibitory concentration for HIV or CMV.

Review: Facial endophenotypes in non-syndromic orofacial clefting

Cleft lip and/or palate (CL/P) is one of the most frequent congenital malformations, with a frequency of 1 in 700 live births. Non-syndromic orofacial clefting is a multifactorial condition, with both a genetic and an environmental component. Although numerous studies have been published addressing the genetic etiology of CL/P, this factor remains incompletely understood. A promising approach to find candidate gene regions for CL/P is the investigation of endophenotypes, which are characteristics associated with a certain condition and that can be an expression of underlying susceptibility genes. This review focuses on the known facial endophenotypes in CL/P (such as distortion of the orbicularis oris muscle and facial features in non-affected relatives of patients with CL/P) and genes that could be associated with these characteristics. Possibilities for further endophenotype-related studies in the field of non-syndromic CL/P are discussed.

1,2,3,4,8,9,10,11-octahydrobenzo[j]phenanthridine-7,12-diones as new leads against Mycobacterium tuberculosis

Tuberculosis (TB) continues to be a worldwide health problem with over 1.4 million deaths each year. Despite efforts to develop more effective vaccines, more reliable diagnostics, and chemotherapeutics, tuberculosis remains a threat to global health, fueled by the HIV pandemic and the rapid generation of drug resistance. The exploration of novel drugs to serve as a companion drug for existing drugs is of paramount importance. As part of our program to design new 2-aza-anthraquinones with antimycobacterial activity, various tetrahydro- and octahydrobenzo[j]phenanthridinediones were synthesized. These compounds showed high in vitro potency against Mycobacterium tuberculosis, the etiological agent of TB and against other clinically relevant mycobacterial species at submicromolar concentrations. The susceptibility of a multidrug resistant strain toward these compounds and their ability to target intracellular replicating Mycobacterium tuberculosis was demonstrated. Next to the acute toxicity, the genotoxicity of these compounds was investigated. Often overlooked in studies, genotoxicity could be dismissed for the investigated compounds, making them a promising scaffold in TB drug research.

The normal-equivalent: a patient-specific assessment of facial harmony

Evidence-based practice in oral and maxillofacial surgery would greatly benefit from an objective assessment of facial harmony or gestalt. Normal reference faces have previously been introduced, but they describe harmony in facial form as an average only and fail to report on harmonic variations found between non-dysmorphic faces. In this work, facial harmony, in all its complexity, is defined using a face-space, which describes all possible variations within a non-dysmorphic population; this was sampled here, based on 400 healthy subjects. Subsequently, dysmorphometrics, which involves the measurement of morphological abnormalities, is employed to construct the normal-equivalent within the given face-space of a presented dysmorphic face. The normal-equivalent can be seen as a synthetic identical but unaffected twin that is a patient-specific and population-based normal. It is used to extract objective scores of facial discordancy. This technique, along with a comparing approach, was used on healthy subjects to establish ranges of discordancy that are accepted to be normal, as well as on two patient examples before and after surgical intervention. The specificity of the presented normal-equivalent approach was confirmed by correctly attributing abnormality and providing regional depictions of the known dysmorphologies. Furthermore, it proved to be superior to the comparing approach.

Robust and regional 3D facial asymmetry assessment in hemimandibular hyperplasia and hemimandibular elongation anomalies

Hemimandibular hyperplasia (HH) and hemimandibular elongation (HE) anomalies present with facial asymmetry and deranged occlusion. Currently, diagnosis and assessment of the facial dysmorphology is based on subjective clinical evaluation, supported by radiological scans. Advancements in objective assessments of facial asymmetry from three-dimensional (3D) facial scans facilitate a re-evaluation of the patterns of facial dysmorphology. Automated, robust and localised asymmetry assessments were obtained by comparing a 3D facial scan with its reflected image using a weighted least-squares superimposition. This robust superimposition is insensitive to severe asymmetries. This provides an estimation of the anatomical midline and a spatially dense vector map visualising localised directional differences between the left and right hemifaces. Analysis was conducted on three condylar hyperplasia phenotypes confirmed by clinical and CT evaluation: HH; HE; and hybrid phenotype. The midline extraction revealed chin point displacements in all cases. The upper lip philtrum and nose tip deviation to the affected side and a marked asymmetry of the mid face was noted in cases involving HE. Downward and medial rotation of the mandible with minor involvement of the midface was seen in the HH associated deformity. The hybrid phenotype case exhibited asymmetry features of both HH and HE cases.

Improved facial outcome assessment using a 3D anthropometric mask

The capacity to process three-dimensional facial surfaces to objectively assess outcomes of craniomaxillofacial care is urgently required. Available surface registration techniques depart from conventional facial anthropometrics by not including anatomical relationship in their analysis. Current registrations rely on the manual selection of areas or points that have not moved during surgery, introducing subjectivity. An improved technique is proposed based on the concept of an anthropometric mask (AM) combined with robust superimposition. The AM is the equivalent to landmark definitions, as used in traditional anthropometrics, but described in a spatially dense way using (∼10.000) quasi-landmarks. A robust superimposition is performed to align surface images facilitating accurate measurement of spatial differences between corresponding quasi-landmarks. The assessment describes magnitude and direction of change objectively and can be displayed graphically. The technique was applied to three patients, without any modification and prior knowledge: a 4-year-old boy with Treacher-Collins syndrome in a resting and smiling pose; surgical correction for hemimandibular hypoplasia; and mandibular hypoplasia with staged orthognathic procedures. Comparisons were made with a reported closest-point (CP) strategy. Contrasting outcomes were found where the CP strategy resulted in anatomical implausibility whilst the AM technique was parsimonious to expected differences.

Augmentation of linear facial anthropometrics through modern morphometrics: a facial convexity example

BACKGROUND

The facial region has traditionally been quantified using linear anthropometrics. These are well established in dentistry, but require expertise to be used effectively. The aim of this study was to augment the utility of linear anthropometrics by applying them in conjunction with modern 3-D morphometrics.

METHODS

Facial images of 75 males and 94 females aged 18-25 years with self-reported Caucasian ancestry were used. An anthropometric mask was applied to establish corresponding quasi-landmarks on the images in the dataset. A statistical face-space, encoding shape covariation, was established. The facial median plane was extracted facilitating both manual and automated indication of commonly used midline landmarks. From both indications, facial convexity angles were calculated and compared. The angles were related to the face-space using a regression based pathway enabling the visualization of facial form associated with convexity variation.

RESULTS

Good agreement between the manual and automated angles was found (Pearson correlation: 0.9478-0.9474, Dahlberg root mean squared error: 1.15°-1.24°). The population mean angle was 166.59°-166.29° (SD 5.09°-5.2°) for males-females. The angle-pathway provided valuable feedback.

CONCLUSIONS

Linear facial anthropometrics can be extended when used in combination with a face-space derived from 3-D scans and the exploration of property pathways inferred in a statistically verifiable way.

Structural identification of caged vanadium doped silicon clusters

The geometry of cationic silicon clusters doped with vanadium, Si(n)V(+) (n=12-16), is investigated by using infrared multiple photon dissociation of the corresponding rare gas complexes in combination with ab initio calculations. It is shown that the clusters are endohedral cages, and evidence is provided that Si(16)V(+) is a fluxional system with a symmetric Frank-Kasper geometry.

Contractile effects of 5-hydroxytryptamine (5-HT) in the equine jejunum circular muscle: functional and immunohistochemical identification of a 5-HT1A-like receptor

REASONS FOR PERFORMING STUDY

Prokinetic drugs used to treat gastrointestinal ileus in man have equivocal results in horses. In man, prokinetic drugs have 5-hydroxytryptamine4(5-HT4) receptors as their target, but little is known about the 5-HT-receptor subtypes in the equine small intestine.

OBJECTIVE

Functional and immunohistochemical identification of the serotonin receptor subtype(s) responsible for the 5-HT induced contractile response in the equine circular jejunum.

METHODS

Isometric organ-bath recordings were carried out to assess spontaneous and drug-evoked contractile activity of equine circular jejunum. Histological investigations by immunofluorescence analyses were performed to check for presence and localisation of this functionally identified 5-HT receptor subtype.

RESULTS

Tonic contractions were induced by 5-HT in horse jejunal circular muscle. Tetrodotoxin, atropine and NG-nitro L-arginine did not modify this response. A set of 5-HT receptor subtype selective antagonists excluded interaction with 5-HT1B, 1D, 2A, 3, 4 and 7 receptors. The selective 5-HT1A receptor antagonists WAY 100635 and NAN 190 caused a clear rightward shift of the concentration-response curve to 5-HT. The contractile effect of 5-CT, that can interact with 5-HT1A, 1B, 1D, 5 and 7 receptors was also antagonised by WAY 100635, identifying the targeted 5-HT receptor as a 5-HT1A-like receptor. Immunohistology performed with rabbit polyclonal anti-5-HT1A receptor antibodies confirmed the presence of muscular 5-HT1A receptors in the muscularis mucosae, and both longitudinal and circular smooth muscle layers of the equine jejunum.

CONCLUSIONS

Contractile responses in equine jejunal circular smooth muscle induced by 5-HT involves 5-HT1A-like receptors.

Large-scale in-vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction

A large-scale study of facial soft tissue depths of Caucasian adults was conducted. Over a 2-years period, 967 Caucasian subjects of both sexes, varying age and varying body mass index (BMI) were studied. A user-friendly and mobile ultrasound-based system was used to measure, in about 20min per subject, the soft tissue thickness at 52 facial landmarks including most of the landmarks used in previous studies. This system was previously validated on repeatability and accuracy [S. De Greef, P. Claes, W. Mollemans, M. Loubele, D. Vandermeulen, P. Suetens, G. Willems, Semi-automated ultrasound facial soft tissue depth registration: method and validation. J. Forensic Sci. 50 (2005)]. The data of 510 women and 457 men were analyzed in order to update facial soft tissue depth charts of the contemporary Caucasian adult. Tables with the average thickness values for each landmark as well as the standard deviation and range, tabulated according to gender, age and BMI are reported. In addition, for each landmark and for both sexes separately, a multiple linear regression of thickness versus age and BMI is calculated. The lateral asymmetry of the face was analysed on an initial subset of 588 subjects showing negligible differences and thus warranting the unilateral measurements of the remaining subjects. The new dataset was statistically compared to three datasets for the Caucasian adults: the traditional datasets of Rhine and Moore [J.S. Rhine, C.E. Moore, Tables of facial tissue thickness of American Caucasoids in forensic anthropology. Maxwell Museum Technical series 1 (1984)] and Helmer [R. Helmer, Schädelidentifizierung durch elektronische bildmischung, Kriminalistik Verlag GmbH, Heidelberg, 1984] together with the most recent in vivo study by Manhein et al. [M.H. Manhein, G.A. Listi, R.E. Barsley, R. Musselman, N.E. Barrow, D.H. Ubelbaker, In vivo facial tissue depth measurements for children and adults. J. Forensic Sci. 45 (2000) 48-60]. The large-scale database presented in this paper offers a denser sampling of the facial soft tissue depths of a more representative subset of the actual Caucasian population over the different age and body posture subcategories. This database can be used as an updated chart for manual and computer-based craniofacial approximation and allows more refined analyses of the possible factors affecting facial soft tissue depth.

Agonists of the P2Y(AC)-receptor activate MAP kinase by a ras-independent pathway in rat C6 glioma

We have previously shown that an ecto-NPPase modulates the ATP- and ADP-mediated P2Y(AC)-receptor activation in rat C6 glioma. In the present study, 2MeSADP and Ap(3)A induced no detectable PI turnover and were identified as specific agonists of the P2Y(AC)-receptor with EC(50) values of 250 +/- 37 pM and 1 +/- 0.5 microM, respectively. P2Y(AC)-receptor stimulation increased MAP kinase (ERK1/2) activation that returned to the basal level 4 h after stimulation and was correlated with a gradual desensitization of the P2Y(AC)-purinoceptor. The purinoceptor antagonists DIDS and RB2 blocked MAP kinase activation. An IP(3)-independent Ca(2+)-influx was observed after P2Y(AC)-receptor activation. Inhibition of this influx by Ca(2+)-chelation, did not affect MAP kinase activation. Pertussis toxin, toxin B, selective PKC-inhibitors and a specific MEK-inhibitor inhibited the 2MeSADP- and Ap(3)A-induced MAP kinase activation. In addition, transfection with dominant negative RhoA(Asn19) rendered C6 cells insensitive to P2Y(AC)-receptor-mediated MAP kinase activation whereas dominant negative ras was without effect. Immunoprecipitation experiments indicated a significant increase in the phosphorylation of raf-1 after P2Y(AC)-receptor activation. We may conclude that P2Y(AC)-purinoceptor agonists activate MAP kinase through a G(i)-RhoA-PKC-raf-MEK-dependent, but ras- and Ca(2+)-independent cascade.

Protein tyrosine kinase-dependent regulation of adenylate cyclase and phosphatidylinositol 3-kinase activates the expression of glial fibrillary acidic protein upon induction of differentiation in rat c6 glioma

Glial fibrillary acidic protein (GFAP) is expressed upon cAMP-mediated induction of differentiation of glial progenitor cells into type II astrocytes. The protein is regulated by hormones, growth factors and cytokines but the signal transduction pathways involved in the regulation of GFAP expression are largely unknown. Specific protein kinase inhibitors were used to study their effect on the expression of GFAP in rat C6 glioma cells. Herbimycin A, a selective protein tyrosine kinase inhibitor, reduced GFAP mRNA and protein expression upon cAMP analog or beta-adrenergic receptor-mediated induction of differentiation. The latter inhibitor attenuated the elevation of cAMP by adenylate cyclase and abolished the activity of phosphatidylinositol 3-kinase (PI 3-K). These data indicate that GFAP expression is regulated by protein tyrosine phosphorylations, modulating the cAMP concentration and PI 3-K activity in C6 glioma cells.

Identification of the tumor metastasis suppressor Nm23-H1/Nm23-R1 as a constituent of the centrosome

Processes like cell proliferation, differentiation, and tumor metastasis require a flexible adaptation of cell shape and cell plasticity. A regulator of cell structure and shape is the centrosome and its associated microtubules. Recently, oncogenes like p53, pRB, and the tumor suppressor BRCA1 have been characterized as members of the centrosome. In this communication, we identified rat Nm23-R1/NDPKbeta, a homologue of the human tumor metastasis suppressor Nm23-H1 and a regulator of cell proliferation and differentiation, as a component of the centrosomal complex. We used confocal laser scanning microscopy on different cell types and biochemical analysis of purified centrosomes to demonstrate that Nm23-R1 is located in the centrosome of dividing and nondividing cells. We also showed that the centrosomal enzyme is catalytically active and able to transfer the gamma-phosphate from a nucleoside triphosphate to a nucleoside diphosphate. In addition, Nm23-R1 coimmunoprecipitated with gamma-tubulin, a core centrosomal protein essential for microtubule nucleation. In addition, human Nm23-R1/-H1 was also shown to be present in the centrosome of different human and rat cell types, demonstrating that the presence of Nm23-H1 homologues in the latter organelle is a general event.

Phosphatidylinositol 3-kinase activity is required for the expression of glial fibrillary acidic protein upon cAMP-dependent induction of differentiation in rat C6 glioma

Glial fibrillary acidic protein (GFAP) is an intermediate filament (IF) protein expressed upon maturation of astrocytes and upregulated during reactive astrogliosis. Its expression is modulated by several growth factors and hormones. Although an upregulation of intracellular cAMP is required for the induction of GFAP expression in astrocytes, little information is available on other downstream factors of the signal transduction pathways involved in the regulation of its expression. In this communication, we identified phosphatidylinositol 3-kinase (PI 3-K) as a necessary enzyme for GFAP expression in rat C6 glioma cells. Use of the specific PI 3-K inhibitors wortmannin and LY294002 and transfection of C6 cells with a dominant negative PI 3-K construct, resulting in a decrease of the enzymatic activity of PI 3-K, inhibited the cAMP-dependent expression of GFAP. Furthermore, confocal laser scanning microscopy demonstrated that inhibition of the PI 3-K activity by LY294002 or wortmannin concomitant with induction of differentiation changes the cellular distribution leading to a pericentrosomal localization of GFAP and an altered cell shape lacking process formation. We conclude that the expression and cellular distribution of GFAP is mediated through a PI 3-K-dependent mechanism.

Nucleoside diphosphate kinase beta (Nm23-R1/NDPKbeta) is associated with intermediate filaments and becomes upregulated upon cAMP-induced differentiation of rat C6 glioma

Nucleoside diphosphate kinases (Nm23/NDPK) are enzymes functional in cell proliferation, differentiation, development, tumor progression, and metastasis. Nevertheless, no consensus exists about the molecular mechanism by which Nm23/NDPK isoforms exert their role in these processes. We investigated the expression of the rat Nm23-R1/NDPKbeta and Nm23-R2/NDPKalpha isoforms, homologues of the human Nm23-H1/NDPK A and Nm23-H2/NDPK B proteins, respectively, upon cAMP-induced differentiation of rat C6 glioma cells and demonstrated a differential interaction with intermediate filaments. Semiquantitative RT-PCR, immunoblotting, and flow cytometry showed a constitutive expression of both Nm23 isoforms. After induction of differentiation in C6 cells with cAMP analogs or isoproterenol, a dose-dependent 2- and 2.5-fold upregulation of the Nm23-R1 mRNA and protein, respectively, was observed. In contrast, the expression of Nm23-R2 remained unchanged. Localization of both isoforms with confocal laser scanning microscopy demonstrated a punctate reticular staining pattern for both Nm23 isoforms in the cytosol and processes of the cells which was particularly intense in the perinuclear region. In addition, while Nm23-R2 was colocalized and coimmunoprecipitated with vimentin in nondifferentiated cells, both isoforms were associated with GFAP in differentiated cells. The significance of these findings in relation to a possible function of Nm23 isoforms in cell proliferation, differentiation, and tumor-associated mechanisms is discussed.

Massive fat emboli syndrome after unsuccessful unreamed nailing of the tibia

A patient is presented in whom massive fat emboli syndrome (FES) developed after the unsuccessful treatment of a solitary tibial fracture with an unreamed tibial nail. Ultimately, a reamed tibial nail was inserted. Several risk factors for the development of FES were identified retrospectively in this particular case: a very small medullary canal, a large-diameter unreamed tibial nail, reaming of a small medullary canal and insertion of a thick reamed tibial nail. Even in the presence of patients with solitary lesions and without obvious risks for FES, one should always take this dangerous complication into account.