Corrigendum to "Computational design of nanomolar-binding antibodies specific to multiple SARS-CoV-2 variants by engineering a specificity switch of antibody 80R using RosettaAntibodyDesign (RAbD) results in potential generalizable therapeutic antibodies for novel SARS-CoV-2 virus" [Heliyon 9(4) (April 2023) e15032]

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15032.].

Computational design of nanomolar-binding antibodies specific to multiple SARS-CoV-2 variants by engineering a specificity switch of antibody 80R using RosettaAntibodyDesign (RAbD) results in potential generalizable therapeutic antibodies for novel SARS-CoV-2 virus

The human infectious disease COVID-19 caused by the SARS-CoV-2 virus has become a major threat to global public health. Developing a vaccine is the preferred prophylactic response to epidemics and pandemics. However, for individuals who have contracted the disease, the rapid design of antibodies that can target the SARS-CoV-2 virus fulfils a critical need. Further, discovering antibodies that bind multiple variants of SARS-CoV-2 can aid in the development of rapid antigen tests (RATs) which are critical for the identification and isolation of individuals currently carrying COVID-19. Here we provide a proof-of-concept study for the computational design of high-affinity antibodies that bind to multiple variants of the SARS-CoV-2 spike protein using RosettaAntibodyDesign (RAbD). Well characterized antibodies that bind with high affinity to the SARS-CoV-1 (but not SARS-CoV-2) spike protein were used as templates and re-designed to bind the SARS-CoV-2 spike protein with high affinity, resulting in a specificity switch. A panel of designed antibodies were experimentally validated. One design bound to a broad range of variants of concern including the Omicron, Delta, Wuhan, and South African spike protein variants.

De novo design and Rosetta-based assessment of high-affinity antibody variable regions (Fv) against the SARS-CoV-2 spike receptor binding domain (RBD)

The continued emergence of new SARS-CoV-2 variants has accentuated the growing need for fast and reliable methods for the design of potentially neutralizing antibodies (Abs) to counter immune evasion by the virus. Here, we report on the de novo computational design of high-affinity Ab variable regions (Fv) through the recombination of VDJ genes targeting the most solvent-exposed hACE2-binding residues of the SARS-CoV-2 spike receptor binding domain (RBD) protein using the software tool OptMAVEn-2.0. Subsequently, we carried out computational affinity maturation of the designed variable regions through amino acid substitutions for improved binding with the target epitope. Immunogenicity of designs was restricted by preferring designs that match sequences from a 9-mer library of "human Abs" based on a human string content score. We generated 106 different antibody designs and reported in detail on the top five that trade-off the greatest computational binding affinity for the RBD with human string content scores. We further describe computational evaluation of the top five designs produced by OptMAVEn-2.0 using a Rosetta-based approach. We used Rosetta SnugDock for local docking of the designs to evaluate their potential to bind the spike RBD and performed "forward folding" with DeepAb to assess their potential to fold into the designed structures. Ultimately, our results identified one designed Ab variable region, P1.D1, as a particularly promising candidate for experimental testing. This effort puts forth a computational workflow for the de novo design and evaluation of Abs that can quickly be adapted to target spike epitopes of emerging SARS-CoV-2 variants or other antigenic targets.

Hallucinating structure-conditioned antibody libraries for target-specific binders

Antibodies are widely developed and used as therapeutics to treat cancer, infectious disease, and inflammation. During development, initial leads routinely undergo additional engineering to increase their target affinity. Experimental methods for affinity maturation are expensive, laborious, and time-consuming and rarely allow the efficient exploration of the relevant design space. Deep learning (DL) models are transforming the field of protein engineering and design. While several DL-based protein design methods have shown promise, the antibody design problem is distinct, and specialized models for antibody design are desirable. Inspired by hallucination frameworks that leverage accurate structure prediction DL models, we propose the F_vHallucinator for designing antibody sequences, especially the CDR loops, conditioned on an antibody structure. Such a strategy generates targeted CDR libraries that retain the conformation of the binder and thereby the mode of binding to the epitope on the antigen. On a benchmark set of 60 antibodies, F_vHallucinator generates sequences resembling natural CDRs and recapitulates perplexity of canonical CDR clusters. Furthermore, the F_vHallucinator designs amino acid substitutions at the V_H-V_L interface that are enriched in human antibody repertoires and therapeutic antibodies. We propose a pipeline that screens F_vHallucinator designs to obtain a library enriched in binders for an antigen of interest. We apply this pipeline to the CDR H3 of the Trastuzumab-HER2 complex to generate in silico designs predicted to improve upon the binding affinity and interfacial properties of the original antibody. Thus, the F_vHallucinator pipeline enables generation of inexpensive, diverse, and targeted antibody libraries enriched in binders for antibody affinity maturation.

Affinity maturation of TCR-like antibodies using phage display guided by structural modeling

TCR-like antibodies represent a unique type of engineered antibodies with specificity toward pHLA, a ligand normally restricted to the sensitive recognition by T cells. Here, we report a phage display-based sequential development path of such antibodies. The strategy goes from initial lead identification through in silico informed CDR engineering in combination with framework engineering for affinity and thermostability optimization, respectively. The strategy allowed the identification of HLA-DQ2.5 gluten peptide-specific TCR-like antibodies with low picomolar affinity. Our method outlines an efficient and general method for development of this promising class of antibodies, which should facilitate their utility including translation to human therapy.

Antibody variable sequences have a pronounced effect on cellular transport and plasma half-life

Monoclonal IgG antibodies are the fastest growing class of biologics, but large differences exist in their plasma half-life in humans. Thus, to design IgG antibodies with favorable pharmacokinetics, it is crucial to identify the determinants of such differences. Here, we demonstrate that the variable region sequences of IgG antibodies greatly affect cellular uptake and subsequent recycling and rescue from intracellular degradation by endothelial cells. When the variable sequences are masked by the cognate antigen, it influences both their transport behavior and binding to the neonatal Fc receptor (FcRn), a key regulator of IgG plasma half-life. Furthermore, we show how charge patch differences in the variable domains modulate both binding and transport properties and that a short plasma half-life, due to unfavorable charge patches, may partly be overcome by Fc-engineering for improved FcRn binding.

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IgG variable region sequences greatly affect cellular uptake and recycling

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Variable region charge patches affect FcRn binding and transport

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The presence of cognate antigen modulates cellular transport and FcRn binding

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Fc-engineering for improved FcRn binding can overcome unfavorable charge patches

A high-affinity human TCR-like antibody detects celiac disease gluten peptide-MHC complexes and inhibits T cell activation

Antibodies specific for peptides bound to human leukocyte antigen (HLA) molecules are valuable tools for studies of antigen presentation and may have therapeutic potential. Here, we generated human T cell receptor (TCR)-like antibodies toward the immunodominant signature gluten epitope DQ2.5-glia-α2 in celiac disease (CeD). Phage display selection combined with secondary targeted engineering was used to obtain highly specific antibodies with picomolar affinity. The crystal structure of a Fab fragment of the lead antibody 3.C11 in complex with HLA-DQ2.5:DQ2.5-glia-α2 revealed a binding geometry and interaction mode highly similar to prototypic TCRs specific for the same complex. Assessment of CeD biopsy material confirmed disease specificity and reinforced the notion that abundant plasma cells present antigen in the inflamed CeD gut. Furthermore, 3.C11 specifically inhibited activation and proliferation of gluten-specific CD4⁺ T cells in vitro and in HLA-DQ2.5 humanized mice, suggesting a potential for targeted intervention without compromising systemic immunity.

A TRAV26-1-encoded recognition motif focuses the biased T cell response in celiac disease

The semi-public T-cell response towards the gluten epitope DQ2.5-glia-α2 uses a prototypic TCR encoded by the germline segments TRAV26-1 and TRBV7-2. Through mutagenesis experiments, we show that a TRAV26-1encoded recognition motif contacts the MHC β-chain and the TCR CDR3β loop underpinning this conserved T-cell response restricted to the prototypic TCRs.

Plasma Cells Are the Most Abundant Gluten Peptide MHC-expressing Cells in Inflamed Intestinal Tissues From Patients With Celiac Disease

BACKGROUND & AIMS

Development of celiac disease is believed to involve the transglutaminase-dependent response of CD4⁺ T cells toward deamidated gluten peptides in the intestinal mucosa of individuals with specific HLA-DQ haplotypes. We investigated the antigen presentation process during this mucosal immune response.

METHODS

We generated monoclonal antibodies (mAbs) specific for the peptide-MHC (pMHC) complex of HLA-DQ2.5 and the immunodominant gluten epitope DQ2.5-glia-α1a using phage display. We used these mAbs to assess gluten peptide presentation and phenotypes of presenting cells by flow cytometry and enzyme-linked immune absorbent spot (ELISPOT) in freshly prepared single-cell suspensions from intestinal biopsies from 40 patients with celiac disease (35 untreated and 5 on a gluten-free diet) as well as 18 subjects with confirmed noninflamed gut mucosa (controls, 12 presumed healthy, 5 undergoing pancreatoduodenectomy, and 1 with potential celiac disease).

RESULTS

Using the mAbs, we detected MHC complexes on cells from intestinal biopsies from patients with celiac disease who consume gluten, but not from patients on gluten-free diets. We found B cells and plasma cells to be the most abundant cells that present DQ2.5-glia-α1a in the inflamed mucosa. We identified a subset of plasma cells that expresses B-cell receptors (BCR) specific for gluten peptides or the autoantigen transglutaminase 2 (TG2). Expression of MHC class II (MHCII) was not restricted to these specific plasma cells in patients with celiac disease but was observed in an average 30% of gut plasma cells from patients and controls.

CONCLUSIONS

A population of plasma cells from intestinal biopsies of patients with celiac disease express MHCII; this is the most abundant cell type presenting the immunodominant gluten peptide DQ2.5-glia-α1a in the tissues from these patients. These results indicate that plasma cells in the gut can function as antigen-presenting cells and might promote and maintain intestinal inflammation in patients with celiac disease or other inflammatory disorders.

A TCRα framework-centered codon shapes a biased T cell repertoire through direct MHC and CDR3β interactions

Selection of biased T cell receptor (TCR) repertoires across individuals is seen in both infectious diseases and autoimmunity, but the underlying molecular basis leading to these shared repertoires remains unclear. Celiac disease (CD) occurs primarily in HLA-DQ2.5+ individuals and is characterized by a CD4+ T cell response against gluten epitopes dominated by DQ2.5-glia-α1a and DQ2.5-glia-α2. The DQ2.5-glia-α2 response recruits a highly biased TCR repertoire composed of TRAV26-1 paired with TRBV7-2 harboring a semipublic CDR3β loop. We aimed to unravel the molecular basis for this signature. By variable gene segment exchange, directed mutagenesis, and cellular T cell activation studies, we found that TRBV7-3 can substitute for TRBV7-2, as both can contain the canonical CDR3β loop. Furthermore, we identified a pivotal germline-encoded MHC recognition motif centered on framework residue Y40 in TRAV26-1 engaging both DQB1*02 and the canonical CDR3β. This allowed prediction of expanded DQ2.5-glia-α2-reactive TCR repertoires, which were confirmed by single-cell sorting and TCR sequencing from CD patient samples. Our data refine our understanding of how HLA-dependent biased TCR repertoires are selected in the periphery due to germline-encoded residues.

Modeling and docking of antibody structures with Rosetta

We describe Rosetta-based computational protocols for predicting the 3D structure of an antibody from sequence (RosettaAntibody) and then docking the antibody to protein antigens (SnugDock). Antibody modeling leverages canonical loop conformations to graft large segments from experimentally determined structures, as well as offering (i) energetic calculations to minimize loops, (ii) docking methodology to refine the V_L-V_H relative orientation and (iii) de novo prediction of the elusive complementarity determining region (CDR) H3 loop. To alleviate model uncertainty, antibody-antigen docking resamples CDR loop conformations and can use multiple models to represent an ensemble of conformations for the antibody, the antigen or both. These protocols can be run fully automated via the ROSIE web server (http://rosie.rosettacommons.org/) or manually on a computer with user control of individual steps. For best results, the protocol requires roughly 1,000 CPU-hours for antibody modeling and 250 CPU-hours for antibody-antigen docking. Tasks can be completed in under a day by using public supercomputers.

Managerial practices regarding workers working while ill

Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants' policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or "stomach flu," possible symptoms of foodborne illness. When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non-food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%). Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill.

Volatile anaesthetics reduce neutrophil inflammatory response by interfering with CXC receptor-2 signalling

BACKGROUND

Growing evidence suggests a protective effect of volatile anaesthetics in ischaemia-reperfusion (I/R)-injury, and the accumulation of neutrophils is a crucial event. Pro-inflammatory cytokines carrying the C-X-C-motif including interleukin-8 (IL-8) and CXC-ligand 1 (CXCL1) activate CXC receptor-1 (CXCR1; stimulated by IL-8), CXC receptor-2 (CXCR2; stimulated by IL-8 and CXCL1), or both to induce CD11b-dependent neutrophil transmigration. Inhibition of CXCR1, CXCR2, or both reduces I/R-injury by preventing neutrophil accumulation. We hypothesized that interference with CXCR1/CXCR2 signalling contributes to the well-established beneficial effect of volatile anaesthetics in I/R-injury.

METHODS

Isolated human neutrophils were stimulated with IL-8 or CXCL1 and exposed to volatile anaesthetics (sevoflurane/desflurane). Neutrophil migration was assessed using an adapted Boyden chamber. Expression of CD11b, CXCR1, and CXCR2 was measured by flow cytometry. Blocking antibodies against CXCR1/CXCR2/CD11b and phorbol myristate acetate were used to investigate specific pathways.

RESULTS

Volatile anaesthetics reduced CD11b-dependent neutrophil transmigration induced by IL-8 by >30% and CD11b expression by 18 and 27% with sevoflurane/desflurane, respectively. This effect was independent of CXCR1/CXCR2 expression and CXCR1/CXCR2 endocytosis. Inhibition of CXCR1 signalling did not affect downregulation of CD11b with volatile anaesthetics. Blocking of CXCR2-signalling neutralized effects by volatile anaesthetics on CD11b expression. Specific stimulation of CXCR2 with CXCL1 was sufficient to induce upregulation of CD11b, which was impaired with volatile anaesthetics. No effect of volatile anaesthetics was observed with direct stimulation of protein kinase C located downstream of CXCR1/CXCR2.

CONCLUSION

Volatile anaesthetics attenuate neutrophil inflammatory responses elicited by CXC cytokines through interference with CXCR2 signalling. This might contribute to the beneficial effect of volatile anaesthetics in I/R-injury.

Treatment with nimodipine or mannitol reduces programmed cell death and infarct size following focal cerebral ischemia

The present study was conducted to evaluate the effects of nimodipine and mannitol on infarct size and on the amount of apoptosis after transient focal cerebral ischemia. Focal cerebral ischemia was induced in male Sprague-Dawley rats (weight 300-380 g) by transient occlusion of the right middle cerebral artery (MCAO) using an intraluminal thread model. All animals underwent ischemia for 2 h, followed by 24 h of reperfusion. Group I (n=16) was untreated. Group II (n=16) received 15% mannitol (1 g/kg as bolus) and group III (n=9) received 15 microg/kg/h nimodipine intravenously beginning 15 min prior to MCAO. Twenty-four hours after reperfusion, the brain was taken and sectioned in coronal slices. The slices were stained with H&E and with the transferase dUTP nick-end labeling (TUNEL) technique. Histopathological analysis revealed a significant (P<0.05) decrease in infarct size in the striatum with both drugs: mannitol (group II) 25.4+/-5.9% and nimodipine (group III) 21.5+/-11.0% versus control (group I) 34.9+/-7.0% and in the cortex 2.7+/-2.0% (group II) and 6.3+/-2.4% (group III) versus control 14.4+/-9.0% (group I). The number of apoptotic cells was statistically lower in the therapy groups (group III 9.6, group II 25.8) versus control (group I 57.9) (Mann-Whitney-Wilcoxon U-test Z>1.96, P<0.05). This study indicates that mannitol and nimodipine provide neuroprotection by preventing both the necrotic and apoptotic components of cell death after transient focal cerebral ischemia and may be effective as neuroprotective drugs for cerebrovascular surgery.

Modified technique for heterotopic rat heart transplantation under cardioplegic arrest

The development of microsurgical techniques offers a valuable opportunity to use small animals for experimental studies of vascularized organ transplants. Availability of inbred strains, natural resistance to infection, and economy make the rat an ideal animal model to investigate the effects of heart transplantation. The recent high interest and substantial laboratory activity with regard to posttransplantory immunological tissue reactions and apoptotic tissue processes led us to optimize transplantation technique by improving myocardial protection during ischemia and thereby minimizing adverse effects of the transplantation procedure itself. Thus the present report details the technique of heterotopic heart transplantation in rats using cardioplegic arrest.

Indirect methods for characterization of carbon dioxide levels in fermentation broth

Various factors which influence dissolved carbon dioxide levels were indirectly evaluated in pilot scale and laboratory studies. For pilot scale studies, off-gas carbon dioxide (percentage in exit air) was measured using a mass spectrometer and then its potential impact on dissolved carbon dioxide concentrations qualitatively examined. Greater volumetric air flowrates reduced off-gas carbon dioxide levels more effectively at lower airflow ranges and thus lowered expected dissolved carbon dioxide levels through gas stripping. Lower broth pH values decreased off-gas carbon dioxide levels but increased expected dissolved carbon dioxide levels due to the pH-dependence of the gas/liquid carbon dioxide equilibrium. While back-pressure increases had an insignificant effect on off-gas carbon dioxide levels, they directly affected expected dissolved carbon dioxide levels according to Henry's law. Laboratory studies, conducted using both uninoculated and inoculated fermentation media, quantified the response of the media to pH changes with bicarbonate addition, specifically its buffering capacity. This effect then was related qualitatively to expected dissolved carbon dioxide levels. Higher dissolved carbon dioxide levels, as demonstrated by reduced pH changes with bicarbonate addition, thus would be expected for salt solutions of increased ionic strength and higher protein content media. In addition, pH changes with greater bicarbonate additions declined for fermentation samples taken over the course of a one week cultivation, most likely due to the higher protein content associated with biomass growth. The presence of weak acids/bases initially in the media or formed as metabolic by products, as well as the concentration of buffering ions such as phosphate, also were believed to be important contributing elements to the buffering capacity of the solution.

Early suppression of viremia by ZDV does not alter the spread of feline immunodeficiency virus infection in cats

Prophylactic zidovudine (ZDV) therapy in feline immunodeficiency virus (FIV) inoculated cats was evaluated for 12 months postinfection (pi) and 11 months post drug treatment. Plasma FIV antigenemia was prevented in six of six ZDV-treated and none of six untreated cats during the initial phase of infection. The present study is a continuation of that earlier work. CD4 lymphocyte numbers from ZDV-treated cats were higher than in the untreated cats. CD8 lymphocytes numbers were maintained within control limits in the ZDV-treated cats, while they declined in the untreated cats. Anti-FIV antibody titers were comparable between the ZDV-treated and the untreated cats. Histologically, lymphoid tissues for the untreated and ZDV-treated cats were unremarkable and similar to those of the uninfected control cats. Low-level FIV antigen was detected by enzyme-linked immunosorbent assay in thymus or lymph node homogenates from 3 of 11 cats tested. Polymerase chain reaction analysis showed FIV DNA in blood, lymph node, bone marrow, spleen, thymus, and brain from FIV-inoculated cats irrespective of ZDV treatment. Therefore, while prophylactic ZDV treatment prevented detectable plasma antigenemia and FIV-induced CD8 lymphocyte decline, it did not slow infection of tissues and blood cells of FIV-inoculated cats.

Intracranial venous hypertension and the effects of venous outflow obstruction in a rat model of arteriovenous fistula

A model of rat arteriovenous fistula (AVF) was created using a proximal common carotid artery to distal external jugular vein anastomosis. Anatomical dissections revealed that the external jugular vein is the primary vessel draining intracranial venous blood. Physiological measurements were made with the AVF open and closed, and during venous outflow occlusion of the contralateral external jugular vein. Opening the AVF increased torcular pressure from 6.5 +/- 0.6 to 13.5 +/- 1.1 mm Hg and decreased mean arterial pressure from 82.7 +/- 1.8 to 62.8 +/- 1.8 mm Hg (both P less than .05), decreasing cerebral perfusion pressure from 76.2 +/- 1.7 to 49.3 +/- 2.2 mm Hg (P less than .05). Middle cerebral artery blood flow velocity (MCA BFV) decreased from 6.8 +/- 1.1 to 4.2 +/- 0.7 cm/s (P less than 0.05). In rats with an AVF, occlusion of venous outflow increased torcular pressure to 34.8 +/- 3.1 mm Hg (P less than 0.05), MCA BFV decreased to 1.8 +/- 0.5 cm/s (P less than 0.05), and severe ischemic changes were seen on the electroencephalogram. Under this condition, torcular pressure and systemic arterial pressure had a positive linear relationship (P less than 0.05), whereas in control rats torcular pressure and arterial pressure had no relationship. Restoration of cerebral perfusion pressure by release of venous outflow occlusion and AVF closure transiently increased MCA BFV to 69% above baseline (P less than 0.05). Histological examination 1 week after permanent venous outflow occlusion revealed venous infarction, subarachnoid hemorrhage, and severe brain edema in rats with an AVF but not in control rats without an AVF. This model of cerebrovascular steal with venous hypertension reproduces both hemodynamic and hemorrhagic complications of human AVF and emphasizes the importance of venous outflow obstruction and venous hypertension in the pathophysiology of these lesions.

Hypothalamic-pituitary dysfunction and Hirschsprung's disease in the Bardet-Biedl syndrome

A child with the Bardet-Biedl syndrome associated with Hirschsprung's disease and multiple anterior pituitary hormone deficiencies is described. The importance of endocrine assessment of such patients who show disturbance of growth or puberty is emphasized.

[MR measurements on a perfused renal artery model with pulsatile flow]

MR tomography permits visual demonstration of flow and turbulence. A model was used to compare MR-measured signal intensities and flow profiles as obtained by Doppler anemometry.

[Placental metastases from a maternal angioblastic sarcoma of the vagina (author's transl)]

Metastasizing maternal tumors during pregnancy with spread to the placenta are spontaneous attempts of malignant tumor transplantation to the Fetus. Because of the resistance of the Syncytiotrophoblast to metastases, carcinomas do not appear to transgress the placental barrier wheras malignant melanomas and sarcomas may do so in some cases. In the described case of maternal angioblastic sarcoma the lack of resistance to tumor spread of the epithelial trophoblast was compensated by resistance of the fetal stroma of the chorionic villi against invasive spread of the tumor. The infant was delivered by Caesarean Section and showed no evidence of a malignant tumor acquired by transplacental spread at the age of 2 1/2 months.

[Primary combined chemotherapy following removal of an endodermal sinus tumor or yolk-sac tumor of the ovary (author's transl)]

The yolk-sac tumor or endodermal sinus tumor is a rare but highly malignant ovarian teratoma with its highest incidence in young women. The tumor is relatively resistant to radiotherapy but sensitive to combined chemotherapy and should therefore be differentiated in the diagnosis from embryonal carcinoma and radio-sensitive dysgerminomas of the ovary. It is possible that the determination of alpha-fetoprotein is of differential diagnostic value. Two patients are alive and well 8 months and 2 1/2 years following removal of a yolk-sac tumor and primary chemotherapy. One patient received chemotherapy for peritoneal recurrence after removal of the tumor and radiotherapy. She died 1 1/2 years following the primary operation. Long term chemotherapy of the yolk-sac tumor is indicated following operation, irrespective of the stage of the tumor.

[Morphological investigation of the neonatal lung with respiratory distress syndrome which was maximally distended with Somentor 33 and formalin (author's transl)]

The importance of morphological immaturity of the lung in the development of the respiratory distress syndrome was investigated. Atelectatic lungs of newborns were maximally expanded with a mineral oil of low kinematic viscosity (Somentor 33) or 10% Formalin. With this method, surface active forces of peripheral air spaces should not impede expansion of the lungs. 27 lungs of neonates who died of respiratory distress syndrome and 10 lungs of neonates without primary respiratory problems were examined. Following maximal expansion of the lungs with the respiratory distress syndrome show a hypercellular densely cellular tissue of the pulmonary segments, much like glanduloid hyperplasia with small peripheral air spaces and long distances for diffusion of the respiratory gases. The lungs of newborns without respiratory distress syndromes are well alveolar following expansion and show an optimal morphology for gas diffusion. A lack of a surfactant should have significant consequences in small air spaces.

[Adequate treatment of micro-invasive carcinoma of the uterine cervix (author's transl)]

At the University Department in Heidelberg 58 micro-invasive carcinomas of the uterine cervix were found between 1965 and 1974. 8 cases were diagnosed in other institutions by directed biopsies. Three cases were detected during the microscopic examination of uteri removed for emergency indications and three cases were detected after hysterectomy for cytological findings indicative of carcinoma in situ of the uterine cervix. In 44 cases an optimal conization of the cervix was carried out. Microscopic examination of these cases showed early stromal invasion in 33 cases. In 6 cases a newtork infiltration was found und in 5 cases a plump infiltration was found. The incidence of radical Wertheim operations of 21 in this group is explained by cases in this group who had inadequate diagnosis prior to admission. In 8 cases the indication for the Wertheim radical hysterectomy was a carcinomatous lymphangiosis in the conization specimen. In none of these cases metastatic tumor was found in the lymph nodes although 13 to 44 lymph nodes were examined per case. In accordance with the newer literature it is recommended to limit treatment of micro-invasive changes of the uterine cervix to routine hysterectomy or to optimal conization of the cervix if certain prerequisites are met. The results of the follow-up examinations of the reported cases appear to justify this recommendation.