Neural stem cell homeostasis is affected in cortical organoids carrying a mutation in Angiogenin

Mutations in Angiogenin (ANG) and TARDBP encoding the 43 kDa transactive response DNA binding protein (TDP-43) are associated with amyotrophic lateral sclerosis and frontotemporal dementia (ALS-FTD). ANG is neuroprotective and plays a role in stem cell dynamics in the haematopoietic system. We obtained skin fibroblasts from members of an ALS-FTD family, one with mutation in ANG, one with mutation in both TARDBP and ANG, and one with neither mutation. We reprogrammed these fibroblasts to induced pluripotent stem cells (iPSCs) and generated cortical organoids as well as induced stage-wise differentiation of the iPSCs to neurons. Using these two approaches we investigated the effects of FTD-associated mutations in ANG and TARDBP on neural precursor cells, neural differentiation, and response to stress. We observed striking neurodevelopmental defects such as abnormal and persistent rosettes in the organoids accompanied by increased self-renewal of neural precursor cells. There was also a propensity for differentiation to later-born neurons. In addition, cortical neurons showed increased susceptibility to stress, which is exacerbated in neurons carrying mutations in both ANG and TARDBP. The cortical organoids and neurons generated from patient-derived iPSCs carrying ANG and TARDBP gene variants recapitulate dysfunctions characteristic of frontotemporal lobar degeneration observed in FTD patients. These dysfunctions were ameliorated upon treatment with wild type ANG. In addition to its well-established role during the stress response of mature neurons, ANG also appears to play a role in neural progenitor dynamics. This has implications for neurogenesis and may indicate that subtle developmental defects play a role in disease susceptibility or onset. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

1263 Does Multimorbidity Influence the Likelihood of Receiving A Total Hip Replacement for Osteoarthritis?

Introduction

Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis. Thus, patients with multimorbidity and their clinicians across the UK are making decisions on whether or not to proceed with total hip replacement without clear information available on the potential risks and benefits. It is not known how such patients are currently managed. The aim of this study was to investigate the influence of multimorbidity on the likelihood of receiving total hip replacement in patients with hip osteoarthritis in the UK.

Method

A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcome was total hip replacement, evaluated using Kaplan-Meier survival and competing-risk analyses.

Results

28,025 patients were included. 10,948 patients underwent total hip replacement. Increased multimorbidity burden was associated with decreased likelihood of undergoing surgery, irrespective of the method of scoring multimorbidity. Electronic Frailty Index had the largest difference between categories. Adjusted hazard ratio (‘severe multimorbidity versus ‘fit’) was 0.34 (95% CI 0.22, 0.51).

Conclusions

Patients with hip osteoarthritis and concurrent multimorbidity were up to two thirds less likely to undergo total hip replacement. Whether this difference in healthcare management is appropriate depends on to what extent multimorbidity influences the outcomes of total hip replacement.

1279 Does Multimorbidity Influence the Outcomes of Total Hip Replacement for Osteoarthritis?

Introduction

Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis, including the rate of complications and degree of functional benefit. The aim of this study was to investigate the influence of multimorbidity on the outcomes of total hip replacement in the UK.

Method

A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink and receipt of primary total hip replacement recorded in Hospital Episode Statistics Admitted Patient Care. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcomes were (i) the risks of total hip replacement, assessed by serious post-operative complications within 90 days (analysed with logistic regression), and (ii) the benefits of surgery, assessed by post-operative Oxford Hip Score (OHS) and EQ-5D quality of life score (analysed with linear regression).

Results

6,682 patients were included. The rate of complications was 3.2%. Patients with severe multimorbidity burden were at 1.5 to 2.5 times increased risk of complications than patients without multimorbidity. There was no clinically meaningful difference in the benefits of surgery between patients with and without multimorbidity, irrespective of the method of scoring multimorbidity.

Conclusions

Even for patients with severe multimorbidity burden, the potential benefits of total hip replacement for osteoarthritis remain substantial, while the increase in risk is relatively small.

Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?

OBJECTIVE

To evaluate the prevalence and risk factors of wrist pain.

METHODS

Systematic review.

DATA SOURCES

The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers.

RESULTS

In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study).

CONCLUSIONS

Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO under the registration number CRD42018090834.

LEVEL OF EVIDENCE

1 (Prognostic study).

Toxicity and Efficacy of Stereotactic Ablative Body Radiotherapy for Moderately Central Non-small Cell Lung Cancers Using 50 Gy in Five Fractions

AIMS

Stereotactic ablative body radiotherapy doses for peripheral lung lesions caused high toxicity when used for central non-small cell lung cancer (NSCLC). To determine a safe stereotactic ablative body radiotherapy dose for central tumours, the phase I/II Radiation Therapy Oncology Group RTOG 0813 trial used 50 Gy/five fractions as a baseline. From 2013, 50 Gy/five fractions was adopted at the Beatson West of Scotland Cancer Centre for inoperable early stage central NSCLC. We report our prospectively collected toxicity and efficacy data.

MATERIALS AND METHODS

Patient and treatment characteristics were obtained from electronic medical records. Tumours were classed as moderately central or ultra-central tumours using published definitions. Toxicity was assessed in a centralised follow-up clinic at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years after treatment.

RESULTS

Fifty patients (31 women, 19 men, median age 75.1 years) were identified with T1-2N0M0 moderately central NSCLC; one patient had both an ultra-central and a moderately central tumour. Eighty-four per cent were medically unfit for surgery. Forty per cent had biopsy-proven NSCLC and 60% were diagnosed radiologically using 18-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Fifty-six per cent of patients were Eastern Cooperative Oncology Group (ECOG) performance status 2 or worse. All patients received 50 Gy/five fractions on alternate days on schedule. Two patients died within 90 days of treatment, one from a chest infection, the other cause of death was unknown. There was one episode of early grade 3 oesophagitis and one grade 3 late dyspnoea. There was no grade 4 toxicity. Over a median follow-up of 25.2 months (range 1-70 months), there were 34 deaths: 18 unrelated to cancer and 16 due to cancer recurrence. The median overall survival was 27.0 months (95% confidence interval 20.6-35.9) and cancer-specific survival was 39.8 months (95% confidence interval 28.6, not reached).

CONCLUSION

This study has shown that 50 Gy/five fractions is a safe dose and fractionation for early stage inoperable moderately central NSCLC, with outcomes comparable with other series, even with patients with a poor performance status.

The secretion of the angiogenic and neurotrophic factor angiogenin is COPII and microtubule dependent

The RNaseA superfamily member Angiogenin (ANG) is a secreted protein involved in neovascularization, cell proliferation and stress response. Dysregulation of ANG expression is found in many cancers with poor prognosis and mutations in ANG are associated with neurodegenerative diseases. While the uptake and nuclear translocation of ANG is relatively well characterised, little is known about how it reaches the plasma membrane and its mode of secretion. We generated SH-SY5Y neuroblastoma cell lines constitutively expressing wild type (WT) Hemagglutinin (HA) epitope tagged mouse Ang1 (mAng1), and two amyotrophic lateral sclerosis associated ANG variants (C39W and K40I). Herein, we show that these cell lines secrete mAng1 into the culture media. Using small molecule inhibitors we probed the route taken between the endoplasmic reticulum and trans-Golgi network during secretion and have characterised it as COPII and microtubule dependent. In addition, we show that disruption by the PI3-kinase inhibitor wortmannin of the later stages of transit to the plasma membrane leads to mAng1 trafficking to lysosomal compartments. This suggests an autophagy dependent regulation of secretion.

The catalytic activity and secretion of zebrafish RNases are essential for their in vivo function in motor neurons and vasculature

Angiogenin (hANG), a member of the Ribonuclease A superfamily has angiogenic, neurotrophic and neuroprotective activities. Mutations in hANG have been found in patients with Amyotrophic lateral sclerosis (ALS). The zebrafish (Danio rerio) rnasel-1, 2 and 3 are orthologues of hANG and of these only Rnasel-1 and Rnasel-2 have been shown to be angiogenic. Herein we show that NCI-65828, a potent and specific small molecule inhibitor of hANG inhibits Rnasel-1 to a similar extent. Treatment of early zebrafish embryos with NCI-65828, or with terrein, a fungal metabolite which prevents the secretion of hANG, resulted in spinal neuron aberrations as well defects in trunk vasculature. Our detailed expression analysis and inhibitor studies suggest that Rnasel-1 plays important roles in neuronal migration and pathfinding as well as in angiogenesis in zebrafish. Our studies suggest the usefulness of the zebrafish as a model to dissect the molecular consequences of the ANG ALS variants.

Management of Malignant Dysphagia by Intubation at Endoscopy

A method of relieving dysphagia in inoperable oesophagogastric neoplasms by per oral intubation using the Nottingham tube introducer was attempted in 63 patients with 3 failures. Twelve patients died within 10days of intubation, including 4 from a perforation of the growth sustained during the procedure, and 51 patients left hospital swallowing satisfactorily. The average period of survival was 3 months and 10patients survived for a year or more, including 2 in whom the tube was removed after regression of a squamous carcinoma following radiotherapy.

Endoscopic per oral intubation is a simple and relatively safe procedure which when used in patients with oesophagogastric neoplasms gives adequate symptomatic relief and allows home management in the terminal stages of the illness.

The cellular uptake of angiogenin, an angiogenic and neurotrophic factor is through multiple pathways and largely dynamin independent

Angiogenin (ANG), a member of the RNase superfamily (also known as RNase 5) has neurotrophic, neuroprotective and angiogenic activities. Recently it has also been shown to be important in stem cell homeostasis. Mutations in ANG are associated with neurodegenerative diseases such as Amyotrophic Lateral Sclerosis (ALS) and Fronto-temporal dementia (FTD). ANG is a secreted protein which is taken up by cells and translocated to the nucleus. However, the import pathway/s through which ANG is taken up is/are still largely unclear. We have characterised the uptake of ANG in neuronal, astrocytic and microglial cell lines as well as primary neurons and astrocytes using pharmacological agents as well as dominant negative dynamin and Rab5 to perturb uptake and intracellular trafficking. We find that uptake of ANG is largely clathrin/dynamin independent and microtubule depolymerisation has a marginal effect. Perturbation of membrane ruffling and macropinocytosis significantly inhibited ANG uptake suggesting an uptake mechanism similar to RNase A. Our findings shed light on why mutations which do not overtly affect RNase activity but cause impaired localization are associated with neurodegenerative disease.

Dynamic expression of the mouse orthologue of the human amyotropic lateral sclerosis associated gene C9orf72 during central nervous system development and neuronal differentiation

The hexanucleotide repeat in the first intron of the C9orf72 gene is the most significant cause of amyotropic lateral sclerosis as well as some forms of fronto-temporal dementia. The C9orf72 protein has been previously reported to be expressed in post-mortem human brain as well as in late embryonic and some postnatal stages in mice. Herein, we present a detailed study of the distribution of C9orf72 protein in the embryonic, postnatal and adult mouse brain, spinal cord as well as during the differentiation of P19 embryonal carcinoma cells to neurons including motor neurons. We show that the expression levels of the C9orf72 transcripts in the developing and adult mouse brain as well as in differentiating neurons, are dynamic. Besides the strong expression in the cerebellum and motor cortex reported previously, we show for the first time that C9orf72 is expressed strongly in the olfactory bulb and also in the hippocampus. Our immunostaining data also reveal a hitherto unreported switch in the cellular distribution of C9orf72 from a predominantly cytoplasmic to a nucleo-cytoplasmic distribution during corticogenesis. This switch in distribution was also observed during differentiation of the pluripotent embryonal carcinoma P19 cell line to mature neurons. Our findings have implications for interpreting the pathophysiology caused by the repeat expansions in C9orf72 in mouse models.

PA6 Stromal Cell Co-Culture Enhances SH-SY5Y and VSC4.1 Neuroblastoma Differentiation to Mature Phenotypes

Neuroblastoma cell lines such as SH-SY5Y have been used for modelling neurodegenerative diseases and for studying basic mechanisms in neuroscience. Since neuroblastoma cells proliferate and generally do not express markers of mature or functional neurons, we exploited a co-culture system with the stromal cell line PA6 to better induce differentiation to a more physiologically relevant status. We found that co-culture of the neuroblastoma cell lines in the presence of neural inducers such retinoic acid was able to generate a high proportion of quiescent neurons with very long neurites expressing differentiation markers. The co-culture system additionally cuts short the time taken to produce a more mature phenotype. We also show the application of this system to study proteins implicated in motor neuron disease.

Trace element concentration and speciation in selected urban soils in New York City

A long history of urbanization and industrialization has affected trace elements in New York City (NYC) soils. Selected NYC pedons were analyzed by aqua regia microwave digestion and sequential chemical extraction as follows: water soluble (WS); exchangeable (EX); specifically sorbed/carbonate bound (SS/CAR); oxide-bound (OX); organic/sulfide bound (OM/S). Soils showed a range in properties (e.g., pH 3.9 to 7.4). Sum of total extractable (SUMTE) trace elements was higher in NYC parks compared to Bronx River watershed sites. NYC surface horizons showed higher total extractable (TE) levels compared to US non-anthropogenic soils. TE levels increased over 10 year in some of the relatively undisturbed and mostly wooded park sites. Surface horizons of park sites with long-term anthropogenic inputs showed elevated TE levels vs. subsurface horizons. Conversely, some Bronx River watershed soils showed increased concentrations with depth, reflective of their formation in a thick mantle of construction debris increasing with depth and intermingled with anthrotransported soil materials. Short-range variability was evident in primary pedons and satellite samples (e.g., Pb 253 ± 143 mg/kg). Long-range variability was indicated by PbTE (348 versus 156 mg/kg) and HgTE (1 versus 0.3 mg/kg) concentrations varying several-fold in the same soil but in different geographic locations. Relative predominance of fractions: RES (37 %) > SS/CAR (22 %) > OX (20 %) > OM/S (10 %) > EX (7 %) > WS (4 %). WS and EX fractions were greatest for Hg (7 %) and Cd (14 %), respectively. RES was predominant fraction for Co, Cr, Ni, and Zn (41 to 51 %); SS/CAR for Cd and Pb (40 and 63 %); OM/S for Cu and Hg (36 and 37 %); and OX for As (59 %).

High-grade Angiosarcoma Associated with Ruptured Breast Implants

Summary:

Since the serendipitous discovery that implanted polymers cause sarcomas in rats, much research has been conducted to prove or disprove a link between silicone breast implants and/or polymer-based materials and breast cancer. In light of an initial report that 35% of rats implanted with a variety of polymers developed fibrosarcomas, we report a case of primary angiosarcoma found in a patient presenting with bilateral rupture of gel-filled breast implants.

Bacteriostatic effect of sequential hydrodynamic and ultrasound-induced stress

AIMS

To elucidate the mechanism of action of a nonchemical microbial control technology employing coupled hydrodynamic and ultrasound-induced stress.

METHODS & RESULTS

The effects of a laboratory model system using a commercial nonchemical device on Pseudomonas putida revealed growth and respiration were inhibited without a loss of viability from the treated population. Damage to cell membranes was evident using fluorescent microscopy and a reporter strain containing lux genes fused with a membrane damage stress-response promoter. Other reporter strains also indicated the possible involvement of DNA and protein repair systems. A consequence of treatment was a reduced ability to form biofilms.

CONCLUSIONS

The nonchemical device caused a biostatic effect on treated cells induced by sublethal damage to several cellular systems, including cell membranes.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study demonstrates that biostasis can be an effective mechanism for microbial control in some industrial systems and provides insight into understanding and applying this device and other nonchemical microbial control technologies to real-world problems of microbial contamination.

Immunosuppression with belatacept-based, corticosteroid-avoiding regimens in de novo kidney transplant recipients

Current immunosuppressive regimens in renal transplantation typically include calcineurin inhibitors (CNIs) and corticosteroids, both of which have toxicities that can impair recipient and allograft health. This 1-year, randomized, controlled, open-label, exploratory study assessed two belatacept-based regimens compared to a tacrolimus (TAC)-based, steroid-avoiding regimen. Recipients of living and deceased donor renal allografts were randomized 1:1:1 to receive belatacept-mycophenolate mofetil (MMF), belatacept-sirolimus (SRL), or TAC-MMF. All patients received induction with 4 doses of Thymoglobulin (6 mg/kg maximum) and an associated short course of corticosteroids. Eighty-nine patients were randomized and transplanted. Acute rejection occurred in 4, 1 and 1 patient in the belatacept-MMF, belatacept-SRL and TAC-MMF groups, respectively, by Month 6; most acute rejection occurred in the first 3 months. More than two-thirds of patients in the belatacept groups remained on CNI- and steroid-free regimens at 12 months and the calculated glomerular filtration rate was 8-10 mL/min higher with either belatacept regimen than with TAC-MMF. Overall safety was comparable between groups. In conclusion, primary immunosuppression with belatacept may enable the simultaneous avoidance of both CNIs and corticosteroids in recipients of living and deceased standard criteria donor kidneys, with acceptable rates of acute rejection and improved renal function relative to a TAC-based regimen.

Experience with sodium fluorescein flow cytometry in the determination of red cell volume

Sodium fluorescein flow cytometry for the calculation of red cell volume is an exciting proposition in that the repeatability of the technique in a short time frame should allow for applications such as the measurement of surgical red cell volume loss. Our results found that the rapid decay in fluorescence negated the usefulness of this technique as currently described. However, further investigation into the behaviour of the sodium fluorescein labelled red blood cells may allow for the mathematical correction of the fluorescent red cell population prior to red cell volume calculation.

Woodland caribou persistence and extirpation in relic populations on Lake Superior

Extended: The hypothesis was proposed that woodland caribou (Rangifer tarandus caribou) in North America had declined due to wolf predation and over-hunting rather than from a shortage of winter lichens (Bergerud, 1974). In 1974, two study areas were selected for testing: for the lichen hypothesis, we selected the Slate Islands in Lake Superior (36 km2), a closed canopy forest without terrestrial lichens, wolves, bears, or moose; for the predation hypothesis, we selected the nearby Pukaskwa National Park (PNP) where terrestrial lichens, wolves, bears, and moose were present. Both areas were monitored from 1974 to 2003 (30 years). The living and dead caribou on the Slates were estimated by the ‘King census’ strip transect (mean length 108±9.3 km, extremes 22-190, total 3026 km) and the Lincoln Index (mean tagged 45±3.6, extremes 15-78). The mean annual population on the Slate Islands based on the strip transects was 262±22 animals (extremes 104-606), or 7.3/km2 (29 years) and from the Lincoln Index 303±64 (extremes 181-482), or 8.4/km2 (23 years). These are the highest densities in North America and have persisted at least since 1949 (56 years). Mountain maple (Acer spicatum) interacted with caribou density creating a record in its age structure which corroborates persistence at relatively high density from c. 1930. The mean percentage of calves was 14.8±0.34% (20 years) in the fall and 14.1±1.95% (19 years) in late winter. The Slate Islands herd was regulated by the density dependent abundance of summer green foods and fall physical condition rather than density independent arboreal lichen availability and snow depths. Two wolves (1 wolf/150 caribou) crossed to the islands in 1993-94 and reduced two calf cohorts (3 and 4.9 per cent calves) while female adult survival declined from a mean of 82% to 71% and the population declined ≈100 animals. In PNP, caribou/moose/wolf populations were estimated by aerial surveys (in some years assisted by telemetry). The caribou population estimates ranged from 31 in 1979 to 9 in 2003 (Y=1267 - 0.628X, r=-0.783, n=21, P<0.01) and extirpation is forecast in 2018. Animals lived within 3 km of Lake Superior (Bergerud, 1985) with an original density of 0.06/km2, similar to many other woodland herds coexisting with wolves (Bergerud, 1992), and 100 times less than the density found on the Slate Islands. The mean moose population was 0.25±0.016/km2 and the wolf population averaged 8.5±0.65/1000 km2. Late winter calf percentages in PNP averaged 16.2±1.89 (25 years); the population was gradually reduced by winter wolf predation (Bergerud, 1989; 1996). The refuge habitat available is apparently insufficient for persistence in an area where the continuous distribution of woodland caribou is fragmented due to moose exceeding 0.10/km2 and thereby supporting wolf densities ≥6.5/1000 km2. A second experimental study was to introduce Slate Island caribou to areas with and without wolves. A release to Bowman Island, where wolves and moose were present, failed due to predation. Bowman Island is adjacent to St. Ignace Island where caribou had persisted into the late 1940s. A second release in 1989 to the mainland in Lake Superior Provincial Park of 39 animals has persisted (<10 animals) because the animals utilize off-shore islands but numbers are also declining. A third release to Montréal Island in 1984 doubled in numbers (up to 20 animals) until Lake Superior froze in 1994 and wolves reached the island. A fourth release was to Michipicoten Island (188 km2) in 1982 where wolves were absent and few lichens were available. This herd increased at λ= 1.18 (8 to ±200, 160 seen 2001) in 19 years. This was the island envisioned for the crucial test of the lichen/predation hypotheses (Bergerud, 1974: p.769). These studies strongly support the idea that ecosystems without predators are limited bottom–up by food and those with wolves top-down by predation; however the proposed crucial test which has been initiated on Michipicoten Island remains to be completed and there is a limited window of opportunity for unequivocal results.

FTY720/cyclosporine regimens in de novo renal transplantation: a 1-year dose-finding study

FTY720 is a novel immunomodulator being investigated for rejection prophylaxis in renal transplantation when combined with full-dose cyclosporine (CsA; FDC). This 1-year phase II study compared FTY720 plus FDC (Neoral) with FTY720 plus reduced-dose CsA (RDC) and mycophenolate mofetil (MMF) plus FDC in de novo renal transplant patients. Patients were randomized 2:2:2:1 to FTY720 5 mg plus RDC (n = 72); FTY720 2.5 mg plus RDC (n = 74); FTY720 2.5 mg plus FDC (n = 76); or MMF plus FDC (n = 39) for 12 months. CsA exposure in the RDC group was reduced on average by 50% as assessed by C(2) monitoring. The primary efficacy endpoint was the composite incidence of biopsy-proven acute rejection (BPAR), graft loss, death or premature study discontinuation. The incidences for this composite endpoint were 24% and 22%, respectively, for FTY720 5 mg plus RDC and FTY720 2.5 mg plus FDC versus 39% for MMF plus FDC. Patients receiving FTY720 2.5 mg plus RDC were discontinued from treatment due to risk of under-immunosuppression. FTY720 2.5 mg plus FDC and FTY720 5 mg plus RDC were safe and effective in de novo renal transplant patients over 12 months.

Results of phase I clinical trials of Coramsine in patients with advanced solid tumors

2070

Background: Coramsine (C) is a 1:1 mixture of solasonine and solamargine, plant glycoalkaloids found in the species Solanum Linneanum, with single agent and synergistic combination in vitro and in vivo preclinical efficacy in various tumor models through interaction with rhamnose-containing cell membrane glycoproteins and subsequent internalization. Methods: C initially as a 2-hr IV infusion daily × 5 every 2 weeks to define the MTD, recommended Phase II dose, toxicity and pharmacokinetics. Based on preclinical toxicology the infusion duration was increased to 4 hours and 24 hours (120 hr continuous infusion). Doses studied range from 0.75 mg/kg/day to 3.0 mg/kg/day. Results: 27 pts were treated. DLT occurred in 2/2 pts at 1.5 mg/kg/day (2 hr) and 2/2 pts each at 3.0 mg/kg/day (4 hr and 24 hr). Preceding dose levels 1.0 mg/kg (2 hr) and 1.5 mg/kg (4 hr) produced DLT in 2/6 pts each with no grade IV. Over 24 hr, 2.25 mg/kg/day produced DLT in 4/6 patients. Limiting toxicity at all schedules was grade III/IV transaminitis with grade I-III increases of bilirubin and grade I-II creatinine. Hepatotoxicity was maximal at days 3–5, resolved over 10–21 days, was clinically asymptomatic apart from grade I-II fatigue, and was not cumulative. No myelosuppression or other serious drug-related toxicity was recorded. Partial responses were documented in 2 pts (renal, NSCLC) and minor response in 1 pt with unknown primary. Responses were seen using both 2 hr and 4 hr infusions. Pharmacokinetic parameters for solasonine and solamargine are linear across the narrow range of doses studied with elimination T1/2 of 5.57 ± 1.27 hr (solasonine), 8.40 ± 2.00 hr (solamargine) and Cl of 5.6 ± 1.6 L/hr (solasonine), 3.0 ± 0.7 L/hr (solamargine). Peak levels of both exceed active in vitro levels (>2,000 ng/ml). Conclusions: Coramsine produces dose-limiting hepatotoxicity at doses above 1.0 mg/kg/day over 2 hours or 1.5 mg/kg/day over 4 hours. 2.25 mg/kg/day over 24 hours exceeds the MTD. Activity has been seen against resistant solid tumors. Phase II studies in renal cancer and melanoma will be performed using 1.5 mg/kg/day over 4 hours.

[Table: see text]

Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke

OBJECTIVE

To determine the interval between symptom onset and hospital arrival and its relationship to baseline clinical characteristics, use of thrombolysis, and in-hospital outcomes in patients with acute ischemic stroke admitted to the 11 hospitals in the Buffalo metropolitan area and Erie County.

METHODS

The medical records of 1,590 patients were reviewed to determine the severity of the neurologic deficits (NIH Stroke Scale [NIHSS]), in-hospital mortality, favorable outcome (modified Rankin Scale score of < or = 2 at discharge), and strata of time interval between symptom onset and hospital arrival.

RESULTS

The time interval between symptom onset and hospital arrival was 0 to 3 hours in 337 (21%) patients, 3 to 6 hours in 177 (11%) patients, 6 to 24 hours in 301 (19%) patients, > 24 hours in 420 (26%) patients, and undetermined in 355 (22%) patients. IV (n = 23) and intra-arterial (n = 4) thrombolysis was used in 27 (8%) of the 337 patients that presented within 3 hours of symptom onset. In 1,235 patients with known time interval between symptom onset and hospital arrival, an association (p = 0.008) was observed between strata of increasing time interval and higher proportion of favorable outcomes at discharge. The initial NIHSS score was higher with decreasing interval between symptom onset and hospital arrival (p < 0.0001).

CONCLUSIONS

A small proportion of patients who present within 3 hours of symptom onset receive thrombolytic therapy. The observation that patients with more severe neurologic deficits and subsequently worse in-hospital outcomes appear to present early after symptom onset to the hospital may have implications for clinical studies.

On the difference in scattering behavior of cyclic and linear polymers in bulk

It has been suggested that, due to topological constraints, rings in the melt may assume a more compact shape than Gaussian chains. In this paper, we exploit the availability of narrow fractions of perdeuterated linear and cyclic polydimethylsiloxane (PDMS) and, through the analysis of the small angle neutron scattering (SANS) profiles, demonstrate the difference in scattering properties of linear and cyclic PDMS molecules. As expected for Gaussian chains, for the H/D linear PDMS samples, log-log plots of the scattered intensity versus scattering vector Q display a Q((-2)) dependence. However, for H/D cyclic blends, the scaling exponent is higher than 2, as predicted by computer simulations reported in the literature. We show that cyclic molecules in bulk display the characteristic maximum in plots of scattered intensity versus Q((-2)) that is expected on the basis of Monte Carlo calculations and from the Casassa equation [E. F. Casassa, J. Polym. Sci. A 3, 605 (1965)]. It is also shown that, for rings, the Debye equation [P. Debye, J. Appl. Phys. 15, 338 (1944)] is no longer appropriate to describe the SANS profiles of H/D cyclic blends, at least up to M(w) approximately 10 000. For these samples, the Casassa form factor gives a better representation of the SANS data and we show that this function which was developed for monodisperse cyclics is still adequate to describe our slightly polydisperse samples. Deviations from all above observations are noted for M(w)>11 000 and are attributed to partial contamination of cyclic samples with linear chains. The failure of both the Debye and the Casassa form factors could be due to contamination of the cyclic fractions by linear polymers or to a real conformational change.

Photoporation and cell transfection using a violet diode laser

The introduction and subsequent expression of foreign DNA inside living mammalian cells (transfection) is achieved by photoporation with a violet diode laser. We direct a compact 405 nm laser diode source into an inverted optical microscope configuration and expose cells to 0.3 mW for 40 ms. The localized optical power density of ~1200 MW/m2 is six orders of magnitude lower than that used in femtosecond photoporation (~104 TW/m2). The beam perforates the cell plasma membrane to allow uptake of plasmid DNA containing an antibiotic resistant gene as well as the green fluorescent protein (GFP) gene. Successfully transfected cells then expand into clonal groups which are used to create stable cell lines. The use of the violet diode laser offers a new and simple poration technique compatible with standard microscopes and is the simplest method of laser-assisted cell poration reported to date.

Wide-field retinal hemodynamic imaging with the tracking scanning laser ophthalmoscope

Real time, high-speed image stabilization with a retinal tracking scanning laser ophthalmoscope (TSLO) enables new approaches to established diagnostics. Large frequency range (DC to 19 kHz), wide-field (40-deg) stabilized Doppler flowmetry imaging was demonstrated in initial human subject tests. The fundus imaging method is a quasi-confocal line-scanning laser ophthalmoscope (LSLO). The retinal tracking system uses a confocal reflectometer with a closed loop optical servo system to lock onto features in the ocular fundus and automatically re-lock after blinks. By performing a slow scan with the laser line imager, frequency-resolved retinal perfusion and vascular flow images were obtained free of eye motion artifacts. Normal adult subjects and patients were tested with and without mydriasis to characterize flow imaging performance.

FTY720 immunomodulation: optimism for improved transplant regimens

FTY720, a sphingosine 1-phosphate receptor (S1P-R) agonist, is the first in a new class of immunomodulators. FTY720 has been shown to be highly effective for preventing graft rejection in preclinical models of cardiac, renal, and hepatic transplantation. To date, phase I single and multiple dosing studies conducted in stable renal transplant patients have revealed a favorable efficacy and tolerability profile. Following these preliminary clinical evaluations, phase II studies have determined optimal dosing for prevention of acute rejection and the efficacy and tolerability of FTY720 in combination with reduced and full-dose cyclosporine (CsA). Data available for these studies demonstrate that FTY720 5 mg combined with reduced-dose CsA provides equivalent freedom from acute rejection to a standard mycophenolate mofetil (MMF)/CsA regimen. Moreover, rejection prophylaxis with a 5-mg dose of FTY720 appears to allow for a 50% reduction in the dose of calcineurin inhibitors while effectively preventing graft rejection. These studies have also shown that FTY720 has no overlapping toxicity with classical immunosuppressive agents; FTY720 can be used safely in combination with CsA and everolimus. Overall, these synergistic effects suggest that FTY720 has the potential to provide a real improvement in the efficacy and tolerability of future immunosuppressive regimens.

Image stabilization for scanning laser ophthalmoscopy

A scanning laser ophthalmoscope with an integrated retinal tracker (TSLO) was designed, constructed, and tested in human subjects without mydriasis. The TSLO collected infrared images at a wavelength of780 nm while compensating for all transverse eye movements. An active, high-speed, hardware-based tracker was able to lock onto many common features in the fundus, including the optic nerve head, blood vessel junctions, hypopigmentation, and the foveal pit. The TSLO has a system bandwidth of ~1 kHz and robustly tracked rapid and large saccades of approximately 500 deg/sec with an accuracy of 0.05 deg. Image stabilization with retinal tracking greatly improves the clinical potential of the scanning laser ophthalmoscope for imaging where fixation is difficult or impossible and for diagnostic applications that require long duration exposures to collect meaningful information.