Role of T1 mapping in identification of convalescent Takotsubo cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Background

Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis.

Purpose

We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis.

Methods

We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR.

Results

All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (>1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%).

Conclusion

Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield.

Abstract Figure. CMR in convalescent Takotsubo

Outcomes associated with modern treatment paradigms in connective tissue disease (CTD)-associated pulmonary arterial hypertension (PAH): a meta-analysis of randomized controlled trials (RCTs)

Background

CTD-PAH has historically represented a PAH subtype with poor prognosis. New therapies, as well as combination therapy approaches targeting multiple pathways have been approved for PAH based on RCTs. CTD-PAH patients comprise a subgroup of the RCT populations and efficacy analyses are based on subgroup analyses which can be less reliable than the overall analysis. We conducted a meta-analysis of RCTs of approved PAH therapies to evaluate outcomes of patients with CTD-PAH.

Purpose

To use meta-analysis to determine response to treatment in patients with CTD-PAH.

Methods

The PubMed and EMBASE databases were searched for English-only articles published between January 1, 2000 and November 25, 2019. Inclusion criteria were multicenter RCTs that enrolled adults with WHO group 1 pulmonary hypertension (PAH); enrollment in 2000 or later; long-term clinical morbidity and/or mortality event or 6-minute walk distance (6MWD) as an efficacy endpoint reported for ≥30 patients with CTD-PAH; and evaluation of a US Food and Drug Administration-approved PAH therapy. The primary outcomes were treatment effect as measured by the study time to first morbidity or morality event and change in 6MWD from baseline to between 3–6 months, per the data provided in each article. Results from individual studies were combined using a random-effects model for overall study population (PAH patients) and the subgroup of CTD-PAH patients.

Results

Ten RCTs (N=4329 PAH patients; n=1263 (29%) with CTD-PAH) met inclusion criteria and were included in the meta-analysis. At baseline, PAH patients had a mean age of 50 years, approximately 78% were female, and approximately 58% had functional class III or IV disease. These characteristics were balanced between treatment and control groups. Baseline 6MWD was 356 m for the overall population and 337 m for patients with CTD-PAH. Five RCTs (N=3172; n=941 with CTD-PAH [30%]) reported hazard ratios (HRs) for time to a morbidity or mortality event by drug treatment and PAH etiology: overall population HR=0.63 (95% confidence interval [CI], 0.56–0.72; P<0.001); CTD-PAH population HR=0.64 (95% CI, 0.51–0.80; P<0.001) (Figure). Nine RCTs reported mean change with drug treatment from baseline to 3 to 6 months in 6MWD for PAH and CTD patients: 33.9 m (95% CI, 21.9–45.9; P<0.001) in the overall population; 20.2 m (95% CI, 10.8–29.7; P<0.001) in CTD-PAH patients.

Conclusions

The improvement in 6MWD in patients with CTD-PAH is smaller than in those with other types of PAH, perhaps reflecting comorbidities and CTD-induced mobility constraints, independent of their cardiopulmonary capacity. Data from long term clinical morbidity/mortality endpoint studies in this large group of patients with CTD-PAH demonstrate that these patients derive significant benefit from currently available PAH therapies which, in many patients, comprised the addition of a drug targeting a second or third pathway involved in the pathophysiology of PAH.

Treatment effect on morbidity/mortality

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.

Long-term outcomes in newly diagnosed pulmonary arterial hypertension (PAH) patients receiving initial triple oral combination therapy: insights from the randomised controlled TRITON study

Introduction

Long-term outcomes are important in PAH.

Purpose

To evaluate the long-term efficacy and safety of initial triple oral therapy with selexipag, macitentan and tadalafil vs initial double oral therapy with macitentan and tadalafil in PAH.

Methods

TRITON, a multicentre, double-blind, placebo-controlled, phase 3b study, randomised 1:1 newly diagnosed, treatment-naïve PAH patients to initial triple vs double therapy. Macitentan and tadalafil were initiated at randomisation and selexipag/placebo at day 15 (uptitrated to wk 12). Efficacy and safety were assessed in a blinded manner until the last patient randomised completed wk 26 (end of observation period). Pulmonary vascular resistance (PVR; primary endpoint) and 6-minute walk distance (6MWD) were assessed at wk 26. Other secondary endpoints included time to first disease progression event (centrally adjudicated) to end of observation period +7 days. Time to all-cause mortality up to end of observation period was analysed post-hoc.

Results

247 patients were randomised to initial triple (n=123) or initial double therapy (n=124); baseline characteristics were balanced between groups. Median follow-up was 77.6 (initial triple) and 75.8 wks (initial double). Initial triple and initial double therapy improved PVR (by 54% and 52%) and 6MWD (by 55 and 56 m), with no difference between groups. A 41% reduction in the risk of first disease progression event driven by PAH-related hospitalisation and all-cause death was observed with initial triple vs initial double therapy (hazard ratio 0.59, 95% CI 0.32–1.09, p=0.087; Figure). Two patients died in the initial triple vs 9 in the initial double therapy group (hazard ratio 0.23, 95% CI 0.05–1.04). Adverse events were consistent with the known safety profiles of the study drugs.

Conclusions

In TRITON, assessments at wk 26 showed marked improvements in both treatment arms, with no difference between groups. Exploratory analysis indicated a signal for improved long-term outcome with initial triple versus initial double therapy.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd.

FRI0539 SURVIVAL IN PATIENTS WITH CONNECTIVE TISSUE DISEASE-ASSOCIATED PULMONARY ARTERIAL HYPERTENSION (CTD-PAH): A META-ANALYSIS OF OBSERVATIONAL REGISTRIES

Background:

Although patients with CTD-PAH comprise approximately one third of the overall PAH population, the literature on survival outcomes in CTD-PAH patients overall and by CTD subtype is limited by small sample sizes. We conducted a meta-analysis of more than 4,000 patients with CTD-PAH enrolled in observational registries.

Objectives:

To determine survival rates in patients with CTD-PAH overall and by CTD subtypes.

Methods:

The PubMed and EMBASE databases were searched for English-only articles published between January 1, 2000 and November 25, 2019. Inclusion criteria were multicenter registries of adults with WHO group 1 pulmonary hypertension (PAH); conducted in 2000 or later; and survival data for ≥30 patients with CTD-PAH. Meta-analysis of survival was performed using a random-effects model. Survival was estimated for CTD-PAH overall; for CTD-PAH stratified by registries primarily conducted before and after 2010 to assess the impact of new therapies, as well as combination therapy approaches targeting multiple pathways; and for CTD subtypes (systemic sclerosis [SSc] and systemic lupus erythematosus [SLE]).

Results:

Nineteen registries met inclusion criteria and reported data on 4,008 patients with CTD-PAH. Of these patients, 1,485 had SSc, 456 had SLE, and CTD subtype was not specified in 2,067. CTD-PAH patients had a mean age of 55 years and 87% were female. Most patients (70%) had functional class III or IV disease and the mean 6-minute walk distance at enrollment was 327 m. Among registries that enrolled patients of all PAH etiologies (N=7,829), survival rates in the CTD-PAH subpopulation (n=2113), were 83%, 73%, and 62% at 1-, 2-, and 3- years, respectively. These survival rates were lower than those reported for the overall PAH population: 88%, 79%, and 72% at 1-, 2-, and 3- years, respectively. Numerically higher survival rates at 1-, 2-, and 3- years were observed in CTD-PAH patients treated in 2010 and later: 85% vs 90%, 74% vs 82%, and 65% vs 73%. Among all CTD-PAH patients, survival rates were lower for patients with SSc compared to those with SLE: 88% vs 92%, 75% vs 90%, 67% vs 87% at 1-, 2-, and 3- years, respectively (Figure).

Conclusion:

Patients with CTD-PAH have a substantial risk of death, however, CTD-PAH patients treated within the last ten years have numerically higher survival rates than those treated earlier. This may be related to increased screening for PAH, especially in SSc (leading to earlier diagnosis) and/or the availability of new treatment approaches. Consistent with clinical observations, patients with SSc have worse survival rates than those with SLE. Given the high risk of mortality in these patients, early detection and upfront aggressive treatment are warranted.

References:

Acknowledgments:

This analysis was funded by Actelion Pharmaceuticals.

Disclosure of Interests:

Dinesh Khanna Shareholder of: Eicos, Grant/research support from: NIH NIAID, NIH NIAMS, Consultant of: Acceleron, Actelion, Bayer, BMS, Boehringer-Ingelheim, Corbus, Galapagos, Genentech/Roche, GSK, Mitsubishi Tanabi, Sanofi-Aventis/Genzyme, UCB Pharma, Carol Zhao Shareholder of: Actelion Pharmaceuticals US, Inc., Employee of: Actelion Pharmaceuticals US, Inc., Lorinda Chung Grant/research support from: United Therapeutics, Boehringer Ingelheim, Consultant of: Bristol-Myers Squibb, Boehringer Ingelheim, Mitsubishi Tanabe, Eicos Sciences, Gerry Coghlan Grant/research support from: Johnson & Johnson, Consultant of: Bayer, Johnson & Johnson, GlaxoSmithKline, Speakers bureau: Bayer, Johnson & Johnson, GlaxoSmithKline, Rajan Saggar Grant/research support from: Actelion, Gilead Science, United Therapeutics, Consultant of: Actelion, Gilead Science, United Therapeutics, Speakers bureau: Actelion, Gilead Science, United Therapeutics, Stephen Mathai Consultant of: Actelion, Liquidia, Arena, United Therapeutics, Mehul Shah Shareholder of: Actelion Pharmaceuticals US, Inc, Employee of: Actelion Pharmaceuticals US, Inc, John Hartney Shareholder of: Actelion Pharmaceuticals US, Inc, Employee of: Actelion Pharmaceuticals US, Inc, Vallerie McLaughlin Grant/research support from: Reata Pharmaceutics, SoniVie, United Therapeutics, Bayer, Acceleron, Actelion Pharmaceuticals US, Inc., Consultant of: Actelion Pharmaceuticals US, Inc., Acceleron, Arena Pharmaceuticals, Bayer, Caremark, CiVi Biopharma, United Therapeutics

CA125 Value As an Indicator for Imaging for Detection of CA Ovary Recurrence After Primary Treatment

Background: GCIG states that CA125 value double of upper limit of normal during follow-up after primary treatment is a criteria for further intervention. However, in our institution we found that significant number of women with a CA 125 > 35 u/mL have recurrent disease on imaging. Aim: To compare values of CA125 rise as an indicator for imaging for detection of recurrence after primary treatment. Methods: It was retrospective observational study. 64 women with stage III and IV epithelial ovarian cancer who had normal CA125 on completion of primary therapy from January 2012 to December 2016 at Tata Medical Center, Kolkata, India were included in the study. These women were followed up with Ca125 three monthly for 2 years then six monthly. CA 125 doubling from posttreatment baseline or exceeding 35 u/mL were investigated with CT imaging. Data were collected from hospital management system electronic medical records. Results: Out of 146 patients who underwent IDS 64 (43.8%) had normal CA125 post treatment. 2 patients with doubling of Ca125 but < 35 u/mL had recurrence, all of whom had R0 during IDS. 1 patient with normal CA 125 had clinical recurrence and this patient had R2 disease during IDS. 2 patients with normal CA 125 had recurrence on radiology only and they had R0 during IDS. 18 (24%) had radiologic recurrence when CA125 was > 35 u/mL out of which14 patients had R0 and 4 patients R1 disease during IDS. 41 patients had recurrence detected on radiology when CA125 was > 70 u/mL. Out of these 27 had R0, 11 patients had R1 and 3 patients had R2 disease on IDS. 78% of R0 patients had disease recurrence when CA125 was > 35 u/mL. Conclusion: Imaging should be considered when CA125 rises > 35u/mL, rather than waiting for it to double the upper limit of normal, so that early detection of recurrence can initiate timely treatment. Rise of CA125 above 35 u/mL is a good criteria for imaging to detect recurrence even in women with R0 resection. CA125 can be used as a good tool for follow-up especially in low resource setting where people cannot afford routine imaging.

Strategies to Motivate Cancer-Affected Individuals and Their Families to Mobilize Their Kith and Kin, Neighbours and Community to Assess Their Awareness Level to Accept and Attend Screening Clinic to Prevent Cervical Cancer

Background and context: Cervical cancer is second most common cancer among women across the world. It is a public health problem especially in a developing country like India, as it alone accounts for one-quarter of the worldwide burden of cervical cancer. It is estimated by ICMR that a total of 100,000 new cases were diagnosed in 2016. This figure is expected to touch 1,04,000 during 2020. If treated in early stages more than 90% 5-year survival may be expected. However, less than 10% of our patients are diagnosed early resulting in an overall poor outcome. We do not have any organized national program for cervical cancer screening that might help in reducing the incidence of and death from cervical cancer. Aim: The aim of this study was to evaluate the efficacy of establishing a hospital-based opportunistic screening clinic with the underlying intention of disseminating awareness and knowledge by empowering cancer affected women to mobilize women folks or relatives known to them for voluntary participation in screening clinic. Strategy/Tactics: We have initiated the following measures: 1. Enlisting the phone numbers of female cancer patients from hospital records and contacting their families for participating in the screening clinic. 2. One to one counseling of patients suffering from any other cancer and involving their accompanying family members to avail the facility. 3. Encouraging them to bring their neighbors, relatives, friends to participate. 4. To identify patient representatives involved in community work like NGOs, clubs, religious institutes etc. and empower them with knowledge for motivating others to participate. 5. Development of IC (information and communication) materials like standees, leaflets, audio visuals for people waiting in hospital lobby. 6. Involving the male members of the family in encouraging the women to participate in the screening. 7. Assess the awareness level of women participating in the screening clinic. Program/Policy process: To create awareness and empower the affected cancer people and their relatives/attendants to participate and to mobilize the community for voluntary participation in screening clinic for prevention of cervical cancer. Outcomes: The outcome measure is assessed by the number of healthy women of any age coming forward to attend the screening/vaccination/awareness clinic per one cancer affected women. We have already registered 270 participants and screened 268 women for cervical cancer. Seventeen women were detected with HPV infection and underwent colposcopy. Interest in vaccination of young girl in the family was generated by people visiting our hospital. What was learned: The strategy to establish “screening clinic” for women with help of cancer patients has proved to be effective in reaching out to the community through the involvement of their kith and kin.

Developing Interinstitutional Multimodality Model for Translational Studies for Cervical Cancer Screening and Treatment: Pragmatic Issues Pertaining to Logistics, Infrastructure and Solutions

Background and context: Cervical cancer claims the life of 67,500 women every year in India. Persistence of HPV leads to the development of high grade CIN which may progress to invasive cancer. Almost 80% of women are infected with the virus in their lifetime but only a small proportion of women progress to develop cervical cancer. In early cervical cancer patients despite surgery about 25% recur and in advanced cervical cancer about 50%-60% women respond to radiotherapy while the rest progress or recur with disease after standard treatment. The risk to progression and failure to treatment is dependent on both viral/tumor and host factors; therefore an integrated approach should be adopted in developing predictive and prognostic biomarkers to address these clinical questions. Aim: Establishing a clinical and translational research model to provide an infrastructure that will facilitate targeted screening and targeted therapeutics in cervical precancer and cancer. Strategy/Tactics: Integration of various premium institutions in the city with their infrastructure to form a “Systems Medicine Cluster” was established to conduct this research. We have adopted a primary HPV screening (HC2 DNA and genotyping) strategy as a clinical protocol and devised SOPS to enable sample collection strategies for several research usage from the same sample including cytology testing, genomics, metabolomics, microbiome, proteomics. Similarly a translational pathway has been created for seamless tissue collection from cancer patients for multidimensional research usage. Collaboration was established between clinicians, scientists, clinical trial coordinators, research nurses, data managers and biobank personnel to orchestrate this working model. Program/Policy process: Collaboration of various institutions to form a “Systems Medicine Cluster” to effectively implement research strategies for cervical cancer screening and treatment. Outcomes: With the help of translation work we intend to identify of viral and host factors which determine the persistence of the HPV in screened women, thereby risk stratifying them for colposcopic evaluation. In women with cervical cancer who are treated with standard care, we expect to identify modifiable tumor or host factors and drug targets that can be used to reduce the risk of recurrence and improve survival. In 3 months of implementation we have screened 260 women in the cervical cancer screening clinic and obtained samples from 190 cervical cancer patients for translational research. All women have also contributed to the collection of vaginal fluid and blood samples for various research protocols associated with cervical cancer. What was learned: These translational studies conducted hand in hand with clinical pathways requires meticulous planning and teamed approach. The formation of the “Systems Medicine Cluster” with different expertise to address clinical strategies has been a successful model.

A novel diketopiperazine improves functional recovery given after the onset of 6-OHDA-induced motor deficit in rats

BACKGROUND AND PURPOSE

Cyclo-L-glycyl-L-2-allylproline (NNZ-2591), a modified diketopiperazine, is neuroprotective and improves long-term function after hypoxic-ischaemic brain injury in rats. The present studies were designed to examine both the neuroprotective and neurotrophic actions of NNZ-2591 on neurochemical and behavioural changes in a rat model of Parkinson's disease.

EXPERIMENTAL APPROACH

To examine its protective effect, either NNZ-2591 (20 ng.day(-1)) or saline was given intracerebroventricularly for 3 days starting 2 h after 6-hydroxydopamine (6-OHDA) induced unilateral striatal lesion. In a subsequent experiment either NNZ-2591 (0.2, 1 and 5 mg.day(-1), s.c.) or saline was administered daily for 14 days starting 2 weeks after the lesion. Behavioural and neurochemical outcomes were examined using the adjusting step test and immunohistochemical staining.

KEY RESULTS

Cyclo-L-glycyl-L-2-allylproline given 2 h after the lesion reduced the degree of motor deficit compared with the saline-treated group. Delayed treatment with NNZ-2591, initiated after the onset of motor deficit, significantly improved motor function from week 7 onwards compared with the saline-treated group. Neither treatment regime altered nigrostriatal dopamine depletion. NNZ-2591 significantly enhanced the expression of doublecortin-positive neuroblasts in the sub-ventricular zone.

CONCLUSIONS AND IMPLICATIONS

These studies reveal that early treatment with NNZ-2591 protects against the motor deficit induced by 6-OHDA and that treatment initiated after the establishment of motor impairment significantly improves long-term motor function. These effects of NNZ-2591 on functional recovery were independent of dopamine depletion and also appeared not to be symptomatic as the improved motor function was long-lasting. NNZ-2591 has potential as a therapeutic agent for neurodegenerative disorders.

Peripheral administration of a novel diketopiperazine, NNZ 2591, prevents brain injury and improves somatosensory-motor function following hypoxia-ischemia in adult rats

The current study describes the neuroprotective effects of an endogenous diketopiperazine, cyclo-glycyl-proline (cyclic GP), in rats with hypoxic-ischemic brain injury and the pre-clinical development of an analogue, cyclo-L-glycyl-L-2-allylproline (NNZ 2591), modified for improved bioavailability. The compounds were given either intracerebroventricularly or subcutaneously 2h after hypoxia-ischemia. Histology, immunohistochemistry and behavior were used to evaluate treatment effects. The central uptake of NNZ 2591 was also examined in normal and hypoxic-ischemic injured rats by HPLC-mass spectrometry. Central administration of cyclic GP or NNZ 2591 reduced the extent of brain damage in the lateral cortex, the hippocampus and the striatum (p<0.001), with NNZ 2591 being more potent. NNZ 2591 was stable in the plasma and crossed the blood-brain barrier independent of hypoxic-ischemic injury. The level of NNZ 2591 in the CSF was maintained for 2 h after a single subcutaneous dose, and modest neuroprotection was seen after a bolus subcutaneous administration (overall p<0.001). Treatment with NNZ 2591 for 5 d subcutaneously improved somatosensory-motor function (p<0.05) and long-term histological outcome (overall p<0.0001). NNZ 2591 treatment not only reduced both caspase-3 mediated apoptosis and microglial activation but also enhanced astrocytic reactivity, which may mediate its protective effect. The pharmacokinetic profile and potent long-term protective effects of NNZ 2591 suggests its utility for the treatment of ischemic brain injury and other neurological conditions requiring chronic intervention.

Neuroprotective effects of the N-terminal tripeptide of insulin-like growth factor-1, glycine-proline-glutamate (GPE) following intravenous infusion in hypoxic-ischemic adult rats

The N-terminal tripeptide of insulin-like growth factor-1, GPE is neuroprotective when given intracerebroventricularly 2 h after hypoxic-ischemic (HI) brain injury in rats. We have now examined whether GPE can cross the blood-brain barrier and exert neuroprotective actions following intravenous administration. Following a single bolus intravenous injection, GPE was rapidly metabolized and cleared from the circulation. The short half-life (<2 min) in blood was subsequently associated with modest and inconsistent neuroprotection. In contrast, potent neuroprotection of GPE was consistently observed in all brain regions examined following 4 h intravenous infusion (12 mg/kg). The neuroprotective effects of GPE after infusion showed a broad effective dose range (1.2-120 mg/kg) and an extended window of treatment to 7-11 h after injury. The central penetration of GPE after intravenous infusion was injury-dependent. GPE also improved long-term somatofunction with a comparable neuronal outcome. GPE reduced both caspase-3-dependent and -independent apoptosis in the hippocampus. Treatment with GPE also inhibited microglial proliferation and prevented the injury-induced loss of astrocytes. In conclusion, the neuroprotective actions of GPE infusion were global, robust and displayed a broad effective dose range and treatment window. GPE's activity included the prevention of neuronal apoptosis, promotion of astrocyte survival and inhibition of microglial proliferation. With injury specific central penetration, GPE has considerable promise as a systemic neuroprotective treatment after acute encephalopathies.

Effects of tactile-kinesthetic stimulation in preterms: a controlled trial

BACKGROUND

To determine the effects of tactile-kinesthetic stimulation to preterms on physiologic parameters, physical growth and behavioral development.

DESIGN

Controlled trial.

SETTING

The premature unit (growing nursery) of a large, teaching hospital.

SUBJECTS

48 well preterms with birth weights between 1000-2000 grams.

INTERVENTION

The neonates were systematically allocated into test and control groups. Test babies received tactile-kinesthetic stimulation in the form of a structured baby massage from day 3 to term corrected age. They were observed for changes in vital parameters (heart rate, respiration, temperature and oxygen saturation) during the first few days of stimulation in hospital. Thereafter, massage was continued at home. Changes in weight, length and head circumference and neuro-behavior (Brazelton Neuro-Behavioral Assessment Scale) were assessed in both groups before, during and after the study period.

RESULTS

An increase in heart rate (within physiologic range) was seen in the test group during stimulation. This group also showed a weight gain of 4.24 g/day more than controls, which was statistically significant. On the Brazelton Scale the test group showed statistically significant improved scores on the "orientation", "range of state", "regulation of state" and "autonomic stability" clusters at follow-up. No significant complications were noted. A positive correlation was found between the duration of stimulation in days and the weight gain in grams but this did not reach statistical significance.

CONCLUSIONS

Tactile-kinesthetic stimulation when administered to well, preterm infants has a beneficial effect on growth and behavioral development with no adverse effects on physiologic parameters.

Intergeneric protoplast fusion between xylanase producing Bacillus subtilis LYT and Corynebacterium acetoacidophilum ATCC 21476

Hybrids between a strain of Bacillus subtilis isolated in our laboratory and having the ability to degrade xylan and other complex polysaccharides and Corynebacterium acetoacidophilum, a lysine producer, were prepared by protoplast fusion. Based on distinctive parental biochemical characteristics the fusants were grouped into 9 categories, viz. BC1 through BC9. Three of the hybrids, BC5, BC7a and BC7b, were tested for their ability to produce xylanase and lysine. Both BC7a and BC7b produced xylanase but BC5 did not, however all of them produced lysine albeit to different degrees. These results demonstrate that intergeneric gene transfer takes place through protoplast fusion between these 2 important genera of bacteria and some of the fusants inherit the useful traits of both the parents.