CYP3A5 unexpectedly regulates glucose metabolism through the AKT-TXNIP-GLUT1 axis in pancreatic cancer

CYP3A5 is a cytochrome P450 (CYP) enzyme that metabolizes drugs and contributes to drug resistance in cancer. However, it remains unclear whether CYP3A5 directly influences cancer progression. In this report, we demonstrate that CYP3A5 regulates glucose metabolism in pancreatic ductal adenocarcinoma. Multi-omics analysis showed that CYP3A5 knockdown results in a decrease in various glucose-related metabolites through its effect on glucose transport. A mechanistic study revealed that CYP3A5 enriches the glucose transporter GLUT1 at the plasma membrane by restricting the translation of TXNIP, a negative regulator of GLUT1. Notably, CYP3A5-generated reactive oxygen species were proved to be responsible for attenuating the AKT-4EBP1-TXNIP signaling pathway. CYP3A5 contributes to cell migration by maintaining high glucose uptake in pancreatic cancer. Taken together, our results, for the first time, reveal a role of CYP3A5 in glucose metabolism in pancreatic ductal adenocarcinoma and identify a novel mechanism that is a potential therapeutic target.

A CRISPR-drug perturbational map for identifying compounds to combine with commonly used chemotherapeutics

Combination chemotherapy is crucial for successfully treating cancer. However, the enormous number of possible drug combinations means discovering safe and effective combinations remains a significant challenge. To improve this process, we conduct large-scale targeted CRISPR knockout screens in drug-treated cells, creating a genetic map of druggable genes that sensitize cells to commonly used chemotherapeutics. We prioritize neuroblastoma, the most common extracranial pediatric solid tumor, where ~50% of high-risk patients do not survive. Our screen examines all druggable gene knockouts in 18 cell lines (10 neuroblastoma, 8 others) treated with 8 widely used drugs, resulting in 94,320 unique combination-cell line perturbations, which is comparable to the largest existing drug combination screens. Using dense drug-drug rescreening, we find that the top CRISPR-nominated drug combinations are more synergistic than standard-of-care combinations, suggesting existing combinations could be improved. As proof of principle, we discover that inhibition of PRKDC, a component of the non-homologous end-joining pathway, sensitizes high-risk neuroblastoma cells to the standard-of-care drug doxorubicin in vitro and in vivo using patient-derived xenograft (PDX) models. Our findings provide a valuable resource and demonstrate the feasibility of using targeted CRISPR knockout to discover combinations with common chemotherapeutics, a methodology with application across all cancers.

Proteasome inhibition targets the KMT2A transcriptional complex in acute lymphoblastic leukemia

Rearrangments in Histone-lysine-N-methyltransferase 2A (KMT2Ar) are associated with pediatric, adult and therapy-induced acute leukemias. Infants with KMT2Ar acute lymphoblastic leukemia (ALL) have a poor prognosis with an event-free-survival of 38%. Herein we evaluate 1116 FDA approved compounds in primary KMT2Ar infant ALL specimens and identify a sensitivity to proteasome inhibition. Upon exposure to this class of agents, cells demonstrate a depletion of histone H2B monoubiquitination (H2Bub1) and histone H3 lysine 79 dimethylation (H3K79me2) at KMT2A target genes in addition to a downregulation of the KMT2A gene expression signature, providing evidence that it targets the KMT2A transcriptional complex and alters the epigenome. A cohort of relapsed/refractory KMT2Ar patients treated with this approach on a compassionate basis had an overall response rate of 90%. In conclusion, we report on a high throughput drug screen in primary pediatric leukemia specimens whose results translate into clinically meaningful responses. This innovative treatment approach is now being evaluated in a multi-institutional upfront trial for infants with newly diagnosed ALL.

Abstract 1907: Combocat: A high-throughput framework for drug combination studies

Drug combinations are the basis of treatment for modern diseases but arriving at successful combination therapies is fraught with challenges. Decades ago, the limited number of drugs represented a tractable candidate list from which to design combination experiments. However, the current pool of single-agent drugs to potentially combine is far too large to brute-force screen, and purely computational predictions have performed poorly. Suitable screening methods are needed, but the design of experimental approaches has proven to be highly complex; researchers need to carefully balance many variables such as appropriate drug concentration ranges, number of doses, inclusion of replicates, and throughput. Perhaps the most significant obstacle facing these studies is the approach to data analysis, where conflicting definitions of synergy and unintuitive metrics serve to confuse researchers and render largely uninterpretable results. Collectively, these challenges hamper the progress of drug combination research and ultimately translational impact. To overcome these limitations, we have developed a fully self-contained framework to handle both the experimental design and analysis of drug combination experiments. Our method, called Combocat, provides a straightforward way to test and analyze any number of drug combinations and samples, and is suitable for high-throughput. Combocat provides a high-resolution of concentration combinations compared to most current approaches. This is automated by common instruments and uses scripts included within our protocol. Through careful template design, we were able to include 3 replicates of each 10x10 matrix, single-agent drugs, and controls - all within a single 384-well plate. We found our method to work robustly with varying sample types (Human cancer, bacteria, fungi), and readouts. After data generation, files can simply be dragged into our Combocat analysis tool directly. We provide a free, web-based software suite to fully automate the analysis after data collection. The Combocat web tool is intuitive and facilitates interactive exploration of synergy. It also provides a rich array of information such as dose-response curves, IC50 values, synergy matrices, ranked hit plots, and more. Data normalization, synergy algorithms, scoring functions, and other complex calculations are run swiftly and automatically in the background with no need for user input. Notably, we employ statistical testing by taking advantage of experimental replicates, which is a feature we found lacking in most methods. We use a well-documented synergy metric but also decided to formulate our own Combocat score which considers statistical measurements and assay quality. The Combocat score provides an easy interpretation of results and facilitates quick identification of top hits. Collectively, our platform will be used to enhance and expedite the selection of effective drug combinations.

Citation Format: William C. Wright, Min Pan, Hyeong-Min Lee, Gregory A. Phelps, Jonathan Low, Duane Currier, Richard E. Lee, Taosheng Chen, Paul Geeleher. Combocat: A high-throughput framework for drug combination studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1907.

Abstract 456: Jointly leveraging spatial transcriptomics and deep learning models for image annotation achieves better-than-pathologist performance in cell type identification in tumors

For over 100 years, the traditional tools of pathology, such as tissue-marking dyes (e.g. the H&E stain) have been used to study the disorganization and dysfunction of cells within tissues. This has represented a principal diagnostic and prognostic tool in cancer. However, in the last 5 years, new technologies have promised to revolutionize histopathology, with Spatial Transcriptomics technologies allowing us to measure gene expression directly in pathology-stained tissue sections. In parallel with these developments, Artificial Intelligence (AI) applied to histopathology tissue images now approaches pathologist level performance in cell type identification. However, these new technologies still have severe limitations, with Spatial Transcriptomics suffering difficulties distinguishing transcriptionally similar cell types, and AI-based pathology tools often performing poorly on real world out-of-batch test datasets. Thus, century-old techniques still represent standard-of-care in most areas of clinical cancer diagnostics and prognostics. Here, we present a new frontier in digital pathology: describing a conceptually novel computational methodology, based on Bayesian probabilistic modelling, that allows Spatial Transcriptomics data to be leveraged together with the output of deep learning-based AI used to computationally annotate H&E-stained sections of the same tumor. By leveraging cell-type annotations from multiple independent pathologists, we show that this integrated methodology achieves better performance than any given pathologist’s manual tissue annotation in the task of identifying regions of immune cell infiltration in breast cancer, and easily outperforms either technology alone. We also show that on a subset of histopathology slides examined, the methodology can identify regions of clinically relevant immune cell infiltration that were missed entirely by an initial pathologist’s manual annotation. While this use case has clear diagnostic and prognostic value in cancer (e.g. predicting response to immunotherapy), our methodology is generalizable to any type of pathology images and also has broad applications in spatial transcriptomics data analytics, where most applications (such as identifying cell-cell interactions) rely on correct cell type annotations having been established a priori. We anticipate that this work will spur many follow-up studies, including new computational innovations building on the approach. The work sets the stage for better-than-pathologist performance in other cell-type annotation tasks, with relevant applications in diagnostics and prognostics across almost all cancers.

Citation Format: Asif Zubair, Rich Chapple, Sivaraman Natarajan, William C. Wright, Min Pan, Hyeong-Min Lee, Heather Tillman, John Easton, Paul Geeleher. Jointly leveraging spatial transcriptomics and deep learning models for image annotation achieves better-than-pathologist performance in cell type identification in tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 456.

Molecular basis of crosstalk in nuclear receptors: heterodimerization between PXR and CAR and the implication in gene regulation

The 48 human nuclear receptors (NRs) form a superfamily of transcription factors that regulate major physiological and pathological processes. Emerging evidence suggests that NR crosstalk can fundamentally change our understanding of NR biology, but detailed molecular mechanisms of crosstalk are lacking. Here, we report the molecular basis of crosstalk between the pregnane X receptor (PXR) and constitutive androstane receptor (CAR), where they form a novel heterodimer, resulting in their mutual inhibition. PXR and CAR regulate drug metabolism and energy metabolism. Although they have been broadly perceived as functionally redundant, a growing number of reports suggests a mutual inhibitory relation, but their precise mode of coordinated action remains unknown. Using methods including RNA sequencing, small-angle X-ray scattering and crosslinking mass spectrometry we demonstrate that the mutual inhibition altered gene expression globally and is attributed to the novel PXR–CAR heterodimerization via the same interface used by each receptor to heterodimerize with its functional partner, retinoid X receptor (RXR). These findings establish an unexpected functional relation between PXR, CAR and RXR, change the perceived functional relation between PXR and CAR, open new perspectives on elucidating their role and designing approaches to regulate them, and highlight the importance to comprehensively investigate nuclear receptor crosstalk.

Unraveling the Structural Basis of Selective Inhibition of Human Cytochrome P450 3A5

The human cytochrome P450 (CYP) CYP3A4 and CYP3A5 enzymes metabolize more than one-half of marketed drugs. They share high structural and substrate similarity and are often studied together as CYP3A4/5. However, CYP3A5 preferentially metabolizes several clinically prescribed drugs, such as tacrolimus. Genetic polymorphism in CYP3A5 makes race-based dosing adjustment of tacrolimus necessary to minimize acute rejection after organ transplantation. Moreover, the differential tissue distribution and expression levels of CYP3A4 and CYP3A5 can aggravate toxicity during treatment. Therefore, selective inhibitors of CYP3A5 are needed to distinguish the role of CYP3A5 from that of CYP3A4 and serve as starting points for potential therapeutic development. To this end, we report the crystal structure of CYP3A5 in complex with a previously reported selective inhibitor, clobetasol propionate (CBZ). This is the first CYP3A5 structure with a type I inhibitor, which along with the previously reported substrate-free and type II inhibitor-bound structures, constitute the main CYP3A5 structural modalities. Supported by structure-guided mutagenesis analyses, the CYP3A5-CBZ structure showed that a unique conformation of the F-F' loop in CYP3A5 enables selective binding of CBZ to CYP3A5. Several polar interactions, including hydrogen bonds, stabilize the position of CBZ to interact with this unique F-F' loop conformation. In addition, functional and biophysical assays using CBZ analogs highlight the importance of heme-adjacent moieties for selective CYP3A5 inhibition. Our findings can be used to guide further development of more potent and selective CYP3A5 inhibitors.

The chemotherapeutic CX-5461 primarily targets TOP2B and exhibits selective activity in high-risk neuroblastoma

Survival in high-risk pediatric neuroblastoma has remained around 50% for the last 20 years, with immunotherapies and targeted therapies having had minimal impact. Here, we identify the small molecule CX-5461 as selectively cytotoxic to high-risk neuroblastoma and synergistic with low picomolar concentrations of topoisomerase I inhibitors in improving survival in vivo in orthotopic patient-derived xenograft neuroblastoma mouse models. CX-5461 recently progressed through phase I clinical trial as a first-in-human inhibitor of RNA-POL I. However, we also use a comprehensive panel of in vitro and in vivo assays to demonstrate that CX-5461 has been mischaracterized and that its primary target at pharmacologically relevant concentrations, is in fact topoisomerase II beta (TOP2B), not RNA-POL I. This is important because existing clinically approved chemotherapeutics have well-documented off-target interactions with TOP2B, which have previously been shown to cause both therapy-induced leukemia and cardiotoxicity-often-fatal adverse events, which can emerge several years after treatment. Thus, while we show that combination therapies involving CX-5461 have promising anti-tumor activity in vivo in neuroblastoma, our identification of TOP2B as the primary target of CX-5461 indicates unexpected safety concerns that should be examined in ongoing phase II clinical trials in adult patients before pursuing clinical studies in children.

Building a Chemical Toolbox for Human Pregnane X Receptor Research: Discovery of Agonists, Inverse Agonists, and Antagonists Among Analogs Based on the Unique Chemical Scaffold of SPA70

Pregnane X receptor (PXR) plays roles in detoxification and other physiological processes. PXR activation may enhance drug metabolism (leading to adverse drug reactions) or inhibit inflammation. Therefore, PXR agonists, antagonists, and inverse agonists may serve as research tools and drug candidates. However, a specific PXR modulator with an associated structure-activity relationship is lacking. Based on the scaffold of specific human PXR (hPXR) antagonist SPA70 (10), we developed 81 SPA70 analogs and evaluated their receptor-binding and cellular activities. Interestingly, analogs with subtle structural differences displayed divergent cellular activities, including agonistic, dual inverse agonistic and antagonistic, antagonistic, and partial agonistic/partial antagonistic activities (as in compounds 111, 10, 97, and 42, respectively). We generated a pharmacophore model that represents 81 SPA70 analogs, and docking models that correlate strong interactions between the compounds and residues in the AF-2 helix with agonistic activity. These compounds are novel chemical tools for studying hPXR.

Discovery and Characterization of the Antimetabolite Action of Thioacetamide-Linked 1,2,3-Triazoles as Disruptors of Cysteine Biosynthesis in Gram-Negative Bacteria

Increasing rates of drug-resistant Gram-negative (GN) infections, combined with a lack of new GN-effective antibiotic classes, are driving the need for the discovery of new agents. Bacterial metabolism represents an underutilized mechanism of action in current antimicrobial therapies. Therefore, we sought to identify novel antimetabolites that disrupt key metabolic pathways and explore the specific impacts of these agents on bacterial metabolism. This study describes the successful application of this approach to discover a new series of chemical probes, N-(phenyl)thioacetamide-linked 1,2,3-triazoles (TAT), that target cysteine synthase A (CysK), an enzyme unique to bacteria that is positioned at a key juncture between several fundamental pathways. The TAT class was identified using a high-throughput screen against Escherichia coli designed to identify modulators of pathways related to folate biosynthesis. TAT analog synthesis demonstrated a clear structure-activity relationship, and activity was confirmed against GN antifolate-resistant clinical isolates. Spontaneous TAT resistance mutations were tracked to CysK, and mode of action studies led to the identification of a false product formation mechanism between the CysK substrate O-acetyl-l-serine and the TATs. Global transcriptional responses to TAT treatment revealed that these antimetabolites impose substantial disruption of key metabolic networks beyond cysteine biosynthesis. This study highlights the potential of antimetabolite drug discovery as a promising approach to the discovery of novel GN antibiotics and the pharmacological promise of TAT CysK probes.

Clobetasol Propionate Is a Heme-Mediated Selective Inhibitor of Human Cytochrome P450 3A5

The human cytochrome P450 (CYP) enzymes CYP3A4 and CYP3A5 metabolize most drugs and have high similarities in their structure and substrate preference. Whereas CYP3A4 is predominantly expressed in the liver, CYP3A5 is upregulated in cancer, contributing to drug resistance. Selective inhibitors of CYP3A5 are, therefore, critical to validating it as a therapeutic target. Here we report clobetasol propionate (clobetasol) as a potent and selective CYP3A5 inhibitor identified by high-throughput screening using enzymatic and cell-based assays. Molecular dynamics simulations suggest a close proximity of clobetasol to the heme in CYP3A5 but not in CYP3A4. UV-visible spectroscopy and electron paramagnetic resonance analyses confirmed the formation of an inhibitory type I heme-clobetasol complex in CYP3A5 but not in CYP3A4, thus explaining the CYP3A5 selectivity of clobetasol. Our results provide a structural basis for selective CYP3A5 inhibition, along with mechanistic insights, and highlight clobetasol as an important chemical tool for target validation.

KANSL2 and MBNL3 are regulators of pancreatic ductal adenocarcinoma invasion

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal forms of cancer. One major reason for this is that PDAC quickly metastasizes to other organs, thereby making its treatment difficult. The molecular machinery driving PDAC metastasis is still poorly understood. In this study, we applied an unbiased approach using CRISPR screening to identify genes that strongly regulate invasion (based on an in vitro assessment of their metastatic potential) in PANC-1, a PDAC cell line. Through CRISPR screening, we identified MBNL3 and KANSL2 as strong regulators of invasion in PANC-1 cells. We further validated MBNL3 and KANSL2 as regulators of PANC-1 cell invasion by using the doxycycline-inducible shRNA system. We also showed that MBNL3 and KANSL2 do not affect cell proliferation. Through our efforts, we have established a process to identify genes that regulate cell invasion and can be further investigated as potential targets for therapeutic intervention.

Structural Perspectives of the CYP3A Family and Their Small Molecule Modulators in Drug Metabolism

Cytochrome P450 enzymes function to catalyze a wide range of reactions, many of which are critically important for drug response. Members of the human cytochrome P450 3A (CYP3A) family are particularly important in drug clearance, and they collectively metabolize more than half of all currently prescribed medications. The ability of these enzymes to bind a large and structurally diverse set of compounds increases the chances of their modulating or facilitating drug metabolism in unfavorable ways. Emerging evidence suggests that individual enzymes in the CYP3A family play discrete and important roles in catalysis and disease progression. Here we review the similarities and differences among CYP3A enzymes with regard to substrate recognition, metabolism, modulation by small molecules, and biological consequence, highlighting some of those with clinical significance. We also present structural perspectives to further characterize the basis of these comparisons.

Strategies for developing pregnane X receptor antagonists: Implications from metabolism to cancer

Pregnane X receptor (PXR) is a ligand-activated nuclear receptor (NR) that was originally identified as a master regulator of xenobiotic detoxification. It regulates the expression of drug-metabolizing enzymes and transporters to control the degradation and excretion of endobiotics and xenobiotics, including therapeutic agents. The metabolism and disposition of drugs might compromise their efficacy and possibly cause drug toxicity and/or drug resistance. Because many drugs can promiscuously bind and activate PXR, PXR antagonists might have therapeutic value in preventing and overcoming drug-induced PXR-mediated drug toxicity and drug resistance. Furthermore, PXR is now known to have broader cellular functions, including the regulation of cell proliferation, and glucose and lipid metabolism. Thus, PXR might be involved in human diseases such as cancer and metabolic diseases. The importance of PXR antagonists is discussed in the context of the role of PXR in xenobiotic sensing and other disease-related pathways. This review focuses on the development of PXR antagonists, which has been hampered by the promiscuity of PXR ligand binding. However, substantial progress has been made in recent years, suggesting that it is feasible to develop selective PXR antagonists. We discuss the current status, challenges, and strategies in developing selective PXR antagonists. The strategies are based on the molecular mechanisms of antagonism in related NRs that can be applied to the design of PXR antagonists, primarily driven by structural information.

Genome-wide CRISPR screen reveals PSMA6 to be an essential gene in pancreatic cancer cells

BACKGROUND

Despite its relatively low incidence, pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer deaths because of the aggressive growth/metastasis of the tumor, the lack of early symptoms, and the poor treatment options. Basic research to identify potential therapeutic targets for PDAC is greatly needed.

METHODS

We used a negative-selection genome-wide CRISPR screen to identify essential genes in the PANC-1 human pancreatic carcinoma cell line. We validated the top hits with follow-up siRNA screens, using the HPNE, HPAF-II, AsPC-1, and Mia PaCa-2 cell lines.

RESULTS

The PSMA6 gene was an identified candidate hit after the CRISPR screen, siRNA validation screen, and siRNA deconvolution screen. Spheroid formation assays and flow cytometry analysis showed that PSMA6 is critical for survival in many pancreatic ductal carcinoma cell models. Lastly, as PSMA6 protein is a proteosomal subunit of the 20S core complex, we showed that bortezomib, a proteasome inhibitor, was especially toxic in PANC-1 cells.

CONCLUSIONS

Further study of PSMA6 and the proteasome subunit that it encodes, along with other hits identified in our CRISPR screens, may provide valuable insights into potential therapeutic targets for PDAC.

RNA interference screen identifies NAA10 as a regulator of PXR transcription

The pregnane X receptor (PXR) is a principal xenobiotic receptor crucial in the detection, detoxification, and clearance of toxic substances from the body. PXR plays a vital role in the metabolism and disposition of drugs, and elevated PXR levels contribute to cancer drug resistance. Therefore, to modulate PXR activity and mitigate drug resistance, it is imperative to fully understand its regulation. To this end, we screened a transcription factor siRNA library in pancreatic cancer cells that express high levels of PXR. Through a comprehensive deconvolution process, we identified N-alpha-acetyltransferase 10 (NAA10) as a factor in the transcriptional machinery regulating PXR transcription. Because no one single factor has 100% operational control of PXR transcriptional regulation, our results together with other previous findings suggest that the transcriptional regulation of PXR is complex and that multiple factors contribute to the process including NAA10.

CINPA1 binds directly to constitutive androstane receptor and inhibits its activity

The constitutive androstane receptor (CAR) and pregnane X receptor (PXR) are xenobiotic sensors that regulate the expression of drug-metabolizing enzymes and efflux transporters. CAR activation promotes drug elimination, thereby reducing therapeutic effectiveness, or causes adverse drug effects via toxic metabolites. CAR inhibitors could be used to attenuate these adverse drug effects. CAR and PXR share ligands and target genes, confounding the understanding of the regulation of receptor-specific activity. We previously identified a small-molecule inhibitor, CINPA1, that inhibits CAR (without activating PXR at lower concentrations) by altering CAR-coregulator interactions and reducing CAR recruitment to DNA response elements of regulated genes. However, solid evidence was not presented for the direct binding of CINPA1 to CAR. In this study, we demonstrate direct interaction of CINPA1 with the CAR ligand-binding domain (CAR-LBD) and identify key residues involved in such interactions through a combination of biophysical and computational methods. We found that CINPA1 resides in the ligand-binding pocket to stabilize the CAR-LBD in a more rigid, less fluid state. Molecular dynamics simulations, together with our previously reported docking model, enabled us to predict which CAR residues were critical for interactions with CINPA1. The importance of these residues for CINPA1 binding were then validated by directed mutations and testing the mutant CAR proteins in transcription reporter and coregulatory interaction assays. We demonstrated strong hydrogen bonding of CINPA1 with N165 and H203 and identified other residues involved in hydrophobic contacts with CINPA1. Overall, our data confirm that CINPA1 directly binds to CAR.

Transcription factor ZNF148 is a negative regulator of human muscle differentiation

Muscle differentiation is a complex process in which muscle progenitor cells undergo determination and eventually cellular fusion. This process is heavily regulated by such master transcription factors as MYOD and members of the MEF2 family. Here, we show that the transcription factor ZNF148 plays a direct role in human muscle cell differentiation. Downregulation of ZNF148 drives the formation of a muscle phenotype with rapid expression of myosin heavy chain, even in proliferative conditions. This phenotype was most likely mediated by the robust and swift upregulation of MYOD and MEF2C.

Differential Regulation of CYP3A4 and CYP3A5 and its Implication in Drug Discovery

BACKGROUND

Cancer cells use several mechanisms to resist the cytotoxic effects of drugs, resulting in tumor progression and invasion. One such mechanism capitalizes on the body's natural defense against xenobiotics by increasing the rate of xenobiotic efflux and metabolic inactivation. Xenobiotic metabolism typically involves conversion of parent molecules to more soluble and easily excreted derivatives in reactions catalyzed by Phase I and Phase II drug metabolizing enzymes.

METHODS

We performed a structured search of peer-reviewed literature on P450 (CYP) 3A, with a focus on CYP3A4 and CYP3A5.

RESULTS

Recent reports indicate that components of the xenobiotic response system are upregulated in some diseases, including many cancers. Such components include the pregnane X receptor (PXR), CYP3A4 and CYP3A5 enzymes. The CYP3A enzymes are a subset of the numerous enzymes that are transcriptionally activated following the interaction of PXR and many ligands.

CONCLUSION

Intense research is ongoing to understand the functional ramifications of aberrant expression of these components in diseased states with the goal of designing novel drugs that can selectively target them.

Increasing exfiltration from pervious concrete and temperature monitoring

Pervious concrete typically has an infiltration rate far exceeding any expectation of precipitation rate. The limiting factor of a retention based pervious concrete system is often defined by how quickly the underlying soil subgrade will infiltrate the water temporarily stored within the concrete and/or aggregate base. This issue is of particular importance when placing a pervious concrete system on compacted fine textured soils. This research describes the exfiltration from twelve pervious concrete plots constructed on a compacted clay soil in eastern Tennessee, USA. Several types of treatments were applied to the clay soil prior to placement of the stone aggregate base and pervious concrete in an attempt to increase the exfiltration rate, including: 1) control--no treatment; 2) trenched--soil trenched and backfilled with stone aggregate; 3) ripped--soil ripped with a subsoiler; and 4) boreholes--placement of shallow boreholes backfilled with sand. The average exfiltration rates were 0.8 cm d(-1) (control), 4.6 cm d(-1) (borehole), 10.0 cm d(-1) (ripped), and 25.8 cm d(-1) (trenched). The trenched treatment exfiltrated fastest, followed by the ripped and then the borehole treatments, although the ripped and borehole treatments were not different from one another at the 5% level of significance. The internal temperature of the pervious concrete and aggregate base was monitored throughout the winter of 2006-2007. Although the temperature of the pervious concrete dropped below freezing 24 times, freezing concrete temperatures never coincided with free water being present in the large pervious concrete pores. The coldest recorded air temperature was -9.9 degrees C, and the corresponding coldest recorded pervious concrete temperature was -7.1 degrees C. The temperature of the pervious concrete lagged diurnal air temperature changes and was generally buffered in amplitude, particularly when free water was present since the addition of water increases the thermal capacity of the pervious concrete greatly. The temperature of the aggregate base was further buffered to diurnal changes, and no freezing temperatures were recorded.

Fentanyl for epidural intravascular test dose in obstetrics

BACKGROUND AND OBJECTIVES

Although dizziness and drowsiness may be produced with either intravenous or epidural fentanyl, their occurrence after an intravenous injection is more rapid and relatively more pronounced. The purpose of this study was to determine whether or not the difference between routes of administration would be a reliable method of detecting an accidental intravascular injection.

METHODS

In part 1, using a double-blinded protocol, we prospectively assessed in laboring women the incidence of dizziness, drowsiness, or both associated with intravenous fentanyl (100 micrograms). In random order, subjects received two peripheral intravenous injections: 2 ml of fentanyl and 2 ml of saline, separated by a 3-minute observation period.

RESULTS

In group 1 (18/18) and group 2 (22/22), all subjects reported a response to intravenous fentanyl within the one-minute assessment. In part 2, we evaluated in laboring patients the frequency of dizziness, drowsiness, or both to epidural fentanyl (100 micrograms). The study design was identical to part 1; however, the subjects received 2 ml of fentanyl and 2 ml of saline via a functional epidural catheter. In group 3 (1/18) and group 4 (1/22), one subject reported a response to epidural fentanyl within the 3-minute observation period.

CONCLUSIONS

Overall, the responses to intravenous fentanyl (40/40) occurred in a remarkably more consistent fashion when compared to epidural fentanyl (2/40). Thus, the results suggest that in laboring patients, intravenous fentanyl produces predictable and easily detectable changes that may be useful in identifying an epidural catheter unintentionally placed intravascularly.

Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine

The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.

Unrecognized thrombocytopenia and regional anesthesia in parturients: a retrospective review

Charts from 2929 consecutive parturients were reviewed. Twenty-four had platelet counts less than 100,000/microL in the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven had asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/microL) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.

Management of Root-knot Nematodes by Phenamiphos Applied through an Irrigation Simulator with Various Amounts of Water

Phenamiphos (6.7 kg a.i./ha) was applied via an irrigation simulator to squash at planting (AP) and 2 weeks after planting (PP), and to corn AP and 1 week PP to manage root-knot nematodes (Meloidogyne incognita). The nematicide was applied with 0.25, 0.64, 1.27, and 1.91 cm surface water/ ha to a Lakeland sand in which the soil moisture was at or near field capacity. Based on efficacy and crop response, no additional benefits resulted when phenamiphos was applied in volumes of water greater than 0.25 crn/ha. The cost of applying each 0.25 cm of water over a hectare is approximately $1.08, or a 92% reduction in nematicide application cost over conventional methods ($13.50/ha). Low root-gall indices and high yields from squash and corn indicate more effective nematode management when phenamiphos was applied AP rather than PP. Results from this method of applying phenamiphos suggest that certain nematicides could be used as salvage alternatives when nematodes are detected in crops soon after planting. For multiple-pest management, nematicides, other compatible biocides, and fertilizers could be applied simultaneously with sprinkler irrigation.

Cryptococcosis in the acquired immunodeficiency syndrome

The clinical course and response to therapy of 27 patients with cryptococcosis and the acquired immunodeficiency syndrome were reviewed. Cryptococcosis was the initial manifestation of the syndrome in 7 patients, and the initial opportunistic infection in an additional 7. Meningitis was the commonest clinical feature (18 patients). Blood cultures and serum cryptococcal antigen were frequently positive. In patients with meningitis, leukocyte count, protein level, and glucose level in cerebrospinal fluid were frequently normal; cerebrospinal fluid India ink test (82%), culture (100%), and cryptococcal antigen (100%) were usually positive. Only 10 of 24 patients had no evidence of clinical activity of cryptococcal infection after completion of therapy; 6 of these 10 had relapses shown by clinical findings or at autopsy. Standard courses of amphotericin B alone or combined with flucytosine were ineffective. Cryptococcosis in patients with the syndrome is a debilitating disease that does not respond to conventional therapy; earlier diagnosis or long-term suppressive therapy may improve the prognosis.

Influence of water and soil temperature on the concentration and efficacy of phenamiphos for control of root-knot nematodes

Field plots of Tifton loamy sand were treated with phenamiphos for control of root-knot nematodes in a multiple-crop system of turnips, field corn, and southern peas. Preplant applications of phenamiphos protected roots of turnips and corn from damage by root-knot nematodes. Concentrations of phenamiphos at application in the 0-15-cm soil layer were near 6 mug/g on turnips and near 4 mug/g on corn and southern peas. After 30 d, concentrations were approximately 1 mug phenamiphos/g of soil for all crops. Concentrations of 2.0-3.8 mug phenamiphos/g of soil for 9-d duration appeared to be adequate for control of root-knot nematodes on field corn and southern peas in this multiple-crop system. Stepwise regression analyses indicated that 31%, 62%, and 22% of the variations in concentration of phenamiphos in the soil planted to turnips, corn, and southern peas, respectively, were attributable to the amount of water that the plots received. Soil temperature had no effect on concentrations of phenamiphos.

Distinction of seventy-one cultured human tumor cell lines by polymorphic enzyme analysis

A large collection of cultured human tumor cell lines was characterized for the phenotypes of 16 polymorphic enzyme loci: ACP1, ADA, AK1, ESD, FUCA, GLO1, GOT2, G6PD, ME2, PEPA, PEPB, PEPC, PEPD, PGD, PGM1, and PGM3 primarily to detect and monitor against cell line contamination. Among 100 highly characterized cell lines, 59 lines from different patients and 6 pairs of lines (each pair from the same patient's tumor) had unique phenotype combinations and were therefore presumed to be authentic, uncontaminated cell lines. Besides these 71 lines, the remaining 29 lines consisted of several small groups of two to three lines, each group having a different combination and being among the more frequent in the normal population. The 29 lines, therefore, were not suspected to be contaminants. Among unusual findings were the ME2 1 plus 2 phenotype determined for two bladder tumor lines, a G6PD A phenotype found in a line of Caucasian origin determined not to be a HeLa contaminant, and asymmetrical heterozygous phenotypes in several lines. Except for kidney tumor lines, there was no correlation of adenosine deaminase tissue isoenzymes between tumor lines and normal tissues of origin. For several enzymes significant deviations were found in proportions of the phenotypes observed in Caucasian cell lines from expected proportions on the basis of normal population data, indicating possible natural selection among these lines in tissue culture or among the patients of origin.

Two relative efficiencies of polymorphic enzymes for characterizing cell lines, detecting contaminations, and monitoring transplants

A new calculation of the relative efficiency of polymorphic enzyme markers, called the REB, was determined and compared with one of Fisher's determinations of the relative efficiency called REA here. The REA estimates the chance of failing, and 1-REA of succeeding, to show a phenotypic difference between two randomly selected persons or cultured cell lines (Case 1). In this study it was shown that the REA also estimates the chance of detecting a cell line mislabeling or similar mixup (Case 2) and a cell line cross-contamination leading to the complete replacement of an original line by contaminating line (Case 3). The new REB determines the probability of failing, and 1 - REB of succeeding, to detect a contamination of an original line by another line leading to their coexistence, or at least a sufficiently long period of transitional coexistence before one overgrows the other. The REA and REB also apply to determining the efficiency of polymorphic markers in detecting donor and recipient cells in tissue transplants.

High rate of sister chromatid exchanges of Bloom's syndrome chromosomes is corrected in rodent human somatic cell hybrids

The high rate of sister chromatid exchange (SCE) characteristic of cultured somatic cells from patients with Bloom's syndrome (BS) was found to be fully corrected in BS chromosomes retained by somatic cell hybrids between Chinese hamster cells (CHO-YH 21) and BS fibroblasts (GM 1492), independent of the type and the number of human chromosomes retained. On the contrary, the average rate of SCE per Chinese hamster chromosome remained unaffected by hybridization with both BS and normal human cells. A partial suppression of SCE of about 30% was observed in the BS cells themselves when these were co-cultivated with Chinese hamster/Bloom's syndrome hybrid cells. In these hybrids, the rate of SCE per chromosome (Chinese hamster or human) was unaffected by co-cultivation. The data reported indicate that the high rate of SCE in BS cells must be considered to be the consequence of a lost normal function, rather than the acquisition of a new abnormal one, and that several independent genetic systems may be involved in the control of SCE during the replication of mammalian cells. Accordingly, the high rate of SCE in a cultured cell line or an individual should be looked upon as the common phenotype resulting from mutation(s) at any one of these systems. The occurrence of genetic complementation for SCE across the species barrier suggests that at least some of these genetic systems are homologous in different mammalian species and emphasizes the potential(s) of somatic cell hybridization for studying the biology of SCE, in general, and the genetics of Bloom's syndrome, in particular.

Detection and analysis of a glucose 6-phosphate dehydrogenase phenotype B cell line contamination

Eight of approximately 100 cell lines derived at the Scott and White Clinic from human solid tumors were found to have the same phenotypes when analyzed for 15 polymorphic enzymes at the Sloan-Kettering Institute for Cancer Research. These data were confirmed at the M. D. Anderson Hospital and Tumor Institute. The similarity was supported by cytogenetic studies at both institutions. The chronology of the establishment of these cell lines and isoenzyme and cytogenetic studies indicated that six of these lines have cross cell contamination. These include SW-527 and SW-613 mammary carcinomas, SW-598 meningioma, SW-608 astrocytoma, SW-732 cervix carcinoma, and SW-733 bladder carcinoma. Our data supported the authenticity of SW-480 and SW-620, which were derived from a colon carcinoma and its metastasis, respectively, from the same patient.

Absence of HeLa cell contamination in 169 cell lines derived from human tumors

Numerous cell lines derived from human tumors are not HeLa contaminants. Of 192 lines established in this or other laboratories, 169 lines were found to be G6PD type B. Twenty-three lines were type A as HeLa; three of these were of Negroid origin. There is reasonable doubt that the remaining 20 lines will all be shown to be confounded with HeLa.

Partial DiGeorge syndrome with substantial cell-mediated immunity

Results of studies on two male infants with incomplete expression of the DiGeorge syndrome are analyzed. Both infants demonstrated neonatal tetany with hypoparathyroidism, cardiovascular anomalies, and absence of a thymus shadow on roentgenographic examination. Some degree of cellular immunity was present in both infants, however, including normal in vitro responses to phytohemagglutinin, thus postponing attempts at thymus transplantation. Both infants died suddenly at home, one at age 7 1/2 weeks and the other at age 44 weeks. At autopsy, no thymus was found in one, and a 2x2-mm thymus was detected after extensive search in the other. These cases emphasize the need for repeated monitoring of all immunologic measurements in the partial DiGeorge syndrome, so that early therapeutic intervention can be undertaken.

Decreased bactericidal activity of leukocytes of stressed newborn infants

Previous studies have established that leukocyte phagocytosis and intracellular killing are normal in term and low-birthweight newborns who are well. To determine the effect of stress or illness on newborn leukocyte function, the phagocytic and bactericidal activity of leukocytes from 40 sick newborns was compared with that of leukocytes from 12 newborns and 23 normal adults. To eliminate abnormal phagocytosis resulting from serum opsonic defects in newborn sera, pooled adult sera were used in all assays. Twenty-five of the 40 stressed newborns (63%) had decreased in vitro activity against either Staphylococcus aureus 502A or Escherichia coli, or both, compared with decreased activity in two of 12 well infants (17%) and in four of 23 adult controls (17%). The mean bactericidal activity (percentage of organisms killed after two hours) of leukocytes from stressed newborns against S. aureus (83% +/- 2 [SEM]) and E. coli. (87% +/- 4 [SEM]) was significantly less than in the combined well infant and adult control group (94% +/- 1 for S. aureus and 97% +/- .5 for E. coli). Although the more severely ill infants had an increased incidence of impaired antibacterial activity, the degree of impairment was not related to the severity of illness. No consistent relationship of decreased activity to birthweight, gestational age, age when studied, or specific diagnosis was seen. The leukocyte abnormality in stressed infants against S. aureus was principally a killing defect, while against E. coli both phagocytosis and killing were abnormal. This study indicates that a wide variety of neonatal disorders may affect one or more of the steps required for normal bacterial killing. The lability of leukocytic antibacterial function under stress is an additional mechanism for the newborn's increased susceptibility to infection.