Correlation between serum cytokines and clinicopathological features in patients with drug-induced liver injury

Objectives: Changes in serum levels of cytokines have been proposed as possible biological markers of tissue damage, including drug-induced liver injury (DILI). Here, we aimed to screen cytokine markers that have guiding significance for the degree of inflammation of DILI. Patients and methods: 54 patients with DILI were retrospectively analyzed as the experimental group, and 14 healthy subjects were randomly selected as the control group. A total of 20 cytokines were detected by using a cytokine protein antibody chip, and differentially expressed proteins were screened. Results: There were significant differences in serum cytokines between DILI patients and healthy controls. Compared with the control group, the DILI group expressed 11 differential proteins. IL-8, TNF RII, TNFα, TNF RI, MIP-1β, MIP-1α, and IL-1β were differentially expressed in DILI patients with different degrees of inflammation from G1 to G4. MIG, IL-12p40, and IL-10 were differentially expressed in the higher degree of inflammation groups (G2, G3, and G4 groups). Tissue inhibitor of metalloproteinases-1 (TIMP-1) was differentially expressed in the group with the highest inflammation degree (G4 group). Chemokine C-C motif ligand 1 (I-309) was only differentially expressed in the lowest inflammation group (G1 group). Conclusion: The changes and differential expression of specific cytokine levels were helpful for evaluating different degrees of inflammation of DILI.

[Pollution Characteristics and Source Apportionment of Atmospheric Volatile Organic Compounds in Summer in Yuncheng City]

Based on the online monitoring data of VOCs, O₃, and NO₂ in Yuncheng City from June to August 2020, the pollution characteristics of VOCs in Yuncheng City in summer were analyzed. At the same time, the main emission sources were determined using a PMF model, and the chemical reactivity of VOCs was evaluated using the maximum incremental reactivity (MIR) method and fractional aerosol coefficients (FAC). The results showed that the urban area of Yuncheng was seriously polluted by VOCs and NO₂ in the early morning and evening during summer, the peak value of VOCs daily variation occurred at 08:00 and 20:00, respectively, and was mainly affected by the morning and evening peaks in traffic. The ρ(VOCs) from June to August was 50.52 μg·m^-3, and the species with the highest proportion were alkanes (39.39%) and oxygenated volatile organic compounds (OVOCs, 34.63%). Five VOCs emission sources were determined by the PMF model, of which the largest contribution was from motor vehicle exhaust emission sources (33.10%), followed by industrial emission sources (29.46%), natural gas and coal combustion sources (17.31%), solvent use sources (11.94%), and plant emission sources (8.19%). Controlling motor vehicle exhaust emission sources is the key to alleviate VOCs pollution in summer in Yuncheng City. The average ozone formation potential (OFP) of VOCs was 162.88 μg·m^-3, in which OVOCs had the highest contribution rate (45.37%); acetaldehyde, propionaldehyde, ethylene, isoprene, and toluene were the key active components; and industrial emission sources were the emission sources with the highest contribution rate. The average value of secondary organic aerosol formation potential (SOA_p) of VOCs was 0.40 μg·m^-3, in which the contribution rate of aromatic hydrocarbons was the highest (88.00%), and the solvent use source was the emission source with the highest contribution rate.

[Spatiotemporal Distribution and Seasonal Characteristics of Regional Transport of PM2.5 in Yuncheng City]

The spatiotemporal distribution characteristics of PM_2.5 pollution in Yuncheng City were analyzed based on the ambient air quality monitoring data from March 2019 to February 2020, and the hybrid single-particle Lagrangian integrated trajectory (HYSPLIT) and cluster analysis were used to discuss the contamination transportation pathway and the distribution of potential pollution sources affecting PM_2.5 in Yuncheng City in different seasons. The results showed that the PM_2.5 concentration in Yuncheng was the highest in winter (111.24 μg·m^-3) and the lowest in summer (30.02 μg·m^-3). PM_2.5/PM₁₀ was greater than 0.6 in autumn and winter, indicating that the particulate matter pollution in Yuncheng City in autumn and winter was mainly fine particulate matter; spatially, the annual mean value of PM_2.5 presented distribution characteristics that were high in the northern and central regions and low in the eastern and western regions. The high-value areas of PM_2.5 were significantly and strongly correlated with SO₂, NO₂, and CO, indicating that local emissions contributed to the high values. The highest values in spring and winter were located in Hejin City (58.50 μg·m^-3) and Jishan County (142.33 μg·m^-3), and the highest values in summer and autumn were located in Pinglu County (36.92 μg·m^-3) and the Salt Lake area (62.94 μg·m^-3), respectively. Transportation analysis showed that spring and winter were mainly affected by air masses transporting northwestward, accounting for 58.69% and 55.77%. In summer, air masses were mainly eastward and southward, and in autumn, pollution was from short-distance transport air masses from southwestern Henan. The largest ratio was 32.89%; the potential source area was the smallest in spring and summer; it then began to grow in autumn, and it was the widest in the winter and had the highest contribution. The main source area in spring and summer was located in western and central Henan, and in autumn and winter, source areas were concentrated at the junction of Shaanxi, Shanxi, and Henan and west of Shaanxi.

Herb-induced autoimmune-like hepatitis associated with Xiang-tian-guo (Swietenia macrophylla seeds): A case report and literature review

RATIONALE

Drug-induced liver injury (DILI) has a relatively low incidence, whereas the incidence of herb-induced liver injury (HILI) is still under investigation. As a special type of DILI, the diagnosis of drug-induced autoimmune-like hepatitis presents a persistent challenge, because this condition has partial characteristics of both DILI and autoimmune hepatitis (AIH), such as a certain history of medication use and histology that similar is to AIH. Thus, the differential diagnosis between DILI and AIH can be confusing.

PATIENT CONCERNS

A 67-year-old woman taking xiang-tian-guo for 6 months was admitted to our hospital with a complaint of experiencing jaundice for 2 weeks.

DIAGNOSIS

A liver biopsy exhibited interface inflammation, foam cells, and "rosette" -like hepatocytes. She was diagnosed with herb-induced liver injury (hepatocellular and acute), a RUCAM score of 7 (probable), a severity for grade 4 liver injury, and accompanied autoimmune-like changes.

INTERVENTIONS

The patient was instructed to cease the administration of suspicious drugs. The patient also received liver protection and albumin transfusion.

OUTCOMES

After 25 days of hospitalization, the patients aminotransferase levels returned to normal. No recurrence was observed after the administration of the treatments and a close follow-up.

LESSONS

We must to be vigilant about the safety of xiang-tian-guo as a herbal medicine. When faced with the difficulty of distinguishing between AIH and DILI, long-term follow-up observations for recurrence can aid clinicians in making a judgment.

A Novel Strategy to Fabricate Cation-Cross-linked Graphene Oxide Membrane with High Aqueous Stability and High Separation Performance

Graphene oxide (GO) membranes have shown enormous promise in desalination and molecular/ionic sieving. However, the instability of GO membranes in aqueous solutions seriously hinders their practical applications. Herein, we report a novel and simple strategy to fabricate stable GO membranes in water-based environments through the insertion of various metal cations from metal foils (e.g., copper (Cu), iron (Fe), nickel (Ni), and zinc (Zn) foils) and natural deposition. Based on the cation-π, coordination, and electrostatic interaction between metal cations and GO nanosheets, the aqueous stability and mechanical strength of the membranes are significantly improved. The permeation rates for acetone, toluene, and p-xylene molecules across the GO membrane cross-linked by copper ions with a deposition time of 24 h are 0.966, 0.074, and 0.100 mol m^-2 h^-1, respectively. Moreover, this membrane displays excellent separation performance, and the separation factor of K⁺/Mg²⁺ is up to 68.8 in mono-/multivalent metal cation sieving, which indicate the effective molecular/ionic sieving performance. Meanwhile, the ionic sieving of the GO membrane cross-linked by copper ions has excellent repeatability and long-term stability. The versatility of this natural deposition strategy to fabricate GO membranes cross-linked by metal cations is investigated by using Fe foil, Zn foil, and Ni foil as well as other porous substrates such as polyvinylidene fluoride (PVDF), polyethersulfone (PES), and nylon membranes and filter paper. This fabrication strategy also enables low-cost preparation of large-area GO membranes. Therefore, GO membranes cross-linked by metal cations and prepared by this simple metal cation incorporation strategy have large potential application for molecular/ionic sieving in various solution systems.

[Clinical factors of pathological complete response after neoadjuvant chemoradiotherapy in rectal cancer]

Objective: To explore the feasibility of clinical factors to predict the pathological complete response after neoadjuvant chemoradiotherapy in rectal cancer. Methods: A retrospective analysis was performed on clinical factors of 162 patients with rectal cancer, who underwent neoadjuvant chemoradiotherapy in the General Hospital of People's Liberation Army from January 2011 to December 2018.According to the postoperative pathological results, the patients were divided into pathological complete response (pCR) group and non-pathological complete response group (non-pCR group) to check the predictive clinical factors for pCR. Results: Twenty-eight cases achieved pCR after neoadjuvant chemoradiation (17.3%, 28/162). Univariate analysis showed that patients with higher differentiation (P=0.024), tumor occupation of the bowel lumen≤1/2 (P=0.006), earlier clinical T stage (P=0.013), earlier clinical N stage (P=0.009), the time interval between neoadjuvant chemoradiotherapy and surgery>49 days (P=0.006), and maximum tumor diameter≤5 cm (P=0.019) were more likely to obtain pCR, and the differences werestatistically significant. Multivariate analysis showed that tumor occupation of the bowel lumen≤1/2 (P=0.01), maximum tumor diameter≤5 cm (P=0.035), and the interval>49 days (P=0.009) were independent factors in predicting pCR after neoadjuvant therapy. Conclusion: Tumor occupation of the bowel lumen, maximum tumor diameter, and the time interval between neoadjuvant chemoradiotherapy and surgery can predict the pCR in rectal cancer.

Primary sclerosing cholangitis with increased immunoglobulin G4 levels: A case report

RATIONALE

Primary sclerosing cholangitis (PSC) is recognized as an autoimmune-mediated liver disease characterized by progressive biliary inflammation and fibrosis. Some PSC cases with elevated immunoglobulin G4 (IgG4) levels are likely to be misdiagnosed with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC). Thus, distinguishing these 2 diseases is particularly important.

PATIENT CONCERNS

A 34-year-old male presented with right hypochondrium abdominal intermittent pain and jaundice lasting for 1 month. Here, we present a case of PSC with increased IgG4 levels with improvement of quality of life upon liver transplantation (LT).

DIAGNOSIS

The diagnosis of PSC was confirmed based on clinical symptoms, laboratory test results, imaging findings, pathologic results and a lack of response to steroid therapy.

INTERVENTIONS

LT surgery was performed successfully when his vital parameters were stabilized. Immunosuppressive agents were routinely used after LT.

OUTCOMES

Three years after LT, liver function values show that alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were in the normal range. An abdominal ultrasonography showed no obvious abnormalities.

LESSONS

There are similar biochemical characteristics and cholangiographic findings between PSC and IgG4-SC. Therefore, distinguishing these 2 diseases is particularly important. LT remains the only option for end-stage PSC. Early diagnosis and effective treatment can achieve a good prognosis.

Mutation in PHKA2 leading to childhood glycogen storage disease type IXa: A case report and literature review

INTRODUCTION

Glycogen storage disease (GSD) type IX, characterized by liver enlargement and elevated aminotransferase levels, is the most frequent type of GSD. The global incidence of GSD type IXa is only about 1/100,000 individuals. Case reports of GSD type IX are rare in China. We present the first case report of GSD type IXa in Northeast China caused by mutation of PHKA2.

PATIENT CONCERNS

An 11-year-old boy was referred to our hospital because of liver enlargement with consistently elevated transaminase levels over 6 months.

DIAGNOSIS

Histopathological results following an ultrasound-guided liver biopsy confirmed a diagnosis of GSD. Further genetic testing showed that the patient had GSD type IXa caused by the c.133C>T mutation in PHAK2.

INTERVENTIONS

We placed the patient on a high-protein and high-starch diet and provided hepatoprotective and supportive therapy.

OUTCOMES

The patient's transaminase levels decreased significantly and were nearly normal at 10-month follow-up.

CONCLUSION

This is the first reported case of GSD type IXa in Northeast China. We hope that the detailed and complete report of this case will provide a reference for the diagnosis of liver enlargement of unknown etiology in future clinical practice.

Liver failure associated with benzbromarone: A case report and review of the literature

BACKGROUND

Benzbromarone is a uricosuric agent that reduces proximal tubular reabsorption of uric acid. Because of hepatotoxicity, it has been withdrawn from the market in Europe. Recently, some benefit-risk assessments of benzbromarone suggest that benzbromarone has greater benefits than risks, and the application of benzbromarone in the treatment of gout and hyperuricemia is still under debate.

CASE SUMMARY

A 39-year-old man was admitted to the hospital for icterus and nausea, and he was treated with benzbromarone (100 mg/d) for 4 mo because of hyperuricemia. He had a 10-year history of beer drinking (alcohol: about 28 g/d). Laboratory data showed severe liver injury and serious coagulation dysfunction; tests for autoimmune antibodies, viral hepatitis, and human immunodeficiency virus were negative. Despite administration of liver function-protecting drugs and efficient supportive treatment, the patient deteriorated quickly after hospitalization and developed grade II encephalopathy within a few days. The patient accepted continuous plasma exchange six times; however, his condition did not improve. Based on suggestions from multidisciplinary consultation, the patient underwent liver transplantation 26 d after admission. Liver specimen pathology results showed massive necrosis consistent with drug-induced liver injury, supporting the diagnosis of acute liver failure associated with benzbromarone. The patient recovered quickly thereafter.

CONCLUSION

This case highlights that clinicians should be on the alert for the severe hepatotoxicity of benzbromarone. Before prescribing benzbromarone, physicians should evaluate the high-risk factors that may lead to liver injury and provide suggestions for monitoring benzbromarone's hepatotoxicity during treatment.

Nanocomposite Hydrogels with Optic-Sonic Transparency and Hydroacoustic-Sensitive Conductivity for Potential Antiscouting Sonar

In this paper, we report on the design and simple fabrication of novel nanocomposite hydrogels with optic-sonic transparency and hydroacoustic-sensitive conductivity. The proposed nanocomposite hydrogels are constructed by poly( N, N-dimethylacrylamide) and exfoliated Laponite clay nanosheets via free radical polymerization. With lithium chloride (LiCl) as ionic additives inside the polymeric networks of the hydrogels, the lithium cations (Li⁺) could be stored on and in the clay nanosheets owing to the electrostatic adsorption and cation exchange. Triggered by hydroacoustic wave oscillation, the stored Li⁺ ions could escape from the clay nanosheets, resulting in the augmentation of ionic concentration inside the polymeric networks and thus the increase of the conductivity of the nanocomposite hydrogel. Inversely, upon removing the hydroacoustic signals, the Li⁺ ions could be readsorbed again by the clay nanosheets; as a result, the conductivity of the nanocomposite hydrogel decreases again. Moreover, the fabricated nanocomposite hydrogels also feature high stretchability and spliceable and antifreezing properties. Such novel nanocomposite hydrogels are highly promising for development of systems for camouflaging and sensing sonar scanning.

Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report

BACKGROUND

Twenty percent of patients infected with hepatitis B virus (HBV) develop extrahepatic manifestations with HBV detected in the lymph nodes, spleen, bone marrow, kidneys, and skin. HBV infection has been associated with some autoimmune disorders. Dermatomyositis (DM) is an idiopathic inflammatory myopathy, which involves a viral infection, and DM has been identified in patients infected with HBV, but there is no direct histological evidence for an association between HBV and DM.

CASE SUMMARY

We describe a familial HBV-infected patient admitted with liver function abnormality, rashes, a movement disorder, and an elevated level of creatine kinase (CK). A computed tomography scan of the lung showed pulmonary fibrosis, and a liver biopsy identified nodular cirrhosis. An electromyogram revealed myogenic damage, and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells. Immunohistochemical staining showed negative results for HBsAg and HBcAg. Fluorescence in situ hybridization showed a negative result for HBV DNA. The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone, mycophenolate mofetil, and lamivudine. Eight months later, the patient was readmitted for anorexia and fatigue. The blood examination showed elevated levels of aminotransferases and HBV DNA, however, the CK level was within the normal range. The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.

CONCLUSION

DM in chronic HBV-infected patients does not always associate with HBV. Antiviral and immunosuppressive drugs should be taken into consideration.

Madelung disease: A case report

RATIONALE

Madelung disease (MD), a rarely reported disease, also known as benign symmetric lipomatosis, a disorder resulting from alcoholic abuse. It's largely under-recognized and under-reported, possibly because of unawareness of the condition by physicians.

PATIENT CONCERNS

A 45-year-old Chinese man presented with intermittent fatigue and abdominal distension and progressive bilateral breast enlargement. He has been a heavy drinker for ten years before onset of the disease with an average daily alcohol intake of more than 120 g/day.

DIAGNOSIS

Due to the patient's symptoms, laboratory test results, radiographic findings, he was diagnosed with MD.

INTERVENTIONS

We treated him with abstinence from alcohol and supportive therapy.

OUTCOMES

The patient is now in stable condition, with improvement in symptoms during follow-up.

LESSONS

Doctors, confronted with progressive bilateral breast enlargement in a patient with alcoholic liver disease, should be aware of the underreported MD. Recognition of this syndrome could help doctors establish diagnosis and emphasize the importance of alcohol abstinence as the mainstay of management.

Primary biliary cirrhosis with refractory hypokalemia: A case report

RATIONALE

Renal tubular acidosis (RTA) represents a class of metabolic disorders characterized by metabolic acidosis with a normal plasma anion gap. As a rare complication of primary biliary cirrhosis (PBC), RTA is easily overlooked, likely leading to misdiagnosis.

PATIENT CONCERNS

A 32-year-old woman who had been diagnosed with PBC at our hospital was found to have hypokalemia due to repeated fatigue for 2 years, and the etiology was unknown.

DIAGNOSES

Due to the laboratory test results, radiographic findings, and pathologic results, she was diagnosed with PBC associated with RTA.

INTERVENTIONS

She was then treated with ursodeoxycholic acid, potassium citrate, and calcium supplements together with activated vitamin D.

OUTCOMES

Thus far, the patient showed a good response to ursodeoxycholic acid, and the clinical symptoms and liver function were significantly improved.

LESSONS

Physicians that encounter refractory hypokalemia in a patient with PBC should be aware of the presence of RTA. The early diagnosis and treatment of such patients are of paramount importance to alleviate clinical symptoms and delay disease progression.

[HBV genotyping based on key epitopes of PreS1 antigen and its correlation with genotyping by full-length PreS1 sequencing]

Objective: The aim was to investigate the genotype distribution of two major epitopes of large surface protein (PreS1) of hepatitis B in Chinese patients and to explore the association between the genotypes of these two epitopes, and to determine whether PreS1 full-length genotype could be revealed according to the polypeptide sequence of key epitopes. Methods: HBV DNA was extracted from the serum of patients for PCR amplification. 278 samples amplified successfully were sequenced and compared with the known HBV sequences in Genbank to determine the two key epitopes of HBV PreS1 genotype (amino acid epitope 21-47 and 94-117, abbreviated as P21 and P94) and PreS1 full-length genotypes. The correlation among three genotyping approaches was analyzed by Cohen's kappa coefficient to verify the consistency between the key-epitope genotyping and the full-length preS1 genotyping. Results: 232 samples were successfully sequenced. The genotyping based on the kind of P21 epitope protein sequence, 201 cases for genotype C, 23 cases for genotype B and 8 cases for uncertain genotypes and genotyping based on the form of P94 epitope protein sequence, 199 cases for genotype C, 25 cases for genotype B and 8 cases for indeterminate genotypes. Lastly, the genotyping based on sequence of the full-length PreS1 sequence, 207 and 25 cases for genotype C and B. P21 or P94 epitope genotyping and PreS1 full length genotyping were highly consistent, respectively, 96.55% and 96.12%, and the two epitopes (P21and P94) genotyping have parallel consistency (93.10%). Conclusion: In this study, an innovatively genotyping method based on the amino acid sequence of key epitopes was proposed. The genotypes of HBV in china were mainly B and C genotypes, and the genotypes of key conserved epitopes of HBV PreS1 were highly consistent with the full-length genotyping ( > 96%). Moreover, genotyping with one or two key epitopes can be used in place of the full-length genotyping.

Hemolytic anemia in alcoholic liver disease: Zieve syndrome: A case report and literature review

RATIONALE

Zieve syndrome, a rarely reported disease resulting from alcohol abuse, consists of a triad of symptoms: hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. It is largely under-recognized and under-reported, possibly because of unawareness of the condition by physicians. Here, we report a case of Zieve syndrome managed at the Jilin University First Bethune Hospital.

PATIENT CONCERNS

A 30-year-old Chinese woman presented with a 4-month history of fatigue, yellowish discoloration of the eyes, and tea-colored urine. She had been a heavy drinker for 2 years prior to onset of the disease with an average daily alcohol intake of 60 g/d and more than 80 g/d for the previous 6 months.

DIAGNOSIS

The diagnosis of Zieve syndrome was confirmed based on hemolysis and cholestatic jaundice secondary to alcoholic liver disease and heavy drinking. Bone marrow biopsy and liver biopsy both supported the diagnosis.

INTERVENTIONS

We treated her with abstinence from alcohol and supportive therapy.

OUTCOMES

The patient was discharged 14 days after admission with an improvement in symptoms, which continued to subside during the 2-month follow-up period.

LESSONS

Doctors confronted with hemolysis in a patient with alcoholic liver disease should be aware of the under-reported Zieve syndrome. Recognition of this syndrome could help doctors avoid unnecessary invasive procedures and emphasize the importance of alcohol abstinence as the mainstay of management. Glucocorticoids may not be useful in treating hemolytic anemia in Zieve syndrome.

Identification of biomarkers for diagnosis of gastric cancer by bioinformatics

BACKGROUND

We aimed to discover potential gene biomarkers for gastric cancer (GC) diagnosis.

MATERIALS AND METHODS

Genechips of 10 GC tissues and 10 gastric mucosa (GM, para-carcinoma tissue, normal control) tissues were generated using an exon array of Affymetrix containing 30,000 genes. The differentially expressed genes (DEGs) between GC tissues and normal control were identified by the Limma package and analyzed by hierarchical clustering analysis. Gene ontology (GO) and pathway enrichment analyses were performed for investigating the functions of DEGs. Receiver operating characteristics (ROC) analysis was performed to measure the effects of biomarker candidates for diagnosis of GC.

RESULTS

Totals of 896 up-regulated and 60 down-regulated DEGs were identified to be differentially expressed between GC samples and normal control. Hierarchical clustering analysis showed that DEGs were highly differentially expressed and most DEGs were up-regulated. The most significantly enriched GO-BP term was revealed to be mitotic cell cycle and the most significantly enriched pathway was cell cycle. The intersection analysis showed that most significant DEGs were cyclin B1 (CCNB1) and cyclin B2 (CCNB2). The sensitivities and specificities of CCNB1 and CCNB2 were both high (p<0.0001). Areas under the ROC curve for CCNB1 and CCNB2 were both greater than 0.9 (p<0.0001).

CONCLUSIONS

CCNB1 and CCNB2, which were involved in cell cycle, played significant roles in the progression and development of GC and these genes may be potential biomarkers for diagnosis and prognosis of GC.

IgG4-related autoimmune pancreatitis overlapping with Mikulicz’s disease and lymphadenitis: A case report

Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis that is categorized as type 1 or type 2 according to the clinical profile. Type 1 AIP, which predominantly presents in a few Asian countries, is a hyper-IgG4-related disease. We report a case of IgG4-related AIP overlapping with Mikulicz’s disease and lymphadenitis, which is rare and seldom reported in literature. A 63-year male from Northeast China was admitted for abdominal distension lasting for one year. He presented symmetric swelling of the parotid and submandibular glands with slight dysfunction of salivary secretion for 6 mo. He had a 2-year history of bilateral submandibular lymphadenopathy without pain. He underwent surgical excision of the right submandibular lymph node one year prior to admission. He denied any history of alcohol, tobacco, or illicit drug use. Serological examination revealed high fasting blood sugar level (8.8 mmol/L) and high level of IgG4 (15.2 g/L). Anti-SSA or anti-SSB were negative. Computed tomography of the abdomen showed a diffusely enlarged pancreas with loss of lobulation. Immunohistochemical stain for IgG4 demonstrated diffuse infiltration of IgG4-positive plasma cells in labial salivary gland and lymph node biopsy specimens. The patient received a dose of 30 mg/d of prednisone for three weeks. At this three-week follow-up, the patient reported no discomfort and his swollen salivary glands, neck lymph node and pancreas had returned to normal size. The patient received a maintenance dose of 10 mg/d of prednisone for 6 mo, after which his illness had not recurred.

Role of PNPLA3 polymorphism in pathogenesis of liver diseases

Hepatic fat accumulation, a common phenomenon in nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD), is associated with liver inflammation development and disease progression. Besides, hepatic fat accumulation is also seen in HCV-infected patients, which influences the response to anti-HCV therapy. Although the causes of fatty accumulation in the above three diseases are different, hereditary factors causing fatty accumulation have attracted more and more attention. PNPLA3, a member of patatin-like phospholipase family, has the activity of triglyceride hydrolase and can influence the liver fatty metabolism. In recent years, PNPLA3 polymorphism has become a hot topic in research of NAFLD, ALD, and HCV, and important results have been achieved. This article describes the expression of PNPLA3 in human tissues and review recent progress in understanding the role of PNPLA3 polymorphism in the pathogenesis of the above three liver diseases.

Improved Therapeutic Outcome Following Combination Immunogene Vaccination Therapy in Murine Myeloma

Increasing evidence suggests a role for immunologic vaccination and therapy in the management of minimal residual myeloma. We have previously demonstrated a synergistic effect of combining the Th1 stimulating cytokine IL-12 with the co-stimulatory molecule CD80 in murine myeloma vaccination therapy. We reasoned that the efficacy of such treatment might be further improved by incorporating additional gene products which enhance the function of antigen presenting cells. Studies were therefore conducted with murine myeloma BM1 cells expressing Flt3L (membrane bound or soluble forms) or GM-CSF and the IL-12 x CD80 combination. Single agent and combined therapeutic approaches were explored. All gene-modified BM1 cells, except BM1/IL-12 x CD80, developed tumors when subcutaneously injected into BALB/c mice. As prophylactic tumor vaccines, the combined use of gene-modified BM1/sFlt3L+GM-CSF+IL-12 x CD80 was most effective, providing 100% protection against subsequent parental BM1 tumor challenge. By comparison, only partial protection was observed with any single gene-engineered tumor vaccine. Notably, IL-12 x CD80 coexpressing BM1 cell vaccines were the most effective therapeutic vaccine in a minimal disease model. Such protective vaccination was achieved by stimulation of lymphocyte proliferation and enhancement of cytotoxic lymphocyte activity.

Tricistronic viral vectors co-expressing interleukin-12 (1L-12) and CD80 (B7-1) for the immunotherapy of cancer: preclinical studies in myeloma

Synergy between interleukin-12 (IL-12) and B7-1 (CD80) for cancer immunotherapy has previously been demonstrated in animal models of breast cancer, lymphoma, and multiple myeloma. With a view to human clinical application, tricistronic retroviral and adenovirus vectors co-expressing IL-12 (IL-12p40 plus IL-12p35) and CD80 were constructed by utilizing two internal ribosome entry site (IRES) sequences to link the three cDNAs. A murine stem cell virus (MSCV)-based retroviral vector (MSCV-hIL12.B7) utilized distinct IRES sequences from the encephalomyocarditis virus (EMCV) and the foot-and-mouth disease virus (FMCV), whereas Ad5-based adenovirus vectors contained transcriptional units with two EMCV IRES sequences under the control of murine (AdMh12.B7) or human (AdHh12.B7) cytomegalovirus promoters. AdMh12.B7 was found to consistently direct higher levels of IL-12 and CD80 expression than AdHh12.B7 following infection of a number of human tumor cell lines. In preclinical studies, the human myeloma cell line U266 was infected with MSCV-hIL12.B7 and a resulting clonal cell line, U/MSCV-h12.B7, was generated with stable expression of CD80 and secreting IL-12 at 1 ng/24 h/10(6) cells. By comparison, following AdMh12.B7 infection, 81% of infected U266 cells (U/AdMh12.B7) expressed CD80 and secreted IL-12 at 25-50 ng/24 h/10(6) cells. Both engineered myeloma cell lines stimulated enhanced allogeneic mixed lymphocyte proliferation and provoked increases in cytotoxic T-lymphocyte responses and gamma-interferon release from normal donor lymphocytes exposed to parental U266 cells. These results suggest potential clinical utility of AdMh12.B7 in immunotherapy strategies for the treatment of multiple myeloma and other cancers.

Adenovirus-mediated human endostatin gene delivery demonstrates strain-specific antitumor activity and acute dose-dependent toxicity in mice

Purified recombinant mouse endostatin protein has been reported to regress established murine solid tumors by inhibiting the proliferation of endothelial cells. To develop a clinical gene therapy strategy with endostatin, we cloned the cDNA of human endostatin by RT-PCR from human placenta. A 150-bp sequence encoding the IgG leader peptide was fused in frame to the 5' end of the endostatin cDNA and recombinant adenoviruses, AdENDO-YFP and AdENDO, carrying endostatin gene expression cassettes were rescued. AdENDO-YFP infects cultured mammalian cells at high efficiency and expresses a biologically active human endostatin in secreted form at high levels both in vitro and in vivo. When delivered in vivo, a strain-specific expression pattern was observed, with the highest and longest endostatin expression in 129/J mice. After systemic delivery of 2 x 10(9) PFU of AdENDO-YFP into 129/J mice, human endostatin expression was achieved at a mean value of 1.34 +/- 0.42 microg/ml of serum (n = 6) and inhibition of lung metastasis was observed in an EOMA tumor model. However, high dose intravenous delivery of AdENDO-YFP and AdENDO was associated with severe acute toxicity in recipient mice that included loss of weight, bleeding, and death of animals. These events were not observed with the injection of identical doses of a control adenovirus that did not contain the endostatin gene. Because the endostatin adenovirus-associated acute toxicity was also observed in immunodeficient NCRNU-M nude mice, the toxicity does not appear to be the result of the immunogenicity against human endostatin or the EYFP protein.

Murine phosphatidylserine-specific phospholipase A1 (Ps-pla1) maps to chromosome 16 but is distinct from the lpd (lipid defect) locus

We have previously generated a mouse transgenic line with an insertional mutation designated lpd that demonstrates a phenotype of hypertriglyceridemia and fatty liver. Since the recently identified phosphatidylserine-specific phospholipase A1 (PS-PLA1) demonstrates significant homology to triglyceride lipases, we reasoned that the mouse Ps-plaI gene may be the disrupted gene within the lpd locus. Using a rat PS-PLA1 cDNA sequence to search the EST database, we identified a mouse EST homolog AA839424. Sequencing analysis of AA839424 revealed a putative Ps-pla1 protein of 456 amino acids with extensive overall structural conservation with human and rat PS-PLA1 and with triglyceride lipases. Conserved sequences in Ps-pla1 include a lipase consensus sequences GxSxG, a catalytic triad, and eight of the ten conserved cysteine residues that are required for tertiary structure. Mouse Ps-plal carries a phosphatidylserine-binding motif that is absent in all triglyceride lipases. Using a mouse whole-genome radiation hybrid (WG-RH) mapping panel (T31), we mapped mouse Ps-pla1 to Chromosome (Chr) 16 between genetic markers D16Mit194 and D16Mit38, which is 17.1 cM centromeric to the lpd locus. On the basis of chromosome location, we conclude that Ps-pla1 and lpd are distinct genes in lipid metabolism.

Identification of c-myc promoter-binding protein and X-box binding protein 1 as interleukin-6 target genes in human multiple myeloma cells

Interleukin-6 (IL-6) is implicated in the in vivo proliferation of malignant plasma cells in multiple myeloma. To define the molecular basis of the IL-6-induced mitogenic response in myeloma cells, we applied STAR (subtractive transcriptional amplification of mRNA), a new differential expression analysis technology, to isolate mRNAs preferentially expressed in IL-6-treated versus untreated cultures of the factor-responsive myeloma cell line U266. From the resulting collection of STAR clones, sequence information was obtained for a total of 72 distinct transcripts. Of these, 29 were found to correspond to known genes, 22 matched expressed sequence tags in public databases and 21 showed no sequence similarity to any existing entries. Among the known genes uncovered in the screen were those encoding proteins that function in cell division, cell signalling and gene/protein expression. Northern blot analysis documented that two transcription factor genes chosen for further study, c-myc promoter-binding protein (MBP-1) and X-box binding protein 1 (XBP-1), were up-regulated in U266 cells about 3-fold relative to the cell cycle-dependent beta-actin gene 12 h after IL-6 treatment. Both genes were also similarly up-regulated by IL-6 in factor-dependent ANBL-6 myeloma cells. These results indicate that MBP-1 and XBP-1 are IL-6 genes in myeloma cells; as such, they may play a role in IL-6-mediated growth control in multiple myeloma.

Characterization of lpd (lipid defect): a novel mutation on mouse chromosome 16 associated with a defect in triglyceride metabolism

Recent epidemiological studies have identified plasma triglyceride as a risk factor for atherogenesis. We have generated a mouse transgenic line that carries a recessive mutation designated lpd (lipid defect). Homozygous lpd mice develop as runts and die by age 10-15 days with striking liver pathology characterized by the presence of numerous lipid-containing vacuoles and extensive accumulation of triglycerides. Cloning of the mutant insertion locus and the wild-type lpd locus have revealed a duplication of host genomic sequences at the site of integration. Mapping of the lpd locus with the Jackson Laboratory BSS interspecific backcross panel of (C57BL/6JEi x SPRET/Ei) F1 x SPRET/Ei placed the lpd locus to the distal part of chromosome 16. These observations suggest that the transgene disrupts a putative gene at the lpd locus and that lpd is a novel locus related to triglyceride metabolism. The lpd mutant mice may serve as models for human disorders of fatty livers or hypertriglyceridemia.

Genetic mapping of two mouse homeobox genes Tlx-1 and Tlx-2 to murine chromosomes 19 and 6

We have previously cloned two mouse homeobox genes Tlx-1 (T-cell leukemia homeobox gene-1) and a related gene Tlx-2 based on their homology to human HOX11, a putative proto-oncogene involved in human T-cell leukemia. We have mapped Tlx-1 to mouse chromosome 19 and Tlx-2 to chromosome 6 by linkage analysis using an interspecific backcross (C57BL/6J x Mus spretus) F1 x M. spretus. The proposed gene orders and genetic distances for Tlx-1 and Tlx-2 are centromere 19-Lpc-1-(25.53 cM)-Pltr-4-(5.32 cM)-Tlx-1- (3.19 cM)-Ins-1-(7.45 cM)-Xmv-18, and centromere 6-Tcrb-(12.90 cM)-Mltr-3-(10.75 cM)-Tlx-2-(18.42 cM)-Xmv-6.

[Using BPV transforming foci as selective markers to express HBsAg]

We constructed a plasmid pBMTHBR2 containing mouse MT promoter, entire HBsAg gene (preS and S gene), splicing signal from SV40 and complete BPV genome. Using calcium phosphate precipitation technique to transform C127 Cells and using BPV transforming foci as selective markers, we obtained transformed cell clones. The experiment shows that 57% of the cloned cell lines can secrete HBsAg continuously.