SAT0003 ELEVATED BASELINE AND INCREASING AUTOANTIBODY LEVELS ARE ASSOCIATED WITH INCREASED RISK FOR IMMINENT ONSET OF INFLAMMATORY ARTHRITIS IN A PROSPECTIVELY STUDIED ANTI-CITRULLINATED PROTEIN ANTIBODY POSITIVE COHORT: THE TIP-RA COLLECTIVE

Background:

The Targeting Immune Responses for Prevention of RA (TIP-RA) Collaborative prospectively studies individuals at high risk for developing RA because of serum ACPA positivity in absence of baseline inflammatory arthritis (IA).

Objectives:

The objective of the analyses presented herein is to evaluate the role of baseline and changing levels of ACPA and rheumatoid factor (RF) in relationship to incident IA/RA.

Methods:

ACPA+ subjects and ACPA- controls were identified who did not have baseline historical or examination evidence of IA. ACPA+ was defined by serum elevation of anti-CCP3 ≥20 units (Inova). Subjects were evaluated annually or sooner if they had changes in joint symptoms. Factors including RFIgM and RFIgA (Inova) were also assessed, and relationships between autoantibody levels at baseline and over time and incident IA/RA were evaluated using t-tests, with paired testing where applicable.

Results:

Baseline characteristics of ACPA+ and ACPA- subjects are in Table 1. Sixteen of the 94 (17%) ACPA+ subjects developed IA/RA a mean of 518 days from the baseline visit; 14 of these met 2010 ACR/EULAR criteria for RA at the time of detection of IA. There was a trend for ACPA+ subjects who later developed IA/RA to have higher baseline levels of anti-CCP3 compared to those who did not develop IA/RA (Table 2). In addition, those who developed IA/RA had significantly higher mean levels of RFIgM and RFIgA compared to those who did not. While not statistically significant, in longitudinal analyses in the ACPA+ subjects with incident IA/RA, anti-CCP3 levels increased from baseline to identification of IA (mean [SD] of 119 [102] to 126 [100], p=0.42). Furthermore, RFIgM levels increased from 36 [49] at baseline to 43 [51] at the time of IA (p=0.31), and RFIgA levels increased from 16 [29] to 21 [31] (p=0.10). In contrast, in ACPA+ subjects who did not develop IA/RA, anti-CCP3 levels increased only slightly over follow-up of a mean of 712 days: 75 [75] to 80 [76], p=0.70 while the levels of RFIgM and RFIgA decreased slightly during the same follow-up: for RFIgM mean [SD] levels went from 9 [22] to 8 [19], p=0.74; for RFIgA, 5 [16] to 3 [12], p=0.67.

Table 1.

Baseline characteristics of ACPA+/- subjects

ACPA-(n=162)ACPA+(n=94)p-valueAge, mean58580.90% Female69680.67% Ever smoker33340.87RF-IgM, mean (SD)3.2 (10.0)13.5 (30.2)<0.01RF-IgA, mean (SD)0.3 (0.6)6.5 (19.1)<0.01Table 2.

Baseline characteristics of 16 ACPA+ subjects who developed incident IA/RA vs. 78 ACPA+ who did not

Did not develop IA/RA (n=78)Developed IA/RA (n=16)p-valueDays from baseline to IA/RA or follow-up, mean (SD)712 (124)518 (295)–% Meeting 2010 criteria at time of IA-88–CCP3, mean (SD)74.5 (75.3)119.1 (102.1)0.05RFIgM, mean (SD)9 (22)36 (49)<0.01RFIgA, mean (SD)4 (16)16 (29)0.03

Conclusion:

In this prospectively followed cohort of ACPA+ subjects, higher levels of RFIgM and RFIgA at baseline were significantly associated with development of IA/RA within the follow-up period. Furthermore, there was a trend for rising levels of anti-CCP3 and RFIgM and A to be associated with development of IA/RA. These finding support the use of higher and/or rising levels of autoantibodies as additional features to predict imminent onset of IA/RA in ACPA+ individuals as well as potentially to use as outcomes of success of preventive interventions. Furthermore, the trend of increasing levels of RFIgM and RFIgA over time in individuals who developed IA/RA suggests that targeting pathways of RF development may lead to preventive interventions in a subset of RA.

References:

None

Disclosure of Interests:

Kevin Deane Grant/research support from: Janssen, Consultant of: Inova, ThermoFisher, Janseen, BMS and Microdrop, Gary Firestein Grant/research support from: Lilly, Janssen, Abbvie, David Boyle: None declared, Jane Buckner Grant/research support from: Bristol-Myers Squibb, Janssen, Eddie A. James Grant/research support from: Janssen, Pfizer, Sanofi, Novartis, Sylvia Posso Grant/research support from: Janssen, William Robinson Grant/research support from: Janssen, Laurie K. Moss Grant/research support from: Janssen, Jennifer Seifert Grant/research support from: Janssen, Roger Gilmore Grant/research support from: Janssen, Saman Barzideh Grant/research support from: Janssen, Navin Rao Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Frederic Baribaud Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Sunil Nagpal Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Alyssa Johnsen Employee of: Janssen, V. Michael Holers Grant/research support from: Janssen, Celgene, and BMS

OP0337 DIFFERENTIAL METHYLATION OF PERIPHERAL BLOOD ADAPTIVE IMMUNE CELLS IN INDIVIDUALS AT HIGH RISK FOR RA AND WITH EARLY RA COMPARED WITH CONTROLS IDENTIFIES PATHWAYS IMPORTANT IN TRANSITION TO ARTHRITIS

Background:

The “Targeting Immune Responses for Prevention of RA” (TIP-RA) collaboration studies individuals at high risk for developing RA because of serum anti-citrullinated protein antibody positivity in absence of arthritis, and is focused on defining how they transition from at-risk to classifiable disease. One potential mechanism is through alterations in epigenetics patterns in adaptive immune cells.

Objectives:

Previous studies showed that DNA methylation patterns of early RA (ERA) synoviocytes differ from long-standing RA, suggesting that abnormal methylation occurs early in synovium and evolves over time. To extend these observations, we performed a cross-sectional analysis in TIP-RA of DNA methylation signatures in peripheral blood cells in ERA, at-risk anti-CCP3+ individuals and demographically matched CCP- controls.

Methods:

Genomic DNA was isolated from two independent cohorts of CCP- (cohorts 1 and 2, respectively: B cell: n = 17/34; memory T cell: n = 21/34; and naïve T cell: n = 21/33), CCP3+ (B cell: n = 18/37; memory T cell: n = 20/36; and naïve T cell: n = 20/35), and CCP3+ ERA (B cell: n = 4/18; memory T cell: n = 5/18; and naïve T cell: n = 5/18) after separating PBMCs using antibodies and magnetic beads. Methylation was measured by Illumina Infinium MethylationEPIC chip. Differentially methylated loci (DMLs) were identified using Welch’s t-test and mapped to gene promoter regions to define DM genes (DMGs). Principal component analysis (PCA) was used to represent relationship among groups. Pathway analysis was applied by Reactome.

Results:

For the initial cohort, 1494, 1097 and 1330 DMLs were identified among CCP+, CCP- and ERA in B cells, memory T cells and naïve T cells, respectively. For the confirmatory cohort, 523, 793 and 548 DMLs were found in corresponding cell populations. The DML overlap between the 2 cohorts was highly significant (p= 2.48E-77). The DMLs were combined for both groups and corresponded to 411, 412, and 351 DMGs in B cells, memory T cells and naïve T cells. Of these, we found 246, 198 and 195 DMGs between CCP3+ and ERA in each peripheral blood cell population, respectively. PCA showed separation of CCP+, CCP- and ERA in each of the three blood cell types by DMLs (Fig. 1). DMGs were mapped to biological pathways to identify DM pathways. Although most were not significant, there were several highly significant differences comparing CCP+, ERA and CCP- in memory T cells involving pathways, including “Interferon gamma signaling” (FDR 7.48E-14), “PD-1 signaling” (FDR 8.71E-10), “Translocation of ZAP-70 to Immunological synapse” (FDR 4.75E-10), and “Phosphorylation of CD3 and TCR zeta chains” (FDR 8.71E-10).

Figure 1.

PCA shows the separation of CCP+, CCP- and ERA patients in memory T cells in confirmatory cohort.

Conclusion:

We identified reproducible methylation signatures of CCP-, CCP+, and ERA in peripheral blood B cells, memory T cells and naïve T cells in initial and confirmatory cohorts. The methylome of ERA also demonstrated a distinctive pattern from CCP+, indicating that progression to RA is accompanied by epigenetic remodeling, especially in T cell signaling and interferon responses. These signatures identify critical pathways in CCP positivity and classifiable RA and could provide the basis of novel interventions to prevent disease.

Disclosure of Interests:

Rizi Ai: None declared, David Boyle: None declared, Deepa Hammaker: None declared, Kevin Deane Grant/research support from: Janssen, Consultant of: Inova, ThermoFisher, Janseen, BMS and Microdrop, V. Michael Holers Grant/research support from: Janssen, Celgene, and BMS, Andre Matti: None declared, William Robinson: None declared, Jane Buckner Grant/research support from: Bristol-Myers Squibb, Janssen, Navin Rao Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Frederic Baribaud Shareholder of: Janssen Research & Development, LLC, Employee of: Janssen Research & Development, LLC, Alyssa Johnsen Employee of: Janssen, Sunil Nagpal Shareholder of: Janssen Pharmaceuticals, Employee of: Janssen Pharmaceuticals, Wei Wang: None declared, Gary Firestein Grant/research support from: Lilly, Janssen, Abbvie

Diagnostic Value of Spinal Computer Tomography in Patients with Intraspinal Metastases Causing Complete Block on Myelography

The value of post-myelographic spinal computer tomography (CT) was evaluated in cancer patients with spinal metastases causing complete myelographic block. In 22 out of 25 lumbar myelographies (88%) showing complete blockade, sufficient contrast medium had leaked proximally to allow determination of the cranial limit of the metastasis on the CT-scan. It is concluded that the post-myelographic spinal CT can replace a supplementary cervical myelography in the majority of patients with epidural metastasis, causing a complete myelographic block.

Molecular requirements for inhibition of the chemokine receptor CCR8--probe-dependent allosteric interactions

BACKGROUND AND PURPOSE

Here we present a novel series of CCR8 antagonists based on a naphthalene-sulfonamide structure. This structure differs from the predominant pharmacophore for most small-molecule CC-chemokine receptor antagonists, which in fact activate CCR8, suggesting that CCR8 inhibition requires alternative structural probes.

EXPERIMENTAL APPROACH

The compounds were tested as inverse agonists and as antagonists against CCL1-induced activity in Gα(i) signalling and chemotaxis. Furthermore, they were assessed by heterologous competition binding against two radiolabelled receptor ligands: the endogenous agonist CCL1 and the virus-encoded antagonist MC148.

KEY RESULTS

All compounds were highly potent inverse agonists with EC(50) values from 1.7 to 23 nM. Their potencies as antagonists were more widely spread (EC(50) values from 5.9 to 1572 nM). Some compounds were balanced antagonists/inverse agonists whereas others were predominantly inverse agonists with >100-fold lower potency as antagonists. A correspondingly broad range of affinities, which followed the antagonist potencies, was disclosed by competition with [(125)I]-CCL1 (K(i) 3.4-842 nM), whereas the affinities measured against [(125)I]-MC148 were less widely spread (K(i) 0.37-27 nM), and matched the inverse agonist potencies.

CONCLUSION AND IMPLICATIONS

Despite highly potent and direct effects as inverse agonists, competition-binding experiments against radiolabelled agonist and tests for antagonism revealed a probe-dependent allosteric effect of these compounds. Thus, minor chemical changes affected the ability to modify chemokine binding and action, and divided the compounds into two groups: predominantly inverse agonists and balanced antagonists/inverse agonists. These studies have important implications for the design of new inverse agonists with or without antagonist properties.

Ancestral polymorphism in exon 2 of bluethroat (Luscinia svecica) MHC class II B genes

The genes of the major histocompatibility complex (MHC) are important model genes for understanding selective forces in evolution. Here, we document, using a cloning and sequencing approach, high polymorphism at the exon 2 of the MHC class II B (MHCIIB) genes in the bluethroat (Luscinia svecica); a minimum of 61 unique alleles were detected in 20 individuals, and at least 11 functional loci. In addition, several pseudogenes were revealed. The specimens originated from three different bluethroat subspecies (azuricollis, cyanecula and svecica), and we also analysed four specimens of the closely related thrush nightingale (L. luscinia) for comparison. Phylogenetic analyses of the functional alleles revealed 258 equally parsimonious trees with poor statistical support for the majority of nodes. The distribution of the sequences in the trees point to an ancestral origin of the polymorphism in MHC class II B genes, a portion of which predated the phylogenetic split between the bluethroat and the thrush nightingale. Strong signatures of balancing selection were uncovered for the codons coding for the peptide-binding residues of the functional MHCIIB exon 2 alleles. Our results highlight the importance of duplication and recombination events for shaping passerine MHC and give insights in the evolutionary dynamics of MHC variation among closely related taxa.

Cell-mediated immunity and multi-locus heterozygosity in bluethroat nestlings

Recent evidence suggests that marker-based heterozygosity-fitness correlations may be driven by only one or a few markers, indicating local heterozygosity effects caused by linkage disequilibrium with functional genes. In this study, we investigated the relationship between microsatellite heterozygosity and a measure of cell-mediated immunity (phytohaemagglutinin; PHA) in bluethroat (Luscinia s. svecica) nestlings using a full-sibling design. We found significant positive associations between PHA response and two different indices of microsatellite heterozygosity, i.e. multi-locus heterozygosity and mean d(2). However, model comparisons disclosed that both associations were more likely caused by local effects rather than general effects and that the two local effects appeared to be realized through two different genetic mechanisms. Our results indicate that both the random assortment of parental chromosomes during meiosis as well as inbreeding can drive heterozygosity-fitness correlations.

Avian Clock gene polymorphism: evidence for a latitudinal cline in allele frequencies

In comparison with most animal behaviours, circadian rhythms have a well-characterized molecular genetic basis. Detailed studies of circadian clock genes in 'model' organisms provide a foundation for interpreting the functional and evolutionary significance of polymorphic circadian clock genes found within free-living animal populations. Here, we describe allelic variation in a region of the avian Clock orthologue which encodes a functionally significant polyglutamine repeat (ClkpolyQcds), within free-living populations of two passerine birds, the migratory bluethroat (Luscinia svecica) and the predominantly nonmigratory blue tit (Cyanistes caeruleus). Multiple ClkpolyQcds alleles were found within populations of both species (bluethroat: 12 populations, 7 alleles; blue tit: 14 populations, 9 alleles). Some populations of both species were differentiated at the ClkpolyQcds locus as measured by F(ST) and R(ST) values. Among the blue tit, but not bluethroat populations, we found evidence of latitudinal clines in (i) mean ClkpolyQcds repeat length, and (ii) the proportions of three ClkpolyQcds genotype groupings. Parallel analyses of microsatellite allele frequencies, which are considered to reflect selectively neutral processes, indicate that interpopulation allele frequency variation at the ClkpolyQcds and microsatellite loci does not reflect the same underlying demographic processes. The possibility that the observed interpopulation ClkpolyQcds allele frequency variation is, at least in part, maintained by selection for microevolutionary adaptation to photoperiodic parameters correlated with latitude warrants further study.

A spatial genetic structure and effects of relatedness on mate choice in a wild bird population

Inbreeding depression, as commonly found in natural populations, should favour the evolution of inbreeding avoidance mechanisms. If natal dispersal, the first and probably most effective mechanism, does not lead to a complete separation of males and females from a common origin, a small-scale genetic population structure may result and other mechanisms to avoid inbreeding may exist. We studied the genetic population structure and individual mating patterns in blue tits (Parus caeruleus). The population showed a local genetic structure in two out of four years: genetic relatedness between individuals (estimated from microsatellite markers) decreased with distance. This pattern was mainly caused by immigrants to the study area; these, if paired with fellow immigrants, were more related than expected by chance. Since blue tits did not avoid inbreeding with their social partner, we examined if individuals preferred less related partners at later stages of the mate choice process. We found no evidence that females or males avoided inbreeding through extra-pair copulations or through mate desertion and postbreeding dispersal. Although the small-scale genetic population structure suggests that blue tits could use a simple rule of thumb to select less related mates, females did not generally prefer more distantly breeding extra-pair partners. However, the proportion of young fathered by an extra-pair male in mixed paternity broods depended on the genetic relatedness with the female. This suggests that there is a fertilization bias towards less related copulation partners and that blue tits are able to reduce the costs of inbreeding through a postcopulatory process.

Speciation, introgressive hybridization and nonlinear rate of molecular evolution in flycatchers

Evolutionary history of Muscicapidae flycatchers is inferred from nuclear and mitochondrial DNA (mtDNA) sequence comparisons and population genetic analysis of nuclear and mtDNA markers. Phylogenetic reconstruction based on sequences from the two genomes yielded similar trees with respect to the order at which the species split off. However, the genetic distances fitted a nonlinear, polynomial model reflecting diminishing divergence rate of the mtDNA sequences compared to the nuclear DNA sequences. This could be explained by Haldane's rule because genetic isolation might evolve more rapidly on the mitochondrial rather than the nuclear genome in birds. This is because hybrid sterility of the heterogametic sex (females) would predate that of the homogametic sex (males), leading to sex biased introgression of nuclear genes. Analyses of present hybrid zones of pied (Ficedula hypoleuca) and collared flycatchers (F. albicollis) may indicate a slight sexual bias in rate of introgression, but the introgression rates were too low to allow proper statistical analyses. It is suggested, however, that the observed deviation from linearity can be explained by a more rapid mutational saturation of the mtDNA sequences than of the nuclear DNA sequences, as supported by analyses of third codon position transversions at two protein coding mtDNA genes. A phylogeographic scenario for the black and white flycatcher species is suggested based on interpretation of the genetic data obtained. Four species appear to have diverged from a common ancestor relatively simultaneously during the Pleistocene. After the last glaciation period, pied and collared flycatchers expanded their breeding ranges and eventually came into secondary contact in Central and Eastern Europe and on the Baltic Isles.

Female bluethroats enhance offspring immunocompetence through extra-pair copulations

Female birds frequently copulate with extra-pair males, but the adaptive value of this behaviour is poorly understood. Some studies have suggested that 'good genes' may be involved, where females seek to have their eggs fertilized by high-quality males without receiving any material benefits from them. Nevertheless, it remains to be shown that a genetic benefit is passed on to offspring. Here we report that nestling bluethroats, Luscinia svecica, sired by extra-pair males had a higher T-cell-mediated immune response than their maternal half-siblings raised in the same nest. The difference could not be attributed to nestling body mass, sex or hatching order, but may be an effect of paternal genotype. Extra-pair young were also more immunocompetent than their paternal half-sibs raised in the genetic father's own nest, which indicates an additional effect of maternal genotype. Our results are consistent with the idea that females engage in extra-pair copulations to obtain compatible viability genes, rather than 'good genes' per se.

Colour bands, mate choice and paternity in the bluethroat

Studies of several bird species have shown that coloured leg bands may affect a male's success in mate attraction and/or mating competition. From a colour band experiment in the field, we have previously reported that male bluethroats, Luscinia s. svecica, with blue and orange bands (BO males) guarded their mates less intensely at the peak of female fertility, and spent more time advertising for additional mates, than males banded with non-BO colours. These responses indicated that BO males experienced less threat to their paternity than did non-BO males, possibly mediated through an increased attractiveness. Here we present paternity analyses of the broods from the field study and test whether there were differences between the two male groups in within-pair or extrapair paternity. There were no significant differences between the two groups of males in paternity, suggesting effective male protection of paternity. However, extrapair paternity was infrequent in the 2 years of the field experiment; hence, the power in detecting effects on paternity does not allow a definitive conclusion on this issue. We also conducted an aviary experiment in which females were given the choice between a BO male and a non-BO male, to test whether females had preferences for particular colour bands. Females did not associate more with BO males, as would have been expected if these males were more attractive in social mate choice. Our results suggest that the effects of colour bands on social mate choice and paternity are, at best, weak. Copyright 2000 The Association for the Study of Animal Behaviour.

Phagocytic antigen processing and effects of microbial products on antigen processing and T-cell responses

Processing of exogenous antigens and microbes involves contributions by multiple different endocytic and phagocytic compartments. During the processing of soluble antigens, different endocytic compartments have been demonstrated to use distinct antigen-processing mechanisms and to process distinct sets of antigenic epitopes. Processing of particulate and microbial antigens involves phagocytosis and functions contributed by phagocytic compartments. Recent data from our laboratory demonstrate that phagosomes containing antigen-conjugated latex beads are fully competent class II MHC (MHC-II) antigen-processing organelles, which generate peptide:MHC-II complexes. In addition, phagocytosed antigen enters an alternate class I MHC (MHC-I) processing pathway that results in loading of peptides derived from exogenous antigens onto MHC-I molecules, in contrast to the cytosolic antigen source utilized by the conventional MHC-I antigen-processing pathway. Antigen processing and other immune response mechanisms may be activated or inhibited by microbial components to the benefit of either the host or the pathogen. For example, antigen processing and T-cell responses (e.g. Th1 vs Th2 differentiation) are modulated by multiple distinct microbial components, including lipopolysaccharide, cholera toxin, heat labile enterotoxin of Escherichia coli, DNA containing CpG motifs (found in prokaryotic and invertebrate DNA but not mammalian DNA) and components of Mycobacterium tuberculosis.

Down-regulation of the transporter for antigen presentation, proteasome subunits, and class I major histocompatibility complex in tumor cell lines

Tumor cells may alter the expression of proteins involved in antigen processing and presentation, allowing them to avoid recognition and elimination by cytotoxic T cells. In this study, reverse transcription-PCR was used to assess the expression in human tumor cell lines of mRNA for multiple components of the class I MHC antigen-processing pathway, including several proteasome subunits that have been implicated in antigen processing but have not been previously examined in this context (e.g., low molecular weight polypeptide proteasome subunit (LMP) 10, proteasome activator (PA) 28alpha, and PA28beta). Deficiencies in the expression of antigen-processing genes were demonstrated in 9 of 27 cell lines, representing a variety of histological types. In some cases, virtually complete deficiencies were observed in the expression of the four genes encoded within the MHC (TAP1, TAP2, LMP2, and LMP7), as well as LMP10, which is encoded outside the MHC. Combined deficiencies of these gene products were common, and marked deficiency of LMP10 was found in five of the nine cell lines with deficits. The existence of deficiencies in the expression of genes at dispersed loci suggested that the basis for the deficiencies was a regulatory mechanism, as opposed to mutation or deletion of these genes. Furthermore, most of the deficiencies were reversed by treatment with IFN-gamma. In contrast to such extreme deficiencies, we found unaltered or only partially decreased expression of PA28alpha and PA28beta in tumor cell lines. Thus, tumors may evade immune surveillance by simultaneously down-regulating multiple components of the MHC-I antigen-processing pathway, thereby altering the processing and presentation of tumor antigens. Expression of essential proteasome subunits, however, may still be maintained.

Studying the influence of paternity on parental effort: a comment on Kempenaers & Sheldon

Copyright 1998 The Association for the Study of Animal Behaviour

Use of fluorocitrate and fluoroacetate in the study of brain metabolism

Fluoroacetate and its toxic metabolite fluorocitrate cause inhibition of aconitase. In brain tissue, both substances are preferentially taken up by glial cells and leads to inhibition of the glial TCA cycle. It is important to realise, however, that the glia-specificity of these compounds depends both on the dosage and on the model used. The glia-inhibitory effect of fluorocitrate as obtained by intracerebral microinjection in vivo is reversible within 24 h. A substantial inhibition of the glial TCA cycle by systemic administration of fluoroacetate requires a lethal dose. Inhibition of the glial aconitase leads to accumulation of citrate and to a reduction in the formation of glutamine. Whereas the former is likely to be responsible for the main toxic effect of these compounds possibly by chelation of free calcium ions, it is the latter that has received most attention in the study of glial-neuronal interactions, since glutamine is an important precursor for transmitter glutamate and GABA.

Coloured leg bands affect male mate-guarding behaviour in the bluethroat

Artificial traits such as coloured leg bands may affect an individual's mating success, as shown for some birds. One explanation is that colour-matching with a sexual ornament affects the individual's sexual attractiveness. This study reports a colour-band experiment with free-living bluethroats, Luscinia s. svecicaa species where males have a distinct blue and chestnut throat and upper breast. There was no apparent difference in pairing success between males with ornament-matching colour bands (blue and orange) and males with non-ornamental colour bands. However, males with ornamental bands guarded their mates less intensely and spent more time singing, performing song flights and intruding into neighbours' territories than males with non-ornamental bands. We conclude that colour bands affect the trade-off between mate guarding and advertisement behaviour in a way that is consistent with the hypothesis that bands with ornamental colours improve a male's attractiveness. The results are in concordance with a previous study of the same population, showing that males with experimentally reduced attractiveness guarded their mates more closely and advertised less for additional mates, than non-manipulated males.

Radiologic features compared to clinical findings in a prospective study of 153 patients with metastatic spinal cord compression treated by radiotherapy

Plain radiography, myelography and post-myelographic CT-scan are described and related to clinical findings in a prospective study of 153 consecutive patients with myelographic signs of spinal cord compression. The majority of the metastatic tumours arise in the vertebral body or the pedicles. In 80% of the patients with total blockage to the contrast medium on myelography the post-myelographic-CT showed passage of the contrast medium. Ambulatory function at time of diagnosis was correlated to the degree and the localization of the epidural block. In 64 patients who underwent a second myelography, the post-treatment findings of sensory function were correlated to radiological regression.

The human proteasome subunit HsN3 is located in the inner rings of the complex dimer

Subunit HsN3 of the human proteasome is a beta-type subunit homologous to PRE4 from yeast, X1 beta from Xenopus and RN3 from the rat. Using electron microscopy, the binding sites of a monoclonal antibody with specificity for subunit HsN3 have been located in the two juxtaposed inner rings of the human proteasome. Subunit HsN3 was present in two copies, one in each ring, in accordance with our concept of two identical halves making up the complete human proteasome. The subunit is involved in the trypsin-like as well as the peptidylglutamyl-peptide cleavage activities.

Heterogeneity of neocortical cerebral blood flow deficits in dementia of the Alzheimer type: a [99mTc]-d,l-HMPAO SPECT study

Regional cerebral blood flow (rCBF) was measured with high resolution brain dedicated single photon emission computer tomography (SPECT) and [99mTc]-d,l-hexamethyl-propylene-amine-oxime (HMPAO) in 25 patients with probable Alzheimer's disease and in 25 control subjects, selected according to rigorous inclusion and exclusion criteria. The aim was to analyse the topography of rCBF deficits in individual patients. In the group of patients with Alzheimer's disease as a whole, global CBF was reduced, but a factorial analysis of variance did not show disproportionate reduction of rCBF in any brain region. A parametric analysis of the rCBF data in individual patients was carried out with reference to normal values for internal rCBF ratios and to 13 different abnormal rCBF patterns. These theoretical patterns were predefined by showing significant hypoperfusion in at least one, or in any relevant combination of two, three, or four, of four major brain regions (a left and right frontal and a left and right posterior region). All patients with Alzheimer's disease and none of the control subjects had an abnormal rCBF pattern. Eleven of the 13 different patterns were seen in the patients. Frontal changes were seen in 19 (76%) of the patients, more often than previously reported. No single Alzheimer's disease pattern could be derived from our data. The number of regions with hypoperfusion, but not the presence of frontal changes, correlated significantly with the duration of disease. It is concluded that a clinical diagnosis of probable Alzheimer's disease is associated with heterogeneous patterns of rCBF deficits as measured with SPECT and [99mTc]-d,l-HMPAO. This heterogeneity may reflect different stages of the disease or cognitive subtypes and help explain published discrepancies concerning the topography of hypoperfusion in Alzheimer's disease. An analysis of individual rCBF data may add important information in the investigation of diseases with heterogeneous effects on the brain.

Echinomycin, a bis-intercalating agent, induces C-->T mutations via cytosine deamination

Echinomycin, a bis-intercalating, antitumor drug, has been studied for its ability to induce the deamination of cytosine to uracil (C-->U) in double-stranded DNA. We have employed a sensitive lacZ alpha-complementation reversion assay to detect G.C-->A.T mutations at a number of sites in M13mp2 DNA to determine the extent to which distortions of DNA structure induced by echinomycin may affect C-->U rates. When double-stranded M13mp2 DNA with a 12-base target containing a CpG site was incubated at 37 degrees C, the reversion frequency of the echinomycin-treated DNA increased linearly over time, with a rate constant 3-fold greater than DNA incubated without echinomycin. Of the 11 ways that blue pseudo-revertants can occur in the target, 96% of the observed revertants arose from C-->T and tandem CC-->TT transitions, with 78% attributable to single-base C-->T changes at three sites. Transfection into ung+ cells decreased the reversion frequencies by 85% to near background levels, indicating that the increase in C-->T mutations was due to deamination of C to U. The cytosine deamination rate constants for the entire target at pH 6.0 and 37 degrees C were 1.2 x 10(-11) sec-1 for untreated DNA and 3.5 x 10(-11) sec-1 for echinomycin-treated DNA. The increase in C-->T mutation rates occurred at cytosines both proximal and distal to a CpG echinomycin-binding site. We hypothesize that this increase in deamination rate is due to a more open or single-stranded DNA structure caused by the echinomycin: DNA interaction.

Increased cerebral blood flow in anemic patients on long-term hemodialytic treatment

CBF was measured in 15 patients on chronic hemodialytic treatment. CBF was measured with xenon-133 inhalation using single photon emission tomography. In addition, computerized tomography (CT) and a neurological examination were done prior to hemodialysis. Mean CBF was 66.2 +/- 17.3 (SD) ml 100 g-1 min-1, which was significantly higher (t-test, p less than 0.05) than for an age-matched control group (54.7 +/- 10.2 ml 100 g-1 min-1). However, the hematocrit for the patients was considerably lower, 0.30 +/- 0.07, as compared to 0.43 +/- 0.03 in the controls. A significant negative correlation was observed between CBF and the hematocrit (y = -1.79x + 120.7, r = -0.71, p less than 0.01). Calculating CBF from this equation in the dialyzed patients using a hematocrit of 0.43 yielded a mean CBF value of 43.7 ml 100 g-1 min-1, i.e., 20% below the expected. Two patients showed a focal CBF decrease. CT showed central or cortical atrophy in five patients, and two had small hypodense lesions. The neurological examination revealed slight to moderate dementia in seven cases. Although mean CBF was found to be increased by 21% as compared to the control group, an even higher CBF level would have been expected to outweigh the decreased oxygen carrying capacity of the blood. The findings suggest a lowered metabolic demand of the brain tissue, probably due to subtle brain damage.

Comparison of myelography combined with postmyelographic spinal CT and MRI in suspected metastatic disease of the spinal canal

Comparison between myelography (MY) and magnetic resonance imaging (MRI) was carried out in 36 patients with clinical suspicion of spinal cord or root compression due to metastatic disease in the spinal canal. In 3 patients metastatic lesions were visualized on MY but not on MRI, while there were no cases with a negative MY and a positive MRI. In 44% of the cases MY alone or combined with postmyelographic CT (pm-CT) showed a larger tumor extension than did MRI, while the opposite occurred in 25%. As for detection of bony metastases and tumor masses localized outside the spine there was no difference between MRI and MY + pm-CT. The results indicate that the choice between MRI and MY + pm-CT still can be based on the availability and quality of the procedure at a given institution.

Selective inhibition of glial cell metabolism in vivo by fluorocitrate

The effect of fluorocitrate on glial and neuronal amino acid metabolism was studied. One nmol of fluorocitrate administered intrastriatally in the rat caused a 95% reduction of glutamine formation from [14C]acetate, a substrate which enters the glial cells selectively. The metabolism of [14C]glucose which enters neurons, was unaffected by fluorocitrate treatment except for the glutamine formation. This is evidence that fluorocitrate is a selective inhibitor of the glial Krebs' cycle. [14C]Citrate and 2-oxoglutarate labelled amino acids in a manner similar to [14C]acetate, which shows that these substrates are taken up and metabolized by glial cells. Differences in the labelling of gamma-aminobutyric acid (GABA) from [14C]acetate and citrate suggest that astrocytes associated with GABAergic and glutamatergic nerve terminals may differ in their preference for amino acid precursors.

Focal reductions of cerebral blood flow in amyotrophic lateral sclerosis: a [99mTc]-d,l-HMPAO SPECT study

We investigated regional cerebral blood flow (rCBF) using the [99mTc]-d,l-HMPAO technique with brain dedicated high resolution single photon emission computer tomography (SPECT) in 14 consecutive patients with amyotrophic lateral sclerosis (ALS), median age 62 years (45-77). Global CBF, expressed in % relative to the cerebellum, was significantly lower (P less than 0.05) in the ALS group (80.5 +/- 6.7%) than in the control group of 14 age-matched healthy volunteers (87.0 +/- 7.5%). Eight patients (57%) had abnormal rCBF distribution maps with reduced flow, primarily in the frontal lobes. Three of the 8 patients with abnormal rCBF had mild to moderate dementia and another one had mild aphasia. None of the patients with normal rCBF distribution maps had dementia. In the group of ALS patients as a whole rCBF was significantly reduced in the frontal cortex, the hippocampus, and the central white matter. We conclude that reduced rCBF, primarily in the frontal lobes, is a frequent finding in patients with ALS. The decreased rCBF may be associated with cognitive deficits and is most likely caused by neuronal degeneration and reduced metabolic needs.

99mTc-d,l-HMPAO and SPECT of the brain in normal aging

Single photon emission computed tomography (SPECT) with 99mTc-d,l-hexamethylpropyleneamine oxime (99mTc-d,l-HMPAO) was used to determine global and regional CBF in 53 healthy subjects aged 21-83 years. For the whole group, global CBF normalized to the cerebellum was 86.4% +/- 8.4 (SD). The contribution of age, sex, and atrophy to variations in global CBF was studied using stepwise multiple regression analysis. There was a significant negative correlation of global CBF with subjective ratings of cortical atrophy, but not with ratings of ventricular size, Evans ratio, sex, or age. In a subgroup of 33 subjects, in whom volumetric measurements of atrophy were performed, cortical atrophy was the only significant determinant for global CBF, accounting for 27% of its variance. Mean global CBF as measured with the 133Xe inhalation technique and SPECT was 54 +/- 9 ml/100 g/min and did not correlate significantly with age. There was a preferential decline of CBF in the frontal cortex with advancing age. The side-to-side asymmetry of several regions of interest increased with age. A method was described for estimation of subcortical CBF, which decreased with advancing cortical atrophy. The relative area of the subcortical low-flow region increased with age. These results are useful in distinguishing the effects of age and simple atrophy from disease effects, when the 99mTc-d,l-HMPAO method is used.

Diagnostic value of spinal computer tomography in patients with intraspinal metastases causing complete block on myelography

The value of post-myelographic spinal computer tomography (CT) was evaluated in cancer patients with spinal metastases causing complete myelographic block. In 22 out of 25 lumbar myelographies (88%) showing complete blockade, sufficient contrast medium had leaked proximally to allow determination of the cranial limit of the metastasis on the CT-scan. It is concluded that the post-myelographic spinal CT can replace a supplementary cervical myelography in the majority of patients with epidural metastasis, causing a complete myelographic block.

Requirements for drug monitoring of verapamil: experience from an unselected group of patients with cardiovascular disease

Serum verapamil and metabolite concentrations were determined by HPLC in 29 patients in routine treatment with verapamil, and 23 were in steady state. Dosage levels and corresponding mean trough levels (+/- S.D.) were as follows: 120 mg daily: 79.1 (+/- 77) nmol/l, 240 mg daily: 173.3 (+/- 200.1) nmol/l, 360 mg daily: 204 (+/- 110.2) nmol/l and 480 mg daily: 361.0 (+/- 231.4) nmol/l. The variation coefficients were 97.3, 115.4, 54.0, and 62.1, respectively, thus showing considerable interpatient variation. Repeated determination of trough levels showed, in contrast, only small intrapatient variation (variation coefficient 35.8, 1.9, and 7.4, at the dosage levels 120, 240 and 340 mg per day). No significant correlation was found between serum verapamil levels age, sex, or weight. No significant effect of digoxin on the concentration of serum verapamil was found. No relation was observed between serum verapamil concentrations and desired effect or side-effects. Two patients showed no measurable serum verapamil, but one of these had detectable levels of metabolites. Such patients may represent subgroups of fast metabolizers or non-absorbers. Measurements of the metabolites nor-verapamil, D 620 and D 617 indicated saturation of the first-pass metabolism. In conclusion, therapeutic drug monitoring is not indicated during routine verapamil treatment, whereas single measurements of verapamil may be warranted in patients not responding to treatment in order to identify fast metabolizers or non-absorbers.

Cerebral computed tomography in paroxysmal atrial fibrillation

Atrial fibrillation (AF) is associated with an increased risk of stroke. In patients with chronic AF, without clinically known cerebrovascular disease, computed tomography (CT) has revealed a high frequency of abnormal low-density areas suggesting old asymptomatic infarcts. To investigate the frequency of such lesions in paroxysmal AF, 30 patients with paroxysmal AF and 30 controls matched in sinus rhythm, without history of cerebrovascular disease, were CT scanned. Four patients with paroxysmal AF (13%) and 3 controls (10%) had abnormal CT scans with areas of low density with sharp demarcation from surrounding tissue. The abnormal areas probably reflected small, clinically silent infarcts. There were no differences between paroxysmal AF and controls in number and size of abnormal areas with apparent tissue loss. In contrast to chronic AF, the risk of such lesions in paroxysmal AF does not seem to be increased compared with matched sinus rhythm controls. This is in agreement with the clinical experience of a low risk of stroke in paroxysmal AF.

Experimental studies of the influence of vigabatrin on the GABA system

1. Studies of the influence of clinically relevant concentrations of vigabatrin on GABA-transaminase and on the release of endogenous GABA were performed in selectively cultured astrocytes and neurons. In addition, the two stereoisomers of vigabatrin were investigated separately. 2. The results indicated a preferential inhibition of neuronal GABA-transaminase by vigabatrin. 3. Only the (S)-form of vigabatrin seems to inhibit GABA-transaminase. This finding corresponds to observations in epileptic animals that the (R)-form exhibits no anticonvulsant effect. 4. Resynthesis of GABA-transaminase, following withdrawal of vigabatrin showed that maximum enzyme activity was obtained within 6 days. This finding corresponds to the persistent effect after withdrawal of the drug in patients, observed in clinical trials. 5. At a concentration of 25 microM, vigabatrin caused a significant increase in the release of endogenous GABA from cultured GABAergic neurons. Although no data on brain levels of the drugs are currently available, judging from vigabatrin blood concentrations in man and from information of brain levels in animals, following chronic treatment, it is conceivable that a sufficiently high concentration of the drug in human brain is obtained to augment GABA release.

Hemoglobin hafnia: alpha 2 (beta 116 (G18) His----Gln)2; a new hemoglobin variant mistaken for glycated hemoglobin

Isoelectric focusing of hemolysate from patients with diabetes mellitus is routinely performed to measure their level of HbA1c (glycated hemoglobin). For a 6 year old boy with diabetes mellitus this analysis showed an HbA1c fraction of approx. 50%, which is very unlikely to occur. The possibility of a hemoglobin variant was considered, and by HPLC-separation the presence of two different beta-chains was shown. One tryptic fragment was found to deviate from the normal, and amino-acid analysis and sequence determination revealed the following amino-acid substitution: beta 116 His----Gln. It is the first reported mutation at this position. Functional studies showed almost normal behaviour, consistent with the fact that the affected persons are without any symptoms. In a family survey we found five nondiabetic members with an abnormality similar to the proband. For the variant we chose the name Hafnia, which is Latin for Copenhagen.

Neuropeptide Y in guinea pig, rabbit, rat and man. Identical amino acid sequence and oxidation of methionine-17

Neuropeptide Y (NPY) was isolated and characterised from acid-ethanol extracts of rabbit and guinea pig brain. In both instances the chromatographic purification was a two-step procedure of gel filtration followed by reverse-phase high-performance liquid chromatography. The amino acid sequence of rabbit and guinea pig NPY was found to be identical to human and rat NPY as deduced from the cDNA structures. With the exception of the porcine peptide, all mammalian NPYs characterised to date have a methionine residue in position 17. This methionine residue is readily oxidized as indicated by the high degree of spontaneous oxidation of peptides found in the rabbit and guinea pig brain extracts and in NPY extracted from a rat phaeochromocytoma cell line. It is concluded that NPY is among the most highly conserved peptides and that NPYs containing methionine in position 17 are prone to oxidation.

Balloon-dilatation of esophageal strictures in children

Dilatation of benign esophageal strictures by means of a balloon-catheter is a well-established procedure in adults. This method is also useful in children. The technique is described and the results of treatment in 10 children are reported. In all our patients the stricture developed after an operation for esophageal atresia with an end-to-end anastomosis. Dilatation with a balloon-catheter seems to have the same or an even better effect than the traditional dilatation with bougies. Complications following balloon-dilatations have been few and negligible in this series and dilatations can be performed using sedation instead of general anaesthesia. Therefore, this method is recommended.

Hippuran renography and scintigraphy in children with myelomeningocele

Long-term surveillance of the urinary tract is necessary in children with myelomeningocele and neurogenic bladder dysfunction. The results of Hippuran renography and scintigraphy were analyzed in 52 cases and compared to those of intravenous urography. In addition the radionuclide evaluation was correlated to the clinical course. It was concluded that renography is a suitable examination for the monitoring of the kidneys and upper urinary tract in these children. A decrease of renal function and drainage may occur without any changes of the clinical state.

The prognosis of surgically treated congenital hydronephrosis after diagnosis in utero

Nine patients with a prenatal ultrasonic diagnosis of unilateral ureteropelvic junction obstruction underwent pyeloplasty in early neonatal life. Based on radiological and renographical assessment of the results, immediate postnatal intervention had no demonstrable advantage over those subjects in a control group who underwent an operation after presenting with symptoms. Half of the children in both groups had normal parenchymal function of the hydronephrotic kidney. Because of the operative complications we found it unacceptable to operate on neonates without symptoms and with normal function of the affected kidney. The advantage of prenatal diagnosis lies in the early recognition of the necessity of close surveillance. The primary indications for surgical intervention should be symptoms and impairment of the hydronephrotic kidney function.

Bronchopleural leakage treated with fibrin sealant and high-frequency positive-pressure ventilation

In a 62-year-old man, left spontaneous pneumothorax appeared 14 days after right pneumonectomy. The large air leakage necessitated thoracotomy and resection of a bullous area in the left upper lobe. Pleurectomy was not performed. The air leakage continued for 14 more days until, at a second left thoracotomy, numerous bullae were oversewn and covered with fibrin sealant. High-frequency positive-pressure ventilation (90 respirations/min, 21 l/min) was used for the following 6 hours. After 18 hours there was no more air leakage during spontaneous ventilation and the patient made a good recovery.