Implementation and adoption of advanced care planning in the elderly trauma patient

Background

Geriatric trauma has high morbidity and mortality, often requiring extensive hospital stays and interventions. The number of geriatric trauma patients is also increasing significantly and accounts for a large proportion of trauma care. Specific geriatric trauma protocols exist to improve care for this complex patient population, who often have various comorbidities, pre-existing medications, and extensive injury within a trauma perspective. These guidelines for geriatric trauma care often suggest early advanced care planning (ACP) discussions and documentation to guide patient and family-centered care.

Methods

A provincial ACP program was implemented in April of 2012, which has since been used by our level 1 trauma center. We applied a before and after study design to assess the documentation of goals of care in elderly trauma patients following implementation of the standardized provincial ACP tool on April 1, 2012.

Results

Documentation of ACP in elderly major trauma patients following the implementation of this tool increased significantly from 16 to 35%. Additionally, secondary outcomes demonstrated that many more patients received goals of care documentation within 24 h of admission, and 93% of patients had goals of care documented prior to intensive care unit (ICU) admission. The number of trauma patients that were admitted to the ICU also decreased from 17 to 5%.

Conclusion

Early advanced care planning is crucial for geriatric trauma patients to improve patient and family-centered care. Here, we have outlined our approach with modest improvements in goals of care documentation for our geriatric population at a level 1 trauma center. We also outline the benefits and drawbacks of this approach and identify the areas for improvement to support improved patient-centered care for the injured geriatric patient. Here, we have provided a framework for others to implement and further develop.

Electronic supplementary material

The online version of this article (10.1186/s13017-018-0201-6) contains supplementary material, which is available to authorized users.

Different Stroke Volumes for the Left and Right Ventricles in the Moving-Actuator Type Total Artificial Heart

A new electromechanical moving-actuator type total artificial heart (TAH) has been developed to solve the imbalance problem without an extra compliance chamber. A different stroke volume was achieved by the large left sac size and the asymmetry of the actuator motion referred to the center position. The left ventricle consists of a double sac with the outer sac attached to the actuator providing active diastolic filling, while the double sac of the right ventricle being free from the actuator, and having sufficient suction produced due to the rigid pump housing. The stroke volume difference between the left and right sac is compensated through the air in the interventricular space of the variable volume (VV) space. Computer simulation based on the geometrical relationships between the blood sacs and the actuator was performed to simulate the physical mechanisms of the moving-actuator type TAH. Results were then compared with the measured pressure changes in various chambers of the pump and the stroke volume differences in mock circulation test. In two acute calf experiments, the balanced left and right atrial pressures were achieved in the moving-actuator type TAH without an extra compliance chamber

Transdisciplinary research for complex One Health issues: a scoping review of key concepts

In order to address the complexity inherent in researching One Health (OH) issues, we support the concept that researchers must transcend individual disciplinary and non-disciplinary boundaries, and move into the realm of transdisciplinary (TD) research approaches. For the purposes of this paper we use the term OH and the concept that OH research is conducted to solve complex health challenges at the animal-human--human-ecosystem interface. TD goes beyond interdisciplinary research to engages disciplines and communities through a unified conceptual framework. In this scoping review we investigated key concepts, definitions and themes in OH and TD based on the peer reviewed literature. We identified nine emerging themes in TD research: (1) education, (2) conflict amongst disciplines, (3) effective communication, (4) shared conceptual framework, (5) leadership, (6) perceived power differentials, (7) community-based methodologies, (8) support for TD research and (9) time and effort. This review provides a synthesized knowledge base that describes the nature, extent of evidence and challenges of engaging in TD initiatives. This knowledge base further provides a foundation for those interested in developing improved strategies for TD collaborative and cross-sectoral research in OH.

SU-E-J-01: Analysis of Acquisition Parameters That Caused Artifacts in Four-Dimensional (4D) CT Images of Targets Undergoing Regular Motion

PURPOSE

The aim of this study was to clarify the impacts of acquisition parameters on artifacts in four-dimensional computed tomography (4D CT) images, such as the partial volume effect (PVE), partial projection effect (PPE), and mis-matching of initial motion phases between adjacent beds (MMimph) in cine mode scanning.

METHODS

A thoracic phantom and two cylindrical phantoms (2 cm diameter and heights of 0.5 cm for No. 1 and 10 cm for No.2) were scanned using 4D CT. For the thoracic phantom, acquisition was started automatically in the first scan with 5 sec and 8 sec of gantry rotation, thereby allowing a different phase at the initial projection of each bed. In the second scan, the initial projection at each bed was manually synchronized with the inhalation phase to minimize the MMimph. The third scan was intentionally un-synchronized with the inhalation phase. In the cylindrical phantom scan, one bed (2 cm) and three beds (6 cm) were used for 2 and 6 sec motion periods. Measured target volume to true volume ratios (MsTrueV) were computed. The relationships among MMimph, MsTrueV, and velocity were investigated.

RESULTS

In the thoracic phantom, shorter gantry rotation provided more precise volume and was highly correlated with velocity when MMimph was minimal. MMimph reduced the correlation. For moving cylinder No. 1, MsTrueV was correlated with velocity, but the larger MMimph for 2 sec of motion removed the correlation. The volume of No. 2 was similar to the static volume due to the small PVE, PPE, and MMimph.

CONCLUSIONS

Smaller target velocity and faster gantry rotation resulted in a more accurate volume description. The MMimph was the main parameter weakening the correlation between MsTrueV and velocity. Without reducing the MMimph, controlling target velocity and gantry rotation will not guarantee accurate image presentation given current 4D CT technology.

Endogenous factors affecting oxidative stability of beef loin, pork loin, and chicken breast and thigh meats

The susceptibility of meats from different animal species (chicken breast [CB] and thigh [CT], pork [PL and beef [BL]) to lipid oxidation was studied. The amounts of TBARS in raw PL, CB, and CT did not change during a 7-d storage period. TBARS values of raw BL, however, significantly increased during 7-d storage because of high heme iron content, high lipoxygenase-like activities, and low 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activities. Ferric ion reducing capacities (FRC) were detected in all raw meats, but their characteristics were different: storage-unstable in CB and CT and storage-stable in PL and BL. Ferric ion reducing capacities in raw CB and CT was higher than those of PL and BL, and could be related to their high oxidative stability. The TBARS values of cooked meat increased significantly with storage. The rates of TBARS increase in cooked CT and BL were significantly higher than those of cooked CB and PL after a 7-d storage. Nonheme iron content in cooked BL was higher than other meats and increased significantly after 7 d. Cooked BL had a higher amount of heat-stable FRC, which acted as a prooxidant in the presence of high free ionic irons, than other meats. Therefore, high heat-stable FRC and increased nonheme iron content in cooked BL were responsible for its high susceptibility to lipid oxidation. Despite relatively low nonheme iron and heat-stable FRC levels, cooked CT showed similar levels of TBARS to cooked BL after a 7-d storage because of its high PUFA content.

Phase I trial of neoadjuvant concurrent chemoradiotherapy with S-1 and weekly irinotecan in locally advanced rectal cancer

14543

Background: S-1 is a novel, orally administered 5-FU analogue and is known of radiosensitizer. The aim of this study was to establish the feasibility and efficacy of S-1 in combination with weekly irionotecan with concurrent pelvic radiotherapy (RT) in patients with locally advanced rectal cancer. Methods: Clinical stage T3–4 or N+(on MRI) rectal adenocarcinoma patients received weekly irinotecan 40mg/m2(day1,8,15,22,29) and S-1 at dose levels of 40, 50, 60 and 70mg/m2 (5days a week from day 1 to 38) according to phase I methodology. Concurrently conventional RT was given at daily fractions of 1.8 Gy on 5 days a week for a total dose of 50.4 (45 + 5.4)Gy. Surgery was performed 4–8 weeks following completion of chemoradiation. Results: A total 16 patients (10M/7F, median age 46 years, ECOG PS0–1) were enrolled between August 2005 and July 2006. One pt withdrew the consent during CCRT. Dose-limiting toxicity (DLT) occurred at 50mg/m2 of S-1 in one of six pts (G4 cerebral infarction). At dose of 60, 70mg/m2 of S-1, no DLT occurred. G3/4 toxicties were rare. Fifthteen pts underwent surgery and R0 resection was achieved in 13 pts. Four pts (25.0%) had a pathological complete response. Conclusions: The recommended dose (RD) for further study is S-1 70mg/m2 with irinotecan and radiotherapy. Neoadjuvant S-1/irinotecan/RT is feasible and well tolerated. Phase II trial is being conducted.

No significant financial relationships to disclose.

Genomics and the evolution of aminoacyl-tRNA synthesis

Translation is the process by which ribosomes direct protein synthesis using the genetic information contained in messenger RNA (mRNA). Transfer RNAs (tRNAs) are charged with an amino acid and brought to the ribosome, where they are paired with the corresponding trinucleotide codon in mRNA. The amino acid is attached to the nascent polypeptide and the ribosome moves on to the next codon. Thus, the sequential pairing of codons in mRNA with tRNA anticodons determines the order of amino acids in a protein. It is therefore imperative for accurate translation that tRNAs are only coupled to amino acids corresponding to the RNA anticodon. This is mostly, but not exclusively, achieved by the direct attachment of the appropriate amino acid to the 3'-end of the corresponding tRNA by the aminoacyl-tRNA synthetases. To ensure the accurate translation of genetic information, the aminoacyl-tRNA synthetases must display an extremely high level of substrate specificity. Despite this highly conserved function, recent studies arising from the analysis of whole genomes have shown a significant degree of evolutionary diversity in aminoacyl-tRNA synthesis. For example, non-canonical routes have been identified for the synthesis of Asn-tRNA, Cys-tRNA, Gln-tRNA and Lys-tRNA. Characterization of non-canonical aminoacyl-tRNA synthesis has revealed an unexpected level of evolutionary divergence and has also provided new insights into the possible precursors of contemporary aminoacyl-tRNA synthetases.

A single amidotransferase forms asparaginyl-tRNA and glutaminyl-tRNA in Chlamydia trachomatis

Aminoacyl-tRNA is generally formed by aminoacyl-tRNA synthetases, a family of 20 enzymes essential for accurate protein synthesis. However, most bacteria generate one of the two amide aminoacyl-tRNAs, Asn-tRNA or Gln-tRNA, by transamidation of mischarged Asp-tRNA(Asn) or Glu-tRNA(Gln) catalyzed by a heterotrimeric amidotransferase (encoded by the gatA, gatB, and gatC genes). The Chlamydia trachomatis genome sequence reveals genes for 18 synthetases, whereas those for asparaginyl-tRNA synthetase and glutaminyl-tRNA synthetase are absent. Yet the genome harbors three gat genes in an operon-like arrangement (gatCAB). We reasoned that Chlamydia uses the gatCAB-encoded amidotransferase to generate both Asn-tRNA and Gln-tRNA. C. trachomatis aspartyl-tRNA synthetase and glutamyl-tRNA synthetase were shown to be non-discriminating synthetases that form the misacylated tRNA(Asn) and tRNA(Gln) species. A preparation of pure heterotrimeric recombinant C. trachomatis amidotransferase converted Asp-tRNA(Asn) and Glu-tRNA(Gln) into Asn-tRNA and Gln-tRNA, respectively. The enzyme used glutamine, asparagine, or ammonia as amide donors in the presence of either ATP or GTP. These results suggest that C. trachomatis employs the dual specificity gatCAB-encoded amidotransferase and 18 aminoacyl-tRNA synthetases to create the complete set of 20 aminoacyl-tRNAs.

Cytotoxic triterpenoides from Alismatis Rhizoma

Four prostane-type triterpenes were isolated from a methanol extract of Alismatis Rhizoma by bioassay-guided isolation using in vitro cytotoxic assay. The compounds were identified as alisol B 23-acetate (1), alisol C 23-acetate (2), alisol B (3), alisol A 24-acetate (4) by spectroscopic methods. Amongst the compounds, alisol B (3) showed significant cytotoxicity against SK-OV3, B16-F10, and HT1080 cancer cell lines with ED50 values of 7.5, 7.5, 4.9 microg/ml, respectively.

A new naphthoquinone from Pyrola japonica

A new naphthoquinone, 5,8-dihydro-2,7-dimethyl-[1,4]naphthoquinone (1), which was named 5,8-dihydrochimaphilin, isolated from an ethyl acetate soluble fraction from the root of Pyrola japonica, together with chimaphilin (2). Compound 1 was transformed rapidly to 2 upon exposure to air by HPLC analysis. This fact supported that chimaphilin (2) may be an artifact from 1.

Neonatal exposure to antigen primes the immune system to develop responses in various lymphoid organs and promotes bystander regulation of diverse T cell specificities

Neonatal exposure to Ag has always been considered suppressive for immunity. Recent investigations, however, indicated that the neonatal immune system could be guided to develop immunity. For instance, delivery of a proteolipid protein (PLP) peptide on Ig boosts the neonatal immune system to develop responses upon challenge with the PLP peptide later. Accordingly, mice given Ig-PLP at birth and challenged with the PLP peptide as adults developed proliferative T cells in the lymph node that produced IL-4 instead of the usual Th1 cytokines. However, the spleen was unresponsive unless IL-12 was provided. Herein, we wished to determine whether such a neonatal response is intrinsic to the PLP peptide or could develop with an unrelated myelin peptide as well as whether the T cell deviation is able to confer resistance to autoimmunity involving diverse T cell specificities. Accordingly, the amino acid sequence 87-99 of myelin basic protein was expressed on the same Ig backbone, and the resulting Ig-myelin basic protein chimera was tested for induction of neonatal immunity and protection against experimental allergic encephalomyelitis. Surprisingly, the results indicated that immunity developed in the lymph node and spleen, with deviation of T cells occurring in both organs. More striking, the splenic T cells produced IL-10 in addition to IL-4, providing an environment that facilitated bystander deviation of responses to unrelated epitopes and promoted protection against experimental allergic encephalomyelitis involving diverse T cell specificities. Thus, neonatal exposure to Ag can prime responses in various organs and sustain regulatory functions effective against diverse autoreactive T cells.

Neonatal immunity develops in a transgenic TCR transfer model and reveals a requirement for elevated cell input to achieve organ-specific responses

In recent years, it has become clear that neonatal exposure to Ag induces rather than ablates T cell immunity. Moreover, rechallenge with the Ag at adult age can trigger secondary responses that are distinct in the lymph node vs the spleen. The question addressed in this report is whether organ-specific secondary responses occur as a result of the diversity of the T cell repertoire or could they arise with homogeneous TCR-transgenic T cells. To test this premise, we used the OVA-specific DO11.10 TCR-transgenic T cells and established a neonatal T cell transfer system suitable for these investigations. In this system, neonatal T cells transferred from 1-day-old DO11.10/SCID mice into newborn (1-day-old) BALB/c mice migrate to the host's spleen and maintain stable frequency. The newborn BALB/c hosts were then given Ig-OVA, an Ig molecule carrying the OVA peptide, and challenged with the OVA peptide in CFA at the age of 7 wk; then their secondary responses were analyzed. The findings show that the lymph node T cells were deviated and produced IL-4 instead of IFN-gamma and the splenic T cells, although unable to proliferate or produce IFN-gamma, secreted a significant level of IL-2. Supply of exogenous IL-12 during Ag stimulation restores both proliferation and IFN-gamma production by the splenic T cells. This restorable form of splenic unresponsiveness referred to as IFN-gamma-dependent anergy required a transfer of a high number of neonatal DO11.10/SCID T cells to develop. Thus, the frequency of neonatal T cell precursors rather than repertoire diversity exerts control on the development of organ-specific neonatal immunity.

Genomics and the evolution of aminoacyl-tRNA synthesis

Translation is the process by which ribosomes direct protein synthesis using the genetic information contained in messenger RNA (mRNA). Transfer RNAs (tRNAs) are charged with an amino acid and brought to the ribosome, where they are paired with the corresponding trinucleotide codon in mRNA. The amino acid is attached to the nascent polypeptide and the ribosome moves on to the next codon. Thus, the sequential pairing of codons in mRNA with tRNA anticodons determines the order of amino acids in a protein. It is therefore imperative for accurate translation that tRNAs are only coupled to amino acids corresponding to the RNA anticodon. This is mostly, but not exclusively, achieved by the direct attachment of the appropriate amino acid to the 3'-end of the corresponding tRNA by the aminoacyl-tRNA synthetases. To ensure the accurate translation of genetic information, the aminoacyl-tRNA synthetases must display an extremely high level of substrate specificity. Despite this highly conserved function, recent studies arising from the analysis of whole genomes have shown a significant degree of evolutionary diversity in aminoacyl-tRNA synthesis. For example, non-canonical routes have been identified for the synthesis of Asn-tRNA, Cys-tRNA, Gln-tRNA and Lys-tRNA. Characterization of non-canonical aminoacyl-tRNA synthesis has revealed an unexpected level of evolutionary divergence and has also provided new insights into the possible precursors of contemporary aminoacyl-tRNA synthetases.

Neonatal exposure to antigen induces a defective CD40 ligand expression that undermines both IL-12 production by APC and IL-2 receptor up-regulation on splenic T cells and perpetuates IFN-gamma-dependent T cell anergy

T cell deletion and/or inactivation were considered the leading mechanisms for neonatal tolerance. However, recent investigations have indicated that immunity develops at the neonatal stage but evolves to guide later T cell responses to display defective and/or biased effector functions. Although neonatal-induced T cell modulation provides a useful approach to suppress autoimmunity, the mechanism underlying the biased function of the T cells remains unclear. In prior studies, we found that exposure of newborn mice to Ig-PLP1, a chimera expressing the encephalitogenic proteolipid protein (PLP) sequence 139-151, induced deviated Th2 lymph node cells producing IL-4 instead of IL-2 and anergic splenic T cells that failed to proliferate or produce IFN-gamma yet secreted significant amounts of IL-2. However, if assisted with IFN-gamma or IL-12, these anergic splenic T cells regained full responsiveness. The consequence of such biased/defective T cells responses was protection of the mice against experimental allergic encephalomyelitis. In this study, investigations were performed to delineate the mechanism underlying the novel form of IFN-gamma-dependent splenic anergy. Our findings indicate that CD40 ligand expression on these splenic T cells is defective, leading to noneffective cooperation between T lymphocytes and APCs and a lack of IL-12 production. More striking, this cellular system revealed a requirement for IL-2R expression for CD40 ligand-initiated, IL-12-driven progression of T cells into IFN-gamma production.

[Exploration of high expressions of retroviral vectors containing hFIX minigene in murine myoblast cells]

OBJECTIVE

To explore the effect of different vector structure on hF IX protein expression in murine myoblasts in order to construct more efficient expression vector for my oblast-mediated gene therapy for hemophilia B.

METHODS

Three types of retroviral vectors pLMe2 IX m(2)SN (forward Me2: Me2 inserted into enhancer region of 3'LTR in forward orientation), pLMe2 IX m(2)SN (reversed Me2) and pL IX m(2)SN which contained intron m(2) and two copies of MCK enhancer (Me2) were transferred into packaging cell line PA317. The hFIX expression level in selected single and mixed clones of stably transfected myoblasts were determined by ELISA and PCR.

RESULTS

There was statistically significant difference in hFIX expression levels among the four vectors tested. The expression order was LMe2 IX m(2)SN (forward) > LMe2 IX m(2)SN (reversed) > L IXm(2)SN > L IX SN. The hF IX expression level of forward Me2 vector was higher than that of reversed one, because of one or two copies of reversed Me in the 5'LTR being deleted in the genome of myoblasts, but the orientation of Me or Me2 remained unchanged.

CONCLUSIONS

To select a tissue-specific enhancer and optimize FIX minigene construction are effective methods for increasing the expression level. Forward Me2 vector can express hFIX more stably than the reversed one.

Radiographic comparison of diaphyseal grit blasted with smooth surface stems by matched pair analysis

A matched pair comparison of two groups of 42 patients who had a total hip arthroplasty with uncemented fixation of the femoral stem with proximal porous coating and distal grit blasting were compared with a stem of identical design except with diaphyseal smooth surfaces. Radiographic analysis was done to determine differences in fixation and bone remodeling at the 2-year followup, and these results were compared with clinical results. The method used for measuring cortical thickness was semiquantitative, with measurements done at 15 1-cm increments beginning at 3 cm distal to the midlesser trochanter. This study determined whether, with an identical stem design, diaphyseal biologic fixation, rather than mechanical fixation, would provide better fixation without significant stress shielding differences. Seven percent of grit blasted stems had radiolucent lines in Gruen Zones 3 to 5, compared with 79% of smooth stems. The smooth stem was on average one size larger so the stress shielding was not different between matched pairs. There was a distinct pattern of adaptive remodeling that occurred in the femur with both stem surfaces. Bone loss was greatest in the proximal medial and proximal posterior bone and occurred along the entire anterior cortex. Bone thickening occurred in the distal medial and posterior cortices and extended below the tip of the prosthesis.

A dual-specificity aminoacyl-tRNA synthetase in the deep-rooted eukaryote Giardia lamblia

Cysteinyl-tRNA (Cys-tRNA) is essential for protein synthesis. In most organisms the enzyme responsible for the formation of Cys-tRNA is cysteinyl-tRNA synthetase (CysRS). The only known exceptions are the euryarchaea Methanococcus jannaschii and Methanobacterium thermoautotrophicum, which do not encode a CysRS. Deviating from the accepted concept of one aminoacyl-tRNA synthetase per amino acid, these organisms employ prolyl-tRNA synthetase as the enzyme that carries out Cys-tRNA formation. To date this dual-specificity prolyl-cysteinyl-tRNA synthetase (ProCysRS) is only known to exist in archaea. Analysis of the preliminary genomic sequence of the primitive eukaryote Giardia lamblia indicated the presence of an archaeal prolyl-tRNA synthetase (ProRS). Its proS gene was cloned and the gene product overexpressed in Escherichia coli. By using G. lamblia, M. jannaschii, or E. coli tRNA as substrate, this ProRS was able to form Cys-tRNA and Pro-tRNA in vitro. Cys-AMP formation, but not Pro-AMP synthesis, was tRNA-dependent. The in vitro data were confirmed in vivo, as the cloned G. lamblia proS gene was able to complement a temperature-sensitive E. coli cysS strain. Inhibition studies of CysRS activity with proline analogs (thiaproline and 5'-O-[N-(l-prolyl)-sulfamoyl]adenosine) in a Giardia S-100 extract predicted that the organism also contains a canonical CysRS. This prediction was confirmed by cloning and analysis of the corresponding cysS gene. Like a number of archaea, Giardia contains two enzymes, ProCysRS and CysRS, for Cys-tRNA formation. In contrast, the purified Saccharomyces cerevisiae and E. coli ProRS enzymes were unable to form Cys-tRNA under these conditions. Thus, the dual specificity is restricted to the archaeal genre of ProRS. G. lamblia's archaeal-type prolyl- and alanyl-tRNA synthetases refine our understanding of the evolution and interaction of archaeal and eukaryal translation systems.

The heterotrimeric Thermus thermophilus Asp-tRNA(Asn) amidotransferase can also generate Gln-tRNA(Gln)

Thermus thermophilus strain HB8 is known to have a heterodimeric aspartyl-tRNA(Asn) amidotransferase (Asp-AdT) capable of forming Asn-tRNA(Asn) [Becker, H.D. and Kern, D. (1998) Proc. Natl. Acad. Sci. USA 95, 12832-12837]. Here we show that, like other bacteria, T. thermophilus possesses the canonical set of amidotransferase (AdT) genes (gatA, gatB and gatC). We cloned and sequenced these genes, and constructed an artificial operon for overexpression in Escherichia coli of the thermophilic holoenzyme. The overproduced T. thermophilus AdT can generate Gln-tRNA(Gln) as well as Asn-tRNA(Asn). Thus, the T. thermophilus tRNA-dependent AdT is a dual-specific Asp/Glu-AdT resembling other bacterial AdTs. In addition, we observed that removal of the 44 carboxy-terminal amino acids of the GatA subunit only inhibits the Asp-AdT activity, leaving the Glu-AdT activity of the mutant AdT unaltered; this shows that Asp-AdT and Glu-AdT activities can be mechanistically separated.

Neonatal tolerant immunity for vaccination against autoimmunity

Autoimmunity arises when the immune system no longer tolerates self and precipitates lymphocyte reactivity against our own antigens. Although the developing T cell repertoire is constantly purging, self-recognition events do exist when such tight control is evaded and autoreactive lymphocytes escape the thymus (the sites of T cell development) and migrate to the periphery. Upon activation these autoreactive cells may exert aggressive behavior toward one's own tissues and organs leading to autoimmune disease. Multiple sclerosis, Rheumatoid arthritis, and type I diabetes are autoimmune diseases mediated by autoreactive T cells. A logical approach to prevent such autoimmunity would be to reprogram those lymphocytes to tolerate the self antigen. Injection of antigen at the neonatal stage promotes a state of tolerance such that successive encounter with antigen does not precipitate aggressive reactions. The mechanism underlying neonatal tolerance involves priming of T cells whose effector functions do not cause inflammatory reactions upon recognition of antigen but rather induce protective immunity. This form of tolerant immunity provides an attractive strategy for vaccination against autoimmunity. Herein, it is shown that neonatal exposure to a self-peptide-immunoglobulin chimera drives a tolerant immunity toward the self-peptide and protects against the autoimmune disease, experimental allergic encephalomyelitis.

Differential control of neonatal tolerance by antigen dose versus extended exposure and adjuvant

Ig-PLP1, an immunoglobulin (Ig) chimera carrying the encephalitogenic proteolipid protein (PLP) sequence 139-151 (PLP1), induces neonatal tolerance in mice and confers resistance to experimental allergic encephalomyelitis (EAE) without the need for incomplete Freund's adjuvant (IFA). The mechanism underlying such tolerance involves organ-specific T cell regulation characterized by lymph node deviation and an unusual IFNgamma-dependent splenic anergy. This form of T cell modulation may prove useful for prevention of autoimmunity. However, since the neonatal period is susceptible to regulation, further investigations are necessary to define parameters required to establish regimens suitable for optimal protection against disease. Therefore, studies were carried out to investigate the effect that IFA, the dose of Ig-PLP1, and the number of Ig-PLP1 injections might have on Ig-PLP1-mediated neonatal tolerance and protection against disease. Herein it is reported that as little as 1 microg of Ig-PLP1 supported IFNgamma-dependent splenic anergy but lymph node deviation and protection against disease strengthened as the dose of tolerogen increased. However, when a two-injection regimen was applied, resistance to disease was observed but the mechanism manifested proliferative and cytokine unresponsiveness in both lymphoid organs. Furthermore, the use of IFA along with Ig-PLP1 yielded a suppressive mechanism similar to that of the two-injection regimen. Therefore, the dose of Ig-PLP1 displays a quantitative influence, while the number of injections of Ig-PLP1 and the presence of IFA rather drive qualitative influences on such tolerance.

Potentiating effect of obacunone from Dictamnus dasycarpus on cytotoxicity of microtuble inhibitors, vincristine, vinblastine and taxol

The limonoid triterpene, obacunone, was found to enhance the cytotoxicity of vincristine against L1210 cells by approximately 10-fold. Further, it was found that the cytotoxicity of other microtubule inhibitors such as vinblastine and taxol in drug-sensitive KB-3-1 cells as well as in multidrug-resistant KB-V1 cells was enhanced greatly in the presence of obacunone. On the other hand, there was no remarkable potentiating effect of obacunone on the cytotoxicity of other antineoplastic drugs such as adriamycin, cisplatin or 5-fluorouracil. From these results, it is implied that the potentiating action of obacunone may be limited to microtubule inhibitors.