Radicava/Edaravone Findings in Biomarkers From Amyotrophic Lateral Sclerosis (REFINE-ALS): Protocol and Study Design

Objectives

To identify putative biomarkers that may serve as quantifiable, biological, nonclinical measures of the pharmacodynamic effect of edaravone in amyotrophic lateral sclerosis (ALS) and to report real-world treatment outcomes.

Methods

This is a prospective, observational, longitudinal, multicenter (up to 40 sites) US study (Clinicaltrials.gov; NCT04259255) with at least 200 patients with ALS who will receive edaravone for 24 weeks (6 cycles; Food and Drug Administration-approved regimen). All participants must either be treatment naive for edaravone or be more than 1 month without receiving any edaravone dose before screening. Biomarker quantification and other assessments will be performed at baseline (before cycle 1) and during cycles 1, 3, and 6. Selected biomarkers of oxidative stress, inflammation, neuronal injury and death, and muscle injury, as well as biomarker discovery panels (EpiSwitch and SOMAscan), will be evaluated and, when feasible, compared with biobanked samples. Clinical efficacy assessments will include the ALS Functional Rating Scale-Revised, King's clinical staging, ALS Assessment Questionnaire-40, Appel ALS Score (Rating Scale), slow vital capacity, hand-held dynamometry and grip strength, and time to specified states of disease progression or death. DNA samples will also be collected for potential genomic evaluation. The predicted rates of progression and survival, and their potential correlations with biomarkers, will be evaluated. Adverse events related to the study will be reported.

Results

The study is estimated to be completed in 2022 with an interim analysis planned.

Conclusions

Findings may help to further the understanding of the pharmacodynamic effect of edaravone, including changes in biomarkers, in response to treatment.

Current and Future Projections of Amyotrophic Lateral Sclerosis in the United States Using Administrative Claims Data

BACKGROUND

Various methodologies have been reported to assess the real-world epidemiology of amyotrophic lateral sclerosis (ALS) in the United States. The aim of this study was to estimate the prevalence, incidence, and geographical distribution of ALS using administrative claims data and to model future trends in ALS epidemiology.

METHODS

We performed a retrospective analysis of deidentified administrative claims data for >100 million patients, using 2 separate databases (IBM MarketScan Research Databases and Symphony Health Integrated DataVerse [IDV]), to identify patients with ALS. We evaluated disease prevalence, annual incidence, age- and population-controlled geographical distribution, and expected future trends.

RESULTS

From 2013 to 2017, we identified 7,316 and 35,208 ALS patients from the MarketScan databases and IDV, respectively. Average annual incidence estimates were 1.48 and 1.37 per 100,000 and point prevalence estimates were 6.85 and 5.16 per 100,000 and in the United States for the MarketScan databases and IDV, respectively. Predictive modeling estimates are reported out to the year 2060 and demonstrate an increasing trend in both incident and prevalent cases.

CONCLUSIONS

This study provides incidence and prevalence estimates as well as geographical distribution for what the authors believe to be the largest ALS population studied to date. By using 2 separate administrative claims data sets, confidence in our estimates is increased. Future projections based on either database demonstrate an increase in ALS cases, which has also been seen in other large-scale ALS studies. These results can be used to help improve the allocation of healthcare resources in the future.

Clinical staging in amyotrophic lateral sclerosis: analysis of Edaravone Study 19

OBJECTIVE

This was a post hoc analysis of the Edaravone Phase III Study MCI186-19 ('Study 19') to examine the utility of clinical staging systems as end points in clinical trials in amyotrophic lateral sclerosis (ALS).

METHODS

Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised item scores from Study 19 were retrospectively mapped to King's stage and Milano-Torino staging (MiToS) stage. We assessed the percentage of patients who experienced progression in King's and MiToS stages during Study 19. We also assessed disease progression in subgroups of patients according to baseline King's stage.

RESULTS

During double-blind treatment, the percentage of patients who experienced a progression in King's stage was lower for edaravone (42.0%, 95% CI 30.4% to 53.6%) than placebo (55.9%, 95% CI 44.1% to 67.6%). The most pronounced effect was noted among patients who were in stage 1 and was maintained throughout open-label treatment. An analysis of a ≥2-stage progression in MiToS stage showed no difference between treatment arms during double-blind treatment, but during the open-label period, more rapid progression was noted among patients in the placebo-edaravone arm than among those in the edaravone-edaravone arm (log-rank test, p<0.001).

CONCLUSIONS

The King's and MiToS staging systems provided utility in assessing clinical progression in Edaravone Study 19. These findings may support the use of staging systems as end points in ALS clinical trials and to understand the timing of benefit as measured by these scales.

Ground and In-Flight Calibration of the OSIRIS-REx Camera Suite

The OSIRIS-REx Camera Suite (OCAMS) onboard the OSIRIS-REx spacecraft is used to study the shape and surface of the mission's target, asteroid (101955) Bennu, in support of the selection of a sampling site. We present calibration methods and results for the three OCAMS cameras-MapCam, PolyCam, and SamCam-using data from pre-flight and in-flight calibration campaigns. Pre-flight calibrations established a baseline for a variety of camera properties, including bias and dark behavior, flat fields, stray light, and radiometric calibration. In-flight activities updated these calibrations where possible, allowing us to confidently measure Bennu's surface. Accurate calibration is critical not only for establishing a global understanding of Bennu, but also for enabling analyses of potential sampling locations and for providing scientific context for the returned sample.

Ground and In-Flight Calibration of the OSIRIS-REx Camera Suite

The OSIRIS-REx Camera Suite (OCAMS) onboard the OSIRIS-REx spacecraft is used to study the shape and surface of the mission's target, asteroid (101955) Bennu, in support of the selection of a sampling site. We present calibration methods and results for the three OCAMS cameras-MapCam, PolyCam, and SamCam-using data from pre-flight and in-flight calibration campaigns. Pre-flight calibrations established a baseline for a variety of camera properties, including bias and dark behavior, flat fields, stray light, and radiometric calibration. In-flight activities updated these calibrations where possible, allowing us to confidently measure Bennu's surface. Accurate calibration is critical not only for establishing a global understanding of Bennu, but also for enabling analyses of potential sampling locations and for providing scientific context for the returned sample.

The Relationship of Transcranial Doppler Ultrasonography with Attention, Motor, and Social-Emotional Functioning in Pediatric Sickle Cell Disease

Objective

Children with sickle cell disease (SCD) are at greater risk for certain neuropsychological deficits due to their medical condition and associated complications. Previous studies have explored the relationship between Transcranial Doppler (TCD) ultrasonography and various domains of neuropsychological functioning in pediatric SCD populations; however, these studies are dated, present variable and inconsistent findings, and are somewhat limited in scope. The goal of this study was to update and expand upon previous research by examining the predictive relationship of TCD results with measures of attention, motor, and social-emotional functioning.

Methods

Thirty-six patients ages 3-19 with SCD with no known history of stroke, with TCD completed within the past 12 months, underwent a brief neuropsychological exam. Attention, motor, and social-emotional functioning were assessed as appropriate for age using the Conners Continuous Performance Test (K-CPT2/CPT3), Purdue Pegboard, and PROMIS, respectively. TCD values were gathered via medical record review, using the highest value of most recent TCD.

Results

TCD significantly predicted certain aspects of attention and motor ability, but not social-emotional functioning. Specifically, TCD significantly predicted Detectability (p = .005), Omissions (p = .001), Commissions (p = .012), Perseverations (p = .035), and HRT SD (p = .046) on K-CPT2/CPT-3 and the non-dominant (p = .009) and bilateral (p = .024) trial scores on the Purdue Pegboard.

Conclusion

This study provides new evidence that TCD may be predictive of motor functioning in pediatric SCD. Results confirm that TCD is predictive of attentional function, though subdomains impacted varied from previous research. While no significant relationship between psychosocial symptoms and TCD were identified, further studies utilizing more comprehensive measurement within this domain is warranted.

Immunological responses and evaluation of the protection in dairy cows vaccinated with staphylococcal surface proteins

Bovine mastitis is a significant cause of economic losses in the dairy industry. Staphylococcus aureus is one of the most common contagious mastitis pathogens, whereas Staphylococcus chromogenes increasingly became a significant cause of subclinical mastitis in dairy cows. Current mastitis control measures are not effective on all mastitis pathogens. There is no effective vaccine to control Staphylococcal mastitis in dairy cows. The objective of this study was to evaluate the immune responses and protection in dairy cows vaccinated with S. aureus surface proteins (SASP) or S. chromogenes surface proteins (SCSP). We divided eighteen Holstein dairy cows randomly into three groups of 6 animals each. We vaccinated group 1 and 2 animals with SASP and SCSP with Emulsigen-D adjuvant, respectively. We injected control (group 3) animals with PBS (pH 7.2) in Emulsigen®-D. We vaccinated animals three times at 28 and 14 days before drying off, and at dry off. Two weeks after the third vaccination, we challenged each animal by dipping all teats in S. aureus culture suspension once daily for 14 consecutive days. We evaluated milk or mammary secretion and serum antibody titers during vaccination and challenge periods. We evaluated milk samples for the number of bacteria shedding and somatic cell counts (SCC). Out of six cows vaccinated with SASP, one cow was removed from the study due to injury, two were infected clinically, another two were infected subclinically, and the remaining cow was not infected. No SCSP vaccinated cows developed clinical or subclinical mastitis. Out of six control cows, two developed clinical mastitis whereas four were infected subclinically. The SCSP vaccine cross-protected against S. aureus mastitis and reduced number of S. aureus shedding in milk. We concluded that the SCSP is a promising vaccine to control Staphylococcal mastitis in dairy cows.

Immunoglobulin Binding Properties of the Prosorba Immunadsorption Column in Treatment of Rheumatoid Arthritis

Studies of the humoral effects of the Prosorba column were conducted in conjunction with the Phase 3 trial of Prosorba versus sham therapy for rheumatoid arthritis (RA). When perfused with normal human plasma in vitro, Prosorba bound predominantly IgG with a maximal capacity of approximately 462 g of Ig per Prosorba column, equal to about 1.5% of circulating IgG. Prosorba treatment did not alter the concentrations of albumin, IgG, IgM, and IgA in 3 RA patients, except for a small dilutional effect. Kinetic studies demonstrated that Prosorba removed IgG > IgM, IgA, and IgM rheumatoid factor (RF) during the initial moments of apheresis and almost exclusively IgM RF after 15 min. No net protein removal occurred at > or = 60 min. Mean values of circulating immune complexes (CICs) were not significantly decreased by 12 weekly treatments. Complement was activated by the apheresis system upstream of the Prosorba column without changing C3 or C4 levels. We conclude that the Prosorba mechanism of action in RA is not bulk removal of Ig, but might involve modification of the CIC repertoire and could include, but not be limited to, effects related to complement activation.

Anti-adhesion molecule therapy as an interventional strategy for autoimmune inflammation

Functional inactivation of leukocyte adhesion molecules has been used to intervene in the development of tissue injury in experimental models of postperfusion infarction as well as autoimmune inflammation. We investigated the use of humanized monoclonal antibodies (mAb) against CD18 in the treatment of five patients with vasculitic tissue injury sufficient to threaten infarction or gangrene. The treatment was monitored in three ways: (i) whole-body gamma camera scintiscanning of autologous indium-labeled PMN, (ii) an index of the therapeutic inhibition of adhesion derived from comparison pre, during, and post mAb treatment of the ability of patients' PMN to be aggregated after activation by fMLP, and (iii) flow cytometric analysis of PMN CD18 expression. Four of five patients given anti-CD18 at 20 mg/day for up to 3 weeks showed prompt clinical improvement, with healing of the ulceration and restoration of limb function within 4 weeks, which was sustained. The fifth patient, who was not doing well clinically, decided to withdraw from all active treatment: at autopsy there was no evidence of the underlying vasculitis evident pretreatment. Our findings suggest that anti-adhesion molecule treatment might be an effective immediate treatment in severe vasculitis especially when tissue viability is threatened by progressive infarction and/or development of gangrene.

Truncated RanGAP encoded by the Segregation Distorter locus of Drosophila

Segregation Distorter (SD) in Drosophila melanogaster is a naturally occurring meiotic drive system in which the SD chromosome is transmitted from SD/SD+ males in vast excess over its homolog owing to the induced dysfunction of SD+-bearing spermatids. The Sd locus is the key distorting gene responsible for this phenotype. A genomic fragment from the Sd region conferred full distorting activity when introduced into the appropriate genetic background by germline transformation. The only functional product encoded by this fragment is a truncated version of the RanGAP nuclear transport protein. These results demonstrate that this mutant RanGAP is the functional Sd product.

Male sterility and meiotic drive associated with sex chromosome rearrangements in Drosophila. Role of X-Y pairing

In Drosophila melanogaster, deletions of the pericentromeric X heterochromatin cause X-Y nondisjunction, reduced male fertility and distorted sperm recovery ratios (meiotic drive) in combination with a normal Y chromosome and interact with Y-autosome translocations (T(Y;A)) to cause complete male sterility. The pericentromeric heterochromatin has been shown to contain the male-specific X-Y meiotic pairing sites, which consist mostly of a 240-bp repeated sequence in the intergenic spacers (IGS) of the rDNA repeats. The experiments in this paper address the relationship between X-Y pairing failure and the meiotic drive and sterility effects of Xh deletions. X-linked insertions either of complete rDNA repeats or of rDNA fragments that contain the IGS were found to suppress X-Y nondisjunction and meiotic drive in Xh-/Y males, and to restore fertility to Xh-/T(Y;A) males for eight of nine tested Y-autosome translocations. rDNA fragments devoid of IGS repeats proved incapable of suppressing either meiotic drive or chromosomal sterility. These results indicate that the various spermatogenic disruptions associated with X heterochromatic deletions are all consequences of X-Y pairing failure. We interpret these findings in terms of a novel model in which misalignment of chromosomes triggers a checkpoint that acts by disabling the spermatids that derive from affected spermatocytes.

Rapid resolution of chronic colitis in the cotton-top tamarin with an antibody to a gut-homing integrin alpha 4 beta 7

BACKGROUND & AIMS

Integrins play diverse roles in cellular actions and signalling in the immune system. In the context of mucosal immune responses, the integrin alpha 4 beta 7 has received particular attention because of its intimate involvement in lymphocyte recruitment to normal gastrointestinal mucosa and associated lymphoid tissue. The aim of this study was to determine the functional relevance of alpha 4 beta 7 in the pathogenesis of colonic inflammatory disease using the colitic cotton-top tamarin, an animal model of human ulcerative colitis.

METHODS

Chronically colitic cotton-top tamarins were given either a cross-reactive monoclonal antibody to human alpha 4 beta 7 or an irrelevant control monoclonal antibody. The animals were then evaluated clinically and mucosal biopsy specimens assessed by histological and quantitative morphometric analysis.

RESULTS

A blocking monoclonal antibody to alpha 4 beta 7 integrin ameliorated inflammatory activity and rapidly improved stool consistency when administered to chronically colitic animals. Furthermore, using morphometric analysis of biopsy specimens, antibody therapy reduced the mucosal density of alpha 4 beta 7+ lymphocytes and alpha 4 beta 7 neutrophils and macrophages.

CONCLUSIONS

These results suggest that the alpha 4 beta 7 integrin represents a novel, potentially organ-specific therapeutic target for the treatment of inflammatory bowel disease.

Clinicopathologic study of the effect of radial tears and loop fixation on intraocular lens decentration

PURPOSE

The purpose of this study is to determine the effect of loop fixation and anterior capsular tears on intraocular lens (IOL) decentration.

METHODS

A retrospective measurement of IOL decentration was performed on 144 human eyes with posterior chamber (PC) IOLs obtained after death.

RESULTS

Decentration in eyes with asymmetrical bag-sulcus fixation (mean +/- standard deviation, 0.64 +/- 0.39 mm) was significantly higher than eyes with symmetrical fixation. In the presence of radial tears, symmetrically fixated IOLs in either the capsular bag or the ciliary sulcus decentered to a similar degree, 0.35 +/- 0.25 mm and 0.4 +/- 0.26 mm, respectively. The least decentration was observed with capsular fixation and no radial tears (0.18 +/- 0.09 mm). This was significantly less decentration than with any other form of fixation in the presence of radial tears.

CONCLUSION

This study shows that capsular fixation with no radial tears, as can be achieved by using the continuous curvilinear capsulorhexis, is associated with the least decentration.

Maintaining a clinical level of correctness

I wonder how many readers noted the positioning of the catheter tubing in the photograph illustrating Nursing Standard's clinical article, 'The bladder model: clinical implications' (October 21)?

Acute dependence on depressant drugs is determined by common genes in mice

Withdrawal seizure prone (WSP) and withdrawal seizure resistant (WRS) mice were genetically selected to express severe or mild handling-induced convulsions (HIC), respectively, after cessation of chronic ethanol (EtOH) vapor inhalation. The studies reported here tested WSP and WSR mice to determine whether elevated HIC were seen after administration of acute doses of several drugs that depress central nervous system activity. The drugs tested were EtOH, pentobarbital, t-butanol, acetaldehyde, and diazepam. All drugs initially suppressed HIC in WSP mice. This suppression was followed by an exacerbation of HIC, suggestive of a state of rebound central nervous system hyperexcitability during acute withdrawal. Susceptibility to acute withdrawal seizures was clearly under genetic control, since WSR mice did not display acute withdrawal HIC to any appreciable extent. Acute EtOH withdrawal seizures did not require testing WSP mice repeatedly, as they could be seen upon a single HIC test 8 hr after EtOH injection. Results with acetaldehyde and t-butanol suggest that the formation of acetaldehyde may be sufficient, but is not necessary for the elicitation of acute EtOH withdrawal. Earlier studies had found that WSP mice displayed more severe withdrawal HIC than WSR mice after chronic treatment with t-butanol, phenobarbital, nitrous oxide, or diazepam. The genetic predisposition to chronic EtOH withdrawal HIC in WSP mice generalized to all central nervous system depressants acutely tested, suggesting that acute and chronic withdrawal to all these drugs is largely under the control of a common group of genes.

Effect of chronic ivermectin treatment on GABA receptor function in ethanol withdrawal-seizure prone and resistant mice

Ivermectin, a potent, effective anthelmintic, is easy to administer, has a broad spectrum of action and a wide safety margin. However, no testing has been done in hosts genetically selected for seizure susceptibility which may be more sensitive to the effects of ivermectin than other animals. This was done in the present experiments with seizure prone and seizure resistant mice infested with Syphacia obvelata (pinworm). These subjects were treated daily with oral ivermectin in their drinking water every other week for six weeks, for a total of 21 days. The treatment cleared the mice of the pinworm infestation, but did not alter the seizure susceptibility or binding parameters of [3H]flunitrazepam in either of the selected lines.

Effects of ageing and long-term subcultivation on collagen lattice contraction and intra-lattice proliferation in three rat cell types

Many cells can contract a hydrated collagen lattice when seeded within one, reorganizing the collagen fibrils into a compact structure by tractional forces exerted during cell movement and translocation. The effects of ageing on this tractional-motility property of cells was examined for three cell types from adult Fischer 344 male rats: skin fibroblasts, aortic smooth muscle cells, and dedifferentiated chondrocytes. All cell types at low population doubling levels (PDL less than 10) contracted collagen lattices, though with different proficiencies (smooth muscle cells greater than dedifferentiated chondrocytes greater than skin fibroblasts). There was no significant difference in contraction ability of cell isolates of the same type obtained from 4-month and 24-30-month animals. Cells that had been subcultivated extensively (PDLs of 50-110) retained contractional ability. The cell types proliferated within lattices to varying extents, and there was no correlation between a cell type's extent of proliferation in a lattice and its proliferation in monolayer culture. That lattice contraction ability is preserved intact with ageing in three cell types suggests that the tractional forces exerted by cells on a collagen matrix in vitro may have a significant role in adult life in vivo.

RspX I: a new restriction endonuclease with a recognition sequence of 5'T/CATGA3'

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Collagen biosynthesis by cells in a tissue equivalent matrix in vitro

Collagen biosynthesis by fibroblasts and subsequent processing and polymerization have been studied in conventional monolayer cultures and in a new model system in vitro in which cells organize into a tissue like structure. While the bulk of the newly made collagen becomes tightly and selectively bound to the matrix of the tissue equivalent model, in monolayer cultures most of the collagen passes into the culture medium. Collagen biosynthesis appears to be regulated differently in cells of the tissue equivalent model as compared with monolayered cells. In the former there is a 6- to 8-fold decrease in collagen output even though overall protein synthesis per unit of DNA is twice as great as in monolayered cells. Cells grown in tissue lattices exhibit much higher collagenolytic activity than cells in monolayer suggesting the model may also be of special use for studying collagen turnover and matrix remodeling.

Cyclic variations in sensitivity to X-irradiation during meiosis in Saccharomyces cerevisiae

Cyclic variation in mutation induction and lethality was found following X-irradiation during meiosis in Saccharomyces cerevisiae. An enhanced mutagenic response was found in meiotic G1 phase cells in comparison to cells later in meiosis, similar to the response shown during mitosis, but meiotic G1 phase cells appeared more resistant to the lethal effects of X-irradiation than mitotic G1 phase cells. Resistance to the lethal effects of X-rays was found during meiotic DNA synthesis in the strain SK1, which may indicate the operation of a sister-chromatid exchange repair mechanism. A difference was found between gene conversion which appeared to be at a maximum by the end of meiotic DNA synthesis and reciprocal recombination, which could be induced up to prophase I.

Endogenous peroxidases in normal human dermis: a marker of fibroblast differentiation

Incubation of unfixed and unfrozen slices of normal human skin allows visualization of a peroxidase activity associated with the perinuclear envelope and with the endoplasmic reticulum of resident dermal macrophages, dermal mastocytes, and also of some dermal fibroblasts. No peroxidase activity can be detected in fibroblasts cultivated in monolayer, while 80% of fibroblasts in an "in vitro" collagen lattice, called a dermal equivalent, express a peroxidase activity in the perinuclear envelope and the endoplasmic reticulum. Hence expression of this peroxidase activity in normal human skin fibroblasts serves as a marker of fibroblast differentiation and seems to depend on an interaction to fibroblast with the elements of a three-dimensional matrix.

The reconstitution of living skin

A living-skin equivalent useful as a skin replacement and as a model system for basic studies has been fabricated and tested extensively. It consists of two components: (1) a dermal equivalent made up of fibroblasts in a collagen matrix that is contracted and modified by the resident cells, and (2) an epidermis that develops from keratinocytes "plated" on the dermal equivalent. A multilayered keratinizing epidermis with desmosomes, tonofilaments, and hemidesmosomes forms. Basement lamella formation occurs within 2 weeks in vitro when rat cells are used. With human cells, crypt or pseudofollicular morphogenesis is observed in vitro within 3 weeks after plating cells on the dermal equivalent. Autografts and isografts of rat-skin equivalents made with cultured cells from biopsies are rapidly vascularized, block wound contraction, and persist essentially for the lifespan of the host. Seven to 9 days after grafting, donor cells become activated biosynthetically and mitotically. By 1 year, the dermal population decreases to a normal level and the matrix has been extensively remodeled. The grafts remain free of hair and sebaceous glands. Grafts to rats have been in place for over 2 years. Now, allografts of dermal equivalents have been made across a major histocompatibility barrier and are not rejected. The persistence of cellular elements of the grafts is monitored by use of a genetic marker. Challenge of the allograft with a second skin-equivalent graft after 1 month does not result in rejection of the original graft or of the second skin-equivalent graft. We propose that allografts of tissue equivalents are tolerated because cells with class II antigens are selected against during in vitro cultivation and are excluded from the graft. Thus the fabrication of skin-equivalent tissues or of other equivalent tissues with parenchymal cells that do not bear class II antigens may render transplants of such tissues immunologically acceptable despite the presence of allogeneic cells. The capacity to graft across major histocompatibility barriers using living tissue equivalents may have important clinical significance.

An assay for mutagenic activity of 4CMB, 4HMB and BC, using the "microtitre" fluctuation test

4CMB, 4HMB and BC were assayed for mutagenic activity using the 'microtitre' bacterial fluctuation test without metabolic activation. 4CMB was positive in strains of Salmonella typhimurium detecting both base-substitution and frameshift mutation. BC was weakly positive only in the strain which detects base-substitution mutation. 4HMB was negative in both strains. 4CMB and 4HMB were equally toxic to the strains, whilst BC was comparatively less toxic.

Treating adolescent obesity: a pilot project in a school

A weight control program for junior high school students was developed to change eating, exercise and habit patterns. The course included dietary management, physical activity and behavior modification techniques. Classes were structured to emphasize peer group involvement and daily practical application. The curriculum was compiled in a book for educational personnel. The program was tested as a pilot project with a selected group of eighth grade obese adolescent girls and a comparison group. Immediately after the course, the subjects' percent of overweight had decreased; at a subsequent eight-month follow-up, additional losses were noted. The percent of overweight of the girls in the comparison group remained relatively unchanged. While the program was successful with this particular group of students, several key questions, requiring further study, were defined.

Regulation of proliferation of fibroblasts of low and high population doubling levels grown in collagen lattices

While IMR 90 and AG 1519 fibroblasts of low and high population doubling levels grow to confluency when plated on plastic surfaces, they cease to divide within four days when incorporated into collagen lattices. Growth inhibition in the lattices is not due to exhaustion of the medium or isotope, or to contact inhibition; nor is it due to impermeability of the lattice to the materials in the medium. While cells in a lattice arrest in G0, this state is reversible when cells are permitted to leave the lattice and populate a plastic substrate. We conclude that fibroblasts in tissue-like lattices may be responsive to some of the same controls as cells in connective tissues.

Development and use of a living skin equivalent

We have developed a living skin equivalent, which serves as a skin substitute in experimental animals. On application it is rapidly vascularized, it inhibits wound contraction, and it is immunologically tolerated and persists for as long as it is allowed to remain in place. It comes to resemble normal skin, although it lacks secondary derivatives, the cells for which may in time be available for incorporation into the fabricated tissue.

Production of a tissue-like structure by contraction of collagen lattices by human fibroblasts of different proliferative potential in vitro

Fibroblasts can condense a hydrated collagen lattice to a tissue-like structure 1/28th the area of the starting gel in 24 hr. The rate of the process can be regulated by varying the protein content of the lattice, the cell number, or the concentration of an inhibitor such as Colcemid. Fibroblasts of high population doubling level propagated in vitro, which have left the cell cycle, can carry out the contraction at least as efficiently as cycling cells. The potential uses of the system as an immunologically tolerated "tissue" for wound healing and as a model for studying fibroblast function are discussed.

An interactive computer system for the analysis of cell lineages

We have developed an interactive computer system for analysing cell lineage data. It can be utilized in studies of cell motility, cell division, cell differentiation, and cell aging. It has enabled us to document the heterogeneity of human foreskin fibroblasts in culture and to propose that loss of proliferative potential may mean that cells enter a state of differentiation which makes them unable to respond to mitotic stimulation. Our method, which enables us to apply immunological and cytochemical probes after recording the history of a cell lineage, should allow us to define precisely features which uniquely distinguish cycling from noncycling cells on an individual cell basis.

Loss of division potential in vitro: aging or differentiation?

We have examined the hypothesis that diploid cells grown in vitro age, and propose that only proliferative potential and not life-span is telescoped. We suggest that explanted or transplanted diploid cells are driven to divide by the process of subculturing in vitro or in vivo and, in response to this pressure, also complete their differentiation and become refractory to further mitotic stimulation. We conclude that differentiation rather than "mortality" distinguishes diploid from transformed cells and that the former may not age in vitro, but are lost because culture methods are selective for cycling cells.

Arteriovenous fistulas of the internal mammary artery. Review of the literature

Arteriovenous fistulas of the internal mammary artery are rare. This second recorded instance of congestive heart failure from such a fistula occurred in an aged patient 19 years after a gunshot wound. The etiologic and pathophysiologic classifications of 19 cases already reported in the world literature are discussed, as are symptoms, diagnostic methods, and observations during management of this type of fistula.