Geroscience: Aging and Oral Health Research

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States

INTRODUCTION

Edentulism affects health and quality of life.

OBJECTIVES

Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS

The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set (n = 4,288) was split into selection (70%, n = 3,002) and test data (30%, n = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training (n = 1,716) and validation (n = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples.

RESULTS

From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate (P = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION

Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT

This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

Oral Diseases Associated with Nonalcoholic Fatty Liver Disease in the United States

The US prevalence of nonalcoholic fatty liver disease (NAFLD) is 30.6% and increasing. NAFLD shares some risk factors with periodontitis and dental caries. We explored the association between NAFLD and several oral conditions among US adults, using data from the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES), 1988 to 1994. NAFLD was assessed with ultrasonography (USON), the screening gold standard not available in the more recent NHANES, and the noninvasive Fibrosis Score (FS), Fatty Liver Index (FLI), and US Fatty Liver Index (US-FLI) as other screening alternatives. There were 5,421 eligible dentate adults aged 21 to 74 y with complete relevant data, with transferrin levels ≤50%, without hepatitis B or C, who were not heavy drinkers. Multivariable models were developed to examine the independent effects of moderate-severe periodontitis, untreated dental caries, caries experience, and tooth loss (<20 teeth) on NAFLD while controlling for clinical, biological, and sociodemographic factors. Weighted estimates for odds ratios (ORs) and 95% CIs were calculated with logistic regression. Between 17% and 24% of adults had NAFLD depending on the classification criteria. In adjusted models, as compared with those with better oral health, adults with <20 teeth were more likely to have NAFLD depending on the measure (USON: OR = 1.50, 95% CI = 1.11 to 2.02; FS: OR = 4.36, 95% CI = 3.47 to 5.49; FLI: OR = 1.99, 95% CI = 1.52 to 2.59; US-FLI: OR = 2.32, 95% CI = 1.79 to 3.01). People with moderate-severe periodontitis were more likely to have NAFLD (USON: OR = 1.54, 95% CI = 1.06 to 2.24; FS: OR = 3.10, 95% CI = 2.31 to 4.17; FLI: OR = 1.61, 95% CI = 1.13 to 2.28; US-FLI: OR = 2.21, 95% CI = 1.64 to 2.98). People with any untreated caries were more likely to have NAFLD (USON: OR = 1.51, 95% CI = 1.20 to 1.90; FLI: OR = 1.80, 95% CI = 1.33 to 2.44). NAFLD was associated with tooth loss, periodontitis, and, for some NAFLD measures, untreated dental caries but not overall caries experience after controlling for several key sociodemographic and behavioral factors. Results suggest that further evaluation is needed to better understand this health-oral health interrelationship and potential opportunities for medical-dental integration.

Renal Transplant Arterial Stenosis Treated With Bare-Metal Versus Drug-Eluting Stents: Comparison of Treatment Outcomes

INTRODUCTION

This study aims to evaluate outcomes of bare-metal stents (BMS) versus drug-eluting stents (DES) in patients who undergo stenting for transplant renal arterial stenosis.

MATERIALS AND METHODS

We retrospectively reviewed records of renal transplantation patients who underwent transplant renal arterial stenting from September 2009 to September 2013. All stents greater than 5 mm were excluded to allow for equivalent comparison between the DES and BMS groups. Statistical comparisons were performed using a two-tailed Fischer exact test, and analysis of continuous variables was analyzed using a one-way analysis of variance.

RESULTS

The final study population included a total of 18 patients who received either BMS or DES (11 and 7 patients, respectively) for transplant renal arterial stenosis. The most common indications for stenting were increasing creatinine level and abnormal Doppler velocities. There were more re-interventions with BMS (n = 4/11) than DES (n = 0/7), but the trend was not statistically significant (P = .12). Three patients who received BMS had a clinically significant decrease in blood pressure versus 4 in the DES group (P = .33). Six patients who received BMS had a clinically significant decrease in creatinine level versus 3 in the DES group (P = 1.0).

CONCLUSION

There is an absolute but not statistically significant difference in the incidence of restenosis requiring repeat intervention between the BMS and DES groups. No difference was detected in clinical success as measured by decreases in blood pressure or creatinine. Future larger studies are needed to corroborate these findings.

Maternal oral bacterial levels predict early childhood caries development

OBJECTIVE

To calculate the association of maternal salivary bacterial challenge (mutans streptococci [MS] and lactobacilli [LB]) from pregnancy through 24 months' postpartum with child caries incidence (≥1 cavitated or restored teeth) at 36 months.

MATERIALS & METHODS

Dental, salivary bacterial, sociodemographic, and behavioral measures were collected at three- to six-month intervals from a birth cohort of low-income Hispanic mother-child dyads (N = 243). We calculated the relative child caries incidence, adjusted for confounding, following higher maternal challenge of MS (>4500 colony-forming units per milliliter of saliva [CFU/mL]) and LB (>50 CFU/mL) based on multivariable models.

RESULTS

Salivary MS and LB levels were greater among mothers of caries-affected children versus caries-free children. Mothers with higher salivary MS challenge were more likely to have MS-positive children (>0 CFU/mL), but maternal LB challenge was not a statistically significant predictor of child LB-positive status. Adjusting for sociodemographics, feeding and care practices, and maternal dental status, higher maternal salivary challenge of both MS and LB over the study period predicted nearly double the child caries incidence versus lower MS and LB (cumulative incidence ratio: 1.9; 95% confidence interval: 1.1, 3.8).

CONCLUSION

Maternal salivary bacterial challenge not only is associated with oral infection among children but also predicts increased early childhood caries occurrence.

Value of drug-eluting stents after failed percutaneous transluminal angioplasty in the infrapopliteal vessels for the treatment of critical limb ischemia: favorable mid-term patency and limb salvage results

AIM

The endovascular treatment of infrapopliteal arterial disease in the setting of critical limb ischemia (CLI) is increasing in use. In patients in whom percutaneous transluminal angioplasty (PTA) resulted in suboptimal angiographic results, flow limiting dissection or re-coil is thought to limit clinical success. This single-center experience examines the angiographic and clinical results when Drug-Eluting Stents (DES) were placed in a large cohort of patients with CLI after immediate infrapopliteal PTA failure.

METHODS

A retrospective review of a prospectively collected single-center endovascular database was performed. Sixty-seven Rutherford grade 4, 5, and 6 patients were treated between October 2005 and February 2010 with PTA because lack of an acceptable autologous vein for bypass-grafting or severe medical comorbidities precluded them from surgical bypass. The study cohort had suboptimal angiographic results immediately after PTA that was subsequently treated with DES. Patients were then placed on clopidogrel and aspirin indefinitely. Angiographic, clinical, and the results of noninvasive vascular examinations were collected.

RESULTS

In total, 123 stents (94 sirolimus, 27 everolimus, 2 paclitaxel) were placed in 67 patients to treat a total of 84 angiographic lesions. Simultaneous femoral-popliteal intervention was performed in 66% of the patients while 45% of the treated lesions were total occlusions. Lesion length ranged from 17 mm-142 mm (mean 50 mm). Initial technical success was 100%, with all 84 lesions being treated successfully with less than 10% stenosis after stent implantation. Mean follow-up was 20 months (1-42 months) with 6, 12, and 24-month primary patency rates of 90%, 86%, and 72% respectively. Freedom from major amputation was 91.1% (61/67) with all six amputations occurring in the Rutherford grade 6 group (6/11). Overall mortality rate was 19% (13/67) with one death occurring within 30 days.

CONCLUSION

The use of drug-eluting stents following suboptimal PTA for the treatment of infrapopliteal arterial disease in this cohort of patients with CLI produced high primary patency and limb salvage rates supporting the efficacy of this treatment strategy.

A randomized, placebo-controlled, double-blind clinical trial of curcuminoids in oral lichen planus

We studied the efficacy of curcuminoids in the treatment of oral lichen planus (OLP), a chronic, mucocutaneous, immunological disease. Curcuminoids are components of turmeric (Curcuma longa) that have anti-inflammatory activity. Turmeric has been used in Ayurveda (Indian traditional medicine) for centuries. A randomized, double-blind, placebo-controlled trial was conducted. In all, 100 consecutive, eligible patients with OLP presenting to the oral medicine clinic at the University of California, San Francisco, were to be selected. Two interim analyses were to be conducted during the trial. The trial was conducted between February 2003 and September 2004. The first interim analysis was conducted in October 2004 using data from the first 33 subjects. Study subjects were randomized to receive either placebo or curcuminoids at 2000 mg/day for 7 weeks. In addition, all subjects received prednisone at 60 mg/day for the first 1 week. The primary outcome was a change in symptoms from baseline. Secondary outcomes were changes in clinical signs and occurrence of side effects. The first interim analysis did not show a significant difference between the placebo and curcuminoids groups. Conditional power calculations suggested a less than 2% chance that the curcuminoids group would have a significantly better outcome as compared with the placebo group if the trial were continued to completion. Therefore, the study was ended early for futility. Reaching a conclusion regarding the efficacy of curcuminoids based on the results of this study is not possible as it was ended early for futility. Curcuminoids at this dose were well tolerated and the results suggest that for future studies a larger sample size, a higher dose and/or longer duration of curcuminoids administration should be considered; however, for the next step, an RCT of a shorter duration, using a higher dose of curcuminoids, and without an initial course of prednisone, should be considered.

Welfare dental intervention improves employment and quality of life

Chronic, untreated oral disease adversely affects one's systemic health, quality of life, and economic productivity. This study evaluated the effect of rehabilitative dental treatment on the oral-health-related quality of life and employment of welfare recipients. Three hundred and seventy-seven participants in a novel welfare dental program received oral examinations, questionnaires, and rehabilitative dental treatment. Seventy-nine percent of participants exhibited improvement in their oral-health-related quality-of-life scores following dental treatment. Improved OHIP-14 change scores were associated with being Caucasian or African-American, initial poor general health, severity of treatment urgency, worse baseline oral-health-related quality-of-life scores, subsequent patient satisfaction with the Dental Program, and resolution of their chief complaint (all p < 0.04). Those who completed their dental treatment were twice as likely to achieve a favorable/neutral employment outcome (OR = 2.01, 95%CI = 1.12, 3.62). Thus, oral health improved the quality of life and employment outcome for this welfare population.

Immunological responses to parasitic arthropods

Parasitic arthropods are responsible for enormous economic losses to livestock producers throughout the world. These production losses may range from simple irritation caused by biting and non-biting flies to deaths and/or damage to carcass, fleece, or skin resulting from attack by myiasis flies. The estimated costs of these losses are colossal but even these usually include only direct losses and ignore those associated with pesticide application. In the USA alone (in 1976), these losses were conservatively estimated at more than 650 million US dollars. The long term use of chemical control measures for these pests has resulted in many serious problems including residues in meat and milk products, rapid development of insecticide resistance, the destruction of non-target organisms, environmental pollution, and mortality and morbidity of livestock. These concerns have prompted researchers to seek alternative methods of arthropod control, including the artificial induction of immunity. In this review, R. W. Baron and J. Weintraub discuss several examples of ectoparasites that can induce immunological resistance in the host, including Sarcoptes and Demodex mites, the sheep ked (Melophagus ovinus), Anopluran lice and myiasis-causing flies such as Hypoderma.

Contrast-enhanced breath-hold three-dimensional magnetic resonance angiography in the evaluation of renal arteries: optimization of technique and pitfalls

The authors describe the optimization of a contrast-enhanced, breath-held, three-dimensional magnetic resonance angiography (CE-BH-3DMRA) technique in the assessment of the renal arteries and compare its utility with conventional x-ray angiography (XRA). Signal optimization using specific pulse sequence parameters was based on the patient's circulatory conditions, injection rate, and pulse sequence timing. Fifty-one patients (27 M, 24 F; mean age 69.7 years) were evaluated with CE-BH-3DMRA and XRA. All patients had an MR angiogram 3 months either before or after XRA. A test bolus study was performed for accurate assessment of transit time in each patient. A total of 51 patients (115 vessels) were studied in which the sensitivity and specificity for all renal artery stenoses including the proximal and mid-renal arterial segments were 96% and 92%, respectively. In-stent stenosis could only be diagnosed by quantifying flow beyond the stent using an additional triggered phase contrast cine pulse sequence. A total of 11 accessory renal arteries were correctly identified. In addition, fibromuscular dysplasia in two patients and stents in three patients were correctly identified on MRA. J. Magn. Reson. Imaging 2000;12:912-923.

Efficacy of a liquid-based thin layer method for cervical cancer screening in a population with a low incidence of cervical cancer

The performance of the ThinPrep(R) Pap Testtrade mark (TP) (Cytyc Corp., Boxborough, MA) for detection of cervical cancer precursors in a population with a low incidence of disease was evaluated. This prospective trial compared results obtained with TP to those obtained with the standard cytologic smear in women from the general community who were being screened for cervical cancer from January 1, 1995-December 31, 1997 by physicians in private practice (n x 130, 381 conventional examinations and 39,864 TP examinations). In the TP series there was a significant increase in the proportion of "satisfactory" examinations (91.9% TP vs. 72.2% conventional) and positive diagnoses (5.5% TP vs 2.4% conventional, odds ratio x 2.21; 95% confidence interval (CI), 2.08-2.34). The likelihood of detecting a high-grade squamous intraepithelial lesion (HSIL) by TP was significantly greater than in controls (odds ratio x 1.86; 95% CI, 1.68-2.06). Detection of low-grade squamous intraepithelial lesions (LSIL), or atypical squamous cells of undetermined significance (ASCUS), was significantly greater in the TP series than in controls (LSIL odds ratio x 3.41; 95% CI, 3.07-3.79; ASCUS odds ratio x 1.68; 95% CI, 1.56-1.82). A histologic lesion was confirmed in 141 (93%) of the biopsies for HSIL (130 HSIL or greater, 10 LSIL, 1 SIL not otherwise specified). In conclusion, both diagnostic sensitivity and sample adequacy were significantly improved using the ThinPrep(R) Pap test under routine conditions in an outpatient population with a low incidence of cervical cancer.

Bilateral secondary angle-closure glaucoma as a complication of anticoagulation in a nanophthalmic patient

PURPOSE

To describe bilateral hemorrhage of the posterior segment and secondary angle-closure glaucoma as sequelae of anticoagulation therapy in a nanophthalmic patient.

METHODS

An 80-year-old man who was nanophthalmic and was undergoing anticoagulation therapy presented with declining visual acuity in left eye. Six months later, he experienced declining visual acuity in his right eye.

RESULTS

In the LE and six months later in the RE, ocular examination disclosed angle-closure glaucoma and a hemorrhagic retinal detachment. Peripheral iridoplasty successfully treated the initial attack. The subretinal hemorrhage was successfully drained by pars plana vitrectomy, retinotomy, and air-fluid exchange in the left eye. Anatomic success and intraocular pressure control were obtained, but visual recovery was limited.

CONCLUSION

Intraocular hemorrhage and angle-closure glaucoma are potential complications of anticoagulation therapy in a patient with nanophthalmos.

Concurrent interfollicular Hodgkin's disease and metastatic breast carcinoma in lymph nodes

The clinical and pathological findings are reported concerning a 73-year-old woman with progressive metastatic carcinoma of the left breast, who developed interfollicular Hodgkin's disease within the right cervical lymph nodes. Metastatic carcinoma and Hodgkin's disease were present concurrently as a "collision tumor' in the lymph nodes examined. To the best of the authors' knowledge, this is the first description of a collision tumor with these particular histologic components in this tissue. The factors influencing the coexistence and the order of appearance of the two pathologies in the present case remain unknown.

Compression sonography in patients with indeterminate or low-probability lung scans: lack of usefulness in the absence of both symptoms of deep-vein thrombosis and thromboembolic risk factors

OBJECTIVE

We sought to determine whether compression sonography could be eliminated in the evaluation of patients who lacked both thromboembolic risk factors and symptoms of deep-vein thrombosis and who had an indeterminate or low-probability lung scan.

MATERIALS AND METHODS

The medical records of 155 consecutive patients who underwent bilateral lower-extremity sonography after an indeterminate or low-probability lung scan were reviewed. The presence of thromboembolic risk factors and deep-vein thrombosis symptoms and the result of sonography were recorded. Patients were divided into two groups: group 1 consisted of patients with either thromboembolic risk factors or deep-vein thrombosis symptoms, and group 2 consisted of patients without thromboembolic risk factors and without deep-vein thrombosis symptoms. The incidences of deep-vein thrombosis in groups 1 and 2 were compared by use of a two-tailed Fisher's exact test.

RESULTS

Thromboembolic risk factors or deep-vein thrombosis symptoms were found in 109 of 155 patients (70%) (group 1). Deep-vein thrombosis was found in nine of 108 patients (8%) in group 1. Both thromboembolic risk factors and deep-vein thrombosis symptoms were absent in 47 of 155 patients (30%) (group 2). Deep-vein thrombosis was found in none of 47 patients (95% confidence interval, 0-8%) in group 2. The difference in the incidences of deep-vein thrombosis in groups 1 and 2 approached statistical significance (p = .0579). The negative predictive value of the absence of both thromboembolic risk factors and deep-vein thrombosis symptoms in excluding deep-vein thrombosis was 100% (95% confidence interval, 93-100%).

CONCLUSION

If both symptoms of deep-vein thrombosis and thromboembolic risk factors are absent, the usefulness of lower-extremity sonography in detecting deep-vein thrombosis in patients with an indeterminate or low-probability lung scan is low. The manner in which these findings may be used to modify individual practice patterns will undoubtedly depend on the rate of detection of deep-vein thrombosis at a given institution.

The comparative test performance of dot filter hybridization (Viratype) and conventional morphologic analysis to detect human papillomavirus

To investigate the test performance of a commercially available detection kit for human papillomavirus (HPV), the relationship between the detection of HPV by dot filter hybridization (DFH) and by standard morphologic methods was studied. Four hundred two cervical samples taken from 381 patients referred to a colposcopy clinic were examined. Human papillomavirus DNA sequences were identified and typed using commercially available anti-sense RNA probes. Simultaneous cytologic smears were obtained in 289 patients, directed biopsy samples in 284, and both smears and biopsy samples in 171 samples. Human papillomavirus DNA was detected in 164 specimens (41%), of which 24 (15%) were type 6/11, 74 (45%) were type 16/18, 39 (24%) were type 31/33/35, and 27 (16%) were untyped due to the presence of multiple positive signals. Viral types 16/18 and 31/33/35 were eight and six times more frequent in cervical intraepithelial neoplasia (CIN) II/CIN III lesions than in condyloma/CIN I, respectively. When the cytologic diagnosis was considered the standard of reference, the results of DFH for the detection of HPV were concordant in 167 (56%) paired samples. The sensitivity of DFH was 48% and the specificity was 77%. The distribution of the morphologic diagnoses in the group of false-negative results and true-positive results was similar. When the histologic diagnosis was considered the standard of reference, the efficiency of DFH was 62%, the sensitivity was 59%, and the specificity was 79%. In the subgroup of 118 samples with simultaneous smear and biopsy and at least one positive examination, 42 (36%) were positive by all three methods, 42 (36%) by two, and 34 (29%) by one, including 6 (5%) by DFH alone. Fifteen cases more were detected by the complementary use of DFH and cytology than with cytology alone. The results demonstrated that the sets of patients positive for HPV when detected by DFH or by morphologic methods were not identical but rather overlapped. The detection of HPV may be slightly improved by using DFH in addition to conventional examinations. A significant number of HPV-positive patients without a morphologic lesion and patients with low-grade lesions had HPV 16/18 or 31/33/35, suggesting a possible role for typing in establishing a risk profile. However, given uncertainties in understanding the biology of HPV-associated lesions, the role, if any, of clinical testing for HPV by DFH remains to be defined.

Loss of heterozygosity for the short arm of chromosome 11 (11p15) in human milk epithelial cells immortalized by microinjection of SV40 DNA

We have developed, by microinjection of SV40 DNA into human milk epithelial cells, a new mammary cell line, Hu-MI, which exhibits the phenotype of luminal cells or so-called "breast cancer precursor cells." This cell line retains the phenotype of primary cells as demonstrated by the expression of keratins 18 and 19 and of polymorphic epithelial mucins. However, the cells do not grow in agar after more than 80 passages, nor do they form tumors in nude mice. Established cells contain 2 copies of SV40 DNA integrated into the cellular genome and up to 14 copies of free SV40 DNA. A deletion of the short arm of chromosome 11 (11p15) including the c-Ha-ras and the beta-globin genes was found in the immortalized cells when the DNA from these cells was compared to the DNA from peripheral blood mononuclear cells obtained from the same donor. In addition, this cell line showed a good transfection efficiency for other DNA sequences using classical transfection and selection techniques with a neomycin resistance gene (pKOneo). Selective microinjection of DNA into tumor precursor cells may prove useful for the study of the molecular mechanisms involved in breast carcinogenesis. The possible significance of the loss of 11p13-15 in malignant progression of breast cancer is discussed.

The application of immunocytochemical techniques to routinely-fixed and stained cytologic specimens. An aid in the differential diagnosis of undifferentiated malignant neoplasms

Routinely-fixed and Papanicolaou stained smears with the cytologic diagnosis of undifferentiated malignant neoplasm that had been prepared with cells obtained by fine needle aspiration biopsy (n = 7), pulmonary lavage (n = 5), or thoracentesis (n = 3) from 15 unselected patients were stained by an immunocytochemical technique to evaluate the presence of keratin proteins and the leukocyte common antigen (LCA). Commercially available, well-characterized monoclonal antibodies with specificities for keratin proteins and the leukocyte common antigen, and a streptavidin-biotin-horseradish peroxidase labelling method were used. Evaluation of the stained smears revealed the presence of one of the two antigens in material obtained from each patient, thus indicating the probable cell-lineage of the neoplastic cells. The specificity of the monoclonal antibody reagents used was further evaluated in routinely-fixed and stained cytologic material from 24 histologically confirmed carcinomas and 12 lymphomas. In conclusion, immunocytochemical techniques may be successfully applied to routinely processed archival cytologic smears to determine the antigenic profile of morphologically undifferentiated cells and therefore aid in the differential diagnosis of undifferentiated malignant neoplasms.

[The role of human papillomavirus in the pathogenesis of papillomas of the upper aero-digestive tract]

The term 'papilloma' is used to describe a highly diverse group of exophytic pathologic lesions in the upper aero-digestive tract. These lesions differ according to anatomic site, constituent epithelium and endoscopic appearance. The varying pathogenesis of papillomas is incompletely understood, but appears to be related both to host factors, e.g. regional differences in the susceptibility of epithelial cells, and to a number of cofactors. Among the cofactors already identified, the human papilloma virus is increasingly recognized as playing an important role in the pathogenesis of laryngeal papillomata and some specific oral proliferative lesions. The systematic identification and characterization of human papilloma viruses in tissues from papillomas will provide the basis for a better understanding of the potential pathogenetic role of these viruses in the development of benign and malignant proliferation in the upper aero-digestive tract.

CA 125 is an excretory product of human endometrial glands

The present investigation was undertaken to study the cellular localization and kinetics of synthesis of CA 125 in the endometrium. CA 125 was localized by immunohistochemistry to the infranuclear region of epithelial cells during the proliferative phase and to the apical luminal border during the secretory phase. In gestational endometrium, both the cytoplasm and the apical luminal border of epithelial cells were intensely positive. No staining was seen in endometrial stromal cells during the normal cycle or in decidualized endometria. Results obtained from in vitro cultures of separated glandular and stromal cells were similar to those obtained by immunohistochemistry. That is, epithelial cells released between 5 and 25 times more CA 125 into the culture medium than did stromal cells. The release of CA 125 was highest in epithelial and stromal cells obtained during the early secretory phase. CA 125 concentrations were markedly elevated in endometrial aspirations obtained during the secretory phase or in endometria with crumbling stroma compared to plasma levels. Plasma levels of CA 125 were slightly elevated during menses. These results suggest that CA 125 is an exocrine product of endometrial epithelial cells. Plasma levels of CA 125 may be of endometrial origin only when the membrane barriers, which normally prevent its entry into the circulation, are damaged.

A simple method for estrogen receptor antigen preservation in cytologic specimens containing breast carcinoma cells

We report a modified method to prepare cytologic specimens for the evaluation of estrogen receptors by immunocytochemistry. Cytologic samples were obtained by needle aspiration of tumor masses (nine patients) and body cavity fluids (nine patients). The cytologic material was divided, and slides for immunostaining were prepared according to two different techniques: (1) fixation of cells in suspension (modified method); and (2) fixation of cells adherent to slides (standard method). The results after immunostaining demonstrated that the number of cells adhering to slides prepared according to the modified method was greatly increased as compared with the number of cells remaining attached to slides prepared according to the standard method. There was no loss of cell groups or aggregates using the modified method. The antigenicity of estrophilin and the cell morphology were well-preserved for up to 30 days. With this modified method, cytologic samples may be stored and conveniently processed in batches, thereby improving the utilization of laboratory resources.

Evaluation of estrogen receptors by immunocytochemistry on fine-needle aspiration biopsy specimens from breast tumors

The estrogen receptor (ER) content of 31 surgically removed breast tumors (26 duct carcinomas, one lobular carcinoma, one papillary carcinoma, one colloid carcinoma, one duct carcinoma in situ, and one atypical fibroadenoma) was determined by a commercially available immunocytochemical method (Abbott Laboratories, ER-ICA) on cytologic material obtained by fine needle aspiration biopsy (FNAB) of surgical specimens. Immunocytochemical staining of cells by a peroxidase-antiperoxidase technique was evaluated on the basis of the percentage of positive cells and the intensity of staining. An immuno-staining score for cytologic (IS-CYTO) and histologic (IS-HISTO) material was defined and a threshold of positivity determined to facilitate the semi-quantitation of results and the comparison of cases. The results of immunostaining of cytologic material were compared with the evaluation of ER in corresponding tissue samples as determined by the radioligand binding assay using the dextran-coated charcoal procedure (ER-DCC) and by ER-ICA using cryostat sections of frozen tissue. The sensitivity, specificity, predictive value of a positive test, and test efficiency of ER-ICA in cytologic material as compared to ER-DCC was 96%, 83%, 96% and 93%, respectively. The IS-CYTO was significantly correlated with the IS-HISTO in corresponding histologic material (r = 0.72, P less than 0.001). In conclusion, the combination of ER-ICA with FNAB represents a useful new technique for the evaluation of ER which may be applied to small primary tumors, tumor recurrences, and metastases.

Comparison of methods for analysis of CSF proteins in patients with Alzheimer's disease

Cerebrospinal fluid (CSF) from patients with Alzheimer's disease (AD) and controls was analyzed by one- and two-dimensional gel electrophoresis, electron microscopy, and fluorescence microscopy with thioflavin S staining. In CSF from patients with AD, abnormal proteins were found following two-dimensional gel electrophoresis and silver staining. In CSF samples from most of the AD patients studied, a highly argentophilic material was detected upon silver staining the stacking gel of the one-dimensional gels. Electron microscopy of material eluted from the stacking gel showed fibers of approximately 7-10 nm diameter, with some twisting; properties consistent with paired helical filaments or amyloid. Furthermore, material with the characteristics of amyloid (fiber diameter ranging from 4-10 nm) was found in the CSF sediment. The CSF from AD patients had significantly elevated numbers of yellow fluorescent particles following thioflavin S staining when compared with age-matched, other neurological disease controls. We did not see an increase in autofluorescence, indicating that thioflavin S staining is specific. Our data suggest that AD CSF contains plaque amyloid and possibly proteins from neurofibrillary tangles. The thioflavin S staining method appears to have potential for development as a diagnostic tool.

Lymphocyte responsiveness in cattle previously infested and uninfested with Hypoderma lineatum (de Vill.) and H. bovis (L.) (Diptera: Oestridae)

Cattle exposed to their third consecutive warble (Hypoderma lineatum and H. bovis) infestation had significantly reduced apparent and accumulative grub populations and produced significantly fewer grubs than animals exposed to their first infestation. These resistant animals had enhanced reactivity to mitogens (concanavalin A (con A) and pokeweed) upon reinfestation and a strong antigen-specific response at 2 months post-infestation. Their responsiveness to con A and antigen was also enhanced at 7 months post-infestation when grubs appeared in the backs, and the response to antigen continued at 10 months post-infestation. Responsiveness to mitogens in previously uninfested animals was similar to the control response throughout the infestation apart from the suppression of the con A response at 7 months post-infestation. These animals finally responded to antigen at 10 months post-infestation. These results suggest that acquired resistance to hypodermosis has a cellular basis with participation of both B- and T-cell components.

Essential thrombocythemia and leukemic transformation

Alkylating agents and 32P have been widely employed in the treatment of patients with essential thrombocythemia (ET). During a four-month period, we observed 3 cases of ET that had transformed into leukemia. Two patients had been treated with uracil mustard: One developed acute myelogenous leukemia 79 months after institution of therapy, and the other patient developed chronic myelomonocytic leukemia 24 months after the start of therapy. The third patient had been treated with busulfan, and ET evolved into myelofibrosis and eventually into acute undifferentiated leukemia with myelofibrosis. The patient who developed acute myelogenous leukemia was asymptomatic at the time of diagnosis of ET but was treated because his platelet count was greater than 1,000,000/mm3. He died 1 month after leukemic transformation, during induction chemotherapy. The other 2 patients presented with symptoms referable to their thrombocythemia. Review of the English literature revealed 12 other definite or probable cases of ET with leukemic transformation, all but 1 having been treated with alkylating agents and/or 32P. We propose that the natural history of ET may be similar to that of polycythemia vera, with evolution into leukemia being an unusual occurrence except in the setting of previous chemotherapy. Therefore, the current practice of treating asymptomatic patients with ET may not be justified, since administration of alkylating agents or 32P may increase the risk of subsequent development of leukemia.

Immunization of cattle against hypodermatosis (Hypoderma lineatum (deVill.) and H. bovis (L.)) using H. lineatum antigens

The feasibility of immunizing calves against Hypoderma lineatum and H. bovis with a crude H. lineatum larval extract or culture-derived antigen was investigated. Larval survival was followed through pupation. Grub appearance in the backs of both of the immunized groups was found to be 50% of that in the control groups. First appearance of H. bovis was significantly retarded in both immunized groups; however, H. lineatum was unaffected. Duration of H. bovis dropping was also shorter in animals receiving crude extract than in controls while duration of dropping of H. lineatum was not influenced by immunization. Survival of H. lineatum larvae to pupation was significantly reduced in animals immunized with crude larval extract, but not in those receiving culture-derived antigen. H. bovis survival was reduced by both treatments.

Prevention of cerebral malaria by adoptive transfer of malaria-specific cultured T cells into mice infected with Plasmodium berghei

Murine T cell populations specific for Plasmodium berghei parasites were generated in vitro from BALB/c immune lymph node cells. The malaria-specific T lymphocytes were shown: a) to proliferate specifically in vitro in response to stimulation with P. berghei-infected red blood cells; b) to exhibit the Thy-1+, Lyt-1+2- cell surface phenotype; c) to provide specific helper activity for an in vitro anti-hapten (TNP) plaque-forming cell antibody response; and d) to protect P. berghei-infected mice from early mortality due to cerebral malaria.