P14.34 Priority of comet tail sign in the planning of stereotactic irradiation for the treatment of brain metastases

BACKGROUND

A highly enhanced cap attached to the surface of metastatic tumours in the brain parenchyma is occasionally encountered on magnetic resonance (MR) images. This atypical cap termed “comet tail sign (CTS)” is attributed to leakage of contrast medium from the tumour body into the oedema surrounding it and is containing no neoplastic tissue (Mitsuya, et al. 2016. J Neurooncol). The purpose of this study was to demonstrate our clinical results of excluding CTS in the planning of stereotactic irradiation (STI) for brain metastases to avoid radiation necrosis.

METHODS

We selected 16 consecutive cases of newly diagnosed brain metastases with CTS treated with STI between May 2007 and January 2019. Patients underwent STI with target fields including CTS until December 2014 (Group A, n=4), while STI with fields excluding CTS from January 2015 (Group B, n=12). CTS was carefully diagnosed using contrasted T1-weighted images and T2-weighted images by radiation oncologists and neurosurgeons. Treatment outcome and toxicity were compared among two groups.

RESULTS

Primary cancers were lung in 13 and colon in 3 patients. Ten (63%) were male, and the median age was 68 years (range, 47 to 78). The median follow-up time was 13.5 months from STI. There was no significant difference of the mean tumour volume between two groups (4.28ml vs. 4.68ml). Disease control rates were 25% in Group A and 92% in Group B. Symptomatic radiation necrosis was observed in two (50%) patients of Group A but none (0%) of Group B.

CONCLUSION

CTS could be excluded from STI target planning to increase local control and to decrease radiation toxicity. Prospective study is needed to clarify optimal STI planning for patients with brain metastasis accompanied CTS in the future.

P14.70 Systemic therapy for brain metastases in elderly patients with lung cancer: A systematic review

BACKGROUND

Brain metastases (BM) account for the majority of intracranial malignant tumours in the elderly. Almost 50% of BM originate from lung cancer, particularly non-small cell lung cancer (NSCLC). The objective of this review is to summarize the involvement of elderly patients in emerging systemic therapies especially targeted therapies for the treatment of BM from NSCLC.

MATERIAL AND METHODS

PubMed database was searched from 2008 to December 2018. Randomized controlled trials and systematic reviews for BM from NSCLC treated with targeted therapy were included.

RESULTS

A total of 85 studies were evaluated for eligibility, and 23 publications met the eligibility criteria and were screened for inclusion. Of these, only two phase-III studies met all the criteria (Sperduto 2013, Yang 2017), and three other studies of subgroup analysis of trials were focused on BM (Schuler 2016, Gadgeel 2018, Camidge 2018). In the 23 papers, eligibility criteria for age were from 18 years to 75 years old or no upper limits. Actual mean or median ages ranged 51 to 64 years. Population of patients with active BM consisted none to 100% in each study. The two phase-III studies focused on treatment of BM, median ages were 63 and 57 years. The latter reported a TKI showed significantly longer intracranial PFS and no difference in HR was found in age groups older or younger than 60 years. In the three papers of subgroup analysis, response rate of BM or intracranial distant recurrence were examined. Median ages were 51 to 62 years, ranged from 18 to 86 years. However in these analytical efforts, no results were reported about age as an outcome factor.

CONCLUSION

Patients with active or treated BM have become included in randomized controlled trials of systemic pharmacotherapies. Elderly patients also have become included in trials. However, outcomes focused on BM are not clearly understood especially in elderly patients. We need prospective studies and assessment of targeted therapy for elderly patients with BM for better understanding of treatment strategies and options for those patients increasing in number.

Abstract P1-17-09: Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period

Background: Leptomeningeal disease (LMD) is a pattern of central nervous system (CNS) metastasis that occurs in metastatic breast cancer (MBC) patients (pts). Some reports have revealed that it occurs more frequently in pts with estrogen receptor-positive (ER+), HER2-MBC than in pts with other subtypes. However, in such ER+HER2-MBC pts, LMD mainly occurs in the terminal stage of the disease; thus, the details of LMD have not been well described.

Methods: We reviewed the medical records of ER+HER2-MBC pts who were treated from 2002 to present, with the aim of assessing the incidence, background and outcomes of LMD. Statistical analyses were performed using the chi-squared test, Kaplan-Meyer method, log-rank test and a multivariate COX regression analysis.

Results: We identified a total of 369 ER+HER2-MBC pts, and 102 (27.6%) developed CNS metastasis. LMD developed in 32 (8.7%) pts, with the median time to LMD of 778 days (95% confidence interval [CI] 335-1221; range 0-3757 days) from the diagnosis of MBC. In most cases (28, 87.5%), LMD was accompanied by bone metastasis, and 24 pts (75.0%) showed metastasis to the skull. Thirteen pts (40.6%) had accompanying brain metastasis (BM) at the diagnosis of LMD. The majority of the pts had symptoms (25, 78.1%), and their accompanying extra-CNS lesions showed progression (23, 71.9%). Palliative radiotherapy (RT) was introduced in 27 pts (84.4%), with 4 pts (12.5%) receiving whole CNS RT. The intrathecal injection of methotrexate was introduced to one patient. The median overall survival (OS) from the diagnosis of LMD was 104 days (95% CI 38-170); however, when limited to pts without BM (N = 19), the median OS was 146 days (95%CI 79-213). All of the pts died, and the causes of death were as follows: CNS lesion progression, n=10 (31.3%); cachexia, n=9 (28.1%); respiratory failure, n=8 (25.0%); hepatic failure, n=4 (12.5%) and infection, n=1 (3.1%). There was no significant relationship between the time to LMD and OS after the diagnosis of LMD (Spearman's ρ=0.55, not significant). The multivariate analysis did not reveal any specific factors—such as the patient age, the presence of any symptom(s) at the diagnosis of LMD, the distribution of extra-CNS lesion(s) or the control of extra-CNS lesion(s)—that affected OS after the diagnosis of LMD.

As a control, 70 ER+HER2-MBC pts who developed BM without LMD (BM-only group) within the same observation period were analyzed. The median time to BM was 611 days (95%CI 404-818), and it did not differ from that of pts with LMD (LMD-group) to a statistically significant extent (P >0.1). The BM-only group showed superior OS after the diagnosis of their CNS lesions in comparison to LMD-group (median, 295 days and 104 days, respectively, P <0.001). At the diagnosis of the CNS lesion, the LMD-group showed a higher rate of CNS symptoms (P <0.01), a lower rate of liver metastasis (P <0.05), a higher rate of bone metastasis (P <0.05) and a higher rate of skull metastasis (P < 0.01).

Conclusion: Our retrospective analysis at a single institute revealed that the prognosis of LMD in pts with ER+HER2-MBC was still extremely poor. The data suggest that LMD is distinct from BM in terms of its pathology and response to therapy.

Citation Format: Watanabe J, Mitsuya K, Hayashi N, Nakasu Y. Leptomeningeal disease in ER+HER2- metastatic breast cancer patients: A review of the cases in a single institute over a 14-year period [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-09.

Application of the RTOG recursive partitioning analysis classification to brain metastases from colorectal cancer

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Background: Colorectal cancer infrequently causes brain metastases (BMs). Recently, the incidence of BMs from colorectal cancer (CRC) has been reported to be increasing as 3 % of all metastatic CRCs, especially in patients (pts) with lung metastases (LMs). The RTOG previously developed three prognostic classes for BMs using a recursive partitioning analysis (RPA) classification, including Karnofsky performance status, controlled primary tumor, extracranial metastases, and an age. However, the relevance of this classification for CRC remains unclear, because only a few CRC pts were included in the RTOG database. The present studies retrospectively evaluate the usefulness of RPA classification for BMs from CRC. Methods: The subjects were consecutive 290 metastatic CRCs without symptomatic BMs who treated with any chemotherapy initiated in our institution between 2002 and 2005. The treatment of BMs, including whole brain radiation therapy (WBRT), surgery, and stereotactic radiosurgery (SRS), were indicated for pts whose life expectancy was considered to exceed 3 months (M). Results: BMs were detected in 20 pts out of 133 (15%) with LMs at base line, with a median follow-up time of 17.7 M. In the remaining 157 pts, BMs were found in 3 pts out of 41(7%) who had developed LMs during follow-up and 2 pts out of 116 (2%) without LMs. In total, overall incidence of BMs was 9% (25/ 290). Median duration from the diagnosis of LMs to BMs was 12 M (range: 4.4–33.6). According to RPA, the 25 pts with BMs were classified into Class I 0 (0%), Class II 12 (48%) and Class III 13 (52%). Treatments for BMs were performed to all pts of Class II, and to 6 pts (46%) of Class III. Median overall survivals from detecting BMs were Class II 9.7 M and Class III 3.0 M (logrank test; p=0.02). In the 18 pts treated for BMs, median BMs progression-free survival of Class II and Class III were 3.0 M and 3.1 M. Conclusions: It is suggested that the incidence of BMs from CRC is more common than previously reported. Overall survivals for BMs reproduce the results from RPA classification.

No significant financial relationships to disclose.

Tentorial enhancement on MR images is a sign of cavernous sinus involvement in patients with sellar tumors

BACKGROUND AND PURPOSE

This study was undertaken to analyze enhancement patterns of the dura around sellar tumors and to compare the results with tumor invasion or compression of the cavernous sinuses. Postoperative enhancement patterns on MR images were compared with preoperative findings.

METHODS

Contrast-enhanced coronal and sagittal MR images were examined prospectively in 96 patients with sellar tumors (65 macroadenomas, 15 microadenomas, 14 Rathke cleft cysts, and two chordomas at the sella). All patients underwent surgical treatment, and pre- and postsurgical features on MR images were compared.

RESULTS

Presurgical MR images showed dural enhancement in 36.5% of the patients: asymmetric tentorial enhancement in 24 patients, symmetric tentorial enhancement in seven, and sphenoidal ridge or clivus enhancement in four. Asymmetric tentorial enhancement disappeared after surgical decompression in seven patients. For evaluation of cavernous sinus invasion ipsilateral to the enhancement, sensitivity and specificity of the asymmetric tentorial enhancement sign were 81.3% and 86.3%, respectively. Sensitivity and specificity of the sign were 42.9% and 93.6% for cavernous sinus involvement, including compression and invasion.

CONCLUSION

Asymmetric tentorial enhancement is a useful sign in the diagnosis of invasion or severe compression of the cavernous sinus by sellar tumor. The sign may represent venous congestion or collateral flow in the tentorium due to obstructed flow in the medial portion of the cavernous sinus.

Comprehensive analysis of 28 patients with latex allergy and prevalence of latex sensitization among hospital personnel

Recently anaphylactic shock caused by latex gloves and medical instruments has been discussed as an important problem in surgical operations. Patients with contact urticaria or anaphylaxis due to natural rubber latex were first reported in Japan in 1993, and the number of cases is gradually increasing. In the present study, we analyzed 28 patients examined in our clinic from 1993 to 1998. The diagnosis of latex allergy was made on the basis of clinical history, latex specific IgE antibody, skin test, and use test. The 3 male and 25 female patients included 20 nurses, 4 doctors, 2 housewives, one animal hospital employee, and one worker in a senile rehabilitation center. The majority were health care workers. Contact urticaria from rubber gloves was the most common clinical symptom. Some of the patients developed severe attacks of anaphylaxis. During the period from 1995 to 1997, we also performed a questionnaire study and a serum examination of latex specific IgE antibody among the personnel of our university hospital. The screening test for the antibody was more reliable than our questionnaire study in detecting latex-sensitive persons. The prevalence of latex allergy was found to be 4.6%. This indicates that not only dermatologists but also all hospital workers should be aware of this type of allergy.

Epigenetic heterogeneity at imprinted loci in normal populations

Genomic imprinting is the phenomenon by which the two alleles of certain genes are differentially expressed according to their parental origin. Extensive analysis of allelic expression at multiple imprinted loci in a normal population has not performed so far. In the present study, we examined the allelic expression pattern of three imprinted genes in a panel of 262 Japanese normal individuals. We observed differences in the extent of maintenance of allele-specific expression of the three genes. The allelic expression of small nuclear ribonucleoprotein N (SNRPN) was stringently regulated while that of multimembrane-spanning polyspecific transporter-like gene 1 (IMPT1) showed a large degree of variation. Significant biallelic expression of insulin-like growth factor II (IGF2) was observed in about 10% of normal individuals. Our findings add to the accumulating evidence for variable allelic expression at multiple loci in a normal human population. This epigenetic heterogeneity can be a stable trait and potentially influence individual phenotypes.

Loss of imprinting of long QT intronic transcript 1 in colorectal cancer

Loss of imprinting (LOI) of the insulin-like growth factor 2 (IGF2) and H19 genes on human chromosome 11 has been found not only in childhood tumors but also in common adult cancers including colorectal cancer. Recently, a transcript called LIT1 (long QT intronic transcript 1) has been identified within the KvLQT1 locus on chromosome 11. LIT1 is expressed preferentially from the paternal allele and is transcribed in most human tissues. LOI of LIT1 was found in a considerable number of Beckwith-Wiedemann syndrome (BWS) patients, suggesting that it is associated with the etiology of BWS. Since LOI of IGF2 was observed in association with overexpression of IGF2 in colorectal cancer in our previous study, we examined the status of genomic imprinting of LIT1 and H19 in comparison with IGF2 in colorectal cancer. We examined 44 surgically dissected colorectal cancer tissues. Ten of them represented informative cases for LIT1. None of these patients exhibited loss of heterozygosity (LOH) of LIT1, and LOI of LIT1 was observed in 4 of the 10 (40%) informative patients, but not in non-cancerous tissues. Neither LOH nor LOI of H19 was observed. LOI of IGF2 was observed in 4 of 18 (22%) informative patients. These results suggest that LOI of LIT1 is frequently observed in colorectal cancer and may be a useful marker for diagnosis of colorectal cancer.

Construction of 700 human/mouse A9 monochromosomal hybrids and analysis of imprinted genes on human chromosome 6

As an in vitro assay system for the identification of human imprinted genes, a library of human/mouse A9 monochromosomal hybrids containing a single, intact bsr-tagged human chromosome of known parental origin, derived from normal human fibroblasts, has been previously generated by microcell-mediated chromosome transfer (MMCT). To supplement this assay system, we constructed additional 700 A9 monochromosomal hybrids, using a pSTneo or pPGKneo selection marker. To validate the A9 hybrids, we screened them with chromosome-specific polymorphic markers, and identified the hybrids containing either human chromosome 6, 7, 14, 18, or 21 of known parental origin. Matching paternal and maternal chromosome pairs of A9 hybrids were identified for chromosomes 6, 7, 14, and 18. The paternal-specific expression of ZAC (zinc finger protein, which regulates apoptosis and cell cycle arrest) and HYMAI (hydatidiform mole-associated and imprinted transcript), and the maternal-specific methylation of a CpG island within an imprinted domain on human chromosome 6q24, were maintained in A9 hybrids. For an example, we profiled the expression of expressed sequence tags (ESTs) and the methylation of CpG islands in the 300-kb imprinted domain around 6q24, which may be associated with cancers and transient neonatal diabetes mellitus (TNDM). Thus, the 700 A9 hybrids should be useful for various aspects of imprinting studies.

A novel maternally expressed gene, ATP10C, encodes a putative aminophospholipid translocase associated with Angelman syndrome

Lack of a maternal contribution to the genome at the imprinted domain on proximal chromosome 15 causes Angelman syndrome (AS) associated with neurobehavioral anomalies that include severe mental retardation, ataxia and epilepsy. Although AS patients have infrequent mutations in the gene encoding an E6-AP ubiquitin ligase required for long-term synaptic potentiation (LTP), most cases are attributed to de novo maternal deletions of 15q11-q13. We report here that a novel maternally expressed gene, ATP10C, maps within the most common interval of deletion and that ATP10C expression is virtually absent from AS patients with imprinting mutations, as well as from patients with maternal deletions of 15q11-q13.

Large-scale evaluation of imprinting status in the Prader-Willi syndrome region: an imprinted direct repeat cluster resembling small nucleolar RNA genes

Loss of paternal gene expression at the imprinted domain on proximal human chromosome 15 causes Prader-Willi syndrome (PWS), a complex multiple-anomaly disorder involving variable mental retardation, hyperphasia leading to obesity and infantile hypotonia with failure to thrive. Although numerous paternally expressed transcripts have been identified that reside in the candidate region, the individual contributions to the development of PWS have not been firmly established. Recent studies of mouse models carrying a cytogenetic deletion suggest that paternal deficiency of the SNRPN-IPW interval is critical for perinatal lethality of potential relevance to PWS. Here we determined the allelic expression profiles of a total of 118 cDNA clones using monochromosomal hybrids retaining either a paternal or maternal human chromosome 15. Our results demonstrated a preponderance of unusual transcripts lacking protein-coding potential that were expressed exclusively from the paternal copy of the critical interval. This interval was also found to encompass a large direct repeat (DR) cluster displaying a potentially active chromatin conformation of paternal origin, as suggested by enhanced sensitivity to nuclease digestion. Database searches revealed an unexpected organization of tandemly repeated consensus elements, all of which possessed well-defined box C and D sequences characteristic of small nucleolar RNAs (snoRNAs). Southern blot analysis further demonstrated a considerable degree of phylogenetic conservation of the DR locus in the genomes of all mammalian species tested, but not in chicken, Xenopus and Drosophila. These findings imply a potential direct contribution of the DR locus, representing a cluster of multiple snoRNA genes, to certain phenotypic features of PWS.

Targeted disruption of the human LIT1 locus defines a putative imprinting control element playing an essential role in Beckwith-Wiedemann syndrome

Human chromosome 11p15.5 harbors an intriguing imprinted gene cluster of 1 Mb. This imprinted domain is implicated in a wide variety of malignancies and Beckwith-Wiedemann syndrome (BWS). Recently, several lines of evidence have suggested that the BWS-associated imprinting cluster consists of separate chromosomal domains. We have previously identified LIT1, a paternally expressed antisense RNA within the KvLQT1 locus through a positional screening approach using human monochromosomal hybrids. KvLQT1 encompasses the translocation breakpoint cluster in BWS and patients exhibit frequent loss of maternal methylation at the LIT1 CpG island, implying a regulatory role for the LIT1 locus in coordinate control of the imprinting cluster. Here we generated modified human chromosomes carrying a targeted deletion of the LIT1 CpG island using recombination-proficient chicken DT40 cells. Consistent with the prediction, this mutation abolished LIT1 expression on the paternal chromosome, accompanied by activation of the normally silent paternal alleles of multiple imprinted loci at the centromeric domain including KvLQT1 and p57(KIP2). The deletion had no effect on imprinting of H19 located at the telomeric end of the cluster. Our findings demonstrate that the LIT1 CpG island can act as a negative regulator in cis for coordinate imprinting at the centromeric domain, thereby suggesting a role for the LIT1 locus in a BWS pathway leading to functional inactivation of p57(KIP2). Thus, the targeting and precise modification of human chromosomal alleles using the DT40 cell shuttle system can be used to define regulatory elements that confer long-range control of gene activity within chromosomal domains.

Osteochondroma of the pubic symphysis associated with sexual disturbance

Osteochondroma of the pubic symphysis is a rare benign skeletal tumor. We report here a case of an osteochondroma of the pubic symphysis associated with a sexual disturbance, where a computed tomography scan clearly showed a tumor lesion of the pubic symphysis. The case is reported not only because of its rarity but also because it is important that gynecologists should bear this disease in mind, since a patient with this tumor may not visit an orthopedist but a gynecologist.

Multipoint imprinting analysis in sporadic colorectal cancers with and without microsatellite instability

Disrupted imprinting is implicated in certain tumorigenesis. Since aberrant methylation has been described for a majority of microsatellite instability (MSI)-positive sporadic colorectal cancers, we have investigated alteration to the imprinting in 55 sporadic colorectal cancers with or without MSI. Loss of imprinting (LOI) of IGF2 and PEG1/MEST was observed in 42% and 35% of informative cancers, respectively. H19 expression was not detected in 24% of informative cancers. SNRPN and NDN retained monoallelic expression in all the cancers examined. These findings indicate no simultaneous disruption of the imprinted genes. LOI of IGF2 and PEG1/MEST was also observed in colorectal mucosa from almost all the patients with LOI in tumor tissue. Moreover, MSI-positive colorectal cancers exhibit LOI of IGF2 with a high frequency compared to MSI-negative cancers (P=0.013). These observations, consistent with a previous report, establish an association between LOI of IGF2 and MSI in colorectal cancers and provide insight into susceptibility of tumor development.

Changes in platelet ATP secretion and aggregation during pregnancy and in preeclampsia

BACKGROUND

Platelet secretion plays an important role in the aggregation of platelets. However, the quantitative relationship between platelet aggregation and secretion of ATP during pregnancy and in pre-eclampsia has yet to be clarified. This study is designed to determine whether platelet count, volume, aggregation, and the amount of secreted ATP change in healthy, nonpregnant women, nonpreeclamptic pregnant women, and preeclamptic pregnant women and whether beta-thromboglobulin (BTG) and platelet factor 4 (PF-4) concentrations alter in nonpreeclamptic and pre-eclamptic women.

METHODS

Peripheral blood was collected from 114 women. Nonpreeclamptic pregnant women were divided into four groups (gestational weeks 10, 20, 30, and 35). Platelet aggregation and ATP secretion were investigated with the use of a lumi-aggregometer. BTG and PF-4 concentrations in peripheral blood were determined in 12 pregnant and 11 preeclamptic women.

RESULTS

The amount of secreted ATP upon induction by 5 microM ADP increased significantly (P < 0.05-0.01) with gestational age. On the other hand, the amount of secreted ATP induced by 5 microg/mL collagen reached the maximal value from gestational weeks 20 to 35 in nonpreeclamptic women. Significantly more platelet aggregation was induced by the ADP and collagen in nonpreeclamptic women in gestational weeks 20 and 30 than in the gestational weeks 10 or 35 (P < 0.05-0.005). The amount of secreted ATP and platelet count were significantly lower (P < 0.05) in preeclampsia than in normal pregnancy. The BTG and PF-4 concentrations were significantly higher (P < 0.05) in preeclampsia than in normal pregnancy.

CONCLUSIONS

The sensitivity of platelets for ATP secretion may intensify with progression of pregnancy. In normal pregnancy, around gestational week 35, the platelets may exhibit weaker ability to aggregate but maintain the capacity to secrete ATP. In preeclampsia, secreted ATP decreased because platelets may be stimulated to undergo a partial secretion.

LIT1, an imprinted antisense RNA in the human KvLQT1 locus identified by screening for differentially expressed transcripts using monochromosomal hybrids

Mammalian imprinted genes are frequently arranged in clusters on particular chromosomes. The imprinting cluster on human chromosome 11p15 is associated with Beckwith-Wiedemann syndrome (BWS) and a variety of human cancers. To clarify the genomic organization of the imprinted cluster, an extensive screen for differentially expressed transcripts in the 11p15 region was performed using monochromosomal hybrids with a paternal or maternal human chromosome 11. Here we describe an imprinted antisense transcript identified within the KvLQT1 locus, which is associated with multiple balanced chromosomal rearrangements in BWS and an additional breakpoint in embryonal rhabdoid tumors. The transcript, called LIT1 (long QT intronic transcript 1), was expressed preferentially from the paternal allele and produced in most human tissues. Methylation analysis revealed that an intronic CpG island was specifically methylated on the silent maternal allele and that four of 13 BWS patients showed complete loss of maternal methylation at the CpG island, suggesting that antisense regulation is involved in the development of human disease. In addition, we found that eight of eight Wilms' tumors exhibited normal imprinting of LIT1 and five of five tumors displayed normal differential methylation at the intronic CpG island. This contrasts with five of six tumors showing loss of imprinting of IGF2. We conclude that the imprinted gene domain at the KvLQT1 locus is discordantly regulated in cancer from the imprinted domain at the IGF2 locus. Thus, this positional approach using human monochromosomal hybrids could contribute to the efficient identification of imprinted loci in humans.

Mouse A9 cells containing single human chromosomes for analysis of genomic imprinting

To develop an systematic in vitro approach for the study of genomic imprinting, we generated a new library of human/mouse A9 monochromosomal hybrids. We used whole cell fusion and microcell-mediated chromosome transfer to generate A9 hybrids containing a single, intact, bsr-tagged human chromosome derived from primary fibroblasts. A9 hybrids were identified that contained either human chromosome 1, 2, 4, 5, 7, 8, 10, 11, 15, 18, 20, or X. The parental origin of these chromosomes was determined by polymorphic analysis using microsatellite markers, and matched hybrids containing maternal and paternal chromosomes were identified for chromosomes 5, 10, 11 and 15. The imprinted gene KVLQT1 on human chromosome 11p15.5 was expressed exclusively from the maternal chromosome in A9 hybrids, and the parental-origin-specific expression patterns of several other imprinted genes were also maintained. This library of human monochromosomal hybrids is a valuable resource for the mapping and cloning of human genes and is a novel in vitro system for the screening of imprinted genes and for their functional analysis.

Loss of imprinting of a paternally expressed transcript, with antisense orientation to KVLQT1, occurs frequently in Beckwith-Wiedemann syndrome and is independent of insulin-like growth factor II imprinting

Genomic imprinting plays a fundamental role in cancer and some hereditary diseases, including Beckwith-Wiedemann syndrome (BWS), a disorder of prenatal overgrowth and predisposition to embryonal malignancies such as Wilms tumor. We have previously shown that the KVLQT1 gene on chromosomal band 11p15 is imprinted, with expression of the maternal allele, and that the maternal allele is disrupted in rare BWS patients with balanced germ-line chromosomal rearrangements. We now show that an antisense orientation transcript within KVLQT1, termed LIT1 (long QT intronic transcript 1) is expressed normally from the paternal allele, from which KVLQT1 transcription is silent, and that in the majority of patients with BWS, LIT1 is abnormally expressed from both the paternal and maternal alleles. Eight of sixteen informative BWS patients (50%) showed biallelic expression, i.e., loss of imprinting (LOI) of LIT1. Similarly, 21 of 36 (58%) BWS patients showed loss of maternal allele-specific methylation of a CpG island upstream of LIT1. Surprisingly, LOI of LIT1 was not linked to LOI of insulin-like growth factor II (IGF2), which was found in 2 of 10 (20%) BWS patients, even though LOI of IGF2 occurs frequently in Wilms and other tumors, and in some patients with BWS. Thus, LOI of LIT1 is the most common genetic alteration in BWS. We propose that 11p15 harbors two imprinted gene domains-a more centromeric domain including KVLQT1 and p57(KIP2), alterations in which are more common in BWS, and a more telomeric domain including IGF2, alterations in which are more common in cancer.

Expression of MAGE-1, MAGE-2 and MAGE-3 genes in human gastric carcinomas; lack of evidence for cytotoxic effects in cases with simultaneous expression of MAGE-3 and HLA-A2

The human MAGE gene products are recognized by major histocompatibility complex-restricted cytotoxic T lymphocytes. We analyzed by RT-PCR the expression of MAGE-1, MAGE-2, MAGE-3 and HLA-A2 genes in 10 human gastric cancer cell lines and 46 human stomachs removed due to advanced gastric carcinomas. All the cell lines expressed MAGE genes, except for MKN-45 and -74 which lacked the expression of MAGE-1 and -3 genes in this study. Of the 46 gastric carcinomas, MAGE-1, -2 and -3 genes were expressed in 14 (30%), 10 (22%) and 26 (57%) cases, respectively, regardless of histological type. Normal gastric mucosa and intestinal metaplastic mucosa showed no expression of these genes. HLA-A2 gene expression was noted in 14 both normal and carcinoma cases. Simultaneous expression of MAGE-3 and HLA-A2 genes was noted in 7 cases. Mean apoptotic and Ki-67-labeling indices (AI and KI) of carcinoma cells were 2.3 +/- 0.5 and 48.1 +/- 6.0 in 7 cases, and 2.8 +/- 0.2 and 47.3 +/- 2.7 in the other 39 cases lacking the expression of MAGE-3 and/or HLA-A2 genes, respectively. The two-year survival rate did not differ between the two groups. Although this study confirmed the relatively higher expression of the MAGE gene family in human advanced gastric carcinomas, it might suggest that simultaneous expression of MAGE-3 and HLA-A2 genes does not necessarily imply the induction of cancer cell apoptosis by CTL.

Epigenetic reprogramming of the human H19 gene in mouse embryonic cells does not erase the primary parental imprint

BACKGROUND

Genomic imprinting in mammals is thought to result from epigenetic modifications to chromosomes during gametogenesis, which leads to differential allelic expression during development. There is a requirement for an appropriate experimental system to enable the analysis of the mechanisms of genomic imprinting during embryogenesis.

RESULTS

To develop a novel in vitro system for studying the molecular basis of genomic imprinting, we constructed mouse cell lines containing either a paternal or maternal human chromosome 11, by microcell-mediated chromosome transfer. Allele-specific expression and DNA methylation studies revealed that the imprinting status of the human H19 gene was maintained in mouse A9 mono-chromosomal hybrids. Each parental human chromosome was introduced independently into mouse near-diploid immortal fibroblasts (m5S) and two embryonal carcinoma (EC) cell lines (OTF9-63 and P19). The paternal allele of human H19 remained in a repressed state in m5S cells, but was de-repressed in both EC cells. The paternal H19 allele was demethylated extensively in OTF9-63 cells, whereas the only alteration in P19 hybrids was de novo methylation on both alleles in the 3' region. Following in vitro differentiation, the expressed paternal H19 allele was selectively repressed in differentiated derivatives of EC hybrids.

CONCLUSION

These results indicated that human imprint marks could function effectively in mouse cells, and that the imprinting process was epigenetically reprogrammed in embryonal carcinoma cells, without erasure of the primary imprint that marked the parental origin. Therefore, these mono-chromosomal hybrids could provide a valuable in vitro system to study the mechanisms involved in the regulation of imprinted gene expression.

Aspirin-sensitive urticaria: provocation with a leukotriene receptor antagonist

The diagnosis of two patients with aspirin-induced urticaria (AIU) was confirmed by oral provocation with aspirin, other non-steroidal anti-inflammatory drugs, and food additives. Low doses of a novel leukotriene (LT) receptor antagonist, ONO-1078 (ONO, Japan) induced urticaria in these patients, while the same doses of ONO-1078 did not provoke any eruptions in 10 normal healthy volunteers or five patients with aspirin-unrelated chronic urticaria. This is the first report that a selective LTD4/LTE4 receptor antagonist that is effective as an antiasthmatic agent evoked urticaria in patients with AIU. Our observation suggests that the pathogenesis of AIU depends on the stimulation of LT receptors. The accumulation of results of anti-LT therapy may provide clues to resolve the pathogenetic mechanisms of this disorder.

Paternal expression of WT1 in human fibroblasts and lymphocytes

The Wilms' tumor suppressor gene ( WT1 ) was previously identified as being imprinted, with frequent maternal expression in human placentae and fetal brains. We examined the allele-specific expression of WT1 in cultured human fibroblasts from 15 individuals. Seven of 15 fibroblast lines were heterozygous for polymorphic alleles, and the expression patterns were variable, i.e., equal, unequal or monoallelic paternal expression in three, two and two cases, respectively. Exclusive paternal expression of WT1 was also shown in non-cultured peripheral lymphocytes from the latter two individuals. The allele-specific expression profiles of other imprinted genes, IGF2 and H19, on human chromosome 11 were constant and consistent with those in other tissues. Our unexpected observations of paternal or biallelic expression of WT1 in fibroblasts and lymphocytes, together with the previous findings of maternal or biallelic expression in placentae and brains, suggest that the allele-specific regulatory system of WT1 is unique and may be controlled by a putative tissue- and individual-specific modifier.

Evidence for uniparental, paternal expression of the human GABAA receptor subunit genes, using microcell-mediated chromosome transfer

We have constructed mouse A9 hybrids containing a single normal human chromosome 15, via microcell-mediated chromosome transfer. Cytogenetic and DNA-polymorphic analyses identified mouse A9 hybrids that contained either a paternal or maternal human chromosome 15. Paternal specific expression of the known imprinted genes SNRPN (small nuclear ribonucleoprotein-associated polypeptide N gene) and IPW (imprinted gene in the Prader-Willi syndrome region) was maintained in the A9 hybrids. Using this system, we first demonstrated that human GABAAreceptor subunit genes, GABRB3 , GABRA5 and GABRG3 , were expressed exclusively from the paternal allele and that E6-AP (E6-associated protein or UBE3A ) was biallelically expressed. Moreover, the 5' portion of the GABRB3 gene was found to be hypermethylated on the paternal allele. Our data imply that GABAAreceptor subunit genes are imprinted and are possible candidates for Prader-Willi syndrome, and that this human monochromosomal hybrid system enables the efficient analysis of imprinted loci.

Isolation and mapping of human homologues of an imprinted mouse gene U2af1-rs1

We have isolated human homologues of the imprinted mouse gene, U2af1-rs1. Two different types of cDNAs and three distinct genomic DNAs belonging to different groups were isolated. We have identified chromosomal genes corresponding to each cDNA by restriction mapping and sequencing. Using both a panel of rodent/human somatic cell hybrids and fluorescence in situ hybridization, group 1 and group 2 genes were mapped to chromosome 5q22 and chromosome Xp22.1, respectively. We designated group 1 and group 2 genes as human U2AF1-RS1 and U2AF1-RS2, respectively, because these genes corresponded to mouse U2af1-rs1 (chromosome 11) and U2af1-rs2 (chromosome X), which we also isolated and mapped. Amino acid sequences of human U2AF1-RS1 and U2AF-RS2 showed significant homology to U2AF small subunit. The group 3 gene, designated as U2AF1-RS3, of which the cDNA has not yet been isolated, was mapped to chromosome 19p13.2.

Normal human chromosome 2 induces cellular senescence in the human cervical carcinoma cell line SiHa

For identification of the chromosome carrying cellular senescence-inducing activity, normal human chromosome 2, 3, 6, 7, 9, 11, or 12 tagged with a selectable marker gene (neo) was introduced into the human cervical carcinoma cell line SiHa via microcell-mediated chromosome transfer. Seventy-six percent (158/207) of the G418-resistant clones obtained by the transfer of chromosome 2 showed a remarkable change in morphology (cells were flat), and 93% (147/158) of them ceased to divide (senesced) prior to 6-9 population doublings, whereas most of the clones generated by the transfer of other chromosomes exhibited a morphology similar to that of the parental cells and continued to grow. Chromosome analyses suggested that cells which escaped from senescence contained only a small fragment derived from the transferred chromosome 2, whereas the transferred chromosomes were apparently intact in most of the continuously growing microcell hybrids with introduction of other chromosomes. These results indicate that the normal human chromosome 2 carries a gene or genes that induce cellular senescence in SiHa cells.

Isolation and mapping of 186 new DNA markers on human chromosome 1

To obtain DNA markers on human chromosome 1, we first isolated 500 cosmid clones from mouse A9 cells containing a human chromosome 1 tagged with pSV2neo. Of these, 186 were localized on each band of human chromosome 1 by R-banding fluorescence in situ hybridization; 118 and 68 were on the short and long arms, respectively. We performed restriction fragment length polymorphism (RFLP) analysis of these cosmid clones, and polymorphism was recognized with one or more enzyme in 43 of them. Two markers proved to have variable numbers of tandem repeats. Since several tumor suppressor genes, as well as genes responsible for hereditary disorders, may be located on this human chromosome, the DNA markers will be useful for RFLP analysis or the isolation of new genes related to various disorders.

Study of the efficacy of antiseptic handrub lotions with hand washing machines

The effectiveness of quick handwashing in regards to four alcohol-based handrub lotions, including two products already on the market and our original lotions 1, 2, with two different kinds of hand washing machines was studied in vivo. We also tried to evaluate the efficacy of the four lotions in vitro. The in vivo testing of each lotion, including ethanol, was evaluated using two hand washing methods, first with and then without a previous soap wash. Computerized image analysis was used to calculate the bacterial count on the hand surface. The results showed that a 3 second application of the original lotion 2 (0.5% chlorhexidine in a 77% ethyl alcohol solution) preceded by a soap wash eradicated 89.3% of the bacteria on the hands; this was the highest reduction rate of all four detergents. AROKULIN-E (67.9% ethyl alcohol solution) without a prior handwashing produced the lowest reduction, 49.1% against hand surface bacteria. These results were compatible with those in vitro. It seems that an alcohol-based solution containing an effective antimicrobial detergent preceded by a soap wash is necessary to acceptably reduce hand surface bacteria.

[A clinical study on memory function in climacteric and periclimacteric women]

This study was designed to investigate memory function in climacteric and periclimacteric women who lived a normal, ordinary life. Two hundred women treated at the gynecological outpatient clinic of Koshigaya Hospital were divided into 7 groups: groups A(31-35 yr), B(36-40 yr), C(41-45 yr), D(46-50 yr), E(51-55 yr), F(56-60 yr) and G(61-65 yr). Each group consisted of 30 women except group G(n = 20). The memory function of each group was determined and the mean scores for 10 paired hard-associates after three trials of presentation were compared. The mean scores (+/- SD) for groups A and B were 8.0 +/- 2.0 and 8.2 +/- 1.7, respectively, which were not statistically different. The scores for both groups were significantly higher than those for the other groups (p < 0.01). The mean scores for groups C and D were 5.9 +/- 2.1 and 5.6 +/- 2.4, respectively, which were not statistically different. The score for group C was significantly higher than those for groups E(4.5 +/- 2.4), F(4.2 +/- 2.2), and G(3.3 +/- 1.6) (p < 0.05). The score for group D was significantly higher than those for groups F and G(p < 0.05). The score for group E was significantly higher than that for group G(p < 0.01). The decrease in memory function was the greatest in group C. In the climacterium, memory impairment was also observed in group E. The former corresponds to the climacteric commencement age group where cyclic changes in serum estrogen levels decrease or cease, and the latter corresponds to the age group for menopause.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation, using computerized image analysis, of antimicrobial efficacy of an automatic hand washing machine with ultrasonic wave spraying

We studied the antimicrobial efficacy of hand washing with a quick-dry hand washing machine [TE-KIREIKI] employing ultrasonic wave spraying and its incidental alcohol-based product [AROKULIN-E]. The subjects of this study were 10 males who had been instructed not to use any antimicrobial agent for the previous 2 weeks or any hand soap for the previous 5 hours. They pressed their palms on agar before and after washing their hands. After 48-hour incubation at 37 degrees C, the bacterial colonies grown on the agar were counted using the [ASPECT] image processing system. The colony count was expressed as the post-stamp versus pre-stamp percent (%) reduction. Two patterns of hand washing were examined in this study: [A] a 3-second hand wash using an alcohol-based product [AROKULIN-E] and [B] a 30-second hand wash using a nonmedicated detergent soap with running water in addition to hand washing by [A]. The percent (%) reduction after hand washing patterns [A] and [B] were 49.1% and 51.3%. These reduction rates indicated that these patterns did not eradicate bacteria from the hand surface. Therefore, we concluded that this quick-dry hand washing machine employing an ultrasonic wave spraying method combined with an alcohol-based product needs improvement.

The incidence of isolation of methicillin-resistant Staphylococcus aureus (MRSA) strains from skin infections during the past three years (1989-1991)

We did a statistical study of 294 strains of Staphylococcus aureus (S. aureus) isolated from skin infections during the period from January of 1989 to December of 1991 in the Department of Dermatology, Kansai Medical University Hospital. We especially examined methicillin-resistant S. aureus (MRSA) from the point of view of incidence, variety of skin infections with MRSA, coagulase type, phase type, and resistance against antimicrobial agents. The frequency of isolation of MRSA has been increasing. In 1991, the proportion of MRSA isolates among all S. aureus strains isolated from skin infections was 41.5%. MRSA was isolated most often from infectious decubitus. Coagulase type II and phage group NT (not typable) MRSA were most frequently isolated. The resistance of MRSA to OFLX and IMP/CS had remarkably increased. Notably, the resistance to MINO was low before 1991.