A chimeric antigen receptor uniquely recognizing MICA/B stress proteins provides an effective approach to target solid tumors

BACKGROUND

The advent of chimeric antigen receptor (CAR) T cell therapies has transformed the treatment of hematological malignancies; however, broader therapeutic success of CAR T cells has been limited in solid tumors because of their frequently heterogeneous composition. Stress proteins in the MICA and MICB (MICA/B) family are broadly expressed by tumor cells following DNA damage but are rapidly shed to evade immune detection.

METHODS

We have developed a novel CAR targeting the conserved α3 domain of MICA/B (3MICA/B CAR) and incorporated it into a multiplexed-engineered induced pluripotent stem cell (iPSC)-derived natural killer (NK) cell (3MICA/B CAR iNK) that expressed a shedding-resistant form of the CD16 Fc receptor to enable tumor recognition through two major targeting receptors.

FINDINGS

We demonstrated that 3MICA/B CAR mitigates MICA/B shedding and inhibition via soluble MICA/B while simultaneously exhibiting antigen-specific anti-tumor reactivity across an expansive library of human cancer cell lines. Pre-clinical assessment of 3MICA/B CAR iNK cells demonstrated potent antigen-specific in vivo cytolytic activity against both solid and hematological xenograft models, which was further enhanced in combination with tumor-targeted therapeutic antibodies that activate the CD16 Fc receptor.

CONCLUSIONS

Our work demonstrated 3MICA/B CAR iNK cells to be a promising multi-antigen-targeting cancer immunotherapy approach intended for solid tumors.

FUNDING

Funded by Fate Therapeutics and NIH (R01CA238039).

117 FT536 Path to IND: Ubiquitous targeting of solid tumors with an off-the-shelf, first-of-kind MICA/B-specific CAR-iNK cellular immunotherapy

Background

Chimeric antigen receptor (CAR)-T cell therapy has revolutionized cancer treatment, but it is associated with significant dose-limiting toxicities, restricted tumor targeting (limited by specific antigen expression), and, notably, a lack of multi-antigen targeting capability to mitigate tumor associated immune evasion and heterogeneity. Furthermore, dysfunctional starting material, product inconsistency, and small manufacturing lot size limits the application and on-demand availability of CAR-T cell therapy.

Methods

To overcome these considerable limitations, we have developed FT536, a first-of-kind, induced pluripotent stem cell (iPSC)-derived NK (iNK) cell with a novel CAR that ubiquitously targets cancer cells through canonical stress ligand recognition. We have previously reported FT536 recognizes the conserved α3 domain of the pan-tumor associated antigens MICA and MICB (MICA/B), and is derived from a renewable master iPSC line that contains multiplexed genetic edits to enhance effector cell functionality, persistence, and multi-antigen targeting capabilities via high affinity non cleavable CD16 (hnCD16) mediated antibody dependent cellular cytotoxicity (ADCC). Here we preview the nonclinical study for the investigational new drug (IND) application for FT536.

Results

Utilizing a manufacturing process analogous to pharmaceutical drug product development, we demonstrate FT536 can be consistently and uniformly produced with a greater than 4x10E7 fold cellular expansion per manufacturing campaign. Furthermore, FT536 can be cryopreserved at clinical scale to support off-the-shelf clinical application, with rapid product thaw and immediate patient infusion in an out-patient setting. Functional evaluation demonstrated that FT536 uniquely possesses potent and persistent antigen specific cytolytic activity against an array of solid and hematological tumor lines. Through its hnCD16 modality, FT536 can be utilized in combination with monoclonal antibodies to provide multi-antigen targeting capabilities and in conjunction with chemotherapeutics and/or radiation that augment surface MICA/B expression. In addition, directly thawed and infused FT536 demonstrated significant tumor growth inhibition in multiple solid and liquid in vivo xenograft models, in which tumor control was further enhanced in combination with a therapeutic antibody (figure 1). Finally, ongoing studies utilizing a lung adenocarcinoma model have highlighted the sustained persistence of FT536 in lung tissue up to 33 days following a single dose infusion without the need for exogenous cytokine support.

Abstract 117 Figure 1

FT536 provides statistically significant in vivo anti-tumor activity which is enhanced in combination with ADCC active monoclonal antibody therapy. (A-B) FT536 significantly reduced the number of lung and liver (not shown) metastases compared to CAR negative iNK control cells in a murine metastatic melanoma model using B16-F10 cells engineered to overexpress human MICA. (C-D) FT536 alone, and in combination with Herceptin, demonstrate significant tumor growth inhibition (TGI) compared to Herceptin alone in an orthotopic xenograft model of human lung adenocarcinoma.

Conclusions

Collectively, these studies demonstrate that FT536 is a highly potent, multi-tumor targeting CAR-iNK cell product that is uniform in composition and can be effectively and safely used off-the-shelf for on-demand treatment of multiple solid and hematological malignancies. An IND submission is planned for 2021, with an initial Phase 1 clinical trial to follow.

Abstract 1591: FT536: Preclinical development of a novel off-the-shelf CAR-MICA/B NK cell immunotherapy combined with radiation and antibody treatments as a first-of-kind pan-cancer targeting strategy

Cancer immunotherapies have revolutionized cancer treatment by showing clinical efficacy across multiple cancer indications. However, tumor heterogeneity and evasion from host immune cell surveillance often limit the durability and efficacy of these strategies as monotherapies. Consequently, it is becoming common practice to combine existing anticancer treatments and novel immunotherapies to maximize clinical efficacy. The pan tumor-associated antigens MICA and MICB (MICA/B) are surface proteins induced by cellular stress, often associated with tumorigenesis, and are recognized by the NK cell activating receptor NKG2D. To evade immune recognition, cancer cells often proteolytically shed the membrane distal domains of MICA/B, leading to reduced NKG2D recognition. To combat this pervasive tumor escape mechanism and create a ubiquitous cancer targeting platform, we have developed a novel CAR-iPSC-derived NK (iNK) cell that targets the conserved α3 domain of MICA/B, rendering it resistant to inhibition by shed MICA/B. To enhance effector cell function, persistence and multi-antigen capacity, further genetic editing at the iPSC stage was conducted to equip the CAR-iNK cells with a unique IL-15/IL-15 receptor fusion, the knockout of CD38 and a novel high-affinity, non-cleavable CD16 (hnCD16) to enhance antibody-dependent cellular cytotoxicity (ADCC). In this study, we evaluated the function of multiplexed engineered MICA/B CAR iNK cells (termed FT536) in combination with monoclonal antibodies (mAbs), to elicit multi-antigen targeting, and radiation therapy, to augment surface MICA/B expression. FT536 showed superior in vitro cytotoxicity and in vivo tumor control against an array of MICA/B expressing tumor lines. Furthermore, ADCC, induced in combination with cetuximab or trastuzumab, enhanced the potency of FT536 against various solid tumor lines (p <0.05). To demonstrate the capability of FT536 to synergize with irradiation therapy, we utilized a panel of tumor lines, divergent in tissue origin and MICA/B expression profiles. This approach highlighted that irradiation of the SK-BR-3 tumor line, a breast adenocarcinoma that expresses low levels of surface MICA/B and high levels of EGFR, induced the upregulation of MICA/B expression (p <0.05). As anticipated, FT536 exhibited enhanced, CAR-dependent cytotoxicity against irradiated SK-BR-3 cells. Ongoing work is focused on the development of in vivo models that combine FT536 with in situ tumor irradiation and mAbs in order to promote durable responses and the elimination of resistant and heterogenous cancer cells. These data demonstrate successful targeting of MICA/B positive tumors by FT536 can be augmented by mAb and radiation therapies as first-of-kind combinatorial strategies to broadly target escape-prone tumors.

Citation Format: John Goulding, Robert Blum, Bryan Hancock, Moyar Ge, Brian Groff, Soheila Shirinbak, Joy Grant, Martin Hosking, Mochtar Pribadi, Yijia Pan, Hui-Yi Chui, Shohreh Sikaroodi, Lauren Fong, Janel Huffman, Wen-I Yeh, Chia-Wei Chang, Thomas Dailey, Miguel Meza, Cokey Nguyen, Lucas Ferrari de Andrade, Tom Lee, Ryan Bjordahl, Kai W. Wucherpfennig, Bahram Valamehr. FT536: Preclinical development of a novel off-the-shelf CAR-MICA/B NK cell immunotherapy combined with radiation and antibody treatments as a first-of-kind pan-cancer targeting strategy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1591.

Abstract 1550: FT576 path to first-of-kind clinical trial: translation of a versatile multi-antigen specific off-the-shelf NK cell for treatment of multiple myeloma

Chimeric antigen receptor (CAR) directed therapies have been used successfully to treat a variety of hematological malignancies. With the advent of multi-modal engineering, adoptive cell therapy offers the opportunity to tackle increasingly complex disease settings such as multiple myeloma (MM), where targeting of single tumor associated antigen by CAR or monoclonal antibodies (mAb) is confounded by antigen loss and clonal heterogeneity. Further, expanding treatment options beyond primary T and NK cell based therapies has multiple advantages, including the use of induced pluripotent stem cells (iPSC) to derive effector cells using precision genetic engineering that can be uniformly manufactured at scale from a clonally-derived master cell bank (MCB).FT576 is a multiplex-edited, iPSC-derived CAR-NK (CAR-iNK) cell therapy designed for treatment of Multiple Myeloma. FT576 is engineered 1) to express a recombinant IL-15/IL-15 receptor signaling complex (IL-15RF) for enhanced persistence; 2) to express an enhanced high-affinity, non-cleavable CD16 (hnCD16) ; 3) to disrupt expression of CD38, allowing for enhanced ADCC without NK cell fratricide; and 4) to express a BCMA-targeted CAR with NK-cell optimized signaling.CAR-directed specificity of the FT576 cells for BCMA was demonstrated using a short-term cytotoxicity assay (90.8% cytotoxicity against BCMA+ vs 22.1% BCMA- cells, p<0.0001). Utilizing a long-range tumor clearance assay without exogenous cytokine support, serial restimulation by repeated rounds of exposure to fresh MM target cells showed remarkable persistence and antigen-mediated expansion of FT576 by CAR alone or combined with anti-CD38 mAb. Continuous long-range clearance assays demonstrated levels of BCMA targeting activity of FT576 alone was equivalent to primary BCMA-targeted CAR-T cells against a panel of BCMA+ target cells. BCMA-CAR targeting was tested in combination with multiple therapeutic mAbs to explore breadth of tumor clearance in primary bone marrow samples.In xenograft models, dosing of FT576 as a monotherapy was highly protective against MM progression, resulting in deeper tumor regression and delayed outgrowth. The treatment of MM-bearing mice with both FT576 and daratumumab produced greater myeloma control than either agent alone, demonstrating combined CAR and antibody-directed cytotoxicity. Additionally, FT576 demonstrated enhanced persistence compared to peripheral blood NK cells, suggestive of antigen mediated expansion. Together, these studies demonstrate the versatility of FT576 as a highly effective multi-antigen targeting and cost-effective, off-the-shelf BCMA-CAR iNK cell product and support the rational for a first-of-kind Phase I Study of FT576 as a monotherapy or in combination with therapeutic mAbs targeted to MM-associated surface antigens.

Citation Format: Jode P. Goodridge, Ryan Bjordahl, Sajid Mahmood, John Reiser, Svetlana Gaidarova, Robert Blum, Frank Cichocki, Hui-yi Chu, Greg Bonello, Tom Lee, Brian Groff, Miguel Meza, Thomas Daley, Yu-waye Chu, Bruce Walcheck, Karl-Johan Malmberg, Jeffrey S. Miller, Armin Rehm, Bahram Valamehr. FT576 path to first-of-kind clinical trial: translation of a versatile multi-antigen specific off-the-shelf NK cell for treatment of multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1550.

Abstract 3226: Patient-derived xenograft (PDX) models for triple negative breast cancer (TNBC): A pre-clinical platform for drug discovery

In the United States, TNBC comprises 15-20% of breast cancers and are characterized by the lack of expression of estrogen receptor, progesterone receptor and receptor tyrosine protein kinase ERBB2 or Her-2/neu oncogene amplification. As a result, this type of breast cancer is difficult to treat as most of the chemotherapies target these 3 receptors. TNBC is highly aggressive and is associated with high morbidity, mortality and shorter disease-free survival. Given its heterogeneous clinical presentation, histology and response to therapy, prognosis and management of TNBC is complicated. In this study, we report development and characterization of the TNBC PDX model. We used patient derived TNBC tissues to generate 5 new TNBC models in NOD-SCID mice. Patient tumors were pre-screened for their ER, PR and Her-2/Neu expression by IHC, prior to inoculation in mice. Efficacy of two standard of care drugs, Cisplatin and Vinorelbine in the TNBC PDX model demonstrates the potential utility of the TNBC model in drug discovery effort in oncology for treatment of TNBC.

Citation Format: Jayant Thatte, Miguel Meza, Jill Ricono, Cyrus Mirsaidi, Thomas Broudy. Patient-derived xenograft (PDX) models for triple negative breast cancer (TNBC): A pre-clinical platform for drug discovery. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3226. doi:10.1158/1538-7445.AM2015-3226

Sepiapterin reductase regulation of endothelial tetrahydrobiopterin and nitric oxide bioavailability

Sepiapterin reductase (SPR) catalyzes the final step of tetrahydrobiopterin (H(4)B) biosynthesis and the first step of H(4)B regeneration from an exogenous precursor sepiapterin. Despite the potential significance of SPR in regulating H(4)B-dependent nitric oxide (NO(*)) production, the endothelium-specific sequence and functions of SPR remain elusive. We first cloned endothelial SPR cDNA from bovine aortic endothelial cells (Genebank: DQ978331). In cells transiently transfected with SPR gene, SPR activity (HPLC) was dramatically increased by 19-fold, corresponding to a significant increase in endothelial H(4)B content (HPLC) and NO(*) production (electron spin resonance). In vivo delivery of SPR gene significantly increased vascular SPR protein expression (mouse vs. bovine antibodies to differentiate endogenous vs. exogenous), activity, H(4)B content, and NO(*) production, as well as NO(*)-dependent vasorelaxation. In endothelial cells transfected with small interfering RNA specific for SPR, approximately 87% of mRNA were attenuated (real-time quantitative RT-PCR), corresponding to a significant reduction in SPR protein expression and activity, which was associated with decreases in both intracellular H(4)B content and NO(*) level. Exogenous administration of sepiapterin to endothelial cells significantly upregulated H(4)B and NO(*) levels, which were attenuated by SPR RNA interference (RNAi). H(4)B-stimulated increase in NO(*) production, however, was SPR RNAi independent. GTP cyclohydrolase 1 expression and activity, as well as dihydrofolate reductase expression, were not affected by SPR RNAi, whereas dihydrofolate reductase activity was significantly downregulated. These data represent the first to study endothelial SPR functionally and clearly demonstrate an important role of endothelial SPR in modulating H(4)B and NO(*) bioavailability.

Beneficial Therapeutic Effect of Cellcept® in Systemic Lupus Erythematosis (SLE); Suggested Mechanism of Action (50.26)

Cellcept® inhibits proliferative responses of T- and B-lymphocytes to both mitogenic and allospecific stimulation and suppresses antibody formation in B-lymphocytes. MPA prevents the glycosylation of lymphocyte and monocyte glycoproteins that are involved in adhesion to endothelial cells. Although Cellcept® is prescribed "off label" to treat SLE and shows great benefits, the exact mechanism of action is not fully understood. MRL/lpr developing glomerular disease mice that exhibit similar pathology to human SLE were used to study the therapeutic effects of Cellcept®. Although Cellcept® at 100mg/kg doses significantly decreased the proteinurea levels in the treated mice, it had marginal effects on the ds-DNA antibody levels. In addition, Cellcept® reduced the levels of B cells in the spleens of treated mice consistent with its immunosuppressant benefit. Histopathological evaluation demonstrated that Cellcept® reduced glomerulonephritis but not vasculitis in kidneys of treated mice. Furthermore, it was shown that Cellcept® lowered the number of monocytes in kidneys; this is the most likely mechanism of action responsible for the less kidney damage and lower proteinurea levels. The reduction in the number of monocytes in kidneys is the first major indication that the beneficial effect of Cellcept® to the kidney function in patients with SLE might be due to the inhibition of mocnocyte infiltration responsible for the destruction of nephritic tissues and not through the action on B cells by lowering the ds-DNA antibody levels.

Potent Therapeutic Effect of Apeaz™ Cream in the Mouse Collagen Induced Arthritis Model (50.20)

Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology, characterized by chronic inflammation in the joints and subsequent destruction of the cartilage and bone. OTC NSAIDs are only approved for temporary pain relief and do not qualify as Disease-modifying antirheumatic drugs (DMARDs). Apeaz™ is an OTC cream approved for temporary relief of pain resulting from arthritis. The main ingredient in Apeaz™ is methyl salicylate as anti-inflammatory with glucosamine sulfate, menthol, camphor and methyl sulfonyl ethane as inactive excipients. Because Collagen-induced arthritis (CIA) is a murine experimental disease model sharing a number of clinical, histological and immunologic features with RA, we used it to study the effect of topically applied Apeaz™, once a day, on the pathogenesis of arthritis. The results show that treatment with Apeaz™ has great benefit at the clinical and pathological levels, as the therapeutic effect of Apeaz™ was associated with the downregulation of both inflammatory and autoimmune components of the disease. Treatment with Apeaz™ completely abrogated joint swelling and destruction of cartilage and bone as demonstrated by histopathology and X-ray analysis of joints. In addition, Apeaz™ reduced the levels of inflammatory cytokines in the joints of arthritic mice. Our data suggest that Apeaz™ could be a viable candidate as a DMARD for RA.

Genomewide clonal analysis of lethal mutations in the Drosophila melanogaster eye: comparison of the X chromosome and autosomes

Using a large consortium of undergraduate students in an organized program at the University of California, Los Angeles (UCLA), we have undertaken a functional genomic screen in the Drosophila eye. In addition to the educational value of discovery-based learning, this article presents the first comprehensive genomewide analysis of essential genes involved in eye development. The data reveal the surprising result that the X chromosome has almost twice the frequency of essential genes involved in eye development as that found on the autosomes.

Integrating nursing diagnoses, interventions, and outcomes in public health nursing practice

TOPIC

Applying standardized nursing language in public health nursing practice.

PURPOSE

To develop a charting format to document public health nursing practice based on standardized nursing language.

SOURCES

Literature review of documentation systems for public health nursing practice.

CONCLUSIONS

A task force of public health nurses developed a charting format based on Taxonomy I of Nursing Diagnosis (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC).

[Incidence of congenital malformations in 10 Chilean maternity hospitals that participate in the ECLAMC. Comparison of 3 periods (1971-1977, 1982-1988, 1989-1994)]

BACKGROUND

The Latin American Collaborative Study of Congenital Malformations is an epidemiological surveillance system for congenital malformations that operates in 11 Latin American Countries.

AIM

To report the incidence of congenital malformations in 8 Chilean maternity hospitals participating in this study, between 1989 and 1994.

MATERIAL AND METHODS

During the study period, 133,564 newborns and 1,196 stillbirths from 8 Chilean maternity hospitals were examined. These results were compared with those of a similar survey performed in 1982-1988.

RESULTS

The proportion of stillbirths in the study period was 0.88%. There were 3,268 malformed newborns (2.42%) and 125 malformed stillbirths (10.45%). These proportion of malformations among newborns were lower and among stillbirths were higher than those reported for the rest of Latin American countries. When comparing the results with the previous survey, a reduction in the proportion of malformations among newborns was observed. However, in all Latin American countries, the prevalence of malformations in newborns and stillbirths increased in this period. In the period 1969-1995, in one Chilean hospital, maternal ages and the proportion of congenital malformation showed parallel and rising curves.

CONCLUSIONS

This survey shows some differences in the prevalence of congenital malformations, when the figures are compared with other Latin American countries and with previous surveys.

[Shortened version of the Barcelona test (III): criterion validity with the ADAS-Cog]

The aim of this study was to assess the criterion validity of a global score of an abbreviated version of the Barcelona Test (BTA), normalized for age and education, as a clinical neuropsychometric test for the assessment of cognitive impairment. This study made a correlational analysis between test scores of the BTA and scores of the cognitive part of the Alzheimer's Disease Assessment Scale (ADAS-Cog) adjusted for age and education. It was made in a University Hospital (Dementia Unit). A group of 172 subjects (74 male, 98 female) was distributed according the Global Deterioration Stages (GDS) from 1 to 6. GDS-1 (normal controls), n = 60; GDS-2 (subjective complaints), n = 27; GDS-3, n = 21, GDS-4, n = 22; GDS-5, n = 16; GDS 6, n = 26. All dementia patients fulfilled the NINCDS/ADRDA criteria. BTA global scores correlated significantly with adjusted scores on the ADAS-Cog (r = 0.872, r2 = 0.761), p < 0.0001. The BTA has a criterion validity as a clinical neuropsychometric test for the study of cognitive impairment.

[Shortened version of the Barcelona test (II): global standard score]

The aim of this study was to determine a global scoring method for a shortened and version of the Barcelona Neuropsychological test (TB) of 55 items. 341 healthy volunteers, 178 male (52.19%), and 163 female (47.1%) were studied. Age mean: 54.80, SD = 17.44. Subjects were stratified in five groups considering age and education. A scale of cut-off points was selected in order to divide the scores of each subtest into three bands (categories): 0 (lowest), 1 (intermediate), 2 (highest). Raw scores (possible range 0-110) were obtained and then were converted to a mean of 100 and SD of 15 each normative group. Tables of normative data were obtained for each group. This study shows the cognitive profiles of the TB and a global standard score related to them. This global score will provide new possibilities in the neuropsychological assessment of neurological patients.

Myocardial contrast echocardiography: reliable, safe, and efficacious myocardial perfusion assessment after intravenous injections of a new echocardiographic contrast agent

Reliable and reproducible myocardial opacification after intravenous administration of echocardiographic contrast agents has remained elusive. This study was performed to determine whether a new agent, FS069, a suspension of perfluoropropane-filled albumin microspheres (3.6 microns average microbubble size, concentration 8 x 8(8)/ml), could achieve safe and successful myocardial opacification in open-chest dogs. Seventeen dogs (group 1, n = 7, group 2, n = 10) underwent two-dimensional echocardiography before, during, and after the administration of intravenous FS069. Safety was evaluated by measuring arterial and pulmonary artery pressures, heart rate, blood gases, systolic function, myocardial blood flow, and postmortem analysis of myocardial viability by triphenyl-tetrazolium chloride staining. Efficacy to detect changes in regional myocardial perfusion was assessed by injecting FS069 at baseline, after sequential coronary occlusions and reperfusion, and during intravenous vasodilators with and without coronary occlusions. Results were compared with radiolabeled microspheres. FS069 was found to be safe and effective. In the absence of coronary occlusions, uniform myocardial opacification was observed in all dogs. A perfusion defect was observed in all dogs during coronary occlusions. Background-subtracted peak contrast intensity in the myocardium correctly identified regional myocardial blood flow changes and showed a significant correlation with radiolabeled microspheres (r = 0.65, p = 0.0001).

Dobutamine echocardiography and myocardial contrast echocardiography. Two new techniques for the assessment of myocardial viability

As investigators have discovered that cardiac regions displaying resting wall motion abnormalities are not the necessary equivalent of myocardial scar (and therefore of irreversible injury) but are potentially viable regions rendered dysfunctional by stunning or hibernation, a new field of medicine has developed to identify viable myocardium that can improve in function after revascularization. Moreover, improvements in myocardial preservation and perfusion during coronary artery bypass grafting and percutaneous transluminal coronary angioplasty have enabled patients with poor resting ejection fractions to undergo safer revascularization. In this review, we describe briefly the diagnostic techniques most commonly used in identifying dysfunctional but viable myocardium. We give specific attention to the assets and limitations of these techniques and special emphasis to 2 promising new techniques: dobutamine echocardiography and myocardial contrast echocardiography.

[Persistent microalbuminuria in insulin-dependent diabetics and cardiovascular risk factors]

A possible association of cardiovascular risk factors and early diabetic nephropathy was investigated in 32 patients. Microalbuminuria (radioimmunoassay), total and HDL cholesterol and triglycerides (enzymatic methods), glycosylated hemoglobin (colorimetric methods), Apo A1 and B (immunonephelometric) and LDL were measured. Microalbuminuria was present in 28% of patients. Compared to subjects with no microalbuminuria they had increased levels of cholesterol (200.2 +/- 13.5 (SE) vs 168.6 +/- 9.4 mg/dl, p < 0.025) and LDL cholesterol (171.9 +/- 14.1 vs 137.4 +/- 9.1 mg/dl, p < 0.025). Systolic blood pressure was also higher in patients with microalbuminuria (127.8 +/- 3.9 vs 114.5 +/- 2.8 mmHg, p < 0.01). Microalbuminuria was correlated to the level of diastolic blood pressure (r = 0.74, p < 0.025). Thus, persistent microalbuminuria in insulin dependent diabetic patients is associated to cardiovascular risk factors which may explain the increased cardiovascular morbidity and mortality in these patients.

Aberrant thymus--MR assessment

Aberrant thymic tissue, particularly when it is located posteriorly, can present a diagnostic dilemma. Once a mediastinal "lesion" is defined on the plain film, MR is the most efficient and best diagnostic test for defining the nature of the mass and showing its relationship to other mediastinal structures. Two cases of aberrant thymic tissue, one on the right side and one on the left, are presented to elucidate the unique role of MRI.

[Tuberculosis and diabetes mellitus: a longitudinal-retrospective study in a teaching hospital]

We analyzed 1529 diabetic patients seen between 1959 and 1982 at a teaching hospital in Concepción, Chile. 116 of them were insulin dependent diabetics. Gestational diabetes was excluded. The 10 year actuarial risk of acquiring tuberculosis was 24.2% for insulin-dependent diabetics and 4.8% for the rest (p less than 0.001). The risk of the diabetic population as a whole was 5.9% compared to 0.8% for the population at large. Thus, diabetics are a high risk group for tuberculosis, especially insulin-dependent patients whose risk is about 38 times higher than the general population under 40 years of age.

A study in the relationship between emotional stability, intellectual ability, academic attainment, personal contentment and vocational aspirations

This study investigated the relationship between ability, attainment and emotional stability, as measured by neuroticism, in underachieving, emotionally disturbed children. Forty children participated in four groups (mean age: 12.6, SD: 2.4; mean IQ: 103.3, SD: 13.6). Three experimental groups received different treatments in a therapeutic community, the fourth (control group) comprised children attending remedial units in mainstream education. For group 1 emphasis was on individualized education; for group 2 on psychological treatment and for group 3 on individualized education and psychological treatment combined. Pre- and post-experiment assessments were made on emotional stability, intelligence, reading, spelling and maths quotients, vocational aspirations and contentment with life. All the experimental groups showed significant improvements on all the criteria assessed. Group 3 improved most, P less than 0.001 on all criteria except contentment and vocational aspirations (P less than 0.01). The control group showed a deterioration over the experimental year on all criteria but mostly not at a significant level.

Postplacental manual insertion of the Multiload Copper 250 IUD

A Multiload (ML) Cu 250 IUD was inserted manually immediately after childbirth in 200 volunteer women. The patients were followed up at 1, 3, 6, 12, and 24 months. There were no undesirable side effects and no serious complications occurred. No noteworthy bleeding occurred either in the postpartum period or subsequently. Maternal lactation was not affected. During the 2 years, 6 devices were removed for medical reasons and the IUD was expelled spontaneously in only 2 patients. 2 pregnancies occurred among the women who were followed up. Postpartum manual insertion of the ML Cu 250 is a very good method of postpartum contraception because there are no significant complications, the rate of expulsion is minimal, and the efficacy is quite high.