Quality control guidelines for clinical-grade human induced pluripotent stem cell lines

Use of clinical-grade human induced pluripotent stem cell (iPSC) lines as a starting material for the generation of cellular therapeutics requires demonstration of comparability of lines derived from different individuals and in different facilities. This requires agreement on the critical quality attributes of such lines and the assays that should be used. Working from established recommendations and guidance from the International Stem Cell Banking Initiative for human embryonic stem cell banking, and concentrating on those issues more relevant to iPSCs, a series of consensus workshops has made initial recommendations on the minimum dataset required to consider an iPSC line of clinical grade, which are outlined in this report. Continued evolution of this field will likely lead to revision of these guidelines on a regular basis.

HIV-1 RRE RNA acts as an RNA silencing suppressor by competing with TRBP-bound siRNAs

Several proteins and RNAs expressed by mammalian viruses have been reported to interfere with RNA interference (RNAi) activity. We investigated the ability of the HIV-1-encoded RNA elements Trans-Activation Response (TAR) and Rev-Response Element (RRE) to alter RNAi. MicroRNA let7-based assays showed that RRE is a potent suppressor of RNAi activity, while TAR displayed moderate RNAi suppression. We demonstrate that RRE binds to TAR-RNA Binding Protein (TRBP), an essential component of the RNA Induced Silencing Complex (RISC). The binding of TAR and RRE to TRBP displaces small interfering (si)RNAs from binding to TRBP. Several stem-deleted RRE mutants lost their ability to suppress RNAi activity, which correlated with a reduced ability to compete with siRNA-TRBP binding. A lentiviral vector expressing TAR and RRE restricted RNAi, but RNAi was restored when Rev or GagPol were coexpressed. Adenoviruses are restricted by RNAi and encode their own suppressors of RNAi, the Virus-Associated (VA) RNA elements. RRE enhanced the replication of wild-type and VA-deficient adenovirus. Our work describes RRE as a novel suppressor of RNAi that acts by competing with siRNAs rather than by disrupting the RISC. This function is masked in lentiviral vectors co-expressed with viral proteins and thus will not affect their use in gene therapy. The potent RNAi suppressive effects of RRE identified in this study could be used to enhance the expression of RNAi restricted viruses used in oncolysis such as adenoviruses.

In vivo bioimaging with tissue-specific transcription factor activated luciferase reporters

The application of transcription factor activated luciferase reporter cassettes in vitro is widespread but potential for in vivo application has not yet been realized. Bioluminescence imaging enables non-invasive tracking of gene expression in transfected tissues of living rodents. However the mature immune response limits luciferase expression when delivered in adulthood. We present a novel approach of tissue-targeted delivery of transcription factor activated luciferase reporter lentiviruses to neonatal rodents as an alternative to the existing technology of generating germline transgenic light producing rodents. At this age, neonates acquire immune tolerance to the conditionally responsive luciferase reporter. This simple and transferrable procedure permits surrogate quantitation of transcription factor activity over the lifetime of the animal. We show principal efficacy by temporally quantifying NFκB activity in the brain, liver and lungs of somatotransgenic reporter mice subjected to lipopolysaccharide (LPS)-induced inflammation. This response is ablated in Tlr4(-/-) mice or when co-administered with the anti-inflammatory glucocorticoid analogue dexamethasone. Furthermore, we show the malleability of this technology by quantifying NFκB-mediated luciferase expression in outbred rats. Finally, we use somatotransgenic bioimaging to longitudinally quantify LPS- and ActivinA-induced upregulation of liver specific glucocorticoid receptor and Smad2/3 reporter constructs in somatotransgenic mice, respectively.

Hyperactive piggyBac transposons for sustained and robust liver-targeted gene therapy

The development of robust nonviral vectors could facilitate clinical gene therapy applications and may overcome some of the immune complications of viral vectors. Nevertheless, most nonviral gene deliver approaches typically yield only transient and/or low gene expression. To address these caveats, we have explored piggyBac transposons to correct hemophilia B by liver-directed factor IX (FIX) gene therapy in hemophilic mice. To achieve this, we combined the use of: (i) a hyperactive codon-optimized piggyBac transposase, (ii) a computationally enhanced liver-specific promoter, (iii) a hyperfunctional codon-optimized FIX transgene (FIX R338L Padua), and (iv) a modification of the transposon terminal repeats. This combination strategy resulted in a robust 400-fold improvement in vector performance in hepatocytes, yielding stable supraphysiologic human FIX activity (>1 year). Liver-specific expression resulted in the induction of FIX-specific immune tolerance. Remarkably, only very low transposon/transposase doses were required to cure the bleeding diathesis. Similarly, PB transposons could be used to express supraphysiologic factor VIII levels using low transposon/transposase doses. PB transposition did not induce tumors in a sensitive hepatocellular carcinoma-prone mouse model. These results underscore the potency and relative safety of the latest generation PB transposons, which constitutes a versatile platform for stable and robust secretion of therapeutic proteins.

Mobilisation, alteration, and redistribution of monosulfidic sediments in inland river systems

The accumulation of monosulfidic sediments in inland waterways is emerging as a major environmental issue. Mobilisation and suspension of monosulfidic sediments can result in deoxygenation, acidification of the water column and mobilisation of trace metals. The controls on monosulfidic sediment mobilisation and the critical thresholds for its scour and entrainment have not been established. This study examines the effect of a minor flood event (average return interval of 5 years) on sulfidic sediment scour in the Wakool River in southern NSW, Australia. Five profiles were sampled within a small (~300 m) reach before and after a minor flood event to determine the degree of sediment scour and transport. The results indicate substantial scour of both monosulfidic sediments and underlying bed sediments (approximately 2100 m(3)). Changes in the sediment geochemistry suggest large concentrations of monosulfidic sediments had been suspended in the water column, partially-oxidised and redeposited. This is supported by (210)Pb results from one of the profiles. These results suggest that these monosulfidic sediments can move as bed load during minor flood events.

Perinatal gene transfer to the liver

The liver acts as a host to many functions hence raising the possibility that any one may be compromised by a single gene defect. Inherited or de novo mutations in these genes may result in relatively mild diseases or be so devastating that death within the first weeks or months of life is inevitable. Some diseases can be managed using conventional medicines whereas others are, as yet, untreatable. In this review we consider the application of early intervention gene therapy in neonatal and fetal preclinical studies. We appraise the tools of this technology, including lentivirus, adenovirus and adeno-associated virus (AAV)-based vectors. We highlight the application of these for a range of diseases including hemophilia, urea cycle disorders such as ornithine transcarbamylase deficiency, organic acidemias, lysosomal storage diseases including mucopolysaccharidoses, glycogen storage diseases and bile metabolism. We conclude by assessing the advantages and disadvantages associated with fetal and neonatal liver gene transfer.

Monosulfidic black ooze accumulations in sediments of the Geographe Bay area, Western Australia

Mobilisation of sedimentary monosulfidic black ooze (MBO) may result in rapid deoxygenation and acidification of surface waters, and release of potentially toxic metals. This study examines the extent and nature of MBO accumulation in the Geographe Bay area, Western Australia. MBO accumulations were found to be widespread in benthic sediments of the Geographe Bay area with acid-volatile sulfide (AVS) contents as high as 320 μmol g(-1). The MBO materials often had unusually high dissolved sulfide (S(-II)) concentrations in their pore-waters (up to 610 mg L(-1)) and elevated elemental sulfur (S(0)) contents (up to 51 μmol g(-1)). Dissolved S(-II) is able to accumulate due to limited iron availability and S(0) is largely its partial oxidation product. The availability of organic carbon and Fe limited MBO accumulation at many sites. A comparison of AVS and simultaneously extracted metal (SEM) concentrations has shown that metals are likely to be bound in sulfide complexes.

Efficient gene delivery to the adult and fetal CNS using pseudotyped non-integrating lentiviral vectors

Non-integrating lentiviral vectors show considerable promise for gene therapy applications as they persist as long-term episomes in non-dividing cells and diminish risks of insertional mutagenesis. In this study, non-integrating lentiviral vectors were evaluated for their use in the adult and fetal central nervous system of rodents. Vectors differentially pseudotyped with vesicular stomatitis virus, rabies and baculoviral envelope proteins allowed targeting of varied cell populations. Efficient gene delivery to discrete areas of the brain and spinal cord was observed following stereotactic administration. Furthermore, after direct in utero administration (E14), sustained and strong expression was observed 4 months into adulthood. Quantification of transduction and viral copy number was comparable when using non-integrating lentivirus and conventional integrating vector. These data support the use of non-integrating lentiviral vectors as an effective alternative to their integrating counterparts in gene therapy applications, and highlight their potential for treatment of inherited and acquired neurological disorders.

Compartment syndrome following ankle sprain

Injury to the perforating branch of the peroneal artery has not been reported previously as a cause of acute compartment syndrome following soft-tissue injury to the ankle. We describe the case of a 23-year-old male who sustained such an injury resulting in an acute compartment syndrome. In a review of the literature, we could find only five previous cases, all of which gave rise to a false aneurysm which was detected after the acute event.

Laparoscopic resection of diverticular fistulae: a 10-year experience

OBJECTIVE

Until recently the laparoscopic approach was reserved for uncomplicated diverticular disease. We show that fistulating diverticular disease can be resected safely, with good clinical outcome via a laparoscopic approach.

METHOD

Between April 1994 and May 2005, 31 consecutive patients [17 male, median age of 63 years (range 40-85)], underwent attempted laparoscopic resection for diverticular fistulae. Patient data were prospectively recorded.

RESULTS

There were 22 colovesical and nine colovaginal fistulae. The median operative time was 150 min (range 60-310) and the median postoperative stay was 7 days (range 3-21). Conversion to an open procedure was required in nine of 31 patients (29%). This rate fell to 10% in cases performed after April 2000. There were two nonsurgically related postoperative deaths. Both occurred in the converted group. At 3 months follow-up, two patients complained of frequency of stools, which settled by 6 months. To date there has been no recurrence of symptomatic diverticulosis or fistulation.

CONCLUSION

Totally laparoscopic resection for diverticular fistulae is safe and feasible. Fistulae should not be considered as a contraindication to laparoscopic resection for an experienced laparoscopic surgeon.

Stable gene transfer to muscle using non-integrating lentiviral vectors

Human immunodeficiency virus (HIV)-based lentiviral vectors (LVs) hold immense promise for gene delivery applications because of their relatively large packaging capacity and their ability to infect a range of cell types. The genome of HIV non-specifically integrates into the host genome, and this promotes efficient, stable transgene expression in dividing cells. However, integration can also be problematic because of variations in gene expression among cells, possible gene silencing and, most importantly, insertional mutagenesis which can lead to undesirable effects such as malignant transformation. In order to alleviate these problems, we have developed a range of non-integrating LVs (NILVs) by introducing point mutations into the catalytic site, chromosome binding site, and viral DNA binding site of the viral integrase (IN). In addition, we have mutated the IN attachment (att) sites within the HIV long terminal repeats (LTRs). All of the vectors produced show efficient reverse transcription and transgene expression in dividing cells and prolonged expression in non-dividing myotubes. Finally, we show that NILV can be used for achieving highly effective gene transfer and expression in muscle in vivo.

Management of unstable cervical spine injuries in southern Iraq during OP TELIC

INTRODUCTION

Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3.

METHODOLOGY

The MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries.

RESULTS

Forty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation.

CONCLUSIONS

Five casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK.

RECOMMENDATIONS

All unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from Role 3. Halo Rings and Vests should be available at Role 3 facilities.

Analysis of 47 road traffic accident admissions to BMH Shaibah

OBJECTIVE

To analyse road traffic accident (RTA) admissions to British Military Hospital (BMH) Shaibah with respect to seatbelt usage, position in vehicle, age, type of injury and mechanism of injury.

METHOD

Retrospective analysis of discharge summaries and hospital notes of all service personnel admitted to BMH Shaibah due to RTA, from August 2003 to January 2004. Results During the study there were 315 reported RTA, 3 fatalities, and 47 inpatient admissions. 87% of admissions were male; in 32% of cases the vehicle had rolled and 28% of individuals admitted had been ejected from the vehicle. 85% of individuals had not been wearing their seatbelts and none of the ejected individuals had been restrained. 92% of those ejected were travelling in the rear of the Land Rover. Of those ejected, 38% suffered more than one type of injury, and 62% suffered a fracture, (accounting for 50% of all fractures admitted). 34% of admissions had sustained a fracture, and were evacuated to the UK.

CONCLUSIONS

These figures correlate well with previous evidence showing the likelihood of serious injury is increased by more than 300% if the patient is ejected. Those travelling in the rear of a Land Rover would appear to be in the most dangerous position. Seatbelts are the single most effective means of reducing fatal and non-fatal injuries in motor vehicle accidents. Standing orders states that seatbelt use mandatory, but compliance is poor. This may be due to misconceptions on the relative dangers faced by soldiers in Iraq. Education and enforcement needs to be more effective if the Army is to reduce the number and seriousness of injuries attributable to RTA.

Simulation of accident risk displays in motorway driving with traffic

The study used a vehicle-based driving simulator to evaluate two graphical displays, one showing risk probability in terms of safety margin (Time Headway, TH), and one showing risk severity in terms of Kinetic Energy (KE). Twenty-seven subjects were randomly allocated to one of three experimental conditions: Control, TH, and KE. Subjects undertook three driving tasks (ABA design). For the second driving task in the TH and KE conditions, subjects drove in the presence of their respective feedback displays. Measures of TH and KE levels were taken, as well as subjective measures of risk and task loading. It was found that the KE display was more effective than the TH display in reducing the proportion of time subjects spent at short headways. The KE display was also effective in reducing the proportion of time subjects spent at high speed. The KE display appeared to affect the perception of risk (severity of potential accidents). It was concluded that further research evaluating displays that combined the positive effects of both parameters within a single representation display is needed.

Effect of background scene complexity and field dependence on the legibility of head-up displays for automotive applications

This study examined the legibility of information presented on head-up displays (HUDs) for automotive application as a function of background scene complexity, the position of the HUD within field of view relative to the background scene, and the perceptual capacity of the perceiver. Groups of field-dependent and field-independent subjects viewed video footage from the perspective of following a lead car on an open road with low, moderate, and high scene complexity. Subjects were required to track the lead vehicle and identify HUD-presented targets of a specified orientation and specified changes in a HUD-presented speedometer. The results indicate that (a) HUD legibility deteriorated with increased visual complexity of the background scene; (b) positioning the HUD on the roadway reduced the effect of background scene complexity on HUD legibility; and (c) field-dependent subjects made fewer correct and more false positive target identifications than did field-independent subjects.

Field observation of advance warning/advisory signage for passive railway crossings with restricted lateral sightline visibility: an experimental investigation

This study evaluated a newly proposed series of signs intended for passive crossings with restrictions to lateral sightline visibility. These signs provide advance warning of a crossing and the restriction to lateral visibility. In addition, the signs advise motorists to come to a complete stop before crossing. Motorist behaviour was examined before and after installation of these signs at a rural passive crossing. A second site was observed in parallel to control partially for any confounding effects. Results indicated that motorists reduced speed and searched approach quadrants longer at points in the approachway after installation of the signs. However, there was no reliable increase in the number of motorists coming to complete stop, engaging in search behaviours, or classified as safe. The results are discussed in terms of reasons for the lack of compliance with the sign advisory.

Head-up displays and their automotive application: an overview of human factors issues affecting safety

In response to the recent innovations to use head-up displays (HUDs) in vehicles, this paper discusses the relevant human factors issues arising from this display format and the potential safety implications. A review is made of the relevant HUD literature, primarily from the aviation field. The primary issues for automotive HUDs relevant to system performance and safety in the driving task involve interference from background scene complexity, system novelty, user perceptual style, cognitive disruption, and perceptual tunnelling. Basic research is necessary to investigate the extent of these issues as well as to resolve fundamental design specifications (e.g. HUD size, shape, placement, information content). It is suggested that the introduction of HUDs into vehicles be carefully considered. This will necessitate not only the reconsideration what constitutes an in-vehicle display, but also what constitutes the information to be conveyed.

Alcohol and mortality in Busselton, Western Australia

The authors analyzed 23-year mortality (1966-1989) in 2,171 subjects aged > or = 40 years from a Busselton, Western Australia, prospective study. The analysis revealed significant inverse associations between alcohol consumption and mortality, with trends of decreasing mortality shown from nondrinkers to mild drinkers to moderate drinkers. Compared with nondrinkers, moderate drinkers had an adjusted relative risk of death due to all causes of 0.76 (95% confidence interval (CI) 0.61-0.94). The adjusted relative risk of cardiovascular disease death among moderate drinkers was 0.68 (95% CI 0.51-0.91), and that of coronary heart disease death was 0.66 (95% CI 0.45-0.98). Adjustment for baseline coronary disease risk factors strengthened these trends in the relative risks observed in both women and men. Baseline and follow-up data suggested that 87% of the nondrinkers were long-term abstainers, with 77% having been such for a lifetime.

Diuretic actions in man of a selective kappa opioid agonist: U-62,066E

The effect of a selective kappa opioid agonist, U-62,066E, on urine formation in human volunteers was assessed. Volunteers received single intramuscular injections of either placebo or 2, 3, 4, 5 or 6 micrograms/kg of U-62,066E in a randomized, double-blind study. U-62,066E caused dose-dependent maximal increases in urine volume of 2.6 times control in the first 4 hr after administration. A corresponding decrease in urine osmolality to 20% of base-line values occurred. No changes in total urinary Na, K or Cl excretion were identified. Kappa agonists produce a water-only diuresis at low doses in humans. The mechanism of this effect was not examined in this study but probably relates to alterations in antidiuretic hormone activity.

Reading with and without eye movements: reply to Just, Carpenter, and Woolley

Just, Carpenter, and Woolley propose that measures of single-word processing times, such as gaze durations during normal reading or durations of reader-controlled exposures, can be used both for developing theories of comprehension and for determining the course of new reading technologies. We argue that better understanding of comprehension processes does not necessarily follow from observed correlations between text variables and eye-fixation parameters. Further, recent rapid serial visual presentation (RSVP) research suggests that eye fixation data obtained from studies of normal reading might have little practical value in optimizing the readability of RSVP displays and other means of text presentation.