Resurgence of congenital syphilis: new strategies against an old foe

Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425 cases per 100 000 livebirths-substantially higher than WHO's elimination target of 50 cases per 100 000 livebirths. Case rates are rising in many high-income countries, but remain low compared with those in low-income and middle-income settings. This Review aims to summarise the current epidemiology and knowledge on transmission and treatment of syphilis in pregnancy, and proposes measures to reduce the rising incidence seen worldwide. We also describe emerging diagnostic and treatment tools to prevent vertical transmission and improve management of congenital syphilis. Finally, we outline a programme of public health priorities, which include research, clinical, and preventive strategies.

Deep spatial-omics analysis of Head & Neck carcinomas provides alternative therapeutic targets and rationale for treatment failure

Immune checkpoint inhibitor (ICI) therapy has had limited success (<30%) in treating metastatic recurrent Head and Neck Oropharyngeal Squamous Cell Carcinomas (OPSCCs). We postulate that spatial determinants in the tumor play a critical role in cancer therapy outcomes. Here, we describe the case of a male patient diagnosed with p16+ OPSCC and extensive lung metastatic disease who failed Nivolumab and Pembrolizumab/Lenvatinib therapies. Using advanced integrative spatial proteogenomic analysis on the patient's recurrent OPSCC tumors we demonstrate that: (i) unbiased tissue clustering based on spatial transcriptomics (ST) successfully detected tumor cells and enabled the investigation of phenotypic traits such as proliferation or drug-resistance genes in the tumor's leading-edge and core; (ii) spatial proteomic imagining used in conjunction with ST (SpiCi, Spatial Proteomics inferred Cell identification) can resolve the profiling of tumor infiltrating immune cells, (iii) ST data allows for the discovery and ranking of clinically relevant alternative medicines based on their interaction with their matching ligand-receptor. Importantly, when the spatial profiles of ICI pre- and post-failure OPSCC tumors were compared, they exhibited highly similar PD-1/PD-L1low and VEGFAhigh expression, suggesting that these new tumors were not the product of ICI resistance but rather of Lenvatinib dose reduction due to complications. Our work establishes a path for incorporating spatial-omics in clinical settings to facilitate treatment personalization.

Indirect effects of cytomegalovirus infection: Implications for vaccine development

Development of a cytomegalovirus (CMV) vaccine is a high priority due to its significant global impact-contributing to mortality in immunosuppressed individuals, neurodevelopmental delay in infected neonates and non-genetic sensorineural hearing loss. The impact of CMV on the general population has been less well studied; however, a wide range of evidence indicates that CMV may increase the risk of atherosclerosis, cancer, immunosenescence, and progression of tuberculosis (TB) and human immunodeficiency virus. Due to the high seroprevalence of CMV worldwide, any modulation of risk by CMV is likely to have a significant impact on the epidemiology of these diseases. This review will evaluate how CMV may cause morbidity and mortality outside of the neonatal and immunosuppressed populations and consider the potential impact of a CMV vaccine on these outcomes.

Recurrent Diabetic Ketoacidosis following Bariatric Surgery: The Role of Micronutrients

We report a case of a 29-year-old woman admitted twice to our hospital with diabetic ketoacidosis (DKA) within 45 days following her bariatric surgery. The first admission required intensive care during her postoperative days after bariatric surgery. Subsequently, she continued to report high level of ketones on a daily basis. At her second admission, she presented with all three criteria of DKA. She was treated with a standard protocol for DKA, but ketones plasma level remained high despite significant improvement in pH and glycemic control. The administration of thiamine replacement was associated with normalization of the hyperketonemia. Thiamine deficiency can be associated with bariatric surgery and can lead to high ketone level in individuals with type 1 diabetes.

The mTOR downstream regulator (p-4EBP1) is a novel independent prognostic marker in ovarian cancer

Ovarian cancer is associated with the highest mortality rate among gynaecologic malignancies. There is a need to refine the classification of ovarian cancer and identify novel targets. The mammalian target of rapamycin (mTOR) pathway has a crucial role in the pathogenesis and progression of ovarian cancer. This study aims to investigate the prognostic role of p-mTOR and its major downstream effectors p-4EBP1 (eukaryotic initiation factor 4E-binding protein 1) and p-P70S6K (ribosomal protein S6 kinase) in ovarian cancer. p-mTOR, p-4EBP1 and p-P70S6K protein expression was assessed on 195 consecutive ovarian epithelial cancers and correlated to clinicopathological features and survival. We found that high cytoplasmic expression of p-4EBP1 and p-P70S6K was associated with a serous type carcinoma (p = .005) and an advanced FIGO stage (p = .012), respectively. Univariate outcome analysis showed an inverse association between a high expression of p-4EBP1 expression and overall ovarian cancer survival (OS; p = .005) and progression-free survival (PFS; p = .005). p-P70S6K showed an inverse association with PFS (p = .001). Multivariate analyses indicated that p-4EBP1 was an independent predictor of both OS and PFS (p = .016 and p = .041, respectively). Therefore, we concluded that p-4EBP1 high protein expression is an independent predictor of outcome in ovarian cancer patients. Therefore, it could be used as a potential biomarker for prognostic stratification and treatment decisions. Impact statement What is already known on this subject? The mammalian target of rapamycin (mTOR) pathway has a crucial role in the pathogenesis and progression of ovarian cancer. To-date, very limited knowledge is known about the importance of mTOR major downstream effectors p-4EBP1 (eukaryotic initiation factor 4E-binding protein 1) and p-P70S6K (ribosomal protein S6 kinase) in ovarian cancer. What do the results of this study add? In this study, we have provided further evidence of the adverse prognostic behaviour associated with the positive expression of p-mTOR and its major downstream effectors. Moreover and by performing multivariate analysis, we for the first time have proved that p-4EBP1 is an independent predictor of clinical outcome in ovarian cancer. What are the implications of these findings for clinical practice and/or further research? p-4EBP1 could be used as a potential biomarker for prognostic stratification and treatment decisions in ovarian cancer management.

Computational Design of Strain in Core-Shell Nanoparticles for Optimizing Catalytic Activity

Surface strains in core-shell nanoparticles modify catalytic activity. Here, a continuum-based strategy enables accurate surface-strain-based screening and design of core-shell systems using minimal input as a means to enhance catalytic activity. The approach is validated here for Pt shells on Cu(x)Pt(1-x) cores and used to interpret experimental results on the oxygen reduction reaction in the same system. The analysis shows that precise control of particle sizes and shell thicknesses is required to achieve peak activity, rationalizing the limited increases in activity observed in experiments. The method is also applied to core-shell nanorods to demonstrate its wide applicability.

Bcl2 is an independent prognostic marker of triple negative breast cancer (TNBC) and predicts response to anthracycline combination (ATC) chemotherapy (CT) in adjuvant and neoadjuvant settings

BACKGROUND

TNBC represents a heterogeneous subgroup of BC with poor prognosis and frequently resistant to CT.

MATERIAL AND METHODS

The relationship between Bcl2 immunohistochemical protein expression and clinico-pathological outcomes was assessed in 736 TNBC-patients: 635 patients had early primary-TNBC (EP-TNBC) and 101 had primary locally advanced (PLA)-TNBC treated with neo-adjuvant- ATC-CT.

RESULTS

Negative Bcl2 (Bcl2-) was observed in 70% of EP-TNBC and was significantly associated with high proliferation, high levels of P-Cadherin, E-Cadherin and HER3 (P's < 0.01), while Bcl2+ was significantly associated with high levels of p27, MDM4 and SPAG5 (P < 0.01). After controlling for chemotherapy and other prognostic factors, Bcl2- was associated with 2-fold increased risk of death (P = 0.006) and recurrence (P = 0.0004). Furthermore, the prognosis of EP-TNBC/Bcl2- patients had improved both BC-specific survival (P = 0.002) and disease-free survival (P = 0.003), if they received adjuvant-ATC-CT. Moreover, Bcl2- expression was an independent predictor of pathological complete response of primary locally advanced triple negative breast cancer (PLA-TNBC) treated with neoadjuvant-ATC-CT (P = 0.008).

CONCLUSION

Adding Bcl2 to the panel of markers used in current clinical practice could provide both prognostic and predictive information in TNBC. TNBC/Bcl2- patients appear to benefit from ATC-CT, whereas Bcl2+ TNBC seems to be resistant to ATC-CT and may benefit from a trial of different type of chemotherapy with/without novel-targeted agents.

Salivary antimicrobial protein response to prolonged running

Introduction

Prolonged exercise may compromise immunity through a reduction of salivary antimicrobial proteins (AMPs). Salivary IgA (IgA) has been extensively studied, but little is known about the effect of acute, prolonged exercise on AMPs including lysozyme (Lys) and lactoferrin (Lac).

Objective

To determine the effect of a 50-km trail race on salivary cortisol (Cort), IgA, Lys, and Lac.

Methods

14 subjects: (6 females, 8 males) completed a 50km ultramarathon. Saliva was collected pre, immediately after (post) and 1.5 hrs post race (+1.5).

Results

Lac concentration was higher at +1.5 hrs post race compared to post exercise (p < 0.05). Lys was unaffected by the race (p > 0.05). IgA concentration, secretion rate, and IgA/Osm were lower +1.5 hrs post compared to pre race (p < 0.05). Cort concentration was higher at post compared to +1.5 (p < 0.05), but was unaltered from pre race levels. Subjects finished in 7.81±1.2 hrs. Saliva flow rate did not differ between time points. Saliva Osm increased at post (p < 0.05) compared to pre race.

Conclusions

The intensity could have been too low to alter Lys and Lac secretion rates and thus, may not be as sensitive as IgA to changes in response to prolonged running. Results expand our understanding of the mucosal immune system and may have implications for predicting illness after prolonged running.

Abstract P6-07-09: Identification of Trophinin associated protein (TROAP) as a novel biological marker in breast cancer (BC): Co-expression of TROAP and TOPO2A predicts response of anthracycline based chemotherapy (ATC-CT)

Introduction: Recently, TOPO2A alteration was found to be a predictor for ATC-CT and by using neural network and pathways analysis of gene expression array data, TROAP gene was revealed as a major hub in TOPO2A pathway and strongly related to genes that are involved in mitotic cell cycle regulation. In addition, we found that TROAP gene was among top 10 ranked genes out of 48,000 of transcripts, that accurately predicted worse clinical outcome, and differentiated between low and high grade based on a 10-fold external cross-validation analysis with an average classification accuracy of &gt;99.999%. TROAP protein is essential for centrosome integrity and proper bipolar organisation of spindle assembly during mitosis and plays essential role in cell proliferation.

In the current study the molecular and clinicopathological functions of TROAP expression and its effect on management of breast cancer have been investigated.

Methods: The co-expression of TROAP and TOPO2A protein was evaluated by using dual immunoflurescent in BC cell lines. In addition both TROAP and TOP2A protein expressions were immunohistochemically (IHC) assessed in 40 normal breast tissues and a well characterised series of 1650 primary BC and were correlated to clinicopathological and other biomarkers. IHC staining was performed using Anti-TROAP rabbit polyclonal (HPA044102; Sigma).

The association between TROAP and response to chemotherapy was investigated in 350 ER negative BC treated with adjuvant ATC-CT and 260 locally advanced BC treated with neoadjuvant ATC-CT. In addition the clinical outcome of TROAP expression was evaluated in a series of 180 ER− high risk BC patients who did not received any CT.

Results: No expression of TROAP protein was observed in normal breast tissue while, 25% of BC showed TROAP protein overexpression. By using dual immunoflurescent in BC cell lines, The MCF7 cells showed strong cytoplasmic TROAP staining with no TOPO2A expression, while The T47D cells did not express TROAP but expressed TOPO2A. SKBr3, MDA468 and MDA231 cell lines showed co-expression of TROAP and TOPO2A. TROAP overexpression was significantly associated with aggressive clinico-pathological features including; high grade, high mitotic rate, absence of hormonal receptors, overexpression of HER2, TOP2A and EGFR (p &lt; 0.001), Triple negative phenotype (p &lt; 0.001), basal-like BC (p &lt; 0.001), p53 mutation (p &lt; 0.001) and inactive p16 (p &lt; 0.001). With regard to outcome, receiving anthracycline chemotherapy had a positive impact on high risk ER− BC patients with TROAP protein over-expression as TROAP protein overexpression showed 50% less risk of recurrence compared to TROAP negative expression; p &lt; 0.0001. Moreover, in locally advanced BC who received anthracycline-based neoadjuvant chemotherapy, 31/81 (39%) of BC with co-expression of TROAP+/TOPO2A+ achieved pCR while none of those with absence of both TROAP−/TOPO2A− (0/51) had achieved pCR (p &lt; 0.00001).

Conclusion: TROAP is an important novel gene implicated in the survival of BC cells and its protein expression is a predictor for Anthracycline CT. TROAP may provide new avenues for the discovery of new predictive marker to guide therapeutic intervention.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-09.

Abstract P6-07-18: Identification of Sperm Associated Antigen 5 (SPAG5) as a novel biological and predictive biomarker in Breast cancer

Introduction: SPAG5 has been found to be involved in the functional and dynamic regulation of mitotic spindles, and to be essential for chromosome segregation fidelity. Recently we found by using neural network and pathways analysis of a gene expression array data that SPAG5 was among top 10 ranked genes out of 48,000 of transcripts, that accurately predicted worse clinical outcome based on a 10-fold external cross-validation analysis with an average classification accuracy of &gt;99.999%. Moreover we found that 5% of BC showed amplification of SPAG5 locus at chromosome 17q11.2 and SPAG5 mRNA expression levels displayed a statistically significant correlation with its copy number.

Methods: In the current study the molecular and clinicopathological features of SPAG5 expression and its effect on management of BC have been investigated in 2800 BC patients with primary operable invasive BCs constituted four cohorts: 1) A series of 1650 BC patients received adjuvant endocrine and/or CMF chemotherapy according to NPI.2) A series of 256 BC received adjuvant anthracycline-based chemotherapy (ATC-CT)3) A series of 140 primary BC HER2+ patients treated with ATC-CT+ Herceptin 4) To validate SPAG5 as a predictor factor for ATC-CT, 260 patients with locally advanced primary breast cancer treated with neoadjuvant ATC-CT were included and the pathological complete response (pCR) was used to evaluate the response to chemotherapy.

Immunohistochemical staining was performed using Anti–SPAG5 rabbit polyclonal (HPA022479; Sigma).

Results: i) By using dual immunoflurescent in BC cell lines, co-expression of SPAG5 and proliferating cell nuclear antigen (PCNA) was detected in 4 out of 5 of the breast cancer cell lines screened (MCF7, T47D, MDA468 and MDA231) providing evidence for the importance of SPAG5 in cell proliferation. ii) 20% of breast cancer showed SPAG5 protein overexpression. SPAG5 overexpression showed a statistically significant association with ER−, PR−, triple negative phenotype, high grade tumour, high ki67, basal like phenotype and epithelial mesenchymal transition phenotype, p53 mutation and absence of DNA repair genes (BRCA1, ATM and XRCC1); p values &lt;0.0001. iii) In high risk ER− BC patients who did not received any adjuvant therapy or received ineffective CMF chemotherapy, SPAG5+ protein expression had a similar risk of death and recurrence. Receiving ATC-CT had a positive impact on high risk ER− BC patients with SPAG5 protein + expression as SPAG5+ protein expression showed 72–65% less of death, recurrence and metastases compared to SPAG5−; p &lt; 0.0001. The positive impact of ATC-CT on SPAG5+BC has also been confirmed in HER2+ who either received ATC-CT only or ACT-CT plus Herceptin. iv) Moreover, BC received neoadjuvantATC-CT, SPAG5+ BC achieved 39% pCR vs., 6% of SPAG5-negative BC (p &lt; 0.00001). After controlling to other validated predictors for pCR, SPAG5 remained as a powerful independent predictor (HR; 2.4, CI 95%; 1.5–3.9; p = 0.00001).

Conclusion: SPAG5 is an important novel gene implicated in the survival of BC cells and its protein expression is an independent predictor for ATC- CT. SPAG5 may provide new avenues for the discovery of new predictive marker to guide therapeutic intervention.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-18.

P4-09-11: Kinesin Family Member 2C (KIF2C) Is a New Surrogate Prognostic Marker in Breast Cancer (BC)

Introduction

Gene expression microarrays, artificial neural network (ANN), tissue microarray and immunohistochemistry (IHC) techniques allow for the analysis of huge numbers of gene transcripts and their corresponding proteins and have been widely applied in predicting clinical outcome.

Methods

1- In this study, we analysed 48,000 gene transcripts of 171 unselected series of BC using ANN and pathways analysis to identify genes that can be used to predict clinical outcome of BC.

2- The clinic-pathological outcome of candidate genes were validated by using IHC in 4 independent primary BC data sets: a) a series of 379 consecutive high risk BC (NPI&gt;3.4) who treated with surgery (S)+ radiotherapy (RT) and did not received neither endocrine (ET) nor chemo-therapies (CT), b) A series of 1650 consecutive cases of BC who treated with S + RT and received adjuvant CMF and/or ET according to Nottingham prognostic index (NPI), menopausal and ER status, c) 250 locally advanced BC treated with anthracycline-based combination with or without Taxane followed by S + RT and d) 145 BC overexpressing HER-2 treated with S + RT followed by sequential adjuvant anthracycline combination CT + trastuzumab.

Results

Gene expression analysis

ANN analysis revealed that KIF2C gene was the highest ranked gene that predicted clinical outcome and accurately differentiated between low and high grade BC based on a 10-fold external cross-validation analysis with an average classification accuracy of &gt;98%. High KIF2C gene expression level was associated with shortest BC specific survival (BCSS), disease free (DFS) and distal metastasis free survivals (DM-FS); p&lt;0.0001. In univariate analysis, high level of KIF2C gene expression was associated with large tumour size, higher lymph node stage, negative ER, positive p53 expression and HER2 overexpression. However in multivariate analysis, KIF2C gene expression level was only statistically associated with histological grade (p&lt;00001) and mitosis (p&lt;0.0001). Pathways analysis revealed that KIF2C is likely to play a significant role in cytokinesis, cell division and cell cycle regulations.

Immunohistochemistry

75% of BC showed overexpression of KIF2C protein. KIF2C protein overexpression was associated with unfavourable clinic-pathological features including high grade, high mitotic index, basal like phenotype, triple negative phenotype, HER2 overexpression, TOP2A overexpression, p53 mutation, and loss of BRCA1 (adjusted p&lt;0.0001).

In univariate analysis, KIF2C protein overexpression was associated with patient's BCSS in both ER+/high risk patients (NPI &gt; 3.4) who did not received ET (HR: 3.3, 95% CI: 1.2−9.3, p=0.02) and ER-/high risk patients who did not received CT (HR: 3.2, 95% CI: 1.1−8.8, p=0.025).

In 1650 BC series, multivariate Cox regression model including validated prognostic factors, confirmed that KIF2C overexpression is an independent prognostic factor. KIF2C overexpression showed increase in the risk of death (HR: 1.5, 95% CI: 1.1−2.0, p=0.009), recurrence (HR: 1.4, 95% CI: 1.1−1.8, p=0.017) and DM (HR: 1.6, 95% CI: 1.2−2.3, p=0.005).

In conclusion, our findings provide a new insight to a better understanding of mammary carcinogenesis and that KIF2C is a promising molecular prognostic factor and a potential therapeutic target.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-09-11.

P1-06-14: Topoisomerase II alpha (Top2a) Protein Expression Is a Predictor for Response to Anthracycline-Based Chemotherapy (ATC-CT): Is It Due to Gene Amplification, HER2−Coamplification or a Summation of Pathways Leading to This Highly Proliferative Phenotype?

Background: The evaluation of Top2a protein may be clinically more useful than gene alterations as a predictive marker for ATC-CT. In this study we assessed the association between gene copy number, gene and protein expressions of both TOP2A and HER2, and their effect on clinicopathological outcomes and management of breast cancer (BC).

Methods: 1- To study the response to anthracycline based chemotherapy (ATC-CT): The associations between clinical outcomes and both gene copy number changes (using in-situ hybridization; CISH) and protein expression (using immunohistochemistry) were studied in the neoadjuvant and adjuvant settings: a) 250 locally advanced primary BC treated with Neoadjuvant ATC-CT with or without Taxane followed by surgery (S) + radiotherapy (RT); pathological complete response (pCR) was used as the primary end point (PEP), b) 245 BC in which all patients were treated with S + RT followed by Adjuvant ATC-CT; progression free survival (PFS) was used as PEP ii) 145 primary BC overexpressing HER-2 treated with S+ RT followed by sequential adjuvant ATC-CT+ trastuzumab; PFS was used as PEP. 2- To study the clinic-pathological association of TOP2A alterations, we evaluated TOP2A alterations detected by CISH and IHC in unselected series of 1650 consecutive cases of primary BC who treated with S + RT and received adjuvant CMF and/or endocrine therapies according to Nottingham prognostic index and ER status. 3- To study in details the molecular alterations of TOP2A/HER2, in 171 unselected series of primary BC, we evaluated a) gene copy number changes using both high resolution oligo array CGH and CISH, b) mRNA expression using Agilent gene expression array and c) protein expression using IHC. We analysed 48,000 gene transcripts using Artificial Neural Networks (ANN) and pathway analysis to identify genes and biological pathways that related to TOP2A gene alterations.

Results: 1) In the ATC-CT neoadjuvant series, the pCR rate was 32/115 (28%) in tumours expressing high levels of Topo2A, compared to 5/74 (7%) in tumours expressing low levels of Topo2A (p&lt;0.0001).

In multivariate analysis, Top2A overexpression was an independent predictor for pCR (HR 5.1, CI 95%; 1.4−18.4, p&lt;0.001). 2) TOP2A overexpression was strongly associated with mitotic index, histological grade, KIF2C, loss of p53 function and the absence of both BRCA1 and ATM inactivation (p&lt;0.0001). 3) ANN and pathway analysis revealed that TOP2A-strongly correlated genes are involved in: mitotic cell cycle regulation especially M phase and cell division (AURKB, KIF2C, BRIC5, ASPM, CCNA2, BUB1, FBXO5, PTTG1, CDCA5, CDCA3 CDCA8), Kinesin and microtubules regulator genes (KIF2C, KIF11, KIF14, KIF20A, KIF23, and KIFC1), and metastases (BRIC5, BUB1B, CCNA2, CCNE, PRRG1, PRM2, STMN1). Conclusions: Top2A protein expression is an independent predictor for pCR after ATC-CT treatment. The high response rate of top2A protein overexpression supports the theory that Top2a protein is a direct target of ATC-CT in these highly proliferative tumour cells. Furthermore, evaluation of Top2A protein may lead to a clinically useful test.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-06-14.

Haemodialysis induces mitochondrial dysfunction and apoptosis

BACKGROUND

Mitochondria play a crucial role in the regulation of the endogenous pathways of apoptosis activated by oxidant stress. Nuclear factor-kappaB (NF-kappaB) is a central integration site for pro-inflammatory signals and oxidative stress.

MATERIALS AND METHODS

Peripheral blood mononuclear cells (PBMC) were isolated from eight end-stage renal disease (ESRD) patients before haemodialysis (Pre-HD) and during the last 10 min of HD (End-HD). A new polysulfone membrane (F70, Fresenius) was used for dialysis. Intracellular generation of reactive oxygen species (ROS), mitochondrial redox potential (Deltapsim) and PBMC apoptosis were determined by flow-cytometry.

RESULTS

Plasma levels of interleukin-6 (IL-6) (24.9+/-7.0 vs. 17.4+/-5.5 pg dL(-1), P<0.05), IL-6 soluble receptor (52.2+/-4.9 vs. 37.6+/-3.2 ng dL(-1), P<0.02) and IL-6 gp130 (405.7+/-41.0 vs. 235.1+/-38.4 ng dL(-1), P<0.02) were higher end-HD compared to pre-HD. IL-6 secretion by the isolated PBMC (24.0+/-2.3 vs. 19.3+/-3.5 pg dL(-1), P<0.02) increased end-HD. Percentage of lymphocytes exhibiting collapse of mitochondrial membrane potential (43.4+/-4.6% vs. 32.6+/-2.9%, P<0.01), apoptosis (33.4+/-7.1% vs. 23.7+/-7.7%, P<0.01), and generation of superoxide (20.7+/-5.2% vs. 12.5+/-2.9%, P<0.02) and hydrogen peroxide (51.1+/-7.8% vs.38.2+/-5.9%, P<0.04) were higher at end-HD than pre-HD. NF-kappaB activation (3144.1+/-208.1 vs. 2033.4+/-454.6 pg well(-1), P<0.02), expression of B-cell lymphoma protein-2 (6494.6+/-1461 vs. 3501.5+/-796.5 ng mL(-1), P<0.03) and heat shock protein-70 (9.81+/-1.47 vs. 6.38+/-1.0 ng mL(-1), P<0.05) increased during HD.

CONCLUSIONS

Intra-dialytic activation of cytokines, together with impaired mitochondrial function, promotes generation of ROS culminating in augmented PBMC apoptosis. There is concomitant activation of pathways aimed at attenuation of cell stress and apoptosis during HD.

Activation of heat-shock response by an adenovirus is essential for virus replication

Successful viral infection requires viruses to redirect host biochemistry to replicate the viral genome, and produce and assemble progeny virions. Cellular heat-shock responses, which are characterized as elevation and relocalization of heat-shock proteins, occur during replication of many viruses. Such responses might be host reactions to the synthesis of foreign protein, or might be irrelevant consequences of the viral need to activate transcription. Alternatively, as heat-shock proteins can facilitate protein folding, activating a heat-shock response might be a specific virus function ensuring proper synthesis of viral proteins and virions. It is not possible to determine whether heat-shock response is essential for virus replication, because the implicated viral genes (such as Ad5 EIA, ref. 10) also control other essential replication steps. Here we report that expression of Gam1, a protein encoded by the avian virus CELO (ref. 11), elevates and relocalizes hsp70 and hsp40. Gam1-negative CELO is replication-defective; however, Gam1 function can be partially replaced by either heat shock or forced hsp40 expression. Thus, an essential function of Gam1 during virus replication is to activate host heat-shock responses with hsp40 as a primary target.

Stress proteins and the immune response

The heat shock or stress response is one of the most highly conserved adaptive responses in nature. In single cell organisms, the stress response confers tolerance to a variety of stresses including hyperthermia, hyperoxia, hypoxia, and other perturbations, which alter protein synthesis. This tolerance phenomenon is also extremely important in the multicellular organism, resulting in not only thermal tolerance, but also resistance to stresses of the whole organism such as ischemia-reperfusion injury. Moreover, recent data indicates that these stress proteins have the ability to modulate the cellular immune response. Although the terms heat shock proteins (HSPs) and stress proteins are often used interchangeably, the term stress proteins includes the HSPs, the glucose-regulated proteins (GRPs) and ubiquitin. The stress proteins may be grouped by molecular weight ranging from the large 110 kDa HSP110 to ubiquitin at 8 kDa. These proteins serve as cellular chaperones, participating in protein synthesis and transport through the various cellular compartments. Because these proteins have unique cellular localizations, the chaperone function of the stress proteins often involves a transfer of peptides between stress proteins as the peptide is moved between cellular compartments. For example, HSP70 is a cytosolic and nuclear chaperone, which is critical for the transfer of cellular peptides in the mitochondrion through a hand-off that involves mitochondrial HSP60 at the inner mitochondrial membrane. Similarly, cytosolic proteins are transferred from HSP70 to gp96 as they move into the endoplasmic reticulum. The central role of the stress proteins in the transfer of peptides through the cell may be responsible for the recently recognized importance of the stress proteins in the modulation of the immune system [Feder, M.E., Hofmann, G.E., 1999. Heat-shock proteins, molecular chaperones, and the stress response: evolutionary and ecological physiology. Annu. Rev. Physiol. 61, 243-282.]. This importance in immune regulation is best addressed using Matzinger's model of the immune response - The Danger Theory of Immunity [Matzinger, P., Fuchs, E.J., 1996. Beyond self and non-self: immunity is a conversation, not a war. J. NIH Res. 8, 35-39.]. Matzinger suggests that an immune system model based on the differentiation between "self and non-self" does not easily account for the changes that occur in the organism with growth and development. Why, for example does an organism not self-destruct when the immune system encounters the myriad of new peptides generated at puberty? Instead, she proposes a model of immune function based on the ability to detect and address dangers. This model states that the basic function of all cells of the organism is appropriately timed death "from natural causes". This type of cell death, or apoptosis, generates no stress signals. If, on the other hand, a cell is "murdered" by an infectious agent or dies an untimely death due to necrosis or ischemia, the cell undergoes a stress response with the liberation of stress protein-peptide complexes into the extracellular environment upon cell lysis. Not only do they serve as a "danger signal" to alert the immune system to the death of a cell under stress, but their role as protein carriers allows the immune effector cells to survey the peptides released by this stressed cell and to activate against new or unrecognized peptides carried by the stress protein. Matzinger bases the Danger Theory of Immunity on three "Laws of Lymphotics". These laws state that: (1) resting T lymphocytes require both antigen stimulation by an antigen-presenting cell (APC) and co-stimulation with a danger signal to become activated; (2) the co-stimulatory signal must be received through the APC; and (3) T cells receiving only antigen stimulation without the co-stimulatory signal undergo apoptosis. The Danger Theory gives a simple model for both tolerance and activation. (ABSTRACT TRUNCATED)

Induction of heat-shock protein 70 in neutrophils during exposure to subphysiologic temperatures

The expression of heat-shock protein (HSP) 70, a marker of cellular stress, was evaluated in neutrophils. In cells isolated by conventional method, expression of both the inducible HSP72 and the constitutive HSP73 forms of HSP70 was found. This was observed when cells were isolated at room temperature or at 4 degrees C. When autologous plasma was used during the isolation procedure and the entire procedure was done at 37 degrees C, there was no expression of HSP72. Omission of plasma from the isolation procedure done at 37 degrees C also resulted in increased expression of HSP72. These studies demonstrate that the expression of HSP70 in neutrophils is induced by isolation at low temperatures and in the absence of plasma. These observations may be important for studies of the regulation of HSP expression and for other studies that relate to neutrophil activation.

Local allergen challenge and bronchoalveolar lavage of allergic asthmatic lungs. Description of the model and local airway inflammation

The local mechanisms that result in the cellular inflammation and bronchial airway hyperreactivity that characterize allergic bronchial asthma are poorly defined. In order to study these processes, we developed a method for local allergen challenge using a fiberoptic bronchoscope and direct observation and bronchoalveolar lavage (BAL) to assess the airway responses to allergen. In these studies, 11 allergic asthmatics (all of whom had previously demonstrated a late-phase asthmatic response to aeroallergen challenge) and 6 healthy, asymptomatic subjects volunteered to undergo bronchoalveolar lavage after local airway challenge via a bronchoscope wedged into subsegmental airways. These studies revealed that asthmatic airways respond to allergen with an immediate pallor followed by reactive hyperemia, edema, and bronchial narrowing. This site and a control site were relavaged at 48 or 96 h after the immediate response. Neutrophils and eosinophils increased significantly at 48 h after challenge, as did helper T-lymphocytes. Characteristically, at 96 h, neutrophil counts returned to normal values, whereas eosinophiles and helper T-cells remained elevated. Peroxidase-staining cells were also elevated at 48 h after local allergen challenge. Electron microscopy revealed degranulation of mast cells and eosinophils, both immediately and later (48 and 96 h) after local allergen challenge. Macrophages were highly activated and had phagocytized, partially intact granules from both eosinophils and mast cells. There was a significant correlation (p less than 0.001) between the concentration of allergen required to produce a visible airway response and a positive end-point skin titration in the asthmatic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Methods for bronchoalveolar lavage in asthmatic patients following bronchoprovocation and local antigen challenge

We employed bronchoalveolar lavage (BAL) of subsegmental airways to study the local inflammatory effects of aeroallergen bronchoprovocation (BPC) and local instillation of allergen in allergic asthmatic patients, allergic rhinitis patients, and normal subjects. Two protocols were used: (1) BAL was performed in three subsegments following BPC or during spontaneous seasonal exposure, and (2) 5-ml aliquots of increasing doses of allergen were instilled into a single subsegment until there was at least 30 percent closure of the airway; the airway was then immediately lavaged. A subsegment in the opposite lung was lavaged as a control site. These same two segments were lavaged again two to 14 days later and the cells and fluid analyzed. Fifty-five lavages have been performed without complications. Pulmonary function tests (FEV1) were not significantly disturbed by either local challenge or lavage procedures. Cells were examined using light and electron microscopy and showed inflammatory cells in alveolar airways and dissolution of mast cell and eosinophil granules. Using selected criteria, we were able to use these methods in mildly, seasonally asthmatic patients to obtain safely cells and fluid for analysis. These techniques may permit studies which further our understanding of the mechanisms responsible for allergic asthma.

Pulmonary extraction of biogenic amines during septic shock

The effect of live Escherichia coli on the pulmonary extraction of the biogenic amines 14C 5-hydroxytryptamine, (5-HT) and 3H-epinephrine was investigated. The labeled isotopes were injected into a central venous catheter and collected from an aortic catheter. One hundred per cent of the labeled epinephrine was recovered in the control and septic state. Only 32.8 +/- 3.6% SEM of the 5-hydroxytryptamine was recovered before sepsis and 42.5 +/- 4.9% SEM after sepsis. During sepsis, mean arterial pressure fell to 58 mm Hg from 121 mm Hg. Pulmonary shunt increased from .7 +/- .05 SEM to .33 +/- .09 SEM.

Pregnancy and thrombophlebitis

There is an increased risk of thromboembolic disease during pregnancy. Diagnosis is accomplished through noninvasive measuring, impedance plethysmography and Doppler ultrasound. It is best managed by heparin therapy.