Treatment of Patients with Waldenström Macroglobulinaemia: Clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on use of other agents including BCL2 inhibitors and on treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia review the available evidence on the treatment of WM since the last publication in 2017 and provide specific recommendations to assist Australian clinicians in the management of this disease.

Retrospective review of patients with atypical bisphosphonate related proximal femoral fractures

INTRODUCTION

Patients may be at an increased risk of atypical proximal femoral fractures with prolonged bisphosphonate use.

PATIENTS AND METHODS

This was a retrospective review of patients who sustained a subtrochanteric fracture of the femur in our department between April 2009 and March 2014. The radiographs were reviewed for features of atypical femoral fractures as described by the American Society of Bone Mineral Research.

RESULTS

185 patients were coded according to the National Hip Fracture Database as having sustained a subtrochanteric fracture of the femur. Of these, 26 patients had radiographic findings consistent with an atypical subtrochanteric fracture. 5 patients were excluded as their histology confirmed malignancy. 12 patients were taking bisphosphonates on admission. All 12 patients were females taking alendronic acid on admission, who sustained the fracture as the result of minimal or no trauma and underwent long gamma nail fixation. The mean age was 71.6 years (range 62-79 years). The mean length of time on bisphosphonates prior to admission was 8.33 years (range 3-25 years). 9/12 patients had pre-existing symptoms for between 5days and 2 years prior to admission. 1 patient sustained a broken gamma nail 14 weeks post-operatively requiring revision. The mean time to discharge from theatre was 16days (range 5-57days). The mean time to radiological union in the patients in whom there was evidence was 24 weeks.

CONCLUSIONS

In this small group of patients, management of this fracture pattern can be complex with the potential for delayed or non-union and prodromal symptoms are common.

Are Albumin Levels a Good Predictor of Mortality in Elderly Patients with Neck of Femur Fractures?

BACKGROUND

Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes.

MATERIALS AND METHODS

Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made.

RESULTS

471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%.

CONCLUSIONS

Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.

The Scotland Leukaemia Registry Audit of Incidence, Diagnosis and Clinical Management of New Patients with Chronic Myeloid Leukaemia in 1999 and 2000

The management of CML has recently become increasingly complex. The Scotland Leukaemia Registry (SLR) sent questionnaires to all 26 Scottish haematology units, of which 18 (69%) responded. From January 1999 to December 2000, 64 new cases of CML were identified by the audit (incidence 0.64/100,00/yr), of which 46 were registered with the SLR. At diagnosis, all 18 units combined bone marrow examination with cytogenetics/FISH, but only 13 performed RT-PCR. Of four units that calculated the Hasford Score, only two used it to inform clinical decisions. 52% of patients entered clinical trials, 57% involving imatinib mesylate (IM). Of the 23 patients who were tissue typed, suitable donors were found for 18, 11 sibling, and 7 unrelated, representing 28% of the total patient population. Only 13/64 patients (20%) did not have a BMT donor identified or enter a clinical trial. Although 38% of units would consider reduced intensity allografting in patients > 60 years, no centres currently routinely tissue-type such patients. For first line therapy 56% of patients received hydroxyurea +/- interferon. Of the newer agents, 83% of units believed imatinib mesylate should be reserved for clinical trials, 83% would consider using oral ara-C and 89% pegylated-interferon.

Light therapy and serotonin transporter binding in the anterior cingulate and prefrontal cortex

OBJECTIVE

To investigate the effects of light therapy on serotonin transporter binding (5-HTT BPND ), an index of 5-HTT levels, in the anterior cingulate and prefrontal cortices (ACC and PFC) of healthy individuals during the fall and winter. Twenty-five per cent of healthy individuals experience seasonal mood changes that affect functioning. 5-HTT BPND has been found to be higher across multiple brain regions in the fall and winter relative to spring and summer, and elevated 5-HTT BPND may lead to extracellular serotonin loss and low mood. We hypothesized that, during the fall and winter, light therapy would reduce 5-HTT BPND in the ACC and PFC, which sample brain regions involved in mood regulation.

METHOD

In a single-blind, placebo-controlled, counterbalanced, crossover design, [(11) C]DASB positron emission tomography was used measure 5-HTT BPND following light therapy and placebo conditions during fall and winter.

RESULTS

In winter, light therapy significantly decreased 5-HTT BPND by 12% in the ACC relative to placebo (F1,9 = 18.04, P = 0.002). In the fall, no significant change in 5-HTT BPND was found in any region across conditions.

CONCLUSION

These results identify, for the first time, a central biomarker associated with the intervention of light therapy in humans which may be applied to further develop this treatment for prevention of seasonal depression.

Intracranial involvement by multiple myeloma

Intracranial involvement is a rare complication of multiple myeloma. It results either from direct extra-osseous spread from adjacent skeletal plasmacytomas or extra-medullary disease via haematogenous dissemination. The imaging appearances are non-specific, and dural, leptomeningeal, and parenchymal involvement can all occur. The purpose of this review is to illustrate the various neuroimaging appearances of this rare entity, focusing on MRI.

A multicentre retrospective comparison of central nervous system prophylaxis strategies among patients with high-risk diffuse large B-cell lymphoma

Background:

Central nervous system (CNS) relapse in diffuse large B-cell lymphoma (DLBCL) is a devastating complication; the optimal prophylactic strategy remains unclear.

Methods:

We performed a multicentre, retrospective analysis of patients with DLBCL with high risk for CNS relapse as defined by two or more of: multiple extranodal sites, elevated serum LDH and B symptoms or involvement of specific high-risk anatomical sites. We compared three different strategies of CNS-directed therapy: intrathecal (IT) methotrexate (MTX) with (R)-CHOP ‘group 1' R-CHOP with IT MTX and two cycles of high-dose intravenous (IV) MTX ‘group 2' dose-intensive systemic antimetabolite-containing chemotherapy (Hyper-CVAD or CODOXM/IVAC) with IT/IV MTX ‘group 3'.

Results:

Overall, 217 patients were identified (49, 125 and 43 in groups 1–3, respectively). With median follow-up of 3.4 (range 0.2–18.6) years, 23 CNS relapses occurred (12, 10 and 1 in groups 1–3 respectively). The 3-year actuarial rates (95% CI) of CNS relapse were 18.4% (9.5–33.1%), 6.9% (3.5–13.4%) and 2.3% (0.4–15.4%) in groups 1–3, respectively (P=0.009).

Conclusions:

The addition of high-dose IV MTX and/or cytarabine was associated with lower incidence of CNS relapse compared with IT chemotherapy alone. However, these data are limited by their retrospective nature and warrant confirmation in prospective randomised studies.

Natural killer T cell defects in multiple myeloma and the impact of lenalidomide therapy

The causes of multiple myeloma (MM) remain obscure and there are few known risk factors; however, natural killer T (NKT) cell abnormalities have been reported in patients with MM, and therapeutic targeting of NKT cells is promoted as a potential treatment. We characterized NKT cell defects in treated and untreated patients with MM and determined the impact of lenalidomide therapy on the NKT cell pool. Lenalidomide is an immunomodulatory drug with co-stimulatory effects on NKT cells in vitro and is an approved treatment for MM, although its mode of action in that context is not well defined. We find that patients with relapsed/progressive MM had a marked deficiency in NKT cell numbers. In contrast, newly diagnosed patients had relatively normal NKT cell frequency and function prior to treatment, although a specific NKT cell deficiency emerged after high-dose melphalan and autologous stem cell transplantation (ASCT) regimen. This also impacted NK cells and conventional T cells, but the recovery of NKT cells was considerably delayed, resulting in a prolonged, treatment-induced NKT cell deficit. Longitudinal analysis of individual patients revealed that lenalidomide therapy had no in-vivo impact on NKT cell numbers or cytokine production, either as induction therapy, or as maintenance therapy following ASCT, indicating that its clinical benefits in this setting are independent of NKT cell modulation.

Limited role for surveillance PET-CT scanning in patients with diffuse large B-cell lymphoma in complete metabolic remission following primary therapy

Background:

The usefulness of positron emission tomography with computed tomography (PET–CT) in the surveillance of patients with diffuse large B-cell lymphoma (DLBCL) in complete metabolic remission after primary therapy is not well studied.

Methods:

We performed a retrospective review of our database between 2002 and 2009 for patients with de novo DLBCL who underwent surveillance PET–CT after achieving complete metabolic response (CMR) following primary therapy.

Results:

Four-hundred and fifty scans were performed in 116 patients, with a median follow-up of 53 (range 8–133) months from completion of therapy. Thirteen patients (11%) relapsed: seven were suspected clinically and six were subclinical (all within first 18 months). The positive predictive value in patients with international prognostic index (IPI) <3 was 56% compared with 80% in patients with IPI⩾3. Including indeterminate scans, PET–CT retained high sensitivity 95% and specificity 97% for relapse.

Conclusion:

Positron emission tomography with computed tomography is not useful in patients for the majority of patients with diffuse large B-cell lymphoma in CMR after primary therapy, with the possible exception of patients with baseline IPI ⩾3 in the 18 months following completion of primary therapy. This issue could be addressed by a prospective clinical trial.

Pegfilgrastim compared with filgrastim for cytokine-alone mobilization of autologous haematopoietic stem and progenitor cells

Haematopoietic stem and progenitor cells (HSPC) mobilization, using cytokine-alone, is a well-tolerated regimen with predictable mobilization kinetics. Single-dose pegfilgrastim mobilizes HSPC efficiently; however, there is surprisingly little comparative data on its use without chemotherapy for HSPC mobilization. Pegfilgrastim-alone and filgrastim-alone mobilization regimens were compared in 52 patients with haematological malignancy. Pegfilgrastim 12 mg (n=20) or 6 mg (n=2) was administered Day 1 (D1) in 22 patients (lymphoma n=17; myeloma n=5). Thirty historical controls (lymphoma n=18; myeloma n=12) received filgrastim 10 mcg/kg daily from D1. Peripheral blood (PB) CD34(+) counts reached threshold (5 × 10(6)/L) and apheresis commenced on D4(4-5) and D4(4-6). Median PB CD34(+) cell count on D1 of apheresis was similar (26.0 × 10(6)/L (2.5-125.0 × 10(6)/L) and 16.2 × 10(6)/L (2.6-50.7 × 10(6)/L); P=0.06), for pegfilgrastim and filgrastim groups, respectively. Target yield (2 × 10(6) per kg CD34(+) cells) was collected in 20/22 (91%) pegfilgrastim patients and 24/30 (80%) in the filgrastim group (P=0.44), in a similar median number of aphereses (3(1-4) versus 3(2-6), respectively; P=0.85). A higher proportion of pegfilgrastim patients tended to yield 4 × 10(6) per kg CD34(+) cells; 16/22 (73%) versus 14/30 (47%) filgrastim patients (P=0.09). One pegfilgrastim patient developed hyperleukocytosis that resolved without incident. Pegfilgrastim-alone is a simple, well-tolerated, and attractive option for outpatient-based HSPC mobilization with similar mobilization kinetics and efficacy to regular filgrastim.

Uninformative visual experience establishes long term perceptual bias

Visual appearance depends upon the resolution of ambiguities that arise when 2D retinal images are interpreted as 3D scenes. This resolution may be characterized as a form of Bayesian perceptual inference, whereby retinal sense data combine with prior belief to yield an interpretation. Under this framework, the prior reflects environmental statistics, so an efficient system should learn by changing its prior after exposure to new statistics. We conjectured that a prior would only be modified when sense data contain disambiguating information, such that it is clear what bias is appropriate. This conjecture was tested by using a perceptually bistable stimulus, a rotating wire-frame cube, as a sensitive indicator of changes in the prior for 3D rotation direction, and by carefully matching perceptual experience of ambiguous and unambiguous versions of the stimulus across three groups of observers. We show for the first time that changes in the prior-observed as a change in bias that resists reverse learning the next day-is affected more by ambiguous stimuli than by disambiguated stimuli. Thus, contrary to our conjecture, modification of the prior occurred preferentially when the observer actively resolved ambiguity rather than when the observer was exposed to environmental contingencies. We propose that resolving stimuli that are not easily interpreted by existing visual rules must be a valid method for establishing useful perceptual biases in the natural world.

Ex vivo culture of chimeric antigen receptor T cells generates functional CD8+ T cells with effector and central memory-like phenotype

The anti-tumor efficacy of adoptively transferred T cells requires their in vivo persistence and memory polarization. It is unknown if human chimeric antigen receptor (CAR)-expressing T cells can also undergo memory polarization. We examined the functional status of CAR CD8(+) T cells, re-directed to Lewis Y antigen (LeY-T), throughout a period of ex vivo expansion. Immediately before culture CD8(+) T cells comprised a mixture of phenotypes including naive (CD45RA(+)/CCR7(+)/CD27(+)/CD28(+)/perforin-), central memory (CM, CD45RA(-)/CCR7(lo)/CD27(+)/CD28(+)/perforin(lo)), effector memory (EM, CD45RA(-)/CCR7(-)/CD27(+)/CD28(+)/perforin(mod)) and effector (Eff, CD45RA(+)/CCR7(-)/CD27(-)/CD28(-)/perforin(hi)) cells. After transduction and expansion culture of peripheral blood mononuclear cells from normal donors or multiple myeloma patients, CD8(+) LeY-T cells polarized to EM- and CM-like phenotype. CD8(+) LeY-T cells differed from starting CD8(+) CM and EM T cells in that CD27, but not CD28, was downregulated. In addition, CD8(+) LeY-T cells expressed high levels of perforin, similar to starting CD8(+) Eff. CD8(+) LeY-T cells also showed hallmarks of both memory and Eff function, underwent homeostatic proliferation in response to interleukin (IL)-15, and showed interferon (IFN)-γ production and cytotoxicity in response to Le-Y antigen on OVCAR-3 (human ovarian adenocarcinoma) cells. This study confirms CD8(+) LeY-T cells have a CM- and EM-like phenotype and heterogeneous function consistent with potential to persist in vivo after adoptive transfer.

Perceptual comparison of features within and between objects: a new look

The integration of spatially distinct elements into coherent objects is a fundamental process of vision. Yet notwithstanding an extensive literature on perceptual grouping, we still lack a clear understanding of the representational consequences of grouping disparate visual locations. We investigated this question in a feature comparison task; subjects identified matching features that belonged either to the same apparent object (within-object condition) or to different apparent objects (between-object condition). The stimulus was backward-masked at a variable SOA, to examine the consequences of changes in the perceptual organization of the segments over time. Critical to our aims, the two objects composing our stimulus were occluded to a variable extent, so that differences in within-object and between-object performance could be unequivocally related to the formation of objects. For certain stimulus arrangements, we found superior performance for within-object matches. The pattern of performance was, however, highly dependent on the stimulus orientation and was not related to the strength of the object percept. Using an oblique stimulus arrangement, we observed superior between-object comparisons that did vary with the object percept. We conclude that performance in our feature comparison task is strongly influenced by spatial relations between features that are independent of object properties. Indeed, this dominating effect may hide an underlying mechanism whereby formation of a visual object suppresses comparison of distinct features within the object.

101. ISOLATION OF PUTATIVE EMBRYONIC STEM CELLS FROM CLONED PIG EMBRYOS

The isolation of embryonic stem cells from cloned embryos (NT-ESC) from domestic animals would have a number of biomedical and agricultural applications. Putative ESC lines from in vivo derived and in vitro produced pig embryos were recently established using a new isolation method1. The aim of the current study was to determine whether NT-ESC lines could be isolated from cloned pig embryos using this method. To do this we determined initially whether the treatment of embryos with Trichostatin A (TSA), a histone deacetylase inhibitor, could increase the number of cloned embryos that develop to the blastocyst stage because TSA has been shown to increase blastocyst development and NT-ESC isolation efficiencies in mice2. Cloned embryos were produced as described previously3. Briefly, in vitro matured sow oocytes were enucleated, fused with adult fibroblasts using an electrical pulse and activated about 1.5 hrs later with a second electrical pulse. Reconstructed embryos were then cultured in modified NCSU23 with or without 50nM TSA treatment for the initial 24 hours of culture. Embryo development was assessed on day 6. Treatment with TSA increased the number of cloned embryos that developed to the blastocyst stage (143/471; 30%) compared with control (54/353; 15%; P < 0.0001). Blastocysts were then plated by mechanical depression onto mitotically inactivated mouse embryonic fibroblast feeder layers in a serum-free culture system on day 7. There was no significant difference in the efficiencies of establishment of homogeneous primary outgrowths between TSA treated (17/96; 18%) and control blastocysts (8/43; 19%). Thirteen homogenous outgrowths from the TSA treated group were vitrified at passage 2 or 3. Sublines are currently being characterised to determine their pluripotency.

Do patients with diabetes wear shoes of the correct size?

BACKGROUND

Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes.

METHODS

One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a 'Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded.

RESULTS

One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy.

CONCLUSIONS

Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination.

Alterations in dopamine D3 receptors in the circling (ci3) rat mutant

We have previously described a black-hooded mutant rat (BH.7A/Ztm-ci3/ci3) that displays abnormal lateralized circling behavior, but normal auditory and vestibular functions. Neurochemical determination of dopamine and dopamine metabolite levels in striatum, nucleus accumbens and substantia nigra showed that ci3 rats have a significant asymmetry in striatal dopamine in that dopamine levels were significantly lower in the hemisphere contralateral to the preferred direction of turning. Consistent with this finding, immunohistological examination of dopaminergic neurons in substantia nigra and ventral tegmental area yielded a significant laterality in the medial part of substantia nigra pars compacta with a lower density of tyrosine hydroxylase-positive neurons in the contralateral hemisphere of mutant circling rats, while no laterality was seen in unaffected rats of the background strain. In the present study, quantitative autoradiography was used to examine the binding of [(3)H]SCH 23390, [(3)H]raclopride and [(3)H]7-OH-DPAT (7-hydroxy-N,N-di-n-propyl-2-aminotetralin) to dopamine D1, D2, and D3 receptors, respectively, in various brain regions of ci3 rats and unaffected rats of the background strain (BH.7A(LEW)/Won). No significant differences between circling rats and controls were obtained for D1 and D2 receptor binding in any region, but mutant rats differed from controls in dopamine D3 binding in several regions. A significant decrease in D3 binding was seen in the shell of the nucleus accumbens, the islands of Calleja, and the subependymal zone of ci3 mutant rats. Furthermore, a significant laterality in D3 binding was determined in ci3 rats in that binding was lower in the contralateral hemisphere in the shell of the nucleus accumbens and the islands of Calleja. Our data indicate that alterations of dopamine D3 receptors may be involved in the behavioral phenotype of the ci3 rat, thus substantiating the findings from a recent genetic linkage analysis that indicated the D3 receptor gene as a candidate gene in this rat mutant.

33 USE OF ADULT MESENCHYMAL STEM CELLS FOR CLONING PIGS

Current cloning efficiencies are relatively low and there is evidence to suggest that a less differentiated cell type can increase these (Jaenisch et al. 2002 Cloning and Stem Cells 4, 389-396). As part of an ongoing study that aims to develop cloning as a breeding tool for the pig industry, we examined whether mesenchymal stem cells (MSCs) isolated from bone marrow (Experiment 1) and blood (Experiment 2) could increase cloning efficiencies compared with fibroblasts isolated from ear tissue of live animals. MSCs were isolated from the femurs and blood of two pigs over a Histopaque-1077 density gradient. Cells were seeded and cultured in DMEM supplemented with 10% fetal bovine serum (FBS) and antibiotics/antimycotics. Blood MSCs were plated onto fibronectin-coated dishes (Faast and Nottle, Proc. Australian Health Med. Res. Congress 2004, abst. 1272). Cells from passages 2-4 were used for nuclear transfer by means of a fusion before being subjected to the activation protocol described previously (Harrison et al. 2004 Cloning and Stem Cells 6, 327-331). Embryos were cultured in a modified NCSU23 for 7 days. In Experiment 1 there was no difference in the number of fused embryos that cleaved in the bone marrow MSC and fibroblast groups (374/447; 84% vs. 370/446; 83%, respectively; 9 replicates). The number of embryos that developed to the blastocyst stage by day 7 was significantly higher in the bone marrow MSC group compared with the fibroblast group (136/447; 30% vs. 79/446; 18%, respectively, Chi square test; P < 0.01). In Experiment 2 there was no difference in the percentage of embryos that cleaved in the blood MSC and fibroblast groups (287/375; 77% vs. 275/347; 79%, respectively; 8 replicates). The number of embryos that developed to the blastocyst stage by day 7 was also similar between the blood MSC and fibroblast groups (67/375; 18% vs. 63/347; 18%, respectively). In conclusion, our results suggest that bone marrow MSCs may be a more efficient cell type, compared with fibroblasts, for the cloning of live animals.

Immunotherapy in multiple myeloma - possibility or probability?

In a small number of patients with multiple myeloma (MM), long-term disease-free survival has been achieved by harnessing the immune phenomenon, 'graft-versus-tumour' effect, induced by allogeneic haemopoietic stem cell transplantation. This has prompted many investigators to examine ways in which a patient's own immune system can be more effectively directed against their disease, with the ultimate aim of tumour eradication. In this review we assess the current understanding of immunobiology in MM, and how the different components of the immune system, such as dendritic cells, T cells and natural killer cells, may be harnessed using in-vitro and in-vivo priming techniques. We look at the clinical immunotherapy trials reported to date and whether, in light of the current information, immunotherapy for MM is an achievable goal.

Targeting the silent minority: emerging immunotherapeutic strategies for eradication of malignant stem cells in chronic myeloid leukaemia

Standard allogeneic stem cell transplantation (alloSCT) has provided a cure for chronic myeloid leukaemia (CML) over the last 25 years, but is only an option for a minority of patients. It was hoped that the introduction of imatinib mesylate (IM), a specific tyrosine kinase inhibitor that targets the Bcr-Abl oncogene product, would provide long-term remission or even cure for those patients without a donor, but studies have shown that IM does not eliminate leukaemic stem cells in CML patients. To overcome this problem of molecular persistence, research is underway to combine reduced intensity stem cell transplant or non-donor-dependent immunotherapies with IM with the aim of increasing cure rate, reducing toxicity and improving quality of life. The alternative approach is to combine IM or second-generation agents with other novel drugs that interrupt key signalling pathways activated by Bcr-Abl. This article will focus on the latest immunotherapy and molecularly targeted therapeutic options in CML and how they may be combined to improve the outcome for CML patients in the future.

Cardioversion and the use of sedation

Nurse led cardioversion services have achieved significant reductions in both cost and waiting time. However, the question of safety of the procedure raises several areas of concern.

Physician administered sedation for DC cardioversion

Providing anaesthetic cover for DC cardioversion can sometimes prove a challenge for the cardiologist, with potentially disastrous consequences for the patient

Effect of DNA concentration on transgenesis rates in mice and pigs

A retrospective analysis of transgenesis rates obtained in seven pronuclear microinjection programs was undertaken to determine if a relationship existed between the amount of DNA injected and transgenesis rates in the pig. Logistic regression analysis showed that as the concentration of DNA injected increased from 1 to 10 ng/microl, the number of transgenics when expressed as a proportion of the number liveborn (integration rate) increased from 4% to an average of 26%. A similar relationship was found when the number of molecules of DNA injected per picolitre was analysed. No evidence was obtained to suggest either parameter influenced integration rate in mice when the same constructs were injected. The number of transgenics liveborn when expressed as a proportion of ova injected (efficiency rate), increased as DNA concentration increased up to 7.5 ng/microl and then decreased at 10 ng/microl for both species suggesting that at this concentration DNA (or possible contaminants) may have influenced embryo survival. The relationship between efficiency and the number of molecules injected per picolitre was complex suggesting that the concentration at which DNA was injected was a better determinant of integration and efficiency rates. In conclusion, the present study suggests that transgenes need to be injected at concentrations of between 5 and 10 ng/microl to maximise integration and efficiency rates in pigs.

Mammalian reovirus L2 gene and lambda2 core spike protein sequences and whole-genome comparisons of reoviruses type 1 Lang, type 2 Jones, and type 3 Dearing

The reovirus L2 genome segment encodes the core spike protein lambda2, which mediates enzymatic reactions in 5' capping of the viral plus-strand transcripts. Complete nucleotide-sequence determinations were made for the L2 genome segments of eight mammalian reoviruses, including the prototype isolates of serotypes 1 and 2: Lang (T1L) and Jones (T2J), respectively. Each L2 segment was found to be 3912 or 3915 bases in length. Partial nucleotide-sequence determinations were also made for the 3916-base L2 segment of reovirus type 3 Dearing (T3D), the prototype isolate of serotype 3. The whole-genome sequence of reovirus T3D was reported previously. The T1L L2 analysis represents completion of the whole-genome sequence of that isolate as well. The T2J L2 analysis leaves only the sequence of the M1 segment yet to be reported from the genome of that isolate. The T2J M1 sequence made available from analysis in another lab was used for initiating whole-genome comparisons of reoviruses T1L, T2J, and T3D in this report. The nine L2 gene sequences and deduced lambda2 protein sequences were used to gain further insights into the biological variability, structure, and functions of lambda2 through comparisons of the sequences and reference to the crystal structure of core-bound lambda2. Phylogenetic comparisons suggest the presence of three evolutionary lines of divergent L2 alleles among the nine isolates. Localized regions of conserved amino acids in the lambda2 crystal structure include active-site clefts of the RNA capping enzyme domains, sites of interactions between lambda2 domains within the pentameric spike structure, and sites of interaction between lambda2 subunits and other proteins in viral particles.

Delayed appearance of a traumatic intracranial aneurysm. Case report and review of the literature

Giant traumatic intracranial aneurysms are rare, and thus their incidence and clinical behavior are poorly understood. In most cases, traumatic aneurysms develop and become symptomatic within months following injury. The authors present the case of a 46-year-old war veteran, in whom a giant internal carotid artery aneurysm developed as a result of a penetrating cranial shrapnel injury sustained 25 years earlier during the Vietnam war. The aneurysm had not been evident on previous imaging studies. At surgery, a piece of shrapnel was found embedded in the dome of the aneurysm. The presentation, diagnosis, management, and treatment options related to this lesion are discussed.

Management of heparin allergy during pregnancy with danaparoid

We report a patient who presented with a left proximal deep vein thrombosis at 25 + 5 weeks gestation. She developed a severe urticarial rash 3 weeks following initiation of therapy with Enoxaparin. The patient was heterozygous for the factor V Leiden mutation. She was treated with subcutaneous twice-daily danaparoid (Orgaran) for the remainder of the pregnancy, achieving anti-Xa levels in the therapeutic range 0.5-1.0 IU/ml. Delivery was at term by caesarean section 2 days after spontaneous rupture of membranes and failure to progress in labour. Danaparoid was withheld during this time. Danaparoid was restarted 3 h post delivery and the patient anticoagulated with warfarin in the post-partum period. There was no recurrence of thrombosis or bleeding events during therapy with danaparoid. No anti-Xa activity was demonstrated in breast milk.

Measurements of free radicals in isolated, ischemic lungs and lung mitochondria

Previous studies in isolated, ventilated lungs have demonstrated by indirect measurements that oxidant generation occurs during pulmonary ischemia before reperfusion. To identify and quantify the types of free radical species generated during ischemia, we used electron paramagnetic resonance (EPR) spectroscopy in the presence and absence of the spin trap, 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). EPR spectra obtained from the vascular effluent of isolated ferret lungs, contained a doublet signal (g = 2.005) indicative of ascorbyl radical. This signal doubled in magnitude after 180 min of ischemia, providing evidence of oxidant formation during ischemia. When DMPO, which reacts with radicals including superoxide anions and hydroxyl radicals, was added to the perfusate, the spectra contained ascorbyl radical signals but no DMPO-adducts. To clarify the relationship between ascorbyl radical and DMPO-adduct formation, additional studies were conducted in the presence and absence of ascorbate with isolated lung mitochondria as the source of free radicals. The results showed that in the presence of ascorbate, oxygen free radicals were not detected by EPR spin trapping with DMPO because of the formation of prominent ascorbyl radical signals. These data suggest that DMPO may be useful for the detection of reactive oxygen species in isolated lungs, provided the ascorbate can be sufficiently depleted. Alternatively, as shown by our results, EPR studies that directly monitor ascorbyl radical formation may be used as a marker of oxidative stress in the lung.

An investigation of the metabolism of isoleucine to active Amyl alcohol in Saccharomyces cerevisiae

The metabolism of isoleucine to active amyl alcohol (2-methylbutanol) in yeast was examined by the use of (13)C nuclear magnetic resonance spectroscopy, combined gas chromatography-mass spectrometry, and a variety of mutants. From the identified metabolites a number of routes between isoleucine and active amyl alcohol seemed possible. All involved the initial decarboxylation of isoleucine to alpha-keto-beta-methylvalerate. The first, via branched chain alpha-ketoacid dehydrogenase to alpha-methylbutyryl-CoA, was eliminated because abolition of branched-chain alpha-ketoacid dehydrogenase in an lpd1 disruption mutant did not prevent the formation of active amyl alcohol. However, the lpd1 mutant still produced large amounts of alpha-methylbutyrate which initially seemed contradictory because it had been assumed that alpha-methylbutyrate was derived from alpha-methylbutyryl-CoA via acyl-CoA hydrolase. Subsequently it was observed that alpha-methylbutyrate arises from the non-enzymic oxidation of alpha-methylbutyraldehyde (the immediate decarboxylation product of alpha-keto-beta-methylvalerate). Mutant studies showed that one of the decarboxylases encoded by PDC1, PDC5, PDC6, YDL080c, or YDR380w must be present to allow yeast to utilize alpha-keto-beta-methylvalerate. Apparently, any one of this family of decarboxylases is sufficient to allow the catabolism of isoleucine to active amyl alcohol. This is the first demonstration of a role for the gene product of YDR380w, and it also shows that the decarboxylation steps for each alpha-keto acid in the catabolic pathways of leucine, valine, and isoleucine are accomplished in subtly different ways. In leucine catabolism, the enzyme encoded by YDL080c is solely responsible for the decarboxylation of alpha-ketoisocaproate, whereas in valine catabolism any one of the isozymes of pyruvate decarboxylase will decarboxylate alpha-ketoisovalerate.

Fusion and instrumentation at C1-3 via the high anterior cervical approach

OBJECT

The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure.

METHODS

Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1-3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization.

CONCLUSIONS

Fusion and instrumentation at C1-3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital-C1 mobility.

MiAMP1, a novel protein from Macadamia integrifolia adopts a Greek key beta-barrel fold unique amongst plant antimicrobial proteins

MiAMP1 is a recently discovered 76 amino acid residue, highly basic protein from the nut kernel of Macadamia integrifolia which possesses no sequence homology to any known protein and inhibits the growth of several microbial plant pathogens in vitro while having no effect on mammalian or plant cells. It is considered to be a potentially useful tool for the genetic engineering of disease resistance in transgenic crop plants and for the design of new fungicides. The three-dimensional structure of MiAMP1 was determined through homonuclear and heteronuclear ((15)N) 2D NMR spectroscopy and subsequent simulated annealing calculations with the ultimate aim of understanding the structure-activity relationships of the protein. MiAMP1 is made up of eight beta-strands which are arranged in two Greek key motifs. These Greek key motifs associate to form a Greek key beta-barrel. This structure is unique amongst plant antimicrobial proteins and forms a new class which we term the beta-barrelins. Interestingly, the structure of MiAMP1 bears remarkable similarity to a yeast killer toxin from Williopsis mrakii. This toxin acts by inhibiting beta-glucan synthesis and thereby cell wall construction in sensitive strains of yeast. The structural similarity of MiAMP1 and WmKT, which originate from plant and fungal phyla respectively, may reflect a similar mode of action.

Mammalian reovirus L3 gene sequences and evidence for a distinct amino-terminal region of the lambda1 protein

To complement evidence for nucleoside triphosphate phosphohydrolase (NTPase), RNA helicase, RNA 5' triphosphate phosphohydrolase, and nucleic acid-binding activities by the core shell protein lambda1 of mammalian orthoreoviruses (reoviruses), we determined nucleotide sequences of the lambda1-encoding L3 gene segments from three isolates: type 1 Lang (T1L), type 2 Jones (T2J), and type 3 Dearing (T3D). The T1L and T3D L3 gene sequences and deduced lambda1 protein sequences shared high levels of identity (97.7% and 99.3%, respectively). The lambda1 sequences differed at only 9 of 1275 amino acids. Two single-nucleotide insertions relative to a previously published sequence for T3D L3 extended the lambda1 open reading frame to within 60 nucleotides of the plus-strand 3' end for T3D and the other isolates sequenced, in keeping with the short 3' nontranslated regions of the other nine gene segments. Seven of the nine amino acid differences between T1L and T3D lambda1 were located within the amino-terminal 500 residues of lambda1, a region with putative sequence similarities to NTPases and RNA helicases. The T2J L3 and lambda1 sequences were found to be more divergent, especially within the amino-terminal 180 residues of lambda1, preceding the putative CCHH zinc finger motif. The T2J L3 sequence, along with partial sequences for L3 genes from three other reovirus isolates, suggested that one or more of the polymorphisms at amino acids 71, 215, 500, 1011, and/or 1100 in lambda1 contribute to the L3-determined differences in ATPase activities by T1L and T3D cores. The findings contribute to our ongoing efforts to elucidate sequence-structure-function relationships for the lambda1 core protein.

Purification and characterization of a plant antimicrobial peptide expressed in Escherichia coli

MiAMP1 is a low-molecular-weight, cysteine-rich, antimicrobial peptide isolated from the nut kernel of Macadamia integrifolia. A DNA sequence encoding MiAMP1 with an additional ATG start codon was cloned into a modified pET vector under the control of the T7 RNA polymerase promoter. The pET vector was cotransformed together with the vector pSB161, which expresses a rare arginine tRNA. The peptide was readily isolated in high yield from the insoluble fraction of the Escherichia coli extract. The purified peptide was shown to have an identical molecular weight to the native peptide by mass spectroscopy indicating that the N-terminal methionine had been cleaved. Analysis by NMR spectroscopy indicated that the refolded recombinant peptide had a similar overall three-dimensional structure to that of the native peptide. The peptide inhibited the growth of phytopathogenic fungi in vitro in a similar manner to the native peptide. To our knowledge, MiAMP1 is the first antimicrobial peptide from plants to be functionally expressed in E. coli. This will permit a detailed structure-function analysis of the peptide and studies of its mode of action on phytopathogens.

An investigation of the metabolism of valine to isobutyl alcohol in Saccharomyces cerevisiae

The metabolism of valine to isobutyl alcohol in yeast was examined by 13C nuclear magnetic resonance spectroscopy and combined gas chromatography-mass spectrometry. The product of valine transamination, alpha-ketoisovalerate, had four potential routes to isobutyl alcohol. The first, via branched-chain alpha-ketoacid dehydrogenase to isobutyryl-CoA is not required for the synthesis of isobutyl alcohol because abolition of branched-chain alpha-ketoacid dehydrogenase activity in an lpd1 disruption mutant did not prevent the formation of isobutyl alcohol. The second route, via pyruvate decarboxylase, is the one that is used because elimination of pyruvate decarboxylase activity in a pdc1 pdc5 pdc6 triple mutant virtually abolished isobutyl alcohol production. A third potential route involved alpha-ketoisovalerate reductase, but this had no role in the formation of isobutyl alcohol from alpha-hydroxyisovalerate because cell homogenates could not convert alpha-hydroxyisovalerate to isobutyl alcohol. The final possibility, use of the pyruvate decarboxylase-like enzyme encoded by YDL080c, seemed to be irrelevant, because a strain with a disruption in this gene produced wild-type levels of isobutyl alcohol. Thus there are major differences in the catabolism of leucine and valine to their respective "fusel" alcohols. Whereas in the catabolism of leucine to isoamyl alcohol the major route is via the decarboxylase encoded by YDL080c, any single isozyme of pyruvate decarboxylase is sufficient for the formation of isobutyl alcohol from valine. Finally, analysis of the 13C-labeled products revealed that the pathways of valine catabolism and leucine biosynthesis share a common pool of alpha-ketoisovalerate.

A 13C nuclear magnetic resonance investigation of the metabolism of leucine to isoamyl alcohol in Saccharomyces cerevisiae

The metabolism of leucine to isoamyl alcohol in yeast was examined by 13C nuclear magnetic resonance spectroscopy. The product of leucine transamination, alpha-ketoisocaproate had four potential routes to isoamyl alcohol. The first, via branched-chain alpha-keto acid dehydrogenase to isovaleryl-CoA with subsequent conversion to isovalerate by acyl-CoA hydrolase operates in wild-type cells where isovalerate appears to be an end product. This pathway is not required for the synthesis of isoamyl alcohol because abolition of branched-chain alpha-keto acid dehydrogenase activity in an lpd1 disruption mutant did not prevent the formation of isoamyl alcohol. A second possible route was via pyruvate decarboxylase; however, elimination of pyruvate decarboxylase activity in a pdc1 pdc5 pdc6 triple mutant did not decrease the levels of isoamyl alcohol produced. A third route utilizes alpha-ketoisocaproate reductase (a novel activity in Saccharomyces cerevisiae) but with no role in the formation of isoamyl alcohol from alpha-hydroxyisocaproate because cell homogenates could not convert alpha-hydroxyisocaproate to isoamyl alcohol. The final possibility was that a pyruvate decarboxylase-like enzyme encoded by YDL080c appears to be the major route of decarboxylation of alpha-ketoisocaproate to isoamyl alcohol although disruption of this gene reveals that at least one other unidentified decarboxylase can substitute to a minor extent.

A peroxidase gene promoter induced by phytopathogens and methyl jasmonate in transgenic plants

The expression of two closely related peroxidase isogenes, Shpx6a and Shpx6b, of the legume Stylosanthes humilis was studied using isogene-specific reverse transcriptase PCR techniques. Results indicated that transcripts of both genes were rapidly induced following inoculation with the fungal pathogen Colletotrichum gloeosporioides, wounding and treatment with the defense regulator methyl jasmonate (MeJA). In contrast treatment of leaves of S. humilis with abscisic acid (ABA) and salicylic acid (SA) did not induce transcripts of either isogene. A genomic clone containing the Shpx6b gene was isolated and 594 bp of 5' sequence upstream of the translation start was fused in frame to the coding region of the uidA reporter gene and introduced into tobacco. Expression from the Shpx6b promoter in transgenic plants was determined by histochemical staining and quantitative assays of beta-glucuronidase (GUS). In transgenic tobacco, GUS expression was detected in cotyledons, vascular cells of young leaves, anthers, pollen, and the stigma and style. Wounding of the tobacco plants produced very localized GUS staining. Much more extensive staining for GUS was observed following inoculation of tobacco leaves with conidia of the fungal pathogen Cercospora nicotianae and the inoculation of wound sites with mycelium of the Oomycete pathogen Phytophthora parasitica var. nicotianae. Treatment of mature leaves with methyl jasmonate induced GUS activity while treatment with ABA, SA, and H2O2 had no effect. A similar strong induction of GUS activity was measured in young transgenic seedlings germinated on MeJA while some, but much weaker, induction of GUS activity was observed in seedlings treated with SA. The sequence of the promoter contained motifs homologous to putative cis elements in other plant genes responsive to MeJA. The Shpx6b gene is the first plant peroxidase gene shown to be induced by both microbial pathogens and MeJA and its promoter will be useful for investigations of signaling processes during fungal infection and for the expression of foreign gene products at infection sites.

Purification, characterisation and cDNA cloning of an antimicrobial peptide from Macadamia integrifolia

An antimicrobial peptide with no significant amino acid sequence similarity to previously described peptides has been isolated from the nut kernels of Macadcamia integrifolia. The peptide, termed MiAMP1, is highly basic with an estimated pI of 10.1, a mass of 8.1 kDa and contains 76 amino acids including 6 cysteine residues. A cDNA clone containing the entire coding region corresponding to the peptide was obtained. The deduced amino acid sequence of the cDNA indicated a 26-amino-acid signal peptide at the N-terminus of the preprotein. Purified MiAMP1 inhibited the growth of a variety of fungal, oomycete and gram-positive bacterial phytopathogens in vitro. Some pathogens exhibited close to 100% inhibition in less than 1 microM peptide (5 microg/ml). Antimicrobial activity was diminished against most, but not all, microbes in the presence of calcium and potassium chloride salts (1 mM and 50 mM, respectively). MiAMP1 was active against bakers yeast, was inactive against Escherichia coli and was non-toxic to plant and mammalian cells. Analysis of genomic DNA indicated that MiAMP1 was encoded on a single copy gene containing no introns. The MiAMP1 gene may prove useful in genetic manipulations to increase disease resistance in transgenic plants.

Integument and sensillum auriforme of the opisthosoma of Rhipicephalus appendiculatus (Acari:Ixodidae)

The opisthosomal integument and sensilla auriformia of Rhipicephalus appendiculatus Neumann larvae, nymphs, females and males, both unfed, fed, and during molt, were examined by light and electron microscopy in relation to semiochemical production. The integument consists of epidermis, endocuticle, exocuticle, epicuticle, a superficial wax layer and a variable additional deposit. The integument of immature instars and females grows greatly during feeding. The integument is traversed by pore canals from the epidermis to the outer wax canals. The epidermis can secrete material to the exterior by way of the pore canals and wax canals. The sensillum auriforme is a common disk-shaped organ, with a complex internal chamber open to the exterior by way of a pore. It has no apparent secretory capacity and is of presumed sensory function. It is located in the integument of scutum and alloscutum of all instars.

Integumental glands of the tick Rhipicephalus appendiculatus (Acari:Ixodidae) as potential producers of semiochemicals

The opisthosomal integument and associated secretory organs of Rhipicephalus appendiculatus Neumann larvae, nymphs, females and males, both unfed and fed were examined by light and electron microscopy. Type 1 dermal glands were found on the alloscutum and scutum of all ticks. They were undeveloped in unfed ticks and reached full development in engorging ticks. They produced secretory granules from 2 glandular cells but without accumulation of a reservoir of secreted material. Type 2 dermal glands were found in all ticks, with pores on the alloscutum, edge of scutum, and on anal plates. These glands produced secretion during feeding and accumulated large reservoirs of secreted material that were present in engorging, recently detached and questing ticks. Spiracular glands were found in all ticks below the spiracle plate. They produced small amounts of secretion and had pores to the exterior by way of spiracle goblets. No obvious cycle of secretory activity was recorded. Foveal glands were present and produced secretions in nymphs, females, and males. They were largest in females with an accumulation of secretory vesicles in feeding ticks. The potential function of these glands is discussed in the context of the chemical ecology of this tick.

Convective warming combined with vasodilator therapy accelerates core rewarming after coronary artery bypass surgery

In a prospective, randomized, controlled study, we have investigated the effect of forced air warming on the rate of change of nasopharyngeal and rectal temperatures in 20 patients after coronary artery bypass grafting. All patients had nasopharyngeal temperatures less than 36 degrees C on arrival in the intensive care unit and received an infusion of glyceryl trinitrate 15 mg h-1, but none received inotropes. Ten patients were warmed under an aluminized plastic "space" blanket (control group) and 10 were warmed under a "Bair Hugger" blanket connected to its power unit on "high" setting (Bair Hugger group). The rates of increase in nasopharyngeal temperature were 0.4 and 0.95 degrees C h-1, respectively, in the control and Bair Hugger groups (P < 0.01) during the first 2 h after operation. Over the same period of time, rectal temperatures increased at a rate of 0.25 and 0.75 degrees C h-1 in the control and Bair Hugger groups, respectively (P < 0.01).

Spontaneous oxygen radical production at sites of antigen challenge in allergic subjects

Allergic reactions in the lung are characterized by the production of mediators, an influx of inflammatory cells, increased vascular permeability, and changes in airway mechanics. The mechanisms responsible for these airway changes have not been fully defined but may involve the production of reactive oxygen species (ROS) produced by the inflammatory cells. To examine whether ROS are produced by inflammatory cells at sites of antigen exposure, bronchoalveolar lavage (BAL) was performed in airway segments 19 h after challenge with saline or antigen in 14 allergic subjects. Antigen challenge increased cell recovery, predominantly as a result of an influx of eosinophils. Using electron paramagnetic resonance (EPR) spectroscopy with the spin trap 5,5-dimethyl-1-pyrroline-N-oxide (DMPO), BAL cells from saline-challenged sites produced minimal ROS. Cells from antigen-challenged sites spontaneously produced a prominent DMPO-OH signal that was inhibited by superoxide dismutase (SOD), indicating the production of superoxide anions (O2-.). Reduction of ferricytochrome c and production of luminol-dependent chemiluminescence via SOD-inhibitable reactions confirmed the spontaneous production of O2-. Following density gradient separation of the antigen-challenged BAL cells, the granulocytic cells, which were predominantly eosinophils, not the mononuclear cells, were the major source of the ROS. At the sites of antigen challenge, the degree of airway permeability as assessed by albumin concentration in BAL fluid was correlated with O2- production by BAL cells measured by EPR spectroscopy. These results demonstrate that cells at sites of antigen challenge generate ROS that may contribute to the airway injury associated with allergic inflammation.

Differential expression of peroxidase isogenes during the early stages of infection of the tropical forage legume Stylosanthes humilis by Colletotrichum gloeosporioides

Infection of Stylosanthes humilis by the fungal phytopathogen Colletotrichum gloeosporioides is associated with an increase in peroxidase enzyme activity within 24 h postinoculation. Peroxidase gene expression was investigated as a first step towards understanding the regulation and functional importance of this host response to fungal attack. Four distinct cDNAs Shpx 2, 5, 6, and 12, isolated from a cDNA library of S. humilis contained deduced amino acid (aa) sequence motifs characteristic of peroxidases. Three of these (Shpx 2, 5, and 6) were full-length and their deduced proteins each fell into a different homology group based on comparisons with other plant peroxidases. Each cDNA appeared to hybridize to only one or two genes in S. humilis. mRNAs corresponding to Shpx2, Shpx6, and Shpx12 were expressed relatively abundantly in young leaves, with lesser expression of Shpx2 and Shpx6 and no expression of Shpx12 detected in roots. No expression of these genes was detected in stems or old leaves. The mRNA of Shpx5 was relatively abundant in stems and to a lesser extent in young leaves. However, infection of young leaves with C. gloeosporioides greatly increased expression of the mRNAs of Shpx2 and Shpx6 but not Shpx5 nor Shpx12 compared to mock-inoculated controls. The mRNA of Shpx6 was strongly induced by the pathogen 4 h postinoculation, a time which precedes fungal penetration, while Shpx2 was induced to higher levels than controls at 24 h after inoculation. The mRNAs of both Shpx2 and Shpx6 but not Shpx5 and Shpx12 were also induced by wounding.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorda tympani nerve injury following inferior alveolar injection: a review of two cases

Permanent nerve injury following the injection of local anesthetic during dental procedures is rare. Two cases of chorda tympani nerve injury shown by ageusia are presented.