Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma

Anti-PD-1 monoclonal antibodies yield high response rates in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but most patients will eventually progress. Allogeneic hematopoietic cell transplantation (alloHCT) after PD-1 blockade may be associated with increased toxicity, raising challenging questions about the role, timing, and optimal method of transplantation in this setting. To address these questions, we assembled a retrospective cohort of 209 cHL patients who underwent alloHCT after PD-1 blockade. With a median follow-up among survivors of 24 months, the 2-year cumulative incidences (CIs) of non-relapse mortality and relapse were 14 and 18%, respectively; the 2-year graft-versus-host disease (GVHD) and relapse-free survival (GRFS), progression-free survival (PFS), and overall survival were 47%, 69%, and 82%, respectively. The 180-day CI of grade 3-4 acute GVHD was 15%, while the 2-year CI of chronic GVHD was 34%. In multivariable analyses, a longer interval from PD-1 to alloHCT was associated with less frequent severe acute GVHD, while additional treatment between PD-1 and alloHCT was associated with a higher risk of relapse. Notably, post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis was associated with significant improvements in PFS and GRFS. While awaiting prospective clinical trials, PTCy-based GVHD prophylaxis may be considered the optimal transplantation strategy for this patient population.

Automated anti-Mullerian hormone measurement: data review to provide insights and interpretation

RESULTS

AMH results were pooled and a table with 2.5 and 97.5 percentiles for each age group constructed. Based on Youden index, the optimal cut off for low responders (0-3 eggs), was 5.5 pmol/l (87% sensitivity, 55% specificity) and for high responders (>15 eggs) 15.6 pmol/l (78% sensitivity, 57% specificity). AMH correlated with number of eggs collected (r = 0.48) and clinical pregnancies (r = 0.14), (p < .0001).

CONCLUSIONS

The table of AMH levels measured using the Access 2 fully automated immunoassay system according to age may be used as a reference and cutoff levels for high and poor responders are clearly defined to help tailor controlled ovarian stimulation, maximizing efficiency and ensuring patient safety. The use of a random access automated immunoassay system means that blood sampled on arrival can produce an AMH result in 40 mins by the time the subject enters the doctor's clinic together with other relevant endocrine markers.

Wnt receptor Frizzled 8 is a target of ERG in prostate cancer

Prostate cancer (PCa) is one of the most frequently diagnosed cancers among men. Many molecular changes have been detailed during PCa progression. The gene encoding the transcription factor ERG shows recurrent rearrangement, resulting in the overexpression of ERG in the majority of prostate cancers. Overexpression of ERG plays a critical role in prostate oncogenesis and development of metastatic disease. Among the downstream effectors of ERG, Frizzled family member FZD4 has been shown to be a target of ERG. Frizzled-8 (FZD8) has been shown to be involved in PCa bone metastasis. In the present study, we show that the expression of FZD8 is directly correlated with ERG expression in PCa. Furthermore, we show that ERG directly targets and activates FZD8 by binding to its promoter. This activation is specific to ETS transcription factor ERG and not ETV1. We propose that ERG overexpression in PCa leads to induction of Frizzled family member FZD8, which is known to activate the Wnt pathway. Taken together, these findings uncover a novel mechanism for PCa metastasis, and indicate that FZD8 may represent a potential therapeutic target for PCa.

Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies

BACKGROUND

Fibre-optic bronchoscopy with bronchoalveolar lavage (BAL) is a safe procedure and is associated with low morbidity and mortality in immunocompromised children. Although many studies have highlighted the advantages of positive BAL results in the diagnosis of pulmonary infections, there have been few reports examining the impact of a negative BAL result on clinical management in immunocompromised children on empiric broad-spectrum antimicrobial therapy.

AIM

The aim of this study was to evaluate BAL in the diagnosis of pulmonary infections in children with haematological malignancies who develop pneumonia unresponsive to empiric antimicrobial therapy, and also to determine whether a negative BAL result contributed to the clinical management of these patients.

MATERIALS AND METHODS

A retrospective review of 44 BAL procedures performed in 33 children with haematological malignancy diagnosed and treated at Our Lady's Children Hospital, Crumlin, Dublin 12, Ireland, over a 10-year period was carried out.

RESULTS

We identified a pathogen causing pneumonia in 24 of 44 BAL procedures (54.5 %). The BAL procedure resulted in modification of antimicrobial treatment after 20 of 24 procedures with positive results (83.3 %) in 16 of 20 patients (80 %). Management was changed after 8 of 20 procedures with negative results (40 %) in 8 of 18 patients (44.4 %). The procedure was well tolerated in all patients.

CONCLUSIONS

Our study supports the use of bronchoscopy with BAL as a diagnostic intervention in this patient population. We consider BAL a safe procedure from which both positive and negative results contribute to the patient's clinical management.

Lesson of the month (2). An unique presentation of infective endocarditis

This lesson reports the case of endophthalmitis, a rare presentation of infective endocarditis (IE), two months following cardiac surgery. Although inflammatory markers were increased, blood cultures were negative. Transoesophageal echocardiography demonstrated an aortic root abscess. Culture of tissue obtained at surgery revealed the infective organism to be Aspergillus fumigatus, a rare cause of IE in the immunocompetent patient.

The cytolytic molecules Fas ligand and TRAIL are required for murine thymic graft-versus-host disease

Thymic graft-versus-host disease (tGVHD) can contribute to profound T cell deficiency and repertoire restriction after allogeneic BM transplantation (allo-BMT). However, the cellular mechanisms of tGVHD and interactions between donor alloreactive T cells and thymic tissues remain poorly defined. Using clinically relevant murine allo-BMT models, we show here that even minimal numbers of donor alloreactive T cells, which caused mild nonlethal systemic graft-versus-host disease, were sufficient to damage the thymus, delay T lineage reconstitution, and compromise donor peripheral T cell function. Furthermore, to mediate tGVHD, donor alloreactive T cells required trafficking molecules, including CCR9, L selectin, P selectin glycoprotein ligand-1, the integrin subunits alphaE and beta7, CCR2, and CXCR3, and costimulatory/inhibitory molecules, including Ox40 and carcinoembryonic antigen-associated cell adhesion molecule 1. We found that radiation in BMT conditioning regimens upregulated expression of the death receptors Fas and death receptor 5 (DR5) on thymic stromal cells (especially epithelium), while decreasing expression of the antiapoptotic regulator cellular caspase-8-like inhibitory protein. Donor alloreactive T cells used the cognate proteins FasL and TNF-related apoptosis-inducing ligand (TRAIL) (but not TNF or perforin) to mediate tGVHD, thereby damaging thymic stromal cells, cytoarchitecture, and function. Strategies that interfere with Fas/FasL and TRAIL/DR5 interactions may therefore represent a means to attenuate tGVHD and improve T cell reconstitution in allo-BMT recipients.

NOD2 regulates hematopoietic cell function during graft-versus-host disease

Nucleotide-binding oligomerization domain 2 (NOD2) polymorphisms are independent risk factors for Crohn's disease and graft-versus-host disease (GVHD). In Crohn's disease, the proinflammatory state resulting from NOD2 mutations have been associated with a loss of antibacterial function of enterocytes such as paneth cells. NOD2 has not been studied in experimental allogeneic bone marrow transplantation (allo-BMT). Using chimeric recipients with NOD2^−/− hematopoietic cells, we demonstrate that NOD2 deficiency in host hematopoietic cells exacerbates GVHD. We found that proliferation and activation of donor T cells was enhanced in NOD-deficient allo-BMT recipients, suggesting that NOD2 plays a role in the regulation of host antigen-presenting cells (APCs). Next, we used bone marrow chimeras in an experimental colitis model and observed again that NOD2 deficiency in the hematopoietic cells results in increased intestinal inflammation. We conclude that NOD2 regulates the development of GVHD through its inhibitory effect on host APC function.

The T Cell Cytolytic Molecules FasL and TRAIL are Required for Thymic GVHD (141.14)

Thymic graft-versus-host-disease (tGVHD) is an important contributor to impaired T cell reconstitution in patients with GVHD. We analyzed molecules relevant for T cell trafficking and cytolytic function in tGVHD.

Thymic output and cellularity were inversely proportional to numbers of mature donor T cells in the allograft, suggesting that tGVHD severity was inversely associated with thymic function. Upon adoptive transfer of CFSE-labeled donor T cells, we noted that thymus-infiltrating alloreactive donor T cells were largely fast-proliferating and highly activated. These T cells infiltrated the thymus within one week after allogeneic bone marrow transplantation.

We analyzed T cells in tGVHD with mice deficient for certain molecules, and found that the trafficking molecules CCR9, β7 integrin, and PSGL-1 were all partially required for tGVHD, while L-selectin and αE integrin subunit may be dispensable. Similarly, we examined the role of T cell cytolytic pathways for tGVHD, and found that FasL and tumor necrosis factor associated apoptosis inducing ligand (TRAIL) were required for tGVHD, but that perforin and TNF were dispensable.

As host thymic stroma may be an important target for donor alloreactive T cells, we assessed the expression of the death receptors Fas and DR5 in thymic stroma from normal and irradiated mice, and found that endothelium and fibroblasts, as well as epithelial cells upregulated the expression of both Fas and DR5 after irradiation. FLIP, which is a negative regulator of Fas ligand and TRAIL mediated apoptosis, was also downregulated after irradiation.

Our study suggests that TRAIL, which has previously been shown to be important in graft-versus-tumor activity, may also be important for mediating GVHD.

The response of IFNAR2 to high-dose IFNα2b during a neoadjuvant clinical trial

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Background: The appropriate subgroup of melanoma patients to select for high-dose IFNa2b (HDI) adjuvant therapy has been undefined since approval of this modality in 1996. A biomarker appropriate for clinical practice and relevant to the biological effects of this agent would be of great importance. IFNAR2 is required for type I IFN-dependent signaling. Therefore, the response of IFNAR2 during HDI was evaluated during a prospective neoadjuvant clinical trial of HDI. Methods: Following diagnostic biopsy and before definitive surgery, HDI was administered as a neoadjuvant therapy for patients with stage IIIB melanoma, in the context of an IRB-approved protocol UPCI 00- 008, separately reported. Immunohistochemical analysis of IFNAR2 was performed on fixed paired biopsies of 8 patients. Paired-sample permutation tests and two-sample permutation tests were used to evaluate the findings of this study. Mean values of the percentage of IFNAR2 positive cells are presented with standard errors (SE). Results: HDI down-regulates IFNAR2 in both responders and non- responders, from 86.875 ± 5.82 (pre-treatment) to 34.375 ± 9.919 (post-treatment), p = 0.0145. However, the decrease in IFNAR2 differs between responders (25.0 ± 12.583) and non-responders (69.0 ± 3.588), p = 0.021. Conclusions: HDI down-regulates IFNAR2 expression, and may provide a biomarker relevant to HDI benefit, given differences between patients with and without response to neoadjuvant therapy. A larger clinical trial is needed to evaluate these pilot data.

No significant financial relationships to disclose.

Refinement of purothionins reveals solute particles important for lattice formation and toxicity. Part 2: structure of beta-purothionin at 1.7 A resolution

The crystal structure of beta-purothionin (beta-PT) has been determined at 1.7 A resolution. beta-PT and previously solved alpha(l)-PT belong to a family of membrane-active plant toxins homologous to crambin. (beta-PT crystallizes in the same space group as alpha(l)-PT (1422) but with the c axis 3 A longer than (alpha(l)-PT. The unit-cell dimensions of beta-PT crystals are a = b = 53.94 and c = 72.75 A. Two data sets were collected on a multiwire area detector, each with R(sym) around 6.0%, and were merged to get a single data set at 1.7 A, (R(merge) = 9.6%). The X-ray structure of alpha(l)-PT was used to build a starting model for beta-PT. The beta-PT model was refined using the program PROLSQ from 10 to 1.7 A resolution to an R-factor of 19.8% with very good geometry. The final structure contains 439 atoms including 337 protein atoms, 77 waters, two acetates, two glycerols and one phosphate. The high-resolution structure of the beta-PT agreed well with that of the lower resolution alpha(l)-PT structure only after the latter was extensively rerefined. Both refinements revealed phosphate and glycerol molecules which are important in lattice formation. The binding of phosphate and glycerol molecules to purothionins (PT) was confirmed by NMR and was implicated in the biological activity of toxins. Modeling of phospholipid binding to PT based on glycerol and phosphate-binding site could shed light on the lytic toxicity of this protein-toxin family. Although the structures of (alpha(l)-PT and beta-PT preserve the overall fold of crambin, they exhibit key differences that are directly relevant to the toxicity of thionins.

Proposal for molecular mechanism of thionins deduced from physico-chemical studies of plant toxins

We propose a molecular model for phospholipid membrane lysis by the ubiquitous plant toxins called thionins. Membrane lysis constitutes the first major effect exerted by these toxins that initiates a cascade of cytoplasmic events leading to cell death. X-ray crystallography, solution nuclear magnetic resonance (NMR) studies, small angle X-ray scattering and fluorescence spectroscopy provide evidence for the mechanism of membrane lysis. In the crystal structures of two thionins in the family, alpha(1)- and beta-purothionins (MW: approximately 4.8 kDa), a phosphate ion and a glycerol molecule are modeled bound to the protein. (31)P NMR experiments on the desalted toxins confirm phosphate-ion binding in solution. Evidence also comes from phospholipid partition experiments with radiolabeled toxins and with fluorescent phospholipids. This data permit a model of the phospholipid-protein complex to be built. Further, NMR experiments, one-dimensional (1D)- and two-dimensional (2D)-total correlation spectroscopy (TOCSY), carried out on the model compounds glycerol-3-phosphate (G3P) and short chain phospholipids, supported the predicted mode of phospholipid binding. The toxins' high positive charge, which renders them extremely soluble (>300 mg/mL), and the phospholipid-binding specificity suggest the toxin-membrane interaction is mediated by binding to patches of negatively charged phospholipids [phosphatidic acid (PA) or phosphatidyl serine (PS)] and their subsequent withdrawal. The formation of proteolipid complexes causes solubilization of the membrane and its lysis. The model suggests that the oligomerization may play a role in toxin's activation process and provides insight into the structural principles of protein-membrane interactions.

Antiplatelet agents in atherothrombotic diseases

Atherothrombotic disease places a huge financial and social burden on the nation, and antiplatelet therapy is important in preventing this. Aspirin is most widely used but newer compounds are valuable, especially on top of standard therapy in patients with unstable angina or non-ST segment elevation myocardial infarction. This article reviews the changing use of antiplatelets.

Antiplatelet drugs in cardiovascular diseases

Platelets play a key role in the pathogenesis of atherothrombotic conditions, e.g. acute coronary syndromes, cerebrovascular and peripheral vascular events. Antiplatelet agents interfere with platelet activation and aggregation and, as such, would be expected to modify the natural history of cardiovascular disease. In this review we explore the evidence to support the use of such drugs, singly or in combination, in a variety of situations characterised by thrombosis and summarise some of the concerns inherent in their use.

Pulmonary fibrosis in a tool sharpener

A36-year-old man who had been employed as a tool grinder and sharpener for the last 18 years presented with dyspnoea, dry cough and left-sided pleuritic chest pain of 6 weeks duration. He recalled an episode of a very small amount of haemoptosis. He described his work environment as dusty and under ventilated. His work involved sharpening tungsten carbide parts.

Characterization of AnRP-mediated negative regulation of the xylanase gene, cgxA, from Chaetomium gracile in Aspergillus nidulans

AIM

In vivo regulatory features of AnRP, a repressor for the cgxA gene, were characterized.

METHODS AND RESULTS

Titration of AnRP by introducing multiple copies of its specific binding sequence 'TTGACAAAT' into an Aspergillus nidulans strain containing the Chaetomium gracile cgxA gene enhanced the cgxA gene expression. AnRP functions independently of and cooperatively with CreA to modulate the cgxA gene expression.

CONCLUSIONS

AnRP is a CreA-independent negative regulatory factor controlling the cgxA expression.

SIGNIFICANCE AND THE IMPACT OF THE STUDY

Xylanases of filamentous fungi have received increased interest because of their potential biotechnological applications. Elucidation of the factors involved in the regulation of the xylanolytic genes in fungi will help to increase levels of xylanase production.

High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801

PURPOSE

Vaccine alternatives to high-dose interferon alfa-2b therapy (HDI), the current standard adjuvant therapy for high-risk melanoma, are of interest because of toxicity associated with HDI. The GM2 ganglioside is a well-defined melanoma antigen, and anti-GM2 antibodies have been associated with improved prognosis. We conducted a prospective, randomized, intergroup trial to evaluate the efficacy of HDI for 1 year versus vaccination with GM2 conjugated to keyhole limpet hemocyanin and administered with QS-21 (GMK) for 96 weeks (weekly x 4 then every 12 weeks x 8).

PATIENTS AND METHODS

Eligible patients had resected stage IIB/III melanoma. Patients were stratified by sex and number of positive nodes. Primary end points were relapse-free survival (RFS) and overall survival (OS).

RESULTS

Eight hundred eighty patients were randomized (440 per treatment group); 774 patients were eligible for efficacy analysis. The trial was closed after interim analysis indicated inferiority of GMK compared with HDI. For eligible patients, HDI provided a statistically significant RFS benefit (hazard ratio [HR] = 1.47, P = .0015) and OS benefit (HR = 1.52, P = .009) for GMK versus HDI. Similar benefit was observed in the intent-to-treat analysis (RFS HR = 1.49; OS HR = 1.38). HDI was associated with a treatment benefit in all subsets of patients with zero to > or = four positive nodes, but the greatest benefit was observed in the node-negative subset (RFS HR = 2.07; OS HR = 2.71 [eligible population]). Antibody responses to GM2 (ie, titers > or = 1:80) at days 29, 85, 365, and 720 were associated with a trend toward improved RFS and OS (P2 = .068 at day 29).

CONCLUSION

This trial demonstrated a significant treatment benefit of HDI versus GMK in terms of RFS and OS in melanoma patients at high risk of recurrence.

Comparison of long-term immunosuppression for limb transplantation using cyclosporine, tacrolimus, and mycophenolate mofetil: implications for clinical composite tissue transplantation

This study compared the efficacy of long-term intermittent immunosuppression in preventing the rejection of a limb transplant across the strongest histocompatibility barrier in ACI --> Lewis rats using the conventional immunosuppressive agent cyclosporine-A and the newer immunosuppressive agents FK-506 (tacrolimus) and RS-61443 (mycophenolate mofetil). The recipient animals were immunosuppressed daily for 14 days postoperatively, followed by long-term intermittent, twice-weekly immunosuppression using cyclosporine 25 mg/kg, RS-61443 30 mg/kg, or FK-506 2 mg/kg. All three immunosuppressive agents were able to prolong the rejection of the skin component of a limb transplant compared with nonimmunosuppressed controls. Eight of nine animals receiving cyclosporine immunosuppression showed signs of rejection of the skin component of the limb transplant while continuing to receive long-term immunosuppression and had a mean rejection time of 61.6 days. Seven of 10 animals immunosuppressed with RS-61443 also showed signs of rejection while still receiving immunosuppression, with a mean rejection time of 43.6 days. Nine of 10 animals receiving FK-506 immunosuppression showed no signs of skin rejection, but died of bacterial pneumonia between 273 and 334 days after transplantation, with a mean rejection time of 296.1 days. There was no statistically significant difference between intermittent immunosuppression with cyclosporine and RS-61443, but FK-506 was significantly superior to both cyclosporine and RS-61443. The implication of this study is that FK-506, but not cyclosporine or RS-61443, is probably the only single immunosuppressive agent capable of preventing rejection of the skin component of a composite tissue transplant. Combination immunosuppression with FK-506 and RS-61443, therefore, may be required to allow composite tissue transplantation to become a predictable clinical reality in the future.

Growth hormone secretion in children and adolescents at high risk for major depressive disorder

BACKGROUND

Decreased growth hormone (GH) response to pharmacologic stimulation has been found in children and adolescents during an episode of major depressive disorder and after recovery. In this study, we sought to determine whether GH secretion is similarly altered in children and adolescents who had never experienced depression but were at high risk of developing depression.

METHODS

Subjects were 8 through 16 years of age and selected for high- and low-risk status according to familial loading for mood disorders. Sixty-four high-risk and 55 low-risk healthy subjects participated in the study, which assessed the following GH measures: (1) GH before growth hormone-releasing hormone (GHRH) infusion, every 15 minutes for 30 minutes; (2) GH response after intravenous infusion of GHRH (0.1 microg/kg), every 15 minutes for 90 minutes; and (3) nocturnal GH every 20 minutes from 9 PM until morning awakening.

RESULTS

After stimulation with GHRH, the high-risk subjects secreted significantly less GH compared with the low-risk healthy controls (effect sizes for mean and peak GH, 0.52 [P =.007] and 0.40 [P =.04], respectively). In contrast, there were no between-group differences in the pre-GHRH and nocturnal GH secretion levels. Exposure to recent stressors was not associated with GH secretion.

CONCLUSIONS

Taken together with previous evidence of decreased GH after GHRH infusion in acutely depressed and recovered children, these results indicate that the decreased GH response found in high-risk subjects may represent a trait marker for depression in children and adolescents.

Predictors of first onset and recurrence of major depression in young women during the 5 years following high school graduation

Although most depressive episodes in adulthood are recurrences of the disorder, lifetime history of major depression (MD) is often neglected in predictive models. On the basis of research and theory suggesting differential prediction of MD across the course of the disorder, the authors explored whether factors that predict a first MD onset would not predict MD recurrence. Predictors of MD were examined longitudinally in a sample of 128 young women followed for 5 years. Controlling for lifetime MD history, 5-year MD was predicted by the presence before study entry of 3 variables: having witnessed family violence before age 16, having a parent with a psychiatric disorder, and having a nonmood Axis I disorder. During the follow-up period, chronic and episodic stress predicted MD. Prior lifetime MD interacted with both chronic stress and parental psychopathology to predict MD, such that first onsets, but not recurrences, were predicted by these risk variables.

High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190

PURPOSE

Pivotal trial E1684 of adjuvant high-dose interferon alfa-2b (IFNalpha2b) therapy in high-risk melanoma patients demonstrated a significant relapse-free and overall survival (RFS and OS) benefit compared with observation (Obs).

PATIENTS AND METHODS

A prospective, randomized, three-arm, intergroup trial evaluated the efficacy of high-dose IFNalpha2b (HDI) for 1 year and low-dose IFNalpha2b (LDI) for 2 years versus Obs in high-risk (stage IIB and III) melanoma with RFS and OS end points.

RESULTS

A total of 642 patients were enrolled (608 patients eligible), of whom a majority (75%) had nodal metastasis (50% had nodal recurrence). Unlike E1684, E1690 allowed entry of patients with T4 (> 4 mm) deep primary tumors, regardless of nodal dissection, and 25% of the patients entered onto this trial had deep primary tumors (compared with 11% in E1684). At 52 months' median follow-up, HDI demonstrated an RFS benefit exceeding that of LDI compared with Obs. The 5-year estimated RFS rates for the HDI, LDI, and Obs arms were 44%, 40%, and 35%, respectively. The hazards ratio for the intent-to-treat analysis of HDI versus Obs was 1.28 (P(2) =.05); for LDI versus Obs, it was 1.19 (P(2) =.17). By Cox analysis, the impact of HDI on RFS achieved significance (P(2) =.03). The RFS benefit was equivalent for node-negative and node-positive patients. Neither HDI nor LDI has demonstrated an OS benefit compared with Obs at this time. A major improvement in the median OS of patients in the E1690 Obs arm was noted in comparison with E1684 (6 years v 2.8 years). An analysis of salvage therapy for patients who relapsed on E1690 demonstrated that a significantly larger proportion of patients in the Obs arm received IFNalpha-containing salvage therapy compared with the HDI arm; this therapy was unavailable to patients during E1684, and patients with undissected regional nodes were not included in E1684. This study did not specify therapy at recurrence. Analysis of treatments received at recurrence demonstrated significantly more frequent use of IFNalpha2b at relapse from Obs than from HDI, which may have confounded interpretation of the survival benefit of assigned treatments in E1690.

CONCLUSION

The results of the intergroup E1690 trial demonstrate an RFS benefit of IFNalpha2b that is dose-dependent and significant for HDI by Cox multivariable analysis.

Contribution of development to buspirone effects on REM sleep: a preliminary report

In order to assess whether development influences the regulation of rapid eye movement (REM) sleep by serotonergic (5-HT) systems, the REM sleep responses to the partial 5-HT(1A) agonist, buspirone, were assessed in 14 normal adolescent and adult volunteers. Subjects were studied on three separate sessions for three consecutive nights. On the second night of each session, subjects received placebo or one of two doses of buspirone (0.14 mg/kg and 0.28 mg/kg, orally). Night 3 was considered the "recovery" night. In adolescents, both doses of buspirone significantly delayed REM latency. In contrast, low-dose buspirone had no effect on REM latency in the adults, and there was only a tendency for prolongation of REM latency with the higher dose. Other measures of REM sleep on nights 2 and 3 were comparable between the two groups. These preliminary results suggest that post-synaptic 5-HT(1A) acceptor-coupled REM sleep responses, particularly REM latency, may be relatively greater in youngsters than in adults, possibly due to reduced presynaptic input. The findings are discussed in relation to the age-dependent expression of REM sleep changes associated with depression.

Relationship between depression and substance use disorders in adolescent women during the transition to adulthood

OBJECTIVES

To examine the continuity of substance use disorder (SUD) in adolescent women during the transition to adulthood and to assess psychosocial functioning associated with SUD. Furthermore, to examine concurrent and longitudinal relationships' between major depressive disorder (MDD) and SUD during this developmental transition.

METHOD

One hundred fifty-five women, aged 17 to 19 years, were recruited from 3 high schools and were followed annually for 5 years. Comprehensive diagnostic and psychosocial assessments were performed with standardized instruments. The primary outcome measures included MDD and SUD during follow-up in those with and without a prior history of MDD or SUD, and psychosocial functioning associated with SUD.

RESULTS

The 5-year incidence of SUD was 9.6% and, by the end of follow-up, 18.7% had a lifetime episode. Prior SUD significantly increased the risk for SUD diagnosis during the study. Co-occurrence of MDD and SUD was high during adolescent and early adult years, with episodes of both disorders occurring in close temporal proximity. SUD also predicted MDD over time, but the reverse was not true. After controlling for the effects of MDD on social adjustment, SUD was associated with significant impairment in school functioning.

CONCLUSIONS

These results suggest that the risk for new onset and recurrence of SUD is high during the developmental transition to adulthood. SUD during this developmental period is associated with significant school-related problems. The findings also suggest that SUD and MDD frequently co-occur during the post-high school transition in women. Given the significant psychosocial dysfunction associated with these illnesses, early detection of these problems and effective intervention are crucial.

Age-related effects of scopolamine on REM sleep regulation in normal control subjects: relationship to sleep abnormalities in depression

In order to assess the influence of development on the regulation of rapid eye movement (REM) sleep by cholinergic systems, the REM sleep responses to scopolamine were assessed in five normal adolescent and seven adult control subjects in this preliminary investigation. Subjects were studied on two separate occasions for three consecutive nights. Subjects received placebo or scopolamine (1.5 ug/kg, i.m.) on night 2; night 3 was considered the "recovery" night. As expected, scopolamine delayed REM latency and suppressed REM sleep on night 2 in both the adolescents and adults. Subtle developmental differences occurred, with scopolamine having a tendency to suppress REM sleep less effectively in younger subjects. On night 3, REM latency was shortened and REM sleep was increased to comparable extent in both the adolescents and adults. The comparable REM sleep responses to scopolamine between normal adolescents and adults, particularly on night 3, are discussed in relation to the age-related expression of REM sleep abnormalities in depression.

REM sleep in depression is influenced by ethnicity

The influence of ethnicity on the manifestation of EEG sleep changes in depression was studied in 95 patients (21 African-Americans [AA], 17 Asians [AS], 37 Caucasians [C] and 20 Hispanics [H]) with unipolar major depression. Subjects were studied twice for 2 consecutive nights. On the second night of each 2-night session, placebo or scopolamine (1.5 microg/kg, IM, at 23.00 h) was administered. On the baseline (placebo) night, sleep architecture, sleep continuity and rapid eye movement (REM) sleep variables were generally comparable among the groups. However, REM sleep was less in AA and AS subjects than in C and H subjects. Furthermore, the distribution of REM sleep over the course of the night in AA and AS subjects differed significantly from that in the C and H groups. Although scopolamine significantly affected sleep continuity and REM sleep measures, no significant differential effects of scopolamine were observed. Because many antidepressants suppress REM sleep, the differences in baseline REM sleep observed might be related to the greater sensitivity of some ethnic-minority depressed patients to pharmacotherapy.

Relationship between ethnicity and sleep patterns in normal controls: implications for psychopathology and treatment

The purpose of the study was to examine ethnic influences on sleep regulation. Seventy-three normal volunteers from four ethnic groups (17 African-Americans, 10 Asians, 30 Caucasians and 16 Hispanics) were studied for two consecutive nights with sleep polysomnography recordings in the laboratory. The subjects were in good physical and psychological health, and were asymptomatic with respect to sleep/wake complaints or sleep disorders. With the exception of minor differences, sleep continuity, sleep architecture and rapid eye movement (REM) sleep patterns were comparable among the four groups. African-Americans had evidence of more stages 1 and 2 and diminished stage 4 sleep, whereas the Hispanics had higher REM density. These preliminary findings suggest that sleep patterns are remarkably similar across cultures. There are, however, important cross-ethnic differences, specifically in the depth of sleep and in phasic REM measures. Because sleep disturbances are common symptoms of emotional disorders and since many psychoactive agents affect sleep, cross-ethnic differences in sleep patterns may have potential implications for the treatment and prevention of psychiatric disorders.

Factors associated with the development of substance use disorder in depressed adolescents

OBJECTIVE

To document rates of substance use disorders (SUD) in adolescents with unipolar major depressive disorder and to examine demographic, clinical, and biological factors associated with the development of SUD.

METHOD

Twenty-eight adolescents with unipolar major depression and no SUD history and 35 group-matched normal controls who participated in a cross-sectional sleep polysomnography and neuroendocrine study were reassessed clinically 7 years later.

RESULTS

The risk for SUD was high in both groups (34.6% in the depressed group and 24.2% in the controls). Depressed adolescents had earlier onset of SUD than controls. Depressed adolescents who developed SUD had more significant psychosocial impairment than depressed adolescents who did not develop SUD. More anxiety traits and elevated cortisol secretion near sleep onset were associated with SUD in depressed teenagers, whereas less emotional responsiveness to exciting stimuli and higher density of eye movements during REM sleep were related to depression without SUD.

CONCLUSIONS

Depressed adolescents who have anxiety traits and whose hypothalamic-pituitary-adrenal axis is active when the system is normally quiescent may be at risk for developing SUD. Co-occurrence of depression and SUD is associated with serious psychosocial morbidity. Identification of risk factors for SUD in depressed teenagers may be helpful in developing more effective treatment and prevention programs.

Prenatal stress is associated with depression-related electroencephalographic sleep changes in adult male rats: a preliminary report

1. Prenatal stress in rats has been shown to produce long-term behavioral, neuroendocrine and neurochemical changes. These changes may model aspects of human depressive illness. 2. In this pilot investigation, adult male offspring exposed to stress in utero and non-stressed controls were studied using 24-hour electroencephalographic sleep recordings. 3. Prenatally stressed animals demonstrated reduced latency to the onset of rapid eye movement (REM) sleep, prolongation of the first REM episode, and diminished slow-wave sleep. 4. Although preliminary, the observed changes parallel those seen in studies of human depression. These data further support the face validity of the prenatal stress model as a potential tool for future studies on the pathophysiology of depressive disorder.