Anti-TNF therapy is not associated with an increased risk of post-colectomy complications, a population-based study

AIM

Previous studies have raised concerns that the use of anti-tumour necrosis factor (anti-TNF) therapy in patients with ulcerative colitis (UC) undergoing surgery may increase the risk of postoperative complications. We have taken a population-based approach to investigate whether there is an association between anti-TNF therapy and postoperative complications in UC patients undergoing subtotal colectomy.

METHOD

Hospital Episode Statistics (HES) data and procedural coding were used to identify all patients in England between April 2006 and March 2015 undergoing subtotal colectomy for UC. Patients were grouped into those who received anti-TNF therapy within 12 or 4 weeks of surgery and those who did not. The incidence of postoperative complications was evaluated by HES coding and compared between groups.

RESULTS

In all, 6225 UC patients underwent subtotal colectomy. 753 patients received anti-TNF therapy within 12 weeks prior to surgery (418 within 4 weeks). There was no difference in postoperative complications between groups although groups were not comparable for age and comorbidities. Logistic regression with complications as the outcome variable did not show any significant association between anti-TNF therapy and complications. Colectomy performed during an unplanned admission (vs planned admission) and smoking were associated with complications.

CONCLUSION

This large population-based study does not demonstrate any association between preoperative anti-TNF therapy and postoperative complications in UC patients undergoing subtotal colectomy. The only variables associated with complications were colectomy performed during an unplanned admission and smoking.

Viral Sepsis

Viruses are the smallest infective agents currently known to affect humans and animals. The virus has a centrally situated nucleic acid, which is encased within a capsid consisting of a protein core. Viruses are obligatory intracellular microorganisms that live inside cells, using components of the nucleic acid and protein generating system of the host to replicate and trigger cell destruction leading to diseases. Alternatively, the host’s defense mechanisms lead to cell destruction in an attempt to clear cells infected by the viruses. The nucleic acid is RNA or DNA, which may be single-stranded or double-stranded [1]. The pathophysiology of viral infections may be attributed to the degeneration and cellular necrosis of the infected cells, leading to local and systemic inflammatory responses. The body’s defense mechanisms include phagocytosis, humoral and cell-mediated responses and the production of interferons [2]. Interferons prevent the local spread of viruses, whereas antibodies prevent viremia, ensure long-term immunity and sensitize infected cells to be destroyed by T-cells and macrophages [3, 4]. Cell-mediated immunity leads to an increase in cytotoxic cells that then release lymphokines, including interferon.

Abstract P4-01-07: Evaluation of FLT PET-CT as an imaging biomarker of proliferation in primary breast cancer

Background

[18F]flurothymidine (FLT) is proposed as an positron emission tomography (PET) imaging biomarker of proliferation for breast cancer. The aim of this prospective study was to assess the feasibility of FLT PET-CT as a technique for predicting response to neoadjuvant chemotherapy (NAC) in operable breast cancer and to compare baseline FLT to Ki-67.

Methods

20 patients with primary breast cancer were recruited into this study and 19 received NAC with FEC (n = 6) or FEC-T (n = 13). A baseline FLT PET-CT scan was performed and repeated before the second cycle of chemotherapy. Expression of Ki-67 in the diagnostic biopsy was quantified after being stained by Dako Ki67 MIB-1 antibody and% positive cells scored. From the FLT PET-CT scans standardized uptake value maximum (SUVmax) were calculated.

Results

All 20 patients completed the baseline scan and 17 completed the second scan. Baseline Ki-67 results were available for 19 patients. Median age was 52 years (range 32 to 67), 12 patients were ER/ PR +ve, 6 Her-2 +ve and 6 triple negative.

Mean baseline SUVmax was 7.3 (range 2.92 to 13.87) and 4.62 (range 1.79 to 14.15) post 1 cycle of NAC (range 7 to 14 days), representing a drop of 2.68 (36.3%). Mean baseline Ki-67 was 32.23 (range 2.3 to 68.4). Pearsons correlation showed a significant correlation between pre-chemotherapy Ki-67 and SUVmax of 0.604 (p = 0.006).

7 out of 17 (41%) patients achieved near pCR or pCR (pathological responders) after NAC and all of these had a reduction in SUVmax with a mean percentage value of –36.5% (range -0.5% to -62.5%). 10 out of 17 (59%) patients were non-responders and 8 of these had a reduction in SUVmax with a mean percentage value of -36.2% (range 11.3% to -70.7).

Conclusions

Baseline SUVmax measurements of FLT PET-CT were significantly related to Ki-67 suggesting that it is a proliferation biomarker. However, in this series neither the baseline value or the change in SUVmax after one cycle of NAC were able to predict response as most patients had a sizeable SUVmax reduction.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-07.

Potential femoral head osteonecrosis model induced by high-intensity focused ultrasound

Osteonecrosis of the femoral head is a common disease that can result in complex hip replacement. To evaluate potential treatments, a model that consistently creates osteonecrosis is needed. We studied and demonstrated the possibility of developing an osteonecrosis model using high-intensity focused ultrasound (HIFU) on canine femora in vitro. To achieve these goals, the temperature in the medullary cavity of the femoral head was measured. A phenomenological model was developed to fit the measured temperature variations with the HIFU parameters for similar HIFU experiments on femoral heads. The average temperature discrepancy between model and measured values was less than 0.83°C. Histology confirmed that the temperature in the medullary cavity can be elevated to a level at which an acute thermal injury is created. HIFU has the potential to be used in a non-invasive model of osteonecrosis.

Allelic imbalance in Drosophila hybrid heads: exons, isoforms, and evolution

Unraveling how regulatory divergence contributes to species differences and adaptation requires identifying functional variants from among millions of genetic differences. Analysis of allelic imbalance (AI) reveals functional genetic differences in cis regulation and has demonstrated differences in cis regulation within and between species. Regulatory mechanisms are often highly conserved, yet differences between species in gene expression are extensive. What evolutionary forces explain widespread divergence in cis regulation? AI was assessed in Drosophila melanogaster-Drosophila simulans hybrid female heads using RNA-seq technology. Mapping bias was virtually eliminated by using genotype-specific references. Allele representation in DNA sequencing was used as a prior in a novel Bayesian model for the estimation of AI in RNA. Cis regulatory divergence was common in the organs and tissues of the head with 41% of genes analyzed showing significant AI. Using existing population genomic data, the relationship between AI and patterns of sequence evolution was examined. Evidence of positive selection was found in 30% of cis regulatory divergent genes. Genes involved in defense, RNAi/RISC complex genes, and those that are sex regulated are enriched among adaptively evolving cis regulatory divergent genes. For genes in these groups, adaptive evolution may play a role in regulatory divergence between species. However, there is no evidence that adaptive evolution drives most of the cis regulatory divergence that is observed. The majority of genes showed patterns consistent with stabilizing selection and neutral evolutionary processes.

Size-fractionated heparins have differential effects on human neutrophil function in vitro

BACKGROUND AND PURPOSE

Heparin is known to possess a range of activities, other than effects on blood coagulation, many of which are anti-inflammatory. Effects with potential anti-inflammatory applications include the inhibition of elastase release from neutrophils, as well as the adhesion of these cells to vascular endothelium. In the present study we aimed to investigate whether fractionation of heparin may yield molecules with enhanced or specific effects on human neutrophil function.

EXPERIMENTAL APPROACH

Fractions of defined molecular size were obtained from heparin by different methods and assessed for their effects on elastase release induced by formyl Met-Leu-Phe (fMLP), from neutrophils, in some cases following the priming of these cells with tumour necrosis factor-alpha (TNF-alpha). Effects of the fractions on neutrophil adhesion to interleukin-1beta (IL-beta)-stimulated human umbilical vein endothelial cells (HUVECs) were also examined.

KEY RESULTS

Elastase release was inhibited by very low molecular weight fractions of heparin, with an apparent minimum chain length of 10 saccharides required for full effect. In contrast, neutrophil-endothelial adhesion was unaffected by these fractionated heparins, suggesting that certain non-anticoagulant actions of heparin may be lost by such an approach.

CONCLUSIONS AND IMPLICATIONS

These data suggest that an optimum chain length of heparin possibly exists for certain non-anticoagulant actions of heparin, which may prove to be useful in the design of novel drugs with specific anti-inflammatory actions.

The myosin ATPase inhibitor 2,3-butanedione-2-monoxime (BDM) inhibits tip growth and cytokinesis in the fission yeast, Schizosaccharomyces pombe

The growth of fission yeast cultures was reversibly inhibited by exposure to the myosin-ATPase inhibitor 2,3-butanedione-2-monoxime (BDM). Wild-type cells treated with 20 mM BDM for approximately two generation times were smaller than untreated controls and had a septation index approximately twice that seen in the absence of the inhibitor. The organization of actin at the cell poles was somewhat disorganized in the presence of BDM; however, cells formed a cytokinetic actin ring. When nitrogen-starved stationary-phase cells were reinoculated into fresh medium in the presence of BDM, the time taken to repolarize the actin cytoskeleton and to resume the characteristic vegetative cell shape before initiation of the first cell division were both substantially delayed. BDM significantly inhibited the increase in cell length of cdc25.22 cells arrested for cell cycle progress by incubation at the restrictive temperature and substantially delayed the initiation of both mitosis and cytokinesis in arrested cdc25.22 cells after release of the temperature block. These results suggest that tip growth and cytokinesis--processes in fission yeast that involve the actin cytoskeleton--also require myosin activity.

Changes in myocardial protein expression in pacing-induced canine heart failure

Canine rapid ventricular pacing produces a low output cardiomyopathic state which is similar to dilated cardiomyopathy. In this study dogs were paced at 245 beats per minute (bpm) for 3-4 weeks until signs of heart failure were apparent. Unpaced dogs were used as controls. A previous study identified myocardial protein changes in the pH region 4-7 following ventricular pacing by using two-dimensional electrophoresis (2-DE) (Heinke et al., Electrophoresis 1998 19, 2021-2030). Many of these proteins were associated with mitochondria, energy metabolism within the cardiomyocyte, the cytoskeleton and calcium cycling. The present study aimed to examine the proteins migrating in the more basic region of the 2-DE pattern using immobilised pH gradient 3-10 strips to separate myocardial proteins. The expression of 31 proteins was altered in the paced myocardium: 21 were decreased and 10 increased. Following the identification of 23 of these spots by either amino acid compositional analysis or peptide mass fingerprinting or a combination of both, we confirm that many of the proteins whose expression is altered following ventricular pacing are associated with the mitochondria and energy production within the cardiomyocyte, including creatine kinase M, triosephosphate isomerase, phosphoglycerate mutase, cytochrome c oxidase, cytochrome b5, hydroxymethyl glutaryl CoA synthase, myoglobin, and 3,2-trans-enoyl-CoA transferase. Additionally, the cytoskeletal protein actin was increased in the paced hearts. These results strongly support the notion that energy production is impaired and mitochondrial dysfunction is involved in the development of heart failure in the paced dog.

Ultrasound image texture analysis for characterizing intramuscular fat content of live beef cattle

The primary factors in determining beef quality grades are the amount and distribution of intramuscular fat percentage (IMFAT). Texture analysis was applied to ultrasound B-mode images from ribeye muscle of live beef cattle to predict its IMFAT. We used wavelet transform (WT) for multiresolutional texture analysis and second-order statistics using a gray-level co-occurrence matrix (GLCM) technique. Sets of WT- and GLCM-based texture features were calculated from ultrasonic images from 207 animals and linear regression methods were used for IMFAT prediction. WT-based features included energy ratios, central moments of wavelet-decomposed subimages and wavelet edge density. The regression model using WT features provided a root mean square error (RMSE) of 1.44 for prediction of IMFAT using validation images, while that of GLCM features provided an RMSE of 1.90. The prediction models using the WT features showed potential for objective quality evaluation in the live animals.

Antibodies to heat-shock protein 27 are associated with improved survival in patients with breast cancer

The overexpression of the heat-shock proteins hsp90, hsp70 and hsp27 in human mammary carcinomas has previously been shown to correlate with reduced overall survival. Moreover, antibodies to hsp90 were detectable in the serum of a large proportion of breast cancer patients but they were not found in normal controls. High antibody levels also correlated with reduced survival. Here, we show that antibodies to hsp27 were also detectable in the sera from breast cancer patients but not from normal controls, whereas antibodies to hsp70 were detectable in approximately one-third of both groups. The presence of antibodies to hsp27 was correlated with an improved rather than a reduced survival, particularly beyond the first 5 years. Hence, the overexpression of hsps in breast cancer cells does not provoke a generalized immune response to all the hsps. Moreover, the presence of antibodies to different hsps has distinct associations with survival. These effects are discussed in terms of the mechanisms that provoke an immune response to the hsps and the protective/non-protective effects of such a response.

Organic anion transporting polypeptide mediates organic anion/HCO3- exchange

Organic anion transporting polypeptide (oatp) is an integral membrane protein cloned from rat liver that mediates Na+-independent transport of organic anions such as sulfobromophthalein and taurocholic acid. Previous studies in rat hepatocytes suggested that organic anion uptake is associated with base exchange. To better characterize the mechanism of oatp-mediated organic anion uptake, we examined transport of taurocholate in a HeLa cell line stably transfected with oatp under the regulation of a zinc-inducible promoter (Shi, X., Bai, S., Ford, A. C., Burk, R. D., Jacquemin, E., Hagenbuch, B., Meier, P. J., and Wolkoff, A. W. (1995) J. Biol. Chem. 270, 25591-25595). Whereas noninduced transfected cells showed virtually no uptake of [3H]taurocholate, taurocholate uptake by induced cells was Na+-independent and saturable (Km = 19.4 +/- 3.3 microM; Vmax = 62.2 +/- 1.4 pmol/min/mg protein; n = 3). To test whether organic anion transport is coupled to HCO3- extrusion, we compared the rates of taurocholate-dependent HCO3- efflux from alkali-loaded noninduced and induced cells. Monolayers grown on glass coverslips were loaded with the pH-sensitive dye 2', 7'-bis(carboxyethyl)-5(6)-carboxyfluorescein; intracellular pH (pHi) was measured by excitation ratio fluorometry. Noninduced and induced cells were alkalinized to an equivalent pHi ( approximately 7.7) by transient exposure to a 50 mM HCO3-, Cl--free solution. In the absence of extracellular Cl- and taurocholate, isohydric reduction of superfusate HCO3- concentration from 50 to 25 mM resulted in an insignificant change in pHi over time (dpHi/dt) in both groups. Addition of 25 microM taurocholate to the superfusate led to a rapid fall in pHi in induced (-0.037 +/- 0.011 pH units/min to pHi of 7.41 +/- 0.14) but not in noninduced (0.003 +/- 0.006 pH units/min to pHi of 7.61 +/- 0.08) cells (p < 0.03). These data indicate that oatp-mediated taurocholate transport is Na+-independent, saturable, and accompanied by HCO3- exchange. We conclude that organic anion/base exchange is an important, potentially regulatable component of oatp function.

Interleukin 6 activates heat-shock protein 90 beta gene expression

The levels of the cytokine interleukin-6 (IL-6) and the heat-shock protein hsp90 have both been reported to be elevated in patients with active systemic lupus erythematosus (SLE). We show that hsp90 protein accumulates to increased levels in both HuH7 hepatoma cells and peripheral blood mononuclear cells (PBMCs) treated with IL-6. In PBMCs this effect occurs without induction of the other hsps, paralleling the specific elevation of hsp90 in SLE. IL-6 is able to activate the hsp90 gene promoter directly; this activation can also be achieved by overexpressing either of the transcription factors NF-IL-6 or NF-IL-6 beta whose synthesis is induced by IL-6 treatment. Hence the induction of hsp90 protein accumulation by IL-6 is likely to be dependent on the enhanced activity of the hsp90 beta gene promoter produced by increased levels of NF-IL-6 and/or NF-IL-6 beta. These effects are discussed in terms of the role of hsp90 in the normal immune system and the mechanism of its activation in patients with SLE.

Over-expression of heat shock protein 70 protects neuronal cells against both thermal and ischaemic stress but with different efficiencies

Primary cultures of dorsal root ganglia (DRG) sensory neurons can be protected against subsequent severe thermal or ischaemic stress by prior exposure to a mild thermal or ischaemic insult. The degree of protection correlates with the amount of 70 kDa heat shock protein (hsp70) induced by the mild stress. We show directly that over-expression of hsp70 alone is sufficient to protect DRG neurons against thermal or ischaemic stress with a given level of hsp70 over-expression providing greater protection against thermal stress. In contrast over-expression of the 90 kDa heat shock protein (hsp90) has little or no protective effect against either stress. These results are discussed in terms of the role of individual hsps in protecting neuronal cells against different stresses.

The degree of protection provided to neuronal cells by a pre-conditioning stress correlates with the amount of heat shock protein 70 it induces and not with the similarity of the subsequent stress

A mild thermal stress protects primary cultures of dorsal root ganglion (DRG) neurons against a subsequent lethal heat stress as well as to a lesser extent against a subsequent lethal ischaemia. In contrast, a mild ischaemic stress protects DRG neurons only against a subsequent severe thermal stress and not against severe ischaemia. A greater induction of heat shock protein (hsp) synthesis was observed in these cells following mild temperature stress compared to mild ischaemia. This suggests that the protective effect observed is dependent on hsp synthesis resulting in the observed cross-protective effect and does not involve a particular pre-stress specifically protecting against a subsequent, more severe application of the same stress. Moreover, a particular level of hsp induction produces a better protective effect against lethal heat stress than against lethal ischaemia.

Clinical profile of cholera in young children--a hospital based report

Clinical profile of cholera was studied in children attending Diarrhea Training and Treatment Unit from January-December 1993. Out of a total 8714 cases of acute watery diarrhea, 64 children (0.7%) were suspected to have cholera on the basis of acute onset loose water/rice watery stools, high purge rate with or without excessive vomiting and/or severe dehydration. Stool culture was positive for cholera in 33 cases (51.6%). All the isolates were V. cholerae 01 biotype El Tor serotype Ogawa. Sixty four per cent of stool culture positive cases were below 5 years of age. The results assume importance because out of 28 children < 2 years with clinical suspicion of cholera, 11 cases (39.3%) were culture positive for V. cholerae, youngest child being 3 months old. Comparison of various parameters revealed that presence of vomiting > 4 episodes/ day (p < 0.005), frequency of stools >12/24 hours (p <0.002), rice watery stools (p < 0.01) and presence of severe dehydration (p < 0.01) were significant parameters associated with positive stool culture. Beside examination of stool sample by hanging drop method was an excellent diagnostic tool (p < 0.001) with a sensitivity of 51.5%, specificity 100% and positive predictive value of 100%. The isolates of V. cholerae were susceptible to furazolidone, cephelexin, nalidixic acid, norfloxacin and gentamicin. Our observations indicate that cholera is not uncommon in infants and young children. Like children in the older age group, acute onset diarrhea with watery/rice watery stools and high purge rate with or without excessive vomiting and/or rapid development of severe dehydration should arouse suspicion of cholera in younger children also. They should be investigated for cholera even in non-endemic areas and in the absence of cholera outbreaks.

Elevated levels of the 70 kD heat shock protein in patients with systemic lupus erythematosus are not dependent on enhanced transcription of the hsp70 gene

The level of the heat inducible hsp70 protein (hsp72) has been shown to be elevated in the peripheral blood mononuclear cells of a subset of SLE patients. We show that this increased level of hsp70 is not dependent on enhanced transcription of the hsp70 gene or elevated levels of the hsp70 mRNA, neither of which are observed in SLE patients with enhanced protein levels. This indicates that posttranscriptional processes involving either improved translatability of the hsp70 mRNA or increased protein stability are responsible for the observed increase in protein levels in these patients.

The impedance of a spherical monopolar electrode

The impedance of a monopolar electrode immersed in an environmental volume conductor consists of two parts; the impedance of the active electrode-electrolyte interface, and the resistance of the environmental conductor. Two studies were carried out to quantitate these components. First, impedance-frequency data were collected for five spherical stainless-steel electrodes (ranging from 0.473 to 1.11 cm in diameter) immersed in 0.9% saline (p = 70 omega-cm). Impedance measurements were made from 100 Hz to 100 kHz and two sets of data were obtained; one before and one after each electrode was polished with fine emery paper. At low frequency, the measured impedances were high and varied with electrode surface preparation. However, above a transition frequency, the impedances were resistive, independent of the electrode surface preparation, and equal to rho/2 pi d as predicted from the theory. This study indicates that the low frequency impedance of a monopolar electrode is dominated by the impedance of the electrode-electrolyte interface. Above a transition frequency, the resistance of the environmental conductor dominates, the value of this resistance depending on the electrode geometry and the resistivity (rho) of the environmental conductor. A second study was conducted, to examine the effect of the distance to the indifferent electrode. A frequency (100 kHz) above the transition frequency was used and impedance data were collected for various distances between the monopolar and indifferent electrodes. The measured resistance increased asymptotically as the distance between the electrodes was increased. When the indifferent electrode diameter was at least 10 times the diameter of the spherical monopolar electrode, the measured resistance was within 5% of the value predicted for an indifferent electrode at infinity.

Anti-IgG combined with rate nephelometry for measuring polyethylene glycol-precipitated circulating immune complexes

Immune complexes from serum were assayed for IgG by a simple rate-nephelometric method after extraction with polyethylene glycol that removes monomeric IgG. A 30-min preincubation of the extracted material in reaction buffer before the anti-IgG is introduced eliminates falsely increased values owing to precipitation that increased baseline light scatter in the reaction buffer. We found good parallelism in the reaction of anti-IgG with the IgG calibrator, aggregated human globulin, or endogenous immune complex. Thus IgG can be used for calibration in place of aggregated human globulin, greatly simplifying the assay. A good correlation was found between the present assay and the C1q-binding test (r = 0.83). The present assay is both sensitive and reproducible. The extraction and assay are straightforward and can be completed in a single morning after an overnight precipitation. The reagents for extraction are easily prepared and inexpensive, and the materials for assay are available in kit form. We believe this approach to be well suited for many clinical laboratories to measure circulating immune complexes.

Anti-IgG combined with rate nephelometry for measuring polyethylene glycol-precipitated circulating immune complexes

Immune complexes from serum were assayed for IgG by a simple rate-nephelometric method after extraction with polyethylene glycol that removes monomeric IgG. A 30-min preincubation of the extracted material in reaction buffer before the anti-IgG is introduced eliminates falsely increased values owing to precipitation that increased baseline light scatter in the reaction buffer. We found good parallelism in the reaction of anti-IgG with the IgG calibrator, aggregated human globulin, or endogenous immune complex. Thus IgG can be used for calibration in place of aggregated human globulin, greatly simplifying the assay. A good correlation was found between the present assay and the C1q-binding test (r = 0.83). The present assay is both sensitive and reproducible. The extraction and assay are straightforward and can be completed in a single morning after an overnight precipitation. The reagents for extraction are easily prepared and inexpensive, and the materials for assay are available in kit form. We believe this approach to be well suited for many clinical laboratories to measure circulating immune complexes.

Glandular kallikrein in plasma and urine: evaluation of a direct RIA for its determination

To determine whether there is glandular kallikrein in plasma, untreated as well as acetone-treated and heated-acidified rat plasmas together with rabbit anti-rat urinary kallikrein were used in counterimmunoelectrophoresis. Precipitation bands were observed with untreated and acetone-treated plasma, suggesting that glandular kallikrein is present in plasma. This enzyme, however, cannot be quantified in the untreated plasma by a new direct RIA since kallikrein inhibitors present in plasma appear to interfere with this assay. Destroying the inhibitors by acetone treatment or by heat and acidification of the plasma partially solves this problem. In the second part of the study, this RIA as well as a kininogenase and an esterase assay were used to measure urinary kallikrein in DOCA-salt treated rats and in control rats. There is a significant correlation between urinary kallikrein measured by the direct RIA and by a kininogenase method (r = 0.75, p less than 0.001) in both DOCA-salt treated and in the control rats. Although the results obtained by the direct RIA and an esterase method significantly correlate in the control rats (r = -0.048, p greater than 0.1). This suggests that part of the urinary esterase activity in the Doca-salt rats is due to urinary enzymes other than kallikrein and that the esterase assay is not reliable for the determination of urinary kallikrein in pathological situations. However, the direct RIA and the kininogenase assay are suitable for this purpose.