ITIH5, a novel member of the inter-alpha-trypsin inhibitor heavy chain family is downregulated in breast cancer

The inter-alpha-trypsin inhibitor (ITI) family constitutes a group of proteins built up from one light chain and a variable set of heavy chains. Originally identified as plasma protease inhibitors, recent data indicate that ITI plays a role in extracellular matrix (ECM) stabilization and in prevention of tumor metastasis. Here we describe cloning as well as phylogenetic and expression analysis of a novel member of the heavy chain gene family, ITIH5. ITIH5 contains the two domains conserved in all known ITIHs, the vault protein inter-alpha-trypsin (VIT) domain and a von Willebrand type A (vWA) domain. However, ITIH5 diverged early from a common ancestor of the other subfamilies. We found strong downregulation of ITIH5 expression in breast tumors by real-time PCR and RNA in situ hybridization. While normal breast epithelial cells clearly express ITIH5, expression is consistantly lost or strongly downregulated in invasive ductal carcinoma. ITIH5 mRNA was neither detectable in cancerous nor benign breast cell lines. We propose that loss of ITIH5 expression may be involved in breast cancer development.     

Estimation of ocular perfusion: a practical oriented comparison of different methods

BACKGROUND: Ocular haemodynamics play a prominent part in many ocular diseases. This leads to the need to determine ocular perfusion. Several studies reveal advantages of colour Doppler imaging (CDI) in ophthalmologic diagnostics. Little is known about correlation of CDI results with other methods. PATIENTS AND METHODS: N = 56 eyes were examined with CDI, laser Doppler flowmetry (LDF) and Langham-OBF (LOBF). Correlations between the methods were identified by the Spearman correlation coefficient (R). RESULTS: LDF correlated with time average maximum (TAMx) and mean (TAMn) velocity assessed by CDI in the long posterior ciliary artery (TAMx: R = 0.466, p = 0.038, n = 20; TAMn: R = 0.462; p = 0.040, n = 20), but not in the short posterior ciliary artery. LOBF correlated with pulsatility index (PI) and resistive index (RI) of CDI in short (PI: R = 0.514, p = 0.002, n = 35; RI: R = 0.438, p = 0.008, n = 35) and long posterior ciliary arteries (PI: R = 0.436, p = 0.009, n = 35; RI: R = 0.506, p = 0.002, n = 35). DISCUSSION: Methods strengthen each other by partial correlation. CDI allows a more detailed insight into ocular perfusion than the other methods.     

Vertigo caused by a nasopharyngeal carcinoma

A case of a 63 year-old woman with acute vertigo, hearing loss and tinnitus caused by a nasopharyngeal carcinoma is reported. Despite a long-standing unilateral Eustachian tube dysfunction, only the occurrence of vertigo attacks lead to the diagnosis in this patient. Inner ear-related symptoms are rare in nasopharyngeal carcinoma and the disease is uncommon in Europe. Skull base tumors are an important differential diagnosis of labyrinth dysfunction that can be detected by MRI. A complete diagnostic work-up is necessary in patients with unilateral tube dysfunction, to allow early detection of this disorder.     

Effects of chronic low-dose ultraviolet B radiation on DNA damage and repair in mouse skin.

Chronic exposure to sunlight causes skin cancer in humans, yet little is known about how habitual exposure to low doses of ultraviolet B radiation (UVB) affects DNA damage in the skin. We treated Skh-1 hairless mice with daily doses of suberythemal UVB for 40 days and analyzed the amount and distribution of DNA photodamage using RIAs and immunofluorescence micrography. We found that DNA damage accumulated in mouse skin as a result of chronic irradiation and that this damage persisted in the dermis and epidermis for several weeks after the chronic treatment was terminated. Although the persistent damage was evenly distributed throughout the dermis, it remained in the epidermis as a small number of heavily damaged cells at the dermal-epidermal boundary. Rates of DNA damage induction and repair were determined at different times over the course of chronic treatment in response to a higher challenge dose of UVB light. The amount of damage induced by the challenge dose increased in response to chronic exposure, and excision repair of cyclobutane pyrimidine dimers and pyrimidine(6-4)pyrimidone dimers was significantly reduced. The sensitization of mouse epidermal DNA to photoproduct induction, the reduction in excision repair, and the accumulation of nonrepairable DNA damage in the dermis and epidermis suggest that chronic low-dose exposure to sunlight may significantly enhance the predisposition of mammalian skin to sunlight-induced carcinogenesis.     

Human exposure to airborne aniline and formation of methemoglobin: a contribution to occupational exposure limits

Aniline is an important starting material in the manufacture of polyurethane-based plastic materials. Aniline-derived methemoglobinemia (Met-Hb) is well described in exposed workers although information on the dose–response association is limited. We used an experimental design to study the association between aniline in air with the formation of Met-Hb in blood and the elimination of aniline in urine. A 6-h exposure of 2 ppm aniline in 19 non-smoking volunteers resulted in a time-dependent increase in Met-Hb in blood and aniline in urine. The maximum Met-Hb level in blood (mean 1.21 ± 0.29 %, range 0.80–2.07 %) and aniline excretion in urine (mean 168.0 ± 51.8 µg/L, range 79.5–418.3 µg/L) were observed at the end of exposure, with both parameters rapidly decreasing after the end of exposure. After 24 h, the mean level of Met-Hb (0.65 ± 0.18 %) returned to the basal level observed prior to the exposure (0.72 ± 0.19 %); whereas, slightly elevated levels of aniline were still present in urine (means 17.0 ± 17.1 vs. 5.7 ± 3.8 µg/L). No differences between males and females as well as between slow and fast acetylators were found. The results obtained after 6-h exposure were also comparable to those observed in four non-smoking volunteers after 8-h exposure. Maximum levels of Met-Hb and aniline in urine were 1.57 % and 305.6 µg/L, respectively. Overall, our results contribute to the risk assessment of aniline and as a result, the protection of workers from aniline-derived adverse health effects at the workplace.     

A ribavirin-induced ORF2 single-nucleotide variant produces defective hepatitis E virus particles with immune decoy function

Hepatitis E virus (HEV) is the causative agent of hepatitis E in humans and is the leading cause of enterically transmitted viral hepatitis worldwide. Ribavirin (RBV) is currently the only treatment option for many patients; however, cases of treatment failures or posttreatment relapses have been frequently reported. RBV therapy was shown to be associated with an increase in HEV genome heterogeneity and the emergence of distinct HEV variants. In this study, we analyzed the impact of eight patient-derived open reading frame 2 (ORF2) single-nucleotide variants (SNVs), which occurred under RBV treatment, on the replication cycle and pathogenesis of HEV. The parental HEV strain and seven ORF2 variants showed comparable levels of RNA replication in human hepatoma cells and primary human hepatocytes. However, a P79S ORF2 variant demonstrated reduced RNA copy numbers released in the supernatant and an impairment in the production of infectious particles. Biophysical and biochemical characterization revealed that this SNV caused defective, smaller HEV particles with a loss of infectiousness. Furthermore, the P79S variant displayed an altered subcellular distribution of the ORF2 protein and was able to interfere with antibody-mediated neutralization of HEV in a competition assay. In conclusion, an SNV in the HEV ORF2 could be identified that resulted in altered virus particles that were noninfectious in vitro and in vivo, but could potentially serve as immune decoys. These findings provide insights in understanding the biology of circulating HEV variants and may guide development of personalized antiviral strategies in the future.

Despite its rising global prevalence, hepatitis E is a disease that is mostly overlooked. Every year, more than 44,000 people die as a result of ∼20 million infections worldwide (1). Healthy individuals usually display no or only mild symptoms of viral hepatitis, such as fever, nausea, vomiting, and abdominal pain (2), while patients with preexisting liver disease, pregnant women, and immunocompromised individuals suffer from liver cirrhosis and liver failure (3). Pregnant women additionally present with increased mortality rates of >25% (4). Despite those liver-associated problems, there are also extrahepatic manifestations, such as hematopoietic disease, neurological disorders, and renal injury (5–9). The underlying agent, hepatitis E virus (HEV), is classed within the species of Paslahevepirus balayani (10), formerly known as Orthohepevirus A, which includes isolates from human, swine, wild boar, rat, and other mammals. HEV is a quasienveloped virus existing as both enveloped and non-enveloped particles (11, 12). To date, eight distinct genotypes (GT) of this species of the single-stranded RNA virus have been described (13), which display similar genomic structures. The positive orientated HEV genome is organized in three main open reading frames (ORF1 to ORF3) with a total length of 7.2 kb. Nonstructural proteins forming the HEV replicase complex, such as the RNA-dependent RNA polymerase (RdRp), RNA helicase, or methyltransferase, are encoded by ORF1, while the viral capsid protein is encoded by ORF2. During the HEV replication cycle, HEV produces at least three forms of ORF2 protein: infectious ORF2 (ORF2i), glycosylated ORF2 (ORF2g), and cleaved ORF2 (ORF2c) protein (14). The ORF2i protein is the structural component of infectious particles that is likely derived from the assembly of the intracellular ORF2 (ORF2intra) protein form. In contrast, ORF2g and ORF2c protein are not associated with infectious virions, but secreted in large amounts and are the most abundant antigens detected in patient sera (14). ORF3 encodes for a functional ion channel required for assembly and release of infectious particles by interacting with a variety of host factors (15).In immunocompetent patients, acute hepatitis E usually does not involve antiviral therapy; however, chronically infected and immunocompromised patients often require clinical intervention to clear the infection. Antiviral therapies include pegylated interferon (16–18), successfully implemented for many virus infections, and sofosbuvir (19, 20), a direct acting antiviral against hepatitis C virus, both of which have not yet been systematically evaluated in the context of HEV therapy. Recent studies have investigated the antiviral potential of silvestrol (21), zinc salts (22), and other possible drug candidates in vitro [reviewed in detail by Kinast et al. (23)], but the findings remain to be clinically validated. Lacking specific treatment options, the broad antiviral ribavirin (RBV) (24) is frequently used off-label. However, RBV therapy is often discontinued due to adverse side effects and is only effective in ∼80% of patients, implying that 20% of treated patients remain viremic (25). RBV treatment is specifically contraindicated in pregnant women and can give rise to variants such as G1634R, as well as other amino acid substitutions within the ORF1-encoded polyprotein, potentially contributing to treatment failure and poor clinical long-term outcomes (26–28). In this context, we recently identified viral populations of HEV harboring variations in the capsid-encoding ORF2 region during RBV therapy. With the use of an efficient HEV cell-culture model system, we characterized the impact of these ORF2 variants in the HEV replication cycle.     

Cost‐of‐illness of chronic leg ulcers in Germany

Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost‐of‐illness in Germany. The aim was to determine the cost‐of‐illness of venous leg ulcers (VLU) in Germany. Prospective cost‐of‐illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health‐related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA‐w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 ± 12.0 years. The mean total cost of the ulcer per year and patient was € 9569, [ € 8658.10 (92%) direct and € 911.20 (8%) indirect costs]. Of the direct costs, € 7630.70 was accounted for by the statutory health insurance and € 1027.40 by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper‐going cost‐of‐illness‐studies and cost‐benefit analyses are necessary if management of chronic wounds is to be improved.     

Acute muscle inflammation enhances the monosynaptic reflexes and c-fos expression in the feline spinal cord.

The aim of this research was to study the changes of the motor reflex activity (monosynaptic reflex (MSR) of the flexor and extensor muscles) and Fos immunoreactivity in lumbo-sacral spinal cord after acute induced myositis of m. gastrocnemius-soleus (GS). The experiments were carried out on ischaemic decerebrated, spinalized in C1 cats. After infiltration of the GS muscle with carrageenan (2%) MSRs of flexors and extensors showed a significant increase in amplitude +127+/-24.5% and +155+/-28.5%, respectively, p<0.05. The exposed effect was initiated within 30 min and achieved a maximum 2.8h after the intramuscular injections of carrageenan. After analysis of dynamics of the MSRs, animals were perfused and c-fos expression in the spinal segments L6-S1 was evaluated. In comparison to sham-operated animals, the number of Fos-immunoreactive (Fos-ir) cells was noticeably increased in the lumbar cord of cats with carrageenan-induced myositis. The labeled cells were concentrated in the ipsilateral laminae I/II, neck of the dorsal horn (V/VI) and intermediate zone (VII), however, clear predominance of their concentration was found in the deep laminae. The effect of muscle inflammation was also expressed as a significant decline in the number of NADPH-d-reactive cells (p<0.05) in ipsilateral laminae I/II of L6/L7. The results show that the input from acutely inflamed muscles may induce an increase of the reflex responsiveness of flexors and extensors which is not mediated via the gamma-spindle-loop and which coincides with a significant increase in c-fos expression in the deep laminae of the lumbar spinal cord.