Stimulating capacity of fresh and cultured human leukaemic lymphoid and myeloid cells in `one-way'' mixed lymphocyte reaction

Fresh normal peripheral blood B lymphocytes possess a strong stimulating capacity while fresh thymus cells or fresh peripheral T lymphocytes possess a weak, but significant stimulating capacity on allogeneic lymphocytes in `one-way' mixed lymphocyte reaction. Fresh leukaemic T lymphoid cells from patients with T-cell ALL or T-cell CLL exert little or no stimulation on allogeneic lymphocytes. Fresh leukaemic B lymphoid cells from patients with B-cell CLL or B-cell HCL, on the other hand, exert a lesser stimulation on allogeneic lymphocytes, as compared to that of normal B lymphocytes. Leukaemic myeloblasts from patients with AML or Ph<sup>1</sup>(+) CML-BP exert significantly higher stimulation than leukaemic lymphoid cells in `one-way' mixed lymphocyte reaction (P<0.05). Cultured leukaemic T lymphoid cells (MOLT-4) possess no stimulating capacity, cultured leukaemic B lymphoid cells (BALM-2) possess a moderate degree of stimulating capacity and cultured leukaemic, possibly myeloid, cells (NALM-1 and K562) possess vigorous stimulation on allogeneic lymphocytes. The stimulating capacity of NALM-1 or K562 cells is significantly higher than that of BALM-2 cells (P<0.01 or P<0.05, respectively) and that of MOLT-4 cells (P<0.001). These observations suggest that the stimulating capacity of leukaemic T or B lymphoid cells may have been completely or partially lost during the process of leukaemogenesis. Since we do not have an opportunity to study the stimulating capacity of normal myeloblasts, it is not known whether the stimulating capacity of leukaemic myeloblasts, which is found to be very strong on allogeneic lymphocytes, may have been modified during the process of leukaemogenesis.     

The GAP-related domain of tuberin, the product of the TSC2 gene, is a target for missense mutations in tuberous sclerosis

Tuberous sclerosis is an autosomal dominant trait in which the dysregulation of cellular proliferation and differentiation results in the development of hamartomatous growths in many organs. The TSC2 gene is one of two genes determining tuberous sclerosis. Inactivating germline mutations of TSC2 in patients with tuberous sclerosis and somatic loss of heterozygosity at the TSC2 locus in the associated hamartomas indicate that TSC2 functions as a tumour suppressor gene and that loss of function is critical to expression of the tuberous sclerosis phenotype. The TSC2 product, tuberin, has a region of homology with the GTPase activating protein rap1GAP and stimulates the GTPase activity of rap1a and rab5a in vitro. Here we show that the region of homology between tuberin and human rap1GAP and the murine GAP mSpa1 is more extensive than previously reported and spans approximately 160 amino acid residues encoded within exons 34-38 of the TSC2 gene. Single strand conformation polymorphism analysis of these exons in 173 unrelated patients with tuberous sclerosis and direct sequencing of variant conformers together with study of additional family members enabled characterisation of disease associated mutations in 14 cases. Missense mutations, which occurred in exons 36, 37 and 38 were identified in eight cases, four of whom shared the same recurrent change P1675L. Each of the five different missense mutations identified was shown to occur de novo in at least one sporadic case of tuberous sclerosis. The high proportion of missense mutations detected in the region of the TSC2 gene encoding the GAP-related domain supports its key role in the regulation of cellular growth.      

Concentrations of endometrial protein PP 14 and CA-125 in uterine flushings performed in natural and stimulated cycles

BACKGROUND: Impaired implantation in assisted reproduction cycles with high serum estradiol (E(2)) concentrations may be attributed to abnormal endometrial development. This study compared concentrations of endometrial proteins in uterine flushings of infertile patients between natural and stimulated cycles. METHODS: Patients received a standard regimen of ovarian stimulation. Seven days after the LH surge in natural cycles or the hCG injection in stimulated cycles, uterine flushings were performed by slowly injecting and aspirating normal saline through a paediatric Foley catheter. Natural cycles were considered as group A whereas stimulated cycles with serum E(2) <20 000 pmol/l and serum E(2) >20 000 pmol/l were classified as groups B and C respectively. PP 14 and CA-125 in uterine flushings were measured and expressed per total protein content. RESULTS: Concentrations of the total protein, PP 14 and CA-125 in the uterine flushings were similar among the three groups. PP 14 per total protein in the uterine flushings was significantly correlated with serum E(2) on the day of hCG (r = 0.459; P = 0.009) in natural cycles only but not in stimulated cycles. CONCLUSION: There was no significant difference between natural and stimulated cycles in concentrations of PP 14 and CA-125 in uterine flushings performed in the mid-luteal phase.     

Glycoproteins present in human follicular fluid that inhibit the zona- binding capacity of spermatozoa

Previous studies have suggested that human follicular fluid contains factors that reduce the zona-binding capacity of spermatozoa. The present study provides further evidence of the existence of such factors. Using the hemizona binding assay (HZA), we have shown that the inhibitory effect of human follicular fluid on the zona-binding capacity of spermatozoa is concentration-dependent, an inhibitory effect being detected when the concentration of human follicular fluid was > or = 10%. A 1% concentration of human follicular fluid did not possess this inhibitory activity. Heating human follicular fluid at 56 degrees C for 30 min did not affect its inhibitory properties; treatment with proteinase-K abolished such inhibition. Human follicular fluid was fractionated sequentially by concanavalin-A affinity chromatography, Mono Q ion-exchange chromatography and Superose-12 gel filtration. The zona binding inhibitory activity resided in the fraction which bound to the lectin and Mono Q column and contained molecules with native molecular weights of 32 and 192 kDa. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis analysis suggested that the 192 kDa glycoprotein was a tetramer, while the 32 kDa glycoprotein remained as a single molecular species under denaturing conditions. We conclude that two glycoproteins were responsible for the zona binding inhibitory activity of human follicular fluid. The physiological role of these factors remains unclear.      

A novel Plasmodium falciparum erythrocyte binding protein-2 (EBP2/BAEBL) involved in erythrocyte receptor binding

The 175-kDa erythrocyte binding protein (EBA-175) of Plasmodium falciparum and Duffy antigen binding proteins of P. vivax and P. knowlesi are members of a protein family. The features of this protein family include a cysteine-rich motif present in the erythrocyte receptor-binding domain. We identify here a novel 140-kDa P. falciparum erythrocyte binding protein (EBP2/BAEBL) containing the signature cysteine-rich motif by comparative analysis of gene sequence information. Polyclonal antibodies generated by immunization with an EBP2/BAEBL DNA vaccine immunoprecipitated a 140-kDa protein from P. falciparum schizont-infected erythrocyte lysates. Similar to EBA-175, the binding of EBP2/BAEBL to human erythrocytes was dependent on sialic acids because neuraminidase treatment of those erythrocytes rendered them incapable of binding, but differed from EBA-175 in that trypsin treatment decreased EBP2/BAEBL binding by only twofold compared to a 10-fold reduction in EBA-175 binding. Antibodies raised against the putative erythrocyte-binding domain of EBP2/BAEBL effectively blocked the binding of native EBP2/BAEBL to erythrocytes. These functional antibodies localize EBP2/BAEBL to the invasive apical end of the merozoite. We identify EBP2/BAEBL as a paralogue of EBA-175 and as a novel P. falciparum vaccine candidate.     

Tuberous sclerosis complex: neonatal deaths in three of four children of consanguineous, non-expressing parents.

We describe here four sibs, born to consanguineous, healthy, asymptomatic parents. Three of these infants had a rapidly fatal course in the neonatal period; death was attributed to congestive heart failure with radiographic evidence of cardiomegaly in all of them. Necropsy was done in only one of them and showed the typical findings of tuberous sclerosis complex (TSC) in the central nervous system (CNS), kidneys, heart, and liver. The fourth sib, currently 2 years old, also has typical signs of TSC, namely hypomelanotic skin macules and calcified subependymal nodules. Both parents and a living maternal grandmother had appropriate examination, which included skin inspection under Wood's lamp, dental examination, fundoscopy, echocardiography, abdominal and renal ultrasound, and head CT and MRI scans, and no signs of TSC were found in either parent or in the only living grandmother. By history alone there is no other relative with signs or symptoms suggestive of TSC. Linkage analysis and loss of heterozygosity (LOH) investigations on a variety of lesions obtained from postmortem and tissue or blood specimens from all available family members studied failed to identify a microdeletion in the chromosomal regions where TSC genes are located. It is very unusual that in a single TSC family there were three consecutive neonatal deaths, and very likely that all had cardiac rhabdomyomas. Moreover, to the best of our knowledge, there are no previous reports of TSC families with more than one affected sib, unusually severe manifestations of the disease, and completely normal, consanguineous parents.     

Late-onset globoid cell leukodystrophy

During the past 12 years, ten cases of globoidcell leukodystrophy (GLD) have been followed up: seven of these patients were affected by the late infantile form. The authors point out the clinical aspects and the course of these patients and stress the high frequency of this form of GLD in Sicily.     

NEW SUSPENSION DEVICE FOR LARYNGEAL ENDOSCOPIC PROCEDURES

In view of the economic constraints in acquiring sophisticated equipments in service hospitals, a new suspension device for endolaryngeal surgery using anaesthetic laryngoscope and routinely available tonsillectomy instruments has been developed. This device is a modification of Ijadoula''s suspension laryngoscope.KEY WORDS: Suspension laryngoscope, Laryngeal endoscopy     

Bias due to incomplete follow up in a cohort study

AIM: To investigate the bias introduced by incomplete follow up in a cohort study of ocular outcome after premature birth. METHODS: A geographically defined cohort of children born before 32 weeks' gestation was prospectively recruited at birth to study the ocular outcome at 2 years. On the basis of attendance at 2 years, the children's families were allocated to one of three groups: group 1 attended for follow up, group 2 were difficult to trace, and group 3 were very reluctant for assessment. All children were examined by a single ophthalmologist, masked to these groupings. RESULTS: 558 children (98.8% of study group) were examined, of whom 505 were in group 1, 20 in group 2, and 33 in group 3. The groups which were more difficult to study (groups 2 and 3) showed a significantly higher prevalence of ocular abnormalities, including strabismus (p=0. 02) and cicatricial retinopathy of prematurity (p=0.002) compared with those attending for follow up. Further, not all of these cases could have been identified by review of the children's previous records. Ocular abnormalities would be underestimated by 16% (11.3% in group 1 compared with 13.4% in the total cohort, p=0.77). CONCLUSIONS: This study suggests that the prevalence of abnormalities would be underestimated by incomplete follow up, as those subjects who were most difficult to obtain for study had a significantly higher prevalence of abnormalities.     

Survival following whole brain radiation treatment for cerebral metastases: an audit of 474 patients.

BACKGROUND AND PURPOSE: To report the outcome of patients with brain metastases from solid tumors treated with whole brain radiotherapy (WBRT) in a single institution. Given the high proportion of melanoma patients, a secondary aim was to compare our outcomes for patients with melanoma to those with other cancers. PATIENTS AND METHODS: A retrospective audit identified 474 patients treated between January 1983 and December 1999. Survival was calculated using the Kaplan-Meier method. Cox regression modeling was used for multivariate analysis. RESULTS: Four hundred and fifty nine patients have died from their disease. The median survival was 4.1 months for the whole group and 3.6 months for the 42% of patients with melanoma. The 1 and 2 year survival was 15 and 5%. Six patients lived beyond 5 years. 105 of 186 patients with a single brain metastasis underwent surgery plus WBRT, and 81 received WBRT alone. Median survival was 8 and 4 months, respectively, (P<0.0001). 30 Gy in 10 fractions was used more commonly in the early part of the study compared to 20 Gy in 5 fractions more recently. There was no difference in survival by time period. CONCLUSIONS: The survival in this series was comparable to other studies. Performance status, resection, dose, and the presence of extracranial disease appeared to be significant prognostic factors. The survival for the large number of patients with melanoma did not differ from the rest of the cohort.