Renal transplantation in pre-school children

This short report describes the outcome of 13 renal transplants in 11 children under 5 years of age. Nine (82%) of the 11 recipients are alive; 2 children died with functioning grafts. Approximately 50% of grafts are functioning at 5 years post transplantation. Children with congenital kidney malformations can be successfully managed to transplantation.     

Release of lymphotoxin by control and chemical carcinogen-treated lymphocyte cultures derived from black healthy subjects and cancer patients

In an age-adjusted comparison with white men, black men have a significantly higher increase in esophageal and other types of cancer associated with environmental causes. The basis of this increase in cancer rates in blacks over the last two decades is unknown. Since cancer patients generally show an impairment in cell-mediated immune (CMI) functions, we measured certain CMI reactions in cultured lymphocytes derived from black healthy subjects and cancer patients. We also determined the levels of aryl hydrocarbon hydroxylase (AHH) induced in these lymphocytes. AHH catalyzes the activation of polycyclic aromatic hydrocarbons (PAH) to intermediates which might alter CMI functions.     

Overexpression of aromatase leads to development of testicular leydig cell tumors : an in vivo model for hormone-mediated TesticularCancer

Despite recent advances in diagnosis and treatment of testicular cancer, its causes remain unknown. The most common conditions known to be associated with testicular cancer are cryptorchidism, infertility, and overexposure to pesticides or radiation. Recent studies also indicate hormones may play a crucial role in testicular tumorigenesis. Our studies show that about half of the male transgenic mice overexpressing aromatase in testis were infertile and/or had larger than normal testicles. Gross pathology and histological analysis showed the mice to have Leydig cell tumors, unilaterally or bilaterally. Serum estradiol levels for transgenic mice were at least twice as high as those for nontransgenic mice. Expression of aromatase and estrogen receptor were also very high in testicular tissue of transgenic mice compared to nontransgenic mice. Consistent with increased estrogenic activity in the testicular tissue, we also saw an increase in the levels of genes involved in cell cycle that are regulated by the estrogen. To obtain a better understanding of the biological significance of testicular tumorigenesis, a reliable animal model is necessary to clarify the mechanisms and correlations associated with human cancers. Here we describe such a model, which shows that overexpression of aromatase results in increased estrogen production and a changed hormone milieu, leading to the induction of testicular cancer (Leydig cell tumors). This predictable and useful model is a potential tool for the study of testicular tumorigenesis, hormonal carcinogenesis, synergistic action of other carcinogens on hormone-induced tumors, and tumor dependency on endocrine factors.     

Mechanisms of action of major-histocompatibility-complex-linked genes affecting reproduction

PROBLEM: To provide insight into the mechanisms of action of the major-histocompatibility-complex (MHC)-linked genes affecting reproduction. METHOD OF STUDY: The data were obtained using a variety of cellular and molecular techniques in experimental animals and from population genetic studies in humans. RESULTS: In the mouse, the preimplantation embryonic development (Ped) locus, whose functional gene is Q9, regulates fast and slow cleavage of the early embryo. There is also evidence for a growth and reproduction complex (Grc)-like region from serologic, molecular, and cytogenetic studies. In the human, the human leukocyte antigen (HLA)-G gene has been associated with an increased rate of embryonic cleavage in those embryos that express the HLA-G antigen. Sharing of HLA antigens in couples has been associated with recurrent spontaneous abortions, gestational trophoblastic tumors, and unexplained infertility. Detailed mapping studies showed that the genes responsible are not the HLA genes themselves, but genes closely linked to the HLA-DR-DQ-B genes. The HLA region genes can interact epistatically with the C3 allele of transferrin to increase the incidence of fetal loss. In the rat, the Grc region, which is closely linked to the MHC, has been associated with embryonic loss, growth defects, and susceptibility to chemical carcinogens. The Grc can interact epistatically with the tail anomaly lethal (Tal) gene or the hood restriction (Hre) gene to enhance these effects. CONCLUSIONS: There are two basic mechanisms for the effects of MHC-linked genes on reproduction and development: individual gene effects (Ped [Q9], HLA-G) and extended genetic effects (MHC-linked genes in the rat [Grc] and in the human). The nature of these genetic effects, particularly the MHC-linked effects, can also provide some insight into the different theories of human origins: These effects are most consistent with the monogenic theory.     

Ramp-function work test suitable for automatic computation

Heart rate (HR) response to step-function and ramp-function (20 W/min) work tests was compared in 12 healthy subjects. For a given power output (P), HR was substantially lower in the ramp tests. The HR difference increased with power output and increasing difference in work time between the test types. The HR difference can be explained in terms of a drift component (which accounts for 1/3 of the difference) and a lag component (2/3). As a consequence of the HR differences, P for a given HR is higher in ramp tests. Work capacity expressed, for example as P170, can be determined in ramp tests, and the result can be translated to step-function P170. The precision in this translation is markedly improved if a steady-state period is incorporated into the ramp test.     

Stage, survival and delays in lung, colorectal, prostate and ovarian cancer: comparison between diagnostic routes

BACKGROUND: Very few studies have reported cancer outcomes of patients referred through different routes, despite the prominence of current UK cancer urgent referral guidance. AIM: This study aimed to compare outcomes of cancer patients referred through the urgent referral guidance with those who were not, with respect to stage at diagnosis, survival, and delays in diagnosis. Design of study: Analysis of hospital records. SETTING: One hospital trust in England. METHOD: The records of 889 patients diagnosed in 2000-2001 with one of four types of cancer were analysed: 409 with lung cancer; 239 with colorectal cancer; 146 with prostate cancer; and 95 with ovarian cancer. Outcome measures were diagnostic stage, survival, referral and secondary care delays. RESULTS: For lung cancer, urgent referrals had more advanced TNM (tumor, node, metastasis) stage than patients diagnosed through other routes (P = 0.035) and poorer survival (P = 0.020). There was no difference in stage or survival for the other cancers. For each cancer, a higher proportion of urgent referrals was seen within 2 weeks. Secondary care delays for lung and colorectal cancer were shorter for inter-specialty referrals. CONCLUSION: For patients with lung cancer, the guidance appears to be prioritising those in the more advanced stages of disease. This was not the case for the other three cancers. Referral delays were shorter for patients urgently referred, as is the intention of the guidance. The avoidance of delays in outpatient diagnostics probably accounts for shorter secondary care delays for inter-specialty referrals.     

RELATIONSHIP BETWEEN THE RESPONSIVENESS OF MATERNAL AND FOETAL LYMPHOCYTES TO PHYTOHAEMAGGLUTININ AND TO MICROBIAL ANTIGENS

The response of 105 maternal-foetal lymphocyte pairs to specific and non-specific stimulation were evaluated using a newly defined method of analysis. There were no significant differences in the responses of maternal or foetal lymphocytes to phytohaemogglutinin (PHA) or the various antigens as a function of concentration over the ranges tested. The maternal lymphocytes were stimulated by all of the antigens and responded to PHA three-five times more strongly than to the antigens. The foetal lymphocytes were stimulated by PHA and tetanus toxoid only and were suppressed by streptokinase-streptodornase (SKSD). They responded to stimulation by antigens at a lower level than did the maternal lymphocytes, but they responded at a much higher level to PHA. Unstimulated cultures of foetal lymphocytes incorporated more isotope than did those of maternal lymphocytes in both autologous and AB plasma. The data were cross-classified to determine whether the responses of the foetal lymphocytes varied concordantly with the responses of the maternal lymphocytes in both autologous and AB plasma by the Chi-square test for independence and by rank correlation analysis. There was no significant correlaiton in either plasma to stimulation with the antigens. Thus, the presence of antigen reactive lymphocytes in the circulation of the mother does not mean that the foetus is sensitized to that antigen. Comparison of the lymphocyte responses in autologous plasma with those in AB plasma provided evidence for the presence of circulating immunoregulatory substances. Autologous maternal plasma suppressed the lymphocyte responses to high concentrations of candida and SKSD and stimulated the response to mumps, varicella and tetanus toxoid. Autologous fetal plasma suppressed the lymphocyte responses to candida, varicell and SKSD and stimulated the response to PHA. The responsiveness of maternal lymphocytes to PHA was less in foetal plasma than in autologous maternal or AB plasma.     

Monoclonal antibody to CD4+ T cells abrogates genetic resistance to Haemonchus contortus in sheep.

The roles of CD4+ and CD8+ T cells in genetically determined resistance of sheep to Haemonchus contortus (a natural host-parasite relationship) was investigated by selectively depleting genetically resistant merino lambs of their CD4+ or CD8+ T cells by treatment with mouse monoclonal antibody (mAb) specific for the appropriate determinant before and during challenge infection. Administration of anti-CD4 mAb to genetically resistant lambs completely abrogated their expression of genetic resistance as indicated by significantly higher faecal egg output and worm burdens found in the CD4+ T-cell-depleted lambs compared with those of controls. Host responses associated with resistance to H. contortus including mucosal mast cell hyperplasia and tissue eosinophilia were also significantly suppressed in CD4-depleted lambs. The development of anamnestic anti-parasite antibody responses were also significantly inhibited by anti-CD4 mAb. Furthermore, anti-CD4 mAb abolished differences in host responses between genetically resistant and random-bred (susceptible) lambs. In contrast, depletion of CD8+ T cells had no effect on genetic resistance; faecal egg output, worm counts, mast cells and eosinophil responses in CD8-depleted lambs were not significantly different from those in controls. Together, these results suggest that CD4+ T cells play a pivotal role in mediating genetic resistance to H. contortus, and in the generation of mucosal mast cell hyperplasia, tissue eosinophilia and anti-Haemonchus antibody. CD8+ T cells appear to play no protective role. The possible mechanisms by which CD4+ T cells might mediate anti-parasite resistance are discussed.