Allele-specific PCR and Next-generation sequencing based genetic screening for Congenital Adrenal Hyperplasia in India

Genetic screening of Congenital Adrenal Hyperplasia (CAH) is known to be challenging due to the complexities in CYP21A2 genotyping and has not been the first-tier diagnostic tool in routine clinical practice. Also, with the advent of massive parallel sequencing technology, there is a need for investigating its utility in screening extended panel of genes implicated in CAH. In this study, we have established and utilized an Allele-Specific Polymerase Chain Reaction (ASPCR) based approach for screening eight common mutations in CYP21A2 gene followed by targeted Next Generation Sequencing (NGS) of CYP21A2, CYP11B1, CYP17A1, POR, and CYP19A1 genes in 72 clinically diagnosed CAH subjects from India. Through these investigations, 88.7% of the subjects with 21 hydroxylase deficiency were positive for eight CYP21A2 mutations with ASPCR. The targeted NGS assay was sensitive to pick up all the mutations identified by ASPCR. Utilizing NGS in subjects negative for ASPCR, five study subjects were homozygous positive for other CYP21A2 variants: one with a novel c.1274G>T, three with c.1451G>C and one with c.143A>G variant. One subject was compound heterozygous for c.955C>T and c.1042G>A variants identified using ASPCR and NGS. One subject suspected for a Simple Virilizing (SV) 21 hydroxylase deficiency was positive for a CYP19A1:c.1142A>T variant. CYP11B1 variants (c.1201-1G>A, c.1200+1del, c.412C>T, c.1024C>T, c.1012dup, c.623G>A) were identified in all six subjects suspected for 11 beta-hydroxylase deficiency. The overall mutation positivity was 97.2%. Our results suggest that ASPCR followed by targeted NGS is a cost-effective and comprehensive strategy for screening common CYP21A2 mutations and the CAH panel of genes in a clinical setting.     

Report of the symposium

Summary The past decades have seen considerable shifts of emphasis in surgical care. The recognition that pus was not laudable, was followed by a realisation that not all complications were inevitable and that prophylaxis could effectively reduce the incidence of most common problems in the post-operative period. As anaesthesia has become safer, it has been possible to embark on more intricate and prolonged procedures and for sufficient time to be available to ensure adequate intraoperative care.These two phenomena have firstly increased the complexity of management in the post-operative period, and have brought this aspect of surgical care more obviously to the limelight. However, many separate disciplines are involved in the care of the patient post-operatively, and the Symposium was organised¹ to bring the different groups together to identify the areas of recent development in the different specialities and to integrate the overall care of the individual patient.Abbreviations ARDS adult respiratory distress syndrome - DIC disseminated intravascular clotting     

Protein micelles of human histocompatibility antigens (HLA-A and HLA-B)

Human histocompatibility antigens (HLA-A and -B) are membrane proteins which have large hydrophilic domains outside the cell membrane and a small hydrophobic portion in the lipid bilayer. In this paper we describe optimal conditions for preparing micelles of detergent-solubilized HLA-A2 and -B7 antigens. These homogeneous protein aggregates are water soluble and free of detergent and lipid. Hydrophobic interactions between the intramembraneous portions of the HLA antigens are the driving forces in the formation of these protein micelles. The papain-solubilized fragment of the HLA antigens is not included in the micelle. The average molecular weight of the HLA micelles is around 9 × 10⁵ daltons, which suggests sixteen HLA-A2 and/or HLA-B7 antigenic molecules per protein aggregate. Electron microscopic studies revealed that the most frequent size of the micelles is 12 mm and that HLA-micelles are similar but not identical to micelles from Sindbis Virus glycoproteins (E1 and E2) The HLA-A2 and -B7 micelles retained full antigenic activity as judged by precipitations with allo- and heteroantisera. Such micelles will no doubt be important tools in further studies of the role of histocompatibility antigens.     

Effects of "Below-Zero" Habituation on the Electrodermal Orienting Response to a Test Stimulus

Two experiments were designed to investigate the effect of below-zero habituation training on skin conductance response (SCR) amplitude to a change in auditory stimulus frequency. In both experiments, subjects were trained with a 1000 Hz tone until zero responding and then received 5, 10, or IS further training trials. In Experiment 1 (N=45), subjects then received 1 presentation of a test stimulus of 1400 Hz, while in Experiment 2 (N=45), the test stimulus was a tone of 670 Hz. On the basis of dual-process theory, it was hypothesized that response amplitude to the test stimulus would be inversely related to amount of below-zero training. However, the results of both experiments indicate that SCR amplitude was positively related to amount of below-zero training. These results suggest that in situations of extended habituation training, an expectancy or subjective probability of stimulus occurrence gradient is important in determining response amplitude to a test stimulus.     

Two Measures of Auditory Evoked Response Amplitude and Their Relationship to Background EEG

All-night sleep EEG and auditory evoked responses (AERs) were recorded in 8 children whose ages ranged from 27 to 60 months. EEG intensity was measured by means of a Drohocki-type integrator. Two measures of evoked response amplitude were calculated: the peak-to-peak amplitude of the P₂N₂ component, and a multiple-component amplitude measure of the first 500 msec of the response. Both amplitude measurements were found to correlate well with each other. Changes in EEG intensity between subjects were not correlated with changes in AER amplitude, but a number of correlations between AER amplitude and EEG intensity were found within individual subjects. Further analysis suggested the latter finding might be a result of the presence of “unaveraged’EEG in individual AER plots. It is concluded that little correlation exists between AER amplitude and EEG intensity in children during sleep.     

Polyamines in Trichomonas vaginalis

Trichomonas vaginalis was grown in a modified Bushby's medium and putrescine, spermidine and spermine levels were determined in extracts from 24- and 48-h cultures and also in the culture media. All three polyamines were present in T. vaginalis extracts; the putrescine level and putrescine/spermidine ratio were much higher than those reported for other protozoa or for mammalian tissues. There were no significant differences between 24-h and 48-h amine levels per mg protein in these extracts, but amine levels per cell were higher at 24 than at 48 h. The spent culture media had a much higher putrescine content than corresponding uninoculated media and it was concluded that T. vaginalis secreted putrescine into the culture medium.     

Hemagglutination by Staphylococcus aureus strains responsible for human bacteremia or bovine mastitis

Although hemagglutination by Staphylococcus aureus has been associated with the pathogenesis of bovine mastitis, this trait has not been characterized with regard to human disease. In this study, the prevalence of hemagglutination in 100 strains of S. aureus responsible for bovine mastitis or human bacteremia, was characterized. Under optimum conditions hemagglutination was noted in 23% of the bovine strains, but only 13% of human strains, leading us to conclude that this trait is not a significant virulence determinant in human systemic infection. Additional studies indicate the hemagglutinin of S. aureus strains responsible for human bacteremia is proteinaceous in character.     

Correlation between soluble serum CD16 (sCD16) levels and disease stage in patients with multiple myeloma

CD16, the type III receptor for IgG, is expressed on neutrophils, natural killer cells, and some T lymphocytes, mast cells, and activated monocytes but not on cells of the B-lymphocyte lineage including plasma cells. It is also produced in a soluble form found in serum. We analyzed sera from 165 multiple-myeloma patients, 29 patients with monoclonal gammopathies of unknown significance, and 20 normal disease-free donors. We found that the level of soluble CD16 was significantly decreased in sera from patients with multiple myeloma compared to sera from healthy and monoclonal gammopathies of unknown significance donors (P=0.0001). In addition, a stage-dependent decrease in soluble CD16 was observed, with a highly significant difference (P=0.004) between stage I and stage II+III myeloma patients. The correlation between the myeloma stage and the serum level of soluble CD16, which is related to the host response, was found to be more sensitive than that of ₂-microglobulin, which reflects the tumor burden. The concomitant evaluation of the serum levels of these two markers allows better staging and therefore has a more precise prognostic value.     

The laminar organization of dorsal horn cells responding to peripheral C fibre stimulation

Summary Cat dorsal horn was searched for all detectable units that responded to peripheral C fibre input. Fifty-seven such units were examined in detail. They were located in two main areas. One group was in the superficial laminae 1, 2, and possibly dorsal 3 (n = 29), and the other group was much deeper in laminae 5 and 6 (n = 24). Only four units were situated in the region of lamina 4.Differences were found in the responses to C fibre stimulation of these two groups, both in the optimum stimulus and in the timing of responses to repeated stimulation. Superficial units often did not respond to C fibre stimulation unless a train of two or more stimuli (10 ms apart) were applied, but when responses did occur they were usually very even and regular, with precise onset latencies on repeated stimulation. Deep units tended to need only one peripheral C fibre stimulus for excitation, but the responses were irregular with latencies fluctuating with each stimulus. Some superficial and deep units showed a steady increase in latency of the late C response on repeated stimulation. Increases of up to 80 ms after 30 s of stimulation at 1 Hz were observed.The results are discussed in terms of the neuronal connections in the dorsal horn.The work was supported by the Medical Research Council and the National Institutes of HealthM. Fitzgerald is a Medical Research Council Training Fellow