Influence of infection on malaria-specific antibody dynamics in a cohort exposed to intense malaria transmission in northern Uganda.

The role of submicroscopic infections in modulating malaria antibody responses is poorly understood and requires longitudinal studies. A cohort of 249 children ≤5 years of age, 126 children between 6 and 10 years and 134 adults ≥20 years was recruited in an area of intense malaria transmission in Apac, Uganda and treated with artemether/lumefantrine at enrolment. Parasite carriage was determined at enrolment and after 6 and 16 weeks using microscopy and PCR. Antibody prevalence and titres to circumsporozoite protein, apical membrane antigen-1 (AMA-1), merozoite surface protein-1 (MSP-119 ), merozoite surface protein-2 (MSP-2) and Anopheles gambiae salivary gland protein 6 (gSG6) were determined by ELISA. Plasmodium falciparum infections were detected in 38·1% (194/509) of the individuals by microscopy and in 57·1% (284/493) of the individuals by PCR at enrolment. Antibody prevalence and titre against AMA-1, MSP-119 , MSP-2 and gSG6 were related to concurrent (sub-)microscopic parasitaemia. Responses were stable in children who were continuously infected with malaria parasites but declined in children who were never parasitaemic during the study or were not re-infected after treatment. These findings indicate that continued malaria infections are required to maintain antibody titres in an area of intense malaria transmission.

Circulation of the plasma membrane in Dictyostelium.

We have developed a fluorimetric assay with the use of the dye FM1-43 to determine the rate at which Dictyostelium amoebae endocytose their surface membrane. Our results show that they do so about once each 4-10 min. A clathrin null mutant takes its surface up only approximately 30% more slowly, showing that this membrane uptake cannot be caused by clathrin-coated vesicles. Surprisingly, Ax2 and its parent, NC4, which differ in their rates of fluid-phase internalization by approximately 60-fold, take up their surfaces at the same rates. These results show that, in axenic cells, the uptake of fluid and of surface area are separate processes. The large activity of this new endocytic cycle in both Ax2 and NC4 amoebae appears capable of delivering sufficient new surface area to advance the cells' fronts during migration.

Quality of life in hospice patients. A pilot study.

The general public and the medical community often perceive dying patients' quality of life (QOL) as rapidly deteriorating before death. However, with appropriate palliative services, this effect may be positively modified. Objective data are lacking on the true experience of dying from the point of view of the patient that this pilot study begins to address. Patients caregivers, and staff in our hospice program completed questionnaires evaluating the patient's QOL every 2 weeks until the patient's death. This pilot study found that patients QOL was relatively high and stable over time. Primary caregivers rated the patient's QOL lower than patient self-ratings, whereas the hospice staff evaluated the patient's QOL similarly to the patient. Many dying patients suffer and are perceived as having no QOL in the final days by their caregivers. This perception may be modified to maintain one's QOL with the help of palliative medical services, thereby relieving the suffering of those who are actively facing death.

The distribution of circulating receptors on COS 7 cells.

Rapidly circulating receptors on the surfaces of migrating or spreading cells are often concentrated toward the cells' leading edges. This polar distribution is the principal evidence that circulating membrane is returned to the surface of these cells at their fronts, where it is proposed to assist the forward extension of the cell. However, when low-density lipoprotein (LDL) receptors are transiently expressed in COS cells-cells which actively spread-their distribution is random, indicating that COS cells do not behave like other motile cells. This anomaly is examined here. I find that COS cell lines expressing either transferrin or LDL receptors do, in fact, usually have polar distributions of both receptors. The transient expression of LDL receptors interferes, in an unknown way, with the polar properties of COS cells. Furthermore, it is shown that whether receptors are located toward the cell's edge or are randomly distributed depends both on the ability of the receptor to circulate and on the state of the particular cell at that time.

Thrombosis related to the use of L-asparaginase in adults with acute lymphoblastic leukemia: a need to consider coagulation monitoring and clotting factor replacement.

L-asparaginase (L-asp) has become an important component of combination chemotherapy for acute lymphoblastic leukemia (ALL). However, L-asp can produce depletions in many of the clotting factors with an associated risk for thrombosis and hemorrhage. Three consecutive patients seen at the Mayo Clinic with L-asp related thrombosis are described and an in-depth review of the literature is provided. Two of the 3 patients developed central nervous system (CNS) complications with evidence of thrombosis and hemorrhagic infarction. Two of the patients also developed extensive upper extremity thrombosis. The results of comprehensive hemostatic surveys showed marked abnormalities in all 3 patients. Many of the thrombotic complications related to L-asp involve the CNS, as illustrated in 2 of our patients. These patients should be treated aggressively since full recovery is possible. The precise cause of thrombosis is yet to be determined but is likely multifactorial. The optimal treatment and prevention of thrombosis in this group of patients remains poorly defined.

Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer.

PURPOSE: We report on a clinical trial developed to compare four different instruments that provide overall quality-of-life (QOL) scores, ranging from a simple, one-item instrument to more detailed instruments. Two issues addressed were (1) Will QOL tools suffer from missing data when used in a community-based cooperative group setting?, and (2) Are there additional data generated by a more detailed multiitem instrument over that provided by a single-item global QOL question? MATERIALS AND METHODS: A four-arm randomized trial was designed to compare four instruments that provide overall QOL scores in patients with advanced colorectal cancer. Patients and physicians completed the single-item Spitzer Uniscale (UNISCALE) at baseline and monthly. Patients were randomly assigned to complete, in addition, either the 22-item Functional Living Index-Cancer (FLIC), the five-item Spitzer QOL index (QLI), a picture-face scale (PICT), or nothing else. RESULTS: A total of 128 patients were randomized. Greater than 90% complete QOL data were obtained. There was strong correlation, concordance, and criterion-related validity among all four patient-completed tools. The UNISCALE had a greater decrease over time than did the FLIC (P=.005), which suggests a greater sensitivity; the UNISCALE was similar to the QLI and the PICT in this regard. Physicians provided lower UNISCALE scores than patients. Results supported the hypothesis that QOL is prognostic for survival. CONCLUSION: Patients can effectively complete QOL tools in a cooperative group setting with proper education of health care providers and patients. A simple single-item tool (UNISCALE) appears to be appropriate to obtain a measure of overall QOL.

Membrane traffic during cell locomotion.

The key role played by a polarised endocytic cycle in extending the front of a eukaryotic cell is now becoming established. Highlights that have occurred during the past year include the visualisation of vesicles fusing with the advancing edge of Physarum, directly leading to extensions of the cell; furthermore, the fusion of vesicles at the leading edge in plant pollen tubes appears to be controlled by a small GTPase, Rop 1, which is a plant homologue of the mammalian Rac. In animal cells, Rac appears to help determine where exocytosis occurs on the surface of a polarised cell. These and other observations illuminate how the endocytic cycle assists the locomotory process in animal cells.

EGF induces recycling membrane to form ruffles.

KB cells are know to respond to epidermal growth factor (EGF) by producing prodigious ruffles in the plasma membrane within minutes. The signal transduction pathway underlying this effect in fibroblasts is mediated through Rac, a member of the Ras-like family of GTPases. As ruffles are rich in components of the cytoskeleton--particularly in actin and ezrin--it has been suggested that ruffles arise when activated Rac modulates the actin cytoskeleton to push out a membrane protrusion. We set out to see whether the surface of new ruffles arises from neighbouring membrane, or whether it comes from an intracellular pool of endocytosed membrane. If it arose by exocytosis from endosomes, it would be expected to be enriched in those recycling receptors that are concentrated in coated pits in the endocytic side of the cycle. On the other hand, if it arose passively from the adjacent plasma membrane, a uniform distribution of these receptors would be expected. Here, we show that as soon as ruffles appear on KB cells in response to EGF, their membrane surfaces are enriched in both transferrin and low density lipoprotein (LDL) receptors. Both these proteins are known to be selectively concentrated into endosomal membranes by clathrin-mediated endocytosis. Our results reveal that the surfaces of ruffles arise by exocytosis of internal membrane from the endocytic cycle and, therefore, that a primary action of Rac is to redirect the exocytosis of recycling membrane into just those specific sites where ruffles form.

Dictyostelium myosin II null mutant can still cap Con A receptors.

Cross-linked antigens on the surface of a motile cell cap at the trailing end of the cell. In Dictyostelium discoideum, myosin II null mutants have previously been reported to be unable to cap Con A receptors, although they are able to locomote. This finding implicated myosin II as an essential component of the capping mechanism, although not of the machinery for locomotion. Here we show that myosin II null mutants do cap Con A receptors, albeit less efficiently than does wild type. This shows that cap formation is not absolutely dependent on myosin II and that a close mechanistic relationship between capping, particle movement, and cell migration may still exist.

Pilot study evaluating local anesthetics administered systemically for treatment of pain in patients with advanced cancer.

Based on evidence that suggested that systemically administered local anesthetics might be useful in chronic pain, we initiated a pilot study to evaluate the activity and toxicity of mexiletene and flecainide in the treatment of cancer pain. Twenty-one courses of either mexiletine or flecainide were administered to patients with an Eastern Cooperative Oncology Group performance status of three or better, who were suffering from cancer pain inadequately controlled with opioid analgesics. Pain control was assessed by patient questionnaires to monitor benefit and toxicity. In 17 cases, there was no suggestion of benefit. Two cases had relatively clear-cut analgesic benefit, and two others had some suggestion of mild-to-moderate analgesic relief. Flecainide was relatively well tolerated, but mexiletine appeared to cause nausea and/or vomiting in five of eight patients. This pilot trial suggests that systemically administered local anesthetics can relieve pain in a minority of patients with cancer pain.

Expression and changing distribution of the human transferrin receptor in developing Drosophila oocytes and embryos.

In order to understand better the membrane systems in a developing Drosophila oocyte, the human transferrin receptor has been expressed there. This was achieved using the armadillo promoter combined with K10 or oskar trailer sequences; these enable the messenger RNA to be transcribed in nurse cells and then transported to, and translated in, oocytes. This is the first exogenous protein to be expressed in oocytes. At stage 8, the transferrin receptors are mainly concentrated towards the posterior pole of the oocyte and are associated with large cytoplasmic vesicles; when combined with the shibire mutation the transferrin receptors are transferred to the oolemma, demonstrating that they participate in an endocytic cycle. At stage 10, the transferrin receptors are localised either to the anterior margin of the oocyte or to the posterior pole, depending on where the mRNA is located. In newly laid eggs, all the transferrin receptors are found in large cytoplasmic vesicles. The results reveal remarkable sorting processes which occur as oocytes mature and show that ring canals, which separate the oolemma from nurse cell plasma membranes, act as barriers to prevent components in these two compartments from intermixing.

Circulating integrins: alpha 5 beta 1, alpha 6 beta 4 and Mac-1, but not alpha 3 beta 1, alpha 4 beta 1 or LFA-1.

The alpha 5 beta 1, alpha 6 beta 4 and Mac-1 integrins all participate in the endocytotic cycle. By contrast, alpha 3 beta 1, alpha 4 beta 1 and LFA-1 do so much more slowly, or not at all, in the cell lines examined. This indicates that the alpha-chains appear to determine whether an integrin cycles or not, and that alpha 5 beta 1, alpha 6 beta 4 and Mac-1 can be brought to the leading edge of a moving cell by endocytosis and recycling.

Cells can use their transferrin receptors for locomotion.

Cells of the B lymphoblastoid cell line JY attach to substrata made of antibodies to the transferrin receptor. Many of these attached cells migrate considerable distances. JY cells also attach to an anti-integrin substratum (anti LFA-1), but on this surface they do not migrate. These results suggest that a circulating receptor--the transferrin receptor--can be used for locomotory purposes, whereas LFA-1, which is not endocytosed in these cells, cannot be used for locomotion. This indicates that the endocytotic cycle can drive cell locomotion.

Distinct endocytotic pathways in epidermal growth factor-stimulated human carcinoma A431 cells.

Addition of EGF to human epidermoid carcinoma A431 cells increases the rate of fluid-phase pinocytosis 6-10-fold as measured by horseradish peroxidase uptake (Haigler, H.T., J. A. McKanna, and S. Cohen. 1979. J. Cell Biol. 83:82-90). We show here that in the absence of extracellular Na+ or in the presence of amiloride the stimulation of pinocytosis by EGF is substantially reduced. Amiloride had no effect on the endocytosis of EGF itself or of transferrin, demonstrating that the receptor-mediated endocytotic pathway operated normally under conditions that blocked stimulated pinocytosis. Amiloride blocked EGF-stimulated pinocytosis in both HCO3(-)-containing and HCO3(-)-free media. The EGF-stimulated pinocytotic activity can frequently be localized to areas of the cell where membrane spreading and ruffling are taking place. These results demonstrate that (a) EGF induces a distinct amiloride-sensitive endocytotic pathway on A431 cells; (b) occupied EGF receptors do not utilize this pathway for their own entry; (c) endocytosis of occupied EGF receptors is not in itself sufficient to stimulate pinocytosis.