Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children.

OBJECTIVES: In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. METHODS: Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. RESULTS: Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 µSv for DXA and 232.7 µSv for radiographs. Image quality was similar. CONCLUSION: Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children. KEY POINTS: • Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs. • The rate of unreadable vertebrae for DXA is lower than for radiographs. • Effective dose of DXA is significantly lower than radiographs. • Children prefer DXA to radiographs. • Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.

Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?

BACKGROUND: Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. OBJECTIVE: To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. MATERIALS AND METHODS: Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. RESULTS: Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming. CONCLUSION: Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures.

Short communication: Bovine-derived proteins activate STAT3 in human skeletal muscle in vitro.

Bovine milk contains biologically active peptides that may modulate growth and development within humans. In this study, targeted bovine-derived proteins were evaluated for their effects on signal transducer and activator of transcription-3 (STAT3) phosphorylation in human skeletal muscle cells. Following an acute exposure, bovine-derived acidic fibroblast growth factor-1 (FGF) and leukemia inhibitory factor (LIF) activated STAT3 in differentiating myotubes. Chronic exposure to FGF and LIF during the proliferative phase reduced myoblast proliferation and elevated MyoD and creatine kinase (CKM) mRNA expression without altering apoptotic genes. In mature myotubes, neither FGF nor LIF elicited any action. Together, these data indicate that a reduction in proliferation in the presence of bovine-derived FGF or LIF may stimulate early maturation of myoblasts.

The tammar wallaby and fur seal: models to examine local control of lactation.

Mammary development and function are regulated by systemic endocrine factors and by autocrine mechanisms intrinsic to the mammary gland, both of which act concurrently. The composition of milk includes nutritional and developmental factors that are crucial to the development of the suckled young, but it is becoming increasingly apparent that milk also has a role in regulating mammary function. This review examines the option of exploiting the comparative biology of species with extreme adaptation to lactation to examine regulatory mechanisms that are present but not readily apparent in other laboratory and livestock species. The tammar wallaby has adopted a reproductive strategy that includes a short gestation (26 d), birth of an immature young, and a relatively long lactation (300 d). The composition of milk changes progressively during the lactation cycle, and this is controlled by the mother and not the sucking pattern of the young. Furthermore, the tammar can practice concurrent asynchronous lactation; the mother provides a concentrated milk high in protein and fat for an older animal that is out of the pouch and a dilute milk low in fat and protein but high in carbohydrates from an adjacent mammary gland for a newborn pouch young. This phenomenon suggests that the mammary gland is controlled locally. The second study species, the Cape fur seal, has a lactation characterized by a repeated cycle of long at-sea foraging trips (up to 28 d) alternating with short suckling periods of 2 to 3 d ashore. Lactation almost ceases while the seal is off shore, but the mammary gland does not progress to apoptosis and involution, most likely because of local control of the mammary gland. Our studies have exploited the comparative biology of these models to investigate how mammary function is regulated by endocrine factors, and particularly by milk. This review reports 3 major findings using these model animals. First, the mammary epithelial cell has an extraordinary intrinsic capacity for survival in our culture model, and the path to either function or death by apoptosis is actively driven. The second outcome is that the route to apoptosis is most likely regulated by specific milk factors. Finally, whey acidic protein, a major milk protein in some species, may play a role in normal mammary development, but that role in vivo may be limited to marsupials. Evolutionary pressure has led to changes in the structure of the protein with an accompanying change in function. Therefore, we propose that a loss of function of this protein in eutherians may relate to a reproductive strategy that is less dependent on lactation.

The neuronal apoptosis inhibitory protein suppresses neuronal differentiation and apoptosis in PC12 cells.

The human neuronal apoptosis inhibitory protein (NAIP) gene has been discovered as a candidate gene for spinal muscular atrophy, a genetic disorder characterized by motor neuron loss in the spinal cord. The telomeric NAIP gene on human chromosome 5 is deleted together with survival motor neurons (SMN) in many cases of the most severe forms of the disorder. NAIP, c-IAP1 (inhibitor of apoptosis-1), c-IAP2, X-IAP, survivin and Apollon comprise the mammalian inhibitors of the apoptosis family and contain an N-terminal domain with 1-3 imperfect repeats of an approximately 65 amino acids domain named the baculovirus IAP repeat (BIR) motif. We identified six NAIP genes in the mouse genome which were found to be expressed in a broad range of tissues. Furthermore, we have investigated the effects of NAIP in the rat pheochromocytoma PC12 cell line. These cells differentiate in the presence of nerve growth factor (NGF) into cells that resemble sympathetic neurons. We observed that NAIP overexpression impaired NGF-induced neurite outgrowth. The BIR motifs of NAIP (residues 1-345) were not required for this effect. However, the BIR domains of NAIP were essential to prevent apoptosis in PC12 cells after NGF deprivation or TNF-alpha receptor stimulation. Expression of full-length but not BIR-deleted-NAIP protects against cell death. This correlates with reduced activity of the cell death effector protease, caspase-3, in lysates of NAIP-PC12 cells, as measured by cleavage of the fluorogenic tetrapeptide substrate Asp-Glu-Val-Asp. Thus, unregulation of cellular differentiation and/or caspase suppression may contribute to motoneuron dysfunction and cell death in spinal muscular atrophy where NAIP is mutated.

The anti-apoptotic protein ITA is essential for NGF-mediated survival of embryonic chick neurons.

The avian ITA is homologous to the baculoviral and mammalian inhibitor of apoptosis (IAP) proteins, which can prevent apoptosis by inhibition of specific caspases. We investigated the role of ITA in embryonic chick sympathetic and dorsal root ganglionic neurons, which depend on nerve growth factor (NGF) for their survival. Within 6 hours, NGF upregulated ITA protein production more than 25-fold in sensory and sympathetic neurons. Overexpression of ITA in primary neurons supported survival of these cells in the absence of NGF, and ita antisense constructs inhibited NGF-mediated survival. Thus the induction of ITA expression seems to be an essential signaling event for survival of sympathetic and dorsal root ganglionic sensory neurons in response to NGF.

Coadministration of IFN-gamma enhances antibody responses in chickens.

The development of new generation vaccines has focused on the use of natural immunologic adjuvants that are capable of enhancing a protective immune response. The use of cytokines as immunomodulators in livestock animals, particularly poultry, is becoming more feasible with the recent cloning of several cytokine genes and the progression of new delivery technologies, such as live vectors and DNA delivery. Given that chickens are reared under intensive conditions that are conducive to infection by opportunistic pathogens, the primary mechanism for disease control in poultry is early and effective vaccination. However, many poultry vaccines offer only short-term protection or give nonuniform responses within flocks. We have developed a model system with which to measure the adjuvant potential of cytokines in chickens. This involves measuring antibody levels following coadministration of chicken interferon-gamma (Ch-IFN-gamma) with sheep red blood cells (SRBC). Groups of SPF and commercial broiler birds were injected with two different doses of SRBC with and without coadministration of Ch-IFN-y. Three weeks later, all birds were boosted with SRBC alone. Sera were collected weekly and anti-SRBC antibody titers (total Ig and IgG) were determined by hemagglutination. Priming Ch-IFN-gamma resulted in enhanced primary and secondary (IgG) antibody responses that persisted at higher levels when compared with birds that received SRBC alone. Second, coadministration of Ch-IFN-y allowed a 10-fold lower dose of antigen to be as effective as a high dose of antigen that was given without Ch-IFN-gamma. Third, treatment with Ch-IFN-y resulted in an increase in the proportion of birds responding to antigen challenge. These results suggest the potential use for Ch-IFN-gamma as a vaccine adjuvant.

Potential use of cytokine therapy in poultry.

Newly hatched chickens are highly susceptible to infection during the first 2 weeks of life. The utilisation of cytokines as therapeutic agents in livestock animals, in particular poultry, has become more feasible with the recent cloning of cytokine genes and the progression of new technologies such as live vectors. We have constructed a live recombinant fowlpox virus (FPV) that expresses chicken myelomonocytic growth factor (fp/cMGF). Administration of fp/cMGF to chicks resulted in a marked and sustained increase in the number of circulating blood monocytes as well as an increase in their state of activation, as measured by enhanced phagocytic activity and elevated production of nitric oxide. We have recently cloned the gene for chicken interferon-gamma (ChIFN-gamma). Recombinant ChIFN-gamma was capable of protecting chick fibroblasts from undergoing virus-mediated lysis and induced nitrite secretion from chicken macrophages in vitro. Preliminary vaccination trials have indicated that co-administration of ChIFN-gamma with antigen (sheep red blood cells) resulted in enhanced secondary (IgG) antibody responses and allowed a 10-fold lower dose of antigen to be used. Furthermore, administration of ChIFN-gamma resulted in enhanced weight gain in chicks and improved their resistance to disease challenge. The ability of cytokines to combat infection and enhance vaccine efficacy makes them excellent candidates as a therapeutic agents and adjuvants.

Expression of the inhibitor of T-cell apoptosis (ita) gene in hen ovarian follicles during development.

It is now well established that within the hen ovary, preovulatory follicles rarely become atretic and that granulosa cells from preovulatory follicles are relatively resistant to undergoing apoptosis in vitro. By comparison, prehierarchal (< or = 8-mm diameter) follicles are highly susceptible to becoming atretic in vivo, and approximately 70% of granulosa cells collected from 3- to 8-mm-diameter follicles rapidly undergo apoptosis when incubated for as little as 6 h in vitro in defined medium. The present studies were conducted to characterize expression of an inhibitor of apoptosis (iap) gene, inhibitor of T-cell apoptosis (ita), within hen follicle tissues at various stages of follicle development. The ita gene product has recently been shown to share homology within both the baculovirus repeat sequences of the N-terminus and the zinc ring-finger motif from the C-terminus and was originally determined to be expressed in chicken cells of T-lymphocyte lineage. In the present studies, highest levels of ita mRNA within the granulosa cell layer were found in preovulatory (atresia-resistant) follicles, with significantly lower levels detected in prehierarchal follicles. After 24 h of primary culture, ita mRNA levels increased in granulosa cells from preovulatory follicles by 3.2-fold as compared to those in freshly collected cells and were elevated by 8.9-fold in those granulosa cells from 6- to 8-mm follicles that successfully formed a primary culture monolayer. Moreover, ita mRNA levels were significantly increased in 6- to 8-mm-follicle granulosa cells after only 2 h of suspension culture, and this increase could be prevented by actinomycin D. This spontaneous increase in ita expression may serve to protect from cell death the relatively small population of prehierarchal follicle granulosa cells that survive in vitro. It is concluded from these data, taken together, that patterns of ita mRNA expression during follicle development are consistent with a potential role for this gene in protecting granulosa cells from apoptosis and thus maintaining follicle viability.

In vivo effects of chicken interferon-gamma during infection with Eimeria.

Newly hatched chickens are highly susceptible to infection by opportunistic pathogens during the first 1 or 2 weeks of life. The use of cytokines as therapeutic agents has been studied in animal models as well as in immunosuppressed patients. This approach has become more feasible in livestock animals, in particular poultry, with the recent cloning of cytokine genes and the development of new technologies, such as live delivery vectors. We have recently cloned the gene for chicken interferon-gamma (Ch-IFN-gamma). Poly-HIS-tagged recombinant Ch-IFN-gamma was expressed in Escherichia coli, was purified by Ni chromatography, and was found to be stable at 4 degrees C and an ambient temperature for at least several months and Several weeks, respectively. Ch-IFN-gamma was capable of protecting chick fibroblasts from undergoing virus-mediated lysis, induced nitrite secretion from chicken macrophages in vitro, and enhanced MHC class II expression on macrophages. Administration of recombinant Ch-IFN-gamma to chickens resulted in enhanced weight gain over a 12-day period. Furthermore, the therapeutic potential of Ch-IFN-gamma was assessed using a coccidial challenge model. Birds were treated with Ch-IFN-gamma or a diluent control and then infected with Eimeria acervulina. Infected birds treated with Ch-IFN-gamma showed improved weight gain relative to noninfected birds. The ability of Ch-IFN-gamma to enhance weight gain in the face of coccidial infection makes it an excellent candidate as a therapeutic agent.

Measurement of radical production as a result of cavitation in medical ultrasound fields.

This paper describes the use of the terephthalate dosimeter to measure the threshold and extent of cavitation arising from medical ultrasound sources at high frequencies. Significant hydroxyl radical production was noted from a physiotherapy source and low level activity was also detected when using a pulsed, diagnostic type transducer system. The effect of sound intensity and the type of field is described. The possibility of using polymer degradation to monitor the cavitation is also discussed.

ITA, a vertebrate homologue of IAP that is expressed in T lymphocytes.

Apoptosis plays a crucial role in both the development and the control of the immune system. During T lymphocyte development, thymocytes undergo apoptosis as part of the process of elimination of self-reactive clones. Mature T cells also undergo apoptosis following antigen-stimulated proliferation as part of a mechanism that controls the immune response. Apoptosis also provides a defense mechanism against viruses whereby the rapid death of virus-infected cells reduces virus spread. Viruses, on the other hand, often express proteins that inhibit apoptosis of their host cells, thereby enhancing their infectivity. We have isolated a novel gene, ita (inhibitor of T cell apoptosis), which is a vertebrate homologue of the viral apoptosis inhibitor IAP. Expression of ita appears to be restricted to cells of the T lymphocyte lineage, and high levels of ita mRNA are induced within 4-8 hr of T cell activation. Immunohistologic studies show that medullary and cortical thymocytes express detectable levels of ITA. ITA is a 69 kDa protein that contains a C-terminal ring-finger motif that is found in several oncogenic proteins and N-terminal repeat elements that have only been reported in other apoptosis inhibitors. These findings suggest that ITA may play a role in controlling apoptosis in T cells.

In vitro characterization of a novel avian haemopoietic growth factor derived from stromal cells.

To better define the role of the chicken haemopoietic microenvironment in supporting haemopoiesis, a continuous cell line was generated by RSV transformation of avian spleen stromal cells (SSL-1). Supernatants from this line were found to contain haemopoietic growth factor activity as measured by the ability to induce proliferation and differentiation of precursor cells present in embryonic and post-hatched haemopoietic tissues. Comparison of cultures grown in the presence of cMGF and SSL-1 conditioned media (CM) revealed that both cytokine sources induced similar types of cell populations. Both sources supported the proliferation of predominantly macrophage-like cells based on colony morphology, differential staining, non-specific esterase staining, and phagocytosis activity. Interestingly, SSL-1 does not express any message for cMGF, nor does it secrete any IL-2 or interferon activities suggesting that the growth factor activities seen in SSL-1 are novel.

Technical note: measurement of collapse cavitation in ultrasound fields.

This note describes a method for the measurement of hydroxyl free radical concentration due to collapse acoustic cavitation in medical ultrasound fields using aqueous terephthalic acid (TA) solution. An enclosed cylindrical chamber with acoustically transparent membranes at either end was used. Control of cavitation activity was achieved by seeding the solution with polystyrene microspheres to provide cavitation centres. Insonation experiments using unseeded TA previously exposed to air gave very variable results, sometimes detecting cavitation activity and at other times detecting nothing, under the same exposure conditions. Introduction of polystyrene microsphere seeds into the TA enabled it to detect reproducibly levels of cavitation activity at least one order of magnitude higher than in unseeded solutions. An experiment using the seeded TA in a standing wave ultrasound field, set up using a brass reflecting plate, demonstrated that the presence of a standing wave inhibited the measured cavitation yield.

Production of interferon-gamma by chicken T cells.

In mammals, interferon (IFN)-alpha/beta (type I) is typically resistant to exposure to heat and low pH, whereas IFN-gamma (type II) is labile. Type I IFN has been described in birds; however, the existence of type II IFN has been questioned. We have generated cloned chicken T cell lines that produce high levels of IFN and have studied the physiochemical properties of this IFN activity to determine whether it represents the type I or type II IFN found in mammals. When incubated at 60 degrees C, the IFN activity present in the supernatants from these chicken T cells was found to be labile, two-thirds of the activity being lost within 1-2 minutes. Consistent with IFN-gamma activity, this heat-labile IFN was also sensitive to exposure to pH 2. The heat-resistant IFN lost activity at a much slower rate (half-life > 2 h at 60 degrees C) and was also resistant to exposure to pH 2, which is characteristic of IFN-alpha/beta. To confirm further the presence of IFN-gamma activity, these T cell supernatants were assayed for their ability to activate macrophages as measured by induction of nitrite production. Consistent with mammalian IFN-gamma, the nitrite-inducing activity was found to be heat labile, with over 90% of the activity lost within 5 minutes of heating. These results show that chicken T cells produce IFN-gamma.

Cloning and expression of the chicken interferon-gamma gene.

We have cloned the gene for chicken interferon-gamma (ChIFN-gamma) from a cDNA expression library generated from a T cell line (CC8.1h) that produces high levels of IFN-gamma activity. CC8.1h constitutively produces IFN activity that shares physiochemical properties with mammalian IFN-gamma. ChIFN-gamma, when secreted by CC8.1h or expressed in transfected COS cells, is heat labile, inactivated by exposure to pH 2, and capable of inducing nitrite production by chicken macrophages. These properties clearly distinguish it from chicken and mammalian type I IFN. The ChIFN-gamma gene codes for a predicted mature protein of 145 amino acids with a molecular mass of 16.8 kD. There are two potential N-glycosylation sites located near the N terminus. ChIFN-gamma protein shares significant amino acid homology with mammalian IFN-gamma proteins; in particular it also contains the highly conserved motifs that are present in all mammalian IFN-gamma proteins. ChIFN-gamma is 35 and 32% identical to the equine and human counterparts, respectively, but shares only 15% homology with chicken type I IFN. These findings show that the emergence of the two principal types of IFN predates the divergence of avians and mammals that occurred some 350 million years ago.