Longitudinal stability of JCV antibody index in Natalizumab treated people with multiple sclerosis.

OBJECTIVE: The aim of this study was to evaluate the evolution of JCV index over time in Natalizumab treated people with multiple sclerosis. MATERIALS AND METHODS: We retrospectively reviewed antibody index values from pwMS who were treated with Natalizumab for greater than six months and had at least two antibody results available between 2011 and 2019. Survival analysis was performed on those who were JCV index value negative at baseline to evaluate time to seroconversion. In pwMS who had index values available at 48 and/or 96 months post Natalizumab initiation, t-tests were performed to evaluate change in index over time. RESULTS: 1144 JCV antibody index results were available for 132 pwMS. Median time to seroconversion based on survival analysis was 103 months. Annualised seroconversion rate was 5.8%. Initial antibody index and rate of seroconversion did not differ with regards to age or gender. Antibody index increased significantly over time on treatment for the cohort as a whole, initial antibody index (0.27) to final antibody testing (0.86), t(131)=6.45, p<.0005. There was a significant increase in those with initial positive index value, between first (0.95) and final index (2.14), t(33) = 4.85, p<.0005 over a median of 77 months. CONCLUSIONS: In those who were seronegative at baseline there is a long median duration of treatment with Natalizumab prior to seroconversion. In individuals with positive JCV antibody index at treatment initiation, antibody index increases over time.

Insuficiencia ovárica primaria familiar asociada a una translocación X;autosoma / Familial primary ovarian insuffciency associated with X;autosomal translocation

La insuficiencia ovárica primaria (IOP) es una condición clínica que describe un estado de disfunción ovárica que se presenta antes de los 40 años. En el 8-9 % de las pacientes se han descripto anomalías del cromosoma X, tanto familiares como esporádicas. Estas incluyen anomalías numéricas como la monosomía o trisomía X, aneuploidías parciales como deleciones o isocromosomas, y anomalías estructurales como las translocaciones X;autosoma (TXA). Presentamos una paciente con diagnóstico de hipogonadismo hipergonadotrófico efectuado a los 18 años, en la que el estudio citogenético reveló un cariotipo 46,X,t(X;11)(q23;q22), interpretándose como una translocación X;autosoma balanceada con punto de ruptura en la región crítica para la función ovárica normal. A los 25 años de edad, bajo tratamiento hormonal sustitutivo cursó un embarazo. Nació una niña con crecimiento y desarrollo normales, con telarca y pubarca a los 11 años. A los 13 años y 3 meses, debido a una detención en el desarrollo puberal, se le diagnosticó un hipogonadismo hipergonadotrófico. El estudio citogenético detectó la traslocación X;autosoma balanceada heredada de su madre. Las mujeres con translocaciones X;autosoma balanceadas frecuentemente desarrollan falla ovárica prematura por interrupción de la región crítica del cromosoma X que se extiende entre Xq13 a Xq27. En conclusión, presentamos dos pacientes (madre e hija) con diagnóstico de una TXA balanceada, y discutimos los aspectos vinculados con las alteraciones de los segmentos del cromosoma X involucrados en el funcionamiento ovárico, así como las consecuencias para su eventual descendencia.

Primary Ovarian Insufficiency (POI) is a clinical condition characterized by ovarian dysfunction before 40 years of age. In 8-9 % of patients, both familial and sporadic chromosome abnormalities have been reported. These include numerical abnormalities such as monosomy or trisomy X, partial aneuploidies, such as deletions or isochromosomes, and structural abnormalities such as X;autosomal translocation (XAT). We report the case of a patient diagnosed with hypergonadotropic hypogonadism at the age of 18, whose cytogenetic study revealed a formula 46,X,t(X;11)(q23;q22), interpreted as an X;autosome balanced translocation with breakpoint in the critical region for normal ovarian differentiation. At the age of 25, under hormone replacement therapy, the patient became pregnant. She gave birth to a girl with normal growth and development, with thelarche and menarche at 11 years old. At the age of 13 years and 3 months, because of an arrest of pubertal development, she was diagnosed with hypergonadotropic hypogonadism. The cytogenetic study detected the X;autosome balanced translocation inherited from her mother. Women with X;autosome balanced translocation frequently develop premature ovarian failure because of breakpoints in the critical region of the X chromosome from Xq13 to Xq27. In conclusion, we report the case of two patients (mother and daughter) with a diagnosis of XAT, and discuss molecular genetics issues related to alterations of X chromosome segments involved in ovarian function, as well as the consequences for potential offspring.

Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis.

OBJECTIVE: To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis. DESIGN: Analysis of prospective observational data. SETTING: Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred. PARTICIPANTS: All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated. METHODS: During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing of M tuberculosis isolates was performed by restriction fragment-length polymorphism analysis. RESULTS: We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing). CONCLUSIONS: We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.

Sensitisation of human carcinoma cells to the prodrug CB1954 by adenovirus vector-mediated expression of E. coli nitroreductase.

The enzyme nitroreductase from E. coli can reduce the weak, monofunctional alkylating agent 5-(aziridin-1-yl)-2, 4-dinitrobenzamide (CB1954) to a potent cytotoxic species that generates interstrand crosslinks in DNA. Nitroreductase therefore has potential as a "suicide enzyme" for cancer gene therapy, as cells that express nitroreductase become selectively sensitive to the prodrug CB1954. We have incorporated a nitroreductase expression cassette into a replication-defective adenovirus vector (Ad-CMV-ntr), which allowed efficient gene transfer to SK-OV-3 or IGROV-1 ovarian carcinoma cells. Nitroreductase levels increased in line with multiplicity of infection, and this was reflected in increasing sensitisation of the cells to CB1954, reaching an optimum (approx. 2, 000-fold sensitisation) with 25-50 p.f.u. per cell. Similar Ad-CMV-ntr-dependent sensitisation to CB1954 was seen in 3 of 6 low-passage primary ovarian tumour lines. Cells grown at low-serum concentration to inhibit proliferation remained equally susceptible to the Ad-CMV-ntr-dependent cytotoxicity of CB1954, indicating a distinct advantage over retroviral gene delivery and other popular enzyme-prodrug systems for human tumours with a low rate of cell proliferation. Additionally, cisplatin-resistant cells were sensitised towards CB1954 by Ad-CMV-ntr as efficiently as the parental cells, indicating that the system could be effective in patients with cisplatin-resistant tumours. In a murine xenograft model for disseminated peritoneal carcinomatosis with ascites, treatment of nude mice bearing intraperitoneal SUIT2 tumours with Ad-CMV-ntr and CB1954 almost doubled the median survival from 14 to 26 days (p < 0.0001).

Improved titers of retroviral vectors from the human FLYRD18 packaging cell line in serum- and protein-free medium.

The influence of serum on the production of retroviral vectors by the HT1080 human fibrosarcoma-derived packaging cell line FLYRD18 was investigated. A fourfold increase in virus titer was observed under serum-free conditions, as compared with medium supplemented with 10% fetal calf serum. A similar improvement was also seen for bulk transduction efficiency. Serum had a negative and dose-dependent effect on titer without affecting cell growth, virus stability, or infectivity. In contrast to virus from NIH 3T3-derived packaging cells [Hanenberg, H., et al. (1996). Nature Med. 2, 876-882], the FLYRD18-derived virus did not adhere to fibronectin or serum proteins adsorbed at the surface of culture flasks. Electron microscopy supports the conclusion that the effect of serum is at the level of virus production by the cells. Addition of soybean trypsin inhibitor had an inhibitory effect on virus production, while pretreatment of serum with trypsin was found to enhance the retroviral titer. These results suggest that protease inhibitors present in serum may be responsible for the inhibition of virus production. The exact mechanism remains, however, to be determined. As compared with medium supplemented with 10% serum, the combination of increased virus titer and absence of exogenous protein under serum-free conditions resulted in a 300-fold increase in the virus:total protein ratio in the supernatants harvested from the FLYRD18 packaging line. This improvement enhances prospects for further concentration and purification of the virus.

Adenoviral delivery of B7-1 (CD80) increases the immunogenicity of human ovarian and cervical carcinoma cells.

The majority of tumour cells do not express immune costimulatory molecules and this may account for their inability to stimulate directly an antitumour T cell response. Here we report on the construction of a recombinant E1/E3-deleted adenovirus encoding the human B7-1 costimulatory molecule. We explored the use of this vector for gene transfer to a number of human ovarian and cervical tumour cell lines, and to primary ovarian tumour material. Rapid and efficient gene transfer and expression was obtained in the majority of cases using a multiplicity of infection of 30 plaque forming units per cell. B7-1 expression was detectable at the cell surface within 12 h and was still detectable 10 days after infection. The immunogenicity of gene-modified tumour cells was tested in an allogeneic mixed lymphocyte tumour cell culture. Tumour cells expressing B7-1 were found to induce significantly higher levels of T cell proliferation than tumour cells modified with a control adenovirus carrying the beta-galactosidase gene. B7-1-induced T cell proliferation could be blocked by the addition of anti-B7-1 antibodies at the initiation of cocultures. These results support the rationale for use of adenovirally delivered B7-1 for genetic immunotherapy of ovarian and cervical cancer.

Virus directed enzyme prodrug therapy for ovarian and pancreatic cancer using retrovirally delivered E. coli nitroreductase and CB1954.

Expression of the E. coli enzyme nitroreductase (NTR) in tumour cells enables them to activate the prodrug CB1954 (5-(aziridin-1-yl)-2,4-dinitrobenzamide), leading to interstrand DNA crosslinking and cell death. Using transfected or retrovirally transduced SKOV3 ovarian carcinoma cell clones, we show a strong correlation between sensitivity to CB1954 and level of NTR enzyme activity. Importantly for clinical application in ovarian cancer, a cisplatin-resistant ovarian tumour cell line remains as susceptible to the NTR-dependent cytotoxicity of CB1954 as parental cells. In mixed populations of NTR-expressing and non-expressing cells, we observe a marked 'bystander killing' effect with this system. The use of NTR-encoding retroviruses from clonal producer cell lines at titres of 5 x 10(5) c.f.u./ml to transduce either established or low passage primary ovarian carcinoma lines only achieves an average 10-fold sensitisation of the cultures at gene transfer efficiencies of 15-25%. Concentration of the retrovirus to 3 x 10(7) c.f.u./ml elevates gene transfer to 80-90% in a single exposure to target cells, resulting in up to 500-fold sensitisation of the entire, unselected SKOV3 population to CB1954. In an initial investigation of NTR/CB1954 for the treatment of tumours in vivo, we observe regression of tumours expressing NTR following administration of CB1954, resulting in significantly increased median survival.

Assessing individual risk for breast cancer: risky business.

There is increasing demand for prediction of individual women's risk for breast cancer from women, clinicians, researchers, and health planners. Risk assessment for breast cancer is the process of identifying characteristics of an individual woman that are relevant to her risk, and combining those characteristics into a quantitative or qualitative risk profile. This article reviews and compares available methods of predicting risk, discusses benefits and drawbacks to the methods, and compares risk estimates for several hypothetical subjects using the different methods. Current and future uses for risk assessment are described. Risk assessment, while a promising tool for research now, and for clinical areas in the future, is still too imprecise for accurate prediction of breast cancer occurrence in individuals.

Glucose stimulates the activity of the guanine nucleotide-exchange factor eIF-2B in isolated rat islets of Langerhans.

Over short time periods glucose controls insulin biosynthesis predominantly through effects on preexisting mRNA. However, the mechanisms underlying the translational control of insulin synthesis are unknown. The present study was carried out to determine the effect of glucose on the activity and/or phosphorylation status of eukaryotic initiation and elongation factors in islets. Glucose was found to increase the activity of the guanine nucleotide-exchange factor eIF-2B over a rapid time course (within 15 min) and over the same range of glucose concentrations as those that stimulate insulin synthesis (3-20 mM). A nonmetabolizable analogue of glucose (mannoheptulose), which does not stimulate insulin synthesis, failed to activate eIF-2B. The best characterized mechanism for modulating eIF-2B activity involves changes in the phosphorylation of the alpha-subunit of its substrate eIF-2. However, in islets, no change in eIF-2 alpha phosphorylation was seen under conditions where eIF-2B activity was increased, implying that glucose regulates eIF-2B via an alternative pathway. Glucose also did not affect the phosphorylation states of three other regulatory translation factors. These are the cap-binding factor eIF-4E, 4E-binding protein-1, and elongation factor eEF-2, which do not therefore seem likely to be involved modulating the translation of the preproinsulin mRNA under these conditions.

Implementing a tuberculosis control program.

Between January 1989 and December 1990, 26 patients acquired multidrug-resistant tuberculosis at our institution. Their exposures occurred when they were admitted to a ward where a patient with acid fast bacillus smear-positive pulmonary tuberculosis was also admitted. In 20 cases, the infectious patients were not isolated until the sputum smears were positive. When the outbreak was recognized in the spring of 1990, the infection control department undertook a risk assessment and instituted measures that would become the tuberculosis control program. Since then, administrative and environmental controls have been implemented, education programs are ongoing, personal protective equipment is in use, and a more aggressive employee health testing program is underway. The steps we took and the barriers we had to overcome to implement our plan are included in this article.

Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital.

OBJECTIVE: To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB). DESIGN: Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms). SETTING: A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States. PARTICIPANTS: All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients. RESULTS: The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P = 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P = 0.15), although the difference was not statistically significant. CONCLUSIONS: Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

Use of advance directives: a survey in three clinics.

Advance directives (ADs) are instructions from patients to their physician and family regarding their wishes for medical care in the event they become incapable of communicating those wishes. This study sought to describe the characteristics of adults who have completed advance directives and those who have expressed interest in them, and to determine what distinguishes these groups from the group with no interest in ADs. A further objective was to survey the study population on the barriers to completion of ADs. A random sample of 160 outpatients visiting one of three clinics (General Internal Medicine Clinic (GIM), HIV Clinic, and Oncology Clinic) were selected for the study. A 10-item questionnaire was administered which included questions on familiarity with, sources of information on, and interest in ADs. Demographic information was collected as well as information on subject experiences with illness and death. Twenty-six of the 160 participants (16%) had completed ADs. The prevalence of completion differed among the three clinics: HIV Clinic 25%, Oncology Clinic 18%, and GIM Clinic 8%. Nearly all patients (95%) expressed interest in ADs. Those not interested in ADs were more likely than those who were interested or those who had already completed ADs to have been in an intensive care unit themselves. Multiple barriers to completing ADs were identified. Advance directives are still used by relatively few people despite a general openness and interest in them. Few characteristics, demographic and otherwise, were identified to distinguish those who completed ADs from those who did not.

Glucose modulates the binding activity of the beta-cell transcription factor IUF1 in a phosphorylation-dependent manner.

In the human insulin gene, three regulatory sequences upstream of the transcription start site at -77 (the CT1 box), -210 (the CT2 box), and -315 (the CT3 box) bind a beta-cell-specific transcription factor, IUF1. Recent studies have mapped a glucose response element to a CT-like sequence in the rat insulin I gene. The present study was therefore undertaken to ascertain the role of IUF1 in glucose-stimulated insulin gene transcription. IUF1-binding activity was measured by electrophoretic mobility shift assay using the CT2 box as probe. When freshly isolated rat islets of Langerhans were incubated in medium containing low concentrations (3 mM) of glucose IUF1 activity fell to undetectable levels within 6 h. In high (20 mM) glucose IUF1 activity remained constant over a 24 h period. The loss of IUF1 activity was reversible. Thus when islets were incubated for 4 h in low glucose and transferred to high glucose, IUF1 levels recovered within 15 min. This effect was dependent on glucose metabolism as it was inhibited by mannoheptulose. Incubation of islets for 4 h in low concentrations of glucose supplemented with phosphatase inhibitors prevented the fall in IUF1 activity. No recovery in IUF1 activity was observed when islets were treated for 4 h with low glucose and then for a further 1 h with low glucose and dibutyryl cyclic AMP, or forskolin, or the phorbol ester phorbol 12-myristate 13-acetate. These results demonstrate that the IUF1-binding activity in islets of Langerhans is modulated by glucose in a phosphorylation-dependent manner, and that protein kinase A or protein kinase C are not involved. Finally, IUF1 was shown to be immunologically related to a recently cloned factor, IPF1, that binds to a CT-like sequence in the rat insulin I gene promoter.

Variation at the apo AI/CIII/AIV gene complex is associated with elevated plasma levels of apo CIII.

A number of studies have reported that a variant allele (S2) of the apo AI/CIII/AIV complex is associated with high plasma lipid levels in some populations and furthermore that the frequency of this allele is 2-5-fold higher in patient groups with premature coronary heart disease compared to control groups. This study shows in the healthy "English" population that the S2 allele is associated with elevated plasma apo CIII levels but not with low apo AI levels. In addition, it shows that the allele is associated with elevated plasma levels of apo B in men. Regression analysis shows in both men and women that apo CIII levels are positively correlated with plasma triglyceride levels and moreover that they are a stronger predictor of this parameter than apo AI, B or AIV. Apo CIII levels are also an independent predictor of total plasma cholesterol and HDL-cholesterol levels in males and females, respectively. Together these data suggest that a genetic predisposition to develop elevated plasma levels of apo CIII, alone or in combination with elevated plasma apo AIV levels, is the primary defect responsible for the association of the S2 allele with hyperlipidemia and/or premature CHD.

Monoclonal antibodies to ROS 17/2.8 cells recognize antigens, some of which are restricted to osteoblasts and chondrocytes.

We have raised a panel of 15 monoclonal antibodies (MAbs) recognizing cell surface antigens of the rat osteoblast-like cell line ROS 17/2.8. The MAbs were selected on the basis of preferential binding to ROS 17/2.8 cells compared to ROS 25/1 cells. Immunohistochemical studies of antigen localization on cryostat sections of rat calvaria, long bone, and soft tissues demonstrated that five of these MAbs, UBIM 1, 2, 3, 12, and 17, recognize antigens that are restricted to normal rat osteoblasts and chondrocytes. The antigens appear to be localized to the cell surface of the osteoblast, with no apparent staining of bone matrix in either undecalcified or decalcified sections. In vitro, these MAbs recognize cell surface antigens present on two additional cell lines, ROS 24/1 and Rat 2 cells, and on the adherent cell population cultured from rat long bone marrow. Of these MAbs, three (UBIM 1, 2, and 3) recognize high-molecular-weight antigens of Mr 200,000-225,000. This study has also identified cell surface antigens of ROS 17/2.8 cells that are not expressed by osteoblasts in vivo. MAbs UBIM 9 and 21 bind to marrow cells in long bone sections, to the 7-day-old nonadherent cell population from cultured marrow, and to lymphoid tissue in sections of spleen. Another four MAbs (UBIM 10, 11, 14, and 22) bind to a variety of cells and tissues both in vitro and in vivo. Studies of the interactions of this panel of MAbs with osteogenic tissues and cell lines may have an important impact on the understanding of osteoblast physiology.