A randomized, double blind, comparative trial of micafungin (FK463) vs. fluconazole for the treatment of oesophageal candidiasis.

AIM: To determine efficacy and safety of intravenous micafungin vs. intravenous fluconazole in the treatment of oesophageal candidiasis. METHODS: A total of 523 patients > or =16 years with documented oesophageal candidiasis were randomized (1:1) in this controlled, non-inferiority study to receive either micafungin (150 mg/day) or fluconazole (200 mg/day). Response was evaluated clinically and endoscopically. Post-treatment assessments were performed at 2 and 4 weeks after discontinuation of therapy. RESULTS: Median duration of therapy was 14 days. For the primary end-point of endoscopic cure, treatment difference was -0.3% (micafungin 87.7%, fluconazole 88.0%). Documented persistent invasive disease at the end of therapy was reported in 2.7% and 3.9% of patients, respectively. Both 84.8% of micafungin and 88.7% of fluconazole patients remained recurrence free at 4-weeks post-treatment. The overall therapeutic response rate was 87.3% for micafungin and 87.2% for fluconazole. The incidence of drug-related adverse events was 27.7% for micafungin and 21.3% for fluconazole. Six (2.3%) micafungin- and two (0.8%) fluconazole-treated patients discontinued therapy; rash was the most common event leading to discontinuation. CONCLUSION: Intravenous micafungin (150 mg daily) is well tolerated and as efficacious as intravenous fluconazole (200 mg daily) in the primary treatment of oesophageal candidiasis, achieving high rates of clinical and endoscopic cure.

Annexins V and VI: major calcium-dependent atrial secretory granule-binding proteins.

Atrial natriuretic peptide is stored by atrial myocytes in secretory granules, known as atrial specific granules, and is released from these granules by exocytosis. We have isolated a group of atrial proteins by affinity chromatography that bind to atrial specific granules in a calcium-dependent manner. The two major proteins isolated (32.5 kd and 67 kd) are calcium-binding proteins and have been identified as annexins V and VI by immunoblotting with specific antisera. The calcium dependence of their binding to atrial specific granules has been characterized in vitro and indicates that this interaction takes place at micromolar levels of calcium. In addition, the group of proteins isolated includes another calcium-binding protein of 20 kd, as well as GTP-binding proteins of 22 to 26 kd. Membrane interactions during exocytosis are presumably mediated by the interaction of specific proteins with the granule membrane. The properties of the proteins described here, and their ability to bind to atrial specific granules in a calcium-dependent manner, make them likely candidates in the search for regulatory proteins mediating atrial natriuretic peptide secretion.

Improved method for the routine identification of toxigenic Escherichia coli by DNA amplification of a conserved region of the heat-labile toxin A subunit.

This report describes a DNA amplification procedure for routine identification of heat-labile-toxin-producing Escherichia coli. Two oligonucleotide primers were used in a polymerase chain reaction procedure to amplify a highly conserved region of the A subunit of the heat-labile enterotoxin gene. Amplifications were done directly on E. coli colonies from plates when Salmonella, Shigella, or parasite infections were excluded as agents of the severe diarrhea in the patients. The conditions for the polymerase chain reaction method were empirically determined, and the procedure is inexpensive, sensitive, and specific. Positive results can be obtained over a wide variation in bacterial numbers, with no inhibition of Thermus aquaticus DNA polymerase. Detection of the amplified product can be done by agarose gel electrophoresis, which is specific and sensitive enough for routine diagnosis of this pathogen in clinical isolates. If greater sensitivity and specificity are required, hybridization with 32P- or alkaline phosphatase-labeled oligonucleotide probes can be used. Our results suggest that heat-labile-toxin-producing E. coli is responsible for about 9% of nondiagnosed diarrhea cases in Tygerberg Hospital, Tygerberg, Republic of South Africa.

No evidence for point mutations in codons 12, 13, and 61 of the ras gene in a high-incidence area for esophageal and gastric cancers.

The molecular mechanisms underlying the induction of esophageal and gastric cancer are not yet understood. It is possible that different etiological factors from geographically distinct areas play a role in the onset of these cancers. Twenty-seven primary esophageal and 11 gastric cancers originating from the high-incidence areas of South Africa were analyzed for the presence of ras protooncogene mutations. We found no evidence for mutations in codons 12, 13, or 61 or the H-ras, K-ras, and N-ras genes in these primary cancers. Our results indicate that etiological factors such as fungal contamination of basic foodstuffs in a high-incidence area for these cancers do not play a role in the activation of ras genes and that mutations in these genes are not directly involved in the development of primary esophageal and gastric cancers in the South African population.

Increased intracellular Ca2+ is necessary for maximal expression of the proto-oncogene c-jun in the Jurkat T-cell line.

The time course and signal-transduction requirements for proto-oncogene c-jun expression in T-cells were investigated. Expression of c-jun mRNA was evident at 30 min after stimulation. Both the activation of Ca2+/phospholipid-dependent kinase as well as an increased intracellular free Ca2+ concentration were necessary for the maximal induction of c-jun mRNA and synthesis of Jun protein 1 h after stimulation.

Linkage study of the low-density lipoprotein-receptor gene and cholesterol levels in an Afrikaner family. Quantitative genetics and identification of a minor founder effect.

Overlap of clinical and biochemical characteristics between hypercholesterolaemia in members of the general population and familial hypercholesterolaemic (FH) individuals may lead to misdiagnosis. Quantitative analysis of family data may circumvent this problem. A way of looking for an association between plasma cholesterol levels and restriction fragment length polymorphism markers (RFLP) on the low-density lipoprotein (LDL) receptor gene by using reference cholesterol distributions was explored. Linkage, with a logarithm of the odds (LOD) score of 6.8 at theta 0, was detected between cholesterol levels and the LDL receptor in an extended Afrikaner family. Two RFLP-haplotypes, one previously found in a majority of Afrikaner FH homozygotes, and a second, Stu I-, BstE II+, Pvu II+, Nco I+, were associated with high cholesterol levels in this pedigree.

Autoantibodies from patients with systemic lupus erythematosus can affect DNA and RNA synthesis in cultured cells.

Sera reacting positively for anti-DNA antibodies from systemic lupus erythematosus (SLE) patients were tested for their effect on DNA and RNA synthesis in permeabilized cultured cells and isolated nuclei. The immunoglobulin fraction obtained by ammonium sulfate precipitation of serum was shown to exert considerable influence on DNA and RNA synthesis in cultured cells and nuclei. A component of this antibody population is anti-DNA. These antibodies exert different effects on DNA template activity which is a function of their conformational specificity. Intracellular penetration of autoantibodies as noted in SLE may be one of the reasons for clinical manifestations of disease in these patients.

Location and methylation pattern of a nuclear matrix associated region in the human pro alpha 2(I) collagen gene.

Using both a 25 mM Lithium di-iodosalicylic acid (LIS) and a 2M NaCl extraction procedure to extract nuclear matrices from white cells we have identified a 0.9 kb nuclear matrix associated region (MAR) in the human pro alpha 2(I) collagen gene. The MAR is located towards the 3' coding end of the gene, it is completely associated with the matrix in transcriptionally inactive white cells but is incompletely associated with the matrix in transcriptionally active fibroblasts. Furthermore the methylation state of the fibroblast gene in the region coinciding with the MAR showed unique differences when compared to adjacent sites in the fibroblast gene and corresponding sites of the white cell gene.

Naturally occurring anti-DNA antibodies from systemic lupus erythematosus patients may be used to study gene expression in vitro.

Anti-B-DNA and anti-Z-DNA antibodies were prepared from the serum of systemic lupus erythematosus (SLE) patients by affinity chromatography. The anti-Z-DNA antibodies were shown to exhibit site-specific binding preferences in pBR322 negatively supercoiled (plasmid) DNA, as assayed by restriction-enzyme cleavage. The anti-B-DNA antibodies were found to stimulate in vitro transcription of pBR322, whereas little effect was observed on combination with anti-Z-DNA antibodies. The results support the proposal that the formation of Z-DNA is a down-regulatory mechanism and that the B to Z conformational change may be a flip-flop control for gene expression.

Structural alterations in chromatin during myogenesis in the chicken.

Differentiation of mononucleated myoblasts to multinucleated myotubes is accompanied by hypertrophy achieved by co-ordinated synthesis of muscle proteins. This process may be achieved by co-ordinated synthesis and translation of new mRNA or gradual accumulation of constitutively synthesized mRNA, followed by coordinated translational activation. If the former process occurs, many structural alterations should occur in chromatin, whereas in the latter scenario, no chromatin changes will be necessary. The results of our investigation into chromatin structure of myoblast and myotube nuclei show that according to techniques used, viz. chromatin solubilization by nucleases, thermal denaturation, in vitro transcription, nucleosome sizing, there are major structural changes in chromatin during muscle cell differentiation. Since these alterations were detectable at a fairly gross level, many genes must be affected which could account for the increase in RNA and proteins observed in myotubes. This evidence argus in favour of new mRNA synthesis for rapid translation, rather than a gradual accumulation of mRNA followed by co-ordinated translation.

Characterization of a new alpha zero thalassaemia defect in the South African population.

A new alpha thalassemia defect has been detected in the South African population. Restriction mapping of the alpha globin gene cluster in affected individuals has established that the defect is associated with the removal of 22.8-23.7 kb of DNA, including the psi zeta 1, psi alpha 1, psi alpha 2, alpha 2 and alpha 1 globin genes. The 5' endpoint of the deletion has been localized between the zeta 2 and psi zeta 1 globin genes, and the 3' endpoint lies 4-5 kb 3' to the alpha 1 globin gene. We have called the deletion - -SA in order to distinguish it from alpha zero thalassaemia defects described in other populations.

A new assay for anti-DNA antibodies in serum which includes the measurement of anti-Z-DNA.

A simple, rapid assay for measuring anti-DNA titre of serum which includes anti-Z-DNA is described. The assay involves solution binding of antibody to labelled DNA under conditions such that the DNA is altered to form a left-handed or Z-DNA structure in the presence of cobalt ions. The absence or presence of cobalt determines a B or Z form structure in DNA and antibodies to these forms are detectable. The majority of SLE and RA patients (88%) have a higher anti-DNA titre in the presence of cobalt ions. An additional 25% of SLE patients and 22/23 RA patients who had normal anti-DNA levels according to the Crithidea assay, reacted with abnormal titres in our assay. Patients experiencing a relapse in SLE also showed a large increase in anti-DNA in the presence of antigenic Z-DNA. These results suggest that monitoring anti-DNA levels in SLE and RA to detect anti-Z DNA antibodies, provides significant advantages over methods currently in use to measure anti-DNA antibodies.

The gene coding for tropoelastin is represented as a single copy sequence in the haploid sheep genome.

The identity of the primary in vitro translation products of fetal sheep nuchal ligament elastin mRNA was confirmed as two distinct polypeptides of 63 Kdal and 65 Kdal in both rabbit reticulocyte and wheat germ extract cell-free translation systems. Both polypeptides were co-translationally processed by a microsomal membrane signal peptidase, with the removal of 20-25 amino acid residues. A single (3,5 kb) RNA species encodes both tropoelastin polypeptides. Restriction endonuclease mapping of sheep genomic DNA by hydridization with two radiolabelled genomic DNA fragments containing sequences coding for sheep tropoelastin (pSE1-1,3 and pSE1-0.7,) indicated the presence of a single elastin gene. The elastin gene copy number was further quantitated by comparison of hybridisation of pSE1-1.3 and pSE1-0.7 to slot-blots and Southern transfers of sheep genomic DNA and to standard curves constructed with each clone. These results clearly demonstrate that each of these sequences is represented only once per haploid genome, suggesting that the two tropoelastin polypeptides are products of a single elastin gene.

Esophageal cancer: vitamin and lipotrope deficiencies in an at-risk South African population.

The nutritional status of individuals from areas of South Africa that are known for having a high incidence of esophageal cancer was investigated. Our results show that individuals living in high-risk areas differ significantly from those in low-risk areas with respect to vitamins A, E, and B12 in addition to folate. These results suggest that deficiencies in these nutrients may play a significant role in the etiology of esophageal cancer.

Linkage disequilibrium between a marker on the low-density lipoprotein receptor and high cholesterol levels.

We describe the presence of a linkage disequilibrium between high cholesterol levels in Afrikaner individuals and the common allele of the Pvu II restriction fragment polymorphism on the low-density lipoprotein (LDL) receptor gene. The frequencies of the common and the rare allele in a sample of the Afrikaner population were 0.654 and 0.346 (65 individuals) and 0.794 and 0.206 in the hypercholesterolaemic population (34 patients) (P less than 0.05). This finding supports other evidence for a founder origin of the high frequency of familial hypercholesterolaemia among Afrikaners.

Detection of a high frequency RsaI polymorphism in the human pro alpha 2(I) collagen gene which is linked to an autosomal dominant form of osteogenesis imperfecta.

Screening of the pro alpha 2(I) collagen genes of Southern African populations for restriction fragment length polymorphisms (RFLPs) has revealed a locus polymorphic for the restriction enzyme RsaI. The frequency of the RFLP was 0.38 in Afrikaners, but much lower in indigenous Southern African populations, which suggests that it is of European origin. The polymorphism was used to study 19 affected and non-affected individuals in a four generation family with the autosomal dominant disorder, osteogenesis imperfecta (OI) type I. Co-inheritance of the loss of the RsaI site and the OI phenotype was observed with a lod score of 3.91 at a recombination fraction (theta) of zero, indicating strong linkage. This suggests that the defect in this family is caused by a structural mutation within or close to the pro alpha 2(I) collagen gene. The use of this high frequency RFLP together with other recently described polymorphisms at this locus will facilitate the analysis of the role of this gene in OI and other inherited disorders of connective tissue.

Polymorphism of DNA sequence in the human pro alpha 2(I) collagen gene.

The human pro alpha 2(I) collagen gene was analysed for the presence of restriction fragment length polymorphisms. DNA from randomly selected unrelated persons of three Southern African populations was cleaved with one of eight different restriction enzymes, electrophoresed, blotted, and hybridised with cDNA and genomic probes specific for the pro alpha 2(I) gene. An MspI polymorphism was detected which results from the loss of a cleavage site within the 3' half of the gene. In two of the populations studied, the polymorphism occurred at significant frequencies, and should therefore prove useful as a genetic marker for the study of inherited disorders of connective tissue involving collagen structure or biosynthesis.

Defective splicing of thyroglobulin gene transcripts in the congenital goitre of the Afrikander cattle.

The structure of thyroglobulin mRNA was analyzed in an inbred herd of Afrikander cattle with hereditary goitre. Northern transfer of RNA from affected animals revealed both a shorter (approximately 7100 bases) and a normal-sized (approximately 8200 bases) thyroglobulin mRNA when hybridized to bovine thyroglobulin cDNA clones. S1 nuclease mapping experiments established that 1100 bases are deleted in the 5' region of the smaller mRNA. Electron microscopy of RNA from animals with goitre hybridized to a bovine genomic DNA clone showed that the region deleted corresponds to exon 9 of the thyroglobulin gene. Southern blot analysis of the exon 9 region revealed differences between affected and control animals with the enzymes PstI and TaqI. Although they could reflect a linkage disequilibrium between the mutation and restriction fragment length polymorphism, it is noteworthy that these differences map in the region of the exon 9/intron 9 junction. Our results show that a genetic lesion in the thyroglobulin gene causes aberrant splicing of the pre-mRNA, and suggest that the responsible mutation is at the exon 9/intron 9 junction.