Impact of malignancy on Clostridium difficile infection.

PURPOSE: The purpose of this study was to investigate the impact of malignancy and chemotherapy on the clinical and microbiological characteristics of Clostridium difficile infections (CDI). METHODS: CDI patients with a history of malignancy within 5 years were defined as the cancer group. The characteristics of the patients were compared according to the presence of malignancy. RESULTS: Of 580 patients with CDI, 159 (27.4 %) belonged to the cancer group and 421 (72.6 %) to the non-cancer group. More of the patients in the cancer group than those in the non-cancer group had been hospitalized within the prior 2 months (P < 0.001). Leukocytosis was more common in the non-cancer group (P = 0.034), while infection by PCR ribotype 017 strains was more common in the cancer group, with marginal significance (P = 0.07). Recurrence was more frequent in the cancer group (20.4 % vs. 9.5 %, P =0.005) and cancer was an independent risk factor for recurrence of CDI (OR = 2.66, 95 % CI 1.34-5.29, P =0.005). Age also contributed to the recurrence of CDI (OR = 1.03, 95 % CI 1.00-1.06, P =0.026). CONCLUSIONS: Malignancy and age are independent risk factors for recurrence of CDI. Cancer patients require careful observation for recurrence after treatment of CDI.

Clinical characteristics of relapses and re-infections in Clostridium difficile infection.

The purpose of this study was to identify factors associated with relapses or re-infections in patients with recurring Clostridium difficile infections (CDIs). From September 2008 to January 2012, cases with two or more isolates from consecutive CDI episodes were included. PCR-ribotyping and multilocus variable-number tandem-repeat analysis were performed using paired isolates. Among 473 patients, 68 (14.4%) experienced one to five recurrences. Fifty-one of these with two or more isolates from consecutive CDI episodes were included in the study; 25 (49%) were classified as relapses and 26 (51%) as re-infections. Recurrence interval was shorter in the relapse group (26.0 versus 67.5 p 0.001), but more patients in the re-infection group were hospitalized during recurrence interval (53.8% versus 8.0%, p<0.001). Relapse rates in infections by ribotype 017, ribotype 018 and other ribotypes were 63.6%, 63.6% and 22.2%, respectively (p 0.274, p 0.069, and p 0.005). In multivariate logistic regression, infections by ribotypes 017 and 018 were associated with CDI relapse (OR 4.77, 95% CI 1.02-22.31, p 0.047; OR 11.49, 95% CI 2.07-63.72, p 0.005). Conversely, admission during recurrence interval lowered the risk of relapse (OR 0.044, 95% CI 0.006-0.344, p 0.003). In conclusion, relapse was more likely when infection was caused by PCR ribotypes 017 and 018.

Epidemiology of Clostridium difficile infections in a tertiary-care hospital in Korea.

To survey healthcare-associated Clostridium difficile infection (HA-CDI) in a 900-bed tertiary-care hospital, we prospectively investigated the epidemiology of CDI and distribution of PCR-ribotypes. From February 2009 through January 2010, all patients with HA-CDI were enrolled. Epidemiological information and prescription records for antibiotics were collected. The C. difficile isolates were characterized using reference strains and were tested for antibiotic susceptibility. During the survey, incidence of HA-CDI was 71.6 per 100 000 patient-days. In total, 140 C. difficile isolates were obtained from 166 patients with HA-CDI. The PCR-ribotyping yielded 38 distinct ribotypes. The three most frequently found ribotypes made up 56.4% of all isolates; they comprised 37 isolates (26.4%) of PCR-ribotype 018, 22 (15.7%) of toxin A-negative PCR-ribotype 017, and 20 (14.3%) of PCR-ribotype 001. Clostridium difficile PCR-ribotype 018 was present in all departments throughout the hospital during the 11 months, whereas ribotype 017 and ribotype 001 appeared mostly in the pulmonary department. Hypervirulent C. difficile PCR-ribotype 027 was detected in 1 month on two wards. The incidence of CDI in each department showed a seven-fold difference, which correlated significantly with the amount of prescribed clindamycin (R = 0.783, p 0.013) or moxifloxacin (R = 0.733, p 0.025) in the departments. The rates of resistance of the three commonest ribotypes to clindamycin and moxifloxacin were significantly higher than those of other strains (92.1% versus 38.2% and 89.5% versus 27.3%, respectively). CDI is an important nosocomially acquired infection and this study emphasizes the importance of implementing country-wide surveillance to detect and control CDI in Korea.

TM-25659 enhances osteogenic differentiation and suppresses adipogenic differentiation by modulating the transcriptional co-activator TAZ.

BACKGROUND AND PURPOSE: The transcriptional co-activator with PDZ-binding motif (TAZ) is characterized as a transcriptional modulator of mesenchymal stem cell differentiation into osteoblasts and adipocytes. Moreover, increased TAZ activity in the nucleus enhances osteoblast differentiation and suppresses adipocyte development by interacting with runt-related transcription factor 2 (RUNX2) and PPARγ, respectively. Therefore, it would be of interest to identify low MW compounds that modulate nuclear TAZ activity. EXPERIMENTAL APPROACH: High-throughput screening was performed using a library of low MW compounds in order to identify TAZ modulators that enhance nuclear TAZ localization. The effects and molecular mechanisms of a TAZ modulator have been characterized in osteoblast and adipocyte differentiation. KEY RESULTS: We identified 2-butyl-5-methyl-6-(pyridine-3-yl)-3-[2'-(1H-tetrazole-5-yl)-biphenyl-4-ylmethyl]-3H-imidazo[4,5-b]pyridine] (TM-25659) as a TAZ modulator. TM-25659 enhanced nuclear TAZ localization in a dose-dependent manner and attenuated PPARγ-mediated adipocyte differentiation by facilitating PPARγ suppression activity of TAZ. In addition, TAZ-induced RUNX2 activity activation was further increased in osteoblasts, causing increased osteoblast differentiation. Accordingly, TM-25659 suppressed bone loss in vivo and decreased weight gain in an obesity model. After oral administration, TM-25659 had a favourable pharmacokinetic profile. CONCLUSION AND IMPLICATIONS: TM-25659 stimulated nuclear TAZ localization and thus caused TAZ to suppress PPARγ-dependent adipogenesis and enhance RUNX2-induced osteoblast differentiation in vitro and in vivo. Our data suggest that TM-25659 could be beneficial in the control of obesity and bone loss.

Effect of astaxanthin on the hepatotoxicity, lipid peroxidation and antioxidative enzymes in the liver of CCl4-treated rats.

Astaxanthin is one of many carotenoids present in marine animals, vegetables and fruits. Since carotenoids are known to have antioxidant properties, we tested to determine if astaxanthin could have protective effects in the CCl4-treated rat liver by activating the antioxidant system. Astaxanthin blocked the increase of glutamate-oxalacetate transaminase (GOT) and glutamate-pyruvate transaminase (GTP) activity and thiobarbituric acid reactive substances (TBARS) in response to carbon tetrachloride (CCl4), while causing an increase in glutathione (GSH) levels and superoxide dismutase (SOD) activities in the CCl4-treated rat liver. These results suggest that astaxanthin protects liver damage induced by CCl4 by inhibiting lipid peroxidation and stimulating the cellular antioxidant system.

Chronic iron overload and toxicity: clinical chemistry perspective.

The content of body iron is regulated primarily by absorption since humans have no physiological mechanism by which excess iron is excreted. This regulation, however, is not absolute. Many factors such as the content of diets, iron doses, life styles, etc. influence iron absorption. In the past, nutrition programs for iron fortification and the ingestion of iron preparations have been widely practiced because of the seriousness of worldwide iron deficiency. Also, we now know that a significant number of asymptomatic people carry the hemochromatosis gene, HFE, indicating that these people have the potential to accumulate excess body iron in their lifetime. Excess body iron can be highly toxic. This toxicity involves many organs leading to a variety of serious diseases such as liver disease, heart disease, diabetes mellitus, hormonal abnormalities, dysfunctional immune system, etc. The tissue damage associated with iron overload is believed to result primarily from free radical reactions mediated by iron. Iron is an effective catalyst in free radical reactions. The diseases associated with iron overload can be managed effectively or prevented. Therefore, early diagnosis of iron overload and appropriate therapy are critical. By providing the necessary laboratory data, clinical chemistry laboratories can play the pivotal role in the management of these health problems.

Anti-tumor effect associated with down-regulation of MHC class 1 antigen after co-transfection of GM-CSF and IFN-gamma genes in CT26 tumor cells.

We previously reported that co-expression of GM-CSF and IFN-gamma genes in tumors induces a synergistic anti-tumor effect. Interestingly, we have used flow cytometry to identify two kinds of populations of CT26 cells that co-express GM-CSF and IFN-gamma genes: one population (CT26/G/I-down) that expresses very low levels of MHC class I and a second population (CT26/G/I-up) that expresses high levels of H-2Kd antigen. We have compared the anti-tumor effect between CT26/I-up and CT26/G/I-down cells. When wild-type (wt) CT26 cells were injected subcutaneously into Balb/c mice, tumor was formed 5-7 days after injection. However, when both CT26/G/I-up and CT26/G/I-down cells were injected, we did not identify any tumor. The protection' study showed that both CT26/G/I-up and CT26/G/I-down. cells could induce systemic immunity against secondary challenge with unmodified parental tumor cell. CT26/G/I-down cells showed normal expression of the heavy chain of MHC class I (HC), beta2-microglobulin (beta2m) and the TAP gene. Furthermore, in CT26/G/I-down cell, although the MHC molecules were detected normally in the cytoplasmic fraction, no message was detected in the membrane fraction. Pulse-chase experiments showed that class I antigen was normally synthesized like wt CT26 or CT26/G/I-up cells. Based on our results, non-MHC restricted immune effectors might play the major role in synergistic anti-tumor effects with co-expression of GM-CSF and IFN-gamma in CT26 tumor model.

Hemophilic pseudotumor of the ulna treated with low dose radiation therapy: a case report.

We report a case of hemophilic pseudotumor in the ulna of a 6-year-old boy treated with radiation therapy. A total dose of 900 cGy in 6 fractions was given in 6 consecutive days. Progression of cystic changes was halted within a month. New bone formation and trabeculation were found on the 4th month. Complete healing of the lesion and bony replacement were found on the 12th month. The patient was followed up to 72 months and there was no evidence of recurrence and no bone growth disturbance. Radiation therapy can be an effective alternative modality in treating hemophilic pseudotumor.

Effect of GM-CSF and IL-2 co-expression on the anti-tumor immune response.

We evaluated the effect of potential therapeutic genes, GM-CSF and IL-2 respectively, or in combination of both cytokines, on the activation of systemic antitumor responses. CT26 tumor cells were modified to secrete GM-CSF and/or IL-2. The growth rate of the modified tumor cells versus the parental CT26 cells did not show any difference. When we implanted the CT26 tumor cells which secrete either GM-CSF or IL-2, delayed and suppressed tumorigenicity was observed. However, another CT26 cell line which expresses both GM-CSF and IL-2 (CT26/GMCSF/IL-2) did not form any tumor mass in the immunocompetent syngeneic Balb/c mice, showing the potential immune responses. Immunohistochemical examination of the modified tumor masses implanted with the cells expressing GM-CSF or IL-2 showed increased necrosis and infiltration of NK (CD56+) lineage cells and macrophage/monocytes. In the vaccination model, the growth of rechallenged wild-type CT26 was more suppressed int he mice which were injected with GM-CSF or IL-2, however, the wild-type CT26 tumor formed normal tumor mass in the mice vaccinated with CT26/GM-CSF/IL-2 showing acute non-T-cell mediated immune response. As a treatment, we injected those modified tumor cells into the established tumor. There we could find tumor growth suppression by the injection of cytokine-modified CT26 cells, especially by the CT26/GM-CSF/IL-2. In the present study we could induce the eradication of tumorigenicity by the transfection of both GM-CSF and IL-2 genes and a potent role in the growth suppression of an established tumor.

ECP level in nasopharyngeal secretions and serum from children with respiratory virus infections and asthmatic children.

Infection with respiratory virus has been shown to exacerbate asthma in humans. However, the role of a respiratory virus in the pathogenesis of chronic asthma and/or wheezing in young children has not been clearly defined. It has also been debated whether virus-induced wheezing in young children is one entity and allergic asthma another, or whether they are different expressions of the same disease. The present study was done to compare ECP concentrations in nasopharyngeal secretions and serum from 32 nonasthmatic wheezing children with viral infections (RSV in 15 children; influenza B virus in 17 children detected by immunofluorescence antibody technique), 8 asthmatic children without viral infections, and 13 normal children as the controls to understand the role of eosinophil inflammation. The geometric mean of ECP in nasopharyngeal secretions was significantly higher in asthmatic children than in children with virus-induced wheezing (p < 0.05). ECP levels of nasopharyngeal secretions from children with the virus-induced wheezing were significantly greater than those of the controls. However, there were no significant differences in ECP levels in serum among subjects.

Reduced expression of MHC class I antigen in human cancer cell lines with defective LMP-7.

The function of major histocompatibility complex (MHC) class I molecule is to sample peptides derived from intracellular proteins and to present these peptides to CD8+ T cells. We analyzed twenty-nine human cancer cell lines for expression of the TAP-1/2 and LMP-2/7 genes and identified whether defects in these genes were associated with the level of expression of MHC molecules in cancer cells. Expression of TAP-1 was positive in 86% (25/29) of the cell lines, TAP-2 expression was positive in 82% (24/29), LPM2 was positive in 86% (25/29), and LMP-7 was positive in 52% (15/29) at the cell lines. In fifteen cell lines that expressed LMP-7, the mean fluorescence intensity (MFI) was 825.1 +/- 123.2; however, in the cell lines that lacked LMP-7, the MFI was 314.7 +/- 77.2. These data suggest that the expression level of MHC class I molecules is associated, in most cases, with the loss of the LMP-7 gene but without the loss of the TAP-1, TAP-2 or LMP-2 genes.

Analysis of induced sputum to examine the effects of inhaled corticosteroid on airway inflammation in children with asthma.

BACKGROUND: Analysis of induced sputum can be performed safely in children with asthma and is useful for both cellular and biochemical markers of inflammation. Glucocorticosteroid inhalation has become the first line therapy for chronic asthma by suppressing airway inflammation, which produces the decrease of bronchial hyperreactivity and reduces the number of eosinophil in bronchial submucosa. OBJECTIVE: To determine the characteristics of the inflammatory cells and their markers in sputum and to examine the pharmacokinetic effects of glucocorticoid within 3 hours after inhalation therapy on FEV1 and sputum inflammatory indices in children with clinically defined chronic asthma. METHODS: Thirty subjects with asthma included 14 current symptomatic asthmatics and 14 normal controls inhaled 4.5% hypertonic saline for 10 minutes by nebulizer. The expectorated sputum were collected from all asthmatics before and 3 hours after corticosteroid inhalation for children with asthma and were reduced by dithiotreitol. Total cell counts and differentials were determined. ECP was measured by CAP system. Interleukin-5, GM-CSF and albumin were measured by double sandwich ELISA. RESULTS: The mean eosinophil percentage and ECP in induced sputum of asthmatics were significantly higher than that of controls. The induced sputum samples obtained after glucocorticoid inhalation showed a significant reduction in mean eosinophil percentage, but FEV1, IL-5, GM-CSF, albumin, and ECP values were not significantly decreased. CONCLUSION: The present results in induced sputum may be interpreted to reflect direct steroid action on airways and lack of effect on bone marrow effectors at 3 hours after glucocorticoid inhalation.

Combination gene therapy of IL-12 and allogeneic MHC class I gene via stimulating NK cytolytic activity.

In this study, we tested whether expressing an allogeneic MHC class I gene and/or a cytokine gene in tumor cells could induce anti-tumor immunity. We compared the potential therapeutic benefit of introducing IL-12 or H-2Kb alone and in combination into CT26 tumor cells. Whereas IL-12 expression in CT26 cells delayed the formation of tumors, the expression of class I molecules alone was apparently insufficient to reduce tumorigenicity. The combined expression of IL-12 and H-2Kb, however, more efficiently reduced tumor growth than did either genes alone. Histological examination of tumors expressing IL-12 and H-2Kb showed a non-specific inflammatory reaction, such as a necrosis, and an increased tissue infiltrate of immune effectors. These results suggest that the combined expression of IL-12 and H-2Kb in tumor cells has potential therapeutic benefit.

Prevalence of specific antibodies to Chlamydia pneumoniae in Korea.

To clarify the endemic status of Chlamydia pneumoniae in Korea, the incidence of antibodies in 564 serum samples from healthy individuals, patients with respiratory infection, and cord blood specimens was evaluated. We conclude that C. pneumoniae infection is highly endemic in Korea and that this infection is associated with acute respiratory diseases.

Synergistic anti-tumor effects with co-expression of GM-CSF and IFN-gamma in murine tumors.

We explored the potential therapeutic benefit of introducing GM-CSF, IFN-gamma or a combination of both factors into CT26 tumor cells. CT26 cells secreting either GM-CSF or IFN-gamma exhibited delayed tumorigenicity; however, cells expressing both GM-CSF and IFN-gamma did not form tumors. Even when wild type CT26 cells were introduced into a distant site of mice that had been inoculated with CT26/GM-CSF/IFN-gamma cells, no tumors were generated. Furthermore, when we injected GM-CSF + IFN-gamma cells into animals bearing established tumors, the tumors were either rejected or their development was delayed, suggesting that synergistic effects were induced against these tumors via a systemic immune response. Histopathological examination of the tumors injected with cells expressing GM-CSF and IFN-gamma combined showed necrosis and few signs of malignancy. The growth of tumors from mice treated with CT26/GM-CSF/IFN-gamma cells exhibited a delay in tumor formation and no effects were seen in athymic nude mice, which are deficient in T lymphocytes, or in splenectomized nude mice, which are deficient in natural killer (NK) cells, respectively. Our data indicate a dual role for T and NK cells in mediating the anti-tumor activity of this therapy. Our results suggest that transduction of tumor cells with both GM-CSF + IFN-gamma results in a powerful synergistic effect of the 2 cytokines that is of greater therapeutic benefit than transduction with either cytokine alone.

Toxicity associated with iron overload found in hemochromatosis: possible mechanism in a rat model.

Hemochromatosis is characterized by pathologic iron overload which often leads to various pathological conditions. The mechanism by which excess iron induces these conditions is not clearly understood. Using rats as the model, this investigation was conducted to explore the mechanism of toxicity associated with iron overload. Sprague-Dawley male rats were fed a 3% carbonyl iron-supplemented diet for eight weeks to achieve iron accumulation. Liver iron reached approximately 2 mg/g which is more than 16 times the control values (mean +/- SD, 0.12 +/- 0.02 mg/g, p < 0.001). Serum iron was consistently higher in the experimental rats (mg/L): 3.41 +/- 0.58 versus 1.89 +/- 0.18, p < 0.001. The high levels of iron accompanied enhanced oxidative damage in the hepatic nuclear DNA when 8-hydroxy-2'-deoxyguanosine (8-OHdG) was measured as a product of DNA oxidation. The levels of 8-OHdG in the experimental samples were significantly higher than the controls (8-OHdG X 10(-5)/dG): 4.22 +/- 1.82 versus 1.84 +/- 0.33, p < 0.05. The results of serum enzyme assays suggest that iron overload caused mild hepatocellular damage: alanine transaminase significantly increased; lactate dehydrogenase did not change; alkaline phosphatase decreased. Since the accumulation of 8-OHdG in the nuclear DNA is highly deleterious to cells, these data suggest oxidative damage in the nuclear DNA may be a critical factor in inducing diseases associated with iron overload.

Partially purified Toxoplasma gondii antigens by immunoaffinity chromatography.

Tachyzoite antigens of Toxoplasma gondii (RH) were partially purified by immunoaffinity chromatography. The cultivated Toxoplasma in vivo (mouse) and in vitro (Hep-2 cell) and peritoneal fluid of T. gondii infected mice were collected for antigen analysis. Tachyzoite antigens collected from infected mouse showed positive bands of 76 kDa, 70 kDa, 64 kDa, 53 kDa, 46 kDa, 44 kDa, 41 kDa, 35 kDa, 25 kDa, 18 kDa, and 13 kDa on immunoblot with anti-Toxoplasma rabbit sera, and those from infected Hep-2 cells revealed reactive bands of 70 kDa, 64 kDa, 53 kDa, 35 kDa 28 kDa, and 13-10 kDa. After applying to an IgG-Sepharose column, two elution peaks, E-1 and E-2 fractions, were obtained from both soluble antigen of T. gondii and the peritoneal fluid of infected mice, respectively. Immunoblots of soluble antigen with immunized rabbit sera revealed positive bands of 97 kDa, 63 kDa, 53 kDa, and 35 kDa from E-1 fraction and 53 kDa and 35 kDa from E-2. In the case of the eluted peaks from mice peritoneal fluid, E-1 showed protein bands of 84 kDa, 76 kDa, 53 kDa, and 29 kDa bands and 53 kDa and 45 kDa from E-2 on immunoblots. Serum IgG antibody titer of mice immunized with T. gondii tachyzoites was increased on 1 week after booster immunization when analysed by ELISA using crude antigen, while it was elevated on 3 weeks after booster immunization by ELISA using purified antigen.

Nosocomial respiratory syncytial virus infection in a newborn nursery.

Respiratory syncytial virus (RSV) has been recognized as a major nosocomial hazard on pediatric wards, but symptomatic RSV infection is uncommon during the first four weeks of life. We report here four cases of neonatal RSV infection in a special-care newborn nursery and two of them probably acquired the infection nosocomially. By rapid diagnosis using immunofluorescent technique and early implementation of infection control measures, we were able to prevent further spread of RSV infection.

Methylated purine bases in hepatic and colonic RNA of rats treated with 1,2-dimethylhydrazine.

Administration of 1,2-dimethylhydrazine (DMH) to rats produces colon cancer. The mechanism by which this agent induces colon cancer is unclear. This investigation was conducted to assess the effect of DMH on the hepatic RNA and the colonic RNA of rats. DMH (300 mg/kg body wt) was administered to rats by ip injections. After 24 h, the hepatic RNA and the colonic RNA were isolated and their component purine bases were analyzed by HPLC. DMH treatment resulted in the formation of 1-methyladenine, 1-methylguanine, N2-methylguanine, O6-methylguanine, and 7-methylguanine in RNA. These methylated products may play a role in cellular injury produced by DMH.