Cost of illness of HER2-positive and metastatic and recurrent HER2-positive breast cancer - a Danish register-based study from 2005 to 2016.

BACKGROUND: Information and knowledge about cost of illness and labour productivity in patients with HER2-positive early-stage and metastatic breast cancer treated with trastuzumab is limited. The aim of this study was to estimate the direct and indirect costs associated with treatment of HER2-positive breast cancer among patients with early-stage and metastatic breast cancer, treated with trastuzumab, in a 10-year period after diagnosis. MATERIALS AND METHODS: This study included all Danish HER2-positive breast cancer patients (≥ 18 years) treated with trastuzumab between 2005 and 2016 identified in The Danish Patient Register and the Danish Cancer Register. Furthermore, we identified patients experiencing metastatic or recurrent breast cancer. For the study populations, we estimated total direct costs and indirect costs for one year prior to the breast cancer diagnosis and up to 10 years after diagnosis compared with a group of matched controls free of breast cancer. In addition to The Danish Patient Register and Cancer Register, we applied patient level data from The Civil Registration System, The National Pathology Register, National Health Service Register for Primary Care, Register of Medicinal Product Statistics, Register of Municipal Services, The DREAM database, and Population's Education Register. RESULTS: We identified 4,153 HER2-positive breast cancer patients, whereof 27% were identified with metastatic or recurrent breast cancer. During the follow-up period of 10 years, we estimated excess direct costs of EUR 115,000 among the total study population compared to controls; EUR 211,000 among patients with metastases or recurrence; and EUR 89,000 among patients without metastases or recurrence. Direct costs were found to be highest in the first year after diagnosis and also peaked in the year after recurrence. Labour productivity was significantly lower among patients with recurrence 10 years after breast cancer diagnosis compared with controls. CONCLUSIONS: In this study, we estimated the direct and indirect cost associated with HER2-positive breast cancer. The costs were significantly higher during the 10 years after diagnosis compared to the control group, specifically among patients experiencing metastases or recurrence of breast cancer.

Microfluidic jet injection for delivering macromolecules into cells.

We present a microfluidic based injection system designed to achieve intracellular delivery of macromolecules by directing a picoliter-jet of a solution towards individual cells. After discussing the concept, we present design specification and criteria, elucidate performance and discuss results. The method has the potential to be quantitative and high throughput, overcoming limitations of current intracellular delivery protocols.

Structure of dihydroorotate dehydrogenase B: electron transfer between two flavin groups bridged by an iron-sulphur cluster.

BACKGROUND: The fourth step and only redox reaction in pyrimidine de novo biosynthesis is catalyzed by the flavoprotein dihydroorotate dehydrogenase (DHOD). Based on their sequences, DHODs are grouped into two major families. Lactococcus lactis is one of the few organisms with two DHODs, A and B, belonging to each of the two subgroups of family 1. The B enzyme (DHODB) is a prototype for DHODs in Gram-positive bacteria that use NAD+ as the second substrate. DHODB is a heterotetramer composed of two different proteins (PyrDB and PyrK) and three different cofactors: FMN, FAD, and a [2Fe-2S] cluster. RESULTS: Crystal structures have been determined for DHODB and its product complex. The DHODB heterotetramer is composed of two closely interacting PyrDB-PyrK dimers with the [2Fe-2S] cluster in their interface centered between the FMN and FAD groups. Conformational changes are observed between the complexed and uncomplexed state of the enzyme for the loop carrying the catalytic cysteine residue and one of the lysines interacting with FMN, which is important for substrate binding. CONCLUSIONS: A dimer of two PyrDB subunits resembling the family 1A enzymes forms the central core of DHODB. PyrK belongs to the NADPH ferredoxin reductase superfamily. The binding site for NAD+ has been deduced from the similarity to these proteins. The orotate binding in DHODB is similar to that in the family 1A enzymes. The close proximity of the three redox centers makes it possible to propose a possible electron transfer pathway involving residues conserved among the family 1B DHODs.

The crystal structure of the flavin containing enzyme dihydroorotate dehydrogenase A from Lactococcus lactis.

BACKGROUND: . Dihydroorotate dehydrogenase (DHOD) is a flavin mononucleotide containing enzyme, which catalyzes the oxidation of (S)-dihydroorotate to orotate, the fourth step in the de novo biosynthesis of pyrimidine nucleotides. Lactococcus lactis contains two genes encoding different functional DHODs whose sequences are only 30% identical. One of these enzymes, DHODA, is a highly efficient dimer, while the other, DHODB, shows optimal activity only in the presence of an iron-sulphur cluster containing protein with which it forms a complex tetramer. Sequence alignments have identified three different families among the DHODs: the two L. lactis enzymes belong to two of the families, whereas the enzyme from E. coli is a representative of the third. As no three-dimensional structures of DHODs are currently available, we set out to determine the crystal structure of DHODA from L. lactis. The differences between the two L. lactis enzymes make them particularly interesting for studying flavoprotein redox reactions and for identifying the differences between the enzyme families. RESULTS: . The crystal structure of DHODA has been determined to 2.0 resolution. The enzyme is a dimer of two crystallographically independent molecules related by a non-crystallographic twofold axis. The protein folds into and alpha/beta barrel with the flavin molecule sitting between the top of the barrel and a subdomain formed by several barrel inserts. Above the flavin isoalloxazine ring there is a small water filled cavity, completely buried beneath the protein surface and surrounded by many conserved residues. This cavity is proposed as the substrate-binding site. CONCLUSIONS: . The crystal structure has allowed the function of many of the conserved residues in DHODs to be identified: many of these are associated with binding the flavin group. Important differences were identified in some of the active-site residues which vary across the distinct DHOD families, implying significant mechanistic differences. The substrate cavity, although buried, is located beneath a highly conserved loop which is much less ordered than the rest of the protein and may be important in giving access to the cavity. The location of the conserved residues surrounding this cavity suggests the potential orientation of the substrate.

Two purine nucleoside phosphorylases in Bacillus subtilis. Purification and some properties of the adenosine-specific phosphorylase.

Two purine nucleoside phosphorylases (purine-nucleoside:orthophosphate ribosyltransferase, EC 2.4.2.1) were purified from vegetative Bacillus subtilis cells. One enzyme, inosine-guanosine phosphorylase, showed great similarity to the homologous enzyme of Bacillus cereus. It appeared to be a tetramer of molecular weight 95 000. The other enzyme, adenosine phosphorylase, was specific for adenosine and deoxyadenosine. The molecular weight of the native enzyme was 153 000 +/- 10% and the molecular weight of the subunits was 25 500 +/- 5%. This indicates a hexameric structure. The adenosine phosphorylase was inactivated by 10(-3) M p-chloromercuribenzoate and protected against this inactivation by phosphate, adenosine and ribose 1-phosphate.

Uracil phosphoribosyltransferase from the extreme thermoacidophilic archaebacterium Sulfolobus shibatae is an allosteric enzyme, activated by GTP and inhibited by CTP.

Uracil phosphoribosyltransferase, which catalyses the formation of UMP and pyrophosphate from uracil and 5-phosphoribosyl alpha-1-pyrophosphate (PRPP), was partly purified from the extreme thermophilic archaebacterium Sulfolobus shibatae. The enzyme required divalent metal ions for activity and it showed the highest activity at pH 6.4. The specific activity of the enzyme was 50-times higher at 95 degrees C than at 37 degrees C, but the functional half-life was short at 95 degrees C. The activity of uracil phosphoribosyltransferase was strongly activated by GTP, which increased Vmax of the reaction by approximately 20-fold without much effect on K(m) for the substrates. The concentration of GTP required for half-maximal activation was about 80 microM. CTP was a strong inhibitor and acted by raising the concentration of GTP needed for half-maximal activation of the enzyme. We conclude that uracil phosphoribosyltransferase from S. shibatae is an allosteric enzyme which is activated by a purine nucleotide and inhibited by a pyrimidine nucleotide as seen for several enzymes in the pyrimidine nucleotide biosynthetic pathway of Escherichia coli, but not observed before for any phosphoribosyltransferase.

Crystallization and preliminary X-ray diffraction studies on the Apo form of orotate phosphoribosyltransferase from Escherichia coli.

Three different crystal forms of the apoenzyme orotate phosphoribosyltransferase, with M(r) = 23,552 from Escherichia coli have been grown. The crystals, which are all suitable for X-ray diffraction analysis, have been grown by the hanging drop vapour diffusion method. The first form crystallizes in the orthorhombic space group P2(1)2(1)2, with cell dimensions: a = 136.34 A, b = 75.98 A and c = 40.32 A; the second form in the monoclinic space group P2, with unit cell dimensions: a = 101.61 A, b = 40.49 A, c = 79.05 A and beta = 87.33 degrees; and the third form in P2(1)2(1)2(1), the cell dimensions being a = 70.27 A, b = 103.53 A, c = 53.83 A.

High concentrations of ppGpp decrease the RNA chain growth rate. Implications for protein synthesis and translational fidelity during amino acid starvation in Escherichia coli.

We show that the RNA chain growth rate on lacZ is reduced by an elevated ppGpp level even in the absence of starvation. Under these conditions the polypeptide chain elongation rate is affected little, if at all. These results lead us to re-examine the role of ppGpp in the reduction of protein synthesis and translational fidelity during amino acid starvation. We find that ppGpp has little or no direct effect on translation rate or fidelity. Rather, the effects of ppGpp on translation are indirectly caused by the fact that ppGpp inhibits mRNA synthesis, making mRNA limiting for translation during amino acid starvation. The reduced level of mRNA thereby reduces the severity of the aminoacyl-tRNA limitation and, in turn, decreases mistranslation. Mistranslation in the starved relA strain therefore results from an increased severity of aminoacyl-tRNA limitation due to the failure of this strain to reduce mRNA levels by increasing the level of ppGpp. Finally, the initial rise of the ppGpp level in the starved stringent strain, followed by a characteristic reduction to a steady poststarved level, can now be explained by the initially high, and then decreasing number of "hungry" codons adjusted through the mRNA pool.

Purification and characterization of dihydroorotate dehydrogenase A from Lactococcus lactis, crystallization and preliminary X-ray diffraction studies of the enzyme.

Lactococcus lactis is the only organism known to contain two dihydroorotate dehydrogenases, i.e., the A- and B-forms. In this paper, we report the overproduction, purification, and crystallization of dihydroorotate dehydrogenase A. In solution, the enzyme is bright yellow. It is a dimer of subunits (34 kDa) that contain one molecule of flavin mononucleotide each. The enzyme shows optimal function in the pH range 7.5-9.0. It is specific for L-dihydroorotate as substrate and can use dichlorophenolindophenol, potassium hexacyanoferrate (III), and, to a lower extent, also molecular oxygen as acceptors of the reducing equivalents, whereas the pyridine nucleotide coenzymes (NAD+, NADP+) and the respiratory quinones (i.e., vitamins Q6, Q10 and K2) were inactive. The enzyme has been crystallized from solutions of 30% polyethylene glycol, 0.2 M sodium acetate, and 0.1 M Tris-HCl, pH 8.5. The resulting yellow crystals diffracted well and showed little sign of radiation damage during diffraction experiments. The crystals are monoclinic, space group P21 with unit cell dimensions a = 54.19 A, b = 109.23 A, c = 67.17 A, and beta = 104.5 degrees. A native data set has been collected with a completeness of 99.3% to 2.0 A and an Rsym value of 5.2%. Analysis of the solvent content and the self-rotation function indicates that the two subunits in the asymmetric unit are related by a noncrystallographic twofold axis perpendicular to the crystallographic b and c axes.

The crystal structure of Lactococcus lactis dihydroorotate dehydrogenase A complexed with the enzyme reaction product throws light on its enzymatic function.

Dihydroorotate dehydrogenases (DHODs) catalyze the oxidation of (S)-dihydroorotate to orotate, the fourth step and only redox reaction in the de novo biosynthesis of pyrimidine nucleotides. A description is given of the crystal structure of Lactococcus lactis dihydroorotate dehydrogenase A (DHODA) complexed with the product of the enzyme reaction orotate. The structure of the complex to 2.0 A resolution has been compared with the structure of the native enzyme. The active site of DHODA is known to contain a water filled cavity buried beneath a highly conserved and flexible loop. In the complex the orotate displaces the water molecules from the active site and stacks above the DHODA flavin isoalloxazine ring, causing only small movements of the surrounding protein residues. The orotate is completely buried beneath the protein surface, and the orotate binding causes a significant reduction in the mobility of the active site loop. The orotate is bound by four conserved asparagine side chains (Asn 67, Asn 127, Asn 132, and Asn 193), the side chains of Lys 43 and Ser 194, and the main chain NH groups of Met 69, Gly 70, and Leu 71. Of these the Lys 43 side chain makes hydrogen bonds to both the flavin isoalloxazine ring and the carboxylate group of the orotate. Potential interactions with bound dihydroorotate are considered using the orotate complex as a basis for molecular modeling. The role of Cys 130 as the active site base is discussed, and the sequence conservation of the active site residues across the different families of DHODs is reviewed, along with implications for differences in substrate binding and in the catalytic mechanisms between these families.

Photochemical reactions and on-line UV detection in microfabricated reactors.

This work presents an application of microfabricated reactors and detectors for photochemical reactions. Two fabrication schemes were demonstrated for the integration of the reaction and the detection modules: coupling individually packaged chips, and monolithic integration of the two functions. In the latter fabrication scheme, we have succeeded in bonding quartz wafers to patterned silicon wafers at low temperature using a Teflon-like polymer-CYTOP[trade mark sign]. Using quartz substrates allows reaction and detection with UV light of lower wavelengths than Pyrex substrates permit. The pinacol formation reaction of benzophenone in isopropanol was the model reaction to demonstrate the performance of the microreactors. The extent of reaction was controlled by varying the flow rate and therefore the on-chip residence time. Crystallization of the product inside the microreactors was avoided by the continuous-flow design. Instead, crystallization was observed in the effluent storage device. Off-chip analysis using HPLC confirms the results obtained from the on-line UV spectroscopy. The quantum yield estimated suggests that the reactor design is effective in improving the overall efficiency of the reactor unit.

The contribution of late-generated neurons to the callosal projection in rat: a study with prenatal x-irradiation.

Studies utilizing horseradish peroxidase tracing methods have suggested that there are species differences in the relative contribution of the different neocortical layers to the callosal projection. The present investigation utilized x-irradiation at different gestational ages to eliminate the late-generated neurons in the rat neocortex. The caudorostral gradient of reduction in the neuronal population of the supragranular layers is closely correlated with the gradient of reduction in the size of the corpus callosum. Furthermore, the callosal projection is absent in anteroposterior cortical segments in which the development of the supragranular layers was prevented without a reduction of the number of neurons in the infragranular layers of the neocortex. These results indicate that late-generated neurons residing primarily in the supragranular layers are essential for the formation of the corpus callosum.

Specific inhibition of a family 1A dihydroorotate dehydrogenase by benzoate pyrimidine analogues.

Dihydroorotate dehydrogenases (DHODs) catalyze the conversion of dihydroorotate to orotate in de novo pyrimidine biosynthesis. We have found that 3,4-dihydroxybenzoate and 3,5-dihydroxybenzoate are competitive inhibitors vs dihydroorotate with the prototypical family 1A DHOD from Lactococcus lactis. The dissociation constants of these compounds, determined by spectral titrations, were similar to the dissociation constant of orotate, the enzymatic reaction product, suggesting that hydroxybenzoates could be developed into useful drugs for treating infections by certain protozoan parasites.

Effects of ozone and acidic fog on red spruce needle epicuticular wax production, chemical composition, cuticular membrane ultrastructure and needle wettability.

One-year-old red spruce (Picea rubens Sarg.) seedlings were exposed, from bud break, to ozone (O3 ) and acidic fog for 14, 42 or 77 days. Ozone was more damaging than acidic fog to epicuticular wax. Wax quantity on needles exposed to charcoal-filtered air (CFA) and pH 4.2 fog (control) increased from 14 to 42 days, but decreased by 77 days. Exposure of elongating needles to 70 ppb O3 and pH 4.2 fog reduced the rate of de novo wax synthesis. Red spruce wax is composed of secondary alcohols (50%), nonacosane diols (25%), alkyl esters (12%), primary alcohols (6 %), estolides (2 %), fatty acids (3 %), and hydroxy-fatty acids (2 %). Wax chemical composition varied temporally. Needles exposed to O3 had significantly less secondary alcohols, diols, alkyl esters, fatty acids, and hydroxy-fatty acids than needles exposed to CFA. Production of secondary alcohols was significantly reduced following needle exposure to fog at pH 3.0. Cuticular membrane thickness increased significantly following needle exposure to O3 . The increase in thickness at 250 ppb O3 was due to a new amorphous layer which appeared above the reticulate layer. Contact angles on needles exposed to CFA and pH 4.2 fog increased from 92° after 14 days to 96° after 42 days, then declined to 77° after 77 days. Needle exposure to O3 for 42 or 77 days significantly decreased contact angles.

Methods to identify and characterize developmental neurotoxicity for human health risk assessment. II: neuropathology.

Neuropathologic assessment of chemically induced developmental alterations in the nervous system for regulatory purposes is a multifactorial, complex process. This calls for careful qualitative and quantitative morphologic study of numerous brains at several developmental stages in rats. Quantitative evaluation may include such basic methods as determination of brain weight and dimensions as well as the progressively more complex approaches of linear, areal, or stereologic measurement of brain sections. Histologic evaluation employs routine stains (such as hematoxylin and eosin), which can be complemented by a variety of special and immunohistochemical procedures. These brain studies are augmented by morphologic assessment of selected peripheral nervous system structures. Studies of this nature require a high level of technical skill as well as special training on the part of the pathologist. The pathologist should have knowledge of normal microscopic neuroanatomy/neuronal circuitry and an understanding of basic principles of developmental neurobiology, such as familiarity with the patterns of physiologic or programmed cell de

Three genes preceding pyrE on the Escherichia coli chromosome are essential for survival and normal cell morphology in stationary culture and at high temperature.

Previous studies of the upstream region of the pyrE gene in Escherichia coli revealed three genes of unknown function. Inactivation of these genes (designated orfE, orfX and orfY) by crossing the KmR-cassette-disrupted orf into the chromosome indicated that they were not required during exponential growth (Poulsen et al., Mol., Microbiol., 1989 b). Here we report that the three genes are of importance in the stationary phase. Thus, cultures of the mutants grown to a stationary state in rich media contained bacterial filaments of abnormal morphology. In addition, flow cytometric analyses showed that outgrown cultures of the orf mutants have anomalous size distribution and DNA content, and that rifampicin treatment of exponentially growing mutants results in cell populations with chromosome numbers in the range from about 1 to 10, compared with wild type strains that end up with 4 and 8 full chromosomes. Finally, it appeared that the three orf's are indispensable at high temperatures since the insertion mutants were unable to form colonies above 45 degrees C and since cultures of exponentially growing mutants lysed upon a temperature shift from 37 degrees C to 45 degrees C.

Quantitative aspects of drug and toxicant-induced astrogliosis.

A universal cellular reaction to damage of the CNS is hypertrophy of astrocytes. The hallmark of this response, often termed 'reactive gliosis', is the enhanced expression of the major intermediate filament protein of astrocytes, glial fibrillary acidic protein (GFAP). This latter observation suggests that increased synthesis of GFAP would occur in response to diverse neurotoxic insults. To investigate this possibility, prototype neurotoxicants were administered to experimental animals and the effects of these agents on the tissue content of GFAP was determined by immunoassay. Assays of GFAP were found to reveal dose-, time- and region-dependent patterns of neurotoxicity at toxicant dosages below those that cause light microscopic evidence of cell loss or damage. Moreover, the temporal and regional increments in GFAP correspond to the temporal and regional patterns of argyrophilia, as revealed by the cupric silver degeneration stain of de Olmos. Our findings indicate that assays of GFAP represent a sensitive, simple and quantitative approach for evaluation of nervous system damage. Combining this indirect yet quantitative indicator of neurotoxicity with more traditional neuroanatomical endpoints, should augment the armamentarium of techniques useful for detection and characterization of neurotoxicity.

Glutamate neurotoxicity in the developing rat cochlea: physiological and morphological approaches.

The neurotoxic effects of exogenous glutamate were studied in the rat cochlea. Glutamate-treated rats (4 g/kg/day i.p., postnatal days 2-9) exhibited electrophysiologically-measured elevations in high frequency thresholds usually associated with hair cell loss in the basal region of the cochlea. While surface preparations of the organ of Corti revealed no loss of hair cells, there was a dramatic and selective reduction of neurons in the basal, high frequency-related portion of the spiral ganglion. This sensitivity of developing spiral ganglion cells to the neurotoxicity of glutamate is consistent with the hypothesis that glutamate or a structurally related substance is a neurotransmitter at afferent synapses of cochlear hair cells.

Evidence for two complementary patterns of thalamic input to the rat somatosensory cortex.

We provide evidence that the thalamic projections originating from the medial portion of the posterior thalamic complex to the somatosensory cortex of the rat are distributed in a detailed pattern which is complementary to the pattern of projections which originate in the ventral posterior nucleus.

Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity.

This study describes alterations in the nervous system resulting from chronic administration of the fluoroaluminum complex (AlF3) or equivalent levels of fluoride (F) in the form of sodium-fluoride (NaF). Twenty seven adult male Long-Evans rats were administered one of three treatments for 52 weeks: the control group was administered double distilled deionized drinking water (ddw). The aluminum-treated group received ddw with 0.5 ppm AlF3 and the NaF group received ddw with 2.1 ppm NaF containing the equivalent amount of F as in the AlF3 ddw. Tissue aluminum (Al) levels of brain, liver and kidney were assessed with the Direct Current Plasma (DCP) technique and its distribution assessed with Morin histochemistry. Histological sections of brain were stained with hematoxylin & eosin (H&E), Cresyl violet, Bielschowsky silver stain, or immunohistochemically for beta-amyloid, amyloid A, and IgM. No differences were found between the body weights of rats in the different treatment groups although more rats died in the AlF3 group than in the control group. The Al levels in samples of brain and kidney were higher in both the AlF3 and NaF groups relative to controls. The effects of the two treatments on cerebrovascular and neuronal integrity were qualitatively and quantitatively different. These alterations were greater in animals in the AlF3 group than in the NaF group and greater in the NaF group than in controls.