Optical coherence tomographic patterns in diabetic macular oedema: prediction of visual outcome after focal laser photocoagulation.

AIM: To identify optical coherence tomography (OCT) patterns predictive of visual outcome in diabetic macular oedema (DMO) patients who undergo focal laser photocoagulation. METHODS: This study involved 70 eyes (45 patients) with clinically significant macular oedema that underwent focal laser photocoagulation using the Early Treatment Diabetic Retinopathy Study protocol. Preoperative macular OCT images were retrospectively examined. OCT features were classified into four patterns: diffuse retinal thickening (DRT); cystoid macular oedema (CMO), serous retinal detachment and vitreomacular interface abnormalities (VMIA). Changes in retinal thickness, retinal volume and visual acuity (VA) after focal laser photocoagulation were evaluated and compared with respect to their OCT features. RESULTS: After focal laser photocoagulation, changes in retinal thickness and retinal volume were significantly different for different OCT types (p = 0.002 and p<0.001). The change in VA from baseline was not significantly different between groups (p = 0.613). The DRT pattern was associated with a greater reduction in retinal thickening and better VA improvement than the CMO or VMIA patterns. Proportions of patients with persistent DMO (central macular thickness >250 microm after laser treatment) were greater for the CMO and VMIA patterns than DRT pattern. CONCLUSION: DRT patients achieved a greater reduction in retinal thickening and greater VA increases than CMO and VMIA patients. We suggest that classifying DMO structural patterns using OCT might allow visual outcome to be predicted after laser photocoagulation.

Expression and purification of heterologous proteins in plant tissue using a geminivirus vector system.

In the past, plant molecular biologists have relied on Escherichia coli, baculovirus and other expression systems to produce plant proteins to quantities sufficient for biochemical analysis. However, such expression systems often result in the production of proteins which possess improper posttranslational modifications. Here, we present a plant virus-based expression system superior to those currently available. We demonstrate that bean yellow dwarf geminivirus (BeYDV) replicates and expresses foreign proteins at high levels in tobacco, Arabidopsis, and other dicotyledonous plants, making it more universal than plant RNA viruses with restricted host ranges which are currently used as expression systems. The DNA-based nature of the BeYDV genome renders it stable for the incorporation of large plant open reading frames, and gives it an advantage over other plant virus-based expression systems which possess insert size restrictions. Using this expression system, the rapid accumulation of a novel Arabidopsis-derived mitogen-activated protein kinase to levels sufficient for standard biochemical analysis is demonstrated.

Proteolytic exposure of a cryptic site within collagen type IV is required for angiogenesis and tumor growth in vivo.

Evidence is provided that proteolytic cleavage of collagen type IV results in the exposure of a functionally important cryptic site hidden within its triple helical structure. Exposure of this cryptic site was associated with angiogenic, but not quiescent, blood vessels and was required for angiogenesis in vivo. Exposure of the HUIV26 epitope was associated with a loss of alpha1beta1 integrin binding and the gain of alphavbeta3 binding. A monoclonal antibody (HUIV26) directed to this site disrupts integrin-dependent endothelial cell interactions and potently inhibits angiogenesis and tumor growth. Together, these studies suggest a novel mechanism by which proteolysis contributes to angiogenesis by exposing hidden regulatory elements within matrix-immobilized collagen type IV.

Systemically expressed soluble Tie2 inhibits intraocular neovascularization.

Retinal and choroidal neovascularization are the most frequent causes of severe and progressive vision loss. Studies have demonstrated that Tie2, an endothelial-specific receptor tyrosine kinase, plays a key role in angiogenesis. In this study, we determined whether adenovirus-mediated gene delivery of extracellular domain of the Tie2 receptor (ExTek) could inhibit experimental retinal and choroidal neovascularization. Immunofluorescence histochemistry with a monoclonal antibody to human Tie2 showed that Tie2 expression is prominent around and within the base of newly formed blood vessels of retinal and choroidal neovascular lesions. A single intramuscular injection of adenovirus expressing ExTek genes achieved plasma levels of ExTek exceeding 500 microg/ml in mice for 10 days (in neonates) and 7 days (in adults). This treatment inhibited retinal neovascularization by 47% (p < 0.05) in a murine model of ischemia-induced retinopathy. The same treatment reduced the incidence and extent of sodium fluorescein leakage from choroidal neovascular lesions by 52% (p < 0.05) and 36% (p < 0.01), respectively, in a laser-induced murine choroidal neovascularization model. The same mice showed a 45% (p < 0.001) reduction of integrated area of the choroidal neovascularization. These findings indicate that Tie2 signaling is a common component of the angiogenic pathway in both retinal and choroidal neovascularization, providing a potentially useful target in the treatment of intraocular neovascular diseases.

A cysteine-rich adipose tissue-specific secretory factor inhibits adipocyte differentiation.

A 12.5-kDa cysteine-rich adipose tissue-specific secretory factor (ADSF/resistin) is a novel secreted protein rich in serine and cysteine residues with a unique cysteine repeat motif of CX(12)CX(8)CXCX(3)CX(10)CXCXCX(9)CC. A single 0.8-kilobase mRNA coding for this protein was found in various murine white adipose tissues including inguinal and epididymal fats and also in brown adipose tissue but not in any other tissues examined. Two species of mRNAs with sizes of 1.4 and 0.8 kilobases were found in rat adipose tissue. Sequence analysis indicates that this is because of two polyadenylation signals, the proximal one with the sequence AATACA with a single base mismatch from murine AATAAA and the distal consensus sequence AATAAA. The mRNA level was markedly increased during 3T3-L1 and primary preadipocyte differentiation into adipocytes. Its expression in adipose tissue is under tight nutritional and hormonal regulation; the mRNA level was very low during fasting and increased 25-fold when fasted mice were refed a high carbohydrate diet. It was also very low in adipose tissue of streptozotocin-diabetes and increased 23-fold upon insulin administration. Upon treatment with the conditioned medium from COS cells transfected with the expression vector, conversion of 3T3-L1 cells to adipocytes was inhibited by 80%. The regulated expression pattern suggesting this factor as an adipose sensor for the nutritional state of the animals and the inhibitory effect on adipocyte differentiation implicate its function as a feedback regulator of adipogenesis.

Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer.

N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.

A delayed-implantation-associated protein prevents resumption of DNA synthesis by the trophectoderm of delayed-implanting mouse blastocysts in vitro.

Objective of this study was to determine the ability of a delayed-implantation-associated protein (MW 170,000, DIAP170K) to inhibit DNA synthesis by mouse blastocysts. Mice were ovariectomized on day 3 of pregnancy and treated with daily injections with 1 mg progesterone till day 7 to induce delayed implantation. Blastocysts were collected on day 8 with or without a single injection of 25 ng estradiol-17 beta on day 7 that activates blastocyst metabolisms (activated blastocysts and delayed-implanting blastocysts respectively). DNA synthesis was determined by measuring [3H]thymidine incorporation by blastocysts. DIAP170K at 10 micrograms/m/ suppressed resumption of DNA synthesis by delayed-implanting blastocysts and suppression was maximal at 50 micrograms/m/. However, DIAP170K did not affect DNA synthesis by blastocysts obtained on day 5 of pregnancy (normal blastocysts) and activated blastocysts. Resumption of DNA synthesis in the inner cell mass (ICM) and trophectoderm from delayed-implanting blastocysts was then separately assessed. DNA synthesis resumed in the trophectoderm of intact blastocysts during 24-hr culture but not in the trophectoderm cultured apart from the ICM. DIAP170K inhibited the resumption of DNA synthesis by the trophectoderm of intact delayed-implanting blastocysts but did not affect DNA synthesis by the ICM. In conclusion, DIAP170K inhibits resumption of DNA synthesis by trophectoderm of delayed-implanting blastocysts. This action of DIAP170K may play a central role in maintaining, but not achieving, dormancy of DNA synthesis by delayed-implanting blastocysts in mice.

Compensatory nutrition-directed mammary cell proliferation and lactation in rats.

The proper use of a time-dependent and controlled nutrition regimen during the hormone-sensitive growth phase before first parturition can significantly affect mammary growth and subsequent lactation performance. The objective of the present study was to determine if a compensatory nutrition regimen improves lactation performance by affecting proliferation and apoptosis of mammary epithelial cells. Forty female rats (7 weeks of age, average weight 148 g) were assigned to either (1) control, free access to diet or (2) stair-step compensatory nutrition regimen, an alternating 3-4-week schedule beginning with an energy-restricted diet (31.2% restriction) for 3 weeks, followed by the control diet for 4 weeks. Estimated milk yield was greater (P < 0.05) on day 15 of lactation in the compensatory nutrition group than in the control group. Mammary cell proliferation values were 1.4- and 2.7-fold greater in mammary tissue from the compensatory group during pregnant and early lactating stages respectively, compared with those from the control group. Ornithine decarboxylase (EC 4.1.17) mRNA was 24% higher (P < 0.05) in mammary tissues of rats from the compensatory nutrition group during pregnancy than in those from the control group. These results indicate that the compensatory nutrition regimen imposed during the peripubertal growth phase stimulated mammary epithelial cell proliferation and improved lactation performance.

A somatostatin analogue decreases embryonic loss following superovulation in rats by normalizing insulin-like growth factor-I action in the uterus.

This study was designed to determine whether the somatostatin analogue, octreotide, could prevent embryonic loss by normalizing increased uterine insulin-like growth factor-I (IGF-I) action related to hyperoestrogenaemia following superovulation. Superovulated immature and oestradiol-17beta-treated adult rats were infused with 100 or 300 microg/ml of octreotide respectively, or injected daily with 1 or 10 microg of octreotide from day 1 to day 3 of pregnancy. On day 3, embryos were collected from the oviducts and uteri. Uterine luminal fluid was subjected to embryo culture. The amounts of uterine IGF-I and IGF binding proteins (IGFBP) were determined by radioimmunoassay and ligand binding assay respectively. Octreotide infusion normalized uterine IGF-I action following superovulatory and oestradiol-17beta treatment, by reducing IGF-I concentrations and increasing IGFBP concentrations. Octreotide infusion increased the number of normal embryos by 2.7-fold and 1.7-fold in superovulated and oestradiol-17beta-treated rats respectively, and reversed the detrimental effects of uterine luminal fluid on embryonic development caused by superovulatory and oestradiol-17beta treatment. Daily injections with octreotide had similar but reduced effects in all parameters examined in both treatment groups. In conclusion, octreotide may reduce embryonic loss, at least in part, by normalizing IGF-I action following superovulation.

Investigation of effects of pregnant mare serum gonadotropin (PMSG) on the chromosomal complement of CD-1 mouse embryos.

PURPOSE: The objective of this study was to examine the effect of superovulatory doses of gonadotropins on the frequency of chromosomal abnormalities of mouse embryos. METHODS: Chromosome analysis of 8- to 16-cell stage mouse embryos and zygotes was performed by a cytogenetic method. RESULTS: There was no significant effect of the pregnant mare serum gonadotropin (PMSG) dose on the level of aneuploidy and structural abnormalities from 8- to 16-cell-stage embryos among superovulated groups. However, a simple dose-response relationship between the PMSG dose and the incidence of polyploidy was observed, with the level of polyploidy rising from 2.9% with 10 i.u. PMSG to 10.5% with 15 i.u. PMSG. In zygote stage, the proportion of polyploid embryos also increased as the dose increased, from 1.9% in 5 i.u. to 6.7% in 15 i.u. PMSG. It was observed that the extra chromosomal set in polyploidy embryos originated by both fertilization of a diploid oocyte and dispermy. CONCLUSIONS: These results indicate a dose-response relationship between the PMSG dose and the incidence of polyploidy in the CD-1 mouse. Both a disturbance at maturation division and an error at fertilization were the cause of polyploidy.

Role for insulin-like growth factor I in the regulation of electrolyte composition of uterine luminal fluid.

A potential role for insulin-like growth factor I (IGF-I) in the regulation of the uterine electrolyte environment was studied in conjunction with hyperoestrogenaemia caused by superovulation. Uterine luminal fluid from immature rats treated with 4 (control), 10, 20 and 40 i.u. (superovulation) pregnant mares' serum gonadotrophin (PMSG, day -2) and the electrolyte composition was determined on day 3 of pregnancy. Superovulation increased total cation content in uterine flushes by more than twofold, suggesting a comparable increase in the uterine luminal fluid volume. Percentages of K+ and HCO-3 content to total cations or anions increased by 27% and 16%, respectively, and those of Na+ and Cl- decreased by 26% and 15%, respectively, after superovulation. Daily injections with 1.0 micrograms or more oestradiol, from day 0 to day 2, in the 4 i.u. PMSG-primed immature rats caused similar changes in total cation content and electrolyte composition of uterine luminal fluid. Anti-IGF-I antibody infusion in the superovulated or oestradiol-treated immature rats restored the alterations in cation composition but had no effect on anion composition and total cation content. IGF-I was infused into adult rats to achieve increased IGF-I action observed after superovulation. IGF-I infusion altered electrolyte composition, as is observed after superovulation or oestradiol treatment, but had no effect on total cation content. In conclusion, hyperoestrogenaemia caused by superovulation may alter the uterine electrolyte environment for preimplantation embryonic development. IGF-I appears to play a central role in mediating this action of oestrogen.

Cowden's disease--a report on the first case in Korea and literature review.

Cowden's disease, or multiple hamartoma syndrome, is an uncommon condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. We describe a 32-year-old man with oral mucosal papillomatosis and plantar hyperkeratosis as a definite case of Cowden's disease according to the criteria proposed by Salem and Steck. The patient also had a thyroid mass and numerous gastrointestinal polyps endoscopically. Histologically the polyps were hamartomatous or hyperplastic polyps. The oral papillary lesions were fibroepithelial polyps and the thyroid mass was a follicular adenoma. We review the literature on this entity and summarize the pertinent findings. To the best of our knowledge, this is the first documented case of Cowden's disease in a Korean.

An improved technique for molecular cytogenetic analysis of human preimplantation embryos with fluorescence in situ hybridization.

OBJECTIVE: To develop a method for the cytogenetic evaluation of preimplantation embryos using nonradioactive centromeric probes for chromosomes 1, 16 and X. STUDY DESIGN: The embryos used for this study were either fragmented or polyploid embryos rejected from an in vitro fertilization program. Prior to in situ hybridization, the embryos were treated with 0.5% protease. After application of gradual fixation, conventional hybridization protocol was followed. RESULTS: Ten of 11 embryos showed hybridization signals suggesting that the success rate of in situ hybridization of human embryos is improved when a modified method of digesting the zona pellucida and gradual fixation with removal of the cytoplasm are used. CONCLUSION: The method described in this study demonstrates that the zona pellucida is the key to successful in situ hybridization of whole human embryos. When the zona pellucida is removed, penetration by a probe becomes possible.

The role for the uterine insulin-like growth factor I in early embryonic loss after superovulation in the rat.

OBJECTIVES: To examine possible roles of the insulin-like growth factor (IGF) system in increased early embryonic loss after superovulation. DESIGN: Changes in the uterine IGF system were examined in superovulated rats. Insulin-like growth factor I (IGF-I) was infused to the right uterine horns to mimic enhanced IGF-I actions after superovulation. Uterine luminal fluids were collected after IGF-I infusions and embryos were cultured with uterine luminal fluids. MAIN OUTCOME MEASURES: Steroid hormones, IGF-I, IGF binding protein (IGFBP), and IGF-I receptor levels, developmental rate, and cell numbers of embryos. RESULTS: Elevated IGF-I levels and suppressed IGFBP levels were found from days 1 to 3 of pregnancy after superovulation. Uterine luminal fluids of the IGF-I infusion and superovulation groups impaired embryo development in vitro. Anti-IGF-I antibody infusions after superovulation reversed detrimental effects of superovulation. Dialysis of uterine luminal fluids of the IGF-I infusion and superovulation groups before culture improved embryo development. CONCLUSIONS: Enhanced IGF-I actions in the uterus after superovulation may be responsible for the increase of early embryonic loss. The detrimental factor for embryo development seems a small molecule and is likely a local product of the uterus in which IGF-I actions are enhanced.

Separation of a 170-K delayed-implantation-associated protein with inhibitory activity on trophoblast outgrowth and RNA synthesis by mouse embryo.

PROBLEM: To screen the uterine protein responsible for embryonic dormancy associated with delayed implantation. METHOD: Uterine protein extracts and sera from mice in which delayed implantation had been induced and those from pregnant mice were separated by three steps of chromatography and SDS-PAGE by monitoring an inhibitory activity on trophoblast outgrowth. The presence of the separated protein in the uterine luminal fluid was assessed. Effect of the protein on cell proliferation and RNA synthesis by blastocysts were assessed. RESULTS: A 170-K protein was found in the uterine tissue as well as uterine luminal fluid associated with delayed implantation. The 170-K protein suppressed RNA synthesis by approximately 50% and cell proliferation in blastocysts. CONCLUSION: A 170-K protein is secreted into the uterine lumen during delayed implantation period. The ability of 170-K protein to suppress RNA synthesis and cell proliferation may play a role in regulation of embryonic dormancy associated with delayed implantation.

Insulin actions on ovarian steroidogenesis are not modulated by metformin.

Metformin, an agent used in treatment of non-insulin-dependent diabetes mellitus, is believed to act by potentiating the effects of insulin on glucose metabolism. This study was designed to determine whether metformin affects the actions of insulin on ovarian steroidogenic capability. Rat thecal-interstitial (T-I) and granulosa (G) cells were cultured in chemically defined media for 144 h with or without gonadotrophins [luteinizing hormone (LH) at 100 ng/ml or follicle stimulating hormone (FSH) at 100 ng/ml], insulin (1 microgram/ml) and/or metformin (1 and 5 micrograms/ml). Production of testosterone and progesterone by T-I cells, and 17 beta-oestradiol and progesterone by G cells were assessed. Insulin potentiated LH-dependent stimulation of testosterone production by T-I cells and FSH-dependent stimulation of 17 beta-oestradiol production by G cells, but did not significantly affect progesterone production by T-I cells or G cells in the presence or absence of gonadotrophins. Metformin did not affect any of the actions of insulin on steroidogenesis. These results suggest that insulin may modulate ovarian steroidogenesis via a pathway separate from that modulating glucose metabolism. Actions of insulin on steroidogenesis are selective with regard to stimulation of specific aspects of steroidogenesis and do not simply amplify gonadotrophin effects.