Differentially expressed genes in adult familial myelodysplastic syndromes.

The precise genetic events leading to myelodysplastic syndromes (MDSs) and leukemic transformation remain poorly defined. Even less is known about adult familial MDS. We report an adult MDS family in whom enriched tissue-specific transcripts were derived by subtractive hybridization of cDNA from the mononuclear and CD34+ cells of affected and unaffected family members. These expression libraries were then hybridized to Genome Discovery arrays containing 18 404 genes and expressed sequence tags, and several clusters of differentially expressed genes were identified. A group of 21 genes was underexpressed (>5-fold) in affected vs unaffected family members, and among these were transcription factors and genes involved in myeloid differentiation, such as ZNF140 and myeloid nuclear differentiation antigen (MNDA). Another group of 36 genes was overexpressed (>5-fold), and these encoded proteins belonging to signaling pathways, such as Ras- and Fos-related genes. The top two genes downregulated in this MDS family, ZNF140 and MNDA, were similarly altered in another MDS family, and in some cases of sporadic MDS. Our data suggest that we have identified genes differentially expressed in adult familial MDS, and that alteration of some of these genes may also be important for the evolution of different stages or severity of sporadic MDS.

Multidrug resistance in leukaemia.

Multidrug resistance hampers successful chemotherapy in many haematological neoplasms and is mediated by several cellular proteins. In some cases, the genes encoding these proteins have been shown to confer resistance on transfer to drug-sensitive cell lines. This is true for the efflux pump product of the MDR1 gene, P-170. Upregulation of enzymes such as GST has been observed, although the contribution of this enzyme in drug resistance expressed by malignant haematopoietic cells is still uncertain. Cells also appear to be able to downregulate enzymes which are drug targets. Examples include the decrease in Topo II which accompanies the resistance shown by cells to VP-16 and VM-26. Although many reports include both presentation and relapsed patients, there are few data on samples drawn from the same patients before and after chemotherapy. While P-170 and GST appear to be raised more often in cells from resistant and relapsed disease, it is quite clear that such mechanisms can be active in de novo malignancy and do not necessarily emerge as a consequence of prior chemotherapy. Methods of detecting drug resistance are reviewed here; these include in vitro cellular assays for drug toxicity, and molecular, immunological and functional detection of P-170 or Topo II. The clinical evaluation of such assays is only just beginning and some of the data are contradictory. To some extent, this may reflect the complex way in which the various resistance mechanisms may interact. Nevertheless, there are some encouraging early signs that the application of these assays to clinical material will yield valuable data on the relative contributions of these mechanisms and on ways in which they may be overcome. At present, much attention has focused on the potential of agents which prevent the P-170 efflux pump from exporting cytotoxics from the cell. This is likely to be only the first of new therapies arising from an improved understanding of multidrug resistance. More immediately, assays for multidrug resistance and its parameters may find their place as routine diagnostic and prognostic tools in the laboratory.

Increased drug accumulation ex vivo with cyclosporin in chronic lymphatic leukemia and its relationship to epitope masking of P-glycoprotein.

The ability of cyclosporin to modify drug accumulation in vitro, measured by the cellular accumulation of daunorubicin, was examined. In 42 patients with chronic lymphatic leukaemia this correlates well with the levels of P-glycoprotein (Pgp) measured by immunofluorescent labelling of Pgp after treatment of the cells with neuraminidase to unmask the epitope recognized by the monoclonal antibody MRK 16. It is shown that flow cytometric analysis using MRK 16 to detect Pgp expression levels together with drug accumulation studies can rapidly assess the multidrug-resistant phenotype of patients' cells, and enable selection of those suitable for therapy with agents known to circumvent mdr-1 mediated drug resistance.

Listeria meningitis and paté.

Listeria meningitis occurred in a 63 year old man who was in complete haematological remission following chemotherapy for acute myeloid leukaemia. The patient had followed Department of Health advice to immunocompromised patients and had avoided soft cheeses, cook-chill meals, and salads. He had, however, recently eaten paté produced in Belgium. This was no longer available for examination but a coincidental survey of paté in the Cardiff area found Listeria monocytogenes in 16 out of 73 samples. Paté should be included in the list of foods to be avoided by immunocompromised patients.

Mesenteric venous thrombosis due to protein C deficiency.

Protein C deficiency is a known underlying risk factor for thromboembolic disease. Most commonly it presents as thrombophlebitis, deep venous thrombosis or pulmonary embolism. Less common presentations are becoming increasingly recognized now that assays for protein C are more widely available. We present two cases of mesenteric venous thrombosis who were found to have protein C deficiency.

Expression of the multiple drug resistance gene (mdr-1) and epitope masking in chronic lymphatic leukaemia.

Resistance to cytotoxic agents is a common clinical problem in the treatment of chronic lymphatic leukaemia (CLL). The multidrug resistant (MDR) phenotype characterized by increased levels of a specific cell membrane p-glycoprotein, confers cross resistance to a wide range of structurally dissimilar antineoplastic drugs. We have studied the expression of this p-glycoprotein in chronic lymphatic leukaemia measured by immunofluorescence using a monoclonal antibody MRK 16 by flow cytometry. Initial results showed that only 12% of lymphocyte samples from CLL patients showed increased p-glycoprotein, conflicting with a previous observation that 53% of CLL patients had an increased level of mdr-1 mRNA. Treatment of the cells with neuraminidase to remove sialic acid residues increased the proportion of patients showing increased p-glycoprotein to 52%. This suggest that in a subset of CLL patients post translational modification of the protein occurs masking the epitope recognized by MRK 16. Abnormal sialylation patterns associated with malignancy are a well-recognized phenomenon.

Unusual radiographic features in a female patient with ankylosing spondylitis.

A 71 year old woman suffering from ankylosing spondylitis with aggressive peripheral joint disease for 46 years developed unusual radiographic features in the hips and knees. The pathogenic processes responsible are uncertain, and no histology is yet available. Although she had been treated with radiotherapy to the knees, there was no similar history to explain the hitherto unreported appearance of the hips.

The metabolic effects of thiazide therapy in the elderly: a population study.

The metabolic consequences of thiazide diuretics are well known. The elderly to whom these agents are widely prescribed may be particularly susceptible. To quantify this metabolic risk, plasma and intracellular electrolytes and plasma glucose were measured in the elderly population of a Somerset village. Highly significant reductions in both plasma and cellular magnesium and potassium were found in the 47 thiazide-treated people. Forty-eight per cent of the thiazide-treated group were hypomagnesaemic and 28% were hypokalaemic. Thus, magnesium and potassium depletion are commonly associated with thiazide therapy in the elderly. These metabolic effects should be considered carefully prior to the use of these agents.