Novel paradigm enables accurate monthly gestational screening to prevent congenital toxoplasmosis and more.

Background: Congenital toxoplasmosis is a treatable, preventable disease, but untreated causes death, prematurity, loss of sight, cognition and motor function, and substantial costs worldwide. Methods/Findings: In our ongoing USA feasibility/efficacy clinical trial, data collated with other ongoing and earlier published results proved high performance of an Immunochromatographic-test(ICT) that enables accurate, rapid diagnosis/treatment, establishing new paradigms for care. Overall results from patient blood and/or serum samples tested with ICT compared with gold-standard-predicate-test results found ICT performance for 4606 sera/1876 blood, 99.3%/97.5% sensitive and 98.9%/99.7% specific. However, in the clinical trial the FDA-cleared-predicate test initially caused practical, costly problems due to false-positive-IgM results. For 58 persons, 3/43 seronegative and 2/15 chronically infected persons had false positive IgM predicate tests. This caused substantial anxiety, concerns, and required costly, delayed confirmation in reference centers. Absence of false positive ICT results contributes to solutions: Lyon and Paris France and USA Reference laboratories frequently receive sera with erroneously positive local laboratory IgM results impeding patient care. Therefore, thirty-two such sera referred to Lyon's Reference laboratory were ICT-tested. We collated these with other earlier/ongoing results: 132 of 137 USA or French persons had false positive local laboratory IgM results identified correctly as negative by ICT. Five false positive ICT results in Tunisia and Marseille, France, emphasize need to confirm positive ICT results with Sabin-Feldman-Dye-test or western blot. Separate studies demonstrated high performance in detecting acute infections, meeting FDA, CLIA, WHO ASSURED, CEMark criteria and patient and physician satisfaction with monthly-gestational-ICT-screening. Conclusions/Significance: This novel paradigm using ICT identifies likely false positives or raises suspicion that a result is truly positive, rapidly needing prompt follow up and treatment. Thus, ICT enables well-accepted gestational screening programs that facilitate rapid treatment saving lives, sight, cognition and motor function. This reduces anxiety, delays, work, and cost at point-of-care and clinical laboratories. Author's Summary: Toxoplasmosis is a major health burden for developed and developing countries, causing damage to eyes and brain, loss of life and substantial societal costs. Prompt diagnosis in gestational screening programs enables treatment, thereby relieving suffering, and leading to > 14-fold cost savings for care. Herein, we demonstrate that using an ICT that meets WHO ASSURED-criteria identifying persons with/without antibody to Toxoplasma gondii in sera and whole blood with high sensitivity and specificity, is feasible to use in USA clinical practice. We find this new approach can help to obviate the problem of detection of false positive anti- T.gondii IgM results for those without IgG antibodies to T.gondii when this occurs in present, standard of care, predicate USA FDA cleared available assays. Thus, this accurate test facilitates gestational screening programs and a global initiative to diagnose and thereby prevent and treat T.gondii infection. This minimizes likelihood of false positives (IgG and/or IgM) while maintaining maximum sensitivity. When isolated IgM antibodies are detected, it is necessary to confirm and when indicated continue follow up testing in ∼2 weeks to establish seroconversion. Presence of a positive ICT makes it likely that IgM is truly positive and a negative ICT makes it likely that IgM will be a false positive without infection. These results create a new, enthusiastically-accepted, precise paradigm for rapid diagnosis and validation of results with a second-line test. This helps eliminate alarm and anxiety about false-positive results, while expediting needed treatment for true positive results and providing back up distinguishing false positive tests.

Thromboxane synthase is preferentially conserved in activated mouse peritoneal macrophages.

Resident macrophages isolated from uninfected animals produce large quantities of arachidonic acid (AA) metabolites. Immunizing animals with protein antigens or bacteria activates macrophages and causes an 80% reduction in the cyclooxygenase and lipoxygenase metabolites relative to resident cells. Since some products have been shown to modulate immune functions, we examined how the AA metabolic enzyme activities regulate the products that are synthesized. We demonstrate that the cyclooxygenase, 5-lipoxygenase, prostacyclin synthase, and probably prostaglandin (PG) endoperoxide E-isomerase activities were decreased in activated peritoneal macrophages. In sharp contrast, thromboxane synthase activity was selectively unchanged or enhanced in the activated macrophages. Thus the immune response appears to modulate the activity of the AA and PG endoperoxide-dependent enzymes, thus dictating a major shift in the profile of metabolites synthesized by macrophages.

Celecoxib inhibits N-butyl-N-(4-hydroxybutyl)-nitrosamine-induced urinary bladder cancers in male B6D2F1 mice and female Fischer-344 rats.

Epidemiological studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) may have a role in the prevention of human cancers. A number of preclinical studies have also suggested that inhibition of cyclooxygenase (COX) with NSAIDs has an anticancer effect in animal models of colon, urinary bladder, skin, and breast. In these studies, we evaluated the COX-2 inhibitor celecoxib in two rodent models of urinary bladder cancer. Male B6D2F1 mice treated with N-butyl-N-(4-hydroxybutyl)-nitrosamine (OH-BBN) developed transitional and squamous cell urinary bladder cancers, many of which grew rapidly and caused substantial morbidity that required sacrifice of the mice. Groups of mice received various daily doses of celecoxib in the diet (1250, 500, or 200 mg/kg of diet) beginning 7 days before the initiation of 12 weekly doses of OH-BBN. Mice were checked weekly for the presence of palpable urinary bladder masses. The study was terminated at 8 months following the initial treatment with OH-BBN. The percentage of mice with large palpable bladder lesions, which necessitated sacrifice of the mice, was 40% in the OH-BBN control group. In contrast, only 10% of all celecoxib-treated mice required sacrifice before the scheduled termination of the experiment, implying that all three doses of celecoxib inhibited the formation of large palpable lesions. Celecoxib did not significantly alter the incidence of preneoplastic bladder lesions, but did dose-dependently decrease the total number of urinary bladder cancers/mouse, palpable plus microscopic, by 77, 57, and 43% at dosages of 1250, 500, and 200 mg of celecoxib/kg of diet, respectively. In the second model, female Fischer-344 rats were administered OH-BBN twice/week for a period of 8 weeks. After 8 months, all rats developed preneoplastic lesions, whereas roughly 60% of the rats developed relatively small urinary bladder cancers. Rats were treated continually with celecoxib in the diet (500 or 1000 mg/kg of diet) beginning either 1 week prior to the initial OH-BBN treatment or beginning 1 week following the last OH-BBN treatment. Neither celecoxib treatment regimen significantly altered the number of preneoplastic lesions. Whereas celecoxib treatment initiated prior to OH-BBN administration decreased cancer incidence roughly 65%, celecoxib treatment initiated beginning 1 week after the last dose of OH-BBN profoundly decreased cancer incidence (>95%). Celecoxib did not alter the body weights of the mice or rats, or cause other signs of toxicity at any of the doses studied. Taken together these results demonstrate that: (a) celecoxib effectively inhibits tumor growth and enhances survival in the mouse model of urinary bladder cancer; and (b) celecoxib profoundly inhibits development of urinary bladder cancers in the rat model even when administered following the last dose of OH-BBN. Clinical trials will be necessary to determine whether COX-2 inhibitors will provide a clinical benefit in human bladder cancer.

Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors.

We provide evidence that cyclooxygenase (COX)-2-derived prostaglandins contribute to tumor growth by inducing newly formed blood vessels (neoangiogenesis) that sustain tumor cell viability and growth. COX-2 is expressed within human tumor neovasculature as well as in neoplastic cells present in human colon, breast, prostate, and lung cancer biopsy tissue. COX-1 is broadly distributed in normal, as well as in neoplastic, tissues. The contribution of COX-2 to human tumor growth was indicated by the ability of celecoxib, an agent that inhibits the COX-2 enzyme, to suppress growth of lung and colon tumors implanted into recipient mice. Mechanistically, celecoxib demonstrated a potent antiangiogenic activity. In a rat model of angiogenesis, we observe that corneal blood vessel formation is suppressed by celecoxib, but not by a COX-1 inhibitor. These and other data indicate that COX-2 and COX-2-derived prostaglandins may play a major role in development of cancer through numerous biochemical mechanisms, including stimulation of tumor cell growth and neovascularization. The ability of celecoxib to block angiogenesis and suppress tumor growth suggests a novel application of this anti-inflammatory drug in the treatment of human cancer.

A murine model of subglottic granulation.

OBJECTIVE: This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes. METHODS: Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation. RESULTS: Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury. CONCLUSION: Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.

Upregulation of COX-2 during cardiac allograft rejection.

BACKGROUND: The hypothesis that cyclooxygenase-2 (COX-2) is involved in the myocardial inflammatory response during cardiac allograft rejection was investigated using a rat heterotopic abdominal cardiac transplantation model. METHODS AND RESULTS: COX-2 mRNA and protein in the myocardium of rejecting cardiac allografts were significantly elevated 3 to 5 days after transplantation compared with syngeneic controls (n=3, P<0.05). COX-2 upregulation paralleled in time and extent the upregulation of iNOS mRNA, protein, and enzyme activity in this model. COX-2 immunostaining was prominent in macrophages infiltrating the rejecting allografts and in damaged cardiac myocytes. Prostaglandin (PG) levels in rejecting allografts were also higher than in native hearts. Because NO has been reported to modulate PG synthesis by COX-2, additional transplants were performed using animals treated with a selective COX-2 inhibitor (SC-58125) and a selective inhibitor of the inducible nitric oxide synthase (iNOS) N-aminomethyl-L-lysine. At posttransplant day 5, inhibitor administration resulted in a significant reduction of COX-2 mRNA expression (3764+/-337 versus 5110+/-141 arbitrary units, n=3, P<0.05) and iNOS enzymatic activity (1.7+/-0.4 versus 22.8+/-14. 4 nmol/mg protein, n=3, P<0.01) compared with vehicle-treated allogeneic transplants. Allograft survival in treated animals was increased modestly from 5.4 to 6.4 days (P<0.05). However, apoptosis of cardiac myocytes (TUNNEL method) was only marginally reduced relative to vehicle controls in treated graft recipients. The intensity of allograft rejection was also similar in the treated and untreated allografts. CONCLUSIONS: The data indicates that COX-2 expression is enhanced in parallel with iNOS in the myocardium during cardiac allograft rejection.

Cellular interactions and exaggerated arachidonic acid metabolism in rabbit renal injury.

Cell cultures from explants of the rabbit hydronephrotic kidney (HNK) cortex consisted of fibroblasts and an esterase-positive cell that phagocytizes zymosan. Cortical cell cultures from the contralateral kidney (CLK) contained only the fibroblast. The HNK cultures exhibited an endotoxin-induced prostaglandin (PG) E2 (three - fourfold) release indicative of the presence of macrophages, whereas no response was observed in the CLK cultures. At bradykinin concentrations as low as 10(-9)M there was a 20-fold stimulation of PGE2 from the HNK cultures and a sevenfold stimulation in the CLK cultures. The heterogeneous population of cells in the HNK cultures was separated using a mild trypsin treatment which permits passage of only the fibroblasts. The HNK-passaged cultures contained no phagocytic cells and did not release PGE2 in response to endotoxin. The passaged HNK cultures released less PGE2 in response to bradykinin as compared to primary cultures and had a decreased cyclooxygenase activity as determined by exogenous arachidonic acid conversion to PGE2. Conditioned media from adherent rabbit peripheral blood mononuclear cells stimulated basal PGE2 production (two - threefold) from both the HNK and CLK cultures. These findings demonstrated the similarity of the PGE2 production by cultured HNK cortical cells as compared to the ex vivo perfused HNK.

Heparin interferes with the biological effectiveness of atriopeptin.

The chromatographic mobility of atriopeptin-28 or of the prohormone is markedly altered by preincubation of the peptides with heparin before separation on reverse-phase high performance liquid chromatography. Protamine prevented the heparin effect and reestablished the original migration pattern of the atrial peptides. The addition of heparin to either rat or human plasma samples did not interfere with the atriopeptin immunoreactivity. The influence of heparin on the biological activity of the atriopeptin-28 in anesthetized rats was also investigated. Infusion of heparin (30 U/min) significantly reduced the dose-dependent fall of blood pressure produced by atriopeptin-28, but did not interfere with the hypotensive effect of nitroglycerin. Similarly, infusion of heparin in volume-expanded rats markedly decreased the diuresis produced by atriopeptin-28 without altering the urine volume excreted in response to furosemide. These data suggest that the highly charged molecule heparin can modify the physical and biological properties of atriopeptins, perhaps by binding to the numerous arginine residues (i.e., 5 arginine residues in atriopeptin-28) in the atriopeptin molecules.

Oxidative stress induces the levels of a MafG homolog in hamster HA-1 cells.

The Maf family encodes nuclear proteins that recognize AP-1-like response elements. MafB, MafK, MafF, and MafG, are all able to heterodimerize with each other, c-fos, and erythroid cell-specific transcription factor NF-E2, to affect the transcription of target genes. Using the technique of differential display, we recently identified a new oxidant-inducible mRNA, designated adapt66, in HA-1 hamster fibroblasts. Cloning, partial sequencing, and GenBank analysis of adapt66 revealed strong homology to chicken mafG, a newly identified member of the maf oncogene family. The mafG homolog/adapt66 mRNA induction appeared to be dependent upon calcium; occurred as early as 90 minutes following exposure of HA-1 cells to hydrogen peroxide; and peaked between 5 and 10 hours after peroxide treatment. It has previously been demonstrated that several cellular transcription factors, including Fos, can be induced by oxidative stress. The induction of the DNA binding sequence mafG homolog/adapt66 by hydrogen peroxide, and it's known interaction with c-fos, may represent important mechanisms by which oxidative stress can modulate gene expression.

Role of cyclooxygenases in angiogenesis.

Angiogenesis is the process by which new blood vessels are formed. This process supports normal physiology as well as contributes to progression of disease. Progressive rheumatoid arthritis and growth of tumors are two pathologies to which angiogenesis contributes. In arthritis, we know that prostaglandins (PGs) and the enzyme cyclooxygenase-2, which catalyses prostaglandin production, are inflammatory mediators. These mediators are involved in rheumatoid arthritis and cancer-induced angiogenic processes. We discuss, herein, recent findings on the expression of cyclooxygenases in both rheumatoid arthritis and human cancer, and the links between COX-2, PGs, and angiogenesis. We also propose a model for the possible mechanistic interaction of the various cell types involved in angiogenesis.

Brain natriuretic peptides: differential localization of a new family of neuropeptides.

Brain natriuretic peptide (BNP) is a recently discovered neuropeptide, isolated from the porcine brain, that is highly homologous to atriopeptin (AP), the atrial natriuretic peptide. We used a set of highly selective antisera against the two peptides to map their differential distribution immunohistochemically in the rat central nervous system. BNP immunoreactivity has a distinct distribution, involving many central autonomic and endocrine control structures that contain little if any AP immunoreactivity. AP and BNP belong to a family of neuropeptides that may be important in central cardiovascular control.

The antioxidant, U74389, ameliorates the depression of vascular reactivity caused by lipopolysaccharide.

There is growing evidence that an oxidant stress contributes to the deleterious effects of bacterial lipopolysaccharide (LPS). The present study evaluated the ability of the antioxidant, U74389, to prevent the depression of vascular reactivity caused by LPS. Aortic rings taken from rats given LPS showed a depression of maximum force in response to phenylephrine that was reversed by an inhibitor of nitric oxide synthase. Pretreatment of animals with U74389 attenuated this depression of vascular reactivity. U74389 did not limit the increase in serum tumor necrosis factor levels caused by LPS. These results show that U74389 can ameliorate the depression of vascular reactivity caused by LPS possibly by interfering with the induction of nitric oxide synthase.

Genetic testing for breast cancer susceptibility: frequency of BRCA1 and BRCA2 mutations.

Genetic testing for breast cancer susceptibility became a reality after two cancer predisposition genes, BRCA1 and BRCA2, were identified. Mutations in these two genes were predicted to account for 85% to 90% of hereditary breast and ovarian cancer syndromes. We present results of mutation analysis of the coding sequence of these two genes in 110 consecutive non-Jewish breast cancer patients with a positive family history of breast and/or ovarian cancer. The individuals were identified in various cancer risk evaluation centers in the country. Twenty-two (20%) mutations in the BRCA1 gene and 8 mutations (7%) in the BRCA2 gene were detected. We also analyzed 52 Ashkenazi Jewish breast cancer patients for mutations in the BRCA1 and BRCA2 genes. Eleven Jewish individuals (21%) carried either one of the two common mutations, 185delAG and 5382InsC, in the BRCA1 gene and 4 individuals (8%) had the 6174delT mutation in the BRCA2 gene. The frequency of mutations in BRCA genes in affected people in this ethnic group was not significantly different from the non-Jewish population. On further analysis, the data demonstrate that neither age of onset nor phenotype of the disease had any significant predictive value for the frequency of mutations in these genes. These data confirm the lower prevalence of mutations in either of the BRCA genes in clinical families when compared to high-risk families used for obtaining linkage data in a research setting.

Distribution of COX-1 and COX-2 in normal and inflamed tissues.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of a number of inflammatory diseases and are believed to act via inhibition of the enzyme cyclooxygenase (COX). This enzyme catalyzes the conversion of arachidonic acid to the prostaglandins (PGs). Although commercially available NSAIDs are efficacious anti-inflammatory agents, significant side effects limit their use. Recently two forms of COX were identified-a constitutively expressed COX-1 and a cytokine-inducible COX-2. Potent anti-inflammatory agents like the glucocorticoids are known to inhibit specifically the expression of COX-2 while commercially available NSAIDs like indomethacin inhibit both COX-1 and COX-2. These findings have led to the hypothesis that toxicities associated with NSAID therapy are due to inhibition of the non-regulated or constitutive form of COX (COX-1), whereas therapeutic benefit derives from inhibition of the inducible enzyme, COX-2. We have examined the relative distribution of COX-1 and COX-2 in both normal and inflamed tissues and report that COX-1 expression dominates normal tissues while COX-2 mRNA is induced at the inflammatory site. Furthermore, compounds that selectively inhibit COX-2 are anti-inflammatory without gastric toxicity.

Effects of treating corn silage with alpha-amylase and(or) sorbic acid on beef cattle growth and carcass characteristics.

The effects on beef cattle growth performance and carcass characteristics of feeding silages produced by altered fermentations were determined. Alpha-amylase was added at 0 or .05% (wet basis) and sorbic acid was added at 0 or .10% (wet basis) to chopped whole corn plants before ensiling in a 2 x 2 factorial arrangement of treatments. For three successive years, 40 beef heifers (224 kg) were fed these silages for 80 d, finished on corn-and-cob meal (107 d) and slaughtered when backfat thickness over the 13th rib reached 12 mm. Silages treated with alpha-amylase had a slightly higher percentage of N-free extract (P less than .10). Silages treated with sorbic acid had lower percentages of ADFN (P less than .10). During the silage-feeding phase, heifers fed silages treated with alpha-amylase gained more (P less than .01) daily than heifers fed the other two silages (.84 vs .78 kg) and they were more efficient (P less than .01) in weight gain per unit of dry feed consumed (.149 vs .139 kg). During the finishing phase, heifers that previously had been fed the alpha-amylase-treated silage continued to have higher (P less than .05) ADG (.93 vs .87 kg), although all were fed the same diet during this period. Added sorbic acid had no effect on ADG in either period. The percentage of kidney fat in heifers on the alpha-amylase treatments was increased (P less than .02, 2.2 vs 2.0). The biological mechanisms associated with the beneficial results of alpha-amylase addition are not understood yet.

An assessment of data quality in the Vermont-Oxford Trials Network database.

The Vermont-Oxford Trials Network is a voluntary collaborative research group of neonatologists that maintains a database for very low birthweight infants (501-1500 g). The database (1) provides core data for randomized trials, (2) serves as a resource for outcomes research in neonatology, and (3) generates quality management reports for participating sites. To assess the reliability of this database and to determine the sources of error, we reviewed 635 medical records chosen at random from among the 4341 eligible infants born at 40 participating data generating sites during an 18-month period beginning January 1, 1990. The estimated frequencies of disagreement between the medical record and database for each of the 10 data items studied and the standard errors of the estimates (in parentheses) were: date of birth 1.3% (0.4), date of admission 2.5% (0.6), date of discharge 8.8% (1.0), birthweight (difference > 50 g) 2.9% (0.6), location of birth (inborn or outborn) 2.1% (0.5), multiple birth 2.2% (0.5), cesarean section 2.5% (0.6), gender 2.1% (0.5), status 28 days after birth 3.4% (0.6), final status 2.9% (0.6). The overall proportions and mean values for items in the database were close to the estimated values based on the random sample of records. There were a total of 247 disagreements between the database and the medical records in the sample. Twenty-three were due to data keying errors. Two hundred twenty-four were due to errors in transcription or interpretation. The rate of data keying errors decreased from over 50 errors per 10,000 fields to less than 15 errors per 10,000 fields when specific quality control procedures, including visual inspection, were instituted. Data keying errors accounted for 13.7% of all disagreements between the database and medical record before improved data entry methods were introduced, and only 3.7% of all errors after they were introduced. We concluded that the Vermont-Oxford Trials Network Database is reliable. Data keying errors have been reduced by the introduction of additional quality control measures. Further reductions in database errors will require measures aimed at minimizing transcription or interpretation errors by individuals completing the data forms.

adapt78 protects cells against stress damage and suppresses cell growth.

We have previously identified several genes whose RNA products are induced in HA-1 hamster cells under conditions where a cytoprotective adaptive response is observed. One of these genes, designated adapt78, was found to have a human homolog with some homology to glucose-regulated protein 78 (Grp78). We subsequently determined that adapt78 and grp78 mRNAs are induced by the same stress agents and conclude that adapt78 is a stress-response gene and putative new member of the grp stress gene family. Here we extend these studies to assess the effect of overexpressing adapt78 on stress protection and growth arrest. HA-1 cells stably transfected with adapt78 cDNA were found to exhibit significantly reduced calcium- and hydrogen peroxide-mediated cytotoxicity as compared with control transfectants. In addition, adapt78 stable overexpressors exhibited significantly reduced cell growth. Both cytoprotection and growth arrest accompanied only modest overexpression of adapt78. Flow cytometry revealed that the growth arrest occurred in G(1)-phase. Immunoflourescent analysis revealed that Adapt78 protein exhibits significant perinuclear staining suggestive of endoplasmic reticulum localization in addition to cytoplasmic localization. These data indicate that adapt78 is both cytoprotective and growth suppressive and that these effects may be mediated by Adapt78 protein at the endoplasmic reticulum.

Ultrasound identification of lateral ventricular asymmetry in the human neonate.

Sonography was used to investigate left-right asymmetries of the brain in 66 human neonates with gestational ages of 28-44 wk. The body of the left lateral ventricle was larger than the right in 21 infants (31.8%), whereas the right was larger than the left in only four infants (6.1%)(p less than 0.001). Asymmetry of the lateral ventricles can be detected in the normal neonatal brain using sonography.

Real-time ultrasonography: its use in diagnosis and management of neonatal hydrocephalus.

Real-time ultrasonography of the brain is useful in the examination of neonates with suspected hydrocephalus. Abnormalities of the cerebral ventricles can be identified and changes in ventricular size determined with repeated studies performed at the bedside. The response of hydrocephalus to medical and surgical intervention can be monitored. We studied cases of hydrocephalic infants with myelomeningocele, posterior fossa cyst, posthemorrhagic hydrocephalus, meningitis, and congenital intracranial teratoma. We also studied the role of ultrasonography in the diagnosis and follow-up of these cases.