Trasduzione del segnale inositide-dipendente nel carcinoma della mammella

Breast carcinoma, one of the most frequent malignancies in women, is a complex disease in which a number of different factors combine to drive pathogenesis. The biopathological characterization of these tumors is essential to determine their aggressiveness and to find the most appropriate therapy. As in others neoplasms, the deregulation of signal transduction pathways is frequently responsible for conferring selective biological advantages to the tumor. Phosphoinositides play an essential role in diverse cellular functions, their metabolism is highly active, and is tightly controlled. Among the enzymes implicated in this pathway, phospholipase C beta 1 (PLCβ1) is one of the key regulators, both at the cytoplasmic and the nuclear level. The PLCβ1 gene maps onto the short arm of chromosome 20, a region that has been shown to be altered in several solid tumors, including breast cancer. In the present study a FISH approach was used to investigate the genetic alterations of the PLCβ1 gene in various classes of breast cancer which differ in their invasiveness and proliferation status, according to their mitotic index. The overall aim was to find out whether this enzyme could be a suitable prognostic marker for this neoplasm. Our results show that 83% of cases had aneusomies at the 20p12 level, and the most frequent alteration is a gain in this specific locus. Indeed, we found that this amplification is not related to the invasion status since there were no differences in amplified tumor frequencies between in situ and invasive breast cancer. On the contrary, the gain of PLCβ1 was significantly related to the mitotic index (p = 0.001). To verify if the change in genetic dosage influences the expression of PLCβ1 we performed Real Time PCR and Immunohystochemical analysis. Our results confirmed that amplified tumors have higher levels of PLCβ1 mRNA, which is the sum of the two splicing isoforms 1a and 1b. On the other hand, even if protein levels were higher in the majority of cases compared to the nontumoral specimens, there were no significant associations between gain and overexpression. Finally, the significant association between the amplification of PLCβ1 and others important clinicopathological parameters, such as grading and hormonal receptors status, confirmed a correlation of this enzyme with the aggressiveness of breast cancer. This suggests that PLCβ1 has the potential to be a prognostic marker in these tumors. However, further work needs to be carried out to validate these preliminary findings.

Analyse von Biotransformationen und Naturstoffsynthesen in pflanzlichen Zellkulturen unter Anwendung der in vivo NMR-Spektroskopie ohne Markierung

Die Aufklärung von Biosynthesewegen erfolgt häufig mit Hilfe von Fütterungsexperimenten mit radioaktiven oder stabilen Isotopen markierten Präkusoren oder auf der Basis der Enzymreinigung mit anschließender molekularbiologischer Charakterisierung. Die erstgenannte Methode verlangt die Isolierung der Produkte. Jedoch besteht bei Aufarbeitung und Extraktion immer die Gefahr, daß sich der Metabolit teilweise oder vollständig chemisch verändert. Ein weiterer Nachteil der genannten Methoden ist, daß diese generell mühsam und zeitaufwendig sind. Mit Hilfe der in vivo NMR-Spektroskopie können diese Nachteile umgangen werden. In der vorliegenden Arbeit wurden Biotransformationen und Biosynthesesequenzen des Ajmalin-Biosyntheseweges mit Hilfe der in vivo NMR-Spektroskopie in Pflanzenzellkulturen von Rauvolfia serpentina und Rauvolfia serpentina x Rhazya stricta anhand der natürlichen 13C-Häufigkeit untersucht. Dafür wurden ein 700 MHz, 800 MHz und ein 500 MHz CryoProbe Spektrometer eingesetzt, um die Biotransformationen von Isatin-3-oxim und Isatin sowie die Metabolisierungen der Alkaloide Vellosimin, Vinorin, Vomilenin, Ajmalin, Nß-Methyl-dihydrochano-ajmalin und Perakin mit der 1H-13C invers korrelierten NMR-Spektroskopie zu verfolgen.

Die Bedeutung von NFAT-Transkriptionsfaktoren für die Expression von Mastzell-Cytokinen

Zusammenfassung Die Rolle verschiedener Mitglieder der NFAT- Familie in der Entwicklung von T- Zellen und deren Funktion wird intensiv untersucht, wohingegen vergleichbare Untersuchungen in Mastzellen rar sind. Mastzellen exprimieren eine Vielzahl biologisch hochaktiver Mediatoren und sind auf diese Weise sowohl in angeborenen als auch adaptiven Immunantworten beteiligt. Die von Mastzellen produzierten Th2-Cytokine verstärken lokal Th2- Reaktionen und TNF-alpha ist ein wichtiger Initiator antimikrobieller Antworten. In dieser Arbeit wird gezeigt, dass die Transkriptionsfaktoren NFATc1 und NFATc2 eine bedeutende Rolle in der Regulation der Expression von TNF-alpha und IL-13 einnehmen, wohingegen NFATc3 hierbei keine Funktion zukommt. Murine „Bone marrow derived mast cells“ (BMMC) aus NFATc2- defizienten Mäusen, aktiviert entweder durch Kreuzvernetzung des IgE- Rezeptors oder Ionomycin, zeigen eine drastisch reduzierte Expression dieser Cytokine verglichen mit Mastzellen aus Wildtyp- Mäusen. Genauere Untersuchungen zeigen, dass sowohl NFATc2 als auch NFATc1 an der Expression von IL-13 und TNF-alpha beteiligt sind, wohingegen sie auf die Degranulation und die Expression von IL-6 keinen Einfluss nehmen. Zusammenfassend scheint eine hohe Aktivität von NFAT- Faktoren für die Induktion des IL-13 und TNF-alpha Promoters in Mastzellen erforderlich zu sein, unabhängig davon, ob diese durch NFATc2 oder NFATc1 oder eine Kombination beider Transkriptionsfaktoren bewerkstelligt wird.

Regelmechanismen und Determinanten der Transkription in Polytänchromosomen von Chironomus und Drosophila

Die kumulative Habil.‐Schrift gründet sich auf 6 Originalpublikationen, die beschreiben: [Sass, H. (1982), Cell 28: 269‐278]. RNA polymerase B in polytene chromosomes: Immunofluorescent and autoradiographic analysis during stimulated and repressed RNA synthesis. Elektronenmikroskopie charakterisierte das C. tentans Balbianiring BR2‐Gen von Speicheldrüsenchromosomen als hoch aktives 5‐6 μm langes single‐copy Gen, das 33/μm RNAPolymerasen B (Pol II) transkribieren (Diss., Sass, H., 1978, Univ. Tübingen). Diese Immunfluoreszenzstudie ortet Pol II in allen Interbanden von Region IV‐3B10‐3B5 des nichtinduzierten BR2. Prominente Fluoreszenz im BR2‐Genort 3B9/10 zeigt, das BR2‐Gen ist präaktiv, wie erwartet. 3H‐Autoradiogramme beweisen, in allen fluoreszierenden BR2, BR1, BR3, Puffs, aufgelockerten Banden, Interbanden und Loci ohne Puffing, synthetisiert Pol II RNA. Die genomweite ständige Pol II‐Präsenz zeigt, dass, wie beim nichtinduzierten BR2‐Gen, bereits schon gebundene Pol II wohl auch andere Gene präaktiviert. So erfolgt die Regulation der Transkription mehr über die transkriptionelle Elongation. Auch durch α‐Amanitin, oder Actinomycin D, oder Hitzeschock in vivo kollabierte BR2, BR1, BR3 besitzen Pol II. [Sass, H. (1984), Chromosoma 90: 20‐25]. Gene identification in polytene chromosomes: some Balbiani ring 2 gene sequences are located in an interband‐like region of Chironomus tentans. Immunfluoreszenz und 3H‐Autoradiographie zeigen, dass Injektionen von DRB in Larven die Balbianiringe (BR) sowie andere Puffs und deren Pol II‐Konzentration dramatisch reduzieren. Trotzdem zeigen 3H‐Uridin markierte Speicheldrüsenchromosomen, dass RNA‐Synthese doch in nichtinduzierten BR2, BR1, BR3 erfolgt, aber nur auf reduziertem Level. Das widerspricht der von Egyházi E. (1975, PNAS 73:947‐950) propagierten „Inhibition of Balbiani ring RNA synthesis at the initiation level“ durch DRB. Vielmehr sieht es so aus, DRB wirkt bei der transkriptionellen Elongation inhibierend. Durch in situ‐Hybridisierung von Sequenzen klonierter BR2‐DNA wurde in Speicheldrüsenchromosom IV das BR2‐Gen in Region 3B9/10 direkt identifiziert. [Sass, H. and Pederson, T. (1984), J. Mol. Biol. 180: 911‐926]. Transcription‐dependent localization of U1 and U2 small nuclear ribonucleoproteins at major sites of gene activity in polytene chromosomes. Immunolokalisation von Sm‐, U1‐ und U2snRNP‐spezifischen Antigenen in Speicheldrüsenchromosomen von C. tentans hat zur Entdeckung der beim Spleißen von prä‐mRNA beteiligten U1/U2snRNPs in Balbianiringen BR2, BR1, BR3 sowie anderen Puffs und aufgelockerten Banden geführt. Die überraschenden BR‐Daten zeigen erstmals: (i) Der Spleiß‐Apparat ist in Genloci mit intensiver RNA‐Synthese schon vorhanden. (ii) Immunfluoreszenz reflektiert den Exon‐Intron‐Bau dieser BR‐Gene. (iii) Transkription und spleißosomales Ausschneiden von Introns sind koordiniert. [Sass, H. (1989), Nucleic Acids Research 17: 10508]. Hsp82‐neo transposition vectors to study insertional mutagenesis in Drosophila melanogaster and tissue culture cells; [Sass, H. (1990), Gene 89: 179‐186]. P‐transposable vectors expressing a constitutive and thermoinducible hsp82‐neo fusion gene for Drosophila germline transformation and tissue‐culture transfection. Beschrieben sind Design, Konstruktion und Expression der Genfusion hsp82‐neo als ein in vivo selektierbares Reporter‐/Markergen, die Transposons P{hsp82‐neo/Adh} sowie P{hsp82‐neo} und Transformations‐Vektoren pHS22, pHS24, pHS85, pHS103 und pHS104. Sie stellen das von der Fliege gebildete Enzym bakteriellen Ursprungs, Neomycin‐Phosphotransferase II, für die G418‐Selektion bereit, um die Position, Struktur, Expression und Funktion von Genen mittels hsp82‐neo‐Mutagenese zu erforschen. [Sass, H. and Meselson, M. (1991), Proc. Natl. Acad. Sci. USA 88: 6795‐6799]. Dosage compensation of the Drosophila pseudoobscura Hsp82 gene and the D. melanogaster Adh gene at ectopic sites in D. melanogaster. Quantitative Unterschiede in der Dosiskompensation des X‐chromosomalen hsp82‐Gens von D. pseudoobscura und autosomalen Adh‐Gens von D. melanogaster wurden als Erhöhung der RNAMenge in D. melanogaster gemessen. Beide Transgene sind dosiskompensiert, sprang P{hsp82‐ neo/Adh} in euchromatische Regionen des D. melanogaster X‐Chromosoms. Beide Transgene sind nicht dosiskompensiert, insertierte P{hsp82‐neo/Adh} ins β‐Heterochromatin in Region 20 an der Basis des X. Keine der zehn autosomalen Insertionen ist dosiskompensiert. Die Ergebnisse lassen vermuten, dass X‐chromosomale regulatorische Sequenzen, die für die Verstärkung der Genaktivität um Faktor 2 in Männchen verantwortlich sind, gehäuft im X vorkommen, jedoch im β‐ Heterochromatin und den Autosomen fehlen. Das Kompensationsverhalten der transponierten Gene wird durch das neue chromosomale Milieu des Insertionsortes bestimmt.

Holocene tsunami events in the Eastern Ionian Sea - Geoscientific evidence from Cefalonia and the western Peloponnese (Greece)

This study presents geo-scientific evidence for Holocene tsunami impact along the shores of the Eastern Ionian Sea. Cefalonia Island, the Gulf of Kyparissia and the Gialova Lagoon were subject of detailed geo-scientific investigations. It is well known that the coasts of the eastern Mediterranean were hit by the destructive influence of tsunamis in the past. The seismically highly active Hellenic Trench is considered as the most significant tsunami source in the Eastern Ionian Sea. This study focuses on the reconstruction and detection of sedimentary signatures of palaeotsunami events and their influence on the Holocene palaeogeographical evolution. The results of fine grained near coast geo-archives are discussed and interpreted in detail to differentiate between tsunami, storm and sea level highstands as sedimentation processes.rnA multi-method approach was applied using geomorphological, sedimentological, geochemical, geophysical and microfaunal analyses to detect Holocene tsunamigenic impact. Chronological data were based on radiocarbondatings and archaeological age estimations to reconstruct local geo-chronostratigraphies and to correlate them on supra-regional scales.rnDistinct sedimentary signatures of 5 generations of tsunami impact were found along the coasts of Cefalonia in the Livadi coastal plain. The results show that the overall coastal evolution was influenced by tsunamigenic impact that occured around 5700 cal BC (I), 4250 cal BC (II), at the beginning of the 2nd millennium cal BC (III), in the 1st millennium cal BC (IV) and posterior to 780 cal AD (V). Sea level reconstructions and the palaeogeographical evolution show that the local Holocene sea level has never been higher than at present.rnAt the former Mouria Lagoon along the Gulf of Kyparissia almost four allochtonous layers of tsunamigenic origin were identified. The stratigraphical record and palaeogeographical reconstructions show that major environmental coastal changes were linked to these extreme events. At the southern end of the Agoulenitsa Lagoon at modern Kato Samikon high-energy traces were found more than 2 km inland and upt ot 9 m above present sea level. The geo-chronological framework deciphered tsunami landfall for the 5th millennium cal BC (I), mid to late 2nd mill. BC (II), Roman times (1st cent. BC to early 4th cent. AD) (III) and most possible one of the historically well-known 365 AD or 521/551 AD tsunamis (IV).rnCoarse-grained allochthonous sediments of marine origin were found intersecting muddy deposits of the quisecent sediments of the Gialova Lagoon on the southwestern Peloponnese. Radiocarbondatings suggest 6 generations of major tsunami impact. Tsunami generations were dated to around 3300 cal BC (I), around the end of 4th and the beginning of 3rd millennium BC (II), after around 1100 cal BC (III), after the 4th to 2nd cent. BC (IV), between the 8th and early 15th cent. AD (V) and between the mid 14th to beginning of 15th cent. AD (VI). Palaeogeographical and morphological characteristics in the environs of the Gialova Lagoon were controlled by high-energy influence.rnSedimentary findings in all study areas are in good accordance to traces of tsunami events found all over the Ionian Sea. The correlation of geo-chronological data fits very well to coastal Akarnania, the western Peloponnese and finding along the coasts of southern Italy and the Aegean. Supra-regional influence of tsunamigenic impact significant for the investigated sites. The palaeogeographical evolution and palaeo-geomorphological setting of the each study area was strongly affected by tsunamigenic impact.rnThe selected geo-archives represent extraordinary sediment traps for the reconstruction of Holocene coastal evolution. Our result therefore give new insight to the exceptional high tsunami risk in the eastern Mediterranean and emphasize the underestimation of the overall tsunami hazard.

Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008

Objective High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988—1995) and HAART (1996—2008) eras in HIV-infected patients and the general population in Switzerland. Method The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0—17.0) in the pre-HAART era to 3.5 (95% CI=2.5—4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4—20.9) to 5.7 (95% CI=3.2—10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.

Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings

Objectives: We assessed mortality associated with immunologic and virologic patterns of response at 6 months of highly active antiretroviral therapy (HAART) in HIV-infected individuals from resource-limited countries in Africa and South America. Methods: Patients who initiated HAART between 1996 and 2007, aged 16 years or older, and had at least 1 measurement (HIV-1 RNA plasma viral load or CD4 cell count) at 6 months of therapy (3-9 month window) were included. Therapy response was categorized as complete, discordant (virologic only or immunologic only), and absent. Associations between 6-month response to therapy and all-cause mortality were assessed by Cox proportional hazards regression. Robust standard errors were calculated to account for intrasite correlation. Results: A total of 7160 patients, corresponding to 15,107 person-years, were analyzed. In multivariable analysis adjusted for age at HAART initiation, baseline clinical stage and CD4 cell count, year of HAART initiation, clinic, occurrence of an AIDS-defining condition within the first 6 months of treatment, and discordant and absent responses were associated with increased risk of death. Conclusions: Similar to reports from high-income countries, discordant immunologic and virologic responses were associated with intermediate risk of death compared with complete and no response in this large cohort of HIV-1 patients from resource-limited countries. Our results support a recommendation for wider availability of plasma viral load testing to monitor antiretroviral therapy in these settings.

Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study

The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy.

The sodium-dependent ascorbic acid transporter family SLC23

Transporters for vitamin C and its oxidized form dehydroascorbic acid (DHA) are crucial to maintain physiological concentrations of this important vitamin that is used in a variety of biochemical processes. The human SLC23 family consists of the Na(+)-dependent vitamin C transporters SVCT1 (encoded by the SLC23A1 gene) and SVCT2 (SLC23A2) as well as an orphan transporter SVCT3 (SLC23A3). Phylogenetically, the SLC23 family belongs to the nucleobase-ascorbate transporter (NAT) family, although no nucleobase transport has yet been demonstrated for the human members of this family. The SVCT1 and SVCT2 transporters are rather specific for ascorbic acid, which is an important antioxidant and plays a crucial role in a many metal-containing enzymes. SVCT1 is expressed predominantly in epithelial tissues such as intestine where it contributes to the supply and maintenance of whole-body ascorbic acid levels. In contrast to various other mammals, humans are not capable of synthesizing ascorbic acid from glucose and therefore the uptake of ascorbic acid from the diet via SVCT1 is essential for maintaining appropriate concentrations of vitamin C in the human body. The expression of SVCT2 is relatively widespread, where it serves to either deliver ascorbic acid to tissues with high demand of the vitamin for enzymatic reactions or to protect metabolically highly active cells or specialized tissues from oxidative stress. The murine Slc23a3 gene encoding the orphan transporter SVCT3 was originally cloned from mouse yolk sac, and subsequent studies showed that it is expressed in the kidney. However, the function of SVCT3 has not been reported and it remains speculative as to whether SVCT3 is a nucleobase transporter.

Structure-activity relationships from in vitro efficacies of the thiazolide series against the intracellular apicomplexan protozoan Neospora caninum

Nitazoxanide (2-acetolyloxy-N-(5-nitro 2-thiazolyl) benzamide; NTZ) represents the parent compound of a novel class of broad-spectrum anti-parasitic compounds named thiazolides. NTZ is active against a wide variety of intestinal and tissue-dwelling helminths, protozoa, enteric bacteria and a number of viruses infecting animals and humans. While potent, this poses a problem in practice, since this obvious non-selectivity can lead to undesired side effects in both humans and animals. In this study, we used real time PCR to determine the in vitro activities of 29 different thiazolides (NTZ-derivatives), which carry distinct modifications on both the thiazole- and the benzene moieties, against the tachyzoite stage of the intracellular protozoan Neospora caninum. The goal was to identify a highly active compound lacking the undesirable nitro group, which would have a more specific applicability, such as in food animals. By applying self-organizing molecular field analysis (SOMFA), these data were used to develop a predictive model for future drug design. SOMFA performs self-alignment of the molecules, and takes into account the steric and electrostatic properties, in order to determine 3D-quantitative structure activity relationship models. The best model was obtained by overlay of the thiazole moieties. Plotting of predicted versus experimentally determined activity produced an r2 value of 0.8052 and cross-validation using the "leave one out" methodology resulted in a q2 value of 0.7987. A master grid map showed that large steric groups at the R2 position, the nitrogen of the amide bond and position Y could greatly reduce activity, and the presence of large steric groups placed at positions X, R4 and surrounding the oxygen atom of the amide bond, may increase the activity of thiazolides against Neospora caninum tachyzoites. The model obtained here will be an important predictive tool for future development of this important class of drugs.

Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection

BACKGROUND: Pneumocystis jiroveci pneumonia (PCP) remains the most common opportunistic infection in patients infected with the human immunodeficiency virus (HIV). Among patients with HIV infection and PCP the mortality rate is 10 to 20% during the initial infection and increases substantially with the need for mechanical ventilation. It was suggested that in these patients corticosteroids adjunctive to standard treatment for PCP could prevent the need for mechanical ventilation and decrease mortality. OBJECTIVES: To assess the effects of adjunctive corticosteroids on overall mortality and the need for mechanical ventilation in HIV-infected patients with PCP and substantial hypoxemia (arterial oxygen partial pressure <70 mmHg or alveolar-arterial gradient >35 mmHg on room air). SEARCH STRATEGY: We searched Medline (January 1980-December 2004), EMBASE (January 1985-December 2004) and The Cochrane Library (Issue 4, 2004) without language restrictions to identify randomised controlled trials that compared adjunctive corticosteroids to control in HIV-infected patients with PCP. We further reviewed the reference lists from previously published overviews, we searched UptoDate version 2005 and Clinical Evidence Concise (Issue 12, 2004), contacted experts of the field, and searched reference lists of identified publications for citations of additional relevant articles. SELECTION CRITERIA: Trials were considered eligible for this review if they compared corticosteroids to placebo or usual care in HIV-infected patients with PCP in addition to baseline treatment with trimethoprim-sulfamethoxazole, pentamidine or dapsone-trimethoprim, used random allocation, and reported mortality data. We excluded trials in patients with no or mild hypoxemia (arterial oxygen partial pressure >70 mmHg or an alveolar-arterial gradient <35 mmHg on room air) and trials with a follow-up of less than 30 days. DATA COLLECTION AND ANALYSIS: Two teams of reviewers independently evaluated the methodology and extracted data from each primary study. We pooled treatment effects across studies and calculated a weighted average risk ratio of overall mortality in the treatment and control groups by using a random effects model. MAIN RESULTS: Six studies were included in the review and meta-analysis. Risk ratios for overall mortality for adjunctive corticosteroids were 0.56 (95% confidence interval [CI], 0.32-0.98) at 1 month and 0.68 (95% CI, 0.50-0.94) at 3-4 months of follow-up. To prevent 1 death, numbers needed to treat are 9 patients in a setting without highly active antiretroviral therapy (HAART) available, and 23 patients with HAART available. Only the 3 largest trials provided data on the need for mechanical ventilation with a risk ratio of 0.38 (95% CI, 0.20-0.73) in favour of adjunctive corticosteroids. AUTHORS' CONCLUSIONS: The number and size of trials investigating adjunctive corticosteroids for HIV-infected patients with PCP is small, but evidence from this review suggests a beneficial effect for patients with substantial hypoxemia.

[In Medea's gardens--two tales of colchicine]

Colchicine is a highly active alkaloid used in the treatment of acute inflammatory syndromes such as Mediterranean fever, M. Behçet or gouty arthritis. The two cases we present here illustrate exemplarily the pros and contras of colchicine therapy. In the first case, colchicine was successfully given for recurrent febrile attacks due to acute rheumatic fever. The second patient unfortunately had a fatal colchicine intoxication. The pharmacology of colchicine, the clinical features associated with overdose and the options for treatment are discussed. Colchicine should not be given in combination with macrolides, especially in patients with renal insufficiency.

High-dose therapy and autologous stem cell transplantation for children with HIV-associated non-Hodgkin lymphoma

In contrast to adults, autologous stem cell transplantation (ASCT) as part of the salvage strategy after high-dose chemo/radiotherapy in human immunodeficiency virus (HIV) related Non-Hodgkin lymphoma (NHL) is not yet established for children. We report on a 13-year patient with congenital HIV infection and refractory Burkitt lymphoma, who was successfully treated by high-dose therapy (HDT) including rituximab followed by ASCT. After 26 months follow-up the patient remains in complete remission and his HIV parameters have normalized with continued highly active antiretroviral therapy (HAART). HIV infection may no longer exclude children from ASCT as part of salvage therapy. Pediatr Blood Cancer (c) 2006 Wiley-Liss, Inc.

Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries

BACKGROUND: Highly active antiretroviral therapy (HAART) is being scaled up in developing countries. We compared baseline characteristics and outcomes during the first year of HAART between HIV-1-infected patients in low-income and high-income settings. METHODS: 18 HAART programmes in Africa, Asia, and South America (low-income settings) and 12 HIV cohort studies from Europe and North America (high-income settings) provided data for 4810 and 22,217, respectively, treatment-naive adult patients starting HAART. All patients from high-income settings and 2725 (57%) patients from low-income settings were actively followed-up and included in survival analyses. FINDINGS: Compared with high-income countries, patients starting HAART in low-income settings had lower CD4 cell counts (median 108 cells per muL vs 234 cells per muL), were more likely to be female (51%vs 25%), and more likely to start treatment with a non-nucleoside reverse transcriptase inhibitor (NNRTI) (70%vs 23%). At 6 months, the median number of CD4 cells gained (106 cells per muL vs 103 cells per muL) and the percentage of patients reaching HIV-1 RNA levels lower than 500 copies/mL (76%vs 77%) were similar. Mortality was higher in low-income settings (124 deaths during 2236 person-years of follow-up) than in high-income settings (414 deaths during 20,532 person-years). The adjusted hazard ratio (HR) of mortality comparing low-income with high-income settings fell from 4.3 (95% CI 1.6-11.8) during the first month to 1.5 (0.7-3.0) during months 7-12. The provision of treatment free of charge in low-income settings was associated with lower mortality (adjusted HR 0.23; 95% CI 0.08-0.61). INTERPRETATION: Patients starting HAART in resource-poor settings have increased mortality rates in the first months on therapy, compared with those in developed countries. Timely diagnosis and assessment of treatment eligibility, coupled with free provision of HAART, might reduce this excess mortality.

A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men

BACKGROUND: Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors observed in patients starting HAART. METHODS: Data from five cohort studies (British Regional Heart Study, Caerphilly and Speedwell Studies, Framingham Offspring Study, Whitehall II) on 13,100 men aged 40-70 and 114,443 years of follow up were used. CHD was defined as myocardial infarction or death from CHD. Model fit was assessed using the Akaike Information Criterion; generalizability across cohorts was examined using internal-external cross-validation. RESULTS: A parametric model based on the Gompertz distribution generalized best. Variables included in the model were systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, diabetes mellitus, body mass index and smoking status. Compared with patients not on HAART, the estimated CHD hazard ratio (HR) for patients on HAART was 1.46 (95% CI 1.15-1.86) for moderate and 2.48 (95% CI 1.76-3.51) for severe metabolic complications. CONCLUSIONS: The change in the risk of CHD in HIV-infected men starting HAART can be estimated based on typical changes in risk factors, assuming that HRs estimated using data from non-infected men are applicable to HIV-infected men. Based on this model the risk of CHD is likely to increase, but increases may often be modest, and could be offset by lifestyle changes.