A technological framework based on automatic messaging for improving adherence of diabetic patients

En todo el mundo se ha observado un crecimiento exponencial en la incidencia de enfermedades crónicas como la hipertensión y enfermedades cardiovasculares y respiratorias, así como la diabetes mellitus, que causa un número de muertes cada vez mayor en todo el mundo (Beaglehole et al., 2008). En concreto, la prevalencia de diabetes mellitus (DM) está aumentando de manera considerable en todas las edades y representa un serio problema de salud mundial. La diabetes fue la responsable directa de 1,5 millones de muertes en 2012 y 89 millones de años de vida ajustados por discapacidad (AVAD) (OMS, 2014). Uno de los principales dilemas que suelen asociarse a la gestión de EC es la adherencia de los pacientes a los tratamientos, que representa un aspecto multifactorial que necesita asistencia en lo relativo a: educación, autogestión, interacción entre los pacientes y cuidadores y compromiso de los pacientes. Medir la adherencia del tratamiento es complicado y, aunque se ha hablado ampliamente de ello, aún no hay soluciones “de oro” (Reviews, 2002). El compromiso de los pacientes, a través de la participación, colaboración, negociación y a veces del compromiso firme, aumentan las oportunidades para una terapia óptima en la que los pacientes se responsabilizan de su parte en la ecuación de adherencia. Comprometer e involucrar a los pacientes diabéticos en las decisiones de su tratamiento, junto con expertos profesionales, puede ayudar a favorecer un enfoque centrado en el paciente hacia la atención a la diabetes (Martin et al., 2005). La motivación y atribución de poder de los pacientes son quizás los dos factores interventores más relevantes que afectan directamente a la autogestión de la atención a la diabetes. Se ha demostrado que estos dos factores desempeñan un papel fundamental en la adherencia a la prescripción, así como en el fomento exitoso de un estilo de vida sana y otros cambios de conducta (Heneghan et al., 2013). Un plan de educación personalizada es indispensable para proporcionarle al paciente las herramientas adecuadas que necesita para la autogestión efectiva de la enfermedad (El-Gayar et al. 2013). La comunicación efectiva es fundamental para proporcionar una atención centrada en el paciente puesto que influye en las conductas y actitudes hacia un problema de salud ((Frampton et al. 2008). En este sentido, la interactividad, la frecuencia, la temporalización y la adaptación de los mensajes de texto pueden promover la adherencia a un régimen de medicación. Como consecuencia, adaptar los mensajes de texto a los pacientes puede resultar ser una manera de hacer que las sugerencias y la información sean más relevantes y efectivas (Nundy et al. 2013). En este contexto, las tecnologías móviles en el ámbito de la salud (mHealth) están desempeñando un papel importante al conectar con pacientes para mejorar la adherencia a medicamentos recetados (Krishna et al., 2009). La adaptación de los mensajes de texto específicos de diabetes sigue siendo un área de oportunidad para mejorar la adherencia a la medicación y ofrecer motivación a adultos con diabetes. Sin embargo, se necesita más investigación para entender totalmente su eficacia. Los consejos de texto personalizados han demostrado causar un impacto positivo en la atribución de poder a los pacientes, su autogestión y su adherencia a la prescripción (Gatwood et al., 2014). mHealth se puede utilizar para ofrecer programas de asistencia de autogestión a los pacientes con diabetes y, al mismo tiempo, superar las dificultades técnicas y financieras que supone el tratamiento de la diabetes (Free at al., 2013). El objetivo principal de este trabajo de investigación es demostrar que un marco tecnológico basado en las teorías de cambios de conducta, aplicado al campo de la mHealth, permite una mejora de la adherencia al tratamiento en pacientes diabéticos. Como método de definición de una solución tecnológica, se han adoptado un conjunto de diferentes técnicas de conducta validadas denominado marco de compromiso de retroacción conductual (EBF, por sus siglas en inglés) para formular los mensajes, guiar el contenido y evaluar los resultados. Los estudios incorporan elementos del modelo transteórico (TTM, por sus siglas en inglés), la teoría de la fijación de objetivos (GST, por sus siglas en inglés) y los principios de comunicación sanitaria persuasiva y eficaz. Como concepto general, el modelo TTM ayuda a los pacientes a progresar a su próxima fase de conducta a través de mensajes de texto motivados específicos y permite que el médico identifique la fase actual y adapte sus estrategias individualmente. Además, se adoptan las directrices del TTM para fijar objetivos personalizados a un nivel apropiado a la fase de cambio del paciente. La GST encierra normas que van a ponerse en práctica para promover la intervención educativa y objetivos de pérdida de peso. Finalmente, los principios de comunicación sanitaria persuasiva y eficaz aplicados a la aparición de los mensajes se han puesto en marcha para aumentar la efectividad. El EBF tiene como objetivo ayudar a los pacientes a mejorar su adherencia a la prescripción y encaminarlos a una mejora general en la autogestión de la diabetes mediante mensajes de texto personalizados denominados mensajes de retroacción automáticos (AFM, por sus siglas en inglés). Después de una primera revisión del perfil, consistente en identificar características significativas del paciente basadas en las necesidades de tratamiento, actitudes y conductas de atención sanitaria, el sistema elige los AFM personalizados, los aprueba el médico y al final se transfieren a la interfaz del paciente. Durante el tratamiento, el usuario recopila los datos en dispositivos de monitorización de pacientes (PMD, por sus siglas en inglés) de una serie de dispositivos médicos y registros manuales. Los registros consisten en la toma de medicación, dieta y actividad física y tareas de aprendizaje y control de la medida del metabolismo. El compromiso general del paciente se comprueba al estimar el uso del sistema y la adherencia del tratamiento y el estado de los objetivos del paciente a corto y largo plazo. El módulo de análisis conductual, que consiste en una serie de reglas y ecuaciones, calcula la conducta del paciente. Tras lograr el análisis conductual, el módulo de gestión de AFM actualiza la lista de AFM y la configuración de los envíos. Las actualizaciones incluyen el número, el tipo y la frecuencia de mensajes. Los AFM los revisa periódicamente el médico que también participa en el perfeccionamiento del tratamiento, adaptado a la fase transteórica actual. Los AFM se segmentan en distintas categorías y niveles y los pacientes pueden ajustar la entrega del mensaje de acuerdo con sus necesidades personales. El EBF se ha puesto en marcha integrado dentro del sistema METABO, diseñado para facilitar al paciente diabético que controle sus condiciones relevantes de una manera menos intrusiva. El dispositivo del paciente se vincula en una plataforma móvil, mientras que una interfaz de panel médico permite que los profesionales controlen la evolución del tratamiento. Herramientas específicas posibilitan que los profesionales comprueben la adherencia del paciente y actualicen la gestión de envíos de AFM. El EBF fue probado en un proyecto piloto controlado de manera aleatoria. El principal objetivo era examinar la viabilidad y aceptación del sistema. Los objetivos secundarios eran también la evaluación de la eficacia del sistema en lo referente a la mejora de la adherencia, el control glucémico y la calidad de vida. Se reclutaron participantes de cuatro centros clínicos distintos en Europa. La evaluación del punto de referencia incluía datos demográficos, estado de la diabetes, información del perfil, conocimiento de la diabetes en general, uso de las plataformas TIC, opinión y experiencia con dispositivos electrónicos y adopción de buenas prácticas con la diabetes. La aceptación y eficacia de los criterios de evaluación se aplicaron para valorar el funcionamiento del marco tecnológico. El principal objetivo era la valoración de la eficacia del sistema en lo referente a la mejora de la adherencia. En las pruebas participaron 54 pacientes. 26 fueron asignados al grupo de intervención y equipados con tecnología móvil donde estaba instalado el EBF: 14 pacientes tenían T1DM y 12 tenían T2DM. El grupo de control estaba compuesto por 25 pa cientes que fueron tratados con atención estándar, sin el empleo del EBF. La intervención profesional tanto de los grupos de control como de intervención corrió a cargo de 24 cuidadores, entre los que incluían diabetólogos, nutricionistas y enfermeras. Para evaluar la aceptabilidad del sistema y analizar la satisfacción de los usuarios, a través de LimeSurvey, se creó una encuesta multilingüe tanto para los pacientes como para los profesionales. Los resultados también se recopilaron de los archivos de registro generados en los PMD, el panel médico profesional y las entradas de la base de datos. Los mensajes enviados hacia y desde el EBF y los archivos de registro del sistema y los servicios de comunicación se grabaron durante las cinco semanas del estudio. Se entregaron un total de 2795 mensajes, lo que supuso una media de 107,50 mensajes por paciente. Como se muestra, los mensajes disminuyen con el tiempo, indicando una mejora global de la adherencia al plan de tratamiento. Como se esperaba, los pacientes con T1DM recibieron más consejos a corto plazo, en relación a su estado. Del mismo modo, al ser el centro de T2DM en cambios de estilo de vida sostenible a largo plazo, los pacientes con T2DM recibieron más consejos de recomendación, en cuanto a dietas y actividad física. También se ha llevado a cabo una comparación de la adherencia e índices de uso para pacientes con T1DM y T2DM, entre la primera y la segunda mitad de la prueba. Se han observado resultados favorables para el uso. En lo relativo a la adherencia, los resultados denotaron una mejora general en cada dimensión del plan de tratamiento, como la nutrición y las mediciones de inserción de glucosa en la sangre. Se han llevado a cabo más estudios acerca del cambio a nivel educativo antes y después de la prueba, medidos tanto para grupos de control como de intervención. Los resultados indicaron que el grupo de intervención había mejorado su nivel de conocimientos mientras que el grupo de control mostró una leve disminución. El análisis de correlación entre el nivel de adherencia y las AFM ha mostrado una mejora en la adherencia de uso para los pacientes que recibieron los mensajes de tipo alertas, y unos resultados no significativos aunque positivos relacionados con la adherencia tanto al tratamiento que al uso correlacionado con los recordatorios. Por otra parte, los AFM parecían ayudar a los pacientes que no tomaban suficientemente en serio su tratamiento en el principio y que sí estaban dispuestos a responder a los mensajes recibidos. Aun así, los pacientes que recibieron demasiadas advertencias, comenzaron a considerar el envío de mensajes un poco estresante. El trabajo de investigación llevado a cabo al desarrollar este proyecto ofrece respuestas a las cuatro hipótesis de investigación que fueron la motivación para el trabajo. • Hipótesis 1 : es posible definir una serie de criterios para medir la adherencia en pacientes diabéticos. • Hipótesis 2: es posible diseñar un marco tecnológico basado en los criterios y teorías de cambio de conducta mencionados con anterioridad para hacer que los pacientes diabéticos se comprometan a controlar su enfermedad y adherirse a planes de atención. • Hipótesis 3: es posible poner en marcha el marco tecnológico en el sector de la salud móvil. • Hipótesis 4: es posible utilizar el marco tecnológico como solución de salud móvil en un contexto real y tener efectos positivos en lo referente a indicadores de control de diabetes. La verificación de cada hipótesis permite ofrecer respuesta a la hipótesis principal: La hipótesis principal es: es posible mejorar la adherencia diabética a través de un marco tecnológico mHealth basado en teorías de cambio de conducta. El trabajo llevado a cabo para responder estas preguntas se explica en este trabajo de investigación. El marco fue desarrollado y puesto en práctica en el Proyecto METABO. METABO es un Proyecto I+D, cofinanciado por la Comisión Europea (METABO 2008) que integra infraestructura móvil para ayudar al control, gestión y tratamiento de los pacientes con diabetes mellitus de tipo 1 (T1DM) y los que padecen diabetes mellitus de tipo 2 (T2DM). ABSTRACT Worldwide there is an exponential growth in the incidence of Chronic Diseases (CDs), such as: hypertension, cardiovascular and respiratory diseases, as well as diabetes mellitus, leading to rising numbers of deaths worldwide (Beaglehole et al. 2008). In particular, the prevalence of diabetes mellitus (DM) is largely increasing among all ages and constitutes a major worldwide health problem. Diabetes was directly responsible for 1,5 million deaths in 2012 and 89 million Disability-adjusted life year (DALYs) (WHO 2014). One of the key dilemmas often associated to CD management is the patients’ adherence to treatments, representing a multi-factorial aspect that requires support in terms of: education, self-management, interaction between patients and caregivers, and patients’ engagement. Measuring adherence is complex and, even if widely discussed, there are still no “gold” standards ((Giardini et al. 2015), (Costa et al. 2015). Patient’s engagement, through participation, collaboration, negotiation, and sometimes compromise, enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation. Engaging and involving diabetic patients in treatment decisions, along with professional expertise, can help foster a patient-centered approach to diabetes care (Martin et al. 2005). Patients’ motivation and empowerment are perhaps the two most relevant intervening factors that directly affect self-management of diabetes care. It has been demonstrated that these two factors play an essential role in prescription adherence, as well as for the successful encouragement of a healthy life-style and other behavioural changes (Heneghan et al. 2013). A personalised education plan is indispensable in order to provide the patient with the appropriate tools needed for the effective self-management of the disease (El-Gayar et al. 2013). Effective communication is at the core of providing patient-centred care since it influences behaviours and attitudes towards a health problem (Frampton et al. 2008). In this regard, interactivity, frequency, timing, and tailoring of text messages may promote adherence to a medication regimen. As a consequence, tailoring text messages to patients can constitute a way of making suggestions and information more relevant and effective (Nundy et al. 2013). In this context, mobile health technologies (mHealth) are playing significant roles in improving adherence to prescribed medications (Krishna et al. 2009). The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but further research is needed to fully understand their effectiveness. Personalized text advices have proven to produce a positive impact on patients’ empowerment, self-management, and adherence to prescriptions (Gatwood et al. 2014). mHealth can be used for offering self-management support programs to diabetes patients and at the same time surmounting the technical and financial difficulties involved in diabetes treatment (Free et al. 2013). The main objective of this research work is to demonstrate that a technological framework, based on behavioural change theories, applied to mHealth domain, allows improving adherence treatment in diabetic patients. The framework, named Engagement Behavioural Feedback Framework (EBF), is built on top of validated behavioural techniques to frame messages, guide the definition of contents and assess outcomes: elements from the Transtheoretical Model (TTM), the Goal-Setting Theory (GST), Effective Health Communication (EHC) guidelines and Principles of Persuasive Technology (PPT) were incorporated. The TTM helps patients to progress to a next behavioural stage, through specific motivated text messages, and allow clinician’s identifying the current stage and tailor its strategies individually. Moreover, TTM guidelines are adopted to set customised goals at a level appropriate to the patient’s stage of change. The GST was used to build rules to be applied for enhancing educational intervention and weight loss objectives. Finally, the EHC guidelines and the PPT were applied to increase the effectiveness of messages. The EBF aims to support patients on improving their prescription adherence and persuade them towards a general improvement in diabetes self-management, by means of personalised text messages, named Automatic Feedback Messages (AFM). After a first profile screening, consisting in identifying meaningful patient characteristics based on treatment needs, attitudes and health care behaviours, customised AFMs are selected by the system, approved by the professional, and finally transferred into the patient interface. During the treatment, the user collects the data into a Patient Monitoring Device (PMD) from a set of medical devices and from manual inputs. Inputs consist in medication intake, diet and physical activity, metabolic measurement monitoring and learning tasks. Patient general engagement is checked by estimating the usage of the system and the adherence of treatment and patient goals status in the short and the long term period. The Behavioural Analysis Module, consisting in a set of rules and equations, calculates the patient’s behaviour. After behavioural analysis is accomplished, the AFM library and the dispatch setting are updated by the AFM Manager module. Updates include the number, the type and the frequency of messages. The AFMs are periodically supervised by the professional who also participates to the refinement of the treatment, adapted to the current transtheoretical stage. The AFMs are segmented in different categories and levels and patients can adjust message delivery in accordance with their personal needs. The EBF was integrated to the METABO system, designed to facilitate diabetic patients in managing their disease in a less intrusive approach. Patient device corresponds in a mobile platform, while a medical panel interface allows professionals to monitoring the treatment evolution. Specific tools allow professional to check patient adherence and to update the AFMs dispatch management. The EBF was tested in a randomised controlled pilot. The main objective was to examine the feasibility and acceptance of the system. Secondary objectives were also the assessment of the effectiveness of system in terms of adherence improvement, glycaemic control, and quality of life. Participants were recruited from four different clinical centres in Europe. The baseline assessment included demographics, diabetes status, profile information, knowledge about diabetes in general, usage of ICT platforms, opinion and experience about electronic devices and adoption of good practices with diabetes. Acceptance and the effectiveness evaluation criteria were applied to evaluate the performance of the technological framework. The main objective was the assessment of the effectiveness of system in terms of adherence improvement. Fifty-four patients participated on the trials. Twenty-six patients were assigned in the intervention group and equipped with mobile where the EBF was installed: 14 patients were T1DM and 12 were T2DM. The control group was composed of 25 patients that were treated through a standard care, without the usage of the EBF. Professional’s intervention for both intervention and control groups was carried out by 24 care providers, including endocrinologists, nutritionists, and nurses. In order to evaluate the system acceptability and analyse the users’ satisfaction, an online multi-language survey, using LimeSurvey, was produced for both patients and professionals. Results were also collected from the log-files generated in the PMDs, the professional medical panel and the entries of the data base. The messages sent to and from the EBF and the log-files of the system and communication services were recorded over 5 weeks of the study. A total of 2795 messages were submitted, representing an average of 107,50 messages per patient. As demonstrated, messages decrease over time indicating an overall improvement of the care plan’s adherence. As expected, T1DM patients were more loaded with short-term advices, in accordance with their condition. Similarly, being the focus of T2DM on long-term sustainable lifestyle changes, T2DM received more reminders advices, as for diet and physical activity. Favourable outcomes were observed for treatment and usage adherences of the intervention group: for both the adherence indices, results denoted a general improvement on each care plan’s dimension, such as on nutrition and blood glucose input measurements. Further studies were conducted on the change on educational level before and after the trial, measured for both control and intervention groups. The outcomes indicated the intervention group has improved its level of knowledge, while the control group denoted a low decrease. The correlation analysis between the level of adherences and the AFMs showed an improvement in usage adherence for patients who received warnings message, while non-significantly yet even positive indicators related to both treatment and usage adherence correlated with the Reminders. Moreover, the AFMs seemed to help those patients who did not take their treatment seriously enough in the beginning and who were willing to respond to the messages they received. Even though, patients who received too many Warnings, started to consider the message dispatch to be a bit stressful. The research work carried out in developing this research work provides responses to the four research hypothesis that were the motivation for the work: •Hypothesis 1: It is possible to define a set of criteria to measure adherence in diabetic patients. •Hypothesis 2: It is possible to design a technological framework, based on the aforementioned criteria and behavioural change theories, to engage diabetic patients in managing their disease and adhere to care plans. •Hypothesis 3: It is possible to implement the technological framework in the mobile health domain. •Hypothesis 4: It is possible to use the technological framework as a mobile health solution in a real context and have positive effects in terms of diabetes management indicators. The verification of each hypothesis allowed us to provide a response to the main hypothesis: The Main Hypothesis is: It is possible to improve diabetic adherence through a mHealth technological framework based on behavioural change theories. The work carried out to answer these questions is explained in this research work. The framework was developed and applied in the METABO project. METABO is an R&D project, co-funded by the European Commission (METABO 2008) that integrates mobile infrastructure for supporting the monitoring, management, and treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.

Diseño de un módulo de IFMIF para irradiación de envolturas regeneradoras basadas en metales líquidos para reactores de fusión

La fusión nuclear es, hoy en día, una alternativa energética a la que la comunidad internacional dedica mucho esfuerzo. El objetivo es el de generar entre diez y cincuenta veces más energía que la que consume mediante reacciones de fusión que se producirán en una mezcla de deuterio (D) y tritio (T) en forma de plasma a doscientos millones de grados centígrados. En los futuros reactores nucleares de fusión será necesario producir el tritio utilizado como combustible en el propio reactor termonuclear. Este hecho supone dar un paso más que las actuales máquinas experimentales dedicadas fundamentalmente al estudio de la física del plasma. Así pues, el tritio, en un reactor de fusión, se produce en sus envolturas regeneradoras cuya misión fundamental es la de blindaje neutrónico, producir y recuperar tritio (fuel para la reacción DT del plasma) y por último convertir la energía de los neutrones en calor. Existen diferentes conceptos de envolturas que pueden ser sólidas o líquidas. Las primeras se basan en cerámicas de litio (Li2O, Li4SiO4, Li2TiO3, Li2ZrO3) y multiplicadores neutrónicos de Be, necesarios para conseguir la cantidad adecuada de tritio. Los segundos se basan en el uso de metales líquidos o sales fundidas (Li, LiPb, FLIBE, FLINABE) con multiplicadores neutrónicos de Be o el propio Pb en el caso de LiPb. Los materiales estructurales pasan por aceros ferrítico-martensíticos de baja activación, aleaciones de vanadio o incluso SiCf/SiC. Cada uno de los diferentes conceptos de envoltura tendrá una problemática asociada que se estudiará en el reactor experimental ITER (del inglés, “International Thermonuclear Experimental Reactor”). Sin embargo, ITER no puede responder las cuestiones asociadas al daño de materiales y el efecto de la radiación neutrónica en las diferentes funciones de las envolturas regeneradoras. Como referencia, la primera pared de un reactor de fusión de 4000MW recibiría 30 dpa/año (valores para Fe-56) mientras que en ITER se conseguirían <10 dpa en toda su vida útil. Esta tesis se encuadra en el acuerdo bilateral entre Europa y Japón denominado “Broader Approach Agreement “(BA) (2007-2017) en el cual España juega un papel destacable. Estos proyectos, complementarios con ITER, son el acelerador para pruebas de materiales IFMIF (del inglés, “International Fusion Materials Irradiation Facility”) y el dispositivo de fusión JT-60SA. Así, los efectos de la irradiación de materiales en materiales candidatos para reactores de fusión se estudiarán en IFMIF. El objetivo de esta tesis es el diseño de un módulo de IFMIF para irradiación de envolturas regeneradoras basadas en metales líquidos para reactores de fusión. El módulo se llamará LBVM (del inglés, “Liquid Breeder Validation Module”). La propuesta surge de la necesidad de irradiar materiales funcionales para envolturas regeneradoras líquidas para reactores de fusión debido a que el diseño conceptual de IFMIF no contaba con esta utilidad. Con objeto de analizar la viabilidad de la presente propuesta, se han realizado cálculos neutrónicos para evaluar la idoneidad de llevar a cabo experimentos relacionados con envolturas líquidas en IFMIF. Así, se han considerado diferentes candidatos a materiales funcionales de envolturas regeneradoras: Fe (base de los materiales estructurales), SiC (material candidato para los FCI´s (del inglés, “Flow Channel Inserts”) en una envoltura regeneradora líquida, SiO2 (candidato para recubrimientos antipermeación), CaO (candidato para recubrimientos aislantes), Al2O3 (candidato para recubrimientos antipermeación y aislantes) y AlN (material candidato para recubrimientos aislantes). En cada uno de estos materiales se han calculado los parámetros de irradiación más significativos (dpa, H/dpa y He/dpa) en diferentes posiciones de IFMIF. Estos valores se han comparado con los esperados en la primera pared y en la zona regeneradora de tritio de un reactor de fusión. Para ello se ha elegido un reactor tipo HCLL (del inglés, “Helium Cooled Lithium Lead”) por tratarse de uno de los más prometedores. Además, los valores también se han comparado con los que se obtendrían en un reactor rápido de fisión puesto que la mayoría de las irradiaciones actuales se hacen en reactores de este tipo. Como conclusión al análisis de viabilidad, se puede decir que los materiales funcionales para mantos regeneradores líquidos podrían probarse en la zona de medio flujo de IFMIF donde se obtendrían ratios de H/dpa y He/dpa muy parecidos a los esperados en las zonas más irradiadas de un reactor de fusión. Además, con el objetivo de ajustar todavía más los valores, se propone el uso de un moderador de W (a considerar en algunas campañas de irradiación solamente debido a que su uso hace que los valores de dpa totales disminuyan). Los valores obtenidos para un reactor de fisión refuerzan la idea de la necesidad del LBVM, ya que los valores obtenidos de H/dpa y He/dpa son muy inferiores a los esperados en fusión y, por lo tanto, no representativos. Una vez demostrada la idoneidad de IFMIF para irradiar envolturas regeneradoras líquidas, y del estudio de la problemática asociada a las envolturas líquidas, también incluida en esta tesis, se proponen tres tipos de experimentos diferentes como base de diseño del LBVM. Éstos se orientan en las necesidades de un reactor tipo HCLL aunque a lo largo de la tesis se discute la aplicabilidad para otros reactores e incluso se proponen experimentos adicionales. Así, la capacidad experimental del módulo estaría centrada en el estudio del comportamiento de litio plomo, permeación de tritio, corrosión y compatibilidad de materiales. Para cada uno de los experimentos se propone un esquema experimental, se definen las condiciones necesarias en el módulo y la instrumentación requerida para controlar y diagnosticar las cápsulas experimentales. Para llevar a cabo los experimentos propuestos se propone el LBVM, ubicado en la zona de medio flujo de IFMIF, en su celda caliente, y con capacidad para 16 cápsulas experimentales. Cada cápsula (24-22 mm de diámetro y 80 mm de altura) contendrá la aleación eutéctica LiPb (hasta 50 mm de la altura de la cápsula) en contacto con diferentes muestras de materiales. Ésta irá soportada en el interior de tubos de acero por los que circulará un gas de purga (He), necesario para arrastrar el tritio generado en el eutéctico y permeado a través de las paredes de las cápsulas (continuamente, durante irradiación). Estos tubos, a su vez, se instalarán en una carcasa también de acero que proporcionará soporte y refrigeración tanto a los tubos como a sus cápsulas experimentales interiores. El módulo, en su conjunto, permitirá la extracción de las señales experimentales y el gas de purga. Así, a través de la estación de medida de tritio y el sistema de control, se obtendrán los datos experimentales para su análisis y extracción de conclusiones experimentales. Además del análisis de datos experimentales, algunas de estas señales tendrán una función de seguridad y por tanto jugarán un papel primordial en la operación del módulo. Para el correcto funcionamiento de las cápsulas y poder controlar su temperatura, cada cápsula se equipará con un calentador eléctrico y por tanto el módulo requerirá también ser conectado a la alimentación eléctrica. El diseño del módulo y su lógica de operación se describe en detalle en esta tesis. La justificación técnica de cada una de las partes que componen el módulo se ha realizado con soporte de cálculos de transporte de tritio, termohidráulicos y mecánicos. Una de las principales conclusiones de los cálculos de transporte de tritio es que es perfectamente viable medir el tritio permeado en las cápsulas mediante cámaras de ionización y contadores proporcionales comerciales, con sensibilidades en el orden de 10-9 Bq/m3. Los resultados son aplicables a todos los experimentos, incluso si son cápsulas a bajas temperaturas o si llevan recubrimientos antipermeación. Desde un punto de vista de seguridad, el conocimiento de la cantidad de tritio que está siendo transportada con el gas de purga puede ser usado para detectar de ciertos problemas que puedan estar sucediendo en el módulo como por ejemplo, la rotura de una cápsula. Además, es necesario conocer el balance de tritio de la instalación. Las pérdidas esperadas el refrigerante y la celda caliente de IFMIF se pueden considerar despreciables para condiciones normales de funcionamiento. Los cálculos termohidráulicos se han realizado con el objetivo de optimizar el diseño de las cápsulas experimentales y el LBVM de manera que se pueda cumplir el principal requisito del módulo que es llevar a cabo los experimentos a temperaturas comprendidas entre 300-550ºC. Para ello, se ha dimensionado la refrigeración necesaria del módulo y evaluado la geometría de las cápsulas, tubos experimentales y la zona experimental del contenedor. Como consecuencia de los análisis realizados, se han elegido cápsulas y tubos cilíndricos instalados en compartimentos cilíndricos debido a su buen comportamiento mecánico (las tensiones debidas a la presión de los fluidos se ven reducidas significativamente con una geometría cilíndrica en lugar de prismática) y térmico (uniformidad de temperatura en las paredes de los tubos y cápsulas). Se han obtenido campos de presión, temperatura y velocidad en diferentes zonas críticas del módulo concluyendo que la presente propuesta es factible. Cabe destacar que el uso de códigos fluidodinámicos (e.g. ANSYS-CFX, utilizado en esta tesis) para el diseño de cápsulas experimentales de IFMIF no es directo. La razón de ello es que los modelos de turbulencia tienden a subestimar la temperatura de pared en mini canales de helio sometidos a altos flujos de calor debido al cambio de las propiedades del fluido cerca de la pared. Los diferentes modelos de turbulencia presentes en dicho código han tenido que ser estudiados con detalle y validados con resultados experimentales. El modelo SST (del inglés, “Shear Stress Transport Model”) para turbulencia en transición ha sido identificado como adecuado para simular el comportamiento del helio de refrigeración y la temperatura en las paredes de las cápsulas experimentales. Con la geometría propuesta y los valores principales de refrigeración y purga definidos, se ha analizado el comportamiento mecánico de cada uno de los tubos experimentales que contendrá el módulo. Los resultados de tensiones obtenidos, han sido comparados con los valores máximos recomendados en códigos de diseño estructural como el SDC-IC (del inglés, “Structural Design Criteria for ITER Components”) para así evaluar el grado de protección contra el colapso plástico. La conclusión del estudio muestra que la propuesta es mecánicamente robusta. El LBVM implica el uso de metales líquidos y la generación de tritio además del riesgo asociado a la activación neutrónica. Por ello, se han estudiado los riesgos asociados al uso de metales líquidos y el tritio. Además, se ha incluido una evaluación preliminar de los riesgos radiológicos asociados a la activación de materiales y el calor residual en el módulo después de la irradiación así como un escenario de pérdida de refrigerante. Los riesgos asociados al módulo de naturaleza convencional están asociados al manejo de metales líquidos cuyas reacciones con aire o agua se asocian con emisión de aerosoles y probabilidad de fuego. De entre los riesgos nucleares destacan la generación de gases radiactivos como el tritio u otros radioisótopos volátiles como el Po-210. No se espera que el módulo suponga un impacto medioambiental asociado a posibles escapes. Sin embargo, es necesario un manejo adecuado tanto de las cápsulas experimentales como del módulo contenedor así como de las líneas de purga durante operación. Después de un día de después de la parada, tras un año de irradiación, tendremos una dosis de contacto de 7000 Sv/h en la zona experimental del contenedor, 2300 Sv/h en la cápsula y 25 Sv/h en el LiPb. El uso por lo tanto de manipulación remota está previsto para el manejo del módulo irradiado. Por último, en esta tesis se ha estudiado también las posibilidades existentes para la fabricación del módulo. De entre las técnicas propuestas, destacan la electroerosión, soldaduras por haz de electrones o por soldadura láser. Las bases para el diseño final del LBVM han sido pues establecidas en el marco de este trabajo y han sido incluidas en el diseño intermedio de IFMIF, que será desarrollado en el futuro, como parte del diseño final de la instalación IFMIF. ABSTRACT Nuclear fusion is, today, an alternative energy source to which the international community devotes a great effort. The goal is to generate 10 to 50 times more energy than the input power by means of fusion reactions that occur in deuterium (D) and tritium (T) plasma at two hundred million degrees Celsius. In the future commercial reactors it will be necessary to breed the tritium used as fuel in situ, by the reactor itself. This constitutes a step further from current experimental machines dedicated mainly to the study of the plasma physics. Therefore, tritium, in fusion reactors, will be produced in the so-called breeder blankets whose primary mission is to provide neutron shielding, produce and recover tritium and convert the neutron energy into heat. There are different concepts of breeding blankets that can be separated into two main categories: solids or liquids. The former are based on ceramics containing lithium as Li2O , Li4SiO4 , Li2TiO3 , Li2ZrO3 and Be, used as a neutron multiplier, required to achieve the required amount of tritium. The liquid concepts are based on molten salts or liquid metals as pure Li, LiPb, FLIBE or FLINABE. These blankets use, as neutron multipliers, Be or Pb (in the case of the concepts based on LiPb). Proposed structural materials comprise various options, always with low activation characteristics, as low activation ferritic-martensitic steels, vanadium alloys or even SiCf/SiC. Each concept of breeding blanket has specific challenges that will be studied in the experimental reactor ITER (International Thermonuclear Experimental Reactor). However, ITER cannot answer questions associated to material damage and the effect of neutron radiation in the different breeding blankets functions and performance. As a reference, the first wall of a fusion reactor of 4000 MW will receive about 30 dpa / year (values for Fe-56) , while values expected in ITER would be <10 dpa in its entire lifetime. Consequently, the irradiation effects on candidate materials for fusion reactors will be studied in IFMIF (International Fusion Material Irradiation Facility). This thesis fits in the framework of the bilateral agreement among Europe and Japan which is called “Broader Approach Agreement “(BA) (2007-2017) where Spain plays a key role. These projects, complementary to ITER, are mainly IFMIF and the fusion facility JT-60SA. The purpose of this thesis is the design of an irradiation module to test candidate materials for breeding blankets in IFMIF, the so-called Liquid Breeder Validation Module (LBVM). This proposal is born from the fact that this option was not considered in the conceptual design of the facility. As a first step, in order to study the feasibility of this proposal, neutronic calculations have been performed to estimate irradiation parameters in different materials foreseen for liquid breeding blankets. Various functional materials were considered: Fe (base of structural materials), SiC (candidate material for flow channel inserts, SiO2 (candidate for antipermeation coatings), CaO (candidate for insulating coatings), Al2O3 (candidate for antipermeation and insulating coatings) and AlN (candidate for insulation coating material). For each material, the most significant irradiation parameters have been calculated (dpa, H/dpa and He/dpa) in different positions of IFMIF. These values were compared to those expected in the first wall and breeding zone of a fusion reactor. For this exercise, a HCLL (Helium Cooled Lithium Lead) type was selected as it is one of the most promising options. In addition, estimated values were also compared with those obtained in a fast fission reactor since most of existing irradiations have been made in these installations. The main conclusion of this study is that the medium flux area of IFMIF offers a good irradiation environment to irradiate functional materials for liquid breeding blankets. The obtained ratios of H/dpa and He/dpa are very similar to those expected in the most irradiated areas of a fusion reactor. Moreover, with the aim of bringing the values further close, the use of a W moderator is proposed to be used only in some experimental campaigns (as obviously, the total amount of dpa decreases). The values of ratios obtained for a fission reactor, much lower than in a fusion reactor, reinforce the need of LBVM for IFMIF. Having demonstrated the suitability of IFMIF to irradiate functional materials for liquid breeding blankets, and an analysis of the main problems associated to each type of liquid breeding blanket, also presented in this thesis, three different experiments are proposed as basis for the design of the LBVM. These experiments are dedicated to the needs of a blanket HCLL type although the applicability of the module for other blankets is also discussed. Therefore, the experimental capability of the module is focused on the study of the behavior of the eutectic alloy LiPb, tritium permeation, corrosion and material compatibility. For each of the experiments proposed an experimental scheme is given explaining the different module conditions and defining the required instrumentation to control and monitor the experimental capsules. In order to carry out the proposed experiments, the LBVM is proposed, located in the medium flux area of the IFMIF hot cell, with capability of up to 16 experimental capsules. Each capsule (24-22 mm of diameter, 80 mm high) will contain the eutectic allow LiPb (up to 50 mm of capsule high) in contact with different material specimens. They will be supported inside rigs or steel pipes. Helium will be used as purge gas, to sweep the tritium generated in the eutectic and permeated through the capsule walls (continuously, during irradiation). These tubes, will be installed in a steel container providing support and cooling for the tubes and hence the inner experimental capsules. The experimental data will consist of on line monitoring signals and the analysis of purge gas by the tritium measurement station. In addition to the experimental signals, the module will produce signals having a safety function and therefore playing a major role in the operation of the module. For an adequate operation of the capsules and to control its temperature, each capsule will be equipped with an electrical heater so the module will to be connected to an electrical power supply. The technical justification behind the dimensioning of each of these parts forming the module is presented supported by tritium transport calculations, thermalhydraulic and structural analysis. One of the main conclusions of the tritium transport calculations is that the measure of the permeated tritium is perfectly achievable by commercial ionization chambers and proportional counters with sensitivity of 10-9 Bq/m3. The results are applicable to all experiments, even to low temperature capsules or to the ones using antipermeation coatings. From a safety point of view, the knowledge of the amount of tritium being swept by the purge gas is a clear indicator of certain problems that may be occurring in the module such a capsule rupture. In addition, the tritium balance in the installation should be known. Losses of purge gas permeated into the refrigerant and the hot cell itself through the container have been assessed concluding that they are negligible for normal operation. Thermal hydraulic calculations were performed in order to optimize the design of experimental capsules and LBVM to fulfill one of the main requirements of the module: to perform experiments at uniform temperatures between 300-550ºC. The necessary cooling of the module and the geometry of the capsules, rigs and testing area of the container were dimensioned. As a result of the analyses, cylindrical capsules and rigs in cylindrical compartments were selected because of their good mechanical behavior (stresses due to fluid pressure are reduced significantly with a cylindrical shape rather than prismatic) and thermal (temperature uniformity in the walls of the tubes and capsules). Fields of pressure, temperature and velocity in different critical areas of the module were obtained concluding that the proposal is feasible. It is important to mention that the use of fluid dynamic codes as ANSYS-CFX (used in this thesis) for designing experimental capsules for IFMIF is not direct. The reason for this is that, under strongly heated helium mini channels, turbulence models tend to underestimate the wall temperature because of the change of helium properties near the wall. Therefore, the different code turbulence models had to be studied in detail and validated against experimental results. ANSYS-CFX SST (Shear Stress Transport Model) for transitional turbulence model has been identified among many others as the suitable one for modeling the cooling helium and the temperature on the walls of experimental capsules. Once the geometry and the main purge and cooling parameters have been defined, the mechanical behavior of each experimental tube or rig including capsules is analyzed. Resulting stresses are compared with the maximum values recommended by applicable structural design codes such as the SDC- IC (Structural Design Criteria for ITER Components) in order to assess the degree of protection against plastic collapse. The conclusion shows that the proposal is mechanically robust. The LBVM involves the use of liquid metals, tritium and the risk associated with neutron activation. The risks related with the handling of liquid metals and tritium are studied in this thesis. In addition, the radiological risks associated with the activation of materials in the module and the residual heat after irradiation are evaluated, including a scenario of loss of coolant. Among the identified conventional risks associated with the module highlights the handling of liquid metals which reactions with water or air are accompanied by the emission of aerosols and fire probability. Regarding the nuclear risks, the generation of radioactive gases such as tritium or volatile radioisotopes such as Po-210 is the main hazard to be considered. An environmental impact associated to possible releases is not expected. Nevertheless, an appropriate handling of capsules, experimental tubes, and container including purge lines is required. After one day after shutdown and one year of irradiation, the experimental area of the module will present a contact dose rate of about 7000 Sv/h, 2300 Sv/h in the experimental capsules and 25 Sv/h in the LiPb. Therefore, the use of remote handling is envisaged for the irradiated module. Finally, the different possibilities for the module manufacturing have been studied. Among the proposed techniques highlights the electro discharge machining, brazing, electron beam welding or laser welding. The bases for the final design of the LBVM have been included in the framework of the this work and included in the intermediate design report of IFMIF which will be developed in future, as part of the IFMIF facility final design.

Fetal origins of the TEL-AML1 fusion gene in identical twins with leukemia

The TEL (ETV6)−AML1 (CBFA2) gene fusion is the most common reciprocal chromosomal rearrangement in childhood cancer occurring in ≈25% of the most predominant subtype of leukemia— common acute lymphoblastic leukemia. The TEL-AML1 genomic sequence has been characterized in a pair of monozygotic twins diagnosed at ages 3 years, 6 months and 4 years, 10 months with common acute lymphoblastic leukemia. The twin leukemic DNA shared the same unique (or clonotypic) but nonconstitutive TEL-AML1 fusion sequence. The most plausible explanation for this finding is a single cell origin of the TEL-AML fusion in one fetus in utero, probably as a leukemia-initiating mutation, followed by intraplacental metastasis of clonal progeny to the other twin. Clonal identity is further supported by the finding that the leukemic cells in the two twins shared an identical rearranged IGH allele. These data have implications for the etiology and natural history of childhood leukemia.

A rhodopsin-guanylyl cyclase gene fusion functions in visual perception in a fungus

Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Targeting HIV proteins to the major histocompatibility complex class I processing pathway with a novel gp120-anthrax toxin fusion protein

A challenge for subunit vaccines whose goal is to elicit CD8+ cytotoxic T lymphocytes (CTLs) is to deliver the antigen to the cytosol of the living cell, where it can be processed for presentation by major histocompatibility complex (MHC) class I molecules. Several bacterial toxins have evolved to efficiently deliver catalytic protein moieties to the cytosol of eukaryotic cells. Anthrax lethal toxin consists of two distinct proteins that combine to form the active toxin. Protective antigen (PA) binds to cells and is instrumental in delivering lethal factor (LF) to the cell cytosol. To test whether the lethal factor protein could be exploited for delivery of exogenous proteins to the MHC class I processing pathway, we constructed a genetic fusion between the amino-terminal 254 aa of LF and the gp120 portion of the HIV-1 envelope protein. Cells treated with this fusion protein (LF254-gp120) in the presence of PA effectively processed gp120 and presented an epitope recognized by HIV-1 gp120 V3-specific CTL. In contrast, when cells were treated with the LF254-gp120 fusion protein and a mutant PA protein defective for translocation, the cells were not able to present the epitope and were not lysed by the specific CTL. The entry into the cytosol and dependence on the classical cytosolic MHC class I pathway were confirmed by showing that antigen presentation by PA + LF254-gp120 was blocked by the proteasome inhibitor lactacystin. These data demonstrate the ability of the LF amino-terminal fragment to deliver antigens to the MHC class I pathway and provide the basis for the development of novel T cell vaccines.

Cloning and Sequencing of a Protein Involved in Phagosomal Membrane Fusion in Paramecium

An mAb was raised to the C5 phagosomal antigen in Paramecium multimicronucleatum. To determine its function, the cDNA and genomic DNA encoding C5 were cloned. This antigen consisted of 315 amino acid residues with a predicted molecular weight of 36,594, a value similar to that determined by SDS-PAGE. Sequence comparisons uncovered a low but significant homology with a Schizosaccharomyces pombe protein and the C-terminal half of the β-fructofuranosidase protein of Zymomonas mobilis. Lacking an obvious transmembrane domain or a possible signal sequence at the N terminus, C5 was predicted to be a soluble protein, whereas immunofluorescence data showed that it was present on the membranes of vesicles and digestive vacuoles (DVs). In cells that were minimally permeabilized but with intact DVs, C5 was found to be located on the cytosolic surface of the DV membranes. Immunoblotting of proteins from the purified and KCl-washed DVs showed that C5 was tightly bound to the DV membranes. Cryoelectron microscopy also confirmed that C5 was on the cytosolic surface of the discoidal vesicles, acidosomes, and lysosomes, organelles known to fuse with the membranes of the cytopharynx, the DVs of stages I (DV-I) and II (DV-II), respectively. Although C5 was concentrated more on the mature than on the young DV membranes, the striking observation was that the cytopharyngeal membrane that is derived from the discoidal vesicles was almost devoid of C5. Approximately 80% of the C5 was lost from the discoidal vesicle-derived membrane after this membrane fused with the cytopharyngeal membrane. Microinjection of the mAb to C5 greatly inhibited the fusion of the discoidal vesicles with the cytopharyngeal membrane and thus the incorporation of the discoidal vesicle membranes into the DV membranes. Taken together, these results suggest that C5 is a membrane protein that is involved in binding and/or fusion of the discoidal vesicles with the cytopharyngeal membrane that leads to DV formation.

Distinct leukemia phenotypes in transgenic mice and different corepressor interactions generated by promyelocytic leukemia variant fusion genes PLZF–RARα and NPM–RARα

Acute promyelocytic leukemia (APL) is characterized by a specific chromosome translocation involving RARα and one of four fusion partners: PML, PLZF, NPM, and NuMA genes. To study the leukemogenic potential of the fusion genes in vivo, we generated transgenic mice with PLZF–RARα and NPM–RARα. PLZF–RARα transgenic animals developed chronic myeloid leukemia-like phenotypes at an early stage of life (within 3 months in five of six mice), whereas three NPM–RARα transgenic mice showed a spectrum of phenotypes from typical APL to chronic myeloid leukemia relatively late in life (from 12 to 15 months). In contrast to bone marrow cells from PLZF–RARα transgenic mice, those from NPM–RARα transgenic mice could be induced to differentiate by all-trans-retinoic acid (ATRA). We also studied RARE binding properties and interactions between nuclear corepressor SMRT and various fusion proteins in response to ATRA. Dissociation of SMRT from different receptors was observed at ATRA concentrations of 0.01 μM, 0.1 μM, and 1.0 μM for RARα–RXRα, NPM–RARα, and PML–RARα, respectively, but not observed for PLZF–RARα even in the presence of 10 μM ATRA. We also determined the expression of the tissue factor gene in transgenic mice, which was detected only in bone marrow cells of mice expressing the fusion genes. These data clearly establish the leukemogenic role of PLZF–RARα and NPM–RARα and the importance of fusion receptor/corepressor interactions in the pathogenesis as well as in determining different clinical phenotypes of APL.

Embryonic expression of the tumor-associated PAX3-FKHR fusion protein interferes with the developmental functions of Pax3

A unique chromosomal translocation involving the genes PAX3 and FKHR is characteristic of most human alveolar rhabdomyosarcomas. The resultant chimeric protein fuses the PAX3 DNA-binding domains to the transactivation domain of FKHR, suggesting that PAX3-FKHR exerts its role in alveolar rhabdomyosarcomas through dysregulation of PAX3-specific target genes. Here, we have produced transgenic mice in which PAX3-FKHR expression was driven by mouse Pax3 promoter/enhancer sequences. Five independent lines expressed PAX3-FKHR in the dorsal neural tube and lateral dermomyotome. Each line exhibited phenotypes that correlated with PAX3-FKHR expression levels and predominantly involved pigmentary disturbances of the abdomen, hindpaws, and tail, with additional neurological related alterations. Phenotypic severity could be increased by reducing Pax3 levels through matings with Pax3-defective Splotch mice, and interference between PAX3 and PAX3-FKHR was apparent in transcription reporter assays. These data suggest that the tumor-associated PAX3-FKHR fusion protein interferes with normal Pax3 developmental functions as a prelude to transformation.

Dynamic modeling of gene expression data

We describe the time evolution of gene expression levels by using a time translational matrix to predict future expression levels of genes based on their expression levels at some initial time. We deduce the time translational matrix for previously published DNA microarray gene expression data sets by modeling them within a linear framework by using the characteristic modes obtained by singular value decomposition. The resulting time translation matrix provides a measure of the relationships among the modes and governs their time evolution. We show that a truncated matrix linking just a few modes is a good approximation of the full time translation matrix. This finding suggests that the number of essential connections among the genes is small.

A genomic approach to gene fusion technology

Gene expression profiling provides powerful analyses of transcriptional responses to cellular perturbation. In contrast to DNA array-based methods, reporter gene technology has been underused for this application. Here we describe a genomewide, genome-registered collection of Escherichia coli bioluminescent reporter gene fusions. DNA sequences from plasmid-borne, random fusions of E. coli chromosomal DNA to a Photorhabdus luminescens luxCDABE reporter allowed precise mapping of each fusion. The utility of this collection covering about 30% of the transcriptional units was tested by analyzing individual fusions representative of heat shock, SOS, OxyR, SoxRS, and cya/crp stress-responsive regulons. Each fusion strain responded as anticipated to environmental conditions known to activate the corresponding regulatory circuit. Thus, the collection mirrors E. coli's transcriptional wiring diagram. This genomewide collection of gene fusions provides an independent test of results from other gene expression analyses. Accordingly, a DNA microarray-based analysis of mitomycin C-treated E. coli indicated elevated expression of expected and unanticipated genes. Selected luxCDABE fusions corresponding to these up-regulated genes were used to confirm or contradict the DNA microarray results. The power of partnering gene fusion and DNA microarray technology to discover promoters and define operons was demonstrated when data from both suggested that a cluster of 20 genes encoding production of type I extracellular polysaccharide in E. coli form a single operon.

ATP-dependent Membrane Assembly of F-Actin Facilitates Membrane Fusion

We recently established an in vitro assay that monitors the fusion between latex-bead phagosomes and endocytic organelles in the presence of J774 macrophage cytosol (Jahraus et al., 1998). Here, we show that different reagents affecting the actin cytoskeleton can either inhibit or stimulate this fusion process. Because the membranes of purified phagosomes can assemble F-actin de novo from pure actin with ATP (Defacque et al., 2000a), we focused here on the ability of membranes to nucleate actin in the presence of J774 cytosolic extracts. For this, we used F-actin sedimentation, pyrene actin assays, and torsional rheometry, a biophysical approach that could provide kinetic information on actin polymerization and gel formation. We make two major conclusions. First, under our standard in vitro conditions (4 mg/ml cytosol and 1 mM ATP), the presence of membranes actively catalyzed the assembly of cytosolic F-actin, which assembled into highly viscoelastic gels. A model is discussed that links these results to how the actin may facilitate fusion. Second, cytosolic actin paradoxically polymerized more under ATP depletion than under high-ATP conditions, even in the absence of membranes; we discuss these data in the context of the well described, large increases in F-actin seen in many cells during ischemia.

Effects of estrogen on growth plate senescence and epiphyseal fusion

Estrogen is critical for epiphyseal fusion in both young men and women. In this study, we explored the cellular mechanisms by which estrogen causes this phenomenon. Juvenile ovariectomized female rabbits received either 70 μg/kg estradiol cypionate or vehicle i.m. once a week. Growth plates from the proximal tibia, distal tibia, and distal femur were analyzed after 2, 4, 6, or 8 weeks of treatment. In vehicle-treated animals, there was a gradual senescent decline in tibial growth rate, rate of chondrocyte proliferation, growth plate height, number of proliferative chondrocytes, number of hypertrophic chondrocytes, size of terminal hypertrophic chondrocytes, and column density. Estrogen treatment accelerated the senescent decline in all of these parameters. In senescent growth plates, epiphyseal fusion was observed to be an abrupt event in which all remaining chondrocytes were rapidly replaced by bone elements. Fusion occurred when the rate of chondrocyte proliferation approached zero. Estrogen caused this proliferative exhaustion and fusion to occur earlier. Our data suggest that (i) epiphyseal fusion is triggered when the proliferative potential of growth plate chondrocytes is exhausted; and (ii) estrogen does not induce growth plate ossification directly; instead, estrogen accelerates the programmed senescence of the growth plate, thus causing earlier proliferative exhaustion and consequently earlier fusion.

The human formin-binding protein 17 (FBP17) interacts with sorting nexin, SNX2, and is an MLL-fusion partner in acute myelogeneous leukemia

We have cloned a fusion partner of the MLL gene at 11q23 and identified it as the gene encoding the human formin-binding protein 17, FBP17. It maps to chromosome 9q34 centromeric to ABL. The gene fusion results from a complex chromosome rearrangement that was resolved by fluorescence in situ hybridization with various probes on chromosomes 9 and 11 as an ins(11;9)(q23;q34)inv(11)(q13q23). The rearrangement resulted in a 5′-MLL/FBP17-3′ fusion mRNA. We retrovirally transduced murine-myeloid progenitor cells with MLL/FBP17 to test its transforming ability. In contrast to MLL/ENL, MLL/ELL and other MLL-fusion genes, MLL/FBP17 did not give a positive readout in a serial replating assay. Therefore, we assume that additional cooperating genetic abnormalities might be needed to establish a full malignant phenotype. FBP17 consists of a C-terminal Src homology 3 domain and an N-terminal region that is homologous to the cell division cycle protein, cdc15, a regulator of the actin cytoskeleton in Schizosaccharomyces pombe. Both domains are separated by a consensus Rho-binding motif that has been identified in different Rho-interaction partners such as Rhotekin and Rhophilin. We evaluated whether FBP17 and members of the Rho family interact in vivo with a yeast two-hybrid assay. None of the various Rho proteins tested, however, interacted with FBP17. We screened a human kidney library and identified a sorting nexin, SNX2, as a protein interaction partner of FBP17. These data provide a link between the epidermal growth factor receptor pathway and an MLL fusion protein.

Eradication of human hepatic and pulmonary melanoma metastases in SCID mice by antibody-interleukin 2 fusion proteins.

Antibody-cytokine fusion proteins combine the unique targeting ability of antibodies with the multifunctional activity of cytokines. Here, we demonstrate the therapeutic efficacy of such constructs for the treatment of hepatic and pulmonary metastases of different melanoma cell lines. Two antibody-interleukin 2 (IL-2) fusion proteins, ch225-IL2 and ch14.18-IL2, constructed by fusion of a synthetic sequence coding for human IL-2 to the carboxyl end of the Cgamma1 gene of the corresponding antibodies, were tested for their therapeutic efficacy against xenografted human melanoma in vivo. Tumor-specific fusion proteins completely inhibited the growth of hepatic and pulmonary metastases in C.B-17 scid/scid mice previously reconstituted with human lymphokine-activated killer cells, whereas treatment with combinations of the corresponding antibodies plus recombinant IL-2 only reduced the tumor load. Even when treatment with fusion proteins was delayed up to 8 days after inoculation of tumor cells, it still resulted in complete eradication of micrometastases that were established at that time point. Selection of tumor cell lines expressing or lacking the targeted antigen of the administered fusion protein proved the specificity of the observed antitumor effect. Biodistribution analysis demonstrated that the tumor-specific fusion protein accumulated not only in subcutaneous tumors but also in lungs and livers affected with micrometastases. Survival times of animals treated with the fusion protein were more than doubled as compared to those treated with the combination of the corresponding antibody plus IL-2. Our data demonstrate that an immunotherapeutic approach using cytokines targeted by antibodies to tumor sites has potent effects against disseminated human melanoma.

Preferential expansion and survival of B lymphocytes based on VH framework 1 and framework 3 expression: "positive" selection in appendix of normal and VH-mutant rabbits.

B cells with a rearranged heavy-chain variable region VHa allotype-encoding VH1 gene segment predominate throughout the life of normal rabbits and appear to be the source of the majority of serum immunoglobulins, which thus bear VHa allotypes. The functional role(s) of these VH framework region (FR) allotypic structures has not been defined. We show here that B cells expressing surface immunoglobulin with VHa2 allotypic specificities are preferentially expanded and positively selected in the appendix of young rabbits. By flow cytometry, a higher proportion of a2+ B cells were progressing through the cell cycle (S/G2/M) compared to a2- B cells, most of which were in the G1/G0 phase of the cell cycle. The majority of appendix B cells in dark zones of germinal centers of normal 6-week-old rabbits were proliferating and very little apoptosis were observed. In contrast, in 6-week-old VH-mutant ali/ali rabbits, little cell proliferation and extensive apoptosis were observed. Nonetheless even in the absence of VH1, B cells with a2-like surface immunoglobulin had developed and expanded in the appendix of 11-week-old mutants. The numbers and tissue localization of B cells undergoing apoptosis then appeared similar to those found in 6-week-old normal appendix. Thus, B cells with immunoglobulin receptors lacking the VHa2 allotypic structures were less likely to undergo clonal expansion and maturation. These data suggest that "positive" selection of B lymphocytes through FR1 and FR3 VHa allotypic structures occurs during their development in the appendix.