Studio delle citochine nella distrofia muscolare di Emery-Dreifuss: Possibili marker patogenetici e bersagli di cura della malattia

La distrofia muscolare di Emery-Dreifuss (EDMD) è una miopatia degenerativa ereditaria caratterizzata da debolezza e atrofia dei muscoli senza coinvolgimento del sistema nervoso. Individui EDMD presentano, inoltre, cardiomiopatia con difetto di conduzione che provoca rischio di morte improvvisa. Diversi studi evidenziano un coinvolgimento di citochine in diverse distrofie muscolari causanti infiammazione cronica, riassorbimento osseo, necrosi cellulare. Abbiamo effettuato una valutazione simultanea della concentrazione di citochine, chemochine, fattori di crescita, presenti nel siero di un gruppo di 25 pazienti EDMD. L’analisi effettuata ha evidenziato un aumento di citochine quali IL-17, TGFβ2, INF-γ e del TGFβ1. Inoltre, una riduzione del fattore di crescita VEGF e della chemochina RANTES è stata rilevata nel siero dei pazienti EDMD rispetto ai pazienti controllo. Ulteriori analisi effettuate tramite saggio ELISA hanno evidenziato un aumento dei livelli di TGFβ2 e IL-6 nel terreno di coltura di fibroblasti EDMD2. Per testare l’effetto nei muscoli, di citochine alterate, abbiamo utilizzato terreno condizionante di fibroblasti EDMD per differenziare mioblasti murini C2C12. Una riduzione del grado di differenziamento è stata osservata nei mioblasti condizionati con terreno EDMD. Trattando queste cellule con anticorpi neutralizzanti contro TGFβ2 e IL-6 si è avuto un miglioramento del grado di differenziamento. In C2C12 che esprimevano la mutazione H222P del gene Lmna,non sono state osservate alterazioni di citochine e benefici di anticorpi neutralizzanti. I dati mostrano un effetto patogenetico delle citochine alterate come osservato in fibroblasti e siero di pazienti, suggerendo un effetto sul tessuto fibrotico di muscoli EDMD. Un effetto intrinseco alla mutazione della lamina A è stato rilevato sul espressione di caveolina 3 in mioblasti differenziati EDMD. I risultati si aggiungono a dati forniti sulla patogenesi dell' EDMD confermando che fattori intrinseci ed estrinseci contribuiscono alla malattia. Utilizzo di anticorpi neutralizzanti specifici contro fattori estrinseci potrebbe rappresentare un approccio terapeutico come mostrato in questo studio.

Identification of novel genetic alterations in pediatric cytogenetically normal acute myeloid leukemia by next-generation sequencing

Pediatric acute myeloid leukemia (AML) is a molecularly heterogeneous disease that arises from genetic alterations in pathways that regulate self-renewal and myeloid differentiation. While the majority of patients carry recurrent chromosomal translocations, almost 20% of childhood AML do not show any recognizable cytogenetic alteration and are defined as cytogenetically normal (CN)-AML. CN-AML patients have always showed a great variability in response to therapy and overall outcome, underlining the presence of unknown genetic changes, not detectable by conventional analyses, but relevant for pathogenesis, and outcome of AML. The development of novel genome-wide techniques such as next-generation sequencing, have tremendously improved our ability to interrogate the cancer genome. Based on this background, the aim of this research study was to investigate the mutational landscape of pediatric CN-AML patients negative for all the currently known somatic mutations reported in AML through whole-transcriptome sequencing (RNA-seq). RNA-seq performed on diagnostic leukemic blasts from 19 pediatric CN-AML cases revealed a considerable incidence of cryptic chromosomal rearrangements, with the identification of 21 putative fusion genes. Several of the fusion genes that were identified in this study are recurrent and might have a prognostic and/or therapeutic relevance. A paradigm of that is the CBFA2T3-GLIS2 fusion, which has been demonstrated to be a common alteration in pediatric CN-AML, predicting poor outcome. Important findings have been also obtained in the identification of novel therapeutic targets. On one side, the identification of NUP98-JARID1A fusion suggests the use of disulfiram; on the other, here we describe alteration-activating tyrosine kinases, providing functional data supporting the use of tyrosine kinase inhibitors to specifically inhibit leukemia cells. This study provides new insights in the knowledge of genetic alterations underlying pediatric AML, defines novel prognostic markers and putative therapeutic targets, and prospectively ensures a correct risk stratification and risk-adapted therapy also for the “all-neg” AML subgroup.

Strahlungsinduzierte Mukositis als Risiko der Raumfahrt : Modelluntersuchungen an Röntgen- und Schwerionen-bestrahlten organotypischen Mundschleimhaut-Modellen

Während ausgedehnter Weltraumflüge zum Mond und Mars wäre die Besatzung eines Raumschiffs dicht ionisierender Schwerionenstrahlung, der sogenannten kosmischen Strahlung, ausgesetzt. Da bei vielen Krebspatienten die orale Mukositis als eine gravierende Nebenwirkung bei der herkömmlichen Strahlentherapie auftritt, könnte diese Erkrankung ein medizinisches Problem während ausgedehnter Weltraumflüge darstellen. Allerdings liegen bislang keine Untersuchungen über eine mögliche Mukositis-induzierte Wirkung von Schwerionenstrahlung vor. Um das Risiko strahlungsinduzierter oraler Mukositis durch kosmische Strahlung abzuschätzen, wurden dreidimensionale organotypische Mundschleimhaut-Modelle 12C Schwerionen- bzw. Röntgenstrahlung ausgesetzt und nach definierten Inkubationszeiten kryokonserviert. Aus dem Material wurden Kryoschnitte gefertigt, mit denen anschließend histologische und immunhistologische Fluoreszenzfärbungen zum Nachweis von zum Beispiel Kompaktheitsverlust, Doppelstrangbrüchen der DNA und NF-κB-Aktivierung durchgeführt wurden. Die Ausschüttung von Tumornekrosefaktor α, Interleukin 1β, Interleukin 6 und Interleukin 8 wurde in Probenüberständen mittels ELISA analysiert. Das Hauptaugenmerk dieser Studie lag dabei auf den frühen durch Strahlung verursachten Effekten. rnIm Rahmen dieser Dissertation wurde ein dreidimensionales Mundschleimhaut-Modell etabliert, das verglichen mit humaner Mundschleimhaut viele organotypische Differenzierungsmarker und in vivo-ähnliche Reaktionen auf bestimmte Reize zeigte. Nach einer Bestrahlung mit schweren Kohlenstoffionen bzw. mit Röntgenstrahlung wurden strahlungsinduzierte Effekte auf mehreren Ebenen detektiert. Bereits 1 h nach Bestrahlung konnten dosisabhängig vermehrte Doppelstrangbrüche in der DNA detektiert werden, wobei bei gleicher Dosis Schwerionenstrahlung im Durchschnitt doppelt so viele DSB verursachte wie Röntgenstrahlung. Das Mundschleimhaut-Modell reagierte auf beide Strahlungsarten mit einer Aktivierung des Transkriptionsfaktors NF-κB p50, wobei Röntgenstrahlung diese Aktivierung früher induzierte als Schwerionen. Eine strahlungsinduzierte Aktivierung von NF-κB p65 wurde in den organotypischen Kulturen zu den untersuchten Zeitpunkten nicht beobachtet. Im Vergleich zu nicht bestrahlten Kulturen waren die Konzentrationen von Interleukin 6 und Interleukin 8 unabhängig von der Strahlungsqualität nach Bestrahlung signifikant erhöht. Interleukin-1β dagegen wurde nur nach Röntgenbestrahlung signifikant vermehrt ausgeschüttet. In Schwerionen-bestrahlten Proben wurden zwar tendenziell höhere Konzentrationen beobachtet, statistische Signifikanzen ergaben sich aber nicht. Die Analysen zur TNF-α- und IFN-γ-Ausschüttung in bestrahlten organotypischen Kulturen ergaben innerhalb des gewählten Beobachtungszeitraums von 48 h keine strahlungsinduzierten Effekte. Bei den Untersuchungen der Proliferation in den Zellen der bestrahlten organotypischen Kulturen wurde bereits 24 h nach Röntgenstrahlung und 3 Tage nach Schwerionenstrahlung eine deutliche verminderte Proliferation beobachtet. Des Weiteren zeigte das Mundschleimhaut-Modell unabhängig von Strahlungsqualitäten einen eindeutigen Verlust in der Zellintegrität und daraus resultierenden Kompaktheitsverlust des Gewebes, was in der in vivo-Situation wahrscheinlich einer Gewebedegeneration entspricht. rnNach Bestrahlung mit sowohl Röntgenstrahlung als auch schweren Ionen wurden im gewählten Mukosa-Modell innerhalb von 48 h nach Behandlung strahlungsinduzierte proinflammatorische Marker eindeutig und reproduzierbar detektiert. Dies deutet darauf hin, dass während langer extraterrestrischer Expeditionen das Risiko der oralen Mukositis einkalkuliert und mit den daraus folgenden Konsequenzen gerechnet werden muss.rn

Synthese und Charakterisierung von HPMA-stabilisierten Kolloiden sowie deren Evaluierung in vitro und in vivo

Nanodimensionale Wirkstoff-Trägersysteme sind in der Lage, sowohl die Bioverfügbarkeit als auch das pharmakokinetische Profil von Wirkstoffen drastisch zu verbessern. Hauptgründe dafür sind eine erhöhte Plasma-Halbwertszeit durch die größenbedingte verminderte renale Ausscheidung und eine gesteigerte Anreicherung im Tumorgewebe durch den EPR-Effekt. Diese Arbeit beschreibt die Synthese und Entwicklung neuer kolloidaler Wirkstoff-Trägersysteme, welche biokompatibel, teilweise bioabbaubar und funktionalisierbar sind. Ein Fluoreszenzfarbstoff wurde als hydrophobes Wirkstoffmodell eingekapselt. Wohldefinierte, eng verteilte und funktionalisierbare HPMA-basierte Block- und statistische Copolymere unterschiedlicher Molekulargewichte (10-25 kDa) und hydrophiler/hydrophober Zusammensetzung (10-50 mol%) wurden mittels RAFT- Polymerisation in Kombination mit dem Reaktivesteransatz hergestellt und in Miniemulsionsprozesse eingesetzt, um ihre Stabilisierungseffizienz zu untersuchen. Dabei zeigte sich, dass die kleineren Copolymere (10 kDa) mit einem Einbau von 10 mol% LMA, sowohl im Modellsystem Polystyrol, als auch im bioabbaubaren PDLLA-System, besonders geeignet sind und ergaben monodisperse Kolloide im Größenbereich von 100 bis 300 nm. Die kolloidalen Systeme zeigten keine Wirkung auf die Zellviabilität. In Folge dessen wurde das Aggregationsverhalten in humanem Blutserum mittels DLS untersucht, wobei keine Interaktion mit Blutbestandteilen festgestellt werden konnte. Zellaufnahmestudien wurden an HeLa-Zellen durchgeführt, um das Schicksal der Kolloide in vitro zu untersuchen. Dabei wurden Kernmaterial, Hülle und das hydrophobe Wirkstoffmodell durch unterschiedliche Fluoreszenzmarkierung getrennt betrachtet. Das hydrophobe Wirkstoffmodell wurde allein durch Interaktion der Kolloide mit den Zellen übertragen, was für eine diffusionsbedingte, initiale, aber unspezifische Freisetzung spricht. Eine solche Freisetzungskinetik kann durch Verwendung von Nitroglycerin, als vasodilatierender Wirkstoff mit geringer unspezifischer Wirkung, ausgenutzt werden, um den EPR-Effekt zu unterstützen. Die Aufnahme des Partikels hingegen geschieht zeitverzögert. Das Schicksal der Kolloide (sowohl des Kern- und desrnHüllmaterials) wurde durch doppelte Fluoreszenzmarkierung untersucht. Dabei kam es zu einer intrazellulären Ablösung der stabilisierenden Block-Copolymere zwischen 8 und 24 h. Nach Aufklärung der Aufnahme- und Freisetzungskinetiken wurde nun die Körperverteilung der PS- und PDLLA-Kolloide nach 18F-Markierung mittels PET und ex vivo-Biodistributiosstudien untersucht. Dabei hatte das Kernmaterial einen Einfluss auf die Körperverteilung. PET-Studien in Mäusen zeigten, dass die stabilisierenden Block-Copolymere beider Kolloide ein starkes Signal in der Niere geben, wobei das der PS-Kolloide weiter ausgeprägt war. Darüber hinaus war eine Anreicherung dieser in Lunge, Leber und Milz festzustellen. Die Verdrängung der stabilisierenden Polymere durch die Interaktion mit Blutbestandteilen erklärt dabei das erhöhte Nieren- und Blasensignal der PS- Kolloide. Das Anreicherungsmuster der PDLLA-Kolloide hingegen zeigte neben der Nierenakkumulation eine erhöhte Blutaktivität und somit die gewünschten langzirkulierenden Eigenschaften. Diese Ergebnisse konnten auch mittels ex vivo- Biodistributionsstudien bestätigt werden. Um die Tumoranreicherung weiter zu verbessern wurde die Verwendung von Folat als Erkennungsstruktur am einfachen HPMA-Polymer untersucht. Die Konjugate zeigten eine erhöhte Anreicherung im Vergleich zu den Polymeren ohne Erkennungsstrukturen. Blockadestudien bestätigten die Selektivität der Anreicherung. Diese Daten zeigen das Potential der Folat-Erkennungsstruktur in vivo innerhalb kurzer Zeitfenster, welche nun auf kolloidale Systeme übertragen werden kann.

Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology

Background Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations. Methods To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry. Results Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented. Conclusions Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.

The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT)

Zoledronic acid 5 mg (ZOL) annually for 3 years reduces fracture risk in postmenopausal women with osteoporosis. To investigate long-term effects of ZOL on bone mineral density (BMD) and fracture risk, the Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial (HORIZON-PFT) was extended to 6 years. In this international, multicenter, double-blind, placebo-controlled extension trial, 1233 postmenopausal women who received ZOL for 3 years in the core study were randomized to 3 additional years of ZOL (Z6, n = 616) or placebo (Z3P3, n = 617). The primary endpoint was femoral neck (FN) BMD percentage change from year 3 to 6 in the intent-to-treat (ITT) population. Secondary endpoints included other BMD sites, fractures, biochemical bone turnover markers, and safety. In years 3 to 6, FN-BMD remained constant in Z6 and dropped slightly in Z3P3 (between-treatment difference = 1.04%; 95% confidence interval 0.4 to 1.7; p = 0.0009) but remained above pretreatment levels. Other BMD sites showed similar differences. Biochemical markers remained constant in Z6 but rose slightly in Z3P3, remaining well below pretreatment levels in both. New morphometric vertebral fractures were lower in the Z6 (n = 14) versus Z3P3 (n = 30) group (odds ratio = 0.51; p = 0.035), whereas other fractures were not different. Significantly more Z6 patients had a transient increase in serum creatinine >0.5 mg/dL (0.65% versus 2.94% in Z3P3). Nonsignificant increases in Z6 of atrial fibrillation serious adverse events (2.0% versus 1.1% in Z3P3; p = 0.26) and stroke (3.1% versus 1.5% in Z3P3; p = 0.06) were seen. Postdose symptoms were similar in both groups. Reports of hypertension were significantly lower in Z6 versus Z3P3 (7.8% versus 15.1%, p < 0.001). Small differences in bone density and markers in those who continued versus those who stopped treatment suggest residual effects, and therefore, after 3 years of annual ZOL, many patients may discontinue therapy up to 3 years. However, vertebral fracture reductions suggest that those at high fracture risk, particularly vertebral fracture, may benefit by continued treatment.

TALDICE-1 age scale of the Talos Dome deep ice core, East Antarctica

A new deep ice core drilling program, TALDICE, has been successfully handled by a European team at Talos Dome, in the Ross Sea sector of East Antarctica, down to 1620 m depth. Using stratigraphic markers and a new inverse method, we produce the first official chronology of the ice core, called TALDICE-1. We show that it notably improves an a priori chronology resulting from a one-dimensional ice flow model. It is in agreement with a posteriori controls of the resulting accumulation rate and thinning function along the core. An absolute uncertainty of only 300 yr is obtained over the course of the last deglaciation. This uncertainty remains lower than 600 yr over Marine Isotope Stage 3, back to 50 kyr BP. The phasing of the TALDICE ice core climate record with respect to the central East Antarctic plateau and Greenland records can thus be determined with a precision allowing for a discussion of the mechanisms at work at sub-millennial time scales.

Two new rapid SNP-typing methods for classifying Mycobacterium tuberculosis complex into the main phylogenetic lineages

There is increasing evidence that strain variation in Mycobacterium tuberculosis complex (MTBC) might influence the outcome of tuberculosis infection and disease. To assess genotype-phenotype associations, phylogenetically robust molecular markers and appropriate genotyping tools are required. Most current genotyping methods for MTBC are based on mobile or repetitive DNA elements. Because these elements are prone to convergent evolution, the corresponding genotyping techniques are suboptimal for phylogenetic studies and strain classification. By contrast, single nucleotide polymorphisms (SNP) are ideal markers for classifying MTBC into phylogenetic lineages, as they exhibit very low degrees of homoplasy. In this study, we developed two complementary SNP-based genotyping methods to classify strains into the six main human-associated lineages of MTBC, the "Beijing" sublineage, and the clade comprising Mycobacterium bovis and Mycobacterium caprae. Phylogenetically informative SNPs were obtained from 22 MTBC whole-genome sequences. The first assay, referred to as MOL-PCR, is a ligation-dependent PCR with signal detection by fluorescent microspheres and a Luminex flow cytometer, which simultaneously interrogates eight SNPs. The second assay is based on six individual TaqMan real-time PCR assays for singleplex SNP-typing. We compared MOL-PCR and TaqMan results in two panels of clinical MTBC isolates. Both methods agreed fully when assigning 36 well-characterized strains into the main phylogenetic lineages. The sensitivity in allele-calling was 98.6% and 98.8% for MOL-PCR and TaqMan, respectively. Typing of an additional panel of 78 unknown clinical isolates revealed 99.2% and 100% sensitivity in allele-calling, respectively, and 100% agreement in lineage assignment between both methods. While MOL-PCR and TaqMan are both highly sensitive and specific, MOL-PCR is ideal for classification of isolates with no previous information, whereas TaqMan is faster for confirmation. Furthermore, both methods are rapid, flexible and comparably inexpensive.

Stem Cells From Umbilical Cord Wharton's Jelly From Preterm Birth Have Neuroglial Differentiation Potential

Objective:The aim of the study is to determine the neuroglial differentiation potential of human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) from preterm birth when compared to term delivery.Study Design:The WJ-MSCs from umbilical cords of preterm birth and term controls were isolated and induced into neural progenitors. The cells were analyzed for neuroglial markers by flow cytometry, real-time polymerase chain reaction, and immunocytochemistry. Results:Independent of gestational age, a subset of WJ-MSC displayed the neural progenitor cell markers Nestin and Musashi-1 and the mature neural markers microtubule-associated protein 2, glial fibrillary acidic protein, and myelin basic protein. Neuroglial induction of WJ-MSCs from term and preterm birth resulted in the enhanced transcription of Nestin and Musashi-1.Conclusions:Undifferentiated WJ-MSCs from preterm birth express neuroglial markers and can be successfully induced into neural progenitors similar to term controls. Their potential use as cellular graft in neuroregenerative therapy for peripartum brain injury in preterm birth has to be tested.

Stable virulence levels in the HIV epidemic of Switzerland over two decades

OBJECTIVE: To determine whether the virulence of HIV-1 has been changing since its introduction into Switzerland. DESIGN: A prospective cohort study of HIV-1 infected individuals with well-characterized pre-therapy disease history. METHODS: To minimize the effect of recently imported viruses and ethnicity-associated host factors, the analysis was restricted to the white, north-west-European majority population of the cohort. Virulence was characterized by the decline slope of the CD4 cell count (n = 817 patients), the decline slope of the CD4:CD8 ratio (n = 815 patients) and the viral setpoint (n = 549 patients) in untreated patients with sufficient data points. Linear regression models were used to detect correlations between the date of diagnosis (ranging between 1984 and 2003) and the virulence markers, controlling for gender, exposure category, age and CD4 cell count at entry. RESULTS: We found no correlation between any of the virulence markers and the date of diagnosis. Inspection of short-term trends confirmed that virulence has fluctuated around a stable level over time. CONCLUSIONS: The lack of long-term time trends in the virulence markers indicates that HIV-1 is not evolving towards increasing or decreasing virulence at a perceptible rate. Both highly virulent and attenuated strains have apparently been unable to spread at the population level. This result suggests that either the evolution of virulence may be slow or inhibited due to evolutionary constraints, or HIV-1 may have already evolved to optimal virulence in the human host.

POOR PERFORMANCE OF BOOTSTRAP CONFIDENCE INTERVALS FOR THE LOCATION OF A QUANTITATIVE TRAIT LOUCS

The aim of many genetic studies is to locate the genomic regions (called quantitative trait loci, QTLs) that contribute to variation in a quantitative trait (such as body weight). Confidence intervals for the locations of QTLs are particularly important for the design of further experiments to identify the gene or genes responsible for the effect. Likelihood support intervals are the most widely used method to obtain confidence intervals for QTL location, but the non-parametric bootstrap has also been recommended. Through extensive computer simulation, we show that bootstrap confidence intervals are poorly behaved and so should not be used in this context. The profile likelihood (or LOD curve) for QTL location has a tendency to peak at genetic markers, and so the distribution of the maximum likelihood estimate (MLE) of QTL location has the unusual feature of point masses at genetic markers; this contributes to the poor behavior of the bootstrap. Likelihood support intervals and approximate Bayes credible intervals, on the other hand, are shown to behave appropriately.

A Faster Circular Binary Segmentation Algorithm for the Analysis of Array CGH Data

Motivation: Array CGH technologies enable the simultaneous measurement of DNA copy number for thousands of sites on a genome. We developed the circular binary segmentation (CBS) algorithm to divide the genome into regions of equal copy number (Olshen {\it et~al}, 2004). The algorithm tests for change-points using a maximal $t$-statistic with a permutation reference distribution to obtain the corresponding $p$-value. The number of computations required for the maximal test statistic is $O(N^2),$ where $N$ is the number of markers. This makes the full permutation approach computationally prohibitive for the newer arrays that contain tens of thousands markers and highlights the need for a faster. algorithm. Results: We present a hybrid approach to obtain the $p$-value of the test statistic in linear time. We also introduce a rule for stopping early when there is strong evidence for the presence of a change. We show through simulations that the hybrid approach provides a substantial gain in speed with only a negligible loss in accuracy and that the stopping rule further increases speed. We also present the analysis of array CGH data from a breast cancer cell line to show the impact of the new approaches on the analysis of real data. Availability: An R (R Development Core Team, 2006) version of the CBS algorithm has been implemented in the ``DNAcopy'' package of the Bioconductor project (Gentleman {\it et~al}, 2004). The proposed hybrid method for the $p$-value is available in version 1.2.1 or higher and the stopping rule for declaring a change early is available in version 1.5.1 or higher.

A KEL gene encoding serine at position 193 of the Kell glycoprotein results in expression of KEL1 antigen

BACKGROUND: The KEL2/KEL1 (k/K) blood group polymorphism represents 578C>T in the KEL gene and Thr193Met in the Kell glycoprotein. Anti-KEL1 can cause severe hemolytic disease of the fetus and newborn. Molecular genotyping for KEL*1 is routinely used for assessing whether a fetus is at risk. Red blood cells (RBCs) from a KEL:1 blood donor (D1) were found to have abnormal KEL1 expression during evaluation of anti-KEL1 reagents. STUDY DESIGN AND METHODS: Kell genotyping methods, including KEL exon 6 direct sequencing, were applied. KEL cDNA from D1 was sequenced. Flow cytometry was used to assess KEL1 and KEL2 RBC expression. RESULTS: RBCs from the donor, her mother, and an unrelated donor gave weak or negative reactions with some anti-KEL1 reagents. Other Kell-system antigens appeared normal. The three individuals were homozygous for KEL C578 (KEL*2) but heterozygous for a 577A>T transversion, encoding Ser193. They appeared to be KEL*2 homozygotes by routine genotyping methods. Flow cytometry revealed weak KEL1 expression and normal KEL2, similar to that of KEL*2 homozygotes. CONCLUSION: Ser193 in the Kell glycoprotein appears to result in expression of abnormal KEL1, in addition to KEL2. The mutation is not detected by routine Kell genotyping methods and, because of unpredicted KEL1 expression, could lead to a misdiagnosis.

The locus for bovine dilated cardiomyopathy maps to chromosome 18

Bovine dilated cardiomyopathy (BDCMP) is a severe and terminal disease of the heart muscle observed in Holstein-Friesian cattle over the last 30 years. There is strong evidence for an autosomal recessive mode of inheritance for BDCMP. The objective of this study was to genetically map BDCMP, with the ultimate goal of identifying the causative mutation. A whole-genome scan using 199 microsatellite markers and one SNP revealed an assignment of BDCMP to BTA18. Fine-mapping on BTA18 refined the candidate region to the MSBDCMP06-BMS2785 interval. The interval containing the BDCMP locus was confirmed by multipoint linkage analysis using the software loki. The interval is about 6.7 Mb on the bovine genome sequence (Btau 3.1). The corresponding region of HSA19 is very gene-rich and contains roughly 200 genes. Although telomeric of the marker interval, TNNI3 is a possible positional and a functional candidate for BDCMP given its involvement in a human form of dilated cardiomyopathy. Sequence analysis of TNNI3 in cattle revealed no mutation in the coding sequence, but there was a G-to-A transition in intron 6 (AJ842179:c.378+315G>A). The analysis of this SNP using the study's BDCMP pedigree did not conclusively exclude TNNI3 as a candidate gene for BDCMP. Considering the high density of genes on the homologous region of HSA19, further refinement of the interval on BTA18 containing the BDCMP locus is needed.

Endocrine symptom assessment in women with breast cancer: what a simple "yes" means

GOALS OF WORK: To investigate the self-reported symptoms related to endocrine therapy in women with early or advanced breast cancer and the impact of these symptoms on quality of life (QL) indicators. MATERIALS AND METHODS: Symptom occurrence was assessed by the Checklist for Patients on Endocrine Therapy (C-PET) and symptom intensity was assessed by linear analogue self-assessment (LASA) indicators. Patients also responded to global LASA indicators for physical well-being, mood, coping effort and treatment burden. Associations between symptoms and these indicators were analysed by linear regression models. MAIN RESULTS: Among 373 women, the distribution of symptom intensity showed considerable variation in patients reporting a symptom as present. Even though patients recorded a symptom as absent, some patients reported having experienced that symptom when responding to symptom intensity, as seen for decreased sex drive, tiredness and vaginal dryness. Six of 13 symptoms and lower age had a detrimental impact on the global indicators, particularly tiredness and irritability. CONCLUSIONS: Patients' experience of endocrine symptoms needs to be considered both in patient care and research, when interpreting the association between symptoms and QL.