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Biomedical subjects

K Marks

Publications and source records attributed to K Marks.

At least 19 recordsLinked to original sources

Combined immunocytochemistry and FISH: an improved method to study engraftment of accessory bone marrow stromal cells.

In aplastic anaemia (AA), correction of bone marrow (BM) stromal function may contribute to the outcome of bone marrow transplantation (BMT). Engraftment of BM stromal cells is rarely observed, but engraftment of accessory cells (macrophages and T cells) may be important. We have improved a method of combined immunocytochemistry and FISH described by van Tol et al. (1998) to define the cellular origin and time course of engraftment of BM stromal accessory cells after sex-mismatched BMT. Long-term bone marrow cultures were trypsinized and cytospin preparations stained by immunocytochemistry using monoclonal antibodies against specific cell lineages followed by FISH for X and Y chromosomes. Low level phase contrast microscopy was used to study staining of individual cells simultaneously with fluorescence microscopy to define chromosomal pattern. In controls, the combined procedure did not affect the intensity of APAAP staining or the accuracy of sex chromosome determination. In cultures from AA patients after sex-mismatched BMT, cell lineages could be identified and donor or recipient origin determined unequivocally. This procedure enabled us to examine the origin (host/donor) of different cell lineages with high confidence, in addition to producing images of the combined staining.

Adult↗

Measurement of CP-violating asymmetries in B0 decays to CP eigenstates.

We present measurements of time-dependent CP-violating asymmetries in neutral B decays to several CP eigenstates. The measurement uses a data sample of 23x10(6) Upsilon(4S)-->BbarB decays collected by the BABAR detector at the PEP-II asymmetric B Factory at SLAC. In this sample, we find events in which one neutral B meson is fully reconstructed in a CP eigenstate containing charmonium and the flavor of the other neutral B meson is determined from its decay products. The amplitude of the CP-violating asymmetry, which in the standard model is proportional to sin2beta, is derived from the decay time distributions in such events. The result is sin2beta = 0.34+/-0.20 (stat)+/-0.05 (syst).

Journal Article↗

Phase II trial of liposomal doxorubicin (Doxil) in advanced soft tissue sarcomas.

PURPOSE: To assess the objective response rate, toxicity experienced, progression-free survival, and overall survival of patients with previously untreated advanced soft tissue sarcomas treated with a liposomal doxorubicin formulation (Doxil). METHODS: Patients with metastatic or recurrent soft tissue sarcoma who had received no prior chemotherapy for advanced disease were treated with liposomal doxorubicin (Doxil) according to a two stage accrual design. Doxil was administered at 50 mg/m2 every 4 weeks. A total of 15 patients were treated and are evaluable for response and toxicity. RESULTS: The male/female ratio was 7/8, the median age was 60 years (34-75) and the ECOG performance status was 0-1 in >90% of patients. Leiomyosarcoma (7/15) and malignant fibrous histiocytoma (2/15) were the most common histologic diagnoses. No objective responses were observed in the 15 evaluable patients. No lethal toxicity occurred. Grade 3-4 leukopenia or neutropenia were reported in 3/15 (20%) patients. Grade 3 mucositis or hand-foot syndrome occurred in 2/15 (13%) and 1/15 (7%) patients respectively and seemed more severe in older patients. The median time to progression was 1.9 months (range 0.9-6.2). Twelve patients have now died. The Kaplan-Meier estimate of median overall survival is 12.3 months. As called for in the study design, accrual was terminated because no responses were obtained in the first 15 patients. CONCLUSION: Though well-tolerated, Doxil given according to this dose and schedule to patients with advanced soft tissue sarcoma had no significant therapeutic activity. A correlation between older age and skin/mucosal toxicity of Doxil is suggested in this study but needs confirmation. Future investigations of Doxil in soft tissue sarcomas should use a different schedule and dose.

Adult↗

Transformation-defective polyoma middle T antigen mutants defective in PLCgamma, PI-3, or src kinase activation enhance ERK2 activation and promote retinoic acid-induced, cell differentiation like wild-type middle T.

In HL-60 human myeloblastic leukemia cells, retinoic acid is known to cause cFMS, RAF, MEK, and ERK2 dependent myeloid cell differentiation and G0 arrest associated with RB tumor suppressor protein hypophosphorylation, implicating receptor tyrosine kinase signal transduction in propelling these retinoic acid-induced cellular effects. Furthermore, ectopic expression of polyoma middle T antigen, which activates similar early signal transduction molecules as PDGF class receptors such as cFMS, accelerates these retinoic acid-induced effects. To determine if this depends on middle T's ability to activate PLCgamma, PI-3 kinase, and src-like kinases, stable transfectants of HL-60 cells expressing either the polyoma middle T dl23 mutant, which is defective for PLCgamma and PI-3 kinase activation, or the Delta205 mutant, which in addition has greatly attenuated src-like kinase activation ability, were created and compared to wild-type middle T-transfected HL-60. The transgenes were under control of the retinoic acid (or 1, 25-dihydroxy vitamin D3) inducible Moloney murine leukemia virus LTRs. Expression of the dl23 or Delta205 mutant accelerated retinoic acid-induced cell differentiation. The effects of the mutants were comparable to those of the wild-type middle T. Likewise, retinoic acid-induced G0 arrest of mutant transfected cells and wild-type middle T transfected cells was similar. The same was true for 1, 25-dihydroxy vitamin D3-induced monocytic differentiation as for retinoic acid-induced myeloid differentiation. The mutants did not cause the same slight shortening of the cell cycle as wild-type middle T. Both the mutants and the wild-type middle T caused a similar increase in the cellular basal level of activated ERK2 MAPK. Since retinoic acid increases ERK2 activation, which is necessary for differentiation, the data suggest that mutant and wild-type middle T enhanced the retinoic acid effects by increasing basal levels of ERK2 activation. Consistent with this, the polyoma-induced foreshortening of the time for differentiation coincided with the time for retinoic acid to significantly increase ERK2 activation. As in wild-type HL-60, retinoic acid induced the early down-regulation of RXRalpha in mutant transfectants similar to wild-type middle T transfectants, consistent with no loss or gain of relevant functions due to the mutations. In contrast, vitamin D3 did not down-regulate RXRalpha in HL-60 or transfectants. Polyoma middle T and these transformation-defective mutants thus enhanced ERK2 activation to have an early effect in promoting retinoic acid-induced differentiation without a strong dependence on activating PLCgamma, PI-3 kinase, or src-like kinase.

Antigens, Viral, Tumor↗

Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use.

A full-term newborn developed oliguric renal failure at 24 hr of life, which persisted for several days. Her mother ingested therapeutic doses of nimesulide, a non-steroidal anti-inflammatory (cyclo-oxygenase-2 inhibitor) drug, during the last 2 weeks of pregnancy. She was found at delivery to have developed oligohydramnion, esophagitis, and a bleeding peptic ulcer. The infant's fractional excretion of sodium was very low (0.5%) pointing for a severe vasoconstrictive mechanism involved. Renal sonogram showed hyperechogenic medullary papillae, which resolved during convalescence. This case emphasizes the importance of renal prostagandins in the control of vascular tone and sodium homeostasis. This is the first report of an adverse effect of fetal renal circulation by maternal ingestion of nimesulide.

Acute Kidney Injury↗

Measurement of cerebral blood flow in newborn infants using near infrared spectroscopy with indocyanine green.

Cerebral blood flow (CBF) measurement by near infrared spectroscopy (NIRS) using oxyhemoglobin (HbO2) as a tracer (CBF-HbO2) needs rapid changes in arterial oxygen saturation (SaO2) which often cannot be achieved in many sick infants. An alternative method based on the same adaptation of the Fick principle using i.v. injection of the dye indocyanine green (ICG) is described (CBF-ICG). Six mechanically ventilated infants (age 26-38 wk, birth weight 0.885-3.730 kg) requiring supplementary oxygen therapy were studied within 72 h of birth. For CBF-ICG measurements, ICG (0.1 mg x kg-1 was injected via an umbilical venous catheter, and blood ICG concentration was measured by an optical umbilical artery catheter and brain ICG concentration was measured by NIRS. For CBF-HbO2 measurements the inspired oxygen concentration was rapidly increased, blood HbO2 concentration was calculated from SaO2 measured by pulse oximetry, and brain HbO2 concentration was measured by NIRS. A series of CBF measurements were performed using each method before and after altering the arterial carbon dioxide tension (PaCO2). Mean CBF values from repeated measurements by each method at any given PaCO2 were used to compare the methods. The SD of single measurements within an individual subject by CBF-ICG was 15%, and by CBF-HbO2, 24%. The relationship between the methods was mean CBF-ICG = (1.13 x mean CBF-HbO2) - 2.76 mL x 100 g-1 x min-1 HbO2 (r = 0.93, p < 0.001). The mean difference between the methods (CBF-ICG - CBF-HbO2) was -0.25 mL x 100 g-1 x min-1 (95% confidence interval 6.30 to -6.80). The methods were in good agreement, and the use of i.v. ICG permitted rapid and repeated CBF measurements in the sickest infants at greatest risk of cerebral injury.

Brain↗

Maturational change in the cortical response to hypoperfusion injury in the fetal sheep.

A characteristic of perinatal encephalopathies are the distinct patterns of neuronal and glial cell loss. Cerebral hypoperfusion is thought to be a major cause of these lesions. Gestational age is likely to influence outcome. This study compares the cortical electrophysiologic and histopathologic responses to hypoperfusion injury between preterm and near term fetuses. Chronically instrumented 0.65 (93-99-d, n = 9) and 0.9 (119-133-d, n = 6) gestation fetal sheep underwent 30 min of cerebral hypoperfusion injury. The parasagittal cortical EEG and impedance (measure of cytotoxic edema) responses plus histologic outcome (3 d) were compared. The acute rise in impedance was similar in amplitude, but the onset was delayed (5.0 +/- 0.7 versus 9.1 +/- 1.1 min, p < 0.05) in the preterm fetuses relative to those near term. In contrast the extent of the secondary rise was reduced (p < 0.01) and peaked earlier in the preterm fetuses (19.8 +/- 1.0 versus 40.5 +/- 3.5 h, p < 0.01). Both groups had a similar fall in EEG spectral edge frequency. The preterm fetuses had a milder loss of EEG intensity at 72 h (-7.7 +/- 1.5 versus -12.8 +/- 0.9 dB, p < 0.05). At both ages there was a predominantly parasagittal cortical distribution of damage with a similar pattern of neuronal loss in the thalamus and striatum. There was extensive selective neuronal loss within the upper layers of the cortex in those near term. In contrast the preterm fetuses developed subcortical infarcts (p < 0.05). The cortical response to injury altered during the last trimester. The results suggest the severity of the delayed phase of cortical neuronal injury and selective neuronal loss increased near term. In contrast, the preterm fetuses had a more rapidly evolving injury leading to necrosis of the subcortical white matter.

Animals↗

Cytogenetic and fluorescent in-situ hybridization chromosomal studies on in-vitro fertilized and intracytoplasmic sperm injected 'failed-fertilized' human oocytes.

This study was undertaken to establish baseline data on the chromosomal status of 'failed-fertilized' oocytes derived from in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedures. A cytogenetic analysis was undertaken on 162 IVF and 51 ICSI oocytes. In all, 82.1% (133/162) of the IVF and 78.4% (40/51) of the ICSI oocytes had metaphase II (MII) plates, of which 50.4% of the IVF and 47.5% of the ICSI oocytes were analysed further. Chromosomes of the G-group (21-22) were identified with the majority of the anomalies. No overall significant difference in the aneuploidy rate was found for the IVF (37.3%) of ICSI (31.6%) oocytes, or with maternal age. However, chromosome anomalies, e.g. diploidy, fragmented and broken chromatids, single sperm and oocyte chromatids, were found in oocytes from IVF patients aged > 36 years and in the ICSI oocytes throughout the maternal age range (31-38 years). The status of the polar body chromatin indicated that there was no overall significant difference in the maturation of the IVF and ICSI oocytes. Evidence of successful sperm delivery was found in 72.5% (37/51) of the ICSI failed-fertilized oocytes. In this group there was a significant increase in the incidence of premature chromosome condensation: 19.6% (10/51) contained sperm chromosomes, 7.8% (4/51) had swollen sperm heads, and the remaining 45.0% had condensed sperm heads. The presence of both sperm and MII oocyte chromosomes was found in 19.6% (10/51) of the ICSI and 8.6% (14/162) of the IVF failed-fertilized oocytes. Specific fluorescent in-situ hybridization DNA probes were used to re-analyse the chromosomes of karyotyped 'failed-fertilized' IVF oocytes and, for the first time, applied to the karyotyped chromosomes of failed-fertilized ICSI oocytes. The hybridization efficiency was 86-95% for the centromere probe and 100% for probes 21 and 18.

Adult↗

Dinucleotide repeats in the human surfactant protein-B gene and respiratory-distress syndrome.

Pulmonary surfactant, a lipoprotein complex, is essential for normal lung function, and deficiency of surfactant can result in respiratory-distress syndrome (RDS) in the prematurely born infant. Some studies have pointed towards a genetic contribution to the aetiology of RDS. Because the surfactant protein B (SP-B) is important for optimal surfactant function and because it is involved in the pathogenesis of pulmonary disease, we investigated the genetic variability of the SP-B gene in individuals with and without RDS. We identified a 2.5 kb BamHI polymorphism and studied its location, nature and frequency. We localized this polymorphism in the first half of intron 4 and found that it is derived by gain or loss in the number of copies of a motif that consists of two elements, a 20 bp conserved sequence and a variable number of CA dinucleotides. Variability in the number of motifs resulting from either deletion (in 55.3% of the cases with the variation) or insertion (44.7%) of motifs was observed in genomic DNAs from unrelated individuals. Analysis of 219 genomic DNAs from infants with (n = 82) and without (n = 137) RDS showed that this insertion/deletion appears with significantly higher frequency in the RDS population (29.3 as against 16.8%, P < 0.05).

Base Sequence↗

First trimester amnifiltration: technical, cytogenetic and pregnancy outcome of 104 consecutive procedures.

OBJECTIVE: To investigate the technical, cytogenetic and pregnancy complications of first trimester amnifiltration for the diagnosis of fetal karyotype. DESIGN: Observational study. SETTING: The fetal medicine unit, UMDS St Thomas' Campus, London. SUBJECTS: One hundred and four women seeking prenatal diagnosis of fetal karyotype. MAIN OUTCOME MEASURES: Sampling success, culture rate, harvest time and karyotype, pregnancy outcome and complications. RESULTS: Sampling was successful in all 104 cases, but equipment failure forced the procedure to be changed to early amniocentesis in eight (7%) cases. The karyotype was normal in 101 (97%) cases, abnormal in three. The mean harvest time was 14 days (range 9-26 days; SD = 3.4), and three cultures failed (2.8%). Pregnancies resulted in 99 (95%) live births, with a mean gestation of 277 days (range 182-300 days; SD = 16). There was one termination for trisomy 21 and four spontaneous miscarriages (3.8%). Amniotic fluid leakage occurred in six cases (5%), all resulted in live births, five at term and one at 35 weeks. CONCLUSIONS: This study demonstrates that amnifiltration is technically possible in the first trimester of pregnancy, and that samples can be successfully karyotyped. The harvest time for culture is similar to early amniocentesis and chorion villus sampling. The rate of fetal loss, adjusted by the estimated natural loss, is 1.7%, which compares favourably with both chorionic villus sampling and early amniocentesis.

Adult↗

Fanning the SPARC.

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Computer Communication Networks↗

Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy.

OBJECTIVE: To examine the significance of fetal nuchal translucency at 10-14 weeks' gestation in the prediction of abnormal fetal karyotype. DESIGN: Prospective screening study. SETTING: The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London. SUBJECTS: 827 fetuses undergoing first trimester karyotyping by amniocentesis or chorionic villus sampling. MAIN OUTCOME MEASURE: Incidence of chromosomal defects. RESULTS: The incidence of chromosomal defects was 3% (28 of 827 cases). In the 51 (6%) fetuses with nuchal translucency 3-8 mm thick the incidence of chromosomal defects was 35% (18 cases). In contrast, only 10 of the remaining 776 (1%) fetuses were chromosomally abnormal. CONCLUSION: Fetal nuchal translucency > or = 3 mm is a useful first trimester marker for fetal chromosomal abnormalities.

Adult↗

Amnifiltration in the first trimester: feasibility, technical aspects and cytological outcome.

An amnifiltration system has been developed which allows collection of cells from the amniotic sac in the first trimester of pregnancy whilst only removing 1 ml of amniotic fluid in total. The cells can be cultured and harvested, using the same methods as early amniocentesis, to enable prenatal diagnosis of fetal karyotype. A range of filters constructed from different materials and of differing pore sizes were examined for their ability to trap and subsequently release a maximum number of amniotic fluid cells. The best filter membrane was found to be a cellulose acetate filter of 0.8 micro m pore size. To achieve the same cytogenetic outcome as a 10 ml amniocentesis, a minimum of 20 ml amniotic fluid must be filtered and recirculated through the system.

Journal Article↗

Randomized study of early amniocentesis versus chorionic villus sampling: a technical and cytogenetic comparison of 650 patients.

In a prospective randomized trial of 650 patients at 10-13 weeks' gestation, early amniocentesis was compared to chorionic villus sampling (CVS) for successful sampling and cytogenetic results and the speed with which results can he obtained. The indications for fetal karyotyping were advanced maternal age, parental anxiety or a family history of chromosomal abnormality in the absence of a balanced parental translocation. At early amniocentesis, 10 ml of amniotic fluid were successfully obtained in all 324 cases, in 320 (98.8%) at the first attempt and in four cases (1.2%) after two needle insertions. CVS provided sufficient material for cytogenetic analysis in 314 of 326 (96.3%) cases at the first attempt and in nine (2.8%) after two needle insertions; in three cases only maternal tissue was obtained and subsequently early amniocentesis was performed. Cell culture and chromosomal analysis were successful in 318 of 324 (98.1%) cases of early amniocentesis and in 321 of the 323 (99.4%) cases of CVS where villi were obtained. The median interval between sampling and successful result from cell culture was 12 days for early amniocentesis and 11 days for CVS. Mosaicism was detected in five cases of CVS but in none of the early amniocenteses; three of these cases were confirmed as true fetal mosaics. This study illustrates that early amniocentesis is a viable alternative to CVS for first-trimester fetal karyotyping. The results of the continuing prospective 1 trial will establish the safety and cytogenetic accuracy of the two techniques.

Clinical Trial↗