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Biomedical subjects

R G Miller

Publications and source records attributed to R G Miller.

At least 91 records · Page 5Linked to original sources

Cell cycle progression out of G1 sensitizes primary-cultured nontransformed T cells to TCR-mediated apoptosis.

Shortly after primary activation and IL-2-induced entry into cell cycle, splenic or lymph node T cells can be induced to undergo apoptosis by recrosslinking of the TCR complex using anti-TCR antibodies. We demonstrate here that primary-activated T cells induced to undergo apoptosis by TCR recrosslinking during the G1 phase of the cell cycle did not arrest in the G1 phase of the cell cycle. Instead, the cells continued to progress through the cell cycle and underwent at least one mitosis before dying. Rapamycin, an inhibitor of IL-2-induced S phase entry, prevented this apoptotic death. Prevention of cell death correlated with delayed entry into S phase from G1 following TCR religation in the rapamycin-treated cultures. Addition of rapamycin after cells had entered S phase or had already divided failed to prevent cell death. Treatment of activated T cells with dibutyryl cAMP or forskolin, which also block primary-activated T lymphocytes in G1, also inhibited TCR-induced cell death. In contrast, treatment of TCR-religated cells with reagents that blocked cell cycle progression in S phase (aphidicolin, deferoxamine) after TCR religation failed to prevent apoptotic cell death. Activated T cells sorted for S + G2/M DNA content following Hoechst 33342 staining were also found to be more sensitive to TCR-induced apoptosis than cells sorted for G1 DNA content. Rapamycin inhibited apoptosis in G1-sorted cells, but not in S + G2/M-sorted cells. Together, these results suggest that factors regulating cell cycle progression also control the induction of TCR-mediated apoptosis. Primary-activated T cells may become committed to programmed cell death only after progressing into S phase of the cell cycle.

Animals↗

Characterization of apoptosis-resistant antigen-specific T cells in vivo.

Clonal deletion via activation-induced apoptosis (AIA) of antigen-specific T cells (ASTC) plays a very important role in the induction of peripheral tolerance. However, none of the studies performed so far has shown a complete deletion of ASTC, a small population always persisting in the periphery. The mechanism by which this small population of ASTC escapes AIA has not been determined. Since the existence of these ASTC may influence the outcome of autoimmune diseases and long-term graft survival, we have characterized the properties of these residual ASTC in vivo with the objective of determining mechanisms that may contribute to their persistence. It was found that the resistance of the residual ASTC to AIA is not due to lack of activation or Fas/Fas-L expression. Compared to those susceptible to AIA, the residual ASTC express a high level of Th2-type cytokines that may help them to escape from AIA. Furthermore, they are able to suppress proliferation of other ASTC, suggesting they may, in fact, prolong tolerance in vivo.

Animals↗

CD28 costimulation inhibits TCR-induced apoptosis during a primary T cell response.

Murine splenic T cells undergo apoptosis when the TCR complex is re-cross-linked in the absence of costimulation during a primary immune response. However, if the CD28 complex is also cross-linked, growth continues without induction of apoptosis. Prevention of apoptosis by CD28 costimulation was associated with increased expression of bcl-xL, while overexpression of bcl-2 in T cells from bcl-2 transgenic mice was not protective. In both situations, surviving cells can be recovered in a growth arrested state following the primary response, many more if CD28 was also religated. When these cells were restimulated in secondary response, those surviving TCR religation without CD28 costimulation could not be induced to proliferate further. In contrast, cells given CD28 costimulation during the primary response proliferated well after restimulation. Thus, the CD28 signaling pathway may function not only in the initial activation of naive T cells, but also in maintaining their viability and responsiveness during a primary immune response. In addition, the results further suggest that bcl-2 and bcl-xL regulate T cell survival under different conditions, with bcl-xL being perhaps more important in maintaining viability of activated T cells traversing the cell cycle.

Animals↗

Nerve root hypertrophy as the cause of lumbar stenosis in chronic inflammatory demyelinating polyradiculoneuropathy.

Two patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developed signs of lumbar stenosis. Radiologic, intraoperative, and pathologic findings demonstrated lumbar stenosis secondary to nerve root hypertrophy. This syndrome has been demonstrated in hereditary but not acquired demyelinating neuropathies. CIDP should be considered in the differential diagnosis of sciatica and nerve root hypertrophy.

Adult↗

Electrical and mechanical properties of skeletal muscle underlying increased fatigue in patients with amyotrophic lateral sclerosis.

To investigate the mechanical efficiency of surviving motor units of anterior tibial muscle in patients with amyotrophic lateral sclerosis (ALS), we studied motor unit action potentials, muscle force, and muscle fatigability in patients with ALS and controls using 25 min of low to moderate intensity voluntary isometric exercise. During exercise, tetanic force (TF) and maximum voluntary contraction declined more in patients than in controls. The mean motor unit action potential duration, amplitude, and polyphasia were increased in patients compared to controls but did not change during 9 months of disease progression. The enlarged motor units in patients were negatively correlated to the muscle force and positively correlated to muscle fatigability. Furthermore, after a mean follow-up period of 9 months, the decline in force-generating capacity of the anterior tibial muscle in patients (twitch tension by 37.5 +/- 11.2%, TF by 30.6 +/- 7.4%) was greater than the decline in the amplitude of the compound muscle action potential (21.1 +/- 8.8%, P < 0.05), suggesting a relative dissociation between electrical and mechanical properties. In conclusion, the enlarged motor units in patients with ALS are mechanically less efficient and fatigue relatively more than in healthy muscles, possibly due to an abnormality that is primarily distal to the muscle membrane.

Action Potentials↗

A placebo-controlled trial of recombinant human ciliary neurotrophic (rhCNTF) factor in amyotrophic lateral sclerosis. rhCNTF ALS Study Group.

Preclinical investigations indicated that recombinant human ciliary neurotrophic factor (rhCNTF) may have potential as therapy for amyotrophic lateral sclerosis (ALS). We evaluated the safety and efficacy of rhCNTF in a prospective, double-blind, placebo-controlled trial in 570 patients with ALS. Patients were randomized to receive 0.5, 2, or 5 micrograms/kg/day rhCNTF, or placebo, for 6 months. The primary efficacy end point was the change from baseline to the last on-treatment value of a combination megascore for limb strength (maximum voluntary isometric contraction) and pulmonary function. Secondary end points included individual arm and leg megascores, pulmonary function tests, an activities-of-daily-living outcome measure, and survival. The four treatment groups were similar at baseline with respect to age, sex, disease duration, and muscle strength values. At all doses tested, rhCNTF had no beneficial effect on the primary or secondary end points. Certain adverse events, as follows, appeared to be dose related: injection site reactions, cough, asthenia, nausea, anorexia, weight loss, and increased salivation. There was an increased number of deaths at the highest dose level. rhCNTF had no beneficial effect on any measure of ALS progression. There were increased adverse events in the 5 micrograms/kg group and increased deaths.

Adult↗

A clinical trial of verapamil in amyotrophic lateral sclerosis.

Seventy-two patients with amyotrophic lateral sclerosis (ALS) were enrolled in a clinical trial of the efficacy of verapamil in the treatment of ALS. In period 1 (pretreatment, months 1-3) and period 3 (posttreatment, months 10-12), patients received no drug. In period 2 (months 4-9), patients received verapamil. The slopes of declining pulmonary function and limb megascores were not significantly different during drug treatment compared to natural history and washout periods. Thus, verapamil was ineffective in slowing the clinical progression in ALS patients. Controlled trials using a natural history period may represent a faster and less expensive method of screening drugs for ALS compared to placebo-controlled trials.

Amyotrophic Lateral Sclerosis↗

Compartmentation of endogenously synthesized amino acids in neonates.

The conversion of D-[U-13C]glucose to proline (Pro), aspartate (Asp), and cysteine (Cys) is limited in premature neonates, implying that these amino acids (AA) are conditionally essential. This study was performed to determine whether these findings resulted from an insufficient precursor dose or intracellular compartmentation of newly synthesized amino acids, rather than inadequate synthesis. In the first phase of this study, seven total parenteral nutrition-fed, premature neonates received IV D-[U-13C]glucose at 5 mg/kg/min for 4 hr. In the second phase, a separate cohort of eight patients received an identical infusion. Blood was obtained before and at the end of the infusion. Isotopic enrichments of the free plasma AA and glucose were measured using gas chromatography/mass spectrometry in both studies. In phase 2, the isotopic enrichments of the AA bound to the hepatically synthesized proteins, fibrinogen and VLDL-apolipoprotein B-100 (apo B-100), were measured. In phase 1, despite a glucose precursor enrichment greater than 66%, Pro, Asp, and Cys remained the least enriched of all amino acids studied (P < 0.05). Asp, but not Pro, demonstrated very high enrichments in apo B-100 (P < 0.001), reflecting distinct intracellular compartmentation. We conclude that the limited conversion Of D-[U-13C]glucose to Pro, Asp, and Cys did not result from low precursor glucose enrichment and that there is evidence of Asp compartmentation (intracellular) in premature neonates. However, the low Pro enrichment in the free plasma AA pool and the absence of intracellular Pro compartmentation suggest that Pro may be a conditionally essential AA for premature neonates.

Amino Acids↗

Controlled trial of nimodipine in amyotrophic lateral sclerosis.

Calcium channel blocking drugs antagonize excitatory amino acid receptor activation, decrease calcium entry into damaged neurons, and might help to slow or reverse amyotrophic lateral sclerosis (ALS). We enrolled 87 patients with ALS in a randomized, placebo-controlled, prospective, double-blind crossover study of nimodipine therapy. Monthly measures of isometric muscle strength and respiratory function compared the effects of drug and placebo. No difference in adverse events occurred in placebo vs drug-treated patients, but diarrhoea, nausea, and lightheadedness were more common with nimodipine. There was no significant difference in the rate of decline of pulmonary function or limb strength during treatment with drug or placebo. Nimodipine was ineffective in slowing the progress of ALS.

Amyotrophic Lateral Sclerosis↗

Survival after aberrant right subclavian artery-esophageal fistula: case report and literature review.

Development of a fistula between an aberrant right subclavian artery and the esophagus is a rare cause of heretofore fatal hematemesis. We report the first known survivor of this devastating complication of the most common aortic arch anomaly. Intraoperative esophagogastroduodenoscopy, intraesophageal balloon tamponade, and arteriography were the keys to successful management. This lesion should be suspected in the setting of bright red, "arterial" hematemesis. Prolonged nasogastric and/or endotracheal intubation should be avoided in patients with a known aberrant right subclavian artery or other aortic arch anomaly.

Child↗

A method to codetect introduced genes and their products in gene therapy protocols.

To monitor the presence of introduced genes and the distribution of the encoded proteins in host tissues after gene transfer, we combined fluorescence in situ hybridization (FISH) and immunohistochemistry in two separate gene therapy paradigms. In brain tissue sections from animals injected with pHSVlac vector, we localized nuclei containing vector DNA both in cells expressing and not expressing beta-galactosidase (beta-gal). This suggests that the efficiency of gene transfer is affected not only by gene delivery, but also by cellular controls on gene expression. In a second paradigm, following myoblast transplantation, we detected donor nuclei in the muscle of a patient with Duchenne's muscular dystrophy. The donor nuclei were either surrounded by host nuclei or apparently fused in the patient's muscle fiber producing dystrophin. The combined FISH and immunohistochemistry assay offers greater sensitivity and more information than currently used polymerase chain reaction and protein detection methods.

Adult↗

Quantitative analysis of the dentin adhesive interface by Auger spectroscopy.

The ultimate success of a dentin adhesive bond is dependent in large part on specific conditions at the interface between the tooth and the adhesive. Most current dentin adhesive systems use some sort of pre-treatment to demineralize the first few microns of the dentin surface, leaving a meshwork of collagen into which the adhesive resin can penetrate, infiltrate, and polymerize. The general hypothesis tested in this experiment was that the penetration and distribution of adhesive resin into the demineralized zone are a function of the conditioner used as a pre-treatment for the adhesive application. Four commercially available adhesive systems were modified to incorporate hydroxyethylthiomethacrylate (HETMA), a sulfur-substituted, traceable analogue of 2-hydroxyethylmethacrylate (HEMA), thereby allowing for a qualitative measurement of the amount and distribution of monomer in the treated dentin substrate by energy-dispersive x-ray spectroscopy (EDS) and a quantitative measurement by Auger electron spectroscopy (AES). The dentin pre-treatments investigated were: (1) 10% citric acid/3% ferric chloride, (2) 10% maleic acid, (3) 2.5% nitric acid, and (4) an alcoholic solution of HEMA with a phosphorus acid ester. These pre-treatments were applied to freshly extracted teeth that had been sectioned to expose the dentin and ground to simulate the smeared layer. After the appropriate pre-treatment was applied, a 10% (v/v) solution of HETMA in acetone was applied to the surface, followed by the corresponding adhesive resin, which was then polymerized. The samples were then processed for observation by scanning transmission electron microscopy (STEM), AES, and STEM/EDS analysis. The results indicated significant differences in the ability of HETMA to penetrate the dentin surface conditioned by the four pretreatments investigated here. This study also demonstrated that AES and STEM/EDS could be used in a correlative fashion to determine the distribution of HETMA within or adjacent to the treated dentin surface.

Dentin-Bonding Agents↗

Effect of resistant and digestible starch on intestinal absorption of calcium, iron, and zinc in infant pigs.

The first nonmilk foods that are given to infants contain high levels of starch, a fraction of which is resistant to enzyme hydrolysis. Incomplete digestion of starch may interfere with the absorption of certain minerals. A fraction of dietary starch which is resistant to in vitro enzymatic hydrolysis has been termed resistant starch. The aim of this study was to compare the intestinal apparent absorption of calcium, phosphorus, iron, and zinc in the presence of either resistant or digestible starch. Twelve 7-10-d-old piglets were fitted with a T-tube inserted into the intestine approximately 3 m distal to the duodenum. Animals received in random order 200 mL of a test meal of cooked, cooled, high amylose corn starch (16.4% resistant starch), or cooked rice starch (digestible starch) administered by an orogastric tube. Both meals contained the same amount of calcium, phosphorus, iron, and zinc. The test meal also contained tracer amounts of 59Fe and 65Zn, as well as polyethylene glycol 3350, as a nonabsorbable marker. Intestinal apparent absorption of starch was greater the meal with digestible starch (71.0 +/- 17.0%) than after the meal with resistant starch (49.2 +/- 10.3) (p < 0.001). After feeding the meals with resistant and digestible starch, mineral apparent absorption was, respectively: calcium, 40.2 +/- 11.8% versus 28.1 +/- 16.4% (p < 0.05); phosphorus, 73.2 +/- 14.0% versus 67.8 +/- 18% (NS); iron, 24.1 +/- 12.2% versus 12.6 +/- 10.6% (p < 0.01), and zinc, 35.0 +/- 13.0% versus 30.6 +/- 8.22% (NS). In conclusion, a meal containing 16.4% resistant starch resulted in a greater apparent absorption of calcium and iron compared with a completely digestible starch meal. If this finding holds true for the whole bowel, administration of resistant starches could have a positive effect on intestinal calcium and iron absorption.

Animals↗

ALS care: a resource for measuring and improving ALS outcomes.

The Amyotrophic Lateral Sclerosis Clinical Assessment, Research, and Education Project (ALS CARE) will conduct outcomes research and develop educational programs that benefit ALS patients and neurologists. An advisory board of neurologists, who are experts in ALS, will establish the policies governing this project and control the dissemination of aggregate data on ALS practices and outcomes. As a first step toward improving the care of ALS patients, a data coordinating center has been established in the Center for Outcomes Research at the University of Massachusetts Medical Center, which will manage a North American Database of ALS Outcomes. This voluntary database is designed to (1) guide the development of educational programs to improve the care of ALS patients and (2) provide a mechanism for neurologists to evaluate the impact of their diagnostic and therapeutic decisions in a manner that is timely, confidential, and objective.

Amyotrophic Lateral Sclerosis↗

Clinical trials of riluzole in patients with ALS. ALS/Riluzole Study Group-II.

Two double-blinded, placebo-controlled clinical trials of riluzole have now been carried out in more than 1,100 patients with ALS. The results of both studies show a modest benefit in prolonging survival that is statistically significant. These results led to the availability of this drug by the Food and Drug Administration for use in the United States beginning in early 1996. This is the first drug that has been available for ALS. It begins a new era in both basic and clinical research in an attempt to find a cure for this disease.

Adult↗

Toxicity and tolerability of recombinant human ciliary neurotrophic factor in patients with amyotrophic lateral sclerosis.

We examined the toxicity of both single and multiple subcutaneous injections of recombinant human ciliary neurotrophic factor (rhCNTF) in 72 patients with ALS, in doses ranging from 2 to 100 micrograms/kg. Adverse events were generally dose related and ranged from mild to severe. The tolerability of daily subcutaneous rhCNTF was equivalent to placebo at doses < or = 5 micrograms/kg/day. At higher doses, anorexia, weight loss, reactivation of herpes simplex virus (HSV1) labialis/stomatitis, cough, and increased oral secretions occurred.

Adult↗

Placebo-controlled trial of gabapentin in patients with amyotrophic lateral sclerosis. WALS Study Group. Western Amyotrophic Lateral Sclerosis Study Group.

We designed a phase II trial to evaluate the efficacy of gabapentin in slowing the rate of decline in muscle strength of patients with amyotrophic lateral sclerosis (ALS) and to assess safety and tolerability. Gabapentin (800 mg) or placebo was administered t.i.d. in a randomized, double-blinded, placebo-controlled, trial for 6 months. We enrolled 152 patients at eight sites in the United States. The primary outcome measure was the slope of the arm megascore, the average maximum voluntary isometric strength from eight arm muscles standardized against a reference ALS population. A secondary outcome measure was forced vital capacity. Slopes of arm megascores for patients on gabapentin were compared with slopes of those taking placebo using a two-way ANOVA. We observed a nonstatistically significant trend (p = 0.057-0.08) toward slower decline of arm strength in patients taking gabapentin compared with those taking placebo (mean difference 24%, median 37%). We observed no treatment effect on forced vital capacity. Gabapentin was well tolerated by patients with ALS. These results suggest that further studies of gabapentin in ALS are warranted.

Acetates↗