Biomedical subjects
Publications and source records attributed to S Johnson.
Isolation and low morale prompted health visitors in Forth Valley health board to set up a group which could work together proactively at a time of uncertainty and change. Sally Johnson describes the group's beginnings and achievements so far.
The majority of parkinsonian patients on long-term treatment with levodopa develop fluctuations in motor performance. Several of the features of long-term levodopa treatment seem to be associated with levodopa concentrations in the plasma. In order to overcome the dose-related clinical fluctuations, sustained or controlled-release oral tablets have been developed to achieve more stable plasma concentrations of the drug. This paper describes a Norwegian multi-centre study of Sinemet CR in 56 patients with mild to moderate parkinsonism. After 24 weeks on Sinemet CR the performance of 40 patients was evaluated as improved, i.e. better than when they were treated with standard levodopa. Patients with mild disease or with no motor fluctuations experienced similar clinical benefit from controlled-release levodopa as the more advanced parkinsonian patients. The authors also discuss the advantages and problems of controlled-release levodopa in parkinsonian patients in general.
A fluorescein-binding single-chain Fv (scFv) was chosen as a model for the study of the physicochemical parameters associated with synthetic IgG fragments. Three such scFv proteins were designed from the primary sequences of one anti-fluorescyl monoclonal antibody (Mab 4.4.20). These were constructed with varying-length interdomain peptide linkers of between 12 and 25 residues, expressed in Escherichia coli, and the protein folding, stability, and antigen-binding characteristics were assessed. Efficient renaturation could be accomplished in vitro to yield approximately 26 mg of active scFv/L of fermentation. Scatchard analysis for fluorescein ligand binding revealed that the scFv designs come within 2-fold of the Ka = 1.99 (+/- 0.18) x 10(9) observed for the parental 4.4.20 Fab and have identical stoichiometries (n approximately 0.99). Reversible solvent denaturation studies demonstrated that the unfolding/refolding equilibria for the scFv proteins can be fit to a simple two-state model and that two of the scFv designs were found to be slightly more stable than single IgG domains (VL and CL) when assessed in terms of the free energy of unfolding, delta Gon-u, or nearly identical to other multiple domain immunoglobulin proteins such as light chains and Fab's when relative transition midpoints, Cm, are compared. Linkers which conferred conformational flexibility beyond the minimally required length of 12 residues were found to have a stabilizing effect. By these criteria of ligand-binding function and protein stability, the scFv proteins were found to be bona fide minimal replicas of their parental IgG molecules.
We report the heavy chain variable region sequences from the cDNAs of five previously described monoclonal cell lines producing human antibodies specific for the human immunodeficiency virus type 1 and detail the molecular characteristics, germ-line origins, and extent of somatic mutation among these antibodies. Three of the five heavy chain variable regions derive from the VHIV gene family, but each has arisen from a different heavy chain variable region (VH) gene segment within the VHIV family. In addition, one is derived from a VHI gene segment, and one is derived from a VHV gene segment. Since four of the five antibodies arise from known germ-line VH elements, a precise determination of the extent of somatic variation is possible. The amount of variation from the closest germ-line sequence ranges from 4.5% to 14.8% among these antibodies, most of which is concentrated in the complementarity-determining regions. In general, the diversity (D) segments are long, characteristic of D-D fusions and/or extensive terminal deoxynucleotidyltransferase activity; however, definitive homologies cannot be found with the known germ-line D segments. Joining (JH) gene segment utilization appears random. The use of five different germ-line VH gene segments and extensive somatic mutation provides evidence that a polyclonal, antigen-driven immune response occurs during the natural infection with human immunodeficiency virus.
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Tumor-infiltrating lymphocytes (TILs) can be grown in vitro in medium containing interleukin-2 (IL-2). In clinical trials at the Surgery Branch of the National Cancer Institute, patients with metastatic malignant melanomas were treated with IL-2 plus the adoptive transfer of autologous TILs. At the time of treatment, TILs were assayed for in vitro lysis of fresh autologous and allogeneic melanoma cells and Daudi cells. Patients were evaluated for clinical response 4-8 weeks later. Lysis of autologous tumor cells by TILs was significantly higher for responding than for nonresponding patients. Tumor cells from responding and nonresponding patients were equally sensitive to lysis by allogeneic lymphokine-activated killer (LAK) cells. There was no difference between TILs from responding and nonresponding patients for lysis of LAK-sensitive Daudi cells, which was low in most cases and demonstrated that TIL lysis of autologous tumor cells was not due to LAK cells. The observed association of autologous tumor cell lysis by TILs with clinical response suggests that the development of culture methods to optimize lysis of autologous tumors may lead to increased response rates using this TIL treatment regimen.
BACKGROUND: Despite multiple antiviral humoral and cellular immune responses, infection with the human immunodeficiency virus (HIV) results in a progressively debilitating disease. We hypothesized that a more effective immune response could be generated by post-infection vaccination with HIV-specific antigens. METHODS: We performed a phase I trial of the safety and immunogenicity of a vaccine prepared from molecularly cloned envelope protein, gp160, in 30 volunteer subjects with HIV infection in Walter Reed stage 1 or 2. The vaccine was administered either on days 0, 30, and 120 or on days 0, 30, 60, 120, 150, and 180. HIV-specific humoral and cellular immune responses were measured; local and systemic reactions to vaccination, including general measures of immune function, were monitored. RESULTS: In 19 of the 30 subjects both humoral and cellular immunity to HIV envelope proteins increased in response to vaccination with gp160. Seroconversion to selected envelope epitopes was observed, as were new T-cell proliferative responses to gp160. Response was associated with the CD4 cell count determined before vaccination (13 of 16 subjects [81 percent] with greater than 600 cells per milliliter responded, as compared with 6 of 14 [43 percent] with less than or equal to 600 cells per milliliter; P = 0.07) and with the number of injections administered (87 percent of subjects randomly assigned to receive six injections responded, as compared with 40 percent of those assigned to three injections; P = 0.02). Local reactions at the site of injection were mild. There were no adverse systemic reactions, including diminution of general in vitro or in vivo cellular immune function. After 10 months of follow-up, the mean CD4 count had not decreased in the 19 subjects who responded, but it had decreased by 7.3 percent in the 11 who did not respond. CONCLUSIONS: This gp160 vaccine is safe and immunogenic in volunteer patients with early HIV infection. Although it is too early to know whether this approach will be clinically useful, further scientific and therapeutic evaluation of HIV-specific vaccine therapy is warranted. Similar vaccines may prove to be effective for other chronic infections.
OBJECTIVE: To determine the efficacy of hepatitis B vaccine when added to the routine expanded programme on immunisation under field conditions in rural Africa. DESIGN: Infants were immunised according to two schedules--an early schedule at birth, 3 months, and 6 months and a later schedule to correspond with routine vaccination in the expanded programme on immunisation at 3 months, 4 1/2 months, and 6 months. SETTING: Venda, northern Transvaal, South Africa, a self governing region of 7460 square kilometers varying from rural villages to small towns. SUBJECTS: The 1989 birth cohort of Venda. MAIN OUTCOME MEASURES: Coverage for hepatitis B vaccine at first, second, and third doses; serological assessment of vaccine efficacy by prevalence of antibodies to hepatitis B surface antigen in infants who had completed the three dose course of immunisation; antibodies to hepatitis B core antigen to determine if natural infection occurred. RESULTS: Vaccine coverage for hepatitis B dropped sharply from 99% to 53% to 39% for the first, second, and third dose respectively. In contrast, vaccine coverage was maintained at 97-99% for the three doses of poliomyelitis vaccine. Serological evaluation of vaccine efficacy showed that only 3.5% of recipients of all three doses failed to develop antibodies to hepatitis B surface antigen. Only 6.6% of vaccine recipients were vaccinated according to either the early or later schedules whereas 93.4% received their doses of vaccine at intervals beyond the limits of either of the planned schedules. There was, however, no significant difference in seroconversion to the surface antigen between the "unscheduled" or scheduled groups of those who were vaccinated according to the early or late schedules. The pattern of prevalence of antibodies to hepatitis B core antigen, which showed a sharp fall in children aged over 7 months, suggested that the antibodies were acquired passively rather than by active infection. CONCLUSIONS: Supplementation of the present expanded programme on immunisation with hepatitis B vaccine in rural Africa is fraught with difficulties. However, the vaccine was effective within a fairly wide spacing of dosage. Adding hepatitis B vaccine to diphtheria, tetanus, and pertussis as a tetravalent vaccine is proposed as a means of effectively integrating it into the expanded programme on immunisation in Third World settings.
Vaccination of health care workers is highly effective in preventing occupationally acquired hepatitis B virus (HBV) infection, but cost is a major factor impeding routine immunisation programmes. Pre-vaccination serological screening may be cost-beneficial if the prevalence of immunity is sufficiently high to offset its cost against the consequent reduction in vaccination needs. This critical population prevalence can be calculated given the cost of vaccination and testing. Samples of health care worker populations were examined for immunity and, using local present-day costs, it was calculated that pre-vaccination screening would be cost-beneficial in black nursing and laboratory personnel, but not their white counterparts or any student health care workers.
Von Recklinghausen neurofibromatosis (NF1) is a common autosomal dominant disorder mapped to 17q11.2 and typically characterized by the occurrence of neural crest-derived tumors. The gene has recently been cloned using reverse genetics or "positional cloning" approaches. Its function, however, remains unknown. We have performed cytogenetic and molecular analyses on 9 malignant tumors from NF1 patients to look for loss of alleles or chromosome rearrangements involving chromosome 17 to test the hypothesis that the NF1 gene acts as a recessive "tumor suppressor" gene. Loss of alleles on this chromosome was detected for 3 of 9 malignant tumors. Two peripheral nerve sheath tumors showed allele loss at informative loci on both the long and short arms of chromosome 17. In contrast, a glioblastoma with focal gliosarcoma showed loss of heterozygosity on the short arm of chromosome 17 only, and not at loci on the long arm. One nerve sheath tumor was previously shown by direct sequence analysis to have a point mutation at the TP53 locus at 17p13. These data support a role for the TP53 gene or other genes on the short arm of chromosome 17 in at least some malignancies in NF1. Six other neurofibrosarcomas showed no allele loss at informative loci on chromosome 17. Cytogenetic analysis was performed on 7 tumors, including 2 with allele loss. The two tumors with allele loss showed abnormal karyotypes while all others were normal. Southern blot and pulsed-field gel analysis using probes within or closely linked to the NF1 locus detected no gross deletions or rearrangements in the tumors studied.(ABSTRACT TRUNCATED AT 250 WORDS)
A cDNA encoding maize enolase (2-phospho-D-glycerate hydrolase) was purified by functional genetic complementation using an enolase deficient mutant of Escherichia coli, DF261. This cDNA, pZM245, was characterized by restriction mapping and DNA sequence analysis. The cDNA contained an open reading frame encoding a protein of 446 amino acids with a high degree of similarity to enolase sequences from other organisms (72% identity to yeast enolase and 82% identity to human enolase). The pZM245 contains a correctly positioned consensus prokaryotic translation initiation sequence. The specific activity of enolase in maize increases to about twice its initial level after 48 hours of anaerobiosis. Northern-blot analysis showed a five-fold anaerobic induction in enolase mRNA, while heat shock or cold shock increased enolase mRNA levels only slightly. Southern-blot analysis of maize genomic DNA indicated that there is one copy of the pZM245 hybridizing sequence per haploid genome in maize.
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It is now generally agreed that while numerous monoclonal antibodies (MAbs) have been shown to efficiently target tumors in patients, much still needs to be accomplished to optimize MAb based tumor targeting and the use of MAbs in the therapy of human carcinoma. This article will review some recent studies undertaken in our laboratory in an attempt to generate novel recombinant constructs and test new principles to aid in optimizing MAb based diagnosis and therapy. Three areas will be covered: (a) the analysis of dose fractionation protocols; (b) the generation of recombinant/chimeric (rec/chi) MAbs including the generation of a single chain antigen binding protein (SCA); and (c) the use of recombinant interferons (rec IFNs) to selectively up-regulate tumor antigen expression. Each of these topics has been previously described in detail and appropriate references to these articles are included.
A new selective blood agar medium, Strep A Isolation Agar (SI) from Remel (Lenexa, KS), was compared with Becton Dickinson's Streptococcus Selective Agar (SA) (Becton Dickinson Microbiology Systems, Cockeysville, MD) and with a nonselective Columbia Blood Agar (CB) (Difco, Detroit, MI). Throat swabs from patients with acute pharyngitis were cultured with the use of a single swab to inoculate each of the three plates in a specific order, rotating in three-week cycles. Plates were examined (each medium by a different technologist) after 24 and 48 hours of incubation at 35 degrees C in 5% carbon dioxide, and beta-hemolytic streptococci were serogrouped with the use of coagglutination. The positivity rate was significantly greater for SI (25%) and SA (26%) than for CB (18%) (P less than 0.001). The respective rates of Group A streptococcal detection by SI, SA, and CB were 91%, 95%, and 67%, respectively. However, a feature associated with the use of SI or SA, in contrast to CB, was delayed identification of isolates by 24-48 hours because of small colony size, slower growth rate, and inability to serogroup colonies taken directly from primary culture plates. Recovery of non-Group A beta-hemolytic streptococci occurred with CB (12%) greater than SI (8%) greater than SA (6%). SI is superior to a nonselective medium, such as CB, and is equal to SA for recovery of Group A streptococci from throat cultures.
A prospective study was undertaken to compare the accuracy of the Lachman test, anterior drawer test and jerk test with the KT1000 knee arthrometer in patients with proven anterior cruciate ligament deficiency. The Lachman and anterior drawer tests were found to be the most accurate indicators of anterior cruciate ligament deficiency. The KT1000 knee arthrometer was found to be totally inaccurate, which precludes its use as an objective measure of anteroposterior laxity of the knee.
Antimicrobial susceptibility results were compared for 13,090 isolates recovered from patients of Oklahoma hospitals and nursing homes. The most striking results confirm earlier suspicions that nursing home patients represent the largest pool of methicillin-resistant (greater than 60%) Staphylococcus aureus.
This paper presents methods used to develop a conceptual model for a patient database forming the centerpiece of a clinical information system under development. Various modeling techniques are discussed using a simplified fragment of the model. A method for mapping the model onto a relational design optimized for single patient retrievals is described. The results section discusses a number of issues pertaining to the flexibility and usability of this architecture.