Adrienne M. Flanagan

The Gene for Cherubism Maps to Chromosome 4p16.3

Cherubism is a rare familial disease of childhood characterized by proliferative lesions within the mandible and maxilla that lead to prominence of the lower face and an appearance reminiscent of the cherubs portrayed in Renaissance art. Resolution of these bony abnormalities is often observed after puberty. Many cases are inherited in an autosomal dominant fashion, although several cases without a family history have been reported. Using two families with clinically, radiologically, and/or histologically proved cherubism, we have performed a genomewide linkage search and have localized the gene to chromosome 4p16.3, with a maximum multipoint LOD score of 5. 64. Both families showed evidence of linkage to this locus. Critical meiotic recombinants place the gene in a 3-cM interval between D4S127 and 4p-telomere. Within this region a strong candidate is the gene for fibroblast growth factor receptor 3 (FGFR3); mutations in this gene have been implicated in a diverse set of disorders of bone development.

Transforming growth factor-β1 (TGF-β) stimulates the osteoclast-forming potential of peripheral blood hematopoietic precursors in a lymphocyte-rich microenvironment

Osteoclasts are generated from peripheral blood mononuclear cells (PBMNCs) in the presence of soluble receptor activator of NFkappaB ligand (sRANKL) and macrophage colony-stimulating factor (M-CSF). We show that human osteoclast formation is enhanced when PBMNCs are cultured in the presence of transforming growth factor (TGF)-beta and M-CSF prior to the addition of sRANKL. The effect was only observed in the presence of a nonadherent lymphocyte PBMNC fraction. Osteoclast formation was enhanced to a level equivalent to that induced by TGF-beta when nonadherent PBMNC fraction was removed from the cultures, prior to RANKL treatment. These data suggest that TGF-beta enhances osteoclast formation by abrogating the suppressive effect of the nonadherent PBMNCs, thereby maintaining the osteoclast-forming potential of the osteoclast precursor population. TGF-beta was without effect on proliferation of the adherent PBMNCs and did not stimulate osteoclast size or modify their immunophenotype. The effect was not mediated through prostaglandin synthesis. These results indicate that the microenvironment encountered by the osteoclast precursor prior to RANKL exposure contributes significantly to the regulation of osteoclast formation. Furthermore, the data emphasize that the effect of TGF-beta is determined by the cytokine milieu of the microenvironment and/or the state of activation of the cell being targeted by TGF-beta; thus, the effect of TGF-beta is context-dependent.

Update on the biologic effects of macrophage colony-stimulating factor.

Macrophage colony-stimulating factor (M-CSF) is critically involved in the survival, proliferation, and differentiation of cells of the mononuclear phagocyte system. These cells acquire specialized functions depending on the tissue in which they reside, suggesting that the development of mature phenotypes is determined by the cooperative effect of other growth factors, and also by the various biologically active isoforms of M-CSF which are differentially regulated. Alteration of M-CSF expression is associated with many pathologic processes, implying that the cells of the mononuclear phagocyte system are critical in maintaining the balance between health and disease in conditions such as infertility, osteopetrosis, osteoporosis, atherosclerosis, uremia, and Alzheimers disease.

Allelotype of Uterine leiomyomas

Uterine leiomyomas are the most common benign tumor that arise from smooth muscle cells of the myometrium. Little is known about the etiology and pathogenesis of this tumor. To investigate the molecular pathogenesis of these tumors, we have conducted an allelotype of 102 leiomyomas from 12 patients, using 67 fluorescently-tagged oligonucleotide primers amplifying microsatellite loci covering all autosomes. No areas of the genome showed frequent loss of heterozygosity (LOH); however, the highest rate of LOH (9%) was observed on 7q, consistent with previous cytogenetic observations. Uterine leiomyomas are sometimes multiple. In general, multiplicity of other types of neoplasm is associated with genetic predisposition to the disease. Because multiple tumors were available from each of the 12 patients studied, we looked for evidence of allele-specific LOH, which might indicate the presence of an underlying predisposition gene. However, no evidence for allele-specific LOH was detected, indicating that if cases of multiple uterine leiomyoma are due to an underlying predisposition gene, it is unlikely to be a recessive oncogene.

Generation of human osteoclasts in stromal cell-free and stromal cell-rich cultures: differences in osteoclast CD11c/CD18 integrin expression

Osteoclasts form in the presence of macrophage colony‐stimulating factor (M‐CSF) and receptor activator of Nfκb ligand (RANKL), a membrane‐bound differentiation factor that is now available as a soluble recombinant molecule. Acquisition of the osteoclast phenotype [the αvβ3 subunit of the vitronectin receptor (VNR)‐, calcitonin receptor (CTR)‐ and F‐actin ring‐positive cells] is associated with loss of monocyte/macrophage‐associated integrins, specifically CD11b, CD11c and CD18. We hypothesized that differences in the osteoclast integrin adhesion molecule profile may exist in osteoclasts generated in stromal cell‐rich and in stromal‐free conditions. Unlike osteoclasts generated in vivo, F‐actin ring‐positive (resorbing) osteoclasts formed in soluble RANKL in vitro, in the absence of stromal cells, and co‐expressed CD11c and CD18. However, when osteoclasts were generated from peripheral blood mononuclear cells (PBMNCs) in co‐cultures with the murine bone marrow stromal cell line 218 (which does not produce membrane‐bound RANKL) in the presence of soluble RANKL, CD11c and CD18 were not expressed by osteoclasts. These findings indicate that the persistent expression of CD11c and CD18 is not accounted for by RANKL being presented in a soluble form and that membrane‐bound RANKL is not required for the normal integrin expression in resorbing osteoclasts. This study demonstrates that potentially misleading information may arise by using data obtained from osteoclasts generated in the absence of stromal cells as they do not completely reflect the situation in vivo.

Study of the nonresorptive phenotype of osteoclast-like cells from patients with malignant osteopetrosis : A new approach to investigating pathogenesis

Osteopetrosis manifests as failure of osteoclastic bone resorption. The cause of the disease lies either in the hematopoietic lineage or in the bone marrow stromal microenvironment. It has not been possible to define the cell type involved in the various forms of the human disease because of the inability to form human osteoclasts in vitro. Using the recently described method for generating human osteoclasts from peripheral blood in coculture with rat osteoblastic UMR 106 cells, we demonstrate that a defect lies in the mature osteoclast‐like cells in four cases of this disease. Control and osteopetrotic cocultures generated large numbers of osteoclast‐like cells (calcitonin and vitronectin receptor positive, and F‐actin ring–positive cells) with similar morphology. Bone resorption did not occur in three of the four osteopetrotic cultures. In case 1, in which bone resorption was identified, the area of resorption was negligible compared with the number of osteoclast‐like cells in the culture and was detected only by scanning electron microscopy. In contrast, up to 20% of the bone surface in controls was resorbed. The normal and osteopetrotic osteoclast‐like cells had a similar phenotype except that two of the osteopetrotic cases did not express CD44 and two expressed CD44 weakly, whereas CD44 was strongly expressed in the controls. This study shows that it is possible to reproduce in vitro the pathological features of human osteopetrosis, and the assay provides a means of acquiring a greater understanding of the pathogenesis of human osteopetrosis. (J Bone Miner Res 2000;15:352–360)

Macrophage colony-stimulating factor and receptor activator NF-κB ligand fail to rescue osteoclast-poor human malignant infantile osteopetrosis in vitro

Malignant infantile osteopetrosis (MIOP) is a disease characterized by failure in bone resorption, leading to dense fragile bones with a severely reduced bone marrow cavity. Normal or increased numbers of osteoclasts are present in the common variant of this disease; in such cases, the defect is likely to be inherent to the mature osteoclast and can be cured by bone marrow transplantation. However, MIOP also results from failure of osteoclast formation (osteoclast-poor MIOP). We report on two infants diagnosed with osteoclast-poor MIOP and utilize modern cell culture techniques to investigate the pathogenesis of disease. Peripheral blood mononuclear cells (PBMNCs) from these children were cultured in the presence of recombinant macrophage colony-stimulating factor and receptor activator NF-kappaB ligand for up to 3 weeks. Control cultures included PBMNCs from age-matched children, one of whom had an osteoclast-rich form of MIOP. Formation of osteoclasts (cells coexpressing vitronectin receptor and F-actin rings) occurred in all the control cultures. Significant bone resorption occurred in cultures from PBMNCs of the healthy individuals, whereas almost no bone resorption occurred in the osteoclast-rich MIOP cultures. In contrast, PBMNC cultures from the osteoclast-poor MIOP child formed only very occasional small F-actin ring-positive osteoclasts, which coexpressed vitronectin receptor and cathepsin K, and extremely rare foci of resorption. Because neither macrophage colony-stimulating factor nor receptor activator NF-kappaB ligand rescued the defect in osteoclast differentiation in the two cases of osteoclast-poor MIOP in vitro, there would be little benefit in treating these children with either of these recombinant proteins. Finally, these results demonstrate that this experimental culture model replicates the human osteopetrosis phenotype observed in vivo and should prove useful in analyzing the pathogenesis of the various forms of MIOP.

Investigation of Ethnic Neutropenia by Assessment of Bone Marrow Colony-Forming Cells

Healthy individuals with African ancestry have lower neutrophil counts than Caucasians. It has previously been postulated that this was consequent on either a diminished bone marrow granulocyte reserve or an altered distribution of neutrophils between the circulating and marginated granulocyte pools. Recent indirect evidence supports the former hypothesis. In this study we have compared the number of granulocyte plus granulocyte-macrophage colony-forming units (CFUs) in the bone marrow of healthy African and Afro-Caribbean subjects with the number of CFUs in the bone marrow of healthy age and sex-matched Caucasians. We found the group with African ancestry to have significantly fewer CFUs than the Caucasian group. There was no evidence of any qualitative difference between the CFUs of the two ethnic groups: they showed similar sensitivity to granulocyte-monocyte colony stimulating factor and similar enhancement of growth when cultured with a larger range of cytokines. These observations suggest that ethnic neutropenia observed in those with African ancestry is likely to result from reduced numbers of bone marrow progenitor cells in comparison with numbers present in Caucasians.

Bronchopulmonary and Mediastinal Leishmaniasis: An Unusual Clinical Presentation of Leishmania donovani Infection

We describe a case of unusual leishmaniasis in a Sudanese man with a history of progressively enlarging granulomatous mediastinal lymphadenopathy, worsening hemoptysis, and an intense mucosal granulomatous inflammatory response in the large bronchi. Leishmania donovani DNA was detected in bronchial biopsies by polymerase chain reaction. This is a novel description of human leishmanial infection in an immunocompetent patient involving this anatomical site. The patients condition improved clinically, spirometrically, and radiologically after a course of treatment with amphotericin B. The cell-mediated immune response was analyzed before, during, and after successful antileishmanial chemotherapy.

Interleukin-4 and interleukin-13: bidirectional effects on human osteoclast formation.

Osteoclasts are cells that resorb bone; they derive from macrophage colony-stimulating factor (M-CSF)-dependent hematopoietic precursors in the presence of soluble activator of NFkappaB ligand (sRANKL). Because transforming growth factor (TGF)-beta, a macrophage deactivator, enhances osteoclast formation we hypothesized that interleukin (IL)-4 and IL-13, also macrophage deactivators, should exert a similar effect. However, IL-4 and IL-13 have been reported as suppressors of murine osteoclast formation. In contrast to the effect of these molecules on murine osteoclast formation, IL-4 and IL-13 were found to be powerful inducers of osteoclast formation and bone resorption when added to human peripheral blood mononuclear cell (PBMC) cultures for 4 days. This stimulatory effect was only observed in cultures containing nonadherent PBMCs. In contrast, both molecules significantly suppressed osteoclast formation in lymphocyte-depleted cultures. These data demonstrate that the cytokine milieu and/or state of cell activation determines how cells of the osteoclast precursor respond to IL-4 and IL-13.