Monika Ortmann

Effects of endotoxin on human myocardial contractility involvement of nitric oxide and peroxynitrite

OBJECTIVES This study examined the effects of endotoxin on cardiac contractility in human myocardium. BACKGROUND In animal myocardium, endotoxin and cytokine treatment led to enhanced inducible nitric oxide synthase (iNOS) expression and contractile dysfunction. Effects in human myocardium are unknown. METHODS Left ventricular myocardial preparations from failing (n = 18) and nonfailing (n = 5) human hearts were incubated for 6 and 12 h in tyrode solution or in tyrode plus lipopolysaccharides (LPS), with LPS plus N(G)-mono-methyl-L-arginine (L-NMMA), with LPS plus hemoglobin or with LPS plus the superoxide scavenger 4,5-dihydroxy-1,3-benzene disulfonic acid (Tiron). Force of contraction in response to isoprenaline (0.001 to 3 micromol/liter) was determined in electrically stimulated muscle preparations. The iNOS mRNA expression was examined by in situ hybridization and by polymerase chain reaction. The cyclic guanosine monophosphate (cGMP) levels were determined by radioimmunoassay. RESULTS Isoprenaline concentration dependently increased force of contraction. Six and 12 hours of LPS treatment of failing myocardium decreased maximum inotropic response to isoprenaline by 54% (p = 0.009) and by 69% (p = 0.0023), respectively. In nonfailing myocardium, 12 h of LPS treatment decreased maximum inotropic effect of isoprenaline by 66% (p < 0.001). The LPS effects were attenuated by L-NMMA, hemoglobin and also Tiron. The iNOS mRNA was expressed in all LPS-treated preparations but also in most control myocardial preparations. In situ hybridization revealed iNOS expression within cardiac myocytes. There was no increase in myocardial cGMP content in response to endotoxin. CONCLUSIONS Endotoxin exposure of human myocardium leads to a depression of cardiac contractility, which is mediated by enhanced iNOS activity and release of nitric oxide (NO). Consecutive reaction of NO with superoxide and formation of peroxynitrite may contribute to the decrease in force of contraction.

Renal oncocytoma. II. Lectin and immunohistochemical features indicating an origin from the collecting duct.

SummaryThe present study is aimed to gain more insight into the histochemical properties of renal oncocytomas. Ten oncocytomas and normal kidneys were investigated using several lectins (peanut agglutinin - PNA, Dolichos biflorus agglutinin - DBA and Ulex europaeus agglutinin - UEA) and antibodies against epithelial membrane antigen (EMA), Tamm-Horsfall glycoprotein (THG) and lysozyme. Lectin histochemistry revealed a characteristic binding pattern in renal oncocytomas, with strong DBA-binding and, in some cases, a weaker staining with UEA apparent in the cytoplasm of the oncocytes. PNA binding sites were evident only after enzymatic cleavage of sialic acid by neuraminidase. Comparative evaluation of normal kidneys exhibiting a strict compartmentalization of saccharide moieties in the various nephron segments revealed a similar binding pattern exclusively in interspersed collecting duct epithelium. This striking resemblance suggests that renal oncocytomas may originate from the collecting duct system. Further support for this assumption has been provided by the demonstration of strong cytoplasmic EMA reactivity in the oncocytes. In normal kidneys prominent labeling for EMA was apparent in the very same interspersed cells of the collecting ducts. THG and lysozyme failed to react in renal oncocytomas. In accordance with observations recently reported in the literature, these results clearly favor a histogenetic origin of renal oncocytomas from the collecting duct epithelium.

Renal oncocytoma. I. Cytochrome c oxidase in normal and neoplastic renal tissue as detected by immunohistochemistry--a valuable aid to distinguish oncocytomas from renal cell carcinomas.

SummaryUsing a polyclonal antibody raised against bovine heart cytochrome c oxidase, the occurrence of this mitochondrial marker enzyme has been investigated in 63 kidney tumors (ten renal oncocytomas, 43 renal cell carcinomas and ten tubulopapillary adenomas) as well as in normal renal tissue by an immunoperoxidase method (PAP-technique). The differentiation between renal oncocytomas and mitochondria-rich carcinomas represents a problem of histopathology since these tumors have a different prognosis and require different patient managements. The strong immunoreactivity in renal oncocytomas contrasted with the much weaker reactivity in renal carcinomas and adenomas. Even mitochondria-rich (granular cell type) carcinomas exhibited only moderate staining intensity. Furthermore, single strongly stained oncocytes or small complexes were sometimes detected in normal renal tissue. The demonstration of marked differences in enzyme content between renal oncocytomas and granular cell carcinomas renders this method suitable for unequivocal distinction between these renal neoplasms. The antibody proved to be a valuable marker for detecting “true” oncocytic transformation in renal tumors and was useful in defining even single oncocytes or small oncocytic lesions.

Treatment of visceral leishmaniasis with intravenous pentamidine and oral fluconazole in an HIV-positive patient with chronic renal failure — a case report and brief review of the literature

We report the case of an HIV-positive patient with visceral leishmaniasis and several relapses after treatment with the two first-line anti-leishmanial drugs, liposomal amphotericin B and miltefosine. End-stage renal failure occurred in 2007 when the patient was on long-term treatment with miltefosine. A relapse of leishmaniasis in 2008 was successfully treated with a novel combination regimen of intravenous pentamidine and oral fluconazole. Secondary prophylaxis with fluconazole monotherapy did not prevent parasitological relapse of leishmaniasis.

Occurrence and distribution of glycoconjugates in human tissues as detected by the Erythrina cristagalli lectin.

We applied a horseradish peroxidase-Erythrina cristagalli agglutinin (HRP-ECA) conjugate for histochemical staining of tissue sections from various formalin-fixed, paraffin-embedded human tissue specimens. The HRP-ECA conjugate showed broad reactivity, but there was a distinct distribution of native (not masked by sialic acid) and sialic acid-masked ECA binding sites in the various organs. Free ECA binding sites could be detected on red blood cells, lymphocytes of thymus, tonsil, lymph node, and in mucous substances of different organs. Independent of blood group type, the vascular endothelium exhibited strong ECA reactivity. Free ECA binding sites occurred in the cytoplasm of Kupffers cells in liver, in histiocytic cells of thymus, lymph node, tonsil, and in bone marrow. Podocytes of kidney glomerulus, syncytiotrophoblasts of placenta, megakaryocytes in bone marrow, myelin sheath of nerve, medullary thymocytes, and hepatocytes, as well as islet cells of pancreas, contained only sialic acid-capped ECA binding sites. Inhibiting studies with galactose, lactose, and N-acetyl-lactosamine, as well as other sugars, revealed that this lectin is specific for galactosyl residues. In comparison to galactose and lactose, N-acetyl-lactosamine exhibited the highest inhibitory activity on lectin binding, supporting the concept that this lectin is most reactive with N-acetyl-lactosamine-type (type 2 chain) glycoconjugates.

Revised risk estimation and treatment stratification of low- and intermediate-risk neuroblastoma patients by integrating clinical and molecular prognostic markers

Purpose: To optimize neuroblastoma treatment stratification, we aimed at developing a novel risk estimation system by integrating gene expression–based classification and established prognostic markers. Experimental Design: Gene expression profiles were generated from 709 neuroblastoma specimens using customized 4 × 44 K microarrays. Classification models were built using 75 tumors with contrasting courses of disease. Validation was performed in an independent test set (n = 634) by Kaplan–Meier estimates and Cox regression analyses. Results: The best-performing classifier predicted patient outcome with an accuracy of 0.95 (sensitivity, 0.93; specificity, 0.97) in the validation cohort. The highest potential clinical value of this predictor was observed for current low-risk patients [5-year event-free survival (EFS), 0.84 ± 0.02 vs. 0.29 ± 0.10; 5-year overall survival (OS), 0.99 ± 0.01 vs. 0.76 ± 0.11; both P < 0.001] and intermediate-risk patients (5-year EFS, 0.88 ± 0.06 vs. 0.41 ± 0.10; 5-year OS, 1.0 vs. 0.70 ± 0.09; both P < 0.001). In multivariate Cox regression models for low-risk/intermediate-risk patients, the classifier outperformed risk assessment of the current German trial NB2004 [EFS: hazard ratio (HR), 5.07; 95% confidence interval (CI), 3.20–8.02; OS: HR, 25.54; 95% CI, 8.40–77.66; both P < 0.001]. On the basis of these findings, we propose to integrate the classifier into a revised risk stratification system for low-risk/intermediate-risk patients. According to this system, we identified novel subgroups with poor outcome (5-year EFS, 0.19 ± 0.08; 5-year OS, 0.59 ± 0.1), for whom we propose intensified treatment, and with beneficial outcome (5-year EFS, 0.87 ± 0.05; 5-year OS, 1.0), who may benefit from treatment de-escalation. Conclusions: Combination of gene expression–based classification and established prognostic markers improves risk estimation of patients with low-risk/intermediate-risk neuroblastoma. We propose to implement our revised treatment stratification system in a prospective clinical trial. Clin Cancer Res; 21(8); 1904–15. ©2014 AACR. See related commentary by Attiyeh and Maris, p. 1782

Sialylated glycoconjugates in chromophobe cell renal carcinoma compared with other renal cell tumors : indication of its development from the collecting duct epithelium

SummaryThe present study was designed to shed light on the extraordinary histochemical properties of the chromophobe cell renal carcinoma detected by Hale’s colloidal iron reaction. Special emphasis was laid on the lectin histochemical analysis of cytoplasmic glycoconju-gates. Binding of peanut agglutinin (PNA) and Erythrina cristagalli agglutinin (ECA) after enzymatic release of sialic acid and direct binding of Dolichos biflorus agglutinin (DBA) correlates well with the expression of binding sites for Sambucus nigra agglutinin (SNA) and Maackia amurensis agglutinin (MAA) revealing abundant sialylated carbohydrate moieties within the cytoplasm. This characteristic binding pattern differs considerably from the faint staining observed in the majority of other renal carcinomas, thus confirming that the chromophobe cell renal carcinoma is a distinct entity. However, the lectin binding pattern of renal oncocytoma obviously resembles that of chromophobe carcinoma indicating a close relationship between these renal tumors. Detailed analysis of adjacent renal parenchyma revealed a lectin binding pattern quite similar to that described in the chromophobe carcinomas exclusively in the intercalated cells lining the collecting duct. This finding suggests that the chromophobe cell renal carcinoma originates from the collecting duct epithelium. The detection of small complexes consisting of altered epithelia which display the morphological characteristics of chromophobe carcinoma and the histochemical properties of intercalated cells probably indicates the emergence of preneoplastic lesions preceding the development of chromophobe carcinoma. Even though further studies are clearly needed to elucidate the physiological role of the cellular glycoconjugates detected, the present results already provide valuable insight into the histogenesis and pathogenesis of the chromophobe cell renal carcinoma.

Renal and cerebral necrosis in survivor after in utero death of co-twin

SummaryA newborn with bilateral renal cortical necrosis and severe cerebral damage in association with a macerated stillborn twin is reported. The alterations in the kidneys and brain of the twin born alive suggest that the primary event took place before birth. Thromboplastic material and embolizing particles derived from the dead fetus may have passed the monoamnionic-monochorionic twin placenta and caused disseminated intravascular coagulation in the living twin, followed by infarction in other organ systems.

Chromosome 17/17q gain and unaltered profiles in high resolution array-CGH are prognostically informative in neuroblastoma.

The prognostic relevance of chromosome 17 gain in neuroblastoma is still discussed. This investigation specifies the frequency, type, size, and transcriptional relevance in a large patient cohort. Primary tumor material of 202 patients was analyzed using high‐resolution oligonucleotide array‐based comparative genomic hybridization (aCGH) and correlated with clinical and survival data. A subset (n = 145) was correlated for differentially expressed genes (DEG) by microarray analysis. Chromosome 17 aCGH analysis showed numerical gain in 94/202 patients (47%), partial gain in 93/202 patients (46%), and no gain in 15/202 patients (7%). The frequency of partial gain was higher in stage 4 neuroblastoma (stage 1 15%; stage 2 12%; stage 3 16%; stage 4S 7%; and stage 4 50%). Overall survival (OS) was superior in patients with numerical gain compared with patients with partial gain or no gain (5‐y‐OS: 0.95 ± 0.02 vs. 0.63 ± 0.05 vs. 0.60 ± 0.13; P < 0.001). Gene expression analysis demonstrated 95/130 DEGs between tumors with numerical or partial chromosome/no gain. Only one DEG (CCKBR) was detected comparing tumors with partial gain and those with no gain. In patients with partial gain, the distribution of breakpoints did not correlate with stage and 11q status, but with MYCN amplification and 1p status. The “best” breakpoints in cases with partial 17q gain were at 42.5 Mb for event‐free and 26.6 Mb for OS. Numerical gain of chromosome 17 is associated with a better prognosis than partial and no gain. The group of tumors with partial gain was similar to the group without gain with respect to stage distribution, outcome, and gene expression profile.

Tuberculous spondylitis and paravertebral abscess formation after kyphoplasty: a case report.

Study Design. Case report. Objective. To report a patient with spinal tuberculosis (TB) and paravertebral abscess formation after kyphoplasty of L1. The literature is reviewed, and diagnostic options are discussed. Summary of Background Data. Kyphoplasty is a well-established procedure in the treatment of osteoporotic compression fractures and metastatic tumors of the vertebrae. Although complication rates are low, there is evidence for an increased risk of serious local infections after kyphoplasty in patients with any history of systemic infection. Spinal TB accounts for 2% of all TB cases with a trend toward an increased incidence in parallel with the growing number of immunocompromised patients. To our knowledge, only 1 article had reported a patient suffering from Pott disease after vertebroplasty. Methods. A 70-year-old patient with compression fracture of L1 underwent percutaneous kyphoplasty using polymethyl methacrylate. Results. Two weeks after kyphoplasty, the patient was readmitted with backache and signs of acute infection. Magnetic resonance imaging confirmed the diagnosis of spondylitis with paravertebral abscess formation. A tissue specimen obtained by computed tomography-guided percutaneous biopsy did not yield any pathogen. As broad-spectrum antibiotic therapy failed, combined surgery consisting of posterior instrumentation of Th11–L3 and anterior debridement, corporectomy of L1, and interposition of a titanium mesh cage filled with autologous rib graft was performed. Histologic examination of resected tissue and PCR and culture results confirmed diagnosis of spinal TB. Despite adequate antibiotic treatment and local surgical interventions, the patient died from septic multiple organ failure. Conclusion. Indication for kyphoplasty in patients with any history of local or systemic infection should be scrutinized rigorously. Symptoms of spinal TB are often nonspecific, and the clinician should be aware of this entity. Active investigation including microbiological and histologic examination is of utmost importance to avoid any delay in correct diagnosis and specific treatment.