Randall F. Holcombe

Mapping a gene for familial hypertrophic cardiomyopathy to chromosome 14q1

To identify the chromosomal location of a gene responsible for familial hypertrophic cardiomyopathy, we used clinical and molecular genetic techniques to evaluate the members of a large kindred. Twenty surviving and 24 deceased family members had hypertrophic cardiomyopathy; 58 surviving members were unaffected. Genetic-linkage analyses were performed with polymorphic DNA loci dispersed throughout the entire genome, to identify a locus that was inherited with hypertrophic cardiomyopathy in family members. The significance of the linkage detected between the disease locus and polymorphic loci was assessed by calculating a lod score (the logarithm of the probability of observing coinheritance of two loci, assuming that they are genetically linked, divided by the probability of detecting coinheritance if they are unlinked). A DNA locus (D14S26), previously mapped to chromosome 14 and of unknown function, was found to be coinherited with the disease in this family. No instances of recombination were observed between the locus for familial hypertrophic cardiomyopathy and D14S26, yielding a lod score of +9.37 (theta = 0). These data indicate that in this kindred, the odds are greater than 2,000,000,000:1 that the gene responsible for familial hypertrophic cardiomyopathy is located on chromosome 14 (band q1).

Inclusion of black Americans in oncology clinical trials : The Louisiana State University Medical Center Experience

Recruitment of patients from diverse ethnic, racial, and socioeconomic backgrounds for clinical trials is desirable for both scientific and ethical reasons. Participation rates in clinical trials are low for minorities and especially for black Americans. This report summarizes the experience at Louisiana State University Medical Center in Shreveport, Louisiana, in enrolling black Americans in oncology treatment and prevention trials. Barriers to enrollment are identified and discussed. Although major strides must still be made in the area of cancer prevention, the universitys experience demonstrates that black Americans can be encouraged to participate in and can be enrolled in cancer clinical trials.

Correlation of Serum Interleukin-8 and Cell Surface Lysosome-associated Membrane Protein with Clinical Disease Activity in Systemic Lupus Erythematosus:

Cell surface expression of lysosome-associated membrane proteins (LAMPs) correlates with serum interleukin-8 (IL-8) levels, shorter disease duration, greater functional impairment from disease-related symptoms and soluble IL-2 receptor levels (sIL-2R) in patients with scleroderma. In this study of 46 patients with systemic lupus erythematosus (SLE), the relationship of serum IL-8 and cell surface LAMP to two clinical measures of disease activity, the SLEDAI and SLAM scales, was evaluated. IL-8 levels were determined on serum samples by the immunometric sandwich enzyme immunoassay technique. Cell surface LAMP expression was determined by flow cytometric quantitation of peripheral blood mononuclear cells with monoclonal antibodies directed against two of the major LAMP proteins, lamp1 and lamp2. The clinical disease activity scales correlated significantly with each other, with C3 levels, serum IL-8, C4, dsDNA and sIL-2R. Lamp1 and lamp2 expression correlated with the SLAM but not the SLEDAI scale. Serum IL-8 levels were elevated in 49 of 51 samples tested (44 of 46 patients) and had a stronger correlation with disease activity than C4, dsDNA and sIL-2R levels. Significantly higher levels of IL-8 were seen in patients with evidence of renal involvement. Serum IL-8 and cell surface LAMP expression may be useful indicators of disease activity in patients with SLE. The possible role of IL-8 in the pathogenesis of SLE requires further investigation.

Social Drinking and the Immune Response: Impairment of Lymphokine-Activated Killer Activity

The effect of limited and intermittent alcohol ingestion on the immune response in humans has not been extensively studied. The authors, in this study, evaluate peripheral blood mononuclear cell cytotoxicity before and after alcohol ingestion in a setting designed to mimic social drinking. Eleven healthy volunteers consumed two 12 oz (355 mL) cans of beer in 30 minutes while eating pizza. Five control individuals ingested non-alcoholic beverages. Natural killer and lymphokine-activated killer activity were determined for peripheral blood mononuclear cells obtained before and 30 minutes after alcohol ingestion. Interleukin 2-induced lymphokine-activated killer activity was significantly reduced in blood samples obtained after alcohol ingestion when compared with pre-alcohol samples (p < 0.01). Natural killer activity (unstimulated) was not affected by alcohol ingestion. The authors demonstrate that ingestion of a small amount of alcohol impairs the cytotoxic capacity of peripheral blood mononuclear cells. Alcohol in the context of social drinking may have deleterious effects on the immune systems ability to clear virus-infected cells or cells that have undergone neoplastic transformation, especially for individuals with pre-existing immunosuppression.

Levamisole and Interleukin-2 for advanced malignancy

Therapy for cancer patients with biologically active immune modulators is attractive but has met with limited clinical success. Interleukin-2 (IL2) stimulates T-cells and natural killer (NK) cells to kill tumor cells and levamisole (LMS) is an immunostimulant which has been shown to increase NK cells and activated T-cells in patients receiving this adjuvantly along with 5FU for Stage III colon cancer. This study was designed to evaluate whether treatment with LMS prior to IL2 would provide synergistic activity and improve response rates. Four patients with advanced malignancies were treated with LMS at 50mg po TID for 3 days followed on day 4 with 600,000 units/kg IL2 as a single iv bolus. This treatment was repeated weekly until progression. Serum soluble IL2 receptor (sIL2R) and interferon-γ levels were monitored throughout the treatment course as markers of immune activation. All patients had eventual progression of disease. Toxicity was minimal with Grade II orthostatic hypotension the major consequence of therapy. The pattern of sIL2R levels in 3/4 patients revealed a steady increase over the several weeks of therapy, indicating ongoing immunostimulation (r =0.53 , p= 0.001). Short-term treatment with LMS, however, resulted in a significant and consistent decreases in sIL2R levels (2198 U/ml vs. 1969 U/ml, p=0.001) in all patients. In conclusion, LMS/IL2 in the dose and schedule utilized here was not clinically effective. However, LMS reduced sIL2R levels immediately following a three-day course. This reduction in sIL2R by LMS may improve the possibility of response to IL2 by facilitating a decrease in inhibitory sIL2R. Combinations of these two agents should continue to be investigated as potential synergistic anti-tumor agents.

Linkage of loci associated with two pigment mutations on mouse chromosome 13

Progeny from one intra- and two inter-specific backcrosses between divergent strains of mice were typed to map multiple markers in relation to two pigment mutations on mouse chromosome 13, beige (bg) and pearl (pe). Both recessive mutants on a C57BL/6J background were crossed separately with laboratory strain PAC (M. domesticus) and the partially inbred M. musculus stock PWK. The intra- and inter-specific F1 hybrids were backcrossed to the C57BL/6J parental strain and DNA was prepared from progeny. Restriction fragment length polymorphisms were used to follow the segregation of alleles in the backcross offspring at loci identified with molecular probes. The linkage analysis defines the association between the bg and pe loci and the loci for the T-cell receptor gamma-chain gene (Tcrg), the spermatocyte specific histone gene (Hist1), the prolactin gene (Prl), the Friend murine leukaemia virus integration site 1 (Fim-1), the murine Hanukuh Factor gene (Muhf/Ctla-3) and the dihydrofolate reductase gene (Dhfr). This data confirms results of prior chromosomal mapping studies utilizing bg as an anchor locus, and provides previously unreported information defining the localization of the prolactin gene on mouse chromosome 13. The relationship of multiple loci in relation to pe is similarly defined. These results may help facilitate localization of the genes responsible for two human syndromes homologous with bg and pe, Chediak-Higashi syndrome and Hermansky-Pudlak syndrome.

Alteration in lymphocyte phenotype associated with administration of adjuvant levamisole and 5-fluorouracil

Levamisole (LMS) and 5-fluorouracil (5FU) administered adjuvantly are effective in reducing the relapse rate following surgical resection of Dukes stage C colon carcinoma. It has been postulated that LMS acts to stimulate the immune system and that this is one mechanism through which this drug exerts its antitumor effects. In this study, peripheral blood mononuclear cells (PBMC) were analyzed in nine patients with surgically resected colon carcinoma prior to initiation of adjuvant LMS/5FU and at several subsequent times while patients were on therapy. Changes in lymphocyte phenotype and soluble interleukin-2 receptor (sIL-2R) between pre-study samples and samples obtained during adjuvant LMS/5FU were evaluated. Significant increases were seen in the proportion of PBMC expressing natural killer (NK) antigen CD56 (14.7±2.4% versus 18.1±2.6%;P<0.05) and surface IL-2R (CD25; 0% versus 0.42±0.15%;P<0.05), in sIL-2R (314±86 U/ml versus 736±173 U/ml;P<0.05), and in the CD4∶CD8 ratio (2.34±0.93 versus 3.47±1.23;P<0.01). A significant decrease in the proportion of CD8+ PBMC (24.7±3.8% versus 18.8±2.6%;P<0.01) and total CD8+ PBMC (537±118 versus 324±37;P<0.01) was seen. The increase in CD56+ cells correlated with sIL2R levels (r=0.46;P<0.05). No changes were noted for CD3, CD4, CD5, CD14, CD16, CD19, CDw49a, or TCRδ. The greatest increase in CD56+ cells and the smallest reduction in CD8+ cells were seen in the subgroup of patients who remained disease-free following adjuvant chemotherapy. This study suggests that adjuvant LMS/5FU has significant stimulatory effects on the immune system, which correlate with patient outcome and may account at least in part for its clinical efficacy.

Interleukin-2-induced cytotoxicity of Chediak-Higashi lymphocytes

Peripheral blood mononuclear cells (PBMCs) from patients with Chediak-Higashi syndrome (CHS) exhibit minimal natural-killer-like cytotoxicity by standard 51Cr-release assays in vitro. However, a CHS-derived gamma delta-T-cell clone maintained in long-term culture with low-dose interleukin-2 (IL-2) does exhibit cytotoxic activity. PBMCs from 2 patients with CHS were stimulated with low-dose IL-2 in short-term culture and compared with a control for induction of cytotoxicity against a panel of target cell lines. The CHS-derived PBMCs exhibited IL-2-induced cytotoxicity, though the magnitude of induction was uniformly less than in controls. This was accompanied by no significant change in the proportion of PBMCs bearing the gamma delta-T-cell receptor antigens. The inducibility of cytotoxicity with low-dose IL-2 in vitro suggests a possible in vivo therapy for patients with CHS.

Gamma-Delta T Cells in Chediak-Higashi Syndrome

Lymphocytes from children with Chediak-Higashi syndrome (CHS) have impaired natural killer (NK) activity and lack antibody-dependent cell-mediated cytotoxicity. Study of T cells bearing an alternate T cell receptor comprised of gamma- and delta-chains, which typically demonstrate NK activity in vitro, was undertaken in CHS patients. We demonstrate that the cellular machinery for lysis of target cells in vitro is present in CHS-derived gamma delta T cell clones. We also show that the proportion of gamma delta T cells among peripheral blood mononuclear cells is significantly increased in CHS, the first example of a specific immunodeficiency disorder with a relative expansion of these T cells.

Drug-Induced Granulocytopenia with Natural Killer Lymphocytosis after Renal Transplantation

Following renal transplantation, a patient developed life-threatening granulocytopenia secondary to a specific combination of drugs which are commonly utilized in this setting. Coincident with the depression of granulocytes, an expansion of natural killer cells was seen, which may have been a consequence of immunosuppressive therapy required for allograft retention. Infection with cytomegalovirus may have contributed to both phenomena.