RESUMEN
The nuclear p68 RNA helicase is a prototypical member of the DEAD-box family of RNA helicases. p68 RNA helicase has been implicated in cell proliferation and early organ development and maturation. However, the functional role of p68 RNA helicase in these biological processes at the molecular level is not well understood. We previously reported that tyrosine phosphorylation of p68 RNA helicase mediates the effects of platelet-derived growth factor (PDGF) in induction of epithelial mesenchymal transition by promoting ß-catenin nuclear translocation. Here, we report that phosphorylation of p68 RNA helicase at Y593 upregulates transcription of the Snail1 gene. The phosphorylated p68 activates transcription of the Snail1 gene by promoting histone deacetylase (HDAC)1 dissociation from the Snail1 promoter. Our results showed that p68 interacted with the nuclear remodeling and deacetylation complex MBD3:Mi-2/NuRD. Thus, our data suggested that a DEAD-box RNA unwindase could potentially regulate gene expression by functioning as a protein 'displacer' to modulate protein-protein interactions at the chromatin-remodeling complex.
Asunto(s)
ARN Helicasas DEAD-box/metabolismo , Histona Desacetilasa 1/fisiología , Regiones Promotoras Genéticas , Factores de Transcripción/metabolismo , Diferenciación Celular/genética , Diferenciación Celular/fisiología , Núcleo Celular/genética , Núcleo Celular/metabolismo , Proliferación Celular , ARN Helicasas DEAD-box/genética , Histona Desacetilasa 1/metabolismo , Humanos , Fosforilación , Factor de Crecimiento Derivado de Plaquetas/genética , Factor de Crecimiento Derivado de Plaquetas/metabolismo , ARN/genética , ARN/metabolismo , Secuencias Reguladoras de Ácidos Nucleicos , Factores de Transcripción de la Familia Snail , Factores de Transcripción/genética , Regulación hacia Arriba , beta Catenina/genética , beta Catenina/metabolismoRESUMEN
BACKGROUND: Inflammation is a significant component of atherosclerosis lesions. Bacteria, including periodontopathogens, have been demonstrated in atherosclerotic plaques and cross-reactivity of the immune response to bacterial GroEL with human heat shock protein 60 has been suggested as a link between infections and atherosclerosis. METHODS: In this study, the nature of the inflammatory infiltrate and the presence of human heat shock protein 60 and GroEL were examined in 31 carotid endarterectomy specimens. Additionally, monoclonal antibodies were used to detect the presence of six bacteria, including those implicated in periodontal disease. RESULTS: The inflammatory cell infiltrate of the lesions was dominated by CD14(+) macrophages and CD4(+) T cells. Most cells of the infiltrate as well as the endothelium were HLA-DR(+), indicating activation; however, there was an absence of CD25 expression, demonstrating that the activated T cells were not proliferating. Few CD1a(+) and CD83(+) cells were noted. Human heat shock protein 60 expression was evident on endothelial cells and cells with the appearance of smooth muscle cells and lymphocytes. GroEL and bacteria were detected within intimal cells. Chlamydia pneumoniae, Porphyromonas gingivalis, Fusobacterium nucleatum, Tannerella forsythia, Prevotella intermedia, and Actinobacillus actinomycetemcomitans were found in 21%, 52%, 34%, 34%, 41%, and 17% of arteries, respectively. CONCLUSION: These results give evidence for a specific immune response associated with atherosclerosis. Whether bacteria initiate the observed inflammation in atherosclerotic lesions is not clear; however, the present study shows that maintenance of inflammation may be enhanced by the presence of periodontopathic bacteria.
Asunto(s)
Aterosclerosis/patología , Chaperonina 60/análisis , Enfermedades Periodontales/microbiología , Aggregatibacter actinomycetemcomitans/aislamiento & purificación , Antígenos CD/análisis , Antígenos CD1/análisis , Aterosclerosis/inmunología , Aterosclerosis/microbiología , Bacteroides/aislamiento & purificación , Linfocitos T CD4-Positivos/patología , Chlamydophila pneumoniae/aislamiento & purificación , Endarterectomía Carotidea , Células Endoteliales/patología , Endotelio Vascular/inmunología , Endotelio Vascular/patología , Fusobacterium nucleatum/aislamiento & purificación , Antígenos HLA-DR/análisis , Humanos , Inmunoglobulinas/análisis , Inmunohistoquímica , Inflamación/patología , Receptores de Lipopolisacáridos/análisis , Activación de Linfocitos/inmunología , Macrófagos/patología , Glicoproteínas de Membrana/análisis , Músculo Liso Vascular/patología , Porphyromonas gingivalis/aislamiento & purificación , Prevotella intermedia/aislamiento & purificación , Túnica Íntima/microbiología , Antígeno CD83Asunto(s)
Infecciones por VIH/complicaciones , Admisión del Paciente/estadística & datos numéricos , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Servicio de Admisión en Hospital/estadística & datos numéricos , Causas de Muerte , Niño , Infecciones por VIH/mortalidad , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Neumonía/complicaciones , Sudáfrica/epidemiologíaRESUMEN
Tannerella forsythia has been implicated as a defined periodontal pathogen. In the present study a mouse model was used to determine the phenotype of leukocytes in the lesions induced by subcutaneous injections of either live (group A) or nonviable (group B) T. forsythia. Control mice (group C) received the vehicle only. Lesions were excised at days 1, 2, 4, and 7. An avidin-biotin immunoperoxidase method was used to stain infiltrating CD4+ and CD8+ T cells, CD14+ macrophages, CD19+ B cells, and neutrophils. Hematoxylin and eosin sections demonstrated lesions with central necrotic cores surrounded by neutrophils, macrophages and lymphocytes in both group A and group B mice. Lesions from control mice exhibited no or only occasional solitary leukocytes. In both groups A and B, neutrophils were the dominant leukocyte in the lesion 1 day after injection, the numbers decreasing over the 7-day experimental period. There was a relatively low mean percent of CD4+ and CD8+ T cells in the lesions and, whereas the percent of CD8+ T cells remained constant, there was a significant increase in the percent of CD4+ T cells at day 7. This increase was more evident in group A mice. The mean percent of CD14+ macrophages and CD19+ B cells remained low over the experimental period, although there was a significantly higher mean percent of CD19+ B cells at day 1. In conclusion, the results showed that immunization of mice with live T. forsythia induced a stronger immune response than nonviable organisms. The inflammatory response presented as a nonspecific immune response with evidence of an adaptive (T-cell) response by day 7. Unlike Porphyromonas gingivalis, there was no inhibition of neutrophil migration.
Asunto(s)
Bacteroides/patogenicidad , Absceso/inmunología , Absceso/microbiología , Animales , Subgrupos de Linfocitos B , Bacteroides/inmunología , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , Modelos Animales de Enfermedad , Femenino , Inmunohistoquímica , Recuento de Leucocitos , Ratones , Ratones Endogámicos BALB C , NeutrófilosRESUMEN
Recently, mast cells have been shown to produce cytokines which can direct the development of T-cell subsets. The aim of the present study was to determine the relationship between mast cells and the Th1/Th2 response in human periodontal disease. Tryptase+ mast cell numbers were decreased in chronic periodontitis tissues compared with healthy/gingivitis lesions. Lower numbers of c-kit+ cells, which remained constant regardless of clinical status, indicate that there may be no increased migration of mast cells into periodontal disease lesions. While there were no differences in IgG2+ or IgG4+ cell numbers in healthy/gingivitis samples, there was an increase in IgG4+ cells compared with IgG2+ cells in periodontitis lesions, numbers increasing with disease severity. This suggests a predominance of Th2 cells in periodontitis, although mast cells may not be the source of Th2-inducing cytokines.
Asunto(s)
Mastocitos/inmunología , Periodontitis/inmunología , Linfocitos B/inmunología , Linfocitos B/patología , Recuento de Células , Movimiento Celular , Enfermedad Crónica , Encía/citología , Gingivitis/inmunología , Gingivitis/patología , Humanos , Inmunoglobulina G/análisis , Mediadores de Inflamación/análisis , Mastocitos/patología , Análisis Multivariante , Periodontitis/patología , Células Plasmáticas/inmunología , Células Plasmáticas/patología , Proteínas Proto-Oncogénicas c-kit/análisis , Serina Endopeptidasas/análisis , Células TH1/inmunología , Células TH1/patología , Células Th2/inmunología , Células Th2/patología , TriptasasRESUMEN
This study examined the nature of the infiltrating cells in Porphyromonas gingivalis-induced lesions and immunoglobulins in the serum samples of BALB/c (H-2d), C57BL6 (H-2b), DBA/2J (H-2d) and CBA/CaH (H-2k) mice. Mice were immunized intraperitoneally with P. gingivalis outer membrane antigens or sham-immunized with phosphate-buffered saline followed by subcutaneous challenge with live organisms 1 week after the final immunization. The resulting skin abscesses were excised 7 days later, cryostat sections cut and an immunoperoxidase method used to detect the presence of CD4+ and CD8+ T-cell subsets, CD14+ macrophages and CD19+ B cells. Peroxidase positive neutrophils and IgG1- and IgG2a-producing plasma cells were also identified. Anti P. gingivalis IgG1 and IgG2a subclass antibodies were determined in serum obtained by cardiac puncture. Very few CD8+ T cells and CD19+ B cells were found in any of the lesions. The percentages of CD4+ cells, CD14+ cells and neutrophils were similar in lesions of immunized BALB/c and C57BL6 mice, with a trend towards a higher percentage of CD14+ cells in sham-immunized mice. The percentage of CD14+ cells was higher than that of CD4+ cells in immunized compared with sham-immunized DBA/2J mice. The percentages of CD4+ and CD14+ cells predominated in immunized CBA/CaH mice and CD4+ cells in sham-immunized CBA/CaH mice. The percentage of neutrophils in immunized CBA/CaH mice was significantly lower than that of CD14+ cells and CD4+ cells in sham-immunized mice. IgG1+ plasma cells were more dominant than IgG2a+ cells in immunized BALB/c, C57BL6 and DBA/2J mice, whereas IgG2a+ plasma cells were more obvious in sham-immunized mice. IgG2a+ plasma cells were predominant in immunized and sham-immunized CBA/CaH mice. In the serum, specific anti-P. gingivalis IgG2a antibody levels (Th1 response) were higher than IgG1 levels (Th2 response) in sham-immunized CBA/CaH and DBA/2J mice. In immunized BALB/c mice, IgG2a levels were lower than IgG1 levels, while IgG2a levels were higher in immunized C57BL6 mice. In conclusion, this study has shown differences in the proportion of infiltrating leukocytes and in the subclasses of immunoglobulin produced locally and systemically in response to P. gingivalis in different strains of mice, suggesting a degree of genetic control over the response to P. gingivalis.
Asunto(s)
Inmunoglobulina G/inmunología , Leucocitos/inmunología , Ratones Endogámicos/microbiología , Porphyromonas gingivalis/inmunología , Animales , Anticuerpos Antibacterianos/inmunología , Antígenos Bacterianos/inmunología , Antígenos CD19/análisis , Linfocitos B/inmunología , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Femenino , Inmunoglobulina G/genética , Leucocitos/microbiología , Receptores de Lipopolisacáridos/análisis , Macrófagos/inmunología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Endogámicos CBA , Ratones Endogámicos DBA , Ratones Endogámicos/inmunología , Neutrófilos/inmunología , Fenotipo , Células Plasmáticas/inmunologíaRESUMEN
T cells are present in the inflammatory infiltrates of periodontal disease lesions and require antigen presentation by antigen-presenting cells (APCs). While it is still not known whether Th1 or Th2 cells predominate in these lesions, it has been reported that different APCs may induce activation of different T-cell subsets. An immunoperoxidase technique was used to investigate the presence of CD1a+, CMRF-44+, CMRF-58+ and CD83+ dendritic cells, CD14+ macrophages or dendritic cell precursors and CD19+ B cells in gingival biopsies from 21 healthy or gingivitis and 25 periodontitis subjects. The samples were divided into three groups according to the size of infiltrate (group 1, small infiltrates; group 2, medium infiltrates; group 3, extensive infiltrates). The presence of numerous CD1a+ Langerhans cells was noted in the epithelium with no differences between the healthy/gingivitis and periodontitis groups. The percentage of CD83+ dendritic cells in the infiltrates was higher than the percentage of CD1a+, CMRF-44+ or CMRF-58+ dendritic cells. Endothelial cells positive for CD83 were found predominantly in areas adjacent to infiltrating cells, CD83+ dendritic cells being noted in the region of CD83+ endothelium. The percentage of CD14+ cells in the inflammatory infiltrates was similar to that of CD83+ dendritic cells. B cells were the predominant APC in group 2 and 3 tissues. The percentage of B cells in group 3 periodontitis lesions was increased in comparison with group 1 periodontitis tissues and also in comparison with group 3 healthy/gingivitis sections. Functional studies are required to determine the roles of different APC subpopulations in periodontal disease.
Asunto(s)
Células Presentadoras de Antígenos/clasificación , Periodontitis/inmunología , Presentación de Antígeno/inmunología , Células Presentadoras de Antígenos/inmunología , Antígenos CD/análisis , Antígenos CD1/análisis , Antígenos CD19/análisis , Antígenos de Diferenciación/análisis , Linfocitos B/clasificación , Linfocitos B/inmunología , Células Dendríticas/clasificación , Células Dendríticas/inmunología , Endotelio/inmunología , Epitelio/inmunología , Encía/inmunología , Gingivitis/inmunología , Humanos , Técnicas para Inmunoenzimas , Inmunoglobulinas/análisis , Células de Langerhans/clasificación , Células de Langerhans/inmunología , Modelos Lineales , Receptores de Lipopolisacáridos/análisis , Macrófagos/clasificación , Macrófagos/inmunología , Glicoproteínas de Membrana/análisis , Análisis Multivariante , Periodontitis/patología , Estadística como Asunto , Subgrupos de Linfocitos T/inmunología , Antígeno CD83RESUMEN
Cytokines produced by T-cells in periodontal lesions may determine the nature of the adaptive immune response. Since different antigen-presenting cells (APC) may direct the Th1/Th2 response, P. gingivalis-specific T-cell lines were established by different APC subpopulations, and their cytokine profiles were determined. Peripheral blood mononuclear cells induced similar percentages of IL-4+ and IFN-gamma+ T-cells and lower percentages of IL-10+ T-cells. Epstein-Barr virus-transformed B-cells (LCL) induced higher percentages of IL-4+ cells than IFN-gamma+ cells, with lower percentages of IL-10+ cells. Peripheral blood mononuclear cells induced a higher percent of IFN-gamma+ CD8 cells than LCL (p = 0.004). Purified B-cells, monocytes, and dendritic cells induced similar percentages of IL-4+ and IFN-gamma+ cells, although again, the percentage of IL-10+ cells was lower. The results of the present study have demonstrated that, as measured by FACS analysis of intracytoplasmic cytokines, P. gingivalis-specific T-cells produce both Th1 and Th2 cytokines, regardless of the APC population.
Asunto(s)
Células Presentadoras de Antígenos/inmunología , Línea Celular/inmunología , Citocinas/biosíntesis , Epítopos de Linfocito T/inmunología , Enfermedades Periodontales/inmunología , Porphyromonas gingivalis/inmunología , Subgrupos de Linfocitos T/metabolismo , Células TH1/metabolismo , Células Th2/metabolismo , Adulto , Células Presentadoras de Antígenos/citología , Linfocitos B/inmunología , Proteínas de la Membrana Bacteriana Externa/inmunología , Línea Celular/metabolismo , Células Dendríticas/inmunología , Femenino , Humanos , Interferón gamma/biosíntesis , Interleucina-10/biosíntesis , Interleucina-4/biosíntesis , Leucocitos Mononucleares/inmunología , Masculino , Persona de Mediana Edad , Subgrupos de Linfocitos T/inmunología , Células TH1/inmunología , Células Th2/inmunologíaRESUMEN
T cell cytokine profiles and specific serum antibody levels in five groups of BALB/c mice immunized with saline alone, viable Fusobacterium nucleatum ATCC 25586, viable Porphyromonas gingivalis ATCC 33277, F. nucleatum followed by P. gingivalis and P. gingivalis followed by F. nucleatum were determined. Splenic CD4 and CD8 cells were examined for intracytoplasmic interleukin (IL)-4, interferon (IFN)-gamma and IL-10 by dual colour flow cytometry and the levels of serum anti-F. nucleatum and anti-P. gingivalis antibodies determined by an ELISA. Both Th1 and Th2 responses were demonstrated by all groups, and while there were slightly lower percentages of cytokine positive T cells in mice injected with F. nucleatum alone compared with the other groups immunized with bacteria, F. nucleatum had no effect on the T cell production of cytokines induced by P. gingivalis in the two groups immunized with both organisms. However, the percentages of cytokine positive CD8 cells were generally significantly higher than those of the CD4 cells. Mice immunized with F. nucleatum alone had high levels of serum anti-F. nucleatum antibodies with very low levels of P. gingivalis antibodies, whereas mice injected with P. gingivalis alone produced anti-P. gingivalis antibodies predominantly. Although the levels of anti-F. nucleatum antibodies in mice injected with F. nucleatum followed by P. gingivalis were the same as in mice immunized with F. nucleatum alone, antibody levels to P. gingivalis were very low. In contrast, mice injected with P. gingivalis followed by F. nucleatum produced equal levels of both anti-P. gingivalis and anti-F. nucleatum antibodies, although at lower levels than the other three groups immunized with bacteria, respectively. Anti-Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Prevotella intermedia serum antibody levels were also determined and found to be negligible. In conclusion, F. nucleatum immunization does not affect the splenic T cell cytokine response to P. gingivalis. However, F. nucleatum immunization prior to that of P. gingivalis almost completely inhibited the production of anti-P. gingivalis antibodies while P. gingivalis injection before F. nucleatum demonstrated a partial inhibitory effect by P. gingivalis on antibody production to F. nucleatum. The significance of these results with respect to human periodontal disease is difficult to determine. However, they may explain in part differing responses to P. gingivalis in different individuals who may or may not have had prior exposure to F. nucleatum. Finally, the results suggested that P. gingivalis and F. nucleatum do not induce the production of cross-reactive antibodies to other oral microorganisms.
Asunto(s)
Linfocitos B/inmunología , Infecciones por Bacteroidaceae/inmunología , Infecciones por Fusobacterium/inmunología , Fusobacterium nucleatum/inmunología , Porphyromonas gingivalis/inmunología , Subgrupos de Linfocitos T/inmunología , Animales , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Especificidad de Anticuerpos , Antígenos Bacterianos/inmunología , Infecciones por Bacteroidaceae/sangre , Reacciones Cruzadas , Femenino , Infecciones por Fusobacterium/sangre , Humanos , Inmunidad , Ratones , Ratones Endogámicos BALB CRESUMEN
Within the last 5 years there has been a large outgrowth of smoking cessation research, largely encouraged by the release of the 1996 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. These federal guidelines published by the Agency for Healthcare Policy and Research offered comprehensive empirical evidence that tobacco cessation interventions are effective and encouraged routine implementation within medical settings. Since that time, numerous studies in tobacco cessation have augmented the state of knowledge regarding successful smoking intervention modalities. Unfortunately, approximately one-third of cancer-related deaths continue to be attributed to smoking behaviors. It is imperative that health care providers encourage and participate in the smoking cessation efforts of their patients and family members. This article provides a review of the current literature in smoking cessation and describes first-line therapies with proven effectiveness in tobacco cessation. Clinicians are encouraged to consistently screen for tobacco use and provide brief interventions utilizing behavioral counseling and pharmacotherapies to treat their patients' tobacco dependence.
Asunto(s)
Neoplasias Pulmonares/prevención & control , Oncología Médica , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Guías como Asunto/normas , Humanos , Oncología Médica/tendenciasRESUMEN
An immunoperoxidase technique was used to examine IP-10 (interferon-gamma inducible protein 10), RANTES (regulated on activation normal T cell expressed and secreted), MCP-1 (monocyte chemoattractant protein-1), and MIP-1 alpha (macrophage inflammatory protein-1 alpha) in gingival biopsies from 21 healthy/gingivitis and 26 periodontitis subjects. The samples were placed into 3 groups according to the size of infiltrate. MIP-1 alpha+ cells were more abundant than the other chemokines with few MCP-1+ cells. The mean percent MIP-1 alpha+ cells was higher than the percent MCP-1+ cells (P = 0.02) in group 2 (intermediate size infiltrates) lesions from periodontitis subjects, other differences not being significant due to the large variations between tissue samples. Analysis of positive cells in relation to CD4/CD8 ratios showed that with an increased proportion of CD8+ cells, the mean percent MIP-1 alpha+ cells was significantly higher in comparison with the mean percent RANTES+ and MCP-1+ cells (P < 0.015). Endothelial cells were MCP-1+ although positive capillaries were found on the periphery of infiltrates only. Keratinocyte expression of chemokines was weak and while the numbers of healthy/gingivitis and periodontitis tissue sections positive for IP-10, RANTES and MCP-1 reduced with increasing inflammation, those positive for MIP-1 alpha remained constant for all groups. In conclusion, fewer leucocytes expressed MCP-1 in gingival tissue sections, however, the percent MIP-1 alpha+ cells was increased particularly in tissues with increased proportions of CD8 cells and B cells with increasing inflammation and also in tissues with higher numbers of macrophages with little inflammation. Further studies are required to determine the significance of MIP-1 alpha in periodontal disease.
Asunto(s)
Quimiocina CCL2/biosíntesis , Quimiocina CCL5/biosíntesis , Quimiocinas CXC/biosíntesis , Proteínas Inflamatorias de Macrófagos/biosíntesis , Enfermedades Periodontales/inmunología , Quimiocina CCL4 , Quimiocina CXCL10 , Tejido Conectivo/inmunología , Tejido Conectivo/patología , Endotelio Vascular/citología , Endotelio Vascular/inmunología , Encía/inmunología , Encía/patología , Humanos , Queratinocitos/citología , Queratinocitos/inmunología , Enfermedades Periodontales/patologíaRESUMEN
Women volunteers with or without a first-degree relative with breast cancer (FDR) were compared on several measures. Relative to the comparison group, women in the FDR group had more negative attitudes about breast cancer (including more anxiety about breast cancer), viewed their risk for getting breast cancer as greater (although they underestimated the actual risk), and were more likely to engage in appropriate screening behavior. A high percentage of women in both groups stated that they would want to have a genetic test for breast cancer if it were generally available.
Asunto(s)
Actitud Frente a la Salud , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/psicología , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Mujeres/educación , Mujeres/psicología , Adulto , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/psicología , Depresión/diagnóstico , Depresión/psicología , Femenino , Pruebas Genéticas/psicología , Pruebas Genéticas/estadística & datos numéricos , Humanos , Mamografía/psicología , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Negativismo , Linaje , Factores de Riesgo , Encuestas y Cuestionarios , Análisis de SupervivenciaRESUMEN
Genetic testing for inherited forms of breast cancer is currently available to individuals who want to learn their genetic status for the BRCA1 and BRCA2 genes. Although still largely limited to research programs, widespread commercial testing and incorporation of genetic testing into primary care practices will occur in the not too distant future. Despite the availability of this technology, treatment and prevention strategies offered to these often healthy women are limited and somewhat controversial. Due to the medical and emotional complexities associated with the gap between genetic information and treatment interventions, behavioral scientists are currently investigating the psychosocial implications involved in genetic testing for the BRCA1/2 genes. This article attempts to summarize the current research models, and reviews the most recent findings of investigations evaluating the emotional and behavioral implications associated with genetic testing for breast cancer susceptibility.
Asunto(s)
Neoplasias de la Mama/genética , Pruebas Genéticas/psicología , Proteína BRCA2 , Neoplasias de la Mama/psicología , Femenino , Genes BRCA1 , Asesoramiento Genético , Humanos , Proteínas de Neoplasias/genética , Investigación/tendencias , Factores de Transcripción/genéticaRESUMEN
This report describes a commercial laboratory's novel approach to providing genetic testing services to detect BRCA1 mutations in persons with hereditary breast/ovarian cancer. The approach involves the use of institutional review board (IRB)-approved protocols as a paradigm for conducting genetic testing in a commercial setting. We discuss the rationale for this approach and the key elements of the protocol. In addition, we provide data on the first 6 months of implementation of the protocol in 32 clinical sites. A phased testing approach was used, consisting of an allele-specific oligonucleotide assay for the 8 most common BRCA1 mutations, a protein truncation test of exon 11, and direct sequencing of the remaining regions of the gene. Data are presented on the yield of mutation carriers by category of family history and by stage of analysis.
Asunto(s)
Genes BRCA1 , Pruebas Genéticas/métodos , Mutación , Proteína BRCA2 , Neoplasias de la Mama/genética , Análisis Mutacional de ADN/métodos , Estudios de Evaluación como Asunto , Exones , Femenino , Genes Supresores de Tumor , Humanos , Proteínas de Neoplasias/genética , Neoplasias Ováricas/genética , Factores de Transcripción/genéticaRESUMEN
In 1990, the five leading causes of cancer death in men aged 65 and older were carcinomas of the lung, prostate, colon and rectum, and pancreas, and leukemia. For women in this age group, the five leading causes of cancer death were carcinomas of the lung, breast, colon and rectum, pancreas, and ovary. To determine the representation of the elderly in clinical trials, the 1992 accrual of the National Cancer Institute (NCI)-sponsored Clinical Cooperative Group treatment trials (which included more than 8000 elderly patients) for the aforementioned sites was compared with the 1990 incidence data from the NCI's Surveillance, Epidemiology, and End Results program. Of the male patients enrolled in the trials, an average of 39% were older than 65 (47.3% lung, 79.5% prostate, 47.5% colorectal, 45.6% pancreas, and 9.6% leukemia); whereas 25.9% of all women enrolled in trials were 65 or older (43.6% lung, 17.3% breast, 46.2% colorectal, 59.6% pancreas, and 35.4% ovary). With respect to incidence, older patients generally are underrepresented in cancer treatment trials. With the exception of the data on prostate cancer, each of the comparisons using the Z statistic gave probability values of less than 0.01. The most significant discrepancies between incidence and participation in cancer treatment protocols were noted for leukemia in males and breast cancer in females. Possible explanations for these findings include (1) a research focus on aggressive therapy, which may be unacceptably toxic to the elderly; (2) presence of comorbidity in the elderly; (3) fewer trials available specifically aimed at older patients; (4) limited expectations for long term benefits on the part of physicians, relatives, and the patients themselves; and (5) a lack of financial, logistic, and social support for the participation of elderly patients in clinical trials. Recognizing this situation, NCI recently sponsored a number of trials that specifically target the elderly. This paper describes the status of all major Phase II and III clinical trials that recently were closed, still are active, or now are in review that address the clinical care of this important segment of the U.S. population.
Asunto(s)
Anciano , Ensayos Clínicos como Asunto , Neoplasias/terapia , Neoplasias de la Mama/epidemiología , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Neoplasias del Colon/epidemiología , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , National Institutes of Health (U.S.) , Neoplasias/epidemiología , Neoplasias/mortalidad , Neoplasias Ováricas/epidemiología , Neoplasias Pancreáticas/epidemiología , Neoplasias de la Próstata/epidemiología , Neoplasias del Recto/epidemiología , Sistema de Registros , Proyectos de Investigación , Estados UnidosRESUMEN
Neoadjuvant therapy has come to play an increasingly prominent role in the treatment of cancer. Originally defined as systemic therapy given before local treatment, the concept has been extended to include radiation therapy given before surgery. Potential advantages include improved local and distant control, direct evaluation, and organ-sparing treatment. Potential disadvantages include increased toxicity and cost, potential delay in effective treatment, and obscuring of pathologic staging. Neoadjuvant therapy in cancer treatment may be viewed in three categories: tumors in which neoadjuvant treatment has been shown effective, thus becoming standard therapy; tumors in which it has been shown to facilitate organ-sparing, and tumors in which its utility has not been shown. For patients with osteogenic sarcoma, for example, preoperative chemotherapy and limb salvage therapy have become the standard of care. Response to chemotherapy, ascertained by histologic review of the surgical specimen, can be used to tailor postoperative chemotherapy. In patients with advanced laryngeal squamous cell carcinoma, neoadjuvant chemotherapy followed by radiation has permitted laryngeal preservation in a majority of patients without compromising overall survival. Phase II and III studies conducted in women with breast cancer have demonstrated promising results for neoadjuvant chemotherapy given before radiation therapy and/or surgery. Phase III studies to compare neoadjuvant therapy to standard therapy in patients with breast cancer are underway. For neoadjuvant therapy, as with other innovations in cancer treatment, it is crucial that a new strategy must be compared closely to standard therapy in terms of recurrence, survival, and impact on organ sparing, as well as quality of life and treatment costs.
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Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Quimioterapia Adyuvante , Humanos , Neoplasias/radioterapia , Neoplasias/cirugíaAsunto(s)
Ensayos Clínicos como Asunto , Interleucina-6/uso terapéutico , Neoplasias/terapia , Adenocarcinoma/terapia , Neoplasias de la Mama/terapia , Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Células Pequeñas/terapia , Femenino , Humanos , Neoplasias Renales/terapia , Neoplasias Pulmonares/terapia , Melanoma/terapia , Síndromes Mielodisplásicos/terapia , National Institutes of Health (U.S.) , Neoplasias Ováricas/terapia , Estados UnidosRESUMEN
BACKGROUND: Until recently, environmental factors were considered of greatest importance in the etiology of esophageal cancer. Recent studies, however, have suggested that genetic factors also have a role. PURPOSE: Since no formal genetic study of this cancer has been previously reported, we carried out a statistical analysis to determine how important genetic factors are in the etiology of esophageal cancer in high-incidence areas of North China. METHODS: Using a logistic regressive model, we performed a segregation analysis on 221 high-risk nuclear families from the Yaocun Commune, Linxian, Henan Province of China, with at least one affected family member and with all offspring aged 40 years or older. Three models, the mendelian, the environmental, and the no-transmission models, were each compared with the general-transmission model that incorporated both genetic and environmental factors. RESULTS: According to Akaike's Information Criterion, the mendelian model provided the best fit for the data. By the chi-square test, the mendelian inheritance model was not rejected, but the environmental and the no-transmission models were both rejected. CONCLUSION: The segregation analysis indicated an autosomal recessive mendelian inheritance, with the alleged mendelian gene present at a frequency of 19%, causing 4% of this population to be predisposed to develop esophageal cancer. Large, unmeasured, residual familial factors, however, were also significant. IMPLICATIONS: Both an autosomal recessive gene and unexplained environmental factors appear to be important in the etiology of esophageal cancer in the subpopulation studied.
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Neoplasias Esofágicas/genética , Frecuencia de los Genes/genética , Genes Recesivos , China/epidemiología , Neoplasias Esofágicas/epidemiología , Femenino , Humanos , MasculinoRESUMEN
We examined the relation between central body fat distribution and breast cancer in a prospective cohort of women who participated in the Framingham Study. At the baseline examination in 1948, a total of 2,201 women aged 30-62 years were analyzed. An index of central to peripheral body fat (the central adiposity ratio) was calculated from the sum of the trunkal skinfolds (chest, subscapular, and abdominal) divided by the sum of the extremity skinfolds (triceps and thigh). These skinfolds were measured at the fourth examination in 1954. The cohort was followed for up to 28 years and yielded 106 cases of breast cancer. When divided into quartiles based on the central adiposity ratio, only women in the fourth quartile (those with the highest central to peripheral body fat distribution) demonstrated an increased risk for breast cancer. The age- and adiposity-adjusted relative risk estimate for having an increased central adiposity ratio (fourth quartile) compared to lower central adiposity ratios was 1.8 (95% confidence interval, 1.2-2.6). Adjustment for potential confounders of height, parity, and education did not appreciably alter this estimate (1.7, 1.1-2.5). There was no association between degree of adiposity, as measured by the sum of the five skinfolds or by body mass index (weight in kg divided by height in m2), and subsequent breast cancer. The results of this study suggest that increased central to peripheral body fat distribution predicts breast cancer risk independently of the degree of adiposity and may be a more specific marker of a premalignant hormonal pattern than degree of adiposity.