CTLA4 Autoimmunity-Associated Genotype Contributes to Severe Pulmonary Tuberculosis in an African Population

The gene of Cytotoxic T Lymphocyte-associated Antigen 4 (CTLA4), a negative regulator of T lymphocytes, contains a single-nucleotide polymorphism (SNP) at position +6230A->G (ct60A->G), which has been found associated with several autoimmune diseases and appears to reduce T-cell inhibitory activity. In Ghana, West Africa, we compared the frequencies of CTLA4 +6230 A/G and 6 haplotype-tagging SNPs in 2010 smear-positive, HIV-negative patients with pulmonary tuberculosis (TB) and 2346 controls matched for age, gender and ethnicity. We found no difference in allele frequencies between cases and controls. However, +6230A and a distinct CTLA4 haplotype and a diplotype comprising the +6230A allele were significantly less frequent among cases with large opacities in chest radiographs compared to those with small ones (P_{corrected [cor]} = 0.002, P_cor = 0.00045, P = 0.0005, respectively). This finding suggests that an increased T-cell activity associated with the CTLA4 +6230G allele contributes to pathology rather than to protection in pulmonary TB.     

Skeletal muscle creatine kinase MB alterations in women marathon runners

Total creatine kinase (CK) and CK MB activities were determined in gastrocnemius muscle and serum obtained from 14 female marathon runners. The level of CK MB in muscle increased significantly (p less than 0.05) after chronic exercise training from 5.3% to 10.5% of the total CK activity, but not after acute exercise (post-marathon 8.9%). No significant differences in total CK activities were detected. However, the total CK activity in the muscles were significantly (p less than 0.05) less than those previously reported from the muscle of men runners (1800 U/g, 3000 U/g respectively). No significant correlation existed between fiber type and muscle CK MB activity. Additionally, trace amounts of mitochondrial CK and CK BB were present in muscle homogenates. A significant correlation was observed in the increase in mean serum total CK (597 UL-1) and CK MB (23 UL-1) activities 24 h after the race (r = 0.97, p less than 0.05). These results suggest that gastrocnemius muscle in women adapts to training with increased CK MB activities and imply that skeletal muscle is the major source of elevated serum CK MB activities in women marathon runners.     

Describing Ordinal Odds Ratios for Stratified r × c Tables

For an r × ctable with ordinal responses, odds ratios are commonly used to describe the relationship between the row and column variables. This article shows two types of ordinal odds ratios where local‐global odds ratios are used to compare several groups on a c‐category ordinal response and a global odds ratio is used to measure the global association between a pair of ordinal responses. When there is a stratification factor, we consider Mantel‐Haenszel (MH) type estimators of these odds ratios to summarize the association from several strata. Like the ordinary MH estimator of the common odds ratio for several 2 × 2 contingency tables, the estimators are used when the association is not expected to vary drastically among the strata. Also, the estimators are consistent under the ordinary asymptotic framework in which the number of strata is fixed and also under sparse asymptotics in which the number of strata grows with the sample size. Compared to the maximum likelihood estimators, simulations find that the MH type estimators perform better especially when each stratum has few observations. This article provides variances and covariances formulae for the local‐global odds ratios estimators and applies the bootstrap method to obtain a standard error for the global odds ratio estimator. At the end, we discuss possible ways of testing the homogeneity assumption.     

Endothelin blockade augments pulmonary vasodilation in the ovine fetus

Ivy, D. Dunbar, John P. Kinsella, and Steven H. Abman.Endothelin blockade augments pulmonary vasodilation in the ovine fetus. J. Appl. Physiol. 81(6):2481-2487, 1996.The physiological role of endothelin-1 (ET-1) inregulation of vascular tone in the perinatal lung is controversial.Recent studies suggest that ET-1 contributes to high basal pulmonaryvascular resistance in the normal fetus, but its role in the modulationof pulmonary vascular tone remains uncertain. We hypothesized that highET-1 activity opposes the vasodilator response to some physiological stimuli such as increased pressure. To test the hypothesis that ET-1modulates fetal pulmonary vascular responses to acute and prolongedphysiological stimuli, we performed a series of experiments in thelate-gestation ovine fetus. We studied the hemodynamic effects of twoET-1 antagonists, BQ-123 (a selectiveET_A-receptor antagonist) andphosphoramidon (a nonselective ET-1-converting enzyme inhibitor) duringmechanical increases in pressure due to partial ductus arteriosuscompression in chronically prepared late-gestation fetal lambs. Incontrol studies, partial ductus arteriosus compression decreased theratio of pulmonary arterial pressure to pulmonary artery flow in theleft lung 34 ± 6% from baseline. Intrapulmonary infusions ofBQ-123 (0.5 µg/min for 10 min; 0.025 µg/min for 2 h) orphosphoramidon (1.0 mg/min for 10 min) augmented the peak vasodilatorresponse during ductus arteriosus compression (52 ± 3 and 49 ± 6% from baseline, respectively, P < 0.05 vs. control). In addition, unlike the transient vasodilator response to ductus arteriosus compression in control studies, ET-1blockade with BQ-123 or phosphoramidon prolonged the increase in flowcaused by ductus arteriosus compression. In summary,ET_A-receptor blockade andET-1-converting enzyme inhibition augment and prolong fetal pulmonaryvasodilation during partial compression of the ductus arteriosus. Weconclude that ET-1 activity modulates acute and prolonged responses ofthe fetal pulmonary circulation to changes in vascular pressure. Wespeculate that ET-1 contributes to regulation and maintenance of highpulmonary vascular resistance in the normal ovine fetal lung.