Anabolic agents and osteoporosis: quo vadis?

There are preclinical studies and limited clinical experiences with bone and muscle anabolic agents (e.g., parathyroid hormone (PTH), sodium fluoride (NaF), prostaglandins (PGs), growth hormones (GH), etc.) that show they have significant advantages over antiremodeling agents in patients with established osteoporosis. The strength of anabolic therapy is as follows: it rapidly reverses bone loss in laboratory animal models and humans, the quality of bone with some agents is believed to be normal, an increase in bone strength in animal models, and a reduction of spinal fracture rate with PTH. The weaknesses of this therapy are high cost, poor understanding of mechanism of action, parenteral mode of administration, rapid bone loss following termination of treatment, abnormal quality of bone, lack of tissue specificity, and undesirable side effects. Both animal and clinical studies have shown one can preserve the bone gain following termination of treatment with antiremodeling agents or exercise based on the lose, restore and maintain (LRM) concept. However, the more important efficacy issues which need to be addressed are tissue specificity and reduction of undesirable side effects. This report will address these issues with the suggestions that the potentiation of the mechanical loading osteogenic response by anabolic agents can overcome the disadvantages which accompany the use of anabolic agents. In addition, the possible role of nitric oxide (NO), an agent required for mechanical loading-induced bone formation, will be discussed.     

Developmental plasticity and evolution—quo vadis?

The role of developmental (phenotypic) plasticity in ecology and evolution is receiving a growing appreciation among the biologists, and many plasticity-specific concepts have become well established as part of the mainstream evolutionary biological thinking. In this essay, I posit that despite this progress several key perspectives in developmental plasticity remain remarkably traditional, and that it may be time to re-evaluate their continued usefulness in the face of the available evidence as the field looks to its future. Specifically, I discuss the utility of viewing plastic development as ultimately rooted in genes and genomes, and investigate the common notion that the environment—albeit a critical source of information—nevertheless remains passive, external to and separable from the organism responding to it. I end by highlighting conceptual and empirical opportunities that may permit developmental plasticity research to transcend its current boundaries and to continue its contributions toward a holistic and realistic understanding of organismal development and evolution.     

Heart valve tissue engineering: quo vadis?

Surgical replacement of diseased heart valves by mechanical and tissue valve substitutes is now commonplace and generally enhances survival and quality of life. However, a fundamental problem inherent to the use of existing mechanical and biological prostheses in the pediatric population is their failure to grow, repair, and remodel. A tissue engineered heart valve could, in principle, accommodate these requirements, especially somatic growth. This review provides a brief overview of the field of heart valve tissue engineering, with emphasis on recent studies and evolving concepts, especially those that establish design criteria and key hurdles that must be surmounted before clinical implementation.     

Iron chelation,quo vadis?

Orally bioavailable chelators for transfusional iron overload have been sought since the introduction of deferoxamine (Desferal) in 1962. Despite tremendous efforts, to date, only deferiprone (Ferriprox) and deferasirox (Exjade) have successfully reached the market, reflecting the difficulty to combine oral activity and safety. Owing to the risk of failure, few new oral chelators can be expected in the future for the treatment of transfusional iron overload. As iron is involved in many disease processes, deferiprone and deferasirox have been proposed to be potentially useful in a variety of indications not characterized by general iron overload. Although it may be possible to obtain clinical benefit from current compounds, more selective chelators tailored to the particular target are needed for successful intervention in these indications.     

Targeted therapeutics and nanodevices for vascular drug delivery: quo vadis?

This issue of the journal is dedicated to targeted delivery of therapeutics in the vasculature, an approach that holds promise to optimize treatment of diverse pathological conditions ranging from ischemia and tumor growth to metabolic and genetic diseases. From the standpoint of drug delivery, circulation system represents the natural route to the targets, whereas its components (blood and vascular cells) represent targets, carriers or barriers for drug delivery. Diverse nanodevices and targeted therapeutic agents that are designed and tested in animal and early clinical studies to achieve optimal and precise spatiotemporal control of the pharmacokinetics, destination, metabolism and effect of pharmacological agents will be discussed in this introductory essay and subsequent critical reviews in this series.     

Gene therapy for autoimmune diseases: quo vadis?

Biological therapies using antibodies and cytokines are becoming widespread for the treatment of chronic inflammatory autoimmune diseases. However, these treatments have several limitations - such as expense, the need for repeated injections and unwanted side-effects - that can be overcome by genetic delivery. This review summarizes the ingenuity, sophistication and variety of gene-therapy approaches that have been taken in the design of therapeutic molecules and vectors, the engineering of cells and the regulation of gene expression for the targeting of disease outcome. We focus our attention on multiple sclerosis, type 1 diabetes and rheumatoid arthritis.     

Heart transplantation in the Netherlands: quo vadis?

Heart transplantation is limited by the lack of donor organs. Twenty years after the start of the Dutch transplant programmes in Rotterdam and Utrecht the situation has even worsened, despite efforts to increase the donor pool. The Dutch situation seems to be worse than in other surrounding countries, and several factors that may influence donor organ availability and organ utilisation are discussed. The indications and contraindications for heart transplantation are presented, which are rather restrictive in order to select optimal recipients for the scarce donor hearts. Detailed data on donor hearts, rejected for transplantation, are shown to give some insight into the difficult process of dealing with marginal donor organs. It is concluded that with the current low numbers of acceptable quality donor hearts, there is no lack of capacity in the two transplanting centres nor is the waiting list limiting the number of transplants. The influence of our current legal system on organ donation, which requires (prior) permission from donor and relatives, is probably limited. The most important determinants of donor organ availability are: 1. The potential donor pool, consisting of brain dead victims of (traffic) accidents and CVAs and 2. Lack of consent to a request for donation. The potential donor pool is remarkably small in the Netherlands, due to relatively low numbers of (traffic) accidents, with an almost equal number of CVA-related brain dead patients compared with neighbouring countries. Lack of consent can only be pushed back by improved public awareness of the importance of donation and improved skills of professionals in asking permission in case there is no previous consent.     

The Utah paradigm on animal models of skeletal disorders: quo vadis?

Skeletal disorders that need effective studies in suitable animal models include "osteoporosis", arthroses and hard and soft tissue healing. For people doing or analyzing such studies this article provides a brief overview and some salient implications of the Utah paradigm of skeletal physiology. The article leaves discussing and resolving any disagreements and controversies about such things to other times, places and people.     

Molecular mechanisms of neuronal migration disorders, quo vadis?

Following terminal mitosis, neuronal precursor cells leave their site of origin and migrate towards their definitive site of residency. In order to establish the intricate cytoarchitecture described in the adult human brain, neuronal migration must be finely regulated. In humans, brain malformations can result from neuronal migration defects. The spectrum of migration disorder severity extends from few heterotopic neurons, as observed in periventricular heterotopia, to a complete cortical disorganization, as observed in cases of lissencephaly. Recently, specific migration disorders have been linked to mutations/deletions in the doublecortin, filamin-1, LIS1 and reelin genes. These proteins act at different levels of the signaling cascades transducing extracellular guiding cues into cytoskeletal reorganization. Here, we summarize the data concerning these four molecules and speculate on their functions and interaction partners during neuronal development.     

Coeliac disease in children and adolescents with type 1 diabetes mellitus: to screen or not, to treat or not?

Coeliac disease is more prevalent in individuals with type 1 diabetes mellitus than in the normal population. It often presents in an atypical or silent form. Specific autoantibodies are found in almost all cases. Untreated coeliac disease may be associated with long-term health risks, so screening and early treatment with a gluten-free diet seem to be justified. However, extended follow-up is needed to document the clinical benefits of screening and treatment in diabetic patients.     

The course of diabetes in children,adolescents and young adults: does the autoimmunity status matter?

Background

Initial classification of diabetes of young may require revision to improve diagnostic accuracy of different forms of diabetes.The aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0–25 years) patients with type 1 diabetes and compare the presentation and course of the disease according to the presence of pancreatic antibodies.

Methods

Cross-sectional population-based study was performed covering 100% of pediatric (n?=?860) and 70% of 18–25 years old adult patients (n?=?349) with type 1 diabetes in Lithuania.

Results

No antibodies (GAD65, IA-2, IAA and ICA) were found in 87 (7.5%) cases. Familial history of diabetes was more frequent in those with antibodies-negative diabetes (24.1 vs. 9.4%, p?<?0.001). Gestational age, birth weight and age at diagnosis was similar in both groups. Ketosis at presentation was more frequent in patients with autoimmune diabetes (88.1 vs. 73.5%, p?<?0.05). HbA1c at the moment of investigation was 8.6 (3) vs. 8.7 (2.2)% in antibodies-negative and antibodies-positive diabetes groups, respectively, p?>?0.05. In the whole cohort, neuropathy was found in 8.8% and nephropathy - in 8.1% of cases, not depending on autoimmunity status. Adjusted for age at onset, disease duration and HbA1c, retinopathy was more frequent in antibodies-negative subjects (13.8 vs. 7.8%, p?<?0.05).

Conclusion

Antibodies-negative pediatric and young adult patients with type 1 diabetes in this study had higher incidence of family history of diabetes, higher frequency of retinopathy, less frequent ketosis at presentation, but similar age at onset, HbA1c, incidence of nephropathy and neuropathy compared to antibodies-positive patients.

     

Foreword: Predicting the responses of animals to their nutrients - quo vadimus?

For its 2006 Annual Meeting BSAS organised an invited session on ‘Responses to Nutrients’. The session was appropriately chaired by Professor Colin Whittemore, who was responsible for the first systematic approach to the integration of information about an animal its feed and the environment in which it was kept, with a view to predicting its responses and simulating its performance (Whittemore and Fawcett, 1976). In his usual indomitable fashion Professor Whittemore questioned whether there was a need for such a session. Was there anything that we did not already about know animals responded to their intake of nutrients? After all models of growth for pigs and poultry have in the past 30 years been able not only to predict such responses, but at the same time to deal with the more challenging task of voluntary feed intake prediction. Such models have been used increasingly to optimise feed and feeding programmes in pig and poultry enterprises worldwide. On the other hand, in ruminants many applied feeding models are still largely based on meeting animal requirements.     

Schistosomiasis in African infants and preschool children: to treat or not to treat?

The occurrence of schistosomiasis in African infants and preschool children has been largely overlooked, with preventive chemotherapy usually focused on school-aged children instead. Two recent surveys by Bosompem et al. and Odogwu et al. have shown that schistosomiasis in younger children is much more common than previously thought. This article highlights the importance of the disease in this age group and discusses the future prospects for schistosomiasis control.     

Are basal metabolic rate prediction equations appropriate for female children and adolescents?

Wong, William W., Nancy F. Butte, Albert C. Hergenroeder,Rebecca B. Hill, Janice E. Stuff, and E. O'Brian Smith. Are basalmetabolic rate prediction equations appropriate for female children andadolescents? J. Appl. Physiol. 81(6):2407-2414, 1996.The basal metabolic rate (BMR), which accountsfor 50-70% of total energy expenditure, is essential forestimation of patient and population energy needs. Numerous equationshave been formulated for prediction of human BMR. Most equations incurrent use are based on measurements of Caucasians performed more thanfour decades ago. We evaluated 10 prediction equations commonly usedfor estimation of BMR in 76 Caucasian and 42 African-American girlsbetween 8 and 17 yr of age against BMR measured by whole-bodycalorimetry. The majority of the prediction equations (9 of10) overestimated BMR by 60 ± 46 kcal/day (range,15-176 kcal/day). This overestimation was found to besignificantly greater (P < 0.05) forAfrican-Americans (77 ± 17 kcal/day) than for Caucasians (25 ± 17 kcal/day) in six equations, controlling for age, weight, and sexualmaturity. We conclude that ethnicity is an important factor inestimation of the BMR and that the current prediction equations are notappropriate for accurate estimation of the BMR of individual femalechildren and adolescents.

     

Quantity and quality of communication during parental deployment: Links to adolescents’ functioning

Using an online survey methodology, we examined individual differences in distance communication between 75 adolescents and their deployed parents and found substantial individual differences in both the quantity and quality of their communication. We also examined the statistical associations between these features of distance communication and adolescents’ functioning, including emotional reactions following communication, health-related quality of life, and externalizing and internalizing problems. The quantity of communication of deployed parents with their adolescents was not associated with adolescents’ functioning, but more positive and less controlling communication was statistically associated with adolescents’ higher functioning. Implications for theory, practice, and future research are discussed.     

Glycosylation diseases: Quo vadis?

About 250 to 500 glycogenes (genes that are directly involved in glycan assembly) are in the human genome representing about 1–2% of the total genome. Over 40 human congenital diseases associated with glycogene mutations have been described to date. It is almost certain that the causative glycogene mutations for many more congenital diseases remain to be discovered. Some glycogenes are involved in the synthesis of only a specific protein and/or a specific class of glycan whereas others play a role in the biosynthesis of more than one glycan class. Mutations in the latter type of glycogene result in complex clinical phenotypes that present difficult diagnostic problems to the clinician. In order to understand in biochemical terms the clinical signs and symptoms of a patient with a glycogene mutation, one must understand how the glycogene works. That requires, first of all, determination of the target protein or proteins of the glycogene followed by an understanding of the role, if any, of the glycogene-dependent glycan in the functions of the protein. Many glycogenes act on thousands of glycoproteins. There are unfortunately no general methods to identify all the potentially large number of glycogene target proteins and which of these proteins are responsible for the mutant phenotypes. Whereas biochemical methods have been highly successful in the discovery of glycogenes responsible for many congenital diseases, it has more recently been necessary to use other methods such as homozygosity mapping. Accurate diagnosis of many recently discovered diseases has become difficult and new diagnostic procedures must be developed. Last but not least is the lack of effective treatment for most of these children and of animal models that can be used to test new therapies.     

Chrysanthemum Biotechnology: Quo vadis?

Chrysanthemum is globally the second most important ornamental in terms of socioeconomic importance. Even though the vast range of flower colors, shapes and forms were initially created using conventional and mutation breeding, transgenic strategies are now more frequently used with Agrobacterium-mediated transformation being the most popular form of introducing foreign genes into chrysanthemums. Even so, transformation efficiency remains dependent on cultivar and regeneration procedure. Transgenic molecular breeding has seen the introduction of important traits such as novel flower color and form and plant architecture, prolonged cut-flower vase-life, resistance to biotic stresses such as viruses/viroids, pathogens and insects. However, chimerism and transgene silencing continue to be limiting factors. Transgenic strategies, despite opening up new avenues for creating new cultivars with improved agronomic and horticultural traits, may be limited due to the risk of transgenic pollen escaping into the wild.