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Research News for July 1996

Genotyping for Alzheimer's is accurate
Duke University researchers report in the July Lancet 1996;347:90-93. that genotyping for Alzheimer's disease has a high degree of accuracy. Dr. Allen Roses and associates examined postmortem brain tissue from 67 patients diagnosed with probable Alzheimer's disease before death. The researchers looked for the characteristic neurofibrillary plaques and tangles associated with Alzheimer's disease and also tested brain tissue for the Alzheimer's disease "susceptibility gene," apolipoprotein E4 (APOE4). On postmortem exam the study found that 85% of the tissue samples came from people who had died of the disease. All of the tissue samples from those who had died from the disease had evidence of APOE4, but none of the tissue samples from persons who had not died from Alzheimer's disease contained evidence of the presence of the epsilon 4 allele.

Interoitus sampling for Chlamydia
The detection of genital Chlamydia trachomatis infection is an important preventive maneuver in high-risk women but the need for skilled clinicians to perform a speculum examination and the reluctance of some women to undergo testing limit widespread screening. These researchers determined the yield of "noninvasive sampling" from the vaginal introitus, and polymerase chain reaction (PCR) testing of these samples, in 300 women attending a sexually transmitted disease clinic in Pittsburgh. Reporting in the American Journal of Obstetrics and Gynecology 1996 May, all of the women also had PCR testing, culture, and enzyme immunoassay of endocervical specimens; and PCR and culture from the urethra. The accuracy of introitus PCR was as good as any other single diagnostic modality. Among a subset of 200 women who also submitted self-collected introitus swabs, the sensitivity was 81 percent and specificity 100 percent. The authors theorize that self-collection of introitus specimen "may revolutionize sexually transmitted disease testing."

Cord blood registry studied
A recent study released in The New England Journal of Medicine (June) strongly suggests that cord blood, blood taken from a newborn's umbilical cord, immediately following birth, has shown to have a lower risk of rejection in transplants than bone marrow. In addition, these recipients had significantly higher survival rates using cord blood, even if it did not come from a family member. This is because cord blood does not have to match the patient's blood and tissue types exactly. As a result of this finding, cord blood may soon come to replace traditional bone marrow transplants because not only is the threat of rejection reduced using cord blood, it also eliminates the long and often fatal waiting period that is typically associated with a bone marrow transplant. Furthermore, cord blood now offers donors, recipients and healthcare providers with a less costly, invasive and painful transplant alternative. researchers from Duke University and New York Blood Center have shown that even genetically mismatched cord blood worked well with young patients. In 23 of 25 patients, all but one of them children, the transplants of cord blood were not rejected.

HIV skin test is reliable
Clinicians often base their interpretation of a negative tuberculin test on simultaneous anergy skin testing. A study reported in the Am J Respir Crit Care Med 1996 Jun; 153:1982-4, examined the reliability of anergy testing in HIV-infected patients. Nearly 500 HIV-infected patients (with CD4 lymphocyte counts distributed reasonably evenly from below 200 to over 600 cells/uL) had serial skin tests with tuberculin, mumps, and candida antigens. At baseline, 36 percent were considered anergic (i.e., they had no response to any skin test). But at one year, a third of these "anergic" patients had a reaction to either mumps or candida antigens. Anergic patients with higher baseline CD4 counts were more likely to become reactive on subsequent testing.

Islet cell transplant successful
VivoRx, Inc., Santa Monica, CA has received FDA approval to initiate Phase I/II clinical trials of encapsulated porcine islets (BetaRx-P) in Type I diabetic patients with kidney transplants. In addition to these Phase I/II trials in patients with kidney transplants, the company has initiated trials with the BetaRx-P product in Type I diabetic patients on no immunosuppression. To date, three patients have received encapsulated porcine islets with highly encouraging results.

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