The macrophage capability to recognize bacterial DNA is mimicked by oligodeoxynucleotides containing unmethylated CG dinucleotides ('CpG' motifs) in specific sequence contexts (CpG ODN). CpG ODN stimulates NF-kappaB activation in murine macrophages. In light of the pivotal role played by NF-kappaB in osteoclast differentiation, we examined the ability of CpG ODN to modulate osteoclastogenesis. CpG ODN alone induced TRAP-positive cells in bone marrow macrophage (BMM) cultures, but not multinucleation or calcitonin receptor expression. CpG ODN inhibited RANKL-induced osteoclastogenesis when present from the beginning of BMM culture, but strongly increased RANKL-induced osteoclastogenesis in RANKL-pretreated BMMs. CpG ODN enhanced the expression of interleukin 1beta (IL-1beta) and tumor necrosis factor alpha (TNF-alpha). Antibodies to TNF-alpha and the TNF type 1 receptor, but not the addition of IL-1 receptor antagonist, blocked CpG ODN-induced osteoclastogenesis in RANKL-pretreated cultures. On the other hand, CpG ODN reduced expression of the M-CSF receptor, which is critical during the initiation of osteoclast differentiation. These results suggest that CpG ODN, via the induction of TNF-alpha, support osteoclastogenesis in cells that are committed to the osteoclast differentiation pathway but, due to down-modulation of M-CSF receptor, inhibit early steps of osteoclast differentiation. Thus, CpG ODN represents a potential therapeutic tool for treating bone diseases.

An analysis of the coronary collateral circulation in a consecutive series of 116 postinfarction angiograms from patients with persistent 100% occlusion of their infarct artery is reported. Patients were classified into four groups according to the interval between acute infarction and angiography. Of 42 patients studied within 6 hours of infarction (Group I), 52% had no evidence of any coronary collateral development as compared with only 8% (1 of 16 patients) studied 1 day to 2 weeks after infarction (Group II). Virtually all patients studied beyond 2 weeks after myocardial infarction (14 to 45 days, Group III) and later than 45 days (Group IV) had visible collateral flow. Angiographically "well developed" collateral channels were seen in only 16% of Group I patients compared with 62, 75 and 84% of patients in Groups II to IV, respectively. Of six patients studied twice, on the day of the infarction and 2 weeks later, only one patient had collateral vessels on the day of infarction, whereas all six patients did at follow-up study. Group I patients were studied as part of a randomized acute myocardial infarction reperfusion trial, whereas the other patients were referred for angiography primarily because of post-infarction ischemia. Within the limitations imposed by the patient selection process, it is concluded that well developed coronary collateral vessels are rarely present at the time of infarction. After infarction, they develop rapidly and are generally demonstrable within 2 weeks. It may also be inferred that the preservation of ischemic myocardium by well developed coronary collateral vessels at the time of myocardial infarction may be an uncommon occurrence.

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To better characterize the changes in left ventricular ejection fraction after myocardial infarction, we compared radionuclide ventriculograms obtained acutely and 2 weeks after acute myocardial infarction in 40 patients. These patients underwent angiography within a mean of 4 hr and 20 min after the onset of symptoms of infarction and either received no therapy (32 patients who were control subjects in a thrombolysis trial) or did not experience reperfusion (eight patients) despite receiving streptokinase infusions. In all 40 patients, the change in left ventricular ejection fraction over 2 weeks was small ( + 2.6%). Patients were then grouped according to the presence or absence of residual flow on their angiograms. Residual flow was considered to be present in 21 patients, in 12 by virtue of subtotal occlusion of the artery supplying the area of infarct and in nine because of welldeveloped coronary collaterals to the distal infarct artery. Mean change in ejection fraction for patients with residual flow was + 6.9 ± 2.3% vs -2.2 + 1.7% for patients without residual flow (p < .01). Fourteen of 21 (67%) patients with residual flow had a spontaneous rise in ejection fraction of greater than 5%, as compared with two of 19 (1 1%) patients without residual flow (p < .01). Time to peak level of creatine kinase (CK) was significantly shorter in the residual flow group ( 15 vs 23 hr, p < .01 ), while the peak level of CK was lower (1550 vs 2220 IU) in these patients. This latter difference did not reach statistical significance (p = 10). Of patients with residual flow, those with subtotal occlusion had greater improvement in ejection fraction (9.6 -+ 3.0%) than those with collateral vessels (3.2 3.2%). We conclude that spontaneous improvement in left ventricular ejection fraction is frequently observed in patients after acute myocardial infarction and that the presence of residual flow on angiograms obtained shortly after appearance of symptoms is predictive of subsequent improvement. These findings must be considered when evaluating the results of nonrandomized acute myocardial infarction trials. Circulation 71, No. 3, 466-472, 1985. IN RECENT YEARS a variety of interventions designed to limit myocardial necrosis by early reperfusion of coronary arteries have been proposed. -4To evaluate the impact of these interventions on left ventricular function, most investigators have used serial radionuclide ventriculography. Improvements observed between the short-term and 2 week follow-up study have been ascribed to myocardial salvage secondary to successful intervention.

The microbial oxidation of ebastine to carebastine was investigated. Among the 15 micro-organisms examined, only the Cunninghamella strains showed the desired biotransformation. Cunninghamella blakesleeana oxidised the substrate within 7 days, via the intermediates alcohol and aldehyde, mainly to carebastine, the corresponding carboxylic acid. Optimisation of the culture conditions increased the yield from initially 10% up to a reproducible 40%. For the synthesis of carebastine a substrate concentration of 200 mg/l, a starting pH of 5.0 and the addition of 1% poly(vinyl alcohol) is favourable. The results achieved in experiments with shaking flasks are transferable to the fermentation scale and yielded 270 mg carebastine in a 3-1 fermentation of 600 mg ebastine. The progress of the reaction was detected by TLC and HPLC, the products were identified by mass spectrometry and NMR.