Bone marrow transplantation for Fanconi anemia. Adjustment of the dose of cyclophosphamide for preconditioning

PURPOSE

Five patients with Fanconi anemia have been treated by bone marrow transplantation.

PATIENTS AND METHODS

They were conditioned with cyclophosphamide (CY) (20-150 mg/kg), antilymphocyte globulin, and thoracoabdominal irradiation (4-6 Gy). The dose of CY for preconditioning was adjusted individually, based on the in vitro effect of CY metabolites on the chromosomes of patients with Fanconi anemia. Four patients received marrow from human leukocyte antigen (HLA)-identical siblings, and one received marrow from his HLA phenotypically identical father.

RESULTS

All patients achieved engraftment, and acute graft-versus-host disease (GVHD) grade II or more was not observed. Three developed chronic GVHD. All patients are surviving 2-5 years after grafting, with hematological improvement.

CONCLUSIONS

These results indicate that the individual dose adjustment of CY used for preconditioning may prevent graft failure and severe acute GVHD.

Indications and technique for reopening closed filtering blebs using the Nd:YAG laser--a review and case series

We reviewed the results of Nd:YAG laser treatment used with gonioscopy to reopen the internal sclerostomy in 10 consecutive patients with failing filtering blebs in whom the sclerostomy had become occluded internally with a membrane or iris after filtering surgery. Sixteen to 50 applications of 6- to 6.9-millijoules Nd:YAG laser irradiation were directed to the internal sclerostomy site. In 6 of the 10 patients, filtration was successfully reestablished, initially reducing the mean intraocular pressure (IOP) from 26.5 mm Hg (range, 20 to 40 mm Hg) to 8.6 mm Hg (range, 5 to 16 mm Hg), with an average IOP of 13.5 mm Hg at 7 months after the laser treatment. Nine of the patients were on significantly fewer glaucoma medications. We conclude that the YAG laser can be successfully used to reopen the fistula by the internal approach in carefully-selected patients who previously have had well-established filtering blebs. Identification of these suitable candidates involves careful gonioscopy.

Culture-induced alterations in alveolar type II cell Na+ conductance

Changes in Na+ transport in rat alveolar type II (ATII) cells during culture were quantified and related to alterations in spatial distribution of proteins antigenically related to amiloride-sensitive Na+ channels. Adult rat ATII cells were cultured for periods ranging from 24 to 96 h. When patch clamped in the whole cell mode, both freshly isolated and cultured ATII cells exhibited outwardly rectified Na+ currents. At 0 and 24 h in culture, these currents were equally inhibited by amiloride, benzamil, and 5-(N-ethyl-N-isopropyl)-2',4'-amiloride (inhibitory constant approximately 1 microM). These conductive pathways were equally permeable to Na+ and K+. Immunocytochemical localization at 0 or 24 h in culture revealed the presence of plasma membrane antigenic sites; after 48 h, the appearance of intracellular antigenic sites increased significantly. A single band of molecular mass 135 kDa in membrane proteins of freshly isolated ATII cells was recognized in Western blots; at 48 h in culture, two lower bands with molecular masses of 75 and 65 kDa were detected in either membrane or cytoplasmic proteins. Photolabeling with 2'-methoxy-5'-nitrobenzamil showed that the 135-, 75-, and 65-kDa bands contained amiloride-binding sites. These results suggest the presence of low amiloride affinity conductive pathways in freshly isolated and cultured ATII cells. Culturing ATII cells resulted in internalization and possible breakdown of these pathways and decreased Na+ transport.

Rapid purification of an amiloride-sensitive Na+ channel from bovine kidney and its functional reconstitution

We have used ion-exchange chromatography to isolate and partially purify an amiloride-sensitive Na+ channel protein from bovine renal papillae. The channel was purified by sequential chromatography on an anion-exchange and a cation-exchange cartridge. Five different approaches were applied to monitor the degree of purification of this Na+ channel. First, [3H]Br-benzamil binding activities to the purified proteins were determined. We found that no specific binding was measured in protein fractions eluted from a QUAT anion-exchange cartridge, whereas proteins eluted from an SP cation-exchange cartridge bound [3H]Br-benzamil specifically. Second, we examined the HPLC profiles of purified proteins through both ion-exchange chromatography steps and observed a major peak of very high molecular mass proteins (> 670 kDa) after final purification. Third, using anti-Na+ channel antibodies, Western and slot blot analyses were performed to assess qualitatively the enrichment of channel epitopes at each step of purification. Fourth, amiloride-sensitive 22Na+ influx could be demonstrated after the proteins eluted from the cation-exchange resin were reconstituted into liposomes. Fifth, the proteins eluted from the cation-exchange resin were reconstituted into planar lipid bilayers, and single amiloride-sensitive Na+ channel activity was measured. In summary, we have developed a new protocol applicable for speed- and scale-up purification of a functional amiloride-sensitive Na+ channel from bovine kidney papillae.

Insulin-like growth factor (IGF)-independent action of IGF-binding protein-3 in Hs578T human breast cancer cells. Cell surface binding and growth inhibition

Estrogen receptor-negative Hs578T human breast cancer cells secrete insulin-like growth factor binding protein (IGFBP)-3 and IGFBP-4 as major binding protein (BP) species. Our previous immunohistochemical studies (Oh, Y., Müller, H. L., Pham, H., Lamson, G., and Rosenfeld, R. G. (1992) Endocrinology 131, 3123-3125) have demonstrated the existence of cell surface-associated IGFBP-3 and release of cell surface-associated IGFBP-3 into conditioned media by addition of IGF peptide in Hs578T cells. In this study, we have demonstrated that IGFBP-3 binding on the cell surface is specific and receptor-mediated, by showing: 1) a dose-dependent increase of IGFBP-3 binding by addition of divalent cations (CaCl2 and MnCl2); 2) dose-dependent competition of 125I-IGFBP-3E. coli by unlabeled IGFBP-3E.coli (> 80% competition at 100 nM), but not by IGFBP-1 or fibronectin. In addition, exogenous IGFBP-3 treatment resulted in a significant inhibitory effect on monolayer growth of Hs578T cells. This inhibitory effect of IGFBP-3 was shown to be specific and IGF-independent by demonstrating: 1) dose-dependent inhibition on cell growth (60% inhibition at 20 nM) and inhibition on DNA synthesis (10 nM; p < 0.05, 20 nM; p < 0.005) by exogenous IGFBP-3E. coli, but not by IGFBP-1; 2) absence of stimulatory effects on monolayer cell growth by either native IGFs or IGF analogs which have significantly decreased affinity for IGFBPs, but retain full affinity for type 1 and 2 IGF receptors; 3) significant diminution of the IGFBP-3 inhibitory effects on monolayer growth by coincubation with native IGFs, but not by coincubation with IGF analogs with decreased affinity for IGFBP-3. In conclusion, exogenous IGFBP-3 shows specific binding on the cell surface and can inhibit Hs578T cell monolayer growth by itself, suggesting the existence of specific membrane-associated proteins or receptors for IGFBP-3. Furthermore, IGF-I and -II can attenuate inhibitory effect of IGFBP-3 by forming IGF.IGFBP-3 complexes, thereby preventing cell surface binding of IGFBP-3.

Regulation by phosphorylation of purified epithelial Na+ channels in planar lipid bilayers

To determine the mechanism by which vasopressin increases apical membrane Na+ entry, we evaluated whether or not this hormone could recruit Na+ channels from a subapical membrane pool using specific polyclonal antibodies raised against high amiloride affinity bovine renal papillary Na+ channels. We also studied the effect of protein kinase A (PKA)-mediated phosphorylation on single-channel activity of highly purified Na+ channels incorporated into planar lipid bilayer membranes. PKA induced a significant increase in open-channel probability (Po) with no change in single-channel conductance. As shown previously and reconfirmed in the present work, PKA catalyzed the phosphorylation of a single subunit of this Na+ channel protein, namely, a 300-kDa polypeptide. On the other hand, protein kinase C, in combination with diacylglycerol, Ca2+, and phosphatidylserine, phosphorylated both the 130- and 55-kDa subunits of this purified Na+ channel, with a concomitant decrease in Po of both untreated and previously PKA-treated channels. We also found, in expression studies conducted in confluent monolayers of amphibian renal A6 cells, that vasopressin did not induce the apical insertion of new channel proteins. These observations support the hypothesis that vasopressin increases the apical Na+ permeability by activating Na+ channels already resident in the apical membrane by a direct phosphorylation mechanism rather than by cytoplasmic recruitment of latent Na+ channels.

Single-channel characteristics of a purified bovine renal amiloride-sensitive Na+ channel in planar lipid bilayers

We have purified an amiloride-inhibitable Na+ channel protein from bovine renal papillae using ion-exchange and immunoaffinity chromatography. In the present study, these purified Na+ channels were reconstituted into planar lipid bilayers, and their single-channel characteristics were studied. We observed both large- and small-conductance Na(+)-selective ion channels in planar lipid bilayers. Single-channel conductance for the large- and small-conductance channels saturated as a function of Na+ concentration. These relations could be fitted by a simple Langmuir isotherm with a Michaelis constant of 55 and 45 mM and a maximum open-state conductance of 56 or 8.4 pS, respectively. Both channels were perfectly cation selective, with a Na(+)-to-K+ permeability ratio of 6.7:1 for the large channel and 7.8:1 for the small channel, and their open single-channel current-voltage relations were linear when bathed with symmetrical Na+ solutions. The percent open time of the reconstituted large or small channels varied between 10 and 50% or 1 and 20%, respectively. After application of amiloride, both the large- and small-conductance Na+ channels were inhibited in a dose-dependent manner.

Insulin-like growth factor binding protein (IGFBP)-3 levels in conditioned media of Hs578T human breast cancer cells are post-transcriptionally regulated

Hs578T human breast cancer cells secrete insulin-like growth factor binding protein (IGFBP)-3 (41-kDa and 39-kDa) and IGFBP-4 (24-kDa) as major BP species. In addition, cell surface-associated IGFBP-3 is demonstrable by use of cell monolayer affinity cross-linking or by employing immunoperoxidase staining of the cell surface with specific polyclonal anti-human IGFBP-3 antibodies (alpha IGFBP-3gl and alpha IGFBP-3ngl). In this study, we have demonstrated that regulation of Hs578T IGFBP-3 by IGF peptides is specific, non-receptor mediated, and post-translational by showing: 1) dose-dependent increase of IGFBP-3 in conditioned media(CM) following addition of IGF-I and IGF-II (maximum 8-13-fold increase at 100 ng/ml concentration), but not by insulin up to 1 microgram/ml; 2) confirmation of IGF-induced increases in CM concentrations of IGFBP-3 by means of Western ligand blot, affinity cross-linking, and IGFBP-3-specific radioimmunoassay; 3) increase of IGFBP-3 in CM by addition of IGF analogs which retain full affinity for IGFBPs ([Leu27]IGF-II and [Tyr55,Gln56]IGF-I), but not by IGF analogs which have significantly decreased affinity for IGFBPs ([Gln3,Ala4,Tyr15,Leu16]IGF-I, [Gln6,Ala7,Tyr18,Leu19,Leu27]IGF-II and IGF-I/insulin hybrid); 4) no change in IGFBP-3 mRNA following addition of IGFs; 5) existence of metal ion-dependent IGFBP-3 specific protease in CM and protection of IGFBP-3 from protease by formation of [IGF:IGFBP-3] complexes; and 6) release of cell surface-associated IGFBP-3 into CM by addition of IGF peptides. These studies demonstrate that IGF peptides regulate CM concentrations of IGFBP-3 through non-receptor mediated events, including dissociation of cell surface-associated IGFBP-3 and protection of IGFBP-3 from protease activity.

Characterization of the affinities of insulin-like growth factor (IGF)-binding proteins 1-4 for IGF-I, IGF-II, IGF-I/insulin hybrid, and IGF-I analogs

Insulin-like growth factor (IGF)-binding proteins (BPs) bind IGF-I and IGF-II with high affinity and modify the activity of IGF peptides in a complex manner. We have characterized the affinities of IGFBP-1-4 for IGF-I and -II by employing 1) purified IGFBP preparations, 2) both [125I]IGF-I and [125I]IGF-II as radioligands, and 3) multiple IGF analogs designed to have altered affinities for IGFBPs. To this end, human (h) IGFBP-1, hIGFBP-2, and rat (r) IGFBP-4 have been purified to homogeneity from human amniotic fluid, human prostate epithelial cell culture, and B104 rat neuroblastoma cells; for human IGFBP-3, the glycosylated recombinant form (rec-hIGFBP-3), produced in Chinese hamster ovary cells, was employed. The IC50 values of IGF-I for hIGFBP-1, hIGFBP-2, rec-hIGFBP-3, rIGFBP-4, and human serum IGFBPs were 0.05 +/- 0.01, 5.0 +/- 0.01, 0.25 +/- 0.20, 0.6 +/- 0.4, and 0.1 +/- 0.01 ng/ml, respectively. While hIGFBP-1 and rIGFBP-4 had virtually equivalent affinities for IGF-I and IGF-II, hIGFBP-2 and rec-hIGFBP-3 demonstrated 2- to 5-fold higher affinities for IGF-II than for IGF-I. Studies with [Gln3,Ala4,Tyr15,Leu16]IGF-I and Des-(1-3)-IGF-I indicate that specific residues in the first 16 amino acids of the B domain of IGF-I appear to be critical for binding to all of the IGFBPs tested, but not to IGF receptors. However, severe modifications in the B domain disrupt binding affinity, not only for IGFBPs, but also for receptors (IGF-I/insulin hybrid and B-chain mutant). Interestingly, modifications in the A domain of IGF-I, which is believed to contain residues critical for binding to IGF-I and insulin receptors, show differential effects on binding affinity to BPs. [Thr49,Ser50,Ile51]IGF-I, which has normal affinity for the type I IGF receptor, shows at least a 500-fold decreased affinity for hIGFBP-1 and recombinant hIGFBP-3, in contrast to 50- to 100-fold reduced affinity for hIGFBP-2 and rIGFBP-4, and 5- to 10-fold reduced affinity for purified human serum IGFBP-3. More significantly, [1-27,Gly4,38-70]IGF-I shows a 30-fold decreased affinity for the type I IGF receptor and 10- and 2.5-fold reduced affinities for hIGFBP-1 and rec-hIGFBP-3, respectively, but no reduction in affinity for hIGFBP-2 or rIGFBP-4.(ABSTRACT TRUNCATED AT 400 WORDS)

Non-receptor mediated, post-transcriptional regulation of insulin-like growth factor binding protein (IGFBP)-3 in Hs578T human breast cancer cells

Hs578T human breast cancer cells secrete insulin-like growth factor binding protein 3 (IGFBP-3) as the major BP species. In addition, cell surface-associated IGFBP-3 is demonstrable by the use of cell monolayer affinity cross-linking or immunoperoxidase staining of the cell surface with a specific polyclonal anti-human IGFBP-3 antibody (alpha IGFBP-3 gamma 1). In this study, we have demonstrated that regulation of Hs578T IGFBP-3 by IGF peptides is specific, non-receptor mediated, and post-translational by showing: 1) dose-dependent increase of IGFBP-3 in conditioned media (CM) following addition of IGF-I and -II (maximum 13 fold increase at 100 ng/ml), but not by insulin up to 1 mg/ml; 2) no change in CM IGFBP-3 level by [Gln3,Ala4,Tyr15,Leu16] IGF-I, which has decreased affinity for IGFBPs; 3) no change in IGFBP-3 mRNA following addition of IGFs; 4) release of cell surface-associated IGFBP-3 into CM by the addition of IGFs, but not by [Gln3,Ala4,Tyr15,Leu16]IGF-I. These studies demonstrate that IGF peptides regulate CM concentrations of IGFBP-3 through non-receptor mediated dissociation of cell surface-associated IGFBP-3.

Biochemical evidence for the presence of an amiloride binding protein in adult alveolar type II pneumocytes

An amiloride binding protein in adult rat and rabbit alveolar type II (ATII) cells was characterized using three different antibodies against epithelial Na+ channel proteins. We found that 1) polyclonal antibodies raised against epithelial Na+ channel proteins from bovine kidney cross-react with a 135-kDa protein in ATII membrane vesicles on Western blots; 2) using the photoreactive amiloride analog, 2'-methoxy-5'-nitrobenzamil (NMBA), in combination with anti-amiloride antibodies, we found that NMBA specifically labeled the same M(r) protein; and 3) monoclonal anti-idiotypic antibodies directed against anti-amiloride antibodies also recognized this same M(r) protein on Western blots. We also demonstrated a low benzamil affinity binding site (apparent Kd = 370 nM) in rabbit ATII cell membranes and both high and low benzamil affinity binding sites (apparent Kd = 6 nM and 230 nM) in bovine kidney membranes using [3H]Br-benzamil as a ligand. Pharmacological inhibitory profiles for displacing bound [3H]Br-benzamil were also different between ATII cells and bovine kidneys. These observations indicate that adult ATII pneumocytes express a population of epithelial Na+ channels having a low affinity to benzamil and amiloride and a pharmacological inhibitory profile different from that in bovine kidney.

The insulin-like growth factor II (IGF-II)/mannose 6-phosphate receptor mediates IGF-II-induced motility in human rhabdomyosarcoma cells

Insulin-like growth factor-II (IGF-II) is an autocrine growth and motility factor for human rhabdomyosarcoma. It interacts with three different receptors: the IGF-I, the IGF-II, and the insulin receptor. A specific function of the IGF-II receptor in mediating IGF-II responses has not been defined. In this report we investigate the mechanism of IGF-II-mediated motility in rhabdomyosarcoma cells. We demonstrate that IGF-II and [Leu27]IGF-II, an analog selective for the IGF-II receptor, stimulate motility at concentrations in which they interact only with their own receptor. An antibody that blocks the IGF-I receptor does not inhibit either peptide activity, while an antibody specific for the IGF-II receptor suppresses the IGF-II-induced motility. This antibody does not interfere with rhabdomyosarcoma cell proliferation. We conclude that in rhabdomyosarcoma cells IGF-II stimulates two different responses mediated by distinct receptors: 1) a mitogenic response through the type I receptor and 2) a motility response through the type II receptor.

Immunocytochemical and functional characterization of Na+ conductance in adult alveolar pneumocytes

The purpose of this study was to document the existence, assess the spatial localization, and characterize some of the transport properties of proteins antigenically related to epithelial Na+ channels in freshly isolated rabbit and rat alveolar type II (ATII) cells. ATII cells, isolated by elastase digestion of lung tissue and purified by density-gradient centrifugation, were incubated with polyclonal antibodies raised against Na+ channel protein purified from beef kidney papilla (NaAb), followed by a secondary antibody (goat antirabbit immunoglobulin G conjugated to fluorescein isothiocyanate). Rat ATII cells exhibited specific staining with NaAb at the level of the plasma membrane, which, in most cells, colocalized with that of the lectin Maclura pomiferra agglutinin, an apical surface marker. In Western blots, NaAb specifically recognized a 135 +/- 10-kDa protein in rat ATII membrane vesicles. When patch clamped in the whole cell mode using symmetrical solutions (150 mM Na+ glutamate), ATII cells exhibited outwardly rectified Na+ currents that were diminished by amiloride (10-100 microM) instilled into the bath solution. Ion substitution studies showed that the conductive pathways were three times more permeable to Na+ than K+. Amiloride, benzamil, and 5-(N-ethyl-N-isopropyl)-2',4'-amiloride were equally effective in diminishing 22Na+ flux into rabbit and rat ATII cells (45% inhibition at 100 microM, with IC50 of approximately 1 microM for all inhibitors). Tetraethylammonium chloride (10 mM) or BaCl2 (2 mM), well-known K+ channel blockers, had no effect on 22Na+ uptake. These results indicate that ATII cells express an amiloride-sensitive Na+ conductance, probably a channel, with a lower affinity for amiloride and its structural analogues than the well-established amiloride-sensitive Na+ channels found in bovine renal papila and cultured amphibian A6 kidney cells.

Local and systemic influenza haemagglutinin-specific antibody responses following aerosol and subcutaneous administration of inactivated split influenza vaccine

An easily administered and safe vaccine is required to produce the herd immunity necessary to control influenza epidemics worldwide. A commercial quadrivalent inactivated split influenza vaccine was administered intranasally in aerosol form to a group of 46 volunteers; other groups were given the same vaccine subcutaneously and saline intranasally. The results show that mucosal stimulation via intranasal vaccination resulted in a marked increase in local HA-specific IgA antibodies, and that this stimulation was necessary for serum HA-specific IgA responses. Serum HA-specific IgA antibody levels can be used as indicators of local antigenic stimulation, providing a method for evaluating potency and antigenicity in humans of intranasal influenza vaccine. This vaccination route shows much promise for the future.

A simple and sensitive ELISA of antibodies to pertussis antigens

A precise method for quantifying serum antibody levels to antigens of Bordetella pertussis is required to evaluate pertussis vaccines, to diagnose pertussis infections, and to detect transplacentally transmitted maternal antibodies. The purpose of this paper is to report a rapid, sensitive, easy and standardized ELISA method using polystyrene balls for the assay of serum antibodies against pertussis toxin (PT) and filamentous haemagglutinin (FHA), which are protective antigens of B. pertussis. By the polystyrene ball method, a clear-cut difference was observed between values of pre- and postvaccination serum samples while by the conventional plate method those values overlapped. It was concluded that the PS ball method is one of the most sensitive and simple methods for detecting antibodies against PT and FHA.

Elevation of serum erythropoietin after subtotal parathyroidectomy in chronic haemodialysis patients

After successful subtotal parathyroidectomy (PTX) in 10 chronic haemodialysis patients, significant elevation of Epo was observed, from 48.4 +/- 17.8 mU/ml(M +/- SEM) at preoperative state to 103.3 +/- 34.7 mU/ml at 6 h and 163.4 +/- 50.2 mU/ml at 12 h after PTX. Significant reductions in both PTH-m and ionized calcium (iCa) were confirmed. Since Epo did not increase in the cases with an inadequate PTX and ovariectomy, an abrupt reduction in PTH with a decrease in iCa may play some role in the elevation of Epo.

Enzyme-linked immunosorbent assay of influenza specific IgA antibody in nasal mucus

An enzyme-linked immunosorbent assay of influenza HA specific IgA antibody in nasal mucus is described. This assay is very sensitive and only a minute quantity of nasal mucus is required.