Meeting the needs of home care patients 24 hours a day

Meeting the patient care needs after the regular work day requires agencies to have a well-planned, comprehensive extended-hours program. This description of a large agency's approach to providing this service can be helpful to all agencies, regardless of size and location.

Effect of 1-28 alpha-h atrial natriuretic peptide on acute renal failure in cadaveric renal transplantation

The efficacy and safety of (1-28) alpha-human ANP in preventing acute tubular necrosis (ATN) in cadaveric renal transplantation was tested by comparing ANP infusion with a maximal hydration (MH) regimen which we previously reported as effective in lowering the incidence of ATN (1, 2). Since the production of endogenous ANP increases with volume overloading (3), we hypothesized that increased endogenous ANP production may contribute to the beneficial effects of MH in renal transplant recipients. We thus conducted an open randomized study comparing the effect on early renal allograft function of MH (control group) versus moderate hydration plus ANP infusion (ANP group). Forty patients were blindly paired in two groups of 20 according to the duration of cold ischemia time (mean +/- 2 h). The demographic characteristics of donors and recipients were similar. Using a Swan-Ganz catheter, hemodynamic parameters were monitored for 4 h after transplantation. The group receiving ANP and moderate hydration was perfused to a mean pulmonary arterial pressure (PAP) of < or = 20 mmHg. The PAP in patients receiving MH was driven to > or = 25 mmHg. In the ANP group, a bolus of 100 micrograms of ANP was infused into the graft's renal artery at the time of unclamping, followed by 24 h of continuous intravenous infusion at 0.03 microgram/kg/min. Thereafter, the patients received ANP at a rate of 0.01 microgram/kg/min until the serum creatinine reached < 2 mg/dl. As a consequence of the hydration regimen, the PAP at unclamping was lower in the ANP group than in the control group; 20 +/- 3 and 26 +/- 4 mmHg, respectively (p < 0.05). The ANP plasma levels were significantly higher during the first 3 d in the ANP group (p < 0.001). The median recovery rate of renal function was similar in both groups. No patients in the ANP group experienced ATN while 4 patients (20%) in the control group did (p = 0.125). The need for hemodialysis was markedly reduced in the ANP group compared to the control group (1 ANP-treated patient required dialysis once whereas 5 patients from the control group underwent dialysis a total of 26 times; p = 0.068). ANP administration was well-tolerated and no hypotensive episodes were reported. This preliminary study suggests that ANP infusion is at least as effective as maximal hydration in preventing ATN and represents an efficient alternative for transplantation centers which do not use maximal hydration as a standard regimen in managing kidney allograft recipients.

Factors influencing serum levels and peritoneal clearances of low molecular weight proteins in continuous ambulatory peritoneal dialysis

To identify the factors influencing the serum concentrations and the peritoneal clearances of low molecular weight proteins (LMWP), fourteen patients on continuous ambulatory peritoneal dialysis (CAPD) for 1 to 57 (mean 9.4) months were examined. LMWP [Beta 2-microglobulin (Beta 2m, molecular wt 11.8 kD), cystatin C (cyst C, molecular wt 13.2 kD), Clara cell protein (CC16, molecular wt 15.8 kD), retinol-binding protein (RBP, molecular wt 21 kD) and alpha 1-microglobulin (Alpha 1m, molecular wt 33 kD)] and high molecular weight proteins (HMWP) [albumin (Alb, molecular wt 66 kD), immunoglobulins (IgG, molecular wt 170 kD and IgM, molecular wt 600 kD) and alpha 2-macroglobulin (Alpha 2m, molecular wt 718 kD)] were determined by latex immunoassay in the serum and dialysate collected during the peritoneal equilibration test (PET) with 2.27% dextrose (N = 14), and in dialysate from 56 standard exchanges, performed the day preceding PET, with 1.36% (N = 21), 2.27% (N = 23) and 3.86% (N = 12) dextrose. Determinants of serum concentrations and transperitoneal clearances of the proteins were traced by stepwise regression analysis using as possible contributors age, sex, residual diuresis, duration of the therapy (for serum concentrations), molecular radius of the protein and peritoneal membrane characteristics (for peritoneal clearances). LMWP serum concentrations were markedly increased whereas serum concentrations of HMWP were within the normal range. Residual diuresis, age and duration of dialysis emerged as significant determinants of serum concentration of some proteins, whereas transperitoneal clearance was dependent mainly on the size of the protein and, only for HMWP, on the dwell time. Residual diuresis was inversely related to the serum concentrations of four LMWP. Age was negatively correlated to the serum concentrations of beta 2m, CC16 and RBP. RBP and Alb were the only proteins whose serum concentration significantly decreased with time on CAPD. The relationship between peritoneal clearance and M(r) shows two slopes suggesting the existence of two populations of pores in the peritoneal capillary wall: small pores of about 20 to 25 A radius and large pores exceeding 100 A radius. A long dialysis cycle is associated with significant loss of HMWP only. Daily peritoneal protein losses, in mg (mean +/- SD), were as follows: Beta 2m 43.4 +/- 4.5; cyst C 9.6 +/- 1.8; CC16 1.8 +/- 0.3; RBP 58.9 +/- 11.1; Alpha 1m 149.5 +/- 15.7; Alb 6570 +/- 530; IgG 750 +/- 111; IgM 46.4 +/- 14.9; and alpha 2m 67.0 +/- 12.7. In conclusion, LMWP concentrations in the serum of patients on CAPD were markedly increased and influenced mainly by patient-related factors (residual diuresis and age). Serum albumin and RBP declined with the duration of dialysis. Peritoneal protein loss was determined by the size of the protein and, for large proteins, by the dwell time. The peritoneum behaves as a membrane with at least two populations of pores.

Fetal lung maturation in congenital diaphragmatic hernia

OBJECTIVE

Our purpose was to determine whether congenital diaphragmatic hernia is associated with abnormalities of fetal lung maturation.

STUDY DESIGN

We measured surfactant protein A and saturated phosphatidylcholine in amniotic fluid from 19 pregnancies with a prenatal diagnosis of congenital diaphragmatic hernia (gestational age 16 to 40 weeks) and 48 control pregnancies (gestational age 16 to 39 weeks). Results were compared by analysis of covariance.

RESULTS

Beyond 34 weeks of gestation there was a progressive rise in amniotic fluid surfactant protein A and saturated phosphatidylcholine in control pregnancies, whereas in most fetuses with prenatal diagnosis of congenital diaphragmatic hernia these values remained low (p < 0.01). Amniotic fluid surfactant protein A was lower in fetuses with congenital diaphragmatic hernia who died or required extracorporeal membrane oxygenation than in survivors treated with conventional management (4.9 +/- 2.9 vs 16.8 +/- 5.7 micrograms/ml surfactant protein A, respectively, p < 0.05 by Mann-Whitney U test).

CONCLUSIONS

There are decreased surfactant components in amniotic fluid in many pregnancies complicated by congenital diaphragmatic hernia, which may reflect fetal lung immaturity or hypoplasia.

Low molecular weight proteinuria in Chinese herbs nephropathy

Urinary excretion of five low molecular weight proteins (LMWP) [beta 2-microglobulin (beta 2m), cystatin C (cyst C), Clara cell protein (CC16), retinol-binding protein (RBP) and alpha 1-microglobulin (alpha 1m)], albumin and N-acetyl-beta-D-glucosaminidase (NAG) were quantified in 16 patients who followed a weight reduction program which included Chinese herbs, which have been incriminated in the genesis of Chinese herbs nephropathy (CHN). An additional group of four patients transplanted for CHN were investigated. Urinary data were obtained for comparison purpose in five groups of proteinuric patients: two groups with normal serum creatinine (SCr) and glomerular albuminura [12 patients with diabetes mellitus and microalbuminuria (DN), 10 patients with primary nephrotic syndrome (NS)]; two groups with normal SCr and toxic nephropathy [6 patients with analgesic (AN), 9 patients with cadmium nephropathy (CdN)]; and one group of seven patients with glomerular diseases and increased SCr (GN). Patients were classified according to serum level S beta 2m to take into account the possibility of overflow proteinuria at S beta 2m > or = 5 mg/liter. Three patients (CHN0) with a S beta 2m < 5 mg/liter, had a normal urinary protein pattern including NAG and a normal S beta 2m. Eight patients (CHN1) with a S beta 2m < 5 mg/liter had various abnormalities of their urinary protein pattern. In four of them (CHN1a) only beta 2m, RBP and CC16 were increased while total proteinuria and SCr were normal. In the other four (CHN1b and c) albumin, cyst C, alpha 1m and NAG were also elevated, while total proteinuria and SCr were moderately raised. Five patients (CHN2) with a S beta 2m > or = 5 mg/liter had a markedly increased excretion of all LMWP, albumin and NAG (CHN1 vs. CHN2, P < 0.05) as well as a further increase in total proteinuria and SCr. The urinary LMWP/albumin concentration ratio was strikingly higher in CHN patients than in patients with glomerular albuminuria (CHN1 vs. DN and NS, P < 0.01) or moderate renal failure with elevated S beta 2m level (CHN2 vs. GN, P < 0.01), confirming the existence of a tubular proteinuria independent of glomerular albuminuria or overflow proteinuria. A similar proteinuria pattern was present in the two toxic nephropathies (CdN and AN). This pattern was no longer recognizable after transplantation. In conclusion, CHN exhibits various profiles of tubular proteinuria which are the hallmarks of the disease. This pattern is still detectable in patients with renal failure and/or glomerular albuminuria. It is identical to that observed in cadmium and analgesic nephropathies. It does not recur after transplantation. Its most sensitive and reliable marker is a raised urinary level of CC16 or RBP.

Potential role of Clara cell protein, an endogenous phospholipase A2 inhibitor, in acute lung injury

It is now recognized that epithelial cells lining airways and alveoli are capable of releasing various mediators, which have the potential to modulate local inflammatory reactions. The amount of the 16 kDa Clara cell protein (CC16), an inhibitor of phospholipase A2 activity produced by pulmonary epithelial cells, was measured by means of a sensitive immunoassay in the unconcentrated bronchoalveolar lavage fluid (BALF) of 13 control subjects, and in patients with acute lung injury (14 with the full-blown adult respiratory distress syndrome (ARDS); 21 after standard cardiopulmonary bypass surgery, a known risk factor for ARDS). The level of CC16 was compared with other markers of inflammation with a wide range of molecular weights: albumin (nephelometry); total protein (spectrophotometry); beta 2-microglobulin (latex immunoassay); cystatin C (latex immunoassay); alpha 1-antitrypsin (immunoradiometry), and lipocortin-1 (enzyme-linked immunosorbent assay (ELISA)). The Clara cell protein (CC16) was detectable in all BALF, and significantly higher levels of this protein were observed in BALF from patients with acute lung injury. Changes in BALF Clara cell protein levels differed from those of alpha 2-macroglobulin and the natural phospholipase inhibitor lipocortin-1. Alpha 2-macroglobulin levels were not significantly enhanced in patients at risk for ARDS, but were increased in patients with ARDS; whereas, lipocortin 1 levels were not elevated in either group. Pretreatment of patients at risk for ARDS with high dose methylprednisolone did not alter the amount of Clara cell protein recovered in BALF. The mean CC16 level in BALF from patients with ARDS who died was significantly lower than from those who survived. The data presented in this study suggest that pulmonary epithelial cells secrete a natural anti-inflammatory protein during acute lung injury, which might have a protective and immunosuppressive role.

Expression of fatty acid binding protein in the liver during pregnancy and lactation in the rat

Expression of the liver fatty acid binding protein (L-FABP) has been studied in the liver of pregnant and lactating rats. The L-FABP concentration found in the cytosol by immuno-enzymatic assay (ELISA) was consistently higher in the dams during the pregnancy and the lactation than in the age-matched virgin females. Paradoxically, a decrease in the L-FABP mRNA level occurred in the maternal liver during the last days of the gestation. This level remained low on days 7 and 14 of the lactation. Since the transcription rate of the L-FABP gene was unchanged in the maternal liver, these data suggest a post-transcriptional regulation of the L-FABP during pregnancy and lactation in the rat. The nutritional adaptations occurring during pregnancy and lactation are not involved in this regulation since a chronic maternal food-restriction failed to correct these modifications. The mechanism of this regulation is presently unknown, but possibilities include hormonally mediated effects.

Sphingosine, oleylamine and stearylamine inhibit both CD11a/CD18-dependent and -independent homotypic aggregation: demonstration by cytofluorimetry

An CD11a/CD18-dependent homotypic aggregation pathway is induced by triggering CD45 molecules on human thymocytes. By contrast, a CD11a/CD18-independent homotypic aggregation process is induced by triggering the CD99 molecule (E2, MIC2 gene product) expressed at the surface of either Jurkat T cells or human thymocytes. A new quantitative method based on FACS analysis of aggregated cells was used and allowed to show that both types of aggregation (CD11a/CD18-dependent and CD11a/CD18-independent) were inhibited with sphingosine, oleylamine or stearylamine. These three compounds had no effect on the expression of CD99, CD45, CD11a, CD18 or other [correction of others] known integrins expressed at the surface of the cells studied.

The effect of cooling and hypertonic exposure on murine oocyte function, fertilization, and development

Several individual but related steps are involved in the cryopreservation process, including the addition of cryoprotectants at various temperatures, cooling to subzero temperatures, and long-term storage. The process is completed by rewarming and removal of cryoprotectants prior to a return to physiological conditions. In this series of experiments we have attempted to distinguish the effects of some of these procedures. Control, untreated ovulated mouse oocytes showed 95% in vitro fertilization (190/200) and 92% subsequent development to hatching blastocyst (184/200). Exposure of oocytes to either isotonic or hypertonic media at 37 degrees C did not significantly change the rate of fertilization (90%, 108/120; and 89%, 154/174, respectively) or subsequent embryonic development (85%, 102/120; and 82%, 143/174, respectively). Slow cooling in isotonic medium (-3 degrees C/min) to 0 degree C had no effect on the rate of fertilization (83%, 103/124), but rapid cooling (> 1000 degrees C/min) to 0 degree C resulted in a significant reduction in fertilization rate to 75% (151/202). When oocytes suspended in a hypertonic solution were cooled using slow or rapid rates, there were marked decreases in fertilization to 26% (61/231) and 56% (156/278), respectively. Subsequent embryonic growth was reduced to 15% (34/231) after slow cooling and 26% (72/278) after rapid cooling. Exposure of oocytes to glycerol at 37 degrees C and dimethyl sulfoxide at 0 degree C reduced the fertilization rate to 57% (67/118) and 73% (103/145), respectively, with a corresponding reduction in embryonic growth to 52% (61/118) and 65% (94/145), but there were no additional effects of cooling or hypertonic exposure after addition of cryoprotectants.

Clara cell protein (CC-16) induces a phospholipase A2-mediated inhibition of fibroblast migration in vitro

Clara cell protein (CC-16, also designated CC-10) is synthesized by the bronchiolar epithelium and has been suggested as an inhibitor of phospholipase A2 (PLA2) activity. Therefore, CC-16 is a candidate for controlling inflammatory events in the lung. Because CC-16 amounts and function may be altered in fibrosing lung diseases in which bronchiolar injury has been reported, it was measured in alveolar fluids and sera. Secretory PLA2 activity in alveolar fluids and the influence of CC-16 on platelet-derived growth factor-induced human fibroblast chemotaxis and cytosolic PLA2 activity were also explored. CC-16 content was decreased in alveolar fluids from idiopathic pulmonary fibrosis (IPF: 1.3 +/- 0.1 mg/L) and bleomycin lung (1.1 +/- 0.2 versus 2.1 +/- 0.2 mg/L in controls, p < 0.05), whereas there was a three- to ninefold increase in secretory PLA2 activity (p < 0.05 versus controls). CC-16 inhibited fibroblast chemotaxis in a dose-dependent manner (90% inhibition at 30 micrograms/ml CC-16). This inhibition was reversed by reducing CC-16. CC-16 was also able to lower fibroblastic cytosolic PLA2 activity by 50% in vitro. In summary, CC-16 is able to inhibit fibroblast chemotaxis in vitro by mechanisms that may be related to a blockage of cytosolic PLA2 activity. It can be postulated that CC-16 deficiency may contribute to fibroblast burden activity in fibrosing lung diseases.

Cassette baculovirus vectors for the production of chimeric, humanized, or human antibodies in insect cells

Plasmid cassette-transfer vectors pBHuC chi and pBHuC gamma l have been designed which enable the construction of recombinant baculoviruses directing the co-expression of complete immunoglobulin in insect cells. We describe the application of these vectors for the expression of a human/mouse chimeric monoclonal antibody of potential immunosuppressive clinical value derived from a mouse anti-human CD29 monoclonal antibody (Mu-K20). The chimeric K20 light and heavy chains produced in sf9 insect cells were correctly processed and assembled into a normal immunoglobulin which is secreted into the culture medium of infected cells. The chimeric mAb Ch-K20-sf9 reproduces in vitro the functional properties of the parental mouse K20, including affinity and inhibition of lymphocyte proliferation. These results demonstrate that the baculovirus/insect cell expression system is suitable for the expression of fully active monoclonal antibodies of therapeutic value. Our generic cassette approach makes this system a very flexible and convenient one for the rapid production of either chimeric, humanized or human mAb with heavy and light chains of any isotype.

The glycosylphosphatidylinositol-anchored CD59 protein stimulates both T cell receptor zeta/ZAP-70-dependent and -independent signaling pathways in T cells

The glycosylphosphatidylinositol (GPI)-anchored CD59 protein (human protectin) protects cells against complement-induced lysis, binds to CD2 and also transduces activation signals within T cells. We have further examined the biochemical signals transduced by CD59 and addressed its role in regard to the CD3-mediated signaling cascade. We show here that CD59 cross-linking induces a time-dependent activation of p56lck and of p70zap (ZAP-70) in CD3-positive Jurkat cells, leading to the stimulation of the T cell receptor zeta/ZAP-70 signaling cascade and interleukin-2 (IL-2) synthesis. Cross-linking of CD59 on peripheral T cells and thymocytes induces tyrosine phosphorylations identical to those seen in Jurkat cells and this is followed by lymphokine production and proliferation. In contrast, only activation of CD59-associated p56lck occurs in CD3-negative Jurkat cells, while IL-2 production is impaired, consistent with the lack of ZAP-70 tyrosine phosphorylation observed in these cells. CD59 triggers activation events even in the absence of CD3/T cell receptor expression in Jurkat cells. CD59 cross-linking synergizes with sub-optimal doses of phorbol ester for activation of the protein kinase C and of the p42mapk, as shown by in vitro phosphorylation of histone HIIIS and myelin basic protein, respectively, and leads to CD25 but not CD69 expression. In conclusion, at least two signaling pathways are triggered through CD59, the first one involving ZAP-70 activation and leading to IL-2 secretion and a second pathway observed in the absence of ZAP-70 activation leading to CD25 expression. These two pathways are likely to be involved in the modulation of T cell activation by CD59 protein.

Identification of key charged residues of human interleukin-5 in receptor binding and cellular activation

Interleukin-5 (IL-5) is a cytokine that plays a major role in the differentiation and activation of eosinophils. In order to identify which charged residues of human IL-5 are important in binding to its receptor and subsequent cellular activation, we have systematically replaced all of the clusters of charged amino acids with alanine residues. The mutants have been expressed in Escherichia coli, renatured, and purified. They were assayed for ability to cause proliferation of the erythroleukaemic cell line TF-1 and the up-regulation of eosinophil adhesion to ICAM-1. In addition, we studied receptor binding using either immobilized recombinant IL-5 receptor alpha-chain or the alpha/beta-receptor complex expressed on TF-1 cells. The key charged residue involved in binding to the beta-chain of the receptor is Glu-12. This residue is in an identical position to those previously identified in IL-3 and granulocyte-macrophage colony-stimulating factor (GM-CSF) involved in binding to the receptor beta-chain. The alpha-chain binding site is shown to involve the side chains Arg-90 and Glu-109, located in the second beta sheet and after the end of the fourth helix, respectively. It is unique to IL-5 and does not occur in IL-3 or GM-CSF. Understanding the topology of the interaction of IL-5 with its receptor chains will help in the search for rationally designed antagonists of IL-5 function.

Oleylamine and stearylamine increase phosphatidylserine synthesis in T cells by synergy with calcium ions

Oleylamine and stearylamine, two cationic amphiphilic drugs, strongly increase phosphatidylserine synthesis in human T cells. The two compounds had little effect on either phosphatidylcholine or phosphatidylethanolamine synthesis. A decrease in the formation of phosphatidylethanolamine through decarboxylation of phosphatidylserine was observed, but this effect is only marginally involved in increased phosphatidylserine synthesis. The high incorporation of [3H]-serine into phosphatidylserine is a protein kinase C independent process and is due to a synergy of either oleyamine or stearylamine with calcium ions.

Monocyte-independent T cell activation by simultaneous binding of three CD2 monoclonal antibodies (D66 + T11.1 + GT2)

Mitogenic pairs of CD2 mAb typically transduce activation/proliferation signals within T cells. However, complementary signal(s) provided by accessory cells are required to induce T cell proliferation. We show here that a particular combination of three CD2 mAb, D66 + GT2 + T11.1, leads to the proliferation of highly purified human T lymphocytes, without other complementary signal(s). The CD2 triplets was able to induce CD4+ and, to a lesser extent, CD8+ cells to proliferate. Interestingly, the so-called "naive" T cells (CD45RA+) were strongly stimulated, but more immature cells, such as thymocytes, were not. The proliferative response induced by the CD2 triplet was entirely mediated by the IL-2 autocrine pathway, as shown by the complete inhibition with anti-IL2 Ab. T cells stimulated with the CD2 triplet were also able to secrete TNF alpha. We found no evidence for an unusual secretion of cytokines that might explain the lack of requirement of complementary signal(s). As high as it was, the proliferation induced by the CD2 mAb triplet could be further increased by the addition of IL-1, and this proliferative fraction could be inhibited by antibodies against TNF alpha. The CD2 mAb triplet increased [Ca2+]i, while mitogenic CD2 mAb pairs needed the presence of a cross-linking agent. Thus, our data show that T cells can be activated to fully proliferate by this particular CD2 pathway, in the absence of accessory signal(s).

Real-time monitoring of antigen-antibody recognition on a metal oxide surface by an optical grating coupler sensor

Real-time monitoring of intermolecular interactions can provide a direct and rapid estimate of the affinity and kinetics of interactions between biomolecules. Optical methods based on the measurement of changes of refractive index in the immediate vicinity of a liquid-solid interface are particularly convenient because they require no radioactive, fluorescent or other labelling of the molecules under study. In the present work we have followed the specific interaction of protein molecules on a SiO2/TiO2 surface with the help of the optical grating coupler sensor instrument BIOS-1. This instrument allows the determination of the absolute mass of protein adsorbed to the sensor surface and, therefore, the calculation of the molar ratio of the components partaking in an intermolecular interaction. For example, about 3 ng avidin/mm2 surface area could be adsorbed. This amount closely corresponds to a monolayer composed of densely packed globular avidin molecules. A dimeric, biotinylated leucine zipper peptide was bound to this avidin layer at a molar ratio of 1:1 (1 peptide molecule/4 biotin binding sites of tetrameric avidin). An average of 1/2.6 peptides was recognized by a peptide-specific monoclonal antibody. Even though avidin was not covalently bound to the sensor surface, the avidin-coated chip could be used repeatedly to measure the time course of antibody binding as a function of the concentration of the antibody. From such measurements it was possible to calculate the association and dissociation rate constants assuming that the interaction of the antibody with the surface-bound antigen can be described by a simple Langmuir binding model. The limits of the Langmuir model are discussed. The same antigen-antibody reaction was also analyzed by a surface plasmon resonance biosensor (BIAcoreTM, Pharmacia). The results obtained with the two instruments, which register different optical phenomena and employ different surface chemistry, were in good agreement.

Health risk assessment of long-term exposure to non-genotoxic chemicals: application of biological indices

For chemical pollutants, health risk assessment of long-term exposure is usually best realized through an epidemiologic approach which attempts to link cumulative levels of exposure to the potential for occurrence of early adverse effects. For some chemicals, however, the frequency of peak exposures may be more relevant for assessing the health risk than the integrated dose. In very few circumstances, biological exposure indices directly reflect the cumulative dose (e.g. PCB in blood). More frequently they are indicators of short-term interval dose but provided they have been measured with a sufficient frequency, their integration over the duration of exposure may represent a valid surrogate of the cumulative dose. This has been clearly demonstrated for lead or cadmium in blood. The selection of the appropriate biological effect markers for the study of the dose-effect/dose-response relationships is frequently a controversial issue when information on the mechanism of action of the pollutant is insufficient. In this case, the study of the health significance of the observed biological changes may be required for assessing a meaningful no-adverse-effect level. For example, in adult male workers moderate exposure to lead may affect the synthesis of vasodilatory prostaglandins in the kidney but presently there is no indication that this effect should be taken into account to define the acceptable occupational exposure level to lead because it is not associated with an impairment of the hemodynamic response of the kidney to an acute protein load. On the contrary, a low-molecular-weight proteinuria induced by cadmium may be predictive of an increased age-related decline of the glomerular filtration rate. Although the use of early biological effect markers for the study of the dose-effect or dose-response relationships in humans is probably less affected by selection biases than morbidity data, the possibility of such an interference cannot be excluded. For example, in the general population, the tubulotoxic effects of cadmium may occur at a lower body burden of the metal than in adult male workers. Whatever the adverse biological effect considered, the application of an uncertainty factor remains justified when extrapolating a no-effect level from adult male workers to the general population.

Induction of MMP9 (92 kDa gelatinase) activity and expression of tissue inhibitor of metalloproteinase-2 mRNA (TIMP-2) in primitive neuroectodermal cells infected with retrovirus HTLV-I

Matrix-degrading proteases, including metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), are involved in modulation of the extracellular matrix, which participates in neural cell differentiation, brain morphogenesis and tissue integrity. Metalloproteinases and TIMPs are associated with inflammatory and degenerative processes in the central nervous system and are regulated by cytokines. Human retroviral infections are frequently associated with neurological disturbances. In the present paper, we have studied the changes occurring in human primitive neuroectodermal cells following infection with human T cell lymphotropic virus type 1 (HTLV-I), a retrovirus responsible for HTLV-I-associated myelopathy. Infected neural cells were found to have high metalloproteinase 9 (MMP9-92 kDa gelatinase) activity. MMP9 induction is dependent on HTLV-I infection of neural cells. In addition, soluble factors, especially tumour necrosis factor alpha, secreted by infected cells, act as mediators of induction. HTLV-I infection also induces expression of RNA coding for tissue inhibitor of metalloproteinase 2. These observations indicate that HTLV-I infection selectively modulates the expression of molecules involved in the dynamic equilibrium between the synthesis and degradation of the neural cell matrix and leads to its remodelling, which modifies cell-cell interactions and cellular function.

Vitrification of human oocytes following minimal exposure to cryoprotectants; initial studies on fertilization and embryonic development

Investigations were made into the low temperature preservation of pre-ovulatory human oocytes by vitrification using a method of brief exposure of the oocytes to the vitrification solution at room temperature. Assessments of morphological survival, fertilization and embryonic development were recorded. All those oocytes exposed to the vitrification solution alone were morphologically normal and 86% of them were fertilized after incubation with spermatozoa. All the fertilized ova (86%) underwent cell division. Following cooling to -196 degrees C, morphological survival (65%) and fertilization (45%) rates remained high. However, in all vitrified oocytes, embryonic cell division and further development were inhibited. From our study it appears that fresh human oocytes can be vitrified using only brief exposure to cryoprotective agents and survive to undergo fertilization. However, progress remains to be made in achieving further embryonic development.

Low-molecular-weight proteins as markers of organ toxicity with special reference to Clara cell protein

Low-molecular-weight (M(r) between 5 and 40 kDa) proteins present several features related to their small size making them potentially interesting biomarkers of toxicity. They are readily exchangeable and might serve as peripheral indicators of toxic events in relatively inaccessible target organs. They have a short half-life in plasma and may thus respond to both acute and chronic toxic effects. Their catabolism takes place in the proximal tubule which is the segment of nephron which is the most vulnerable to toxic injury. Low-M(r) proteins have been used hitherto in toxicology mainly in relation to their renal handling, i.e. as markers of proximal tubule dysfunction or of glomerular filtration rate, e.g. beta 2-microglobulin (beta 2-m), alpha 1-microglobulin (alpha 1-m) and retinol-binding protein (RBP). The potential of low-M(r) proteins as biomarkers of toxicity might go beyond the field of nephrotoxicity, as suggested by our investigations on a new low-M(r) protein called protein 1 or Clara cell protein (CC16). CC16 is a 16-kDa protein synthesised by non-ciliated cells of the tracheobronchial epithelium, among which the Clara cells which, because of their high xenobiotic-metabolizing activity, are particularly vulnerable to a number of air pollutants. CC16 secreted in the respiratory tract diffuses passively by transsudation into the serum where it may mirror changes occurring in the lung. Recent studies on subjects exposed to lung toxicants (e.g. tobacco smoke and silica) suggest that CC16 in serum or bronchoalveolar lavage fluid is a sensitive marker of bronchial tree injury. CC16 is handled by the kidney as other low-M(r) proteins and may also be used to detect proximal tubule dysfunction. In this respect too, CC16 shows a unique sensitivity and can detect very subtle defects in proximal tubular dysfunction that remain undetected when screening is based on the assay of classical urinary low-M(r) proteins (i.e. beta 2-m, alpha 1-m or RBP).

Calmodulin, a junction between two independent immunosuppressive pathways in Jurkat T cells

Calmodulin (CaM) antagonists chlorpromazine, trifluoperazine, and N-(6-aminohexyl)-5-chloro-1-naphthalene-sulfonamide HCl inhibit Jurkat T cell activation, as monitored by measuring interleukin-2 synthesis in cells treated by a combination of CD3 monoclonal antibody and phorbol myristate acetate. T cell activation with CD3 monoclonal antibody is accompanied by a decreased synthesis of phosphatidylserine due to the release of Ca2+ from the endoplasmic reticulum. CaM antagonists reverse the phosphatidylserine (PtdSer) inhibition induced by CD3. This increase of PtdSer synthesis was observed in the absence of any modification of CD3-induced Ca2+ movements. Both in intact cells and in an acellular system, the increase of PtdSer synthesis induced by CaM antagonists was abolished in the presence of EGTA, indicating that the base exchange enzyme system responsible for PtdSer synthesis is regulated by CaM provided that Ca2+ is present. By contrast, cyclosporin A that inhibits T cell activation through the interaction of cyclophilin-cyclosporin A complexes with the calmodulin-activated phosphatase, calcineurin, had no effect on PtdSer synthesis. Calmodulin thus appears as a junction leading to at least two independent pathways of regulation of T cell activation, one involving the calcineurin phosphatase and the other the base exchange enzyme system responsible for PtdSer synthesis.

Recombinant soluble trimeric CD40 ligand is biologically active

CD40 ligand (CD40L) is expressed on the surface of activated CD4+ T cells, basophils, and mast cells. Binding of C40L to its receptor, CD40, on the surface of B cells stimulates B cell proliferation, adhesion and differentiation. A preparation of soluble, recombinant CD40L (Tyr-45 to Leu-261), containing the full-length 29-kDa protein and two smaller fragments of 18 and 14 kDa, has been shown to induce differentiation of B cells derived either from normal donors or from patients with X-linked hyper-IgM syndrome (Durandy, A., Schiff, C., Bonnefoy, J.-Y., Forveille, M., Rousset, F., Mazzei, G., Milili, M., and Fischer, A. (1993) Eur. J. Immunol. 23, 2294-2299). We have now purified each of these fragments to homogeneity and show that only the 18-kDa fragment (identified as Glu-108 to Leu-261) is biologically active. When expressed in recombinant form, the 18-kDa protein exhibited full activity in B cell proliferation and differentiation assays, was able to rescue of B cells from apoptosis, and bound soluble CD40. Sucrose gradient sedimentation shows that the 18-kDa protein sediments as an apparent homotrimer, a result consistent with the proposed trimeric structure of CD40L. This demonstrates that a soluble CD40L can stimulate CD40 in a manner indistinguishable from the membrane-bound form of the protein.

Molecular correlates between reactive and developmental plasticity in the rat hippocampus

Area CA3 of the hippocampus is the most epileptogenic structure of the brain. Various studies have shown that kainate-induced experimental epilepsy in rats and human cases of epilepsy are associated with sprouting of the mossy fibers of the dentate granule neurons and selective loss of pyramidal neurons, notably in the CA3-CA4 areas of Ammon's horn. In experimental models of epilepsy, brief seizure activity initiates a cascade of molecular alterations that will contribute to changes in the expression of numerous genes, which can last several weeks. The products of some of these genes will contribute to the permanent state of enhanced synaptic efficiency, to the sprouting and formation of novel excitatory synapses, and possibly to neuronal cell loss. The expression of genes encoding transcription factors and numerous growth factors is rapidly altered following seizure episodes. Based on observations in vivo and in vitro in cultured hippocampal neurons, it is hypothesized that an interplay between transcription and growth factors, because of their pleiotropic effects on the regulation of effector genes, may be instrumental in coupling transient extracellular stimuli to irreversible cellular alterations.