Securing systems leadership by local government through health and wellbeing strategies

Background

The aim of this study was to strengthen Health and Wellbeing Strategies (HWSs) by identifying potential areas for system leadership across local authorities in relation to specific aspects of health/illness, wider determinants of health and transformational change management.

Method

The work involved a document analysis of strengths of the first 12 HWSs produced in the North East of England applying principles of appreciative inquiry (AI), followed by a knowledge-to-action group approach with stakeholders. A summative event resulted in Health and Wellbeing Board (HWB) members identifying potential areas for collaboration.

Results

The study identified diverse examples of good practice, and considerable consensus in terms of key priorities, both wider determinants such as employment, transport and housing, and subject areas such as lifestyle issues and children having the best start in life. There was agreement in principle to work across local authority boundaries, with academic partners. Consideration of HWSs as part of a complex adaptive system was welcomed by HWB Members.

Conclusions

Collaborative working across HWBs could strengthen the effectiveness of HWSs in relation to inequalities in health, place-shaping and wider determinants of wellbeing. The co-production of identified areas to work toward health improvement was successful.

Exploring the acceptability of a 'limited patient consent procedure' for a proposed blood-borne virus screening programme: a Delphi consensus building technique

OBJECTIVE

To identify components of a proposed blood-borne virus (BBV) population screening programme and its associated consent procedure that both the public and health practitioners (HPs) would find acceptable. The proposed BBV screening system would aim to reduce late diagnosis of BBVs and be used in patients undergoing routine blood tests, aided by risk stratification software to target individuals at higher risk of infection.

DESIGN

A Delphi technique was used to build consensus among two separate groups, public participants and HPs in England.

METHODS

A survey incorporating vignettes was developed, with input from an external panel of experts. Over three rounds, 46 public participants and 37 HPs completed the survey, rating statements on a four-point Likert scale. The survey covered issues around stigma and sensitivity, the use of risk stratification algorithms and 'limited' patient consent (ie, preinformed of the option to 'opt-out'). Consensus was defined as >70% of participants agreeing or disagreeing with each statement.

RESULTS

Consensus was achieved among both groups in terms of acceptability of the screening programme. There was also consensus on using patient data to risk-stratify screening algorithms and the need to obtain some form of consent around the time of drawing blood.

CONCLUSIONS

This study found that the special protected status of HIV in England is no longer deemed necessary today and hinders appropriate care. We propose that a novel 'limited consent procedure' could be implemented in future screening programmes.

Rivastigmine for gait stability in patients with Parkinson's disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial

BACKGROUND

Falls are a frequent and serious complication of Parkinson's disease and are related partly to an underlying cholinergic deficit that contributes to gait and cognitive dysfunction in these patients. Gait dysfunction can lead to an increased variability of gait from one step to another, raising the likelihood of falls. In the ReSPonD trial we aimed to assess whether ameliorating this cholinergic deficit with the acetylcholinesterase inhibitor rivastigmine would reduce gait variability.

METHODS

We did this randomised, double-blind, placebo-controlled, phase 2 trial at the North Bristol NHS Trust Hospital, Bristol, UK, in patients with Parkinson's disease recruited from community and hospital settings in the UK. We included patients who had fallen at least once in the year before enrolment, were able to walk 18 m without an aid, had no previous exposure to an acetylcholinesterase inhibitor, and did not have dementia. Our clinical trials unit randomly assigned (1:1) patients to oral rivastigmine or placebo capsules (both taken twice a day) using a computer-generated randomisation sequence and web-based allocation. Rivastigmine was uptitrated from 3 mg per day to the target dose of 12 mg per day over 12 weeks. Both the trial team and patients were masked to treatment allocation. Masking was achieved with matched placebo capsules and a dummy uptitration schedule. The primary endpoint was difference in step time variability between the two groups at 32 weeks, adjusted for baseline age, cognition, step time variability, and number of falls in the previous year. We measured step time variability with a triaxial accelerometer during an 18 m walking task in three conditions: normal walking, simple dual task with phonemic verbal fluency (walking while naming words beginning with a single letter), and complex dual task switching with phonemic verbal fluency (walking while naming words, alternating between two letters of the alphabet). Analysis was by modified intention to treat; we excluded from the primary analysis patients who withdrew, died, or did not attend the 32 week assessment. This trial is registered with ISRCTN, number 19880883.

FINDINGS

Between Oct 4, 2012 and March 28, 2013, we enrolled 130 patients and randomly assigned 65 to the rivastigmine group and 65 to the placebo group. At week 32, compared with patients assigned to placebo (59 assessed), those assigned to rivastigmine (55 assessed) had improved step time variability for normal walking (ratio of geometric means 0.72, 95% CI 0.58-0.88; p=0.002) and the simple dual task (0.79; 0.62-0.99; p=0.045). Improvements in step time variability for the complex dual task did not differ between groups (0.81, 0.60-1.09; p=0.17). Gastrointestinal side-effects were more common in the rivastigmine group than in the placebo group (p<0.0001); 20 (31%) patients in the rivastigmine group versus three (5%) in the placebo group had nausea and 15 (17%) versus three (5%) had vomiting.

INTERPRETATION

Rivastigmine can improve gait stability and might reduce the frequency of falls. A phase 3 study is needed to confirm these findings and show cost-effectiveness of rivastigmine treatment.

FUNDING

Parkinson's UK.

Systematic review of the use of data from national childhood obesity surveillance programmes in primary care: a conceptual synthesis

This study reviewed the use in primary care of national surveillance data for children to determine the data's potential utility to inform policy and practice decisions on how to prevent and treat childhood obesity. We reviewed the 28 countries identified by the World Obesity Federation as having high-quality comparable body mass index data for children. Literature published from any period up to December 2013 was included. Peer review literature was searched using Web of Science (Core Collection, MEDLINE). Grey literature was searched using the Internet by country name, programme name and national health and government websites. We included studies that (i) use national surveillance obesity data in primary care, or (ii) explore practitioner or parent perspectives about the use of such data. The main uses of national surveillance data in primary care were to identify and recruit obese children and their parents to participate in school and general practice-based research and/or interventions, and to inform families of children's measurements. Findings indicate a need for school staff and practitioners to receive additional training and support to sensitively communicate with families. Translation of these findings into policy and practice could help to improve current uses of national child obesity surveillance data in primary care.

The ReSPonD trial--rivastigmine to stabilise gait in Parkinson's disease a phase II, randomised, double blind, placebo controlled trial to evaluate the effect of rivastigmine on gait in patients with Parkinson's disease who have fallen

BACKGROUND

Gait impairment is common in people with Parkinson's disease. There is a lack of effective interventions to target this debilitating complication and therefore a need to identify new therapeutic options. An underlying cholinergic deficit contributes to both the gait and cognitive dysfunction seen in Parkinson's disease. The combined impact of both impairments can be assessed in gait tasks performed with concomitant cognitive tasks. The aim of this trial is to evaluate the impact of a cholinesterase inhibitor on cognitive function and gait performance in people with established Parkinson's disease.

METHODS/DESIGN

This is a single centre, double-blind, randomised placebo-controlled trial in 130 people with Hoehn and Yahr stage 2-3 idiopathic Parkinson's disease who have fallen in the past year. Participants will be randomised to two groups, receiving either rivastigmine capsules or identical placebo capsules for 8 months. Assessment will be undertaken at baseline and at the end of medication prescription (i.e. 8 months) with participants remaining enrolled in the trial for a further 4 months to monitor for falls and adverse events. The primary outcome is step time variability, assessed with and without the addition of concurrent cognitive tasks. Secondary outcomes will include other gait parameters, sensorimotor and balance performances, cognitive indices, falls and fall related injury, fear of falling, Parkinson's symptoms and data pertaining to possible harms.

DISCUSSION

This randomised controlled trial will examine the effect of cholinesterase inhibitor therapy on gait, balance and falls in Parkinson's disease. If effective, it would offer a new therapeutic option to ameliorating gait and cognitive deficits in a population at high risk of falls.

TRIAL REGISTRATION

ISRCTN19880883, UTN U1111-1124-0244.

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation

OBJECTIVES

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting.

DESIGN

Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice.

SETTING

The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot.

PARTICIPANTS

General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot.

MAIN OUTCOME MEASURES

General practitioners' views, experiences and usage of the system.

RESULTS

Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form.

CONCLUSIONS

Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

Development of a community-based model for respiratory care services

BACKGROUND

Chronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between now and 2020. Care for chronic diseases is increasingly located in community settings for reasons of efficiency and patient preference, though what services should be offered and where is contested. Our aim was to identify the key characteristics of a community-based service for chronic respiratory disease to help inform NHS commissioning decisions.

METHODS

We used the Delphi method of consensus development. We derived components from Wagner's Chronic Care Model (CCM), an evidence-based, multi-dimensional framework for improving chronic illness care. We used the linked Assessment of Chronic Illness Care to derive standards for each component.We established a purposeful panel of experts to form the Delphi group. This was multidisciplinary and included national and international experts in the field, as well as local health professionals involved in the delivery of respiratory services. Consensus was defined in terms of medians and means. Participants were able to propose new components in round one.

RESULTS

Twenty-one experts were invited to participate, and 18 agreed to take part (85.7% response). Sixteen responded to the first round (88.9%), 14 to the second round (77.8%) and 13 to the third round (72.2%). The panel rated twelve of the original fifteen components of the CCM to be a high priority for community-based respiratory care model, with varying levels of consensus. Where consensus was achieved, there was agreement that the component should be delivered to an advanced standard. Four additional components were identified, all of which would be categorised as part of delivery system design.

CONCLUSIONS

This consensus development process confirmed the validity of the CCM as a basis for a community-based respiratory care service and identified a small number of additional components. Our approach has the potential to be applied to service redesign for other chronic conditions.

Adiposity and blood pressure in 7- to 11-year-old children: comparison of British Pakistani and white British children, and of British Pakistani children of migrant and British-born mothers

OBJECTIVES

This study tested hypotheses that: (1) levels of adiposity, as assessed by triceps and subscapular skinfold thicknesses (SFTs), and blood pressure would be higher in British Pakistani children than in white British children; and (2) British Pakistani children of mothers born in the UK would have smaller SFTs and lower blood pressure than children of mothers born in Pakistan.

METHODS

Participants aged 7 to 11 years were recruited from five primary schools in a deprived urban area. BMI, waist circumference, triceps and subscapular SFT, and blood pressure were measured.

RESULTS

Participants comprised 209 white British and 132 British Pakistani children, including 79 children born in the UK to migrant mothers and 49 children born to British-born mothers. In comparisons by ethnic group, triceps SFT was significantly higher in British Pakistani children only after controlling for BMI. Subscapular SFT was higher in British Pakistani children, a finding strengthened after controlling for BMI. Systolic blood pressure was significantly higher in British Pakistani children, but not after controlling for socioeconomic status (SES). There were no significant differences between British Pakistani children born to migrant or British-born mothers, except that systolic blood pressure was lower in children of British-born mothers after controlling for SES, a finding that was not significant after controlling for BMI.

CONCLUSIONS

This study confirms previous findings of larger SFTs and higher blood pressure in British children of Pakistani origin than in children of white European origin. Further work with larger sample sizes is needed to investigate differences between generations.

Home sweet home? Community care for older people in Australia

Community care provision for older Australians is growing in places and options, based on older people's preference to stay in their own homes, coupled with its cost efficiency compared to long-term residential care. Australia's aging population, cultural diversity, and dispersed population in rural and remote areas presents significant challenges in meeting these care needs. The objective of this review is to provide a critical overview of community care services in Australia, from its origin in the 1940s through to the current array of programs that deliver care. Barriers to access for these programs, growth in funding and expenditure, evidence of client satisfaction and the problems of workforce provision are presented. It is not clear how the growing future demands for care programs, resulting from greater client expectation, increasingly complex care needs and a diminishing workforce of paid and unpaid carers, will be met. However, the economic burden is anticipated to be manageable. Despite seemingly well-structured programs, the current multiplicity and rigidity of services means care provided is sometimes unsatisfactory at the point of delivery. It remains to be seen therefore if services can be expanded, modified and developed to address current deficiencies and meet future demands. The reality of timely and equitable care for all older Australians living in the community is elusive at present. The ongoing rationing of residential care beds coupled with people's desires to stay in their own homes means community care is here to stay. The future inevitably presents huge challenges to those planning, implementing and providing care in this setting.

Developmentally-regulated cell surface N-linked oligosaccharides participate in intercellular cohesion in Dictyostelium discoideum

The ability of purified plasma membrane glycoconjugates to inhibit the EDTA-resistant agglutination between aggregation-stage cells of Dictyostelium discoideum has suggested that receptor binding of these glycoconjugates provides a basis for cell-cell cohesion during aggregation. This has been tested by analysis of a series of mutants with different defects in the assembly of N-linked oligosaccharides. Mutant HL241 lacks outer branch components of N-linked oligosaccharides and fails to aggregate or express EDTA-resistant cohesion. HL244 makes unsulphated but otherwise normal N-linked oligosaccharides, generates multiple tips on aggregated cell mounds in some clones, and shows abnormally strong EDTA-resistant cohesion. Two mutants that are temperature-sensitive for complete processing of N-linked oligosaccharides are also temperature-sensitive for expression of both aggregation ability and EDTA-resistant cohesion. A revertant that recovered essentially normal N-linked oligosaccharide processing at the restrictive temperature has also recovered its ability to aggregate and to agglutinate in EDTA.

Cell differentiation in Dictyostelium discoideum controls assembly of protein-linked glycans

The prestalk and prespore cells from the Dictyostelium discoideum multicellular slug stage of development differ in assembly of glycoconjugates. Prespore cells are 2- to 3-fold more active than prestalk cells in the assembly of N-linked glycans and 20-fold more active in their fucosylation. Only prespore cells synthesize an O-linked glycan consisting in part of Fuc alpha-linked to N-acetylglucosamine. Incorporation of fucose, glucosamine, mannose and galactose into large pronase-resistant glycoconjugates was almost exclusively into prespore cells. Such glucosamine-labelled glycoconjugates resist fragmentation by beta-elimination and include a glycoantigen dependent on the modB genetic locus. In contrast, large fucose-labelled glycoconjugates consisted of multiple, small, O-linked oligosaccharides on carrier peptides. The spore coat protein SP96 has several fucosylated O-linked oligosaccharides, one of which correlates with a fucose epitope previously shown to localize in prespore vesicles and the outer layer of the spore coat.

Home pass assessment in neurorehabilitation practice

The patient undergoing in-patient neurorehabilitation is often encouraged to go home with a family member or other carer for a short period when fit to do so. This home pass is helpful to both the family and the rehabilitation nursing staff in gauging how well the patient will function when discharged, but valuable feedback information can be lost. This study describes the experience of using a home pass assessment form to document the patients' performance and discusses the nursing staff and relative's perceptions of the usefulness of this instrument and the possible reasons for discrepancies between the nurses' assessment of the patient's abilities and the carers' reports.

Conditional intercellular cohesion in a Dictyostelium discoideum mutant which is temperature sensitive for correct processing of asparagine-linked oligosaccharides

Mutants of Dictyostelium discoideum have been isolated by a selection for cells with temperature-sensitive defects in the maturation of glycoprotein N-linked oligosaccharides. Here we describe a mutant, HT7, which is unable to aggregate at the restrictive temperature, but which aggregates and makes fruiting bodies at the permissive temperature. HT7 shows normal early developmental intercellular cohesion, but is temperature sensitive for expression of the ethylenediamine-tetraacetic acid (EDTA)-resistant cohesion characteristic of aggregation. The mutant initiates aggregation, but forms only loose cell mounds which later disperse. Metabolic labelling studies indicate that the thermolabile defect is not in protein synthesis, assembly of the lipid-linked precursor of N-linked oligosaccharides or transfer of the precursor to proteins. However, the defect does prevent assembly of fully processed N-linked oligosaccharides. Further, two glycopeptides, obtained from exhaustive Pronase digests of wild-type plasma membrane glycoproteins, inhibit intercellular cohesion of aggregation-stage wild-type cells. HT7 produces only approximately 50% of the wild-type level of these glycopeptides at the restrictive temperature and one of the glycopeptides has reduced cohesion inhibition ability. A revertant of HT7 was found to aggregate normally, to have restored EDTA-resistant cohesion, to have normal profiles of N-linked oligosaccharides and to express the two cohesion-inhibiting glycopeptides normally. These data strongly support a model in which cohesion during late aggregation is at least in part due to recognition between surface glycans and receptors on neighbouring cells.

Biochemical differentiation in a mutant of Dictyostelium discoideum defective in cyclic AMP chemotaxis and in intercellular cohesion

A temperature-sensitive mutant of Dictyostelium discoideum has been isolated based on its lack of chemotaxis toward cyclic AMP at the restrictive temperature, 27 degrees C. The mutant develops normally at the permissive temperature, 22 degrees C, but fails to aggregate or complete development at the restrictive temperature. The temperature-sensitive phenotype can be bypassed by allowing cultures to grown into late log phase or to starve for 60–90 min at 22 degrees C prior to a shift to 27 degrees C. At 27 degrees C, the mutant overproduces cell surface cyclic AMP receptors of both high and low affinity and is capable of spontaneous oscillations in light scattering in cell suspensions. Despite its complete lack of morphological development, the mutant undergoes extensive biochemical differentiation. At the onset of starvation, it shows increased levels of N-acetylglucosaminidase, it express cyclic AMP receptors at the normal time and, although somewhat slowly, suppresses those receptors as if aggregation had been achieved. Metabolic pulse labellings with [35S]methionine revealed that the mutant at 27 degrees C displays the same changes in the patterns of newly synthesized proteins observed during the vegetative-to-aggregation and the aggregation-to-slug stages of normal development. The only clear difference from wild type was the failure of the culmination-stage isozyme of beta-glucosidase to appear. The mutant is defective in establishment of intercellular cohesion mechanisms, correlated with poor agglutination by concanavalin A, at the restrictive temperature. The properties of the mutant place severe constraints on models regarding the role of chemoreception and intercellular cohesion in regulation of gene expression.

Differential regulation of glycoprotein sulfation and fucosylation during growth of Dictyostelium discoideum

During early starvation-induced development, amoebae of Dictyostelium discoideum have been previously shown to increase sulfation and fucosylation of glycoprotein-linked oligosaccharides to levels above those observed in axenically growing cells. We report here that the axenic broth culture itself induces generation of high levels of fucosylated glycoprotein-linked oligosaccharides at all stages in the growth curve. However, when grown on bacteria, amoebae of both the axenic strain and the wild type show dramatic depression in fucose incorporation during early exponential growth. In mid- and late-exponential stages of growth, fucosylation rises to the levels found at all stages of axenic culture. Sulfation also increases during early development, but, in contrast to fucosylation, oligosaccharide sulfation is not altered by growth in axenic medium and does not increase during growth on bacteria. Starvation of bacterially grown cells results in increased sulfation and a further rise in fucosylation, as is also characteristic of broth-grown cells. The ability of axenic culture to uncouple control of these two classes of glycan-modification steps suggests that the synchronous increases during early development actually reflect responses to different regulatory signals, even though they participate in the same metabolic process. The increase in in vivo fucosyltransferase activity, which can act on many substrate glycoproteins, may alter many characteristics of the cells.

Cell surface oligosaccharides participate in cohesion during aggregation of Dictyostelium discoideum

Plasma membrane glycoproteins from Dictyostelium discoideum amoebae at three stages of early development were digested with Pronase and endoglycosidase H and fractionated by gel filtration. This gave three classes of glycans (polysaccharides, endoglycosidase H-resistant glycopeptides, and endoglycosidase H-released oligosaccharides), which were tested for their ability to block agglutination of amoebae from vegetative, aggregation (8-hr), and late-aggregation (13-hr) stages of development. The endoglycosidase H-resistant glycopeptides from 8-hr cells inhibited agglutination of disaggregated 8-hr cells but not vegetative or 13-hr cells. The 8-hr polysaccharide and endo H-sensitive oligosaccharides did not inhibit. The glycopeptides from 8-hr cells were resolved into five species by electrophoresis in borate-containing buffer. Two of these had agglutination-inhibiting activity, and three did not. None of the glycan fractions from vegetative or 13-hr cells inhibited agglutination of vegetative, 8-, or 13-hr cells. These data implicate specific cell surface glycans in aggregation-stage intercellular cohesion and suggest that both these glycans and receptors for them are developmentally regulated.

Defective intercellular cohesion in glycosylation mutants of Dictyostelium discoideum

In order to identify the biological roles of protein-linked oligosaccharides, we have isolated mutants by a selection for amoebae with temperature-sensitive defects in glycan assembly and processing. Of these, 75% were also temperature sensitive for development [Boose and Henderson, 1986]. Two such mutants with distinct developmental phenotypes and glycosylation patterns are described. Mutant HT7 cannot complete aggregation at the restrictive temperature and is defective in expression of EDTA-resistant cohesion. The biochemical defect appears to be early in glycan processing. A revertant of HT7 has recovered aggregation capability, EDTA-resistant cohesion, and reverted almost totally to wild-type glycosylation. Mutant HT15 aggregates at the restrictive temperature but then disperses into a cell lawn. It is less deficient in EDTA-resistant cohesion than HT7 and has a different glycosylation profile. These results provide strong support for a role of protein N-linked oligosaccharides in aggregation-stage intercellular cohesion.

Altered cyclic-AMP receptor activity and morphogenesis in a chemosensory mutant of Dictyostelium discoideum

The functional properties of the cell-surface cyclic-AMP receptor that controls chemotaxis were found to be altered in an aggregation mutant of Dictyostelium discoideum. The mutant aggregated without stream formation and had a tenfold increased cell-density requirement for the initiation of aggregation. After aggregation, mounds formed multiple tips and subsequently subdivided to give multiple fruits that were small and abnormally proportioned. Cyclic-AMP-induced light-scattering changes in cell suspensions indicated that the mutant had a diminished response to external cyclic-AMP signals. Associated with these altered functional responses was a physical change in the cyclic-AMP sensory system. Cyclic-AMP-binding studies showed that the parent had two classes of cyclic-AMP binding sites, i.e., Kd = 32 and 110 nM. In contrast, the mutant had two- to threefold or more high-affinity sites (Kd = 25 nM) and altered low-affinity sites (Kd less than 3 microM). These results indicate that both affinity classes of binding site are independently mutable. This observation suggests that the two affinity classes can be interconverted by mutation, or the mutation alters a single molecular species and its equilibrium between binding sites with different affinities for cyclic AMP, as postulated in receptor cycling models.

Fluorographic detection of tritiated glycopeptides and oligosaccharides separated on polyacrylamide gels: analysis of glycans from Dictyostelium discoideum glycoproteins

Previous workers have shown that oligosaccharides and glycopeptides can be separated by electrophoresis in buffers containing borate ions. However, normal fluorography of tritium-labeled structures cannot be performed because the glycans are soluble and can diffuse during equilibration with scintillants. This problem has been circumvented by equilibration of the gel with 2,5-diphenyloxazole (PPO) prior to electrophoresis. The presence of PPO in the gel during electrophoresis does not alter mobility of the glycopeptides and oligosaccharides. After electrophoresis, the gel is simply dried and fluorography performed. This allows sensitive and precise comparisons of labeled samples in parallel lanes of a slab gel and, since mobilities are highly reproducible, between different gels. The procedure is preparative in that after fluorography the gel bands can be quantitatively eluted for further study, without any apparent modification by the procedure. In this report, the procedure is illustrated by fractionation of both neutral and anionic glycopeptides produced by the cellular slime mold Dictyostelium discoideum.

Sulfate suicide selection of Dictyostelium discoideum mutants defective in protein glycosylation

The assembly and processing of glycoprotein-linked oligosaccharides in Dictyostelium discoideum has been shown to generate a wide array of glycan structures which undergo dramatic developmental regulation. As late steps in processing of these oligosaccharides involve sulfation, a sulfate suicide selection procedure was developed to select for temperature-sensitive glycoprotein-processing mutants. Of 673 clones derived from the survivors of suicide selection, 99 were classified by replica-plating fluorography as temperature sensitive for sulfate transport or incorporation. Of these, 74 were unable to complete the developmental program to the fruiting body stage at the restrictive temperature, 29 being blocked in some aspect of aggregation and 45 being blocked at some postaggregation stage. Quantitative metabolic labeling experiments with representative clones showed that they incorporated wild-type levels of [35S]methionine but reduced levels of sulfate at the restrictive temperature. The specific incorporation patterns in the mutants suggest that distinct oligosaccharide-processing steps are involved in different developmental events.

Glycoprotein biosynthesis in dictyostelium discoideum: developmental regulation of the protein-linked glycans

The biosynthesis of glycoprotein N-linked oligosaccharides in D. discoideum is initiated by the transfer of a large precursor glycan from a carrier lipid. The subsequent processing of this precursor is dramatically dependent upon the stage of development. In early development processing retains the high mannose structure of the precursor and modifies some glycans by addition of fucose to core sugars and sulfate and phosphate to others. These reactions are coordinately lost during aggregation. Processing in late development extensively trims the precursor and adds fucose to peripheral mannose units of the smallest glycans. These reactions appear coincident with formation of tips on cell mounds. Experiments in which cells were starved in shaken suspension suggest that intercellular contacts and cyclic AMP signals may be sufficient to cause the controlled expression of these two alternate sets of processing enzymes.

Developmental regulation of Dictyostelium discoideum plasma membrane proteins

Developmental changes in the plasma membrane proteins of Dictyostelium discoideum have been studied using metabolic labeling with [35S]methionine and two-dimensional electrophoresis. Pulse labeling for 1 h at the early interphase, late interphase, aggregation, and tip formation stages of development showed that the profile of newly synthesized plasma membrane proteins changed dramatically over this interval. Only 14% of the polypeptide species were synthesized at all four stages at detectable levels; 86% of the species changed over this developmental interval according to the criterion that they were synthesized at some but not all of the four stages tested. Long-term labeling during vegetative growth followed by initiation of development showed that the "steady-state" levels of the plasma membrane proteins changed very little over the same period. The only changes were in minor species (33% overall change). Similar analyses of whole cell proteins showed 27 and 20% change, respectively. Cell surface radioiodination revealed 52 external proteins in the plasma membrane. Comparison with the uniform methionine labeling results showed that these proteins were, with one notable exception, minor membrane components. In these external proteins, also, developmental changes were limited and were observed in the less abundant species. These results demonstrate the existence of two general classes of plasma membrane proteins. The first is a population of high-abundance proteins that are present in vegetative cells and are largely conserved through development. These possibly serve "housekeeping" functions common to all stages. The second class consists of low-abundance species that are expressed in a highly stage-specific manner and which presumably participate in developmentally important functions.

Guanidine hydrochloride-induced shedding of a Dictyostelium discoideum plasma membrane fraction enriched in the cyclic adenosine 3',5'-monophosphate receptor

The cell surface cyclic AMP receptor of Dictyostelium discoideum is under study in a number of laboratories with respect to both its role in development of the organism and the physiology of excitation-response coupling. We report here that when starved amoebae are exposed to the chaotrope guanidine hydrochloride at 1.8 M, they shed a particulate cyclic AMP binding activity into the medium. This activity is due to membrane vesicles which originate from the cell surface. The vesicles are enriched up to 150-fold in cyclic AMP binding activity and up to 14-fold in phospholipid content when compared to the starting amoebae. The cyclic AMP binding activity of the membrane vesicles is identical to that of the cell surface receptor with respect to the following properties; (i) it is lacking in preparations from unstarved, vegetative amoebae; (ii) it is not inhibited by cyclic GMP and is stimulated by calcium ions; (iii) it has very rapid rates of association and dissociation of bound cyclic AMP; (iv) it has two classes of binding sites with dissociation constants similar to those of the surface receptors of whole amoebae. The binding activity of the isolated membranes is stable for several days at 4 degrees C and the lower affinity binding sites are stable up to several months when stored at -80 degrees C. Due to enrichment and stability of the receptor in this preparation, it should be highly suitable for many types of studies. The usefulness is enhanced by the fact that the preparation does not contain detectable cyclic AMP phosphodiesterase activity.

Thermosensitive development and tip regulation in a mutant of Dictyostelium discoideum

A thermosensitive developmental mutant of Dictyostelium discoideum identifies a gene product that is nonessential for cell multiplication but is continuously required during aggregation and the period when multicellular mounds are formed. After mounds form a tip, which has the properties of an embryonic organizer, this gene product may be nonessential. Surgical removal of the tip from a polarized developing multicellular structure (the slug) leads to emergence of a new tip at the permissive temperature but not at the restrictive temperature. The mutant continues to develop abnormally when mixed with wild-type cells; therefore, a cell-limited rather than an exchangeable factor is altered. Assays show that the mutant has a thermosensitive defect in chemotaxis toward cAMP. The mutation reduces the number of cell surface cAMP receptors expressed at the restrictive temperature without affecting their dissociation constants or their apparent thermostability. The expression of two developmentally regulated enzymes, N-acetylglucosaminidase and cAMP phosphodiesterase, is unaffected by the mutation.

Developmental regulation of glycoprotein biosynthesis in Dictyostelium

We have examined the glycoprotein-linked oligosaccharides assembled during the life cycle of Dictyostelium discoideum, and found their expression to be dramatically dependent upon the stage of development. During early development mature glycans have a high mannose character, and a substantial proportion acquire a fucose residue that correlates with endo-H resistance. One-third of the glycans also acquire sulfate residues. These glycans diminish in importance during aggregation. The mature glycans expressed during aggregation. The mature glycans expressed during late development contain fewer mannose residues, from five to ten mannose residues, and are characterized by the absence of sulfate residues and by the presence of fucose residues on endo-H-sensitive glycans. These glycans make their appearance coincident with the construction of tips on tight cell mounds. At this stage glycans characteristic of both early and late stages occur simultaneously. Developmental regulation of the wide array of protein-linked glycans expressed during the life cycle of Dictyostelium discoideum may be as simple as the controlled transition from a group of structures that are assembled by the vegetative cells to a group of structures that are assembled by the terminally differentiating cells. The potential biological significance of this transition is discussed.

The cyclic adenosine 3':5'-monophosphate receptor of Dictyostelium discoideum. Binding characteristics of aggregation-competent cells and variation of binding levels during the life cycle

Both cyclic guanosine 3':5'-monophosphate and dithiothreitol stimulate binding of cyclic adenosine 3':5'-monophosphate (cAMP) to aggregation-competent amoebae. Both compounds appear to function solely by preventing the hydrolysis of cAMP by the cell-bound phosphodiesterase. The dissociation constant for binding of cAMP is 36 nM. Both cAMP binding and membrane-bound phosphodiesterase activities increase dramatically as cells develop aggregation competence, reach a maximum at about 11 hours, and remain at high levels for up to 48 hours if cells are maintained in shaken suspension. When amoebae are allowed to aggregate and develop naturally, binding of cAMP increases during aggregation, decreases during tip formation, and disappears during culmination. Phosphodiesterase activity parallels binding activity except that the decreased level after tip formation is retained throughout culmination. Two N-6-modified cAMP derivatives compete with cAMP for binding sites. One derivative is fluorescent (1,N-6-etheno-cAMP); the other is photolyzable [N-6(ethyl-2-diazomalonyl)cAMP]. This result opens the possibilities of using fluorescence quenching for assay of in vitro binding and of affinity labeling of binding sites. Competition by the derivatives is only partial, indicating possible heterogeneity of binding sites. Both compounds inhibit hydrolysis of cAMP by the membrane-bound phosphodiesterase.