Quantitative studies of human urinary excretion of uropontin

Uropontin is the urinary form of osteopontin, an aspartic acid-rich phosphorylated glycoprotein. Uropontin has been previously shown to be a potent inhibitor of the nucleation, growth and aggregation of calcium oxalate crystals and the binding of these crystals to renal epithelial cells. Quantitative data defining the excretion of this protein are necessary to determine its role in urinary stone formation. In the present studies, we determined uropontin excretion rates of normal humans. Urine samples were obtained under conditions of known dietary intake from young adult human volunteers with no history, radiographic or laboratory evidence of renal disease. Urinary concentrations of uropontin were measured by a sensitive ELISA employing an affinity purified polyclonal antiserum to uropontin. Thirteen normal subjects ingested a constant diet providing 1 gram of calcium, 1 gram of phosphorus, 150 mEq of sodium and 1 gram of protein per kilogram of body wt per day during an eight day study period. The relationship of urinary volume to uropontin excretion was assessed by varying fluid intake on the last four days of the study to change the mean urine volume/24 hr by > 500 ml. Urine collected in six hour aliquots for eight days was analyzed for uropontin by ELISA, and for calcium, and creatinine. Daily uropontin excretion of 13 individual subjects was 3805 +/- 1805 micrograms/24 hr (mean +/- 1 SD). The mean urinary levels (1.9 micrograms/ml) detected in the present study are sufficient for inhibition of crystallization; our previous studies have demonstrated that the nucleation, growth and aggregation of calcium oxalate crystals and their binding to renal cells in vitro are inhibited by this concentration of purified uropontin. In contrast to the regular pattern of diurnal variation of calcium excretion seen in most subjects, uropontin excretion showed no regularity of diurnal variation and was not directly related to either calcium or creatinine excretion or changes in urinary volume. However, uropontin concentration varied inversely with urine volume (P < or = 0.001), so that the highest uropontin concentrations occurred when urine volume was the lowest. We conclude that the physiologic characteristic of an inverse relationship of uropontin concentration to urine volume favors protection from urinary crystallization of calcium oxalate by uropontin. Our quantitative definition of urinary uropontin excretion of normal adults provides the basis for the evaluation of uropontin excretion by individuals who have formed urinary stones.

Mutations of CLCN5 in Japanese children with idiopathic low molecular weight proteinuria, hypercalciuria and nephrocalcinosis

The annual urinary screening of Japanese children above three years of age has identified a progressive renal tubular disorder characterized by low molecular weight proteinuria, hypercalciuria and nephrocalcinosis. The disorder has been observed in over 60 patients and has a familial predisposition. Mutations of a renal chloride channel gene, CLCN5, have been reported in four such families, and we have undertaken studies in additional patients from 10 unrelated, non-consanguineous Japanese families to further characterize such CLCN5 mutations and to ascertain their prevalence. CLCN5 abnormalities we identified in 7 of the 10 unrelated patients and consisted of 5 mutations (2 nonsense, 1 frameshift and 2 missense), 1 deletion and 1 silent polymorphism. A clustering of these mutations in CLCN5 exons 8 and 10 was observed. Over 80% of the CLCN5 mutations could be readily detected by single stranded conformational polymorphism (SSCP) analysis, thereby providing a useful mutation screening method. Our results, which indicate that over 70% of Japanese patients with this renal tubulopathy have CLCN5 mutations, will help in the genetic and clinical evaluation of children at risk from this disorder.

[Advances in the treatment of hemolytic uremic syndrome (HUS)]

The hemolytic uremic syndrome (HUS) is the end result of a variety of etiologic agents that can induce endothelial cell injury and thrombotic microangiopathy (TMA) mostly within the kidney. The typical, post-diarrheal verocytotoxin associated HUS (D + HUS) is the major cause of acute renal failure in children worldwide. In the course of HUS treatment, fluid overload is usually the result of overhydration in the context of oliguria or anuria which cause edema, hypertension, worsening of neurologic signs and cardiac failure. Appropriate and timely use of dialysis has dramatically reduced complications of renal failure and extra-renal complications are now the main causes of mortality and morbidity in D + HUS. The reasons for treatment by infusion of fresh frozen plasma and/or plasmapheresis for D + HUS are theoretical and their therapeutic effects are inconclusive. We believe that plasma administration for regular D + HUS has no value and is potentially harmful. Until new strategies become available in clinical practice, the general consensus for the moment is that careful supportive management with patience is still the most appropriate form of D + HUS therapy.

Hypercalciuria and nephrocalcinosis in patients with idiopathic low-molecular-weight proteinuria in Japan: is the disease identical to Dent's disease in United Kingdom?

Idiopathic low-molecular-weight (LMW) proteinuria is a newly described renal disease in Japan and Italy. We report on 7 patients who manifested bilateral or unilateral nephrocalcinosis, as demonstrated by abdominal computed tomography scans. Renal histology revealed calcinosis of renal tubules in 2 patients. Computed tomography is a reliable method for the detection of nephrocalcinosis in this disorder. Hypercalciuria was also seen in 6 patients. A calcium-loading test performed in 2 patients suggested that hypercalciuria was of renal origin. Although the true pathogenesis is still not known, hypercalciuria and nephrocalcinosis appear to be a common complication in patients with idiopathic LMW proteinuria. These complications and clinical features suggest that idiopathic LMW proteinuria in Japan is likely to be identical to Dent's disease in the United Kingdom.

Inhibition of calmodulin-dependent myosin light-chain kinase by growth-hormone-releasing factor and vasoactive intestinal peptide

In view of the ability of calmodulin to bind vasoactive intestinal peptide (VIP) and growth-hormone-releasing factor (GRF) with high affinity [Stallwood, Brugger, Baggenstoss, Stemmer, Shiraga, Landers and Paul (1992) J. Biol. Chem. 267, 19617-19621], the effects of these neuropeptides on a model calmodulin-dependent enzyme, myosin light-chain kinase (MLCK), were studied. Both peptides were potent inhibitors of MLCK activity. The inhibition of enzyme activity by VIP and GRF was progressively overcome with increasing calmodulin concentrations, with no inhibition observed at a saturating calmodulin concentration. Nanomolar concentrations of MLCK blocked the formation of calmodulin-[125I-Tyr10]VIP complexes. These data provide support for a functional role of VIP and GRF binding by calmodulin.

The effects of 6-hydroxydopamine and oxidative stress on the level of brain metallothionein

Oxidative stress, resulting either from excess generation or reduced scavenging of free radicals, has been proposed to play a role in damaging striatal neurons in Parkinson's disease. Since metallothionein is able to regulate the intracellular redox potential, we have undertaken a group of experiments to see whether or not 6-hydroxydopamine, which generates free radicals and is toxic to dopaminergic neurons, could alter the level of zinc and metallothionein. 6-Hydroxydopamine (8 micrograms in 4 microliters 0.02% ascorbic acid) reduced the level of zinc and metallothionein in the striatum but not other brain regions tested. Dopamine plus selegiline increased the synthesis of metallothionein in Chang cells as judged by enhanced incorporation of [35S]cysteine into metallothionein. The effect of dopamine was selective, in that dopamine could not stimulate the synthesis of metallothionein in neuroblastoma IMR-32 cells, which are devoid of dopaminergic receptors. The effect of dopamine in stimulating the synthesis of metallothionein was similar to that of zinc, known to generate the synthesis of metallothionein, and to that of H2O2 and FeS04, known to generate free radicals. The results of these experiments provide additional evidence that zinc or zinc metallothionein are altered in conditions where oxidative stress has taken place.

Identity of a membrane-bound vasoactive intestinal peptide-binding protein with calmodulin

A vasoactive intestinal peptide (VIP)-binding protein purified from guinea pig lung membranes (p18) was digested with trypsin, and the amino acid sequence of the peptide fragments was determined. The sequence of six tryptic fragments of p18 was identical with subsequences present in mammalian calmodulin. Authentic porcine brain calmodulin and p18 co-migrated on an sodium dodecyl sulfate-electrophoresis gel and displayed identical chromatographic behavior on a reverse phase high performance liquid chromatography column. The VIP-binding properties of p18 and calmodulin were indistinguishable. Both proteins displayed saturable and apparent high affinity binding of VIP, evidenced by potent inhibition of complexation with [Tyr10-125I]VIP by unlabeled VIP (IC50 = 6.0-8.1 nM). Rat growth hormone releasing factor and a C terminally extended form of VIP ([Leu17]VIP-GKR) also displayed potent inhibition of the binding (IC50 = 6.4 and 4 nM, respectively). These neuropeptides are potential modulators of calmodulin function.

Successful management of CAPD in infants with cardiac failure

Continuous ambulatory peritoneal dialysis (CAPD) was selected and introduced as a primary dialysis method in two infants with cardiac failure. CAPD was started at 14 days after birth with body weight of 2125 gm and at 7 months of age with body weight of 2325 gm. In both cases, cardiac failure was due to large ventricular septal defect (VSD) and renal failure was due to dysplastic kidneys. In the first case (case 1), direct closure of atrial septal defect and patch closure of VSD were successfully completed at 9.5 months of age with body weight of 4844 gm. CAPD has been managed well for 1 year and 8 months and the child reached a body weight of 8440 gm. In the second case (case 2), CAPD was managed well for 11 months with body weight increasing to 4920 gm at the age of 1 year and 7 months. This marked deterioration of this boy's physical growth was mainly caused by the delay in introducing CAPD and partly due to his cardiac dysfunction which has not been corrected surgically. Both cases show almost normal mental development and are managed well at home. Although CAPD introduction yielded water balance and physical growth in these infants, earlier introduction of CAPD may result in better clinical outcomes including management following open heart surgery. Selection of CAPD as a primary dialysis maneuver is strongly recommended for uremic infants with cardiac failure.

Inhibition of calcium oxalate crystal growth in vitro by uropontin: another member of the aspartic acid-rich protein superfamily

The majority of human urinary stones are primarily composed of calcium salts. Although normal urine is frequently supersaturated with respect to calcium oxalate, most humans do not form stones. Inhibitors are among the multiple factors that may influence the complex process of urinary stone formation. We have isolated an inhibitor of calcium oxalate crystal growth from human urine by monoclonal antibody immunoaffinity chromatography. The N-terminal amino acid sequence and acidic amino acid content of this aspartic acid-rich protein, uropontin, are similar to those of other pontin proteins from bone, plasma, breast milk, and cells. The inhibitory effect of uropontin on calcium oxalate crystal growth in vitro supports the concept that pontins may have a regulatory role. This function would be analogous to that of other members of the aspartic acid-rich protein superfamily, which stereospecifically regulate the mineralization fronts of calcium-containing crystals.

Prepulse-free 30-TW, 1-ps Nd:glass laser

A 30-TW,1.0-ps laser pulse at 1053 nm has been generated by chirped-pulse amplification in a large-aperture Nd:phosphate glass laser system. A peak-to-prepulse intensity ratio of better than 10(7) was obtained by temporal windowing of a self-phase-modulated chirped pulse before amplification and compression.

Guanidino compound levels in the serum of healthy adults and epileptic patients

Some guanidino compounds are known to be convulsants and to change in the brain during seizures. In this study, we examined the serum levels of guanidino compounds in healthy adults (controls), non-epileptic neurological patients (NENP) and epileptic neurological patients (ENP). In healthy adults, serum levels of guanidinoacetic acid (GAA), creatinine (CRN) and homoarginine (HArg) were significantly lower in women than in men. Serum levels of GAA in ENP and NENP were significantly lower than in controls, with the exception of female NENP. In the male patients, CRN levels were significantly lower in ENP and NENP compared to the controls. Significantly higher arginine (Arg) levels were observed in both male and female ENP and NENP. HArg levels in the male patients were significantly lower in ENP compared with both controls and NENP. With regard to serum levels of guanidino compounds in ENP with symptomatic generalized epilepsy and with symptomatic partial epilepsy, significantly lower levels of HArg were observed in male ENP with symptomatic generalized epilepsy than in NENP. Serum levels of GAA and HArg in uncontrolled female ENP were significantly lower than those in controlled ENP. Furthermore, Arg and HArg levels in uncontrolled male ENP were significantly lower than in controlled ENP. Serum levels of Arg in male ENP and HArg in both sexes of ENP taking valproic acid were significantly lower than those in ENP not taking valproic acid. These results suggest that some metabolic disorder of guanidino compounds may exist in ENP and NENP and that guanidino compounds may be affected by seizure types, seizure severity and anticonvulsants.

Short-pulse pumping of a recombination Balmer-alpha laser of hydrogenic sodium

A NaF foil target was irradiated at an intensity of 6.0 x 10(14) W/cm(2) with a 28-psec, 526-nm, 23-J laser pulse. A space- and time-averaged gain coefficient of 4 +/- 1 cm(-1) was obtained for Na XI H-alpha at 5.42 nm. Computer simulation gives a peak time- and space-resolved gain of ~18 cm(-1).

"Intact nephrons" as the primary origin of proteinuria in chronic renal disease. Study in the rat model of subtotal nephrectomy

Single nephron filtration rate of albumin (SNGFRAlb) was measured in remnant nephrons of Munich-Wistar rats 4-6 wk after subtotal nephrectomy (NPX). Serial thin-section histological analysis was then conducted on the same glomeruli by light microscopy. SNGFRAlb ranged from 1 to 15 times normal. However, a direct relationship between abnormalities of structure and function was not seen, e.g. the glomeruli with the fewest structural abnormalities and marked hyperfiltration often had the highest SNGFRAlb. Moreover, the majority of glomeruli had minimal structural abnormalities. Normalization of the markedly elevated glomerular capillary pressure (PGC) in these glomeruli was accomplished by acute intravenous infusion of verapamil, which decreased SNGFRAlb by 9-83% without affecting the single nephron filtration rate of water (SNGFRH2O). 1-2 wk after subtotal NPX, all glomeruli were hyperfiltering and had elevated PGC. The fractional clearance of larger (greater than 36 A) dextrans was selectively increased in these glomeruli that lacked discernible damage by light microscopy. Verapamil normalized PGC, reduced proteinuria to 48 +/- 4% of baseline, and improved glomerular size selectivity without altering SNGFRH2O. Proteinuria after subtotal NPX thus originates largely from glomeruli with minimal structural abnormalities. The defect in size selectivity is largely attributed to the prevailing high PGC, producing large, nonselective channels on the glomerular capillary wall. The observations raise the possibility that in chronic renal diseases, the reduction in proteinuria often seen after therapeutic measures, including antihypertensive medication, may reflect their functional effect on the relatively intact glomeruli rather than their structure-sparing effect on severely damaged glomeruli, which contribute little to the proteinuria.

Serial micropuncture analysis of single nephron function in subtotal renal ablation

We developed a series of methodology to analyze function-structure relationship at single nephron level in animal models of chronic renal disease. Micropuncture measurements were repeated to measure single nephron GFR (SNGFR) and glomerular capillary hydraulic pressure (PGC) in the same nephrons, and subsequently examine the morphology of these glomeruli by serial section histological analysis. Using this approach, a potential causal link between early functional pattern and late structural abnormalities was examined in glomeruli of 10 Munich-Wistar rats up to six weeks after surgical removal of 5/6 total renal mass. After two weeks all SNGFR and PGC values increased uniformly but to varying degrees within each remnant kidney. Thereafter, values for SNGFR were highly variable, many declining while other increased in the same kidney. PGC showed an initial increase with subsequent decrease by four to six weeks. Serial section histological analysis of these same glomeruli revealed that the extent of glomerular sclerosis positively correlated with the functional deterioration, that is, the degree of reduction in SNGFR (P less than 0.01). However, the degree of sclerosis had no tendency to correlate with the levels of SNGFR or PGC recorded in early stage. These studies indicate that pathophysiologic mechanisms other than, or in addition to, early hyperfunction are involved in determining the extent of glomerular structural damage in this model of chronic renal failure.

Delta-guanidinovaleric acid as an endogenous and specific GABA-receptor antagonist: electroencephalographic study

Sporadic spike discharges recorded on EEGs from epidural electrodes appeared 5-10 min after topical application of 0.3 nmol delta-guanidinovaleric acid (DGVA) on the pia mater of the sensorimotor cortex, on the same side as the application. Spike discharges induced by DGVA were completely suppressed within 10 min of supplementary application of GABA (50 nmol), (3R)-(-)-4-amino-3-hydroxybutanoic acid (L-GABOB) (5 nmols) or muscimol (5 nmols) on the pia mater, but the discharges were not affected by supplementing with 500 nmol of alpha-amino-DGVA, i.e., arginine (Arg). Whereas spike discharges were not induced by DGVA together with L-GABOB or muscimol, DGVA applied together with Arg induced spike discharges. Neither phenobarbital (PB) (20 mg/kg, i.m.), diazepam (DZ) (10 mg/kg, i.p.), sodium valproate (200 mg/kg, i.p.) nor diphenylhydantoin (20 mg/kg, i.p.) showed any suppressive effects on spike discharges induced by DGVA. DGVA induced spike discharges 20 min after pre-injection of PB or DZ. These electroencephalographic findings suggest that DGVA, which has one more carbon in its chain than N-amidino-GABA, might act directly on the GABA-receptor to induce spike discharges and might be a specific GABA-receptor antagonist.

Convulsive activity of alpha-guanidinoglutaric acid and the possible involvement of 5-hydroxytryptamine in the alpha-guanidinoglutaric acid-induced seizure mechanism

alpha-Guanidinoglutaric acid (alpha-GGA) was first found in cobalt-induced epileptogenic focus tissue in the cerebral cortex of cats. We examined the effect of alpha-GGA on the electroencephalogram and on the brain 5-hydroxytryptamine (5-HT) level after intraventricular administration into rats. Sporadic low-voltage spikes appeared 4 min after the administration of alpha-GGA. Spikes increased in voltage 6 min after the administration. Multiple spikes appeared 10 min after the administration, and they reached maximal frequency 30 min after the administration. The epileptic discharges disappeared 100 min after the administration. The 5-HT level increased in the right and left cortices 3 min after the administration. The 5-HT level decreased in the mid-brain 5 min after the administration and subsequently in all regions of the brain 10 min after the administration. No change in the 5-HT level was found 30 min and 100 min after the administration. These results show that alpha-GGA induces epileptic seizures in rats after intraventricular administration. The results also suggest that alpha-GGA-induced seizures are associated with abnormal serotonergic function and that they are initiated by a decrease in the 5-HT level.