[Therapy of AV nodal reentry tachycardia with catheter ablation of the fast retrograde pathway]

AV-nodal reentrant tachycardia (AVNRT) is a common cause of recurrent supraventricular tachycardia. Currently, catheter ablation of either slow or fast pathway are nonpharmacologic options for the treatment of patients with AVNRT. Radiofrequency (RF) catheter ablation of the fast pathway was attempted in 35 patients (aged 46.7 +/- 15 years; 12 m, 23 f) with recurrent AVNRT. RF energy (25-50 watt, 30-90 s) was delivered to the anterior right atrial septum. The catheter was placed posterior to the largest His bundle deflection. AV conduction was monitored during continuous pacing of the high right atrium while the RF current was applied. RF-ablation was acutely successful using a mean of 6.5 +/- 6.2 impulses in 31 patients. Late spontaneous block of the slow pathway occurred in one patient (pat. 17) with an unsuccessful initial attempt of fast pathway ablation. PQ and AH interval increased significantly after the ablation procedure (PQ: from 149 +/- 27 to 208 +/- 34 ms, AH: from 76 +/- 22 to 131 +/- 38 ms; p value: < 0.0001). Acute interruption of retrograde VA conduction was the result in 23 patients. Six patients (17%) had a recurrence of AVNRT during a follow-up period of 11.9 +/- 7.5 months. Five of 6 patients underwent a second successful procedure. Complete AV block occurred in 3 of the first 10 consecutive patients and in none of the subsequent 25 patients (overall incidence: 8.6%). Thus, RF ablation of the fast retrograde pathway is an effective method for the curative treatment of AVNRT.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the H2-receptor antagonist cimetidine, on the pharmacokinetics and pharmacodynamics of the H1-receptor antagonists hydroxyzine and cetirizine in rabbits

The effects of coadministration of the H2-receptor antagonist cimetidine on the pharmacokinetics and pharmacodynamics of the H1-receptor antagonists hydroxyzine and cetirizine were studied in rabbits. A single dose of hydroxyzine, 10 mg (Experiment A), or cetirizine, 10 mg (Experiment B), was given intravenously on three occasions: 2 weeks before cimetidine administration, after cimetidine, 100 mg/kg, had been given every 12 hr for 1 week, and 2 weeks after the cimetidine was discontinued. Serum concentrations of hydroxyzine and cetirizine, the active metabolite of hydroxyzine arising in vivo (Experiment A), or cetirizine (Experiment B) were measured by HPLC. The pharmacologic effects of hydroxyzine and cetirizine were monitored by measuring the suppression of histamine-induced wheals, using an IBM-PC and digitizer. The hydroxyzine and cetirizine half-life and AUC0-->infinity values were significantly increased and the systemic clearance rates were significantly decreased in the presence of cimetidine. Similar results were obtained when cetirizine was administered de novo. Wheal suppression produced by hydroxyzine or cetirizine was increased and prolonged in the presence of cimetidine. The synergism observed between hydroxyzine or cetirizine and cimetidine in suppression of the histamine-induced cutaneous response may be due to a pharmacokinetic interaction.

Reversal of rapidly transported protein and organelles at an axonal lesion

The time required for both rapid axonally transported organelles (vesicles and tubulo-vesicular structures) and proteins to undergo anterograde to retrograde reversal at a crush site was examined using sciatic nerve preparations obtained from Xenopus laevis. The transport and reversal of a pulse of newly synthesized 35S-labeled proteins was studied with a position-sensitive detector of ionizing radiation. Organelle transport and reversal were studied using video microscopy. Both protein and organelle reversal were assessed in two bathing media: a physiological saline and a medium that was compatible with the intracellular environment (internal medium). The time required for protein transport to reverse at a ligature was determined as a function of the time interval between the application of the ligature and the arrival of the pulse at the ligature (lesion time). In physiological saline, reversal times were greatest, about 3.5 h, when the lesion time was 1 h or less and decreased to approximately 1.5 h for lesion times of 4-12 h. When corrected for the approximately 2 mm length of degeneration caused by the saline, the results were similar to those obtained in internal medium and indicated a minimal reversal time for proteins of about 2 h. Organelle transport was examined close to narrow lesions in single myelinated axons. That the organelles moving away from the lesion represented organelles that had undergone reversed transport was suggested by observation of the reversal of individual organelles, and by a correlation between the flux of organelles towards and away from the lesion. Analysis of organelle flux within and adjacent to a segment of axon isolated by two lesions indicated that 70-80% of organelles moving away from a lesion represented reversed transport. Observations in internal medium were consistent with a reversal time of < 15 min, and in physiological saline < 30 min. The substantially smaller reversal time for organelle transport as compared to protein transport is consistent either with the existence of two types of organelles with different reversal times and hence different reversal mechanisms, or with the possibility that during reversal proteins are off-loaded from carrier organelles and subsequently up-loaded to different organelles.

Structure of human factor D. A complement system protein at 2.0 A resolution

Factor D, an essential enzyme for the activation of the alternative pathway of the complement system, belongs to the serine protease superfamily. The crystal structure of the enzyme was solved by a combination of multiple isomorphous replacement and molecular replacement methods. The present model was refined to an R-factor of 18.8% using 23,681 observed reflections between 7.5 and 2.0 A resolution, with a root-mean-square deviation from standard bond lengths of 0.016 A. The two non-crystallographically related molecules in the triclinic unit cell have distinctive active site conformations. The protein has the general structural fold of a serine protease, but there are several unique amino acid substitutions resulting in significant alterations in the critical loops responsible for catalysis and substrate specificity in serine proteases. Factor D is the first complement serine protease whose three-dimensional structure has been determined.

Photosensitized cross-linking and cleavage of pBR322 and M13 DNA: comparison of 4,4',6-trimethylangelicin and 3-carbethoxypsoralen

The furocourmarins 3-carbethoxypsoralen (3-CP) and 4,4',6-trimethylangelicin (TMA) were generally believed to be incapable of cross-linking DNA upon irradiation with ultraviolet light. Denaturation of photosensitized pBR322 DNA, either supercoiled or previously linearized with a restriction enzyme, proved that 3-CP was indeed monofunctional, but that TMA produced cross-links. Identical conclusions were reached with double stranded M13 DNA which had been linearized with EcoR 1. Both sensitizers also induced partial DNA cleavage. In contrast to 3-CP, photosensitization with TMA made the DNA resistant to enzymatic cleavage.

Distribution of MAP kinase, S6 kinase, and casein kinase II in rat tissues: activation by insulin in spleen

We examined the distribution of mitogen-activated protein (MAP) kinase, S6 kinase, and casein kinase II (CK-II) in the muscle, spleen, brain, and testes of Wistar rats. It was observed that spleen extracts contained the highest activity of all the kinases. Anion-exchange chromatography of spleen extracts by a MonoQ column resolved a single peak of myelin basic protein phosphotransferase activity that eluted after the usual position of the previously described p42 and p44 MAP kinases. Immunoblotting of the peak fractions with anti-MAP kinase antibody did not detect any immunoreactive bands that coincided with the activity peak, suggesting that the activity may represent a potentially novel MAP kinase. The MonoQ fractionation also resolved a single peak of phosvitin phosphotransferase activity which coincided with the intensity of two immunoreactive bands of 39 and 43 kilodaltons that were detected with antibodies against CK-II. The chromatographic behaviour and immunoblotting data indicate that the phosvitin kinase peak represented CK-II and suggested that the rat spleen CK-II had a molecular structure of alpha alpha ' beta 2. Furthermore, using an intact rat model, we showed that the potentially novel spleen MAP kinase and CK-II were markedly activated following intravenous injection of insulin. The significance of these findings remains to be determined.

[Cloning and sequencing of the major surface antigen gene of Toxoplasma gondii]

According to the published gene sequence of the major surface antigen (P30), a pair of primers were designed and synthesized. At the 5' end of sense and anti-sense strand of the primers, EcoRI and BamHI sites were added, respectively. Using PCR, the coding sequences of P30 gene were amplified. The amplified gene fragments and plasmid pBV220 were digested with EcoRI and BamHI, and then ligated. The inserted gene fragment was sequenced by the chain termination method. The reading revealed that nucleotide sequence determined here was the same as the sequence published by Burg (1988), except one base was exchanged. The recombinant plasmid pBV220-P30 was constructed.

Role of programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and documented sustained ventricular tachyarrhythmias: inducibility and prognostic value in 102 patients

The role of programmed ventricular stimulation (PVS) in patients at high risk of sudden death related to idiopathic dilated cardiomyopathy (DCM) is still controversial. The possible reason is that most study series have been too small or that only a few patients had documented sustained ventricular tachyarrhythmias. This study therefore, looked at PVS performed in 102 patients with DCM and documented sustained ventricular tachycardia (VT; n = 63) or ventricular fibrillation (VF; n = 39). Sustained VT was induced in 27 of 63 patients (43%) with documented sustained VT and in 14 of 39 patients (36%) with documented VF (ns). VF was induced in nine patients (14%) with a history of sustained VT and in seven (18%) with a history of VF (ns). At a mean follow-up of 32 +/- 15 months, sudden death occurred in 14 (14%) patients, a rate similar in both patients with documented VT and VF (ns). Incidence of sudden death at 36 months was 6% in patients with inducible sustained VT/VF compared to 29% in patients without inducible VT/VF (P < 0.05). A favourable drug regimen (response to drug and no intolerable side effects) was obtained by serial drug testing in 25 of all 102 patients (25%). A cardioverter defibrillator (ICD) was implanted in 32 patients, in 63% of whom discharges were observed during 18 +/- 11 months of follow-up; only one patient (3%) died suddenly. Thus, in patients with DCM, there was no relationship between documented and inducible ventricular tachyarrhythmias, and initiation of sustained VT or VF had little prognostic value for the prediction of subsequent sudden death. Wherever antiarrhythmic drug therapy was of limited value, implantation of an ICD may improve the prognosis of these high risk patients.

Hyaluronic acid-induced lymphocyte signal transduction and HA receptor (GP85/CD44)-cytoskeleton interaction

The purposes of this study are to characterize the binding of hyaluronic acid (HA) to mouse T lymphoma cells, to measure changes in intracellular Ca2+ after HA binding, to elucidate the interaction between the HA receptor, GP85(CD44), and ankyrin in the membrane skeleton, and finally to correlate these events with HA receptor patching/capping and cell adhesion to HA. First, we established an in vivo assay using [3H]HA to measure the binding of HA to mouse T lymphoma cells, and found that the binding of [3H]HA to these cells is readily inhibited by the addition of anti-GP85(CD44) antibody suggesting that GP85(CD44) is the HA receptor. Next, we examined various signal transducing events that occur after HA binds to its receptor on mouse T lymphoma cells. The results of these studies indicate that the concentration of intracellular Ca2+ (as measured by Fura-2 fluorescence) begins to increase within seconds, and reaches a maximal level 5 min after the addition of HA to the cells. After this increase of intracellular Ca2+, HA induces both its receptors, GP85(CD44), to form patched/capped structures, and cell adhesion to HA-coated plates. Furthermore, we have determined that GP85(CD44) binds directly and specifically to ankyrin (Kd approximately 1.94 nM) in a saturable manner; and that ankyrin is preferentially accumulated underneath the HA-induced GP85(CD44) capped structures. The Ca2+ ionophore, ionomycin, was found to stimulate HA-induced receptor capping and adhesion while EGTA (a Ca2+ chelator), nefedipine/bepridil (Ca2+ channel blockers), W-7 (a calmodulin antagonist), and cytochalasin D (a microfilament inhibitor), but not colchicine (a microtubule disrupting agent), inhibit HA-induced receptor redistribution and adhesion to HA-coated plates. These findings strongly suggest that ankyrin plays an important role in linking the HA receptor, GP85(CD44), to the membrane-associated actomyosin contractile system during hyaluronic acid-mediated lymphocyte activation.

Hyaluronic acid-induced lymphocyte signal transduction and HA receptor (GP85/CD44)-cytoskeleton interaction

The purposes of this study are to characterize the binding of hyaluronic acid (HA) to mouse T lymphoma cells, to measure changes in intracellular Ca2+ after HA binding, to elucidate the interaction between the HA receptor, GP85(CD44), and ankyrin in the membrane skeleton, and finally to correlate these events with HA receptor patching/capping and cell adhesion to HA. First, we established an in vivo assay using [3H]HA to measure the binding of HA to mouse T lymphoma cells, and found that the binding of [3H]HA to these cells is readily inhibited by the addition of anti-GP85(CD44) antibody suggesting that GP85(CD44) is the HA receptor. Next, we examined various signal transducing events that occur after HA binds to its receptor on mouse T lymphoma cells. The results of these studies indicate that the concentration of intracellular Ca2+ (as measured by Fura-2 fluorescence) begins to increase within seconds, and reaches a maximal level 5 min after the addition of HA to the cells. After this increase of intracellular Ca2+, HA induces both its receptors, GP85(CD44), to form patched/capped structures, and cell adhesion to HA-coated plates. Furthermore, we have determined that GP85(CD44) binds directly and specifically to ankyrin (Kd approximately 1.94 nM) in a saturable manner; and that ankyrin is preferentially accumulated underneath the HA-induced GP85(CD44) capped structures. The Ca2+ ionophore, ionomycin, was found to stimulate HA-induced receptor capping and adhesion while EGTA (a Ca2+ chelator), nefedipine/bepridil (Ca2+ channel blockers), W-7 (a calmodulin antagonist), and cytochalasin D (a microfilament inhibitor), but not colchicine (a microtubule disrupting agent), inhibit HA-induced receptor redistribution and adhesion to HA-coated plates. These findings strongly suggest that ankyrin plays an important role in linking the HA receptor, GP85(CD44), to the membrane-associated actomyosin contractile system during hyaluronic acid-mediated lymphocyte activation.

Atrioventricular nodal reentry tachycardia: electrophysiologic comparisons in patients with and without 2:1 infra-His block

Patients with atrioventricular nodal reentry tachycardia (AVNRT) occasionally may demonstrate a 2:1 infra-His block during tachycardia. However, the electrophysiologic background of this phenomenon has not been established so far. In the present study we compared the electrophysiologic parameters of 10 consecutive patients with a transient 2:1 infra-His block during AVNRT of the common type (Group A) with those of 17 consecutive patients without this phenomenon during tachycardia (Group B). Transient 2:1 infra-His block occurred without termination of the tachycardia in all 10 patients of Group A. The tachycardia sustained despite intermittent or permanent conduction disturbance of the infrahisian tissue in 8 of these 10 patients. In comparison, the electrophysiologic parameters of 17 patients without 2:1 block during AVNRT of the common type (Group B) were analyzed. A significantly longer antegrade (318 +/- 58 ms vs. 259 +/- 50 ms) and retrograde (308 +/- 59 ms vs. 239 +/- 20 ms) AV conduction capacity could be demonstrated in these patients. The tachycardia cycle length did not differ significantly between the two groups, although the mean tachycardia cycle length was 48 ms longer in patients of Group B. These observations demonstrate an advanced conduction capacity in patients with a transient infra-His block during AVRNT of the common type. This study underlines that the reentry circuit in AVNRT is not necessarily dependent on infrahisian tissue.

[Sequential observation on the influence of artificial wind-cold environment to immunologic function of mononuclear phagocytic system in mice]

According to TCM theory of Six Evils, the Wind-Cold is one of the pathogen. In order to find the mechanism of Wind-Cold in causing disease, the effect of subacute Wind-Cold stimulation on the phagocyte immunization in mice was observed. Results showed that through exposing in the Wind-Cold environment, the reticuloendothelial system (RES) clearance function and the hydrogen-peroxide releasing of peritoneal macrophage were suppressed. Sequential observation showed that the peak of immunosuppression occurred on the 3rd day after stimulation and began to normalize at 5th day. These results suggested that Wind-Cold stimulation could inhibit temporary phagocytosis of macrophage and bacteriocidal effect. Action of immunosuppression was believed to be produced by the increase of stress hormone after stimulation. Results also suggested that the pathogenic action of Wind-Cold on disease is somewhat related with the suppression of nonspecific cellular immunity.

DNA cleavage, antiviral and cytotoxic reactions photosensitized by simple enediyne compounds

Very potent antibiotic antitumor natural products contain a enediyne moiety which, upon thermal activation, is capable of abstracting hydrogens from DNA. 1,6-Diphenyl-3-hexene-1,5-diyne was selected as a candidate for inducing DNA strand breaks photochemically. Easily interconverted with light, both geometric isomers 1 and 2 were expected to be phototoxic. As anticipated, they photosensitized the production of strand breaks in double-stranded supercoiled pBR322, and in single-stranded M13 DNA. The DNA cleavage reactions were favored by the presence of oxygen and were inhibited by ethanol. Preliminary experiments with the (Z)-isomer indicated moderate light-dependent antiviral activity against human immunodeficiency virus (HIV), Sindbis virus, and mouse cytomegalovirus. The enediynes were cytotoxic to Escherichia coli, a gram-negative organism, to Streptococcus faecalis, a gram-positive organism, to Daphnia magna and to fish (Pimephales promelas), but only in the presence of light. The production of o-terphenyl, the expected product of Bergman cyclization of 1, could not be confirmed. However, both 1 and 2 photosensitized the formation of singlet oxygen and of superoxide anion radical, and photodynamic reactions could have been responsible for some of the phototoxic reactions observed.

A proteolytic fragment from the central region of p53 has marked sequence-specific DNA-binding activity when generated from wild-type but not from oncogenic mutant p53 protein

p53 is a sequence-specific DNA-binding oligomeric protein that can activate transcription from promoters bearing p53-binding sites. Whereas the activation region of p53 has been identified within the amino terminus, the location of the specific DNA-binding domain has not been reported. Thermolysin treatment of p53 protein generates a stable protease-resistant fragment that binds with marked specificity to p53 DNA-binding sites. Amino-terminal sequencing of the fragment located the thermolysin cleavage site to residue 91. Because the fragment does not contain the cdc2 phosphorylation site at Ser-315, we conclude that the the site-specific DNA-binding domain of p53 spans the central region of the protein. The vast majority of the mutations in oncogenically derived p53 proteins are located within this central portion of the molecule. Such mutant p53 proteins exhibit defective sequence-specific DNA-binding. Although thermolysin digestion of mutant p53 proteins generates proteolytic patterns that differ from wild-type protein, one mutant tested, His-273, generates a resistant fragment that migrates with a similar electrophoretic mobility to the wild-type protease-resistant fragment. Interestingly, although intact mutant His-273 protein binds to DNA at 20 degrees C, the thermolysin-resistant mutant fragment does not. In addition, the central protease-resistant, site-specific binding region of wild-type p53 does not demonstrate nonspecific DNA-binding. Thus, although sequences outside of the central region of p53 contribute to both nonspecific DNA-binding and oligomerization, they are not required for sequence-specific DNA-binding.

[Torsade de pointes]

Torsade de pointes (TDP) is a polymorphic ventricular tachycardia with a particular electrocardiographic pattern of continuously changing ("twisting") morphology of the QRS complex occurring in the setting of delayed myocardial repolarization (i.e., prolongation of the QT interval). TDP may develop in the setting of an idiopathic disorder (Jervell/Lange-Nielsen syndrome, Romano-Ward syndrome, sporadic long QT syndrome) or may be induced by pharmacologic agents which prolong the QT interval, as well as by other clinical circumstances under which repolarization is delayed (e.g., hypokalemia, hypomagnesemia, bradycardia) (acquired long QT syndrome). Since the treatment of TDP strongly differs from that of conventional ventricular tachycardia, correct diagnosis is critical as it guides the treating physician in selecting the appropriate mode of therapy. In this paper mainly the electrocardiographic criteria presently used for the correct identification of this unusual form of ventricular arrhythmia are presented. Additionally, the potential mechanisms and therapeutic modalities of TDP are discussed.

[Application of SP-RIA in the antibody surveillance and serologic diagnosis of epidemic cerebrospinal meningitis]

This paper reports the effectiveness of SP-RIA in the antibody surveillance on population, the observation of immune persistence after vaccination with Group A Neisseria meningococcal capsular polysaccharide vaccine, as well as its use in the serological diagnosis of Neisseria meningitis. In comparison with other assays used presently, SP-RIA might be better and more sensitive for quantitative assay of the antibody. The results showed the practical value of SP-RIA in the study of epidemiology and serology of epidemic cerebrospinal meningitis.

Yeast actin with a mutation in the "hydrophobic plug" between subdomains 3 and 4 (L266D) displays a cold-sensitive polymerization defect

Holmes et al. (Holmes, K. C., D. Popp, W. Gebhard, and W. Kabsch. 1990. Nature [Lond.] 347: 44-49) hypothesized that between subdomains 3 and 4 of actin is a loop of 10 amino acids including a four residue hydrophobic plug that inserts into a hydrophobic pocket formed by two adjacent monomers on the opposing strand thereby stabilizing the F-actin helix. To test this hypothesis we created a mutant yeast actin (L266D) by substituting Asp for Leu266 in the plug to disrupt this postulated hydrophobic interaction. Haploid cells expressing only this mutant actin were viable with no obvious altered phenotype at temperatures above 20 degrees C but were moderately cold-sensitive for growth compared with wild-type cells. The critical concentration for polymerization increased 10-fold at 4 degrees C compared with wild-type actin. The length of the nucleation phase of polymerization increased as the temperature decreased. At 4 degrees C nucleation was barely detectable. Addition of phalloidin-stabilized F-actin nuclei and phalloidin restored L266D actin's ability to polymerize at 4 degrees C. This mutation also affects the overall rate of elongation during polymerization. Small effects of the mutation were observed on the exchange rate of ATP from G-actin, the G-actin intrinsic ATPase activity, and the activation of myosin S1 ATPase activity. Circular dichroism measurements showed a 15 degrees C decrease in melting temperature for the mutant actin from 57 degrees C to 42 degrees C. Our results are consistent with the model of Holmes et al. (Holmes, K. C., D. Popp, W. Gebhard, and W. Kabsch. 1990. Nature [Lond.]. 347:44-49) involving the role of the hydrophobic plug in actin filament stabilization.