Urinary IL-6: a marker for mesangial proliferative glomerulonephritis?

A prospective study of plasma and urinary interleukin-6 (IL-6) levels was performed in 54 patients undergoing renal biopsy to determine whether detectable urinary IL-6 was a reliable marker for mesangial proliferation. Interleukin-6 was found in both the urine and plasma of seven patients, the urine alone of 15 patients, and the plasma alone of two patients. Interleukin-6 was not detected in the urine or the plasma of the remaining 30 patients, the urine of 10 healthy controls or the urine of 10 patients with rheumatoid arthritis with raised plasma IL-6. Interleukin-6 was found in the urine of only one out of an additional seven patients with lupus nephritis. Urinary IL-6 was associated with a variety of renal abnormalities and was not restricted to those with mesangial hypercellularity. Furthermore, many patients with mesangial hypercellularity did not have detectable urinary IL-6. There was no correlation between urinary IL-6 and plasma IL-6, urinary albumin excretion or urinary creatinine. These results suggest that IL-6 detected in the urine is a marker of renal IL-6 production, but not specifically of mesangial hypercellularity. The patients with IL-6 in the urine had a mean serum creatinine significantly higher than those without IL-6. It is not possible to distinguish at present whether IL-6 contributes to renal dysfunction or whether it reflects renal damage.

Anti-idiotype and immunosuppressant treatment of murine lupus

The effect of the administration of a xenogeneic anti-idiotype antibody (anti-Id33) to a cross-reactive idiotype (Id33) present on anti-dsDNA antibody was examined in 6-week-old (NZB/NZW) F1 (BWF1) female mice. The administration of anti-Id33 led to a transient reduction in immunoglobulins expressing Id33, followed by a rise at 30 and 34 weeks that was significantly higher than in untreated mice (P less than 0.05). Likewise, anti-dsDNA antibody levels were significantly higher at 10 and 18 weeks than in untreated mice (P less than 0.01). No differences were seen in survival to 40 weeks, proteinuria or the severity of glomerulonephritis. Concurrent administration of cyclosporin A (CyA) with anti-Id33 markedly ameliorated glomerular injury and proteinuria and improved survival. By contrast, glomerular injury, proteinuria and survival were worse in mice treated with cyclophosphamide plus anti-Id33, compared with untreated mice. Neither CyA nor cyclophosphamide treatment, when given with anti-Id33 altered serum levels of anti-dsDNA, anti-ssDNA or Id33+ immunoglobin, compared with untreated mice. The different effects of CyA and cyclophosphamide on T lymphocytes and their discrepant effects on glomerular injury when given with anti-Id33 in this model lead us to postulate a role for T lymphocytes in the glomerular injury of BWF1 lupus.

Prognostic factors in acute renal failure following aortic aneurysm surgery

This study analyses the prognostic factors associated with survival in 70 patients who developed acute renal failure following surgery for an aortic aneurysm. Forty-nine patients (70 per cent) had surgery for a ruptured aortic aneurysm and 21 patients (30 per cent) had an elective procedure. Fifty-nine patients received haemodialysis. Thirty-three patients (47 per cent) survived the episode of acute renal failure. Six of these thirty-three patients died within three months of recovering from acute renal failure, giving an overall survival of 27/70 (39 per cent). A stepwise logistic regression analysis showed that the following factors significantly adversely affected survival: a need for inotropic support, ventilation for more than three days and age over 65 years. A model developed using these variables provided a basis for predicting outcome.

The bistratenes: new cytotoxic marine macrolides which induce some properties indicative of differentiation in HL-60 cells

The biological effects of cytotoxic macrolide polyethers, the bistratenes, isolated from the ascidian Lissoclinum bistratum, have been examined. Bistratene A was toxic to HL-60 human promyelocytic leukemia cells with an IC50 value of 424 nM. At lower concentrations (10-100 nM), bistratene A induced the incomplete differentiation of these cells along the monocyte/macrophage pathway. These effects were not due to inhibition of DNA synthesis. Bistratene B had similar effects to bistratene A. At micromolar concentrations these compounds enhance the phospholipid-dependent activity of type II protein kinase C from bovine spleen. The bistratenes provide new probes for studying the molecular mechanisms governing cell growth and differentiation.

High-power cadmium photoionization laser pumped by soft x rays from a laser-produced multispot plasma

Soft x rays from as many as nine plasma spots, produced by a 1-J, 8-nsec Nd:YAG laser system, have been used to excite Cd atoms by inner-shell photoionization and to generate high-power laser radiation in Cd(+) at 442 and 325 nm. With our multifoci setup a strong reduction of photoelectron impact and radiation losses during the excitation and laser process was possible, resulting in Cd(+) laser output energies (peak powers) as high as 1.1 mJ (85 kW) at 442 nm and 140 microJ (11 kW) at 325 nm, which are, to our knowledge, the highest achieved to date.

Acquired cystic disease of the kidney: ultrasound as the primary screening procedure

Patients with end-stage renal disease on long term dialysis may develop de novo renal cystic disease. We used ultrasound as a primary screening procedure for renal cysts in 71 patients. In seven patients (10%) the native kidneys could not be identified. In 35 patients renal cysts were identified indicating a prevalence of acquired renal cystic disease of 49%.

Assessment of glomerular size in renal biopsies including minimal change nephropathy and single kidneys

A method of assessing glomerular size on sections of post-mortem kidney was adapted for use on needle biopsies of kidney. A semi-automatic image analyser was used to measure the cross-sectional area of the outline of Bowman's capsule on all glomeruli in renal biopsies. The mean of approximately the largest 25 per cent of areas was calculated. The method was used to compare glomeruli in 13 control patients without obvious structural abnormalities with those in 10 patients with a single kidney, 22 with minimal change nephropathy, and 20 with membranous nephropathy. Patients were at least 14 years old. Glomeruli in minimal change nephropathy were significantly smaller than those in all other groups. Glomeruli in single kidneys were significantly larger than those in all other groups. Glomeruli in membranous nephropathy were the same size as controls. Any differences between groups could not be explained by differences in body build. It is possible that in adults glomeruli in minimal change nephropathy are abnormally small. The method of assessing glomerular size can be used on renal biopsies as well as on sections of whole kidney.

Preliminary trial of minidose heparin prophylaxis for painful sickle cell crises

Four patients with well-documented severe recurrent painful sickle cell crises received 12-month courses of self-administered minidose heparin (5000-7500 units every 12 hours). Patients were evaluated weekly or bi-weekly for symptoms and signs of sickle crises. The observations were compared with identical observations during 12 months off heparin (control). Prior to starting heparin, baseline laboratory values were established, including hematocrits, platelet counts, and plasma coagulation factors. Bone density was evaluated by radiologic measurement of metacarpal cortical width and by forearm transmission osteodensitometry. Laboratory values were repeated at each visit; bone density was reevaluated every 6 months. At each visit clinical status for the preceding 1-2 weeks was classified as: no pain (I), minor pain controllable by non-prescription medications (II), pain requiring office or emergency room admissions for parenteral narcotics (III), hospitalized for about 3 days for pain crisis (IV). One patient completed a single 2-year cycle; one patient completed 2 cycles (followed 4 years), and 2 patients have undertaken 3 cycles (followed greater than or equal to 6 years). No treatment-related complications occurred requiring discontinuation of heparin. Thrombocytopenia was not observed. There was no evidence of progressive osteopenia. All patients improved while receiving heparin; 1 moderately, 3 markedly. Cumulative data (8.7 patient years on heparin, 12 control years) revealed a 73% reduction in days of hospitalization per year and 74% reduction in hours spent in emergency rooms per year during heparin administration. Pretreatment pain patterns recurred when heparin was discontinued.

IgG subclasses of PEG precipitable IgG in systemic lupus erythematosus sera

Polyethylene glycol (PEG, 4%)-precipitated macromolecular IgG isolated from the sera of 20 patients with systemic lupus erythematosus (SLE) and 15 control subjects was analyzed for its IgG isotype concentration by single radial immunodiffusion. PEG precipitates from SLE sera had higher mean levels of IgG1, IgG2 and IgG3 and lower IgG4 than PEG precipitates isolated from normal sera although only the IgG2 levels were significantly different. Using an anti-complementary assay there was a significant correlation between the ability of parent sera to fix complement and the absolute levels of PEG precipitable IgG1, IgG2 and IgG3. These data suggest that the ability of immune complexes in the sera of patients with SLE to fix complement is dependent on their IgG subclass composition.

Reactive oxygen products in heterologous anti-glomerular basement membrane nephritis in rats

The effect of 'scavengers' of reactive oxygen products (ROPs) was studied in the heterologous phase of anti-glomerular basement (anti-GBM) nephritis induced in rats. Glomerulonephritis was induced by the intravenous administration of sheep anti-GBM antibody (5 mg/100 g) to rats on day 0. The intraperitoneal administration of superoxide dismutase (SOD) 30 mg/kg/day or 150 mg/kg/day leads to a significant reduction in proteinuria on day 1 and also on day 3 in animals given SOD 30 mg/kg/day. Proteinuria was not significantly reduced by the intraperitoneal administration of inactivated SOD (150 mg/kg/day). In rats given polyethylene glycol coupled catalase (PEG-catalase) intraperitoneally at a dose of 10,000 iu/kg/day and 100,000 iu/kg/day proteinuria was lower than in rats with unmodified anti-GBM nephritis. These differences were significant on day 1 (P less than 0.05) in rats given PEG-catalase 100,000 iu/kg/day and on days 3 and 5 in rats treated with either dose of PEG-catalase (P less than 0.01). These data suggest a role for superoxide anion and hydrogen peroxide, or a product of their interaction such as hydroxyl radical, in glomerular injury induced by anti-GBM antibody.

Chronic ambulatory peritoneal dialysis in patients aged over seventy

Thirteen patients with end-stage renal disease aged 70 years have been successfully treated by chronic dialysis treatment. Despite many problems associated with the elderly, a good quality of life was achieved.

Different types of segmental sclerosing glomerular lesions in six experimental models of proteinuria

From 133 to 615 glomeruli were examined in sections of kidneys from each of 60 animals, representing six rodent models of proteinuria. Particular attention was paid to the position of segmental lesions. Lewis rats given sheep anti-rat glomerular basement membrane antibodies had lesions almost exclusively at the glomerulo-tubular junction. Wistar rats on a diet of 24 per cent casein or with subtotal nephrectomy and a diet of 24 per cent soya had lesions mainly at the hilum. Wistar rats given bovine serum albumin had global lesions but virtually no segmental lesions. Wistar rats given puromycin aminonucleoside had lesions at the glomerulo-tubular junction and global mesangial abnormalities shortly after the treatment but later developed segmental lesions at all parts of the glomerulus. Untreated BUF/Mna rats had lesions at the glomerulo-tubular junction early in life but later had lesions at all parts of the glomerulus. Untreated NZB/NZW hybrid mice had various types of glomerulonephritis and also had lesions at the glomerulo-tubular junction. These findings showed that (1) segmental lesions at the glomerulo-tubular junction, or glomerular tip, occur in experimental animals, a fact not previously reported, and these tip changes are a common feature in several different models of proteinuria; (2) hilar segmental lesions are seen in conditions with hyperfiltration of protein; and (3) segmental lesions at various parts of the glomerulus are seen in some models of proteinuria and probably indicate late effects of random toxic damage to the glomerulus. Thus, there are at least three different types of segmental glomerular lesions in experimental animals--tip, hilar, and random--with different morphology and pathogenesis. It is likely that these findings can be extended to human renal diseases with segmental glomerular lesions. This will help to clarify the controversial and unsatisfactory term focal segmental glomerulosclerosis.

The treatment of diabetic renal failure by continuous ambulatory peritoneal dialysis

During the 6-year period 1981-1987, 309 patients started chronic ambulatory peritoneal dialysis (CAPD), of whom 75 (24%) had diabetes. Despite severe peripheral vascular problems (20%), ischaemic heart disease (90%), and complete blindness (21%) the 1-year patient survival on CAPD was 88%. The actuarial patient survival for diabetic patients was similar to that of the non-diabetic cohort over the first 18 months but fell to 48% (compared to 70% in non-diabetic patients) at 3 years. Complications associated with CAPD, including the incidence of peritonitis, were no different between the diabetic and non-diabetic patient populations. Successful treatment for end-stage renal disease (ESRD) in diabetic patients can be achieved and justified in a liberal selection programme for the treatment of diabetic ESRD.

T-cell-independent and T-cell-dependent antibody responses in patients with chronic renal failure

Antibody responses against pneumococcal capsular antigens and tetanus toxoid were measured in 14 patients with chronic renal failure who were managed by continuous ambulatory peritoneal dialysis (CAPD) or haemodialysis (HD) and in eight healthy controls. IgG antipneumococcal responses were predominantly of the IgG2 and to a lesser extent IgG1 subclasses, while the IgG response against tetanus toxoid was largely IgG1 with smaller amounts of IgG4 and IgG3. The post-immunisation serum levels of IgG1 and IgM antibody against both antigens were significantly reduced in the uraemic patients compared with controls (P less than 0.05). All the uraemic patients had normal levels of IgG, IgA and IgM in the serum, but elevated levels of IgG3 prior to immunisation. The mechanisms responsible for the asymmetric depression of antibody responses in uraemia are unclear and may account in part for the increased susceptibility to infection in these patients.

Vancomycin and ceftazidime in the treatment of CAPD peritonitis

102 episodes of continuous ambulatory peritoneal dialysis (CAPD) peritonitis were studied prospectively during a 288-day period at The Queen Elizabeth Hospital, Birmingham. Organisms were isolated from 76% of the episodes, with coagulase-negative staphylococci, being the most commonly encountered organism (55%). Initial treatment consisted of intraperitoneal vancomycin and ceftazidime with subsequent adjustment on the basis of antibiotic sensitivities. With this regimen, 83% of the positive cultures became negative by 72 h, 9.8% of cases relapsed and removal of the CAPD catheter was necessary in 8 patients (7.8%). Overall, 92% of cases were cured. No adverse drug reactions were seen. This combination of antibiotics appears effective and safe in the treatment of CAPD peritonitis.

Hypogammaglobulinaemia in nephrotic rats is attributable to hypercatabolism of IgG

The effect of the nephrotic syndrome induced by puromycin aminonucleoside (PA) in rats on specific antibody responses to 2,4 dinitrophenyl (DNP) conjugated to either spider crab haemocyanin (MSH), a T cell-dependent antigen, or hydroxyethyl starch (HES), a T cell-independent type 2 antigen were studied. The serum IgG anti-DNP levels following immunization with both antigens were reduced in nephrotic animals compared with controls while IgM anti-DNP antibody titres were higher. The half-life of IgG anti-DNP antibodies passively transferred into non-immunized nephrotic rats was markedly reduced while the half-life of anti-DNP antibodies of the IgM class was comparable to that in controls. Low serum IgG and elevated IgM levels were seen in nephrotic animals compared to controls. Antibody-forming cells specific for DNP were demonstrated by immunohistology on rat spleens and the numbers of both IgG and IgM-producing cells were found to be significantly increased (P less than 0.05) in nephrotic animals in response to both DNP-HES and DNP-MSH. These data indicate that in nephrotic rats the alteration seen in the serum immunoglobulin levels is not attributable to reduced antibody production but increased catabolism of serum IgG antibodies.

Does cyclosporin A adversely affect Pneumocystis carinii infection?

Fourteen immunosuppressed patients with Pneumocystis carinii infection presented in two clusters that were separated by 2 years. The diagnosis in all cases was made early by alveolar lavage with cytology. The first group of seven patients was immunosuppressed with cyclophosphamide or azathioprine and prednisolone. All recovered with high dose co-trimoxazole. The second group of seven patients was on prednisolone and cyclosporin A. Despite identical treatment three patients died and a further two who survived lost their grafts from rejection. Our data suggest that cyclosporin A adversely affects the prognosis from Pneumocystis carinii infection and raises the question of prophylactic co-trimoxazole in these patients. The clustering of Pneumocystis carinii infection suggests the possibility of nosocomial transmission although in this study we were unable to implicate person-to-person spread of infection.

Studies on the molecular organization of rat insulin secretory granules

Secretory granule-enriched fractions prepared from isolated rat islets of Langerhans, previously labeled in culture for 18 h with [3H]leucine, have been lysed and separated into pH 5.4 soluble and insoluble fractions by zonal sucrose gradient centrifugation. A high proportion of both labeled and immunoreactive rat insulins I and II were recovered in the insoluble granule core fraction in the expected ratio of approximately 60/40, respectively. Essentially equivalent amounts of the rat C-peptides on a molar basis were recovered in the granule supernatant fractions. The proportion of labeled proinsulin in the granule core fraction was less than 2% relative to insulin, while the soluble fraction contained about 8%, which probably arose mainly from disrupted proinsulin-rich noncrystalline prosecretory vesicles. Electron microscopic examination of the granule core fraction revealed large numbers of well preserved crystalline cores exhibiting typical dimensions and regular internal spacings of normal mature rat beta-granule inclusions. These results provide direct biochemical evidence that the beta-granules are nonuniform in composition with the insulin contained mainly in a crystalline state in the electron-dense central inclusions while the C-peptide is dissolved in the fluid bathing the crystalline hormone. The significance of this structural organization of the beta-granule is discussed.

Use of a synthetic peptide antigen to generate antisera reactive with a proteolytic processing site in native human proinsulin: demonstration of cleavage within clathrin-coated (pro)secretory vesicles

Polyclonal antibodies reactive with a cleavage site in human proinsulin (HPI) (C-peptide-A-chain junction) have been raised (rabbit, guinea pig) using a synthetic peptide antigen coupled with keyhole limpet hemocyanin. These antisera recognize native HPI and des-31,32-HPI equally well but react 20-50 times less well with des-64,65-HPI, the intermediate cleaved at the C-peptide-A-chain junction and lacking the Lys-Arg pair. The guinea pig antisera did not recognize insulin but reacted weakly with C peptide at high concentrations; the rabbit antisera reacted with neither insulin nor C peptide. Immunocytochemical studies with human islet tissue localized the immunoreactivity of these antisera to clathrin-coated (pro)secretory vesicles derived from the trans Golgi, indicating that cleavage of the C-peptide-A-chain junction of proinsulin occurs mainly, if not exclusively, in this compartment of the beta cell.

The role of superoxide anion and hydrogen peroxide in glomerular injury induced by puromycin aminonucleoside in rats

1. The nephrotic syndrome was induced in inbred female Wistar rats by the intravenous injection of puromycin aminonucleoside (PA) (5 mg/100 g body weight). 2. One group (n = 12) received superoxide dismutase (SOD) (15 mg/kg body weight), a second group (n = 12) received polyethylene glycol coupled catalase (PEG-catalase) (5000 i.u./kg body weight) and the third (n = 9) saline (150 mmol/l NaCl) via the intraperitoneal route, in addition to the PA. 3. SOD and PEG-catalase reduced the 24 h urine protein on days 8 and 15 compared with unmodified puromycin treated animals and this difference was significant on day 15 for SOD (P less than 0.05) and for PEG-catalase (P less than 0.01). Glomerular filtration rate, as measured by the creatinine clearance, was lower in the PEG-catalase group but did not differ significantly from the saline treated group. 4. These data suggest that superoxide anion and hydrogen peroxide, or their reaction products, are involved in the glomerular injury of puromycin nephropathy.

Amyloidosis in continuous ambulatory peritoneal dialysis

We report a 53 year old man with chronic renal failure on continuous ambulatory peritoneal dialysis. Following eight episodes of severe peritonitis over a 2 year period, he died and was found to have widespread AA amyloid at post-mortem.

Rheumatoid arthritis and IgA nephropathy

We describe four patients with seropositive rheumatoid arthritis who developed proteinuria and microscopic haematuria. Renal biopsy demonstrated a mesangial proliferative glomerulonephritis with mesangial deposits of IgA. These data suggest a possible causal relationship between rheumatoid arthritis and IgA nephropathy.

Epstein's syndrome: case report and survey of the literature

A diagnosis of Epstein's syndrome was made in a young female with congenital macrothrombopathic thrombocytopenia, a nephropathy and mild sensorineural deafness. Previous case reports of this rare disorder are briefly reviewed and attention is drawn to the frequent association between inherited thrombocytopenia and renal disease.

The glomerular tip lesion: a steroid responsive nephrotic syndrome

The glomerular tip nephropathy is a cause of the nephrotic syndrome and has distinct pathological features. Glomerular tufts appear normal on light microscopy except for a segmental lesion invariably present in all glomeruli at the origin of the proximal tubule. Data on twenty adults whose renal biopsies demonstrated this lesion and who were followed for a mean of 7.4 years are analyzed. Eighteen patients were treated with steroids; ten of these had complete remission of proteinuria and seven a significant reduction of their proteinuria. Ten patients had moderately impaired renal function (serum creatinine greater than 120 mumol/l) at presentation, eight received steroids and achieved a reduction in serum creatinine. The prognosis was good, with no patient developing chronic renal failure requiring dialysis.

Renal failure and the histopathological features of myeloma kidney reversed by intensive chemotherapy and peritoneal dialysis

Images

Changing pattern of acute renal failure

During the four-year period 1981-1984, 250 patients with severe acute renal failure were treated at one centre. There were seven obstetric cases (2.8 per cent) 118 'surgical' cases (47.2 per cent) and 125 medical cases (50 per cent). This is a different pattern from that seen in the majority of earlier reports. In 60 of the 125 medical patients the aetiology of the acute renal failure could only be determined by renal biopsy. This series suggests that with changing medical practice (particularly the improvement in resuscitation) and an ageing population, the pattern of causes of acute renal failure is altering. It also highlights the value of renal histology as a guide to diagnosis and treatment in patients with unexplained acute renal failure.

Diagnosing Pneumocystis carinii pneumonia by cytological examination of bronchoalveolar lavage fluid: report of 15 cases

Sixty episodes of pneumonia occurring in 53 immunosuppressed patients were investigated by bronchoalveolar lavage. Pneumocystis carinii was diagnosed on 15 (25%) occasions. In all cases the Papanicolaou stained lavage fluid presented a distinctive appearance and contained abundant, often biphasic, staining, "honeycomb" debris, and few alveolar macrophages. The Grocott methenamine silver technique confirmed the presence of characteristic cystic organisms in the debris in all 15 instances. Cysts containing internal sporozoites were identified in Gram stained material only with difficulty. Neither May-Grünwald-Giemsa stain nor fluorescence microscopy under ultraviolet light were effective for routine investigation.

Change in plasma immunoreactive atrial natriuretic peptide during sequential ultrafiltration and haemodialysis

Plasma immunoreactive human atrial natriuretic peptide (Ir-ANP) levels were measured in eight patients with chronic renal failure who were volume-expanded and during treatment by sequential ultrafiltration and haemodialysis. One patient was studied at two separate treatment sessions. Plasma Ir-ANP levels were raised in all patients (mean +/- SE 184 +/- 44 pmol/l, n = 9) compared with healthy controls (11 +/- 1.4 pmol/l), but showed considerable inter-patient variability. Plasma Ir-ANP levels fell with fluid removal during ultrafiltration (123 +/- 30 pmol/l, n = 9, P less than 0.02) and again as fluid was removed during haemodialysis (76 +/- 20 pmol/l, n = 9, P less than 0.02). Seven patients studied 48 h later, before their next dialysis treatment, had regained weight and showed a coincident rise in circulating plasma Ir-ANP (130 +/- 33 pmol/l, n = 7). Our data would support the hypothesis that the secretion of ANP is determined by volume or by a stimulus related to volume. However, it does not exclude the possibility that a factor other than extracellular fluid volume expansion contributes to the raised plasma Ir-ANP levels in chronic renal failure.

Strongyloides stercoralis hyperinfestation syndrome with Escherichia coli meningitis: report of two cases

Two cases of Strongyloides stercoralis hyperinfestation syndrome accompanied by Gram negative bacteraemia and meningitis were studied. Both occurred in non-immunosuppressed West Indian women.

Non-steroidal anti-inflammatory drugs and renal failure

In 3 years seventeen patients presented to one unit with renal failure associated with the use of non-steroidal anti-inflammatory drugs (NSAID). Seven patients presented with acute renal failure, in four due to acute tubular necrosis and in three to acute interstitial nephritis; all recovered when NSAID treatment was stopped. Four patients presented with symptomless renal impairment discovered during routine follow-up in a rheumatology clinic; again all improved on withdrawal of NSAID. The remaining six patients presented with chronic renal failure, a disorder not previously associated with NSAID treatment. The pattern of renal disease associated with NSAID may be more extensive than has previously been recognised. A history of NSAID use should be sought in all patients presenting with unexplained renal failure.

Hybromet: a ligand for purifying opioid receptors

Condensation of the Grignard reagent derive from 2-[4-(allyloxy)phenyl]ethyl bromide (4b) with 7 alpha-acetyl-6,14-endo-ethenotetrahydrothebaine (5) furnished the (R) tertiary carbinol, 7, which upon methoxymercuration followed by treatment with the KBr gave the bromomercurio compound 10 (Hybromet). The corresponding N-cyclopropylmethyl analogue, 11, was prepared also. The bromomercurio compound, 1, and the mercaptobenzothiazole derivative, 3, gave allyl phenyl ether when treated with BAL at room temperature. Similar treatment of 10 with BAL gave 7 in high yield. Binding studies using rat brain homogenates indicated that 7, 13, and 14 have moderately high affinities for mu rather than delta binding sites. Although much weaker, 10 showed preferential mu binding also. These results along with the fact that 10 reacted smoothly with sulfhydryl groups suggest that Hybromet would be a suitable ligand for use in affinity chromatography.

Peritonitis due to Streptococcus viridans in patients receiving continuous ambulatory peritoneal dialysis

Images

Chloroacryloyl amides and alpha-methylenelactones from naltrexone, oxymorphone and fentanyl

A series of chloroacryloyl amides and alpha-methylenelactones were prepared from naltrexone and oxymorphone and some chloroacryloyl amides from fentanyl were prepared as potential Michael acceptors and irreversible ligands. The relative rates of Michael additions of p-methoxybenzenethiol to the double bonds were measured in an NMR spectrometer. The IC50's in rat brain homogenates and the irreversible binding to rat brain membranes were determined. In the methylene-lactone series, it was found that both the alpha and beta isomers derived from naltrexone and oxymorphone were excellent Michael acceptors, but only the beta isomers were more active in the opioid binding assays. The beta isomer derived from naltrexone was an irreversible ligand whereas the oxymorphone analogue was active only in the presence of 100 mM NaCl. In the chloroacryloyl series, only the alpha-chloroacryloyl amide derived from beta naltrexamine proved to be an irreversible binding ligand in the absence of NaCl. It was an excellent Michael acceptor. Under the conditions of our experiments, beta-FNA was a poor Michael acceptor and did not behave as an irreversible ligand in rat membranes.