Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.

Phase II trial of hepatic arterial infusion of fluorouracil and recombinant human interferon alfa-2b for liver metastases of colorectal cancer refractory to systemic fluorouracil and leucovorin

PURPOSE

To determine the toxicity, response rate, and survival in patients treated with hepatic arterial infusion (HAI) of fluorouracil (5-FU) plus recombinant human interferon alfa-2b (rIFN-alpha 2b) (Intron-A; Schering-Plough, Inc, Kenilworth, NJ) for colorectal carcinoma (CRC) liver metastases refractory to systemic 5-FU plus leucovorin (LCV).

PATIENTS AND METHODS

Forty-eight patients were given a 6-hour HAI of rIFN-alpha 2b 5 MU/m2 followed by an 18-hour HAI of 5-FU, 1,500 mg/m2 daily for 5 days. Twenty-nine patients were treated through percutaneously placed catheters and 19 through implantable infusion pumps (Shiley Infusaid Inc, Noorwood, MA). Treatment cycles were repeated every 28 to 35 days.

RESULTS

There were three (6.6%) complete remissions (CRs) and 12 (26.6%) partial remissions (PRs), for a CR plus PR rate of 33.3% among 45 assessable patients (95% confidence interval [CI], 20% to 49%). The median response duration was 7 months, while median survival duration was 15 months. Grade 3 to 4 treatment-related toxic effects included mucositis (40%), neutropenia (42%), and thrombocytopenia (12%). No hepatobiliary toxicity was encountered in any of the patients. Treatment was discontinued because of progressive liver disease in 23 patients and extrahepatic progression in 16, while six patients continue treatment through an infusaid pump.

CONCLUSION

HAI of 5-FU plus rIFN-alpha 2b is well tolerated, devoid of hepatobiliary toxicity, and can produce a response rate of 33.3% among patients refractory to bolus intravenous (IV) 5-FU plus LCV. The lack of hepatobiliary toxicity may permit salvage HAI with floxuridine (FUDR) in patients whose liver tumors fail to respond to HAI of 5-FU plus rIFN-alpha 2b. Because diarrhea was not a common side effect of HAI of 5-FU plus rIFN-alpha 2b, it would be of interest to investigate whether alternating HAI of 5-FU and rIFN-alpha 2b with systemic irinotecan (CPT-11) will decrease the incidence of both hepatic and extrahepatic disease progression.

Squash racquets. A review of physiology and medicine

Squash is a moderate to high intensity sport which demands specific fitness. Squash at any level places a high demand on the aerobic system for energy delivery during play and recovery. In addition, the sport requires bursts of intense, anaerobic physical activity involving the lactic anaerobic energy system. Players must possess appropriate levels of local muscular endurance, strength, power, flexibility and speed, combined with agility, balance and co-ordination. Irrespective of the standard of play, aerobic fitness training and specific anaerobic training should be undertaken by all who play or intend to play squash. Aerobic fitness for the individual who is new to the game and has little training background can be improved using low intensity continuous running. Training sessions and matches should be preceded by warm-up and flexibility exercises which may reduce the chance of injury and enhance readiness to perform. Despite squash being an indoor sport, it is likely that play in hot and humid weather may generate significant thermal loads with the associated elevations in heart rate. Fluid losses of 2 L/min and rectal temperatures of 39 degrees C may occur, thereby increasing the cardiovascular stress of participation and the risk of heat illness. Sudden death and other manifestations of heart disease can occur in squash, therefore advice regarding the safe participation for those with, or who have the potential to develop disease appears essential. For those under 40 years of age who are well and have no known heart disease, medical clearance is not mandatory prior to taking up squash; for such individuals, regular medical monitoring may be unnecessary. For healthy individuals older than 40 years of age irrespective of health status, but particularly for those with coronary disease or relevant risk factors, a medical checkup is recommended prior to, and at least annually after taking up squash. Healthy individuals older than 40 years of age with one or more risk factors require a medical checkup prior to commencing squash for the first time and at regular intervals (every 2 years) thereafter. These individuals should also have a medically supervised exercise test. Those individuals older than 40 years of age who have a known history of heart disease, most commonly coronary artery disease, may play squash if it is demonstrated that, on examination or following therapy or surgery, they can exercise safely to a high workload. Most eye injuries which occur in squash are related to eye/ball and eye/racquet contact. The incidence of injury is very low but such injuries may be totally preventable. Ideally, all players should wear protective eye apparatus. The "ideal' protective apparatus should comply with the Australian/New Zealand Standard for eye protectors for racquet sports. It should be recognised at the outset that there is a paucity of specific data regarding squash and pregnancy. Most women with normal pregnancies may continue to exercise and play squash particularly in the early stages of pregnancy but should notify their physician of their intention to do so. Musculo-skeletal injuries to the lower limb dominate most studies and common injuries include sprains and strains to the back and ankles. Of particular interest is the development of degenerative hip disease in elite squash players necessitating retirement or curtailment of activity in the third decade. Dealing with injuries and illness that are attributed to squash requires an approach based on prevention as well as on appropriate injury management.

Effects of gender on listeners' judgments of speech intelligibility

Effects of gender on listeners' judgments of intelligibility were investigated. Subjects (15 women; 15 men) provided magnitude-estimation scaling responses and over-all impression of the intelligibility of a male and female speaker's comparable versions of audiotaped speech samples varying systematically in terms of the number of phonemes produced correctly. There was no significant difference between male and female subjects' magnitude-estimation scaling responses; however, their over-all impressions of the intelligibility of the speakers tended to differ. Women indicated that the male speaker was more understandable, and men indicated that the female speaker was more understandable. Magnitude-estimation scaling may provide an objective means for evaluating a speaker's intelligibility. It appears to transcend gender-biases associated with judgments of speech intelligibility.

Site-dependent expression of vascular endothelial growth factor, angiogenesis and proliferation in human gastric carcinoma

To determine the role of site of tumor implantation on tumor angiogenesis, we implanted gastric cancer cells in the orthotopic (stomach) and ectopic (subcutaneous) locations in nude mice. Tumors in the stomach demonstrated greater vascularization, higher levels of vascular endothelial growth factor (VEGF) expression, and greater proliferation compared with tumors in the subcutaneous tissues. These data suggest that the relationships among the expression of VEGF, vascularization, and proliferation of human gastric cancer cells are regulated by the organ microenvironment. In addition, VEGF may provide a target for anti-angiogenic therapy for gastric cancers.

Glycine conjugation of para-aminobenzoic acid (PABA): a quantitative test of liver function

OBJECTIVE

To evaluate glycine conjugation of para-aminobenzoic acid (PABA) to the hippurated metabolites, para-aminohippuric acid (PAHA), and para-acetamidohippuric acid (PAAHA) as a quantitative liver function test in patients with liver disease.

DESIGN AND METHODS

Serum concentrations of PABA and metabolites were measured by high pressure liquid chromatography in 24 controls and 50 patients with hepatobiliary disease.

RESULTS

Hippurate formation was significantly decreased in all patient groups with chronic liver disease versus controls. The hippurate ratio (% hippurated metabolites formed) correlated with severity of disease, serum albumin, and factor VII concentrations. PAHA concentration was a better prognostic indicator than factor VII concentrations in patients with acute liver disease; concentrations of zero correctly predicted a poor outcome in patients with fulminant liver failure.

CONCLUSIONS

Glycine conjugation of PABA may be useful as a quantitative liver function test in patients with hepatobiliary disease and as a prognostic index in patients with fulminant liver failure.

Expression, characterization, and crystallization of the catalytic core of the human insulin receptor protein-tyrosine kinase domain

The deduced primary sequence of the cytoplasmic protein-tyrosine kinase domain of the insulin receptor contains a conserved kinase homology region (receptor residues 1002-1257) flanked by a juxtamembrane region and a C-terminal tail. A soluble 48-kDa derivative (residues 959-1355) containing these regions but lacking the first six residues of the juxtamembrane region had earlier been synthesized in Sf9 cells using a baculovirus expression system. The catalytic core of the kinase domain was studied first by proteolytic analysis of the 48-kDa kinase and then by expressing a series of truncated kinase domains in transiently transfected COS cells. Based on these studies, two core kinases of 34 (residues 985-1283) and 35 (residues 978-1283) kDa, respectively, were overexpressed in Sf9 cells. Biochemical characterization of the 35-kDa kinase revealed that the core kinase conserved the major functional properties of the native receptor kinase domain. Activity of the 35-kDa kinase toward a synthetic peptide increased more than 200-fold upon autophosphorylation, which occurred exclusively at Tyr-1158, Tyr-1162, and Tyr-1163; the largest increase was observed between bis- and trisphosphorylation of the kinase. The activated 35- and 48-kDa kinases were similar with respect to specific activity and ATP and Mg2+ requirements for peptide phosphorylation. Moreover, autophosphorylation appeared to initiate predominantly at Tyr-1162, immediately followed by phosphorylation at Tyr-1158 and then at Tyr-1163. The rate of autophosphorylation was dependent on enzyme concentration, consistent with a trans-phosphorylation mechanism. Finally, the 35-kDa kinase was crystallized, making possible elucidation of its three-dimensional structure by x-ray crystallography.

Exercise intensity increased by addition of handheld weights to rebounding exercise

PURPOSE

Researchers who studied the effects of rebound exercise on fitness have concluded that the intensity of rebound exercise elicited only minimal improvements in fitness. This study determined how the addition of arm pumping with handheld weights (HHW) would increase exercise intensity while rebounding.

METHODS

Fifteen male subjects (20 to 43 years) ran in place on a mini-trampoline at a stride frequency of 120 foot strikes per minute, with the sole of the foot 15 cm above the rebounder rim. Oxygen uptake (VO2) and heart rate (HR) were measured while rebounding alone, and also while pumping 0.45 kg, 0.91 kg, and 1.36 kg HHW to heights of 61 and 91 cm.

RESULTS

All combinations of weights and pumping levels resulted in significantly (P < .05) higher VO2 and HR than rebounding alone. The estimated mean increase in VO2 was 3.2 mL/kg/min when the weight was increased from 0.91 kg to 1.36 kg at the 91 cm pumping height. The corresponding HR increase was 10.1 bpm. Similarly, when 1.36 kg weights were pumped at 91 cm instead of 61 cm, the mean increase in VO2 and HR was 6.2 mL/kg/min and 11.4 bpm, respectively.

CONCLUSIONS

The addition of HHW exercise to rebounding substantially increases exercise intensity. Because rebounding without weights results in a relatively low intensity, the addition of HHW should be considered in the use of rebounding for cardiovascular training.

Crystal structure of the tyrosine kinase domain of the human insulin receptor

The X-ray crystal structure of the tyrosine kinase domain of the human insulin receptor has been determined by multiwavelength anomalous diffraction phasing and refined to 2.1 A resolution. The structure reveals the determinants of substrate preference for tyrosine rather than serine or threonine and a novel autoinhibition mechanism whereby one of the tyrosines that is autophosphorylated in response to insulin, Tyr 1,162, is bound in the active site.

Structural determinants of substrate selection by the human insulin-receptor protein-tyrosine kinase

Using NMR spectroscopy to visualise tyrosine phosphorylation kinetics in real time, we have investigated the sequence-dependent determinants of the selectivity of the human insulin receptor protein-tyrosine kinase for different tyrosine residues. The peptides used encompass the multiple-tyrosine-containing autophosphorylation site sequences from the insulin receptor kinase core domain (Tyr1158, Tyr1162 and Tyr1163) and from its specific C-terminal tail domain (Tyr1328 and Tyr1334). Comparison of the phosphorylation kinetics with those found for the tyrosine residues on a peptide comprising the regulatory tyrosine phosphorylation site of cdc2 points to the role of the primary sequence context of the phosphate acceptor. The particularly deleterious influence of a basic residue immediately C-terminal to the tyrosine is discussed in relation to the autophosphorylation properties of the regulatory loop regions of the insulin and epidermal growth factor receptor kinases. The data further suggest that receptor tyrosine kinase active sites and their substrate targets act in concert to ensure that specific downstream effects are activated.

Phosphorylation effects on flanking charged residues. Structural implications for signal transduction in protein kinases

1H-NMR and 31P-NMR spectroscopy were employed to assess the electrostatic consequences of phosphorylation of single and multiple tyrosine residues in peptides derived from the core and tail autophosphorylation regions of the human insulin receptor tyrosine-kinase domain. In both peptides, phosphorylation was accompanied by changes in the resonances from basic side-chains; those from acidic residues were unaffected. Tyrosine phosphorylation caused increases of up to one in the pKa values of histidine residues situated up to eight residues away in the primary sequence. Titration curve analysis by Hill plots suggested some cooperativity of histidine and phosphate ionizations. Behaviour closely analogous to that of the insulin receptor tail peptide was observed during changes in phosphorylation of the intact insulin receptor kinase domain, suggesting that the electrostatic dissemination effects seen for the isolated peptide are retained by the peptide sequence in the context of the much larger protein. Similar changes in the behaviour of basic residues were also observed upon tyrosine phosphorylation of a cdc2-derived peptide, suggesting that this potential of phosphorylation events to propagate directed structural changes may find a widespread utility in the activation of protein kinases and in the transduction of phosphorylation-based signalling.

Use of high-fat formula for premature infants with bronchopulmonary dysplasia: metabolic, pulmonary, and nutritional studies

The use of dietary fat in preference to carbohydrate offers the theoretic advantage of diminishing carbon dioxide production and thus the respiratory quotient, which may be beneficial for babies with chronic lung disease. Ten premature infants (birth weight (mean +/- SEM), 1.13 +/- 0.12 kg; postnatal age, 9 +/- 1 weeks) with bronchopulmonary dysplasia were alternately fed a high-fat and a high-carbohydrate formula each for 1 week, in randomized order. Lower rates of carbon dioxide production (6.6 +/- 0.3 versus 7.4 +/- 0.4 ml/kg per minute; p < 0.05), and consequently lower respiratory quotients (0.80 +/- 0.02 versus 0.94 +/- 0.01 ml/kg per minute; p < 0.005), were observed during the administration of the high-fat formula. There were no significant differences in results of pulmonary function tests with the use of either formula. Both formulas were equally well tolerated and able to promote adequate growth and normal biochemical profiles. However, weight gain was significantly greater with the administration of the high-carbohydrate formula, possibly because of an increase in the accretion of body fat. We conclude that the short-term use of high-fat formula for infants with bronchopulmonary dysplasia decreases carbon dioxide production while maintaining adequate growth and nutritional status.

Magnitude-estimation scaling: an effective method for the measurement of the quality of filtered speech

17 subjects provided magnitude estimations in the form of quality judgments of a filtered speech stimulus which was a nonsense sentence containing all of the consonants of English from Fairbanks. It was presented to subjects at 8 high-pass and 8 low-pass filtering conditions. Consistent magnitude estimations to the filtered stimulus were similar for both conditions. Also, for both conditions, subjects' numerical responses consistently increased in value as stimulus quality was judged to be poorer.

A new transgenic mouse model of chronic hyperglycemia

Expression under the control of the mouse transferrin promoter of a transgene encoding a soluble secreted derivative of the ectodomain of the human insulin receptor in transgenic mice results in the accumulation of this high-affinity insulin-binding protein in the plasma. Alterations of glucose homeostasis are observed including postabsorptive hyperglycemia concomitant with increased hepatic glucose production and hyperinsulinemia. Thus, this is the first transgenic animal model of chronic hyperglycemia with alterations in glucose homeostasis that are produced without a targeted alteration of pancreatic function. These mice provide a new experimental model to follow the progression and long-term consequences of chronic hyperglycemia.

Prolactin variants in term and preterm human milk: altered structural characteristics, biological activity and immunoreactivity

This study was undertaken to determine if PRL variants differing in structural characteristics as well as biological activity and immunoreactivity are present in human milk and to assess whether the physiological state of the mammary gland (premature initiation of lactation, progression of lactation) influences the forms or activity of human milk-borne PRL. Human milk samples were collected in early (day 1-5) or mature lactation (1-4 months) from women delivering term (T) or preterm (PT) infants. Milk was fractionated on Sephadex G-100, Concanavalin A-Sepharose, or Phosphogel to estimate molecular weight (MW), degree of glycosylated PRL(G), and degree of phosphorylated (P) PRL, respectively. Prolactin-like bioactivity (B) was measured by the PRL-dependent proliferation of the Nb-2 lymphoma cell and PRL-like immunoreactivity (I) by radioimmunoassay (RIA) using NIDDK reagents. Milk obtained from mothers of T infants contained significantly greater B than I-PRL at each stage of lactation (early: B = 132 +/- 13.9 P.E./ml, I = 83.43 +/- 12 P.E./ml, mature: B = 41.74 +/- 8.9 P.E./ml, I = 27.19 +/- 5.5 P.E./ml; P < 0.01-0.001). PRL-like bioactivity was greatest in early milk produced by mothers of T infants and declined as lactation progressed. No differences in B or I-PRL were evident for milk collected from mothers of preterm infants at any stage of lactation. In early lactation the PRL-like bioactivity of milk collected from mothers of T infants was significantly greater than in unfractionated milk collected from mothers of PT infants (P < 0.05). The number of PRL variants present in milk was characteristic of the stage of lactation and gestation (T early > PT early; T early > T mature). Early milk from mothers of T infants contained an average of 5 bioactive PRL variants, early milk from mothers of PT infants an average of 4 bioactive variants, and mature milk from mothers of T infants an average of 3 bioactive variants. The distribution of molecular weights associated with PRL variants in milk infranatant was variable among subjects within a specific stage of lactation/gestation. However, the representative range of molecular weights of PRL variants identified in milk sample was similar between groups (T early: < 8, 16, 20, 24, 25-28, 32, 42, > 66; PT early: 16, 20, 23, 25-28, 32, > 66; T mature: 20, 25-28, 32, 35, > 66).(ABSTRACT TRUNCATED AT 400 WORDS)

Home-delivered meals programs for the elderly: distribution of services in New York State

This study examined the ability of six countywide home-delivered meals programs in upstate New York to meet the challenge of serving the elderly in geographically isolated and impoverished regions. The six counties were divided geographically into county subdivisions. For each subdivision, program client levels were analyzed in relation to two subdivision-level census statistics: poverty rates and population densities for community-residing individuals aged 65 years and older. Client levels were positively correlated with population densities but not with poverty rates. These findings suggest that service delivery was concentrated in densely populated regions. In contrast, impoverished and sparsely populated regions received minimal services.

The religiosity of mothers and their offspring as related to the offspring's sex and sexual orientation

This study sought to determine the nature and extent of the relationship between the religiosity of mothers and their offspring, taking both the sex and the sexual orientation of the offspring into account. Religiosity was measured in terms of both intensity (importance of religion, frequency of church attendance) and denominational preference. Female offspring were found to be more religious than male offspring, and their religiosity tended to more closely resemble that of their mothers than did the religiosity of males. Offspring of both sexes who were not exclusively heterosexual in orientation tended to be less religious and less likely to emulate their mother's religiosity as compared to exclusively heterosexual offspring.

Insulin receptor tyrosine kinase domain auto-dephosphorylation

We have observed dephosphorylation of the soluble, 48 kDa insulin receptor tyrosine kinase domain following its tyrosine autophosphorylation. Dephosphorylation was associated with generation of inorganic phosphate, thereby making catalysis by reversal of the kinase reaction unlikely. The kinase domain preparations could not be shown to contain detectable, contaminating protein tyrosine phosphatase activity. In addition, dephosphorylation was insensitive to protein phosphatase inhibitors. However, it was blocked by the kinase inhibitor staurosporine. These results are consistent with insulin receptor kinase domain auto-dephosphorylation via catalysis involving the kinase itself. These findings raise the possibility of a novel mechanism for termination of the insulin receptor signal.

Structural organization of the human insulin receptor ectodomain

To provide an experimental system amenable to a detailed biochemical and structural investigation of the extracellular (ligand binding) domain of the insulin receptor, we developed a mammalian heterologous cell expression system from which tens of milligrams of the soluble secreted ectodomain (the IR921 protein) can be routinely purified using methods that do not require harsh elution conditions. The purified IR921 protein has a Stokes radius of 6.8 nm and a sedimentation coefficient of 9.8 S, from which we calculate a hydro-dynamic mass of 281 kDa. Electron microscopic images, using both rotary shadowing and negative staining techniques, demonstrate a characteristic substructure for the IR921 protein consisting of two elongated arms, with a globular domain at each end, connected to each other at a point somewhat off-center to form a Y structure. Analysis using circular dichroism and fluorescence spectroscopy illustrate that insulin binding results in conformational changes in the ectodomain. Furthermore, fluorescence anisotropy decay data reveal segmental mobility within the IR921 protein that is successively frozen as a result of insulin binding, in contrast to results obtained in a previous study of the epidermal growth factor receptor ectodomain. This result suggests a divergence in hormone-induced signaling mechanisms used by the insulin and epidermal growth factor receptors.

An assessment of human insulin receptor phosphorylation and exogenous kinase activity following deletion of 69 residues from the carboxyl-terminus of the receptor beta-subunit

A mutant human insulin receptor with a carboxyl-terminal deletion of 69 amino acids (proreceptor residues 1287-1355) is expressed as a stable protein in transiently transfected COS cells. We find that in intact cells this mutant is phosphorylated in an insulin-dependent manner on core tyrosines 1158, 1163 and 1163. As expected, the carboxyl-terminal beta-subunit phosphorylation sites (serines 1305/6, tyrosines 1328/34 and threonine 1348) are absent from this mutant. However, the two major insulin-stimulated serine phosphopeptides remain. In intact cells, insulin stimulates exogenous substrate phosphorylation by the truncated receptor only approximately 1.9-fold (cf. approximately 9-fold for the wild-type receptor in these cells), a consequence of a approximately 4.8-fold elevation in basal insulin-independent kinase activity.

Characterization of insulin-stimulated protein serine/threonine kinases in CHO cells expressing human insulin receptors with point and deletion mutations

The activation of insulin-stimulated protein-serine/threonine kinases has been investigated in CHO cell lines transfected with cDNAs encoding either wild-type or mutant human insulin receptors. (1) Insulin treatment of CHO cells over-expressing wild-type insulin receptors resulted in the rapid and substantial (5-10-fold) activation of cytosolic protein kinases which phosphorylated myelin basic protein, Kemptide and two peptide substrates based on sites phosphorylated on ribosomal protein S6 in vivo. (2) Further fractionation of cytosolic extracts by MonoQ chromatography revealed two peaks of insulin-stimulated myelin basic protein kinase activity which were highly related to the previously described mitogen-activated protein (MAP) kinases ERK1 and ERK2. In addition, at least two major peaks of S6 kinase activity were resolved, which exhibited properties similar to the 70 kDa and 90 kDa S6 kinases described by others; the predominant effect of insulin was on the activity of the 90 kDa enzyme and was in excess of 10-fold. (3) MonoQ fractionation of extracts from parental CHO cells, or cells expressing kinase-deficient receptors, showed all insulin-stimulated peaks of activity to be almost completely absent. (4) Further studies demonstrated that substitution of tyrosine residues 1162 and 1163 (or 1162 alone) with phenylalanine led to a substantial reduction in the ability of insulin to stimulate these protein kinase activities when assayed in cytosolic extracts. In contrast, deletion of 69 amino acids from the C-terminus of the insulin receptor beta-subunit caused a leftward shift in the insulin dose-response curve of the MAP kinase activity, but apparently not in that of the 90 kDa S6 kinase activity.

Bentiromide test using liquid-chromatographic measurement of p-aminobenzoic acid and its metabolites for diagnosing pancreatic insufficiency in childhood

We assessed the diagnostic capability of the bentiromide test using a high-pressure liquid-chromatography method to analyze p-aminobenzoic acid and its metabolites in plasma as an indirect measure of exocrine pancreatic function. Mean total amine concentration in pancreatic-insufficient subjects was significantly lower than in control subjects. There were 3 of 15 false-negative results and no false-positive results. We conclude that this chromatographic method is an effective means of analyzing p-aminobenzoic acid and its metabolites after ingestion of bentiromide.

Differential regulation of multiple hepatic protein tyrosine phosphatases in alloxan diabetic rats

The involvement of tyrosine phosphorylation in insulin action led us to hypothesize that increased activity of protein tyrosine phosphatases (PTPases) might contribute to insulin resistance in alloxan diabetes in the rat. Hepatic PTPase activity was measured using two artificial substrates phosphorylated on tyrosine: reduced, carboxyamidomethylated, and maleylated lysozyme (P-Tyr-RCML) and myelin basic protein (P-Tyr-MBP), as well as an autophosphorylated 48-kD insulin receptor tyrosine kinase domain (P-Tyr-IRKD). Rats that were made alloxan diabetic exhibited a significant increase in hepatic membrane (detergent-soluble) PTPase activity measured with P-Tyr-MBP, without a change in activity measured with P-Tyr-RCML or the P-Tyr-IRKD. The PTPase active with P-Tyr-MBP behaved as a high molecular weight peak during gel filtration chromatography. Characterization of this enzyme indicated it shared properties with CD45, the prototype for a class of transmembrane, receptor-like PTPases. Our results indicate that alloxan diabetes in the rat is associated with an increase in the activity of a large, membrane-associated PTPase which accounts for only a small proportion of insulin receptor tyrosine dephosphorylation. Nonetheless, increased activity of this PTPase may oppose tyrosine kinase-mediated insulin signal transmission, thus contributing to insulin resistance.

A developmentally regulated plasmalemmal antigen present in synaptosomes but not in growth cones

Monoclonal antibody 2L4 was generated against rat synaptosomes but does not cross-react with nerve growth cones. Expression of the 2L4 antigen is developmentally regulated in a manner that is, in part, the opposite of the expression of the 5B4-CAM antigen, a marker of neuronal outgrowth belonging to the N-CAM family. While 5B4-CAM appears and increases during sprouting and then decreases to reach low levels in the adult, the 2L4 antigen appears only late in development, when neuronal outgrowth ceases, at or around the time of synaptogenesis. Once expressed, the antigen is found on the entire plasmalemmal surface of the neuron, but seems to be enriched at synaptic endings, at least of some neuron types. Biochemical analyses involving blotting of non-denaturing gels and immunoaffinity chromatography identify the antigen as a pair of polypeptides with similar, basic isoelectric points. These polypeptides form a somewhat diffuse, probably glycosylated band at 67 kDa and may be part of a hetero-oligomeric complex. The localization, biochemical, and developmental results suggest that the 2L4 antigen is a plasmalemmal marker of maturing and/or mature neurons whose expression may be triggered by synaptogenesis.

Detection of a new hormone contact site within the insulin receptor ectodomain by the use of a novel photoreactive insulin

We have used a preparation of soluble human insulin receptor ectodomain and a novel photoreactive, biotinylated derivative of insulin (4-azidosalicyloyl(B1-biocytinyl-B2-lysine)-insulin) to identify a new hormone contact site within the extracellular domain of the insulin receptor. The ectodomain was photoaffinity-labeled and digested to completion with trypsin, and the resulting tryptic fragment was purified by either HPLC or by streptavidin-affinity chromatography. The amino terminus of the fragment was identified as Gly390 within the alpha-subunit. These results suggest that residues that are carboxyl-terminal to the cysteine-rich domain, in addition to previously identified regions within the amino terminus of the alpha-subunit, contribute to the insulin binding site. The implications of these results for the de novo folding of the insulin receptor to constitute the hormone binding site are discussed.

Racial/ethnic variations in male testosterone levels: a probable contributor to group differences in health

Racial and ethnic variations in serum testosterone levels were investigated among a large sample of male Vietnam era veterans. Based on geometric means, significant average differences were found between 3,654 non-Hispanic white and 525 black individuals. The geometric mean for testosterone levels among 200 Hispanic individuals was similar to that of non-Hispanic white individuals. Regarding two other racial/ethnic groups (Asian/Pacific Islanders and Native Americans), no significant differences were found, due perhaps to small sample sizes. Results were interpreted as having considerable potential for explaining some of the race differences in the incidences of cardiovascular diseases, hypertension, and prostate cancer.

Insulin-stimulated serine and threonine phosphorylation of the human insulin receptor. An assessment of the role of serines 1305/1306 and threonine 1348 by their replacement with neutral or negatively charged amino acids

Insulin promotes insulin receptor beta-subunit phosphorylation on tyrosine, serine, and threonine residues in a variety of cells, including simian COS cells which transiently express human insulin receptors following transfection with a cDNA encoding the wild-type receptor protein. To examine the potential roles of serines 1305 and 1306 and threonine 1348 as sites of insulin-stimulated phosphorylation in these cells, these residues (i.e. either serines 1305 and 1306, or threonine 1348) were replaced with neutral (alanine) or negatively charged (aspartate) amino acids. Following transient expression of each of these mutant receptors in COS cells, two-dimensional phosphopeptide mapping reveals that threonine 1348 is the major, if not the only, insulin-stimulated threonine phosphorylation site. In contrast, while serines 1305 and/or 1306 are phosphorylated in an insulin-dependent manner, these sites comprise only a minor proportion of insulin receptor serine phosphorylation in these cells. Substitution of either serines 1305 and 1306 or threonine 1348 with neutral or negatively charged amino acids has no effect on insulin-stimulated tyrosine autophosphorylation of these mutant receptors in intact cells. Furthermore, insulin-stimulated exogenous protein-tyrosine kinase activity of the mutant receptors is unaffected, as assessed following either phosphorylation of receptors in intact cells or following immunopurification of receptors and their autophosphorylation in vitro.

Evidence for hybrid rodent and human insulin receptors in transfected cells

Chinese hamster ovary cells and NIH 3T3 cells overexpressing mutant human insulin receptors were examined for the presence of hybrid receptors composed of human and rodent insulin receptors. In the present studies, most of the endogenous rodent receptors were found to be immunoprecipitated from the transfected cells but not the parental cells with a monoclonal antibody specific for human receptor. These data indicate that in these transfected cells, most of the endogenous rodent receptors are in a hybrid complex with the overexpressed human receptor. These results together with the in vitro studies of Treadway et al. (Treadway, J.L., Morrison, B.D., Soos, M.A., Siddle, K., Olefsky, J., Ullrich, A., McClain, D.A., and Pessin, J.E. (1991) Proc. Natl. Acad. Sci. U.S.A. 88, 214-218) showing that hybrid receptors exhibit transdominant inhibition explain the prior finding indicating that overexpression of defective insulin receptors interferes with the normal signaling of endogenous receptors.

Deletion of approximately 10 kDa from the carboxyl terminus of a soluble approximately 48-kDa insulin receptor protein-tyrosine kinase results in slower rates of diphosphorylation of a series of dodecapeptide substrates. An assessment by 1H NMR

Autophosphorylation of a soluble approximately 48-kDa derivative of the insulin receptor protein-tyrosine kinase is accompanied by an increase in its specific activity towards exogenous substrates. In the present study, we have utilized 1H NMR to compare the order and rate of mono- and diphosphorylation of multiple tyrosine residues in a series of synthetic dodecapeptide substrates (based on the receptor sequence, which includes major sites of autophosphorylation (RRDIYETDYYRK), with substitution(s) at positions 6 and/or 7 based on residue size and/or charge) by the approximately 48-kDa enzyme and by a approximately 38-kDa enzyme generated by tryptic deletion of approximately 10 kDa from the carboxyl terminus of the approximately 48-kDa protein. Both enzymes exhibit a marked order and progression of phosphorylation of peptide tyrosine residues; for each peptide, phosphorylation initiates and proceeds to completion first on tyrosine 9, followed by phosphorylation on tyrosine 10. Although removal of the carboxyl terminus does not affect the rate of monophosphorylation of these peptides on tyrosine 9, the smaller enzyme exhibits a slower rate of diphosphorylation (at tyrosine 10), as compared with the approximately 48-kDa enzyme.

The bentiromide test using plasma p-aminobenzoic acid for diagnosing pancreatic insufficiency in young children. The effect of two different doses and a liquid meal

The bentiromide test was evaluated using plasma p-aminobenzoic acid as an indirect test of pancreatic insufficiency in young children between 2 months and 4 years of age. To determine the optimal test method, the following were examined: (a) the best dose of bentiromide (15 mg/kg or 30 mg/kg); (b) the optimal sampling time for plasma p-aminobenzoic acid; and (c) the effect of coadministration of a liquid meal. Sixty-nine children 91.6 +/- 1.0 years) were studied, including 34 controls with normal fat absorption and 35 patients (34 with cystic fibrosis) with fat maldigestion due to pancreatic insufficiency. Control and pancreatic insufficient subjects were studied in three age-matched groups: (a) low-dose bentiromide (15 mg/kg) with clear fluids; (b) high-dose bentiromide (30 mg/kg) with clear fluids; and (c) high-dose bentiromide with a liquid meal. Plasma p-aminobenzoic acid was determined at 0, 30, 60, and 90 minutes then hourly for 6 hours. The dose effect of bentiromide with clear liquids was evaluated. High-dose bentiromide best discriminated control and pancreatic insufficient subjects, due to a higher peak plasma p-aminobenzoic acid level in controls, but poor sensitivity and specificity remained. High-dose bentiromide with a liquid meal produced a delayed increase in plasma p-aminobenzoic acid in the control subjects probably caused by retarded gastric emptying. However, in the pancreatic insufficient subjects, use of a liquid meal resulted in significantly lower plasma p-aminobenzoic acid levels at all time points; plasma p-aminobenzoic acid at 2 and 3 hours completely discriminated between control and pancreatic insufficient patients. Evaluation of the data by area under the time-concentration curve failed to improve test results. In conclusion, the bentiromide test is a simple, clinically useful means of detecting pancreatic insufficiency in young children, but a higher dose administered with a liquid meal is recommended.

Biosynthesis of the precursor of a soluble human insulin receptor ectodomain in insect Sf9 cells infected with a recombinant baculovirus

In contrast to transfected mammalian cells, insect Sf9 cells infected with a recombinant Baculovirus inefficiently process and secrete a soluble derivative of the extracellular domain of the human insulin receptor. The high-mannose form of the receptor precursor that accumulates intracellularly is not grossly aberrant or malfolded, as its interaction with a diverse panel of monoclonal antibodies are comparable to secreted precursor and proteolytically processed receptor, both of which bear partially trimmed oligosaccharide chains. Thus the inefficient step in the biosynthesis of this protein in Sf9 cells is either at, or just preceding, the trimming of its high-mannose oligosaccharide chains.

Insulin receptor tyrosine kinase structure and function

Six years have now elapsed since efforts to establish heterologous cell expression systems for studies of the human insulin receptor were begun. As is apparent from the results summarized in Figs. 1 and 2, a significant number of studies have been devoted to the analysis of receptor mutations, both experimentally derived (i.e. by mutagenesis) and those identified in human patients, as well as to the generation of soluble derivatives of the major functional domains of the receptor for use in biophysical studies. While it is certainly clear that these methods can be expected to yield an ever-increasing body of data concerning insulin receptor structure/function, it is equally apparent that attention to a number of basic experimental limitations inherent in these approaches will be required to resolve a number of fundamental questions and disagreements concerning particular receptor mutations. Given the level of interest in the insulin receptor that has persisted over the past several decades, one expects that these efforts will be forthcoming, and that our understanding of this complex transmembrane receptor will, with time, improve.