Colicin M is inactivated during import by its immunity protein

Colicin M (Cma) displays a unique activity that interferes with murein and O-antigen biosynthesis through inhibition of lipid-carrier regeneration. Immunity is conferred by a specific immunity protein (Cmi) that inhibits the action of colicin M in the periplasm. The subcellular location of Cmi was determined by constructing hybrid proteins between Cmi and the TEM-beta-lactamase (BlaM), which confers resistance to ampicillin only when it is translocated across the cytoplasmic membrane with the aid of Cmi. The smallest Cmi'-BlaM hybrid that conferred resistance to 50 micrograms/ml ampicillin contained 19 amino acid residues of Cmi; cells expressing Cmi'-BlaM with only five N-terminal Cmi residues were ampicillin sensitive. These results support a model in which the hydrophobic sequence of Cmi comprising residues 3-23 serves to translocate residues 24-117 of Cmi into the periplasm and anchors Cmi to the cytoplasmic membrane. Residues 8-23 are integrated in the cytoplasmic membrane and are not involved in Cma recognition. This model was further tested by replacing residues 1-23 of Cmi by the hydrophobic amino acid sequence 1-42 of the penicillin binding protein 3 (PBP3). In vivo, PBP3'-'Cmi was as active as Cmi, demonstrating that translocation and anchoring of Cmi is not sequence-specific. Substitution of the 23 N-terminal residues of Cmi by the cleavable signal peptide of BlaM resulted in an active BlaM'-'Cmi hybrid protein. The immunity conferred by BlaM'-'Cmi was high, but not as high as that associated with Cmi and PBP3'-'Cmi, demonstrating that soluble Cmi lacking its membrane anchor is still active, but immobilization in the cytoplasmic membrane, the target site of Cma, increases its efficiency. Cmi delta 1-23 remained in the cytoplasm and conferred no immunity. We propose that the immunity protein inactivates colicin M in the periplasm before Cma can reach its target in the cytoplasmic membrane.

Paracrine renal endothelin system in rats with liver cirrhosis

1. Liver cirrhosis was induced in rats by CCl4 administration. We analysed the expression of endothelin receptor subtypes in the renal cortex and medulla using Scatchard analysis and receptor autoradiography, and measured plasma as well as renal-tissue endothelin-1 concentrations using a specific radioimmunoassay. Furthermore, we analysed the effects of the non-selective (A/B) endothelin receptor antagonist, bosentan (6 and 100 mg kg-1 day-1) on mean arterial blood pressure, water and sodium excretion and glomerular filtration rate. 2. Our study revealed an overexpression of the endothelin B receptor (ETB) in the renal medulla of rats with liver cirrhosis (Cir: 2775 +/- 299 fmol mg-1; Con: 1695 +/- 255 fmol mg-1; n = 8; means +/- s.d., P < 0.01), whereas the density of ETB in the cortex and the endothelin A receptor (ETA) in the cortex and medulla were similar in both cirrhotic and control rats. Receptor autoradiography showed that the upregulation of medullary ETB in cirrhotic rats was due to an upregulation of ETB in the inner medullary collecting duct cells. 3. The tissue endothelin-1 concentrations were increased in the renal medulla of cirrhotic rats (Cir: 271 +/- 68 pg g-1wet wt.; Con: 153 +/- 36 pg g-1 wet wt., n = 8; means +/- s.d., P < 0.01). 4. The glomerular filtration rate was slightly decreased in cirrhotic rats but not altered after bosentan treatment in either cirrhotic or control rats. Bosentan decreased sodium excretion to a similar extent in both cirrhotic and control rats, whereas water excretion was significantly reduced by both dosages of bosentan in cirrhotic rats only (Cir + vehicle: 12.5 +/- 0.62 m day-1, Cir + 6 mg kg-1 day-1 bosentan: 8.6 +/- 1.0 ml day-1; Cir + 100 mg kg-1 day-1 bosentan: 7.4 +/- 0.6 ml day-1; n = 10; means +/- s.e.mean). 5. We therefore suggest that the upregulation of the medullary ETB in cirrhotic rats is involved in the regulation of water excretion in rats with CCl4-induced liver cirrhosis.

Lithium induced polyuria and renal vasopressin receptor density

BACKGROUND

Lithium, a drug frequently used for treatment of affective disorders, is known to cause a vasopressin-resistant state, leading to polyuria and polydipsia. It has been suggested that lithium interacts with the renal V2-vasopressin receptor. Detailed studies on the influence of lithium on the AVP receptor, however, have so far been difficult due to the lack of a suitable radioligand with high specific activity and high affinity.

METHODS

Using 125I-[8-(p-(OH)-phenylpropionyl)]- LVP, we studied the effects of lithium on V2-vasopressin receptors in male Sprague-Dawley rats and LLC-PK1 cells. Rats, having free access to water, were orally treated with 10 mg lithium/100 mg b.w./day or placebo for 10 days. Scatchard analysis was performed using membranes prepared from homogenized renal papillae.

RESULTS

Lithium caused significant polyuria and an impaired renal concentration capacity after water deprivation. Binding studies showed no effect of lithium on binding affinity KD (0.98 +/- 0.21 nmol/l vs. 0.86 +/- 0.15 nmol/l (Li) (n.s.). Receptor density, however, significantly decreased from 130 +/- 12.3 nmol/kg protein in controls (n = 8) to 101.7 +/- 13.4 nmol/kg protein (n = 8), (P < 0.05). Plasma osmotically and AVP were not significantly altered by lithium treatment. Vasopressin receptor density on LLC-PK1-cells, a pig renal cell line, was not changed by preincubation with lithium (312 +/- 22 nmol/kg vs. 329 +/- 25 nmol/kg (Li) (n = 6, n.s.).

CONCLUSIONS

The decrease of AVP-receptor density in vivo might be related to vasopressin resistance, either primary, or secondary to other factors, e.g. actual water transport.

Adult immunizations

New vaccines have been licensed for hepatitis A, varicella, and typhoid. This paper reviews these vaccines and their recommended uses in adults. Special attention is given to a new national policy establishing age 50 years as a time for review of preventive health measures with emphasis on evaluating risk factors that indicate a need for pneumococcal vaccine and the initiation of annual influenza immunization.

Natural killer cell cytotoxicity in elderly humans after influenza immunization

Previous studies have reported that human natural killer (NK) cytotoxicity can be augmented by either in vitro stimulation with influenza virus antigens or in vivo administration of killed influenza vaccine. The study demonstrating the latter conclusion reported an increase in NK cytotoxicity lasting for 4 weeks postvaccination in young subjects. We initiated our study to determine if a similar increase in NK activity was observed in an elderly population after immunization with the 1992-1993 influenza vaccine. NK activity of 34 elderly (mean age, 77.3 years) was determined at 3 time points: prevaccination, 4 to 6 weeks postvaccination, and 5 to 6 months after vaccination. In contrast to the results of the previous study, the NK cytotoxicity of our elderly subjects was not augmented by the influenza vaccine at any time tested. We also determined the number of CD56+ cells in whole-blood samples at each of the time points and found that there is no change in NK cell number after influenza vaccination.

Plasma endothelin-1 in patients with left-to-right shunt

Endothelin-1 (ET-1) has been implicated in the pathogenesis of pulmonary vascular disease in patients with congenital heart disease. We studied the effect of pulmonary blood flow on plasma ET-1 concentrations. Systemic venous, pulmonary arterial, and pulmonary venous blood samples were obtained from 40 patients with atrial septal defect II (n = 21), ventricular septal defect (n = 10), persistent ductus arteriosus (n = 6), and complete (n = 2) and partial (n = 1) atrioventricular canal at cardiac catheterization and analyzed by radioimmunoassay. Median age (range) was 5.2 years (8 months to 66 years), and the resistance ratio (Rp/Rs) was 0.08 (0.03 to 0.67). Pulmonary vein to pulmonary artery ET-1 ratio in patients with "high flow" (n = 26, Qp/Qs > or = 1.5; ET-1 ratio = 0.8) did not differ from those with "low flow" (n = 14, Qp/Qs < 1.5; ET-1 ratio = 1.0). We conclude that an increase in pulmonary blood flow alone does not result in an increase in plasma ET-1.

Water retention after oral chlorpropamide is associated with an increase in renal papillary arginine vasopressin receptors

Chlorpropamide (CP), a sulfonylurea used for treatment of non-insulin dependent diabetes mellitus, is known to potentiate the antidiuretic action of arginine vasopressin (AVP), predisposing to hyponatremia. It has been suggested that CP acts directly on the antidiuretic vasopressin receptor. Detailed studies on the influence of CP on the AVP receptor, however, have been hampered by lack of a suitable radioligand. Using a newly developed radioiodinated derivative of AVP with high specific activity and high affinity for the AVP V2-receptor (125I-[8-(p-(OH)-phenylpropionyl)]-LVP), we studied the role of AVP V2-receptors in CP-induced water retention. Male-Sprague-Dawley rats were treated orally with 40 mg CP/day or placebo for 7 days, after which Scatchard analysis was performed using membranes prepared from homogenized renal papilla. After oral water load, CP-treated rats but not control rats showed a significant decrease in plasma osmolality (289 +/- 2.2 to 284 +/- 0.8 mosmol/kg, p < 0.05). The Kd was 0.69 +/- 0.16 nmol/l in controls and 0.70 +/- 0.12 nmol/l after CP treatment (NS); Bmax was 129 +/- 5.3 nmol/kg protein in controls (N = 8). Chlorpropamide significantly increased receptor density (Bmax) to 167 +/- 8.4 nmol/kg protein (N = 8) (p < 0.05). Plasma AVP did not change significantly during CP treatment. These data show for the first time that CP in vivo increases the density of AVP V2 receptors without altering plasma AVP. This is associated with an impairment in water excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation and characterization of the EF-1 alpha gene of the filamentous fungus Puccinia graminis f. sp. tritici

A gene of Puccinia graminis f. sp. tritici, coding for the translation elongation factor 1 alpha (EF-1 alpha), was isolated from a P. graminis genomic library using the EF-1 alpha gene sequence of Absidia glauca. The coding region of 1389 nucleotides encodes a polypeptide of 463 amino acids and is interrupted by eight introns. An additional intron is located in the 5' untranslated region. A single transcription start point (tsp) was mapped by primer extension. A cDNA fragment corresponding to P. graminis EF-1 alpha mRNA hybridized with a 1.9-kb-long poly(A+)RNA, sufficient to encode the EF-1 alpha protein. Southern hybridization of digested genomic DNA revealed that two copies of the EF-1 alpha gene exist in the genome of P. graminis.

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome

No matter how typical a cutaneous eruption may be in a patient with the acquired immunodeficiency syndrome, early histologic evaluation is necessary if a delay in diagnosis and treatment is to be avoided. We report the case of a 33-year-old man with acquired immunodeficiency syndrome who was clinically misdiagnosed as having a drug-induced eruption. Three weeks later he died with disseminated histoplasmosis.

[Conservative treatment in chronic kidney insufficiency]

Modern therapeutic concepts of chronic renal insufficiency are based on observations showing a retardation of progressive renal failure by therapeutic measures. In the context emphasis is now placed on the treatment of arterial hypertension and on the patient's adherence to a protein-restricted diet. In addition to these conservative measures it is important to avoid nephrotoxins, to hydrate the patient sufficiently and to treat advanced hyperlipidemias. Deficiencies of active vitamin D should be treated by oral vitamin D substitution after correction of hyperphosphatemia. In the treatment of the latter, preparations of calcium carbonate are now the preferred mode of treatment. In advanced renal insufficiency it is important to maintain a salt-restricted diet and to treat any attendant hyperkalemia and hyponatremia.

Interactive effects of elevated CO(2) and soil drought on growth and transpiration efficiency and its determinants in two European forest tree species

The responses of growth and transpiration efficiency (W = biomass accumulation/water consumption) to ambient and elevated atmospheric CO(2) concentrations (350 and 700 micro mol mol(-1), respectively) were investigated under optimal nutrient supply in well-watered and in drought conditions in two temperate-forest tree species: Quercus petraea Liebl. and Pinus pinaster Ait. Under well-watered conditions, doubling the CO(2) concentration for one growing season increased biomass growth by 138% in Q. petraea and by 63% in P. pinaster. In contrast, under drought conditions, elevated CO(2) increased biomass growth by only 47% in Q. petraea and had no significant effect on biomass growth in P. pinaster. Transpiration efficiency was higher in Q. petraea than in P. pinaster in all treatments. This difference was linked (i) to lower carbon isotope discrimination (Delta), and thus lower values of the intercellular/ambient CO(2) concentration (c(i)/c(a)) ratio, in Q. petraea, (ii) to lower values of leaf mass ratio (LMR, leaf mass/whole plant mass), which we suggest was positively related to the proportion of daytime carbon fixation lost by respiration (Phi), in Q. petraea, and (iii) to slightly lower C concentrations in Q. petraea than in P. pinaster. The CO(2)-promoted increase in W was higher in Q. petraea (+80%) than in P. pinaster (+50%), and the difference was associated with a more pronounced decrease in Phi in response to elevated CO(2) in Q. petraea than in P. pinaster, which could be linked with the N dilution effect observed in Q. petraea. Because Phi also directly affects growth, the CO(2)-induced enhancement of Phi in Q. petraea is a crucial determinant of the growth stimulation observed in this species. Leaf gas exchange regulation was not the only factor involved in the responses of growth and W to elevated CO(2) and drought, other physiological processes that have crucial roles include carbon and N allocation and respiration.

Colicins: structures, modes of action, transfer through membranes, and evolution

This article intends to inform a broader audience on a fascinating class of protein toxins (bacteriocins) which usually kill only cells of the same species. Those who gained a deeper interest in bacteriocins can find a comprehensive description of the field in a recent book based on a conference (James et al. 1992), and in more specialized review articles dealing with certain aspects (Pugsley 1984a, b), or certain colicins (De Graaf and Oudega 1986; Harkness and Olschläger 1991; Lazdunski et al. 1988). The older literature has been reviewed by Brandis and Smarda (1971), Reeves (1972), Hardy (1975) and Konisky (1982).

[Balance sheet of CETRADIM after 10 years of functioning as an alternative to hospitalization]

CETRADIM (Educational Centre for the Treatment of Diabetes and Nutritional Diseases) is a hospital department of the Roubaix (France) general hospital functioning uniquely as an alternative to conventional hospital care (outpatient clinics, day hospital, weekday hospital). Its catchment area is essentially local, covering a population of about 200,000. Its vocation is triple: care (including education), training and the supply of information to the treating team and general public. The aim of this study was to evaluate the effect of the existence of a unit of this kind on the frequency of admission of patients for conventional hospital care to the various medical departments of the Roubaix hospital. The indicator used was the percentage of conventional hospitalisation (PCH) in the Endocrinology/Diabetology/Nutrition department, calculated by dividing the number of conventional hospital stay in this specialty by the total number of hospital stay days. Data were obtained for the Roubaix hospital and for 3 hospitals in the Northern region serving comparable types of population but lacking any institution functioning totally as an alternative to hospital care. The PCH was 4.3% for the Roubaix Hospital Centre and 8.2, 8.46 and 10.6% respectively for the other three hospitals. These findings suggest that the existence of an institution such as CETRADIM reduces the number of conventional hospital stay days of patients with Endocrine/Diabetes/Nutrition diseases. Its effects on the constitution of new local care units is discussed, and arguments in favour of its role in the improvement of health care and education costs developed.

Domains of colicin M involved in uptake and activity

Colicin M inhibits murein biosynthesis by interfering with bactoprenyl phosphate carrier regeneration. It belongs to the group B colicins the uptake of which through the outer membrane depends on the TonB, ExbB and ExbD proteins. These colicins contain a sequence, called the TonB box, which has been implicated in transport via TonB. Point mutations were introduced by PCR into the TonB box of the structural gene for colicin M, cma, resulting in derivatives that no longer killed cells. Mutations in the tonB gene suppressed, in an allele-specific manner, some of the cma mutations, suggesting that interaction of colicin M with TonB may be required for colicin M uptake. Among the hydroxylamine-generated colicin M-inactive cma mutants was one which carried cysteine in place of arginine at position 115. This colicin derivative still bound to the FhuA receptor and killed cells when translocated across the outer membrane by osmotic shock treatment. It apparently represents a new type of transport-deficient colicin M. Additional hydroxylamine-generated inactive derivatives of colicin M carried mutations centered on residues 193-197 and 223-252. Since these did not kill osmotically shocked cells the mutations must be located in a region which is important for colicin M activity. It is concluded that the TonB box at the N-terminal end of colicin M must be involved in colicin uptake via TonB across the outer membrane and that the C-terminal portion of the molecule is likely to contain the activity domain.

Translocation of cytoplasm and nucleus to fungal penetration sites is associated with depolymerization of microtubules and defence gene activation in infected, cultured parsley cells

We describe a novel system of reduced complexity for analysing molecular plant-fungus interactions. The system consists of suspension-cultured parsley (Petroselinum crispum) cells infected with a phytopathogenic fungus (Phytophthora infestans) which adheres to a coated glass plate and thus immobilizes the plant cells for live microscopy. Conventional light and electron microscopy as well as time-lapse video microscopy confirmed the virtual identity of fungal infection structures and of several characteristic early plant defence reactions in the cultured cells and whole-plant tissue. Using this new system to approach previously unresolved questions, we made four major discoveries: (i) rapid translocation of plant cell cytoplasm and nucleus to the fungal penetration site was associated with local depolymerization of the microtubular network; (ii) the directed translocation was dependent on intact actin filaments; (iii) a typical plant defence-related gene was activated in the fungus-invaded cell; and (iv) simultaneous activation of this gene in adjacent, non-invaded cells did not require hypersensitive death of the directly affected cell.

Work absenteeism in type 2 diabetes mellitus: results of the prospective Diabetes Intervention Study

Newly diagnosed mild Type 2 diabetic patients, aged 30-55 years, were included in the prospective, multi-centre Diabetes Intervention Study. They were randomly allotted to either an intervention group receiving intensified health education or to a control group on usual care. This paper reports the incidence, duration of and causes for absence from work due to any disease in the patients who were working during the first 5-year follow-up. Data from 817 patients could be taken into account. 14.5% of the intervention patients and 17.3% of the control patients had never been on the sick list. Those patients who had undergone intensified health education were listed sick less often. Women showed a higher work absenteeism in either group; they had higher blood pressure and higher body mass index at entry. Cardiovascular diseases and musculo-skeletal disorders were major reasons for absence from work. However, when compared to the general population, these Type 2-diabetic patients were approximately four times more often on the sick list. Thus, the health education programme of the Diabetes Intervention Study was shown to be effective with respect to work absenteeism. Teaching patients is recommended as an important part of the therapeutic regimen.

[Different effects of fibrates on the lipoprotein profile. Comparison of the effectiveness of gemfibrozil and bezafibrate in various types of hyperlipoproteinemia]

AIMS

To compare the efficacy and tolerability of Gemfibrozil and Bezafibrate in patients with hyperlipoproteinemia, types IIa, IIb and IV.

METHOD

In an open, randomized parallel study, the tolerability and efficacy of Gemfibrozil (G) and Bezafibrate (B) were investigated over a period of 12 weeks in 178 hyperlipidemic (HLP) patients first submitted to an 8-week "wash-out" (diet only) phase. In HLP type IIa patients, LDL cholesterol was lowered (G: -13%, B: -10%). In HLP type IIb, a decrease in triglyceride (TG) levels (G: -41%, B: -31%), an increase in HDL-cholesterol (G: +19%, B: +5%), and a decrease in the total cholesterol/HDL cholesterol ratio (G: -32%, B: -9%) predominated. Patients with type IV HLP responded to both fibrates with an appreciable reduction in TG levels (G: -45%, B: -42%). The effects of the preparations differed significantly with respect to the elevation of HDL cholesterol and a decrease in the total cholesterol/HDL cholesterol ratio in HLP type IIb patients. The respective lipid baseline concentration appeared to be of importance for the sense and extent of the changes induced.

Internalization of V2-vasopressin receptors in LLC-PK1-cells: evidence for receptor-mediated endocytosis

The mechanism of internalization of the vasopressin-receptor (V2-subtype) of LLC-PK1-cells, a pig renal tubular cell line, is unknown. We studied internalization utilizing a novel, highly specific vasopressin analogue ((125I)-[8-p(OH)-phenylpropionyl]-LVP, 2000 Ci/mmol). Scatchard analysis performed with membranes of LLC-PK1-cells revealed a Kd of 0.8 +/- 0.2 nM and a Bmax of 366 +/- 41 fmol/mg of protein. Degradation of the ligand was excluded by RP-HPLC-analysis. Internalization was proven by the acid-wash technique, quantitative light-microscopic autoradiography and electron microscopy. The ligand was internalized in a time- and temperature-dependent manner. At 4 degrees C, no uptake was found; at 22 degrees C, after 30 min of incubation, more than 50% of the radioligand was found inside the cell. Electron microscopy demonstrated that plasma-membrane bound vasopressin receptors are internalized by receptor-mediated endocytosis via coated pits.

Intracellular distribution of endothelin-1 receptors in rat liver cells

We studied the binding of (125I)-endothelin-1 as well as that of the vasopressin analogue (125I)-[8-phenylpropionyl]-LVP to purified plasma membranes, Golgi cisternae and cell nuclei from rat liver. Cell organelles were isolated by differential centrifugation and discontinuous sucrose gradients. Endothelin-1 exhibited specific binding to plasma membranes, Golgi cisternae and nuclei, while the binding of (125I)-[8-phenylpropionyl]-LVP was restricted to the plasma membranes. The number of receptors (Bmax) and the binding constants (Kd) were determined by Scatchard analysis of competition binding studies. In all cases only one class of Et-1 binding sites could be detected. The presence of Et-1 receptors on the Golgi complex either indicates that the receptor is glycosylated within the cisternae or alternatively, there exists a recycling pathway. The unexpected finding of Et-1 receptors on highly purified nuclei suggests that this peptide may exert part of its biological functions intracellularly via the nucleus.

[Appendicitis in children]

In 1992, appendicitis is still common among children. Mortality due to a belated or erroneous diagnosis is far from being nil. The disease must always be present in the clinician's mind, and its diagnosis is purely clinical. No significant advance has been made on this subject, and clinical findings remain of paramount importance. Hospitalization for observation at the slightest doubt and emergency surgery when the diagnosis is probable are the best means of improving the management of appendicitis in children.

Evaluation of (13C)ethanol incorporation into very-low-density lipoprotein triglycerides using gas chromatography/isotope ratio mass spectrometry coupling

Gas chromatography/isotope ratio mass spectrometry (GC/IRMS) coupling was used to evaluate (13C)ethanol incorporation into plasmatic very-low-density lipoprotein (VLDL) triglycerides of three healthy human volunteers. After the perfusion of 13C-enriched alcohol, VLDL triglyceride fractions were extracted from plasma samples and prepared for the analysis of (13C)fatty acid methyl esters. The GC/IRMS coupling line, the analytical procedure and the data collection are described. The results show that ethanol itself may be used as a substrate for lipogenesis, though to a small extent: less than 10% of VLDL triglycerides may be derived from this metabolic pathway. Ethanol incorporates predominantly into myristic and palmitic acid. The small amount of sample material required for analysis, which minimizes the amount of isotope-labelled substrate required, makes this technique a valuable tool for metabolic investigations in human subjects.

[The hemodynamic effects of isradipine and nifedipine in hypertension]

Hemodynamic Effects of Isradipine and Nifedipine in Hypertension Myocardial wall tension is an important determinant of the oxygen demand, the function and the degree of hypertrophy of the left ventricle. Myocardial wall tension should be influenced more favourably by a non-cardiodepressive antihypertensive than by a potentially cardiodepressive one. Therefore, we investigated the effects of an intravenous infusion of the calcium antagonists isradipine (I; 0.4 mg; 3,5-pyridinecarboxylic acid, 4-[benzofurazanyl]-1,4-dihydro-2,6-dimethyl-,methyl-ethylester+ ++ [9CI]; CAS75695-93-1) and nifedipine (N; 2.0 mg) resp., on hemodynamics and myocardial wall tension in 12 hypertensives by an intraindividual comparison. The adrenergic reflex activation induced by vasodilation was limited by pre-medication with 0.1 mg propranolol/kg body weight (i.v.) before application of I and N. Baseline blood pressure of the patients and its changes in response to both calcium antagonists were statistically comparable, as were the left ventricular end-diastolic volumes. The end-systolic volumes, however, decreased significantly on I but not on N: before I: 69 +/- 7.0 (mean +/- standard error), after I: 61 +/- 6.1 ml, 2p less than 0,001; before N: 62 +/- 6.1, after N: 64 +/- 7.0 ml, n.s. (difference to I: 2 p less than 0.05). Stroke volume increased only on I (before I: 62 +/- 4.1, after I: 69 +/- 4.1 ml, 2p less than 0.001; before N: 64 +/- 3.5, after N: 65 +/- 3.8 ml, n.s. (difference to I: 2p less than 0.05)).(ABSTRACT TRUNCATED AT 250 WORDS)

Alzheimer's disease in Down's syndrome with SPECT

Alzheimer's disease often occurs in patients with Down's syndrome. SPECT scanning with I-123 IMP and Tc-99m HMPAO identifies decreased cerebral perfusion and metabolism in these patients at lower cost. In this case, SPECT scanning revealed changes in Alzheimer's disease in a Down's syndrome patient.

[Significance of hyponatremia in patients with oropharyngeal tumors]

We observed 29 patients with hyponatremia associated with oropharyngeal carcinoma. In 19/29 the hyponatremia was attributable to a decreased effective arterial blood volume whereas in the remainder (10/29) the presence of SIADH could be demonstrated. These etiologies of hyponatremia were best differentiated by the plasma urea concentration (less than 30 mg/dl in SIADH), urate concentration (less than 4,0 mg/dl in SIADH) and creatinine concentration (less than 0,9 mg/dl in SIADH). Furthermore, SIADH patients had a spontaneous natriuresis. The mainstay of therapy in either form of hyponatremia is fluid restriction (less than 1 l/d).

Action of aldosterone on cultured renal collecting duct cells during the latent period

The effects of aldosterone on protein synthesis in the latent period were investigated on cultured renal collecting duct cells from neonatal rabbit kidneys. Tissue was incubated with radioactively labelled uridine and amino acids and then precipitated with trichloroacetic acid in order to determine the intracellular precursor pool and identify new synthesis of RNA and protein. During the latent period, aldosterone increased the intracellular radioactive uridine pool and total radioactive RNA content already 20 and 60 min after its application; conversely 40 min after aldosterone introduction, no stimulation was found. Further experiments revealed that the intracellular radioactive amino acid pool was generally increased by aldosterone after 20, 40 and 60 min, while a distinct increased radioactive protein content was found to be induced by aldosterone only after 40 min. This indicates that aldosterone increases the uptake of RNA and protein precursors and the new synthesis of RNA and proteins. These events seem to to be regulated not continuously but intermittently. The induced proteins possibly take part in the mediation of the early hormone response. Experiments with the aldosterone antagonist, spironolactone, provide evidence for the specificity of the described hormone effects. The results after application of the Na+ channel blocker, amiloride, and the Na+/K(+)-ATPase inhibitor, G-strophanthin, indicate that the aldosterone effects are controlled by Na+ channels and Na+ pumps and therefore by the intracellular Na+ content. The inhibitory effect of cycloheximide on the aldosterone-induced protein synthesis indicates the role of these proteins on the hormone-stimulated Na+ transport.

Lithium treatment reduces the renal kallikrein excretion rate

Lithium salts are widely used agents for the prophylactic treatment of affective disorders. Lithium salts may be associated with distal nephron dysfunction. Kallikrein is a protease which is generated by the distal nephron. We used an amidolytic assay of chromatographically purified enzyme to determine the urinary excretion rate of active kallikrein in relation to lithium treatment. All plasma lithium concentrations were within the therapeutic range (0.4 to 0.9 mmol/liter). In 15 patients the urinary excretion rate of active kallikrein was 267.4 +/- 65.6 mU/24 hrs before lithium treatment, and fell to 117.8 +/- 39.6 mU/24 hrs (P less than 0.05) on day 14 of lithium treatment. This reduction was associated with a decrease of immunoreactive kallikrein in the same urines by 66%. In another 15 patients who had undergone lithium therapy for an average period of 5.6 years, the urinary excretion rate of active kallikrein was 86.1 +/- 14.5 mU/24 hrs, while 21 age-matched healthy controls had an excretion rate of 364.1 +/- 58.4 mU/24 hrs (P less than 0.05). Measurements of immunoreactive kallikrein in the same urine samples demonstrated a reduction of kallikrein after long-term lithium treatment by 78%. These observations could not be attributed to changes in creatinine clearance, renal sodium or potassium excretion rates or plasma concentrations of aldosterone and vasopressin. Addition of lithium to the urine in vitro had no demonstrable effect on kallikrein measurement by amidolytic assay. We conclude that lithium in therapeutic plasma concentrations may directly suppress the secretion of kallikrein by renal connecting tubule cells.

Osteoid osteoma of the acetabulum: two cases

We report two cases of osteoid osteoma of the acetabulum associated with severe chronic synovitis. The diagnosis is difficult and usually delayed because the acetabulum is a rare site for this tumor and clinical signs are nonspecific. Computed tomography (CT) scanning is the best diagnostic technique. An intraarticular surgical approach allows complete resection, but one case required spongy bone grafts. Postoperative results are excellent.

Cation channels in the apical membrane of collecting duct principal cell epithelium in culture

The apical cell membrane of cultured monolayers of collecting duct principal cells was investigated with the patch-clamp technique to study single ion channels. A broad spectrum of channel events was observed which complicated the analysis. Although principal cells absorb mainly Na+ ions and although most patches must have contained an Na+ conductance as evidenced by asymmetric clamp currents in the presence of amiloride, single Na+ channel events could not be identified with certainty, possibly because single-channel conductance was too low (less than or equal to 5 pS). Instead, non-selective cation channels of 21.2 +/- 4.0 pS were frequently observed. They were impermeable to choline and anions but did not discriminate between Na+ and K+. These channels, however, do not appear to participate in active Na+ absorption. Different types of K+ channels were observed: a high-conductance Ca2(+)-activated K+ channel and a bursting low-conductance K+ channel. Since the former channel has been denied a role in K+ secretion/absorption in native collecting ducts, the latter might be involved. In addition three types of Cl- channels have been observed which will be described separately. At least one of those, a 30-pS outwardly rectifying Cl- channel appears to allow small amounts of Cl- ions to be absorbed across principal cells.

[Kidney function in heart failure]

Congestive cardiac failure is a syndrome in which a decrease of cardiac output triggers a series of neuro-humoral compensatory mechanisms in part involving the kidney. In this response, dysfunction of atrial volume receptors as well as disturbances of the autonomic nervous system have recently been demonstrated and are held responsible for excessive stimulation of angiotensin II, followed by adverse regulatory effects. Renal hemodynamic compensation for heart failure primarily involves constriction of efferent arterioles thereby defending glomerular filtration. In this setting, the occurrence of prerenal insufficiency is indicative of a far advanced reduction in renal blood flow. Apparent diuretic resistance in the treatment of heart failure is usually caused by iatrogenic vascular compromise or by the use of a single diuretic rather than an appropriate combination. Hyponatremia, vasopressin stimulation and elevation of plasma N-epinephrine concentration have been found to be the most reliable indicators of a poor prognosis of heart failure. Atrial natriuretic peptide is stimulated in proportion to the degree of atrial distension in heart failure, however its intrarenal effects are markedly blunted or may even be absent in this particular disease.

Inappropriate secretion of antidiuretic hormone, polydipsia and hypothalamic calcifications

We studied a 41 year old patient who had pathologic fluid intake of 10 1/day together with syndrome of inappropriate antidiuretic hormone. Imaging studies revealed a lesion of the anterior wall of the third cerebral ventricle. A review of relevant literature indicated several different disturbances by which alterations of thirst, vasopressin-secretion and abnormalities of anterior third ventricle may be associated. The present case presents an unusual and potentially dangerous combination in this spectrum of changes.

Action of aldosterone on protein expression in cultured collecting duct cells from neonatal rabbit kidney

To investigate whether 'aldosterone-induced proteins' could be detected in mammalian species, cultured renal collecting duct epithelia from neonatal rabbit kidneys were labelled under aldosterone administration with radioactive methionine and subsequently fractionated into cytosolic and coarse membrane protein fractions. Newly synthesized proteins were then analyzed by SDS-PAGE, isoelectric focussing and two-dimensional electrophoresis. Quantitative estimates of individual newly synthesized proteins were performed utilizing gel slicing, scintillation counting and autoradiography. The labelling experiments demonstrated that, in comparison to controls, aldosterone (1 X 10(-6) M) generally increased the amount of radioactive protein. No qualitative changes in the pattern of newly synthesized proteins and, therefore, no classical aldosterone-induced proteins were observed. The increase of radioactive protein was already seen after 1, 6, and 18 h of hormone treatment. The effect could be blocked partially by spironolactone (1.5 X 10(-4) M), and totally by amiloride (1 X 10(-6) M), g-strophantin (5 X 10(-4) M), and cycloheximide (1 X 10(-6) M. Thus, the interference of aldosterone action at the receptor level, the Na+ channels and the Na+/K(+)-ATPase pump demonstrate that the expression of proteins in cultured renal collecting duct cells is a sensitive system and seems to be controlled by aldosterone at the receptor level, but also counter-controlled by specific plasma membrane sites.

Action of aldosterone on citrate synthase in cultured renal collecting duct cells

Cultured renal collecting duct cells from neonatal rabbit kidney were used to examine the influence of aldosterone on enzymatic activity of citrate synthase during increase in Na+ transport. Control epithelia showed citrate synthase activity of 71 +/- 3 mU/mg protein (n = 28), while after aldosterone treatment citrate synthase activity was significantly increased to 79 +/- 6 mU/mg at 1 h (n = 5), to 88 +/- 6 mU/mg at 2 h (n = 6) and to 93 +/- 8 mU/mg protein at 3 h (n = 5). Citrate synthase activity subsequently decreased to basal values. Spironolactone fully blocked the aldosterone-induced increase in citrate synthase activity. The time course of enzyme stimulation after aldosterone administration indicates that the hormone activates citrate synthase during the physiological early response phase.