Mentoring mission leaders of the future. Program prepares laity for ministry leadership

As religious sponsors increasingly relinquished their CEO positions throughout the 1980s and early 1990s, they established mission integration positions-staffed primarily by women religious-to help ensure the Catholic identity of their facilities. Now that role, too, is undergoing change as sponsors seek to empower the laity in their organizations with responsibility for carrying on the Church's healing mission. At St. Vincent Hospitals and Health Services in Indianapolis, the Daughters of Charity of St. Vincent de Paul, the organization's sponsor, has developed a mentoring program to train the laity in the roles and responsibilities involved in mission. The year-long program has 11 modules that present theory on such topics as ethics, spirituality, the sponsor's history and charism, and the relationship of the healthcare organization to the Church. Participants also attend committee meetings, complete a mission integration project, and gain practical experience in mission-related activities.

Human fetal testis endoplasmic reticulum glucose-6-phosphatase enzyme protein

Microsomal glucose-6-phosphatase (EC 3.1.3.9) is an enzyme system traditionally thought to be present only in gluconeogenic tissues. We have used microassay techniques, immunohistochemistry using monospecific antibodies to the liver enzyme, and specific DNA probes and primers to examine whether glucose-6-phosphatase is present in human and rat testis. Microsomal glucose-6-phosphatase activities in human fetal testis (weeks 15-20 of gestation) are approximately 25% of corresponding liver values. Localization is predominantly in Leydig cells, with variable and weak immunoreactivity in developing seminiferous tubules. Kinetic analysis of glucose-6-phosphatase in intact and disrupted microsomes and Southern blot analysis of polymerase chain reaction products indicated that the specific glucose-6-phosphatase enzyme system was also present in rat testis. We have shown for the first time that specific microsomal glucose-6-phosphatase activity, protein, and mRNA are present in testis, and that the predominant site of expression is the Leydig cell in human fetal testis.

Genetic variation in bilirubin UPD-glucuronosyltransferase gene promoter and Gilbert's syndrome

BACKGROUND

The genetic basis of Gilbert's syndrome is ill-defined. This common mild hyperbilirubinaemia sometimes presents as an intermittent jaundice. A reduced hepatic bilirubin UPD- glucuronosyltransferase (UGT) is associated with this syndrome. We have examined variation in the gene encoding the UGT1*1 enzyme and serum bilirubin levels in a Scottish population.

METHODS

Blood was collected from 12 patients with confirmed or suspected Gilbert's syndrome, from 6 members of a family with 4 Gilbert members, and from 77 non-smoking, alcohol-free, drug-free volunteers recruited from the staff of a teaching hospital in Dundee. Polymerase chain reaction amplification was used to examine sequence variation of the promoter upstream of the UGT1*1 exon I. Genotypes were assigned as follows: 6/6 (homozygous for a common allele bearing the sequence [TA](6)TAA), 7/7 (homozygous for a rarer allele with the sequence [TA](7)TAA), and 6/7 (heterozygous with one of each allele).

FINDINGS

Individuals in the population with the 7/7 genotype had significantly higher bilirubin concentrations than those who had the 6/7 or 6/6 genotype. 14 volunteers underwent a 24 h fasting test to see if they had Gilbert's syndrome, and all four positives had the 7/7 genotype. One confirmed Gilbert's patient, two recurrent jaundice patients (with suspected Gilbert's syndrome), and nine clinically diagnosed cases had the 7/7 genotype. Segregation of the 7/7 genotype with the Gilbert phenotype was also demonstrated in the family with four affected members. The frequency of the 7/7 genotype in this eastern Scottish population was 10-13%.

INTERPRETATION

In a healthy population there was an association between variation in bilirubin concentration and a mutation within the gene encoding the enzyme bilirubin UGT. This and other findings suggest the existence of a mild and a more severe form of Gilbert's syndrome, depending on whether the gene defect lies in the promoter sequence upstream of UGT1*I exon I, as here (mild), or in the coding sequence (severe) of the gene.

The human embryonic-fetal kidney endoplasmic reticulum phosphate-pyrophosphate transport protein

Glucose-6-phosphatase is a multicomponent endoplasmic reticulum system comprising at least six different proteins, including a lumenal enzyme and several transport proteins. One of the transport proteins, T2beta, transports the substrate pyrophosphate and the product phosphate and its genetic deficiency is termed type 1c glycogen storage disease. We have used anti-T2beta antibodies for immunohistochemistry with image analysis and kinetic analysis of the glucose-6-phosphatase system to study for the temporal and spatial development of T2beta in human embryonic and fetal kidney. In metanephric kidney, there is an early predominance of T2beta expression in the ureteric bud derivatives and this changes with ontogeny such that developing nephrons, particularly proximal tubules, become dominant by mid-gestation. T2beta has the same spatial and temporal pattern as the glucose-6-phosphatase enzyme in both mesonephric and metanephric kidney. Pyrophosphate transport capacity is appropriate for the amount of glucose-6-phosphatase activity present in mid-gestation fetal kidney, in contrast to liver, where pyrophosphate transport capacity is developmentally delayed. Increasing knowledge of the temporal and spatial expression of the glucose-6-phosphatase proteins and their catalytic roles in early human development is essential for the elucidation of the aetiology of renal disease in both type I glycogen storage diseases and the developmental disorders of the glucose-6-phosphatase system.

Differential expression and immunohistochemical localisation of the phenol and hydroxysteroid sulphotransferase enzyme families in the developing lung

Reversible sulphation, catalysed by sulphotransferases and sulphatases, of biologically active compounds such as androgens and oestrogens is a sensitive mechanism for regulating their bioavailability, and we have previously hypothesised that this process plays a significant role in the regulation of human fetal lung development. Sulphation is also a major detoxification reaction, contributing significantly to the body's chemical defence mechanism. We have used qualitative and semiquantitative immunological studies to determine the temporal expression and localisation of phenol and hydroxysteroid sulphotransferases during human lung development. Our results show that in the early fetal lung, phenol sulphotransferase expression is at its highest, and is most widely distributed throughout the developing respiratory epithelium. With later development, expression levels decrease and become predominantly restricted to the more proximal airways. In contrast, hydroxysteroid sulphotransferase is present only at very low levels in the early-gestation lung but expression increases rapidly through gestation to reach an apparent peak by 1 year postnatal age. The proximal-to-distal gradients of phenol and hydroxysteroid sulphotransferase expression were similar in mature respiratory epithelium, with immunoreactivity in ciliated cells, non-ciliated secretory cells and basal cells, but with no apparent expression in mucus-secreting cells. These studies provide supporting evidence for the hypothesis that hydroxysteroid sulphotransferase, an androgen-inactivating enzyme, contributes to the role of androgens in retarding the maturation of human lung in utero.

The glucose-6-phosphatase enzyme in developing human trachea and oesophagus

Glucose-6-phosphatase is an endoplasmic reticulum system which is found primarily in liver and kidney. Recently, it has become clear that it is also present in lower amounts in a variety of other tissues. Previous histochemical studies of glucose-6-phosphate hydrolysis in trachea have given equivocal results and only one study on adult oesophagus has shown glucose-6-phosphatase, enzymatic activity but without cellular localization. We have now shown, using microassay techniques, that microsomes isolated from human foetal trachea and oesophagus both contain low levels of specific glucose-6-phosphatase activity (mean = 0.9 and 1.5 nmol min-1 mg-1 microsomal protein, respectively) which are less than 10% of the levels in microsomes of human foetal liver of similar age. In the developing trachea, glucose-6-phosphatase immunoreactivity has been found, using a monospecific antibody to the catalytic subunit of the glucose-6-phosphatase enzyme, to be first present at 10-11 weeks' gestation, and thereafter in foetal life, predominantly present in ciliated cells, with smaller amounts in non-ciliated secretory cells, duct lining cells, and occasional basal cells. The foetal oesophageal epithelium is transiently ciliated from 10 to 11 weeks' gestation, but ciliated cells are gradually replaced by squamous cells from 14 to 16 weeks onwards. Glucose-6-phosphatase immunoreactivity in human foetal oesophagus is predominantly confined to ciliated cells, but non-ciliated luminal cells are also reactive, as are occasional basal cells. Mucus secretory cells in foetal trachea and oesophagus are immunonegative, as is the entire epithelium of both organs in the embryo (up to 56 postovulatory days.

The ontogeny of key endoplasmic reticulum proteins in human embryonic and fetal red blood cells

Recently, using immunohistochemical methods, we surprisingly found that endoplasmic reticulum glucose-6-phosphatase is present in human embryonic and fetal red blood cells (RBCs) but not in adult RBCs. The fact that an endoplasmic reticulum enzyme, whose major site of expression in adults is the liver, is present in human embryonic and fetal RBCs, particularly nucleated cells, indicated that it would be sensible to determine whether these cells also contain other endoplasmic reticulum enzyme systems normally found in adult liver. Therefore, we have studied the expression of other endoplasmic reticulum proteins and found that human embryonic and fetal RBC precursors contain other protein components of the glucose-6-phosphatase system, ie, the phosphate and glucose transport proteins as well as other enzymes (eg, uridine diphosphate-glucuronosyltransferases, cytochrome P450 isozymes, nicotinamide adenine dinucleotide phosphate cytochrome P450 oxidoreductase, and prostaglandin H synthase). In addition, we also found the predominantly cytosolic markers 15-hydroxyprostaglandin dehydrogenase, prostaglandins PGE2 and 13,14-dihydro-15-keto-PGE2. The expression of key enzymes that control glucose production, detoxification of endobiotics and xenobiotics, and the regulation of prostaglandin levels in embryonic and early fetal RBCs means that these cells may have an important role in protecting the developing conceptus before it establishes an efficient circulation and before all tissues fully express their normal complement of these enzymes.

A rapid combined immunocytochemical and fluorescence in situ hybridisation method for the identification of human fetal nucleated red blood cells

Fetal nucleated red blood cells are found in the maternal circulation during pregnancy. If a simple routine method of detection of these cells was developed, it could be used as the basis of non-invasive prenatal diagnosis of fetal genetic disorders. Fetal male and adult female blood were mixed to mimic maternal blood in pregnancy and used to establish a simple technique to unequivocally detect fetal nucleated red blood cells. These were identified by combined immunocytochemistry using a human fetal haemoglobin antibody and a rapid and simple-to-use fluorescence in situ hybridisation method using X and Y chromosome probes. Initial studies using the alkaline phosphatase anti-alkaline phosphatase technique as the first procedure showed that the stain was unstable and unsuitable for in situ hybridisation. An immunoperoxidase technique was found to produce a stable stain resistant to harsh fixation steps required in subsequent in situ hybridisation. This enabled the simultaneous visualisation of immunopositivity and in situ hybridisation signals on the same cell with neither procedure affecting the other's signal quality. We are currently using this procedure to detect a range of endoplasmic reticulum proteins in fetal nucleated red blood cells from maternal blood in an attempt to diagnose disorders of liver protein expression in early pregnancy.

Differential release of prostaglandins by organ cultures of human fetal trachea and lung

Human fetal lung at 16-19 weeks gestation has a partially differentiated epithelium, and in organ culture, distal airsacs dilate and the epithelium autodifferentiates to type I and II pneumatocytes, processes regulated by endogenous prostaglandin PGE2. Human fetal trachea, at the same gestation, has a terminally differentiated mucociliary epithelium but after 4-6 d in organ culture, develops squamous metaplasia. Tracheal cultures restricted to 3 d have normal phase-contrast and light microscopy appearances and immunohistochemical reactivities (epithelium: cytokeratin 7,8,18; glutathione S-transferase pi-isozyme; epithelial membrane antigen and mesenchyme; desmin; vimentin). In human fetal trachea organ cultures, the predominant prostaglandins released are 6-keto-PGF1 alpha, PGF2 alpha, and PGE2, a pattern similar to that previously described for human adult trachea and lung. In fetal lung cultures, 13,14-dihydro-15-keto-PGF2 alpha is the major prostaglandin released with lesser amounts of 13,14-dihydro-15-keto-PFG2 alpha,PGF2 alpha,PGE2, and 6-keto-PGF1 alpha. Human fetal lung in vitro has the competence to self-differentiate, as early as 12 weeks gestation and presence of high levels in fetal lung of the inactive metabolite 13,14-dihydro-15-keto-PGE2 relative to PGE2 suggests that active prostaglandin catabolism may be one of the mechanisms to retard this stage of maturation in vivo by limiting PGE2 availability. Surprisingly, the profile of prostaglandins released from fetal lung organ culture does not change to that of a mature lung with terminal differentiation of the epithelium, and this may indicate differences in the expression of key prostaglandin-metabolizing enzymes in developing human fetal lung in culture and with in utero ontogeny.

Preparation and characterization of anti-peptide antibodies directed against human phenol and hydroxysteroid sulphotransferases

Sulphotransferases (STs) catalyze the sulphation and, in general, detoxication of a large number of xenobiotics and endogenous compounds. A total of six synthetic peptides derived from the cDNA-derived amino acid sequences of the human phenol-sulphating form of phenosulphotransferase (P-PST) and human hydroxysteroid sulphotransferase (HST)--three from each sequence--were separately conjugated to the carrier protein keyhole limpet hemocyanin, and used to immunize rabbits. One successful antibody preparation was produced from among the P-PST peptides, and two from the HST peptides. On immunoblot analysis following SDS/PAGE, the anti-P-PST antibodies recognized two major forms of phenol ST in man, P-PST and the monoamine-sulphating form of PST, M-PST, and the two antibody preparations against HST recognized the human HST. These experiments demonstrate that it is possible to design specific antibodies against human sulphotransferases based on their amino acid sequences.

The glucose-6-phosphatase system in human development

The classical role of glucose-6-phosphatase in liver and kidney is the production of glucose for release into blood. In liver, glucose-6-phosphatase catalyses the terminal step of glycogenolysis and gluconeogenesis. Abnormally low hepatic glucose-6-phosphatase activity is found in human genetic deficiencies i.e. glycogen storage disease type I and in cases of developmental delay, found predominantly in preterm infants. In contrast, abnormally high liver glucose-6-phosphatase occurs in poorly controlled or untreated diabetes mellitus. Hepatic glucose-6-phosphatase is an integral endoplasmic reticulum (and nuclear membrane) protein and it is part of a multicomponent system. Its active site is situated inside the lumen of the endoplasmic reticulum and transport proteins are needed to allow its substrates glucose-6-phosphate (and pyrophosphate) and its products phosphate and glucose to cross the endoplasmic reticulum membrane. In addition, a calcium binding protein is also associated with the glucose-6-phosphatase enzyme. Immunohistochemical studies, in combination with image analysis, have shown that glucose-6-phosphatase is present in liver and kidney and also in specific cell types in a variety of human tissues, for example Leydig cells in the testis and some astrocytes in the brain. Where practicable, enzymatic analysis, direct transport assays and/or immunological detection of the endoplasmic reticulum glucose and phosphate transport proteins have been used to demonstrate the presence and activity of the whole glucose-6-phosphatase system. The distribution of the human glucose-6-phosphatase system changes dramatically during development with a different spatial and temporal pattern in each tissue. The most unexpected localization was in circulating, predominantly nucleated, embryonic and early fetal red blood cells.

Human fetal adrenal hydroxysteroid sulphotransferase: cDNA cloning, stable expression in V79 cells and functional characterisation of the expressed enzyme

Dehydroepiandrosterone sulphate (DHEAS) is a major adrenal secretory product, particularly in the fetus where it serves as a substrate for oestrogen biosynthesis by the placenta. The enzyme in the adrenal responsible for synthesising DHEAS, hydroxysteroid sulphotransferase (HST), is therefore essential for human development. We have isolated a full-length cDNA clone, encoding human fetal adrenal HST, and constructed a stable cell line expressing it by transfection into V79 Chinese hamster lung fibroblast cells. This cDNA was essentially identical to that isolated from adult human liver, where the role of HST is less well understood. This recombinant cell line allowed determination of the substrate specificity and kinetic properties of this enzyme towards various steroid hormones, and by comparison of these activities with human liver cytosol we have shown that HST is the major sulphotransferase responsible for the sulphation of DHEA, androsterone and pregnenolone in man and that, functionally, the hepatic and adrenal enzymes are very similar. The expressed HST was also active with testosterone, cortisol (although at low levels) and the xenobiotic 17 alpha-ethinyloestradiol, but not with oestrone or 1-naphthol. We have therefore created a valuable resource for the study of this important enzyme.

Evidence for glucuronide (small molecule) sorting by human hepatic endoplasmic reticulum

The entry of substrates into, and the export of glururonides from, the lumen of hepatic endoplasmic reticulum (ER) in vitro (sealed microsomes) has been measured using radioactivity-labelled materials and a rapid filtration assay. Analysis of liver microsomes from a jaundiced patient showed the accumulation of bilirubin glucuronides within the lumen of the ER. Further analysis of these hepatic microsomes revealed that newly synthesized 1-naphthol glucuronide could exit from the microsomes whereas bilirubin glucuronide was accumulated within the microsomes. These results suggest the existence of mechanisms for the sorting of small molecules, destined for export through bile canalicular or basolateral plasma membranes, by ER. Furthermore, these sorting processes may be regulated by specific transporters within the ER.

The ontogeny of the glucose-6-phosphatase enzyme in human embryonic and fetal red blood cells

We have shown for the first time that the microsomal glucose-6-phosphatase enzyme protein is present in human embryonic and fetal red blood cells and the ontogeny of its expression has been determined. In the earliest embryos, red cells are predominantly of the primitive megaloblastic type. Circulating red cells in the primitive megaloblastic series are predominantly nucleated and glucose-6-phosphatase immunopositive. Non-nucleated, immunoreactive megaloblastic cells are in a minority. In fetuses > 12 weeks gestation, the erythrocytes are of the definitive normoblastic series and in the transitional period of switch-over in late embryonic-early fetal life, up to 30% of glucose-6-phosphatase immunopositive cells are definitive normoblastic in type, with a variable contribution from nucleated and non-nucleated cells. Thereafter, the number of immunopositive cells in the definitive normoblastic series decreases such that after 12 weeks gestation it is less than 5%. The fact that a predominantly hepatic protein in adults (glucose-6-phosphatase) is present in embryonic and fetal red blood cells, particularly nucleated red cells, raises the possibility of diagnosis of disorders of liver protein expression in nucleated fetal red cells isolated from the first trimester maternal circulation.

The human adrenal microsomal glucose-6-phosphatase system

Microsomal glucose-6-phosphatase (EC 3.1.3.9) is a multicomponent enzyme system traditionally thought only to be present in gluconeogenic tissues. The enzyme is associated with transport systems, for its substrate glucose-6-phosphate, and its products phosphate and glucose. It has been shown, using immunohistochemical methods and monospecific antibodies, that the component proteins of the enzyme system are present in human embryonic and fetal adrenal gland and are predominantly located in the fetal zone with lesser reactivities in the definitive zone. In addition, specific glucose-6-phosphatase activity was shown, and the rates of entry of glucose-6-phosphate, phosphate, and glucose into microsomes isolated from human fetal adrenals were measured. Although the complete enzyme system is present, the ratio of the component activities and comparison with human fetal and adult liver indicate that the regulation of the adrenal and liver glucose-6-phosphatase systems is different. In the human postnatal adrenal, immunoreactivies to the protein components decrease dramatically and are confined predominantly to the zona reticularis, suggesting a specialized role for adrenal glucose-6-phosphatase in fetal life.

Differential localisation of UDP-glucuronosyltransferase in kidney during human embryonic and fetal development

The aim of our study was to localise UDP-glucuronosyltransferase (UDPGT) in the developing mesonephric and metanephric kidneys of the human embryo and fetus, using immunohistochemical methods and an antibody preparation with broad specificity to the human isoforms. In embryonic and early fetal development of the metanephric kidney, UDPGT is located primarily in derivatives of the ureteric bud such as the ureter, pelvis, calyces and collecting ducts. This early predominance of UDPGT to ureteric bud derivatives declines by mid-fetal life: a) as nephrons evolve and develop they become increasingly UDPGT immunoreactive such that in mature metanephric kidney, the proximal tubules are highly UDPGT reactive, with other elements of the nephron also immunopositive (albeit at lower reactivities) and b) with the formation of an immunonegative transitional epithelium in ureter, pelvis and calyces, the reactivity retained in collecting ducts is only a small proportion of the total. The distribution of UDPGT immunoreactivity is relatively uniform in proximal tubular cells throughout development. This is in contrast to collecting ducts where, in fetal life, this reactivity is displaced to apices and bases by intracellular glycogen deposits. Parietal cells of Bowman's capsule are immunoreactive, but glomeruli are negative. In mesonephric kidney, as early as 32 days post-ovulation, tubules and the mesonephric duct are UDPGT immunoreactive and mesonephric immunopositivity overlaps with that in the developing metanephric kidney.

Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves

Percutaneous fetal cystoscopy was performed in a male fetus with ultrasonographic evidence of lower urinary tract obstruction at 19 weeks of gestation. The diagnosis of posterior urethral valves was confirmed. Percutaneous endoscopic fulguration of the valves was successfully performed at 22 weeks of gestation, and urethral patency was established. This case illustrates the feasibility of performing diagnostic and therapeutic endoscopic procedures within the human fetus for the management of a congenital anomaly. While we believe that fetal cystoscopy may improve our diagnostic, prognostic, and therapeutic capabilities in the management of fetuses with lower obstructive uropathy, studies are needed to establish the actual value, risks, and limitations of this new approach in fetal medicine.

Low birthweight: a 10-year outcome study of the continuum of reproductive casualty

Disability rates among low-birthweight infants, particularly those related to congenital abnormality and cerebral palsy, are high. Both prenatal and perinatal factors are likely to be involved in the aetiology of most types of disability. IQ tends to be lower among low-birthweight infants, but does not appear to be closely related to birthweight alone. The confounding effect of social class should be considered when assessing aetiology and outcome. The long-term outcome for the increasing number of low-birthweight infants who survive and receive intensive neonatal care requires to be continually assessed; however, studies should not be confined to the very- and extremely-low-birthweight infant requiring prolonged intensive care, but should include abortions, stillbirths and neonatal deaths. As disability in survivors can relate to preterm birth but not perinatal complications, all low-birthweight infants require to be studied if selective bias is to be solved.