Posttransplantation lymphoproliferative disorder: changing manifestations of disease in a renal transplant population

OBJECTIVE

To review the changing manifestations of PTLD in patients with renal transplants.

METHODS

Review of 1954 records of the renal transplantation clinic from 1971 to 1993 produced 17 patients with the diagnosis of PTLD.

RESULTS

With changes in immunosuppression, the sites of involvement of PTLD have changed. Central nervous system involvement was the predominant site of disease prior to the use of cyclosporine. With the institution of cyclosporine, thoracic, and abdominal presentations became more common. PTLD isolated to the renal transplant is a new manifestation of disease that may be a result of immunosuppression with OKT3. Monomorphous PTLD was associated with a 78% PTLD related mortality. Polymorphous PTLD had a 0% PTLD related mortality. In patients with cross-sectional imaging abnormalities, PTLD presented as solitary or multiple masses in 78%. This is the finding most suggestive of PTLD in a transplant population.

CONCLUSION

Posttransplantation lymphoproliferative disorder is a heterogeneous grouping of lymphoid proliferation with variable clinical and radiographic manifestations. An understanding of the range of manifestations may lead to improved diagnosis of this unusual disorder.

Radiographic pulmonary infiltrates

The finding of a pulmonary infiltrate on chest radiograph may represent a spectrum of pathologic entities in the acutely ill hospitalized adult. Timely intervention depends on the advanced practice nurse's ability to devise a differential diagnosis based on the characteristics of the infiltrate and the clinical setting. Pulmonary infiltrates are described as interstitial or alveolar, diffuse or focal. Their presentation may be chronic or acute in nature. Understanding the nuances of chest radiographic interpretation provides the foundation on which the infiltrate is described and is therefore the first step in establishing the differential diagnosis. Thorough clinical assessment and thoughtful requisition of diagnostic studies are used to discriminate the disorders found in the differential diagnosis. Using an organized approach to describe the radiographic abnormality and define its clinical context, the advanced practice nurse can efficiently establish a diagnosis so that the work of treatment may begin.

Activation of the Src-family tyrosine kinase Hck by SH3 domain displacement

The protein Hck is a member of the Src family of non-receptor tyrosine kinases which is preferentially expressed in haematopoietic cells of the myeloid and B-lymphoid lineages. Src kinases are inhibited by tyrosine-phosphorylation at a carboxy-terminal site. The SH2 domains of these enzymes play an essential role in this regulation by binding to the tyrosine-phosphorylated tail. The crystal structure of the downregulated form of Hck has been determined and reveals that the SH2 domain regulates enzymatic activity indirectly; intramolecular interactions between the SH3 and catalytic domains appear to stabilize an inactive form of the kinase. Here we compare the roles of the SH2 and SH3 domains in modulating the activity of Hck in an investigation of the C-terminally phosphorylated form of the enzyme. We show that addition of the HIV-1 Nef protein, which is a high-affinity ligand for the Hck SH3 domain, to either the downregulated or activated form of Hck causes a large increase in Hck catalytic activity. The intact SH3-binding motif in Nef is crucial for Hck activation. Our results indicate that binding of the Hck SH3 domain by Nef causes a more marked activation of the enzyme than does binding of the SH2 domain, suggesting a new mechanism for regulation of the activity of tyrosine kinases.

Dominant negative inhibition by fragments of a monomeric enzyme

Dominant negative inhibition is most commonly seen when a mutant subunit of a multisubunit protein is coexpressed with the wild-type protein so that assembly of a functional oligomer is impaired. By analogy, it should be possible to interfere with the functional assembly of a monomeric enzyme by interfering with the folding pathway. Experiments in vitro by others suggested that fragments of a monomeric enzyme might be exploited for this purpose. We report here dominant negative inhibition of bacterial cell growth by expression of fragments of a tRNA synthetase. Inhibition is fragment-specific, as not all fragments cause inhibition. An inhibitory fragment characterized in more detail forms a specific complex with the intact enzyme in vivo, leading to enzyme inactivation. This fragment also associated stoichiometrically with the full-length enzyme in vitro after denaturation and refolding, and the resulting complex was catalytically inactive. Inhibition therefore appears to arise from an interruption in the folding pathway of the wild-type enzyme, thus suggesting a new strategy to design dominant negative inhibitors of monomeric enzymes.

Involvement of the alpha subunit of farnesyl-protein transferase in substrate recognition

Using photoaffinity labeling, we have identified a region in mammalian farnesyl-protein transferase (FPTase) involved in substrate recognition. The photolabel used (Compound 1) is a peptide containing the photoactive amino acid p-benzoylphenylalanine (Bpa). Upon exposure to UV light. Compound 1 inhibits FPTase activity in a time- and concentration-dependent manner. Photoinhibition of FPTase activity by Compound 1 is prevented by adding H-Ras to the reaction mixture, indicating that labeling is targeted to the enzyme active site. We used peptide mapping by HPLC, Edman sequencing, and matrix-assisted time-of-flight (MALDI-TOF) mass spectrometry to identify the site of interaction with radiolabeled Compound 1. These experiments indicate that a specific region of the alpha subunit of the enzyme, Asp110-Arg112, is involved in substrate binding and suggest that Glu111 is likely to be the residue covalently modified by the photoaffinity label. Sequence alignments between yeast and mammalian FPTases reveal that Glu111 is conserved. The implications of this finding are discussed in light of previous mutagenesis studies on FPTase.

Observer performance in the localization of tubes and catheters on digital chest images: the role of expertise and image enhancement

RATIONALE AND OBJECTIVES

To determine whether observer performance in the localization of tubes and catheters on computed radiography (CR) chest images can be improved by using an automatic image-processing algorithm.

METHODS

Comparisons were made of CR hard-copy, CR soft-copy, and CR enhanced soft-copy images obtained with an image-processing algorithm. The enhanced images used gray-level optimization and nonlinear unsharp masking to emphasize the edges of the devices. Chest radiologists (n = 4), general radiologists (n = 4), and interns (n = 6) read 45 images that contained endotracheal tubes, pulmonary artery catheters, and central venous catheters.

RESULTS

Chest radiologists had the smallest mean interobserver localization variability (4 mm), followed by general radiologists (6 mm) and interns (8 mm). Localization variability was greatest for hard-copy images and least for enhanced soft-copy images.

CONCLUSION

Use of an automatic imaging-processing algorithm reduced localization variability and enabled the medical interns to perform at approximately the same level as the chest radiologists.

Amino-terminal sequence determinants for substrate recognition by platelet-derived growth factor receptor tyrosine kinase

The specificity of protein kinases has been shown to be influenced by residues near the phosphoaccepting amino acid. To examine the determinants for platelet-derived growth factor receptor (PDGFR) tyrosine kinase specificity, a peptide library with three degenerate positions N-terminal to tyrosine was constructed. After reaction with PDGFR, the most abundant phosphopeptides were isolated by immunoaffinity chromatography on a column containing monoclonal anti-phosphotyrosine antibody. Further separation of bound phosphopeptides with reverse-phase HPLC led to the identification of three optimal substrates for PDGFR: Ala-Ala-Asn-Ile-Thr-Tyr-Ala-Ala-Arg-Arg-Gly, Ala-Ala-Asn-Arg-Thr-Tyr-Ala-Ala-Arg-Arg-Gly and Ala-Ala-Leu-Ile-Thr-Tyr-Ala-Ala-Arg-Arg-Gly, where underlined residues are in the degenerate positions of the peptide library. Kinetic analyses of the three individual peptides (synthesized separately) showed these peptides to be among the best reported substrates for PDGFR. Our results expand the range of amino acid residues that have been shown to serve as recognition elements for receptor tyrosine kinases.

Src homology domains of v-Src stabilize an active conformation of the tyrosine kinase catalytic domain

To examine the interactions between Src homology domains and the tyrosine kinase catalytic domain of v-Src, various combinations of domains have been expressed in bacteria as fusion proteins. Constructs containing the isolated catalytic domain, SH2 + catalytic domain, and SH3 + SH2 + catalytic domains were active in autophosphorylation assays. For the catalytic domain of v-Src, but not for v-Abl, addition of exogenous Src SH3-SH2 domains stimulated the autophosphorylation activity. In contrast to results for autophosphorylation, constructs containing Src homology domains were more active towards a synthetic peptide substrate than the isolated catalytic domain. The ability of the SH2 and SH3 domains of v-Src to stabilize an active enzyme conformation was also confirmed by refolding after denaturation in guanidinium hydrochloride. Collectively the data suggest that, in addition to their roles in intermolecular protein-protein interactions, the Src homology regions of v-Src exert a positive influence on tyrosine kinase function, potentially by maintaining an active conformation of the catalytic domain.

Determinants of substrate recognition in the protein-tyrosine phosphatase, PTP1

Photoaffinity labeling has been used to identify amino acids involved in recognition of protein substrates by the protein-tyrosine phosphatase PTP1. The photoactive amino acid p-benzoylphenylalanine (Bpa) was incorporated into a phosphotyrosine-containing peptide derived from epidermal growth factor autophosphorylation site Tyr992 (EGFR988 998). This peptide photoinactivated PTP1 in a time- and concentration-dependent manner. Three lines of evidence indicate that the interaction between PTP1 and the photoaffinity label was specific: 1) photoinactivation was inhibited in the presence of a non-Bpa-containing peptide from EGFR Tyr992 in molar excess. 2) The photoaffinity label-containing phosphopeptide was rapidly dephosphorylated by PTP1 with kinetic constants similar to those of the non-Bpa-containing peptide under identical conditions. 3) After complete photoinactivation, the level of incorporation of radioactive photoaffinity label into PTP1 was approximately 0.9 mol of label/mol of enzyme, consistent with a 1:1 stoichiometry of photolabeling. Radiolabeled peptide was used to identify sites of cross-linking to PTP1. Bpa peptide-PTP1 was digested with trypsin, and radioactive fragments were purified by high performance liquid chromatography (HPLC) and analyzed by Edman sequencing. In two parallel experiments which were analyzed using different HPLC columns, a site in the alpha2 region of PTP1, most likely Ile23, was labeled by the Tyr992-derived peptide. The results are discussed in light of the crystal structure of human PTP1B and suggest that an additional mode of substrate recognition must exist for PTP1 catalysis.

Pulmonary mucormycosis

Mucormycosis is an opportunistic, angioinvasive fungal infection characteristically affecting individuals with diabetes mellitus, chronic renal failure, and hematologic malignancies. In most cases it is a rapidly progressive infection with an 80% overall mortality. Radiographic manifestations are usually nonspecific focal consolidation or masses. The air crescent sign is a rare manifestation of angioinvasive fungi and indicates either aspergillosis or mucormycosis.

Aspergillosis: a disease with many faces

Aspergillus causes a variety of pulmonary diseases. For the most part, they can be divided into three groups: mycetoma, invasive aspergillosis, and allergic forms of aspergillosis. The mycetoma form of aspergillosis has no effective treatment other than surgery, which is reserved for the severely symptomatic patient, usually with massive hemoptysis. Invasive aspergillosis is a dangerous pulmonary infection seen in patients who are generally severely immunocompromised. It is treated with amphotericin B and success in treatment of this form of aspergillosis is limited. Two of the allergic forms of Aspergillus infection, allergic bronchopulmonary aspergillosis and bronchocentric granulomatosis, are treated with steroids. The third allergic type of reaction, hypersensitivity lung, is best treated by removal of the patient from exposure to the antigen. Although these are the characteristic forms of aspergillosis, there is occasional overlap of the different types of aspergillosis.

Substrate specificities of the insulin and insulin-like growth factor 1 receptor tyrosine kinase catalytic domains

To compare the substrate specificities of the insulin and insulin-like growth factor 1 (IGF-1) receptor tyrosine kinases, the catalytic domains of the enzymes have been expressed in Escherichia coli as fusion proteins. The purified proteins have kinase activity, demonstrating that the catalytic domain of IGF-1 receptor, like that of insulin receptor, is active independent of its ligand-binding and transmembrane domains. The specificities of the two enzymes for the divalent cations Mg2+ and Mn2+ are indistinguishable. A series of peptides has been prepared that reproduces the major phosphorylation sites of insulin receptor substrate-1, a common substrate for the two receptor tyrosine kinases in vivo. Insulin and IGF-1 receptors show distinct preferences for these peptides; whereas insulin receptor prefers peptides based on Tyr-987 or Tyr-727 of insulin receptor substrate-1, the IGF-1 receptor preferentially recognizes the Tyr-895 site. The latter site, when phosphorylated, is a binding site for the SH2 domain-containing adapter protein Grb2. The ability of the two receptor tyrosine kinases to be phosphorylated and activated by v-Src has also been examined. The catalytic activity of IGF-1 receptor is stimulated approximately 3.4-fold by treatment with purified v-Src, while insulin receptor shows very little effect of Src phosphorylation under these conditions. This observation is relevant to recent findings of IGF-1 receptor activation in Src-transformed cells, and may represent one method by which Src amplifies its mitogenic signal. Collectively the data suggest that the catalytic domains of the two receptor kinases possess inherently different substrate specificities and signaling potentials.

Precision substrate targeting of protein kinases v-Abl and c-Src

The active site substrate specificities of v-Abl and c-Src are compared and contrasted. Both enzymes catalyze the phosphorylation of a broad assortment of peptide-bound aliphatic and aromatic alcohols, such as achiral and simple straight chain residues. In addition, both protein kinases exhibit a "dual specificity" with respect to the ability to utilize D- and L-configurational isomers as substrates. However, c-Src and v-Abl are extremely inefficient as catalysts for certain structural arrangements, including secondary alcohols and primary alcohols containing large substituents in close proximity to the hydroxyl moiety. In addition to these similarities, these enzymes also display noteworthy differences in catalytic behavior. Whereas c-Src exhibits a modest preference for aromatic versus aliphatic alcohols, v-Abl does not. Most dramatic is the ability of c-Src to utilize short chain alcohols as substrates, an activity virtually absent from the catalytic repertoire of v-Abl. The implications of these observations are 2-fold. First, because both enzymes are able to accommodate a wide variety of structural variants within their respective active site regions, there exists a substantial degree of flexibility with respect to inhibitor design. Second, because these enzymes exhibit disparate active site specificities, it is possible that other tyrosine-specific protein kinases will display unique substrate specificities as well. Consequently, it may ultimately be possible to exploit these differences to generate inhibitors that precisely target specific protein kinases.