Evolution of incipient nephropathy in type 2 diabetes mellitus

BACKGROUND

We examined the course of glomerular injury in 12 Pima Indians with long-standing (>8 years) type 2 diabetes mellitus, normal serum creatinine, and microalbuminuria. They were compared with a group of 10 Pima Indians in Arizona with new-onset (<5 years) type 2 diabetes, normal renal function, and normoalbuminuria (<30 mg albumin/g creatinine on random urine specimens).

METHODS

A combination of physiological and morphological techniques was used to evaluate glomerular function and structure serially on two occasions separated by a 48-month interval. Clearances of iothalamate and p-aminohippuric acid were used to determine glomerular filtration rate (GFR) and renal plasma flow, respectively. Afferent oncotic pressure was determined by membrane osmometry. The single nephron ultrafiltration coefficient (Kf) was determined by morphometric analysis of glomeruli and mathematical modeling.

RESULTS

The urinary albumin-to-creatinine ratio (median + range) increased from 84 (28 to 415) to 260 (31 to 2232) mg/g between the two examinations (P = 0.01), and 6 of 12 patients advanced from incipient (ratio = 30 to 299 mg/g) to overt nephropathy (>/=300 mg/g). A 17% decline in GFR between the two examinations from 186 +/- 41 to 155 +/- 50 mL/min (mean +/- SD; P = 0.06) was accompanied by a 17% decline in renal plasma flow (P = 0.003) and a 6% increase in plasma oncotic pressure (P = 0.02). Computed glomerular hydraulic permeability was depressed by 13% below control values at both examinations, a result of a widened basement membrane and a reduction in frequency of epithelial filtration slits. The filtration surface area declined significantly, however, from 6.96 +/- 2.53 to 5.51 +/- 1.62 x 105 mm2 (P = 0.01), a change that was accompanied by a significant decline in the number of mesangial cells (P = 0.001), endothelial cells (P = 0.038), and podocytes (P = 0.0005). These changes lowered single nephron Kf by 20% from 16.5 +/- 6.0 to 13.2 +/- 3.6 nL/(minutes + mm Hg) between the two examinations (P = 0.02). Multiple linear regression analysis revealed that among the determinants of GFR, only the change in single nephron Kf was related to the corresponding change in GFR.

CONCLUSION

We conclude that a reduction in Kf is the major determinant of a decline in GFR from an elevated toward a normal range as nephropathy in type 2 diabetes advances from an incipient to an overt stage.

Detection and identification of labeled DNA by surface enhanced resonance Raman scattering

The detection of specific sequences of DNA bases in a single strand can be achieved by hybridization of a known sequence of synthetic DNA. Due to the low concentrations usually used, a fluorescent label is required to detect the probe. Surface enhanced resonance Raman scattering (SERRS) also has the required sensitivity and provides a specific set of signals that are more applicable to discrimination of a number of probes without separation. A reliable SERRS method is reported here using two probes specifically designed for SERRS. It was possible to detect a 2 x 10(-12)M solution of labeled DNA, which illustrated the sensitive nature of SERRS for DNA analysis.

The First Red Azo Lake Pigment whose Structure is Characterized by Single Crystal Diffraction

A model for red azo pigment Ca4B was characterized structurally using synchrotron radiation. This highly anisotropic ladder structure represents a new structural class in azo pigment chemistry. The picture shows that the calcium atoms coordinate in a complex manner to three azo ligands (one terdentate, one bidentate, and one monodentate) and two water molecules simultaneously.

Nitration of internal tyrosine of cytochrome c probed by resonance Raman scattering

Tyrosines can be selectively nitrated in a protein and the resultant chromophore can be used as an in situ probe of the tyrosine environment. Resonance Raman scattering could have specific advantages as a detection method because of the inherent selectivity of the technique and because shifts in the intensity and frequency of the nitro stretch can be detected and related to the form and environment of the nitrotyrosine. To evaluate this possibility the internal residue Tyr67 of cytochrome c was nitrated and resonance Raman scattering was recorded. With 413.1-nm excitation the resonance scattering from the heme protein dominates, but with 457.9-nm excitation intense bands due to nitrostretching vibrations are readily observed. The frequency of the internal Tyr67 indicates an aqueous environment that suggests that on nitration this residue becomes exposed on the protein surface or that water enters the active pocket. pH dependent measurements can be used to follow the protonation of the residue. A pK(a) of approximately 7 also indicates an aqueous environment. This initial study indicates that resonance Raman scattering does have unique advantages as an in situ probe of the local structure of nitrated tyrosine residues.

Is stenting following ureteroscopy for removal of distal ureteral calculi necessary?

PURPOSE

We determine the morbidity associated with no stent placement following uncomplicated ureteroscopy for removal of distal ureteral calculi.

MATERIALS AND METHODS

A total of 93 patients undergoing uncomplicated, complete removal of distal ureteral calculi were contacted 1 to 3 days and 7 to 10 days postoperatively to determine analgesic requirements and time of return to normal activity. Radiological followup consisted of an excretory urogram or renal ultrasound 8 weeks postoperatively.

RESULTS

Of 93 patients 40 (43%) had no discomfort postoperatively. Of the 53 patients who had discomfort 45 (85%) had mild discomfort only, controlled with oral analgesics. When discomfort occurred it resolved in 41 patients (77%) in 2 days or less. Of 12 patients who required intravenous narcotics postoperatively 5 required preoperative hospitalization for the narcotics and were still hospitalized at the time of stone removal. None of the 59 patients who had followup excretory urogram or renal ultrasound has had a newly identified ureteral stricture to date.

CONCLUSIONS

In the majority of patients undergoing uncomplicated ureteroscopy for removal of distal ureteral calculi postoperative discomfort is modest, lasts less than 2 days and is easily controlled with oral analgesics. Stricture formation has not been identified. We do not believe that routine placement of a ureteral stent following uncomplicated ureteroscopy for distal ureteral calculi is necessary.

Lightning injuries during snowy conditions

Skiers and other snow sports enthusiasts can become lightning casualties. Two such accidents are reported, one being fatal. There are fewer warning signals of impending lightning strikes in winter-like conditions. However, outdoor activists should be aware of at least two suspicious clues: the appearance of convective clouds, and the presence of graupel (snow pellets) during precipitation.

Evidence for carbimazole as an antioxidant?

There is evidence in the literature to support the view that antioxidants are involved in the pathogenesis of Graves disease and that antioxidants may act as free radical scavengers. This study has compared the effects of a 12 month course of conventional Carbimazole therapy on peripheral blood antioxidant levels with those of a 12 month course of a higher dose treatment regime. Fifty seven patients were enrolled into the study. Those in Group 1 (n = 23) received a 12 month course of 60 mg/day Carbimazole. Those in Group 2 (n = 34) received 45 mg/day for the first month, 30 mg/day for the second and 20 mg/day for the remaining 10 months of treatment. T3 was added in both groups after 2-4 months to maintain patients euthyroid. Baseline samples were also obtained from 30 control subjects. Blood samples were taken for the measurement of plasma thiol (PSH), lysate thiol (LSH), superoxide dismutase (SOD) and caeruloplasmin (CP) and for routine thyroid function tests (TT4, TT3 and TSH). In untreated Graves' patients, serum levels of PSH and SOD were reduced and levels of LSH increased compared to controls. Following 2 months high dose Carbimazole therapy there was a significant increase in PSH levels and a significant reduction in CP levels compared to presentation levels. In the more conventional dose Group 2 patients PSH levels also rose significantly during the first 2 months of treatment. Levels for both groups were still significantly lower than the control group. After 12 months high dose Carbimazole therapy PSH levels had decreased so that they no longer differed from untreated levels. LSH and SOD levels still remained abnormal. CP levels continued to fall. Similar findings were obtained in those patients receiving the more conventional course of treatment. At no point was their any significant difference in antioxidant levels between the two treatment groups. The abnormal levels of antioxidants in the serum of untreated Graves' patients confirm their involvement in the pathogenesis of Graves' disease. Carbimazole therapy appeared to have only short term effects on the peripheral blood levels of the antioxidants measured. Carbimazole appeared to act only on the extra cellular markers of antioxidant activity (PSH, CP) although the disease itself had marked intracellular effects (LSH, SOD). These findings suggest that Carbimazole does not act as a free radical scavenger.

Fatty acid-induced alteration of the porphyrin macrocycle of cytochrome P450 BM3

Surface-enhanced resonance Raman scattering (SERRS) of substrate-free and substrate-bound forms of the P450 domain of cytochrome P450 BM3 are reported and assigned. Substrate-free P450 yields mixed spin heme species in which the pentacoordinate high-spin arrangement is dominant. The addition of laurate or palmitate leads to an increase in high spin content and to an allosteric activation of heme mode v29, which is sensitive to peripheral heme/protein interactions. Differences between laurate and palmitate binding are observed in the relative intensities of a number of bands and the splitting of the heme vinyl modes. Laurate binding to P450 results in different protein environments being experienced by each vinyl mode, whereas palmitate binding produces a smaller difference. The results demonstrate the ability of SERRS to probe substrate/prosthetic group interactions within an active site, at low protein concentrations.

Erythrocyte glutathione balance and membrane stability during preeclampsia

This study aimed to determine whether oxidative damage to the erythrocyte occurs in preeclampsia, and relates to disease severity. The oxidative status of intact erythrocytes from preeclamptic patients and normal pregnant women was determined using spin echo 1H-NMR, which measures both the concentration and redox state of intracellular glutathione. Previous studies of preeclampsia have only measured total glutathione levels. Membrane fragility was determined from the degree of lysis caused by incubation in hypotonic saline. Erythrocytes from moderate-severe preeclamptic patients underwent more lysis than erythrocytes from control pregnant women (p < .05) or mild preeclamptic patients. It is suggested that increased lysis results from oxidative damage to the erythrocyte membrane, causing a decrease in membrane fluidity and reducing its ability to withstand osmotic changes. Intracellular glutathione was more oxidized in erythrocytes from pregnant women compared to nonpregnant controls (p < .05), and there was a less significant trend toward more oxidized glutathione with increasing severity of preeclampsia. The moderate-severe group showed a clear division in glutathione redox status: some patients had very oxidized glutathione while others had a normal redox balance. This novel finding suggests that some patients may be unusually susceptible to erythrocyte glutathione oxidation, possibly leading to general cellular damage, in particular HELLP Syndrome.

Oxidation of erythrocyte glutathione by monocytes stimulated with interleukin-6. Analysis by 1H spin echo NMR

1H spin echo NMR was used to follow the release of reactive oxygen species (ROS) from human monocytes by monitoring erythrocyte glutathione status, which is sensitive to applied oxidative stress. This allowed the ability of the cytokine interleukin-6 (IL-6) to stimulate release of ROS from monocytes to be assessed in terms of oxidative damage to other cells, providing an estimation of its importance in vivo. It was found that incubation of monocytes with erythrocytes in the presence of IL-6 resulted in oxidation of the erythrocyte glutathione pool, indicating that oxidants are released in sufficient amounts to cause oxidative stress. High levels of IL-6 occurring in plasma of women with severe pre-eclampsia could therefore be responsible for depleted plasma antioxidants and haemolysis. The oxidation of erythrocyte glutathione was inhibited by the presence of the cyclooxygenase inhibitor indomethacin, suggesting that this may be of value in the treatment of oxidative pathologies.

Aging is associated with a decrease in synaptosomal glutamate uptake and an increase in the susceptibility of synaptosomal vitamin E to oxidative stress

We examined the influence of aging upon the uptake of glutamate by synaptosomes, and the oxidation of synaptosomal vitamin E. Synaptosomes isolated from the cerebral hemispheres of Fischer 344 rats, 4 and 24 months old, were suspended at 37 degrees C in buffer (pH 7.4) simulating extracellular fluid containing 10 mM glucose. The Km for the high affinity uptake of tritium labeled glutamate was approximately 10 microM. The uptake of glutamate was lower in synaptosomes from older animals than those from younger animals for periods of up to 20 minutes. Upon incubation with a mixture of ferrous iron and ascorbate, more of the alpha tocopherol in synaptosomes derived from older rats was oxidized than in those derived from younger ones. Older animals may be more susceptible to excitotoxicity because: a) synaptosomal reuptake of glutamate is less efficient and b) oxidative stress induced by various agents including glutamate may be higher in synaptosomes from the older animal.

Alpha-tocopherol in rat brain subcellular fractions is oxidized rapidly during incubations with low concentrations of peroxynitrite

The reaction of superoxide (a reactive oxygen species) and nitric oxide (one of the nitrogen oxides with numerous biological functions) results in the production of peroxynitrite. The characteristics of oxidation of alpha-tocopherol (vitamin E) in synaptosomes (nerve ending particles) and mitochondria by peroxynitrite were studied. The subcellular fractions were isolated from brain hemispheres of 4-month-old male Fischer 344 rats by standard centrifugation procedures involving Ficoll gradients. Peroxynitrite treatment oxidized alpha-tocopherol in <5 s. This reaction was selective because another membrane component, cholesterol, was not oxidized at the same time, as observed in our previous studies. Mitochondrial alpha-tocopherol was more susceptible to peroxynitrite-induced oxidation than synaptosomal tocopherol. Measurable and significant (P < 0.05) oxidation of tocopherol occurred when mitochondria or synaptosomes were incubated with peroxynitrite in concentrations as low as 5 or 10 micromol/L, respectively. The oxidation could be readily monitored by estimating the production of tocopherolquinone. Oxidation of tocopherol induced by ferrous iron and ascorbate was much slower and the yield of tocopherolquinone lower than by peroxynitrite. The fast and selective oxidation of alpha-tocopherol by peroxynitrite suggests that vitamin E may play an important role in preventing membrane oxidation induced by peroxynitrite. Literature reports indicate the existence of threshold concentrations of tocopherol below which functional alterations occur. Tocopherol oxidation by peroxynitrite could reduce tocopherol concentrations in tissues and subcellular structures to these threshold levels by different concentrations of peroxynitrite. Hence the sensitivity of tissues to peroxynitrite could vary over a wide range.

Myocrisin-mediated oxidative stress

This study reports on the ability of myocrisin to mediate in the production and detoxification of oxidants (principally hydrogen peroxide) in the monocyte in-vivo and in-vitro. The hydrogen peroxide produced by the monocyte derived from rheumatoid arthritis patients being treated with myocrisin was found to be 14.9 +/- 1.6 nmoles/10(6) cells and is elevated above levels found in monocytes obtained from patients either being treated with non-steroidal anti-inflammatory drugs (NSAIDs) (11.3 +/- 0.4 nmoles/10(6) cells; P < 0.01) or normal healthy volunteers (11.2 +/- 1.2 nmoles/10(6) cells; P < 0.01). A comparative study on glutathione (GSH) oxidation indicated that levels of monocyte GSH were elevated in myocrisin-treated patients (2.4 +/- 0.49 mmol/l) over normal healthy volunteers (0.83 +/- 0.18 mM; P < 0.01) and that levels of monocyte diglutathione (GSSG) were depressed (myocrisin, 0.97 +/- 0.41 micromol/l; normal, 5.71 +/- 0.73 micromol/l; P < 0.01). The non-inhibition of glutathione reductase and the inhibition of glutathione peroxidase by gold provides the link between these two observations. Thus, gold therapy would seem to elevate monocyte hydrogen peroxide, increase monocyte reduced glutathione and decrease plasma glutathione peroxidase activity. Subsequently, the data from this small group of patients (n = 10) provides an indication that, in-vivo, myocrisin contributes to an increase in oxidative stress.

Oxidation of cholesterol in synaptosomes and mitochondria isolated from rat brains

Cholesterol and alpha-tocopherol oxidations were studied in brain subcellular fractions isolated from cerebral hemispheres of 4-month-old, male Fischer 344 rats. The fractions were suspended in buffered media (pH 7.4, 37 degrees C0 and oxidized by adding (i) ferrous iron (Fe2+) with or without ascorbate or (ii) peroxynitrite (an endogenous oxidant produced by the reaction of superoxide and nitric oxide). Treatment of subcellular fractions with Fe2+ in the presence or absence of ascorbate produced primarily 7-keto- and 7-hydroxy-cholesterols and small amounts of 5 alpha, 6 alpha-epoxycholesterol. Since brain contains high levels of ascorbate, and release of iron could result in oxysterol formation. Peroxynitrite oxidized alpha-tocopherol but not cholesterol. Hence, the toxicity of peroxynitrite or nitric oxide could not be due to cytotoxic oxysterols. When synaptosomes were incubated for 5 min in the presence of 0.5 to 2 microM Fe2+ and ascorbate, alpha-tocopherol was oxidized while cholesterol remained unchanged. Thus, alpha-tocopherol is functioning as an antioxidant, protecting cholesterol. Diethylenetriaminepentaacetic acid blocked production of oxysterols, whereas citrate, ADP and EDTA did not. A significant percentage of mitochondrial cholesterol was oxidized by treatment with Fe2+ and ascorbate. Hence, mitochondrial membrane properties dependent on cholesterol could be particularly susceptible to oxidation. The oxysterols formed were retained within the membranes of synaptosomes and mitochondria. The 7-oxysterols produced are known to be inhibitors of membrane enzymes and also can modify membrane permeability. Hence, oxysterols may plan an important role in brain tissue damage during oxidative stress.

HPLC determination of biologically active thiols using pre-column derivatisation with 5,5'-dithio-(bis-2-nitrobenzoic acid)

5,5'-Dithio-(bis-2-nitrobenzoic acid), Ellmans reagent (ESSE), is used as a pre-column derivatisation reagent for the determination of biologically active thiols by HPLC. D-penicillamine, N-acetyl-d-penicillamine, N-acetylcysteine, cysteine, captopril and thiomalic acid all give well resolved derivatives. The calibration graph and reproducibility (%R.S.D. +/- 1.3%) for the analysis of glutathione indicates that the method could be used for quantitative analysis. ESSE is widely used as a reagent in thiol determinations by electronic spectroscopy via the detection of the Ellmans anion (ES-) generated without any prior separation procedures. However, there are considerable reservations over its use for the spectrophotometric determination of thiols because of the possibility of side reactions which generate another Ellmans based species (ESO2-). The assay described determines the thiol as a derivatised mixed disulphide (ESSR) and since speciation between the anion ES- and the oxidation product ESO2- occurs it enables the process of oxidation to be monitored simultaneously.

Oxygen costs using a reciprocating gait orthosis in a paraplegic (T9) patient with a bilateral below-knee amputation: case report

The Reciprocating Gait Orthosis (RGO) is a useful aid to ambulation for patients with paraplegia. Its use has been described previously though not in conjunction with limb prostheses. We report here the energy costs of ambulation of a patient, disabled by paraplegia at T9 and bilateral below-knee amputations, walking at her preferred rate using an RGO while gas exchange was measured by the Douglas bag method. Oxygen uptake (VO2) rose from 0.198 1 min-1 at rest to 0.582 1 min-1 in the last minute of exercise, representing a VO2 of 14.3 ml kg-1 min-1. During the fourth minute of ambulation, energy consumption was 30.44 J kg-1 s-1 with an energy cost of 4.17 J kg-1 m-1 at a velocity of 0.13 m s-1, Ambulation with this combination of disability is possible with the aid of limb prostheses and an RGO though it is slow and the energy expenditure as consumption per second and cost per metre are high.

Analysis of hydroxy and keto cholesterols in oxidized brain synaptosomes

A rapid method for the simultaneous determination of cholesterol and its oxidation products as well as alpha-to-copherol and tocopherolquinone in brain subcellular fractions is described. The samples are saponified and extracted with hexane. It is not necessary to remove cholesterol in the sample before analyzing for oxysterols. The hexane extract can be used for the assay of cholesterol compounds by capillary gas chromatography and tocopherol compounds by liquid chromatography using a procedure reported previously. Oxidation of synaptosomes by a mixture of Fe2+ plus ascorbate resulted in the production of 7-keto-, 7 alpha-hydroxy-, 7 beta-hydroxy-, and 5 alpha, 6 alpha-epoxycholesterols. The identities of these products were confirmed with gas chromatography/mass spectrometry. Cholesterol oxidase treatment did not result in the formation of any of the above compounds. Thus the types and amounts of the products of oxidation of cholesterol were dependent upon the oxidizing agent. Extraction of the oxysterols under milder conditions without saponification using sodium dodecyl sulfate cannot be used since such treatment results in low recovery of oxysterols. Oxidation of synaptosomes by low concentrations of ferrous iron and ascorbate resulted in (i) low levels of oxidation of cholesterol which could be followed by estimating the production of oxysterols and (ii) oxidation of a substantial percentage of alpha-tocopherol. The proposed procedure will be useful in monitoring the oxidation of small quantities of membrane cholesterol in vitro.

Inhibitor/fatty acid interactions with cytochrome P-450 BM3

The interaction of fatty acid substrate (palmitate) and inhibitor (metyrapone: 2-methyl-1,2-di-3-pyridyl-1-propanone) with cytochrome P-450 BM3 was analysed by UV-visible and circular dichroism spectroscopy, and by surface-enhanced resonance Raman scattering (SERRS). While visible spectroscopy provides information on the relative affinities of these compounds, SERRS provides additional novel data indicating palmitate-induced structural changes in the haem environment. SERRS also demonstrates that binding of both palmitate and the large nitrogenous ligand metyrapone occurs simultaneously to P-450 BM3 -- highlighting the usefulness of this technique in probing haemoprotein active sites.

Observation of structural variation and spin state conversion of cytochrome P450 CYP2B4 on binding of sterically different substrates

Addition of sterically different substrates to CYP2B4 suggests perturbation of the environment of the haem ring and differing degrees of 6cls-5chs conversion. Strain on the ring, by implication induced by changes in the surrounding protein environment, is demonstrated by the emergence of the v29 band upon laurate binding. Furthermore, intensity differences and frequency shifts for non-Raman active (Eu) modes appear to be substrate dependent and are sensitive to haem/substrate interactions. The likelihood is that substrate induced distortion of the haem will have an effect on catalytic activities and attention needs to be directed towards substrate pocket interactions. SERRS (Surface enhanced resonance Raman scattering) provides a unique and sensitive spectroscopic probe of these interactions.

Interaction of nitrogen monoxide with cytochrome P-450 monitored by surface-enhanced resonance Raman scattering

The reaction of mammalian cytochrome P-450 2B4 with nitrogen monoxide and oxygen has been studied by surface-enhanced resonance Raman scattering (SERRS) to obtain sharp and definitive information in situ on the nature of the changes in the active site pocket. The initial reaction produces a six co-ordinate low spin haem-nitrogen monoxide adduct. A slower reaction leads to the irreversible formation of a five co-ordinate high-spin iron (III) haem with no nitrogen monoxide bound to it and to the nitration of an aromatic side chain, probably a tyrosine, in the proximity of the active site. In the presence of excess nitrogen monoxide, the second reaction is controlled by oxygen concentration. The sequence of events corresponds to the biphasic inhibition induced by NO in other cytochromes P-450 and peroxidases and is postulated to occur by the formation of a nitrating agent at the haem followed by diffusion to the tyrosine. The nitrated amino acid and the oxidation and spin state of the haem are observed easily by SERRS with low concentrations of protein making it a particularly suitable method for the investigation of reactions of NO in complex biological matrices.

In situ surface enhanced resonance Raman scattering analysis of a reactive dye covalently bound to cotton

An in situ surface enhanced resonance Raman scattering (SERRS) procedure is described for the analysis of a reactive dye covalently bound to a single strand of a cotton fibre. This procedure can be completed in 5 h, whereas an alternative enzyme digestion method takes approximately 21 h. These two fibre preparation methods give similar spectra from picogram quantities of dye present on a 2-5 mm length of fibre. The in situ nature of the analysis and the small sample size make this method particularly suitable for forensic applications.