Thromboembolic and other events following valve replacement in a pediatric population treated with antiplatelet agents

To determine if anticoagulation therapy is necessary after valve replacement with the St. Jude Medical prosthesis in young subjects, 30 consecutive patients were studied. They ranged in age from 4 to 20 years, and each had undergone valve replacement some time between February, 1982, and June, 1984. There was 1 hospital death (3.3%; 70% confidence limits [CL] = 0.4% to 10.9%). The 29 hospital survivors were treated with aspirin and dipyridamole. All patients were followed up. There were 5 late deaths (17.2%; 70% CL = 9% to 27%), at a mean of 8 months postoperatively. Follow-up revealed that 7 thromboembolic events occurred in 7 of the hospital survivors (24.1%; 70% CL = 15% to 35%). Hemiparesis occurred in 1 patient, and documented valve thrombosis and death occurred in another. Transient sensorimotor deficits were found in the 5 other patients. Prosthetic valve endocarditis developed in 1 hospital survivor (3.5%; 70% CL = 0.4% to 11%) and resulted in late death. There were no reoperations in the hospital survivors. We conclude that the St. Jude Medical prosthesis is useful for valve replacement in the young because of its low profile, durability, and hemodynamic characteristics. However, we recommend that these patients receive full anticoagulation therapy.

Phlorizin binding to isolated enterocytes: membrane potential and sodium dependence

Phlorizin binding is studied in isolated intestinal epithelial cells of the chick. Cells are ATP depleted to allow extensive manipulation of ionic gradients and membrane potential (delta psi). Phlorizin binding is assayed at steady state. Carrier specific phlorizin binding is defined as D-glucose (90 mM) inhibitable binding. Specific binding displays simple Michaelian kinetics as a function of phlorizin, indicating the presence of a single homogeneous binding site. Sodium concentrations and delta psi modify the apparent binding affinity but not the maximum number of binding sites. In contrast, the activation curve as a function of sodium concentrations is sigmoid and the apparent maximum number of binding sites at saturating sodium is phlorizin dependent. The rate of phlorizin association is both delta psi and sodium-concentration dependent. Dissociation is sodium-concentration dependent but not delta psi dependent. Theoretical analysis indicates binding order of substrates is random. In addition, data suggests that the phlorizin/sodium stoichiometry is 2:1. The delta psi dependence can be explained by two models: either translocation is the delta psi-dependent step and the free carrier is anionic, or sodium binding is the delta psi-dependent step.

The potential dependence of the intestinal Na+-dependent sugar transporter

The unidirectional influx of the lipophilic cation tetraphenylphosphonium (TPP+) into isolated intestinal epithelial cells exhibits a marked dependence on the membrane potential (delta psi) maintained by or experimentally imposed on these cells. By taking advantage of this fact, we have described a "crossover" procedure that allows the relative permeability of a cation and anion pair to be determined. Measurements of such relative permeabilities permits diffusion potentials of defined magnitude to be imposed across the plasma membrane of ATP-depleted cells. This in turn allows description of the relationship between [14C]TPP+ influx and delta psi. We have determined that the flux-potential relationship is that predicted by the Goldman flux equation. Using this relationship as a calibration tool for delta psi, we then determined the quantitative relationship between membrane potential and the Na+-dependent influx of an actively transported sugar, alpha-methylglucoside (alpha-MG). The influx of [14C]alpha-MG also shows an exponential dependence on delta psi although it is more sharply potential dependent than that shown by TPP+. The specific relationship is consistent with that expected for a system with 2:1 Na+ stoichiometry which obeys the potential dependence predicted by Eyring rate theory with a single energy barrier occurring near the midpoint of the membrane. Over the range of potentials from +33 to -61 mV, we find no evidence for a minimum or threshold potential necessary to support transport and no evidence for an optimal potential that can maximize sugar transport. The data raise the possibility for using either [14C]TPP+ or [14C]alpha-MG influx as the basis for a new noninvasive procedure for measurement of delta psi.

The mechanistic nature of the membrane potential dependence of sodium-sugar cotransport in small intestine

Methods are described which demonstrate the use of unidirectional influx of 14C-tetraphenylphosphonium (14C-TPP+) into isolated intestinal epithelial cells as a quantitative sensor of the magnitude of membrane potentials created by experimentally imposed ion gradients. Using this technique the quantitative relationship between membrane potential (delta psi) and Na+-dependent sugar influx was determined for these cells at various Na+ and alpha-methylglucoside (alpha-MG) concentrations. The results show a high degree of delta psi dependence for the transport Michaelis constant but a maximum velocity for transport which is independent of delta psi. No transinhibition by intracellular sugar (40 mM) can be detected. Sugar influx in the absence of Na+ is insensitive to 1.3 mM phlorizin and independent of delta psi. The mechanistic implications of these results were evaluated using the quality of fit between calculated and experimentally observed kinetic constants for rate equations derived from several transport models. The analysis shows that for models in which translocation is the potential-dependent step the free carrier cannot be neutral. If it is anionic, the transporter must be functionally asymmetric. A model in which Na+ binding is the potential-dependent step (Na+ well concept) also provides an appropriate kinetic fit to the experimental data, and must be considered as a possible mechanistic basis for function of the system.

Kinetic analysis of mechanism of intestinal Na+-dependent sugar transport

Zero-trans kinetics of Na+-sugar cotransport were investigated. Sugar influx was measured at various sodium and sugar concentrations in K+-loaded cells treated with rotenone and valinomycin. Sugar influx follows Michaelis-Menten kinetics as a function of sugar concentration but not as a function of Na+ concentration. Nine models with 1:1 or 2:1 sodium:sugar stoichiometry were considered. The flux equations for these models were solved assuming steady-state distribution of carrier forms and that translocation across the membrane is rate limiting. Classical enzyme kinetic methods and a least-squares fit of flux equations to the experimental data were used to assess the fit of the different models. Four models can be discarded on this basis. Of the remaining models, we discard two on the basis of the trans sodium dependence and the coupling stoichiometry [G. A. Kimmich and J. Randles, Am. J. Physiol. 247 (Cell Physiol. 16): C74-C82, 1984]. The remaining models are terter ordered mechanisms with sodium debinding first at the trans side. If transfer across the membrane is rate limiting, the binding order can be determined to be sodium:sugar:sodium.

A new method for determination of relative ion permeabilities in isolated cells

The unidirectional influx of the lipophilic cation tetraphenylphosphonium (TPP+) into isolated epithelial cells is a function of the membrane potential that exists across the cellular plasma membrane. Because of the potential dependence, [14C]TPP+ influx can be used as a qualitative sensor of changes in the membrane potential induced by diffusion of ions after the experimental imposition of transmembrane ion gradients. This report describes a "crossover" procedure in which the influx of [14C]TPP+ during systematic changes in the ionic composition of incubation media is used to identify conditions in which no change in membrane potential occurs. The ion ratio at the crossover provides a measure of the relative permeabilities of the two test ions being compared. By using this approach, the ion permeabilities for intestinal epithelial cells prepared from White Rock chickens can be ranked relative to the permeability of Na+ (PNa), i.e., when PNa is equal to 1.0. The permeability sequence and relative values for ion permeability in this system are tris(hydroxymethyl)aminomethane-gluconate (less than 0.1) less than Li+ (0.3) less than Na+ (1.0) less than Cl- (2.0) less than K+ (6.0) = NO3- (6.0) less than SCN- (18) less than K+ + valinomycin (40). The procedure is general enough in principle to be of broad application to a wide variety of cell or membrane vesicle preparations.