Titin: major myofibrillar components of striated muscle

Electrophoretic analyses of protein components of striated muscle myofibril purified from various vertebrate and invertebrate species revealed that proteins much larger than myosin heavy chain are present in significant amounts. To define possible roles of these heretofore unidentified proteins, we purified a combination of two uncommonly large proteins, designated as titin, from chicken breast myofibrils. Chemical and immunological studies indicated that titin is distinct from myosin, actin, and filamin. Specific titin anti body crossreacts with similar protein in both skeletal and cardiac myofibrils of many vertebrate and invertebrate species. Immunofluorescent staining of glycerinated chicken breast myofibrils indicated that titin is present in M lines, Z lines, the junctions of A and I bands, and perhaps throughout the entire A bands. Similar staining studies of myofibrils from other species suggest that titinlike proteins may be organized in all myofibrils according to a common architectural plan. We conclude that titin is a structurally conserved myofibrillar component of vertebrate and invertebrate striated muscles.

Intracellular distributions of mechanochemical proteins in cultured fibroblasts

We have used methods that have allowed simultaneous fluorescent staining of intracellular actin together with either myosin, filamin, or tubulin in normal rat kidney fibroblasts in monolayer culture. In the main portions of the cell body, the actin, myosin, and filamin are all present in two structures: in one, the three proteins are present in the same fiber bundles (stress fibers); in the other, there is a diffuse distribution of the three proteins. On portions of the cell periphery however-in the basal regions of microspikes, in ruffles, and in regions of cell-cell contact-actin and filamin are present, but myosin is severely depleted or absent. Microtubules are present in the cell body in a distribution independent of the stress fibers and are mostly absent from the cell periphery. Microspikes and ruffles are highly dynamic structures on the cell surface, and regions of cell-cell contact generally result from the association of ruffles on the two contacting cells. Therefore, the presence of filamin and actin but not myosin in these specialized regions on the cell surface, together with the recent demonstration [Wang, K. & Singer, S. J. (1977) Proc. Natl. Acad. Sci. USA 74, 2021-2025)] that pure filamin interacts with individual F-actin filaments in solution to form fiber bundles and sheet-like structures, suggest that in vivo filamin-actin interactions play an important role in the control of actin filament structure, in cell motility, and in the stabilization of cell-cell contacts.

Filamin, a new high-molecular-weight protein found in smooth muscle and nonmuscle cells. Purification and properties of chicken gizzard filamin

Filamin, a major high-molecular-weight protein of chicken gizzard smooth muscle, was purified to homogeneity by salt extraction, ammonium sulfate precipitation, agarose gel filtration, and diethylaminoethylcellulose ion-exchange chromatography. Purified filamin is an asymmetric oligomer consisting of two large subunits of identical size (2 X 250 000 daltons) as indicated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, chemical cross-linking, sedimentation analysis (s10, wo = 10S) and Stokes'radius estimation (a = 120 A), It has no intersubunit disulfide but appears from oxidation studies to have adjacent thiols near the subunit interface. Filamin contains no amino sugars, methylated lysine, methylated histidine, or hydroxyproline, nor does it exhibit myosin-like ATPase activities. Its amino acid composition and physical properties differ from those of gizzard myosin, for which a pruification procedure is described. Filamin and the protein spectrin of erythrocyte membranes have strikingly similar physical properties, but they are chemically distinct.

Interaction of filamin with f-actin in solution

Filamin is a major high-molecular-weight protein in smooth muscle which was recently identified and isolated [Wang, K., Ash, J. F. & Singer, S. J. (1975) Proc. Natl. Acad. Sci. U.S.A. 72, 4483-4486]. In the present studies, we shown that highly purified chicken gizzard filamin and muscle F-actin react in solution to form aggregates containing both proteins. Occasionally, these aggregates coagulate and contract into a dense gel in the absence of MgATP or CaATP. Immunofluorescence and electron microscopic studies suggest that the F-actin filaments are collected into fiber bundles and a crosslinked fiber meshwork by the binding of filamin molecules. These studies suggest that the function of filamin intact cells may be to regulate the ultrastructural state of F-actin filaments in a variety of dynamic cellular processes.

Multifocal atrial tachycardia

Multifocal atrial tachycardia (MAT) was observed in 41 patients, 35 of whom were in acute respiratory distress. A hospital mortality of 37% reflected the seriousness of their underlying conditions. In no patient was the arrhythmia the primary cause of death. The MAT preceded and/or followed atrial fibrillation (AF) or atrial flutter (Af) in 19 patients (46%). The MAT simulated AF in several cases in which P-waves were inconspicuous. Our cases suggest that MAT is not a manifestation of digitalis intoxication. Quinidine sulfate, procainamide hydrochloride, lidocaine, and phenytoin (diphenythydantoin) did not affect the rhythm. Digitalis was usually not effective in slowing the ventricular response in patients with MAT. Propranolol hydrochloride was given to seven patients and was effective in slowing the atrial rate in all cases. An attempt at electrocardioversion was unsuccessful in one patient.

Sudden disappearance of electrocardiographic pattern of anteroseptal myocardial infarction. Result of superimposed acute posterior myocardial infarction

In a 76-year-old man an electrocardiographic pattern of acute anteroseptal myocardial infarction disappeared suudenly. At necropsy, a more recent posterior myocardial infarct was found, in addition to an acute anteroseptal infarct. "Normalization" of the electrocardiogram from the pattern of anteroseptal myocardial infarction in this case resulted from the loss of opposing electromotive forces in the posterior wall because of posterior infarction.

Filamin, a new high-molecular-weight protein found in smooth muscle and non-muscle cells

A new high-molecular-weight protein, named filamin, was isolated from chicken gizzard. In chicken gizzard, filamin is present in an amount approximately 30-40% of that of myosin. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of highly purified filamin revealed a single polypeptide of about 250,000 daltons. Rabbit antibody directed against purified chicken gizzard filamin did not crossreact with myosin purified from the same source. By the use of microcomplement fixation and indirect immunofluorescent staining with antibodies to chicken gizzard filamin, an antigenically similar or identical protein was found to be widely distributed both in other organs of the chicken and in cultured cells of other species, but not in chicken skeletal muscle. In cultured cells, filamin was found largely to be arranged as a filamentous array very similar to that found for myosin. These data imply that filamin is a widely occurring and chemically conserved component of filaments is smooth muscle and non-muscle cells.

Reaction of dimethyl-3,3'-dithiobispropionimidate with intact human erythrocytes. Cross-linking of membrane proteins and hemoglobin

Dimethyl-3,3'-dithiobispropionimidate penetrates intact human erythrocytes and cross-links many of the membrane proteins to hemoglobin as well as to each other. The cross-linked complexes so produced have been analyzed by both one- and two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis, making use of the easy cleavability of the disulfide-containing reagent. The basic pattern of cross-linked complexes appears identical with that seen with unsealed ghosts. Although subtle relative motions cannot be ruled out, no rearrangement of nearest neighbor peptide chains, on a scale that would alter the cross-linking pattern, occurs during osmotic lysis of erythrocytes. Superimposed on the basic pattern was a series of complexes involving globin chains. Bands 1, 2, 2.2, 2.4, 3, 4.1, 4.2, 6, and 7 (nomenclature of Steck, T.L. (1972) J. Mol. Biol. 66, 295-305) are all cross-linked to hemoglobin. Bands 2.2 and 2.4, recently shown to be accessible to the external surface of the membrane (Staros, J. V., and Richards, F. M. (1974) Biochemistry 13, 2720-2726), may be transmembrane proteins on the basis of the present findings. Band 5 is the only major band to show no detectable complexes with hemoglobin; oligomers of Band 5 itself, however, are seen. The absence of hemoglobin/Band 5 cross-linking in this case could reflect a special, as yet unexplained, environment for the Band 5 peptide. The amount of Band 6 in isolated membranes diminishes with increasing reagent concentration.

Prosthetic aortic valvular endocarditis

Infective endocarditis (IE) continues to be one of the most serious complications following cardiovascular surgery, particularly that for replacement of valves. In order to define more clearly the clinical course and the role of surgical therapy, clinical and necropsy data were reviewed in 16 adult patients with prosthetic aortic valvular endocarditis (PAVE) and compared with the experience cited in the literature. Positive blood cultures were obtained in each of the patients with bacterial endocarditis. Gram positive bacteria predominate and the onset of infection is usually later than 25 days postoperatively. In 11 of 16 patients, aortic insufficiency was recognized. Autopsy material demonstrated large perivalvular abscesses which loosened the attachment of the prosthetic valve in each case and which made successful operation unlikely. Aortic insufficiency appears to be of prognostic importance, since patients who developed aortic insufficiency early in the course of PAVE died. Survivors included patients who made an excellent response to medical therapy and who either did not develop aortic insufficiency or developed aortic insufficiency either late in the course or even after cure of PAVE, Poor response to medical therapy and progressive aortic insufficiency even in the absence of left ventricular failure appear to be indications for prompt surgical replacement of the prosthetic aortic valve.

Bacterial endocarditis in idiopathic hypertrophic subaortic stenosis

Bacterial endocarditis complicating idiopathic hypertrophic subaortic stenosis (IHSS) is uncommon but endocarditis may be the first clinical manifestation of IHSS. In this report of such a case, the aortic and the mitral valves were the sites of the bacterial infection. Many chordae tendineae to the mitral valve were ruptured from the extension of the infectious process. The endothelial lesions, which served as the seat for the bacterial infection on the anterior mitral leaflet, likely resulted from its abutting action against the septal prominence. Damage to the aortic valve leaflet may have resulted from abnormal valve motion caused by IHSS and created an environment conducive to endocarditis. This patient developed aortic insufficiency during the course of bacterial endocarditis, suggesting that the occasional association of aortic insufficiency in patients with IHSS may be secondary to healed endocarditis of the aortic valve.

Hemodynamic predictors of myocardial oxygen consumption during static and dynamic exercise

Hemodynamic predictors of myocardial oxygen consumption (MVO 2 ) during static and dynamic exercise were examined in ten normal subjects. Studies were done under the following circumstances: 1) during upright bicycle exercise at an average heart rate of 147 beats/min, 2) during static exercise with an isometric load in the left hand equal to 17% of the maximal voluntary contraction (MVC), and 3) during combined dynamic exercise (average heart rate 147 beats/min) and static exercise using 17% MVC of the left hand. Mean myocardial blood flow (MBF) was 181 ml/100 gm LV/min during dynamic exercise, 98 ml/100 gm LV/min during static exercise, and 201 ml/100 gm LV/min during combined static and dynamic exercise. Addition of a static load to the dynamic load resulted in a higher blood pressure (average 12 mm Hg), MVO 2 and MBF than during dynamic exercise alone. MVO 2 correlated best with products of heart rate and blood pressure regardless of whether the blood pressure was obtained by a central aortic catheter ( r = 0.88) or by a blood pressure cuff ( r = 0.85).

When the current data were combined with previous data, 82 determinations of MVO 2 and MBF in 29 normal subjects during several levels of upright exercise were available for analysis. Forty-four determinations were done during dynamic upright exercise, 18 during exercise after propranolol, ten during combined static and dynamic work, and ten during static work alone. MVO 2 correlated best with the product of heart rate and blood pressure ( r = 0.86). Heart rate alone correlated better with MVO 2 ( r = 0.82) than did the tension time index ( r = 0.65) or the product of systolic blood pressure, heart rate, and ejection time ( r = 0.68). The readily measured variables of heart rate and of heart rate x blood pressure correlated well with MVO 2 in normal young men during exercise under a wide variety of circumstances.

Effect of propranolol on myocardial oxygen consumption and its hemodynamic correlates during upright exercise

Measurements were made of heart rate, aortic blood pressure, systolic ejection period/beat, myocardial blood flow, and myocardial oxygen consumption in nine normal young men during three bouts of upright bicycle exercise: 1) at the workload which produced a heart rate of 120 beats/minute, 2) at the higher workload necessary to produce a heart rate of 120 beats/minute after administration of intravenous propranolol 0.25 mg/kg, and 3) with infusion of propranolol, at the same workload as the first exercise bout. Comparing exercises 1 and 2, we found a much higher workload was required to produce the same heart rate after propranolol. The blood pressure, heart rate-blood pressure product, and myocardial oxygen consumption were the same despite the much greater level of exertion. Comparing exercises 1 and 3, the heart rate, blood pressure, heart rate-blood pressure product, and myocardial oxygen consumption were all significantly lower during exercise 3 after propranolol despite the fact that the same degree of exercise was being done. As in previous studies, the heart rate-blood pressure product was an excellent correlate of myocardial oxygen consumption despite the change in contractility induced by propranolol. The systolic ejection period was prolonged significantly altering the tension-time index (TTI), which became an inadequate index of myocardial oxygen consumption. It is concluded that the heart rate-blood pressure product is a good index of myocardial metabolic needs during exercise and the relationship is undistorted by marked changes in contractility, but the tension-time index is a poor correlate. This data emphasizes the fact that the relative metabolic loads for the whole body and for the heart are determined separately and may not change in parallel with a given intervention.

Bicuspid aortic valve. Comparison of congenital and acquired types

Two dominant types of congenital bicuspid valves are described. The classical type is characterized by the presence of a low ridge or raphe along the aortic aspect of the conjoined cusp. The other is characterized by a tall raphe, the upper edge of which corresponds with the upper level of the aortic cusps. Some such ridges may result from acquired fusion of the adjacent halves of two cusps (yielding an acquired bicuspid valve). In other cases, the ridge is a protrusion of the aorta and not derived from fused cuspid tissue. Such valves are considered to portray a condition which may be termed pseudoacquired congenital bicuspid aortic valve. The acquired bicuspid valve in some cases is compounded of this congenital process and acquired fusion of cuspid tissue. The ratio of classical congenital bicuspid to pseudoacquired congenital bicuspid aortic valve is 4 to 1. Exceptional forms of pseudoacquired congenital bicuspid aortic valves are also described.

Complete heart block complicating bacterial endocarditis

Among 142 cases of bacterial endocarditis (BE), complete heart block (CHB) was found in six cases (4%) and first-degree (1°) or second-degree (2°) A-V block in 14 cases (10%).

The aortic valve was involved in 18 of 20 cases with atrioventricular (A-V) conduction disturbance, including all six cases of CHB.

Anatomic observations (four autopsy, one operative) were made in five of the six cases of CHB. In these cases, a common finding, in addition to involvement of the aortic valve, was extension of the infection to adjacent structures resulting in cardioaortic fistulae. CHB likely resulted from extension of infection to the major conduction tissues.

Five of the six patients with CHB died suddenly while in the hospital. One patient was treated with electric pacing while the infection was being controlled and, 38 days later, underwent successful replacement of the aortic valve. Conduction abnormalities are important possible complications of aortic valvular BE. Prompt pacing may be a lifesaving procedure, allowing eradication of infection as a prelude to surgical therapy.