[Vascular injuries in children]

Vascular trauma in children differs in some respects from that in adults. In infants and children the total blood volume is smaller, and despite effective compensatory mechanisms, critical blood loss is also smaller. Gentle and meticulous technical skill is needed to correct injuries of minute vessels and allow adequate blood flow. The use of synthetic tubes and materials is not recommended, as they do not lengthen as the child grows. Ischemia is a major factor influencing limb growth and function. 3 different types of vascular injuries operated on in the past year are presented.

[Emergency therapy with granulocyte-macrophage colony-stimulating factor (GM-CSF)]

Granulocyte-macrophage colony stimulating factor (GM-CSF) has been tested for tolerability and efficacy on a compassionate need case basis in 17 patients (5 females, 12 males aged 4-72 years, median 35 years). GM-CSF was given at the rate of 3.5-32 micrograms/kg for 2-64 days as a continuous infusion for the following indications: impending rejection following bone marrow transplantation (5 patients), severe neutropenia secondary to chemotherapy in tumor patients (5), severe aplastic anemia (3), immune granulocytopenia (2) and accidental overdose with cytostatic agents (2 patients). Tolerance of GM-CSF was good in regard to doses of up to 16 micrograms/kg. Fever, myalgia and eosinophilia were the most frequent side effects. The patient treated with 32 micrograms/kg developed thrombosis of the vena cava. Efficacy is more difficult to assess in this heterogenous population, but 11 of 17 patients showed increased granulocyte counts and 3 patients clearly recovered from severe neutropenia. The role of GM-CSF in this recovery, however, cannot be proven. The results further indicate that GM-CSF cannot reverse ongoing rejection following allogenic BMT and cannot correct immune neutropenia. The value of GM-CSF therapy in patients with severe aplastic anemia and in the context of chemotherapy still needs to be defined. It is certainly indicated in patients with an accidental overdose of chemotherapeutic agents.

Tetravalent vanadium releases ferritin iron which stimulates vanadium-dependent lipid peroxidation

The iron storage protein, ferritin, represents a possible source of iron for oxidative reactions in biological systems. It has been shown that superoxide and several xenobiotic free radicals can release iron from ferritin by a reductive mechanism. Tetravalent vanadium (vanadyl) reacts with oxygen to generate superoxide and pentavalent vanadium (vanadate). This led to the hypothesis that vanadyl causes the release of iron from ferritin. Therefore, the ability of vanadyl and vanadate to release iron from ferritin was investigated. Iron release was measured by monitoring the generation of the Fe(2+)-ferrozine complex. It was found that vanadyl but not vanadate was able to mobilize ferritin iron in a concentration dependent fashion. Initial rates, and iron release over 30 minutes, were unaffected by the addition of superoxide dismutase. Glutathione or vanadate added in relative excess to the concentration of vanadyl, inhibited iron release up to 45%. Addition of ferritin at the concentration used for measuring iron release prevented vanadyl-induced NADH oxidation. Vanadyl promoted lipid peroxidation in phospholipid liposomes. Addition of ferritin to the system stimulated lipid peroxidation up to 50% above that with vanadyl alone. Ferritin alone did not promote significant levels of lipid peroxidation.

Effects of 1,4-naphthoquinone derivatives on red blood cell metabolism

The effect on red blood cell metabolism of a series of substituted 1,4-naphthoquinones has been investigated. 2-Methoxy-1,4-naphthoquinone was found to be a potent oxidative compound, generating hydrogen peroxide in erythrocytes and causing both methemoglobin formation and glutathione depletion in the absence of glucose. Flux of glucose through both glycolysis and the hexose monophosphate shunt was stimulated. 2-Hydroxy- and 2,3-dihydroxy-1,4-naphthoquinone were less oxidative. Both compounds caused oxidation of glutathione and formation of hydrogen peroxide with corresponding stimulation of the hexose monophosphate shunt, but did not cause methemoglobin formation. 2-Hydroxy-3-alkyl-1,4-naphthoquinones were not oxidative but did increase the flux of glucose through glycolysis, possibly reflecting membranal damage. The in vitro oxidative effects of these substances do not correlate with their hemolytic activity in rats, indicating that factors other than oxidative damage are important in mediating the in vivo toxicity of these substances.

Kringle 1 domain of human tissue-type plasminogen activator is a functional module mediating fibrinogen-stimulated plasminogenolytic activity

The functions of the finger and kringle-2 (K2) domains of human tissue-type plasminogen activator (t-PA) in mediating fibrin-stimulated plasminogenolytic activity are well documented. Contradictory results have been reported for the kringle-1 (K1) domain with respect to this property. To clarify this issue we have deleted the finger and the K2 domains of t-PA according to the exon-intron organization of the gene by site-directed mutagenesis. The resulting derivative (GK1L) was constitutively expressed in permanent clones of Chinese hamster ovary cells. The secreted proteins have been partially purified and characterized by Western blotting. Since the plasminogenolytic activity of GK1L is stimulated by fibrin, the K1 domain of t-PA must be a functional domain in this context.

The Arthus reaction in cats deficient in Hageman factor (factor XII)

A study was made of the Arthus reaction in an animal model of Hageman-factor deficiency, namely Hageman trait cats, and in control cats with normal Hageman-factor activity. At three time points, there was a significant decrease (P less than 0.01) in the size of the cutaneous Arthus reaction to chicken red blood cells in biopsies from Hageman trait cats compared with the reaction in biopsies from control animals. Injection of a positive control, histamine, and a negative control, phosphate-buffered saline, produced no significant differences between the two groups. Hageman trait cats had a significant decrease (P less than 0.001) in the number of neutrophils in the skin lesions compared with controls. When Hageman trait cats were injected intravenously with purified cat Hageman factor, Arthus reactions were similar to those observed in control cats.

Desferrioxamine protects human red blood cells from hemin-induced hemolysis

Hemin binding to red cell membranes, its effect on red cell hemolysis, and it interaction with desferrioxamine (DFO) in these processes were investigated. DFO interacted with hemin via the iron moiety. Blockage of the binding groups in DFO prevented interaction of DFO with hemin, implying the importance of the hydroxamic acid groups in DFO-hemin interactions. Since hemolysis is a result of hemin association with the membrane components, its binding in the presence and absence of DFO was studied. DFO strongly inhibited hemin-induced lysis in a concentration-dependent manner. With 50 microM hemin, 1 mM DFO completely inhibited lysis. Preincubation of ghost membranes with DFO (1 mM) inhibited binding of hemin (50 microM) to membranes by 42%. After ghost membranes were preincubated with hemin (50 microM), the addition of DFO (1 mM) removed 20% of the membrane-bound hemin. It is suggested that DFO may have an important role in alleviating the hemin-induced deleterious effects on the red cell membrane, especially in hemolytic anemias associated with unstable, autoxidized hemoglobins.

Tetravalent vanadium mediated oxidation of low density lipoprotein

1. Tetravalent vanadium causes oxidation of low density lipoprotein (LDL) as manifest by protein degradation and lipid peroxidation. 2. Oxidative modification of the apolipoprotein B-100 is paralleled by the formation of thiobarbituric acid reactive substance and fluorescent chromolipid production. 3. The metal chelators ethylenediamine tetracetic acid and desferrioxamine, and the alcohols, ethanol and isopropanol inhibit the oxidation of LDL by tetravalent vanadium. No inhibition is observed with superoxide dismutase, catalase or mannitol. 4. The data suggest that aldehydes formed during the process of lipid peroxidation induced by tetravalent vanadium react with the proteins in LDL to form fluorescent chromolipids and that the oxidative process originates within the hydrophobic domain of LDL.

Transient cyclic neutropenia following GM-CSF in a patient with chronic granulocytic leukemia transplanted with HLA-identical T cell-depleted donor bone marrow

Treatment with GM-CSF or G-CSF is becoming widely used in patients with chronic neutropenia, or who are aplastic following chemotherapy or autologous or allogeneic bone marrow transplantation. Recently, some authors have described a phenomenon analogous to cyclic agranulocytosis following treatment with G-CSF in a patient with chronic neutropenia. We wish to describe the same phenomenon in a patient with chronic granulocytic leukemia who received GM-CSF (Sandoz) after T cell depletion in order to accelerate hematological reconstitution.

Effect of oxidative stress on membrane phospholipid and protein organization in human erythrocytes

Membrane phospholipid and protein organization was studied in intact human erythrocytes exposed to phenylhydrazine, an oxidative agent inducer. The evaluation of the membrane phospholipid and protein organization was carried out in terms of asymmetric distribution across the membrane bilayer for the phospholipids, and in terms of accessibility of cleavable sites present on the outer membrane surface for the proteins. Treatment of phenylhydrazine-exposed erythrocytes either with bee venom phospholipase A2 or with trinitrobenzenesulfonic acid indicated that phosphatidylserine (PS), which is the only phospholipid not formally present on the outer leaflet of the membrane, was translocated to the outer surface of the cell membrane. The extent of this phenomenon was directly proportional to the concentration of the oxidant having a peak value at 0.1 mM. Phosphatidylcholine and phosphatidylethanolamine conserved their original distribution across the erythrocyte membrane throughout the study. The oxidant, at a dose which did not induce any modification of the sodium dodecyl sulfate-polyacrylamide gel electrophoresis cytoskeleton membrane protein pattern, did not provoke any alteration of the membrane protein surface architecture, although the translocation of PS to the membrane outer leaflet in intact erythrocytes was present.

Functional topology of human tissue-type plasminogen activator: characterization of two deletion derivatives and of a duplication derivative

Three types of permanent Chinese hamster ovary (CHO) cell lines with different amplified expression constructs that abundantly secrete derivatives of human tissue-type plasminogen activator (t-PA) were established. The first one expresses a deletion derivative in which the kringle 2 domain (K2) has been removed (FGK1L). In the second derivative, the growth-factor-homologous domain (G) has also been deleted (FK1L); a third line expresses a duplication derivative of K2 (FK2K2L) lacking the (G) and kringle 1 (K1). All deletion derivatives were constructed according to the exon-intron organization of the gene. We have analyzed the secreted proteins and the fibrinogen-stimulated plasminogenolytic activity as a function of different culturing conditions (fetal calf serum, aprotinin) of the cells. The specific activities of the two deletion derivatives (FGK1L and FK1L) were only 10-20% of the specific activity of t-PA. Surprisingly, the specific activity of the K2-duplication derivative, FK2K2L, was three times higher than that of t-PA. These data were correlated with the morphological properties of CHO cells constitutively secreting the described derivatives under different culturing conditions. CHO cells secreting the deletion derivatives (FGK1L and FK1L) remained attached to the surface of the petri dishes. Cell lines secreting the duplication derivative FK2K2L detached from the surface even in the presence of the protease inhibitor aprotinin.

Vanadate-mediated oxidation of NADH: description of an in vitro system requiring ascorbate and phosphate

Oxidation of NADH has been observed in an in vitro system requiring NADH, vanadate, ascorbate, and phosphate. Similar results were observed with NADPH. Ascorbate provides the reducing equivalents necessary to reduce vanadate to vanadyl. Vanadyl autoxidizes producing superoxide which initiates a free radical chain reaction resulting in oxidation of NADH. Oxidation is inhibited by superoxide dismutase but not by catalase or ethanol. Ascorbate functions to initiate the free radical chain reaction but is not required in stoichiometric concentrations. At higher concentrations, ascorbate inhibits NADH oxidation. Inorganic phosphate was required for NADH oxidation. Dialysis of phosphate buffers against solutions containing apoferritin or conalbumin or addition of transition metal cations or chelators to the reaction medium did not alter dependence on phosphate. Phosphate and vanadate were interchangeable in their effects on kinetic parameters of NADH oxidation except that vanadate was 100 times more potent than phosphate. Vanadate participates directly in the initiating and propagating redox reactions of NADH oxidation. Phosphate may be important in lowering the energy of activation for the necessary transfer of hydronium ion and water in the transition state between vanadate anion and vanadyl cation.

Accidental overdose of multiple chemotherapeutic agents

A 35-year-old man with refractory low grade diffuse centroblastic centrocytic non-Hodgkin's lymphoma was treated accidentally with an overdose of multiple chemotherapeutic agents. He was given adriamycin 50 mg/m2 and cyclophosphamide 350 mg/m2 for 6 days followed by 4 days of vincristine 1 mg/m2 and bleomycin 10 mg/m2. He was transferred when he developed pancytopenia, fever, severe mucositis, ileus and peripheral neuropathy. He was treated with broad spectrum antibiotics, red cell and single donor platelet transfusions and strict parenteral nutrition. In addition, he was given a continuous infusion of 400 micrograms daily human recombinant granulocyte macrophage-colony stimulating factor (rh GM-CSF) for 17 days. Intractable severe bleeding from his oral mucositis necessitated treatment with a continuous infusion of 8-ornithine-vasopressin for 8 days. He recovered and could be discharged home after 36 days of hospitalization with normal blood counts and without severe sequelae.

Glucose metabolism and hemoglobin reactivity in human red blood cells exposed to the tryptophan metabolites 3-hydroxyanthranilate, quinolinate and picolinate

Glucose metabolism and hemoglobin reactivity in intact human erythrocytes were assessed in the presence of the tryptophan metabolites, 3-hydroxyanthranilate (3-HAT), quinolinate and picolinate. Of these compounds, only 3-HAT altered red cell oxidative status by inducing, in a dose-dependent manner, formation of methemoglobin and non-functional oxidation products of hemoglobin, and by increasing both net glycolytic flux and flux through the hexose monophosphate shunt. 3-HAT also decreased the normal lactate to pyruvate production ratio with pyruvate accumulating at the expense of lactate. These findings are consistent with the auto-oxidative reactivity of quinolinate, picolinate, and 3-HAT in that only 3-HAT undergoes base-catalyzed auto-oxidation (Dykens et al., Biochem Pharmacol 36: 211-217, 1987). Lactate and pyruvate added to the medium in physiologic concentrations uncoupled oxidative glycolysis from reductive glycolysis, resulting in accumulation of pyruvate in the presence of 3-HAT with little increase in total glycolytic flux. Superoxide dismutase (SOD), which accelerates 3-HAT auto-oxidation in vitro (Dykens et al., Biochem Pharmacol 36: 211-217, 1987), exacerbated HAT-mediated oxidative insult by increasing methemoglobin formation, hexose monophosphate shunt flux, and pyruvate accumulation. Persistence of 3-HAT-induced red cell metabolic responses and oxidative damage in the presence of SOD, DETAPAC (diethylenetriaminepentaacetic acid) and formate suggests that an organic-based radical, perhaps the anthranilyl radical produced during 3-HAT auto-oxidation, is the proximate agent exerting oxidative stress. Slow rates of auto-oxidation indicate that 3-HAT may be useful as a probe of antioxidant mechanisms in normal and diseased red blood cells.

Toxicity of aromatic thiols in the human red blood cell

Thiophenol and 4-aminothiophenol were used to study levels of toxicity in human red blood cells. Thiophenols caused conversion of oxyhemoglobin to methemoglobin. Reduction of corresponding disulfides by intracellular glutathione caused cyclic reduction/oxidation reactions, resulting in increased oxidative flux. Three levels of oxidative stress were observed in these experiments: the lowest level resulted from incubation with 0.25 mM thiophenol; the intermediate level with 0.50 mM thiophenol or 0.25 mM 4-aminothiophenol; the highest levels with 0.50 mM 4-aminothiophenol. Methemoglobin formation increased with increasing level of oxidative stress. Glycolysis and the hexose monophosphate shunt were inhibited at the intermediate and highest levels of stress, respectively. Above the highest level of stress non-intact hemoglobin was formed and cell lysis occurred. These metabolic responses were reflected in cellular levels of NADH, NADPH and reduced glutathione. At the lowest level of oxidative stress, both glycolysis and hexose monophosphate shunt were increased such that near-normal levels of NADH, NADPH and reduced glutathione were maintained and methemoglobin formation was kept to a minimum. The response of red cells to 0.25 mM thiophenol appears to represent a level of oxidative stress to which the cell is capable of adaptive metabolic response. Glycolysis contributes approximately one-quarter of the total reducing equivalents from glucose metabolism in response to the oxidative challenge by thiophenol. The results suggest that the metabolic response to autoxidation of endogenous thiols is thiol exchange with glutathione and reduction of resulting glutathione disulfide by the hexose monophosphate shunt.

Prooxidant and antioxidant effects of ascorbate on tBuOOH-induced erythrocyte membrane damage

1. t-Butylhydroperoxide (tBuOOH) a lipoperoxide analog, causes rapid and considerable sulphydryl (SH) oxidation but almost no lipid peroxidation in red blood cell membranes (ghosts) containing no detectable haemoglobin. 2. tBuOOH, in the presence of ascorbate, produces significant lipid peroxidation the level of which is proportional to the ascorbate concentration. The initiation of lipid peroxidation is thought to occur by the reactive tBuO (butoxyl) species via the reductive decomposition of tBuOOH by ascorbate. 3. Ascorbate protects ghost membranes from the tBuOOH-induced SH oxidation in a dose-dependent fashion. 4. There is no parallelism between lipid peroxidation and SH oxidation in these systems. This suggests that the two processes occur independently of each other. 5. These findings indicate that, simultaneously, ascorbate can have both a protective and a prooxidant action in different membrane components under the same oxidative stress.

Autoimmune endotheliopathy and chronic herpetic conjunctivitis

A migrating endothelial line of keratic precipitates associated with overlying corneal edema suggests an immune attack on the corneal endothelium. This is seen most commonly in corneal allotransplantation rejection. The etiology of such lines in the absence of this condition is unclear. We document the presence of an intranuclear virus compatible with herpesvirus in this condition.

Binding of iron to human red blood cell membranes

The binding of Fe3+ to red cell membranes was studied in a system in which lipid peroxidation was proportional to Fe3+ concentration. Binding of Fe3+ was evaluated by labeling with 59FeCl3 and measurement of NMR water-proton relaxation times. Labeling with 59Fe showed that 95% of the Fe3+ was membrane bound at 100 microM FeCl3 in a 1.5 mg protein/ml membrane suspension. Both spin-lattice (T1) and spin-spin (T2) relaxation times decreased with increasing Fe3+ concentration. Addition of red cell membrane suspensions largely prevents the Fe3+ effect on relaxation times. Charge transfer to Fe3+ may occur at the membrane binding site with resultant decrease in the Fe3+ effect on water-proton relaxation times. These studies support the hypothesis that Fe3+ binds to the membrane and generates free radicals at the binding site.

Human red cells enhance the formation of 5-lipoxygenase-derived products by neutrophils

Upon activation, human neutrophils generate 5-lipoxygenase products which are involved in inflammation as well as other physiological and pathophysiological processes. We have examined the influence of red cells on the generation of lipoxygenase-derived products by neutrophils utilizing high pressure liquid chromatography system which permitted quantitation of 5-HETE, leukotriene B4 (and its isomers) and the omega oxidation products of leukotriene B4 (20-hydroxyleukotriene B4, 20-carboxyleukotriene B4) within the same sample. Co-incubation of red cells with neutrophils (50:1, red cells:neutrophils) resulted in a 722 percent increase in 5-hydroxyeicosatetraenoic acid production and a slight increase in leukotriene B4 and its omega oxidation products which were not accompanied by increases in 15-hydroxyeicosatetraenoic acid production. The role of the sulfhydryl status of the red cell and its ability to scavenge hydrogen peroxide were assessed in relationship to the interaction of red cells on the neutrophil-derived lipoxygenase products. Together, these findings indicate that red cells can regulate the levels of lipid-derived mediators produced by neutrophils. Moreover, they suggest that red cell-neutrophil interactions may be of importance in inflammatory reactions.

Evaluation of right and left ventricular function in hard metal workers

Ingested cobalt has previously been associated with the development of a congestive cardiomyopathy. Despite occasional reports of cardiomyopathy after industrial exposure to cobalt, this association remains controversial. In a study of 30 cemented tungsten carbide workers with a mean duration of exposure to cobalt of 9.9 +/- 5.3 years radionuclide ventriculography was performed to study right and left ventricular ejection fractions at rest and exercise. For the entire group, rest and exercise biventricular function was normal. There was, however, a weak but significant inverse correlation between duration of exposure and resting left ventricular function (r = -0.40, p less than 0.03). Workers with abnormal chest x ray findings (9/30) had relatively lower exercise right ventricular ejection fractions (45% +/- 6 v 52% +/- 7, p less than 0.02). An inverse relation was also found between rest and exercise right ventricular ejection fraction and severity of parenchymal abnormalities on x ray examination (r = -0.44, p less than 0.01 and r = -0.41, p less than 0.02). Diminished right ventricular reserve was probably due to fibrotic lung disease and early cor pulmonale. Although overt left ventricular dysfunction was not present, prolonged exposure to industrial cobalt may be a weak cardiomyopathic agent with unknown long term significance.

Influence of exogenous iron and ascorbate on H2O2-induced glutathione oxidation in red cells

The effective fall in cytosolic reduced glutathione levels in intact red cells exposed to exogenous oxidant stress in the form of Fe2+, H2O2 and ascorbate was caused by H2O2 alone. Relatively high concentrations of Fe2+ had no contributory effect on the oxidizing capacity of H2O2. Ascorbate, at physiological levels, showed no protection whereas glucose was totally protective. Since glucose, via hexose monophosphate shunt, is the only source of reducing equivalent in red cells, the NADPH/NADP+ redox role in the diminution of intracellular reduced glutathione.

NMR water-proton spin-lattice relaxation time of human red blood cells and red blood cell suspensions

NMR water-proton spin-lattice relaxation times were studied as probes of water structure in human red blood cells and red blood cell suspensions. Normal saline had a relaxation time of about 3000 ms while packed red blood cells had a relaxation time of about 500 ms. The relaxation time of a red cell suspension at 50% hematocrit was about 750 ms showing that surface charges and polar groups of the red cell membrane effectively structure extracellular water. Incubation of red cells in hypotonic saline increases relaxation time whereas hypertonic saline decreases relaxation time. Relaxation times varied independently of mean corpuscular volume and mean corpuscular hemoglobin concentration in a sample population. Studies with lysates and resealed membrane ghosts show that hemoglobin is very effective in lowering water-proton relaxation time whereas resealed membrane ghosts in the absence of hemoglobin are less effective than intact red cells.

Medial discoid meniscus with cyst formation in a child

A medial discoid meniscus with cystic formation was found in a 9-year-old girl. The cyst was located in the anterolateral part of the meniscus, mechanically blocking knee extension. The presenting symptom was knee flexion contracture. Total meniscectomy was followed by full recovery.

Unusual cough related stress injuries

Two cases of unusual cough related stress injuries of the ribs are described. Both were detected on a 2 h delay bone scan. To our knowledge, cough stress injuries have been not previously described scintigraphically.

The Arthus reaction in domestic cats

A classic Arthus reaction was elicited in normal domestic cats using chicken red blood cells as antigen. The response was quantitated grossly by measuring the area of the resulting skin bleb at several set time intervals and by microscopic examination of biopsies taken at the conclusion of each of the trials. This method produced an intense Arthus reaction in each of the cats tested.

Screening devices for diminished cognitive capacity

This study compares three commonly used tests to detect organic mental disorders: the Mini-Mental State (MMS), Cognitive Capacity Screening Examination (CCSE), and Tachistoscope (T-Scope). Ninety-seven medical-surgical inpatients at the Mount Sinai Hospital referred for psychiatric consultation had a Missouri Mental Status Examination performed by a psychiatrist who also rated the patients' organic mental disorder as "none," "mild," "moderate," or "severe." The CCSE, MMS, and T-Scope, respectively, showed: sensitivity--0.54, 0.52, 0.68; specificity--0.85, 0.76, 0.79; and positive predictive value--0.83, 0.74, 0.79. False negatives occurred more often among those patients with mild organic mental disorders with all instruments (p = 0.05), while the T-Scope could not be administered in 27% of the patients. Screening instruments with increased acceptability, sensitivity, and specificity need to be developed to identify a potentially life-threatening disorder.

Cholesteryl octanoate breath test. Preliminary studies on a new noninvasive test of human pancreatic exocrine function

A new breath test for noninvasive assessment of pancreatic exocrine function in humans was developed. The test is based on the hydrolysis of cholesteryl-[1-14C]octanoate by pancreatic carboxyl ester lipase (cholesterol esterase) with subsequent absorption and hepatic metabolism of the liberated octanoate to 14CO2. The rate at which 14CO2 appears in breath appeared to be proportional to the rate of hydrolysis. The substrate is administered as a gum acacia stabilized emulsion of vegetable oil (18 g) containing cholesteryl octanoate (2 g; 4.4 microCi) dispersed in a 500-ml isotonic meal. Tests were performed in 6 healthy volunteers and 11 patients with pancreatic disease with varying degrees of steatorrhea. In healthy subjects, 14CO2 output was rapid with peak output occurring at 60-90 min in all subjects; cumulative output in 4 h averaged 30%. Duplicate studies indicated that the time-course of 14CO2 recovery was reproducible. The pattern of 14CO2 output in patients with pancreatic disease varied widely. Patients without steatorrhea (fecal fat less than or equal to 7 g/day) or with mild steatorrhea (fecal fat 7-11 g/day) had normal or near normal patterns of 14CO2 output, whereas patients with moderate or severe steatorrhea (fecal fat greater than 11 g/day) expired 14CO2 at a rate one-third to one-tenth that of the healthy volunteers. Addition of pancreatic enzyme supplementation to the test meal increased 14CO2 output in 6 of 6 patients with moderate or severe steatorrhea, suggesting that the activity of pancreatic carboxyl ester lipase was rate limiting in these patients. In an additional study in a healthy volunteer, 14CO2 and 13CO2 were measured simultaneously in breath after ingestion of a test meal containing cholesteryl-[1-13C]octanoate and 14C-octanoate. 14CO2 was expired more rapidly than 13CO2, suggesting that hydrolysis of the substrate may also be rate limiting in healthy volunteers. These studies indicate that severe pancreatic exocrine dysfunction can be detected with a simple breath test in 60-90 min.

Human red cells scavenge extracellular hydrogen peroxide and inhibit formation of hypochlorous acid and hydroxyl radical

The ability of intact human red cells to scavenge extracellularly generated H2O2 and O2-, and to prevent formation of hydroxyl radicals and hypochlorous acid has been examined. Red cells inhibited oxidation of ferrocytochrome c by H2O2. Cells treated with aminotriazole no longer inhibited, indicating that protection was almost entirely due to intracellular catalase. Contribution by the GSH system was slight, and apparent only with low H2O2 concentrations when catalase was inhibited by aminotriazole. The cells were about a quarter as efficient at inhibiting cytochrome c oxidation as an equivalent concentration of purified catalase. No inhibition of O2(-)-dependent reduction of ferricytochrome c or nitroblue tetrazolium was observed, although extracted red cell superoxide dismutase inhibited nitroblue tetrazolium reduction at one fortieth the concentration of that in the cells. Red cells efficiently inhibited deoxyribose oxidation by hydroxyl radicals generated from H2O2, O2- and Fe(EDTA), and myeloperoxidase-dependent oxidation of methionine to methionine sulfoxide by stimulated neutrophils. Most of the red cell inhibition of hydroxyl radical production, and all the inhibition of methionine oxidation, was prevented by blocking intracellular catalase with aminotriazole. Thus red cells are able to efficiently scavenge H2O2, but not O2-, produced in their environment, and to inhibit formation of hydroxyl radicals and hypochlorous acid. They may therefore have an important role in extracellular antioxidant defense.

Mechanism of kainate toxicity to cerebellar neurons in vitro is analogous to reperfusion tissue injury

The neuroexcitotoxin kainate has been used as a selective lesioning agent to model the etiology of a number of neurodegenerative disorders. Although excitotoxins cause susceptible neurons to undergo prolonged or repeated depolarization, the proximate metabolic pathology responsible for neuronal necrosis has remained elusive. We report here that kainate-induced death of cerebellar neurons in culture is prevented by inhibiting the enzyme xanthine oxidase, a cellular source of cytotoxic superoxide radicals (O2-.). Moreover, neurons are also protected from excitotoxin-induced death by the addition to the culture medium of either superoxide dismutase or mannitol, which scavenge superoxide and hydroxyl radicals, respectively, or serine protease inhibitor, which forestalls formation of xanthine oxidase. These findings indicate that excitotoxin-induced neuronal degeneration is mediated by superoxide radicals generated by xanthine oxidase, a mechanism partially analogous to that proposed for tissue damage seen upon reperfusion of ischemic tissues.

Common mechanism controlling phase and antigenic variation in pathogenic neisseriae

The expression of the Neisseria gonorrhoeae opacity protein (Op, protein II), a major antigenic determinant of the outer membrane, is subject to frequent phase transitions. At least nine expression loci (opaE) are involved in the production of a large number of serologically distinct Op types. Using opa-specific oligonucleotides as probes in genomic blots, we detect Op-related gene sequences (opr) in N. meningitidis as well as in N. lactamica. DNA sequence analysis of such opr genes derived from N. meningitidis reveals distinct regions of homology with gonococcal opa E genes. As shown in the immunoblot, the proteins encoded by opa and opr are serologically related. Like the opaE genes, the 5'-coding sequences of the opr genes include a repetitive sequence composed of pentameric CTCTT units. The number of these coding repeat (CR) units is variable. This finding, together with the observation that all opr genes are constitutively transcribed, regardless of the status of protein production, suggests a translational control mechanism identical to that of the opa genes in gonococci. The related structures and control mechanisms of opa and opr genes imply a general significance of their gene products for the pathogenic character of the investigated Neisseria species.

Inhibition of mammalian fatty acid synthetase activity by NADP involves decreased mobility of the 4'-phosphopantetheine prosthetic group

Mammalian fatty acid synthetase carrying a 3-keto, 3-hydroxy, or 2-enoyl acyl-enzyme intermediate on the 4'-phosphopantetheine thiol is reversibly inhibited by binding of NADP to the enoyl reductase domain. Acyl moieties which can normally leave the enzyme by thioester hydrolysis or by transfer to a CoA acceptor cannot readily be removed from the NADP-inhibited enzyme; in addition, 3-keto or 2-enoyl moieties attached to the enzyme 4'-phosphopantetheine cannot readily be reduced when NADP is replaced by NADPH, even though model substrates can be reduced immediately. Reactivation of the NADP-inhibited 3-ketoacyl-enzyme, by exposure to NADPH, is paralleled by reduction and dehydration of the 3-ketoacyl moiety to a saturated acyl moiety without accumulation of either the 3-hydroxy or 2-enoyl acyl-enzyme intermediates, indicating that once the 4'-phosphopantetheine engages the ketoacyl moiety in the ketoreductase domain, subsequent reactions occur very rapidly. The results are consistent with a hypothesis which proposes that NADP binding to the enoyl reductase domain of fatty acid synthetase carrying an acyl intermediate other than a saturated moiety induces a conformational change in the enzyme that results in decreased mobility of the 4'-phosphopantetheine prosthetic group. Normal mobility of the prosthetic group, essential for transfer of acyl-enzyme intermediates through the active sites of the various functional domains, is restored relatively slowly when NADP is replaced by NADPH. It remains to be determined whether this modulation by pyridine nucleotides observed in vitro plays a role in the regulation of fatty acid synthetase activity in vivo.

Extraluminal compression of an aortic graft simulating recoarctation

Restenosis rarely develops after surgical correction of coarctation of the aorta in adults. Late morbidity is usually related to residual hypertension or progressive aortic valve disease. A patient in whom symptoms and signs of recurrent coarctation developed 19 years after initial graft repair is described. Dehiscence of the original silk suture line was found at operation. Extensive thrombus had produced graft compression. Milder hypertension persisted in the postoperative period despite relief of the aortic obstruction.

Fluorescent properties of merocyanine 540 in solutions of sialogangliosides

The spectral modifications in the absorption and emission properties of merocyanine 540 have been evaluated in solvents of varying dielectric constants. The fluorescence behavior of dye in solutions of low dielectric constant has offered a possibility for monitoring the micropolarity of sialoganglioside micelles in aqueous solutions. Our results demonstrate that sialic acid residues markedly influence the aggregation properties of gangliosides in solution as well as the nature of dye binding to the micellar structures.

Oxidative reactivity of the tryptophan metabolites 3-hydroxyanthranilate, cinnabarinate, quinolinate and picolinate

The oxidative reactivities of four tryptophan metabolites in the kynurenine pathway were examined as a potential mechanism for their reported neurotoxicities and carcinogenicities. Neither quinolinic acid, a neurotoxin, nor its monocarboxylic analogue, picolinic acid, auto-oxidized over a wide pH range. However, 3-hydroxyanthranilic acid (3-HAT), a carcinogen, readily auto-oxidized and the reaction rate increased exponentially with increasing pH. 3-HAT auto-oxidation likely involves two steps: auto-oxidation of 3-HAT to the semiquinoneimine (anthranilyl radical) which oxidizes to the quinoneimine, followed by condensation and oxidation reactions to yield a second carcinogen, cinnabarinic acid. 3-HAT auto-oxidation to cinnabarinate required molecular oxygen and generated superoxide radicals and H2O2. Superoxide dismutase (SOD) accelerated 3-HAT auto-oxidation 4-fold, probably by preventing back reactions between superoxide and either the anthranilyl radical or the quinoneimine formed during the initial step of auto-oxidation. Catalase did not accelerate 3-HAT auto-oxidation, but it did prevent destruction of cinnabarinate by H2O2. Interconversion between oxyhemoglobin and methemoglobin occurred during 3-HAT auto-oxidation, although neither form of hemoglobin altered rates of 3-HAT auto-oxidation. Mn2+, Mn3+ and Fe3+-EDTA did not directly catalyze cinnabarinate formation in the absence of O2, but they did accelerate cinnabarinate formation under aerobic conditions.

The control mechanism of opacity protein expression in the pathogenic Neisseriae

The expression of Neisseria gonorrhoeae opacity protein shows frequent phase transitions. The genome contains at least twelve copies of the opa gene. Each copy is complete and different from most of the others in certain hypervariable regions. All opa genes are constitutively transcribed. Part of the leader peptide of all Op's is encoded by repetitive CTTCT pentameric units, the so-called coding repeat (CR). The number of repeat units found in the genes and mRNA is subject to frequent and precise changes. Such changes affect the expression of individual opa genes at the translational level. This control mechanism is common also to the class 5 proteins of N. meningitidis and the Op-related proteins of N. lactamica.

Phenylhydrazine-induced changes in erythrocyte membrane surface lipid packing

Phenylhydrazine-induced oxidative damage in red cells results in increased binding of merocyanine 540, a fluorescence probe sensitive to changes in lipid packing. Fluorescence polarization studies with diphenylhexatriene did not reveal major changes in order parameters both in intact red cells and lysates treated with phenylhydrazine. These fluorescence studies indicate that major changes are observed in membrane lipids. Analytical studies of membrane phospholipids revealed a significant decrease in phosphatidylethanolamine. The results of the fluorescence and lipid studies, taken in association with our previously reported findings on spectrin and other cytoskeletal protein degradation in red cells exposed to phenylhydrazine, suggests that degradation of cytoskeleton membrane proteins is also responsible for changes in the lipid bilayer surface of the red cell membrane.

Opacity genes in Neisseria gonorrhoeae: control of phase and antigenic variation

The chromosome of N. gonorrhoeae contains several complete expression genes coding for variant opacity proteins. DNA sequence analysis of two opacity genes derived from the same locus (opaE1) of two isogenic gonococcal variants reveals common and variable regions in these genes. Genomic blotting experiments using synthetic probes suggest gene conversion as a principle for the assembly of variant sequence information in opacity genes. The 5' region of opacity genes is composed of identical pentameric pyrimidine units (CTCTT) encoding the hydrophobic portion of the opacity leader peptide. This coding repeat is variable in a given locus with respect of the number of pentameric units. While all expression loci in a single cell are constitutively transcribed, the production of opacity proteins is determined by the coding repeat sequence on the translational level.