Identification of a genetic locus for familial atrial fibrillation

BACKGROUND

Atrial fibrillation, the most common sustained cardiac-rhythm disturbance, affects over 2 million Americans and accounts for one third of all strokes in patients over 65 years of age. The molecular basis for atrial fibrillation is unknown, and palliative therapy is used to control the ventricular rate and prevent systemic emboli. We identified a family of 26 members of whom 10 had atrial fibrillation which segregated as an autosomal dominant disease. We subsequently identified two additional families in which the disease was linked to the same locus.

METHODS

We screened the human genome with 300 polymorphic dinucleotide-repeat markers using an unconventional strategy of pooling the DNA samples into two groups (affected and unaffected), which reduced the sample size by approximately 90 percent, before performing linkage analysis to map the locus. This made it possible to identify potential loci within a few weeks.

RESULTS

The lod scores for markers D10S569 and D10S607, located at 10q22-q24, were 3.60 in Family 1. The disease locus in Families 2 and 3 was also linked to the same markers, with lod scores of 6.02 and 5.35 for markers D10S569 and D10S607, respectively, when data on all three families were combined. Haplotype analysis of the three families showed that the locus was between D10S1694 and D10S1786, an interval of 11.3 centimorgans.

CONCLUSIONS

Identification of the gene for familial atrial fibrillation will help to elucidate the molecular basis of the disease and provide insights into acquired forms. The strategy of pooling DNA samples for analysis is more time and cost effective than conventional screening and should accelerate the process of gene mapping in the future.

Mosaic trisomy 14 with hepatic involvement

Mosaic trisomy 14 in liveborns is rare and may be accompanied by uniparental disomy in the euploid cell line. We report the case of a 6 month old male with growth failure, microcephaly, macroglossia, developmental delay, hypotonia, congenital heart disease, neonatal hepatitis, cryptorchidism, talipes equinovarus, limb length asymmetry, bilateral overriding of 1st by 2nd toe, and extended abnormal pigmentation in a linear-whorl distribution. The proband's karyotype in peripheral lymphocytes and skin fibroblasts was mos47,XY,+14/46,XY. Parental blood chromosomes were normal. Molecular analysis excluded uniparental disomy in the euploid cell line of the proband.

Phonological patterns in Puerto Rican Spanish-speaking children with phonological disorders

This study characterizes the phonological patterns in phonologically disordered Spanish-speaking children who speak the Puerto Rican dialect. A single-word assessment was used to describe the mean percentage-of-occurrence and standard deviation of phonological processes and the number and type of nontargeted process errors in 543- and 4-year-olds. Analyses were made in reference to the Puerto Rican dialect of Spanish, yielding a number of specific patterns that characterized the speech of these children.

Accuracy of wax, autopolymerized, and light-polymerized resin pattern materials

PURPOSE

The marginal fit of MOD inlay and full-crown patterns fabricated from wax, autopolymerized acrylic resin, and two light-polymerized, diacrylate resin pattern materials was compared on standardized dies.

MATERIALS AND METHODS

Four pattern materials were studied-two light-polymerized, diacrylate resin materials (Palavit G LC and Triad VLC Burnout Paste), an inlay wax, and an autopolymerized resin (Duralay). Patterns were fabricated using incremental and bulk techniques on stone dies made from addition silicone impressions of American Dental Association MOD and full-crown master dies. Gaps were measured with a measuring microscope in four marginal areas on the master dies at 1 and 24 hours after fabrication.

RESULTS

For the MOD inlay patterns, marginal gaps ranged from 7 to 23 microns, and the light-polymerized, diacrylate resins and autopolymerized acrylic resin material had statistically smaller gaps than the inlay wax. For the full-crown patterns, marginal gaps ranged from 10 to 23 microns, with the exception of the autopolymerized acrylic resin prepared by the bulk technique (40 to 46 microns). With the incremental technique, the light-polymerized, diacrylate resins and inlay wax had statistically smaller gaps than the autopolymerized acrylic resin material. Overall, the incremental technique produced equal or smaller marginal gaps than the bulk technique for full-crown patterns. Generally, the patterns measured at 1 hour had smaller marginal gaps than at 24 hours.

CONCLUSIONS

When measured on intra- and extracoronal master dies, the light-polymerized, diacrylate resins had equal or better marginal fit, compared with wax or autopolymerized acrylic resin, and were less affected by placement technique and storage. The marginal gaps of all four pattern materials ranged from 7 to 46 microns and are within the range of clinical acceptability.

Control of starch composition and structure through substrate supply in the monocellular alga Chlamydomonas reinhardtii

In Chlamydomonas, as in higher plants, synthesis of ADP glucose catalyzed by ADP-glucose pyrophosphorylase is rate-limiting for the building of starch in the chloroplast. We have isolated disruptions of the STA1 ADP-glucose pyrophosphorylase structural gene that rendered the enzyme less responsive to the allosteric activator 3-phosphoglycerate. The structure and composition of the residual starch synthesized by all mutants of the STA1 locus is dramatically altered. The residual polysaccharide is shown to be devoid of amylose despite the presence of granule-bound starch synthase, the amylose biosynthetic enzyme. In addition, the fine structure of the mutant amylopectin revealed the presence of an altered chain-length distribution. This distribution mimicks that which is observed during growth and photosynthesis and differs markedly from that observed during storage. We therefore propose that low nucleotide sugar concentrations are either directly or indirectly responsible for the major differences observed in the composition or structure of starch during storage and photosynthesis.

Primary amyloidosis presenting as renal infarction

We report a case of primary amyloidosis affecting the kidney and presenting as a renal infarction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radio-logical literature with these imaging characteristics.

Microleakage of a 4-methacryloxyethyl trimellitate anhydride bonding agent with amalgams

Microleakage contributes to deterioration of materials, recurrent decay, growth of microorganisms at the interface, and postoperative tooth sensitivity. This study examined the microleakage between amalgams and tooth surfaces with a cavity liner, a 4-methacryloxyethyl trimellitate anhydride bonding agent (Amalgambond) and six different types of amalgams. Class 1 cavity preparations in extracted human molars were filled with different combinations of liners and amalgams and were stored at 37 degrees C in physiologic saline solution. After 1 week half of each amalgam restoration was removed. Within the same group the same cavity treatment was performed and the same type of amalgam was packed as before. Microleakage was determined after 2000 thermal cycles. Statistical analysis indicated that Amalgambond significantly reduced microleakage of different amalgams compared with the Copalite-lined and unlined controls. No microleakage was detected at the interface between the existing and replacement amalgams.

Changes in plasma cholesterol levels after hospitalization for acute coronary events

To retrospectively assess the changes in total cholesterol levels after a hospital admission for an acute coronary event, 287 patients were identified who had one isolated event: 130 patients with acute myocardial infarction, 122 patients after coronary artery bypass graft surgery, 35 patients after percutaneous transluminal coronary angioplasty. To be included, patients had to have a total cholesterol measurement within the 3 months prior to hospitalization and periodically after the acute coronary event. Total cholesterol measurements were recorded during four time periods: 0-3 months before hospital admission (baseline); and 0-3, 3-6, and 6-9 months after the hospitalization. Mean total cholesterol value was used if a patient had multiple measurements during a time period.

RESULTS

There was no significant difference in the baseline total cholesterol levels among the three groups (acute myocardial infarction, coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty). In all three groups, there was a decrease in total cholesterol level after hospital admission compared to baseline (p < 0.0001). This decrease was significantly greater in coronary artery bypass graft surgery patients compared to the other two groups. Total cholesterol levels returned to baseline levels by 3 months after the hospitalization in all three groups. Total cholesterol decreased significantly from baseline in patients after an acute myocardial infarction; this decrease was significantly greater if they received thrombolytic therapy (p < 0.05). Total cholesterol returned to baseline 3 months after hospitalization in both groups.

CONCLUSIONS

During the 3 months following hospital admission for an acute coronary event, total cholesterol levels are not representative of the patient's baseline values. Management of hypercholesterolemia in this setting requires the use of baseline (preadmission) total cholesterol values.

Cholesteryl ester transfer activity in liver disease and cholestasis, and its relation with fatty acid composition of lipoprotein lipids

Liver disease is accompanied by major qualitative and quantitative disturbances in plasma lipoprotein metabolism, the extent and intensity of which depend on the degree of parenchymal damage, cholestasis, or both. The main objective of this study was to determine the cholesteryl ester transfer CETP activity and its association with the lipoprotein neutral lipid composition in patients with either liver cirrhosis or cholestasis, as compared to normal controls. Lipoproteins were isolated by ultracentrifugation, lipids and apolipoproteins were measured by conventional methods, and the fatty acid composition was established by gas chromatography; CETP activity in lipoprotein-deficient plasma was measured by determining the transfer of [3H]cholesteryl esters from HDL to VLDL. Lipoprotein lipase and hepatic lipase activities were measured in post-heparin plasma by radiochemical methods. In patients with liver cirrhosis, low levels of VLDL, HDL, apo B, and Lp(a) were observed, as well as a change in the composition of HDL particles, with increases in the relative proportion of triglyceride and free cholesterol. Respectively, the last two changes could be attributed in part to the low hepatic lipase activity observed in this study, and to the low lecithin:cholesterol acyltransferase activity previously observed by others. In patients with cholestasis, a moderate hyperlipidemia due to the elevation of LDL was found. In contrast, HDL and apo A-I levels were very low reflecting a low number of HDL particles, which also had altered compositions with increases in the triglyceride and free cholesterol contents relative to apo A-I and esterified cholesterol, respectively. As regards the fatty acid composition of lipoprotein lipids, the two groups of patients showed, in general, a lower proportion of linoleic acid and a compensating higher proportion of oleic acid as compared to the controls, changes that were observed in both cholesteryl esters and triglycerides. In contrast, the proportions of oleic and palmitoleic acids in phospholipids were increased, whereas that of stearic acid was decreased in patients as compared to controls. In patients with liver cirrhosis, as well as in controls, no changes were observed in the fatty acid compositions of cholesteryl ester, triglycerides, or phospholipids among the different lipoproteins, which probably reflects the equilibration reached by the action of CETP. In patients with cholestasis, no differences were observed in fatty acid composition among the lipoprotein phospholipids but, interestingly, cholesteryl esters from VLDL had a significantly lower linoleic acid content than those from HDL, whereas triglycerides from VLDL had significantly higher oleic acid and lower linoleic acid contents than those from HDL. This distinct fatty acid composition of the neutral lipids between lipoproteins was associated with a significant decrease (25%) in the cholesteryl ester transfer activity in patients with cholestasis. We suggest that fat malabsorption due to the biliary defect may induce a decrease in cholesteryl ester transfer protein synthesis or section, which in turn would slow the equilibration of the neutral lipids among plasma lipoproteins.

Impaired migration but not differentiation of haematopoietic stem cells in the absence of beta1 integrins

Adhesive interactions mediated by integrins of the beta1 subfamily are thought to be critical in controlling differentiation and migration of blood cell precursors. Here we report that chimaeric mice generated with beta1-integrin-deficient embryonic stem (ES) cells lack beta1(-/-) cells in blood and in haematopoietic organs such as spleen, thymus and bone marrow. Chimaeric embryos contain beta1-null haematopoietic cells in the yolk sac and in fetal blood but not in fetal liver. We show that such beta1(-/-) haematopoietic stem cells derived from yolk sac of 10.5-day-old chimaeric embryos readily generate erythroid and myeloid colonies and that beta1(-/-) ES cells can differentiate into mature B lymphocytes in vitro. Our results indicate that haematopoietic stem cells lacking beta1 integrins can form and differentiate into different lineages but cannot colonize the fetal liver.

Longitudinal study on lipoprotein profile, high density lipoprotein subclass, and postheparin lipases during gestation in women

To understand the mechanism responsible for maternal hyperlipidemia, 25 healthy pregnant women were studied longitudinally during the three trimesters of gestation and at post-partum, and 11 were studied again at post-lactation. Triglyceride and cholesterol levels increased with gestation in all the lipoprotein fractions. However, the greatest change appeared in low density (LDL) and high density (HDL) lipoproteins, both of which showed an increase in their triglyceride/cholesterol ratio. The proportional distribution of HDL subfractions showed that the HDL2b fraction was the only one that increased with gestation, whereas both HDL3a and HDL3b had the greatest decrease. Cholesteryl ester transfer protein activity increased during the second trimester of gestation. While postheparin lipoprotein lipase activity decreased during the third trimester, postheparin hepatic lipase activity progressively decreased from the first trimester. The 17 beta-estradiol, progesterone, and prolactin hormones progressively increased from the first trimester of gestation. The lipoprotein-triglyceride values correlated linearly and negatively with the logarithm of either postheparin lipase activities, HDL-triglycerides showing the highest correlation coefficient when plotted against the hepatic lipase values (r = -0.757). It appeared that the highest correlation between any of the HDL subclasses and the activity of the enzymes was for hepatic lipase activity versus HDL2b (r = 0.456) or HDL3a (r = 0.519). A significant lineal correlation also appeared between the postheparin hepatic lipase activity and the logarithm of any of the sex hormones studied, the highest value corresponding to estradiol (r = -0.783). Therefore, during gestation, the effect of estrogen in enhancing very low density lipoprotein (VLDL) production and decreasing hepatic lipase activity plays a key role in the accumulation of triglycerides in lipoproteins of density higher than VLDL.

Gout nodulosis: widespread subcutaneous deposits without gout

Subcutaneous tophaceous deposits of monosodium urate, in the absence of arthritis, may occasionally occur as the initial manifestation of gout. In this report, we describe a 35-year-old man who presented with a 6-year history of multiple subcutaneous nodules and no history of previous articular complaints. Needle aspirations of the nodules proved them to be deposits of monosodium urate. A literature search revealed 28 other cases with a similar presentation. We propose the term "gout nodulosis" as a clinical entity at one end of the spectrum of gout to describe this group of patients.

Percutaneous transhepatic treatment of a posttransplant portal vein thrombosis and a preexisting spontaneous splenorenal shunt

Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow.

Activation of a myelin basic protein-specific human T cell clone by antigen-presenting cells from rhesus monkeys

This study addresses the capacity of peripheral blood mononuclear cells (PBMC) from rhesus monkeys (Macaca mulatta) to present myelin basic protein (MBP), a candidate auto-antigen for multiple sclerosis, to MBP-specific human CD4+ T cell clones. MHC-restriction of the human T cell clones was determined with HLA-DR-transfected L cells, and epitope specificity was established with a panel of overlapping 20-mer peptides. The MHC-DR region of the rhesus monkeys (Mamu) was characterized serologically and by sequence analysis. We identified one CD4+ HLA-DRB1*0301-restricted Th1-like human T cell clone (ES-BP8) that was activated to proliferation with human or rhesus monkey MBP, or peptide MBP 29-48 presented by PBMC from six different rhesus monkeys expressing the Mamu-DRB1*0305 or -DRB1*0306 alleles. After transformation to continuous growth with Herpesvirus saimiri, the T cell clone could still be stimulated by antigen (Ag) and Ag-presenting cells (APC) from monkeys. Two other T cell clones with the same HLA-restriction and the same peptide-specificity did not respond to MBP presented by these rhesus monkeys. The exon 2 sequences HLA-DRB1*0301, Mamu-DRB1*0305 and -DRB1*0306 differ at positions 32, 47, 67, 73 and 86. These amino acid differences are not critical for the binding of MBP 29-48 and do not abrogate recognition by the clone ES-BP8, but interfere with the recognition of the two other HLA-DRB1*0301-restricted T cell clones. In conclusion, studying Ag-presentation from rhesus monkey may provide further insight into the interaction of antigenic peptide, TCR and MHC.(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin D dependent rickets type II and normal vitamin D receptor cDNA sequence. A cluster in a rural area of Cauca, Colombia, with more than 200 affected children

Vitamin D dependent rickets type II is an autosomal recessive disease caused by the vitamin D defective receptor. More than 200 patients with different types of lower limb deformities were detected in a rural area of the Cauca department in the southwest part of Colombia. Patients were well nourished and in good physical condition in spite of their deformities. None of them presented alopecia, myopathy, seizures or aminoaciduria. Serum analysis showed significantly lower serum calcium as compared to normal relatives, though in the normal low range, normal phosphorus, high alkaline phosphatase, normal 25-hydroxyvitamin D3 and high 1,25-dihydroxyvitamin D3, indicating target organ resistance. The cDNA analysis showed normal nucleotide sequence. We suggest that our patients represent a distinct form of receptor-positive resistance to vitamin D. This report is the first extensive study on this class of patients.

Transmission of HIV in dialysis centre

In August, 1993, 13 dialysis patients at one dialysis centre in Colombia, South America, were found to be HIV positive, and this prompted an epidemiological investigation. We carried out a cohort study of all dialysis centre patients during January, 1992 to December, 1993 (epidemic period) to determine risk factors for HIV seroconversion. Haemodialysis and medical records were reviewed, dialysis centre staff and surviving patients were interviewed, and dialysis practices were observed. Stored sera from all dialysis centre patients were tested for HIV antibody. 12 (52%) of 23 patients tested positive for HIV antibody by enzyme immunoassay and western blot during the epidemic period. Of the 23 tested, 9 (39%) converted from HIV antibody negative to positive (seroconverters) and 10 (44%) remained HIV negative (seronegatives). The HIV seroconversion rate was higher among patients dialysed at the centre while a new patient, who was HIV seropositive, was dialysed there (90% vs 0%; p < 0.01), or when the dialysis centre reprocessed access needles, dialysers, and bloodlines (60% vs 0%). While 2 of 9 HIV seroconverters had had sex with prostitutes, none had received unscreened blood products or had other HIV risk factors. No surgical or dental procedures were associated with HIV seroconversion. Dialysers were reprocessed separately with 5% formaldehyde and were labelled for use on the same patient. Access needles were reprocessed by soaking them in a common container with a low-level disinfectant, benzalkonium chloride; 4 pairs of needles were placed in one pan creating the potential for cross-contamination or use of one patient's needles on another patient. HIV transmission at the dialysis centre was confirmed. Improperly reprocessed patient-care equipment, most probably access needles, is the likely mechanism of transmission. This outbreak was discovered by accident and similar transmission may be occurring in many other countries where low-level disinfectants are used to sterilise critical patient-care equipment.

The role of autoimmune T lymphocytes in the pathogenesis of multiple sclerosis

Autoimmune T cells play a key role as regulators and effectors of autoimmune disease. In multiple sclerosis (MS), activated T cells specific for myelin components or other locally expressed autoantigens enter the CNS and recognize their antigen(s) on local antigen-presenting cells. After local stimulation, the T cells produce a plethora of cytokines and inflammatory mediators that have profound effects on the local cellular environment, induce and recruit additional inflammatory cells, and contribute to myelin damage. An increasingly detailed knowledge of these processes will greatly facilitate the development of new immunotherapies. This article focuses on the role of T cells in MS. We provide a brief overview of the principles of T-cell immunology, discuss the experimental techniques available for studying T cells, address the role of T cells in the pathogenesis of MS, and highlight modern concepts for immunotherapy.

T cell receptor repertoire in polymyositis: clonal expansion of autoaggressive CD8+ T cells

In polymyositis (PM), CD8+ T cell receptor (TCR) alpha/beta + cells invade and destroy major histocompatibility complex class I-positive muscle fibers. We combined polymerase chain reaction (PCR) and double-fluorescence immunocytochemistry to analyze the T cell receptor (TCR) repertoire expressed in muscle of PM patients. In patient 1, inverse PCR revealed a preferential usage of TCR V alpha 33.1, V beta 13.1, and V beta 5.1. Six of six TCR V alpha 33.1+ clones and five of seven V beta 13.1+ clones had identical nucleotide sequences. In contrast, the V beta 5.1+ TCRs were more heterogeneous. Similar results were obtained with an independent PCR method using primers specific for TCR V alpha 33, V beta 13, or V beta 5. No TCR sequences could be amplified from noninflammatory control muscle. Furthermore, none of the TCR sequences found in PM muscle could be detected in blood from the same patient or from a normal control subject. Immunohistochemistry confirmed that V beta 5.1 and V beta 13.1 were overrepresented in the muscle lesions of this patient. 32% of all CD8+ T cells were V beta 13.1+, and 16% were V beta 5.1+. However, approximately 60% of the CD8+ T cells that invaded muscle fibers were V beta 13.1+, whereas 10% were V beta 5.1+. In patient 2, 50% of the T cells were V beta 5.1+, and as in patient 1, these T cells were mainly located in interstitial areas. In patient 3, > 75% of the autoinvasive T cells stained with an anti-V beta 3 mAb. Sequence analysis of 15 PCR clones amplified with a V beta 3-specific primer showed that 9 (60%) sequences were identical. The results suggest that (a) a strikingly limited TCR repertoire is expressed in PM muscle; (b) there is a dissociation between the TCR usage of autoinvasive and interstitial T cells; and (c) the autoinvasive T cells are clonally expanded.

Life-span, T-cell responses, and incidence of lymphomas in congenic mice

Survival, T-cell functions, and postmortem histopathology were studied in H-2 congenic strains of mice bearing H-2b, H-2k, and H-2d haplotypes. Males lived longer than females in all homozygous and heterozygous combinations except for H-2d homozygotes, which showed no differences between males and females. Association of heterozygosity with longer survival was observed only with H-2b/H-2b and H-2b/H-2d mice. Analysis using classification and regression trees (CART) showed that both males and females of H-2b homozygous and H-2k/H-2b mice had the shortest life-span of the strains studied. In histopathological analyses, lymphomas were noted to be more frequent in females, while hemangiosarcomas and hepatomas were more frequent in males. Lymphomas appeared earlier than hepatomas or hemangiosarcomas. The incidence of lymphomas was associated with the H-2 haplotype--e.g., H-2b homozygous mice had more lymphomas than did mice of the H-2d haplotype. More vigorous T-cell function was maintained with age (27 months) in H-2d, H-2b/H-2d, and H-2d/H-2k mice as compared with H-2b, H-2k, and H-2b/H-2k mice, which showed a decline of T-cell responses with age.

Knockout mice: how to make them and why. The immunological approach

Transgenic technology has developed at breakneck speed in the past years. The establishment of embryonic stem cells and the finding that they can serve as bridge between genetic manipulations in vitro and biological analysis in vivo enabled the systematic creation of mouse strains with defined genetic alterations. This review lists the strategies which can be used to alter the genetic makeup of mice and summarizes some of the results which have been obtained in genetically altered mice of immunological interest.

Deletion of CD4+ T cells and thymocytes by apoptosis in mouse mammary tumor virus (C4)-infected V beta 2 transgenic mice

Mouse mammary tumor virus MMTV (C4) encodes a V beta 2-specific superantigen. In V beta 2 transgenic (TG2) mice more than 98% of peripheral T cells express V beta 2. Infection of Tg2 mice with MMTV (C4) at birth through their mothers' milk or at 6-8 weeks of age by intravenous injection resulted in massive deletion of peripheral CD4+ T cells and suppressed thymopoiesis. The number of peripheral CD8+ T cells was not affected in neonatally infected mice. In older mice injected with MMTV (C4), splenic CD8+ T cells were significantly elevated. Suppressed thymopoiesis was observed in both neonatally infected and older mice injected with MMTV (C4). Thymocytes which expressed high level CD3 or V beta 2 were deleted. To determine if T cells or thymocytes were deleted through apoptosis, DNA fragmentation was examined by flow cytometry and diphenylamine (DPA) binding assay. Approximately 31% of CD4+ T cells from MMTV (C4)-infected Tg2 mice as compared to 6% from normal Tg2 mice contained fragmented nuclear DNA by flow-cytometric analysis. The DPA binding assay showed significantly increased total soluble DNA in lymph node cells and thymocytes from MMTV (C4)-infected mice. The kinetics of T cell and thymocyte apoptosis correspond to their deletion, supporting apoptosis as the mechanism of T cell and thymocyte deletion. CD4+ T cell and thymocyte deletion by MMTV (C4) in Tg2 mice provides a sensitive system for the analysis of retrovirus superantigen-induced apoptosis.