Protection by amylin of gastric erosions induced by indomethacin or ethanol in rats

1. The effect of amylin on gastric ulcers induced by oral administration of indomethacin (Indo, 20 mg kg-1 at a dosing volume of 5 ml) or ethanol 50% (EtOH, 1 ml/rat) was investigated in conscious rats. 2. Amylin given intracerebroventricularly (0.22, 0.66 and 2.2 micrograms/rat, i.c.v.) demonstrated a dose-dependent cytoprotective effect against both Indo and EtOH-induced ulcers. In contrast, amylin, given subcutaneously at doses effective in inhibiting acid gastric secretion (2.5, 10 and 40 micrograms kg-1, s.c.), did not show any cytoprotective effect. 3. The interaction between amylin and endogenous nitric oxide (NO) in the maintenance of gastric mucosal integrity was investigated by pretreating the rats with a selective inhibitor of NO-synthesis, NG-nitro-L-arginine methyl ester (L-NAME, 25 and 70 mg kg-1, s.c.). Administration of L-NAME to rats did not significantly increase the degree of the Indo-induced ulcer index and was not able to remove the protective effect of amylin on Indo-induced ulcers, thus excluding a role for endogenous NO in mediating the protective effect of this peptide. 4. To determine whether the cytoprotective effect of amylin was mediated by endogenous prostaglandins, we studied the effect of amylin (2.2 micrograms/rat, i.c.v.) on EtOH- induced ulcers in rats pretreated with Indo (10 mg kg-1, s.c.) to inhibit prostanoid biosynthesis; Indo was injected 30 min before amylin and EtOH after a further 30 min. Pretreatment with Indo did not significantly increase the ulcer index induced by EtOH but counteracted the ability of amylin to prevent the ulcer formation. 5. These findings suggest that amylin exerts a gastroprotective activity that is not strictly related to inhibition of acid gastric secretion and can be partly explained through a prostaglandin-dependent mechanism mediated by receptors for the peptide in the brain. Amylin might be considered as a new brain-gut peptide.

Rapid and specific immunoassay for cardiac troponin I in the diagnosis of myocardial damage

We evaluated a new immunometric assay for the quantitation of cardiac troponin I with the Behring Opus analyzer. All assay steps are performed automatically by the analyzer, the complete procedure requiring 20 min for the first test result. Total precision (coefficient of variation) varied between 5.6% and 13.0%. Comparison with the Pasteur immunoenzymometric assay showed good correlation (r = 0.959), but the Opus assay gave approximately tenfold higher values. Cardiac troponin I was undetectable (< 0.5 microgram/l) in sera from healthy subjects (n = 46), patients with severe skeletal muscle damage (n = 8), and all but 1 patient with chronic renal failure (n = 39). In patients with myocardial infarction (n = 21), investigated for 4 days after onset by frequent sampling, cardiac troponin I peaked at 20.8 +/- 8.1 h after onset with a mean concentration of 164.8 +/- 361.3 micrograms/l, remaining elevated in 89% of patients on the 4th day. In patients with unstable angina (n = 15), cardiac troponin I measurement was valuable in predicting the type of lesion morphology on coronary angiography and the short-term outcome.

L273S missense substitution in human lysosomal acid lipase creates a new N-glycosylation site

Human lysosomal acid lipase (LAL), when expressed in HeLa cells using the Vaccinia T7 expression system, showed four major molecular forms ranging from 42 to 54 kDa. Treatment with endoglycosidase H resulted in a 42 kDa protein, indicating that the molecular weight variations were due to N-glycosylation. A missense substitution, L273S, previously detected in a patient with cholesteryl ester storage disease (CESD), produced catalytically inactive LAL showing a largest molecular mass form of 56 kDa instead of 54 kDa. Analysis of the amino acid sequence in the close proximity of the mutation (NMS- NML) indicated that the L273S mutation creates an additional N-glycosylation consensus (N-X-S/T) in this region. Two site directed mutants disrupting this consensus, QMS and QML, when expressed in HeLa cells, did not show the 56 kDa form but the normal 54 kDa band whereas deglycosylation always resulted in the major 42 kDa form, as observed with normal LAL and the L273S mutant. These data confirmed that an additional N-glycosylation at N271 was responsible for the 56 kDa form of the protein produced from the L273S allele. Furthermore, deglycosylation of normal LAL reduced the acid hydrolase activity towards both tri-oleyl glycerol and cholesteryl oleate by 50%, strongly suggesting that N-linked carbohydrate residues are important for optimal catalytic activity.

Role of the neuronal histaminergic system in the regulation of somatotropic function: comparison between the neonatal and the adult rat

To study possible age-related differences in the role of neuronal histaminergic pathways in the control of GH secretion, the effects of alpha-fluoromethylhistidine (alpha-FMH), an irreversible inhibitor of histamine (HA) synthesis, were examined on basal and opioid-induced GH release in neonatal and adult rats. The mechanisms involved in such effects were evaluated by measuring pituitary GH mRNA levels and hypothalamic levels of GH-releasing hormone (GHRH) and somatostatin (SRIF) mRNAs. Daily injection of alpha-FMH (20 mg/kg, s.c.) in pups of either sex, from birth until 10 days of age, caused a significant increase in baseline plasma GH and potentiated the GH response to the [Met5]-enkephalin analog FK 33-824 (1 mg/kg, s.c.) administered 3 h after the last alpha-FMH injection. GH and SRIF mRNA levels were significantly higher in alpha-FMH-treated pups than in controls, whereas no difference was observed in GHRH mRNA levels. In young adult male rats, acute administration of alpha-FMH (100 mg/kg, s.c., 3 h before) did not change significantly basal GH levels but potentiated FK 33-824 (0.3 mg/kg, intracarotid)-induced stimulation of GH secretion. Repeated administration of alpha-FMH (200 micrograms/rat, i.c.v., for 3 days) failed to modify basal and FK 33-824-induced GH secretion, caused a significant reduction in hypothalamic GHRH mRNA levels and left SRIF and GH mRNAs unchanged. These findings indicate that HA exerts an inhibitory effect on GH secretion in both neonatal and adult rats. The different effects of short-term HA depletion on hypothalamic and pituitary indices of somatotropic function observed at the two age periods may be ascribed to the immaturity of the HA system in early postnatal life and to a different functional role of GH-regulatory factors during ontogeny.

Expression of lysosomal acid lipase mutants detected in three patients with cholesteryl ester storage disease

Lysosomal acid lipase (LAL) gene mutations were identified in three patients with cholesteryl ester storage disease (CESD). Direct sequencing of genomic DNA revealed that: patient 1 was a compound heterozygote for a P181L mutation and an A to G3' splice site substitution that causes skipping of exon 7, with a loss of 49 amino acids from LAL (delta 205-253); patient 2 was a compound heterozygote for a G66V mutation and a 5' splice site mutation (G to A) that leads to skipping of exon 8 (delta 254-277); and patient 3 was a compound heterozygote for a L273S mutation and an unidentified null allele. Furthermore, patients 2 and 3 showed a novel G-2A polymorphism that could be detected by an Xbal restriction fragment length polymorphism. All these mutants and a previously reported H274Y allele were expressed in vitro in HeLa cells using the vaccinia T7 expression system. The resulting recombinant proteins were inactive towards cholesteryl oleate and trioleylglycerol, demonstrating the direct involvement of these mutations in the pathogenesis of CESD. Immunoblotting of normal LAL expressed in HeLa cells revealed four major molecular forms, at least two of high molecular mass (54 and 50-51 kDa) and two of low molecular mass (42 and 43 kDa). L273S and P181L substitutions and delta 254-277 were shown to result in altered LAL molecular forms, some of which suggest that post-translational processing may interfere with the catalytic activity of LAL.

Induction of human endothelial cell growth by mildly oxidized low density lipoprotein

The aim of the present study was to examine whether endothelial growth could be modulated by mildly oxidized low density lipoprotein. When human endothelial cells were cultured in the presence of mildly oxidized low density lipoprotein (1 microgram/ml), a significant induction of endothelial cell growth was observed, whereas native low or high density lipoprotein were ineffective. Further, treatment of endothelial cells with mildly oxidized low density lipoprotein modulated the expression of cytokines and growth factors which may be relevant in atherogenesis. Endothelial cells chronically exposed to mildly oxidized low density lipoprotein underwent a more rapid onset of cellular senescence. Since senescence is associated with endothelial dysfunction, the novel finding showing that mildly oxidized low density lipoprotein induces endothelial cell growth may be relevant in the development and evolution of the atherosclerotic lesions.

[Anesthesiology problems for implant and explant of left ventricular Novacor systems]

OBJECTIVES

To review experience with anaesthetic management in patients undergoing a left ventricular assist system (LVAS) Novacor implant as a bridge to cardiac transplantation.

DESIGN

Retrospective clinical study.

SETTING

Cardiothoracic operating room in a university hospital.

PATIENTS

Nine, aged 37-62 years, suffering from 8 dilated and 1 postischemic cardiomyopathy at end stage heart failure. INTERVENTIONS OR METHODS: Under general anaesthesia and cardio-pulmonary bypass the LVAS pump is placed in the abdomen and connected to the left ventricle through an inflow cannula and to the aorta through an outflow cannula. The pump has an output of 5-7 l/min and works in synchronous counterpulsation with the left ventricle.

RESULTS

The mean Novacor support has been 75.56 days (DS +/- 85.95). Five out of 9 patients have been transplanted, while 3 are still waiting at home. Pretransplant CI was on average 1.66 l/min/m2 (DS +/- 0.27) and REF 11.44% (DS +/- 5.29); after the Novacor implant CI was 3.44 (DS +/- 0.49) and REF 22.22% (DS +/- 4.49).

CONCLUSIONS

A LVAS can bridge patients to heart transplantation while improving or preserving their health conditions. Some factors are to be taken into account for the anaesthesiological management of the implant/explant of a LVAS: the patients' poor clinical conditions; the knowledge of the components and functioning of the LVAS that conditions the choice of the anaesthesiological drugs and volemia; the unassisted right ventricle function that has to be pharmacologically supported; the bleeding problem because of the adherences during the explant surgery.

Surgery for atrial fibrillation

OBJECTIVE

The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia.

METHODS

In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients.

RESULTS

In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 44%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P < 0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P < 0.001). Restoration of the right atrial function raised the cardiac index from 2.25 +/- 0.55 1/min per m2 during atrial fibrillation to 2.54 +/- 0.58 1/min per m2, with a mean percentage increase in cardiac index of 13.5% (P < 0.00018). Atrial partitioning ("maze operation") was performed on five patients with an immediate sinus rhythm recovery of 100%, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5%), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications. 2-52 months after operation. Thirteen of 14 patients with "lone" atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92%.

CONCLUSIONS

Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.

Biological variation in urinary excretion of pyridinium crosslinks: recommendations for the optimum specimen

We assessed the analytical and biological variation of pyridinium crosslinks in early morning, 2 h fasting, and 24 h urine specimens from 14 healthy adults over a 1 month period. The results were expressed both in terms of pyridinoline concentration and pyridinoline/creatinine ratio. The data obtained were used to select the optimum specimen for clinical purposes. We found that: (a) early morning specimens are preferred; (b) results should be expressed as pyridinoline/creatinine ratio; (c) reference intervals should be stratified according to gender; (d) the necessary analytical imprecision (CV < or = 9%), derived from biological variation, is not easily achieved by current methods; (e) the difference between serial results from an individual must be > 50% to be statistically significant; and (f) assessment of risk for osteoporotic fracture by means of the pyridinium crosslink assay would, in a significant number of patients, require analysis of multiple urine specimens.

Modified method for Novacor left ventricular assist device implantation

We have developed and applied in 7 cases an alternative "orthodromic" technique for Novacor left ventricular assist device implantation. After sternotomy, the pocket is tailored, dividing the insertion of the diaphragm to the lower ribs, for easier bleeding control. On cardiopulmonary bypass, the aorta is cross-clamped and cardioplegia administered. Apical cannulation is performed first on a dry, still field. The device is then easily deaired, with blood flowing in the physiologic direction. The aorta is declamped and the outflow conduit is anastomosed. Before the suture is tied, the final deairing is obtained. This technique allows extreme precision in apical cannulation, easier control of bleeding, and accurate deairing of the pump. The ischemic time is short and damage to the right ventricle negligible.

Nonenzymic glycation of apolipoprotein B in patients with insulin- and noninsulin-dependent diabetes mellitus

OBJECTIVE

To evaluate the level of nonenzymatic glycation of apolipoprotein B in patients with insulin and noninsulin dependent diabetes mellitus.

METHODS

Using a method based on a combination of affinity chromatography and immunonephelometry, we measured the concentration of glycated apolipoprotein B (apo B) in serum of 140 diabetic patients, 43 insulin-dependent (IDDM), and 97 noninsulin-dependent (NIDDM), and 45 nondiabetic control subjects.

RESULTS

Although total apo B concentration in serum was significantly increased only in NIDDM patients, both groups of diabetics showed higher percentages of glycated apo B (IDDM, 4.84 +/- 0.8%; NIDDM, 5.61 +/- 1.1%) than did control subjects (4.28 +/- 1.0%), the greatest percentage (5.80%) being found in patients with diabetic nephropathy. No significant correlations were found between glycated apo B and the traditional parameters of glycemic control, such as glycated hemoglobin and fructosamines, and direct influence by sudden plasma glucose fluctuations on apo B glycation was not shown either, perhaps for a low inherent glycability of this apolipoprotein.

CONCLUSIONS

It is unclear if these low proportions of glycated apo B in vivo may significantly affect lipoprotein metabolism assuming a pathophysiological role in atherogenesis.

Biological variation in bone-derived biochemical markers in serum

Analytical, within-subject and between-subject components of variation have been determined for total alkaline phosphatase (ALP) and its bone isoform, osteocalcin, and tartrate-resistant acid phosphatase (TR-ACP) in serum specimens from a cohort of 10 healthy subjects over a 1-month period. From these data, we have calculated the desirable analytical imprecisions, the indices of individuality, the critical differences for significant change detection, and the number of specimens required to estimate the homeostatic setpoint of an individual. For total ALP and its bone isoform, most of the observed variability was biologic, whereas osteocalcin and TR-ACP also had relatively high analytical variability. Total and bone ALP were also the parameters showing the lowest within-subject variability, whereas TR-ACP showed the lowest interindividual fluctuation. Osteocalcin and bone ALP had marked individuality, showing that the use of population-based reference limits is inadequate for their interpretation. The applicable differences required for two results to be significantly different (p < or = 0.05) are bone ALP: 20%; osteocalcin: 29%; and TR-ACP: 35%. The results demonstrate that the biochemical markers of bone turnover studied are of limited use to screen for metabolic bone disorders, but can be useful adjuncts for monitoring groups of patients in longitudinal studies.

Inhibitory effect of amylin on growth hormone responsiveness to growth-hormone-releasing hormone in the rat

The effects of intracerebroventricular (i.c.v.) or intracarotid (i.a.) administration of amylin (AMY) on growth hormone (GH) release induced by GH-releasing hormone (GHRH) were examined in conscious male rats. Amylin (25 ng-5 micrograms/rat, i.c.v. or 10 micrograms/rat, i.a.) was administered 10 min before GHRH (2 micrograms/kg, i.a.). I.c.v. administration of AMY dose-dependently inhibited GH secretion induced by GHRH but when given peripherally, AMY did not modify the GH response to GHRH. Amylin (10(-8)-10(-6) M) had no direct effect on the rat anterior pituitary in vitro either alone or when incubated with GHRH. To characterize the mechanism(s) involved in vivo in the inhibition of GH by AMY, we examined, at first, the effects of AMY on GHRH-induced GH release in rats depleted of somatostatin by pretreatment (4 h before) with cysteamine (300 mg/kg s.c.). The inhibitory activity of AMY on GH secretion elicited by GHRH seems to be independent of hypothalamic somatostatin; in fact, AMY was still active in rats treated with cysteamine. In addition, we examined the effects of i.c.v. AMY administration on clonidine (CLO)-induced GH secretion and on dopamine and noradrenaline content in the brain, since it is known that GHRH is a stimulus sensitive to changes in central catecholaminergic activity. The failure of AMY to affect GH secretion induced by activation of postsynaptic alpha 2-receptors by CLO and the finding that the peptide decreased noradrenaline content in the hypothalamus and striatum, indicates that AMY may inhibit GH release by interfering with the facilitatory influence of the catecholaminergic system on GH secretion.

Bovine seminal plasma contains factors that enhance lymphocyte transformation in vitro

The important immunosuppressive properties of seminal plasma have significant functions in the processes of reproduction. They mask the presence of an immunostimulating activity. From bovine seminal plasma two active factors have been isolated and characterized with marked enhancing activity for in vitro PHA-dependent lymphocyte transformation. They have inosine and hypoxanthine structures, as confirmed by UV absorption profiles, TLC, mass spectrometry, HPLC patterns, behavior to enzymatic treatments, and breaking of purine ring after acid treatment. Nevertheless, their biological activities are about two orders of magnitude higher than those of commercially available inosine and hypoxanthine standards. Biological activities became practically identical when these were processed (HPLC) in the same way as native molecules. A study to explain such a discrepancy is in progress.

Differential effects of CGRP on adenylyl cyclase in adult and embryonic rat brain

The presence of functional receptors for calcitonin gene-related peptide (CGRP) in the brain of adult rats and on nerve cell cultures was investigated. Neuronal and glial cultures were obtained from mesencephalons of embryos at gestational day 16. The response to CGRP was tested by measuring the adenylyl cyclase (AC) activity on isolated membranes. CGRP binding in adult rat brains was ineffective in activating AC, whereas a dose-dependent stimulation of AC activity was induced by the peptide both in neuronal and glial cultures. This effect was more pronounced in the glial cells where high affinity binding sites for CGRP were detected. The presence of functional CGRP receptors in embryonic mesencephalic cells, suggests a role for CGRP in the development of rat mesencephalon.

Determination of glycated apolipoprotein B in serum by a combination of affinity chromatography and immunonephelometry

We have developed and optimized a procedure for the quantitation of non-enzymatically glycated apolipoprotein B (apo B). Glycated and non-glycated apo B were separated from serum using m-aminophenylboronate affinity chromatography, determined by immunophelometry and the percentage of glycated apo B was calculated. The measuring range of the assay was 2.9-185 mg/dL apo B. The within- and between-run coefficients of variation were < 7.4% and 14.6%, respectively, and recovery was > 98%. Free glucose in serum did not affect the results at concentrations below 25 mmol/L. In 45 non-diabetic subjects the mean concentration of glycated apo B was 4.3% (SD 1%). In type 1 (n = 17) and Type 2 (n = 60) diabetic patients the mean glycated apo B concentrations were 5.3% (SD 0.7%) and 5.9% (SD 1.1%), respectively, significantly higher than in controls (P < 0.001).

Modulators of oxidized LDL-induced hyperadhesiveness in human endothelial cells

The adherence of monocytes to the endothelium is an early event in atherogenesis. Our previous studies have demonstrated that oxidized LDL induced U937 cells-endothelial interactions and that HDL prevented oxidized LDL effects. Here, we provide evidence that treatment of endothelial cells with the anti-inflammatory agent indomethacin abolished oxidized LDL as well as interleukin 1- and lipopolysaccharide-stimulated U937 adhesion. It is noteworthy that HDL, which is known to be protective against atherosclerosis, was effective only in negating U937 adhesion induced by oxidized LDL, while it did not affect interleukin 1- and lipopolysaccharide-induced hyperadhesiveness in endothelial cells. Since indomethacin inhibits cyclooxygenase which is the key enzyme in the synthesis of prostanoids, we have studied the effect of oxidized LDL on the expression of cyclooxygenase type 2 and demonstrated that oxidized LDL induces a sustained increase in the expression of cyclooxygenase mRNA.

A histidine to tyrosine replacement in lysosomal acid lipase causes cholesteryl ester storage disease

The genetic defect causing cholesteryl ester storage disease (CESD) has been investigated in an 11 year old patient. Lysosomal acid lipase (LAL) activity in cultured skin fibroblasts and peripheral lymphocytes was reduced to approximately 3% and approximately 4% of controls, respectively. The parents had low acid lipase activity in white blood cells. Using the polymerase chain reaction followed by ribonuclease protection assay, we examined the LAL mRNA from the liver of the affected patient to identify small deletion, abnormal splicing or missense mutation. Using this technique we identified a LAL mRNA cytosine to thymidine transition in position 923, predicting a missense substitution of tyrosine for histidine in codon 274. By differential oligonucleotide hybridization on an amplified white blood cell mRNA, the cytosine to thymidine transition was investigated in the family members and in the population. No normal mRNA coding for cytosine in position 923 was detectable in the propositus and mRNA from the phenotypically normal parents coded for both cytosine and thymidine. This can only be accounted for by assuming that the propositus is homozygote for the mutation. The mutation, segregated in the family with levels of acid lipase activity in white blood cells, was not detected in mRNA from 60 normal subjects. These data provide evidence that the cytosine to thymidine transition in position 923 in LAL mRNA causes the clinical expression of CESD in this patient. The predicted substitution of tyrosine for histidine in codon 274 suggests that this amino acid is involved in the structure-function of the lysosomal acid lipase enzyme.