[Hypothyroidism followed by hyperthyroidism under treatment with amiodarone]

Hypothyroidism followed by hyperthyroidism is described in two patients treated by amiodarone. Euthyroidism was rapidly restored after treatment with antithyroid drugs and potassium perchlorate. The physiopathology of amiodarone-induced hypothyroidism is discussed. Withdrawal of amiodarone is advised in the case of both hypothyroidism and hyperthyroidism.

Structure-function analysis of the ion channel selectivity filter in human annexin V

Electrophysiology and structural studies were performed on an annexin V variant containing a mutation of glutamic acid-95 to serine in the center of the pore region. The mutation resulted in a lower single channel conductance for calcium and a strongly increased conductance for sodium and potassium, indicating that glutamic acid-95 is a crucial constituent of the ion selectivity filter. There were only minor differences in the crystal structures of mutant and wild-type annexin V around the mutation site; however, the mutant showed structural differences elsewhere, including the presence of a calcium binding site in domain III unrelated to the mutation. Analysis of the membrane-bound form of annexin V by electron microscopy revealed no differences between the wild type and mutant.

A rapid and efficient purification method for recombinant annexin V for biophysical studies

Annexin V binds in a calcium-dependent manner to acidic phospholipids and exhibits ion channel activity in vitro. We are investigating mutants of annexin V by single channel measurements, X-ray crystallography and electron microscopy in order to understand the structure-function relationships of the ion channel activity. We describe here a method to obtain very pure recombinant annexin V required for such studies. The initial step is the mild opening of the bacterial cells by an osmotic shock. In the purification procedure, use is made of the reversible calcium-mediated binding of annexin V to liposomes. In the last purification step the protein is subjected to ion-exchange chromatography and elutes as a single peak free of any detectable contaminants.

[Antimycotic agents. 20. Bioisoteric 6-arylpyrimidine derivatives]

Condensation of N-(2-hydroxyethyl)-N-methylguanidine-sulfate (1) with the beta-diketones 4a-e bearing 1-aryl substituents leads to the bioisosteric 2-[(2-hydroxyethyl)-methylamino]-6-arylpyrimidines 5a-e. Compounds 5a-c exhibit significant antimycotic in vivo and in vitro activities.

Mechanism-based inhibitors of prostaglandin omega-hydroxylase: (R)- and (S)-12-hydroxy-16-heptadecynoic acid and 2,2-dimethyl-12-hydroxy-16-heptadecynoic acid

12-Hydroxy-16-heptadecynoic acid has been shown to selectively inactivate cytochrome P450 4A4, a pulmonary cytochrome P450 enzyme that catalyzes the omega-hydroxylation of prostaglandins [Muerhoff, A. S.; Williams, D. E.; Reich, N. O.; CaJacob, C. A.; Ortiz de Montellano, P. R.; Masters, B. S. S. J. Biol. Chem. 1989, 264, 749-756]. Potent, specific inhibitors of this enzyme are required to explore its physiological role. In a continuing effort to develop such agents, the two enantiomers of 12-hydroxy-16-heptadecynoic acid have been stereospecifically synthesized, their absolute stereochemistry confirmed, and the dependence of enzyme inactivation on absolute stereochemistry determined using cytochrome P450 4A4 purified from the lungs of pregnant rabbits. The 12S enantiomer is roughly twice as active (KI = 1.8 microM, t1/2 = 0.7 min) as the 12R enantiomer (KI = 3.6 microM, t1/2 = 0.8 min), but the chirality of the hydroxyl group is not a major determinant of the specificity for the prostaglandin omega-hydroxylase. The flexibility of the acyclic skeleton of the inhibitor may account for the relatively low enantiomeric discrimination. 2,2-Dimethyl-12-hydroxy-16-heptadecynoic acid, an analogue that cannot undergo beta-oxidation, has also been synthesized as a potential in vivo inhibitor of the enzyme and has been shown to inactivate the purified enzyme with KI = 4.9 microM and t1/2 = 1.0 min. These acetylenic agents, particularly the dimethyl analog, are promising in vivo inhibitors of cytochrome P450 4A4.

The trap of the displaced blind spot in automated perimetry

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Calcium influx through annexin V ion channels into large unilamellar vesicles measured with fura-2

A new assay for the calcium channel activity of annexin V was developed. The calcium-sensitive fluorescence indicator, fura-2, was incorporated into large unilamellar vesicles (LUV). After establishing a calcium gradient across the liposomal membranes, native or mutated annexin V was added. The resulting calcium influx into the LUV detected through the fluorescence changes of fura-2 was used as a qualitative test for the electrophysiological properties of annexin V.

[Autoimmune diseases and treatment with interferon-alpha: review of the literature apropos of a case of hyperthyroidism]

We report a case of thyrotoxicosis in a male patient under alpha-interferon (INF-alpha) therapy. Data from the literature show that treatment with IFN-a alone or combined with interleukin-2 (IL-2) can induce dysthyroidism (hypothyroidism, hyperthyroidism, thyroiditis). The frequency of dysthyroidism under INF-alpha therapy ranges from 10 to 40% depending on the authors. During combined INF-alpha and IL-2 therapy these figures reach 20 to 91%. The presence of anthyroid antibodies before treatment makes it more probable that dysthyroidism will occur. The administration of INF-alpha can exacerbate or induce various autoimmune diseases.

Annexin V-crystal structure and its implications on function

Annexins constitute a family of cytosolic, water soluble proteins, which bind to negatively charged phospholipids in a calcium-dependent manner. They display structural and functional features of both soluble and integral membrane proteins. The annexins face the hydrophilic as well as the hydrophobic phase (Janus-faced proteins) and mediate ion transport in vitro. We present the refined structure and molecular model of annexin V at 2.0 A resolution. The molecule is almost entirely alpha-helical, and each of the four repeats of annexin V is folded into a compact domain of similar structure. The four domains are arranged in an almost planar, cyclic array. In the center of the molecule, one can find a prominent hydrophilic pore, which we associate with the calcium-selective channel found in annexin V. Annexin V has an overall flat, slightly curved shape with two faces, one convex and one concave. The three calcium binding sites Ca1 to Ca3, all located at the convex face of the molecule, are assumed to be phospholipid binding sites, as suggested by their structural similarity to the calcium site of phospholipase A2. Soluble and membrane-bound annexin have closely similar structures, as shown by electron microscopic analysis. Several other observations provide evidence that the membrane-anchoring region of the annexin V molecule is located on the convex face. In the last part of this article, the electrophysiology of the annexins is described. Ion permeation occurs in discrete conductance states and is regulated by voltage across the membrane. A model for the annexin V-membrane interaction, the ion channel formation, and the ion conduction pathway is proposed.

Crystal and molecular structure of human annexin V after refinement. Implications for structure, membrane binding and ion channel formation of the annexin family of proteins

Two crystal forms (P6(3) and R3) of human annexin V have been crystallographically refined at 2.3 A and 2.0 A resolution to R-values of 0.184 and 0.174, respectively, applying very tight stereochemical restraints with deviations from ideal geometry of 0.01 A and 2 degrees. The three independent molecules (2 in P6(3), 1 in R3) are similar, with deviations in C alpha positions of 0.6 A. The polypeptide chain of 320 amino acid residues is folded into a planar cyclic arrangement of four repeats. The repeats have similar structures of five alpha-helical segments wound into a right-handed compact superhelix. Three calcium ion sites in repeats I, II and IV and two lanthanum ion sites in repeat I have been found in the R3 crystals. They are located at the convex face of the molecule opposite the N terminus. Repeat III has a different conformation at this site and no calcium bound. The calcium sites are similar to the phospholipase A2 calcium-binding site, suggesting analogy also in phospholipid interaction. The center of the molecule is formed by a channel of polar charged residues, which also harbors a chain of ordered water molecules conserved in the different crystal forms. Comparison with amino acid sequences of other annexins shows a high degree of similarity between them. Long insertions are found only at the N termini. Most conserved are the residues forming the metal-binding sites and the polar channel. Annexins V and VII form voltage-gated calcium ion channels when bound to membranes in vitro. We suggest that annexins bind with their convex face to membranes, causing local disorder and permeability of the phospholipid bilayers. Annexins are Janus-faced proteins that face phospholipid and water and mediate calcium transport.

Cortical blindness in postpartum preeclampsia progressing to eclampsia: case report

A 23-year-old woman who had an uneventful prenatal course and normal delivery developed severe, generalized headache and blurred vision on postpartum day four. The patient was noted to have generalized hyperreflexia and sustained ankle clonus. The blood pressure was 170/100 mm Hg, there was no edema, and the urine showed trace proteinuria. The visual disturbance rapidly progressed to complete blindness with preserved pupillary reactions. The patient then had a generalized tonic-clonic seizure lasting about one minute. Treatment was initiated with intravenous diazepam and phenytoin, and there was no recurrence of seizure activity. Vision returned to normal and the patient made a complete recovery. This case is presented to demonstrate progressive postpartum pre-eclampsia and the importance of early recognition and treatment. Pathophysiologic mechanisms and treatment options are discussed.

[Inhibitory activity of allene cholesteryl derivatives on the biosynthesis of ecdysone]

Prothoracic glands of the migratory locust Locusta migratoria during the postembryonnic development, are the biosynthetic source of ecdysone. The production of ecdysone by these glands in vitro has been used to evaluate the inhibitory activity of four cholesteryl derivatives with an allenic function on the side chain at C-22. These molecules were devised as potential inhibitors of hydroxylation at C-22 which is an obligate step in the biosynthesis of ecdysone. Three of the four molecules tested induce a marked depressory effect of the production of ecdysone. The effect of the compound with the higher activity was dose dependent and irreversible.

Ghosts of chromaffin granules accumulate biogenic amines according to a "pump and leak system" without contribution of carrier-mediated efflux

Unidirectional inward transport into, accumulation by and loss of biogenic amines from ghosts of bovine chromaffin granules were studied to determine whether a carrier-mediated process contributes to the outward passage of amines across the granule membrane. In the presence of ATP-Mg2+, incubated ghosts (30 degrees C; pH 7.3) showed a reserpine-sensitive (IC50 2-5 nmol/l), unidirectional, inward transport of catecholamine (CA = 70% adrenaline/30% noradrenaline), 5-hydroxytryptamine (5-HT) and tyramine with different Km values (mumol/l: tyramine 2; 5-HT 5; CA 8) but with the same Vmax [20 nmol/(mg protein.min)] during the first 3 min of incubation. During longer incubation, the rate of unidirectional inward transport declined rapidly with time to about 30 to 40%, at which level it stayed nearly constant from 50 to 100 min of incubation. As the decline of unidirectional transport was independent of the amine accumulated in the ghosts, it is concluded that it reflects ageing of the membrane vesicles. During incubation for up to 100 min with CA, 5-HT or tyramine (10- to 30-fold Km) in the presence of ATP-Mg2+, the amine content of the ghosts increased, approaching a steady-state content (nmol amine/mg protein: CA 400-500, 5-HT 250, tyramine 60), which was negatively correlated with the lipid solubility of the amine (tyramine greater than 5-HT greater than CA), whereas the rate of approach to steady state (t1/2 in min: CA 20-30, 5-HT 7-10, tyramine less than 5) was positively correlated. Low concentrations of reserpine (greater than or equal to 25 nmol/l) caused net loss of amine from amine-loaded ghosts by inhibition of inward transport. However, reserpine did not reduce the fractional rate of loss (FRL) of CA-loaded ghosts induced by NH+4 or uncoupling agents. Accelerated exchange diffusion was not found to occur at the granule membrane, as addition of high concentrations of 5-HT or dopamine to CA-loaded ghosts did not result in a higher FRL of CA than did blockade of inward transport by reserpine. Analysis of steady-state kinetics revealed the following features of the granule transport. The approach to steady state (t1/2) was independent of the rate of inward transport. The steady-state amine content of ghosts approached a limiting value as the external concentration of the amine was increased; it was determined by the same kinetic constants (Km and the time-dependent Vmax) as found for the rate of carrier-mediated inward transport.(ABSTRACT TRUNCATED AT 400 WORDS)

Nitroglycerin and sucrose permeability as quality markers for reconstructed human epidermis

In order to evaluate the epidermal permeability barrier of in vitro reconstructed epidermis, the penetration of nitroglycerin (NG) and sucrose were measured across human keratinocytes cultured at the air-liquid interface, using de-epidermized dermis (DED) as a substrate. In the presence of reconstructed epidermis on top of DED the penetration rate of sucrose is about 100 times and that of NG 2 times lower, as compared to DED only, indicating that the stratum corneum of the cultured epidermis exhibits considerable barrier capacity. The permeability of reconstructed epidermis was for both solutes higher (3- to 10-fold) than that of freshly excised human skin. Based on the impaired barrier function and distribution of various differentiation markers it can be concluded that the reconstructed human epidermis used in the present study shows a high extent of similarity with hyperproliferating epidermis.

The effect of (+/-)-dobutamine on adrenergic nerve endings

Possible effects of (+/-)-dobutamine on adrenergic nerve endings were determined in experiments with ghosts of bovine chromaffin granules, with rat phaeochromocytoma (PC-12) cells and with the rat vas deferens. Dobutamine inhibited the vesicular uptake of a mixture of 70% adrenaline + 30% 3H-noradrenaline into ghosts, with an IC50 of 1.7 mumol/l. Dobutamine inhibited uptake1 of 3H-noradrenaline in PC-12 cells (with an IC50 of 0.38 mumol/l) without being a substrate. However, dobutamine easily entered PC-12 cells by diffusion. After inhibition of MAO, COMT and vesicular uptake dobutamine (15 and 45 mumol/l) released tritium from rat vasa deferentia preloaded with 3H-noradrenaline. Equi-inhibitory concentrations of dobutamine and desipramine (against uptake1) were equi-releasing. On the other hand, when MAO and vesicular uptake were intact, dobutamine (15 mumol/l) increased the efflux of tritium from preloaded vasa deferentia much more than did an equi-inhibitory concentration of desipramine. Most of the released tritium was then 3H-DOPEG. Dobutamine is a potent inhibitor of uptake1 as well as of vesicular uptake; moreover, it easily diffuses into adrenergic nerve endings. Hence, it blocks the neuronal and the vesicular re-uptake of noradrenaline; consequently, when MAO and vesicular uptake are intact, dobutamine increases the net leakage of noradrenaline from the storage vesicles, thereby leading to an efflux of deaminated metabolites. However, dobutamine is virtually unable to release noradrenaline into the extracellular space.

Hyperprealbuminemia, euthyroid hyperthyroxinemia, Zollinger-Ellison-like syndrome and hypercorticism in a pancreatic endocrine tumour

Prealbumin, one of the main thyroxine transport proteins, has recently been shown to be a valuable immunohistochemical marker of neuroendocrine tumours. We report the case of a multisecretory pancreatic endocrine tumour whose prealbumin secretion was so high that it produced a peak on routine serum protein electrophoresis and induced a euthyroid hyperthyroxinemia. The maximal binding capacity of prealbumin for thyroxine was indeed markedly increased, whereas its affinity for this hormone was normal. The tumour was associated with gastric hyperacidity and hypergastrinemia thereby evoking a Zollinger-Ellison syndrome. The secretin stimulation test and gastrin tumoural immunohistochemistry were, however, negative. We suggest that the concomitant tumoural production of gastrin-releasing peptide was responsible for the gastric hyperacidity and hypergastrinemia. This hormone probably also accounted for a moderate hypercorticism.

Visual acuity, corrective lenses, and accidents in helicopter pilots

The visual acuity of 38 helicopter pilots experiencing serious air accidents was compared to that of a control group of 72 pilots, matched for age, aircraft, and hours of flight. Decrease in visual acuity was divided into two groups: 1) minor decreases in vision up to 20/25 (not requiring corrective lenses); and 2) visual acuity of 20/30 or less with correction to 20/20. Minor decreases in visual acuity were found in 23.7% (9/38) of those in the accident group compared to 25.0% (18/72) in the control group. There were more pilots in the control group who needed corrective lenses (12.5% (18/72) versus 2.8% (1/38), p less than 0.07). We conclude that helicopter pilots with corrective lenses or minor uncorrected decreases in visual acuity are not at increased risk for serious air accidents.

[Hyperthyroidism induced by amiodarone]

The incidence of amiodarone-induced thyrotoxicosis remains unclear, partly due to the difficulties encountered in making a firm diagnosis based on thyroid hormone levels. Amiodarone is known to inhibit thyroxine (T4) metabolism, thus bringing plasma T4 concentrations up to levels that may simulate T4 toxicosis. On the other hand, the iodine overload due to the drug itself may create true hyperthyroidism. The purpose of this paper is to suggest practical means of detecting thyrotoxicosis in patients on amiodarone and to discuss the treatment of this side-effect.