A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis

BACKGROUND

Cerebral metastasis is a common oncologic problem that occurs in 15-30% of cancer patients; approximately half such metastases are single. Previous retrospective studies and two randomized trials reported that the addition of surgical extirpation prior to radiation therapy increased survival, neurologic function, and quality of life compared with radiation alone in patients with a single brain metastasis.

METHODS

A randomized controlled trial was conducted in which patients with a single brain metastasis were allocated to undergo radiation alone or surgery plus radiation. Radiation consisted of 3000 centigray to the whole brain in 10 fractions.

RESULTS

Forty-three patients received radiation alone and 41 patients surgery plus radiation. All but two of the study patients died. No difference in survival was detected between the groups; the median survival for the radiation group was 6.3 months (95% confidence interval, 3-11.4) compared with 5.6 months for the surgery plus radiation group (95% confidence interval, 3.9-7.2) (P = 0.24). Most patients died within the first year (69.8% in the radiation arm vs. 87.8% in the surgery plus radiation arm). There were no significant differences in the 30-day mortality, morbidity, or causes of death. Extracranial metastases was an important predictor of mortality (relative risk, 2.3). The mean proportion of days that the Karnofsky performance status was > or = 70% did not differ between the 2 groups.

CONCLUSIONS

This trial failed to demonstrate that the addition of surgery to radiation therapy improved outcome of patients with a single brain metastasis. Thus, the efficacy of surgery plus radiation compared with radiation alone needs to be addressed by further clinical trials and/or a meta-analysis.

High-performance liquid chromatographic-ultraviolet assay for the simultaneous quantitation of BMS-181101 and its putative hydroxy metabolites in rat and monkey plasma

A specific, accurate, precise, and reproducible High-performance liquid chromatographic-Ultraviolet (HPLC-UV) method was developed for the simultaneous quantitation of BMS-181101 (I), a new antidepressant, and its putative metabolites, 6'-hydroxy (II) and 7'-hydroxy (III) of BMS-181101 in rat and monkey plasma. The assay procedure involved solid-phase extraction of the three analytes and the internal standard (IS; BMY-42568) on 1 mL Bond Elut CN cartridge using an automated solid phase extraction controller (ASPEC) system. The final elution of the analytes was performed using 0.25% triethylamine in methanol. The eluate mixture was evaporated to dryness, the residue was reconstituted in the mobile phase and injected onto a Zorbax Phenyl column (4.6 x 250 mm; 5 microns) at a flow-rate of 1.2 mL/min. The mobile phase consisted of 20% acetonitrile, 10% methanol, 69% water and 1% 1.0 M ammonium phosphate and 1.0 M tetramethylammonium hydroxide mixture adjusted to pH 3 by phosphoric acid. An ultraviolet absorbance detector set at 287 nm was used to detect the analytes. The nominal retention times were 5, 8, 15, and 18 min for II, III, I, and IS, respectively. The standard curves for the three analytes were linear in the concentration range of 50-1000 ng/mL. The lower limit of quantitation was 50 ng/mL for each analyte. The analyses of quality control (QC) samples indicated that the nominal values could be predicted with an accuracy of (+/-) 10.5% for all three analytes in rat and monkey plasma. The precision values of the QC samples for all three analytes were within 12.7% RSD for rat and monkey plasma. All three analytes and the IS were stable in the autosampler for at least 38 h; freeze/thaw stability of the 3 analytes was established for three cycles. Stability of BMS-181101 was established for one month at -20 degrees C. The application of the assay to a pharmacokinetic study in monkey is described.

A study of human lens cell growth in vitro. A model for posterior capsule opacification

PURPOSE

After intraocular lens (IOL) implant surgery for cataract, cell growth on the posterior capsule is responsible for renewed visual impairment in approximately 30% of patients. The authors have, therefore, developed a human lens capsule system to study this growth in vitro.

METHODS

Sham cataract surgery, including anterior capsulorhexis, nucleus hydroexpression, and aspiration of lens fibers, was performed on donor eyes. In some cases, a polymethylmethacrylate IOL implant was placed in the capsular bag. The capsular bag was dissected free, pinned flat on a plastic culture dish, covered with Eagle's minimum essential medium supplemented with 10% fetal calf serum and observed by phase-contrast and dark-field microscopy for as long as 100 days. At the end-point, capsules were examined by fluorescence microscopy for actin, vimentin, and chromatin.

RESULTS

Within 24 hours, there was evidence of cell growth in the equatorial region. After 2 to 3 days, cells were normally observed growing from the rhexis onto the posterior capsule and across the anterior surface of the IOL, if present. Growth proceeded rapidly so that the posterior capsule, for example, was totally covered by a confluent monolayer of cells at 5.8 +/- 0.6 days and 7.2 +/- 0.7 days for capsules aged < 40 years and > 60 years, respectively. Total cover of the anterior IOL surface generally followed 4 to 5 days behind that of the capsule. Capsular wrinkles became increasingly apparent as time progressed, causing a marked rise in light scatter. An increase in capsular tension also occurred, and the actin filaments became more polarized near the wrinkles.

CONCLUSIONS

The model presented here for posterior capsule opacification shows many of the changes seen in vivo, including rapid lens cell growth, wrinkling, tensioning, and light scatter in the posterior capsule. It will be possible to develop strategies for inhibiting cell growth with this system.

LFA-1-deficient mice show normal CTL responses to virus but fail to reject immunogenic tumor

The leukocyte integrin LFA-1 (CD11a/CD18) plays an important role in lymphocyte recirculation and homotypic interactions. Leukocytes from mice lacking CD11a displayed defects in in vitro homotypic aggregation, in proliferation in mixed lymphocyte reactions, and in response to mitogen. Mutant mice mounted normal cytotoxic T cell (CTL) responses against systemic LCMV and VSV infections and showed normal ex vivo CTL function. However, LFA-1-deficient mice did not reject immunogenic tumors grafted into footpads and did not demonstrate priming response against tumor-specific antigen. Thus CD11a deficiency causes a selective defect in induction of peripheral immune responses whereas responses to systemic infection are normal.

Calcium ionophore induced proteolysis and cataract: inhibition by cell permeable calpain antagonists

Two dipeptide aldehyde cell permeable calpain inhibitors, cBz-Val-Phe and calpeptin, have been assessed for their ability to prevent cytoskeletal proteolysis and loss of transparency in whole rat lenses. Calcium overload, induced by ionomycin in artificial aqueous humor with 1mM calcium, resulted in lens opacification and degradation of cytoskeletal proteins including spectrin, filensin, and vimentin. No such changes resulted from incubation in ionomycin in the absence of calcium. In calcium overload lenses both inhibitors gave some protection against cytoskeletal protein degradation and loss of transparency. These experiments indicate that calpain has a role in cortical opacification in high calcium lenses and that cell penetrating calpain inhibitors do indeed enter lens cells and reduce both proteolysis and opacification.

An Investigation off Learning Styles of Practical and Baccalaureate Nursing Students

The purpose of this non-experimental, descriptive study was to identify the predominant perception and ordering learning styles of practical and baccalaureate nursing students and to ascertain if there was a difference in the learning styles of the two levels of nursing students. The Gregorc Style Delineator was used to assess the learning styles. The sample consisted of 55 practical nursing students at a vocational college and 48 junior and senior baccalaureate nursing students at a small university. Both colleges were located in the midwestern United States. The findings indicated there was a statistically significant relationship between the learning style of practical and baccalaureate nursing students. The small sample size (N = 103) and the use of a non-random, convenience sample limits the generalization of the findings.

Human phylogenetic relationships according to the D1S80 locus

By analyzing the allelic frequencies at the D1S80 locus in 43 human populations, we show that the locus is polymorphic globally and that it can be used to discriminate between major racial groups and subpopulations through phylogenetic analysis. Although the use of informative multiple loci generally provides more accurate phylogenetic relationships, in instances where time and/or target DNA availability is limited, D1S80 could provide useful data to discriminate between human groups. Also, knowledge of which loci independently provide accurate phylogenetic relationships, such as the D1S80, can be used to design more accurate multi-locus combinations. In addition, allele frequencies at the locus are reported, for the first time, for Bahamian individuals of African origin and for Chimila, Bari, and Navajo (Cañoncito Valley) native Americans. Allelic data was obtained using standard polymerase chain reaction (PCR) techniques. In the four new populations, 65 genotypes and 20 segregating alleles were observed. All populations conformed to Hardy-Weinberg expectations except the Chimila.

Calcium mobilisation modulates growth of lens cells

The modulating effect of calcium cell signalling agonists on tissue growth was studied in a rabbit lens cell line (NN1003A). Calcium mobilisation was measured after Fura-2 incorporation and growth assayed either by direct Coulter counting or [3H]-thymidine incorporation. Transient increases in cytoplasmic calcium were elicited by rabbit serum, histamine, ATP and PDGF. Thapsigargin induced a prolonged increase and all of the above agonists failed to elicit a response after thapsigargin. Rabbit serum and PDGF both increased cell growth in a concentration-dependent manner. While histamine and ATP had little effect in serum-free medium, they reduced serum-stimulated growth. Acetylcholine and FGF did not produce a marked rise in cytoplasmic calcium and neither did they modulate growth. Both thapsigargin and caffeine greatly inhibited growth. These findings indicate that, in lens cells, agonists that mobilise calcium, whether by acting through G-protein or tyrosine kinase receptors, also modulate lens cell growth. Agents such as thapsigargin and caffeine that inactivate the same calcium store also inhibit growth.

Gait speed and activities of daily living function in geriatric patients

OBJECTIVE

To establish the relationship between gait speed (GS) and functional independence in elderly people.

DESIGN

GS is suggested as being a criterion standard in rehabilitation reflecting muscle strength. This study assessed the relationship between gait speed and functional independence in Activities of Daily Living (ADL). GS was measured by portable accelerometer over 2 meters. The mean of 3 attempts was taken. ADL function was measured by an occupational therapist using the modified Barthel ADL Index. The relationship between these measures was assessed by a statistician.

SETTING

A geriatric unit in a hospital in Scotland.

PATIENTS

One hundred sixty-one inpatients and outpatients were selected at random from the patients of a geriatric unit over a 3-month period. Patients were eligible if they were mobile with or without a walking aid.

INTERVENTIONS

GS was measured by portable ultrasonic accelerometer. Patients were reviewed by an occupational therapist, blinded to their GS, who recorded functional capacity. Case sheet review provided diagnostic details and cognitive function. The type of floor surface was recorded.

MAIN OUTCOME MEASURES

GS (m/sec), and Barthel score.

RESULTS

Patients with GS of < .25m/sec were more likely to be dependent in one or more ADL function, p < .01. Those with a GS between .35 and .55m/sec were more likely to be independent in all ADL functions, p < .001. Patients whose GS was > .55m/sec did not maintain this independence. There was no relationship between GS and floor surface or cognitive function.

CONCLUSIONS

GS is a useful indicator of ADL function in geriatric patients.

Calcium localization and ultrastructure of clear and pCMPS-treated rat lenses

PURPOSE

The sulfhydryl complexing agent p-chloromercuri-phenylsulfonate (pCMPS) has been shown to increase lens membrane permeability, Na+ and Ca2+ content, and light scatter in the rat lens in vitro. This study aimed to investigate the ultrastructural changes accompanying the increase in light scatter. In addition, high-resolution histochemistry was used to study the cellular distribution of Ca2+ in normal and cataractous lenses.

METHODS

Rat lenses were incubated for 4 hours in normal (1 mM) and high (5 mM) Ca2+ containing media supplemented with 40 microM pCMPS. Control lenses were incubated in 1 mM Ca2+ containing medium. They were prepared for scanning and transmission electron microscopy and for Ca2+ localization using the oxalate-pyroantimonate procedure.

RESULTS

Control lenses incubated for 4 hours had normal morphology and showed no evidence of light scatter. Calcium distribution as observed with the oxalate-pyroantimonate precipitation method was low in superficial fibers, high in the membranes of intermediate fibers, and declined again toward the nucleus. In the deeper cortex, there also were small vacuoles of calcium accumulation. pCMPS treatment (in 1 and 5 mM Ca2+) induced a significant influx of calcium into the lens cytoplasm. Calcium-containing extracellular vacuoles also were seen in the intermediate cortex in both cases. The presence of these vacuoles appeared to correlate with the major areas of light scatter in the lens. In 5 mM Ca2+, intracellular vacuoles were observed throughout the superficial cortex.

CONCLUSIONS

Most of the calcium observed by oxalate-pyroantimonate in the normal lens is located at the membrane, and the staining appears strongest in the intermediate cortex. In pCMPS treatment, large extracellular vacuoles are present in this intermediate zone and appear to be the major source of light scatter. This zone may be the initiation site of many different types of cataract, including some described in human lenses.

Public education and depth of primary malignant melanoma, Hutt Hospital, 1985-92

AIMS

To document the depth of primary malignant melanoma treated at the Wellington regional plastic and maxillo-facial surgical unit, Hutt Hospital, from 1985-92. To determine the effects of public education campaigns commenced in 1987, on the presentation of melanoma at Hutt Hospital, and to ascertain whether the Department of Health, Health Goals for 1995 were attained in relation to Hutt Hospital.

METHODS

A surgical audit was established in 1985 to record all cases of melanoma treated at the plastic surgical unit, Hutt Hospital. Data relating to the depth (Breslow index) of each primary melanoma was extracted from this audit, and reviewed. Metastatic or recurrent disease was excluded.

RESULTS

The number of cases of primary melanoma treated at this unit increased greatly following the Cancer Society initiated Spotcheck programme in 1987. There was a significant increase (p < 0.001) in the number and proportion of thin (less than 0.76mm) invasive melanomas treated, from 30% of the total in 1985, through to 70% in 1992. There was no increase in the actual number of thick (> 0.75mm) invasive melanoma, with the total number of cases being treated remaining relatively constant from 1989 onwards.

CONCLUSIONS

Significantly more patients are presenting with thin melanoma. This may be due to the nature of the disease itself, alterations in referral patterns, or due to earlier identification of malignant lesions due to greater public education. The education campaigns appear to be responsible for the observed increase in cases of melanoma presenting to our unit. The Department of Health goals for 1995 have already been achieved with > 60% of primary malignant melanoma being < 0.76 mm in depth at time of presentation.

Histamine and ATP mobilize calcium by activation of H1 and P2u receptors in human lens epithelial cells

1. Cytoplasmic calcium concentration ([Ca2+]1) of single superfused tissue-cultured human lens epithelial cells (HLEC) was monitored using the fluorescent dye fura-2; the resting values were low and stable for several hours ([Ca2+]i = 96 +/- 20 nM; mean +/- S.D., n = 16). 2. Continuous superfusion with either ATP or histamine (0.1-10 microM) produced regular oscillations in [Ca2+]i that could be maintained for a short time in the absence of external calcium. 3. Short (30 s) pulses of histamine (0.1-100 microM) induced a transient rise in [Ca2+]i, the time course of which was insensitive to the removal of external calcium. The rate of rise and the amplitude of the response were very sensitive to agonist concentration, whereas the rate of recovery was relatively constant. 4. The responses to long pulses of histamine (> 100 s) consisted of an initial transient followed by a maintained [Ca2+]i which returned to baseline on removal of external calcium. 5. The kinetics of the responses to short and long pulses of ATP (0.1-100 microM) were very similar to those of histamine and showed a similar sensitivity to the presence or absence of external calcium. 6. The histamine responses were abolished by triprolidine (1 microM), but unaffected by ranitidine (1 microM), indicating that an Hi receptor subtype is activated by histamine. 7. The ATP responses were reversibly inhibited by suramin and the potency sequence for a range of agonists was ATP = UTP = ATP gamma S > ADP = GTP >> AMP = adenosine, indicating that activation of a P2u receptor subtype was responsible for the increase in [Ca2+]i. 8. Both histamine and ATP responses were abolished by thapsigargin (100 nM), confirming that calcium release from intracellular stores was responsible for the initial peak of the response. Application of either agonist during the plateau phase of the thapsigargin response often led to a marked, but reversible, decline in [Ca2+]i, indicating the presence of a further, normally hidden, calcium regulatory factor associated with the presence of the agonist. 9. Maximal concentrations of either histamine or ATP totally emptied the calcium store as a subsequent application of the other agonist (or thapsigargin), in the absence of external calcium, failed to induce a further increase in the calcium signal.

Acute stroke in South Ayrshire: comparative study of pre and post stroke units

In September 1993 arrangements for managing acute stroke victims in South Ayrshire changed with the opening of a six bedded Acute Stroke Unit and a fifteen bedded Rehabilitation Stroke Unit. Previously all such patients were managed within general medical wards with a few being managed in geriatric assessment and rehabilitation facilities. This study compares the management and outcome from acute stroke before and after the establishment of these new Units. Fifty-eight patients' medical, nursing and paramedical records were studied for the period of investigation in 1992 and 68 for the same period in 1993. There was no significant difference in the age of the patients admitted or in the degree of neurological or functional impairment at the time of admission. There was a reduction in mortality from 37.9% in 1992 to 22.0% in 1993. This was not accomplished by an increase in the number of survivors requiring long term institutional care and there was no significant difference in the degree neurological or functional impairment at the time of discharge. A variety of specific management issues were also addressed by the study and in all areas there were improvements in the quality of care received by this group of patients in 1993. This study supports the view that management of acute stroke victims in specifically designated Stroke Units has a beneficial effect on outcome and quality of care.

Validation of the doubly labeled water method in growing pigs

The CO2 production (rCO2) of eight growing pigs was determined by continuous collection of CO2 over 21 days and simultaneously estimated using the doubly labeled water (DLW) method. The aim was to assess the accuracy of the method before and after correction for known sources of error and to test for any residual discrepancy arising from as yet unidentified sources of error. Mass spectrometer accuracy was verified by analyzing serial dilutions of the dose material in the form of an artificial decay curve; no significant bias was detected. The physiological errors were linearly dependent on weight gain. DLW-derived rCO2 (corrected only for fractionated water loss) underestimated the true value by 0.270 l CO2/g wt gain or -8% in the restricted (group R) and -16% in the ad libitum-fed (group AL) groups. Known sources of error accounted for -0.006 (methane), -0.032 (fecal 2H losses), -0.108 (fat synthesis), and -0.146 (changing pool size) l CO2/g wt gain. After correction for these sources of error the DLW-derived rCO2 differed from the true value by -2 +/- 3% in group R and 0 +/- 3% in group AL. Thus there was no significant bias in the DLW method after correction for known sources of error, even during rapid weight gain or at weight stability with or without correction. The precision estimates include both dose and background errors and uncertainty in the correction factors used. Strategies for optimizing precision are presented.

The influence of exercise on the energy requirements of adult males in the UK

Energy expenditure was measured over 10 d using the doubly-labelled water (DLW) and activity diary methods in summer and winter in subjects with 'light' occupations but leisure activities which ranged from 'non-active' to 'very active'. The basal metabolic rate (BMR) and the energy cost of activities were determined by indirect calorimetry. The Department of Health (1991) predicted BMR for the group (6.89 (SD 0.30) MJ/d; n 18) was not significantly different from the measured value (7.17 (SD 0.70) MJ/d; n 18). The range of DLW-derived expenditure values within the group was BMR x 1.41 to 2.41. The largest seasonal change within individuals was BMR x 0.5. The energy expenditure of the group as a whole was lower in winter (BMR x 1.88; SD 0.33; n 9) than summer (BMR x 2.01; SD 0.30; n 9) though the difference was not statistically significant. The average summer and winter DLW-derived expenditure was BMR x 1.96 (SD 0.31; n 17). The activity diary estimate of expenditure was BMR x 1.79 (SD 0.32; n 17). In a subset of the group who were representative of the most active 26% of all adult males in the UK, the DLW-derived expenditure was BMR x 2.08 (SD 0.24; n 11). This is higher than the highest Department of Health (1991) estimate of BMR x 1.6 for individuals in light occupations. The measured energy costs of low-intensity activities were similar to those presented in the Department of Health (1991) report but the value determined for running (BMR x 13.08; SD 2.4; n 6) was higher than the highest value in the report (BMR x 6 to 8). The results indicate that the recent Department of Health (1991) reference values for energy may underestimate the expenditure of a significant proportion of the UK population largely because the energy costs of activity used in the report to calculate expenditure do not accurately reflect those achieved during active leisure in individuals who take regular exercise.

cAMP regulates morphogenesis in the fungal pathogen Ustilago maydis

The fungal pathogen Ustilago maydis exhibits a dimorphic switch from budding to filamentous growth in response to mating interactions and environmental conditions. We have found that disruption of the uac1 gene, encoding adenylate cyclase, results in a constitutively filamentous phenotype. Budding is restored to the uac1 mutant upon growth in the presence of cAMP or by extragenic suppression because of a mutation in the ubc1 gene. The ubc1 gene encodes a type II regulatory subunit of cAMP-dependent protein kinase (PKA); defects in this gene attenuate the filamentous growth that normally occurs in response to mating and exposure to air. Growth of wild-type cells in cAMP and mutation of the ubc1 gene also cause defects in the separation of mother and daughter cells (cytokinesis) and alter bud site selection. These results indicate a key role for cAMP and PKA in morphogenesis in U. maydis; this role may be common among dimorphic fungal pathogens.

Living wills: would sick people change their minds?

Patients admitted acutely to a geriatric medical unit were interviewed on admission about their opinions on cardiopulmonary resuscitation (CPR). They underwent a general examination and their mental health was documented by completing the geriatric depression scale. Those who did not wish CPR in the event of a cardiac arrest were questioned again on recovery. Of 216 patients admitted, only three objected to answering the questions and after the other exclusion criteria were applied, 100 patients were included in the study. A total of 92% of patients wished CPR in the event of a cardiac arrest. The 8% who did not wish CPR contained more people scoring high on the geriatric depression scale. After recovery, three of that eight had changed their minds and wished CPR if required. Patients who are acutely unwell may make decisions that are influenced by their condition at this point in time and it is important to recognize that these decisions may not be maintained. In this study, consultant geriatricians did not reflect their patients' desires in making decisions about who should receive CPR if required.

A correlated study of metabolic cell communication and gap junction distribution in the adult frog lens

By using low molecular weight dye injection and laser scanning confocal microscopy it has been possible to assess the degree of dye communication in several regions (intraepithelial, epithelium-fibre cell, fibre-epithelium and fibre-fibre) of the adult frog lens. These same areas of the lens have also been examined by freeze fracture electron microscopy for the presence and organisation of gap junctions. Epithelial cell lateral membranes have numerous gap junctions which efficiently transmitted dye to their neighbours though none was detectable in the underlying fibre cells. This was correlated with an apparent absence of gap junctions at the epithelium/fibre cell interface. Dye spread between cortical fibre cells was only observed in a subset of fibres in the bow region of the lens. Neither mature cortical fibres nor immature bow fibres appeared to be dye-coupled and we detected no dye passed from fibre cells to adjacent epithelial cells at their anterior ends. This pattern of dye communication was also correlated with the apparent absence of recognisable gap junctions on the lateral membranes of either the recently differentiated bow fibres or the mature cortical fibres. Classical gap junctions were only found on the membranes of fibres between five and ten cells in from the lens bow, i.e. the subset of fibres which were dye-coupled. No gap junctions were found between deeper cortical fibres or nuclear fibres, although they were characterised by a number of square arrays. Though electrically well coupled the adult frog lens may be relatively poorly dye coupled and this could depend on the age and differentiation stage of the cells concerned. The model of a freely communicating lens clearly requires re-examination by correlated physiological and morphological studies.

Calmodulin antagonists induce changes in lens permeability and transparency

Calmodulin has been shown to perform several important functions in the lens including regulation of the plasma membrane Ca(2+)-ATPase. This study investigated the effects of a variety of different CaM antagonists on rat lens membrane potential, membrane resistance, intracellular Na+ and Ca2+ content and transparency, in order to examine the role of CaM in control of lens membrane permeability. W7, calmidazolium and trifluoperazine caused biphasic changes in lens membrane electrical characteristics. Phase 1 consisted of a depolarization of the membrane potential and an increase in resistance, indicating that K+ channels were being blocked. This was confirmed by application of the K+ channel antagonist, quinine, which inhibited Phase 1 changes. Phase 2 was a further depolarization coupled with a decrease in resistance, indicating the activation of a cation conductance. Application of W7 in low Na+ medium slowed the Phase 2 depolarization and decrease in resistance indicating that Na+ is the main charge carrier through the activated conductance. The CaM inhibitors also led to a large increase in the Na+ and Ca2+ contents of the lens. W5, a less potent analogue of W7, caused a depolarization and increase in membrane resistance, but no Phase 2 changes were observed. Na+ and Ca2+ contents were similar to control lenses after 4 hours incubation in 200 microM W5. In addition, exposure to W7, TFP and calmidazolium resulted in a loss of transparency, while W5 treated lenses remained clear. It appears, therefore, that CaM is involved in control of lens membrane permeability. Loss of control of these channels leads to catastrophic changes in the intracellular ionic environment and hence opacification of the lens.

Calcium regulation in tissue-cultured human and bovine lens epithelial cells

PURPOSE

To study calcium regulatory mechanisms in lens cells with particular reference to the relative contributions from the calcium adenosine triphosphatase of plasma and endoplasmic reticulum membranes, respectively.

METHODS

The calcium-sensitive fluorescent dye, Fura 2, was incorporated into tissue-cultured human and bovine epithelial cells and internal calcium was calibrated using the ionomycin (1 microM) method. The dynamics of calcium release from the endoplasmic reticulum were also studied in digitonin-permeabilized bovine cells.

RESULTS

Tissue-cultured bovine and human lens cells have very similar resting calcium levels (235 +/- 22 nM and 216 +/- 12 nM, respectively). Thapsigargin caused an increase in cytoplasmic calcium both in the presence and absence of external calcium, but the calmodulin antagonist W7 only initiated an increase in the presence of external Ca2+. The effects of thapsigargin and W7 were additive. Exposing lens cells to Na(+)-free perfusing solutions caused a transient increase in internal Ca2+. Bovine lens cells permeabilized by digitonin-released Ca2+ when exposed to inositol (1,4,5) triphosphate and the effect was maximal at 1 microM.

CONCLUSIONS

Lens cytoplasmic calcium is controlled by calcium adenosine triphosphatases at the plasma and endoplasmic reticulum membranes. The former is inhibited by W7 and insensitive to thapsigargin whereas the latter is inhibited by thapsigargin, but insensitive to W7. The lens endoplasmic reticulum store is also controlled by an inositol (1,4,5) trisphosphate calcium-release mechanism. Na+/Ca2+ exchange plays a relatively minor role in calcium regulation, at least at resting calcium levels.

pCMPS-induced changes in lens membrane permeability and transparency

PURPOSE

To investigate the role of externally facing membrane protein sulfhydryl groups in controlling lens permeability and transparency using the impermeant sulfhydryl complexing agent p-chloromercuriphenyl sulfonate (pCMPS).

METHODS

Membrane permeability changes were studied by measuring lens voltage and resistance. Ion movements were monitored by measuring 22Na+ and 45Ca2+ fluxes, and internal free calcium was monitored by ion-selective microelectrodes. Opacification was quantified by photographing and analyzing back-scattered light.

RESULTS

pCMPS, at concentrations above 1 microM, produced a depolarization of membrane potential and decrease in membrane resistance. These changes were accompanied by a marked stimulation in 22Na+ and 45Ca2+ influxes into the lens. There was a concomitant loss of lens transparency, mainly in the bow region. The pCMPS-induced electrical changes could be prevented by substituting N-methyl-D-glucamine for Na+ in the external medium. Na(+)-free solution alone increased 45Ca2+ influx, and the addition of pCMPS further stimulated the influx. Quinine (300 microM) was found to reduce the pCMPS-induced stimulation of 22Na+ and 45Ca2+ influxes and also to reduce opacification.

CONCLUSIONS

pCMPS at low concentrations induces many of the cation permeability changes previously found to occur with age and cataract in the lens. The fact that quinine can ameliorate pCMPS-induced changes in ion movements and opacification suggests a novel approach for membrane-based anticataract strategies.