The immunogenetics of early nephropathy in insulin-dependent diabetes mellitus: association between the HLA-A2 antigen and albuminuria

One-hundred and seventy-two normotensive, insulin-dependent diabetic patients without clinical proteinuria (Albustix negative) were typed for the major histocompatibility complex class I (HLA-A, -B) and class II (HLA-DR) antigens. Urinary albumin excretion was measured as the albumin:creatinine ratio (UA/UC, mg/mmol) in an early morning sample. Patients expressing the HLA-A2 antigen had significantly higher UA/UC values than those not expressing the antigen. The observed ratio of geometric means was 1.77 (95 per cent confidence interval (CI) 1.18-2.67; p < 0.01); the relative risk of microalbuminuria (UA/UC > 3.0 mg/mmol) associated with expression of HLA-A2 was 2.52 (95 per cent CI 1.11-5.73; p < 0.05). There was no significant association between UA/UC and HLA-B8, -B15, -DR3, -DR4 or other antigens. Patients were re-studied after a mean period of 5.3 years: multiple linear regression analysis showed that the UA/UC at this time was positively related to the initial glycosylated haemoglobin level (p < 0.01) and expression of the HLA-A2 antigen (p < 0.05), but not to blood pressure or creatinine clearance. Fifteen patients developed macroalbuminuria at follow-up (UA/UC > 45.5 mg/mmol). Compared with a group matched for age, sex, duration of diabetes, and glycosylated haemoglobin who did not develop macroalbuminuria, macroalbuminuric patients had a higher frequency of HLA-A2 (p < 0.01). The odds ratio of progressing to macroalbuminuria associated with HLA-A2 had a 95 per cent CI of 1.71 to infinity. We conclude that an immunogenetic factor may play a role in the development of early diabetic nephropathy and that the risk associated with expression of the HLA-A2 antigen is independent of metabolic control and blood pressure.

Surgical treatment of pulmonary hypertension in protein C deficiency

Two patients with protein C deficiency developed symptomatic pulmonary hypertension secondary to chronic pulmonary embolism. They were successfully treated by thromboendarterectomy.

Neutrophil activation by Helicobacter pylori

Helicobacter pylori infection of the stomach is accompanied by a persistent polymorphonuclear leukocyte (PMNL) infiltrate of the mucosa. The aim of this work was to study the activation of human PMNL by substances produced by H pylori. Filtered H pylori conditioned media stimulated a significant PMNL oxidative burst (p less than 0.002). This was equal to 26% of the maximal response stimulated by the PMNL chemotactic peptide N-formyl-methionyl-leucyl-phenylalanine (FMLP, 1 mumol/l). The response to FMLP was prolonged by the combined presence of complement inactivated human anti-H pylori plasma and conditioned medium (p less than 0.002). High pressure liquid chromatography of an extract of conditioned medium showed a fraction that stimulated PMNL, eluted, and antigenically cross reacted with FMLP. Washed H pylori cells, and those opsonised with complement inactivated human anti-H pylori plasma, did not induce a significant oxidative burst. Opsonized H pylori, however, prolonged the oxidative burst induced by FMLP (p less than 0.02). In conclusion, H pylori synthesizes and secretes a substance, probably FMLP, that may account for the PMNL accumulation that accompanies H pylori infections. Immune complexes composed of H pylori antigen and specific antibody potentiate the PMNL oxidative burst. This combination of H pylori derived products, and host PMNL and antibodies, may be involved in the mucosal damage observed in H pylori associated gastritis.

Aminopropylidine diphosphonate (APD) in mild primary hyperparathyroidism: effect on clinical status

Mild hypercalcaemia associated with primary hyperparathyroidism has been increasingly recognized with the use of automated biochemical screening. Management is often difficult as symptoms are often absent or non-specific. Accordingly, we employed the hypocalcaemic effect of the diphosphonate APD to assess the effect of an acute fall in plasma calcium on indices of general well being, blood pressure, and vasoactive hormones in patients with mild primary hyperparathyroidism. Ten patients were studied in a randomized single blind, placebo-controlled cross-over study, using 30 mg APD intravenously or control saline infusion, over 2 h. Metabolic measurements, formal tests of muscle strength and cognitive function, and a standardized questionnaire were assessed 7 days after infusions. Albumin corrected plasma calcium was significantly lower (mean 2.49 +/- 0.04 SEM mmol/l) after APD when compared to control values (2.70 +/- 0.06 mmol/l, P less than 0.001). Twenty-four-hour urinary calcium, plasma magnesium and absolute monocyte count decreased significantly, whereas plasma parathyroid hormone increased after APD (P less than 0.05). There was no significant change in hypercalcaemic symptoms, muscle strength or cognitive function, and blood pressure, renin, aldosterone and atrial natriuretic peptide did not change. Side-effects, when they occurred, were mild. It is concluded that APD is a safe and effective means of lowering plasma calcium in mild primary hyperparathyroidism, but these acute reductions are associated with little or no improvement in clinical status in these patients.

The application of a short anxiety and depression questionnaire to oil industry staff

A short anxiety and depression questionnaire developed by Goldberg et al. was applied to 796 employees of an oil company operating offshore in the North Sea. Anxiety and depression scores were compared in offshore staff and their onshore counterparts at different levels of seniority. These scores were taken to be indicators of stress levels. No statistically significant differences in anxiety or depression scores were identified between groups working onshore or offshore.

Addition of carbohydrate side chains at novel sites on influenza virus hemagglutinin can modulate the folding, transport, and activity of the molecule

We have constructed and expressed a series of mutant influenza virus hemagglutinins, each containing a new consensus site for glycosylation in addition to the seven sites found on the wild-type protein. Oligosaccharide side chains were added with high efficiency at four of the five novel sites, located on areas of the protein's surface that are not normally shielded by carbohydrate. Investigations of the structure, intracellular transport, and biological activities of the mutant hemagglutinin molecules indicated that (a) supernumerary carbohydrate side chains can be used to shield or disrupt functional epitopes on the surface of hemagglutinin, and (b) the presence of an additional oligosaccharide may cause temperature-dependent defects in the transport of the glycoprotein. We discuss the addition of supernumerary oligosaccharides as a general tool for shielding chosen areas of the surface of proteins that enter or traverse the secretory pathway.

The spontaneous and enzymatic reaction of N-acetyl-p-benzoquinonimine with glutathione: a stopped-flow kinetic study

The spontaneous and glutathione (GSH) transferase catalyzed reactions of GSH and N-acetyl-p-benzoquinonimine (NABQI) have been studied by stopped-flow kinetics. The spontaneous reaction was shown to be first order in NABQI, GSH and inversely proportional to the H+ concentration; e.g., at pH 7.0 and 25 degrees C the second-order rate constant was 3.2 X 10(4) M-1 s-1. Data for the enzymatic reaction gave values for Km of 27, 1.3, 7, and 7 microM and values for kappa cat of 90, 37, 5.1, and 165 s-1 for rat liver GSH transferases 1-1, 2-2, 3-3, and 7-7, respectively. Over a wide range of reactant concentrations and pH, the spontaneous reaction yields three products, namely a GSH conjugate, 3-(glutathion-S-yl)acetaminophen; a reduction product, acetaminophen; and an oxidation product, glutathione disulfide in the proportions 2:1:1. Analysis of products formed after enzymatic reaction showed that both GSH conjugation and the reduction of NABQI to acetaminophen were catalyzed to an extent characteristic of each isoenzyme. With respect to GSH conjugation, GSH transferase isoenzymes were effective in the order 7-7 greater than 2-2 greater than 1-1 greater than 3-3 greater than 4-4, and with respect to NABQI reduction these isoenzymes were effective in the order 1-1 greater than 2-2 greater than 7-7 the position of isoenzymes 3-3 and 4-4 being uncertain. Human GSH transferases delta, mu, and pi behave similarly to the homologous rat enzymes, i.e., toward conjugation in the order pi greater than delta greater than mu and the reduction delta greater than mu greater than pi (for nomenclature see W. B. Jakoby, B. Ketterer, and B. Mannervik, (1984) Biochem. Pharmacol. 33, 2539-2540). Possible mechanisms of the reaction and its effect on the toxicity of NABQI are discussed.

Erythrocyte fatty acid profiles in patients with bronchogenic carcinoma

The use of the erythrocyte stearic:oleic acid ratio in the diagnosis and prognosis of bronchogenic carcinoma has been assessed. Although there was a significant difference (P less than 0.02) in the erythrocyte stearic:oleic acid ratio between bronchogenic carcinoma patients and healthy adults, the large overlap observed in the two groups rendered the test unsuitable for the diagnosis of malignancy. Furthermore, there was no consistent rise in this ratio after surgical resection, indicating the test to be of little prognostic use. A new explanation for the lower stearic:oleic acid ratios in certain patients has been postulated.

The influenza hemagglutinin precursor as an acid-sensitive probe of the biosynthetic pathway

The hemagglutinin of influenza virus (HA), an acid-activated membrane fusion protein, is synthesized in the endoplasmic reticulum and transported through the Golgi complex to the cell surface of infected cells as an uncleaved, fusion-incompetent precursor, HA0. The mature, proteolytically activated HA is known to undergo a rapid, irreversible, acid-induced conformational change which mediates membrane fusion and virus penetration. On the basis of antigenic modifications and the acquisition of trypsin susceptibility, we demonstrate here that HA0, while unable to cause fusion, is acid sensitive. It undergoes irreversible conformational changes quite similar to those of HA at mildly acidic pH (pH less than 6.0). The ectodomain of HA0 does not, however, acquire hydrophobic properties and the changes occur in a less concerted manner (the pH dependence is much broader and the rate of conversion slower). These differences are likely to account for the inability of acid-treated HA0 to trigger membrane fusion. It was shown, moreover, that HA0 acquired its acid-sensitive properties immediately following trimerization in the endoplasmic reticulum. Since HA0 did not convert to the acid form at any point during its intracellular transport, we concluded that the trans-Golgi compartment, known to be more acidic than the cytosol and involved in constitutive membrane transport, is not likely to have a pH less than 6.0.

Reactivity of thiols towards derivatives of 2- and 6-methyl-1,4-naphthoquinone bioreductive alkylating agents

The stoichiometry and kinetics of the anaerobic reactions between some thiols and derivatives of 2- and 6-methyl-1,4-naphthoquinones in water were measured using stopped flow spectrophotometry. The stoichiometry of the reaction with representative compounds was 1:2 thiol:quinone, a finding consistent with the formation of a hydroquinone as well as a thioether in the reaction. The first-order dependence of rate on thiol concentration, and the pH-dependent rate constants indicated that the thiolate anion was involved in the rate-limiting step, with rate constants at pH 7.6 generally increasing in the order glutathione (GSH) less than cysteamine less than dithiothreitol (DTT) less than cysteine. Despite the lower reactivity of GSH, the half-lives of the uncatalyzed conjugation reaction of these quinones at typical biological concentrations of GSH (e.g. 2 mM) ranged from about 2.0 to 20 s at pH 7.6 and 25 degrees C. The implications of these reactions in the use of naphthoquinones as potential bioreductive alkylating agents and as hypoxic cell radiosensitizers are discussed.

Control of the generation and reactions of free radicals in biological systems by kinetic and thermodynamic factors

Quantifiable redox properties are useful predictors of substrate reactivity in enzyme-catalysed redox reactions of e.g. nitroreductases or peroxidases. Redox properties may also control the rates of electron-transfer reactions between radical products of reduction and oxidation, and endogenous oxidants and reductants respectively. However, in numerous instances prototropic properties of substrate or radical may have profound kinetic consequences, protonation of radicals frequently slowing down electron-transfer reactions. Further, reactions which are thermodynamically extremely unfavourable may still proceed if radical products are removed from the pre-equilibrium efficiently. Thus kinetic considerations often outweigh the purely thermodynamic viewpoint.

One-electron reduction of 2- and 6-methyl-1,4-naphthoquinone bioreductive alkylating agents

The semiquinones, Q.-, of derivatives of 2- and 6-methyl-1,4-naphthoquinones, some incorporating leaving groups with substituents such as CH2Br or CH2OCONHCH3, have been produced by radiolytic reduction of Q by (CH3)2COH radicals. The absorption spectra and decay kinetics of Q.- were all closely similar to that produced from 2-methyl-1,4-naphthoquinone, with no evidence for unimolecular elimination of a leaving group in the semiquinone form, but immediate loss of leaving group upon two-electron reduction of Q to the hydroquinone. The redox equilibria between Q/Q.- and O2/O2.- were characterized, and reduction potentials of the couples Q/Q.- in water at pH 7.6 were calculated. The implications of these observations for the use of these compounds as bioreductive alkylating agents or as radiosensitizers with potential selective activity toward hypoxic cells are discussed.

Peroxidase activation of 1-naphthol to naphthoxy or naphthoxy-derived radicals and their reaction with glutathione

1-Naphthol was metabolised by horseradish peroxidase (HRP) in a H2O2-dependent reaction to methanol-soluble and covalently bound products. Spectrophotometric and electron spin resonance (ESR) studies established that HRP catalysed the one electron oxidation of 1-naphthol to naphthoxy or a naphthoxy-derived radical. Inclusion of glutathione (GSH) in the reaction caused a dose-dependent inhibition of covalent binding and an increase in the amount of unmetabolised 1-naphthol present at the end of the incubation. gamma-Radiolysis studies suggest that this is due to the reduction of naphthoxy radicals by GSH yielding 1-naphthol and GS.. In agreement with this, HRP-catalysed-oxidation of 1-naphthol in the presence of GSH, was found to stimulate oxidised glutathione (GSSG) formation.