Characterization of the catalase-peroxidase gene (katG) and inhA locus in isoniazid-resistant and -susceptible strains of Mycobacterium tuberculosis by automated DNA sequencing: restricted array of mutations associated with drug resistance

The catalase-peroxidase gene (katG) and a two-gene locus (inhA) containing mutations associated with resistance to isoniazid in Mycobacterium tuberculosis were sequenced in 34 resistant and 12 susceptible strains. Virtually all resistant organisms had amino acid changes in KatG or nucleotide substitutions upstream of inhA. A region of katG encoding two amino acids frequently altered in resistant strains (residues Ser315 and Arg463) and the inhA locus were sequenced in 10 susceptible and 51 isoniazid-resistant isolates from the Netherlands. Most (84%) of the resistant isolates had mutations in katG or the inhA locus or lacked katG. Together, approximately 75% of isoniazid-resistant isolates had replacements at amino acids 315 or 463 in KatG or nucleotide substitutions upstream of inhA. All 16 strains of Mycobacterium bovis and Mycobacterium microti studied had Leu463 rather than Arg463 in KatG, an observation consistent with the hypothesis that Leu463 is the ancestral condition in M. tuberculosis.

Psychosocial evaluation and prediction of compliance problems and morbidity after heart transplantation

We examined prospectively determined psychosocial evaluation data in 125 consecutive adult patients undergoing heart transplantation from January 1992 to April 1994 to determine their associations with morbidity, mortality, and compliance. Prospective ratings included age, sex, weight, education, social support, living arrangements, motivation, knowledge and expectations about transplantation, intercurrent social stressors, substance abuse, personality disorder, cognitive impairment, other psychiatric disorders, and the evaluating psychiatrist's global assessment of psychosocial risk. Additional variables evaluated were support group attendance and waiting list time. We examined outcomes including patient survival, compliance, episodes of rejection and infection, development of transplant coronary artery disease, number of missed appointments, and maintenance of ideal body weight. The posttransplant follow-up period was 13.8 +/- 9.9 months (mean +/- SD). In univariate analyses, compliance problems were associated with substance abuse history (P = .0007), personality disorder (P = .007), living arrangements (P = .02), and global psychosocial risk (P = .001). The number of rejection episodes was associated with global psychosocial risk (P = .029), and transplant coronary artery disease was inversely associated with education (P = .01). Survival was not associated with any of the predictor variables. In stepwise multivariate analyses, the significant predictors of compliance were substance abuse (odds ratio 3.69, confidence limits 1.07-12.71) and global psychosocial risk (odds ratio 3.76, confidence intervals 1.18-11.97). These findings suggest that pretransplant evaluation of psychosocial risk factors can identify patients with increased risk of postoperative noncompliance and morbidity.

Comparison of topical cyclosporin and dexamethasone for the treatment of chronic superficial keratitis in dogs

Thirty dogs with chronic superficial keratitis (CSK) were randomly assigned to treatment with 0.2 per cent cyclosporin ointment or 0.1 per cent dexamethasone drops. They were treated for six weeks and examined before and after three and six weeks of treatment, and then every three weeks without treatment until the lesions recurred. The regression of the disease during the treatment and the time to a recurrence after the cessation of treatment were determined. Changes in the size of the corneal lesions were measured by image analysis of photographs taken at each examination, and the severity of adnexal changes such as conjunctival hyperaemia was assessed by means of a scoring system. Clinical evaluations suggested that both drugs were equally effective as treatments for CSK and a statistical analysis showed that they had reduced the size of the lesions to the same extent at each examination. There was a significant increase in tear production, measured by the Schirmer tear test, during the treatment with cyclosporin.

Pharmacology of L-754,142, a highly potent, orally active, nonpeptidyl endothelin antagonist

L-754,142, (-)-N-(4-iso-propylbenzenesulfonyl)-alpha-(4-carboxyl-2-n-propy lphenoxy)-3,4- methylenedioxyphenylacetamide, is a potent nonpeptidyl endothelin antagonist (e.g., Ki: cloned human ETA = 0.062 nM: cloned human ETB = 2.25 nM), with high specificity for endothelin receptors. In vitro, L-754,142 is a potent antagonist of ET-1-induced phosphatidyl inositol hydrolysis in Chinese hamster ovary cells expressing cloned human endothelin receptors (IC50: hETA = 0.35 nM; hETB = 26 nM) and of ET-1 induced contractions in rabbit iliac artery rings (pA2 = 7.74) and rat aortic rings (pA2 = 8.7). In vivo, L-754,142 is a potent and specific antagonist of exogenously administered ET-1 or big ET-1, L-754,142 fully protects against ET-1-induced lethality in mice (AD50 = 0.26 mg/kg i.v.). The pressor response to big ET-1 in the anesthetized ferret is blocked by this compound with an ED50 value of 0.019 mg/kg i.v. L-754,142 also blocks the pressor response to big ET-1 in the conscious rat with ED50 values of 0.30 mg/kg i.v. and 0.56 mg/kg p.o. The duration of action of L-754,142 in this rat model is more than 12 hr after an oral dose of 3 mg/kg. In summary, L-754,142 is a potent, orally active ET antagonist with a long duration of action in several in vivo models.

De novo solid malignancies after cardiac transplantation

BACKGROUND

As long-term survival after cardiac transplantation improves, neoplastic complications are increasingly being discovered. Although lymphoproliferative disorders predominate, the incidence and clinical spectrum of solid tumors in a uniform population of heart transplant recipients remains uncertain.

METHODS

We reviewed our experience with 712 patients who underwent cardiac transplantation. Clinical charts were reviewed and telephone interviews were conducted, when possible.

RESULTS

De novo solid malignancies were identified in 3.3% of patients at risk (21 of 633 patients). Twenty patients were male; mean age was 51.5 +/- 8.6 years. Most patients reported a significant smoking history. Pulmonary, urologic, and Kaposi's sarcoma were the most common malignancies identified. Mean interval from transplantation to diagnosis was 35 months. Six patients were diagnosed within 6 months of transplantation. One-year and 5-year survival after transplantation were 90% and 49%, respectively. One-year and 3-year survival after cancer diagnosis were 60% and 52%, respectively.

CONCLUSIONS

De novo solid malignancy after transplantation occurred with about half the frequency of lymphoproliferative disorders. A striking male predominance was noted. The interval from transplantation to the appearance of cancer is variable, and no clustering was identified. A significant smoking history warrants aggressive search for occult malignancy during pretransplantation evaluation of potential heart recipients.

Evolution of rifampin resistance in human immunodeficiency virus-associated tuberculosis

Acquired rifampin resistance without preexisting isoniazid resistance is highly unusual in patients with tuberculosis. The purpose of this report is to describe and characterize that unusual pattern of acquired drug resistance in three patients with human immunodeficiency virus (HIV) infection. The patients originally had Mycobacterium tuberculosis strains that were susceptible to isoniazid and rifampin. During treatment in two patients and after completion of therapy in the remaining one, each patient developed active, rifampin-resistant, isoniazid-susceptible tuberculosis. One patient subsequently developed isoniazid resistance also. Studies on patients' M. tuberculosis isolates using IS6110 restriction fragment length polymorphism typing and rpoB gene sequencing indicated that rifampin resistance in each patient arose during therapy by an rpoB gene mutation in the original M. tuberculosis isolate. Detection of this unusual drug-resistance phenotype in three patients with HIV infection suggests that acquired rifampin resistance is somehow associated with co-infection due to HIV and tuberculosis.

Influence of roughage and grain processing in high-concentrate diets on the performance of long-fed Holstein steers

The effects of roughage source and timing of inclusion in high-concentrate diets on feedlot performance were evaluated in each of 2 yr with 144 and 120 long-fed Holstein steers, respectively. Roughage, when included in the diet, was delivered in a built-in-roughage (BIR) pellet supplying 15 and 6% roughage (percentage of DM) or hay crop silage (HCS) supplying 7 and 10% roughage (percentage of DM) for the growing and finishing periods, respectively. The six dietary treatments (two pens each) investigated were continuous whole corn and pelleted supplement (no added roughage; WSC-PEL); BIR with cracked corn either in the growing (BIR-G) or finishing (BIR-F) period with whole corn being fed with pelleted supplement when BIR was not part of the diet; BIR and cracked corn fed continuously (BIR-CONT); and two HCS treatments in which the corn was fed either whole (HCS-WSC) or cracked (HCS-CSC) for the entire feeding period. Replicates were slaughtered 4 and 3 wk apart for yr 1 and 2, respectively. Pooled daily gains (yr 1 and 2) for the entire trial (1.39 to 1.45 kg/d) were not different (P > .05). Daily DM and concentrate intakes were lower (P < .001) and gain efficiency was higher (P < .001) for the WSC-PEL than for the other treatments. Carcass characteristics were similar among treatments except for an improved yield grade (P < .02) for the HCS treatments over the BIR treatments. The WSC-PEL treatment was the most profitable (+/steer) and the BIR-CONT diet was the least profitable. The HCS treatments were the most profitable of the roughage treatments. A newly proposed intake prediction equation for feedlot cattle performed similarly to the 1984 NRC equation with long-fed Holstein steer calves.

Preliminary findings of ophthalmological abnormalities in farmed halibut

Ocular abnormalities occurring in farmed halibut at the Sea Fish Industry Authority Marine Farming Unit, Ardtoe, Argyll were investigated clinically and post mortem. A significant number of fish were found to have posterior polar cystic changes either causing scleral ectasia or gross degenerative posterior segment abnormalities with chorioretinal atrophy. Other ocular abnormalities included cataract formation and intraocular inflammation. In a small number of fish gas bubble formation in the anterior chamber was observed during capture and examination. It is possible that the lesions seen in these fish are a form of gas bubble disease although super-saturation, the cause of gas bubble disease previously reported in farmed fish, does not occur in the tanks in which these fish are housed. While this paper provides no answers with regard to the aetiopathogenesis of the lesions, it is hoped that it will stimulate discussion, leading to resolution of these questions through a multidisciplinary approach to the problem.

Ethanol fixation of sputum sediments for DNA-based detection of Mycobacterium tuberculosis

The effect of ethanol fixation on PCR detection and viability of Mycobacterium tuberculosis in human sputum sediments was evaluated. M. tuberculosis seeded into sputum sediments was efficiently killed when treated for 1 h with 50, 70, or 95% ethanol. PCR amplification of a 123-bp fragment of the M. tuberculosis-specific IS6110 was not affected in ethanol-treated samples even when fixation was extended to 24 h. Ethanol fixation of sputum sediments did not affect the PCR detection of M. tuberculosis in clinical samples. PCR results from ethanol-treated clinical samples containing M. tuberculosis (smear positive and smear negative) or other respiratory pathogens correlated directly with the results by conventional detection methods for M. tuberculosis. Our results show that ethanol fixation of human sputum sediments containing M. tuberculosis significantly reduces the potential exposure of workers to viable M. tuberculosis without affecting DNA analysis by PCR. Also, ethanol fixation of sputum sediments provides a simple and inexpensive way to store and transport clinical specimens identified for DNA-based diagnostics without refrigeration.

Partial characterization of chitinolytic enzymes from Streptomyces albidoflavus

Streptomyces albidoflavus NRRL B-16746 secreted three types of chitinolytic enzymes: N-acetyl-glucosaminidase, chitobiosidase and endochitinase. Optimal activity for all three types of enzymes occurred at pH 4-6; however 55-74% of the chitobiosidase and endochitinase activity was detectable at pH 8-10. Chitobiosidase activity originated from two strongly acidic (pI < 3.0) proteins with molecular mass of 27 kDa and 34 kDa, while endochitinase activity originated from five major acidic proteins (pI 5.1, 5.3, 5.75, 5.8-5.9 and 6.4) with molecular mass of 59, 45, 38.5, 27 and 25.5 kDa. Purified chitobiosidases significantly reduced spore germination and germ tube elongation of Botrytis cinerea and Fusarium oxysporum. Chitinolytic enzymes with significant activity at pH 4-10 may be used, transgenically, to reduce the growth and/or development of a broad spectrum of insects and fungi that are major economic pests.

Comparison of the carbohydrate biological response modifiers Krestin, schizophyllan and glucan phosphate by aqueous size exclusion chromatography with in-line argon-ion multi-angle laser light scattering photometry and differential viscometry detectors

A major barrier to the development, preclinical and clinical application of natural carbohydrate biological response modifiers has been the difficulty involved in accurately characterizing carbohydrate polymers with molecular masses ranging from 10(4) to 10(7) g/mol. Herein, we employed size exclusion chromatography with multi-angle laser light scattering and differential viscometry to compare and contrast structural properties of the biological response modifiers Krestin, schizophyllan and glucan phosphate. Krestin, schizophyllan and glucan phosphate exhibit significant differences in molecular mass moments, molecular mass distribution, polymer sizes, intrinsic viscosity and perhaps their solution behaviour. This knowledge of precise physicochemical data is required for a better understanding of the properties and higher structure of complex carbohydrate biological response modifiers.

Relapse of Mycobacterium leprae infection with ocular manifestations

A case of ocular leprosy as the manifestation of persistent or relapsed Mycobacterium leprae infection approximately 20 years following treatment is reported. The clinical and pathological features of this case are described, and the molecular methods needed to arrive at the definitive diagnosis are examined. If blindness is to be averted, clinicians must have a high index of suspicion for the diagnosis of ocular leprosy when anterior segment changes are noted during ophthalmologic examination of a patient from an area in which M. leprae is endemic. The indolent nature of ocular leprosy may require lifelong surveillance and therapy to insure sight preservation.

Cell surface "blanket" of apolipoprotein E on rat adrenocortical cells

Apolipoprotein (apo) E is expressed at high levels by adrenocortical cells. In the present study, an affinity-purified antibody to rat apoE was used in combination with immunogold visualization at both the light and electron microscopic levels to determine the cellular and subcellular distribution of apoE within the rat adrenal cortex. At the light microscopic level, apoE was found primarily in z. fasciculata and z. reticularis with little or none detected in z. glomerulosa and medulla. Within the z. fasciculata and z. reticularis, apoE was present in the cytoplasm of all parenchymal cells. ApoE also was found on the cell surface both on the sinusoidal front and in regions well removed from the subendothelial space. Electron microscopic examination of the z. fasciculata showed that apoE on the sinusoidal front was on the parenchymal cell surface but not the endothelial cell. Cell surface apoE was prominent on microvilli as well as non-microvillar regions of plasma membrane in the subendothelial space. ApoE was also associated with the cell surface in intercellular spaces continuous with but well removed from the subendothelial space. These findings at the light and electron microscopic levels suggest that the z. fasciculata cell is encircled or covered with apoE on all faces of the cell. These results are consistent with the idea that this cell surface "blanket" of apoE participates in the uptake of lipoprotein cholesterol by either the endocytic or selective uptake pathways.

Direct genotypic detection of Mycobacterium tuberculosis rifampin resistance in clinical specimens by using single-tube heminested PCR

Recent analysis of the gene encoding the beta subunit of Mycobacterium tuberculosis RNA polymerase (rpoB) has demonstrated a small region that harbors the mutations most frequently associated with rifampin resistance. Earlier reports have described a high degree of sequence conservation of rpoB among mycobacteria other than M. tuberculosis and other GC-rich bacteria that can lead to false-positive amplification when applied directly to clinical specimens. We developed reagents for PCR amplification that are based on signature nucleotides discovered by comparative sequence analysis of the rpoB genes of organisms phylogenetically related to M. tuberculosis. The specificities of the reagents were challenged with 20 isolates of multiple-drug-resistant M. tuberculosis and more than 20 species of mycobacteria other than M. tuberculosis and other GC-rich organisms. A single-tube heminested PCR protocol was devised to obtain sensitivity equal to those of an IS6110-based PCR assay and culture in spiked sputum experiments. The assay correctly identified 21 of 24 (87.5%) culture-positive specimens, 13 of which were acid-fast smear-negative, in a panel of 51 clinical specimens. Three specimens that were false-positive initially were negative upon repeat testing when the assay was modified to eliminate the potential for aerosol carryover of the first-round amplification product during the open-tube addition of the second set of reaction reagents. This assay is the most sensitive and specific test to date for the direct detection of M. tuberculosis rpoB in clinical specimens. This rapid PCR-based assay can be used for the simultaneous identification of M. tuberculosis and its rifampin susceptibility genotype.

Rapid identification of a point mutation of the Mycobacterium tuberculosis catalase-peroxidase (katG) gene associated with isoniazid resistance

The complete catalase-peroxidase (katG) gene DNA sequence was determined for 15 strains of Mycobacterium tuberculosis with a wide range of susceptibility to isoniazid. Five of 9 strains with isoniazid MICs > or = 1.0 microgram/mL had one or more missense mutations and all 5 strains had a common G-->T transversion in codon 463, causing the replacement of arginine with leucine and the loss of an NciI or MspI restriction site. None of 6 strains with an isoniazid MIC < 1.0 microgram/mL had mutations affecting codon 463. Restriction analysis of 43 strains with isoniazid MICs > or = 1.0 microgram/mL showed that 19 (44.2%) had lost the NciI-MspI restriction site at the locus of codon 463 while only 1 of 32 strains with isoniazid MICs < or = 1.0 microgram/L had this restriction polymorphism. These results indicate that the mutation arginine-->leucine in codon 463 of the catalase-peroxidase gene occurs in a significant fraction (44.2%) of M. tuberculosis strains with isoniazid MICs > or = 1.0 microgram/mL.

NO, nitrosonium ions, nitroxide ions, nitrosothiols and iron-nitrosyls in biology: a chemist's perspective

The multiplicity of biological functions thus far attributed to NO has led to suggestions that some effects might be mediated by other, related species instead. The radical nature of NO cannot account for its cytotoxicity, but its reaction with superoxide to form peroxynitite and highly reactive hydroxyl radicals may be important in this context. The ease with which NO can react with and destroy Fe-S clusters is also an important factor. Nitrosonium and nitroxide ions can be produced in vivo and will react under conditions that are physiologically relevant. Both could, in theory, serve in cell signalling or as cytotoxic agents. More direct experimental evidence for their involvement is needed before we can confidently assign them specific biological roles. In this article, Anthony Butler, Frederick Flitney and Lyn Williams discuss the chemistry of NO and related species.

Apolipoprotein (apo) B and apoII gene expression are both estrogen-responsive in chick embryo liver but only apoII is estrogen-responsive in kidney

Estrogen regulates the hepatic synthesis of a variety of proteins required for egg yolk production in oviparous vertebrates. In chickens, two of these proteins, apolipoprotein (apo) B and apoII, comprise the major protein components of specialized very low density lipoprotein particles that transport triacylglycerols and cholesterol to the developing egg yolk. In the adult, apoB is synthesized constitutively in liver, small intestine, and kidney but is estrogen-responsive only in the liver. In this work we have examined the embryonic expression of the apoB and apoII genes in yolk sac, liver, kidney, and small intestine. The 14 kb apoB mRNA was first detected at day 3 of development in vascular yolk sac, a tissue involved in the transfer of yolk lipids into the embryonic circulation. Constitutive apoB mRNA expression was detectable in liver at day 6.5 and in kidney at day 7.5, but in intestine was barely detectable before hatching. The hepatic apoB gene acquired estrogen-responsiveness at day 6.5 and its hormone-dependent expression increased throughout development in concert with the estrogen-responsive expression of the apoII gene. In contrast, the constitutively expressed apoB gene in kidney remained unresponsive to estrogen. Surprisingly, the apoII gene was found to be responsive to estrogen in both the embryonic kidney and small intestine. ApoII mRNA induction by estrogen in kidney at day 11 was at 10% of the level in the liver but estrogen-responsiveness decreased later in development and was low in the adult.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of rifampin-resistance in pathogenic mycobacteria

The emergence of rifampin-resistant strains of pathogenic mycobacteria has threatened the usefulness of this drug in treating mycobacterial diseases. Critical to the treatment of individuals infected with resistant strains is the rapid identification of these strains directly from clinical specimens. It has been shown that resistance to rifampin in Mycobacterium tuberculosis and Mycobacterium leprae apparently involves mutations in the rpoB gene encoding the beta-subunit of the RNA polymerases of these species. DNA sequences were obtained from a 305-bp fragment of the rpoB gene from 110 rifampin-resistant and 10 rifampin-susceptible strains of M. tuberculosis from diverse geographical regions throughout the world. In 102 of 110 rifampin-resistant strains 16 mutations affecting 13 amino acids were observed. No mutations were observed in rifampin-susceptible strains. No association was found between particular mutations in the rpoB gene and drug susceptibility patterns of multidrug-resistant M. tuberculosis strains. Drug-resistant M. tuberculosis strains from the same outbreak and exhibiting the same IS6110 DNA fingerprint and drug susceptibility pattern contained the same mutation in the rpoB gene. However, mutations are not correlated with IS6110 profiling outside of epidemics. The evolution of rifampin resistance as a consequence of mutations in the rpoB gene was documented in a patient who developed rifampin resistance during the course of treatment. Rifampin-resistant strains of M. leprae, Mycobacterium avium, and Mycobacterium africanum contained mutations in the rpoB gene similar to that documented for M. tuberculosis. This information served as the basis for developing a rapid DNA diagnostic assay (PCR-heteroduplex formation) for the detection of rifampin susceptibility of M. tuberculosis.

Clinical trial of fusidic acid for lepromatous leprosy

Fusidic acid was assessed for antileprosy activity in nine lepromatous leprosy patients. Patients received fusidic acid at either 500 mg/day for 12 weeks or 750 mg/day for 4 weeks followed by 500 mg/day for 8 weeks. All patients showed time-dependent clinical improvement and decreases in bacillary morphological index, radiorespirometric activity and PCR signal, and in serum phenolic glycolipid I. Fusidic acid appears to be a weakly bactericidal antileprosy agent which may have a role in the multidrug treatment of leprosy pending an evaluation of lepra-reaction-suppressive activity.