Cytoplasmic intermediate filaments revealed as dynamic and multipurpose scaffolds

Intermediate filaments are cytoskeletal polymers encoded by a large family of differentially expressed genes that provide crucial structural support in the cytoplasm and nucleus of higher eukaryotes. Perturbation of their function accounts for several genetically determined diseases in which fragile cells cannot sustain mechanical and non-mechanical stresses. Recent studies shed light on how this structural support is modulated to meet the changing needs of cells, and reveal a novel role whereby intermediate filaments influence cell growth and death through dynamic interactions with non-structural proteins.

Stem cell cardiomyoplasty: state-of-the-art

Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. No long-term therapeutic option for end-stage CHF is available except for orthotopic heart transplant. Cellular-based therapy has emerged as a potential new therapy for patients with advanced heart failure. Different cell types are being explored in preclinical and clinical studies with encouraging results. Critical issues, such as types of cells, ideal number of cells, route of delivery, timing and targets of delivery, remain to be optimised to maximise the benefits of the cell therapy. In this review, we seek to summarise the latest data and postulate future directions in this potentially exciting field.

Leukoreduction and acute rejection in liver transplantation: An interim analysis

BACKGROUND

Little is known about the effect of blood transfusions and leukoreduction on acute rejection in liver transplantation. The purpose of this study was to assess the impact of leukoreduction on the occurrence of early rejection episodes in liver transplantation.

METHODS

In 1999, mandatory leukoreduction was implemented in our program. Data from 339 consecutive liver transplant recipients were analyzed with attention to the time period as a proxy for leukoreduction, the number of transfusions, the wait list status, the hepatitis B or C status, the recipient age, and the type of immunosuppression.

RESULTS

Using an early (6-month) rejection-free graft survival model, we observed that introduction of leukoreduction was independently associated with fewer rejection episodes (P =.001). Despite the lower rejection rate, due to a regimen of tacrolimus and antithymocyte globulin, the effect of implementation of leukoreduction remained significant (P =.021).

CONCLUSION

The use of leukoreduction is associated with fewer early rejections, irrespective of the type of immunosuppression. These data support an exploration of the immunomodulatory effect of leukoreduction.

Altered expression of preproenkephalin and prodynorphin mRNA in a genetic model of paroxysmal dystonia

The dtsz mutant hamster represents a model of primary paroxysmal dystonia, in which dystonic episodes occur in response to stress. Previous examinations demonstrated striatal dysfunctions in dtsz hamsters. In the present study, in situ hybridization was used to examine preproenkephalin and prodynorphin expression as potential indices of imbalances between the striatopallidal and striatonigral pathways. Brain analyses were performed in dtsz hamsters under basal conditions, i.e., in the absence of dystonia, as well as mutant hamsters that exhibited severe stress-induced dystonic attacks immediately prior to sacrifice. In the striatum the basal expression of prodynorphin tended to be higher, while that of preproenkephalin tended to be lower in mutant hamsters in comparison to non-dystonic control hamsters. Significant basal changes were restricted to higher levels of prodynorphin in the ventrolateral striatum and lower prodynorphin and preproenkephalin mRNA expression in the hippocampus and/or in subregions of the hypothalamus. After stressful stimulation, the neuropeptides increased in several regions in both animals groups. In comparison to stimulated control hamsters, a significantly lower prodynorphin expression was found in several limbic areas of stimulated mutant hamsters during the manifestation of dystonia, while preproenkephalin mRNA was significantly lower in the anterior and dorsal striatal subregions and in nucleus accumbens. Since changes in the expression of these opioid peptides have been suggested to be related to abnormal dopaminergic activity, the present findings may reflect disturbances in striatal dopaminergic systems, and also in limbic structures in the dtsz mutant, particularly during the expression of dystonia.

Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia

BACKGROUND

Impingement of the tracheal tube (ETT) on upper airway structures during railroading over the fibreoptic bronchoscope (FOB) occurs commonly. Potential complications of impingement include prolonged intubation time, leading to arterial desaturation, failed intubation and laryngeal trauma. The objective of this randomized, controlled trial was to assess the effect of the double setup ETT (a paediatric ETT is placed inside an adult ETT) on the incidence of impingement during orotracheal fibreoptic intubation.

METHOD

Two hundred patients were randomized to have a single ETT or double setup ETT. After induction of anaesthesia, fibreoptic orotracheal intubation was performed. The degree of impingement of the ETT during advancement over the FOB was assessed using a standardized scoring system based on the manoeuvres required to overcome the impingement.

RESULTS

The incidence of impingement was lower using the double setup ETT compared with the single ETT (18 vs 93%, P<0.001). The double setup ETT also reduced the incidence of impingement requiring more than a simple 90 degrees counterclockwise rotation to achieve intubation (3 vs 14%, P=0.01) and reduced the median intubation time (31 vs 35 s, P=0.046).

CONCLUSIONS

The double setup ETT is effective in reducing ETT impingement and in reducing intubation time. We did not find an association between ETT impingement and arterial desaturation.

Accuracy and reliability of a Cosmed K4b2 portable gas analysis system

The purpose of this study was to assess the validity and reliability of a Cosmed K4b2 portable telemetric gas analysis system. Twelve physically fit males performed a treadmill running session consisting of an easy 10 min run, a hard 3 min run and a 1 min sprint (with rest periods of 10 min separating each run), on four separate occasions. Sessions were identical with the exception of the apparatus used to measure VO2. During two (test-retest) sessions a Cosmed K4b2 portable gas analysis system was used; in another, a laboratory metabolic cart and, in one session, both systems were used to measure VO2 simultaneously. Comparison of Cosmed K4b2 and metabolic cart measurements in isolation revealed significantly (p < 0.05) increased values of VO2, VCO2, FE CO2 (except FE CO2 at 10 min) and lower values of FE O2 for each run duration by the Cosmed system. Linear regression equations to predict metabolic cart results from Cosmed values were, respectively; cart VO2 = 0.926 (Cosmed VO2-0.227 (r2 = 0.84) and cart VCO2 = 1.057 (Cosmed VCO2-0.606 (r2 = 0.92). Bland-Altman plots and comparison of the test-retest cosmed measurements revealed that the K4b2 system showed good repeatability of measurement for measures of VE, VO2 and VCO2, particularly for 10 min and 3 min tests (ICC = 0.7-0.9, p < 0.05). In conclusion, the Cosmed K4b2 portable gas analysis system recorded consistently higher VO2 and VCO2 measurements in comparison to a metabolic cart. However, satisfactory test-retest reliability of the system was demonstrated.

Type II epithelial keratin 6hf (K6hf) is expressed in the companion layer, matrix, and medulla in anagen-stage hair follicles

More than half of the known keratin genes (n approximately 50) are expressed in the hair follicle. An in-depth knowledge of their differential expression in this organ will help us to understand the mechanisms of its formation and cycling, and the etiology of inherited hair disorders. Keratin 6hf is a type II keratin recently shown to occur in the companion layer. We cloned the mouse ortholog and characterized its expression in skin and oral mucosa. The mK6hf gene is 9.1 kb long and located in the cluster of type II keratin genes on mouse chromosome 15, between the keratin 6 (mK6alpha/mK6beta) and hair keratin genes. In situ hybridization and protein immunolocalization showed that, in addition to the companion layer, mK6hf is expressed in the upper matrix and medulla of the anagen-stage hair. This distribution is seen for all types of mouse hairs and medullated human hairs. The distribution of keratin 6hf protein in the hair shaft mirrors that of keratin 17, and the observation of reduced levels of keratin 6hf in keratin 17 null hair argues for a direct interaction between them. mK6hf is also expressed in the nail bed epithelium and fungiform papillae of dorsal tongue epithelium. Our findings provide an additional marker for the hair matrix and medulla, and suggest that the cellular precursors for the medulla, cortex, and cuticle compartments are already spatially segregated within the hair matrix. They also have obvious implications for the epithelial alterations associated with defects in keratin 6 genes.

A hypothesis on the role of the electrical charge of haemoglobin in regulating the erythrocyte shape

A previously proposed mechanism of erythrocyte shape has been proposed in which the ratio of the two conformations of Band 3, the anion exchange protein, controls the erythrocyte shape by modifying the degree of contraction or relaxation of the membrane skeleton. This mechanism was previously shown to explain several observations related and unrelated to the erythrocyte shape. We show that it can also explain the occurrence of target cells in blood smears of individuals expressing Hb A variants with significantly lower and higher isoelectric points. This would provide further support of its validity and would have the following implications. The electrical charge of of Hb A influences the erythrocyte shape and deformability, thus explaining the low level of expression of Hb A2 with an isoelectric point significantly higher than Hb A. It would suggest that Hb A2 has a physiological function related to the control of the erythrocyte shape. This could be of regulating the activity of the K-Cl cotransport system or of tuning finely the cell pH. A role of haemoglobin in the control of the erythrocyte shape would ensure a more efficient oxygenation of tissues and removal of carbon dioxide generated by tissues. It would also provide a basis for the absence of spreading in populations of some haemoglobin variants differing only by the electrical charge.

Loss of keratin 6 (K6) proteins reveals a function for intermediate filaments during wound repair

The ability to heal wounds is vital to all organisms. In mammalian tissues, alterations in intermediate filament (IF) gene expression represent an early reaction of cells surviving injury. We investigated the role of keratin IFs during the epithelialization of skin wounds using a keratin 6α and 6β (K6α/K6β)-null mouse model. In skin explant culture, null keratinocytes exhibit an enhanced epithelialization potential due to increased migration. The extent of the phenotype is strain dependent, and is accompanied by alterations in keratin IF and F-actin organization. However, in wounded skin in vivo, null keratinocytes rupture as they attempt to migrate under the blood clot. Fragility of the K6α/K6β-null epidermis is confirmed when applying trauma to chemically treated skin. We propose that the alterations in IF gene expression after tissue injury foster a compromise between the need to display the cellular pliability necessary for timely migration and the requirement for resilience sufficient to withstand the rigors of a wound site.

Role for keratins 6 and 17 during wound closure in embryonic mouse skin

Injury to adult skin triggers a response designed to restore its vital barrier function. A conserved aspect of this response is a rapid switch in gene expression whereby the type II keratin 6 (K6) and type I keratins 16 and 17 (K16, K17) are induced in epithelial cells at the wound edge. This induction occurs at the expense of the keratins normally expressed during terminal differentiation and correlates with the activation of epithelial cells at the wound edge, ahead of their migration into the wound site. Here, we show that the capacity to enact this switch is already acquired in E11.5 stage mouse embryos. Such early timing is well ahead of the onset of differentiation-specific gene expression (approximately E13.5) and the acquisition of barrier formation by developing epidermis (approximately E16.5). Induction of K6, K16, and K17 correlates with changes in the morphology of epithelial cells at the wound edge. The closure of embryonic wounds is significantly delayed in K17 null embryos, but not embryos null for K6. These observations significantly extend the correlation between K6, K16, and K17 expression and epithelial wound closure, and provide direct evidence that expression of these keratins, K17 in particular, is important for the timeliness of this process.

Cytostatic potential of novel agents that inhibit the regulation of intracellular pH

Cells within the acidic extracellular environment of solid tumours maintain their intracellular pH (pHi) through the activity of membrane-based ion exchange mechanisms including the Na(+)/H(+) antiport and the Na(+)-dependent Cl(-)/HCO(3)(-) exchanger. Inhibition of these regulatory mechanisms has been proposed as an approach to tumour therapy. Previously available inhibitors of these exchangers were toxic (e.g. 4,4-diisothiocyanstilbene-2,2-disulphonic acid), and/or non-specific (e.g. 5-N-ethyl-N-isopropyl amiloride). Using two human (MCF7, MDA-MB231) and one murine (EMT6) breast cancer cell lines, we evaluated the influence of two new agents, cariporide (an inhibitor of the Na(+)/H(+) antiport) and S3705 (an inhibitor of the Na(+)-dependent Cl(-)/HCO(3)(-) exchanger) on the regulation of intracellular pH (pHi). The cytotoxicity of the two agents was assessed by using clonogenic assays. Our results suggest that cariporide has similar efficacy and potency to 5-N-ethyl-N-isopropyl amiloride for inhibition of Na(+)/H(+) exchange while S3705 is more potent and efficient than 4,4-diisothiocyanstilbene-2,2-disulphonic acid in inhibiting Na+-dependent Cl(-)/HCO3(-) exchange. The agents inhibited the growth of tumour cells when they were incubated at low pHe (7.0-6.8), but were non-toxic to cells grown at doses that inhibited the regulation of pHi. Our results indicate that cariporide and S3705 are selective cytostatic agents under in vitro conditions that reflect the slightly acidic microenvironment found in solid tumours.

A hypothesis of haemolysis in haemolytic anaemias associated with enzymopathies

A feature of a previously proposed mechanism of erythrocyte shape control is a control of the shape by the Donnan equilibrium ratio. An enzymopathy of the glycolytic pathway and nucleotide metabolism could alter the Donnan ratio, since it alters levels of phosphate intermediates and of end-products carbonic gas (CO(2)) and ammonia gas (NH(3)) which are ionized at the erythrocyte pH. Thus, a hypothesis of haemolysis in haemolytic anaemias associated with enzymopathies of the glycolytic pathway and nucleotide metabolism would be that it results from an inhibition of the mechanism by a modification of the Donnan ratio. This hypothesis seems plausible as it would explain coherently observations in these haemolytic anaemias.

A hypothesis of the stomatocytosis in individuals with the phenotype Rh(null)

A hypothesis of the stomatocytosis in individuals with the Rh(null) phenotype is proposed on the assumptions that the RhAG polypeptide of the Rh antigenic complex has the function of transporting ammonium and that a previously proposed mechanism of erythrocyte shape control is valid.

Design, synthesis, and SAR of amino acid derivatives as factor Xa inhibitors

A series of potent and selective factor Xa inhibitors was synthesized using various readily available amino acids as central templates. The most potent compound displays IC(50) of 3 nM.

A simple method to estimate the required dialysis time for cases of alcohol poisoning

BACKGROUND

Conventional dialysis management of ethylene glycol and methanol poisoning includes frequent intradialytic determinations of serum toxin concentration. Dialysis is continued until a target toxin concentration is reached. Initially, the required dialysis duration is unknown, making planning difficult. We devised a simple method to estimate the duration of dialysis required and avoid quantitation of multiple toxin samples.

METHODS

Using the assumption that toxic alcohols would have a dialysis clearance similar to urea, we proposed that required dialysis time (hours) to reach a 5 mmol/L toxin concentration target would be: [-V ln(5/A)]/0.06k, where V (liters) is the Watson estimate of total body water, A is the initial toxin concentration (mmol/L), and k is 80% of the manufacturer-specified dialyzer urea clearance (mL/min) at the initial observed blood flow rate. Directly measured dialysis and renal toxin clearance, and true dialysis requirement by conventional treatment protocol were compared with our estimate in two methanol and three ethylene glycol poisonings treated with Fresenius F8 dialyzers.

RESULTS

There were no clinically or statistically significant differences between predicted dialysis duration (7.6 +/- 1.9 hours, +/-SD) and that actually provided using hourly toxin concentration sampling (7.4 +/- 1.9 hours). Renal toxin clearance was negligible compared to that of dialysis, and predicted dialysis clearance did not differ significantly from that observed.

CONCLUSIONS

The simple estimate method is sufficiently valid to guide the prescription of dialysis for toxic alcohol poisoning. Data required at dialysis start include only the initial toxin concentration, dialyzer manufacturer's specified urea clearance at initial observed blood pump speed, and patient demographics to estimate total body water. This approach allows for planned dialysis therapy, without the need for additional toxin concentration measurements until dialysis is completed.