ACTH and MSH assays and their clinical application

Major antigenic site B of human influenza H3N2 viruses has an evolving local fitness landscape

Antigenic drift of influenza virus hemagglutinin (HA) is enabled by facile evolvability. However, HA antigenic site B, which has become immunodominant in recent human H3N2 influenza viruses, is also evolutionarily constrained by its involvement in receptor binding. Here, we employ deep mutational scanning to probe the local fitness landscape of HA antigenic site B in six different human H3N2 strains spanning from 1968 to 2016. We observe that the fitness landscape of HA antigenic site B can be very different between strains. Sequence variants that exhibit high fitness in one strain can be deleterious in another, indicating that the evolutionary constraints of antigenic site B have changed over time. Structural analysis suggests that the local fitness landscape of antigenic site B can be reshaped by natural mutations via modulation of the receptor-binding mode. Overall, these findings elucidate how influenza virus continues to explore new antigenic space despite strong functional constraints.

Increased glucocorticoid receptor expression and activity mediate the LPS resistance of SPRET/EI mice

SPRET/Ei mice are extremely resistant to acute LPS-induced lethal inflammation when compared with C57BL/6. We found that in vivo SPRET/Ei mice exhibit strongly reduced expression levels of cytokines and chemokines. To investigate the role of the potent anti-inflammatory glucocorticoid receptor (GR) in the SPRET/Ei phenotype, mice were treated with the GR antagonist RU486 or bilateral adrenalectomy. Under such conditions, both C57BL/6 and SPRET/Ei mice were strongly sensitized to LPS, and the differences in LPS response between SPRET/Ei and C57BL/6 mice were completely gone. These results underscore the central role of GR in the LPS hyporesponsiveness of SPRET/Ei mice. Compared with C57BL/6, SPRET/Ei mice were found to express higher GR levels, which were reflected in increased GR transactivation. Using a backcross mapping strategy, we demonstrate that the high GR transcription levels are linked to the Nr3c1 (GR) locus on chromosome 18 itself. Unexpectedly, SPRET/Ei mice exhibit a basal overactivation of the hypothalamic-pituitary-adrenal axis, namely strongly increased corticosterone levels, ACTH levels, and adrenocortical size. As a consequence of the excess of circulating glucocorticoids (GCs), levels of hepatic gluconeogenic enzymes are increased, and insulin secretion from pancreatic β-cells is impaired, both of which result in hyperglycemia and glucose intolerance in SPRET/Ei mice. We conclude that SPRET/Ei mice are unique as they display an unusual combination of elevated GR expression and increased endogenous GC levels. Hence, these mice provide a new and powerful tool for the study of GR- and GC-mediated mechanisms, including immune repressive functions, neuroendocrine regulation, insulin secretion, and carbohydrate metabolism.

ACTH in normal children and children with pituitary and adrenal diseases. I. Measurement in plasma by radioimmunoassay--basal values

Plasma ACTH was measured by radioimmunoassay including preliminary extraction onto adsorbent glass particles. Normal basal values for children 4-16 years of age were 11-82 microgram/ml, corresponding to values found in the literature. Normal values were found in girls with precocious puberty, children with McCune-Albright and Beckwith-Wiedemann's syndrome. Values between 233 and 305 pg/ml were found in untreated children with congenital adrenal hyperplasia. In primary Addison's disease, very high levels (654-1 413 pg/ml) before cortisone therapy and their decline to nearly normal values during therapy are described. ACTH values in a case of pituitary Cushing's syndrome was just above the normal range (104-163 microgram/ml).

Evaluation of a sensitive radioimmunoassay of plasma corticotropin using commercial reagents

A radioimmunological method for the sensitive estimation of plasma corticotropin immunoreactivity (ACTH) using commercially available reagents is presented. The method involves silica extraction of corticotropin from plasma, desorption with acid protein solution, neutralization and subsequent radiomimmunoassay (RIA). [125I]corticotropin is added as internal standard to the plasma sample. The amounts of corticotropin extractable with silica differed considerably between the plasma samples of individual subjects. There were marked differences in the affinity of five different corticotropin standards to the antiserum used. The detection limit of the method was found to be 1.47 pmol/l. Blanks arising in water and in charcoal stripped serum were lower than the detection limit. Precision and accuracy were within the range commonly achieved for RIA-methods. Morning levels of normal subjects ranged from 6.5-10.9-18.5 pmol/l. Hydrocortisone infusion suppressed plasma corticotropin from 12.6 +/- 6.4 (S.D.) to 4.4 +/- 3.1 (S.D.) pmol/l. Infusion of metyrapone increased corticotropin levels from 7.3 +/- 4.2 (S.D.) to 15.3 +/- 6.0 (S.D.) pmol/l.

Cushing's syndrome: a review of diagnostic tests

This review presents an analysis and interpretation of the published experimental data that form the basis for laboratory tests commonly used for screening, definitive diagnosis, and differential diagnosis in Cushing's syndrome. The single-dose overnight dexamethasone suppression test is excellent for screening outpatients since this test has a very low incidence of false-negative results (1.9% of 154 patients with Cushing's syndrome). The definitive diagnosis of Cushing's syndrome is best established by combining basal state measurements of the daily urine-free cortisol excretion and late evening plasma cortisol levels with the 2-mg low-dose dexamethasone suppression test. The etiology of Cushing's syndrome is best determined by combining measurements of basal state plasma adrenocorticotropin (ACTH) levels with the 8-mg high-dose dexamethasone suppression test. Under certain conditions, the basal state daily urine excretion of 17-hydroxycorticosteroids and 17-ketogenic steroids, the insulin tolerance test, and the metyrapone test may be useful in the definitive or differential diagnosis of Cushing's syndrome.

Assessment of pituitary function

Sellar and parasellar tumours comprise 10-15% of all intracranial neoplasms. Neurologists will this often be faced with the problem of assessing pituitary function. A thorough clinical examination is of the foremost importance. In addition a small number of simple and rapid tests is required. Knowledge of the physiological variation in pituitary function is, however, necessary to allow a safe interpretation of the results. A simple routine procedure for assessing pituitary function is proposed.