Whole exome sequencing discloses a pathogenic MTM1 gene mutation in a continuous polyhydramnios family in China: Case report and literature review

Polyhydramnios can be caused by genetic defects at times. However, to establish an accurate diagnosis and provide a precise prenatal consultation in a given case is still a great challenge toward obstetricians. To uncover the genetic cause of polyhydramnios in the two consecutive pregnancies, we performed whole-exome sequencing of DNA for the second suffering fetuses, their parents, and targeted sanger sequencing of other members of this family. We discovered a hemizygous truncating variant in MTM1 gene, c.438_439 del (p. H146Q fs*10) in this Chinese family. In the light of the molecular discoveries, the fetus's clinical phenotype was considered to be a good fit for X-linked myotubular myopathy (XLMTM). There is no related research to the prenatal manifestations of MTM1-related XLMTM among Chinese population, and this is the first one to present. Though the etiology of polyhydramnios is complicated, WES may provide us with a creative avenue in prenatal diagnosis.

[Comparison of the anesthetic effects of mivacurium and cisatracurium besylate in laser laryngeal microsurgery]

Objective: To compare the anesthetic effects of mivacurium and cisatracurium besylate in laser laryngeal microsurgery, and to provide clinical evidence and reference for further optimization of muscle relaxation application. Methods: From October 2021 to January 2022, fifty-six patients of Beijing Tongren Hospital, Capital Medical University, scheduled for laser laryngeal microsurgery with general anesthesia, were enrolled. These patients, aged 18-65 years old, 25 males and 31 females, were divided into two groups (n=28) by random number table method. Cisatracurium besylate group (group C): cisatracurium besylate was injected at 0.1 mg/kg. Normal saline was continuously infused during operation. Mivacurium group (group M):Mivacurium was injected at 0.25 mg/kg and continuously infused at 0.3 mg·kg^-1·h^-1 during operation.The intubation time, the extubation time, recovery index, Cooper's score, Cormack-Lehane grade, surgical condition grade, postoperative residual neuromuscular block and allergic related adverse events were compared between the two groups. Results: The intubation time and the extubation time of group M were (3.7±1.1) and (16.2±5.0) min, which were statistically significant shorter than those of group C (4.9±0.7) and (26.4±8.6) min (all P<0.05). The recovery indexes of the patients in group M and group C were (4.5±3.4) and (6.2±5.0) min. The Cooper's scores of the two groups were both 9(9, 9). The Cormack-Lehane grades of the two groups were all grade Ⅰ. The number of cases with good/excellent surgical condition grades in group M and group C were 5/23 and 0/28. There were no significant differences in recovery index, Cooper's score, Cormack-Lehane grades and surgical condition grades between the two groups (all P>0.05). The TOF ratio of group M in the post anesthesia care unit (PACU) was (95.7±2.6) %, which was significantly higher than (92.9±3.9) % of group C(P=0.015). There were no significant differences in MAP and HR between the two groups at different time points (all P>0.05). The incidence of skin flushing in group M and group C was 10.7% (3/28) and 0, and the difference was not statistically significant (P=0.074). There were no cases of severe hypotension, significantly elevated airway pressure or airway spasm in both groups. Conclusion: In laser laryngeal microsurgery, compared with cisatracurium besylate, mivacurium has shorter intubation time and extubation time, stable hemodynamics, no significant increase in allergic related adverse events. mivacurium is safe and effective.

[Clinical study on liver function, virology, serological changes and the safety of drug withdrawal in pregnant women who are chronic HBV carriers during pregnancy and postpartum]

Objective: To observe the changes of liver function, virology and serology and the safety of drug withdrawal in pregnant women who are chronic hepatitis B virus (HBV) carriers. Methods: A prospective clinical cohort was established to enroll pregnant women who are chronic HBV carriers and they were divided into the nucleoside/nucleotide analogs (NAs) intervention group and the non-NAs intervention group according to patients' wishes. Liver function, HBV DNA and HBV serological markers were detected at gestation, postpartum 6 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. Results: 351 patients were enrolled, 320 in the NAs intervention group and 31 in the non-NAs intervention group. The proportion of postpartum hepatitis flares in both groups was higher than that in pregnancy (39.4% vs 12.5%, P < 0.001; 38.7% vs 3.2%, P = 0.001). Six weeks postpartum was the peak period of hepatitis flares, and 96.0% (121/126) of the hepatitis flares occurred within 24 weeks postpartum. At 6 weeks postpartum, there were 6 cases of alanine aminotransferase (ALT) ≥ 10 times upper limit of normal (ULN) in the NAs intervention group. The rate of the hepatitis flare after drug withdrawal was 16.7% (34/203). Conclusion: Regardless of the presence or absence of NAs intervention, pregnant women who are chronic HBV carriers have a certain proportion of hepatitis flares during pregnancy and postpartum, and the hepatitis flare even have a tendency to be severe. Therefore, drug withdrawal after delivery is not always safe, which requires close observation and classification. At 6 weeks postpartum, the incidence of hepatitis flares was high, and those who meet the treatment indications can get better therapeutic effects if given appropriate treatment. The vast majority (96%) of postpartum hepatitis flares occur within 24 weeks, so it is recommended to follow up to at least 24 weeks postpartum after discontinuation.

[Low-levels of HBsAg quantification at 48-week in HBeAg-negative chronic hepatitis B patients are the advantageous population for HBsAg clearance]

Objective: To analyze the therapeutic effect on HBeAg-negative chronic hepatitis B patients treated with Peg-IFNα-2a combined with NAs to obtain the influencing factors for predicting HBsAg clearance. Methods: A retrospective study was conducted to investigate the effect of pegylated interferon alpha-2a combined with nucleoside analogues (lamivudine/adefovir dipivoxil) on HBeAg-negative chronic hepatitis B. The treatment course was 96 weeks. Patients were followed up 120 weeks after the treatment. HBsAg clearance at 120 weeks was taken as the objective of the study. Logistic regression and receiver operating characteristic curve analysis screened the related factors affecting HBsAg clearance. χ (2) test was used to compare count data. Results: 111 patients were treated with pegylated interferon alpha-2a combined with nucleoside analogues, and 107 patients completed the scheduled course of treatment and follow-up. HBsAg clearance rate at120 week was 29.0% (31/107). The influencing factors for analysis were: (1) gender had no effect on HBsAg clearance rate; age and baseline levels of HBV DNA and alanine aminotransferase had no significant effect on HBsAg clearance; low baseline level of HBsAg (< 3.023 lgIU/ml) was beneficial to HBsAg clearance. The area under the working characteristic curve of the subjects was 0.746, the positive predictive value was 44.4%, and the negative predictive value was 86.8%. (2) HBsAg quantification or decline in 24 weeks and 48 weeks of treatment had a good predictive effect on HBsAg clearance, and the 48 weeks predicted value was higher than 24 weeks. When the HBsAg quantification was≤2.070 lgIU/ml at 48 weeks, the area under the receiver operating characteristic curve was 0.931, the positive predictive value was 52.8%, and the negative predictive value was 94.4%. When HBsAg decreased from baseline to≥0.991 lgIU/ml, the area under the receiver operating characteristic curve was 0.888, the positive predictive value was 50.8%, and the negative predictive value was 97.9%. (3) The analysis of HBsAg subgroup levels at 48 weeks suggested that the "interval analysis" can forecast HBsAg clearance more exactly than "nodal analysis" .The final HBsAg clearance rate of 100 IU/ml < HBsAg≤1 000 IU/ml, 10 IU/ml < HBsAg≤100 IU/ml and HBsAg≤10 IU/ml groups reached 6.7%, 31.8% and 67.7%, respectively. (4) The ALT abnormal group in the course of treatment obtained a higher HBsAg clearance rate (48.0%, 12/25). Conclusion: 96-weeks long-term treatment with pegylated interferon-alpha -alpha-2a combined with nucleoside analogues for HBeAg-negative chronic hepatitis B has a good predictive value for HBsAg clearance at baseline and during treatment. The "interval level" of HBsAg at 48-weeks is more accurate in predicting HBsAg clearance, suggesting that HBeAg-negative chronic hepatitis B patients with low HBsAg levels at 48-weeks are the advantageous populations with HBsAg clearance. These patients are worthy of prolonged treatment to pursue "clinical cure".

Role of HMGB1 in Post-traumatic Endoplasmic Reticulum Stress in Rat Lung Tissues

OBJECTIVES

To explore the role of high mobility group B1 （HMGB1） protein in the post-traumatic endoplasmic reticulum stress （ERS） in rat lung tissues.

METHODS

The rat model of acute lung injury was established by crushing the hind limbs of rats with standard weight. The first experiment was to divide rats into postural control group and crush groups （6 h, 18 h and 30 h after crushing）. The second experiment was to divide rats into postural control group, 18 h crush group, HMGB1 inhibitor sodium butyrate （SB） group and 18 h crush+SB group. The protein expression changes of HMGB1 and ERS- related proteins （GRP78, caspase-12, CHOP and IRE1α） in rat lung tissues were detected with Western blotting. Meanwhile, the pathological changes of rat lungs were observed by HE stain.

RESULTS

Compared with the postural control group, the expression levels of ERS-related proteins （GRP78, caspase-12, CHOP and IRE1α） and HMGB1 protein in rat lung tissues by crushing the hind limbs of rats were obviously increased. The protein levels reduced at 30 h after crushing but were still higher than those of postural control group and obvious pathological changes of acute lung injury were observed simultaneously in rats. Compared with the 18 h crush group, the expression levels of the ERS-related proteins and HMGB1 protein in rat lung tissues were attenuated in 18 h crush+SB group, and the pathological changes of rat lung injury began to alleviate.

CONCLUSIONS

HMGB1-ERS pathway activated by traumatic stress can lead to acute lung injury in rats.

Extra green light induced ZnO ultraviolet lasing enhancement assisted by Au surface plasmons

We observed the dramatic enhancement of the intrinsic spontaneous and stimulated emission as well as the ensuing suppression of defect-related green emission in Au-decorated ZnO microrods. A series of spectral experiments and theoretical analysis demonstrated an electron transfer assisted process by surface plasmon (SP) resonant coupling between the Au nanoparticles and ZnO. The mechanism indicates an approach to enhance the UV emission of ZnO through an extra excitation of visible light similar to that for the defect emission of ZnO. Based on the coupling mechanism, the externally enhanced ultraviolet lasing was further improved from 1.5 to 2.8-fold by adjusting the pumping power of the green light intensity in the Au/ZnO hybrid cavity. This research not only further confirms the SPR-assisted electron transfer process but also offers an approach to improve the intrinsic UV emission even for heavily-defected ZnO through visible light excitation via a nonlinear process.

Detection methods of Cyprinid herpesvirus 2 infection in silver crucian carp (Carassius auratus gibelio) via a pORF72 monoclonal antibody

Cyprinid herpesvirus 2 (CyHV-2) is the main pathogen responsible for causing haematopoietic necrosis disease in Carassius auratus gibelio. Although many nucleic acid-based diagnostic methods have been applied, no stable and sensitive immunological diagnostic approaches have been reported. In this study, to detect CyHV-2 in clinical samples using immunological methods, recombinant ORF72 protein (pORF72), encoded by the CyHV-2 ORF72 gene, was used as a capture antigen to identify blood and tissues infected with CyHV-2. First, ORF72 gene was amplified from the CyHV-2 genome and cloned into a PGEX-4t-3 expression vector to produce pORF72 in Escherichia coli. The purified pORF72 was used as an immunogen to prepare monoclonal antibodies. The Western blotting assays revealed that the monoclonal antibody could specifically identify the pORF72. Furthermore, an immunohistochemical protocol and a blood smear method were established to detect CyHV-2 in carps. The results indicate that the monoclonal antibody against pORF72 could be utilized as an effective detection tool for haematopoietic necrosis disease in Carassius auratus gibelio.

[Long-term clinical effect and safety observation of sublingual dermatophagoides farinae drop in preschool and school-age children with allergic rhinitis]

Objective:To evaluate the efficacy of specific sublingual immunotherapy (SLIT) with Dermatophagoides farinae drops on preschool and school age children with allergic rhinitis.Method:Fifty preschool children (≤6 year), and 52 school age children (> 6 year), who suffered from dust mite induced allergic rhinitis, were randomly divided into subingual immunotherapy (SLIT) + drug group and drug group. SLIT + drug group was treated with a standardized subingual immunotherapy drops of Dermatophagoides farinae and combined with symptomatic therapy, drug group was treated with mometasone furoate nasal spray and dseloratdine tablets as symptomatic treatment. These children were followed up for 2 years with one visit in every 3 months. Symptom scores and medication scores were record at each visit. Comprehensive evaluation of symptom, medication, and patients' degree of satisfaction were used.Result:Two years after SLIT finished, symptom scores (SLIT + drug group: 1.13±1.05; drug group: 4.68±3.09), medication scores (SLIT + drug group: 0.07±0.04; drug group: 0.36±0.25) of SLIT+drug group were significantly lower than those in drug group respectively, all P< 0.01. The subjective assessment of patient' symptom, medication, and treatment satisfaction in SLIT+drug group was significantly lower than those in drug group. Subjective assessment symptoms, medication, and treatment satisfaction in preschool group was the same as in school age group. After SLIT ended for 2 years, subjective assessment and treatment satisfaction in the school age group was better than those in preschool group in medication score.Conclusion:SLIT demonstrated clinical improvement in children of different ages during 2 years treatment. the symptom scores, medication scores and subjective satisfaction in school age group are better than those in preschool group.

Lasing mode regulation and single-mode realization in ZnO whispering gallery microcavities by the Vernier effect

The wide direct bandgap and strong exciton binding energy of ZnO have inspired examinations of ultraviolet lasing over the previous decades. However, regulation of the lasing mode, especially the realization of single mode lasing, is still a challenge. In this study, a ZnO comb-like structure with an array of microrods was selected to design coupled whispering-gallery-mode cavities, wherein the naturally varied air-gap between the adjacent microrods created a flexible condition for optical field coupling without any complicated micromanipulation. Spectral behaviour of lasing and coupling interaction between coupled ZnO microrods were systematically investigated. By regulating the nano-scale inter-space of dual coupled microrods, stable single-mode lasing with a higher Q factor and lower threshold was obtained successfully based on the Vernier effect. The formation conditions and the mechanism of single-mode lasing derived from the coupled ZnO microrods were discussed in detail. It also demonstrated an approach to construct high quality single-mode lasing by tuning the diameters of the coupled ZnO microrods.

In vitro binding of heavy metals by an edible biopolymer poly(gamma-glutamic acid)

An edible biopolymer poly(gamma-glutamic acid) (gamma-PGA) was evaluated for possible use as an chelating/binding agent in the treatment of metal intoxication in humans. In vitro binding of the toxic heavy metals lead and cadmium as affected by pH, contact time, metal concentration, gamma-PGA dose, and essential metals was carried out in a batch mode. A maximum binding occurred in the pH range 5-7, corresponding to the gastrointestinal pH values except for the stomach. Binding isotherms at pH 5.5 were well described by the heterogeneous models (Freundlich and Toth), while the lead isotherm at pH 2.5 showed a S-type curve, which was fitted as multiple curves with the Langmuir model and a shifted-squared Langmuir model. However, no adsorption occurred for cadmium at pH 2.5. The maximum binding capacities of lead and cadmium at pH 5.5 were 213.58 and 41.85 mg/g, respectively. A curvilinear biphasic Scatchard plot signified a multisite interaction of metals. Binding was extremely rapid with 70-100% of total adsorption being attained in 2 min. Kinetics at low and high metal concentrations obeyed pseudo-first-order and pseudo-second-order models, respectively. The gamma-PGA dose-activity relationship revealed a low dose of gamma-PGA to be more efficient in binding a large amount of metals. Incorporation of Cu, Zn, Fe, Mg, Ca, and K showed only a minor influence on lead binding but significantly reduced the binding of cadmium.

Adsorption of toxic mercury(II) by an extracellular biopolymer poly(gamma-glutamic acid)

Adsorption of mercury(II) by an extracellular biopolymer, poly(gamma-glutamic acid) (gamma-PGA), was studied as a function of pH, temperature, agitation time, ionic strength, light and heavy metal ions. An appreciable adsorption occurred at pH>3 and reached a maximum at pH 6. Isotherms were well predicted by Redlich-Peterson model with a dominating Freundlich behavior, implying the heterogeneous nature of mercury(II) adsorption. The adsorption followed an exothermic and spontaneous process with increased orderliness at solid/solution interface. The adsorption was rapid with 90% being attained within 5 min for a 80 mg/L mercury(II) solution, and the kinetic data were precisely described by pseudo second order model. Ionic strength due to added sodium salts reduced the mercury(II) binding with the coordinating ligands following the order: Cl(-) >SO(4)(2-) >>NO(3)(-). Both light and heavy metal ions decreased mercury(II) binding by gamma-PGA, with calcium(II) ions showing a more pronounced effect than monovalent sodium and potassium ions, while the interfering heavy metal ions followed the order: Cu(2+) >> Cd(2+) > Zn(2+). Distilled water adjusted to pH 2 using hydrochloric acid recovered 98.8% of mercury(II), and gamma-PGA reuse for five cycles of operation showed a loss of only 6.5%. IR spectra of gamma-PGA and Hg(II)-gamma-PGA revealed binding of mercury(II) with carboxylate and amide groups on gamma-PGA.

Antioxidant properties of phenolic diterpenes from Rosmarinus officinalis

AIM

To investigate the inhibition capacities of carnosol, rosmanol, and epirosmanol, which are phenolic diterpenes from Rosmarinus officinalis, to oxidized low-density lipoprotein (LDL) formation in human blood and detect their scavenging activities to lipid free radical and superoxide anion in vitro.

METHODS

The antioxidant activities which were expressed with the inhibilities to lipid free radicals in the membrane lipid of cell and oxidized LDL formation were evaluated by TBARS assay and ESR method. The inhibition on the Cu2+-mediated oxidization of apo B formation in LDL was investigated by fluorescence spectroscopy.

RESULTS

Carnosol, rosmanol, and epirosmanol had an inhibitory activity to lipid peroxidation and oxidized apo B formation in human bloods LDL. The IC50 were 7-10 micromol/L. The antioxidant mechanism was related to the scavenging activities to lipid free radical.

CONCLUSION

carnosol, rosmanol, and epirosmanol showed the activity in inhibiting LDL oxidation.

Disruption of a yeast very-long-chain acyl-CoA synthetase gene simulates the cellular phenotype of X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD) is characterized biochemically by elevated levels of saturated very long-chain fatty acids (VLCFAs) in plasma and tissues. In X-ALD, peroxisomal very-long-chain acyl-CoA synthetase (VLCS) fails to activate VLCFAs, preventing their degradation via beta-oxidation. However, the product of the defective XALD gene (ALDP) is not a VLCS, but rather a peroxisomal membrane protein (PMP). Disruption of either or both of two yeast PMP genes related to the XALD gene did not produce a biochemical phenotype resembling that found in X-ALD fibroblasts. The authors identified a candidate yeast VLCS gene (the FAT1 locus) by its homology to rat liver VLCS. Disruption of this gene decreased VLCS activity, but had no effect on long-chain acyl-CoA synthetase activity. In FAT1-disruption strains, VLCS activity was reduced to 30-40% of wild-type in both a microsome-rich 27,000 g supernatant fraction and a peroxisome- and mitochondria-rich pellet fraction of yeast spheroplast homogenates. Separation of the latter organelles by density gradient centrifugation revealed that VLCS activity was peroxisomal and not mitochondrial. VLCS gene-disruption strains had increased cellular VLCFA levels, compared to wild-type yeast. The extent of both the decrease in peroxisomal VLCS activity and the VLCFA accumulation in this yeast model resembles that observed in cells from X-ALD patients. Characterization of the gene(s) responsible for the residual peroxisomal VLCS activity may suggest new therapeutic approaches in X-ALD.

[The effect of melatonin on enhancing immune function and inhibiting the ability of NO over-release in morphine dependent mice]

AIM

To observe the effects and mechanism of melatonin (MT) on the immune function of morphine dependent mice.

METHODS

A physical dependent mice model was established by repeated subcutaneous injection of morphine. The intensity of morphine withdrawal syndrome was evaluated according to the weight of immune organs, the proliferation reaction of stimulated splenic lymphocytes by Con A, the phagoindex of blood primed macrophages and the content of NO induced in the peritoneal macrophage (pM phi).

RESULTS

MT reversed the inhibitory effect of morphine on the proliferation ability of splenic lymphocytes and enhanced the phagocytosis of macrophages of morphine dependent mice obviously and prevented the over-release of NO from pM phi. The enhancing effects of MT on the phagocytosis can be prevented by naloxon.

CONCLUSION

MT can significantly enhance the immune function of morphine dependent mice and inhibit NO excessive release from pM phi.

Population pharmacokinetics of tobramycin in hospitalized patients receiving once-daily dosing regimen

The population pharmacokinetics of tobramycin was investigated in a group of 327 adult hospitalized patients receiving once-daily administration of tobramycin at a dose of 7 mg kg(-1). The patients had an average age of 57+/-18 y and an average weight of 65+/-14 kg; 153 of the patients were female. Data, comprised of 575 serum concentrations, were analyzed using a nonlinear mixed-effect model (NONMEM) with a first-order conditional estimation method and were best described with a one-compartment model. The patient covariates including body weight, gender, age and creatinine clearance (CL(CR)) were added in a stepwise fashion to identify their potential influences on tobramycin pharmacokinetics. Results showed that tobramycin clearance (CL) was linearly correlated with CL(CR) (proportionality constant: 0.066+/-0.002 x CL(CR) (ml min(-1))) and the volume of distribution (Vd) was linearly related to body weight (proportionality constant: 0.40+/-0.024 x body weight (1 kg(-1))). The mean population estimates for CL and Vd were 4.53 l h(-1) and 27.3 l, respectively. The half-life of tobramycin was estimated to be 4.2 h. The inter-individual variability in CL and Vd were 37.0 and 28.5%, respectively. The residual error was 1.2 mg l(-1). Based on the results, optimal dosing intervals for renal impaired patients were calculated and were comparable with the intervals derived from the previous established nomogram.

Arsenite, arsenate and vanadate affect human erythrocyte membrane

Effects of arsenite, arsenate and vanadate on human erythrocyte membrane have been assessed according to their routes passing through the membrane, their binding modes to the membrane and their influences on membrane proteins and lipids. The uptake of arsenate (1.0 mM) by cells approached a limit with intracellular arsenic of about 0.2 mM in 5 h, and was strongly inhibited (approximately 95%) by 4,4'-diisothiocyano-2,2'-disulfonic stilbene (DIDS), indicating that arsenate, similar to vanadate, passed across the membrane through the anion exchange protein, band 3. Arsenite (1.0 mM) influx reached a maximum of about 0.4 mM in 30 min, and was not inhibited by DIDS. The transformed species of arsenite bound to the membrane from cytosol. In contrast, arsenate bound rapidly from the outside, followed by releasing and re-binding. The binding to the membrane via sulfhydryl was indicated by the decrease of the sulfhydryl level of membrane proteins. Polyacrylamide gel electrophoresis in sodium dodecyl sulfate (SDS-PAGE) analysis revealed that the proteins, bands 1-3, were among the targets of arsenite, arsenate and vanadate. Their binding to the membrane also induced changes in the fluidity of membrane lipids and in the negative charge density in the outer surface of the membrane.

Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles

Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prophylaxis of eclampsia in patients with severe pre-eclampsia. It is usually given by either the intramuscular or intravenous routes. The intramuscular regimen is most commonly a 4 g intravenous loading dose, immediately followed by 10 g intramuscularly and then by 5 g intramuscularly every 4 hours in alternating buttocks. The intravenous regimen is given as a 4 g dose, followed by a maintenance infusion of 1 to 2 g/h by controlled infusion pump. After administration, about 40% of plasma magnesium is protein bound. The unbound magnesium ion diffuses into the extravascular-extracellular space, into bone, and across the placenta and fetal membranes and into the fetus and amniotic fluid. In pregnant women, apparent volumes of distribution usually reach constant values between the third and fourth hours after administration, and range from 0.250 to 0.442 L/kg. Magnesium is almost exclusively excreted in the urine, with 90% of the dose excreted during the first 24 hours after an intravenous infusion of MgSO4. The pharmacokinetic profile of MgSO4 after intravenous administration can be described by a 2-compartment model with a rapid distribution (a) phase, followed by a relative slow beta phase of elimination. The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8 to 3.0 mmol/L has been suggested for treatment of eclamptic convulsions. The actual magnesium dose and concentration needed for prophylaxis has never been estimated. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L. Careful attention to the monitoring guidelines can prevent toxicity. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly followed variables. In this review, we will outline the currently available knowledge of the pharmacokinetics of MgSO4 and its clinical usage for women with pre-eclampsia and eclampsia.

X-linked adrenoleukodystrophy: genes, mutations, and phenotypes

X-linked adrenoleukodystrophy (X-ALD) is a complex and perplexing neurodegenerative disorder. The metabolic abnormality, elevated levels of very long-chain fatty acids in tissues and plasma, and the biochemical defect, reduced peroxisomal very long-chain acyl-CoA synthetase (VLCS) activity, are ubiquitous features of the disease. However, clinical manifestations are highly variable with regard to time of onset, site of initial pathology and rate of progression. In addition, the abnormal gene in X-ALD is not the gene for VLCS. Rather, it encodes a peroxisomal membrane protein with homology to the ATP-binding cassette (ABC) transmembrane transporter superfamily of proteins. The X-ALD protein (ALDP) is closely related to three other peroxisomal membrane ABC proteins. In this report we summarize all known X-ALD mutations and establish the lack of an X-ALD genotype/phenotype correlation. We compare the evolutionary relationships among peroxisomal ABC proteins, demonstrate that ALDP forms homodimers with itself and heterodimers with other peroxisomal ABC proteins and present cDNA complementation studies suggesting that the peroxisomal ABC proteins have overlapping functions. We also establish that there are at least two peroxisomal VLCS activities, one that is ALDP dependent and one that is ALDP independent. Finally, we discuss variable expression of the peroxisomal ABC proteins and ALDP independent VLCS in relation to the variable clinical presentations of X-ALD.

Effect of verbascoside on decreasing concentration of oxygen free radicals and lipid peroxidation in skeletal muscle

AIM

To detect the effects of verbascoside on decreasing the concentration of oxygen free radicals (OFR) and lipid peroxidation in skeletal muscle resulting from exhaustive exercise.

METHODS

Electron spin resonance (ESR) technique and thiobarbituric acid reaction (TBAR) method were used to detect the concentration of OFR in intact gastrocnemius muscle and the contents of milondialdehyde (MDA) in muscle homogenate.

RESULTS

Verbascoside decreased the concentration of OFR (P < 0.05) and the level of lipid peroxidation (P < 0.05) in muscle caused by exercise.

CONCLUSION

Verbascoside has the effects of reducing oxidative stress in muscle caused by exhaustive exercise by decreasing the concentration of free radicals and the level of lipid peroxidation.

Gene redundancy and pharmacological gene therapy: implications for X-linked adrenoleukodystrophy

As more functional redundancy in mammalian cells is discovered, enhanced expression of genes involved in alternative pathways may become an effective form of gene therapy. X-linked adrenoleukodystrophy (X-ALD) is a peroxisomal disorder with impaired very-long-chain fatty acid metabolism. The X-ALD gene encodes a peroxisomal membrane protein (ALDP) that is part of a small family of related peroxisomal membrane proteins. We show that 4-phenylbutyrate treatment of cells from both X-ALD patients and X-ALD knockout mice results in decreased levels of and increased beta-oxidation of very-long-chain fatty acids; increased expression of the peroxisomal protein ALDRP; and induction of peroxisome proliferation. We also demonstrate that ALDP and ALDRP are functionally related, by ALDRP cDNA complementation of X-ALD fibroblasts. Finally, we demonstrate the in vivo efficacy of dietary 4-phenylbutyrate treatment through its production of a substantial reduction of very-long-chain fatty acid levels in the brain and adrenal glands of X-ALD mice.

Disruption of the Saccharomyces cerevisiae FAT1 gene decreases very long-chain fatty acyl-CoA synthetase activity and elevates intracellular very long-chain fatty acid concentrations

Activation of fatty acids to their coenzyme A derivatives is necessary for subsequent metabolism. Very long-chain fatty acids, which accumulate in tissues of patients with X-linked adrenoleukodystrophy, are activated by very long-chain acyl-CoA synthetase (VLCS) normally found in peroxisomes and microsomes. We identified a candidate yeast VLCS gene (FAT1), previously identified as encoding a fatty acid transport protein, by its homology to rat liver peroxisomal VLCS. Disruption of this gene decreased, but did not abolish, cellular VLCS activity. Fractionation studies showed that VLCS activity, but not long-chain acyl-CoA synthetase activity, was reduced to about 40% of wild-type level in both 27,000 x g supernatant and pellet fractions. Separation of organelles in the pellet fraction by density gradient centrifugation revealed that VLCS activity was associated with peroxisomes and microsomes but not mitochondria. FAT1 deletion strains exhibited decreased growth on medium containing dextrose, oleic acid, and cerulenin, an inhibitor of fatty acid synthesis. FAT1 deletion strains grown on either dextrose or oleic acid medium accumulated very long-chain fatty acids. Compared with wild-type yeast, C22:0, C24:0, and C26:0 levels were increased approximately 20-, 18-, and 3-fold in deletion strains grown on dextrose, and 2-, 7-, and 5-fold in deletion strains grown on oleate. Long-chain fatty acid levels in wild-type and deletion strains were not significantly different. All biochemical defects in FAT1 deletion strains were restored to normal after functional complementation with the FAT1 gene. The level of VLCS activity measured in both wild-type and deletion yeast strains transformed with FAT1 cDNA paralleled the level of expression of the transgene. The extent of both the decrease in peroxisomal VLCS activity and the very long-chain fatty acid accumulation in the yeast FAT1 deletion model resembles that observed in cells from X-linked adrenoleukodystrophy patients. These studies suggest that the FAT1 gene product has VLCS activity that is essential for normal cellular very long-chain fatty acid homeostasis.

Genetic analysis of N-acetyltransferase polymorphism in a Chinese population

AIM

To study the genetic basis of N-acetylatransferase polymorphism in Chinese.

METHODS

Genotypes in 120 healthy Han volunteers from 19 provinces of China were assayed. The 3 common mutant alleles (M1, M2, M3) and one normal wild-type (WT) allele of the N-acetyltransferase (NAT2) gene were detected by allele-specific polymerase chain reaction technique.

RESULTS

The NAT2 allele frequencies in 120 Chinese (WT = 0.625, M1 = 0.0458, M2 = 0.188, M3 = 0.142) were different (P < 0.01). The NAT2 genotype distribution for all detected combinations of NAT2 alleles in 120 Chinese subjects was consisitent with Hardy-Weinberg equilibrium (chi 2 = 7.27, nu = 8, 0.7 > P > 0.5). Fifty subjects (41.7%) were homozygous wildtypes, 50 subjects (41.7%) were heterozygous mutants, and 20 subjects (16.7%) were homozygous mutants.

CONCLUSION

The lower frequency of mutant M1 allele compared with that of Caucasians explains the low frequency of slow acylators in Chinese.

[Determination of caffeine metabolite for the evaluation of N-acetyltransferase, CYP1A2 and xanthine oxidase activities]

Caffeine was used as a metabolic probe to measure, in 120 healthy volunteers, the activities of three enzymes, deduced to be N-acetyltransferase(NAT2), CYP1A2 and xanthine oxidase (XO). The caffeine metabolites of 5-acetylamino-6-formylamino-3-methyluracil (AFMU), 1-methylxanthine(1X), 1-methyluric acid(1U), 1, 7-dimethylxanthine(17X), and 1, 7-dimethyluric acid(17U) in urine were determined with HPLC after 4-5 hours of caffeine drink. The ratios of AFMU/1X or AFMU/(AFMU + 1X + 1U), (AFMU + 1X + 1U)/17X or (AFMU + 1X + 1U)/17U, and 1U/1X or 1U/(1X + 1U) were used as the index of NAT2, CYP1A2, and XO activities respectively. Frequency distribution analysis of the metabolic ratios of NAT2 indicated two distinct group with 20 slow acetylators and 100 rapid acetylators. Similar CYP1A2 activity was found in Chinese compared with European volunteers. Frequency analysis of CYP1A2 indicated the log normal distribution in 120 Chinese. The CYP1A2 index was much higher in smokers than that in nonsmokers. But no obvious difference was observed between young and old volunteers. The XO index also showed log normal distribution and has the similar value compared with European volunteers. The concentration variations of 1X and 1U in young volunteers were much lower than that in old volunteers.

A mouse model for X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD) is a peroxisomal disorder with impaired beta-oxidation of very long chain fatty acids (VLCFAs) and reduced function of peroxisomal very long chain fatty acyl-CoA synthetase (VLCS) that leads to severe and progressive neurological disability. The X-ALD gene, identified by positional cloning, encodes a peroxisomal membrane protein (adrenoleukodystrophy protein; ALDP) that belongs to the ATP binding cassette transporter protein superfamily. Mutational analyses and functional studies of the X-ALD gene confirm that it and not VLCS is the gene responsible for X-ALD. Its role in the beta-oxidation of VLCFAs and its effect on the function of VLCS are unclear. The complex pathology of X-ALD and the extreme variability of its clinical phenotypes are also unexplained. To facilitate understanding of X-ALD pathophysiology, we developed an X-ALD mouse model by gene targeting. The X-ALD mouse exhibits reduced beta-oxidation of VLCFAs, resulting in significantly elevated levels of saturated VLCFAs in total lipids from all tissues measured and in cholesterol esters from adrenal glands. Lipid cleft inclusions were observed in adrenocortical cells of X-ALD mice under the electron microscope. No neurological involvement has been detected in X-ALD mice up to 6 months. We conclude that X-ALD mice exhibit biochemical defects equivalent to those found in human X-ALD and thus provide an experimental system for testing therapeutic intervention.

[HPLC determination of five caffeine metabolites]

An HPLC method for the determination of caffeine metabolites in urine was established. Shim Pack CLC-ODS column (5 microns) was eluted with the mobile phase of methanol--acetonitrile--0.05% acetic acid = 12:1:87 (v/v) at a flow rate of 1.2 ml.min-1, and the ultraviolet absorbance was monitored at 280 nm. The 13 caffeine metabolites and caffeine were well separated and the concentrations of the five metabolites, AFMU, 1U, 1X, 17U, and 17X, were determined. The recoveries of the five metabolites were above 87%, the inter- and intra-day variations were less than 3%. The concentrations of the five metabolites in 120 volunteers were determined. The ratios of the metabolites were employed for the assessment of CYP1A2, NAT, and XO enzymes successfully.

The chirality selectivity in the uptake of platinum (II) complexes with 1,2-cyclohexanediamine isomers as carrier ligand by human erythrocytes

The uptake kinetics of cisplatin analogs of 1,2-cyclohexanediamine(dach) isomers with various leaving groups, by human erythrocytes in plasma isotonic buffer, were studied. The experimental results showed that the uptake rate constants (k values) decrease with the change of leaving group in the sequence: chloride (Cl) > squaric acid (SA) > oxalate (OX) > demethylcantharic acid (DA), with the same dach isomer as carrier group. It is noteworthy that for the platinum (II) complexes with the same leaving group, the k values always reduce as: 1R, 2R-dach > 1R, 2S-dach > 1S, 2S-dach. This result reflects the chirality selectivity. No differences in reactivity to protein thiols and effects on membrane permeability were found for the R,R-, R,S-, S,S-isomeric complexes. It is proposed that the chirality selectivity in uptake is due to the recognition of the chirality of the platinum complexes by the erythrocyte membrane. The interactions between the chiral platinum complexes and the head groups of the membrane phospholipid molecules are probably involved.

Heterologous expression and site-directed mutagenesis studies on the activation mechanism and the roles of the basic residues in the prosegment of aspergillopepsinogen I

To study the structure/function relationship of the prosegment of aspartic proteinase, a putative proform of aspergillopepsin I (or proteinase B) from Aspergillus niger var. macrosporus was expressed by Escherichia coli, refolded in vitro, and purified. The conversion of the purified proenzyme (aspergillopepsinogen I, proproteinase B) into the active mature form occurred at pH < or = 4.5 and was completely inhibited by pepstatin A, a specific inhibitor for aspartic proteinase, suggesting autoprocessing. The N-terminus of this mature form was Glu67 (numbering in preproform), which was different from the N-terminal Ser70 of native proteinase B although there was no significant difference in enzymatic activity. During the conversion, two intermediates were observed on SDS/PAGE, indicating a stepwise mechanism. The Lys56-Phe57 sequence seems to be a counterpart of the Lys-Tyr pair highly conserved in the prosequences of aspartic proteinases. When the mutant proenzyme (K56N), in which Lys56 was replaced with Asn by site-directed mutagenesis, was allowed to refold under various conditions, no significant potential activity could be obtained. Proproteinase B was also expressed by Bacillus brevis HPD31. This system required no in vitro refolding to obtain potentially active proenzyme, which was secreted into the culture medium (30-120 mg/l) and had the same properties with that obtained by the E. coli system. The K56N mutant prepared by this system also had no potential activity, and was rapidly digested by incubation with native proteinase B, suggesting that the mutant did not fold correctly. On the other hand, the K56R mutant (Lys56-Arg) was potentially active. These results indicated that Lys56 is essential for the folding through electrostatic interaction with the catalytic Asp residues in the active site although it may be replaced with Arg. In the presence of a low concentration of pepstatin A, an incompletely processed form with N-terminal Ser53 was obtained. Further, the R52Q (Arg52-->Glin) mutant showed no processing but was converted to the active mature form by incubation with the native enzyme. Therefore, the cleavage between Arg52 and Ser53 is considered to be the initial and essential step of the autoactivation. The R26Q, K27Q, R36Q, K40Q, R42Q, and K66Q mutants were also potentially active. The K66Q mutant was processed to a form with N-terminal Ala55.

The effect of cisplatin and transplatin on the conformation and association of F-actin

The effects of cisplatin and transplatin on the conformation and association of F-actin were studied by ESR, turbidimetry and CD measurement. The results indicate that the major component affecting F-actin secondary conformation is derived from their effect on the tertiary or quaternary conformation and association states of F-actin. The effect of platinum is seen by the fact that binding of cisplatin causes first an increase in molecular size followed by a later decrease. The induction time for the association depended on the concentration of cisplatin. Transplatin was able to reach the target site more readily, resulting in the dissociation of F-actin even at a very low concentration.

Molecular cloning of a cDNA for proctase B from Aspergillus niger var. macrosporus and sequence comparison with other aspergillopepsins I

A cDNA for proctase B from Aspergillus niger var. macrosporus was isolated and sequenced. The deduced amino acid sequence (394 residues) of the preproform of the enzyme was highly homologous (98% identify) with those of aspergillopepsins I from A. awamori and A. saitoi, and moderately homologous (68% identity) with that of A. oryzae. Most of the sequence differences were found in the carboxyl-terminal domain.

Pharmacokinetic-pharmacodynamic modeling of electroencephalographic effects of midazolam in eight Chinese men

The effects of midazolam (Mid) on the electroencephalogram (EEG) were related to Mid concentrations in serum in 8 Chinese healthy male volunteers for the assessment of concentration-effect relationship. The total number of waves per second within the frequency range of 12-30 Hz (TNW12-30) in the central-occipital (C1-O1) lead EEG obtained by aperiodic analysis was used as EEG effect of the drug. The PK-PD parameters were calculated by PK-PD software using the sigmoid Emax model. They were: T1(2)keo = 1.3 +/- 0.9 min-1, EC50 = 254 +/- 54 micrograms.L-1, N = 2.9 +/- 0.6. E0 and Emax were calculated from the observed values, being 3.4 +/- 1.3 and 11.4 +/- 2.2 TNW12-30, respectively. Our results showed that the concentration-EEG effect relationship of Mid could be characterized in individual Chinese man using TNW12-30 as a measure of pharmacological response.

The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups

The widespread use of standardized health surveys is predicated on the largely untested assumption that scales constructed from those surveys will satisfy minimum psychometric requirements across diverse population groups. Data from the Medical Outcomes Study (MOS) were used to evaluate data completeness and quality, test scaling assumptions, and estimate internal-consistency reliability for the eight scales constructed from the MOS SF-36 Health Survey. Analyses were conducted among 3,445 patients and were replicated across 24 subgroups differing in sociodemographic characteristics, diagnosis, and disease severity. For each scale, item-completion rates were high across all groups (88% to 95%), but tended to be somewhat lower among the elderly, those with less than a high school education, and those in poverty. On average, surveys were complete enough to compute scales scores for more than 96% of the sample. Across patient groups, all scales passed tests for item-internal consistency (97% passed) and item-discriminant validity (92% passed). Reliability coefficients ranged from a low of 0.65 to a high of 0.94 across scales (median = 0.85) and varied somewhat across patient subgroups. Floor effects were negligible except for the two role disability scales. Noteworthy ceiling effects were observed for both role disability scales and the social functioning scale. These findings support the use of the SF-36 survey across the diverse populations studied and identify population groups in which use of standardized health status measures may or may not be problematic.

Midazolam pharmacokinetics and electroencephalographic changes in eight Chinese men

Eight Chinese healthy male volunteers aged 27 +/- s 4 a were injected i.v. midazolam (Mid) 15 mg. Blood samples were collected at 0, 2, 5, 7, 10, 20, 30, 45, 60, 90, 120, 180, and 240 min. A HPLC method was established for determining the Mid concentrations in serum. The concentration-time data was fitted with biexponential curve. Pharmacokinetic parameters were: T1/2 alpha = 6.8 +2- 2.5 min, T1/2 beta = 118 +/- 27 min, Vc = 25 +/- 7 L, Cl = 393 +/- 79 ml.min-1, Vdss = 59 +/- 13 L, AUC0-infinity = 39.6 +/- 8.6 g.min.L-1. The electroencephalogram (EEG) showed a decrease in alpha activity and an increase in beta activity. The EEG pattern reverted toward baseline after 2-3 h. Pharmacokinetic and EEG findings suggest that Mid is a preferable anesthesia inducing agent.

[Effects of jiang tang tong mai ning on serum ascorbyl radical, superoxide dismutase activity, lipid peroxide level and tissue free oxygen radical in diabetic rats]

The effect of Jiang Tang Tong Mai Ning treatment on body weight, the level of blood sugar, the serum ascorbyl radical, SOD activity, LPO level and peroxidic radial (O2.-) of heart and kidney tissue in alloxan induced diabetic rats were observed. The results were also compared with that of Jiang Tang Jia Pian and vitamin E treated groups, which showed that the level of blood sugar, the level of serum ascorbyl radical, the concentration of LPO and peroxidic radical (O2.-) of myocardium and kidney tissue decreased significantly respectively (P < 0.01, 0.01, 0.01, 0.05), and the body weight, SOD activity increased obviously after the treatment (P < 0.05). For the first time, a W-wave between S-peak and T-peak of ESR spectrum in the tissue of rat, which is similar to the form of Fe-Mo-flavoprotein has been observed in this investigation, a positive correlation appears to exist between A value and the corresponding G value of W-wave.

The influence of bilirubin on fluidity and rotational correlation times of human erythrocyte membrane

The effects of bilirubin on the membrane motion parameters of human erythrocyte membrane were determined by the spin labelled ESR method. It causes a decrease in the order parameter and an increase in the corresponding fluidity of the lipid molecules. Bovine serum albumin was found to inhibit effectively the effects due to bilirubin. The disturbance to the organization of membrane molecules by bilirubin as well as the protective effects of serum albumin are discussed on the basis of the experimental results.

The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study

This study estimated the validity and relative precision (RP) of four methods (MOS long- and short-form scales, global items, and COOP Poster Charts) in measuring six general health concepts. The authors also tested whether and how precisely each method discriminated relatively well adult patients (N = 638) from those with only severe chronic medical (N = 168) and only psychiatric conditions (N = 163), as clinically defined. For comparisons between the well group and both medical and psychiatric groups, RP estimates favored long-form over short-form, multi-item scales, and favored multi-item scales over single-item global measures and poster charts. In relation to long forms, short-form multi-item scales achieved a median RP of .93; RP estimates for global items and poster charts were .81 and .67, respectively. Variations in RP across methods and concepts were linked to differences in the coarseness of measurement scales, reliability, and content (including the effects of chart illustrations). These variations in RP have implications for the interpretation of scores, the statistical power of comparisons between clinical groups, and the size of confidence intervals around individual patient scores.

The t(15;17) breakpoint in acute promyelocytic leukemia cluster within two different sites of the myl gene: targets for the detection of minimal residual disease by the polymerase chain reaction

The retinoic acid receptor alpha (RAR alpha) and the myl gene are involved in the translocation breakpoint t(15;17)(q22;q21) in acute promyelocytic leukemia (APL). The majority of the breakpoint sites have been mapped within the second intron of the RAR alpha gene; however, the breakpoint sites on the myl gene are variable. Using primer sets derived from exon 2 or exon 3 of the RAR alpha gene and a primer derived from the myl cDNA, we were able to amplify the breakpoint sites of the fusion transcripts of all six APL RNA samples by the reverse transcriptase-polymerase chain reaction (RT-PCR). A DNA fragment of 290 bp (breakpoint A) was amplified using RNA samples from three patients, whereas two DNA fragments of 630 and 774 bp (breakpoint B) were amplified using RNA samples from the other three APL patients. DNA sequence analysis of the amplified fragments suggests that the APL breakpoints clustered within two different introns of the myl gene. Northern blot analysis demonstrated that fusion transcripts RAR alpha/myl and myl/RAR alpha of varying sizes were detected in patients with different breakpoint sites on the myl gene. In addition, we analyzed five APL samples in complete remission and detected t(15;17)-positive cells. We conclude that the t(15;17) breakpoints in APL can be amplified by PCR using a single primer set and that minimal residual disease can be demonstrated in APL using RT-PCR.

[Pharmacokinetic-pharmacodynamic model of magnesium sulfate in treatment of pregnancy-induced hypertension]

Ten pregnancy-induced hypertension gravidas aged 24-36 (28.1 +/- 3.31) yr were infused iv with fast (7.5 g in 1 h) and slow (7.5 g in 5 h) rates consecutively. Blood pressure were measured and blood samples were collected at 0, 1, 6, 7, 9, 11, 15 h. The drug concentration of each sample in the serum was determined by colorimetric method. The integrated pharmacokinetic and pharmacodynamic model was used to analyze the data. The serum data were fitted to a biexponential equation and the effect data were fitted to a sigmoid Emax model. Their pharmacodynamic parameters were: Kco = 0.52.h-1, T1/2(kco) = 1.33 h, Emax = 20.5% Cc (50) = 6.15 micrograms.ml-1), y = 3.64. kco was not equal to k21 of the mammillary model. It shows that the site of action is situated in the effect compartment. The predicted effect could last 24 h.

Down regulation of myeloperoxidase gene associated with specific nuclease hypersensitive sites during TPA induced differentiation of HL-60

The level of myeloperoxidase (MPO) mRNA is reduced significantly after HL-60 induced differentiation with the tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). We examined the chromatin structural changes of the MPO gene during TPA induction. Before TPA induction about nine DNase I hypersensitive sites (HS) were found on the 5' upstream and at various intron regions of the MPO gene. A new HS was found on intron 8 within 4 h of induction; its appearance preceded down regulation of the MPO gene. At the same time DNase I HS found in 0.3 and 1-1.5 kb upstream of the MPO CAP site, were significantly reduced or disappeared after TPA induction. These chromatin structural changes could be closely linked to the mechanism which regulates the MPO gene expression.

Hemoglobins of the Lucina pectinata/bacteria symbiosis. II. An electron paramagnetic resonance and optical spectral study of the ferric proteins

We report an optical and EPR spectral study of three hemoglobins, Hb I, II, and III, from the gill of the clam Lucina pectinata. Hemoglobin I reacts much more avidly with hydrogen sulfide than do Hbs II and III. The proximal ligand to the heme iron of each hemoglobin is histidyl imidazole. The acid/alkaline transition of ferric Hb I occurs with pK 9.6; those of ferric Hbs II and III with pK 6.6 and 5.9, respectively. At their acid limits each ferric hemoglobin exists as aquoferric hemoglobin. Broadening of the g = 6 resonance suggests that the bound water enjoys great positional freedom. Ferric Hb I, at the alkaline limit (pH 11), exists as ferric hemoglobin hydroxide. Ferric Hbs II and III, at their alkaline limit (pH 7.5), each exist as equal mixtures of two species. The low spin species with optical maxima near 541 and 576 nm and g values of 2.61, 2.20, and 1.82, are identified as ferric hemoglobin hydroxide. The high spin species, with optical maxima near 486 and 603 nm and g values of 6.71, 5.87, and 5.06, resemble Dicrocoelium hemoglobin and hemoglobin MSaskatoon. Here we show that Hbs II and III resemble hemoglobin MSaskatoon in which a distal tyrosinate oxygen ligated to the ferric heme iron at alkaline pH is displaced by water at acid pH. The H2S product of ferric Hb I is identified as ferric hemoglobin sulfide.