SPTSSA variants alter sphingolipid synthesis and cause a complex hereditary spastic paraplegia

Sphingolipids are a diverse family of lipids with critical structural and signalling functions in the mammalian nervous system, where they are abundant in myelin membranes. Serine palmitoyltransferase, the enzyme that catalyses the rate-limiting reaction of sphingolipid synthesis, is composed of multiple subunits including an activating subunit, SPTSSA. Sphingolipids are both essential and cytotoxic and their synthesis must therefore be tightly regulated. Key to the homeostatic regulation are the ORMDL proteins that are bound to serine palmitoyltransferase and mediate feedback inhibition of enzymatic activity when sphingolipid levels become excessive. Exome sequencing identified potential disease-causing variants in SPTSSA in three children presenting with a complex form of hereditary spastic paraplegia. The effect of these variants on the catalytic activity and homeostatic regulation of serine palmitoyltransferase was investigated in human embryonic kidney cells, patient fibroblasts and Drosophila. Our results showed that two different pathogenic variants in SPTSSA caused a hereditary spastic paraplegia resulting in progressive motor disturbance with variable sensorineural hearing loss and language/cognitive dysfunction in three individuals. The variants in SPTSSA impaired the negative regulation of serine palmitoyltransferase by ORMDLs leading to excessive sphingolipid synthesis based on biochemical studies and in vivo studies in Drosophila. These findings support the pathogenicity of the SPTSSA variants and point to excessive sphingolipid synthesis due to impaired homeostatic regulation of serine palmitoyltransferase as responsible for defects in early brain development and function.

Bi-allelic ATG4D variants are associated with a neurodevelopmental disorder characterized by speech and motor impairment

Autophagy regulates the degradation of damaged organelles and protein aggregates, and is critical for neuronal development, homeostasis, and maintenance, yet few neurodevelopmental disorders have been associated with pathogenic variants in genes encoding autophagy-related proteins. We report three individuals from two unrelated families with a neurodevelopmental disorder characterized by speech and motor impairment, and similar facial characteristics. Rare, conserved, bi-allelic variants were identified in ATG4D, encoding one of four ATG4 cysteine proteases important for autophagosome biogenesis, a hallmark of autophagy. Autophagosome biogenesis and induction of autophagy were intact in cells from affected individuals. However, studies evaluating the predominant substrate of ATG4D, GABARAPL1, demonstrated that three of the four ATG4D patient variants functionally impair ATG4D activity. GABARAPL1 is cleaved or "primed" by ATG4D and an in vitro GABARAPL1 priming assay revealed decreased priming activity for three of the four ATG4D variants. Furthermore, a rescue experiment performed in an ATG4 tetra knockout cell line, in which all four ATG4 isoforms were knocked out by gene editing, showed decreased GABARAPL1 priming activity for the two ATG4D missense variants located in the cysteine protease domain required for priming, suggesting that these variants impair the function of ATG4D. The clinical, bioinformatic, and functional data suggest that bi-allelic loss-of-function variants in ATG4D contribute to the pathogenesis of this syndromic neurodevelopmental disorder.

Continuing a search for a diagnosis: the impact of adolescence and family dynamics

The "diagnostic odyssey" describes the process those with undiagnosed conditions undergo to identify a diagnosis. Throughout this process, families of children with undiagnosed conditions have multiple opportunities to decide whether to continue or stop their search for a diagnosis and accept the lack of a diagnostic label. Previous studies identified factors motivating a family to begin searching, but there is limited information about the decision-making process in a prolonged search and how the affected child impacts a family's decision. This study aimed to understand how families of children with undiagnosed diseases decide whether to continue to pursue a diagnosis after standard clinical testing has failed. Parents who applied to the Undiagnosed Disease Network (UDN) at the National Institutes of Health (NIH) were recruited to participate in semi-structured interviews. The 2015 Supportive Care Needs model by Pelenstov, which defines critical needs in families with rare/undiagnosed diseases, provided a framework for interview guide development and transcript analysis (Pelentsov et al in Disabil Health J 8(4):475-491, 2015. https://doi.org/10.1016/J.DHJO.2015.03.009 ). A deductive, iterative coding approach was used to identify common unifying themes. Fourteen parents from 13 families were interviewed. The average child's age was 11 years (range 3-18) and an average 63% of their life had been spent searching for a diagnosis. Our analysis found that alignment or misalignment of parent and child needs impact the trajectory of the diagnostic search. When needs and desires align, reevaluation of a decision to pursue a diagnosis is limited. However, when there is conflict between parent and child desires, there is reevaluation, and often a pause, in the search. This tension is exacerbated when children are adolescents and attempting to balance their dependence on parents for medical care with a natural desire for independence. Our results provide novel insights into the roles of adolescents in the diagnostic odyssey. The tension between desired and realistic developmental outcomes for parents and adolescents impacts if, and how, the search for a diagnosis progresses.

Self-Reported Behavior Change and Predictors of Engagement With a Multidomain Brain Health Intervention for Midlife and Older Adults: A Pilot Clinical Trial

OBJECTIVES

This study evaluated the efficacy of a multidomain brain health intervention on health behavior change and sought to understand whether health literacy or brain health knowledge predicted engagement with the intervention.

METHODS

One-hundred thirty midlife and older adults were assigned to one of three intervention conditions: brain fitness (B-Fit) utilizing education and goal setting, education-only, or waitlist. Questionnaires were completed at baseline and post-intervention.

RESULTS

Both B-Fit and education-only conditions reported improvements in health behaviors over time. Although effect size for the education-only condition was moderate, only the B-Fit condition differed significantly in health behaviors from the waitlist post-intervention. Lower baseline brain health knowledge predicted improvements in health behaviors for education-only condition.

DISCUSSION

The multidomain brain health intervention was successful in helping participants change their behaviors, but it was not more effective than the education-only condition. For those with lower brain health knowledge, an education-only intervention may be sufficient to encourage behavior change.

169 Use of stored zonae pellucidae from young and old mares to study sperm–oocyte binding

Natural and standard IVF requires sperm binding to the zona pellucida (ZP); however, difficulties in obtaining equine ZP limit research in this area. In a previous study, an in vitro assay was used to assess ZP sperm binding for oocytes collected from old and young mares’ dominant follicles, with similar numbers of sperm bound per ZP (means of 45.5 and 58.1 sperm per ZP; P=0.12) (Lupole et al. 2010 Anim. Reprod. Sci. 121, 252-253). We hypothesised that ZP from uncleaved equine oocytes after intracytoplasmic sperm injection (ICSI) could be used to study ZP sperm binding. For this study, oocytes from mares >20 years (old, n=13 oocytes) and 4 to 12 years (young, n=16 oocytes) were collected by transvaginal, ultrasound-guided aspirations and injected with a single sperm. Only oocytes that failed to cleave into at least 2 cells within 2 days after ICSI were used. The oocytes were stored in hyperosmotic salt solution at 4°C for 2 years. The sperm binding assay was performed similar to the previous study (Lupole et al. 2010). Oocytes were removed from salt solution and placed into TALP and incubated for 1h at 38.5°C in 6% CO2 and air. Following incubation, oocytes were moved to a 45-µL drop of TALP. Frozen-thawed sperm (100,000 total sperm) from one stallion of good fertility were added and incubated for 2h. Oocytes were then washed through 4 drops of TALP using a pipette tip with a 175-µm inner diameter to remove loosely bound sperm. Oocytes and tightly bound sperm were stained in 4’6-diamidino-2-phenyindole (DAPI; 10µg mL−1) for 15min. The oocytes were secured on a glass slide under a coverslip that was supported by a mix of paraffin and petroleum jelly and viewed at 400× magnification using an epifluorescence microscope (Nikon Eclipse E800, Nikon, Tokyo, Japan). The number of tightly bound sperm was recorded. Sperm counts for age groups were compared using Student’s t-test, with data presented as mean±s.e.m. Sperm binding was not different between groups (59.2±16.9 for old mares and 36.8±10.6 for young mares; P=0.25). As previously observed with oocytes that had not been injected with sperm and minimal time in salt storage, we found no significant effect of mare age on sperm binding to the ZP. In addition, numbers of sperm bound to the ZP were similar between projects. Our findings suggest that equine oocytes that fail to cleave after ICSI could provide a valuable source of ZP for research. Further work is ongoing to determine the effect of time that oocytes are stored in salt solution on sperm binding.

Formation of drug nanocrystals under nanoconfinement afforded by liposomes

In response to freeze–thaw, liposome-encapsulated antibiotic (A) is converted into nanocrystalline form (B) resulting in an attenuated drug release profile.

Correction: Formation of drug nanocrystals under nanoconfinement afforded by liposomes

Correction for ‘Formation of drug nanocrystals under nanoconfinement afforded by liposomes’ by D. Cipolla et al., RSC Adv., 2016, 6, 6223–6233.

Production of solid lipid nanoparticle suspensions using supercritical fluid extraction of emulsions (SFEE) for pulmonary delivery using the AERx system

The aims of the current work included: development of a new production method for nanoparticles of water-insoluble drugs in combination with lipids, characterization of the nanoparticles and development of lipid nanosuspension formulations, and investigation of the feasibility of delivering the nanosuspensions as aerosols for inhalation using Aradigm's AERx Single Dose Platform (SDP) with micron-sized nozzles and the all mechanical AERx Essence with sub-micron-sized nozzles. The continuous SFEE method was used for particle precipitation of solid lipid nanoparticles (SLN). The method allowed for production of stable particulate aqueous suspensions of a narrow size distribution, with a volume mean diameter below 30 nm (D99% cumulative volume below 100 nm). Thus the particle size obtained was significantly smaller than previously has been achieved by other techniques. The residual solvent content in the final suspension was consistently below 20 ppm. Drug loading values between 10-20% w/w drug were obtained for model compounds ketoprofen and indomethacin in formulation with lipids such as tripalmitin, tristearin and Gelucire 50/13. It was observed that the loading capacity achieved was higher than the thermodynamic limit of the solubility of the drugs in molten lipids. Lipid nanosuspension formulations were successfully aerosolized using both of the AERx systems. As measured by both cascade impactor and laser diffraction, the aerosol fine particle fraction (FPF) was comparable to drug solution formulations typically used in these devices; i.e., greater than 90% of the aerosol mass resided in particles less than 3.5 mum aerodynamic diameter.

Induction by sphingomyelinase of shiga toxin receptor and shiga toxin 2 sensitivity in human microvascular endothelial cells

Shiga toxin-producing enterohemorrhagic Escherichia coli is the major cause of acute renal failure in young children. The interaction of Shiga toxins 1 and 2 (Stx1 and Stx2) with endothelial cells is an important step in the renal coagulation and thrombosis observed in hemolytic uremic syndrome. Previous studies have shown that bacterial lipopolysaccharide and host cytokines slowly sensitize endothelial cells to Shiga toxins. In the present study, bacterial neutral sphingomyelinase (SMase) rapidly (1 h) sensitized human dermal microvascular endothelial cells (HDMEC) to the cytotoxic action of Stx2. Exposure of endothelial cells to neutral SMase (0.067 U/ml) caused a rapid increase of intracellular ceramide that persisted for hours. Closely following the change in ceramide level was an increase in the expression of globotriaosylceramide (Gb3), the receptor for Stx2. A rapid increase was also observed in the mRNA for ceramide:glucosyltransferase (CGT), the first of three glycosyltransferase enzymes of the Gb3 biosynthetic pathway. The product of CGT (glucosylceramide) was also increased. In contrast, mRNA for the third enzyme of the pathway, Gb3 synthase, was constitutively produced and was not influenced by SMase treatment of HDMEC. These results describe a rapid response mechanism by which extracellular neutral SMase derived from either bacteria or eukaryotic cells may signal endothelial cells to become sensitive to Shiga toxins.

MHC class II proteins contain a potential binding site for the verotoxin receptor glycolipid CD77

Globotriaosyl ceramide or CD77 functions as a cell surface receptor for toxins of the Shiga toxin/verotoxin family and as a marker for germinal center stage B-cells. The B-cell protein CD19 and the interferon-alpha receptor possess verotoxin-like amino acid sequences in their extracellular domains, and CD77 has been shown to function in CD19-mediated adhesion and interferon-induced growth inhibition. The Burkitt's lymphoma cell line, Daudi, is similar to germinal center B-cells in their expression of CD77, CD19 and MHC class II molecules. Using the multiple sequence alignment program, ClustalW, we have identified a verotoxin-like amino acid sequence on the beta-chain of human and murine MHC class II molecules. Binding of CD77 at this site could modulate the peptide-binding properties of these MHC class II molecules. Using Western blot analysis of whole cell extracts, we found that CD77-positive Daudi cells have higher levels of HLA-D proteins than VT500 cells, a Daudi-derived CD77-deficient mutant cell line. In contrast, MHC class II-mediated adhesion and surface expression are similar in the two cell lines. Therefore, CD77 could play a functional or regulatory role in MHC class II-mediated functions specifically relating to antigen presentation by B-cells to T helper cells.

A watershed of new knowledge in biomedical sciences

The Inaugural Scientific Symposium of the Barcelona Science Park, held March 9, 2001, covered research topics that are prominently represented at the Biomedical Research Institute of the Park, including cell and developmental biology, molecular pathology, medicinal chemistry and structural biology. Featured speakers at the symposium were Fotis Kafatos (European Molecular Biology Laboratory, Heidelberg, Germany); Kurt Wuthrich (Swiss Federal Institute of Technology, Zurich, Switzerland); Mariann Bienz (Medical Research Council, Laboratory of Molecular Research, Cambridge, U.K.); Joan Massague (Memorial Sloan-Kettering Cancer Center, New York, and Howard Hughes Medical Institute, Chevy Chase, Maryland, U.S.A.); Philip Cohen (Dept. of Biochemistry, University of Dundee, Scotland, U.K.); Mariano Barbacid (Spanish National Cancer Center, Madrid, Spain); and Harold Varmus (Memorial Sloan-Kettering Cancer Center, New York, U.S.A.).

Total cost comparison of 2 biopsy methods for nonpalpable breast lesions

OBJECTIVE

To identify, quantify, and compare total facility costs for 2 breast biopsy methods: vacuum-assisted biopsy (VAB) and needle-wire-localized open surgical biopsy (OSB).

STUDY DESIGN

A time-and-motion study was done to identify unit resources used in both procedures. Costs were imputed from published literature to value resources. A comparison of the total (fixed and variable) costs of the 2 procedures was done.

PATIENTS AND METHOD

A convenience sample of 2 high-volume breast biopsy (both VAB and OSB) facilities was identified. A third facility (OSB only) and 8 other sites (VAB only) were used to capture variation. Staff interviews, patient medical records, and billing data were used to check observed data. One hundred and sixty-seven uncomplicated procedures (71 OSBs, 96 VABs) were observed. Available demographic and clinical data were analyzed to assess selection bias, and sensitivity analyses were done on the main assumptions.

RESULTS

The total facility costs of the VAB procedure were lower than the costs of the OSB procedure. The overall cost advantage for using VAB ranges from $314 to $843 per procedure depending on the facility type. Variable cost comparison indicated little difference between the 2 procedures. The largest fixed cost difference was $763.

CONCLUSIONS

Facilities must consider the cost of new technology, especially when the new technology is as effective as the present technology. The seemingly high cost of equipment might negatively influence a decision to adopt VAB, but when total facility costs were analyzed, the new technology was less costly.

Ongoing progress in the Alzheimer's disease arena

The World Alzheimer Congress 2000, held in Washington, D.C., July 918, 2000, addressed the medical, social, psychological and economic effects of this disease, and offered the latest information on its pathophysiology, epidemiology, diagnosis and treatment. Pharmacological approaches to treatment currently under investigation or represented by drugs on the market include beta-amyloid targeted therapies, cholinergic therapies, neuroprotective agents, hormone-based therapies and others. Presentations at the congress also addressed the preventive potential of diet and the treatment of the behavioral disturbances associated with the disease.

Primary leiomyosarcoma of the mandible in a 7-year-old girl: report of a case and review of the literature

Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a "floating-in-air" appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease.

A comparison of the effects of verocytotoxin-1 on primary human renal cell cultures

Infection with verocytotoxin-producing Escherichia coli causes haemolytic uraemic syndrome (HUS). Verocytotoxin-1 (VT1) is cytopathic to renal microvascular endothelial cells in culture, supporting the hypothesis that the vasculopathy of HUS is caused directly by the toxic action of VT1 on cells. We provide evidence that VT1 inhibits protein synthesis in primary cultures of glomerular epithelial cells (GE), cortical tubular epithelial cells (CTE) and mesangial cells (MC). Using 100 pg/ml of VT1 we saw a decrease in protein synthesis to 14.3+/-1.9% in vero cells (a primate cell line), 1.7+/-0.3% in GE, 0.9+/-0.4% in CTE and 74.8+/-1.3% in MC at 24 h. The human renal epithelial cells are at least as sensitive as vero cells to the protein synthesis inhibitory effects of VT1 if not more so. Cell viability decreased in all cultures as measured by MTT reduction, neutral red incorporation and lactate dehydrogenase release and followed the same pattern of susceptibility as for protein synthesis inhibition. However, unlike vero cells, death occurred without DNA fragmentation. Cell sensitivity was greatest in cells which bound more VT1.

Verotoxins inhibit the growth of and induce apoptosis in human astrocytoma cells

Verotoxin 1 (VT1) is an E. coli toxin comprising an A subunit with N-glycanase activity, and five smaller B subunits capable of binding to the functional receptor globotriaosylceramide (Galalpha1-4-Galbeta1-4-Glcceramide-Gb3). VT is implicated in hemorrhagic colitis and the more serious hemolytic uremic syndrome. VT1 is active against various tumor cell lines in vitro and in vivo. To extend the anti-cancer spectrum of activity of VT to human brain tumors, in the present analysis we studied the effects of VT on the growth of 6 permanent human astrocytoma cell lines. All astrocytoma cell lines analyzed express Gb3 and were sensitive to VT-1 at a dose of 50 ng/ml, but sensitivity was not proportional to the relative Gb3 concentration. VT induced apoptosis in these cells was shown by electron microscopy. Morphological evidence (nuclear shrinkage and chromatin condensation) of apoptosis could be clearly distinguished 1.5 hrs after toxin addition. Ultrastructural preservation of organelles was observed in conjunction with blebbing of the plasma membrane, condensation of chromatin within the nucleus and nuclear shrinkage. Apoptosis was also induced by the recombinant toxin B subunit alone, suggesting that the ligation of Gb3 is the primary induction mechanism. These studies indicate that verotoxin/Gb3 targetting may provide a novel basis for the inhibition of astrocytoma tumour cell growth.

The expression and characterization of a putative adhesin B from H. influenzae

In the H. influenzae type b (Hib) genome, two putative adhesin B genes, HI0119 and HI0362, have been identified on the basis of homology to the adhesin B (FimA) of Streptococcus parasanguis. We expressed and characterized one of them, HI0119, from a non-typeable H. influenzae strain (NTHI). This 37 kDa protein was selectively isolated from an H. influenzae surface protein (water) extract by elution from a celite matrix with EDTA. The adhesin B protein is 97.7% identical to that of H. influenzae, strain Rd, has 23.7% identity and 47.8% similarity to FimA of Streptococcus parasanguis but is distinguished from the FimA family by the absence of the N-terminal lipid anchor consensus sequence LXXC, the presence of a C-terminal disulfide-bonded domain, and a central histidine-rich domain. Recombinant fusion protein bound specifically to celite. Antisera raised against fusion protein recognized a 37 kDa protein from whole cell extracts of H. influenzae on Western blots. A truncated mutant lacking the C-terminal disulfide-bonded domain and a Cys308 to Ser mutant were constructed and expressed as fusion proteins. Both mutants retained celite binding. However, purified fusion proteins could not, unlike H. influenzae, bind Hep2 cells, suggesting that HI0119 may not be an adhesin in this organism.

Intracellular signaling events in superoxide generation and adhesion of channel catfish, Ictalurus punctatus rafinesque, neutrophils to the extracellular matrix protein fibrinogen

Activation of channel catfish neutrophils is essential if these cells are to participate in adhesion to extracellular matrix proteins or generate intracellular superoxide for killing of microbes. Various signaling pathways are required for these activities to occur. The objective of this study was to identify components of the signal transduction pathways in channel catfish neutrophils. A23187, bryostatin, and phorbol dibutyrate (PDBU) all induced catfish neutrophil adhesion to fibrinogen coated plates and the adhesion could be significantly reduced when neutrophils were pretreated with staurosporine (1 x 10(-7) M). Staurosporine was the only inhibitor used in the study that inhibited or reduced PDBU-induced adhesion of catfish neutrophils to fibrinogen. Phorbol dibutyrate at the concentrations used in the adhesion assay was the only stimulant that caused generation of intracellular superoxide and therefore was the only stimulant used in the remainder of the study. Aristolochic acid (1 x 10(-4) and 3 x 10(-5) M) + PDBU and staurosporine (1 x 10(-7) and 1 x 10(-8) M) + PDBU caused a significant decrease (p < or = 0.05) in PDBU-induced intracellular oxygen generation. The role of protein kinase C and phospholipases in channel catfish neutrophil adhesion and superoxide generation are discussed.

Identification of the key protein for zinc uptake in Hemophilus influenzae

Very little is known about specific mechanisms for zinc accumulation and transport in bacteria. In this study a putative adhesin B in Hemophilus influenzae, the product of gene HI0119, has been identified as a periplasmic zinc-binding protein (PZP1). A pzp1-deficient mutant has been constructed which is defective for growth under aerobic conditions and grows poorly under anaerobic conditions. The growth defect is specifically rescued by supplementing the growth medium with high concentrations of zinc. Subcellular fractionation was used to localize PZP1 to the periplasmic region in a nontypeable H. influenzae strain and in a transfected recombinant Escherichia coli strain (TApzp1). Recombinant PZP1, purified from a periplasmic extract of E. coli strain TApzp1, contained approximately two zinc atoms/protein molecule as determined by neutron activation analysis and atomic absorption spectroscopy. The zinc atoms could be removed by incubation with EDTA, and, by further addition of zinc, a total of five zinc atoms/PZP1 could be bound. Direct binding of 65Zn to the recombinant protein by Western blot was demonstrated. Taken together, these results provide direct evidence that PZP1 plays a key role in zinc uptake by H. influenzae.

Leg morbidity and function following fibular free flap harvest

Over a period of 3 years, 50 consecutive free fibular flaps for mandibular reconstruction were performed on 47 patients. In 38 patients (81%) a skin paddle was included with the flap to provide either mucosal lining or skin cover; in 9 patients (19%) bone alone was used. Thirty-one patients (66%) required a skin graft to close the donor defect in the leg. Donor leg morbidity and function were determined by patient questionnaire and by physical examination. Forty-one donor sites in 40 patients were available for long-term follow-up. The follow-up ranged from 4 to 39 months with an average of 17 months. Immediate postoperative infection occurred in the donor site of 1 patient (2%) and required additional surgery. There was no other immediate donor site complications when closure required skin grafting. Eleven patients (27%) had late donor site morbidity, consisting of motor weakness of the great toe in 5 patients, ankle instability and/or stiffness in 3 patients, donor site pain in 1 patient, and edema in 2 patients. All complications were graded as mild in severity by the patient and by the examiner. In this series, although most donor site defects required skin grafting, short- and long-term morbidity was minimal. After a short rehabilitation period, all patients were fully able to engage in all daily and recreational activities.

The stability of recombinant human growth hormone in poly(lactic-co-glycolic acid) (PLGA) microspheres

PURPOSE

The development of a sustained release formulation for recombinant human growth hormone (rhGH) as well as other proteins requires that the protein be stable at physiological conditions during its in vivo lifetime. Poly(lactic-co-glycolic acid) (PLGA) microspheres may provide an excellent sustained release formulation for proteins, if protein stability can be maintained.

METHODS

rhGH was encapsulated in PLGA microspheres using a double emulsion process. Protein released from the microspheres was assessed by several chromatrographic assays, circular dichroism, and a cell-based bioassay. The rates of aggregation, oxidation, diketopiperazine formation, and deamidation were then determined for rhGH released from PLGA microspheres and rhGH in solution (control) during incubation in isotonic buffer, pH 7.4 and 37 degrees C.

RESULTS

rhGH PLGA formulations were produced with a low initial burst (< 20%) and a continuous release of rhGH for 30 days. rhGH was released initially from PLGA microspheres in its native form as measured by several assays. In isotonic buffer, pH 7.4 and 37 degrees C, the rates of rhGH oxidation, diketopiperazine formation, and deamidation in the PLGA microspheres were equivalent to the rhGH in solution, but aggregation (dimer formation) occurred at a slightly faster rate for protein released from the PLGA microspheres. This difference in aggregation rate was likely due to the high protein concentration used in the encapsulation process. The rhGH released was biologically active throughout the incubation at these conditions which are equivalent to physiological ionic strength and pH.

CONCLUSIONS

rhGH was successfully encapsulated and released in its fully bioactive form from PLGA microspheres over 30 days. The chemical degradation rates of rhGH were not affected by the PLGA microspheres, indicating that the internal environment of the microspheres was similar to the bulk solution. After administration, the microspheres should become fully hydrated in the subcutaneous space and should experience similar isotonic conditions and pH. Therefore, if a protein formulation provides stability in isotonic buffer, pH 7.4 and 37 degrees C, it should allow for a safe and efficacious sustained release dosage form in PLGA microspheres.

Comparative cytotoxicity of purified Shiga-like toxin-IIe on porcine and bovine aortic endothelial and human colonic adenocarcinoma cells

Porcine and bovine aortic endothelial cells and human colonic adenocarcinoma cells were compared for their susceptibility to the toxic effect of purified Shiga-like toxin IIe (SLT-IIe), measured by the neutral red cytotoxicity assay. Cytotoxicity correlated with toxin binding as indicated by fluorescence activated cell sorter analysis and with the globotriosylceramide (Gb3) and globotetraosylceramide (Gb4) content of cells determined by high pressure liquid chromatography. One line of porcine aortic endothelial cells was 1400-fold more susceptible than the line of bovine aortic endothelial cells that was tested, but a second line of porcine aortic endothelial cells was highly refractory to SLT-IIe. Human colonic adenocarcinoma cells lacked detectable levels of Gb4 and were least susceptible to SLT-IIe.

Acute ischaemic preconditioning protects against skeletal muscle infarction in the pig

OBJECTIVE

The aims were to investigate the efficacy of acute ischaemic preconditioning for protection of skeletal muscles against infarction and its effect on muscle blood flow and ischaemic muscle metabolism.

METHODS

The efficacy of preconditioning was tested by subjecting pig latissimus dorsi and gracilis muscles to different numbers and durations of ischaemia/reperfusion cycles before 4 h of global ischaemia. Infarction was assessed at 48 h of reperfusion, using nitroblue tetrazolium dye. Blood flow in the latissimus dorsi was measured at the end of preconditioning and 1.5 and 3.0 h of reperfusion, using the radioactive microsphere (15 microns) technique. Muscle biopsies were taken from the latissimus dorsi before ischaemia, at the end of 2 and 4 h of ischaemia, and 1.5 h of reperfusion.

RESULTS

At least three cycles of 10 min ischaemia and 10 min reperfusion were required for preconditioning of latissimus dorsi and gracilis muscles for protection against infarction. Preconditioning reduced the total infarct size by 44% and 62% in latissimus dorsi and gracilis muscles, respectively. Preconditioning did not affect preischaemia muscle blood flow but it reduced the muscle content (preischaemia reserve) of phosphocreatine and ATP and the muscle energy charge potential (ECP) by 13.5%*, 27.5%*, and 8%* (*P < 0.05), respectively. In spite of a lower preischaemia reserve of phosphocreatine and ATP, the muscle contents of phosphocreatine and ATP and muscle ECP were maintained higher and the lactate lower (*P < or = 0.05) in the preconditioned than in the non-preconditioned (control) muscles at the end of 4 h of ischaemia [phosphocreatine 8.0(SEM 0.4) v 3.2(0.3)*; ATP 9.8(0.7) v 7.8(0.3); ECP 0.72(0.02) v 0.66(0.01)*; lactate 115.4(8.6) v 160.5(11.8)* mumol.g-1 dry muscle]. The level of ATP and ECP also remained significantly higher and the level of lactate significantly lower in the preconditioned than in the non-preconditioned latissimus dorsi muscles at 1.5 h of reperfusion. Hyperaemia was seen in the preconditioned latissimus dorsi muscles at 1.5 h of reperfusion and it subsided by the end of 3h of reperfusion.

CONCLUSIONS

The protective effect of preconditioning can be induced in pig skeletal muscle but at a higher threshold than reported previously in pig cardiac muscle (one cycle). Preconditioning of pig skeletal muscle is associated with a lower energy metabolism during sustained ischaemia. At the present time, it is not known if this energy sparing effect is a major mechanism of ischaemic preconditioning against infarction in skeletal muscles.

Shiga toxin-associated hemolytic uremic syndrome: effect of sodium butyrate on sensitivity of human umbilical vein endothelial cells to Shiga toxin

Escherichia coli O157:H7-related vascular damage such as hemolytic uremic syndrome is believed to require the Shiga-like toxins. This study demonstrated that sodium butyrate sensitized human umbilical vein endothelial cells to Shiga toxin and increased the expression of Shiga toxin receptor, globotriaosylceramide (Gb3), on human umbilical vein endothelial cells.

Evidence that verotoxins (Shiga-like toxins) from Escherichia coli bind to P blood group antigens of human erythrocytes in vitro

The interaction of verotoxins (VTs) with human erythrocytes (RBCs) in vitro was investigated, with particular reference to the role of P blood group glycolipids that are structurally related to the known VT receptors. RBC binding of purified VT1, VT2, VT2c, and VT2e was detected by direct and indirect immunofluorescence. Glycolipids were extracted from defined RBCs, separated by thin-layer chromatography, and assessed for VT binding in an overlay assay by adding toxin and specific antibodies. All VTs bound to P1 phenotype (Pk, P, and P1 antigens) and P2 phenotype (Pk and P antigens) RBCs but not to p phenotype (lacking the Pk, P, and P1 antigens) RBCs. Binding of VT1 and VT2 was approximately 10-fold greater to P1 and the rare Pk2 (Pk antigen but no P1 or P antigen) phenotype cells than to P2 phenotype RBCs, whereas VT2e bound equally well to P1 and P2 phenotype cells. The VT1 and VT2 immunofluorescence results correlated with the detection of P1 and/or increased amounts of Pk (globotriaosylceramide) antigen; VT2e immunofluorescence correlated with the detection of P (globotetraosylceramide) antigen. The Pk band pattern and VT binding observed in the thin-layer chromatogram of human P1 and P phenotype RBC extracts varied from that of human kidney and Pk1 phenotype (Pk and P1 antigens) RBCs. We conclude that each VT binds to human RBCs in vitro by utilizing specific P blood group glycolipids as receptors. On P1 and P phenotype RBCs, the accessibility of the Pk antigen for VTs appeared to be restricted. The occurrence of VT-RBC binding in natural VT-producing Escherichia coli disease and its relevance for the pathophysiology of hemolytic uremic syndrome remain to be established.

Lipid modulation of glycolipid receptor function. Availability of Gal(alpha 1-4)Gal disaccharide for verotoxin binding in natural and synthetic glycolipids

Verotoxins bind to glycosphingolipids containing terminal Gal(alpha 1-4)Gal residues. Globotriaosylceramide is the most effective receptor for verotoxin-1 in vitro and is the functional plasma-membrane receptor which mediates cytopathology for most sensitive cells. Binding of verotoxin-1 to a series of galabiose-containing or globotriaose-containing synthetic glycolipids with monoalkylsulfides and bisalkylsulfides or sulfones as the lipid moiety, have been studied for toxin binding by TLC overlay and in solid phase in the presence of auxiliary lipids. The results demonstrate that for an identical carbohydrate, binding is dramatically altered according to the nature of the lipid moiety. The close proximity of the galabiose sequence and the hydrophobic species also compromised recognition. The lipid environment is also a major determinant of receptor function, since species that were effective, even preferred toxin receptors as monitored by TLC overlay, were not necessarily recognized in the presence of auxiliary lipids. Certain glycolipids, which were not recognized by TLC overlay, were nevertheless found to be effective receptors in an auxiliary lipid matrix. These results demonstrate the crucial role of the lipid moiety in verotoxin/glycolipid recognition and are discussed in relation to toxin pathogenesis and glycolipid receptor function.

Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?

Eight patients who underwent a partial glossectomy and associated floor of the mouth resection for squamous cell carcinoma were reconstructed with a sensate radial forearm flap in which the lateral antebrachial cutaneous nerve was anastomosed to the (divided) lingual nerve. The patients were compared prospectively with matched controls who received noninnervated forearm flaps for the same defect. A "blinded" therapist performed detailed sensory testing at least 6 months following surgery. In all modalities examined, the sensate proved superior to the nonsensate flap and not statistically different from the opposite side of the tongue. Two-point discrimination and pressure sensitivity were much greater in the innervated forearm flaps than in the forearms from which they came. The results are discussed with reference to the density of sensory receptors, the degree of cortical representation, and the subcortical anatomy of the neurosensory tracts. It appears that the density of sensory receptors is not directly related to the sensory potential in a given tissue transfer and that this potential is more related to the cortical fidelity of the recipient nerve. A historical matched cohort of 10 patients receiving pectoralis flaps for similar defects also was examined. Although the follow-up was longer, reinnervation was of a very low order--even worse than with noninnervated forearm flaps. This work supports the concept that sensory reinnervation should be attempted whenever possible following ablative oral surgery. This would include suture or grafting of major sensory nerves as well as the reinnervation of flaps.

Increased globotriaosylceramide on plasma membranes of synchronized familial dysautonomia cells. Verotoxin binding studies

Familial dysautonomia is an autosomal recessive genetic disease found almost exclusively among Ashkenazi Jews, characterized by deficits in autonomic, sensory, and central functions. Although the gene has been localized to chromosome 9, the biochemical defect remains elusive. We previously reported an increase in globotriaosylceramide in dysautonomic fibroblasts and lymphoblasts, and unusual fibroblast growth patterns suggesting plasma membrane abnormalities. Globotriaosylceramide is a plasma membrane component, and the natural receptor for verotoxin derived from E. coli. In Vero and HeLa cells, which are susceptible to verotoxin, the expression of globotriaosylceramide on the cell surface is maximal at the G1/S boundary of the cell cycle. Measurement of toxin binding at 0 degrees C at this boundary is indicative of the amount of globotriaosylceramide exposed on the cell surface. Above 0 degrees C, verotoxin enters, and is toxic to, the cell. We analyzed verotoxin-globotriaosylceramide interactions in synchronized FD and normal cells at this boundary. 125I-toxin binding was much more marked to lymphoblasts from patients than from controls. When cells were grown in the presence of verotoxin, at 10(-2)-10(-7) micrograms/mL, 70% of dysautonomic lymphoblasts died, compared to 25% of controls. The CD50 was 10 ng/mL for dysautonomic fibroblasts vs 450 for controls. These results may be exploited to create a biological assay to differentiate between FD and normal cells.

Glycosphingolipid receptor function is modified by fatty acid content. Verotoxin 1 and verotoxin 2c preferentially recognize different globotriaosyl ceramide fatty acid homologues

Verotoxins (VT) are a family of Escherichia coli-derived toxins which have been associated with hemolytic uremic syndrome, the leading cause of acute pediatric renal failure, and hemorrhagic colitis. Verotoxins (VT1 and VT2c) both show terminal gal alpha 1-4gal-dependent binding to globotriaosylceramide (Gal alpha 1-4Gal beta 1-4Glc-Cer; Gb3), yet VT2c shows a thousandfold lower specific cytotoxic activity in vitro. Our previous studies have shown this discrepancy is a function of the receptor binding B subunit and that VT1/Gb3 binding in a lipid matrix is affected by heterogeneity in the ceramide fatty acid chain length. The influence of the fatty acid composition of Gb3 on the binding of VT1 and VT2c has now been compared using 14 homogeneous semisynthetic Gb3 molecular species of differing fatty acid chain length and degree of saturation from C12 to C24. The binding of verotoxin was quantitated by Scatchard analysis using a solid-phase binding assay in the presence of auxiliary lipids, which may in some respects approximate to receptor function within the plasma membrane of sensitive cells. Differential binding was observed for several of these species in the lipid matrix, indicating that the fatty acid moiety of Gb3 is important for VT binding under such conditions. The short chain fatty acid containing Gb3 (C12 and C14) showed minimal binding. Middle and long chain fatty acid Gb3 homologues (C16, C18, C20, C22, and C24) were effectively recognized by VTs. The presence of an unsaturated fatty acid in Gb3 significantly increased VT binding in all cases. C20:0 and C22:1 containing Gb3 had the greatest capacity to bind VT1. In contrast, C18:0 and C18:1 homologues showed the greatest capacity for VT2c binding (higher than VT1). These results were, in general, reflected in cell cytotoxicity in that receptor-deficient cells reconstituted with C22:1Gb3 were maximally sensitive to VT1 in vitro whereas cells reconstituted with C18:1Gb3 were maximally sensitive to VT2c. VT2c was an ineffective inhibitor of 125I-VT1 binding to C22:1 Gb3 but in contrast, more effective than VT1 to compete binding to C18:1 Gb3. Similarly, VT1 was less effective than VT2c to compete binding of 125I-VT2c to C18:1 but more effective than VT2c to compete for C22:1 Gb3 binding. These results suggest that VT1 and VT2c bind selectively to different but overlapping carbohydrate epitopes on the Gb3 molecule which are differentially available in these Gb3 fatty acid homologues in a lipid environment.(ABSTRACT TRUNCATED AT 400 WORDS)