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Grignani G, Gamba G, Geroldi D, Pacchiarini L, Solerte B, Ferrari E, Ascario E. Enhanced Antithrombotic Mechanisms in Patients with Maturity-Onset Diabetes mellitus without Thromboembolic Complications. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummarySome haemostatic parameters have been evaluated in a group of rigorously selected patients with maturity-onset diabetes mellitus without thromboembolic complications and in apparently normal subjects of the same age before and after the venous occlusion test (VOT).In basal conditions diabetics had higher levels of AT III as biological activity and higher fibrinolytic and antifibrinolytic activities than controlsAfter VOT, F VIII R:Ag increased significantly in both groups, more markedly in controls than in diabetics, while F VIII: C showed no modification.Also AT III R:Ag increased after the test, but such variation was significant only in diabetics; on the contrary, the biological activity of AT III was always significantly decreased after the test.After VOT there were also in both groups highly significant increases in the fibrinolytic and antifibrinolytic activities.Finally, HbA1c levels directly correlated with AT III as biological activity before VOT, but with no other parameter either before or after the test.These data suggest the existence in patients with diabetes mellitus without thromboembolic complications of an activated protective mechanism against intravascular clotting.
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Affiliation(s)
- G Grignani
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - G Gamba
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - D Geroldi
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - L Pacchiarini
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - B Solerte
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - E Ferrari
- The Department of Clinical Medicine I° “Adolfo Ferrata” of the University of Pavia, Italy
| | - E Ascario
- The Department of Medical Pathology of the University of Pavia, Italy
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Gamba G, Grignani G, Ascari E. Synoviorthesis Versus Synovectomy in the Treatment of Recurrent Haemophilic Haemarthrosis: Long-Term Evaluation. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe authors report a long-term evaluation of the effects of chemical and surgical synovectomies performed in two groups of patients which were comparable as regards number of haemarthrosis per year and joint mobility. The results obtained indicated that both synovectomy and synoviorthesis were effective in reducing the bleeding episodes; however, while synovectomy stopped almost completely the recurrence of haemarthrosis, synoviorthesis in 3 patients younger than 12 years did not modify it and in one case it even increased the bleeding tendency.Moreover, the occurrence of arthritic pain was observed in 6 knees treated by synoviorthesis and only in 3 knees treated by synovectomy. Finally, the joint function was significantly reduced in the synoviorthesis group as compared to the synovectomy group.In conclusion, synovectomy gave better results than synoviorthesis but the latter treatment has a number of economical and technical advantages and should therefore be considered in patients older than 12 years of age with good joint function and without evident radiological changes, in whom fulldose replacement therapy has had no effect on the recurrence of haemarthrosis.
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Affiliation(s)
- G Gamba
- The Department of Clinical Medicine “Adolfo Ferrata”, University of Pavia, Italy, and Haemophilia Center, San Matteo Hospital, Pavia, Italy
| | - G Grignani
- The Department of Clinical Medicine “Adolfo Ferrata”, University of Pavia, Italy, and Haemophilia Center, San Matteo Hospital, Pavia, Italy
| | - E Ascari
- Department of Medical Pathology, University of Pavia, Italy
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Abstract
SummaryThe immediate effect of cigarette-smoking on ADP-induced platelet aggregation and on platelet adhesiveness was investigated in 12 normal subjects aged 20 to 40, in 10 normal subjects aged 43 to 72 and in 10 patients with cerebrovascular disease aged 45 to 75.All the subjects were heavy smokers (more than 20 cigarettes a day).After smoking 2 cigarettes a significant increase in ADP aggregation and platelet adhesiveness was found in the group of young heavy smokers, while in the old subjects with or without cerebrovascular disease the increase in platelet activity was never significant.These data were discussed and some hypotheses for this higher reactivity of platelets from young people were suggested.
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Di Sabatino A, Ambaglio C, Aronico N, Ghidelli N, Lenti MV, Gamba G, Corazza GR. Acquired von Willebrand syndrome in inflammatory bowel disease. Haemophilia 2017; 23:e231-e233. [PMID: 28314057 DOI: 10.1111/hae.13209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 01/30/2023]
Affiliation(s)
- A Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - C Ambaglio
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - N Aronico
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - N Ghidelli
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - M V Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - G Gamba
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - G R Corazza
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Labs KH, Degischer S, Gamba G, Jaeger KA. Effectiveness and safety of calcium dobesilate in treating chronic venous insufficiency: randomized, double-blind, placebo-controlled trial. Phlebology 2016. [DOI: 10.1258/0268355041753380] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To determine whether calcium dobesilate is effective in reducing chronic venous insufficiency-related peripheral oedema. Methods: Randomized, double-blind, placebo-controlled, multicentre, parallel-group study in 253 consecutive outpatients with chronic venous insufficiency (CEAP C3-C4). The patients were treated for four weeks with either calcium dobesilate (CaD) 500 mg three times a day or matching placebo. The primary outcome measure was the reduction in lower leg volume. The leg volume calculation was based on a truncated cone model Results: Active drug treatment resulted in a median reduction of the leg volume of 25.5 ± 33.6 ml/l tissue. The difference in the median change of the leg volume between the treatment groups at week 4 was -12.2 ml/l tissue (95 % CI -21.6 to -2.8; P =0.01). In contrast with the placebo, the effects of CaD were independent of the duration of CVI and most pronounced in more severely diseased patients. Safety variables did not differ significantly between groups. Conclusions: Calcium dobesilate is an effective and well tolerated treatment for chronic venous insufficiency.
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Lisi C, Di Natali G, Sala V, Tinelli C, Canepari M, Gamba G, Dalla Toffola E. Interobserver reliability of ultrasound assessment of haemophilic arthropathy: radiologist vs. non‐radiologist. Haemophilia 2016; 22:e211-4. [DOI: 10.1111/hae.12876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Lisi
- Physical Medicine and Rehabilitation Unit IRCCS Policlinico S. Matteo FoundationPavia Italy
| | - G. Di Natali
- Physical Medicine and Rehabilitation Unit IRCCS Policlinico S. Matteo FoundationPavia Italy
| | - V. Sala
- Physical Medicine and Rehabilitation Unit University of PaviaPavia Italy
| | - C. Tinelli
- Clinical Epidemiology and Biometric Unit IRCCS Policlinico S. Matteo FoundationPavia Italy
| | - M. Canepari
- Institute of Radiology IRCCS Policlinico San Matteo FoundationPavia Italy
| | - G. Gamba
- Centre for Haemophilia and Congenital Bleeding Disorders IRCCS Policlinico S. Matteo Foundation Pavia Italy
| | - E. Dalla Toffola
- Physical Medicine and Rehabilitation Unit IRCCS Policlinico S. Matteo FoundationPavia Italy
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Castellano F, Lax A, Gamba G, Santambrogio J, Tremolada M, Amidani F, Rossetti A, Capuzzi E, Crocamo C, Nava R, Carrà G, Papagno C, Clerici M. Facial Emotion Recognition and Disorganization in Subjects with Schizophrenia and Alcohol, Substance Use Disorder. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- R Ciccocioppo
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Castaman G, Coppola A, Zanon E, Boeri E, Musso M, Siragusa S, Federici AB, Mancuso G, Barillari G, Biasoli C, Feola G, Franchini M, Moratelli S, Gamba G, Schinco P, Valdrè L, Dragani A, Mazzucconi G, Tagliaferri A, Morfini M. Efficacy and safety during formulation switch of a pasteurized VWF/FVIII concentrate: results from an Italian prospective observational study in patients with von Willebrand disease. Haemophilia 2012; 19:82-8. [DOI: 10.1111/hae.12005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - A. Coppola
- Federico II University Hospital; Naples; Italy
| | - E. Zanon
- University Hospital; Padua; Italy
| | | | - M. Musso
- University Hospital Catania; Catania; Italy
| | | | - A. B. Federici
- IRCCS Cà Granda Maggiore Policlinico Hospital Foundation and Department of Internal Medicine; AB Bonomi Hemophilia Thrombosis Center; University of Milan; Milan; Italy
| | | | | | | | - G. Feola
- San Luca Hospital; Vallo della Lucania; Italy
| | | | | | - G. Gamba
- San Matteo Hospital; Pavia; Italy
| | - P. Schinco
- San Giovanni Battista Hospital; Torino; Italy
| | - L. Valdrè
- S. Orsola-Malpighi Hospital; Bologna; Italy
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Sanchez-Pozos K, Barrera-Chimal J, Garzon-Muvdi J, Perez-Villalva R, Rodriguez-Romo R, Cruz C, Gamba G, Bobadilla NA. Recovery from ischemic acute kidney injury by spironolactone administration. Nephrol Dial Transplant 2012; 27:3160-9. [DOI: 10.1093/ndt/gfs014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Imberti R, Pietrobono L, Klersy C, Gamba G, Iotti GA, Cornara G. Intraoperative intravenous administration of rFVIIa and hematoma volume after early surgery for spontaneous intracerebral hemorrhage: a randomized prospective phase II study. Minerva Anestesiol 2012; 78:168-175. [PMID: 21750485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Surgery of spontaneous supratentorial intracerebral hemorrhage (ICH), especially if performed early, can be complicated by rebleeding, a condition that can worsen the outcome. We evaluated the effect of recombinant activated factor VII (rFVIIa) on postoperative rebleeding. METHODS In this randomized, open-label, single-blinded study, 21 patients with spontaneous supratentorial ICH diagnosed by computed tomography (CT) scan were treated with intravenous rFVIIa (100 mcg/Kg b.w., N=13) or placebo (N=8). Hematoma volume was assessed using CT scan immediately, 18-30 hours, and 5-7 days after hematoma evacuation. The primary endpoint was a hematoma volume at 18-30 hours after surgery. All CT scans were evaluated at one center by the same investigator who was unaware of the treatment. Hematoma volume was measured using dedicated software. RESULTS At baseline, the hematoma volume was 59.2±27.4 and 71.5±32.1 mL in the rFVIIa and placebo group, respectively. Hematoma evacuation resulted in significantly smaller ICH volumes that were similar in the rFVIIa and placebo group at 18-30 hours after surgery (15.9±14.2 mL and 18±15.1 mL, respectively; mean difference 2.1 mL, 95% confidence interval -12.1 to 16.2, P=0.76 (0.03 mL after adjustment for baseline value)). The frequencies of deep venous thrombosis, myocardial infarction, troponin I elevation and cerebral ischemia were similar in both groups. CONCLUSION In this pilot study, intraoperative, intravenous rFVIIa administration did not modify hematoma volume after early ICH surgery. However, the 95% CI was wide, which indicates considerable uncertainty. Therefore, our results do not disprove the potential benefit of rFVIIa administration, which could be shown in a larger study.
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Affiliation(s)
- R Imberti
- Direzione Scientifica, Policlinico S. Matteo Fondazione IRCCS, Pavia, Italy.
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Abstract
AIM The aim of this study was to determine, in patients with Turner syndrome (TS), the prevalence of thrombophilic disorders correlating with a higher risk of venous thromboembolism (VTE), to evaluate if thrombophilia is associated with the genetic features of these patients and whether screening before hormone replacement therapy (HRT) is advisable. PATIENTS AND METHODS We examined 82 TS patients. In all patients we analyzed activated factor VIII:C, fibrinogen, antithrombin (AT), protein C (PC), protein S (PS), activated PC resistance, and homocysteine. For every patient, an investigation for mutations in prothrombin G20210A, factor V R506Q, methylenetetrahydropholate reductase (MTHFR) C 677T and A1298C was conducted. RESULTS Low values of PC in 3 patients (3.70%), low values of PS in 12 (14.81%), and hyperhomocysteinemia in 4 (4.87%) were found; 52 girls (64.2%) presented hyperfibrinogenemia. Three patients were heterozygous for the prothrombin G20210A allele mutation (3.66%) and the factor V mutation was present in 4 patients (4.88%). No TS patient had a homozygous mutation. Mutations in the MTHFR gene were present in 62 girls, in 17 patients (20.7%) they were homozygous and in 45 patients (54.88%) heterozygous. CONCLUSIONS Considering the increased risks with the association between VTE and the higher prevalence of PC and PS deficiencies, TT genotype mutations and high level of fibrinogen, it is advisable to perform a complete thrombophilia screening in TS patients before starting HRT.
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Affiliation(s)
- V Calcaterra
- Department of Pediatrics, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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Brazzelli V, Grasso V, Fornara L, Moggio E, Gamba G, Villani S, Borroni G. Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity. Int J Immunopathol Pharmacol 2010; 23:911-6. [PMID: 20943063 DOI: 10.1177/039463201002300327] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyperhomocysteinaemia represents an independent risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. Psoriasis is a chronic inflammatory skin disease associated with increased atherothrombosis and cardiovascular risk profile. The aim of this study is to investigate homocysteine, folic acid and vitamin B12 levels in a cohort of psoriatic patients and its relationship with the severity of the disease. A retrospective observational study in 98 patients with chronic plaque psoriasis and 98 healthy controls was performed. Total plasma homocysteine level, folic acid, vitamin B12 and PASI index were assessed in every patient. Patients with psoriasis had plasma homocysteine levels higher than controls (57% of cases and 25% of controls; p<0.0001). Folic acid and vitamin B12 plasma levels were lower in psoriatic patients than in controls (p = NS), lower levels of vitamin B12 were found in patients with hyperhomocysteinaemia compared to patients with a normal value of homocysteine (p = 0.0009). The severity of psoriasis assessed according to PASI (19.51+/-16.26) did not directly correlate either with higher levels of homocysteine or with vitamin B12 and folic acid plasma levels. In conclusion, a significantly higher prevalence of hyperhomocysteinaemia was found in psoriatic patients compared to healthy controls. A significant correlation between hyperhomocysteinaemia and lower vitamin B12 levels, but not folic acid, was evidenced. On the contrary, our data do not correlate the high level of homocysteine with higher PASI scores or psoriasis type, suggesting that homocysteine level can be considered an independent risk factor in psoriatic patients.
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Affiliation(s)
- V Brazzelli
- Department of Human and Hereditary Pathology, Institute of Dermatology, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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Termine C, Trotti R, Ondei P, Gamba G, Montani N, Gamba A, De Simone M, Marni E, Balottin U. Mitral valve prolapse and abnormalities of haemostasis in children and adolescents with migraine with aura and other idiopathic headaches: a pilot study. Acta Neurol Scand 2010; 122:91-6. [PMID: 19804471 DOI: 10.1111/j.1600-0404.2009.01268.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence of mitral valve prolapse (MVP) and abnormalities of haemostasis in children and adolescents with migraine with aura (MA) compared with peers affected by other idiopathic headaches. MATERIALS AND METHODS We recruited 20 MA patients (10 men and 10 women; age range 8-17 years) and 20 sex- and age-matched subjects with other idiopathic headaches. Both groups underwent colour Doppler transthoracic echocardiography to detect MVP and the following laboratory work-up: plasma prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, protein C, protein S, homocysteine, lupus anticoagulant, von Willebrand factor (vWF) ristocetin cofactor activity, immunoglobulins (Ig) G and M anticardiolipin antibodies (aCL). Factor V Leiden, factor II and methylenetetrahydrofolate reductase were investigated (we did not test the entire genes, but screened for specific point mutations). RESULTS The prevalence of MVP was significantly higher in the MA subjects than in the patients affected by other idiopathic headaches (40% vs 10%; P < 0.05). Moreover, the MA patients showed a higher rate of above-normal IgM aCL titres (45% vs 10%; P < 0.05). Finally, in the group of patients with MVP we found a higher prevalence of aCL in those with MA compared with those affected by other idiopathic headaches. CONCLUSIONS A proportion, at least, of the MA patients showed a more complex phenotype characterized by MVP and/or positive aCL titres. The pathogenetic role of these associations is obscure and larger studies are needed to confirm the usefulness of echocardiographic and laboratory investigations in this area and to identify possible new treatment approaches that might be explored in this group of MA patients.
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Affiliation(s)
- C Termine
- Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Piazza Biroldi 19, Varese, Italy.
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Storti E, Ascari E, Gamba G. POST-OPERATIVE COMPLICATIONS AND JOINT FUNCTION AFTER KNEE SYNOVECTOMY IN HAEMOPHILIACS. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1982.0544a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Longoni R, Fornara L, Bocchi L, Montani N, Brazzelli V, Gamba G. CARDIOVASCULAR DISEASE, HYPERHOMOCYSTEINEMIA AND ATHEROTHROMBOTIC RISK FACTORS IN PSORIATIC PATIENTS. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb02315.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Capra ACM, Scotti V, Amigoni M, Paleari F, Gamba G, Whisstock C, Montemerlo E, Grosso G, Giannattasio C, Mancia G. Alterations in Cardiac Structure in Nondiabetic Offsprings of Diabetic Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Gamba G, Marcantonatos M. Détermination de constantes de formation des complexes phosphorescents du bore avec la benzoylacétone, à l'aide de durées de vie moyenne d'émission. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19710540537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Marcantonatos M, Gamba G, Monnier D. Etude phosphorimétrique des complexes de l'acide borique avec la benzoylacétone dans des glaces d'«éther diéthylique-acide sulfurique concentré» à 77K. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19690520742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rampino T, Marasà M, Malvezzi PM, Soccio G, Roscini E, Gamba G, Noris P, Alessiani M, Dal Canton A. Platelet-Independent defect in hemostasis associated with sirolimus use. Transplant Proc 2004; 36:700-2. [PMID: 15110636 DOI: 10.1016/j.transproceed.2004.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sirolimus is currently used to prevent rejection of solid organ transplant, and sirolimus-eluting stents have shown promise for the prevention of coronary artery restenosis. Thrombocytopenia is a well-known adverse effect of sirolimus limiting its use. Herein we report on a patient in whom sirolimus caused a platelet-independent hemostasis defect. The patient was a 52-year-old woman who underwent renal transplant with consequent normal kidney function. The immunosuppressive regimen included basiliximab, steroids, and cyclosporine induction later shifted to sirolimus and mycophenolate due to biopsy findings of tubular necrosis on day 6 posttransplantation. At discharge the serum creatinine was 0.7 mg/dL. Four months after transplantation the patient was admitted to our hospital because of fever (37.5 degrees C to 38 degrees C), anorexia, and asthenia. Blood analysis showed: creatinine 1.7 mg/dL, Hb 9.6 g/dL, WBC 6 x 10(3)/microL, PLT 123 x 10(3)/microL, liver function tests normal, LDH 720 mU/mL, fibrinogen 628 mg/dL, d-dimer 0.42 ng/mL, FDP > 40 ng/mL, INR 1.10, PT 87%, aPTT 40 seconds. Cultures and tests for infection were negative. Serum sirolimus level was 25.9 ng/mL. The following day the serum creatinine rose to 2.3 mg/dL and diuresis fell to 20 mL/h. Multiple bleeding times (Ivy test) performed before the renal biopsy were repeatedly over 30 minutes (normal 3 to 5 minutes), despite normal platelet count and platelet function studies. There was no spontaneous aggregation and in vitro aggregation was normal (collagen, ADP, adrenalin, and ristocetin induced). Coagulation studies showed a defect in fibrin formation and a reduction of fibrinolysis. Suspension of sirolimus treatment was followed by remission of fever, improvement of renal function (serum creatinine 1.2 mg/dL), and normalization of bleeding time.
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Affiliation(s)
- T Rampino
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Policlinico San Matteo and University, Pavia, Italy.
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Aceto S, Sica M, Gamba G, Montieri S, Farina A, Gaudio L. Isolation and characterization of microsatellite loci from Asparagus acutifolius (Liliaceae). ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1471-8286.2003.00411.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The growing molecular identification of renal transporter genes is revealing that alternative splicing is common among transporters. In this paper, I review the physiological consequences of alternative splicing in some genes encoding renal transporters in which spliced isoforms have recently been identified. In some cases, the spliced isoforms resulted in nonfunctional proteins, which, however, possess a dominant negative effect on the cotransporter function, suggesting that the presence of such isoforms can be important in the functional regulation of the transporter. In most transporter genes, however, the spliced isoforms have been shown to be functional, resulting in a variety of physiological consequences, including, for example, changes in the polarization of isoforms to the apical or basolateral membrane, changes in pharmacological or kinetic properties, and changes in tissue distribution or intrarenal localization. In some cases, although the spliced isoform is functional, the consequence of splicing is still unknown. Different regulation among isoforms is an interesting possibility. Thus the diversity of several renal transporters is enhanced by alternative splicing mechanisms.
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Affiliation(s)
- G Gamba
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Mexico City CP 14000, Mexico.
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Gamba G, Cisternino M, Kasirye I, Montani N, Bertolino G, Gamba A, Capezzera M, Soldavini E, Noris P. [Menometrorrhagia in adolescents: is it the first expression of congenital defects of hemostasis?]. Minerva Pediatr 2001; 53:479-80. [PMID: 11668278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- G Gamba
- IRCCS Policlinico S. Matteo, Dipartimento di Medicina Interna, Università degli Studi, Pavia, Italy
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Abstract
The electroneutral cotransport of potassium and chloride is mediated by potassium-chloride transporters, which are encoded by members of the gene family of cation-chloride cotransporters. A significant body of evidence argues for swelling-activated, basolateral potassium-chloride transport in the proximal tubule and thick ascending limb, with a potential role in transepithelial salt transport. However, the lack of specific inhibitors has impeded progress in this area. The cloning of the four potassium-chloride cotransporter genes has sparked new interest in this transport pathway, and promises to yield novel insights into their roles in cellular and renal physiology.
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Affiliation(s)
- D B Mount
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA.
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Mercado A, de los Heros P, Vázquez N, Meade P, Mount DB, Gamba G. Functional and molecular characterization of the K-Cl cotransporter of Xenopus laevis oocytes. Am J Physiol Cell Physiol 2001; 281:C670-80. [PMID: 11443066 DOI: 10.1152/ajpcell.2001.281.2.c670] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The K-Cl cotransporters (KCCs) have a broad range of physiological roles, in a number of cells and species. We report here that Xenopus laevis oocytes express a K-Cl cotransporter with significant functional and molecular similarity to mammalian KCCs. Under isotonic conditions, defolliculated oocytes exhibit a Cl(-)-dependent (86)Rb(+) uptake mechanism after activation by the cysteine-reactive compounds N-ethylmaleimide (NEM) and mercuric chloride (HgCl(2)). The activation of this K-Cl cotransporter by cell swelling is prevented by inhibition of protein phosphatase-1 with calyculin A; NEM activation of the transporter was not blocked by phosphatase inhibition. Kinetic characterization reveals apparent values for the Michaelis-Menten constant of 27.7 +/- 3.0 and 15.4 +/- 4.7 mM for Rb(+) and Cl(-), respectively, with an anion selectivity for K(+) transport of Cl(-) = PO(4)(3-) = Br(-) > I(-) > SCN(-) > gluconate. The oocyte K-Cl cotransporter was sensitive to several inhibitors, including loop diuretics, with apparent half-maximal inhibition values of 200 and 500 microM for furosemide and bumetanide, respectively. A partial cDNA encoding the Xenopus K-Cl cotransporter was cloned from oocyte RNA; the corresponding transcript is widely expressed in Xenopus tissues. The predicted COOH-terminal protein fragment exhibited particular homology to the KCC1/KCC3 subgroup of the mammalian KCCs, and the functional characteristics are the most similar to those of KCC1 (Mercado A, Song L, Vazquez N, Mount DB, and Gamba G. J Biol Chem 275: 30326--30334, 2000).
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Affiliation(s)
- A Mercado
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Tlalpan 14000, Mexico City, Mexico
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Gamba G. [Initial sequence and analysis of the human genome]. Rev Invest Clin 2001; 53:294-7. [PMID: 11599473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
We administered the anti-angiogenic drug thalidomide to 21 patients (12 men) with myelofibrosis with myeloid metaplasia (MMM), who were not responsive to standard treatment. Patients received thalidomide at an escalating dose from 100 to 400 mg/d. Administration of the drug was discontinued before the planned 6 months of treatment in 19 patients (90.5%), mainly because of somnolence and/or fatigue, neurological symptoms or neutropenia. Of the 13 evaluable patients (who received more than 30 d of therapy), anaemia improved in three out of seven (43%) who were treated because of anaemia; thrombocytopenia improved in two out of three (66.6%) who were treated because of thrombocytopenia; splenomegaly was reduced in four (30.8%). Undesired increases in white blood cell and platelet counts were observed in three (23.1%) and five (38.5%) patients respectively. A severity score, indexed on haematological and clinical parameters, improved in two patients (15.4%), but worsened in five (38.5%). In conclusion, standard-dose thalidomide in MMM patients is burdened with a high rate of side-effects, which prevent prolonged treatment. Because the drug is effective in improving anaemia and thrombocytopenia and in reducing splenomegaly, low-dose therapy warrants evaluation. The unexpected observation of leucocytosis and thrombocytosis suggests biological studies and better criteria for selection of patients for treatment.
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Affiliation(s)
- G Barosi
- Laboratory of Medical Informatics, IRCCS Policlinico S. Matteo, Pavià, Italy.
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29
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Moreno G, Bobadilla NA, González-Salazar J, Mercado A, Tapia E, Hong E, Herrera-Acosta J, Gamba G. Thiazide-sensitive cotransporter mRNA expression is not altered in three models of hypertension. Kidney Blood Press Res 2001; 24:57-63. [PMID: 11174008 DOI: 10.1159/000054207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Several lines of evidence support that the kidney is involved in the increase of arterial blood pressure, and some genetic studies suggest that the thiazide-sensitive Na+:Cl- cotransporter could be implicated in the development of hypertension. In the present study, we analyzed the Na+:Cl- cotransporter mRNA levels in the kidney during the development of hypertension in three experimental models. METHODS The first model included 18 spontaneously hypertensive rats studied at 4, 10, and 16 weeks of age. The second model included 28 Wistar rats with two-kidney, one-clip Goldblatt hypertension studied at 7, 14, 21, and 28 days. The third model included 6 Wistar rats treated with N(G)-nitro-L-arginine methyl ester during 10 days. Respective controls were studied for all models. At the end of each experimental period, the systolic blood pressure was measured in the tail by plethysmography. Individual renal cortex total RNA was extracted, and the mRNA levels of the thiazide-sensitive Na+:Cl- cotransporter were assessed following a semiquantitative RT-PCR strategy. RESULTS All experimental models developed systemic hypertension. However, the level of mRNA expression of the Na+:Cl- cotransporter did not change in any of the models studied as compared with their respective controls. CONCLUSION Our results suggest that a change in mRNA levels of the thiazide-sensitive Na+:Cl- cotransporter is not associated with the development of hypertension in spontaneously hypertensive rats, in rats with renovascular hypertension, nor in rats with hypertension induced by nitric oxide synthesis inhibition.
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MESH Headings
- Animals
- Benzothiadiazines
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Disease Models, Animal
- Diuretics
- Gene Expression Regulation
- Hypertension/genetics
- Hypertension/metabolism
- Hypertension/physiopathology
- Hypertension, Renovascular/genetics
- Hypertension, Renovascular/metabolism
- Hypertension, Renovascular/physiopathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Rats
- Rats, Inbred SHR
- Rats, Inbred WKY
- Rats, Wistar
- Receptors, Drug/genetics
- Receptors, Drug/metabolism
- Sodium Chloride Symporter Inhibitors/metabolism
- Sodium Chloride Symporters
- Solute Carrier Family 12, Member 3
- Symporters
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Affiliation(s)
- G Moreno
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Salvador C, Martinez M, Mora SI, Egido W, Farias JM, Gamba G, Escobar LI. Functional properties of a truncated recombinant GIRK5 potassium channel. Biochim Biophys Acta 2001; 1512:135-47. [PMID: 11334631 DOI: 10.1016/s0005-2736(01)00314-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Xenopus laevis oocytes codify a G-protein-activated inward rectifier potassium channel (GIRK5 or Kir3.5). Coinjection of other GIRKs, the muscarinic m2 receptor, or Gbetagamma protein cRNAs is required to observe functional GIRKx-GIRK5 heteromultimers in oocytes. Studies with GIRK2 isoforms have shown that the size of the amino or carboxyl terminus plays a crucial role on giving functional K(+) channels. In this work we studied the properties of a GIRK5 with 25 amino acids deleted toward its amino-terminal domain. Injection of GIRK5-Delta25 cRNA alone displayed large basal and transient inward rectifying currents in oocytes. The instantaneous currents reached a stationary level after a long duration voltage pulse (10 s). For this relaxation, fast (tau(1)) and slow (tau(2)) time constants were estimated at different voltages. Recovery from inactivation followed a monoexponential function (tau=0.95+/-0.07 s). By contrast with other inward rectifier channels, blockade of GIRK5-Delta25 by extracellular Ba(2+) was voltage-independent (K(d)=102+/-2 microM), suggesting the presence of a Ba(2+) site at the external channel vestibule. To confirm this hypothesis, the Ba(2+) sensitivity of two charged mutants GIRK5-Delta25(N129E) and GIRK5-Delta25(K157E) at each of the external loops was determined. GIRK5-Delta25(N129E) and GIRK5-Delta25(K157E) showed a 100-fold and 2-fold higher affinity to Ba(2+), respectively, supporting the existence of this Ba(2+) binding site.
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Affiliation(s)
- C Salvador
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F., México
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Benencia F, Courrèges MC, Gamba G, Cavalieri H, Massouh EJ. Effect of aminoguanidine, a nitric oxide synthase inhibitor, on ocular infection with herpes simplex virus in Balb/c mice. Invest Ophthalmol Vis Sci 2001; 42:1277-84. [PMID: 11328740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE To study the effect of aminoguanidine (AMG), an inhibitor of nitric oxide production, on the ocular infection of Balb/c mice with herpes simplex virus (HSV) type 1 strain F and HSV-2 strain G. METHODS Animals were treated with different amounts of AMG (0.5, 0.1, and 0.05 mg/mouse) by topical application in the eye from postinfection (PI) days -2 through +5, considering 0 the day of infection. At different PI days, development of herpetic keratitis was evaluated in treated and control mice. RESULTS Treated animals showed a dose-dependent increase in ocular disease after viral infection, compared with control animals. Viral titers in ocular washings were higher in AMG-treated mice (PI day 2, HSV-1: AMG 0.5 mg, 1.3 x 10(3) plaque-forming units (PFU)/ml; control, 0. 22 x 10(2) PFU/ml, P < 0.025). At PI day 3, control corneas had only scattered inflammatory cells, whereas those from treated animals showed a conspicuous infiltrate consisting primarily of neutrophils. Viral titers were also higher in brains of treated mice. These animals died earlier and in a greater proportion than control animals (percentage of mortality, PI day 12, HSV-1: AMG 0.5 mg, 40% +/- 4%; control, 18% +/- 3%, P < 0.05). CONCLUSIONS These data indicate an inhibitory effect of nitric oxide on HSV ocular infection.
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MESH Headings
- Administration, Topical
- Animals
- Cornea/drug effects
- Cornea/enzymology
- Cornea/virology
- DNA, Viral/analysis
- Disease Progression
- Dose-Response Relationship, Drug
- Enzyme Inhibitors/therapeutic use
- Guanidines/therapeutic use
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 1, Human/physiology
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 2, Human/physiology
- Keratitis, Herpetic/drug therapy
- Keratitis, Herpetic/pathology
- Keratitis, Herpetic/virology
- Mice
- Mice, Inbred BALB C
- Nitric Oxide Synthase/antagonists & inhibitors
- Nitric Oxide Synthase/genetics
- Nitric Oxide Synthase/metabolism
- Ophthalmic Solutions
- Reverse Transcriptase Polymerase Chain Reaction
- Trigeminal Ganglion/virology
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Affiliation(s)
- F Benencia
- Laboratory of Immunochemistry, Department of Biological Chemistry, Faculty of Sciences, University of Buenos Aires, Pabellón II, Piso 4, Ciudad Universitaria, 1428 Buenos Aires, Argentina.
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Cueto-Manzano AM, Gamba G, Correa-Rotter R. Peritoneal protein loss in patients with high peritoneal permeability: comparison between continuous ambulatory peritoneal dialysis and daytime intermittent peritoneal dialysis. Arch Med Res 2001; 32:197-201. [PMID: 11395184 DOI: 10.1016/s0188-4409(01)00271-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dialysate protein loss is involved in the etiology of hypoalbuminemia and malnutrition on continuous ambulatory peritoneal dialysis (CAPD). Patients with high peritoneal membrane permeability had the lowest serum albumin (Alb) and highest dialysate protein concentrations and achieved higher small solute dialysis/plasma equilibration in a shorter time than patients with low peritoneal transport. The aim of this prospective crossover study was to evaluate whether protein loss might be decreased in patients with high peritoneal permeability on short dwell-time (DT) peritoneal dialysis. METHODS Five high and nine high-average peritoneal transport patients were subjected to the following sequential dialysis schemes (four exchanges/day, glucose 1.5%): scheme A, three daytime exchanges (4-6 h DT) and one nightly (8-12 h DT) for 2-3 days, scheme B, 3-h DT each and dry peritoneum at night during 5 days, a wash-out period similar to scheme A, and scheme C, 2-h DT each and dry peritoneum the remainder of day and night during 5 days. Dialysate Alb, IgG, IgA, and IgM losses and adequacy of dialysis were evaluated at the end of each scheme. RESULTS Dialysate IgM was not detected. All protein losses were reduced with the short DT dialysis schemes; however, dialysis CCl and KT/V(urea) were also decreased. In patients with high peritoneal transport type, the 3-h DT dialysis scheme achieved a reduction in Alb loss without significant reduction of adequacy of dialysis. CONCLUSIONS Peritoneal Alb, IgG, and IgA losses are significantly reduced in patients with high peritoneal permeability on short dwell-time dialysis and extended dry periods. However, a reduction of dialysis contribution to small solute clearances was also observed, Three-hour dwell-time dialysis may be particularly useful in patients with high peritoneal transport type, as it tends to reduce peritoneal protein loss without notably reducing adequacy of dialysis.
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Affiliation(s)
- A M Cueto-Manzano
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Centro Médico de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico.
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Plata C, Meade P, Hall A, Welch RC, Vázquez N, Hebert SC, Gamba G. Alternatively spliced isoform of apical Na(+)-K(+)-Cl(-) cotransporter gene encodes a furosemide-sensitive Na(+)-Cl(-)cotransporter. Am J Physiol Renal Physiol 2001; 280:F574-82. [PMID: 11249848 DOI: 10.1152/ajprenal.2001.280.4.f574] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the absence of vasopressin, medullary thick ascending limb cells express a K(+)-independent, furosemide-sensitive Na(+)-Cl(-) cotransporter that is inhibited by hypertonicity. The murine renal specific Na(+)-K(+)-2 Cl(-) cotransporter gene (SLC12A1) gives rise to six alternatively spliced isoforms. Three feature a long COOH-terminal domain that encodes the butmetanide-sensitive Na(+)-K(+)-2 Cl(-) cotransporter (BSC1-9/NKCC2), and three with a short COOH-terminal domain, known as mBSC1-A4, B4, or F4 (19). Here we have determined the functional characteristics of mBSC1-A4, as expressed in Xenopus laevis oocytes. When incubated at normal oocyte osmolarity (approximately 200 mosmol/kgH(2)O), mBSC1-4-injected oocytes do not express significant Na(+) uptake over H(2)O-injected controls, and immunohistochemical analysis shows that the majority of mBSC1-4 protein is in the oocyte cytoplasm and not at the plasma membrane. In contrast, when mBSC1-4 oocytes are exposed to hypotonicity (approximately 100 mosmol/kgH(2)O), a significant increase in Na(+) uptake but not in (86)Rb(+) uptake is observed. The increased Na(+) uptake is Cl(-) dependent, furosemide sensitive, and cAMP sensitive but K(+) independent. Sodium uptake increases with decreasing osmolarity between 120 and 70 mosmol/kgH(2)O (r = 0.95, P < 0.01). Immunohistochemical analysis shows that in hypotonic conditions mBSC1-A4 protein is expressed in the plasma membrane. These studies indicate that the mBSC1-A4 isoform of the SLC12A1 gene encodes a hypotonically activated, cAMP- and furosemide-sensitive Na(+)-Cl(-) cotransporter. Thus it is possible that alternative splicing of the BSC1 gene could provide the molecular mechanism enabling the Na(+)-Cl(-)-to-Na(+)-K(+)-2Cl(-) switching in thick ascending limb cells.
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Affiliation(s)
- C Plata
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City CP 14000, Mexico
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Labs KH, Tschoepl M, Gamba G, Aschwanden M, Jaeger KA. The reliability of leg circumference assessment: a comparison of spring tape measurements and optoelectronic volumetry. Vasc Med 2001; 5:69-74. [PMID: 10943582 DOI: 10.1177/1358836x0000500202] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare the reliability of repeated spring tape measurements with optoelectronic volumeter measurements for the assessment of lower leg circumferences. The limb circumferences at mid-calf and ankle level of both legs were measured three times using a spring tape measure as well as an optoelectronic volumeter. In all, 30 healthy volunteers participated in the study. Test reliability and repeatability were described through the process-related and between-subject variances and variance-derived parameters such as the reliability coefficient (intraclass correlation coefficient, RC), the relative precision (RP), and the coefficient of repeatability (CR). A higher value for the RC and a lower value for the RP indicate that the test variability is predominantly due to between-subject variance and not to test process-related variance. RCs for both methods, independent of whether measurements were taken at calf or at ankle level, always exceeded 0.95. RPs were in the same order of magnitude for both methods but lower for measurements at calf than at ankle level (range: RPcalf 6.36-8.74%; range: RPankle 12.49-18.56%). CRs for both methods were low and of comparable magnitude (CR range: 4.8-7.7), although slightly smaller for the spring tape. When measurement results from the spring tape and the volumeter were compared, results achieved with the volumeter were significantly longer than those from the spring tape (p<0.05). Results from both methods were linearly in good agreement and there was no proportional bias; differences shown were due to a significant constant bias regarding the volumeter. Circumference measurements taken by spring tape and by optoelectronic volumetry are both characterized by a comparably high reliability. However, these methods cannot be used in an interchangeable way because a constant bias exists for volumetry, resulting in significantly larger circumferences compared with those measured using the spring tape.
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Affiliation(s)
- K H Labs
- Department of Angiology, University of Basel Medical School, Switzerland
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35
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Gamba G. [La Revista de Investigación Clínica becomes a bilingual publication]. Rev Invest Clin 2001; 53:6-10. [PMID: 11332052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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González-Michaca L, Soto-Ramírez LE, Rodríguez R, Gamba G. [Viral hepatitis C in patients with terminal chronic renal insufficiency. III. Viral quantification]. Rev Invest Clin 2001; 53:21-7. [PMID: 11332047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND We have previously shown that the prevalence of hepatitis associated with the hepatitis C virus (HCV) in patients with end stage renal disease in our institution is 10.2%. However, quantification of viral RNA in plasma and its relation with clinical variables has never been studied in our patients. Thus, the aim of the present work was to quantify the HCV viral load in patients with ESRD in dialysis, and to correlate these values with the dialysis modality and the viral genotype. METHODS We performed a transverse, prospective and comparative study in patients with HCV infection in hemodialysis, continuous ambulatory peritoneal dialysis and patients in peritoneal dialysis, but with history of hemodialysis. Viral load was quantified with RT-PCR by using a commercial kit known as Amplicor HCV 2.0. Clinical variables studied were: age, gender, end stage renal disease etiology, modality and time in dialysis, transfusions, serum albumin, aminotransferases, blood urea nitrogen, and serum creatinine. RESULTS Twenty four patients in dialysis with HCV infection entered into the study. Of these patients, 25% were on peritoneal dialysis, 29% on peritoneal dialysis with history of hemodialysis, and 46% were in hemodialysis. The average viral load (copies x 10(6)/mL) was 1.41 +/- 3.01. Viral load was lower in patients on peritoneal dialysis than in patients treated, or with history of hemodialysis (0.20 +/- 0.12 vs 2.04 +/- 0.88; p < 0.05). We observed no differences in viral load among patients with different viral genotypes. DISCUSSION The average viral load of our patients in dialysis is lower than the levels usually observed in hepatitis C infected patients without end stage renal disease. The lower viral load in patients treated with peritoneal dialysis, and no history of hemodialysis, probably denotes lower risk of chronic liver disease in these subpopulation.
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Affiliation(s)
- L González-Michaca
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran.
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Iester M, Orsoni GJ, Gamba G, Taffara M, Mangiafico P, Giuffrida S, Rolando M. Improvement of the ocular surface using hypotonic 0.4% hyaluronic acid drops in keratoconjunctivitis sicca. Eye (Lond) 2000; 14:892-8. [PMID: 11584850 DOI: 10.1038/eye.2000.244] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The ocular surface changes of keratoconjunctivitis sicca (KCS) could be the result of the effect of an altered tear film on the epithelial environment. PURPOSE To evaluate the possibility of improving the environmental conditions of the ocular surface by lowering tear osmolarity, increasing tear film volume and stabilising the tear film. Also, to study the effect of such an improvement on the epithelial cells of the ocular surface. METHODS One hundred and thirty-five patients with a diagnosis of KCS were treated on a randomised basis with either unpreserved hypotonic 0.4% hyaluronic acid (HHA) eye drops or 0.3% hydroxypropylmethylcellulose plus 0.1% Dextran 70 (HPMC) eye drops 6 times a day for 60 or 90 days. In all patients a Schirmer I test, break-up time (BUT), ocular surface staining with 1% Bengal Rose, or 2% fluorescein, as well as subjective symptoms, were recorded before and 15, 30 and 60 days after the beginning of the study. Patients were divided into three subgroups and the effect of the treatment was studied using three different techniques: the tear ferning test, conjunctival impression cytology and tear osmolarity measurement. RESULTS Improvements in BUT, vital staining, Schirmer I and symptoms were recorded in both groups of treatment, with significant differences for patients treated with 0.4% HHA. On day 60, 30 min after installation: tear ferning patterns changed from 100% pathological (types III-IV) to 93% physiological (types I-II) in the 0.4% HHA group and from 100% pathological to 78% physiological in the 0.3% HPMC group (p < 0.01 between groups). Tear osmolarity shifted from 353 +/- 23 to 305 +/- 6 mosmol/l in the 0.4% HHA group and from 346 +/- 15 to 336 +/- 8 mosmol/l in the 0.3% HPMC group (p < 0.001 between groups). On day 90, the impression cytology score improved from 1.2 to 1.9 in the 0.4% HHA group while it did not change in the 0.3% HPMC group (p < 0.05 between groups). CONCLUSION In KCS appropriate treatment with a hypotonic 0.4% HHA tear substitute can change the tear environment and results in improvement of the epithelial conditions of the ocular surface.
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Affiliation(s)
- M Iester
- Department of Neurological and Visual Science, Ophthalmology B, University of Genoa, Italy.
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Cueto-Manzano AM, Gamba G, Correa-Rotter R. Quantification and characterization of protein loss in continuous ambulatory peritoneal dialysis. Rev Invest Clin 2000; 52:611-7. [PMID: 11256103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND/AIMS Dialysate protein loss is involved in the etiology of hypoalbuminemia and malnutrition on CAPD. There is no information regarding the peritoneal transport of proteins in neither Mexican nor LatinAmerican CAPD patients. Therefore, the aim of this study was to quantify and characterize the peritoneal membrane transport of albumin (Alb), IgG, IgA, and IgM in CAPD patients. In addition, factors associated to protein losses were investigated. METHODS Thirty-seven CAPD patients were randomly selected and subjected to a standard peritoneal equilibration test (PET). Alb, IgG, IgA, and IgM were measured during the PET in both serum and dialysate. RESULTS Dialysate IgM was not detected with the employed nephelometry method. A significant continuous and gradual increasing pattern in Alb, IgG and IgA losses was observed throughout the PET. During the PET, patients with the fastest transport type displayed the lowest serum concentration of Alb (but not Igs) and the greatest dialysate loss of all the assayed proteins. The strongest predictor for Alb, IgG, and IgA losses was peritoneal transport rate in both the univariate and multivariate analyses. CONCLUSIONS Peritoneal Alb, IgG, and IgA losses in Mexican CAPD patients are mainly dependent on peritoneal transport rate and dialysate dwell-time.
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Affiliation(s)
- A M Cueto-Manzano
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jal.
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Sánchez-Lozada LG, Gamba G, Bolio A, Jiménez F, Herrera-Acosta J, Bobadilla NA. Nifedipine prevents changes in nitric oxide synthase mRNA levels induced by cyclosporine. Hypertension 2000; 36:642-7. [PMID: 11040251 DOI: 10.1161/01.hyp.36.4.642] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cyclosporine toxicity mainly affects kidney and liver function. We have previously shown that cyclosporine nephrotoxicity alters kidney nitric oxide synthase mRNA pattern of expression. To determine if nitric oxide synthase expression changes are mediated directly by cyclosporine or by secondary hemodynamic alterations induced by cyclosporine, we evaluated if these effects are tissue specific and if nifedipine-induced vasodilation prevents these alterations. Uninephrectomized Wistar rats treated for 7 days with olive oil, cyclosporine (30 mg/kg), nifedipine (3 mg/kg), and nifedipine+cyclosporine were studied. In vehicle and cyclosporine groups, the gene expression of the neuronal, inducible, and endothelial nitric oxide synthases in cerebellum, heart, intestine, liver, renal cortex, and medulla was evaluated. The administration of cyclosporine was associated with nephrotoxicity and hepatotoxicity, increased endothelial nitric oxide synthase mRNA levels in renal cortex and liver, and a decrease in inducible nitric oxide synthase and neuronal nitric oxide synthase in renal medulla. The mRNA levels of the 3 nitric oxide synthase isoforms were not affected in any other tissue. Nifedipine did not alter nitric oxide synthase expression in the control group but prevented changes associated with cyclosporine. These results suggest that cyclosporine-induced changes in the pattern of expression of the nitric oxide synthases may be secondary to its hemodynamic effects.
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Affiliation(s)
- L G Sánchez-Lozada
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Abstract
The K(+)-Cl(-) cotransporters (KCCs) are members of the cation-chloride cotransporter gene family and fall into two phylogenetic subgroups: KCC2 paired with KCC4 and KCC1 paired with KCC3. We report a functional comparison in Xenopus oocytes of KCC1 and KCC4, widely expressed representatives of these two subgroups. KCC1 and KCC4 exhibit differential sensitivity to transport inhibitors, such that KCC4 is much less sensitive to bumetanide and furosemide. The efficacy of these anion inhibitors is critically dependent on the concentration of extracellular K(+), with much higher inhibition in 50 mm K(+) versus 2 mm K(+). KCC4 is also uniquely sensitive to 10 mm barium and to 2 mm trichlormethiazide. Kinetic characterization reveals divergent affinities for K(+) (K(m) values of approximately 25.5 and 17.5 mm for KCC1 and KCC4, respectively), probably due to variation within the second transmembrane segment. Although the two isoforms have equivalent affinities for Cl(-), they differ in the anion selectivity of K(+) transport (Cl(-) > SCN(-) = Br(-) > PO(4)(-3) > I(-) for KCC1 and Cl(-) > Br(-) > PO(4)(-3) = I(-) > SCN(-) for KCC4). Both KCCs express minimal K(+)-Cl(-) cotransport under isotonic conditions, with significant activation by cell swelling under hypotonic conditions. The cysteine-alkylating agent N-ethylmaleimide activates K(+)-Cl(-) cotransport in isotonic conditions but abrogates hypotonic activation, an unexpected dissociation of N-ethylmaleimide sensitivity and volume sensitivity. Although KCC4 is consistently more volume-sensitive, the hypotonic activation of both isoforms is critically dependent on protein phosphatase 1. Overall, the functional comparison of these cloned K(+)-Cl(-) cotransporters reveals important functional, pharmacological, and kinetic differences with both physiological and mechanistic implications.
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Affiliation(s)
- A Mercado
- Molecular Physiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlalpan 14000, Mexico City, Mexico
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Merino A, Moreno G, Mercado A, Bobadilla NA, Gamba G. Na(+):K(+):ATPase mRNA expression in the kidney during adaptation to sodium intake and furosemide treatment. Arch Med Res 2000; 31:486-92. [PMID: 11179582 DOI: 10.1016/s0188-4409(00)00102-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nephron tubular epithelium possesses the capacity of adaptation to any salt ingestion condition. The mechanism of adaptation is due in part to an increase in the activity of Na(+):K(+):ATPase at the basolateral membrane. The goal of the present study was to analyze the long-term regulation of the Na(+):K(+):ATPase alpha(1)-subunit mRNA expression during changes in NaCl metabolism. Male Wistar rats given a normal, high, or low NaCl diet, and intraperitoneal administration of the loop diuretic furosemide from 12 h to 7 days were studied. Rats were kept in metabolic cages 4 days before and throughout the study to determine daily urinary electrolyte excretion and osmolarity. At the end of each experimental period, creatinine clearance and serum electrolytes were also measured. Total RNA was extracted from each individual cortex or outer medulla and from pooled inner medullas using the guanidine/cesium chloride method. Na(+):K(+):ATPase alpha(1)-subunit mRNA expression was assessed by nonradioactive dot-blot analysis. Experimental maneuvers were well tolerated and all groups developed the appropriate renal response to each experimental condition. Urinary sodium excretion was significantly higher in rats administered a high sodium diet or furosemide and lower in rats treated with a low sodium diet after 7 days of treatment. Glomerular filtration rate was similar among all groups. However, the level of expression of the Na(+):K(+):ATPase alpha(1)-subunit did not change in any model. Nephron adaptation to the modification in NaCl intake or furosemide administration over 7 days did not include changes in Na(+):K(+):ATPase alpha(1)-subunit mRNA levels.
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Affiliation(s)
- A Merino
- Unidad de Fisiología Molecular, Instituto Nacional de Ciencia Médicas y Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Abstract
The family of electroneutral chloride-coupled co-transporters has been expanded in the past year by the identification of new genes or new alternatively spliced isoforms of already known genes. In this review, we discuss the molecular cloning of new members of the family, the knowledge revealed by the production of transgenic animals and some new aspects of the functional characteristics of co-transporters.
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Affiliation(s)
- G Gamba
- Molecular Physiology Unit, Instituto Nacional de la Nutrición Salvador Zubirán, Tlalpan, Mexico City, México.
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Gamba G. [In search of prognostic factors in continuous ambulatory peritoneal dialysis]. Rev Invest Clin 2000; 52:565-8. [PMID: 11195185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- G Gamba
- Unidad de Fisiología Molecular, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México
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González-Michaca L, Mercado A, Gamba G. [Viral C hepatitis in patients with end stage renal disease. II. Viral genotypes]. Rev Invest Clin 2000; 52:491-6. [PMID: 11195176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The hepatitis C virus infection is highly prevalent in patients on chronic dialysis. There are more than 10 variants of the hepatitis C virus, with 55 to 72% of identity among them at the amino acid level. However, we do not know the specific genotype in dialysis patients in Mexico. Thus, the aim of the present study was to know the specific genotypes of the C virus in infected dialysis patients, to know the distribution of genotypes in the different dialysis techniques and to know the relation between genotype and hepatic disease stage. METHODS We performed a prospective, transversal and comparative study in patients in dialysis in three hospital centers in the south of Mexico City. The presence of C-type hepatitis infection was assessed by ELISA II and qualitative RT-PCR in blood samples. The genotype of the hepatitis C virus was determined by analysis of the restriction pattern of the RT-PCR product using Mva I, Hinf I, BstU I and ScrF I restriction enzymes. Variables analyzed were: age, gender, etiology of renal failure, kind and time in substitutive therapy, transfusion and hepatitis history, liver function test, blood urea, serum creatinine and blood cell count. RESULTS We studied 235 dialysis patients that were divided following their dialysis modality into: 132 in continue ambulatory peritoneal dialysis (CAPD), 17 in CAPD, but with history of hemodialysis (PD/HD) of at least one month and 86 on hemodialysis (HD). The hepatitis infection was detected in 24 of the 235 patients (CAPD = 4.5%, PD/HD = 41.1% and HD = 12.7%; p < 0.001). The most common genotype was 1B (12/24), followed by 1A and 2A (4/24 each one), and finally by 2B and 2C (2/24 each one). We detected no patients with genotypes 3 to 6. The patients with 2A genotype were older than those infected with 1A (p < 0.05). History of surgery, transfusions, and hepatitis was similar in all genotypes. Finally the time in dialysis was longer in patients with 2A genotype than others (2A = 60.5 +/- 71.5 months, vs. 1A = 11.5 +/- 11.3, 1B = 26 +/- 26.4 y 2B/C = 17.5 +/- 13.4), but the difference did not reach statistical significance. The genotype distribution between dialysis techniques showed that 1B genotype was the most frequent in all modalities. The 1A genotype was present in similar proportions in patients of the three dialysis groups, the 2C genotype was present only in patients with CAPD. Finally, the 2B was only found in hemodialysis patients. DISCUSSION The assessment of viral genotype revealed that 1B is the most common genotype in patients on chronic dialysis in Mexico City. The fact that the 1B and 1A genotypes were the most common types in our dialysis population suggest that transmission was similar to the general population, that is, probably by blood transfusions.
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Affiliation(s)
- L González-Michaca
- Unidad de Fisiología Molecular, Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
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Lang F, Klingel K, Wagner CA, Stegen C, Warntges S, Friedrich B, Lanzendorfer M, Melzig J, Moschen I, Steuer S, Waldegger S, Sauter M, Paulmichl M, Gerke V, Risler T, Gamba G, Capasso G, Kandolf R, Hebert SC, Massry SG, Broër S. Deranged transcriptional regulation of cell-volume-sensitive kinase hSGK in diabetic nephropathy. Proc Natl Acad Sci U S A 2000; 97:8157-62. [PMID: 10884438 PMCID: PMC16686 DOI: 10.1073/pnas.97.14.8157] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Transforming growth factor beta (TGF-beta) has been shown to participate in the pathophysiology of diabetic complications. As shown most recently, TGF-beta stimulates the expression of a distinct serine/threonine kinase (hSGK) which had previously been cloned as an early gene transcriptionally regulated by cell volume alterations. The present study was performed to elucidate transcription and function of hSGK in diabetic nephropathy. As shown by Northern blotting, an increase of extracellular glucose concentration increased hSGK mRNA levels in cultured cells, an effect qualitatively mimicked by osmotic cell shrinkage or treatment with TGF-beta (2 microgram/liter), phorbol 12,13-didecanoate (1 microM), or the Ca(2+) ionophore ionomycin (1 microM) and blunted by high concentrations of nifedipine (10 and 100 microM). In situ hybridization revealed that hSGK transcription was markedly enhanced in diabetic nephropathy, with particularly high expression in mesangial cells, interstitial cells, and cells in thick ascending limbs of Henle's loop and distal tubules. According to voltage clamp and tracer flux studies in Xenopus oocytes expressing the renal epithelial Na(+) channel ENaC or the mouse thick ascending limb Na(+),K(+),2Cl(-) cotransporter BSC-1, coexpression with hSGK stimulated ENaC and BSC-1 11-fold and 6-fold, respectively, effects reversed by kinase inhibitors staurosporine (1 microM) and chelerythrine (1 microM) and not elicited by inactive hSGK. In conclusion, excessive extracellular glucose concentrations enhance hSGK transcription, which in turn stimulates renal tubular Na(+) transport. These observations disclose an additional element in the pathophysiology of diabetic nephropathy.
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Affiliation(s)
- F Lang
- Departments of Physiology, Molecular Pathology, and Nephrology, University of Tubingen, Tubingen D-72076, Germany
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Monroy A, Plata C, Hebert SC, Gamba G. Characterization of the thiazide-sensitive Na(+)-Cl(-) cotransporter: a new model for ions and diuretics interaction. Am J Physiol Renal Physiol 2000; 279:F161-9. [PMID: 10894798 DOI: 10.1152/ajprenal.2000.279.1.f161] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The thiazide-sensitive Na(+)-Cl(-) cotransporter (TSC) is the major pathway for salt reabsorption in the apical membrane of the mammalian distal convoluted tubule. When expressed in Xenopus laevis oocytes, rat TSC exhibits high affinity for both cotransported ions, with the Michaelis-Menten constant (K(m)) for Na(+) of 7.6 +/- 1.6 mM and for Cl(-) of 6.3 +/- 1.1 mM, and Hill coefficients for Na(+) and Cl(-) consistent with electroneutrality. The affinities of both Na(+) and Cl(-) were increased by increasing concentration of the counterion. The IC(50) values for thiazides were affected by both extracellular Na(+) and Cl(-). The higher the Na(+) or Cl(-) concentration, the lower the inhibitory effect of thiazides. Finally, rTSC function is affected by extracellular osmolarity. We propose a transport model featuring a random order of binding in which the binding of each ion facilitates the binding of the counterion. Both ion binding sites alter thiazide-mediated inhibition of transport, indicating that the thiazide-binding site is either shared or modified by both Na(+) and Cl(-).
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Affiliation(s)
- A Monroy
- Molecular Physiology Unit, Instituto Nacional de la Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas, National University of Mexico, Tlalpan 14000 Mexico City, Mexico
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Gamba G. [The second chromosome in the account]. Rev Invest Clin 2000; 52:370-1. [PMID: 11061094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Gamba G, Quintanilla L, del Bosque MD, Chew-Wong A, Correa-Rotter R. [Clinical course and prognostic factors in lupus nephropathy]. Rev Invest Clin 2000; 52:397-405. [PMID: 11061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The present study was designed to know the clinical course of lupus nephritis and the risk factors associated with the development of end stage renal disease. METHODS This a retrospective study performed in a cohort of 154 patients with biopsy proven lupus nephritis that were seen in our hospital between 1984 and 1990. The clinical records of all patients were reviewed in order to collect the following information at the time of the biopsy: age, sex, number and type of lupus criteria according with the American College of Reumathology, mean arterial pressure, serum creatinine, BUN, and albumin, as well as urinary protein excretion. The follow up was registered from the day the biopsy was performed to one of the following end points: end stage renal disease (defined as requirement of chronic dialysis), death or the end of study. All biopsies were analyzed by light microscopy to obtain the hystological subtype of lupus nephritis (WHO classification) and when type IV was diagnosed, the activity and chronicity indexes were also assessed. Kaplan-Meier survival tables were constructed. The association of clinical and laboratory variables with the development of end stage renal disease was obtained by log rank analysis. Variables obtained as significant were used to evaluate their individual impact using either the Cox multivariate proportional hazard method. RESULTS Follow up was complete in 144 patients with a follow up time of 68 +/- 38 months. Ninety three patients were female with mean age of 28 +/- 9 years. At the time of the biopsy, renal manifestations had been present for 35 +/- 38 months and the number of lupus criteria per patient were 4 +/- 1. The clinical picture at the time of the biopsy was: nephrotic syndrome in 60%, non nephrotic proteinuria in 40%, and nephritic syndrome in only 2%. The hystological type of lupus nephritis was: I in 2%, II in 8%, III in 6%, IV in 71% and V in 11%. At the end of the study 28 patients developed end stage renal disease. For the whole group the survival of renal function was 85% at 70 months and 70% at 140 months. All, but one patient that developed end stage renal disease exhibited type IV nephropathy. In this subpopulation the mean activity and chronicity indexes were 8.5 +/- 3.5 and 3.1 +/- 2.4, respectively. By multivariate analysis the strongest predictors of end stage renal disease were the serum creatinine at the time of the biopsy, chronicity index, and age. The higher the serum creatinine and chronicity index at the time of biopsy, the higher the probability of developing end stage renal disease. CONCLUSIONS We conclude that the clinical course of lupus nephritis in our population is similar to that seen in other series. The variables indicating advanced renal disease, such as high serum creatinine and chronicity index, were the strongest predictors of end stage renal disease.
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Affiliation(s)
- G Gamba
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
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Labs KH, Tschoepl M, Gamba G, Aschwanden M, Jaeger K. The reliability of leg circumference assessment: a comparison of spring tape measurements and optoelectronic volumetry. Vasc Med 2000. [DOI: 10.1191/135886300670529089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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González-Michaca L, Mercado A, Gamba G. [Hepatitis C viral in patients with terminal chronic kidney failure. I. Prevalence]. Rev Invest Clin 2000; 52:246-54. [PMID: 10953607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND The prevalence of hepatitis C in patients with end stage renal disease, under renal replacement therapy either with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), is higher than in the general population. The prevalence of hepatitis C in patients under dialysis, however, is unknown in Mexico. Thus, the major goals of the present study were to determine the prevalence of hepatitis C in our patients on dialysis, and the risk factors associated with it. METHODS We performed a cross-sectional and comparative study in patients under dialysis in three hospital centers in the south of Mexico City. For every patient we evaluated: age, gender, etiology of the renal failure, modality and time in dialysis, transfusion and surgical history, serum albumin, aminotranferases, BUN, and serum creatinine. The presence of hepatitis C was assessed by ELISA II and qualitative RT-PCR in blood samples. In all patients diagnosed as having hepatitis C, RT-PCR to amplified part of the virus genome was also carried out in the dialysis fluid. RESULTS We studied 235 dialysis patients that were classified according to their dialysis modality in: 132 patients under CAPD, 17 under CAPD and history of HD (PD/HD) and 86 under HD. The time under dialysis was different between the study groups: CAPD 29.6 +/- 22.3 months, PD/HD 39 +/- 42.3 and HD 14.2 +/- 15.6 (p < 0.01). The presence of hepatitis C was detected in 24 of the 235 patients, for a global prevalence of 10.2%. In no case was viral RNA found in the dialysis fluid. The prevalence varied, however, according to the type of dialysis. It was in the CAPD group 4.5%, 12.7% in the HD group, and 41.1% in the PD/HD group (p < 0.001). The multivariate analysis showed that the risk factors for hepatitis C are transfusions before the year of 1991 (Odds Ratio = 6.4), and history of hepatitis (OR = 4.3). Since less patients are seen with transfusions before 1991, we constructed another model in which this variable was excluded. This new multivariate model showed that history of surgery (OR = 4.4), the use of HD as the dialysis modality (OR = 3.5), and prolonged time under dialysis (OR = 1.01) were all significantly associated with the presence of hepatitis. DISCUSSION Our results show that the prevalence of hepatitis C is lower in our patients that the prevalence reported by many others (average of other countries 18.5%). Since we found a higher prevalence in HD than in CAPD, even with the lower time under dialysis in the HD group, it is possible that our lower overall prevalence is secondary to the fact that CAPD is the most frequent mode of dialysis in our country. We observed the highest prevalence in the PD/HD group, that is probably due to longer exposure to the risk factors. The association with transfusions before 1991 indicates that the infection was acquired in some patients before dialysis was started. Our results showed that the CAPD is the dialysis technique with lower risk of hepatitis C infection.
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Affiliation(s)
- L González-Michaca
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de la Nutrición Salvador Zubirán.
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