Variants in Apaf-1 segregating with major depression promote apoptosome function

APAF1, encoding the protein apoptosis protease activating factor 1 (Apaf-1), has recently been established as a chromosome 12 gene conferring predisposition to major depression in humans. The molecular phenotypes of Apaf-1 variants were determined by in vitro reconstruction of the apoptosome complex in which Apaf-1 activates caspase 9 and thus initiates a cascade of proteolytic events leading to apoptotic destruction of the cell. Cellular phenotypes were measured using a yeast heterologous expression assay in which human Apaf-1 and other proteins necessary to constitute a functional apoptotic pathway were overexpressed. Apaf-1 variants encoded by APAF1 alleles that segregate with major depression in families linked to chromosome 12 shared a common gain-of-function phenotype in both assay systems. In contrast, other Apaf-1 variants showed neutral or loss-of-function phenotypes. The depression-associated alleles thus have a common phenotype that is distinct from that of non-associated variants. This result suggests an etiologic role for enhanced apoptosis in major depression.

Antibody to the alpha4 integrin decreases infarct size in transient focal cerebral ischemia in rats

BACKGROUND AND PURPOSE

Inflammation, a process that involves neutrophils, lymphocytes, and monocytes, contributes to cerebral ischemic injury. Blockade of neutrophil adhesion to endothelium improves outcome after experimental stroke. In this study we sought to assess the contribution of lymphocytes and monocytes to ischemic brain injury.

METHODS

Male Lewis rats underwent 3 hours of middle cerebral artery occlusion followed by 45 hours of reperfusion. Two hours after the onset of ischemia, one group of animals received an intraperitoneal injection of antibodies to the alpha(4) integrin (n=16); another group was injected with an isotype control antibody (n=11). Neurological examination, body temperature, and body weight were assessed at different time points after stroke. Animals were killed 48 hours after the onset of ischemia for determination of infarct volume and leukocyte counts.

RESULTS

There were no significant differences in body temperature or weight at any time. Neurological scores (deficits) were significantly less in animals treated with anti-alpha(4) antibodies at 24 (2.0+/-1.2 versus 3. 0+/-0.4; P:=0.006) and 48 (2.0+/-1.2 versus 3.0+/-0.8; P:=0.011) hours after ischemia. Peripheral blood leukocyte counts were significantly higher in anti-alpha(4)-treated animals (6.8+/-2.2 x 10(9) versus 2.9+/-1.9 x 10(9); P:=0.001) and revealed a lymphocyte/monocyte predominance (86.0+/-16.2% versus 71.0+/-15.6%; P:=0.008). Infarct volume was significantly less in animals treated with antibodies to alpha(4) (120.1+/-51.21 versus 173.7+/-42.29 mm(3); P:=0.012).

CONCLUSIONS

These data support a role for lymphocytes and monocytes in cerebral ischemic injury and show that blockade of alpha(4), even when instituted after the onset of ischemia, can improve neurological outcome and decrease infarct volume.

Mechanisms of hypoxia-induced endothelial cell death. Role of p53 in apoptosis

Endothelial cell death may contribute to tissue injury from ischemia. Little is known, however, about the characteristics of endothelial cell death in response to hypoxia. Using an in vitro model, we found that human umbilical vein endothelial cells were resistant to hypoxia-induced cell death with only a 2% reduction in viability at 24 h and 45% reduction in viability at 48 h. Overexpression of a mutant, IkappaBalpha, via adenoviral vector did not potentiate cell death in hypoxia, indicating that nuclear factor-kappaB activation was not involved in cytoprotection. Cell death in hypoxia was determined to be apoptotic by 3' labeling of DNA using terminal deoxynucleotidyl transferase staining and reversibility of cell death with a caspase inhibitor. Exposure of endothelial cells to hypoxia did not alter levels of proapoptotic and antiapoptotic Bcl-2 family members Bax and Bcl-XL by immunoblot analysis. In contrast, changes in p53 protein levels correlated with the induction of apoptosis in hypoxic endothelial cells. Inhibition of the proteasome increased p53 protein levels and accelerated cell death in hypoxia. Overexpression of p53 by adenoviral transduction was sufficient to initiate apoptosis of normoxic endothelial cells. These data provide a framework for the study of factors regulating endothelial cell survival and death in hypoxia.

Endothelial and leukocyte adhesion molecules in inflammation and disease

Injury associated with ischemia and reperfusion is a significant factor in a number of clinical diseases. We have completed a number of preclinical studies investigating the blockade of leukocyte adhesion molecules in ischemia-reperfusion injury. In our work and in the work of other investigators, monoclonal antibodies directed to CD18, P-selectin and L-selectin were effective in reducing ischemia-reperfusion injury to the rabbit ear and in reducing injury following hemorrhagic shock in both rabbits and nonhuman primates. Ischemia-reperfusion injury was also reduced by synthetic oligosaccharide sLe(x). These studies suggest that adhesion blockade might be effective in the clinical setting.

Human monocytes bind to two cytokine-induced adhesive ligands on cultured human endothelial cells: endothelial-leukocyte adhesion molecule-1 and vascular cell adhesion molecule-1

Vascular cell adhesion molecule-1 (VCAM-1) and endothelial-leukocyte adhesion molecule-1 (ELAM-1) are adhesive proteins induced on endothelium by cytokines. We examined the contribution of these adhesive proteins to human peripheral blood monocyte adherence to endothelium using transfected Chinese hamster ovary (CHO) cells stably expressing these proteins and monoclonal antibodies (MoAbs) to ELAM-1, VCAM-1, or CD49d/CD29 (VLA-4), the leukocyte receptor for VCAM-1. Monocytes bound to CHO cells transfected with cDNA of ELAM-1 or VCAM-1. Binding to ELAM-1 was inhibited by MoAb to ELAM-1 and binding to VCAM-1 was inhibited by MoAb to VCAM-1 or the alpha-chain of very late activation antigen-4 (VLA-4) (CD49d). Additive inhibition of adherence to unstimulated human umbilical vein endothelium (HUVE) was observed when monocytes were pretreated with both MoAb to CD49d and MoAb to CD18, the common beta-chain of the leukocyte beta 2 integrin receptors. Adherence of monocytes to HUVE stimulated by recombinant human tumor necrosis factor-alpha was not reduced by MoAbs to CD18, CD49d, or ELAM-1 when used singly, but combinations of these MoAbs produced significant inhibition. We conclude that multiple receptor-ligand systems are involved in monocyte adherence to endothelium.

Streptococcus pneumoniae-stimulated macrophages induce neutrophils to emigrate by a CD18-independent mechanism of adherence

Neutrophil adherence to and emigration across endothelium are in large part dependent upon the neutrophil membrane CD11/CD18 glycoprotein complex. Recently, however, we have demonstrated that some stimuli can elicit neutrophil emigration in the lung by a CD18-independent pathway. We examined further the mechanism involved in CD18-independent emigration in a rabbit model of inflamed peritoneum. Neutrophil emigration in the peritoneum induced by instillation of E. coli and S. pneumoniae was studied under four experimental conditions: Group 1--normal peritoneum, Group 2--peritoneum primed with protease peptone to increase the number of macrophages, Group 3--peritoneum treated by protease peptone instillation and then depleted of the increased macrophage population, and Group 4--peritoneum with macrophages transplanted from animals enriched as in Group 2. Experiments were run in pairs with animals in each group assigned to receive either saline (control) or monoclonal antibody (MAb) 60.3 prior to bacterial instillation in the peritoneum. Neutrophil emigration in response to E. coli was greater than 86% inhibited by MAb 60.3 in both the normal and the macrophage-enriched peritoneum. Neutrophil emigration in response to S. pneumoniae was inhibited greater than 85% in the normal peritoneum and the macrophage-enriched and the transplanted macrophage peritoneum. These data indicate that macrophages can augment PMN emigration by a non-CD18 mechanism, and may explain the increased sensitivity of organs with large resident macrophage populations, liver and lung, to injury following shock and sepsis.

Endoscopic placement of biliary stents for treatment of high risk geriatric patients with common duct stones

Ten elderly (mean age, 77 yr) sick patients with large common duct stones were managed with stents when conventional nonsurgical methods for stone extraction failed. Five subjects had intact gallbladders, and four of these had cholelithiasis. Patients were at increased risk for perioperative complications--yet endoscopic placement of stents was performed safely in all instances. Pain and jaundice resolved and elevated serum bilirubin values returned to normal in all patients. After a maximum follow up of 35 months, no subject has required surgery for biliary symptoms or complications. Two patients have died, one following elective cholecystectomy and common duct exploration and another from unrelated causes. These results suggest that endoscopic placement of stents for management of large common duct stones is safe, and favorable long-term results can be achieved. Geriatric patients who are unfit for surgery are probably good candidates for this treatment.

Colour effect of denture base on denture tooth materials

A study using a HunterLab colorimeter was conducted to determine the colour effect of denture base materials on denture tooth acrylics. The results show that denture base materials create a measurable change in the chroma of denture tooth acrylics and suggest that optimal shade selection of teeth should include a determination of the background effects of denture base materials.

Lung lymph flow after bone marrow injection into goats was reduced by indomethacin

We examined the pulmonary response to bone marrow embolism in untreated and indomethacin-treated goats. Pulmonary arterial pressure increased by 15 cmH2O after bone marrow infusion, reaching a peak of 37.2 then stabilizing at greater than 30 cmH2O in the control group. In the treated group it increased by 4.3 cmH2O from a base line of 18.5 cmH2O but had returned to base line by 6 h. Lymph flow increased in the control group from a base line of 7.3 ml/h to a peak of 22.4 ml/h and remained near that level. It increased from a base line of 6.4 ml/h to a peak of 9.8 ml/h in the treated group and remained close to that value. The lymph-to-plasma protein ratio was little changed throughout the experiment. Cardiac output decreased by 1.2 l/min in the control group but was unchanged from base line in the treated group. Systemic arterial pressure was similar in both groups of animals. We conclude that indomethacin prevents the pulmonary hypertension seen after bone marrow infusion and protects against some of the increased permeability.

Neutrophil depletion does not prevent lung edema after endotoxin infusion in goats

Neutropenia was produced in goats by injection of either nitrogen mustard, (1.5 mg/kg) or hydroxyurea (200 mg X kg-1 X day-1). A nitrogen mustard (M + E) group (n = 6), a hydroxyurea (H + E) group (n = 5), and a control (E) group (n = 7) were given 1-h infusions of endotoxin (5 micrograms/kg total dose), then monitored for up to 5 h. Postmortem extravascular lung water (EVLW) was significantly higher in the M + E group (14.2 +/- 4.4 ml/kg) and the E group (11.9 +/- 3.9 ml/kg) when compared with a normal control (6.6 +/- 1.3 ml/kg) group that did not receive endotoxin. EVLW in a group made neutropenic with nitrogen mustard (6.7 +/- 1.3 ml/kg) and the H + E (7.9 +/- 1.5 ml/kg) groups were not statistically different from each other or from normal controls. Circulating neutrophil counts averaged 32 +/- 42 cells/microliter in the M + E group and 180 +/- 210 cells/microliter in the H + E group. Only minimal histological changes were seen in the H + E group, but the E and M + E lungs had severe pulmonary edema. We conclude that neutrophils are not required for increased EVLW and decreased arterial O2 partial pressure after endotoxin infusion, and hydroxyurea prevents at least part of the pulmonary edema after endotoxin by a mechanism that is not neutrophil dependent.

Lung permeability and hemodynamics during endotoxemia: effect of aprotinin

To test the hypothesis that the broad spectrum protease inhibitor, aprotinin, can prevent early pathophysiology of sepsis, we administered endotoxin (0.1-0.75 microgram/kg) by a 30-min infusion to awake goats. Animals were used as their own controls receiving endotoxin with no treatment on one day and treatment with a bolus injection (10 trypsin inhibitory units, TIU, per kg) followed by a 6-hr infusion (5 TIU/kg/hr) of aprotinin on another. The effect on systemic and pulmonary hemodynamics, lung lung lymph flow (QL), lymph plasma protein ratio (L/P), and systemic eicosanoid levels were assessed. QL quickly reached 28 ml/hr (four times baseline) in both groups then slowly returned toward baseline. L/P ratio of both groups decreased by about 10% then returned to baseline. QL and L/P were not different between groups. Likewise, vascular parameters were not different between groups. Mean pulmonary artery pressure increased approximately 150% to a peak of 58 cm H2O in both groups while pulmonary artery wedge pressure doubled from a baseline of 8 cm H2O then both groups returned to baseline. Systemic arterial pressure decreased over the 6 hr experimental period by 15 Torr to 70 Torr in both groups. Cardiac output declined from 4.3 to 3 liter/min after the endotoxin, remaining at the level for 2 hr then progressively increased to about 5 liter/min in both groups. We conclude that aprotinin, in doses similar to those reported to give protection from acute lung injury of various origins, fails to modify the early cardiopulmonary pathophysiology of endotoxin.

Relationship between percent body fat and menstrual patterns in athletes and nonathletes

The relationship between body fat percentage and menstrual patterns was examined in a longitudinal study of 25 collegiate athletes and 41 college-aged nonathletic control subjects. The athletes were training in gymnastics, figure skating, synchronized swimming, volleyball, or track. Data were collected each month concerning cycle, flow length, weight, and skinfold thicknesses (iliac crest, triceps, and subscapular). Height was determined once. Body fat percentage was estimated using the Sloan and Weir (1970) nomogram. Total energy expenditure was estimated for athletes according to sport. Mean body fat percentages of controls and athletes differed significantly, t = 4.4, p less than .01, but no significant difference was found in cycle length, F = 3.3, p = .078. Multiple regression analysis revealed no clear relationship between length of menstrual cycle and height, weight, skinfold thickness, or total energy expenditure. No significant relationship existed between body fat percentage and menstrual cycle length as tested with the Pearson correlation coefficient. This study confirmed that menstrual phenomena cannot be defined as normal or pathologic by rhythmic occurrence alone. Rather, an individual's menstrual cycle length may be more suitably evaluated according to a multivariable continuum of menstrual patterns.

Indomethacin, dazoxiben and extravascular lung water after Escherichia coli infusion

The effects of selectively inhibiting synthesis of thromboxane A2 (TXA2) with dazoxiben and of all cyclooxygenase products with indomethacin were studied in goats after infusion of 5 X 10(8) live Escherichia coli bacteria/kg. Pulmonary and systemic pressures, cardiac output, and double indicator dilution extravascular lung water (EVLW) were measured at 15-min intervals. EVLW was determined gravimetrically at 6 hr to confirm the final double indicator dilution values. Plasma levels of TXA2 and prostacyclin (PGI2) were measured as their stable metabolites, TXB2 and 6-keto-PGF1 alpha, respectively. Dazoxiben blocked the increase in plasma TXB2, prevented pulmonary hypertension, and attenuated the increase in EVLW after E. coli. Mean gravimetric EVLW was 8.7 ml/kg in the dazoxiben-treated group compared to 11.3 ml/kg in the untreated control group. Indomethacin blocked the increased plasma TXB2 and 6-keto-PGF1 alpha, attenuated pulmonary hypertension, and prevented almost all increases in EVLW. Mean gravimetric EVLW was 8.2 ml/kg after indomethacin. We conclude that in acute bacteremia, the early pulmonary hypertension is mediated largely by TXA2 (however, a second phase of hypertension results from non-cyclooxygenase products), either production of cyclooxygenase products (perhaps PGI2) inhibits part of the action of pulmonary vasoconstrictors, or indomethacin stimulates the production of other vasoconstrictors (such as lipoxygenase products), and indomethacin prevents the accumulation of EVLW by blocking formation of cyclooxygenase products or by other nonspecific actions.

Cytoskeletal changes as an early event in hydrogen peroxide-induced cell injury: a study in A549 cells

Hydrogen peroxide (H2O2) and other oxygen metabolites have been implicated in the pathogenesis of cell and tissue injury. The nature of the injury occurring in cells exposed to oxygen metabolites is unknown. A549 cells, derived from human lung carcinoma, were exposed to glucose-glucose oxidase or hydrogen peroxide in vitro. The distribution of actin and cytokeratin filaments, as well as 51chromium (51Cr) release and trypan blue dye exclusion were assessed. Both glucose-glucose oxidase and H2O2 resulted in changes which were time- and dose-dependent. Alterations in the cytoskeleton were detected by immunofluorescence microscopy at two hours, at which time the cells excluded trypan blue dye, while 51Cr release and trypan blue uptake first occurred at 8 h and required a five-fold greater concentration of glucose oxidase. The addition of catalase to glucose-glucose oxidase or H2O2, or inactivation of glucose oxidase by boiling, abrogated the injury. Therefore, one of the early targets of H2O2-induced cell injury may be the cytoskeleton.

Endoscopic drainage of pancreatic pseudocysts

Enlarging pancreatic pseudocysts, as well as those that develop complications such as bleeding, leak, infection, and intestinal or biliary obstruction, require treatment. This treatment is usually surgical and consists of internal or external drainage or, less commonly, excision. Transcutaneous aspiration with or without drain placement has also been reported. We describe four cases of endoscopic cystogastrostomy and cystoduodenostomy undertaken in high risk patients who had either failed previous surgery (two) or were initially refused surgery because of prohibitive operative risk (two). Technique, limitations, and potential use of this procedure are discussed.

Thromboxane A2 mediates lung vasoconstriction but not permeability after endotoxin

The effect of dazoxiben, a selective thromboxane (Tx) synthetase inhibitor, on systemic and pulmonary hemodynamics, eicosanoids, and lung permeability was assessed in awake goats with lung lymph fistulae following infusion of Escherichia coli endotoxin (1 microgram/kg). Animals received endotoxin either with no treatment or pretreatment with a bolus (25 mg/kg) followed by a maintenance infusion (10 mg/kg per h) of dazoxiben. In untreated animals, the peak rise of 26.8 cm H2O in pulmonary artery (Ppa) and of 13.5 cm H2O in wedge (Pw) pressures occurred at the same time as the peak elevations in plasma thromboxane B2 (T X B2). Maximum reduction in cardiac output (Qt) also occurred at the same time. Lung lymph flow (QL) increased during this period and remained elevated for at least 6 h after endotoxin. T X B2 levels had returned from a peak of 13.1 to 0.7 ng/ml by 2 h. In dazoxiben-treated animals, plasma concentrations of T X B2 were never significantly elevated. Increases in Ppa and Pw were markedly reduced and decreased Qt was transient. QL in treated animals began to increase by 30 min after endotoxin and reached a peak by 2 h. Increased QL in treated animals was not as great as in the untreated animals. Moreover, lymph-plasma protein ratios increased significantly in treated animals. Plasma prostaglandin (PG)F2 alpha and 6-keto-PGF1 alpha concentrations were elevated in both groups after endotoxin with values significantly greater in treated animals. We conclude that selective inhibition of Tx ameliorates many adverse hemodynamic consequences of endotoxemia but does not prevent lung permeability changes.

Selective inhibition of thromboxane synthesis during experimental endotoxemia in the goat: effects on pulmonary haemodynamics and lung lymph flow

1 The effects of a selective thromboxane synthetase inhibitor, dazoxiben (UK 37248), on haemodynamics, eicosanoid levels, and lung vascular permeability were assessed in three unanesthetized goats with chronic lung lymph fistulae following infusions of E. coli endotoxin (1 microgram/kg). Each animal received an infusion of endotoxin in both a control and treatment trial. In the control trial endotoxin alone was infused. In the treatment trial endotoxin administration was preceded by a bolus intravenous infusion of dazoxiben 25 mg/kg followed by a maintenance infusion of 10 mg/kg/h. 2 In animals receiving endotoxin alone the peak elevation in pulmonary artery and wedge pressures, the initial increase in lymph flow, and the fall in cardiac output correlated with the peak elevation in plasma thromboxane B2 (TXB2) concentration at 30 min after endotoxin. Although TXB2 levels had returned to baseline by 3 h, lung lymph flow remained elevated for at least 6 h after endotoxin. The lymph/plasma protein ratio (L/P) did not fall. 3 In dazoxiben-treated animals the rise in plasma concentrations of TXB2 after endotoxin was prevented and, in concert, the increase in pulmonary artery and wedge pressures, the fall in cardiac output, and the initial increase in lymph flow were greatly attenuated. The increase in lymph flow at 2-6 h after endotoxin, however, was not prevented in dazoxiben-treated animals, and again L/P did not change. 4 Plasma 6-keto-prostaglandin F1 alpha concentrations were not significantly altered by dazoxiben treatment except for an earlier peak. 5 We conclude that selective total inhibition of thromboxane synthesis can be achieved by dazoxiben. The inhibition ameliorates many of the adverse haemodynamic consequences of experimental endotoxaemia and reduces, but does not prevent pulmonary oedema formation. This seems to be due to an increase in lung microvascular permeability which is not mediated by TXA2.

Preparation of phosphatidyl[2-3H]inositol from yeast grown in medium containing myo[2-3H]inositol

Phosphatidyl[2-3H]inositol was prepared from Saccharomyces cerevisiae (YSC-2), grown in synthetic medium containing myo[2-3H]inositol. Over 44 microCi (or 81%) of the radiolabeled inositol was taken up by the organism, with 34 microCi incorporated into phosphatidylinositol. Upon purification by silicic acid pressure liquid chromatography (MPLC), a final yield of 24 to 26 microCi of phosphatidyl[2-3H]inositol with a specific radioactivity of 40 X 10(3) dpm/nmole was obtained. The purified phosphatidyl[2-3H]inositol was found to be a suitable for phospholipase C from human platelets.

Magnesium-dependent adenosine triphosphatase as a marker enzyme for the plasma membrane of human polymorphonuclear leukocytes

The adenosine triphosphatase (ATPase) activities of human polymorphonuclear leukocytes (PMNL) were studied with an assay that monitored the release of 32P-labeled inorganic pyrophosphate (32P1) from gamma-[32P]adenosine 5'-triphosphate (ATP). In cell homogenates, (Na+ + K+)-sensitive, ouabain-inhibitable ATPase comprised an insignificant fraction of the total ATPase activity. Additions of p-nitrophenyl phosphate and beta-glycerophosphate (substrates for nonspecific acid and alkaline phosphatases) and of tartrate (inhibitor of acid phosphatase) gave no indication of inhibition. This suggested that the assay was relatively specific for ATP hydrolysis. The activity was found to have a pH optimum of 8.7 and a Km for ATP of 0.6 mM. There was an absolute requirement for Mg2+, with other divalent cations substituting less efficiently. When the Mg2+-dependent ATPase activity of intact cells was compared with that in homogenized cells, no significant difference was observed. The activity in intact cells was linear with respect to incubation time up to at least l0 min. Trypan blue staining and lactate dehydrogenase assays revealed that greater than 92% of the PMNL remained intact and viable during the assay. No soluble ATPase was released from the cells under assay conditions. In following the distribution of gamma[32P]ATP and 32P2 counts became cell associated. Since the experimental evidence supports the observation that PMNL remain intact and viable and that ATP does not penetrate the cell under assay conditions, it is proposed that greater than 90% of the Mg2+-dependent ATPase of the human PMNL is associated with a plasma membrnae enzyme. This would qualify the enzyme for the role of a plasma membrane marker for future fractionation and isolation attempts.