The epigenetic EZH2/H3K27me3 axis modulates lactotroph tumor cell proliferation

Interest in epigenetics has gained substantial momentum as a result of their identified role in the regulation of tumor progression as well as their ability to pharmacologically target genes. Pituitary neuroendocrine tumors (PitNETs) tend to be inactivated via epigenetic modification, and although emerging evidence has suggested a role for epigenetic factors in PitNET tumorigenesis, the degree to which these factors may be targeted by new therapeutic strategies still remains poorly understood. The objective of the present study was to examine the participation of the EZH2/H3K27me3 axis in the proliferation of lactotroph tumor cells. We demonstrated that the levels of EZH2 and H3K27me3 were increased in murine experimental prolactin (PRL) tumors with respect to a control pituitary, in contrast with the low p21 mRNA levels encountered, with an H3K27me3 enrichment being observed in its promoter region in a GH3 tumor cell. Furthermore, specific EZH2/H3K27me3 axis inhibition blocked the proliferation of primary tumor cell culture and GH3 cells, thereby making it an attractive therapeutic target for PRL PitNETs.

Age and sex differences in the risk of causing vehicle collisions in Spain, 1990 to 1999

This retrospective, paired case-control study was designed to estimate crude and adjusted effects of age and sex on the risk of causing collisions between vehicles with four or more wheels in Spain during the period from 1990 to 1999. We selected all 220284 collisions registered from 1990 to 1999 in the Spanish Dirección General de Tráfico (DGT) traffic crash database in which only one driver committed any infraction. Information was collected about age, sex and several confounding factors for both the responsible and paired-by-collision nonresponsible drivers. Crude and adjusted odds ratios (aORs) were calculated for each age and sex category. For men, the lowest risk was seen for drivers aged 25-49 years. Below the age of 35 years the crude odds ratio (cOR) was highest in the 18-24-year-old group (1.61; CI: 1.57-1.65). The risk increased significantly and exponentially after the age of 50 years, to a maximum odds ratio of 3.71 (3.43-4.00) for drivers aged >74 years. In women, the lowest risk values were found for the 25-44-year-old age group. In older women the risk increased significantly with age to a maximum odds ratio of 3.02 (2.31-3.97) in the oldest age group. aOR estimates tended to be lower than crude estimates for drivers younger than 40 years of age, but the opposite was seen for drivers 40 years old and older. Regarding sex differences, among younger drivers crude and aORs for men were higher than for women. Our results suggest that the risk of causing a collision between vehicles with four or more wheels is directly dependent on the driver's age.

[An assessment of the effect of helmet use among cyclists and the risk of head injury and death in Spain, 1990 to 1999]

BACKGROUND AND OBJECTIVE

This study aimed to assess the protective effect of helmet use by cyclists on risk of suffering head injury or dying as a consequence of a traffic crash.

SUBJECTS AND METHOD

26,832 cyclists involved in traffic crashes with victims registered in the Dirección General de Tráfico database from 1990 to 1999 in Spain were studied. From this database, variables relating to each cyclist (i.e., age, sex, presence of head trauma, severity of lesions) and those related with the crash (i.e., place, date, type of crash), were collected. The odds ratio and the proportion of the population attributable risk for non-use of a helmet by cyclist were estimated.

RESULTS

An adjusted odds ratio of 2.45 (2.19-2.73) for the association between non-use of a helmet and the risk of head injury was obtained. As death of the cyclist as the outcome, the corresponding odds ratio was 1.35 (1.09-1.67). The values of proportion of the population attributable risk were 0.51 (0.47-0.55) and 0.22 (0.07-0.36), for head injury and death, respectively.

CONCLUSIONS

This study confirms that helmet use among cyclists significantly decreased the risk of head injury and, to a lesser extent, death. These results constitute a strong argument for increasing in the frequency of helmet use among cyclists in Spain.

Orthotopic liver transplantation for autoimmune hepatitis and cryptogenic chronic hepatitis in children

BACKGROUND

Autoimmune hepatitis (AIH) and cryptogenic chronic hepatitis (CCH) are important causes of liver failure in children, frequently necessitating orthotopic liver transplantation (OLT). The aim of this study is to review disease progression and potential differences between subgroups of children with AIH and CCH.

METHODS

The medical records of 65 children diagnosed with AIH or CCH between 1980 and 1998 were evaluated.

RESULTS

The median age at presentation was 9 years, 8 months (range 4 months-19 years), and the median follow-up period was 8 years (range 3 months-18 years, 10 months). Forty-one patients (63%) were female. Twenty-eight patients were Hispanic, 28 were Caucasian, 8 were African-American, and 1 was Asian. Forty-three patients (66%) were diagnosed with type 1 AIH, 8 (12%) with type 2 AIH, and 14 (22%) with CCH. Forty patients (62%) underwent OLT (51% of those with type 1 AIH, 75% of those with type 2 AIH, and 86% of those with CCH). Thirteen (33%) of the transplanted patients experienced disease recurrence. African-American patients experienced a significantly higher rate of disease recurrence post-OLT than did Hispanic patients. Seven patients (11%) died, two without OLT, and five posttransplantation.

CONCLUSIONS

AIH and CCH frequently necessitate OLT in children. CCH is a more aggressive disease than Type 1 AIH among children with these disorders. Ethnicity influences the rate of disease recurrence after liver transplantation.

Mice with combined disruption of Gpx1 and Gpx2 genes have colitis

Glutathione peroxidase (GPX)-1 and gastrointestinal (GI) epithelium-specific GPX (GPX-GI), encoded by Gpx1 and Gpx2, provide most GPX activity in GI epithelium. Although homozygous mice deficient in either the Gpx1 or Gpx2 gene appeared to be normal under standard housing conditions, homozygous mice deficient in both genes, double-knockout (KO) mice, had symptoms and pathology consistent with inflammatory bowel disease. These symptoms included a high incidence of perianal ulceration, growth retardation that started around weaning, and hypothermia that resembled that observed in calorie-restricted mice, even though the double-KO mice in our study were allowed to eat ad libitum. The growth retardation and hypothermia were components of cachexia, which is fatal in a high percentage of mice. Histological examination revealed that the double-KO mice had a high incidence of mucosal inflammation in the ileum and colon but not in the jejunum. Elevated levels of myeloperoxidase activity and lipid hydroperoxides were also detected in colon mucosa of these homozygous double-KO mice. These results suggest that GPX is essential for the prevention of the inflammatory response in intestinal mucosa.

Enterocystoplasty and renal transplantation

PURPOSE

We report on our experience with renal transplantation in patients with severe chronic bladder contracture who underwent prior intestinal bladder augmentation, and assess the safety of the procedure.

MATERIALS AND METHODS

A total of 7 patients with severe alterations to the lower urinary tract and renal insufficiency underwent enterocystoplasty before renal transplantation. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in 4 cases, neurogenic bladder secondary to myelomeningocele in 1, chronic cystitis secondary to intravesical instillation of glutaraldehyde in 1 and hyperreflexic, contracted bladder in 1. Mean patient age was 38.4 years (range 19 to 57). The intestinal segment used was ileal conduit in 6 cases and an ileocaecal segment in 1. All 7 patients have received renal transplant from cadaveric donors.

RESULTS

Graft survival rate was 100% and graft function was good after a mean followup of 48 months (range 8 to 97). Of the patients 6 are continent and void spontaneously and 1 requires intermittent self-catheterization.

CONCLUSIONS

In our experience bladder augmentation is an acceptable method, although not exempt from complications, for patients with alterations to the lower urinary tract and who are candidates for renal transplantation.

[Resistance to antibiotics in clinical isolates of the genus Enterococcus]

The purpose of our study was to determine the prevalence of resistance in 114 clinical strains of enterococci. Identification was made using PASCO dehydrated panels and by the conventional method of Facklam and found the following: 92.1% E. faecalis, 7% E. faecium and 0.9% E. avium. The antibiotic susceptibility was determined by the PASCO system, and the minimum inhibitory concentrations of vancomycin, teicoplanin, gentamicin and streptomycin were determined by the agar dilution method. All the strains were susceptible to vancomycin and teicoplanin. We detected resistance to ampicillin in 4.4% of isolates, to penicillin in 6%, to tetracycline in 41.2%, to rifampicin in 12.3%, to chloramphenicol in 23.7%, to erythromycin in 66.7%, to ciprofloxacin in 53.5%, to gentamicin to a high level in 43.9%, and to streptomycin to a high level in 57%. E. faecium was associated with high-level resistance to gentamicin. E. faecium was more resistant than E. faecalis to quinolones, rifampicin, penicillin and ampicillin, and showed similar susceptibility to tetracycline and chloramphenicol. However, E. faecalis was more resistant than E. faecium to aminoglycosides, mainly to gentamicin.

Renal Doppler sonographic and histologic findings in post-transplant primary cytomegalovirus disease

Cytomegalovirus (CMV) infections frequently develop in renal transplant patients. The transplanted kidney may be not only the source of infection but also the target for it. We report a case of primary CMV infection in a seronegative patient who received a graft from a seropositive cadaveric donor. The onset of CMV was clinically apparent on post-transplant day 22. Interestingly, soon after transplantation, the patient developed a long-lasting graft dysfunction episode for which diffuse endothelial-cell swelling was the most relevant finding at biopsy. On sonography, renal graft vascular impedance deteriorated and improved repeatedly during the follow-up period. We postulate that the patient had CMV-induced immunogenic-mediated endothelial-cell injury.

Regulation of the human Na(+)-glucose cotransporter gene, SGLT1, by HNF-1 and Sp1

The Na(+)-glucose cotransporter (SGLT1) is expressed primarily by small intestinal epithelial cells and transports the monosaccharides glucose and galactose across the apical membrane. Here we describe the isolation and characterization of 5.3 kb of the 5'-flanking region of the SGLT1 gene by transiently transfecting reporter constructs into a variety of epithelial cell lines. A fragment (nt -235 to +22) of the promoter showed strong activity in the intestinal cell line Caco-2 but was inactive in a nonintestinal epithelial cell line (Chinese hamster ovary). Within this region, three cis-elements, a hepatocyte nuclear factor-1 (HNF-1) and two GC box sites are critical for maintaining the gene's basal level of expression. The two GC boxes bind to several members of the Sp1 family of transcription factors and, in the presence of HNF-1, synergistically upregulate transactivation of the promoter. A novel 16-bp element just downstream of one GC box was also shown to influence the interaction of Sp1 to its binding site. In summary, we report the identification and characterization of the human SGLT1 minimal promoter and the critical role that HNF-1 and Sp1-multigene members have in enhancing the basal level of its transcription in Caco-2 cells.

Serial pulsatility index measurements in renal grafts before, during, and after episodes of urinary obstruction

The usefulness of pulsatility index determinations for the diagnosis of obstructive collecting system dilatation was investigated in 10 renal transplant patients whose grafts developed urinary obstruction from different causes. For this purpose we compared pulsatility index values obtained (1) before the ultrasonographic detection of obstruction or baseline study, (2) 1 day before surgical repair, and (3) within 2 weeks after surgery. In 7 of 10 obstructed grafts, the pulsatility index values were increased only mildly to moderately preoperatively. In the remaining three grafts, a mild decrease in pulsatility index was observed in spite of severe collecting system dilatation. Changes in pulsatility index were not statistically significant. Impedance measurements appeared not to be useful for diagnosing obstructive collecting system dilatation.

Transcriptional control of the murine polymeric IgA receptor promoter by glucocorticoids

Glucocorticoids have been implicated as an important regulator of intestinal epithelial cell ontogeny. The polymeric IgA receptor (pIgR) is expressed in the intestinal epithelial layer and is regulated by several mediators, including glucocorticoids. The mechanism of how corticosteroids alter the transcriptional regulation of pIgR expression has not been defined. In this study, we demonstrated that glucocorticoids upregulate steady-state pIgR mRNA levels in the proximal intestine of suckling rats and in the IEC-6 intestinal cell line. We performed functional analysis of the 5'-flanking region in the presence of glucocorticoids and its receptor using the intestinal cell line Caco-2. We screened 4.7 kb of the upstream region of the murine gene and identified the most potent steroid response element to reside between nt -215 and -163 relative to the start of transcription. Substitution mutation analysis of this region identified the location of the putative steroid response element to be between nt -195 and -176. In vitro DNase I footprint analysis using the recombinant glucocorticoid receptor DNA binding domain confirmed a single area of protection that spans the nt identified by mutagenesis analysis. Electrophoretic mobility shift assays of the putative element confirmed the binding of both recombinant and cell synthesized glucocorticoid receptor in a specific manner. In summary, we report the identification and characterization of the glucocorticoid-DNA response element located in the immediate 5'-upstream region of the murine pIgR gene.

Missense mutations in SGLT1 cause glucose-galactose malabsorption by trafficking defects

Glucose-galactose malabsorption (GGM) is an autosomal recessive disorder caused by defects in the Na+/glucose cotransporter (SGLT1). Neonates present with severe diarrhea while on any diet containing glucose and/or galactose [1]. This study focuses on a patient of Swiss and Dominican descent. All 15 exons of SGLT1 were screened using single stranded conformational polymorphism analyses, and aberrant PCR products were sequenced. Two missense mutations, Gly318Arg and Ala468Val, were identified. SGLT1 mutants were expressed in Xenopus laevis oocytes for radiotracer uptake, electrophysiological experiments, and Western blotting. Uptakes of [14C]alpha-methyl-d-glucoside by the mutants were 5% or less than that of wild-type. Two-electrode voltage-clamp experiments confirmed the transport defects, as no noticeable sugar-induced current could be elicited from either mutant [2]. Western blots of cell protein showed levels of each SGLT1 mutant protein comparable to that of wild-type, and that both were core-glycosylated. Presteady-state current measurements indicated an absence of SGLT1 in the plasma membrane. We suggest that the compound heterozygote missense mutations G318R and A468V lead to GGM in this patient by defective trafficking of mutant proteins from the endoplasmic reticulum to the plasma membrane.

Factors affecting growth after pediatric liver transplantation

BACKGROUND

Poor linear growth after pediatric orthotopic liver transplantation (OLT) is a well-described phenomenon. We have undertaken a bivariate and multivariate analysis of multiple factors that might effect postOLT growth in all children who underwent transplantation at a single center, with survival > 1 year and adequate follow-up.

METHODS

Standardized height score (Z score) and height deficit (centimeters below the 50th percentile) were computed for each patient over time. The variables assessed were (i) age at OLT, (ii) gender, (iii) pretransplantation diagnosis, (iv) Z score and height deficit at OLT, (v) tacrolimus versus cyclosporine as primary immunosuppressive therapy, (vi) retransplantation, (vii) graft disease, (viii) chronic illness, (ix) posttransplant lymphoproliferative disease, (x) intractable rejection, and (xi) prednisone withdrawal.

RESULTS

A total of 236 children met the inclusion criteria, with a mean follow-up of 3.8+/-1.9 years. For the population as a whole, the baseline Z score was -1.72 (fourth percentile) with a significant improvement to - 1.37 (ninth percentile) at 2 years, but with no additional gain at 5 years (Z score -1.4). The baseline height deficit was -6.4 cm, with no improvement at 2 years (-6.52 cm), and was significantly worse at 5 years (-7.87 cm). In the bivariate analysis, the most important variables affecting growth were age at OLT, Z score at OLT, and diagnosis. In general, children <2 years with biliary atresia and those with the most growth delay at OLT showed the best posttransplantation growth. In the multivariate analysis, 18 factors were considered, of which 9 were significant. These were (i) Z score at baseline, (ii) follow-up time, (iii) age at OLT, (iv) diagnosis of tumor, (v) diagnosis of fulminant hepatic failure, (vi) retransplantation, (vii) graft disease, (viii) posttransplant lymphoproliferative disease, and (ix) stoppage of prednisone. Multivariate models using these nine variables accounted for 84% of the variation in standardized height.

CONCLUSION

In general, children after OLT show some potential for catch-up growth but do not achieve normal height compared with their age and sex-matched peers. A multivariate analysis was necessary to investigate the interdependent effects of the many variables that can affect growth after OLT. The most important detrimental affects were older age at time of OLT, Z scores greater than -2.0 at OLT, fulminant hepatic failure, tumor, and postOLT complications causing graft dysfunction.

Prevention and preemptive therapy of postransplant lymphoproliferative disease in pediatric liver recipients

BACKGROUND

We have previously reported a 10% incidence of posttransplant lymphoproliferative disease (PTLD) in pediatric patients receiving first liver grafts and primarily immunosuppressed with tacrolimus. To decrease the incidence of PTLD, we developed a protocol utilizing preemptive intravenous ganciclovir in high-risk recipients (i.e., donor (D)+, recipient (R)-), combined with serial monitoring of peripheral blood for Epstein Barr virus (EBV) by polymerase chain reaction (PCR).

METHODS

Consecutive pediatric recipients of a first liver graft were immunosuppressed with oral tacrolimus (both induction and maintenance), and low-dose prednisone. EBV serologies were obtained at the time of orthotopic liver transplant in recipients and donors. Recipients were divided into groups: group 1, high-risk (D+R-), and group 2, low-risk (D+R+; D-R-; D-R+). In group 1 (high-risk), all patients received a minimum of 100 days of intravenous ganciclovir (6-10 mg/kg/day), while, in group 2 (low-risk), patients received intravenous ganciclovir during their initial hospitalization and then were converted to oral acyclovir (40 mg/kg/day) at discharge. Semiquantitative EBV-PCR determinations were made at 1-2-month intervals. In both groups, patients with an increasing viral copy number by EBV-PCR had tacrolimus levels decreased to 2-5 ng/ml. Tacrolimus was stopped, and intravenous ganciclovir reinstituted for PTLD. A positive EBV-PCR with symptoms, but negative histology, was defined as EBV disease; PTLD was defined as histologic evidence of polyclonal or monoclonal B cell proliferation.

RESULTS

Forty children who had survived greater than 2 months were enrolled. There were 18 children in group 1 (high-risk; mean age of 14+/-15 months and mean follow-up time of 243+/-149 days) and 22 children in group 2 (low-risk; mean age of 64+/-65 months and follow-up time of 275+/-130 days). In group 1 (high-risk), there was no PTLD and one case of EBV disease (mononucleosis-like syndrome), which resolved. In group 2 (low-risk), there were two cases of PTLD; both resolved when tacrolimus was stopped. Both children were 8 months old at time of transplant. Neither received OKT3, and they had one and two episodes of steroid-sensitive rejection, respectively. One child had EBV disease (mild hepatitis), which resolved.

CONCLUSIONS

Since instituting this protocol, the overall incidence of PTLD has fallen from 10% to 5% for children receiving primary tacrolimus therapy after OLT. No high-risk pediatric liver recipient treated preemptively with intravenous ganciclovir developed PTLD. Both children with PTLD were less than 1 year at OLT and considered low-risk. However, their positive EBV antibody titers may have been maternal in origin and not have offered long-term protection. Serial monitoring of EBV-PCR after pediatric OLT is recommended to decrease the risk of PTLD by allowing early detection of EBV infection, which is then managed by decreasing immunosuppression and continuing intravenous ganciclovir.

Characterization of the 5'-flanking region of the murine polymeric IgA receptor gene

The regulatory elements that control basal and activated transcriptional expression of the polymeric IgA receptor gene (pIgR) have not been defined. In this study, we performed functional analysis of the murine pIgR 5'-upstream region. Transient transfection studies identified the gene's minimal promoter to reside within 110 nucleotides upstream from the start of transcription. Substitution mutations of this region identified both a putative activator (-78 to -70) and a repressor (-66 to -52) element. DNase I footprint analysis confirmed an area of protection that spans from nucleotides -85 to -62. Mobility shift assays of the putative region confirmed binding of upstream stimulatory factor 1 (USF1) to an E box element at positions -75 and -70, representing the putative enhancer. Overexpression studies using various forms of USF suggest that both USF1 and USF2 enhance activity of the pIgR minimal promoter. We report the identification and characterization of the murine pIgR minimal promoter, as well as the critical role of USF in enhancing its basal level of transcription in Caco-2 cells.

Genomic cloning and structural analysis of the murine polymeric receptor (pIgR) gene and promoter region

The role of the polymeric receptor (pIgR) is to transport polymeric IgA across various mucosal epithelial layers. Although several mammalian pIgR cDNAs, including mouse, have been cloned, genomic structure has only been partially analyzed in the human, and neither its 5'-upstream region nor its transcriptional start site is known. We report the isolation and characterization of the murine pIgR gene that spans 32 kb and contains 11 exons. The general organization of the murine gene, including its intron/exon boundaries was similar to its human homolog; however, the second intron was 7.2 kb in the mouse vs. only 0.8 kb in humans. Primer extension and 5'-RACE independently identified the identical transcriptional initiation site. Sequence analysis of 350 base pairs in the 5'-flanking region revealed several motifs, including a TATA box, and putative interferon-gamma, HNF-3beta and AP1 sites. In summary, we have isolated the murine pIgR gene and described its structure and organization.

Ontogenetic development and distribution of antibody transport and Fc receptor mRNA expression in rat intestine

The intestine of the suckling rat has the unique capacity of absorbing immunoglobulins from maternal milk. We investigated intestinal Fc receptor mRNA expression and the absorption of orally administered antibodies to delineate the ontogeny and tissue specificity of this transport system. Duodenal expression of Fc receptor mRNA was at maximum levels between 1 and 19 days of age, but was not detectable during fetal life and in animals after weaning. Along the horizontal axis of the intestine, FcRn mRNA expression was maximum in the proximal duodenum and declined gradually in distal bowel. Similarly, absorption of orally administered antibody was low shortly after birth, but reached maximum levels at 14 days of age. By the time of weaning, antibody uptake had almost completely ceased. These data further delineate the temporal and spatial nature of the intestinal immunoglobulin transport system, and represent additional examples of how the intestinal Fc receptor is transcriptionally regulated.

Compound missense mutations in the sodium/D-glucose cotransporter result in trafficking defects

BACKGROUND & AIMS

Defects in the Na+-dependent glucose transporter (SGLT1) are associated with the disorder glucose-galactose malabsorption, characterized by severe diarrhea. This study focused on a unique proband with glucose-galactose malabsorption who was investigated 30 years ago, and the aims of the study were to identify mutations in the SGLT1 gene and to determine the defect in sugar transport.

METHODS

Mutations were identified by sequencing, and each mutant protein was then studied using a Xenopus oocyte heterologous expression system. Analysis included Western, freeze fracture, radiotracer uptake, and electrophysiological assays.

RESULTS

Two heterozygous missense mutations (Cys355Ser and Leu147Arg) were identified that entirely eliminated Na+/sugar cotransport activity. Western blot analysis showed that the levels of both mutant proteins in the oocyte were comparable to wild-type SGLT1, but no complex glycosylation was detected. No SGLT1 charge movements were observed with the mutant proteins, and freeze fracture data showed that neither mutant protein reached the plasma membrane.

CONCLUSIONS

The Cys355Ser and Leu147Arg mutations eliminate the Na+/sugar cotransport by blocking the transfer of SGLT1 protein from the endoplasmic reticulum to the plasma membrane. This is consistent with earlier studies on phlorizin binding to the brush border membrane of duodenal biopsy specimens from this patient.

Genetic defects at the UGT1 locus associated with Crigler-Najjar type I disease, including a prenatal diagnosis

Characterization of the UGT1 gene complex locus encoding both multiple bilirubin and phenol UDP-glucuronosyltransferases (transferases) has been critical in identifying mutations in the bilirubin isoforms. This study utilizes this information to identify the bases of deficient bilirubin UDP-glucuronosyltransferase activity encoded by the UGT1A gene for the major bilirubin isozyme, HUG-Br1, in 3 Crigler-Najjar type I individuals and the genotype of an at-risk unborn sibling of one patient. A homozygous and heterozygous two-base mutation (CCC to CGT) created the HUG-Br1P387R mutant of the major bilirubin transferase in 2 different Crigler-Najjar type I patients, B.G. and G.D., respectively. Both parents of B.G. and his unborn sibling, J.G., were determined to be carriers of the P387R mutation. G.D. also contains the CAA to TAA nonsense mutation (G1n357st). Y.A. has a homozygous CT deletion in codons 40/41. The HUG-Br1P387R mutant protein was totally inactive at the major pH optimum (6.4), but retained 26% normal activity at the minor pH optimum (7.6), which was 5.4% of the combined activities measured at the two pH values.

Prenatal identification of a heterozygous status in two fetuses at risk for glucose-galactose malabsorption

Glucose-galactose malabsorption (GGM) is an autosomal recessive disorder which presents with severe osmotic diarrhoea shortly after birth. Two proband siblings with GGM were previously demonstrated to contain a missense mutation (D28N) in the Na(+)-dependent glucose/galactose cotransporter (SGLT1) that accounts for the defect in sugar absorption. Prenatal screening for GGM was performed in two subsequent pregnancies in this large consanguineous family. The first exon of the SGLT1 gene was PCR-amplified from genomic DNA and screened for the presence of the D28N mutation by EcoRV restriction digestion. The proband's sibling was heterozygous and a cousin was not a carrier of the D28N mutation. Both children at 2-years of age remain healthy and have had no diarrhoeal symptoms. Molecular biology techniques will allow a prospective determination of the presence of an abnormal SGLT1 allete and potentially decrease the postnatal morbidity.

Defects in Na+/glucose cotransporter (SGLT1) trafficking and function cause glucose-galactose malabsorption

Cotransporters harness ion gradients to drive 'active' transport of substrates into cells, for example, the Na+/glucose cotransporter (SGLT1) couples sugar transport to Na+ gradients across the intestinal brush border. Glucose-Galactose Malabsorption (GGM) is caused by a defect in SGLT1. The phenotype is neonatal onset of diarrhea that results in death unless these sugars are removed from the diet. Previously we showed that two sisters with GGM had a missense mutation in the SGLT1 gene. The gene has now been screened in 30 new patients, and a heterologous expression system has been used to link the mutations to the phenotype.

The molecular basis of inherited disorders of the gastrointestinal and hepatobiliary tracts. An update on recent progress

In this article, genetic disorders of the gastrointestinal and hepatobiliary tracts ranging from common to very rare are reviewed. The first portion of each section highlights the clinical manifestations of the disorder; the second and more detailed portion of each section discusses what is currently known about the biology and genetics of the disorder. The potential use of gene therapy to treat many of these disorders is also reviewed.

Structure of the human Na+/glucose cotransporter gene SGLT1

Intestinal uptake of dietary glucose and galactose is mediated by the SGLT1 Na+/glucose cotransporter of the brush border. An SGLT1 missense mutation underlies hereditary glucose/galactose malabsorption, characterized by potentially fatal diarrhea; conversely, oral rehydration therapy exploits normal transport to alleviate life-threatening diarrhea of infectious origin. We have mapped the entire human SGLT1 Na+/glucose cotransporter gene from cosmid and lambda phage clones representing a genomic region of 112 kilobases. Transcription initiation occurred from a site 27 base pairs 3' of a TATAA sequence. All exon-flanking regions were sequenced, and the entire 112-kilobase region mapped with four restriction enzymes. SGLT1 is comprised of 15 exons (spanning 72 kilobases); a possible evolutionary origin from a six-membrane-span ancestral precursor via a gene duplication event is suggested from comparison of exons against protein secondary structure and from sequence considerations. A new missense mutation in exon 1 causing glucose/galactose malabsorption is also described. This is the first Na(+)-dependent cotransporter gene structure reported. These data facilitate the search for new glucose/galactose malabsorption-related mutations in this important gene and provide a basis for future evolutionary comparisons with other Na(+)-dependent cotransporters.

Parenterally or enterally administered anti-somatostatin antibody induces increased gastrin in suckling rats

This study demonstrates the effectiveness of parenteral and oral anti-somatostatin monoclonal antibody to stimulate gastrin cell activity in suckling rats. Intraperitoneal anti-somatostatin monoclonal antibody increased serum gastrin concentration (> 2-fold), and orally administered antibodies retained their neutralizing capabilities as demonstrated by a 30% induction of gastrin synthesis. Absorption of luminal monoclonal antibody was time dependent and saturable as demonstrated by measurement of serum murine immunoglobulin G and the subsequent effects on serum gastrin and antral gastrin mRNA concentrations. Enhanced gastrin synthesis after oral administration required whole antibody in that enterally delivered F(ab')2 fragments were not absorbed and did not increase serum gastrin concentrations. In addition, pretreatment with excess Fc fragments decreased monoclonal antibody absorption and eliminated the serum gastrin response to oral monoclonal antibody. These results demonstrate that orally administered murine anti-somatostatin monoclonal antibody was rapidly and efficiently absorbed via an Fc-dependent mechanism and retained immunoneutralizing activity against endogenous somatostatin, neutralizing its inhibition of gastrin cell activity. These results indicate that orally administered monoclonal antibodies could potentially be used to determine the role of other peptides and growth factors as potential physiological regulators during the suckling period of postnatal development.

Hormonal control of intestinal Fc receptor gene expression and immunoglobulin transport in suckling rats

Hormonal control of immunoglobulin (Ig) absorption and of intestinal Fc receptor mRNA expression were investigated in rats to assess its potential role in the normal postsuckling inhibition of this transport system. Corticosterone and L-thyroxine therapy caused premature inhibition of the absorption of orally administered murine monoclonal antibody and of Fc receptor mRNA expression in a dose- and time-dependent manner. Low-dose corticosterone had no effect on Fc receptor mRNA synthesis after 3 d but decreased Ig transport fivefold after 7 d. High dose corticosterone resulted in a threefold reduction in Fc receptor after 3 d, and there was almost complete inhibition (> 30-fold) of transport and of Fc receptor transcript levels after 7 d. Similarly, 7 d of high-dose thyroxine decreased both serum Ig transport and Fc receptor (> 30-fold). However, adrenalectomy did not prevent the normal post-suckling declines in Ig transport or receptor synthesis. This study demonstrates that exogenous corticosteroids and thyroxine hormone inhibit Ig transport and steady-state duodenal Fc receptor mRNA levels in suckling rats. Endogenous adrenal steroids however, do not appear to be entirely responsible for the age-dependent decline in this transport system.