Role of Oxidative Stress in Ocular Diseases: A Balancing Act

Redox homeostasis is a delicate balancing act of maintaining appropriate levels of antioxidant defense mechanisms and reactive oxidizing oxygen and nitrogen species. Any disruption of this balance leads to oxidative stress, which is a key pathogenic factor in several ocular diseases. In this review, we present the current evidence for oxidative stress and mitochondrial dysfunction in conditions affecting both the anterior segment (e.g., dry eye disease, keratoconus, cataract) and posterior segment (age-related macular degeneration, proliferative vitreoretinopathy, diabetic retinopathy, glaucoma) of the human eye. We posit that further development of therapeutic interventions to promote pro-regenerative responses and maintenance of the redox balance may delay or prevent the progression of these major ocular pathologies. Continued efforts in this field will not only yield a better understanding of the molecular mechanisms underlying the pathogenesis of ocular diseases but also enable the identification of novel druggable redox targets and antioxidant therapies.

Activation of Disulfide Redox Switch in REDD1 Promotes Oxidative Stress Under Hyperglycemic Conditions

The stress response protein regulated in development and DNA damage response 1 (REDD1) has been implicated in visual deficits in patients with diabetes. The aim here was to investigate the mechanism responsible for the increase in retinal REDD1 protein content that is observed with diabetes. We found that REDD1 protein expression was increased in the retina of streptozotocin-induced diabetic mice in the absence of a change in REDD1 mRNA abundance or ribosome association. Oral antioxidant supplementation reduced retinal oxidative stress and suppressed REDD1 protein expression in the retina of diabetic mice. In human retinal Müller cell cultures, hyperglycemic conditions increased oxidative stress, enhanced REDD1 expression, and inhibited REDD1 degradation independently of the proteasome. Hyperglycemic conditions promoted a redox-sensitive cross-strand disulfide bond in REDD1 at C150/C157 that was required for reduced REDD1 degradation. Discrete molecular dynamics simulations of REDD1 structure revealed allosteric regulation of a degron upon formation of the disulfide bond that disrupted lysosomal proteolysis of REDD1. REDD1 acetylation at K129 was required for REDD1 recognition by the cytosolic chaperone HSC70 and degradation by chaperone-mediated autophagy. Disruption of REDD1 allostery upon C150/C157 disulfide bond formation prevented the suppressive effect of hyperglycemic conditions on REDD1 degradation and reduced oxidative stress in cells exposed to hyperglycemic conditions. The results reveal redox regulation of REDD1 and demonstrate the role of a REDD1 disulfide switch in development of oxidative stress.

REDD1 Ablation Attenuates the Development of Renal Complications in Diabetic Mice

Chronic hyperglycemia contributes to development of diabetic kidney disease by promoting glomerular injury. In this study, we evaluated the hypothesis that hyperglycemic conditions promote expression of the stress response protein regulated in development and DNA damage response 1 (REDD1) in the kidney in a manner that contributes to the development of oxidative stress and renal injury. After 16 weeks of streptozotocin-induced diabetes, albuminuria and renal hypertrophy were observed in wild-type (WT) mice coincident with increased renal REDD1 expression. In contrast, diabetic REDD1 knockout (KO) mice did not exhibit impaired renal physiology. Histopathologic examination revealed that glomerular damage including mesangial expansion, matrix deposition, and podocytopenia in the kidneys of diabetic WT mice was reduced or absent in diabetic REDD1 KO mice. In cultured human podocytes, exposure to hyperglycemic conditions enhanced REDD1 expression, increased reactive oxygen species (ROS) levels, and promoted cell death. In both the kidney of diabetic mice and in podocyte cultures exposed to hyperglycemic conditions, REDD1 deletion reduced ROS and prevented podocyte loss. Benefits of REDD1 deletion were recapitulated by pharmacological GSK3β suppression, supporting a role for REDD1-dependent GSK3β activation in diabetes-induced oxidative stress and renal defects. The results support a role for REDD1 in diabetes-induced renal complications.

Stress response protein REDD1 promotes diabetes-induced retinal inflammation by sustaining canonical NF-κB signaling

Inflammation contributes to the progression of retinal pathology caused by diabetes. Here, we investigated a role for the stress response protein regulated in development and DNA damage response 1 (REDD1) in the development of retinal inflammation. Increased REDD1 expression was observed in the retina of mice after 16-weeks of streptozotocin (STZ)-induced diabetes, and REDD1 was essential for diabetes-induced pro-inflammatory cytokine expression. In human retinal MIO-M1 Müller cell cultures, REDD1 deletion prevented increased pro-inflammatory cytokine expression in response to hyperglycemic conditions. REDD1 deletion promoted nuclear factor erythroid-2-related factor 2 (Nrf2) hyperactivation; however, Nrf2 was not required for reduced inflammatory cytokine expression in REDD1-deficient cells. Rather, REDD1 enhanced inflammatory cytokine expression by promoting activation of nuclear transcription factor κB (NF-κB). In WT cells exposed to tumor necrosis factor α (TNFα), inflammatory cytokine expression was increased in coordination with activating transcription factor 4 (ATF4)-dependent REDD1 expression and sustained activation of NF-κB. In both Müller cell cultures exposed to TNFα and in the retina of STZ-diabetic mice, REDD1 deletion promoted inhibitor of κB (IκB) expression and reduced NF-κB DNA-binding activity. We found that REDD1 acted upstream of IκB by enhancing both K63-ubiquitination and auto-phosphorylation of IκB kinase complex. In contrast with STZ-diabetic REDD1^+/+ mice, IκB kinase complex autophosphorylation and macrophage infiltration were not observed in the retina of STZ-diabetic REDD1^-/- mice. The findings provide new insight into how diabetes promotes retinal inflammation and support a model wherein REDD1 sustains activation of canonical NF-κB signaling.

Müller Glial Expression of REDD1 Is Required for Retinal Neurodegeneration and Visual Dysfunction in Diabetic Mice

Clinical studies support a role for the protein regulated in development and DNA damage response 1 (REDD1) in ischemic retinal complications. To better understand how REDD1 contributes to retinal pathology, we examined human single-cell sequencing data sets and found specificity of REDD1 expression that was consistent with markers of retinal Müller glia. Thus, we investigated the hypothesis that REDD1 expression specifically in Müller glia contributes to diabetes-induced retinal pathology. The retina of Müller glia-specific REDD1 knockout (REDD1-mgKO) mice exhibited dramatic attenuation of REDD1 transcript and protein expression. In the retina of streptozotocin-induced diabetic control mice, REDD1 protein expression was enhanced coincident with an increase in oxidative stress. In the retina of diabetic REDD1-mgKO mice, there was no increase in REDD1 protein expression, and oxidative stress was reduced compared with diabetic control mice. In both Müller glia within the retina of diabetic mice and human Müller cell cultures exposed to hyperglycemic conditions, REDD1 was necessary for increased expression of the gliosis marker glial fibrillary acidic protein. The effect of REDD1 deletion in preventing gliosis was associated with suppression of oxidative stress and required the antioxidant transcription factor nuclear factor erythroid-2-related factor 2 (Nrf2). In contrast to diabetic control mice, diabetic REDD1-mgKO mice did not exhibit retinal thinning, increased markers of neurodegeneration within the retinal ganglion cell layer, or deficits in visual function. Overall, the findings support a key role for Müller glial REDD1 in the failed adaptive response of the retina to diabetes that includes gliosis, neurodegeneration, and impaired vision.

The stress response protein REDD1 as a causal factor for oxidative stress in diabetic retinopathy

Diabetic Retinopathy (DR) is a major cause of visual dysfunction, yet much remains unknown regarding the specific molecular events that contribute to diabetes-induced retinal pathophysiology. Herein, we review the impact of oxidative stress on DR, and explore evidence that supports a key role for the stress response protein regulated in development and DNA damage (REDD1) in the development of diabetes-induced oxidative stress and functional defects in vision. It is well established that REDD1 mediates the cellular response to a number of diverse stressors through repression of the central metabolic regulator known as mechanistic target of rapamycin complex 1 (mTORC1). A growing body of evidence also supports that REDD1 acts independent of mTORC1 to promote oxidative stress by both enhancing the production of reactive oxygen species and suppressing the antioxidant response. Collectively, there is strong preclinical data to support a key role for REDD1 in the development and progression of retinal complications caused by diabetes. Furthermore, early proof-of-concept clinical trials have found a degree of success in combating ischemic retinal disease through intravitreal delivery of an siRNA targeting the REDD1 mRNA. Overall, REDD1-associated signaling represents an intriguing target for novel clinical therapies that go beyond addressing the symptoms of diabetes by targeting the underlying molecular mechanisms that contribute to DR.

Diabetes enhances translation of Cd40 mRNA in murine retinal Müller glia via a 4E-BP1/2-dependent mechanism

Activation of the immune costimulatory molecule cluster of differentiation 40 (CD40) in Müller glia has been implicated in the initiation of diabetes-induced retinal inflammation. Results from previous studies support that CD40 protein expression is elevated in Müller glia of diabetic mice; however, the mechanisms responsible for this increase have not been explored. Here, we evaluated the hypothesis that diabetes augments translation of the Cd40 mRNA. Mice receiving thiamet G (TMG), an inhibitor of the O-GlcNAc hydrolase O-GlcNAcase, exhibited enhanced retinal protein O-GlcNAcylation and increased Cd40 mRNA translation. TMG administration also promoted Cd40 mRNA association with Müller cell-specific ribosomes isolated from the retina of RiboTag mice. Similar effects on O-GlcNAcylation and Cd40 mRNA translation were also observed in the retina of a mouse model of type 1 diabetes. In cultured cells, TMG promoted sequestration of the cap-binding protein eIF4E (eukaryotic translation in initiation factor 4E) by 4E-BP1 (eIF4E-binding protein 1) and enhanced cap-independent Cd40 mRNA translation as assessed by a bicistronic reporter that contained the 5'-UTR of the Cd40 mRNA. Ablation of 4E-BP1/2 prevented the increase in Cd40 mRNA translation in TMG-exposed cells, and expression of a 4E-BP1 variant that constitutively sequesters eIF4E promoted reporter activity. Extending on the cell culture results, we found that in contrast to WT mice, diabetic 4E-BP1/2-deficient mice did not exhibit enhanced retinal Cd40 mRNA translation and failed to up-regulate expression of the inflammatory marker nitric-oxide synthase 2. These findings support a model wherein diabetes-induced O-GlcNAcylation of 4E-BP1 promotes Cd40 mRNA translation in Müller glia.

The stress response protein REDD1 promotes diabetes-induced oxidative stress in the retina by Keap1-independent Nrf2 degradation

The transcription factor nuclear factor erythroid-2-related factor 2 (Nrf2) plays a critical role in reducing oxidative stress by promoting the expression of antioxidant genes. Both individuals with diabetes and preclinical diabetes models exhibit evidence of a defect in retinal Nrf2 activation. We recently demonstrated that increased expression of the stress response protein regulated in development and DNA damage 1 (REDD1) is necessary for the development of oxidative stress in the retina of streptozotocin-induced diabetic mice. In the present study, we tested the hypothesis that REDD1 suppresses the retinal antioxidant response to diabetes by repressing Nrf2 function. We found that REDD1 ablation enhances Nrf2 DNA-binding activity in the retina and that the suppressive effect of diabetes on Nrf2 activity is absent in the retina of REDD1-deficient mice compared with WT. In human MIO-M1 Müller cell cultures, REDD1 deletion prevented oxidative stress in response to hyperglycemic conditions, and this protective effect required Nrf2. REDD1 suppressed Nrf2 stability by promoting its proteasomal degradation independently of Nrf2's interaction with Kelch-like ECH-associated protein 1 (Keap1), but REDD1-mediated Nrf2 degradation required glycogen synthase kinase 3 (GSK3) activity and Ser-351/Ser-356 of Nrf2. Diabetes diminished inhibitory phosphorylation of glycogen synthase kinase 3β (GSK3β) at Ser-9 in the retina of WT mice but not in REDD1-deficient mice. Pharmacological inhibition of GSK3 enhanced Nrf2 activity and prevented oxidative stress in the retina of diabetic mice. The findings support a model wherein hyperglycemia-induced REDD1 blunts the Nrf2 antioxidant response to diabetes by activating GSK3, which, in turn, phosphorylates Nrf2 to promote its degradation.

REDD1 Activates a ROS-Generating Feedback Loop in the Retina of Diabetic Mice

Purpose

The present study was designed to evaluate the role of the stress response protein REDD1 in diabetes-induced oxidative stress and retinal pathology.

Methods

Wild-type and REDD1-deficient mice were administered streptozotocin to induce diabetes. Some mice received the antioxidant N-acetyl-l-cysteine (NAC). Visual function was assessed by virtual optometry. Retinas were analyzed by Western blotting. Reactive oxygen species (ROS) were assessed by 2,7-dichlorofluoroscein. Similar analyses were performed on R28 retinal cells in culture exposed to hyperglycemic conditions, NAC, and/or the exogenous ROS source hydrogen peroxide.

Results

In the retina of diabetic mice, REDD1 expression and ROS were increased. In cells in culture, hyperglycemic conditions enhanced REDD1 expression, ROS levels, and the mitochondrial membrane potential. However, similar effects were not observed in the retina of diabetic mice or cells lacking REDD1. In the retina of diabetic mice and cells exposed to hyperglycemic conditions, NAC normalized ROS and prevented an increase in REDD1 expression. Diabetic mice receiving NAC also exhibited improved contrast sensitivity as compared to diabetic controls. Hydrogen peroxide addition to culture medium increased REDD1 expression and attenuated Akt/GSK3 phosphorylation in a REDD1-dependent manner. In REDD1-deficient cells exposed to hyperglycemic conditions, expression of a dominant negative Akt or constitutively active GSK3 increased the mitochondrial membrane potential and promoted ROS.

Conclusions

The findings provide new insight into the mechanism whereby diabetes-induced hyperglycemia causes oxidative stress and visual dysfunction. Specifically, hyperglycemia-induced REDD1 activates a ROS-generating feedback loop that includes Akt/GSK3. Thus, therapeutic approaches targeting REDD1 expression and ROS may be beneficial for preventing diabetes-induced visual dysfunction.

O-GlcNAcylation alters the selection of mRNAs for translation and promotes 4E-BP1-dependent mitochondrial dysfunction in the retina

Diabetes promotes the posttranslational modification of proteins by O-linked addition of GlcNAc (O-GlcNAcylation) to Ser/Thr residues of proteins and thereby contributes to diabetic complications. In the retina of diabetic mice, the repressor of mRNA translation, eIF4E-binding protein 1 (4E-BP1), is O-GlcNAcylated, and sequestration of the cap-binding protein eukaryotic translation initiation factor (eIF4E) is enhanced. O-GlcNAcylation has also been detected on several eukaryotic translation initiation factors and ribosomal proteins. However, the functional consequence of this modification is unknown. Here, using ribosome profiling, we evaluated the effect of enhanced O-GlcNAcylation on retinal gene expression. Mice receiving thiamet G (TMG), an inhibitor of the O-GlcNAc hydrolase O-GlcNAcase, exhibited enhanced retinal protein O-GlcNAcylation. The principal effect of TMG on retinal gene expression was observed in ribosome-associated mRNAs (i.e. mRNAs undergoing translation), as less than 1% of mRNAs exhibited changes in abundance. Remarkably, ∼19% of the transcriptome exhibited TMG-induced changes in ribosome occupancy, with 1912 mRNAs having reduced and 1683 mRNAs having increased translational rates. In the retina, the effect of O-GlcNAcase inhibition on translation of specific mitochondrial proteins, including superoxide dismutase 2 (SOD2), depended on 4E-BP1/2. O-GlcNAcylation enhanced cellular respiration and promoted mitochondrial superoxide levels in WT cells, and 4E-BP1/2 deletion prevented O-GlcNAcylation-induced mitochondrial superoxide in cells in culture and in the retina. The retina of diabetic WT mice exhibited increased reactive oxygen species levels, an effect not observed in diabetic 4E-BP1/2-deficient mice. These findings provide evidence for a mechanism whereby diabetes-induced O-GlcNAcylation promotes oxidative stress in the retina by altering the selection of mRNAs for translation.

Deletion of the stress-response protein REDD1 promotes ceramide-induced retinal cell death and JNK activation

The role of dyslipidemia in the development of retinal dysfunction remains poorly understood. Using an animal model of diet-induced obesity/pre-type 2 diabetes, we investigated molecular defects in the retina arising from consumption of a diet high in saturated fats and sugars ( i.e., a Western diet). We found that feeding mice a Western diet increased the abundance of retinal sphingolipids, attenuated protein kinase B (Akt) phosphorylation, enhanced JNK activation, and increased retinal cell death. When we used palmitate or C6-ceramide (Cer) to assess sphingolipid-mediated signaling in cultured murine and human cells, we observed similar effects on Akt, JNK, and cell death. Furthermore, both Western diet and C6-Cer exposure enhanced expression of the stress-response protein regulated in development and DNA damage response 1 (REDD1) and loss of REDD1 increased C6-Cer-induced JNK activation and cell death. Exogenous REDD1 expression repressed JNK-mediated phosphorylation in cultured cells. We found that thioredoxin-interacting protein (TXNIP) expression was elevated in REDD1-deficient cell lines and C6-Cer promoted TXNIP expression in both wild-type and REDD1-deficient cells. Likewise, TXNIP knockdown attenuated JNK activation and caspase 3 cleavage after either C6-Cer exposure or REDD1 deletion. The results support a model wherein Cer-induced REDD1 expression attenuates TXNIP-dependent JNK activation and retinal cell death.-Dai, W., Miller, W. P., Toro, A. L., Black, A. J., Dierschke, S. K., Feehan, R. P., Kimball, S. R., Dennis, M. D. Deletion of the stress-response protein REDD1 promotes ceramide-induced retinal cell death and JNK activation.

Deletion of the Akt/mTORC1 Repressor REDD1 Prevents Visual Dysfunction in a Rodent Model of Type 1 Diabetes

Diabetes-induced visual dysfunction is associated with significant neuroretinal cell death. The current study was designed to investigate the role of the Protein Regulated in Development and DNA Damage Response 1 (REDD1) in diabetes-induced retinal cell death and visual dysfunction. We recently demonstrated that REDD1 protein expression was elevated in response to hyperglycemia in the retina of diabetic rodents. REDD1 is an important regulator of Akt and mammalian target of rapamycin and as such plays a key role in neuronal function and survival. In R28 retinal cells in culture, hyperglycemic conditions enhanced REDD1 protein expression concomitant with caspase activation and cell death. By contrast, in REDD1-deficient R28 cells, neither hyperglycemic conditions nor the absence of insulin in culture medium were sufficient to promote cell death. In the retinas of streptozotocin-induced diabetic mice, retinal apoptosis was dramatically elevated compared with nondiabetic controls, whereas no difference was observed in diabetic and nondiabetic REDD1-deficient mice. Electroretinogram abnormalities observed in b-wave and oscillatory potentials of diabetic wild-type mice were also absent in REDD1-deficient mice. Moreover, diabetic wild-type mice exhibited functional deficiencies in visual acuity and contrast sensitivity, whereas diabetic REDD1-deficient mice had no visual dysfunction. The results support a role for REDD1 in diabetes-induced retinal neurodegeneration.

Activation of the Stress Response Kinase JNK (c-Jun N-terminal Kinase) Attenuates Insulin Action in Retina through a p70S6K1-dependent Mechanism

Despite recent advances in therapeutics, diabetic retinopathy remains a leading cause of vision impairment. Improvement in the treatment of diabetic retinopathy requires a better understanding of the molecular mechanisms that cause neurovascular complications, particularly in type 2 diabetes. Recent studies demonstrate that rodents fed a high fat diet exhibit retinal dysfunction concomitant with attenuated Akt phosphorylation. The purpose of the present study was to evaluate the impact of a high fat/high sucrose diet on retinal insulin signaling and evaluate the mechanism(s) responsible for the changes. Mice fed a high fat/sucrose diet exhibited attenuated Akt phosphorylation in the retina as compared with mice fed normal chow. Retinas of mice fed a high fat/sucrose diet also exhibited elevated levels of activated JNK as well as enhanced p70S6K1 autoinhibitory domain phosphorylation. In cells, JNK activation enhanced p70S6K1 phosphorylation and mTORC1-dependent activation of the kinase, as evidenced by enhanced phosphorylation of key substrates. Rictor phosphorylation by p70S6K1 was specifically enhanced by the addition of phosphomimetic mutations in the autoinhibitory domain and was more sensitive to inhibition of the kinase as compared with rpS6. Notably, rictor and IRS-1 phosphorylation by p70S6K1 attenuate insulin action through a negative feedback pathway. Indeed, p70S6K1 inhibition prevented the repressive effect of JNK activation on insulin action in retinas. Overall, the results identify the JNK/S6K1 axis as a key molecular mechanism whereby a high fat/sucrose diet impairs insulin action in retina.

The Translational Repressor 4E-BP1 Contributes to Diabetes-Induced Visual Dysfunction

Purpose

The translational repressor 4E-BP1 interacts with the mRNA cap-binding protein eIF4E and thereby promotes cap-independent translation of mRNAs encoding proteins that contribute to diabetic retinopathy. Interaction of 4E-BP1 with eIF4E is enhanced in the retina of diabetic rodents, at least in part, as a result of elevated 4E-BP1 protein expression. In the present study, we examined the role of 4E-BP1 in diabetes-induced visual dysfunction, as well as the mechanism whereby hyperglycemia promotes 4E-BP1 expression.

Methods

Nondiabetic and diabetic wild-type and 4E-BP1/2 knockout mice were evaluated for visual function using a virtual optomotor test (Optomotry). Retinas were harvested from nondiabetic and type 1 diabetic mice and analyzed for protein abundance and posttranslational modifications. Similar analyses were performed on cells in culture exposed to hyperglycemic conditions or an O-GlcNAcase inhibitor (Thiamet G [TMG]).

Results

Diabetes-induced visual dysfunction was delayed in mice deficient of 4E-BP1/2 as compared to controls. 4E-BP1 protein expression was enhanced by hyperglycemia in the retina of diabetic rodents and by hyperglycemic conditions in retinal cells in culture. A similar elevation in 4E-BP1 expression was observed with TMG. The rate of 4E-BP1 degradation was significantly prolonged by either hyperglycemic conditions or TMG. A PEST motif in the C-terminus of 4E-BP1 regulated polyubiquitination, turnover, and binding of an E3 ubiquitin ligase complex containing CUL3.

Conclusions

The findings support a model whereby elevated 4E-BP1 expression observed in the retina of diabetic rodents is the result of O-GlcNAcylation of 4E-BP1 within its PEST motif.

Ovarian function after hematopoietic cell transplantation: a descriptive study following the use of GnRH agonists for myeloablative conditioning and observation only for reduced-intensity conditioning

Gonadal failure is a health and quality-of-life concern in hematopoietic cell transplant (HCT) survivors. While ovarian dysfunction is nearly universal following myeloablative (MA) conditioning, the risk is unclear after reduced-intensity conditioning (RIC). Gonadotropin-releasing hormone agonists decrease ovarian failure rates following conventional chemotherapy, but little is known about its effectiveness with HCT. We investigated the impact of leuprolide on ovarian function after MA conditioning and monitored ovarian function after RIC in this descriptive pilot study. Post-menarchal females <50 years undergoing HCT with adequate baseline ovarian function (follicle-stimulating hormone (FSH) level <40 mIU/mL and normal menstruation) were eligible. Prior to MA conditioning, leuprolide was administered. Those undergoing RIC were observed. FSH was measured at various time points. Seventeen women aged 12-45 years were evaluated (7 in the intervention group and 10 in the observation group). Compared to the historical high rate of ovarian failure after MA conditioning, 3 of 7 evaluable Lupron recipients had ovarian failure at a median of 703 days post transplant. Ovarian failure occurred in 1 of 10 recipients of RIC at a median follow-up of 901 days. In conclusion, leuprolide may protect ovarian function after MA conditioning. Additionally, RIC with cyclophosphamide, fludarabine and low-dose TBI has a low risk of ovarian failure.

Glucosamine induces REDD1 to suppress insulin action in retinal Müller cells

Resistance to insulin action is a key cause of diabetic complications, yet much remains unknown about the molecular mechanisms that contribute to the defect. Glucose-induced insulin resistance in peripheral tissues such as the retina is mediated in part by the hexosamine biosynthetic pathway (HBP). Glucosamine (GAM), a leading dietary supplement marketed to relieve the discomfort of osteoarthritis, is metabolized by the HBP, and in doing so bypasses the rate-limiting enzyme of the pathway. Thus, exogenous GAM consumption potentially exacerbates the resistance to insulin action observed with diabetes-induced hyperglycemia. In the present study, we evaluated the effect of GAM on insulin action in retinal Müller cells in culture. Addition of GAM to Müller cell culture repressed insulin-induced activation of the Akt/mTORC1 signaling pathway. However, the effect was not recapitulated by chemical inhibition to promote protein O-GlcNAcylation, nor was blockade of O-GlcNAcylation sufficient to prevent the effects of GAM. Instead, GAM induced ER stress and subsequent expression of the protein Regulated in DNA Damage and Development (REDD1), which was necessary for GAM to repress insulin-stimulated phosphorylation of Akt on Thr308. Overall, the findings support a model whereby GAM promotes ER stress in retinal Müller cells, resulting in elevated REDD1 expression and thus resistance to insulin action.

Intensity of MRI Gadolinium Enhancement in Cerebral Adrenoleukodystrophy: A Biomarker for Inflammation and Predictor of Outcome following Transplantation in Higher Risk Patients

BACKGROUND AND PURPOSE

Outcomes following hematopoietic stem cell transplantation for higher risk childhood-onset cerebral adrenoleukodystrophy are variable. We explored whether a brain MR imaging gadolinium intensity scoring system improves prediction of neurologic outcome.

MATERIALS AND METHODS

We developed a 4-point scale of gadolinium intensity relative to the choroid plexus: 0 = no enhancement; 1 = hypointense; 2 = isointense; 3 = hyperintense. The interobserver concordance of the scale was assessed on 30 randomly chosen studies. Scores were generated for 64 evaluable patients and compared with CSF chitotriosidase levels, a known inflammatory marker correlating with outcomes following transplantation. For 25 evaluable higher risk patients (Loes ≥10), the gadolinium intensity score was compared with longer term posttransplantation clinical change.

RESULTS

The gadolinium intensity scoring system showed good interobserver reproducibility (κ = 0.72). Of 64 evaluable boys, the score positively correlated with average concomitant CSF chitotriosidase activity in nanograms/milliliter/hour: 0: 2717, n = 5; 1: 3218, n = 13; 2: 6497, n = 23; and 3: 12,030, n = 23 (P < .01). For 25 evaluable higher risk patients, more intense pretransplantation brain MR imaging gadolinium enhancement predicted greater average loss on the adrenoleukodystrophy neurologic function scale following transplantation: 0/1: adrenoleukodystrophy neurologic function scale score difference = 4.3, n = 7; 2/3: adrenoleukodystrophy neurologic function scale score difference = 10.4, n = 18 (P = .05).

CONCLUSIONS

Gadolinium enhancement intensity on brain MR imaging can be scored simply and reproducibly for cerebral adrenoleukodystrophy. The enhancement score significantly correlates with chitotriosidase. In boys with higher risk cerebral disease (Loes ≥10), the enhancement score itself predicts neurologic outcome following treatment. Such data may help guide treatment decisions for clinicians and families.

Childhood cerebral X-linked adrenoleukodystrophy: diffusion tensor imaging measurements for prediction of clinical outcome after hematopoietic stem cell transplantation

BACKGROUND AND PURPOSE

DTI in cerebral X-linked adrenoleukodystrophy may demonstrate abnormalities in both affected and nonaffected WM; these values have not been studied serially after hematopoietic stem cell transplantation. The purpose of this study was to study pretransplant and posttransplant DTI parameters serially and ultimately to determine the ability of pretransplant DTI parameters to predict clinical outcome after HSCT in children with ALD.

MATERIALS AND METHODS

Eight patients with posterior-pattern cerebral ALD underwent DTI at 3T before HSCT (T0), at 30-60 days (T1), 90-120 days (T2), 180 days (T3), and 1 year (T4) after HSCT. FA and MD were serially measured in 19 regions, and these measurements were compared with those in control patients. MR imaging severity (Loes) scores were recorded. Correlations were performed between DTI parameters and Loes scores, neurologic function scores, and several neuropsychologic scores.

RESULTS

Both FA and MD in subjects differed significantly from that in controls at nearly every time point within cerebellar WM, callosal splenium, and parieto-occipital WM; FA alone was significantly different at each time point within the optic radiations, lateral geniculate, and the Meyer loop (P < .05). Loes scores at T0 correlated strongly with each clinical score at T4 (r = 0.771-0.986, P < .05). The only significant DTI correlation at T0 with a clinical score at T4 was callosal body FA with adaptive function (r = 0.976, P < .001). Correlating the change in DTI values with change in NFS (change between T0 and T4) showed that only ΔMD within the optic radiations correlated strongly with ΔNFS (r = 0.903, P < .05).

CONCLUSIONS

DTI values at T0 were generally poor predictors of outcome at 1 year, whereas Loes scores were generally good predictors. ΔMD within the optic radiations strongly correlates with ΔNFS over that year. In addition, certain normal-appearing regions, such as cerebellar WM, may have DTI abnormalities before HSCT that persist after HSCT.

Release of nitrogen and phosphorus from poultry litter amended with acidified biochar

Application of poultry litter (PL) to soil may lead to nitrogen (N) losses through ammonia (NH(3)) volatilization and to potential contamination of surface runoff with PL-derived phosphorus (P). Amending litter with acidified biochar may minimize these problems by decreasing litter pH and by retaining litter-derived P, respectively. This study evaluated the effect of acidified biochars from pine chips (PC) and peanut hulls (PH) on NH(3) losses and inorganic N and P released from surface-applied or incorporated PL. Poultry litter with or without acidified biochars was surface-applied or incorporated into the soil and incubated for 21 d. Volatilized NH(3) was determined by trapping it in acid. Inorganic N and P were determined by leaching the soil with 0.01 M of CaCl(2) during the study and by extracting it with 1 M KCl after incubation. Acidified biochars reduced NH(3) losses by 58 to 63% with surface-applied PL, and by 56 to 60% with incorporated PL. Except for PH biochar, which caused a small increase in leached NH(4) (+)-N with incorporated PL, acidified biochars had no effect on leached or KCl-extractable inorganic N and P from surface-applied or incorporated PL. These results suggest that acidified biochars may decrease NH(3) losses from PL but may not reduce the potential for P loss in surface runoff from soils receiving PL.

Oxytetracycline Dynamics on Peach Leaves in Relation to Temperature, Sunlight, and Simulated Rain

Oxytetracycline (OTC), a member of the tetracycline antibiotics, is used as a foliar spray to control Xanthomonas arboricola pv. pruni on stone fruits and Erwinia amylovora on pome fruits. We studied the dynamics of OTC residues on attached peach (Prunus persica) leaves treated with 300 ppm active ingredient of an agricultural OTC in relation to temperature, natural sunlight, and simulated rain. We further evaluated the potential of three ultraviolet (UV) protectants (lignin, titanium dioxide, and oxybenzone) and one sticker-extender (Nu Film-17) to prolong OTC longevity on the leaf surface. OTC residue was determined by high-pressure liquid chromatography (HPLC)-UV (C18 reversed-phase column). In controlled conditions in darkness, constant temperatures up to 40°C did not affect OTC degradation on leaves. In contrast, OTC residue decreased rapidly in natural sunlight in the absence of rain, declining, on average, by 43.8, 77.8, and 92.1% within 1, 2, and 4 days after application, respectively; 7 days after application, OTC levels were near the detection limit. Use of shade fabric with 10 and 40% sunlight transmittance, simulating overcast sky, reduced OTC degradation significantly but did not extend OTC persistence beyond 7 days. Areas under the OTC residue curve, summarizing OTC dynamics during the 7-day exposure period, were negatively and significantly correlated with solar radiation and UV radiation variables, but not with temperature. UV protectants and Nu Film-17 were ineffective in improving OTC persistence in outdoor conditions. Simulated rain at 44 mm h^-1 drastically (by 67.2%) lowered OTC residue after 2 min, and levels were near the detection limit after 60 min of continuous rain, regardless of whether plants were exposed to rainfall 1 or 24 h after OTC application. In artificial inoculation experiments with X. arboricola pv. pruni on attached peach leaves, OTC concentrations ≥50 ppm active ingredient (corresponding to ≥0.06 μg OTC cm^-2 leaf surface) were sufficient to suppress bacterial spot development. By extrapolation from our outdoor exposure experiments, similar OTC residues following application of labeled OTC rates would be reached after less than 2 days under full sunlight, after 4 days under overcast sky, or after 2 min of a heavy rainstorm.

Bermudagrass sod growth and metal uptake in coal combustion by-product-amended media

Coal combustion by-products (CCB) include fly ash and bottom ash and are generated nationally at rates of 10(8) Mg yr(-1). Land applications of CCB have improved physicochemical properties of soil, yet inherent bulkiness and trace metal content of CCB often limit their use. Likewise, utilization of biosolids and manure as fertilizer can be problematic due to unfavorable nutrient ratios. A 2-yr field study evaluated environmental and technical parameters associated with CCB-organic waste utilization as growth media in turfgrass sod production. Experimental growth media formulated with CCB and organic waste and a sand-compost control mixture were uniformly spread at rates from 200 to 400 m3 ha(-1) and sprigged with hybrid bermudagrass [Cynodon dactylon (L.) Pers. x C. transvaalensis Burtt-Davy]. Leaf clippings were collected and analyzed for total elemental content each year. In Year 2, growth media samples were collected during establishment 47 and 84 days after planting (DAP) and viable Escherichia coli organisms were quantified. At harvest (99 or 114 DAP), sod biomass and physicochemical properties of the growth media were measured. During sod propagation, micronutrient and metal content in leaf clippings varied by growth media and time. After 47 d of typical sod field management, viable E. coli pathogens were detected in only one biosolids-amended plot. No viable E. coli were measured at 84 DAP. In both years, sod biomass was greatest in media containing biosolids and fly ash. Following installation of sod, evaluations did not reveal differences by media type or application volume. Using CCB-organic waste mixes at the rates described herein is a rapid and environmentally safe method of bermudagrass sod production.

Composition and element solubility of magnetic and non-magnetic fly ash fractions

Magnetic and non-magnetic fractions of coal fly ashes from SE US electric power plants were characterized with special emphasis on the potential environmental consequences of their terrestrial disposal. Quartz and mullite were the crystalline minerals dominating the non-magnetic fractions. Magnetic fractions contained magnetite, hematite, and, to a lesser extent, quartz and mullite. Chemical analyses revealed that magnetic fractions had about 10 times higher concentrations of Fe, and 2-4 times higher concentrations of Co, Ni, and Mn. Non-magnetic fractions were enriched in K, Al and Ca. Iron content within fly ash particles was negatively correlated with elements associated with aluminosilicate matrix (Si, Al, K, Na). Solubility of most elements was higher in the non-magnetic than in the magnetic fractions of alkaline fly ashes at comparable pH. Calcium was associated with the non-magnetic fraction of the alkaline fly ashes which resulted in a higher pH buffering capacity of this fraction.

Long-term biosolids application effects on metal concentrations in soil and bermudagrass forage

The long-term application of biosolids that periodically contained elevated metal concentrations has raised questions about potential effects on animal health. To address these concerns, we determined metal concentrations (As, Cd, Cu, Pb, Hg, Mo, Ni, Se, and Zn) in both soil and bermudagrass [Cynodon dactylon (L.) Pers.] forage from 10 fields in the following categories of biosolids application: six or more years (>6YR), less than six years (<6YR), and no applications (NS). Soil metal concentrations in all groups were similar to values reported for mineral soils in Georgia, and well below USEPA cumulative limits. Average metal concentrations in the forage were below the maximum tolerable level (MTL) for beef cattle, although two biosolids-amended fields in the >6YR group produced forage that was at or near the MTL for Cd and Mo, and one field in the <6YR group produced forage above the MTL for Cd. The Cu to Mo ratios in forage decreased with increasing time of sludge application, with the average in the >6YR group at a proposed 5:1 Cu to Mo ratio limit to protect ruminant health. Sulfur concentrations in the forage from all three groups was near the MTL of 4 g kg(-1). The study indicated that toxic levels of metals have not accumulated in the soils due to long-term biosolids application. Overall forage quality from the biosolids-amended fields was similar to that of commercially fertilized fields; however, due to the relatively high S and potential for a low Cu to Mo ratio, Cu supplements should be used to ensure ruminant health.

The effect of variation of the lingual shape of mandibular complete dentures on lingual resistance to lifting forces

Increasing life expectancy, age related reduction in adaptability and progressive severe mandibular resorption all add to the importance of any factor improving the prosthetic success.

OBJECTIVE

To investigate the effect of two different lingual shapes of lower dentures on patients' ability to resist lifting forces.

DESIGN

Tongue pressures on the lingual surface of complete mandibular experimental dentures were recorded from mid-line, premolar and molar transducers. Two experimental prostheses were fabricated for each subject: one conventionally contoured, the other formed by piezography.

SETTING

A clinical research laboratory.

SUBJECTS

Five experienced complete denture wearers between age 64 and 82 years.

INTERVENTION

Lifting forces were applied at the midline, left and right premolar sites in random order.

MAIN OUTCOME MEASURES

Peak resistance to lifting forces and lingual pressures used during these tests.

RESULTS

Lingual pressures exerted anteriorly were dramatically higher than those on premolar and molar surfaces. Significantly higher pressures were used to resist lifting forces applied to piezographically than conventionally formed contours; correspondingly, significantly higher lifting peak forces were, on average, resisted.

CONCLUSIONS

Providing a lower denture with a piezographically produced lingual surface was shown, in this preliminary study, to enhance tongue retentive ability over a conventional design. It seems reasonable to maximise retentive potential with oblique sublingual polished surfaces and minimise the adaptive demand, particularly for older patients, by using a piezographic technique which "customises" the contour and precludes over-extension.

Accumulation of potentially toxic elements in plants and their transfer to human food chain

Contaminated soils can be a source for crop plants of such elements like As, Cd, Cr, Cu, Ni, Pb, and Zn. The excessive transfer of As, Cu, Ni, and Zn to the food chain is controlled by a "soil-plant barrier"; however, for some elements, including Cd, the soil-plant barrier fails. The level of Cd ingested by average person in USA is about 12 micrograms/day, which is relatively low comparing to Risk Reference Dose (70 micrograms Cd/day) established by USEPA. Food of plant origin is a main source of Cd intake by modern society. Fish and shellfish may be a dominant dietary sources of Hg for some human populations. About half of human Pb intake is through food, of which more than half originates from plants. Dietary intake of Cd and Pb may be increased by application of sludges on cropland with already high levels of these metals. Soils amended with sludges in the USA will be permitted (by USEPA-503 regulations) to accumulate Cr, Cd, Cu, Pb, Hg, Ni, and Se, and Zn to levels from 10 to 100 times the present baseline concentrations. These levels are very permissive by international standards. Because of the limited supply of toxicity data obtained from metals applied in sewage sludge, predictions as to the new regulations will protect crop plants from metal toxicities, and food chain from contamination, are difficult to make.

Incorporation of the troponin regulatory complex of post-ischemic stunned porcine myocardium reduces myofilament calcium sensitivity in rabbit psoas skeletal muscle fibers

Decreased calcium sensitivity of tension in post-ischemic myocardium is thought to be a mechanism of depressed function in stunning. The purpose of this study was to determine if the decrease in calcium sensitivity of tension results from ischemia and/or reperfusion-induced alterations in the thin filament regulatory troponin. The experiments utilized an open-chest porcine model of regional LAD myocardial stunning that has previously been shown to cause a decrease in calcium sensitivity of tension in permeabilized myocytes. Stunning was induced by 45 min of low-flow ischemia to the left anterior descending (LAD) coronary artery perfusion bed, which was followed by 30 min of reperfusion. Regional LAD function after reperfusion was 0.5+/-2.8%, as assessed by systolic wall thickening (v 23.9+/-4.1% thickening in control, P<0.001). Core biopsy samples from control circumflex and stunned LAD myocardium were acquired from each heart (n=9) after LAD reperfusion, and were used to obtain purified troponin complexes. Isometric tension-pCa relationships were measured in permeabilized psoas skeletal fibers before and after partial exchange of cardiac troponin from either control circumflex (n=6) or stunned LAD (n=8) myocardium for endogenous skeletal troponin. Calcium sensitivity of tension as assessed by pCa50 (i.e. pCa for half-maximal tension) was unchanged after exchange of troponin from control circumflex myocardium (pCa50=5. 98+/-0.02 v 5.96+/-0.06), but there was a significant decrease in calcium sensitivity of tension after exchange of troponin from stunned LAD myocardium (pCa50=5.97+/-0.07 v 5.82+/-0.05, P<0.05). We conclude that the decrease in calcium sensitivity of tension in postischemic stunned myocardium is, in part, due to ischemia and/or reperfusion-induced alterations in the cardiac troponin regulatory complex.

Onset of reduced Ca2+ sensitivity of tension during stunning in porcine myocardium

Recent data suggest that reduced Ca2+ sensitivity of tension is a mechanism of the post-ischemic myocardial dysfunction, termed stunning. The purpose of the present study was to determine whether the decrease in myofilament Ca2+ sensitivity occurs during ischemia or during the subsequent period of reperfusion. Serial biopsies from an in vivo open-chest porcine model of regional LAD myocardial stunning (n = 6) were used to obtain in vitro measurements of Ca2+ sensitivity of tension in myocardium from the LAD bed. Regional ventricular myocardial function was assessed from percentage systolic myocardial wall thickening (%Th) and the load-independent end-systolic pressure wall thickness relation (ESPTR). Stunning was induced by 45 min of low flow LAD ischemia (43 +/- 4 ml/min/100 gm) followed by 30 min of reperfusion with control aerobic flow (117 +/- 7 ml/min/100 g). Endocardial biopsies were obtained from the LAD bed during pre-ischemia, ischemia (immediately prior to reperfusion), and post-ischemia (after 30 min of reperfusion). Biopsies were mechanically disrupted and single cell-sized preparations of permeabilized myocardium were attached to a force transducer to measure directly steady-state tension-pCa relationships. The % decreased to 7 +/- 11% of control during ischemia (P < 0.001) and returned to 30 +/- 11% of control in the post-ischemic stunned state (P < 0.001). Stunning resulted in a significant leftward shift of the ESPTR as compared to control, indicating depressed regional myocardial function. The pCa (-log[Ca2+]) for half maximal activation of tension, i.e. pCa50, was 5.96 +/- 0.04 in control myocardium and was unchanged during ischemia (5.95 +/- 0.03), but significantly decreased to 5.82 +/- 0.04 upon reperfusion (P < 0.05). These data show that the decrease in Ca2+ sensitivity of tension associated with stunning occurs during reperfusion, and supports the idea that reperfusion injury is a mechanism of myocardial stunning.

Isometric and dynamic contractile properties of porcine skinned cardiac myocytes after stunning

The purpose of this study was to investigate myofibrillar mechanisms of depressed contractile function associated with myocardial stunning. We first tested whether the degree of stunning was directly related to changes in myofilament Ca2+ sensitivity. Variable degrees and durations of low-flow ischemia were followed by 30 minutes of reperfusion in an open-chest porcine model of regional myocardial stunning (n = 27). Ca2+ sensitivity of isometric tension was measured in skinned myocytes obtained from endocardial biopsies taken during control aerobic flow and after 30 minutes of reperfusion. The degree of stunning, as assessed by percent systolic wall thickening, ranged from -3% to 75% of control but did not correlate (r = .11) with changes in pCa50, ie, pCa for half-maximal tension. Only in the group (n = 10) with the most severe level of ischemia was there a significant decrease in pCa50 (from 5.97 +/- 0.06 in the control condition to 5.86 +/- 0.07 after ischemia, P < .05). Less severe levels of ischemia (n = 17) resulted in significant stunning (percent systolic wall thickening, 38 +/- 4% of control) but no change in pCa50. To investigate the possibility that alterations in myofibrillar cross-bridge kinetics contribute to depressed function in stunning, maximum velocity of shortening (Vo) was measured in postischemic myocytes. Vo in postischemic myocytes was reduced to 56 +/- 4% of Vo in control myocytes and was independent both of the degree of stunning (r = .26) and changes in Ca2+ sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of altered contractility on the linearity of regional left ventricular end-systolic relations in intact hearts

The purpose of these studies was to determine the effect of altered regional contractility on the linearity of regional left ventricular end-systolic relations. Significant change in the shape of these relations would limit their application as load-independent indices of regional contractility. In a paced, open-chest pig heart preparation (n = 7), the left ventricular end-systolic pressure-segment length relation (ESPLR) and pressure-wall thickness relation (ESPTR) were obtained over a wide range of end-systolic pressures (134 +/- 9 to 70 +/- 6 mm Hg). Regional inotropic state was varied with intracoronary calcium and verapamil. The shapes of the ESPLR and ESPTR were characterized by using linear and quadratic models. Both provided a good fit, although the quadratic model showed a slight concavity to the segment length and thickness axes (second-order coefficient < 0). In the linear model, calcium increased the slope of the ESPLR by 111% (p < 0.01) and the slope of the ESPTR by 170% (p < 0.01). At a pressure of 100 mm Hg, end-systolic segment length (L100) shifted to the left (p < 0.05) and end-systolic wall thickness (T100) to the right (p < 0.025). Verapamil decreased the slope of the ESPLR by 45% (p < 0.01) and of the ESPTR by 33% (p not significant) and produced significant shifts in L100 (p < 0.001) and T100 (p < 0.025). The values of L100 and T100 determined by the quadratic fit were nearly identical to those for the linear fit, and both showed similar significant shifts with altered contractility. There was no significant change in the shape of the quadratic fit (as assessed by the second-order coefficient) with different contractile states. It is concluded that the curvilinearity of the ESPLR and ESPTR under physiologic conditions is slight and appears to be independent of the contractile state. Furthermore, a linear model of regional end-systolic relations can be used to assess regional left ventricular function in intact hearts.

Improved densitometric measurement of left ventricular ejection fraction using dual-energy digital subtraction angiography

The effects of misregistration artifacts and background corrections on the densitometric measurement of left ventricular ejection fraction (EF) from digital subtraction angiography (DSA) images were studied in 20 patients. Densitometric ejection fraction measurements were performed on both conventional time subtraction images and on dual-energy subtraction images. Dual-energy subtraction is not sensitive to the motion induced artifacts which often mar time subtraction images. While the time subtraction images had varying degrees of misregistration artifacts, none of the dual-energy studies contained significant misregistration artifacts. Densitometrically determined ejection fractions measured with and without correction for background signals were compared. Poor agreement between time subtraction ejection fractions determined with and without background correction (EFNO-BKG = 0.88 EFBKG - 6.0%, SEE = 8.1%, r = 0.83) demonstrated the sensitivity of time subtraction EFs to the performance of a background correction procedure. Conversely, densitometric measurement of ejection fraction using dual-energy subtraction was significantly less sensitive to the performance of a background correction (EFNO-BKG = 0.99 EFBKG - 5.3%, SEE = 4.3%, r = 0.96). Since background correction requires accurate definition of ventricular borders, but motion artifacts often preclude accurate border definition, it is concluded that dual-energy subtraction is a significantly more robust method for measuring left ventricular ejection fraction using densitometry. It is further concluded that identification of the systolic endocardial border is not required when performing densitometric EF measurements on dual-energy images. Drawing of the end-diastolic border alone is sufficient to produce an accurate ejection fraction measurement.

Densitometric assessment of regional left ventricular systolic function during graded ischemia in the dog by use of dual-energy digital subtraction ventriculography

Densitometric analysis of images obtained by digital subtraction angiography (DSA) allows for more reproducible and less operator-dependent quantitation of ventricular function. Conventional DSA uses temporal subtraction but is limited by misregistration artifacts. Dual-energy digital subtraction angiography (DE-DSA) is immune to such misregistration artifacts. The ability of DE-DSA to quantitate changes in regional ventricular volume resulting from ischemia was tested. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images was used to quantitate regional left ventricular systolic function during four levels of ischemia ranging from mild to severe in open-chest dogs (n = 10). DE-DSA left ventriculograms were obtained by means of central venous injections of iodinated contrast medium. Ischemia was graded according to percentage of systolic wall thickening as measured by sonomicrometry. Phase-matched end-systolic images were obtained at each of four levels of ischemia by subtracting an end-systolic control image from each end-systolic ischemic image. Ejection fraction images were obtained at the control level and at each level of ischemia by subtracting an end-systolic image from an end-diastolic image of the same cardiac cycle. The resulting wall motion difference signals represent the changes in regional ventricular volumes and were quantitated by densitometry. Densitometry was able to detect the effect of all levels of ischemia on regional function, even the mildest. Densitometric analysis of both phase-matched and ejection fraction DE-DSA images provides a sensitive technique for detecting and quantitating the changes in regional left ventricular systolic volume that occur with ischemia.

Altered calcium sensitivity of isometric tension in myocyte-sized preparations of porcine postischemic stunned myocardium

Postischemic ventricular myocardial dysfunction, termed stunning, is characterized by a persistent but ultimately reversible depression of contractile function. The present study was undertaken to investigate the possibilities that reduced contractile force in stunning is due to a decrease in maximal tension-generating capability or to a decrease in the Ca2+ sensitivity of the myofilaments. The experiments combine an in vivo open-chest porcine heart model of stunning (n = 5) with in vitro measures of myocyte myofilament calcium sensitivity from these same hearts. Regional myocardial function in the left anterior descending coronary artery (LAD) perfusion bed of porcine hearts was measured with transmural ultrasonic crystals. The protocol was 45 minutes of low-flow LAD ischemia at 40% of control flow, followed by 30 minutes of postischemic reperfusion at control aerobic flow. Percent systolic wall thickening decreased to 8 +/- 5% of control during ischemia (p < 0.05) and returned to 38 +/- 8% of control in the postischemic stunned state (p < 0.05). Serial endocardial biopsies were obtained from the preischemic and postischemic myocardium in the LAD perfusion bed and from the aerobically perfused myocardium in the circumflex bed. The biopsies were mechanically disrupted, and myocyte-sized preparations of permeabilized myocardium were attached to a force transducer and a length-changing device to allow for direct measurement of steady-state tension-pCa (i.e., -log[Ca2+]) relations. The pCa for half-maximal activation of tension, i.e., pCa50, in LAD myocardium decreased from 5.88 +/- 0.05 before ischemia to 5.69 +/- 0.03 after ischemia (p < 0.05); however, maximal Ca(2+)-activated tension and the slope of the tension-pCa relation were unaffected by the ischemic episode.(ABSTRACT TRUNCATED AT 250 WORDS)

Accordion effect in tortuous right coronary arteries during percutaneous transluminal coronary angioplasty

Coronary spasm and intimal dissection are well-known complications of coronary angioplasty with potentially serious consequences. Their treatments are different and need to be instituted quickly to prevent vessel closure. We report two cases of mechanical deformation caused by the angioplasty hardware masquerading as dissection or spasm during coronary angioplasty of tortuous native right coronary arteries.

Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique

Digital subtraction angiography (DSA) allows quantitative analysis of ventricular function via densitometric and parametric imaging techniques. However, DSA is limited by the artifacts in temporal subtraction images that result from patient and cardiac motion. Dual-energy subtraction imaging is insensitive to motion. This study evaluated the initial application of dual-energy subtraction in cardiac patients. The image quality of dual-energy subtraction left ventriculograms obtained from a pulmonary artery injection of contrast was assessed in 13 patients, ranging in weight from 54 to 100 kg. The dual-energy images were compared with left ventricular images obtained using standard left ventricular injection cine angiography. End-systolic and end-diastolic ventricular volumes calculated from the cine (C) and dual-energy (DE) images using the Area-Length method were compared. The resulting regression line was DE = 0.98 C+ 7.0 ml, and the r value was 0.987. Dual-energy subtraction provided good left ventricular visualization, free from misregistration artifacts, even during patient motion.

Time dependence of regional systolic left ventricular relationships in intact hearts

In intact hearts the beat-to-beat left ventricular systolic pressure-length relationship is not uniquely defined, but rather is history dependent and appears hysteretic. The purpose of these studies was to assess the time course of this phenomenon. In an open chest swine heart preparation, left ventricular pressure, regional lengths, and wall thickness were measured. Loading conditions were altered by the infusion of volume into the left ventricle to increase peak systolic pressure approximately 30 mmHg. The resultant interbeat systolic pressure-dimension relationships were hysteretic. The first part of the study (n = 13) was to test whether the myocardium exhibited a long-term memory of prior mechanical events. Measurements obtained 30 and 120 s after volume loading revealed no residual differences in pressure or dimension compared with preinjection values. Thus the phenomenon was transient and complete (reversible) by 30 s. To better characterize this event, the temporal effects of myocardial loading were studied (n = 8). A randomized comparison of two different rates of volume infusions (27 +/- 2 vs. 56 +/- 2 ml/s, P less than 0.001) was performed. Varying the volume loading resulted in similar increases in peak left ventricular pressure (35 +/- 3 vs. 31 +/- 3 mmHg) but at different increments of development, i.e., greater than 5-7 cardiac cycles at the slower rate of volume infusion vs. greater than 2-3 cardiac cycles (P less than 0.001) at the faster rate. The isochronal systolic pressure-dimension relationships were quantitated by measuring the area of the hysteretic relationship and its slope.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary hyperperfusion and ventricular function in intact and isovolumic pig hearts

This study characterized the effect of coronary hyperperfusion on left ventricular (LV) geometry and myocardial vascular and tissue volumes in intact hearts, and tested the hypothesis that ventricular function is significantly enhanced only under isovolumic conditions. Randomized 10-min trials of coronary perfusion pressures at approximately 100-110, approximately 150-160, and approximately 180-190 mmHg were performed in extracorporeally perfused pig hearts. First, ultrasonic crystals were used to measure LV wall thickness and major and minor epicardial diameters. LV pressures, maximum dP/dt, and myocardial O2 consumption were not significantly different despite increases in the end-diastolic and end-systolic wall thickness. There were either no changes or small decreases in epicardial major and minor axis dimensions. Second, intramyocardial small vessel vascular and extracellular volumes were measured using radiolabeled dextran and inulin. There was no significant difference in small vessel plasma volume or extracellular space. Finally, pigs were placed on cardiopulmonary bypass and LV volume was fixed with a ventricular balloon. In this isovolumic preparation, coronary hyperperfusion significantly increased peak LV pressure. We conclude that coronary hyperperfusion in hearts with intact peripheral circulations results in small changes in LV geometry but no physiologically significant changes in LV performance. Only under the rigid conditions of an isovolumic preparation is LV function enhanced, and thus the "garden-hose" effect is a model-dependent phenomenon.

Effects of load alteration and coronary perfusion pressure on regional end-systolic relations

Left ventricular end-systolic pressure-wall thickness and pressure-segment length relations have been used to assess regional myocardial contractility. The purpose of these studies was to determine whether the method of afterload alteration, coronary perfusion pressure, and the definition of end systole affected regional end-systolic relations. In paced open-chest pig hearts (n = 10), left ventricular pressure, wall thickness, and segment length were measured during vena caval occlusions. First, regional end-systolic relations were obtained before and after an increase in afterload with intravenous phenylephrine. This comparison was performed with the coronary circulation intact (closed loop) and with coronary perfusion pressure controlled extracorporeally (open loop). Second, with the open-loop preparation, the independent effect of a range of coronary perfusion pressures (45-155 mm Hg) on end-systolic relations was assessed. In both procedures, end systole was defined by the maximal isochronal slope, termed regional Emax, and by the maximal ratio of left ventricular pressure to regional dimension, termed Ees. In the first procedure, the slope and x-axis intercept of regional Emax were unchanged with phenylephrine. In contrast, the slope of Ees decreased with phenylephrine, consistent with a decrease in contractility. The extrapolated x-axis intercept of Ees shifted in a direction consistent with an increase in contractility. In the second procedure, increases in coronary perfusion pressure did not affect regional Emax but increased the slope of Ees. A decrease in the coronary perfusion pressure, particularly with ischemia, shifted the x-axis intercepts of both Emax and Ees in a direction consistent with a decrease in contractility. Thus, regional end-systolic relations in intact hearts are dependent on the method of afterload alteration and the coronary perfusion pressure. Furthermore, Emax differs from Ees, so the assessment of regional relations depends on how end systole is defined.

Anomalous origin of the right coronary high above the left sinus of Valsalva

Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare and previously has been reported to be associated with congenital aortic valve disease. We report a case of the right coronary artery arising from the mid ascending aorta, high above the left sinus, with a clinically and angiographically normal aortic valve.

Coronary hyperperfusion and myocardial metabolism in isolated and intact hearts

We determined the independent influence of coronary hyperperfusion on myocardial metabolism in isolated and intact hearts. In an isovolumic blood-perfused rat heart preparation working against a left ventricular (LV) balloon, the effect of increasing coronary perfusion pressure from 100 to 150 mmHg was assessed. In three groups of rat hearts LV volume was fixed to obtain LV peak pressures of 42 +/- 3, 101 +/- 5, and 130 +/- 6 mmHg. With coronary hyperperfusion, LV pressure increased 27, 18, and 16%, LV maximum time derivative of pressure (dP/dt) increased 39, 20, and 22%, and myocardial O2 consumption (VO2) increased 16, 17, and 33%, respectively. In a fourth group, LV peak pressure was held constant at 92 +/- 4 mmHg during coronary hyperperfusion by decreasing LV volume. In this group, despite an increase in coronary blood flow of 48%, there was no significant difference in LV maximum dP/dt or myocardial VO2. Thus, in isolated rat hearts, coronary hyperperfusion was not an independent stimulus to myocardial VO2. To further test this, the effect of coronary hyperperfusion on myocardial metabolism was studied in an intact working swine heart preparation where the cardiac output was fixed with a right heart bypass circuit. Fatty acid oxidation in the left anterior descending bed was assessed by production of 14CO2 from [14C(U)]palmitate. A comparison of coronary perfusion 106 +/- 5 vs. 197 +/- 5 mmHg resulted in no significant change in global LV function, including LV internal diameter. Despite a 70% increase in coronary blood flow, there was no significant change in myocardial VO2 or fatty acid utilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of oral milrinone on end-systolic relations in patients with severe congestive heart failure

The new inotropic agent milrinone has both vasodilator and inotropic cardiovascular effects, but the importance of these effects in patients with severe congestive heart failure (CHF) is controversial. The left ventricular (LV) end-systolic pressure-diameter relation was used to determine the independent inotropic effect of milrinone. Seven patients with New York Heart Association class III CHF were invasively monitored with right-sided heart catheters and radial arterial lines. M-mode echocardiography was used to measure LV dimensions. The effect of a 10-mg oral dose of milrinone on hemodynamic, echocardiographic and end-systolic variables was determined. End-systolic pressure was measured at the dicrotic notch of the arterial pressure tracing and end-systolic LV dimensions at the time of aortic valve closure. Methoxamine (n = 6) or nitroprusside (n = 1) was used to alter afterload so that the end-systolic pressure-diameter relation could be determined. Arterial vasodilation from milrinone was evidenced by a decrease in mean arterial blood pressure (88 +/- 5 to 77 +/- 2 mm Hg, p less than 0.025) and an increase in cardiac index (from 2.7 +/- 0.2 to 3.2 +/- 0.2 liters/min/m2, p less than 0.025), with no change in heart rate (80 +/- 5 beats/min). Milrinone decreased preload as assessed by the pulmonary artery wedge pressure (from 17 +/- 2 to 10 +/- 2 mm Hg, p less than 0.01) and end-diastolic LV diameter (from 7.4 +/- 0.4 to 7.0 +/- 0.4 cm, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of 2-tetradecylglycidic acid on myocardial function in swine hearts

Fatty acids in excess impair myocardial function in intact hearts both during aerobic and ischemic blood flow. The purpose of these studies was to determine whether decreases in acylcarnitine, effected by 2-tetradecylglycidic acid (TDGA), would result in the preservation of myocardial function in intact hearts during fatty acid excess. Two groups of intact working swine hearts in which serum fatty acids were augmented three- to fourfold were perfused extracorporeally with whole blood and compared over 90 min. Labeled [U-14C]palmitate was administered selectively into the left anterior descending coronary circulation to follow fatty acid oxidation, and regional myocardial function was assessed with ultrasonic crystals. Coronary flow in this bed was decreased by 50% over the final 30 min of perfusion. Treated swine (n = 10) were compared with a placebo-treated control group (n = 9). At similar levels of aerobic flow, TDGA effected a marked decrease in 14CO2 production during 60 min of aerobic perfusion, but levels were similar during the final 30 min of ischemia. Tissue levels of acylcarnitine were significantly reduced and acetyl-CoA levels significantly increased in TDGA-treated hearts both in aerobic and ischemic myocardium. This inhibition of fatty acid metabolism during aerobic flow was associated with an increase in regional myocardial shortening in the treated group. This occurred at similar levels of O2 consumption, evidencing enhanced carbohydrate substrate utilization. During the first 30 min of ischemia 14CO2 production and mechanical function were compromised similarly, whereas lactate production was 70% less (P less than 0.025) in the treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

End-systolic pressure-diameter relationships during pulsus alternans in intact pig hearts

Pulsus alternans has previously been ascribed to variations in end-diastolic fiber length and/or an alternating contractile state. In six paced, whole blood-perfused, intact, working pig hearts, left ventricular internal diameters were measured with ultrasonic crystals, and left ventricular pressures were measured with a micromanometer-tipped catheter. Pulsus alternans was induced with propranolol (24-51 micrograms X kg-1 X min-1). End-systolic pressure-diameter relationships were determined during pulsus alternans from a series of consecutive, variably volume-loaded beats using a previously described technique. Beats analyzed prior to any change in loading conditions revealed a left ventricular pressure of 62.7 +/- 8.7 mmHg for the strong beats and 55.2 +/- 7.0 for the weak beats (P less than 0.050). The end-diastolic diameter prior to the stronger beats was larger than that prior to the weaker beats (24.80 +/- 2.73 vs. 23.82 +/- 2.82 mm, P less than 0.025), but there was no significant difference in the corresponding end-diastolic pressures. The maximum dP/dt of the strong beats was 1,275 +/- 249 mmHg/s compared with 1,038 +/- 222 for the weak beats (P less than 0.025). The slope of the end-systolic pressure-diameter relationship, which provides an index of contractility independent of end-diastolic diameter, averaged 42.3 +/- 6.4 mmHg/mm for the strong beats and 24.4 +/- 6.8 for the weak beats (P less than 0.025). These data support an alternating contractile state as an independent mechanism for pulsus alternans in the intact animal.

Regional end-systolic pressure-length relationships using a volume-loading technique in the intact pig heart

The purpose of this study was to characterize left ventricular systolic elastances as derived from pressure-segment length and pressure-diameter relationships, and to compare the resulting regional and global elastances to known changes in inotropy. Left ventricular pressure-segment length and pressure-diameter were varied in a series of consecutive beats by means of a volume-loading technique, and both regional and global relationships at 20-msec intervals throughout systole were found to be nonlinear and to exhibit hysteresis. In eight animals, regional hysteresis was present after vagotomy, propranolol (1.0 mg/kg), and atropine (0.1 mg/kg), and was present no matter whether hearts were loaded by volume (45-60 ml/sec) or by pressure (partial aortic occlusion) over a similar range of left ventricular systolic pressures. Elastance was linearly approximated by the slope of the major axis of the hysteresis loops. In each instance, elastance increased to a maximum and then decreased, thus defining end-systole. In seven animals, maximum elastance-length and -diameter were compared before and after treatments with dobutamine (5-13 micrograms/kg per min) and propranolol (6-51 micrograms/kg per min), or after induction of global ischemia. Dobutamine increased maximum elastance-diameter by 37% (P less than 0.01) and maximum elastance-length by 159% (P less than 0.05). Propranolol decreased maximum elastance-diameter by 27% (P less than 0.05) and maximum elastance-length by 6% (P = NS). Global ischemia (50% reduction in coronary flow) did not significantly change either maximum elastance-diameter or -length. However, with ischemia, the diameter intercept of maximum elastance-diameter increased by 24% (P less than 0.025), and the time to maximum elastance-length decreased by 33% (P less than 0.01). Comparing all interventions, the percent changes in maximum elastance-length and -diameter related directly but with a low correlation coefficient (r = 0.49). These differences in regional and global elastance suggest a complex relationship between regional and global myocardial mechanics, and may not necessarily reflect specific changes in contractility.