Biomedical subjects
A Maurer
Publications and source records attributed to A Maurer.
Preclinical and clinical evaluation of interleukin 3.
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Results of phase I/II trials with recombinant human interleukin-3.
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Impairment of renal function in medical intensive care: predictability of acute renal failure.
Acute causes and chronic risk factors for the development of acute renal failure were analyzed in prospective acquired data of 261 patients in a medical ICU. The population was divided into a group requiring dialysis treatment for established renal failure (n = 95) and a collective maintaining mild renal insufficiency (n = 166). Bivariate and linear discriminant analyses revealed that, above all, variables related to bacterial infections (sepsis and administration of antibiotic agents) and pancreatitis contributed to the discrimination, followed by bleeding, volume depletion, and chronic liver disease in the discriminant function. Bivariate analysis also yielded significant results for mechanical ventilation, CNS depression, and surgery. The importance of the nephrotoxic properties of aminoglycosides may be outweighed by their role as an indicator of severe infectious disease. The overall correct classification rate of the discriminant function was 78.5%, which reflects the importance of the predictor variables, but does not allow individual predictions.
Outcome prediction models on admission in a medical intensive care unit: do they predict individual outcome?
Prospectively acquired data from 941 patients staying greater than 24 h in a medical ICU were analyzed to determine the relevance of scoring on ICU admission by the following methods of outcome prediction: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS), and Mortality Prediction Model (MPM). Analysis was performed separately for all patients (group A) and for a subsample (group B), obtained by excluding coronary care patients. Calculation of risk and classification of patients were carried out as recommended in the literature for MPM, APACHE II, and SAPS. In group A, sensitivities (correct prediction of hospital mortality) were 44.7%, 51.1%, and 21.2% and specificities (correct prediction of survival) were 84.5%, 85.4%, and 96.8%, respectively; overall correct classification rates were 73.3%, 75.8%, and 75.6%. In group B, sensitivities were slightly higher, but total correct classification rates did not reach group A levels. Goodness-of-fit testing showed low levels of fit for all methods in both groups. Application of APACHE II to diagnostic subgroups, using disease-adapted risk calculations, revealed marked inconsistencies between the estimated risk and the observed mortality. We conclude that the estimation of risk on admission by the three methods investigated might be helpful for global comparisons of ICU populations, although the lack of disease specificity reduces their applicability for severity grading of a given illness. The inaccuracy of these methods makes them ineffective for predicting individual outcome; thus, they provide little advantage in clinical decision-making.
[Acute myocardial infarct: aspects of changed mortality at the intensive care unit. Results of a prospective study from 1985 to 1987].
Between 1975 and 1987 the mortality rate among 3143 patients with acute myocardial infarction admitted to an intensive care unit fell from 25% to below 10%. Among 829 patients examined prospectively during three consecutive years, the rate was 12.5% in 1985, 13.1% in 1986, and 9.3% in 1987 (mean of 11.6%). In addition to higher age, other risk factors were identified (mortality in brackets): female sex (14.6%), heart failure (20.6%), and diabetes (19.7%). Hypertension (11.2%) and previous infarct (12.8%) had no influence on mortality rate. The mortality rate was significantly reduced (P less than 0.0003) among 290 patients who had received intravenous fibrinolytic treatment, but this effect was marked only among women, elderly patients and those without risk factors. It is concluded that many measures had led to the observed reduction in acute death rate to about 10%. It is not yet possible to determine which of the different interventions played a part.
Characterization of nicked myotoxin a and its effect on the sarcoplasmic reticulum calcium pump.
Myotoxin a, a muscle-necrotizing polypeptide isolated from Crotalus viridis viridis (prairie rattlesnake) venom, was nicked at Met-28 by cyanogen bromide. Amino acid analysis indicated that the methionine content was reduced to zero from the original 1 mol. Judging from circular dichroism, the nicked myotoxin a had a conformation similar to that of original myotoxin. Raman spectra indicated that the conformations of the three disulfide bonds are not affected in nicked myotoxin a. Like the original toxin, nicked myotoxin a was myotoxic and inhibited calcium ion loading activity, although the inhibitory action was slightly lower than that of the original myotoxin a. Both modified and unmodified myotoxin a showed myonecrotic activity as determined by examining histological slides. The modified toxin also inhibited the formation of decavanadate-induced two-dimensional crystalline arrays of the sarcoplasmic reticulum Ca2+-ATPase just as the original myotoxin a does.
Purification and crystallization of calcium-binding protein from skeletal muscle sarcoplasmic reticulum.
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Crystallization of the Ca2+-ATPase of skeletal muscle sarcoplasmic reticulum. Inhibition by myotoxin a.
Decavanadate produces extensive ordered arrays of Ca2+-ATPase molecules on sarcoplasmic reticulum (SR) vesicle surfaces [(1984) J. Bioenerg. Biomembranes 16, 491-505] and the basic unit of these crystalline structures seems to be a dimer of Ca2+-ATPase [(1983) J. Ultrastruct. Res. 24, 454-464; (1984) J. Mol. Biol. 174, 193-204]. Myotoxin a, isolated from the venom of the prairie rattlesnake Crotalus viridis viridis, is a muscle-degenerating polypeptide and its primary site of interaction is the SR membrane, where it uncouples CA2+-translocation from CA2+-dependent ATP hydrolysis [(1986) Arch. Biochem. Biophys. 246, 90-97]. The effect of myotoxin a on decavanadate-induced two-dimensional Ca2+-ATPase crystals of SR membranes has been investigated. The toxin inhibits the formation of two-dimensional SR-membrane crystals and disrupts previously formed crystals in a time- and concentration-dependent manner, which parallels the uncoupling of ATP hydrolysis from Ca2+ translocation. Two-dimensional crystalline arrays of the SR membrane have a typical diffraction pattern which, after myotoxin a treatment, displays a progressive loss of order. Decavanadate is an uncompetitive inhibitor of the Ca2+-ATPase enzyme-myotoxin a complex. The present results suggest that a Ca2+-ATPase dimer is required for coupling Ca2+ translocation to Ca2+-dependent ATP hydrolysis.
Apparent cooperativity of Ca2+ binding associated with crystallization of Ca2+-binding protein from sarcoplasmic reticulum.
Needle-shaped crystals of the Ca2+-binding protein (CBP) isolated from rabbit skeletal muscle sarcoplasmic reticulum were studied with regard to the influence of Ca2+, K+, and H+ on its solubility and cation binding. The solubility of CBP is sharply decreased with concentration of Ca2+, whereas K+ increased it. Aggregation of the CBP and crystal formation is correlated with the binding of Ca2+. The Ca2+ bound to the crystalline CBP is two to three times higher than that of the soluble form. A strong apparent positive cooperative behavior of Ca2+ binding by CBP was observed concomitant with the shift in equilibrium from the soluble to the crystalline form. From the steepest Hill slope we obtained Hill coefficients of 3.3 for soluble CBP and 14 for the transition between soluble and crystalline forms of CBP. A detailed treatment is presented to validate the applicability of Hill plots for the combined binding and crystallization process. Two-thirds of the Ca2+-binding sites were K+ sensitive and one-third were K+ insensitive. An increase in H+ concentration decreased the Ca2+ binding by crystalline CBP without affecting its solubility, with a pK value of 6.2 determined for this process. These results indicate that the equilibrium between the soluble and crystalline forms of CBP is determined by the amount and nature of the bound cations, Ca2+, K+, and H+. They suggest the possibility that a cycle of aggregation and solubilization of CBP attends the uptake and release of Ca2+ in the sarcoplasmic reticulum, respectively.
Interaction of myotoxin a with the Ca2+-ATPase of skeletal muscle sarcoplasmic reticulum.
Myotoxin a is a muscle-damaging toxin isolated from the venom of Crotalus viridis viridis. Its interaction with the Ca2+-ATPase of sarcoplasmic reticulum (SR) vesicles purified from rabbit skeletal muscle was investigated. Myotoxin a inhibited Ca2+ loading and stimulated Ca2+-dependent ATPase without affecting unidirectional Ca2+ efflux. Its action was dose, time, and temperature dependent. Myotoxin a partially blocked the binding of specific anti-(rabbit SR Ca2+-ATPase) antibodies. It is concluded that myotoxin a attaches to the SR Ca2+-ATPase and uncouples Ca2+ uptake from Ca2+-dependent ATP hydrolysis. Myotoxin a also prevented the formation of decavanadate-induced two-dimensional crystalline arrays of the SR Ca2+-ATPase.
Characterization of the junctional face membrane from terminal cisternae of sarcoplasmic reticulum.
We have recently described a preparation of junctional terminal cisternae (JTC) from fast skeletal muscle of rabbit hind leg. The fraction differs from other heavy sarcoplasmic reticulum (SR) fractions in that it contains a substantial amount of junctional face membrane (JFM) (15-20% of the membrane) with morphologically well-defined junctional feet structures. In common with other heavy SR preparations, it contains predominantly the calcium pump membrane (80-85% of the membrane) and compartmental contents (CC), consisting mainly of calcium-binding protein (calsequestrin). In this study, a modified procedure for the preparation of JTC from frozen rabbit back muscle is described. The yield is substantially greater (threefold per weight of muscle), yet retaining characteristics similar to JTC from fresh hind leg muscles. Methodology has been developed for the disassembly of the JTC. This is achieved by selectively extracting the calcium pump membrane with 0.5% Triton X-100 in the presence of 1 mM CaCl2 to yield a complex of JFM with CC. The CC are then solubilized in the presence of EDTA to yield JFM. This fraction contains unidirectionally aligned junctional feet structures protruding from the cytoplasmic face of the membrane with repeat spacings comparable to that observed in JTC. The JFM contains 0.16 mumol phosphorus (lipid) per milligram protein. Characteristic proteins include 340 and 79-kD bands, a doublet at 28 kD, and a component that migrates somewhat slower than or equivalent to the calcium pump protein. Approximately 10% of the calcium-binding protein remains bound to the JFM after EDTA extraction, indicating the presence of a specific binding component in the JFM. The JFM, which is involved in junctional association with transverse tubule and likely in the Ca2+ release process in excitation-contraction coupling, is now available in the test tube.
Hemodynamic predictors of outcome in patients undergoing valve replacement.
The afterload-corrected end-systolic volume index (ratio of end-systolic stress to end-systolic volume index [ESS/ESVI]) was previously useful in predicting outcome in patients with mitral regurgitation undergoing valve replacement. Therefore we tested ESS/ESVI together with standard hemodynamic variables as possible predictors of outcome in 39 patients with various valvular lesions who underwent valve replacement. Thirteen patients had preoperative mitral regurgitation, 16 had aortic stenosis, nine had aortic regurgitation, and one had mitral stenosis. Twenty-seven patients (group S) had a satisfactory outcome as defined by a return to NYHA class I or II together with a normal postoperative ejection fraction. Twelve patients who died, remained in class III or IV, or had a subnormal postoperative ejection fraction were deemed to have an unsatisfactory result (group U). Mean right atrial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, end-diastolic volume index, end-systolic volume index (ESVI), and end-systolic wall stress were all greater in group U, whereas ESS/ESVI and ejection fraction were lower in group U. When these and other factors were submitted to stepwise discriminant multivariate analysis, ESS/ESVI and ESVI were the only independent predictors of outcome. However, when patients with mitral regurgitation (who might have biased the study) were excluded, discriminant analysis showed ESVI as the only independent predictive variable. We conclude that end-systolic indicators of ventricular function are superior to other standard hemodynamic variables in predicting outcome of valve replacement.
Phospholipid protection against proteolysis of D-beta-hydroxybutyrate dehydrogenase, a lecithin-requiring enzyme.
D-beta-Hydroxybutyrate dehydrogenase is a lipid-requiring enzyme which is localized on the inner face of the mitochondrial inner membrane. The apodehydrogenase, i.e. the purified enzyme devoid of lipid, has been purified from beef heart mitochondria and as such is inactive. It can be reactivated by insertion into phospholipid vesicles containing lecithin. Proteolytic digestion with different proteases has been carried out to obtain insight into the orientation of the enzyme in the membrane and to assess the extent of immersion of the protein into the phospholipid bilayer. Digestion of the apodehydrogenase with either trypsin, chymotrypsin, Staphylococcus aureus protease, thermolysin, carboxypeptidases A and Y, or Pronase (from Streptomyces griseus) leads to loss of activity, as assayed with phospholipid. Limited digestion with carboxypeptidase results in complete inactivation. Of the proteases tested, only Pronase and chymotrypsin cleave and inactivate the enzyme inserted into phospholipid vesicles (enzyme-phospholipid complex). For the enzyme-phospholipid complex, the loss of activity with Pronase digestion follows a single exponential decay to less than 10% of the initial activity. With chymotrypsin digestion, the staining intensity of the original approximately 31,500-dalton polypeptide decreases more rapidly than the loss of enzymic activity. The enzyme-phospholipid complex, after limited cleavage with chymotrypsin, retains enzymic activity and resonance energy transfer from protein to bound NADH and an approximately 26,000-dalton polypeptide is observed. Phospholipid alters the cleavage pattern with both chymotrypsin and Pronase, and the rate of inactivation of the enzyme-phospholipid complex is slowed in the presence of NAD(H). Moreover, the rate of inactivation of the apodehydrogenase with chymotrypsin is diminished approximately 3-fold in the presence of NAD+. Digestion of submitochondrial vesicles with either trypsin, chymotrypsin, or Pronase rapidly inactivates D-beta-hydroxybutyrate dehydrogenase; the addition of NAD+ or NADH, together with dithiothreitol and increased salt (to 50 mM), decreases the rate of inactivation, and with trypsin, virtually eliminates inactivation.(ABSTRACT TRUNCATED AT 400 WORDS)
Purification and crystallization of the calcium binding protein of sarcoplasmic reticulum from skeletal muscle.
The calcium binding protein of skeletal muscle sarcoplasmic reticulum (also referred to as calsequestrin) was purified by release from the compartment of the vesicles with the detergent octaethyleneglycol mono-n-dodecyl ether (C12E8) and by subsequent precipitation of the calcium binding protein with specific divalent cations. The isolated protein exhibited a single band on NaDodSO4/PAGE and bound 903 nmol of Ca2+ per mg of protein. The calcium binding protein could be crystallized in the presence of Ca2+, Mg2+, Sr2+, or combinations of these three cations used in a narrow concentration range. Needle-shaped crystals of up to 500 X 50 micron were obtained. The removal of the divalent cations resulted in solubilization of the crystals. The spacings and angles of the crystals were obtained by electron microscopy using three different methods of sample preparation. By freeze-drying and negative staining electron microscopy, the spacings along axes a and b were determined to be 10-11 nm each, and the angle between the two axes was 90 degrees. By thin section electron microscopy, the spacing along axis a was 11 nm, along axis c was 15-16 nm, and the angle between the two axes was 75 degrees. This study reports (i) a simple and rapid method for purification of the calcium binding protein; (ii) conditions to crystallize the protein using Ca2+, Mg2+, Sr2+, or combinations of the three; and (iii) some preliminary characteristics of the crystals. The crystalline nature was characterized by electron microscopy and x-ray diffraction. The larger crystals diffracted beyond 3-A Bragg spacing.
Hazards of indiscriminate screening for sickling.
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[New phenazon-4-sulfonic acid derivatives with potential effect].
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