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Biomedical subjects

B M Patel

Publications and source records attributed to B M Patel.

At least 19 recordsLinked to original sources

alpha beta Spectrin coiled coil association at the tetramerization site.

On the basis of sequence homology studies, it has been suggested that the association of human erythrocytes alpha and beta spectrin at the tetramerization site involves interactions between helices. However, no empirical details are available, presumably due to the experimental difficulties in studying spectrin molecules because of its size and/or its structural flexibility. It has been speculated that erythrocyte tetramerization involves helical bundling rather than coiled coil association. We have used recombinant spectrin peptides to model alpha and beta spectrin to study their association at the tetramerization site. Two alpha peptides, Sp alpha 1-156 and Sp alpha 1-368, and one beta peptide, Sp beta 1898-2083, were used as model peptides to demonstrate the formation of the alpha beta complex. We also found that the replacement of R28 in Sp alpha 1-368 to give Sp alpha 1-368R28C abolished complex formation with the beta peptide. Circular dichroism techniques were used to monitor the secondary structures of the individual peptides and of the complex, and the results showed that both Sp alpha 1-156 and Sp beta 1898-2083 peptides in solution, separately, included helices that were not paired with other helices in the absence of their binding partners. However, in a mixture of Sp alpha 1-156 and Sp beta 1898-2083 and formation of the alpha beta complex, the unpaired helices associated to form coiled coils. Since the sequences of these two peptides that are involved in the coiled coil association are derived from a native protein, the information obtained from this study also provides insight toward a better understanding of naturally occurring coiled coil subunit-subunit association.

Amino Acid Sequence↗

Physiology of vasopressin relevant to management of septic shock.

Vasopressin is emerging as a rational therapy for the hemodynamic support of septic shock and vasodilatory shock due to systemic inflammatory response syndrome. The goal of this review is to understand the physiology of vasopressin relevant to septic shock in order to maximize its safety and efficacy in clinical trials and in subsequent therapeutic use. Vasopressin is both a vasopressor and an antidiuretic hormone. It also has hemostatic, GI, and thermoregulatory effects, and is an adrenocorticotropic hormone secretagogue. Vasopressin is released from the axonal terminals of magnocellular neurons in the hypothalamus. Vasopressin mediates vasoconstriction via V1-receptor activation on vascular smooth muscle and mediates its antidiuretic effect via V2-receptor activation in the renal collecting duct system. In addition, vasopressin, at low plasma concentrations, mediates vasodilation in coronary, cerebral, and pulmonary arterial circulations. Septic shock causes first a transient early increase in blood vasopressin concentrations that decrease later in septic shock to very low levels compared to other causes of hypotension. Vasopressin infusion of 0.01 to 0.04 U/min in patients with septic shock increases plasma vasopressin levels to those observed in patients with hypotension from other causes, such as cardiogenic shock. Increased vasopressin levels are associated with a lesser need for other vasopressors. Urinary output may increase, and pulmonary vascular resistance may decrease. Infusions of > 0.04 U/min may lead to adverse, likely vasoconstriction-mediated events. Because clinical studies have been relatively small, focused on physiologic end points, and because of potential adverse effects of vasopressin, clinical use of vasopressin should await a randomized controlled trial of its effects on clinical outcomes such as organ failure and mortality.

Animals↗

Pharmacologic treatment of noncognitive behavioral disturbances in elderly demented patients.

Fifty-nine elderly residents of long-term care facilities who had DSM-III diagnoses of dementia were studied in an 8-week randomized, double-blind comparison trial of haloperidol, oxazepam, and diphenhydramine to test the efficacy of these agents in the treatment of clinically significant behavioral disturbances in patients with dementia. All three agents demonstrated modest but significant efficacy as measured by clinician ratings of agitated behavior and activities of daily living. The absolute magnitude of improvement was greater for haloperidol and diphenhydramine than for oxazepam, but differences among groups did not approach statistical significance. Frequencies of acute adverse events during the trial were similar across the drug treatment groups. Although these drugs may differ in terms of long-term safety and efficacy, they appear to be equivalent for short-term management of agitated behavior in severely demented patients.

Activities of Daily Living↗

Common IgA and IgM rheumatoid factor idiotypes in autoimmune diseases.

Anti-idiotypic antibodies to four monoclonal IgM, one polyclonal IgM, and one polyclonal IgA rheumatoid factors were produced in rabbits and tested for cross reactivity with rheumatoid factors from nine patients with essential mixed cryoglobulinaemia, three patients with rheumatoid arthritis, four patients with systemic sicca syndrome, and one patient with systemic lupus erythematosus. Variable (3/16 to 10/16) cross reactivity for each anti-idiotypic antibody was observed which was not restricted by disease category, clonality, or isotype of the rheumatoid factor. These findings suggest that rheumatoid factor genes are highly conserved from the germ-line antibody repertoire.

Arthritis, Rheumatoid↗

Crossreactivity of antiphospholipid antibodies.

Using a solid phase radioimmunoassay to detect anticardiolipin antibodies, the crossreactivity of these antibodies with phospholipids and DNA was tested in 10 patients with autoimmune disorders and 1 patient with secondary syphilis. The crossreactivity of anti-ds DNA and anti-ss DNA antibodies with cardiolipin was tested in 10 additional patients with SLE. In the 10 sera tested with high anticardiolipin antibody levels, there was marked inhibition of anticardiolipin antibody activity by negatively charged phospholipids. The zwitterionic phospholipids inhibited anticardiolipin antibody activity in some sera, and in instances where this occurred, inhibition was less than that obtained for the negatively charged phospholipids. There was minimal inhibition of anticardiolipin antibody by ss DNA in only 2 of 10 sera tested and no inhibition by ds DNA in any sera tested. Conversely, cardiolipin inhibited anti-ss DNA antibody activity in 2 of 10 sera, and anti-ds DNA antibody activity in 2 of 10 sera tested. There was no correlation between anticardiolipin antibody levels and either anti-ds DNA or anti-ss DNA antibody levels. These results suggest that antiphospholipid and anti-DNA antibodies are largely separate groups of antibodies. On the basis of these studies, we suggest that there may be various groups of antiphospholipid antibodies in patients with SLE and other autoimmune disorders.

Autoantibodies↗

Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus.

A new solid-phase radioimmunoassay for the detection of anticardiolipin antibodies is 200-400 times more sensitive than the precipitation method used in the Venereal Disease Reference Laboratory test. 61% of serum samples from patients with systemic lupus erythematosus (SLE) had high levels of anticardiolipin antibodies of at least one immunoglobulin class. There were strong correlations between raised anticardiolipin levels and the lupus anticoagulant, venous and arterial thrombosis, and thrombocytopenia, but no correlation with anti-DNA antibody levels. Of the 15 patients with the highest anticardiolipin titres, 6 had a history of venous thrombosis, 5 cerebral thrombosis, 5 thrombocytopenia, and 2 each pulmonary hypertension and multiple abortions. This simple immunoassay appears to have predictive value for thrombosis in SLE and related disorders.

Adolescent↗

IgA and IgM rheumatoid factors in serum, saliva and other secretions: relationship to immunoglobulin ratios in systemic sicca syndrome and rheumatoid arthritis.

Paired serum and saliva samples from seven patients with systemic sicca syndrome (SSS), 15 patients with rheumatoid arthritis and a positive Schirmer's test (RA+), 15 patients with rheumatoid arthritis and negative Schirmer's test (RA-) and 14 normal individuals were analysed for albumin and immunoglobulin concentration as well as IgA and IgM rheumatoid factor (RF) activity. Protein levels in saliva were higher in SSS and RA+ but, when corrected for serum concentration and salivary flow rate, only the IgG ratio remained significantly elevated in SSS (P less than 0.01) and RA- (P less than 0.05) and the IgM ratio was reduced in RA- (P less than 0.05) compared to controls. Although IgM RF activity in serum and saliva was strongly correlated (P less than 0.001) in all three patient groups, the activity in saliva was considerably lower than serum activity. In the two (RA) patients tested, IgM RF in saliva contained secretory component. Mean salivary IgA RF activity varied between 34% (RA-) and 84% (SSS) of serum activity and correlated with serum activity in SSS (P less than 0.001) and RA- (P less than 0.01). IgA RFs in saliva, but not in serum, contained secretory component. Additional demonstration of IgA RF activity in nasal and duodenal secretions in SSS may be related to involvement of the common mucosal immune system.

Adult↗

Radioimmunoassay profile of antiglobulins in connective tissue diseases: elevated level of IgA antiglobulin in systemic sicca syndrome.

A microplate radioimmunoassay for IgG, IgA and IgM antiglobulins reactive with rabbit IgG was performed on sera from 69 patients with various connective tissue diseases. IgM antiglobulins were detected in rheumatoid arthritis, systemic sicca syndrome and some patients with systemic vasculitis. IgA antiglobulins were found in seven of 10 patients with systemic sicca syndrome and only five of 59 patients with other connective tissue diseases. There was no correlation between the levels of IgM and IgA antiglobulins in the systemic sicca syndrome or rheumatoid arthritis (r = -0.21 and 0.2 respectively). IgG antiglobulins were not detected in any serum which lacked IgM or IgA antiglobulins. IgG isolated by DEAE columns showed antiglobulin activity in six of 15 rheumatoid arthritis and two of 10 systemic sicca syndrome sera tested. Antiglobulin analysis of sera fractionated by sucrose density ultracentrifugation at neutral and acid pH enabled the size of each class of antiglobulin to be determined. In certain sera, antiglobulin activity extended into the denser region of the gradient at pH 7.2 suggesting that the antiglobulins were complexed.

Adult↗