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Biomedical subjects

B T Emmerson

Publications and source records attributed to B T Emmerson.

At least 19 recordsLinked to original sources
PubMed1996

The management of gout.

We now have sufficient knowledge to be able to identify the factors contributing to hyperuricemia in most patients with gout. Some of these factors, such as obesity, a high-purine diet, regular alcohol consumption, and diuretic therapy, may be correctable. In patients with persistent hyperuricemia, regular medication should lower the serum urate concentration to an optimal level. The continuing challenge is to educate patients about correctable factors and the importance of regular medication and ensure their compliance so that attacks of gout do not recur.

Acute Disease↗
PubMed1996

Variable hyperhomocysteinaemia phenotype in heterozygotes for the Gly307Ser mutation in cystathionine beta-synthase.

BACKGROUND: A deficiency of cystathionine beta-synthase (CBS) activity is the most frequent cause of homocystinuria, an autosomal recessive disease with multiple clinical manifestations. Mutations in the CBS gene have been reported in several patients with homocystinuria. AIMS: To establish the molecular basis of CBS deficiency in a female patient with pyridoxine non-responsive homocystinuria, and to apply the findings to genetic screening of her family members. METHODS: The entire coding region of the CBS cDNA was amplified by PCR and used for direct sequence analysis. Mutant alleles were confirmed by direct sequence analysis of PCR-amplified genomic DNA, and by a combination of single strand conformation polymorphism and temperature gradient gel electrophoresis analysis. RESULTS: The proband was homozygous for a G919A base transition which predicts the substitution of serine for glycine at codon 307 in the CBS protein (G307S). The parents (both of Irish background) were heterozygotes for the G307S allele, while an asymptomatic sibling had normal CBS sequence, Plasma homocysteine, assessed after an oral methionine load, indicated the mother clearly had moderate hyperhomocysteinaemia, whereas the father had normal concentrations of homocysteine. This is the first report of a normal methionine load test in a proven heterozygote for a CBS mutation which causes severe homocystinuria in the homozygote. Other factor(s) may have contributed to hyperhomocysteinaemia in the mother. The G307S allele has been reported in other patients and appears to be a common allele among families of Celtic origin.

Adolescent↗
PubMed1992

A review of the molecular basis of hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency.

Hypoxanthine-guanine phosphoribosyltransferase (HPRT, EC 2.4.2.8) is a purine salvage enzyme that catalyses the conversion of hypoxanthine and guanine to their respective mononucleotides. Partial deficiency of this enzyme can result in the overproduction of uric acid leading to a severe form of gout, whilst a virtual absence of HPRT activity causes the Lesch-Nyhan syndrome which is characterised by hyperuricaemia, mental retardation, choreoathetosis and compulsive self-mutilation. The HPRT-encoding gene is located on the X chromosome in the region q26-q27 and consists of nine exons and eight introns totalling 57 kb. This gene is transcribed to produce an mRNA of 1.6 kb, which contains a protein encoding region of 654 nucleotides. With the advent of increasingly refined techniques of molecular biology, it has been possible to study the HPRT gene of individuals with a deficiency in HPRT activity to determine the genetic basis of the enzyme deficiency. Many different mutations throughout the coding region have been described, but in the absence of precise information on the three-dimensional structure of the HPRT protein, it remains difficult to determine any consistent correlation between the structure and function of the enzyme.

Base Sequence↗
PubMed1992

Gout due to renal disease.

From 120 patients attending a referral gout clinic, 12 patients were found to have primary renal disease at the time of, or prior to, their first attack of acute gouty arthritis. This number excluded those with chronic lead nephropathy, polycystic kidneys or who were receiving diuretics. The nature of the renal disease was usually of the tubulointerstitial variety rather than of glomerular origin. The renal clearance of urate per unit of glomerular filtration rate, which usually increases with renal disease, was generally reduced, suggesting impairment of renal excretion of urate. Nine of the patients were female (four premenopausal) and only three were males. The degree of renal impairment was only mild to moderate. Other common associations with gout, such as obesity, hypertension and regular alcohol consumption, were not prominent. The intrinsic renal disease in these patients was considered to be the major contributor to their development of hyperuricaemia and gout.

Adult↗
PubMed1992

Genetic control of the renal clearance of urate: a study of twins.

Although a genetic predisposition to gout has been recognised for centuries, its mechanism has never been defined. This study was designed to determine whether this factor might be the renal clearance of urate, which is an important determinant of the concentration of urate in serum. In this study the renal clearance of urate was examined in 37 pairs of normouricaemic twins to determine whether this resemblance was genetically mediated. Monozygotic twins had more similar values of urate clearance and fractional excretion of urate than dizygotic twins. The heritability of the renal clearance of urate was estimated as about 60% (95% confidence limits 40 to 100%), whereas the heritability of the fractional excretion of urate was 87% (confidence limits 45 to 100%). This study supports the hypothesis that genetic factors exert an important control on the renal clearance of urate, which determines some of the familiarity of hyperuricaemia and gout.

Adolescent↗
PubMed1991

The molecular characterisation of HPRT CHERMSIDE and HPRT COORPAROO: two Lesch-Nyhan patients with reduced amounts of mRNA.

A complete deficiency of the purine salvage enzyme, hypoxanthine phosphoribosyltransferase (HPRT; EC 2.4.2.8), in man results in the Lesch-Nyhan (LN) syndrome. Two unrelated patients with the full LN syndrome showed no evidence of a major alteration to the gene encoding HPRT (HPRT) by restriction endonuclease analysis, but exhibited negligible levels of HPRT mRNA on Northern blots. DNA from these patients was characterised further. Amplification, by the polymerase chain reaction (PCR), of individual HPRT-exon fragments from genomic DNA followed by nucleotide (nt) sequence analysis using automated technology, revealed single-base mutations in each patient. One patient has an insertion of a T within exon-2, which places a stop codon in frame, presumably resulting in premature termination of translation of the HPRT mRNA. The other patient has a G----A base substitution at the 5' end of intron-6, at the junction of exon-6 and intron-6. Although dot blot analysis indicated negligible HPRT mRNA in lymphoblast cells from both patients, we were successful in amplifying HPRT cDNA using PCR. Direct nt sequence analysis of the amplified cDNA confirmed the insertion of a T in exon-2 in the one patient and revealed a complete deletion of exon-6 in the other patient, the latter event presumably arising due to aberrant splicing of primary message. Both mutations were also confirmed by hybridisation of amplified genomic DNA with allele-specific oligodeoxyribonucleotide probes. This study illustrates two approaches for analysing DNA mutations at the molecular level and demonstrates the power of PCR technology in the study of genetic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗
PubMed1991

Identification of the causes of persistent hyperuricaemia.

Accurate identification of the factors that contribute to hyperuricaemia in an individual may enable some of these factors to be modified, and lead to permanent correction of the hyperuricaemia. A protocol is described which can supplement clinical assessment. Measurement of the effects on serum urate and urinary urate excretion of a low-purine diet for 7 days facilitates the identification of the contributions made by urate production (either endogenous or from purine consumption) and renal underexcretion of urate (either as a low urate clearance in the absence of renal disease or due to renal glomerular insufficiency).

Humans↗
PubMed1991

Localization of the 5-phospho-alpha-D-ribosyl-1-pyrophosphate binding site of human hypoxanthine-guanine phosphoribosyltransferase.

Human erythrocyte hypoxanthine-guanine phosphoribosyltransferase (HPRT) is inactivated by iodoacetate in the absence, but not in the presence, of the substrate, 5-phospho-alpha-D-ribosyl-1-pyrophosphate (PRib-PP). Treatment of HPRT with [14C]iodoacetate followed by tryptic digestion, peptide separation and sequencing has shown that Cys-22 reacts with iodoacetate only in the absence of PRib-PP; this strongly suggests that Cys-22 is in or near the PRib-PP binding site. In contrast, Cys-105 reacts with [14C]iodoacetate both in the presence and absence of PRib-PP. Carboxymethylation of Cys-22 resulted in an increase in the Km for PRib-PP, but no change in Vmax. Storage of HPRT also resulted in an increase in the Km for PRib-PP and a decrease in its susceptibility to inactivation by iodoacetate. Dialysis of stored enzyme against 1 mM dithiothreitol resulted in a marked decrease in Km for PRib-PP. The stoichiometry of the reaction of [14C]iodoacetate with Cys-22 in HPRT leading to inactivation (approx. 1 residue modified per tetramer) showed that, in this preparation of HPRT purified from erythrocytes, only about 25% of the Cys-22 side chains were present as free and accessible thiols. Titration of thiol groups [with 5,5'-dithiobis(2-nitrobenzoic acid)] and the effect of dithiothreitol on Km for PRib-PP indicate that oxidation of thiol groups occurs on storage of HPRT, even in the presence of 1 mM beta-mercaptoethanol.

Binding Sites↗
PubMed1991

Hypoxanthine-guanine phosphoribosyltransferase deficiency: analysis of HPRT mutations by direct sequencing and allele-specific amplification.

The Lesch-Nyhan syndrome is a severe X chromosome-linked human disease caused by a virtual absence of hypoxanthine-guanine phosphoribosyltransferase (HPRT) activity. A partial deficiency in the activity of this enzyme can result in gouty arthritis. To determine the genetic basis for reduction or loss of enzyme activity, we have amplified and sequenced the coding region of HPRT cDNA from four patients: one with Lesch-Nyhan syndrome (HPRTPerth) and three with partial deficiencies of HPRT activity, which have been designated HPRTUrangan, HPRTSwan and HPRTToowong. In all four patients, the only mutation identified was a single base substitution in exons 2 or 3 of the coding region, which in each case predicts a single amino acid substitution in the translated protein. Each base change was confirmed by allele-specific amplification of the patient's genomic DNA. It is interesting to note that the mutation found for HPRTPerth is identical to that reported for HPRTFlint. It appears that the two mutations are de novo events.

Alleles↗
PubMed1991

Ultrastructural studies of the reaction of urate crystals with a cultured renal tubular cell line.

Hypotheses concerning the development of uric acid and gouty nephropathy suggest that the initiating disease mechanism involves an interaction between uric acid or monosodium urate monohydrate (MSUM) crystals and renal tubular epithelial cells. We have studied the interaction of these crystals with Madin-Darby canine kidney (MDCK) cells, which exhibit many of the characteristics of cells of the collecting duct epithelium. Addition of MSUM crystals to monolayer cultures of MDCK cells leads to the formation of reaction sites, localised areas which are raised above the monolayer forming a 3-dimensional structure. These reaction sites are evident within 4-8 h and appear to be initiated by the interaction of a single crystal or small number of crystals with a single cell. With time, both cells and crystals accumulate at the site. By 24 h most reaction sites involve 6-12 cells and numerous crystals. Interaction of MSUM crystals and MDCK cells not only involves the attachment of crystals to cells but, by 8 h, some crystals appear to be completely or partially covered by the cell membrane, and MDCK cells appear to react by growing around the crystals. Transmission electron microscopy shows that crystals are found not only within cells, but also within the intercellular spaces. Within the cells, crystals have been shown in vacuoles containing lysosomal enzymes, indicating the formation of a phagolysosome. Ultimately, enzyme release occurs. These studies support the hypothesis that some interstitial deposits of urate and uric acid in the kidney may be derived from intratubular deposits that react with the tubular epithelium and pass into the interstitium; loss of tubular integrity may not be a prerequisite for crystal migration.

Animals↗