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Biomedical subjects

H Blumberg

Publications and source records attributed to H Blumberg.

At least 19 recordsLinked to original sources

11 IL-1 family members in inflammatory skin disease.

The cytokines IL-1alpha and IL-1beta have long been known to play a profound role in inflammation, and in the past decade another cytokine, IL-18 (originally known as IGIF), has also been realized to be an IL-1 family member and to possess significant inflammatory activity. Half a dozen additional members of the IL-1 family have been identified in recent years, and given their relatedness to IL-I and IL-18, it is tempting to speculate that they too might possess inflammatory potential. We have demonstrated that certain of these cytokines can activate MAP kinases and the pathway leading to NFkappaB, via known IL-1R family members. Moreover, when overexpressed in skin, they are capable of causing an inflammatory skin condition resembling that seen in human disease.

Animals↗

Glutamate and GABA systems as targets for novel antidepressant and mood-stabilizing treatments.

Glutamate and gamma-amino butyric acid (GABA) systems are emerging as targets for development of medications for mood disorders. There is increasing preclinical and clinical evidence that antidepressant drugs directly or indirectly reduce N-methyl-D-aspartate glutamate receptor function. Drugs that reduce glutamatergic activity or glutamate receptor-related signal transduction may also have antimanic effects. Recent studies employing magnetic resonance spectroscopy also suggest that unipolar, but not bipolar, depression is associated with reductions in cortical GABA levels. Antidepressant and mood-stabilizing treatments also appear to raise cortical GABA levels and to ameliorate GABA deficits in patients with mood disorders. The preponderance of available evidence suggests that glutamatergic and GABAergic modulation may be an important property of available antidepressant and mood-stabilizing agents. Future research will be needed to develop and evaluate new agents with specific glutamate and GABA receptor targets in the treatment of mood disorders.

Antidepressive Agents↗

Interleukin 20: discovery, receptor identification, and role in epidermal function.

A structural, profile-based algorithm was used to identify interleukin 20 (IL-20), a novel IL-10 homolog. Chromosomal localization of IL-20 led to the discovery of an IL-10 family cytokine cluster. Overexpression of IL-20 in transgenic (TG) mice causes neonatal lethality with skin abnormalities including aberrant epidermal differentiation. Recombinant IL-20 protein stimulates a signal transduction pathway through STAT3 in a keratinocyte cell line, demonstrating a direct action of this ligand. An IL-20 receptor was identified as a heterodimer of two orphan class II cytokine receptor subunits. Both receptor subunits are expressed in skin and are dramatically upregulated in psoriatic skin. Taken together, these results demonstrate a role in epidermal function and psoriasis for IL-20, a novel cytokine identified solely by bioinformatics analysis.

Animals↗

Hippocampal and anterior cingulate activation deficits in patients with geriatric depression.

OBJECTIVE: The authors assessed frontotemporal function in patients with geriatric depression, a debilitating and increasingly prevalent disorder that has not been examined with brain activation paradigms. METHOD: Six depressed elderly patients and five healthy comparison subjects underwent high-sensitivity [(15)O]H(2)O positron emission tomography scans during a paced word generation task and a resting condition. RESULTS: Bilateral activation deficits were noted in the dorsal anterior cingulate gyrus and hippocampus of the depressed geriatric patients relative to the comparison subjects. Patients had memory deficits that correlated with lower hippocampal activity during both rest and activation. CONCLUSIONS: These initial findings suggest that hippocampal and dorsal anterior cingulate hypoactivation may constitute contributing neural substrates of geriatric depression. They also suggest that hippocampal dysfunction is related to the memory dysfunction characteristic of this disorder.

Age Factors↗

TACI and BCMA are receptors for a TNF homologue implicated in B-cell autoimmune disease.

B cells are important in the development of autoimmune disorders by mechanisms involving dysregulated polyclonal B-cell activation, production of pathogenic antibodies, and co-stimulation of autoreactive T cells. zTNF4 (BLyS, BAFF, TALL-1, THANK) is a member of the tumour necrosis factor (TNF) ligand family that is a potent co-activator of B cells in vitro and in vivo. Here we identify two receptors for zTNF4 and demonstrate a relationship between zTNF4 and autoimmune disease. Transgenic animals overexpressing zTNF4 in lymphoid cells develop symptoms characteristic of systemic lupus erythaematosus (SLE) and expand a rare population of splenic B-Ia lymphocytes. In addition, circulating zTNF4 is more abundant in NZBWF1 and MRL-lpr/lpr mice during the onset and progression of SLE. We have identified two TNF receptor family members, TACI and BCMA, that bind zTNF4. Treatment of NZBWF1 mice with soluble TACI-Ig fusion protein inhibits the development of proteinuria and prolongs survival of the animals. These findings demonstrate the involvement of zTNF4 and its receptors in the development of SLE and identify TACI-Ig as a promising treatment of autoimmune disease in humans.

Amino Acid Sequence↗

Community-acquired Pseudomonas stutzeri vertebral osteomyelitis in a previously healthy patient: case report and review.

Pseudomonas stutzeri is a rare pathogen, and its recovery is often associated with colonization and contamination. We report a case that, to our knowledge, is the first of community-acquired P. stutzeri vertebral osteomyelitis in a previously healthy patient, and we review the literature regarding infections with this uncommon organism. Of the 29 previously reported cases of P. stutzeri infection cited in the literature, only two resulted in death, reflecting the relatively low degree of virulence of this organism. Predisposing risk factors for P. stutzeri infection can be categorized as follows: (1) previous surgery or procedure (implying probable nosocomial acquisition), with or without a foreign body; (2) immunocompromise (an underlying predisposition to infection by an organism with low virulence); (3) immunocompromise and a previous procedure; and (4) previous trauma or superficial infection, with or without possible nosocomial contamination. Our patient lacked any known risk factors for either pyogenic vertebral osteomyelitis or P. stutzeri infection.

Acute Disease↗

Sympathetic nervous system and pain: a clinical reappraisal.

The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called "reflex sympathetic dystrophy" (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called "sympathetically maintained pain" (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic-sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.

Aged↗

Inhibitory properties of a novel human Kunitz-type protease inhibitor homologous to tissue factor pathway inhibitor.

In a previous report, we described the molecular cloning, expression, and partial characterization of a second human tissue factor pathway inhibitor (TFPI), which we designated as TFPI-2 [Sprecher, C. A., et al. (1994) Proc. Natl. Acad. Sci. U.S.A. 91, 3353-3357]. Recombinant TFPI-2 inhibited the amidolytic activity of trypsin as well as that of factor VIIa in complex with tissue factor. TFPI-2 recently has been shown to be identical to placental protein 5 (PP5), a glycoprotein originally isolated from placenta that exhibits serine protease inhibitory activity. In the present study, we have examined TFPI-2/PP5 for its ability to inhibit a number of serine proteases involved in blood coagulation and fibrinolysis, inasmuch as TFPI-2/PP5 prolonged the coagulation time of human plasma induced by either tissue factor or contact activation in a dose-dependent manner. In addition to its ability to inhibit the amidolytic and proteolytic activities of the factor VIIa-tissue factor complex, TFPI-2/PP5 strongly inhibited the amidolytic activities of human factor XIa, human plasma kallikrein, and human plasmin with Ki values of 15, 25, and 3 nM, respectively. TFPI-2/PP5 was also a weak inhibitor of the activation of factor X by a complex of human factor IXa and poly(lysine) with an apparent Ki of 410 nM. Heparin markedly enhanced the ability of TFPI-2/PP5 to inhibit factor VIIa-tissue factor both in the solution phase and on cell surfaces. In addition, heparin augmented the inhibition of human factor Xa amidolytic activity at relatively high levels (10-100 nM) of TFPI-2/PP5. No significant inhibition of glandular kallikrein, urinary plasminogen activator, tissue plasminogen activator, human activated protein C, human factor Xa, human thrombin, or leukocyte elastase was observed when these proteases were incubated with TFPI-2 in the absence of heparin.

Amino Acid Sequence↗

[Diagnosis of sympathetic reflex dystrophy. Comparison of ischemia test and modified guanethidine blockade].

Recently, the ischemia-test (IT) had been suggested to be part of the diagnostic procedure for reflex sympathetic dystrophy (RSD). The present study investigated, for the first time whether pain suppressing, as typically occurring under the IT, would correlate in RSD to the pain relieving effect following a diagnostic guanethidine blockade. For this purpose, both IT and guanethidine blockade were applied to 40 RSD-patients. A high correlation was found between the results of both procedures: 89% of those cases, who showed a positive IT (38 out of 40 patients) also reported acute pain relieve following the guanethidine blockade. Thus, both procedures have the same diagnostic value for pain in RSD. These results are in agreement with new pathophysiological considerations, assuming an indirectly (via the microvascular system) mediated sympathetic-afferent coupling as a cause of pain in RSD.

Adult↗

The anatomy of a consultation: a teaching method.

The Anatomy of a Consultation is a teaching method useful in introducing residents to Consultation-Liaison psychiatry. It is designed to stimulate them to think actively about the process of consultation in its broadest implications, including interaction with staff. The residents are encouraged to observe, make inferences, establish hypotheses about the evolution of the consultation, and to test these hypotheses by obtaining new information. The analogy of an unfolding detective story is used. A resident is asked to present the evolution of a consultation chronologically for ongoing group discussion. A vertical and a horizontal approach to the examination of the material are used. The vertical proceeds with clarification of the consultation as it evolves toward closure. The horizontal takes as its point of departure various topics that emerge to illustrate general principles and applications in different situations. These topics are approached more systematically and in greater detail in later teaching. Emphasis is placed upon coping and adaptation and the principles of active interventions useful for people in crisis. Patient data is organized within two broad categories: 1) the diagnostic, phenomenologic, and psychopathologic; and 2) the psychodynamic, conflictual, and life historical. An illustrative example is presented.

Adaptation, Psychological↗

GATA-4 is a novel transcription factor expressed in endocardium of the developing heart.

We have isolated and characterized Xenopus cDNA clones for a new transcription factor that represents an early marker for the developing heart. The cDNAs encode a protein that we have designated GATA-4; it contains the highly conserved DNA-binding domain that characterizes this family of cell-type restricted transcriptional activators. Whole-embryo in situ analysis of Xenopus embryos demonstrates that the GATA-4 gene is transcribed in presumptive cardiac ventral mesoderm at the time that bilateral progenitors fuse and form the cardiac tube. GATA-4 is therefore the earliest molecular marker of cardiogenesis yet characterized. By stage 30, the GATA-4 mRNA is expressed in the developing atria and ventricles; at stage 38, cross-sections reveal that the gene is active in the endocardial layer, but not in myocardium. By stage 40, GATA-4 message is detected in the great vessels. In the adult frog, the GATA-4 gene is highly transcribed in heart and gut; lower levels of message are detected in various endoderm-derived tissues and gonads. Expression in the stomach is largely confined to the epithelium. The GATA-4 gene is first activated at stage 11; mRNA is initially present throughout the marginal zone of explants and later partially localized to the ventral marginal zone. GATA-4 mRNA is also detected at high levels in cultured endodermal explants derived from the vegetal region of early embryos. In mesoderm induction experiments, GATA-4 transcription is not induced in animal caps treated with activin or bFGF. The GATA-4 gene may provide a new early marker for studying the inductive processes that lead to the formation of the cardiovascular system and for the specification of the endocardial lineage.

Amino Acid Sequence↗

A split zinc-finger protein is required for normal yeast growth.

We have identified a gene that, when present in multiple copies, partially inhibits nuclear protein localization in Saccharomyces cerevisiae. This gene encodes a protein that is a unique member of the Cys2His2 zinc-finger family of DNA-binding proteins. It is designated SFP1 for split finger protein because its two zinc-finger domains are separated from one another by 40 amino acids (aa) as opposed to the usual spacing of 7 or 8 aa for Cys2His2 proteins. Disruption of the SFP1 gene results in slow cell growth, with cells having multiple, nucleated buds.

Amino Acid Sequence↗

A homologue of the bacterial heat-shock gene DnaJ that alters protein sorting in yeast.

Heat-shock proteins have been implicated in assembly of protein complexes, correct protein folding and uptake of proteins into organelles. In Escherichia coli, the heat-shock protein DnaJ and the Hsp70 homologue, DnaK, act together to disassemble a protein complex involved in bacteriophage lambda replication. We report the identification of SCJ1, a gene in the yeast Saccharomyces cerevisiae that encodes a homologue of the bacterial DnaJ protein. SCJ1 was identified by a genetic screen in which increased expression of candidate genes results in missorting of a nuclear-targeted test protein. The predicted amino-acid sequence of SCJ1 is 37% identical to the entire E. coli DnaJ protein. Hybridization experiments indicate that there is a family of yeast genes related to SCJ1. These findings suggest that the Hsp70 DnaK-DnaJ interaction is general to eukaryotes.

Amino Acid Sequence↗

Tremor in reflex sympathetic dystrophy.

Postural hand tremor was quantitatively investigated on both sides in 21 patients suffering from unilateral reflex sympathetic dystrophy of the upper extremity. On the affected side, enhanced tremor amplitude, with a mean tremor frequency of 7.2 Hz, was found in 57% of the patients. The appearance of tremor did not correlate to the occurrence of a single clinical symptom of reflex sympathetic dystrophy. On loading with increasing weight, the frequency of this pathological tremor shifted toward lower values, as it is found in physiological tremor. However, the peak frequencies of the electromyogram remained more or less stable. On recovery from this condition, the reflex sympathetic dystrophy tremor disappeared. Acute sympatholytic intervention could normalize reflex sympathetic dystrophy tremor. This would suggest that the sympathetic supply of the affected extremity contributes to the tremor in reflex sympathetic dystrophy. In conclusion, it is suggested that reflex sympathetic dystrophy should be included among the causes of tremor. According to our findings, tremor in reflex sympathetic dystrophy should be regarded as an enhanced physiological tremor.

Electromyography↗

[Neurologic aspects of clinical manifestations, pathophysiology and therapy of reflex sympathetic dystrophy (causalgia, Sudeck's disease)].

The symptomatology of reflex sympathetic dystrophy (RSD), a diagnostic term which today includes causalgia and M. Sudeck, is characterized clinically by a triad of autonomic (sympathetic), motor and sensory disturbances. They develop following a noxious event--though independent of its nature and location--in a generalized distribution pattern at the distal site of the affected extremity. Pathophysiologically, a complex disturbance of the sympathetic vasoconstrictor system is involved, which mediates the dominant symptoms of RSD, namely the spontaneous pain and the swelling. This disturbance is thought to be initiated by nociceptive impulses, occurring in conjunction with the preceding noxious event, and to be maintained reflexly, in a form of a vicious circle, by means of the typical pain sensation accompanying the RSD-syndrome. From these ideas, an important part of the RSD therapy is deduced; i.e. the early interruption of the neuronal sympathetic activity by means of a sympathetic blockade. Such a blockade can interrupt the pain and at the same time also the vicious circle of RSD. Altogether, for the RSD syndrome there are relevant neurological aspects with respect to its clinical symptomatology, its pathophysiology and its therapy.

Autonomic Nerve Block↗

General assay for phosphoproteins in cerebrospinal fluid: a candidate marker for paraneoplastic cerebellar degeneration.

The components of protein phosphorylation systems (protein kinases, protein phosphatases, and their phosphoprotein substrates) are highly enriched in neuronal cells compared with other cell types. We exploited this relative neuronal enrichment of protein phosphorylation system components to develop a general assay technique for putative protein kinase substrates (phosphoproteins) in human cerebrospinal fluid. Using this cerebrospinal fluid phosphoprotein assay, we have detected a putative protein kinase C substrate protein of apparent Mr 60 kd in 6 of 14 patients with paraneoplastic cerebellar degeneration but not in any of 55 patients with a variety of other neurological diseases. Phosphoproteins in cerebrospinal fluid may provide novel and unique markers for the diagnosis or staging of neuronal diseases as well as offer potential insights into the biochemical characterization of affected neuronal populations.

Adult↗

[New viewpoints on the clinical picture, diagnosis and pathophysiology of reflex sympathetic dystrophy (Sudeck's disease)].

Reflex sympathetic dystrophy can be elicited by various factors (e. g. trauma, herpes zoster, myocardial infarction). Independent of kind and site of a lesion, symptoms occur most often in the whole distal part of the affected extremity. There in most cases, a triad of autonomic, motor and sensory disturbances can be found clinically. For early diagnosis--beside clinical investigation--a comparative measurement of skin temperatures on both sides of finger or toe tips, respectively, is recommended. Hereby the clinical finding of a warmer or colder extremity can be proved, which supplies evidence of a disturbed skin blood flow. In case, the above mentioned triad and a disturbance of skin circulation is found, diagnosis of sympathetic reflex dystrophy can be made with great certainty. With regard to the underlying pathophysiology, symptoms can be explained at this time satisfactory only by the assumption of a vicious circle. Starting from a painful event (e.g. trauma, mark in a plaster cast, nerve lesion or myocardial infarction) a functional disturbance of the sympathetic nervous system is initiated. This results in a disturbance of the circulation in all of the affected tissues (skin, muscle, bone and joint), which finally gives rise to an abnormal excitation of afferent receptors, particularly of nociceptors. This excitation maintains the disturbance of the sympathetic nervous system at central nervous level (vicious circle). The most relevant pathomechanism in this process seems to be the occurrence of an imbalance between the activity of sympathetic vasoconstrictor neurons supplying arteries and those, supplying veins. A sympatholytic therapy, if applied in time, is able to cut off the vicious circle, which may lead to a restitutio ad integrum. Further investigations will show to what extent psychological factors are involved in developing the central nervous disturbance of the sympathetic nervous system and may also show if in addition the motor system is affected.

Diagnosis, Differential↗