Biomedical subjects

N Longo

Publications and source records attributed to N Longo.

At least 37 records · Page 2Linked to original sources

PubMed1999

Mutations in the organic cation/carnitine transporter OCTN2 in primary carnitine deficiency.

Primary carnitine deficiency is an autosomal recessive disorder of fatty acid oxidation caused by defective carnitine transport. This disease presents early in life with hypoketotic hypoglycemia or later in life with skeletal myopathy or cardiomyopathy. The gene for this condition maps to 5q31.2-32 and OCTN2, an organic cation/carnitine transporter, also maps to the same chromosomal region. Here we test the causative role of OCTN2 in primary carnitine deficiency by searching for mutations in this gene in affected patients. Fibroblasts from patients with primary carnitine deficiency lacked mediated carnitine transport. Transfection of patient's fibroblasts with the OCTN2 cDNA partially restored carnitine transport. Sequencing of the OCTN2 gene revealed different mutations in two unrelated patients. The first patient was homozygous (and both parents heterozygous) for a single base pair substitution converting the codon for Arg-282 to a STOP codon (R282X). The second patient was a compound heterozygote for a paternal 1-bp insertion producing a STOP codon (Y401X) and a maternal 1-bp deletion that produced a frameshift creating a subsequent STOP codon (458X). These mutations decreased the levels of mature OCTN2 mRNA and resulted in nonfunctional transporters, confirming that defects in the organic cation/carnitine transporter OCTN2 are responsible for primary carnitine deficiency.

Amino Acid Sequence↗

PubMed1999

Primary and secondary alterations of neonatal carnitine metabolism.

Carnitine plays an essential role in the transfer of long-chain fatty acids across the inner mitochondrial membrane, in the detoxification of acyl moieties, and in maintaining normal levels of free coenzyme A. Although carnitine can be synthesized in liver and kidney, normal adults obtain the majority of carnitine from the diet. Preterm newborns have a reduced capacity to synthesize carnitine. Total parenteral nutrition lacks carnitine and exposes very low birth weight infants to carnitine deficiency, with decreased production of ketones from long-chain fatty acids. Supplementation with low doses of carnitine improves nitrogen balance and growth in these infants. Carnitine deficiency can be part of a number of inherited and acquired diseases. Primary carnitine deficiency is an autosomal recessive disorder characterized by increased losses of carnitine in the urine and decreased accumulation in the heart and skeletal muscle caused by defective carnitine transport. This condition is corrected by high-dose carnitine supplementation. Secondary carnitine deficiency can be caused by increased losses, pharmacological therapy, or a number of inherited metabolic disorders that must be correctly diagnosed before initiating carnitine supplementation.

Carnitine↗

PubMed1999

Progressive decline in insulin levels in Rabson-Mendenhall syndrome.

Mutations in the insulin receptor gene cause the severe insulin-resistant syndromes leprechaunism and Rabson-Mendenhall syndrome, whose metabolic features include fasting hypoglycemia, post-prandial hyperglycemia, and extremely elevated insulin levels. Patients with Rabson-Mendenhall syndrome have a protracted course and eventually develop ketoacidosis. To determine the mechanism causing this progression and the paradoxical fasting hypoglycemia, we conducted a retrospective study in a patient with Rabson-Mendenhall syndrome, who was a compound heterozygous for two missense mutations affecting the kinase domain of the insulin receptor beta-subunit (I1115T and R1131W). At birth, the patient had fasting hypoglycemia and postprandial hyperglycemia. This was followed at approximately 3 yr of age by constant hyperglycemia and, at 6 yr of age, by constant ketoacidosis. Urinary organic acids during ketoacidosis resembled those of patients with type 1 diabetes. Plasma glucose levels increased (r2 = 0.31; P < 0.01), whereas insulin levels decreased with age (r2 = 0.51; P < 0.01). During periods ofhypoglycemia and hyperglycemia (0-1 yr of age), constant hyperglycemia (3-4 yr of age), and hyperglycemia with ketoacidosis (6-7 yr of age), insulin levels were significantly correlated with plasma glucose levels (P < 0.05). However, the slope of the regression and the predicted insulin level at zero glucose decreased with increasing age. When insulin levels were normalized for the plasma glucose concentrations, an exponential decrease in the insulin/glucose ratio was observed (r2 = 0.92; P < 0.01), with most of the decline occurring before 2 yr of age. These results indicate that the paradoxical fasting hypoglycemia of patients with Rabson-Mendenhall syndrome is associated with severely increased levels of circulating insulin and that the progression of this disease is due to a decline in insulin levels.

Blood Glucose↗

PubMed1998

Role of arginine 86 of the insulin receptor in insulin binding and activation of glucose transport.

Mutations in the insulin receptor gene cause the inherited insulin resistant syndrome leprechaunism. Patient Atl-1 with leprechaunism was homozygous for the substitution of Arg-86 with Pro (R86P) in the alpha subunit of the insulin receptor. Fibroblasts homozygous for the mutant receptor had defective insulin binding, but increased glucose transport and receptor kinase activity. The R86P mutation is located in a putative beta turn N-terminal to a proposed insulin binding domain of the receptor [P. DeMeyts, J.L. Gu, R.M. Shymko, B.E. Kaplan, G.I. Bell, J. Whittaker, Mol. Endocrinol. 4 (1990) 409-416]. To get further insight into the mechanism of the paradoxical activation of receptor signalling by the R86P mutation, the codons for proline, alanine, and glycine were substituted in the R86 position of the insulin receptor cDNA by PCR-mediated mutagenesis and stably transfected into Chinese hamster ovary (CHO) cells. Insulin binding increased 10-20 fold in CHO cells transfected with the wild type, the R86A, and the R86G insulin receptor cDNA, but did not increase in cells expressing the R86P mutation. The R86P mutation caused a constitutive activation of insulin receptor phosphorylation in CHO cells, but did not increase basal glucose transport or its sensitivity to insulin stimulation. By contrast, transfection with the wild type and the R86A receptors increased 20-30 fold the sensitivity of glucose transport to stimulation by insulin. The R86G insulin receptor bound insulin normally, but was four times less efficient than the wild type or R86A insulin receptor in increasing the sensitivity for insulin stimulation of glucose transport. These results indicate that position 86 of the insulin receptor alpha subunit is tolerant to substitution by alanine, but not by proline. Substitution with glycine allows insulin binding, but does not activate normally glucose transport, further supporting an essential role of this position in the initiation of insulin receptor signalling of glucose transport.

3-O-Methylglucose↗

PubMed1998

Human glucose transporters.

Concentrative and facilitative glucose transporters are responsible for the movement of glucose across the plasma membrane of human cells. Defects in concentrative glucose transporters cause renal glycosuria and glucose-galactose malabsorption. Alterations in facilitative glucose transporters explain the newly discovered syndrome of low CNS glucose in the presence of normal blood sugar, causing seizures and developmental delay. Defects in other facilitate glucose transporters also help explain Fanconi-Bickel syndrome, glycogen storage disease type, Id, and non-insulin-dependent diabetes mellitus.

Carbohydrate Metabolism, Inborn Errors↗

PubMed1997

Abnormal formation of collagen cross-links in skin fibroblasts cultured from patients with Ehlers-Danlos syndrome type VI.

Ehlers-Danlos syndrome type VI (EDS VI) is an autosomal recessive disorder of connective tissue characterized by hyperextensible, friable skin and joint hypermobility. Severe scoliosis and ocular fragility are present in some patients. This disease is caused by defective collagen lsyl hydroxylase, a vitamin C-dependent enzyme that converts lysyl residues to hydroxylysine on procollagen peptides. Hydroxylysine is essential for the formation of the covalent pyridinium cross-links pyridinoline (Pyr) and deoxypyridinoline (Dpyr), among mature collagen molecules. Pyr derives from three hydroxylysyl residues, whereas Dpyr derives from one lysyl and two hydroxylysyl residues. Patients with EDS VI have high urinary excretion of Dpyr, resulting in a high ratio of Dpyr-Pyr. In this study, we evaluate content and production of pyridinium cross-links in the skin and cultured fibroblasts from patients with EDS VI. The skin of normal controls contained both Pyr and Dpyr, with a marked predominance of Pyr as observed in normal urine. The skin of patients with EDS VI had reduced total content of pyridinium cross-links, with the presence of Dpyr but not Pyr. Long-term cultures of control fibroblasts produced both Pyr and Dpyr, with a pattern resembling that of normal skin. By contrast, cross-links were not detected in dermal fibroblasts cultured from patients with EDS VI. Vitamin C, which improves the clinical manifestations of some patients with EDS VI, decreased Dpyr accumulation though only minimally affecting Pyr content in control cells. By contrast, addition of vitamin C to fibroblasts from patients with EDS VI stimulated the formation of Dpyr more than that of Pyr and greatly increased total pyridinium cross-link formation. These results indicate that qualitative and quantitative alterations of pyridinium cross-links occur in skin and in cultured dermal fibroblasts of patients with EDS VI and may be responsible for their abnormal skin findings. The vitamin C-stimulated production of Dpyr and Pyr in fibroblasts from patients with EDS VI may explain at least in part the therapeutic effects of this vitamin in EDS VI.

Adolescent↗

PubMed1997

[Follow-up of testicular tumors in the metastatic diffusion phase. Current orientation].

Lymphadenectomy in germinal tumors of the testis, in spite of the immediate morbility (postoperative complications) and of the permanent morbility (unejaculation), is still, as regards the group of non-seminoma neoplasms, the most suitable for survival. However, groups of oncologists are seeking the possibility of avoiding this technique at stage I and II of the lesions, with the help, of course, of careful observation by CT, NMR, markers. The use of combined therapies (chemotherapy and radius therapy) has increased survival and the patients' life, allowing a highly satisfying percentage of recovery also in the non-initial stages.

Humans↗

PubMed1996

Insulin stimulates the Na+,K(+)-ATPase and the Na+/K+/Cl- cotransporter of human fibroblasts.

Insulin regulation of K+ (Rb+) transport was investigated in cultured human fibroblasts using a non-radioactive method which allows the simultaneous determination of the intracellular concentration of other monovalent cations. Insulin stimulated Rb+ influx through the Na+,K(+)-ATPase and the Na+/K(+)/Cl- cotransporter in human fibroblasts. Insulin stimulation was very rapid and maximal effect was observed within 10 min. Insulin stimulation of Rb+ uptake via the Na+,K(+)-ATPase and the Na+/K(+)/Cl- cotransporter was dose-dependent, with half-maximal stimulation at 2-3 nM of hormone. Insulin increased the V(max) of both transporters involved, affecting only minimally their Km. In other cells, insulin stimulates the Na+,K(+)-pump by increasing Na+ availability through the Na+/H+ exchanger. In human fibroblasts, insulin stimulation of Na+,K(+)-ATPase occurred in the presence of ethyl-isopropyl amiloride, an inhibitor of the Na+/H+ exchanger, and without sustained changes in intracellular[Na+]. By contrast, insulin action on Na+,K(+)-ATPase was impaired by the protein kinase inhibitors staurosporine and genistein. These results indicate that, in human fibroblasts, insulin stimulates both the Na+,K(+)-ATPase and the Na+/K+/Cl- cotransporter, that stimulation of the Na+,K(+)-ATPase occurs in the absence of changes in intracellular [Na+], and that protein kinase activity is essential for this insulin action.

Adult↗

PubMed1996

Ketanserin plus prostaglandin E1 (PGE-1) as intracavernosal therapy for patients with erectile dysfunction unresponsive to PGE-1 alone.

OBJECTIVE: To evaluate the treatment of patients with erectile dysfunction and who were unresponsive to intracavernosal injections of prostaglandin E-1 (PGE-1) alone with a combination of PGE-1 and ketanserin, a peripheral vasodilator antagonizing 5-hydroxytryptamine receptors and with mild alpha-blocking effects. PATIENTS AND METHODS: The study comprised 98 men with erectile dysfunction all of whom received an intracavernosal injection of 5-40 micrograms of PGE-1. The 45 patients unresponsive to the maximum dose of 40 micrograms were selected for further treatment using a combined dose of 40 micrograms PGE-1 and 2-7 mg of ketanserin. Their erectile response was assessed both subjectively, by interviewing the patient and their partner, and objectively using the 'Rigiscan' monitor. RESULTS: The combined therapy was effective in producing an erection sufficient for sexual intercourse in 34 (76%) of the patients. The combined dose was tolerated well and there were no adverse effects. CONCLUSIONS: The results of this preliminary study suggest that the combination of PGE-1 and ketanserin may be a therapeutic alternative to the implantation of a prosthesis in patients unresponsive to PGE-1.

Alprostadil↗

PubMed1995

Altered subcellular location of an activated and tumour-associated epidermal growth factor receptor.

The epidermal growth factor (EGF) receptor is a membrane bound tyrosine kinase whose activity is initiated by ligand binding. The malignant brain tumour glioblastoma frequently shows amplification and rearrangements of the EGF receptor gene that are associated with the synthesis of a constitutively activated tyrosine kinase, lacking amino acids 6-273 near the protein's N-terminus. When expressed in Chinese hamster ovary (CHO) cells, this mutant receptor (p140EGFR) displays ligand-independent tyrosine kinase activity, stimulates DNA synthesis, and promotes cell proliferation. Here, we investigate the subcellular location of p140EGFR in CHO cell transfectants as well as in human glioblastoma tumours. p140EGFR had an intracellular location that contrasted sharply with the plasma membrane location of the wild-type EGF receptor. Endoglycosidase H sensitivity analysis and the pattern of p140EGFR immunoreactivity suggested that the aberrant tyrosine kinase resided primarily in the endoplasmic reticulum. The half-life of p140EGFR in the endoplasmic reticulum was extended several-fold over that of the ligand-activated wild-type receptor. The altered subcellular location of p140EGFR in combination with its prolonged half-life suggest that this activated tyrosine kinase may escape the regulatory mechanisms utilized for the attenuation of wild-type receptor signaling. Therefore, the previously reported growth stimulatory property of the ligand-independent p140EGFR may be attributed to a sustained tyrosine kinase activity resulting from an altered subcellular location.

Animals↗

PubMed1995

Prenatal analysis of the insulin receptor gene in a family with leprechaunism.

Leprechaunism is an autosomal recessive disease characterized by intrauterine and postnatal growth restriction, loss of glucose homeostasis, and severe insulin resistance. This disease is caused by a failure of function of the insulin receptor and is lethal early in life. Here we report the prenatal diagnosis of leprechaunism in one consanguineous family, Atl-1, in which two homozygous-affected siblings died with leprechaunism. The mutation in their insulin receptor impaired insulin binding and altered receptor signalling. Prenatal diagnosis could not be accomplished using insulin binding to cultured amniocytes, but was possible mutational analysis of the insulin receptor gene in DNA from amniotic cells.

Abnormalities, Multiple↗

PubMed1995

Two mutations in the insulin receptor gene of a patient with leprechaunism: application to prenatal diagnosis.

Leprechaunism is an autosomal recessive disorder caused by mutations in the insulin receptor gene and characterized by intrauterine and postnatal growth restriction, abnormal glucose homeostasis, and severe insulin-resistance. Here we report the biochemical and molecular characterization of a male patient, NZ, who died at 2 yr of age with this syndrome. 125I-Insulin binding to fibroblasts from the proband, his mother, father, and unaffected sister was reduced to 8, 53, 38, and 35% of controls, respectively. Analysis of the insulin receptor gene by polymerase chain reaction amplification using primers flanking each of the 22 exons and direct DNA sequencing identified 2 different mutations in the proband. The paternal mutation was an in-frame deletion of base pairs 1159-1161 in exon 3, which resulted in the loss of the codon for Asn-281. The maternal mutation was a G-->A transition in the first nucleotide of the splice-donor junction in intron 13. The maternal mutation activated a cryptic splice site 27 base pairs upstream in exon 13 and caused an in-frame deletion of amino acids 859-867 of the extracellular domain of the insulin receptor beta subunit. Identification of both mutations enabled prenatal diagnosis in 2 subsequent pregnancies. In the first pregnancy, DNA from cells cultured from chorionic villus (CV) biopsies carried both mutations in the insulin receptor gene. In the second pregnancy, DNA from the CV biopsy cells was negative for both mutations, indicating that the fetus was unaffected by leprechaunism. Insulin binding could not be used in prenatal diagnosis because cells cultured from some control CV biopsies failed to bind insulin. These data indicate that patient NZ with leprechaunism was a compound heterozygote for 2 novel mutations in the insulin receptor gene and that direct DNA sequencing enables prenatal diagnosis for this lethal disorder.

Base Sequence↗

PubMed1995

[Natural history of prostatic adenocarcinoma. Recent advances in prognostic parameters and biological behavior].

For many years diagnosis and management of prostatic adenocarcinoma were straightforward. However, with the advent of medical and less invasive therapies for the treatment of prostatic cancer, it has become necessary to know more about the etiology and pathophysiology of the disease. For example, hormonal factors, growth factors, stromal-epithelial interactions and aging have all been implicated in the etiology of the disease. The pathology of the disease demonstrates heterogeneity in the ratio of the stroma to the epithelium in any given patient, and the pathophysiology varies. Recognizing this heterogeneity in the disease, it is clear that no one form of medical or interventional therapy should be expected to result in a complete response.

Adenocarcinoma↗

PubMed1994

Impaired growth in Rabson-Mendenhall syndrome: lack of effect of growth hormone and insulin-like growth factor-I.

Mutations in the insulin receptor gene cause the severe insulin-resistant syndromes leprechaunism and Rabson-Mendenhall syndrome. There is no accepted therapy for these inherited conditions. Here we report the results of recombinant human GH (rhGH) and recombinant human insulin-like growth factor-I (rhIGF-I) treatment of a male patient, Atl-2, with Rabson-Mendenhall syndrome. The patient was small for gestational age, had premature dentition, absence of sc fat, acanthosis nigricans, fasting hypoglycemia and postprandial hyperglycemia, and extremely high concentrations of circulating insulin (up to 8500 microU/mL). Fibroblasts and lymphoblasts established from this patient had reduced insulin binding, which was 20-30% of the control value. Binding of epidermal growth factor, IGF-I, and GH to the patient's fibroblasts was normal. The growth of fibroblasts cultured from patient Atl-2 in vitro was intermediate between that of fibroblasts from patients with leprechaunism and control values. The patient's growth curve in vivo was far below the fifth percentile despite adequate nutrition. To stimulate growth, therapy with rhGH was initiated, the rationale being to stimulate hepatic IGF-I production and IGF-I receptor signaling, and bypass the inherited block in insulin receptor signaling. Therapy with rhGH (up to 0.5 mg/kg.week) did not improve growth and failed to increase the levels of circulating IGF-I and IGF-binding protein-3 over a 14-month period. As rhGH could not stimulate growth, rhIGF-I (up to 100 micrograms/kg.day) was given by daily sc injection. No increase in growth velocity was observed over a 14-month period. These results indicate that both GH and IGF-I fail to correct growth in a patient with severe inherited insulin resistance. The lack of efficacy of IGF-I treatment may be related to multiple factors, such as the poor metabolic state of the patient, the deficiency of serum carrier protein for IGF-I, an increased clearance of the growth factor, IGF-I resistance in target cells at a receptor or postreceptor level, or an inhibitory action of the mutant insulin receptors on IGF-I receptor signaling.

Acanthosis Nigricans↗

PubMed1994

Functional characterization of an EGF receptor with a truncated extracellular domain expressed in glioblastomas with EGFR gene amplification.

The most common type of alteration of the epidermal growth factor receptor gene (EGFR) in human glioblastomas results in the synthesis of an aberrant mRNA lacking 801 bases that encode amino acids 6-273 of the receptor's extracellular domain. To study the effects of this mutation on receptor function, we have developed chinese hamster ovary cell transfectants which express the mutant EGF receptor. Comparison of wild-type and mutant receptor properties in this cell host indicates that the truncated receptor does not bind EGF or TGF-alpha and, consequently, DNA synthesis is not stimulated in cultures of mutant transfectants by either grown factor. However, levels of DNA synthesis determined for mutant transfectants in serum-free media are several-fold higher than those determined for corresponding cultures of wild-type transfectants. Western blot analysis with anti-phosphotyrosine antibody indicates that the mutant receptor is constitutively phosphorylated in CHO cells, and the same analysis applied to lysates of glioblastoma biopsies reveals the altered receptor is readily detectable as a phosphotyrosine protein in tumors for which there is evidence of corresponding EGFR gene and transcript alterations. In total, these results indicate that the aberrant EGF receptor synthesized in glioblastomas, and which lacks a portion of the extracellular domain necessary for ligand binding, is an activated tyrosine kinase.

Animals↗

PubMed1993

Defective receptors for platelet-derived growth factor AA in human fibroblasts with mutant insulin receptors.

Leprechaunism is an inherited disorder characterized by growth restriction and severe insulin resistance and caused by mutations in the insulin receptor gene. Cells from these patients have defective insulin binding. Fibroblasts from some patients have concomitant defects in other tyrosine kinase receptors, such as those for Insulin-like Growth Factor I (IGF-I) and Epidermal Growth Factor (EGF). In this report, binding of insulin, IGF-I, EGF, and Platelet derived growth factor (PDGF) AA and PDGF-BB is compared among fibroblasts of patients with defined mutations in their insulin receptor gene. Fibroblasts from patient Atl-1, homozygous for a R86P substitution in the insulin receptor, had reduced binding of Platelet-Derived Growth Factor AA (PDGF-AA), a specific ligand for type alpha PDGF receptors. The reduction in PDGF binding impaired the ability of this growth factor to stimulate DNA synthesis.

Abnormalities, Multiple↗

PubMed1993

Activation of glucose transport by a natural mutation in the human insulin receptor.

Naturally occurring mutations in the insulin receptor gene cause heritable severe insulin resistance. These mutations usually impair insulin receptor signaling in cells cultured from affected individuals. However, fibroblasts cultured from a patient with intrauterine growth restriction and severe insulin resistance (leprechaun Atl-1) had normal amounts of insulin receptor protein and defective insulin binding but constitutive activation of insulin-receptor autophosphorylation and kinase activity and of glucose transport. In the same fibroblasts, growth was impaired. Homozygosity for a mutation in the insulin receptor gene was suspected, since he inherited identical DNA haplotypes for this gene from both related parents. Here we report that the proband was homozygous and both parents were heterozygous for a point mutation in the insulin receptor gene converting the Arg86 codon (CGA) to Pro (CCA) (R86P). The R86P substitution is contiguous to the hydrophobic beta-sheet of the receptor alpha subunit implicated by DeMeyts et al. [DeMeyts, P., Gu, J.-L., Shymko, R. M., Kaplan, B. E., Bell, G. I. & Whittaker, J. (1990) Mol. Endocrinol. 4, 409-416] in the binding of aromatic residues of the insulin molecule. The R86P mutant insulin receptor cDNA was inserted into a plasmid under control of a simian virus 40 promoter and transfected into Chinese hamster ovary (CHO) cells. In contrast with fibroblasts from patient Atl-1, which had normal insulin receptor processing, CHO cells stably transfected with the R86P mutant cDNA (CHO-R86P) had altered posttranslational processing. The R86P mutant receptor failed to bind insulin but caused a significant increase in basal glucose transport in CHO cells. As in fibroblasts cultured from the patient, the R86P mutant insulin receptor did not stimulate growth in transfected CHO cells. These results suggest that the R86P mutation in the insulin receptor activates glucose transport without promoting cell growth and that distinct cell types process this mutant insulin receptor differently.

Amino Acid Sequence↗

PubMed1993

Home parenteral nutrition for the management of chronic intestinal failure: a 34 patient-year experience.

Home parenteral nutrition (HPN) was used for the treatment of 18 patients with chronic intestinal failure (CIF): short bowel syndrome (9), extensive intestinal disease (4), motility disorder (4), entero-enteric fistulas (1). The underlying diseases were: chronic inflammatory (7), mesenteric vascular (4), scleroderma (2), pseudo-obstruction (2), malignancy (2), radiation enteritis (1). HPN was more effective on protein-calorie nutritional status than on fluid and electrolyte balances. About two-thirds of the patients achieved full or partial social rehabilitation. During the 6 months before HPN, there were 20 hospitalizations (mean stay: 55 days). During HPN (mean length of treatment: 22 months/patient) there were 16 hospitalizations (mean stay: 22 days), 8 of which were caused by HPN complications (sepsis and deep vein thrombosis; overall incidence of catheter-related complications: 0.411 per patient-year). Bone demineralization, liver abnormalities and biliary stones developed, respectively, in 57%, 28% and 11% of the cases. The underlying intestinal condition played a role in their pathogenesis. The annual cost of HPN ranged from 40 (Hospital Pharmacy Service) to 80 (commercial firm) million lire per patient. To sum up, HPN improves the nutritional status and the quality of life of patients with CIF, and the risk of complications is acceptable. The medical and social advantages are considered to offset the cost of the technique.

Adult↗