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Biomedical subjects

R Jacobs

Publications and source records attributed to R Jacobs.

At least 127 records · Page 7Linked to original sources
PubMed1997

Detection of Pneumocystis carinii DNA in air samples: likely environmental risk to susceptible persons.

The means by which humans acquire Pneumocystis carinii is not well understood. Whether it can be acquired from specific environmental sources or transmitted from person to person has not been determined. This study was designed to detect nucleic acids of P. carinii in air samples from various locations, including P. carinii-infected patients' homes and hospital rooms, non-P. carinii-infected patients' hospital rooms, empty hospital rooms, offices at Indiana University, and other homes in different locations. DNA was extracted from cellulose-ester filters through which air samples had been filtered, and the P. carinii DNA was amplified by PCR with primers specific for the internal transcribed spacer regions of rRNA. P. carinii DNA was found in 17 of 30 air samples (57%) from the rooms of P. carinii-infected patients. It was also found in 6 of the 21 other hospital rooms sampled (29%) but was not found in any of the offices, storage areas, or control homes. Environmental sampling suggests that the airborne presence of P. carinii genetic material and infectious organisms is plausible. The organism was also detected in locations where P. carinii patients were not immediately proximate, such as the hospital rooms of non-P. carinii-infected patients.

Air Microbiology↗
PubMed1997

Postural orientation, equilibrium, and the spinal cord.

In summary, adequate control of postural orientation and equilibrium is a prerequisite for virtually all skilled motor acts, even those apparently simple tasks of standing and walking. In the cat, certain aspects of postural orientation appear to be organized at the spinal level. In contrast, postural equilibrium is not achieved by spinal circuits in isolation, but seems to require input from higher centers. The challenge is to identify those higher centers and the means by which they produce appropriate postural reactions for maintaining balance. If, indeed, postural equilibrium is a function of descending systems, then in the future, the amount of recovery of postural equilibrium after injury and/or treatment could provide a quantitative measure of the degree of sparing and/or re-establishment of functional connections between higher centers and the spinal cord.

Animals↗
PubMed1996

Phenotype and function of hematopoietic-derived cells in the CNS of SCID mouse-Lewis rat bone marrow chimeras.

Severe combined immunodeficient (SCID) mice previously transplanted with Lewis rat hematopoietic cells (SCID mouse-Lewis rat chimeras) developed experimental autoimmune encephalomyelitis (EAE) following injection with myelin basic protein (BP)-specific Lewis rat T lymphocytes. Rat T cells did not cause EAE in non-chimeric SCID mice. Thus, in addition to BP-specific rat T cells, transplanted rat hematopoietic cells were involved in the development of EAE in SCID mice. In order to examine the role of hematopoietic rat cells in the development of EAE, chimeras were constructed in SCID mice by transplanting 40 x 10(6) T cell-depleted adult Lewis rat bone marrow cells. Single cell suspensions of brain, blood and spleen from chimeric mice were phenotyped by monoclonal antibody staining specific for mouse or rat cellular differentiation markers at 2 week intervals. Brain cells from chimeric mice were also evaluated for the presence of rat antigen-presenting cells (APC). Four and six weeks after hematopoietic cell transfer, mouse brain contained rat cells expressing the phenotypic markers (CD45+, CD11b/c+) of CNS antigen-presenting cells (APC). Six weeks after hematopoietic cell transfer, rat cells populating the CNS of chimeras were shown to function as APC, stimulating BP-specific Lewis rat T lymphocytes in vitro.

Animals↗
PubMed1996

Coordinate gene expression of the alpha3, alpha4, and alpha5 chains of collagen type IV. Evidence from a canine model of X-linked nephritis with a COL4A5 gene mutation.

Canine X-linked hereditary nephritis is an animal model for human X-linked hereditary nephritis with a premature stop codon in the alpha5(IV) gene of collagen type IV. We used this model to examine the other alpha(IV) chains at the mRNA and protein level in the kidney, since in human X-linked hereditary nephritis, the alpha3(IV) and alpha4(IV) chains are often absent from the glomerular basement membrane, although both are encoded by autosomal genes. cDNA probes for the alpha1(IV)-alpha6(IV) chains were generated from normal dog kidney using the polymerase chain reaction. Sequences were >/=88% identical at the DNA level and >/=92% identical at the protein level to the respective human alpha(IV) chains. By Northern analysis, transcripts for the alpha1(IV), alpha2(IV), and alpha6(IV) chains were detected at comparable levels in both normal and affected male dog kidney RNA. As previously shown, the transcript for the alpha5(IV) chain was reduced to approximately 10% of normal. Unexpectedly, the alpha3(IV) and alpha4(IV) transcripts were both decreased >/=77% in affected male dog kidney, suggesting a mechanism coordinating the expression of these three basement membrane components. The NC1 domain of collagen type IV isolated from normal dog glomeruli was positive for the alpha3(IV), alpha4(IV), and alpha5(IV) chains by Western blotting. In contrast, in the NC1 domain isolated from affected dog glomeruli, these three chains were not detectable, except for a trace of alpha3(IV) dimer. In X-linked hereditary nephritis, the absence of the alpha3(IV) and alpha4(IV) chains from glomerular basement membrane may reflect factors acting at the transcriptional and/or translational level in addition to the protein assembly level.

Amino Acid Sequence↗
PubMed1996

[10 years transplantation of bone marrow and hematopoietic stem cells in adults at the Hannover Medical School].

PATIENTS AND METHODS: From January 1986 until August 1995 230 adult patients received an allogeneic or autologous transplantation of bone marrow or hematopoietic blood stem cells. The conditioning and myeloablative treatment regimens were chosen according to the underlying disease and type of transplant. RESULTS: The observation period comprises 1 to 115 months after transplantation. After allogeneic transplantation from HLA-identical family donors, the probabilities of disease-free survival were for acute myeloid leukemia in first complete remission (CR) (n = 35) 77%, for acute lymphoid leukemia in 1st CR (n = 7) 72% and in 2nd CR (n = 10) 40%, in first chronic phase of chronic myeloid leukemia (n = 34) 50% and in severe aplastic anemia (n = 7) 100%. Following myeloablative therapy and autologous transplantation the probabilities of disease-free survival were 47% in relapsed Hodgkin's disease (n = 22) and 42% for relapsed high-grade non-Hodgkin's lymphoma (n = 12). Eight of 10 patients with acute myeloid and 7 of 8 with acute lymphoid leukemia suffered a leukemic relapse after autologous bone marrow transplantation. Three of 8 patients with relapsed testicular cancer survived relapse-free. Treatment failures were due to more advanced acute graft versus host disease after allogeneic transplantation and caused by relapse after autologous transplantation. Current protocols evaluate the allogeneic transplantation of enriched CD34+ blood stem cells. In chronic myeloid leukemia the autologous transplantation of blood stem cells after myeloablative therapy is being studied.

Adolescent↗
PubMed1996

Catecholamines modulate human NK cell circulation and function via spleen-independent beta 2-adrenergic mechanisms.

Increases in catecholamines have been shown to induce changes in migration of lymphocytes, in particular NK cells. To analyze the mechanisms of catecholamine-induced NK cell trafficking, normal healthy male human subjects and splenectomized individuals were infused with either adrenaline (0.10 microgram/kg/min), noradrenaline (0.15 microgram/kg/min), or NaCl i.v. for 20 min. Lymphocyte subsets (CD3+, CD4+, CD8+) transiently increased after administration of both catecholamines, with most pronounced increases (up to 600%) in NK cell numbers (CD16+ or CD56+) after infusion of adrenaline. These changes in NK cell numbers and function were accompanied neither by alterations in expression of adhesion molecules (CD11a), CD11b, CD31, CD43, CD44, CD62L) on NK cells nor by changes in plasma concentrations of soluble (s) adhesion molecules (sVCAM-1, sICAM-1, sE-selectin). Comparable increases in lymphocyte subsets were observed in splenectomized subjects, suggesting lymphocyte recruitment from other sources than the spleen. Furthermore, catecholamine-induced increases in lymphocyte subsets could be inhibited by pretreatment with the nonselective beta-adrenoceptor antagonist propranolol, but not by the beta1-selective antagonist bisoprolol. These data demonstrate that adrenaline and noradrenaline modulate the migratory capacity of human NK cells via spleen-independent beta 2-adrenoceptor mechanism.

Adrenergic beta-2 Receptor Antagonists↗
PubMed1996

Mechanical output from individual muscles during explosive leg extensions: the role of biarticular muscles.

The main result of this study is that biarticular leg muscles contribute significantly to the work done at joints, due to transfer of power during explosive leg extensions. In particular, a net power transfer was shown from hip to knee joint during jumping and sprinting. Seven elite athletes performed explosive one legged jump and spring push offs. Kinematics, ground reaction forces and electromyography (EMG) of leg muscles were recorded. The mechanical output of six individual muscle groups was estimated by using Hill-based muscle models. The EMG and kinematics served as input to these models. For jumping as well as for sprinting, the model estimated similar results for the relative work contribution done about a joint due to transfer of power by the biarticular muscles. Rectus femoris showed a power transfer from hip to knee joint, while in contrast hamstrings showed a power transfer from knee to hip joint. Regardless of these opposite directions of power transfer, a net transfer occurred from the hip to the knee joint. The relative work contribution of hamstrings done in hip extension was 7% in jumping and 11% in sprinting. For rectus femoris, the relative work contribution done in knee extension was 21% in jumping and 31% in sprinting. Power transferring actions by gastrocnemius from knee to ankle contributed 25% in jumping and 28% in sprinting to the work done in plantar flexion. These results support the hypothesis that the action of biarticular muscles contributes to a net transfer of power from proximal to distal joints during explosive leg extensions. This action of the biarticular muscles causes an efficient conversion of body segment rotations into the desired translation of the body centre of gravity.

Adult↗
PubMed1996

Chronic pelvic pains represent the most prominent urogenital symptoms of "chronic prostatitis".

OBJECTIVES: To refine and standardize evaluation of current symptoms in men with "chronic prostatitis." METHODS: We reviewed the literature, developed a symptom index, and evaluated the clinical utility of this tool in 50 patients with chronic prostatitis and 75 control patients (25 with benign prostatic hyperplasia [BPH] and 50 with sexual dysfunction). RESULTS: Patients with prostatitis reported more perineal, lower abdominal, testicular, penile, and ejaculatory pain than patients with BPH (P < 0.05 for each symptom) or sexual dysfunction (P < 0.01 for each symptom). Ejaculatory pain was also more common among men with prostatitis than among men with BPH (P = 0.07) or among men with sexual dysfunction (P < 0.01). Although described as characteristic of prostatitis in the literature, low back or rectal pain did not distinguish patients with prostatitis from those with BPH. Patients with prostatitis were intermediate between patients with BPH and sexual dysfunction on the voiding scale and similar to the BPH group on the sexual dysfunction scale. CONCLUSIONS: Pain symptoms were the predominant urologic manifestations of chronic prostatitis. The symptom index may prove valuable for evaluating patients and describing clinical results.

Adult↗
PubMed1996

Modulation of the immunologic response to acute stress in humans by beta-blockade or benzodiazepines.

Acute stress evokes immediate responses in the cardiovascular endocrine, and immune systems. In particular, the number and activity of natural killer (NK) lymphocytes increase after stress. Here, we investigate the possibility to pharmacologically interfere with these stress-induced immunologic changes. Twenty-five healthy males were subjected to an acute stressor, a first-time tandem parachute jump. Subjects were randomly assigned to a beta-adrenoceptor antagonist (propranolol), a benzodiazepine (alprazolam), or placebo group. To analyze the role of the spleen in lymphocyte redistribution, splenectomized subjects performed a parachute jump. Propranolol, but no alprazolam, inhibited the heart rate increase during jumping. Increases in epinephrine and cortisol in the propranolol group were comparable to placebo, but were attenuated by alprazolam. The number and activity of NK cells significantly increased in the placebo group but not in the propranolol group immediately after stress. Alprazolam treatment did not alter the increase in NK cell numbers but did inhibit the increase in NK activity. In splenectomized subjects, NK cell numbers, but not NK activity, increased as in placebo subjects. We conclude that stress-induced changes in the immune system are controlled by beta-adrenergic mechanisms and only partly depend on the spleen; central interference with alprazolam differentially affects stress-induced changes in the NK cell compartment.

Adrenergic beta-Antagonists↗
PubMed1996

Administration of oral acyclovir suppressive therapy after neonatal herpes simplex virus disease limited to the skin, eyes and mouth: results of a phase I/II trial.

BACKGROUND: Neonatal herpes simplex virus (HSV) infections limited to the skin, eyes and mouth (SEM) can result in neurologic impairment. A direct correlation exists between the development of neurologic deficits and the frequency of cutaneous HSV recurrences. Thus, the National Institutes of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted a Phase I/II trial of oral acyclovir therapy for the suppression of cutaneous recurrences after SEM disease in 26 neonates. METHODS: Infants < or = 1 month of age with virologically confirmed HSV-2 SEM disease were eligible for enrollment. Suppressive oral acyclovir therapy (300 mg/m2/dose given either twice daily or three times per day) was administered for 6 months. RESULTS: Twelve (46%) of the 26 infants developed neutropenia (< 1000 cells/mm3) while receiving acyclovir. Thirteen (81%) of the 16 infants who received drug 3 times per day experienced no recurrences of skin lesions while receiving therapy. In comparison, a previous Collaborative Antiviral Study Group study found that only 54% of infants have no cutaneous recurrences in the 6 months after resolution of neonatal HSV disease if oral acyclovir suppressive therapy is not initiated. In one infant, HSV DNA was detected in the cerebrospinal fluid during a cutaneous recurrence, and an acyclovir-resistant HSV mutant was isolated from another patient during the course of the study. CONCLUSIONS: Administration of oral acyclovir can prevent cutaneous recurrences of HSV after neonatal SEM disease. The effect of such therapy on neurologic outcome must be assessed in a larger, Phase III study. As such, additional investigation is necessary before routine use of suppressive therapy in this population can be recommended.

Acyclovir↗
PubMed1996

Long-term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy.

The overall aim of this study was to examine the relationship between bone mass of the jaw and the axial skeleton. Sixty-nine subjects (age at entry: 32-64), who underwent hormone replacement therapy during the study period, participated. Bone mass of the lumbar spine was determined using dual photon absorptiometry. The jaw-bone of the posterior region of the mandible was evaluated by means of standardized long-cone radiography using individual bite-blocks. A densitometric wedge in the film holder provided a reference to quantify bone mass. From both measurements, it appeared that the bone mass of the mandible and the lumbar spine showed a moderate relationship. The present results also confirmed that estrogen replacement therapy had a positive effect on the bone mass of the mandible and the lumbar spine. Different estrogen regimens resulted in different increases in bone mass during the observation period, which was on average 5 yr.

Absorptiometry, Photon↗
PubMed1996

Population pharmacokinetics of ganciclovir in newborns with congenital cytomegalovirus infections. NIAID Collaborative Antiviral Study Group.

The population pharmacokinetics of ganciclovir was investigated in a group of 27 newborns with symptomatic congenital cytomegalovirus infection by nonlinear mixed-effects modeling analysis. Individual characteristics including approximated creatinine clearance from serum (ASCC) and body weight (WGE) were identified to significantly influence total clearance from plasma (CL) and the apparent total volume of distribution (V) of ganciclovir, respectively. The regression equations used to model these relationships were expressed as CL (in liters per hour) = 0.262 + (0.00271 x ASCC) and V (in liters) = 0.627 + (0.437 x WGE). By using this model, typical values of the pharmacokinetic parameter CL and V were 0.428 +/- 0.079 liters/h and 1.773 +/- 0.320 liters, respectively. Upon validation with a larger number of newborns, this model should allow for the definition of possible relationships between the pharmacokinetic disposition of ganciclovir and pharmacodynamic events in neonates.

Antiviral Agents↗
PubMed1996

Two functional muscle groupings during postural equilibrium tasks in standing cats.

1. This study examined the relation between electromyographic (EMG) activation and the contact force and joint torques of the left hindlimb during postural equilibrium tasks in the standing cat. It is the appropriate application of force by the limbs against the support surface that allows the animal to control its center of mass and maintain equilibrium. 2. Cats were trained to stand quietly on a moveable force platform. During quiet stance, the cat was perturbed by a platform translation in each of 12 directions evenly spaced in the horizontal plane. EMG activity of mono- and biarticular thigh muscles, three-dimensional ground reaction force under the paw (contact force), and kinematics of the hindlimb segments were recorded Net joint torques were computed using inverse dynamics. The analysis focused on the functional organization of the rapid, automatic postural response in relation to the sagittal plane contact force and joint torques. 3. The muscles of the thigh were subdivided into two functional groups, based on the relationship of the evoked response to the various components of the sagittal plane contact force or joint torques. The first group, consisting of the monoarticular and some biarticular muscles, was correlated with the vertical force component, Fz. The second group, consisting of a separate group of biarticular muscles, was correlated with the difference between knee and hip torque. This torque difference is a function of both sagittal plane force components, Fz and Fy, and is related to contact force direction. 4. It is suggested that this subdivision of muscle activations reflects a neural strategy of parallel control of the two muscle groups in relation to their influence on Fz and Fy. Such a control mechanism could be a strategy for simplifying the control of the multisegmented limb in contact force tasks such as maintaining postural equilibrium.

Animals↗
PubMed1996

Technical and safety aspects of blood and marrow transplantation using G-CSF mobilized family donors.

An allogeneic transplantation programme using immunoselected blood progenitor and bone marrow CD34+ cells has been established. Thirteen healthy HLA-matched, MLC negative sibling donors received two doses of 5 micrograms kg-1 G-CSF (s.c. daily) for 5 days. On days 4 and 5, large-volume mononuclear cell aphereses were performed (COBE Spectra) and on day 5 one unit of autologous blood was obtained. Mononuclear cells were pooled and cryopreserved after CD34+ cell-immunoselection on day 5. Bone marrow (BM) of the same donors was procured under routine conditions 10-45 days later (median: 27 days). The final graft consisted of blood CD34+ cells with either complete BM (n = 5) or immunoselected BM CD34+ cells (n = 8). The present paper describes the progenitor cell mobilization and apheresis protocol and analyzes the cell loss by BM and peripheral blood progenitor cell (PBPC) donation. Considerably larger amounts of mononuclear cells (CD45+), T-lymphocytes (CD3+) and platelets were lost by the apheresis as compared to bone marrow without apparent immediate clinical consequences for the donors. Owing to cross-cellular contamination of the apheresis concentrate, blood platelet count (PC) significantly decreased (mean PC after the second apheresis 116 x 10 microL-1); furthermore on average 3.04 x 10(10) CD3+ cells were removed by two apheresis sessions. This loss did not lead to long-term total lymphocyte count changes (2370 microL-1 versus 1889 microL-1) as observed during the long-term follow-up of 7/13 donors (mean 290 days). Subjectively, the PBPC collections were better accepted than BM donations in all but one family donor.

Adult↗
PubMed1995

The treatment of stage III nonsmall cell lung cancer using high dose conformal radiotherapy.

PURPOSE: To review our experience using conformal treatment planning and high-dose radiotherapy for Stage IIIa and IIIb nonsmall cell lung cancer (NSCLC), and to identify a subset of patients best suited for this approach by analyzing multiple pretreatment patient and tumor characteristics. METHODS AND MATERIALS: Between December 1987 and June 1992, 37 patients with Stage III NSCLC treated with high-dose radiotherapy using conformal radiotherapy were reviewed. The patient characteristics were as follows: Stage IIIa (18 patients), IIIb [19]; T1-2 [13], T3-4 [24]; N0-1 [8], N2-3 [29]; and median age 63. All patients were treated with 1.8-2.0 Gy fractions to a median dose of 66 Gy (range 60-70 Gy). Outcome was analyzed by multiple pretreatment variables including age, sex, Karnofsky performance score, pretreatment symptoms, stage group, T and N stage, tumor volume (calculated from computed tomography (CT) contours), presence of atelectasis, and tumor histology. Outcome was also analyzed by total radiotherapy dose. RESULTS: The median, 1-year and 2-year survival rates for the entire group were 19.5 months, 75 and 37%, respectively. The median, 1-year, and 2-year local progression-free survival rates are 15.6 months, 62 and 23%. There was no difference in survival by stage group (IIIa vs. IIIb) or by T or N stage. Tumor volumes ranged from 47-511 cc in the patients without atelectasis and were not a significant prognostic factor. Histology was found to be a significant prognostic factor, with squamous cell carcinoma having a better overall survival and local progression-free survival than other histologies. No other patient characteristic was found to be significant by either univariate or multivariate analysis. When outcome was analyzed by radiotherapy dose, no dose response was evident in the narrow dose range studied (60-70 Gy). Toxicity included two cases of pneumonitis, which resolved with conservative therapy. CONCLUSION: High-dose conformal radiotherapy, in our experience, results in overall survival rates that compare favorably with trials of chemoradiotherapy or conventional radiotherapy with a low treatment-associated morbidity. However, local progression remains a significant problem despite median radiotherapy doses of 66 Gy. Future trials using escalating radiotherapy doses with conformal radiotherapy are therefore, indicated.

Adult↗
PubMed1995

Combined transplantation of allogeneic bone marrow and CD34+ blood cells.

Allogeneic peripheral blood progenitor cells (PBPCs) were transplanted after immunoselection of CD34+ cells. Two patient groups were studied: group I patients received immunoselected blood CD34+ cells and unmanipulated marrow cells from the same donor. Group II patients were given immunoselected blood and bone marrow (BM) CD34+ cells. One to 6 weeks before bone marrow transplantation (BMT), PBPCs from HLA-identical and MLC- sibling donors were mobilized with granulocyte colony-stimulating factor (G-CSF) (5 micrograms/kg twice daily subcutaneously) for 5 days. Aphereses were performed at days 4 and 5 of G-CSF application. CD34+ cells were separated from the pooled PBPC concentrates by immunoadsorption onto avidin with the biotinylated anti-CD34 monoclonal antibody 12.8 and then stored in liquid nitrogen. BM was procured on the day of transplantation. Patients were conditioned with either busulfan (16 mg/kg) or total body irradiation (12 Gy) followed by cyclophosphamide (120 mg/kg). Cyclosporin A and short methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. After transplantation, all patients received 5 micrograms G-CSF/kg/d from day 1 until greater than 500 neutrophils/microL were reached and 150 U erythropoietin/kg/d from day 7 until erythrocyte transfusion independence for 7 days. Group I consisted of patients with acute myeloid leukemia (AML) (n = 2), chronic myeloid leukemia (CML) (n = 2), and T-gamma-lymphoproliferative syndrome and BM aplasia (n = 1). The patients received a mean of 3.3 x 10(6) CD34+ and 3.7 x 10(5) CD3+ cells/kg body weight of PBPC origin and 4.5 x 10(6) CD34+ and 172 x 10(5) cells/kg body weight of BM origin. Group II consisted of five patients (two AML, two CML, one non-Hodgkin's lymphoma). They received a mean of 3.3 x 10(6) CD34+ and 3.2 x 10(5) CD3+ cells/kg from PBPC and 1.4 x 10(6) CD34+ and 0.6 x 10(5) CD3+ cells from BM. A matched historical control group (n = 12) transplanted with a mean of 5.2 x 10(6) CD34+ and 156 x 10(5) CD3+ cells/kg from BM alone was assembled for comparison. In group I, the median time to neutrophil recovery to > 100, > 500, and > 1,000/microL was 12, 15, and 17 days, respectively. Patients from group II reached these neutrophil levels at days 13, 15 and 17 post BMT. Neutrophil recovery in the control patient group occurred at days 17, 18, and 20 respectively. Group I patients were given platelet transfusions within 18 days and red blood cells within 10 days, whereas for group II patients, these time points were 26 and 17 days, respectively. These same transfusions could be ceased within 38 and 24 days, respectively, in control patients. The addition of about 2% more peripheral blood CD3+ cells (group I patients) did not result in higher grades of acute GVHD (median grade II) as compared with the controls (median grade II). Four of five group II patients showed no signs of acute GVHD. These data suggest that the addition of immunoselected allogeneic CD34+ progenitor cells to BM cells may accelerate hematopoietic recovery.

Adult↗
PubMed1995

The formation of Golgi stacks from vesiculated Golgi membranes requires two distinct fusion events.

We have reconstituted the fusion and assembly of vesiculated Golgi membranes (VGMs) into functionally active stacks of cisternae. A kinetic analysis of this assembly process revealed that highly dispersed VGMs of 60-90 nm diameter first fuse to form larger vesicles of 200-300 nm diameter that are clustered together. These vesicles then fuse to form tubular elements and short cisternae, which finally assemble into stacks of cisternae. We now provide evidence that the sequential stack formation from VGMs reflects two distinct fusion processes: the first event is N-ethyl-maleimide (NEM)-sensitive factor (NSF) dependent, and the second fusion event requires an NSF-like NEM-sensitive ATPase called p97. Interestingly, while the earliest steps in stack formation share some similarities with events catalyzing fusion of transport vesicles to its target membrane, neither GTP gamma S nor Rab-GDI, inhibitors of vesicular protein traffic, inhibit stack formation.

Carrier Proteins↗