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Biomedical subjects

R Sanjuán

Publications and source records attributed to R Sanjuán.

17 recordsLinked to original sources

Theory of lethal mutagenesis for viruses.

Mutation is the basis of adaptation. Yet, most mutations are detrimental, and elevating mutation rates will impair a population's fitness in the short term. The latter realization has led to the concept of lethal mutagenesis for curing viral infections, and work with drugs such as ribavirin has supported this perspective. As yet, there is no formal theory of lethal mutagenesis, although reference is commonly made to Eigen's error catastrophe theory. Here, we propose a theory of lethal mutagenesis. With an obvious parallel to the epidemiological threshold for eradication of a disease, a sufficient condition for lethal mutagenesis is that each viral genotype produces, on average, less than one progeny virus that goes on to infect a new cell. The extinction threshold involves an evolutionary component based on the mutation rate, but it also includes an ecological component, so the threshold cannot be calculated from the mutation rate alone. The genetic evolution of a large population undergoing mutagenesis is independent of whether the population is declining or stable, so there is no runaway accumulation of mutations or genetic signature for lethal mutagenesis that distinguishes it from a level of mutagenesis under which the population is maintained. To detect lethal mutagenesis, accurate measurements of the genome-wide mutation rate and the number of progeny per infected cell that go on to infect new cells are needed. We discuss three methods for estimating the former. Estimating the latter is more challenging, but broad limits to this estimate may be feasible.

Antiviral Agents↗

[Acute renal failure in critically ill patients. A prospective epidemiological study].

AIMS: To determine factors which may predict mortality in patients admitted to intensive care unit who present acute renal failure. METHODS: Prospective observational study of the patients admitted to a multidisciplinary intensive care unit over a year. The inclusion criteria were a creatinine plasmatic value > or = 2 mg/dl (177 micromol/l) or an increase (30% or higher) of its basal value on admittance. RESULTS: One hundred and twenty-seven patients (age = 65.83 +/- 15.06 years; 38% male) with acute renal failure, were prospectively enrolled in the study (13% of intensive care unit admissions). The univariate analysis showed that hospital origin, acute tubular necrosis, late ARF, oliguria, maintained hypotension, sedation or coma, oncological disease and need of mechanical ventilation were significantly associated with mortality (p < 0.05). This association was also found for sepsis (OR: 41.5), multiorganic failure (OR: 3.58) and respiratory, cardiovascular or haematological failure according to the SOFA score. The multivariate analysis found that four clinical variables had an independent predictive value for mortality risk: acute tubular necrosis [OR: 4.57 (2.32-9.00)], use of vasoactive drugs [OR: 2.32 (1.22-4.40)], oliguria [OR: 2.15 (1.12-4.13)] and the acute renal failure starting during admission [OR: 2.06 (1.09-3.88)]. CONCLUSION: Data related to renal failure have worse prognosis than other demographic or clinical data in critically ill patients with acute renal failure. Multicentric studies with unified criteria are needed to analyse the most important prognostic factors.

Acute Kidney Injury↗

Relationships between heart rate variability, functional capacity, and left ventricular function following myocardial infarction: an evaluation after one week and six months.

BACKGROUND: Relationships between heart rate (HR) variability and different prognostic markers such as ejection fraction, functional capacity, and patency of the infarct-related artery, as well as the comparison of their time courses are not fully elucidated. HYPOTHESIS: The aim of study was to assess prospectively the early postinfarction changes in HR variability and its evolution over a period of 6 months: the relationships between HR variability and functional capacity in exercise testing; left ventricular function in cardiac catheterization: status of the infarct-related artery; and the comparison of their time courses. METHODS: In 42 patients with anterior myocardial infarction, a study was made of the early changes in HR variability analyzed by the complex demodulation method, its evolution over a period of 6 months. and the relationships between HR variability and (1) functional capacity in exercise testing, (2) left ventricular function in cardiac catheterization, and (3) status of the infarct-related artery. RESULTS: At 1 week HR variability parameters correlated directly with functional capacity indicators such as METS, percent change in HR from rest to peak exercise (%deltaHR), difference between initial and peak HR (HR range), percent peak theoretical HR (% peak HR), left ventricular ejection fraction (EF), and, inversely, with end-systolic volume (ESV). Stepwise multiple regression analysis to establish HR variability parameters (recorded at 1 week) as related to functional capacity and left ventricular function at 1 week and 6 months postinfarction established the following variables: (1) At 1 week: standard deviation (SD) of the RR cycles in relation to %deltaHR (r = 0.60, p <0.0001), HR range (r = 0.43, p < 0.01), and EF (r = 0.79, p < 0.0001). (2) At 6 months, the sole accepted HR variability parameter was the SD in relation to %deltaHR (r = 0.38, p < 0.05) and HR range (r = 0.45, p < 0.01). No variability parameter was accepted in relation to METS, % peak HR, or ESV. Relationship between EF or ESV and HR variability parameters was not significant when both were evaluated at 6 months. At that time, there was a significant increase in all HR variability parameters among all surviving patients (n = 39), with the exception of the LF/HF ratio and mean RR cycle. The percent increase in HR variability between the first week and 6 months was greater among those patients with the lowest basal EF. No relation was established between HR variability and patency of the infarct-related artery. CONCLUSION: The decrease in HR variability observed following myocardial infarction is associated with a diminished functional capacity and an increased alteration of the EF. This does not affect the recovery of HR variability, which was observed in all surviving patients.

Adult↗

Transmission bottlenecks and the evolution of fitness in rapidly evolving RNA viruses.

We explored the evolutionary importance of two factors in the adaptation of RNA viruses to their cellular hosts, size of viral inoculum used to initiate a new infection, and mode of transmission (horizontal versus vertical). Transmission bottlenecks should occur in natural populations of viruses and their profound effects on viral adaptation have been previously documented. However, the role of transmission mode has not received the same attention. Here we used a factorial experimental design to test the combined effects of inoculum (bottleneck) size and mode of transmission in evolution of vesicular stomatitis virus (VSV) in tissue culture, and compared our results to the predictions of a recent theoretical model. Our data were in accord with basic genetic principles concerning the balance between mutation, selection and genetic drift. In particular, attenuation of vertically transmitted viruses was a consequence of the random accumulation of deleterious mutations, whereas horizontally transmitted viruses experiencing similar bottlenecks did not suffer the same fitness losses because effective bottleneck size was actually determined by the number of host individuals. In addition, high levels of viral fitness in horizontally transmitted populations were explained by competition among viral variants.

Animals↗

Tracing the origin of the compensasome: evolutionary history of DEAH helicase and MYST acetyltransferase gene families.

Dosage compensation in Drosophila is mediated by a complex of proteins and RNAs called the "compensasome." Two of the genes that encode proteins of the complex, maleless (mle) and males-absent-on-the-first (mof), respectively, belong to the DEAH helicase and MYST acetyltransferase gene families. We performed comprehensive phylogenetic and structural analyses to determine the evolutionary histories of these two gene families and thus to better understand the origin of the compensasome. All of the members of the DEAH and MYST families of the completely sequenced Saccharomyces cerevisiae and Caenorhabditis elegans genomes, as well as those so far (June 2000) found in Drosophila melanogaster (for which the euchromatic part of the genome has also been fully sequenced) and Homo sapiens, were analyzed. We describe a total of 39 DEAH helicases in these four species. Almost all of them can be grouped in just three main branches. The first branch includes the yeast PRP2, PRP16, PRP22, and PRP43 splicing factors and their orthologs in animal species. Each PRP gene has a single ortholog in metazoans. The second branch includes just four genes, found in yeast (Ecm16) and Drosophila (kurz) and their orthologs in humans and Caenorhabditis. The third branch includes (1) a single yeast gene (YLR419w); (2) six Drosophila genes, including maleless and spindle-E/homeless; (3) four human genes, among them the ortholog of maleless, which encodes RNA helicase A; and (4) three C. elegans genes, including orthologs of maleless and spindle-E. Thus, this branch has largely expanded in metazoans. We also show that, for the whole DEAH family, only MLE and its metazoan orthologs have acquired new protein domains since the fungi/animals split. We found a total of 17 MYST family proteins in the four analyzed species. We determined putative orthologs of mof in both C. elegans and H. sapiens, and we show that the most likely ortholog in yeast is the Sas2 gene. Moreover, a paralog of mof exists in Drosophila. All of these results, together with those found for a third member of the compensasome, msl-3, suggest that this complex emerged after the fungi/animals split and that it may be present in mammalian species. Both gene duplication and the acquisition of new protein modules may have played important roles in the origin of the compensasome.

Acetyltransferases↗

[The RICVAL study. Acute myocardial infarct in the city of Valencia. Data on 1,124 patients during the first twelve months of the registry (December, 1993--November, 1994)].

BACKGROUND AND OBJECTIVES: Information on the management of acute myocardial infarction in Spain is still scarce. The Register of Acute Myocardial Infarction of Valencia City (RICVAL) was established to collect, in a prospectively and uniformly way, data of patients with acute myocardial infarctions discharged from Valencia coronary care units, in order to obtain updated information on the management of these patients. Data of the first twelve months of the register are presented. METHODS: Using standardised variables, demographic, clinical, procedural and outcome data from patients with acute myocardial infarction were collected at the eight hospitals collaborating in the RICVAL, from 1 December 1993 to 30 November 1994. RESULTS: The eight participating hospitals cover 1,665,720 people. During 12 months, 1,124 patients were discharged from the participating coronary care units. Mean age was 65.1 years and 23.9% were female. The case fatality rate was 16.9%. Left ventricular failure (Killip 2, 3 and 4) was present in 42%. Thrombolytic therapy was applied in 43.5% with a median time delay of 210 minutes from chest pain onset. The delay time in initiating thrombolysis was longer in the women and in the elderly. CONCLUSION: Analysis of present data shows the feasibility of an acute myocardial infarction register in Valencia City. The RICVAL study will allow a better knowledge of demographic, clinical, procedural and outcome data in patients with myocardial infarction. The case fatality rate is still high when we consider that an acceptable level of thrombolytic therapy has been reached. The long delay time in initiating thrombolysis, particularly in the elderly and in the women, must be emphasized.

Acute Disease↗

A comparative study of the incorporation of a 1,6-beta-glucan and an O-glycosylated protein epitope into the cell wall of Candida albicans.

The topological distribution of two epitopes in the cell wall of Candida albicans, the kinetics of their incorporation into the regenerating protoplast wall, and the effect of different antibiotics upon their incorporation and localization have been studied. To do so, two monoclonal antibodies that react against an O-glycosylated mannoprotein (1B12) and against a 1,6-beta-glucan epitope (JRR1) were used. The results show that the JRR1 epitope is localized in an internal layer of the cell wall, in contrast to the 1B12 epitope, which is superficial, and that the incorporation of the JRR1 epitope into walls of regenerating protoplasts precedes that of the 1B12 epitope. The JRR1 epitope is normally found in the culture medium of control cells, but not in that of papulacandin-B-treated cells, and tunicamycin interferes with the incorporation of the 1B12 epitope into the cell walls. Finally, the results support the hypothesis that mannoproteins are not 1,6-beta-glycosylated before their secretion.

Antibodies, Monoclonal↗

[Survival in patients with sick sinus syndrome and artificial pacemaker. Determining clinical factors].

INTRODUCTION AND OBJECTIVE: The hypothesis that ventricular pacing is the most important factor in the survival of patients with Sick Sinus Syndrome remains controversial. The aim of this report was to determine independent clinical variables to predict survival in paced SSS patients. METHODS: Retrospective, nonrandomized study of 153 patients with a mean age of 69 +/- 11 years, who received an initial pacemaker for Sick Sinus Syndrome between 1980 and 1994: 65 physiologic pacing (32 dual chamber, 33 atrial) and 88 ventricular pacing mode. After a maximum follow up of 177 months (median 57 months) the end point was total mortality. RESULTS: Total mortality was 21%. Using univariate analysis, single chamber ventricular pacing, age > or = 70 years and NYHA > or = 2, was associated with a higher risk for total mortality (4 times increased risk for ventricular pacing compared to other pacing modalities). Independent predictors using multivariate analysis were: 1) NYHA > or = 2 (p < 0.05). 2) Coronary artery disease (p < 0.01). 3) Chronic obstructive pulmonary disease (p < 0.05) and 4) Gender (p < 0.05). CONCLUSIONS: Mortality in patients with the Sick Sinus Syndrome is strongly predicted by preimplant baseline clinical variables. Our data indicate that the role of ventricular pacing mode remains inconclusive. A large, randomized study is necessary to confirm these results.

Age Factors↗

Identification of glucan-mannoprotein complexes in the cell wall of Candida albicans using a monoclonal antibody that reacts with a (1,6)-beta-glucan epitope.

The use of a novel monoclonal antibody (mAb) that reacts with (1,6)-beta-glucan has permitted the study of the different covalent linkages between glucan and mannoproteins in the cell wall of Candida albicans. The mAb JRR1 was originally raised by immunization with Zymolyase extracts from C. albicans cell walls, but it soon became apparent that it reacted with a (1,6)-beta-glucan epitope. By using this antibody, we show the existence of glucan-mannoprotein complexes between the (1,6)-beta-glucan epitope recognized by the antibody and cell wall mannoproteins. The topology of the (1,6)-beta-glucan in the cell wall of C. albicans has also been studied.

Antibodies, Monoclonal↗

Incorporation of specific wall proteins during yeast and mycelial protoplast regeneration in Candida albicans.

The kinectics of incorporation of two precursor mannoproteins into the regenerating cell wall of Candida albicans protoplasts have been followed at 28 degrees C and 37 degrees C using two monoclonal antibodies specific for protein epitopes (MAb 1B12 and 4C12) as probes. Both molecules were secreted from the beginning of the regeneration process, and their incorporation was retarded significantly. Analysis of the secreted materials by Western immunoblotting with MAb 1B12 allowed the identification of two closely migrating bands at apparent Mr higher than 170 kDa and significant amounts of a highly polydisperse material of even greater molecular mass. Some of these mannoproteinaceous species carried both N- and O-glycosidically linked mannose residues, as deduced from their drop in apparent Mr when synthesized in the presence of tunicamycin and by their reactivity with Concanavalin A. Following secretion, the molecules reacting with MAb 1B12 were incorporated into the regenerating walls by covalent binding. Then, when the antigen molecules were solubilized from partially regenerated walls, their mobility differed when regeneration took place at 28 degrees C (blastoconidia) or 37 degrees C (mycelial cells).

Antibodies, Monoclonal↗

[The incidence and significance of late potentials in patients with aborted sudden death].

BACKGROUND: Reentrant ventricular tachycardia and fibrillation probably have different electrophysiological bases. Regional conduction delay during sinus rhythm seems to be greatest in patients with spontaneous sustained ventricular tachycardia than in patients with spontaneous sustained ventricular fibrillation. We investigated the prevalence and significance of late potentials in patients with documented VT or VF in the setting of coronary diseases and other organic heart diseases. PATIENTS AND METHODS: Nineteen patients with a history of spontaneous sustained ventricular tachycardia (11 patients) or fibrillation (8 patients) were studied with signal-averaged ECG. All patients had been resuscitated of sudden cardiac death. All recordings were made in sinus rhythm in an antiarrhythmic free state following the recommendations of the Committee of the European Society of Cardiology for data acquisition and analysis of ventricular late potentials using Signal Averaged Electrocardiography. The relationship between this late potentials and tachyarrhythmia inducibility during electrophysiologic study were established. RESULTS: Abnormal late potentials were found in 79% of patients with sudden cardiac death. Patients with spontaneous ventricular tachycardia had a longer ventricular activation time in sinus rhythm than did patients with spontaneous ventricular fibrillation, but this difference did not reach statistic significance. The only analysis of late potentials could not discern the mechanism of sudden cardiac death. However when sudden cardiac death was caused by a spontaneous ventricular tachycardia, a good correlation between abnormal late potentials and induced ventricular tachycardia by programmed stimulation was found. Quantitative indices of late potentials did not correlate with ventricular tachycardia cycle length. CONCLUSIONS: 1) We have found and elevated incidence of abnormal late potentials in patients with sudden cardiac death, and 2) only when the mechanism of sudden cardiac death was a spontaneous VT, we were able to correlate abnormal late potential with provoked ventricular tachycardia during electrophysiologic study.

Aged↗

Observations on variability of atrioventricular nodal conduction in man and the dual-pathway response.

A study was made of nodal conduction times of atrial stimuli with fixed coupling intervals, in 23 patients divided into two groups according to their atrial stimulus test response: Group I (continuous AV node function curve; 17 cases) and Group II (dual AV node pathway; six cases). The stimulation protocol involved the delivery of 75 stimuli with a fixed coupling interval 20 ms greater than the effective refractory period (ERP) of the AV node (Group I) or fast pathway (Group II). The atrial coupling intervals (A1A2) and node conduction times (A2H2) were measured. An evaluation was made of the dispersion of intervals with range (R) and of the distribution of A2H2 times (X2 test). In both Groups, R (A2H2) was greater than R(A1A2) (P less than 0.05); R(A2H2) in Group II was greater than R(A2H2) in Group I (P less than 0.001). In Group I the distribution of A2H2 was non-normal in four cases and bimodal in five; in Group II the distribution was non-normal and bimodal in all cases. It is concluded that: (1) the AV node generates a dispersion in its conduction times in the vicinity of its ERP, although the nodal conduction curve is continuous; and (2) the so-called dual pathway may constitute an exaggeration of AV node response inhomogeneity.

Adolescent↗