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Biomedical subjects

T J Egan

Publications and source records attributed to T J Egan.

At least 19 recordsLinked to original sources

Periodate modification of human serum transferrin Fe(III)-binding sites. Inhibition of carbonate insertion into Fe(III)- and Cu(II)-chelator-transferrin ternary complexes.

Periodate modification of human serum transferrin produces a species that binds Fe(III) weakly at pH 7.4 contrary to previous reports that Fe(III)-binding activity is completely lost. Ternary complexes of periodate-modified transferrin and either Fe(III) with nitrilotriacetate (NTA), oxalate, citrate, or EDTA, or of Cu(II) with oxalate could be formed. Peak wavelength maxima of these spectral bands are identical to those reported for native transferrin in the absence of bicarbonate. No carbonate ternary complexes of periodate-modified transferrin with Fe(III), Al(III), Cu(II), or Zn(II) could be formed. Conditional (Fe(NTA)) binding constants (log K) for C- and N-terminal modified sites are 7.33 and 7.54, respectively. The respective extinction coefficients at 470 nm are decreased 45% compared with the native protein. The electron paramagnetic resonance spectrum of the complex closely resembles that of the Fe(III)-NTA ternary complex formed with native transferrin in the absence of bicarbonate. Anions, including bicarbonate, at high concentrations destabilize formation of this Fe(III)-NTA ternary complex, while Fe(III) chelators readily remove the bound Fe(III). Bicarbonate, sulfate, and pyrophosphate still bind to the modified binding sites in the absence of metal although with slightly lower affinity and with lower molar difference absorptivities. Results are interpreted as an inhibition of a crucial protein conformational change by an intramolecular cross-link, preventing formation of the particularly stable metal-carbonate ternary complex from the less stable metal-chelate ternary complex. The method can be used to produce monosited transferrins.

Anions

Release of iron from C-terminal monoferric transferrin to phosphate and pyrophosphate at pH 5.5 proceeds through two pathways.

Iron release fro C-terminal monoferric transferrin at pH 5.5 and 37 degrees C was studied as a function of chloride, phosphate, and pyrophosphate concentration. The rate constant for iron release depends linearly on chloride concentration, confirming that anion binding is mandatory for iron release, not only at pH 7.4 as has been previously reported, but also at pH 5.5. The extent of iron release is relatively small (< 20% for 1.0 M chloride). Concentrations of > 0.2 M phosphate are required for complete iron removal, but millimolar concentrations of pyrophosphate effect complete removal. The observed rate constants for iron release to phosphate and pyrophosphate change from one linear dependence to another less steep linear dependence on the concentration of these ligands, providing quantitative evidence that the two-pathway mechanism that we previously proposed for iron release at pH 7.4 persists at pH 5.5. According to this model, the pathway of iron release is determined by the nature of the anion occupying a kinetically significant anion binding site on the protein. The qualitative similarity of the current data with that recently reported for iron release from the transferrin-transferrin receptor complex provides strong support for the contention that the two-pathway mechanism also persists in this complex at low pH and is hence likely to be operative in vivo.

Chlorides

Quinoline anti-malarial drugs inhibit spontaneous formation of beta-haematin (malaria pigment).

Polymerisation of haematin to beta-haematin (haemozoin or malaria pigment) in acidic acetate solutions was studied using infrared spectroscopy. The reaction was found to occur spontaneously between 6 and 65 degrees C, in 0.1-4.5 M acetate and pH 4.2-5.0. The anti-malarial drugs quinine, chloroquine and amodiaquin were found to block spontaneous beta-haematin formation, while the anti-malarially inactive 9-epiquinine and 8-hydroxyquinoline had no effect on the reaction, as did primaquine, a drug which is active only against exo-erythrocytic stages of infection. It is argued that the intra-erythrocytically active anti-malarial agents act by binding to haematin, blocking beta-haematin formation and leaving toxic haematin in the parasite food vacuoles.

Antimalarials

Catalysis of the Haber-Weiss reaction by iron-diethylenetriaminepentaacetate.

To help settle controversy as to whether the chelating agent diethylenetriaminepentaacetate (DTPA) supports or prevents hydroxyl radical production by superoxide/hydrogen peroxide systems, we have reinvestigated the question by spectroscopic, kinetic, and thermodynamic analyses. Potassium superoxide in DMSO was found to reduce Fe(III)DTPA. The rate constant for autoxidation of Fe(II)DTPA was found (by electron paramagnetic resonance spectroscopy) to be 3.10 M-1 s-1, which leads to a predicted rate constant for reduction of Fe(III)DTPA by superoxide of 5.9 x 10(3) M-1 s-1 in aqueous solution. This reduction is a necessary requirement for catalytic production of hydroxyl radicals via the Fenton reaction and is confirmed by spin-trapping experiments using DMPO. In the presence of Fe(III)DTPA, the xanthine/xanthine oxidase system generates hydroxyl radicals. The reaction is inhibited by both superoxide dismutase and catalase (indicating that both superoxide and hydrogen peroxide are required for generation of HO.). The generation of hydroxyl radicals (rather than oxidation side-products of DMPO and DMPO adducts) is attested to by the trapping of alpha-hydroxethyl radicals in the presence of 9% ethanol. Generation of HO. upon reaction of H2O2 with Fe(II)DTPA (the Fenton reaction) can be inhibited by catalase, but not superoxide dismutase. The data strongly indicate that iron-DTPA can catalyze the Haber-Weiss reaction.

Catalase

Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy.

To identify patients with common bile duct stones, all patients considered for laparoscopic cholecystectomy in this unit undergo intravenous cholangiography (IVC) with tomography and, more recently, operative cholangiography. To date 100 consecutive patients with symptomatic gallstones have undergone laparoscopic cholecystectomy with no specific exclusion criteria. Eight patients of 100 were found to have duct stones on IVC with one false-positive. These IVC data were compared with data from 52 patients who also had operative cholangiograms performed. One stone was detected on operative cholangiography that was not identified on IVC. No additional information was gained from operative cholangiography. These data suggest that preoperative IVC is adequate for the detection of duct stones in patients considered for laparoscopic cholecystectomy.

Adolescent

The effects of anions on the kinetics of reductive elimination of iron from monoferrictransferrins by thiols.

The kinetics of reductive elimination of iron from the human serum monoferric transferrins by thioglycollate (TG), 3-mercaptopropionate (MP), cysteine (Cys), cysteamine (Cym) and 2-mercaptoethanol (ME) have been studied at 37 degrees C using bathophenanthroline sulphonate (BPS) as the ferrous ion acceptor. Analysis of the entire course of the reaction was possible only with thioglycollate since the other thiols cause eventual protein precipitation; in these cases, initial rates were used. The rate of iron release is linearly dependent on thiol concentration at low concentrations of reductant (less than approx. 0.2 M) and increases more rapidly with higher concentrations (up to 0.5-0.75 M). The thiols fall into two distinct groups, with TG, MP and Cys reacting at approx. the same rate, which is an order of magnitude faster than the reaction with Cym and ME. The carboxylate functionality present in the first group may be responsible for the faster reaction rate, by competitively weakening the interaction between the protein and synergistic anion. The pH-dependence of the rate of reductive elimination appears to depend on ionizable functionalities on both the protein and reducing agent. The addition of NaCl, NaClO4, NaHCO3 and Na2HPO4 increases the rate of iron release from the monoferric transferrins. The last two have particularly large accelerating effects and, in the case of the N-terminal monoferrictransferrin, gave saturation kinetics, suggesting that the observed effect is due to conformational changes in the protein caused by binding of ions. The role of the Fe-synergistic anion complex in the transferrins as a 'trapped intermediate' is considered.

3-Mercaptopropionic Acid

Duodenal obstruction in advanced pancreatic carcinoma: how effective is gastroenterostomy in palliation?

Gastro-enterostomy produces variable and often disappointing results in the management of duodenal obstruction due to advanced pancreatic carcinoma. In a series of 51 patients who had palliative surgery for carcinoma of the pancreas five required a gastro-enterostomy. Three of these subsequently had difficulty with gastric emptying. The problem of gastro-enterostomy failure in palliation of pancreatic carcinoma is discussed.

Aged

Iliac artery aneurysm in Marfan's syndrome.

A case of iliac artery aneurysm in a young male patient with Marfan's Syndrome is described. The aneurysm was managed by a simple exclusion technique. The occurrence of such an aneurysm suggests that the inherent mural weakness in the syndrome is more widespread in the arterial tree than is generally appreciated. The association of iliac artery aneurysm and Marfan's Syndrome does not seem to have been previously reported.

Adult

Timing of strangulation in adult hernias.

This retrospective study aimed to determine why the incidence of strangulated hernias in adults remains high. Seventy-nine patients presented with clinical evidence of hernia strangulation which required urgent surgery during the period 1979-87. Forty-six patients (58 per cent) had noted a hernia present for at least 1 month before strangulation: 18 (23 per cent) had not reported it to their family doctor, 19 (24 per cent) were known by family practitioners or non-surgical medical personnel to have a hernia but had not been referred for surgical opinion, and nine (11 per cent) had been previously assessed surgically with a view to elective repair. Of these nine, five were considered unfit, three were on waiting lists for operation and one had refused surgery. Thirty-two patients (40 per cent) presented primarily with strangulation within days of developing a hernia. The duration of hernia before strangulation in one patient was unknown. Although an unavoidable number of patients will continue to present with strangulation within days of developing a hernia, the overall incidence could be significantly reduced by greater public awareness of the risks of hernia strangulation and by a policy of immediate patient referral and prompt elective repair.

Adult

Human amnion in the management of chronic ulceration of the lower limb: a clinico-pathologic study.

This study shows that unmodified human amnion can make a useful contribution to the management of venous ulceration. By suppressing infection, and, by providing a healthy granulating surface, it significantly reduces the pre-skin graft preparation time, when compared with a conventional method of treatment. However, it does not seem to significantly influence the prospects of graft take, or of long term graft survival, in this comparison. A reversion towards normal of local vasculature, as characterized by vessel wall thinning and widening of the lumen, appears to be a significant tissue change induced by amnion treatment. Such a change may have considerable relevance in any analysis of the basis of the therapeutic efficacy of amnion.

Aged

An expanded emergency service: role of telephone services in the emergency department.

The Medical Information Center at The Hospital for Sick Children in Toronto began in March 1977 to improve triage, provide an improved poison information center, improve response to telephone callers seeking medical advice, and establish a telephone consultation service for physicians. It employs specially trained nursing staff and integrates functionally related services. To determine program effectiveness we studied the records of patients triaged, telephone calls to the poison information center, and calls for other medical information, for periods both before and after the center's opening. We analyzed in detail a sample of telephone calls about acute illness, and surveyed parents who had made such calls. Unnecessary emergency visits have decreased; more patients are sent to a walk-in clinic. Use of the poison information center, especially by physicians, has increased, but fewer poisonings are treated in the emergency department or hospitalized. The Medical Information Center telephone service ensures that more children are managed at home rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service.

Emergency Service, Hospital