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Pancarditis in Whipple's disease: electronmicroscopic demonstration of intracardiac bacillary bodies.

The advent of electron microscopy has repeatedly confirmed Whipple's original postulate that bacterial infestation might be the cause of intestinal lipodystrophy (Whipple's disease). We have recently studied two patients, a 67-year-old man and a 38-year-old woman, who died of untreated Whipple's disease, and both were found to have clinically unrecognized pancarditis. Histologically, PAS-positive histiocytes in foci of chronic inflammation were demonstrable in several organs, including the heart. Electron microscopy of autopsy tissues showed numerous intracellular and extracellular rod-shaped bacillary bodies and serpiginous membranes. The bacillary bodies, some sectioned transversely and others longitudinally, were about 0.2 mum wide and 2 mum long; each had a double-layered cell wall. These bacillary bodies have not been previously identified in the heart, and may be casually related to cardiac lesions occurring in many untreated cases of Whipple's disease.

Adult↗

1982 Borden Award lecture. Nutritional, biochemical, and clinical aspects of inositol and phosphatidylinositol metabolism.

Recent advances in nutritional and biochemical research have substantiated the importance of myo-inositol both as a dietary component and a constituent of cellular phosphatidylinositol. This work has indicated the importance of acyltransferase reactions for the enrichment of membrane phosphatidylinositol in arachidonic acid and the formation of the 1-stearoyl 2-arachidonoyl molecular species which commonly predominate in mammalian tissues. Inositol deficiency in animals has been shown to produce an accumulation of triglyceride in liver, intestinal lipodystrophy, and other abnormalities. Cellular functions elucidated for phosphatidylinositol in biological membranes include mediating cellular responses to external stimuli and serving as a source of arachidonic acid for the biosynthesis of prostaglandins including thromboxane. An alteration in inositol metabolism has been documented in patients with diabetes mellitus and chronic renal failure which has led to clinical interest in modulating dietary inositol levels in the prevention and treatment of human disease.

Arachidonic Acids↗

Metabolism and function of myo-inositol and inositol phospholipids.

Alterations in the level of dietary inositol can significantly influence the concentration of free inositol and inositol-containing phospholipid in the circulation and in selected mammalian tissues and cells. The 1-stearoyl 2-arachidonyl molecular species that commonly predominates in cellular phosphoinositides may be of considerable importance for the functioning of these phospholipids in biological membranes. Retailoring reactions subsequent to the de novo biosynthesis of PI involving the acylation of lyso(1-acyl) PI allow for the preferential enrichment of this phospholipid in arachidonic acid. The impaired release of plasma lipoprotein, increased fatty acid mobilization from adipose tissue, and enhanced fatty acid synthesis in liver have all been implicated as causative factors in the hepatic triacylglycerol accumulation occurring with experimental inositol deficiency. The severe intestinal lipodystrophy that develops in female gerbils consuming inositol-deficient diets is likely mediated by a reduced synthesis of PI and the associated impairment of chylomicron assembly and secretion. Membrane PI can potentially regulate enzyme activities and transport processes as well as providing a source of free arachidonic acid for production of the eicosanoids. There has been mounting evidence recently to indicate that an accelerated turnover of the phosphoinositides may play a key role in mediating cellular responses to external stimuli. The transient rise of phosphoinositide-derived 1,2-diacylglycerol in stimulated cells may serve as a signal for the transmembrane control of protein phosphorylation by activating protein kinase C. Receptor occupancy also elicits the phosphodiesterase-catalyzed release of the second messenger inositol 1,4,5-trisphosphate, which appears to provide for the mobilization of calcium from internal stores. Subnormal levels of free inositol and inositol phospholipid, as found in the nerves of animals with experimental diabetes and in sciatic nerves removed postmortem from diabetic patients, have been implicated in the impaired nerve conduction of human diabetics. Patients with renal failure exhibit a dramatic hyperinositolemia that may have clinical significance. Nutritional intervention may offer an approach for counteracting abnormalities in inositol and inositol phospholipid profiles and associated physiological responses in certain disease states.

Absorption↗

[George H. Whipple. Nobel Prize in Physiology or Medicine in 1934. Whipple's disease, pernicious anemia, and other contributions to medicine].

George Hoyot Whipple (1878-1976) was awarded the Nobel Prize in Physiology and Medicine in 1934, along with Minot and Murphy for their studies in pernicious anemia. Whipple's name has been given to the bacterial disease which he describes in 1907 that we know today as Whipple's disease or intestinal lipodystrophy. He gave the name of thalasemia to the Mediterranean anemia of Cooley, and made diverse contributions to hematology and general pathology. He worked with William Welch in the Department of Pathology at Johns Hopkins Hospital and later became director of the University of Rochester. He died in 1976 at the age of 98.

Anemia, Pernicious↗