Evidence for a role of the ileum in the control of nitrogen homeostasis via the regulation of arginine metabolism.

As arginine plays a key role in the regulation of liver ureagenesis, we hypothesised that a modulation of enzymes involved in arginine metabolism within the intestine contributes to the regulation of N homeostasis according to protein supply. Our aim was to study the influence of variations in protein or amino acid (AA) supply on intestinal arginase, glutaminase, ornithine aminotransferase (OAT), argininosuccinate lyase and argininosuccinate synthetase. We evaluated in vivo in rats the responses of these enzymes to short-term (ST, 16 h) and long-term (LT, 15 d) variations in dietary protein (10, 17 or 25 % protein diet). In addition, in order to test whether these responses could involve a direct action of AA on the gene expression and activity of these enzymes, Caco-2/TC7 cells were cultured for 3 d with increasing AA concentrations. In vivo, in the ST, both high- and low-protein diets increased arginase activity in the intestinal mucosa (ST25 %: 46 (sem 2) µmol/g per min and ST10 %: 46 (sem 2) µmol/g per min v. ST17 %: 36 (sem 3) µmol/g per min, P < 0.05). In the LT, OAT expression was increased in the LT10 % group (+277 %, P < 0.05) compared with the LT17 % group. Caco-2/TC7 cells showed inverse relationships between AA supply and arginase (P = 0.058) and OAT (P = 0.035) expressions. The present study demonstrates the regulation of intestinal arginase and OAT expressions in response to protein supply. Our in vitro experiments further indicate a direct AA-induced regulation of the mRNA abundance of these enzymes. In situations of limited protein supply, this regulation would increase intestinal arginine catabolism and, possibly via a decrease in arginine portal release, decrease hepatic AA oxidation, thus promoting N sparing.

Simple-sugar meals target GLUT2 at enterocyte apical membranes to improve sugar absorption: a study in GLUT2-null mice.

The physiological significance of the presence of GLUT2 at the food-facing pole of intestinal cells is addressed by a study of fructose absorption in GLUT2-null and control mice submitted to different sugar diets. Confocal microscopy localization, protein and mRNA abundance, as well as tissue and membrane vesicle uptakes of fructose were assayed. GLUT2 was located in the basolateral membrane of mice fed a meal devoid of sugar or containing complex carbohydrates. In addition, the ingestion of a simple sugar meal promoted the massive recruitment of GLUT2 to the food-facing membrane. Fructose uptake in brush-border membrane vesicles from GLUT2-null mice was half that of wild-type mice and was similar to the cytochalasin B-insensitive component, i.e. GLUT5-mediated uptake. A 5 day consumption of sugar-rich diets increased fructose uptake fivefold in wild-type tissue rings when it only doubled in GLUT2-null tissue. GLUT5 was estimated to contribute to 100 % of total uptake in wild-type mice fed low-sugar diets, falling to 60 and 40 % with glucose and fructose diets respectively; the complement was ensured by GLUT2 activity. The results indicate that basal sugar uptake is mediated by the resident food-facing SGLT1 and GLUT5 transporters, whose mRNA abundances double in long-term dietary adaptation. We also observe that a large improvement of intestinal absorption is promoted by the transient recruitment of food-facing GLUT2, induced by the ingestion of a simple-sugar meal. Thus, GLUT2 and GLUT5 could exert complementary roles in adapting the absorption capacity of the intestine to occasional or repeated loads of dietary sugars.

Intestinal responses to xenobiotics.

The gastrointestinal tract represents the first barrier met by the exogenous compounds of food or orally delivered drugs. To be transferred to the whole body, drugs and xenobiotics have first to pass through the intestinal epithelium, where detoxification systems have to minimize the potential of damage from toxic xenobiotics. However, most studies on xenobiotic-metabolizing enzymes have focused on liver enzymes. Such a situation may be explained by the fact that this organ is the site of toxification/detoxification for both endogenous and exogenous compounds, and also because adequate in vitro hepatocytes models have been available for a long time. By contrast, normal cellular models for the in vitro study of the intestinal processes of biotransformation still remain difficult to obtain. In the present report we will thus focus on the most commonly used models, which are Caco-2 cells and their derivative clones, and we will report recent procedures that allow the isolation of normal enterocytes which maintain their functions and integrity for several hours or even several days. Their respective performance and advantages for the study of the induction of the drug-metabolizing enzymes will be discussed.

Activity of hepatocyte nuclear factor 1alpha and hepatocyte nuclear factor 1beta isoforms is differently affected by the inhibition of protein phosphatases 1/2A.

Phosphorylation/dephosphorylation processes are known to control the activity of several transcription factors. The nutrition-dependent expression of sucrase-isomaltase and Na+/glucose co-transporter 1, two proteins implicated in the intestinal absorption of glucose, has been shown to be closely related to modifications of hepatocyte nuclear factor 1 (HNF1) activity. This study was conducted to determine whether phosphorylation/dephosphorylation processes could control HNF1 activity. We show that expression of the gene encoding sucrase-isomaltase is inhibited in the enterocytic Caco-2 clone TC7 by okadaic acid at a concentration that is known to inhibit protein phosphatases 1/2A and that does not affect cell viability. At the same concentration, phosphorylation of the HNF1alpha and HNF1beta isoforms is greatly enhanced and their DNA-binding capacity is decreased. The phosphorylation state of HNF1beta isoforms directly affects their DNA-binding capacity. In contrast, the decreased DNA-binding activity of the HNF1alpha isoforms, which was observed after the inhibition of protein phosphatases 1/2A, is due to a net decrease in their total cellular and nuclear amounts. Such an effect results from a decrease in both the HNF1alpha mRNA levels and the half-life of the protein. This is the first evidence for the implication of protein phosphatases 1/2A in the control of the activity of HNF1 isoforms. Moreover, these results emphasize a physiological role for the balance between phosphatases and kinases in the nutrition-dependent regulation of HNF1-controlled genes.

Postmitotic differentiation of colon carcinoma caco-2 cells does not prevent reentry in the cell cycle and tumorigenicity.

Our purpose was to analyze whether postmitotic Caco-2 colon cancer cells, although they express most of the differentiation characteristics of terminally differentiated intestinal epithelial cells, still maintain, unlike normal cells, a proliferation potential. Experiments were performed with clone TC7 of the Caco-2 cell line. Dividing TC7 cells are undifferentiated and express detectable levels of thymidylate synthase (TS) and cytochrome P450 1A1 (CYP1A1) mRNAs. When reaching confluence TS and CYP1A1 are downregulated, mitosis is no longer detectable, and differentiation takes place, as demonstrated by appearance and increasing levels of differentiation-associated marker mRNAs (e.g., sucrase-isomaltase (SI), dipeptidylpeptidase-IV (DPP-IV) or GLUT5), increasing activities of sucrase and DPP-IV, and increasing expression, on immunofluorescence analysis, of SI on the surface of the cell layer. Trypsinization and seeding of late postconfluent cells (day 30) expressing complete differentiation results within 24 h in upregulation of TS and CYP1A1, a concomitant and dramatic disappearance of differentiation marker mRNAs associated with a decrease in sucrase and DPP-IV activities, and delayed resumption of cell division. This is followed, after the cells have reached confluence again, by downregulation of TS and CYP1A1 and resumption of cell differentiation. The ability of differentiated cells to dedifferentiate was further confirmed by wounding the cell layer of late postconfluent differentiated cultures: within 24 h following the wound, cells migrate from the wound edge and dedifferentiate, as demonstrated by transmission electron microscopy and disappearance of SI from the cell surface of migrating cells. Late postconfluent differentiated cells were tumorigenic in nude mice. These results raise the question of the validity of the concept of differentiation therapy when applied to colon cancer cells.

The sugar binding activity of MR60, a mannose-specific shuttling lectin, requires a dimeric state.

MR60 is an intracellular membrane protein which has been shown to act as a mannoside specific lectin and to be identical to ERGIC-53, a protein characteristic of the endoplasmic reticulum-Golgi apparatus-intermediate compartment, acting as a shuttle. According to its primary sequence, this MR60/ERGIC-53 protein contains a luminal domain including the carbohydrate recognition domain, a stem, a transmembrane segment and a cytosolic domain. The endogenous MR60/ERGIC-53 protein is spontaneously oligomeric, (dimers and hexamers). In this paper, we study the relationship between the oligomerization state and the sugar binding capacity by using recombinant proteins. The expression of the recombinant proteins was evidenced by immunocytochemistry and by immunoprecipitation followed by SDS-PAGE analysis. The full size recombinant protein binds mannosides and is oligomeric, up to the hexameric form. Two truncated proteins lacking the transmembrane and the cytosolic domains were prepared and characterized. A long one, containing the cysteine 466 close to the C-terminal end of the recombinant protein but lacking the cysteine 475, close to the C-terminal end of the native protein, does bind mannosides and forms dimers but no higher oligomeric forms. A shorter one, lacking both the cysteines 466 and 475, does not bind mannosides and does not form dimers or higher polymers. The two cysteines in the carbohydrate recognition domain (C190 and C230) are not involved in the stabilization of oligomers. In conclusion, this study shows that the luminal moiety of MR60/ERGIC-53 contains a device allowing both its oligomeric pattern and its sugar binding capability.

Intradermal DNA immunization: antisera specific for the membrane lectin MR60/ERGIC-53.

The trafficking of intracellular membrane proteins in Golgi apparatus, endoplasmic reticulum or intermediate compartment has not yet been fully elucidated. The human MR60/ ERGIC-53 and the rat p58 proteins are one such protein; and to study them in cell-free and in situ systems, high quality monospecific antisera are required. Highly specific antisera have been obtained after immunization of mice with plasmids containing a gene encoding either the full length or a truncated protein. The best results were obtained after intradermal injections of a plasmid encoding a truncated protein comprising both the luminal carbohydrate recognition domain and the stem down to a cysteine residue close to the C-terminal end, but neither the transmembrane nor the cytosolic domains. Such antisera have a very high titer and are very efficient tools to visualize the MR60 protein in situ or to selectively precipitate the MR60 proteins from a whole cell lysate.

Two HNF-1 binding sites govern the glucose repression of the human sucrase-isomaltase promoter.

We have previously shown, using the Caco-2 clone PF11, that glucose represses transcription of the human sucrase-isomaltase (SI) gene and that the -370/+30 fragment of the SI gene conferred glucose-regulated expression on a heterologous gene. Different fragments beginning at the already characterized SI footprint (SIF) 1 (-53/-37), SIFR (-153/-129) or SIF3 (-176/-156) elements [Wu, Chen, Forslund and Traber (1994) J. Biol. Chem. 269, 17080-17085] were tested, in comparison with the -370/+30 fragment, for their capacity to inhibit reporter gene expression under high-glucose (25 mM) conditions. Unlike SIF1 and SIFR, the addition of the HNF (hepatocyte nuclear factor)-1-binding element SIF3 to the promoter fragment was required for repression under high-glucose conditions. This effect was enhanced when the SI promoter was extended to position -370, indicating that the -370/-176 region contains elements that may co-operate with SIF3 to increase the metabolic control of the SI promoter. We have characterized an additional HNF-1-binding site near to and upstream from SIF3; SIF4. By mutagenesis of the three HNF-1-binding elements we show that the two distal HNF-1-recognition sites are the most important for the glucose regulation of the SI gene. Moreover, this glucose regulation was abolished in PF11 cells overexpressing vHNF-1C (variant HNF, an isoform of the HNF-1 family). We thus propose that the differential binding of HNF-1-family proteins to their DNA targets on the SI promoter constitutes the molecular mechanism that controls the glucose regulation of the SI gene transcription.

Decreased expression of gamma-glutamyltranspeptidase in the intestinal cell line Caco-2 by inducers of cytochrome P450 1A1.

Our purpose was to investigate whether inducers of cytochrome P450 1A1 (CYP1A1), which cause a decreased expression in Caco-2 cells, at both the mRNA and protein levels, of membrane proteins associated with the uptake and transport of hexoses, would also affect the expression of gamma-glutamyltranspeptidase (gammaGT) (EC 2.3.2.2). In Caco-2 clonal TC7 cells grown under standard conditions (25 mM glucose), exposure to beta-naphthoflavone (beta-NF), 2,3,7,8-tetrachlorodibenzo-p-dioxin, and 3-methylcholanthrene resulted in increased glucose consumption and decreased gammaGT activity in cells grown to confluence, i.e. when the differentiation is optimum. GammaGT activity was further analyzed during the time course of differentiation of TC7 cells treated or not with beta-naphthoflavone: while gammaGT activity in untreated cells showed a 10-fold increase from the exponential phase of growth until late postconfluence, gammaGT activity in beta-NF-treated cells, although increasing by 4-fold, remained at a much lower level (<25%). This decreased activity of gammaGT was associated with a decreased level of gammaGT mRNA. This inhibiting effect was not dependent on the CYP1A1 activity, as it also occurred in the presence of CYP1A1 inhibitors such as alpha-naphthoflavone, 8-methoxypsoralen or ellipticin. It was however dependent on glucose supply as it was not observed when the cells were cultured in low glucose (1 mM). These results raise the question of whether, in Caco-2 cells, CYP1A1 inducers or the signal transduction system which controls CYP1A1 are involved in the regulation of the expression of gammaGT through a mechanism involving glucose metabolism.

Hypoxia and CYP1A1 induction-dependent regulation of proteins involved in glucose utilization in Caco-2 cells.

Although induction of cytochrome P-450 1A1 (CYP1A1) in the Caco-2 clone TC7 alters glucose utilization and modifies the expression of sucrase-isomaltase (SI) and hexose transporters, nothing is known of the events that control these effects. In this study, we analyzed the effects of beta-naphthoflavone (beta-NF) and hypoxia on these parameters and expression of key enzymes of glucose metabolism. Both beta-NF and hypoxia induce similar changes: 1) induction of CYP1A1 mRNA; 2) increased glucose consumption and lactic acid production and lower glycogen content; 3) downregulation of SI and upregulation of GLUT1 mRNAs; 4) downregulation of fructose-1,6-bisphosphatase and pyruvate kinase mRNAs and upregulation of phosphoenolpyruvate carboxykinase, pyruvate dehydrogenase, lactate dehydrogenase, and phosphofructokinase mRNAs; and 5) upregulation of c-fos and c-jun mRNAs. Although addition of inhibitors of CYP1A1 catalytic activity to beta-NF-treated cells totally inhibits the enzyme activity, it does not modify CYP1A1 mRNA response and associated effects, thus excluding a direct role for the enzyme per se. These results point to a possible physiological implication of the signal-transduction pathway responsible for CYP1A1 induction.

GalNAc-alpha-O-benzyl inhibits NeuAcalpha2-3 glycosylation and blocks the intracellular transport of apical glycoproteins and mucus in differentiated HT-29 cells.

Exposure for 24 h of mucus-secreting HT-29 cells to the sugar analogue GalNAc-alpha-O-benzyl results in inhibition of Galbeta1-3GalNAc:alpha2,3-sialyltransferase, reduced mucin sialylation, and inhibition of their secretion (Huet, G., I. Kim, C. de Bolos, J.M. Loguidice, O. Moreau, B. Hémon, C. Richet, P. Delannoy, F.X. Real., and P. Degand. 1995. J. Cell Sci. 108:1275-1285). To determine the effects of prolonged inhibition of sialylation, differentiated HT-29 populations were grown under permanent exposure to GalNAc-alpha-O-benzyl. This results in not only inhibition of mucus secretion, but also in a dramatic swelling of the cells and the accumulation in intracytoplasmic vesicles of brush border-associated glycoproteins like dipeptidylpeptidase-IV, the mucin-like glycoprotein MUC1, and carcinoembryonic antigen which are no longer expressed at the apical membrane. The block occurs beyond the cis-Golgi as substantiated by endoglycosidase treatment and biosynthesis analysis. In contrast, the polarized expression of the basolateral glycoprotein GP 120 is not modified. Underlying these effects we found that (a) like in mucins, NeuAcalpha2-3Gal-R is expressed in the terminal position of the oligosaccharide species associated with the apical, but not the basolateral glycoproteins of the cells, and (b) treatment with GalNAc-alpha-O-benzyl results in an impairment of their sialylation. These effects are reversible upon removal of the drug. It is suggested that alpha2-3 sialylation is involved in apical targeting of brush border membrane glycoproteins and mucus secretion in HT-29 cells.

Trypanosoma cruzi: impact of clonal evolution of the parasite on its biological and medical properties.

Trypanosoma cruzi populations are subdivided into natural clones that can exhibit considerable genetic differences. It has been proposed that T. cruzi clonal structure has a major impact on this parasite's biological properties. The present work aims at testing this hypothesis. Twenty-one stocks isolated from various ecological cycles, places, and hosts were characterized by multilocus enzyme electrophoresis (MLEE) with 22 genetic loci and random amplification of polymorphic DNA (RAPD) with 10 primers on the one hand and by 14 different biological parameters on the other hand. These parameters were related to: (i) growth kinetics of epimastigotes and amastigotes; (ii) infection of culture cells by amastigotes; (iii) viability of extracellular trypomastigotes; or (iv) sensitivity of epimastigotes, trypomastigotes, and amastigotes to Benznidazole and Nifurtimox. MLEE and RAPD results exhibited parity to each other, as previously noted (M. Tibayrenc, K. Neubauer, C. Barnabé, F. Guerrini, D. Skarecky, and F. J. Ayala, 1993, Proceedings of the National Academy of Sciences of the USA 90, 1335-1339), and showed that the 21 stocks were distributed into three main genetic groups, 19/20, 32, and 39, corresponding to the major clones 19, 20, 32, and 39 previously described on the basis of 15 isozyme loci. Most biological parameters showed a strong correlation to the genetic distances evaluated from either MLEE or RAPD, which favors the working hypothesis. The only exception came from drug sensitivity estimated on trypomastigote forms. The overall results made it possible to firmly reject the null hypothesis that there is no relationships between evolutionary distances and biological differences in T. cruzi natural clones.

Glucose-dependent transcriptional regulation of the human sucrase-isomaltase (SI) gene.

We have previously shown that the transcription of the human sucrase-isomaltase (SI) gene was negatively regulated by glucose. Using two clonal metabolic variants of the human colon adenocarcinoma cell line Caco-2 we demonstrate here that: 1) although similar growth-related variations of phosphoenolpyruvate carboxykinase (PEPCK), frutose 1,6-diphosphatase (F1, 6-dPase), pyruvate kinase (PK) and SI mRNA levels are observed, only F1,6-dPase, PK and SI mRNA levels vary in the same way in response to modifications of glucose utilization; and 2) regulatory elements responsible for the glucose-dependent transcription of the SI gene are located within the -370/+30 region of the promoter.

Human cytochrome P450 2E1 (CYP2E1): from genotype to phenotype.

CYP2E1 is involved in the activation of various carcinogens, including N-nitrosamines, which are believed to be important in human carcinogenesis. Humans exhibit wide interindividual variability in levels of CYP2E1 mRNA and protein, which might explain interindividual differences in susceptibility to carcinogens activated by CYP2E1. Such variability could be due either to genetic polymorphisms observed in the CYP2E1 gene (Rsa I in the 5'-flanking region, Dra I in intron 6 and Taq I in intron 7) or to varying inducibility by xenobiotics. The aim of the present study was to establish whether, in a Caucasian population (n = 93), there existed a relationship between allelic forms of the CYP2E1 gene and the phenotype determined in vitro by hepatic ability to 6-hydroxylate chlorzoxazone. Rates of chlorzoxazone-6-hydroxylation were significantly correlated with levels of immunochemically measured CYP2E1 (p < 0.001). CYP1A2, 2C8, 2C9, 2C18, 2D6, 3A4 and 3A5 did not appear to be significantly involved in chlorzoxazone metabolism, whereas the participation of CYP1A1 could not be excluded. Frequencies of the rare alleles for the three polymorphism sites were 2.2% for RsaI, 7.5% for DraI and 8.5% for TaqI. Despite substantial interindividual variations in chlorzoxazone hydroxylase activity, no relationship between any of the three polymorphisms and CYP2E1 activity was established. Therefore, in humans, interindividual variability in CYP2E1 levels is probably due to differing induction levels as a result of environmental factors, or to genetic factors other than those studied in this work.

Regulation of sucrase-isomaltase and hexose transporters in Caco-2 cells: a role for cytochrome P-4501A1?

Involvement of cytochrome P-4501A1 (CYP1A1) in the regulation of sucrase-isomaltase and hexose transporters was analyzed in low (TC7)- and high (PF11)-glucose-consuming Caco-2 clones. CYP1A1 mRNA is elevated in exponentially growing cells concomitantly with high rates of glucose consumption and high levels of GLUT-1 and GLUT-3 mRNA. After confluency, CYP1A1 is not detectable in TC7 cells; this is associated with a decreased glucose consumption, a downregulation of GLUT-1 and GLUT-3, and an upregulation of sucrase-isomaltase, SGLT-1, GLUT-2, and GLUT-5. In PF11 cells CYP1A1 mRNA remains elevated, along with high glucose consumption, high levels of GLUT-1 and GLUT-3, and minimal expression of sucrase-isomaltase, SGLT-1, GLUT-2, and GLUT-5. Exposure of TC7 cells to inducers of CYP1A1 results in high levels of CYP1A1 mRNA, a 10-fold increase of glucose consumption after confluency, an upregulation of GLUT-1 and GLUT-3, and a downregulation of sucrase-isomaltase, GLUT-2, and, to a lesser extent, SGLT-1 and GLUT-5. These results suggest that activation of CYP1A1, whether spontaneous or drug induced, is involved in the variations of glucose utilization and in the associated modifications of expression of sucrase-isomaltase and hexose transporters.

CYP3A5 is the major cytochrome P450 3A expressed in human colon and colonic cell lines.

CYP3A is known to be expressed in liver, small intestine and colon. However, its isoform distribution (CYP3A4, 3A5 and 3A7) and inducibility have not been clearly elucidated in the colon. Therefore, we analyzed CYP3A in human colon and compared its expression and inducibility to the human colonic cell lines HT29 and Caco2, which were used as models. Patients suffered either from sigmoiditis or colonic adenocarcinoma. Patients as well as HT29 and Caco2 cells were treated with rifampicin. CYP3A protein expression was analyzed in the colon of patients and in the cells by immunoblot and by isoelectric focusing enabling separation of CYP3A isoforms, while mRNA expression was determined using specific reverse transcription-polymerase chain reaction. In both human colon and cells, CYP3A5 was the main isoform expressed at the protein and mRNA levels. Rifampicin treatment had no effect on CYP3A expression. HT29 and Caco2 cells exhibiting the same CYP3A expression and inducibility might therefore be useful in vitro models for studying xenobiotic metabolism in human colon.

High levels of DNA adducts in human colon are associated with colorectal cancer.

Colon cancer is one of the most frequent causes of cancer death in western countries. Epidemiological studies suggest that colorectal cancer can be attributed, at least in part, to carcinogens and mutagens present in the diet and/or the environment. The covalent binding of these xenobiotics or their reactive metabolites to DNA is believed to initiate this chemical carcinogenesis. In the present study, using a 32P-postlabeling method, we investigated DNA adduct levels in control colons from patients without colorectal adenocarcinoma and in nontumoral and tumoral tissues from patients with colorectal adenocarcinoma. Our results show that the DNA adduct level is significantly higher (P < 0.001) in nontumoral than in control or tumoral colon samples. For the first time, we demonstrate in humans that the presence of numerous adducts in colonic mucosa is associated with colorectal cancer, a finding in agreement with the importance of chemical factors in causing this disease; therefore, after confirmation of the link between DNA adducts and colorectal cancer, the measurement of DNA adduct levels in colon samples could constitute a useful approach to the early detection of colorectal cancer.

Expression of cytochrome P-450 3A in HT29-MTX cells and Caco-2 clone TC7.

HT-29 sublines and Caco-2 clones were analyzed for the expression of cytochrome P-450 3A. The enzyme was found to be expressed in differentiated HT-29 cells selected by resistance to methotrexate and in one of seven Caco-2 clones, TC7. Its expression parallels the differentiation process, with highest levels being observed at late confluency. P-450 3A mRNA and protein patterns, as well as subcellular distribution, are intermediate between those observed in human adult intestine and fetal liver.

Cataract extraction with lens implantation at Biloxi Veterans Affairs Medical Center: experience of ophthalmology residents.

We reviewed and analyzed the visual acuities achieved and the complications after 949 cataract operations done by ophthalmology residents during the transitional period in which an intracapsular cataract extraction technique was replaced by an extracapsular one. The available records of all patients from 1982 through 1991 were reviewed. Eighteen intracapsular and 896 extracapsular cataract extractions were performed, followed by 906 primary and 43 secondary implants. Posterior capsular rupture occurred in 6.3% of the cases with vitreous loss in 3.4%. Cystoid-macular edema was the most common postoperative complication. The postoperative visual acuity was 20/40 or better in 91% of cases, and it was better than the preoperative visual acuity in 99.5% of cases. With appropriate training and supervision, a resident can achieve good results by doing extracapsular cataract extractions with lens implantations. These results were comparable to those reported by others.