Exercise during haemodialysis: West of Scotland pilot study.

BACKGROUND: Exercise during dialysis (EDD) in End-Stage Renal Disease (ESRD) has been documented as an effective intervention to improving a patient's aerobic capacity. AIMS: This pilot study aimed to confirm physiological improvements, to establish its safety and practicality and to form guidelines for a long-term study, leading to the integration of EDD in ESRD therapy. METHODS: A total of 17 patients on hospital haemodialysis were recruited: ten exercisers (age 42.4 +/- 12.6) and six controls (age 41.0 +/- 8.3). Both groups were initially tested for estimated VO(2max), heart rate, blood pressure, leg extension peak torque, anxiety and depression levels, as well as biochemical and haematological values. The exercisers then underwent cycling ergometer exercise sessions during dialysis, twice weekly, for a total of 12 sessions. Both groups were re-tested after this period. RESULTS: All test and exercise sessions were completed without complication. Compliance was high with only 1 exerciser failing to complete all 12 sessions. The exercisers showed a statistically significant increase (p < 0.05) in EDD workrates (44.3 to 52.1 watts) during the 12 sessions and a reduction in anxiety (p < 0.05). Statistical analysis showed no other significant changes in either group after the 6-week period. CONCLUSION: This pilot study has confirmed that aerobic EDD is feasible and well accepted by patients on hospital haemodialysis. EDD reduced anxiety scores and showed a trend for an improved level of aerobic fitness.

Oculopharyngeal muscular dystrophy: phenotypic and genotypic studies in a UK population.

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant disorder of late onset that commonly presents with ptosis and dysphagia. The genetic basis of the condition has been identified recently as a stable trinucleotide repeat expansion in exon 1 of the poly(A) binding protein 2 gene (PABP2), in which (GCG)(6) is the normal repeat length. The prevalence of OPMD is greatest in patients of French-Canadian origin. It is not clear if expansion repeat length is a reliable test in other populations. In this study, we analysed the phenotypic and genotypic characteristics of 31 patients with OPMD in the UK. Ptosis was the first reported symptom in two-thirds of the patients, and half of the subjects studied had evidence of ophthalmoplegia. All but one family had a pathological expansion in the PABP2 gene, ranging from (GCG)(8) to (GCG)(13). In contrast to the French-Canadian population, (GCG)(10) was almost as common as (GCG)(9), evidence against a strong founder effect in the UK population. There was a weak association between repeat length and age of disease onset. Patients with longer repeat lengths, such as (GCG)(13), developed severe limb weakness early in the disease. We were unable to detect the (GCG)(7) polymorphism in over 200 normal controls, suggesting that the frequency of this expansion is lower than that found in the French-Canadian population. One family was negative for the expansion. Affected members presented with the classical features of OPMD, namely ptosis, dysphagia and cytoplasmic inclusions on muscle biopsy, although with some atypical features, such as early age of onset, high serum levels of creatine kinase and a profound ophthalmoplegia. This family is an example of a GCG expansion-negative oculopharyngeal syndrome requiring further genetic investigation. We conclude that PABP2 analysis is a reliable non-invasive diagnostic test for OPMD in the UK population.

Point-of-care testing in the United Kingdom.

Point-of-care testing in the United Kingdom is currently at the embryo stage of development, and is approximately 10 years behind the United States in incorporation and application into clinical practice. Safeguards to ensure proper use are not in place within the UK at present, and there is no legal requirement for POCT users to be proficiency tested by an internal or external body before they can routinely use the equipment. Internal quality control and external quality assessment are not statutory requirements within the UK, leading to unease regarding the extent and range of point-of-care tests offered and whether the results are a true biochemical representation of the patient's clinical condition. Cost-benefit analysis is very sparse, but faster turnaround times can only lead to more rapid treatment of the patient, which will lead to fewer clinical complications. This will result in decreased hospital admissions by the emergency department and reduced length of hospital stay in ward-based patients. National Health Service (NHS) accountants will see this, as the way forward, as fewer patients being admitted into hospital and length of stay reduction will result in decreased expenditure by the service provider.

Pharmacokinetics of meropenem in intensive care unit patients receiving continuous veno-venous hemofiltration or hemodiafiltration.

OBJECTIVE: To evaluate an intravenous meropenem dosage regimen in adult intensive care patients with acute renal failure treated by continuous renal replacement therapy. DESIGN: A prospective, clinical study. SETTING: General intensive care unit of a university hospital. PATIENTS: Ten critically ill adult patients being treated with meropenem and receiving continuous veno-venous hemofiltration (hemofiltration rates, 1-2 L/hr) (n = 5) or continuous venovenous hemodiafiltration (hemofiltration rates, 1-1.5 L/hr; dialysis rates, 1-1.5 L/hr) (n = 5) via a polyacrylonitrile hollow fiber 0.9-m2 filter. INTERVENTIONS: Patients received a meropenem dose of 1 g iv every 12 hrs as a 5-min bolus. MEASUREMENTS AND MAIN RESULTS: Meropenem concentrations were measured by high-performance liquid chromatography in serum taken at timed intervals and in ultrafiltrate/dialysate to determine serum concentration-time profiles, derive pharmacokinetic variable estimates, and determine sieving coefficients and filter clearances. The serum concentrations were examined to see whether they were above the minimum inhibitory concentrations (MICs) for pathogens that may be encountered in intensive care patients. Serum concentrations exceeded 4 mg/L (MIC90 for Pseudomonas aeruginosa) during 67% of the dosage period in all patients. Sub-MIC90 concentrations were obtained in three patients immediately before treatment and in one patient 12 hrs after treatment. Mean (SD) (n = 10) pharmacokinetic variable estimates were as follows: elimination half-life, 5.16 hrs (1.83 hrs); volume of distribution, 0.35 L/kg (0.10 L/kg); and total clearance, 4.30 L/hr (1.38 L/hr). A sieving coefficient of 0.93 (0.06) (n = 9) indicated free flow across the filter. The fraction cleared by the extracorporeal route was 48% (13%) (n = 9), which is clinically important. CONCLUSIONS: A meropenem dose of 1g iv every 12 hrs provides adequate serum concentrations in the majority of patients receiving continuous veno-venous hemofiltration or continuous venovenous hemofiltration with a 0.9-m2 polyacrylonitrile filter at combined ultrafiltrate/dialysate flow rates of up to 3 L/hr. A lower dose would not be sufficient for the empirical treatment of potentially life-threatening infections in all patients.

Long-circulating bacteriophage as antibacterial agents.

The increased prevalence of multidrug-resistant bacterial pathogens motivated us to attempt to enhance the therapeutic efficacy of bacteriophages. The therapeutic application of phages as antibacterial agents was impeded by several factors: (i) the failure to recognize the relatively narrow host range of phages; (ii) the presence of toxins in crude phage lysates; and (iii) a lack of appreciation for the capacity of mammalian host defense systems, particularly the organs of the reticuloendothelial system, to remove phage particles from the circulatory system. In our studies involving bacteremic mice, the problem of the narrow host range of phage was dealt with by using selected bacterial strains and virulent phage specific for them. Toxin levels were diminished by purifying phage preparations. To reduce phage elimination by the host defense system, we developed a serial-passage technique in mice to select for phage mutants able to remain in the circulatory system for longer periods of time. By this approach we isolated long-circulating mutants of Escherichia coli phage lambda and of Salmonella typhimurium phage P22. We demonstrated that the long-circulating lambda mutants also have greater capability as antibacterial agents than the corresponding parental strain in animals infected with lethal doses of bacteria. Comparison of the parental and mutant lambda capsid proteins revealed that the relevant mutation altered the major phage head protein E. The use of toxin-free, bacteria-specific phage strains, combined with the serial-passage technique, may provide insights for developing phage into therapeutically effective antibacterial agents.

The protein disease database of human body fluids: I. Rationale for the development of this database.

We are developing a relational database to facilitate quantitative and qualitative comparisons of proteins in human body fluids in normal and disease states. For decades researchers and clinicians have been studying proteins in body fluids such as serum, plasma, cerebrospinal fluid and urine. Currently, most clinicians evaluate only a few specific proteins in a body fluid such as plasma when they suspect that a patient has a disease. Now, however, high resolution two-dimensional protein electrophoresis allows the simultaneous evaluation of 1,500 to 3,000 proteins in complex solutions, such as the body fluids. This and other high resolution methods have encouraged us to collect the clinical data for the body fluid proteins into an easily accessed database. For this reason, it has been constructed on the Internet World Wide Web (WWW) under the title Protein Disease Database (PDD). In addition, this database will provide a linkage between the disease-associated protein alterations and images of the appropriate proteins on high-resolution electrophoretic gels of the body fluids. This effort requires the normalization of data to account for variations in methods of measurement. Initial efforts in the establishment of the PDD have been concentrated on alterations in the acute-phase proteins in individuals with acute and chronic diseases. Even at this early stage in the development of our database, it has proven to be useful as we have found that there appear to be several common acute-phase protein alterations in the plasma and cerebrospinal fluid from patients with Alzheimer's disease, schizophrenia and major depression. Our goal is to provide access to the PDD so that systematic correlations and relationships between disease states can be examined and extended.

The Protein Disease Database of human body fluids: II. Computer methods and data issues.

The Protein Disease Database (PDD) is a relational database of proteins and diseases. With this database it is possible to screen for quantitative protein abnormalities associated with disease states. These quantitative relationships use data drawn from the peer-reviewed biomedical literature. Assays may also include those observed in high-resolution electrophoretic gels that offer the potential to quantitate many proteins in a single test as well as data gathered by enzymatic or immunologic assays. We are using the Internet World Wide Web (WWW) and the Web browser paradigm as an access method for wide distribution and querying of the Protein Disease Database. The WWW hypertext transfer protocol and its Common Gateway Interface make it possible to build powerful graphical user interfaces that can support easy-to-use data retrieval using query specification forms or images. The details of these interactions are totally transparent to the users of these forms. Using a client-server SQL relational database, user query access, initial data entry and database maintenance are all performed over the Internet with a Web browser. We discuss the underlying design issues, mapping mechanisms and assumptions that we used in constructing the system, data entry, access to the database server, security, and synthesis of derived two-dimensional gel image maps and hypertext documents resulting from SQL database searches.

Identification and use of constitutive proteins for the normalization of high resolution electrophoretograms.

Quantitative inter-gel comparisons of proteins separated by high resolution two-dimensional protein electrophoresis present a number of problems. These problems may arise from: variations in pipetting and other mechanical manipulations of samples, protein loss during transfer from the first to the second gel dimension, variations in staining, and/or variations in film development during autoradiography, in the case of radioactively labeled proteins. This study presents a discussion of these issues and a normalization algorithm to deal with variations, which relies on a class of proteins present in most biological samples which by their nature may be considered internal standards. This class consists of proteins which are controlled by constitutive genes. Constitutive genes are genes that are expressed constantly. We have developed an algorithm which is currently available as a subroutine, 'FINDCONS', in the computerized densitometry and protein comparison analysis program, developed by Olson & Miller (1988). This algorithm identifies potentially 'constitutive' proteins. A normalization method employing these potentially 'constitutive' proteins was compared to several others by examining 2D-electrophoretograms of proteins from developing gypsy moths (Lymantria dispar L.) insect tissue. Following normalization, inter-gel comparisons of spots, which were 'identified' as 'constitutive', were observed to vary less in density than when no normalization method was used, or when normalization based on total integrated spot density was used. In addition to its use as a normalization tool, this algorithm and the subroutine FINDCONS may be useful as an aid in biological studies to identify 'constitutive' proteins.

Localization of Ca(2+)-binding proteins of rat cortex on two-dimensional gels-I. Identification of calmodulin and the b subunit of calcineurin.

At least three Ca(2+)-binding proteins were detected in rat cortex by (45)Ca(2+) autoradiography of two-dimensional electrophoretograms. The identities of two of these Ca(2+)-binding proteins were determined to be calmodulin and the B subunit of calcineurin. The identification was based upon the following criteria: (1) co-localization on polyacrylamide gels with the appropriate purified proteins, (2) staining of nitrocellulose blots with specific antisera for calmodulin and calcineurin and (3) ability to bind Ca(2+). This information is useful in that it identifies two major brain proteins visible on silver-stained two-dimensional polyacrylamide gels. In addition, this data reveals the location of an unidentified Ca(2+)-binding protein of molecular weight ? 18,000 Da and pI 5.4 on these gels.

Localization of Ca(2+)-binding proteins of rat cortex on two-dimensional gels-II. analysis of Ca(2+) binding proteins in ammonium sulfate fractions of rat brain.

A total of seven high-affinity calcium-binding proteins have been detected in rat brain. This was accomplished using a combination of ammonium sulfate fractionation, two-dimensional gel electrophoresis, western blotting and (45)Ca(2+)-autoradiography. Of these seven proteins, three are detectable in a crude tissue punch of rat cortex while four are seen only after protein enrichment with ammonium sulfate. Four of the seven proteins detected in this study have been identified: calmodulin, the B subunit of calcineurin, the intestinal vitamin D-dependent calcium-binding protein and parvalbumin. The identities of the other three proteins visualized by (45)Ca(2+)-autoradiography in this study are unknown.

Incorporation of amino acids into proteins of the hypothalamus of prepuberal female rats after estradiol treatment.

The arcuate nucleus-median eminence complex (AM) undergoes major structural and functional changes during normal puberty or if exposed to a pulse of estradiol in the prepuberal period. Those changes are expressed by increased synaptogenesis and by a drastic alteration in the feedback control of anterior pituitary gland hormone release. In this study we investigated the effects of estradiol benzoate (EB) on specific proteins in this hypothalamic area. Prepuberal, 25-day-old female rats were administered 10 micrograms of EB s.c. in oil or sesame oil vehicle. The animals were decapitated either 17 or 42 h after treatment. The brains were removed, blocked and serially sections at 300 micron using a Vibratome. The AM was dissected out and incubated for 6 h in a medium containing 35S-methionine and 35S-cysteine. Proteins from the AM were separated by two-dimensional gel electrophoresis, and the gels were exposed to X-ray film. The resulting autofluorographs were analyzed by scanning densitometry. The results show that the incorporation of labeled amino acids was increased in 10 proteins and decreased in 2 proteins in rats killed 17 h after EB. At 42 h after EB, 6 proteins showed an increased incorporation of amino acids and two proteins showed a decrease. Our results suggest that one or several of these proteins might be involved in the neuroendocrine and structural changes observed in the AM during puberty.

Isolation of specific proteins affected by estradiol in the arcuate-median eminence of prepuberal female rats.

Prepuberal female rats (25 days of age) were injected with estradiol benzoate (EB 10 micrograms/rat, s.c. in oil) or oil vehicle. Forty-eight hours after treatment, all animals were decapitated, their brains removed and sectioned. The arcuate nucleus of the hypothalamus and median eminence were microdissected and processed for isoelectric focusing followed by slab gel electrophoresis. The resulting two-dimensional electrophoretic gels were analyzed to quantitate the specific proteins resolved using a scanning microdensitometric method. Out of 235 proteins measured, 8 proteins were found to be significantly increased and 4 were decreased by EB treatment. The proteins which increased in concentration ranged in molecular weight from 15 to 43 kDa and isoelectric points (pI) of 4.9 to 7.0. The 4 proteins decreased by the EB treatment were 44, 67, 74 and 80 kDa in molecular weight and their pI's ranged from 6.5 to 7.1. It is suggested that these proteins might be involved in some of the neuroendocrine effects that are induced by estradiol in this region of the brain.

Iron deficiency alters discrete proteins in rat caudate nucleus and nucleus accumbens.

Young rats (21 days old) made nutritionally iron deficient, by feeding them a semisynthetic diet containing skimmed milk for 5 weeks, had significantly lowered hemoglobin levels (5.2 +/- 4 g/100 ml). The nonheme iron content in caudate nucleus was decreased by 47%. The behavioral response of iron-deficient rats to apomorphine (2 mg/kg) and the density of 3,4-dihydroxyphenylethylamine (dopamine) D2 receptors, as measured by [3H]spiperone binding in caudate nucleus, were significantly reduced by 70 and 53%, respectively. The possibility that nutritional iron deficiency may affect protein content in brain was investigated by measuring the apparent concentration of proteins in caudate nucleus and nucleus accumbens from iron-deficient and control animals using two-dimensional gel electrophoresis. The data indicate that iron deficiency can affect content in these two brain regions. Significant changes in the content of 10 proteins were noted in the caudate nucleus and nucleus accumbens in iron-deficient rats. The albumin level was significantly increased in both regions studied, whereas the neuron-specific enolase level was increased in the nucleus accumbens and the glial fibrillary acidic protein level was reduced in the caudate nucleus. The significance of these protein content changes, as well as a reduction in content of a 94-kilodalton protein (a molecular size similar to that of the D2 dopamine receptor), remains to be established.

Protein patterns in various malignant human brain tumors by two-dimensional gel electrophoresis.

Two-dimensional gel electrophoresis with silver staining was used to study protein patterns in various malignant human brain tumors obtained at surgery. These samples included 20 high-grade astrocytomas (anaplastic astrocytomas and glioblastomas), one low-grade astrocytoma, six juvenile astrocytomas, four ependymomas, and five medulloblastomas. Histological correlates of the sampled tissue were carefully established prior to micropunch sampling. The molecular weight range of these gels was 14,000 to 100,000, and the isoelectric points ranged from 4.7 to 7.0. Proteins that have been identified include albumin, actin, tubulin, glial fibrillary acidic protein, vimentin, glutamic oxaloacetic transaminase, neuron-specific enolase, and the beta-subunit of the guanine nucleotide regulatory proteins. Each type of tumor was found to have a characteristic protein profile that set it apart from the other tumors studied. By providing a convenient tool for the display of a wide spectrum of tumor markers in a single study, two-dimensional gel electrophoresis protein profiles may be useful as diagnostic and prognostic adjuncts. Furthermore, several protein spots that were not noted in normal human cortex were identified in the various tumor gels. Antibodies can be raised against some of these tumor-associated proteins, and their further characterization could provide valuable insights into the biology of these tumors.

Subfornical organ: effects of salt loading and water deprivation on in vitro radioamino acid incorporation into individual proteins.

The subfornical organ of the brain has a role in the regulation of fluid balance in higher animals. In this study the effects of salt loading and water deprivation on specific proteins in this organ were investigated. For 4 days, 3 groups of rats were given an appropriate fluid diet (control, 2% NaCl and water deprived), with all groups having free access to food. Animals were killed by decapitation, and the subfornical organ was quickly dissected out and incubated for 6 h in a medium containing [35S]methionine and [35S]cysteine. Proteins from these organs were then separated by two-dimensional electrophoresis, and the resulting autofluorographs were analyzed by scanning densitometry. The results show that the incorporation of labeled amino acids into 8 proteins was changed due to the experimental manipulations.

Effect of 5,7-dihydroxytryptamine on the concentration of individual proteins in different areas of the rat brain.

Proteins which are apparently regulated in concentration in two different areas of the rat brain by the indole neurotransmitter serotonin were identified using two-dimensional gel electrophoresis combined with computerized scanning densitometry. Reduction in central serotonin levels produced a decrease in the concentration of 3 different proteins (2 in the parietal cortex, 1 in the hippocampus). Two proteins, both in the hippocampus, were elevated in concentration following serotonin depletion. These results demonstrate that there exist in the brain a limited number of proteins whose concentration is influenced by serotonin.

Effects of bilateral lesion of the locus coeruleus and of neonatal administration of 6-hydroxydopamine on the concentration of individual proteins in rat brain.

The role that norepinephrine plays in regulating the concentration of different proteins in the parietal cortex, hippocampus and cerebellum was assessed by investigating the effects of either a bilateral lesion of the locus coeruleus or neonatal administration of 6-hydroxydopamine. Two weeks after lesioning the locus coeruleus, the concentration of two different proteins was elevated in the hippocampus; a third protein was reduced in concentration in this brain area as a result of the lesion. Three proteins were affected in concentration in the cerebellum after the locus coeruleus lesion--two were elevated in concentration and one was reduced in concentration. No proteins were altered in concentration in the parietal cortex as a result of the lesion. Seventy days after neonatal treatment with 6-hydroxydopamine, a total of 6 proteins were found to be changed. Four of these (one in the hippocampus and 3 in the parietal cortex) were reduced in concentration while two proteins (both in the cerebellum) were elevated in concentration after neonatal treatment with the catecholamine neurotoxin. There was little overlap between those proteins affected in concentration by the bilateral lesion of the locus coeruleus and those changed by neonatal treatment with 6-hydroxydopamine. These results suggest that the concentration of a number of different proteins may, under normal physiological conditions, be regulated in vivo by norepinephrine in the brain.

Effect of chronic treatment with clorgyline on the relative concentration of specific proteins in the hippocampus and parietal cortex of the rat.

The effect of the chronic administration of clorgyline, a type A inhibitor of monoamine oxidase, on the relative concentration of proteins from the brain of the rat was examined by analysis of two-dimensional electrophoretic gels. The results from this study showed that the administration of clorgyline for 3 weeks produced a significant elevation in the relative concentration of two proteins in the parietal cortex (mol. wt 23,000 and 30,000) and one protein in the hippocampus (mol. wt 25,000). In contrast, the relative concentration of three proteins (mol. wt 31,000, 42,000 and 45,000) was significantly reduced in the parietal cortex by chronic treatment with clorgyline. No protein in the hippocampus was found to be significantly reduced by treatment with clorgyline. Since a previous study has indicated that the relative concentration of three different proteins were significantly altered by the repeated administration of desipramine, the results from the present experiment indicate that different changes in proteins are produced by repeated treatment with the type A monoamine oxidase inhibitor, clorgyline, as compared to those produced by the tricyclic antidepressant, desipramine. These results support previous suggestions that different classes of antidepressant compounds may exert their effects through different mechanisms of action.

The beta subunit of the guanine nucleotide regulatory proteins: identification of its location on two-dimensional gels of brain tissue and its regional and subcellular distribution in brain.

The beta subunit of the guanine nucleotide regulatory proteins (also termed G proteins) has been examined in both rat and human brain. Proteins contained within samples of fresh rat and human brain tissue were separated by two-dimensional gel electrophoresis and either stained with silver or reacted with various antisera raised against the G proteins. In both rat and human brain, a single protein of molecular weight 36,000 daltons and pI 5.8 reacted the antisera. This protein also comigrated with one of the proteins present in a purified preparation of bovine brain G proteins. Based upon molecular weight, pI, and reaction with specific antisera, it was concluded that this protein is the beta subunit of the G proteins in brain. Using this information, the regional and subcellular distribution of the G protein beta subunit was studied in rat brain. Of 25 distinct neuroanatomical areas examined, cortical regions were generally found to contain the largest amount of this protein. The subcellular distribution of the G protein beta subunit revealed that large amounts are present in the synaptic membrane, crude synaptic vesicles, and microsomes. These studies serve to identify another protein visible on silver-stained two-dimensional electrophoretograms of rat and human brain. The regional and subcellular distribution of the G protein beta subunit correlate well with the proposed physiological function of this protein.

Studies on catechol-O-methyltransferase in rat brain using two-dimensional gel electrophoresis.

The presence of catechol-O-methyltransferase (COMT) in the rat brain was studied using a combination of two-dimensional gel electrophoresis (2-DE), protein blotting and a specific antiserum. Two major immunoreactive proteins were identified-one with mol. wt 23 kdalton and an isoelectric point of 5.2, the other of mol. wt 25 kdalton and an isoelectric point of 5.1. In addition, multiple lower molecular weight immunoreactive proteins, possibly corresponding to breakdown products of the enzyme, were also detected. The 23 kdalton form of COMT, which is probably the soluble form of the enzyme, is a major protein visible on silver-stained 2-D gels of rat brain. In contrast, the other proteins recognized by the antiserum were not detected by the silver stain. These results demonstrate, using 2-DE, that at least two distinct forms of catechol-O-methyltransferase are present in rat brain. In addition, since one of these proteins is stained by silver, these results also serve to identify another protein visible on 2-D electrophoretograms of rat brain.