Transport of the placental estriol precursor 16α-hydroxy-dehydroepiandrosterone sulfate (16α-OH-DHEAS) by stably transfected OAT4-, SOAT-, and NTCP-HEK293 cells.

16α-Hydroxy-dehydroepiandrosterone sulfate (16α-OH-DHEAS) mainly originates from the fetus and serves as precursor for placental estriol biosynthesis. For conversion of 16α-OH-DHEAS to estriol several intracellular enzymes are required. However, prior to enzymatic conversion, 16α-OH-DHEAS must enter the cells by carrier mediated transport. To identify these carriers, uptake of 16α-OH-DHEAS by the candidate carriers organic anion transporter OAT4, sodium-dependent organic anion transporter SOAT, Na(+)-taurocholate cotransporting polypeptide NTCP, and organic anion transporting polypeptide OATP2B1 was measured in stably transfected HEK293 cells by LC-MS-MS. Furthermore, the study aimed to localize SOAT in the human placenta. Stably transfected OAT4-HEK293 cells revealed a partly sodium-dependent transport for 16α-OH-DHEAS with an apparent Km of 23.1 ± 5.1 µM and Vmax of 485.0 ± 39.1 pmol/mg protein/min, while stably transfected SOAT- and NTCP-HEK293 cells showed uptake only under sodium conditions with Km of 319.0 ± 59.5 µM and Vmax of 1465.8 ± 118.8 pmol/mg protein/min for SOAT and Km of 51.4 ± 9.9 µM and Vmax of 1423.3 ± 109.6 pmol/mg protein/min for NTCP. In contrast, stably transfected OATP2B1-HEK293 cells did not transport 16α-OH-DHEAS at all. Immunohistochemical studies and in situ hybridization of formalin fixed and paraffin embedded sections of human late term placenta showed expression of SOAT in syncytiotrophoblasts, predominantly at the apical membrane as well as in the vessel endothelium. In conclusion, OAT4, SOAT, and NTCP were identified as carriers for the estriol precursor 16α-OH-DHEAS. At least SOAT and OAT4 seem to play a functional role for the placental estriol synthesis as both are expressed in the syncytiotrophoblast of human placenta.

Co-expression studies of the orphan carrier protein Slc10a4 and the vesicular carriers VAChT and VMAT2 in the rat central and peripheral nervous system.

The orphan carrier protein Slc10a4 represents a novel member of the so-called "sodium-bile acid co-transporter family," SLC10. Slc10a4 has a close phylogenetic relationship with the liver bile acid carrier Ntcp (Slc10a1), but has no transport activity for bile acids. In a previous study Slc10a4 proved to be predominantly expressed in the rat brain, where it was localized within cholinergic neurons. However, whether this cholinergic expression pattern was exclusive for Slc10a4 and whether this protein might also be expressed in the peripheral nervous system or other peripheral organs, remained unclear. Therefore, in the present study we analyzed the expression of Slc10a4 in neuronal and non-neuronal rat tissues more systematically, employing immunofluorescence co-localization studies of the vesicular acetylcholine transporter VAChT and the vesicular monoamine transporter VMAT2. The Slc10a4 protein was found to be widely expressed throughout structures of the CNS and peripheral nervous system. In addition to cholinergic neurons in the CNS, the retina, the neuromuscular junction and parasympathetic innervations, Slc10a4 was also localized in certain monoaminergic neurons and nerve fibers in the substantia nigra, the spinal cord and sympathetic innervations. Slc10a4 expression was also detected in granules of rat peritoneal and tissue mast cells using immunofluorescence and electron microscopy. Western blot and immunoprecipitation experiments with rat brain vesicle preparations revealed that the Slc10a4 protein was expressed in synaptic vesicles where it co-localized with synaptophysin, VAChT and VMAT2. This vesicular expression pattern was also shown in the rat adrenal pheochromocytoma cell line PC12 by immunofluorescence. Based on the findings of the present study we can speculate about the function of Slc10a4 as follows: (I) Slc10a4 could be a novel vesicular transporter for cholinergic and/or various monoaminergic neurotransmitters in the central and peripheral nervous system or (II) may be involved in the regulation of the synaptic vesicle sorting or exocytosis process.

P-glycoprotein is functionally expressed in the placenta-derived bovine caruncular epithelial cell line 1 (BCEC-1).

Drug treatment is critical in pregnant cows due to the possibility of a maternal-to-fetal drug transfer across the placenta. Since the (syn)epitheliochorial bovine placental barrier includes an intact uterine epithelium, which in general limits drug transfer to the fetal trophoblast, the establishment of a species- and organ-specific in vitro model like the bovine caruncular epithelial cell line 1 (BCEC-1) for testing bovine placental drug transport is desirable. P-glycoprotein (P-gp or ABCB1) is an important efflux carrier that limits drug permeability across blood-tissue barriers such as the placenta and transports a wide range of structurally unrelated compounds including many drugs commonly used in veterinary medicine. The aim of the present study was to elucidate the suitability of BCEC-1 as an appropriate in vitro model for P-gp mediated drug transport in the bovine placenta. P-gp mRNA expression was detected by RT-PCR in BCEC-1 and placental tissue. Additionally, the carrier protein was localised in the apical membrane of BCEC-1 by immunofluorescence staining with the mouse monoclonal antibody C494. Drug transport in BCEC-1 was investigated by FACS analysis using the fluorescent P-gp substrate Rhodamine 123. Inhibition of Rhodamine 123 efflux by the P-gp inhibitors Verapamil and PSC833 confirmed functional expression of P-gp in BCEC-1. Furthermore, transport measurements in the transwell-system revealed a basal-to-apical net flux of the P-gp substrate digoxin at concentrations ranging from 10nM to 10 µM. This transwell digoxin flux was inhibited by Verapamil. In conclusion, P-gp is functionally expressed in BCEC-1 and mediates a basal-to-apical flux of digoxin indicating dominant apical localization of P-gp in this cell culture model. Therefore, BCEC-1 may be an appropriate in vitro model to study drug transport across the maternal epithelium as part of the epitheliochorial placental barrier of the cow.

Placental steroids in cattle: hormones, placental growth factors or by-products of trophoblast giant cell differentiation?

The bovine placenta produces large amounts of steroids, mainly estrone (E1) and progesterone (P4). Specific features of bovine placental steroidogenesis are 1) the expression of all enzymes needed for the production of estrogens from cholesterol in the trophoblast 2) an only marginal and temporal contribution to peripheral maternal P4 levels restricted to a period between approx. days 150 - 240 of gestation 3) the predominance of sulfoconjugated over free E1 and 4) a complementary setting of steroidogenic enzymes in the two morphologically discriminable trophoblast cell types, the uninucleated trophoblast cells (UTC) and the trophoblast giant cells (TGC). In cattle so far no definite information is available on the specific biological roles of placental estrogens and P4. However, the detection of estrogen receptors and progesterone receptors in the placentomes suggests a role primarily as local regulators of caruncular growth, differentiation and functions. Inconsistent with a function as a caruncular growth factor is the strong evidence that in cattle placental estrogens enter the maternal compartment almost completely as estrone sulfate (E1S), which is not active at classical nuclear receptors. On the other hand, E1S may be converted locally to free active estrogens via the action of steroid sulfatase (StS), which has been detected in specific parts of the bovine caruncular epithelium. Alternatively or in addition, StS expression in the caruncular epithelium may serve the utilization of sulfated neutral steroid precursors (e.g. pregnenolone sulfate or cholesterol sulfate) supplied with maternal blood, thus providing free substrates for further metabolization in the adjacent trophoblast. The down-regulation of P450scc and P450c17 and the up-regulation of 3beta-HSD and aromatase during the differentiation of TGC from UTC in parallel with the up-regulation of ER beta and estrogen sulfotransferase in maturing TGC suggests a function of placental estrogens primarily as autoor intracrine regulators during this process and assigns to conjugated placental estrogens a role as inactivated by-products of TGC differentiation intended for excretion. Collectively, despite some evidence from recent studies for putative roles of placental steroids in cattle their exact functions in the bovine species remain still undefined.

Cloning and molecular characterization of the orphan carrier protein Slc10a4: expression in cholinergic neurons of the rat central nervous system.

We report on the cloning and molecular characterization of the rat carrier Slc10a4 and its cellular localization in the CNS by immunohistochemistry. Slc10a4 is the rat counterpart of the human orphan carrier SLC10A4, which was recently reported to be highly expressed in brain and placenta. Both carriers belong to the solute carrier family SLC10, formerly named the "sodium/bile acid cotransporter family." So SLC10A4/Slc10a4 has a phylogenetic relationship to the Na+/taurocholate cotransporting polypeptide Ntcp (Slc10a1) and the apical sodium-dependent bile acid transporter Asbt (Slc10a2). The rat Slc10a4 protein consists of 437 amino acids and exhibits a seven transmembrane domain topology with N(exo)/C(cyt)trans-orientation of the N- and C-terminal ends. Expression of the Slc10a4 protein was detected in motor regions of the spinal cord and rhombencephalon, as well as in mesopontine cholinergic neurons, the medial habenula, cholinergic areas of the forebrain, and the gut myenteric plexus. Co-localization studies with the cholinergic marker proteins choline acetyltransferase (ChAT), vesicular acetylcholine transporter (VAChT), and high-affinity choline transporter (CHT1) demonstrated expression of Slc10a4 in cholinergic neurons. Despite its close phylogenetic relationship to Ntcp, Slc10a4 showed no transport activity for the Ntcp substrates taurocholate, estrone-3-sulfate, dehydroepiandrosterone sulfate, and pregnenolone sulfate when expressed in HEK293 cells or Xenopus laevis oocytes. Slc10a4 also did not transport choline, which is a substrate of CHT1. Although the functional properties of Slc10a4 could not be elucidated in this study, Slc10a4 is regarded as a new marker protein for cholinergic neurons in the rat CNS.

Frequency of the nt230 (del4) MDR1 mutation in Collies and related dog breeds in Germany.

MDR1 (ABCB1) P-glycoprotein exerts a protective function in the blood-brain barrier thereby limiting the entry of many drugs and other xenobiotics to the central nervous system. A nonsense mutation has been described for Collies and related dog breeds which abolishes this function and is associated with increased susceptibility to neurotoxic side effects of several drugs including ivermectin, moxidectin and loperamide. In order to evaluate the occurrence and frequency of this nt230 (del4) MDR1 mutation in Germany, we screened 1500 dogs. Frequency of the homozygous mutated genotype was highest for Collies (33.0%), followed by Australian Shepherd (6.9%) and Shetland Sheepdog (5.7%). Thirty-seven percent of the Wäller dogs and 12.5% of the Old English Sheepdogs were heterozygous for the mutant MDR1 (-) allele. Considering the predominant role of MDR1 P-glycoprotein in drug disposition and in particular for blood-brain barrier protection, MDR1 genotype-based breeding programs are recommended for improving the safety of drug therapy in these canine breeds.

Development of a PCR-based diagnostic test detecting a nt230(del4) MDR1 mutation in dogs: verification in a moxidectin-sensitive Australian Shepherd.

A subpopulation of dogs of the Collie and Australian Shepherd breeds show increased sensitivity to central nervous actions of ivermectin, doramectin, loperamide, and probably several other drugs. The molecular background for this greater sensitivity is a nonsense mutation in the MDR1 efflux pump, which is part of the functional blood-brain barrier and normally limits drug penetration into the brain. This report describes a rapid PCR-based method for detection of this nt230(del4) MDR1 mutation using a small amount of genomic DNA from blood cells. Thereby, homozygous intact, homozygous mutated, and heterozygous mutated MDR1 genotypes can be clearly differentiated by high resolution polyacrylamide gel electrophoresis. Using this diagnostic test two Collies and one Australian Shepherd were screened for the nt230(del4) MDR1 mutation. The Collies had no history of altered drug sensitivity and showed homozygous intact and heterozygous mutated MDR1 alleles, respectively. However, the Australian Shepherd developed clear signs of neurotoxicity including ataxia, crawling, acoustic and tactile hyperexcitability, and miosis after a single dose of moxidectin (400 microg/kg). For this dog two mutated MDR1 alleles were detected. This report describes for the first time moxidectin neurotoxicosis in a dog with a homozygous MDR1 mutation.

Endothelium-specific replacement of the connexin43 coding region by a lacZ reporter gene.

The murine gap junction protein connexin43 (Cx43) is expressed in blood vessels, with vastly different contribution by endothelial and smooth muscle cells. We have used the Cre recombinase under control of TIE2 transcriptional elements to inactivate a floxed Cx43 gene specifically in endothelial cells. Cre-mediated deletion led to replacement of the Cx43 coding region by a lacZ reporter gene. This allowed us to monitor the extent of deletion and to visualize the endothelial expression pattern of Cx43. We found widespread endothelial expression of the Cx43 gene during embryonic development, which became restricted largely to capillaries and small vessels in all adult organs examined. Mice lacking Cx43 in endothelium did not exhibit altered blood pressure, in contrast to mice deficient in Cx40. Our results show that lacZ activation after deletion of the target gene allows us to determine the extent of cell type-specific deletion after phenotypical investigation of the same animal.

General and conditional replacement of connexin43-coding DNA by a lacZ reporter gene for cell-autonomous analysis of expression.

Using the Cre/loxP system, we have circumvented early postnatal lethality and possible pleiotropic effects of general Cx43 gene deletion, in order to determine the expression and function of connexin43 (Cx43) in defined cell types. General or cell type-specific, Cre-mediated deletion of the floxed (i.e. flanked by loxP sites) Cx43-coding region led to activation of the inserted lacZ reporter gene in cells with transcriptional activity of the Cx43 gene. As deduced from lacZ expression in mice with general deletion, transcriptional activity of the Cx43 gene was not only found in a broad range of cell types known to a express Cx43, but also inpancreatic duct cells and vascular cells of the gut and skeletal muscle. Cre-mediated deletion restricted to defined cell types led to lacZ activation highlighting corresponding subsets of cells expressing Cx43, such as vascular endothelial cells, hepatic duct cells and putative neural crest cells, which were otherwise masked by strong Cx43 expression in neighbouring cells. In Cx43 expressing cell types, the floxed Cx43 allele was useful as a Cre-excision reporter for the characterization of Cre transgenes.

Factors that contribute to complications during intrahospital transport of the critically ill.

Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. A high incidence of serious hemodynamic or respiratory alteration is associated with the intrahospital transport of critically ill patients. In one third of critically ill intrahospital transports, technical mishaps (eg, i.v. disconnects, which could potentially lead to deleterious physiologic outcomes) may occur. As patient acuity increases, there is a greater risk of hemodynamic instability. The purpose of this study was to further investigate the patient complications during transportation to and from the ICU to a diagnostic or treatment site. The sample consisted of thirty-five critically ill patients from the Neuro/Trauma ICU who required continuous physiological monitoring and had an arterial catheter in place. The systemic blood pressure, heart rate and peripheral oxygen saturation were monitored at nine time points throughout the transport process. The incidence of defined technical mishaps that occurred when the patient was off the unit were also recorded. Transport factors examined included the length of time spent off the unit and the number and level of personnel accompanying the patient. A within-subject repeat measure design was used to examine the physiologic changes and mishaps that occurred. Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment.

[Resuscitation of a near-drowning patient by the use of a portable extracorporeal circulation device]. / Reanimation eines Beinah-Ertrunkenen mittels einer portablen extrakorporalen Zirkulation.

We report on a 21-year old patient who nearly drowned in cold water under inexplicable circumstances. About 1/2 hour later he was found with cardiac arrest. Immediate cardiopulmonary resuscitation remained unsuccessfully but was continued. After transportation to the nearest hospital a core temperature of 26.1 degrees C was recorded. A team of our hospital arrived 2 1/2 hours after start of cardiopulmonary resuscitation. After introducing a femo-femoral bypass the patient was rapidly rewarmed and oxygenated using a portable extracorporeal circulation and membrane oxygenation. Defibrillation succeeded at a core temperature of 34.4 degrees C. A severe ARDS developed the same day which was successfully treated by membrane oxygenation. 41 days later the patient left the hospital fully recovered.

Seven years of experience with the centrifugal pump in patients with cardiogenic shock.

From September 1987 to September 1994 61 patients between 29 and 78 years of age received mechanical circulatory support by means of the Biomedicus centrifugal pump. The patients were divided into three groups by indication: Group I included 15 patients with early postcardiotomy cardiogenic shock and 24 patients with late postcardiotomy cardiogenic shock. Group II 11 patients with therapy-resistant cardiogenic shock following acute myocardial infarction, and Group III 11 patients with cardiogenic shock of other etiologies. Duration of support was 1 to 347 hours. Survival rates were 46.7% and 33.3% in patients with early and late postcardiotomy cardiogenic shock, respectively (Group I), 27.2% in Group II, and 18.1% in Group III. Most frequent complications were bleeding (40%, 58%) and acute renal failure (26.7%, 29.2%) in Group I and multiple organ failure in Groups II and III (64% and 45.5%). Major causes of death were bleeding and multiple organ failure in Group I (37.5%) and multiple organ failure in Groups II and III (87.5% and 50%). Groups II and III (87.5% and 50%).

application of the human dermal model skin(2) ZK 1350 to phototoxicity and skin corrosivity testing.

The human three-dimensional in vitro model Skin(2) ZK 1350(TM) [Advanced Tissue Sciences (ATS), La Jolla, USA] was tested for two in vitro toxicology applications, prediction of phototoxicity and classification of skin corrosivity. For phototoxicity testing chemicals were applied topically for 1 or 24 hr followed by 30 min of irradiation with a non-irritating dose of UVA. Phototoxicity was assessed 24 hr later by comparing cytotoxicity of UVA-exposed and non-exposed tissue in the MTT assay. In a European EC/COLIPA in vitro phototoxicity validation trial with 20 test chemicals (11 phototoxic and nine non-phototoxic), the best result was obtained with the Skin(2) ZK 1350 assay in the 24-hr exposure protocol where nine of the 11 phototoxins were classified correctly both at ATS and ZEBET. 6-Methylcoumarin could only be identified as a phototoxin when applied through the medium to the dermis side of the skin model for 24 hr. All of the nine non-phototoxic chemicals were identified correctly with either 1- or 24-hr preincubation. To classify chemicals as corrosive to the skin with an in vitro assay, ZEBET and two other laboratories tested 50 chemicals under blind conditions in the Skin(2) ZK 1350 model within a European ECVAM validation trial. The results obtained with the ZK 1350 assay showed a satisfactory classification of skin corrosive/non-corrosive chemicals and a sufficient prediction of the three UN Packing Groups for corrosive chemicals. Predictions obtained at ZEBET with the Skin(2) ZK 1350 model (sensitivity: 64%, specificity: 76%; positive and negative predictive values: 68%) compared with a sensitivity of 81% and a specificity of 77% as mean values for the three laboratories testing the model.

[New avenues in therapy of postoperative low output syndrome]. / Neue Wege in der Therapie des postoperativen Low-output-Syndroms.

The present definitions of low-output syndrome (LOS) associated with cardiac surgery are based on data obtained via the Swan-Ganz-catheter. However, further important data such as signs of chronic renal insufficiency, arterial vascular disease, and perioperative volume overload have hardly been considered. At the Heart Center NRW, FRG, the Swan-Ganz-Catheter is not used routinely to monitor patients following cardiac surgery. According to our experience, the definition of low-output syndrome includes a wider spectrum of relevant criteria. In addition to the data obtained by means of a central venous catheter the clinical aspect of the patient as well as laboratory analysis should be regarded as well. In 1259 consecutive patients (pts) (914 with coronary surgery and 318 with valve surgery) the incidence and mortality of low-output syndrome were determined. In 49 of the 941 coronary surgery pts (5.2%) a postoperative low-output syndrome occurred. Nine pts (0.95%) died as a result of this complication. According to our therapeutical strategy, the low-output syndrome was treated medically in 28 pts (2.9%); in 14 pts (1.5%) IABP implantation was necessary, and 7 pts needed mechanical circulatory support. Surprisingly, the same incidence of LOS occurred in the valve surgery group of pts as in the coronary group. We saw a low-output syndrome in 17 of the 318 pts (5.3%), with fatal outcome in three pts. In 14 of these pts (4.4%) the LOS was treated medically, while the remaining three pts (0.9%) required diastolic augmentation of the IABP.

EEC/COLIPA project on in vitro phototoxicity testing: First results obtained with a Balb/c 3T3 cell phototoxicity assay.

In a joint validation project eight laboratories from the European Cosmetic Industry Association (COLIPA) as well as FRAME (England) and ZEBET (Germany) are trying to develop validated in vitro methods to be incorporated into new international guidelines for acute phototoxicity testing. The first stage of the study involved selection of the most promising in vitro phototoxicity tests for further validation. 20 chemicals with known phototoxic properties (12 phototoxins, four UV-absorbing non-phototoxins and four non-UV absorbing non-phototoxins) were tested under identical conditions of UV exposure conditions (sun simulator, UVA 5 J/cm(2)) in a standardized cytotoxicity assay with Balb/c 3T3 fibroblasts (endpoint: neutral red uptake, NRU). 19 of the 20 chemicals were correctly classified by the 3T3 NRU phototoxicity test, and therefore, this simple assay for phototoxicity seems very promising and should be validated further.

[Bronchial obstruction caused by incorrect positioning of a temperature probe]. / Bronchusobstruktion durch Fehllage einer Temperatursonde.

In a case of open heart surgery a temperature probe was inserted orally to monitor the temperature in the esophagus. After insertion, the arterial oxygen tension decreased. Fiberoptic examination of the bronchial system revealed an obstruction in the right main bronchus by the temperature probe. After removal of the probe normal oxygenation was restored.

[On the question of endocrine side effects in patients on medication for renal calcium stone disease (author's transl)]. / Zur Frage endokriner Nebenwirkungen bei der medikamentösen Prophylaxe calciumhaltiger Harnsteine.

In patients with recurrent idiopathic nephrolithiasis we studied whether treatment with sodium cellulose phosphate leading to decreased intestinal calcium absorption could induce secondary hyperparathyroidism and whether thiazides which diminish calciuria would impair glucose tolerance. After removal of a actual kidney stone, 74 patients were treated for one year as follows: 25 (group 1) received conventional therapy (Nieron), 22 (group 2) received sodium cellulose phosphate, and 27 (group 3) received sodium cellulose phosphate plus hydrochlorothiazide. The period of one year was too short to evaluate the effectiveness of treatment regarding stone recurrence, however, a significant decrease in calciuria only was seen in group 3. With respect to the possibility to develop secondary hyperparathyroidism, group 2 and group 3 did not reveal any hints. In group 3, the thiazide treatment did not worsen glucose tolerance. Therefore, longer lasting studies with these drugs could be performed without evident danger to develop the mentioned side effects.