Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS.

HIV/AIDS has the unfortunate distinction of being one of the most devastating epidemics of the twentieth century. By the end of June, 1999, 420,201 deaths in persons with AIDS had been reported in the United States. While HIV/AIDS patients are currently living longer as a result of more effective and complex treatments, no vaccination or cure has yet been discovered. Over the years, the HIV/AIDS epidemic has become multifactorial and currently affects several different special population groups. Individuals who are at high risk for becoming infected with HIV or who already suffer from HIV/AIDS can benefit greatly from the interventions of psychiatrists or other mental health professionals. It is important that psychiatrists collaborate very closely with infectious disease specialists in the management of HIV/AIDS and its psychological sequelae. The authors describe the psychiatric conditions that most often occur in association with HIV/AIDS: mood disorders, anxiety disorders, substance-related disorders, psychotic disorders, insomnia and sleep disorders, delirium, dementia, and pain syndromes. We present guidelines for diagnosis and psychopharmacological and psychotherapeutic treatment of these disorders in patients with HIV/AIDS. The article concludes with a discussion of prevention strategies that can be used in a mental health treatment setting and special issues related to treating HIV/AIDS in certain special population groups.

Effects of acute alcohol intoxication on cerebral blood flow measured with PET.

Regional distribution of cerebral blood flow was assessed in a group of 13 normal social drinkers under baseline conditions and after acute alcohol intoxication. Blood flow measurements were done using 15O-labeled water and positron emission tomography (PET). Each subject underwent two control sessions under baseline conditions and two sessions after alcohol. Seven of the subjects were given 0.5 g/kg of alcohol and six were given 1 g/kg of alcohol p.o. The first and second post-alcohol scans were done 40 and 60 min after alcohol ingestion. The studies revealed that both the high and the low doses of alcohol reduced blood flow to the cerebellum. This effect was significant only for the high doses of alcohol, which also increased blood flow to the right temporal and the prefrontal cortex. The decrease in blood flow of the cerebellum could account for the muscular incoordination induced by alcohol.

Effect of acute ethanol on serine biosynthesis in liver.

The effect of an acute intraperitoneal dose of ethanol (1 g/kg), glucose (7.2 g/kg), or the combination of the two on the metabolite pattern of the biosynthetic pathway of L-serine has been determined in rabbit liver in vivo as has the effect of 10 mM ethanol on the glucose-, fructose-, or pyruvate-stimulated accumulation of L-serine in rabbit hepatocytes in vitro. In vivo, the 50% increase in L-serine and 80% increase in L-phosphoserine content of liver following glucose injection was completely prevented by ethanol. In fact, the L-phosphoserine content fell to only 6% of the control value. In spite of these and other significant changes in the metabolite pattern of the pathway of L-serine biosynthesis (D-3-phosphoglycerate dehydrogenase, L-phosphoserine aminotransferase (PSAT), and L-phosphoserine phosphatase), the mass action ratio of the combined reactions of the first two steps remained close to their equilibrium position. As a consequence it is estimated that the tissue content of phosphohydroxypyruvate fell to less than 2% of the control value, to approximately 0.3% of its Km for the PSAT reaction. The conclusion that acute ethanol blocks L-serine biosynthesis (presumably by redox effects) was supported by the prevention or inhibition of L-serine accumulation in hepatocytes metabolizing glucose, fructose, or pyruvate. Because L-serine is an important source of one-carbon fragments, the inhibition of its biosynthesis may be another mechanism by which ethanol interferes with folate and one-carbon metabolism.

Gluconeogenesis from serine in rabbit hepatocytes.

L-Serine alone is not gluconeogenic in isolated rabbit hepatocytes, whereas in rat liver this amino acid has been reported to yield as much glucose as does L-lactate itself. The current study has been an investigation into the explanation of the difference between the two species. Hepatocytes were isolated from 48-h-starved, 750- to 1000-g male rabbits, and the viability of each preparation was judged by ATP levels (2.4 +/- 0.2 mumol/g wet wt) at the beginning and end of the incubation as well as gluconeogenesis from 10 mM L-lactate (0.83 +/- 0.08 mumol/min/g wet wt). L-Serine alone produced virtually no glucose or pyruvate accumulation above baseline. Hydroxypyruvate, however, did appear in the incubation mixture. When L-serine and pyruvate were combined to test the functional activity of L-serine:pyruvate aminotransferase (EC 2.6.1.51), however, gluconeogenesis remained at the rate produced by pyruvate alone (0.61 +/- 0.04 mumol/min/g wet wt). On the other hand, the combination of L-serine and L-lactate produced rates of glucose accumulation 35% above that of L-lactate alone. The combination of L-lactate plus hydroxypyruvate produced nearly maximal rates (1.39 +/- 0.08 mumol/min/g wet wt), approaching those achieved by a physiologic ratio (10:1) of L-lactate and pyruvate. Hydroxypyruvate itself was only moderately gluconeogenic (0.44 +/- 0.04 mumol/min/g wet wt). That a reduction of the cytoplasmic free [NAD+]/[NADH] ratio by L-lactate was not its only contribution to L-serine utilization was suggested by the fact that ethanol completely eliminated gluconeogenesis from virtually all precursors (or combinations) tested, with the exception of hydroxypyruvate. It has been concluded from the data that, probably in contrast to the rat, the major pathway for the entrance of L-serine into gluconeogenesis in rabbit hepatocytes is through the pathway initiated by L-serine: pyruvate aminotransferase and that L-lactate is an important participant (i) by generating cytoplasmic reducing equivalents (NADH), (ii) by supplying pyruvate for the transaminating reaction itself, and, perhaps, (iii) by preventing hydroxypyruvate from being reduced by L-lactate dehydrogenase (EC 1.1.1.27) to L-glycerate.

Purification and properties of phosphoserine aminotransferase from bovine liver.

L-Phosphoserine aminotransferase was purified from bovine liver to apparent homogeneity as judged by nondenaturing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, analytical ultracentrifugation, and immunochemical analysis. The purification procedure described involves the specific elution of the enzyme from Cibacron blue-agarose by micromolar concentrations of its substrate, phosphohydroxypyruvate. The purified enzyme had a specific activity of approximately 13 mumol of phosphohydroxypyruvate formed min-1 mg-1 of protein at 38 degrees C. Determinations of the native molecular weight and the subunit molecular weight indicated that the phosphoserine aminotransferase from bovine liver was a dimer composed of two subunits with identical molecular weights of 43,000.

Substrate specificity of choline kinase.

The substrate specificity of choline kinase (ATP:choline phosphotransferase, EC 2.7.1.32) from brewer's yeast has been examined using multiple analogs of choline, most of which have been reported to be a substrate of one or another choline-using system from other sources. In contrast to many such systems, choline kinase from brewer's yeast has been found to have relatively stringent and straight-forward structural requirements for its substrates. It is hypothesized that there are at least four points of interaction of the substrate with the enzyme--one for the hydroxyalkyl side chain and one for each of the three substituents on the quaternary nitrogen. Of the latter, one site seems relatively more sterically hindered than the other two. Short, single or double alkyl substitutions on the quaternary nitrogen are possible without a large loss of substrate capacity of the analog. Thus N,N-dimethyl-N-propylethanolamine had a relative Vmax of 116% and a relative Vmax 96% that of choline and a Km of 68 +/- 15 microM [nearly four times that of choline itself (18 microM)]. However, N-butyl-N,N-dimethylethanolamine and N,N,N-triethylethanolamine were very poor substrates. Analogs with substituents on the quaternary nitrogen of longer chain length were without activity as were aromatic derivatives. None of the bisquaternary compounds of the general structure HOCH2CH2N+(CH3)2-(CH2)n-N+(CH3)2CH2CH2OH (n = 2-10) showed any substrate capacity, as well. Restrictions on the hydroxyethyl side chain were also severe. One additional methylene group in this chain greatly reduced substrate capacity of the analog and two additional ones eliminated it entirely, as did almost any substituent on the beta carbon. A single (but not a double) substituent on the alpha carbon was moderately tolerated, however. Thus alpha-methylcholine and N-methyl-2-hydroxymethylpiperidine were substrates (although the latter one was a poor one) but beta-methylcholine and N-methyl-3-hydroxypiperidine were not. Such information may be of use toward designing cholinergic probes targeting specific enzyme or metabolic functions.

Purification and subunit structure of phosphoglycerate dehydrogenase from rabbit liver.

D-3-Phosphoglycerate dehydrogenase (EC 1.1.1.95) was purified from rabbit liver by (NH4)2SO4 fractionation, DEAE-Sephacel chromatography, affinity chromatography on AMP-agarose and molecular-sieve h.p.l.c. The purified enzyme was homogeneous as judged by SDS/polyacrylamide-slab-gel electrophoresis. On the basis of molecular-sieve h.p.l.c. and SDS/polyacrylamide-gel electrophoresis, the enzyme is a tetramer composed of subunits of Mr 60,000.

The reactions of the phosphorylated pathway of L-serine biosynthesis: thermodynamic relationships in rat liver in vivo.

The effect of the induction of the enzymes of the phosphorylated pathway of L-serine biosynthesis on the thermodynamic relationships among the reactions has been determined in rat liver in vivo. The mass action ratios of the reactions involved were calculated from the concentrations of appropriate metabolites in freeze-clamped liver from animals fed normal and low-protein diets for 2 weeks. These ratios were compared with the equilibrium constants of the same reactions previously determined under physiological conditions and the results previously obtained in the rabbit. The thermodynamic relationships in the pathway were different between the normal rat and rabbit as might have been expected, because of the significantly lower activities of the L-serine biosynthetic enzymes in the former animal. Although the delta G for the overall pathway is nearly identical in the rat and rabbit (-5.8 versus -5.5 kcal/mol, respectively), the distribution of delta G among the reactions is different. The disequilibrium in the pathway in rat liver is nearly equally divided between the L-phosphoserine phosphatase (EC 3.1.3.3) step and the other two reactions [D-3-phosphoglycerate dehydrogenase (EC 1.1.1.95) and L-phosphoserine aminotransferase (EC 2.6.1.52)], whereas in rabbit the phosphatase reaction accounts for nearly the entire delta G. Feeding the rat a low protein diet, however, induced the activity of D-3-phosphoglycerate dehydrogenase 12-fold, that of L-phosphoserine aminotransferase 20-fold, and that of L-phosphoserine phosphatase 2-fold. With the induction of the pathway, L-phosphoserine appeared in the tissue, there was a more than 3-fold rise in L-serine in the liver, and the pattern of delta G in the rat liver approached that in the rabbit.

High-affinity hemicholinium-3 binding to brain membranes: reduction by treatment with physostigmine in vivo.

We examined high-affinity, sodium-dependent binding of hemicholinium-3 to brain membranes. Binding, with Kd of about 3 nM, was highest in corpus striatum, intermediate in cerebral cortex and hippocampus, and low in cerebellum. Treatment with physostigmine in vivo reduced binding in all regions without affecting apparent affinity.

The reactions of the phosphorylated pathway of L-serine biosynthesis: thermodynamic relationships in rabbit liver in vivo.

The thermodynamic relationships among the reactions of the phosphorylated pathway of L-serine biosynthesis have been determined in rabbit liver in vivo in different dietary states. The mass action ratios of the reactions involved were calculated from the concentrations of appropriate metabolites in freeze-clamped liver and compared with the equilibrium constants of the same reactions previously determined under physiological conditions. Toward this goal, a new, highly specific enzymatic assay for L-phosphoserine was developed to allow the accurate measurement of this intermediate in biological material. The level of L-phosphoserine, the immediate precursor of L-serine, varied significantly with diet, being 0.81, 0.38, and 0.21 mumol/g wet wt in the fed, and 24 h and 48 h fasted states, respectively. The tissue content of L-phosphoserine was also sensitive to anoxia, falling almost fivefold within 5 min after the liver was removed. Values of for the combined reactions of the first two steps of the pathway of L-serine biosynthesis [D-3-phosphoglycerate dehydrogenase (EC 1.1.1.95) and L-phosphoserine aminotransferase (EC 2.6.1.52)] in livers from animals in different dietary states were calculated to be 1.2 X 10(-4) (fed), 1.4 X 10(-4) (24 h starved), and 0.70 X 10(-4) (48 h starved), all being very close to the value of the combined equilibrium constant of the same reactions (2.44 X 10(-4). Even when there were major changes in the individual components of, such as a fivefold drop in L-phosphoserine and a sevenfold fall in alpha-ketoglutarate following 5 min of anoxia, remained relatively unchanged (2.7 X 10(-4). Thus, it has been concluded that, in rabbit liver under most normal conditions, the combined reactions of D-3-phosphoglycerate dehydrogenase and L-phosphoserine aminotransferase remain very near equilibrium, and that almost all of the disequilibrium of the pathway, amounting to a delta G of -5.5 kcal/mol in the fed state, is at the last step, the L-phosphoserine phosphatase reaction (EC 3.1.3.3).

The calculation of the mitochondrial free [NAD+]/[NADH][H+] ratio in brain: effect of electroconvulsive seizure.

This study is an investigation into the validity of calculating the mitochondrial redox state in brain in vivo using models of seizure and anoxia in rats. At six intervals following electroconvulsive seizure (0.5-10 min) and after 5 min of complete anoxia, multiple metabolites were measured in freeze-blown or freeze-clamped brain. From substrate ratios, the apparent changes in the mitochondrial free [NAD+]/[NADH] [H+] ratio were calculated from the L-glutamate dehydrogenase reaction [EC 1.4.1.3] and compared with shifts in the oxidized to reduced ratio of total ubiquinone (a component of the mitochondrial phosphorylation chain). During complete anoxia the calculated mitochondrial free [NAD+]/[NADH] [H+] ratio and the ubiquinone redox ratio both became more reduced by a factor of approximately 7. In contrast, following seizure the two indicators of the mitochondrial redox state moved in opposite directions. Mainly because of a large increase in tissue NH4+, the calculated mitochondrial free [NAD+]/[NADH] [H+] ratio paradoxically became more oxidized, plateauing between 2 and 10 min post seizure at a value approximately double that of the control. At the same time, however, the ubiquinone redox state fell to one-half the control value at two min and moved back towards normal between 5 and 10 min after the onset of the seizure. The results have been taken to be evidence against the applicability of the calculation of the mitochondrial free [NAD+]/[NADH] [H+] ratio from the L-glutamate dehydrogenase reaction in brain at least under conditions of rapid change. The results also suggest the possibility that the NH4+ produced during seizure is extra-mitochondrial and has relatively little tendency to diffuse into the matrix.

Acute effect of ethanol on metabolite concentrations of dog pancreas in vivo.

Sections of dog pancreas were freeze-clamped before and 1 hr after oral administration of 1 g/kg of ethanol in anesthetized, respirated, 24-hr-fasted animals, and multiple metabolites were determined in the perchloric acid extract of the frozen tissue. In spite of the fact that the pancreas contained little or no alcohol dehydrogenase activity (less than 0.01 IU/g of tissue), significant metabolite changes did occur. Although arterial oxygenation was constant and adequate (pO2 = 100 +/- 7 mM Hg) there was a significant 1.7-fold rise in L-lactate and fall in the cytoplasmic free [NAD+]/[NADH] ratio from 719 +/- 87 to 453 +/- 88 after ethanol. Except for a tendency for L-malate and L-alpha-glycerolphosphate to parallel the rise in L-lactate, there was little consistent disturbance in the remainder of the glycolytic metabolites (glucose, glucose 6-phosphate, pyruvate, 2-ketoglutarate, citrate, 3-phosphoglycerate, etc.) or in high energy intermediates and related compounds (ATP, creatine phosphate, ADP, Pi, creatine). There was, however, an unexpected and significant fall in the levels of the major transaminating amino acids, L-glutamate, L-aspartate, and L-alanine. The results can be only partially explained by an influence of blood-borne metabolites and imply significant effects of ethanol on the metabolism of the pancreas in vivo not directly mediated through alcohol dehydrogenase. Evidence is presented suggesting that both L-alanine and L-aspartate aminotransferases are functioning near equilibrium in the pancreas in vivo.