Total and free plasma concentrations of the active metabolite of leflunomide in relation to therapeutic outcome in kidney transplant recipients with BK-virus nephropathy.

Plasma concentrations of A771726, the active moiety of leflunomide, have been suggested to be associated with antiviral efficacy and/or an increased risk of toxicity. A771726 is >99% bound to serum albumin, which can be relevant in kidney transplant recipients (KTRs) displaying impaired function, which leads to increased pharmacologically active free drug concentrations. This study investigated the relationship of total (t-) and free (f-) A771726 concentrations with clinical outcomes. The 20 KTRs displayed a median daily dose and time on leflunomide of 20 mg (range, 10-50) and 16.5 months (range, 2-28), respectively. A median of 6 (range, 1-15) trough concentrations were measured in each patient. All patients received steroids and a calcineurin inhibitor (CNI) as well as 4 of them, cidofovir. To evaluate therapeutic efficacy, we monitored viral loads in the urine and blood, serum creatinine, and kidney histology. To detect toxicity, we recorded blood and platelet counts, hematocrit, hemoglobin concentrations, liver enzymes (alanine aminotransferase [ALT], and aspartate aminotransferase [AST]), and skin diseases. The median t-A771726 concentration was 31.5 mg/L (interindividual range, 11.0-56.4); the median f-A771726 concentration and fraction were 55.8 µg/L and 0.19% (interindividual ranges, 27.9-148.4 µg/L and 0.12%-0.50%), respectively. A weak but significant inverse correlation was observed between the free drug fraction and both the glomerular filtration rate estimated by the Modification of Diet in Renal Disease formula (MDRD-GFR) (r = -0.202) and serum albumin (r = -0.358). Higher MDRD-GFRs were associated with greater t-A771726 concentrations. There were no significant associations between efficacy parameters and either the t- or f-A771726 concentration or between the t-A771726 concentration and toxicity parameters. In contrast, the f-A771726 concentration was significantly associated with leukopenia. These results indicated that f-A771726 concentrations may be more reliable than t-A771726 content to estimate the risk of leukopenia. Intensified elimination due to a higher free drug fraction and compromised absorption associated with a low GFR may have been responsible for the positive correlation between MDRD-GFR and t-A771726.

Diverse system stresses: common mechanisms of chromosome fragmentation.

Chromosome fragmentation (C-Frag) is a newly identified MCD (mitotic cell death), distinct from apoptosis and MC (mitotic catastrophe). As different molecular mechanisms can induce C-Frag, we hypothesize that the general mechanism of its induction is a system response to cellular stress. A clear link between C-Frag and diverse system stresses generated from an array of molecular mechanisms is shown. Centrosome amplification, which is also linked to diverse mechanisms of stress, is shown to occur in association with C-Frag. This led to a new model showing that diverse stresses induce common, MCD. Specifically, different cellular stresses target the integral chromosomal machinery, leading to system instability and triggering of MCD by C-Frag. This model of stress-induced cell death is also applicable to other types of cell death. The current study solves the previously confusing relationship between the diverse molecular mechanisms of chromosome pulverization, suggesting that incomplete C-Frag could serve as the initial event responsible for forms of genome chaos including chromothripsis. In addition, multiple cell death types are shown to coexist with C-Frag and it is more dominant than apoptosis at lower drug concentrations. Together, this study suggests that cell death is a diverse group of highly heterogeneous events that are linked to stress-induced system instability and evolutionary potential.

Suppression of the inducible form of nitric oxide synthase prior to traumatic brain injury improves cytochrome c oxidase activity and normalizes cellular energy levels.

We have previously shown that the observed immediate increase in nitric oxide (NO) plays a significant role in the control of the cerebral microcirculation following traumatic brain injury (TBI). However, a second consequence of increased NO production after TBI may be impaired mitochondrial function, due to the fact that NO is a well-known inhibitor of cytochrome c oxidase (CcO). CcO is a key enzyme of the mitochondrial oxidative phosphorylation (OxPhos) machinery, which creates cellular energy in the form of ATP. NO competes with oxygen at the heme a(3)-Cu(B) reaction center of CcO. We thus hypothesized that TBI triggers inhibition of CcO, which would in turn lead to a decreased energy production by OxPhos at a time of an elevated energy demand for tissue remodeling. Here we show that TBI as induced by an acceleration weight drop model of diffuse brain injury in rats leads to CcO inhibition and dramatically decreased ATP levels in brain cortex. CcO inhibition can be partially restored by application of iNOS antisense oligonucleotides prior to TBI, which leads to a normalization of ATP levels similar to the controls. We propose that a lack of energy after TBI caused by inhibition of CcO is an important aspect of trauma pathology.

Mammalian subunit IV isoforms of cytochrome c oxidase.

Cytochrome c oxidase (COX) contains ten nuclear encoded subunits, three of them known to show tissue isoforms in mammals. We have now found a fourth isoform, for subunit IV, in human, rat and mouse (COX IV-2). Comparison of the two human isoform genes shows a similar structural organization, including an overall size of about 8 kb, the presence of five exons, and the initiation of translation in the second exon, consistent with formation by gene duplication. Also consistent is the higher identity of precursor peptides of 78% within the new IV-2 isoform (average in the three species) compared to 44% average identity with the IV-1 isoform. Northern analysis and quantitative PCR with human and rat tissues show high IV-2 expression in adult lung and lower expression in all other tissues investigated, including fetal lung. In contrast, the IV-1 isoform is ubiquitously expressed. In situ hybridizations were performed to localize isoform transcripts in rat lung. Both isoforms are found in similar ratios in most lung cell types except for smooth muscle and respiratory epithelium, which have a IV-2 and a IV-1 preference, respectively. Structural modeling of the IV-2 isoform from human, based on the bovine crystal data, produces a conformation in which two of three conserved cysteine groups, exclusively present in the mammalian IV-2 isoform, are in close proximity. The formation of a cysteine bond and the implications for function of these sequence differences for subunit IV, which plays a pivotal role in COX regulation, are discussed.

Suprabasal overexpression of the hsRPB7 gene in psoriatic epidermis as identified by a reverse transcriptase-polymerase chain reaction differential display model comparing psoriasis plaque tissue with peritonsillar mucosa.

In psoriasis an etiopathogenetic vicious circle is nowadays hypothesized that the disease is triggered by skin-specific autoantigen structures, the expression and accessibility of which are positively correlated with the intensity of the hyperproliferation and inflammation in the epidermopapillary compartment driven by autoreactive T cells. Despite the close microanatomical relation between skin and mucosa, clinicians have always been intrigued by the observation that psoriatic affection of the mucosa, if at all existing, is only seen as very rare events in the lips and tongue sparing buccopharyngeal sites. This prompted us to establish an experimental model system comparing psoriatic-involved skin and peritonsillar mucosa from tonsillectomies by a reverse transcriptase-polymerase chain reaction/differential display strategy. Among more than 60 cDNA species to be displayed in psoriasis, but missing in peritonsillar mucosa, one species was identified as coding for the RNA polymerase IIA seventh subunit (hsRPB7 gene) as a most critical factor for DNA to RNA transcription. Immunohistochemistry showed a hitherto unknown, distinctive pattern of hsRPB7 expression that was 1) tissue type-dependent with a surplus in skin keratinocytes and a near absence in peritonsillar mucosa, 2) tightly regulated by the keratinocyte differentiation process with a sharp suprabasal up-regulation in contrast to a basal down-regulation, and 3) substantially augmented in psoriatic-involved skin as compared to normal and psoriatic uninvolved skin. Keratinocytes of actinic keratoses also showed a strong hsRPB7 expression that however did not strictly spare the basal cell layer presumably reflecting the disturbed intraepidermal stratification because of the premalignant status of these precancerous lesions.

Cytochrome C oxidase and the regulation of oxidative phosphorylation.

Life of higher organisms is essentially dependent on the efficient synthesis of ATP by oxidative phosphorylation in mitochondria. An important and as yet unsolved question of energy metabolism is how are the variable rates of ATP synthesis at maximal work load during exercise or mental work and at rest or during sleep regulated. This article reviews our present knowledge on the structure of bacterial and eukaryotic cytochrome c oxidases and correlates it with recent results on the regulatory functions of nuclear-coded subunits of the eukaryotic enzyme, which are absent from the bacterial enzyme. A new molecular hypothesis on the physiological regulation of oxidative phosphorylation is proposed, assuming a hormonally controlled dynamic equilibrium in vivo between two states of energy metabolism, a relaxed state with low ROS (reactive oxygen species) formation, and an excited state with elevated formation of ROS, which are known to accelerate aging and to cause degenerative diseases and cancer. The hypothesis is based on the allosteric ATP inhibition of cytochrome c oxidase at high intramitochondrial ATP/ADP ratios ("second mechanism of respiratory control"), which is switched on by cAMP-dependent phosphorylation and switched off by calcium-induced dephosphorylation of the enzyme.

Mitochondrial energy metabolism is regulated via nuclear-coded subunits of cytochrome c oxidase.

A new mechanism on regulation of mitochondrial energy metabolism is proposed on the basis of reversible control of respiration by the intramitochondrial ATP/ADP ratio and slip of proton pumping (decreased H+/e- stoichiometry) in cytochrome c oxidase (COX) at high proton motive force delta p. cAMP-dependent phosphorylation of COX switches on and Ca2+-dependent dephosphorylation switches off the allosteric ATP-inhibition of COX (nucleotides bind to subunit IV). Control of respiration via phosphorylated COX by the ATP/ADP ratio keeps delta p (mainly delta psi(m)) low. Hormone induced Ca2+-dependent dephosphorylation results in loss of ATP-inhibition, increase of respiration and delta p with consequent slip in proton pumping. Slip in COX increases the free energy of reaction, resulting in increased rates of respiration, thermogenesis and ATP-synthesis. Increased delta psi(m) stimulates production of reactive oxygen species (ROS), mutations of mitochondrial DNA and accelerates aging. Slip of proton pumping without dephosphorylation and increase of delta p is found permanently in the liver-type isozyme of COX (subunit VIaL) and at high intramitochondrial ATP/ADP ratios in the heart-type isozyme (subunit VIaH). High substrate pressure (sigmoidal v/s kinetics), palmitate and 3,5-diiodothyronine (binding to subunit Va) increase also delta p, ROS production and slip but without dephosphorylation of COX.

New isoforms of cytochrome c oxidase subunit IV in tuna fish.

In the present study, the cDNA sequences of cytochrome c oxidase subunit IV isoforms from tuna fish are reported. The cDNAs share 57% identity among each other and the deduced amino acid sequences of the mature proteins 56% identity. Until now, only in yeast are two isoforms of the corresponding subunit V known, which are expressed in response to the oxygen supply. The hypothetical function of the new isoforms in fish for adaptation to different oxygen partial pressures in tissues of higher organisms is discussed.

Isolation and sequence of the human cytochrome c oxidase subunit VIIaL gene.

The gene for human cytochrome c oxidase subunit VIIa liver isoform (COX7AL) was isolated and its sequence determined and analyzed. The three introns of the gene are considerably larger than those of the heart isoform of subunit VIIa (COX7AH), but the position of the introns relative to the cDNA sequences is homologous between the two genes. Comparison with other isolated COX7AL genes suggests that the promoter region binding motifs for transcription factors have evolved along with the coding region. In fibroblasts cultured originally from a Leigh's disease patient, a shortened COX7AL cDNA was identified by RT-PCR, consisting of exon I joined to exon IV, omitting exons II and III. No mutation could be identified in COX7AL of the patient, suggesting that the shortened cDNA is due to an alteration of the genome during cell culture. A surprising transcription of COX7AH was observed in cultured fibroblasts, suggesting a potential utility of these cells for study of its gene expression.

Turkey cytochrome c oxidase contains subunit VIa of the liver type associated with low efficiency of energy transduction.

Cytochrome c oxidase was isolated from turkey liver, heart and breast skeletal muscle and separated by SDS/PAGE. The N-terminal amino-acid sequence of subunit VIa from all tissues and internal sequences from the skeletal muscle enzyme show homology to the mammalian liver-type subunit VIaL, which was verified by isolation and sequencing of the cDNA of turkey subunit VIa. No cDNA corresponding to subunit VIaH (mammalian heart-type) could be found by RACE-PCR with mRNA from all turkey tissues. Measurement of proton translocation with the reconstituted enzymes from turkey liver and heart revealed H+/e- ratios below 0.5 that were independent of the intraliposomal ATP/ADP ratio, as previously found with the bovine liver enzyme. Under identical conditions, the bovine heart enzyme revealed H+/e- ratios of 0.85 at low and 0.48 at high intraliposomal ATP/ADP ratios. The results suggest that in birds the lower H+/e-ratio of cytochrome c oxidase participates in elevated resting metabolic rate and thermogenesis.

Iontophoresis of nickel elicits a delayed cutaneous response in sensitized individuals that is similar to an allergic patch test reaction.

Wearing of patch test chambers for 1-2 days is uncomfortable for patients. Allergen application by iontophoresis avoids this, but it is unknown so far whether iontophoresis itself interferes with the delayed immune response. We compared the effects occurring 48 h after iontophoresis with distilled water, 0.9% NaCl, and 0.01 M NiSO4 in normal volunteers and in nickel-sensitized patients (total n=36). Visual assessment was performed and transepidermal water loss (TEWL), stratum corneum hydration, cutaneous blood flow, and immunohistopathology were determined. After iontophoresis with nickel sulfate, only individuals sensitized to nickel reacted with a positive clinical response, increase in cutaneous blood flow, decline in epidermal CD-1a-positive cells, increase in epidermal proliferation (Ki-67-positive cells), pronounced infiltration of cells positive for CD4, CD11, or CLA, and cellular activation (expression of ICAM1, HLA-DR). Iontophoresis with distilled water or saline did not result in such reactions in volunteers with or without nickel sensitization, and the latter also tolerated nickel iontophoresis without significant skin reactions. We conclude that the delayed cutaneous response to nickel induced via iontophoresis is specific and similar to a positive patch test reaction. Iontophoresis may therefore be considered as an alternative to patch testing.

The possible role of isoforms of cytochrome c oxidase subunit VIa in mammalian thermogenesis.

A single cDNA of cytochrome c oxidase subunit VIa was characterised from liver, heart and the thermogenic organ of the partially endotherm tuna fish. The amino acid sequence revealed high identity with subunit VIa from carp and trout, but low identity to subunits VIaL (liver type) and VIaH (heart type) of mammalian cytochrome c oxidase. In reconstituted cytochrome c oxidase from bovine heart, the H+/e- stoichiometry is decreased from 1.0 to 0.5 at high intraliposomal ATP/ADP ratios via exchange of bound ADP by ATP at the matrix domain of the transmembraneous subunit VIaH. Reconstituted cytochrome c oxidase from bovine liver and kidney, containing subunit VIaL, revealed H+/e- ratios below 0.5, independent of the ATP/ADP ratio. The results suggest the evolution of three types of subunit VIa. Subunits VIaH and VIaL are postulated to participate in mammalian thermogenesis.

Regulation of energy transduction and electron transfer in cytochrome c oxidase by adenine nucleotides.

Cytochrome c oxidase from bovine heart contains seven high-affinity binding sites for ATP or ADP and three additional only for ADP. One binding site for ATP or ADP, located at the matrix-oriented domain of the heart-type subunit VIaH, increases the H+/e- stoichiometry of the enzyme from heart or skeletal muscle from 0.5 to 1.0 when bound ATP is exchanged by ADP. Two further binding sites for ATP or ADP, located at the cytosolic and the matrix domain of subunit IV, increases the K(M) for cytochrome c and inhibit the respiratory activity at high ATP/ADP ratios, respectively. We propose that thermogenesis in mammals is related to subunit VIaL of cytochrome c oxidase with a H+/e- stoichiometry of 0.5 compared to 1.0 in the enzyme from bacteria or ectotherm animals. This hypothesis is supported by the lack of subunit VIa isoforms in cytochrome c oxidase from fish.

The cDNA sequences of cytochrome c oxidase subunit VIa from carp and rainbow trout suggest the absence of isoforms in fishes.

The cDNAs of subunit VIa of cytochrome c oxidase from rainbow trout liver and carp heart are presented, revealing 82% identity of their deduced amino acid sequences. The two cDNAs are evolutionary equally distant from the livertype (VIaL) and heart-type (VIaH) of mammalian subunit VIa. The data suggest that in ectotherm fishes no isoforms of subunit VIa occur, and that the postulated tissue-specific mechanism of thermogenesis in mammals, based on interaction of ATP with subunit VIaH (Frank, V. and Kadenbach, B. (1996) FEBS Lett. 382, 121-124), is absent.

[Ultra-high dosage streptokinase lysis in dysfunction of a St. Jude aortic prosthesis]. / Ultrahochdosierte Streptokinase-Lyse bei Dysfunktion einer St.-Jude-Aortenprothese.

HISTORY AND CLINICAL FINDINGS: A 64-year-old man was hospitalised because of progressively worsening dyspnoea over the preceding few months. Three years previously he had undergone aortic valve replacement (St. Jude Medical bileaflet valve) for severe aortic stenosis and some regurgitation. He was much improved postoperatively and one year after the operation echocardiography demonstrated a well functioning prosthetic valve and a transvalvar pressure gradient (by Doppler echocardiography) of 28 mm Hg. On admission the patient reported to have stopped phenprocoumon 9 months before admission. The patient was in cardiac failure, grade III (NYHA classification). On auscultation there was a 4/6 crescendo-decrescendo systolic murmur and a 2/6 early diastolic decrescendo murmur maximal over the second right ICS. INVESTIGATIONS: Echocardiography confirmed the suspected diagnosis of dysfunction of the prosthetic valve, one leaflet being immobile, with severe outflow obstruction (peak transvalvar pressure gradient 101 mm Hg) combined with severe regurgitation. At fluoroscopy one leaflet moved normally, the other one being fixed between opening and closing positions. TREATMENT AND COURSE: As thrombosis was the most likely cause of the prosthetic valve dysfunction, thrombolysis treatment was started. After administration of 9 mill. IU streptokinase both leaflets showed normal movement. The peak transvalvar gradient (by echocardiography) was now 40 mm Hg and there was only slight regurgitation. No complications were noted. After oral anticoagulation for 6 months the prosthetic valve was functioning normally with unchanged movement pattern of both leaflets. CONCLUSION: Thrombolysis may be successful in thrombotic dysfunction of a prosthetic valve. If there are no contraindications, this form of treatment should be tried before reoperation is undertaken.

[Ischemia tolerance of the heart in percutaneous transluminal coronary angioplasty. Controlled study of the effect of isosorbide dinitrate and nifedipine]. / Ischämietoleranz des Herzens während perkutaner transluminaler Koronarangioplastie. Kontrollierte Studie zur Wirkung von Isosorbiddinitrat und Nifedipin.

In a randomized controlled study, influence of sublingual isosorbide dinitrate (ISDN) and nifedipine on ischemic tolerance of the heart during percutaneous transluminal coronary angioplasty (PTCA) was examined. After dilations without premedication except heparin ten patients received 10 mg ISDN sublingually and dilations after one, five, and ten minutes were repeated, then 20 mg nifedipine sublingually was administered followed by dilations at one, five, ten, and 15 minutes intervals (group A). First 20 mg nifedipine and then 10 mg ISDN were given sublingually with the same repeated dilations in ten patients forming group B. Mean arterial pressure decreased from 111 +/- 11 to 97 +/- 14 mmHg after ISDN (p less than 0.001) in group A and to 86 +/- 12 mmHg after nifedipine (p less than 0.001). In group B arterial pressure remained constant after nifedipine and decreased to 84 +/- 15 mmHg after ISDN (p less than 0.05). Coronary perfusion pressure in group A remained constant at about 27 +/- 11 mmHg and increased in group B from 27 +/- 14 to 31 +/- 20 mmHg after nifedipine and decreased to 20 +/- 16 mmHg after ISDN (n.s.). Dilation period increased in group A from 33 +/- 15 s to 69 +/- 25 s after ISDN (p less than 0.001) and remained constant after nifedipine 67 +/- 23 s. Dilation time in group B increased from 31 +/- 8 s to 49 +/- 17 s after nifedipine (p less than 0.001) and to 81 +/- 46 s after ISDN (p less than 0.001). Time until ST segment depression of greater than 0.1 mV increased from 14 +/- 5 s to 37 +/- 19 s by ISDN in group A and to 33 +/- 16 s after nifedipine (p less than 0.001). Times in group B measured 16 +/- 5 s and 24 +/- 8 s after nifedipine and 39 +/- 24 s after ISDN (p less than 0.05). In groups A and B arrhythmias could be suppressed despite prolonged dilation times only by application of both drugs.(ABSTRACT TRUNCATED AT 250 WORDS)