Knowledge and educational needs of individuals with the factor V Leiden mutation.

BACKGROUND: Genetic testing for factor (F)V Leiden is widely performed in an effort to prevent thrombosis-related morbidity. The implications of a positive test for patients' health perception and the extent of patients' understanding of results are not known. OBJECTIVES: This study examined patient experience of genetic testing for FV Leiden. PATIENTS AND METHODS: The study was a cross-sectional, mailed survey of 110 patients who tested positive for the FV Leiden gene mutation at an academic medical center between 1995 and 2001. Patient knowledge about FV Leiden, satisfaction with available information, and psychosocial reactions to testing were assessed and the influence of demographic and clinical characteristics on outcome measured. RESULTS: The magnitude of thrombosis risk associated with FV Leiden was incorrectly estimated by 79% of participants. Many patients (64%) stated that they had not been given much information about FV Leiden and 68% still had many questions. Most patients (53%) felt that their healthcare providers do not understand FV Leiden. Patients who had been seen by a hematologist or in a specialized thrombosis clinic were more knowledgeable and had less information need. Most patients (88%) were glad to know genetic test results, despite negative psychosocial implications such as increased worry (43%). CONCLUSIONS: Knowledge of genetic status increases awareness of thrombosis risk among patients, but magnitude of risk is often overestimated. Affected individuals indicate that there is a lack of available information about FV Leiden and that additional educational resources are needed.

Antenatal corticosteroids and newborn screening for congenital adrenal hyperplasia.

OBJECTIVE: To assess the effect of reported corticosteroid exposure on neonatal levels of 17-hydroxyprogesterone (17-OHP), the cortisol precursor used in newborn screening for congenital adrenal hyperplasia, in newborns weighing less than 2500 g at birth. DESIGN: A retrospective study of newborns weighing less than 2500 g at birth and exposed to corticosteroids as reported on their newborn screening card compared with newborns weighing less than 2500 g at birth and reported as not exposed to corticosteroids. METHODS: Birth weight, gestational age, age at screening, special care information, and name of screening hospital were obtained from newborn screening cards for 16 115 newborns screened in Michigan during the first 3 months of 2000. Levels of 17-OHP, measured by fluoroimmunoassay, were obtained from Michigan's Newborn Screening Program database. RESULTS: The mean 17-OHP level for the 69 low-birth-weight newborns in the corticosteroid-exposed group was 52 ng/mL, which was higher than that for the 771 low-birth-weight newborns in the unexposed group (35 ng/mL) (P<.001). Reported corticosteroid use did not decrease the number of expected borderline positive screening results for congenital adrenal hyperplasia (P>.05). Levels of 17-OHP varied by birth weight in corticosteroid-exposed and unexposed newborns. CONCLUSIONS: Corticosteroid exposure may not suppress screening 17-OHP levels. Therefore, newborn screening should not be delayed in premature newborns because of antenatal exposure to corticosteroids.

Functional analysis of the mouse galactose-1-phosphate uridyl transferase (GALT)promoter.

Galactose-1-phosphate uridyltransferase (GALT) is expressed in most tissues, but the near total absence of catalytic activity in humans with the disease galactosemia leads to specific organ dysfunction, the pathophysiology of which remains an enigma. To characterize the transcriptional regulation of the mouse GALT gene, we isolated and sequenced over 3 kb of a 5'-flanking sequence and functionally characterized the region using in vitro transient transfection and in transgenic mice. A minimal promoter of 145 bp was found to function in both HepG2 cells and NS20Y mouse neuroblastoma cells. The minimal promoter contains regions of homology to the corresponding rat and human GALT genes. In transgenic mice expressing a luciferase transgene under control of a 1.9-kb fragment of the mGALT promoter region, reporter activity was found in most tissues, with higher than expected reporter levels in neonatal brain. To determine if high galactose levels in tissues could induce promoter activity, we bred the mGALT:luciferase transgene into a line of mice in which the GALT gene function has been eliminated by homologous recombination. High tissue levels of galactose and metabolites did not induce reporter activity above background. The studies show that GALT transcriptional regulation is complex and not directly induced by substrate levels.

A mouse model of galactose-1-phosphate uridyl transferase deficiency.

Galactose-1-phosphate uridyl transferase (GALT) deficiency causes classical galactosemia in humans. Mice deficient in this enzyme were created by gene targeting. GALT-deficient mice develop biochemical features similar to those seen in humans with GALT deficiency, but fail to develop the pattern of acute toxicity seen in newborns with classical galactosemia. This study suggests that alternative routes of galactose metabolism are important in the pathogenesis of galactosemia.

The human galactose-1-phosphate uridyltransferase gene.

Classical galactosemia is an inborn error of metabolism caused by a deficiency of galactose-1-phosphate uridyltransferase (GALT). Standard treatment with dietary galactose restriction will reverse the potentially lethal symptoms of the disease that are manifest in the newborn period. However, the long-term prognosis for these patients is variable. As a first step toward investigating the molecular basis for phenotypic variation in galactosemia, we have cloned and sequenced the entire gene for human galactose-1-phosphate uridyltransferase. This gene is organized into 11 exons spanning 4 kb. In exons 6, 9, and a portion of 10, there is a high degree of amino acid sequence conservation among Escherichia coli, yeast, mouse, and human. We have identified a number of nucleotide changes in the GALT genes of galactosemic patients that alter conserved amino acids. The most common of these is an A to G transition at nucleotide position 1470, converting a glutamine to an arginine at amino acid codon position 188 (Q188R).(ABSTRACT TRUNCATED AT 250 WORDS)

The chicken urokinase-type plasminogen activator gene.

The chicken urokinase-type plasminogen activator (uPA) cDNA and gene have been isolated and the complete nucleotide sequence of each established. cDNA sequence and Northern blot RNA analysis indicate that the chicken uPA mRNA is approximately 2500 nucleotides in size and contains a large 3'-noncoding region (998 nucleotides). The predicted amino acid sequence of the chicken uPA primary translation product (434 residues) suggests a domain architecture comparable to the mammalian uPA proteins with the form: (i) signal peptide, (ii) growth factor domain (GF), (iii) kringle domain (K), and (iv) serine protease domain (C). The overall sequence identity between the chicken and human proteins is 43.1%, with 56.3, 48.5, and 45.6% identity in the GF, K, and C domains, respectively. The chicken uPA gene is similar to the mammalian uPA genes in both size (8158 base pairs between transcription initiation and polyadenylation sites) and organization (11 exons). However, the sequence of the chicken uPA gene is similar to the mammalian uPA genes only within the protein-coding portions of exons. The transcription initiation site is flanked by a remarkably G/C-rich region (77% between nucleotides -1 and -300) which contains a TATA element and several potential transcription factor Spl-binding sites. The promoter region also contains several repeat elements, including two 11-nucleotide repeats that encompass six potential transcription factor AP-2-binding sites. This work provides a foundation for exploring the mechanism(s) by which protein-tyrosine kinase pp60v-src and protein kinase C modulate uPA gene transcription.

Plasminogen activator gene expression is induced by the src oncogene product and tumor promoters.

Secretion of urokinase-type plasminogen activator (uPA) by chicken embryo fibroblasts (CEF) is increased approximately 50-fold following transformation by Rous sarcoma virus (RSV). Using a cloned and fully sequenced chicken uPA cDNA probe, we have established that this increase in plasminogen activator production can be largely accounted for by an increase in cellular uPA mRNA. CEF contained on average less than 1 molecule of uPA mRNA/cell, whereas RSV-CEF contained 25-60 molecules/cell. The increase in cellular uPA mRNA levels was dependent on the activity of the RSV-encoded transforming protein, protein-tyrosine kinase pp60v-src. Cells infected with an RSV mutant encoding a temperature-sensitive form of the src protein (ts-NY68) contained low uPA mRNA levels when cultured at the nonpermissive temperature and high uPA mRNA levels when maintained at the permissive temperature. Temperature shift studies with tsNY68-CEF demonstrated that changes in pp60v-src activity rapidly altered uPA mRNA levels; the uPA mRNA content of total RNA extracts increased and decreased with half-time kinetics of 3-5 h. Serine/threonine-specific protein kinases also appear to modulate uPA mRNA levels in CEF cultures. Exposure of CEF and RSV-CEF for 24 h to the protein kinase C activating agent phorbol myristate acetate (PMA) increased cellular uPA mRNA levels to 20 and 260 molecules/cell, respectively. These data are consistent with the previously observed synergism between RSV and PMA in increasing plasminogen activator secretion. Nuclear run-on transcription analyses established that both RSV and PMA increase cellular uPA mRNA levels by way of increased uPA gene expression.

Endocrine disorders in children.

The childhood endocrine disorders in which surgical intervention is a common or indispensable part of management are succinctly reviewed. Pathophysiology and rational approaches to diagnosis are emphasized.