Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

BACKGROUND: Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS: Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS: A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS: The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

Epidermal growth factor protects the heart against low-flow ischemia-induced injury.

The role of ErbB4 and ErbB2 in the heart of adult mammals is well established. The heart also expresses ErbB1 (the epidermal growth factor (EGF) receptor), but this receptor has received less attention. We studied the effect of EGF on the response of isolated mouse heart to low-flow ischemia and reperfusion. Reducing perfusate flow to 10% for 30 min resulted in an increase in anaerobic metabolism and the leakage of lactate dehydrogenase during reperfusion. In addition, left ventricle +dP/dt and developed pressure were depressed (20-25%) during reperfusion. The addition of EGF 5 min before and throughout the ischemic period prevented the increase in anaerobic metabolism and the leakage of intracellular lactate dehydrogenase during reperfusion. EGF improved both +dP/dt and developed pressure during ischemia and prevented the decrease in dP/dt during reperfusion. To determine whether the effect of EGF on cell integrity depends on its effect on contractility, we studied nonbeating isolated myocytes. In these cells, anoxia and reoxygenation reduced cell viability by nearly 25%. EGF prevented such a decrease. Our results indicate that, like ErbB4 and ErbB2, ErbB1 also has an important role in the heart of adult animals.

Epidermal growth factor protects the heart against low-flow ischemia-induced injury

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The role of ErbB4 and ErbB2 in the heart of adult mammals is well established. The heart also expresses ErbB1 (the epidermal growth factor (EGF) receptor), but this receptor has received less attention. We studied the effect of EGF on the response of isolated mouse heart to low-flow ischemia and reperfusion. Reducing perfusate flow to 10% for 30 min resulted in an increase inanaerobic metabolism and the leakage of lactate dehydrogenase during reperfusion. In addition, left ventricle +dP/dt and developed pressure were depressed (20–25%) during reperfusion. The addition of EGF 5 min before and throughout the ischemic period prevented the increase in anaerobic metabolism and the leakage of intracellular lactate dehydrogenase during reperfusion. EGF improved both +dP/dt and developed pressure during ischemia and prevented the decrease in dP/dt during reperfusion. To determine whether the effect of EGF on cell integrity depends on its effect on contractility, we studied nonbeating isolated myocytes. In these cells, anoxia and reoxygenationreduced cell viability by nearly 25%. EGF prevented such a decrease. Our results indicate that, like ErbB4 and ErbB2, ErbB1 also has an important role in the heart of adult animals (AU)

Carnitine worsens both injury and recovery of contractile function after transient ischemia in perfused rat heart.

While carnitine overload appears to have therapeutic effects in pathological situations such as heart recovery after ischemia, its benefits as dietary supplementation for aerobic exercise have been questioned. We studied the effect of carnitine supplementation on the response of perfused rat heart to ischemia and reperfusion. Supplementation of the perfusion medium with 1 mM carnitine had no effect on cardiac performance in normoxic hearts, although it lowered lactate production by nearly 80%. Carnitine did not affect the amount of lactate accumulated during 30 min of ischemia, which was recovered in the perfusate immediately after reperfusion. However, carnitine worsened tissue injury, as shown by the 70% increase in creatine kinase release. Carnitine also worsened the recovery of contractile function, as revealed by the slower increase in heart rate and contractile force. In addition, carnitine supplementation increased contracture of the heart shortly after reperfusion. Therefore, in conditions where it does not increase glucose oxidation, carnitine supplementation worsens both injury and recovery of contractile function after transient ischemia in perfused rat heart.

Carnitine worsens both injury and recovery of contractile function after transient ischemia in perfused rat heart

While carnitine overload appears to have therapeutic effects in pathological situationssuch as heart recovery after ischemia, its benefits as dietary supplementation foraerobic exercise have been questioned. We studied the effect of carnitine supplementationon the response of perfused rat heart to ischemia and reperfusion. Supplementationof the perfusion medium with 1mM carnitine had no effect on cardiac performancein normoxic hearts, although it lowered lactate production by nearly 80%.Carnitine did not affect the amount of lactate accumulated during 30 min of ischemia,which was recovered in the perfusate immediately after reperfusion. However, carnitineworsened tissue injury, as shown by the 70% increase in creatine kinaserelease. Carnitine also worsened the recovery of contractile function, as revealed bythe slower increase in heart rate and contractile force. In addition, carnitine supplementationincreased contracture of the heart shortly after reperfusion. Therefore, inconditions where it does not increase glucose oxidation, carnitine supplementationworsens both injury and recovery of contractile function after transient ischemia inperfused rat heart (AU)

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Immobilization stress induces c-Fos accumulation in liver.

Acute stress-induced injury in tissues has been revealed by both biochemical markers in plasma and microscopy. However, little is known of the mechanisms by which tissue integrity is restored. Recently, induction of early response genes such as c-fos has been reported in the heart and stomach of immobilized animals. Herein, we show that immobilization stress in mice increased plasma alanine aminotransferase activity, a marker of liver damage. c-Fos protein accumulation in liver was induced by stress after 20 minutes of immobilization and persisted for 3 hours. Immobilization also induced the release of epidermal growth factor (EGF) from submandibular salivary glands and a transient increase in EGF concentration in plasma. Although EGF administration induced a 2.5-fold increase in c-Fos mass in the liver of anesthetized mice, sialoadenectomy (which abolished the effect of immobilization on plasma EGF) did not affect the stress-induced rise in plasma alanine aminotransferase activity or liver c-Fos accumulation. Therefore, we conclude that immobilization stress induces c-Fos accumulation in liver and that this effect is not triggered by the increase in plasma EGF concentration.

Epidermal growth factor secreted from submandibular salivary glands interferes with the lipolytic effect of adrenaline in mice.

We had described that epidermal growth factor (EGF) interfered with the lipolytic effect of catecholamines in isolated adipocytes. Since catecholamines stimulate the release of EGF from submandibular salivary glands to blood plasma in male mice, we studied whether EGF affected also the lipolytic response to adrenaline in whole animals. We studied the effect of adrenaline in sialoadenectomized and sham-operated mice receiving or not a high dose of EGF following adrenaline injection. There was no difference in plasma EGF concentration between sham-operated and sialoadenectomized animals receiving saline. After adrenaline administration plasma EGF increased by 20-fold in sham-operated but did not increase in sialoadenectomized mice. Indeed, the increase was much higher (more than 100-fold) in mice receiving exogenous EGF. The effect of adrenaline on plasma concentration of both glycerol and nonesterified fatty acids was higher as lower was plasma EGF concentration. Isolated adipocytes obtained from sham-operated or sialoadenectomized mice had identical lipolytic response to adrenaline. The lipolytic response of adipocytes to isoproterenol was decreased by addition of EGF. To study whether the interference with the in vivo lipolytic effect of adrenaline had further metabolic consequences, we measured plasma beta-hydroxybutyrate concentration in plasma. There was no difference in the response to adrenaline between sham-operated and sialoadenectomized mice in spite of the difference in plasma nonsterified fatty acid concentration. Studies in isolated hepatocytes indicated that ketogenesis run at near maximal rate in this range of substrate concentration. These results suggest that EGF in the physiological range decreases the lipolytic effect of adrenaline but does not compromise further metabolic events like the enhancement of ketogenesis.

Interaction between adrenaline and epidermal growth factor in the control of liver glycogenolysis in mouse.

Epidermal growth factor (EGF) stimulates glycogenolysis in mouse liver, but the effect requires concentrations that are only achieved in plasma upon adrenergic stimulation of EGF release from submandibular salivary glands. Thus, we studied the interaction between adrenaline and EGF in liver glycogen metabolism, both in whole animals and in isolated hepatocytes. Adrenaline administered to anesthetized mice stimulated both the endocrine secretion of EGF from submandibular salivary glands and the degradation of glycogen in the liver. In sialoadenalectomized mice, adrenaline administration did not increase plasma EGF concentration. In these animals, the glycogenolytic response to adrenaline was enhanced. The sensitivity of hepatocytes to adrenaline was similar in cells from sialoadenalectomized and sham-operated mice. EGF, added to isolated hepatocytes, reduced the glycogenolytic effect of adrenaline (the maximal effect but not the ED50). Adrenaline stimulated glycogen degradation through both an alpha1-adrenergic mediated Ca2+ increase and a beta-adrenergic-mediated cAMP increase. EGF did not interfere with the rise of cytosolic Ca2+ but decreased the cAMP signal. EGF did not decrease the glycogenolytic effect of phenylephrine or VP (which increased cytosolic Ca2+ but not cAMP), but EGF decreased both the glycogenolytic effect and the cAMP signal generated by glucagon or forskolin. EGF did not interfere with the glycogenolytic effect of CPT-cAMP or bt2-cAMP. The effect of EGF on cAMP was blocked by 3-isobutyl-1-methylxanthine. These results demonstrate that the effect of EGF on the glycogenolytic action of adrenaline involves interference with the generation of the cAMP signal. We suggest that EGF induces such an effect through the activation of a phosphodiesterase.

The antilipolytic effects of insulin and epidermal growth factor in rat adipocytes are mediated by different mechanisms.

Epidermal growth factor (EGF) and insulin induced similar effects in isolated rat adipocytes. To determine whether EGF and insulin produced similar effects through the same mechanisms, we focused on lipolysis. Insulin inhibited the lipolysis stimulated by isoproterenol, glucagon (either alone or in combination with adenosine deaminase), adenosine deaminase itself, or forskolin. In contrast, EGF did not inhibit the lipolysis stimulated by forskolin or by hormones when the cells were also incubated with adenosine deaminase. The effect of insulin, but not that of EGF, on isoproterenol-stimulated lipolysis disappeared when adipocytes were incubated with 1 microM wortmannin. These results indicate that EGF and insulin affected lipolysis through different mechanisms. We observed that EGF, but not insulin, increased cytosolic Ca2+. The effect of EGF, but not that of insulin, disappeared when the cells were incubated in a Ca2+-free medium. We suggest that EGF, but not insulin, mediate its antilipolytic effect through a Ca2+-dependent mechanism which, however, do not involve Ca2+-activated protein kinase C isoforms. This is based on the following: 1) phorbol 12-myristate 13-acetate affected lipolysis in an opposite way to that of EGF; and 2) the protein kinase C inhibitor bisindolylmaleimide GF 109203X did not affect the antilipolytic action of EGF. Our results indicate that the antilipolytic effect of EGF resembles more that of vasopressin than that of insulin.

Epidermal growth factor administration decreases liver glycogen and causes mild hyperglycaemia in mice.

Several laboratories report different effects of epidermal growth factor (EGF) on glycogen metabolism in hepatocytes. The discrepancies may be attributed to differences in the experimental conditions. It is therefore important to establish the actual effect of EGF in vivo. Because large physiological variations of EGF concentration in plasma occur in mice, we used this species to address this question. In freshly isolated mouse hepatocytes, EGF increased glycogen degradation in a dose-dependent manner. The maximal effect (36% increase over basal glycogenolysis) was smaller than maximal effects of classical glycogenolytic hormones like adrenaline or glucagon (more than 150% increase over basal). This is in keeping with the smaller effect of EGF on phosphorylase a activity. In contrast with these hormones, EGF did not inhibit glycolysis. Thus these effects of EGF in mouse hepatocytes are similar to those recently described by us in rat hepatocytes [Quintana, Grau, Moreno, Soler, Ramirez and Soley (1995) Biochem J 308, 889-894]. When administered to whole animals, EGF increased phosphorylase a activity, decreased the glycogen content in the liver and caused mild hyperglycaemia. Taking together the results obtained for isolated cells and for whole animals, we suggest that the glucosyl residues released from glycogen are used mostly by the liver rather than released to the circulation. This would be different from the action of the classical glycogenolytic hormones, adrenaline and glucagon.

The early stimulation of glycolysis by epidermal growth factor in isolated rat hepatocytes is secondary to the glycogenolytic effect.

We have studied the relationship between the effect of epidermal growth factor (EGF) on glycogen metabolism and its effect on glycolysis, in rat hepatocyte suspensions. Although 10 nM glucagon or 10 microM adrenaline increased glycogen degradation by more than 120%, 10 nM EGF increased glycogenolysis by less than 20% in hepatocytes incubated in glucose-free medium. Both glucagon and adrenaline increased phosphorylase a activity by more than 130%; EGF increased this activity by about 30%. Under basal conditions, 65% of the glucosyl residues were released as free glucose and about 30% ended up as C3 molecules (lactate and pyruvate). Both glucagon and adrenaline decreased the proportion of glucosyl units that rendered glycolysis end-products (to 2% for glucagon and 6% for adrenaline) and increased the proportion that ended up as free glucose (to 94% and 88% of the glucosyl residues for glucagon and adrenaline respectively). EGF increased the production of both free glucose and lactate+pyruvate, but the proportion of glucosyl residues that ended up as free glucose or glycolysis end-products was unchanged. In glycogen-depleted hepatocytes incubated in the presence of 25 mM glucose, EGF affected neither glycogen deposition nor glycolysis. EGF increased cytosolic free Ca2+, and neomycin decreased both the Ca2+ signal and the glycogenolytic effect. In conclusion, our results indicate that the effect of EGF on glycolysis is secondary to the Ca(2+)-mediated stimulation of glycogenolysis in rat hepatocyte suspensions.

Role of heterotrimeric G-proteins in epidermal growth factor signalling.

Since in 1986 it was reported that a pertussis toxin-sensitive substrate was involved in the Ca2+ signal induced by epidermal growth factor (EGF) in rat hepatocytes, much evidence accumulated to implicate heterotrimeric G-proteins in EGF action. EGF can also induce a cyclic AMP signal, but while the generation of a Ca2+ signal appears to be quite general in EGF action, the increase in cyclic AMP occurs only in few cell types. In non-transformed cell types these effects appear to involve G-proteins. EGF not only induces cell proliferation but also interacts with hormones in the short-term control of cell function in quiescent cells. Most of the known interactions are on cyclic AMP mediated hormone effects, and in many cases, the interaction between EGF and hormones involves G-proteins. Here we review the evidence accumulated in recent years that implicate G-proteins in EGF action. An understanding of the mechanisms involved may reveal new mechanisms of G-protein regulation and will contribute to our knowledge of EGF function and signal transduction.

Relationship between epidermal growth factor in mouse submandibular glands, plasma, and bile: effects of catecholamines and fasting.

The epidermal growth factor (EGF) concentration in bile is high (approximately 150 fold higher than that in plasma), but little is known about its physiological control. Acute administration of the alpha 1-adrenergic agonist phenylephrine (1.7 mg/kg, iv) to male mice produced a rapid increase in the EGF concentration in bile. We suggest that this EGF originates in submandibular glands and not in the liver. The bases for this are: 1) this increase was parallel to the increase in plasma, and the EGF content of the submandibular glands decreased after phenylephrine injection; and 2) the EGF concentrations in plasma and bile did not increase after phenylephrine administration to sialoadenalectomized mice. The concentration of EGF in bile is not only under pharmacological control, but is also regulated physiologically. Thus, the EGF concentrations in plasma, bile, and submandibular glands increased in fasted mice. All of these changes were reversed by refeeding. As 1) [125I]EGF binding to liver membranes decreased only after 2 days of fasting, but the level of circulating EGF was already increased in 1-day fasted mice, and 2) EGF secretion by submandibular glands from 1-day fasted mice incubated in vitro increased, we suggest that the increase in EGF concentrations in plasma and bile is the consequence of increased endocrine secretion by submandibular glands. Taken together, our results suggest that there is a flux of EGF from submandibular glands to bile in mice, which is under physiological control.

Effects of epidermal growth factor on gluconeogenesis and cellular redox state do not require Na+/H+ exchange or Na+/K(+)-ATPase activities.

Epidermal growth factor (EGF) triggers rapid and delayed effects on gluconeogenesis, cytosolic (lactate/pyruvate ratio) and mitochondrial (3-hydroxybutyrate/acetoacetate ratio) redox states (Soler, C. and Soley, M., Biochem. J., 294 (1993) 865-872). This study attempts to determine whether the mechanism by which EGF modulates any of these parameters is dependent on the regulation of Na+/H+ exchange and/or Na+/K(+)-ATPase activities. The Na+/H+ exchange was inhibited by either amiloride or the analogue 5-(N,N-hexamethylene)amiloride (HMA), and the Na+/K(+)-ATPase activity was inhibited by ouabain. The delayed EGF inhibition of gluconeogenesis, increase of the lactate/pyruvate ratio and decrease in the 3-hydroxybutyrate/acetoacetate ratio were unaltered in the presence of amiloride, HMA or ouabain. The rapid EGF stimulation of gluconeogenesis was also observed in the presence of HMA or ouabain. Although Na+/H+ exchange and/or Na+/K(+)-ATPase are regulated by EGF, our results indicate that these activities are not required for the effects of EGF on gluconeogenesis and/or cytosolic and mitochondrial redox state.

Rapid and delayed effects of epidermal growth factor on gluconeogenesis.

Most reports on the effects of epidermal growth factor (EGF) on gluconeogenesis have indicated that such effects depend on the substrate used and are only observable after a lag time of 30-40 min. Recently, an immediate and transient effect of EGF on glucose synthesis was described in a perfused liver system. Here we extend the study of the effect of EGF on gluconeogenesis to isolated hepatocytes from fasted rats. The delayed effect of EGF on gluconeogenesis was studied by adding the substrate 40 min after the peptide. Under these conditions EGF increased glucose synthesis from pyruvate, decreased it when the substrate was lactate or glycerol and did not modify gluconeogensis from fructose or dihydroxyacetone. EGF did not affect the metabolic flux through glycolysis, determined as the production of lactate+pyruvate from 30 mM glucose. Furthermore, EGF did not modify the metabolic flux through pyruvate kinase, determined as the production of lactate+pyruvate from 1 mM dihydroxyacetone. The differing effects of EGF on gluconeogenesis depending on the substrate used can be explained by the effects of EGF on the cytosolic redox state (measured as the lactate/pyruvate ratio). About 20 min after the addition of EGF, the mitochondrial redox state (measured as the 3-hydroxybutyrate/acetoacetate ratio) decreased. This effect of EGF was blocked by ammonium, which also abolished the effect of the peptide on gluconeogenesis. Thus the effect of EGF at the mitochondrial level appears to be necessary for its effects on gluconeogenesis. Taken together, our results indicate that the delayed effects of EGF on gluconeogenesis are secondary to the effects of the peptide at both the mitochondrial and cytosolic levels. In addition to these delayed effects, we observed that EGF rapidly and transiently stimulated glucose synthesis from lactate, decreased the cytosolic redox state and increased oxygen consumption. All of these rapid effects required the presence of extracellular calcium and disappeared in the presence of rotenone, suggesting that this rapid effect of EGF on gluconeogenesis is secondary to the stimulation of mitochondrial respiration.

Epidermal growth factor modulates the lipolytic action of catecholamines in rat adipocytes. Involvement of a Gi protein.

In isolated adipocytes, epidermal growth factor (EGF) did not affect basal (nonstimulated) lipolysis, but interfered with the lipolytic action of isoproterenol (ISO) or glucagon. Similarly, EGF did not affect basal levels of cyclic AMP but interfered with the signal generated by ISO. However, EGF did not affect lipolysis stimulated by forskolin or cyclic AMP analogues. These results suggest that EGF interfered with the signal transduction between lipolytic hormone receptors and adenylate cyclase. To determine whether EGF was activating a Gi protein, adenosine deaminase (ADA) was added to degrade endogenously released adenosine. While the nonmetabolizable adenosine analogue N6-(phenylisopropyl)adenosine (PIA) inhibited ADA-stimulated lipolysis, EGF affected neither ADA-stimulated lipolysis nor the dose-response curve for PIA. However, EGF did not affect ISO-stimulated lipolysis in pertussis toxin-treated cells. Similarly, in the presence of ADA, the effects of ISO on lipolysis and on cyclic AMP levels were not affected by EGF. The addition of PIA restored the effect of EGF on both lipolysis and cyclic AMP. Since EGF decreased the IC50 for the inhibitory effect of PIA on (ISO+ADA)-stimulated lipolysis, we suggest that EGF modulates the interaction between GS and Gi in the control of adenylate cyclase.

Epidermal growth factor interferes with the effect of adrenaline on glucose production and on hepatic lipase secretion in rat hepatocytes.

We studied the interaction of epidermal growth factor (EGF) and adrenaline in the control of several metabolic functions in isolated hepatocytes from fed rats. EGF did not modulate glucose release, urea production or hepatic lipase secretion, but interfered with the stimulatory effect of adrenaline on both glucose and urea production and also with the inhibitory effect of this hormone on hepatic lipase secretion. EGF also interfered with the effect of both angiotensin II and vasopressin on glucose release and on hepatic lipase secretion. While the effect of EGF interfering with the action of adrenaline on glucose release was potentiated in the absence of extracellular calcium, the effect on the inhibition of hepatic lipase secretion was abolished. These results suggest that EGF interfered with catecholamine actions in the liver at a site distal from the generation of the calcium signal.

Ornithine decarboxylase activity and urea in liver of late-pregnant rats. Effect of streptozotocin-induced diabetes.

It has been suggested that the induction of ornithine decarboxylase (ODC) activity during pregnancy might contribute to the low ureagenic flux that enables the pregnant mother to spare nitrogen and support growth. Thus, we have studied the ODC activity, and urea and polyamine levels in livers of virgin and 21-day pregnant rats, either in a basal state or after the induction of ureagenesis by inducing diabetes in rats by streptozotocin injection. Diabetes led to a marked increase in circulating and liver urea levels in virgin rats. This response was significantly reduced in late-pregnant animals. Diabetes did not modify ODC activity in pregnant rats, which showed much lower activities than their virgin controls. Diabetes caused a depletion of the liver spermine content in pregnant rats. Spermidine levels were higher in both groups of pregnant animals than in their respective controls. Our results suggest first that the mechanisms contributing to spare nitrogen in the pregnant mother are likely to be present in diabetic pregnant animals and, second, that ODC does not mediate the metabolic adaptations leading to a low ureagenic flux and a higher nitrogen retention at the last stage of pregnancy.

Effect of epidermal growth factor on ornithine decarboxylase activity and urea synthesis in isolated rat hepatocytes.

Ornithine decarboxylase (ODC) activity is induced by protein-synthesis independent mechanisms in freshly isolated rat hepatocytes, incubated either without or with a mixture of amino acids in the incubation medium. Urea synthesis rates were two- to three-fold higher in those hepatocytes incubated in the presence of amino acids that in those lacking amino acids in the medium. Epidermal growth factor (EGF) delayed ODC induction, but only in the presence of amino acids. EGF significantly decreased ureagenesis when hepatocytes were incubated in the presence of amino acids and only endogenous substrates were available. No evidence of any link between ODC induction and urea synthesis was found.