Outbreak of keratitis presumed to be caused by Acanthamoeba.

PURPOSE: A sharp increase of Acanthamoeba keratitis from two cases per year to 30 cases per year at our institution prompted this study to determine whether there was a change in the clinical characteristics, basic epidemiology, and outcome of this disease. METHODS: We reviewed all cases of Acanthamoeba keratitis diagnosed at the University of Iowa Hospitals and Clinics from mid-1993 through 1994. RESULTS: We screened 217 patients with keratitis by tandem scanning confocal microscopy and suspected Acanthamoeba in 51 patients. Diagnosis was confirmed by cytology in 43 patients (48 eyes). There were no positive cultures. Patients examined within four weeks of onset of symptoms were younger (mean age, 32.6 +/- 15.4 years) and wore contact lenses (11 of 18 patients), and infrequently herpes simplex keratitis (four of 18 patients) was diagnosed. Patients examined after four weeks were older (mean age, 54.0 +/- 19.5 years), infrequently wore contact lenses (six of 25 patients), and often had herpes simplex keratitis (12 of 25 patients). CONCLUSIONS: Corneal examination with tandem scanning confocal microscopy was associated with a marked increase in the detection of Acanthamoeba, strongly suggesting that the disease is more prevalent than suspected. Acanthamoeba may account for many cases of clinically presumed herpes simplex keratitis, the leading cause of corneal blindness in the United States. Acanthamoeba should be considered in the differential diagnosis of any unexplained keratitis, even those of short duration.

Both type I and II insulin-like growth factor receptor binding increase during lactogenesis in bovine mammary tissue.

Bovine GH is a potent stimulant of lactation, and the insulin-like growth factors I and II (IGF-I and -II) are believed to mediate GH's growth-promoting actions. Since all of IGF's known actions are mediated through its receptor subtypes, we analyzed the distribution of IGF receptor subtypes in lactating and nonlactating bovine mammary tissue. Analysis of competition curves showed that IGF-I had greater potency than IGF-II in competing with [125I]IGF-I for binding to membranes prepared from both lactating and nonlactating animals. An insulin concentration of 4 micrograms/ml displaced less than 40% of the [125I]IGF-I bound to membranes prepared from both lactating and nonlactating animals, indicating that a high percentage of [125I]IGF-I was bound to the type II receptor. Lactation was associated with an increase in the total amount of [125I]IGF-I bound, and this change was due to an increase in binding to both receptor subtypes. Specifically, membranes prepared from lactating animals had a 3-fold increase in binding competed for by insulin and a 2-fold increase in binding not competed for by insulin. Affinity cross-linking of [125I]IGF-I to membranes prepared from both lactating and nonlactating animals, followed by polyacrylamide gel electrophoresis (PAGE) and autoradiography, showed that 260K and 135K bands were present. Competition experiments indicated that unlabeled IGF-I effectively competed for binding to the 260K band, whereas insulin did not. Binding to the 135K band could be inhibited by both IGF-I and insulin. The intensity of the labeled bands showed that type II receptors were relatively more abundant than type I receptors in membranes from both lactating and nonlactating animals. Membranes prepared from lactating animals showed both 135K and 127K species of the type I receptor, whereas nonlactating animals showed only the 135K band. We conclude that type I and II receptors are present in bovine mammary tissue, and type II predominate. Lactation is associated with increases in the concentration of both receptor subtypes, especially type I receptors. Lactation may be associated with structural changes in the type I receptor. These changes in receptor distribution could play a role in modulating the physiological effects of the IGFs on mammary tissue.

An insulin-like growth factor (IGF) binding protein enhances the biologic response to IGF-I.

The insulin-like growth factors IGF-I and IGF-II circulate in blood bound to carrier proteins. The higher molecular mass IGF-binding protein complex (150 kDa) is composed of subunits, and one subunit that forms this complex is growth hormone dependent. In addition, many cell types and tissues secrete another form of IGF binding protein that is not growth hormone dependent. Both forms of the IGF binding protein are believed to inactivate the IGFs and to function as delivery systems to tissues. This conclusion was based on studies that determined the effects of impure preparations of these binding proteins or that examined the effect of these proteins only on the insulin-like actions of the IGFs. We report here that a pure preparation of the extracellular form of the IGF binding protein (purified from human amniotic fluid) markedly potentiated replication of several cell types in response to human IGF-I. Secondary cultures of human, mouse, and chicken embryo fibroblasts as well as porcine aortic smooth muscle cells showed marked enhancement of their DNA synthesis response (2.8- to 4.4-fold increases) to IGF-I in the presence of this protein. These responses were synergistic since the sum of the responses to either IGF-I or to the binding protein alone was between 8 and 17% of the increase obtained in cultures exposed to both peptides. The binding protein not only potentiated the DNA synthesis response but also enhanced the increase in cell number in response to IGF-I. This stimulation is specific for growth factors that bind to the binding protein since incubation with insulin, which binds to the type I IGF receptor but not to the binding protein, did not result in potentiation of this response. We conclude that a form of IGF binding protein that is present in extracellular fluids and is secreted by many types of cells can markedly potentiate the cellular response to IGF-I.

Alterations in the synthesis of a fibroblast surface associated 35 K protein modulates the binding of somatomedin-C/insulin-like growth factor I.

Human fibroblasts, a cell type that is used extensively to determine the pleiotypic effects of the insulin-like growth factors, have been shown to secrete a 35K protein that binds somatomedin-C/insulin-like growth factor I (Sm-C/IGF-I) but not insulin. This 35 K protein is associated with the fibroblast surface and following transfer to the surface of cell types that do not have this protein on their surfaces, it alters the binding of radiolabeled Sm-C/IGF-I. In this study human fibroblast monolayers that were incubated with cyclohexamide (50 micrograms/ml) for 14 h at 37 C had no detectable 35 K protein on their cell surface, but type I Sm-C/IGF-I receptors were still present. Loss of the 35 K protein was associated with 60-70% increase in binding of Sm-C/IGF-I to type I receptors. The relative affinity of the type I receptor for Sm-C/IGF-I was apparently increased because unlabeled Sm-C/IGF-I (12 ng/ml) competitively displaced 63% of radiolabeled Sm-C/IGF-I after cycloheximide exposure, whereas in cultures not exposed to cycloheximide [125I]Sm-C/IGF-I binding was increased by 11%. Coincubation of fibroblast conditioned media containing the 35 K protein with cycloheximide-treated fibroblast monolayers resulted in restoration of the paradoxical increase in Sm-C/IGF-I binding and loss of sensitivity to competition by unlabeled Sm-C/IGF-I. Exposure of suspended fibroblasts, which do not have 35 K on their cell surface, to media conditioned by fibroblast monolayers also induced both of these changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Somatomedin-C binding to cultured human fibroblasts is dependent on donor age and culture density.

Cultured fibroblasts have been used extensively to study age-related changes in the cellular response to serum stimulation. Since somatomedin-C (Sm-C) is an important growth factor in serum, we determined if there were age-related changes in Sm-C fibroblast receptor number or affinity and if culture density influenced these changes. Skin fibroblasts were obtained from six normal donors in three separate age groups and tested for their capacity to bind Sm-C. Sparse cultures (10-15K cells/well) derived from fetal donors had an affinity for Sm-C that was 4.7-fold greater than that of cultures derived from elderly (74-96 yr old) donors [9.4 +/- 0.2 (+/- SD) compared to 2.0 +/- 0.2 X 10(10) M-1]). When grown to high density (60-100K cells/well), the affinity of the fetal cultures was significantly reduced to 2.2 +/- 0.2 X 10(10) M-1 (P less than 0.001) and was not significantly different from the affinity of high density elderly donor cultures (2.3 +/- 0.4 X 10(10) M-1). Intermediate age donors (3-14 yr old) also had a significant reduction in receptor affinity with increasing density. Fetal donor cultures showed no density-dependent changes in receptor number. Fetal donor cells at low density had 5.2 +/- 1.0 X 10(4) receptors/cell compared to 5.9 +/- 0.6 X 10(4) receptors/cell in the high density cultures. In contrast, cells derived from donors aged 3-14 yr had 12.0 +/- 1.6 X 10(4) receptors/cell at 15K cells/well and 5.1 +/- 0.6 X 10(4) at 80K cells/well (P less than 0.05). Cultures from elderly donors had significantly greater mean receptor numbers per cell compared to fetal donor cells at four of five densities tested and had a significantly lower receptor number per cell with increasing culture density 25.2 +/- 1.2 X 10(4) (10-15K cells/well) compared to 5.2 +/- 0.2 X 10(4) (60-100K) cells/well. Thus, increasing donor age at low culture density was associated with an increase in receptor number per cell and a decrease in receptor affinity. At high culture densities, these differences were not detected. These changes in Sm-C receptor number and affinity at low density could lead to donor age-related changes in the cellular response to Sm-C.

Cultured fibroblast monolayers secrete a protein that alters the cellular binding of somatomedin-C/insulinlike growth factor I.

We studied somatomedin-C/insulinlike growth factor (Sm-C/IGF-I) binding to human fibroblasts in both adherent monolayers and in suspension cultures. The addition of Sm-C/IGF-I in concentrations between 0.5 and 10 ng/ml to monolayers cultures resulted in a paradoxical increase in 125I-Sm-C/IGF-I binding and concentrations between 25 and 300 ng/ml were required to displace the labeled peptide. The addition of unlabeled insulin resulted in no displacement of labeled Sm-C/IGF-I from the adherent cells. When fibroblast suspensions were used Sm-C/IGF-I concentrations between 1 and 10 ng/ml caused displacement, the paradoxical increase in 125I-Sm-C/IGF-I binding was not detected, and insulin displaced 60% of the labeled peptide. Affinity cross-linking to fibroblast monolayers revealed a 43,000-mol wt 125I-Sm-C-binding-protein complex that was not detected after cross-linking to suspended cells. The 43,000-mol wt complex was not detected after cross-linking to smooth muscle cell monolayers, and binding studies showed that 125I-Sm-C/IGF-I was displaced greater than 90% by Sm-C/IGF-I using concentrations between 0.5 and 10 ng/ml. Because fibroblast-conditioned medium contains the 43,000-mol wt complex, smooth muscle cells were incubated with conditioned medium for 24 h prior to initiation of the binding studies. 125I-Sm-C/IGF-I-binding increased 1.6-fold compared to control cultures and after cross-linking the 43,000-mol wt complex could be detected on the smooth muscle cell surface. Human fibroblast monolayers secrete a protein that binds 125I-Sm-C/IGF-I which can be transferred to the smooth muscle cell surface and alters 125I-Sm-C/IGF-I binding.