Análisis de los costes y la efectividad del uso de cilostazol frente a naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente en España / Cost-effectiveness analysis of cilostazol vs naftidrofuryl and pentoxifylline for the treatment of intermittent claudication in Spain

Introducción: El cilostazol es un inhibidor reversible de la fosfodiesterasa III que presenta actividad antiagregante plaquetaria y vasodilatadora. El objetivo de este estudio fue estimar las consecuencias clínicas y económicas del uso de cilostazol en comparación con naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente (CI) en España. Métodos: Se ha construido un modelo fármaco económico basado en la literatura para describir el manejo de la CI y sus consecuencias clínicas y económicas para cada opción terapéutica evaluada en pacientes con 40 o más años y una historia de CI sintomática, secundaria a enfermedad vascular periférica de las extremidades inferiores. Los resultados clínicos provienen de una revisión de los ensayos clínicos respectivos. Se utilizaron costes unitarios españoles para medir las consecuencias económicas asociadas al uso de recursos sanitarios a partir de un estudio similar realizado en el Reino Unido. Resultados: Iniciar el tratamiento con cilostazol en lugar de pentoxifilina aumentaría la distancia máxima recorrida en un 72%, reduciendo los costes en un 11,5%. En comparación con naftidrofurilo, cilostazol se asoció a un aumento de la efectividad del 34% y un aumento de los costes sanitarios del 11,2%. Estos resultados suponen que cilostazol, naftidrofurilo y pentoxifilina presentarían ratios de coste por punto porcentual de aumento de la distancia máxima recorrida de 7,8, 9,1 y 14,7 € respectivamente. Conclusiones: Los resultados de este estudio muestran que iniciar tratamiento con cilostazol presenta una relación de costes y efectividad más favorable respecto a otros tratamientos para la CI en España(AU)

Introduction: Cilostazol is a reversible selective inhibitor of phosphodiesterase III which has platelet antiaggregating and vasodilatory activity. The aim of this study was to estimate the clinical and economic consequences of the use of cilostazol compared with naftidrofuryl and pentoxifylline in the treatment of intermittent claudication (IC) in Spain. Methods: A pharmaco economic model was built based on the literature to describe the management of IC and its clinical and economic consequences for each treatment option evaluated in patients 40 years or older with a medical history of symptomatic IC secondary to peripheral vascular disease of the lower extremities. Clinical results were obtained from a review of clinical trials of the comparators. Spanish unit costs were used to measure the economic consequences associated with the use of healthcare resources based on a similar study performed in the UK. Results: Starting treatment with cilostazol instead of pentoxifylline would increase the maximum distance covered by 72%, reducing costs by 11.5%. Compared with naftidrofuryl, cilostazol was associated with an increase in effectiveness of 34% and an increase in healthcare costs of 11.2%. These results mean that cilostazol, naftidrofuryl and pentoxifylline would have a cost, per one percentage point increase of the maximum distance covered, of € 7.8, € 9.1 and € 14.7, respectively. Conclusions: The study results demonstrate that starting treatment with cilostazol has a more favourable cost-effectiveness ratio compared to other treatments for IC in Spain(AU)

Adding questions about cardiovascular risk factors improve the ability of the ADA questionnaire to identify unknown diabetic patients in Spain

Introduction: Currently, there are not specific questionnaires for Spanish population to identify people at risk of undiagnosed diabetes. When American Diabetes Association (ADA) test is validated in the Spanish population, the sensitivity and specificity values obtained are lower than those found in the USA. Objectives: To develop a screening tool based on the ADA questionnaire, to prospectively identify undiagnosed type 2 diabetes in Spanish ambulatory patients. Methods: Epidemiological, transversal, multicentre study, including 2,662 ambulatory patients of Primary Care centres, mean age (SD) 61.7 (10.2) years (53% women), needing a blood test and attending follow-up protocols for chronic pathologies or periodic screening programs. Classification tree construction was achieved through classical and Artificial Intelligence (AI) methods. The sensitivity, specificity, and the positive and negative predictive values were described and compared with the ADA questionnaire. Results: The final selected classification tree included the following variables: previous impaired fasting glucose or glucose intolerance; recent weight gain; parents, siblings or children with diabetes; smoking habit and pharmacologic treatment for lipid disorders (sensitivity: 80.7%; specificity: 70.9%; positive predictive value: 45.3%; negative predictive value: 92.5%). This tree showed a better Receiver Operating Characteristic curve than that of the ADA test (sensitivity: 84.3%; specificity: 20.9%). Conclusions: The inclusion of questions regarding lipid disorders, smoking habit and weight gain increase the specificity of the ADA test to identify undiagnosed type 2 diabetes in Spanish patients older than 45 years (AU)

Tyrosine phosphorylation regulates manganese superoxide dismutase (MnSOD) RNA-binding protein activity and MnSOD protein expression.

All cells tested contain a cytosolic protein that binds to a defined region in the 3' untranslated region of manganese superoxide dismutase (MnSOD) RNA; both the MnSOD RNA-binding protein (MnSOD-BP) and the cis element are required for efficient translation of MnSOD RNA [Chung, D. J., Wright, A. E., and Clerch, L. B. (1997) Biochemistry 37, 16298-16306]. This study was designed to test the hypothesis that MnSOD-BP activity is regulated by phosphorylation. When cell extracts from whole rat lung or a rat lung fibroblast cell line, RFL-6, were treated in vitro with a protein tyrosine phosphatase, there was a 4-fold increase in MnSOD-BP activity indicating that MnSOD-BP activity was upregulated by tyrosine dephosphorylation. RFL-6 cells treated in cell culture with herbimycin A or genistein, inhibitors of protein tyrosine kinase, had significantly more MnSOD-BP activity than cells treated with diluent. In RFL-6 cells treated with herbimycin A, the increase in MnSOD-BP activity was associated with an increase in the level of MnSOD protein without a change in MnSOD mRNA concentration. We propose that the modulation of MnSOD protein expression by the tyrosine phosphorylation state of MnSOD-BP is a potential therapeutic target for increasing MnSOD activity during periods of oxidative stress.

Rat lung peroxiredoxins I and II are differentially regulated during development and by hyperoxia.

Peroxiredoxin I (Prx I) and peroxiredoxin II (Prx II) are found in abundance in the cytoplasm of cells and catalyze the reduction of hydrogen peroxide with the use of electrons provided by thioredoxin. Here we examined Prx I and Prx II expression in rat lung during perinatal development and in response to hyperoxia. Prx I protein increased during late gestation and after birth fell to adult levels; conversely, Prx I mRNA increased after birth. Prx II protein concentration was unchanged in the perinatal period, but Prx II mRNA increased after birth. In response to hyperoxia begun on postnatal day 4, there was no change in Prx II expression; however, Prx I mRNA, protein, and enzymatic activity increased significantly. These data show that 1) Prx I and Prx II are developmentally regulated at the level of translational efficiency and 2) Prx I, but not Prx II, is inducible and is upregulated during the late-gestational preparation for the oxidative stress experienced by the lung at birth and during exposure to hyperoxia in the neonatal period.

Retinoic acid receptor-beta: an endogenous inhibitor of the perinatal formation of pulmonary alveoli.

Pulmonary alveoli are formed, in part, by subdivision (septation) of the gas-exchange saccules of the immature lung. Septation is developmentally regulated, and failure to septate at the appropriate time is not followed by delayed spontaneous septation. We report retinoic acid receptor (RAR) beta knockout mice exhibit premature septation; in addition, they form alveoli twice as fast as wild-type mice during the period of septation but at the same rate as wild-type mice thereafter. Consistent with the perinatal effect of RARbeta knockout, RARbeta agonist treatment of newborn rats impairs septation. These results 1) identify RARbeta as the first recognized endogenous signaling that inhibits septation, 2) demonstrate premature onset of septation may be induced, and 3) show the molecular signaling regulating alveolus formation differs during and after the period of septation. Suppressing perinatal RARbeta signaling by RARbeta antagonists may offer a novel, nonsurgical, means of preventing, or remediating, failed septation in prematurely born children.

Post-transcriptional regulation of lung antioxidant enzyme gene expression.

It is an honor, and indeed fitting, to have a chapter on pulmonary oxygen toxicity included in a Festschrift for Dan Gilbert, whose contributions to the free radical theory of oxygen toxicity have been a catalyst to the last half-century of investigation in this field. There is cellular damage that results in pulmonary edema and even death if the increase in reactive oxygen species produced in the lung during exposure to hyperoxia is not counterbalanced by an increase in the cell's antioxidant defense systems. In this chapter experimental evidence will substantiate the importance of post-transcriptional regulation of antioxidant enzyme gene expression in animal models of pulmonary oxygen toxicity and tolerance to hyperoxia with special emphasis given to the role of manganese superoxide dismutase (MnSOD) synthesis, specific activity, and RNA half-life and to a proposed function of a MnSOD RNA-binding protein as a positive regulator in the control of translational efficiency.

A region in the 3' UTR of MnSOD RNA enhances translation of a heterologous RNA.

The studies reported in this paper were designed to test the hypothesis that a cis element located in the 3' UTR of manganese superoxide dismutase (MnSOD) RNA, designated MnSOD-response element (MnSOD-RE), is a translational enhancer in vivo. NIH/3T3 cells were transfected with a posttranscriptional reporter construct in which MnSOD-RE was placed 3' of the coding region of chloramphenicol acetyltransferase (CAT); this construct is designated CAT-RMS. Transient transfection of CAT-RMS did not change the concentration of CAT mRNA but increased CAT activity by approximately 400% compared to a control construct, CAT-V, which contains approximately the same size of non-MnSOD 3' UTR sequence. Transfection of CAT-RMS had no effect on endogenous MnSOD protein, mRNA, or MnSOD RNA-binding protein activity. Because of its ability to increase translation of a heterologous RNA, MnSOD-RE may be useful in designing expression vectors for in vitro expression systems and in vivo gene therapy.

Estrogen regulates angiotensin AT1 receptor expression via cytosolic proteins that bind to the 5' leader sequence of the receptor mRNA.

Two of the most highly recognized factors implicated in the pathogenesis of hypertension, atherosclerosis, congestive heart failure and associated cardiovascular disease are the renin angiotensin system (RAS) and estrogen. A major effect of estrogen results from its influence on the RAS. Beta-estradiol (E2) replacement in ovariectomized (OVX) rats significantly decreased type 1 angiotensin (AT1) receptor expression in the pituitary and adrenal, whereas it significantly increased receptor expression in the uterus when compared to OVX controls. Additional evidence demonstrated an important influence of estrogen on a recently discovered post-transcriptional mechanism for regulating expression of the AT1 receptor. This mechanism consists of cytosolic RNA binding proteins (BPs) that recognize the 5' leader sequence (5'LS) of the receptor mRNA. The activities of these 5'LS BPs were modulated by estrogen in an inverse manner to AT1 receptor regulation. Moreover, in vitro translation assays in wheat germ lysates suggested that the 5'LS BPs inhibited AT1 receptor translation. Our data therefore indicate that hormonal regulation of AT1 receptors involves modulation of 5'LS BPs by estrogen. These findings may in part account for the observed protective effects of estrogen on cardiovascular disease.

Regulation of lung manganese superoxide dismutase: species variation in response to lipopolysaccharide.

Lipopolysaccharide (LPS) treatment increases survival of rats, but not of mice, during hyperoxia. Manganese superoxide dismutase (Mn SOD) in the lung plays a critical role in LPS-induced tolerance to hyperoxia in rats. Therefore, we now compared the response of lung Mn SOD with treatment of mice and rats with LPS. LPS treatment of rats increased Mn SOD activity and protein concentration, did not change its specific activity, increased Mn SOD mRNA concentration 35-fold, and elevated Mn SOD synthesis 50% without changing general protein synthesis. LPS treatment of mice did not alter any of these parameters except for a 16-fold increase in Mn SOD mRNA concentration. Mn SOD translational efficiency (synthesis/mRNA concentration) was diminished 93% in rat lung and 76% in mouse lung by treatment with LPS. However, the absolute translational efficiency was twofold higher in lungs of LPS-treated rats than in lungs of LPS-treated mice. The failure of LPS to raise Mn SOD activity in mouse lungs is due, at least in part, to a smaller increase in Mn SOD mRNA and lower translational efficiency in LPS-treated mice than in LPS-treated rats.

Gene expression of cellular retinoid-binding proteins: modulation by retinoic acid and dexamethasone in postnatal rat lung.

In rats, septation of gas-exchange saccules occurs during the first 2 postnatal weeks; dexamethasone (DEX) treatment irreversibly impairs septation, and treatment with all-trans retinoic acid (RA) prevents the DEX-induced inhibition of septation. Cellular retinoic acid-binding protein I (CRABP I) and cellular retinol-binding protein I (CRBP I) are important modulators of the cellular metabolism of retinoids. In the present study, therefore, we measured the mRNA concentration of CRABP I and CRBP I in lungs of neonatal rats. In untreated rats, CRABP I and CRBP I mRNA peaked at postnatal d 8, indicating that CRABP I and CRBP I are developmentally regulated at least in part at a pretranslational level during lung septation. Daily treatment of 3- to 8-d-old rats with RA (500 microg/kg/d) had no effect on the level of CRABP I mRNA; treatment with DEX (0.25 microg/d) from d 4 to 8 caused a decrease in CRABP I mRNA that was not prevented by concomitant treatment with RA. These findings suggest that a decrease in CRABP I expression may be important in the DEX-induced block of septation but not in the prevention by RA of DEX-induced inhibition of septation. RA treatment caused an increase of CRBP I mRNA; conversely, treatment with DEX caused a decrease in CRBP I mRNA that was prevented by concomitant treatment with RA. These data suggest CRBP I may play a role in RA-induced septation, in the inhibition of septation caused by DEX, and in the ability of RA to prevent DEX-blocked septation.

The 3' untranslated region of manganese superoxide dismutase RNA contains a translational enhancer element.

A redox-sensitive protein that binds to the 3' untranslated region (UTR) of manganese superoxide dismutase (MnSOD) RNA has been described previously [Fazzone, H., Wangner, A., and Clerch, L. B. (1993) J. Clin. Invest. 92, 1278-1281; Chung, D. J., and Clerch, L. B. (1997) Am. J. Physiol. 16, L714-L719]. In the present study, cross-competition gel retardation and RNase H assays were used to identify a 41-base region located 111 bases downstream of the stop codon as the 3' UTR cis element involved in protein binding. The base sequence of this region is approximately 75% conserved among the 3' UTRs of rat, mouse, cow, and human MnSOD mRNAs at approximately the same distance downstream of the stop codon. The role of this protein-binding region in RNA translation was assessed in an in vitro rabbit reticulocyte lysate system. Translation of MnSOD RNA from which the 3' UTR element was deleted decreased 60% compared with translation of MnSOD RNA containing the 3' UTR cis element. In the presence of a specific competitor oligoribonucleotide that inhibits MnSOD RNA protein-binding activity, translation of MnSOD RNA containing the 3' UTR was decreased by 65%. Thus, both the cis element and RNA protein-binding activity were required for more efficient translation of the MnSOD. An analysis of ribosomal profiles suggests the MnSOD RNA-binding protein participates in the formation of the translation initiation complex. When MnSOD RNA-binding activity was inhibited, initiation complex formation was decreased by 50%. From the data obtained in this study, we propose that the 3' UTR cis element of MnSOD through its interaction with MnSOD RNA-binding protein may function as a translational enhancer.

Omeprazole and ranitidine in long-term treatment of duodenal ulcer: a double-blind comparison of length of time in remission.

In most patients duodenal ulcer is a chronic relapsing disease. If no active maintenance treatment or eradication therapy is given after healing, around 70-100% of patients have a relapse during the first year. We conducted a double-blind multicenter study in 472 patients with duodenal ulcer. They were treated with omeprazole 20 mg every morning for four or eight weeks and when healed were randomly allocated to maintenance treatment with either omeprazole 20 mg every morning or ranitidine 150 mg at bedtime for up to six months. The patients were assessed by endoscopy at monthly intervals until healing occurred. Thereafter scheduled endoscopy was carried out after 1, 3, and 6 months of maintenance treatment or immediately in the event of a suspected relapse. Healing status (intention to treat approach) was 87% at four weeks and 93% at eight weeks. At six months the estimated remission rate was 90% for omeprazole and 82% for ranitidine (P = 0.03, 95% CI 1-15%). The incidence of adverse events was similar during the two maintenance treatments. Treatment with omeprazole 20 mg every morning maintained significantly more patients in remission than treatment with ranitidine 150 mg at bedtime.

Molecular mechanisms of antioxidant enzyme expression in lung during exposure to and recovery from hyperoxia.

Manganese superoxide dismutase (MnSOD) activity falls approximately 50% in lung during 48 h of exposure of adult rats to > 95% O2 (L. B. Clerch and D. Massaro. J. Clin. Invest. 91: 499-508, 1993). We now show that hyperoxia also decreased MnSOD activity in lungs of adult baboons, making the phenomenon potentially more important to humans. In rats, a decrease in lung MnSOD activity during an initial 48 h of exposure to > 95% O2 and its increase during an immediately subsequent 24 h in air were due to decreases and increases, respectively, in MnSOD specific activity and synthesis rate; the latter was due to altered translational efficiency. The concentration in the lung of copper-zinc superoxide dismutase mRNA, catalase mRNA, and glutathione peroxidase mRNA, unchanged during the initial 48 h of exposure to O2, rose approximately twofold during reexposure to O2 after 24 h in air. The demonstration that the fall in MnSOD activity is translationally and posttranslationally regulated during the initial exposure to hyperoxia suggests that gene transfer to increase MnSOD activity in hyperoxic lungs may also require therapy that maintains translational efficiency and MnSOD specific activity.

Kidney extracts from spontaneously hypertensive rats (SHR) have greater dopamine 1A receptor RNA-binding activity than extracts from normotensive Wistar-Kyoto (WKY) rats.

Rat kidney extracts contain a 52 kDa protein that binds to the 3' untranslated region of the dopamine 1A (D1A) receptor mRNA at a 243 base-long cis element starting at the stop codon and ending approximately 220 bases upstream of an AUUUA-rich region. The D1A receptor RNA-binding protein (D1A-BP) is redox-sensitive; free sulfhydryl groups on the protein are required for binding. Kidney extracts from SHR have significantly more D1A-BP activity than extracts from WKY rats. When kidney extracts were tested for binding to an 80-base RNA containing four AUUUA repeats, there was also greater binding activity in extracts from SHR. These increases are at least partly specific because there was no difference in catalase RNA-binding protein activity between the two rat strains. These data suggest D1A-BP and AUUUA-binding protein may play a role in posttranscriptional regulation of the D1A receptor in the hypertensive rat.

RNA in polysomes is an inhibitor of manganese superoxide dismutase RNA-binding protein activity.

A redox-sensitive protein in rat lung binds to the 3'-untranslated region (3'-UTR) of manganese superoxide dismutase (Mn-SOD) mRNA; the activity of this Mn-SOD RNA-binding protein (Mn-SOD-BP) is greater in 12,000-g supernatant fractions (S12) from neonates than in S12 from adults (H. Fazzone, A. Wangner, and L. B. Clerch. J. Clin. Invest. 92: 1278-1281, 1993). To determine the mechanism underlying this developmental difference, lung subcellular fractions were tested for their effect on Mn-SOD-BP activity. Protein in the 130,000-g supernatant (S130) of lung extracts bound the 3'-UTR. However, the developmental difference in binding was not present in S130. The 130,000-g pellet (P130) did not bind the 3'-UTR; rather, it contained an inhibitor of Mn-SOD-BP activity. Addition of P130 to S130 decreased RNA binding in a dose-dependent manner. Furthermore, adult P130 was a more potent inhibitor of RNA-binding activity than neonatal P130. These data indicate that the developmental difference in Mn-SOD-BP activity is due, in part, to an inhibitor in P130. Biochemical characterization revealed that the inhibitor is an RNA that may participate in the posttranscriptional control of Mn-SOD gene expression.

Radiation-initiated, immortal Syrian hamster embryo fibroblasts release elevated levels of H2O2 and show divergent MnSOD and catalase activities.

To characterize molecular events associated with the neoplastic conversion of primary cells by ionizing radiation, we studied the activities and mRNA expression of manganese superoxide dismutase (MnSOD) and catalase (CAT) in Syrian hamster embryo fibroblasts during the early stages of immortalization after treatment with gamma-rays. The irradiated cells showed divergent MnSOD and CAT responses relative to unirradiated controls. At passage 6, MnSOD activity was increased about 50-fold, although the concentration of MnSOD mRNA increased only 1.6-fold. By contrast, CAT activity diminished 2-fold despite an increase of 1.6-fold in the concentration of CAT mRNA. This divergence between the MnSOD and CAT activities was maintained upon culturing and, at passage 12, MnSOD was 35-fold increased and CAT 3.7-fold decreased, relative to unirradiated cells. The amount of H2O2 released into the culture medium by the radiation-initiated cells was 6-fold greater than in control media. Because H2O2 is a causative agent in the induction of malignant transformation in vitro, our results suggest that the elevated production of H2O2 caused by the imbalance between the activities of MnSOD and CAT may participate in the immortalization and subsequent malignant conversion of Syrian hamster embryo fibroblasts by ionizing radiation.

Increased manganese superoxide dismutase activity, protein, and mRNA levels and concurrent induction of tumor necrosis factor alpha in radiation-initiated Syrian hamster cells.

The levels of the antioxidant enzyme manganese superoxide dismutase (Mn-SOD) are frequently decreased in tumor cells and increased in normal cells upon treatment with ionizing radiation. We studied Mn-SOD at different stages during the neoplastic conversion of radiation-initiated Syrian hamster embryo HDR-3 cells. Mn-SOD activity and the concentration of Mn-SOD protein and mRNA increased gradually during the malignant transformation of HDR-3 cells after radiation exposure; fully neoplastic cells showed greater Mn-SOD levels than preneoplastic and normal 84-3 cells. Inhibitors of superoxide (SO) anion production (thenoyltrifluoroacetone and rotenone) decreased the concentration of Mn-SOD mRNA, raising the possibility that the generation of SO radicals participated in the upregulation of Mn-SOD in cells transformed by exposure to radiation. We observed an increase in the concentration of tumor necrosis factor alpha (TNF alpha) in HDR-3 cells relative to mock-irradiated cells. Together with the observation that TNF alpha stimulates the production of SO by mitochondria and increases the level of Mn-SOD mRNA in other experimental systems, our results suggest that as normal 84-3 cells undergo malignant transformation induced by ionizing radiation they produce TNF alpha, to which the cells respond by increasing the concentration of Mn-SOD mRNA and protein and the activity of the enzyme.

Pertussis toxin alters the concentration and turnover of manganese superoxide dismutase in rat lung.

Treatment of rats with pertussis toxin (PTX) decreases the activity of manganese superoxide dismutase (Mn-SOD) in the lung and results in oxygen toxicity in air (L. B. Clerch, G. Neithardt, U. Spencer, J. A. Melendez, G. D. Massaro, and D. Massaro. J. Clin. Invest. 93: 2482-2489, 1994). To examine aspects of the mechanism of the PTX-induced fall in Mn-SOD activity, we injected rats with PTX (50 micrograms/kg), killed the rats 72 h later, and measured the activity, concentration, specific activity, and turnover of Mn-SOD in the lung. Treatment with PTX caused an approximately 50% fall in Mn-SOD activity and Mn-SOD concentration but no change in Mn-SOD specific activity. PTX also caused an increase in Mn-SOD mRNA concentration, a fall in Mn-SOD synthesis, and an increase in the half-life of Mn-SOD and general proteins. We conclude the PTX-induced low concentration of Mn-SOD is due to a decrease of translational efficiency. We suggest that, under normoxic conditions, signal transduction via heterotrimeric guanine nucleotide binding proteins regulates the expression of Mn-SOD at the level of translation and Mn-SOD degradation.

Early divergent lung antioxidant enzyme expression in response to lipopolysaccharide.

Lipopolysaccharide (LPS), a component of the cell wall of Gram-negative bacteria, interacts with eukaryotic cells, causing changes in gene expression and a rapid increase in the formation of superoxide and H2O2. We now report that, within 6 h of treating rats with LPS, there was a divergent response in the lung of manganese superoxide dismutase (Mn-SOD) and catalase expression without a change in expression of copper-zinc superoxide dismutase or glutathione peroxidase. The activity and mRNA concentration of Mn-SOD increased during the time catalase mRNA concentration and activity decreased. These divergent changes and activation of nuclear factor-kappa B (NF-kappa B) were preceded by a fall, 1 h after LPS treatment, in the RNA binding activity of two redox-sensitive proteins: Mn-SOD RNA binding protein and catalase RNA binding protein. The rapid onset of these changes, the bacteriostatic properties of H2O2, and the signaling function of NF-kappa B suggest that the divergent expression of Mn-SOD and catalase is a coordinated component of the acute phase reaction to bacterial invasion.

Evidence that glutathione peroxidase RNA and manganese superoxide dismutase RNA bind the same protein.

Rat lung extract contains protein that binds to a cis element in the 3' untranslated region of glutathione peroxidase (GPx) mRNA; this region is located 200 bases downstream of the stop codon and 77 bases downstream of the selenocysteine insertion sequence. GPx mRNA-binding protein (GPx-BP) has the following characteristics in common with Mn superoxide dismutase mRNA-binding protein (MnSOD-BP): 1. RNA-binding activity is redox-sensitive; free sulfhydryl groups on the protein are required for binding. 2. RNA-binding activity is enriched in a 130,000 x g supernatant fraction and is inhibited by RNA in the polysomal fraction. 3. The MnSOD and GPx cis elements compete with each other for protein binding. 4. UV crosslinking studies with each probe reveal a [32P]-labeled protein of the same apparent molecular mass, 56 kDa. These observations provide evidence that MnSOD and GPx RNAs bind the same protein.