Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury.

BACKGROUND: Biochemical markers have not been routinely used in children at risk for myocardial damage. Yet, because of somatic growth and the duration of survival, a low level of myocardial damage may ultimately be of more consequence in children than in adults. METHODS AND RESULTS: We investigated the utility of cardiac troponin T (cTnT) blood levels (CARDIAC T ELISA Troponin T, Boehringer Mannheim Corp) in 51 consecutively sampled patients from 1 day to 34 years of age (median=5.7 years) undergoing cardiovascular (n=19) or noncardiovascular (n=17) surgery or who received doxorubicin for acute lymphoblastic leukemia (ALL) (n=15). Minimum detectable cTnT elevations were 0.03 ng/mL. cTnT was measurable in children of all ages with myocyte damage. In patients who underwent cardiovascular surgery, a correlation was noted between a score of increasing surgical severity and the mean level of postoperative cTnT (r=.79, P<.0001). Postoperative cTnT levels were elevated in children who completed cardiovascular surgery with an open chest compared with those with a closed chest (P=.0083). In addition, cTnT levels before cardiovascular surgery predicted postoperative survival (P=.007). cTnT elevations were observed after initial doxorubicin therapy for ALL. The magnitude of elevation predicted left ventricular dilatation (r=.80 when variables were treated as continuous, P=.003) and wall thinning (r=.61, P=.044) 9 months later. CONCLUSIONS: Elevations of blood cTnT in children relate to the severity of myocardial damage and predict subsequent subclinical and clinical cardiac morbidity and mortality.

Mechanisms of inhibition by heparin of PDGF stimulated MAP kinase activation in vascular smooth muscle cells.

Heparin and heparan are potent inhibitors of vascular smooth muscle cell (VSMC) proliferation. To investigate the mechanisms by which heparin suppresses growth factor stimulated mitogenesis, the present experiments investigated the effects of heparin on platelet-derived growth factor (PDGF) stimulated signal transduction pathways. Heparin treatment substantially inhibited PDGF-BB stimulated rat VSMC growth. Western analysis showed a 30 min PDGF-BB treatment of VSMC induced the tyrosine phosphorylation of multiple protein bands; cotreatment with heparin inhibited mitogen-activated protein (MAP) kinase tyrosine phosphorylation but had little effect on PDGF receptor tyrosine phosphorylation. In-gel kinase assays demonstrated that heparin inhibited PDGF-BB stimulated MAP kinase activity at late (25 min) but not early (10 min) time points. These data indicate that heparin does not inhibit the initial signalling events after PDGF-BB binding but instead acts through an alternate mechanism to inhibit MAP kinase. To investigate if heparin directly stimulates tyrosine phosphatase-mediated suppression of MAP kinase, we treated VSMC with orthovanadate, a tyrosine phosphatase inhibitor. Heparin inhibited MAP kinase tyrosine phosphorylation after orthovanadate treatment, indicating that heparin does not suppress MAP kinase by enlistment of a tyrosine phosphatase. Experiments were performed to investigate signalling pathways upstream of MAP kinase. To determine if protein kinase C (PKC) mediates PDGF-BB, serum, and EGF stimulation of MAP kinase, we treated VSMC overnight with phorbol ester (PMA) to downregulate PKC. Abolition of conventional and novel PKC activity significantly suppressed both serum and PDGF-BB induced MAP kinase activation, indicating protein kinase C is an important mediator for these mitogens. In contrast, downregulation of these PKC isoforms had little effect on EGF stimulation of MAP kinase. As heparin inhibits PDGF and serum but not EGF stimulation of MAP kinase, there data precisely correlate heparin inhibition of MAP kinase with activation through PKC-dependent pathways. Immunoprecipitation analysis found that heparin inhibited serum, PMA, and PDGF but not EGF induced raf-1 phosphorylation. These studies demonstrate that heparin did not block PDGF-BB receptor activation, which initiates the mitogenic signalling cascade. Heparin did inhibit specific postreceptor second messenger signals, such as the late phase activation of MAP kinase, which may be mediated by suppression of PKC-dependent pathways.

A case against the specificity of "cardiac" troponin-T.

A case of a spurious rise in cardiac troponin-T in an 85 year old Caucasian man with myelodysplastic syndrome and multiple malignancies but with intact cardiac and renal function is reported. The patient presented to the accident and emergency department with fever and chest pain. Inconsistent laboratory findings in biochemical markers diagnostic of myocardial infarction were observed. Discrepant findings included a rise in the concentration of the cardiac specific marker troponin-T in the absence of an increase in creatine kinase (CK) isoenzyme MB activity. Somewhat surprisingly, there was a significant and consistent increase in CK isoenzyme BB activity. Awareness of the increase in troponin-T concentrations in patients with multiple clinical non-cardiac problems may prevent an erroneous diagnosis of myocardial infarction and avert institution of unduly aggressive treatment.

Heparin inhibits mitogen-activated protein kinase activation in intact rat vascular smooth muscle cells.

Heparin is potently antiproliferative for vascular smooth muscle cells in vivo and in vitro, inhibiting early proto-oncogene expression and blocking proliferation in the G1 phase of the cell cycle. The mitogen-activated protein kinase (MAPK) family of serine- and threonine-specific kinases is activated in response to a wide range of mitogenic and other factors and is a key intermediate in cell signaling. We found that heparin inhibits activation of MAPK in response to fetal calf serum and phorbol 12-myristate 13-acetate, but not epidermal growth factor, revealing heparin-sensitive and -insensitive pathways of MAPK activation. This report tentatively links suppression of early proto-oncogene expression and inhibition of cellular proliferation by heparin with inhibition of a mitogenically relevant kinase in living cells.

Isolation of heparin-insensitive aortic smooth muscle cells. Growth and differentiation.

Previous work has shown heparin and heparan sulfates to be potent inhibitors of vascular smooth muscle cell (VSMC) growth. This laboratory has previously isolated a VSMC line insensitive to the antiproliferative action of heparin by subjecting VSMCs that grew out from rat aortic medial explants to continuous passage in media containing heparin at 200 micrograms/mL. In the present study, we have isolated two additional heparin-resistant (HR) cell lines and have used the HR cells to investigate cellular mechanisms responsible for the potent antiproliferative activity of heparin. In contrast to normal heparin-sensitive VSMCs, the HR cells were smaller, displayed elongated processes, and possessed altered growth characteristics; however, both HR and normal cells bound and internalized comparable amounts of heparin. Immunohistochemical detection of smooth muscle cell-specific actin in growth-arrested cells showed staining of nearly all normal VSMCs and of a much smaller percentage of HR cells; heparin treatment caused a marked increase in the percentage of HR cells expressing smooth muscle cell alpha-actin, indicating that the antiproliferative and differentiation-promoting actions of heparin are independent. Proteins from control VSMCs and HR cells were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and heparin affinity chromatography. Several proteins were expressed preferentially by either HR cells or normal VSMCs, with the most significant difference being the secretion of a high-affinity, heparin-binding protein (M(r), 38,000) by control VSMCs but not by HR cells. We conclude that the aortic VSMC population may give rise to HR cells under selective conditions and that their unique characteristics, such as alterations in their ability to produce heparin-binding proteins, will prove useful in deciphering the cellular mechanisms involved in heparin's regulation of VSMC growth and differentiation.

Heparin suppresses specific second messenger pathways for protooncogene expression in rat vascular smooth muscle cells.

We investigated the molecular mechanisms underlying the ability of heparin to inhibit vascular smooth muscle cell (VSMC) growth. Previous experiments have shown that heparin inhibits induction of c-fos and c-myc protooncogene mRNA in rat VSMC stimulated by phorbol 12-myristate 13-acetate (PMA) but not when stimulated by epidermal growth factor (EGF) (Pukac, L. A., Castellot, J. J., Wright, T. C., Caleb, B. L., and Karnovsky, M. J. (1990) Cell Regul. 1, 435-443). The present experiments show that these mitogens activate distinct second messenger pathways in VSMC, because PMA but not EGF induction of c-fos and c-myc mRNA was suppressed in protein kinase C (PKC) down-regulated VSMC; this suggests that EGF does not act through a PKC-dependent pathway for induction of these genes. Heparin inhibited serum stimulation of c-fos mRNA in control VSMC, but heparin did not inhibit the smaller but significant serum stimulation of c-fos mRNA in PKC down-regulated VSMC, indicating that heparin may selectively inhibit PKC-dependent, but not PKC-independent, stimulation of gene expression. To further determine if heparin inhibits non-PKC pathways, VSMC were treated with dibutyryl cAMP, 3-isobutyl-1-methyl-xanthine, and Ca2+ ionophore A23187; stimulation of c-fos mRNA by this treatment was not inhibited by heparin. DNA synthesis and cell proliferation were inhibited in rat VSMC exposed briefly to heparin during the G0/G1 phase of the cell cycle. These experiments indicate heparin can act early in the cell cycle and suggest PKC-dependent but not PKC-independent signaling pathways for gene expression are selectively sensitive to heparin inhibition.

Clostridium difficile toxin B induces reorganization of actin, vinculin, and talin in cultured cells.

Clostridium difficile toxin B is a powerful cytopathic agent which causes animal cells in culture to become rounded and arborized, an effect similar to that induced by the cytochalasins. In this study, we demonstrated that the morphological effects of the toxin are directed specifically against the actin and related components of the cytoskeleton. Dramatic disruption and reorganization of the actin stress fibers were detectable prior to significant changes in cell shape and alterations in the microtubular and intermediate filament networks. Along with F-actin, the adhesion plaque proteins, vinculin and talin were localized in intoxicated cells in a patchy pattern reminiscent of that seen in cells treated with phorbol esters or transformed by oncogenic viruses. A quantitative fluorescence assay for cellular F-actin showed that these morphological changes were accompanied by a modest net depolymerization of only 15 to 20% of the actin filaments in the cell, and that depolymerization was closely correlated with changes in cell shape. In complementary studies on cells spreading on a substrate, we found that the toxin affected the actin content and the shape of the processes extended from the cell body. As in cells treated with cytochalasin, there was a differential response between normal and virally transformed cells spreading in the presence of the toxin. The results of this study support the view that C. difficile toxin B affects one or more cellular components that regulate the structure and function of the actin cytoskeleton, and that its predominant effect is to cause a dramatic disruption of stress fibers and relocalization of the F-actin.+

Radiations emitted in the decay of 165Er: a promising medical radionuclide.

The 10.3-h 165Er, decaying by electron capture to stable 165Ho, offers an excellent promise for use in diagnostic nuclear medicine, especially in conjunction with multiwire proportional-counter cameras. Using an ultra-high-resolution Si(Li) photon spectrometer, L and K x-ray photon yields in 165Er decay have been measured. The ratio PL/PK of electron-capture probalities in L and K shells is determined to be 0.196+/-0.030, in good agreement with theory. Estimates of Auger electron yields and yields of very-low-energy electrons from Coster-Kronig transitions are presented. Levels of 169Er and 171Er radioactive impurities in the reactor-produced 165Er sample are experimentally determined. Whole-body dose estimates for 165Er are given. These compare favorably with 99mTc dose.