Effect of early interferon beta-1a therapy on conversion to multiple sclerosis in Iranian patients with a first demyelinating event.

BACKGROUND: A new treatment approach to multiple sclerosis (MS) is the initiation of interferon therapy in the early phase of the disease when a patient presents with clinically isolated syndrome. AIMS OF THE STUDY: The goal of this study was to assess the effect of early treatment on the risk of conversion to clinically definite MS in Iranian patients. METHODS: Eligible patients had presented with a first episode of neurological dysfunction suggesting MS within the previous 3 months and had abnormal brain magnetic resonance imaging (MRI). Patients were randomly assigned to receive intramuscular interferon beta 1a 30 mug or placebo once a week for 3 years. RESULTS: Of the 217 patients randomized, 202 patients completed the study; 104 received Avonex and 98 received placebo. Fewer patients converted to clinically definite multiple sclerosis in the treated group than in the placebo group during the study (36.6% vs 58.2%, P < 0.003). The number of active T2-weighted MRI lesions was significantly lower in the treated group. CONCLUSIONS: The results of our study, which are consistent with those from western studies, show that treatment at an early stage of MS delays conversion to definite MS and has positive effects on MRI outcomes.

Treatment of early onset multiple sclerosis with suboptimal dose of interferon beta-1a.

BACKGROUND: Patients with early onset multiple sclerosis may develop disability at a younger age than adults. There are several reports about safety of beta interferons in childhood and juvenile MS with different doses. OBJECTIVES: To determine safety and efficacy of substandard dose of intramuscular interferon beta-1a in a prospective randomized trial in patients with multiple sclerosis under the age of 16. METHODS: Sixteen patients were divided into two groups randomly. The first group was treated with intramuscular interferon beta-1a 15 micrograms once a week and the second group received no disease-modifying therapy. RESULTS: The patients were followed for four years. There was no significant side effect and none of the treated patients discontinued the drug. There were significant differences between two groups regarding relapse rates (p = 0.04), disability progression (p = 0.01), and new T2 lesions (p = 0.006). CONCLUSION: Treatment with interferon beta-1a is well tolerated for a long period of time and may be effective in substandard doses in early onset multiple sclerosis.

Mutations at the histidine 249 ligand profoundly alter the spectral and iron-binding properties of human serum transferrin N-lobe.

Human serum transferrin is an iron-binding and -transport protein which carries iron from the blood stream into various cells. Iron is held in two deep clefts located in the N- and C-lobes by coordinating to four amino acid ligands, Asp 63, Tyr 95, Tyr 188, and His 249 (N-lobe numbering), and to two oxygens from carbonate. We have previously reported the effect on the iron-binding properties of the N-lobe following mutation of the ligands Asp 63, Tyr 95, and Tyr 188. Here we report the profound functional changes which result from mutating His 249 to Ala, Glu, or Gln. The results are consistent with studies done in lactoferrin which showed that the histidine ligand is critical for the stability of the iron-binding site [H. Nicholson, B. F. Anderson, T. Bland, S. C. Shewry, J. W. Tweedie, and E. N. Baker (1997) Biochemistry 36, 341-346]. In the mutant H249A, the histidine ligand is disabled, resulting in a dramatic reduction in the kinetic stability of the protein toward loss of iron. The H249E mutant releases iron three times faster than wild-type protein but shows significant changes in both EPR spectra and the binding of anion. This appears to be the net effect of the metal ligand substitution from a neutral histidine residue to a negative glutamate residue and the disruption of the "dilysine trigger" [MacGillivray, R. T. A., Bewley, M. C., Smith, C. A., He, Q.-Y., Mason, A. B., Woodworth, R. C., and Baker, E. N. (2000) Biochemistry 39, 1211-1216]. In the H249Q mutant, Gln 249 appears not to directly contact the iron, given the similarity in the spectroscopic properties and the lability of iron release of this mutant to the H249A mutant. Further evidence for this idea is provided by the preference of both the H249A and H249Q mutants for nitrilotriacetate rather than carbonate in binding iron, probably because NTA is able to provide a third ligation partner. An intermediate species has been identified during the kinetic interconversion between the NTA and carbonate complexes of the H249A mutant. Thus, mutation of the His 249 residue does not abolish iron binding to the transferrin N-lobe but leads to the appearance of novel iron-binding sites of varying structure and stability.

Transferrin, is a mixed chelate-protein ternary complex involved in the mechanism of iron uptake by serum-transferrin in vitro?

Iron uptake by transferrin from triacetohydroxamatoFe(III) (Fe(AHA)3) in the presence of bicarbonate has been investigated between pH 7 and 8.2. The protein transits from the opened apo- to the closed holoform by several steps with the accumulation of at least three kinetic intermediates. All these steps are accompanied by proton losses, probably occurring from the protein ligands and the side-chains involved in the interdomain H-bonding nets. The minor bihydroxamatoFe(III) species Fe(AHA)2 exchanges its iron with the C-site of apotransferrin in interaction with bicarbonate without detectable formation of any intermediate protein-iron-ligand mixed complex; direct second-order rate constant k1=4.15(+/-0.05)x10(7) M(-1) s(-1). The kinetic product loses a single proton and undergoes a modification in its conformation followed by the loss of two or three protons; first-order rate constant k2=3.25(+/-0.15) s(-1). This induces a new modification in the conformation; first-order rate constant k3=5.90(+/-0.30)x10(-2) s(-1). This new modification in conformation rate controls iron uptake by the N-site of the protein and is followed by a single proton loss; K3a=6.80 nM. Finally, the holoprotein or the monoferric transferrin in its thermodynamic equilibrated state is produced by a last modification in the conformation occurring in about 4000 seconds. But for the Fe(AHA)3 dissociation and the involvement of Fe(AHA)2 in the first step of iron uptake, this mechanism is identical to that reported for iron uptake from FeNAc3. This implies that the exchange of iron between a chelate and serum-transferrin occurs by a single general mechanism. The nature of the iron-providing chelate is only important for the first kinetic step of the exchange, which can be slowed to such an extent that it rate limits the exchange of iron.

Transferrins--a mechanism for iron uptake by lactoferrin.

Iron uptake by bovine lactoferrin from nitrilotriacetatoFe(III) [FeN(Ac)3] in the presence of bicarbonate has been investigated at pH 7.1-8.7. Deprotonated apolactoferrin interacting with bicarbonate or carbonate extracts iron from nitrilotriacetatoFe(III); the direct second-order rate constant k1 = (4.90 +/- 0.20)x10(4) M(-1) s(-1), a reverse second-order rate constant k(-1) = (1.80+/-0.05)x10(5) M(-1) s(-1), and the iron-exchange equilibrium constant K1 = 0.25+/-0.05. The newly formed iron-protein complex loses a single proton with proton dissociation constant K3a = (17+/-0.5) nM, then undergoes a modification in its conformation followed by the loss of two or three protons; the first-order rate constant k2 = (1.0+/-0.10) s(-1). This induces a new modification in the conformation; the first-order rate constant k3 = (8.75+/-0.40)x10(-3) s(-1). This second modification in conformation controls the rate of iron uptake by the N site of the protein and is followed by a single proton loss; K5a = 8.0 nM. Finally, the holoprotein or the monoferric lactoferrin in their final equilibrated states are produced by a third modification in the conformation occurring in about 9000 s. The mechanism of iron uptake by lactoferrin is very similar to that of serum transferrin with a cooperativity between the C and N sites upon iron uptake but with lower rates, higher affinities and at least one more proton loss involved. These differences may be the result of slight discrepancies in the intimate structures of binding sites for serum transferrin and lactoferrin. In order to analyse the cooperativity between these iron-binding sites, the three-dimensional position of the chain of amino acid residues separating the N and C lobes of human apo-, holo- and dicopper-lactoferrin have been compared by the recognition of the three-dimensional shape dissimilarity program. The interlobe peptides of human hololactoferrin and apolactoferrin showed only 75.5 % tridimensional similarity, indicating that iron uptake affects the three-dimensional structure of the interlobe chain.

Transferrin--interactions of lactoferrin with hydrogen carbonate.

The interaction of apolactoferrin with hydrogen carbonate (bicarbonate) has been investigated in the pH range 6.5-9.2. In the absence of bicarbonate apolactoferrin loses a single proton with pK1a of 8.10. This proton loss is independent of the interaction with the synergistic anion. The C-site of apolactoferrin interacts with bicarbonate with a very low affinity (K(-1)C = 3.2 M(-1)). This process is accompanied by a proton loss, which is probably provided by the bicarbonate in interaction with the protein. This proton loss can possibly be the result of a shift in the proton dissociation constant, pKa, of the bicarbonate/carbonate acid/base equilibrium, which would decrease from pKa 10.35 to pK2a 6.90 in the bicarbonate-lactoferrin adduct. The N-site of the protein interacts with bicarbonate with an extremely low affinity, which excludes the presence of the N-site-synergistic anion adduct in neutral physiological media. Contrary to serum transferrin, the concentration of the apolactoferrin in interaction with bicarbonate is pH dependent. Between pH 7.4 and pH 9 with [HCO3-] about 20 mM, the concentration of the serum transferrin-bicarbonate adduct is always about 30%, whereas that of the apolactoferrin-synergistic anion adduct varies from 25% at pH 7.5 to 90% at pH 9. This implies that, despite an affinity for bicarbonate two orders of magnitude lower than that of serum transferrin, lactoferrin interacts better with the synergistic anion. This can be explained by the possible interaction of lactoferrin with carbonate in neutral media, whereas transferrin only interacts with bicarbonate.

A mechanism for iron uptake by transferrin.

Iron uptake by transferrin from iron nitrilotriacetate (FeNAc3) in the presence of bicarbonate has been investigated in the pH range 6.5-8. Apotransferrin, in interaction with bicarbonate, extracts iron from FeNAc3, without the formation of an intermediate protein-iron-ligand mixed complex (iron-exchange-equilibrium constant, K1=1 +/- 0.05; direct second-order-rate constant, k1=8.0x10(4) +/- 0.5x10(4)M(-1)s(-1)., reverse second-order-rate constant, k-1=7.5x10(4) +/- 0.5x10(4)M(-1)s(-1). The newly formed iron-protein complex loses a single proton (proton-dissociation constant, Ka=16 +/- 1.5nM) and then undergoes a modification of its conformation followed by loss of two or three protons (first-order-rate constant, K2=2.80 +/- 0.10s-1). This includes a new modification in the conformation (first-order-rate constant, K2=6.2x10(2) +/- 0.3x10(-2)s(-1). This second modification in conformation controls the rate of iron uptake by the N-site of the protein and is followed by loss of one proton (K3a=6.80 nM). Finally, the holoprotein or the monoferric transferrin in its final equilibrated state is produced by a third modification in the conformation that occurs after approximately 3000 s. Iron uptake by the N-site does not occur when the apotransferrin interacts with bicarbonate. Nevertheless, it occurs with the monoferric transferrin, in which iron is bound to the C-site, in its final state of equilibrium by a mechanism similar to that of iron uptake by the C-site of apotransferrin. These modifications in the conformation of the protein occur after iron uptake by the C-site and may be important for the recognition of the protein by its receptor prior to iron delivery by endocytosis.

Transferrin, a mechanism for iron release.

Iron release from transferrin has been investigated in mildly acidic and acidic media in the presence of formate, acetate and citrate. It occurs first from the N-terminal iron-binding site (N-site) of the holoprotein. It is independent of the nature and the concentration of competing ligands and is controlled by a slow proton transfer; second-order rate constant k1 = (7.4 +/- 0.5) x 10(4) M-1 s-1 which can be attributed to a rate-limiting slow proton gain by a protein ligand subsequent to a fast decarbonation of the N-site. Iron loss from the C-terminal iron-binding site (C-site) is slower than that from the N-site and occurs by two pathways. The first is favoured below pH 4 and does not involve the formation of an intermediate ternary complex. It can be controlled by a rate-limiting slow proton-triggered decarbonation of the binding site; second-order rate constant k3 = (2.25 +/- 0.05) x 10(4) M-1 s-1. The second pathway is favoured above pH 4 and involves a mixed protein-ligand iron complex. It takes place through the slow protonation of the mixed ternary complex and depends on the nature of the competing ligand. It is faster in the presence of citrate than in that of acetate; second-order rate constant k4 = (1.75 +/- 0.10) x 10(3) M-1 s-1 for citrate and (85 +/- 5) M-1 s-1 for acetate. All these phenomena can possibly describe proton-triggered changes of conformation of the binding sites.