Experimental Design Optimization of a Capillary Zone Electrophoresis Method for the Screening of Several Diuretics and ACE Inhibitors

Experimental design methodologies are applied to the development of a capillary zone electrophoretic method for the separation of the angiotensin-converting enzyme inhibitor enalapril and its derivative enalaprilat and the diuretics xipamide and hydrochlorothiazide. The effects of pH, buffer concentration, proportion of boric acid in the mixed boric acid-potassium dihydrogen phosphate background electrolyte, temperature, applied voltage, and percentage of organic modifier are studied. Critical factors are identified in a screening design (a 2(6-2) fractional factorial design), and afterwards, optimal conditions for the separation are reached by means of an optimization design (a 2(2) + 2 x 2 + k central composite design). The studied response is the resolution between peaks. The four studied compounds can be separated in less than 3.5 min using an electrolyte of 20mM boric acid-potassium dihydrogen phosphate (75:25, v/v) with 5% MeOH adjusted to pH 8.0 with KOH, at a potential of 30 kV. The detection wavelength and temperature are 206 nm and 35 degrees C, respectively.

[BK virus in kidney allografts: a search for histologic evidence of the infection]

BACKGROUND

BK virus (BKV) associated interstitial nephritis is a complication in renal transplantation recipients. Its incidence is controversial. The aim of the present study is to determine the incidence of histopathologic evidence of BKV-infection in a single centre.

MATERIALS AND METHODS

Renal allograft tissue samples (n = 838) from 526 patients undergoing renal transplant were evaluated by light microscopy. Polymerase chain reaction (PCR) assay for BKV DNA was performed in 41 microdissected cell populations from cases with viral inclusions, cases with other nuclear changes, and cases without nuclear changes.

RESULTS

Polyomavirus-inclusions were identified in six cases (five with interstitial nephritis and other one with only urothelial infection). In one case with interstitial nephritis the DNA was degraded. PCR confirmed BKV infection in the other five and was negative in cases without inclusions.

CONCLUSIONS

Five patterns of inclusions bodies are observed and they appear to be characteristic. PCR assay seemingly have a high specificity for BKV detection and it does not usually detect latent viral infection.

Pathology and pathogenesis of bovine spongiform encephalopathy and scrapie

In common with other prion diseases or transmissible spongiform encephalopathies (TSEs), scrapie of sheep and bovine spongiform encephalopathy (BSE) are characterized by grey matter vacuolation and accumulation of an abnormal isoform of the host prion protein (PrP) in the central nervous system (CNS). In apparent contrast with human disease, neither neuronal loss nor gliosis are invariable features of the pathology of domestic food animal TSEs. In sheep, accumulation of abnormal PrP may also occur in the lymphoreticular and peripheral nervous systems where it may be detected within months of birth. The involvement of tissues other than CNS is influenced by dose, PrP genotype of the host and strain of TSE agent. Although many different strains of scrapie agent have been isolated in rodents following serial passage of affected sheep brain tissue, the significance of these murine strains for natural sheep scrapie, and the extent to which different sheep scrapie strains occur naturally are uncertain. Whereas the consistent vacuolar pattern in the brains of BSE-affected cattle suggests a single strain of agent, the patterns of vacuolation in sheep scrapie are highly variable and cannot be easily used to define strain. In sheep scrapie, immunohistochemistry can be used to visualize different morphological types of abnormal PrP within individual brains. These different types of PrP accumulation seem to be associated with different brain cell types and with variation in the processing of abnormal PrP. When assessed in whole brain, different patterns of PrP accumulation are helpful in distinguishing between different sheep scrapie strains and also between ovine BSE and natural sheep scrapie.

[HFE gene mutations, hepatic iron content, and histological severity in hepatitis C virus-induced chronic hepatitis]

OBJECTIVE

To study whether any relationship exists between the C282Y and H63D mutations of the HFE gene, iron liver content, and the severity of histological damage in patients with hepatitis C virus (HCV)-induced chronic hepatitis.

MATERIAL AND METHODS

In 72 patients diagnosed with HCV-chronic infection, naïve for antiviral therapy, and undergoing liver biopsy, the Knodell index was established, a morphometric evaluation of hepatic hemosiderin deposits was performed by using a semiautomatic method of image analysis, and mutations of the HFE gene were identified through a polymerase chain reaction on leukocyte genomic DNA by using specific restriction enzymes. The control group for the distribution of HFE genetic variants was composed of 181 healthy individuals with the same ethnic and geographical (white Spaniards) origin.

RESULTS

(Cases/controls): 1. Genotype distribution: a) mutation C282Y: no homozygotes, 6/23 heterozygotes, 66/158 without the mutation (not significant, n.s.); b) mutation H63D: 2/5 homozygotes, 26/52 heterozygotes, 44/124 without the mutation (n.s.). compound heterozygotes 2/6. 2. Allele frequencies: a) mutation C282Y: 0.042/0.064 (n.s.); b) mutation H63D: 0.208/0.171 (n.s.). Four C282Y heterozygous patients had stainable liver iron (p=0.015 vs patients without mutations). Sixty-six patients were not carriers of the C282Y mutation; among them, 26.9% of 26 carriers and 15% of 40 non-carriers of the H63D mutation had liver stainable iron (n.s.). Knodell index score, gender, age at diagnosis, mode of transmission, and serum and liver iron values were not related to the HFE genotype.

CONCLUSIONS

our results suggest that the C282Y mutation, but not the H63D mutation, of the HFE gene is frequently associated with stainable iron in the liver in HCV-related chronic hepatitis. The HFE genotype is not related to the histological severity of the disease.

Experimental design approach for the optimisation of a HPLC-fluorimetric method for the quantitation of the angiotensin II receptor antagonist telmisartan in urine

A high performance liquid chromatographic method with fluorimetric detection has been developed for the quantitation of the angiotensin II receptor antagonist (ARA II) 4-((2-n-propyl-4-methyl-6-(1-methylbenzimidazol-2-yl)-benzimidazol-1-yl)methyl)biphenyl-2-carboxylic acid (telmisartan) in urine, using a Novapak C18 column 3.9 x 150 mm, 4 microm. The mobile phase consisted of a mixture acetonitrile-phosphate buffer (pH 6.0, 5 mM) (45:55, v/v) pumped at a flow rate of 0.5 ml min(-1). Effluent was monitored at excitation and emission wavelengths of 305 and 365 nm, respectively. Separation was carried out at room temperature. Chromatographic variables were optimised by means of experimental design. A clean-up step was used for urine samples consisting of a solid-phase extraction procedure with C8 cartridges and methanol as eluent. This method proved to be accurate (RE from -12 to 6%), precise (intra- and inter-day coefficients of variation (CV) were lower than 8%) and sensitive enough (limit of quantitation (LOQ), ca. 1 microg l(-1)) to be applied to the determination of the active drug in urine samples obtained from hypertensive patients. Concentration levels of telmisartan at different time intervals (from 0 up to 36 h after oral intake) were monitored.

Transcranial Doppler sonography in fulminant hepatic failure

The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by the presence of cerebral edema and endocranial hypertension. In spite of the multiple studies using Transcranial Doppler Sonography (TCDS), few have shown the cerebral blood flow (CBF) pattern among patients with encephalopathy resulting from FHF.

OBJECTIVE

Our objective was to characterize the CBF pattern in these patients through the use of TCDS to provide therapeutic strategies.

METHOD

The TCDS pattern was assessed in five patients diagnosed with FHF and compared with a control group who displayed critical neurologic conditions not associated with FHF. Pulsatile index, systolic, diastolic, and mean velocity of the middle cerebral artery were measured.

RESULTS

The mean age of patients with FHF was 45.4 years. One hundred percent were women, with viral hepatitis as the predominant etiology. A cerebral hypoperfusion pattern was found in 80% of the FHF group and 40% of the control group. In the former group there was no evidence of hyperemia, as there was among 20% of the control group. The mean values of velocity and pulsatile index were 36.6 cm/sec and 2.4, respectively, in the FHF group and 47.8 cm/s and 1.8 in the control group (P=0.268, P=0.402).

CONCLUSIONS

FHF patients show a predominance of cerebral hypoperfusion pattern with mean velocities lower than normal values and an increased pulsatile index. We recommend that clinicians take appropriate measures to improve cerebral perfusion and avoid hypoxia. Hyperventilation as a first level measure is contraindicated.

The transplantation donation process in the Centro de Investigaciones Medico Quirurgicas of Cuba: 1999-2002

OBJECTIVE

In 1998 in the Centro de Investigaciones Medico Quirurgicas the Transplant Coordination Office (TCO) was created, with the aim to organize a system to support a hepatic transplantation program. This organization, which changed the transplantation-donation process not only in our center but in the whole country, is described in this article.

METHOD

The files of donors generated in our hospital were studied together with the transplant coordination records, from 1999 till the first half of 2002.

RESULTS

In the period studied, 21 potential donors were diagnosed with brain death, yielding a donation rate of 71.4%. Brain death was most frequently caused by vascular brain disease; however, in the realized donor group, the cranioencephalic trauma predominated. The typical donor was a man of average age 39.2 years (range, 18-86 years). Among the potential donors, 24% were excluded based on medical criteria, and 5% due to family objections. Forty liver transplantation were performed in 36 patients including 1 liver-kidney simultaneous procedure. The principal etiologies for transplant included hepatitis C virus cirrhosis, 22%; alcoholic, 19%; and acute hepatic failure, 13%. Kidney transplantations were performed in 70 patients, including 41 from cadaveric donors (53.6%) and 29 from living related donors (41.4%). In 2001, a pancreas-kidney transplantation program was started.

CONCLUSION

The creation of the TCO has been of paramount importance to optimize transplantation program functions.

[Familial focal and segmentary hyalinosis]

Focal segmental glomerulosclerosis represents a finding in several renal disorders, characterized by proteinuria and sometimes by arterial hypertension and progressive decline in renal function. There are primary (idiopathic and familial) and secundary forms. In the last 20 years several familial cases has been reported, with a great genetic heterogeneity (dominant and recessive forms) and with multiple associations with particular MHC class-I and class-II gene loci, being Al, DR3 o DR7 the most frequently reported. We described three members of same family with focal segmental hyalinosis that shared the HLA haplotype A31 B61 DR13. This association has not been described previously. We highlight that genetic and acquired factors (obesity, hypertension...) could have importance in the development of progressive renal failure in these patients.

Antifungal activity of some Cuban Zanthoxylum species

Ethanolic extracts of the trunk bark of Zanthoxylum fagara, Z. elephantiasis and Z. martinicense showed activity against different species of fungi. No antibacterial activity was detected.

Pathology of ovine pulmonary adenocarcinoma

Clinical, gross pathology, histopathology and electron microscopy of the ovine pulmonary adenocarcinoma (OPA, jaagsiekte) either natural or experimentally induced in sheep, goat and moufflon are described. OPA is caused by an oncogenic betaretrovirus,jaagsiekte sheep retrovirus (JSRV). Most natural cases of OPA appear in animals 1-4 years old. There is no evidence of sex or breed susceptibility. Sheep affected by OPA show an afebrile respiratory illness associated with loss of weight. A very characteristic clinical sign is moist rales caused by the accumulation of fluid in the respiratory airways which is discharged from the nostrils when the head is lowered. Gross lesions are confined to the lungs but occasionally thoracic or extrathoracic structures are also affected. Two pathologic forms of OPA are currently recognized, classical and atypical. In classical forms the neoplastic lesions occurs particularly in the cranioventral parts of all lung lobes. They are diffuse or nodular, light grey or light purple in colour. On the cut surface the tumour is moist, and frothy fluid may pour from the airways on slight pressure. Atypical forms tend to be more nodular in both early and advanced tumours. They are pearly white in colour, very hard in consistency, very well demarcated from the surrounding parenchyma and their surface is dry. Histology of the lung sections reveals the presence of several foci of epithelial cell neoplastic proliferation in both alveolar or bronchiolar regions. The tumours, derived from type II pneumocytes and Clara cells, proliferate into mostly papillary but also acinar or occasionally solid growths. The tumour generally shows a benign histological pattern but intra- and extrathoracic metastases have been detected in some cases. Several considerations suggest that the tumour should be classified as an adenocarcinoma of the lung. The histology of atypical OPA is similar to that of the classical disease, with an increase in the stromal reaction accompanying the epithelial proliferations. Pathological features of OPA induced experimentally in sheep, or of OPA in goats and moufflon are similar to those described in sheep. Detailed electron microscopy of tumour material confirms that type II pneumocytes and Clara bronchiolar epithelial cells are the origin of the neoplasia. Also included in this chapter is a description of the morphology of the viral particles associated with OPA.

Cell-associated variants of disease-specific prion protein immunolabelling are found in different sources of sheep transmissible spongiform encephalopathy

Scrapie and bovine spongiform encephalopathy (BSE) are transmissible spongiform encephalopathies (TSEs) or prion diseases affecting domestic and exotic ruminants. In previous immunohistochemical studies, we have shown that different sheep TSE sources may be distinguished by both the proportion of disease-specific prion protein (PrP(d)) accumulation relative to different cell types in the brain (the 'PrP(d) profile') and by different labelling patterns for PrP peptide sequences within phagocytic cells. In the present study, we have further characterized the intracellular accumulation patterns of PrP(d) in the lymphoreticular system (LRS) and in the brain of sheep clinically affected with scrapie or BSE. BSE-infected PrP(ARQ/ARQ) sheep of different breeds were compared with scrapie-infected sheep of different PrP genotypes. Cases of BSE infection could be distinguished from scrapie cases by a marked reduction in labelling of PrP(d) containing the 84-105 amino acid residues in phagocytic cells of the LRS and in neurones and glia of the brain. These results therefore indicate that TSE agent-dependent processing of PrP in specific cell types within the brain and LRS can be used to distinguish between BSE in PrP(ARQ/ARQ) sheep and scrapie in sheep of several PrP genotypes. Three different N-terminal peptide antibody labelling patterns were recognized for different cell types in different tissues of BSE-infected sheep, suggesting that different truncated forms of PrP(d) are formed following infections with this agent strain. These variations in the cleavage sites of BSE PrP(d) may be due to cell-specific variation in endosomal-lysosomal digestion or to cell- and tissue-specific differences in BSE PrP(d) conformation.

Fetal development of the human tympanic ossicular chain articulations

OBJECTIVES

To obtain further knowledge on the morphogenesis of the articulations in the tympanic ossicular chain in humans.

MATERIAL AND METHODS

In 25 temporal bones of human fetuses the structural development of incudomallear, incudostapedial and stapediovestibular articulations was studied. The chronological ages were between the 7th week (21 mm) and the 29th week (270 mm).

RESULTS AND DISCUSSION

Incudomallear articulation showed diarthrosis and sellar joint characteristics. It showed a homogenous interzone in the 7th week of development, a three-layered interzone in the 8th week, the first cavitation signs in the 9th week and the presence of an articular cavity in the 10th week. The presence of a hyaline cartilage covering articular surfaces was observed starting in the 20th week of development. Incudostapedial articulation showed typical characteristics of a diarthrosis and spheroidal joint with a homogenous interzone at the 7th week, showing similar characteristics for 12 weeks, and completed its cavitation at the 16th week. We observed hyaline cartilage on articular surfaces from 29 weeks. Stapediovestibular articulation showed typical characteristics of syndesmosis. The annular ligament primordium derived from cartilage differentiation, both from stapedial footplate and from the surrounding otic capsule, into mesenchyme and its subsequent transformation into fibrous tissue, reaching definitive characteristics from the 12th week.

Occurrence and distribution of infection-specific PrP in tissues of clinical scrapie cases and cull sheep from scrapie-affected farms in Shetland

The prion protein (PrP) genotypes of all cull sheep originating from four scrapie-affected farms in Shetland in 1998-1999 were determined and a representative sample of the different genotypes was selected for necropsy. Samples of brain and selected viscera were removed from 159 such sheep aged 2-11 years. These samples were examined immunohistochemically and by Western blotting for infection-specific forms of PrP. None of the sheep bearing the following genotypes showed any evidence of PrP accumulation in brain, intestine, selected lymph nodes or the cranial mesenteric ganglia: ARQ/ARQ (n = 41), ARQ/ARH (n = 12), ARH/ARH (n = 2), ARQ/ARR (n = 24), ARR/ARR (n= 2). In five of 71 sheep bearing a single VRQ allele, PrP accumulation was detected immunohistochemically in viscera or brain, or both. These results suggested that only a small proportion of susceptible sheep showed evidence of infection (accumulation of PrP) on the farms studied, and that even sheep of the most susceptible genotype (VRQ/VRQ) did not invariably develop disease in an infected environment. Furthermore, there was no evidence that, in sheep of semi-resistant or fully resistant genotypes, infection could be sequestered within the lymphoreticular system or peripheral nervous system and thereby provide a possible "carrier" source of infection. Rather, the data suggested that some sheep, possibly because they had been exposed to a relatively low infective dose, became infected and accumulated the infective agent over a protracted pre-clinical phase of the disease. Such sheep might be potentially infective for many years. In two VRQ/ARR genotype sheep, PrP was confined to the brain. Infection-specific PrP was also confined to the brain in two of 24 clinical cases of VRQ/ARQ scrapie. Thus, direct neuroinvasion, apparently without a prior phase of replication in the lymphoreticular system, occurred in a proportion of VRQ/ARQ sheep. Possibly it may occur in all sheep of the VRQ/ARR genotype. The factors responsible for direct neuroinvasion are not understood. However, it cannot be attributed to genotype alone.

Vacuolar lesion profile in sheep scrapie: factors influencing its variation and relationship to disease-specific PrP accumulation

Detailed neuropathological examination for vacuolar lesions was performed on the brains of 42 sheep with clinical signs compatible with scrapie. The sheep were grouped according to their breed (Poll-Dorset, Cheviot, Welsh Mountain, Shetland and Suffolk), their PrP genotype at codons 136, 154 and 171 (VRQ/VRQ, VRQ/ARQ, VRQ/ARR and ARQ/ARQ) and the type of infection (experimental infection with SSBP/1, or natural disease). Twenty-two neuroanatomical sites from seven brain regions were examined for vacuolation in the neuropil and five sites at the level of the obex were examined for intraneuronal vacuolation. In 36 sheep, immunohistochemical examination for disease-specific PrP (PrP(d)) accumulation had also been performed in the same brain regions in an earlier study. The magnitude of total neuropil vacuolation was highest in the naturally affected ARQ/ARQ Suffolk sheep and lowest in the experimentally infected VRQ/VRQ Cheviot sheep and VRQ/ARR Poll-Dorset sheep. The severity of neuropil vacuolation at nine of the 22 neuroanatomical sites examined was used to generate a vacuolar lesion profile, which showed variations between the different sheep groups. These variations could be attributed to both PrP genotype and sheep breed and also possibly to scrapie agent; there was, however, considerable individual variation in lesion profile within sheep groups. All groups showed a similar ratio of neuropil vacuolation to neuronal vacuolation at the level of the obex. Although a positive correlation between neuropil vacuolation and PrP(d) deposition was generally observed, it was low except for the astrocyte-associated pattern of PrP(d) accumulation. The study suggests that vacuolar lesion profiles in sheep are affected by several factors and, by comparison with lesion profiles in mice, are of no more than limited value for discriminating between scrapie strains.