The utility of the oxygen pulse recovery as a marker of the cardiac output response to exercise in patients with chronic heart failure

PURPOSE

The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of chronic heart failure (CHF). The recovery of the oxygen pulse (OP) is a non-invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central haemodynamic response to exercise remains to be determined. We hypothesized that an impaired OP recovery is associated with a reduced CO response to exercise in CHF patients.

METHODS

Sixty one CHF patients performed cardiopulmonary exercise test with simultaneous measurement of CO. Impaired OP recovery was defined as an overshoot during the first minute of recovery or OP at 1-min recovery as a percentage of peak OP (OP_RR ).

RESULTS

An OP overshoot was observed in 9% (n = 5) of patients. In these patients, peak CO and VO₂ were significantly lower (peak CO 7.9 ± 0.8 versus 11.2 ± 4.3 L/min and peak VO₂ 14.1 ± 4.7 versus 19.6 ± 5.8 ml min^-1  kg^-1 ). Mean relative recovery of OP was 78 ± 20%. Slow OP recovery (negative OP_RR ) was seen in 13% (n = 8). Peak CO and VO₂ were significantly lower in the negative OP_RR group (11 ± 4 versus 8 ± 0.7 L/min and 19.7 ± 5.9 versus 14.6 ± 3.7 ml kg min^-1 ). There was a significant relation between OP_RR and stroke volume (SV) _RR (r = .57), as well as between OP_RR and a-v O₂ diff _RR (r_s  = .4).

CONCLUSION

An impaired OP recovery is associated with a reduced CO response to exercise and worse functional status. Therefore, the OP recovery can be used to grade the severity of CHF.

Chronic lower leg pain: entrapment of common peroneal nerve or tibial nerve

Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. Awareness among traumatologists regarding these nerve entities is low. A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.

Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

Knowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20–25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

Exercise Testing and Training in a Cancer Rehabilitation Program: The Advantage of the Steep Ramp Test

OBJECTIVE

To compare the short maximal exercise capacity test (steep ramp test) with the submaximal test to determine the most appropriate exercise test in cancer rehabilitation.

DESIGN

A prospective study in which a submaximal test, a maximal short exercise capacity test (steep ramp test), and a maximal oxygen consumption test (Vo(2)max test) were performed before and after an 18-week training program. Vo(2)max testing, the criterion standard for the measurement of physical capacity, was compared with the submaximal test and the steep ramp test.

SETTING

Community hospital and physiotherapy.

PARTICIPANTS

Thirty-seven cancer survivors (10 men, 27 women) treated with chemotherapy. The subjects' mean age +/- standard deviation (SD) was 48+/-11 years.

INTERVENTION

An 18-week training program including strength training, interval aerobic training, and home-based activities (endurance).

MAIN OUTCOME MEASURES

Estimated Vo(2)max (submaximal test) and maximal workload (steep ramp test) were assessed during the exercise tests and compared with the results of the Vo(2)max test.

RESULTS

A paired t test showed a significant improvement in Vo(2)max (+13%, P<.001) and maximal workload (+19%, P<.001) after the training program. This improvement was confirmed in the steep ramp test (maximal workload, +13%, P<.001) but not in the submaximal test (estimated Vo(2)max, +4%, P=.192). Pearson correlation quantified only a moderate correlation between the Vo(2)max test and the submaximal test and a high correlation between the Vo(2)max test and the steep ramp test. Intraclass correlation determined the test-retest reliability of the submaximal test (.873) and the steep ramp test (.996). A linear regression model (Vo(2)max, 6.7; steep ramp Wmax, +356.7) was estimated to predict Vo(2)max from the steep ramp test outcome, implying a prediction margin of +/-2 SDs (616 mL/min).

CONCLUSIONS

The submaximal test proved to be invalid, whereas the steep ramp test seems to be a practicable, reliable, and valid test for the assessment of the training dose. The steep ramp test can be regularly repeated during the training program, providing information needed to readjust the training dose according to the progress made.

Myocardial adaptation in different endurance sports: an echocardiographic study

OBJECTIVE

Of this study was to investigate three groups of highly trained competitive endurance athletes consisting of marathon runners, triathletes and cyclists for differences in left ventricular adaptation.

METHODS

25 marathon athletes, 21 triathlon athletes and 38 cyclists underwent a standard echocardiographic and Doppler study.

RESULTS

The left ventricular internal diameter in diastole divided by body surface area was significantly larger in cyclists than in marathon runners (31.6+/-3.0 vs. 30.0+/-2.0 mm/ m2, p < 0.05) but did not differ of that of triathletes. Left ventricular mass was significantly different between marathon runners and triathletes (253.6+/-63.7 vs. 322.0+/-62.1 g, p < 0.005) and between marathon runners and cyclists (253.6+/-63.7 vs. 314.2+/-79.2 g, p < 0.005). Systolic wall stress was significantly different between the marathon runners and the triathletes (88.4+/-11.7 vs. 78.9+/-11.0 g/cm2 p < 0.05). Only a minority of the endurance athletes showed concentric remodeling (7%), whereas a majority showed eccentric remodeling (65%) of the left ventricle. The prevalence of eccentric remodeling was more apparent in cyclists. There were some specific differences in left ventricular diastolic function between the three different endurance sports, but no left ventricular diastolic dysfunction could be detected.

CONCLUSION

There is a sport-specific left ventricular adaptation in endurance athletes. The triathlon heart and the heart of a cyclist differ significantly from a marathon heart.

Left atrial and ventricular dimensions in highly trained cyclists

OBJECTIVES

This study sought to investigate the development of left ventricular remodeling during active cycling.

METHODS

A group of 17-year-old (+/- 0.2 years) highly trained competitive cyclists (group I, n = 66) and a group of 29-year old (+/- 2.6 years) professional cyclists (group II, n = 35) underwent two-dimensional (2D) echocardiography. Data from groups I and II were compared with values of normal untrained subjects based on the literature.

RESULTS

Left atrial dimensions were significantly increased in group II as compared to group I (44 +/- 5 vs. 36 +/- 4 mm, p < 0.005). Left ventricular end diastolic diameter was significantly increased in group II as compared to group I (61 +/- 5 vs. 54 +/- 6 mm, p < 0.005). Left ventricular mass was also significantly increased in group II as compared to group I (321 +/- 77 vs. 246 +/- 59 g, p < 0.005). Wall stress showed a significant inverse relation: 104 +/- 42 mmHg in group I vs. 83 +/- 14 mmHg in group II (p < 0.005). The early filling phase of the left ventricular inflow was significantly larger in both athlete groups in relation to the normal value. The E-wave in the athletes compared to the E-wave in normal subjects was 0.87 +/- 0.17 vs. 0.71 +/- 0.14 m/s in group I, p < 0.005, 0.82 +/- 0.17 vs. 0.71 +/- 0.14 m/s in group II, p < 0.05. Late filling phase and the ratio of the diastolic filling pattern did not show significant differences between the two groups.

CONCLUSIONS

Left atrial and left ventricular remodeling starts early in the athlete's career. Athletes of 17 years of age already show significant left atrial and left ventricular dilatation compared to data of untrained subjects described in literature. The process of dilatation continues during the athlete's career. Also left ventricular mass is increased at a young age which continues for several years. More than 60% of the athletes in both groups demonstrated an intermediate form of left ventricular hypertrophy. Diastolic function of the left ventricle remains normal during a long period of athletic career performance.

Arrhythmogenic right ventricular dysplasia and sudden cardiac death in endurance athletes

Arrhythmogenic right ventricular dysplasia (ARVD) is a cardiomyopathy with several time-dependent clinical presentations. The clinical characteristics depend on the penetration grade of the disease. There are two different histological patterns consisting of a lipomatous and a fibrolipomatous form. The presence of arrhythmias in the ARVD syndrome constitutes an important risk factor for sudden cardiac death in athletes. In this article, we describe two professional endurance athletes who died suddenly. One of these athletes had asymptomatic ARVD, the other had symptomatic polymorphic ventricular tachycardias. Both athletes showed fatty penetration of the disease in both the right and left ventricle; one of them also showed fatty involvement at the atrial level and in the other there were signs of myocarditis consistent with ARVD. In the last few years magnetic resonance imaging has become an important diagnostic tool in patients with ARVD.

Mutation-dependent aggregation of tau protein and its selective depletion from the soluble fraction in brain of P301L FTDP-17 patients

Mutations in the gene for the microtubule-associated protein tau are associated with frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17). In this study we compared the presence of the P301L mutated tau protein from brain material of patients with that of the normal 4-repeat, using polyclonal antibodies specific for the P301L point mutation and its normal counterpart. We determined the relative ratio of mutated versus normal tau protein in the sarkosyl-soluble and -insoluble protein fractions from several brain regions. Although mutated and normal tau proteins are both present in the sarkosyl-insoluble deposits, quantitative analysis showed that the mutated protein is the major component. In the sarkosyl-soluble fraction of frontal and temporal cortex the overall ratio of 3-repeat versus 4-repeat tau isoforms is unchanged but there is a dramatic depletion of mutant tau protein. Furthermore, we observed an increase in tau-immunoreactive cleavage products with the P301L antibody, suggesting that the mutant protein is partly resistant to degradation and this is confirmed by pulse-chase experiments. This is the first direct evidence using patient material that shows a selective aggregation of mutant tau protein resulting in sarkosyl-insoluble deposits and the specific depletion of mutated tau protein in the soluble fraction.

FMR1 gene expression in olfactory neuroblasts from two males with fragile X syndrome

The fragile X mental retardation 1 gene (FMR1) mutation is strongly correlated with specific and marked neurobehavioral and neuroanatomical abnormalities. The protein product, FMRP, is highly expressed in neurons of the normal mammalian brain, and absent or in low levels in leukocytes from individuals with fragile X (FraX)-associated mental impairment. Inferences which arise from these findings are that FMRP has a critical role in the development and functioning of the brain, and that leukocyte-derived molecular assessments provide a good indicator of FMR1 expression in that organ. This latter conclusion appears true in most cases even though the typical FMR1 mutation is an unstable triplet repeat expansion which demonstrates somatic heterogeneity within and across tissues. Blood to brain correspondence in FraX patients has only rarely been confirmed by the direct study of human brain specimens and, to our knowledge, it has never been studied in living individuals with the FMR1 mutation. In this report, we describe the FMR1 patterns in olfactory neuroblasts (ON) from two living brothers with expansion mutations in their leukocytes who are mentally retarded and autistic. ON were chosen for study because they are accessible neurons closely linked to the brain. In both subjects, the ON genotype was highly, but not perfectly, consistent with that observed in leukocytes. Protein phenotypes across tissues were completely consistent showing the absence of FMRP-immunoreactivity (-ir). These results augment the limited amount of direct evidence which indicates that FMR1 mutation patterns in leukocytes are a good, albeit potentially fallible, reflection of such patterns in the brain. This report further demonstrates the feasibility of using ON samples to evaluate the FMR1 mutation in humans in vivo.

Association of FMRP with ribosomal precursor particles in the nucleolus

The fragile X syndrome, one of the most common forms of inherited mental retardation, is caused by an expansion of a polymorphic CGG repeat upstream the coding region of the FMR1 gene. These expansions are associated with hypermethylation of the FMR1 gene, which results in the absence of the gene product, the FMR1 protein (FMRP). The physiological function of FMRP remains to be determined. We studied the ultrastructural localization of FMRP at the electron microscopical level using the immunogold technique. FMRP is associated with ribosomes attached to the endoplasmic reticulum and with ribosomes free in the cytoplasm. In addition, FMRP is found in the nucleus where the protein is associated with the granular component of the nucleolus. The cellular function of FMRP is hypothesized in relation to its subcellular distribution.

Specific immunologic recognition of the tumor-specific E2A-PBX1 fusion-point antigen in t(1;19)-positive pre-B cells

The t(1;19) translocation is the most commonly observed chromosomal translocation in childhood acute lymphoblastic leukemia (ALL). Its presence among pre-B cell ALL cases, has been associated with a poor prognosis. Two genes, E2A and PBX1, are involved in this t(1;19) translocation. As a consequence, parts of the E2A and PBX1 genes are fused, resulting in a chimeric E2A-PBX1 gene, encoding chimeric E2A-PBX1 proteins. As such, the amino acid sequence at the fusion site represents a unique tumor-specific determinant. We report on the generation of a polyclonal antiserum, termed BP 1/19, raised against the tumor-specific E2A-PBX1 junction of E2A-PBX1 proteins. The specificity of antiserum BP 1/19 for the E2A-PBX1 fusion-point is demonstrated at the peptide and at the protein level. Furthermore, specific binding of antiserum BP 1/19 to t(1;19) positive cells was shown using immunofluorescence techniques. The study shows that: (1) the tumor-specific fusion-point epitope on E2A-PBX1 proteins is presented in an antigenic fashion, and (2) this particular fusion-point epitope can be used in immunological marker analysis using fluorescence microscopy.

Low-conductance chloride channels in IEC-6 and CF nasal cells expressing CFTR

The properties of the cystic fibrosis gene product (CFTR) were studied by expression of cloned cDNA in different cell systems. Infection of both simian fibroblast (Vero) cells and immortalized CF nasal polyp cells (NCF3A) with a vaccinia virus encoding CFTR induced forskolin-induced Cl- permeability and low-conductance (8 pS) Cl- channels. By stable transfection of the rat intestinal crypt-derived cell line IEC-6 we have isolated a clone, IEC-CF7, which expresses CFTR mRNA and antigen. IEC-CF7 cells, but not IEC-6, display forskolin-induced Cl- permeability and multiple linear low-conductance (+/- 8 pS) Cl- channels in cell-attached membrane patches. In excised patches of IEC-CF7 cells, low-conductance Cl- channels could be activated by addition of the catalytic subunit of the adenosine 3',5'-cyclic monophosphate-dependent protein kinase A (PKA) plus ATP. During bath fluid replacement studies, the activated low-conductance channel remained active in the absence of ATP at room temperature and showed saturation kinetics. Rectifying (32 pS) Cl- channels were not observed in either IEC-6 cells or IEC-CF7 cells, indicating that there is no relation between CFTR expression and the incidence of this channel. Our data strongly support the conclusion that CFTR can act as a low-conductance Cl- channel, gated by PKA. The IEC-6-derived cell line IEC-CF7 may prove to be a useful model in the study of CFTR function because of the absence of 32-pS Cl- channel activity and its potential for differentiation.

Chloride transport in the cystic fibrosis enterocyte

Molecular mechanisms of intestinal chloride channel regulation and potential abnormalities in electrogenic chloride secretion in intestinal epithelium from cystic fibrosis (CF) patients were investigated by a combination of Ussing chamber, vesicle transport and off-cell patch-clamp analysis. Short circuit current (Isc) measurements in normal and CF rectal biopsies provided evidence for i) a defect in the cAMP-provoked activation of chloride secretion and a (hyper)expression of cAMP-dependent potassium secretion in all CF patients examined (n = 11); ii) a defect in the carbachol-provoked chloride secretion and a (hyper)expression of carbachol-induced potassium secretion in 6/11 patients; iii) a residual (but still impaired) carbachol-induced chloride secretion in 5/11 CF patients (including 2 sibs). The latter class of CF patients appeared to consist genetically of compound heterozygotes for the major delta-F508 deletion, suggesting a correlation between the nature of the mutation in the CF gene and the severity of the chloride secretory defect in CF intestine. In our search for a regulatory function of GTP-binding (G-) proteins detected previously in the luminal membrane of rat and human intestinal epithelial cells, evidence was found for the presence of a GTP[S]-activatable- and GDP[S]-inhibitable chloride conductance in the apical membrane of rat enterocytes and human colonocytes. In excised patches of human colonocyt membranes, this G-proteine-sensitive chloride conductance was identified further as a novel type of chloride channel (20pS; inwardly rectifying) that was different from the 33pS outwardly rectifying chloride channel activatable by cAMP-dependent proteinkinase (PK-A) and voltage depolarization.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular defect in combined beta-galactosidase and neuraminidase deficiency in man

In normal human fibroblasts, an enzymically active 85,000-dalton precursor form of beta-galactosidase is processed, via a number of intermediates, into a mature 64,000-dalton form. In addition there is an enzymically inactive 32,000-dalton component and its 54,000-dalton precursor. In fibroblasts from patients with a combined deficiency of beta-galactosidase and neuraminidase these last two components are absent and hardly any mature beta-galactosidase can be demonstrated. Nevertheless, in the mutant fibroblasts, precursor beta-galactosidase is synthesized and processed normally. The excessive intralysosomal degradation that is responsible for the deficiency of mature beta-galactosidase can be partially corrected by addition of the protease inhibitor leupeptin, which results in the accumulation of 85,000-dalton precursor beta-galactosidase and of a partially processed 66,000-dalton form. When mutant cells were grown in the presence of a "corrective factor" purified from the medium of NH4Cl-stimulated cell cultures, both beta-galactosidase and neuraminidase activities were restored to low control levels. The immunoprecipitation pattern was completely normal after addition of the corrective factor, and mature 64,000-dalton beta-galactosidase accumulated in the mutant fibroblasts. We propose that the combined beta-galactosidase/neuraminidase deficiency is caused by a defective 32,000-dalton glycoprotein which is normally required to protect beta-galactosidase and neuraminidase against excessive intralysosomal degradation and to give these enzymes their full hydrolytic activity.

Correction of I-cell defect by hybridization with lysosomal enzyme deficient human fibroblasts

I-cell fibroblasts with a multiple intracellular lysosomal enzyme deficiency were hybridized with cells from patients with different types of single lysosomal enzyme defects. Fusion with G(M2) gangliosidosis, type 2, (Sandhoff disease) fibroblasts resulted in a restoration of the hexosaminidase activity, in a normalization of the electrophoretic mobility of the isoenzymes, and in a decreased activity in the medium. Fusion of I-cells with fibroblasts from G(M1) gangliosidosis, type 1, led to enhancement of beta-galactosidase (beta-gal) activity. This complementation must be the result of the presence of normal polypeptide chains in I-cells, whereas the other cell types provide a factor that causes the intracellular retention of the enzymes. Restoration of beta-gal was also observed in heterokaryons after fusion of I-cells with beta-galactosidase/neuraminidase-deficient (beta-gal(-)/neur(-)) variants, indicating that the neuraminidase(s) and the posttranslational modification of beta-gal are affected in a different way in I-cell disease and in beta-gal(-)/neur(-) variants. Fusion of I-cells with mannosidosis fibroblasts resulted in a restoration of the acidic form of alpha-mannosidase and in a decrease of the extracellular activity of both this enzyme and the hexosaminidase enzyme, indicating that fusion of I-cells with different types of fibroblasts with a single lysosomal enzyme deficiency not only leads to complementation for one particular enzyme but also to a correction of the basic defect in I-cells.

Somatic cell hybridisation studies showing different gene mutations in Niemann-Pick variants

Cultured skin fibroblasts from patients with different clinical types of Niemann-Pick disease were hybridized and sphingomyelinase activities were measured in the heterokaryon cell population. Both the natural substrate (3H-choline) sphingomyelin and the chromogenic analogue hexadecanoylamino-4-nitrophenylphosphorylcholine were used in the complementation analysis. In fusions between cells from type C Niemann-Pick disease with those from type A or B a clear restoration of sphingomyelinase activity occurred, whereas no complementation was found in other fusion combinations. The results indicate that at least two different genes are involved in the mutations leading to the different Niemann-Pick variants.

Alkaline phosphatase activity of normal and cystic fibrosis fibroblasts

Alkaline phosphatase (ALP) activities were compared in fibroblasts from three cystic fibrosis patients and two normal controls after culturing the cells in normal growth medium and in medium containing Tamm-Horsfall glycoprotein, isoproterenol, and theophylline. No consistent alterations in ALP activities were noted, either between the same cell lines grown under different conditions, or between normal and cystic cell lines. It is concluded that it is not possible to use changes in ALP activity in cultured cells for the prenatal diagnosis of cystic fibrosis.

A two-year-old patient with an atypical expression of GM1-beta-galactosidase deficiency: biochemical, immunological, and cell genetic studies

Cultured skin fibroblasts from a 2-year-old boy with an atypical form of beta-galactosidase deficiency have been studied. With the artificial substrate 4-methylumbelliferyl-beta-D-galactopyranoside, 5--15% residual activity was found in fibroblasts from this patient. Most of this activity was in the monomeric A form of the enzyme, very little in the multimeric B form. Km value, pH profile, and heat lability of the mutant enzyme were similar to those of beta-galactosidase from control fibroblasts. Immunological studies showed that the mutant enzyme cross-reacted with an antiserum raised against human liver beta-galactosidase, but the catalytic activity per unit antigenic activity was lower than normal. It was demonstrated by somatic cell hybridization that the gene mutation in this patient is different from that in patients with type 1 or type 2 GM1-gangliosidosis. No genetic complementation was found after fusion of fibroblasts from this patient with those from two other clinical variants of GM1-gangliosidosis formerly designated type 3 and adult type 4.

Adult type GMl-gangliosidosis: a complementation study on somatic cell hybrids

Two adult siblings with progressive pyramidal and extrapyramidal lesions, and generalized muscle atrophy had a profound deficiency of beta-galactosidase in all the cells and body fluids examined. Neuraminidase activity was normal in fibroblasts. The fused fibroblasts of infantile GMl-gangliosidosis and each of these adult patients had beta-galactosidase activity as expected for the average value in a mixture of equal numbers of parental cells. However, there was a remarkable increase in the activity of beta-galactosidase when the cells from each of these cases were fused with those from the beta-galactosidase-deficient adult with cherry-red spots, cerebellar ataxia, myoclonus and neuraminidase deficiency in fibroblasts. It was concluded that the two siblings represent a new genetic variant (adult type) of GMl-gangliosidosis.

A rapid and simple microfractionation method for the analysis of hexosaminidase A and B activities in small numbers of cultured (amniotic fluid) cells

A simple and rapid microfractionation procedure is described which enables the separate analysis of hexosaminidase A and B activities in as little as a few hundred to a thousand cultured human cells. 25 microliter cell homogenate is added to a pellet of DEAE-cellulose and 50 microliter 0.1 M NaCl in buffer. After centrifugation the hex B and I forms are measured in the supernatant, whereas hex A is determined by direct incubation of the DEAE pellet with methylumbelliferyl substrate. The reliability and reproducibility of the method is compared with that of heat inactivation and column chromatography. The application of the procedure is illustrated by analyses of fibroblasts and cultured amniotic fluid cells from pregnancies at risk for Tay-Sachs disease and by serum assays for the diagnosis and heterozygote testing of this disease.

Biochemical, immunological, and cell genetic studies in glycogenosis type II

Fibroblasts from patients with the adult, juvenile, and infantile form of glycogenosis type II (Pompe disease) were cultured under standardized conditions, and the activity of acid alpha-glucosidase (E.C.3.2.1.20) towards glycogen, maltose, and 4-methylumbelliferyl-alpha-D-glucopyranoside was measured. Glycogen levels in muscle biopsies and in cultured fibroblasts from patients were determined. Residual enzyme activities varying from 7%-22% were detected in fibroblasts from patients with the adult form but not from patients with the infantile form of glycogenosis II. An inverse correlation was found between the severity of the clinical manifestation and the degree of residual enzyme activity in the fibroblasts. The kinetic and electrophoretic properties of acid alpha-glucosidase in fibroblasts from the adult patients and from control individuals were similar. Immunological studies suggested that the decrease of acid alpha-glucosidase activity is caused by a mutation that affects the production or degradation of the enzyme rather than its catalytic activity. Complementation studies were carried out by fusing fibroblasts from patients with the adult, juvenile, and infantile form of glycogenosis II, but neither conventional assays on multikaryons nor enzyme assays on single binuclear heterokaryons gave any evidence for genetic heterogeneity among these forms.

Characterization of beta-D-N-acetylhexosaminidase isoenzymes in man-Chinese hamster somatic cell hybrids

A series of man-Chinese hamster hybrids were investigated with the use of an anti-Chinese hamster hexosaminidase serum, a specific anti-human hex A serum and an anti-human hex B serum. The expression of human hex A was found to be dependent on the presence of hex B. A heteropolymeric molecule is formed independently of hex B, which consists of Chinese hamster and specific hex A moieties. It has an electrophoretic mobility nearly identical to hex A. A relationship between the absence and presence of the heteropolymeric molecule, mannosephosphate isomerase (MPI), and pyruvate kinase (PK-3), assigned to chromosome 15, was established. With respect to the two locus subunit model, the gene coding for the alpha subunit, specific for hex A, has been localized on chromosome 15.