Impact of medication intensification on 30-day hospital readmissions in a geriatric trauma population: A multicenter cohort study

BACKGROUND

Fall-related injuries are a significant health issue that occur in 25% of older adults and account for a significant number of trauma-related hospitalizations. Although medication intensification may increase the risk of hospital readmissions in non-trauma patients, data on a geriatric trauma population are lacking.

OBJECTIVE

The primary objective was to evaluate the effect of medication intensification on 30-day hospital readmissions in geriatric patients hospitalized for fall-related injuries.

METHODS

This multicenter, retrospective cohort study included patients with geriatric who presented to one of three trauma centers within a large, health-system between January 1, 2018 and December 31, 2020. Patients at least 65 years old admitted with a fall-related injury were eligible for inclusion. Patients were grouped according to medication changes at discharge, which included intensified and non-intensified groups. Medication intensification included increased dose(s) or initiation of new agents. The primary outcome was the 30-day hospital readmission rate.

RESULTS

Of the 870 patients included (median [interquartile range, IQR] age, 82 [74-89] years, 522 (60%) female, and 220 (25%) with a previous fall), there were 471 (54%) and 399 (46%) patients in the intensified and non-intensified groups, respectively. The intensified group had a higher 30-day hospital readmission rate (21% intensified vs. 16% non-intensified, p = 0.043; number needed to harm 20) based on an unweighted analysis. According to a weighted propensity score logistic regression, medication intensification was associated with higher 30-day hospital readmissions (24% [95% confidence interval [CI] 19-31%] intensified vs. 15% [95% CI 11-20%] non-intensified, p = 0.018). These results were consistent within competing risk models accounting for death (cause-specific model: hazard ratio [HR] 1.63 [95% CI 1.07-2.49], p = 0.023; Fine-Gray model: HR 1.64 [95% CI 1.07-2.50], p = 0.022).

CONCLUSIONS

In a geriatric trauma population hospitalized after a fall, intensification of medications may pose an increased risk of 30-day hospital readmission.

Are we waiting for the sky to fall? Predictors of withdrawal of life-sustaining support in older trauma patients: A retrospective analysis

BACKGROUND

Limited data exist regarding the impact of advanced care planning for injured geriatric patients. We hypothesized that patients with advance directives limiting care (ADLC) compared with those without ADLC are more likely to undergo withdrawal of life-sustaining support (WLSS).

METHODS

This is a propensity-matched analysis utilizing American College of Surgeons Trauma Quality Improvement Program patients 65 years or older who presented between 2017 and 2018. Patients with and without ADLC on admission were compared. The primary outcome was WLSS and days prior to WLSS. Additional factors examined included hospital length of stay (LOS), unplanned operations, unplanned intensive care unit admissions, and in-hospital cardiac arrests. Prior to matching, logistic regression model assessed factors associated with WLSS. Patients with and without ADLC were matched 1:1 via a propensity score using patient and injury factors as covariates, and matched pair analysis compared differences in WLSS between patients with and without ADLC.

RESULTS

There were 597,840 patients included: 44,001 patients with an ADLC (7.36%) compared with 553,839 with no ADLC (92.64%). Patients with an ADLC underwent WLSS more often than those with no ADLC (7.68% vs. 2.48%, p < 0.001). In a 1:1 propensity-matched analysis, patients with ADLC were more likely to undergo WLSS (odds ratio [OR], 2.38' 95% confidence interval [CI], 2.22-2.55), although stronger predictors of WLSS included severity of injury (Injury Severity Score, 25+; OR, 23.84; 95% CI, 21.55-26.36), unplanned intensive care unit admissions (OR, 3.30; 95% CI, 2.89-3.75), and in-hospital cardiac arrests (OR, 4.97; 95% CI, 4.02-6.15).

CONCLUSION

A small proportion of the geriatric trauma population had ADLC on admission. While ADLC was predictive of WLSS, adverse events were more strongly associated with WLSS. To ensure patient-centered care and reduce futile interventions, surgeons should delineate goals of care early regardless of ADLC.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

Structural and functional characterization of three Type B and C chloramphenicol acetyltransferases from Vibrio species

Chloramphenicol acetyltransferases (CATs) were among the first antibiotic resistance enzymes identified and have long been studied as model enzymes for examining plasmid-mediated antibiotic resistance. These enzymes acetylate the antibiotic chloramphenicol, which renders it incapable of inhibiting bacterial protein synthesis. CATs can be classified into different types: Type A CATs are known to be important for antibiotic resistance to chloramphenicol and fusidic acid. Type B CATs are often called xenobiotic acetyltransferases and adopt a similar structural fold to streptogramin acetyltransferases, which are known to be critical for streptogramin antibiotic resistance. Type C CATs have recently been identified and can also acetylate chloramphenicol, but their roles in antibiotic resistance are largely unknown. Here, we structurally and kinetically characterized three Vibrio CAT proteins from a nonpathogenic species (Aliivibrio fisheri) and two important human pathogens (Vibrio cholerae and Vibrio vulnificus). We found all three proteins, including one in a superintegron (V. cholerae), acetylated chloramphenicol, but did not acetylate aminoglycosides or dalfopristin. We also determined the 3D crystal structures of these CATs alone and in complex with crystal violet and taurocholate. These compounds are known inhibitors of Type A CATs, but have not been explored in Type B and Type C CATs. Based on sequence, structure, and kinetic analysis, we concluded that the V. cholerae and V. vulnificus CATs belong to the Type B class and the A. fisheri CAT belongs to the Type C class. Ultimately, our results provide a framework for studying the evolution of antibiotic resistance gene acquisition and chloramphenicol acetylation in Vibrio and other species.

Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis

BACKGROUND

Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown.

METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program for community-dwelling adults who underwent 1 of 7 emergency general surgery procedures and were discharged home or to a skilled nursing facility from 2012 to 2016. Propensity score matching and multivariable regression analyses were performed to determine the relationship between discharge disposition and outcomes.

RESULTS

Overall, 140,922 patients met the inclusion criteria. The majority were discharged home (95.9%). After applying 1:1 propensity score matching, in comparison to patients discharged home, individuals discharged to a skilled nursing facility had a greater odds of respiratory (odds ratio 2.32; 95% confidence interval, 1.59-3.38) and septic complications (odds ratio 1.63, 95% confidence interval 1.12-2.36) after discharge. Furthermore, following surgery, individuals discharged to a skilled nursing facility had a greater odds of 30-day readmission (odds ratio 1.14; 95% confidence interval, 1.01-1.29), and death within 30 days of the procedure (odds ratio 2.07; 95% confidence interval, 1.65-2.61).

CONCLUSION

After accounting for patient severity and perioperative course, discharge to a skilled nursing facility is an independent risk factor for death, readmission, and postdischarge complications.

An overview of complications associated with open and percutaneous tracheostomy procedures

Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

Dynamic behavior of venous collapsibility and central venous pressure during standardized crystalloid bolus: A prospective, observational, pilot study

INTRODUCTION

Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical intensive care unit (SICU). Most surrogates for volume status, including central venous pressure (CVP) and pulmonary artery wedge pressure, require invasive lines associated with a number of potential complications. Sonographic assessment of the collapsibility of the inferior vena cava (IVC) has been described as a noninvasive method for determining volume status. The purpose of this study was to analyze the dynamic response in IVC collapsibility index (IVC-CI) to changes in CVP in SICU patients receiving fluid boluses for volume resuscitation.

MATERIALS AND METHODS

A prospective pilot study was conducted on a sample of SICU patients who met clinical indications for intravenous (IV) fluid bolus and who had preexisting central venous access. Boluses were standardized to crystalloid administration of either 500 mL over 30 min or 1,000 mL over 60 min, as clinically indicated. Concurrent measurements of venous CI (VCI) and CVP were conducted right before initiation of IV bolus (i.e. time 0) and then at 30 and 60 min (as applicable) after bolus initiation. Patient demographics, ventilatory parameters, and vital sign assessments were recorded, with descriptive outcomes reported due to the limited sample size.

RESULTS

Twenty patients received a total of 24 IV fluid boluses. There were five recorded 500 mL boluses given over 30 min and 19 recorded 1,000 mL boluses given over 60 min. Mean (median) CVP measured at 0, 30, and 60 minutes post-bolus were 6.04 ± 3.32 (6.5), 9.00 ± 3.41 (8.0), and 11.1 ± 3.91 (12.0) mmHg, respectively. Mean (median) IVC-CI values at 0, 30, and 60 min were 44.4 ± 25.2 (36.5), 26.5 ± 22.8 (15.6), and 25.2 ± 21.2 (14.8), respectively.

CONCLUSIONS

Observable changes in both VCI and CVP are apparent during an infusion of a standardized fluid bolus. Dynamic changes in VCI as a measurement of responsiveness to fluid bolus are inversely related to changes seen in CVP. Moreover, an IV bolus tends to produce an early response in VCI, while the CVP response is more gradual. Given the noninvasive nature of the measurement technique, VCI shows promise as a method of dynamically measuring patient response to fluid resuscitation. Further studies with larger sample sizes are warranted.

Effects of lenses with different power profiles on eye shape in chickens

PURPOSE

Defocus imposed to the periphery of the visual field can affect the development of foveal/central refractive errors. To make use of this observation, lenses can be designed to reduce myopia progression, but it is important to know which power profiles of the lenses are most effective. We have studied this question in chickens.

METHODS

Sixty male white leghorn chickens were used. From day 7 after hatching, they were treated for 5 days either with full field -7D or +7D lenses, with -7D lenses with a 4mm central hole, with hemi-field lenses of the same power, or with two different types of radial refractive gradient (RRG) lenses with increasing positive power from the center to the periphery, which were designed by Rodenstock GmbH, Munich, Germany. A macro file was written for "ImageJ" to trace and average the outlines of several excised eyes after treatment. Shapes of fellow control eyes and lens-treated eyes were compared in the horizontal and vertical meridians. Refractions were determined at -45°, 0°, and 45° over the horizontal visual field, at the beginning and at the end of experiments, using automated infrared photoretinoscopy.

RESULTS

(1) Eye length, as determined by the new automated eye shape tracing technique, was well correlated with A-scan ultrasound data. (2) The effects of previously tested lens designs were reproduced with the new tracing technique. Full field lenses were by far the most effective (-7D: external axial length +0.24mm with an increase in eye volume of about 6%, +7D: -0.08 mm, with a decrease in eye volume of about 2%). Hemi-field lenses and negative lenses with a 4mm central hole induced conspicuous local changes in eye shape. (3) The first type of RRG lenses with a plano zone of about 4mm (equivalent to about ± 12.52° in the visual field for a vertex distance of 5mm) had no apparent effect on central refractions but induced small hyperopic shifts in the periphery, more significant in the temporal retina (+1.70 ± 1.70 D, p<0.001, paired t-test to untreated fellow eyes). The second type of RRG lenses with a small plano zone of 2mm (equivalent to ± 6.34°) induced peripheral hyperopia but also changed the central refraction (temporal retina +1.50 ± 1.17D, p<0.001, central retina +0.77 ± 1.15 D, p<0.01, nasal retina +1.47±1.35D, p<0.001, paired t-test to untreated control eyes).

CONCLUSIONS

In the afoveate chick, RRG lenses have an effect on central refraction and eye growth only if the central plano zone is small (<4mm). For the second type of RRG lens with a central plano zone of about 2mm, inhibitory effects on eye growth were detected in both the center and periphery even though the optical power of the lenses in the periphery was low.

Effects of myopic spectacle correction and radial refractive gradient spectacles on peripheral refraction

The recent observation that central refractive development might be controlled by the refractive errors in the periphery, also in primates, revived the interest in the peripheral optics of the eye. We optimized an eccentric photorefractor to measure the peripheral refractive error in the vertical pupil meridian over the horizontal visual field (from -45 degrees to 45 degrees ), with and without myopic spectacle correction. Furthermore, a newly designed radial refractive gradient lens (RRG lens) that induces increasing myopia in all radial directions from the center was tested. We found that for the geometry of our measurement setup conventional spectacles induced significant relative hyperopia in the periphery, although its magnitude varied greatly among different spectacle designs and subjects. In contrast, the newly designed RRG lens induced relative peripheral myopia. These results are of interest to analyze the effect that different optical corrections might have on the emmetropization process.

Tomographic method for measurement of the gradient refractive index of the crystalline lens. II. The rotationally symmetrical lens

In the first part of this paper we presented a tomographic method to reconstruct the refractive index profile of spherically symmetrical lenses. Here we perform the generalization to lenses that are rotationally symmetrical around the optical axis, as is the ideal human lens. Analysis of the accuracy and versatility of this method is carried out by performing numerical simulations in which different magnitudes of experimental errors and two extreme case scenarios for the likely shape of the refractive index distribution of the human lens are considered. Finally, experimental results for a porcine lens are shown. Conceptually simple and computationally swift, this method could prove to be a valuable tool for the accurate retrieval of the gradient index of a broad spectrum of rotationally symmetrical crystalline lenses.

Tomographic method for measurement of the gradient refractive index of the crystalline lens. I. The spherical fish lens

We present an iterative tomographic algorithm to reconstruct refractive-index profiles for meridional planes of the lens of the spherical fish eye from measurements of deflection angles of refracted rays. Numerical simulations show that the algorithm allows accuracy up to the fourth decimal place, provided that the refractive index can be regarded as an analytical function of the radial coordinate and the experimental errors are neglected. An experimental demonstration is given by applying the algorithm to retrieve the refractive-index profile of a spherical fish lens. The method is conceptually simple and does not require matching of the index of the surrounding medium to that of the surface of the lens, and the related iterative algorithm rapidly converges.

Cortical neuronal ensembles driven by dorsal horn spinal neurones with spontaneous activity in the cat

Simultaneous recordings of cortical activity, recorded as the cortical local field potential (CLFP) in the contralateral posterior sigmoid gyrus, and the spinal activity, recorded as the cord dorsum potential (CDP) of the L6 lumbar segment, were made in the anaesthetized cat. The electrodes were positioned in somatosensory regions where the largest spontaneous negative CLFPs and CDPs were recorded. We found that spontaneous negative CLFPs were preceded by spontaneous negative CDPs with a mean latency of 14.4+/-3.5 ms. Amplitude of these spontaneous negative CLFPs was abolished after section of the dorsal columns and ipsilateral dorsolateral funiculus. It is concluded that the neurones of the primary somatosensory cortex can be driven by dorsal horn spinal neurones producing the spontaneous negative CDPs. This suggests very strongly that spontaneous neuronal activity in somatosensory regions of the brain is generated not only by ongoing activity of neurones located at supraspinal sites, but also by ongoing activity of spinal neurones.

Altered response to partial bladder outlet obstruction in mice lacking inducible nitric oxide synthase

INTRODUCTION

Following prolonged partial bladder outlet obstruction (BOO) in the mouse, cholinergic mediated detrusor contractility decreases. Previous work has demonstrated an increase in the inducible form of nitric oxide synthase (iNOS) at the mRNA and protein levels soon after obstruction. Since nitric oxide (NO), the product of the action of iNOS on molecular oxygen and l-arginine, produces vasodilation and decreases platelet aggregation, we believe it is an integral part of the initial detrusor response to obstruction. These experiments evaluated the detrusor response in mice incapable of producing iNOS.

MATERIALS AND METHODS

Wild type and knockout mice were partially obstructed for 1, 3, and 5 weeks. Physiologic evaluation consisted of cystometric analyses, and muscle strip studies in response to cholinergic and electrical stimulation. Strips were also relaxed with L-arginine, sodium nitroprusside, and 8-bromoguanosine 3' - 5' cyclic GMP, after precontraction.

RESULTS

After 5 weeks of obstruction, both wild type (WT) and knockout (KO) mouse bladders increased significantly in weight. WT bladders obstructed for 5 weeks had the greatest capacity (increase of 42%, p = 0.022), and a decreased contractile response to carbachol (decrease of 32% at 10-5 M, p = 0.018). No differences were noted at 1 and 3 weeks of obstruction. In contrast, KO mice had a significantly larger bladder capacity at 1 week of obstruction compared with WT, and had significantly lower responses to electrical stimulation than WT at the same time (p = 0.03). Additionally, after 5 weeks of obstruction, bladder capacity and contractility returned to baseline levels in KO mice, at a time when WT mice had significantly larger capacity and decreased contractility.

CONCLUSIONS

Bladder function following partial BOO in mice incapable of producing iNOS differed significantly from the normal response. Our data suggest that generation of iNOS soon after obstruction is necessary to prevent detrusor dysfunction at that time. Moreover, the enhanced function seen in KO bladders after longer periods of obstruction (5 weeks) in comparison to WT bladders suggests that reactive nitrogen species-induced protein nitrosylation may be involved in the loss of contractile function observed after more prolonged periods of obstruction.

Hypercortisolemia, hippocampal glucocorticoid receptors, and fast feedback

Glucocorticoids are critical for survival. The absence of glucocorticoids leads to the inability of the organism to cope with stress and subsequent death. However, diseases of glucocorticoid excess, such as Cushing's disease, make it clear that 'too much circulating glucocorticoids is also bad.' The need to control the circulating levels of glucocorticoids to prevent oversecretion leads to an elaborate set of checks and balances, in particular, the levels of glucocorticoid 'feedback' to the controlling elements to turn off glucocorticoid secretion and consequently maintain the homeostatic range of glucocorticoids. In order to accomplish these goals, multiple types of feedback exist which appear to use different intracellular mechanisms. In addition to multiple types of feedback, there are multiple sites of feedback including numerous limbic areas that influence the inhibition of the stress response. In this article, we will discuss the role of hippocampal limbic circuits in modulation of the stress response and the evidence which support the theory that changes in these circuits are associated with feedback abnormalities. We will review studies in humans which suggest that damage to the hippocampus can lead to changes in glucocorticoid feedback, and finally we will review the evidence that glucocorticoids themselves can lead to changes in hippocampal neurons resulting in feedback abnormalities.

Thoracic disc herniation, cord compression, and paraplegia caused by electrical injury: case report and review of the literature

The case of a patient with thoracic intervertebral disc prolapse, cord compression, and delayed paraplegia with recovery secondary to high-tension electrical current is presented. The unusual entry wound in the neck, makes this a rare event that to our knowledge has not been previously described in the literature. Magnetic resonance imaging allowed noninvasive and early diagnosis, and in the future probably will reveal the true incidence of cord compression in electrical injury victims.

Carbamazepine metabolism in humans: effect of concurrent anticonvulsant therapy

Free and total carbamazepine (CBZ) and carbamazepine-epoxide (CBZ-EP) plasma levels were obtained on 113 patients with epilepsy (18-61 years old) controlled on either monotherapy or coadministration with either phenobarbital (PB), phenytoin (PHT), valproic acid (VPA), or all three. A subset of patients were administered tetradeuterium labeled CBZ to evaluate the effects of autoinduction and coadministration of VPA on the kinetics of CBZ and its metabolite CBZ-EP. Polytherapy had variable effect on free and total CBZ plasma levels compared to monotherapy. Coadministered PHT (co-PHT), or all three anticonvulsants together (PHT, PB, and VPA: co-AEDs) decreased free and total CBZ plasma levels. No change was noted for coadministered VPA (co-VPA). Compared to monotherapy the free and total CBZ-EP levels increased with co-VPA, less with coadministered PB (co-PB), and no change with co-PHT or co-AEDs. Protein binding of CBZ and CBZ-EP was not affected by any antiepileptic drugs studied. The free and total CBZ-EP/CBZ ratio was tripled with co-VPA or co-AED's, and doubled with co-PHT or co-PB. Isotope labeling did not demonstrate any differences in half-life (t1/2), plasma clearance (Cl), or volume of distribution (Vd). Compared to naive controls, monotherapy and co-VPA decreased CBZ t1/2 by 50%, and more than doubled the CBZ Cl without a significant change in the Vd. Autoinduction is one explanation for these changes with chronic CBZ therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsant drugs determined by EMIT in spiked brain samples: a correlation with HPLC values

Phenobarbital (PB), diphenylhydantoin (PHT) and carbamazepine (CBZ) levels were determined in spiked rat brain homogenates by means of the EMIT assay, and these were compared with results obtained by high-pressure liquid chromatography (HPLC). The extraction procedure of the three drugs was identical for both methods, with minor modifications for EMIT (no addition of internal standard; reconstitution with the buffer used in routine plasma level analysis). Correlation coefficients between the data obtained by EMIT and HPLC were extremely good (PB, 0.90-0.98; PHT, 0.92-0.98; CBZ, 0.93-0.99). The results indicate that the EMIT system can detect PB, PHT, and CBZ in brain tissue with good accuracy, although HPLC remains the most accurate and proven method available for research purposes.

Polypeptide synthesis catalyzed by p-hydroxymercuribenzoate-modified ribosomes

The stimulation of poly(U)-directed polyphenylalanine synthesis produced by modification of Escherichia coli ribosomes with p-hydroxymercuribenzoate, at low molar ratios of reagent to ribosomes, is due to an increase in the average chain length of polyphenylalanine synthesized, and not to the activation of inactive ribosomes. At a higher molar ratio of p-hydroxymercuribenzoate to ribosomes, which produces no overall change in activity, approximately 50% of the active ribosomes present in the untreated preparation have been completely inactivated, and the remaining active ones, like the ribosomes of the stimulated preparation, synthesize polyphenylalanine at an increased rate as compared with the untreated ribosomes.

Structure of the yeast ribosomes. Proteins associated with the rRNA

Polyamines have been shown to bind to doubled stranded regions of rRNA [3]. Therefore, ribosomal proteins that can be cross linked to these molecules in the ribosomes structure must be bound to or located in the vicinity of the RNA. This technique is the first to yield results on the proteins associated with the rRNA in the eukaryotic ribosome where the lack of purified ribosomal proteins does not allow the use of direct binding studies as in bacterial systems. Proteins S7, S10, S13, S21, S22 and S27 in the small subunit and L2/3, L5, L10/12, L19/20, L22, L23, L36/37, L42 and L43' in the large subunit are labelled when cross linked to [14C]spermidine using 1,5-difluoro 2,4-dinitrobenzene and are good candidates to be RNA-binding proteins in ribosomes from Saccharomyces cerevisiae.

Inhibition, by selected antibiotics, of protein synthesis in cells growing in tissue cultures

A large number of compounds including actinobolin, adrenochrome, amicetin, anisomycin, aurintricarboxylic acid, blasticidin S, chartreusin, chlortetracycline, cycloheximide, doxycycline, edeine A1, edeine complex, emetine, fusidic acid, gougerotin, GppCH2p, oxytetracycline, pactamycin, polydextran sulphate, puromycin, pyrocatechol violet, sparsomycin and tubulosine have been tested for inhibitory effects on protein synthesis in cultured cells from both mouse fibroblasts (3T6 cells) and chick embryo fibroblasts (CEF). Essentially, similar results were obtained with both cell types with the most effective inhibitors being pactamycin, emetine, tubulosine, anisomycin and cycloheximide and with no significant inhibitory activity being detected with edeine complex, edeine A1, GppCH2p, polydextran sulphate, aurintricarboxylic acid, pyrocatechol violet and adrenochrome. The concentration of pactamycin required to produce 50% inhibition of protein synthesis approximated 5 X 10(-9) M, but for most of the inhibitors it ranged from 5 X 10(-6) M to 5 X 10(4) M. The molecular basis underlying these differences may be related, in addition to their intrinsic inhibitory power, to differences in permeability of the cells towards the various drugs tested. Alternatively, active accumulation of the drugs by the cells may be the variable parameter.

Proteins associated with rRNA in the Escherichia coli ribosome

Ribosomal proteins located near the rRNA have been identified by cross linking to [14C]spermine with 1,5-difluoro-2,4-dinitrobenzene. The polyamine binds to double-stranded rRNA; those proteins showing radioactivity covalently bound after treatment with the bifunctional reagent should therefore be located in the vicinity of these regions of rRNA. Six proteins from the small subunit, S4, S5, S9, S18, S19 and S20 and ten proteins from the large subunit L2, L6, L13, L14, L16, L17, L18, L19, L22 and L27 preferentially take up the label. The results obtained with three proteins from the large subunit, L6, L16 and L27, show a high degree of variability that could reflect differences of conformation in the subunit population. Several proteins were drastically modified by the cross-linking agent but were not detected in the two-dimensional gel electrophoresis (e.g., S1, S11, S21, L7, L8 and L12) and therefore could not be studied.

Binding of [3H]narciclasine to eukaryotic ribosomes. A study on a structure-activity relationship

[3H]Narciclasine is a specific inhibitor of peptide bond formation on eukaryotic ribosomes and binds to 60-S ribosomal subunits. Binding of [3H]-narciclasine to yeast ribosomes is inhibited by many other inhibitors of peptide bond formation including anisomycin, several sequiterpene antibiotics (trichodermin, trichothecin, fusarenon X and verrucarin A) several Cephalotaxus alkaloids (harringtonine, homoharringtonine and isoharringtonine), several Amaryllidaceae alkaloids (pretazettine, haemanthamine, lycorine, pseudolycorine and dihydrolycorine) and the narciclasine derivatives trans-dihydronarciclasine, trans-dihydronarciclasine acetonide and isonarciclasine. Binding is also inhibited, although to a very small extent, by methylnarciclasine and cisdihydronarciclasine. In contrast, no inhibition of [3H]narciclasine binding was observed in the presence of certain other inhibitors of peptide bond formation including blasticidin S, gougerotin, sparsomycin and puromycin.

Competition between trichodermin and several other sesquiterpene antibiotics for binding to their receptor site(s) on eukaryotic ribosomes

1. Of the five sesquiterpene antibiotics tested and found to inhibit protein synthesis in yeast spheroplasts, trichothecin, trichodermol or trichodermin stabilized polyribosomes whereas, in contrast, verrucarin A or T-2 toxin induced 'run off' of polyribosomes with a corresponding increase in 80S monoribosomes. The effect of fusarenon X on the system could not be determined as the drug failed to enter the cells. 2. [acetyl-14C]Trichodermin bound to yeast polyribosomes with a dissociation constant of 2.10 muM and to yeast 'run off' ribosomes with a dissociation constant of 0.72 muM. 3. Trichothecin, trichodermol, fusarenon X, T-2 toxin and verrucarin A competed with [acetyl-14C]trichodermin for binding to its receptor site on 'run off' ribosomes. The observed competition was quantitatively similar for all drugs tested. In contrast, the five drugs competed to different extents with trichodermin for binding to its receptor site on polyribosomes. Thus trichothecin competed with relative efficiency, whereas verrucarin A competed poorly, and the other drugs occupied intermediate positions between these two extremes. 4. Studies were also carried out with yeast 'run off' ribosomes prepared from both a wild-type strain and a strain resistant to trichodermin. Competition experiments between verrucarin A and [3H]anisomycin indicated that verrucarin A bound to 'run off' ribosomes from the mutant strain less efficiently than to those from the wild-type.

Activities of protein-deficient particles derived from 50-S ribosomal subunits by NH4Cl/ethanol treatment

Protein-deficient ribosomal particles obtained by treatment of 50-S subunits from Escherichia coli ribosomes with 1 M NH4Cl and 50% ethanol contain less than 3% of proteins L7 and L12 and about 7% of proteins L10 and L11. Proteins L1, L5, L8/9 and L25 are also released during the treatment but in amounts accounting for less than 40%. The particles are able to form peptide bonds in different systems, such as 'fragment reaction', puromycin reaction and formation of dipeptides. They also bind N-acetylphenylalanyl-tRNA and phenylalanyl-tRNA non-enzymically but are unable to support any of the elongation-factor-dependent reactions tested. However, when methanol is present, they display up to 20% of the control EF-G-dependent GTP activities such as GTP hydrolysis and formation of the ternary complex EF-G-GuoPP(CH2)P-ribosome. The first activity is totally sensitive to the antibiotic thiostrepton while the formation of the ternary complex is unaffected by the drug. When measured by equilibrium dialysis the core particles are shown to be able to bind radioactive thiostrepton. The results show that protein L11 is not an absolute requirement either for peptidyl transferase activity or for the binding of thiostrepton, although in the last case the protein strongly enhances the ribosome affinity for the antibiotic.

Initiation of the polypeptide chain by reticulocyte cell-free systems. Survey of different inhibitors of translation

In order to elucidate the mechanism of action of inhibitors that block the initiation of protein synthesis in mammalian systems, we have studied the following steps: (a) formation of the ternary complex Met-tRNAr-IF-E2-GTP, (b) binding of the initiator Met-tRNAf to the 40-S ribosomal subunit in the presence of initiation factors and dependent or not on the addition of mRNA, (c) formation of the initiation complex with 80-S ribosomes and (d) formation of the first peptide bond. Adrenochrome, aurintricarboxylic acid, polydextran sulphate, pyrochatechol violet and showdomycin block the formation of the ternary complex Met-tRNAf-IF-E2-GTP. Edeine A1, aurintricarboxylic acid and polydextran sulphate block the binding of the mRNA to the 40-S ribosomal subunit. Pactamycin induces the formation of stable smaller initiation complexes which are unable to go through the subsequent steps of initiation. Stimulation of the binding of the initiator Met-tRNAf to the 80-S ribosome in the presence of initiation factors is observed with sparsomycin and antibiotics of the sesquiterpene family (verrucarin A, trichodermin and trichothecin). However, these antibiotics block the reaction of the bound Met-tRNAf with puromycin. Narciclasine has no effect on the binding of the initiator to the ribosome but strongly blocks its reaction with puromycin. We have developed a simple technique to detect the Met-tRNAf-40-S-subunit-poly(A, G, U) initiation complexes by chromatography on Sepharose 6B columns. The requirements for the formation of such complexes measured by this technique and its comparison with the sucrose gradient centrifugation method are described.

Structure and function of rat-liver ribosomes. Modification by 2-methoxy-5-nitrotropone treatment

Rat liver ribosomes and 60-S ribosome subunits were treated with the primary-amino-group-specific reagent 2-methoxy-5-nitrotropone. Important differences in the sensitivity of several ribosomal activities to inactivation by the reagent were observed. While elongation-factor-dependent activities are totally abolished in the treated particles, peptidyl transferase activity is either unaffected in 60-S ribosomal subunits or even strongly stimulated in 80-S ribosomes. Analysis of the ribosomal proteins modified by nitrotropone made it possible to draw some conclusions on their accessibility in the ribosomal structure and to relate some proteins with their involvement in the ribosome active centers. Thus, proteins L3, L13, L15 and L23 seem to be in a rather well protected position while proteins L10, L35, L37, X1 and X2 are totally exposed to the reagent. The protein accessibility also depends on the ribosome conformation, proteins L14 and L17, for instance, being sensitive in 80-S ribosomes and protected in 60-S subunits. In relation to the implication of proteins in functional centers, the data presented here together with other data obtained from protein-deficient core particles seem to indicate a possible role of proteins L21 and/or L26 in the peptidyl transferase center.

Polypeptide-chain elongation promoted by guanyl-5'-yl imidodiphosphate

In a purified system from Escherichia coli containing ribosomes complexed with poly(uridylic acid) and N-acetyl-phenylalanyl-tRNA, the nonhydrolyzable analog of GTP, guanyl-5'-yl imidodiphosphate (Guo-5'-P2-NH-P), promotes polypeptide synthesis at a rate several times slower than GTP. The activity is completely dependent on elongation factors EF-T (i.e, EF-Ts + EF-Tu) and EF-G. Examination of individual steps of the elongation cycle in partial reactions shows that Guo-5'-P2-NH-P is as efficient as GTP in promoting the EF-T-dependent binding of phenylalanyl-tRNA to the ribosomal A site. In contrast, Guo-5'-P2-NH-P promotes the translocation-dependent binding of phenylalanyl-tRNA to a ribosome complexed with A-site-bound N-acetyl-phenylalanyl-tRNA much more slowly than GTP. This slow rate of binding is due to the presence of EF-G on the ribosome, and not to sluggish translocation, since (a) the rate remains slow even after translocation of N-acetylphenylalanyl-tRNA is completed, (b) it is greatly speeded up by removal of EF-G from the reaction mixture (after translocation has occurred), and (c) it is slowed down again by readdition of the factor. Moreover, with post-translocated ribosomes and in the absence of EF-G, formation of dipeptide subsequent to the EF-T-dependent binding of phenylalanyl-tRNA is much slower when binding of this substrate has been promoted by Guo-5'-P2-NH-P than it is when promoted by GTP. The results suggest that, during polymerization with Guo-5'-P2-NH-P, EF-G and EF-Tu are slowly released from the ribosome and, consequently, the steps of the elongation cycle subsequent to translocation and aminoacyl-tRNA binding (aminoacyl-tRNA binding and peptide bond formation, respectively) are delayed. Thus, durong elongation cycle, GTP hydrolysis is probably essential for fast release of the factors from the ribosome.

Activities of nucleoprotein particles derived from rat liver ribosome

80-S ribosomes and 60-S subunits from rat liver were treated at increasing KC1 concentrations giving protein-deficient ribosomal particles whose components were analyzed and their activity tested. Most of the activities assayed stand treatment up to KC1 concentrations of around 0.6 M; peptidyl transferase, measured by the fragment reaction, however was 50% inhibited by 0.5 M KC1 in 60-S subunits but not in 80-S ribosomes. Three proteins, L21, L26 and L31, might be implicated in this loss of activity. 60-S subunits forming part of the 80 S ribosome are more resistant to the salt treatment and the pattern of proteins released by the treatment differs from the one obtained from free 60-S subunits, implying perhaps a change of conformation of this subunit upon association to form 80-S couples. According to their resistance to release by KC1 the proteins of the large sub-unit can be divided into three groups: (1) easily removed, including proteins: L1, L11, L17 and L25 in 80-s subunits and in addition, L5, L8, L9, L13, L20, L22, L26, L29, L31 and L32/33 in 60-S subunits; (2) proteins resistant to release by high salt concentrations in 80-S ribosomes as well as in 60-S subunits, namely proteins L3, L14, L27, L36, L40, L41, X1 and X2; (3) the rest of the proteins which are released in a more or less continuous way throughout the treatment. 5 S RNA is not released by KC1 treatment at the concentrations used. The binding sites for the antibiotics trichodermin and anisomycin are affected in a different way by the salt treatment, indicating that they are structurally different.

Binding of aminoacyl-tRNA to rat liver ribosomal proteins

Rat liver ribosome treatment with ethanol and 1 M NH4Cl releases some 31-33 ribosomal proteins. This split protein fraction binds Phe-tRNA, Ac-Phe-tRNA, Met-tRNAM and f-Met-tRNAF in the absence of K+ and Mg++ ions. When the split protein fraction is passed through Sephadex G-100 only six proteins are retained in the column: S10, S14, S15, S19, L35, and L36. The aminoacyl-tRNA binding activity of this protein fraction retained in the Sephadex G-100 column is similar to that of the total split protein fraction, suggesting that the above six proteins, or only some of them, are involved in the binding reaction.

A form of elongation factor G insensitive to N-ethyl-maleimide

Treatment of elongation factor G (EF-G) with the thiol reagent N-ethylmaleimide only partially inhibits (10 to 70%) the activity of the factor in (a) guanosine nucleotide-EF-G-ribosome complex formation, (b) uncoupled ribosome-dependent GTP hydrolysis, and (c) polypeptide synthesis. Moreover, a similar treatment of the factor with N-[3H]ethylmaleimide does not lead to 3H-label being associated with a GDP-EF-G-ribosome-fusidic acid complex. Thus, the results indicate the presence in EF-G preparations of a form of the factor that does not react with N-ethylmaleimide.

Stoichiometry of polypeptide chain elongation

To quantitate the amount of GTP hydrolyzed during polypeptide chain elongation, an in vitro system containing purified endogenous Escherichia coli polysomes has been developed. The polysomes are washed with 1 M NH4Cl to eliminate endogenous GTPase activities and are depleted of subunits and free ribosomes to diminish the uncoupled elongation factor G-dependent GTP hydrolysis. These polysomes, supplemented with elongation factors, aminoacyl-tRNA, and low concentrations of GTP, incorporate amino acids in their nascent peptide chains. After correcting for a background of uncoupled GTP hydrolysis, it has been found that the incorporation of each molecule of amino acid is associated with the hydrolysis of 2 molecules of GTP.

Inhibitors of protein synthesis in eukarytic cells. Comparative effects of some amaryllidaceae alkaloids

The effects of eighteen compounds obtained from bulbs of the Amaryllidaceae family were tested on (a) animal cell growth, (b) DNA, RNA and protein synthesis by intact cells and (c) protein synthesis in cell-free systems. Dihydrolycorine, haemanthamine, lycorine, narciclasine, pretazettine and pseudolycorine halted HeLa cell growth at 10(-1) mM or lower concentrations. These compounds at their growth inhibitory concentrations block protein synthesis in ascites cells and stabilize HeLa cell polysomes in vivo. Endomyocarditis virus RNA-directed cell-free polypeptide synthesis by an ascites S-30 extract and acetyl-[14C]leucyl-puromycin formation by ascites ribosomes are also inhibited by the six compounds indicated above. It is therefore concluded that they halt protein synthesis in eukaryotic cells by inhibiting the peptide bone formation step.