Anti-CELA1 antibody KF4 prevents emphysema by inhibiting stretch-mediated remodeling

There are no therapies to prevent emphysema progression. Chymotrypsin-like elastase 1 (CELA1) is a serine protease that binds and cleaves lung elastin in a stretch-dependent manner and is required for emphysema in a murine antisense oligonucleotide model of α-1 antitrypsin (AAT) deficiency. This study tested whether CELA1 is important in strain-mediated lung matrix destruction in non-AAT-deficient emphysema and the efficacy of CELA1 neutralization. Airspace simplification was quantified after administration of tracheal porcine pancreatic elastase (PPE), after 8 months of cigarette smoke (CS) exposure, and in aging. In all 3 models, Cela1-/- mice had less emphysema and preserved lung elastin despite increased lung immune cells. A CELA1-neutralizing antibody was developed (KF4), and it inhibited stretch-inducible lung elastase in ex vivo mouse and human lung and immunoprecipitated CELA1 from human lung. In mice, systemically administered KF4 penetrated lung tissue in a dose-dependent manner and 5 mg/kg weekly prevented emphysema in the PPE model with both pre- and postinjury initiation and in the CS model. KF4 did not increase lung immune cells. CELA1-mediated lung matrix remodeling in response to strain is an important contributor to postnatal airspace simplification, and we believe that KF4 could be developed as a lung matrix-stabilizing therapy in emphysema.

Opioid Prescribing Behaviors Among Surgical Intensive Care Unit Attending Physicians

BACKGROUND

More than 5 million Americans misuse opioids. Six percent of patients who receive opioids for acute pain progress to chronic use; this increases with higher doses and longer prescriptions. Prescribing variation exists within trauma centers and after emergency surgery but has not been demonstrated among intensivists.

METHODS

Milligram morphine equivalents (MME) per patient-ICU-day provided by eleven surgical intensivists were analyzed. The patients were separated into 2 groups based on their percentage of time intubated in the surgical ICU. Both study groups were compared using demographics and comorbidity scores. The attendings were divided into high- and low-prescribing groups based on their MME/pt-ICU-day for intubated patients, and bivariate statistical analyses were performed. A similar analysis compared surgery vs anesthesia intensivists.

RESULTS

The analysis included 257 patients in the "long-vent group" (LVG) and 668 patients in the "short-vent group" (SVG). The average MME/pt-ICU-day for the LVG was 222. Despite no significant differences in age, sex, or Elixhauser Comorbidity Index, there was a 45% difference between the high- and low-prescribing physicians in the LVG (253.7 vs 175.4 MME/pt-ICU-day; P = .008). This difference was not observed for patients in the SVG (74.3 vs 93.1 MME/pt-ICU-day; P = .141) nor based on intensivist specialty (LVG: 217.9 vs 209.5 MME/pt-ICU-day; P = .8) (SVG: 79.0 vs 93.3 MME/pt-ICU-day; P = .288).

Consequences of Delayed Dental Extraction in Lesch-Nyhan Disease

Patients with Lesch-Nyhan disease (LND) often engage in self-injurious biting. This problem requires difficult management choices, sometimes including removal of the teeth. Although many health care professionals are reluctant to remove teeth in a child because of the permanent negative cosmetic consequences of the edentulous state, disfigurement of the face and tongue from self-biting can be worse. We analyzed the records of 5 LND patients who used mouth guards to spare the teeth. Success was variable, and dental extraction ultimately was required in 4 cases. We also reviewed previously published cases on the use of dental devices to spare teeth in LND. Various devices have been recommended, but failure rates are high, and tooth extraction often is still needed. Although dental extraction is not required in all cases, it should not be delayed when biting is severe.

How long does it take to diagnose cervical dystonia?

BACKGROUND

Dystonia is a neurological disorder characterized by involuntary twisting movements and postures. The neck is among the most commonly affected regions, and diagnosis can be made readily through a simple clinical evaluation. The goal of this study was to explore how long it took patients to receive a diagnosis of cervical dystonia after symptom onset.

METHODS

A structured questionnaire was administered at outpatient clinics of a tertiary care academic medical center to 146 consecutively evaluated patients. The questionnaire addressed the length of time from symptom onset to diagnosis, the numbers and types of providers seen before reaching a diagnosis, and treatments attempted prior to receiving botulinum toxin.

RESULTS

A total of 108 patients saw a mean of 3.5 providers over a mean period of 44 months from symptom onset to diagnosis. For patients with symptom onset in the last decade only, patients saw a mean of 3.0 providers over a mean of 14 months.

CONCLUSIONS

Although cervical dystonia is the most common form of dystonia with clinical features readily identifiable by a simple history and examination, patients typically see multiple providers over more than a year before reaching a diagnosis and receiving optimal therapy. Improved awareness of the clinical features will enable patients to obtain appropriate therapy more rapidly.

Comparison of a computerized physical activity recall with a triaxial motion sensor in middle-school youth

PURPOSE

To develop and test a computerized activity recall (CAR) for capturing activity and energy expenditure (EE) in youth and to further our understanding of the use of the three-dimensional accelerometer (Tritrac) for studying activity and EE.

METHODS

Forty-five students (25 girls and 20 boys) in grade 6-8, completed 5 consecutive days of the CAR and were randomly assigned to wear the Tritrac during 1 day in which they also completed the CAR. Twenty-two subjects also repeated 5 d of the CAR and 1 d of Tritrac monitoring 1-2 wk later.

RESULTS

The correlation between CAR and Tritrac for total EE was significant (r = 0.510, P = 0.0003). However, the total EE computed from the Tritrac was significantly greater than the CAR (1941 +/- 273 kcal vs 1576 +/- 343 kcal (8.14 +/- 1.14 vs 6.60 +/- 1.44 MJ); P < 0.001). The EE of activities was similar for the Tritrac and CAR, approximately 670 kcal (2.80 MJ), suggesting that the difference between the two methods was their estimates of resting EE. Comparison of the CAR and Tritrac for classifying active and inactive subjects indicated that both methods similarly classified 35 of the 45 subjects or 78% (P = 0.0038). Although significant, the Kappa statistic (kappa = 0.398) indicated a low-level of agreement between methods. The Tritrac indicated 50.4 +/- 29.2 min.d-1 of activities of > or = 3 METs, whereas the CAR indicated 76.7 +/- 71.9 min.d-1 (P = 0.02). The week 1 vs 2 test-retest correlation was 0.0485 (P = 0.022) for the Tritrac and 0.820 (P = 0.0001) for the CAR.

CONCLUSIONS

It appears that both methods have acceptable reliability. However, the validity of each method to measure total and activity EE remains unclear, as the Tritrac appears to overestimate resting energy expenditure, whereas the CAR overestimates total minutes of activity.

Effects of electromagnetic fields on molecules and cells

Evidence suggests that cell processes can be influenced by weak electromagnetic fields (EMFs). EMFs appear to represent a global interference or stress to which a cell can adapt without catastrophic consequences. There may be exceptions to this observation, however, such as the putative role of EMFs as promoters in the presence of a primary tumor initiator. The nature of the response suggests that the cell is viewing EMFs as it would another subtle environmental change. The age and state of the cell can profoundly affect the EMF bioresponse. There is no evidence that direct posttranscription effects occur as a result of EMF exposure. Although transcription alterations occur, no apparent disruption in routine physiological processes such as growth and division is immediately evident. What is usually observed is a transient perturbation followed by an adjustment by the normal homeostatic machinery of the cells. DNA does not appear to be significantly altered by EMF. If EMF exposure is associated with an increased risk of cancer, the paucity of genotoxic effects would support the suggestion that the fields act in tumor promotion rather than initiation. The site(s) and mechanisms of interaction remain to be elaborated. Although there are numerous studies and hypotheses that suggest the membrane represents the primary site of interaction, there are also several different studies showing that in vitro systems, including cell-free systems, are responsive to EMFs. The debate about potential hazards or therapeutic value of weak electromagnetic fields will continue until the mechanism of interaction has been clarified.

Magnetic fields after translation in Escherichia coli

Quantitative two-dimensional gel electrophoresis of proteins in E. coli exposed for 60 min to weak, pulsed magnetic fields (1.5 mT peak) show that numerous proteins are both increased and decreased by a factor of 2 or more. An increase in the levels of two proteins, the a subunit of DNA-dependent RNA polymerase and NusA, was confirmed by Western blot analysis.

Altered protein synthesis in a cell-free system exposed to a sinusoidal magnetic field

This report describes a new approach for examining weak extremely low frequency (ELF) electric and magnetic field interactions with living systems that exploits a cell-free transcription/translation system derived from Escherichia coli. Using two-dimensional polyacrylamide gel electrophoresis we previously had determined that the level of the alpha subunit of RNA polymerase in intact E. coli was elevated by exposure to weak ELF magnetic fields. In this paper, plasmids containing the alpha, or both the beta,beta' subunits of the RNA polymerase from E. coli were placed into a cell-free expression system. When this transcription/translation system was exposed to a 72-Hz sinusoidal magnetic field in the range 0.07 to 1.1 mT (rms) for periods of 5 min to 1 h, expression was enhanced. Weaker fields must be applied longer to produce an effect. For 10 min of field exposure, the threshold for an effect is 0.1 mT. These experiments demonstrate that an intact membrane is not an absolute requirement for transducing magnetic bio-effects.

Periodicity of amide proton exchange rates in a coiled-coil leucine zipper peptide

The two-stranded coiled-coil motif, which includes leucine zippers, is a simple protein structure that is well suited for studies of helix-helix interactions. The interaction between helices in a coiled coil involves packing of "knobs" into "holes", as predicted by Crick in 1953 and confirmed recently by X-ray crystallography for the GCN4 leucine zipper [O'Shea, E.K., Klemm, J.D., Kim, P.S., & Alber, T. (1991) Science 254, 539]. A striking periodicity, extending over six helical turns, is observed in the rates of hydrogen-deuterium exchange for amide protons in a peptide corresponding to the leucine zipper of GCN4. Protons at the hydrophobic interface show the most protection from exchange. The NMR chemical shifts of amide protons in the helices also show a pronounced periodicity which predicts a short H-bond followed by a long H-bond every seven residues. This variation was anticipated in 1953 by Pauling and is sufficient to give rise to a local left-handed superhelical twist characteristic of coiled coils. The amide protons that lie at the base of the "hole" in the "knobs-into-holes" packing show slow amide proton exchange rates and are predicted to have short H-bond lengths. These results suggest that tertiary interactions can lead to highly localized, but substantial, differences in stability and dynamics within a secondary structure element and emphasize the dominant nature of packing interactions in determining protein structure.

An increase in the negative surface charge of U937 cells exposed to a pulsed magnetic field

Pulsed magnetic fields have been used to enhance healing of bone fractures and purportedly of lesions in soft tissue. However, their mechanism of action is poorly understood. We report changes in the plasma membrane of a nonadherent mammalian cell line, U937, which was exposed to a 25-pps magnetic field for 48 hours. Aqueous polymer two-phase partition studies showed that magnetic-field-exposed cells exhibited an increased negative surface charge but membrane hydrophobicity was not significantly altered. The observed increase in membrane electronegativity of exposed cells did not reflect a significant change in growth rate.

Folding of a peptide corresponding to the alpha-helix in bovine pancreatic trypsin inhibitor

A short peptide corresponding to the alpha-helical region of BPTI shows partial folding in aqueous solution (pH 7) as judged by circular dichroism (CD). Folding is temperature and denaturant sensitive, and the peptide is monomeric. The difference CD spectrum, obtained from spectra at two temperatures, indicates that the peptide folds as an alpha-helix. Difference CD spectroscopy provides a sensitive assay for helix formation in peptides exhibiting small amounts of structure. Helix stability in this peptide shows a marked pH dependence which is consistent with stabilizing charged side-chain interactions with the helix dipole and/or salt bridge formation.

Low frequency electric and magnetic fields have different effects on the cell surface

There is a considerable controversy over the nature of weak electromagnetic-field effects in living organisms. Part of the controversy can be traced to a lack of understanding of whether electric or magnetic fields are involved in producing bioeffects. We find that both 60 Hz electric and magnetic fields alter the cell surface of Physarum polycephalum. Exposure to electric fields increases the negative charge on the cell surface while magnetic-field exposure decreases the hydrophobic character of the surface. These effects appear to be additive and independent of the waveform of the applied fields.

Pulsed magnetic fields alter the cell surface

Pulsed magnetic fields (PMFS) are routinely used in the medical community to facilitate bone repair in clinical cases of non-union or pseudarthoses [(1984) Orth. Clin. No. Am. 15, 61-87]. Although this therapeutic regimen appears to be reasonably effective, the mechanism of action between specific PMFs and the target tissue remains unknown. Adding urgency to the need to understand the mechanism are a wide number of reports that have appeared which demonstrate that PMFs similar to those in clinical use can alter many basic physiological functions. We report that a 24 h exposure to PMFs alters the cell surface of Physarum polycephalum amoebae. Further, using the technique of aqueous two-phase partitioning, we present evidence for individual magnetic and electric field, cell surface effects.

Differences in the surface properties of the mating types of Physarum polycephalum

In the slime mold Physarum polycephalum, formation of a diploid plasmodium occurs when compatible haploid amoebae fuse. To study cell surface changes associated with the fusion process, a non-destructive method known as aqueous, two-phase partitioning was employed. Using a two-phase system of dextran and polyethylene glycol, we observed that the two mating types (RSD4 and MA185) have different partition coefficients and hence different surface properties. Based on their partitioning behavior, MA185 cells appear to have a more hydrophobic surface than RSD4 amoeba. The partition coefficient of both cell types decreased with time. If amoebae were maintained in culture until they encysted, differences in their surface were not detectable.

Effects of sinusoidal 60-Hz electric and magnetic fields on ATP and oxygen levels in the slime mold, Physarum polycephalum

We have previously reported that exposing the vegetative plasmodia stage of Physarum polycephalum to either individual or simultaneously applied electric and magnetic fields (45-75 Hz, 0.14-2.0 G, and 0.035-0.7 V/m) lengthens their mitotic cycle, depresses their rate of reversible shuttle streaming, and lowers their respiration rate. In this article we report the effects of simultaneously applied electromagnetic fields (60 Hz, 1.0 G, 1.0 V/m), electric fields only (60 Hz, 1.0 V/m), magnetic fields only (60 Hz, 1.0 G) on the haploid amoeba of Physarum exposed for 120-180 days. Statistically significant depressions (about 8-11%) in ATP levels were observed with all field conditions; however, respiration was significantly decreased only when amoebae were subjected to either combined fields or electric fields alone. Magnetic fields alone failed to induce a significant decrease in respiration.

Magnetic field effects on mitotic cycle length in Physarum

Large plasmodia of Physarum polycephalum were formed from mixtures of micro-plasmodia grown in shaker cultures exposed to 2.0 G (rms), 75 Hz magnetic fields and non-exposed, control cultures. The exposed cultures had been grown continuously in the field and displayed a longer mitotic cycle than the controls. Mixed cultures display synchronous mitosis and a cycle length intermediate to the cycle lengths of exposed and control cultures. The cycle length of mixed cultures varied with the proportions of the mixture in a non-linear manner. The results are discussed in terms of several models.

Metabolism during differentiation in the slime mold Physarum polycephalum

The introduction of growing microplasmodia into a balanced salt solution induces the formation of hard-walled units (spherules) within 24 h to 36 h. The respiration rate was followed throughout differentiation and was found to decrease from a starting value of 62 μl O2/mg protein per hour to 17.5 μl O2/mg protein per hour after 40 h in the salt solution. The use of exogenous glucose and protein catabolism was also studied, and the results indicate that proteins are a major energy source during spherulation. On the basis of the data from this study and the results of other investigators, the process of spherulation has been divided into three developmental periods.

Axenic culture of myxamoebae of the myxomycete Physarum polycephalum

Myxamoebae of the acellular slime mold Physarum polycephalum have been cultured axenically in a soluble medium. The growth medium contains bovine serum albumin, embryo extracts, liver infusion broth, peptone, and glucose. Cell densities ranging from 3 x 10(6) to 5 x 10(6) cells/ml have been obtained with this medium. To date, myxamoebae have been serially transferred more than 100 times without deleterious effect.

Polyphosphate and other phosphorus compounds during growth and differentiation of Physarum polycephalum

Polyphosphate has been isolated from the Plasmodium of the myxomycete Physarum polycephalum, and its metabolic role during growth and spherulation (differentiation) has been studied. The results of this investigation indicate that Physarum contains two types of polyphosphate distinguished by their solubilities in acid. Comparisons of both acid-soluble and acid-insoluble polyphosphate revealed the latter to be the more metabolically active form. The variability found in the amount of acid-insoluble polyphosphate appeared to be correlated with the metabolic states of the Plasmodium. In addition, changes in the amounts of other phosphorus compounds were also determined during growth and spherulation.

Some principles of treatment in children with cerebral palsy and mental retardation

Cerebral Palsy is a comparatively common condition in this community. It presents the patient, parents and medical team with a lifelong problem.