High-Demand Spinal Deformity With Multi-Rod Constructs and Porous Fusion/Fixation Implants: A Finite Element Study

STUDY DESIGN

Basic science (finite element analysis).

OBJECTIVES

Pedicle subtraction osteotomy (PSO) at L5 is an effective treatment for sagittal imbalance, especially in select cases of patients showing kyphosis with the apex at L4-L5 but has been scarcely investigated. The aim of this study was to simulate various "high-demand" instrumentation approaches, including varying numbers of rods and sacropelvic implants, for the stabilization of a PSO at L5.

METHODS

A finite element model of T10-pelvis was modified to simulate posterior fixation with pedicle screws and rods from T10 to S1, alone or in combination with an L5 PSO. Five additional configurations were then created by employing rods and novel porous fusion/fixation implants across the sacroiliac joints, in varying numbers. All models were loaded using pure moments of 7.5 Nm in flexion-extension, lateral bending, and axial rotation.

RESULTS

The osteotomy resulted in a general increase in motion and stresses in posterior rods and S1 pedicle screws. When the number of rods was varied, three- and four-rod configurations were effective in limiting the maximal rod stresses; values approached those of posterior fixation with no osteotomy. Maximum stresses in the accessory rods were similar to or less than those observed in the primary rods. Multiple sacropelvic implants were effective in reducing range of motion, particularly of the SIJ.

CONCLUSIONS

Multi-rod constructs and sacropelvic fixation generally reduced maximal implant stresses and motion in comparison with standard posterior fixation, suggesting a reduced risk of rod breakage and increased joint stability, respectively, when a high-demand construct is utilized for the correction of sagittal imbalance.

Stability and Instrumentation Stresses Among Sacropelvic Fixation Techniques With Novel Porous Fusion/Fixation Implants: A Finite Element Study

BACKGROUND

Sacropelvic fixation is frequently combined with thoracolumbar instrumentation for correcting spinal deformities. This study aimed to characterize sacropelvic fixation techniques using novel porous fusion/fixation implants (PFFI).

METHODS

Three T10-pelvis finite element models were created: (1) pedicle screws and rods in T10-S1, PFFI bilaterally in S2 alar-iliac (S2AI) trajectory; (2) fixation in T10-S1, PFFI bilaterally in S2AI trajectory, triangular implants bilaterally above the PFFI in a sacro-alar-iliac trajectory (PFFI-IFSAI); and (3) fixation in T10-S1, PFFI bilaterally in S2AI trajectory, PFFI in sacro-alar-iliac trajectory stacked cephalad to those in S2AI position (2-PFFI). Models were loaded with pure moments of 7.5 Nm in flexion-extension, lateral bending, and axial rotation. Outputs were compared against 2 baseline models: (1) pedicle screws and rods in T10-S1 (PED), and (2) pedicle screws and rods in T10-S1, and S2AI screws.

RESULTS

PFFI and S2AI resulted in similar L5-S1 motion; adding another PFFI per side (2-PFFI) further reduced this motion. Sacroiliac joint (SIJ) motion was also similar between PFFI and S2AI; PFFI-IFSAI and 2-PFFI demonstrated a further reduction in SIJ motion. Additionally, PFFI reduced max stresses on S1 pedicle screws and on implants in the S2AI position.

CONCLUSION

The study shows that supplementing a long construct with PFFI increases the stability of the L5-S1 and SIJ and reduces stresses on the S1 pedicle screws and implants in the S2AI position.

CLINICAL RELEVANCE

The findings suggest a reduced risk of pseudarthrosis at L5-S1 and screw breakage. Clinical studies may be performed to demonstrate applicability to patient outcomes.

LEVEL OF EVIDENCE

Not applicable (basic science study).

Automatic Diagnosis of Spinal Disorders on Radiographic Images: Leveraging Existing Unstructured Datasets With Natural Language Processing

STUDY DESIGN

Retrospective study.

OBJECTIVES

Huge amounts of images and medical reports are being generated in radiology departments. While these datasets can potentially be employed to train artificial intelligence tools to detect findings on radiological images, the unstructured nature of the reports limits the accessibility of information. In this study, we tested if natural language processing (NLP) can be useful to generate training data for deep learning models analyzing planar radiographs of the lumbar spine.

METHODS

NLP classifiers based on the Bidirectional Encoder Representations from Transformers (BERT) model able to extract structured information from radiological reports were developed and used to generate annotations for a large set of radiographic images of the lumbar spine (N = 10 287). Deep learning (ResNet-18) models aimed at detecting radiological findings directly from the images were then trained and tested on a set of 204 human-annotated images.

RESULTS

The NLP models had accuracies between 0.88 and 0.98 and specificities between 0.84 and 0.99; 7 out of 12 radiological findings had sensitivity >0.90. The ResNet-18 models showed performances dependent on the specific radiological findings with sensitivities and specificities between 0.53 and 0.93.

CONCLUSIONS

NLP generates valuable data to train deep learning models able to detect radiological findings in spine images. Despite the noisy nature of reports and NLP predictions, this approach effectively mitigates the difficulties associated with the manual annotation of large quantities of data and opens the way to the era of big data for artificial intelligence in musculoskeletal radiology.

Effect of Sacropelvic Hardware on Axis and Center of Rotation of the Sacroiliac Joint: A Finite Element Study

BACKGROUND

The sacroiliac joint (SIJ) transfers the load of the upper body to the lower extremities while allowing a variable physiological movement among individuals. The axis of rotation (AoR) and center of rotation (CoR) of the SIJ can be evaluated to analyze the stability of the SIJ, including when the sacrum is fixed. The purpose of this study was to determine how load intensity affects the SIJ for the intact model and to characterize how sacropelvic fixation performed with different techniques affects this joint.

METHODS

Five T10-pelvis models were used: (1) intact model; (2) pedicle screws and rods in T10-S1; (3)pedicle screws and rods in T10-S1, and bilateral S2 alar-iliac screws (S2AI); (4) pedicle screws and rods in T10-S1, bilateral S2AI screws, and triangular implants inserted bilaterally in a sacral alar-iliac trajectory ; and (5) pedicle screws and rods in T10-S1, bilateral S2AI screws, and 2 bilateral triangular implants inserted in a lateral trajectory. Outputs of these models under flexion-extension were compared: AoR and CoR of the SIJ at incremental steps from 0 to 7.5 Nm for the intact model and AoR and CoR of the SIJ for the instrumented models at 7.5 Nm.

RESULTS

The intact model was validated against an in vivo study by comparing range of motion and displacement of the sacrum. Increasing the load intensity for the intact model led to an increase of the rotation of the sacrum but did not change the CoR. Comparison among the instrumented models showed that sacropelvic fixation techniques reduced the rotation of the sacrum and stabilized the SIJ, in particular with triangular implants.

CONCLUSION

The study outcomes suggest that increasing load intensity increases the rotation of the sacrum but does not influence the CoR, and use of sacropelvic fixation increases the stability of the SIJ, especially when triangular implants are employed.

CLINICAL RELEVANCE

The choice of the instrumentation strategy for sacropelvic fixation affects the stability of the construct in terms of both range of motion and axes of rotation, with direct consequences on the risk of failure and mobilization. Clinical studies should be performed to confirm these biomechanical findings.

Does the anterior column realignment technique influences the stresses on posterior instrumentation in sagittal imbalance correction? A biomechanical, finite-element analysis of L5-S1 ALIF and L3-4 lateral ACR

STUDY DESIGN

Biomechanical finite-element study.

OBJECTIVE

To directly compare the biomechanical effects of two different techniques for sagittal plane correction of adult spine deformity based on the anterior longitudinal ligament (ALL) resection and use of hyperlordotic cages, namely, the anterior column realignment (ACR) in L3-4, and ALIF in L5-S1 in terms of primary stability and rod stresses using finite-element models.

METHODS

A finite-element model of the thoracolumbar spine was used to perform the analysis. Starting from this "intact" model, three further models were constructed through the insertion of spinal instrumentation, i.e., pedicle screws, rods and cages: 1) posterior instrumentation between T9 and S1 (referred to as "T9-S1"); 2) posterior instrumentation T9-S1 + Hyperlordotic (26°) ALIF cage in L5-S1 ("ALIF"); 3) posterior instrumentation T9-S1 + Hyperlordotic (30°) ACR cage in L3-4 ("ACR"). These models were studied by simulations applying, alternately, a pure moment of 7.5 Nm between the three planes of motion (flexion, extension, lateral bending, and bilateral axial rotation), uniformly distributed over the upper surface of the T9 thoracic vertebra. A total of 24 simulations were performed (6 per models).

RESULTS

All models presented a significant reduced ROM when compared to the intact model; the ROM reduction was higher both at L3-4 in the ACR model and at L5-S1 in the ALIF model. At L3-4, the ACR model had, in all cases, the lowest maximum values of Von Mises stresses on the rods, especially in flexion-extension. At L4-5, the ALIF model had the lowest stresses during flexion-extension and axial rotation, while the ACR model had the lowest stresses during lateral bending. At L5-S1, the ALIF model had, in all cases, the lowest stresses on the rods.

CONCLUSIONS

This finite-element study showed how both ACR at L3-4 and ALIF-ACR at L5-S1 are effective in restoring lumbar lordosis (LL), stabilizing the spine and reducing stress on posterior rods at the index level when compared to a simple fixation model. Interestingly, ALIF-ACR reduces rod stress even at L4-5 in flexion-extension and axial rotation, possibly due to a better distribution of LL, especially on the lower arch, while ACR reduces the stress at L4-5 in lateral bending, possibly thanks to the larger footprint of the cage that increases the area of contact with the lateral side of the endplates.

A fresh look at spinal alignment and deformities: Automated analysis of a large database of 9832 biplanar radiographs

We developed and used a deep learning tool to process biplanar radiographs of 9,832 non-surgical patients suffering from spinal deformities, with the aim of reporting the statistical distribution of radiological parameters describing the spinal shape and the correlations and interdependencies between them. An existing tool able to automatically perform a three-dimensional reconstruction of the thoracolumbar spine has been improved and used to analyze a large set of biplanar radiographs of the trunk. For all patients, the following parameters were calculated: spinopelvic parameters; lumbar lordosis; mismatch between pelvic incidence and lumbar lordosis; thoracic kyphosis; maximal coronal Cobb angle; sagittal vertical axis; T1-pelvic angle; maximal vertebral rotation in the transverse plane. The radiological parameters describing the sagittal alignment were found to be highly interrelated with each other, as well as dependent on age, while sex had relatively minor but statistically significant importance. Lumbar lordosis was associated with thoracic kyphosis, pelvic incidence and sagittal vertical axis. The pelvic incidence-lumbar lordosis mismatch was found to be dependent on the pelvic incidence and on age. Scoliosis had a distinct association with the sagittal alignment in adolescent and adult subjects. The deep learning-based tool allowed for the analysis of a large imaging database which would not be reasonably feasible if performed by human operators. The large set of results will be valuable to trigger new research questions in the field of spinal deformities, as well as to challenge the current knowledge.

The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading

Simplified loading conditions such as pure moments are frequently used to compare different instrumentation techniques to treat spine disorders. The purpose of this study was to determine if the use of realistic loading conditions such as muscle forces can alter the stresses in the implants with respect to pure moment loading. A musculoskeletal model and a finite element model sharing the same anatomy were built and validated against in vitro data, and coupled in order to drive the finite element model with muscle forces calculated by the musculoskeletal one for a prescribed motion. Intact conditions as well as a L1-L5 posterior fixation with pedicle screws and rods were simulated in flexion-extension and lateral bending. The hardware stresses calculated with the finite element model with instrumentation under simplified and realistic loading conditions were compared. The ROM under simplified loading conditions showed good agreement with in vitro data. As expected, the ROMs between the two types of loading conditions showed relatively small differences. Realistic loading conditions increased the stresses in the pedicle screws and in the posterior rods with respect to simplified loading conditions; an increase of hardware stresses up to 40 MPa in extension for the posterior rods and 57 MPa in flexion for the pedicle screws were observed with respect to simplified loading conditions. This conclusion can be critical for the literature since it means that previous models which used pure moments may have underestimated the stresses in the implants in flexion-extension and in lateral bending.

Innovative sacropelvic fixation using iliac screws and triangular titanium implants

PURPOSE

Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for the correction of severe spinal deformities. The purpose of this study was to explore the effects of the triangular titanium implants on the iliac screw fixation. Our hypothesis was that the use of triangular titanium implants can increase the stability of the iliac screw fixation.

METHODS

Three T10-pelvis instrumented models were created: pedicle screws and rods in T10-S1, and bilateral iliac screws (IL); posterior fixation and bilateral iliac screws and triangular implants inserted bilaterally in a sacro-alar-iliac trajectory (IL-Tri-SAI); posterior fixation and bilateral iliac screws and two bilateral triangular titanium implants inserted in a lateral trajectory (IL-Tri-Lat). Outputs of these models, such as hardware stresses, were compared against a model with pedicle screws and rods in T10-S1 (PED).

RESULTS

Sacropelvic fixation decreased the L5-S1 motion by 75-90%. The motion of the SIJ was reduced by 55-80% after iliac fixation; the addition of triangular titanium implants further reduced it. IL, IL-Tri-SAI and IL-Tri-Lat demonstrated lower S1 pedicle stresses with respect to PED. Triangular implants had a protective effect on the iliac screw stresses.

CONCLUSION

Sacropelvic fixation decreased L5-S1 range of motion suggesting increased stability of the joint. The combination of triangular titanium implants and iliac screws reduced the residual flexibility of the sacroiliac joint, and resulted in a protective effect on the S1 pedicle screws and iliac screws themselves. Clinical studies may be performed to demonstrate applicability of these FEA results to patient outcomes.

2-step deep learning model for landmarks localization in spine radiographs

In this work we propose to use Deep Learning to automatically calculate the coordinates of the vertebral corners in sagittal x-rays images of the thoracolumbar spine and, from those landmarks, to calculate relevant radiological parameters such as L1–L5 and L1–S1 lordosis and sacral slope. For this purpose, we used 10,193 images annotated with the landmarks coordinates as the ground truth. We realized a model that consists of 2 steps. In step 1, we trained 2 Convolutional Neural Networks to identify each vertebra in the image and calculate the landmarks coordinates respectively. In step 2, we refined the localization using cropped images of a single vertebra as input to another convolutional neural network and we used geometrical transformations to map the corners to the original image. For the localization tasks, we used a differentiable spatial to numerical transform (DSNT) as the top layer. We evaluated the model both qualitatively and quantitatively on a set of 195 test images. The median localization errors relative to the vertebrae dimensions were 1.98% and 1.68% for x and y coordinates respectively. All the predicted angles were highly correlated with the ground truth, despite non-negligible absolute median errors of 1.84°, 2.43° and 1.98° for L1–L5, L1–S1 and SS respectively. Our model is able to calculate with good accuracy the coordinates of the vertebral corners and has a large potential for improving the reliability and repeatability of measurements in clinical tasks.

The importance of curve severity, type and instrumentation strategy in the surgical correction of adolescent idiopathic scoliosis: an in silico clinical trial on 64 cases

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine which is frequently corrected with the implantation of instrumentation with generally good or excellent clinical results; mechanical post-operative complications such as implant loosening and breakage are however relatively frequent. The rate of complications is associated with a lack of consensus about the surgical decision-making process; choices about the instrumentation length, the anchoring implants and the degree of correction are indeed mostly based on personal views and previous experience of the surgeon. In this work, we performed an in silico clinical trial on a large number of subjects in order to clarify which factors have the highest importance in determining the risk of complications by quantitatively analysing the mechanical stresses and loads in the instrumentation after the correction maneuvers. The results of the simulations highlighted the fundamental role of the curve severity, also in its three-dimensional aspect, and of the instrumentation strategy, whereas the length of the fixation had a lower importance.

The use of triangular implants to enhance sacropelvic fixation: a finite element investigation

BACKGROUND CONTEXT

Long thoracolumbar fixation and fusion have become a consolidated treatment for severe spinal disorders. Concomitant sacropelvic fixation with S2 alar-iliac (S2AI) screws is frequently performed to limit instrumentation failure and pseudarthrosis at the lumbosacral junction.

PURPOSE

This study explored the use of triangular titanium implants in different configurations in which the implants supplemented standard sacropelvic fixation with S2AI screws in order to further increase the stability of S2AI fixation.

STUDY DESIGN

Finite element study.

METHODS

Four T10-pelvis instrumented models were built: pedicle screws and rods in T10-S1 (PED); pedicle screws and rods in T10-S1, and bilateral S2 alar-iliac screws (S2AI); pedicle screws and rods in T10-S1, bilateral S2AI screws, and triangular implants inserted bilaterally in a sacral alar-iliac trajectory (Tri-SAI); pedicle screws and rods in T10-S1, bilateral S2AI screws and two bilateral triangular titanium implants inserted in a lateral trajectory (Tri-Lat). The models were tested under pure moments of 7.5 Nm in flexion-extension, lateral bending and axial rotation.

RESULTS

SIJ motion was reduced by 50% to 66% after S2AI fixation; the addition of triangular titanium implants in either a SAI or a lateral trajectory further reduced it. S2AI, Tri-SAI, and Tri-Lat resulted in significantly lower stresses in S1 pedicle screws when compared to PED. Triangular implants had a protective effect on the maximal stresses in S2AI screws, especially when placed in the SAI trajectory. Sacropelvic fixation did not have any protective effect on the posterior rods.

CONCLUSIONS

Supplementing S2AI screws with triangular implants had a protective effect on the S2AI screws themselves, as well as the S1 pedicle screws, in the tested model.

CLINICAL SIGNIFICANCE

Triangular implants can substantially reduce the residual flexibility of the SIJ with respect to S2AI fixation alone, suggesting a possible role in patients needing reinforced fixation. In vivo investigation is needed to determine if these in vitro effects translate into clinically important differences.

Image-based biomechanical models of the musculoskeletal system

Finite element modeling is a precious tool for the investigation of the biomechanics of the musculoskeletal system. A key element for the development of anatomically accurate, state-of-the art finite element models is medical imaging. Indeed, the workflow for the generation of a finite element model includes steps which require the availability of medical images of the subject of interest: segmentation, which is the assignment of each voxel of the images to a specific material such as bone and cartilage, allowing for a three-dimensional reconstruction of the anatomy; meshing, which is the creation of the computational mesh necessary for the approximation of the equations describing the physics of the problem; assignment of the material properties to the various parts of the model, which can be estimated for example from quantitative computed tomography for the bone tissue and with other techniques (elastography, T1rho, and T2 mapping from magnetic resonance imaging) for soft tissues. This paper presents a brief overview of the techniques used for image segmentation, meshing, and assessing the mechanical properties of biological tissues, with focus on finite element models of the musculoskeletal system. Both consolidated methods and recent advances such as those based on artificial intelligence are described.

In vivo imaging of CNS microglial activation/macrophage infiltration with combined [18F]DPA-714-PET and SPIO-MRI in a mouse model of relapsing remitting experimental autoimmune encephalomyelitis

Purpose

To evaluate the feasibility and sensitivity of multimodality PET/CT and MRI imaging for non-invasive characterization of brain microglial/macrophage activation occurring during the acute phase in a mouse model of relapsing remitting multiple sclerosis (RR-MS) using [¹⁸F]DPA-714, a selective radioligand for the 18-kDa translocator protein (TSPO), superparamagnetic iron oxide particles (SPIO), and ex vivo immunohistochemistry.

Methods

Experimental autoimmune encephalomyelitis (EAE) was induced in female SJL/J mice by immunization with PLP_139–151. Seven symptomatic EAE mice and five controls underwent both PET/CT and MRI studies between 11 and 14 days post-immunization. SPIO was injected i.v. in the same animals immediately after [¹⁸F]DPA-714 and MRI acquisition was performed after 24 h. Regional brain volumes were defined according to a mouse brain atlas on co-registered PET and SPIO-MRI images. [¹⁸F]DPA-714 standardized uptake value (SUV) ratios (SUVR), with unaffected neocortex as reference, and SPIO fractional volumes (SPIO-Vol) were generated. Both SUVR and SPIO-Vol values were correlated with the clinical score (CS) and among them. Five EAE and four control mice underwent immunohistochemical analysis with the aim of identifying activated microglia/macrophage and TSPO expressions.

Results

SUVR and SPIO-Vol values were significantly increased in EAE compared with controls in the hippocampus (p < 0.01; p < 0.02, respectively), thalamus (p < 0.02; p < 0.05, respectively), and cerebellum and brainstem (p < 0.02), while only SPIO-Vol was significantly increased in the caudate/putamen (p < 0.05). Both SUVR and SPIO-Vol values were positively significantly correlated with CS and among them in the same regions. TSPO/Iba1 and F4/80/Prussian blue staining immunohistochemistry suggests that increased activated microglia/macrophages underlay TSPO expression and SPIO uptake in symptomatic EAE mice.

Conclusions

These preliminary results suggest that both activated microglia and infiltrated macrophages are present in vulnerable brain regions during the acute phase of PLP-EAE and contribute to disease severity. Both [¹⁸F]DPA-714-PET and SPIO-MRI appear suitable modalities for preclinical study of neuroinflammation in MS mice models.

Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques

PURPOSE

Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for complex deformity correction and is commonly associated with pseudoarthrosis, implant failure and loosening. This study compared pedicle screw fixation (PED) with three different sacropelvic fixation techniques, namely iliac screws (IL), S2 alar-iliac screws (S2AI) and laterally placed triangular titanium implants (SI), all in combination with lumbosacral instrumentation, accounting for implant micromotion.

METHODS

Existing finite element models of pelvis-L5 of three patients including lumbopelvic instrumentation were utilized. Moments of 7.5 Nm in the three directions combined with a 500 N compressive load were simulated. Measured metrics included flexibility, instrumentation stresses and bone-implant interface loads.

RESULTS

Fixation effectively reduced the sacroiliac flexibility. Compared to PED, IL and S2AI induced a reduction in peak stresses in the S1 pedicle screws. Rod stresses were mostly unaffected by S2AI and SI, but IL demonstrated a stress increase. In comparison with a previous work depicting full osteointegration, SI was found to have similar instrumentation stresses as those due to PED.

CONCLUSIONS

Fixation with triangular implants did not result in stress increase on the lumbosacral instrumentation, likely due to the lack of connection with the posterior rods. IL and S2AI had a mild protective effect on S1 pedicle screws in terms of stresses and bone-implant loads. IL resulted in an increase in the rod stresses. A comparison between this study and previous work incorporating full osteointegration demonstrates how these results may be applied clinically to better understand the effects of different treatments on patient outcomes. These slides can be retrieved under Electronic Supplementary Material.

Antithrombin Milano, Single Amino Acid Substitution at the Reactive Site, Arg393 to Cys

Antithrombin Milano is an unusual antithrombin variant, exhibiting an abnormal, fast moving component on crossed immunoelectrophoresis (in the absence of heparin). Antithrombin isolated from the propositus could be resolved into two peaks on anion-exchange chromatography; anti thrombin Milano peak 1 of Mr ∼60,000 which could inhibit thrombin, and antithrombin Milano peak 2 of Mr ∼120,000 which was inactive. The latter component also reacted with antisera to both antithrombin and albumin on immunoblotting. Under reducing conditions, the ∼120,000 Mr component migrated on SDS-PAGE as two distinct bands with Mr ∼60,000, one of which reacted with antiserum to antithrombin and the other (of slower mobility) of which reacted with antiserum to albumin only. These and other results established the ∼120,000 Mr component to be an inactive, disulphide-linked variant antithrombin and albumin complex. The variant antithrombin was isolated, following reduction and S-carboxy-methylation, by reverse-phase HPLC and then it was fragmented with CNBr. A major CNBr pool containing the sequence Gly339-Met423 was treated with trypsin, followed by V8 protease. The resulting peptides were analysed by fast atom bombardment mass spectrometry (Fab-MS) mapping. A peptide of molecular mass 1086, corresponding to the normal sequence Ala382-Arg393, was almost absent from the mass spectrum, but an additional peptide of mass number 1772 was present. These results are almost identical to those found in another variant antithrombin, North-wick Park (Erdjument et al., J Biol Chem, 262: 13381, 1987; Erdjument et al., J Biol Chem, 263: 5589-5593, 1988), indicating the same single amino acid substitution of Arg393 to Cys.

Imaging of brain TSPO expression in a mouse model of amyotrophic lateral sclerosis with (18)F-DPA-714 and micro-PET/CT

PURPOSE

To evaluate the feasibility and sensitivity of (18)F-DPA-714 for the study of microglial activation in the brain and spinal cord of transgenic SOD1(G93A) mice using high-resolution PET/CT and to evaluate the Iba1 and TSPO expression with immunohistochemistry.

METHODS

Nine symptomatic SOD1(G93A) mice (aged 117 ± 12.7 days, clinical score range 1 - 4) and five WT SOD1 control mice (aged 108 ± 28.5 days) underwent (18)F-DPA-714 PET/CT. SUV ratios were calculated by normalizing the cerebellar (rCRB), brainstem (rBS), motor cortex (rMCX) and cervical spinal cord (rCSC) activities to that of the frontal association cortex. Two WT SOD1 and six symptomatic SOD1(G93A) mice were studied by immunohistochemistry.

RESULTS

In the symptomatic SOD1(G93A) mice, rCRB, rBS and rCSC were increased as compared to the values in WT SOD1 mice, with a statistically significantly difference in rBS (2.340 ± 0.784 vs 1.576 ± 0.287, p = 0.014). Immunofluorescence studies showed that TSPO expression was increased in the trigeminal, facial, ambiguus and hypoglossal nuclei, as well as in the spinal cord, of symptomatic SOD1(G93A) mice and was colocalized with increased Iba1 staining.

CONCLUSION

Increased (18)F-DPA-714 uptake can be detected with high-resolution PET/CT in the brainstem of transgenic SOD1(G93A) mice, a region known to be a site of degeneration and increased microglial activation in amyotrophic lateral sclerosis, in agreement with increased TSPO expression in the brainstem nuclei shown by immunostaining. Therefore, (18)F-DPA-714 PET/CT might be a suitable tool to evaluate microglial activation in the SOD1(G93A) mouse model.

Outbreak of NDM-1-producing Enterobacteriaceae in northern Italy, July to August 2011

Between July 2011 and August 2011, the New Delhi metallo-beta-lactamase 1 (NDM-1) gene was detected in Klebsiella pneumoniae and Escherichia coli isolates obtained from six patients hospitalised in four healthcare facilities in northern Italy. The patient who had been hospitalised in New Delhi, India, from February to May 2011 and subsequently in the Bologna area, Italy, from May to July 2011, may have been the source of the outbreak. Our findings suggest ongoing spread of this carbapenem-resistance gene in Italy and highlight the need for intensive surveillance.

Outbreak of NDM-1-producing Enterobacteriaceae in northern Italy, July to August 2011

Between July 2011 and August 2011, the New Delhi metallo-beta-lactamase 1 (NDM-1) gene was detected in Klebsiella pneumoniae and Escherichia coli isolates obtained from six patients hospitalised in four healthcare facilities in northern Italy. The patient who had been hospitalised in New Delhi, India, from February to May 2011 and subsequently in the Bologna area, Italy, from May to July 2011, may have been the source of the outbreak. Our findings suggest ongoing spread of this carbapenem-resistance gene in Italy and highlight the need for intensive surveillance.

α-smooth muscle actin, fibrillin-1, apoptosis and proliferation detection in primary varicose lower limb veins of women

AIM

The role of SMC apoptosis and proliferation was correlated to the amount of fibrillin and alfa-smooth muscle actin of primary varicose veins.

METHODS

Twenty varicose vein specimens were atraumatically harvested from 20 women undergoing lower extremity primary varicose vein excision. The patients were divided into groups according to age (<50 years, >50 years) and the presence of leg edema (CEAP, class 2 or 3). The surface density of fibrillin-1 fibers (Sv([Fbn-1])), the volume density of smooth muscle cells: (Vv([SMC])), the number of proliferating and apoptotic cells per area. Quantitative data comparisons between class and age groups were performed.

RESULTS

The median value of Vv([SMC]) was 16% greater and the Sv([Fbn-1]) was 35% greater in the intima vein sections from patients up to 50y compared to >50y. Apoptosis was found more frequent in veins sections from varicose women >50y. In the media layer, Sv([Fbn-1]) in veins from patients up to 50y was more important, and women with >50y had also more cells in apoptosis. Vv([SMC]) from women without edema (CEAP-Class 2) was 28% greater in the intima and apoptotic cells were more prominent in the intima of women with edema (CEAP-Class 2). In the media layer, Sv([Fbn-1]) was 12,5% greater in veins from women without edema and apoptosis was more detected in the veins from patients with edema.

CONCLUSION

Age of the patient may affect the remodeling of varicose veins and SMC quantity in the media layer was found decreased in patients with edema.

The plasma von Willebrand factor O-glycome comprises a surprising variety of structures including ABH antigens and disialosyl motifs

BACKGROUND

von Willebrand factor (VWF) is a key component for maintenance of normal hemostasis. Its glycan moieties, accounting for about 20% of its molecular weight, have been shown to affect many of its properties. Previous studies reported correlations between VWF secretion, half-life and the nature or presence of its N-glycans, and more importantly between VWF plasma level and the type of N-linked ABH antigens. Despite the presence of 10 predicted O-glycosylation sites, the O-glycome remains poorly characterized, impairing the complete elucidation of its influence on VWF functions. So far only a single glycan structure, a disialyl core 1 glycan, has been identified.

OBJECTIVES

To define an exhaustive profile of the VWF O-glycan structures to help the understanding of their role in VWF regulation and properties.

METHODS

Plasma-derived VWF O-linked sugars were isolated and analyzed using state-of-the-art mass spectrometry methodologies.

RESULTS AND CONCLUSIONS

We provide here a detailed analysis of the human plasma-derived VWF O-glycome. Eighteen O-glycan structures including both core 1 and core 2 structures are now demonstrated to be present on VWF. Amongst the newly determined structures are unusual tetra-sialylated core 1 O-glycans and ABH antigen-containing core 2 O-glycans. In conjunction with current models explaining VWF activity, knowledge of the complete O-glycome will facilitate research aimed at providing a better understanding of the influence of glycosylation on VWF functions.

Glycosylation of the phosphate binding protein, PstS, in Streptomyces coelicolor by a pathway that resembles protein O-mannosylation in eukaryotes

Previously mutations in a putative protein O-mannosyltransferase (SCO3154, Pmt) and a polyprenol phosphate mannose synthase (SCO1423, Ppm1) were found to cause resistance to phage, phiC31, in the antibiotic producing bacteria Streptomyces coelicolor A3(2). It was proposed that these two enzymes were part of a protein O-glycosylation pathway that was necessary for synthesis of the phage receptor. Here we provide the evidence that Pmt and Ppm1 are indeed both required for protein O-glycosylation. The phosphate binding protein PstS was found to be glycosylated with a trihexose in the S. coelicolor parent strain, J1929, but not in the pmt(-) derivative, DT1025. Ppm1 was necessary for the transfer of mannose to endogenous polyprenol phosphate in membrane preparations of S. coelicolor. A mutation in ppm1 that conferred an E218V substitution in Ppm1 abolished mannose transfer and glycosylation of PstS. Mass spectrometry analysis of extracted lipids showed the presence of a glycosylated polyprenol phosphate (PP) containing nine repeated isoprenyl units (C(45)-PP). S. coelicolor membranes were also able to catalyse the transfer of mannose to peptides derived from PstS, indicating that these could be targets for Pmt in vivo.

An interpretation of size-scale plasticity in geometrically confined systems

The mesoscopic constitutive behavior of face-centered cubic metals as a function of the system characteristic dimension recently has been investigated experimentally. Strong size effects have been identified in both polycrystalline submicron thin films and single crystal micro pillars. The size effect is manifested as an increase in strength and hardening rate as the system dimensions are decreased. In this article, we provide a mechanistic interpretation for the observed mesoscopic behavior. By performing 3D discrete dislocation dynamics simulations of grains representative of the system microstructure and associated characteristic dimensions, we show that the experimentally observed size effects can be qualitatively described. In these simulations, a constant density of dislocation sources per unit of grain boundary area is modeled by sources randomly distributed at grain boundaries. The source length (strength) is modeled by a Gaussian distribution, in which average and standard deviation is independent of the system characteristic dimension. The simulations reveal that two key concepts are at the root of the observed plasticity size effect. First, the onset of plasticity is governed by a dislocation nucleation-controlled process (sources of various length, i.e., strengths, in our model). Second, the hardening rate is controlled by source exhaustion, i.e., sources are active only once as a result of the limited dislocation mobility arising from size and boundary effects. The model postulated here improves our understanding of why "smaller is stronger" and provides predictive capabilities that should enhance the reliable design of devices in applications such as microelectronics and micro/nano-electro-mechanical systems.

In Vitro and In Vivo Characterization of Indium-111 and Technetium-99m Labeled CCK-8 Derivatives for CCK-B Receptor Imaging

Cholecystokinin (CCK) receptors of the subtype B (CCK-BR) have been shown to be overexpressed in certain neuroendocrine tumors including medullary thyroid cancer. Our recent work has focused on new methods to radiolabel the CCK8 peptide with 111In or 99mTc for CCK-B receptor imaging. Derivatives of CCK8 were obtained by addition at the N-terminus in solid phase of a DTPA derivative (DTPAGlu) linked through a glycine spacer (DTPAGlu-G-CCK8) or cysteine, glycine and a diphenylphosphinopropionyl moiety (PhosGC-CCK8) for labeling with 111In and 99mTc, respectively. CCK-BR overexpressing A431 cancer cell lines were utilized to characterize in vitro properties of the two compounds as well as for generating xenografts in nude mice for in vivo characterization. Both 111In-DTPAGlu-G-CCK8 and 99mTcPhosGC-CCK8 showed similar binding affinities for CCK-BR with dissociation constants of 20-40 nM, were internalized after interaction with the receptor and displayed prolonged cellular retention times. Specific in vivo interaction with the receptor of both CCK8 analogs was observed in our animal model. 111In-DTPAGlu-G-CCK8 showed better target to non-target ratios, although it appeared to be rapidly metabolized after injection and activity cleared through the kidneys. 99mTc-PhosGC-CCK8 was more stable in vivo but showed marked hepatobiliary clearance with resulting high background activity in the bowel. The rapid clearance and lower background obtained with 111In-DTPAGlu-G-CCK8 make this a better candidate for further development.

Modeling human congenital disorder of glycosylation type IIa in the mouse: conservation of asparagine-linked glycan-dependent functions in mammalian physiology and insights into disease pathogenesis

The congenital disorders of glycosylation (CDGs) are recent additions to the repertoire of inherited human genetic diseases. Frequency of CDGs is unknown since most cases are believed to be misdiagnosed or unrecognized. With few patients identified and heterogeneity in disease signs noted, studies of animal models may provide increased understanding of pathogenic mechanisms. However, features of mammalian glycan biosynthesis and species-specific variations in glycan repertoires have cast doubt on whether animal models of human genetic defects in protein glycosylation will reproduce pathogenic events and disease signs. We have introduced a mutation into the mouse germline that recapitulates the glycan biosynthetic defect responsible for human CDG type IIa (CDG-IIa). Mice lacking the Mgat2 gene were deficient in GlcNAcT-II glycosyltransferase activity and complex N-glycans, resulting in severe gastrointestinal, hematologic, and osteogenic abnormalities. With use of a lectin-based diagnostic screen for CDG-IIa, we found that all Mgat2-null mice died in early postnatal development. However, crossing the Mgat2 mutation into a distinct genetic background resulted in a low frequency of survivors. Mice deficient in complex N-glycans exhibited most CDG-IIa disease signs; however, some signs were unique to the aged mouse or are prognostic in human CDG-IIa. Unexpectedly, analyses of N-glycan structures in Mgat2-null mice revealed a novel oligosaccharide branch on the "bisecting" N-acetylglucosamine. These genetic, biochemical, and physiologic studies indicate conserved functions for N-glycan branches produced in the Golgi apparatus among two mammalian species and suggest possible therapeutic approaches to GlcNAcT-II deficiency. Our findings indicate that human genetic disease due to aberrant protein glycosylation can be modeled in the mouse to gain insights into N-glycan-dependent physiology and the pathogenesis of CDG-IIa.

A non-Golgi alpha 1,2-fucosyltransferase that modifies Skp1 in the cytoplasm of Dictyostelium

Skp1 is a subunit of the SCF-E3 ubiquitin ligase that targets cell cycle and other regulatory factors for degradation. In Dictyostelium, Skp1 is modified by a pentasaccharide containing the type 1 blood group H trisaccharide at its core. To address how the third sugar, fucose alpha1,2-linked to galactose, is attached, a proteomics strategy was applied to determine the primary structure of FT85, previously shown to copurify with the GDP-Fuc:Skp1 alpha 1,2-fucosyltransferase. Tryptic-generated peptides of FT85 were sequenced de novo using Q-TOF tandem mass spectrometry. Degenerate primers were used to amplify FT85 genomic DNA, which was further extended by a novel linker polymerase chain reaction method to yield an intronless open reading frame of 768 amino acids. Disruption of the FT85 gene by homologous recombination resulted in viable cells, which had altered light scattering properties as revealed by flow cytometry. FT85 was necessary and sufficient for Skp1 fucosylation, based on biochemical analysis of FT85 mutant cells and Escherichia coli that express FT85 recombinantly. FT85 lacks sequence motifs that characterize all other known alpha 1,2-fucosyltransferases and lacks the signal-anchor sequence that targets them to the secretory pathway. The C-terminal region of FT85 harbors motifs found in inverting Family 2 glycosyltransferase domains, and its expression in FT85 mutant cells restores fucosyltransferase activity toward a simple disaccharide substrate. Whereas most prokaryote and eukaryote Family 2 glycosyltransferases are membrane-bound and oriented toward the cytoplasm where they glycosylate lipid-linked or polysaccharide precursors prior to membrane translocation, the soluble, eukaryotic Skp1-fucosyltransferase modifies a protein that resides in the cytoplasm and nucleus.

Both mosquito-derived xanthurenic acid and a host blood-derived factor regulate gametogenesis of Plasmodium in the midgut of the mosquito

Gametogenesis of Plasmodium in vitro can be induced by the combined stimulus of a 5 degrees C fall in temperature and the presence of xanthurenic acid (XA). In-vitro experiments showed that P. gallinaceum (EC(50)=80 nM) is much more sensitive to XA than P. berghei (9 microM), P. yoelii (8 microM), and P. falciparum (2 microM). However, in the mosquito vector, we do not know whether the temperature shift and XA are the only gametocyte-activating factors (GAF), nor do we know with certainty the true source(s) of XA in the mosquito blood meal. Previous studies indicate that XA is the only source of GAF in the mosquito. By defining, and then contrasting, the ability of an XA-deficient mutant of Aedes aegypti, with the wild-type mosquito to support exflagellation and ookinete formation in vivo, we determined the roles of parasite-, mosquito- and host blood-derived GAF in the regulation of gametogenesis of P. gallinaceum. Removal of both host and vector sources of GAF totally inhibited both exflagellation and ookinete production, whilst the lack of either single source resulted in only a partial reduction of exflagellation and ookinete formation in the mosquito gut. Both sources can be effectively replaced/substituted by synthetic XA. This suggests (1) both mosquito- and vertebrate-derived factors act as GAF in the mosquito gut in vivo; (2) the parasite itself is unable to produce any significant GAF activity. Studies are underway to determine whether vertebrate-derived GAF is XA. These data may form the basis of further studies of the development of new methods of interrupting malarial transmission.

Molecular characterization of the surface layer proteins from Clostridium difficile

Many bacteria express a surface-exposed proteinaceous layer, termed the S-layer, which forms a regular two-dimensional array visible by electron microscopy. Clostridium difficile is unusual in expressing two S-layer proteins (SLPs), which are of varying size in a number of strains. In an approach combining molecular biology with mass spectrometric sequencing strategies, we have identified the structural gene (slpA) for the S-layer from three strains of C. difficile. Both proteins are derived from a common precursor, and processing involves the removal of a signal peptide and a second cleavage to release the two mature SLPs. To our knowledge, this is the first example in which two SLPs have been shown to derive from a single gene product through post-translational processing, rather than from the expression of separate genes. The higher molecular weight (MW) SLP is highly conserved among the three strains, whereas the lower MW SLP shows considerable sequence diversity, reflecting the results from Western blotting. The high-MW SLP shows weak homology to N-acetyl muramoyl-L-alanine amidase from Bacillus subtilis, and both the native SLP from C. difficile and a recombinant protein expressed in Escherichia coli were found to display amidase activity by zymography. The high-MW SLPs showed evidence of glycosylation, whereas the lower MW proteins did not. A family of genes with sequence homology to the amidase domain of the high-MW SLP was identified in the C. difficile strain 630 genome, some of which are located in the same region of the genome as slpA and were shown by reverse transcription-polymerase chain reaction (RT-PCR) analysis to be transcribed.

Structural characterization of the inflammatory moiety of a variable major lipoprotein of Borrelia recurrentis

Louse-borne relapsing fever, caused by Borrelia recurrentis, provides one of the best documented examples of the causative role of tumor necrosis factor (TNF) in the pathology of severe infection in humans. We have identified the principal TNF-inducing factor of B. recurrentis as a variable major lipoprotein (Vmp). Here we report the complete gene sequence of Vmp, including its lipoprotein leader sequence. Using metabolically labeled forms of the native Vmp we confirm that the TNF inducing properties are associated with the lipid portion of the molecule. Quadrupole orthogonal time of flight mass spectrometry unequivocally locates the lipidic moiety at the NH(2)-terminal cysteine of the native polypeptide, and indicates the existence of three forms which are consistent with the structures C16:0, C16:0, C16:0 glyceryl cysteine; C18:1, C16:0, C16:0 glyceryl cysteine; and C18:0, C16:0, C16:0 glyceryl cysteine. These data provide the first direct evidence that the TNF inducing lipid modification of native Borrelia lipoproteins is a structural homologue of the murein lipoprotein of Escherichia coli.

Molecular cloning and demonstration of an aminopeptidase activity in a filarial nematode glycoprotein

ES-62 is an abundant phosphorylcholine-containing secreted glycoprotein of the filarial nematode Acanthocheilonema viteae. Using an antiserum directed against the parasite molecule, 3 cDNAs of size, approximately 1.5-1.6 kbp were isolated from an A. viteae expression library. Sequence analysis in combination with N-terminal amino acid sequencing of purified ES-62 revealed that each clone contained a full-length cDNA for ES-62 corresponding to 474 amino acid residues but differed in their 5' and 3' untranslated regions. Characterisation of the 5' end of ES-62 mRNA using 5' rapid amplification of cDNA ends showed that it coded for a signal sequence. Several tryptic peptides were independently sequenced using quadruple-time-of-flight mass spectrometry and used to confirm the cDNA sequence. The mature protein was found to contain three potential N-linked glycosylation sites. Comparison of the derived amino acid sequence of ES-62 with the SwissProt database identified a sequence (between amino acid residues approximately 250 and 350 of mature ES-62) with significant similarity to several bacterial/fungal aminopeptidases. Incubation of ES-62 with leucine-7-amino-4-methylcoumarin as substrate confirmed that ES-62 possessed aminopeptidase activity.

The cytoplasmic F-box binding protein SKP1 contains a novel pentasaccharide linked to hydroxyproline in Dictyostelium

SKP1 is involved in the ubiquitination of certain cell cycle and nutritional regulatory proteins for rapid turnover. SKP1 from Dictyostelium has been known to be modified by an oligosaccharide containing Fuc and Gal, which is unusual for a cytoplasmic or nuclear protein. To establish how it is glycosylated, SKP1 labeled with [3H]Fuc was purified to homogeneity and digested with endo-Lys-C. A single radioactive peptide was found after two-dimensional high performance liquid chromatography. Analysis in a quadrupole time-of-flight mass spectrometer revealed a predominant ion with a novel mass. Tandem mass spectrometry analysis yielded a set of daughter ions which identified the peptide and showed that it was modified at Pro-143. A second series of daughter ions showed that Pro-143 was hydroxylated and derivatized with a potentially linear pentasaccharide, Hex-->Hex-->Fuc-->Hex-->HexNAc-->(HyPro). The attachment site was confirmed by Edman degradation. Gas chromatography-mass spectrometry analysis of trimethylsilyl-derivatives of overexpressed SKP1 after methanolysis showed the HexNAc to be GlcNAc. Exoglycosidase digestions of the glycopeptide from normal SKP1 and from a fucosylation mutant, followed by matrix-assisted laser desorption time-of-flight mass spectrometry analysis, showed that the sugar chain consisted of D-Galpalpha1-->6-D-Galpalpha1-->L-Fucpalpha1-->2-D- Galpbeta1--> 3GlcNAc. Matrix-assisted laser-desorption time-of-flight mass spectrometry analysis of all SKP1 peptides resolved by reversed phase-high performance liquid chromatography showed that SKP1 was only partially hydroxylated at Pro-143 and that all hydroxylated SKP1 was completely glycosylated. Thus SKP1 is variably modified by an unusual linear pentasaccharide, suggesting the localization of a novel glycosylation pathway in the cytoplasm.

Isolation and characterization of monomeric and dimeric CP47-reaction center photosystem II complexes

Using the detergents n-dodecyl beta-D-maltoside and heptyl thioglycopyranoside, a subcore complex of photosystem II (PSII) has been isolated that contains the chlorophyll-binding protein, CP47, and the reaction center components, D1, D2, and cytochrome b559. We have found, by using sucrose density centrifugation, that the resulting preparation consisted of a mixture of dimeric and monomeric forms of the CP47 reaction center (RC) complex, having molecular masses of 410 +/- 30 and 200 +/- 28 kDa, respectively, as estimated by size exclusion chromatography. The level of the dimer in the preparation is significantly higher than the monomeric form. Both the monomer and dimer contain the proteins CP47, D1, and D2 and the alpha- and beta-subunits of cytochrome b559. Analyses by mass spectrometry and N-terminal sequencing showed that both forms of the CP47-RC complex contain the products of the psbI, psbTc (chloroplast gene), and psbW with molecular masses of 4195.5, 3849.6, and 5927.4 Da, respectively. In contrast to the monomeric form, the CP47-RC dimer contained two extra proteins with low molecular weights, identified as the products of the psbL and psbK genes having molecular masses of 4365.5 and 4292.1, respectively. It was also found that the dimer contained slightly more molecules of chlorophyll a (21 +/- 2.5) than the monomer (18 +/- 1.5), a characteristic also observed in the room temperature absorption spectrum by comparing the ratio of absorption at 416 and 435 nm. Of particular note was the finding that the dimer, but not the monomer, contained plastoquinone-9 (estimated to be 1.5 +/- 0.3 molecules per RC). The results indicate that the CP47-RC monomer is derived from the dimeric form of the complex, and therefore the latter is likely to represent an in vivo conformation. The PsbTc as well as the PsbI and PsbW proteins are identified as being intimately associated with the D1 and D2 proteins, and in the case of the dimer, importance is placed on the PsbL and PsbK proteins in sustaining plastoquinone binding and maintenance of the dimeric organization. Assuming only one copy of the alpha- and beta-subunits of cytochrome b559, the monomeric and dimeric forms of the complex would be expected to contain 21 and 23 x 2 transmembrane helices, respectively.

Identification of xanthurenic acid as the putative inducer of malaria development in the mosquito

Malaria is transmitted from vertebrate host to mosquito vector by mature sexual blood-living stages called gametocytes. Within seconds of ingestion into the mosquito bloodmeal, gametocytes undergo gametogenesis. Induction requires the simultaneous exposure to at least two stimuli in vitro: a drop in bloodmeal temperature to 5 degrees C below that of the vertebrate host, and a rise in pH from 7.4 to 8.0-8.2. In vivo the mosquito bloodmeal has a pH of between 7.5 and 7.6. It is thought that in vivo the second inducer is an unknown mosquito-derived gametocyte-activating factor. Here we show that this factor is xanthurenic acid. We also show that low concentrations of xanthurenic acid can act together with pH to induce gametogenesis in vitro. Structurally related compounds are at least ninefold less effective at inducing gametogenesis in vitro. In Drosophila mutants with lesions in the kynurenine pathway of tryptophan metabolism (of which xanthurenic acid is a side product), no alternative active compound was detected in crude insect homogenates. These data could form the basis of the rational development of new methods of interrupting the transmission of malaria using drugs or new refractory mosquito genotypes to block parasite gametogenesis.

Purification and determination of intact molecular mass by electrospray ionization mass spectrometry of the photosystem II reaction center subunits

A reverse phase high pressure liquid chromatography purification system for the rapid separation of photosystem II reaction center proteins free of salts and detergents is described. This procedure results in the isolation of the three small subunits: alpha- and beta-subunits of cytochrome b559 and PsbI protein, with near base-line resolution between each peak, although the D1 and D2 proteins were partially deconvoluted. The molecular masses obtained by electrospray ionization mass spectrometry for the purified beta-subunit of cytochrome b559, alpha-subunit of cytochrome b559, and the PsbI protein, 4,394.8 +/- 0.4, 9,283.7 +/- 0.8, and 4,209.5 +/- 0.4 Da, respectively, are in excellent agreement with values obtained from previous characterization studies (Sharma, J., Panico, M., Barber, J., and Morris, H. R. (1997) J. Biol. Chem. 272, 3935-3943). Direct electrospray analysis of the D1 and D2 proteins suggests that these components exist in heterogeneous forms. The molecular mass ascribed to a predominant form of the D1 protein, 38, 040.9 +/- 6.5 Da, and the D2 protein, 39,456.1 +/- 7.7, are also in agreement with those expected for the mature nonphosphorylated states of these subunits.

Primary structure characterization of the photosystem II D1 and D2 subunits

Mass spectrometry techniques have been applied in a protein mapping strategy to elucidate the majority of the primary structures of the D1 and D2 proteins present in the photosystem II reaction center. Evidence verifying the post-translational processing of the initiating methionine residue and acetylation of the free amino group, similar to those reported for other higher plant species, are presented for the two subunits from pea plants (Pisum sativum L.). Further covalent modifications observed on the D1 protein include the COOH-terminal processing with a loss of nine amino acids and phosphorylation of Thr2. In addition, the studies reported in this paper provide the first definitive characterization of oxidations on specific amino acids of the D1 and D2 proteins. We believe that these oxidations, and to a much lesser extent the phosphorylations, are major contributors to the heterogeneity observed during the electrospray analysis of the intact subunits reported in the accompanying paper (Sharma, J., Panico, M., Barber, J., and Morris, H. R. (1997) J. Biol. Chem. 272, 33153-33157). Significantly, all of the regions that have been identified as those particularly susceptible to oxidation are anticipated (from current models) to be in close proximity to the redox active components of the photosystem II complex.

The effect of pregnancy on cyclosporine levels in renal allograft patients

OBJECTIVE

To assess the effects of pregnancy on cyclosporine levels in six renal allograft patients.

METHODS

Maternal demographic, laboratory, clinical, and perinatal outcome data were recorded in six pregnant women with previous renal allografts receiving cyclosporine immunosuppression. The cyclosporine and serum creatinine levels were measured before pregnancy, during each trimester, and postpartum.

RESULTS

The mean (standard deviation [SD]) maternal age was 29.1 (3.8) years. Parity ranged from 0 to 3. Mean serum creatinine levels tended to be lower during pregnancy than before or after, as did the mean cyclosporine levels. After adjusting for dose, five of six patients had declines in cyclosporine level during pregnancy. The mean (SD) gestational age at delivery was 37.5 (2.8) weeks with a mean (SD) birth weight of 2837 (538) g.

CONCLUSION

Pregnancy in patients with renal allografts can lead to a substantial decline in cyclosporine levels.

Hypothalamic hypertensive factor: an inhibitor of nitric oxide synthase activity

Human and rat plasma and rat hypothalamus contain a cytochemically detectable substance, the concentration of which rises with an increase in salt intake. The plasma concentration of this material is also raised in essential hypertension and in the spontaneously hypertensive rat (SHR), the Milan hypertensive rat, and the reduced renal mass (RRM) hypertensive rat. In the normal rat, the greatest concentration is found in the hypothalamus of the SHR and the RRM hypertensive rat. The physicochemical characteristics of this cytochemically detectable hypothalamic hypertensive factor (HHF), including chromatographic behavior and molecular weight range, suggest that it may share features common to a substituted guanidine that is present in established nitric oxide synthase (NOS) inhibitors. It was therefore decided to determine the effect on NOS activity of the HHF obtained from mature SHR. The ability of HHF to inhibit NOS activity was studied on (1) NOS extracted from bovine aorta, rat brain, and human platelets by measuring the conversion of radiolabeled L-arginine to L-citrulline and (2) rat liver NOS measured indirectly with a cytochemical technique based on the stimulation of soluble guanylate cyclase activity in hepatocytes by NO. HHF showed a biphasic inhibitory action on platelet NOS activity that was greater with HHF obtained from SHR than from Wistar-Kyoto rats. HHF also had a biphasic inhibitory effect on hepatocyte NOS activity that was more potent when obtained from SHR. It is proposed that the increase in HHF, a novel form of NOS inhibitor that is elevated in SHR, may be involved in the rise in arterial pressure.

Urine flow cytometry as a tool to differentiate acute allograft rejection from other causes of acute renal graft dysfunction

BACKGROUND

Recently, urine flow cytometry (UFC) was introduced as a useful noninvasive tool for the immunological monitoring of renal allograft recipients. The presence of an active urine sediment as determined by UFC was found to be associated with acute rejection (AR) episodes.

METHODS

In the present study we assess the value of UFC in the setting of acute graft dysfunction. UFC was performed in 30 patients (32 events) at the time of admission to the hospital for the evaluation of rising creatinine (serum creatinine increment > or =0.6 mg/dl above baseline). UFC analysis was done blinded to the clinical diagnosis, and results were compared with the discharge diagnosis: AR, n=15; chronic rejection (CR), n=8; drug toxicity, n=4; urinary leak, n=2; recurrence of primary disease, n=1; lymphocele, n=1; and unknown, n=1.

RESULTS

The presence of at least 5% of HLA-DR-positive cells and intercellular adhesion molecule-1-positive cells was detected in 100% and 53%, respectively, of the samples associated with AR (P<0.01 vs. others). The specificity value for the diagnosis of AR was: 100% for the presence of intercellular adhesion molecule-1 or CD3-positive cells and 88% for the presence of interleukin-2 receptor-positive or HLA-DR-positive cells. Half of the samples associated with CR had CD14-positive cells (P=0.03 vs. others) with a specificity value of 87.3%. The samples associated with drug toxicity, urological problems, or recurrence of primary disease were remarkable for the lack of expression of the antigens studied.

CONCLUSION

UFC can clearly differentiate AR from other causes of acute renal allograft dysfunction. HLA-DR is revealed to be the most sensitive and intercellular adhesion molecule-1 the most specific marker for AR. The presence of CD14-positive cells was highly suggestive of CR. Due to its objective nature, UFC should be considered in the evaluation of graft dysfunction.

A novel geometry mass spectrometer, the Q-TOF, for low-femtomole/attomole-range biopolymer sequencing

Ultra-high-sensitivity, biopolymer sequencing is a goal in many fields of molecular biology, and collisionally activated decomposition electrospray mass spectrometry (CAD ES MS/MS) using a triple quadrupole mass spectrometer has become a method of choice for work in the high- to mid-femtomole range. However, when the detection of ions becomes statistical, as it may in that range, the mass assignment of fragment ions is inaccurate and either sequencing becomes impossible or ambiguities result due, for example, to the closeness in amino acid residue masses (I/L, N or K/Q, E). Some ambiguities may be resolved by synthesizing possible sequences, but this is unsatisfactory. In considering the limitations of triple quadrupole MS/MS with respect to scanning ion detection, resolution, transmission, and mass accuracy, we reasoned that a novel geometry quadrupole orthogonal acceleration time-of-flight (Q-TOF) instrument would have special merit for ultra-high-sensitivity MS/MS sequencing, and suggested its construction for this purpose some three years ago. A prototype Q-TOF has now been built by Micromass [Morris et al. (1996), Rapid Commun. Mass Spectrom. 10, 889-896], and in the first research on the instrument, including MHC antigen and filarial nematode glycoprotein studies, we demonstrate low-femtomole- and attomole-range sequencing with mass accuracy of better than 0.1 Da throughout the daughter-ion spectrum, thus removing sequencing ambiguities in some of the most challenging work demanding the highest sensitivity.

Thymopentin loaded microsphere preparation by w/o/w emulsion technique: in vitro/ex vivo evaluation

Poly-D,L-lactide (PDLLA) and polylactide-co-glycolide (PLGA) microspheres containing thymopentin have been prepared by a water-in-oil-in-water-emulsion/solvent evaporation technique. The goal is to stabilize the active compound thymopentin, and to prolong its therapeutic activity, by embedding the drug in a polymeric matrix. The microspheres obtained have been characterized for their morphology and drug content. In-vitro dissolution tests have been performed on the microspheres. Results show that the type of polymer employed (PDLLA or PLGA) does not seem to affect microsphere morphology, while in-vitro dissolution profiles are greatly influenced by the composition of polymer matrix. Ex-vivo evaluation of PLGA microspheres performed on mouse thymocites shows that biological activity of Thymopentin is maintained after loading into PLGA microspheres.

Urine flow cytometry as a predictor of renal allograft function

The value of urine flow cytometry (UFC) in diagnosing acute renal allograft rejection (AR) was recently established in a prospective double-blind study. In this study, we report the 1-year follow-up of three groups of patients identified during the previous study: group 1--stable patients (no ARs) with persistently negative UFCs (n=7); group II--patients who had early ARs (<3 months after transplantation), with positive UFCs that completely normalized with antirejection therapy (n=8); group III--stable patients (no ARs) with positive UFCs (n=7). By definition, group III consists of patients previously considered to have "false positive" UFCs. All patients received standard immunosuppressive therapy, with regimens that included cyclosporine at doses adjusted to maintain target levels. Serum creatinine (SCr) levels (mg/dl) were similar in all three groups at 1 month after transplantation. However, at 1 year after transplantation, SCr was 1.4 +/- 0.2 in group I, 2.0 +/- 0.9 in group II, and 1.9 +/- 0.3 in group III (P=0.004 group I vs. group III). There were no ARs clinically diagnosed during this follow-up period in any of the three groups of patients, but there were significantly higher SCr increments among group III patients after the 1 year of follow-up. The detection of an active urine sediment by flow cytometry in "clinically stable" allograft recipients may indicate ongoing, subclinical acute rejection activity, which in this study was found to be associated with worse renal function at the end of the first posttransplant year as compared with patients with persistently negative UFCs. Increased immunosuppression may be indicated for these patients with persistently positive UFCs.

Characterization of the low molecular weight photosystem II reaction center subunits and their light-induced modifications by mass spectrometry

A sensitive and simple reverse phase HPLC purification scheme was developed for the rapid separation of the small protein subunits from photosystem II reaction center preparations. The precise molecular masses of the alpha- and beta-subunits of cytochrome b559 and the psbI gene product from pea plants, found to be 4394.6 +/- 0. 6, 9283.6 +/- 0.7, and 4209.5 +/- 0.5 Da, respectively, were then successfully determined for the first time by electrospray- and fast atom bombardment-mass spectrometry. Discrepancies between the molecular weights assigned and those calculated from the respective DNA sequences were observed for alpha- and beta-subunits of cytochrome b559. Currently, the nucleotide sequence of the psbI gene product from pea plants is not available. Application of novel mapping and sequencing strategies has assured the elucidation of full primary structures of all of the purified subunits. The modifications identified here include the post-translational processing of the initiating methionine on both subunits of cytochrome b559, NH2-terminal acetylation and an mRNA editing site at residue 26 (Ser --> Phe) on the beta-subunit, and retention of the NH2-terminal formyl-Met on the psbI gene product. In addition, specific oxidation of a single amino acid residue was identified on the psbI gene product and the beta-subunit purified from light-treated reaction center preparations. Overall, these studies provide the first detailed primary structural characterization of the small subunits of the reaction center complex and their associated light-induced modifications.