AB1388 CHARACTERISTICS ASSOCIATED WITH MYCHART ACTIVATION AND REASONS FOR NON-USE AMONG RHEUMATOLOGY CLINIC PATIENTS

Background

Electronic patient portals, such as MyChart by Epic, allow patients to view their medical records, request medication refills, and communicate with their health care providers. Factors associated with portal use include being younger, female, White, having private insurance, and having chronic illness.1

The Hospital for Special Surgery (HSS) rheumatology clinic serves primarily patients with public insurance (Medicaid, which insures low-income adults, and Medicare, which insures adults >65 years old and those with eligible chronic illness/disability). These patients may be at increased risk for poor health outcomes due to clinical and socioeconomic factors and they are less likely to use MyChart than patients seen in HSS private practices. Increased MyChart use may benefit this high-risk group and improve health equity.

Objectives

This study aims to identify characteristics associated with MyChart activation and reasons for its underutilization among patients seen in the HSS rheumatology clinic.

Methods

We identified all patients aged ≥ 18 years seen in the HSS rheumatology clinic at least twice between January 15, 2019 and January 14, 2021, with at least one visit occurring between July 15, 2020 and January 14, 2021. MyChart status (active vs. inactive) and sociodemographic and clinical variables were extracted from the electronic health record (EHR). We used chi-square tests and t-tests to compare characteristics between patients with and without active MyChart; p-value <0.05 was considered significant (Table 1). In addition, 10 rheumatology fellows were prompted on 3 occasions over 6 weeks to informally survey their own clinic patients with inactive MyChart accounts by asking: “What is your primary reason for not using MyChart?”.

Table 1.

Baseline Characteristics of Hospital for Special Surgery Rheumatology Clinic Patients Stratified by MyChart Activation Status

MyChart Active (N=726)MyChart Inactive (N=501)p-valueAge, yrs - Mean (SD)50.3 (15.6)60.0 (15.3)<0.01Female - N (%)601 (82.8)412 (82.2)0.80Race - N (%)0.37•White/Caucasian275 (37.9)184 (36.7)•Black/African American185 (25.5)135 (27.0)•Asian58 (8.0)25 (5.0)•Other189 (26.0)145 (28.9)•Unknown18 (2.5)11 (2.2)Ethnicity - N (%)0.27•Hispanic/Latino294 (40.5)226 (45.1)•Not Hispanic/Latino422 (58.1)268 (53.5)•Unknown10 (1.4)7 (1.4)Preferred language - N (%)<0.01•English611 (84.2)332 (66.3)•Spanish72 (9.9)134 (26.8)•Other43 (5.9)35 (7.0)Needs interpreter - N (%)106 (14.6)156 (31.1)<0.01

Results

There were 1,227 patients included (93.2% with Medicaid and/or Medicare insurance). Compared to patients with inactive MyChart (42.9%), those with active MyChart (57.1%) were younger (50.3 ± 15.6 vs. 60.0 ± 15.3 years, p<0.01). The majority of patients in both groups was female. There was no significant difference in race or ethnicity between groups. Patients without active MyChart were less likely to identify English as their preferred language and more likely to require an interpreter for clinic visits (Table 1).

The rheumatology fellows collectively asked 16 clinic patients with inactive MyChart their primary reason for non-use. The most commonly cited reason was difficulty using the technology (n=8; 50.0%); others included visual impairment (n=2; 12.5%), preference for using the telephone (n=2; 12.5%), concerns about security/spam (n=2; 12.5%), not having a smart phone/computer (n=1; 6.3%), and having a language barrier (n=1; 6.3%).

Conclusion

In the HSS rheumatology clinic, patients who did not have active MyChart were older and less likely to be English-speaking than those who did. The most common barrier to MyChart use reported by patients was difficulty with the technology. This pilot data suggests a need for interventions to facilitate patient-provider communication, specifically targeting older and non-English-speaking rheumatology clinic patients, with the goal of advancing patient engagement and health equity.

References

[1]Ancker JS, et al. J Gen Intern Med. 2011 June 7. doi: 10.1007/s11606-011-1749-y.

Disclosure of Interests

Caroline Siegel: None declared, Anne Bass: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Walgreens, Cytodyn, Omar Bruce: None declared, Justin Olmscheid: None declared, Nilasha Ghosh: None declared, Sebastian E. Sattui Grant/research support from: AstraZeneca, Monica Schwartzman: None declared, Diane Zisa: None declared, Amit Lakhanpal: None declared, Kevin Yip: None declared, Linda Yue: None declared, Juliet Aizer Grant/research support from: Pfizer and Lilly, Jessica Berman: None declared

Abstract P189: Disruption of Cyp2c44 Increases Sodium Chloride Cotransporter Expression and Activity in the Distal Convoluted Tubule

Cytochrome-P450 (CYP) epoxygenase plays an important role in the regulation of renal sodium transport. Previous studies have demonstrated that global disruption of Cyp2c44 , a major epoxygenase in the renal tubules, increased ENaC activity in the collecting duct. In addition, we have demonstrated that an increase in dietary Na intake significantly increased the mRNA expression of CYP2c44 in the DCT. DCT is responsible for the reabsorption of 5-9% of filter Na load and is the target for thiazide diuretic. Na absorption in the DCT is mediated by NaCl cotransporter (NCC) and also by ENaC in the late part of DCT. However, the role of epoxyeicosatrienoic acid (EET) in the regulation Na transport in the DCT is not clear. We now examine the role of CYP2c44 and EET in the regulation of NCC expression. The disruption of Cyp2c44 increases the expression of NCC and ENaC activity in the DCT. The disruption of CYP2c44 also suppressed the renal expression of GPR75, a receptor which is activated by 20-hydroxyeicosatetraenoic acid (20-HETE). Renal Na clearance study also demonstrates that the effect of hydrochlorothiazide on Na excretion in Cyp2c44 knockout (KO) mice was significantly higher than those of WT mice. In addition, the disruption of Cyp2c44 significantly increased the expression of ste20-proline and alanine-rich kinase (SPAK) which is known to stimulate NCC activity by phosphorylation. Increased dietary Na intake decreases NCC expression and this effect is blunted in Cyp2c44 KO mice. The role of EET in the regulation of NCC expression is further suggested by the finding that high fat-diet induced increase in NCC expression is inhibited by application of EET. We conclude that CYP2c44-derived EET plays an important role in inhibiting NCC and ENaC in the DCT.

Abstract P221: Vascular Smooth Muscle-Specific Overexpression of Cyp4a12-20-HETE Synthase Causes Hypertension and Vascular Remodeling

20-Hydroxyeicosatetraenoic acid (20-HETE) is a potent vasoactive eicosanoid of the microcirculation exhibiting effects on vascular smooth muscle (VSM) function that include stimulation of contractility, migration and growth. We have previously demonstrated in mice which globally overexpress 20-HETE that hypertension as well as vascular remodeling is not fully prevented by pharmacological normalization of blood pressure. However, both hypertension and vascular remodeling are prevented by antagonism of 20-HETE, suggesting that 20-HETE exerts vascular effects independent of hypertension. To examine the contribution of VSM-derived 20-HETE to hypertension and vascular remodeling, we have developed a transgenic mouse model that overexpresses the primary mouse 20-HETE synthase, Cyp4a12, specifically in VSM by crossbreeding floxed Cyp4a12 with Myh11-Cre mice. All mice carry the floxed Cyp4a12 gene and express a GFP protein under control of a modified CMV promoter. Cre-recombination excises the GFP cDNA and inserts the Cyp4a12 cDNA.

Three to four month old male Cyp4a12-floxed mice carrying the Myh11-Cre gene (Cyp4a12 fl/fl Myh11 Cre+/- ) exhibited higher systolic blood pressure than control mice Cyp4a12 fl/fl Myh11 Cr-/- (WT) mice (135 vs. 115 mmHg, n=4, *p<0.05). 20-HETE production in Cyp4a12 fl/fl Myh11 Cre+/- mice were higher than in WT in mesenteric (3333±891 vs. 545± 196 ng/mg/h) and renal interlobar arteries (RIA; 1859±376 vs. 242±62 ng/mg/h). Plasma levels of 20-HETE were also elevated (324±61 vs. 185±34 pg/mL) while urinary levels were not significantly different (146±26 vs. 117±29 pg/mL). We also observed increased medial thickness and decreased lumen area of blood vessels by Myh11 immunofluorescence in heart and kidney sections. RIA from male Myh11-Cyp4a12 mice displayed higher constrictor sensitivity to phenylephrine and impaired relaxation to acetylcholine compared to WT.

Taken together, these data suggest that this model displays hypertension and pathological hypertrophic vascular remodeling. We therefore conclude that the Cyp4a12 fl/fl Myh11 Cre/- is a promising and unique transgenic mouse model to examine the contribution of smooth muscle-derived 20-HETE to hypertension and hypertrophic vascular remodeling.

Abstract P186: Proximal Tubular-Specific Overexpression of the Cyp4a12-20-Hete Synthase Promotes Hypertension

20-Hydroxyeicosatetraenoic acid (20-HETE) is a cytochrome P450 (CYP)-derived arachidonic acid metabolite linked to regulation of blood pressure via actions on the renal microvasculature and tubules. In renal microvessels, 20-HETE promotes vasoconstriction, vascular remodeling, and vascular injury; all of which contribute to hypertension, whereas in tubular structures 20-HETE has been linked to inhibition of sodium transport and lowering of blood pressure. Induction or global overexpression of Cyp4a12-20-HETE synthase, the primary 20-HETE producing enzyme in mice, results in hypertension. Since these mice display global overproduction of 20-HETE, it is difficult to dissect the exact contribution of vascular versus tubular 20-HETE to the hypertension. To begin addressing this issue, the current study was undertaken to define the blood pressure phenotype of novel transgenic mice with proximal tubule-specific overexpression of the Cyp4a12-20-HETE synthase (PEPCK-cyp4a12 mice). These mice generated by crossing the Cyp4a12 fl/fl with PEPCK (phosphoenolpyruvate carboxykinase promoter)-Cre mice, showed increased Cyp4a12 mRNA expression (2.6±0.9 fold increase; p<0.05) and 20-HETE production in the renal cortex (138±32 pg/mg vs. 80±6 pg/mg). Most importantly, the systolic blood pressure was markedly elevated in the PEPCK-Cyp4a12 mice as compared to WT littermates (142±2 vs. 111±3 mmHg; p<0.05). Interestingly, the PEPCK-Cyp4a12 mice exhibited significantly higher levels of urinary 20-HETE as compared to WT littermates (205±50 vs 83±5 pg/ml; p<0.05) whereas plasma 20-HETE levels remained unchanged (231±32 vs 190±25 pg/ml). Moreover, in PEPCK-Cyp4a12 (n=4) urinary volume was lower (2.15±0.05 vs 3.17±0.20 ml/day, p=0.003) and UNaV appeared lower (181±7 vs 194±25 μmol/day, p=0.35) as compared to WT littermates. These results are in line with the possibility that 20-HETE overproduction at the level of the proximal tubule promotes rather than opposes hypertension. The exact mechanisms need to be further examined.

Abstract 015: Increased 20-HETE Levels Contribute to Impaired Glucose Metabolism and Type 2 Diabetes in Cyp4a14 Knockout Mice Fed on High Fat Diet

20-HETE (20-Hydroxyeicosatetraenoic acid) is a cytochrome P450 ω-hydroxylase metabolite of arachidonic acid that promotes endothelial dysfunction, microvascular remodeling and hypertension. Previous studies have shown that urinary 20-HETE levels correlate with BMI and plasma insulin levels. However, there is no direct evidence for the role of 20-HETE in the regulation of glucose metabolism, obesity and type 2 diabetes mellitus. In this study we examined the effect of 20-SOLA (2,5,8,11,14,17-hexaoxanonadecan-19-yl-20-hydroxyeicosa-6(Z),15(Z)-dienoate), a water-soluble 20-HETE antagonist, on blood pressure, weight gain and blood glucose in Cyp4a14 knockout (Cyp4a14-/-) mice fed high-fat diet (HFD). The Cyp4a14-/- male mice exhibit high vascular 20-HETE levels and display 20-HETE-dependent hypertension. There was no difference in weight gain and fasting blood glucose between Cyp4a14-/- and wild type (WT) on regular chow. When subjected to HFD for 15 weeks, a significant increase in weight was observed in Cyp4a14-/- as compared to WT mice (56.5±3.45 vs. 30.2±0.7g, p<0.05). Administration of 20-SOLA (10mg/kg/day in drinking water) significantly attenuated the weight gain (28.7±1.47g, p<0.05) and normalized blood pressure in Cyp4a14-/- mice on HFD (116±0.3 vs. 172.7±4.6mmHg, p<0.05). HFD fed Cyp4a14-/- mice exhibited hyperglycemia as opposed to normal glucose levels in WT on a HFD (154±1.9 vs. 96.3±3.0 mg/dL, p<0.05). 20-SOLA prevented the HFD-induced hyperglycemia in Cyp4a14-/- mice (91±8mg/dL, p<0.05). Plasma insulin levels were markedly high in Cyp4a14-/- mice vs. WT on HFD (2.66±0.7 vs. 0.58±0.18ng/mL, p<0.05); corrected by the treatment with 20-SOLA (0.69±0.09 ng/mL, p<0.05). Importantly, glucose and insulin tolerance tests showed impaired glucose homeostasis and insulin resistance in Cyp4a14-/- mice on HFD; ameliorated by treatment with 20-SOLA. This novel finding that blockade of 20-HETE actions by 20-SOLA prevents HFD-induced obesity and restores glucose homeostasis in Cyp4a14-/- mice suggests that 20-HETE contributes to obesity, hyperglycemia and insulin resistance in HFD induced metabolic disorder. The molecular mechanisms underlying 20-HETE mediated metabolic dysfunction are being currently explored.

Abstract 064: 20-HETE Contributes to Vasoconstriction of Renal Microvessels and Sodium Retention in Cyp4a14-/- Mice, a Model of 20-HETE Dependent Hypertension

20-HETE (20-Hydroxyeicosatetraenoic acid), is a cytochrome P450 (CYP) 4A-derived arachidonic acid metabolite. 20-HETE has been linked to both pro-hypertensive (via increased vasoconstriction, vascular remodeling and vascular injury of renal microvessels) and anti-hypertensive (inhibiting ion transport in the distal nephron) functions. In this study we examined the effect of 20-SOLA (2,5,8,11,14,17-hexaoxanonadecan-19-yl-20-hydroxyeicosa-6(Z),15(Z)-dienoate), a water soluble antagonist of the actions of 20-HETE on renal hemodynamics and sodium (Na) excretion in Cyp4a14 knockout (CYP4a14-/-) male mice. The CYP4a14-/- male mice display hypertension accompanied by increased vascular 20-HETE levels. Administration of 20-SOLA (10mg/kg/day in drinking water) normalized blood pressure (BP) in male Cyp4a14-/- mice at day 10 of treatment (124±1 vs. 153±2 mmHg in untreated male Cyp4a14-/- mice; p<0.05). The normalization of blood pressure was accompanied by transient increase in the urinary sodium excretion in the Cyp4a14-/- male mice (8.3±0.7 vs. 5.8±0.5 μmol/g body weight/day; p<0.05). Importantly, 20-SOLA increased glomerular filtration rate (GFR) of Cyp4a14-/- mice (2.38±0.05 vs. 1.88±0.18 μL/min/mg kidney weight, p<0.05) as opposed to no changes observed in the wild type (WT: (2.26±0.18 vs. 2.33±0.20μL/min/mg kidney weight). Evaluation of the renal blood flow (RBF) by laser Doppler flowmetry showed that treatment with 20-SOLA increased the RBF in Cyp4a14-/- mice by 12.3±4%, which remained unaltered in the WT. Additionally, the pressure-induced myogenic tone of isolated preglomerular microvessels was significantly elevated in Cyp4a14-/- mice; 20-SOLA treatment prevented the increase in myogenic responses. The natriuretic response to an isotonic saline loading challenge (10% of body weight, IP) was significantly attenuated in the Cyp4a14-/- mice as compared to the WT (35.5±2.8 vs. 57.4±8.3 percentage of Na load, p<0.05); this was corrected by 20-SOLA (61.7±5.7 percentage of Na load, p<0.05). These results confirm that 20-SOLA normalizes blood pressure of Cyp4a14-/- male mice and demonstrates that this is associated with increases in GFR, RBF and natriuresis.

Abstract 295: The Role of 20-HETE in the Control of Prostate Cancer Tumor Vasculature

20-Hydroxyeicosatetraenoic acid (20-HETE) is a cytochrome P450-derived arachidonic acid metabolite endowed with vasoconstrictor. Recent reports documented that 20-HETE synthesis inhibitors decrease the growth of glioma and renal cell carcimona, and that urinary 20-HETE levels are significantly elevated in prostate cancer patients. These reports led us to investigate the role of 20-HETE in the regulation of blood flow to prostate cancer tumors. First, we compared 20-HETE levels in prostate cancer cell line-LNCaP and normal prostate epithelial cells. Cultured LNCaP cells produced high levels of 20-HETE (566±139 pg/mg protein), whereas 20-HETE production was undetectable in normal prostate epithelial cells. Second, subcutaneous tumors were induced in balb/c nude mice by injection of LNCaP cells, followed by assessment of 20-HETE in both tumors and isolated tumor vessels. We found that LNCaP cell-derived tumors had high levels of 20-HETE (425±97 pg/mg protein), while the level in isolated tumor vessels was undetectable. Third, we used laser-doppler flowmetry to evaluate whether tumor-derived 20-HETE influences tumor blood flow and vessel diameter in vivo. Topical application of the 20-HETE antagonist 20-6,15-HEDE (1 mM) to tumor vessels in vivo increased blood flow by 1.81±0.34-fold and vessel diameter by 1.286±0.133-fold, which responses were reversed by topical application of 20-HETE in a dose-dependent manner. We conclude that LNCaP cell-derived tumors produce 20-HETE which, in turn, promotes vasoconstriction leading to reduction of tumor blood flow.

Abstract 517: The CYP4A-20-HETE System Regulation of Endothelial Progenitor Cell Functions that Associated with Angiogenesis

The CYP4A-20-HETE system regulates the neovascularization process via its potent vascular effects mainly on endothelial cells and vascular smooth muscle cells. Endothelial progenitor cells (EPC) also actively participate in physiological and pathological neovascularization. Our group first reported that the CYP4A-20-HETE system is present and functional in EPC derived from human umbilical cord blood (HUCB) and that EPC also respond to exogenous 20-HETE with increased proliferation and migration. We hypothesized that the angiogenic actions of the CYP4A-20-HETE system may involve regulation of EPC functions that associated with angiogenesis. In this study, we identified CYP4A11/22 as the main 20-HETE synthases in EPC derived from HUCB by real time PCR. We also examined the effects of exogenous 20-HETE on EPC adhesion since adhesion of EPC to extracellular matrix is an important aspect of EPC homing to the sites where angiogenesis is occurring. We found that 20-HETE (1 μM) increased EPC adhesion to fibronectin and SDF-1α coating by ∼40% and ∼35%, respectively. These increases in adhesion are completely abolished in the presence of 20-hydroxy-6, 15-eicosadienoic acid (20-HEDE), a 20-HETE antagonist. We further established the mouse ischemic hindlimb model to study the effects of pharmacological inhibition of the CYP4A/F-20-HETE system using the 20-HETE synthase inhibitor Dibromo-dodecenyl-methylsulfimide (DDMS) and 20-HEDE on compensatory angiogenesis in response to ischemia. Systemic treatment of animals with 10 mg/kg/day of either DDMS or 20-HEDE inhibited hindlimb compensatory angiogenesis by more than 50% without significant effects on the blood pressure. Specific targeting of the EPC-derived CYP4A-20-HETE system needs to be performed to further dissecting the role of systemic and EPC-derived 20-HETE on angiogenic processes. These findings implicates the CYP4A-20-HETE system as a novel regulator of EPC functions that are associated with angiogenesis and suggests that it can act as both an autocrine and paracrine regulatory factor.

Human heme oxygenase-1 gene transfer lowers blood pressure and promotes growth in spontaneously hypertensive rats

Heme oxygenase (HO) catalyzes the conversion of heme to biliverdin, with release of free iron and carbon monoxide. Both heme and carbon monoxide have been implicated in the regulation of vascular tone. A retroviral vector containing human HO-1 cDNA (LSN-HHO-1) was constructed and subjected to purification and concentration of the viral particles to achieve 5x10(9) to 1x10(10) colony-forming units per milliliter. The ability of concentrated infectious viral particles to express human HO-1 (HHO-1) in vivo was tested. A single intracardiac injection of the concentrated infectious viral particles (expressing HHO-1) to 5-day-old spontaneously hypertensive rats resulted in functional expression of the HHO-1 gene and attenuation of the development of hypertension. Rats expressing HHO-1 showed a significant decrease in urinary excretion of a vasoconstrictor arachidonic acid metabolite and a reduction in myogenic responses to increased intraluminal pressure in isolated arterioles. Unexpectedly, HHO-1 chimeric rats showed a simultaneous significant proportionate increase in somatic growth. Thus, delivery of HHO-1 gene by retroviral vector attenuates the development of hypertension and promotes body growth in spontaneously hypertensive rats.

Selective inhibition of arachidonic acid epoxidation in vivo

Cytochrome P450 (CYP)-derived arachidonic acid metabolites, including epoxyeicosatrienoic acids (EETS) and 20-HETE, have been implicated in the regulation of renal function and vascular tone. Studying the function of specific CYP arachidonate metabolites has been hampered due to lack of selective inhibitors and difficulty in their solubilization. We have identified MS-PPOH as a potent and selective inhibitor of CYP-catalyzed arachidonate epoxidation in vitro. We used 2-hydroxypropyl-beta-cyclodextrin as a vehicle in order to administer MS-PPOH in vivo. One hour after administration, MS-PPOH (5 mg, IV bolus) significantly inhibited arachidonic acid epoxidation in rat renal cortical microsomes (vehicle-282 +/- 12 pmol/mg/min, MS-PPOH-206 +/- 10 pmol/mg/min, p < 0.05) but had no effect on 20-HETE formation (vehicle-383 32 pmol/mg/min, MS-PPOH-367 +/- 9 pmol/mg/min). The inhibitory effect lasts at least for 6 hours. There was no inhibition of 20-HETE synthesis at any time point. We also examined the effect of MS-PPOH on renal excretiry function. Three hours after MS-PPOH administration to anesthetized rats, urine flow rate became significantly higher (vehicle-275 +/- 16 microl/hour, MS-PPOH-406 +/- 44 microl/hour, p < 0.05). Sodium excretion rate was also significantly higher (vehicle-28.7 +/- 4 micromol/hour, MS-PPOH-63.3 +/- 10 micromol/hour, p < 0.05) but potassium excretion rate was not affected (vehicle-65.5 +/- 5 micromol/hour, MS-PPOH-79.2 +/- 2 micromol/hour). These results suggest that MS-PPOH may be useful as a selective inhibitor of CYP-catalyzed arachidonic acid epoxidation in vivo, and implicate EETs and anti-diuretic and anti-natriuretic in the regulation of renal function.

Children with cystic fibrosis benefit from massage therapy

OBJECTIVE

To measure the effects of parents giving massage therapy to their children with cystic fibrosis to reduce anxiety in parents and their children and to improve the children's mood and peak air flow readings.

METHODS

Twenty children (5-12 years old) with cystic fibrosis and their parents were randomly assigned to a massage therapy or a reading control group. Parents in the treatment group were instructed and asked to conduct a 20-minute child massage every night at bedtime for one month. Parents in the reading control group were instructed to read for 20 minutes a night with their child for one month. On days 1 and 30, parents and children answered questions relating to present anxiety levels and children answered questions relating to mood, and their peak air flow was measured.

RESULTS

Following the first and last massage session, children and parents reported reduced anxiety. Mood and peak air flow readings also improved for children in the massage therapy group.

CONCLUSIONS

These findings suggest that parents may reduce anxiety levels by massaging their children with cystic fibrosis and their children may benefit from receiving massage by having less anxiety and improved mood, which in turn may facilitate breathing.

Renal cytochrome P-450-related arachidonate metabolism in rabbit aortic coarctation

Cells of the medullary segment of the thick ascending limb of Henle's loop (TALH) convert arachidonic acid (AA) via the cytochrome P-450 monooxygenase pathway to biologically active metabolites: P1, a vasorelaxant, and P2, an inhibitor of Na+-K+-ATPase activity. These AA metabolites may contribute to the renal vascular and metabolic adjustments in response to renal hypoperfusion and the attendant elevation of blood pressure produced by suprarenal aortic coarctation. On the eighth postoperative day, the blood pressures of hypertensive and sham-operated control rabbits were 105 (90-115) and 63 (60-64) mmHg (medians with semiquartile values), respectively (P less than 0.01). Formation of P1 and P2 was increased twofold in TALH cells obtained from hypertensive rabbits: 2.35 (1.79-4.83) and 1.28 (1.56-4.56) micrograms AA converted.mg protein-1.30 min-1 compared with sham-operated rabbits: 1.27 (1.03-1.53) and 0.64 (0.58-1.10) micrograms AA converted.mg protein-1.30 min-1 (P less than 0.05). The profile of biological activity of AA metabolites contained within P1 and P2 was unaffected by aortic coarctation. The cytochrome P-450 monooxygenase-derived AA metabolites may exert a defensive function to limit the degree of TALH cell injury in response to renal hypoperfusion and associated zonal anoxia by reducing energy-dependent Na+-K+-ATPase activity and affecting local vasodilatation.

Novel renal arachidonate metabolites

Cells of the thick ascending limb of the loop of Henle (TALH) metabolize arachidonic acid (AA) via the cytochrome P450 monooxygenase system to biologically active products that are resolved into two peaks, P1 and P2, on reverse-phase HPLC. Each peak contains materials that have characteristic biological activity. P1 contains a material that relaxes blood vessels and is structurally similar to a vasodilator, the 5,6 epoxyeicosatrienoic acid (EET). P2 contains a material that inhibits cardiac Na+-K+-ATPase, the major component of which has been identified as the 11,12 dihydroxyeicosatrienoic acid. In mTALH cells obtained from rabbits made hypertensive by aortic coarctation, there was a selective increase in P1 and P2 formation compared to other renomedullary cells. We have identified AA metabolites in bovine corneal epithelium with biological properties and chemical features similar to those of mTALH cells. 12(R)hydroxyeicosatetraenoic acid (12(R) HETE) a possible derivative of the 11,12-EET, is produced by the cornea and also has been shown to inhibit Na+-K+-ATPase activity. Renal microsomes obtained from spontaneously hypertensive rats (SHRs) also metabolize AA via a cytochrome P450 monooxygenase pathway to three principal biologically active metabolites that are formed in increased amounts during the developmental phase of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Y-derived sequences detected in a 45,X male by in situ hybridization

A two-month-old boy with normal genitalia and descended testes was referred for a suspected hematological disorder. Cytogenetic analysis showed a 45,X chromosome constitution. In situ hybridization with the Y-derived probe 50f (provided by Professor Marc Fellous) was performed utilizing metaphase chromosomes to determine whether Y material could be detected. A significant amount of label (17 of 150 cells) was found on chromosome 5p suggesting a 5;Y translocation. This translocation was verified by high-resolution G-banded and G-11-stained chromosomes.

Vasoactivity of arachidonic acid epoxides

Arachidonic acid (AA) can be metabolized to epoxides and their corresponding diols via the cytochrome P450 epoxygenase pathway. We have compared the vascular activity of four synthetically prepared epoxyeicosatrienoic acids, i.e. 5,6-, 8,9-, 11,12- and 14,15-EET (2-20 microM) on the isolated perfused rat tail artery. The 5,6-EET was equipotent with acetylcholine in dose dependently reducing vascular resistance (ED50 = 3.4 +/- 0.5 microM). The 8,9-, 11,12- and 14,15-EETs of AA did not affect vascular resistance; neither did the 5,6-DHET and delta-lactone, hydrolysis products of 5,6-epoxide. We suggest that the 5,6-epoxide, in contrast to other cytochrome P450-derived products, contributes to the regulation of regional vascular tone.

Spontaneous relapse of naproxen-related nephrotic syndrome

A number of nonsteroidal anti-inflammatory drugs cause nephrotoxicity characterized by nephrotic syndrome, usually with acute renal insufficiency. Remission of proteinuria and renal insufficiency after discontinuation of nonsteroidal anti-inflammatory drug therapy is characteristic. Relapse of nephrotic syndrome in the absence of nonsteroidal anti-inflammatory drug rechallenge has not previously been reported. Nephrotic syndrome developed in an 80-year-old woman taking naproxen, and remitted after discontinuation of the drug. Nephrotic syndrome relapsed four months later without re-exposure to naproxen or other nonsteroidal anti-inflammatory drugs. Renal biopsy at that time revealed minimal-change disease. The relationship between these two episodes of nephrotic syndrome is discussed with regard to possible pathogenetic mechanisms.

Cytochrome P450-dependent arachidonate metabolism in renomedullary cells: formation of Na+K+-ATPase inhibitor

The medullary portion of the thick ascending limb of the loop of Henle (mTALH) has one of the highest concentrations of Na+K+-ATPase found in mammalian tissues, reflecting the importance of this nephron segment in the regulation of extracellular fluid volume, as active sodium transport is driven by Na+K+-ATPase. We have isolated cells derived primarily from the mTALH of the outer medulla of rabbit kidney and have identified a cytochrome P450-dependent mono-oxygenase system which metabolizes arachidonic acid to two biologically active oxygenated peaks, each containing two or more products. One of the peaks potently inhibits cardiac Na+K+-ATPase and the other relaxes blood vessels. We report that formation of these oxygenated arachidonate metabolites is stimulated by arginine vasopressin (AVP) and salmon calcitonin (SCT). In mTALH cells obtained from rabbits made hypertensive by aortic constriction there was a selective increase in P1 and P2 formation compared to other renomedullary cells.

Enriched prostaglandin E-9 ketoreductase activity in outer medullary cells of the rabbit kidney

PGE2 metabolism was examined in rabbit renal slices and cell suspensions from the outer medulla, enriched (TALH) and depleted (OMC) for the thick ascending limb of Henle's loop. Metabolism was negligible in intact cells, either OMC or TALH fractions. However, in OMC and TALH homogenates, transformation of PGE2 to PGF2 alpha by NADPH-dependent prostaglandin E-9 ketoreductase (PGE-9KR) was observed at a PGE2 concentration of 4 X 10(-9) M. This activity was not reversible and was enriched ten-fold in the TALH with 41% of PGE2 transformed to PGF2 alpha after 30 min incubation. PGF2 alpha formation from PGE2 could not be detected in homogenates of cortex, medulla or papilla. PGE-9KR activity, particularly in the thick ascending limb, may be a source of PGF2 alpha in urine.

Renal arachidonic acid metabolism. The third pathway

Cells were isolated from the outer medulla of the rabbit kidney, primarily from the thick ascending limb of Henle's loop (mTALH). These mTALH cells are heavily invested with a cytochrome P450-linked monooxygenase that represents the third pathway by which arachidonic acid is metabolized. After cell separation, approximately 80% of the cells proved to be mTALH in origin, based on electron microscopic criteria and immunofluorescent localization of Tamm-Horsfall protein, a specific marker for mTALH cells. The specific activity of alkaline phosphatase, a marker for proximal tubular cells, decreased threefold after separation of mTALH cells from outer medullary cells, associated with a fourfold increase in the capacity of the separated mTALH cells to metabolize arachidonic acid. Incubation of mTALH cells with 14C-arachidonic acid resulted in formation of oxygenated metabolites, identified as two peaks (P1 and P2), which accounted for 30 to 40% of the recovered radioactivity. Formation of prostaglandin E2 and F2 alpha accounted for only 3 to 5%. The chromatographic retention times of P1 and P2 were different from products of lipoxygenases. An inhibitor of cytochrome P450-dependent enzymes, SKF-525A (50 microM), reduced product formation by mTALH cells by more than 70%, while induction of cytochrome P450 increased product formation. Formation of P1 and P2 by cell-free homogenates of mTALH was totally dependent on the presence of nicotinamide adenine dinucleotide phosphate, reduced form (NADPH), which suggests a NADPH-dependent cytochrome P450-linked monooxygenase pathway. Vasopressin and calcitonin (10(-10) M to 10(-7) M) stimulated release of arachidonic acid metabolites from mTALH cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal cytochrome P450-related arachidonate metabolite inhibits (Na+ + K+)ATPase

The function of the nephron, the anatomical unit of the kidney, is segmented; at least 12 segments have been identified that differ in their morphology, transport properties and hormonal responsiveness. The medullary portion of the thick ascending limb of the loop of Henle (mTALH) has one of the highest concentrations of (Na+ + K+)ATPase found in mammalian tissues, reflecting the importance of this nephron segment in the regulation of extracellular fluid volume, as active sodium transport is driven by (Na+ + K+)ATPase. Here, in cells derived primarily from the mTALH of the outer medulla of rabbit kidney, we have identified a cytochrome P450-dependent monooxygenase system which metabolizes arachidonic acid to two biologically active oxygenated products; one of the products inhibits (Na+ + K+)ATPase and the other relaxes blood vessels. We report that formation of these oxygenated arachidonate metabolites is stimulated by arginine vasopressin (AVP) and salmon calcitonin (SCT).

Regulation of major histocompatibility gene expression in teratocarcinoma 402AX cells

Teratocarcinoma 402AX cells are induced to express major histocompatibility complex (MHC) antigens when passaged in vivo in genetically resistant host mice. Studies reported here demonstrate that MHC antigen induction is regulated in vivo in part by the synergistic action of Lyt 1 and Lyt 2 positive splenic T cells and in vitro by serum from tumor-primed resistant mice. Northern blots suggest that some teratocarcinoma 402AX MHC class I antigens may be post-transcriptionally regulated.

Arachidonic acid metabolism in a cell suspension isolated from rabbit renal outer medulla

We studied arachidonic acid (AA) metabolism by a cell suspension containing principally cells of the thick ascending limb of the loop of Henle (TALH) obtained from the inner stripe of the outer medulla of the rabbit kidney. Based on comparison of specific activities of enzymes before and after separation, alkaline phosphatase, Na+-K+-adenosine triphosphatase, as well as Tamm-Horsfall glycoprotein and electron microscopic appearance, 80% of these cells were estimated to be TALH in origin. TALH cells had low activity of cyclooxygenase and did not show evidence of lipoxygenase activity. However, they selectively converted exogenous AA to oxygenated metabolites by a cytochrome P-450 related mechanism. AA metabolites were produced in large amounts (30-40% conversion of [14C]AA, 1 to 5 micrograms/mg of protein/30 min) and were increased 5-fold after separation of TALH cells from a suspension of outer medullary cells, suggesting that TALH cells synthesized these metabolites. Induction of cytochrome P-450 by pretreatment of rabbits with beta-naphthoflavone and 3-methylcholanthrene increased formation of the AA metabolites by almost 2-fold in the separated cells and correlated with cytochrome P-450 content of the renal outer medulla. Additionally, SKF 525A and carbon monoxide inhibited product formation in these renomedullary cells, supporting a role for a cytochrome P-450-like monooxygenase in TALH cell function.

Conversion of arachidonic acid to two novel products by a cytochrome P450-dependent mixed-function oxidase in polymorphonuclear leukocytes

Canine polymorphonuclear leukocytes metabolize [14C] arachidonic acid into 2 unidentified products, separated by thin-layer chromatography and high performance liquid chromatography, and called peak 1 and peak 2. The formation of peak 1 is maximal at 5 minutes and then declines, while the synthesis of peak 2 increases throughout the 30 minute incubation period. The formation of peak 1 and, to a lesser extent, peak 2, was enhanced after dual inhibition of lipoxygenase and cyclo-oxygenase enzymes with BW755C (94 microns) or nafazatrom (37 microns), or after incubation in a calcium-free buffer. In contrast, the formation of these products was inhibited by SKF-525A (50 microns), suggesting a cytochrome P450-dependent mechanism. The presence of cytochrome P450 in neutrophil microsomes was confirmed by measuring aryl hydrocarbon hydroxylase activity and cytochrome P450 content.

Bradykinin-stimulated differential incorporation of arachidonic acid into lipids of kidney cortex and medulla

We investigated bradykinin-induced changes in the turnover of arachidonate in renal lipids of the perfused rabbit kidney. Upon hormone stimulation, this cellular system undergoes only transient dynamic changes in arachidonic acid metabolism; no loss of bradykinin effect on arachidonate release and prostaglandin generation is shown upon repeated hormone administrations during 8-9 hr of perfusion. Ureter-obstructed rabbit kidneys were perfused for 5-6 hr and then saline or bradykinin in saline was administered, followed after 10 sec by pulse labelling with [14C]arachidonate. The pattern of distribution of [14C]arachidonate in lipid fractions of the cortex showed that bradykinin caused a 2 to 2.5-fold increase in the relative incorporation of arachidonic acid into phosphatidylinositol (PI), phosphatidic acid (PA), diglyceride (DG) and triglyceride (TG) fractions and a concomitant decrease in its incorporation into phosphatidylcholine (PC) and phosphatidylethanolamine (PE). In contrast, in the medulla hormone administration caused a marked increase of arachidonate incorporation into PI and PC, and a decrease in incorporation into PE, PA, DG and TG. This differential arachidonate labelling of cortical vs medullary lipids following bradykinin stimulation suggests that the hormone activates different lipolytic processes in cortex and medulla, and promotes hydrolysis of arachidonic acid from different phospholipid pools.

Evidence for different purinergic receptors for ATP and ADP in rabbit kidney and heart

ATP and ADP stimulated the release of specific prostaglandin products from the perfused rabbit kidney heart. The two nucleotides produced the same qualitative profile of prostaglandin products. In kidney, prostaglandin E2 was the major product, whereas in heart 6-keto prostaglandin F1 alpha and prostaglandin E2 predominated. ATP was a slightly more potent than ADP. ATP administered into the perfused heart to kidney was rapidly hydrolyzed to ADP and AMP. The prostaglandin E2 generating activity of ATP was increased 6-10 fold when ATP was given together with AMP-PCP or AMP-PNP which competitively inhibit the activity of vascular ATPase. Thus, the rapid hydrolysis of ATP reduces its agonistic activity for prostaglandin release. ATP and ADP administered together at maximal stimulating doses produced an additive response for prostaglandin E2 release. These results and the results of tachyphylaxis experiments indicate that ATP and ADP interact independently with different types of purinergic receptors.

Selective induction of de novo prostaglandin biosynthesis in rabbit kidney cortex

Ureter-obstructed kidney develops during perfusion an enhanced responsiveness to bradykinin-stimulated prostaglandin release. This enhanced prostaglandin generation results from de novo synthesis of prostaglandin synthetase and acylhydrolase enzymes during the perfusion and is therefore unaffected by acetylsalicylic acid (aspirin) inhibition of prostaglandin synthesis prior to initiation of perfusion. Studies were carried out to identify the renal cellular site in which the newly synthesizing prostaglandin generating system is localized. Kidneys with or without aspirin treatment were perfused for either 1 or 5 h. Following perfusion, medullary and cortical slices were incubated and prostaglandin E2 production measured. Medullary slices showed similar prostaglandin E2 biosynthetic activity in kidneys perfused for 1 or 5 h. Furthermore, medullary prostaglandin generation was inhibited (90-95%) by aspirin pre-treatment and did not increase during subsequent perfusion for 5 h. In contrast, cortical slices from kidneys pretreated with aspirin regained their full activity after 5 h or perfusion, this regeneration being abolished by infusion of the protein synthesis inhibitor, cycloheximide. The same differences in activities between medulla and cortex were also seen when microsomal fractions were compared. The perfusion-induced formation of prostaglandin synthetase activity is thus specifically localized in the cortex and can be detected in cortical microsomes. This cortical activity is unique in that endogenous arachidonic acid released from esterified lipids is converted to prostaglandins, whereas exogenous added arachidonic acid is not. It thus appears that the induced cortical acylhydrolase and prostaglandin synthetase activities are tightly coupled and that the true molecular form or precursor arachidonate for this prostaglandin generating system is esterified and not free arachidonate.