Indo-US case-control study of senile cataract--design and development

Study design and development are presented for an investigation of risk factors for senile cataract in a collaborative Indo-US case-control study in New Delhi, India. This study emphasizes the relationship of nutritional status, as ascertained by biochemical assessment on plasma and red blood cells and by dietary history, to specific cataract types (nuclear, cortical, posterior subcapsular).

Does eating particular diets alter the risk of age-related macular degeneration in users of the Age-Related Eye Disease Study supplements?

BACKGROUND

Recent information suggests that the Age-Related Eye Disease Study (AREDS) supplement, enhanced intake of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and reducing dietary glycaemic index (dGI) are protective against advanced age-related macular degeneration (AMD).

METHODS

Dietary information was collected at baseline, and fundus photograph grades were obtained during the 8-year trial period from 2924 eligible AREDS AMD trial participants. Using the eye as the unit of analysis and multifailure Cox proportional-hazards regression, the risk of AMD progression was related to dietary intake in the four arms of the trial.

RESULTS

Independent of AREDS supplementation, higher intakes of DHA (> or =64.0 vs <26.0 mg/day) (hazard ratio (HR) = 0.73, 95% confidence interval (CI), 0.57 to 0.94), EPA (> or =42.3 vs <12.7 mg/day) (HR = 0.74, 95% CI 0.59 to 0.94), and lower dGI (dGI, <75.2 vs > or =81.5) (HR = 0.76, 95% CI 0.60 to 0.96) were associated with a lower risk for progression to advanced AMD. Participants consuming a lower dGI and higher DHA or EPA had the lowest risk (p value for synergistic interaction <0.001). Only participants in the "placebo" (p value for antagonistic interaction = 0.006) benefited from a higher DHA intake against early AMD progression (HR = 0.58, 95% CI 0.37 to 0.92; P(trend) = 0.01).

CONCLUSIONS

The findings show an association of consuming a diet rich in DHA with a lower progression of early AMD. In addition to the AREDS supplement, a lower dGI with higher intakes of DHA and EPA was associated with a reduced progression to advanced AMD.

TRIAL REGISTRATION NUMBER

NCT00000145.

Sustained moderate visual loss as a predictive end point for visual loss in non-proliferative diabetic retinopathy

PURPOSE

In PKC-DRS2, the efficacy of the oral PKC-beta inhibitor, ruboxistaurin 32 mg/day, was measured by the primary end point of sustained moderate visual loss (SMVL: a > or = 15 letter decrease from baseline on the ETDRS (Early Treatment Diabetic Retinopathy Study) chart sustained at least for the last 6 months of study participation). We now evaluate whether SMVL is more accurate than moderate visual loss (MVL: a single occurrence of a decrease from baseline of > or = 15 ETDRS letters) for predicting future visual loss.

METHODS

Study eyes with moderately severe to very-severe non-proliferative diabetic retinopathy, best-corrected visual acuity of at least 45 letters on the ETDRS chart (approximately Snellen 20/125), and no prior pan retinal photocoagulation were evaluated in 506 patients (869 eyes) who completed 36 months of treatment.

RESULTS

Sixty-five percentage (26/40) of study eyes with the onset of SMVL within 24 months of enrolment still had SMVL at study completion (36 months). In comparison, only 24% (30/126) with MVL within 24 months had SMVL at study completion. Analyses based on data from 6, 12, and 18 months of treatment were similar.

CONCLUSIONS

SMVL is a more predictable measure of subsequent visual loss than is a single time point measure of MVL.

Cigarette smoking and the risk of development of lens opacities. The Framingham studies

OBJECTIVE

To examine the association between cigarette smoking and the incidence of nuclear and non-nuclear lens opacities in members of the Framingham Eye Study Cohort.

PARTICIPANTS AND METHODS

Eye examinations were conducted on surviving members of the Framingham Heart Study Cohort from 1973 to 1975 (Framingham Eye Study I) and again from 1986 to 1989 (Framingham Eye Study II). Smoking data, collected biennially since 1948 in the Heart Study, were used to examine the relationship between cigarette smoking and the incidence of lens opacities. Two thousand six hundred seventy-five persons were examined in the Framingham Eye Study I. Our analysis included 660 persons, aged 52 to 80 years, who were free of lens opacities at the first eye examination.

RESULTS

During the approximately 12.5 years between eye examinations, lens opacities developed in a total of 381 persons, with nuclear opacities constituting the most frequent type. In logistic regression analyses that controlled for age, sex, education, and diabetes, a significant positive association with increasing duration of smoking and number of cigarettes smoked daily was found for nuclear lens opacities, alone or in combination (test for trend, P < or = .002), but not for nonnuclear opacities (test for trend, P = .62). Among the heavier smokers (persons who smoked > or = 20 cigarettes per day according to 6 or more biennial Framingham Heart Study examinations), 77% were still smoking at the time of the first eye examination. Persons who smoked 20 or more cigarettes per day at the time of the first eye examination were at substantially increased risk for the development of nuclear opacities than nonsmokers (odds ratio, 2.84; 95% confidence interval, 1.46-5.51). There was no apparent excess risk for persons with nonnuclear lens opacities (odds ratio, 1.42; 95% confidence interval, 0.65-3.07).

CONCLUSION

This study provides further evidence that cigarette smokers have an increased risk of developing nuclear lens opacities. The risk was greatest for heavier smokers, who tended to be current smokers and who smoked more cigarettes and for a longer duration.

Location and severity of cortical opacities in different regions of the lens in age-related cataract

PURPOSE

To examine the distribution of cortical opacities across the lens in the Italian-American Natural History Study of Age-Related Cataract and to study the association between an index of sunlight exposure and the location of cortical cataract within the lens.

METHODS

Lens photographs of one eye of 731 persons with cortical opacities (503 with pure and 228 with mixed types of opacity) were included in the analysis. A radial grid superimposed on the photographs was used to assess presence, location, and severity of wedge-shaped cortical opacities.

RESULTS

Both the prevalence and the extent of cortical opacities were highest in the inferior-nasal quadrant and lowest in the superior-nasal quadrant of the lens. In polychotomous logistic regression, persons with the greatest excess areal involvement in the inferior half of the lens were more likely to have high exposure to sunlight, as measured by a sunlight index, than persons with excess involvement in the superior half of the lens (odds ratio, 1.73; 95% confidence interval 1.03, 2.93). Excess areal involvement of the inferior lens also was associated with the pure type of cortical cataract and with the total extent of the opacity.

CONCLUSIONS

Age-related cortical opacities occur more frequently inferiorly than superiorly and, to a lesser extent, nasally than temporally. Possibly higher exposure of these lens segments to sunlight may explain this preferential location of cortical opacities.

The progression of myopia in school age children: data from the Columbia Medical Plan

The purpose of this study was to characterize the clinical course of myopia in a selected pediatric population. The computerized records of a health maintenance organization provided longitudinal data on 501 children aged 5 to 15 years. We examined the influence of age at diagnosis, gender, race, and initial refraction on progression of myopia. Mean follow-up was 34 months, with 75% of children having follow-up longer than 16 months. The mean rate of myopic progression was greater for children whose myopia was diagnosed at a younger age (5-7 years, -0.56 diopters/year versus 11-15 years, -0.28 diopters/year; p < 0.0001). Children with more than one diopter of myopia at first diagnosis progressed faster than children with less than or equal to one diopter of myopia (mean rate -0.48 diopter/year versus -0.41 diopter/year; p = 0.05). Cumulative event rate curves suggest a gender effect in the prepuberty years of 8 to 10, with myopia progressing faster in girls than boys (p = 0.003). Progression of myopia did not differ between white and non-white children. More rapidly progression of myopia is associated with younger age at initial diagnosis and greater severity of initial myopic refraction.

Biochemical factors in the lens opacities. Case-control study. The Lens Opacities Case-Control Study Group

OBJECTIVE

To evaluate associations with biochemical indicators of nutritional and other risk factors in the Lens Opacities Case-Control Study.

DESIGN

Case-control study.

SETTING AND PARTICIPANTS

The Lens Opacities Case-Control Study determined risk factors for cortical, nuclear, and posterior subcapsular opacities among 1380 participants aged 40 to 79 years.

DATA COLLECTION

Vitamin E, selenium, and biochemistry profile determinations were performed on all patients; red blood cell enzymes and amino acids were measured in systematic samples of about 25% of the Lens Opacities Case-Control Study population.

OUTCOME

Laboratory test values in cases and controls were compared and expressed as odds ratios and 95% confidence intervals.

RESULTS

In polychotomous logistic regression analyses controlling for age and sex, the risk of opacities was reduced to less than one half in persons with higher levels of vitamin E (odds ratio, 0.44 for nuclear opacities), albumin-globulin ratio (odds ratio, 0.41 for mixed opacities), or iron (odds ratio, 0.43 for cortical opacities); higher uric acid levels increased risk (odds ratio, 1.74 for mixed opacities). Persons with opacities were twice as likely to have high glutathione reductase activity (with flavin adenine dinucleotide), which suggests low riboflavin status (odds ratio, 2.13). Most odds ratios for amino acids were under unity and were significantly decreased for glycine (0.36) and aspartic acid (0.31).

CONCLUSIONS

Lens opacities were associated with lower levels of riboflavin, vitamin E, iron, and protein nutritional status. Higher levels of uric acid increased risk of mixed opacities. The findings for riboflavin, vitamin E, iron, and uric acid are compatible with the dietary intake and medical history results of the Lens Opacities Case-Control Study.

Mössbauer spectra of the heme peptide (HP) 1-50 and the heme peptide:non-heme peptide (NHP) non-covalent complex 1-50:51-104 derived from cytochrome c: evidence for cytochrome c iron site solvation in aqueous solution

Mössbauer spectroscopic studies on a heme peptide (HP) derived from cytochrome c and on the HP recombined non-covalently with the remaining cleaved section are reported. The results suggest that the environment of the heme site in the known crystal structure of cytochrome c may differ in detail from the environment of the heme in the working protein.

A dose-response effect between a sunlight index and age-related cataracts. Italian-American Cataract Study Group

To explore the existence of a dose-response relationship between sunlight exposure and risk of age-related cataracts, we analyzed data collected from 1008 patients with cataracts and 469 control subjects enrolled in the Italian-American Case-Control Study of Age-Related Cataracts. Fourteen variables related to sunlight exposure history were included in the questionnaire administered to the study participants. A sunlight index was constructed and its relationship to the presence of cataracts was modeled by logistic regression. After adjustments for potential confounding variables and for age and sex, a significant dose-response effect (P = 0.01) was detected between the sunlight exposure index and the presence of pure cortical cataracts. With the exception of corticonuclear cataracts, all the other mixed types of opacity also showed a dose-response association with the sunlight index. These data support the hypothesis that sunlight exposure is a risk factor in the development of cortical cataracts, and demonstrate the existence of a dose-response relationship in this association.

Relative letter and position difficulty on visual acuity charts from the Early Treatment Diabetic Retinopathy Study

Ten Sloan letters were used in the visual acuity charts developed for use in the Early Treatment Diabetic Retinopathy Study. We used the data from the 3,710 Early Treatment Diabetic Retinopathy Study subjects to investigate the relative difficulty of the ten Sloan letters and to evaluate whether the position of a letter on a line affected its relative difficulty. In general, our findings were consistent with those of the previous study. The four letters with curved contours (C, O, S, and D) were more difficult to discern at threshold than the six letters (Z, N, H, V, R, and K) composed of straight lines. Our data demonstrate that under these test conditions, letters at the end of a line are more likely to be read incorrectly than letters at the beginning of the line. This finding indicates that these data are probably not useful for evaluating possible crowding phenomena.

The Linxian cataract studies. Two nutrition intervention trials

OBJECTIVE

To determine whether the vitamin/mineral supplements used in two cancer intervention trials affected the risk of developing age-related cataracts.

DESIGN

Two randomized, double-masked trials with a duration of 5 to 6 years and end-of-trial eye examinations.

SETTING

Rural communes in Linxian, China.

PARTICIPANTS

In trial 1, 2141 participants aged 45 to 74 years, and, in trial 2, 3249 participants aged 45 to 74 years.

INTERVENTIONS

Multivitamin/mineral supplement or matching placebo in trial 1; factorial design to test the effect of four different vitamin/mineral combinations in trial 2 (retinol/zinc, riboflavin/niacin, ascorbic acid/molybdenum, and selenium/alpha-tocopherol/beta carotene).

MAIN OUTCOME MEASURES

Prevalence of nuclear, cortical, and posterior subcapsular cataracts in treatment groups at end of trials.

RESULTS

In the first trial, there was a statistically significant 36% reduction in the prevalence of nuclear cataract for persons aged 65 to 74 years who received the supplements. In the second trial, the prevalence of nuclear cataract was significantly lower in persons receiving riboflavin/niacin compared with persons not receiving these vitamins. Again, persons in the oldest group, 65 to 74 years, benefited the most (44% reduction in prevalence). No treatment effect was noted for cortical cataract in either trial. Although the number of posterior subcapsular cataracts was very small, there was a statistically significant deleterious effect of treatment with riboflavin/niacin.

CONCLUSIONS

Findings from the two trials suggest that vitamin/mineral supplements may decrease the risk of nuclear cataract. Additional research is needed in less nutritionally deprived populations before these findings can be translated into general nutritional recommendations.

Conformational analysis and proteolytic processing of synthetic pre-pro-GnRH/GAP protein

Homogeneous pre-pro-GnRH/GAP protein was recently synthesized in 100 mg quantities by solid-phase methods and surprisingly, the synthetic pre-pro-protein, which normally does not escape the endoplasmic reticulum, was found to inhibit the release of prolactin from cultured pituitary cells. This is the first demonstration of significant biological activity associated with a precursor protein and provides the rationale for its further study. We now report the results of our initial examination of the conformational properties of pre-pro-GnRH/GAP protein as a prelude to solving its solution phase conformation by homonuclear 1H-NMR protocols. Thermal and pH titration fluorescence and circular dichroism spectroscopies reveal that the protein is resistant to thermal-induced conformational changes but is particularly sensitive to pH-induced conformational changes; while Asp/Glu and Arg residues may contribute to structural stability, His and Lys residues predominate. Pre-pro-GnRH/GAP is about 30% helix in the range of 2-40 degrees C; however, even at 90 degrees C, the peptide retains nearly 50% of its helix character. There is no evidence for a cooperative transition; for this reason, differential scanning calorimetry failed to yield a defined transition thermogram. Pre-pro-GnRH/GAP apparently does not pass through a transition state as a function of temperature but appears to flex and retain a high percentage of helix structure, resulting in subtle changes in secondary structure. There is no discernible isodichroic point. On either side of the neutral pH range, however, there are dramatic changes in structure that result in nonreversible denaturation of the protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Total solid-phase synthesis and prolactin-inhibiting activity of the gonadotropin-releasing hormone precursor protein and the gonadotropin-releasing hormone associated peptide

The human gonadotropin-releasing hormone precursor protein, pHGnRH (Met-23-Ile69) (preproGnRH), and three of its fragment peptides, pHGnRH (Asp14-Ile69) (gonadotropin-releasing hormone associated peptide--GAP), pHGnRH (Phe38-Ile69), and pHGnRH (Ser47-Ile69), were assembled in a stepwise solid-phase cosynthesis employing Boc/Bzl tactics and an optimized acylation schedule which included recoupling steps with hexafluoro-2-propanol to help overcome the aggregation of the pendant peptide chains of the peptidoresin during difficult couplings. Reversed-phase high-performance liquid chromatography (HPLC) purification yielded products which were characterized by analytical reversed-phase HPLC, ion-exchange chromatography, capillary zone electrophoresis, SDS-polyacrylamide gel electrophoresis, and ion-spray mass spectrometry to reveal a high degree of homogeneity. Biological characterization demonstrated that only GAP stimulated luteinizing hormone and follicle-stimulating hormone release from primary cultures of rat anterior pituitary cells, while GAP, pHGnRH (Phe38-Ile69), and preproGnRH all inhibited prolactin release, with the latter being the most potent at concentrations comparable to bromocryptine. However, only GAP and pHGnRH (Phe38-Ile69) were able to displace a labeled gonadotropin-releasing hormone agonist from binding to rat pituitary membrane preparations. This first demonstration of significant biological activity with a precursor protein also suggests that the gonadotropin-releasing and prolactin release-inhibiting functions of GAP are not mediated through the same pituitary receptors.

Total chemical synthesis of a D-enzyme: the enantiomers of HIV-1 protease show reciprocal chiral substrate specificity [corrected]

The D and L forms of the enzyme HIV-1 protease have been prepared by total chemical synthesis. The two proteins had identical covalent structures. However, the folded protein-enzyme enantiomers showed reciprocal chiral specificity on peptide substrates. That is, each enzyme enantiomer cut only the corresponding substrate enantiomer. Reciprocal chiral specificity was also evident in the effect of enantiomeric inhibitors. These data imply that the folded forms of the chemically synthesized D- and L-enzyme molecules are mirror images of one another in all elements of the three-dimensional structure. Enantiomeric proteins are expected to display reciprocal chiral specificity in all aspects of their biochemical interactions.

Activity of vertebrate gonadotropin-releasing hormones and analogs with variant amino acid residues in positions 5, 7 and 8 in the goldfish pituitary

All non-mammalian vertebrates as well as marsupial mammals have two or more forms of gonadotropin-releasing hormone (GnRH) in the brain. Goldfish brain and pituitary contains two molecular forms of GnRH, salmon GnRH ([Trp7, Leu8]m-GnRH; s-GnRH) and chicken GnRH-II ([His5, Trp7, Tyr8]m-GnRH; cII-GnRH). Both sGnRH and cII-GnRH stimulate gonadotropin (GtH) as well as growth hormone (GH) release from the goldfish pituitary. The purpose of the present study was to study the activity of the five known forms of GnRHs as well as analogs of mammalian GnRH (m-GnRH) with variant amino acid residues in positions 5, 7 and 8 in terms of binding to GnRH receptors, and release of GTH and GH from the perifused fragments of goldfish pituitary in vitro. All five vertebrate GnRH peptides stimulated both GtH and GH release in a dose-dependent manner, although their potencies were very different. cII-GnRH was somewhat more active than s-GnRH in releasing GtH, whereas s-GnRH tended to have a greater potency than cII-GnRH in terms of GH release. Both chicken GnRH-I (cI-GnRH) and lamprey GnRH (l-GnRH) were significantly less potent than mGnRH, s-GnRH and cII-GnRH in releasing GtH and GH. cII-GnRH binds with higher affinity for the high affinity binding sites compared to all other native peptides. The activity of [Trp7]-GnRH was similar to both s-GnRH and cII-GnRH in releasing GtH and GH. Substitution of His5 resulted in a significant decrease in GtH releasing potencies compared to mGnRH, sGnRH and cII-GnRH. [His5]-GnRH also had lower GH releasing potency than mGnRH and sGnRH. Tyr8, His8 and Leu8 substitutions caused significant decreases in GtH releasing potencies compared to mGnRH, s-GnRH and cII-GnRH, but did not cause a significant change in GH releasing potency. The combination of [His5, Trp7]-GnRH had GtH and GH releasing activities similar to m-GnRH, s-GnRH and cII-GnRH.(ABSTRACT TRUNCATED AT 400 WORDS)

Diarrhea, respiratory infections, and growth are not affected by a weekly low-dose vitamin A supplement: a masked, controlled field trial in children in southern India

Incidence, duration, and severity of diarrhea and respiratory symptoms were monitored weekly for 1 y in 15,419 children 6-60 mo of age in a randomized, placebo-controlled, masked clinical trial conducted in southern India. Half the children received weekly doses of 8.7 mumol (2500 microgram) vitamin A and 46 mumol (20 mg) vitamin E (treated) and the other half, 46 mumol vitamin E (control). Medical and ocular examinations and anthropometric measurements were obtained before and after 52 wk of intervention. Ocular examinations also were obtained after 26 wk. Supplements were delivered weekly from calibrated dispenser bottles by community health volunteers who also recorded each mother's recall of daily morbidity of her child during the previous week. Baseline characteristics of treated and control subjects were similar and documented a prevalence of 11% xerophthalmia and 72% undernutrition. Weekly treatment with the low-dose vitamin A supplement did not influence the incidence, severity, or duration of diarrhea or respiratory infections and did not influence linear or ponderal growth.

Selective FSH-releasing activity of [D-Trp9]GAP1-13: comparison with gonadotropin-releasing abilities of analogs of GAP and natural LHRHs

We had previously shown that fragments of human gonadotropin-releasing hormone associated peptide (GAP) stimulated FSH and LH release in vivo. In particular, GAP1-13 had a preferential FSH-releasing activity. To decrease enzymatic degradation, analogs of GAP1-13 with D-amino acid substitutions were synthesized. The activities were tested in ovariectomized, estrogen-progesterone primed (OEP) rats and compared with those of GAP1-13, mammalian (m), chicken II (cII), and lamprey (1) LHRH. The peptides were injected (IV) into conscious, OEP rats and blood samples were obtained via the jugular catheter. [D-Trp9 )GAP1-13 selectively stimulated FSH release at a dose of 1 microgram. Multiple injections of this analog (10 micrograms every 30 min for 5 injections) induced a marked elevation of plasma FSH values which peaked (p less than 0.001) after the third injection. By contrast, [D-Trp9]GAP1-13 had no effect on LH and prolactin (PRL) release after either single or multiple injections. These doses of [D-Ala4]GAP1-13 had no effect on the release of FSH, LH or PRL. Both human GAP1-13 and its [D-Trp9] analog exerted a selective FSH-releasing effect at a dose of 10 micrograms, however, the [D-Trp9] analog was more potent than GAP1-13 on FSH release. The potency of [D-Trp9]GAP1-13 in releasing FSH was approximately 1/100th that of mLHRH. Chicken II LHRH had slightly selective FSH-releasing activity with a potency 1/10th that of mLHRH. Lamprey LHRH had a preferential LH-releasing activity and a potency 1000 times less than mLHRH. In conclusion. [D-Trp9]GAP1-13 is a selective FSH-releasing peptide of potential clinical value.

Reduced mortality among children in southern India receiving a small weekly dose of vitamin A

BACKGROUND

Clinical vitamin A deficiency affects millions of children worldwide, and subclinical deficiency is even more common. Supplemental vitamin A has been reported to reduce mortality among these children, but the results have been questioned.

METHODS

We conducted a randomized, controlled, masked clinical trial for one year in southern India involving 15,419 preschool-age children who received either 8.7 mumol (8333 IU) of vitamin A and 46 mumol (20 mg) of vitamin E (the treated group) or vitamin E alone (the control group). Vitamin supplements were delivered weekly by community health volunteers who also recorded mortality and morbidity. Weekly contact was made with at least 88 percent of the children in both study groups. The base-line characteristics of the children were similar and documented a high prevalence of vitamin A deficiency and undernutrition.

RESULTS

One hundred twenty-five deaths occurred, of which 117 were not accidental. The risk of death in the group treated with vitamin A was less than half that in the control group (relative risk, 0.46; 95 percent confidence interval, 0.30 to 0.71). The risk was most reduced among children under 3 years of age (6 to 11 months--relative risk, 0.28; 95 percent confidence interval, 0.09 to 0.85; 12 to 35 months--relative risk, 0.46; 95 percent confidence interval, 0.26 to 0.81) and among those who were chronically undernourished, as manifested by stunting (relative risk, 0.11; 95 percent confidence interval, 0.03 to 0.36). The symptom-specific risk of mortality was significantly associated with diarrhea, convulsions, and other infection-related symptoms.

CONCLUSIONS

The regular provision of a supplement of vitamin A to children, at a level potentially obtainable from foods, in an area where vitamin A deficiency and under-nutrition are documented public health problems contributed substantially to children's survival; mortality was reduced on average by 54 percent.

Chimeric analogues of vertebrate gonadotropin-releasing hormones comprising substitutions of the variant amino acids in positions 5, 7, and 8. Characterization of requirements for receptor binding and gonadotropin release in mammalian and avian pituitary gonadotropes

Variant forms of mammalian gonadotropin-releasing hormone (GnRH) (pGlu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly.NH2) are present in chicken ([Gln8] GnRH and [His5, Trp7, Tyr8]GnRH), salmon ([Trp7, Leu8]GnRH), and lamprey ([Tyr3, Leu5, Glu6, Trp7, Lys8] GnRH). To delineate the functional importance of the variant amino acids in positions 5, 7, and 8, the natural peptides and chimeric analogues were tested for gonadotropin-releasing activity and receptor-binding activity in rat, sheep, and chicken pituitaries. The results demonstrate that (i) the mammalian receptor has a high fidelity for Arg8 while the chicken receptor is less discriminatory and accepts basic or neutral amino acids in this position. Arg8 may contribute to conformational stabilization, and conformational constraint with D-Trp6 restored activity to analogues lacking Arg8 in the mammalian systems. D-Trp6 incorporation did not generally enhance activity in the chicken pituitary. (ii) His5 accompanying Arg8 in analogues markedly diminished activity in the chicken while gonadotropin-releasing activity was retained in the sheep pituitary. Receptor-binding activity was increased in the sheep indicating an uncoupling of receptor occupancy and activation. (iii) Substitution in position 7 is tolerated by the mammalian and chicken receptor. With Trp7-substituted analogues receptor-binding activity was relatively lower than gonadotropin-releasing activity in the sheep pituitary, suggesting an enhanced receptor activation by these analogues or the existence of different GnRH receptors.

Grading of images in a clinical trial

We developed a computer model to compare the power in clinical trials that use either of two grading schemes for objectively recorded dependent variables. The example we use is an eye lens photo. The first grading system consists of side by side comparison of the before and after treatment photos; the second involves separate grading of the two photos. This modelling experience suggests that separate grading may often yield more power than side by side comparison, and offers other advantages as well. For applications in which grading error is considerably smaller in the side by side method, power may be markedly better. Most importantly, strong prejudice in favour of one or the other approach in all situations seems unwarranted.

Impaired vision and hip fracture. The Framingham Study

Falls affect a large proportion of the elderly and can result in a variety of injuries, including hip fractures. Several studies have suggested that visual impairment contributes to falls, but studies have not used standardized definitions of visual impairment and have not examined injurious falls or fractures. We looked at the risk of hip fracture associated with visual impairment in those members of the Framingham Study Cohort who took part in the Framingham Eye Study in 1973-75. Of 2,633 subjects followed for 10 years after the eye exam, 110 sustained hip fractures. The fracture rates in those with moderately impaired (20/30 to 20/80) vision (8.5%) and poor (20/100 or worse) vision (11.3%) were higher than in those with good (20/25 or better) vision (3.0%). After adjustment for age, sex, weight, alcohol consumption, and (in women) estrogen use, the relative risk of fracture in those with moderate impairment was 1.54 (95% CI = 0.95-2.49), while for those with poor vision, the relative risk was 2.17 (95% CI = 1.24-3.80). Of note, those with moderately impaired vision in one eye and good vision in the other had a higher risk of fracture (relative risk = 1.94) than those with a similar degree of binocular impairment (relative risk = 1.11). Poor vision in one or both eyes was linked to an elevated fracture risk. This suggests that good stereoscopic vision may be necessary to prevent falls. The risk of fracture with poor and moderately impaired vision combined was increased in women (relative risk = 1.96, 95% CI = 1.23-3.11) but not in men (relative risk = 0.79, 95% CI = 0.23-2.72).(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related cataract in the Tibet Eye Study

The Tibet Eye Study was designed to estimate the prevalence of age-related cataract in Duilong-Deqing County, west of Lhasa, China (altitude, 4000 m). Previous reports have suggested an unusually high prevalence of age-related cataract in Tibet. A two-stage probability sample of persons aged 20 years or older from the 35 townships of the county targeted 2884 persons for inclusion in the study; 2665 (92.4%) were examined. Age-related cataract was diagnosed when (1) visual acuity was worse than 6/12 (20/40) because of nuclear or cortical (including posterior subcapsular) opacities, or (2) aphakia associated with a history of age-related cataract was present in either eye. The prevalence of age-related cataract among persons aged 20 to 39 years was 0.2%; among persons 40 years old or older, the prevalence was 11.8%. Cortical cataracts were by far the most common type of cataract diagnosed. Age- and sex-adjusted prevalence in Tibet was 60% higher than the prevalence in a similar, previously conducted study of 6951 person in Shunyi County, northeast of Beijing (altitude, 50 m). A second, independent slit-lamp classification of lens status was conducted in the Tibet Eye Study using standard photographs previously described. Age-specific cataract prevalence was similar with the two examination techniques. Results from the Tibet Eye Study support previous suggestions of a high prevalence of age-related cataract in Tibet.

India-US case-control study of age-related cataracts. India-US Case-Control Study Group

In a hospital-based case-control study of 1441 patients with age-related cataracts and 549 controls, we studied associations between types of cataract--nuclear, cortical, posterior subcapsular, and mixed--and a number of physiologic, behavioral, environmental, and biochemical variables. Using polychotomous logistic regression analysis, we found an increased risk of cataract with lower educational achievement (all types of cataract), decreased cloud cover at place of residence (all types), use of aspirin less than once a month (posterior subcapsular and mixed), diets low in selected nutrients (posterior subcapsular, nuclear, and mixed), higher blood pressure (nuclear and mixed), lower body mass index (nuclear and mixed), use of cheaper cooking fuels (cortical, nuclear, and mixed), and lower levels of an antioxidant index based on red blood cell levels of glutathione peroxidase and glucose-6-phosphate dehydrogenase and plasma levels of ascorbic acid and vitamin E (posterior subcapsular and mixed). All risks cited were significantly different from those for the other cataract types, a finding that emphasizes the need to investigate the epidemiology of specific types of cataract.

Oxygen activation and ligand binding by pure heme-octapeptide microperoxidase-8 (MP-8)

The rapid, efficient preparation of pure microperoxidase-8 (MP-8) is described. Ligand binding studies confirm that MP-8 is monomeric in alkaline solution. It is shown that the monomeric MP-8 activates oxygen in a similar manner to that already reported for alkaline hemin, establishing the octapeptide as a possible second generation model for the oxygen activation/insertion reactions of the cytochrome P-450.

Gonadotropin-releasing hormone associated peptide (GAP) and putative processed GAP peptides do not release luteinizing hormone or follicle-stimulating hormone or inhibit prolactin secretion in the sheep

A series of experiments was performed to monitor plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin responses to human gonadotropin-releasing hormone (GnRH) associated peptide (GAP) and related peptides. Ovariectomized hypothalamo-pituitary disconnected (HPD) ewes were challenged with injections (1-10 micrograms i.v.) of GAP, or given, with and without estradiol, hourly 500- or 1,000-ng pulses of GAP for 5-7 days. In all cases GAP failed to cause the release of LH or FSH from the pituitary gland or to alter mean plasma prolactin concentrations. When the same HPD ewes were given hourly or 2-hourly pulses of 250 ng GnRH, LH responded in a a pulsatile manner, and FSH secretion was maintained, thus confirming the functional integrity of the pituitary gland after HPD. Fragments of the GAP molecule (pro-GnRH 14-36, 28-36, 38-49, and 51-66) and GAP dimer did not stimulate LH or FSH or inhibit prolactin release in HPD ewes. GAP and GAP dimer did not affect pituitary responsiveness to GnRH administration. GAP also failed to inhibit the thyrotropin-releasing hormone-induced rise in prolactin. Finally, GAP injections (100 micrograms i.v.) given to lactating ewes did not cause any change in plasma prolactin concentrations. These data show that human GAP, GAP dimer, or putative processed GAP peptides do not act on the sheep pituitary gland in a variety of physiological states to regulate gonadotropin or prolactin secretion.

Solid phase synthesis and characterization of two canine gut gastrin-releasing peptides

Two canine gastrin-releasing peptides originally isolated from gut tissue extracts have been synthesized by solid phase methodology and purified by preparative reverse phase high performance liquid chromatography (RP-HPLC). The synthetic gastrin-releasing peptides GRP1-27 and GRP 5-27 were characterized with regard to homogeneity and composition using nine different RP-HPLC systems, mass spectroscopy, amino acid analysis, Edman degradation, methionine oxidation, and peptide mapping with tryptic, Staph. aureus V8 protease and cyanogen bromide cleavage (the latter two systems performed only with GRP 1-27). Although a scarcity of the natural products prevented quantitative biological comparison of the synthetic and natural peptides, they were found to elute identically on RP-HPLC co-chromatography and similar dose dependent biological potencies were observed in canine antral muscle tissue contraction experiments. Indeed, all the peptides containing the bombesin-like carboxyl terminal decapeptide sequence studied to date have similar biological activities.

Significance testing for correlated binary outcome data

Multiple logistic regression is a commonly used multivariate technique for analyzing data with a binary outcome. One assumption needed for this method of analysis is the independence of outcome for all sample points in a data set. In ophthalmologic data and other types of correlated binary data, this assumption is often grossly violated and the validity of the technique becomes an issue. A technique has been developed (Rosner, 1984) that utilizes a polychotomous logistic regression model to allow one to look at multiple exposure variables in the context of a correlated binary data structure. This model is an extension of the beta-binomial model, which has been widely used to model correlated binary data when no covariates are present. In this paper, a relationship is developed between the two techniques, whereby it is shown that use of ordinary logistic regression in the presence of correlated binary data can result in true significance levels that are considerably larger than nominal levels in frequently encountered situations. This relationship is explored in detail in the case of a single dichotomous exposure variable. In this case, the appropriate test statistic can be expressed as an adjusted chi-square statistic based on the 2 X 2 contingency table relating exposure to outcome. The test statistic is easily computed as a function of the ordinary chi-square statistic and the correlation between eyes (or more generally between cluster members) for outcome and exposure, respectively. This generalizes some previous results obtained by Koval and Donner (1987, in Festschrift for V. M. Joshi, I. B. MacNeill (ed.), Vol. V, 199-224.(ABSTRACT TRUNCATED AT 250 WORDS)

Gonadotrophin-releasing hormone--diversity of functions and clinical applications

Gonadotrophin-releasing hormone (GnRH) plays a pivotal role in the regulation of the reproductive system. Chemically synthesised GnRH and analogues have found wide application in clinical medicine. Pulsatile administration of GnRH is used in the treatment of infertility and cryptorchidism. GnRH agonists inhibit gonadotrophin by pituitary desensitisation while antagonists compete out the effects of endogenous GnRH. These agents find application in contraception, the treatment of hormone-dependent neoplasms, precocious puberty, endometriosis, porphyria and disturbances of the menstrual cycle. It is now apparent that GnRH has been co-opted during evolution for functions other than the stimulation of gonadotrophins. GnRH has paracrine (local) effects in the gonads and placenta, acts as a neurotransmitter in the central nervous system, and has autocrine regulatory effects in some tumour cells. Evolutionary studies in non-mammalian vertebrates show that the GnRH gene has been duplicated to produce different molecular forms of unknown function. In addition to producing GnRH, the GnRH precursor is cleaved to produce peptides with novel activities, including prolactin inhibition.

Mild vitamin A deficiency and childhood morbidity--an Indian experience

Over 1500 preschool urban Indian children were followed weekly for morbidity from 12 to 18 mo. Examination for mild xerophthalmia (Bitot's spots and night blindness) was done initially and at 6 and 12 mo. Children with mild xerophthalmia at the start of a 6-mo interval developed respiratory disease in the interval twice as often as children with normal eyes at the start of the interval. No association was found between mild xerophthalmia and incidence of diarrhea.

LH-releasing activity and receptor binding of pHGnRH 14-26 analogues

The human gonadotropin-releasing hormone (GnRH) precursor consists of the GnRH sequence followed by a cleavage and amidation site and a 56-amino acid carboxyl-terminal extension (pHGnRH - precursor human GnRH) which has been shown to stimulate gonadotropin release. This activity has been localized to a decapeptide sequence (corresponding to pHGnRH 17-26) in its amino-terminal region using human pituitary cell cultures. To further characterize the structural features required for gonadotropin release, two analogues, [D-Ala17]pHGnRH 14-26 and [D-Trp22]pHGnRH 14-26, with D-amino acid substitutions inside and peripheral to this decapeptide sequence were chemically synthesized. pHGnRH 14-26 and the D-Ala17 analogue were inactive and GnRH, pHGnRH 14-36 and the D-Trp22 analogue stimulated luteinizing hormone release from cultured rat pituitary cells in a calcium-dependent, dose-responsive manner. Experiments and receptor binding studies with the active pHGnRH peptides in conjunction with GnRH or a GnRH antagonist suggest that the active pHGnRH peptides act through the GnRH receptor.

The delineation of a decapeptide gonadotropin-releasing sequence in the carboxyl-terminal extension of the human gonadotropin-releasing hormone precursor

The human gonadotropin-releasing hormone (GnRH) precursor consists of the GnRH sequence followed by a 59-amino acid carboxyl-terminal extension. A 56-amino acid peptide within this extension has been shown to stimulate gonadotropin release, and this activity has been localized to its amino-terminal region. A series of seven overlapping peptide fragments corresponding to the first 24 amino acids of the carboxyl-extension of the GnRH precursor were synthesized and tested for their ability to stimulate luteinizing hormone and follicle-stimulating hormone release from cultured human anterior pituitary cells. All active peptide fragments were found to incorporate the decapeptide sequence Asn-Leu-Ile-Asp-Ser-Phe-Gln-Glu-Ile-Val which is regarded as a minimal structural requirement delineated for gonadotropin-releasing activity. A further flanking sequence extending this active region from its carboxyl terminus was found to enhance gonadotropin-releasing activity although the flanking sequence itself was inactive. The gonadotropin release stimulated by the active peptides wa shown to be a dose- dependent, specific, and calcium-dependent phenomenon which occurred independently of the GnRH receptor on the pituitary gonadotrophs as a GnRH antagonist did not inhibit activity.

Relationship between measles, malnutrition, and blindness: a prospective study in Indian children

A prospective study was conducted in slum children to determine the incidence of post-measles corneal disease and to clarify its relationship with nutritional status. A total of 318 cases of measles were identified over a period of 15 mo; maximum incidence was observed for children between 1-2 yr. Most of the children showed weight loss and serum proteins decrease during the acute stage of measles. Corneal lesions were observed in 3% of the children, and the lesions responded well to treatment. Serum vitamin A and RBP levels were significantly depressed during the acute stage of measles but were restored to normal 8 wk after recovery. There were no significant differences in the serum levels for those with and without eye lesions, which suggests that these lesions may not be mediated simply through the effect of infection on serum concentration of vitamin A.

Receptor binding and gonadotropin-releasing activity of a novel chicken gonadotropin-releasing hormone ([His5, Trp7, Tyr8]GnRH) and a D-Arg6 analog

Receptor binding and gonadotropin-releasing activity was compared for mammalian GnRH, [Gln8]GnRH (chicken I GnRH), [His5, Trp7, Tyr8]GnRH (chicken II GnRH), [Trp7, Leu8]GnRH (salmon GnRH), and [D-Arg6] chicken II GnRH. The mean ED50 values for mammalian GnRH, chicken I GnRH, chicken II GnRH, and salmon GnRH in stimulating LH release from dispersed chicken pituitary cells were 0.27 nM, 0.28 nM, 0.055 nM, and 0.11 nM, respectively. The relative potencies of the peptides compared in the same assay were 0.93, 1.0, 5.6, and 2.5. The ED50 values for chicken I GnRH, chicken II GnRH, and salmon GnRH in stimulating FSH release were 0.37 nM, 0.034 nM, and 0.18 nM, and the relative potencies were 1.0, 13.5, and 1.8. Chicken II GnRH was, therefore, more potent than chicken I GnRH and mammalian GnRH in releasing LH and appeared to have an even greater relative FSH-releasing activity than chicken I GnRH or mammalian GnRH. Introduction of D-Arg6 into chicken II GnRH enhanced the activity of this analog 4- and 2-fold relative to chicken II GnRH in LH- and FSH-releasing activity, respectively. The ED50 values of mammalian GnRH, chicken I GnRH, chicken II GnRH, and salmon GnRH in releasing LH from cultured sheep pituitary cells were 2.9 nM, 96 nM, 22 nM, and 104 nM, respectively. The relative potencies were 1.0, 0.016, 0.084, and 0.047. Introduction of D-Arg6 into chicken II GnRH enhanced activity 9-fold. In a rat pituitary receptor binding assay the ED50 values of mammalian GnRH, chicken I GnRH, chicken II GnRH, and salmon GnRH were 2.9 nM, 1480 nM, 19 nM, and 258 nM, respectively. [D-Arg6]Chicken II GnRH was 46 times more active than the natural chicken II GnRH peptide. The results show: 1) chicken II GnRH is more potent than chicken I GnRH, which is equipotent with mammalian GnRH in releasing LH from chicken pituitary cells. Chicken II GnRH is even more potent at releasing FSH. 2) Salmon GnRH is also more potent than chicken I GnRH and mammalian GnRH in stimulating gonadotropin release from chicken pituitary cells. It appears, therefore, that Trp in the 7 position contributes to the enhanced activity of salmon and chicken II GnRH. 3) The low activity of chicken I GnRH, chicken II GnRH, and salmon GnRH in the sheep pituitary cell bioassay and rat pituitary receptor binding assay confirms that Arg8 in mammalian GnRH is important for activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Stimulation of gonadotropin release by a non-GnRH peptide sequence of the GnRH precursor

The human gonadotropin-releasing hormone (GnRH) precursor comprises the GnRH sequence followed by an extension of 59 amino acids. Basic amino acid residues in the carboxyl terminal extension may represent sites of processing to biologically active peptides. A synthetic peptide comprising the first 13 amino acids (H X Asp-Ala-Glu-Asn-Leu-Ile-Asp-Ser-Phe-Gln-Glu-Ile-Val X OH) of the 59-amino acid peptide was found to stimulate the release of gonadotropic hormones from human and baboon anterior pituitary cells in culture. The peptide did not affect thyrotropin or prolactin secretion. A GnRH antagonist did not inhibit gonadotropin stimulation by the peptide, and the peptide did not compete with GnRH for GnRH pituitary receptors, indicating that the action of the peptide is independent of the GnRH receptor. The GnRH precursor contains two distinct peptide sequences capable of stimulating gonadotropin release from human and baboon pituitary cells.

Effect of luteinising hormone releasing hormone and its analogues on plasma luteinising hormone concentrations in incubating bantam hens

The ability of synthetic vertebrate luteinising hormone releasing hormones (LHRHs) and their long-acting analogues to maintain elevated plasma luteinising hormone (LH) concentrations and to stimulate ovarian growth was investigated in incubating bantam hens. Chicken LHRH-II (pGlu1-His2-Trp3-Ser4-His5-Gly6-Trp7-Tyr8-Pro9-G ly10-NH2) was more effective than chicken LHRH-I (pGlu1-His2-Trp3-Ser4-Tyr5-Gly6-Leu7-Gln8-Pro9-Gly10-N H2) or porcine LHRH (pGlu1-His2-Trp3-Ser4-Tyr5-Gly6-Leu7-Arg8-Pro9-Gly10-N H2) in stimulating the release of LH. Long-acting analogues of chicken LHRHs (chLHRHs) were created by substituting D-amino acids in position 6. An intravenous injection (10 micrograms/bird) of D-Arg6-chLHRH-II or of a long-acting mammalian analogue of LHRH (buserelin) resulted in a sustained release of LH for up to 8 h. Less sustained releases of LH were observed after the same doses of D-Ala6-chLHRH-I or of D-Trp6-chLHRH-I. Repeated subcutaneous injections of D-Arg6-chLHRH-II or buserelin at 7 to 9 h intervals for 9 d resulted in loss of pituitary gland responsiveness to these analogues. For this reason, the treatment failed to maintain elevated plasma LH concentrations and did not stimulate the growth of the ovary or oviduct.

Further results on a multiple-testing procedure for clinical trials

O'Brien and Fleming (1979, Biometrics 35, 549-556) proposed a procedure for multiple testing in clinical trials for acute disease. We evaluated their procedure for chronic-disease models and found that it can be used without modification. Type I errors are unaltered and no loss of power is seen in comparison with single-sample procedures. However, average savings in sample size are less for the chronic-disease models than for the acute model. Finally, it is shown that for any specific disease model and fixed maximum number of inspections of the data, the percentage reduction in sample size can be readily predicted from the power.

Prevalence and aetiology of cataract in Punjab

Three districts in the Punjab plains were surveyed in 1976-7 for senile cataract and potential risk factors. The prevalence of senile cataract was 15.3% among 1269 persons examined who were aged 30 ang older, and 4.3% for all ages. These figures confirmed previous reports of high prevalence. The prevalence was 1% for ages 30-49 and increased markedly in the sixth and seventh decades to 67% for ages 70 and older. Univariate age-adjusted analyses of selected socioeconomic, demographic, dietary, and other variables suggested that a higher prevalence was associated with being widowed, low education, use of rock salt in cooking, infrequent consumption of various protein foods (beans and lentils, milk, eggs, and curd), short height, and low weight. Multivariate analysis further suggested low total protein consumption as a risk factor that may account for as much as 40% of the excess prevalence of Punjab cataract over that in a US population study.

The natural history of gyrate atrophy of the choroid and retina

Twenty-nine Finnish patients (8-80 years old during follow-up) with hyperornithinemia and gyrate atrophy (HOGA) were followed 2 to 31 years to determine when and how rapidly visual acuities and visual functions were affected by the disease. Considerable variability was observed both in the age at which visual acuities began to decrease and the age at which visual acuities reached 20/200. Acuities in phakic eyes tended to decrease from 20/30 to 20/200 in ten years or less, while aphakic eyes exhibited generally slower loss of vision. Without benefit of cataract surgery, the percentage of eyes with acuity 20/200 or worse would have been 37% at age 30 and 64% at age 40, but through surgery actually performed was 20% at age 40. Constriction of visual fields with age was marked and correlated well with diminution in dark adaptation.