Gene Expression Scoring of Immune Activity Levels for Precision Use of Hydrocortisone in Vasodilatory Shock

PURPOSE

Among patients with vasodilatory shock, gene expression scores may identify different immune states. We aimed to test whether such scores are robust in identifying patients' immune state and predicting response to hydrocortisone treatment in vasodilatory shock.

MATERIALS AND METHODS

We selected genes to generate continuous scores to define previously established subclasses of sepsis. We used these scores to identify a patient's immune state. We evaluated the potential for these states to assess the differential effect of hydrocortisone in two randomized clinical trials of hydrocortisone versus placebo in vasodilatory shock.

RESULTS

We initially identified genes associated with immune-adaptive, immune-innate, immune-coagulant functions. From these genes, 15 were most relevant to generate expression scores related to each of the functions. These scores were used to identify patients as immune-adaptive prevalent (IA-P) and immune-innate prevalent (IN-P). In IA-P patients, hydrocortisone therapy increased 28-day mortality in both trials (43.3% vs 14.7%, P = 0.028) and (57.1% vs 0.0%, P = 0.99). In IN-P patients, this effect was numerically reversed.

CONCLUSIONS

Gene expression scores identified the immune state of vasodilatory shock patients, one of which (IA-P) identified those who may be harmed by hydrocortisone. Gene expression scores may help advance the field of personalized medicine.

Identification of acute respiratory distress syndrome subphenotypes de novo using routine clinical data: a retrospective analysis of ARDS clinical trials

OBJECTIVES

The acute respiratory distress syndrome (ARDS) is a heterogeneous condition, and identification of subphenotypes may help in better risk stratification. Our study objective is to identify ARDS subphenotypes using new simpler methodology and readily available clinical variables.

SETTING

This is a retrospective Cohort Study of ARDS trials. Data from the US ARDSNet trials and from the international ART trial.

PARTICIPANTS

3763 patients from ARDSNet data sets and 1010 patients from the ART data set.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared with biomarker data, allowing identification of subphenotypes.

RESULTS

Data from 4773 patients were analysed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO₂, arterial pH and FiO₂. Participants in subphenotype B showed increased levels of proinflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28 and longer duration of ventilation compared with patients in the subphenotype A.

CONCLUSIONS

Routinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials.

2183. Financial Cost, Length of Stay, and Patient Experience Associated with Healthcare-Associated Infections Across a 43 Hospital Network

Background

Reduction of healthcare-associated infections (HAIs) is critical to improve patient safety and hospital quality. However, not all HAI-associated outcomes are well studied. We examined several of these—the financial and length of stay (LOS) burden of HAIs and patient experience of care.

Methods

National Healthcare Safety Network-reported catheter-associated urinary tract infections (CAUTI), C. difficile infections (CDI), central line-associated bloodstream infections (CLABSI), MRSA bacteremia, and colon surgery surgical site infections (SSI-COLO) were queried for the first 9 months of 2016 from 43 hospitals. Patients with an HAI were matched to controls on hospital and primary diagnosis to create a retrospective case–control study. CAUTI and CLABSI patients were matched to controls with associated device codes. LOS and total direct variable cost (TDVC) were collected for all HAI and control patients. If patients returned a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, their likelihood to recommend (LTR) response was additionally analyzed.

Results

Data were analyzed for 123 CAUTI, 1,116 CDI, 166 CLABSI, 58 MRSA, and 127 SSI-COLO case–control pairs across 43 hospitals. TDVC per case was significantly higher among HAI cases than controls for CDI ($6,484), CLABSI ($14,646), and SSI-COLO ($9,770; figure 1). LOS was significantly higher for cases across all HAI groups, with attributable differences of 7.6 days for CAUTI, 6.4 for CDI, 9.7 for CLABSI, 7.4 for MRSA, and 4.5 for SSI-COLO (Figure 2). Of 3,180 subjects, 198 returned HCAHPS surveys. Response rate of “Yes, definitely” to LTR for 85 HAI patients was 63.5% compared with 72.6% for 113 control patients (Figure 3).

Conclusion

This is the first investigation to our knowledge pairing patient experience of care data with TDVC and LOS for HAI patients. HAIs have a significant impact on patient experience, cost, and length of stay―further supporting the importance of preventing HAIs.

Disclosures

R. Olmsted, Ethicon, Inc.: Speaker’s Bureau, Speaker honorarium; APIC: External faculty HRET/CDC STRIVE project, Speaker honorarium.

Identification of regions of normal grey matter and white matter from pathologic glioblastoma and necrosis in frozen sections using Raman imaging

In neurosurgical applications, a tool capable of distinguishing grey matter, white matter, and areas of tumor and/or necrosis in near-real time could greatly aid in tumor resection decision making. Raman spectroscopy is a non-destructive spectroscopic technique which provides molecular information about the tissue under examination based on the vibrational properties of the constituent molecules. With careful measurement and data processing, a spatial step and repeat acquisition of Raman spectra can be used to create Raman images. Forty frozen brain tissue sections were imaged in their entirety using a 300-µm-square measurement grid, and two or more regions of interest within each tissue were also imaged using a 25 µm-square step size. Molecular correlates for histologic features of interest were identified within the Raman spectra, and novel imaging algorithms were developed to compare molecular features across multiple tissues. In previous work, the relative concentration of individual biomolecules was imaged. Here, the relative concentrations of 1004, 1300:1344, and 1660 cm(-1), which correspond primarily to protein and lipid content, were simultaneously imaged across all tissues. This provided simple interpretation of boundaries between grey matter, white matter, and diseased tissue, and corresponded with findings from adjacent hematoxylin and eosin-stained sections. This novel, yet simple, multi-channel imaging technique allows clinically-relevant resolution with straightforward molecular interpretation of Raman images not possible by imaging any single peak. This method can be applied to either surgical or laboratory tools for rapid, non-destructive imaging of grey and white matter.

Effects of rivaroxaban, acetylsalicylic acid and clopidogrel as monotherapy and in combination in a porcine model of stent thrombosis

BACKGROUND

Despite standard dual antiplatelet therapy (DAT) (acetylsalicylic acid [ASA] and clopidogrel), there is a ≥ 1.4% incidence of in-stent thrombosis in patients with acute coronary syndrome. Factor Xa inhibitors are being investigated for secondary prevention after acute coronary syndrome.

OBJECTIVE

To study the antithrombotic effects of the FXa inhibitor rivaroxaban alone or in combination with DAT.

METHODS

Bare metal stents (12 per animal, three per intervention period) were deployed in a porcine ex vivo arteriovenous shunt and exposed to flowing arterial blood (shear rate: 1500 s(-1)). In-stent thrombus formation was analyzed under different treatments: vehicle (n = 7 animals); intravenous (i.v.) rivaroxaban (0.11, 0.33, and 1.0 μg kg(-1) min(-1)) (n = 8); rivaroxaban + ASA (1.0 mg kg(-1) i.v.) (n = 6); rivaroxaban + ASA (1.0 mg kg(-1) i.v.) + clopidogrel (0.5 mg kg(-1) i.v.) (n = 7); and ASA (1.0 mg kg(-1) i.v.) + clopidogrel (0.5 mg kg(-1) i.v.) (n = 6).

RESULTS

Rivaroxaban dose-dependently reduced stent thrombus weight by ≤ 66% vs. vehicle (P < 0.05, all doses). Rivaroxaban + ASA further reduced thrombus weight vs. vehicle (86% at the highest rivaroxaban dose; P < 0.001). DAT reduced thrombus weight by ≤ 79%. However, rivaroxaban + ASA + clopidogrel almost completely abolished in-stent thrombus formation (98% reduction vs. vehicle at the highest rivaroxaban dose; P < 0.001).

CONCLUSIONS

Our data on the inhibitory effect of rivaroxaban alone or with DAT are consistent with the ATLAS 2 trial findings, and support its potential use for preventing stent thrombosis after stent deployment.

Differentiation of small round blue cell tumors using Raman spectroscopy

PURPOSE

Small round blue cell tumors (SRBCTs) are aggressive undifferentiated embryonal tumors, including neuroblastoma, rhabdomyosarcoma, Ewing sarcoma, and non-Hodgkin lymphoma. They share similar histologic features. Additional studies such as immunohistochemistry and molecular techniques are required to differentiate them. There is no widely available tool for real-time diagnosis. Raman spectroscopy is an analytical technique with potential for quick and accurate diagnosis of tumors in near real-time.

METHODS

Fresh or banked frozen tissue samples from SRBCTs were processed for routine pathology and Raman spectroscopy. Raman results were correlated with the final pathology diagnosis.

RESULTS

The data set was composed of 480 spectra from 32 samples, including 179 neuroblastoma, 37 Ewing sarcoma, 164 rhabdomyosarcoma, and 100 non-Hodgkin lymphoma spectra. Discriminant function analysis showed that a combination of 18 peaks could accurately identify 94% of spectra. At the tissue level, all tumors were correctly identified. Only 10 peaks were needed to classify all tissues with 100% accuracy. Spectral-level classification with this model was 87.9%.

CONCLUSION

Raman spectroscopy is an accurate technique for quickly and accurately differentiating SRBCTs. It could diagnose these specimens and provide a single, easy to use test for near real-time diagnosis.

Risk-sharing policies in the context of the French Flood Prevention Action Programmes

This article analyzes the consequences for risk distribution of the French Flood Prevention Action Programme (PAPI). By redirecting floods from the most vulnerable to the least vulnerable areas, PAPIs expose farmers to greater flood risks. This has led local water management institutions to introduce compensation payments. The article outlines the results of an exhaustive survey of all PAPIs in France, which examined the way the compensation policies are set up locally. Results of the survey showed that the proposed policies may be financially non-viable. Several more viable risk-sharing solutions are then discussed, involving insurance schemes, state intervention and local institutions.

Diagnosis of Wilms' tumor using near-infrared Raman spectroscopy

PURPOSE

Raman spectroscopy has distinguished malignant from normal tissues in several types of cancer. This is the first report of applying Raman spectroscopy to the diagnosis of Wilms' tumor.

METHODS

Specimens of normal kidney, Wilms' tumor, xanthogranuloma, nephrogenic rests, and rhabdoid tumor were collected fresh from the operating room. Specimens of Wilms' tumor, normal kidney, and congenital mesoblastic nephroma were retrieved from the cryobank and thawed to room temperature. At least 12 Raman spectra were collected from each tissue sample. Histologic slides of each specimen were reviewed by pediatric pathologists. A computer algorithm based on discriminant function analysis (DFA) classified the Raman spectra of Wilms' tumor and the normal sample.

RESULTS

Four hundred sixty-seven spectra were collected from 41 specimens. Using DFA, Raman spectroscopy differentiated Wilms' tumor from normal with 100% sensitivity and specificity and treated from untreated Wilms' tumor with 100% sensitivity and specificity. Using a DFA model built from cryopreserved specimens but applied to fresh Wilms' and normal samples, the sensitivity and specificity were 93.3% and 90.9%, respectively.

CONCLUSION

Raman spectroscopy is an accurate technique for differentiating Wilms' tumor from normal kidney and treated from untreated Wilms' tumor. It has potential to diagnose in minutes what currently takes several hours to days.

Raman spectroscopy detects and distinguishes neuroblastoma and related tissues in fresh and (banked) frozen specimens

BACKGROUND

Raman spectroscopy has been shown to accurately distinguish different neural crest-derived pediatric tumors. This study tests the ability of Raman spectroscopy to accurately identify cryopreserved tissue specimens using a classification algorithm designed from fresh tumor data and vice versa.

METHODS

Fresh specimens of neuroblastoma and other pediatric neural crest tumors were analyzed with Raman spectroscopy. After analysis, the specimens were stored at -80 degrees C. At a later date, the specimens were thawed and reanalyzed by Raman spectroscopy. A computer algorithm was used to classify the spectra from the frozen tissue against a computer model built on the fresh tissue data. This classification process was then reversed, testing fresh spectra against a model built from frozen data.

RESULTS

We collected 1114 spectra (862 fresh and 252 frozen) from 62 tissue samples, including 8 normal adrenal glands, 29 neuroblastomas, 14 ganglioneuromas, 8 nerve sheath tumors, and 3 pheochromocytomas. At the tissue level, frozen neuroblastoma, ganglioneuroma, nerve sheath tumor, and pheochromocytoma were distinguished from normal adrenal tissue with 100% sensitivity and specificity. Fresh tissue had the same results except for the misclassification of one specimen of nerve sheath tumor.

CONCLUSIONS

The representative spectra show a high correlation between fresh and frozen tissue, and a clear difference between pathologic conditions. Spectra from frozen tissue can be accurately classified against spectra from fresh tissue and vice versa. This modality makes it possible to determine in a few minutes a result that often takes 12 to 36 hours for tissue processing and consideration by a trained pathologist to achieve.

Cardiovascular effects of a novel potent and highly selective azaindole-based inhibitor of Rho-kinase

BACKGROUND AND PURPOSE

Rho-kinase (ROCK) has been implicated in the pathophysiology of altered vasoregulation leading to hypertension. Here we describe the pharmacological characterization of a potent, highly selective and orally active ROCK inhibitor, the derivative of a class of azaindoles, azaindole 1 (6-chloro-N4-{3,5-difluoro-4-[(3-methyl-1H-pyrrolo[2,3-b]pyridin-4-yl)oxy]-phenyl}pyrimidine-2,4-diamine).

EXPERIMENTAL APPROACH

Pharmacological characterization of azaindole 1 was performed with human recombinant ROCK in vitro. Vasodilator activity was determined using isolated vessels in vitro and different animal models in vivo.

KEY RESULTS

This compound inhibited the ROCK-1 and ROCK-2 isoenzymes with IC50 s of 0.6 and 1.1 nM in an ATP-competitive manner. Although ATP-competitive, azaindole 1 was inactive against 89 kinases (IC50>10 microM) and showed only weak activity against an additional 21 different kinases (IC50=1-10 microM). Only the kinases TRK und FLT3 were inhibited by azaindole 1 in the sub-micromolar range, albeit with IC50 values of 252 and 303 nM, respectively. In vivo, azaindole 1 lowered blood pressure dose-dependently after i.v. administration in anaesthetized normotensive rats. In conscious normotensive and spontaneously hypertensive rats azaindole 1 induced a dose-dependent decrease in blood pressure after oral administration without inducing a significant reflex increase in heart rate. In anaesthetized dogs, azaindole 1 induced vasodilatation with a moderately elevated heart rate.

CONCLUSIONS AND IMPLICATIONS

Azaindole 1 is representative of a new class of selective and potent ROCK inhibitors and is a valuable tool for the elucidation of the role of ROCK in the cardiovascular system.

Generation and characterization of a stable soluble guanylate cyclase-overexpressing CHO cell line

A stably transfected soluble guanylate cyclase (sGC, alpha1 and beta1 subunits of the rat lung enzyme)-overexpressing CHO cell line was generated for the characterization of different types of activators of the soluble guanylate cyclase. Polyclonal antibodies directed against both subunits of the rat enzyme were used to detect both subunits in the cytosol of the transfected CHO cells. We studied the effects of different nitric oxide (NO) donors like SNP and DEA/NO and, in particular, the direct, NO-independent stimulator of the soluble guanylate cyclase 3-(5'-hydroxymethyl-2'furyl)-1-benzyl indazole (YC-1), on intracellular guanosine 3',5'-cyclic monophosphate (cGMP) production. DEA/NO (0.01-3 microM), SNP (1-10 microM), and YC-1 (1-10 microM) induced a concentration-dependent intracellular cGMP increase with maximal effects of 16-fold (3 microM DEA/NO), 8-fold (10 microM SNP), and 6-fold (10 microM YC-1) stimulation compared to controls, respectively. In addition, a synergistic effect of the combination of the NO donor and YC-1 could be observed with a maximal stimulation of 64-fold by SNP (10 microM) and YC-1 (10 microM). 1H-(1,2,4)-Oxadiazolo-(4,3-a)-6-bromo-quinoxazin-1-one (ODQ, 10 microM), a potent and selective inhibitor of sGC, inhibited both the single effects of NO donors [DEA/NO (3 microM), 77%; SNP (3 microM), 83%] and YC-1 [YC-1 (3 microM), 82%], but moreover the synergistic effects between NO donors and YC-1 [DEA/NO (3 microM) + YC-1 (3 microM), 81%; SNP (3 microM) + YC-1 (3 microM),89%] on intracellular cGMP production. In summary,we have generated a simple, sensitive, and useful bioassay method to characterize all types of sGC activators on the cellular level without the need of primary cell culture, several transfections, or purifying enzyme from biological materials.

Application of screen-printed electrodes as transducers in affinity flow-through sensor systems

An affinity flow-through sensor system based on a heterogeneous competitive affinity assay for the determination of low molecular weight compounds is described using the examples of biotin and atrazine determination. The binding proteins, either streptavidin or a biotinylated monoclonal antibody, were immobilized on a biotinylated screen-printed electrode, where the competition between the analyte and an analyte-enzyme-conjugate took place. Determination of the bound enzyme was done through the supply of suitable enzyme substrates and electrochemical determination of an enzyme reaction product. In the assays described here, peroxidase was used as enzyme label. As hydrogen peroxide and hydroquinone were used as enzyme substrates, the amount of enzyme retained at the screen-printed graphite electrode was determined amperometrically at a reducing potential of -600 mV vs a screen-printed platinum electrode. The activation of the electrode by biotinylation was done in a batch procedure outside the system, before the electrode was inserted. All following steps of the assay were performed automatically in an unsegmented flow-through system through an appropriate delivery of required reagents. The system was optimized mainly through the determination of biotin. This assay was based on the competition between biotin and biotinylated peroxidase for the binding sites of streptavidin. The method showed a linear range from 0.045 to 2 micrograms/l (r2 = 0.9997, n = 7) with RSD lower than 3.8%. The system was modified further by using a biotinylated monoclonal antibody against atrazine for analyte recognition and performing a competitive assay between atrazine and a triazine-peroxidase-conjugate. The linear range was from 0.01 to 10 micrograms/l, with IC50 = 0.4 microgram/l and RSD lower than 4.6%. The method was also applied to atrazine spiked water samples. Regeneration of the sensor surface was based on removal of streptavidin in both assays.

Effect of YC-1, an NO-independent, superoxide-sensitive stimulator of soluble guanylyl cyclase, on smooth muscle responsiveness to nitrovasodilators

1. We studied the effects of 3-(5'-hydroxymethyl-2'furyl)-1-benzyl indazole (YC-1) on the activity of purified soluble guanylyl cyclase (sGC), the formation of guanosine-3':5' cyclic monophosphate (cyclic GMP) in vascular smooth muscle cells (VSMC), and on the tone of rabbit isolated aortic rings preconstricted by phenylephrine (PE). In addition, we assessed the combined effect of YC-1, and either NO donors, or superoxide anions on these parameters. 2. YC-1 elicited a direct concentration-dependent activation of sGC (EC50 18.6 +/- 2.0 microM), which was rapid in onset and quickly reversible upon dilution. YC-1 altered the enzyme kinetics with respect to GTP by decreasing KM and increasing Vmax. Activation of sGC by a combination of sodium nitroprusside (SNP) and YC-1 was superadditive at low and less than additive at high concentrations, indicating a synergistic activation of the enzyme by both agents. A specific inhibitor of sGC, 1H-(1,2,4)-oxdiazolo-(4,3-a)-6-bromo-quinoxazin-1-one (NS 2028), abolished activation of the enzyme by either compound. 3. YC-1 induced a concentration-dependent increase in intracellular cyclic GMP levels in rat cultured aortic VSMC, which was completely inhibited by NS 2028. YC-1 applied at the same concentration as SNP elicited 2.5 fold higher cyclic GMP formation. Cyclic GMP-increases in response to SNP and YC-1 were additive. 4. YC-1 relaxed preconstricted endothelium-denuded rabbit aortic rings in a concentration-dependent manner (50% at 20 microM) and markedly increased cyclic GMP levels. Relaxations were inhibited by NS 2028. A concentration of YC-1 (3 microM), which elicited only minor effects on relaxation and cyclic GMP, increased the vasodilator potency of SNP and nitroglycerin (NTG) by 10 fold and markedly enhanced SNP- and NTG-induced cyclic GMP formation. 5. Basal and YC-1-stimulated sGC activity was sensitive to inhibition by superoxide (O-2) generated by xanthine/xanthine oxidase, and was protected from this inhibition by superoxide dismutase (SOD). YC-1-stimulated sGC was also sensitive to inhibition by endogenously generated (O-2 in rat preconstricted endothelium-denuded aortic rings. Relaxation to YC-1 was significantly attenuated in aortae from spontaneously hypertensive rats (SHR), which generated O-2 at a higher rate than aortae from normotensive Wistar Kyoto rats (WKY). SOD restored the vasodilator responsiveness of SHR rings to YC-1. 6. In conclusion, these results indicate that YC-1 is an NO-independent, O-2-sensitive, direct activator of sGC in VSMC and exerts vasorelaxation by increasing intracellular cyclic GMP levels. The additive or even synergistic responses to NO-donors and YC-1 in cultured VSMC and isolated aortic rings apparently reflect the direct synergistic action of YC-1 and NO on the sGC. The synergism revealed in this in vitro study suggests that low doses of YC-1 may be of therapeutic value by permitting the reduction of nitrovasodilator dosage.

Phorbol ester TPA- and bradykinin-induced arachidonic acid release from keratinocytes is catalyzed by a cytosolic phospholipase A2 (cPLA2)

In a previous paper, we have shown that bradykinin (Bk) and the phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) stimulate arachidonic acid release from HEL-30 keratinocytes along a Bk-B2 receptor G-protein-coupled pathway or a protein kinase C-dependent mechanism, respectively. Here we show a cytosolic PLA2 (cPLA2) to be responsible for this effect. This enzyme exhibited a marked acyl-group specificity towards arachidonic acid. It was activated by Ca++ in micromolar concentrations and partially translocated from the cytoplasmic to the membrane fraction upon Ca++ treatment. Translocation was also observed upon treatment of cells with either Bk or TPA. However, only with Bk was a corresponding increase of the cytoplasmic Ca++ level observed, whereas TPA-induced translocation occurred at basal Ca++ concentrations. Indirect evidence for a G protein to be involved in Bk- but not TPA-dependent cPLA2 activation was provided using non-hydrolyzable GTP derivatives. It is concluded that keratinocyte cPLA2 plays a critical role in the initiation by exogenous and endogenous factors of the eicosanoid cascade in skin.

Activation of cytosolic phospholipase A2 by transforming growth factor-alpha in HEL-30 keratinocytes

In the mouse keratinocyte line HEL-30 the epidermal mitogen transforming growth factor-alpha (TGF-alpha) stimulated the rapid release of arachidonic acid in a dose- and time-dependent manner. The liberation of arachidonic acid was due to the activation of a Ca(2+)-dependent cytosolic phospholipase A2 (cPLA2). The activation mechanism critically depended on a functionally active epidermal growth factor receptor tyrosine kinase and occurred independently of phospholipase C-mediated increases in cellular diacylglycerol and inositol 1,4,5-trisphosphate concentrations and protein kinase C activation. The activation included an increase in cytosolic PLA2 (cPLA2) activity and an association of the enzyme with the membrane fraction. Both activation steps apparently occurred in the presence of basal cytoplasmic Ca2+ concentrations. Moreover, cPLA2 or a closely associated protein was found to be phosphorylated on tyrosine upon TGF-alpha challenge of the cells. The data suggest that tyrosine phosphorylation is involved in the TGF-alpha-induced activation of cPLA2.

Epidermal-growth-factor-induced production of phosphatidylalcohols by HeLa cells and A431 cells through activation of phospholipase D

In response to epidermal growth factor (EGF), HeLa cells and A431 cells rapidly accumulate substantial amounts of phosphatidic acid (up to 0.16 and 0.2 micrograms/10(6) cells respectively), which represents approx. 0.17% of total phospholipid. Phosphatidic acid may be a potential product of diacylglycerol kinase and/or of phospholipase D. To evaluate the contribution of phospholipase D, the phosphatidyl-transfer reaction to a primary alcohol (mostly butan-1-ol; 0.2%) was measured; this reaction is known to be mediated exclusively by phospholipase D in intact cells. In HeLa and in A431 cells prelabelled with [1-14C]oleic acid, EGF (10 and 100 nM respectively) caused a 3-fold increase in radioactive phosphatidylbutanol within 5 min at the expense of labelled phosphatidic acid. Dose-response relationships showed 10 nM- and 100 nM-EGF to be maximally effective in HeLa cells and A431 cells respectively. Mass determinations showed that the phosphatidylbutanol formed within 5 min represented only part of the phosphatidic acid. Depletion of protein kinase C by pretreatment of A431 cells for 17 h with the phorbol ester phorbol 12-myristate 13-acetate (0.1 microM) did not impair EGF-induced formation of phosphatidylbutanol, thus indicating that the reaction was independent of this enzyme. Since phosphatidic acid is suggested to exert second-messenger functions as well as to induce biophysical changes in cellular membranes, its formation, including that via the phospholipase D pathway, may represent an important link between extracellular signals and intracellular targets.

Activation of a keratinocyte phospholipase A2 by bradykinin and 4 beta-phorbol 12-myristate 13-acetate. Evidence for a receptor-GTP-binding protein versus a protein-kinase-C mediated mechanism

The release of arachidonic acid from cellular phospholipids and its subsequent conversion to eicosanoids is the common early response of skin keratinocytes to a wide variety of exogenous or endogenous agonists including irritant skin mitogens such as the phorbol ester, 4 beta-phorbol 12-myristate 13-acetate (PMA) or the inflammatory peptide bradykinin. In mouse keratinocytes labeled with [14C]arachidonic acid, both PMA and bradykinin induced the release of the fatty acid in a dose-dependent and time-dependent manner. Three lines of evidence indicate phospholipase A2 activity to be involved in arachidonic acid release: (a) its inhibition by mepacrine, (b) the concomitant generation of lysophosphatidylcholine from [3H]choline-labeled cells and (c) an increase in arachidonic acid release from 14C-labeled phosphatidylcholine in particulate fractions from PMA-treated and bradykinin-treated keratinocytes. Inhibition or down regulation of protein kinase C (PKC) led to a suppression of PMA-induced but not bradykinin-induced arachidonic acid release, indicating a critical involvement of this kinase in phorbol-ester-induced activation of epidermal phospholipase A2 activity. Bradykinin-induced activation of phospholipase A2 was however, shown to be mediated by specific B2 receptors coupled to GTP-binding proteins (G protein). In support of this mechanism it was demonstrated that the bradykinin-induced phospholipase A2 activity was increased in the presence of non-hydrolysable GTP but decreased upon addition of non-hydrolysable GDP analogues. Moreover, cholera toxin stimulated both basal and bradykinin-induced phospholipase A2 activity in a cAMP-independent manner, whereas pertussis toxin was found to be inactive in this respect. The data suggest that epidermal phospholipase A2 activity can be stimulated by bradykinin via a B2 receptor-G-protein-dependent pathway, which is independent of PKC and a PKC-dependent pathway which is activated by phorbol esters such as PMA.

Otolithic evoked potentials: a new technique for vestibular studies

Evoked potentials, EP, are time-locked electroencephalographic voltages bearing temporal relation to an excitatory stimulus, recorded by scalp electrodes and an averaging computer. This paper reports the first apparent recording of otolithic EP. Thirty-nine students on a tilt table underwent head drop conditions stimulatory to the otolithic maculas. The wave-form obtained resembles neither auditory, visual, somatosensory or semicircular EP. Otolithic EP provide heretofore unavailable insights into the electrophysiology of the macular generators, VIII nerve, and related central processing.

A new method for noninvasive measurement of short-term cerebrospinal fluid pressure changes in humans

Changes in cerebrospinal fluid (CSF) pressure were shown to be reflected by changes in tympanic membrane (TM) tension. Impedance audiometry measures mechanical tension on the TM and was used to detect changes during jugular vein compression in normal students. CSF and peri-lymph communicate through the cochlear aqueduct, permitting increases in CSF pressure to result in increased pressure on the stapes footplate. This is transmitted to the TM by the ossicles and detected by impedance audiometry. TM tension was also proportional to CSF pressure in cadavers, where CSF pressure was manipulated by saline injection through a lumbar puncture.