Should we abandon the APTT for monitoring unfractionated heparin?

INTRODUCTION

The activated partial thromboplastin time (APTT) is commonly used to monitor unfractionated heparin (UFH) but may not accurately measure the amount of heparin present. The anti-Xa assay is less susceptible to confounding factors and may be a better assay for this purpose.

MATERIALS AND METHODS

The validity of the APTT for monitoring UFH was assessed by comparing with an anti-Xa assay on 3543 samples from 475 patients (infants [n=165], children 1-15years [n=60] and adults [n=250]) receiving treatment dose UFH.

RESULTS

Overall concordance was poor. The highest concordance (66%; 168/254) was seen in children. Concordance (51.8%) or discordance (48.4%) was almost equal in adult patients. Among adult patients whose anti-Xa level was within 0.3-0.7IU/mL, only 38% had an APTT in the therapeutic range whilst 56% were below and 6% were above therapeutic range. Children and adult patients with anti-Xa of 0.3-0.7IU/mL but sub- therapeutic APTT had significantly higher fibrinogen levels compared to those with therapeutic or supra-therapeutic APTT.

CONCLUSIONS

When the anti-Xa level was 0.3-0.7IU/mL, the majority of samples from infants demonstrated a supra-therapeutic APTT, whilst adults tended to have a sub-therapeutic APTT. This may lead to under anticoagulation in infants or over anticoagulation in adults with risk of bleeding if APTT is used to monitor UFH. These results further strengthen existing evidence of the limitation of APTT in monitoring UFH. Discordance of APTT and anti-Xa level in adults and children may be due to elevation of fibrinogen level.

Gene expression and protein localization of calmodulin-dependent phosphodiesterase during ontogenesis of chick retina

Calmodulin-dependent phosphodiesterase (PDE1) is a key enzyme in cyclic nucleotides metabolism. We studied its gene expression and protein localization during retinal development in chick embryos. Western blot and densitometric analysis demonstrated that the expression of the three isoforms changed during development. PDE1A was highly expressed at the early stages and decreased as development proceeded. PDE1B expression remained relatively low and constant over time. PDE1C showed a prominent increase (13-fold) between embryonic day (E) 7 and E13, followed by a moderate increase between E13 and postnatal day (P) 1. The presence of the enzyme in the different retinal locations was strongly modulated by development. PDE1A immunostaining was first detected at the ganglion cell level (E7), then in the outer retina (E15-E21). At P5, the immunostaining was confined in the optic fiber layer. Isoform C immunolocalization followed the same inner-outer pattern as isoform A. At 5 days posthatching (P5), the immunoreactivity was restricted, as well as for the isoform A, in the optic fiber layer. The isoform B immunolabelling was low and evenly distributed across the retina at all stages. The different developmental profiles of PDE1A, PDE1B, and PDE1C induced a temporal modulation in cyclic nucleotides concentration, suggesting specific roles of this enzyme in the morphofunctional development of retinal circuitry.

Gene expression and protein localization of calmodulin-dependent phosphodiesterase in adult rat retina

Calcium calmodulin-dependent cyclic nucleotide phosphodiesterase (PDE1) was identified in crude extract and immunolabeled sections of rat retina. Both cAMP and cGMP PDE activities were stimulated by calcium-calmodulin (4.7-fold and 2.3-fold, respectively). To characterize PDE1 isoforms in retinal cells further, we used antibodies that specifically recognize PDE1 gene products. PDE1B antibody stained a band at molecular mass of 63 kDa whereas PDE1C antibody recognized two bands at 74- and 70-kDa molecular masses. Two PDE1A antibodies (against N-terminal and C-terminal peptides) detected a band at 79 kDa never described before. Immunohistochemical analysis showed a distribution of PDE1A in the outer retina with a bright fluorescence in the outer segments of photoreceptors. PDE1B is uniformly distributed across the retina. PDE1C is confined mainly to the inner retina, with a precise localization in the inner nuclear layer. Immunostaining with choline acetyltransferase antibody indicates localization in cholinergic amacrine cell. The present data provide evidence of expression of PDE1 isoforms in mammalian retina with a complementary distribution of PDE1A and PDE1C, suggesting different roles in retinal function.

Long-term treatment of the developing retina with the metabotropic glutamate agonist APB induces long-term changes in the stratification of retinal ganglion cell dendrites

The gradual restriction of initially multistratified retinal ganglion cell (RGC) dendrites into ON and OFF sublaminae of the inner plexiform layer (IPL) can be effectively blocked by treating the developing retina with 2-amino-4-phosphonobutyrate (APB), the metabotropic glutamate agonist, or by light deprivation. Previous studies have focused on the short-term consequences of such manipulations, so the long-term effects of arresting dendritic stratification on the structural development of RGCs are as yet unknown. In the present study, we have addressed this issue by performing a morphological analysis of alpha RGCs labeled by retrograde transport of horseradish peroxidase injected into the dorsal lateral geniculate nucleus of adult cats that received monocular injections of APB from postnatal (P) day 2 until P30. A large proportion of the alpha cells in the APB-treated eye (44%) were found to have multistratified dendrites that terminated in both the ON and OFF sublaminae of the IPL. The dendritic arborization pattern in the sublaminae of the IPL of these cells was asymmetric, showing a variety of forms. Immunolabeling of retinal cross-sections showed that mGLUR6 receptors appeared normal in density and location, while qualitative observation suggested an increase in the axonal arborization of rod bipolar cells. These findings indicate that long-term treatment of the neonatal retina with APB induces a long- lasting structural reorganization in retinal circuitry that most likely accounts for some of the previously described changes in the functional properties of RGCs.

Spatial organization of displaced ganglion cells in the chick retina

This study presents a morphological and quantitative analysis of displaced ganglion cells performed in the chick retina at different stages of development (E11, E17, & P2). The lipophilic dye DiI inserted into the optic nerve provided a complete staining of displaced ganglion cell population and of their dendritic trees. From 11 days of incubation (E11) all neurons present a uniform morphology and are unmistakably recognizable by the dimensions of their cell body and by the presence of the axon. Their dendritic arborizations shape a complex network through the retina. Cell bodies are randomly distributed but dendritic trees of neighboring cells constantly present two levels of dendritic overlap: about 50% of the cells present a high degree of overlap, more than the 30% up to 95% of their total area, while the other half overlaps less than 20%. The high degree of overlap identifies a cluster, which is regularly formed by three and more rarely by four neurons starting from 17 days of incubation (E17) onward and after birth. From E17 onward, 94% of clusters is constantly formed by three cells and 6% of the clusters by four neurons. The distribution and the spatial arrangement of clusters are very regular, forming a mosaic that gives rise to a precise retinal coverage. The nearest-neighbor analysis unequivocally demonstrated that the mosaic of clusters is the most regular array so far described. This exact arrangement starts from 11 days of incubation and is maintained and refined through the following stages of development and after birth.

Electrical activity regulates dendritic reorganization in ganglion cells after neonatal retinal lesion in the cat

During the first month of postnatal life, the dendritic arborizations of cat retinal ganglion cells continue to develop and undergo a substantial remodeling. Mechanical and pharmacological interferences with the normal development induce, during this period of time, substantial modifications in ganglion cell morphology. Specifically, the degeneration of those neurons whose axons were severed by a neonatal retinal lesion leads to a zone depleted of ganglion cells. Neurons at the border of the depleted area develop an abnormal elongation of the dendritic trees toward the empty space. In the present paper, we report data showing that this dendritic reorganization can be prevented by blocking the electrical activity with repeated tetrodotoxin injections into the eye during the whole critical period. Our analysis was performed on neurons filled with horseradish peroxidase.

Evidence that the influence of ganglion cell axons on astrocyte morphology is mediated by action spike activity during development

In many mammal retinas, the morphology of astrocytes is strongly influenced by nearby axons of ganglion cells. Astrocyte processes stretch along the axons, fine extensions of the processes contact node-like specialisation of the axon membrane and the morphology of the adult astrocyte is strongly determined by this relationship. The mechanism which attracts astrocyte processes to contact specific regions of the axon membrane is not known however. This study presents evidence that in the neonatal cat blocking the impulse activity of ganglion cells with the Na+-channel blocker tetrodotoxin (TTX) leads to a loss of the axon-related morphology of astrocytes. The morphological change induced in astrocytes by TTX was greater in younger animals and could not be detected in the adult. Conversely, if the TTX block was maintained for 4 postnatal weeks the changes induced in astrocytes persisted at least to 13 weeks. The TTX-induced loss of axon-related morphology in astrocytes suggests that the signal by which axons attract astrocyte processes to contact the axonal membrane in ways which modify astrocyte morphology is released by action spike activity during development.

Interplay between the dendritic trees of alpha and beta ganglion cells during the development of the cat retina

We have analyzed the effect of a small lesion to the retina of a two-day-old kitten and observed that after degeneration of ganglion cells whose axons were severed, a restricted region of the retina remained depleted of cells. Cells located near the borders of the depleted zone showed an abnormal elongation of dendrites towards the bare area. By means of a computer-aided system, we analyzed the whole population of cells at the two borders, and in agreement with previous data found that the effect was most prominent at the border and progressively decreased to eventually disappear at a distance of approximately 500 microns. The distance from the border, however, is not the only factor to influence the degree of asymmetry; with comparable distances, the vicinity of an alpha-cell reduces the projection of the beta-cell dendrites toward the empty area. We suggest that the organization of the adult retinal pattern is also influenced by interactions occurring between dendrites of different classes of ganglion cells.

Binding pattern of alpha-bungarotoxin on horizontal cells of a marine teleost retina

A conjugate of alpha-bungarotoxin and a fluorescent marker (fluorescein isothiocyanate) has been used to localize "nicotinic" acetylcholine receptors on neurons in the outer plexiform layer of marine teleost retina. Toxin binding was confined to bipolar cell dendrites and to intermediate horizontal cells. The arrangement of labeled horizontal cells appears irregular in the whole retina, with a peak density in the ventral and dorsal quandrants. Alpha-bungarotoxin receptors on horizontal cells differ from those on bipolar cells and from those on dendrites in the inner plexiform layer in their sensitivity to agonists and antagonists such as d-tubocurarine and nicotine. They constitute a different type of "nicotinic" receptor that probably has a different function.

Differentiation, extent and layering of amacrine cell dendrites in the retina of a sparid fish

The morphology of amacrine cells has been studied in Golgi-stained retinae of the salt water sparid Boops boops. The great variety of size and shapes of amacrine cells has been organized into five classes according to the qualitative parameter 'dendritic architecture', which describes the number, size, course, degree of dichotomy, and varicosity of dendrites. Extent of dendritic field and depth of stratification in the inner plexiform layer, viewed as quantitative variations of a given cell type morphology, complete the criteria for classification. Each amacrine cell is unequivocally defined by a three element code according to the values assumed by the parameters used for the classification. The possible functional implications of dendritic morphology are briefly discussed.

beta-Glucuronidase activity in the developing uropygial gland

The presence of sterolic compounds and beta-glucuronidase activity have been studied in the uropygial glands of chick embryos (18th day of inc.), chickens (3 weeks after hatching) and young fowls (5 months old). Sterols are histochemically detectable only after hatching and beta-glucuronidase activity, very faint before hatching, reaches its maximum in chicken glands with a peculiar inner localization coincident with sterolic localization. It is suggested that beta-glucuronidase has in uropygial gland a double functional significance: a certain amount of activity is developed to cell proliferation whereas a more strong activity is involved in the hydrolysis of sterol glucuronides.

Occurrence of 7-dehydrocholesterol in the uropygial gland of domestic fowls

Histochemical studies on the uropygial gland of domestic fowls have shown the presence of sterols (among which cholesterol and its esters) in the lipidic fraction of the gland secret. beta-Glucuronidase activity beside A5 3beta- and 17beta-hydroxysteroid dehydrogenase activities suggests that uropygial gland might be involved in sterols metabolism. By thin layer chromatography cholesterol and 7-dehydrocholesterol can be separated from the uropygial extracts and these compounds can be identified in gas liquid chromatography.