Smartphone electrocardiogram for QT interval monitoring in Coronavirus Disease 2019 (COVID-19) patients treated with Hydroxychloroquine

INTRODUCTION

The global pandemic of Corona Virus Disease 2019 (COVID-19) has led to the re-purposing of medications, such as hydroxychloroquine and lopinavir-ritonavir in the treatment of the earlier phase of COVID-19 before the recognized benefit of steroids and antiviral. We aim to explore the corrected QT (QTc) interval and 'torsadogenic' potential of hydroxychloroquine and lopinavir-ritonavir utilising a combination of smartphone electrocardiogram and 12-lead electrocardiogram monitoring.

MATERIALS AND METHODS

Between 16-April-2020 to 30-April- 2020, patients with suspected or confirmed for COVID-19 indicated for in-patient treatment with hydroxychloroquine with or without lopinavir-ritonavir to the Sarawak General Hospital were monitored with KardiaMobile smartphone electrocardiogram (AliveCor®, Mountain View, CA) or standard 12-lead electrocardiogram. The baseline and serial QTc intervals were monitored till the last dose of medications or until the normalization of the QTc interval.

RESULTS

Thirty patients were treated with hydroxychloroquine, and 20 (66.7%) patients received a combination of hydroxychloroquine and lopinavir-ritonavir therapy. The maximum QTc interval was significantly prolonged compared to baseline (434.6±28.2msec vs. 458.6±47.1msec, p=0.001). The maximum QTc interval (456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not significantly different between patients on hydroxychloroquine or a combination of hydroxychloroquine and lopinavir-ritonavir. Five (16.7%) patients had QTc of 500msec or more. Four (13.3%) patients required discontinuation of hydroxychloroquine and 3 (10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de pointes was observed.

CONCLUSIONS

QTc monitoring using smartphone electrocardiogram was feasible in COVID-19 patients treated with hydroxychloroquine with or without lopinavir-ritonavir. The usage of hydroxychloroquine and lopinavir-ritonavir resulted in QTc prolongation, but no torsade de pointes or arrhythmogenic death was observed.

Chronic Finger Joint Instability Reconstructed With Bone–Ligament–Bone Graft from the Iliac Crest

Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone–ligament–bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final followup.

Comparison between Percutaneous Transverse Fixation and Intramedullary K-Wires in Treating Closed Fractures of the Metacarpal Neck of the Little Finger

We performed a non-randomized controlled clinical trial of 59 clinical cases to compare percutaneous transverse K-wire fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. Twenty-nine patients were treated by percutaneous transverse K-wire fixation and 30 patients were treated with intramedullary K-wires. They were reviewed at a mean follow-up of 24 months for radiological and functional outcome in terms of union rate, union time, complication rate, pain, movement and grip strength. Radiographs did not show any significant differences in the union rate and union time. There was no statistical difference in complication rate, pain scores, total active motion and grip strength between the two groups. The authors suggest that both methods are comparable, good and safe methods of treating closed, displaced fractures of the metacarpal neck of the little finger, without significant complications.

Carpal Ligament Injuries with Acute Scaphoid Fractures – A Combined Wrist Injury

Fifty-two consecutive patients with acute scaphoid fractures were treated by closed reduction and percutaneous screw fixation. In addition, all underwent a wrist arthrogram and 22 patients also underwent a wrist arthroscopy. Eighteen patients (34%) had an associated carpal ligament injury (four scapholunate ligament, eight lunotriquetral ligament, two combined, three TFCC and one minor leak from the distal carpal row). These patients had worse Mayo wrist scores (no ligament injury median score = 95: ligament injury median score = 85) at a mean final follow-up of 61 weeks. We advocate that scaphoid fractures with associated carpal ligament injuries should be defined as a combined wrist injury.

Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study

BACKGROUND & AIMS

Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia.

METHODS

We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture.

RESULTS

We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001).

CONCLUSIONS

We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.

Trigger thumbs in children: results of surgical release

OBJECTIVE. To evaluate results from surgical release of trigger thumbs in children in a regional hospital cluster in Hong Kong. DESIGN. Descriptive case series. SETTING. A regional hospital cluster, Hong Kong. PATIENTS. Data from 1993 to 2009 on 180 children with 209 trigger thumbs were collected. Analyses into gender, predominance of thumb, age of onset, associated abnormalities and family history, symptoms and signs, surgical outcomes, and postoperative complications were carried out retrospectively. RESULTS. There were 92 girls and 88 boys having trigger thumbs (1.05:1). In all, 29 (16%) of the children presented with bilateral trigger thumbs, while the right thumb was singly involved in 81 (45%) and the left thumb in 70 (39%) of the children. The mean age of onset was 19 months; only 20% were diagnosed before the age of 1 year. Only nine (5%) of the children were associated with congenital diseases and none had a positive family history of trigger thumb. Flexion deformity was the major presenting feature, other than triggering or pain. A nodule and flexion deformity were very commonly observed during physical examination. More than 95% of the operated thumbs with transverse incision acquired a good range of movement with a scarcely apparent scar. A residual flexion deformity was evident in only 4%, mostly in children who underwent surgical release under the age of 1 year. CONCLUSION. Surgical release is recommended for children with trigger thumbs aged more than 1 year, which attains satisfactory results with minimal complications.

Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis

OBJECTIVE

To identify predictive factors for mortality of patients with upper limb necrotising fasciitis.

DESIGN

Retrospective study.

SETTING

Six hospitals in Hong Kong.

PATIENTS

Clinical records of 29 patients treated in the hospitals were traced and analysed.

MAIN OUTCOME MEASURES

Possible predictive factors for mortality as evaluated by application of Fisher's test.

RESULTS

Overall mortality was 28%. Digital infections conferred a lower mortality, but progressive necrosis necessitated amputation. Vibrio vulnificus was the commonest organism identified in association with marine injury and in patients with cirrhosis. Prognostic indicators with decreasing significance include deranged renal and liver function, thrombocytopaenia, proximal involvement (elbow or above) initially, and presence of hypotension upon admission.

CONCLUSION

With a P value of less than 0.05, deranged renal and liver function, thrombocytopaenia, initial proximal involvement, and hypotension on admission were predictors of mortality in necrotising fasciitis affecting the upper limbs. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.

STUDIES OF THE GENERALIZED SHWARTZMAN REACTION PRODUCED BY DIET : I. PATHOLOGY

The generalized Shwartzman reaction can be produced in pregnant rats by dietary means in the absence of injection of exogenous bacterial endotoxin. The experiment consists of a period of exposure to a diet low in tocopherol followed by exposure to a diet containing oxidized lipids during the gestation period. Pregnancy near term is an essential requirement for the development of the generalized Shwartzman reaction in these experiments. Fibrin thrombi were found in the renal glomeruli in 88.5 per cent, in the lungs in 94.2 per cent, in the liver in 11.4 per cent, in the spleen in 11.4 per cent, and in the adrenal in 40 per cent of animals that died spontaneously. There were pathologic alterations in the placenta which consisted of degeneration of the trophoblast, thrombosis of maternal blood channels in the giant cell trophoblast layer and in the labyrinth, congestion of the labyrinth, hemorrhage into the uterine cavity, placental separation, intra-uterine fetal death, decidual and uterine vein thrombosis, and placentitis in 10 per cent of the cases. The mechanism by which the diet is instrumental in causing this reaction remains to be demonstrated.

STUDIES OF THE GENERALIZED SHWARTZMAN REACTION PRODUCED BY DIET : III. PARTIAL PREVENTION BY ANTIBIOTICS

A 4-fold reduction in the death rate of pregnant rats subjected to a diet capable of inducing the generalized Shwartzman reaction was obtained by the administration of oral absorbable and non-absorbable antibiotics. The possible mechanisms of this partial protection have been discussed.

Endoscopic carpal tunnel release: experience of surgical outcome in a Chinese population

OBJECTIVE

To review the outcomes of endoscopic carpal tunnel release in a Hong Kong public hospital and identify any predictive factors.

DESIGN

Retrospective study.

SETTING

Regional hospital with a hand surgery service, Hong Kong.

PATIENTS

Between January 2001 and December 2007, records of 145 patients (160 carpal tunnel syndromes) having endoscopic release were reviewed. Five major symptom domains (pain, numbness, nocturnal awakening, weakness, and clumsiness) before and after the operation were scrutinised. Functional status was assessed by grading key pinch and hand grip, as well as complications.

INTERVENTION

Endoscopic carpal tunnel release using the modified Chow's extrabursal technique under intravenous anaesthesia.

RESULTS

After the 160 procedures performed, 124 (78%) and 132 (83%) of them revealed improvement in terms of numbness and nocturnal awakening, respectively. Also, there were significant improvements in terms of average functional grading of pinch power and grip power. No serious complications due to the surgery were encountered.

CONCLUSIONS

Experience using the Chow's two-portal endoscopic technique for the treatment of carpal tunnel syndrome in the Chinese population was encouraging. It was a safe and effective method for treating carpal tunnel syndrome. We advocate endoscopic surgical intervention for patients with refractory relief of symptoms following conservative management.

Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial

We carried out a prospective randomised controlled clinical trial to compare the functional and radiological outcomes of casting with percutaneous pinning in treating extra-articular distal radial fracture in an elderly Chinese population. Sixty patients were randomly allocated by sealed envelopes to either a 'Cast' group (n = 30) or a 'K-wire' group (n = 30). All patients were available for final follow-up assessment. The radiological outcomes in terms of dorsal angulation, radial inclination and radial length were statistically significantly better in the K-wire group, whereas the Mayo wrist score and quality of life, healing rate, healing time, and complications were similar. The functional outcomes and quality of life were not affected by the treatments. Both treatments had a very low rate of complication and high healing rates.

Palmar fixation of dorsally displaced distal radius fractures using locking plates with Smartlock locking screws

We performed a prospective cohort study on a consecutive series of 35 unstable, dorsally displaced distal radius fractures, which were treated with palmar locking plates and SmartLock locking screws. There were 17 men and 18 women with a mean age of 44 years who were reviewed at a mean follow-up of 10 months. All the fractures healed at a mean time of 7 weeks. Radiographs did not show any change in alignment from the initial postoperative period until fracture union. The average Mayo wrist score was 90 after fracture union. One patient had an early loss of fracture reduction and one patient developed complex regional pain syndrome. There was no difference in the quality of life before and after surgery. Palmar plate fixation using SmartLock locking screws is effective and safe in stabilising unstable dorsally displaced distal radius fracture and produces good radiological and functional outcomes.

Haemodynamic instability secondary to minimally displaced pubic rami fractures: a report of two cases

We report 2 patients with haemodynamic instability secondary to minimally displaced pubic rami fractures following a fall. Both complained of pain and swelling in the abdomen and groin, and had abdominal distension and bruising in the abdomen, groin, and perineum. All these may be early signs of severe vascular injury and should be treated promptly. Both patients were treated with embolisation of the injured vessels using emergency angiography.

The effectiveness of capsular decompression for internal fixation of intracapsular hip fractures

PURPOSE

To compare the results of screw fixation plus capsular decompression versus screw fixation alone for managing intracapsular hip fractures.

METHODS

Of 201 patients with intracapsular hip fractures, 99 underwent screw fixation with capsular decompression (capsular decompression group) and 102 underwent screw fixation alone (control group). The incidence and time to development of avascular necrosis of the femoral head, union rate, time to union, and other clinical parameters were compared.

RESULTS

In patients with displaced fractures, the incidence of avascular necrosis was significantly higher in the control than capsular decompression group, whereas the time to development of this complication was significantly shorter.

CONCLUSION

Capsular decompression did not improve the union rate and time to union in undisplaced intracapsular hip fractures, but in displaced fractures it appeared to reduce the incidence and delay the onset of avascular necrosis.

Spontaneous fractures in nursing home residents

OBJECTIVES

To evaluate spontaneous long bone fractures occurring in nursing home residents and to identify what factors put them at risk for fractures.

DESIGN

Retrospective study.

SETTING

Department of Orthopaedics and Traumatology of a pubic hospital in Hong Kong.

PATIENTS

A total of 30 nursing home residents who developed spontaneous long bone fractures between 1994 and 2005 were reviewed.

MAIN OUTCOME MEASURES

Demographic data, mechanism of injury, pattern of fractures, associated risk factors, complications, outcomes, and post-treatment status.

RESULTS

The mean age of patients was 84 years. Co-morbidities were as follows: 22 patients were bedridden, 21 required long-term feeding by Ryle's tube, 19 had a history of cerebrovascular accident and 18 of whom had a long bone fracture on the side of the hemiplegia, 15 had dementia, and 25 had lower limb contractures. Closed supracondylar fractures of the femur occurred in 23 patients, 17 of whom presented with limb deformity. In 21 patients, fractures were treated successfully with hinged braces. In one patient, the fracture changed from closed to open. In five patients, the fractures were complicated by sacrum or heel sores, and in one by infected nonunion. In 28 patients, the fractures eventually healed without further complications. Three formerly bedridden patients were able to sit after their fractures had been treated.

CONCLUSIONS

Female nursing home residents who require long-term Ryle's tube feeding, have dementia, hemiplegia, lower limb contractures, osteoporosis, or are bedridden, are at high risk for spontaneous fractures.

Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients

OBJECTIVE

To report preliminary experience on the Camitz operation for elderly Chinese patients in a Hong Kong public hospital.

DESIGN

Retrospective study.

SETTING

Tertiary referral hospital with hand surgery service in Hong Kong.

PATIENTS

Between January 2000 and January 2004, patients with carpal tunnel syndrome having the Camitz operation were recruited. They were assessed using the measurements of pinch and grip power, sensation, the Kapandji score, and functional grading as well as complications encountered during the subsequent follow-up.

INTERVENTION

The Camitz operation.

RESULTS

A total of 21 patients (8 male and 13 female; mean age, 70 years) were recruited. The mean duration of follow-up was 15 months. There was significant improvement in pinch power, grip power, and hand functions, as well as a positive correlation between the functional score and the Kapandji score. No major complication was recorded. One patient with pre-existing osteoarthritis of the ring finger developed contracture of the proximal interphalangeal joint.

CONCLUSION

The Camitz operation is a simple, effective, and safe means of improving hand function in elderly Chinese patients with long-standing carpal tunnel syndrome and thenar muscle atrophy. Newly acquired strength in antepulsion of thumb resulted in improved pinch, grip, and hand function in this patient group.

Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores

To compare the outcomes of gluteal fasciocutaneous rotational flaps and myocutaneous flaps in the treatment of sacral sores, together with a review of surgical complications in two matched cohorts. Thirty-eight patients (18 gluteal fasciocutaneous rotational flaps and 20 myocutaneous flaps) were reviewed retrospectively at a mean follow-up of 58 weeks. The rate of healing of the sore, the sore healing time, and the incidence of surgical complications, together with rate of recurrence, were obtained by chart review. Treatment groups were matched by patient characteristics, operative time and blood loss. The rate of healing of the sore, sore healing time and complication rate were comparable in the two groups but the rate of recurrence was lower to a statistically significant extent in myocutaneous flap patients. The authors suggest that both methods are comparable, good and safe in treating sacral sores; myocutaneous flaps are more durable.

High-pressure injection injuries of the hand in a Chinese population

We performed a retrospective review of 28 digits in 28 patients who suffered high-pressure injection injuries of the hand during the last 10 years. They were all men, with a mean age of 36 years. All were work injury and the injuries were classified into mild, moderate and severe and were either treated conservatively or surgically. There were seven patients with mild injuries and six of these were successfully treated by conservative methods. Sixteen patients had moderate injuries and all were successfully treated with repeated debridement and delayed direct closure. The index fingers of two severely injured patients were salvaged with digital artery flaps and the remainder of the involved fingers were amputated. The authors advocate proper identification of mild injuries to allow conservative treatment, the application of digital artery flaps for resurfacing large finger defects and have formulated a treatment protocol according to the severity of the injury.

Squamous cell carcinoma of the nail bed: three case reports

Squamous cell carcinoma of the nail bed is rare, and the disease is often misdiagnosed as a benign condition. Digital amputation is often performed because of the delay in diagnosis and the involvement of the distal phalanx. Between March 1999 and March 2002, 3 patients presented to the Pamela Youde Nethersole Eastern Hospital, Hong Kong, with squamous cell carcinoma of the nail bed. Two of the patients underwent a digit-salvaging procedure-namely, wide local excision and flap coverage-and their functional outcome was satisfactory. The remaining patient received partial amputation of the thumb without significant functional loss. A high degree of suspicion is thus needed to detect squamous cell carcinoma of the nail bed; a biopsy of chronic recurrent nail bed lesions should be performed.

Femoral shaft fracture in a hip arthrodesis: two cases of retrograde interlocking nailing

Antegrade intramedullary nailing of femoral shaft fractures is a tried and tested treatment modality that has yielded consistently high union rates. Retrograde nailing is controversial as the approach violates the knee joint. We report two cases in which both patients had an arthrodesis of the hip and subsequently suffered a femoral shaft fracture distal to the implant. We feel that this would be an indication for retrograde nailing.

Molecular dynamics simulation of adrenocorticotropin (1-10) peptide in a solvated dodecylphosphocholine micelle

Adrenocorticotropin (ACTH) (1-10), an adrenocorticotropin hormone fragment, has been studied by molecular dynamics (MD) simulation in an NPT ensemble in an explicit dodecylphosphocholine (DPC) micelle. Two starting configurations of the peptide/micelle system, corresponding to the insertion and surface-binding modes, were used. A common equilibrated configuration, in which the peptide lies parallel to the micellar surface, was reached from both simulations. In the initial part of the simulations, distance restraints derived from NMR nuclear Overhauser enhancements were incorporated before the peptide reached an equilibrium configuration with respect to the micelle. Analyses of the trajectories from the subsequent free (unrestrained) MD simulation showed that ACTH (1-10) does not conform strictly to a helical structure. The loss of the helical structure is due to decreased intramolecular hydrogen bonding accompanied by an increase of hydrogen bonding between the amide protons of the peptide and the micellar head groups. However, the extent of the latter interaction is less pronounced than in the negatively charged SDS micelle. The final structure enhances the amphipathic nature of the peptide, facilitating better interactions at the water-hydrophobic interface. The primary hydrophobic interactions with the micelle came from the side chains of Met4, Phe7, and Trp9. All peptide bonds were either hydrated or were involved in intramolecular hydrogen bonding. The interactions with the DPC micelle, the conformation of the bound peptide, and the dynamics of the peptide, as revealed by the time correlation functions of the N-H bonds, were compared with those of the ACTH (1-10)/SDS system studied previously by MD simulations.

NMR studies of adrenocorticotropin hormone peptides in sodium dodecylsulfate and dodecylphosphocholine micelles: proline isomerism and interactions of the peptides with micelles

Three adrenocorticotropin hormone (ACTH) fragments (1-10, 1-24, and 11-24) have been studied in water and in sodium dodecylsulfate (SDS) and dodecylphosphocholine (DPC) micelles by nuclear magnetic resonance spectroscopy. The trans-cis isomerism at all three proline sites (at positions 12, 19, and 24) was found in the 11-24 segment of the peptide. The population of the cis isomers changes with the environment of the peptide. Specifically, the presence of the DPC micelle does not affect the trans-cis equilibrium in the 11-24 segment from that in water. In contrast, the presence of the SDS micelles decreases the population of the cis isomer at Pro(24), but increases its population at Pro(12) and Pro(19). The effect of SDS micelles on the trans-cis equilibrium at these proline sites was discussed. Intermolecular nuclear Overhauser effect (NOE) correlations between the ACTH peptides and the micelles were observed. These correlations occurred only in the 1-10 segment of the peptides, and the hydrophobic side chains contributed most to the intermolecular NOE. The intermolecular NOE pattern corroborates the suggestion that the 1-10 segment of the ACTH peptides bind to these micelles via a surface-binding mode, with most of the interactions coming from the insertion of the hydrophobic side chains.

The structure and dynamics of ACTH (1-10) on the surface of a sodium dodecylsulfate (SDS) micelle: a molecular dynamics simulation study

ACTH (1-10), an adrenocorticotropin hormone fragment, was studied by molecular dynamics (MD) simulation in the NPT ensemble in an explicit sodium dodecylsulfate (SDS) micelle. Initially, distance restraints derived from NMR nuclear Overhauser enhancements were incorporated during the equilibration stage of the simulation. The analyses of the trajectories from the subsequent unrestrained MD showed that ACTH (1-10) does not conform to a helical structure at the micelle-water interface; however, the structure is amphipathic. The loss of the helical structure is due to decreased intramolecular hydrogen bonding accompanied by an increase of hydrogen bonding between the amide hydrogens of the peptide and the micelle head-groups. ACTH (1-10) was found to lie on the surface of the SDS micelle. Most of the hydrophobic interactions came from the side-chains of Met-4, Phe-7 and Trp-9. The peptide bonds were either hydrated or involved in intramolecular hydrogen bonding. Decreased hydration for the backbone of His-6 and Phe-7 was due to intermolecular hydrogen bonding with the SDS head-groups. The time correlation functions of the N-H bonds of the peptide in water and in the micelle showed that the motions of the peptide, except for the N- and C-termini, are significantly reduced when partitioned in the micelle.

Human receptor for measles virus (CD46) enhances nitric oxide production and restricts virus replication in mouse macrophages by modulating production of alpha/beta interferon

Complement regulatory protein CD46 is a human cell receptor for measles virus (MV). In this study, we investigated why mouse macrophages expressing human CD46 restricted MV replication and produced higher levels of nitric oxide (NO) in response to MV and gamma interferon (IFN-gamma). Treatment of MV-infected CD46-expressing mouse macrophages with antibodies against IFN-alpha/beta blocked NO production. Antibodies against IFN-alpha/beta also inhibited the augmenting effect of MV on IFN-gamma-induced NO production in CD46-expressing mouse macrophages. These antibodies did not affect NO production induced by IFN-gamma alone. These data suggest that MV enhances NO production in CD46-expressing mouse macrophages through action of IFN-alpha/beta. Mouse macrophages expressing a human CD46 mutant lacking the cytoplasmic domains were highly susceptible to MV. These cells produced much lower levels of NO and IFN-alpha/beta upon infection by MV, suggesting the CD46 cytoplasmic domains enhanced IFN-alpha/beta production. When mouse macrophages expressing tailless human CD46 were exposed to culture medium from MV-infected mouse macrophages expressing intact human CD46, viral protein synthesis and development of cytopathic effects were suppressed. Pretreating the added culture medium with antibodies against IFN-alpha/beta abrogated these antiviral effects. Taken together, these findings suggest that expression of human CD46 in mouse macrophages enhances production of IFN-alpha/beta in response to MV infection, and IFN-alpha/beta synergizes with IFN-gamma to enhance NO production and restrict viral protein synthesis and virus replication. This novel function of human CD46 in mouse macrophages requires the CD46 cytoplasmic domains.

The study of the conformation and interaction of two tachykinin peptides in membrane mimicking systems by NMR spectroscopy and pulsed field gradient diffusion

Pulsed-field gradient diffusion has been used to study the binding of two tachykinin peptides, [Tyr(8)]-substance P (SP) and [Tyr(0)]-neurokinin A (NKA) to two membrane-mimicking micelles, dodecylphosphocholine, and sodium dodecylsulfate. The structure of these peptides bound to the micelles have also been studied by using two-dimensional nmr and restrained simulated annealing calculations. No major difference in the structures of each peptide in the two micellar media was found. The difference between the micelle-bound structure of [Tyr(8)]SP and that of SP was also minor. The longer helical conformation on the C-terminus for [Tyr(0)]NKA was observed, compared with that for NKA. The relationship between the difference in the biological potencies of [Tyr(8)]SP and SP and the differences in their structure, especially the interaction of the side chains of the two aromatic residues, and the difference in their binding affinities to membrane was discussed. In addition, differences between the result of restrained molecular dynamics simulations of [Tyr(8)]SP in the presence of an explicit micelle and the present results were observed and discussed.

Human CD46 enhances nitric oxide production in mouse macrophages in response to measles virus infection in the presence of gamma interferon: dependence on the CD46 cytoplasmic domains

CD46 is a transmembrane complement regulatory protein widely expressed on nucleated human cells. Laboratory-adapted strains of measles virus (MV) bind to the extracellular domains of CD46 to enter human cells. The cytoplasmic portion of CD46 consists of a common juxtamembrane region and different distal sequences called Cyt1 and Cyt2. The biological functions of these cytoplasmic sequences are unknown. In this study, we show that expression of human CD46 with the Cyt1 cytoplasmic domain in mouse macrophages enhances production of nitric oxide (NO) in response to MV infection in the presence of gamma interferon (IFN-gamma). Human CD46 does not increase the basal levels of NO production in mouse macrophages and does not augment NO production induced by double-stranded polyribonucleotides. Replacing the cytoplasmic domain of human CD46 with Cyt2 reduces MV and IFN-gamma-induced NO production in mouse macrophages. Deleting the entire cytoplasmic domains of human CD46 does not prevent MV infection but markedly attenuates NO production in response to MV and IFN-gamma. Mouse macrophages expressing a tailless human CD46 mutant are more susceptible to MV infection and produce 2 to 3 orders of magnitude more infectious virus than mouse macrophages expressing human CD46 with intact cytoplasmic domains. These results reveal a novel function of CD46 dependent on the cytoplasmic domains (especially Cyt1), which augments NO production in macrophages. These findings may have significant implications for roles of CD46 in innate immunity and MV pathogenesis.

Molecular dynamics study of substance P peptides partitioned in a sodium dodecylsulfate micelle

Two neuropeptides, substance P (SP) and SP-tyrosine-8 (SP-Y8), have been studied by molecular dynamics (MD) simulation in an explicit sodium dodecylsulfate (SDS) micelle. Initially, distance restraints derived from NMR nuclear Overhauser enhancements (NOE) were incorporated in the restrained MD (RMD) during the equilibration stage of the simulation. It was shown that when SP-Y8 was initially placed in an insertion (perpendicular) configuration, the peptide equilibrated to a surface-bound (parallel) configuration in approximately 450 ps. After equilibration, the conformation and orientation of the peptides, the solvation of both the backbone and the side chain of the residues, hydrogen bonding, and the dynamics of the peptides were analyzed from trajectories obtained from the RMD or the subsequent free MD (where the NOE restraints were removed). These analyses showed that the peptide backbones of all residues are either solvated by water or are hydrogen-bonded. This is seen to be an important factor against the insertion mode of interaction. Most of the interactions come from the hydrophobic interaction between the side chains of Lys-3, Pro-4, Phe-7, Phe-8, Leu-10, and Met-11 for SP, from Lys-3, Phe-7, Leu-10, and Met-11 in SP-Y8, and the micellar interior. Significant interactions, electrostatic and hydrogen bonding, between the N-terminal residues, Arg-Pro-Lys, and the micellar headgroups were observed. These latter interactions served to affect both the structure and, especially, the flexibility, of the N-terminus. The results from simulation of the same peptides in a water/CCl4 biphasic cell were compared with the results of the present study, and the validity of using the biphasic system as an approximation for peptide-micelle or peptide-bilayer systems is discussed.

Molecular dynamics study of substance P peptides in a biphasic membrane mimic

Two neuropeptides, substance P (SP) and SP-tyrosine-8 (SP-Y8), have been studied by molecular dynamics (MD) simulation in a TIP3P water/CCl4 biphasic solvent system as a mimic for the water-membrane system. Initially, distance restraints derived from NMR nuclear Overhauser enhancements (NOE) were incorporated in the restrained MD (RMD) in the equilibration stage of the simulation. The starting orientation/position of the peptides for the MD simulation was either parallel to the water/CCl4 interface or in a perpendicular/insertion mode. In both cases the peptides equilibrated and adopted a near-parallel orientation within approximately 250 ps. After equilibration, the conformation and orientation of the peptides, the solvation of both the backbone and the side chain of the residues, hydrogen bonding, and the dynamics of the peptides were analyzed from trajectories obtained in the RMD or the subsequent free MD (where the NOE restraints were removed). These analyses showed that the peptide backbone of nearly all residues are either solvated by water or are hydrogen-bonded. This is seen to be an important factor against the insertion mode of interaction. Most of the interactions with the hydrophobic phase come from the hydrophobic interactions of the side chains of Pro-4, Phe-7, Phe-8, Leu-10, and Met-11 for SP, and Phe-7, Leu-10, Met-11 and, to a lesser extent, Tyr-8 in SP-Y8. Concerted conformational transitions took place in the time frame of hundreds of picoseconds. The concertedness of the transition was due to the tendency of the peptide to maintain the necessary secondary structure to position the peptide properly with respect to the water/CCl4 interface.

Expression of human complement regulatory protein CD46 restricts measles virus replication in mouse macrophages

Measles virus (MV) can infect mouse macrophages to cause a prolonged non-cytopathic infection that produces low levels of infectious virus for days. We have generated RAW264.7 mouse macrophages expressing human CD46, a cell surface complement regulatory protein that serves as a receptor for laboratory-adapted strains of MV. Laboratory-adapted MV strains efficiently enter the CD46-positive mouse macrophages to cause a cytopathic infection with extensive multinucleated cells and pseudopodia-like extensions. However, MV infection of mouse macrophages through CD46 is self-limiting. Both viral protein synthesis and infectious virus production are abruptly terminated after the second day of infection. This novel virus-cell interaction is seen only in mouse macrophages but not in mouse or hamster fibroblasts expressing human CD46. The possible role of CD46 in macrophage antiviral response restricting MV replication is discussed.

Studies of the binding and structure of adrenocorticotropin peptides in membrane mimics by NMR spectroscopy and pulsed-field gradient diffusion

The partition and structure of three adrenocorticotropic hormone peptides ACTH(1-10), ACTH(1-24), and ACTH(11-24) in water and in sodium dodecylsulfate (SDS) and dodecylphosphocholine (DPC) micelles were studied by 2D NMR and NMR gradient diffusion measurements. The diffusion rates, the NH chemical shifts, and the nuclear Overhauser effect patterns provided a coherent picture of binding of these peptides. All three peptides are significantly partitioned in the negatively charged SDS micelles and possess definite secondary structure, as opposed to random structures in water. For ACTH (1-24), the hydrophobic 1-10 segment is partitioned in DPC micelles, but the charged 11-24 segment prefers to remain in the aqueous region. ACTH(11-24) does not bind significantly to the DPC micelles. The binding of the ACTH peptides in these two widely used "membrane mimics" are substantially different from that in 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) bilayers obtained by attenuated total reflection infrared spectroscopy and from our preliminary diffusion studies of the same peptides in POPC vesicles. This study showed that, in a given micellar medium, all corresponding segments of these peptides are located in the same membrane environment in the system, regardless of whether these segments exist by themselves or are attached to other segments. This result may contradict the membrane-compartments concept of Schwyzer, which suggests that ACTH(1-10) and ACTH(1-24) are located in different membrane compartments because they have different address segments, and consequently, bind to different receptors. The present results also suggest that the assumption that micelles are good membrane mimics should be carefully examined.

The cytoplasmic domains of complement regulatory protein CD46 interact with multiple kinases in macrophages

Membrane cofactor protein (CD46), which normally protects autologous cells from complement lysis, is the human cell receptor for measles virus (MV). Interaction between MV and CD46 on monocytes can lead to suppression of monocyte activation. We have investigated the interaction between the cytoplasmic sequences of CD46 and kinases in a mouse macrophage cell line. Glutathione-S-transferase (GST) fusion proteins bearing the Cyt1 or Cyt2 alternative cytoplasmic domain of CD46 associate with macrophage kinase activity, which phosphorylates multiple proteins co-purified with the GST fusion proteins. Association with the macrophage kinase activity correlates with tyrosine phosphorylation of the CD46 cytoplasmic domains. Removing the CD46 sequences or introducing a frame-shift mutation abrogates the association with macrophage kinase activity. Renaturation studies reveal multiple kinases with apparent molecular mass of 82, 79, 58, and 50/49 kDa, which associate specifically with both CD46 cytoplasmic domains. Alanine substitutions at a juxtamembrane Tyr-X-X-Leu motif in the Cyt1 domain completely abrogate the association with macrophage kinases and tyrosine phosphorylation of Cyt1; but similar substitutions in the Cyt2 domain only partially reduce the association with kinases and tyrosine phosphorylation of Cyt2. These results reveal a specific interaction between complement regulatory protein CD46 and macrophage kinases. These findings may provide an important clue for understanding immune modulation by MV.

Division of labour in a lower termite: the majority of tasks are performed by older workers

Division of labour among workers was investigated in the lower termite, Reticulitermes fukienensisWorkers were separated into three age groups based on size, small workers being the youngest, medium workers intermediate and large workers the oldest. Workers were then compared in behavioural assays for the degree to which they would carry out specific tasks, which included: (1) foraging-related tasks; (2) care of eggs, larvae and the queen; and (3) some other important behaviours including burying corpses, alarm-giving and time spent stationary. All tasks were performed by two or all three of the size-groups of workers. Hence evidence does not support the hypothesis of tasks being discretely allocated among different instars in termites and this having evolved towards the extreme of one caste for every task. The oldest workers (i.e. large workers) carried out the highest frequencies of all tasks investigated. This contrasts with the social Hymenoptera, where younger workers specialize in some tasks (especially brood and queen care). The results suggest a new pattern for social insects for division of labour among workers.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

A Fourier Transform IR Study of the Phase Transitions and Molecular Order in the Hexadecyltrimethylammonium Sulfate/Water System

Variable temperature Fourier transform infrared (FTIR) spectroscopy was used to study the transition between the micellar and the coagel phases, and between the cubic and the coagel phases, for the hexadecyltrimethylammonium sulfate (CTAS)/water system. The phase transition takes place at 15&deg;C for the coagel to micelle transition and 17&deg;C for the coagel to cubic phase transition. CTAS in the solid state at two temperatures was also studied by FTIR to provide comparison with the aqueous samples on the molecular motion and packing in these phases. The present FTIR data also suggest the formation of rod-like micelles upon the addition of electrolyte, NaCl, to the CTAS/water system.

Identification of a cytoplasmic Tyr-X-X-Leu motif essential for down regulation of the human cell receptor CD46 in persistent measles virus infection

To investigate the sequence requirements for measles virus (MV)-induced receptor down regulation, we transfected the human CD46 gene into simian cells persistently infected by the Biken strain of MV. Surface expression of CD46 is drastically reduced in these cells. Deletion analysis has shown that the juxtamembrane region of the CD46 cytoplasmic domain is essential for down regulation. Deleting a Tyr-Arg-Tyr-Leu sequence in this region or changing these residues to Ala prevents CD46 down regulation from the infected cell surface. Alanine-scanning mutagenesis has identified two amino acid residues, Tyr and Leu, forming a Tyr-X-X-Leu motif critical for CD46 down regulation. Mutations that prevent CD46 down regulation enhance syncytium formation. These results indicate that CD46 down regulation limits the cytopathic effects in a persistent MV infection and that CD46 down regulation requires a cytoplasmic Tyr-X-X-Leu sequence which resembles known motifs for membrane protein trafficking and receptor signalling.

Human cell receptor CD46 is down regulated through recognition of a membrane-proximal region of the cytoplasmic domain in persistent measles virus infection

Monkey cells persistently infected by measles virus (MV) Biken strain (Biken-CV-1 cells) showed no cytopathic effects and lacked surface expression of a homolog of human cell receptor, membrane cofactor protein CD46. Transfection of a human CD46 gene into these cells induced extensive cell fusion, indicating that down regulation of the endogenous CD46 homolog was essential for the maintenance of a noncytopathic mode of infection. Surface expression of the exogenously introduced human CD46 was also drastically down regulated in the persistently infected cells compared with uninfected cells. The down regulation was specific for CD46 and did not affect surface expression of exogenously introduced CD4. Exogenous human CD46 was synthesized efficiently in the persistently infected cells, but it did not accumulate on the cell surface. Fusion of Biken-CV-1 cells required the extracellular hemagglutinin (H-protein)-binding domain but not the cytoplasmic domain. Replacing the transmembrane and cytoplasmic domains of CD46 with a glycosylphosphatidylinositol anchor did not prevent cell fusion but completely alleviated down regulation of the glycosylphosphatidylinositol-anchored CD46 in Biken-CV-1 cells. Deletion analyses revealed that the membrane-distal sequences of the CD46 cytoplasmic domain were not only unnecessary but also inhibitory for CD46 down regulation. By contrast, the six amino acid residues proximal to the membrane contained a sequence required for CD46 down regulation in the persistently infected cells. These results indicate that CD46 is down regulated in the persistently infected cells by a mechanism that recognizes a membrane-proximal sequence in the CD46 cytoplasmic domain.

Delayed activation of altered fusion glycoprotein in a chronic measles virus variant that causes subacute sclerosing panencephalitis

We compared the intracellular processing of the fusion (F) glycoproteins of an acute measles virus (MV) Nagahata strain and its relative Biken strain that caused subacute sclerosing panencephalitis (SSPE), Nagahata strain synthesizes a precursor F0 which acquires three asparagine (N)-linked oligosaccharide chains sequentially in 1 h. One oligosaccharide chain on the partially glycosylated F0 is less accessible to endo-beta-N-acetylglucosaminidase H (endo-H) but becomes accessible as the protein becomes fully glycosylated, suggesting a protein conformational change. Biken strain SSPE virus synthesizes a similarly glycosylated F0. However, one oligosaccharide chain on the Biken F0 remains less accessible to endo-H even after the protein is fully glycosylated. The Nagahata F0 is cleaved into the F1 and F2 subunits with a half life of 1 h. The Biken F0 is cleaved with a half life of 4 h. We cloned the F genes of Nagahata and Biken strains and showed by transfection that the defect causing delayed cleavage of F0 resides in the Biken F gene. Sequence analysis predicts a mutation in the cleavage recognition sequence, a truncated carboxyl-terminus, and multiple mutations in F1 of the Biken F protein. Expression of chimeric F genes showed the mutated cleavage recognition sequence and the carboxyl-terminal truncation do not delay cleavage of F0. Instead, delayed F0 cleavage is due to multiple mutations in the extracellular domain of F1, and four amino acid substitutions near the transmembrane region impair endo-H access to the oligosaccharide chain. These results provide detailed information on the normal maturation process of the F protein of MV and additional clues to the mechanisms of MV persistence in the CNS.

Isolation and characterization of intranuclear ribonucleoprotein complexes associated with double-stranded RNA adenosine deaminase from brain cells: implications for RNA-editing and hypermutation of viral RNA in the CNS

Double-stranded RNA adenosine deaminase (DsRAD), which converts adenosine in duplex RNA to inosine, has been implicated in editing of cellular mRNA and hypermutation of viral RNA in the central nervous system (CNS). We used subcellular fractionation to show that DsRAD in bovine brain tissues is associated with high-molecular-weight ribonucleoprotein (RNP) complexes in the nuclei. DsRAD-associated RNP complexes have apparent molecular mass of up to 500 kDa and buoyant density of 1.35 to 1.42 g cc-1 in CsCl solution. In human glioma cells, DsRAD is also found exclusively in intranuclear RNP complexes that co-sediment with the largest RNA species. These DsRAD-associated RNP complexes are dissociated by RNase A or high salt. The RNA component is not essential for DsRAD activity, and the protein component can be separated by dsRNA-affinity column, gel filtration column, and glycerol gradient into enzymatically active protein species with apparent molecular mass ranging from 120 kDa to 70 kDa in polyacrylamide gel. The bovine brain DsRAD has no apparent requirement for low-molecular-weight cofactors or metal ions. These results provide insight into the native state of DsRAD in brain cells and have interesting implications for its putative roles in RNA-editing and hypermutation of viral RNA in the CNS.

Nucleoprotein phosphorylated on both serine and threonine is preferentially assembled into the nucleocapsids of measles virus

The nucleoprotein (N) in the nucleocapsids of measles virus (MV) has different conformation and antigenicity than the free N-protein in MV-infected cells. These two forms of N-protein have identical methionine-containing tryptic peptides. The free N-protein contains 4 phosphorylated tryptic peptides. However, the nucleocapsid-associated N-protein has an additional phosphorylated peptide not found in the free N-protein. The free N-protein is phosphorylated only on serine residues, whereas the nucleocapsid-associated N-protein is phosphorylated on both serine and threonine residues. The MV N-protein expressed from a cloned gene in primate cells is also phosphorylated on both serine and threonine residues. These results suggest that cellular kinases phosphorylate the MV N-protein, and N-protein with phosphorylated serine and threonine is preferentially assembled into the viral nucleocapsids.

Delayed activation of altered fusion glycoprotein in a chronic measles virus variant that causes subacute sclerosing panencephalitis

We compared the intracellular processing of the fusion (F) glycoproteins of an acute measles virus (MV) Nagahata strain and its relative Biken strain that caused subacute sclerosing panencephalitis (SSPE). Nagahata strain synthesizes a precursor F0 which acquires three asparagine (N)-linked oligosaccharide chains sequentially in 1 h. One oligosaccharide chain on the partially glycosylated F0 is less accessible to endo-beta-N-acetylglucosaminidase H (endo-H) but becomes accessible as the protein becomes fully glycosylated, suggesting a protein conformational change. Biken strain SSPE virus synthesizes a similarly glycosylated F0. However, one oligosaccharide chain on the Biken F0 remains less accessible to endo-H even after the protein is fully glycosylated. The Nagahata F0 is cleaved into the F1 and F2 subunits with a half life of 1 h. The Biken F0 is cleaved with a half life of 4 h. We cloned the F genes of Nagahata and Biken strains and showed by transfection that the defect causing delayed cleavage of F0 resides in the Biken F gene. Sequence analysis predicts a mutation in the cleavage recognition sequence, a truncated carboxyl-terminus, and multiple mutations in F1 of the Biken F protein. Expression of chimeric F genes showed the mutated cleavage recognition sequence and the carboxyl-terminal truncation do not delay cleavage of F0. Instead, delayed F0 cleavage is due to multiple mutations in the extracellular domain of F1, and four amino acid substitutions near the transmembrane region impair endo-H access to the oligosaccharide chain. These results provide detailed information on the normal maturation process of the F protein of MV and additional clues to the mechanisms of MV persistence in the CNS.

Engineered serine protease inhibitor prevents furin-catalyzed activation of the fusion glycoprotein and production of infectious measles virus

We have identified the major cellular endoprotease that activates the fusion (F) glycoprotein of measles virus (MV) and have engineered a serine protease inhibitor (serpin) to target the endoprotease and inhibit the production of infectious MV. The F-protein precursor of MV was not cleaved efficiently into the mature F protein in human colon carcinoma cells lacking functional furin, indicating that furin is the major enzyme responsible for activation of the MV F protein. A human serpin alpha 1-antitrypsin variant was engineered to specifically inhibit furin. When expressed from a recombinant vaccinia virus in primate cells infected by MV, the engineered serpin (alpha 1-PDX) specifically inhibited furin-catalyzed cleavage of the F-protein precursor without affecting synthesis of other MV proteins. We generated human glioma cells stably expressing alpha 1-PDX. MV infection in these cells did not result in syncytia. The infected cells produced all the MV proteins, but the F-protein precursor remained largely uncleaved. This did not prevent virus assembly. However, the released virions contained inactive F-protein precursor rather than mature F protein, and infectious-virus titers were reduced by 3 to 4 orders of magnitude. These results show that a mature F protein is not required for the assembly of MV but is crucial for virus infectivity. The engineered serpin may offer a novel molecular antiviral approach against MV.

Solution conformation of a cyclic neurokinin antagonist: a NMR and molecular dynamics study

The solution structure of a hexapeptide, cyclo (Gln-Trp-Phe-Gly-Leu-Met), which is a selective NK-2 antagonist, has been studied by a combination of two-dimensional nmr and molecular dynamics (MD) techniques. The simulation based on nmr and MD data resulted in the convergence to a family of structures. Free molecular dynamics for 50 ps in the presence of DMSO solvent molecules shows that the structure is energetically stable. One intramolecular hydrogen bond between the amide proton of Gln and the carbonyl oxygen of Gly was revealed. This result is consistent with the results from the measurement of the temperature coefficient of the amide protons. The extent of intermolecular hydrogen bonding between the amide protons of the peptide and DMSO was also revealed by the free MD simulation. The resulting structure of the cyclic peptide contains a variation type I' beta-turn in the Gly-Leu-Met-Gln segment. Comparison of the structure of this peptide with that of other NK-2 antagonist cyclic hexapeptides was made, and the activity of cyclic antagonists appears to be inversely related to the conformational rigidity of the cyclic peptides.

1H- and 13C-nmr assignments and structural determination of a novel glycoalkaloid from Solanum platanifolium

Four steroidal glycoalkaloids, solasonine [2], solamargine [3], khasianine [4], and ravifoline [5], with solasodine [1] as the aglycone moiety, have been isolated from Solanum platanifolium. The present study involved the characterization of the novel compound 5 by one- and two-dimensional nmr techniques and has also led to the unambiguous and total 13C- and 1H-nmr assignments of all of these steroidal glycoalkaloids and the direct elucidation of their glycosidic linkages.