Tissue factor deficiency causes cardiac fibrosis and left ventricular dysfunction

Exposure of blood to tissue factor (TF) activates the extrinsic (TF:FVIIa) and intrinsic (FVIIIa:FIXa) pathways of coagulation. In this study, we found that mice expressing low levels of human TF ( approximately 1% of wild-type levels) in an mTF(-/-) background had significantly shorter lifespans than wild-type mice, in part, because of spontaneous fatal hemorrhages. All low-TF mice exhibited a selective heart defect that consisted of hemosiderin deposition and fibrosis. Direct intracardiac measurement demonstrated a 30% reduction (P < 0.001) in left ventricular function in 8-month-old low-TF mice compared with age-matched wild-type mice. Mice expressing low levels of murine FVII ( approximately 1% of wild-type levels) exhibited a similar pattern of hemosiderin deposition and fibrosis in their hearts. In contrast, FIX(-/-) mice, a model of hemophilia B, had normal hearts. Cardiac fibrosis in low-TF and low-FVII mice appears to be caused by hemorrhage from cardiac vessels due to impaired hemostasis. We propose that TF expression by cardiac myocytes provides a secondary hemostatic barrier to protect the heart from hemorrhage.

Prevalence and genomic variation of Norwalk-like viruses in central Australia in 1995-1997

Norwalk-like viruses (NLVs) have now been found to be important causes of gastroenteritis amongst infants and young children as well as older children and adults. Although detected, such viruses appeared not to be a major cause amongst infants and young children hospitalized with gastroenteritis in Alice Springs, central Australia over the period January 1995-December 1997. Nine NLV-positive cases were identified amongst stools from 360 different patients. From the nine cases however, eight different NLV strains were identified from comparisons of the sequence of a section of the RNA polymerase gene, and a high degree of genomic diversity was evident amongst them. In general, these strains were more similar to those identified in other countries than to those identified in central Australia over the three year period. Of the strains identified, six (and most probably seven) were classified in genogroup I, while only one was classified in genogroup II. This predominance of genogroup I strains is in contrast to most of the more recent findings made elsewhere, including those made in other parts of Australia. Phylogenetic analysis indicated that the central Australian strains spanned a range of known representative NLV strains, with one of the genogroup I strains showing a 96% nucleotide identity to Saratoga virus.

Functional implications of tissue factor localization to cell-cell contacts in myocardium

Recently published studies suggest that the procoagulant receptor protein tissue factor (TF) is involved in vitro in cell adhesion and migration, via an interaction of its cytoplasmic domain with cytoskeletal proteins. Interestingly, TF is abundantly expressed in myocardium, but not in skeletal muscle. To elucidate the possible roles of TF in the myocardium, this study examined the cellular distribution of TF in relation to cytoskeletal proteins, as well as its relative amounts in different segments of premature, mature, and pathologically altered cardiac muscle. In juvenile and adult hearts, TF was predominantly detectable in the transverse part of the intercalated discs, where it co-localized with cytoskeletal proteins such as desmin and vinculin. The lowest amount of TF was observed in right atrial and the highest in left ventricular myocardium, which correlated with the number of contact sites of cardiomyocytes in these segments of the cardiac muscle. Lower levels of TF were present in structurally altered myocardium from patients with hypertension or ventricular hypertrophy. In addition, TF expression was decreased in human heart during sepsis and transiently decreased in rabbit heart in an endotoxaemia model, which indicates that a reduction in TF may contribute to cardiac failure in sepsis. The microtopography of TF at cardiomyocyte contact sites indicates that TF may play a structural role in the maintenance of cardiac muscle.

Quasilocalization of gravity on a brane by resonant modes

We examine the behavior of gravity in brane theories with extra dimensions in a nonfactorizable background geometry. We find that for metrics which are asymptotically flat far from the brane there is a resonant graviton mode at zero energy. The presence of this resonance ensures quasilocalization of gravity, whereby at intermediate scales the gravitational laws on the brane are approximately four dimensional. However, for scales larger than the lifetime of the graviton resonance the five-dimensional laws of gravity will be reproduced due to the decay of the four-dimensional graviton. We also give a simple classification of effective gravity theories for general background geometries.

Measurement of tissue factor activity in whole blood

High circulating levels of the procoagulant molecule tissue factor (TF) are associated with thrombosis in a variety of diseases including unstable angina, cancer, and sepsis. Currently, there are no clinical assays to measure the level of TF activity in whole blood. We present an assay called Tissue Factor Clotting Time ("TiFaCT") that detects fibrin formation in human blood. The mean baseline clotting time in a healthy population was 472 +/- 94 s (mean +/- SD, n = 150). Bacterial lipopolysaccharide (LPS or endotoxin) shortened the clotting time in a time-dependent manner. Inhibitory anti-TF antibodies prolonged the clotting time of LPS-stimulated blood, indicating that the shortened clotting time was due to induction of TF expression. Patients with unstable angina had shortened mean baseline clotting time (284 +/- 86, n = 13) compared with healthy volunteers (474 +/- 98, n = 30), suggesting that these patients had elevated levels of circulating TF. The TiFaCT assay should prove clinically useful in quantifying the levels of circulating TF in patients at risk of thrombosis.

Etiology of acute lower respiratory tract infection in Central Australian Aboriginal children

BACKGROUND

Aboriginal children in central Australia have attack rates for acute lower respiratory tract infection (ALRI) that are similar to those in developing countries. Although mortality rates are much lower than in developing countries, morbidity is high and ALRI is still the leading cause of hospitalization. However, there are no data on the etiology of ALRI in this population.

METHODS

We prospectively studied 322 cases of ALRI in 280 Aboriginal children admitted to the hospital. Blood, urine and nasopharyngeal aspirate samples were examined for evidence of bacterial, viral and chlamydial infection.

RESULTS

The combination of blood culture, viral studies and chlamydial serology provided at least 1 etiologic agent in 170 of 322 (52.5%) cases. Assays for pneumolysin immune complex and pneumolysin antibody increased etiologic diagnosis to 219 (68.0%). Blood cultures were positive in 6% but pneumolysin immune complex and pneumolysin antibody studies were positive in one-third of cases. Evidence of viral infection was present in 155 (48%) of cases compared with 12% in controls (P < 001). There were only 7 possible cases and 2 definite cases of Chlamydia trachomatis and 3 cases of Chlamydia pneumoniae. Coinfection was common in these children.

CONCLUSION

These findings have implications for both standard treatment protocols and vaccine strategies. The high rate of coinfection may make it difficult to develop simple clinical predictors of bacterial infection. In the setting of a developed country with efficient patient evacuation services, management algorithms that focus on disease severity and need for hospital referral will be most useful to health staff in remote communities. Pneumococcal conjugate vaccines will be required to reduce the high attack rate of pneumococcal disease.

Tissue factor is required for uterine hemostasis and maintenance of the placental labyrinth during gestation

We employed a novel mouse line that expresses low levels of human tissue factor (TF) in the absence of murine TF to analyze the role of TF in gestation. Low-TF female mice had a 14-18% incidence of fatal postpartum uterine hemorrhage, suggesting that TF plays an important role in uterine hemostasis. Low-TF female mice mated with low-TF male mice had a 42% incidence of fatal midgestational hemorrhage (n = 41), whereas no fatal midgestational hemorrhages were observed in low-TF female mice mated with wild-type male mice (n = 43). Placentas of low-TF embryos from both low-TF and normal (+/-) TF females were abnormal and contained numerous maternal blood pools in the labyrinth. Placentas of TF null embryos surviving beyond embryonic day 10.5 exhibited similar defects. The mouse maternal-embryonic placental barrier consists of four cellular layers (layers I, II, and III and endothelial cells), where layer I lines the maternal lacunae. Comparison of TF-deficient placentas with control placentas by immunohistochemical and ultrastructural analyses revealed thinning of layer I and a reduction in the number of cellular contacts of layer I trophoblasts spanning the maternal blood space between adjacent trabeculae. These structural changes in low-TF and TF null placentas result in enlarged maternal lacunae, as determined by morphometric analysis, and placental hemorrhage, which leads to midgestational death of low-TF female mice. This study demonstrated that TF is required for uterine hemostasis and revealed an unexpected role of TF in the maintenance of the placental labyrinth.

Lipopolysaccharide induction of tissue factor expression in rabbits

Tissue factor (TF) is the major activator of the coagulation protease cascade and contributes to lethality in sepsis. Despite several studies analyzing TF expression in animal models of endotoxemia, there remains debate about the cell types that are induced to express TF in different tissues. In this study, we performed a detailed analysis of the induction of TF mRNA and protein expression in two rabbit models of endotoxemia to better understand the cell types that may contribute to local fibrin deposition and disseminated intravascular coagulation. Northern blot analysis demonstrated that lipopolysaccharide (LPS) increased TF expression in the brain, lung, and kidney. In situ hybridization showed that TF mRNA expression was increased in cells identified morphologically as epithelial cells in the lung and as astrocytes in the brain. In the kidney, in situ hybridization experiments and immunohistochemical analysis showed that TF mRNA and protein expression was increased in renal glomeruli and induced in tubular epithelium. Dual staining for TF and vWF failed to demonstrate TF expression in endothelial cells in LPS-treated animals. These results demonstrate that TF expression is induced in many different cell types in LPS-treated rabbits, which may contribute to local fibrin deposition and tissue injury during endotoxemia.

Low activity of key phospholipid catabolic and anabolic enzymes in human substantia nigra: possible implications for Parkinson's disease

To determine whether increased oxidative stress in substantia nigra of patients with idiopathic Parkinson's disease might be related to decreased ability of nigral cells to detoxify oxidized membrane phospholipids, we compared levels of the major phospholipid metabolizing enzymes in autopsied substantia nigra with those in non-nigral (n = 11) brain areas of the normal human brain. Whereas most enzymes possessed a relatively homogeneous distribution, the activity of the major phospholipid catabolizing enzyme phospholipase A2, assayed in the presence of calcium ions, varied amongst different regions, with substantia nigra possessing the lowest activity. Similarly, calcium-independent phospholipase A2 activity, although possessing a relatively homogeneous regional distribution, was also low in the substantia nigra. This, coupled with low activity of phosphoethanolamine- and phosphocholine-cytidylyltransferases, major regulatory enzymes of phospholipid synthesis, in this brain region, suggest that the rate of phospholipid turnover is low in the substantia nigra. Low activity of key phospholipid catabolic and anabolic enzymes in human substantia nigra might result in reduced ability to repair oxidative membrane damage, as may occur in Parkinson's disease.

Phospholipid-metabolizing enzymes in Alzheimer's disease: increased lysophospholipid acyltransferase activity and decreased phospholipase A2 activity

Damage to brain membrane phospholipids may play an important role in the pathogenesis of Alzheimer's disease (AD); however, the critical metabolic processes responsible for the generation and repair of membrane phospholipids affected by the disease are unknown. We measured the activity of key phospholipid catabolic and anabolic enzymes in morphologically affected and spared areas of autopsied brain of patients with AD and in matched control subjects. The activity of the major catabolic enzyme phospholipase A2 (PLA2), measured in both the presence and absence of Ca2+, was significantly decreased (-35 to -53%) in parietal and temporal cortices of patients with AD. In contrast, the activities of lysophospholipid acyltransferase, which recycles lysophospholipids into intact phospholipids, and glycerophosphocholine phosphodiesterase, which returns phospholipid catabolites to be used in phospholipid resynthesis, were increased by approximately 50-70% in the same brain areas. Brain activities of enzymes involved in de novo phospholipid synthesis (ethanolamine kinase, choline kinase, choline phosphotransferase, phosphoethanolamine cytidylyltransferase, and phosphocholine cytidylyltransferase) were either normal or only slightly altered. The activities of PLA2 and acyltransferase were normal in the degenerating cerebellum of patients with spinocerebellar atrophy type 1, whereas the activity of glycerophosphocholine phosphodiesterase was reduced, suggesting that the alterations in AD brain were not nonspecific consequences of neurodegeneration. Our data suggest that compensatory phospholipid metabolic changes are present in AD brain that reduce the rate of phospholipid loss via both decreased catabolism (PLA2) and increased phospholipid resynthesis (acyltransferase and glycerophosphocholine phosphodiesterase).

Increased phospholipid breakdown in schizophrenia. Evidence for the involvement of a calcium-independent phospholipase A2

BACKGROUND

Magnetic resonance spectroscopy studies have suggested above-normal turnover of membrane phospholipids in brains of patients with schizophrenia. One possible explanation for these findings is increased activity of the phospholipid-catabolizing enzyme phospholipase A2 (PLA2). However, attempts to demonstrate higher PLA2 activity in the serum of subjects with schizophrenia have led to conflicting results. We hypothesized that this was due to serum PLA2 activity consisting of a family of different enzymes, with each group of investigators measuring activity of different PLA2 forms.

DESIGN

Activity of PLA2 in serum samples obtained from 24 individuals with schizophrenia was compared with serum obtained from 33 age- and sex-matched control subjects, using both fluorometric and radiometric assays with different substrates. Each method had previously yielded conflicting results concerning the status of the enzyme in schizophrenia.

RESULTS

With the fluorometric assay, serum PLA2 activity in individuals with schizophrenia was markedly increased by 49% compared with control subjects (P < .001). In contrast, radiometric assay of the same serum samples resulted in PLA2 activity not significantly different between patients and control subjects. Further investigations demonstrated that, whereas the radiometric assay measured activity of a calcium-dependent enzyme, the fluorometric assay detected a calcium-insensitive enzyme possessing an acid-neutral pH optimum.

CONCLUSIONS

Increased calcium-independent PLA2 activity was seen in the serum of patients with schizophrenia. This change, if present also in the brain, may well explain the increased levels of phosphodiesters observed using magnetic resonance spectroscopy and therefore may contribute to the pathophysiological features of the disorder.

Distribution of capsular types and antibiotic susceptibility of invasive Streptococcus pneumoniae isolated from aborigines in central Australia

Streptococcus pneumoniae strains isolated from 203 episodes of invasive disease in central Australian Aborigines were studied. Capsular types from children aged 0 to 4 years (n = 89) belonged most commonly to types 14, 6B, 9V, 4, 18C, and 19F, which together accounted for 67% of the pediatric strains. In adults (n = 98), types 1, 7F, 3, 4, 12F, and 8 contributed 68% of the isolates. Of 114 pneumococci from patients 5 years and older, 102 (89.5%) were types represented in the 23-valent pneumococcal polysaccharide vaccine. The MICs of five antibiotics were determined for 201 strains by using the E-Test (AB Biodisk). No chloramphenicol or ceftriaxone resistance was found, but 46 strains (22.9%) showed diminished susceptibility to one or more of the drugs penicillin, erythromycin, and trimethoprim-sulfamethoxazole. Penicillin resistance occurred in 15.4% of all isolates tested but only within the intermediate range (0.1 to 1.0 microgram/ml). Resistance to trimethoprimsulfamethoxazole affected 13.9% of the pneumococci tested. All type 23F and most type 19F organisms were resistant to one or more antibiotics. Resistance was significantly more common in pediatric isolates than in those from adults (chi 2(1) = 14.1; P < 0.001).

Invasive pneumococcal disease in central Australia

OBJECTIVES

To document the incidence, case fatality, clinical and demographic features of invasive pneumococcal disease in central Australia.

DESIGN

Invasive isolates from the regional central laboratory were prospectively recorded over five years and case notes retrospectively reviewed. Population denominators were calculated from national Census data from 1986 and 1991.

RESULTS

The population estimates for the region were 14,568 for Aboriginals and 28,680 for non-Aboriginals. There were 185 episodes of invasive pneumococcal disease over the five years, 162 (87.5%) in Aboriginals and 23 (12.5%), in non-Aboriginals. The incidence in Aboriginal children under two years of age was 2052.7 per 100,000 and for those 20-59 years was 178.2 per 100,000. The relative risk in Aboriginals compared with non-Aboriginals was 10.8 (95% CI, 5.6-20.7; P < 0.0001) for those aged 0-4 years and 20.4 (95% CI, 9.7-42.5; P < 0.0001) for those 15-59 years. Forty-one Aboriginal adults aged over 14 (62%) had at least one conventional risk factor for pneumococcal disease; alcohol abuse was present in 27 (41%). There were 13 Aboriginal deaths and the case fatality rose from 2% in those under four years to 40% for those over 59 years.

CONCLUSIONS

Central Australian Aboriginals have the highest incidence of invasive pneumococcal disease reported. The rate for children under two years is 59 to 80 times the rates for children in the United States and Sweden. These data have implications for improving vaccine use, health service delivery and environmental health in Aboriginal communities.

Upper airway carriage by Haemophilus influenzae and Streptococcus pneumoniae in Australian aboriginal children hospitalised with acute lower respiratory infection

When nasopharyngeal secretions from 171 Australian Aboriginal children hospitalized with acute lower respiratory tract infections (ALRI) were cultured selectively for Streptococcus pneumoniae and Haemophilus influenzae, 136 (79.5%) and 151 (88.3%) children yielded 166 and 254 isolates of S. pneumoniae and H. influenzae, respectively. In colonized subjects multiple populations of S. pneumoniae (20% of carriage-positive patients) and H. influenzae (55%) were common. Pneumococci belonging to 27 types or groups were identified. H. influenzae serotype b colonized 16.4% of all children studied. More than one half of 152 children tested were excreting antibiotics at the time of admission to hospital. Significantly fewer children with serum antibiotic residues were colonized with S. pneumoniae than were antibiotic free children. Antibiotic usage had no measurable impact on the isolation rate of H. influenzae.

Glomerular fibrinolytic activity in anti-GBM glomerulonephritis in rabbits

Fibrin is an important mediator of injury in severe proliferative forms of glomerulonephritis (GN). Normal glomeruli express fibrinolytic activity, which may protect against the injurious effects of fibrin deposition. Changes in glomerular fibrinolytic activity (GFA) may play an important role in modulating fibrin accumulation in GN. To study the changes in GFA associated with fibrin deposition in GN, autologous phase anti-glomerular basement antibody initiated GN (anti-GBM GN) was studied in rabbits. Net GFA was significantly reduced in association with glomerular fibrin deposition (1.3 +/- 0.8 ng fibrin lysed/10(3) glomeruli/2 hr, normal 57.1 +/- 25.4 ng fibrin lysed/10(3) glomeruli/2 hr, P < 0.02). Reduced GFA in fibrin associated GN was associated with decreased expression of tissue type plasminogen activator (tPA) and increased expression of plasminogen activator inhibitor type-1 (PAI-1) and glomerular macrophage infiltration. In a fibrin independent model of anti-GBM induced GN (heterologous phase), with equivalent injury (proteinuria), net GFA was increased (174 +/- 64 ng fibrin lysed/10(3) glomeruli/2 hr). This was associated with increased tPA and uPA, and decreased PAI-1 in the absence of significant macrophage infiltration. These studies demonstrate that fibrin deposition in GN is associated with a net reduction of GFA, attributable to reduced expression of plasminogen activators and augmentation of PAI-1. Reduction of GFA may potentiate glomerular fibrin deposition and consequent glomerular injury. The association between glomerular macrophage influx and reduction in GFA suggests that this change may be directed by macrophages.

An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia

An outbreak of serotype 1 Streptococcus pneumoniae infection involving both adults and children occurred in central Australia during the winter months of 1991. Eighteen patients, mainly Aboriginal men, presented with culture-positive serotype 1 bacteraemic pneumonia. In this group, 11 of 12 adults for whom medical records were available were alcohol dependent. Thirteen children who were separately studied were hospitalised with acute lower respiratory tract infection: none had bacteraemia but all had upper airway colonisation by type 1 pneumococci. Antibiotics taken by 8 of the 13 children before admission to hospital may have compromised the isolation of type 1 pneumococci from blood cultures. Since the availability of antibiotics, epidemic pneumococcal infection is infrequent and has not been reported in Australia. In three outbreaks of type 1 disease recorded elsewhere crowding and alcoholism were identified as contributory factors. In the 16 month period before this outbreak none of 162 strains of pneumococci isolated from blood (32 strains) and nasopharyngeal secretions (130 strains) from Aborigines with acute lower respiratory tract infection and meningitis in the Alice Springs region were serotype 1 organisms.

Exocrine pancreatic dysfunction in malnourished Australian aboriginal children

Pancreatic exocrine dysfunction has been frequently recorded in protein-energy malnutrition in underdeveloped countries. In addition, the pancreas requires optimal nutrition for enzyme synthesis and potentially correctable pancreatic enzyme insufficiency may play a role in the continuation of protein-energy malnutrition. This problem has not been previously evaluated in Australian Aborigines. We have applied a screening test for pancreatic dysfunction (human immunoreactive trypsinogen [IRT] assay) to the study of 398 infants (6-36 months) admitted to the Alice Springs Hospital over a 20-month period. All infants were assessed by anthropometric measures and were assigned to three nutritional groups (normal, moderate or severely malnourished) and two growth groups (stunted or not stunted). Of the 198 infants who had at least a single serum cationic trypsinogen measurement taken, normal values for serum IRT (with confidence limits) were obtained from 57 children, who were normally nourished. IRT levels were significantly correlated with the degree of underweight but there was no correlation with the degree of stunting or age. Mean IRT levels for the moderate and severely underweight groups were significantly greater than the mean for the normal group (P less than 0.01). Seventeen children (8.6%) had trypsinogen levels in excess of the 95th percentile for the normally nourished group, reflecting acinar cell damage or ductal obstruction. We conclude that pancreatic dysfunction may be a common and important overlooked factor contributing to ongoing malnutrition and disease in malnourished Australian Aboriginal children.

Molecular epidemiology of Shigella infection in Central Australia

Shigellosis is endemic in Central Australia and the infections are predominantly due to Shigella flexneri 6, Shigella flexneri 2a and Shigella sonnei. Plasmid profiles of isolates collected from 1985-9, suggested that infections caused by Shigella flexneri 6 were predominantly due to a single clone, whereas those caused by Shigella flexneri 2a and Shigella sonnei were due to several genetically diverse strains, although strains with identical plasmid profiles were found in widely separated geographical areas and in different years.

Enterotoxigenic Escherichia coli in Central Australia: diagnosis using cloned and synthetic nucleic acid probes

Feces from 169 children admitted with diarrhea to Alice Springs Hospital, were screened for enterotoxigenic E. coli (ETEC) using specific DNA probes. E. coli which hybridized with probes for ST-P, ST-H and LT were confirmed by bioassay for toxin production. Fifty children were shown to excrete ETEC. The probes for LT correlated well with bioassay; however, probes for ST-H and ST-P hybridized with more E. coli than were shown to produce toxin by bioassay. When probing for ST was repeated using a synthetic oligonucleotide probe, only those specimens which were bioassay-positive hybridized with the probe.