Patient satisfaction with root canal treatment and outcomes in the Swedish public dental health service. A prospective cohort study

AIM

To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics.

METHOD

The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT-completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and non-respondents and tooth groups.

RESULTS

One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for non-respondents (P<0.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, P = 0.02). Fifty percent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present, or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good.

CONCLUSIONS

The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

Indications for root canal treatment in a Swedish county dental service: patient- and tooth-specific characteristics

AIM

To study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden.

METHODOLOGY

During a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.

RESULTS

The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).

CONCLUSIONS

In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Dose optimisation of double-contrast barium enema examinations

The purpose of the present work was to optimise the filtration and dose setting for double-contrast barium enema examinations using a Philips MultiDiagnost Eleva FD system. A phantom study was performed prior to a patient study. A CDRAD phantom was used in a study where copper and aluminium filtration, different detector doses and tube potentials were examined. The image quality was evaluated using the software CDRAD Analyser and the phantom dose was determined using the Monte Carlo-based software PCXMC. The original setting [100 % detector dose (660 nGy air kerma) and a total filtration of 3.5 mm Al, at 81 kVp] and two other settings identified by the phantom study (100 % detector dose and additional filtration of 1 mm Al and 0.2 mm Cu as well as 80 % detector dose and added filtration of 1 mm Al and 0.2 mm Cu) were included in the patient study. The patient study included 60 patients and up to 8 images from each patient. Six radiologists performed a visual grading characteristics study to evaluate the image quality. A four-step scale was used to judge the fulfillment of three image quality criteria. No overall statistical significant difference in image quality was found between the three settings (P > 0.05). The decrease in the effective dose for the settings in the patient study was 15 % when filtration was added and 34 % when both filtrations was added and detector dose was reduced. The study indicates that additional filtration of 1 mm Al and 0.2 mm Cu and a decrease in detector dose by 20 % from the original setting can be used in colon examinations with Philips MultiDiagnost Eleva FD to reduce the patient dose by 30 % without significantly affecting the image quality. For 20 exposures, this corresponds to a decrease in the effective dose from 1.6 to 1.1 mSv.

Basilar and bilateral carotid dolichoectasia with spontaneous dissection of C2 segment of the internal carotid artery

We describe a previously unreported case of cranial arterial dolichoectasia associated with spontaneous dissection of the petrous (C2) segment of the internal carotid artery (ICA) with 2 patent lumena. Dolichoectasia of the cranial arteries and different types of double lumen of ICA are discussed. A review of previously reported cases is included.

Transclival decompression of brainstem from a compressing coiled aneurysm of the midbasilar artery

The authors present the case of a young woman, suffering from progressive tetraplegia, cranial nerve dysfunction, respiratory failure and lethargy due to radiographically demonstrated increased brainstem compression after coil embolization of an aneurysm of the midportion of the basilar artery. The patients condition improved dramatically after transclival decompression. The importance of understanding the effects of a rigid endovascular mass on adjacent neural structures is emphasized.

Peritoneal leukocyte survival and respiratory burst responses in patients treated with a low glucose degradation and high pH peritoneal dialysis fluid

The discovery of toxicity related to glucose degradation products (GDP) has initiated the development of new PD fluids with low GDP concentrations and higher, more physiological, pH levels. Cell numbers, differential counts and the respiratory burst responses of peritoneal leukocytes were compared between patients treated with the low GDP, high pH fluid Gambrosol-trio (n=10) and a conventional fluid (n=12). Effluents from over-night dwells were collected and leukocytes were evaluated morphologically and by luminol-amplified chemiluminescence (CL) after stimulation with opsonized zymosan. The frequency of necrosis and early apoptosis was quantified by means of annexin V binding and propidium iodide uptake. The Gambrosol-trio group produced significantly higher (p<5%) macrophage counts and stronger CL responses (p<10%) than did the conventional fluid group. The cell compositions did not differ significantly between the groups. Necrosis was significantly more common among the cells in the conventional fluid group. The occurrence of apoptosis did not differ between the fluids.

Kinetics and dose response of the effects of heated glucose peritoneal dialysis fluids on the respiratory burst of rat peritoneal leukocytes

Heat sterilization of glucose containing peritoneal dialysis (PD) fluids induces the production of cytotoxic glucose degradation products (GDPs), some of which are still unidentified. The present study was performed to characterize the kinetics and the dose-response of the respiratory burst inhibition of GDPs and to compare different fluids in this respect. The zymosan-induced respiratory burst of rat peritoneal neutrophils and macrophages was measured by chemiluminescence (CL) after incubation in vitro for 1, 2, and 4 hours in different homemade and commercially available PD fluids, followed by one hour of recovery in Hanks' buffer. Heat sterilized fluids were compared with their filter sterilized equivalents at two different pH levels. The results revealed that the inhibitory effect of heat sterilized fluids on the respiratory burst of peritoneal neutrophils is additive to that of low pH, but more fast-acting and, in contrast to the pH effect, similar in magnitude to its in vivo equivalent. The effect developed within 1 hour and had a linear dose response. The low GDP fluid Gambrosol-Bio was less toxic than the conventional fluid Gambrosol, but the difference was smaller than expected in relation to measured concentrations of known GDPs. Macrophages were less sensitive than neutrophils to the GDP effect.

A commercially available PD fluid with high pH and low GDP induces different morphological changes of rat peritoneum in intermittent PD

The aim of this study was to characterize the morphological changes in the peritoneum following experimental peritoneal dialysis of rats, and to compare the new high-pH and low glucose-derived degradation products (GDP)-level PD fluid PD-Bio with the conventional PD fluid Gambrosol at two different exposure frequencies. Rats were subjected to 10 mL intraperitoneal injections three times per day at 3-hour intervals daytime for 9 days (2 successive weeks, excluding weekends) or once daily for 4 weeks. Untreated animals and animals exposed to Gambrosol or PD-Bio were compared. Biopsy samples were taken from the diaphragm and prepared for light microscopy. Morphometric analysis was used to compare the thickness and the cell density of the sub-mesothelial connective tissue. Intraperitoneal leukocyte numbers were counted. Both fluids induced a significant thickening of the submesothelial connective tissue and an increase in intraperitoneal leukocyte numbers. After exposure three times per day, Gambrosol induced a significantly greater submesothelial thickening than PD-Bio. The submesothelial tissue was more cell-dense after exposure to PD-Bio than after exposure to Gambrosol. The present results indicate that the structural changes of the peritoneum that follow peritoneal dialysis may be dependent upon the chemical composition of the PD fluids.

Integrated bioprocess for production of human proinsulin C-peptide via heat release of an intracellular heptameric fusion protein

An integrated bioprocess has been developed suitable for production of recombinant peptides using a gene multimerization strategy and site-specific cleavage of the resulting gene product. The process has been used for production in E. coli of the human proinsulin C-peptide via a fusion protein BB-C7 containing seven copies of the 31-residues C-peptide monomer. The fusion protein BB-C7 was expressed at high level, 1.8 g l(-1), as a soluble gene product in the cytoplasm. A heat treatment procedure efficiently released the BB-C7 fusion protein into the culture medium. This step also served as an initial purification step by precipitating the majority of the host cell proteins, resulting in a 70% purity of the BB-C7 fusion protein. Following cationic polyelectrolyte precipitation of the nucleic acids and anion exchange chromatography, native C-peptide monomers were obtained by enzymatic cleavage at flanking arginine residues. The released C-peptide material was further purified by reversed-phase chromatography and size exclusion chromatography. The overall yield of native C-peptide at a purity exceeding 99% was 400 mg l(-1) culture, corresponding to an overall recovery of 56%. The suitability of this process also for the production of other recombinant proteins is discussed.

Specific binding of proinsulin C-peptide to human cell membranes

Recent reports have demonstrated beneficial effects of proinsulin C-peptide in the diabetic state, including improvements of kidney and nerve function. To examine the background to these effects, C-peptide binding to cell membranes has been studied by using fluorescence correlation spectroscopy. Measurements of ligand-membrane interactions at single-molecule detection sensitivity in 0.2-fl confocal volume elements show specific binding of fluorescently labeled C-peptide to several human cell types. Full saturation of the C-peptide binding to the cell surface is obtained at low nanomolar concentrations. Scatchard analysis of binding to renal tubular cells indicates the existence of a high-affinity binding process with K(ass) > 3.3 x 10(9) M(-1). Addition of excess unlabeled C-peptide is accompanied by competitive displacement, yielding a dissociation rate constant of 4.5 x 10(-4) s(-1). The C-terminal pentapeptide also displaces C-peptide bound to cell membranes, indicating that the binding occurs at this segment of the ligand. Nonnative D-C-peptide and a randomly scrambled C-peptide do not compete for binding with the labeled C-peptide, nor were crossreactions observed with insulin, insulin-like growth factor (IGF)-I, IGF-II, or proinsulin. Pretreatment of cells with pertussis toxin, known to modify receptor-coupled G proteins, abolishes the binding. It is concluded that C-peptide binds to specific G protein-coupled receptors on human cell membranes, thus providing a molecular basis for its biological effects.

Denatured states of human carbonic anhydrase II: an NMR study of hydrogen/deuterium exchange at tryptophan-indole-H(N) sites

Hydrogen/deuterium (H/D) exchange measurements in low and moderate concentrations of GuHCI were conducted on the side chain H(N) atoms of the seven tryptophans of pseudo wild-type human carbonic anhydrase II. Tryptophans 5, 16 and 245, situated in or close to the N-terminal domain were found to have little protection against exchange. The H/D exchange results for Trp-123, Trp-192 and Trp-209 showed that a previously identified molten globule and the native state gave a similar protection against exchange. Global unfolding of the protein is necessary for the efficient exchange at Trp-97, which is located in the central part of the beta-sheet.

Acute in vivo toxicity of heat-sterilized glucose peritoneal dialysis fluids to rat peritoneal macrophages

OBJECTIVE

To evaluate the in vivo effects of heat-sterilized peritoneal dialysis (PD) fluids on the respiratory burst response of rat peritoneal leukocytes.

DESIGN

Rats were exposed to intraperitoneal injections of a laboratory-made PD fluid that was either heat-sterilized (H-PD) or filtered (F-PD). Control groups of animals were given Hank's buffer (HBSS) or saline (NaCl). Leukocytes were harvested by intraperitoneal lavage at different times in different animals and analyzed with respect to cell numbers, differential counts, and production of superoxide (chemiluminescence) in response to opsonized zymosan. The chemiluminescence responses of the macrophage and the neutrophil populations, respectively, were obtained by curve-fitting techniques from the responses of the mixed populations.

RESULTS

All fluids induced a recruitment of neutrophils, the PD fluids causing a cell number increase that was more transient than that caused by NaCl and HBSS. Macrophage numbers were only slightly influenced, but were generally higher after NaCl and HBSS injections than after PD fluid injections. The H-PD exposure induced a significant inhibition of the macrophage chemiluminescence response after 2 and 12 hours, compared with the exposure to F-PD. The neutrophil chemiluminescence response was not significantly affected.

CONCLUSION

The toxins produced by heat-sterilization of glucose-containing PD fluids inhibit in vivo the respiratory burst response of peritoneal macrophages.

Gene fragment polymerization gives increased yields of recombinant human proinsulin C-peptide

A multimerization strategy to improve yields upon recombinant production of the 31-aa human proinsulin C-peptide is presented. Gene fragments encoding the C-peptide were assembled using specific head-to-tail multimerization. DNA constructs encoding one, three or seven copies of the C-peptide gene, fused to a serum albumin binding affinity tag, were expressed intracellularly in Escherichia coli. The three fusion proteins were produced at similar levels (approximately 50 mg/l) and were proteolytically stable during production. Enzymatic digestion by trypsin-carboxypeptidase B treatment of the fusion proteins was shown to efficiently release native C-peptide, as determined by mass spectrometry, reverse-phase chromatography and a radioimmunoassay. The quantitative yields of C-peptide obtained from the three different fusion proteins suggest that this multimerization strategy could provide a cost-efficient production scheme for the C-peptide, and that this strategy could be useful also for production of other recombinant peptides.

Tertiary structure formation at specific tryptophan side chains in the refolding of human carbonic anhydrase II

The refolding reaction of human carbonic anhydrase II has been characterized by use of seven variants in which tryptophan residues have been replaced by Phe or Cys, in each case giving proteins with six tryptophans. Intrinsic tryptophan fluorescence was used to monitor the refolding in the 2 ms-60 s time range, and kinetic traces showing the contributions from each particular tryptophan were obtained by calculation of differences between the wild-type protein and the variants. Earlier assignment [Mårtensson, L.-G., Jonasson, P., Freskgard, P.-O., Svensson, M., Carlsson, U., & Jonsson, B.-H. (1995) Biochemistry 34, 1011-1021] of specific fluorescence properties to each tryptophan, especially regarding energy transfer and intrinsic fluorescence quenching, has made it possible to use the kinetic data to describe the formation of tertiary structure at defined tryptophan residues. In summary, it was found that tertiary structure is formed earlier at those tryptophans that are associated with the central core of beta-strands than at tryptophan residues in the N-terminal minidomain.

Integrated production of human insulin and its C-peptide

The potential for the development of an integrated process for production of human insulin and its C-peptide in Escherichia coli has been investigated. Human proinsulin was produced intracellularly in E. coli fused to two synthetic IgG-binding domains (ZZ) derived from staphylococcal protein A. High expression levels (3 g/l culture) of the gene product, which accumulated as inclusion bodies, was obtained. Solubilization of inclusion bodies by oxidative sulfitolysis and subsequent renaturation was performed directly after cell lysis and pellet wash. IgG affinity chromatography was used for efficient recovery of pure proinsulin fusion protein in a single step. Monomers of the proinsulin fusion protein constituted approximately 70%. A single step conversion of the fusion protein into insulin and C-peptide by trypsin and carboxypeptidase B treatment was achieved by engineering the junction between proinsulin and its affinity handle, ZZ. Characterization of the cleavage products by reversed phase chromatography (RPC) verified that human insulin and C-peptide were generated and that the ZZ affinity handle was resistant to cleavage. Human insulin and C-peptide were recovered with high yields by preparative reversed-phase high performance liquid chromatography (RP-HPLC). The potential use of the presented scheme for large-scale production of recombinant insulin and/or its C-peptide is discussed.

Affinity-assisted in vivo folding of a secreted human peptide hormone in Escherichia coli

We show that coexpression of a specific binding protein in Escherichia coli can significantly improve the relative yields of correctly folded human insulin-like growth factor I (IGF-I). A glutathione redox buffer was used during growth to allow formation and breakage of disulfide bonds in the periplasm of the bacterial host. Both the binding protein and the peptide hormone were produced as affinity fusions, which allowed purification of the in vivo formed heterodimer by alternative affinity purification methods. The use of affinity-assisted in vivo folding has general implications for expression, folding, and purification of recombinant proteins.

Single-step trypsin cleavage of a fusion protein to obtain human insulin and its C peptide

The kinetics for trypsin cleavage of different fusion proteins, consisting of human proinsulin and two IgG-binding domains (ZZ), were investigated. To achieve simultaneous removal of the fusion tag and processing of proinsulin to insulin and free C peptide, three versions of the ZZ-proinsulin fusion protein were generated, having different trypsin-sensitive cleavage sites, Arg, Lys-Arg or Lys. The ZZ-proinsulin fusion proteins which accumulated as inclusion bodies in Escherichia coli cells were solubilized, refolded and purified by IgG affinity chromatography. The yield of ZZ-proinsulin monomers exceeded 90%. The kinetics for the trypsin cleavage revealed unexpected differences when comparing the three linkers and it was found that the single arginine linker was most efficiently processed. Characterization of the cleavage products by reverse-phase chromatography, mass spectrometry and N-terminal sequencing verified that human insulin and C peptide were generated. The results demonstrate that high yields of native insulin, C peptide and affinity tag can be achieved by simultaneous cleavage of a fusion protein at three different trypsin-sensitive sites in a single step. The implications for production and recovery of various recombinant proteins are discussed.

The effect of periodontal therapy in diabetics. Results after 5 years

The present investigation was performed to study the frequency of recurrence of periodontitis in diabetic subjects, who, prior to the initiation of a 5-year period of monitoring, were treated for moderate to advanced periodontal disease. 20 patients with diabetes, type 1 (IDDM) or type 2 (NIDDM) and 20, sex and age matched, controls with similar amounts of periodontal tissue destruction, were selected for the study. Following a screening examination, all patients were subjected to non-surgical periodontal therapy (oral hygiene instruction, supra- and subgingival scaling). 3 months later, the baseline examination for the study was performed. This included assessments of several parameters such as: number of teeth, plaque, gingivitis, probing pocket depth and probing attachment level. 6 months after the baseline examination, all 40 subjects were recalled for a 2nd examination. Sites which at this 6-month examination exhibited bleeding on probing, and had probing depth > 5 mm, were scheduled for additional surgical therapy (modified Widman flap). Following this selective additional therapy, the main period of monitoring was initiated. During this period, a plaque control program was repeated every 3 months. Re-examinations regarding plaque, gingivitis, probing depth and probing attachment level were performed 12, 24 and 60 months after the baseline examination. The findings from the examinations disclosed that diabetics and non-diabetics alike, treated for moderately to advanced forms of adult periodontitis, during a subsequent 5-year period, were able to maintain healthy periodontal conditions. Thus, the frequency of sites which exhibited signs of recurrent disease was similar in the 2 study groups.

The serum albumin-binding domain of streptococcal protein G is a three-helical bundle: a heteronuclear NMR study

Streptococcal protein G (SPG) is a cell surface receptor protein with a multiple domain structure containing tandem repeats of serum albumin-binding domains (ABD) and immunoglobulin-binding domains (IgBD). In this paper, we have analysed the fold of ABD. Far-UV circular dichroism analysis of ABD indicates high helical content (56%). Based on an analysis of nuclear magnetic resonance 13C secondary chemical shifts, sequential and short-range NOEs, and a few key nuclear Overhauser effects, we conclude that the ABD is a three-helix bundle. The structure of the ABD is, thus, quite different from the IgBD of protein G [Gronenborn, A.M. et al. (1991) Science 253, 657-661]. This strongly suggests that the ABD and the IgBD of SPG have evolved independently from each other. However, the fold of ABD is similar to that of the IgBD of staphylococcal protein A, possibly indicating a common evolutionary ancestor, despite the lack of sequence homology.

Mapping the folding intermediate of human carbonic anhydrase II. Probing substructure by chemical reactivity and spin and fluorescence labeling of engineered cysteine residues

Several conformation-sensitive parameters have shown that human carbonic anhydrase II exists as a stable and compact equilibrium folding intermediate of molten globule type. In this study we have continued a previously initiated mapping of the intermediate structure. Cys residues were engineered, one at a time, into various regions of the protein structure, so as to obtain chemically reactive probes and handles for spectroscopic probes. These probes were used to specifically report on conformational changes accompanying the folding process. Thus, the accessibility of the introduced Cys residues to specific chemical labeling by radioactive iodoacetate was used to monitor the stability and compactness of the substructure surrounding each Cys residue. In addition, a spin-label (nitroxide radical) and a fluorescent probe (IAEDANS) were attached to the inserted SH-groups to give complementary information. The mobility of the spin-label was used to indicate local changes in structure, and the fluorophore was used to probe local changes in polarity at various stages of unfolding. Much of the predominant beta-structure, consisting of 10 beta-strands extending throughout the entire molecule, appears to be compact and largely intact in the intermediate. Thus, beta-strands 3-7, probed at positions 68, 97, 118, 123, 206, and 245, seem to have a native-like structure in the folding intermediate. In contrast, a more flexible structure is found around positions 56, 176, and 256 in the peripheral beta-strands 1, 2, and 9, showing that the stability of the secondary structure in the intermediate state is less in the outer parts of the protein. A hydrophobic region, containing beta-strands 3-5, seems to be remarkably stable and is not ruptured until strong denaturing conditions (5 M GuHCl) are applied. The stability of this hydrophobic beta-core appears to increase toward the center. This stable region is contained in the middle of a sequentially continuous antiparallel structure that spans beta-strands 2-6, suggesting that this part might represent a site where folding is initiated.

Characterization of a folding intermediate of human carbonic anhydrase II: probing local mobility by electron paramagnetic resonance

The spin-labeling method was used to investigate human carbonic anhydrase, HCA II, undergoing unfolding induced by guanidine-HCI (Gu-HCI). The spin-probe, N-(2,2,5,5-tetramethyl-1-yloxypyrrolidinyl-3-yl)iodoacetamide, was attached covalently to the single cysteine (position 206) in the enzyme. The electron paramagnetic resonance spectrum of the folded structure showed the characteristic slow motional spectra. When the concentration of the denaturing agent, Gu-HCI, was gradually increased, new spectral components with narrower lines evolved to give complex electron paramagnetic resonance spectra, apparently containing superimposed contributions from several components of different mobility. By a differentiation technique, it was possible to follow the relative increase of the narrow components as a function of Gu-HCI concentration. The amplitude of difference spectra versus Gu-HCI concentration showed two distinct maxima, indicating the existence of a folding intermediate state/structure. The results were found to agree with optical absorption data, which showed similar transitions at the same Gu-HCI concentrations. From line-shape simulations assuming a Brownian diffusion model, the rotational diffusion constants for the spin-label in the folded, folding intermediate, and unfolded structures were determined. The relative abundances of the three conformations in the region 0-4 M Gu-HCI were obtained by least squares fitting of the simulated spectra to the experimental ones. The folding intermediate was found to have a maximum population of 39 +/- 4% at approximately 0.7 M Gu-HCI.

Contribution of individual tryptophan residues to the fluorescence spectrum of native and denatured forms of human carbonic anhydrase II

Measurements were made of fluorescence spectra produced by pseudo-wild-type human carbonic anhydrase II and mutants in which the tryptophan residues had been replaced by phenylalanine or cysteine residues. 2D NMR spectra of 15N-labeled proteins indicated that the mutations had essentially no long range effects on structure and that the pertubations of structure in the vicinity of the mutated Trp were small. The individual contributions of the seven tryptophan residues were deduced from measurements on native proteins and on proteins subjected to various denaturing conditions. Trp97 and Trp245 are the major fluorescence emitters in the native state, contributing 52% and 38%, respectively, to the total fluorescence intensity. Comparisons of the fluorescence yield of pseudo-wild-type human carbonic anhydrase II and mutant proteins also indicate net energy transfer from Trp16 to Trp5 and from Trp192 to Trp209. The fluorescence from Trp5 is efficiently quenched by His64. In addition, acrylamide quenching of fluorescence was used to probe the environment of tryptophans in proteins incubated in 0, 1.5, and 5 M guanidine hydrochloride. The results indicate that the part of the native protein that corresponds to beta-strands 3-7 forms a compact core in a molten globule intermediate.

Assignment of the contribution of the tryptophan residues to the circular dichroism spectrum of human carbonic anhydrase II

The circular dichroism (CD) spectrum of human carbonic anhydrase II (HCAII) has been investigated using various mutants of the enzyme in which tryptophans have been replaced by site-directed mutagenesis. HCAII contains seven tryptophans which are believed to significantly contribute to the CD spectrum in both the near- and far-UV regions. By substituting the tryptophans one at a time, the spectral effects of the individual tryptophans were studied. The near-UV spectrum of HCAII is very complex, with multiple Cotton effects. This complexity has been attributed to aromatic amino acids, especially tryptophans, located in asymmetric aromatic clusters in the molecule. CD spectra of the individual tryptophans were calculated as difference spectra between the CD spectrum of HCAII and those of the tryptophan mutants. These spectra showed that the tryptophans contributed to the CD spectrum in almost the entire wavelength region investigated (180-310 nm). Summation of the individual tryptophan CD spectra in the near-UV region yielded a spectrum that was qualitatively very similar to that of HCAII, showing that the tryptophans are the major determinant for this part of the CD spectrum. Since tryptophans were also demonstrated to contribute significantly in the far-UV region, tryptophans can interfere considerably with the assignment of changes in CD bands to changes in secondary structure content during folding reactions. Moreover, because of this substantial interference, predictions of the amount of various types of secondary structure from CD data from the far-UV region are made more difficult. These findings are probably of general importance for proteins that, like HCAII, contain several tryptophans.(ABSTRACT TRUNCATED AT 250 WORDS)

Cis-trans isomerization is rate-determining in the reactivation of denatured human carbonic anhydrase II as evidenced by proline isomerase

The refolding of human carbonic anhydrase II is a sequential process. The slowest step involved is the recovery of enzymic activity (t1/2 = 9 min). Kinetic data from 'double-jump' measurements indicate that proline isomerization might be rate determining in the reactivation of the denatured enzyme. Proof of this is provided by the effect of proline isomerase on the reactivation kinetics: the presence of isomerase during reactivation lowers the half-time of the reaction to 4 min, and inhibition of proline isomerase completely abolishes this kinetic effect. A similar acceleration of the refolding process by proline isomerase is also observed for bovine carbonic anhydrase II, in contrast to what has previously been reported. In human carbonic anhydrase II there are two cis-peptidyl-Pro bonds at Pro30 and Pro202. Two asparagine single mutants (P30N and P202N) and a glycine double mutant (P30G/P202G) were constructed to investigate the role of these prolines in the rate limitation of the reactivation process. Both in the presence and absence of PPIase the P202N mutant behaved exactly like the unmutated enzyme. Thus, cis-trans isomerization of the Pro202 cis-peptidyl bond is not rate determining in the reactivation process. The mutations at position 30 led to such extensive destabilization of the protein that the refolding reaction could not be studied.

Structural and functional differences between carbonic anhydrase isoenzymes I and II as studied by site-directed mutagenesis

Site-specific mutagenesis has been used to replace amino acid residues in the active site of human carbonic anhydrase II with residues characterizing carbonic anhydrases I. Previous studies of [Thr200----His]isoenzyme II [Behravan, G., Jonsson, B.-H. & Lindskog, S. (1990) Eur. J. Biochem. 190, 351-357] showed that His200 is important for the specific catalytic properties of isoenzymes I. In this paper some properties of two single mutants, Asn62----Val and Asn67----His, as well as a double mutant, Asn67----His/Thr200----His, are described. The results show that neither Val62 nor His67 give rise to isoenzyme-I-like properties, while the double mutant behaves like the single mutant with His200. At pH 8.9, the variant with Val62 has a higher value of kcat/Km for CO2 hydration than unmodified isoenzyme II, whereas the variant with His67 has an enhanced kcat value. The replacement of Asn62 with Val results in a 20% increase of the 4-nitrophenyl acetate hydrolase activity. For the double mutant, the esterase activity is quite close to that calculated on the assumption that the effects of the two single mutations on the free energy of activation are additive.

Studies of multilayers and thin-foil x-ray mirrors using a soft x-ray diffractometer

A versatile x-ray diffractometer is described in detail. Two applications to the study of x-ray optical elements are presented. The first is a Bragg reflection study of state-of-the-art multilayers deposited both on conventional Si-wafer substrates and on superpolished substrates such as fused quartz and electroless nickel. These data are compared to data previously obtained at FeKα. The second study is a reflectivity and scattering study of various thin-foil x-ray reflectors proposed for up-coming x-ray satellite missions. All the data have been obtained at MgKα = 1.2536 keV.