Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores.

STUDY OBJECTIVES: Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. METHODS: We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED). Risk scores were prospectively calculated and included the first two cTn. Low risk was defined for each score as HEART≤3, TIMI≤0, GRACE≤50, and EDACS≤15. AMI incidence was calculated for low risk patients and compared across scores using Χ2 tests and C statistics. RESULTS: The patients' median age was 57, 58% were male, 60% white, and 80 (18%) had AMI. The missed AMI rate in low risk patients for each of the scores when combined with 2 cTn were HEART 3.6%, TIMI 0%, GRACE 6.3%, EDACS 0.9%, and unstructured clinical impression 0%. The C-statistic was greatest for the EDACS score, 0.94 (95% CI, 0.92-0.97). CONCLUSIONS: Using their recommended cutpoints and non high sensitivity cTn, TIMI and unstructured clinical impression were the only scores with no missed cases of AMI. Using lower cutpoints (GRACE≤48, TIMI=0, EDACS≤11, HEART≤2) missed no case of AMI, but classified less patients as low-risk.

Associations of total and free 25OHD and 1,25(OH)2D with serum markers of inflammation in older men.

UNLABELLED: Vitamin D is hypothesized to suppress inflammation. We tested total and free vitamin D metabolites and their association with inflammatory markers. Interleukin-6 levels were lower with higher 25-hydroxyvitamin D. 1,25-dihydroxyvitamin D and free 25OHD associations mirrored those of 25OHD. However, associations for the two metabolites diverged for tumor necrosis factor alpha (TNF-α) soluble receptors. INTRODUCTION: Vitamin D is hypothesized to suppress inflammation, and circulating 25-hydroxyvitamin D (25OHD) and inflammatory markers are inversely correlated. However, total serum 25OHD may not be the best indicator of biologically active vitamin D. METHODS: We tested serum total 25OHD, total 1,25(OH)2D, vitamin D binding protein (DBP), and estimated free 25OHD and free 1,25(OH)2D associations with inflammatory markers serum interleukin-6 (IL-6), TNF-α and their soluble receptors, interleukin-10 (IL-10), and C-reactive protein (CRP) as continuous outcomes and the presence of ≥2 inflammatory markers in the highest quartile as a dichotomous outcome, in a random subcohort of 679 men in the Osteoporotic Fractures in Men (MrOS) study. RESULTS: IL-6 was lower in men with higher 25OHD (-0.23 µg/mL per standard deviation (SD) increase in 25OHD, 95 % confidence intervals (CI) -0.07 to -0.38 µg/mL) and with higher 1,25(OH)2D (-0.20 µg/mL, 95 % CI -0.0004 to -0.39 µg/mL); free D associations were slightly stronger. 25OHD and DBP, but not 1,25(OH)2D, were independently associated with IL-6. TNF-α soluble receptors were inversely associated with 1,25(OH)2D but positively associated with 25OHD, and each had independent effects. The strongest association with ≥2 inflammatory markers in the highest quartile was for free 1,25(OH)2D (odds ratios (OR) 0.70, 95 % CI 0.54 to 0.89 per SD increase in free 1,25(OH)2D). CONCLUSIONS: Associations of 1,25(OH)2D and free 25OHD with IL-6 mirrored those of 25OHD, suggesting that 1,25(OH)2D and free D do not improve upon 25OHD in population-based IL-6 studies. However, associations for the two metabolites diverged for TNF-α soluble receptor, warranting examination of both metabolites in studies of TNF-α and its antagonists.

Adiponectin is independently associated with NT-proBNP: The Multi-Ethnic Study of Atherosclerosis.

BACKGROUND AND AIMS: To investigate the associations between selected adipokines and the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). METHODS AND RESULTS: As many as 1489 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis were evaluated at 4 clinic visits about every 2 years. The evaluation included fasting venous blood, which was analyzed for NT-proBNP (at visits 1 and 3) and the adipokines adiponectin and leptin (at visits 2 and 3). The mean age was 64.8 ± 9.6 years and 48% were female. After multivariable adjustment, a 1-SD increment in adiponectin was associated with a 14 pg/ml higher NT-proBNP level (p < 0.01), while, compared to the 1st quartile of adiponectin, the 2nd, 3rd and 4th quartiles had 28, 45 and 67% higher NT-proBNP levels (p < 0.01 for all). For changes in NT-proBNP over the follow-up period, and after multivariable adjustment including baseline NT-proBNP, a 1-SD increment in adiponectin was associated with a 25 pg/ml absolute increase in NT-proBNP (p < 0.01), while those in the 2nd, 3rd and 4th quartiles of adiponectin were associated with increases of 5, 28 and 65 pg/ml (p = 0.74, 0.09 and <0.01, respectively). There was a significant interaction between adiponectin and sex for visit 3 NT-proBNP (p-interaction < 0.01), with significantly stronger associations in men. Leptin was not associated with NT-proBNP. CONCLUSION: Higher adiponectin, but not leptin, is significantly associated with higher levels of NT-proBNP, as well as with greater longitudinal increases in NT-proBNP. The associations were stronger in men.

Pregnancy in women with a history of Kawasaki disease: management and outcomes.

OBJECTIVE: To characterise the obstetrical management and outcomes in a series of women with a history of Kawasaki disease (KD) in childhood. DESIGN: Retrospective case series. SETTING: Tertiary healthcare setting in the USA. POPULATION: Women with a history of KD in childhood. METHODS: Women completed a detailed health questionnaire and participated in research imaging studies as part of the San Diego Adult KD Collaborative Study. MAIN OUTCOME MEASURES: Obstetrical management, complications during pregnancy and delivery, and infant outcomes. RESULTS: Ten women with a history of KD in childhood carried a total of 21 pregnancies to term. There were no cardiovascular complications during labour and delivery despite important cardiovascular abnormalities in four of the ten subjects. Pregnancy was complicated by pre-eclampsia and the post-partum course was complicated by haemorrhage in one subject each. Two of the 21 progeny subsequently developed KD. CONCLUSIONS: Women with important cardiovascular sequelae from KD in childhood should be managed by a team that includes both a maternal-fetal medicine specialist and a cardiologist. Pre-pregnancy counselling should include delineation of the woman's current functional and structural cardiovascular status and appropriate adjustment of medications, but excellent outcomes are possible with appropriate care. Review of the English and Japanese literature on KD and pregnancy revealed the occurrence of myocardial infarction during pregnancy in women with missed KD and aneurysms that were not diagnosed until their acute event. Our study highlights the need for counselling with regard to the increased genetic risk of KD in offspring born to these mothers.

The PEP4 gene encodes an aspartyl protease implicated in the posttranslational regulation of Saccharomyces cerevisiae vacuolar hydrolases.

pep4 mutants of Saccharomyces cerevisiae accumulate inactive precursors of vacuolar hydrolases. The PEP4 gene was isolated from a genomic DNA library by complementation of the pep4-3 mutation. Deletion analysis localized the complementing activity to a 1.5-kilobase pair EcoRI-XhoI restriction enzyme fragment. This fragment was used to identify an 1,800-nucleotide mRNA capable of directing the synthesis of a 44,000-dalton polypeptide. Southern blot analysis of yeast genomic DNA showed that the PEP4 gene is unique; however, several related sequences exist in yeasts. Tetrad analysis and mitotic recombination experiments localized the PEP4 gene proximal to GAL4 on chromosome XVI. Analysis of the DNA sequence indicated that PEP4 encodes a polypeptide with extensive homology to the aspartyl protease family. A comparison of the PEP4 predicted amino acid sequence with the yeast protease A protein sequence revealed that the two genes are, in fact, identical (see also Ammerer et al., Mol. Cell. Biol. 6:2490-2499, 1986). Based on our observations, we propose a model whereby inactive precursor molecules produced from the PEP4 gene self-activate within the yeast vacuole and subsequently activate other vacuolar hydrolases.

Changes in N-terminal pro-B-type natriuretic peptide and incidence of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA).

AIMS: This study looked at whether the inverse association of circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP) with incident diabetes is modified by changes in NT-proBNP (ΔNT-proBNP) levels. METHODS: Plasma NT-proBNP was assayed at baseline and 3.2 years later (visit 3) in the Multi-Ethnic Study of Atherosclerosis (MESA). ΔNT-proBNP was calculated as NT-proBNP visit3-NT-proBNP baseline. A Poisson distribution was fitted to determine the incidence density of diabetes, adjusted for age, race, gender, educational attainment, antihypertensive medication, total intentional exercise and plasma IL-6 levels. In the primary analysis (n=3236 without diabetes up to visit 3, followed for a mean of 6.3 years), incidence density was regressed for the following categories of baseline NT-proBNP: (1)<54.4 pg/mL; (2) 54.4-85.9 pg/mL; and (3) 86-54.2 pg/mL. This was crossed with categories of ΔNT-proBNP as medians (ranges): (1) -6.2 (-131-11.7) pg/mL; (2) 19.8 (11.8-30.1) pg/mL; (3) 44.0 (30.2-67.9) pg/mL; and (4) 111.2 (68.0-3749.9) pg/mL. RESULTS: The incidence density of diabetes followed a U-shaped association across categories of ΔNT-proBNP within categories of baseline NT-proBNP after adjusting for other covariates (P=0.02). At each level of baseline NT-proBNP, the incidence density of diabetes was lowest for small-to-moderate increases in NT-proBNP. CONCLUSION: This analysis suggests that NT-proBNP has a biphasic association with diabetes in which the risk of incident diabetes decreases within a 'physiological range' of ΔNT-proBNP, and plateaus or increases as NT-proBNP concentrations increase, probably in response to pathophysiological conditions leading to high levels of NT-proBNP.

Enzymic differentiation of neurologic and nonneurologic forms of Gaucher's disease.

This study explores the biochemical basis that may distinguish neurologic and nonneurologic forms of Gaucher's disease. Crude membrane preparations from spleens of controls and patients representing the three clinical categories of Gaucher's disease were delipidated by extraction with sodium cholate and n-butanol. Total beta-glucosidase activity was estimated using 4-methylumbelliferyl-beta-D-glucopyranoside (MUG) as substrate, and glucocerebrosidase activity was determined using (3H)-glucocerebroside. beta-Glucosidase and glucocerebrosidase activities were reconstituted by inclusion of sodium taurocholate or phosphatidylserine in the assay medium. When assays contained phosphatidylserine, residual beta-glucosidase activity in delipidated spleen preparations from type 1, nonneurologic cases were five times greater than cases of neurologic Gaucher's disease (82.3 vs. 11.3 units per mg protein). However, beta-glucosidase assays using sodium taurocholate did not discriminate Gaucher's disease subtypes. Similar results were obtained when spleen preparations were analyzed for glucocerebrosidase using glucocerebroside as the substrate. Brain beta-glucosidase from patients representing the three classes of Gaucher's disease showed a similar pattern of sensitivity toward phosphatidylserine. The specific activity of beta-glucosidase in an extract of brain from the one case of type 1 Gaucher's disease analyzed was five times greater than the mean residual specific activity of brain beta-glucosidase measured in five cases of type 2 and type 3 Gaucher's disease. These findings suggest that, in patients with type 1 Gaucher's disease, glucocerebrosidase may show greater activity in the presence of acidic phospholipids than glucocerebrosidase does in patients with neurologic forms of the disease. The ability of the brain enzyme from a type 1 case to be profoundly stimulated by an acidic phospholipid may explain why such individuals are spared central nervous system involvement.

Brain glucocerebrosidase in Gaucher's disease.

Using glucocerebroside labeled with carbon 14 as the substrate, we determined that homogenates of brain tissue from both neuropathic and nonneuropathic cases of Gaucher's disease were profoundly deficient (more than 85%) in glucocerebrosidase activity. The beta-glucosidase activity, as measured with 4-methylumbelliferyl-beta-D-glucopyranoside as the substrate, in the homogenates of brain from four cases of Gaucher's disease was less sensitive to inhibition by conduritol B epoxide (CBE) when compared with normal brain beta-glucosidase. However, when homogenates were assayed with radiolabeled glucocerebroside as the substrate, no differential sensitivity toward CBE was indicated, suggesting the presence of an additional, CBE-insensitive, beta-glucosidase in brain tissue. Residual glucocerebrosidase activity partially purified from the brain of an adult with type 1 Gaucher's disease was activated threefold by gluconoyl hydrazine, whereas the same enzyme from control brain was unaffected, and eight times less sensitive to gluconolactone inhibition.

Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism.

Five previous trials of pulmonary embolism (PE) thrombolysis showed individually that duration of symptoms did not affect lung scan reperfusion or angiographic clot lysis. We conducted an overview of 308 patients from these trials. Using 262 pairs of pre- and postlysis lung scans and 222 pairs of angiograms, we evaluated the relation between duration of PE symptoms and changes in reperfusion and/or clot lysis following thrombolysis. When comparing baseline and 24-hour post-thrombolysis lung scans, 77% of patients overall demonstrated improvement, including 69% who were treated 6 to 14 days after onset of symptoms. We detected an inverse relation between duration of symptoms and improvement on post-treatment lung scan reperfusion scores. For each additional day of symptoms before PE thrombolysis, there was a decrement of 0.8% of lung tissue reperfusion on lung scanning (95% confidence interval [CI], 0.2% to 1.4%, p = 0.008). Adjustment for age and baseline lung scan defect had little effect on the results Similarly, on angiography, less clot lysis immediately following thrombolysis was observed in the group of patients with the longest duration of symptoms compared with those with the shortest symptom duration (mean = 1.0 score unit of angiographic improvement in those with symptoms for > or = 6 days vs 1.7 score units for < or = 1 day of symptoms, p = 0.03). This inverse relation between duration of symptoms and response to thrombolysis indicates that thrombolytic treatment should commence as soon as possible after PE is diagnosed. However, thrombolysis is still useful in patients who have had symptoms for 6 to 14 days.

A revised fluorometric assay for Gaucher's disease using conduritol-beta-epoxide with liver as the source of Beta-glucosidase.

To date, enzymatic diagnosis of Gaucher's disease via a fluorometric assay procedure which utilizes 4-methylumbelliferyl-beta-D-glucopyranoside as a substrate has not been possible when liver serves as the source of enzyme since currently employed fluorometric procedures cannot adequately differentiate between a broad-specificity beta-glucosidase and lysosomal glucocerebrosidase activities in crude extracts of liver. Incorporation of conduritol-beta-epoxide into the incubation medium for the fluorometric assay allows one to selectively measure the glucocerebrosidase activity present in a given liver extract. In five cases of Gaucher's disease this revised fluorometric procedure proved as effective as the assy procedure which utilizes authentic, radiolabeled glucocerebroside as the substrate in demonstrating a deficiency of glucocerebrosidase activity in liver.

An improved fluorometric leukocyte beta-glucosidase assay for Gaucher's disease.

Three fluorometric leukocyte beta -glucosidase assays were compared for their ability to diagnose Gaucher's disease and identify carriers of the disorder: the acid beta-glucosidase assay of Beutler and Kuhl [2], a pH 5.5-sodium taurocholate-dependent assay and a new procedure which employs conduritol B epoxide, an active-site specific inhibitor of glucocerebrosidase. All three assays unambiguously identified patients with Gaucher's disease. With regard to identifying carriers the bile salt dependent assay of Peters et al. and the conduritol B epoxide-dependent procedure gave the greatest discrimination between the mean beta-glucosidase values for the control and heterozygote samples when evaluated using Student's t test. The most reliable assay for the identification of the carrier state was the conduritol B epoxide-dependent procedure which can be expected to provide the fewest false negative results when classifying heterozygotes (5%). However, the fact that none of these methods will completely separate control and heterozygote samples indicates that their use in screening programs will result in a significant number of incorrect assignments.

Effects of induced fescue toxicosis on plasma and tissue catecholamine concentrations in sheep.

Sixteen crossbred wethers were distributed among four treatments and fed a control ration based on annual rye-orchardgrass (R-O) for 8 days. Indwelling jugular cannulae were installed and experimental regimes begun the following day (experimental day 1). One-half of the wethers were fed a ration based on endophyte-infected Kentucky-31 fescue while the remainder continued to receive the R-O control diet for 10 days. Spiperone, a dopamine antogonist, was administered to one-half of the wethers receiving each ration on days 8 and 9. Plasma prolactin (PRL), dopamine (DA), norepinephrine (NE) and epinephrine (E) were measured in jugular venous blood on days 1, 3, 5 and 7-10 of the trial. On day 10, the animals were decapitated; and DA, NE, E and 3,4-dihydroxyphenylacetic acid (DOPAC) and monoamine oxidase (MAO) were determined in hypothalamic and pituitary tissue. Plasma DA was elevated (P less than .05) following day 8 in wethers fed infected fescue over those fed (R-O), while plasma PRL was reduced (P = .08). Wethers receiving Spiperone had lowered (P less than .05) plasma DA and elevated (P less than .01) plasma PRL. Plasma DA was negatively correlated (P less than .01) with plasma PRL (r = -0.50) following day 8. Plasma NE and E levels and NE, E, DA and DOPAC tissue concentrations were not affected by Spiperone administration or diet. MAO levels in pituitaries were higher (P less than .01) for Spiperone-treated wethers. Wethers receiving the toxic fescue ration exhibited elevated plasma DA concentrations which was associated with depressed prolactin secretion in wethers.(ABSTRACT TRUNCATED AT 250 WORDS)

Fructose utilization for nucleic acid synthesis in the fetal pig.

Eight fetal pigs, in utero, were injected ip with 20 microCi/fetus [U14C]-fructose between d 55 and 65 pregnancy. The isotope was allowed to equilibrate between blood and tissues within injected fetuses for a period of 240 min. Fetal pigs were then sacrificed and nucleic acids were extracted from cold tissue homogenates of skeletal muscle and liver. Nuclide disintegrations per minute recovered in extracted DNA and RNA were used to calculate incorporation of labeled C from fructose. The recovery of labeled C per mmol of nucleic acids from skeletal muscle was greater (P less than .05) than that from liver. Relative incorporation of labeled C into skeletal muscle RNA (395.9 pmol/mmol) was greater (P less than .05) than for DNA (189.5 pmol/mmol). The same trend was observed for liver RNA (78.0 pmol/mmol) and DNA (55.6 pmol/mmol), but differences were nonsignificant. These data suggest that at least part of the high concentration of endogenous fructose measured in fetal pigs in utero is involved in synthesis of nucleic acids, thereby providing substrate for anabolic functions necessary for fetal growth and development.

beta-Glucosidase assays in the diagnosis of Gaucher's disease.

The description in 1965 of glucocerebroside: beta-glucosidase as the enzymic defect in Gaucher's disease stimulated considerable research interest and effort toward establishing rapid, reliable, and inexpensive enzymic assays for diagnostic purposes and carrier detection. Here, we consider some of the methods currently in use in which the substrate is the synthetic glucoside, 4-methylumbelliferyl-beta-D-glucopyranoside, and leukocytes and fibroblasts are the sources of enzyme. We also consider the concepts of the "acid beta-glucosidase" and multiple forms of beta-glucosidase that have been proposed to explain the effectiveness of the fluorometric assays. Finally, we analyze the limitations of each method and discuss the difficulties involved in instituting heterozygote screening programs in the general population.

Time-resolved inductively coupled plasma mass spectrometry measurements with individual, monodisperse drop sample introduction.

Individual ion clouds, each produced in the ICP from a single drop of sample, were monitored using time-resolved mass spectrometry and optical emission spectrometry simultaneously. The widths of the ion clouds in the plasma as a function of distance from the point of initial desolvated particle vaporization in the ICP were estimated. The Li(+) cloud width (full width at halfmaximum) varied from 85 to 272 µs at 3 and 10 mm from the apparent vaporization point, respectively. The Sr(+) cloud width varied from 97 to 142 µs at 5 and 10 mm from the apparent vaporization point, respectively. The delays between optical and mass spectrometry signals were used to measure gas velocities in the ICP. The velocity data could then be used to convert ion cloud peak widths in time to cloud sizes in the ICP. Li(+) clouds varied from 2.1 to 6.6 mm (full width at half-maximum) and Sr(+) clouds varied from 2.4 to 3.5 mm at the locations specified above. Diffusion coefficients were estimated from experimental data to be 88, 44, and 24 cm(2)/s for Li(+), Mg(+), and Sr(+), respectively. The flight time of ions from the sampling orifice of the mass spectrometer to the detector were mass dependent and varied from 13 to 21 µs for Mg(+) to 93 to 115 µs for Pb(+).

Effectors of three beta-glucosidases from human liver.

1. A third beta-glucosidase from human liver has been isolated using a mild (0.02-0.10%) Triton X-100 extraction of the exhaustively washed high speed (200,000 X g, 30 min) particulate fraction, QAE-Sephadex and concanavalin A-Sepharose chromatography. This new beta-glucosidase, referred to as TX beta-glucosidase, possesses a distinctive set of chemical properties such that it is similar to both, glucocerebrosidase and cytoplasmic beta-glucosidase, but it is not identical to either enzyme. 2. The TX beta-glucosidase hydrolyzes glucocerebroside as well as the beta-D-glucose, beta-D-galactose, beta-D-fucose, beta-D-xylose and alpha-L-arabinose derivatives of 4-methylumbelliferone. Like the cytoplasmic beta-glucosidase, the TX beta-glucosidase is inhibited by bile salts, and unaffected by conduritol B epoxide and heat stable activator protein. 3. All three beta-glucosidases were inhibited by N-hexylpsychosine, and all showed the same, mixed type inhibition kinetics, indicating a common hydrophobic binding site in all three enzymes. 4. The TX beta-glucosidase, which constitutes only a few percent of the total beta-glucosidase activity of human liver, is absent from liver from two cases of neurologic Gaucher disease and present in reduced amounts in a third case with CNS disease. Liver from a case of type 1 Gaucher disease contained normal amounts of the TX beta-glucosidase.

Effects of extracts of toxic fescue given orally to rats.

Fresh fescue (Festuca arundinacea) was obtained from farms where toxicity was encountered in cattle grazing the fescue. The fescue was dried in a forced draft oven at 60 degrees C and then ground. The dry ground fescue was extracted with ether and then re-extracted with either 1% sodium bicarbonate (NaHCO3), sodium hydroxide or hydrochloric acid. The residual ether was evaporated and the residue resuspended in ethyl alcohol diluted with water 1% (control) and 1 mL of the above extracts of fescue were given daily to rats, via stomach tube, beginning the seventh day after breeding. Two of the seven rats given the 1% NaHCO3 fraction of the extract of fescue gave birth to live young. One of these litters contained only five pups, with one being stillborn. Three of the seven rats aborted, one gave birth to seven stillborn pups and one female died during birth. All females fed the 1% NaHCO3 and the other extracts of the fescue gave birth to normal litters. Rats fed the ether extract which was re-extracted with 1% NaHCO3, acidified and re-extracted with ether, dried and resuspended in 1% NaHCO3 produced similar reproductive problems as those rats given the ether extract of fescue which was re-extracted only once with 1% NaHCO3. Therefore, it appears that the toxic entity(s) of fescue can be extracted and that infertility/abortion/still-birth ratio of rats may be used as a bioassay.

Kinetic analysis of the interaction of alkyl glycosides with two human beta-glucosidases.

This paper addresses the similarities and differences in the topology of the catalytic centres of human liver cytosolic beta-glucosidase and placental lysosomal glucocerebrosidase, and utilizes well-documented reversible active-site-directed inhibitors. This comparative kinetic study was performed mainly to decipher the chemical and structural nature of the active site of the cytosolic beta-glucosidase, whose physiological function is unknown. Specifically, analysis of the effects of a family of alkyl beta-glucosides consistently displayed 100-250-fold lower inhibition constants with the cytosolic broad-specificity beta-glucosidase compared with the placental glucocerebrosidase; for example, with octyl beta-D-glucoside the Ki values were 10 microM and 1490 microM for the cytosolic and lysosomal beta-glucosidases respectively. Furthermore the higher affinity of the cytosolic beta-glucosidase than glucocerebrosidase for the amphipathic alkyl beta-D-glucosides was validated by the greater increase in the free energy of binding with increasing alkyl chain length [delta delta G0 (K,)/CH2: lysosomal enzyme, 2.01 kJ/mol (480 cal/mol); cytosolic enzyme, 3.05 kJ/mol (730 cal/mol)]. The implications of the presence of highly non-polar domains in the active site of the cytosolic beta-glucosidase are discussed with regard to its potential physiological substrates.

Activators of spleen glucocerebrosidase from controls and patients with various forms of Gaucher's disease.

Glucocerebrosidase from normal human spleen, and spleen from cases of neurologic (types 2 and 3) and nonneurologic (type 1) Gaucher's disease, was delipidated and inactivated by extraction from membranes with sodium cholate and ice-cold 1-butanol. Control glucocerebrosidase was stimulated markedly by large quantities (20-30 micrograms/assay) of phosphatidylserine (PS), or by a combination of smaller amounts (1-2 micrograms) of PS and 3 micrograms of a heat-stable factor (HSF) derived from the spleen of a patient with Gaucher's disease. The residual glucocerebrosidase from a nonneurologic case, but not a neurologic case, was also responsive to PS and HSF. The combination of HSF and PS decreased the Km of the normal enzyme for 4-methylumbelliferyl-beta-D-glucopyranoside from 8.0 to 1.6 mM. These effectors also increased the reactivity of glucocerebrosidase to the inhibitor conduritol B epoxide; HSF alone had no effect (t1/2 = 19 +/- 0.5 min) whereas the maximum rate of inactivation (t1/2 = 4.0 min) by conduritol B epoxide was achieved in the presence of a mixture of PS (1 microgram) and HSF (3 micrograms). Phosphatidylglycerol (PG) and phosphatidic acid, also acidic phospholipids, were effective activators of glucocerebrosidase. Varying the fatty acid composition of PG had little effect on its ability to stimulate glucocerebrosidase activity. However, in the case of phosphatidylcholine (PC), a weaker activator than PG or PS, fatty acid composition had a significant impact on the ability of this neutral lipid to activate glucocerebrosidase; dilinoleoyl-PC and dicaproyl-PC were moderately effective activators, but distearoyl-PC and dioleoyl-PC were almost totally inactive. The mono-, and di-, and trisialogangliosides (GM1, GD1, and GT1 were less than half as effective as PS as activators of glucocerebrosidase. These results indicate that acidic phospholipids and the heat-stable factor may both play a role in explaining the genetic heterogeneity of Gaucher's disease.