Filtration Markers, Cardiovascular Disease, Mortality, and Kidney Outcomes in Stable Kidney Transplant Recipients: The FAVORIT Trial.

Cystatin C and beta-2-microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFRcys ), B2M (eGFRB2M ), and creatinine (eGFRcr ) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case-cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFRcr , eGFRcys , and eGFRB2M were 46.0, 43.8, and 48.8 mL/min/1.73m2 , respectively. After multivariable adjustment, hazard ratios for eGFRcys and eGFRB2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09-3.76; p = 0.03) and 2.56 (1.35-4.88; p = 0.004) for cardiovascular events; 3.92 (2.11-7.31) and 4.09 (2.21-7.54; both p < 0.001) for mortality; and 9.49 (4.28-21.00) and 15.53 (6.99-34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFRcr . We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients.

Rescue of a telomere length defect of Nijmegen breakage syndrome cells requires NBS and telomerase catalytic subunit.

Nijmegen breakage syndrome (NBS) is a rare human disease displaying chromosome instability, radiosensitivity, cancer predisposition, immunodeficiency, and other defects [1, 2]. NBS is complexed with MRE11 and RAD50 in a DNA repair complex [3-5] and is localized to telomere ends in association with TRF proteins [6, 7]. We show that blood cells from NBS patients have shortened telomere DNA ends. Likewise, cultured NBS fibroblasts that exhibit a premature growth cessation were observed with correspondingly shortened telomeres. Introduction of the catalytic subunit of telomerase, TERT, was alone sufficient to increase the proliferative capacity of NBS fibroblasts. However, NBS, but not TERT, restores the capacity of NBS cells to survive gamma irradiation damage. Strikingly, NBS promotes telomere elongation in conjunction with TERT in NBS fibroblasts. These results suggest that NBS is a required accessory protein for telomere extension. Since NBS patients have shortened telomeres, these defects may contribute to the chromosome instability and disease associated with NBS patients.

A nonsense mutation 1669Glu-->Ter within the regulatory domain of human erythroid ankyrin leads to a selective deficiency of the major ankyrin isoform (band 2.1) and a phenotype of autosomal dominant hereditary spherocytosis.

We describe a nonsense mutation in the regulatory domain of erythroid ankyrin associated with autosomal dominant hereditary spherocytosis with a selective deficiency of the ankyrin isoform 2.1 (55% of normal), a deficiency of spectrin (58% of normal) proportional to the decrease in ankyrin 2.1, and a normal content of the other main ankyrin isoform, protein 2.2. PCR amplification of cDNA encoding the regulatory domain of ankyrin revealed a marked decreased in the ratio of ankyrin 2.1 mRNA to the ankyrin 2.2 mRNA. Sequencing of ankyrin gene in the region where the 2.1 and 2.2 mRNA differ detected a nonsense mutation 1669Glu-->Ter (GAA-->TAA) in one ankyrin allele. Only normal ankyrin 2.1 mRNA was detected in the reticulocyte RNA. Since the alternative splicing within the regulatory domain of ankyrin retains codon 1669 in ankyrin 2.1 mRNA and removes it from ankyrin 2.2 mRNA, we propose that the 1669Glu-->Ter mutation decreases the stability of the abnormal ankyrin 2.1 mRNA allele leading to a decreased synthesis of ankyrin 2.1 and a secondary deficiency of spectrin.

Combination of two mutant alpha spectrin alleles underlies a severe spherocytic hemolytic anemia.

We studied a patient with a severe spherocytic hemolytic anemia without family history of spherocytosis. Analysis of patient's erythrocyte membrane proteins revealed spectrin deficiency and a truncated alpha spectrin protein. We determined that the patient is a compound heterozygote with two mutations in alpha spectrin gene. Mutation in the paternal allele, designated alpha spectrin(PRAGUE), is a transition A to G in the penultimate position of intron 36 that leads to skipping of exon 37, frameshift, and production of the truncated alpha spectrin protein. The maternal allele, designated alpha spectrin(LEPRA), contains transition C-->T in position -99 of intron 30. This mutation enhances an alternative acceptor splice site 70 nucleotides upstream from the regular site. The alternative splicing causes a frameshift and premature termination of translation leading to a significant decrease in alpha spectrin production. The alpha(LEPRA) mutation is linked to a spectrin alphaIIa marker that was found to be associated with recessive or nondominant spectrin-deficient hereditary spherocytosis in approximately 50% of studied families. We conclude that the alpha(LEPRA) mutation combined in trans with the alpha(PRAGUE) mutation underlie the severe hemolytic anemia in the proband. We suggest that allele alpha spectrin(LEPRA) may be frequently involved in pathogenesis of recessive or nondominant spectrin-deficient hereditary spherocytosis.

Duplication of 10 nucleotides in the erythroid band 3 (AE1) gene in a kindred with hereditary spherocytosis and band 3 protein deficiency (band 3PRAGUE).

We describe a duplication of 10 nucleotides (2,455-2,464) in the band 3 gene in a kindred with autosomal dominant hereditary spherocytosis and a partial deficiency of the band 3 protein that is reflected by decreased rate of transmembrane sulfate flux and decreased density of intramembrane particles. The mutant allele potentially encodes an abnormal band 3 protein with a 3.5-kD COOH-terminal truncation; however, we did not detect the mutant protein in the membrane of mature red blood cells. Since the mRNA levels for the mutant and normal alleles are similar and since the band 3 content is the same in the light and dense red cell fractions, we conclude that the mutant band 3 is either not inserted into the plasma membrane or lost from the membrane prior to the release of red blood cells into circulation. We further show that the decrease in band 3 content principally involves the dimeric laterally and rotationally mobile fraction of the band 3 protein, while the laterally immobile and rotationally restricted band 3 fraction is left essentially intact. We propose that the decreased density of intramembrane particles decreases the stability of the membrane lipid bilayer and causes release of lipid microvesicles that leads to surface area deficiency and spherocytosis.

The dynamics of gene expression in human lung microvascular endothelial cells after stimulation with inflammatory cytokines.

Vascular endothelium plays an essential role in the pathogenesis of vasoocclusion. The changes in the endothelial cell function can be triggered by changes in gene expression caused by interaction with cytokines and blood cells. Using cDNA arrays, we have recently reported complex patterns of gene expression after stimulation of endothelial cells with TNFalpha and IL-1beta. Better understanding of the time course of gene expression changes, their concentration dependence and reversibility after withdrawal of the offending cytokine is essential for successful prevention and therapy of vasoocclusion. Here we present a detailed study of the concentration dependence and time course of gene expression in endothelial cells after their exposure to TNFalpha and IL-1beta. We focus on the adhesion molecules (VCAM-1, ICAM-1, E-selectin) and cytokines (IL-6, GCP-2, MCP-1) that are likely to contribute to vasoocclusion. We report differences in the time course and intensity of their expression and in their response to TNFalpha and IL-1beta stimulation. We demonstrate that expression of the studied genes is upregulated by low TNFalpha concentrations that better reflect the TNFalpha levels detected in the plasma of patients developing vasoocclusion. These results help to understand the changes in the endothelium and to design rational prevention and therapy of vasoocclusion.

[Increased risk of malignancies in heterozygotes in families of patients with Nijmegen breakage syndrome]. / Zvýsené riziko malignit u heterozygotu v rodinách pacientu s Nijmegen breakage syndromem.

BACKGROUND: The autosomal recessive chromosomal instability and hyperradiosensitivity Nijmegen breakage syndrome (NBS) in consequence of a mutation in the NBSI gene at 8q21 is associated with high occurrence of lymphoreticular malignancies due to deficient DNA reparation (double strand breaks). In the Slavic population the majority of patients are homozygotes of the so-called "Slavic mutation" 657de15 in exon 6. Increased occurrence of malignant solid tumors (1) in families of NBS patients has been described already prior to the identification of the responsible gene, and the increased risk of malignancies in heterozygotes was thus hypothetical. METHODS AND RESULTS: The possibility of discerning mutation carriers in families from normal homozygotes enables verification of that hypothesis. Through molecular genetics investigations of grandparents and immediate relatives, we have been successful in determining the genotype in 79 of 112 grandparents in 28 families of our 39 patients and 54 their parents and siblings. A single family had affected children in consequence of compound heterozygosity of the 657de15 and R215W mutations in the same exon of the NBSI gene. The proband's families were investigated genealogically and data on relatives were obtained over four generations. Obtained data were repeatedly supplemented and objectively verified in church books and in healthcare documentation. Seven families have been followed up for 20-30 years, six families for 10-20 years, and 15 families for 1-10 years. Out of 28 families we were successful in examining the genotype of both grandparents in 18 families, there having been revealed one non-paternity; in five families only one of the grandparents has been examined; in five families we were not successful in examining any grandparent. Among 40 grandparents - normal homozygotes, there has appeared a malignancy in three (7.4 %), while among 39 heterozygotes of mutation 657de15 in the NBSI gene malignancies were documented in 15 (38,2 %). Mean age of NBS heterozygotes at manifestation of malignancy was 59.3 year (range 47-72 years), in the group of homozygotes it was 52.6 years (range 44-62 years). Nine grandparents died of malignancy prior to the discovery of the NBSI gene and their genotype has been deduced genealogically in seven on the basis of the genotype in the sponse and children, in two from preserved DNA. Out of that number, from three grandparents that had died of malignancies we were successful in obtaining neoplastic tissue for molecular genetics investigation, aimed at LOH or amplification of the NBS1 gene. In another seven grandparents - heterozygotes, malignancies were manifested after determination of their genotype by DNA analysis, and consequently also from tumor tissue that has been obtained from three of them for molecular genetic investigation. CONCLUSIONS: The age distribution and socio-economic status of both groups of grandparents did not differ, the sex ratio was slightly shifted towards females in the group of homozygotic grandparents (22 females and 18 males), and in the group of heterozygotes it was towards males (21 males and 18 females). The sex ratio between heterozygotic grandparents with malignancies was likewise shifted towards the male gender (11 males and 4 females), in the group of homozygotic grandparents malignancy affected one male and two females. As verified in healthcare and church books documentation, the occurrence of malignancies was significantly more frequent among grandparents heterozygotic for NBS1 mutation than in healthy homozygotes. Among sibs of grandparents and great-grandparents was found significant difference in frequency of malignancies in heterozygotes (5/18 = 27,7 %) and healthy homozygotes (2/36 = 5,5 %), too.

Changes in fluidity of erythrocyte membranes after storage of erythrocytes and regeneration of cellular ATP level.

The membrane fluidity of freshly collected human erythrocytes, of erythrocytes stored for 3-4 weeks and of stored erythrocytes rejuvenated with glucose and inosine was investigated by measuring polarization of fluorescence emission of 1,6-diphenyl-1,3,5-hexatriene and N-phenyl-1-naphthylamine. The fluidity of membranes prepared from stored erythrocytes was higher than that of fresh erythrocytes. After rejuvenation of erythrocytes with glucose and with or without inosine the membrane fluidity decreased. These changes were probably due to variations of ATP levels in the erythrocytes.

Fluidity of intact erythrocyte membranes. Correction for fluorescence energy transfer from diphenylhexatriene to hemoglobin.

Membranes of intact erythrocytes were labeled by the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH) using an improved labeling procedure described previously (Plásek, J. and Jarolím, P. (1987) Gen. Physiol. Biophys. 6, 425-437). The relationship between the steady-state DPH fluorescence anisotropy r and the mean corpuscular hemoglobin concentration (MCHC) was studied. Fluorescence anisotropy increased with increasing MCHC. A linear dependence of r = 0.0026 (MCHC) + 0.113 was obtained which enabled us to measure the fluidity of intact red cell membranes. Without this correction for fluorescence quenching by hemoglobin, incorrect conclusions about membrane fluidity could be made. This fact is demonstrated in a group of pyruvate kinase deficient patients compared with a group of healthy blood donors.

Differentiation of human myeloid leukemia cell line ML-1 induced by retinoic acid and 1,25-dihydroxyvitamin D3.

Human myeloblastic leukemia cell line ML-1 was induced to differentiate by 1 mumol/l all-trans-retinoic acid (RA) or by 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). After 4-6 days of the induction several differentiation-associated characteristics were observed: (1) Ability to stimulate respiration burst in the ML-1 induced cells as detected by nitroblue tetrazolium (NBT) test or by chemiluminescence (CL). (The percentage of the NBT-positive cells was up to 99% in the RA-induced cells and up to 85% in the 1,25(OH)2D3-induced cells.) (2) Substantially higher phagocytosis of colloid iron, latex or Staphylococcus particles was found in the induced cells. (3) The 1,25(OH)2D3-induced ML-1 cells expressed the monocytic enzyme NaF-inhibitable alpha-naphthyl butyrate esterase and the surface monocytic antigen CD-14. (4) A majority of the induced cells lost the morphological features of blast cells; while the 1,25(OH)2D3-treated cells acquired certain features of monocyte-macrophage differentiation, the RA-treated cells displayed several granulocytic characteristics. (5) Cytofluorometric DNA assay after treatment of the cells with colcemid showed that the decline observed in the growth rate of the induced cells was connected with their arrest in G1/G0 phase of the cell cycle. The obtained results indicate granulocytic differentiation of the RA-induced ML-1 cells and monocyto/macrophage differentiation of the 1,25-(OH)2-D3 induced cells.

Interaction of the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene with biomembranes.

The relationship between the conditions of membrane labelling by the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH) and its fluorescence parameters was investigated. In the labelling solutions prepared by the usual method, the presence of DPH microcrystals was revealed which led to the lower resultant fluorescence anisotropy values. Lower labelling efficiency was observed with DPH solutions in tetrahydrofuran when compared with solutions in acetone. Modifications of the labelling procedure are proposed which give better reproducibility of the results. There modified method involves the preparation of a 2 X 10(-4) mol. 1(-1) DPH stock solution in acetone, a 100-fold dilution in an appropriate buffer, subsequent bubbling through with nitrogen for 30 min and mixing the resulting solution with cell/membrane suspension in a 1:1 (v/v) ratio. Changes in intensity, anisotropy and spectra of DPH fluorescence in the course of membrane labelling were studied. A two-stage model of the incorporation of DPH into membranes was proposed, according to which DPH molecules first quickly adhere to the membrane surface and then are slowly translocated to the apolar regions of the membrane.

[Chromosome instability syndromes]. / Význam syndromu chromozomální instability.

We refer 55 cases of the chromosomal instability syndromes (SCI), diagnosed in patients of our genetical clinics. Problems of early diagnosis can be documented by a discrepancy between the expected number of patients and their relative advanced age at the time when SCI was ascertained. We have also shown that NBS patients can be diagnosed earlier and the disease sufficiently confirmed on the basis of congenital microcephaly and on the direct detection of 657de15 mutation in NBS1 gene. Genealogical analysis of families with SCI revealed a low risk of prenatal selection of affected homozygotes and high cancer prevalence in relative (in NBS families recognized heterozygotes) at young adult age. Due to severe DNA repair disorder and hyperradiosensitivity of affected homozygotes as well as unaffected heterozygotes, conventional diagnostics and treatment protocols of lymphoreticular malignancies in affected homozygotes are prohibited. The use of Nijmegen treatment protocol improved in our patients dramatically their clinical prognosis, which is documented by 6 NBS patients surviving one or two malignancies. Early diagnose of SCI and information for families and their doctors about consequences of DNA repair disorder and about their hyperradiosensitivity is essential for improving the clinical prognosis of SCI patients.

[Silent forms of hereditary spherocytosis]. / Nemé formy hereditární sférocytózy.

We report 7 cases of "silent" form of hereditary spherocytosis observed among members of 4 different families. Silent form of hereditary spherocytosis occurred in 5.4% of all patients with hereditary spherocytosis treated in our institute. The patients with silent form featured normal Hb level and red blood cell count, normal or slightly elevated reticulocyte count and bilirubin level. Osmotic resistance of red blood cells was decreased and autohemolysis was increased, nevertheless, the differences from normal range were less prominent than in patients with manifest form of the disease. Analysis of red cell membrane revealed deficiency of band 3 protein in all cases of silent form of hereditary spherocytosis.

[Pregnancy in patients with hereditary spherocytosis]. / Tehotenství u nemocných s dedicnou sférocytózou.

The influence of pregnancy on the course of hereditary spherocytosis was investigated in 21 women during their 44 pregnancies. Fourteen pregnancies were followed up directly, 30 were evaluated from anamnestic data. In the majority of investigated women with hereditary spherocytosis pregnancy caused no problems. When complications developed, they were not serious as a rule. Only about one third of pregnancies in non-splenectomized women developed anaemia or anaemia deteriorated. In the latter enhanced haemolysis participated. In splenectomized patients the incidence of complaints was minimal.

[Relation between types of erythrocyte membrane defects and the clinical picture in hereditary spherocytosis]. / Vztah mezi typem membránového defektu erytrocytu a klinickým obrazem u hereditární sférocytózy.

From total number of 130 patients with hereditary spherocytosis from 75 families in 119 patients from 69 families a defect of membrane proteins was detected. In 23 families (33.3%) a spectrin defect was involved, in 32 families (46.3%) a combined defect of spectrin and ancyrine and in 14 families (20.3%) a defect of band 3 proteins. Investigation of the membrane defect and the clinical and laboratory picture revealed that the band 3 protein defect of spectrin and ancyrine. There are significant differences in the clinical picture of the two latter defects.

Multicenter analytical evaluation of a high-sensitivity troponin T assay.

BACKGROUND: High-sensitivity cardiac troponin assays are being introduced clinically for earlier diagnosis of acute myocardial infarction (AMI). We evaluated the analytical performance of a high-sensitivity cardiac troponin T assay (hscTnT, Roche Diagnostics) in a multicenter, international trial. METHODS: Three US and 5 European sites evaluated hscTnT on the Modular® Analytics E170, cobas® 6000, Elecsys 2010, and cobas® e 411. Precision, accuracy, reportable range, an inter-laboratory comparison trial, and the 99th percentile of a reference population were assessed. RESULTS: Total imprecision (CVs) were 4.6-36.8% between 3.4 and 10.3 ng/L hscTnT. Assay linearity was up to 10,000 ng/L and the limit of blank and detection were 3 and 5 ng/L, respectively. The 99th percentile reference limit was 14.2 ng/L (n=533). No significant differences between specimen types, assay incubation time, or reagent lots existed. A substantial positive bias (76%) exists between the 4th generation and hscTnT assays at the low end of the measuring range (<50 ng/L). hscTnT serum pool concentrations were within 2SD limits of the mean of means in the comparison trial, indicating comparable results across multiple platforms and laboratories. CONCLUSION: The Roche hscTnT assay conforms to guideline precision requirements and will likely identify additional patients with myocardial injury suspicious for AMI.