Fractures of the shaft of the humerus. An epidemiological study of 401 fractures.

We studied the epidemiology of 401 fractures of the shaft of the humerus in 397 patients aged 16 years or older. The incidence was 14.5 per 100,000 per year with a gradually increasing age-specific incidence from the fifth decade, reaching almost 60 per 100, 000 per year in the ninth decade. Most were closed fractures in elderly patients which had been sustained as the result of a simple fall. The age distribution in women was characterised by a peak in the eighth decade while that in men was more even. Simple fractures were by far the most common and most were located in the middle or proximal shaft. The incidence of palsy of the radial nerve was 8% and fractures in the middle and distal shaft were most likely to be responsible. Only 2% of the fractures were open and 8% were pathological. These figures are representative of a population with a low incidence of high-energy and penetrating trauma, which probably reflects the situation in most European countries.

Electron microscopy of low iodinated thyroglobulin molecules.

Thyroglobulin molecules were studied in the electron microscope with negative staining technique. In a first series of experiments samples of thyroglobulin varying in iodine content from 0.5 to 0.03% were prepared from the thyroids of mice and rats kept on iodine-poor diets. All samples contained thyroglobulin molecules of the normal ovoid shape, not deviating in size or shape from molecules obtained from normal thyroids. However, in addition, another type of molecule having a cylindrical shape was observed in all samples. The proportion of these cylindrical molecules increased from a few per cent in the moderately iodine-poor thyroglobulin samples to more than 80% in the highly iodine-deficient thyroglobulin (0.03%). In a second series of experiments extremely iodine-poor thyroglobulin (smaller than 0.005%) was obtained from propylthiouracil-treated rats. In these preparations practically all molecules had a cylindrical shape. These samples also contained smaller particles interpreted to be dissociation products. The cylindrical molecules were of two types, one appearing compact and measuring 250 times 135 A (length times diameter) and the other appearing porous and having a length of 145 and a diameter of 205 A. It is concluded that the cylindrical molecules represent non- or low-iodinated thyroglobulin and it is suggested that the porous cylindrical molecule is an unfolded form of the compact cylinder.

Iodide transport in primary cultured thyroid follicle cells: evidence of a TSH-regulated channel mediating iodide efflux selectively across the apical domain of the plasma membrane.

The transport of iodide was studied in porcine thyroid follicle cells cultured in bicameral chambers. The continuous layer of polarized follicle cells, joined by tight junctions, formed a diffusion barrier between the two compartments (apical and basal) of the culture chamber. Uptake and efflux of 125I- at either surface (apical and basolateral) of the cells were thus possible to determine. Protein binding of iodide was inhibited by methimazole (10(-3) M) in all experiments. Radioiodide was taken up by the cells from the basal medium in a thyroid-stimulating hormone (TSH)-dose dependent manner with a maximal cell/medium ratio of 125I- of about 50 in cultures prestimulated with 0.1 to 1 mU/ml for 2 days. This uptake was inhibited by perchlorate and ouabain. In contrast, 125I- was not taken up from the apical medium. In preloaded cells, iodide efflux was rapidly (within 1-2 min) and dose-dependently (0.1-10 mU/ml) stimulated by TSH. Bidirectional measurements revealed that TSH stimulated iodide efflux in apical direction, leaving efflux in basal direction unchanged. In experiments with continuous uptake of label from the basal compartment, the TSH-stimulated efflux in apical direction had a duration of 4 to 6 min and resulted in a reduction in the cellular content of radioiodide by up to 80%. Decreased levels of cellular 125I- remained for at least 15 min after TSH addition. From our observations we conclude that the TSH-regulated uptake and efflux of iodide take place at opposite surfaces of the porcine thyroid follicle cell. Acutely stimulated iodide efflux is not the result of an increased permeability for iodide in the entire plasma membrane but only in the apical domain of this membrane. This implicates the presence of an iodide channel mediating TSH-stimulated efflux across the apical plasma membrane of the follicle cell. The mechanism is suggested to facilitate a vectorial transport of iodide in apical direction, i.e., to the lumen of the intact follicle.

Glutathione peroxidase degrades intracellular hydrogen peroxide and thereby inhibits intracellular protein iodination in thyroid epithelium.

Protein iodination in the thyroid is largely confined to the surface of the epithelium. Intracellular iodine binding is insignificant. We have tested our hypothesis that the key mechanism in the control of intracellular iodination is the control of the intracellular availability of H2O2. The sites of iodination were identified by locating bound radioiodine in electron microscopic autoradiographs, produced from porcine thyroid epithelium grown on filter in Transwell bicameral culture chambers. Autoradiographs obtained after standard incubations with 125I for 15 min to 3 h were all characterized by concentrations of autoradiographic grains along the external surface of the plasma membrane and very few grains over the cytoplasm. The presence of 10 microM H2O2 in the incubation medium resulted in a drastically changed labeling pattern now showing a dissemination of grains over the entire cytoplasm. Epithelia with elevated GSH peroxidase activity produced autoradiographs showing the same restriction of grains to the cell surface as controls; this pattern was the same in the absence and presence of H2O2 (up to 10 microM). Cultures with subnormal GSH peroxidase activity presented cytoplasmic labeling both in the absence and presence of H2O2. In conclusion, iodine binding in filter-cultured thyroid epithelium under normal conditions is an extracellular process located at the cell surface. When H2O2 is available intracellularly, iodination takes place in the cytoplasm, evidently catalyzed by intracellular thyroperoxidase. Normally, this iodination is prevented by cytosolic GSH peroxidase that effectively degrades H2O2 and thus controls intracellular iodination. The observations should be applicable to the thyroid in vivo.

Localization of iodine binding in the thyroid gland in vitro.

Protein-bound radioiodine was localized by electron microscopic autoradiography in follicles and cells isolated from pig and rat thyroid tissue after incubation with 125I- for 1-10 min. Labeled proteins were analyzed by gel electrophoresis and immunoprecipitation. In closed follicles, with colloid-filled follicle lumina, the autoradiographic labeling was concentrated over the lumina and no labeling occurred over the cells. In open follicles, without colloid content, autoradiographic grains were invariably found along the apical cell surface and in some cells over intracellular lumina. Isolated cells with preserved polarity showed some labeling associated with remaining microvilli whereas isolated cells with lost polarity showed no grains at the cell surface. In isolated cells, particularly those with lost polarity, most grains were located over intracellular lumina (which were common in such cells) and some grains over vesicular elements associated with these lumina. About 80% of the labeled soluble proteins and 40% of the labeled proteins solubilized by sodium dodecyl sulfate were thyroglobulin. It is concluded that the site of iodination in follicles is the same in vitro as in vivo, viz. the apical surface of the follicle cells. When thyroid cells are removed from the follicle and lose their polarity, intracellular lumina become the major site of iodination. This shift in iodination sites is thought to be due to retention of Golgi-derived secretory vesicles in nonpolarized cells, leading to coalescence of vesicles with the formation of intracellular lumina and activation of membrane-bound enzymes catalyzing iodination.

Accelerated exocytosis and H2O2 generation in isolated thyroid follicles enhance protein iodination.

Open pig thyroid follicles in which the apical surface of the follicle cells is in direct contact with the incubation medium were used to study the effect of stimulated exocytosis and stimulated H2O2 generation on the iodination of protein in the incubation medium. In previous studies on this system of follicles we have shown (1) that the apical surface of the follicle cells is a major site of protein iodination and (2), that H2O2 is produced at the apical cell surface. In the present study we confirmed the previous finding that H2O2 generation is greatly stimulated by the Ca2+ ionophore A23187. We further found that TSH at a high concentration (greater than 10 mU/ml) and in the presence of Ca2+ stimulated H2O2 generation; TSH had no such effect on follicles incubated in Ca2+-free medium after pretreatment with EGTA. Forskolin did not stimulate H2O2 generation. Exocytosis of thyroglobulin was stimulated by TSH at a low concentration (0.1 mU/ml), and this stimulation was not dependent on Ca2+. Exocytosis was also stimulated by forskolin but not by A23187. Iodination of protein, including thyroglobulin, in the incubation medium was stimulated by A23187, TSH and forskolin. These observations suggest that stimulation of iodination in association with the apical surface of the follicle cells can be achieved separately by an increased rate of H2O2 generation and increased rate of exocytosis. Generation of H2O2 is Ca2+-dependent, whereas exocytosis is mediated by the adenylate cyclase-cAMP system; TSH at a high concentration can stimulate both these processes.

Generation of H2O2 in isolated porcine thyroid follicles.

Generation of H2O2, an essential component in thyroid hormone synthesis, was studied by biochemical and cytochemical methods. Both parts of the study were performed on isolated open pig thyroid follicles in which the cells have preserved polarity and both the apical and basal cell surfaces are exposed to the incubation medium. The biochemical studies, performed with the scopoletin fluorescence assay, showed that H2O2 was released from the follicles into the medium at a rate of 0.5-1.0 nmol min-1 mg-1 DNA under basal conditions. The H2O2 release rate was promptly increased about 10 times by addition of the ionophore A23187 to Ca2+-containing medium. TSH caused an acute but weaker stimulation of H2O2 release, whereas (Bu)2cAMP was without effect, indicating that the TSH action was linked to Ca2+. Both basal and stimulated H2O2 release were strongly inhibited by p-chloromercuribenzene sulfonate. The cytochemical study, performed with the cerium technique, confirmed our previous observations on rat thyroid follicles. Reaction product was found on the apical cell surface but never on the basal cell surface or intracellularly. The apical reaction was enhanced by NADH and NADPH as well as by A23187 in Ca2+-containing medium. The apical reaction was strongly inhibited by p-chloromercuribenzene sulfonate. The observations indicate that the H2O2 released from the open follicles is generated on the apical plasma membrane of the follicle cells, possibly by NAD(P)H oxidase in this membrane. Furthermore, Ca2+ seems to be an important factor in the regulation of this H2O2 generation and, through that, in the regulation of iodination.

Hydrogen peroxide generation and its regulation in FRTL-5 and porcine thyroid cells.

Hydrogen peroxide acts as electron acceptor in the oxidative reactions (iodination and coupling) by which the thyroid hormones are formed. Regulation of the generation of H2O2 was studied in monolayer cultures of the FRTL-5 rat thyroid cell line and in primary monolayer cultures of porcine thyroid cells. Both cell types were grown in a medium containing either a six-hormone mixture, including TSH (6H), or a five-hormone mixture without TSH (5H) for 1 to several days before the experiment. The production of H2O2 was measured with the homovanillic acid fluorescence assay and expressed as picomoles of H2O2 formed per min/microgram DNA. In FRTL-5 cells grown in 6H medium, only a weak and varying stimulation of H2O2 production was induced by TSH at high concentration (greater than 10 mU/ml), and no stimulation was seen by TSH at low concentration or by 8-bromo-cAMP, whereas forskolin had a good stimulatory effect. In FRTL-5 cells grown in 5H medium for 1-3 days, all three substances were potent stimulators. In porcine thyrocytes examined in the same way, none of the three presumptive stimulators had any effect in 6H cultures, and only TSH (at high concentration) had a weak effect in 5H medium. ATP, a stimulator of the Ca2+/phosphatidylinositol cascade via a P2-purinergic receptor, had no effect on H2O2 generation in FRTL-5 cells in 6H medium. Phorbol myristate acetate (PMA), a direct activator of protein kinase-C, induced a weak stimulation in these cells. In FRTL-5 cells in 5H medium, both ATP and PMA evoked a strong, and similar, enhancement of H2O2 production. In porcine cells in 6H medium, ATP evoked a moderate and PMA a strong stimulation; the effects in 5H were similar to the corresponding effects in 6H medium. The observations are interpreted to show that in FRTL-5 cells the regulation of H2O2 generation uses both the cAMP cascade and the Ca2+/phosphatidylinositol cascade, whereas in porcine thyrocytes the cAMP route is unimportant. In FRTL-5 cells the Ca2+/phosphatidylinositol cascade may be influenced by the cAMP system.

Site of iodination in hyperplastic thyroid glands deduced from autoradiographs.

We have tried to ascertain the site of iodination in the chronically stimulated, hyperplastic thyroid gland of rats. Rats were fed propylthiouracil in a commercial rat diet for 10 days. Then the diet was changed to a low iodine diet for 5 days. To label the gland, 10 mCi of 125I-iodide was injected into the left heart ventricle. Ten seconds later the animal was perfused through the left ventricle with a fixative solution containing a goitrogen to block further iodination, and stable iodide to help extract uncombined radioiodide. Electron microscopic autoradiographs prepared from the fixed thyroids show strong labeling over the lumen of the follicle and no consistent labeling of any other site or organelle. We conclude that the site of iodination in the chronically stimulated, hyperplastic thyroid is the follicular lumen, i.e. the same as that in the normal gland.

Site of iodination in the rat thyroid gland deduced from electron microscopic autoradiographs.

The site of iodination of protein in the thyroid gland (whether intracellular or intraluminal) was ascertained by autoradiographic studies using iodide-125I. In tissue fixed within about 40 sec after intravenous injection of radioiodide the silver grains of autoradiographs were concentrated over the follicular lumen generally as a ring of grains close to the apical border of the follicular cells. The zone of grains was sharply limited toward the cells. No concentration of silver grains was detected associated with any intracellular organelle. The autoradiographic ring which had a minimum width of about 2 mum was continuous along the apical plasma membrane of the follicle cells but there was a drastic reduction in grain density along the plasma membrane of the distal portion of pseudopods. Tissue was fixed so soon after radioiodide injection that it appeared likely that a negligible fraction of radioiodoprotein, if formed in the cell, could have been transferred to the lumen. The observations strongly indicate that the iodination of thyroglobulin occurs in the follicle lumen, probably at the apical surface of the follicle cells. Since in the TSH-treated animals the distribution of the labeling along the apical plasma membrane agrees well with the reported histochemical distribution of thyroperoxidase in this membrane, it is further concluded that iodination may well be catalyzed by peroxidase in the apical plasma membrane.

Effects of thyrotropin on thyroglobulin exocytosis and iodination in the rat thyroid gland.

Rats, pretreated with thyroxine for 2 days, were given one or two iv injections of 500 mU of TSH; in some groups the second TSH dose was replaced by 0.75 micronmol isoproternol. The effects of the thyroid stimulators on the following parameters were studied: the number of exocytotic vesicles in the follicle cells; the incorporation of 125I into thyroid proteins, measured over periods of 5 min; and the thyroidal cAMP contents. At 2 h after TSH administration, a second dose of TSH failed to stimulate iodination while at 8 h the iodination response was "normal". Two hours after TSH the follicle cells contained practically no exocytotic vesicles but at 8 h they had a full supply of vesicles, and this was emptied by the second TSH injection. THE CAMP content was less increased by the second TSH injection than by the first one, but the stimulatory effect of the second TSH dose on cAMP was the same at 2 h and at 8 h; this indicates that the lack of iodination response at 2 h was not simply due to blocking of TSH receptors. Isoproternol, which acts on other receptors than does TSH, cause a similar cAMP increase incontrols and at 2 h and 8 h after TSH, but stimulated iodination only in controls and at 8 h after TSH; this supported the conclusion that the lack of iodination response to a second TSH dose at 2 h was not due to impairment of the adenylate cyclase-cAMP system. These observations taken together strongly indicate that a rapid iodination response to TSH depends on stimulated exocytosis which, in turn, requires a pool of exocytotic vesicles in the follicle cells. Such a coupling between exocytosis and iodination seems appropriate since by exocytosis uniodinated thyroglobulin and membrane, showing peroxidase activity histochemically, are delivered to the site of iodination, the apical cell surface.

Exocytosis of protein into the thyroid follicle lumen: an early effect of TSH.

As shown in a preceding paper, only exocytotic vesicles conveying newly synthesized protein to the follicle lumen remain in the apical part of rat thyroid follicle cells following elimination of TSH secretion. In the present paper the effect of TSH on these exocytotic vesicles was investigated. TSH secretion was suppressed by administration of thyroxine for 2 days. In the electron microscope administration of TSH was seen to induce well-known signs of endocytosis, such as formation of pseudopods and colloid droplets. In addition, a previously unrecognized change was noted, namely a progressive decrease in the number of exocytotic vesicles. At 5 min after TSH the number was obviously reduced and at 20 min less than 10% of the original number of vesicles remained. Quantitative electron microscopic autoradiography after administration of [3H]leucine showed that TSH caused, concomitant with the disappearance of vesicles, a transfer of radioactivity from the apical region of the follicle cell to the periphery of the follicle lumen. The distribution of labeled protein in thyroid subcellular fractions was studied 1.5 h after administration of [14C]leucine. At 5 min after administration of TSH there was an increase of protein-bound label in the supernatant fraction, containing the luminal colloid, and a corresponding decrease of label in the particle fraction which contained most of the cell organelles, including the exocytotic vesicles. This TSH-induced redistribution of labeled proteins was more pronounced at 10 min and still more at 20 min and appeared to be dose-dependent. These observations taken together are considered to justify the conclusion that TSH induces transfer of newly synthesized protein from the follicle cells to the follicle lumen by exocytosis (i.e., emptying of specific apical vesicles). It is suggested that a causal and functional interrelation may exist between the exocytotic and endocytotic processes.

Iodination of thyroglobulin. An intracellular or extracellular process?

The location in the thyroid follicle of the iodination of thyroglobulin has been a matter of debate for several decades. This problem is not a question of mere academic interest. Knowledge of the locus--or loci--of iodination is necessary for a full understanding of the mechanisms involved in thyroid-hormone synthesis and release. In the discussion about this problem 3 fundamentally different views have been--and still are--advocated. The first view implies that the site of iodination is the follicle lumen, the second that iodination is an intracellular process restricted to some organelle(s) in the follicle cells and the third that iodination occurs at the interface between the follicle cells and the follicle lumen. Below I will survey the major observations on which these different opinions are based and discuss the validity of the interpretations.

Hydrogen peroxide degradation and glutathione peroxidase activity in cultures of thyroid cells.

The degradation rate of H2O2, added to the incubation medium, and glutathione (GSH) peroxidase activity were measured in cultures of FRTL-5 cells and porcine thyroid cells. The H2O2 degradation rate increased proportionally to the H2O2 concentration and was in FRTL-5 cells, cultured with TSH, approximately 50 nmol/min and mg DNA at 0.01 mM H2O2 and approximately 3 x 10(4) nmol/min and mg DNA at 10 mM H2O2. The GSH peroxidase activity in the same cells was equivalent to an H2O2 degradation of approximately 400 nmol/min and mg DNA. The involvement of enzymes in H2O2 degradation was studied by inhibiting catalase with aminotriazole (ATZ) and reducing GSH peroxidase by omitting glucose in the incubation medium. At 0.1 mM H2O2, ATZ or glucose omission alone did not measurably reduce H2O2 degradation but did so when combined. At 10 mM H2O2 ATZ caused a clear inhibition whereas glucose omission had no additive effect. These observations indicate that GSH peroxidase was involved in H2O2 degradation only at low H2O2 concentrations. The GSH peroxidase activity decreased by reduction of the selenite supply and increased after replenishment. The recovery of the enzyme activity required the presence of TSH in FRTL-5 cells but not in porcine thyrocytes.

Conformational change of the thyroglobulin molecule induced by oxidation in vitro.

Previous electron-microscopical studies from this laboratory have shown that the thyroglobulin molecule can occur in two different conformations, one ovoid and the other cylindrical. Ovoid molecules are characteristic of well-iodinated thyroglobulin whereas cylindrical molecules are found after low-iodine diet or blocking of iodination. The present study was performed in order to elucidate the possible relation between the molecule conformation and the peroxidase-catalyzed reactions that occur in the thyroid in connection with hormone synthesis. Cylindrical thyroglobulin molecules (from PTU-exposed thyroids) were incubated in different media and the proportion of cylindrical and ovoid molecules after incubation was estimated in electron micrographs. It was found that incubation with glucose-glucose oxidase caused an extensive conversion of cylindrical molecules into ovoid molecules. Peroxidase and/or iodide were not necessary for this change of conformation. It is suggested that this in vitro molecule transformation was the result of an oxidation reaction.

The structure of newly synthesized intracellular thyroglobulin molecules.

Thyroglobulin molecules from normal rats and rats treated with propylthiouracil (PTU) were studied in the electron microscope by the negative staining technique. Intracellular molecules were prepared from exocytotic vesicles, and extracellular molecules from the high-speed centrifugation supernatant. In accord with our previous findings, extracellular thyroglobulin molecules from normal glands had an ovoid conformation, whereas extracellular molecules from PTU-treated glands had a different, cylindrical shape. Thyroglobulin molecules from exocytotic vesicles were of the ovoid variety in normal as well as in PTU-exposed thyroids. Two interpretations are discussed. One would be that PTU exerts a non-physiological effect on ovoid molecules in connection with exocytosis of thyroglobulin. The other interpretation is that thyroglobulin molecules normally undergo 2 transformations (ovoid-cylinder-ovoid) during the process of exocytosis; PTU would inhibit the second transformation and cause accumulation of cylinders in the colloid.

Transport of thyroglobulin and peroxidase in the thyroid follicle cell.

The purpose of this study was to explore the nature of the protein(s) in the exocytotic vesicles in the thyroid follicle cells and to ascertain whether or not thyroglobulin and peroxidase are transported by the same vesicles through the apical region of the cells to the follicle lumen. The study was performed on rats pretreated with thyroxine for 2 days in order to inhibit endocytosis. A fraction of exocytotic vesicles was isolated by centrifugation in continuous and discontinuous sucrose density gradients. The protein content of the vesicles were analysed by electrophoresis in continuous polyacrylamide gradient gels. The vesicles contained (uniodinated) thyroglobulin, 12-S protein and thyralbumin. Parallel histochemical studies in the electron microscope. These observations have important bearings on the mechanisms for thyroglobulin iodination, since it has been demonstrated that iodination does not occur in the exocytotic vesicles but in connection with the opening of the vesicles at the apical cell surface.

Effect of P1-purinergic agonist on thyrotropin stimulation of H2O2 generation in FRTL-5 and porcine thyroid cells.

Our previous studies have shown that the generation of H2O2 in FRTL-5 thyroid cells is regulated via both the adenylate cyclase/cyclic adenosine monophosphate (cAMP) and Ca2+/phosphatidylinositol pathway: thyrotropin (TSH) stimulates H2O2 generation through both pathways, via the former at a low concentration and via the latter at a high concentration. In porcine thyrocytes in primary culture H2O2 generation is stimulated only via the Ca2+/phosphatidylinositol route. In the present study we explored the effect of a P1-purinergic agonist (phenylisopropyladenosine, PIA) on stimulations induced by TSH and by adenosine triphosphate (ATP), an activator of the Ca2+/phosphatidylinositol cascade via the P2-purinergic receptor. In FRTL-5 cells, PIA potentiated H2O2 generation stimulated by TSH at 10 U/l (but not at 1 U/l, Ca2+ mobilization induced by TSH and Ca2+ mobilization induced by ATP at 1 mumol/l (but not 10 mumol/l). Phenylisopropyladenosine strongly inhibited TSH-induced cAMP accumulation in FRTL-5 cells. In pig thyrocytes, PIA had no effect on H2O2 generation stimulated by TSH or ATP and no effect on ATP-stimulated Ca2+ mobilization. Also, PIA did not inhibit TSH-stimulated cAMP accumulation in pig thyrocytes, and by itself had no effect on H2O2 generation or Ca2+ mobilization. Thus, in FRTL-5 cells, but not in porcine thyrocytes, PIA modulates TSH-stimulated H2O2 generation by enhancing the Ca2+/phosphatidylinositol route and inhibiting the adenylate cyclase/cAMP route of the TSH signal. The net result of this modulation apparently depends on the balance between inhibition of the cAMP route and enhancement of the Ca2+ route. This may explain the lack of potentiation observed by 1 U/l TSH.