The Association Between Novel Biomarkers and 1-Year Readmission or Mortality After Cardiac Surgery.

BACKGROUND: Novel cardiac biomarkers including soluble suppression of tumorigenicity 2, galectin-3, and the N-terminal prohormone of brain natriuretic peptide may be associated with long-term adverse outcomes after cardiac surgery. We sought to measure the association between cardiac biomarker levels and 1-year hospital readmission or mortality. METHODS: Plasma biomarkers from 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from 8 medical centers were measured in a cohort from the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. We evaluated the association between preoperative and postoperative biomarkers and 1-year readmission or mortality using Kaplan-Meier estimates and Cox proportional hazards modeling, adjusting for covariates used in The Society of Thoracic Surgeons 30-day readmission model. RESULTS: The median follow-up time was 365 days. After adjustment for established risk factors, above-median levels of postoperative galectin-3 (median 10.35 ng/mL; hazard ratio, 1.40; 95% confidence interval, 1.08 to 1.80; p = 0.010) and N-terminal prohormone of brain natriuretic peptide (median = 15.21 ng/mL, hazard ratio, 1.42; 95% confidence interval, 1.07 to 1.87; p = 0.014) were each significantly associated with 1-year readmission or mortality. CONCLUSIONS: In patients undergoing cardiac surgery, novel cardiac biomarkers were associated with readmission or mortality independent of established risk factors. Measurement of these biomarkers may improve our ability to identify patients at highest risk for readmission or mortality before discharge. This will also allow resource allocation accordingly, while implementing strategies for personalized medicine based on the biomarker profile of the patient.

Lipoic acid plays a role in scleroderma: insights obtained from scleroderma dermal fibroblasts.

INTRODUCTION: Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and organs. Increase in oxidative stress and platelet-derived growth factor receptor (PDGFR) activation promote collagen I (Col I) production, leading to fibrosis in SSc. Lipoic acid (LA) and its active metabolite dihydrolipoic acid (DHLA) are naturally occurring thiols that act as cofactors and antioxidants, and are produced by lipoic acid synthetase (LIAS). The goal of this study was to examine whether LA and LIAS was deficient in SSc patients and determine the effect of DHLA on the phenotype of SSc dermal fibroblasts. N-acetylcysteine (NAC), a commonly used thiol antioxidant, was included as a comparison. METHODS: Dermal fibroblasts were isolated from healthy subjects and patients with diffuse cutaneous SSc. Matrix metalloproteinase (MMPs), tissue inhibitors of MMPs (TIMP), plasminogen activator inhibitor-1 (PAI-1) and LIAS were measured by ELISA. The expression of Col I was measured by immunofluorescence, hydroxyproline assay, and quantitative PCR. PDGFR phosphorylation and α-smooth muscle actin (α-SMA) was measured by Western blotting. Student's t-tests were performed for statistical analysis and p-values of less than 0.05 with two-tailed analysis were considered statistically significant. RESULTS: The expression of LA and LIAS in SSc dermal fibroblasts was lower than normal fibroblasts, however LIAS was significantly higher in SSc plasma and appeared to be released from monocytes. DHLA lowered cellular oxidative stress, and decreased PDGFR phosphorylation, Col I, PAI-1, and α-SMA expression in SSc dermal fibroblasts. It also restored the activities of phosphatases that inactivated the PDGFR. SSc fibroblasts produced lower levels of MMP-1 and 3, and DHLA increased them. In contrast, TIMP-1 levels were higher in SSc but DHLA had minimal effect. Both DHLA and NAC increased MMP-1 activity when SSc cells were stimulated with PDGF. In general, DHLA showed better efficacy than NAC in most cases. CONCLUSIONS: DHLA not only acts as an antioxidant but also an antifibrotic since it has the ability to reverse the profibrotic phenotype of SSc dermal fibroblasts. Our study suggests that thiol antioxidants, including NAC and LA/DHLA, could be beneficial for patients with SSc.

Evidence for a functional genetic polymorphism of the human mercaptopyruvate sulfurtransferase (MPST), a cyanide detoxification enzyme.

Mercaptopyruvate sulfurtransferase (MPST) plays a central role in both cysteine degradation and cyanide detoxification. Moreover, deficiency in MPST activity has been suggested to be responsible for a rare inheritable disorder known as mercaptolactate-cysteine disulfiduria (MCDU). To date, no mutation of the human MPST gene has been reported. We developed a screening strategy to search for mutations in the MPST gene of 50 unrelated French individuals. Two intronic polymorphisms (IVS1-110C>G and IVS2+39C>T) and a nonsense mutation (Tyr(85)Stop) were identified and their functional consequences were assessed in vivo by measurement of erythrocyte MPST activity and/or in vitro using heterologous expression or transient transfection assay. The nonsense mutation likely leads to the synthesis of a severely truncated protein without enzymatic activity, as supported by our in vitro data. This work constitutes the first report of the existence of a functional genetic polymorphism affecting MPST and should be of great help to investigate certain disorders such as MCDU.

Effect of glucose-cysteine adduct on cysteine desulfuration in guinea pig tissues.

Effect of intraperitoneal administration (12 mmol/kg of body weight) of glucose-cysteine adduct 2-(D-gluco-pentahydroxypentyl)-thiazolidine-4-carboxylate, (glc-cys) on the rhodanese, gamma-cystathionase and 3-mercaptopyruvate sulfurtransferase (MPST) activity levels in guinea pig tissues was studied. The rhodanese activity value in liver increased by 41%, 3-mercaptopyruvate sulfurtransferase by 24%, and gamma-cystathionase by 12% after three successive days of the administration. In the kidney, on the contrary, glc-cys administration resulted in about 18% decrease in the gamma-cystathionase activity value, whereas no changes in MPST and rhodanese activity values were observed. In the case of the brain, rhodanese and gamma-cystathionase did not change their activity but the activity of MPST decreased by 21%. MPST level did not change substantially in whole blood after glc-cys treatment. The results seem to indicate that in guinea pig liver but not in kidney and brain, glc-cys has a potential to activate the desulfuration pathway of L-cysteine metabolism.

Inconsistent expression of glycolipid sulfotransferase activity between hepatoma and serum.

Glycolipid sulfotransferase activity in human and rat hepatocellular carcinoma tissues was studied, since an elevated level of the enzyme activity in serum had been demonstrated in cancer patients. The level of the enzyme activity in carcinoma tissues, however, could not be distinguished from that of normal controls. Similar observations were made for rat hepatoma. A higher level of enzyme activity was observed in the female than in the male. Inconsistent expression between hepatoma tissue and serum suggests that humoral factor(s) derived from hepatoma tissue stimulates production of the sulfotransferase, which is released into the blood-stream in the host.

Elevated serum level of glycolipid sulfotransferase in patients with hepatocellular carcinoma.

Activity of glycolipid sulfotransferase (cerebroside sulfotransferase) in serum was elevated in 21 (33%) of 63 patients with hepatocellular carcinoma (HCC, mean +/- S.E., 349 +/- 32 pmol/ml per h, n = 63, P less than 0.001) compared to healthy subjects (172 +/- 12, n = 85). Ho significant elevation of the sulfotransferase level was observed in liver cirrhosis (219 +/- 28, n = 10) in which many of biochemical HCC markers increase concomitantly. The elevation of sulfotransferase was independent of the production of alpha-fetoprotein and of aminotransferase levels in HCC, providing complementary value for alpha-fetoprotein-negative HCC cases. However, the sulfotransferase levels (234 +/- 21, n = 32, P less than 0.01) in sera from patients with renal cell carcinoma, in whose involved tissues the enzyme was demonstrated to increase markedly, were less than in HCC.

Presence and characterization of glycolipid sulfotransferase in human cancer serum.

Sulfotransferase, which catalyzes sulfation of the carbohydrate of galactosylceramide (GalCer) and is localised in the Golgi membrane of cells, was assayed for activity in human serum. To do this, an organic solvent was added to the incubated reaction mixture containing GalCer as an acceptor and phosphoadenosine phospho[35S]-sulfate as a donor of sulfate to dissociate the synthesized sulfolipid from serum protein. This was followed by isolation of the sulfolipid on an anion-exchange column. Through this procedure, human serum was found to contain sulfotransferase activity. The serum enzyme was activated by Mn2+. Km values of the enzyme for GalCer and 'active sulfate' were 4.6 microM and 5.2 microM, respectively. The enzyme activity was assayed in sera of cancer patients. The serum activity (mean +/- SE, 0.27 +/- 0.027 pmol.microliter-1.h-1) in renal cell carcinoma patients, whose activity has been demonstrated to be elevated, was significantly (P less than 0.005) increased compared to that of the normal control (mean +/- SE, 0.18 +/- 0.0014 pmol.microliter-1.h-1) and of other urological tumors examined.

Regulation of serum glycosaminoglycan sulfotransferase activities: inhibition by sulfated glycosaminoglycans and activation by polyamines and basic peptides including a polylysine-containing segment of the c-Ki-ras 2 protein.

The regulatory mechanisms for the glycosaminoglycan sulfotransferases in fetal calf serum were investigated. The enzymes examined were those which transfer sulfate from 3'-phosphoadenosine 5'-phosphosulfate to 1) position 6 of the internal N-acetylgalactosamine units of chondroitin, 2) position 6 of galactose units of keratan sulfate, and 3) position 2 (an amino group) of glucosamine units of heparan sulfate. The former two enzymes were activated by spermidine, spermine, protamine, and poly L-lysine. All the enzymes were strongly inhibited by heparin and dextran sulfate, whereas only the chondroitin 6-O-sulfotransferase was inhibited by sulfated galactosaminoglycans. The inhibition of this enzyme by the sulfated glycosaminoglycans was abolished by polylysine, indicating that the activation by polylysine is partly due to the neutralization of endogenous acidic inhibitors, including sulfated glycosaminoglycans. Affinity chromatographic studies demonstrated that heparin specifically binds to the three enzymes, which have anionic isoelectric points, and that chondroitin 6-sulfate, spermine, and polylysine bind to the former two enzymes under physiological conditions. Thus, the activation by spermine and polylysine as well as the inhibition by sulfated glycosaminoglycans also appears to occur through their binding to the enzymes. Studies with synthetic lysine oligomers and an affinity-purified (approximately 700-fold) fraction containing the former two enzymes indicated that the pentamer is the minimum unit required for the activation. A synthetic peptide, containing six consecutive lysines at the carboxy terminus of the human c-Ki-ras 2 protein, also regulated the two enzyme activities at micromolar concentrations. The possible physiological implications of the observed effects of these regulatory substances on the glycosaminoglycan sulfotransferases are discussed in relation to glycosaminoglycan synthesis during the proliferation, differentiation, and transformation of cells. The possibility of sulfated glycosaminoglycans being enzyme regulators is also discussed.

Serum rhodanese in goitre and calcific pancreatitis of tropics.

Rhodanese is one of the enzymes concerned in the detoxification of cyanide. Cassava intake and consequent cyanide toxicity are incriminated in the pathogenesis of goitre and calcific pancreatitis of tropics. So we studied the activity of rhodanese in these patients. 14 controls, 13 patients with pancreatitis and 12 with goitre were studied. The median (and range) of rhodanese in these groups were 82 (50-144), 110 (64-180) and 71 (22-160) units respectively. The serum rhodanese was significantly higher (P less than 0.05) in patients with pancreatitis when compared to the other groups. There was no significant difference between the serum rhodanese in patients with goitre and the controls. The presence of adequate amounts of rhodanese indicates that goitre and chronic pancreatitis are not produced by impaired cyanide detoxification.

Determination of the isoelectric point value of 3-mercaptopyruvate sulfurtransferase and its shift by treatment with oxidized glutathione.

The isoelectric point (pI) value of 3-mercaptopyruvate sulfurtransferase (MST) from human erythrocytes was determined to be 6.3 at 10 degrees C by isoelectric focusing in horizontal slab polyacrylamide gel containing 2% carrier ampholyte (pH 3-10). The value was determined by comparison with the electrofocused bands of bovine pancreatic ribonuclease A-glutathione mixed disulfides (RNase-SG), which were composed of 8 species containing 1 (RNase-SG1) through 8 (RNase-SG8) moles of glutathione per mole of ribonuclease A with different pI values ranging from 5.3 (RNase-SG8) to 8.8 (RNase-SG1). The pI value of the same enzyme in a 110,000 X g supernatant of rat liver was 5.9, which was the same as that of rat erythrocyte enzyme. Treatments of rat hemolysate with oxidized glutathione or diamide resulted in a shift of the pI of MST to a lower value, 5.7-5.5. This shift was inhibited when these treatments were performed in the presence of dithiothreitol. These results indicate that the treatment of the enzyme with oxidized glutathione results in the formation of enzyme-glutathione mixed disulfide.

Determination of isoelectric point value of 3-mercaptopyruvate sulfurtransferase by isoelectric focusing using ribonuclease A-glutathione mixed disulfides as standards.

The pI value of rat erythrocyte 3-mercaptopyruvate sulfurtransferase (EC 2.8.1.2) was determined to be 5.9 at 10 degrees C by isoelectric focusing in a horizontal slab polyacrylamide gel containing 2% carrier ampholyte (pH 3-10). In this study, ribonuclease A-glutathione mixed disulfides (RNase-SG's) (T. Ubuka et al. (1986) J. Chromatogr., 363, 431-437) were used as pI standards. A mixture of RNase-SG was prepared by reducing bovine pancreatic ribonuclease A (RNase) with dithiothreitol and then treating the reduced RNase with oxidized glutathione. The mixture was composed of eight species which contained 1 (RNase-SG1) to 8 (RNase-SG8) mol of glutathione per mole of RNase, and the pI values of these species were determined under conditions minimizing the effect of carbon dioxide. The newly determined pI values of RNase-SG1 through RNase-SG8 were 8.8, 8.2, 7.7, 7.3, 6.9, 6.4, 5.8, and 5.3, respectively. The average change in pI values of these disulfides was 0.50 pH unit per mole of the bound glutathione per mole of RNase. The RNase-SG mixture was stable in acidic solutions and could be stored at 4 degrees C as well as at -20 degrees C with little change for at least 1 year. Thus, the mixture is shown to be an excellent standard for the determination of pI values of proteins by isoelectric focusing in the wide range of pI value.

Is the platelet phenolsulfotransferase involved in the sulfoconjugation of plasma catecholamines?

Catecholamines are predominantly present in the sulfoconjugated forms in human plasma. Phenolsulfotransferase (EC 2.8.2.1), which catalyses the sulfation of phenolic compounds, is widely distributed in human tissues. In blood, a phenolsulfotransferase, more specific for catecholamine sulfation is found exclusively in platelets. Free and sulfoconjugated catecholamines were measured in plasma and platelets of healthy volunteers and compared with those present in patients with uremia or pheochromocytoma to determine the ability of platelet phenolsulfotransferase to sulfurylate plasma catecholamines. In patients with pheochromocytoma, the rise in free and sulfoconjugated plasma catecholamines is accompanied by a simultaneous rise of these molecules in platelets. In uremia, where the level of plasma catecholamines is normal, the rise in the sulfoconjugates is not accompanied by a concomitant increase in either free or sulfoconjugated catecholamines in platelets. Platelet phenolsulfotransferase activity remains unchanged in pheochromocytoma and uremia. These data indicate that the platelet phenolsulfotransferase is involved in the sulfation of the catecholamines present in platelets, but its contribution, if any, to the high level of sulfoconjugated catecholamines found in plasma is negligible. This assertion is confirmed by our observations in thrombocytopenic patients. Indeed, despite the very low number of platelets and the absence of plasma phenolsulfotransferase activity, thrombocytopenic patients have normal plasma levels of free and sulfoconjugated catecholamines.

Elevated chondroitin 6-sulfotransferase activity in fetal bovine serum.

Assay conditions for chondroitin sulfotransferase in serum were established using a rapid and simple paper disk method. Sulfotransferase activities towards endogenous serum glycosaminoglycans and exogenously added chondroitin were determined for fetal, newborn and adult bovine sera. The results indicate that 3'-phosphoadenosine 5'-phosphosulfate (PAPS); chondroitin 6-sulfotransferase activity in fetal calf serum is several times that in newborn or adult bovine sera. The enzyme transfers sulfate onto position 6 of internal nonsulfated galactosamine units of endogenous and exogenous chondroitin.

Erythrocyte catechol-O-methyltransferase, platelet monoamine oxidase, and platelet phenol sulfotransferase activities in patients with prolactin-secreting pituitary adenomas.

Dopamine is metabolized by oxidative deamination catalyzed by monoamine oxidase, O-methylation catalyzed by catechol-O-methyltransferase, and sulfate conjugation catalyzed by phenol sulfotransferase. This study was performed to determine whether platelet monoamine oxidase, red blood cell catechol-O-methyltransferase and platelet phenol sulfotransferase enzymatic activities in patients with prolactinomas were quantitatively different from the same enzyme activities in blood samples from normal subjects. The mean enzyme activities in blood samples from 22 women with histologically proven prolactinomas were compared to the mean enzyme activities in blood samples from 32 normal women. The blood levels of these 3 enzymatic activities were not significantly different between the two groups (P greater than 0.4). If the regulation of these catecholamine-metabolizing enzyme activities in blood elements reflects the regulation of the enzymes in the hypothalamic-hypophyseal region, these results suggest that a defect in the regulation of dopamine-metabolizing enzymes is not associated with the pathogenesis of prolactinomas.

Platelet monoamine oxidase and phenolsulphotransferase M and P in cancer.

Phenolsulphotransferase and monoamine oxidase inactivate a wide range of dietary and endogenous phenols/monoamines by sulphoconjugation and oxidative deamination respectively. In this study, both enzymes were measured in platelets from cancer patients and controls. Of the two variants of phenolsulphotransferase, activity of the P form was normal in all groups. Activity of the M form was, however, significantly less than control values in patients with cancer of the rectum and bowel but not in other cancer patient groups. If this finding reflects enzyme activity elsewhere in the body and is not merely a manifestation of an abnormal platelet population, the deficit could expose affected subjects to the action of potentially carcinogenic dietary phenols. Platelet monoamine oxidase activity was significantly raised in the cancer group as a whole, and in all sub-types investigated apart from breast cancer. The increase in the cancer group as a whole was independent of sex, age, drugs, radiotherapy, smoking or platelet count. Its mechanism and significance are unknown but there may be links with the patients' psychiatric state.

Low platelet monoamine oxidase activity in headache: no correlation with phenolsulphotransferase, succinate dehydrogenase, platelet preparation method or smoking.

Platelet monoamine oxidase activity in male migrainous and cluster headache patients was significantly lower than in male controls, confirming our previous study. The activity range showed a normal distribution and low mean values could not be attributed to a subgroup with particularly low activity. When Corash 's platelet preparation method was used, with its high platelet yield, specific enzyme activities of a similar order were obtained. Thus, the low values encountered were not due to abnormal recovery within the platelet population. Two other enzyme activities, phenolsulphotransferase M and succinate dehydrogenase, were also measured in the same platelet samples. Although low succinate dehydrogenase activity was identified in the headache groups, it appeared to represent a separate phenomenon and there was no significant correlation between activity of either enzyme and that of monoamine oxidase. This shows that the low activity of platelet monoamine oxidase in headache is not related to a generalised platelet enzyme deficit. It was also shown that the low monoamine oxidase activity in the headache patients could not be attributed to smoking.

Platelet phenolsulfotransferase and catecholamines: physiological and pathological variations in humans.

The phenolsulfotransferase (PST) is the main sulfoconjugating enzyme of catecholamines. We have described a standardized, sensitive, and reproducible method of measurement of PST activity from human blood platelets. The affinity of PST was, in descending order, towards dopamine (DA) greater than norepinephrine (NE) greater than epinephrine (E) (Km (DA) equals 17.6 microM, Km (NE) equals 66.6 microM, Km (E) equal 330 micro M). The optimum pH was found to be 5.9. Platelet PST measurements in 26 subjects led to the following observations, (i) The individual PST activity remains relatively stable during manipulations such as direct venous puncture, upright posture, physical exercise, and consumption of a copious meal. (ii) The mean platelet PST activity was 67 plus or minus 34 (mean plus or minus SD) U/mg protein in men and 43 plus or minus 19 U/mg protein in women. (iii) The platelet PST activity varies during the menstrual cycle with a marked decrease 7-10 days before menstruation. (iv) Essential hypertensive patients, appearing clinically as a syndrome imitating pheochromocytoma, had absent or low conjugated catecholamines. In one of them, no PST activity could be detected in platelets using catecholamines as substrates whereas a considerable activity was present with p-nitrophenol. The potential usefulness of the platelet PST measurements is discussed.

Human platelet phenol sulphotransferase: assay procedure, substrate and tissue correlations.

Procedures for the precise assay of human platelet phenol sulphotransferase activity were determined. The coefficient of variation of the assay was 5.8% when the enzyme activity was expressed per 10(8) platelets, and was 9.4% when it was expressed per mg soluble platelet protein. Mean platelet phenol sulphotransferase (PST) activity in samples from 102 randomly selected adults was 1.2 +/- 0.4 units/10(8) platelets (mean +/- S.D.), with a range from 0.2 to 2.9. The mean activity for umbilical cord blood platelet PST was 0.93 +/- 0.3 units/10(8) platelets (mean +/- S.D., n = 27). The substrate used routinely for the assay was 3-methoxy-4-hydroxyphenylglycol (MHPG). There was a significant correlation between the formation of MHPG sulfate by individual platelet preparations and the formation of sulfated product with each of the following substrates: tyramine (r = 0.92, n = 21); dopamine (r = 0.82, n = 16); 5-hydroxytryptamine (r = 0.94, n = 20); acetaminophen (r = 0.77, n = 17); and alphamethyldopa (r = 0.77, n = 17) (p less than 0.001 for each). Platelet PST activity correlated significantly with human renal cortex PST activity (r = 0.54, n = 20, p less than 0.02). The correlation coefficient between platelet PST activity and jejunal mucosal enzyme activity in eight patients was 0.67. These results raise the possibility that human platelet PST activity measured with MHPG as substrate might reflect the enzyme activity in other tissues and the degree of sulfate conjugation of a variety of substrates.