Long term clinical effectiveness of ivacaftor in people with the G551D CFTR mutation.

BACKGROUND: The cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, ivacaftor, was first approved for people with CF and the G551D CFTR mutation. This study describes the long-term clinical effectiveness of ivacaftor in this population. METHODS: We conducted a multicenter, prospective, longitudinal, observational study of people with CF ages ≥6 years with at least one copy of the G551D CFTR mutation. Measurements of lung function, growth, quality of life, and sweat chloride were performed after ivacaftor initiation (baseline, 1 month, 3 months, 6 months, and annually thereafter until 5.5 years). RESULTS: Ninety-six participants were enrolled, with 81% completing all study measures through 5.5 years. This cohort experienced significant improvements in percent predicted forced expiratory volume in 1 second (ppFEV1) of 4.8 [2.6, 7.1] (p < 0.001) at 1.5 years, that diminished to 0.8 [-2.0, 3.6] (p = 0.57) at 5.5 years. Adults experienced larger improvements in ppFEV1 (7.4 [3.6, 11.3], p < 0.001 at 1.5 years and 4.3 [0.6, 8.1], p = 0.02 at 5.5 years) than children (2.8 [0.1, 5.6], p = 0.04 at 1.5 years and -2.0 [-5.9, 2.0], p = 0.32 at 5.5 years). Rate of lung function decline for the overall study cohort from 1 month after ivacaftor initiation through 5.5 years was estimated to be -1.22 pp/year [-1.70, -0.73]. Significant improvements in growth, quality of life measures, sweat chloride, Pseudomonas aeruginosa detection, and pulmonary exacerbation rates requiring antimicrobial therapy persisted through five years of therapy. CONCLUSIONS: These findings demonstrate the long-term benefits and disease modifying effects of ivacaftor in children and adults with CF and the G551D mutation.

Longitudinal development of initial, chronic and mucoid Pseudomonas aeruginosa infection in young children with cystic fibrosis.

BACKGROUND: While the emergence of chronic and mucoid Pseudomonas aeruginosa (Pa) infection are both associated with poorer outcomes among CF patients, their relationship is poorly understood. We examined the longitudinal relationship of incident, chronic and mucoid Pa in a contemporary, young CF cohort in the current era of Pa eradication therapy. METHODS: This retrospective cohort was comprised of patients in the U.S. CF Foundation Patient Registry born 2006-2015, diagnosed before age 2, and with at least 3 respiratory cultures annually. Incidence and age-specific prevalence of Pa infection stages (initial and chronic [≥ 3Pa+cultures in prior year]) and of mucoid Pa were summarized. Transition times and the interaction between Pa stage and acquisition of mucoid Pa were examined via Cox models. RESULTS: Among the 5592 CF patients in the cohort followed to a mean age of 5.5years, 64% (n=3580) acquired Pa. Of those, 13% (n=455) developed chronic Pa and 17% (n=594) cultured mucoid Pa. Among those with mucoid Pa, 36% (211/594) had it on their first recorded Pa+culture, while mucoid Pa emerged at or after entering the chronic stage in 12% (73/594). Mucoidy was associated with significantly increased risk of transition to chronic Pa infection (HR=2.59, 95% CI 2.11, 3.19). CONCLUSIONS: Two-thirds of early-diagnosed young children with CF acquired Pa during a median 5.6years of follow up, among whom 13% developed chronic Pa and 17% acquired mucoid Pa. Contrary to our hypothesis, 87% of young children who developed mucoid Pa did so before becoming chronically infected.

Effect of extracellular fluid volume expansion on maximum glucose reabsorption rate and glomerular tubular balance in single rat nephrons.

Extracellular fluid volume expansion with isotonic saline (7.5% of body weight) decreased maximum glucose reabsorption rate by rat kidneys at plasma glucose concentrations greater than 30 mM. Glucose reabsorption rate was 30.2 +/-1.6 (SE) mumoles/min.g kidney in nonexpanded rats; it was 18.4 +/-1.5 mumoles/min.g in volume-expanded rats. Glucose reabsorption determined by micropuncture was 92% complete at the end of accessible superficial proximal convolutions. Volume expansion resulted in a slight but statistically insignificant reduction of maximal glucose reabsorption rate in superficial nephrons from 786 +/-35 mumumoles/min.g kidney in nonexpanded rats to 720 +/-30 mumumoles/min.g in volume-expanded rats. Superficial nephron filtration rate was increased by volume expansion from 28.8 +/-1.2 nl/min.g to 36.6 +/-1.5 nl/min.g kidney. In nonexpanded rats, the ratio of glucose reabsorption to glomerular filtration (tmg/sgfr) was similar in superficial and juxtamedullary nephrons. In volume-expanded rats superficial nephron tmg/sgfr was greater than juxtamedullary nephron tmg/sgfr. Juxtamedullary nephron function was measured by puncturing loops of Henle in the exposed papillae of small rats. Volume expansion increased sgfr without much effect on tmg in superficial nephrons while it decreased tmg without much effect on sgfr in deep nephrons. Physical changes produced by volume expansion seem to exert their greatest effect on proximal tubular function in the inner cortex. The increase in heterogeneity of glomerular-tubular balance could account for increased splay of glucose titration curves previously reported to accompany volume expansion.

Current and Emerging Targeting Strategies for Treatment of Pancreatic Cancer.

With a dismal 5-year survival rate of only 8%, pancreatic cancer still remains a very lethal disease. As with most cancers, pancreatic cancer is treated with different combinations of chemotherapeutic drugs which result in side effects and potential drug resistance leading in many cases to the unfortunate demise of the patient. Over recent years, a number of therapies have been developed against numerous molecular targets in cancers. Kinase inhibitors and monoclonal antibodies have been shown to target numerous kinases, growth factor receptors, and cell signaling pathways. This can lead to effects on tumor cell growth, angiogenesis, apoptosis, and the microenvironment. Most recent findings are very promising as they relate to the use of immunotherapy to treat certain cancers. Immune checkpoint inhibitors and cancer vaccines are currently being investigated. In this review, we will highlight some novel molecular targeted strategies that are being used or considered as potential therapeutics to treat patients with pancreatic cancer.

The efficacy of fluticasone furoate administered in the morning or evening is comparable in patients with persistent asthma.

BACKGROUND: The inhaled corticosteroid fluticasone furoate (FF) is efficacious as a once-daily treatment for the management of asthma. Asthma is associated with circadian changes, with worsening lung function at night. We compared the efficacy of once-daily FF in the morning or evening for the treatment of asthma. METHODS: Adults with persistent bronchial asthma were enrolled into this randomised, repeat-dose, double-blind, double-dummy, placebo-controlled, three-way crossover study. After a 14-day run-in period, patients received either: FF 100 µg in the morning (AM); FF 100 µg in the evening (PM); or placebo, via the ELLIPTA(®) dry powder inhaler. Patients received all three treatments (14 ± 2 day duration) separated by a 14- to 21-day washout period. The primary endpoint was 24-h weighted mean forced expiratory volume in 1 s (FEV1) measured at the end of each 14-day treatment. RESULTS: A total of 28 patients aged between 19 and 67 years were randomised and 21 (75%) completed all three study arms. Once-daily administration of FF 100 µg resulted in an increased 24-hour weighted mean FEV1; differences between the adjusted means for AM and PM FF dosing versus placebo were 0.077 L (90% confidence interval [CI]: 0.001, 0.152) and 0.105 L (90% CI: 0.029, 0.180), respectively (adjusted mean difference: -0.028 L [90% CI: -0.102, 0.045]). AM or PM doses had comparable incidences of adverse events (AEs; 18/23 versus 18/24, respectively), no serious AEs occurred. CONCLUSION: AM and PM doses of once-daily FF 100 µg produced comparable improvements in lung function relative to placebo.

Immunodetection of a type III sodium-dependent phosphate cotransporter in tissues and OK cells.

Polyclonal antibodies were raised in rabbits against a 14-amino acid portion of the gibbon ape leukemia virus human membrane receptor Glvr-1. This epitope also contained seven amino acids common to the receptor for the amphotropic murine retrovirus Ram-1. Antibody specificity and molecular size of Glvr-1/Ram-1-related proteins were assayed by Western blot. Using a standard Laemmli buffer system, under reducing conditions, a single band of approximately 85 kDa (designated p85) was immunodetected in membranes prepared from opossum kidney (OK) cells and in brain membranes from rat, rabbit and hamster. In mouse brain, p85 as well as a protein of 70-72 kDa were immunodetected. This protein was also present in several other mouse tissues. Limited proteolysis of p85 and the 70-72kDa-protein from mouse yielded similar peptide fragments, suggesting that both proteins are related. Fragments of the same molecular masses were also detected in OK cell membranes following proteolysis, showing that p85 in both models (mouse brain and OK cell) share a similar sequence. p85 is not N-glycosylated since an assay using endoglycosidase F/N-glycosidase F did not alter the electrophoretic mobility of p85. We also observed that regulation of phosphate transport by incubating OK cells without any phosphate or by PTH treatment occurs without any changes in the amount of p85. In conclusion, these data demonstrate for the first time a Western blot detection of a type III phosphate transporter using polyclonal antibodies. They also suggest that, conversely to type I and type II phosphate transporters which are localized in the kidney, this third type of transporter is ubiquitous and probably absorbs the readily available phosphate from interstitial fluid for normal cellular functions in many species and tissues, serving as a housekeeping Na+/Pi cotransport system. This is also the first report showing that p85 is not regulated in the same manner as type II phosphate transporters.

Application of a fiber-matrix model to transport in renal tubules.

The effects of tight junction structure on water and solute fluxes across proximal tubular epithelium were examined with fiber-matrix equations previously derived by Curry and Michel (1980. Microvascular Research. 20:96-99). Using plausible estimates of tight junction fiber length and width the model predicts solute (Ps) and water permeability (Lp) coefficients that agree with the measured values. When fiber-matrix and pore models were compared for physiologically relevant ranges of matrix void fraction (80-98%) and pore radii (0-20 A), the fiber-matrix model predicted a 10-fold higher Lp/Ps ratio. Lp/Ps was most sensitive to small changes in tight junction structure when void fractions exceeded 90%. Void fractions of 96.5% and 97.1% predicted previously measured values for Lp and solute permeabilities in rat and rabbit proximal tubules. These values are consistent with void fractions and permeabilities of artificial membranes. The fiber-matrix tight junction model was incorporated into a model of reabsorption from the rat proximal tubule developed by Weinstein (1984). American Journal of Physiology. 247:F848-F862.) A void fraction of 98% predicted the experimental results for isosmotic reabsorption driven by active transport. Changing void fraction over the range of 97-99% produced a 50-75% change in predicted volume reabsorption with active transport. According to the fiber-matrix model: (a) solute permeabilities alone cannot be used to predict Lp, (b) previously measured solute permeabilities in the proximal tubule are compatible with significant water reabsorption through a water-permeable tight junction, and (c) hydraulic and solute permeabilities may be sensitive to small changes in tight junction fiber length and diameter or ionic strength within the tight junction.

Digoxin reduces cardiac sympathetic activity in severe congestive heart failure.

OBJECTIVES: This study evaluated the effect of digoxin on cardiac sympathetic activity in patients with congestive heart failure. BACKGROUND: Digoxin favorably alters autonomic tone in heart failure. Whether it reduces cardiac sympathetic drive in the setting of heart failure is unknown. METHODS: Digoxin (0.25 mg intravenously) was administered to 12 patients with severe heart failure and elevated left ventricular end-diastolic pressure (> 14 mm Hg, Group A), 5 patients with less severe heart failure who had normal left ventricular end-diastolic pressure (> 14 mm Hg, Group B) and 6 patients with normal ventricular function. Seven additional patients with heart failure were studied as a time control group. Cardiac and total body norepinephrine spillover, systemic arterial pressure, left ventricular filling pressure and peak positive first derivative of left ventricular pressure were all assessed before and 30 min after administration of digoxin. RESULTS: In Group A there were no changes in hemodynamic variables or total body norepinephrine spillover after digoxin administration; however, there was a significant reduction in cardiac norepinephrine spillover (263 +/- 70 to 218 +/- 62 pmol/min, mean +/- SEM, p < 0.001). In contrast, in Group B, digoxin caused a significant increase in cardiac norepinephrine spillover that was not associated with any hemodynamic changes or a change in total body spillover. There were no hemodynamic changes or a change in total body spillover. There were no hemodynamic or spillover changes in the time control or normal ventricular function group. CONCLUSIONS: Digoxin, in the absence of detectable inotropic or hemodynamic effects, caused a reduction in cardiac norepinephrine spillover in patients with heart failure who had elevated filling pressures. This finding suggests a potentially beneficial primary autonomic action of digoxin in patients with severe heart failure.

An examination of the soluble oligomeric complexes extracted from the red cell membrane and their relation to the membrane cytoskeleton.

A part of the spectrin extracted from red cell membranes at low ionic strength occurs in the form of a high-molecular weight oligomeric complex with actin and proteins 4.1 and 4.9. When the extraction is performed at 35 degrees, the spectrin is present in this complex as the dimer, all higher forms being dissociated. We have been unable to establish any correlation between the fraction of the spectrin thus complexed and the metabolic state of the cell. At least a large part of the complex appears to be a defined monodisperse species, sedimenting at 31S. The actin is present as short protofilaments. The average number of spectrin molecules associated with each molecule of complex has been studied by cytochalasin binding and electron microscopy. The complexes present the appearance in the electron microscope of spiders, in which the legs are spectrin dimers, attached to a globular element, containing by inference, actin and proteins 4.1 and 4.9; they are active in nucleating the polymerization of G-actin. The complexes are extremely stable, being resistant to dissociation under the conditions of the deoxyribonuclease assay, even after treatment with trypsin to degrade the actin-associated proteins. It is suggested that the complexes represent intact junctions of the membrane cytoskeletal network. Relevant structural features of the network are revealed by electron microscopy. The results lead to inferences concerning the mechanism of dissociation of the network from the membrane.

Decreased plasma and urinary dopamine during dietary sodium depletion in man.

This study was designed to investigate the influence of dietary sodium restriction on plasma and urine dopamine levels. Five normal white male volunteer subjects wee studied in metabolic balance at constant 150 meq sodium, 60 meq potassium intake and then daily for 7 days on an isocaloric constant diet of 10 meq sodium and 60 meq potassium/day. With dietary sodium restriction, urinary sodium excretion decreased from 152 +/- 13 meq/day in stepwise fashion to 7 +/- 1 meq/day (P less than 0.001) on day 7. On the first day of dietary sodium restriction, a sodium deficit of 122 meq was associated with a decrease in supine plasma dopamine concentration from 58 +/- 10 to 45 +/- 7 pg/ml (P less than values for 2 days but decreased again to 43 +/- 12 pg/ml (P less than 0.05) on day 4 of sodium restriction and remained significantly lower than control on days 5-7 of sodium restriction (P less than 0.01). Supine plasma norepinephrine concentration increased from 193 +/- 34 to 232 +/- 29 pg/ml (P less than 0.05) on day 1 of sodium restriction and remained elevated during each subsequent day of low sodium intake (P less than 0.001). Supine plasma epinephrine concentration was unchanged by sodium restriction. Urinary dopamine excretion decreased from 12 +/- 2 to 8 +/- 1 microgram/h (P less than 0.05) on day 2 of sodium restriction and remained significantly low during each subsequent day of low sodium intake. Urinary norepinephrine was unchanged by sodium restriction. The data indicate a variable decrease in plasma dopamine concentration and a constant decrease in urinary dopamine excretion during the course of dietary sodium restriction in man.

Insulin blunts the natriuretic action of atrial natriuretic peptide in hypertension.

Hyperinsulinemia and insulin resistance are implicated in the etiology of hypertension, but the mechanisms involved have not been established. The objectives of this study were to determine whether untreated essential hypertensive patients are more sensitive to the antinatriuretic action of insulin and more resistant to the counteracting natriuretic effect of atrial natriuretic peptide in contrast to age- and sex-matched normotensive control subjects. Urinary sodium excretion was measured at baseline, during hyperinsulinemic euglycemic clamp, and during coadministration of insulin and atrial natriuretic peptide. Baseline urinary sodium excretion was not significantly different in the normotensive subjects (415 +/- 47 mumol/min, n = 12) and hypertensive patients (381 +/- 18 mumol/min, n = 10); with the institution of insulin infusion, there was a similar and significant decline from baseline (P < .001) to 289 +/- 35 mumol/min in normotensive subjects and 235 +/- 17 mumol/min in hypertensive patients. Atrial natriuretic peptide was able to oppose the antinatriuretic action of insulin in normotensive subjects, increasing urinary sodium excretion significantly to a mean level of 352 +/- 31 mumol/min (P < .05), which did not differ significantly from baseline. In the hypertensive group, atrial natriuretic peptide infusion had no effect on urinary sodium excretion (238 +/- 18 mumol/min), and the difference from baseline remained highly significant (P < .001). The hypertensive patients were significantly less insulin sensitive than their normotensive counterparts, as reflected by a lower glucose utilization rate and higher mean baseline plasma insulin level (P < .05 for each).(ABSTRACT TRUNCATED AT 250 WORDS)

Suppression of basal and stimulated noradrenergic activities by the dopamine agonist bromocriptine in man.

This study was designed to determine the effects of dopaminergic receptor stimulation on basal and stimulated catecholamine release in man. Five normal white male volunteer subjects were studied in metabolic balance at constant 150-meq sodium, 60-meq potassium intake and then daily for 8 days on an isocaloric constant diet of 10 meq sodium and 60 meq potassium/day in each of two separate protocols. In one protocol, the subjects received the dopamine agonist bromocriptine for 14 days before and during the study; in the other protocol, placebo was substituted for bromocriptine. During normal sodium intake, bromocriptine suppressed supine plasma norepinephrine concentrations from 193 +/- 10 to 159 +/- 9 pg/ml (P = 0.01). Dietary sodium depletion increased supine plasma norepinephrine concentrations in subjects taking placebo from 193 +/- 10 to 229 +/- 10 pg/ml (P less than 0.001). Bromocriptine prevented the supine plasma norepinephrine response to sodium depletion. After discontinuation of bromocriptine treatment, supine plasma norepinephrine concentrations returned to placebo control values. Upright posture stimulated an increase in plasma norepinephrine concentrations from 193 +/- 10 to 419 +/- 30 pg/ml (P = 0.0001) during normal sodium intake, and bromocriptine suppressed this response from 419 +/- 30 to 286 +/- 29 pg/ml (P = 0.004). Dietary sodium depletion enhanced the plasma norepinephrine response to upright posture, and bromocriptine markedly suppressed this enhancement. After discontinuation of bromocriptine treatment, supine and upright plasma norepinephrine concentrations returned to placebo control values. Bromocriptine induced a parallel downward shift in the inverse hyperbolic relationship between the plasma norepinephrine concentration and urinary sodium excretion in erect subjects, and decreased overnight urinary norepinephrine excretion in supine subjects from 1.1 +/- 0.1 to 0.6 +/- 0.1 ng/h (P = 0.0002). No consistent effects of bromocriptine on plasma epinephrine or dopamine concentrations were observed. The results of this study strongly suggest an inhibitory action of dopamine receptor stimulation by bromocriptine on basal and stimulated norepinephrine output at noradrenergic nerve terminals in the central nervous system and/or the periphery.

Inhibitory effect of selenomethionine on the growth of three selected human tumor cell lines.

Selenium supplementation has been shown for many years to work as an anticarcinogenic agent both in epidemiology and in in vitro studies. Selenium supplementation has recently been shown to decrease total cancer incidence. However, the mechanism of action of selenium as an anticarcinogenic agent has yet to be elucidated. Selenomethionine was the predominant form of selenium in the dietary supplement in the study by Clark et al. (Clark, L.C., Combs, G.F., Turnbull, W.B., Slate, E.H., Chalker, D.K., Chow, J., Davis, L.S., Glover, R.A., Graham, G.F., Gross, E.G., Krongrad, A., Lesher, J.L., Park, H.K., Sanders, B.B., Smith, C.L., Taylor, J.R. and The Nutritional Prevention of Cancer Study Group (1996) Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin: a randomized controlled trial. J. Am. Med. Assoc., 276 (24), 1957-1963) and therefore we evaluated the growth inhibitory effects of selenomethionine against human tumor cells. Selenomethionine was tested against each of three human tumor cell lines (MCF-7/S breast carcinoma, DU-145 prostate cancer cells and UACC-375 melanoma) and against normal human diploid fibroblasts. All cell lines demonstrated a dose-dependent manner of growth inhibition by selenomethionine. Selenomethionine inhibited the growth of all of the human tumor cell lines in the micromolar (microM) range (ranging from 45 to 130 microM) while growth inhibition of normal diploid fibroblasts required 1 mM selenomethionine, approximately 1000-fold higher than for the cancer cell lines. In short, normal diploid fibroblasts were less sensitive than the cancer cell lines to the growth inhibitory effects of selenomethionine. Furthermore, we show that selenomethionine administration to these cancer cell lines results in apoptotic cell death and aberrant mitoses. These results demonstrate the differential sensitivity of tumor cells and normal cells to selenomethionine.

The effects of dietary selenomethionine on polyamines and azoxymethane-induced aberrant crypts.

We evaluated the effects of dietary selenomethionine supplementation on colonic polyamine levels and the ability of L-selenomethionine supplementation to modulate the carcinogenic activity of azoxymethane (AOM) in the rat colon. Four-week-old male F344 rats were treated with 15 mg/kg body weight of AOM once a week for 2 weeks. Dietary selenomethionine at a concentration of either 1 or 2 ppm was administered in AIN-76A rodent diet to AOM-treated animals for 16 weeks. Aberrant crypt foci (ACF), precursor lesions of colon cancer, were investigated after the 16 week treatment course. Selenomethionine given in the diet at 2 ppm markedly reduced the number of aberrant crypt foci. The multiplicity of ACFs (i.e. the number of aberrant crypts/focus) and the percentage of microadenomas were also affected by selenomethionine in a dose dependent manner. However, evaluation of the colonic tissue polyamine levels between control and treated groups showed no significant difference. These results demonstrate that selenomethionine can modulate the development of AOM-induced premalignant lesions through a polyamine-independent mechanism.

Functional effects of proximal tubular dopamine production.

Significant proximal tubular responses to exogenous dopamine require 0.1 to 10 mumol/L concentrations but endogenous peritubular dopamine and DOPA concentrations are in the picomolar to nanomolar range. Dopamine concentration approaches micromolar levels within proximal tubular cells and their brush borders, as a result of DOPA decarboxylation and secretion, and in collecting duct fluid, as a result of tubular fluid absorption. Thus dopamine probably acts either within the proximal tubule cell or brush border or from the collecting tubular lumen. DOPA and Na+ uptake are coupled; dopamine uptake is linked to intracellular electrical potential and its secretion to H+ counter-transport; therefore alterations in proximal tubular Na+ and H+ transport influence dopamine excretion. Haloperidol and SCH 23390 block dopamine excretion, therefore dopamine antagonists may inhibit tubular dopamine responses by lowering intracellular dopamine concentration as well as by receptor blockade. Evidence for an intracellular site of dopamine action can be deduced from the inhibitory effect of DOPA on oxygen consumption and 86Rb uptake in proximal tubule cells. We have confirmed these findings in isolated proximal tubule cells but not in proximal tubule fragments. The discrepant responses may be due to the fact that isolated cells loose their polarity while tubule fragments remain polarized. Dopamine inhibition of proximal tubular Na+, K(+)-ATPase is not reproduced by single dopamine agonists or inhibited by dopamine antagonists. Dopamine effects which are not linked to known dopamine receptors may be the result of redox cycling. Micromolar dopamine oxidizes sulfhydryl groups which may modify enzyme structure and activate protein kinase C.

O(2) affinity of cross-linked hemoglobins modifies O(2) metabolism in proximal tubules.

Previous experiments using cross-linked tetrameric hemoglobins (XLHb) to perfuse isolated rat kidneys showed that high-O2-affinity XLHb improved proximal tubule function more effectively than low-O2-affinity XLHb. To determine how function was improved, proximal tubule fragments were incubated with albumin, Hb34 [half-saturation point (P50) 34 Torr], or Hb13 (P50 13 Torr) with Po2 values ranging from 22 to 147 Torr. ATP content reflected O2 delivery to mitochondria. Both XLHb increased ATP, Hb34 with Po2 >or= 47 Torr and Hb13 with Po2

Strategies and criteria for developing new urinalysis tests.

Urinalysis provides a non-invasive means to sequentially evaluate renal function and disease processes. Contemporary analytical techniques and the rapidly expanding knowledge of cell biology are yielding new ways of looking at urine constituents. Application of these new analytical techniques to screening, diagnosing and monitoring renal disease requires much more information than is currently available about the correlation of urine analytes with disease processes. Case definitions for specific renal disease depend upon a knowledge of natural history, response to therapy and laboratory data, including biopsy. When tests are being used to detect early stages of renal damage the subjects must be followed for months or years before a definitive diagnosis of irreversible disease can be established; therefore, prospective studies must be used to validate these tests. Analytes chosen for further study should be linked to significant renal pathophysiological processes. Gold standards for evaluating the predictive value of tests results must be established. The influence of renal disease on the analyte should be much greater than its biological variability under non-specific stresses. The results of using the test should benefit patients, taking into account the costs of false positive results and other costs to society that come from providing the test. Prospective studies needed to validate tests should be feasible and affordable. These studies could be facilitated by establishing a collaborative bank of urine samples linked to clinical data. Tests which are not used in clinical decision making are unimportant and of little value. Tests used in decision making should be evaluated as rigorously as the treatments that will be chosen based on the test results.

Mystery of the toxic flea dip: an interactive approach to teaching aerobic cellular respiration.

We designed an interrupted case study to teach aerobic cellular respiration to major and nonmajor biology students. The case is based loosely on a real-life incident of rotenone poisoning. It places students in the role of a coroner who must determine the cause of death of the victim. The case is presented to the students in four parts. Each part is followed by discussion questions that the students answer in small groups prior to a classwide discussion. Successive parts of the case provide additional clues to the mystery and help the students focus on the physiological processes involved in aerobic respiration. Students learn the information required to solve the mystery by reading the course textbook prior to class, listening to short lectures interspersed throughout the case, and discussing the case in small groups. The case ends with small group discussions in which the students are given the names and specific molecular targets of other poisons of aerobic respiration and asked to determine which process (i.e., glycolysis, citric acid cycle, or the electron transport chain) the toxin disrupts.

Nervous disorders of renal function.

Renal nerves contribute to the genesis of at least four disease processes. 1. Excess renal nerve activity contributes significantly to salt and water retention by patients with congestive circulatory failure. 2. Circumstantial evidence suggests that dopamine production may be deficient in a group of patients with idiopathic edema. Aldosterone secretion is high in this group and it has been shown that dopamine exerts a tonic inhibitory effect on angiotensin-stimulated aldosterone secretion. 3. Excess renal nerve activity probably plays a crucial role in the transition from hypotension and pre-renal failure to ischemic acute tubular necrosis. 4. Without doubt hyperactivity of renal nerves causes systemic hypertension in a variety of animal disease models. There is also good reason to believe that this occurs in some forms of human hypertension. The effects of the sympathetic nervous system on renal vascular resistance, renin release, tubular electrolyte reabsorption and aldosterone secretion are discussed in the context of these four diseases.

In patients receiving dopamine infusions for treatment of shock do free radicals convert dopamine to 6-hydroxydopamine?

Free hydroxyl radicals react with dopamine in vitro to produce the neurotoxin 6-hydroxydopamine (6-OHDA). If 6-OHDA were produced in vivo it could destroy central and/or peripheral neurons. Free radicals are produced in patients with cardiovascular or toxic shock. These patients are often treated with intravenous dopamine infusions. Using a newly developed method for measuring 6-OHDA in biological samples, we have examined blood from 15 patients receiving dopamine infusions for treatment of shock. 6-OHDA neither binds to nor elutes from either alumina or ion-exchange resins; therefore we used ODA-silica (Sep-Pak) to prepare samples for HPLC analysis with electrochemical detection. 6-OHDA disappeared rapidly from whole blood or serum at room temperature but was stable at -70 degrees C in an HClO4 extract. Recovery from Sep-Pak was 95% and detection limit 10 nmol/L. We repeated the experiments that showed in vitro hydroxyl radical conversion of dopamine to 5- and 6-OHDA. We detected neither 5- nor 6-OHDA in plasma samples from patients receiving dopamine infusions at 10-28 micrograms kg-1 min-1. Plasma dopamine in these patients was 1-5 mumol/L. We conclude that any 6-OHDA produced by hydroxyl radical attack in vivo is rapidly scavenged by endogenous substances containing sulfhydryl groups.