Tumoral calcinosis: seasonal biochemical studies and chemical studies of eyelid lesion.

We recently described (Arch Ophthalmol 1988; 106:725-6) the presence of unique calcific lesions in the eyelids of a young woman with a history of hyperphosphatemic tumoral calcinosis. Here we document that no immediate family members showed similar lesions and that none was hyperphosphatemic. Dental roentgenography revealed characteristic abnormalities in the patient that confirmed the clinical diagnosis of tumoral calcinosis. Seasonal biochemical studies demonstrated persistently increased concentrations of phosphorus and 1,25-dihydroxyvitamin D in her serum. A calcific eyelid excrescence removed from the patient, studied by x-ray diffraction, was found to consist of crystals of hydroxyapatite. Microprobe analysis indicated the major elements in the deposit to be Ca, P, S, and Cl, just as in the periarticular deposits found in tumoral calcinosis. The Ca concentration in the patient's tear fluid, measured by atomic absorption spectrometry, was within the range found in tears of healthy volunteers. Phosphorus was undetectable (less than 30 mumol/L) in tears of the patient and the volunteers. These findings suggest that the eyelid lesions represent a new manifestation of the pathological process that produces the characteristic periarticular calcific masses of tumoral calcinosis.

Combined effects of ATP and phosphate on rubidium exchange mediated by Na-K-ATPase reconstituted into phospholipid vesicles.

1. Phospholipid vesicles reconstituted with Na-K-ATPase show an (ATP+phosphate)-stimulated Rb-Rb exchange, with properties similar to the K-K exchange of human red cells. This includes a rate 15-20% of the rate of active ATP-dependent Na-K exchange.2. We have studied activation of this Rb-Rb exchange by ATP at fixed phosphate concentrations and by phosphate at fixed ATP concentrations. It is found for both ATP and phosphate that with low concentrations of the fixed ligand an increase in concentration of the complementary ligand produces first stimulation and then inhibition of Rb-Rb exchange. At high concentrations of the fixed ligand the complementary ligand shows only saturation behaviour.3. The pattern of activation and of inhibition by ATP and by phosphate is affected by the Rb(0) concentration in the exterior medium, in that higher concentrations of Rb(0) counteract inhibitory effects of high concentrations of ATP and phosphate.4. (ATP+phosphate)-stimulated Rb-Rb exchange is activated by Rb(0) in the exterior medium along a sigmoid curve. An increase of Rb(i) within the vesicles, which raises the maximal velocity of Rb-Rb exchange, is accompanied by a smaller increase in the Rb(0) concentration required for half-maximal stimulation of the Rb-Rb exchange.5. The data are interpreted in terms of a model similar to those proposed by Karlish & Stein (1982a,b), but extended to include simultaneous effects of ATP and phosphate. Inhibitions by high concentration of ATP or phosphate arise as a result of stabilization of E(1) ATP or E(2)-P forms respectively, in the presence of low concentrations of the complementary ligand. With high concentrations of the fixed ligand, saturation behaviour of the varying ligand is observed because the occluded Rb forms become the dominant transport intermediates. The occluded Rb forms bind both ATP and phosphate weakly and independently. The effects of ATP together with phosphate are accounted for by a simple combination of their separate effects on the Rb-Rb exchange.6. We suggest that the functional role of the occluded Rb form E(2) (Rb)(occ) in active transport is to minimize passive cation leaks through the system and allow control of the direction of cation movements by binding of physiological ligands such as ATP or phosphate.