Integration of Attitude, Ethics, and Communication Competencies into Competency-based UG Curriculum.

The new MBBS curriculum has a course called Attitudes, Ethics, and Communication (AETCOM) which will run across years. Students will be assessed for how they communicate with patients, how they counsel people for organ donation or other challenging procedures, how sensitively they offer care and obtain informed consent? All these elements will count along with competencies. The new regulations mandate the development of AETCOM competencies through 27 modules with emphasis on self-directed learning. Ultimately it is expected that these modules are integrated into the basic curriculum of Indian Medical Graduates. Each module is a comprehensive self-contained unit. It describes learning objectives of competencies addressed, level of learning, contents of learning, professional year of study, hours of study, methods of learning and their formative and summative assessment along with accessible resource material.

Inhibition of the sarco/endoplasmic reticulum (ER) Ca2+-ATPase by thapsigargin analogs induces cell death via ER Ca2+ depletion and the unfolded protein response.

Calcium (Ca2+) is a fundamental regulator of cell signaling and function. Thapsigargin (Tg) blocks the sarco/endoplasmic reticulum (ER) Ca2+-ATPase (SERCA), disrupts Ca2+ homeostasis, and causes cell death. However, the exact mechanisms whereby SERCA inhibition induces cell death are incompletely understood. Here, we report that low (0.1 µm) concentrations of Tg and Tg analogs with various long-chain substitutions at the O-8 position extensively inhibit SERCA1a-mediated Ca2+ transport. We also found that, in both prostate and breast cancer cells, exposure to Tg or Tg analogs for 1 day caused extensive drainage of the ER Ca2+ stores. This Ca2+ depletion was followed by markedly reduced cell proliferation rates and morphological changes that developed over 2-4 days and culminated in cell death. Interestingly, these changes were not accompanied by bulk increases in cytosolic Ca2+ levels. Moreover, knockdown of two key store-operated Ca2+ entry (SOCE) components, Orai1 and STIM1, did not reduce Tg cytotoxicity, indicating that SOCE and Ca2+ entry are not critical for Tg-induced cell death. However, we observed a correlation between the abilities of Tg and Tg analogs to deplete ER Ca2+ stores and their detrimental effects on cell viability. Furthermore, caspase activation and cell death were associated with a sustained unfolded protein response. We conclude that ER Ca2+ drainage and sustained unfolded protein response activation are key for initiation of apoptosis at low concentrations of Tg and Tg analogs, whereas high cytosolic Ca2+ levels and SOCE are not required.

Demethoxycurcumin Is A Potent Inhibitor of P-Type ATPases from Diverse Kingdoms of Life.

P-type ATPases catalyze the active transport of cations and phospholipids across biological membranes. Members of this large family are involved in a range of fundamental cellular processes. To date, a substantial number of P-type ATPase inhibitors have been characterized, some of which are used as drugs. In this work a library of natural compounds was screened and we first identified curcuminoids as plasma membrane H+-ATPases inhibitors in plant and fungal cells. We also found that some of the commercial curcumins contain several curcuminoids. Three of these were purified and, among the curcuminoids, demethoxycurcumin was the most potent inhibitor of all tested P-type ATPases from fungal (Pma1p; H+-ATPase), plant (AHA2; H+-ATPase) and animal (SERCA; Ca2+-ATPase) cells. All three curcuminoids acted as non-competitive antagonist to ATP and hence may bind to a highly conserved allosteric site of these pumps. Future research on biological effects of commercial preparations of curcumin should consider the heterogeneity of the material.

ATPase Activity Measurements by an Enzyme-Coupled Spectrophotometric Assay.

Enzymatic coupled assays are usually based on the spectrophotometric registration of changes in NADH/NAD(+) or NADPH/NADP(+) absorption at 340 nm accompanying the oxidation/reduction of reactants that by dehydrogenases and other helper enzymes are linked to the activity of the enzymatic reaction under study. The present NADH-ATP-coupled assay for ATPase activity is a seemingly somewhat complicated procedure, but in practice adaptation to performance is easily acquired. It is a more safe and elegant method than colorimetric methods, but not suitable for handling large number of samples, and also presupposes that the activity of the helper enzymes is not severely affected by the chemical environment of the sample in which it is tested.

Coupling Ratio for Ca(2+) Transport by Calcium Oxalate Precipitation.

The SERCA isoform 1a is constructed to transport 2 Ca(2+) ions across the sarcoplasmic reticulum membrane coupled to the hydrolysis of one molecule of MgATP. However, observed coupling ratios for Ca(2+) transported/ATP hydrolzyed are usually less than 2:1, since part of the Ca(2+) accumulated at high intravesicular concentrations by the active transport of Ca(2+) leaks out of the vesicles because of Ca(2+)-induced Ca(2+) exchange. However, in the presence of a high concentration of oxalate (5 mM) Ca(2+) will precipitate as Ca-oxalate inside the vesicles and thereby be prevented from leaking out and, in addition, this treatment will reduce the intravesicular free concentration of Ca(2+) to a level where optimal coupling ratios of 2:1 can be achieved.

Tryptophan Fluorescence Changes Related to Ca(2+)-ATPase Function.

Fluorescence measurements as monitored with either extrinsic or intrinsic probes constitute important ways with which to study the molecular properties of macromolecules. With high-quality spectrofluorimeters, it is, e.g., possible kinetically to follow local conformational changes, induced by ligands and inhibitors, with a sensitivity that is unsurpassed by any other physicochemical technique. We demonstrate here with Ca(2+) and two specific inhibitors of SERCA how this can be done by measurements of the intrinsic fluorescence of the tryptophan residues of SERCA.

Ca(2+) Binding and Transport Studied with Ca(2+)/EGTA Buffers and (45)Ca(2+).

The chapter describes procedures useful for determination of Ca(2+) binding by membranous Ca(2+)-ATPase based on the correction for the removal of Ca(2+) present in a non-bound state in the suspension medium. This is done by a filtration procedure that retains the membranous material on the Millipore filters. With suitable sucking devices it is possible to gently remove without dehydration nearly all medium from the Ca(2+) containing membranes, except that required for wetting of the filters on which they are deposited. Correction for this effect can be done with a double-filter where the radioactive content of the lower (protein-free) filter is subtracted from that present in the upper filter for calculation of Ca(2+) binding. This methodology can be used to study the effect of inhibitors on Ca(2+) binding and -transport, and with Ca(2+)/EGTA buffers to explore the Ca(2+) binding affinities and cooperative aspects of the two transport sites.

Discovery of Tricyclic Clerodane Diterpenes as Sarco/Endoplasmic Reticulum Ca(2+)-ATPase Inhibitors and Structure-Activity Relationships.

Tricyclic clerodane diterpenes (TCDs) are natural compounds that often show potent cytotoxicity for cancer cells, but their mode of action remains elusive. A computationally based similarity search (CDRUG), combined with principal component analysis (ChemGPS-NP) and docking calculations (GOLD 5.2), suggested TCDs to be inhibitors of the sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA) pump, which is also the target of the sesquiterpene lactone thapsigargin. Biochemical studies were performed with 11 TCDs on purified rabbit skeletal muscle sarcoplasmic reticulum membranes, which are highly enriched with the SERCA1a isoform. Casearborin D (2) exhibited the highest affinity, with a KD value of 2 µM and giving rise to complete inhibition of SERCA1a activity. Structure-activity relationships revealed that functionalization of two acyl side chains (R1 and R4) and the hydrophobicity imparted by the aliphatic chain at C-9, as well as a C-3,C-4 double bond, play crucial roles for inhibitory activity. Docking studies also suggested that hydrophobic interactions in the binding site, especially with Phe256 and Phe834, may be important for a strong inhibitory activity of the TCDs. In conclusion, a novel class of SERCA inhibitory compounds is presented.

Targeting thapsigargin towards tumors.

The skin irritating principle from Thapsia garganica was isolated, named thapsigargin and the structure elucidated. By inhibiting the sarco/endoplasmic reticulum Ca(2+) ATPase (SERCA) thapsigargin provokes apoptosis in almost all cells. By conjugating thapsigargin to peptides, which are only substrates for either prostate specific antigen (PSA) or prostate specific membrane antigen (PSMA) prodrugs were created, which selectively affect prostate cancer cells or neovascular tissue in tumors. One of the prodrug is currently tested in clinical phase II. The prodrug under clinical trial has been named mipsagargin.

Differential effects of thapsigargin analogues on apoptosis of prostate cancer cells: complex regulation by intracellular calcium.

The inhibition of sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) by thapsigargin (Tg) and Tg-type analogues is considered to trigger cell death by activation of apoptotic pathways. Some of these analogues may be useful as antineoplastic agents after appropriate targeting as peptide conjugated prodrugs to cancer cells. With this in mind, this study evaluates the effect on LNCaP androgen-sensitive cancer cells of thapsigargin substituted with 12-aminododecanoyl linkers and Leu (Leu-8ADT), aspartate (Asp-8ADT) or Boc-8ADT. Our results show that both Leu-8ADT and Asp-8ADT result in rapid ER calcium depletion and an influx of calcium across the plasma membrane by activation of store-operated calcium entry. By contrast, ER Ca(2+) depletion by Boc-8ADT is a very slow process that does not perceptibly increase cytosolic Ca(2+) and activate store-operated calcium entry, because the inhibition of SERCA with this compound is very slow. Nevertheless, we find that Boc-8ADT is a more efficient inducer of apoptosis than both Tg and Leu-8ADT. Compared with Tg and the other analogues, apoptosis induced by Asp-8ADT is very modest, although this compound also activates store-operated calcium entry and at high concentrations (1 µm) causes severe morphological changes, reflecting decreased cell viability. We conclude that many factors need to be considered for optimization of these compounds in antineoplastic drug design. Among these ER stress induced by Ca(2+) endoplasmic reticulum mobilization seems particularly important, whereas the early cytosolic increase of Ca(2+) concentration preceding the executive phase of apoptosis appears to be of no, or little, consequence for a subsequent apoptotic effect.

Water-mediated interactions influence the binding of thapsigargin to sarco/endoplasmic reticulum calcium adenosinetriphosphatase.

A crystal structure suggests four water molecules are present in the binding cavity of thapsigargin in sarco/endoplasmic reticulum calcium ATPase (SERCA). Computational chemistry indicates that three of these water molecules mediate an extensive hydrogen-bonding network between thapsigargin and the backbone of SERCA. The orientation of the thapsigargin molecule in SERCA is crucially dependent on these interactions. The hypothesis has been verified by measuring the affinity of newly synthesized model compounds, which are prevented from participating in such water-mediated interactions as hydrogen-bond donors.

Alpha-Lactalbumin is unfolded by all classes of surfactants but by different mechanisms.

We show that all four classes of surfactants (anionic, cationic, non-ionic, and zwitterionic) denature alpha-lactalbumin (alphaLA), making alphaLA an excellent model system to compare their denaturation mechanisms. This involves at least two steps in all surfactants but is more complex in charged surfactants due to their strong binding properties. At very low concentrations, charged surfactants bind specifically as monomers, but the first denaturation process only sets in when 4-10 surfactant molecules are bound to form clusters on the protein surface and is followed by a second loss of structure as 20-25 surfactant molecules are bound. Sub-micellar interactions can be modeled as simple independent binding at multiple sites which does not achieve saturation before micelle formation sets in. In contrast, no specific sub-micellar surfactant binding is detected by calorimetry in the presence of zwitterionic and non-ionic surfactants, and denaturation only occurs around the cmc. Unfolding rates are very rapid in charged surfactants and reach a similar plateau level around the cmc, indicating that monomers and micelles operate on a mutually exclusive basis. In contrast, unfolding occurs slowly in zwitterionic and non-ionic surfactants and the rate increases with the cmc, suggesting that monomers cooperate with micelles in denaturation.

Aggregation of S6 in a quasi-native state by sub-micellar SDS.

Anionic surfaces promote protein fibrillation in vitro and in vivo. Monomeric SDS has also been shown to stimulate this process. We describe the dynamics of conformational changes and aggregative properties of the model protein S6 at sub-micellar SDS concentrations. S6 exhibits a rich and pH-sensitive diversity in conformational changes around 0.2-2 mM SDS, in which several transitions occur over time scales spanning milliseconds to hours. Monomeric SDS readily precipitates S6 within minutes at pH-values of 5 and below to form states able to bind the fibril-specific dye thioflavin T. At pH 5.5, the process is much slower and shows a mutagenesis-sensitive lag, leading to different forms of organized but not classically fibrillar aggregates with native-like levels of secondary structure, although the tertiary structure is significantly rearranged. The slow aggregation process may be linked to conformational changes that occur at the second-time scale in the same SDS concentration range, leading to an altered structure, possibly with unfolding around the C-terminal helix. The S6 aggregates may be differently trapped states, equivalent to pre-fibrillar structures seen at early stages in the fibrillation process for other proteins. The low quantities of anionic species required suggest that the aggregates may have parallels in vivo.

Modulation of cutinase stability and structure by phospholipid detergents.

Fusarium solani pisi cutinase hydrolyses triglycerides of different lengths. Here we show that micelle-forming short-chain (C6-C9) phospholipids significantly reduce cutinase stability (both below and above the critical micelle concentration cmc) and rates of folding (only above cmc), trapping cutinase in an inactive state which only regains activity over hours to days, rather than the few seconds required for refolding in the absence of detergent. Destabilization decreases with increasing chain length, and increases with cmc, indicating that monomers and micelles cooperate in destabilizing cutinase. Detergents have little effect on enzymatic activity and confer no changes in secondary structure. Some changes in chemical shift occur around the enzyme active site, although distant regions are also affected. To our knowledge, this is the first example of marked destabilization of a water-soluble protein by zwitterionic detergents, highlighting the multitude of different detergent interactions with enzymes that target amphiphilic substrates and providing means of trapping a protein in a metastable state. We propose a model for destabilization where monomers via various binding sites on the native state prime it for interacting with micelles in a destabilizing fashion, whereas only micelles halt refolding due to the absence of these monomer-binding sites in the denatured state.

Aggregation and fibrillation of bovine serum albumin.

The all-alpha helix multi-domain protein bovine serum albumin (BSA) aggregates at elevated temperatures. Here we show that these thermal aggregates have amyloid properties. They bind the fibril-specific dyes Thioflavin T and Congo Red, show elongated although somewhat worm-like morphology and characteristic amyloid X-ray fiber diffraction peaks. Fibrillation occurs over minutes to hours without a lag phase, is independent of seeding and shows only moderate concentration dependence, suggesting intramolecular aggregation nuclei. Nevertheless, multi-exponential increases in dye-binding signal and changes in morphology suggest the existence of different aggregate species. Although beta-sheet content increases from 0 to ca. 40% upon aggregation, the aggregates retain significant amounts of alpha-helix structure, and lack a protease-resistant core. Thus BSA is able to form well-ordered beta-sheet rich aggregates which nevertheless do not possess the same structural rigidity as classical fibrils. The aggregates do not permeabilize synthetic membranes and are not cytotoxic. The ease with which a multidomain all-alpha helix protein can form higher-order beta-sheet structure, while retaining significant amounts of alpha-helix, highlights the universality of the fibrillation mechanism. However, the presence of non-beta-sheet structure may influence the final fibrillar structure and could be a key component in aggregated BSA's lack of cytotoxicity.

Thermodynamics of unfolding of an integral membrane protein in mixed micelles.

Quantitative studies of membrane protein folding and unfolding can be difficult because of difficulties with efficient refolding as well as a pronounced propensity to aggregate. However, mixed micelles, consisting of the anionic detergent sodium dodecyl sulfate and the nonionic detergent dodecyl maltoside facilitate reversible and quantitative unfolding and refolding. The 4-transmembrane helix protein DsbB from the inner membrane of Escherichia coli unfolds in mixed micelles according to a three-state mechanism involving an unfolding intermediate I. The temperature dependence of the kinetics of this reaction between 15 degrees and 45 degrees C supports that unfolding from I to the denatured state D is accompanied by a significant decrease in heat capacity. For water-soluble proteins, the heat capacity increases upon unfolding, and this is generally interpreted as the increased binding of water to the protein as it unfolds, exposing more surface area. The decrease in DsbB's heat capacity upon unfolding is confirmed by independent thermal scans. The decrease in heat capacity is not an artifact of the use of mixed micelles, since the water soluble protein S6 shows conventional heat-capacity changes in detergent. We speculate that it reflects the binding of SDS to parts of DsbB that are solvent-exposed in the native DM-bound state. This implies that the periplasmic loops of DsbB are relatively unstructured. This anomalous thermodynamic behavior has not been observed for beta-barrel membrane proteins, probably because they do not bind SDS so extensively. Thus the thermodynamic behavior of membrane proteins appears to be intimately connected to their detergent-binding properties.

Activation, inhibition, and destabilization of Thermomyces lanuginosus lipase by detergents.

Lipases catalyze the hydrolysis of triglycerides and are activated at the water-lipid interface. Thus, their interaction with amphiphiles such as detergents is relevant for an understanding of their enzymatic mechanism. In this study, we have characterized the effect of nonionic, anionic, cationic, and zwitterionic detergents on the enzymatic activity and thermal stability of Thermomyces lanuginosus lipase (TlL). For all detergents, low concentrations enhance the activity of TlL toward p-nitrophenyl butyrate by more than an order of magnitude; at higher detergent concentrations, the activity declines, leveling off close to the value measured in the absence of detergent. Surprisingly, these phenomena mainly involve monomeric detergent, as activation and inhibition occur well below the cmc for the nonionic and zwitterionic detergents. For anionic and cationic detergents, activation straddles the monomer-micelle transition. The data can be fitted to a three state interaction model, comprising free TlL in the absence of detergent, an activated complex with TlL at low detergent concentrations, and an enzyme-inhibiting complex at higher concentrations. For detergents with the same headgroup, there is an excellent correspondence between carbon chain length and ability to activate and inhibit TlL. However, the headgroup and number of chains also modulate these effects, dividing the detergents overall into three broad groups with rising activation and inhibition ability, namely, anionic and cationic detergents, nonionic and single-chain zwitterionic detergents, and double-chain zwitterionic detergents. As expected, only anionic and cationic detergents lead to a significant decrease in lipase thermal stability. Since nonionic detergents activate TlL without destabilizing the protein, activation/inhibition and destabilization must be independent processes. We conclude that lipase-detergent interactions occur at many independent levels and are governed by a combination of general and structurally specific interactions. Furthermore, activation of TlL by detergents apparently does not involve the classical interfacial activation phenomenon as monomeric detergent molecules are in most cases responsible for the observed increase in activity.

Aggregated assemblies of sodium dodecyl sulfate/dimethyldodecyl ammoniopropane sulfonate and phospholipids at the interface and in the bulk.

Interactions between the binary combinations of sodium dodecyl sulfate (SDS) or dimethyldodecylammoniopropane sulfonate (DPS) with L-alpha-phosphatidylcholine (PC), 1,2-didecanoyl-sn-glycero-3-phosphacholine (DPC), and 1,2-dipalmitoyl-sn-glycero-3-phosphacholine (PPC) at the air/water interface and in aqueous bulk were evaluated with the help of interfacial tension (gamma) and pyrene fluorescence (I(1)/I(3)) measurements by studying the aggregation processes of SDS and DPS in pure water and in the presence of 7-36 microM of each lipid. The gamma measurements suggested that the interface was mainly occupied by the surfactant monomers especially in the presence of PC and PPC, and the surfactant-PC or surfactant-PPC aggregates were mainly available in the bulk with the least surface activity. Significant surface activity was observed in the case of a surfactant-DPC complex. The fluorescence measurements showed clear onset, C(1), and completion, C(2), of a vesicles solubilization process upon incorporation of surfactant monomers into the vesicles in the presence of DPC and PPC whereas this process was not visible in the presence of PC. A comparative study of all the three lipids indicated that both PC and PPC were mainly available in the aggregated form in the bulk due to their higher hydrophobicities and, hence, were the least surface active. On the other hand, DPC with relatively lower hydrophobicity showed considerable surface activity even in the monomeric form. Among both surfactants, DPS showed stronger interactions with DPC and PPC in comparison to SDS due to its zwitterionic nature, which could easily accommodate itself into the lipid-aggregated assemblies with similar headgroup natures, and helped in reducing the interhead-group repulsions.