Removal of digoxin by column for specific adsorption of beta(2)-microglobulin: a potential use for digoxin intoxication.

BACKGROUND: A beta(2)-microglobulin adsorption column used for the treatment of dialysis-related amyloidosis removes serum beta(2)-microglobulin by recognition of lipophilic residue in the protein. No data are available for the adsorption of the highly lipophilic drug digoxin. METHODS: In vivo clearance of digoxin with the beta(2)-microglobulin column was measured by a single use of the column in 8 patients receiving hemodialysis with a therapeutic level of digoxin. In vitro adsorption was evaluated by use of incubation with adsorbent of the column and digoxin or ranitidine, a hydrophilic drug. Clearance with the beta(2)-microglobulin column was further compared with that obtained by use of activated charcoal in the dogs intoxicated with digoxin. RESULTS: Digoxin concentration was reduced from 1.11 +/- 0.25 ng/mL to 0.57 +/- 0.15 ng/mL at 240 minutes after initiation of hemoperfusion with the column in the patients. Digoxin clearance with the beta(2)-microglobulin column was about 145 +/- 20 mL/min, with a blood flow rate of 160 to 220 mL/min (80% of plasma flow rate). Eighty-five percent of digoxin was adsorbed in vitro, and the capacity of the beta(2)-microglobulin column was not saturated until a toxic level was reached (50 ng/mL). This value was higher than that obtained with use of charcoal. In dogs with digoxin intoxication, digoxin clearance was 38.9 +/- 1.5 mL/min, with a blood flow rate of 50 mL/min (95% of plasma flow rate), which was almost twice as that achieved with charcoal. The degree of thrombocytopenia and leukopenia was small with use of the beta(2)-microglobulin column. CONCLUSION: These data suggested that the beta(2)-microglobulin column selectively adsorbs digoxin. This column is a promising tool for the treatment of digoxin intoxication, especially in patients undergoing hemodialysis.

New adsorption column (Lixelle) to eliminate beta2-microglobulin for direct hemoperfusion.

The Lixelle column is an adsorbent column used to eliminate beta2-microglobulin (beta2M) selectively from circulating blood of dialysis related amyloidosis (DRA) patients, which is used in combination with a dialyzer in series. The column has such a high capacity for adsorbing beta2M that the most intensive removal of beta2M has been possible. In clinical trials of the column, the obvious improvement of subjective symptoms such as decreases in the frequency of nocturnal awakening, the joint pain severity index, and the joint mobility index were observed. Hypotension has been the most frequent adverse event observed during treatment since the column was put on the market. It is very important to clarify the causes of both the efficacy and the side effects. A controlled prospective study is now in progress to clarify the efficacy more scientifically. The results will be published soon elsewhere.

[Studies on anti-DNA antibodies associated with renal involvement by enzyme-linked immunosorbent assay in patients with systemic lupus erythematosus].

It has been reported that a significantly higher incidence of lupus nephritis was found in patients with high avidity anti-DNA antibodies. Radioimmunoassay (Farr's assay) is a method which enables to detect high avidity anti-DNA antibodies, whereas enzyme-linked immunosorbent assay (ELISA) can detect anti-DNA antibodies from low to high avidity. There are, however some patients who had high levels of anti-DNA antibodies by Farr's assay without renal involvement. In this study, ELISA was developed to detect IgG anti-DNA antibodies highly associated with lupus nephritis by changing salt concentration of reaction buffer solution. Levels of a fraction, we call [0.1 M - 0.3 M] fraction, which was obtained from the antibody levels measured under 0.1 molar of sodium chloride (NaCl) subtracted by antibodies levels under 0.3 molar of NaCl solution were found to be significantly higher in patients with urinary protein (p = 0.0074) and low serum complement (C 3 less than 50 mg/dl; p = 0.0026, C 4 less than 10 mg/dl; p = 0.0280 and CH 50 less than 30 U/mL; p = 0.0662). Among the patients with hypocomplementemia, levels of [0.1 M - 0.3 M] fraction were significantly higher in patients with urinary protein than in patients without renal involvement. This fraction might be consistent with anti-DNA antibodies with intermediate avidity that are related to lupus nephritis. The ELISA procedure established in this study is showed to be a available method to detect anti-DNA antibodies associated with renal disease in patients with systemic lupus erythematosus.

Long-term clinical evaluation of an adsorbent column (BM-01) of direct hemoperfusion type for beta 2-microglobulin on the treatment of dialysis-related amyloidosis.

The clinical efficacy and safety of a beta 2-microglobulin (beta 2M) adsorbent column, BM-01, on the treatment of dialysis-related amyloidosis were investigated in 7 hemodialysis patients for more than 6 months. The percent reduction of serum beta 2M was more than 60-70%, and the level at the end of each session was less than 10 mg/L in almost all patients. The amount of beta 2M removed was calculated as more than 200-300 mg/session. The results demonstrated that BM-01 performed very well for removing beta 2M, was capable of maintaining less than 25 mg/L of time average concentration (TAC) for beta 2M, and improved the clinical symptoms. Clinically severe side effects were not observed. We recommend that BM-01 should undergo further evaluation for its usefulness in the long-term treatment of dialysis-related amyloidosis, though treatment with the column may not be successful in preventing the onset of the disease.

Site-directed mutation in conserved anionic regions of guinea pig liver transglutaminase.

Transglutaminases (EC 2.3.2.13) catalyze the formation of epsilon-(gamma-glutamyl) lysine cross-links and the substitution of primary amines for the gamma-carboxamide groups of protein-bound glutamine residues. There are conserved anionic regions in transglutaminases, some of which are thought to be possible calcium-binding sites. By site-directed mutagenesis, three mutant forms of recombinant guinea-pig liver transglutaminase, in which some acidic amino acid residues in two conserved regions became nonionic, were expressed in Escherichia coli: TGM1, with Asp-231 and -232 changed to Asn; TGM2, with Glu-445, -448, -449, -450, and -452 changed to Gln; and TGM3, with the mutations of both TGM1 and TGM2. The size and level of synthesis of the mutant proteins were unchanged when monitored by immunoblotting. All mutants retained enzyme activity, and their apparent Km values for substrates during histamine incorporation into acetyl alpha s1-casein were similar to those of the wild-type enzyme, but their Vmax values were smaller. The deamidation rate of glutamine residues in the acetyl alpha s1-casein was unaffected, but the rate of protein cross-linking catalyzed by these mutants was very low. All mutations caused with the enzyme a decrease in the sensitivity to activation by calcium and an increase in the sensitivity to inhibition by GTP. These results indicated that the negative charges of some acidic amino acid residues in the two conserved anionic regions of transglutaminase are not essential for its activity but the loss of their negative charges affects some catalytic properties.

A new treatment for dialysis-related amyloidosis with beta 2-microglobulin adsorbent column.

Dialysis-related amyloidosis (DRA) is characterized by the presence of beta 2-microglobulin (beta 2-m) in the plasma. In order to eliminate beta 2-m from the circulating blood, the beta 2-m selective adsorbent for direct hemoperfusion (DHP) was developed. A DHP column (BM-01), containing 350 ml of the adsorbent, was subjected to clinical trials. The column was connected with a PAN (AN69) membrane dialyzer in series and used 3 times a week for 1 week (11 patients), 4 weeks (5 patients), 6 months (1 patient) and 12 months (2 patients). The percent reduction (%) of beta 2-m was for 16 patients (for 1 or 4 weeks), more than 65, and for 3 patients (for more than 6 months), 76.5 +/- 4.9, 73.5 +/- 5.7, 72.2 +/- 6.2. At the end of each session, beta 2-m plasma levels were found to be below 10 mg/L, with 3.4 mg/L being the lowest. The total amounts of beta 2-m removed were 172.5 +/- 22.3, 257.0 +/- 75.6, 157.6 +/- 32.2 and 429.8 mg/session at max. Two out of these three patients had a favorable effect on joint symptoms and ocular fundus. It can be concluded that this selective adsorption therapy may delay the progression of DRA, and is worth considering for wide application.

Site-directed mutagenesis of a hexapeptide segment involved in substrate recognition of phenylalanine dehydrogenase from Thermoactinomyces intermedius.

Phenylalanine dehydrogenase from Thermoactinomyces intermedius and leucine dehydrogenase from Bacillus stearothermophilus show a 59% sequence similarity in their substrate-binding domains, although their substrate specificities are different. We prepared a phenylalanine dehydrogenase mutant enzyme whose inherent hexapeptide segment (124F-V-H-A-A-129R) in the substrate-binding domain was replaced by the corresponding part of leucine dehydrogenase (M-D-I-I-Y-Q) in order to investigate the mechanism of substrate recognition by phenylalanine dehydrogenase. The catalytic efficiencies (kcat/Km) of the mutant enzyme with aliphatic amino acids and aliphatic keto acids as substrates were 0.5 to 2% of those of the wild-type enzyme. In contrast, the efficiencies for L-phenylalanine and phenylpyruvate decreased to 0.008 and 0.035% of those of the wild-type enzyme, respectively. These results suggest that the hexapeptide segment plays an important role in the substrate recognition by phenylalanine dehydrogenase.

Acyl group transfer from the sn-1 position of phospholipids in the biosynthesis of n-dodecyl palmitate.

The wax ester n-dodecyl palmitate is shown to be synthesized by retinal pigment epithelial membranes. The biosynthesis of this ester is phospholipid dependent and occurs via the transfer of a palmitoyl group from the sn-1 position of lecithin to n-dodecanol. When retinal pigment epithelial membranes are used as the source of enzyme, the apparent Michaelis constant for n-dodecanol in this process is 65.8 microM, and the maximal velocity for n-dodecyl palmitate synthesis is 16.2 nmol/(h.mg of protein). The enzymatic activity is membrane associated and shows a maximum velocity between pH8 and pH9. This transesterification process appears to be similar to the lecithin retinol acyl transferase reaction and is a further example of acyl group transfer reactions from the sn-1 position of phospholipids.

Stannum (IV) chloride stimulates vanadium (IV) catalyzed oxidation of NADH.

Stannum has been found to be an essential ultratrace element, however, the biological functions of stannum remain to be clarified. We found that stannum (IV) chloride stimulates vanadium (IV) catalyzed free radical chain oxidation of NADH. Stannum (IV) chloride, per se, did not catalyze the NADH oxidation. Superoxide, H2O2, and OH. are known to be the key species in vanadium catalyzed NADH oxidation. The inhibition of the vanadium (IV) catalyzed NADH oxidation in the presence of stannum (IV) chloride by catalase, superoxide dismutase (SOD), and hydroxyl radical scavengers indicated that the stannum (IV) chloride stimulated NADH oxidation consisted of almost the same reaction steps as that in the absence of stannum (IV) chloride. The results of inhibition studies on the NADH oxidation with SOD and catalase suggested that the reaction mixture containing stannum (IV) chloride contained a greater amount of H2O2 and a lower amount of O2- than that containing only vanadium (IV). Hydrogen peroxide is the precursor of OH. in the free radical chain reaction. The stimulation of NADH oxidation by stannum (IV) chloride is due to the stimulation of H atom abstraction by OH.. Stannum (IV) chloride might stimulate the generation of OH. by producing H2O2.

Affinity labeling of lecithin retinol acyltransferase.

Lecithin retinol acyltransferase (LRAT) transfers acyl groups regiospecifically from the sn-1 position of lecithins to all-trans-retinol (vitamin A) and similar retinoids. LRAT is essential for the biosynthesis of 11-cis-retinal, the visual pigment chromophore. LRAT is also required for the general dietary mobilization of vitamin A. The enzyme is membrane-bound and has been solubilized and partially, but not completely, purified. It is demonstrated here that all-trans-retinyl alpha-bromoacetate (RBA) is a potent irreversible affinity labeling agent of LRAT. The measured KI = 12.1 microM and the pseudo-first-order rate constant for inhibition is kinh = 8.2 x 10(-4) s-1. The specificity of the inhibition process is further evidenced by the observation that alpha-bromoacetate derivatives of hydrophobic alcohols which are not substrates for LRAT, such as cholesterol and beta-ionol, are not inhibitors of the enzyme. Labeling of the partially purified enzyme with 3H-RBA showed a single radiolabeled band of molecular weight approximately 25,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Purification and characterization of a new NAD(+)-dependent enzyme, L-tartrate decarboxylase, from Pseudomonas sp. group Ve-2.

A new enzyme, L-tartrate decarboxylase, was found in cells of Pseudomonas sp. group Ve-2. The enzyme was purified to homogeneity and characterized. The enzyme requires K+, Mg2+, and NAD+ for L-tartrate decarboxylation. The dependence of the enzymatic decarboxylation on NAD+ suggests that the decarboxylation involves redox reactions of the substrate. The enzyme catalyzes NAD(+)-linked oxidative decarboxylation of D-malate as well. The enzyme is composed of four subunits with identical molecular weight (Mr 40,000). The apparent Michaelis constants for L-tartrate and NAD+ are 1.1 mM, respectively. The cofactor requirements and the physical properties of the enzyme were similar to those of L-tartrate dehydrogenase-D-malate dehydrogenase from Rhodopseudomonas sphaeroides, and tartrate dehydrogenase from P. putida.