Targeting orphan G protein-coupled receptors for the treatment of diabetes and its complications: C-peptide and GPR146.

G protein-coupled receptors (GPCRs) are the most abundant receptor family encoded by the human genome and are the targets of a high percentage of drugs currently in use or in clinical trials for the treatment of diseases such as diabetes and its associated complications. Thus, orphan GPCRs, for which the ligand is unknown, represent an important untapped source of therapeutic potential for the treatment of many diseases. We have identified the previously orphan GPCR, GPR146, as the putative receptor of proinsulin C-peptide, which may prove to be an effective treatment for diabetes-associated complications. For example, we have found a potential role of C-peptide and GPR146 in regulating the function of the retinal pigment epithelium, a monolayer of cells in the retina that serves as part of the blood-retinal barrier and is disrupted in diabetic macular oedema. However, C-peptide signalling in this cell type appears to depend at least in part on extracellular glucose concentration and its interaction with insulin. In this review, we discuss the therapeutic potential of orphan GPCRs with a special focus on C-peptide and GPR146, including past and current strategies used to 'deorphanize' this diverse family of receptors, past successes and the inherent difficulties of this process.

Diversity of the Ig repertoire is maintained with age in spite of reduced germinal centre cells in human tonsil lymphoid tissue.

Humans and almost all species studied to date exhibit a decreased responsiveness to immunization and increased autoimmunity with age. While this has been observed clinically for decades, only recently has an understanding of the molecular basis for these changes begun to be appreciated. Studies of the B-cell aspects of these changes in ageing mice and the very few reports in ageing humans have not been conclusive. Here we examine the nucleotide sequence of over 1250 VH transcripts from the tonsils of individuals of various ages for changes to the VH4 immunoglobulin repertoire. An exhaustive examination of VH, DH and JH gene segment utilization revealed a remarkable similarity of the repertoires. The extent of somatic hypermutation was fully maintained or even increased by some measures into the eighth decade of life. However, we found by middle age that the representation of naïve and germinal centre B-cell subpopulations changed relative to total B lymphocytes in the tonsil. While the percentage of naïve and germinal centre B-cell subpopulations changes during the second half of life, these findings suggest that even with advancing age, humans remain capable of generating an extremely diverse Ig repertoire while maintaining a similar spectrum of Ig rearrangements once the germinal centre reaction begins.

Immunoglobulin heavy-chain receptor editing is observed in the NOD/SCID model of human B-cell development.

Receptor editing and receptor revision are the two mechanisms of antibody diversity that result in either complete V-gene replacement or the formation of hybrid V genes. We do not yet understand how this process unfolds, because they are rare and difficult to study in vivo. In this study, we describe a family of VH4-34:VH4-61 hybrids isolated from a human B-cell chimeric non-obese diabetic/severe combined immunodeficient mouse. The observation of hybrid immunoglobulin sequences in human B cells that developed in this model system makes it useful for the study of this mechanism of diversification and tolerance.

The NOD/SCID chimeric mouse model of human B cell development: studies on the VH4 family immunoglobulin repertoire and implications for SLE.

The use of the NOD/SCID mouse as a transplant recipient for human cord blood B cell progenitors as a tool for investigations into the development of human B cells has become an exciting reality. The characteristics of the immunoglobulin repertoire in such a model is important to investigate, as it is possible that normal or skewed representations could be produced. Here we review our current work in which we describe a normal VH4 repertoire produced in this chimeric mouse model and describe the differences in combinatorial diversity between the human cells that were isolated from the bone marrow and spleen. The implications of this model for studies of systemic lupus erythematosus are also discussed.

Dealing with DRGs: analysis of serum theophylline assays in Medicare patients.

To investigate the therapeutic and economic implications of serum theophylline assay (STA) use in Medicare patients classified in diagnosis-related group 88 as having chronic obstructive pulmonary disease, a retrospective audit was conducted of all serum theophylline assays ordered for these patients in a large teaching hospital during a 6-month period. Based on established pharmacokinetic principles of theophylline therapy, analysis was conducted on rational indication for assay use (n = 146), correct sampling procedure regarding steady-state and peak/trough concentrations (n = 99), and appropriateness of physician response (n = 100). Percentages of appropriate use found for these three parameters were 79.2%, 56.6%, and 85.0%, respectively. Overall compliance regarding all three considerations was 52.1%; this figure declined to 29.9% when admission level assays were excluded from consideration. A need is identified to improve STA sampling procedures in order to insure availability of accurate and valid results on which to make indicated changes in drug therapy.