Can the electrophysiological action of rosiglitazone explain its cardiac side effects?

Recent large clinical trials found an association between the antidiabetic drug rosiglitazone therapy and increased risk of cardiovascular adverse events. The aim of this report is to elucidate the cardiac electrophysiological properties of rosiglitazone (R) on isolated rat and murine ventricular papillary muscle cells and canine ventricular myocytes using conventional microelectrode, whole cell voltage clamp, and action potential (AP) voltage clamp techniques. In histidine-decarboxylase knockout mice as well as in their wild types R (1-30 µM) shortened AP duration at 90% level of repolarization (APD(90)) and increased the AP amplitude (APA) in a concentration-dependent manner. In rat ventricular papillary muscle cells R (1-30 µM) caused a significant reduction of APA and maximum velocity of depolarization (V(max)) which was accompanied by lengthening of APD(90). In single canine ventricular myocytes at concentrations ≥10 µM R decreased the amplitude of phase-1 repolarization, the plateau potential and reduced V(max). R suppressed several ion currents in a concentration-dependent manner under voltage clamp conditions. The EC(50) value for this inhibition was 25.2±2.7 µM for the transient outward K(+ ) current (I(to)), 72.3±9.3 µM for the rapid delayed rectifier K(+ ) current (I(Kr)), and 82.5±9.4 µM for the L-type Ca(2+ ) current (I(Ca)) with Hill coefficients close to unity. The inward rectifier K(+ ) current (I(K1)) was not affected by R up to concentrations of 100 µM. Suppression of I(to), I(Kr), and I(Ca) has been confirmed under action potential voltage clamp conditions as well. The observed alterations in the AP morphology and densities of ion currents may predict serious proarrhythmic risk in case of intoxication with R as a consequence of overdose or decreased elimination of the drug, particularly in patients having multiple cardiovascular risk factors, such as elderly diabetic patients.

Effects of rosiglitazone on the configuration of action potentials and ion currents in canine ventricular cells.

BACKGROUND AND PURPOSE: In spite of its widespread clinical application, there is little information on the cellular cardiac effects of the antidiabetic drug rosiglitazone in larger experimental animals. In the present study therefore concentration-dependent effects of rosiglitazone on action potential morphology and the underlying ion currents were studied in dog hearts. EXPERIMENTAL APPROACH: Standard microelectrode techniques, conventional whole cell patch clamp and action potential voltage clamp techniques were applied in enzymatically dispersed ventricular cells from dog hearts. KEY RESULTS: At concentrations ≥10 µM rosiglitazone decreased the amplitude of phase-1 repolarization, reduced the maximum velocity of depolarization and caused depression of the plateau potential. These effects developed rapidly and were readily reversible upon washout. Rosiglitazone suppressed several transmembrane ion currents, concentration-dependently, under conventional voltage clamp conditions and altered their kinetic properties. The EC(50) value for this inhibition was 25.2 ± 2.7 µM for the transient outward K(+) current (I(to)), 72.3 ± 9.3 µM for the rapid delayed rectifier K(+) current (I(Kr)) and 82.5 ± 9.4 µM for the L-type Ca(2+) current (I(Ca) ) with Hill coefficients close to unity. The inward rectifier K(+) current (I(K1)) was not affected by rosiglitazone up to concentrations of 100 µM. Suppression of I(to), I(Kr), and I(Ca) was confirmed also under action potential voltage clamp conditions. CONCLUSIONS AND IMPLICATIONS: Alterations in the densities and kinetic properties of ion currents may carry serious pro-arrhythmic risk in case of overdose with rosiglitazone, especially in patients having multiple cardiovascular risk factors, like elderly diabetic patients.

Effects of vaccination with heat shock proteins on streptozotocin induced diabetes in histidine decarboxylase knockout mice.

RATIONALE: Type 1 diabetes mellitus (T1D) is an immune mediated disease in which heat shock proteins (hsps) may be involved in the development of the disease. Furthermore, vaccination with different hsps prevented the development of multiple low-dose streptozotocin (STZ) induced autoimmune diabetes in C57BL/KSJ mice. Histamine influences many aspects of the immune response, including Th1/Th2 balance and antibody production. Therefore, a study of diabetes-related immune processes was considered of interest in histidine decarboxylase knockout (HDC-KO) mice. AIM OF THE STUDY: The aim of our study was i) to characterize antibody production in response to vaccination with p277 or hsp65 in wild type (WT) BALB/c and HDC-KO mice, and ii) to establish a possible correlation between vaccination and the changes in the pattern of STZ diabetes. MATERIALS AND METHODS: An ELISA was employed to measure the hsp65- and p277-specific antibody levels. To induce diabetes multiple low-dose of STZ was used. RESULTS: Vaccination with p277 and hsp65 altered the pattern of STZ diabetes both in HDC-KO and WT animals, characterized by a transient increase followed by sustained reduction of blood sugar levels as compared to controls. However, vaccination with hsp65 and p277 caused a significant anti-p277 and anti-hsp65 antibody level increase only in WT animals. CONCLUSION: Multiple low-doses of STZ were able to induce diabetes in HDC-KO mice and the development of diabetes was prevented by vaccination with hsps. This protection developed in spite of the fact that vaccination caused a significant antibody level increase only in WT animals. To explain the therapeutic effect of vaccination we need further examination of the HDC KO strain.

Th1 and Th2 cell responses of type 1 diabetes patients and healthy controls to human heat-shock protein 60 peptides AA437-460 and AA394-408.

RATIONALE: Type 1 diabetes mellitus (T1) is considered to be an immune mediated disease. Based on previous findings it might be suggested that heat shock protein 60 (Hsp60) could be involved in the mediation of the development of the disease. Furthermore a bias toward Th1 immune response was observed in T1D patients where the level of Th1 cytokines was elevated, while the level of Th2 was decreased. AIM OF THE STUDY: To determine Th1 (IFN-gamma) and Th2 (IL-13) cytokine levels in T1 diabetic and control subjects as well as to determine whether there is a shift towards Th1 or Th2 immune response. MATERIALS AND METHODS: ELISPOT (Enzyme-linked ImmunoSPOT) analysis was employed to differentiate antigen specific T-cell responses of a Th1 (IFN-gamma) or Th2 (IL-13) type. 11 T1 diabetic patients and 9 healthy controls were investigated. For T-cell stimulation, we used a polyclonal mitogen or Tetanus toxoid (TT) as positive controls and two peptide antigens Hsp60 AA394-408 and Hsp60 AA437-460. RESULTS: In case of Hsp60 AA437-460 we found significantly decreased Th2 response in patients, although there was no significant difference in Th1 response. In case of Hsp60 AA394-408 and positive controls there was no significant difference. CONCLUSION: Comparing the control and diabetic subjects a significant shift towards Th1 response in T1 diabetes mellitus for Hsp60 AA437-460 was observed.

Comparative study on antibodies to human and bacterial 60 kDa heat shock proteins in a large cohort of patients with coronary heart disease and healthy subjects.

BACKGROUND: Recent observations indicate an association between antibodies against mycobacterial heat shock protein (hsp65) and coronary heart disease (CHD). Previously, we reported on marked differences in antigen specificity and complement activating ability of anti-hsp65 antibodies and auto-antibodies against human heat shock protein, hsp60. Here, we investigated whether there are differences between antih-sp65 and anti-hsp60 antibodies in their association with CHD. DESIGN: We measured by ELISA the levels of antibodies to hsp65, hsp60 and E. coli-derived GroEL in three groups: Group I, 357 patients with severe CHD who underwent by-pass surgery; Group II, 67 patients with negative coronary angiography; Group III, 321 healthy blood donors. Antibodies against Helicobacter pylori were also measured by commercial ELISA. RESULTS: As calculated by multiple regression analysis, the levels of anti-hsp60 auto-antibodies were significantly higher in Group I compared to Group II (P = 0.007) or Group III (P < 0.0001). By contrast, although concentrations of anti-hsp65 and anti-GroEL antibodies in Group I were higher than in Group III, no significant differences between Group I and Group II were found. Antibodies to the two bacterial hsp strongly correlated to each other, but either did not correlate or weakly correlated to hsp60. In Group I, serum concentrations of anti-H.pylori antibodies significantly correlated with those of anti-hsp65 and anti-GroEL antibodies but they did not correlate with the anti-hsp60 antibodies. CONCLUSIONS: As to their clinical relevance, a remarkable difference become evident between antibodies to human hsp60 and antibodies against bacterial hsp in the extent of association with CHD. On the basis of these findings and some pertinent literature data, an alternative explanation for the association between high level of anti-hsp antibodies and atherosclerotic vascular diseases is raised.

Mapping the functional domains of nucleolar protein B23.

Protein B23 is a multifunctional nucleolar protein whose cellular location and characteristics strongly suggest that it is a ribosome assembly factor. The protein has nucleic acid binding, ribonuclease, and molecular chaperone activities. To determine the contributions of unique polypeptide segments enriched in certain classes of amino acid residues to the respective activities, several constructs that produced N- and C-terminal deletion mutant proteins were prepared. The C-terminal quarter of the protein was shown to be necessary and sufficient for nucleic acid binding. Basic and aromatic segments at the N- and C-terminal ends, respectively, of the nucleic acid binding region were required for activity. The molecular chaperone activity was contained in the N-terminal half of the molecule, with important contributions from both nonpolar and acidic regions. The chaperone activity also correlated with the ability of the protein to form oligomers. The central portion of the molecule was required for ribonuclease activity and possibly contains the catalytic site; this region overlapped with the chaperone-containing segment of the molecule. The C-terminal, nucleic acid-binding region enhanced the ribonuclease activity but was not essential for it. These data suggest that the three activities reside in mainly separate but partially overlapping segments of the polypeptide chain.

The nucleolus: an old factory with unexpected capabilities.

The function of the nucleolus as a factory for assembling ribosomal subunits is well established, but many unrelated activities have been discovered over the past decade. Our understanding of the dynamics of nucleolar structure and its reassembly at the end of mitosis has recently advanced and the small nucleolar RNAs have been shown to be major players in the processing and modification of preribosomal RNA. Unexpectedly, the nucleolus also seems to play a role in nuclear export, sequestering regulatory molecules, modifying small RNAs, assembling ribonucleoprotein (RNP) and controlling aging.

Nucleolar protein B23 has molecular chaperone activities.

Protein B23 is an abundant, multifunctional nucleolar phosphoprotein whose activities are proposed to play a role in ribosome assembly. Szebeni et al. (1997) showed stimulation of nuclear import in vitro by protein B23 and suggested that this effect was due to a molecular chaperone-like activity. Protein B23 was tested for chaperone activities using several protein substrates. The temperature-dependent and -independent aggregation of the HIV-1 Rev protein was measured using a zero angle light scattering (turbidity) assay. Protein B23 inhibited the aggregation of the Rev protein, with the amount of inhibition proportional to the concentration of B23 added. This activity was saturable with nearly complete inhibition when the molar ratio of B23:Rev was slightly above one. Protein B23 also protected liver alcohol dehydrogenase (LADH), carboxypeptidase A, citrate synthase, and rhodanese from aggregation during thermal denaturation and preserved the enzyme activity of LADH under these conditions. In addition, protein B23 was able to promote the restoration of activity of LADH previously denatured with guanidine-HCl. Protein B23 preferentially bound denatured substrates and exposed hydrophobic regions when complexed with denatured proteins. Thus, by several criteria, protein B23 behaves like a molecular chaperone; these activities may be related to its role in ribosome biogenesis.

Nucleolar protein B23 stimulates nuclear import of the HIV-1 Rev protein and NLS-conjugated albumin.

Nucleolar phosphoprotein B23 is a putative ribosome assembly factor with a relatively high affinity for peptides containing sequences of nuclear localization signals (NLSs) of the SV40 T-antigen type [Szebeni, A., Herrera, J. E., & Olson, O. J. (1995) Biochemistry 34, 8037-8042]. The effects of protein B23 on nuclear import were determined by an in vitro assay [Dean, D. A., & Kasamatsu, H. (1994) J. Biol. Chem. 269, 4910-4916] using NLS peptide-conjugated bovine serum albumin (NLS-BSA) or the HIV-1 Rev protein as substrates for import into isolated rat liver nuclei. The import was ATP-dependent and inhibited by wheat germ agglutinin or by an antibody against p97, a component of the nuclear import system. The rate of import of either substrate was increased if protein B23 was added to the incubation medium. Similar enhancements of import were seen with both isoforms (B23.1 and B23.2). The stimulatory effect on Rev protein import was saturable with maximum stimulation (2-3-fold) at a molar ratio of protein B23:Rev of approximately 1:1. Phosphorylation of protein B23.1 by casein kinase II produced an additional doubling of the import rate. This effect was not seen if protein B23.1 was phosphorylated with a cdc2 type protein kinase. Mutant forms of protein B23.1 in which the nuclear localization signal was either deleted or altered did not stimulate import of the substrates. These results suggest that protein B23 plays a role as an accessory factor in the nuclear import of the NLS-containing proteins and that phosphorylation at sites in the highly acidic segments of the protein enhances the stimulatory effect.

Interaction of nucleolar protein B23 with peptides related to nuclear localization signals.

Nucleolar protein B23 is a putative ribosome assembly factor with a high affinity for peptides containing nuclear localization signals (NLSs). The interactions of various NLS-containing peptides with two B23 isoforms (B23.1 and B23.2) were examined using equilibrium dialysis and Scatchard analyses. The KD for protein B23 binding to a peptide containing the SV40 T-antigen NLS sequence was approximately 1 microM with a stoichiometry of 1:1 (peptide:protein). No significant differences were seen between the two B23 isoforms in their affinities for any of the peptides tested. Binding by a reverse sequence SV40 T-NLS peptide showed a nonlinear Scatchard plot: this peptide was unable displace the correct sequence peptide, suggesting that the reverse sequence peptide binds to a different site on the protein. A peptide containing the sequence required for nucleolar localization of the HIV-1 Rev protein had an affinity for B23 approximately 10-fold greater than that of the SV40 T-NLS. However, with a sequence sufficient only for Rev location in the nucleoplasm, the affinity for B23 was diminished to a level between that of the longer Rev sequence and the SV40 T-NLS. In competition binding assays, the Rev NLS peptide was able to displace the SV40 T NLS, indicating that both peptides bind to the same site on protein B23. There was no detectable binding to protein B23 by a peptide containing the bipartite NLS of nucleoplasmin. Phosphorylation of protein B23 by casein kinase II enhanced its affinity for the SV40 T- and Rev-derived peptides approximately 2-fold.(ABSTRACT TRUNCATED AT 250 WORDS)

The nucleic acid binding activity of nucleolar protein B23.1 resides in its carboxyl-terminal end.

Protein B23 is a major nucleolar phosphoprotein proposed to be a ribosome assembly factor. Protein B23 exists as two isoforms, B23.1 and B23.2, differing only in their carboxyl-terminal sequences. The interaction of recombinantly produced B23 isoforms with double-stranded DNA was studied using gel retardation and nitrocellulose filter disk assays. Protein B23.1 bound saturably to radiolabeled plasmid DNA. By competition assays protein B23.1 was also capable of binding RNA and single-stranded DNA. On the other hand, protein B23.2, the shorter of the two isoforms, was not capable of binding double-stranded DNA. The latter result suggested that the carboxyl-terminal end of B23.1 is essential for DNA binding activity. This was confirmed by partial digestion experiments using staphylococcal V8 protease which showed that a 5-kDa fragment, containing the carboxyl-terminal end of protein B23.1 retained DNA binding activity similar to that of the parent molecule. In contrast, a 19-kDa fragment from the amino-terminal half of B23.1 did not bind DNA. The sequence of the carboxyl-terminal 68 amino acids comprising the 5-kDa fragment showed little, if any, similarity to other proteins, suggesting that this segment contains a previously undiscovered nucleic acid binding motif.

Basal and thrombin-stimulated platelet cell calcium.

To study platelet cell calcium in dogs, we measured the fura-2-determined calcium concentration (Cai) in platelets derived from blood drawn through indwelling arterial catheters in four dogs. Platelet samples were obtained 3 days a week for 39 days. Canine platelet Cai averages 40.5 +/- 1.7 nmol/L when corrected for extracellular fura-2 dye (n = 46); this mean is significantly smaller than the value obtained without such a correction (50.2 +/- 2.0 nmol/L, P < .05). The amplitude of thrombin-induced Ca2+ transients is proportional to basal Cai, increasing 4.9 +/- 0.9 nmol/L peak Ca2+ per nmol/L increase in baseline Ca2+.

New simple method for thyroid volume determination by ultrasonography.

A new, simple, and accurate ultrasonic method is elaborated for thyroid volume determination with commercially available high-resolution real-time equipment. The method takes into account the special and variable shape of the thyroid. The measurements were taken in three perpendicular sections. Volume calculations were done by applying the corrected ellipsoid model and computer-aided numerical integration, as well as by the conventional simple ellipsoid model. The accuracy of the method was tested by comparing direct measurements of a silicone rubber phantom with ultrasonography of a tissue-equivalent thyroid phantom. Both phantoms were modeled as casts of the same thyroid, which was obtained at autopsy. From the phantom measurements the deviation between the volume calculated by numerical integration or the corrected ellipsoid method and the real volume determined directly with the silicone rubber phantom was less than 5% on average, while volume calculations using the conventional ellipsoid model involved about +20% systematic error. In vivo studies in 40 subjects gave similar results: the ratios of the volumes calculated by simple and corrected ellipsoid method and by numerical integration [V(E), V(CE), and V(NI), respectively] were [V(E)/V(CE)] = 1.19 +/- 0.11 and [V(NI)/V(CE)] = 1.02 +/- 0.11. In conclusion corrected ellipsoid method is suggested for the clinical practice.

Transient cholinergic glycoconjugate secretion from swine tracheal submucosal gland cells.

By inference, muscarinic stimulation of glycoconjugate release from tracheal submucosal gland cells appears to be a transient, nonequilibrium process (J. M. Farley and T. M. Dwyer, Life Sci. 48: 59-67, 1991). To directly characterize the release kinetics of glycoconjugate, we developed an enzyme-linked lectin assay (ELLA) of much improved precision and resolution. To collect secreted products with an improved time resolution, freshly isolated swine tracheal submucosal gland cells were continuously superfused with medium 199 at 37 degrees, buffered with N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES) and CO2 or bicarbonate; fractions were collected every 15 s to 2 min. A 30-s pulse of 30 nM acetylcholine (ACh) increased the rate of glycoconjugate release by 10- to 25-fold for 2-3 min. The peak response averaged 14.2 +/- 9.0 ng protein.ml-1.min-1. 4 million cells-1 or 3.6 +/- 2.3 fg.cell-1.min-1 for 30 nM ACh and 16.2 +/- 3.0 ng protein.ml-1.min-1 for 100 nM ACh. There was no significant glycoconjugate release following a 30-s pulse of either 10 nM or 1 microM ACh. A second pulse after 7 min had no measurable effect on glycoconjugate release but a full response was obtained after 30 min. A continuous superfusion begun 1 min following the 30-s pulse resulted in a greater release of glycoconjugate than the pulse alone, but the response was not sustained, falling to twice basal levels within 5 min. We conclude that a brief muscarinic stimulation causes a triggered release of mucus glycoprotein followed by a relative refractory period.

[First experiences with ultrasonic diagnosis using gastroenterologic endoscopy in Hungary]. / Elsö hazai tapasztalatok gastroenterologiai endoszkópos ultrahangvizsgálattal.

The authors were the first to gain experiences with gastroenterological endoscopic ultrasonography (EUS) in Hungary. Their examinations included the study of the esophageal wall and its environment as well as that of the stomach wall and the neighbouring organs. The construction of the instrument, the technique of the method and the indication for EUS are described on the basis of the authors' experiences and the literary data. They were the first to demonstrate perigastric effusion with EUS. On the basis of the observations it is stated that EUS is more reliable than other methods for the determination of the patency of varices following sclerotherapy. Thus this technique may improve the control of the efficacy of sclerotherapy in patients with portal hypertension. The authors wish to support their observation with prospective examination series carried out with high number of patients.

[Ultrasound-guided percutaneous antegrade wirsungography in chronic calcifying pancreatitis]. / Ultrahanggal vezérelt percutan antegrad wirsungographia idült kalcifikáló pancreatitisben.

Dilated pancreatic duct was found by ultrasonography in a patient in association with the characteristic sonographic features of chronic calcifying pancreatitis. Endoscopic retrograde pancreatography showed an obstruction of the Wirsung's duct 3 cm far from the papilla of Vater. Further parts of the duct could not be opacified by this manner. However, visualisation of the rest of the pancreatic duct was successfully performed by ultrasonically guided antegrade wirsungography making the preoperative planning of the suitable type of surgery possible. Beside the case history the importance of the is method is also discussed in diagnosis of pancreatic diseases.

Ultrasonography and water content of the liver in chronic diffuse liver disease.

Water content in the liver in vivo was determined in 89 patients (33 with normal liver and 56 with chronic liver disease), simultaneously with ultrasonography and histopathological examination. A part of each biopsy specimen was used for this purpose. The difference between wet and dry weights was calculated from the pre- and post-lyophilization weights. According to the attenuation type of ultrasonic images, the patients were divided into two groups, viz., patients of low attenuation type (i.e. patients with type I bright liver) and those of high attenuation type (i.e. with type II bright liver). As to water content, no significant difference was observed between the two groups. No correlation was found between liver water content and histopathology either. It is concluded that knowledge of correlation between numerous parameters is needed to clarify the reason of attenuation differences.

Ultrasonography in the preoperative diagnosis of chronic pancreatitis causing severe obstruction, and in indication for surgery.

It is pointed out that some cases of chronic pancreatitis causing severe obstruction may clinically simulate tumour. This can occasionally be confirmed by other examinations (e.g. ERCP) or by macroscopic inspection at surgery, and palpation. With the passive symptomatological treatment applied in these cases, the patients' condition keeps on deteriorating, reinforcing the suspicion of tumour. Sonography performed by a high-resolution equipment may raise, as an alternative to the tumour, the prevalence of chronic pancreatitis. Of 169 documented cases 7 were found to be of this condition. The strict criteria of establishing diagnosis are reviewed, supported by figures and case reports.

Intravesical ultrasonography as an aid to study the size of bladder cancers.

On clinical examination of 50 patients with bladder cancer the authors performed intravesical ultrasonography. By this method they never failed to detect the tumours. The stage of the pathological material obtained by operation or at autopsy was compared with that obtained by the intravesical ultrasonography. In 88% of the cases the two classifications gave identical results. By ultrasonography the pathologic stage was overestimated in 4, and underestimated in 2 cases. Intravesical ultrasonography can be combined with cystoscopy. It is a fast procedure and an ideal supplement to cystoscopy. The combination of the two methods permits the localization of intravesical tumours as well as the estimation of invasion and of the degree of infiltration.