Contra la medicina basada en la evidencia / Against evidence Based Medicine

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[White-on-white, blue-on-yellow and blue-on-blue perimetry in normal subjects]. / Perimetrías blanco-blanco, azul-amarillo y azul-azul en sujetos normales.

PURPOSE: To compare blue-on-blue differential contrast perimetry (BB), in accordance with E. Land "Retinex" theory, with white-on-white (WW) and blue-on-yellow (BY) perimetries on normal subjects. METHODS: An Octopus 101 perimeter was modified for BB perimetry, using a 4cd/m2 background and stimulus Goldmann size V. Fifty healthy subjects (10 per decade, from 20 to 70 years) were examined twice with each type of perimetry (WW, BB, BY) using the TOP strategy. RESULTS: The results obtained with WW, BY and BB perimetry were respectively: Reduction of sensitivity per year: 0.13, 0.27 and 0.13 dB; correlation coefficient (r) of threshold with age (and error of estimation of Y over X): -0.63 (2.24 dB), -0.70 (3.77 dB) and -0.80 (1.32 dB); threshold fluctuation: 2.21, 3.03 and 2.03 dB; percentage of points deviated more than 5dB from the expected value for the patient age: 8.1, 16.0 and 4.2%. CONCLUSIONS: Perimetric results are more stable with BB strategy than with the other two types of perimetry. BY perimetry gives the worst results: threshold reduction with age is twice higher, individual fluctuation is 50% higher and points away from the mean value are much more frequent. Overlapping between blue and yellow filters is minimal in Octopus. Therefore, an absolute threshold is examined, which is much more unstable than WW or BB differential thresholds.

[Update on glaucoma diagnosis and follow-up]. / Estado actual del diagnóstico y control evolutivo del glaucoma.

PURPOSE: To compare the different methods proposed for glaucoma diagnosis and follow-up. METHODS: Review of those papers that have published the sensitivity and specificity of the different methods, as well as simultaneous comparative studies of several of these methods, especially those that used patients in the initial stages of the disease. RESULTS: After analyzing the sensitivity and specificity results of the proposed techniques, we have found no evidence that blue-yellow perimetry (SWAP), nerve fibers photography, laser polarimetry (GDx), electrophysiological techniques or optic nerve head topography have better diagnosis abilities than white-white perimetry. This last technique evolves with the others, giving new criteria and strategies with higher precision. The different comparative results of the anatomical and functional procedures do not coincide and do not allow one to establish definite conclusions. CONCLUSIONS: The most promising expectations are nowadays on temporal phenomena (FDT, Flicker, PULSAR), new methods for analyzing optic nerve topography results and the value of the loss variance (LV) on TOP perimetry. The worst results correspond to blue-yellow perimetry and GDx.

Estado actual del diagnóstico y control evolutivo del glaucoma / Update on glaucoma diagnosis and follow-up

Objetivo: Comparar los diversos métodos propuestos para el diagnóstico y control evolutivo del glaucoma. Método: Revisión de los trabajos que han publicado cifras de sensibilidad y especificidad de los diferentes procedimientos, así como los estudios comparativos simultáneos de varios de ellos, especialmente los que han utilizado pacientes en fases iniciales. Resultados: Analizado globalmente las cifras de sensibilidad y especificidad de las diferentes técnicas que se han propuesto, no hemos encontrado evidencia de que la perimetría azul-amarillo (SWAP), la fotografía de las fibras nerviosas, la polarimetría laser (GDx), las pruebas electrofisiológicas o la topografía papilar superen en capacidad diagnóstica a la perimetría blanco blanco. Esta última evoluciona con las otras técnicas proporcionando nuevos criterios y estrategias de mayor precisión. Los diversos resultados comparativos de los procedimientos anatómicos y funcionales no son coincidentes y no permiten establecer conclusiones definitivas. Conclusiones: Las mejores expectativas se encuentran actualmente en los fenómenos temporales (FDT, Flicker, PULSAR), en nuevos métodos de análisis de los resultados de la topografía papilar y en el valor de la varianza (LV) en la perimetría TOP. Los peores resultados corresponden a la perimetría azul-amarillo y a GDX (AU)

Purpose: To compare the different methods proposed for glaucoma diagnosis and follow-up. Methods: Review of those papers that have published the sensitivity and specificity of the different methods, as well as simultaneous comparative studies of several of these methods, especially those that used patients in the initial stages of the disease. Results: After analyzing the sensitivity and specificity results of the proposed techniques, we have found no evidence that blue-yellow perimetry (SWAP), nerve fibers photography, laser polarimetry (GDx), electrophysiological techniques or optic nerve head topography have better diagnosis abilities than white-white perimetry. This last technique evolves with the others, giving new criteria and strategies with higher precision. The different comparative results of the anatomical and functional procedures do not coincide and do not allow one to establish definite conclusions. Conclusions: The most promising expectations are nowadays on temporal phenomena (FDT, Flicker, PULSAR), new methods for analyzing optic nerve topography results and the value of the loss variance (LV) on TOP perimetry. The worst results correspond to blue-yellow perimetry and GDx (AU)

The unique proline of the Prochlorothrix hollandica plastocyanin hydrophobic patch impairs electron transfer to photosystem I.

A number of surface residues of plastocyanin from Prochlorothrix hollandica have been modified by site-directed mutagenesis. Changes have been made in amino acids located in the amino-terminal hydrophobic patch of the copper protein, which presents a variant structure as compared with other plastocyanins. The single mutants Y12G, Y12F, Y12W, P14L, and double mutant Y12G/P14L have been produced. Their reactivity toward photosystem I has been analyzed by laser flash absorption spectroscopy. Plots of the observed rate constant with all mutants versus plastocyanin concentration show a saturation profile similar to that with wild-type plastocyanin, thus suggesting the formation of a plastocyanin-photosystem I transient complex. The mutations do not induce relevant changes in the equilibrium constant for complex formation but induce significant variations in the electron transfer rate constant, mainly with the two mutants at proline 14. Additionally, molecular dynamics calculations indicate that mutations at position 14 yield small changes in the geometry of the copper center. The comparative kinetic analysis of the reactivity of plastocyanin mutants toward photosystem I from different organisms (plants and cyanobacteria) reveals that reversion of the unique proline of Prochlorothrix plastocyanin to the conserved leucine of all other plastocyanins at this position enhances the reactivity of the Prochlorothrix protein.

Crystal structure of low-potential cytochrome c549 from Synechocystis sp. PCC 6803 at 1.21 A resolution.

The crystal structure of low-potential cytochrome c549, an extrinsic component of the photosystem II (PS II) from Synechocystis sp. PCC 6803, was obtained directly from single-wavelength 1.21 A resolution diffraction data. This is the first monodomain bis-histidinyl monoheme cytochrome c to be structurally characterized. The extended N-terminal region of c549 builds up a two-strand antiparallel beta-sheet in a hairpin motif, which extends through two molecules owing to crystal packing. Both peptide termini are involved in crystal contacts, which may explain their protrusion out of the globular fold. The C-terminus is preceded by a 9 A-long hydrophobic finger extending from a positively charged base and could be involved in PSII interactions, as well as a protruding negative patch built by a set of conserved acidic residues among c549 sequences.

A single arginyl residue in plastocyanin and in cytochrome c(6) from the cyanobacterium Anabaena sp. PCC 7119 is required for efficient reduction of photosystem I.

Positively charged plastocyanin from Anabaena sp. PCC 7119 was investigated by site-directed mutagenesis. The reactivity of its mutants toward photosystem I was analyzed by laser flash spectroscopy. Replacement of arginine at position 88, which is adjacent to the copper ligand His-87, by glutamine and, in particular, by glutamate makes plastocyanin reduce its availability for transferring electrons to photosystem I. Such a residue in the copper protein thus appears to be isofunctional with Arg-64 (which is close to the heme group) in cytochrome c(6) from Anabaena (Molina-Heredia, F. P., Diaz-Quintana, A., Hervás, M., Navarro, J. A., and De la Rosa, M. A. (1999) J. Biol. Chem. 274, 33565-33570) and Synechocystis (De la Cerda, B., Diaz-Quintana, A., Navarro, J. A. , Hervás, M., and De la Rosa, M. A. (1999) J. Biol. Chem. 274, 13292-13297). Other mutations concern specific residues of plastocyanin either at its positively charged east face (D49K, H57A, H57E, K58A, K58E, Y83A, and Y83F) or at its north hydrophobic pole (L12A, K33A, and K33E). Mutations altering the surface electrostatic potential distribution allow the copper protein to modulate its kinetic efficiency: the more positively charged the interaction site, the higher the rate constant. Whereas replacement of Tyr-83 by either alanine or phenylalanine has no effect on the kinetics of photosystem I reduction, Leu-12 and Lys-33 are essential for the reactivity of plastocyanin.

A comparative study of the thermal stability of plastocyanin, cytochrome c(6) and Photosystem I in thermophilic and mesophilic cyanobacteria.

Cytochrome c(6) (Cyt) from the thermophilic cyanobacterium Phormidium laminosum has been purified and characterized. It is a mildly acidic protein, with physicochemical properties very similar to those of plastocyanin (Pc). This is in agreement with the functional interchangeability of the two metalloproteins as electron donors to Photosystem I (PS I). The kinetic analyses of the interaction of Pc and Cyt with Photosystem I show that both metalloproteins reduce PS I with similar efficiencies, according to an oriented collisional kinetic model involving repulsive electrostatic interactions. The thermostability study of the Phormidium Pc/PS I system compared with those from mesophilic cyanobacteria (Synechocystis, Anabaena and Pseudanabaena) reveals that Pc is the partner limiting the thermostability of the Phormidium couple. The cross-reactions between Pc and PS I from different organisms demonstrate not only that Phormidium Pc enhances the stability of the Pc/PS I system using PS I from mesophilic cyanobacteria, but also that Phormidium PS I possesses a higher thermostability than the other photosystems.

Homology predicted structure and functional interaction of ferredoxin from the eukaryotic alga Chlamydomonas reinhardtii with nitrite reductase and glutamate synthase.

Ferredoxin (Fd) from Chlamydomonas reinhardtii is composed of 94 amino-acid residues and a [2Fe-2S] cluster. The homology modelling technique has been used to predict the tertiary structure of C. reinhardtii Fd. The overall structure shows the typical fifth-stranded beta-grasp plus two additional beta-sheets and three alpha-helices. Site-directed mutagenesis of recombinant Fd has allowed us to obtain four point mutants and one double mutant--all mutations being located in the short alpha-helix at the carboxy-terminal segment as well as a triple mutant affected on helix alpha1. Crosslinking studies and measurement of enzymatic activities reveal that the residues changed are critical for the interaction of Fd with glutamate synthase (GOGAT) and nitrite reductase (NiR). Potentiometric analyses of the Fd mutants show that the replacement of glutamate in position 91 drastically changes the redox potential value (70 mV), thereby suggesting that such a glutamate can modulate the reactivity of Fd towards its reaction partners. According to results herein presented, the reported mutations modify the electrostatic interactions within the complex formed between Fd and GOGAT or NiR.

Negatively charged residues in the H loop of PsaB subunit in Photosystem I from Synechocystis sp. PCC 6803 appear to be responsible for electrostatic repulsions with plastocyanin*.

Wild-type plastocyanin from the cyanobacterium Synechocystis sp. PCC 6803 does not form any kinetically detectable transient complex with Photosystem I (PS I) during electron transfer, but the D44R/D47R double mutant of copper protein does [De la Cerda et al. (1997) Biochemistry 36: 10125-10130]. To identify the PS I component that is involved in the complex formation with the D44R/D47R plastocyanin, the kinetic efficiency of several PS I mutants, including a PsaF-PsaJ-less PS I and deletion mutants in the lumenal H and J loops of PsaB, were analyzed by laser flash absorption spectroscopy. The experimental data herein suggest that some of the negative charges at the H loop of PsaB are involved in electrostatic repulsions with mutant plastocyanin. Mutations in the J loop demonstrate that this region of PsaB is also critical. The interaction site of PS I is thus not as defined as first expected but much broader, thereby revealing how complex the evolution of intermolecular electron transfer mechanisms in photosynthesis has been.

Site-directed mutagenesis of cytochrome c(6) from Anabaena species PCC 7119. Identification of surface residues of the hemeprotein involved in photosystem I reduction.

A number of surface residues of cytochrome c(6) from the cyanobacterium Anabaena sp. PCC 7119 have been modified by site-directed mutagenesis. Changes were made in six amino acids, two near the heme group (Val-25 and Lys-29) and four in the positively charged patch (Lys-62, Arg-64, Lys-66, and Asp-72). The reactivity of mutants toward the membrane-anchored complex photosystem I was analyzed by laser flash absorption spectroscopy. The experimental results indicate that cytochrome c(6) possesses two areas involved in the redox interaction with photosystem I: 1) a positively charged patch that may drive its electrostatic attractive movement toward photosystem I to form a transient complex and 2) a hydrophobic region at the edge of the heme pocket that may provide the contact surface for the transfer of electrons to P(700). The isofunctionality of these two areas with those found in plastocyanin (which acts as an alternative electron carrier playing the same role as cytochrome c(6)) are evident.

Site-directed mutagenesis of cytochrome c6 from Synechocystis sp. PCC 6803. The heme protein possesses a negatively charged area that may be isofunctional with the acidic patch of plastocyanin.

This paper reports the first site-directed mutagenesis analysis of any cytochrome c6, a heme protein that performs the same function as the copper-protein plastocyanin in the electron transport chain of photosynthetic organisms. Photosystem I reduction by the mutants of cytochrome c6 from the cyanobacterium Synechocystis sp. PCC 6803 has been studied by laser flash absorption spectroscopy. Their kinetic efficiency and thermodynamic properties have been compared with those of plastocyanin mutants from the same organism. Such a comparative study reveals that aspartates at positions 70 and 72 in cytochrome c6 are located in an acidic patch that may be isofunctional with the well known "south-east" patch of plastocyanin. Calculations of surface electrostatic potential distribution in the mutants of cytochrome c6 and plastocyanin indicate that the changes in protein reactivity depend on the surface electrostatic potential pattern rather than on the net charge modification induced by mutagenesis. Phe-64, which is close to the heme group and may be the counterpart of Tyr-83 in plastocyanin, does not appear to be involved in the electron transfer to photosystem I. In contrast, Arg-67, which is at the edge of the cytochrome c6 acidic area, seems to be crucial for the interaction with the reaction center.

Solution structure of oxidized cytochrome c6 from the green alga Monoraphidium braunii.

Cytochrome c6 from Monoraphidium braunii, an 89-amino acid electron transfer protein, has been investigated by NMR in solution, in its oxidized form, at pH 7 and 300 K. By using a combination of COSY, TOCSY, and NOESY experiments, 84% of the proton resonances have been assigned. A total of 1668 experimental NOE constraints, 1109 of which were meaningful, together with 288 pseudocontact shifts, have been used to determine the structure in solution. This is represented as a family of 40 structures which have been energy minimized. The rmsd values with respect to the mean structure are 0.57 +/- 0.08 and 0.94 +/- 0.09 A for the backbone and heavy atoms, respectively. The structure has been found to be very similar to that of the reduced form, except for a rearrangement in propionate 7, a feature which has been observed in all c-type cytochromes investigated so far. Such a feature could be relevant for the efficiency of the electron transfer pathway with either the oxidizing or the reducing partners. Other differences in the oxidation states have been noted in the region proposed to be involved in the interaction with the physiological partners.

Cloning and correct expression in Escherichia coli of the petE and petJ genes respectively encoding plastocyanin and cytochrome c6 from the cyanobacterium Anabaena sp. PCC 7119.

The genes coding for plastocyanin (petE) and cytochrome c6 (petJ) from Anabaena sp. PCC 7119 have been cloned and properly expressed in Escherichia coli. The recombinant proteins are identical to those purified from the cyanobacterial cells. The products of both the petE and petJ genes are correctly processed in E. coli, as deduced from their identical N-terminal amino acid sequences as compared with those of the metalloproteins isolated from the cyanobacterium. Physicochemical and functional properties of the native and recombinant protein preparations are also identical, thereby confirming that expression of petE and petJ genes in E. coli is an adequate tool to address the study of the structure/function relationships in plastocyanin and cytochrome c6 from Anabaena by site-directed mutagenesis.

The 2.15 A crystal structure of a triple mutant plastocyanin from the cyanobacterium Synechocystis sp. PCC 6803.

The crystal structure of the triple mutant A42D/D47P/A63L plastocyanin from the cyanobacterium Synechocystis sp. PCC 6803 has been determined by Patterson search methods using the known structure of the poplar protein. Crystals of the triple mutant A42D/D47P/A63L, which are stable for days in its oxidized form, were grown from ammonium sulfate, with the cell constants a = b = 34.3 A and c = 111.8 A belonging to space group P3(2)21. The structure was refined using restrained crystallographic refinement to an R-factor of 16.7% for 4070 independent reflections between 8.0 and 2.15 A with intensities greater than 2 sigma (I), with root mean square deviations of 0.013 A and 1.63 degrees from ideal bond lengths and bond angles, respectively. The final model comprises 727 non-hydrogen protein atoms within 98 residues, 75 water molecules and a single copper ion. The overall tertiary fold of Synechocystis plastocyanin consists of a compact ellipsoidal beta-sandwich structure made up of two beta-sheets embracing a hydrophobic core. Each sheet contains parallel and antiparallel beta-strands. In addition to the beta-sheets, the structure contains an alpha-helix from Pro47 to Lys54 that follows beta-strand 4. The three-dimensional structure of Synechocystis plastocyanin is thus similar to those reported for the copper protein isolated from eukaryotic organisms and, in particular, from the cyanobacterium Anabaena variabilis, the only cyanobacterial plastocyanin structure available so far. The molecule holds an hydrophobic region surrounding His87, as do other plastocyanins, but the lack of negatively charged residues at the putative distant remote site surrounding Tyr83 could explain why the Synechocystis protein exhibits a collisional reaction mechanism for electron transfer to photosystem I (PSI), which involves no formation of the transient plastocyanin-PSI complex kinetically observed in green algae and higher plants.

Changes in the reaction mechanism of electron transfer from plastocyanin to photosystem I in the cyanobacterium Synechocystis sp. PCC 6803 as induced by site-directed mutagenesis of the copper protein.

The kinetic mechanism of plastocyanin oxidation by photosystem I in the cyanobacterium Synechocystis sp. PCC 6803 is drastically changed by modifying the metalloprotein by site-directed mutagenesis. The mutations herein considered concern four specific residues, two in the east face and the other two in the hydrophobic patch of plastocyanin. The first set of mutants include D44A, D44K, D47A, and D47R, as well as the double mutants D44A/D47A and D44R/D47R; the second set consists of L12A and K33E. The kinetic efficiency of all these mutant plastocyanins has been analyzed by laser-flash absorption spectroscopy. The plastocyanin concentration dependence of the observed electron transfer rate constant (kobs) is linear with most mutant plastocyanins, as with wild-type plastocyanin, but exhibits a saturation plateau at high protein concentration with the double mutant D44R/D47R, which suggests the formation of a plastocyanin-PSI transient complex. The effect of ionic strength on kobs varies from the wild-type plastocyanin to some of the mutants, for instance D44K, for which the salt concentration dependence of kobs is just the reverse as compared to the wild-type protein. The ionic strength dependence of kobs with D44R/D47R exhibits a bell-shaped profile, which is similar to that of green algae and higher plants. These findings indicate that the double mutant D44R/D47R follows a reaction mechanism involving not only complex formation with PSI but also further reorientation to properly accommodate the redox centers prior to electron transfer, as is the case in most evolved species, whereas the wild-type copper protein reacts with PSI by following a simple collisional kinetic model.

A comparative thermodynamic analysis by laser-flash absorption spectroscopy of photosystem I reduction by plastocyanin and cytochrome c6 in Anabaena PCC 7119, Synechocystis PCC 6803 and Spinach.

A comparative thermodynamic analysis of photosystem I (PSI) reduction by plastocyanin (Pc) and cytochrome c6 (Cyt) has been carried out by laser-flash absorption spectroscopy in the cyanobacteria Anabaena PCC 7119 and Synechocystis PCC 6803 as well as in spinach. These three organisms have been reported to exhibit different reaction mechanisms [Hervas, M., Navarro, J. A.. Díaz, A., Bottin, H., & De la Rosa, M. A. (1995) Biochemistry, 34, 11321-11326]. Whereas the activation free energy for the overall reaction is mainly enthalpic in nature, long-range electrostatic interactions appear to be attractive in Anabaena, but repulsive in Synechocystis and spinach. The net interaction between PSI and its two donor proteins in Anabaena is similarly affected by ionic strength (the rate constant decreases with increasing salt concentration), but the activation parameters delta H+/+ delta S+/+ show different dependencies on ionic strength. A compensation effect between entropy and enthalpy at varying ionic strength is found in all these Pc/PSI and Cyt/PSI systems, except with Cyt and PSI from Anabaena. Such a compensation effect is proposed to be mainly due to stabilization of the intermediate electrostatic complex by hydrophobic forces. The electron transfer step seems to be well optimized in the Anabaena Cyt/PSI couple, which exhibits a temperature-independent fast kinetic phase and, therefore, a low activation energy barrier. Short-distance forces appear to have gained relevancy in the reaction mechanism of PSI reduction by Cyt and Pc throughout evolution, whereas long-range interactions are prevalent in less evolved organisms.