Complete recovery from Cryptosporidium parvum infection with gastroenteritis and sclerosing cholangitis after successful bone marrow transplantation in two brothers with X-linked hyper-IgM syndrome.

We describe two brothers who suffered from hyper-IgM syndrome (HIGM1) with similar clinical features: recurrent infections, especially cryptosporidium gastroenteritis with cholangitis. Their activated T cells did not express CD40L. Nucleotide sequencing revealed a mutation in both boys with respect to intron 4 and exon 5 boundaries of the CD40L gene in Xq26. They underwent successful bone marrow transplantation (BMT) from HLA-geno-identical siblings. The Cryptosporidium infection and cholangitis resolved thereafter. At 6 months after BMT, expression of CD40L on activated T lymphocytes was normal. After 1 year, both boys are well, and immune reconstitution has improved. Based on these two successful experiences, BMT with a genoidentical sibling seems a reasonable therapeutic approach for HIGM1, if Cryptosporidium infection occurs.

[Mucopolysaccharidosis type I in Morocco: clinical features and genetic profile]. / Mucopolysaccharidose de type I au Maroc: manifestations cliniques et profil génétique.

BACKGROUND: Mucopolysaccharidoses (MPS) are inherited metabolic disorders due to lysosomal enzyme deficiencies, leading to glycosaminoglycan accumulation in lysosomes of different tissues. The aim of this study was to characterize MPS types, particularly MPS I, which are difficult to differentiate by clinical features. PATIENTS AND METHODS: Over a period of three years (June 1996-May 1999), 16 Moroccan patients (3-20 years old) with MPS were investigated. Twelve of them came from the Souss region. In subjects with suspected clinical MPS I or II, the diagnosis was confirmed by biochemical investigations, which included the quantification of total glycosaminoglycans (GAGs) released in urine, their identification, and the assay of alpha-L-iduronidase activity in leucocytes. A molecular analysis was performed in parallel, to provide the genetic proof of the diagnosis. RESULTS: These 16 patients belonged to 12 families, nine of which were consanguineous (75%). Twelve patients had Hurler syndrome and three had Hurler/Scheie's syndrome; no case of Scheie's syndrome was observed. Short stature, coarse face, organomegaly, hernia, cardiac disease, mental delay and dysostosis were observed in variable degrees. We report three cases without corneal clouding. Increased total urinary GAGs, identified as dermatan sulfate and heparan sulfate by thin-layer chromatography and total deficiency of alpha-L-iduronidase activity, were noted in studied subjects. At the molecular level the P533R mutation was detected in 24 among 26 alleles studied. CONCLUSION: It is now possible to perform the screening of MPS I and II in Morocco by analysis of clinical, radiologic observations and biological investigation. The predominance of P533R mutation could permit the screening of healthy heterozygotes and genetic counselling for families of Moroccan descent.

Mucopolysaccharidosis type I: characterization of a common mutation that causes Hurler syndrome in Moroccan subjects.

A group of 13 Moroccan patients with MPS I and their families, including three siblings and twin siblings, was screened for mutations of the alpha-L-iduronidase gene using fluorescence-assisted mismatch analysis (FAMA) and cycle sequencing of PCR products. The P533R mutation, which is rare in Europeans, was identified in 92% of mutant alleles (24/26). This is the highest frequency of this mutation detected in patients with Hurler syndrome. None of the patients carried the W402X or Q70X alleles, the most common MPS I mutations in Europeans. These results suggest that the P533R mutation constitutes the genetic lesion which results in MPS I in people of Moroccan descent and provides yet more evidence for the uneven geographical distribution of mutations in MPS I.

Purification from human plasma of a hexapeptide that potentiates the sulfation and mitogenic activities of insulin-like growth factors.

The human plasma contains small peptide molecules known as low molecular weight growth factors synergistically increasing certain biological actions of insulin-like growth factors. In the present work we isolated and characterized a hexapeptide with HWESAS as structure. This purified peptide was absolutely necessary for the sulfation activity of insulin-like growth factor-I on chick embryo pelvic cartilages and improved the mitogenic activity of both insulin-like growth factors. The effects of this hexapeptide were confirmed by using the homologous synthetic peptide, that exhibited similar biological effects. Other synthetic peptides with structure derived from hexapeptide were shown to be active: the pentapeptide HWESA appeared more potent than the tripeptide HWE, which is about 170 to 200 times less active than the hexapeptide. The sequence of hexapeptide HWESAS is identified in only one human protein that is C3f, a fragment of C3 complement.

Follow-up of nine patients with Hurler syndrome after bone marrow transplantation.

We report our experience in nine patients with Hurler syndrome (six with a severe and three with an intermediate phenotype) who successfully engrafted after bone marrow transplantation. The donor was a human leukocyte antigen-identical sibling in six cases, the human leukocyte antigen-identical father in one case, and an unrelated donor in two cases. One patient with Hurler syndrome and an intermediate phenotype received two successive grafts from the same donor. There was a beneficial effect of bone marrow transplantation on visceral features (hepatosplenomegaly, obstruction of the upper airway, and coarse facies); however, dysostosis multiplex worsened. All patients but one required surgery for carpal tunnel syndrome. Visual acuity was low because of corneal clouding, and two patients had glaucoma several years after the graft. Five patients had normal hearing before the graft that remained normal, and four had hearing impairment that improved. All patients had learning difficulties, but none had severe mental retardation (IQ ranging from 75 to 103). The follow-up of patients with severe Hurler syndrome engrafted for more than 10 years emphasizes the limits and benefits of bone marrow transplantation.

Purification from human plasma of a tetrapeptide that potentiates insulin-like growth factor-I activity in chick embryo cartilage.

Human plasma has been shown to contain a low molecular weight factor that potentiates human IGF-I stimulation of glycosaminoglycan synthesis in chick embryo cartilage. The peptide was purified and characterized by Edman degradation and electrospray mass spectrometry. The primary structure determined was: Trp-Gly-His-Glu. A homologous synthetic peptide similarly promoted matrix biosynthesis in cartilage exposed to IGF-I.

A seric low molecular weight factor modulates IGFs effects on chick cartilage metabolism.

The effects of recombinant human insulin-like growth factors (rhIGF-I and rhIGF-II) alone and in combination with a partially purified serum low molecular weight growth factor (LMW-GF) were studied by measuring proteoglycan (PG) and total protein synthesis by chick embryo cartilage. rhIGF-I alone did not increase the incorporation of L[3H]serine or [35S]Na2SO4 into whole cartilages. LMW-GF + rhIGF-I markedly increased the incorporation of these precursors. rhIGF-I alone stimulated D[3H]glucosamine uptake, and LMW-GF increased the effect of rhIGF-I. These results for whole cartilage were reproduced with glycosaminoglycans (GAG) extracted from cartilage. LMW-GF acted in synergy with rhIGF-I to stimulate PG core protein synthesis, xylosyl transferase activity and sulfation. Total protein synthesis, as measured by [35S]methionine uptake, was not altered by rhIGF-I. LMW-GF plus rhIGF-I increased the incorporation of this precursor into whole cartilage. The effect of rhIGF-II on PG synthesis was different from that of rhIGF-I. rhIGF-II alone stimulated GAG chain lengthening and sulfation. LMW-GF did not modify the effect of rhIGF-II on these steps. In contrast, rhIGF-II did not stimulate the synthesis of core protein. LMW-GF plus rhIGF-II increased the [3H]serine incorporation into the whole cartilage, but this combination did not stimulate the uptake of [3H]serine into extracted GAG. rhIGF-II plus LMW-GF were also without effect on xylosyl transferase activity. The combination of these factors increased the [35S]methionine incorporation into cartilage total proteins. These results suggest that rhIGF-II does not regulate the PG core protein synthesis, but in combination with LMW-GF, stimulates the synthesis of proteins other than proteoglycan core protein.

Expression of secreted recombinant human insulin-like growth factor-II (IGF-II) in Chinese hamster ovary cells.

Chinese hamster ovary (CHO-KI) cells were cotransfected with a plasmid pcDNAI containing the human preproinsulin-like growth factor II cDNA linked downstream to the human cytomegalovirus promoter and with a plasmid containing the neomycin resistance gene (pMAM-neo). CHO neo+ were selected by growth in medium supplemented with G418 geneticin. After amplification, the neomycin-resistant clones were screened for IGF-II production. IGF-II produced was identified by dot blot and quantified by ELISA. The clones C24, C40 and C94 secreted IGF-II at about 350-400 ng per 10(6) cells per day. DNA analysis of C24 and C40 CHO cells by PCR demonstrated the presence of the IGF-II construct in the transfected cells, presumably integrated into the chromosomal DNA. IGF-II produced by CHO cells and purified by RP-HPLC was a mitogen for MCF-7 stimulating mitosis 2-fold.

Muscle bioenergetics in obese Zucker rats.

The purpose of this study was to investigate the energetic metabolism in obese Zucker rats, using phosphorus nuclear magnetic resonance spectroscopy at rest and during a 2-Hz muscle stimulation and subsequent recovery. Animals were anesthetized with ketamine (150 mg/kg ip). Fed obese rats and 2-day-fasted obese rats were compared with their normally fed and 2-day-fasted lean litter mates. No differences were found between the two groups for ATP, total creatine, phosphocreatine (PCr), and intracellular pH. Starvation in lean rats resulted in a significant fall in inorganic phosphate (Pi), increased resting ADP level, and decreased PCr and ADP recovery after stimulation. The obese rats exhibited a decreased PCr/Pi and increased ADP at rest and a decreased PCr resynthesis and ADP metabolization rate after stimulation. Muscle stimulation in fasted obese rats induced higher PCr depletion and more pronounced acidosis. These results suggest an in vivo mitochondrial metabolism dysfunction in fasted lean as well as in fed and fasted obese rats.

Search for cell proliferation markers suitable for cell count in continuous immobilized cell bioreactors.

The control of hybridoma cell cultures in bioreactors requires the use of convenient indicators to monitor the proliferation of the biomass. In order to select appropriate indications, we followed the variations of several compounds including tumoral markers, polyamines, sialic acids, purine and pyrimidine bases, enzymes and metabolites such as glucose, lactate and amino acids, and the variations of cell density during batch culture. Significant correlations were found between the number of viable cells and alkaline phosphatase, beta-glucuronidase, glucose and lactate measured in the culture medium of hybridoma strains. The correlation calculated from alkaline phosphatase and beta-glucuronidase concentrations in culture medium underestimated cell number. The correlation established with glucose and lactate gave the best indication of cell proliferation in continuous culture with an immobilized cell bioreactor. Finally, the exact quantification of the biomass in these culture conditions can be obtained using the mean of glucose and lactate correlations.

Quantification of methylmalonic acid in serum measured by capillary gas chromatography-mass spectrometry as tert.-butyldimethylsilyl derivatives.

Quantification of methylmalonic acid in serum is considered one of the most sensitive parameters for diagnosis of cobalamin deficiency. Methylmalonic acid was measured as tert.-butyldimethylsilyl derivatives formed in the presence of dimethylformamide. Under these conditions the derivative was quantified using gas chromatography-mass spectrometry with selected-ion monitoring at 403 and 406 for methylmalonic acid and methyl-d3-malonic acid, respectively. The characteristics of the method were: linearity from 0.04 to 1.7 mumol/l with linear regression equation y = -0.0199 + 0.727 x (r = 0.999); recovery 95.5 +/- 6.8%; detection threshold 17 fmol injected; within-day variation coefficient ranging from 3.10% to 5.6% according to sample concentration; and day-to-day coefficient of variation of 6.8% and 5.3% for methylmalonic acid concentrations of 0.103 mumol/l and 0.360 mumol/l, respectively. The normal range after log transformation was estimated at 0.03-0.26 mumol/l, 0.06-0.33 mumol/l and 0.02-0.40 mumol/l in children of 4-14 years (n = 39), in healthy subjects at 20-40 years (n = 70) and in healthy elderly persons older than 60 years (n = 14), respectively. The normal range in children was significantly lower than that in adults and, in contrast, normal values in the elderly were significantly higher.

Effect of chronic potassium depletion on muscle bioenergetics in rats.

To test the hypothesis of muscle bioenergetic impairment in potassium depletion, chronic potassium-depleted rats and pair-fed control rats were studied with phosphorus 31 nuclear magnetic resonance measurements of leg muscle intracellular pH, phosphocreatine, inorganic phosphate, and adenosine triphosphate at rest and during maximal nontetanic stimulation, 48 hours after a swimming test. The potassium-depleted rats exhibited a significant hypokalemia, a metabolic extracellular alkalosis, and an intracellular acidosis. Their physical endurance was markedly reduced, and they displayed higher plasma creatine kinase levels than the control group. However, the phosphocreatine/inorganic phosphate ratio, which is a measure of the energy reserve of the cell, was similar in both groups at rest and during electrical stimulation and subsequent recovery. Resting muscle glycogen and relative intracellular acidification during stimulation did not differ in the two groups, arguing against an impairment of anaerobic metabolism in potassium depletion. These results indicate that the energy availability of muscle cell is unchanged during potassium deficiency.

Application of preparative high-performance liquid chromatography to the purification of a fetal ovine insulin-like growth factor II: N-terminal sequence determinations using two different carriers.

A highly efficient procedure for the purification to homogeneity of an ovine fetal insulin-like growth factor II (IGF II) is described. Fetal sheep serum was used as the source material, and the bioactivity was followed throughout purification by an IGF II radioreceptor assay. Ovine IGF II was isolated by a combination of gel permeation, ion-exchange chromatography and reversed-phase high-performance liquid chromatography. The amino-terminal sequence of the first 36 amino acid residues was compared using two supports (polyethylenimine and polybrene) as carrier for protein sequencing. Ovine fetal IGF II was found to differ from human IGF II in three residues of the C-domain, with serine, isoleucine and asparagine substituted for alanine, valine and serine, respectively, at positions 32, 35 and 36. The final yield of highly purified ovine fetal IGF II was 134 micrograms, starting from 450 ml of serum.

Purification and characterization of three molecular forms of insulin-like growth factor II from human Cohn paste IV.

The somatomedins or insulin-like growth factors (IGFs) are a family of peptides present in human serum. They are bound to specific carrier proteins and are thought to mediate growth-promoting actions of human growth hormone. Starting from Cohn fraction IV of human plasma, we describe here a rapid and highly efficient procedure for the purification to homogeneity, in addition to IGF I. of three forms of insulin-like growth factor II: IGF IIA (10-12 kDa), IGF IIB (the "classical" 7.5 kDa IGF II) and IGF IIC, identified as the IGF II variant of Jansen by fast-atom bombardment mass spectrometry. The procedure is based on ion-exchange chromatography and gel permeation chromatography on Biogel P10. As judged by specific radioimmunoassay methods for IGF I and IGF II, one of the most striking advantages of this process at this stage is the yield of IGF I not contaminated by 7.5 kDa IGF II. Isoelectric focusing or chromatofocusing, which require affinity chromatography to separate proteins from the polybuffers, are not necessary in this procedure. Final purification was directly achieved by preparative, followed by analytical high-performance liquid chromatography. The N-terminal sequence of peptide IGF IIB (39 amino acids) and peptide IGF I (29 amino acids) showed total homology with those previously described by Rinderknecht and Humbel [FEBS Lett., 89 (1978) 283]. The final yields of purified human IGF I and IGF IIB were 15 and 25 micrograms, respectively, from 11 of serum. All peptides interact with specific receptors on human lymphocytes and red blood cells, and are biologically active (stimulation of 35S uptake, increasing [3H]thymidine incorporation in human and chick embryo fibroblasts).

Increase of IGF I binding to erythrocyte receptors during the TRH-test: correlation between IGF I binding and thyroid hormone values.

The effects of TRH on insulin-like growth factor I receptors were investigated on erythrocytes from 7 GH-deficient children having plasma GH levels less than 10 ng/ml during two provocation tests. Intravenous injection of synthetic TRH (0.2 mg/m2) was followed by a marked increase of IGF I binding on erythrocytes, from 3.9% +/- 0.3% to 5.9% +/- 0.3% (P less than 0.005) after 1 hour and 7.3% +/- 0.4% (P less than 0.005) after 2 hours. The IGF I binding variations were due to an increase in both the receptor affinity and the number of sites. The levels of plasma GH, IGF I, T3, T4, free T4, TSH and prolactin having been determined during the TRH test at 0, 1 hour, and 2 hours after the injection, the increase in the IGF I binding to erythrocytes at the same time correlated with the rise of thyroid hormones: triiodothyronine T3 (P less than 0.001) and thyroxine T4 (P less than 0.005) and not with the level of the other hormones. These findings suggest that thyroid hormones play a role in the regulation of insulin-like growth factor I receptors.

Isolation and characterization of a low molecular weight growth-promoting factor from human plasma.

A low molecular weight growth factor (LMW-GF) enriched preparation was purified from human plasma after ultrafiltration or gel filtration by means of molecular sieving chromatography low pressure reversed phase chromatography (LP-RPLC) and electrophoresis. Purification was monitored by a biological assay testing the capacity of the fractions to enhance the sulfation activity of the somatomedins/insulin-like growth factors on chick embryo cartilage. Analysis of its chemical nature show that it is hydrophilic, stable to heat, resistant to most of the proteases but that it is degraded by acid hydrolysis or carboxypeptidase Y action. UV absorption spectrum and ion-exchange chromatographic retention behavior support the hypothesis that the most purified active preparation includes a peptide structure. The presence of sugar is suggested by concanavalin A binding experiments. The fact that the purification fractions also enhance thymidine uptake by other cell lines (fibroblasts, activated lymphocytes) widens the role of such small plasma molecules in the field of growth factor activities.

[Physiopathological approach to pathological hyperlactatemia in the diabetic patient. Value of blood metformin]. / Approche physiopathologique des hyperlactatémies pathologiques chez le diabétique. Intérêt de la metforminémie.

Type B lactic acidosis, or pathological hyperlactatemia (PHL), is defined by an arterial lactate level greater than 5 mmol X l-1. It is a known and severe complication of diabetes mellitus treated with biguanide hypoglycaemic agents, particularly phenformin which was taken off the French pharmaceutical market in 1977. Metformin, which remains the only biguanide hypoglycaemic agent currently prescribed in France, may also lead to this complication. However it does so less frequently and mostly in the diabetic presenting with renal failure. A few well studied cases showed that PHL could be correlated with excessive metformin blood levels, i.e. a toxic mechanism. In order to find out whether this toxic mechanism was the real cause of PHL in diabetics treated with metformin, a systematic study of metformin blood levels was carried out in 20 such patients. They had all been admitted to a critical care unit presenting with PHL. The results of this study led us to distinguish between two groups of patients. The seven patients of the first group had high metformin blood levels (4.3 to 65.8 micrograms X l-1). In these, renal excretion or extrarenal dialysis lowered or normalized their hyperlactatemia, and six of the seven recovered from PHL. In the second group, with thirteen patients, metformin blood levels were within the normal therapeutic range (0.225 to 3 micrograms X l-1) for seven patients and close to zero for the other six. This second group received the same treatment as the first one. Only three patients recovered, the others all died.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sulfation and mitogenic activities of growth factors in human serum: importance of compounds of molecular weight lower than 1,000 in the global expression of activity of this serum on 3 different cellular types]. / Activités de sulfatation et mitogéniques des facteurs de croissance du sérum humain: importance des composés de poids moléculaire inférieur à 1,000 dans l'expression globale des activités de ce sérum sur trois types cellulaires différents.

A human serum ultrafiltrate contains compounds needed for a maximal expression of sulfation and mitogenic activities of the corresponding retentate. These low molecular weight (less than 1,000) molecules have no effect, by their own, on 35SO4(2-) uptake in chick embryo cartilage, but show a significant synergistic effect with serum growth polypeptides. Tested alone, they display a slight mitogenic activity as measured by 3H-thymidine incorporation in chick embryo fibroblasts or in lymphocytes activated by phytohemagglutinin. Here they also act in a synergistic way on mitogenic activities of growth factors from human retentate. A fraction (P2B), partially purified from human plasma ultrafiltrates, produces the same synergistic response with human retentate in the three cellular systems (cartilages, fibroblasts, activated lymphocytes). However, concentrations which lead to optimum responses are very different according to the cell type studied. These results suggest the existence of several compounds which can each act specifically on a cellular system.

Liquid chromatographic determination of cyclosporin A in serum with use of a solid-phase extraction. Comparison between high-performance liquid chromatography and radioimmunoassay levels in clinical investigations.

A simple reliable liquid chromatographic method for assay of cyclosporin A in serum or urine is described. Samples were cleaned up on a solid-phase extraction system (cyanopropyl column). The system involved a reversed-phase C18 Ultrasphere column maintained at 72 degrees C and an acetonitrile linear gradient (65 to 95%) in 0.14% triethylammonium phosphate. Liquid chromatographic analysis of radioimmunoassay standards shows that some samples contain a contaminant peak. Comparison of cyclosporin A levels obtained by radioimmunoassay and high-performance liquid chromatography in clinical investigations show that the former values are generally, but not always, higher than the latter, and that cyclosporin A is very differently metabolized depending on the patient, disease and treatment.

The biological assay of human somatomedin A: improvement by small molecular weight natural molecules.

Somatomedin activity is often measured by 35SO4 uptake in pelvic chick embryo cartilage. This assay gives good results when the somatomedin activity is measured in serum, but often gives uninterpretable results for purified somatomedin. An ultrafiltrate (UF 1000) obtained from human normal serum, added to the incubation medium allows measurement of biological somatomedin activity even when somatomedin is highly purified. UF 1000 contains some compounds of molecular weight lower than 1000 daltons. UF 1000 acts either when used simultaneously with somatomedin or in pre-incubation with cartilage before testing biological activity. So, we chose to use it in pre-incubation (1 h) at the optimal concentration of 10% (v/v), the standard curves being realized with normal serum retentates . In these conditions, the proper action of UF 1000 does not interfere with calculation of somatomedin activity. This method has enabled us to show that a diminution of serum somatomedin activity can be linked either to an anomaly of UF 1000 or to a somatomedin deficiency.