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Biomedical subjects

D J Rawlings

Publications and source records attributed to D J Rawlings.

At least 55 records · Page 3Linked to original sources

Impaired expansion of mouse B cell progenitors lacking Btk.

Mutations in the gene encoding the protein tyrosine kinase Btk are associated with the human B cell immunodeficiency X-linked agammaglobulinemia (XLA). In the mouse, a point mutation in the Btk pleckstrin homology domain segregates with a milder X-linked immunodeficiency (xid). To assess the importance of Btk function in murine lymphopoiesis, we generated multiple embryonic stem cell clones bearing a targeted disruption of the btk gene and examined their potential to produce lymphocytes in both C57BL/6 and RAG2-/- host chimeric animals. These mice provide a complementary set of in vivo competition assays that formally establish the genetic basis for the xid phenotype. Although the null mutation yields a phenotype quite similar to that of xid, it also compromises expansion of B cell precursors. Our results suggest that the murine and human consequences of Btk deficiency differ only quantitatively, and represent the same disease process.

Agammaglobulinaemia Tyrosine Kinase↗

A novel glucose-6-phosphate dehydrogenase in Plasmodium falciparum: cDNA and primary protein structure.

The structure of the parasite-encoded G6PD (PfG6PD) may provide clues about the relative protection against malaria in humans with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We have cloned Pfg6pd cDNA encoding a predicted 856 amino acid residues polypeptide with a calculated molecular mass of > 94 kDa. The predicted amino acid sequence is highly homologous to G6PD from other organisms. Pfg6pd maps as a single or low copy number gene to chromosome 14. The unusually large N-terminus and the distance between the NADP-binding site and G6PD-binding site is novel for the parasite G6PD. The differences between parasite and human G6PD proteins could potentially be exploited for designing new chemotherapeutic agents.

Amino Acid Sequence↗

Deletion within the Src homology domain 3 of Bruton's tyrosine kinase resulting in X-linked agammaglobulinemia (XLA).

The gene responsible for X-linked agammaglobulinemia (XLA) has been recently identified to code for a cytoplasmic tyrosine kinase (Bruton's agammaglobulinemia tyrosine kinase, BTK), required for normal B cell development. BTK, like many other cytoplasmic tyrosine kinases, contains Src homology domains (SH2 and SH3), and catalytic kinase domain. SH3 domains are important for the targeting of signaling molecules to specific subcellular locations. We have identified a family with XLA whose affected members have a point mutation (g-->a) at the 5' splice site of intron 8, resulting in the skipping of coding exon 8 and loss of 21 amino acids forming the COOH-terminal portion of the BTK SH3 domain. The study of three generations within this kinship, using restriction fragment length polymorphism and DNA analysis, allowed identification of the mutant X chromosome responsible for XLA and the carrier status in this family. BTK mRNA was present in normal amounts in Epstein-Barr virus-induced B lymphoblastoid cell lines established from affected family members. Although the SH3 deletion did not alter BTK protein stability and kinase activity of the truncated BTK protein was normal, the affected patients nevertheless have a severe B cell defect characteristic for XLA. The mutant protein was modeled using the normal BTK SH3 domain. The deletion results in loss of two COOH-terminal beta strands containing several residues critical for the formation of the putative SH3 ligand-binding pocket. We predict that, as a result, one or more crucial SH3 binding proteins fail to interact with BTK, interrupting the cytoplasmic signal transduction process required for B cell differentiation.

Adult↗

Role of Bruton's tyrosine kinase in immunodeficiency.

The genetic defect associated with human X-linked agammaglobulinemia and murine X-linked immunodeficiency was recently shown to result from lack of function of a new cytoplasmic tyrosine kinase, called Bruton's tyrosine kinase (Btk). The phenotypes associated with these immunodeficiencies indicate that Btk plays a critical role in B-lymphocyte development. The distinctive protein structure of Btk and preliminary functional studies suggest that Btk may act in a novel manner in a variety of signaling pathways.

Agammaglobulinaemia Tyrosine Kinase↗

Mutation of unique region of Bruton's tyrosine kinase in immunodeficient XID mice.

The cytoplasmic tyrosine kinase, Bruton's tyrosine kinase (Btk, formerly bpk or atk), is crucial for B cell development. Loss of kinase activity results in the human immunodeficiency, X-linked agammaglobulinemia, characterized by a failure to produce B cells. In the murine X-linked immunodeficiency (XID), B cells are present but respond abnormally to activating signals. The Btk gene, btk, was mapped to the xid region of the mouse X chromosome by interspecific backcross analysis. A single conserved residue within the amino terminal unique region of Btk was mutated in XID mice. This change in xid probably interferes with normal B cell signaling mediated by Btk protein interactions.

Agammaglobulinaemia Tyrosine Kinase↗

Deficient expression of a B cell cytoplasmic tyrosine kinase in human X-linked agammaglobulinemia.

We describe a novel cytoplasmic tyrosine kinase, termed BPK (B cell progenitor kinase), which is expressed in all stages of the B lineage and in myeloid cells. BPK has classic SH1, SH2, and SH3 domains, but lacks myristylation signals and a regulatory phosphorylation site corresponding to tyrosine 527 of c-src. BPK has a long, basic amino-terminal region upstream of the SH3 domain. BPK was evaluated as a candidate for human X-linked agammaglobulinemia (XLA), an inherited immunodeficiency characterized by a severe deficit of B and plasma cells and profound hypogammaglobulinemia. BPK mapped to within 100 kb of a probe defining the polymorphism most closely linked to XLA at DXS178. Reduction in or the absence of BPK mRNA, protein expression, and kinase activity was observed in XLA pre-B and B cell lines. BPK is likely the XLA gene and functions in pathways critical to B cell expansion.

Agammaglobulinemia↗

Acquired tracheoesophageal fistula in a premature infant.

A fatality from an acquired tracheoesophageal fistula (TEF) in a very low birthweight premature infant is presented. Neonatal tracheal and esophageal injuries related to endotracheal (ET) intubation are discussed. The infant had important risk factors for the development of subglottic stenosis: birthweight less than 1000 gm, prolonged positive pressure ventilation, and repeated ET intubation. The pathologic examination was consistent with acquired fistula formation resulting from a combination of preexisting subglottic stenosis and prolonged and repeated ET intubation. The recognition of clinical signs of an acquired TEF, as observed in our patient, followed by expeditious diagnostic testing may be lifesaving.

Female↗

Prolonged course of illness in a child with malignant lymphoma mimicking sarcoidosis.

We describe a case of malignant lymphoma mimicking the rheumatic presentation of sarcoidosis in an adolescent with a 3-year history of febrile illness. Final diagnosis was established by tissue biopsy after multiple studies failed to provide histological evidence of granulomas consistent with sarcoidosis. We discuss the limited diagnostic specificity of serum angiotensin converting enzyme in sarcoidosis and emphasize the need for aggressive diagnostic evaluation of a patient whose clinical presentation is not fully explained by a known rheumatologic illness.

Adolescent↗

Adjuvant-dependent immune response to malarial transmission-blocking vaccine candidate antigens.

Immune responses in major histocompatibility complex (MHC)-disparate congenic mouse strains immunized with sexual stage malaria parasites or purified recombinant protein were adjuvant dependent. Whereas mice exhibited a limited antibody response to immunization with newly emerged Plasmodium falciparum gametes in Freund's adjuvant, all five congenic mouse strains responded to several transmission-blocking vaccine candidate antigens, when parasites were emulsified in a monophosphoryl lipid A (MPL) and trehalose dimycolate (TDM) adjuvant. The humoral response in those animals immunized with the antigen in a MPL/TDM adjuvant was helper T cell dependent, as evident by boosting of the antibody response after a second immunization. If the immunogen consisted of purified recombinant protein, then the immune response was not MHC class II limited in mice immunized with either complete Freund's adjuvant or TDM/MPL. The potential role of adjuvants in overcoming apparent immune nonresponsiveness and the implications for development of a malaria transmission-blocking vaccine are discussed.

Adjuvants, Immunologic↗

A novel 40-kDa membrane-associated EF-hand calcium-binding protein in Plasmodium falciparum.

A 40-kDa sexual stage radiolabeled surface protein of Plasmodium falciparum, Pfs40, was previously identified as a potential target antigen of transmission blocking immunity by an immunogenetic approach. Synthetic oligonucleotide "guessmers," based on microsequenced tryptic peptides of Pfs40 purified by two-dimensional gel electrophoresis, were used to clone the full length cDNA and genomic DNA encoding Pfs40. The deduced amino acid sequence predicted an integral membrane protein containing five EF-hand calcium-binding domains. The biological activity of one or more of these domains was confirmed by binding of 45Ca to both native and recombinant Pfs40. Antisera to recombinant Pfs40 immunoprecipitated the native radiolabeled 40-kDa surface protein. The predicted noncytosolic membrane-associated localization of Pfs40 is unique within the EF-hand calcium-binding protein superfamily.

Amino Acid Sequence↗

Alpha-tubulin II is a male-specific protein in Plasmodium falciparum.

The tubulin gene family in Plasmodium falciparum consists of one beta-tubulin and two alpha-tubulin genes (alpha-tubulin I and II). We present here data indicating that alpha-tubulin II is expressed only in male sexual stage parasites. An IgM mAb, 5E7, specifically reacted with stage III (day 4-5) through mature (day 10-11) male gametocytes and with emerging, exflagellating, or freely moving male gametes. No reactivity was detected in female gametocytes, female gametes, sporozoites, or asexual parasites. mAb 5E7 also specifically recognized male gametes of the avian parasite, Plasmodium gallinaceum, and immunoblotted a 50 kDa protein in extracts of male gametes from both species. This 50 kDa antigen was localized by immunoelectron microscopy to axonemes of male gametes in a pattern similar to that obtained with anti-alpha- and anti-beta-tubulin antibodies. Furthermore, mAb 5E7 specifically reacted with recombinant alpha-tubulin II protein obtained using the PCR-amplified alpha-tubulin II gene from a gametocyte-specific cDNA library. The sex-specific expression of alpha-tubulin II and its localization to axoneme of the male parasite suggest a role for this molecule in the morphologic changes that occur during exflagellation and in the motility of the parasite. alpha-Tubulin II and mAb 5E7 may prove useful tools in studies of the biology of sexual stage differentiation and development in P. falciparum in addition to the general understanding of post-translational modifications of tubulin isoforms.

Animals↗

Sudden deaths and apparent life-threatening events in hospitalized neonates presumed to be healthy.

We describe 10 apparently healthy newborns who were patients in a level 1 nursery and were found by caregivers to be limp, apneic, and requiring resuscitation. All patients were between ages 15 hours and 3 1/2 days, products of term gestations, and of appropriate weight for gestational age. Prenatal or perinatal complications were present in nine of the 10 patients; in no patient was the complication considered a risk for serious, late-onset neonatal problems. All patients had been examined by a physician and were deemed to be in good health before the apparent life-threatening event. Subsequent to the event, each patient required positive pressure ventilation and seven patients received chest compressions. Five patients died. Autopsies were performed on four of the five patients and in none was an adequate explanation for death established. Intrathoracic petechiae were found in one patient whose sibling had died of sudden infant death syndrome at age 11 weeks. Evaluation of the five survivors failed to determine a cause for the episodes. Of the five survivors, one had normal results of developmental examination at age 6 months, while the remaining four survivors had severe neurologic impairment at age 1 year. Apparent life-threatening events occur in hospitalized newborns presumed to be normal and may be a manifestation of early sudden infant death syndrome or early near-miss sudden infant death syndrome.

Apgar Score↗

Patient dose and associated risk due to radiological investigation of the internal auditory meatus.

The radiation doses and associated somatic risks due to four radiological examinations for acoustic neuromata (AN) have been investigated. These examinations were (1) plain film radiography of the internal auditory meatus (IAM), (2) computed tomography (CT) of the IAM, (3) CT of the posterior fossa and (4) CT of the IAM with air contrast. Organ dose measurements were performed using lithium fluoride thermoluminescent dosemeters loaded in a patient equivalent phantom. Dose equivalents to various organs are presented, together with the effective dose equivalent and collective effective dose equivalent for each examination. Hypothetical fatal somatic risks for each examination studied here have been estimated from the effective dose equivalents. The estimated number of hypothetical fatal cancers induced by radiological examinations for AN is between approximately 110 and 820 times lower than the number of detected AN, depending on the method of assessing the radiation dose to the remainder organs. It is concluded that in this particular study the radiological examinations are of net benefit to this group of patients.

Brain↗

Citywide neonatal program. Ten years experience.

A citywide neonatal program initiated in Jacksonville, Florida, in July 1978 through December 1988 had incorporated all six hospitals that provide obstetrical services in the metropolitan area. Admissions, occupancy rate, as well as patient care days served by the Regional Perinatal Intensive Care Center (RPICC) and the Level II nurseries have increased to capacity. More "step-down" care beds are made available by this program which has also proved to be cost effective. Areas of concern are discussed.

Costs and Cost Analysis↗