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Biomedical subjects

F Cockburn

Publications and source records attributed to F Cockburn.

At least 19 recordsLinked to original sources

Sequence variation at the phenylalanine hydroxylase gene in the British Isles.

Using mutation and haplotype analysis, we have examined the phenylalanine hydroxylase gene in the phenylketonuria populations of four geographical areas of the British Isles: the west of Scotland, southern Wales, and southwestern and southeastern England. The enormous genetic diversity of this locus within the British Isles is demonstrated in the large number of different mutations characterized and in the variety of genetic backgrounds on which individual mutations are found. Allele frequencies of the more common mutations exhibited significant nonrandom distribution in a north/south differentiation. Differences between the west of Scotland and southwestern England may be related to different events in the recent and past histories of their respective populations. Similarities between southern Wales and southeastern England are likely to reflect the heterogeneity that is seen in and around two large capital cities. Finally, comparison with more recently colonized areas of the world corroborates the genealogical origin by range expansion of several mutations.

Alleles

Recommendations for protein and amino acid intake in phenylketonuric patients.

The methods for the determination of protein requirements are reviewed and the difficulties in achieving the recommendations of the dietary management of phenylketonuria proposed by a Medical Research Council Working Party on Phenylketonuria using currently available low phenylalanine (Phe) protein substitutes and low protein foods are examined. These recommendations are that all infants whose blood Phe concentrations exceed 600 mumol/l in the presence of a normal or low plasma tyrosine and an otherwise normal plasma amino acid profile while receiving a normal protein intake (2-3 g/kg/day), should start a low Phe diet immediately. Infants whose blood Phe concentrations remain persistently between 400 and 600 mumol/l for more than a few days should also start treatment. The diet should contain a protein substitute which is Phe free (or at least very low in Phe) and otherwise nutritionally complete with a composition sufficient to provide 100-120 mg/kg per day of tyrosine and a total amino acid intake of at least 3 g/kg per day in children under 2 years of age. In children over 2 years the intake of amino acids should be maintained at a level of 2 g/kg per day. The protein substitute should be spread as evenly as possible through the 24 h. Blood Phe concentrations should be maintained between 120 and 360 mumol/l. In children aged over 10 years it is suggested that the protein substitute should supply the protein reference nutrient intake + 50%. An upper blood Phe limit of 480 mumol/l rather than 360 mumol/l may be acceptable in school age children. Adults and adolescents should continue treatment with the aim to maintain blood Phe concentrations no higher than 700 mumol/l. During the period before conception and during pregnancy women should aim to have plasma Phe concentrations between 60-250 mumol/l.

Adolescent

Effect of diet on the fatty acid composition of the major phospholipids of infant cerebral cortex.

The fatty acid compositions of the major cerebral cortex phospholipids, phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine were measured in 16 term and one preterm 'cot death' infants fed exclusively either breast milk or one of two formulas. Docosahexaenoic acid (DHA; C22:6n-3) content in cerebral cortex phosphatidylethanolamine and phosphatidylserine of breast fed infants was greater than in both formula groups with significances varying between p < 0.1 and p < 0.001. Compensation for this deficiency in DHA in the formula fed infants was largely achieved by increased incorporation of docosapentaenoic acid (C22:5n-6) in the cerebral cortex of term infants and Mead (C20:3n-9) and dihomo Mead acids (C22:3n-9) in the preterm infant. As the phospholipids most affected are known to perform an important role in membrane function and are possibly integral to neurotransmission it is recommended that breast milk substitute infant formulas should contain n-3 and n-6 series polyunsaturated fatty acids in proportions similar to those of human milk.

8,11,14-Eicosatrienoic Acid

Discordant phenylketonuria phenotypes in one family: the relationship between genotype and clinical outcome is a function of multiple effects.

Four members spanning three generations of one family have phenylketonuria of varying degrees of severity. Two first cousins were screened in the neonatal period and have had dietary phenylalanine restriction since diagnosis, the older patient having been classified as having more severe PKU and the younger one as having mild PKU. Their mutual grandfather and his older brother also have a significant hyperphenylalaninaemia and are of normal intelligence despite never having had restricted phenylalanine intake. Mutation analysis of the phenylalanine hydroxylase (PAH) gene has established that there are four different mutations, two in exon 2 (F39L and L48S) and two in exon 3 (R111X and S67P), which give rise to PKU in this family. In order to establish their relative severity, we screened the PKU populations of western Scotland and the south west of England for these mutations. The exon 3 mutations are rare; however, F39L is relatively common in Scotland and L48S in England. A comparison of diagnostic blood phenylalanine concentrations in subjects carrying L48S/null or F39L/null mutations with those carrying two null mutations suggest that these exon 2 mutations are less deleterious. Thus, in this family, the different biochemical phenotypes can be explained, in part, by different genotypes at the PAH locus but our results show that the relationship between genotype and clinical outcome is more complex and is a function of multiple effects.

Aged

Age- and dietary-related distributions of hepatic arachidonic and docosahexaenoic acid in early infancy.

A dietary-related deficiency of docosahexaenoic acid [C22:6(n-3)] in infant cerebral cortex has been identified. Absence or very low rates of hepatic synthesis from the essential fatty acid precursor, alpha-linolenic acid [C18:3(n-3)], in early life may have been a contributory factor. We have analyzed liver total lipid fatty acid compositions in 27 term (37-42 wk gestation) and 4 preterm (30-33 wk gestation) infants who died within the first 6 mo of life from sudden infant death syndrome. The infants were fed exclusively either human or formula milks. Formula-fed infants were subdivided into two groups, one receiving SMA milk with an alpha-linolenic acid content at 1.5% of total fatty acids and the other a composite group fed milks with low alpha-linolenic acid concentrations (< 0.1% to 0.4%). The hepatic content of arachidonic acid [C20:4(n-6)] and docosahexaenoic acid was generally lower in both formula-fed groups than in the human milk-fed group. The age-related distributions of docosahexaenoic acid showed that coincident minimum levels were present in both formula groups in the third month of life. This may indicate that the hepatic enzymes involved in the final stage (delta 4-desaturation) conversion of alpha-linolenic acid to docosahexaenoic acid could be inactive in the first months of life. Emphasis must be on provision of preformed dietary docosahexaenoic acid and possibly arachidonic acid as well as their essential fatty acid precursors, to both term and preterm infants for at least the first 16 wk of life.

Animals

Breast feeding in Scotland.

OBJECTIVE: To measure the prevalence of breast feeding and to examine the value of using information collected on Guthrie cards (used for detecting inherited metabolic disease and hypothyroidism when newborn infants are 7 days old) to calculate this prevalence. DESIGN: Analysis, by geographical area and maternity unit, of information on breast feeding collected on Guthrie cards for 131,759 babies born in 1990 and 1991, and comparison with prevalences from other sources. SETTING: Scotland. RESULTS: Of the 131,759 babies, only 46,949 (35.6%) were breast feeding on day 7. The prevalence of breast feeding ranged from 59.1% (376/636) in Shetland to 21.1% (1836/8719) in Lanarkshire and < 8% in some postcode districts of cities. Analysis of the data by hospital of birth showed that the prevalence ranged from 51.2% (2701/5275) to 16.4% (507/3090). CONCLUSION: The prevalence of breast feeding in Scotland is low and varies among areas and maternity units. Intervention to increase this prevalence is essential, and information collected on Guthrie cards is a useful indication of mothers' intentions to breast feed.

Breast Feeding

Artificial ultraviolet whole-body radiation does not modify serum lipoprotein, plasma fibrinogen, plasminogen or antithrombin III concentrations in post-myocardial infarction patients.

The relationship of ischaemic heart disease (IHD) to seasonal and latitude variation has prompted speculation that exposure to the ultraviolet component of solar radiation may reduce IHD risk. This hypothesis was partially tested by exposing 14 post-myocardial infarction patients to a 6 week course of artificial whole-body ultraviolet radiation (UVR). Serum lipoprotein and plasma coagulation factor concentrations were measured before and after the course of UVR. Results were compared with similar measurements from a placebo-controlled group of 13 post-myocardial patients. Despite a more than two-fold rise in mean serum 25-OHD, serum lipoprotein and plasma fibrinogen, antithrombin III and plasminogen concentrations did not change significantly in the UVR group. Significant but minor change in prothrombin time and thrombin time in the placebo group appear unlikely to be of biological significance. Seasonal and latitude variation in these IHD risk factors appear unrelated to corresponding variation in solar UVR exposure.

Antithrombin III

Mutation analysis of the phenylalanine hydroxylase gene using heteroduplex analysis with synthetic DNA constructs.

Using heteroduplex analysis generated with synthetic PCR-amplifiable DNA we have screened the PKU populations of southwest England and Wales, western Scotland, and southeast and central England for mutations in exons 3, 7 and 12 of the phenylalanine hydroxylase (PAH) gene. The technique characterized three mutations in exon 12, two in exon 3 and five in exon 7. Altogether over 370 PKU chromosomes were screened. In all geographical regions exon 12 mutations (R408W, IVS12nt1g- > a and Y414C) accounted for about 40% of mutant chromosomes. Exon 3 mutations (principally I65T) were found on between 9 and 12% of mutant alleles and exon 7 mutations accounted for a further 5-7%. Heteroduplex analysis is rapid, simple and safe and three constructs covering three exons can identify between 55 and 60% of mutations in various PKU populations of the UK.

DNA

Effect of diet on infant subcutaneous tissue triglyceride fatty acids.

Having demonstrated a deficiency in infant cerebral cortex docosahexaenoic acid of formula fed compared with breast milk fed infants, we sought to identify why the extensive subcutaneous tissue triglyceride fatty acid reserves in term new-born infants appeared to be ineffectual in its prevention. In addition to 24 term and six preterm infants who died from 'cot death', tissue was analysed from four perinatal surgical patients and in the former the results were correlated with dietary milk intake. The higher amounts (about 15% by weight) of unsaturated linoleic acid supplied in the formula milks were quantitatively incorporated into the subcutaneous tissue largely at the expense of the saturated palmitic acid possibly compromising adipocyte fluidity. The six preterm infants were in two formula fed groups and there was only one significant difference, namely a higher subcutaneous tissue concentration of alpha-linolenic acid in one of the preterm groups, distinguishing them from their term counterparts. This may imply that the enzymes involved in absorption and digestion of fatty acids are mature in the preterm infant. From birth the mean weight percentage of docosahexaenoic acid (0.4%) fell rapidly to undetectable levels (< 0.05%) in the formula fed group after about two months. It is therefore concluded that if breast feeding is not possible then a minimum daily requirement of 30 mg docosahexaenoic acid (approximately 0.2 g/100 g fatty acids) should be supplied in formulas designed for term infants to prevent the cerebral cortical deficiency of docosahexaenoic acid.

Adipose Tissue

Prevalence of maternal HIV infection in Scotland based on unlinked anonymous testing of newborn babies. Update.

In January 1990, unlinked anonymous testing of Guthrie cards for HIV antibody commenced in Scotland. Ethics Committee approval allowed testing of 99.6% of Scottish births. Twenty-one mothers spontaneously refused to allow testing of their baby's blood. Samples were coded by district postcodes. For 1990 through 1991, eluates of 132,531 dried blood spots were initially tested for HIV-1 antibody with the Fujirebio technique. Of the 49 positive samples 38 were confirmed to be positive by enzyme-linked immunosorbent assay and western blot (seroprevalence 0.3 per 1000). Thirty-five of 38 samples came from large metropolitan areas in Scotland. Prevalences were 2.0 per 1000 for Edinburgh city, 0.7 per 1000 for Dundee and Aberdeen, 0.15 per 1000 for Glasgow and 0.05 per thousand for all other areas in Scotland. Recent spread of HIV infection to Aberdeen may have occurred. These figures do not support an overall increase of HIV infection in childbearing women in Scotland.

Adult

Epidemiology of Haemophilus type b invasive disease in childhood in Glasgow.

The objective of this study was to investigate the epidemiology of invasive disease due to Haemophilus influenzae type b in childhood in Glasgow. A retrospective study has been made on the hospital records of 252 children aged 0 to 12 years admitted to Glasgow hospitals during 1981-1990. The annual incidence of invasive Haemophilus influenzae type b disease in Glasgow was estimated at 39 per 100,000 children less than five years of age per year. The figure for Haemophilus meningitis was 23.8 per 100,000 children less than five years of age per year. Ninety-five per cent of all cases occurred in children less than five years of age and 72.1% of meningitis cases occurred before two years of age. There was a mortality of 2.77%. Long-term neurological sequelae were found in 15.3% of the survivors. The annual incidence of Haemophilus influenzae type b disease is slightly higher in Glasgow than previously reported for the United Kingdom. The study provides baseline data to help assess efficacy of proposed early childhood vaccination.

Child

Infant cerebral cortex phospholipid fatty-acid composition and diet.

It has not been established whether nutrition in early infancy affects subsequent neurodevelopment and function. If there is an effect, it seems probable that the essential fatty acids and their metabolites, the major constituents of brain structure, will be the most susceptible to dietary influence. We determined the phospholipid fatty-acid composition of cerebral cortex grey matter obtained from 20 term and 2 preterm infants who had died of "cot deaths" and related results to the milk diet the infants had received. Tissues were analysed by gas chromatography. The mean weight percentage of docosahexaenoic acid was significantly greater (p less than 0.02) in 5 breast-milk-fed infants (9.7%) than in 5 age-comparable formula-milk-fed infants (7.6%). In these formula-fed babies, the overall percentage of long-chain polyunsaturated fatty acids was maintained by increased incorporation of the major n-6 series fatty acids. In 1 formula-fed preterm infant, in whom the lowest concentration of cortical docosahexaenoic acid was found, the compensatory effect was only partial with both n-9 series eicosatrienoic acid or Mead acid and docosatrienoic acid also detected in the phospholipid. Supplementation of formula milks for term infants with docosahexaenoic acid and those for preterm infants with both docosahexaenoic and arachidonic acid could prove beneficial to subsequent neurodevelopment.

Age Factors

Direct gas chromatographic assay of urinary medium-chain fatty acylcarnitines by their thermal decomposition.

We report a gas chromatographic assay for urinary medium-chain acylcarnitines which employs their property of thermal lability, and by circumventing the need for specialised mass spectroscopy is suitable for routine laboratory use. The method produces readily interpreted, uncomplicated chromatograms and has proved to be both sufficiently sensitive and specific to enable detection of octanoylcarnitine in a symptomatic individual with medium-chain CoA dehydrogenase deficiency and in two asymptomatic siblings following administration of a carnitine load.

Acyl-CoA Dehydrogenase