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Biomedical subjects

J Holm

Publications and source records attributed to J Holm.

At least 73 records · Page 4Linked to original sources

Control of neuronal morphology in vitro: interplay between adhesive substrate forces and molecular instruction.

Among the factors which influence neuronal morphology, the degree of substrate adhesivity has been suggested to play an important role in the growth and guidance of neurites. The present study was undertaken to investigate apparently contradictory results relating substrate adhesivity to the extent of neurite outgrowth. By using substrates coated with different concentrations of polyornithine to vary adhesivity, we could show that intermediate levels of neuron-to-substrate adhesive strength favored neurite outgrowth more than substrates of high or low adhesivity. However, when neurons were plated on substrates derived from the extracellular matrix, the strength of neuron-to-substrate adhesion was important for the growth of dendrite-like minor neurites, but not for the extension of axon-like major neurites, which grew independently of adhesive forces. On substrates of the cell adhesion molecule L1, growth of both major and minor neurites was adhesion-independent. Finally, in the presence of tenascin added to the culture medium, neurite growth was inhibited irrespective of the adhesivity of the substrate and the presence of substrate-bound extracellular matrix molecules or L1. These observations suggest that intermediate forces of adhesivity favor neurite growth in general, but that purely adhesive forces can be dominated by specific molecular instructions which differentially affect growth of major and minor neurites in positive and negative ways.

Animals↗

Several extracellular domains of the neural cell adhesion molecule L1 are involved in homophilic interactions.

The neural cell adhesion molecule L1 is a multidomain protein that plays important roles in cell adhesion, migration, and neurite outgrowth. It can interact with itself by a self-binding, i.e., homophilic adhesion mechanism (Kadmon et al.: J Cell Biol 110: 193-208, 1990a). To determine the domains of L1 involved in homophilic binding, we have generated protein fragments of L1 in a prokaryotic and a eukaryotic expression system and used these covalently coupled to fluorescent microspheres to quantify aggregation between them by cytofluorometric analysis. Protein fragments containing the first and second Ig-like domains and the third fibronectin type III homologous repeat showed avid self-binding. Ig-like domains III and IV also showed some self-binding, whereas Ig-like domains V and VI and fibronectin type III homologous repeats 1 and 2 as well as 4 and 5 were less or not active. Binding between different domains was also observed: fibronectin type III homologous repeats 4 and 5 interacted with Ig-like domains I and II, and fibronectin type III homologous repeats 3-5 interacted with all Ig-like domains. These results were confirmed by experiments testing the binding of fragment-conjugated microspheres to substrate-coated L1 or to cell surface-expressed L1 on cultured neurons. Binding of L1 to itself was interfered with by all protein fragments tested, suggesting that also less avidly binding domains of L1 contribute to homophilic binding. These observations indicate prominent functional roles of both Ig-like domains and fibronectin type III homologous repeats in homophilic binding of L1.

Animals↗

[Albuminuria in persons with real hypertension, white coat hypertension and normotension].

A prospective comparison of office blood pressure, daytime ambulatory blood pressure and urinary albumin excretion was performed in 284 consecutive patients from general practice with newly diagnosed, untreated mild to moderate hypertension. Based on daytime ambulatory blood pressure 173 were classified as established hypertensives and 111 as white coat hypertensives. A sample of 127 subjects drawn from the Danish national register served as a normotensive control group. It was found that urinary albumin/creatinine ratio differed significantly between the three groups; the difference remained significant after correction for covariables. Early morning urine albumin/creatinine ratio was weakly but significantly correlated to blood pressure. Early morning urine albumin/creatinine ratio was as reproducible a measure as 24-hour albumin excretion. It is concluded that white coat hypertensive patients have less renal involvement than patients with established hypertension, but more than a normotensive control group.

Adult↗

T lymphocytes from human atherosclerotic plaques recognize oxidized low density lipoprotein.

Atherosclerosis, an underlying cause of myocardial infarction, stroke, and other cardiovascular diseases, consists of focal plaques characterized by cholesterol deposition, fibrosis, and inflammation. The presence of activated T lymphocytes and macrophages and high expression of HLA class II molecules are indicative of a local immunologic activation in the atherosclerotic plaque, but the antigen(s) involved has not yet been identified. We established T-cell clones from human atherosclerotic plaques using polyclonal mitogens as stimuli and exposed the clones to potential antigens in the presence of autologous monocytes as antigen-presenting cells. Four of the 27 CD4+ clones responded to oxidized low density lipoprotein (oxLDL) by proliferation and cytokine secretion; this response was dependent on autologous antigen-presenting cells and restricted by HLA-DR. All clones that responded to oxLDL secreted interferon gamma upon activation, but only one produced interleukin 4, suggesting that the response to oxLDL results in immune activation and inflammation but may not be a strong stimulus to antibody production. No significant response to oxLDL could be detected in CD4+ T-cell clones derived from the peripheral blood of the same individuals. Together, the present data suggest that the inflammatory infiltrate in the atherosclerotic plaque is involved in a T-cell-dependent, autoimmune response to oxLDL.

Antibodies, Monoclonal↗

[Augmentation ileo-cystoplasty in women with disabling urge incontinence].

The results after "clam"-augmentation cystoplasty are assessed in 11 consecutively operated women aged 35-78. All were suffering from severe urgency. Eight were urge-incontinent and six of these stress-incontinent as well. Nine patients had been operated before with a total of 14 operations. Bladder distension and parasympatholytic medication had been tried in two and seven instances respectively. One patient died of a pulmonary embolism three weeks postoperatively. Follow-up ranged from 12-52 months, mean 29 months. Eight (80% (44-97)%) of the remaining 10 patients were cured with respect to urgency. One patient was improved, and one unchanged. Three (60% (15-95)%) out of five previously stress-incontinent patients were dry, one was improved and one unchanged in spite of a subsequent stamey urethrosuspension. Eight patients (80% (44-97)%) had spontaneous micturition, one used self-catheterisation once daily and one patient was retained on an indwelling catheter. It is concluded that augmentation cystoplasty is a procedure of considerable value in patients with disabling non-neurogenic urgency, where conservative therapy and previous surgery has failed.

Adult↗

Identification of the border between fibronectin type III homologous repeats 2 and 3 of the neural cell adhesion molecule L1 as a neurite outgrowth promoting and signal transducing domain.

To determine the domains of the neural cell adhesion molecule L1 involved in neurite outgrowth, we have generated monoclonal antibodies against L1 and investigated their effects on neurite outgrowth of small cerebellar neurons in culture. When the 10 antibodies were coated as substrate, only antibody 557.B6, which recognizes an epitope represented by a synthetic peptide comprising amino acids 818 to 832 at the border between the fibronectin type III homologous repeats 2 and 3, was as efficacious as L1 in promoting neurite outgrowth, increasing intracellular levels of Ca2+, and stimulating the turnover of inositol phosphates. These findings suggest that neurite outgrowth and changes in these second messengers are correlated. Such a correlation was confirmed by the ability of Ca2+ channel antagonists and pertussis toxin to inhibit neurite outgrowth on L1 and antibody 557.B6. These observations indicate for the first time a distinct site on cell surface-bound L1 as a prominent signal-transducing domain through which the recognition events appear to be funneled to trigger neurite outgrowth, increase turnover of inositol phosphates, and elevate intracellular levels of Ca2+.

Amino Acid Sequence↗

Urinary excretion of albumin and transferrin in lithium maintenance treatment: daily versus alternate-day lithium dosing schedule.

Urinary excretion of albumin and transferrin was determined by means of sensitive immunochemical methods in 40 manic-depressive patients prior to and following 6 months of daily or alternate-day lithium carbonate treatment. The median dose of lithium carbonate was 700 mg in the daily treatment group and 1200 mg in the alternate-day group, the corresponding median 12-h serum lithium concentration being 0.6 mmol l-1 and 0.7 mmol l-1, respectively. Urinary excretion of albumin and transferrin was significantly elevated in the lithium-treated patients as compared to a control group (Mann-Whitney). The change in urinary albumin:creatinine and transferrin:creatinine ratios between allocation and 6 months of treatment did not correlate significantly with the lithium dosing schedule (multiple linear regression), but did correlate with total lithium carbonate dose. In conclusion, the study provides no evidence of any difference in glomerular function (permeability) in the daily and alternate-day lithium dosing schedules, and lends no support to the hypothesis that alternate-day treatment diminishes the effect of lithium on renal function.

Adult↗

Surgically assisted, rapid maxillary expansion in adults. A retrospective long-term follow-up study.

This study presents a technique for surgically assisted, rapid maxillary expansion performed on 20 patients and the results after orthodontic treatment. The mean age of the patients was 36.3 years and on average they had been followed-up for 3 years and 6 months. The results seemed to be reliable long-term. The definitive expansion in the first molar region was 7.1 mm +/- 2.4 and in the canine region 4.8 mm +/- 2.7. The relapse measured after the observation period, was in the corresponding regions 1.2 mm +/- 1.3 and 0.2 mm +/- 2.1. The study also seemed to support the theory that the suture, anterior to the incisive canal, never ossifies until very late in life.

Adolescent↗

Effects of spinal cord stimulation (SCS) in patients with inoperable severe lower limb ischaemia: a prospective randomised controlled study.

OBJECTIVES: This study was designed to test the hypothesis that spinal cord stimulation (SCS) improves limb salvage in patients with inoperable severe leg ischaemia. DESIGN: Prospective randomised controlled study with 18 months follow-up. SETTING: Vascular surgical units in two university hospitals. MATERIALS: Atherosclerotic (n = 41) and diabetic (n = 10) patients having chronic leg ischaemia with rest pain and/or ischaemic ulcerations due to technically inoperable arterial occlusions. CHIEF OUTCOME MEASURES: Limb salvage and amount of tissue loss within 18 months, pain relief. MAIN RESULTS: Twenty-five patients were randomized to SCS and 26 to analgesic (control) treatment. Macrocirculatory parameters were not different in the two groups during follow-up. Long-term pain relief was observed only in the SCS group. At 18 months, limb salvage rates in the SCS and control groups were 62% and 45% (N.S.). Tissue loss was less (p = 0.05) in the SCS group. A subgroup analysis of patients without arterial hypertension showed a significantly lower amputation rate in the SCS vs the control group. CONCLUSIONS: SCS provided long-term pain relief but limb salvage at 18 months was not significantly improved by SCS in this rather small study. The results suggest that SCS may reduce amputation levels in patients with severe inoperable leg ischaemia and be most effective in patients without arterial hypertension.

Aged↗

When is urgent revascularization unnecessary for acute lower limb ischaemia?

OBJECTIVES: To predict the risk of gangrene by the use of simple clinical parameters available on admission. DESIGN: Retrospective comparison using logistic regression and chi2 analyses of prospectively registered data from two patients series. METHODS: One group of patients with acute lower limb ischaemia, (n = 61) was managed by selective initial non-operative treatment (NO) in a university hospital. The other group (n = 173) contained patients managed by early revascularisation in a multicentre (MC) study from 10 university, county and district hospitals. Gangrene and death within one month were recorded. RESULTS: 57% of patients in the NO group were initially managed by intravenous heparin followed by surgery when necessary. Impaired motor function and skin cyanosis in the ischaemic limb predicted gangrene. Patients without this combination were low risk (LR) patients and constituted 62% (NO) and 67% (MC). Non-operatively managed LR patients did not develop gangrene, whereas 14% of those undergoing early revascularisation in the two series did (p < 0.05). CONCLUSIONS: The results suggest that patients without motor disturbance and cyanosis are at low risk of gangrene and may benefit from initial non-operative treatment, irrespective of the presumed aetiology.

Acute Disease↗

Oral ciprofloxacin versus intravenous cefuroxime as prophylaxis against postoperative infection in vascular surgery: a randomised double-blind, prospective multicentre study.

OBJECTIVES: To test the hypothesis that oral ciprofloxacin is equally effective as intravenous cefuroxime in preventing postoperative infectious complications in patients undergoing peripheral arterial surgery involving the groins. DESIGN: Prospective, randomised, double-blind multicentre study. MATERIALS: 580 patients undergoing arterial surgery involving the groins were randomised to ciprofloxacin (Ciproxin, Bayer) 750 mg x 2 p.o. or cefuroxime (Zinacef, Glaxo) 1.5 g x 3 i.v. given only on the day of surgery. The primary endpoint was wound/graft infection within 30 days postoperatively. Wound infection was defined as pus. RESULTS: The wound infection rate in the ciprofloxacin group was 9.2% (27 patients) and in the cefuroxime group 9.1% (26 patients) according to intention to treat. For correct treatment the corresponding numbers were 9.5% (23 patients) and 9.7% (22 patients), respectively. There were three graft infections (0.5%). The infection rate was 7.1% (31/433) in the absence and 14.9% (22/147) in the presence of distal ulcers (p < 0.05). S. allreus was the most common bacteria isolated. Forty percent of the wound infections were localised to the groins. By multivariate analysis presence of distal ulcer was the only factor of prognostic significance. CONCLUSIONS: The infection rate was similar in the two groups. Thus, oral administration of ciprofloxacin is an attractive, cost-effective and safe alternative to prophylaxis in vascular patients capable of taking oral medication on the day of surgery.

Administration, Oral↗

Folate receptor in malignant effusions of ovarian carcinoma.

Binding of 3H-folate in human ovarian adenocarcinoma tissue was of a high-affinity type (K approximately 10(10) M-1) and displayed apparent positive cooperatively. A high-affinity folate receptor was also present in ascitic fluid and pleural effusion. Radioligand dissociation was slow at pH 7.4, but rapid at pH 3.5. The folate analogues methotrexate and in particular 5-formyltetrahydrofolate acted as inhibitors of 3H-folate binding in ascitic fluid. Ovarian adenocarcinoma tissue showed immunostaining with rabbit antibodies against human milk folate-binding protein. The gel filtration diagram contained two peaks of radiolabelled folate (at 25 and 100 kDa). The 25 kDa peak was predominant in ascitic fluid and pleural effusion. A single band of 70 kDa was seen on SDS-PAGE immunoblotting of tissue and malignant effusions. The concentration of folate receptor in tissue and fluid specimens could be determined by an immunochemical method (ELISA) utilizing antibodies against human milk folate-binding protein.

Adenocarcinoma↗

A high-affinity soluble folate receptor in fluids of non-neoplastic ovarian cysts: radioligand binding, molecular size, hydrophobic residue, and immunological properties.

The presence of a soluble folate receptor in fluids of non-neoplastic ovarian cysts was demonstrated. Radioligand binding exhibited characteristics typical of high-affinity folate-binding proteins. These included positive cooperativity, a tendency to increased binding affinity with decreasing receptor concentration, a slow ligand dissociation at pH 7.4 and inhibition by folate analogues. The folate receptor was probably synthesized in the lining epithelial cells of the cysts which showed positive immunostaining with antibodies against human milk folate-binding protein. The gel filtration profile of cystic fluid contained two radioligand-bound peaks, 25 and 100 kDa, whereas a single band of 70 kDa was seen on SDS-PAGE immunoblotting. Treatment with the enzyme phosphatidylinositol-specific phospholipase C resulted in a partial conversion of the 100 kDa peak to the 25 kDa peak. This suggests that insertion of a hydrophobic glycosylphosphatidylinositol tail into Triton X-100 micelles could give rise to large molecular size forms of the receptor on gel filtration.

Carrier Proteins↗

Patients with low stump pressure and possible pressure fall in the middle cerebral artery during carotid surgery may be identified preoperatively by transcranial Doppler.

Although it has now been established that surgery is the best way to treat patients with symptomatic tight carotid stenosis, the fact remains that perioperative risks are not negligible. Patients with significant contralateral stenosis and/or no collateral flow capacity through the anterior communicating artery are likely to be at higher risk during surgery. We examined a series of 52 patients pre- and postoperatively with transcranial Doppler (TCD) and compared the results to perioperative stump pressures. Our intention was to find out whether the results of the TCD examination of the circle of Willis could be correlated to the perioperative stump pressures, and whether TCD gives reliable information about the collateral flow. We found relatively high stump pressures in patients with potential function of any communicating artery, and in the group with no collateral function most patients had low stump pressures. We also found that preoperative flow velocity fall in the middle cerebral artery (MCA) on compression of the ipsilateral internal carotid artery correlated with perioperative stump-pressure indices. However, we were unable to predict stump pressures in individual patients by flow velocity measurements in the MCA preoperatively.

Adult↗

Expression of the macrophage scavenger receptor in atheroma. Relationship to immune activation and the T-cell cytokine interferon-gamma.

Scavenger receptors mediate internalization of modified lipoproteins and foam cell transformation of monocyte-derived cytokines. We investigated macrophage scavenger receptor (MSR) expression in monocyte-macrophages from human peripheral blood and in atherosclerotic lesions and analyzed its relationship to T lymphocytes and immunoregulatory cytokines by immunohistochemistry and polymerase chain reaction (PCR). Antibodies specific for the two MSR isoforms were generated by immunizing rabbits with isoform-specific synthetic peptides conjugated to keyhole limpet hemocyanin. In human atherosclerotic plaques, these antibodies stained macrophages and foam cells in a pattern that corresponded to the distribution of the macrophage marker CD68. CD3-positive T cells and alpha-actin-positive smooth muscle cells exhibited no reactivity to the anti-MSR antibodies. The frequency of cells stained with antibodies to MSR type I was equal to that of cells stained for type II, suggesting that most macrophages coexpress both isoforms. Reverse transcription (RT)-PCR analysis confirmed that both MSR isoforms were expressed in all plaques examined. There was, however, a tendency toward a lower immunohistochemical staining intensity for MSR type I and a decreased number of lipid-rich foam cells in T cell-rich areas. The mRNAs for interleukin-2 and interferon-gamma, two major products of activated T cells, were detected by RT-PCR in all plaques tested. This indicates that activation of T lymphocytes occurs in atherosclerotic plaques. Since interferon-gamma downregulates MSR expression, these observations suggest a potential mechanism for local regulation of MSR expression in the atherosclerotic plaque.

Aged↗

Arterial smooth muscle cells express nitric oxide synthase in response to endothelial injury.

Endothelial cells regulate vascular tone by secreting paracrine mediators that control the contractility of arterial smooth muscle cells. Nitric oxide (NO) is an important vasodilating agent that is generated from L-arginine by the enzyme nitric oxide synthase (NOS), which is expressed constitutively by the endothelium. NO also inhibits platelet aggregation, contributing to the antithrombotic properties of the endothelial surface. It would therefore be expected that loss of the endothelium during arterial injury would lead to vasospasm and thrombosis but instead, the neointima formed after injury has a nonthrombogenic surface and a maintained vascular patency. We report here that arterial smooth muscle cells in the neointima formed after a deendothelializing balloon injury to the rat carotid artery express the cytokine-inducible isoform of NOS. Expression was detectable by reverse transcription-polymerase chain reaction from day 1-14 after injury and in situ hybridization showed expression of NOS mRNA by neointimal smooth muscle cells, particularly at the surface of the lesion. This was associated with systemically detectable NO production as revealed by electron paramagnetic resonance spectroscopic analysis of nitrosylated red cell hemoglobin. Local NO production by intimal smooth muscle cells after endothelial injury could represent an important mechanism for the maintenance of arterial patency and nonthrombogenicity in the injured artery.

Amino Acid Oxidoreductases↗