Biomedical subjects
Publications and source records attributed to K J Martin.
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Concentrative uptake of 32Pi induced by the dissipation of a Na+ gradient (overshoot) was demonstrated in brush border membrane vesicles obtained from isolated perfused canine kidneys. Na+-dependent 32Pi transport was decreased in brush border vesicles from isolated kidneys perfused with parathyroid hormone (PTH) for 2 h compared to uptake measured in vesicles from kidneys perfused without PTH. Cyclic AMP-dependent 32P phosphorylation of a 62,000 Mr protein band was demonstrable on autoradiograms of sodium dodecyl sulfate-polyacrylamide gels of membrane suspensions from kidneys perfused +/- PTH. Evidence that perfusion with PTH resulted in cAMP-dependent phosphorylation in isolated kidneys from parathyroidectomized dogs (decreased cAMP-dependent 32P phosphorylation of the 62,000-Mr band in brush border vesicles) was obtained after 2-h perfusion with PTH. Decreased 32P phosphorylation was not observed if membranes were allowed to dephosphorylate prior to 32P phosphorylation in vitro. We conclude that brush border vesicles from isolated perfused canine kidneys can be used to study the action of PTH on Na+-Pi cotransport in brush border membranes and on cAMP-dependent phosphorylation of the membrane. It is strongly suggested that PTH effects changes in Na+-dependent 32Pi transport in isolated brush border vesicles and changes in 32P phosphorylation of vesicles via a direct action on the renal cortical cell rather than as a consequence of extrarenal actions of the hormone.
Epitrochlearis muscles obtained from normal male Sprague-Dawley rats used as controls (C) and rats with reduced renal mass (Nx) were incubated for 1 hr in Krebs-Ringer buffer containing 5 mM glucose with or without insulin, 25-hydroxycholecalciferol [25(OH)D3] or 1,25 dihydroxycholecalciferol [1,25(OH)2D3]. Plasma levels of 25(OH)D3 were unaffected by reduction in renal mass. Alanine (ALA), tyrosine (TYR), and phenylalanine (PHE) release rates from muscles of Nx rats were increased 40% above C values. Addition of 100 ng/ml of 25(OH)D3 to the incubating media reduced these release rates to C values within 1 hr of incubation. No additive effects with insulin were seen. Addition of 1 ng/ml of 1,25(OH)2D3 did not affect these results. Reduction of renal mass or the addition of insulin or 25(OH)D3 did not affect tissue concentrations of ATP or phosphocreatine. On the other hand, tissue levels of TYR and PHE were increased significantly (approximately equal to 20 to 25%) in muscles from Nx rats compared to C values and were reduced to control values by the addition of 25(OH)D3. The addition of insulin to the incubating media reduced the tissue levels of TYR and PHE in muscles of C rats by approximately equal to 20%, but reduced these levels in muscles of Nx rats by approximately equal to 55%. 25(OH)D3 did not affect tissue levels of cyclic AMP in muscles from either C or Nx rats. Protein synthetic rates were reduced significantly in muscles from Nx rats and returned to C values after 3 hr of incubation but were unaffected by 25(OH)D3. Muscle uptake of 3H,25(OH)D3 was reduced by approximately equal to 30% in muscles from Nx rats compared to C rats. These data suggest that increased muscle protein catabolism exists in rats with reduced renal mass which can be reduced to C values by 25(OH)D3 and does not appear to be mediated through stimulation of adenylate cyclase. 25(OH)D3 did not affect muscle protein synthetic rates. Reduced uptake of 3H,25(OH)D3 by muscles of Nx rats suggests that resistance to this vitamin metabolite may exist at the level of muscle in uremia.
The present studies were designed to examine the consequences of chronic mild elevations of endogenous parathyroid hormone (PTH) in vivo on the PTH receptor-adenylate cyclase system of canine kidney cortex. Hyperparathyroidism was induced in normal dogs by feeding a diet low in calcium, high in phosphorus to the animals for a period of 6-9 wk. This maneuver resulted in a two to threefold increase in the plasma levels of carboxy-terminal immunoreactive PTH. This degree of hyperparathyroidism is similar to that seen in patients with hyperparathyroidism and normal renal function. After 6-9 wk on the diet the animals were killed and basolateral renal cortical membranes prepared for the study of the PTH receptor-adenylate cyclase system in vitro. The dietary hyperparathyroidism resulted in desensitization of the PTH-responsive adenylate cyclase (Vmax 3,648 +/- 654 pmol cyclic (c)AMP/mg protein per 30 min in hyperparathyroid animals vs. 5,303 +/- 348 in normal controls). The Kact (concentration of PTH required for half-maximal enzyme activation) was unchanged. However, PTH receptor binding (125I-norleucyl8-norleucyl18-tyrosinyl34, 125I[Nle8, Nle18, Tyr34] bPTH (1-34) NH2 as radioligand) was not different in the two groups of animals. Thus, dietary hyperparathyroidism resulted in an uncoupling of the PTH receptor-adenylate cyclase system. This defect was not corrected by guanyl nucleotides in vitro, and the effects of guanyl nucleotides on PTH binding and enzyme activation appeared normal. NaF-stimulated enzyme activity was reduced in the hyperparathyroid animals (8,285 +/- 607 pmol cAMP/mg protein per 30 min vs. 10,851 +/- 247 in controls). These data indicate that desensitization of the PTH-responsive adenylate cyclase system of canine kidney as a result of mild chronic elevations of endogenous PTH is due to a postreceptor defect, demonstrable by NaF activation, not corrected by guanyl nucleotides, leading to abnormal PTH-receptor adenylate cyclase coupling.
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The interaction between glucocorticoids (GC) and PTH has been suggested to play a role in the pathogenesis of GC-induced osteopenia. The present studies were designed to examine the effect of acute (5-h) or chronic (4-week) GC administration in vivo on 1) cAMP release by the isolated perfused dog tibia before (basal) and after the addition of synthetic bovine PTH-(1-34) [syn bPTH-(1-34)] (stimulated) to the perfusate in vitro, in the presence or absence of the phosphodiesterase inhibitor 3-isobutyl-1-methyl-xanthine (IBMX; 1 mM), and 2) the percent arteriovenous difference of immunoreactive PTH across bone. Acute administration of 6 mg/kg methylprednisolone (MP) did not affect the basal release of cAMP from bone (6.9 +/- 1.6 pmol/min in control vs. 6.1 +/- 1.2 pmol/min in MP-treated animals); however, syn bPTH-(1-34) stimulated release of cAMP was higher in the MP-treated animals (45 +/- 8.1 pmol/min) than in controls (26.8 +/- 3.0 pmol/min). When IBMX was added to the perfusate, basal cAMP release was not different in control and MP-treated bone (17.2 +/- 2.1 pmol/min in control vs. 19.1 +/- 1.9 pmol/min in MP-treated bone), and syn bPTH-(1-34)-stimulated release of cAMP was equivalent in both groups. In contrast, chronic prednisone therapy lead to a decrease in both basal and PTH-stimulated release of cAMP from bone (3.1 +/- 0.4 and 6.9 +/- 1.6 pmol/min for basal, and 13.1 +/- 1.7 and 26.8 +/- 3.0 pmol/min for stimulated values, respectively). However, the percent changes from the basal levels were not different in the two groups. These results were correlated with histological studies of rib biopsies obtained from these animals, which showed evidence of osteopenia and decreased bone turnover. Neither acute nor chronic GC administration had any effect on arterio-venous differences for PTH across the bone. Thus, these studies demonstrate that 1) acute administration of MP enhances the response of bone to PTH, an effect that is not apparent in the presence of the phosphodiesterase inhibitor IBMX; and 2) chronic prednisone therapy decreased basal and PTH-stimulated cAMP release, an effect that correlated with histological evidence of decreased bone turnover.
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The effects of continuous ambulatory peritoneal dialysis on parathyroid hormone (PTH) and mineral metabolism were evaluated in ten patients. Utilizing a PTH radioimmunoassay, which measures both intact hormone and carboxyl-terminal PTH fragments, it was found that the mean clearance of immunoreactive parathyroid hormone was 1.5 +/- 0.73 ml/min (SEM) yielding a daily net removal of 13.6 +/- 3.2% of estimated total extracellular parathyroid hormone. Gel electrophoresis of the dialysate revealed the presence of both intact parathyroid hormone and fragments in a similar pattern to that of peripheral plasma. Normal levels of 25-(OH) vitamin D and vitamin D binding protein were observed prior to the initiation of continuous ambulatory peritoneal dialysis and following 6 months of treatment. Timed dialysate collections (N = 93) demonstrated a daily calcium influx of only 9.9 +/- 9.7 mg. The daily removal of phosphorus was 308.4 +/- 15.5 mg. Despite elevated serum magnesium levels in all patients, the net daily removal was inadequate (31.2 +/- 15.5 mg). It was concluded that: (1) Unlike chronic hemodialysis, continuous ambulatory peritoneal dialysis removes significant amounts of parathyroid hormone. (2) Normal 25-(OH) vitamin D and vitamin D binding protein levels are maintained with continuous ambulatory peritoneal dialysis despite large protein losses. (3) Substantial amounts of phosphorus are removed with continuous ambulatory peritoneal dialysis but not to an extent that precludes use of phosphorus binders. (4) Dialysate containing lower magnesium and possibly higher calcium concentrations should be made available to improve mineral homeostasis.
Urinalysis and urine chemistries are most helpful in determining whether acute renal failure is due to a prerenal, renal, or postrenal cause. A plain film of the abdomen should be obtained, with ultrasound or computed tomography also being done if obstruction is suspected. When prerenal and postrenal causes have been excluded, the cause should be considered to be acute tubular necrosis, which progresses through initiating, oliguric (or sometimes nonoliguric), diuretic, and recovery phases. Acute tubular necrosis can produce a variety of clinical consequences affecting the entire body, including hyperkalemia, acidosis, hypocalcemia, anemia, and infection, as well as various cardiovascular, neurologic, and gastrointestinal problems.
During the past five years, much has been learned about the complex pathophysiology of acute renal failure. A number of mechanisms appear to be involved, including cell swelling, inhibition of prostaglandin synthesis, tubular obstruction, and disruption of the basement membrane of the proximal tubule. For patients at high risk of acute tubular necrosis, prophylaxis with mannitol or furosemide (Lasix) should be considered under certain circumstances. If this syndrome does occur, management should focus on maintenance of proper fluid and electrolyte levels and nutrition, which is facilitated by dialysis. The prognosis of acute tubular necrosis has changed little in the past ten years, and mortality remains high.
Metal ions play important roles in the regulation of the activation of adenylate cyclase. Previous studies have suggested that an important site of action of metal ions is at or closely related to the nucleotide regulatory protein. The present studies examine the nature of the regulation of enzyme activity by divalent cations and the influence of Mn2+ on hormone binding and stimulation of adenylate cyclase. Studies were performed in canine renal cortical membranes. Substitution of Mg2+ by Mn2+ was associated with a progressive decline in the ability of GTP or PTH to stimulate adenylate cyclase activity. Mn2+ did not alter specific binding of an iodinated PTH analogue. However, in spite of the loss of guanine nucleotide stimulation of enzyme activity, the effects of guanine nucleotide on PTH binding were not altered in the presence of Mn2+. Substitution of Mg2+ by Mn2+ abolished the inhibitory effect of Ca2+ on basal adenylate cyclase activity. Similarly, the effects of GTP or PTH to enhance the inhibitory effects of Ca2+ on enzyme activity were abolished in the presence of Mn2+. Since Mg2+ and Ca2+ compete for a common allosteric site and Mn2+ abolished the effects of these cations, it would appear that Mn2+ also competes for the binding site of Mg2+ and Ca2+. The present studies demonstrating that Mn2+ does not affect hormone binding or the actions of guanine nucleotides on hormone binding yet totally eliminates the effect of GTP on enzyme activity indicate that the effect of Mn2+ occurs at the level of the interactions of the nucleotide regulatory component with the catalytic unit. In addition, these data suggest that there are two functionally distinct sites of guanine nucleotides with different ionic requirements.
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These studies examine the interactions of Ca2+, Mg2+, and guanine nucleotides with PTH binding to renal receptors and activation of adenylate cyclase in a purified preparation of basolateral renal cortical membranes. Inhibition of adenylate cyclase activity by increasing concentrations of CA2+ was more pronounced in the presence of PTH than on basal activity. This effect was not explained by an effect of Ca2+ on equilibrium PTH binding or binding affinity. The presence of PTH also decreased the requirements of the enzyme for Mg2+, consistent with the competitive nature of Ca2+ and Mg2+ interaction. Guanine nucleotides produced similar changes in the metal requirements for enzyme activity. PTH and guanine nucleotides, however, were not additive in this regard in spite of marked synergism in total enzyme activity. Additional studies were performed to further define the effects of guanine nucleotides on the receptor-cyclase system. GTP and Gpp(NH)p caused a dose-dependent decline in equilibrium PTH binding and a small increase in half-maximal displacement. PTH-stimulated adenylate cyclase activity was markedly increased by either nucleotide, and the half-maximal activity was decreased (Gpp(NH)p greater than GTP). This was partly explained by a marked effect of guanine nucleotides on the dissociation rate of receptor-bound PTH. These data suggest that Ca2+ inhibition of PTH-stimulated adenylate cyclase activity is not due to a decreased binding of PTH but to an effect of PTH on the metal requirements for adenylate cyclase activation at the nucleotide regulatory site.
Recent studies suggest that the uptake of immunoreactive parathyroid hormone (iPTH) displays different characteristics in liver, kidney, and bone. Using the isolated perfused canine bone, we have characterized the uptake of two synthetic analogs of PTH, bovine PTH-(3-34) [bPTH-3(3-34)] and [Nle8,Nle18,Tyr34]bPTH-(3-34) amide, which had previously been shown to inhibit PTH-stimulated adenylate cyclase activity in renal membranes. During the infusion of synthetic bPTH-(1-34) (3 ng/ml), extraction of iPTH by isolated perfused bone averaged 37 +/- 1%, and cAMP production rose from 6.2 +/- 2.0 to 21 +/- 3 pmol/min. Extraction of bPTH-(3-34) was similar (35 +/- 2%), but cAMP levels did not increase over baseline with PTH concentrations as high as 100 ng/ml. Simultaneous infusion of bPTH-(1-34) and bPTH-(3-34) at molar ratios of 1:2 led to a 50% inhibition of PTH-stimulated cAMP increases. The extraction by bone of the more potent in vitro inhibitor of renal cortical adenylate cyclase [Nle8,Nle18,Tyr34]bPTH-(3-34) NH2 (3 ng/ml) averaged 39 +/- 2%. In contrast, cAMP production rose from a baseline of 5.6 +/- 0.5 to 12.5 +/- 2.0 pmol/min, demonstrating agonist activity for the analog. These studies show that [Nle3,Nle18,Tyr34]bPTH-(3-34) NH2 has agonist properties in isolated perfused bone, and unsubstituted bPTh-(3-34) inhibits PTH-stimulated cAMP release by perfused bone.
Current evidence suggests that parathyroid gland adenylate cyclase is involved in the control of parathyroid hormone (PTH) secretion. Thus, the altered control of PTH release in hyperparathyroidism may relate to altered adenylate cyclase activation. Therefore, we examined adenylate cyclase kinetics in membrane preparations from hyperfunctioning human parathyroid glands and normal human and bovine parathyroid tissues. There were no differences in the affinity for ATP between enzymes of normal and pathological tissue. However, the enzyme in 10 hyperfunctioning glands showed increased affinity for Mg++. The activation constant for Mg++ (KaMg) of adenylate cyclase in normal human glands was 10.6 +/- 2 mM, a value not different from that of normal bovine parathyroid tissue (9.5 +/- 1 mM). In contrast, the adenylate cyclase in membrane preparations from three of four hyperplastic and six of seven adenomatous human glands showed a markedly reduced KaMg, ranging from 0.85-1.64 mM and from 1.58-6.46 mM, respectively. In one adenoma and one hyperplastic gland, the Ka of the enzyme for Mg++ was close to normal. The addition of guanylylimidodiphosphate or GTP to the incubation mixture increased, in a dose-dependent manner, the apparent KaMg of the enzyme in the abnormal tissue toward normal, suggesting a defective nucleotide regulatory site in the adenylate cyclase of hyperparathyroid glands. In addition, the hyperparathyroid gland enzyme was less susceptible to inhibition by calcium, requiring 0.7-1 mM Ca++ for 50% inhibition, whereas comparable inhibition of the normal adenylate cyclase was seen at 0.22-0.28 mM Ca++. We conclude that the abnormal control of PTH secretion in hyperparathyroidism may be related, at least in part, to alterations in the characteristics of parathyroid gland adenylate cyclase.
To elucidate the mechanism by which cimetidine, an H2 antagonist, inhibits parathormone secretion, immunoreactive cyclic AMP (cAMP) production was measured at low (0.5 mM) and normal (1.0 mM) calcium concentrations, with histamine stimulation and histamine inhibition by cimetidine, in a cell dispersion preparation from cryopreserved glands of 12 hyperparathyroid patients. At low calcium, histamine-mediated cAMP production increased from a basal level of 382 +/- 44 femtomoles/10(5) cells to 514 +/- 74 femtomoles/10(5) cells (P less than 0.05). Cimetidine inhibition of histamine-stimulated parathyroid cells at low calcium resulted in a decrease in cAMP production from 514 +/- 74 femtomoles/10(5) cells to 410 +/- 62 femtomoles/10(5) cells (P less than 0.01). At normal calcium the cAMP production in the histamine-stimulated experiment increased from a basal level of 293 +/- 66 femtomoles/10(5) cells to 477 +/- 100 femtomoles/10(5) cells (P less than 0.01) and decreased to 321 +/- 69 femtomoles/10(5) cells (P less than 0.01) in the histamine and cimetidine experiment. Stimulation by isoproterenol, a beta-adrenergic agonist, at low calcium in the histamine-primed group showed an increase in cAMP production from 514 +/- 74 femtomoles/10(5) cells to 639 +/- 71 femtomoles/10(5) cells (P less than 0.005). These results suggest that histamine plays an important role in cAMP production in hyperparathyroid cells and that cimetidine inhibition of histamine-stimulated cAMP production may explain the decrease of immunoreactive parathormone by this H2 antagonist reported in patients with hyperparathyroidism.
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