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Jack bean urease (EC 3.5.1.5). IV. The molecular size and the mechanism of inhibition by hydroxamic acids. Spectrophotometric titration of enzymes with reversible inhibitors.

Kinetic, spectral, and other studies establish that hydroxamic acids bind reversibly to active-site nickel ion in jack bean urease. Equilibrium ultracentrifugation studies establish that the molecular weight of native urease is 590 000 +/- 30 000 while that of the subunit formed in 6 M guanidinium chloride in the presence of beta-mercaptoethanol is approximately 95 000. Essentially the same subunit molecular weight (approximately 93 000) is found by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, subsequent to denaturation in a guanidinium chloride - beta-mercaptoethanol system at various temperatures. Coupled with an equivalent weight of 96 600 for binding of the inhibitors acetohydroxamic acid and phosphoramidate, these results establish securely that urease is a hexamer with one active site per 96 600-dalton subunit. Consistent values for the equivalent weight are obtained by a routine spectrophotometric titration of the active site of freshly prepared urease with trans-cinnamoylhydroxamic acid. General equations are derived which describe spectrophotometric titrations of binding sites of any enzyme with a reversible inhibitor. These equations allow the evaluation of the difference spectrum of the protein-inhibitor complex even when the binding sites cannot readily be saturated with the inhibitor or vice versa.

Amino Acids↗

Oxygen-induced changes in pulmonary superoxide dismutase assayed by antibody titrations.

Previous studies have demonstrated a 50% increase in pulmonary superoxide dismutase (SOD) activity in oxygen-adapted rats and have suggested that SOD plays a significant role in the development of "tolerance". To further study these events, the cuprozinc SOD was purified from rat liver and found to be similar to previously purified cuprozinc superoxide dismutases. A rabbit antisera to rat cuprozinc SOD was produced and used to perform antibody titrations of SOD in the lungs of rats exposed to 85% O2 for 5 days. The absolute amount of cuprozinc SOD increased 41% by antibody titration which accounted for most, if not all, of the 48% increase demonstrated in total SOD activity. Spectrophotometric assays at pH 7.8 and 10.0 of pure rat cuprozinc SOD and crude lung homogenates suggest that there is also a manganese SOD present, but the role of that SOD in the development of oxygen tolerance has not been established.

Adaptation, Physiological↗

Influence of chronic metabolic acid-base disorders on the acute CO2 titration curve.

Previous studies from this laboratory have characterized the "whole-body" response to acute hypercapnia in normal dog and humans. A more recent investigation has demonstrated that this response is markedly altered by graded degrees of chronic respiratory acidosis. The present studies were carried out to assess the influence, if any, of chronic metabolic acid-base disturbances on the acute CO2 titration curve in the dog. To this purpose we first produced a broad range of chronic plasma bicarbonate concentration of metabolic nature. Metabolic acidosis (n = 14) was produced by prolonged HCl-feeding and metabolic alkalosis (n = 11) by diuretics and a chloride-free diet. Animals with normal acid-base status (n = 4) were also studied. After the establishment of a chronic steady state of acid-base equilibrium, we then performed an acute CO2 titration of the unanesthetized dogs within a large environmental chamber. Three levels of inspired CO2 fraction (FICO2) were employed ranging from 4 to 15%. The results indicate that chronic metabolic acid-base disturbances exert a dramatic influence on the whole-body response to acute hypercapnia. The acute change in plasma bicarbonate for a given change in partial pressure of CO2 in arterial blood (PaCO2) or plasma pH decreases as a function of the chronic level of plasma bicarbonate concentration. Yet the ability of the organism to defend plasma hydrogen ion concentration is progressively strengthened as the chronic level of plasma bicarbonate increases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Imbalance↗

Effects of losartan titrated to Losartan/Hydrochlorothiazide and amlodipine on left ventricular mass in patients with mild-to-moderate hypertension. A double-blind randomized controlled study.

To study the effects of the angiotensin II receptor antagonist Losartan and Amlodipine on left ventricular mass (LVM), we performed blood pressure measurements and transthoracic echocardiographies at baseline. After a 4-week placebo run-in period, 25 patients with mild-to-moderate essential hypertension were randomly allocated to active treatment with Losartan 50 mg titrated to Losartan 50 mg/hydrochlorothiazide (HCT) 12.5 mg (n = 11) or Amlodipine 5 mg titrated to 10 mg (n = 14) for 16 weeks. After treatment, blood pressure decreased significantly in both groups. LVM and LVM index (mean +/- SD/median) in the Losartan group at baseline were 311 +/- 101/288 g and 163 +/- 55/150 g/m(2) and decreased significantly to 252 +/- 25/255 g and 133 +/- 22/128 g/m(2) (p = 0.003 for LVM; p = 0. 01 for LVM index) after 16 weeks of active treatment. In the Amlodipine group LVM and LVM index decreased from 259 +/- 47/243 g and 136 +/- 25/ 131 g/m(2) to 240 +/- 42/234 g and 126 +/- 24/123 g/m(2) (n.s.). In conclusion, LVM decreased significantly as early as 16 weeks after initiation of antihypertensive treatment with the Angiotensin II antagonist Losartan.

Adult↗

Initiation of CPAP therapy for OSA: does prophylactic humidification during CPAP pressure titration improve initial patient acceptance and comfort?

BACKGROUND: Heated humidifiers (HH) enable effective treatment of upper airway dryness during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA), but the role of prophylactic use of HH during the initiation of nCPAP treatment has not been studied so far. OBJECTIVES: The aim of the present study was to investigate whether prophylactic HH during the initiation of CPAP would result in improved initial patient comfort and acceptance. METHODS: In 44 consecutive, previously untreated OSA patients with no history of upper airway dryness, CPAP titration with and without HH was performed on two consecutive nights in a randomised order. The patients were interviewed after each treatment night in order to establish the comfort of the treatment, and, after the second treatment, they were asked which of the two nights they considered more pleasant, and which treatment they would prefer for long-term use. RESULTS: Following CPAP titration with HH, 32 patients (73%) claimed to have had a better night's sleep than usual (i.e. without CPAP treatment) compared with 33 patients (75%) saying the same following CPAP treatment without HH. For 21 patients (47.7%) treatment with HH was more pleasant, 23 (52.3%) saw no difference or said that treatment without HH was more pleasant. Nineteen patients (43.2%) gave preference to treatment with HH for long-term use, while 25 patients (56.8%) had no preference or said they would prefer treatment without HH. CONCLUSIONS: The use of HH during the initiation phase of CPAP treatment was associated neither with an initial improvement in comfort nor with greater initial treatment acceptance.

Adult↗

Effect of plasmid copy number and lac operator sequence on antibiotic-free plasmid selection by operator-repressor titration in Escherichia coli.

The Escherichia coli strain DH1lacdapD enables plasmid selection and maintenance that is free from antibiotics and selectable marker genes. This is achieved by using only the lac operator sequence as a selectable element. This strain is currently used to generate high copy number plasmids with no antibiotic resistance genes for use as DNA vaccines and for expression of recombinant proteins. Until now these have been limited to pUC-based plasmids containing a high copy number pMB1-derived origin of replication, and the principle lacO(1) and auxiliary lacO(3) operators. In this study we have shown that this system can also be used to select and maintain pBR322-based plasmids with the lower copy number pMB1 origin of replication, and that lacO(1) alone or a palindromic version of lacO(1) can provide a sufficient level of repressor titration for plasmid selection. This is advantageous for recombinant protein production, where low copy number plasmids are often used and plasmid maintenance is important. The degree of repressor titration due to these plasmids was measured using the natural lactose operon in E. coli DH1 as a model.

Acyltransferases↗

Tolerability of beta-blocker initiation and titration with bisoprolol and carvedilol in congestive heart failure -- a randomized comparison.

In clinical trials beta-blockers (BB) are well tolerated in patients with systolic congestive heart failure (CHF). In contrast, in daily practice treatment initiation and titration appear to be more difficult and may differ in various BB -- but systematic data are lacking. We randomized 87 patients with systolic CHF (mean age 70.1 +/- 10.6 years, 24% females, LVEF 0.28 +/- 0.10, NYHA III-IV 29%) to treatment with either bisoprolol or carvedilol, in order to assess and compare the maximally achievable number of patients on treatment with these BB and the maximally achieved dosage during a minimum of 2 months attendance at our out patient heart failure clinic. In those randomized to bisoprolol, mean dose at 2 months was 33% of target dose (3.1 +/- 2.6 mg) and 41% at discharge. In those on carvedilol, the mean dose at 2 months was 27% of target dose (13.4 +/- 14.0 mg) and 32% at discharge. Thirty-nine and 40% of the bisoprolol and carvedilol treated patients, respectively, had stopped treatment at discharge. None of the figures differed significantly between the two treatment groups and no baseline parameter predicted BB tolerability. Thus, almost twice the number of unselected patients with systolic CHF attending a heart failure clinic focusing on systematic medical titration were intolerant to BB treatment and only a minority reached target dose treatment. The present data reveal no clear difference with respect to tolerability of carvedilol and bisoprolol, and no parameter predicts tolerability.

Adrenergic beta-Antagonists↗

In vitro production and titration assays of B-tropic retroviruses isolated from C57BL mouse tumors induced by radiation leukemia virus (RadLV-Rs): effect of dexamethasone.

The effect of dexamethasone (DXM) on the replication and titration assays of B-ecotropic radiation leukemia virus (RadLV-Rs) isolates was examined. The drug was shown to enhance in vitro virus release by otherwise low producer permissive cells. DXM also stimulated infectivity and focus formation in murine S+L--permissive cells and shortened the time-appearance of virus-induced foci. In contrast to foci observed in nontreated cultures, which are generally abortive and composed of only a few morphologically transformed cells, those obtained with DXM were comparable to those induced by ecotropic retroviruses with a potent helper activity for murine sarcoma virus. In addition, DXM increased virus-induced XC cell fusion. These fundamental data allowed a more abundant in vitro production of the B-ecotropic RadLV-Rs virus isolates as well as precise infectivity titration assays.

Animals↗

Antihypertensive efficacy of optimally titrated doses of once-daily sustained-release diltiazem: a placebo-controlled trial. DILPLACOMP Study Group.

This study assessed once-daily sustained-release (o.d. SR) diltiazem in essential hypertension; 158 patients with supine diastolic blood pressures (BP) of 95-115 mm Hg were randomized to 200 mg diltiazem or placebo, then optimally titrated, at 2-week intervals, to 200, 300 or 400 mg to achieve supine diastolic BP < 90 mm Hg or a > or = 10 mm Hg fall from baseline. BP was measured at trough level, 24 h after dosing. After 2 weeks at the dose of 200 mg, supine diastolic BP was significantly reduced (from 101 to 92 mm Hg) compared with placebo (from 101 to 98 mm Hg; p < 0.001), and yielded 57% of responders with diltiazem against 22% with placebo (p < 0.001). Titration allowed supine diastolic BP normalization with diltiazem (88 mm Hg) compared with placebo (93 mm Hg; p < 0.001) and yielded 78% of responders with diltiazem against 37% with placebo (p < 0.01). The safety profile was similar to placebo. 200 and 300 mg o.d. SR diltiazem formulations enable safe and close regimen adjustments in mild-to-moderate essential hypertension.

Adult↗

Modulation of B12 dosage and response in fetal treatment of methylmalonic aciduria (MMA): titration of treatment dose to serum and urine MMA.

OBJECTIVE: Prenatally diagnosed methylmalonic aciduria (MMA) has been treated in only a few fetuses, and has been done empirically with maternally administered cyanocobalamin (B12) in attempts to ameliorate sequelae that include failure to thrive, developmental delay, dehydration, and coma. There has not been a systematic attempt to titrate doses to fetal response. We investigated the alterations in maternal dosage necessary to keep maternal plasma (MP) and urine (MU) levels of MMA in the normal range secondary to the ability of pharmacological doses of B12 to catalyze the reaction of methylmalonyl-coenzyme A to succinyl-coenzyme A. METHODS: A 28-year-old woman, with a 3-year-old son affected with MMA, underwent amniocentesis at 15 weeks which showed a normal karyotype, elevated amniotic fluid MMA, and decreased amniocyte 5'-deoxyadenosylcobalamin, propionate, and methyl-tetrahydrofolate. MP and MU MMA levels were measured biweekly. B12 doses were altered periodically according to laboratory-determined levels. RESULTS: MP and MU levels varied with gestational age and in response to increases in maternally administered B12. CONCLUSIONS: With increasing gestation, fetal, and placental size, increasing doses of B12 are necessary to maintain MP and MU levels of MMA within normal range. The data suggest that close surveillance and frequent measurements of MMA are necessary to properly titrate B12 treatment.

Adult↗

Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome.

Automatic CPAP (auto-CPAP) is engineered to automatically provide a positive pressure to the upper airway in response to apnea, hypopnea, airflow limitation, or snoring in patients with the sleep apnea/ hypopnea syndrome (SAHS). Self-adjusted CPAP has theoretical advantages over traditional fixed CPAP. We investigated the value of auto-CPAP regulation in 20 patients with SAHS in order to predict future fixed-level CPAP needs, as an alternative method to conventional polysomnographically (PSG)-controlled CPAP titration. This was accomplished through comparison of the optimal CPAP level obtained with PSG with that obtained with auto-CPAP. There were no significant differences between the optimal CPAP level achieved with full PSG or with auto-CPAP. As a secondary analysis, we analyzed auto-CPAP performance with regard to sleep-stage distribution and arousals in a group of nine male patients, and compared it with the previous group of 20 patients in which manually CPAP titration was guided by PSG. After adequate CPAP was reached, upward and downward fluctuations in the CPAP level had no significant effect on sleep architecture or fragmentation. We conclude that auto-CPAP permits the prediction of future fixed-level CPAP needs, and does so without sleep disruption.

Adult↗

Accuracy of an unattended home CPAP titration in the treatment of obstructive sleep apnea.

Treatment of sleep apnea-hypopnea syndrome (SAHS) by fixed continuous positive airway pressure (CPAP) requires an in-laboratory titration procedure to determine the effective pressure level (Peff ). We recently reported that one auto-CPAP machine can be used without titration study allowing Peff determination. The aim of this study was to evaluate the accuracy of an auto CPAP trial at home. A 1- or 2-wk automatic CPAP trial was done at home in 40 patients by estimating the reference pressure (Pref ) to be set and a Pref + 3 cm H(2)O/-4 cm H(2)O pressure interval. Peff was then determined according to the percentage of CPAP time that was spent </= Pref. This Peff value was set on a fixed CPAP machine for two additional weeks and a control sleep study was done. The pressure setting on fixed CPAP had to be increased by 1 +/- 1 cm H(2)O (mean +/- SD) above estimated Pref. Sleep improved with fixed CPAP, with a normalization of the apnea + hypopnea index (AHI) in 38 of 40 and resumption of diurnal hypersomnolence. CPAP compliance remained excellent (CPAP use: 6.1 +/- 1.7 h/ night) after 6.5 +/- 2.8 mo of CPAP treatment. These results indicate that auto-CPAP therapy represents a new useful and accurate way to identify conventional CPAP setting outside hospital and sleep laboratories.

Adult↗

Titrating steroids on exhaled nitric oxide in children with asthma: a randomized controlled trial.

RATIONALE: Corticosteroids are the antiinflammatory treatment of choice in asthma. Treatment guidelines are mainly symptom-driven but symptoms are not closely related to airway inflammation. The fraction of nitric oxide in exhaled air (FENO) is a marker of airway inflammation in asthma. OBJECTIVE: We evaluated whether titrating steroids on FENO improved asthma management in children. METHODS: Eighty-five children with atopic asthma, using inhaled steroids, were allocated to a FENO group (n=39) in which treatment decisions were made on both FENO and symptoms, or to a symptom group (n=46) treated on symptoms only. Children were seen every 3 months over a 1-year period. MEASUREMENTS: Symptoms were scored during 2 weeks before visits and 4 weeks before the final visit. FeNO was measured at all visits, and airway hyperresponsiveness and FEV1 were measured at the start and end of the study. Primary endpoint was cumulative steroid dose. RESULTS: Changes in steroid dose from baseline did not differ between groups. In the FENO group, hyperresponsiveness improved more than in the symptom group (2.5 vs. 1.1 doubling dose, p=0.04). FEV1 in the FENO group improved, and the change in FEV1 was not significantly different between groups. The FENO group had 8 severe exacerbations versus 18 in the symptom group. The change in symptom scores did not differ between groups. FENO increased in the symptom group; the change in FENO from baseline differed between groups (p=0.02). CONCLUSION: In children with asthma, 1 year of steroid titration on FENO did not result in higher steroid doses and did improve airway hyperresponsiveness and inflammation.

Adolescent↗

On the mechanism of the splay in the glucose titration curve in advanced experimental renal disease in the rat.

Glucose titration studies were performed in rats with unilateral chronic pyelonephritis before and after removal of the contralateral control kidneys. Identical studies were performed in animals with unilateral partial renal infarction in which the experimental kidneys had a marked reduction in nephron population but no anatomic deformation in the surviving nephrons. In the initial studies, both groups of animals were free of clinical and chemical abnormalities of uremia. In the follow-up studies uremic abnormalities were present. Minimal splay was observed in the titration curves in the initial studies; marked splay was present in the group data from the same kidneys in the subsequent studies. Thus a marked reduction in the nephron population was associated with the evolution of splay in both groups of animals. In association with the increase in splay, the mean values for maximal glucose transport increased; thus a defect in glucose transport can be excluded as the basis of the splay. Glomerular filtration rate increased proportionately more than the maximal transport of glucose; hence the ratios of glomerular filtration rate to maximal glucose transport increased consistently. The possibility of asymmetric hypertrophy of glomerular and tubular functions among the nephron population imposed by scar tissue or other anatomic deformities was considered, but the results in the animals with partially infarcted kidneys militate against this explanation. The splay also could reflect an asymmetric alteration in the distribution of glomerulotubular balance among the residual units initiated by functional adaptations. Finally, the splay could relate to an alteration in the kinetics of glucose transport without any change in the level of functional homogeneity. The possible nature of these has been considered in the text.

Animals↗

A comparison of gas-liquid chromatography and a titration method for the determination of plasma non-esterified fatty add levels during pregnancy.

The level of plasma non-esterified fatty acids (NEFA) was measured by gas-liquid chromatography (GLC) and a titration method in 194 samples collected during pregnancy and from four days to 24 weeks post partum. Both techniques indicated a similar pattern of changes in plasma NEFA associated with pregnancy. The titration estimates of NEFA level were usually greater than those measured by GLC, and there was some suggestion that the disparity between the methods was increased at the end of pregnancy and was reduced at six weeks after delivery.

Fatty Acids, Nonesterified↗

The interpretation of CO2 equilibration data to obtain plaque fluid buffer capacities, and comparison with results obtained by titration.

Titration measurements of pooled plaque fluid buffering capacity (Shellis and Dibdin, 1988), which showed a broadly defined minimum at pH 7, were compared with recent curves published by Carey et al. (1988a), which they obtained by an ultra-micro CO2-equilibration technique and which suggested a quite different profile, peaking sharply at pH 7.1. When analyzed in a different, more conventional way, the raw measurements in the latter study become more consistent with our own results and with earlier findings of Tatevossian (1977). In particular, we conclude that the peak at pH 7.1 is an artifact, and that Carey et al. underestimated buffer capacities below pH 6.4 and above pH 7.4. Rationales for the two modes of analysis are compared, and possible reasons for the remaining differences between the re-analyzed CO2-equilibration results and the titration results are discussed. Suggestions for the improvement of the accuracy of the CO2-equilibration technique are put forward.

Bicarbonates↗

Titration streptomycin therapy for bilateral Meniere's disease: a preliminary report.

Intramuscular dosages of streptomycin sulfate were titrated in eight patients with bilateral Meniere's disease in an attempt to alleviate disabling vertigo and hearing loss. It appears possible to eliminate the vertiginous episodes, preserve or improve hearing, and avoid ataxia and oscillopsia in most of these individuals. At present we consider this treatment regimen our first choice of therapy in people with bilateral active Meniere's disease or in patients whose only hearing ear is actively fluctuating and in whom associated disabling vertigo is present. Great caution and supervision should be exercised in the use of streptomycin titration therapy in the individual with bilateral Meniere's disease, as further experience is required to determine the efficacy of this form of management.

Adult↗

Concomitant administration of timolol and hydrochlorothiazide/amiloride in hypertensive patients. Results of a titration study.

In an open dose titration study we evaluated the antihypertensive effect of the concomitant administration of timolol and hydrochlorothiazide/amiloride, administered on a b.i.d. basis. Twenty-eight out of 39 patients completed the study. Supine and standing systolic and diastolic blood pressures and pulse rate were significantly lower at the end of the titration period than at the end of the diuretic period.

Adult↗