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Identification of the catalytic triad residues of porcine liver acylamino acid-releasing enzyme.

Acylamino acid-releasing enzyme (AARE) [EC 3.4.19.1] is a tetrameric serine protease, which belongs to the oligopeptidase family and specifically removes acetyl amino acids from N-terminally acetylated peptides. By using diisopropyl fluorophosphate, we previously identified one of the residues comprising the catalytic triad of this enzyme as Ser587 [Miyagi, M. et al. (1995) J. Biochem. 118, 771-779]. To elucidate the other two residues forming the catalytic triad of this new serine-type protease, wild-type and four mutant AAREs, in which each candidate residue of the catalytic triad deduced from sequence alignment with other oligopeptidases was substituted by site-directed mutagenesis, were expressed in Escherichia coli as fusion proteins with short peptide chains at both N- and C-termini of a subunit of porcine liver enzyme. All of the recombinant AAREs were estimated to have similar conformational and quaternary structures to the native porcine liver enzyme from their CD spectra and behavior on gel-filtration, but the mutants in which Ala587, Asn675, or Tyr707 was substituted for Ser587, Asp675, or His707, respectively, did not show detectable hydrolytic activity toward acetyl-L-methionyl L-alanine. These facts suggest that Ser587, Asp675, and His707 are essential residues for the AARE activity and comprise the catalytic triad of the enzyme in this order. Thus, AARE has been shown to have a protease-like domain in its C-terminal region, as do other proteins classified as members of the oligopeptidase family.

Amino Acid Sequence↗

The double catalytic triad, Cys25-His159-Asp158 and Cys25-His159-Asn175, in papain catalysis: role of Asp158 and Asn175.

The 1.65 A X-ray structure of papain, which exhibits a Cys25-His159-Asn175 triad, does not correspond to the catalytically active ion pair state since Cys25 is oxidized to cysteic acid and His159 is predominantly neutral. Thus, stochastic boundary molecular dynamics simulations starting from the 1.65 A X-ray structure of papain have been performed for Cys25 and His159 in the SH-ImH+, SH-Im, S(-)-ImH+ and S(-)-Im states and for Asp158 mutated to Asn, Glu and Gly in the ion pair state. By comparing the resulting averaged structures and analyzing the trajectories of certain interatomic distances, important differences in the active-site geometry of papain have been found. In particular, the initial Cys25(S-)-His159(ImH+)-Asn175(C = O) triad found in the X-ray structure is retained in all the structures except the wild type and Asp158-->Asn ion pair states where there is a conformational transition to form the triad, Cys25(S-)-His159(ImH+)-Asp158(COO-). Both triads, Cys25(S-)-His159(ImH+)-Asp158(COO-) and Cys25(S-)-His159(ImH+)-Asn175(C = O) are postulated to participate in catalysis and their roles are discussed. Thus, catalysis does not take place from a single steric position but a two-state mechanism.

Amino Acid Sequence↗

Orbital complications of sinusitis in the aspirin triad syndrome.

Orbital complications are uncommon in adult sinusitis. In contrast, the sinusitis of the aspirin triad syndrome is often fulminate, expansive, and recurrent, and complications may be more frequent. Of 81 patients with aspirin triad who were treated surgically, 7 patients (8.6%) had orbital complications, including sinus mucoceles in 3 patients, lacrimal gland extension in 2 patients, inflammatory orbital mass in 1 patient, and proptosis from expansile sinonasal polyposis in 1 patient. All complications manifested within 2 years of prior surgery. Two patients suffered blindness. In a group of 120 consecutively treated sinus surgery patients without aspirin triad syndrome (51 of whom were followed for more than 2 years), no patient manifested nonoperative orbital complications. The results of this study suggest that aspirin triad patients are at significant risk for orbital complications and therefore should have long-term follow-up with aggressive treatment of persistent disease.

Adolescent↗

A novel embryogenetic mechanism for Currarino's triad: inadequate dorsoventral separation of the caudal eminence from hindgut endoderm.

Currarino's triad is a congenital malformation involving the combination of anorectal stenosis, a presacral mass (most often a teratoma or ventral menigocele) and an anterior sacral bony defect (scimitar sacrum). Current theories regarding its embryogenesis are difficult to reconcile with our current understanding of caudal neuraxial and hindgut development. Caudal neuraxial structures develop from the caudal eminence (or tail bud), which normally separates from the hindgut endoderm concurrent with ingrowth of the posterior notochord during late gastrulation. We describe the first reported association of Currarino's triad with a caudal split cord malformation. It has previously been proposed that split cord malformations and related 'complex dysraphic malformations' involving abnormalities of one or more of the three primary germ layers arise through disordered midline axial integration during gastrulation. The presence of a split cord malformation in a patient with Currarino's triad suggests that the two disorders share a common embryogenetic pathway. We propose that the malformations of Currarino's triad arise through a failure of dorsoventral separation of the caudal eminence from the hindgut endoderm during late gastrulation.

Anus, Imperforate↗

The O'Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears.

We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL-MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to determine the incidence of O'Donoghue's triad (the "unhappy triad"), consisting of ACL, MCL, and medial meniscus tears. Patients were subdivided into two groups for analysis based upon the degree of MCL injury at time of presentation (Group I, 35 patients with a second-degree sprain; Group II, 25 patients with a complete, or third-degree injury). Medial meniscus tears were an uncommon finding. Lateral meniscus tears significantly out-numbered medial meniscus tears in both groups, occurring in 25 (71%) of Group I patients and 8 (32%) of those in Group II. Even chondral fractures of the lateral femoral condyle outnumbered medial meniscus tears [6 (17%) versus 4 (11%)] in patients with a second-degree MCL sprain. Furthermore, when present in Group I patients, tears of the medial meniscus were associated with a concomitant lateral meniscus injury. Group II patients were more likely (60%) than Group I not to have any meniscal abnormality at all. We conclude that the classic O'Donoghue triad is, in fact, an unusual clinical entity among athletes with knee injuries; it might be more accurately described as a triad consisting of ACL, MCL, and lateral meniscus tears. This injury combination appears to be more common when an incomplete, or second-degree, tear of the medial collateral has occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior Cruciate Ligament Injuries↗

Driving force and electronic coupling effects on photoinduced electron transfer in a fullerene-based molecular triad

Tuning thermodynamic driving force and electronic coupling through structural modifications of a carotene (C) porphyrin (P) fullerene (C60) molecular triad has permitted control of five electron and energy transfer rate constants and two excited state lifetimes in order to prepare a high-energy charge-separated state by photoinduced electron transfer with a quantum yield of essentially unity (> or = 96%). Excitation of the porphyrin moiety of C-P-C60 is followed by a combination of photoinduced electron transfer to give C-P(.+)-C60.- and singlet-singlet energy transfer to yield C-P-1C60. The fullerene excited state accepts an electron from the porphyrin to also generate C-P(.+)-C60.-. Overall, this initial state is formed with a quantum yield of 0.97. Charge shift from the carotenoid to yield C(.+)-P-C60.- is at least 60 times faster than recombination of C-P(.+)-C60.-, leading to the overall quantum yield near unity for the final state. Formation of a similar charge-separate species from the zinc analog of the triad with a yield of 40% is also observed. Charge recombination of C(.+)-P-C60.- in 2-methyltetrahydrofuran yields the carotenoid triplet state, rather than the ground state. Comparison of the results for this triad with those for related triads with different structural features provides information concerning the effects of driving force and electronic coupling on each of the electron transfer steps.

Journal Article↗

Recurrent meningitis associated with complete Currarino triad in an adult--case report.

A 58-year-old woman presented with Currarino triad manifesting as recurrent meningitis. Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality, and an anorectal malformation, which is caused by dorsal-ventral patterning defects during embryonic development. She had a history of treatment for anal stenosis in her childhood. Radiographic examinations demonstrated the characteristic findings of Currarino triad and a complicated mass lesion. The diagnosis was recurrent meningitis related to the anterior sacral meningocele. Neck ligation of the meningocele was performed via a posterior transsacral approach after treatment with antibiotics. At surgery, an epidermoid cyst was observed inside the meningocele. The cyst content was aspirated. She suffered no further episodes of meningitis. The meningitis was probably part of the clinical course of Currarino triad. Radiography of the sacrum and magnetic resonance imaging are recommended for patients with meningitis of unknown origin. The early diagnosis and treatment of this condition are important.

Abnormalities, Multiple↗

A professionally led adoption triad group: an evolving approach to search and reunion.

In the field of postadoption services, counseling resources for reunited biological relatives are scarce. An adoption triad search and reunion pilot project at McGill University School of Social Work responded to this scarcity by providing the triad of adopted persons, biological parents, and adoptive parents with supportive counseling, and by conducting research on the outcomes. This article is an evaluative descriptive study of a mutualaid adoption triad group in search and reunion. The data were gathered through pre- and postintervention questionnaires and from process notes of the group meetings, which revealed five major themes. Results of the group experience, in terms of the feelings of the participants, were positive. The mutual-aid triad group can serve as a model for agencies and professionals seeking effective, affordable methods of providing postadoption search and reunion support services.

Adoption↗

The female athlete triad: disordered eating, amenorrhea, and osteoporosis.

The Female Athlete Triad is a common clinical entity amongst female athletes. The physician caring for such athletes needs to keep the symptoms of the triad in mind and recognize their potential severity. Still more needs to be done in the areas of prevention, early detection, and early treatment. Education efforts should be focused on junior high and early high school girls because the rapid bone formation during puberty will be necessary to carry them for the rest of their lives. It is also important to note that the female athlete triad should not be used as a reason to disqualify otherwise healthy female athletes from athletic participation. Athletic participation and exercise are good and healthy, if done appropriately. Women have made great strides in the athletic realm, and it would be inappropriate to imply that they should not participate because of the risk or presence of the Female Athlete Triad.

Adolescent↗

A triad of laryngeal hemorrhages in strangulation: a report of eight cases.

The results of histological studies on larynges from eight cases of manual strangulation, all that had intracartilaginous laryngeal hemorrhages, a recently described and under-recognized lesion associated with strangulation, are reported. Formalin-fixed larynges were examined in serial section using a standardized protocol. In all cases, intracartilaginous laryngeal hemorrhages were associated with subepithelial laryngeal hemorrhages, and intralaryngeal muscular hemorrhages forming a "triad of hemorrhages." In five cases, the triad was found in the presence of laryngeal cartilage microfractures. Since cartilage microfractures can be causally related to mechanical injury to the neck, it is likely that the triad of hemorrhages has diagnostic value as an independent morphological criterion for the postmortem diagnosis of strangulation. Since a proportion of cases of strangulation lack characteristics that are self-evidently due to violent application of pressure on the neck, recognition of the triad may have important implications for the postmortem diagnosis of strangulation.

Adult↗

The female athlete triad.

The female athlete triad is defined as the combination of disordered eating, amenorrhea and osteoporosis. This disorder often goes unrecognized. The consequences of lost bone mineral density can be devastating for the female athlete. Premature osteoporotic fractures can occur, and lost bone mineral density may never be regained. Early recognition of the female athlete triad can be accomplished by the family physician through risk factor assessment and screening questions. Instituting an appropriate diet and moderating the frequency of exercise may result in the natural return of menses. Hormone replacement therapy should be considered early to prevent the loss of bone density. A collaborative effort among coaches, athletic trainers, parents, athletes and physicians is optimal for the recognition and prevention of the triad. Increased education of parents, coaches and athletes in the health risks of the female athlete triad can prevent a potentially life-threatening illness.

Amenorrhea↗

Validation of a food-frequency questionnaire using multiple-day records and biochemical markers: application of the triads method.

BACKGROUND: A food-frequency questionnaire (FFQ) used to assess usual food intake in Southern France has been validated by the classical means of multiple-day food records. To minimise over-estimation of the correlation between the dietary assessments by the FFQ and the reference method, which occurs if the random errors of questionnaire and reference measurement are positively correlated, a triangular comparison, the method of triads, was used. METHODS: We applied the triads model by comparing the FFQ with two multiple-day food records and three biomarkers. Only 87 subjects were included and completed the protocol. One biomarker (beta-carotene) was used for the 87 subjects and two biomarkers (urinary nitrogen and potassium) were measured in only 40 subjects. RESULTS: For beta-carotene intake assessment, the triad model, including the weighed multiple records (PETRA), was the best with estimates of validity coefficient of 0.39 [confidence interval (CI) 0.18-0.60] for the FFQ, 0.52 (CI 0.24-0.86), for PETRA and 0.85 (CI 0.43-1) for plasma levels of the nutrient. For protein and potassium intake assessment, the triad model including the estimated multiple records was the best only for the estimates of FFQ validity coefficient (0.61; CI 0.28-0.96 and 0.31; CI 0.09-0.66 respectively). CONCLUSION: Accuracy of the dietary assessment methods permitted a satisfactory estimation of the validity coefficient for beta-carotene intake by the FFQ, despite a small sample. However, the validity coefficients for protein and potassium showed wide CI values, indicating that a sample size < 50 subjects appears unsatisfactory for validation.

Adult↗

Safety of colonic anastomosis following portal triad occlusion in rats.

Traumatic colon injuries frequently coexist with liver injury. Stopping the bleeding from hepatic pool may require complete portal triad occlusion. The possible effects of portal venous occlusion on healing of colonic anastomosis were examined using a rat model. A colo-colonic anastomosis following resection of a 1 cm segment of the transverse colon was done with just a simple manipulation on the liver and portal triad in the group A. In the group B the portal triad was clamped for 15 minutes. Then, the clamp was released for a thirty minutes reperfusion time. Subsequently, the same technique in the control group for colonic resection and anastomosis was applied. Ischemia/reperfusion resulted in histologically proven alterations in the large bowel in the group B. However, colonic tissue superoxide dismutase values showed no significant differences between the groups. On day 7, no differences were recorded in bursting pressures of the anastomoses and the hydroxyprolene levels of the anastomotic tissues of the two groups. These findings suggest that colonic anastomosis after portal triad occlusion is safe in the absence of peritonitis.

Anastomosis, Surgical↗

Adverse reaction of acetaminophen as an alternative analgesic in A.A.S. Triad.

The syndrome of A.A.S. Triad consisting of an intolerance to analgesics such as aspirin, bronchial asthma and nasal polyps, is every day more frequent. During the last years, the use of acetaminophen as an analgesic-antipyretic alternative in patients with A.A.S. Triad has been imperative. However, there are already publications that show reversible bronchial obstruction symptoms similar to the ones produced by A.A.S., though of less intensity. A study was performed in 32 patients diagnosed of A.A.S. Triad by our allergy specialized office with a challenge test of acetaminophen and placebo. Basal spiromentry, physical examination and control of medication before the test, were noted. Of the 32 patients studied, six of them showed a positive provocation test. We maintain the need to perform a provocation test with acetaminophen at the hospital under medical observation before the medication is used by the patient. In terms of practical medicine, this study with acetaminophen as medications of common use in A.A.S. Triad underlies the importance of more caution in prescribing analgesic drugs to patients sensitive to aspirin and A.I.N.E.

Acetaminophen↗

Phenotypes of alpha-1-antitrypsin in intrinsic asthma and ASA-triad patients.

The frequency of presence of various phenotypes of alpha 1-antitrypsin was studied in 31 patients with intrinsic asthma and 11 with ASA-Triad, and compared to a group of 200 people representative of the general population. The MZ and SZ phenotype is more frequent in intrinsic asthmatics (p < 0.00001) and MZ in ASA-Triad (p < 0.0005) than in the control group. No differences were found between the intrinsic asthmatics and ASA-Triad. All the patients were divided into groups according to their clinical characteristics and an increase of the MZ phenotype was observed (p < 0.001) in patients with: nasal polyposis, intolerance to non-steroidal anti-inflammatories, a family history of atopy and peripheral eosinophilia (p < 0.01). Alpha-1-antitrypsin deficiency could be important in the pathogenesis of inflammatory processes and in the clinical manifestations characteristic of patients with intrinsic asthma and ASA-Triad.

Adult↗

Female athlete triad and stress fractures.

Stress fractures are a common occurrence in athletes, and the incidence of stress fractures in female Division 1 collegiate athletes is double that of men. Hormonal influences on bone and bone morphology may influence the risk for fracture. A high level of suspicion and special imaging procedures allow for accurate diagnosis of these fractures. In stress fractures that are associated with the female athlete triad, addressing the three aspects of the triad--eating disorders, amenorrhea, and osteoporosis--are critical for successful treatment. Preparticipation screening for the presence of signs of the female athlete triad by monitoring weight, energy level, menstrual cycles, and bone mineral density may help to prevent the occurrence of stress fractures in this population.

Amenorrhea↗

Prevalence of the female athlete triad syndrome among high school athletes.

OBJECTIVE: To estimate the prevalence of the female athlete triad (disordered eating, menstrual irregularity, and low bone mass) among high school athletes. DESIGN: Observational cross-sectional study. SETTING: High school. PARTICIPANTS: Female athletes (n= 170) representing 8 sports were recruited from 6 high schools in southern California. MAIN OUTCOME MEASURES: Disordered eating and menstrual status were determined by interviewer-assisted questionnaires. Bone mineral density was measured by dual-energy x-ray absorptiometry of the hip, spine (L1-L4), and total body. RESULTS: Among all athletes, 18.2%, 23.5%, and 21.8% met the criteria for disordered eating, menstrual irregularity, and low bone mass, respectively. Ten girls (5.9%) met criteria for 2 components of the triad, and 2 girls (1.2%) met criteria for all 3 components. Oligomenorrheic/amenorrheic athletes had higher mean +/- SD eating restraint (1.55 +/- 1.60 vs 1.04 +/- 1.27; P = .02) and Eating Disorder Examination Questionnaire global scores (1.68 +/- 1.20 vs 1.33 +/- 1.14; P = .03) than eumenorrheic athletes. After controlling for age, age at menarche, body mass index, race/ethnicity, and sport type, athletes with oligomenorrhea/amenorrhea had significantly lower mean +/- SD bone mineral densities for the trochanter (0.884 +/- 0.090 g . cm(-2)) than eumenorrheic athletes (0.933 +/- 0.130 g . cm(-2); P = .04). CONCLUSIONS: The prevalence of the full female athlete triad was low in our sample; however, a substantial percentage of the athletes may be at risk for long-term health consequences associated with disordered eating, menstrual irregularity, or low bone mass. Preparticipation screening to identify these components should be encouraged as a preventive approach to identify high-risk athletes.

Adolescent↗

Computational, pulse-radiolytic, and structural investigations of lysine-136 and its role in the electrostatic triad of human Cu,Zn superoxide dismutase.

Key charged residues in Cu,Zn superoxide dismutase (Cu,Zn SOD) promote electrostatic steering of the superoxide substrate to the active site Cu ion, resulting in dismutation of superoxide to oxygen and hydrogen peroxide, Lys-136, along with the adjacent residues Glu-132 and Glu-133, forms a proposed electrostatic triad contributing to substrate recognition. Human Cu,Zn SODs with single-site replacements of Lys-136 by Arg,Ala, Gln, or Glu or with a triple-site substitution (Glu-132 and Glu-133 to Gln and Lys-136 to Ala) were made to test hypotheses regarding contributions of these residues to Cu,Zn SOD activity. The structural effects of these mutations were modeled computationally and validated by the X-ray crystallographic structure determination of Cu,Zn SOD having the Lys-136-to-Glu replacement. Brownian dynamics simulations and multiple-site titration calculations predicted mutant reaction rates as well as ionic strength and pH effects measured by pulse-radiolytic experiments. Lys-136-to-Glu charge reversal decreased dismutation activity 50% from 2.2 x 10(9) to 1.2 x 10(9) M-1 s-1 due to repulsion of negatively charged superoxide, whereas charge-neutralizing substitutions (Lys-136 to Gln or Ala) had a less dramatic influence. In contrast, the triple-mutant Cu,Zn SOD (all three charges in the electrostatic triad neutralized) surprisingly doubled the reaction rate compared with wild-type enzyme but introduced phosphate inhibition. Computational and experimental reaction rates decreased with increasing ionic strength in all of the Lys-136 mutants, with charge reversal having a more pronounced effect than charge neutralization, implying that local electrostatic effects still govern the dismutation rates. Multiple-site titration analysis showed that deprotonation events throughout the enzyme are likely responsible for the gradual decrease in SOD activity above pH 9.5 and predicted a pKa value of 11.7 for Lys-136. Overall, Lys-136 and Glu-132 make comparable contributions to substrate recognition but are less critical to enzyme function than Arg-143, which is both mechanistically and electrostatically essential. Thus, the sequence-conserved residues of this electrostatic triad are evidently important solely for their electrostatic properties, which maintain the high catalytic rate and turnover of Cu,Zn SOD while simultaneously providing specificity by selecting against binding by other anions.

Binding Sites↗