AT2 Receptor and Tissue Injury: Therapeutic Implications

The converging clinical effectiveness of mineralocorticoid receptor antagonists (MRAs) Spironolactone and Eplerenone has made their safety profiles/cost-effectiveness key determinants of “agents of choice” across a broad range of clinical indications. The clinical biology of the aldosterone molecule and its range of effects in varied organ systems have been well elucidated from recent mechanistic and systematic studies. Clinical experience with Spironolactone is well established, as is its adverse effects profile. The range of adverse effects experienced with Spironolactone subsequently led to its modification and synthesis of Eplerenone. Recent published reports have confirmed lower prevalence rates of sex-related adverse effects attributable to Eplerenone compared to Spironolactone. There is, however, not much to choose between these agents in regards to other adverse effects including hyperkalemia and kidney failure. As was the experience with Spironolactone, as more robust observational data on Eplerenone accrues, it is possible that the real-life experience of its adverse profile may be discordant with that reported by randomized controlled clinical trials (RCTs). In addition, its metabolism by the vulnerable and highly polymorphic cytochrome dependent pathway also makes it susceptible to various drug interactions. The potential implication of the latter (including morbidity and mortality) may take years to evolve.     

The SM protein Sly1 accelerates assembly of the ER–Golgi SNARE complex

Soluble N-ethylmaleimide–sensitive factor attachment protein receptor (SNARE) and Sec1/Munc18 (SM) proteins constitute the core of an ancient vesicle fusion machine that diversified into distinct sets that now function in different trafficking steps in eukaryotic cells. Deciphering their precise mode of action has proved challenging. SM proteins are thought to act primarily through one type of SNARE protein, the syntaxins. Despite high structural similarity, however, contrasting binding modes have been found for different SM proteins and syntaxins. Whereas the secretory SM protein Munc18 binds to the ‟closed conformation” of syntaxin 1, the ER–Golgi SM protein Sly1 interacts only with the N-peptide of Sed5. Recent findings, however, indicate that SM proteins might interact simultaneously with both syntaxin regions. In search for a common mechanism, we now reinvestigated the Sly1/Sed5 interaction. We found that individual Sed5 adopts a tight closed conformation. Sly1 binds to both the closed conformation and the N-peptide of Sed5, suggesting that this is the original binding mode of SM proteins and syntaxins. In contrast to Munc18, however, Sly1 facilitates SNARE complex formation by loosening the closed conformation of Sed5.In eukaryotic cells, material is transported in vesicles that pinch off of one set of membranes and move along microtubule tracks to the next compartment, where they specifically fuse. Key players in the fusion of a vesicle with its acceptor membrane are the soluble N-ethylmaleimide–sensitive factor attachment protein receptor (SNARE) proteins. Heterologous sets of SNARE proteins drive the fusion of two membranes by zippering into a tight four-helix bundle structure. Distinct sets of SNARE proteins carry out different vesicle fusion steps in the cell. An essential SNARE protein for transport into and across the Golgi is Sed5/syntaxin 5 (1). Besides SNARE complexes, Sed5 exists also in a 1:1 complex with the Sec1/Munc18 (SM) protein Sly1 that is essential for ER–Golgi and intra-Golgi trafficking (2). Distinct types of SM proteins are thought to function together with the respective SNARE complex, specifically its syntaxin (reviewed in refs. 3–8).The very N-terminal region, the so-called N-peptide, of Sed5 binds with nanomolar affinity to the outer surface of Sly1 (9–12). This mode of interaction is consistent with the notion that Sly1 can stay bound during SNARE complex formation and that it might even be actively involved in this reaction (13). This idea was strengthened by the observation that Sec1, the SM protein essential for secretion in yeast, interacts with the assembled SNARE complex but not with its isolated syntaxin (14). Unfortunately, for the interaction of Sec1 with its SNARE unit, no definitive structural foundation exists so far, and it remains uncertain whether Sec1 can be considered as a model for SM protein function. Fortunately, the animal counterpart of Sec1, Munc18-1, has been studied in more detail. However, the results of numerous biochemical studies on Munc18-1 appear not to fit into the concept of SM proteins being factors that promote SNARE assembly. On the contrary, initial studies found that Munc18-1 strongly interferes with the ability of its cognate syntaxin 1 to form a SNARE complex (15, 16). This inhibition is difficult to reconcile with an essential role of Munc18-1 during neurotransmitter release (17). The structure of the Munc18-1/syntaxin 1a complex revealed that the central cavity of Munc18-1 wraps around syntaxin in the so-called “closed conformation” (18). In this conformation, the three-helix bundle formed by syntaxin’s N-terminal Habc domain folds back onto its SNARE motif (19), restricting the availability of syntaxin for its SNARE partners. Thus, although they share a similar structure, Munc18-1 and Sly1 appear to bind to their cognate syntaxins in different modes.New light on this discrepancy was shed when it was discovered that Munc18-1 is able to bind simultaneously to a second, spatially separated binding site on syntaxin 1 (15). This second site involves the N-peptide region of syntaxin 1 that, similar to the Sed5 N-peptide (12), binds to the outer surface of Munc18-1. Interestingly, both binding sites are also present in the Munc18/syxtaxin 1 complex of the choanoflagellate Monosiga brevicollis (20). This suggests that the binding mode involving two different sites is evolutionarily conserved. A comparable binding mode was also described for the SM protein Vps45, which regulates trans-Golgi network trafficking. Vps45 binds tightly to the N-peptide of its cognate syntaxin Tlg2/syntaxin 16 (21). It was shown later that Vps45 is also able to interact with the remainder of its Qa-SNARE, possibly in a closed conformation (15, 22).Not all SM proteins are known to bind to the N-peptide of their cognate syntaxin. For example, in the SM protein Vps33, which plays an essential role in the degradation pathway, the N-peptide binding pocket is blocked (23, 24). Vps33 is part of a multisubunit tethering complex known as the homotypic fusion and protein sorting complex (25). Nevertheless, the structure of Vps33 is very similar to other SM protein types despite having low sequence similarity (23, 24). It would be surprising if such structures were not preserved to maintain similar molecular functions. This raises the question of whether there are missing pieces to our understanding of the molecular role of SM proteins.With the idea of a conserved molecular role of SM proteins in mind, we aimed here at a more thorough comparison of Sly1 and Munc18, which are still thought to represent two examples of SM proteins with contrasting syntaxin binding modes. So far nothing is known about a second binding site in the Sly1/Sed5 complex, but the presence of a homologous N-peptide binding site in Munc18 and Sly1 reveals a certain similarity of the two SM protein types. It is debated whether binding of Sly1 to the N-peptide of Sed5 is essential for Golgi trafficking while biochemically less is known (11, 26–28). Neither the effect of Sly1 on SNARE complex assembly has been determined rigorously, nor is it clear whether Sed5 can adopt a closed conformation that interferes with its ability to form a SNARE complex. We therefore sought to determine whether Sly1, in addition to its tight interaction with the N-peptide of Sed5, interacts with the remaining part of Sed5 and, if so, whether this interaction would have an impact on the ability of Sed5 to form a SNARE complex. We found that Sed5 adopts a closed conformation. Comparable to Munc18-1, Sly1 binds simultaneously to both the closed conformation and the N-peptide region of Sed5, although the latter is the major contributor to its affinity to the complex. Remarkably, in contrast to Munc18-1, which blocks SNARE complex assembly, Sly1 was found to assist Sed5 in forming a SNARE complex.     

Default mode network activity and white matter integrity in healthy middle-aged ApoE4 carriers

Alzheimer’s disease (AD) is most commonly detected during old age, but the underlying neuropathologic changes likely appear decades earlier, especially among patients possessing genetic risk factors, such as the isoform E4 of the apolipoprotein E (ApoE4). In this study, we used magnetic resonance imaging (MRI) to assess default mode network (DMN) connectivity in 22 ApoE4 non-carriers and 14 matched ApoE4 carriers as well as white matter fractional anisotropy (FA) in 15 ApoE4 non-carriers and 11 demographically matched ApoE4 carriers. Cognitive tests were also administered. All of the participants were middle-aged adults. The analysis revealed no cognitive or white matter FA differences between carriers and non-carriers. However, in DMN regions previously implicated in AD, we did detect decreased functional connectivity. Our findings suggest that functional MRI abnormalities may be detectable well before cognitive decline or white matter changes among individuals at increased genetic risk for AD.     

Anesthetic management of an infant with Joubert syndrome for cardiac surgery

The anesthetic implications of Joubert syndrome in an infant who required cardiac surgery using cardiopulmonary bypass (CPB) is presented. Children with Joubert syndrome present with central apnea due to malformations in the midbrain and cerebellum. These patients have a marked sensitivity to opioids. The use of dexmedetomidine along with remifentanil was effective in this case.     

Precision Errors,Least Significant Change,and Monitoring Time Interval in Pediatric Measurements of Bone Mineral Density,Body Composition,and Mechanostat Parameters by GE Lunar Prodigy

Dual-energy X-ray absorptiometry (DXA) method is widely used in pediatrics in the study of bone density and body composition. However, there is a limit to how precise DXA can estimate bone and body composition measures in children. The study was aimed to (1) evaluate precision errors for bone mineral density, bone mass and bone area, body composition, and mechanostat parameters, (2) assess the relationships between precision errors and anthropometric parameters, and (3) calculate a “least significant change” and “monitoring time interval” values for DXA measures in children of wide age range (5–18 yr) using GE Lunar Prodigy densitometer. It is observed that absolute precision error values were different for thin and standard technical modes of DXA measures and depended on age, body weight, and height. In contrast, relative precision error values expressed in percentages were similar for thin and standard modes (except total body bone mineral density [TBBMD]) and were not related to anthropometric variables (except TBBMD). Concluding, due to stability of percentage coefficient of variation values in wide range of age, the use of precision error expressed in percentages, instead of absolute error, appeared as convenient in pediatric population.     

Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995–2016

We studied 10 patients treated because of late avascular necrosis (AVN) mimicking Legg-CalvéPerthes' disease (LCPD) after developmental dislocation of the hip (DDH). DDH was recognized late at an average age of 5.4 months and in all children it was treated without surgery. In 4 children, the treatment was complicated by mild AVN of the femoral head, which had disappeared before 3 years of age. The first clinical signs of LCPD were noted at a mean age of 5.8 years. They all had Catterall's type III or IV of LCPD. The course was typical of LCPD. 8 children were operated on at mean age of 7.4 (5-12) years. In 7 of them, subtrochanteric derotation-varisation osteotomy of the femur with shortening combined mainly with Dega's pelvic osteotomy was done. The operative treatment resulted in a concentric position of the femoral head and good coverage of the acetabulum. Follow-ups were done at 10 (6-35) years. Shortened femoral neck and trochanteric overgrowth occurred in 4 operated hips. According to the Stulberg classification, 2 hips were classified as type I, 1 as I/II, 5 as II, 1 as II/III and 1 as IV. We conclude that LCPD mimicking late AVN can occur in hips treated because of developmental dislocation.     

Investigating the human immunodeficiency virus type 1-infected monocyte-derived macrophage secretome

Mononuclear phagocytes (bone marrow monocyte-derived macrophages, alveolar macrophages, perivascular macrophages, and microglia) are reservoirs and vehicles of dissemination for the human immunodeficiency virus type-1 (HIV-1). How virus alters mononuclear phagocyte immunoregulatory activities to complete its life cycle and influence disease is incompletely understood. In attempts to better understanding the influence of virus on macrophage functions, we used one-dimensional electrophoresis, and liquid chromatography tandem mass spectrometry to analyze the secretome of HIV-1-infected human monocyte-derived macrophages. We identified 110 proteins in culture supernatants of control (uninfected) and virus-infected cells. Differentially expressed cytoskeletal, enzymes, redox, and immunoregulatory protein classes were discovered and validated by Western blot tests. These included, but were not limited to, cystatin C, cystatin B, chitinase 3-like 1 protein, cofilin-1, l-plastin, superoxide dismutase, leukotriene A(4) hydrolase, and alpha-enolase. This study, using a unique proteomics platform, provides novel insights into virus-host cell interactions that likely affect the functional role of macrophages in HIV disease.