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Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Robert Bosch Stiftung (Stuttgart, Germany) Region Stockholm (ALF project; Stockholm, Sweden) Introduction Chest pain is a common chief complaint in emergency departments (EDs). The Acute Cardiovascular Care Association recommends the use of History, ECG, Age, Risk factors, and Troponin (HEART) score for risk stratification. In hectic and overcrowded EDs computerized history taking (CHT) is one structured way for collecting the components of HEART score, which include medical history (H- and R-variables). Purpose To determine the proportion of acute chest pain patients where CHT can be used to calculate HEART score, and what interrater reliability the included variables have with physician acquired medical history. Methods Prospective cohort study with acute chest pain patients self-reporting medical histories using a CHT program (Clinical Expert Operating System, CLEOS) on a tablet. CLEOS, with >17,000 decision nodes, mimics a physician interview and tailors each interview continuously depending on previous answers. Clinically stable women and men aged >18 years with a chief complaint of chest pain and non-diagnostic ECG or serum markers for acute coronary syndrome were enrolled. Patients unable to carry out a CHT interview (e.g., severe impaired vision or confusion) were excluded. As recommended in regional guidelines a modified HEART score using the traditional classification of anginal symptoms, i.e. 1) central chest pain, 2) provoked by physical exertion and/or emotional stress, and 3) relieved by rest and/or nitrates, and traditional risk factors was used (see Table 1). Observations to each discrete H- and R-variable and medical history data were extracted from electronic health records (EHR) and the CHT database by the research staff. Cohen’s kappa statistics and interpretation according to Landis & Koch was used to describe the interrater reliability. Results A total of 1,000 consecutive patients were enrolled in one tertiary university hospital ED during 2017–2019 (mean age 55±17 years; 54% women), comparable to the general chest pain population (mean age 58±19 years; 50% women). A complete HEART score could be calculated in 60% of patients (H-variable 91%; R-variable 60%). Registered observations from EHR and CHT and interrater reliability data are presented in Table 1. Interrater reliability for the H-variable (classical anginal symptoms) was slight to moderate (kappa 0.19-0.44) and the R-variable (traditional risk factors) was moderate to almost perfect (kappa 0.56-0.88). Conclusions HEART score could be calculated in a majority of acute chest pain patients by the use of CHT. Interrater reliability was high for traditional risk factors but low to moderate for classical anginal symptoms. Our ongoing studies assess whether CHT combined with a risk score such as HEART score in an acute setting can be useful for improved risk stratification and, more important, to improve clinical outcomes.

There is continuing controversy about the mechanism for transfer of fatty acids (FA) between plasma and the interior of cells and vice versa. One view is that this is a spontaneous process. The generally accepted view is that each step of the process is facilitated by a specialized protein. Whether uptake is spontaneous or facilitated, the components of the uptake system, e.g., albumin, water, FA, plasma membrane, and putative transport proteins of the plasma membrane, must behave according to the rules of the physical chemistry of the system. We review these features to illustrate the constraints they impose on the design of experiments to adduce the mechanism of uptake. Analysis of the literature in the context of the physical chemistry of the uptake system indicates that arguments for a facilitated mechanism of uptake for FA are not supported by any data extant. By contrast, comparison of the rates for individual steps of the pathway traversed by FA moving from albumin to the inside of a cell (or vesicles of a model system) with rates of uptake of FA of tissues in the steady state shows that the rates of the former are sufficient to account for the rate of the latter.

A comparison of infrared absorption spectra obtained from the differentlayers of squamous epithelium from the human cervix, and infrared spectra obtainedfrom exfoliated cervical cells, is presented. Infrared spectroscopy has been shown (inpart I of this series) to be a sensitive tool to monitor maturation and differentiation ofhuman cervical cells; therefore, this spectroscopic technique provides new insights intothe composition and state of health of exfoliated cells. q 1998 John Wiley & Sons, Inc.Biospectroscopy 4: 55–59, 1998 Keywords: infrared spectroscopy of human tissue; squamous epithelium; exfoliatedcells INTRODUCTION to screen for precancer, for example, revealedmany nonspecific spectral changes, since a num-A number of publications using infrared spectros- ber of different medical conditions produced simi-copy as a possible diagnostic tool for cervical and lar spectral responses: for example, white bloodother cancers, as well as a number of other condi- cells may accumulate in tissue as a response totions, has recently appeared in the literature.

Sir, Beresford’s essay ‘Medical reductionism: lessons from the great philosophers’ is simplistic and sets a dangerous tone for discussing contentious issues affecting everyday medical practice.1 While his argument about a philosophy for medical science will not impact the thinking of working scientists, his statements about evidence-based medicine will be grist for the mills of the know-nothing movement in the USA2 and could embarrass public support for medical science, which is necessary for developing better evidence to inform decision making in everyday practice. On these grounds alone, Beresford’s essay should not go unchallenged. With regard to the conduct of medical research, Beresford acknowledges that rational analysis yields significant insights into the causes and treatments of disease but warns that this reductionist program oversimplifies the complexity of clinical issues, cannot …

Two events in the last decade have set the stage for the large-scale clinical testing of chemopreventive agents for colorectal cancer in people at low to moderate risk for this disease. One of these is the discovery of a cause-effect relationship between the activities of cyclooxygenases (COX) and carcinogenesis in the colon, which can be interdicted by inhibitors of the enzymes. The other is the development of selective inhibitors of COX-2. These agents, when used in animals, also inhibit carcinogenesis in the colon. Additionally, they appear to be safe enough in humans to allow large-scale testing in healthy people. We review the key data implicating a causal relationship between the activity of COX and carcinogenesis and its possible mechanisms of action. We also emphasize work that points to other molecular targets for chemoprevention of colorectal cancer, which is emerging from studies of the link between COX and carcinogenesis.

Infrared absorption spectra of formalin-fixed, paraffin-embedded human cervical tissue are reported for normal, dysplastic and neoplastic samples. The spectral differences found in this study between these states of the tissues are far less than those observed for single cells by us and others. Nevertheless, we find a direct correspondence between spectral data from tissue sections, obtained from biopsies, and individual exfoliated cells, typically obtained during a pap procedure. We also find that spectra due to dysplastic samples fall about halfway between the spectral features of normal and cancerous samples.

Infrared spectral results for the different epithelial layers of human cervical squamous tissue are reported. The layers, representing different cellular maturation stages, exhibit quite different spectral patterns. Thus, infrared spectroscopy presents a powerful tool to monitor cell maturation and differentiation. Furthermore, a detailed understanding of the spectra of the individual layers of tissue permit a proper interpretation of the state of health of cells exfoliated from such tissue. Part II of this series describes the use of the spectral information presented here to interpret the infrared spectra of exfoliated cells.

A comparison of infrared absorption spectra obtained from the different layers of squamous epithelium from the human cervix, and infrared spectra obtained from exfoliated cervical cells, is presented. Infrared spectroscopy has been shown (in part I of this series) to be a sensitive tool to monitor maturation and differentiation of human cervical cells; therefore, this spectroscopic technique provides new insights into the composition and state of health of exfoliated cells.

Studies of the mechanism of lipid-induced regulation of the microsomal enzyme UDP-glucuronosyltransferase have been extended by examining the influence of charge within the polar region on the ability of lipids to activate delipidated pure enzyme. The effects of net negative charge, of charge separation in phosphocholine, and of the distribution of charge in the polar region of lipids were studied using the GT2p isoform isolated from pig liver. Prior experiments have shown that lipids with net negative charge inhibit the enzyme (Zakim, D., Cantor, M., and Eibl, H. (1988) J. Biol. Chem. 263, 5164-5169). The current experiments show that the extent of inhibition on a molar basis increases as the net negative charge increases from -1 to -2. The inhibitory effect of negatively charged lipids is on the functional state of the enzyme and is not due to electrostatic repulsion of negatively charged substrates of the enzyme. Although the inhibitory effect of net negative charge is removed when negative charge is balanced by a positive charge due to a quaternary nitrogen, neutrality of the polar region is not a sufficient condition for activation of the enzyme. In addition to a balance of charge between Pi and the quaternary nitrogen, the distance between the negative and positive charges and the orientation of the dipole created by them are critical for activation of GT2p. The negative and positive charges must be separated by the equivalent of three -CH2- groups for optimal activation by a lipid. Shortening this distance by one -CH2- unit leads to a lipid that is ineffective in activating the enzyme. Reversal of the orientation of the dipole in which the negative charge is on the polymethylene side of the lipid-water interface and the positive charge extends into water also produces a lipid that is not effective for activating GT2p. On the other hand, lipids with phosphoserine as the polar region, which has the "normal" P-N distance but carries a net negative charge, do not inhibit GT2p. This result again illustrates the importance of the dipole of phosphocholine for modulating the functional state of GT2p.

The effects of cholesterol on the activity and thermal properties of a pure, delipidated isoform of UDP-glucuronosyltransferase were examined after incorporation of enzyme into unilamellar bilayers of distearoylphosphatidylcholine (DSPC) or dioleoylphosphatidylcholine (DOPC). Cholesterol, in bilayers of DSPC, decreased enzyme activity and lowered the temperature (from 37 to 30 degrees C) for a reversible transition from the active form of the enzyme to a less active form. These effects could be separated from each other in that the effect on reversible inactivation of the enzyme occurred at lower concentrations of cholesterol than the effect on activity of the active form of the enzyme. In addition, cholesterol in bilayers of DSPC stabilized UDP-glucuronosyltransferase against irreversible thermal inactivation. The extent of stabilization increased with increasing concentration of cholesterol in the bilayers. The effects of cholesterol on UDP-glucuronosyltransferase depended, however, on the nature of the bilayer containing cholesterol. Cholesterol had small effects, if any, on the properties of UDP-glucuronosyltransferase in bilayers of DOPC.

The thermal stability of glucose-6-phosphatase in rat liver microsomes was examined in untreated and cholate-treated microsomes. Activity of the enzyme was measured with both glucose-6-P and mannose-6-P as substrates. Heat treatment did not cause glucose-6-phosphatase activity to decline to zero with a single rate constant in untreated microsomes. Instead, heat treatment produced an enzyme with a small residual activity that was stable. The residual level of activity was not stimulated by addition of detergent. In untreated microsomes the energies of activation for the processes of decay were different for glucose-6-phosphatase and mannose-6-phosphatase activities, suggesting that the rate-limiting steps for the hydrolysis of these compounds were different. Treatment of microsomes with detergent increased the rate constants for the thermal decay of glucose-6-phosphatase by about 150 times, and, in contrast to untreated microsomes, glucose-6-phosphatase and mannose-6-phosphatase decayed to zero with a single rate constant in cholate-treated microsomes. Also, rate constants for thermal inactivation of glucose-6-phosphatase and mannose-6-phosphatase were the same in cholate-treated microsomes. Removal of cholate increased the stability of glucose-6-phosphatase but did not regenerate the form of the enzyme present in untreated microsomes. The data for the stability of glucose-6-phosphatase under different conditions provide evidence that the enzyme can exist in at least five different stable states that are enzymatically active.

When beef liver microsomes are labeled with UDP-[3H]N-acetyl glucosamine, three different lipid-bound saccharides are labeled: dolichol pyrophosphoryl-GlcNAc, dolichol pyrophosphoryl-(GlcNAc)2 and a previously uncharacterized compound (component III). Incubation with UDP leads to the disappearance of dolichol pyrophosphoryl-(GlcNac)2 from microsomes prelabeled with UDP-3H-N-acetyl glucosamine. This result provides further support for the suggestion of Leloir et al. (6) that dolichol pyrophosphoryl-(GlcNAc)2 is synthesized from dolichol pyrophosphoryl-GlcNAc and UDP-N-acetyl glucosamine. Component III cannot be discharged with UMP or UDP. It elutes from DEAE-cellulose exactly as the other components. The saccharide portion of component III has a molecular weight of 800–900 and contains glucose in addition to N-acetyl glucosamine.

UDP-glucuronyltransferase (EC 2.4.1.17) in intact, untreated microsomes from pig liver is activated by relatively low concentrations of UDP-N-acetylglucosamine. This property is absent after treatment of microsomes with detergents or phospholipases, and also is not a characteristic of pure, delipidated enzyme. Sensitivity to activation by UDP-N-acetylglucosamine was reconstituted, however, by incorporation of pure, delipidated enzyme into unilamellar bilayers of phosphatidylcholine that were in a gel phase. Warming of these bilayers to just above the temperature for the gel to liquid crystalline phase transition led to an abrupt loss of sensitivity of UDP-glucuronyltransferase to activation by UDP-N-acetylglucosamine. These experiments establish that sensitivity to activation by UDP-N-acetylglucosamine is an inherent property of UDP-glucuronyltransferase. The data also suggest that the lipid environment of UDP-glucuronyltransferase in intact, untreated microsomes can modulate the sensitivity of this enzyme to allosteric activation by UDP-N-acetylglucosamine, and that this lipid environment is in a gel phase in intact microsomes at 37 degrees C.

Nonpolar substrates of microsomal UDP-glucuronyl-transferase partition between the hydrophobic phase of the microsomal membrane and the bulk aqueous phase in a suspension of microsomes in water. Partitioning of estrone into the membranes was measured in the studies presented and was extensive. Comparison of the rate of conjugation of estrone and the rate of its release from microsomes into the bulk aqueous phase showed that the pool of estrone within the membrane is the substate for UDP-glucuronyl-transferase. The rate of conjugation of estrone was 6-fold greater than the rate of release of estrone from the membrane into the aqueous phase. Several additional experiments showed that the rate of glucuronidation of estrone did not depend on the amount of estrone in the bulk aqueous phase. It is concluded that the microsomal membrane serves to concentrate nonpolar substrates of UDP-glucuronly-transferase. The phospholipid region of the microsomal membrane also may be a co-factor of UDP-glucuronyltransferase in the sense that binding of estrone to the membrane restricts its orientation in a manner that facilitates catalysis.

Two forms of UDPglucuronyltransferase (EC 2.4.1.17) have been purified from microsomes of pig liver. One form is free of phospholipids and the other contains a small amount of residual phospholipids. Each form, however, is responsive to activation on addition of purified phospholipids. Comparison of kinetic properties of these enzymes, after reconstitution with identical phospholipid environments, indicate that these are unique functional forms of UDPglucuronyltransferase. The two differ by as much as 100-fold in their rates of conjugation at Vm of p-nitrophenol. Relative rates of glucuronidation of a variety of phenolic aglycones are different for the two enzymes, which suggests different reaction mechanisms. The energetic basis for binding of UDP-glucuronic acid to the active sites is different for the two forms of UDPglucuronyltransferase. Moreover, one form, but not the other, binds Mn2+, which leads to modulation of kinetic properties.

The factors regulating glucose-6-phosphatase (EC 3.1.3.9) activity and substrate specificity in hepatic microsomes were studied by determining the rate-limiting reaction for the hydrolysis of glucose-6-P, and by examining the effect of detergent activation on phosphotransferase activity. Examination of the pre-steady state kinetics of glucose-6-phosphatase revealed that the steady state rate is determined by the rate of hydrolysis of the enzyme-P intermediate. Treatment of the enzyme with detergent does not alter the extent of the rapid release of glucose per mg of protein, but activates the steady state rate of catalytic turnover. Specificity of the enzyme was evaluated by comparing the effects of mannose and glucose as phosphate acceptors in the phosphotransferase reaction catalyzed by glucose-6-phosphatase. Untreated glucose-6-phosphatase discriminates against mannose as compared with glucose in that mannose and glucose bind to the enzyme-P intermediate of untreated enzyme, but mannose is not an acceptor of Pi. Mannose is an acceptor, however, after treatment of microsomes with detergent. These data cannot be explained in terms of the currently accepted "compartmentation" model for the regulation of glucose-6-phosphatase. The detergent-induced changes in kinetic properties appear to reflect alterations in the intrinsic characteristics of glucose-6-phosphatase, which could result from interaction with its membrane environment.

Postnatal developmental changes in hapatic microsomal UDP-glucuronyltransferase were studied in the rat. The previously reported postnatal decline in the capacity of microsomal fractions to glucuronidate p-nitrophenol was found to be observable in unperturbed preparations only at non-saturating concentrations of the substrate UDP-glucuronic acid. At saturating concentrations of UDP-glucuronic acid, activity is identical in newborns and adults. Kinetic analysis revealed that the enzyme from liver of newborns has a much higher affinity for UDP-glucuronic acid than does the enzyme in adults, but the same activity at Vmax. On the other hand, the enzyme from adult liver microsomal fractions can be activated by the physiological allosteric effector UDP-N-acetylglucosamine, whereas the enzyme from newborns is largely unaffected by it. Thus it appears that the number of enzyme active sites is not changing; rather, the enzyme is maturing to a more highly regulable form. There were also differences between the enzymes in newborns and adults in their response to perturbation of the membrane-lipid environment by detergent and phospholipase A. Possible interpretations of these differences are discussed.

The kinetics of a pure, delipidated form of microsomal UDP-glucuronyltransferase is non-Michaelis-Menten when the enzyme is reconstituted into unilamellar vesicles of phosphatidylcholine that are in a gel phase. Double reciprocal plots of velocity as a function of the concentration of UDP-glucuronic acid show a downward curvature under these conditions. Binding studies indicate that the basis for the kinetic pattern is the presence of one high affinity and one low affinity binding site for UDP-glucuronic acid. The two classes of binding sites seem to be generated by the presence of two subunits that bind UDP-glucuronic acid within a single molecule of UDP-glucuronyltransferase. Melting the phospholipids from the gel phase to the liquid-crystal phase is associated with a switch from non-Michaelis-Menten to Michaelis-Menten kinetics for UDP-glucuronyltransferase. Binding studies for interaction of UDP-glucuronic acid with enzyme present in a liquid-crystal lipid phase indicate that the two binding sites for UDP-glucuronic acid do not become identical in this setting. Instead, one of the sites becomes nonfunctional. Binding studies carried out with UDP as ligand lead to similar results. There is a high affinity and a low affinity site for UDP when enzyme is reconstituted into a phospholipid bilayer in a gel phase. There is only one UDP binding site per holoenzyme when enzyme is reconstituted into a phospholipid bilayer in a liquid-crystal phase. Delipidated enzyme or enzyme reconstituted with lysophosphatidylcholine displays Michaelis-Menten kinetics. Binding studies show that these forms have only one binding site for UDP-glucuronic acid per holoenzyme. However, they have two nonidentical binding sites for binding of UDP. Thus, the physical properties of its phospholipid milieu influence the number of functional binding sites of UDP-glucuronyltransferase.

The effects of bile acids on the detoxification of compounds by glutathione conjugation have been investigated. Bile acids were found to inhibit the total soluble-fraction glutathione S-transferase activity from rat liver, as assayed with four different acceptor substrates. Dihydroxy bile acids were more inhibitory than trihydroxy bile acids, and conjugated bile acids were generally less inhibitory than the parent bile acid. At physiological concentrations of bile acid, the glutathione S-transferase activity in the soluble fraction was inhibited by nearly 50%. This indicates that the size of the hepatic pool of bile acids can influence the ability of the liver to detoxify electrophilic compounds. The A, B and C isoenzymes of glutathione S-transferase were isolated separately. Each was found to be inhibited by bile acids. Kinetic analysis of the inhibition revealed that the bile acids were not competitive inhibitors of either glutathione or acceptor substrate binding. The microsomal glutathione S-transferase from guinea-pig liver was also shown to be inhibited by bile acids. This inhibition, however, showed characteristics of a non-specific detergent-type inhibition.

The affinity of delipidated microsomal UDP-glucuronyltransferase (EC 2.3.1.17) for UDP is greater than that for UDP-glucuronic acid. Measurement of KIglucuronic acid reveals that glucuronic acid binds to the enzyme. Hence, the difference in affinity of the enzyme for UDP versus UDP-glucuronic acid indicates that inherent binding energy for interactions between enzyme and this substrate is used for purposes other than enhancing binding. A reasonable interpretation of these data is that the binding of UDP-glucuronic acid to enzyme requires distortion of the substrate and/or the enzyme. Inherent binding energy due to interactions between enzyme and UDP and glucuronic acid is utilized to effect such distortions. This type of mechanism can cause significant rate enhancement. Phospholipid activators of UDP-glucuronyltransferase activate by amplifying this basic mechanism. Thus, addition of various species of lysophosphatidylcholine to the delipidated enzyme increase the activity at Vmax and enhance the affinity for UDP, glucuronic acid, and UDP-glucuronic acid. However, activators enhance the affinity of the enzyme for UDP-glucuronic acid to a significantly smaller extent than they enhance affinity for the UDP and glucuronic acid portions of the substrate. Calculations of the amount of binding energy for interactions between enzyme and UDP-glucuronic acid that can be used for stimulating activities at Vmax yield values in agreement with the observed enhancement of activities at Vmax for enzyme reconstituted with various types of lysophosphatidylcholine.

Summary The effect of Clofibrate administration on the serum triglyceride response to high caloric sucrose diets has been investigated in normal males. In each subject the sucrose diet increased the serum triglyceride concentration. Clofibrate treatment of normal individuals eating an ad-libitum diet did not decrease the serum triglyceride concentration. Clofibrate therapy did not block the hypertriglyceridemic response to the sucrose diet.

The spontaneous reconstitution of lipid-protein complexes was examined by mixing bacteriorhodopsin or UDP-glucuronosyltransferase with preformed, unilamellar bilayers of pure dimyristoylphosphatidylcholine. Spontaneous insertion of these proteins into vesicles of dimyristoylphosphatidylcholine was facilitated by resonicating the vesicles at 4 degrees C. The property of resonicated vesicles that led to spontaneous reconstitution could be annealed by melting the bilayers, which slowed down reconstitution. The overall process of reconstitution consisted, however, of two steps. There was an initial insertion of proteins into a small portion of vesicles followed by subsequent fusion between protein-free vesicles and vesicles containing lipid-protein complexes. The first step appeared to proceed rapidly in all vesicles in a gel phase, whether or not they were resonicated or whether or not resonicated vesicles were annealed. The rate of the second step was sensitive to these treatments. The membrane proteins also inserted into preformed vesicles in a liquid crystalline phase, but this step was slower than for vesicles in a gel phase. Fusion between protein-free and protein-containing vesicles in a liquid crystalline phase was extremely slow. The data show that the spontaneous insertion of pure membrane proteins into preformed vesicles can be a facile event and that the overall reconstitution of membrane proteins into preformed unilamellar vesicles may be simpler to achieve than has been appreciated.

The properties of the UDP-glucuronyltransferase(s) of guinea-pig liver that catalyse the synthesis of steroid glucuronides were examined. There are many similarities between apparently different substrate-specific forms of these enzymes in that all are activated by bivalent metal ions, and all contain at least 2 thiol groups important for enzyme activity. On the other hand, there are significant differences between the enzymes conjugating steroids and those conjugating non-steroids. Only the latter are activated by UDP-N-acetylglucosamine, which enhances their relatively poor affinity for UDP-glucuronic acid. The steroid-conjugating forms of UDP-glucuronyltransferase are not activated by UDP-N-acetylglucosamine and have relatively high apparent affinities for UDP-glucuronic acid. The rate of glucuronidation of testosterone was inhibited by treatment with phospholipase A. Treatment with cholate or Triton X-100 did not enhance the rates of glucuronidation of any steroid tested. The data indicate several similarities between different forms of UDP-glucuronyltransferase, suggesting that there is a large family of related proteins. At the same time there are important differences in the parameters that modulate the rates of different glucuronidation reactions.

The affinity of delipidated microsomal UDP-glucuronyltransferase (EC 2.3.1.17) for UDP is greater than that for UDP-glucuronic acid. Measurement of KIglucuronic acid reveals that glucuronic acid binds to the enzyme. Hence, the difference in affinity of the enzyme for UDP versus UDP-glucuronic acid indicates that inherent binding energy for interactions between enzyme and this substrate is used for purposes other than enhancing binding. A reasonable interpretation of these data is that the binding of UDP-glucuronic acid to enzyme requires distortion of the substrate and/or the enzyme. Inherent binding energy due to interactions between enzyme and UDP and glucuronic acid is utilized to effect such distortions. This type of mechanism can cause significant rate enhancement. Phospholipid activators of UDP-glucuronyltransferase activate by amplifying this basic mechanism. Thus, addition of various species of lysophosphatidylcholine to the delipidated enzyme increase the activity at Vmax and enhance the affinity for UDP, glucuronic acid, and UDP-glucuronic acid. However, activators enhance the affinity of the enzyme for UDP-glucuronic acid to a significantly smaller extent than they enhance affinity for the UDP and glucuronic acid portions of the substrate. Calculations of the amount of binding energy for interactions between enzyme and UDP-glucuronic acid that can be used for stimulating activities at Vmax yield values in agreement with the observed enhancement of activities at Vmax for enzyme reconstituted with various types of lysophosphatidylcholine.

The temperature dependence of two kinetic properties of the GT2P isoform of microsomal UDP-glucuronosyltransferase was studied for enzyme in intact microsomes and for pure enzyme reconstituted into different types of lipid bilayers. The properties studied were the non-Michaelis-Menten kinetics of the enzyme and activity at Vmax(app). For enzyme in intact microsomes, the pattern of non-Michaelis-Menten kinetics was seen at all temperatures in the range tested (23 to 48 degrees C), and the slopes of the Hill plots of the data were constant across this range of temperatures. Although non-Michaelis-Menten kinetics were present for pure enzyme in bilayers of 1,2-dimyristoylphosphatidylcholine or 1,2-dipalmitoylphosphatidylcholine only in the gel phase (Hockman, Y., Kelley, M., and Zakim, D. (1983) J. Biol. Chem. 258, 6509-6519), it was not possible to reconstitute this pattern of kinetics for enzyme at T greater than 40 degrees C. For example, GT2P displayed Michaelis-Menten kinetics in bilayers of 1,2-distearoylphosphatidylcholine at 44 degrees C. For enzyme in microsomes, activities at Vmax(app) increased with increasing temperature in the range 23 to 48 degrees C, with a discontinuity in the slope of the Arrhenius plot at 34 degrees C. This thermotropic property also could not be reconstituted with pure GT2P. Instead, activities at Vmax(app) for GT2P reconstituted in 1,2-dioleoylphosphatidylcholine, 1,2-distearoylphosphatidylcholine, or 1,2-stearoyl oleoylphosphatidylcholine increased in the range 23 to 37 degrees C, but then decreased at T greater than 37 degrees C. The fall in activity at T greater than 37 degrees C was reversible, indicating that GT2P undergoes a reversible change at 37 degrees C to a less active form of the enzyme. The differences between pure, reconstituted GT2P and microsomal GT2P indicate that the thermotropic properties of the microsomal enzyme are not properties of the enzyme per se but depend on interactions between it and other components in the microsome. The data suggest, therefore, that the properties of GT2P in microsomes results in part from an organization of components in the microsomal membrane.

The reaction of GDP[14C]-mannose with dolichol phosphate (Dol-P) in hepatic microsomes is characterized by an initial brief period of relatively rapid Dol-P-[14C]-mannose synthesis. The time course of this 1--3 min period of rapid synthesis follows approximate first order kinetics. However, the rate of reaction does not decrease to zero as predicted by the kinetics of the initial period of synthesis, but continues instead at a slow, steadily decreasing, rate. Examination of the time course of Dol-P-mannose synthesis for different concentrations of GDP[14C]-mannose revealed that the extrapolated final level of Dol-P-mannose synthesized is increased when the concentration of GDPmannose is raised. These data, plus those derived from studies of the reverse reaction, suggest that the non-linear time course for the synthesis of Dol-P-mannose is due in part to the reaction approaching equilibrium between the forward and reverse reactions. The effects of Mn++ on the time course of the forward and reverse reaction are complex and suggest that the Mn++ complexes of both GDPmannose and GDP are poorer substrates for the enzyme than the free nucleotides. Perturbations of the lipid environment of the microsomal membrane by treatment with phospholipase A, detergent, sonication, or alkaline pH lead to a decrease in the final level of Dol-P-mannose synthesized, but do not affect the time required for half maximal labeling. When the reverse reaction was investigated in phospholipase A-treated microsomes, the final extent of the reaction was also reduced. These data suggest that perturbation of the membrane lipid environment decreases in some undefined way the availability of Dol-P and Dol-P-mannose to enzyme.

The cause of hyperamylasemia associated with chronic liver disease is unclear. In an attempt to identify the tissue of origin of hyperamylasemia in 3 patients with chornic active hepatitis their serum was isoelectrically focused. The isoamylase patterns obtained were compared to those of pancreatic and salivary amylase. The apparent salivary gland origin of the excessive blood amylase in the patients studied was substantiated by radiological demonstration of parotid sialoectasia in one patient and histological evidence of sialoadenitis in another. Further evidence was the coincident isoelectric points of the predominant isoamylase in the sera of the liver disease patients and of patients with parotid inflammatory disease. Hyperamylasemia associated with chronic liver disease may be of salivary gland origin and as such forms part of the spectrum of extrahepatic manifestations of chronic active hepatitis.

Summary: Studies on serum amylase in normal man and in acute pancreatitis. I. L MacGregor and D. Zakim, Aust. N.Z. J. Med. 1976, 6, pp. 551–556. Amylase isoenzymes in serum, urine, saliva, jejunal juice, and pancreatic tissue were separated by isoelectric focusing. Isoamylase patterns obtained indicated that the majority of amylase activity in normal serum is of salivary gland origin. Pancreatic amylase is characteristically predominant in acute pancreatitis. The increased renal clearance of amylase in acute pancreatitis may be partly due to the increased proportion of the smaller molecular weight pancreatic amylase. However, a demonstrated increase in the renal clearance of salivary amylase in acute pancreatitis suggests a renal cause also. Autopsy pancreas samples devoid of TAME (p-tosyl arginine methyl ester) esterase activity (e.g. trypsin and plasma enzymes such as thrombin and pi asm in) had isoenzyme patterns different to those samples with free proteolytic activity. Incubation of TAME esterase free pancreas with trypsin caused conversion of the former isoamylase pattern to one with the predominant isoenzymes focusing coincident with the predominant peak in serum from acute pancreatitis, jejunal aspirate, and TAME esterase positive autopsy pancreas. Such conversion suggests that pancreatic amylase is synthesized in a form different from that found in the intestinal lumen and serum.

The activation of delipidated microsomal UDP-glucuronosyltransferase from pig liver (GT2P type of enzyme) was studied as a function of several structural modifications of 1-palmitoyl-sn-glycero-3-phosphocholine, which is known to be a good activator of the enzyme. The following types of compounds were tested: substitution of H for OH at position 2; substitution of an ether for an acyl link at position 1; variation of the phosphorus-nitrogen or acyl ester-phosphate ester distances; removal of the glycerol backbone; optical isomers; and substitution of phosphoethanolamine for phosphocholine. Although there were variations in the extent to which these compounds activated delipidated enzyme, all the above types of lipids were effective in this regard. By contrast, lipids with a net negative charge did not activate the enzyme. They inhibited it reversibly. Positively charged lipids, even those lacking a phosphate group, were effective activators. These results indicate that GT2P is unlikely to interact with specific chemical groups of its phospholipid milieu. Effective activation appears instead to depend on the physical properties of the lipid environment.

Choloyl-CoA synthetase (EC 6.2.1.7) was characterized for the first time under appropriated assay conditions. The p/ optimum for the reaction is pH 7.2.-7.3. The reaction has an absolute requirement for bivalent cation. Several different metal ions fulfil this requirement, but Mn2+ and Mg2+ were the most effective. The KAppm (apparent Km) for CoA, extrapolated from kinetic data, is 50 micronM, but in fact the rate of reaction is increased little by concentrations of CoA above 25 micronM. The KAppm for ATP is 600 micronM. High concentrations of ATP appear to cause substrate inhibition. The KAppm for cholate was 6 micronM. The enzyme was inhibited by treating the microsomal fraction with N-ethylmaleimide. The inclusion of various conjugated and unconjugated bile salts in the assay also inhibited the enzyme. Unconjugated bile salts were more potent inhibitors than the conjugated bile salts. High concentrations of oleic acid inhibited the enzyme. The properties of choloyl-CoA synthetase were not modified by alterations of the properties of the lipid phase of the microsomal membrane. Treatment with phospholipase A did not alter activity directly. Triton N-101 and Triton X-100 also were without effect on activity, and the enzyme was insensitive to temperature-induced phase transitions within the lipid portion of the membrane. The enzyme can be solubilized from the microsomal membrane in an active form by treatment with Triton N-101.

Synthesis of glyco- or tauro-cholate from choloyl-CoA and the respective amino acid is shown to be catalysed by the soluble fraction of liver cells. Kinetic evidence supports the conclusion that there are separate enzymes for the synthesis of glycocholate and taurocholate. The kinetic parameters of these enzymes were determined.

The kinetic properties of hepatic microsomal UDP-glucuronosyltransferase were studied in sheep in the perinatal period, using acetaminophen as the aglycone. Kinetic analyses indicated that activity at Vmax was significantly less in fetal microsomes (113, 135 or 141 days) as compared with the adult sheep. However, these differences between fetal and adult animals were not due simply to smaller amounts of UDP-glucuronosyltransferases catalyzing conjugation of acetaminophen in fetuses versus adults. Thus, the kinetic properties of UDP-glucuronosyltransferase(s) were different in fetus and adult. The "fetal" versus "adult" enzyme had a higher affinity for UDP-glucuronic acid, but a poorer affinity for acetaminophen. Furthermore, enzyme in fetal liver (113 days of gestation) was activated about 30% by the allosteric effector UDP-N-acetylglucosamine, whereas enzyme in adult liver was activated by 500%. These differences between fetal and adult enzymes diminished just prior to parturition (141-day fetus). Enzyme in microsomes from the 141-day fetus responded to UDP-N-acetylglucosamine-like enzyme in adult microsomes and had affinities for substrates that were similar to "adult" enzymes. These data indicate that maturation of the system that glucuronidates acetaminophen is a complex process. It may involve the expression in fetuses of a type of UDP-glucuronosyltransferase that is different from that expressed in the adult. An alternative but not mutually exclusive possibility is that maturation of the glucuronidation system involves modification of enzyme function by alteration of the phospholipids in the immediate environment of UDP-glucuronosyltransferase within the microsomal membrane.

UDP-glucose, UDP-mannose, and UDP-xylose inhibit microsomal UDP-glucuronyltransferase in assays at 6 degrees. None of these compounds affects activity in assays at 37 degrees. Studies with UDP-glucose revealed an abrupt temperature-dependent change in the effect of this compound on the activity of UDP-glucuronyltransferase. Inhibition by UDP-glucose was observed only at temperatures below 16 degrees. UDP-glucose had no effect on activity in assays at temperatures of 16 degrees and above. UDP-N-acetylglucosamine activates UDP-glucuronyltransferase at temperatures at or above 16 degrees, but has no effect on activity below 16 degrees. The lipid portion of the microsomal membrane is known to undergo a phase change at 16 degrees. These data indicate, therefore, that significant alterations in the regulatory properties of UDP-glucuronyltransferase are associated with temperature-induced phase separations within the lipid portion of the microsomal membrane.

2,3-Butanedione inactivates the pure form of UDP-glucuronyltransferase used in these experiments (GT2P) (EC 2.4.1.17) purified from pig liver microsomes. The kinetics of the reaction indicates that 2,3-butanedione reacts with two amino acids that affect activity. A rapid, partial inactivation is followed by a slower rate of inactivation that leads eventually to completely inactive enzyme. UDP-glucuronic acid and glucuronic acid, as compared with UDP, are effective as protectors against the slow, secondary phase of inactivation; no ligand tested protected against the rapid phase of inactivation. The lipid environment of GT2P was a determinant of the pseudo-first order rate constant for the slow phase of inactivation, but did not affect the rate of the rapid phase of inactivation. The data suggest that GT2P contains an active site arginine that interacts with the -COO- at C-6 of the glucuronic acid moiety of UDP-glucuronic acid.

The rate at which a specific, purified form of microsomal UDP-glucuronyltransferase (designated as the GT2P type of this enzyme) catalyzes the hydrolysis of UDP-glucuronic acid was measured with pure, delipidated enzyme and enzyme reconstituted with different lysophosphatidylcholines. This activity of the GT2P type of UDP-glucuronyltransferase is referred to as alpha-glucuronidase activity. For delipidated enzyme, the rate of hydrolysis of UDP-glucuronic acid catalyzed by GT2P extrapolated to infinite concentrations of UDP-glucuronic acid was 1 X 10(-9) mol/min/mg of protein. This compares with a rate of glucuronidation of p-nitrophenol of 96 X 10(-9) mol/min/mg of enzyme, for delipidated enzyme. Addition of oleoyl- or myristoyllysophosphatidylcholine to GT2P did not affect the alpha-glucuronidase activity significantly. This activity was stimulated, however, in the presence of compounds that bind at the aglycone site but that do not undergo glucuronidation. alpha-Glucuronidase activity extrapolated to infinite concentration of UDP-glucuronic acid was 4.0 X 10(-9) mol/min/mg for delipidated enzyme assayed in the presence of less than saturating concentrations of p-nitrophenyl phenyl ether. Moreover, when the aglycone site of GT2P was occupied by ethers, the alpha-glucuronidase activity of this enzyme was enhanced by addition of phospholipids to delipidated enzyme. The extent of activation of the alpha-glucuronidase activity of GT2P, when the aglycone site was occupied, depended on the acyl chain of the lipid added to delipidated enzyme. These data indicate that the GT2P form of UDP-glucuronyltransferase catalyzes the hydrolysis of UDP-glucuronic acid at a significant rate and that lysophosphatidylcholines can influence this rate.