Blood Transfusion: Use and Abuse of Blood Components

Transfusion of whole blood and some blood components may result in serious or fatal complications, among which hepatitis is most frequent (20,000 to 30,000 cases and 3,000 deaths a year). Although hepatitis B virus (HB Ag) sometimes is implicated in posttransfusion hepatitis, non-A non-B. virus(es) (hepatitis “C” virus) probably accounts for most posttransfusion hepatitis.Half of all blood transfusions may be unnecessary.Responsible transfusion practice requires use of appropriate blood components for which there is adequate justification. Transfusion of red blood cells should be given as packed cells in most instances and whole blood should seldom be used.     

Course of acute hepatitis B in alcoholism

Clinical course of the acute hepatitis B has been analysed in 29 men chronically abusing alcohol. The most frequent source of the infection was surgery and hospitalizations. Clinical course and biochemical findings were similar in this group and in 30 men not drinking alcohol. A sole difference concerned higher GGTP activity in alcoholics. The persistence of HBs antigen was similar in both groups. Chronic alcohol abuse does not seem to have a significant effect on the course and convalescent phase of the acute hepatitis B.     

Transmission of non-A, non-B hepatitis agent to chimpanzees from patients of epidemic hepatitis

Two chimpanzees were inoculated intravenously with acute-phase sera obtained from two patients with epidemic hepatitis. They developed histopathologically confirmed hepatitis. Electron microscopic examination of the liver showed peculiar cytoplasmic tubular structures in the hepatocytes. These ultrastructural findings were similar to those described for the livers of chimpanzees inoculated with the F strain of non-A, non-B hepatitis agent derived from a posttransfusion hepatitis case. The chimpanzee that had recovered from hepatitis caused by the F strain of non-A, non-B hepatitis agent was re-challenged with the serum from one of the patients. The chimpanzee developed neither clinical signs nor histological changes of hepatitis. These results suggested that non-A, non-B hepatitis agent was involved not only in post-transfusion hepatitis but also in epidemic hepatitis.     

Hepatitis C virus. A review.

Hepatitis C virus has been shown to be responsible for most cases of posttransfusion hepatitis, as well as for sporadic non-A, non-B viral hepatitis. Hepatitis C virus has also been implicated in the development of primary hepatocellular carcinoma, autoimmune hepatitis, and fulminant viral hepatitis. Although the role of the parenteral transmission of hepatitis C virus is well established, its route of transmission in cases of sporadic infection remains unclear. Sexual transmission is suspected but not confirmed. Recent work regarding treatment has shown interferon alfa to be effective, but the discontinuation of therapy is associated with a 50% relapse rate.     

Role of alcoholism in the development of upper gastrointestinal tumors

A preliminary report on the results of studies on the relationship between alcohol abuse and upper gastrointestinal tumours is presented. Alcohol abuse was measured with the aid of a questionnaire. GGTP and mean MCV were determined. Within the 1st September, 1986--30th September, 1987, 75 patients with the cancer of the upper gastrointestinal tract and 107 patients with benign lesions to this area were examined. Alcohol abuse was found in 33% of patients with the cancer and 19% of patients with benign lesions to the upper gastrointestinal tract. This difference is statistically significant (p greater than 0.05). The results of GGTP and MCV values were statistically insignificant in both groups. The authors have found more marked correlation of alcohol abuse with the cancer of the upper gastrointestinal tract in relation to the oral cavity and pharynx than the stomach. Further studies including larger groups of patients are recommended.     

The danger of hepatitis B virus infection from transfusions of plasma in which the HBs-antigen was detected retrospectively by highly sensitive methods

The prospective dynamic laboratory and clinical study of premature children was carried out: 55 children who received plasma transfusion during the first weeks of their life and were retrospectively (i. e. after plasma transfusion) found to have HBsAg detected by the passive hemagglutination (PHA) test, the enzyme immunoassay (EIA) and the radioimmunoassay (RIA) and 127 children who received the transfusion of plasma found to be HBsAg-negative according to the results of EIA and RIA. As revealed in this study, the risk of hepatitis B virus infection in such children after the transfusion of plasma containing HBsAg at low concentrations, determined only in the PHA test or in EIA and RIA, was, respectively, 7.5 and 6.3 times greater than in children receiving plasma found to be HBsAg-negative according to the results of EIA and RIA. The results of this investigation showed the tendency towards a decrease not only in the total contamination of plasma recipients with hepatitis B virus, but also in morbidity rate in icteric forms of acute posttransfusion hepatitis B, depending on the concentration of HBsAg in plasma used for transfusion.     

Lymphocyte gamma-glutamyltranspeptidase activity in ataxia-telangiectasia

gamma-Glutamyltranspeptidase (GGTP) is a membrane-bound enzyme, that catalyzes gamma-glutamyl transfer from gamma-glutamyl compounds to amino acid and peptide acceptors. One of the most important clinical findings about ataxia-telangiectasia (A-T), a multisystemic and autosomal-recessive disease, is dysfunction of the immune system. In this study, the activity of GGTP was determined in the lymphocytes from patients with A-T. Lymphocyte GGTP activity in A-T patients was found to be significantly lower than that of control lymphocytes (P less than 0.001). This change may be due to the abnormality in the membrane of lymphocytes of A-T patients.     

Total Screening of Blood Donations for Australia (Hepatitis Associated) Antigen and its Antibody

During a period of one year all of 105,724 blood donations were tested for Australia (Au) antigen and its antibody by rapid immunoelectro-osmophoresis—86 (1 in 1,229) were positive for antigen and 67 (1 in 1,578) positive for antibody. Second donations by previously negative donors reduce the overall incidence of positives. Men prisoners have a significantly higher incidence of Au antigen (1 in 153) than non-institutionalized men (1 in 803). The latter have a significantly higher incidence of antigen than women (1 in 2,019). Only one antigen-positive donor was incubating acute viral hepatitis. Failure to detect one strong and one weak antigen was responsible for two cases of posttransfusion Au-antigen-positive hepatitis.     

Gamma-Glutamyl Transpeptidase Does Not Act As a Cystine Transporter in Brain Microvessels

Gamma-glutamyl transpeptidase (GGTP) is highly enriched in blood-brain barrier (BBB) microvessels. According to the most cited hypothesis its functional role is amino acid transport across the BBB. To test this hypothesis the influence of GGTP inhibition on cystine uptake was measured in isolated brain microvessels. Adult porcine brain microvessels were enzymatically isolated, resulting in an enrichment of GGTP from 3 to 85 U/mg protein. The inhibitors 0.1 mM AT-125 combined with 20 mM hippurate reduced the GGPT enzyme activity by more than 98%. However this inhibition did not influence the uptake of [³⁵S]-cystine, which is the substrate with the highest affinity in the GGTP-reaction. Instead increased glutathione (GSH) levels and elevated [³⁵S] release were found. These results show that GGTP does not mediate the transport of cystine into brain microvessels in vitro and suggest that GGTP plays a role in cellular GSH metabolism.     

Dietary lipids modulate fatty acid composition, gamma glutamyltranspeptidase and lipid peroxidation levels of the epididymis tissue in mice

The purpose of this work was to analyze the effect of diets that contain several oils whose composition in fatty acids were different, on the kinetic parameters of the gamma-glutamyltranspeptidase (GGTP) and the lipoperoxidation of the epididymis because GGTP controls the level of the glutathione that is an molecule that regulates the level of oxidation protecting the maturation and survival of sperm in the lumen of the epididymis. The caput portion of the epididymis was chosen because the epithelium of this segment synthesizes GGTP. Weaned BALB-c mice were fed a commercial or semi-synthetic diet that contained 5% added olein. The mice were maintained on corn oil or fish oil diet for the first 4-8 months of age. The kinetic variables of the GGTP enzyme, analyzed by means of multiple regression analysis using dummy variables, showed that values were similar in olein and corn oil samples, whereas in samples from the fish oil fed group the enzyme behaved as that in animals maintained on commercial diets. Although there were no variations in maximum velocity (Vm) of the enzyme, the Km value, was greater (P < 0.0001) for the mice fed the olein and corn diets. These groups contained greater percentages of the monounsaturated fatty acids, palmitoleic (16:1 n-7) and oleic acid, 18:1 n-9. Similarly, the amount of lipid peroxidation was also greater in the olein and corn oil groups with respect to commercial and fish groups. The significant increment in Km of GGTP in the olein and corn groups was correlated with greater amount of monounsaturated fatty acids and lipid peroxidation in the epididymis. In conclusion, modifications of dietary lipid sources differentially modulated the epididymis tissue fatty acid profile, lipid peroxidation amounts, and the Km of GGTP. These effects may alter the metabolism of the natural substrate of GGTP, glutathione, a tripeptide with a powerful antioxidant activity, which is necessary in maintaining the oxidative state of the sperm microenvironment, thereby favoring maturation of the male gametes.     

Effects of dietary fat and alpha-tocopherol on gamma-glutamyltranspeptidase activity of 7, 12-dimethylbenz(alpha)anthracene-induced mammary gland adenocarcinomas

The levels of gamma-glutamyltranspeptidase (GGTP) (EC 2.3.2.2) were measured in 7, 12-dimethylbenz(alpha)anthracene-induced mammary adenocarcinomas, in control mammary gland tissue and in sera from tumor-bearing and control rats. The carcinogenic process was modulated by diets differing in the type and amount of fat with and without alpha-tocopherol supplementation. Rat mammary adenocarcinomas showed significantly elevated (up to 25-fold) levels of GGTP when compared with adjacent histologically-uninvolved tissue or with mammary tissue of control rats. GGTP activity in sera from tumor-bearing rats was also elevated up to 4-fold than in the corresponding controls. Histochemical studies of the frozen section of mammary adenocarcinomas indicated that GGTP was localized in neoplastic ductal epithelial cells. In tumor rats on alpha-tocopherol supplemented diets, GGTP activity in the adenocarcinomas was mainly in the particulate (membrane-bound) fraction. In contrast, the tumor rats receiving alpha-tocopherol-deficient diets, the total GGTP activity was distributed in both particulate and cytosolic fractions, suggesting an altered membrane-GGTP interaction. The levels of GGTP in control mammary gland and sera of control rats from the low fat dietary groups were up to 7-fold higher than the corresponding control values in either of two high-fat groups. These high levels of GGTP in the serum and tissues of animals from the low fat dietary group are consistent with lower tumor incidence through enhanced carcinogen detoxification.     

Influence of sex hormones on gamma-glutamyltranspeptidase activity in rats serum with Morris hepatoma 5123 D.

The Stilbestrol treatment of the female rats with the Morris hepatoma 5123 D resulted in decrease of the gamma-glutamyl-transpeptidase (GGTP) activity in serum and in hepatoma, but only during the treatment. Given to the male rats under the same conditions, Stilbestrol had no influence on the GGTP activity. Castration of males was the cause of the GGTP activity decay in hepatoma and in serum, but it was not the case with females. Sustanon diminished the GGTP activity in serum of the female rats with hepatoma.     

Toxicity of aromatic hydrocarbons. VII. Hepatotoxicity of 9-nitrophenanthrene, and protection against it by beta-naphthoflavone

Male Sprague-Dawley rats were treated with a single i.p. injection of DMSO (3.0 ml/kg) or 9-nitrophenanthrene (9-NP, mg/kg) in DMSO. 9-NP produced a significant elevation of serum aspartate aminotransferase, alanine aminotransferase, sorbitol dehydrogenase, and gamma-glutamyl transpeptidase (GGTP) levels relative to DMSO-injected rats 24 hr after injection. With the exception of GGTP, the increase in enzyme activities induced by 9-NP was significantly reduced by a 3-day pretreatment with beta-naphthoflavone (BNF; 40 mg/kg/day) in DMSO. The effect of 9-NP on GGTP levels was enhanced by BNF pretreatment.     

Hepatic and intestinal gamma-glutamyltranspeptidase activity: its activation by chronic ethanol administration.

To study the effect of chronic ethanol administration on the activity of gamma-glutamyltranspeptidase (GGTP) in various tissues, female rats were pair-fed liquid diets with 36% of total calories either as ethanol or isocaloric carbohydrate (controls). Six weeks of ethanol feeding in an increase of cytochrome P450 content by 70%. Hepatic microsomal GGTP activity was more than doubled after ethanol feeding whether expressed per gram of liver or per mg of microsomal protein. Furthermore intestinal GGTP activity was significantly enhanced after ethanol, whereas there was no change in the enzyme activity in either kidney or pancreas. Phenobarbital administration to rats also resulted in an enahancement of GGTP activity in the liver but not in the intestine. These results suggest that enhanced hepatic and intestinal GGTP activities may contribute, at least partly, to increased serum GGTP activity frequently seen in alcoholics.     

Prenatal diagnosis of cystic fibrosis by assay of amniotic fluid microvillar enzymes

Summary Activities of the microvillar enzymes -glutamyl-transpeptidase (GGTP), aminopeptidase M (APM), phosphodiesterase and maltase have been examined in second-trimester amniotic fluid as possible aids to the early prenatal diagnosis of cystic fibrosis (CF). The two peptidases, GGTP and APM, gave best results. If the fifth percentile of the normal range is used as an action line, the sensitivity of a positive test (low GGTP value) is 78% and the predictability 84%. At the tenth percentile the sensitivity is 100% and the predictability 77%. These approximate figures apply only to pregnancies where there has been a previous affected child. Until the primary protein defect in CF is discovered, this may prove an acceptable form of prenatal diagnosis to the high-risk mother.     

Protective effect of colchiceine against acute liver damage

Pretreatment of rats with colchiceine (10 micrograms/day/rat) for seven days protected against CCl4-induced liver damage. CCl4 intoxication was demonstrated histologically and by increased serum activities of alanine amino transferase (ALT), alkaline phosphatase (Alk. Phosph.) gamma glutamyl transpeptidase (GGTP), bilirubins and decreased activity of glucose-6-phosphatase (G-6Pase). Furthermore, an increase in liver lipid peroxidation and a decrease in plasma membrane GGTP and Alk. Phosph. activities were found. Colchiceine increased 1.5-fold the LD50 of CCl4 and prevented the release of intracellular enzymes as well as the decrease in GGTP and Alk. Phosph. activities in plasma membranes. It also completely prevented the lipid peroxidation induced by CCl4 and limited the extent of the histological changes.     

Detection of HCV-RNA in liver tissue does not correlate with inflammatory process and fibrosis activity in chronic hepatitis C

The significance of HCV-RNA presence in the liver tissue in chronic hepatitis C activity or prognosis has not yet been clearly explained. Therefore, we have examined the relationship between the presence of HCV-RNA in the liver and selected parameters of disease activity and liver damage. A group of 48 chronically HCV infected patients (7-63 years old, mean 39 years) was evaluated. In the patients we assessed the activity of transaminases (ALT, AST), gammaglutamyltransferase (GGTP), and alkaline phosphatase (ALP). The patients underwent routine liver biopsies and the liver tissue was examined histopathologically and in order to detect the presence of HCV-RNA, by means of a combined procedure joining a new method of HCV-RNA extraction from the liver tissue and HCV-RNA detection with RT-PCR automatic Cobas Amplicor Hepatitis C ver. 2.0 assay (Roche Diagnostics). At the time of the liver biopsy, 44 of the patients were identified as having detectable serum HCV-RNA (as examined by means of Cobas Amplicor Hepatitis C ver. 2.0 assay), 3 patients were negative, and 1 was not tested. The presence of HCV-RNA in the liver tissues was detected in 39 cases (81.2%). In the parameters examined we have not found any significant differences between currently liver HCV-RNA positive and negative patients. Presence of the detectable HCV-RNA in the liver bioptats from chronic hepatitis C patients does not correlate with disease activity or level of liver damage.     

Effect of 1α,25-dihydroxyvitamin D3 in plasma membrane targets in immature rat testis: ionic channels and gamma-glutamyl transpeptidase activity

1α,25-Dihydroxyvitamin D(3) (1,25D(3)) is critical for the maintenance of normal reproduction since reduced fertility is observed in vitamin D-deficient male rats. The aim of this study was to investigate the effect of 1,25D(3) in 30-day-old rat testicular plasma membrane targets (calcium uptake and gamma-glutamyl transpeptidase (GGTP) activity), as well as to highlight the role of protein kinases in the mechanism of action of 1,25D(3). The results demonstrated that 1,25D(3) induced a fast increase in calcium uptake in rat testis through a nongenomic mechanism of action. This effect was dependent on PKA, PKC and MEK. Moreover, ionic channels, such as ATP- and Ca(2+)-dependent K(+) channels and Ca(2+)-dependent Cl(-) channels, are involved in the mechanism of action. The use of BAPTA-AM showed that [Ca(2+)](i) was also implicated, and the incubation with digoxin produced an increase in (45)Ca(2+) uptake indicating that the effect of 1,25D(3) may also result from Na(+)/K(+)-ATPase inhibition. In addition, 1,25D(3) was able to increase the GGTP activity. Considered together, our results indicate a PKA/PKC/MEK-dependent 1,25D(3) pathway as well as ionic involvement leading to (45)Ca(2+) uptake in immature rat testis. These findings demonstrate that 1,25D(3) stimulates calcium uptake and increases GGTP activity which may be involved in male reproductive functions.     

Probing of the coupling site of the beta-adrenergic receptor. Competition between different forms of the guanyl nucleotide binding protein for interaction with the receptor

The interaction of the beta-adrenergic receptor (R) with different forms of the regulatory protein (G) was studied. For this purpose, the reconstituted system formed from separate soluble preparations of R and G was employed (Citri, Y., and Schramm, M. (1980) Nature (Lond.) 287, 297-300). Soluble preparations of the native nonactive G, to which GDP is bound (GGDP), and the persistently active G, to which guanyl-5'-yl-imidophosphate (Gpp(NH)p) is bound GGPP(MH)P), were prepared. Reconstituted systems made of GGDP, GGPP(NH)P, and R were used to test whether each of the two forms of G can affect the other's interaction with R. GGPP(NH)P was found to compete with GGDP for the interaction with R. However, GGDP was unable to interfere with the interaction of R with GGPP(NH)P. Similar experiments were carried out with another persistently active G (GGTP gamma S). In sharp contrast to GGPP(NH)P, GGTP gamma S was found incapable of competing with GGDP for R. The above experiments suggest that GGDP and GGPP(NH)P interact with the same coupling site on R. However, the degree of recognition of G by R depends strongly on the guanyl nucleotide which is bound to G. The relative order of recognition being GGPP(NH)P greater than GGDP greater than GGTP gamma S approximately 0. These findings may also explain the known irreversible effects of GTP gamma S in the adenylate cyclase system.