Excretion Of Glycosaminoglycans Research Articles

Exposure to glycols and their renal effects in motor servicing workers.

Ten car mechanics frequently exposed to glycol-based cooling liquids were followed during a workshift. Airborne ethylene and propylene glycol concentrations in the car mechanics' environment were measured. The car mechanics gave urine samples after the workshift and their excretion of ethylene glycol, propylene glycol, oxalic acid, calcium and ammonia was analysed and compared to that of unexposed office workers. Urinary succinate dehydrogenase activity and glycosaminoglycans were also measured in both groups. Airborne ethylene and propylene glycol concentrations in the car mechanics' environment were negligible. Urinary ethylene glycol excretion in exposed workers was significantly higher than that in unexposed workers, but propylene glycol excretion was at the same levels as in controls. In the exposed group, the excretion of the end metabolite of ethylene glycol, oxalic acid (47 +/- 11 mmol/mol creatinine, mean +/- SD, n = 10) differed slightly from that of controls (36 +/- 14 mmol/mol creatinine, mean +/- SD, n = 10). Urinary excretion of ammonia was higher among exposed workers than office workers. The excretion of calcium did not differ from that of controls. A marginally decreased urinary succinate dehydrogenase activity was found in the exposed men. The excretion of glycosaminoglycans was significantly lower in exposed workers. Therefore, it seems that ethylene glycol is absorbed by skin contact. The internal body burden is associated with oxaluria and increased ammoniagenesis typical of chronic acidosis.

Studies on Urinary Proteoglycan Excretion in Occupational Cadmium Exposure

Six foundrymen occupationally exposed to cadmium fumes excreted in random urine samples 4.8 +/- 2.9 micrograms cadmium/g creatinine (+/- S.D.). Six controls excreted 0.15 +/- 0.09 microgram/g creatinine (+/- S.D.). The excretion of glycosaminoglycans by exposed men (2.3 +/- 1.1 mg/mmol creatinine, +/- S.D.) did not differ from that of controls (2.3 +/- 1.6 mg/mmol, +/- S.D.). However, electrophoretic analysis of the isolated urinary proteoglycan fraction revealed a dose-dependent progressive increase in the intensity of two bands with a molecular weight between 45,000 and 50,000. In control urines and in samples with urinary cadmium less than 3 micrograms/g creatinine, only one major band with a molecular weight of 100,000 was detected. The changes may serve as early indicators of the harmful effects of cadmium on the proteoglycan-containing barriers of the nephron.

1H-NMR Profile of Glycosaminoglycans in Human Urine

A study was performed on human urinary glycosaminoglycans (GAGs) by one- and two-dimensional 500MHz proton nuclear magnetic resonance (1H-NMR) spectroscopy. Urinary GAGs were separated by the precipitation methods with hexadecyl pyridinium and with 85% ethanol, and purified by the β-elimination reaction in alkaline medium containing sodium borohydride to remove proteins and/or peptides. The spectrum of each purified GAG sample from healthy human urine which included chondroitin sulfates (ChS), dermatan sulfate (DS) and heparan sulfate (HS) showed the characteristic signal(s) corresponding to each GAG chain. The assignments and integrations of the structure specific signals in the spectrum made it possible to perform qualitative and quantitative analyses on human urinary GAG mixtures. Furthermore, analytical results of urinary GAGs in children, adults and the aged indicate that the present method is applicable to investigate the effect of aging on excretion of urinary GAGs.

Urinary biochemistry in occupational exposure to glycol ethers

Glycol ethers and glycol ether acetates are dehydrogenated to alkoxyacetic acid congeners which may serve as biological indicators of exposure. The ethereal bond may also be cut in an oxidation reaction catalyzed by the mixed function oxidase. In case of ethylene glycol, the eventual endproduct is oxalic acid. Urinary oxalic acid and alkoxyacetic acid excretion together was found to relate to the decrease of the succinate dehydrogenase activity (SDH) as an indicator of renal mitochondrial effects. The excretion of ammonia by exposed workers was doubled as compared to controls. The excretion of chloride was found to be smaller in the exposed than in controls. The excretion of calcium and glycosaminoglycans (GAG) among exposed workers were similar compared to controls.

Diagnosis of mucopolysaccharidoses in a clinically selected population by urinary glycosaminoglycan analysis: A study of 2,000 urine samples

Two thousand urine samples (from patients presenting with clinical features suggestive of a mucopolysaccharidosis, MPS) were analysed by a procedure that included a quantitative measurement of glycosaminoglycan (GAG) hexuronic acids (harmine reagent), a qualitative GAG analysis (cellulose acetate electrophoresis) and a study of urinary oligosaccharide patterns. One hundred and seventy MPS and 29 oligosaccharidosis-affected patients were found, but 23 MPS patients among the 170 would have been missed by use of a quantitative procedure only. Fourteen of these (mainly MPS IV A) were detected on the basis of abnormal electrophoresis and the 9 others on the basis of abnormal urinary oligosaccharide patterns (MPS IV B patients). Our results emphasize that normal quantitative GAG excretion alone cannot rule out a diagnosis of MPS; qualitative analysis is also required, as well as oligosaccharide screening.

Long-term outcome of Hurler syndrome following bone marrow transplantation.

Previous reports suggested a therapeutic response of lysosomal storage diseases such as Hurler syndrome following bone marrow transplantation. However, a clearer understanding of outcome has awaited long-term follow-up. We evaluated prospectively 11 consecutive patients with Hurler syndrome receiving marrow from an HLA-identical sib donor between September 1983-October 1988. Follow-up evaluations included assessment of donor engraftment by restriction fragment polymorphism analysis, determination of leukocyte alpha-L-iduronidase level, measurement of lumbar cerebrospinal fluid (CSF) pressure, computerized tomography (CT) of the brain, and psychometric testing. In this series there was a survival rate of 9/11 (82%) with all survivors showing complete (7 patients) or partial (2 patients) donor engraftment. Prospective longitudinal evaluation of the 9 surviving children, now 3.8-8.9 years posttransplantation (median 5.5) demonstrated persistence of previously deficient leukocyte alpha-L-iduronidase at levels reflecting the donor genotype and degree of donor engraftment. Urinary glycosaminoglycan excretion declined to near-normal within 5 months of donor engraftment. Prior to treatment, 7 of 8 children studied were found to have occult intracranial hypertension (lumbar CSF pressure > 20 cm CSF); however, all surviving children attained normal or near-normal pressure within 18 months of donor engraftment. Longterm follow-up CT imaging of the brain did not show progressive volume loss (cerebral atrophy) after donor engraftment. Of 9 survivors, 4 children having a developmental quotient (DQ, Mental Development Index on Bayley Scales of Infant Development) above 80 prior to transplantation subsequently maintained IQ scores above this level. However, 5 patients with lower pretransplant DQ scores now have significant cognitive deficits and attention deficit hyperactivity disorder. Progressive brain damage resulting from communicating hydrocephalus may be prevented by successful engraftment. Early transplantation of children with Hurler syndrome who have normal intelligence is likely to have the clearest benefit because long-term intellectual outcome will be limited by brain damage which has occurred prior to treatment.

Effects of a Low-Protein Diet on Urinary Glycosaminoglycan Excretion in Adriamycin-Treated Rats

Adriamycin (ADR) induces glomerular damage in rats with persistent severe proteinuria which reaches a peak 15 days after a single 5 mg/kg intravenous (i.v.) injection. We studied in ADR-treated rats the effects of a low-protein (6%) diet (LPD) supplemented with keto acids on urinary protein and glycosaminoglycan (GAG) excretion and glomerular GAG contents. Animals were divided into three groups: group 1 was used as control, and groups 2 and 3 received a single i.v. injection of ADR; group 2 was fed a standard diet (21% protein) and group 3 an LPD. After ADR, group 2 developed heavy proteinuria and showed a progressive increase in urinary GAG excretion starting a few days after the beginning of proteinuria onset and persisting throughout the experiment. After ADR, group 3 (LPD treatment) did not develop proteinuria, and the level of urinary GAGs was comparable to that of controls. The glomerular GAG level in ADR-treated rats was greatly reduced as compared to controls; this decrease was partly eliminated in rats on an LPD. These results suggest that an LPD has a direct effect on cellular GAG production and turnover in ADR-induced glomerulonephritis.

Urinary glycosaminoglycans in different phases of Balkan endemic nephropathy.

The relationship between glycosaminoglycans and beta 2-microglobulin, glycosaminoglycans and N-acetyl-beta-D-glucosaminidase as well as the relationship between the chondroitin sulfate/heparan sulfate ratio and SDS electrophoresis in the urine of subjects from the endemic area of Balkan nephropathy was studied in order to establish a method for early detection of this disease. The results show an unquestionable increase in urinary excretion of total glycosaminoglycans in subjects with or suspected of having Balkan endemic nephropathy while the chondroitin sulfate/heparan sulfate ratio was not statistically different between the groups studied. Thus, the chondroitin sulfate/heparan sulfate ratio cannot be used as a cheap and quick semiquantitative method for the diagnosis of early tubular damage in Balkan endemic nephropathy. However, the determination of total glycosaminoglycans in the urine of subjects from endemic areas proved to be valuable additional information helping with the diagnosis of Balkan endemic nephropathy.

Urinary Glycosaminoglycan Excretion as a Laboratory Marker in the Diagnosis of Interstitial Cystitis

Urinary macromolecular uronate and glycosaminoglycan uronate concentrations were determined in 209 urine specimens obtained from 192 interstitial cystitis patients, 47 asymptomatic normal individuals and 32 spinal cord injury patients. As a group the concentration of macromolecular uronate or glycosaminoglycan uronate was significantly less in the interstitial cystitis patients than in the normal controls. Some interstitial cystitis patients showed low values of macromolecular uronate and glycosaminoglycan uronate. Analysis of the population distributions suggested that macromolecular uronate may have significant value in diagnosis of interstitial cystitis.

Incorporation of [ 35S]sulfate into glomerular membranes of rats chronically exposed to cadmium and its relation with urinary glycosaminoglycans and proteinuria

The aim of the present work was to assess the effects of long-term exposure to Cd on the sulfation of glomerular membranes and their relation with proteinuria and urinary glycosaminoglycans (GAG). For this purpose the in vitro incorporation of [ 35S]sulfate was investigated in female Sprague-Dawley rats given 100 ppm of Cd in drinking water for 7 months. When compared with their controls, glomeruli from Cd-treated rats showed a 12.8% decrease in the incorporation of the label into glomerular membranes. This effects, which was not explained by differences in viability or in sulfate uptake by the glomeruli, suggests that sulfation of glomerular membranes is impaired in Cd-treated rats. In support of this, in another independent experiment, a decrease, 17.4% on average, of the sulfate content of glomerular membranes was observed in long-term Cd-treated rats (100 ppm in drinking water for 4 months). This effect was significantly correlated with albuminuria and transferrinuria but not with β 2-microglobinuria, suggesting that a loss of heparan sulfate of the glomerular capillary wall could be involved in the Cd-induced glomerular proteinuria. On the other hand an enhanced urinary excretion of GAG, negatively correlated with the sulfate content of glomerular membranes, was also observed in Cd-treated rats. Moreover GAG excretion was associated with tubular and glomerular proteinuria, which suggests that GAG might be a useful marker of Cd-induced nephrotoxicity.

Urinary Glycosaminoglycan Excretion in Rheumatic Diseases

We used Alcian Blue (AB) and dimethylmethylene blue (DMB) methods to measure glycosaminoglycan (GAG) excretion in the first morning urine specimens of patients with osteoarthritis (OA), ankylosing spondylitis (AS), and rheumatoid arthritis (RA) in different stages of disease. By the AB method, urinary GAG excretion in patients with RA was not different from healthy control subjects. However, the DMB method showed significant differences (in milligrams of GAG per gram of creatinine) for OA (median 25.4, range 14.3-44.0, P less than 0.01, n = 23) and RA patients (median 33.0; range 10.0-147.6; P less than 0.001, n = 63) in comparison with unaffected individuals (median 20.2; range 8.9-41.4, n = 38). We noted a significant difference in urinary GAG excretion between RA and OA patients (P less than 0.01) and between RA and AS (P less than 0.01) patients. The DMB method was further investigated by clinical decision analysis. The DMB method is simple and rapid and may be useful in diagnosing RA by distinguishing between RA and OA or AS.

Urinary excretion of citrate, glycosaminoglycans, magnesium and zinc in relation to age and sex in normal subjects and in patients who form calcium stones.

One hundred and ninety-seven healthy subjects and 104 patients with idiopathic calcium stone disease had their urinary excretion of citrate, glycosaminoglycans, magnesium, and zinc measured and the results correlated with sex and age. In normal subjects the daily excretion of citrate, magnesium, and zinc increased with age to a maximum during the fifth decade and remained relatively constant until the eighth decade when they decreased. The daily excretion of magnesium and zinc were higher in men than in women, which was attributed to the higher body weights of the men. The urinary excretion of citrate, magnesium, and zinc related to creatinine remained relatively constant with age in adult life; analyses of magnesium and zinc excretion rates divided by urine creatinine did not distinguish men from women. There was no significant difference between men and women for citrate excretion in 24 hour urine, but the citrate:creatinine ratio was significantly higher in women than men. The higher citrate excretion in women may explain the lower incidence of calcium stones in women. The highest glycosaminoglycan excretion rates were seen during the first two decades which is why children and teenagers are less prone to develop calcium stones in spite of high urinary calcium concentrations. Urinary citrate and magnesium excretion were lower, and glycosaminoglycan and zinc excretion were higher, in stone formers than in controls. It seems that a decreased excretion of citrate and magnesium together with an increased excretion of calcium, may contribute to the formation of calcium stones. The role of urinary glycosaminoglycans and zinc in the formation of calcium stones remains uncertain.

Glycosaminoglycans in urolithiasis.

To determine if there are differences in urinary glycosaminoglycan (GAG) concentrations, 43 stone-forming patients and 37 healthy control subjects of both sexes were studied. Urinary concentrations of calcium, magnesium, creatinine, uric acid and GAGs were determined. GAGs were measured by the Di Ferrante precipitation procedure followed by the Bitter and Muir reaction. Urinary GAG concentration and daily output were significantly lower in stone-forming patients. The present study clearly demonstrates the decreased urinary GAG concentration and excretion in stone-forming patients and suggests an interaction between GAGs and urate that could modify the inhibitory potency of GAGs.

The tilorone-induced mucopolysaccharidosis in rats: Biochemical investigations

The tissues of rats chronically treated with tilorone exhibited a significant accumulation of acid glycosaminoglycans (GAGs): In the liver, the GAG concentration was found to be elevated by a factor of 38, in the spleen by a factor 15 and in the kidneys by a factor of 5. Furthermore, the renal excretion of GAGs was increased 32-fold as compared to control animals. Dermatan sulphate was predominant among the GAGs stored in the three organs; chondroitin sulphate and heparan sulphate were found in smaller amounts. GAG storage was accompanied by accumulation of the drug within the tissues: the molar ratio of tilorone per disaccharide unit of GAG was calculated to be one to two in each tissue. According to previous reports, tilorone-induced mucopolysaccharidosis is due to impaired lysosomal degradation of GAGs. The present results give support to the hypothesis that an interaction between the polyanionic GAGs and the dicationic drug may lead to GAG-drug complexes which cannot be digested by lysosomal enzymes.

Brachyolmia: a skeletal dysplasia with an altered mucopolysaccharide excretion

A 15-year-old girl is described with brachyolmia. She presented with short-trunked dwarfism, hypolordosis of the lower spine and radiological features of the disease. She was initially considered to have a mucopolysaccharidosis (type III Sanfilippo) on account of a pathological urinary glycosaminoglycan excretion pattern. The amount of urinary glycosaminoglycans was normal, but we found an increased amount of an undersulphated chondroitin sulphate molecule. Our finding of an undersulphated glycosaminoglycan points to a disturbance in chondroitin sulphate synthesis, and it is rare that a defect in glycosaminoglycan synthesis leads to a skeletal dysplasia. To our knowledge, this is the second case of brachyolmia with a possible defect in chondroitin sulphate-sulphotransferase.

The Effect of Diclofenac Sodium on Urinary Concentration of Calcium, Uric Acid and Glycosaminoglycans in Traumatic Paraplegics

Non-steroidal anti-inflammatory drugs (NSAID) have been shown to decrease calcium excretion in the experimental animal, in human volunteers and in calcium stone formers. Paraplegics tend to be hypercalciuric during the first 2 years after their injury and this is said to be a predisposing factor for stone formation in these patients. The effect of the NSAID diclofenac sodium was studied in 12 traumatic paraplegics who had sustained their injury 1 to 6 months previously; 24-h urine samples collected before and 2 weeks and 4 weeks after oral diclofenac sodium 50 mg tds were analysed for calcium, uric acid, glycosaminoglycans (GAGs) and volume. There were no significant changes in urinary volume, uric acid and GAGs excretion. However, urinary calcium concentration and 24-h calcium excretion decreased significantly following 2 weeks' and 4 weeks' treatment with diclofenac sodium.

Attempted enzyme replacement using human amnion membrane implantations in mucopolysaccharidoses.

Amnion membrane implantation has been proposed as an approach to enzyme replacement in mucopolysaccharidoses. Human amnion membranes have been subcutaneously implanted in the abdominal wall in 19 patients with mucopolysaccharidoses (MPS I, II and III). A protocol was developed for the objective evaluation of experimental treatments of these patients. Systematic evaluation of the clinical status before and 6 months after amnion membrane implantation reveals no change in function except improvement in joint mobility. The sum of all joint movements showed improvement from baseline values to 6 months after implantation by ANOVA followed by post-hoc analysis (p less than 0.056). The only specific joint movements to significantly improve after 6 months were shoulder extension (p less than 0.01) and hip internal rotation (p less than 0.05). Serial measurements of the deficient lysosomal enzyme activity in serum and white blood cells did not increase in any patient after amnion membrane implantation. Urinary glycosaminoglycan excretion decreased transiently in 2 of 10 patients after implantation, but a second amnion membrane implantation did not result in any change. Biopsy of the implantation site in 10 patients 6 months after amnion membrane implantation revealed a foreign-body reaction with giant cell formation and fibrosis and no recognizable amnion membrane tissue. We conclude that human amnion membrane implantation is not an effective therapy in mucopolysaccharidoses.

Significance of Glycosaminoglycans for the Formation of Calcium Oxalate Stones

Glycosaminoglycans (GAG) are polysaccharide chains composed of repeating disaccharides of identical composition. Little is known about the mechanism of their excretion, but there is no doubt that urinary GAGs are degradation products of high molecular weight proteoglycans. Renal excretion takes place chiefly as glomerular filtration, and tubular reabsorption or secretion has not been demonstrated. Differences in the literature comparing GAG excretion in urolithiasis patients and healthy subjects are mainly attributable to methods of analysis and noncomparability of the investigation conditions. We found no differences between the two groups in several series. It is interesting to note that GAG excretion in men is significantly higher than in women, that a circadian rhythm of GAG concentration and excretion occurs in healthy subjects on a standardized diet, and that values are raised postprandially and at night. Seasonal course of GAG excretion curves is almost synchronous for men and women, irrespective of the absolute values, and GAG excretion in the spring and summer significantly exceeds that in winter months by up to 50%. All crystallization models cited demonstrate that GAG reduce the risk of calcium oxalate stone formation. Inhibitors of crystal growth and aggregation act by blocking the growth sites. Inhibition of calcium oxalate crystallization is also attributed to direct binding of calcium to GAG. In the presence of urate ions, and favorable pH, the ability of chondroitin sulfate C to bind calcium may be impaired by as much as 31%. These measurements support the concept that urate ions interact with GAG in urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Do Extracorporeal Shock Waves Affect Urinary Excretion of Glycosaminoglycans?

Urinary excretion of glycosaminoglycans (GAGs) was studied in 9 anaesthetised dogs and 10 patients with single kidneys. The animals were studied for 4 to 5 hours after administration of shock waves to 1 kidney, the contralateral organ serving as control. Urinary excretion of GAGs was measured on both sides. The patients were studied 0 to 24 and 32 to 56 h after extracorporeal shock wave lithotripsy (ESWL). In the animals an increased mean urinary excretion of GAGs was observed on both sides; this was more marked in the treated kidney. The increase reflects tissue injury in the exposed kidney induced by the extracorporeal shock waves. No increase in mean urinary excretion of GAGs was observed in the patients.

Tamm-Horsfall Autoantibodies in Interstitial Cystitis

Interstitial cystitis presents a diagnostic and therapeutic challenge. Although many etiologies, including autoimmunity, have been proposed its pathogenesis remains obscure. Tamm-Horsfall protein has been identified in the superficial urothelium of patients with interstitial cystitis demonstrating abnormal urothelial permeability. Eight patients with a clinical diagnosis of interstitial cystitis underwent cystoscopy and bladder biopsy. Characteristic cystoscopic findings were present, and each patient had chronic inflammation and mast cells by histopathological analysis. Preoperative anti-Tamm-Horsfall protein serum antibody (IgG) titers were determined by enzyme-linked immunosorbent assay (range 500 to 8,000, mean 2,750). A control group of 8 patients with a negative urological history also had titers of 0 to 500 (p = 0.02). The humoral response to Tamm-Horsfall protein in these patients suggests a role for Tamm-Horsfall protein in interstitial cystitis. Measurement of serum Tamm-Horsfall protein antibody may prove to be useful as a noninvasive diagnostic test in patients with this disease.