Das GAF-Domänen-Protein NreA : ein neuartiger Nitratrezeptor aus Staphylococcus carnosus

Staphylococcus carnosus ist ein fakultativ anaerobes Bakterium, das aerobe Atmung, anaerobe Nitratatmung und Gärungsstoffwechsel betreiben kann. Die Expression des Nitratstoffwechsels wird durch das Dreikomponentensystem NreABC reguliert.rnUnter anaeroben Bedingungen besitzt die Sensorhistidinkinase NreB in ihrer PAS-Domäne ein [Fe4S4]2+-Cluster. Das aktive (anaerobe) [Fe4S4]2+-NreB überträgt nach Autophosphorylierung die Phosphorylgruppe auf den Antwortregulator NreC, welcher dann die Expression der Gene der Nitratatmung aktiviert. Nitrat wirkt mit Hilfe des NreA-Proteins auf diese Gene induzierend. Im Rahmen der vorliegenden Arbeit wurde gezeigt, dass NreA ein GAF-Domänen-Protein und ein neuartiger Nitratrezeptor ist.rnDie Natur von NreA als GAF-Domänen-Protein bestätigte sich beim Vergleich der Kristallstruktur mit denen anderer GAF-Domänen. GAF-Domänen sind weit verbreitet und binden typischer Weise kleine Moleküle. Als physiologischer Ligand von NreA zeigte sich Nitrat, das innerhalb einer definierten Bindetasche gebunden wird. NreA bindet vermutlich in dimerer Form an dimeres NreB und inhibiert dadurch die Phosphorylierung der Sensorhistidinkinase NreB. Die Interaktion von NreA mit NreB wurde in vivo durch BACTH-Messungen und sowohl in vivo als auch in vitro durch Cross-Linking Experimente gezeigt. Nitrat reduziert den Ergebnissen nach die Interaktion von NreA mit NreB.rnDurch Sequenzvergleiche von NreA mit Homologen wurden konservierte Aminosäuren identifiziert. Über gerichtete Mutagenese wurden 25 NreA-Varianten hergestellt und bezüglich ihres Verhaltens in Abhängigkeit von Nitrat in narG-lip-Reportergenstudien getestet. Anhand ihres Phänotyps wurden sie als Wildtyp, NreA- und NreABC-Mutanten klassifiziert. Die Nitratbindetasche war in sechs Fällen betroffen. Die Phänotypen der Mutationen in der Peripherie lassen sich mit Auswirkungen auf die vermutete Konformationsänderung oder auf die Interaktion mit NreB erklären. Mutationen von konservierten, oberflächenexponierten Resten führten vermehrt zu NreA/ON-Varianten. Es ließen sich Bereiche auf der Proteinoberfläche identifizieren, die für NreA/NreA- oder NreA/NreB-Interaktionen wichtig sein könnten.rnDie Untersuchungen zeigten, dass NreA mit NreB interagiert und dass dadurch ein NreA/NreB-Sensorkomplex für die gemeinsame Erkennung von Nitrat und Sauerstoff gebildet wird.

Faltung, Assemblierung und Stabilisierung des Transmembranproteins Cytochrom b 6

In dieser Arbeit wurde der Beitrag der interhelikalen Loops zur Faltung, Assemblierung und Stabilität des kofaktortragenden Transmembranproteins Cytochrom b6 in vitro untersucht. Cytochrom b6 ist aus vier Transmembranhelices aufgebaut, die über drei Loops miteinander verbunden sind. Die beiden nicht-kovalent gebundenen Kofaktoren werden spontan in der Häm-Bindespalte zwischen den zwei Cytochrom b6-Hälften gebunden. Die Ergebnisse zeigen, dass die Verlängerung oder Eliminierung des Loops, der die beiden Hälften verbindet, nicht die Faltung und Assemblierung des Proteins beeinflusst. Der Loop ist für eine räumliche Positionierung und Orientierung der Hälften während der Assemblierung nicht essentiell. Weiterhin scheint keiner der drei interhelikalen Loops für die Bindung der Kofaktoren notwendig zu sein. Die Cytochrom b6-Hälfte, bestehend aus den Helices A und B, besitzt eine Konformation, die stabil genug ist um Häm alleine zu binden. Ebenso zeigt Helix B alleine eine α-helikale Struktur und bindet ebenfalls Häm. In vivo wurden bislang keine Faktoren beschrieben, die an der Assemblierung beteiligt sind. Im Rahmen dieser Arbeit wurden strukturelle Merkmale des Häms identifiziert, welche die Spezifität der Häm-Bindung, wenigstens in vitro, ausmachen. Von großer Bedeutung ist dabei das zentrale Eisen-Ion, dessen Eliminierung oder Austausch die Häm-Bindung verhindert. Die Substituenten des Porphyrinrings scheinen hingegen für die Stabilität der Bindung notwendig zu sein.

3D-ultrastructure, functions and stress responses of rhogocytes from the freshwater gastropods Biomphalaria glabrata and Lymnaea stagnalis

Rhogocytes, also termed ‘pore cells’, exist free in the hemolymph or embedded in the connective tissue of different body parts of molluscs, notably gastropods. These unique cells can be round, elongated or irregularly shaped, and up to 30 μm in diameter. Their hallmark is the so-called slit apparatus: i.e. pocket-like invaginations of the plasma membrane creating extracellular lacunae, bridged by cytoplasmic bars. These bars form distinctive slits of ca. 20 nm width. A slit diaphragm composed of proteins establishes a molecular sieve with holes of 20 x 20 nm. Different functions have been assigned to this special molluscan cell type, notably biosynthesis of the hemolymph respiratory protein hemocyanin. It has further been proposed, but not proven, that in the case of red-blooded snail species rhogocytes might synthesize the hemoglobin. However, the secretion pathway of these hemolymph proteins, and the functional role of the enigmatic slit apparatus remained unclear. Additionally proposed functions of rhogocytes, such as heavy metal detoxification or hemolymph protein degradation, are also not well studied. This work provides more detailed electron microscopical, histological and immunobiochemical information on the structure and function of rhogocytes of the freshwater snails Biomphalaria glabrata and Lymnaea stagnalis. By in situ hybridization on mantle tissues, it proves that B. glabrata rhogocytes synthesize hemoglobin and L. stagnalis rhogocytes synthesize hemocyanin. Hemocyanin is present, in endoplasmic reticulum lacunae and in vesicles, as individual molecules or pseudo-crystalline arrays. The first 3D reconstructions of rhogocytes are provided by means of electron tomography and show unprecedented details of the slit apparatus. A highly dense material in the cytoplasmic bars close to the diaphragmatic slits was shown, by immunogold labeling, to contain actin. By immunofluorescence microscopy, the protein nephrin was localized at the periphery of rhogocytes. The presence of both proteins in the slit apparatus supports the previous hypothesis, hitherto solely based on similarities of the ultrastructure, that the molluscan rhogocytes are phylogenetically related to mammalian podocytes and insect nephrocytes. A possible secretion pathway of respiratory proteins that includes a transfer mechanism of vesicles through the diaphragmatic slits is proposed and discussed. We also studied, by electron microscopy, the reaction of rhogocytes in situ to two forms of animal stress: deprivation of food and cadmium contamination of the tank water. Significant cellular reactions to both stressors were observed and documented. Notably, the slit apparatus surface and the number of electron-dense cytoplasmic vesicles increased in response to cadmium stress. Food deprivation led to an increase in hemocyanin production. These observations are also discussed in the framework of using such animals as potential environmental biomarkers.

Die regulatorische Funktion des Usher-Syndrom-Proteins SANS in Proteinnetzwerken

Die vorliegende kumulative Arbeit umfasst Analysen zur Aufklärung der molekularen Grundlagen des humanen Usher-Syndroms (USH), der häufigsten Ursache kombinierter vererblicher Taub-Blindheit. Ziel dieser Arbeit war es, neue Erkenntnisse zur Funktion der USH-Proteine und den von ihnen organisierten Protein-Netzwerken in der Photorezeptorzelle zu erhalten. Dadurch sollten weitere Einsichten in die molekularen Ursachen des retinalen Phänotyps von USH gewonnen werden. Die Ergebnisse dieser Analysen wurden in einem Übersichtsartikel (I) und zwei Originalarbeiten (II, III) zusammengestellt.rn Im Übersichtsartikel (I) wurden die vorliegenden Hinweise zusammengefasst, die USH auf Grundlage der molekularen Verbindungen ebenfalls als Ciliopathien definiert. Zudem wird die Bedeutung des periciliären USH-Proteinnetzwerkes für das sensorische Cilium (Außensegment) der Photorezeptorzelle herausgestellt. rn In Publikation II wurde der Aufbau des USH1-USH2-Proteinnetzwerkes als Teil des periciliären Komplexes analysiert, der beim cargo handover von vesikulärer Fracht vom Innensegment- auf den ciliären Transport für die Photorezeptorzelle essentiell ist. Experimentell wurde Ush2a als neuer SANS-Interaktionspartner validiert. Des Weiteren wurde ein ternärer Komplex aus den USH-Proteinen SANS, Ush2a und Whirlin identifiziert, dessen Zusammensetzung durch die phosphorylierungsabhängige Interaktion zwischen SANS und Ush2a reguliert werden könnte. Dieser ternäre Komplex kann sowohl der Integrität der Zielmembran dienen als auch am Transfer von Molekülen ins Außensegment beteiligt sein.rn In Publikation III wurde das MAGUK-Protein Magi2 als neuer Interaktionspartner von SANS identifiziert und die Interaktion durch komplementäre Interaktionsassays validiert. Dabei wurde ein internes PDZ-Binde-Motiv in der SAM-Domäne von SANS identifiziert, das die Interaktion zur PDZ5-Domäne von Magi2 phosphorylierungsabhängig vermittelt. Dadurch wurde bestätigt, dass SANS durch post-translationale Modifizierung reguliert wird. Weiterführende Experimente zur Funktion des Magi2-SANS-Komplexes zeigen, dass Magi2 an Prozess der Rezeptor-vermittelten Endocytose beteiligt ist. Die Phosphorylierung von SANS durch die Kinase CK2 spielt bei der Endocytose ebenfalls eine wichtige Rolle. Der Phosphorylierungsstatus von SANS moduliert die Interaktion zu Magi2 und reguliert dadurch negativ den Prozess der Endocytose. In RNAi-Studien wurde die durch Magi2-vermittelte Endocytose darüber hinaus mit dem Prozess der Ciliogenese verknüpft. Die Analyse der subzellulären Verteilung der Interaktionspartner lokalisieren Magi2 im periciliären Komplex und assoziieren das periciliäre USH-Proteinnetzwerk dadurch mit dem Prozess der Endocytose in der ciliary pocket. Der SANS-Magi2-Komplex sollte demnach für Aufbau und Funktion des sensorischen Ciliums der Photorezeptorzelle eine wichtige Rolle spielen.rn Die Gesamtheit an Informationen, die aus den Publikationen dieser Dissertation und aus den Kooperationsprojekten (*) resultieren, haben die Kenntnisse zur zellulären Funktion der USH-Proteine und ihrer Interaktionspartner und damit über die pathogenen Mechanismen von USH erweitert. Dies bildet die Basis, um fundierte Therapiestrategien zu entwickeln.

Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems

BACKGROUND: The adequacy of thromboprophylaxis prescriptions in acutely ill hospitalized medical patients needs improvement. OBJECTIVE: To prospectively assess the efficacy of thromboprophylaxis adequacy of various clinical decision support systems (CDSS) with the aim of increasing the use of explicit criteria for thromboprophylaxis prescription in nine Swiss medical services. METHODS: We randomly assigned medical services to a pocket digital assistant program (PDA), pocket cards (PC) and no CDSS (controls). In centers using an electronic chart, an e-alert system (eAlerts) was developed. After 4 months, we compared post-CDSS with baseline thromboprophylaxis adequacy for the various CDSS and control groups. RESULTS: Overall, 1085 patients were included (395 controls, 196 PC, 168 PDA, 326 eAlerts), 651 pre- and 434 post-CDSS implementation: 472 (43.5%) presented a risk of VTE justifying thromboprophylaxis (31.8% pre, 61.1% post) and 556 (51.2%) received thromboprophylaxis (54.2% pre, 46.8% post). The overall adequacy (% patients with adequate prescription) of pre- and post-CDSS implementation was 56.2 and 50.7 for controls (P = 0.29), 67.3 and 45.3 for PC (P = 0.002), 66.0 and 64.9 for PDA (P = 0.99), 50.5 and 56.2 for eAlerts (P = 0.37), respectively, eAlerts limited overprescription (56% pre, 31% post, P = 0.01). CONCLUSION: While pocket cards and handhelds did not improve thromboprophylaxis adequacy, eAlerts had a modest effect, particularly on the reduction of overprescription. This effect only partially contributes to the improvement of patient safety and more work is needed towards institution-tailored tools.

Clinical and microbiological findings at sites treated with orthodontic fixed appliances in adolescents

INTRODUCTION: Fixed orthodontic appliances can alter the subgingival microbiota. Our aim was to compare the subgingival microbiota and clinical parameters in adolescent subjects at sites of teeth treated with orthodontic bands with margins at (OBM) or below the gingival margin (OBSM), or with brackets (OBR). METHODS: Microbial samples were collected from 33 subjects (ages, 12-18 years) in treatment more than 6 months. The microbiota was assessed by the DNA-DNA checkerboard hybridization method. RESULTS: Bacterial samples were taken from 83 OBR,103 OBSM, and 54 OBM sites. Probing pocket depths differed by orthodontic type (P <0.001) with mean values of 2.9 mm (SD, 0.6) at OBSM sites, 2.5 mm (SD, 0.6) at OBM sites, and 2.3 mm (SD, 0.5) at OBR sites. Only Actinomyces israelii (P <0.001) and Actinomyces naeslundii (P <0.001) had higher levels at OBR sites, whereas Neisseria mucosa had higher levels at sites treated with OBSM or OBM (P <0.001). Aggregatibacter actinomycetemcomitans was found in 25% of sites independent of the appliance. CONCLUSIONS: Different types of orthodontic appliances cause minor differences in the subgingival microbiota (A israelii and A naeslundii) and higher levels at sites treated with orthodontic brackets. More sites with bleeding on probing and deeper pockets were found around orthodontic bands.

Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone

BACKGROUND: There are still limited data on the outcomes of regenerative periodontal surgery using a combination of an enamel matrix protein derivative (EMD) and autogenous bone (AB). AIM: To evaluate the healing of deep intrabony defects treated with either a combination EMD+AB or EMD alone. MATERIALS AND METHODS: Forty patients with advanced chronic periodontitis, with one deep intrabony defect, were randomly treated with either EMD+AB (test) or EMD (control). Clinical assessments were performed at baseline and at 1 year after treatment. The primary outcome variable was relative attachment level (RAL). RESULTS: Healing was uneventful in all patients. The test sites showed a reduction in the mean probing pocket depth (PPD) of 5.6 +/- 0.9 mm (p<0.001), a gain in the mean RAL of 4.2 +/- 1.1 mm (p<0.001) and a gain in the mean probing bone level (PBL) of 3.9 +/- 1.0 mm (p<0.001). The control group displayed a mean PPD reduction of 4.6 +/- 0.4 mm (p<0.001), a mean RAL gain of 3.4 +/- 0.8 mm (p<0.001) and a mean PBL gain of 2.8 +/- 0.8 mm (p<0.001). RAL gains of > or =4 mm were measured in 90% of the test defects and in 55% of the controls. PBL gains of > or =4 mm were obtained in 85% of the test defects and in 25% of the control ones. The test treatment resulted in statistically higher PPD reductions, RAL gains and PBL gains compared with the control (p<0.01). CONCLUSIONS: Within their limits, the present results indicate that: (i) at 1 year after surgery, both therapies resulted in statistically significant clinical improvements compared with baseline and (ii) although the combination of EMD+AB resulted in statistically significant higher soft and hard tissue improvements compared with treatment with EMD, the clinical relevance of this finding is unclear.

A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery

BACKGROUND: Chlorhexidine (CHX) rinsing after periodontal surgery is common. We assessed the clinical and microbiological effects of two CHX concentrations following periodontal surgery. MATERIALS AND METHODS: In a randomized, controlled clinical trial, 45 subjects were assigned to 4 weeks rinsing with a 0.05 CHX/herbal extract combination (test) or a 0.1% CHX solution. Clinical and staining effects were studied. Subgingival bacteria were assessed using the DNA-DNA checkerboard. Statistics included parametric and non-parametric tests (p<0001 to declare significance at 80% power). RESULTS: At weeks 4 and 12, more staining was found in the control group (p<0.05 and p<0.001, respectively). A higher risk for staining was found in the control group (crude OR: 2.3:1, 95% CI: 1.3 to 4.4, p<0.01). The absolute staining reduction in the test group was 21.1% (9 5% CI: 9.4-32.8%). Probing pocket depth (PPD) decreases were significant (p<0.001) in both groups and similar (p=0.92). No rinse group differences in changes of bacterial counts for any species were found between baseline and week 12. CONCLUSIONS: The test CHX rinse resulted in less tooth staining. At the study endpoint, similar and high counts of periodontal pathogens were found.

GSR deposition along the bullet path in contact shots to composite models

In contact shots, all the materials emerging from the muzzle (combustion gases, soot, powder grains, and metals from the primer) will be driven into the depth of the entrance wound and the following sections of the bullet track. The so-called "pocket" ("powder cavity") under the skin containing soot and gunpowder particles is regarded as a significant indicator of a contact entrance wound since one would expect that the quantity of GSR deposited along the bullet's path rapidly declines towards the exit hole. Nevertheless, experience has shown that soot, powder particles, and carboxyhemoglobin may be found not only in the initial part of the wound channel, but also far away from the entrance and even at the exit. In order to investigate the propagation of GSRs under standardized conditions, contact test shots were fired against composite models of pig skin and 25-cm-long gelatin blocks using 9-mm Luger pistol cartridges with two different primers (Sinoxid® and Sintox®). Subsequently, 1-cm-thick layers of the gelatin blocks were examined as to their primer element contents (lead, barium, and antimony as discharge residues of Sinoxid® as well as zinc and titanium from Sintox®) by means of X-ray fluorescence spectroscopy. As expected, the highest element concentrations were found in the initial parts of the bullet tracks, but also the distal sections contained detectable amounts of the respective primer elements. The same was true for amorphous soot and unburned/partly burned powder particles, which could be demonstrated even at the exit site. With the help of a high-speed motion camera it was shown that for a short time the temporary cavitation extends from the entrance to the exit thus facilitating the unlimited spread of discharge residues along the whole bullet path.

Structure-activity relationship and mechanism of action studies of manzamine analogues for the control of neuroinflammation and cerebral infections

Structure-activity relationship studies were carried out by chemical modification of manzamine A (1), 8-hydroxymanzamine A (2), manzamine F (14), and ircinal isolated from the sponge Acanthostrongylophora. The derived analogues were evaluated for antimalarial, antimicrobial, and antineuroinflammatory activities. Several modified products exhibited potent and improved in vitro antineuroinflammatory, antimicrobial, and antimalarial activity. 1 showed improved activity against malaria compared to chloroquine in both multi- and single-dose in vivo experiments. The significant antimalarial potential was revealed by a 100% cure rate of malaria in mice with one administration of 100 mg/kg of 1. The potent antineuroinflammatory activity of the manzamines will provide great benefit for the prevention and treatment of cerebral infections (e.g., Cryptococcus and Plasmodium). In addition, 1 was shown to permeate across the blood-brain barrier (BBB) in an in vitro model using a MDR-MDCK monolayer. Docking studies support that 2 binds to the ATP-noncompetitive pocket of glycogen synthesis kinase-3beta (GSK-3beta), which is a putative target of manzamines. On the basis of the results presented here, it will be possible to initiate rational drug design efforts around this natural product scaffold for the treatment of several different diseases.

Detection of Internal Defects in Concrete Members Using Global Vibration Characteristics

Rock-pocket and honeycomb defects impair overall stiffness, accelerate aging, reduce service life, and cause structural problems in hardened concrete members. Traditional methods for detecting such deficient volumes involve visual observations or localized nondestructive methods, which are labor-intensive, time-consuming, highly sensitive to test conditions, and require knowledge of and accessibility to defect locations. The authors propose a vibration response-based nondestructive technique that combines experimental and numerical methodologies for use in identifying the location and severity of internal defects of concrete members. The experimental component entails collecting mode shape curvatures from laboratory beam specimens with size-controlled rock pocket and honeycomb defects, and the numerical component entails simulating beam vibration response through a finite element (FE) model parameterized with three defect-identifying variables indicating location (x, coordinate along the beam length) and severity of damage (alpha, stiffness reduction and beta, mass reduction). Defects are detected by comparing the FE model predictions to experimental measurements and inferring the low number of defect-identifying variables. This method is particularly well-suited for rapid and cost-effective quality assurance for precast concrete members and for inspecting concrete members with simple geometric forms.

Mutagenesis and computer modeling studies of a GPCR conserved residue W5.43(194) in ligand recognition and signal transduction for CB2 receptor

W5.43(194), a conserved tryptophan residue among G-protein coupled receptors (GPCRs) and cannabinoid receptors (CB), was examined in the present report for its significance in CB2 receptor ligand binding and adenylyl cyclase (AC) activity. Computer modeling postulates that this site in CB2 may be involved in the affinity of WIN55212-2 and SR144528 through aromatic contacts. In the present study, we reported that a CB2 receptor mutant, W5.43(194)Y, which had a tyrosine (Y) substitution for tryptophan (W), retained the binding affinity for CB agonist CP55940, but reduced binding affinity for CB2 agonist WIN55212-2 and inverse agonist SR144528 by 8-fold and 5-fold, respectively; the CB2 W5.43(194)F and W5.43(194)A mutations significantly affect the binding activities of CP55940, WIN55212-2 and SR144528. Furthermore, we found that agonist-mediated inhibition of the forskolin-induced cAMP production was dramatically diminished in the CB2 mutant W5.43(194)Y, whereas W5.43(194)F and W5.43(194)A mutants resulted in complete elimination of downstream signaling, suggesting that W5.43(194) was essential for the full activation of CB2. These results indicate that both aromatic interaction and hydrogen bonding are involved in ligand binding for the residue W5.43(194), and the mutations of this tryptophan site may affect the conformation of the ligand binding pocket and therefore control the active conformation of the wild type CB2 receptor. W5.43(194)Y/F/A mutations also displayed noticeable enhancement of the constitutive activation probably attributed to the receptor conformational changes resulted from the mutations.

A closer look at the high affinity benzodiazepine binding site on GABAA receptors

Ligands of the benzodiazepine binding site of the GABA(A) receptor come in three flavors: positive allosteric modulators, negative allosteric modulators and antagonists all of which can bind with high affinity. The GABA(A) receptor is a pentameric protein which forms a chloride selective ion channel and ligands of the benzodiazepine binding site stabilize three different conformations of this protein. Classical benzodiazepines exert a positive allosteric effect by increasing the apparent affinity of channel opening by the agonist γ-aminobutyric acid (GABA). We concentrate here on the major adult isoform, the α(1)β(2)γ(2) GABA(A) receptor. The classical binding pocket for benzodiazepines is located in a subunit cleft between α(1) and γ(2) subunits in a position homologous to the agonist binding site for GABA that is located between β(2) and α(1) subunits. We review here approaches to this picture. In particular, point mutations were performed in combination with subsequent analysis of the expressed mutant proteins using either electrophysiological techniques or radioactive ligand binding assays. The predictive power of these methods is assessed by comparing the results with the predictions that can be made on the basis of the recently published crystal structure of the acetylcholine binding protein that shows homology to the N-terminal, extracellular domain of the GABA(A) receptor. In addition, we review an approach to the question of how the benzodiazepine ligands are positioned in their binding pocket. We also discuss a newly postulated modulatory site for benzodiazepines at the α(1)/β(2) subunit interface, homologous to the classical benzodiazepine binding pocket.

Characterization of novel StAR (steroidogenic acute regulatory protein) mutations causing non-classic lipoid adrenal hyperplasia

Context Steroidogenic acute regulatory protein (StAR) is crucial for transport of cholesterol to mitochondria where biosynthesis of steroids is initiated. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH). Objective StAR gene mutations causing partial loss of function manifest atypical and may be mistaken as familial glucocorticoid deficiency. Only a few mutations have been reported. Design To report clinical, biochemical, genetic, protein structure and functional data on two novel StAR mutations, and to compare them with published literature. Setting Collaboration between the University Children's Hospital Bern, Switzerland, and the CIBERER, Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain. Patients Two subjects of a non-consanguineous Caucasian family were studied. The 46,XX phenotypic normal female was diagnosed with adrenal insufficiency at the age of 10 months, had normal pubertal development and still has no signs of hypergonodatropic hypogonadism at 32 years of age. Her 46,XY brother was born with normal male external genitalia and was diagnosed with adrenal insufficiency at 14 months. Puberty was normal and no signs of hypergonadotropic hypogonadism are present at 29 years of age. Results StAR gene analysis revealed two novel compound heterozygote mutations T44HfsX3 and G221S. T44HfsX3 is a loss-of-function StAR mutation. G221S retains partial activity (~30%) and is therefore responsible for a milder, non-classic phenotype. G221S is located in the cholesterol binding pocket and seems to alter binding/release of cholesterol. Conclusions StAR mutations located in the cholesterol binding pocket (V187M, R188C, R192C, G221D/S) seem to cause non-classic lipoid CAH. Accuracy of genotype-phenotype prediction by in vitro testing may vary with the assays employed.

Clinical and radiographic evaluation of intrabony periodontal defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute

The aim of this study has been to compare the clinical and radiographic outcome of periodontal intrabony defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute application. Thirty patients diagnosed with advanced periodontits were divided into two groups: the control group (OFD), in which an open flap debridement procedure was performed and the test group (OFD+NHA), in which defects were additionally filled with nanocrystalline hydroxyapatite bone substitute material. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL) were measured prior to, then 6 and 12months following treatment. Radiographic depth and width of defects were also evaluated. There were no differences in any clinical and radiographic parameters between the examined groups prior to treatment. After treatment, BOP, GI, PD, CAL, radiographic depth and width parameter values improved statistically significantly in both groups. The PI value did not change, but the GR value increased significantly after treatment. There were no statistical differences in evaluated parameters between OFD and OFD+NHA groups 6 and 12months after treatment. Within the limits of the study, it can be concluded that the additional use of nanocrystalline hydroxyapatite bone substitute material after open flap procedure does not improve clinical and radiographic treatment outcome.