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At least 145 records · Page 8

Shotgun Immunoproteomic Approach for the Discovery of Linear B-Cell Epitopes in Biothreat Agents Francisella tularensis and Burkholderia pseudomallei

Peptide-based subunit vaccines are coming to the forefront of current vaccine approaches, with safety and cost-effective production among their top advantages. Peptide vaccine formulations consist of multiple synthetic linear epitopes that together trigger desired immune responses that can result in robust immune memory. The advantages of linear compared to conformational epitopes are their simple structure, ease of synthesis, and ability to stimulate immune responses by means that do not require complex 3D conformation. Prediction of linear epitopes through use of computational tools is fast and cost-effective, but typically of low accuracy, necessitating extensive experimentation to verify results. On the other hand, identification of linear epitopes through experimental screening has been an inefficient process that requires thorough characterization of previously identified full-length protein antigens, or laborious techniques involving genetic manipulation of organisms. In this study, we apply a newly developed generalizable screening method that enables efficient identification of B-cell epitopes in the proteomes of pathogenic bacteria. As a test case, we used this method to identify epitopes in the proteome of Francisella tularensis (Ft), a Select Agent with a well-characterized immunoproteome. Our screen identified many peptides that map to known antigens, including verified and predicted outer membrane proteins and extracellular proteins, validating the utility of this approach. We then used the method to identify seroreactive peptides in the less characterized immunoproteome of Select Agent Burkholderia pseudomallei (Bp). This screen revealed known Bp antigens as well as proteins that have not been previously identified as antigens. Although B-cell epitope prediction tools Bepipred 2.0 and iBCE-EL classified many of our seroreactive peptides as epitopes, they did not score them significantly higher than the non-reactive tryptic peptides in our study, nor did they assign higher scores to seroreactive peptides from known Ft or Bp antigens, highlighting the need for experimental data instead of relying on computational epitope predictions alone. The present workflow is easily adaptable to detecting peptide targets relevant to the immune systems of other mammalian species, including humans (depending upon the availability of convalescent sera from patients), and could aid in accelerating the discovery of B-cell epitopes and development of vaccines to counter emerging biological threats.

60 APPLIED LIFE SCIENCES↗

Genome Analysis of a Verrucomicrobial Endosymbiont With a Tiny Genome Discovered in an Antarctic Lake

Organic Lake in Antarctica is a marine-derived, cold (–13°C), stratified (oxic-anoxic), hypersaline (>200 gl –1 ) system with unusual chemistry (very high levels of dimethylsulfide) that supports the growth of phylogenetically and metabolically diverse microorganisms. Symbionts are not well characterized in Antarctica. However, unicellular eukaryotes are often present in Antarctic lakes and theoretically could harbor endosymbionts. Here, we describe Candidatus Organicella extenuata, a member of the Verrucomicrobia with a highly reduced genome, recovered as a metagenome-assembled genome with genetic code 4 (UGA-to-Trp recoding) from Organic Lake. It is closely related to Candidatus Pinguicocccus supinus (163,218 bp, 205 genes), a newly described cytoplasmic endosymbiont of the freshwater ciliate Euplotes vanleeuwenhoeki (Serra et al., 2020). At 158,228 bp (encoding 194 genes), the genome of Ca. Organicella extenuata is among the smallest known bacterial genomes and similar to the genome of Ca. Pinguicoccus supinus (163,218 bp, 205 genes). Ca. Organicella extenuata retains a capacity for replication, transcription, translation, and protein-folding while lacking any capacity for the biosynthesis of amino acids or vitamins. Notably, the endosymbiont retains a capacity for fatty acid synthesis (type II) and iron–sulfur (Fe-S) cluster assembly. Metagenomic analysis of 150 new metagenomes from Organic Lake and more than 70 other Antarctic aquatic locations revealed a strong correlation in abundance between Ca. Organicella extenuata and a novel ciliate of the genus Euplotes. Like Ca. Pinguicoccus supinus, we infer that Ca. Organicella extenuata is an endosymbiont of Euplotes and hypothesize that both Ca. Organicella extenuata and Ca. Pinguicocccus supinus provide fatty acids and Fe-S clusters to their Euplotes host as the foundation of a mutualistic symbiosis. The discovery of Ca. Organicella extenuata as possessing genetic code 4 illustrates that in addition to identifying endosymbionts by sequencing known symbiotic communities and searching metagenome data using reference endosymbiont genomes, the potential exists to identify novel endosymbionts by searching for unusual coding parameters.

59 BASIC BIOLOGICAL SCIENCES↗

X-ray Crystallographic Study of Preferred Spacing by the NF-κB p50 Homodimer on κB DNA

Though originally characterized as an inactive or transcriptionally repressive factor, the NF-κB p50 homodimer has become appreciated as a physiologically relevant driver of specific target gene expression. By virtue of its low affinity for cytoplasmic IκB protein inhibitors, p50 accumulates in the nucleus of resting cells, where it is a binding target for the transcriptional co-activator IκBζ. In this study, we employed X-ray crystallography to analyze the structure of the p50 homodimer on κB DNA from the promoters of human interleukin-6 (IL-6) and neutrophil-gelatinase-associated lipocalin (NGAL) genes, both of which respond to IκBζ. The NF-κB p50 homodimer binds 11-bp on IL-6 κB DNA, while, on NGAL κB DNA, the spacing is 12-bp. This begs the question: what DNA binding mode is preferred by NF-κB p50 homodimer? To address this, we engineered a “Test” κB-like DNA containing the core sequence 5'-GGGGAATTCCCC-3' and determined its X-ray crystal structure in complex with p50. This revealed that, when presented with multiple options, NF-κB p50 homodimer prefers to bind 11-bp, which necessarily imposes asymmetry on the complex despite the symmetry inherent in both the protein and its target DNA, and that the p50 dimerization domain can contact DNA via distinct modes.

59 BASIC BIOLOGICAL SCIENCES↗

1,10-Phenanthroline-Iron Complex-Derived Fe-N-C Electrocatalysts: Enhanced Oxygen Reduction Activity and Stability Through Synthesis Tuning

The development of electrocatalysts composed of earth-abundant elements is essential for advancing the commercial application of Proton Exchange Membrane Fuel Cells (PEMFC). Among these, single-atom electrocatalysts, such as Fe-N-C, show great promise for the oxygen reduction reaction (ORR). This study aims to improve the ORR activity and stability of Fe-N-C electrocatalysts by fine-tuning the straightforward 1,10-phenanthroline-iron complexation synthesis method. Key parameters, including iron-to-phenanthroline ratio, carbon powder surface area, and pyrolysis temperature were systematically varied to evaluate their influence on the resulting electrocatalysts. The findings of this study revealed that the electrocatalysts synthesized with 1,10-phenanthroline (Phen) and high-surface-area Black Pearls (BP) possessed much better ORR activity than electrocatalysts prepared by using Vulcan carbon (lower surface area). Interestingly, electrocatalysts prepared with BP, but with a non-bidentate nitrogen-containing ligand molecule, such as imidazole, showed a much poorer activity, as the resulting material predominantly consisted of inactive structures, such as encapsulated iron nanoparticles and iron oxide, as evidenced by HR-TEM, EXAFS, and XRD. Therefore, the results suggest that only the synergistic combination of the bidentate ligand phenanthroline (Phen) and the high-surface-area carbon support (BP) favored the formation of ORR-active Fe-N-C single-atom species upon pyrolysis. The study also unveiled a significant enhancement in electrocatalyst stability during accelerated durability tests (and air storage) as the pyrolysis temperature was increased from 700 to 1300 °C, albeit at the expense of ORR activity, likely resulting from the generation of iron particles. Pyrolysis at 1050 °C yielded the electrocatalyst with the most favorable balance of activity and stability in rotating disk measurements, while maintaining moderate durability under PEM fuel cell operation. The insights obtained in this study may guide the development of more active efficient and durable electrocatalysts, synthesized via a simple method using earth-abundant elements, for application in PEMFC cathodes.

30 DIRECT ENERGY CONVERSION↗

On the evolution of the lunar orbit

It is generally accepted that the earth-moon separation is at present increasing due to tidal dissipation. Values for the corresponding lunar deceleration and the related slowing of the earth's rotation are obtained from astronomical observations and studies of ancient eclipses. Extrapolation of these values leads to a close approach of the earth and moon 1-3 b.y. BP. Periodicities in the Precambrian stromatolites may yield the number of solar days in a lunar month prior to 500 m.y. BP. These data combined with dynamic constraints on the number of solar days in a lunar month indicate a close approach of the earth and moon at 2.85 plus or minus 0.25 b.y. BP. Mare volcanism on the moon and high-temperature Archean volcanism on the earth prior to this date may be due to tidal heating. Strong tidal heating during a close approach could have contributed to the formation of the first living organisms.

Turcotte, D. L.↗

Holocene submergence of southern Long Island, New York

Samples of basal peat from south-central Long Island have been dated by the radiocarbon method, and a local curve of submergence has been obtained for the past 8,000 yr. The submergence curve indicates that from 7,000 and 3,000 yr BP the Long Island coast was being submerged at a rate of about 25 cm per 100 yr, a rate which slowed markedly to about 10 cm per 100 yr during the past 3,000 yr. Sea-level data for before 7,000 yr show considerable scatter. Samples from the fringing and mid-bay marsh areas of the Great South Bay taken at depths of -1.1 and -0.3 m MSL gave radiocarbon ages of about 1,015 and 300 yr, respectively. The inception of these marshes is estimated to have occurred at about 2,000 yr BP. It seems likely that the change from open lagoon to saltmarsh was initiated in the Great South Bay by a decrease in the rate of submergence at about 3,000 yr BP, which allowed sedimentation to build the floor of the lagoon to a level suitable for colonization by marsh grasses.

Rampino, M. R.↗

Inversion of surface parameters using fast learning neural networks

A neural network approach to the inversion of surface scattering parameters is presented. Simulated data sets based on a surface scattering model are used so that the data may be viewed as taken from a completely known randomly rough surface. The fast learning (FL) neural network and a multilayer perceptron (MLP) trained with backpropagation learning (BP network) are tested on the simulated backscattering data. The RMS error of training the FL network is found to be less than one half the error of the BP network while requiring one to two orders of magnitude less CPU time. When applied to inversion of parameters from a statistically rough surface, the FL method is successful at recovering the surface permittivity, the surface correlation length, and the RMS surface height in less time and with less error than the BP network. Further applications of the FL neural network to the inversion of parameters from backscatter measurements of an inhomogeneous layer above a half space are shown.

Dawson, M. S.↗

Sea ice classification using fast learning neural networks

A first learning neural network approach to the classification of sea ice is presented. The fast learning (FL) neural network and a multilayer perceptron (MLP) trained with backpropagation learning (BP network) were tested on simulated data sets based on the known dominant scattering characteristics of the target class. Four classes were used in the data simulation: open water, thick lossy saline ice, thin saline ice, and multiyear ice. The BP network was unable to consistently converge to less than 25 percent error while the FL method yielded an average error of approximately 1 percent on the first iteration of training. The fast learning method presented can significantly reduce the CPU time necessary to train a neural network as well as consistently yield higher classification accuracy than BP networks.

Dawson, M. S.↗

Nd-142/Nd-144 in bulk planetary reservoirs, the problem of incomplete mixing of interstellar components and significance of very high precision Nd-145/Nd-144 measurements

Apart from the challenge of very high precision Nd-142/Nd-144 ratio measurement, accurate applications of the coupled Sm-(146,147)-Nd-(142,143) systematics in planetary differentiation studies require very precise knowledge of the present-day (post-Sm-146 decay) Nd-142/Nd-144 ratios of bulk planetary objects (BP). The coupled systematics yield model ages for the time of formation of Sm/Nd-fractionated reservoirs by differentiation of Sm/Nd-unfractionated bulk planetary reservoirs. Estimates of (Nd-142/Nd-144)(sub BP) and (Nd-143/Nd-144)(sub BP) therefore provide the critical baseline relative to which these model ages are referenced. In the Sm-147-Nd-143 systematics, Nd-143/Nd-144 variations are mostly large; therefore, small variations in initial Nd-143/Nd-144 ratios generally can be ignored. However, in the case of Sm-146-Nd-142, the range of Nd-142/Nd-144 divergence for differentiated planetary reservoirs is much smaller. Consequently Sm-(146,147)-Nd-(142,143) model ages are sensitive to small variations in bulk planetary Nd-142/Nd-144 (both present-day and initial). One major unanswered question is whether or not Nd shelf standards (CIT Nd beta/Ames metal, La Jolla, NASA-JSC/Ames metal) have Nd-142/Nd-144 identical to the bulk Earth or otherwise might record some degree of radiogenic evolution in an early-fractionated reservoir. Our discussions of earth Earth differentiation based on Nd-142/Nd-144 in Isua and Acasta samples have employed a working assumption: (Nd-142/Nd-144)(sub Nd beta) = (Nd-142/Nd-144)(sub Bulk Earth). This requires experimental justification and is apparently contradicted by chondrite Nd-142/Nd-144 measurements, which have been interpreted to indicate: (Nd-142/Nd-144)(sub JSC/Ames metal) = ((Nd-142/Nd-144)(sub CHUR) = 35 plus or minus 8 ppm). At present, interpretations of the early Earth and Moon hinge largely on this issue. Because Ba in bulk chondrite samples exhibit similar magnitude nuclear anomalies, attributable to incomplete mixing of interstellar components, a critical question is whether or not nuclear effects are also present in Nd-142/Nd-144, both in bulk chondrites and between planetary objects.

Harper, C. L., Jr.↗

Fish Scale Evidence for Rapid Post Glacial Colonization of an Atlantic Coastal Pond

Fish scales from the sediment of Allamuchy Pond, New Jersey, USA, indicate that fishes were present in the pond within 400 years of the time of the first deposition of organic material, at approximately 12,600 yrs BP. The earliest of the scales, from a white sucker, Catostomus commersoni, appears in sediment dated 12,260 +/- 220 yrs BP. Presence of scales in sediment deposited before I 0,000 yrs BP indicates that Atlantic salmon, Salmo salar, sunfish, Lepomis sp., and yellow perch, Perca flavescens, also were early inhabitants of the pond. The timing of the arrival of each of these fishes suggests that they migrated out from Atlantic coastal refugia. A minnow scale, referred to Phoxininae, was also retrieved; it could not be matched to any cyprinid currently found in northeastern North America. The species present historically in this pond are from five families found currently in ponds throughout the Northeast and sugoest that the lentic palaeo-enviromnent was similar to present mid-elevation or high-latitude lentic systems.

Daniels, R. A.↗

Effect of In-Flight Exercise and Extravehicular Activity on Postflight Stand Tests

The purpose of this study was to determine whether exercise performed by Space Shuttle crewmembers during short-duration spaceflights (9-16 days) affects the heart rate (HR) and blood pressure (BP) responses to standing within 2-4 hr of landing. Thirty crewmembers performed self-selected in-flight exercise and maintained exercise logs to monitor their exercise intensity and duration. A 10min stand test, preceded by at least 6 min of quiet supine rest, was completed 10- 15 d before launch (PRE) and within four hours of landing (POST). Based upon their in-flight exercise records, subjects were grouped as either high (HIex: = 3x/week, HR = 70% ,HRMax, = 20 min/session, n = 11), medium (MEDex: = 3x/week, HR = 70% HRmax, = 20 min/session, n = 10), or low (LOex: = 3x/week, HR and duration variable, n = 11) exercisers. HR and BP responses to standing were compared between groups (ANOVA, or analysis of variance, P < 0.05). There were no PRE differences between the groups in supine or standing HR and BP. Although POST supine HR was similar to PRE, all groups had an increased standing HR compared to PRE. The increase in HR upon standing was significantly greater after flight in the LOex group (36+/-5 bpm) compared to HIex or MEDex groups (25+/-1bpm; 22+/-2 bpm). Similarly, the decrease in pulse pressure (PP) from supine to standing was unchanged after spaceflight in the MEDex and HIex groups, but was significantly less in the LOex group (PRE: -9+/- 3, POST: -19+/- 4 mmHg). Thus, moderate to high levels of in-flight exercise attenuated HR and PP responses to standing after spaceflight compared.

Lee, Stuart M. C.↗

Cerebrovascular Responses During Lower Body Negative Pressure-Induced Presyncope

Reduced orthostatic tolerance is commonly observed after space flight, occasionally causing presyncopal conditions. Although the cerebrovascular system may play an important role in presyncope, there have been few reports concerning cerebral hemodynamics during presyncope. The purpose of this study was to investigate cerebrovascular responses during presyncope induced by lower body negative pressure (LBNP). Seven healthy male volunteers were exposed to LBNP in steps of -10 mmHg every 3 min until presyncopal symptoms were detected. Blood pressure (BP) and heart rate (HR) were measured with a finger cuff. Cerebral tissue oxy- and deoxy- hemoglobin (Hb) concentrations were estimated using near infrared spectroscopy (NIRS). Cerebral blood flow (CBF) velocity at the middle cerebral artery was measured with Transcranial Doppler Sonography (TCD). We focused on the data during the 2 min before endpoint. BP marked a gradual decrease (91 to 86 mmHg from 2 min to 30 sec before endpoint), which was accelerated along with HR decrease during the final 30 sec (86 to 71 mmHg). Cerebral oxy-Hb concentration decreases as presyncope is approached while total-Hb concentration remains fairly constant. TCD reveals a decrease in the CBF velocity. The TCD and NIRS results suggest that CBF decreases along with the BP decrease. Cerebrovascular responses during presyncope are closely related to cardiovascular responses.

Kuriyama, Kana↗

Do nonlinearities play a significant role in short term, beat-to-beat variability?

Numerous studies of short-term beat-to-beat variability in cardiovascular signals have not resolved the debate about the completeness of linear analysis techniques. This aim of this paper is to evaluate further the role of nonlinearities in short-term, beat-to-beat variability. We compared linear autoregressive moving average (ARMA) and nonlinear neural network (NN) models for predicting instantaneous heart rate (HR) and mean arterial blood pressure (BP) from past HR and BP. To evaluate these models, we used HR and BP time series from the MIMIC database. Experimental results indicate that NN-based nonlinearities do not play a significant role and suggest that ARMA linear analysis techniques provide adequate characterization of the system dynamics responsible for generating short-term, beat-to-beat variability.

NASA Discipline Cardiopulmonary↗

Effect of acute exposure to hypergravity (GX vs. GZ) on dynamic cerebral autoregulation

We examined the effects of 30 min of exposure to either +3GX (front-to-back) or +GZ (head-to-foot) centrifugation on cerebrovascular responses to 80 degrees head-up tilt (HUT) in 14 healthy individuals. Both before and after +3 GX or +3 GZ centrifugation, eye-level blood pressure (BP(eye)), end tidal PCO2 (PET(CO2)), mean cerebral flow velocity (CFV) in the middle cerebral artery (transcranial Doppler ultrasound), cerebral vascular resistance (CVR), and dynamic cerebral autoregulatory gain (GAIN) were measured with subjects in the supine position and during subsequent 80 degrees HUT for 30 min. Mean BP(eye) decreased with HUT in both the GX (n = 7) and GZ (n = 7) groups (P < 0.001), with the decrease being greater after centrifugation only in the GZ group (P < 0.05). PET(CO2) also decreased with HUT in both groups (P < 0.01), but the absolute level of decrease was unaffected by centrifugation. CFV decreased during HUT more significantly after centrifugation than before centrifugation in both groups (P < 0.02). However, these greater decreases were not associated with greater increases in CVR. In the supine position after centrifugation compared with before centrifugation, GAIN increased in both groups (P < 0.05, suggesting an autoregulatory deficit), with the change being correlated to a measure of otolith function (the linear vestibulo-ocular reflex) in the GX group (r = 0.76, P < 0.05) but not in the GZ group (r = 0.24, P = 0.60). However, GAIN was subsequently restored to precentrifugation levels during postcentrifugation HUT (i.e., as BP(eye) decreased), suggesting that both types of centrifugation resulted in a leftward shift of the cerebral autoregulation curve. We speculate that this leftward shift may have been due to vestibular activation (especially during +GX) or potentially to an adaptation to reduced cerebral perfusion pressure during +GZ.

NASA Discipline Neuroscience↗

Cerebral vasoconstriction precedes orthostatic intolerance after parabolic flight

The effects of brief but repeated bouts of micro- and hypergravity on cerebrovascular responses to head-up tilt (HUT) were examined in 13 individuals after (compared to before) parabolic flight. Middle cerebral artery mean flow velocity (MCA MFV; transcranial Doppler ultrasound), eye level blood pressure (BP) and end tidal CO(2) (P(ET)CO(2)) were measured while supine and during 80 degrees HUT for 30 min or until presyncope. In the postflight tests subjects were classified as being orthostatically tolerant (OT) (n = 7) or intolerant (OI) (n = 6). BP was diminished with HUT in the OT group in both tests (p < 0.05) whereas postflight BP was not different from supine in the OI group. Postflight compared to preflight, the reduction in P(ET)CO(2) with HUT (p < 0.05) increased in both groups, although significantly so only in the OI group (p < 0.05). The OI group also had a significant decrease in supine MCA MFV postflight (p < 0.05) that was unaccompanied by a change in supine P(ET)CO(2). The decrease in MCA MFV that occurred during HUT in both groups preflight (p < 0.05) was accentuated only in the OI group postflight, particularly during the final 30 s of HUT (p < 0.05). However, this accentuated decrease in MCA MFV was not correlated to the greater decrease in P(ET)CO(2) during the same period (R = 0.20, p = 0.42). Although cerebral vascular resistance (CVR) also increased in the OI group during the last 30 s of HUT postflight (p < 0.05), the dynamic autoregulatory gain was not simultaneously changed. Therefore, we conclude that in the OI individuals, parabolic flight was associated with cerebral hypoperfusion following a paradoxical augmentation of CVR by a mechanism that was not related to changes in autoregulation nor strictly to changes in P(ET)CO(2).

Parabolic Flight↗

Inflight exercise affects stand test responses after space flight

PURPOSE: The purpose of this study was to determine whether exercise performed by Space Shuttle crew members during short-duration space flights (9-16 d) affects the heart rate (HR) and blood pressure (BP) responses to standing within 2-4 h of landing. METHODS: Thirty crew members performed self-selected inflight exercise and maintained exercise logs to monitor their exercise intensity and duration. Two subjects participated in this investigation during two different flights. A 10-min stand test, preceded by at least 6 min of quiet supine rest, was completed 10-15 d before launch (PRE) and within 4 h of landing (POST). Based upon their inflight exercise records, subjects were grouped as either high (HIex: > or = 3 times/week, HR > or = 70% HRmax, > or = 20 min/session, N = 11), medium (MEDex: > or = 3 times/week, HR < 70% HRmax, > or = 20 min/session, N = 10), or low (LOex: < or = 3 times/week, HR and duration variable, N = 11) exercisers. HR and BP responses to standing were compared between groups (ANOVA, P < or = 0.05). RESULTS: There were no PRE differences between the groups in supine or standing HR and BP. Although POST supine HR was similar to PRE, all groups had an increased standing HR compared with PRE. The increase in HR upon standing was significantly greater after flight in the LOex group (36 +/- 5 bpm) compared with HIex or MEDex groups (25 +/- 1 bpm; 22 +/- 2 bpm). Similarly, the decrease in pulse pressure (PP) from supine to standing was unchanged after space flight in the MEDex and HIex groups but was significantly greater in the LOex group (PRE: -9 +/- 3; POST: -19 +/- 4 mm Hg). CONCLUSIONS: Thus, moderate to high levels of inflight exercise attenuated HR and PP responses to standing after space flight.

manned↗

Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS)

Patients with the postural orthostatic tachycardia syndrome (POTS) have symptoms of orthostatic intolerance despite having a normal orthostatic blood pressure (BP), which suggests some impairment of cerebrovascular regulation. Cerebrovascular autoregulation refers to the maintenance of normal cerebral blood flow in spite of changing BP. Mechanisms of autoregulation include myogenic, metabolic and neurogenic vasoregulation. Beat-to-beat recording of blood-flow velocity (BFV) is possible using transcranial Doppler imaging. It is possible to evaluate autoregulation by regressing deltaBFV to deltaBP during head-up tilt. A number of dynamic methods, relating deltaBFV to deltaBP during sudden induced changes in BP by occluding then releasing peripheral arterial flow or by the Valsalva maneuver. The deltaBFV to deltaBP provides an index of autoregulation. In orthostatic hypotension, the autoregulated range is typically expanded. In contrast, paradoxical vasoconstriction occurs in POTS because of an increased depth of respiration, resulting in hypocapnic cerebrovascular constriction, and impaired autoregulation.

Review↗

Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia

BACKGROUND: Idiopathic orthostatic tachycardia (IOT) is characterized by an increase in heart rate (HR) with standing of > or = 30 bpm that is associated with elevated catecholamine levels and orthostatic symptoms. A dynamic orthostatic hypovolemia and alpha1-adrenoreceptor hypersensitivity have been demonstrated in IOT patients. There is evidence of an autonomic neuropathy affecting the lower-extremity blood vessels. METHODS AND RESULTS: We studied the effects of placebo, the alpha1-adrenoreceptor agonist midodrine (5 to 10 mg), the alpha2-adrenoreceptor agonist clonidine (0.1 mg), and I.V. saline (1 L) in 13 patients with IOT. Supine and upright blood pressure (BP) and HR were measured before and at 1 and 2 hours after intervention. Midodrine decreased both supine and upright HR (all HR values are given as bpm) at 2 hours (from 78+/-2 supine to 108+/-5 upright before treatment and from 69+/-2 supine to 95+/-5 upright after treatment, P<.005 for supine and P<.01 for upright). Saline decreased both supine and upright HR (from 80+/-3 supine to 112+/-5 upright before infusion and from 77+/-3 supine to 91+/-3 upright 1 hour after infusion, P<.005 for supine and P<.001 for upright). Clonidine decreased supine HR (from 78+/-2 to 74+/-2, P<.03) but did not affect the HR increase with standing. Clonidine very significantly decreased supine systolic BP (from 109+/-3 at baseline to 99+/-2 mm Hg at 2 hours, P<.001), and midodrine decreased supine systolic BP mildly. CONCLUSIONS: IOT responds best acutely to saline infusion to correct the underlying hypovolemia. Chronically, this can be accomplished with increased salt and water intake in conjunction with fludrocortisone. The response of patients to the alpha1-agonist midodrine supports the hypothesis of partial dysautonomia and indicates that the use of alpha1-agonists to pharmacologically replace lower-extremity postganglionic sympathetics is an appropriate overall goal of therapy. These findings are consistent with our hypothesis that the tachycardia and elevated catecholamine levels associated with IOT are principally due to hypovolemia and loss of adequate lower-extremity vascular tone.

Non-NASA Center↗