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IntroductionPapillon-Lefèvre syndrome (PLS) is an autosomal recessive disorder characterised by palmoplantar keratoderma and severe, early onset periodontitis, which results from deficiency of cathepsin C activity secondary to mutations in the cathepsin C gene. To date, 13 different cathepsin C mutations have been reported in PLS patients, all of which are homozygous for a given mutation, reflecting consanguinity.AimTo evaluate the generality of cathepsin C mutations in PLS, we studied an ethnically diverse group of 20 unrelated families.MethodsMutations were identified by direct automated sequencing of genomic DNA amplified for exonic regions and associated splice site junctions of the cathepsin C gene. Long range PCR was performed to determine the genomic structure of the cathepsin C gene.ResultsThe cathepsin C gene spans over 46 kb, with six introns ranging in size from 1.6 to 22.4 kb. Eleven novel mutations and four previously reported mutations were identified in affected subjects from 14 families. Missense mutations were most common (9/15), followed by nonsense mutations (3/15), insertions (2/15), and deletions (1/15). Among these 14 probands, two were compound heterozygotes. Affected subjects with transgressions of the dermal lesions onto the knees or elbows or both had mutations in both the pro- and mature regions of the enzyme, although most were in the mature region.ConclusionMutations in the mature region of cathepsin C were more likely to be associated with the transgressions of the dermatological lesions, although the results were not statistically significant. A comprehensive list of all cathepsin C mutations described to date, representing 25 mutations from 32 families with PLS and related conditions, is also presented.

Glucocorticoids or the glucocorticoid analog dexamethasone (DEX) enhances the differentiation of preadipocytes in the presence of insulin and influences preadipocyte proliferation. The purpose of the present study was to determine if DEX can induce the recruitment of preadipocytes. Using monoclonal antibodies for complement‐mediated cytotoxicity, preadipocytes were removed from porcine stromal vascular (S‐V) cell cultures. Our experiments demonstrated for the first time that after removal of preadipocytes by cytotoxicity, preadipocytes or fat cells could be induced by DEX or DEX plus insulin but not by insulin alone. However, many more fat cells were induced (258 ± 15/unit area) when DEX was added with fetal bovine serum (FBS) followed with insulin treatment, compared to DEX with insulin (21.3 ± 5.1/ unit area) after removal of preadipocytes. Immunocyto‐chemistry with AD‐3, a preadipocyte marker, showed that DEX with FBS for 3 days after seeding (i.e., the proliferation phase) produced many more preadipocytes (AD‐3 positive, 223 ± 45/unit area) than FBS alone (10.5 ± 1.4/unit area). Bromodeoxyuridine (BrdU) incorporation assays demonstrated that the efficiency of DEX with FBS (i.e., during proliferation) was mitosis dependent. Accordingly, we conclude that: porcine S‐V cultures contain preadipocytes at different stages of differentiation and that DEX induced early preadipocyte differentiation depends on mitosis.

Tricho-dento-osseous syndrome (TDO) is characterised by a variable clinical phenotype primarily affecting the hair, teeth, and bone. Different clinical features are observed between and within TDO families. It is not known whether the variable clinical features are the result of genetic heterogeneity or clinical variability. A gene for TDO was localised recently to chromosome 17q21 in four North Carolina families, and a 4 bp deletion in the human distal-less 3 gene (DLX3) was identified in all affected members. A previous genetic linkage study in a large Virginia kindred with TDO indicated possible linkage to the ABO, Gc, and Kell blood group loci. To examine whether TDO exhibits genetic heterogeneity, we have performed molecular genetic analysis to determine whether affected members of this Virginia kindred have the DLX3 gene deletion identified in North Carolina families. Results show that affected subjects (n=3) from the Virginia family have the same four nucleotide deletion previously identified in the North Carolina families. A common haplotype for three genetic markers surrounding the DLX3 gene was identified in all affected subjects in the North Carolina and Virginia families. These findings suggest that all people with TDO who have been evaluated have inherited the same DLX3 gene deletion mutation from a common ancestor. The variable clinical phenotype observed in these North Carolina and Virginia families, which share a common gene mutation, suggests that clinical variability is not the result of genetic heterogeneity at the major locus, but may reflect genetic heterogeneity at other epigenetic loci or contributing environmental factors or both.

Amelogenins are the principal proteins of the extracellular matrix of developing dental enamel and are postulated to function in the processes of biomineralization of the developing tooth although the molecular mechanisms concerned are poorly understood. Recent imaging studies, employing dynamic light scattering, atomic force, and transmission electron microscopy (TEM) have shown that a recombinant amelogenin (Mr-20 000 Da) spontaneously forms supramolecular quasi-spherical aggregates ("nanospheres") of 15-20 nm in diameter. By comparison with in vitroexperiments employing the recombinant amelogenin we show that the nanospheres appear as electron-lucent structures when treated with conventional electron microscopy contrast reagents (phosphotungstate or uranyl acetate) and we speculate that this property derives from the hydrophobic nature of the amelogenin protein. Employing TEM preparations of developing enamel from mouse, bovine, and hamster we demonstrate that the amelogenin nanospheres occur as beaded rows of electron-lucent structures aligned with, and separating, the enamel mineral crystallites. We postulate that the amelogenin monmers self-assemble to form nanospheres which function to space the intial crystallites, control crystal habit, inhibit intercrystalline fusion, and through the apposition of their surfaces, create anionic channels which facilitate ion transport within the mineralizing matrix.

The relation between alcohol consumption during pregnancy and birthweight was investigated prospectively in 900 white women. With adjustment for social class and cigarette smoking, women drinking more than 100 g alcohol a week had a risk of delivering a baby on or below the 10th centile more than double that of women drinking less than 50 g a week. The effect of alcohol was synergistic with that of smoking. Drinking at about the time of conception seems to be important for this effect; therefore, health education should be directed at reducing alcohol consumption before pregnancy.

Upper gastrointestinal endoscopy without sedation by means of a small diameter (9 mm) instrument is feasible but patients often remember the procedure as unpleasant, do not wish to have it repeated, and compare it unfavourably with a barium meal. In contrast, endoscopy with a larger instrument (13 mm) after diazepam sedation is usually well tolerated and often regarded as no more uncomfortable than a barium meal. Even when a narrow instrument is used, patients still benefit from premedication with diazepam, although return to normal activity is slower because of drowsiness.