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Nashville VA Medical Center

Hospital / health systemNashville, Tennessee, United States

Research output, citation impact, and the most-cited recent papers from Nashville VA Medical Center (United States). Aggregated across the NobleBlocks index of 300M+ scholarly works.

Total works
943
Citations
97.1K
h-index
144
i10-index
995
Also known as
Nashville VA Medical Center

Top-cited papers from Nashville VA Medical Center

The mutational constraint spectrum quantified from variation in 141,456 humans
Konrad J. Karczewski, Laurent C. Francioli, Grace Tiao, Beryl B. Cummings +4 more
2020· Nature10.0Kdoi:10.1038/s41586-020-2308-7

Abstract Genetic variants that inactivate protein-coding genes are a powerful source of information about the phenotypic consequences of gene disruption: genes that are crucial for the function of an organism will be depleted of such variants in natural populations, whereas non-essential genes will tolerate their accumulation. However, predicted loss-of-function variants are enriched for annotation errors, and tend to be found at extremely low frequencies, so their analysis requires careful variant annotation and very large sample sizes 1 . Here we describe the aggregation of 125,748 exomes and 15,708 genomes from human sequencing studies into the Genome Aggregation Database (gnomAD). We identify 443,769 high-confidence predicted loss-of-function variants in this cohort after filtering for artefacts caused by sequencing and annotation errors. Using an improved model of human mutation rates, we classify human protein-coding genes along a spectrum that represents tolerance to inactivation, validate this classification using data from model organisms and engineered human cells, and show that it can be used to improve the power of gene discovery for both common and rare diseases.

A structural variation reference for medical and population genetics
Ryan L. Collins, Harrison Brand, Konrad J. Karczewski, Xuefang Zhao +4 more
2020· Nature1.2Kdoi:10.1038/s41586-020-2287-8

Abstract Structural variants (SVs) rearrange large segments of DNA 1 and can have profound consequences in evolution and human disease 2,3 . As national biobanks, disease-association studies, and clinical genetic testing have grown increasingly reliant on genome sequencing, population references such as the Genome Aggregation Database (gnomAD) 4 have become integral in the interpretation of single-nucleotide variants (SNVs) 5 . However, there are no reference maps of SVs from high-coverage genome sequencing comparable to those for SNVs. Here we present a reference of sequence-resolved SVs constructed from 14,891 genomes across diverse global populations (54% non-European) in gnomAD. We discovered a rich and complex landscape of 433,371 SVs, from which we estimate that SVs are responsible for 25–29% of all rare protein-truncating events per genome. We found strong correlations between natural selection against damaging SNVs and rare SVs that disrupt or duplicate protein-coding sequence, which suggests that genes that are highly intolerant to loss-of-function are also sensitive to increased dosage 6 . We also uncovered modest selection against noncoding SVs in cis -regulatory elements, although selection against protein-truncating SVs was stronger than all noncoding effects. Finally, we identified very large (over one megabase), rare SVs in 3.9% of samples, and estimate that 0.13% of individuals may carry an SV that meets the existing criteria for clinically important incidental findings 7 . This SV resource is freely distributed via the gnomAD browser 8 and will have broad utility in population genetics, disease-association studies, and diagnostic screening.

Purification and characterization of the vacuolating toxin from Helicobacter pylori.
Timothy L. Cover, M J Blaser
1992· Journal of Biological Chemistry696doi:10.1016/s0021-9258(19)50054-0

A vacuolating toxin was purified to homogeneity from broth culture supernatant of the human gastric bacterium, Helicobacter pylori. The procedure for isolating the toxin included ammonium sulfate precipitation, hydrophobic interactive chromatography, size exclusion chromatography, and anion exchange chromatography, which together resulted in a greater than 5000-fold purification of toxin activity. The molecular mass of the purified, denatured toxin was 87,000 +/- 320 daltons, and the native toxin was an aggregate with a molecular mass greater than or equal to 972,000 daltons. The amino-terminal sequence of the purified toxin was partially homologous with internal sequences of numerous transport or ion channel proteins. Antiserum raised against the M(r) = 87,000 protein neutralized toxin activity, whereas preimmune serum did not. When reacted with specific antiserum to the M(r) = 87,000 protein in an enzyme-linked immunosorbent (ELISA) assay, culture supernatants from eight tox+ H. pylori strains produced significantly higher optical density readings than eight tox- supernatants (0.614 +/- 0.11 versus 0.046 +/- 0.01, p less than 0.0001). Sera from H. pylori-infected humans recognized the purified M(r) = 87,000 protein significantly better by ELISA than sera from uninfected persons (0.424 +/- 0.06 versus 0.182 +/- 0.02, p = 0.0009). Finally, ELISA recognition of the purified M(r) = 87,000 protein by human sera was significantly associated with toxin-neutralizing activity (p = 0.019, r = 0.518).

Multiple dose-dependent roles for Sox2 in the patterning and differentiation of anterior foregut endoderm
Jianwen Que, Tadashi Okubo, James R. Goldenring, Ki-Taek Nam +4 more
2007· Development526doi:10.1242/dev.003855

Sox2 is expressed in developing foregut endoderm, with highest levels in the future esophagus and anterior stomach. By contrast, Nkx2.1 (Titf1) is expressed ventrally, in the future trachea. In humans, heterozygosity for SOX2 is associated with anopthalmia-esophageal-genital syndrome (OMIM 600992), a condition including esophageal atresia (EA) and tracheoesophageal fistula (TEF), in which the trachea and esophagus fail to separate. Mouse embryos heterozygous for the null allele, Sox2(EGFP), appear normal. However, further reductions in Sox2, using Sox2(LP) and Sox2(COND) hypomorphic alleles, result in multiple abnormalities. Approximately 60% of Sox2(EGFP/COND) embryos have EA with distal TEF in which Sox2 is undetectable by immunohistochemistry or western blot. The mutant esophagus morphologically resembles the trachea, with ectopic expression of Nkx2.1, a columnar, ciliated epithelium, and very few p63(+) basal cells. By contrast, the abnormal foregut of Nkx2.1-null embryos expresses elevated Sox2 and p63, suggesting reciprocal regulation of Sox2 and Nkx2.1 during early dorsal/ventral foregut patterning. Organ culture experiments further suggest that FGF signaling from the ventral mesenchyme regulates Sox2 expression in the endoderm. In the 40% Sox2(EGFP/COND) embryos in which Sox2 levels are approximately 18% of wild type there is no TEF. However, the esophagus is still abnormal, with luminal mucus-producing cells, fewer p63(+) cells, and ectopic expression of genes normally expressed in glandular stomach and intestine. In all hypomorphic embryos the forestomach has an abnormal phenotype, with reduced keratinization, ectopic mucus cells and columnar epithelium. These findings suggest that Sox2 plays a second role in establishing the boundary between the keratinized, squamous esophagus/forestomach and glandular hindstomach.

Tolerance to the humoral and hemodynamic effects of caffeine in man.
David Robertson, Dawn Wade, Robert J. Workman, Raymond L. Woosley +1 more
1981· Journal of Clinical Investigation506doi:10.1172/jci110124

Acute caffeine in subjects who do not normally ingest methylxanthines leads to increases in blood pressure, heart rate, plasma epinephrine, plasma norepinephrine, plasma renin activity, and urinary catecholamines. Using a double-blind design, the effects of chronic caffeine administration on these same variables were assessed. Near complete tolerance, in terms of both humoral and hemodynamic variables, developed over the first 1-4 d of caffeine. No long-term effects of caffeine on blood pressure, heart rate, plasma renin activity, plasma catecholamines, or urinary catecholamines could be demonstrated. Discontinuation of caffeine ingestion after 7 d of administration did not result in a detectable withdrawal phenomenon relating to any of the variables assessed.

Assessment of Wear/Nonwear Time Classification Algorithms for Triaxial Accelerometer
Leena Choi, Suzanne C. Ward, John F. Schnelle, Maciej S. Buchowski
2012· Medicine & Science in Sports & Exercise480doi:10.1249/mss.0b013e318258cb36

PURPOSE: The objective of this study is to assess the performance of existing wear/nonwear time classification algorithms for accelerometry data collected in the free-living environment using a wrist-worn triaxial accelerometer and a waist-worn uniaxial accelerometer in older adults. METHODS: Twenty-nine adults age 76 to 96 yr wore wrist accelerometers for approximately 24 h per day and waist accelerometers during waking for approximately 7 d of free living. Wear and nonwear times were classified by existing algorithms (Alg([ActiLife]), Alg([Troiano]), and Alg([Choi])) and compared with wear and nonwear times identified by data plots and diary records. With the use of bias and probability of correct classification, the performance of the algorithms, two time windows (60 and 90 min), and vector magnitude (VM) versus vertical axis (V) counts from a triaxial accelerometer were compared. RESULTS: Automated algorithms (Alg([Choi]) and Alg([Troiano])) classified wear/nonwear time intervals more accurately from VM than V counts. The use of the 90-min time window improved wear/nonwear classification accuracy when compared with the 60-min window. The Alg([Choi]) and Alg([Troiano]) performed better than the manufacturer-provided algorithm (Alg([ActiLife])), and the Alg([Choi]) performed better than the Alg([Troiano]) for wear/nonwear time classification using the data collected by both accelerometers. CONCLUSIONS: Triaxial wrist-worn accelerometer can be used for an accurate wear/nonwear time classification in free-living older adults. The use of the 90-min window and the VM counts improves the performance of commonly used algorithms for wear/nonwear classification for both uniaxial and triaxial accelerometers.

Integrated Single-Cell Atlas of Endothelial Cells of the Human Lung
Jonas C. Schupp, Taylor Adams, Carlos Cosme, Micha Sam Brickman Raredon +4 more
2021· Circulation452doi:10.1161/circulationaha.120.052318

Background: Cellular diversity of the lung endothelium has not been systematically characterized in humans. We provide a reference atlas of human lung endothelial cells (ECs) to facilitate a better understanding of the phenotypic diversity and composition of cells comprising the lung endothelium. Methods: We reprocessed human control single-cell RNA sequencing (scRNAseq) data from 6 datasets. EC populations were characterized through iterative clustering with subsequent differential expression analysis. Marker genes were validated by fluorescent microscopy and in situ hybridization. scRNAseq of primary lung ECs cultured in vitro was performed. The signaling network between different lung cell types was studied. For cross-species analysis or disease relevance, we applied the same methods to scRNAseq data obtained from mouse lungs or from human lungs with pulmonary hypertension. Results: Six lung scRNAseq datasets were reanalyzed and annotated to identify >15 000 vascular EC cells from 73 individuals. Differential expression analysis of EC revealed signatures corresponding to endothelial lineage, including panendothelial, panvascular, and subpopulation-specific marker gene sets. Beyond the broad cellular categories of lymphatic, capillary, arterial, and venous ECs, we found previously indistinguishable subpopulations; among venous EC, we identified 2 previously indistinguishable populations: pulmonary–venous ECs (COL15A1 neg ) localized to the lung parenchyma and systemic–venous ECs (COL15A1 pos ) localized to the airways and the visceral pleura; among capillary ECs, we confirmed their subclassification into recently discovered aerocytes characterized by EDNRB , SOSTDC1 , and TBX2 and general capillary EC. We confirmed that all 6 endothelial cell types, including the systemic–venous ECs and aerocytes, are present in mice and identified endothelial marker genes conserved in humans and mice. Ligand-receptor connectome analysis revealed important homeostatic crosstalk of EC with other lung resident cell types. scRNAseq of commercially available primary lung ECs demonstrated a loss of their native lung phenotype in culture. scRNAseq revealed that endothelial diversity is maintained in pulmonary hypertension. Our article is accompanied by an online data mining tool ( www.LungEndothelialCellAtlas.com ). Conclusions: Our integrated analysis provides a comprehensive and well-crafted reference atlas of ECs in the normal lung and confirms and describes in detail previously unrecognized endothelial populations across a large number of humans and mice.

KRAS-dependent sorting of miRNA to exosomes
Diana J Cha, Jeffrey L. Franklin, Yongchao Dou, Qi Liu +4 more
2015· eLife379doi:10.7554/elife.07197

Mutant KRAS colorectal cancer (CRC) cells release protein-laden exosomes that can alter the tumor microenvironment. To test whether exosomal RNAs also contribute to changes in gene expression in recipient cells, and whether mutant KRAS might regulate the composition of secreted microRNAs (miRNAs), we compared small RNAs of cells and matched exosomes from isogenic CRC cell lines differing only in KRAS status. We show that exosomal profiles are distinct from cellular profiles, and mutant exosomes cluster separately from wild-type KRAS exosomes. miR-10b was selectively increased in wild-type exosomes, while miR-100 was increased in mutant exosomes. Neutral sphingomyelinase inhibition caused accumulation of miR-100 only in mutant cells, suggesting KRAS-dependent miRNA export. In Transwell co-culture experiments, mutant donor cells conferred miR-100-mediated target repression in wild-type-recipient cells. These findings suggest that extracellular miRNAs can function in target cells and uncover a potential new mode of action for mutant KRAS in CRC.

“I Wish I Had Seen This Test Result Earlier!”
Eric G. Poon, Tejal K. Gandhi, Thomas D. Sequist, Harvey J. Murff +2 more
2004· Archives of Internal Medicine299doi:10.1001/archinte.164.20.2223

BACKGROUND: Failure to review and follow up on outpatient test results in a timely manner represents a patient safety and malpractice concern. Therefore, we sought to identify problems in current test result management systems and possible ways to improve these systems. METHODS: We surveyed 262 physicians working in 15 internal medicine practices affiliated with 2 large urban teaching hospitals (response rate, 64%). We asked physicians about systems they used and the amount of time they spent managing test results. We asked them to report delays in reviewing test results and their overall satisfaction with their management of test results. We also asked physicians to rate features they would find useful in a new test result management system. RESULTS: Overall, 83% of respondents reported at least 1 delay in reviewing test results during the previous 2 months. Despite reporting that they spent on average 74 minutes per clinical day managing test results, only 41% of physicians reported being satisfied with how they managed test results. Satisfaction was associated with fewer self-reported delays in reviewing test results. Physicians who actively tracked their test orders to completion were also more likely to be satisfied. The most highly desired features of a test result management system were tools to help physicians generate result letters to patients, prioritize their workflow, and track test orders to completion. CONCLUSIONS: Delays in test result review are common, and many physicians are not satisfied with how they manage test results. Tools to improve test result management in office practices need to improve workflow efficiency and track test orders to completion.

The Physiology of the Gastric Parietal Cell
Amy C. Engevik, Izumi Kaji, James R. Goldenring
2019· Physiological Reviews278doi:10.1152/physrev.00016.2019

Parietal cells are responsible for gastric acid secretion, which aids in the digestion of food, absorption of minerals, and control of harmful bacteria. However, a fine balance of activators and inhibitors of parietal cell-mediated acid secretion is required to ensure proper digestion of food, while preventing damage to the gastric and duodenal mucosa. As a result, parietal cell secretion is highly regulated through numerous mechanisms including the vagus nerve, gastrin, histamine, ghrelin, somatostatin, glucagon-like peptide 1, and other agonists and antagonists. The tight regulation of parietal cells ensures the proper secretion of HCl. The H + -K + -ATPase enzyme expressed in parietal cells regulates the exchange of cytoplasmic H + for extracellular K + . The H + secreted into the gastric lumen by the H + -K + -ATPase combines with luminal Cl − to form gastric acid, HCl. Inhibition of the H + -K + -ATPase is the most efficacious method of preventing harmful gastric acid secretion. Proton pump inhibitors and potassium competitive acid blockers are widely used therapeutically to inhibit acid secretion. Stimulated delivery of the H + -K + -ATPase to the parietal cell apical surface requires the fusion of intracellular tubulovesicles with the overlying secretory canaliculus, a process that represents the most prominent example of apical membrane recycling. In addition to their unique ability to secrete gastric acid, parietal cells also play an important role in gastric mucosal homeostasis through the secretion of multiple growth factor molecules. The gastric parietal cell therefore plays multiple roles in gastric secretion and protection as well as coordination of physiological repair.

Helicobacter Pylori and Gastroduodenal Disease
Timothy L. Cover, M J Blaser
1992· Annual Review of Medicine263doi:10.1146/annurev.me.43.020192.001031

Helicobacter pylori infection is now recognized as the primary cause of active chronic gastritis in humans. Most infected persons remain asymptomatic, but are at increased risk for the development of peptic ulcer disease and possibly gastric cancer. The pathogenesis of this infection is not well understood, but motility and urease activity are virulence factors in an animal model. The eradication of H. pylori infection is associated with resolution of gastritis and a decreased rate of duodenal ulcer recurrence.

Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading
Tommy Hansson, T. S. Keller, Dan M. Spengler
1987· Journal of Orthopaedic Research®257doi:10.1002/jor.1100050403

Seventeen cadaveric human lumbar motion segments from eight spines were cyclically loaded in vitro under axial compression. Loading frequency and magnitude were chosen to simulate rigorous activity within an in vivo physiological level. The load magnitude was determined as a percentage of the ultimate compressive load, the latter estimated from the bone mineral content (BMC) of lumbar vertebrae determined by dual-photon absorptiometry. Following testing, the degree of macroscopic disc degeneration was assessed and the type of fracture in each specimen was determined from serial sagittal sections. Fractures were found in all but one specimen. Three types of fractures were formed: the node of Schmorl and Junghanns (type I), central endplate fracture (type II), and a crush or burst fracture (type III). The results suggested that type I fractures were predominantly associated with segments with normal discs, type II fractures were found primarily in segments with moderately degenerated discs, and type III fractures were associated with segments that failed on the first cycle. Segment stiffness and fatigue strength (cycles to failure) were correlated with disc degeneration, age, and segment BMC, the latter an in vivo measure of bone density. Fatigue strength also decreased in proportion to a power coefficient with increasing relative stress (cyclic stress range/ultimate stress).

Effect of urease on HeLa cell vacuolation induced by Helicobacter pylori cytotoxin
Timothy L. Cover, W Puryear, G I Perez-Perez, Martin J. Blaser
1991· Infection and Immunity250doi:10.1128/iai.59.4.1264-1270.1991

Concentrated broth culture supernatants from 50 to 60% of Helicobacter pylori strains induce eukaryotic cell vacuolation in vitro. A quantitative assay for cell vacuolation was developed on the basis of the rapid uptake of visibly vacuolated HeLa cells was significantly greater than that of nonvacuolated cells. By using the rapid NRU assay, we sought to determine the roles of H. pylori cytotoxin, urease, and ammonia in the vacuolation of HeLa cells. The NRU of HeLa cells incubated in medium containing ammonium chloride or ammonium sulfate was significantly greater than that of cells incubated in medium alone. In addition, ammonium salts augmented the NRU induced by H. pylori supernatants. The NRU induced by jack bean urease was augmented by the addition of urea to cell culture medium; this suggests that urease-mediated NRU occurs via the generation of ammonia. Acetohydroxamic acid blocked the NRU induced by jack bean urease and urea but failed to block the uptake induced by H. pylori supernatants. Supernatant from a non-urease-producing H. pylori mutant strain induced NRU identical to that of the urease-positive parental strain. These observations indicate that the vacuolating activity in H. pylori supernatants is not mediated solely by urease activity but that it may be potentiated by urease-mediated ammonia production.

Purification of human blood burst‐forming units‐erythroid and demonstration of the evolution of erythropoietin receptors
K Sawada, Sanford B. Krantz, Chunhua Dai, Stephen T. Koury +3 more
1990· Journal of Cellular Physiology240doi:10.1002/jcp.1041420202

To facilitate the direct study of the molecular events that control the development of human burst-forming units-erythroid (BFU-E), we have developed a method to purify BFU-E from peripheral blood. Using density centrifugation, rosetting with a mixture of neuraminidase-treated and IgG-coated sheep erythrocytes, positive panning with anti-My10 monoclonal antibody, overnight adherence to plastic dishes, negative panning with monoclonal antibodies, and density centrifugation, human blood BFU-E were purified from 0.04% to 56.6%, a 1,400-fold purification with a 13% yield. More than 90% of purified BFU-E were recombinant interleukin-3 (rIL-3) dependent, which survived for 48 h with rIL-3 in the absence of recombinant erythropoietin (rEP), and 80% gave rise to erythroid bursts of more than 500 hemoglobinized cells. rEP dependency was not evident until after 72 h of incubation in vitro. The purified cells (day 1) were incubated with rIL-3 and rEP in liquid culture for 24 (day 2), 48 (day 3), and 72 (day 4) h and then were transferred into semisolid cultures and incubated until day 15. The size of the erythroid colonies observed in semisolid cultures decreased continuously in association with the incubation time of day 1 purified cells in liquid cultures. The first appearance of colony-forming units-erythroid (CFU-E) that gave rise to colonies of 8 to 49 cells was observed after 72 h of incubation of day 1 cells in the liquid culture. 125I-rEP was incubated for 5 h at 37 degrees C with purified cells (day 1) or with the cells that had been incubated in liquid culture for an additional 24-72 h, and the presence of erythropoietin (EP) receptors was investigated using autoradiography. Specific binding of 125I-rEP was detected in 19 +/- 7% of the initial day 1 BFU-E. The percentage of 125I-rEP-binding to erythroid progenitor cells and the amount of binding continuously increased as day 1 BFU-E matured. 125I-rEP specific binding was observed with all of the erythroid progenitor cells that had been incubated in liquid culture for 72 h. These data demonstrate that primitive BFU-E have a much lower number of EP receptors than CFU-E and develop an increased concentration of EP receptors in association with their maturation and loss of proliferative capacity.

Alveolar Epithelial Cells Undergo Epithelial-to-Mesenchymal Transition in Response to Endoplasmic Reticulum Stress
Harikrishna Tanjore, Dong‐Sheng Cheng, Amber L. Degryse, Donald F. Zoz +3 more
2011· Journal of Biological Chemistry228doi:10.1074/jbc.m110.181164

Expression of mutant surfactant protein C (SFTPC) results in endoplasmic reticulum (ER) stress in type II alveolar epithelial cells (AECs). AECs have been implicated as a source of lung fibroblasts via epithelial-to-mesenchymal transition (EMT); therefore, we investigated whether ER stress contributes to EMT as a possible mechanism for fibrotic remodeling. ER stress was induced by tunicamyin administration or stable expression of mutant (L188Q) SFTPC in type II AEC lines. Both tunicamycin treatment and mutant SFTPC expression induced ER stress and the unfolded protein response. With tunicamycin or mutant SFTPC expression, phase contrast imaging revealed a change to a fibroblast-like appearance. During ER stress, expression of epithelial markers E-cadherin and Zonula occludens-1 decreased while expression of mesenchymal markers S100A4 and α-smooth muscle actin increased. Following induction of ER stress, we found activation of a number of pathways, including MAPK, Smad, β-catenin, and Src kinase. Using specific inhibitors, the combination of a Smad2/3 inhibitor (SB431542) and a Src kinase inhibitor (PP2) blocked EMT with maintenance of epithelial appearance and epithelial marker expression. Similar results were noted with siRNA targeting Smad2 and Src kinase. Together, these studies reveal that induction of ER stress leads to EMT in lung epithelial cells, suggesting possible cross-talk between Smad and Src kinase pathways. Dissecting pathways involved in ER stress-induced EMT may lead to new treatment strategies to limit fibrosis.

Human and Murine Phenotypes Associated with Defects in Cation-Chloride Cotransport
Eric Delpire, David B. Mount
2002· Annual Review of Physiology222doi:10.1146/annurev.physiol.64.081501.155847

The diuretic-sensitive cotransport of cations with chloride is mediated by the cation-chloride cotransporters, a large gene family encompassing a total of seven Na-Cl, Na-K-2Cl, and K-Cl cotransporters, in addition to two related transporters of unknown function. The cation-chloride cotransporters perform a wide variety of physiological roles and differ dramatically in patterns of tissue expression and cellular localization. The renal-specific Na-Cl cotransporter (NCC) and Na-K-2Cl cotransporter (NKCC2) are involved in Gitelman and Bartter syndrome, respectively, autosomal recessive forms of metabolic alkalosis. The associated phenotypes due to loss-of-function mutations in NCC and NKCC2 are consistent, in part, with their functional roles in the distal convoluted tubule and thick ascending limb, respectively. Other cation-chloride cotransporters are positional candidates for Mendelian human disorders, and the K-Cl cotransporter KCC3, in particular, may be involved in degenerative peripheral neuropathies linked to chromosome 15q14. The characterization of mice with both spontaneous and targeted mutations of several cation-chloride cotransporters has also yielded significant insight into the physiological and pathophysiological roles of several members of the gene family. These studies implicate the Na-K-2Cl cotransporter NKCC1 in hearing, salivation, pain perception, spermatogenesis, and the control of extracellular fluid volume. Targeted deletion of the neuronal-specific K-Cl cotransporter KCC2 generates mice with a profound seizure disorder and confirms the central role of this transporter in modulating neuronal excitability. Finally, the comparison of human and murine phenotypes associated with loss-of-function mutations in cation-chloride cotransporters indicates important differences in physiology of the two species and provides an important opportunity for detailed physiological and morphological analysis of the tissues involved.

Improving Quality of Long-Term Care
Wayne A. Ray
2000· Medical Care211doi:10.1097/00005650-200012000-00001

From the Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine and Geriatric Research, Education and Clinical Center, Nashville VAMC (WAR), Nashville, Tennessee. Address correspondence to: Wayne A. Ray, PhD, Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine and Geriatric Research, Education and Clinical Center, Nashville VAMC (WAR), Nashville, TN 37232.

Spatial learning impairments in rats with selective immunolesion of the forebrain cholinergic system
Ola Nilsson, Giampiero Leanza, Carl Rosenblad, Douglas A. Lappi +2 more
1992· Neuroreport205doi:10.1097/00001756-199211000-00015

A monoclonal antibody to the low-affinity NGF receptor, 192 IgG, coupled to a cytotoxin, saporin, was recently introduced as an efficient selective neurotoxin for the NGFr-bearing cholinergic neurones in the rat basal forebrain. In the present study we report that an intracerebroventricular injection of this 192 IgG-saporin conjugate induces a severe, long-lasting spatial learning impairment, as assessed in the Morris water-maze task. This behavioural impairment was associated with 65-90% depletion of choline acetyltransferase activity (ChAT) in the hippocampus and cortex. ChAT activity associated with other cholinergic neurone systems in the brain (striatum, mesencephalon, spinal cord), was left virtually unaffected. This new immunotoxin holds great promise as a tool for selective and efficient lesions of the forebrain cholinergic system in functional and behavioural studies.

Transcript expression-aware annotation improves rare variant interpretation
Beryl B. Cummings, Konrad J. Karczewski, Jack A. Kosmicki, Eleanor G. Seaby +4 more
2020· Nature201doi:10.1038/s41586-020-2329-2

Abstract The acceleration of DNA sequencing in samples from patients and population studies has resulted in extensive catalogues of human genetic variation, but the interpretation of rare genetic variants remains problematic. A notable example of this challenge is the existence of disruptive variants in dosage-sensitive disease genes, even in apparently healthy individuals. Here, by manual curation of putative loss-of-function (pLoF) variants in haploinsufficient disease genes in the Genome Aggregation Database (gnomAD) 1 , we show that one explanation for this paradox involves alternative splicing of mRNA, which allows exons of a gene to be expressed at varying levels across different cell types. Currently, no existing annotation tool systematically incorporates information about exon expression into the interpretation of variants. We develop a transcript-level annotation metric known as the ‘proportion expressed across transcripts’, which quantifies isoform expression for variants. We calculate this metric using 11,706 tissue samples from the Genotype Tissue Expression (GTEx) project 2 and show that it can differentiate between weakly and highly evolutionarily conserved exons, a proxy for functional importance. We demonstrate that expression-based annotation selectively filters 22.8% of falsely annotated pLoF variants found in haploinsufficient disease genes in gnomAD, while removing less than 4% of high-confidence pathogenic variants in the same genes. Finally, we apply our expression filter to the analysis of de novo variants in patients with autism spectrum disorder and intellectual disability or developmental disorders to show that pLoF variants in weakly expressed regions have similar effect sizes to those of synonymous variants, whereas pLoF variants in highly expressed exons are most strongly enriched among cases. Our annotation is fast, flexible and generalizable, making it possible for any variant file to be annotated with any isoform expression dataset, and will be valuable for the genetic diagnosis of rare diseases, the analysis of rare variant burden in complex disorders, and the curation and prioritization of variants in recall-by-genotype studies.

Global Analysis Reveals the Complexity of the Human Glomerular Extracellular Matrix
Rachel Lennon, Adam Byron, Jonathan D. Humphries, Michael J. Randles +4 more
2014· Journal of the American Society of Nephrology200doi:10.1681/asn.2013030233

The glomerulus contains unique cellular and extracellular matrix (ECM) components, which are required for intact barrier function. Studies of the cellular components have helped to build understanding of glomerular disease; however, the full composition and regulation of glomerular ECM remains poorly understood. We used mass spectrometry-based proteomics of enriched ECM extracts for a global analysis of human glomerular ECM in vivo and identified a tissue-specific proteome of 144 structural and regulatory ECM proteins. This catalog includes all previously identified glomerular components plus many new and abundant components. Relative protein quantification showed a dominance of collagen IV, collagen I, and laminin isoforms in the glomerular ECM together with abundant collagen VI and TINAGL1. Protein network analysis enabled the creation of a glomerular ECM interactome, which revealed a core of highly connected structural components. More than one half of the glomerular ECM proteome was validated using colocalization studies and data from the Human Protein Atlas. This study yields the greatest number of ECM proteins relative to previous investigations of whole glomerular extracts, highlighting the importance of sample enrichment. It also shows that the composition of glomerular ECM is far more complex than previously appreciated and suggests that many more ECM components may contribute to glomerular development and disease processes. The mass spectrometry proteomics data have been deposited to the ProteomeXchange Consortium with the dataset identifier PXD000456.