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ABSTRACT

Both bone mass and prevalent vertebral fractures are powerful predictors of the risk for new vertebral fractures. Combining information about bone mass and prevalent fracture appears to be better for predicting new fractures than either variable alone. Physicians can use these risk factors to identify patients at greatest risk for new fractures.

We report the results of a kinetic investigation on the gelation of purified deoxyhemoglobin S. Gelation was induced by raising the temperature and was monitored by measuring both the heat absorbed, with a microcalorimeter, and the appearance of linear birefringence, with a microspectrophotometer. The kinetics are unusual. Prior to the onset of gelation there is a delay period, followed by a sigmoidal progress curve. The delay time is formally dependent on approximately the 30th power of the deoxyhemoglobin S concentration; a decrease in concentration from 23 to 22 g/dl increases the delay time by a factor of four. It is also extremely temperature dependent; a 1C temperature rise in the range 20-30'C almost halves the delay time. From these results we conclude that the initial rate is controlled by the nucleation of individual fibers. We present a kinetic model that accounts for the concentration, temperature, and time dependence of the initial phase of the gelation reaction. Extrapolation of our data to physiological conditions predicts that changes in intracellular hemoglobin concentration and oxygen saturation, realizable in vivo, produce enormous changes in the delay time. The range of delay times spans both the mean capillary transit and total circulation times. This result points to the delay time as an extremely important variable in determining the course of sickle cell disease, and suggests a new approach to therapy.Hemoglobin S in concentrated solutions aggregates to form a highly viscous material, referred to as a gel. It is the formation of this gel that rigidifies and distorts deoxygenated erythrocytes of patients with sickle cell anemia. Considerable new insight into the structure and equilibrium behavior of this system has been gained through recent electron microscope (1), x-ray diffraction (1, 2), optical (3), solubility (4), sedimentation (5-7), and theoretical (8, 9) studies. The gel may be tentatively described as consisting of two phases in reversible equilibrium: a liquid phase containing mainly monomeric (molecular weight of 64,000) hemoglobin and a solid phase containing polymeric hemoglobin in the form of bundles of long straight fibers (compare ref. 8). The-solid phase, which exhibits optical birefringence and other properties of a liquid crystal, is favored by low oxygen concentrations and high temperatures.Much less is known about gelation kinetics. The rate of gelation of deoxyhemoglobin S at a fixed temperature T may be measured in two ways:(1) oxyHbS (T)In the first experiment gelation is induced by removing oxygen from an oxyhemoglobin S solution. In the second, gelation is induced by raising the temperature of an already deoxygenated hemoglobin S solution from 0C, where it is a nonbirefringent liquid, to the higher temperature T. Although the first experiment may be considered more relevant to the in vivo sickling process, the two experiments should give identical results if the deoxygenation and temperature change are both fast when compared to the rate of gelation. Neit...

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Values of K, delta G(o), delta H(o), delta S(o) and delta C(po) for the binding reaction of small organic ligands forming 1:1 complexes with either alpha- or beta-cyclodextrin were obtained by titration calorimetry from 15 degrees C to 45 degrees C. A hydrogen bond or hydrophobic interaction was introduced by adding a single functional group to the ligand. The thermodynamics of binding with and without the added group are compared to estimate the contribution of the hydrogen bond or hydrophobic interaction. A change in the environment of a functional group is required to influence the binding thermodynamics, but molecular size-dependent solute-solvent interactions have no effect. For phenolic O-H-O hydrogen bond formation, delta H(o) varies from -2 to -1.4 kcal mol(-1) from 15 degrees C to 45 degrees C, and delta C(p) is increased by 18 cal K(-1) mol(-1). The hydrophobic interaction has an opposite effect: in alpha-cyclodextrin, delta C(po) = -13.3 cal K(-1) mol(-1) per ligand -CH(2)-, identical to values found for the transfer of a -CH(2)-group from water to a nonpolar environment. At room temperature, the hydrogen bond and the -CH(2)-interaction each contribute about -600 cal mol(-1) to the stability (delta G(o)) of the complex. With increased temperature, the hydrogen bond stability decreases (i.e., hydrogen bonds "melt"), but the stability of the hydrophobic interaction remains essentially constant.

Titration calorimetry was used to measure equilibrium constants and standard molar enthalpies for the reactions of phenethylamine, ephedrines, and related substances with a-and /3-cyclodextrin. Changes in the chemical shifts A6 of both the ligand and cyclodextrin protons were measured with NMR. The thermodynamic results have been examined in terms of structural features of the ligand that affect these interactions such as the separation of the charge at an amino group and the aromatic ring, steric effects, the presence of additional functional groups (amino, hydroxy, methoxy, and methyl) attached to the aromatic ring, the presence and location of hydroxy group(s) on the ligand, changes in the chirality of the ligand, and the flexibility of the organic molecules attached to the aromatic ring. It was found that the values of thermodynamic quantities for these reactions in phosphate and acetate buffers were different. This difference is attributable to the presence of a hydrophobic alkyl group in the neutral acetic acid molecule and its interaction with the cyclodextrins. Also, there are significant differences in the thermodynamic quantities for the reactions of the chiral isomers of ephedrine and pseudoephedrine in their reactions with /3-cyclodextrin. A plot of the standard molar enthalpy vs the standard molar entropy for the reactions of these chiral isomers with a-and /3-cyclodextrin is linear; the relative order of the ephedrines and pseudoephedrines in the enthalpy-entropy plot is the same for the reactions of these substances with both a-and /3-cyclodextrin. NMR studies demonstrated that the magnitude of the upfield shifts of the cyclodextrin's H3 and H5 protons, A<5(H3) and A<5(H5), and their relative ratio, A<5(H5)/A<5(H3), can be used, respectively, as a measure of the complex stability and the depth of inclusion of the ligand into the cavity. The equilibrium constants determined by titration calorimetry correlate well with the changes in chemical shifts Ad determined by NMR.

Alendronate prevents bone loss in postmenopausal women under 60 years of age to nearly the same extent as estrogen-progestin.