Jacalyn M. Green

Folylpolyglutamates as substrates and inhibitors of folate-dependent enzymes

The true intracellular substrates for folate-dependent enzymes are folylpolyglutamates. We have used measurements of the Ki values of folylpolyglutamate dead end inhibitors to assess the relative affinities of folate-dependent enzymes for folate derivatives of different polyglutamate chain lengths. Studies of four enzymes from pig liver, methylenetetrahydrofolate reductase, serine hydroxymethyltransferase, methylenetetrahydrofolate dehydrogenase and thymidylate synthase, have indicated that folylpolyglutamate inhibitors are bound 3-500 fold more tightly than the corresponding monoglutamates. The individual enzymes differ in their selectivity for polyglutamate vs. monoglutamate inhibitors, and in the chain length associated with the greatest affinity of enzyme for inhibitor. We have also examined the effect of polyglutamate chain length on the catalytic parameters associated with folate substrates. Two enzymes, methylenetetrahydrofolate reductase and serine hydroxymethyltransferase, show decreases in Km values for folylpolyglutamate substrates. Methylenetetrahydrofolate dehydrogenase shows no detectable differences in the catalytic parameters of polyglutamate vs. monoglutamate substrates and no change in the order of substrate addition or product release. Thymidylate synthase shows small effects of Km and Vmax values, but the order of addition of substrates and of release of products is reversed with polyglutamate as compared with monoglutamate substrates. Our studies with thymidylate synthase from L. casei have shown that the bacterial enzyme also exhibits a greatly increased affinity for polyglutamate vs. monoglutamate derivatives of folic acid, and that reversal in the order of substrate addition and product release also occurs with polyglutamate as compared with monoglutamate substrates. We have also studied the polyglutamate specificity of methionine synthase, which is responsible for the conversion of CH3-H4PteGlu1 into H4PteGlu1. This reaction is required for the incorporation of plasma folate into the cellular folate pool, because methyltetrahydrofolate is a poor substrate for folylpolyglutamate synthetase. Our studies demonstrate that CH3-H4PteGlu6, and suggest that incorporation of plasma CH3-H4PteGlu1 will only occur when methylenetetrahydrofolate reductase is inhibited by adenosylmethionine and cellular pools of CH3-H4PteGlu6 are at very low levels.

Interprofessional workshop to improve mutual understanding between pharmacy and medical students.

Objective. To measure changes in pharmacy and medical students’ physician-pharmacist collaboration scores resulting from a workshop designed to promote understanding of the others’ roles in health care. Methods. More than 88% of first-year pharmacy (n = 215) and medical (n = 205) students completed the Scale of Attitudes Toward Physician-Pharmacist Collaboration on 3 occasions in order to establish a baseline of median scores and to determine whether the scores were influenced by an interprofessional workshop. Results. Participation in the interprofessional workshop increased pharmacy students’ collaboration scores above baseline (p=0.02) and raised the scores of medical students on the education component of the collaboration survey instrument (p=0.015). The collaboration scores of pharmacy students greatly exceeded those of medical students (p<0.0001). Conclusion. A workshop designed to foster interprofessional understanding between pharmacy and medical students raised the physician-pharmacist collaboration scores of both. Crucial practical goals for the future include raising the collaboration scores of medical students to those of pharmacy students.

Escherichia coli abg Genes Enable Uptake and Cleavage of the Folate Catabolite p-Aminobenzoyl-Glutamate

Escherichia coli AbgT was first identified as a structural protein enabling the growth of p-aminobenzoate auxotrophs on exogenous p-aminobenzoyl-glutamate (M. J. Hussein, J. M. Green, and B. P. Nichols, J. Bacteriol. 180:6260-6268, 1998). The abg region includes abgA, abgB, abgT, and ogt; these genes may be regulated by AbgR, a divergently transcribed LysR-type protein. Wild-type cells transformed with a high-copy-number plasmid encoding abgT demonstrate saturable uptake of p-aminobenzoyl-glutamate (K(T)=123 microM); control cells expressing vector demonstrate negligible uptake. The addition of metabolic poisons inhibited uptake of p-aminobenzoyl-glutamate, consistent with this process requiring energy. p-Aminobenzoyl-glutamate taken in by cells expressing large amounts of AbgT alone is not rapidly metabolized to a form that is trapped in the cell, as the addition of nonradioactive p-aminobenzoyl-glutamate to these cells results in a rapid loss of intracellular label. The addition of nonradioactive p-aminobenzoate has no effect. The abgA, abgB, and abgAB genes were cloned into the medium-copy-number plasmid pACYC184; p-aminobenzoate auxotrophs transformed with the clone encoding abgAB demonstrated enhanced ability to grow on low levels of p-aminobenzoyl-glutamate. When transformed with complementary plasmids encoding high-copy levels of abgT and medium-copy levels of abgAB, p-aminobenzoate auxotrophs grew on 50 nM p-aminobenzoyl-glutamate. Our data are consistent with a model of p-aminobenzoyl-glutamate utilization in which AbgT catalyzes transport of p-aminobenzoyl-glutamate, followed by cleavage to p-aminobenzoate by a protein composed of subunits encoded by abgA and abgB. While endogenous expression of these genes is very low under the conditions in which we performed our experiments, these genes may be induced by AbgR bound to an unknown molecule. The true physiological role of this region may be related to some molecule similar to p-aminobenzoyl-glutamate, such as a dipeptide.

Glucarpidase to combat toxic levels of methotrexate in patients

In January 2012, glucarpidase (Voraxaze®) received approval from the US Food and Drug Administration for intravenous treatment of toxic plasma methotrexate concentrations due to impaired renal clearance. Methotrexate, an antifolate agent, has been used for over 60 years in the treatment of various cancers. High-dose methotrexate has been particularly useful in the treatment of leukemias and lymphomas. However, even with aggressive hydration and urine alkalinization, such regimens can lead to acute renal dysfunction, as indicated by decreases in urine production and concomitant increases in blood urea nitrogen and serum creatinine levels. Because methotrexate is largely excreted by the kidneys, this can greatly potentiate tissue damage. Toxic levels of blood methotrexate can be rapidly and effectively decreased by intravenous administration of glucarpidase. Glucarpidase is a recombinant form of carboxypeptidase G2, a bacterial enzyme that rapidly cleaves methotrexate to form the amino acid glutamate and 2,4-diamino-N10-methylpteroic acid. Catabolites of methotrexate are much less toxic than the parent compound, and are primarily excreted by hepatic mechanisms. Glucarpidase has been available on a compassionate basis since the 1990s, and a variety of case reports and larger clinical trials have demonstrated the safety and efficacy of this drug in patients ranging in age from infants to the elderly and in a variety of races and ethnic groups. Glucarpidase should not be administered within 2 hours of leucovorin, because this agent is a reduced folate which competes with methotrexate for the enzyme and glucarpidase inactivates leucovorin. Side effects of glucarpidase are rare and relatively mild, and include paraesthesia, flushing, nausea, vomiting, pruritus, and headache. Glucarpidase has seen limited use in intrathecal treatment of methotrexate toxicity for which it is also effective. Future applications of this enzyme in chemotherapy continue to be an active area of research.

Critical Thinking and Reflection Exercises in a Biochemistry Course to Improve Prospective Health Professions Students’ Attitudes Toward Physician-Pharmacist Collaboration

Objective. To determine the impact of performing critical-thinking and reflection assignments within interdisciplinary learning teams in a biochemistry course on pharmacy students’ and prospective health professions students’ collaboration scores. Design. Pharmacy students and prospective medical, dental, and other health professions students enrolled in a sequence of 2 required biochemistry courses. They were randomly assigned to interdisciplinary learning teams in which they were required to complete case assignments, thinking and reflection exercises, and a team service-learning project. Assessment. Students were asked to complete the Scale of Attitudes Toward Physician-Pharmacist Collaboration prior to the first course, following the first course, and following the second course. The physician-pharmacist collaboration scores of prospective health professions students increased significantly (p<0.001). Conclusions. Having prospective health professions students work in teams with pharmacy students to think and reflect in and outside the classroom improves their attitudes toward physician-pharmacist collaboration.

Folate Biosynthesis, Reduction, and Polyglutamylation and the Interconversion of Folate Derivatives

Many microorganisms and plants possess the ability to synthesize folic acid derivatives de novo, initially forming dihydrofolate. All the folic acid derivatives that serve as recipients and donors of one-carbon units are derivatives of tetrahydrofolate, which is formed from dihydrofolate by an NADPH-dependent reduction catalyzed by dihydrofolate reductase (FolA). This review discusses the biosynthesis of dihydrofolate monoglutamate, its reduction to tetrahydrofolate monoglutamate, and the addition of glutamyl residues to form folylpolyglutamates. Escherichia coli and Salmonella, like many microorganisms that can synthesize folate de novo, appear to lack the ability to transport folate into the cell and are thus highly susceptible to inhibitors of folate biosynthesis. The review includes a brief discussion of the inhibition of folate biosynthesis by sulfa drugs. The folate biosynthetic pathway can be divided into two sections. First, the aromatic precursor chorismate is converted to paminobenzoic acid (PABA) by the action of three proteins. Second, the pteridine portion of folate is made from GTP and coupled to PABA to generate dihydropteroate, and the bifunctional protein specified by folC, dihydrofolate synthetase, or folylpolyglutamate synthetase, adds the initial glutamate molecule to form dihydrofolate (H2PteGlu1, or dihydropteroylmonoglutamate). Bacteriophage T4 infection of E. coli has been shown to cause alterations in the metabolism of folate derivatives. Infection is associated with an increase in the chain lengths in folylpolyglutamates and particularly the accumulation of hexaglutamate derivatives.

Escherichia coli aminodeoxychorismate synthase: analysis of pabB mutations affecting catalysis and subunit association

p-Aminobenzoic acid (PABA), an essential component of the vitamin folic acid, is derived from the aromatic branch-point precursor chorismate in two steps. 4-Amino-4-deoxychorismate (ADC) synthase converts chorismate and glutamine to ADC and glutamate, and is composed of two subunits, PabA and PabB. While various experiments have suggested that PabA and PabB act as a complex, attempts to isolate the intact complex have failed. We report here the first successful copurification of PabA and PabB by gel filtration chromatography. The association of PabA and PabB is greatly enhanced by the presence of 5 mM glutamine, and by preincubation at 37 degrees C. Conversely, the association is greatly reduced at cold temperatures. We also report the isolation and characterization of both chemically induced and site-directed mutations in PabB. Mutated PabB enzymes fall into three categories according to their properties: deficiency of chorismate amination coupled with failure to associate with PabA, deficiency of chorismate amination coupled with retention of PabA association, and competency of chorismate amination with failure of PabA association.

C4-Alkylthiols with activity against Moraxella catarrhalis and Mycobacterium tuberculosis

Antimicrobial resistance represents a global threat to healthcare. The ability to adequately treat infectious diseases is increasingly under siege due to the emergence of drug-resistant microorganisms. New approaches to drug development are especially needed to target organisms that exhibit broad antibiotic resistance due to expression of β-lactamases which is the most common mechanism by which bacteria become resistant to β-lactam antibiotics. We designed and synthesized 20 novel monocyclic β-lactams with alkyl- and aryl-thio moieties at C4, and subsequently tested these for antibacterial activity. These compounds demonstrated intrinsic activity against serine β-lactamase producing Mycobacterium tuberculosis wild type strain (Mtb) and multiple (n=6) β-lactamase producing Moraxella catarrhalis clinical isolates.

Challenging Medical Students to Confront their Biases: A Case Study Simulation Approach

We used three approaches to determine whether first-year medical students would begin to confront their biases in response to a simulated encounter with an incarcerated, African-American patient. The patient presented with fatigue in a Biochemistry course workshop. Two hundred five students watched and helped a classmate conduct a simulated interview with the patient who had been imprisoned for attempted murder. We then studied whether the students confronted their biases against the patient using (a) a survey of individual students regarding these biases, (b) one of a number of questions on a formal assignment concerning the case completed in a team format, and (c) an unprompted extra-credit opportunity to reflect as a team on issues of their choice. On the survey, eighty five percent of students confronted their biases against the patient, and they began to reflect critically about these biases. Critical reflection on teams occurred more frequently outside the formally assigned exercise (Effect Size = 0.75, crucial practical importance). Thus, most first-year medical students can be led, even in basic sciences courses, to confront their biases. In this way, they may also begin to mitigate their biases against patients. Such self-regulation of biases by health care professionals on a regular basis should help to decrease health care disparities.

Does Critical Reflection by Biochemistry Learning Teams Foster Patient-centered Beliefs among Medical Students?

The authors measured patient-centered orientation scores of first-year osteopathic medical students before vs. after implementing exercises to foster critical reflection by learning teams. In the 2008–09 academic year, 60 of a total of 130 classroom hours were devoted to team-based learning (TBL) in a sequence of three Biochemistry courses (1500, 1501 and 1502). TBL was modified to include required and extra-credit team critical reflection assignments. Index questions were used to compare student learning on their own using modified TBL to learning facilitated by instructors in the preceding year. Individual student performances on index questions improved using modified TBL as the sequence of three courses progressed from 8% lower than in the prior year for the first course (p<0.001) to 7% higher than in the prior year for the third course (p<0.005). Moreover, team members cooperated more on team tests as they progressed from Biochemistry 1500 through Biochemistry 1502 (p<0.01). Finally, students became more patient-centered and caring (p<0.0001) using modified TBL, whereas the reverse was observed (p<0.01) prior to implementing exercises to foster critical reflection by team-based learning teams. Thus, TBL, modified to include opportunities for team critical reflection, fostered both cooperation and patient-centered orientations in first-year medical students.