[A case of life-threatening acute asthma with marked elevation of serum theophylline level during inhalational anesthesia]

A 21-year-old man was admitted to our hospital because of life-threatening acute asthma. His condition deteriorated while he was receiving aminophylline and high-dose corticosterolids, and complicated by pneumomediaststinum. He was intubated and ventilated mechanically. Since peak inspiratory pressure was very high and arterial blood gases were not improving, he was treated with inhaled haltohane and enflurane, and bronchial lavage was done via a bronchoscope. Anesthesia continued for 114 hours before his condition improved. The serum theophylline levels were elevated during anesthesia. Since the dose of aminophylline was not very high, this elevation may have been related to the inhalation of halothane and enflurane.

Monoclonal antibody HML-1 reactivity with adult T-cell leukaemia/lymphoma and other lymphomas

Human T-cell leukaemia/lymphoma virus type 1 (HTLV-1), a causative virus of adult T-cell leukaemia/lymphoma (ATLL), is known to be transmitted by breast-feeding. Using a monoclonal antibody HML-1 which labels human intestinal intra-epithelial T lymphocytes, we have immunohistochemically examined ATLL tissues in order to evaluate the possibility that HTLV-1 infected intestinal T cells are the origin of ATLL cells. Previously this antibody was reported to react with intestinal T-cell malignant lymphomas but not with peripheral tumours, or any B-cell lymphomas. We investigated 181 patients with malignant lymphomas and found that 19 out of 113 ATLLs were positive for HML-1. T-cell malignant lymphomas excluding ATLL also reacted with HML-1 (7/24), but all the B-cell lymphomas 0/33) and non-neoplastic lymph node and skin lesions (0/10) were negative for HML-1. In patients with ATLL and other T-cell malignant lymphomas, the positivity level of HML-1 was relatively higher in stomach (3/7) and tonsil (2/6) than that in lymph nodes (15/100) and skin (8/47). We observed one HML-1 positive ATLL patient with tumour formation in the skin and lymphadenopathy and marked infiltration of the large intestine but minimal involvement of other organs. Although HML-1 was frequently expressed in gastric infiltration of ATLL, the level of positivity was too low in lymph nodes to support the hypothesis that HTLV-1 infected intestinal T cells are the origin of ATLL cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Tolerance to the vascular effect of a novel nitric oxide-donating vasodilator, FK409

We investigated whether tolerance develops to the vasorelaxant effects of a new vasodilator, (+-)-(E)-4-ethyl-2-[(E)-hydroxy-imino]-5-nitro-3-hexenamide (FK409), in isolated canine coronary artery strips and to its hypotensive effect in rats, and whether FK409 activates soluble guanylate cyclase isolated from vascular tissues in the absence of L-cysteine. No tolerance to FK409 (0.46 nM to 0.46 microM or 1-1000 micrograms/kg, i.v.) or cross-tolerance between FK409 and glyceryl trinitrate was demonstrated in in vitro and in vivo experiments, whereas the tolerance to glyceryl trinitrate (0.44 nM to 4.4 microM or 1-1000 micrograms/kg, i.v.) was marked in both conditions. In addition, FK409 (0.1-10 microM) activated soluble guanylate cyclase without L-cysteine, but glyceryl trinitrate (1-100 microM) required the addition of L-cysteine (5 mM) for the activation of the enzyme. The results suggest that FK409 may be advantageous compared to tolerance-producing nitrates currently in clinical use, and that this property of FK409 is probably due to its independence of a sulfhydryl group donor.

Cold agglutinin disease following allogeneic bone marrow transplantation

We describe a case of cold agglutinin disease (CAD) following allogeneic bone marrow transplantation. This 36-year-old male developed CAD 3 weeks after allogeneic bone marrow transplantation for chronic myelogenous leukemia. Cyclosporin A and methotrexate had been administered to prevent graft-versus-host disease. Other agents administered included cytomegalovirus hyperimmune globulin and recombinant human G-CSF. Pericarditis preceded the development of CAD. The characterization of cold agglutinin (CA) was monoclonal IgM-kappa with anti-Pr antigen specificity, probably derived from the engrafted donor lymphocytes. The administration of prednisolone led to transient improvement. The CA titer decreased without further treatment 12 weeks after transplant.

The motility of lung lymphocytes in hypersensitivity pneumonitis and sarcoidosis

Lymphocytes obtained by bronchoalveolar lavage (BAL) in hypersensitivity pneumonitis (HP) and pulmonary sarcoidosis (PS) are believed to be derived from interstitial inflammatory lesions of the lung in which lymphocytes have migrated from the blood. Because cellular motility is one of the important factors in lymphocyte migration, we investigated the motility of BAL lymphocytes from 12 patients with HP and 12 with PS, as well as their responsiveness to chemoattractants in vitro by modified Boyden chamber method. Motility was evaluated by the number of migrated cells and the migration distance. The numbers of migrated BAL lymphocytes from patients with HP and PS in albumin-containing medium were 318.3 +/- 93.0 (mean +/- SD) and 207.6 +/- 35.5, respectively, and were greater than those of BAL lymphocytes from normal control subjects (133.3 +/- 40.9) and blood lymphocytes, and comparable with those of mitogen-activated blood lymphocytes. The motility of BAL lymphocytes in these diseases compared with blood lymphocytes was also increased in protein-free medium. In addition, the culture supernatants of alveolar macrophages (AM) enhanced the motility of BAL, mitogen-activated, and blood lymphocytes. These results suggest that BAL lymphocytes in these diseases are functionally motile, and their enhanced motility, as well as mediators from AM, may facilitate the accumulation of lymphocytes at the epithelial surface.

Trimethadione tolerance tests for the assessment of feasible size of hepatic resection in patients with hepatocellular carcinoma

Pre-operative evaluation of the quantity of functional remnant hepatic parenchyma after hepatectomy was carried out to predict the optimal amount of hepatic resection using the trimethadione (TMO) tolerance test. This test is an estimate based on serum diamethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 h after oral administration of TMO, and computed tomography (CT) scans of the liver in patients with hepatocellular carcinoma (HCC). The percentage of remnant hepatic parenchyma was calculated pre-operatively from the remaining non-cancerous portion and the whole hepatic parenchyma, excluding the HCC portion, using the CT scans. Presumptive remnant DMO/TMO ratio was calculated by multiplying the percentage of remnant hepatic parenchyma and pre-operative serum DMO/TMO ratio in 45 patients with HCC undergoing resection. The presumptive remnant DMO/TMO ratios were 0.31 +/- 0.10 (mean +/- s.d.) in 42 patients who survived hepatectomy and 0.13 +/- 0.02 (below 0.15) in the three patients who died from postoperative hepatic failure. Of these surviving patients, two patients who had the presumptive remnant DMO/TMO ratios under 0.15 developed postoperative severe complications. Thus, hepatectomy may not be indicated in patients where presumptive remnant DMO/TMO ratio is 0.15 and lower. These findings suggest that pre-operative measurement of presumptive remnant DMO/TMO ratio, when obtained with the CT of the liver and TMO tolerance test, is useful for prediction of the quantity of functional remnant hepatic parenchyma after hepatectomy in patients with chronic liver disease.

[Pathogenesis of development of lung cancer in idiopathic interstitial pneumonia--growth factors in bronchoalveolar lavage fluid]

It has been generally accepted that lung fibrosis as in idiopathic interstitial pneumonia (IIP) is frequently associated with the development of lung cancer. This observation implies that the mechanism involved in carcinogenesis and/or enhanced proliferation of cancer cells is common to the fibrosing process. However, there are few studies reported on the pathogenesis of associated lung cancer except for several studies assessed from the point of view of surgical pathology. This study was undertaken to learn whether BAL fluid, which reflects the local milieu of the fibrosing process, enhances the proliferation of human lung cancer cell line Lu-99, Lu-65 and rat lung fibroblasts as assessed by 3H-thymidine incorporation. BAL fluid was obtained from patients with IIP (n = 8) and normal volunteers (n = 8). BAL fluids from patients with IIP enhanced the mean incorporation of 3H-thymidine of Lu-99 up to 3.6 times (p < 0.01) compared to that of normal volunteers. Furthermore, the mean incorporation of Lu-65 was increased up to 1.8 times (p < 0.05) by BAL fluids from patients with IIP. In contrast, BAL fluids from patients caused no significant increase of the mean incorporation of rat lung fibroblasts as compared to normal BAL fluids. The enhancing activities on the growth of cancer cell line Lu-99, Lu-65 were eluted in several fractions by high performance liquid chromatography using Superose 12. These observations indicate that the BAL fluid of IIP patients contains factors enhancing the growth of cancer cells.

Activin enhances osteoclast-like cell formation in vitro

The effect of activin (activin A/EDF) on osteoclast formation was investigated. In mouse bone marrow cell cultures, activin enhanced the formation of tartrate-resistant acid phosphatase (TRACP)-positive multinucleated cells (MNC) in a dose-dependent manner, either in the presence or absence of 1,25-(OH)2D3 or PTH. In organ cultures of neonatal mouse calvaria, activin also enhanced the generation of TRACP-positive giant cells in the endosteal periosteum and increased the TRACP staining of whole calvaria, but did not exhibit bone resorbing activity. These results indicate that activin stimulates the formation of osteoclasts, but not osteoclast activation. Activin is produced by bone marrow cells and might be involved in the local process of osteoclast differentiation.

Vasorelaxant mechanism of the new vasodilator, FK409

To define the vasorelaxation mechanism of FK409, we examined the effect of the compound on vascular tension and cyclic nucleotide levels in isolated rat thoracic aorta contracted with norepinephrine, and on activities of guanylate cyclase and cyclic GMP phosphodiesterase prepared from rat or rabbit thoracic aorta. FK409 (1 x 10(-9) to 1 x 10(-6) M), like nitroglycerin (1 x 10(-9) to 1 x 10(-6) M), produced a potent vasorelaxant effect associated with an increase in cyclic GMP content of the tissue. There was no change in cyclic AMP levels. The vasorelaxant effect of FK409 was independent of the integrity of the endothelium, and was unaffected by L-NG-monomethylarginine (0.1 mM) or oxyhemoglobin (1 microM). On the other hand, FK409 (3.2 x 10(-7) M) activated soluble guanylate cyclase, and the activating effect was completely inhibited by oxyhemoglobin (10 nM). Cyclic GMP phosphodiesterase was unaffected by FK409 (1 x 10(-7) to 1 x 10(-5) M). Furthermore, in rat aortic soluble fraction FK409 (3 mM) was found to liberate nitric oxide (NO) which was evaluated spectrophotometrically after diazotization of sulfanilic acid and coupling with N-(1-naphthyl)-ethylenediamine. The liberation occurred even in the absence of L-cysteine (5 mM), in contrast to the case with nitroglycerin (3 mM). These results suggest that the vasorelaxant effect of FK409 is associated with an increase in intracellular cyclic GMP, and that the cyclic GMP accumulation is due to activation of soluble guanylate cyclase. The enzyme activation is probably due to NO released from the compound molecule in the vascular smooth muscle cells.

Effect of FK409, a novel nitric oxide donor, on acute experimental myocardial ischemia

The anti-ischemic heart effect of (+/-)-(E)-4-ethyl-2-[(E)-hydroxyimino]- 5-nitro-3-hexenamide (FK409), a novel nitric oxide donor, was studied in dog and rat preparations in vivo and in vitro. In anesthetized dogs with partially occluded coronary artery that were subjected to atrial pacing at a constant blood pressure, FK409 (1-100 micrograms/kg, i.v.) suppressed the ST-segment elevation on epicardial electrocardiograms. Glyceryl trinitrate (GTN; 10, 32 micrograms/kg) or dipyridamole (1000 micrograms/kg) failed to suppress the ST-segment elevation, although continuous i.v. infusion of GTN (32, 100 micrograms/kg/min) was effective. FK409 also suppressed the ST-segment elevation induced by methacholine in anesthetized rats by both i.v. (10, 100 micrograms/kg) and intraduodenal (i.d., 100, 1000 micrograms/kg) injections, while GTN (100 micrograms/kg, i.v.; 1000 micrograms/kg, i.d.) was effective only by the i.v. route. FK409 (0.32 microgram/kg/min, i.v.) and GTN (10 micrograms/kg/min) increased the blood flows of the endomyocardium (ENDO) and the epicardium (EPI) and the flow ratio of ENDO/EPI in the ischemic zone in anesthetized dogs with occluded coronary artery. Furthermore, in isolated dog vascular preparations, FK409 (4.6 x 10(-10)-4.6 x 10(-7) M) had a greater vasorelaxing effect on the large coronary artery [2.0-2.5-mm outer diameter (od)] than on the small coronary artery (0.3-0.5-mm od) or the saphenous artery. The results suggest that FK409 protects against acute experimental myocardial ischemia through relaxation of the large conductive coronary artery, and may be a useful oral drug for the treatment of angina pectoris.

Lung fibrosis in hypersensitivity pneumonitis. Association with CD4+ but not CD8+ cell dominant alveolitis and insidious onset

Seventeen cases of hypersensitivity pneumonitis (HP) at a symptomatic phase were categorized into two groups based on computed tomographic (CT) findings and histologic features of transbronchial lung biopsy specimens, HP accompanied by lung fibrosis (fibrosis group), and HP unaccompanied by lung fibrosis (nonfibrosis group). The fibrosis group comprised bird fancier's lung and HP of unknown etiology, whereas the nonfibrosis group mainly comprised summer-type HP. Comparison of results of pulmonary function tests between these two groups confirmed a restrictive impairment in the fibrosis group. Analyses of cellular components of bronchoalveolar lavage (BAL) fluids revealed lymphocytes, especially CD8+ T lymphocytes, were significantly increased in the nonfibrosis group in comparison with the fibrosis group, whereas CD4+ T cells were increased to the same level in the both groups. Analyses of the onset of disease showed that acute onset was observed mainly in nonfibrosis group and strongly correlated with increased CD8+ T lymphocytes in BAL fluids, while insidious onset was related to lung fibrosis and relatively increased CD4+ T lymphocytes in BAL fluids. These findings raise the possibility that highly elevated CD8+ T cells might have a protective effect on pulmonary fibrosis or that relatively increased CD4+ T cells might play an important role in the pathogenesis of pulmonary fibrosis of HP at the chronic phase.

[Subclass distribution of IgG and IgA antibodies in summer-type hypersensitivity pneumonitis]

The present study was undertaken to determine the most specific of the 3 serotypes of Trichosporon cutaneum responsible for summer type hypersensitivity pneumonitis and to elucidate the subclass distribution of the antibody response, which is partly dependent on the nature of the causative antigen. Western blot analysis revealed that serotype II (TIMM 1318) is the most specific antigen for summer type hypersensitivity pneumonitis. The subclass distributions of anti-Trichosporon cutaneum IgG antibodies and IgA antibodies in sera and bronchoalveolar lavage fluids (BALF) from 13 patients with summer type hypersensitivity pneumonitis and 10 normal volunteers were measured by biotin-avidin-linked immunosorbent assay. The results were as follows, (1) high levels of IgA2 antibodies were found in BALF, but minute amounts in sera, (2) IgG1 antibodies were the predominant subclass in sera and BALF, (3) three out of 13 cases showed high levels of IgG3 antibodies in sera and BALF associated with low levels of IgG1 antibodies, (4) IgA1 antibodies were found in both sera and BALF. (5) the levels of all antibody subclasses were higher in BALF than in sera. The subclass distributions suggest that the protein components of Trichosporon cutaneum are predominantly immunogen, although polysaccharides may participate as an antigen in the respiratory tract.

A neopullulanase-type alpha-amylase gene from Thermoactinomyces vulgaris R-47

Shimizu et al. and ourselves have reported some enzymatic properties of an alpha-amylase from Thermoactinomyces vulgaris R-47 that hydrolyzed pullulan to produce panose [M. Shimizu et al., Agric. Biol. Chem., 42, 1681-1688 (1978); Y. Sakano et al., Agric. Biol. Chem., 46, 1121-1129 (1982)]. In this study, we cloned a gene for an alpha-amylase, which was different from the one mentioned above but also hydrolyzed pullulan to produce panose, from T. vulgaris R-47, and analyzed the entire primary structure of the gene. We designated the previously reported enzyme as T. vulgaris alpha-amylase I (TVA I), and this novel enzyme as T. vulgaris alpha-amylase II (TVA II). The nucleotide sequence had an open reading frame of 1755 base pairs corresponding to a protein of 585 amino acid residues. Although this novel alpha-amylase, TVA II, hydrolyzed both pullulan and starch, the ratio of pullulan-hydrolyzing activity to starch-hydrolyzing activity of the enzyme was higher than that of TVA I, and the primary structure of the enzyme resembled neopullulanase, which scarcely hydrolyzed starch, rather than that of TVA I.

Pulmonary alveolar proteinosis. Xe-133 scintigraphic findings before and after bronchopulmonary lavage

A 44-year-old woman with pulmonary alveolar proteinosis was treated by repeated unilateral bronchopulmonary lavages over 6.5 years. The effectiveness of the treatment was assessed by Xe-133 scintigraphy as well as lung function tests and chest roentgenograms. Xe-133 scintigraphy clearly demonstrated improvement of regional ventilation and perfusion, and equalization of the ventilation and perfusion ratio. Therefore, Xe-133 scintigraphy was found to be useful in the analysis of changes in regional aeration, ventilation, and perfusion before and after bronchopulmonary lavage in pulmonary alveolar proteinosis.

Tumor-associated M(r) 34,000 and M(r) 32,000 membrane glycoproteins that are serine phosphorylated specifically in bovine leukemia virus-induced lymphosarcoma cells

Tumor-associated antigens that are expressed in tumor cells of cattle with enzootic bovine leukosis (EBL) were analyzed previously by use of 13 monoclonal antibodies. We biochemically identified one of the tumor-associated antigens, which is recognized by the c143 monoclonal antibody, as two glycoproteins, each having an apparent molecular weight of 32,000 or 34,000. These glycoproteins were found in the plasma membrane of peripheral blood lymphocytes of both bovine leukemia virus (BLV)-free normal and BLV-infected cattle. With the progression of EBL, the proportion and the absolute number of cells positive for the tumor-associated antigen increased. Moreover, the level of the M(r) 34,000 component, which was susceptible to cell-surface labeling, increased over the level of the M(r) 32,000 component. Partial proteolytic peptide mapping with V8 protease and deglycosylation analysis revealed that the two glycoproteins most likely have an identical M(r) 30,000 polypeptide portion but have different N-linked oligosaccharide portions. Both glycoproteins were found to be phosphorylated at serine residue(s) in EBL-derived B-lymphoid cell lines and in tumor cells and peripheral blood lymphocytes from cattle with EBL, but not in peripheral blood lymphocytes from BLV-free normal cattle and BLV-infected cattle without any evidence of tumor, suggesting that the phosphorylation of these glycoproteins is related to the transformed state of the BLV-infected B-lymphoid cells.

A straight correlation between mutagenic activity and beta-galactosidase activity induced by monofunctional alkylating agents

Eight monofunctional alkylating agents were examined for their ability to induce mutation in Salmonella typhimurium. The assay was carried out in S. typhimurium TA100 with the preincubation method. The SN1-type agents were more mutagenic than the SN2-type ones; besides, methylating agents exerted more mutagenic activity than ethylating ones. Those responses in the reversion assay were quite similar to the results obtained previously with the beta-galactosidase assay in Escherichia coli CSH26/pMCP1000 (alkA'-lacZ') as to the induction of the adaptive response. A good correlation was found between mutagenic potency in the reverse mutation assay and inducing potency in the beta-galactosidase assay.

[A case of intrabronchial dissemination of candida pseudohyphae presenting as respiratory failure]

A 63-year-old man was admitted to our hospital because of fever, skin eruption, leukocytopenia and liver dysfunction. He was receiving H2-blocker for gastric ulcer of the time he developed his symptoms. The H2-blocker was discontinued because of its possible association with leukocytopenia, and steroids were administered. On the 4th day of hospitalization, he suddenly developed expiratory wheeze and dyspnea, resembling an asthmatic attack. WBC was 400/mm3 with 65% neutrophils. Chest X-ray showed hyper inflation and increased thickness of bronchiolar walls. Bronchodilators had no effect and the patient died of respiratory failure on the 8th day. At autopsy, most bronchioles were filled with candida pseudohyphae. The large airways and lung parenchyma were not involved, except for focal bacterial pneumonia. Histological findings suggestive of bronchial asthma such as constriction of bronchial smooth muscle or infiltration of eosinophils were not observed Candida infection was also found in the pharynx, stomach, bowel, and kidneys. Candidiasis is becoming a more important contributory cause of death in compromised hosts. Although rare, this case suggests that patients with bronchopulmonary candidiasis present with expiratory wheeze resembling asthmatic attack.

[A case of small liver cancer presenting as a huge mediastinal mass]

A 61-year-old male was admitted because of hemoptysis. He had a 9 year history of liver cirrhosis associated with HB viral chronic hepatitis. Physical examination revealed no abnormalities. Laboratory investigations revealed positive HBs antigen with normal alpha-fetoprotein. Chest X-ray film showed large mediastinal lymph nodes and an endobronchial polypoid mass in the distal end of the right main bronchus. The right main PA was narrowed due to compression by the mediastinal mass. Bronchoscopic examination revealed a polypoid mass in the right main bronchus. The biopsy specimen was histologically diagnosed as undifferentiated large cell carcinoma. The patient developed respiratory failure, and died 3 weeks after admission. Autopsy revealed a small liver cancer of 1.3 cm diameter within the cirrhotic liver, associated with a small abdominal lymph node metastasis and large mediastinal lymph node swellings. Thromboembolism in the bilateral main pulmonary arteries was concluded to be the cause of death. The mediastinal mass which directly invaded into the right main bronchus had a close histological similarity with the liver cancer, showing undifferentiated carcinoma cells with bizarre nuclei and abundant cytoplasm. An immunohistological study revealed cells positive for alpha-fetoprotein in the mediastinal lymph nodes. The patient was diagnosed as having small liver cancer with mediastinal lymph node metastases. A survey of the literature revealed only a few cases of advanced hepatoma associated with prominent mediastinal metastases. This is the first reported case of small liver cancer presenting with large mediastinal lymph node metastases.

Agents for the treatment of overactive detrusor. II. Synthesis and inhibitory activity on detrusor contraction of 1,1'-biphenyl-2,6-dicarboxylic acid diesters with an aminoalkyl group in the ester function

A series of 1,1'-biphenyl-2,6-dicarboxylic acid diesters with an aminoalkyl group in the ester function were synthesized and examined for their inhibitory activity on detrusor contraction in vitro and in vivo. In the in vivo test, arrhythmia was observed as a side effect. Among those compounds synthesized, 2-methyl 6-[4-(1-methylpiperidinyl)] 3-hydroxy-5-methyl-2'-nitro-1,1'-biphenyl-2,6-dicarboxylate (18) showed strong inhibitory activity on detrusor contractions in vivo (ED50 = 0.54 mg/kg i.v., ED50 = 7.2mg/kg i.d.) and good separation from the side effect. Compound 18 was chosen for further pharmacological evaluation as an agent for the treatment of overactive detrusor.

Sequential changes in lung injury induced by preformed immune complexes

Immune complexes formed in the airside may be involved in the early parenchymal changes in hypersensitivity pneumonitis. The present study was undertaken to compare the responses of animals after an intratracheal injection with preformed immune complexes to those of patients with acute hypersensitivity pneumonitis, with special emphasis on sequential bronchoalveolar lavage findings and the possible role of chemotactic factors in the immune complex-induced lung injury. An increased number and percentage of polymorphonuclear cells could be detected in bronchoalveolar lavage fluids of guinea pigs within 48 hr following an intratracheal injection of preformed immune complexes. Chemotactic factor activity preceded the observed increase of polymorphonuclear cells in bronchoalveolar lavage fluids, suggesting a role for chemotactic factors in the sequestration of these cells in the lung. In addition, this study confirmed the usefulness of bronchoalveolar lavage in evaluating the pulmonary findings because the changes in bronchoalveolar lavage cell populations correlated with sequential histological findings. The sequential characteristics of the involved areas were noted to be of a peribronchial or bronchiolar infiltration with polymorphonuclear cells at early stages, then alveolar sac infiltration, followed by mild infiltration of mononuclear cells into the alveolar walls. The findings suggest a possible role for chemotactic factors in the accumulation of polymorphonuclear cells, and the sequential changes of bronchoalveolar lavage and histological findings in animals are comparable to those in patients with acute hypersensitivity pneumonitis.

Clinical significance of serum levels of a carbohydrate antigen, sialyl SSEA-1, in patients with fibrosing lung disease

Serum levels of sialyl SSEA-1 antigen, a carbohydrate antigen, were measured by radioimmunoassay in 142 patients with nonmalignant lung diseases. In 20 of 41 patients with fibrosing lung disease, either idiopathic or associated with collagen disease, the serum sialyl SSEA-1 levels were abnormally elevated. In patients with other lung diseases, the serum levels were almost within normal limits, less than 38.0 units/ml. In fibrosing lung disease the serum levels ranged from 13.8 to 147.0 units/ml and were largely concurrent with the degree of disease activity. The therapeutic effects of corticosteroid, which were evaluated with clinical-radiographic-physiologic scores and survivals in the patients with elevated serum levels, were significantly lower than those of the patients with the normal range of antigen levels. An immunohistochemical study performed on autopsied lungs from five patients with fibrosing lung disease indicated that the antigen was selectively expressed in the pulmonary epithelial cells that covered the remodeling alveolar septi in the lungs. No antigen was detectable by immunostaining in normal pulmonary epithelium among five normal lungs. From these findings, it is thought that the elevated levels of serum sialyl SSEA-1 may be derived from proliferating epithelial cells that were dominant in the late stage of fibrosing lung disorders. The measurements of serum sialyl SSEA-1 in patients with fibrosing lung disease may be clinically useful in establishing the degree of disease activity that has an influence on patient prognosis and therapeutic response.

Agents for the treatment of overactive detrusor. I. Synthesis and structure-activity relationships of 1,1'-biphenyl derivatives

A series of 1,1'-biphenyl-2,6-dicarboxylic acid diesters were synthesized and examined for their inhibitory activity on guinea-pig detrusor muscle contraction at electrical field stimulation in vitro. Among them, 6-isopropyl 2-methyl 3-hydroxy-5-methyl-2'-nitro-(1,1'-biphenyl)-2,6-dicarboxylate, FR75513 (8a) was one of the potent compounds (IC50 = 3.3 x 10(-6) g/ml). This compound (8a) exhibited a strong inhibitory activity on detrusor contraction after intravenous administration in anesthetized rats (ID50 = 0.04 mg/kg).

[Utilization of D-histidine by the derivative strain TA100 of Salmonella typhimurium LT 2]

In general, wild-type gram-negative enteric bacteria are not able to utilize D-amino acids as the precursors of respective L-amino acids. We found, however, that an L-histidine auxotroph mutant, TA100, derived from Salmonella typhimurium strain LT 2 and used in the Ames test, showed a biphasic growth curve in the presence of both L- and D-histidine at concentrations of 5 micrograms/ml and 100 micrograms/ml, respectively. L-histidine may be utilized preferentially and then, after a short lag, D-histidine may be utilized. The short lag time is therefore considered to be the time required for induction of such an enzyme that converts D-histidine to L-histidine and for uptake of D-histidine by the bacterial cells.

Effects of the anticholinergic drug prifinium bromide on urinary bladder contractions in rat in vivo and in guinea-pig in vitro

The parenteral and enteral effects of prifinium bromide (CAS 4630-95-9; in the following referred to as prifinium), a quaternary ammonium anticholinergic drug, were investigated on contractions of the rat urinary bladder by cystometry and compared with those of atropine, oxybutynin and terodiline. Additionally, in vitro experiments were carried out with the isolated guinea-pig detrusor muscle to clarify the mechanisms of action of these effects. In intravenous doses, all the drugs reduced the amplitude of the contractions in the cystometric studies. The inhibition was dose-dependent, but was not entirely even at the respective largest doses. According to the 40% inhibitory doses, prifinium was as active as atropine, and 10 and 100 times more active than oxybutynin and terodiline, respectively. The potency ratios of the drugs in their in vivo effects were in good agreement with those of their in vitro anticholinergic effects, which were determined with carbachol-induced contractions in the isolated guinea-pig detrusor muscle. On the other hand, in the in vitro studies, prifinium and atropine had little or no effect on contractions induced by electrical stimulation, KCl and BaCl2, whereas oxybutynin and terodiline antagonized all of the stimuli to a similar extent. These findings indicate that the anticholinergic activity of prifinium may be only one factor in the mechanisms of its in vivo inhibition of the rat bladder contractions. Finally, intraduodenal doses of prifinium also inhibited the contractions of the rat bladder, and the effects of the drug by this route were almost the same as those of oxybutynin and terodiline.

Ligand-induced phosphorylation of the colony-stimulating factor 1 receptor can occur through an intermolecular reaction that triggers receptor down modulation

Ligand-induced tyrosine phosphorylation of the human colony-stimulating factor 1 receptor (CSF-1R) could involve either an intra- or intermolecular mechanism. We therefore examined the ability of a CSF-1R carboxy-terminal truncation mutant to phosphorylate a kinase-defective receptor, CSF-1R[met 616], that contains a methionine-for-lysine substitution at its ATP-binding site. By using an antipeptide serum that specifically reacts with epitopes deleted from the enzymatically competent truncation mutant, cross-phosphorylation of CSF-1R[met 616] on tyrosine was demonstrated, both in immune-complex kinase reactions and in intact cells stimulated with CSF-1. Both in vitro and in vivo, CSF-1R[met 616] was phosphorylated on tryptic peptides identical to those derived from wild-type CSF-1R, suggesting that receptor phosphorylation on tyrosine can proceed via an intermolecular interaction between receptor monomers. When expressed alone, CSF-1R[met 616] did not undergo ligand-induced down modulation, but its phosphorylation in cells coexpressing the kinase-active truncation mutant accelerated its degradation.

Antimetastatic effect of defibrinogenation with batroxobin depends on the natural killer activity of host in mice

Using batroxobin, a thrombin-like enzyme found in snake venom, the effects of defibrinogenation on artificial lung metastasis in mice were studied. The role of natural killer (NK) cells in the inhibitory effects of defibrinogenation on metastasis was also investigated. Artificial lung metastasis experiments were performed by inoculating either B16-F10 cells or B16-BL/6 cells, highly metastatic strains of B16 melanoma cells, into C57BL/6 mice via the tail vein. The administration of batroxobin significantly inhibited lung metastasis, as did NK activity augmented by poly (I).poly (C) were administered, lung metastasis was more markedly inhibited. When NK activity was suppressed by administration of anti-(asialo GM1) antibody, lung metastasis was markedly increased. When batroxobin was administered with anti-(asialo GM1) antibody, no inhibitory effects on lung metastasis, such as those seen with batroxobin alone, were observed. The administration of batroxobin had no effect at all on spleen lymphocyte NK activity. These results indicated that defibrinogenation due to batroxobin inhibits lung metastasis, and these effects depend on NK activity of the host.

[The motility of lung lymphocytes in hypersensitivity pneumonitis and sarcoidosis]

Hypersensitivity pneumonitis (HP) and pulmonary sarcoidosis (Sa) are characterized by an accumulation of large numbers of lymphocytes within the interstitium and the epithelial surface of the lung. Although the lymphocytes in bronchoalveolar lavage fluid (BALF) are representative of interstitial cells in these diseases, the mechanism involved in an accumulation of lymphocytes on the epithelial surface are yet unknown. To explore the possibility that the lymphocytes on the epithelial surface are migrated cells from the interstitium, we studied the motility of the BALF lymphocytes in five patients with HP and nine patients with Sa and compared them to that of peripheral blood lymphocytes. The lymphocyte migration assay was performed using blind well chemotaxis chambers and cells migrated into the cellulose nitrate membranes were assessed. The total migrated cell numbers of BALF lymphocytes in HP and Sa were 753.3 +/- 86.5 and 334.2 +/- 41.0, respectively. The migration distance of BALF lymphocytes in HP and Sa assessed with leading front method were 50.2 +/- 3.8 microns and 57.9 +/- 4.6 microns, respectively. The motility of BALF lymphocytes in HP and Sa was significantly greater than that of peripheral blood lymphocytes and the motility of BALF lymphocytes were comparable to that of PHA-activated lymphocytes. The motility of BALF lymphocytes were correlated with the proportion of lymphocytes in BALF cells and the proportion of Ia+T lymphocytes. These results suggest that BALF lymphocytes in these diseases are activated and enhanced motility may facilitate the accumulation of lymphocytes to the epithelial surface.

[Inhalation of a precursor analogue of vasoactive intestinal polypeptide (Leu17 VIP-Gly-Lys) protects ascaris-induced bronchoconstriction in dog]

We studied in vivo the effects of pre-inhalations of vasoactive intestinal polypeptide (VIP) and a precursor analogue of VIP (Leu17 VIP-Gly-Lys: preVIP) in mongrel dogs bronchoconstricted by ascaris. An inhalation of preVIP solution (2 mg/5 ml saline) gave significant protection for 120 min against increases in respiratory resistance (Rrs) and decreases in dynamic compliance (Cdyn) induced by ascaris challenges. An inhalation of VIP solution (2 mg/ml saline) also gave significant protection for 120 min against increases in Rrs induced by ascaris challenges. Protective effect of the inhalation of preVIP against ascaris-induced bronchoconstriction was more potent than that of VIP. The inhalations of preVIP and VIP solution did not change systemic blood pressure or heart rate. These results indicate that inhalations of preVIP or VIP solution would attenuate ascaris-induced bronchoconstriction in dogs without affecting cardiovascular dynamics.

Suppression of atherogenesis in cholesterol-fed rabbits treated with nilvadipine, a new vasoselective calcium entry blocker

We examined the effects of nilvadipine, a new dihydropyridine calcium entry blocker, on atherogenesis in rabbits fed a 1% cholesterol diet. The drug was given subcutaneously to the animals in hypotensive doses of 1.0 or 3.2 mg/kg/day for 10 weeks, and was well tolerated. Plasma total cholesterol increased markedly in all the cholesterol-fed rabbits, and nilvadipine had no effect on this, or on HDL-cholesterol and triglyceride levels. However, the area of Sudan IV positive intimal lesions (one of the parameters of atherosclerosis) in the aorta decreased significantly in the nilvadipine treated animals, and in addition, cholesterol and calcium content in the thoracic aorta were reduced. The reference drugs, nifedipine and nicardipine given subcutaneously in doses of 10.0 mg/kg/day either had no effect or were weaker in antiatherogenic effect than nilvadipine. The findings suggest that nilvadipine has more potent antiatherogenic activity than nicardipine or nifedipine.

Effects of nilvadipine, a new calcium entry blocker, on systemic blood pressure, cardiac hypertrophy and venous distensibility in spontaneously hypertensive rats

We investigated the effects of three different drugs, nilvadipine (NV), nicardipine (NC) and hydralazine (HD), having calcium entry blocking and/or vasodilating properties, on blood pressure, heart weight and venous distensibility in spontaneously hypertensive rats (SHRs). All of these drugs (1.0 and/or 3.2 mg/kg/day, s.c., 12-14 weeks) countered to almost the same extent the development of hypertension in young SHRs and lowered high blood pressure in the older SHRs. In both age-groups, on the other hand, ventricular weight/body weight ratios for the NV-treated group, but not for the NC- or HD-treated group, were significantly smaller than those for the corresponding vehicle-treated group. In addition, lower body venous pressure-volume curves, which were measured on the day after the last drug administration, shifted dose-dependently in the direction of the volume for the NV-treated group, indicating that venous distensibility was expanded by NV. NC and HD did not have such an effect at the same hypotensive doses. We conclude that NV prevented the development of hypertension and lowered high blood pressure in SHRs. NV also improved cardiac hypertrophy and decreased venous capacity. The depressant effect of NV on cardiac hypertrophy may be due not only to its hypotensive effect, but also, at least partially, to its venodilating effect.

Plasma glycosyltransferase activity after ABO-incompatible bone marrow transplantation and development of an inhibitor for glycosyltransferase activity

Plasma glycosyltransferase activities were studied in eight patients after ABO-incompatible bone marrow transplantation. The ABO red blood cell type completely changed from the recipient type to the donor type; however, preexistent plasma glycosyltransferase activities of the recipient type did not change in seven of eight patients after marrow transplantation. Weak transferase activities of the donor type were observed in all of the patients after marrow grafting. One patient with acute and chronic graft-versus-host disease produced a very potent inhibitor that was active on both A- and B-transferase activities. Because this inhibitory activity was absorbed by a protein A-coupled Sepharose column, it was strongly suggested that this inhibitory activity was mediated by an IgG antibody for a transferase.

Leaky wave analysis of an optical grating coupler with a large grating period

Results of a rigorous leaky wave analysis of an optical grating coupler having a large grating period are presented. The coupler is designed so that most of the guided-wave power is transferred to a substrate beam progressing in the forward direction with the first-order air beam made evanescent. It is found that a large power partition into the substrate beam can readily be obtained in spite of the presence of a number of higherorder propagating space harmonics. Validity of the approximate perturbation method for the case of the long grating period is also examined.

Extended transverse rectus abdominis musculocutaneous flap

Blood circulation within the conventional TRAM flap is not generous, and the contralateral random portion of the flap may result in fat or skin necrosis. However, this random portion can be extended safely and used for reconstruction by including the superficial epigastric vessels and the superficial circumflex iliac vessels and by anastomosing either of these to the recipient vessels. We have experienced this extended TRAM flap in two patients without any complications.

Inhibition of colony-stimulating factor-1 activity by monoclonal antibodies to the human CSF-1 receptor

Four of 12 monoclonal antibodies (MoAbs) directed to different epitopes in the extracellular domain of the human colony-stimulating factor-1 receptor (CSF-1R, the c-fms proto-oncogene product) specifically inhibit CSF-1 binding to receptor-bearing cells. All four antibodies abrogated CSF-1-dependent colony formation by human bone marrow-derived macrophage precursors and by mouse NIH-3T3 cells expressing a transduced human c-fms gene. In addition, one of these antibodies (designated MoAb 2-4A5) interfered with the ligand-independent proliferation of NIH-3T3 cells transformed by an oncogenic, mutant c-fms allele. Unlike CSF-1 itself, neither MoAb 2-4A5 nor the other three inhibitory antibodies (MoAbs 12-2D6, 12-3A1, and 12-3A3) induced CSF-1R internalization or degradation. These antibodies should prove useful not only for identifying and quantitating CSF-1R on receptor-bearing cells but for abrogating specific receptor signals that govern the proliferation and survival of human mononuclear phagocytes.

Binding of the new calcium entry blocker nilvadipine to rat aortic and guinea pig left ventricular membranes

The binding of 3H-nilvadipine to the vascular (rat aortic) and cardiac (guinea pig left ventricular) microsomes was reversible and saturable. The results of the competitive binding experiments showed that nilvadipine had a higher affinity (Kd: 1.5 +/- 0.2 nmol/l) for the vascular binding sites than did nifedipine (Kd: 10.7 +/- 0.8 nmol/l) and nicardipine (Kd: 6.9 +/- 2.0 nmol/l), while the affinity of nilvadipine for the cardiac binding sites (Kd: 3.8 +/- 0.4 nmol/l) was similar to that of nifedipine (Kd: 3.3 +/- 0.1 nmol/l) and nicardipine (Kd: 4.2 +/- 0.3 nmol/l). The time courses of dissociation of the unlabeled dihydropyridines from the vascular binding sites were investigated using 3H-nitrendipine. Nilvadipine and nicardipine dissociated more slowly from the binding sites than did nifedipine. These results suggest that the high potency, selectivity for the vascular smooth muscle and long duration of action of nilvadipine may be related to its binding properties.

[Flow cytometric analysis of T lymphocyte subsets after human bone marrow transplantation using monoclonal antibodies and dual immunofluorescence]

Using monoclonal antibodies and a dual immunofluorescence technique, we studied the abnormalities of T lymphocyte subsets after human marrow transplantation. T lymphocytes bearing HLA-DR antigen increased both in patients with acute and chronic graft-versus-host disease (GVHD). Parallel to a decrease in CD4+ cells, a CD4+ 2H4+ subset decreased and gradually recovered with time while the percentage of CD4+ 4B4+ cells increased. A significant increase of CD8+ cells observed after marrow transplant corresponded mainly to an increase in CD8+ CD11- cells. Patients with chronic GVHD tended to have a higher proportion of CD8+ CD11+ cells. These results indicate abnormalities of T cell subsets among both CD4+ and CD8+ cells after marrow grafting.

Monoclonal antibodies to the human CSF-1 receptor (c-fms proto-oncogene product) detect epitopes on normal mononuclear phagocytes and on human myeloid leukemic blast cells

The first monoclonal antibodies (MoAbs) to epitopes in the extracellular domain of the human c-fms proto-oncogene product (receptor for the macrophage colony stimulating factor, CSF-1) were used with flow cytometric techniques to study receptor expression on normal human peripheral blood monocytes, bone marrow cells, and leukemic blasts. On normal cells CSF-1 receptors were restricted in their expression to cells of the mononuclear phagocyte lineage. CSF-1 receptors were detected on leukemic blasts from 15 (30%) of 50 children with acute myeloid leukemia, compared with four (15%) of 26 adults. By contrast, detectable CSF-1 receptors were uniformly absent on blasts from 19 children with acute lymphoblastic leukemia. CSF-1 receptors on normal monocytes and myeloid leukemia cells could be induced to downmodulate by incubation with either human recombinant CSF-1 or phorbol esters, confirming that the receptors had functional ligand-binding sites and responded to transmodulation by inducers of protein kinase C. The numbers of receptors per cell and the percentage of positive cases were highest for leukemic blasts with cytochemical and morphological features of monocytes. However, CSF-1 receptors were also detected on a subset of leukemic blast cells with features of granulocytic differentiation (FAB subtypes M1 through M3). Southern blotting analyses of DNA from 47 cases of acute myeloid leukemia demonstrated no rearrangements within the 32 kb of genomic sequences that contain CSF-1 receptor coding exons or in the 50 kb upstream of the first coding exon. Analysis of the upstream region of the c-fms locus revealed that sequences representing the terminal 112 untranslated nucleotides of c-fms mRNA map 26 kb 5' to the first coding exon, suggesting that at least one c-fms promoter is separated from the receptor coding sequences by a very long intron. Whereas expression of the CSF-1 receptor in myeloid leukemic blasts is not restricted to cells with monocytic characteristics, the apparently aberrant pattern of receptor synthesis in a subset of cases with granulocytic features appears not to be due to chromosomal rearrangements within 50 kb upstream of sequences encoding the receptor.

[A case of retrocecal appendicitis occurrence during effective chemotherapy in lung cancer]

Reported is the case of 61-year-old male patient who developed an abscess, secondary to a ruptured retrocecal appendicitis, while undergoing effective chemotherapy for lung cancer. Patients undergoing cancer chemotherapy are especially susceptible to infectious complications because chemotherapy can cause myelosuppression. To our knowledge, has been no previous reported case of retrocecal appendicitis occurring during chemotherapy for the lung cancer. Retrocecal appendicitis is a dangerous form of complication occurring in patients being treated with chemotherapeutic drugs.

Hypersensitivity pneumonitis induced by toluene diisocyanate: sequelae of continuous exposure

A 41-year-old automobile paint sprayer showed the clinical features of hypersensitivity pneumonitis 1 week after he had begun to work with paint materials containing toluene diisocyanate. His symptoms began 6 to 8 hours after exposure to the agent and spontaneously disappeared by the next morning. He had diffuse, fine reticulonodular shadows on a chest roentgenogram and a restrictive impairment of pulmonary function. Immunoglobulin G antibody to toluene diisocyanate-human serum albumin was present in bronchoalveolar lavage fluid and sera: IgA antibody was present only in bronchoalveolar lavage fluid. Also, the patient had sensitized bronchoalveolar lymphocytes to toluene diisocyanate-human serum albumin. The histologic findings suggested hypersensitivity pneumonitis. The results of bronchoalveolar lavage, which was repeated on four separate occasions, showed lymphocytosis and a predominance of suppressor-cytotoxic T cells. The findings from serial determinations of humoral antibodies showed no changes consistent with the results of clinical and laboratory studies. In contrast, blastogenic responses of bronchoalveolar lymphocytes to toluene diisocyanate markedly decreased, and the patient showed clinical improvement despite continued exposure to the agent.

Accessory cell function of human alveolar macrophages in antigen-induced T lymphocyte proliferation

We compared the accessory cell function of human alveolar macrophages (AM) to that of human blood monocytes (Mo) obtained by bronchoalveolar lavage and venipuncture from normal volunteers. Graded numbers of either AM or Mo were added to autologous peripheral blood T lymphocytes that were stimulated with a purified protein derivative of tuberculin (PPD). Either AM or Mo were cocultured with allogeneic T lymphocytes in mixed lymphocyte reaction (MLR) experiments. Both AM and Mo supported the PPD-induced T lymphocyte proliferation and allogeneic MLR at low ratios of AM or Mo to T lymphocytes with similar efficiency. However, AM showed marked suppressive effects at higher ratios of AM to T lymphocytes (1:1). PPD-pulsed AM, but not AM killed by physical treatments (heat, freeze-thaw, sonication), induced T lymphocyte proliferation. An indirect immunofluorescent study demonstrated that most AM express HLA-DR antigens. Furthermore, AM synthesized DR antigens with molecular weights of 33,000 and 29,000-31,000 daltons. When AM were treated with both anti-DR monoclonal antibody and complement, PPD-induced T lymphocyte proliferation and MLR were diminished. These results suggest that human AM function as accessory cells in the antigen-induced T lymphocyte proliferation and DR antigens on AM play an important role in the accessory cell function.

Effects of nilvadipine on the cardiovascular system in experimental animals

The effects of 5-isopropyl 3-methyl 2-cyano-1,4-dihydro-6-methyl-4-(m-nitrophenyl)-3,5-pyridinedicarboxylate (nilvadipine, FR 34235, FK 235) on the cardiovascular system were investigated in isolated organs and whole animals. 1. Nilvadipine inhibited Ca2+-induced contractions of isolated dog coronary artery in high-K+, Ca2+-free medium, and the pA2 value was 10.64. In this effect, nilvadipine was 18 times more potent than nifedipine and 525 times more potent than diltiazem. In contrast, its inhibitory effect on Ca2+-induced contractions of isolated guinea pig atria was weaker (pA2:8.2): only twice that of nifedipine and 25 times that of diltiazem. 2. Nilvadipine also inhibited K+-induced 45Ca2+ uptake in isolated dog coronary arteries and isolated guinea pig atria. In the coronary arteries, the IC50 value of nilvadipine was 2.7 x 10(-10) mol/l, which was, respectively 17, 8, and 589 times lower than that of nifedipine, nicardipine and diltiazem. In the atria, on the other hand, the IC50 value of nilvadipine was 4.4 x 10(-9) mol/l, almost the same as that of nifedipine or nicardipine, and 47 times lower than that of diltiazem. These 45Ca2+ uptake inhibitory effects of the drugs were consistent with their effects on mechanical response in both tissues. 3. Nilvadipine (2.6 x 10(-10) mol/l and higher) dose-dependently inhibited ergometrine (ergonovine)-, serotonin-, and norepinephrine-induced contractions of isolated dog coronary artery, and its effects were 2 to 450 times more potent than those of nifedipine, nicardipine and diltiazem. 4. Nilvadipine (2.6 x 10(-8) mol/l or more, 32 micrograms/heart or more), like nifedipine, produced negative inotropic and chronotropic effects in isolated guinea pig atria and in dog heart-lung preparation, and was more potent than nifedipine in the negative chronotropic effect. 5. Nilvadipine in intravenous doses of 1-32 micrograms/kg decreased total peripheral resistance and systemic blood pressure, and slightly increased cardiac output, pulmonary arterial blood flow and stroke volume, but had no significant effects on pulmonary vascular resistance or pulmonary arterial blood pressure. Heart rate decreased at doses of 32 micrograms/kg or more. Nifedipine had almost the same effects as nilvadipine on total peripheral resistance and blood pressure, but was more potent than nilvadipine in increasing effects on cardiac output, stroke volume and pulmonary arterial blood flow.(ABSTRACT TRUNCATED AT 400 WORDS)